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Sample records for warrant careful consideration

  1. Patient attributes warranting consideration in clinical practice guidelines, health workforce planning and policy

    Directory of Open Access Journals (Sweden)

    Segal Leonie

    2011-09-01

    Full Text Available Abstract Background In order for clinical practice guidelines (CPGs to meet their broad objective of enhancing the quality of care and supporting improved patient outcomes, they must address the needs of diverse patient populations. We set out to explore the patient attributes that are likely to demand a unique approach to the management of chronic disease, and which are crucial if evidence or services planning is to reflect clinic populations. These were incorporated into a new conceptual framework; using diabetes mellitus as an exemplar. Methods The patient attributes that informed the framework were identified from CPGs, the diabetes literature, an expert academic panel, and two cross-disciplinary panels; and agreed upon using a modified nominal group technique. Results Full consensus was reached on twenty-four attributes. These factors fell into one of three themes: (1 type/stage of disease, (2 morbid events, and (3 factors impacting on capacity to self-care. These three themes were incorporated in a convenient way in the workforce evidence-based (WEB model. Conclusions While biomedical factors are frequently recognised in published clinical practice guidelines, little attention is given to attributes influencing a person's capacity to self-care. Paying explicit attention to predictable threats to effective self-care in clinical practice guidelines, by drawing on the WEB model, may assist in refinements that would address observed disparities in health outcomes across socio-economic groups. The WEB model also provides a framework to inform clinical training, and health services and workforce planning and research; including the assessment of healthcare needs, and the allocation of healthcare resources.

  2. Carotid sinus hypersensitivity: Entity warrants a caution in the critical care unit

    Directory of Open Access Journals (Sweden)

    Sugata Dasgupta

    2016-01-01

    Full Text Available Carotid sinus hypersensitivity (CSH syndrome is an entity caused by an overreaction of the carotid sinus baroreceptors to stimulation. Three subtypes of CSH syndrome are recognized according to the response to carotid sinus massage (CSM: Predominantly cardioinhibitory, predominantly vasodepressor and a mixed subtype. We report here the case of a middle-aged female patient admitted in our critical care unit with respiratory failure requiring mechanical ventilation. There were episodes of severe bradycardia whenever her head was rotated to any side, relieved on neutralizing head position and administering intravenous atropine. CSM revealed she had predominantly cardioinhibitory type of CSH syndrome. A cardioinhibitory form of hypersensitive carotid sinus reflex, which is idiopathic in causation, probably explains the severe bradycardia on head rotation seen in our patient. A heightened awareness of this syndrome is necessary for timely diagnosis and management. CSH syndrome results from an overreaction of the carotid sinus baroreceptors to stimulation, manifesting commonly as bradycardia, hypotension and syncope. It is an entity, which warrants caution during routine critical care practices.

  3. Economic and care considerations of Marfan syndrome.

    Science.gov (United States)

    Blankart, Carl Rudolf; Milstein, Ricarda; Rybczynski, Meike; Schüler, Helke; von Kodolitsch, Yskert

    2016-10-01

    Marfan syndrome is a rare multisystem disease of the connective tissue, which affects multiple organ systems. advances in healthcare have doubled the life-expectancy of patients over the past three decades. to date, there is no comprehensive review that consolidates economic considerations and care for marfan patients. Areas covered: Present research suggests that there may be a link between treatment pattern, disease progression and economic costs of Marfan syndrome. It indicates that an early detection of the disease and preventive interventions achieve a dual aim. From a patient perspective, it may reduce the amount of emergency surgery or intervention, and inpatient stays. In addition, it slows disease progression, lowers lifestyle restrictions, reduces psychological stress, and improves health-related quality of life. Expert commentary: Early detection and preventive measures are likely to achieve a dual aim by simultaneously containing costs and reducing the number and length of inpatient stays.

  4. Appraisal Skills, Health Literacy and the Patient-Provider Relationship: Considerations as the Health Care Consumer Turns to the Internet to Inform their Care.

    Science.gov (United States)

    O'Dell, Rosann

    2012-01-01

    Health care consumers increasingly obtain health information from the Internet to inform their health care; the health care consumer, who also has the role of patient, maintains the right to access information from sources of their choosing for this purpose. However, noteworthy considerations exist including information appraisal skills, health literacy and the patient-provider relationship. Awareness and education are warranted to assist the health care consumer in achieving proficiency as they turn to the Internet for health information.

  5. [From care to consideration of disabled people].

    Science.gov (United States)

    Chossy, Jean-François

    2014-05-01

    The law of 11th February 2005 relating to the equality of the rights and opportunities, participation and citizenship of disabled people was a major step forward. Nevertheless, more progress is needed to ensure more consideration is given to disabled people.

  6. Cultural and spiritual considerations in palliative care.

    Science.gov (United States)

    Long, Carol O

    2011-10-01

    Culture is a fundamental part of one's being. Spirituality is integrated with culture and both play a significant role in a person's journey through life. Yet, culture and spirituality are often misunderstood and may not seem to be important in healthcare settings. For adults with cancer and their families, this cannot be ignored. This paper reviews The Purnell Model of Cultural Competence as a framework for considering culture and spirituality in healthcare and discusses the importance of acknowledging and incorporating practices that support culture and spirituality in healthcare settings. Examples of how to include cultural and spiritual care in palliative and end-of-life care in healthcare settings are provided.

  7. Data privacy considerations in Intensive Care Grids.

    Science.gov (United States)

    Luna, Jesus; Dikaiakos, Marios D; Kyprianou, Theodoros; Bilas, Angelos; Marazakis, Manolis

    2008-01-01

    Novel eHealth systems are being designed to provide a citizen-centered health system, however the even demanding need for computing and data resources has required the adoption of Grid technologies. In most of the cases, this novel Health Grid requires not only conveying patient's personal data through public networks, but also storing it into shared resources out of the hospital premises. These features introduce new security concerns, in particular related with privacy. In this paper we survey current legal and technological approaches that have been taken to protect a patient's personal data into eHealth systems, with a particular focus in Intensive Care Grids. However, thanks to a security analysis applied over the Intensive Care Grid system (ICGrid) we show that these security mechanisms are not enough to provide a comprehensive solution, mainly because the data-at-rest is still vulnerable to attacks coming from untrusted Storage Elements where an attacker may directly access them. To cope with these issues, we propose a new privacy-oriented protocol which uses a combination of encryption and fragmentation to improve data's assurance while keeping compatibility with current legislations and Health Grid security mechanisms.

  8. Legal Considerations for Health Care Practitioners After Superstorm Sandy.

    Science.gov (United States)

    Hershey, Tina Batra; Van Nostrand, Elizabeth; Sood, Rishi K; Potter, Margaret

    2016-06-01

    During disaster response and recovery, legal issues often arise related to the provision of health care services to affected residents. Superstorm Sandy led to the evacuation of many hospitals and other health care facilities and compromised the ability of health care practitioners to provide necessary primary care. This article highlights the challenges and legal concerns faced by health care practitioners in the aftermath of Sandy, which included limitations in scope of practice, difficulties with credentialing, lack of portability of practitioner licenses, and concerns regarding volunteer immunity and liability. Governmental and nongovernmental entities employed various strategies to address these concerns; however, legal barriers remained that posed challenges throughout the Superstorm Sandy response and recovery period. We suggest future approaches to address these legal considerations, including policies and legislation, additional waivers of law, and planning and coordination among multiple levels of governmental and nongovernmental organizations. (Disaster Med Public Health Preparedness. 2016;10:518-524).

  9. Caring for Patients of the Millennial Generation: Considerations for Nurses.

    Science.gov (United States)

    Johanson, Linda S

    2017-07-01

    Much has been written about teaching students of the Millennial Generation (those born between the years 1980 and 2000) and about intergenerational dynamics in the healthcare workforce. However, little can be found in the literature regarding generation-specific nursing care of Millennial patients. This article presents six categories of considerations for nurses caring for patients of the Millennial Generation based on the characteristics, attitudes, and values that have influenced them as well as the healthcare issues confronting this group of young adults. © 2016 Wiley Periodicals, Inc.

  10. Implementing electronic health care predictive analytics: considerations and challenges.

    Science.gov (United States)

    Amarasingham, Ruben; Patzer, Rachel E; Huesch, Marco; Nguyen, Nam Q; Xie, Bin

    2014-07-01

    The use of predictive modeling for real-time clinical decision making is increasingly recognized as a way to achieve the Triple Aim of improving outcomes, enhancing patients' experiences, and reducing health care costs. The development and validation of predictive models for clinical practice is only the initial step in the journey toward mainstream implementation of real-time point-of-care predictions. Integrating electronic health care predictive analytics (e-HPA) into the clinical work flow, testing e-HPA in a patient population, and subsequently disseminating e-HPA across US health care systems on a broad scale require thoughtful planning. Input is needed from policy makers, health care executives, researchers, and practitioners as the field evolves. This article describes some of the considerations and challenges of implementing e-HPA, including the need to ensure patients' privacy, establish a health system monitoring team to oversee implementation, incorporate predictive analytics into medical education, and make sure that electronic systems do not replace or crowd out decision making by physicians and patients. Project HOPE—The People-to-People Health Foundation, Inc.

  11. A new era of emergency care: planning and design consideration.

    Science.gov (United States)

    Zilm, Frank

    2007-01-01

    Emergency care is one of the most complex, rapidly growing areas of ambulatory care. Providers need to consider new issues related to management of low-acuity patients, capacity for surge events, and the need to integrate patient focused care into the emergency department environment. This article explores these issues and discusses basic organizational topologies for facilities.

  12. [Providing regular relief; considerations for palliative care in the Netherlands].

    Science.gov (United States)

    Crul, B J; van Weel, C

    2001-10-20

    Over the last few decades the attention devoted to the palliative aspects of medicine, particularly those in hospital care, has declined due to the emphasis on medical technology. In Anglo-Saxon countries a review of this development resulted in structured palliative care that benefited terminally ill patients with a progressive fatal disease, especially cancer patients. Due to increasing national and international criticism of both the practice of euthanasia (assumed to be too liberal) and the lack of attention devoted to structured palliative care in the Netherlands, the Dutch government decided to improve the structure of palliative care. The government's viewpoint is based on the assumption that good palliative care that includes adequate pain control benefits patient care and might eventually lead to fewer requests for euthanasia. The improvements to palliative care should be realised by means of improvements in the structure, training and knowledge. Six academic medical clusters have been designated as Centres for the Development of Palliative Care (Dutch acronym: COPZ) for a 5-year period. Each COPZ must develop the various aspects needed to improve palliative care within the region it serves and ensure that its activities are carefully coordinated with those in the other centres. Research will focus on measuring the efficacy of palliative care as well as ethical and epidemiological aspects. A government committee will assess the appropriateness of the activities undertaken by each of the centres.

  13. [Providing regular relief; considerations for palliative care in the Netherlands

    NARCIS (Netherlands)

    Crul, B.J.P.; Weel, C. van

    2001-01-01

    Over the last few decades the attention devoted to the palliative aspects of medicine, particularly those in hospital care, has declined due to the emphasis on medical technology. In Anglo-Saxon countries a review of this development resulted in structured palliative care that benefited terminally

  14. Trading Platform for the Global Warrant Markets

    Directory of Open Access Journals (Sweden)

    Iosif ZIMAN

    2011-01-01

    Full Text Available Global warrant markets are among the most active financial markets in the retail derivatives investment landscape currently. In this context some of the most relevant markets in the last years have been the ones across Asia and in particular Hong Kong, Korea and Japan. This paper introduces the financial instruments used in connection with the warrant markets, pre-sents and offers suggestions for setting up a generic warrant market making system and in-troduces the main concepts and components that need to be taken into account when develop-ing these systems targeting an exchange driven or E-Businesscontext.

  15. Philosophy of care, decision making, and ethical considerations.

    Science.gov (United States)

    Ewer, M S

    1989-07-01

    The very nature of critical care opens the door to controversy, for it is in the intensive care unit that staggering amounts of money and human resources are expended. The outcome is frequently suboptimal, and the feeling often persists that our patients, who should be the beneficiaries of our efforts, are paying a tremendous price in the form of isolation from loved ones, life-support systems that do not allow them to communicate with their families or caretakers, and the physical pain of multisystem failure. As Carlon has recently asked, are we allocating our limited resources inappropriately because we are unable to select patients who will not survive despite our intensive care units? This concern may be justified. However, the work we do in the intensive care unit has another, more positive intangible result. Many of the breakthroughs in medicine have been achieved by dedicated pioneers who tried to accomplish something that had not been accomplished before. At first their efforts were often challenged as being useless or overly extravagant or were even opposed as a violation of God's will or the laws of nature. Developing new forms of treatment, some of which can only be tested in an intensive care unit, is a challenge for all of us. We must, of course, balance what we are trying to accomplish with what we spend, since too much as well as too little emphasis on new techniques is suboptimal. If we persevere, some of what we find impossible to achieve today will become possible tomorrow, will become the norm of the future, and will, we hope, give way to still better innovations as medicine continues to evolve.

  16. Smart practice: smart card design considerations in health care.

    Science.gov (United States)

    Lindley, R A; Pacheco, F

    1995-01-01

    Recent innovations in microelectronics and advances in cryptography are driving the appearance of a new generation of smart cards with wider applications; this has important repercussions for our society in the coming years. Essentially, these breakthroughs include built-in microprocessors capable of generating cryptographic transactions (e.g.,Jelectronic blinded signatures, digital pseudonyms, and digital credentials), developments toward a single electronic card offering multi-access to services such as transport, telecommunications, health, financial, and entertainment (Universal Access Services), and incorporation of personal identification technologies such as voice, eye, or skin pattern recognition. For example, by using electronic representatives or cryptographic blinded signatures, a smart card can be used for multi transactions across different organizations and under different generated pseudonyms. These pseudonyms are capable of recognizing an individual unambiguously, while none of her records can be linked [1]. Moreover, tamper-proof electronic observers would make smart cards a very attractive technology for high-security based applications, such as those in the health care field. New trends in smart card technology offer excellent privacy and confidentiality safeguards. Therefore, smart cards constitute a promising technology for the health sector in Australia and other countries around the world in their pursuit of technology to support the delivery of quality care services. This paper addresses the main issues and the key design criteria which may be of strategic importance to the success of future smart card technology in the health care sector.

  17. A new paradigm for HIV care: ethical and clinical considerations.

    Science.gov (United States)

    Noring, S; Dubler, N N; Birkhead, G; Agins, B

    2001-05-01

    Although dramatic advances in clinical treatment have greatly improved the lives of many people with HIV/AIDS, many other patients do not have information about or access to these treatments because of health care providers' presumptive judgments about patients' ability to adhere to medical regimens. The authors contend that with sufficient support and education most patients, even those with difficult social and medical problems, can be helped to initiate and maintain HIV treatment in accordance with current clinical standards. This commentary delineates a new paradigm for HIV care in which patients and providers collaborate on individualized plans to establish patients' readiness for treatment, ensure maintenance of treatment, and make use of the social services necessary to accomplish these goals. Providers have an ethical responsibility to do everything possible to see that patients who might benefit from new HIV treatments have a fair opportunity to do so, and health systems have a responsibility to facilitate this process. Substantial progress toward meeting these responsibilities can be made within the current health care environment.

  18. Glioblastoma: background, standard treatment paradigms, and supportive care considerations.

    Science.gov (United States)

    Ellor, Susan V; Pagano-Young, Teri Ann; Avgeropoulos, Nicholas G

    2014-01-01

    Glioblastoma is a brain tumor condition marked by rapid neurological and clinical demise, resulting in disproportionate disability for those affected. Caring for this group of patients is complex, intense, multidisciplinary in nature, and fraught with the need for expensive treatments, surveillance imaging, physician follow-up, and rehabilitative, psychological, and social support interventions. Few of these patients return to the workforce for any meaningful time frame, and because of the enormity of the financial burden that patients, their caregivers, and society face, utilization reviews become the focus of ethical scrutiny. © 2014 American Society of Law, Medicine & Ethics, Inc.

  19. Inherited epidermolysis bullosa: an update and suggested dental care considerations.

    Science.gov (United States)

    Feijoo, Javier F; Bugallo, Juan; Limeres, Jacobo; Peñarrocha, David; Peñarrocha, Miguel; Diz, Pedro

    2011-09-01

    Epidermolysis bullosa (EB) is a skin disease characterized by epithelial fragility that leads to blistering and erosion of the skin and mucosae. The authors conducted a literature review to provide an update on oral manifestations and dental care of patients with EB. Literature Search. The authors reviewed the dental literature on EB in relation to clinical findings and provision of dental care. They searched textbooks and three databases: MEDLINE, Cochrane Library and Embase. The authors did not impose any date or publication status restrictions. They searched all databases up to August 2010. The literature review revealed that four major groups and 32 subtypes of EB can be distinguished on the basis of the ultrastructural characteristics of skin cleavage, genetic mode of transmission and clinical phenotype. Oral manifestations differ in frequency and severity according to the disease subtype, but the most common are bullae, which leave painful ulcers on rupture, followed by scarring and tissue contraction. Although good oral health status is essential to maintaining oral function, dental treatment can induce new lesions and be hindered by the sequelae of existing lesions. Dental treatment in patients with EB requires a multidisciplinary approach. Dental procedures must be minimally traumatic, and the effectiveness of treatment is determined mainly by the patient's general health, cooperation in the dental office and at home, oral hygiene and diet.

  20. Continued care of uranium mill sites: some economic considerations

    International Nuclear Information System (INIS)

    Harrington, W.; Sawyer, J.W. Jr.

    1978-01-01

    A critique of recently enacted legislation authorizing the New Mexico Environmental Improvement Agency to regulate uranium mills in the state is presented. Under this new legislation, the Agency is authorized to require payment of up to 10 cents per pound of yellowcake from each licensed mill in the state until a total of $1 million has been deposited by that mill. The continued care fund thus created will provide for maintenance in perpetuity of mill sites after being decommissioned. Arguments are presented, based on calculations for a typical 5,000 ton per day mill, that even the maximum amount is not likely to generate sufficient income to support an adequate maintenance program. The matter is further aggravated by the rate of inflation which will increase costs beyond the coverage provided by a fixed funding system. To correct this situation, it is proposed that (1) the fund should generate an income stream sufficient to meet all maintenance costs based on currently available information on costs, interest, and inflation rates, and (2) the terms of the continued care contribution should be readily alterable as new information becomes available. The latter condition should be coupled with removal of the upper statutory limit now established for the fund

  1. Transgender and Gender Nonconforming Adolescent Care: Psychosocial and Medical Considerations

    Science.gov (United States)

    Guss, Carly; Shumer, Daniel; Katz-Wise, Sabra L.

    2015-01-01

    Purpose of review Transgender individuals display incongruence between their assigned birth sex and their current gender identity, and may identify as male, female or elsewhere on the gender spectrum. Gender nonconformity describes an individual whose gender identity, role, or expression are not typical for individuals in a given assigned sex category. This update highlights recent literature pertaining to the psychosocial and medical care of transgender and gender nonconforming (TGN) adolescents with applications for the general practitioner. Recent findings The psychological risks and outcomes of TGN adolescents are being more widely recognized. Moreover, there is increasing evidence that social and medical gender transition reduces gender dysphoria, defined as distress that accompanies the incongruence between one’s birth sex and identified gender. Unfortunately, lack of education about TGN adolescents in medical training persists. Summary Recent literature highlights increased health risks in TGN adolescents and improved outcomes following gender dysphoria treatment. It is important for clinicians to become familiar with the range of treatment options and referral resources available to TGN adolescents in order to provide optimal and welcoming care to all adolescents. PMID:26087416

  2. Transgender and gender nonconforming adolescent care: psychosocial and medical considerations.

    Science.gov (United States)

    Guss, Carly; Shumer, Daniel; Katz-Wise, Sabra L

    2015-08-01

    Transgender individuals display incongruence between their assigned birth sex and their current gender identity, and may identify as male, female, or being elsewhere on the gender spectrum. Gender nonconformity describes an individual whose gender identity, role, or expression is not typical for individuals in a given assigned sex category. This update highlights recent literature pertaining to the psychosocial and medical care of transgender and gender nonconforming (TGN) adolescents with applications for the general practitioner. The psychological risks and outcomes of TGN adolescents are being more widely recognized. Moreover, there is increasing evidence that social and medical gender transition reduces gender dysphoria, defined as distress that accompanies the incongruence between one's birth sex and identified gender. Unfortunately, lack of education about TGN adolescents in medical training persists. Recent literature highlights increased health risks in TGN adolescents and improved outcomes following gender dysphoria treatment. It is important for clinicians to become familiar with the range of treatment options and referral resources available to TGN adolescents in order to provide optimal and welcoming care to all adolescents.

  3. Military Considerations in Transsexual Care of the Active Duty Member.

    Science.gov (United States)

    Folaron, Irene; Lovasz, Monica

    2016-10-01

    Retention standards and policies applied to active duty members in the U.S. military who identify as transgender have recently been in evolution. The Secretary of Defense recently released a new directive allowing transgender members to serve openly with the option to transition gender while in active duty, abrogating the old policy disqualifying transgender members from continued service. There is a reasonable expectation that some may pursue medical and surgical options toward gender transition. The clinical pathway for gender transition relies heavily on Mental Health and Endocrinology services. This article highlights the medical aspects of gender transition and how they can affect readiness and the delivery of military health care. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  4. Ethical considerations in clinical training, care and research in psychopharmacology.

    Science.gov (United States)

    Strous, Rael D

    2011-04-01

    Psychopharmacology is a powerful tool in psychiatry; however, it is one that demands responsibility in order to deal with the ethical complexities that accompany advances in the field. It is important that questions are asked and that ethical mindfulness and sensitivity are developed along with clinical skills. In order to cultivate and deepen ethical awareness and subsequently solve issues in optimal fashion, investment should be made in the development of an ethical decision-making process as well as in education in the ethics of psychopharmacology to trainees in the field at all stages of their educational development. A clear approach to identifying ethical problems, engaging various ethical concepts in considering solutions and then applying these principles in problem resolution is demanded. An openness in identifying and exploring issues has become crucial to the future development and maturation of psychopharmacologists, both research and clinical. Consideration must be given to the social implications of psychopharmacological practice, with the best interests of patients always paramount. From both a research and clinical perspective, psychopharmacology has to be practised with fairness, sensitivity and ethical relevance to all. While ethical issues related to psychopharmacological practice are varied and plentiful, this review focuses on advances in technology and biological sciences, personal integrity, special populations, and education and training.

  5. Clinical pathways for inborn errors of metabolism: warranted and feasible

    Directory of Open Access Journals (Sweden)

    Demirdas Serwet

    2013-02-01

    Full Text Available Abstract Inborn errors of metabolism (IEMs are known for their low prevalence and multidisciplinary care mostly founded on expert opinion. Clinical pathways are multidisciplinary tools to organise care which provide a clear route to the best care and improve communication. In 2010 the Dutch Society for Children and Adults with an Inborn Error of Metabolism (VKS initiated development of clinical pathways for inborn errors of metabolism. In this letter to the editor we describe why it is warranted to develop clinical pathways for IEMs and shortly discuss the process of development for these pathways in the Netherlands.

  6. Altruism and mature care: some rival moral considerations in care ethics.

    Science.gov (United States)

    Hem, Marit Helene; Halvorsen, Kristin; Nortvedt, Per

    2014-11-01

    We discuss Carol Gilligan's original concept of mature care in the light of the altruistic approach to caring and good clinical judgment. In particular, we highlight how the concept of mature care can capture important challenges in today's nursing. Further, we illuminate how mature care might differ normatively from an altruistic approach to caring and the traditional prudential virtues in nursing. We also discuss similarities between mature care and virtue ethics. For nursing and nurses' identity, in today's health care system that is increasingly pressured to 'produce' health, we believe it is important to both developing further theories on mature care and having normative discussions about care. © The Author(s) 2014.

  7. [Basic ethical considerations in intensive care--Switzerland, a pluralistic country].

    Science.gov (United States)

    Muller, A F

    1995-06-10

    The basic ethical considerations surrounding intensive care are analyzed from the historical perspective, with particular reference to the two doctrines still of greatest importance: Kantianism and utilitarianism. They are correlated with the four essential principles of medical ethics: autonomy of the patient, quality, nihil nocere, and equal distribution of medical resources. The inevitable conflicts, particularly arising from pluralism, are reviewed. Finally, the absolute need is stressed for a global medical ethics taking into consideration not only the patient but society as a whole.

  8. Human factors and ergonomics in home care: Current concerns and future considerations for health information technology

    Science.gov (United States)

    Or, Calvin K.L.; Valdez, Rupa S.; Casper, Gail R.; Carayon, Pascale; Burke, Laura J.; Brennan, Patricia Flatley; Karsh, Ben-Tzion

    2010-01-01

    Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention. PMID:19713630

  9. Obesity as a Socially Defined Disease: Philosophical Considerations and Implications for Policy and Care.

    Science.gov (United States)

    Hofmann, Bjørn

    2016-03-01

    Obesity has generated significant worries amongst health policy makers and has obtained increased attention in health care. Obesity is unanimously defined as a disease in the health care and health policy literature. However, there are pragmatic and not principled reasons for this. This warrants an analysis of obesity according to standard conceptions of disease in the literature of philosophy of medicine. According to theories and definitions of disease referring to (abnormal functioning of) internal processes, obesity is not a disease. Obesity undoubtedly can result in disease, making it a risk factor for disease, but not a disease per se. According to several social conceptions of disease, however, obesity clearly is a disease. Obesity can conflict with aesthetic, moral, or other social norms. Making obesity a "social disease" may very well be a wise health policy, assuring and improving population health, especially if we address the social determinants of obesity, such as the food supply and marketing system. However, applying biomedical solutions to social problems may also have severe side effects. It can result in medicalization and enhance stigmatization and discrimination of persons based on appearance or behavior. Approaching social problems with biomedical means may also serve commercial and professionals' interests more than the health and welfare of individuals; it may make quick fix medical solutions halt more sustainable structural solutions. This urges health insurers, health care professionals, and health policy makers to be cautious. Especially if we want to help and respect persons that we classify and treat as obese.

  10. Ethics and values in health care practice: philosophical, educational, and political considerations.

    Science.gov (United States)

    Carvalho, Vilma de

    2011-12-01

    This paper presents philosophical, pedagogical and political considerations on Ethics and Values in Professional Health Care Practice. The current changes and crises in the world, intensified by economic turmoil, have affected social justice issues affecting health and education. to clarify nurses' role in the context of the art to take care of clients both as individuals and community; to urge nurses for attention to laws and codes/norms as established in the profession; and to suggest the application of basic laws of the Philosophy of Art to nursing care. The study presents critical analysis on ethics and values involved in nursing actions and may affect the art of learning-to-be and becoming an expert professional in nursing care. The author's epistemological position is presented to build competencies in the nursing as a health science.

  11. Value choices and considerations when limiting intensive care treatment: a qualitative study.

    Science.gov (United States)

    Halvorsen, K; Førde, R; Nortvedt, P

    2009-01-01

    To shed light on the values and considerations that affect the decision-making processes and the decisions to limit intensive care treatment. Qualitative methodology with participant observation and in-depth interviews, with an emphasis on eliciting the underlying rationale of the clinicians' actions and choices when limiting treatment. Informants perceived over-treatment in intensive care medicine as a dilemma. One explanation was that the decision-making base was somewhat uncertain, complex and difficult. The informants claimed that those responsible for taking decisions from the admitting ward prolonged futile treatment because they may bear guilt or responsibility for something that had gone wrong during the course of treatment. The assessments of the patient's situation made by physicians from the admitting ward were often more organ-oriented and the expectations were less realistic than those of clinicians in the intensive care unit who frequently had a more balanced and overall perspective. Aspects such as the personality and the speciality of those involved, the culture of the unit and the degree of interdisciplinary cooperation were important issues in the decision-making processes. Under-communicated considerations jeopardise the principle of equal treatment. If intensive care patients are to be ensured equal treatment, strategies for interdisciplinary, transparent and appropriate decision-making processes must be developed in which open and hidden values are rendered visible, power structures disclosed, employees respected and the various perspectives of the treatment given their legitimate place.

  12. Funding of drugs : do vaccines warrant a different approach?

    NARCIS (Netherlands)

    Beutels, Philippe; Scuffham, Paul A.; MacIntyre, C. Raina

    2008-01-01

    Vaccines have features that require special consideration when assessing their cost-effectiveness. These features are related to herd immunity, quality-of-life losses in young children, parental care and work loss, time preference, uncertainty, eradication, macroeconomics, and tiered pricing.

  13. Greenhouse gas reductions; not warranted, not beneficial

    International Nuclear Information System (INIS)

    Green, K.

    2003-01-01

    This report deals with climate change and greenhouse gas emissions, especially regional climate change predictions, from a sceptic's point of view. It rejects all the conventional evidence supporting claims of extreme man-made climate changes, dismissing them as alarmist and inherently uncertain. Similarly, it characterizes policy prescriptions based on this evidence as faulty and as measures which, if implemented, would do both current and future generations considerably more harm than good. Calls for energy efficiency and conservation, reliance on renewable energy sources, improved efficiency of conventional vehicles, hybrid and fuel-cell-driven cars, reducing the amount of driving, establishing greenhouse gas registries, are all dismissed as impractical, imposing higher costs on energy generally, slowing economic growth in the process, and scaring people to adopt unwise public policies by exaggerating the certainty of predictions about man-made climate change. While dismissing the arguments advanced by 'old-school' environmentalists, the report does not question the validity of the overall theory or details of the core greenhouse effect, its main targets are the anthropogenic components of the observed temperature record, and the evidence of a clear cause-and-effect link between anthropogenic forcing and changes in the Earth's surface temperature. Overall, the report dismisses the 'conventional' view of the extent of climate change, the cause of that change and the risk it poses. It emphasizes the limitations on economic freedom that proposed policies would inflict, and argues in favour of more studies to provide the foundation for a societal response based on a solid understanding of the science behind climate change, and the impact of proposed policy options. 32 refs., 2 figs

  14. Ethical Considerations in Mandatory Disclosure of Data Acquired While Caring for Human Trafficking Survivors.

    Science.gov (United States)

    Kerr, Patrick L; Dash, Rachel

    2017-01-01

    Accurate data on the prevalence and psychological effects of human trafficking as well as treatment outcomes for survivors are essential for measuring the impact of interventions and generating better understanding of this phenomenon. However, such data are difficult to obtain. A legal mandate for health care professionals to report trafficking opens opportunities for advancing our work in the field of human trafficking but also poses risks to survivors seeking services. In this article, we provide an analysis of some critical ethical considerations for the development and implementation of a mandatory reporting policy and offer recommendations for the ethical implementation of such a policy. © 2017 American Medical Association. All Rights Reserved.

  15. Considerations for Assessing the Appropriateness of High-Cost Pediatric Care in Low-Income Regions

    Directory of Open Access Journals (Sweden)

    Andrew C. Argent

    2018-03-01

    Full Text Available It may be difficult to predict the consequences of provision of high-cost pediatric care (HCC in low- and middle-income countries (LMICs, and these consequences may be different to those experienced in high-income countries. An evaluation of the implications of HCC in LMICs must incorporate considerations of the specific context in that country (population age profile, profile of disease, resources available, likely costs of the HCC, likely benefits that can be gained versus the costs that will be incurred. Ideally, the process that is followed in decision making around HCC should be transparent and should involve the communities that will be most affected by those decisions. It is essential that the impacts of provision of HCC are carefully monitored so that informed decisions can be made about future provision medical interventions.

  16. Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: A case series.

    Science.gov (United States)

    Donaldson, Abigail A; Hall, Allison; Neukirch, Jodie; Kasper, Vania; Simones, Shannon; Gagnon, Sherry; Reich, Steven; Forcier, Michelle

    2018-05-01

    Gender nonconforming youth are at risk for body dissatisfaction and disordered eating. Currently, only a small body of literature addresses this high-risk group. The five cases in this series highlight important themes for this patient population from an interdisciplinary perspective. Identified themes include increased risk for self-harm/suicide, complex psychiatric, and medical implications of delay to treatment for either gender dysphoria or disordered eating, and the importance of collaborative management to maximize care and facilitate healthy development to adulthood. The purpose of this case series is to expand the interdisciplinary discussion regarding the breadth of presentation and management considerations for gender nonconforming adolescents with disordered eating. An interdisciplinary approach to care might enhance access to comprehensive, collaborative treatment for disordered eating, and gender dysphoria in this unique population. © 2018 Wiley Periodicals, Inc.

  17. Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians.

    Science.gov (United States)

    Koper, Ian; van der Heide, Agnes; Janssens, Rien; Swart, Siebe; Perez, Roberto; Rietjens, Judith

    2014-01-01

    Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services. Fifty-four physicians were interviewed on their most recent case of palliative sedation. Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation. Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.

  18. Intimacy and Sexuality in Institutionalized Dementia Care: Clinical-Ethical Considerations.

    Science.gov (United States)

    Mahieu, Lieslot; Anckaert, Luc; Gastmans, Chris

    2017-03-01

    Intimacy and sexuality expressed by nursing home residents with dementia remains an ethically sensitive issue for care facilities, nursing staff and family members. Dealing with residents' sexual longings and behaviour is extremely difficult, putting a burden on the caregivers as well as on the residents themselves and their relatives. The parties in question often do not know how to react when residents express themselves sexually. The overall aim of this article is to provide a number of clinical-ethical considerations addressing the following question: 'How can expressions of intimacy and sexuality by residents with dementia be dealt with in an ethically responsible way?' The considerations formulated are based on two cornerstones: (1) the current literature on older peoples' experiences regarding intimacy and sexuality after the onset of dementia, and (2) an anthropological-ethical framework addressing four fundamental pillars of human existence namely the decentred self, human embodiment, being-in-the-world and being-with-others. The resulting considerations are oriented toward the individual sphere, the partnership sphere, and the institutional sphere. The continuous interaction between these spheres leads to orientations that both empower the residents in question and respect the complex network of relationships that surrounds them.

  19. Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity.

    Science.gov (United States)

    Wee, Christina C; Huskey, Karen W; Bolcic-Jankovic, Dragana; Colten, Mary Ellen; Davis, Roger B; Hamel, Marybeth

    2014-01-01

    Bariatric surgery is one of few obesity treatments to produce substantial weight loss but only a small proportion of medically-eligible patients, especially men and racial minorities, undergo bariatric surgery. To describe primary care patients' consideration of bariatric surgery, potential variation by sex and race, and factors that underlie any variation. Telephone interview of 337 patients with a body mass index or BMI > 35 kg/m(2) seen at four diverse primary care practices in Greater-Boston. Patients' consideration of bariatric surgery. Of 325 patients who had heard of bariatric surgery, 34 % had seriously considered surgery. Men were less likely than women and African Americans were less likely than Caucasian patients to have considered surgery after adjustment for sociodemographics and BMI. Comorbid conditions did not explain sex and racial differences but racial differences dissipated after adjustment for quality of life (QOL), which tended to be higher among African American than Caucasian patients. Physician recommendation of bariatric surgery was independently associated with serious consideration for surgery [OR 4.95 (95 % CI 2.81-8.70)], but did not explain variation in consideration of surgery across sex and race. However, if recommended by their doctor, men were as willing and African American and Hispanic patients were more willing to consider bariatric surgery than their respective counterparts after adjustment. Nevertheless, only 20 % of patients reported being recommended bariatric surgery by their doctor and African Americans and men were less likely to receive this recommendation; racial differences in being recommended surgery were also largely explained by differences in QOL. High perceived risk to bariatric surgery was the most commonly cited barrier; financial concerns were uncommonly cited. Single geographic region; examined consideration and not who eventually proceeded with bariatric surgery. African Americans and men were less likely to

  20. Building the Nonuniversity, Tertiary Care Center Hepatobiliary and Pancreatic Surgery Practice: Structural and Financial Considerations.

    Science.gov (United States)

    Baker, Erin H; Siddiqui, Imran; Vrochides, Dionisios; Iannitti, David A; Martinie, John B; Rorabaugh, Lauren; Jeyarajah, D Rohan; Swan, Ryan Z

    2016-12-01

    Early in their careers, many new surgeons lack the background and experience to understand essential components needed to build a surgical practice. Surgical resident education is often devoid of specific instruction on the business of medicine and practice management. In particular, hepatobiliary and pancreatic (HPB) surgeons require many key components to build a successful practice secondary to significant interdisciplinary coordination and a scope of complex surgery, which spans challenging benign and malignant disease processes. In the following, we describe the required clinical and financial components for developing a successful HPB surgery practice in the nonuniversity tertiary care center. We discuss significant financial considerations for understanding community need and hospital investment, contract establishment, billing, and coding. We summarize the structural elements and key personnel necessary for establishing an effectual HPB surgical team. This article provides useful, essential information for a new HPB surgeon looking to establish a surgical practice. It also provides insight for health-care administrators as to the value an HPB surgeon can bring to a hospital or health-care system.

  1. [Quo vadis, modern intensive care medicine? Outdated considerations regarding risks and side effects].

    Science.gov (United States)

    Duttge, G

    2016-04-01

    Modern intensive care medicine is faced with large challenges which are not solely caused by medical-technical progress, but above all by the demographic and value-related changes of society and its citizens. Thereby, three central problem areas are of particular interest: the fragile effectiveness of a patient's right to self-determination at the end of life, the uncertainties regarding the demarcation of futility, and the question of the influence of economic considerations (rationing) in view of the different levels for the allocation of duties and execution of duties. This article contains the revised version of the lecture from June 18, 2015 on the occasion of the 47th annual joint conference of DGIIN (Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin) and ÖGIAIN (Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin) on the general subject: "quality and humanity".

  2. The economics of bladder cancer: costs and considerations of caring for this disease.

    Science.gov (United States)

    Svatek, Robert S; Hollenbeck, Brent K; Holmäng, Sten; Lee, Richard; Kim, Simon P; Stenzl, Arnulf; Lotan, Yair

    2014-08-01

    Due to high recurrence rates, intensive surveillance strategies, and expensive treatment costs, the management of bladder cancer contributes significantly to medical costs. To provide a concise evaluation of contemporary cost-related challenges in the care of patients with bladder cancer. An emphasis is placed on the initial diagnosis of bladder cancer and therapy considerations for both non-muscle-invasive bladder cancer (NMIBC) and more advanced disease. A systematic review of the literature was performed using Medline (1966 to February 2011). Medical Subject Headings (MeSH) terms for search criteria included "bladder cancer, neoplasms" OR "carcinoma, transitional cell" AND all cost-related MeSH search terms. Studies evaluating the costs associated with of various diagnostic or treatment approaches were reviewed. Routine use of perioperative chemotherapy following complete transurethral resection of bladder tumor has been estimated to provide a cost savings. Routine office-based fulguration of small low-grade recurrences could decrease costs. Another potential important target for decreasing variation and cost lies in risk-modified surveillance strategies after initial bladder tumor removal to reduce the cost associated with frequent cystoscopic and radiographic procedures. Optimizing postoperative care after radical cystectomy has the potential to decrease length of stay and perioperative morbidity with substantial decreases in perioperative care expenses. The gemcitabine-cisplatin regimen has been estimated to result in a modest increase in cost effectiveness over methotrexate, vinblastine, doxorubicin, and cisplatin. Additional costs of therapies need to be balanced with effectiveness, and there are significant gaps in knowledge regarding optimal surveillance and treatment of both early and advanced bladder cancer. Regardless of disease severity, improvements in the efficiency of bladder cancer care to limit unnecessary interventions and optimize effective

  3. The economic impact of work and family issues: child care satisfaction and financial considerations of employed mothers.

    Science.gov (United States)

    Poms, Laura Wheeler; Botsford, Whitney E; Kaplan, Seth A; Buffardi, Louis C; O'Brien, Alison S

    2009-10-01

    This article introduces the role of financial considerations into work-family research by considering the costs and benefits of employed mothers' child care satisfaction. Data from 2 samples offer empirical support for the addition of a fourth factor to a current measure of child care satisfaction so that the measure reflects mothers' satisfaction not only with caregiver attentiveness, communication, and dependability but also with child care-related financial considerations. This article also discusses relationships between child care satisfaction and work-family conflict and job satisfaction for this population. The results of this study provide both organizations and child care providers with a broader picture of the concerns that employed mothers face as they search for reliable, affordable child care. PsycINFO Database Record (c) 2009 APA, all rights reserved.

  4. Pharmacokinetic considerations and recommendations in palliative care, with focus on morphine, midazolam and haloperidol.

    Science.gov (United States)

    Franken, L G; de Winter, B C M; van Esch, H J; van Zuylen, L; Baar, F P M; Tibboel, D; Mathôt, R A A; van Gelder, T; Koch, B C P

    2016-06-01

    A variety of medications are used for symptom control in palliative care, such as morphine, midazolam and haloperidol. The pharmacokinetics of these drugs may be altered in these patients as a result of physiological changes that occur at the end stage of life. This review gives an overview of how the pharmacokinetics in terminally ill patients may differ from the average population and discusses the effect of terminal illness on each of the four pharmacokinetic processes absorption, distribution, metabolism, and elimination. Specific considerations are also given for three commonly prescribed drugs in palliative care: morphine, midazolam and haloperidol). The pharmacokinetics of drugs in terminally ill patients can be complex and limited evidence exists on guided drug use in this population. To improve the quality of life of these patients, more knowledge and more pharmacokinetic/pharmacodynamics studies in terminally ill patients are needed to develop individualised dosing guidelines. Until then knowledge of pharmacokinetics and the physiological changes that occur in the final days of life can provide a base for dosing adjustments that will improve the quality of life of terminally ill patients. As the interaction of drugs with the physiology of dying is complex, pharmacological treatment is probably best assessed in a multi-disciplinary setting and the advice of a pharmacist, or clinical pharmacologist, is highly recommended.

  5. victoria cross awards warrants concerning the victoria cross (1920)

    African Journals Online (AJOL)

    1. WARRANTS CONCERNING THE. VICTORIA CROSS (1920). In order to get a picture of the Royal Warrants promulgated from 1856 to 1920 in respect of the .... to confirmation by us. Eighthly. - It is ordained, where such an act shall not have been performed in the sight of a commanding officer as aforesaid, then the ...

  6. 19 CFR 162.11 - Authority to procure warrants.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Authority to procure warrants. 162.11 Section 162.11 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY (CONTINUED) INSPECTION, SEARCH, AND SEIZURE Search Warrants § 162.11 Authority to procure...

  7. Funding of drugs: do vaccines warrant a different approach?

    Science.gov (United States)

    Beutels, Philippe; Scuffham, Paul A; MacIntyre, C Raina

    2008-11-01

    Vaccines have features that require special consideration when assessing their cost-effectiveness. These features are related to herd immunity, quality-of-life losses in young children, parental care and work loss, time preference, uncertainty, eradication, macroeconomics, and tiered pricing. Advisory committees on public funding for vaccines, or for pharmaceuticals in general, should be knowledgable about these special features. We discuss key issues and difficulties in decision making for vaccines against rotavirus, human papillomavirus, varicella-zoster virus, influenza virus, and Streptococcus pneumoniae. We argue that guidelines for economic evaluation should be reconsidered generally to recommend (1) modelling options for the assessment of interventions against infectious diseases; (2) a wider perspective to account for impacts on third parties, if relevant; (3) a wider scope of costs than health-care system costs alone, if appropriate; and (4) alternative discounting techniques to explore social time preference over long periods.

  8. Social justice considerations in neonatal care for nurse managers and executives.

    Science.gov (United States)

    Yoder, Linda; Walden, Marlene; Verklan, M Terese

    2010-01-01

    This article presents the struggle between social justice and market justice within the current health care system, specifically issues affecting neonatal care. Community benefit is described and discussed as an aspect of social justice demonstrated by hospitals. The federal and state Children's Health Insurance Program also is discussed in relation to social justice and health care costs. Implications for managers and executives overseeing neonatal care are presented in relation to the economic and social issues.

  9. Expeditionary Forensic Support to Joint Force Commanders: What Changes or Considerations are Warranted?

    Science.gov (United States)

    2012-04-10

    builders . Human Intelligence (HUMINT) and Signals Intelligence (SIGINT) could then also be prioritized and employed accordingly for optimal 8...responsibility for digital and multimedia forensics, and DIA responsibility for forensic intelligence activities and programs.31 The Army is also currently...aligning functional oversight of Forensics, Biometrics, Law Enforcement, Detainee Operations, and Physical Security 11 under one overarching

  10. Design considerations for a dental health care for patients with special needs.

    Directory of Open Access Journals (Sweden)

    Krishnan Lakshmi

    2018-05-01

    Full Text Available Out of 121 million population, 2.86 crore accounts for disabled people which 1.21% of total population. It has been reported that oral health care status of disabled people are poor than normal population. The main reason for this situation is barrier to access health care centres. This article throws light on definition and types of disability listed by Indian government. It also highlights the prevalence of disability and their oral health status. Article focuses on barrier in accessing dental care and guidelines required to build a disable friendly dental health care deliver center to make the treatment acceptable for such pupils. It is utmost important to provide dental care to such patients by overcoming the barrier to accessibility. Before motivating the patients and caregivers, it is the dentist who has to be motivated first in fulfilling special health care needs of patients resulting in improvement of quality of life.

  11. Establishing a pediatric cardiac intensive care unit - Special considerations in a limited resources environment

    Directory of Open Access Journals (Sweden)

    Nair Suresh

    2010-01-01

    Full Text Available Pediatric cardiac intensive care has evolved as a distinct discipline in well-established pediatric cardiac programs in developed nations. With increasing demand for pediatric heart surgery in emerging economies, a number of new programs are being established. The development of robust pediatric cardiac intensive care units (PCICU is critical to the success of these programs. Because of substantial resource limitations existing models of PCICU care cannot be applied in their existing forms and structure. A number of challenges need to be addressed to deliver pediatric cardiac intensive care in the developing world. Limitations in infrastructure, human, and material resources call for a number of innovations and adaptations. Additionally, a variety of strategies are required to minimize costs of care to the individual patient. This review provides a framework for the establishment of a new PCICU program in face of resource limitations typically encountered in the developing world and emerging economies.

  12. [Using eHealth in the Continuity Care of Chronic Kidney Disease: Opportunities and Considerations].

    Science.gov (United States)

    Chen, Yu-Chi; Chang, Polun

    2016-04-01

    Kidney disease is a common complication of chronic diseases among adult and elderly populations. As early-stage chronic kidney disease (CKD) is asymptomatic, CKD patients are frequently unaware of their condition and fail to implement requisite self-care in a timely fashion. Furthermore, the shortage of case-management manpower and difficulties in follow-up have led to high incidence rates for CKD worldwide. Integrative and continuous care is key to preventing CKD. How to implement this care effectively is a challenge. However, innovative technologies, online information, and cloud technology are increasingly providing access to good-quality healthcare beyond the traditional limitations of time and location. This environment is not only increasing the participation of patients in their care and collaboration among healthcare team members but is also improving the continuity, accessibility, and promptness of care service in order to promote the effectiveness of disease management. While the primary aim of innovative technologies is to make healthcare more cost-effective, it is also causing disparities in healthcare. Within the high-tech e-healthcare system, the ability of patients to utilize these new services relates directly to their health behaviors and quality of care. Thus, emergent e-healthcare system services should be made as patient-centered as possible in order to maximize the benefits in terms of both cost and patient care. Furthermore, improving the eHealth literacy of patients is crucial to promoting innovative technology within healthcare services.

  13. The Medical Transition from Pediatric to Adult-Oriented Care: Considerations for Child and Adolescent Psychiatrists.

    Science.gov (United States)

    Hart, Laura C; Maslow, Gary

    2018-01-01

    More adolescents and young adults are surviving previously fatal childhood illness and need support to transition from pediatric care to adult-oriented care. There are many barriers, but guidelines and tools assist providers with emphasis on gradually addressing transition with patients and families. Child and adolescent psychiatrists should be particularly attuned to the needs of adolescents with previously identified mental illness who are at high risk of falling out of regular care during transition. Providers are also uniquely suited to address the needs of adolescents and young adults with intellectual and developmental disabilities. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians

    NARCIS (Netherlands)

    Koper, I.; Heide, A.; Janssens, M.J.P.A.; Swart, S.; Perez, R.S.G.M.; Rietjens, J.A.C.

    2014-01-01

    Purpose: Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it

  15. Ethical Considerations for Care of the Child Undergoing Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Carter, Martha A

    2017-02-01

    Extracorporeal membrane oxygenation (ECMO) is a complex, highly technical surgical procedure that can offer hope for children born with congenital heart defects. The procedure may only briefly prolong a life, has limited potential for decreasing mortality, and may lead to serious complications, however. Perioperative nurses play an important role in caring for the child who requires ECMO. They are involved in assessing the child, implementing the plan of care, and facilitating communication between the child's family members and the health care team. Thus, perioperative nurses have a responsibility to consider the broad range of ethical issues associated with the procedure. By examining the ethical concepts of beneficence, nonmaleficence, autonomy, justice, and moral distress, the perioperative nurse can better understand the dilemmas that can affect the care and outcome of the critically ill child who requires ECMO. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  16. Reliability in Plantinga´s Account of Epistemic Warrant

    Directory of Open Access Journals (Sweden)

    John C. Wingard, Jr.

    2002-12-01

    Full Text Available In das paper 1 consider the reliability condition in Alvin Platinga’s proper functionalist account of epistemic warrant I begin by reviewing m some detail the features of the reliability condition as Platinga has articulated a From there, 1 consider what is needed to ground or secure the sort of reliability which Plantinga has m mind, and argue that what is needed is a significant causal condition which has generally been overlooked Then, after identifying eight versions of the relevant sort of reliability, I exam me each alternative as to whether as requirement, along with Platinga’s other proposed conditions, would give us a satisfactory account of epistemic warrant I conclude that there is bale to no hope of formulating a reliability condition that would yield a satisfactory analysts of the sort Plantinga desires

  17. Oral health considerations in anorexia and bulimia nervosa. 2. Multidisciplinary management and personalized dental care.

    Science.gov (United States)

    Bassiouny, Mohamed A; Tweddale, Elizabeth

    2017-01-01

    This article outlines a comprehensive, multidisciplinary strategy for treatment of patients with anorexia and bulimia nervosa. In this approach, primary medical intervention and emergency dental care are followed by the staging of treatment phases that integrate medical care, psychotherapy, nutritional counseling, and dental management, which may encompass various treatment options for repair of damaged dentition. Emphasis is placed on prevention of further tissue damage during all phases of management and following completion of the treatment course.

  18. Individual nurse and organizational context considerations for better Knowledge Use in Pain Care.

    Science.gov (United States)

    Latimer, Margot A; Ritchie, Judith A; Johnston, Celeste C

    2010-08-01

    Nurses are involved in many of the painful procedures performed on hospitalized children. In collaboration with physicians, nurses have an exceptional responsibility to have knowledge to manage the pain; however, the evidence indicates this is not being done. Issues may be twofold: (a) opportunities to improve knowledge of better pain care practices and/or (b) ability to use knowledge. Empirical evidence is available that if used by health care providers can reduce pain in hospitalized children. Theory-guided interventions are necessary to focus resources designated for learning and knowledge translation initiatives in the area of pain care. This article presents the Knowledge Use in Pain Care (KUPC) conceptual model that blends concepts from the fields of knowledge utilization and work life context, which are believed to influence the translation of knowledge to practice. The four main components in the KUPC model include those related to the organization, the individual nurse, the individual patient, and the sociopolitical context. The KUPC model was conceptualized to account for the complex circumstances surrounding nurse's knowledge uptake and use in the context of pain care. The model provides a framework for health care administrators, clinical leaders, and researchers to consider as they decide how to intervene to increase knowledge use to reduce painful experiences of children in the hospital. Copyright 2010 Elsevier Inc. All rights reserved.

  19. Ensuring cultural sensitivity for Muslim patients in the Australian ICU: considerations for care.

    Science.gov (United States)

    Bloomer, Melissa J; Al-Mutair, Abbas

    2013-11-01

    Australia is a diverse and multicultural nation, made up of a population with a predominant Christian faith. Islam, the second largest religion in the world, has demonstrated significant growth in Australia in the last decade. Coming from various countries of origin and cultural backgrounds, Muslim beliefs can range from what is considered 'traditional' to very 'liberal'. It is neither possible nor practical for every intensive care clinician to have an intimate understanding of Islam and Muslim practices, and cultural variations amongst Muslims will mean that not all beliefs/practices will be applicable to all Muslims. However, being open and flexible in the way that care is provided and respectful of the needs of Muslim patients and their families is essential to providing culturally sensitive care. This discussion paper aims to describe the Islamic faith in terms of Islamic teachings, beliefs and common practices, considering how this impacts upon the perception of illness, the family unit and how it functions, decision-making and care preferences, particularly at the end of life in the intensive care unit. Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  20. Professionalism in a digital age: opportunities and considerations for using social media in health care.

    Science.gov (United States)

    Gagnon, Kendra; Sabus, Carla

    2015-03-01

    Since the beginning of the millennium, there has been a remarkable change in how people access and share information. Much of this information is user-generated content found on social media sites. As digital technologies and social media continue to expand, health care providers must adapt their professional communication to meet the expectations and needs of consumers. This adaptation may include communication on social media sites. However, many health care providers express concerns that professional social media use, particularly interactions with patients, is ethically problematic. Social media engagement does not create ethical dissonance if best practices are observed and online communication adheres to terms of service, professional standards, and organizational policy. A well-executed social media presence provides health care providers, including physical therapists, the opportunity-and perhaps a professional obligation-to use social media sites to share or create credible health care information, filling a consumer void for high-quality online information on fitness, wellness, and rehabilitation. This perspective article provides a broad review of the emergence of social media in society and health care, explores policy implications of organizational adoption of health care social media, and proposes individual opportunities and guidelines for social media use by the physical therapy professional. © 2015 American Physical Therapy Association.

  1. Assessing access to care for transgender and gender nonconforming people: a consideration of diversity in combating discrimination.

    Science.gov (United States)

    Cruz, Taylor M

    2014-06-01

    Transgender and gender nonconforming people face stigma and discrimination from a wide variety of sources and through numerous social realms. Stigma and discrimination originating from biomedicine and health care provision may impact this group's access to primary care. Such stigma and discrimination may originate not only from direct events and past negative experiences, but also through medicine's role in providing treatments of transitioning, the development of formal diagnoses to provide access to such treatments, and the medical language used to describe this diverse group. This paper examines the postponement of primary curative care among this marginalized group of people by drawing from the National Transgender Discrimination Survey, one of the largest available datasets for this underserved group. This paper also proposes an innovate categorization system to account for differences in self-conceptualization and identity, which has been of considerable concern for transgender and gender nonconforming communities but remains underexplored in social and health research. Results suggest that experience, identity, state of transition, and disclosure of transgender or gender nonconforming status are associated with postponement due to discrimination. Other findings suggest that postponement associated with primary place of seeking care and health insurance has ties to both discrimination and affordability. These findings highlight the importance of combating stigma and discrimination generated from within or experienced at sites of biomedicine or health care provision in improving access to care for this group of people. Improving access to care for all gender variant people requires a critical evaluation of existing research practices and health care provision to ensure that care is tailored as needed to each person's perspective in relation to larger social processes. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Analysis and specification of an open platform for outpatient care in consideration of actual standard solutions

    Directory of Open Access Journals (Sweden)

    Rosales Saurer, Bruno

    2008-10-01

    Full Text Available The field of ambulatory nursing is rapidly growing due to rising health care costs and the demographic development. Today there are approximately 2 million persons in Germany who need outpatient care. Experts predict that there will be more than twice as much by 2050. Ambulatory care nurses must quickly and efficiently assess their patients’ condition and needs. Against this background, the VitaBIT project started in July 2007 with the objective of reorganizing ambulatory care in order to improve quality while at the same time increasing efficiency and saving costs. VitaBIT is promoted by the German federal ministry of economy and technology (BMWi. VitaBIT runs up to the end of 2009, partners of the project are CAS Software AG, PTV Planung Transport Verkehr AG, FZI Forschungszentrum Informatik, Sozial- und Diakoniestation Weinstadt e.V. und Wibu-Systems AG. VitaBIT aims to design an ICT platform for the safe application of mobile information services in ambulatory nursing. Communication and secure information exchange between all parties involved in the care process will also be guaranteed. The article explains the project’s current approach to develop a user-oriented solution by integrating already existing components and services.

  3. Critical care considerations in the management of the trauma patient following initial resuscitation

    Directory of Open Access Journals (Sweden)

    Shere-Wolfe Roger F

    2012-09-01

    Full Text Available Abstract Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.

  4. Home care nurses' experience of job stress and considerations for the work environment.

    Science.gov (United States)

    Samia, Linda W; Ellenbecker, Carol Hall; Friedman, Donna Haig; Dick, Karen

    2012-01-01

    Home care nurses report increased stress in their jobs due to work environment characteristics that impact professional practice. Stressors and characteristics of the professional practice environment that moderate nurses' experience of job stress were examined in this embedded multiple case study. Real life experiences within a complex environment were drawn from interviews and observations with 29 participants across two home care agencies from one eastern U.S. state. Findings suggest that role overload, role conflict, and lack of control can be moderated in agencies where there are meaningful opportunities for shared decision making and the nurse-patient relationship is supported.

  5. Asian and Pacific Islander Cultural Values: Considerations for Health Care Decision Making.

    Science.gov (United States)

    McLaughlin, Linda A.; Braun, Kathryn L.

    1998-01-01

    Some history on health-care decision making is reviewed. The current "individualist" model in the United States is contrasted with "collectivist" models of Asian and Pacific Islander cultures. Decision making styles are discussed in relationship to Western medicine. Six groups' cultural norms are presented. Conflicts with U.S.…

  6. Smartphone apps and the nutrition care process: Current perspectives and future considerations.

    Science.gov (United States)

    Chen, Juliana; Gemming, Luke; Hanning, Rhona; Allman-Farinelli, Margaret

    2018-04-01

    To provide dietitians with practical guidance on incorporating smartphone applications (apps) in the nutrition care process (NCP) to optimize patient education and counseling. The current evidence-base for mobile health (mHealth) apps was searched using PubMed and Google Scholar. Where and how apps could be implemented by dietitians across the four steps of the NCP is discussed. With functionality to automatically convert patient dietary records into nutrient components, nutrition assessment can be streamlined using nutrition apps, allowing more time for dietitians to deliver education and nutrition counseling. Dietitians could prescribe apps to provide patients with education on nutrition skills and in counseling for better adherence to behavior change. Improved patient-provider communication is also made possible through the opportunity for real-time monitoring and evaluation of patient progress via apps. A practical framework termed the 'Mobile Nutrition Care Process Grid' provides dietitians with best-practice guidance on how to use apps. Including apps into dietetic practice could enhance the efficiency and quality of nutrition care and counseling delivered by dietitians. Apps should be considered an adjunct to enable dietetic counseling and care, rather than to replace the expertise, social support and accountability provided by dietitians. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Mental health treatment associated with community-based depression screening: considerations for planning multidisciplinary collaborative care.

    Science.gov (United States)

    Winchester, Bruce R; Watkins, Sarah C; Brahm, Nancy C; Harrison, Donald L; Miller, Michael J

    2013-06-01

    Depression places a large economic burden on the US health care system. Routine screening has been recognized as a fundamental step in the effective treatment of depression, but should be undertaken only when support systems are available to ensure proper diagnosis, treatment, and follow-up. To estimate differences in prescribing new antidepressants and referral to stress management, psychotherapy, and other mental health (OMH) counseling at physician visits when documented depression screening was and was not performed. Cross-sectional physician visit data for adults from the 2005-2007 National Ambulatory Medical Care Survey were used. The final analytical sample included 55,143 visits, representing a national population estimate of 1,741,080,686 physician visits. Four dependent variables were considered: (1) order for new antidepressant(s), and referral to (2) stress management, (3) psycho therapy, or (4) OMH counseling. Bivariable and multivariable associations between depression screening and each measure of depression follow-up care were evaluated using the design-based F statistic and multivariable logistic regression models. New antidepressant prescribing increased significantly (2.12% of visits without depression screening vs 10.61% with depression screening resulted in a new prescription of an antidepressant). Referral to stress management was the behavioral treatment with the greatest absolute change (3.31% of visits without depression screening vs 33.10% of visits with depression screening resulted in a referral to stress management). After controlling for background sociodemographic characteristics, the adjusted odds ratio of a new antidepressant order remained significantly higher at visits involving depression screening (AOR 5.36; 99.9% CI 2.92-9.82), as did referrals for all behavioral health care services (ie, stress management, psychotherapy, and OMH counseling). At the national level, depression screening was associated with increased new

  8. Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study

    DEFF Research Database (Denmark)

    Sprung, C.L.; Woodcock, T.; Sjokvist, P.

    2008-01-01

    Objective: To evaluate physicians' reasoning, considerations and possible difficulties in end-of-life decision-making for patients in European intensive care units (ICUs). Design: A prospective observational study. Setting: Thirty-seven ICUs in 17 European countries. Patients and participants...... for, considerations in, and difficulties with end-of-life decision-making was germane in each case as it arose. Overall, 2,134 (69%) of the decisions were documented in the medical record, with inter-regional differences in documentation practice. Primary reasons given by physicians for the decision......: A total of 3,086 patients for whom an end-of-life decision was taken between January 1999 and June 2000. The dataset excludes patients who died after attempts at cardiopulmonary resuscitation and brain-dead patients. Measurements and results: Physicians indicated which of a pre-determined set of reasons...

  9. Theoretical and Practical Considerations for Combating Mental Illness Stigma in Health Care.

    Science.gov (United States)

    Ungar, Thomas; Knaak, Stephanie; Szeto, Andrew C H

    2016-04-01

    Reducing the stigma and discrimination associated with mental illness is becoming an increasingly important focus for research, policy, programming and intervention work. While it has been well established that the healthcare system is one of the key environments in which persons with mental illnesses experience stigma and discrimination there is little published literature on how to build and deliver successful anti-stigma programs in healthcare settings, towards healthcare providers in general, or towards specific types of practitioners. Our paper intends to address this gap by providing a set of theoretical considerations for guiding the design and implementation of anti-stigma interventions in healthcare.

  10. Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

    Science.gov (United States)

    Biddison, Lee Daugherty; Berkowitz, Kenneth A; Courtney, Brooke; De Jong, Col Marla J; Devereaux, Asha V; Kissoon, Niranjan; Roxland, Beth E; Sprung, Charles L; Dichter, Jeffrey R; Christian, Michael D; Powell, Tia

    2014-10-01

    Mass critical care entails time-sensitive decisions and changes in the standard of care that it is possible to deliver. These circumstances increase provider uncertainty as well as patients' vulnerability and may, therefore, jeopardize disciplined, ethical decision-making. Planning for pandemics and disasters should incorporate ethics guidance to support providers who may otherwise make ad hoc patient care decisions that overstep ethical boundaries. This article provides consensus-developed suggestions about ethical challenges in caring for the critically ill or injured during pandemics or disasters. The suggestions in this article are important for all of those involved in any pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. We adapted the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology to develop suggestions. Twenty-four key questions were developed, and literature searches were conducted to identify evidence for suggestions. The detailed literature reviews produced 144 articles. Based on their expertise within this domain, panel members also supplemented the literature search with governmental publications, interdisciplinary workgroup consensus documents, and other information not retrieved through PubMed. The literature in this field is not suitable to support evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. We report the suggestions that focus on five essential domains: triage and allocation, ethical concerns of patients and families, ethical responsibilities to providers, conduct of research, and international concerns. Ethics issues permeate virtually all aspects of pandemic and disaster response. We have addressed some of the most pressing issues, focusing on five essential domains: triage and allocation, ethical

  11. Athletes Doing Arabesques: Important Considerations in the Care of Young Dancers.

    Science.gov (United States)

    Wilson, Julie C; Quinn, Bridget J; Stratton, Corinne W; Southwick, Heather; MacDonald, James P

    2015-01-01

    Dance is as much a sport as an art form. Sports medicine clinicians seeing dancers in their practice will need to be familiar with the unique characteristics of dance in order to provide proper care. Dance encompasses different forms, which vary in equipment and terminology. The epidemiology of dance injuries has historically focused on ballet, but there is increasing research on other dance forms. Lower extremity and back injuries predominate. Injury prevention, both primary and secondary, is at the heart of dance medicine. Primary prevention includes preseason conditioning, identifying risk factors for injury, and recognizing the female athlete triad. Secondary prevention includes a comprehensive approach to injury rehabilitation, an appreciation for the unique demands of dance, and an understanding of the particulars of the injury being treated. Dancers may have difficulty accessing medical care or following prescribed advice; the proactive clinician will anticipate these situations.

  12. Methodological considerations for researching the financial costs of family caregiving within a palliative care context.

    Science.gov (United States)

    Gardiner, Clare; Allen, Ruth; Moeke-Maxwell, Tess; Robinson, Jackie; Gott, Merryn

    2016-12-01

    The financial impact of family caregiving in a palliative care context has been identified as an issue which requires further research. However, little is known about how research should be conducted in this area. The aim of this study was to explore the opinions of family caregivers in New Zealand regarding the need to conduct research relating to the financial costs of family caregiving and to explore their perspectives on acceptable and feasible methods of data collection. A qualitative study design was adopted. Semistructured interviews were conducted with 30 family caregivers who were either currently caring for a person with palliative care needs or had done so in the past year. All participants felt that research relating to the costs of family caregiving within a palliative care context was important. There was little consensus regarding the most appropriate methods of data collection and administration. Online methods were preferred by many participants, although face-to-face methods were particularly favoured by Ma¯ori participants. Both questionnaires and cost diaries were felt to have strengths and weaknesses. Prospective longitudinal designs are likely to be most appropriate for future research, in order to capture variations in costs over time. The lack of consensus for a single preferred method makes it difficult to formulate specific recommendations regarding methods of data collection; providing participants with options for methods of completion may therefore be appropriate. 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/.

  13. Ethical considerations in using Facebook for health care support: a case study using concussion management.

    Science.gov (United States)

    Ahmed, Osman Hassan; Sullivan, Stephen John; Schneiders, Anthony G; Anderson, Lynley; Paton, Chris; McCrory, Paul R

    2013-04-01

    Social networking sites (SNS) are now part of everyday life, and SNSs such as Facebook, YouTube, and Twitter are among the most accessed Web sites on the Internet. Although SNSs are primarily used for staying in touch with friends and family, they are increasingly being used for health-related purposes for a variety of conditions, including concussion awareness. As health interventions begin to be more commonly provided through SNSs (particularly Facebook), ethical issues have been raised with regard to confidentiality, privacy, and trust; these issues need to be addressed. This article outlines some of the key considerations when providing a concussion intervention through Facebook and discusses potential solutions to these issues. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  14. Consideration of social values in the establishment of accountable care organizations in the USA.

    Science.gov (United States)

    Keren, Ron; Littlejohns, Peter

    2012-01-01

    The purpose of this paper is to introduce the new US health organizations called accountable care organizations (ACOs) which are expected to improve the quality and reduce the cost of healthcare for Medicare enrolees. It assesses the importance of ACOs, defining and articulating the values that will underpin their strategic and clinical decision making. This paper uses a social values framework developed by Clark and Weale to consider the values relevant to ACOs. It is likely that social values could be made more explicit in a US setting than they have ever been before, via the new ACOs. Social values could start to form part of a local health economy's marketing strategy. ACOs are very new. This paper identifies that they will need to be very explicit about the values relevant to them. The development of ACOs and the articulation of social values therein may even form the basis of a meaningful dialogue on the importance of assessing value for money or cost-effectiveness in the wider US health policy environment.

  15. Time to death and the forecasting of macro-level health care expenditures: some further considerations.

    Science.gov (United States)

    van Baal, Pieter H; Wong, Albert

    2012-12-01

    Although the effect of time to death (TTD) on health care expenditures (HCE) has been investigated using individual level data, the most profound implications of TTD have been for the forecasting of macro-level HCE. Here we estimate the TTD model using macro-level data from the Netherlands consisting of mortality rates and age- and gender-specific per capita health expenditures for the years 1981-2007. Forecasts for the years 2008-2020 of this macro-level TTD model were compared to forecasts that excluded TTD. Results revealed that the effect of TTD on HCE in our macro model was similar to those found in micro-econometric studies. As the inclusion of TTD pushed growth rate estimates from unidentified causes upwards, however, the two models' forecasts of HCE for the 2008-2020 were similar. We argue that including TTD, if modeled correctly, does not lower forecasts of HCE. Copyright © 2012 Elsevier B.V. All rights reserved.

  16. "Futile Care"-An Emergency Medicine Approach: Ethical and Legal Considerations.

    Science.gov (United States)

    Simon, Jeremy R; Kraus, Chadd; Rosenberg, Mark; Wang, David H; Clayborne, Elizabeth P; Derse, Arthur R

    2017-11-01

    Futility often serves as a proposed reason for withholding or withdrawing medical treatment, even in the face of patient and family requests. Although there is substantial literature describing the meaning and use of futility, little of it is specific to emergency medicine. Furthermore, the literature does not provide a widely accepted definition of futility, and thus is difficult if not impossible to apply. Some argue that even a clear concept of futility would be inappropriate to use. This article will review the origins of and meanings suggested for futility, specific challenges such cases create in the emergency department (ED), and the relevant legal background. It will then propose an approach to cases of perceived futility that is applicable in the ED and does not rely on unilateral decisions to withhold treatment, but rather on avoiding and resolving the conflicts that lead to physicians' believing that patients are asking them to provide "futile" care. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  17. Interface design and human factors considerations for model-based tight glycemic control in critical care.

    Science.gov (United States)

    Ward, Logan; Steel, James; Le Compte, Aaron; Evans, Alicia; Tan, Chia-Siong; Penning, Sophie; Shaw, Geoffrey M; Desaive, Thomas; Chase, J Geoffrey

    2012-01-01

    Tight glycemic control (TGC) has shown benefits but has been difficult to implement. Model-based methods and computerized protocols offer the opportunity to improve TGC quality and compliance. This research presents an interface design to maximize compliance, minimize real and perceived clinical effort, and minimize error based on simple human factors and end user input. The graphical user interface (GUI) design is presented by construction based on a series of simple, short design criteria based on fundamental human factors engineering and includes the use of user feedback and focus groups comprising nursing staff at Christchurch Hospital. The overall design maximizes ease of use and minimizes (unnecessary) interaction and use. It is coupled to a protocol that allows nurse staff to select measurement intervals and thus self-manage workload. The overall GUI design is presented and requires only one data entry point per intervention cycle. The design and main interface are heavily focused on the nurse end users who are the predominant users, while additional detailed and longitudinal data, which are of interest to doctors guiding overall patient care, are available via tabs. This dichotomy of needs and interests based on the end user's immediate focus and goals shows how interfaces must adapt to offer different information to multiple types of users. The interface is designed to minimize real and perceived clinical effort, and ongoing pilot trials have reported high levels of acceptance. The overall design principles, approach, and testing methods are based on fundamental human factors principles designed to reduce user effort and error and are readily generalizable. © 2012 Diabetes Technology Society.

  18. Consideration of Intestinal Parasite in Day-Care Center Children in Karaj City in 2012

    Directory of Open Access Journals (Sweden)

    F. Haji Aliani

    2014-12-01

    totally of 904 samples were collected which 460 of them (50.9% were male and 444 (49.1% were female. The prevalence of intestinal parasite infection with formalin ether test was 16.7% and in Scotch tape test for Enterobius vermicularis was 2.3%. The most common protozoan was Blastocystis hominis in 84 children (9.3% and Giardia in 66 children (7.3%. Additionally, infection with Endolimax nana was reported in 3 children (0.3% and Entamoeba histolitica was reported in 4 children (0.4%. In this study there was a significant correlation between intestinal parasite and children’s age and also the way that vegetables were washed. Conclusion: According our results, the prevalence of intestinal parasites especially Giardia and Blastocystis in kindergartens of Karaj is high. This can be due to the lack of awareness of parents and children about the modes of transmission and Untreated infected persons and carriers that serve as carriers know. Health education to children, teachers and parents and six-month trial for child care staff and cure of infected people is effective in reducing the transmission of infection. Overall, poor personal hygiene, transmission of infection from mother to children and from child to other children are effective in persistence of the disease. Therefore high education of children, caregivers and parents and effective treatment of infected people are keys to reduce the rate of infection and transmission.

  19. Is cardiac surgery warranted in children with Down syndrome? A ...

    African Journals Online (AJOL)

    Objectives. To compare children with Down syndrome and children without Down syndrome and investigate whether there is a significant difference in the burden that is placed on the health care system between these two groups only in respect of the repair of congenital heart disease at Red Cross War Memorial Children's ...

  20. Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: a national survey of the considerations and beliefs of GPs, ID physicians and care staff.

    NARCIS (Netherlands)

    Bekkema, N.; Veer, A.J.E. de; Wagemans, A.M.A.; Hertogh, C.M.P.M.; Francke, A.L.

    2014-01-01

    Objective: This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID). Methods: A survey questionnaire covering decision making

  1. Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: A national survey of the considerations and beliefs of GPs, ID physicians and care staff

    NARCIS (Netherlands)

    Bekkema, N.; de Veer, A.J.E.; Wagemans, A.M.A.; Hertogh, C.M.P.M.; Francke, A.L.

    2014-01-01

    Objective: This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID). Methods: A survey questionnaire covering decision making

  2. Diagnosing true virtue? Remote scenarios, warranted virtue attributions, and virtuous medical practice.

    Science.gov (United States)

    Oakley, Justin

    2016-02-01

    Immanuel Kant argues in the Foundations that remote scenarios are diagnostic of genuine virtue. When agents commonly thought to have a particular virtue fail to exhibit that virtue in an extreme situation, he argues, they do not truly have the virtue at all, and our propensities to fail in such ways indicate that true virtue might never have existed. Kant's suggestion that failure to show, say, courage in extraordinary circumstances necessarily silences one's claim to have genuine courage seems to rely on an implausibly demanding standard for warranted virtue attributions. In contrast to this approach, some philosophers-such as Robert Adams and John Doris-have argued for probabilistic accounts of warranted virtue attributions. But despite the initial plausibility of such accounts, I argue that a sole reliance on probabilistic approaches is inadequate, as they are insufficiently sensitive to considerations of credit and fault, which emerge when agents have developed various insurance strategies and protective capacities against their responding poorly to particular eventualities. I also argue that medical graduates should develop the sorts of virtuous dispositions necessary to protect patient welfare against various countervailing influences (even where such influences might be encountered only rarely), and that repeated failures to uphold the proper goals of medicine in emergency scenarios might indeed be diagnostic of whether an individual practitioner does have the relevant medical virtue. In closing, I consider the dispositions involved in friendship. I seek to develop a principled way of determining when remote scenarios can be illuminating of genuine friendship and genuine virtue.

  3. Black-Scholes finite difference modeling in forecasting of call warrant prices in Bursa Malaysia

    Science.gov (United States)

    Mansor, Nur Jariah; Jaffar, Maheran Mohd

    2014-07-01

    Call warrant is a type of structured warrant in Bursa Malaysia. It gives the holder the right to buy the underlying share at a specified price within a limited period of time. The issuer of the structured warrants usually uses European style to exercise the call warrant on the maturity date. Warrant is very similar to an option. Usually, practitioners of the financial field use Black-Scholes model to value the option. The Black-Scholes equation is hard to solve analytically. Therefore the finite difference approach is applied to approximate the value of the call warrant prices. The central in time and central in space scheme is produced to approximate the value of the call warrant prices. It allows the warrant holder to forecast the value of the call warrant prices before the expiry date.

  4. Adaptation of warrant price with Black Scholes model and historical volatility

    Science.gov (United States)

    Aziz, Khairu Azlan Abd; Idris, Mohd Fazril Izhar Mohd; Saian, Rizauddin; Daud, Wan Suhana Wan

    2015-05-01

    This project discusses about pricing warrant in Malaysia. The Black Scholes model with non-dividend approach and linear interpolation technique was applied in pricing the call warrant. Three call warrants that are listed in Bursa Malaysia were selected randomly from UiTM's datastream. The finding claims that the volatility for each call warrants are different to each other. We have used the historical volatility which will describes the price movement by which an underlying share is expected to fluctuate within a period. The Black Scholes model price that was obtained by the model will be compared with the actual market price. Mispricing the call warrants will contribute to under or over valuation price. Other variables like interest rate, time to maturity date, exercise price and underlying stock price are involves in pricing call warrants as well as measuring the moneyness of call warrants.

  5. Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster

    NARCIS (Netherlands)

    Hick, John L.; Christian, Michael D.; Sprung, Charles L.; Camargo, Ruben; Ceraso, Daniel; Azoulay, Elie; Duguet, Alexandre; Guery, Benoit; Reinhart, Konrad; Adini, Bruria; Barlavie, Yaron; Benin-Goren, Odeda; Cohen, Robert; Klein, Motti; Leoniv, Yuval; Margalit, Gila; Rubinovitch, Bina; Sonnenblick, Moshe; Steinberg, Avraham; Weissman, Charles; Wolff, Donna; Kesecioglu, Jozef; de Jong, Menno; Moreno, Rui; An, Youzhong; Du, Bin; Joynt, Gavin M.; Colvin, John; Loo, Shi; Richards, Guy; Artigas, Antonio; Pugin, Jerome; Amundson, Dennis; Devereaux, Asha; Beigel, John; Danis, Marion; Farmer, Chris; Maki, Dennis; Masur, Henry; Rubinson, Lewis; Sandrock, Christian; Talmor, Daniel; Truog, Robert; Zimmerman, Janice; Brett, Steve; Montgomery, Hugh; Rhodes, Andrew; Sanderson, Frances; Taylor, Bruce; Monrgomery, Hugh

    2010-01-01

    To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for a mass disaster or influenza epidemic with a specific focus on surge capacity and infrastructure considerations. Based on a literature review and expert opinion, a Delphi process

  6. Methodological considerations for a randomised controlled trial of podiatry care in rheumatoid arthritis: lessons from an exploratory trial

    OpenAIRE

    Turner, Deborah E; Helliwell, Philip S; Woodburn, James

    2007-01-01

    Abstract Background Whilst evidence exists to support the use of single treatments such as orthoses and footwear, the effectiveness of podiatry-led care as a complex intervention for patients with rheumatoid arthritis (RA) related foot problems is unknown. The aim of this study was to undertake an exploratory randomised controlled parallel arm clinical trial (RheumAFooT) to inform the design and implementation of a definitive trial and to understand the potential benefits of this care. Method...

  7. EU Citizenship and European Arrest Warrant: The Same Rights for All?

    NARCIS (Netherlands)

    Marguery, T.P.

    2011-01-01

    In the case Wolzenburg, the principle of non-discrimination of European Union citizens is applied to the European arrest warrant. The implementation of the European arrest warrant by the Member States cannot escape a control of proportional- ity made by the Court. Member States may impose a period

  8. 8 CFR 287.3 - Disposition of cases of aliens arrested without warrant.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Disposition of cases of aliens arrested without warrant. 287.3 Section 287.3 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS FIELD OFFICERS; POWERS AND DUTIES § 287.3 Disposition of cases of aliens arrested without warrant...

  9. 8 CFR 287.9 - Criminal search warrant and firearms policies.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Criminal search warrant and firearms policies. 287.9 Section 287.9 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS FIELD OFFICERS; POWERS AND DUTIES § 287.9 Criminal search warrant and firearms policies. (a) A...

  10. Behavioral Preferences for Individual Securities : The Case for Call Warrants and Call Options

    NARCIS (Netherlands)

    Ter Horst, J.R.; Veld, C.H.

    2002-01-01

    Since 1998, large investment banks have flooded the European capital markets with issues of call warrants.This has led to a unique situation in the Netherlands, where now call warrants, traded on the stock exchange, and long-term call options, traded on the options exchange, exist.Both entitle their

  11. Homotopy Analysis Method for Boundary-Value Problem of Turbo Warrant Pricing under Stochastic Volatility

    Directory of Open Access Journals (Sweden)

    Hoi Ying Wong

    2013-01-01

    Full Text Available Turbo warrants are liquidly traded financial derivative securities in over-the-counter and exchange markets in Asia and Europe. The structure of turbo warrants is similar to barrier options, but a lookback rebate will be paid if the barrier is crossed by the underlying asset price. Therefore, the turbo warrant price satisfies a partial differential equation (PDE with a boundary condition that depends on another boundary-value problem (BVP of PDE. Due to the highly complicated structure of turbo warrants, their valuation presents a challenging problem in the field of financial mathematics. This paper applies the homotopy analysis method to construct an analytic pricing formula for turbo warrants under stochastic volatility in a PDE framework.

  12. Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

    Science.gov (United States)

    Hick, John L; Christian, Michael D; Sprung, Charles L

    2010-04-01

    To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for a mass disaster or influenza epidemic with a specific focus on surge capacity and infrastructure considerations. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including surge capacity and infrastructure considerations. Key recommendations include: (1) hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas; (2) hospitals should have appropriate beds and monitors for these expansion areas; hospitals should develop contingency plans at the facility and government (local, state, provincial, national) levels to provide additional ventilators; (3) hospitals should develop a phased staffing plan (nursing and physician) for ICUs that provides sufficient patient care supervision during contingency and crisis situations; (4) hospitals should provide expert input to the emergency management personnel at the hospital both during planning for surge capacity as well as during response; (5) hospitals should assure that adequate infrastructure support is present to support critical care activities; (6) hospitals should prioritize locations for expansion by expanding existing ICUs, using postanesthesia care units and emergency departments to capacity, then step-down units, large procedure suites, telemetry units and finally hospital wards. Judicious planning and adoption of protocols for surge capacity and infrastructure considerations are necessary to optimize outcomes during a pandemic.

  13. Person-Centered Care Practices in Long-Term Care in the Deep South: Consideration of Structural, Market, and Administrator Characteristics.

    Science.gov (United States)

    Jacobs, M Lindsey; Snow, A Lynn; Parmelee, Patricia A; Davis, Jullet A

    2018-03-01

    The purpose of this study was to identify structural, market, and administrator factors of nursing homes that are related to the implementation of person-centered care. Administrators of Medicare/Medicaid-certified nursing homes in the Deep South were invited to complete a standardized survey about their facility and their perceptions and attitudes regarding person-centered care practices (PCCPs). Nursing home structural and market factors were obtained from public websites, and these data were matched with administrator data. Consistent with the resource-based theory of competitive advantage, nursing homes with greater resources and more competition were more likely to implement PCCPs. Implementation of person-centered care was also higher in nursing homes with administrators who perceived culture change implementation to be feasible in their facilities. Given that there is a link between resource availability and adoption of person-centered care, future research should investigate the cost of such innovations.

  14. A Competency-Based Approach to Teaching Professional Self-Care: An Ethical Consideration for Social Work Educators

    Science.gov (United States)

    Newell, Jason M.; Nelson-Gardell, Debra

    2014-01-01

    Incorporating material on professional self-care into social work course content is valuable to the education of neophyte social work practitioners. This article presents a review of the literature on professional burnout, secondary traumatic stress, and compassion fatigue, including the risk factors associated with the experience of these…

  15. Family members' involvement in elder care provision in nursing homes and their considerations about financial compensation: a qualitative study.

    Science.gov (United States)

    Habjanič, Ana; Pajnkihar, Majda

    2013-01-01

    The aim of this study was to establish how family members are involved in elder care provision in nursing homes; this included research into their feelings about potentially extending their involvement to obtain financial benefits as compensation for high accommodation costs. Family members remain involved in the caring process after their relatives have been admitted to an institution. On average, accommodation costs in nursing homes in Slovenia have risen above the residents' retirement pension, and families must supplement the difference. Because of this, familial involvement should be linked to reduced accommodation costs. This research employed a non-experimental, descriptive study design through unstructured interviews. Participants included fifty family members (n=50) who visit their relatives in nursing homes. Data were collected in 2010 at five nursing homes in Slovenia and processed by means of conventional content analysis. The major themes that emerged from the content analysis, describing family involvement, were as follows: visiting and making oneself useful, delivery of items for personal use, hands-on care, physical therapy and organization of nursing home activities. Family members showed some interest in receiving financial compensation for their involvement. The proposed financial compensation may be a delicate and morally questionable matter but would involve fairness and transparency, while enabling easier organization of elder care provision. Eventually, nursing home residents' well-being could be improved. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. 38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.

    Science.gov (United States)

    2010-07-01

    ... Secretary may require, such as a power of attorney and assignment. Notice of this assignment will be mailed... Veterans Affairs health care facility solely because of their alcohol or drug abuse or dependency or... discriminate solely on the basis of alcohol, drug abuse or infection with human immunodeficiency virus. Quality...

  17. Methodological considerations for a randomised controlled trial of podiatry care in rheumatoid arthritis: lessons from an exploratory trial

    Directory of Open Access Journals (Sweden)

    Helliwell Philip S

    2007-11-01

    Full Text Available Abstract Background Whilst evidence exists to support the use of single treatments such as orthoses and footwear, the effectiveness of podiatry-led care as a complex intervention for patients with rheumatoid arthritis (RA related foot problems is unknown. The aim of this study was to undertake an exploratory randomised controlled parallel arm clinical trial (RheumAFooT to inform the design and implementation of a definitive trial and to understand the potential benefits of this care. Methods Patients with a definite diagnosis of RA, stable drug management 3 months prior to entry, and a current history of foot problems (pain, deformity, stiffness, skin or nail lesions, or footwear problems were recruited from a hospital outpatient rheumatology clinic and randomised to receive 12 months of podiatry treatment or no care. The primary outcome was change in foot health status using the impairment/footwear (LFISIF and activity limitation/participation restriction (LFISAP subscales of the Leeds Foot Impact Scale. Disease Activity Score (DAS, Health Assessment Questionnaire (HAQ score and walking speed (m/s were also recorded. Results Of the 80 patients identified, 64 patients were eligible to participate in the pilot and 34 were recruited. 16 patients were randomised to receive podiatry led foot care and 18 received no care. Against a backdrop of stable disease (DAS and HAQ scores, there was a statistically significant between group difference in the change in foot health status for foot impairment (LFISIF but not activity/participation (LFISAP or function (walking speed over 12 months. In the podiatry arm, 1 patient declined treatment following randomisation (did not want additional hospital visits and 3 self-withdrew (lost to follow-up. Patients received an average of 3 consultations for assessment and treatment comprising routine care for skin and nail lesions (n = 3, foot orthoses (n = 9, footwear referral to the orthotist (n = 5, and ultrasound

  18. Methodological considerations for a randomised controlled trial of podiatry care in rheumatoid arthritis: lessons from an exploratory trial.

    Science.gov (United States)

    Turner, Deborah E; Helliwell, Philip S; Woodburn, James

    2007-11-06

    Whilst evidence exists to support the use of single treatments such as orthoses and footwear, the effectiveness of podiatry-led care as a complex intervention for patients with rheumatoid arthritis (RA) related foot problems is unknown. The aim of this study was to undertake an exploratory randomised controlled parallel arm clinical trial (RheumAFooT) to inform the design and implementation of a definitive trial and to understand the potential benefits of this care. Patients with a definite diagnosis of RA, stable drug management 3 months prior to entry, and a current history of foot problems (pain, deformity, stiffness, skin or nail lesions, or footwear problems) were recruited from a hospital outpatient rheumatology clinic and randomised to receive 12 months of podiatry treatment or no care. The primary outcome was change in foot health status using the impairment/footwear (LFISIF) and activity limitation/participation restriction (LFISAP) subscales of the Leeds Foot Impact Scale. Disease Activity Score (DAS), Health Assessment Questionnaire (HAQ) score and walking speed (m/s) were also recorded. Of the 80 patients identified, 64 patients were eligible to participate in the pilot and 34 were recruited. 16 patients were randomised to receive podiatry led foot care and 18 received no care. Against a backdrop of stable disease (DAS and HAQ scores), there was a statistically significant between group difference in the change in foot health status for foot impairment (LFISIF) but not activity/participation (LFISAP) or function (walking speed) over 12 months. In the podiatry arm, 1 patient declined treatment following randomisation (did not want additional hospital visits) and 3 self-withdrew (lost to follow-up). Patients received an average of 3 consultations for assessment and treatment comprising routine care for skin and nail lesions (n = 3), foot orthoses (n = 9), footwear referral to the orthotist (n = 5), and ultrasound guided intra-articular steroid injection

  19. Ensuring due process in the IACUC and animal welfare setting: considerations in developing noncompliance policies and procedures for institutional animal care and use committees and institutional officials.

    Science.gov (United States)

    Hansen, Barbara C; Gografe, Sylvia; Pritt, Stacy; Jen, Kai-Lin Catherine; McWhirter, Camille A; Barman, Susan M; Comuzzie, Anthony; Greene, Molly; McNulty, Justin A; Michele, Daniel Eugene; Moaddab, Naz; Nelson, Randall J; Norris, Karen; Uray, Karen D; Banks, Ron; Westlund, Karin N; Yates, Bill J; Silverman, Jerald; Hansen, Kenneth D; Redman, Barbara

    2017-10-01

    Every institution that is involved in research with animals is expected to have in place policies and procedures for the management of allegations of noncompliance with the Animal Welfare Act and the U.S. Public Health Service Policy on the Humane Care and Use of Laboratory Animals. We present here a model set of recommendations for institutional animal care and use committees and institutional officials to ensure appropriate consideration of allegations of noncompliance with federal Animal Welfare Act regulations that carry a significant risk or specific threat to animal welfare. This guidance has 3 overarching aims: 1 ) protecting the welfare of research animals; 2 ) according fair treatment and due process to an individual accused of noncompliance; and 3 ) ensuring compliance with federal regulations. Through this guidance, the present work seeks to advance the cause of scientific integrity, animal welfare, and the public trust while recognizing and supporting the critical importance of animal research for the betterment of the health of both humans and animals.-Hansen, B. C., Gografe, S., Pritt, S., Jen, K.-L. C., McWhirter, C. A., Barman, S. M., Comuzzie, A., Greene, M., McNulty, J. A., Michele, D. E., Moaddab, N., Nelson, R. J., Norris, K., Uray, K. D., Banks, R., Westlund, K. N., Yates, B. J., Silverman, J., Hansen, K. D., Redman, B. Ensuring due process in the IACUC and animal welfare setting: considerations in developing noncompliance policies and procedures for institutional animal care and use committees and institutional officials. © FASEB.

  20. Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions.

    Science.gov (United States)

    Laskowski-Jones, Linda; Caudell, Michael J; Hawkins, Seth C; Jones, Lawrence J; Dymond, Chelsea A; Cushing, Tracy; Gupta, Sanjey; Young, David S; Starling, Jennifer M; Bounds, Richard

    2017-10-01

    Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Right-­turn traffic volume adjustment in traffic signal warrant analysis : final report.

    Science.gov (United States)

    2016-05-06

    This report was based on the research project, Right-Turn Traffic Volume Adjustment in Traffic Signal Warrants, sponsored by the Nevada Department of Transportation (NDOT) and SOLARIS. Right-turn traffic does not affect intersection performance in th...

  2. Right-\\0xADturn traffic volume adjustment in traffic signal warrant analysis : final report.

    Science.gov (United States)

    2016-05-06

    This report was based on the research project, Right-Turn Traffic Volume Adjustment in : Traffic Signal Warrants, sponsored by the Nevada Department of Transportation (NDOT) : and SOLARIS. Right-turn traffic does not affect intersection performance i...

  3. From Four to Two: Transformation of the Army Ordnance Officer and Warrant Officer Corps

    National Research Council Canada - National Science Library

    Napier, Joyce

    2003-01-01

    .... This study will examine how senior leaders within the Army and specifically the Ordnance Corps must change the officer and warrant officer force structure education system and leader development...

  4. Child sexual abuse as an etiological factor of overweight and eating disorders - considerations for primary health care providers.

    Science.gov (United States)

    Opydo-Szymaczek, Justyna; Jarząbek-Bielecka, Grażyna; Kędzia, Witold; Borysewicz-Lewicka, Maria

    2018-01-01

    Despite the recognition of the clinical importance of child sexual abuse, primary health care providers are often not ad-equately prepared to perform medical evaluations and diagnose child sexual maltreatment. Paper presents basic symptoms and signs of CSA, which may suggest the need for further patient's diagnosis and referral. Since the great majority of sexually abused children do not have any abnormal physical findings, special attention is paid to the silent warning signs of CSA, such as changes in attitude towards own body and eating habits. Numerous studies suggest that victims of CSA may develop obesity or eating disorders of various forms and intensities.

  5. Emergency caesarean delivery in a patient with cerebral malaria-leptospira co infection: Anaesthetic and critical care considerations

    Directory of Open Access Journals (Sweden)

    Sukhen Samanta

    2014-01-01

    Full Text Available Malaria-leptospira co-infection is rarely detected. Emergency surgery in such patients has not been reported. We describe such a case of a 24-year-old primigravida at term pregnancy posted for emergency caesarean delivery who developed pulmonary haemorrhage, acute respiratory distress syndrome, acute kidney injury, and cerebral oedema. Here, we discuss the perioperative management, pain management (with transverse abdominis plane block, intensive care management (special reference to management of pulmonary haemorrhage with intra pulmonary factor VIIa and the role of plasmapheresis in leptospira related jaundice with renal failure.

  6. Building the Partners HealthCare Biobank at Partners Personalized Medicine: Informed Consent, Return of Research Results, Recruitment Lessons and Operational Considerations

    Directory of Open Access Journals (Sweden)

    Elizabeth W. Karlson

    2016-01-01

    Full Text Available The Partners HealthCare Biobank is a Partners HealthCare enterprise-wide initiative whose goal is to provide a foundation for the next generation of translational research studies of genotype, environment, gene-environment interaction, biomarker and family history associations with disease phenotypes. The Biobank has leveraged in-person and electronic recruitment methods to enroll >30,000 subjects as of October 2015 at two academic medical centers in Partners HealthCare since launching in 2010. Through a close collaboration with the Partners Human Research Committee, the Biobank has developed a comprehensive informed consent process that addresses key patient concerns, including privacy and the return of research results. Lessons learned include the need for careful consideration of ethical issues, attention to the educational content of electronic media, the importance of patient authentication in electronic informed consent, the need for highly secure IT infrastructure and management of communications and the importance of flexible recruitment modalities and processes dependent on the clinical setting for recruitment.

  7. Human factors considerations in designing for infection prevention and control in neonatal care - findings from a pre-design inquiry.

    Science.gov (United States)

    Trudel, Chantal; Cobb, Sue; Momtahan, Kathryn; Brintnell, Janet; Mitchell, Ann

    2018-01-01

    Qualitative data collection methods drawn from the early stages of human-centred design frameworks combined with thematic analysis were used to develop an understanding of infection prevention practice within an existing neonatal intensive care unit. Findings were used to generate a framework of understanding which in turn helped inform a baseline approach for future research and design development. The study revealed that a lack of clarity between infection transmission zones and a lack of design attributes needed to uphold infection prevention measures may be undermining healthcare workers' understanding and application of good practice. The issue may be further complicated by well-intentioned behavioural attitudes to meeting work objectives; undue influences from spatial constraints; the influence of inadvertent and excessive touch-based interactions; physical and/or cognitive exertion to maintain transmission barriers; and the impact of expanding job design and increased workload to supplement for lack of effective barriers. Practitioner Summary: Despite high hand hygiene compliance within a neonatal intensive care unit, healthcare workers expressed concerns about the unit design and infection prevention practice. Early inquiry methods from human-centred design and thematic analysis helped develop a framework to understand how design can be used to aid infection prevention.

  8. Theoretical and Practical Considerations Regarding the Child’s Right to a Family Environment and to Alternative Care

    Directory of Open Access Journals (Sweden)

    Aurelian Gherghe

    2009-06-01

    Full Text Available The underage child's protection is mainly and habitually done by the parents. The exercise of rights and the fulfilment of the parental duties must have in mind the superior interest of the child and ensure the child's material and spiritual well being, especially by taking care of him/her, by maintaining personal relations with him/her, by ensuring his/her raising, education and maintenance, as well as by his/her regal representation and by the management of his/her patrimony. In this sense, art. 5 paragraph (2 of Law no. 272/2004 stipulates that the responsibility for the bringing up and insurance of the child development devolves mainly upon the parents, who must exert their rights and fulfil their obligations towards the child, taking into account, first of all, his/her highest interest.

  9. Econometric modeling of health care costs and expenditures: a survey of analytical issues and related policy considerations.

    Science.gov (United States)

    Mullahy, John

    2009-07-01

    Econometric modeling of healthcare costs and expenditures has become an important component of decision-making across a wide array of real-world settings. The objective of this article is to provide a brief summary of important conceptual and analytical issues involved in econometric healthcare cost modeling. To this end, the article explores: outcome measures typically analyzed in such work; the decision maker's perspective in econometric cost modeling exercises; specific analytical issues in econometric model specification; statistical goodness-of-fit testing; empirical implications of "upper tail" (or "high cost") phenomena; and issues relating to the reporting of findings. Some of the concepts explored here are illustrated in light of samples drawn from the 2005 Medical Expenditure Panel Survey and the 2005 Nationwide Inpatient Sample. Analysts of healthcare cost data have at their disposal an increasingly sophisticated tool kit for analyzing such data that can in principle and in fact yield increasingly interesting insights into data structures. Yet for such analyses to usefully inform policy decisions, the manner in which such studies are designed, undertaken, and reported must accommodate considerations relevant to the decision-making community. The article concludes with some preliminary thoughts on how such bridges might be constructed.

  10. Medical Care in a Free Clinic: A Comprehensive Evaluation of Patient Experience, Incentives, and Barriers to Optimal Medical Care with Consideration of a Facility Fee.

    Science.gov (United States)

    Birs, Antoinette; Liu, Xinwei; Nash, Bee; Sullivan, Sara; Garris, Stephanie; Hardy, Marvin; Lee, Michael; Simms-Cendan, Judith; Pasarica, Magdalena

    2016-02-19

    Free and charitable clinics are important contributors to the health of the United States population. Recently, funding for these clinics has been declining, and it is, therefore, useful to identify what qualities patients value the most in clinics in an effort to allocate funding wisely. In order to identify targets and incentives for improvement of patients' health, we performed a comprehensive analysis of patients' experience at a free clinic by analyzing a patient survey (N=94). The survey also assessed patient opinions of a small facility fee, which could be used to offset the decrease in funds. Interestingly, our patients believed it is appropriate to be charged a facility fee (78%) because it increases involvement in their care (r = 0.69, p fee. Barriers include affordable housing, transportation, medication, and accessible information. In order to improve medical care in the uninsured population, our study suggested that we need to: 1) offer continuity of medical care; 2) offer affordable preventive health screenings; 3) support affordable transportation, housing, and medications; and 4) consider including a facility fee.

  11. Screening for psychological distress in adult primary brain tumor patients and caregivers: considerations for cancer care coordination

    Directory of Open Access Journals (Sweden)

    Wafa eTrad

    2015-09-01

    Full Text Available IntroductionThis study aimed to assess psychological distress (PD as scored by the Distress Thermometer (DT in adult primary brain tumor (PBT patients and caregivers in a clinic setting, and ascertain if any high risk sub-groups for PD exist. Material and MethodsFrom May 2012 to August 2013, n=96 patients and n=32 caregivers (CG underwent DT screening at diagnosis, and a differing cohort of n=12 patients and n=14 caregivers at first recurrence. Groups were described by diagnosis (high grade, low grade and benign, and English versus non-English speaking. Those with DT score≥4 met caseness criteria for referral to psycho-oncology services. One-way ANOVA tests were conducted to test for between group differences where appropriate.ResultsAt diagnosis and first recurrence, 37.5% and 75.0% (respectively of patients had DT scores above the cut-off for distress. At diagnosis, 78.1% of caregivers met caseness criteria for distress. All caregivers at recurrence met distress criterion. Patients with high grade glioma had significantly higher scores than those with a benign tumor. For patients at diagnosis, non-English speaking participants did not report significantly higher DT scores than English speaking participants.DiscussionPsychological distress is particularly elevated in caregivers, and in patients with high grade glioma at diagnosis. Effective PD screening, triage and referral by skilled care coordinators is vital to enable timely needs assessment, psychological support and effective intervention.

  12. Commentary Considerations for Recommending Extended Use and Limited Reuse of Filtering Facepiece Respirators in Health Care Settings

    Science.gov (United States)

    Fisher, Edward M.; Shaffer, Ronald E.

    2015-01-01

    Public health organizations, such as the Centers for Disease Control and Prevention (CDC), are increasingly recommending the use of N95 filtering facepiece respirators (FFRs) in health care settings. For infection control purposes, the usual practice is to discard FFRs after close contact with a patient (“single use”). However, in some situations, such as during contact with tuberculosis patients, limited FFR reuse (i.e., repeated donning and doffing of the same FFR by the same person) is practiced. A related practice, extended use, involves wearing the same FFR for multiple patient encounters without doffing. Extended use and limited FFR reuse have been recommended during infectious disease outbreaks and pandemics to conserve FFR supplies. This commentary examines CDC recommendations related to FFR extended use and limited reuse and analyzes available data from the literature to provide a relative estimate of the risks of these practices compared to single use. Analysis of the available data and the use of disease transmission models indicate that decisions regarding whether FFR extended use or reuse should be recommended should continue to be pathogen- and event-specific. Factors to be included in developing the recommendations are the potential for the pathogen to spread via contact transmission, the potential that the event could result in or is currently causing a FFR shortage, the protection provided by FFR use, human factors, potential for self-inoculation, the potential for secondary exposures, and government policies and regulations. While recent findings largely support the previous recommendations for extended use and limited reuse in certain situations, some new cautions and limitations should be considered before issuing recommendations in the future. In general, extended use of FFRs is preferred over limited FFR reuse. Limited FFR reuse would allow the user a brief respite from extended wear times, but increases the risk of self-inoculation and

  13. Predictive factors warrant screening for obstructive sleep apnea in COPD: a Taiwan National Survey

    Directory of Open Access Journals (Sweden)

    Hang LW

    2016-03-01

    Full Text Available Liang-Wen Hang,1,2 Jeng-Yuan Hsu,3 Chee-Jen Chang,4 Hao-Chien Wang,5,6 Shih-Lung Cheng,7,8 Ching-Hsiung Lin,9 Ming-Cheng Chan,3 Chin-Chou Wang,10 Diahn-Warng Perng,11 Chong-Jen Yu5,6 On behalf of the Taiwan COPD Consortium 1Department of Respiratory Therapy, College of Health Care, China Medical University, 2Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, 3Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 4Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Linkou Branch, Guishan Township, Taoyuan County, 5Department of Internal Medicine, National Taiwan University Hospital, 6Department of Internal Medicine, National Taiwan University, College of Medicine, Taipei, 7Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, 8Department of Chemical Engineering and Materials Science, Yuan Ze University, Chung-Li City, Taoyuan County, 9Division of Chest Medicine, Changhua Christian Hospital, Changhua City, Changhua County, 10Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 11Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China Background and objectives: COPD and obstructive sleep apnea (OSA share similar pathological processes and cardiovascular sequelae. Coexisting OSA in COPD – “overlap syndrome” – has worse prognosis than either condition alone, and appropriate treatment improves survival. Our objectives were to ascertain the frequency at which COPD coexists with the risk of OSA in Taiwan and to compare the risk factors, COPD symptoms, and life quality metrics between COPD subgroups with versus without risk of OSA. Methods: We conducted a random cross-sectional national telephone survey of adults >40 years old in Taiwan. Participants fulfilling an epidemiological case definition of COPD completed a

  14. Intraday Trading Patterns in the Equity Warrants and Equity Options Markets: Australian Evidence

    Directory of Open Access Journals (Sweden)

    Lydia Segara

    2007-06-01

    Full Text Available This paper extends the microstructure literature, by examining the previouslyundocumented intraday trading patterns in trading volume, price volatility, order depthand relative spreads for both the warrant and option market in Australia. Comparisons ofintraday variations across these derivative securities allows for insight to be drawn intocompeting market microstructure theories and provides the opportunity to examinewhether market design differences explain variations in observed intraday patterns. Wefind that intraday trading patterns documented in the warrant and option markets can beexplained by their market designs, along with theories relating to time-varying informationasymmetry and time-varying hedging trades around nontrading periods.

  15. Management of infections in critically ill returning travellers in the intensive care unit—II: clinical syndromes and special considerations in immunocompromised patients

    Directory of Open Access Journals (Sweden)

    Jordi Rello

    2016-07-01

    Full Text Available This position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians with a standardized approach to the management of serious travel-related infections in the intensive care unit (ICU or the emergency department. This document is a cooperative effort between members of two European Society of Clinical Microbiology and Infectious Diseases (ESCMID study groups and was coordinated by Hakan Leblebicioglu and Jordi Rello for ESGITM (ESCMID Study Group for Infections in Travellers and Migrants and ESGCIP (ESCMID Study Group for Infections in Critically Ill Patients, respectively. A relevant expert on the subject of each section prepared the first draft which was then edited and approved by additional members from both ESCMID study groups. This article summarizes considerations regarding clinical syndromes requiring ICU admission in travellers, covering immunocompromised patients.

  16. Show me the goods: The warranting effect of user-generated photographs in online auctions

    NARCIS (Netherlands)

    Johnson, B.K.; Vang, M.H.; van der Heide, B.

    2015-01-01

    Consumers using online auction websites face the challenge of appraising products at a distance. Sellers and buyers in online auctions navigate this challenge by displaying and evaluating various cues, a critical one being use of photographs. Warranting theory predicts that cues less subject to

  17. ACCOUNTING FOR CONTINGENT CONSIDERATIONS IN BUSINESS COMBINATIONS

    OpenAIRE

    Gurgen KALASHYAN

    2017-01-01

    According to IFRS 3 Business Combinations contingent considerations must be included in the total consideration given for the acquired entity along with cash, other assets, ordinary or preference equity instruments, options, warrants. The contingent consideration is the determined amount which acquiring entity has to pay to acquired entity provided, that certain conditions will be fulfilled in the future. In case the provisions are not satisfied, we will get the situation when the amount of c...

  18. A review on Black-Scholes model in pricing warrants in Bursa Malaysia

    Science.gov (United States)

    Gunawan, Nur Izzaty Ilmiah Indra; Ibrahim, Siti Nur Iqmal; Rahim, Norhuda Abdul

    2017-01-01

    This paper studies the accuracy of the Black-Scholes (BS) model and the dilution-adjusted Black-Scholes (DABS) model to pricing some warrants traded in the Malaysian market. Mean Absolute Error (MAE) and Mean Absolute Percentage Error (MAPE) are used to compare the two models. Results show that the DABS model is more accurate than the BS model for the selected data.

  19. Execution of the European Arrest Warrant by the Romanian Judicial Authorities

    Directory of Open Access Journals (Sweden)

    Ion Rusu

    2009-06-01

    Full Text Available The unprecedented development of criminality at the social and economical levels, the tendency toglobalize some categories of crimes, of maximum gravity, as terrorism, armament traffic, drug traffic orhuman traffic, have determined the world states to undertake specific measures to prevent, combat and finallyreduce it. The first and most important measure taken by the Europe’s Council, regarding the intensificationof judicial cooperation in criminal matters was the adoption of the European Convention on extradition, inParis on 13 December 1957, completed by the two Additional Protocols in Strasbourg, on 15 October 1975and 17 March 1978. In this context, the release of the Council’s Framework Decision on 13 June 2002 on theEuropean arrest warrant and the procedures of delivery among the member states (2002/584/JAI representeda natural decision, with the purpose of contributing at ensuring a free, secure and just European space. TheEuropean arrest warrant is a judicial decision through which a competent judicial authority of a EuropeanUnion member state solicits the arrest and delivery by another member state, in order to proceed to theprosecution, trial or execution of a penalty or safety measure that is privative of freedom.

  20. 'To move or not to move': a national survey among professionals on beliefs and considerations about the place of end-of-life care for people with intellectual disabilities

    NARCIS (Netherlands)

    Bekkema, N.; de Veer, A.J.E.; Wagemans, A.M.A.; Hertogh, C.M.P.M.; Francke, A.L.

    2015-01-01

    Background: The aim of this article was to investigate the beliefs and considerations of professionals concerning an appropriate environment for end-of-life care for people with intellectual disabilities (ID). Method: A survey questionnaire was composed based on a scan of relevant literature and the

  1. ‘To move or not to move’: a national survey among professionals on beliefs and considerations about the place of end-of-life care for people with intellectual disabilities.

    NARCIS (Netherlands)

    Bekkema, N.; Veer, A.J.E. de; Wagemans, A.M.A.; Hertogh, C.M.P.M.; Francke, A.L.

    2015-01-01

    Background: The aim of this article was to investigate the beliefs and considerations of professionals concerning an appropriate environment for end-of-life care for people with intellectual disabilities (ID). Method: A survey questionnaire was composed based on a scan of relevant literature and the

  2. Identifying design considerations for a shared decision aid for use at the point of outpatient clinical care: An ethnographic study at an inner city clinic.

    Science.gov (United States)

    Hajizadeh, Negin; Perez Figueroa, Rafael E; Uhler, Lauren M; Chiou, Erin; Perchonok, Jennifer E; Montague, Enid

    2013-03-06

    Computerized decision aids could facilitate shared decision-making at the point of outpatient clinical care. The objective of this study was to investigate whether a computerized shared decision aid would be feasible to implement in an inner-city clinic by evaluating the current practices in shared decision-making, clinicians' use of computers, patient and clinicians' attitudes and beliefs toward computerized decision aids, and the influence of time on shared decision-making. Qualitative data analysis of observations and semi-structured interviews with patients and clinicians at an inner-city outpatient clinic. The findings provided an exploratory look at the prevalence of shared decision-making and attitudes about health information technology and decision aids. A prominent barrier to clinicians engaging in shared decision-making was a lack of perceived patient understanding of medical information. Some patients preferred their clinicians make recommendations for them rather than engage in formal shared decision-making. Health information technology was an integral part of the clinic visit and welcomed by most clinicians and patients. Some patients expressed the desire to engage with health information technology such as viewing their medical information on the computer screen with their clinicians. All participants were receptive to the idea of a decision aid integrated within the clinic visit although some clinicians were concerned about the accuracy of prognostic estimates for complex medical problems. We identified several important considerations for the design and implementation of a computerized decision aid including opportunities to: bridge clinician-patient communication about medical information while taking into account individual patients' decision-making preferences, complement expert clinician judgment with prognostic estimates, take advantage of patient waiting times, and make tasks involved during the clinic visit more efficient. These findings

  3. Transplanting the Body : Preliminary Ethical Considerations

    NARCIS (Netherlands)

    Miller, Lantz E.

    2017-01-01

    A dissociated area of medical research warrants bioethical consideration: a proposed transplantation of a donor’s entire body, except head, to a patient with a fatal degenerative disease. The seeming improbability of such an operation can only underscore the need for thorough bioethical assessment:

  4. Cost considerations

    NARCIS (Netherlands)

    Michiel Ras; Debbie Verbeek-Oudijk; Evelien Eggink

    2013-01-01

    Original title: Lasten onder de loep The Dutch government spends almost 7 billion euros  each year on care for people with intellectual disabilities, and these costs are rising steadily. This report analyses what underlies the increase in costs that occurred between 2007 and 2011. Was

  5. Radiologic considerations

    International Nuclear Information System (INIS)

    Judge, L.O.

    1987-01-01

    An increasing variety of imaging modalities as well as refinements of interventional techniques have led to a resurgence of radiologic interest and participation in urolithiasis management. Judicious selection of the diagnostic examination, close monitoring during the procedure, consultation with urologic colleagues, and a careful regard for radiation safety guidelines define the role of the radiologist in renal stone disease

  6. Unreliable patient identification warrants ABO typing at admission to check existing records before transfusion.

    Science.gov (United States)

    Ferrera-Tourenc, V; Lassale, B; Chiaroni, J; Dettori, I

    2015-06-01

    This study describes patient identification errors leading to transfusional near-misses in blood issued by the Alps Mediterranean French Blood Establishment (EFSAM) to Marseille Public Hospitals (APHM) over an 18-month period. The EFSAM consolidates 14 blood banks in southeast France. It supplies 149 hospitals and maintains a centralized database on ABO types used at all area hospitals. As an added precaution against incompatible transfusion, the APHM requires ABO testing at each admission regardless of whether the patient has an ABO record. The study goal was to determine if admission testing was warranted. Discrepancies between ABO type determined by admission testing and records in the centralized database were investigated. The root cause for each discrepancy was classified as specimen collection or patient admission error. Causes of patient admission events were further subclassified as namesake (name similarity) or impersonation (identity fraud). The incidence of ABO discrepancies was 1:2334 including a 1:3329 incidence of patient admission events. Impersonation was the main cause of identity events accounting for 90.3% of cases. The APHM's ABO control policy prevented 19 incompatible transfusions. In relation to the 48,593 packed red cell units transfused, this would have corresponded to a risk of 1:2526. Collecting and storing ABO typing results in a centralized database is an essential public health tool. It allows crosschecking of current test results with past records and avoids redundant testing. However, as patient identification remains unreliable, ABO typing at each admission is still warranted to prevent transfusion errors. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. Placing the pieces: Reconstructing the original property mosaic in a warrant and patent watershed

    Science.gov (United States)

    Bain, D.J.; Brush, G.S.

    2005-01-01

    Recent research shows that land use history is an important determinant of current ecosystem function. In the United States, characterization of land use change following European settlement requires reconstruction of the original property mosaic. However, this task is difficult in unsystematically surveyed areas east of the Appalachian Mountains. The Gwynns Falls watershed (Baltimore, MD) was originally surveyed in the 1600-1700s under a system of warrants and patents (commonly known as 'metes and bounds'). A method for the reconstruction and mapping of warrant and patent properties is presented and used to map the original property mosaic in the Gwynns Falls watershed. Using the mapped mosaic, the persistence of properties and property lines in the current Gwynns Falls landscape is considered. The results of this research indicate that as in agricultural areas, the original property lines in the Gwynns Falls watershed are persistent. At the same time, the results suggest that the property mosaic in heavily urbanized/suburbanized areas is generally 'reset.' Further, trends in surveying technique, parcel size, and settlement patterns cause property line density and property shape complexity to increase in the less urbanized upper watershed. The persistence of original patterns may be damping expression of heterogeneity gradients in this urban landscape. This spatial pattern of complexity in the original mosaic is directly opposite of hypothesized patterns of landscape heterogeneity arising from urbanization. The technique reported here and the resulting observations are important for landscape pattern studies in areas settled under unsystematic survey systems, especially the heavily urbanized areas of the eastern United States. ?? 2004 Kluwer Academic Publishers.

  8. The crescent and Islam: healing, nursing and the spiritual dimension. Some considerations towards an understanding of the Islamic perspectives on caring.

    Science.gov (United States)

    Rassool, G H

    2000-12-01

    Caring from Islamic perspectives is not well versed in Eurocentric nursing literature. There is widespread misunderstanding of the concept and practice of Islam within the context of health care and nursing practice. The areas of contention, in the context of health care systems, are whether the western paradigm to nursing care and management are applicable to Muslims and non-Muslims in both Islamic and non-Islamic countries. What is lacking in some of the conceptual frameworks and models of care is not only the fundamental spiritual dimension of care, but also the significance of spiritual development of the individual towards healing. The focus of this paper is to provide an awareness of Islamic health practices, health behaviours, code of ethics and the framework of Islamic perspectives of caring and spirituality. A brief overview of the Muslim world, the historical development in caring and health and the pillars of the Islamic faith provide the context of the paper. The development of a model of care based on the Islamic perspective is suggested.

  9. Financial oil derivatives: from options to oil warrants and synthetic oilfields

    International Nuclear Information System (INIS)

    Trabia, Xavier

    1992-01-01

    This study aims to shed light on some of the most interesting financial oil derivatives issued so far in order to assess the potential of this new wave of innovative funding instruments. In Part I some theoretical background is provided and applied to the problem of the American futures option. The ''binomial'' model for valuing future option contracts is presented and the most accurate alternatives for pricing American futures options are reviewed. The role of these numerical procedures in valuing more complex options involved in oil warrants is examined. Comments are made on the behaviour of volatility, which stands as a key interface between theory and practice in oil trading on the oil futures market. Part II of the study describes in detail some of the most famous new financial oil derivatives. Some final conclusions are drawn on the potential of oil trusts and synthetic oilfields to be involved in project and general funding in the oil industry. (44 figures, 11 tables, 53 references) (UK)

  10. Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention

    Directory of Open Access Journals (Sweden)

    Natalie A. DiPietro

    2014-01-01

    Full Text Available As medication therapy management (MTM continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.   Type: Idea Paper

  11. The valuation of equity warrants under the fractional Vasicek process of the short-term interest rate

    Science.gov (United States)

    Xiao, Weilin; Zhang, Weiguo; Zhang, Xili; Chen, Xiaoyan

    2014-01-01

    Motivated by the empirical evidence of long range dependence in short-term interest rates and considering the long maturities of equity warrants, we propose the fractional Vasicek model to describe the dynamics of the short rate in the pricing environment of equity warrants. Using the partial differential equation approach, we present a valuation model for equity warrants under the assumption that the short rate follows the fractional Vasicek process. After identifying the pricing model for equity warrants, we provide the parameter estimation procedure for the proposed pricing model. Since obtaining the values of equity warrants from the proposed model needs to solve a nonlinear equation, we employ a hybrid intelligent algorithm to get around this optimization problem. Furthermore, to illustrate the practicality of our proposed model, we conduct an empirical study to ascertain the performance of our proposed model using the data from China’s warrant market and the China Foreign Exchange Trade System. The comparison of traditional models (such as the Black-Scholes model, the Noreen-Wolfson model, the Lauterbach-Schultz model, and the Ukhov model) with our proposed model is also presented. The empirical results show that the mean absolute percentage error of our pricing model is 10.30%. By contrast, the Black-Scholes model, the Noreen-Wolfson model, the Lauterbach-Schultz model, and the Ukhov model applied to the same warrant produce mean absolute errors of 35.26%, 37.67%, 33.40%, 32.81%, respectively. Thus the long memory property in stochastic interest rates cannot be ignored in determining the valuation of equity warrants.

  12. An investigation of promotional mix considerations for mail-order prescriptions: facilitating the market's acceptance of a partial health care-cost remedy.

    Science.gov (United States)

    Strutton, D; Pelton, L E; True, S L

    1993-01-01

    While the U.S. health care system is confronted by a daunting assortment of problems, the foremost crisis almost certainly involves the excessive costs of health care. Mail-order prescriptions offer a modest, albeit worthwhile, measure of relief from high health care costs. This study investigates the information search behaviors and product perceptions that characterize current users and nonusers of mail-order prescriptions. Implications and recommendations concerned with the development of promotional strategies for mail-order prescriptions are derived from the findings.

  13. Examining Tensions That Affect the Evaluation of Technology in Health Care: Considerations for System Decision Makers From the Perspective of Industry and Evaluators.

    Science.gov (United States)

    Desveaux, Laura; Shaw, James; Wallace, Ross; Bhattacharyya, Onil; Bhatia, R Sacha; Jamieson, Trevor

    2017-12-08

    Virtual technologies have the potential to mitigate a range of challenges for health care systems. Despite the widespread use of mobile devices in everyday life, they currently have a limited role in health service delivery and clinical care. Efforts to integrate the fast-paced consumer technology market with health care delivery exposes tensions among patients, providers, vendors, evaluators, and system decision makers. This paper explores the key tensions between the high bar for evidence prior to market approval that guides health care regulatory decisions and the "fail fast" reality of the technology industry. We examine three core tensions: balancing user needs versus system needs, rigor versus responsiveness, and the role of pre- versus postmarket evidence generation. We use these to elaborate on the structure and appropriateness of evaluation mechanisms for virtual care solutions. Virtual technologies provide a foundation for personalized, patient-centered medicine on the user side, coupled with a broader understanding of impact on the system side. However, mechanisms for stakeholder discussion are needed to clarify the nature of the health technology marketplace and the drivers of evaluation priorities. ©Laura Desveaux, James Shaw, Ross Wallace, Onil Bhattacharyya, R Sacha Bhatia, Trevor Jamieson. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 08.12.2017.

  14. Front/back office considerations in the operational access to long-term care for older people : Findings of a multiple case study

    NARCIS (Netherlands)

    Schipper, E.C.C.; Meijboom, B.R.; Luijkx, K.G.; Schols, J.M.G.A.

    2013-01-01

    Background Organizations that provide long-term care in the Netherlands are reconsidering the operational access to their services. Principles of operations management, such as front/back office configurations, might improve the redesign of operational access. Once a client gains entrance to the

  15. Key Considerations in Providing a Free Appropriate Public Education for Youth with Disabilities in Juvenile Justice Secure Care Facilities. Issue Brief

    Science.gov (United States)

    Gagnon, Joseph C.; Read, Nicholas W.; Gonsoulin, Simon

    2015-01-01

    Access to high-quality education for youth is critical to their long-term success as adults. Youth in juvenile justice secure care facilities, however, too often do not have access to the high-quality education and related supports and services that they need, particularly youth with disabilities residing in such facilities. This brief discusses…

  16. Ethical considerations on the value of patient knowledge in long-term care: a qualitative study of patients suffering from Korsakoff 's syndrome.

    Science.gov (United States)

    van den Hooff, Susanne L; Goossensen, Anne

    2015-05-01

    This study explores experiences of patients suffering from Korsakoff's syndrome. It contributes to improved reflection on the value of patient knowledge. An ethics of care perspective states the importance of moving to patients in their vulnerable state of being, and to figure out patients' individual needs necessary to provide good care. The information given by patients suffering from Korsakoff's syndrome might be mistaken, invented and even not true. The value of these patients' experiences and knowledge had not been researched to date. Data from six in-depth interviews were analysed concurrently through the constant comparative method. The principles of voluntariness, confidentiality and anonymity were respected during the research process. Four important themes within patients' knowledge emerged: health condition, involuntary admission into the nursing home, the daily routine and interpretation of the caring abilities of healthcare professionals. The findings show that our respondents were able to provide a window into their inner perspective. This study deepens our understanding of the value of patient knowledge in situations where patients see the world in a different manner as do healthcare professionals. The conversations revealed personal subjective knowledge which our respondents create and live by. Healthcare professionals are encouraged to discover and affirm the understandings of these patients, and not be prepossessed due to the diagnosis or general nursing home rules. Understanding patients' unique knowledge through appreciation of the complexity and richness of different views on the situation can assist to give a more humane response to individual needs and pain. Health staff in healthcare institutions are encouraged to evaluate the - unintended - effect of rigidly applied nursing home rules, and the government is challenged to rethink its policy about care, and provide more resources permitting relational care that nurtures the dignity of

  17. SMARTPHONE-BASED DILATED FUNDUS PHOTOGRAPHY AND NEAR VISUAL ACUITY TESTING AS INEXPENSIVE SCREENING TOOLS TO DETECT REFERRAL WARRANTED DIABETIC EYE DISEASE.

    Science.gov (United States)

    Toy, Brian C; Myung, David J; He, Lingmin; Pan, Carolyn K; Chang, Robert T; Polkinhorne, Alison; Merrell, Douglas; Foster, Doug; Blumenkranz, Mark S

    2016-05-01

    To compare clinical assessment of diabetic eye disease by standard dilated examination with data gathered using a smartphone-based store-and-forward teleophthalmology platform. 100 eyes of 50 adult patients with diabetes from a health care safety-net ophthalmology clinic. All patients underwent comprehensive ophthalmic examination. Concurrently, a smartphone was used to estimate near visual acuity and capture anterior and dilated posterior segment photographs, which underwent masked, standardized review. Quantitative comparison of clinic and smartphone-based data using descriptive, kappa, Bland-Altman, and receiver operating characteristic analyses was performed. Smartphone visual acuity was successfully measured in all eyes. Anterior and posterior segment photography was of sufficient quality to grade in 96 and 98 eyes, respectively. There was good correlation between clinical Snellen and smartphone visual acuity measurements (rho = 0.91). Smartphone-acquired fundus photographs demonstrated 91% sensitivity and 99% specificity to detect moderate nonproliferative and worse diabetic retinopathy, with good agreement between clinic and photograph grades (kappa = 0.91 ± 0.1, P smartphone-based telemedicine system that demonstrated sensitivity and specificity to detect referral-warranted diabetic eye disease as a proof-of-concept. Additional studies are warranted to evaluate this approach to expanding screening for diabetic retinopathy.

  18. Burnout in intensive care units - a consideration of the possible prevalence and frequency of new risk factors: a descriptive correlational multicentre study.

    Science.gov (United States)

    Teixeira, Carla; Ribeiro, Orquídea; Fonseca, António Manuel; Carvalho, Ana Sofia

    2013-10-31

    The provision of Intensive Care (IC) can lead to a health care provider's physical, psychological and emotional exhaustion, which may develop into burnout. We notice the absence of specific studies regarding this syndrome in Portuguese Intensive Care Units (ICUs). Our main objective is to study the incidence and risk factors of burnout in Portuguese ICUs. A self-fulfilment questionnaire containing 3 items: (i) socio-demographic data of the study population; (ii) experiences in the workplace; (iii) Maslach Burnout Inventory (MBI) - was applied to evaluate the influence of distinct factors on the prevalence of burnout among physicians and nurses working in ICUs. Three hundred professionals (82 physicians and 218 nurses) from ten ICUs were included in the study, out of a total of 445 who were eligible. There was a high rate of burnout among professionals working in Portuguese ICUs, with 31% having a high level of burnout. However, when burnout levels among nurses and physicians were compared, no significant difference was found. Using multivariate analysis, we identified gender as being a risk factor, where female status increases the risk of burnout. In addition, higher levels of burnout were associated with conflicts and ethical decision making regarding withdrawing treatments. Having a temporary work contract was also identified as a risk factor. Conversely, working for another service of the same health care institution acts as a protective factor. A high rate of burnout was identified among professionals working in Portuguese ICUs. This study highlights some new risk factors for burnout (ethical decision making, temporary work contracts), and also protective ones (maintaining activity in other settings outside the ICU) that were not previously reported. Preventive and interventive programmes to avoid and reduce burnout syndrome are of paramount importance in the future organization of ICUs and should take the above results into account.

  19. Burnout in intensive care units - a consideration of the possible prevalence and frequency of new risk factors: a descriptive correlational multicentre study

    Science.gov (United States)

    2013-01-01

    Background The provision of Intensive Care (IC) can lead to a health care provider’s physical, psychological and emotional exhaustion, which may develop into burnout. We notice the absence of specific studies regarding this syndrome in Portuguese Intensive Care Units (ICUs). Our main objective is to study the incidence and risk factors of burnout in Portuguese ICUs. Methods A self-fulfilment questionnaire containing 3 items: (i) socio-demographic data of the study population; (ii) experiences in the workplace; (iii) Maslach Burnout Inventory (MBI) - was applied to evaluate the influence of distinct factors on the prevalence of burnout among physicians and nurses working in ICUs. Results Three hundred professionals (82 physicians and 218 nurses) from ten ICUs were included in the study, out of a total of 445 who were eligible. There was a high rate of burnout among professionals working in Portuguese ICUs, with 31% having a high level of burnout. However, when burnout levels among nurses and physicians were compared, no significant difference was found. Using multivariate analysis, we identified gender as being a risk factor, where female status increases the risk of burnout. In addition, higher levels of burnout were associated with conflicts and ethical decision making regarding withdrawing treatments. Having a temporary work contract was also identified as a risk factor. Conversely, working for another service of the same health care institution acts as a protective factor. Conclusions A high rate of burnout was identified among professionals working in Portuguese ICUs. This study highlights some new risk factors for burnout (ethical decision making, temporary work contracts), and also protective ones (maintaining activity in other settings outside the ICU) that were not previously reported. Preventive and interventive programmes to avoid and reduce burnout syndrome are of paramount importance in the future organization of ICUs and should take the above results

  20. Announcement effects of convertible bond loans versus warrant-bond loans : An empirical analysis for the Dutch market

    NARCIS (Netherlands)

    de Roon, F.A.; Veld, C.H.

    1995-01-01

    This study investigates the announcement effects of offerings of convertible bond loans and warrant-bond loans using data for the Dutch market. Using standard event study methodology it is found that on average stock prices show a positive but insignificant abnormal return for the announcement of a

  1. 20 CFR 416.934 - Impairments which may warrant a finding of presumptive disability or presumptive blindness.

    Science.gov (United States)

    2010-04-01

    ... Blindness Presumptive Disability and Blindness § 416.934 Impairments which may warrant a finding of presumptive disability or presumptive blindness. We may make findings of presumptive disability and... school, because of mental deficiency or is unable to attend any type of school (or if beyond school age...

  2. Paranormal phenomena in the medical literature sufficient smoke to warrant a search for fire.

    Science.gov (United States)

    Bobrow, Robert S

    2003-06-01

    Paranormal phenomena - events that cannot be explained by existing science - are regularly reported in medicine. Surveys have shown that a majority of the population of the United States and Great Britain hold at least one paranormal belief. Information was retrieved by MEDLINE searches using keywords 'paranormal' and 'psychic', and from the author's own collection. Reports are predominantly by physicians, and from peer-reviewed, MEDLINE-indexed literature. This is a representative sample, as there is no database for paranormal medical phenomena. Presented and discussed are: a case of systemic lupus erythematosis ameliorated by witchcraft; an analysis of studies on distant healing; acupuncture, as a bridge between what is now accepted but recently would have been deemed paranormal; a carefully-done study of a psychic; auditory hallucinations informing a patient, correctly, that she had a brain tumor; two nearly-identical lay press reports of self-predicted death; lycanthropy (the delusion of being an animal); the development of Carl Jung's collective unconscious; hypnosis - still questioned despite documented therapeutic benefit, and a well-researched report of a person speaking a foreign language, apparently unlearned (xenoglossy) while hypnotized; and multiple examples of children who spout the details of the life of an unknown, deceased person. The inability of existing paradigms to explain these observations does not negate them; rather, it elucidates a need for more research.

  3. Considerations and recommendations for conducting qualitative research interviews with palliative and end-of-life care patients in the home setting: a consensus paper.

    Science.gov (United States)

    Sivell, Stephanie; Prout, Hayley; Hopewell-Kelly, Noreen; Baillie, Jessica; Byrne, Anthony; Edwards, Michelle; Harrop, Emily; Noble, Simon; Sampson, Catherine; Nelson, Annmarie

    2015-12-08

    To present and discuss the views of researchers at an academic palliative care research centre on research encounters with terminally ill patients in the home setting and to generate a list of recommendations for qualitative researchers working in palliative and end-of-life care. Eight researchers took part in a consensus meeting to discuss their experiences of undertaking qualitative interviews. The researchers were of varying backgrounds and all reported having experience in interviewing terminally ill patients, and all but one had experience of interviewing patients in their home environment. The main areas discussed by researchers included: whether participation in end-of-life research unintentionally becomes a therapeutic experience or an ethical concern; power relationships between terminally ill patients and researchers; researcher reflexivity and reciprocity; researchers' training needs. Qualitative methods can complement the home environment; however, it can raise ethical and practical challenges, which can be more acute in the case of research undertaken with palliative and patients at the end-of-life. The ethical and practical challenges researchers face in this context has the potential to place both participant and researcher at risk for their physical and psychological well-being. We present a set of recommendations for researchers to consider prior to embarking on qualitative research in this context and advocate researchers in this field carefully consider the issues presented on a study-by-study basis. 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/

  4. Do ultra-orphan medicinal products warrant ultra-high prices? A review

    Directory of Open Access Journals (Sweden)

    Picavet E

    2013-06-01

    Full Text Available Eline Picavet,1 David Cassiman,2 Steven Simoens1 1Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; 2Department of Hepatology, University Hospital Leuven, Leuven, Belgium Abstract: Ultra-orphan medicinal products (ultra-OMPs are intended for the treatment, prevention, or diagnosis of ultra-rare diseases, ie, life-threatening or chronically debilitating diseases that affect less than one per 50,000 individuals. Recently, high prices for ultra-OMPs have given rise to debate on the sustainability and justification of these prices. The aim of this article is to review the international scientific literature on the pricing of ultra-OMPs and to provide an overview of the current knowledge on the drivers of ultra-OMP pricing. The pricing process of ultra-OMPs is a complex and nontransparent issue. Evidence in the literature seems to indicate that ultra-OMPs are priced according to rarity and what the manufacturer believes the market will bear. Additionally, there appears to be a trend between the price of an ultra-OMP and the number of available alternatives. Patients, third-party payers, and pharmaceutical companies could benefit from more transparent pricing strategies. With a view to containing health care costs, it is likely that cost-sharing strategies, such as performance-based risk sharing arrangements, will become increasingly more important. However, it is vital that any measures for price control are consistent with the intended goals of the incentives to promote the development of new OMPs. Ideally, a balance must be struck between attaining affordable prices for ultra-OMPs and securing a realistic return on investment for the pharmaceutical industry. Keywords: ultra-orphan medicinal product, ultra-rare disease, pricing

  5. Hypothyroidism in adults. Levothyroxine if warranted by clinical and laboratory findings, not for simple TSH elevation.

    Science.gov (United States)

    2015-10-01

    Hypothyroidism is a common disorder due to inadequate thyroid hormone secretion. When a patient has signs and symptoms suggestive of hypothyroidism, how is it determined whether thyroid hormone replacement therapy will have a favourable harm-benefit balance? How should treatment be managed? To answer these questions, we conducted a review of the literature using the standard Prescrire methodology. The symptoms of hypothyroidism are due to slow metabolism (constipation, fatigue, sensitivity to cold, weight gain, etc.) and to polysaccharide accumulation in certain tissues, leading to hoarseness, eyelid swelling, etc. A blood TSH concentration of less than 4 or 5 mlU/L rules out peripheral hypothyroidism. TSH levels increase with age. Between 30% and 60% of high TSH levels are not confirmed on a second blood test. In overt hypothyroidism, the TSH level is high and the free T4 (thyroxine) level is low. Most of these patients are symptomatic. So-called subclinical hypothyroidism, which is rarely symptomatic, is characterised by high blood TSH levels and normal free T4 levels. The natural history of hypothyroidism depends on its cause. In chronic autoimmune thyroiditis, the most common form seen in rich countries, hypothyroidism generally worsens over time. However, other situations can lead to transient hypothyroidism that may last several weeks or months. Subclinical hypothyroidism, as the name implies, is usually asymptomatic. The risk of progression to overt hypothyroidism is about 3% to 4% per year overall but increases with the initial TSH level. Treatment guidelines are mainly based on physiological and pharmacological considerations and generally recommend levothyroxine therapy. The adverse effects of levothyroxine are signs of thyrotoxicosis in case of overdose (tachycardia, tremor, sweating, etc.). Even a slight overdose carries a risk of osteoporotic fractures and atrial fibrillation, especially in the elderly. In young adults, levothyroxine is usually started

  6. Peculiarities of the Enforcement of the European Arrest Warrant in the Case of an Illegal Liberty Deprivation

    Directory of Open Access Journals (Sweden)

    Minodora Ioana Rusu

    2010-06-01

    Full Text Available The illegal deprivation of liberty is, under the current context, one of the most serious offenses, being treated differently in the European Union. The need to prevent and combat this violation, it has led the European legislator to include it under different names in the European legislative act that governs the institution of the European arrest warrant. In this context, the European arrest warrant is the most important form of judicial cooperation in penal matters between the Member States of the EU, which is based on mutualrecognition of criminal judgments. The research conducted on how it is regulated the enforcement of the European arrest warrant in the case of illegal liberty deprivation in the European legislative act (the Framework Decision 2002/584/JHA leads to the conclusion that the legislature failed to mention the violation in question in the group of the violation for which it was not necessary the inspection of the double incrimination, but, still, including the offenses as kidnapping, illegal restraint and hostage-taking. Even if theRomanian legislator included this violation in the above mentioned group, this situation is not solved, because it will cause some problems in the request by the Romanian judicial authorities of the enforcement of such warrant. Another criticized issue, observed not only in the European legislative act, but also in the internal law, is related to the lack of stipulations, which can lead to the possibility of issuing and executing a European arrest warrant and for the execution of educational measures for illegal deprivation of liberty and also others. Also, in order to increase the effectiveness of the execution of a European arrest warrant, we consider that it should be granted executive powers of all courts of Romania. The originality of the work consists of the critical observations and the lege ferenda proposal which covers both the European legislativeact and the Romanian Law. At the same time

  7. ACCOUNTING FOR CONTINGENT CONSIDERATIONS IN BUSINESS COMBINATIONS

    Directory of Open Access Journals (Sweden)

    Gurgen KALASHYAN

    2017-07-01

    Full Text Available According to IFRS 3 Business Combinations contingent considerations must be included in the total consideration given for the acquired entity along with cash, other assets, ordinary or preference equity instruments, options, warrants. The contingent consideration is the determined amount which acquiring entity has to pay to acquired entity provided, that certain conditions will be fulfilled in the future. In case the provisions are not satisfied, we will get the situation when the amount of contingent consideration has been included in the total consideration given in the business combination, but in fact, the acquirer has not paid that amount. In its turn, the acquired entity will recognize the contingent consideration as a financial asset according to IFRS 9 Financial Instruments. In that case, it would be appropriately to recognize the contingent consideration as a contingent asset applying IAS 37. In the Article the author will explore the challenges of contingent consideration accounting and suggest the ways of solving the above mentioned problems.

  8. Gastrointestinal Disturbances Associated with the Consumption of Sugar Alcohols with Special Consideration of Xylitol: Scientific Review and Instructions for Dentists and Other Health-Care Professionals

    Science.gov (United States)

    2016-01-01

    Sugar alcohols (polyols) are used in food manufacturing and in medical tests and examinations. d-Glucitol (sorbitol) and d-mannitol were previously the most common alditols used for these purposes. After the 1960s, xylitol became a common ingredient in noncariogenic confectioneries, oral hygiene products, and diabetic food. Erythritol, a polyol of the tetritol type, can be regarded as the sweetener of the “next generation.” The disaccharide polyols maltitol, lactitol, and isomalt have also been used in food manufacturing and in medical tests. Consumption of pentitol- and hexitol-type polyols and disaccharide polyols may cause gastrointestinal disturbances at least in unaccustomed subjects. The occurrence of disturbances depends on consumer properties and on the molecular size and configuration of the polyol molecule. Adaptation may take place as a result of enzyme induction in the intestinal flora. Some of the literature on xylitol has been difficult to access by health-care professionals and will be reviewed here. Research and clinical field experience have found no pathology in polyol-associated osmotic diarrhea—the intestinal mucosa having normal basic structure, except in extreme instances. Xylitol is better tolerated than hexitols or the disaccharide polyols. Erythritol, owing to its smaller molecular weight and configuration that differ from other alditols, normally avoids the gastrointestinal reactions encountered with other polyols. This review will also touch upon the FODMAPs diet concept. PMID:27840639

  9. Gastrointestinal Disturbances Associated with the Consumption of Sugar Alcohols with Special Consideration of Xylitol: Scientific Review and Instructions for Dentists and Other Health-Care Professionals

    Directory of Open Access Journals (Sweden)

    Kauko K. Mäkinen

    2016-01-01

    Full Text Available Sugar alcohols (polyols are used in food manufacturing and in medical tests and examinations. d-Glucitol (sorbitol and d-mannitol were previously the most common alditols used for these purposes. After the 1960s, xylitol became a common ingredient in noncariogenic confectioneries, oral hygiene products, and diabetic food. Erythritol, a polyol of the tetritol type, can be regarded as the sweetener of the “next generation.” The disaccharide polyols maltitol, lactitol, and isomalt have also been used in food manufacturing and in medical tests. Consumption of pentitol- and hexitol-type polyols and disaccharide polyols may cause gastrointestinal disturbances at least in unaccustomed subjects. The occurrence of disturbances depends on consumer properties and on the molecular size and configuration of the polyol molecule. Adaptation may take place as a result of enzyme induction in the intestinal flora. Some of the literature on xylitol has been difficult to access by health-care professionals and will be reviewed here. Research and clinical field experience have found no pathology in polyol-associated osmotic diarrhea—the intestinal mucosa having normal basic structure, except in extreme instances. Xylitol is better tolerated than hexitols or the disaccharide polyols. Erythritol, owing to its smaller molecular weight and configuration that differ from other alditols, normally avoids the gastrointestinal reactions encountered with other polyols. This review will also touch upon the FODMAPs diet concept.

  10. Management of infections in critically ill returning travellers in the intensive care unit—I: considerations on infection control and transmission of resistance

    Directory of Open Access Journals (Sweden)

    Hakan Leblebicioglu

    2016-07-01

    Full Text Available Depending on their destinations and activities, international travellers are at a significant risk of contracting both communicable and non-communicable diseases. On return to their home countries, such travellers may require intensive care. The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV, and more recently Ebola haemorrhagic fever, has highlighted the risks. Other well-known communicable pathogens such as methicillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae have been described previously. However, malaria remains by far the most important cause of death. The issues related to imported antibiotic resistance and protection from highly contagious diseases are reviewed here. Surveillance strategies based on epidemiological data (country visited, duration of travel, and time elapsed since return and clinical syndromes, together with systematic search policies, are usually mandatory to limit the risk of an outbreak. Single-bed hospital rooms and isolation according to symptoms should be the rule while awaiting laboratory test results. Because person-to-person contact is the main route of transmission, healthcare workers should implement specific prevention strategies.

  11. Design considerations in a clinical trial of a cognitive behavioural intervention for the management of low back pain in primary care: Back Skills Training Trial

    Directory of Open Access Journals (Sweden)

    Griffiths Frances E

    2007-02-01

    Full Text Available Abstract Background Low back pain (LBP is a major public health problem. Risk factors for the development and persistence of LBP include physical and psychological factors. However, most research activity has focused on physical solutions including manipulation, exercise training and activity promotion. Methods/Design This randomised controlled trial will establish the clinical and cost-effectiveness of a group programme, based on cognitive behavioural principles, for the management of sub-acute and chronic LBP in primary care. Our primary outcomes are disease specific measures of pain and function. Secondary outcomes include back beliefs, generic health related quality of life and resource use. All outcomes are measured over 12 months. Participants randomised to the intervention arm are invited to attend up to six weekly sessions each of 90 minutes; each group has 6–8 participants. A parallel qualitative study will aid the evaluation of the intervention. Discussion In this paper we describe the rationale and design of a randomised evaluation of a group based cognitive behavioural intervention for low back pain.

  12. Is Bringing Back Warrant Officers the Answer A Loot at How They Could Work in the Air Force Cyber Operations Career Field

    Science.gov (United States)

    2017-03-16

    fulfill that intent. In contrast, the Army, Navy and Marine Corps utilize warrant officers in a multitude of capacities, especially in highly... education and more generalized knowledge of commissioned officers. Warrant officer duties include supervising and managing the execution of cyberspace...trace his or her roots back to the British Royal Navy in the thirteenth century.28 The Crown awarded Royal Warrants to especially experienced sailors to

  13. Representación social de la prevención de enfermedades en la atención primaria de salud Social consideration related to diseases prevention in health primary care

    Directory of Open Access Journals (Sweden)

    Mariela Rodríguez Méndez

    2009-09-01

    Full Text Available INTRODUCCIÓN: el plan del Médico de Familia está instaurado hace más de 20 años para prevenir enfermedades y promover salud; sin embargo, los resultados no se corresponden aún con lo esperado. La forma en que los profesionales de la Atención Primaria de la Salud se representan y practican la prevención pudiera condicionar tal problema. OBJETIVO: explorar la relación de las representaciones sociales del profesional de la salud en la Atención Primaria de la Salud con sus prácticas preventivas cotidianas. MÉTODOS: cualitativos, aplicando las técnicas de entrevista, observación y análisis de contenido a la Revista Cubana de Medicina General Integral. RESULTADOS: los profesionales de la Atención Primaria de la Salud se representan la prevención de enfermedades esencialmente como la ejecución de acciones orientadas por programas e informar a la población sobre las pautas de conducta a seguir. Aunque se manifestó una actitud favorable hacia la prevención en sí, se quejan de sobrecarga laboral y las condiciones de trabajo en este nivel de atención. CONCLUSIONES: las representaciones de la prevención de enfermedades y las prácticas preventivas en Atención Primaria de la Salud son complementarias, puesto que la práctica preventiva en este nivel de atención se caracteriza por realizar lo exigido por los programas, sobre todo, si son priorizados, así como por informar sobre las pautas de conductas preventivas.INTRODUCTION: family Physician program was established twenty years ago to prevent diseases and to promote the health; however, results are not as expected. How the Health Primary Care professionals consider and practice the prevention could fit such problem. AIM: to explore the relation of social consideration of health professional in Health Primary Care with their daily preventive practices. METHODS: qualitative types applying the interview, observation, and content analysis techniques to Cuban Journal of General

  14. Caring-ethical phronetic research: Epistemological considerations

    DEFF Research Database (Denmark)

    Delmar, Charlotte

    2006-01-01

    The purpose of this article is to open discussion about the traditional health science research view of what constitutes valid knowledge and theory. Using an approach from the philosophy of science, this article breaks with the paradigm of "science as usual." It argues that scholars who study...

  15. Measuring the Effect of Housing Quality Interventions: The Case of the New Zealand “Rental Warrant of Fitness”

    Science.gov (United States)

    Telfar-Barnard, Lucy; Bennett, Julie; Howden-Chapman, Philippa; Jacobs, David E.; Ormandy, David; Cutler-Welsh, Matthew; Preval, Nicholas; Baker, Michael G.; Keall, Michael

    2017-01-01

    In New Zealand, as in many other countries, housing in the private-rental sector is in worse condition than in the owner-occupier housing sector. New Zealand residential buildings have no inspection regime after original construction signoff. Laws and regulations mandating standards for existing residential housing are outdated and spread over a range of instruments. Policies to improve standards in existing housing have been notoriously difficult to implement. In this methods paper, we describe the development and implementation of a rental Warrant of Fitness (WoF) intended to address these problems. Dwellings must pass each of 29 criteria for habitability, insulation, heating, ventilation, safety, amenities, and basic structural soundness to reach the WoF minimum standard. The WoF’s development was based on two decades of research on the impact of housing quality on health and wellbeing, and strongly influenced by the UK Housing Health and Safety Rating System and US federal government housing standards. Criteria were field-tested across a range of dwelling types and sizes, cities, and climate zones. The implementation stage of our WoF research consists of a non-random controlled quasi-experimental study in which we work with two city-level local government councils to implement the rental WoF, recruiting adjoining council areas as controls, and measuring changes in health, economic, and social outcomes. PMID:29112147

  16. Measuring the Effect of Housing Quality Interventions: The Case of the New Zealand “Rental Warrant of Fitness”

    Directory of Open Access Journals (Sweden)

    Lucy Telfar-Barnard

    2017-11-01

    Full Text Available In New Zealand, as in many other countries, housing in the private-rental sector is in worse condition than in the owner-occupier housing sector. New Zealand residential buildings have no inspection regime after original construction signoff. Laws and regulations mandating standards for existing residential housing are outdated and spread over a range of instruments. Policies to improve standards in existing housing have been notoriously difficult to implement. In this methods paper, we describe the development and implementation of a rental Warrant of Fitness (WoF intended to address these problems. Dwellings must pass each of 29 criteria for habitability, insulation, heating, ventilation, safety, amenities, and basic structural soundness to reach the WoF minimum standard. The WoF’s development was based on two decades of research on the impact of housing quality on health and wellbeing, and strongly influenced by the UK Housing Health and Safety Rating System and US federal government housing standards. Criteria were field-tested across a range of dwelling types and sizes, cities, and climate zones. The implementation stage of our WoF research consists of a non-random controlled quasi-experimental study in which we work with two city-level local government councils to implement the rental WoF, recruiting adjoining council areas as controls, and measuring changes in health, economic, and social outcomes.

  17. Discrete-Time Pricing and Optimal Exercise of American Perpetual Warrants in the Geometric Random Walk Model

    Energy Technology Data Exchange (ETDEWEB)

    Vanderbei, Robert J., E-mail: rvdb@princeton.edu [Princeton University, Department of Operations Research and Financial Engineering (United States); P Latin-Small-Letter-Dotless-I nar, Mustafa C., E-mail: mustafap@bilkent.edu.tr [Bilkent University, Department of Industrial Engineering (Turkey); Bozkaya, Efe B. [Sabanc Latin-Small-Letter-Dotless-I University, Faculty of Administrative Sciences (Turkey)

    2013-02-15

    An American option (or, warrant) is the right, but not the obligation, to purchase or sell an underlying equity at any time up to a predetermined expiration date for a predetermined amount. A perpetual American option differs from a plain American option in that it does not expire. In this study, we solve the optimal stopping problem of a perpetual American option (both call and put) in discrete time using linear programming duality. Under the assumption that the underlying stock price follows a discrete time and discrete state Markov process, namely a geometric random walk, we formulate the pricing problem as an infinite dimensional linear programming (LP) problem using the excessive-majorant property of the value function. This formulation allows us to solve complementary slackness conditions in closed-form, revealing an optimal stopping strategy which highlights the set of stock-prices where the option should be exercised. The analysis for the call option reveals that such a critical value exists only in some cases, depending on a combination of state-transition probabilities and the economic discount factor (i.e., the prevailing interest rate) whereas it ceases to be an issue for the put.

  18. 'Thinking ill of others without sufficient warrant?' Transcending the accuracy-inaccuracy dualism in prejudice and stereotyping research.

    Science.gov (United States)

    Dixon, John

    2017-03-01

    Research on prejudice seeks to understand and transform inaccurate beliefs about others. Indeed, historically such research has offered a cautionary tale of the biased nature of human cognition. Recently, however, this view has been challenged by work defending the essential rationality of intergroup perception, a theme captured controversially in Jussim and colleagues' (2009) research on the 'unbearable accuracy of stereotyping'. The present paper argues that in its own terms the 'rationalist turn' in socio-cognitive research on stereotyping presents an important challenge to the prejudice tradition, raising troubling questions about its conceptual and empirical foundations. However, it also argues for the necessity of transcending those terms. By focusing on the correspondence between individual beliefs and the supposedly 'objective' characteristics of others, we neglect the historical and discursive practices through which the social realities that we 'perceive' are actively constructed and institutionalized. We mask their social origins, contested and perspectival nature, relativity, and relationship to wider structures of power. By implication, moving beyond the Allportian perspective that has dominated both the prejudice tradition and the emerging stereotype accuracy paradigm, we may now need to prioritize other kinds of questions. Reversing Allport's famous definition of prejudice, it may now be time to ask: How, and with what consequences, does 'thinking ill of others' become sufficiently warranted? How does such thinking become part of institutionalized relations of power and an accepted way of perceiving, evaluating and treating others? What should social psychologists be doing to challenge this state of affairs? © 2017 The British Psychological Society.

  19. Measuring the Effect of Housing Quality Interventions: The Case of the New Zealand "Rental Warrant of Fitness".

    Science.gov (United States)

    Telfar-Barnard, Lucy; Bennett, Julie; Howden-Chapman, Philippa; Jacobs, David E; Ormandy, David; Cutler-Welsh, Matthew; Preval, Nicholas; Baker, Michael G; Keall, Michael

    2017-11-07

    In New Zealand, as in many other countries, housing in the private-rental sector is in worse condition than in the owner-occupier housing sector. New Zealand residential buildings have no inspection regime after original construction signoff. Laws and regulations mandating standards for existing residential housing are outdated and spread over a range of instruments. Policies to improve standards in existing housing have been notoriously difficult to implement. In this methods paper, we describe the development and implementation of a rental Warrant of Fitness (WoF) intended to address these problems. Dwellings must pass each of 29 criteria for habitability, insulation, heating, ventilation, safety, amenities, and basic structural soundness to reach the WoF minimum standard. The WoF's development was based on two decades of research on the impact of housing quality on health and wellbeing, and strongly influenced by the UK Housing Health and Safety Rating System and US federal government housing standards. Criteria were field-tested across a range of dwelling types and sizes, cities, and climate zones. The implementation stage of our WoF research consists of a non-random controlled quasi-experimental study in which we work with two city-level local government councils to implement the rental WoF, recruiting adjoining council areas as controls, and measuring changes in health, economic, and social outcomes.

  20. Discrete-Time Pricing and Optimal Exercise of American Perpetual Warrants in the Geometric Random Walk Model

    International Nuclear Information System (INIS)

    Vanderbei, Robert J.; Pınar, Mustafa Ç.; Bozkaya, Efe B.

    2013-01-01

    An American option (or, warrant) is the right, but not the obligation, to purchase or sell an underlying equity at any time up to a predetermined expiration date for a predetermined amount. A perpetual American option differs from a plain American option in that it does not expire. In this study, we solve the optimal stopping problem of a perpetual American option (both call and put) in discrete time using linear programming duality. Under the assumption that the underlying stock price follows a discrete time and discrete state Markov process, namely a geometric random walk, we formulate the pricing problem as an infinite dimensional linear programming (LP) problem using the excessive-majorant property of the value function. This formulation allows us to solve complementary slackness conditions in closed-form, revealing an optimal stopping strategy which highlights the set of stock-prices where the option should be exercised. The analysis for the call option reveals that such a critical value exists only in some cases, depending on a combination of state-transition probabilities and the economic discount factor (i.e., the prevailing interest rate) whereas it ceases to be an issue for the put.

  1. High-fertility phenotypes: two outbred mouse models exhibit substantially different molecular and physiological strategies warranting improved fertility.

    Science.gov (United States)

    Langhammer, Martina; Michaelis, Marten; Hoeflich, Andreas; Sobczak, Alexander; Schoen, Jennifer; Weitzel, Joachim M

    2014-01-01

    Animal models are valuable tools in fertility research. Worldwide, there are more than 400 transgenic or knockout mouse models available showing a reproductive phenotype; almost all of them exhibit an infertile or at least subfertile phenotype. By contrast, animal models revealing an improved fertility phenotype are barely described. This article summarizes data on two outbred mouse models exhibiting a 'high-fertility' phenotype. These mouse lines were generated via selection over a time period of more than 40 years and 161 generations. During this selection period, the number of offspring per litter and the total birth weight of the entire litter nearly doubled. Concomitantly with the increased fertility phenotype, several endocrine parameters (e.g. serum testosterone concentrations in male animals), physiological parameters (e.g. body weight, accelerated puberty, and life expectancy), and behavioral parameters (e.g. behavior in an open field and endurance fitness on a treadmill) were altered. We demonstrate that the two independently bred high-fertility mouse lines warranted their improved fertility phenotype using different molecular and physiological strategies. The fertility lines display female- as well as male-specific characteristics. These genetically heterogeneous mouse models provide new insights into molecular and cellular mechanisms that enhance fertility. In view of decreasing fertility in men, these models will therefore be a precious information source for human reproductive medicine. Translated abstract A German translation of abstract is freely available at http://www.reproduction-online.org/content/147/4/427/suppl/DC1.

  2. Risk of breast cancer after a diagnosis of ovarian cancer in BRCA mutation carriers: Is preventive mastectomy warranted?

    Science.gov (United States)

    McGee, Jacob; Giannakeas, Vasily; Karlan, Beth; Lubinski, Jan; Gronwald, Jacek; Rosen, Barry; McLaughlin, John; Risch, Harvey; Sun, Ping; Foulkes, William D; Neuhausen, Susan L; Kotsopoulos, Joanne; Narod, Steven A

    2017-05-01

    Preventive breast surgery and MRI screening are offered to unaffected BRCA mutation carriers. The clinical benefit of these two modalities has not been evaluated among mutation carriers with a history of ovarian cancer. Thus, we sought to determine whether or not BRCA mutation carriers with ovarian cancer would benefit from preventive mastectomy or from MRI screening. First, the annual mortality rate for ovarian cancer patients was estimated for a cohort of 178 BRCA mutation carriers from Ontario, Canada. Next, the actuarial risk of developing breast cancer was estimated using an international registry of 509 BRCA mutation carriers with ovarian cancer. A series of simulations was conducted to evaluate the reduction in the probability of death (from all causes) associated with mastectomy and with MRI-based breast surveillance. Cox proportional hazards models were used to evaluate the impacts of mastectomy and MRI screening on breast cancer incidence as well as on all-cause mortality. Twenty (3.9%) of the 509 patients developed breast cancer within ten years following ovarian cancer diagnosis. The actuarial risk of developing breast cancer at ten years post-diagnosis, conditional on survival from ovarian cancer and other causes of mortality was 7.8%. Based on our simulation results, among all BRCA mutation-carrying patients diagnosed with stage III/IV ovarian cancer at age 50, the chance of dying before age 80 was reduced by less than 1% with MRI and by less than 2% with mastectomy. Greater improvements in survival with MRI or mastectomy were observed for women who had already survived 10years after ovarian cancer, and for women with stage I or II ovarian cancer. Among BRCA mutation-carrying ovarian cancer patients without a personal history of breast cancer, neither preventive mastectomy nor MRI screening is warranted, except for those who have survived ovarian cancer without recurrence for ten years and for those with early stage ovarian cancer. Copyright © 2017

  3. Does the health status of intimate partner violence victims warrant pharmacies as portals for public health promotion?

    Science.gov (United States)

    Cerulli, Catherine; Cerulli, Jennifer; Santos, Elizabeth J; Lu, Najii; He, Hua; Kaukeinen, Kimberly; White, Anne Marie; Tu, Xin

    To explore whether the health status of intimate partner violence (IPV) victims warrants pharmacies to be portals for public health promotion. Specific objectives included (1) identifying prevalence of IPV including domestic violence (DV) and sexual assault (SA) in a community sample, (2) describing characteristics and correlates of DV/SA between participants who reported and did not report DV/SA, and (3) exploring whether DV/SA status is related to mental health medication use. Cross sectional. Upstate New York during 2006. English- and Spanish-speaking respondents younger than 65 years of age answering four questions to assess DV/SA. Secondary analysis of a countywide random telephone survey, the 2006 Monroe County Adult Health Survey, which collects prevalence data on health behaviors and health status indicators. To determine whether those reporting DV/SA are at increased odds for mental health medication use, controlling for other sociodemographic- and health-related variables. The survey response rate was 30.3%, with 1,881 respondents meeting inclusion criteria. Those reporting DV/SA were almost twice as likely to use mental health medications. However, when controlling for other variables, only poor mental and physical health were significant in increasing the odds of mental health medication use. The analyses reported here suggest that DV/SA victims in a community sample use mental health medications. When controlling for other variables, survey respondents reported worse physical and mental health. If pharmacies are suitable portals for DV/SA outreach, curricula would need to provide the knowledge and skills needed to take an active role in this public health promotion.

  4. Is a comparative clinical trial for breast cancer tumor markers to monitor disease recurrence warranted? A value of information analysis.

    Science.gov (United States)

    Thariani, Rahber; Henry, Norah Lynn; Ramsey, Scott D; Blough, David K; Barlow, Bill; Gralow, Julie R; Veenstra, David L

    2013-05-01

    Breast cancer tumor markers are used by some clinicians to screen for disease recurrence risk. Since there is limited evidence of benefit, additional research may be warranted. To assess the potential value of a randomized clinical trial of breast tumor marker testing in routine follow-up of high-risk, stage II-III breast cancer survivors. We developed a decision-analytic model of tumor marker testing plus standard surveillance every 3-6 months for 5 years. The expected value of sample information was calculated using probabilistic simulations and was a function of: the probability of selecting the optimal monitoring strategy with current versus future information; the impact of choosing the nonoptimal strategy; and the size of the population affected. The value of information for a randomized clinical trial involving 9000 women was US$214 million compared with a cost of US$30-60 million to conduct such a trial. The probability of making an alternate, nonoptimal decision and choosing testing versus no testing was 32% with current versus future information from the trial. The impact of a nonoptimal decision was US$2150 and size of population impacted over 10 years was 308,000. The value of improved information on overall survival was US$105 million, quality of life US$37 million and test performance US$71 million. Conducting a randomized clinical trial of breast cancer tumor markers appears to offer a good societal return on investment. Retrospective analyses to assess test performance and evaluation of patient quality of life using tumor markers may also offer valuable areas of research. However, alternative investments may offer even better returns in investments and, as such, the trial concept deserves further study as part of an overall research-portfolio evaluation.

  5. West Nile Virus: High Transmission Rate in North-Western European Mosquitoes Indicates Its Epidemic Potential and Warrants Increased Surveillance.

    Directory of Open Access Journals (Sweden)

    Jelke J Fros

    Full Text Available West Nile virus (WNV is a highly pathogenic flavivirus transmitted by Culex spp. mosquitoes. In North America (NA, lineage 1 WNV caused the largest outbreak of neuroinvasive disease to date, while a novel pathogenic lineage 2 strain circulates in southern Europe. To estimate WNV lineage 2 epidemic potential it is paramount to know if mosquitoes from currently WNV-free areas can support further spread of this epidemic.We assessed WNV vector competence of Culex pipiens mosquitoes originating from north-western Europe (NWE in direct comparison with those from NA. We exposed mosquitoes to infectious blood meals of lineage 1 or 2 WNV and determined the infection and transmission rates. We explored reasons for vector competence differences by comparing intrathoracic injection versus blood meal infection, and we investigated the influence of temperature. We found that NWE mosquitoes are highly competent for both WNV lineages, with transmission rates up to 25%. Compared to NA mosquitoes, transmission rates for lineage 2 WNV were significantly elevated in NWE mosquitoes due to better virus dissemination from the midgut and a shorter extrinsic incubation time. WNV infection rates further increased with temperature increase.Our study provides experimental evidence to indicate markedly different risk levels between both continents for lineage 2 WNV transmission and suggests a degree of genotype-genotype specificity in the interaction between virus and vector. Our experiments with varying temperatures explain the current localized WNV activity in southern Europe, yet imply further epidemic spread throughout NWE during periods with favourable climatic conditions. This emphasizes the need for intensified surveillance of virus activity in current WNV disease-free regions and warrants increased awareness in clinics throughout Europe.

  6. DOE handbook: Design considerations

    International Nuclear Information System (INIS)

    1999-04-01

    The Design Considerations Handbook includes information and suggestions for the design of systems typical to nuclear facilities, information specific to various types of special facilities, and information useful to various design disciplines. The handbook is presented in two parts. Part 1, which addresses design considerations, includes two sections. The first addresses the design of systems typically used in nuclear facilities to control radiation or radioactive materials. Specifically, this part addresses the design of confinement systems and radiation protection and effluent monitoring systems. The second section of Part 1 addresses the design of special facilities (i.e., specific types of nonreactor nuclear facilities). The specific design considerations provided in this section were developed from review of DOE 6430.1A and are supplemented with specific suggestions and considerations from designers with experience designing and operating such facilities. Part 2 of the Design Considerations Handbook describes good practices and design principles that should be considered in specific design disciplines, such as mechanical systems and electrical systems. These good practices are based on specific experiences in the design of nuclear facilities by design engineers with related experience. This part of the Design Considerations Handbook contains five sections, each of which applies to a particular engineering discipline

  7. DOE handbook: Design considerations

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-04-01

    The Design Considerations Handbook includes information and suggestions for the design of systems typical to nuclear facilities, information specific to various types of special facilities, and information useful to various design disciplines. The handbook is presented in two parts. Part 1, which addresses design considerations, includes two sections. The first addresses the design of systems typically used in nuclear facilities to control radiation or radioactive materials. Specifically, this part addresses the design of confinement systems and radiation protection and effluent monitoring systems. The second section of Part 1 addresses the design of special facilities (i.e., specific types of nonreactor nuclear facilities). The specific design considerations provided in this section were developed from review of DOE 6430.1A and are supplemented with specific suggestions and considerations from designers with experience designing and operating such facilities. Part 2 of the Design Considerations Handbook describes good practices and design principles that should be considered in specific design disciplines, such as mechanical systems and electrical systems. These good practices are based on specific experiences in the design of nuclear facilities by design engineers with related experience. This part of the Design Considerations Handbook contains five sections, each of which applies to a particular engineering discipline.

  8. Transplanting the Body: Preliminary Ethical Considerations.

    Science.gov (United States)

    Miller, Lantz Fleming

    2017-11-01

    A dissociated area of medical research warrants bioethical consideration: a proposed transplantation of a donor's entire body, except head, to a patient with a fatal degenerative disease. The seeming improbability of such an operation can only underscore the need for thorough bioethical assessment: Not assessing a case of such potential ethical import, by showing neglect instead of facing the issue, can only compound the ethical predicament, perhaps eroding public trust in ethical medicine. This article discusses the historical background of full-body transplantation, documents the seriousness of its current pursuit, and builds an argument for why prima facie this type of transplant is bioethically distinct. Certainly, this examination can only be preliminary, indicating what should be a wide and vigorous discussion among practitioners and ethicists. It concludes with practical suggestions for how the medical and bioethics community may proceed with ethical assessment.

  9. Nutritional Considerations for Bouldering.

    Science.gov (United States)

    Smith, Edward J; Storey, Ryan; Ranchordas, Mayur K

    2017-08-01

    Bouldering competitions are held up to International level and governed by the International Federation of Sport Climbing. Bouldering has been selected to feature at the 2020 Olympic Games in Tokyo, however, physiological qualities and nutritional requirements to optimize performance remain inadequately defined due to large gaps in the literature. The primary goals of training include optimizing the capacity of the anaerobic energy systems and developing sport-specific strength, with emphasis on the isometric function of the forearm flexors responsible for grip. Bouldering athletes typically possess a lean physique, similar to the characteristics of sport climbers with reported body fat values of 6-12%. Athletes strive for a low body weight to improve power to weight ratio and limit the load on the extremities. Specialized nutritional support is uncommon and poor nutritional practices such as chronic carbohydrate restriction are prevalent, compromising the health of the athletes. The high intensity nature of bouldering demands a focus on adequate carbohydrate availability. Protein intake and timing should be structured to maximize muscle protein synthesis and recovery, with the literature suggesting 0.25-0.3 g/kg in 3-4 hr intervals. Supplementing with creatine and b-alanine may provide some benefit by augmenting the capacity of the anaerobic systems. Boulderers are encouraged to seek advice from nutrition experts to enhance performance, particularly important when weight loss is the desired outcome. Further research is warranted across all nutritional aspects of bouldering which is summarized in this review.

  10. Entrepreneurship: Some Considerations

    Directory of Open Access Journals (Sweden)

    V. Martinho

    2016-02-01

    Full Text Available In this work it is presented some considerations about entrepreneurship. Most of these questions are linked with Portuguese context. Portugal has some particularities, namely because the asymmetries between the littoral and the interior. This situation carried out some problems that complicate and prevent the appearance of new innovated business. In a situation of crisis like that we have today this context can become a really problem to solve some questions.

  11. Fusion facility siting considerations

    International Nuclear Information System (INIS)

    Bussell, G.T.

    1985-01-01

    Inherent in the fusion program's transition from hydrogen devices to commercial power machines is a general increase in the size and scope of succeeding projects. This growth will lead to increased emphasis on safety, environmental impact, and the external effects of fusion in general, and of each new device in particular. A critically important consideration in this regard is site selection. The purpose of this paper is to examine major siting issues that may affect the economics, safety, and environmental impact of fusion

  12. Storage array reflection considerations

    International Nuclear Information System (INIS)

    Haire, M.J.; Jordan, W.C.; Taylor, R.G.

    1997-01-01

    The assumptions used for reflection conditions of single containers are fairly well established and consistently applied throughout the industry in nuclear criticality safety evaluations. Containers are usually considered to be either fully water reflected (i.e., surrounded by 6 to 12 in. of water) for safety calculations or reflected by 1 in. of water for nominal (structural material and air) conditions. Tables and figures are usually available for performing comparative evaluations of containers under various loading conditions. Reflection considerations used for evaluating the safety of storage arrays of fissile material are not as well established. When evaluating arrays, it has become more common for analysts to use calculations to demonstrate the safety of the array configuration. In performing these calculations, the analyst has considerable freedom concerning the assumptions made for modeling the reflection of the array. Considerations are given for the physical layout of the array with little or no discussion (or demonstration) of what conditions are bounded by the assumed reflection conditions. For example, an array may be generically evaluated by placing it in a corner of a room in which the opposing walls are far away. Typically, it is believed that complete flooding of the room is incredible, so the array is evaluated for various levels of water mist interspersed among array containers. This paper discusses some assumptions that are made regarding storage array reflection

  13. Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

    Science.gov (United States)

    Penney, Christine; Henry, Effie

    2008-01-01

    raised by the finding in Australia that the current case-mix system is inadequate to describe these patients. Further, given the inadequacy of our understanding of health system capacity and output, consideration of a more comprehensive national reporting system along the care continuum may be warranted. This project is an example of effective collaboration between the provincial government, a national organization and HAs, and suggests that provincial governments can participate in a meaningful way to accomplish research-informed health services policy.

  14. When pathological and radiological correlation is achieved, excision of fibroadenoma with lobular neoplasia on core biopsy is not warranted.

    Science.gov (United States)

    Fives, C; O'Neill, C J; Murphy, R; Corrigan, M A; O'Sullivan, M J; Feeley, L; Bennett, M W; O'Connell, F; Browne, T J

    2016-12-01

    The diagnosis and management of lobular neoplasia (LN) including lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) remains controversial. Current management options after a core needle biopsy (CNB) with lobular neoplasia (LN) incorporating both ALH and LCIS include excision biopsy or careful clinical and radiologic follow up. A retrospective analysis of the surgical database at Cork University Hospital was performed to identify all core needle biopsies from January 1st 2010 to 31st December 2013 with a diagnosis of FA who subsequently underwent surgical excision biopsy. All cases with associated LN including ALH and classical LCIS were selected. We excluded cases with coexistent ductal carcinoma in situ (DCIS), invasive carcinoma, LN associated with necrosis, pleomorphic lobular carcinoma in situ (PLCIS) or lesions which would require excision in their own right (papilloma, radial scar, atypical ductal hyperplasia (ADH) or flat epithelial atypia (FEA)). Cases in which the radiologic targeted mass was discordant with a diagnosis of FA were also excluded. 2878 consecutive CNB with a diagnosis of FA were identified. 25 cases had a diagnosis of concomitant ALH or classical LCIS. Our study cohort consisted of 21 women with a mean age 53 years (age range 41-70 years). The core biopsy diagnosis was of LCIS and FA in 16 cases and ALH and FA in 5 cases. On excision biopsy, a FA was confirmed in all 21 cases. In addition to the FA, residual LCIS was present in 14 cases with residual ALH in 2 cases. One of the twenty-one cases (4.8%) was upgraded to invasive ductal carcinoma on excision. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Some Sociological Contexts for Consideration When Designing a School Puberty/Sexuality Curriculum

    Science.gov (United States)

    Collier-Harris, Christine A.; Goldman, Juliette D. G.

    2017-01-01

    Sociological contexts are key factors in education and schooling. Contemporary contexts of world-view, or "Weltanschauungen," such as human rights, public health, demographics, biosocial factors including earlier puberty and a developmentalist approach, and technological connectivity, warrant significant professional consideration by…

  16. Health care operations management

    NARCIS (Netherlands)

    Carter, M.W.; Hans, Elias W.; Kolisch, R.

    2012-01-01

    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully

  17. Part 8. Deployment considerations

    International Nuclear Information System (INIS)

    Dance, K.D.; Chang, Y.I.; Daly, T.A.

    1980-01-01

    This report addresses considerations of fast breeder reactor development and deployment from a national perspective. Nations vary greatly in their expertise and interest relative to nuclear power, and hence a single set of steps to be taken by a nation in decision-making on breeder development and deployment cannot be presented. The approach taken in this report is to present discussions on key factors influencing the breeder development and deployment decisions, especially in non-breeder nations, by drawing upon historical perspectives of the Light Water Reactor for comparison

  18. Geophysical considerations of geothermics

    Energy Technology Data Exchange (ETDEWEB)

    Hayakawa, M

    1967-01-01

    The development and utilization of geothermal energy is described from the standpoint of geophysics. The internal temperature of the Earth and the history and composition of magmas are described. Methods of exploration such as gravity, magnetic, thermal and electrical surveys are discussed, as are geochemical and infrared photogrammetric techniques. Examples are provided of how these techniques have been used in Italy and at the Matsukawa geothermal field in Japan. Drilling considerations such as muds, casings and cementing materials are discussed. Solutions are proposed for problems of environmental pollution and plant expansion.

  19. Storage array reflection considerations

    International Nuclear Information System (INIS)

    Haire, M.J.; Jordan, W.C.; Taylor, R.G.

    1997-01-01

    The assumptions used for reflection conditions of single containers are fairly well established and consistently applied throughout the industry in nuclear criticality safety evaluations. Containers are usually considered to be either fully water-reflected (i.e. surrounded by 6 to 12 in. of water) for safety calculations or reflected by 1 in. of water for nominal (structural material and air) conditions. Tables and figures are usually available for performing comparative evaluations of containers under various loading conditions. Reflection considerations used for evaluating the safety of storage arrays of fissile material are not as well established

  20. Committee Opinion No. 726 Summary: Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care.

    Science.gov (United States)

    2017-12-01

    Large-scale catastrophic events and infectious disease outbreaks highlight the need for disaster planning at all community levels. Features unique to the obstetric population (including antepartum, intrapartum, postpartum and neonatal care) warrant special consideration in the event of a disaster. Pregnancy increases the risks of untoward outcomes from various infectious diseases. Trauma during pregnancy presents anatomic and physiologic considerations that often can require increased use of resources such as higher rates of cesarean delivery. Recent evidence suggests that floods and human-influenced environmental disasters increase the risks of spontaneous miscarriages, preterm births, and low-birth-weight infants among pregnant women. The potential surge in maternal and neonatal patient volume due to mass-casualty events, transfer of high-acuity patients, or redirection of patients because of geographic barriers presents unique challenges for obstetric care facilities. These circumstances require that facilities plan for additional increases in necessary resources and staffing. Although emergencies may be unexpected, hospitals and obstetric delivery units can prepare to implement plans that will best serve maternal and pediatric care needs when disasters occur. Clear designation of levels of maternal and neonatal care facilities, along with establishment of a regional network incorporating hospitals that provide maternity services and those that do not, will enable rapid transport of obstetric patients to the appropriate facilities, ensuring the right care at the right time. Using common terminology for triage and transfer and advanced knowledge of regionalization and levels of care will facilitate disaster preparedness.

  1. Committee Opinion No. 726: Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care.

    Science.gov (United States)

    2017-12-01

    Large-scale catastrophic events and infectious disease outbreaks highlight the need for disaster planning at all community levels. Features unique to the obstetric population (including antepartum, intrapartum, postpartum and neonatal care) warrant special consideration in the event of a disaster. Pregnancy increases the risks of untoward outcomes from various infectious diseases. Trauma during pregnancy presents anatomic and physiologic considerations that often can require increased use of resources such as higher rates of cesarean delivery. Recent evidence suggests that floods and human-influenced environmental disasters increase the risks of spontaneous miscarriages, preterm births, and low-birth-weight infants among pregnant women. The potential surge in maternal and neonatal patient volume due to mass-casualty events, transfer of high-acuity patients, or redirection of patients because of geographic barriers presents unique challenges for obstetric care facilities. These circumstances require that facilities plan for additional increases in necessary resources and staffing. Although emergencies may be unexpected, hospitals and obstetric delivery units can prepare to implement plans that will best serve maternal and pediatric care needs when disasters occur. Clear designation of levels of maternal and neonatal care facilities, along with establishment of a regional network incorporating hospitals that provide maternity services and those that do not, will enable rapid transport of obstetric patients to the appropriate facilities, ensuring the right care at the right time. Using common terminology for triage and transfer and advanced knowledge of regionalization and levels of care will facilitate disaster preparedness.

  2. Ethics of rationing of nursing care.

    Science.gov (United States)

    Rooddehghan, Zahra; Yekta, Zohreh Parsa; Nasrabadi, Alireza N

    2016-09-21

    Rationing of various needed services, for example, nursing care, is inevitable due to unlimited needs and limited resources. Rationing of nursing care is considered an ethical issue since it requires judgment about potential conflicts between personal and professional values. The present research sought to explore aspects of rationing nursing care in Iran. This study applied qualitative content analysis, a method to explore people's perceptions of everyday life phenomena and interpret the subjective content of text data. Data collection was performed through in-depth, unstructured, face-to-face interviews with open-ended questions. The study population included Iranian nurses of all nursing positions, from clinical nurses to nurse managers. Purposive sampling was employed to select 15 female and 3 male nurses (11 clinical nurses, 3 supervisors, 1 matron, 1 nurse, and 2 members of the Nursing Council) working in hospitals of three cities in Iran. The study protocol was approved by Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all participants. According to the participants, rationing of nursing care consisted of two categories, that is, causes of rationing and consequences of rationing. The first category comprised three subcategories, namely, patient needs and demands, routinism, and VIP patients. The three subcategories forming the second category were missed nursing care, patient dissatisfaction, and nurses' feeling of guilt. Levels at which healthcare practices are rationed and clarity of the rationing are important structural considerations in the development of an equal, appropriate, and ethical healthcare system. Moreover, the procedure of rationing is critical as it not only influences people's lives but also reflects the values that dominate in the society. Therefore, in order to minimize the negative consequences of rationing of nursing care, further studies on the ethical dimensions of this phenomenon

  3. Local anesthesia in dentistry - Clinical Considerations

    OpenAIRE

    Sharmraaj Subramaniam; Prasanna Neelakantan

    2013-01-01

    Local anaesthesia is commonly employed prior to most dental procedures. It is imperative to understand the mechanisms by which local anaesthetics work, so that their efficacy can be improved for painless dental care. Local anaesthesia also has major clinical implications in that it can precipitate emergencies in patients with an underlying systemic disease. It is imperative that a dentist have a thorough knowledge of the considerations one must take when administering local anaesthesia in pat...

  4. 29 CFR 530.303 - Considerations in determining amounts.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Considerations in determining amounts. 530.303 Section 530... REGULATIONS EMPLOYMENT OF HOMEWORKERS IN CERTAIN INDUSTRIES Civil Money Penalties § 530.303 Considerations in... representations; and (5) Exercise of due care. (b) An employer's financial inability to meet obligations under the...

  5. Hypochondriasis: considerations for ICD-11

    Directory of Open Access Journals (Sweden)

    Odile A. van den Heuvel

    2014-01-01

    Full Text Available The World Health Organization (WHO is currently revisiting the ICD. In the 10th version of the ICD, approved in 1990, hypochondriacal symptoms are described in the context of both the primary condition hypochondriacal disorder and as secondary symptoms within a range of other mental disorders. Expansion of the research base since 1990 makes a critical evaluation and revision of both the definition and classification of hypochondriacal disorder timely. This article addresses the considerations reviewed by members of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders in their proposal for the description and classification of hypochondriasis. The proposed revision emphasizes the phenomenological overlap with both anxiety disorders (e.g., fear, hypervigilance to bodily symptoms, and avoidance and obsessive-compulsive and related disorders (e.g., preoccupation and repetitive behaviors and the distinction from the somatoform disorders (presence of somatic symptom is not a critical characteristic. This revision aims to improve clinical utility by enabling better recognition and treatment of patients with hypochondriasis within the broad range of global health care settings.

  6. User interface design considerations

    DEFF Research Database (Denmark)

    Andersen, Simon Engedal; Jakobsen, Arne; Rasmussen, Bjarne D.

    1999-01-01

    and output variables. This feature requires special attention when designing the user interface and a special approach for controlling the user selection of input and output variables are developed. To obtain a consistent system description the different input variables are grouped corresponding......When designing a user interface for a simulation model there are several important issues to consider: Who is the target user group, and which a priori information can be expected. What questions do the users want answers to and what questions are answered using a specific model?When developing...... the user interface of EESCoolTools these issues led to a series of simulation tools each with a specific purpose and a carefully selected set of input and output variables. To allow a more wide range of questions to be answered by the same model, the user can change between different sets of input...

  7. Cosmetic surgery: medicolegal considerations

    Directory of Open Access Journals (Sweden)

    Piras Mauro

    2016-01-01

    Full Text Available Cosmetic surgery is one of the two branches of plastic surgery. The characteristic of non-necessity of this surgical speciality implies an increased severity in the evaluation of the risk-benefit balance. Therefore, great care must be taken in providing all the information necessary in order to obtain valid consent to the intervention. We analyzed judgments concerning cosmetic surgery found in national legal databases. A document of National Bioethics Committee (CNB was also analyzed. Conclusion: The receipt of valid, informed consent is of absolute importance not only to legitimise the medical-surgical act, but it also represents the key element in the question concerning the existence of an obligation to achieve certain results/use of certain methods in the cosmetic surgery.

  8. Epigenetic considerations in aquaculture

    Directory of Open Access Journals (Sweden)

    Mackenzie R. Gavery

    2017-12-01

    Full Text Available Epigenetics has attracted considerable attention with respect to its potential value in many areas of agricultural production, particularly under conditions where the environment can be manipulated or natural variation exists. Here we introduce key concepts and definitions of epigenetic mechanisms, including DNA methylation, histone modifications and non-coding RNA, review the current understanding of epigenetics in both fish and shellfish, and propose key areas of aquaculture where epigenetics could be applied. The first key area is environmental manipulation, where the intention is to induce an ‘epigenetic memory’ either within or between generations to produce a desired phenotype. The second key area is epigenetic selection, which, alone or combined with genetic selection, may increase the reliability of producing animals with desired phenotypes. Based on aspects of life history and husbandry practices in aquaculture species, the application of epigenetic knowledge could significantly affect the productivity and sustainability of aquaculture practices. Conversely, clarifying the role of epigenetic mechanisms in aquaculture species may upend traditional assumptions about selection practices. Ultimately, there are still many unanswered questions regarding how epigenetic mechanisms might be leveraged in aquaculture.

  9. Warrant Officer Examinations. PR-4018

    Science.gov (United States)

    1944-10-10

    ccouunting, Administrative - Clcorica1, Judge, Advo Ge~nc. De~ptsAdxiiniistrati~ve 1 icl Adi isrtv - Supp:ly, generaile8 ~ Administrativo ’ - Supply, Air...chronological index if action in processing special and summary records of trial. Answers teleph.’nic inquirie’s pertaining to subject matter contain- ed...reproduction by lithopraphy, black and white process printing, and gelatin duplication; moy couidinnte and supervise procurement, storage, and distribution of

  10. GENERAL PRINCIPLES OF EU (CRIMINAL LAW: LEGALITY, EQUALITY, NON-DISCRIMINATION, SPECIALTY AND NE BIS IN IDEM IN THE FIELD OF THE EUROPEAN ARREST WARRANT

    Directory of Open Access Journals (Sweden)

    NOREL NEAGU

    2012-05-01

    Full Text Available This article deals with the case law of the Court of Justice of the European Union in the field of the European arrest warrant, critically analysing the principles invoked in several decisions validating the European legislation in the field: legality, equality and non-discrimination, specialty, ne bis in idem. The author concludes that an area of freedom, security and justice could be built on these principles, but further harmonisation of legislation needs to be realised to avoid a ”journey to the unknown” for European citizens in respect to legislation of other member states of the EU.

  11. Do gaming disorder and hazardous gaming belong in the ICD-11? Considerations regarding the death of a hospitalized patient that was reported to have occurred while a care provider was gaming.

    Science.gov (United States)

    Potenza, Marc N

    2018-05-23

    There has been much debate regarding the extent to which different types and patterns of gaming may be considered harmful from individual and public health perspectives. A recent event in which a hospitalized patient was reported to have died while a care provider was gaming is worth considering as an example as to how gaming may distract individuals from work-related tasks or other activities, with potential negative consequences. As the 11th edition of the International Classification of Diseases is being developed, events like these are important to remember when considering entities like, and generating criteria for, disordered or hazardous gaming.

  12. Space Tourism: Orbital Debris Considerations

    Science.gov (United States)

    Mahmoudian, N.; Shajiee, S.; Moghani, T.; Bahrami, M.

    2002-01-01

    Space activities after a phase of research and development, political competition and national prestige have entered an era of real commercialization. Remote sensing, earth observation, and communication are among the areas in which this growing industry is facing competition and declining government money. A project like International Space Station, which draws from public money, has not only opened a window of real multinational cooperation, but also changed space travel from a mere fantasy into a real world activity. Besides research activities for sending man to moon and Mars and other outer planets, space travel has attracted a considerable attention in recent years in the form of space tourism. Four countries from space fairing nations are actively involved in the development of space tourism. Even, nations which are either in early stages of space technology development or just beginning their space activities, have high ambitions in this area. This is worth noting considering their limited resources. At present, trips to space are available, but limited and expensive. To move beyond this point to generally available trips to orbit and week long stays in LEO, in orbital hotels, some of the required basic transportations, living requirements, and technological developments required for long stay in orbit are already underway. For tourism to develop to a real everyday business, not only the price has to come down to meaningful levels, but also safety considerations should be fully developed to attract travelers' trust. A serious hazard to space activities in general and space tourism in particular is space debris in earth orbit. Orbiting debris are man-made objects left over by space operations, hazardous to space missions. Since the higher density of debris population occurs in low earth orbit, which is also the same orbit of interest to space tourism, a careful attention should be paid to the effect of debris on tourism activities. In this study, after a

  13. Physician Encounters with Human Trafficking: Legal Consequences and Ethical Considerations

    OpenAIRE

    Todres, Jonathan

    2017-01-01

    There is growing recognition and evidence that health care professionals regularly encounter - though they may not identify - victims of human trafficking in a variety of health care settings. Identifying and responding appropriately to trafficking victims or survivors requires not only training in trauma-informed care but also consideration of the legal and ethical issues that arise when serving this vulnerable population. This essay examines three areas of law that are relevant to this case...

  14. Matter of 381 Search Warrants Directed to Facebook, 2017 N.Y. Lexis 767, 2; 2017 NY Slip op. 02586, 2 (N.Y. April 4, 2017

    Directory of Open Access Journals (Sweden)

    Trad. Leopoldo Villar

    2017-08-01

    Full Text Available The growing importance of electronic communications gives a special interest to its protection, which involves several fundamental rights and guarantees such as freedom, privacy and property. Due to the importance of the discussion and the different positions it reflects on an issue of such sensitivity and pertinence in the world today, we publish below the translation of the decision by the Supreme Court of the State of New York of April 4, 2017, on the 381 search warrants directed to Facebook user accounts, ordered by the same Court in 2013 in response to a request by the New York County District Attorney, supported in turn by an affidavit given by a prosecutor in a criminal investigation. Facebook filed a motion seeking annulment of the search warrants and disclosure of the Prosecutor’s affidavit but both motions were rejected by the Appeals Division, whereupon Facebook appealed to the New York Supreme Court, which dismissed the appeal. Although most agreed that the appeal was not appropriate, the views of the judges contain interpretations that make their reading very useful and particularly the opinión given by the dissenting judge offers enriching arguments for defending the rights of users of electronic services.

  15. Environmental approvals in New Brunswick : economic considerations

    Energy Technology Data Exchange (ETDEWEB)

    Marrack, C.; Maitland, R. [Suez Renewable Energy North America, Houston, TX (United States)

    2008-07-01

    This presentation provided a timeline of economic considerations related to New Brunswick's regulatory approval process for wind power developments. The economics of wind power projects require careful consideration during the initial planning phases, as it is not yet known if projects are viable. Spending in the early stages of a project should therefore be limited to items that focus on components of the environmental impact assessment (EIA) process that include establishing a relationship with First Nations groups in the area, and conducting seasonal bird studies. Economic considerations change when project viability is confirmed, and developers can then progress to conducting traditional knowledge studies and further seasonal bird studies. Baseline information studies should be reviewed, and biophysical surveys should involve the identification of any wetlands, sensitive areas, and rare plants. Archaeology studies are also required by the provincial government, as well as bat studies to determine if the site has a resident population of bats. Public and stakeholder consultations and open houses should then be held with an adequate time-frame for the submission of questions and concerns and the development of mitigation strategies. Project viability should be confirmed before power purchase agreements (PPAs) are signed. After PPAs are signed, the largest economic consideration is the schedule-related risk associated with legal and financial problems. It was concluded that noise impact, visual impact, and socioeconomic assessments and studies can be conducted after the PPA is secured. tabs., figs.

  16. Cloning humans? Biological, ethical, and social considerations.

    Science.gov (United States)

    Ayala, Francisco J

    2015-07-21

    There are, in mankind, two kinds of heredity: biological and cultural. Cultural inheritance makes possible for humans what no other organism can accomplish: the cumulative transmission of experience from generation to generation. In turn, cultural inheritance leads to cultural evolution, the prevailing mode of human adaptation. For the last few millennia, humans have been adapting the environments to their genes more often than their genes to the environments. Nevertheless, natural selection persists in modern humans, both as differential mortality and as differential fertility, although its intensity may decrease in the future. More than 2,000 human diseases and abnormalities have a genetic causation. Health care and the increasing feasibility of genetic therapy will, although slowly, augment the future incidence of hereditary ailments. Germ-line gene therapy could halt this increase, but at present, it is not technically feasible. The proposal to enhance the human genetic endowment by genetic cloning of eminent individuals is not warranted. Genomes can be cloned; individuals cannot. In the future, therapeutic cloning will bring enhanced possibilities for organ transplantation, nerve cells and tissue healing, and other health benefits.

  17. Medicina intensiva no fim da vida: Reflexão sobre o posicionamento da Igreja católica Intensive medicine in the End-of-life Care: Considerations on the disposition of the Catholic church

    Directory of Open Access Journals (Sweden)

    Filipe Monteiro

    2007-07-01

    Full Text Available O fim da vida e os cuidados médicos são ciclicamente notícia nos órgãos da comunicação social. A posição da Igreja católica, em relação à qual existe um grande desconhecimento, tem estado, paradoxalmente, na origem de alguma controvérsia. Neste artigo, analisamos e reflectimos sobre os vários documentos daquela instituição religiosa, bem como a opinião de algumas personalidades que estudaram esta temática numa perspectiva católica.End-of-life care cyclically occupies the headlines of the mass media. The disposition of the Catholic church, this matter, although unknown to many, has been the subject of discussion and controversy. In this article we analysed various documents of that religious institution, as well as the opinion of some well known personalities who studied this theme from a Catholic perspective.

  18. An official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: ethical and policy considerations in organ donation after circulatory determination of death.

    Science.gov (United States)

    Gries, Cynthia J; White, Douglas B; Truog, Robert D; Dubois, James; Cosio, Carmen C; Dhanani, Sonny; Chan, Kevin M; Corris, Paul; Dark, John; Fulda, Gerald; Glazier, Alexandra K; Higgins, Robert; Love, Robert; Mason, David P; Nakagawa, Thomas A; Shapiro, Ron; Shemie, Sam; Tracy, Mary Fran; Travaline, John M; Valapour, Maryam; West, Lori; Zaas, David; Halpern, Scott D

    2013-07-01

    Donation after circulatory determination of death (DCDD) has the potential to increase the number of organs available for transplantation. Because consent and management of potential donors must occur before death, DCDD raises unique ethical and policy issues. To develop an ethics and health policy statement on adult and pediatric DCDD relevant to critical care and transplantation stakeholders. A multidisciplinary panel of stakeholders was convened to develop an ethics and health policy statement. The panel consisted of representatives from the American Thoracic Society, Society of Critical Care Medicine, International Society for Heart and Lung Transplantation, Association of Organ Procurement Organizations, and the United Network of Organ Sharing. The panel reviewed the literature, discussed important ethics and health policy considerations, and developed a guiding framework for decision making by stakeholders. A framework to guide ethics and health policy statement was established, which addressed the consent process, pre- and post mortem interventions, the determination of death, provisions of end-of-life care, and pediatric DCDD. The information presented in this Statement is based on the current evidence, experience, and clinical rationale. New clinical research and the development and dissemination of new technologies will eventually necessitate an update of this Statement.

  19. Developing nursing care plans.

    Science.gov (United States)

    Ballantyne, Helen

    2016-02-24

    This article aims to enhance nurses' understanding of nursing care plans, reflecting on the past, present and future use of care planning. This involves consideration of the central theories of nursing and discussion of nursing models and the nursing process. An explanation is provided of how theories of nursing may be applied to care planning, in combination with clinical assessment tools, to ensure that care plans are context specific and patient centred.

  20. Advanced LBB methodology and considerations

    International Nuclear Information System (INIS)

    Olson, R.; Rahman, S.; Scott, P.

    1997-01-01

    LBB applications have existed in many industries and more recently have been applied in the nuclear industry under limited circumstances. Research over the past 10 years has evolved the technology so that more advanced consideration of LBB can now be given. Some of the advanced considerations for nuclear plants subjected to seismic loading evaluations are summarized in this paper

  1. Revealed preference with limited consideration

    NARCIS (Netherlands)

    Demuynck, T.; Seel, C.

    2014-01-01

    We derive revealed preference tests for models where individuals use consideration sets to simplify their consumption problem. Our basic test provides necessary and sufficient conditions for consistency of observed choices with the existence of consideration set restrictions. The same conditions can

  2. Ethical Considerations in Technology Transfer.

    Science.gov (United States)

    Froehlich, Thomas J.

    1991-01-01

    Examines ethical considerations involved in the transfer of appropriate information technology to less developed countries. Approaches to technology are considered; two philosophical frameworks for studying ethical considerations are discussed, i.e., the Kantian approach and the utilitarian perspective by John Stuart Mill; and integration of the…

  3. Advanced LBB methodology and considerations

    Energy Technology Data Exchange (ETDEWEB)

    Olson, R.; Rahman, S.; Scott, P. [Battelle, Columbus, OH (United States)] [and others

    1997-04-01

    LBB applications have existed in many industries and more recently have been applied in the nuclear industry under limited circumstances. Research over the past 10 years has evolved the technology so that more advanced consideration of LBB can now be given. Some of the advanced considerations for nuclear plants subjected to seismic loading evaluations are summarized in this paper.

  4. The integration of behavioral health interventions in children's health care: services, science, and suggestions.

    Science.gov (United States)

    Kolko, David J; Perrin, Ellen

    2014-01-01

    Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.

  5. Design Considerations | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  6. State/Federal Regulatory Considerations

    Science.gov (United States)

    This page contains presentations from the Brown to Green: Make the Connection to Renewable Energy workshop held in Santa Fe, New Mexico, during December 10-11, 2008, regarding State/Federal Regulatory Considerations.

  7. Design considerations for community mental health management information systems.

    Science.gov (United States)

    Lowe, B H; Sugarman, B

    1978-01-01

    Many community mental health centers are presently faced with the necessity of implementing a management information system. This article offers guidelines for centers dealing with this situation. Whether a center chooses to adapt an existing system or develop one of its own, careful planning prior to the implementation of the system can help ensure that it will meet the needs of the center and operate successfully. The guidelines are organized into the categories of data considerations, people considerations, and system considerations. The first two categories are of general interest, whereas the last category is more technical in nature.

  8. The European Arrest Warrant in the Italian legal system. Between mutual recognition and mutual fear within the European area of Freedom, Security and Justice

    Directory of Open Access Journals (Sweden)

    Franco Impalà

    2005-12-01

    Full Text Available Italy was the last Member State to transpose the Framework Decision on the European Arrest Warrant. The Italian law entered into full force on 14 May 2005, a full sixteen months later than the appointed date. Conversely, whilst the Framework Decision aimed to speed up extradition between Member States, the Italian implementation law seems to complicate things, providing for dozens of new legal obstacles to surrender. In fact, the execution of an EAW in Italy threatens to become something highly unpredictable. The responsibility for this outcome is shared by the national and the European legislator. Perhaps the latter underestimated the seriousness of the conflict between Third Pillar law and domestic constitutional systems which aim to protect their acquis in the field of fundamental rights. Considering that many Member States seem to be struggling with similar problems, the first part of this article is devoted to describing the current scenario and analysing possible solutions at the supranational level, such as the establishment of a coherent system regulating the allocation of penal competences among Member States. In the next part, the problem of the Framework Decision’s incompatibility with the Italian Constitution will be discussed, and in the final part the Italian implementation law is analysed in more detail.

  9. Physician Encounters with Human Trafficking: Legal Consequences and Ethical Considerations.

    Science.gov (United States)

    Todres, Jonathan

    2017-01-01

    There is growing recognition and evidence that health care professionals regularly encounter-though they may not identify-victims of human trafficking in a variety of health care settings. Identifying and responding appropriately to trafficking victims or survivors requires not only training in trauma-informed care but also consideration of the legal and ethical issues that arise when serving this vulnerable population. This essay examines three areas of law that are relevant to this case scenario: criminal law, with a focus on conspiracy; service provider regulations, with a focus on mandatory reporting laws; and human rights law. In addition to imposing a legal mandate, the law can inform ethical considerations about how health care professionals should respond to human trafficking. © 2017 American Medical Association. All Rights Reserved.

  10. Treatment Effects of a Primary Care Intervention on Parenting Behaviors: Sometimes It's Relative.

    Science.gov (United States)

    Shaffer, Anne; Lindhiem, Oliver; Kolko, David

    2017-04-01

    The goal of this brief report is to demonstrate the utility of quantifying parental discipline practices as relative frequencies in measuring changes in parenting behavior and relations to child behavior following intervention. We explored comparisons across methodological approaches of assessing parenting behavior via absolute and relative frequencies in measuring improvements in parent-reported disciplinary practices (increases in positive parenting practices in response to child behavior; decreases in inconsistent discipline and use of corporal punishment) and child behavior problems. The current study was conducted as part of a larger clinical trial to evaluate the efficacy of a collaborative care intervention for behavior problems, ADHD, and anxiety in pediatric primary care practices (Doctor Office Collaborative Care; DOCC). Participants were 321 parent-child dyads (M child age = 8.00, 65 % male children) from eight pediatric practices that were cluster randomized to DOCC or enhanced usual care (EUC). Parents reported on their own discipline behaviors and child behavior problems. While treatment-related decreases in negative parenting were found using both the absolute and relative frequencies of parenting behaviors, results were different for positive parenting behaviors, which showed decreases when measured as absolute frequencies but increases when measured as relative frequencies. In addition, positive parenting was negatively correlated with child behavior problems when using relative frequencies, but not absolute frequencies, and relative frequencies of positive parenting mediated relations between treatment condition and outcomes. Our findings indicate that the methods used to measure treatment-related change warrant careful consideration.

  11. Ethical considerations for field research on fishes

    Directory of Open Access Journals (Sweden)

    Rhett H. Bennett

    2016-12-01

    Full Text Available Collection of data from animals for research purposes can negatively impact target or by-catch species if suitable animal ethics practices are not followed. This study aimed to assess the ethical requirements of peer-reviewed scientific journals that publish primary literature on fishes, and review the ethical considerations and animal care guidelines of national and international documents on the ethical treatment of animals for research, to provide an overview of the general ethical considerations for field research on fishes. A review of 250 peer-reviewed, ISI-rated journals publishing primary research on fishes revealed that nearly half (46% had no mention of ethics, treatment of animals or ethical requirements for publication in their author guidelines or publication policies. However, 18% of the journals reviewed identify a specific set of ethical guidelines to be followed before publishing research involving animals. Ethical considerations for investigators undertaking field research on fishes, common to most animal care policies, legislation and guiding documents, include adhering to relevant legislation, minimising sample sizes, reducing or mitigating pain and distress, employing the most appropriate and least invasive techniques and accurately reporting methods and findings. This information will provide potential investigators with a useful starting point for designing and conducting ethical field research. Application of ethical best practices in field sampling studies will improve the welfare of study animals and the conservation of rare and endangered species. Conservation implications: This article provides a list of ethical considerations for designing and conducting field research on fishes. By reviewing sampling techniques and processes that are frequently used in field research on fishes and by highlighting the potential negative impacts of these sampling techniques, this article is intended to assist researchers in planning

  12. Design considerations for mechanical snubbers

    International Nuclear Information System (INIS)

    Severud, L.K.; Summers, G.D.

    1980-03-01

    The use of mechanical snubbers to restrain piping during an earthquake event is becoming more common in design of nuclear power plants. The design considerations and qualification procedures for mechanical snubbers used on the Fast Flux Test Facility will be presented. Design precautions and requirements for both normal operation and seismic operation are necessary. Effects of environmental vibration (nonseismic) induced through the piping by pump shaft imbalance and fluid flow oscillations will be addressed. Also, the snubber dynamic characteristics of interest to design and snubber design application considerations will be discussed

  13. Patient care in radiography

    International Nuclear Information System (INIS)

    Ehrlich, R.A.; McCloskey, E.D.

    1989-01-01

    This book focuses on patient care procedures for radiographers. The authors focus on the role of the radiographer as a member of the health care team. The authors report on such topics as communication in patient care: safety, medico-legal considerations, transfer and positioning; physical needs; infection control; medication; CPR standards, acute situations; examination of the GI tract; contrast media; special imaging techniques and bedside radiography

  14. Primary care ... where?

    Science.gov (United States)

    Adcock, G B

    1999-07-01

    Corporate-based nurse managed centers are not the national norm. More prevalent is the use of an occupational health or physician-directed medical model of care. The author describes how a 14-year-old primary care center at a North Carolina computer software company is just "business as usual" when viewed in the context of the company's philosophy, goals, and culture. Included are considerations for nurse practitioners interested in the successful transplantation of this primary care model to other settings.

  15. A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability

    DEFF Research Database (Denmark)

    Eshoj, Henrik; Rasmussen, Sten; Frich, Lars Henrik

    2017-01-01

    BACKGROUND: Anterior shoulder dislocation is a common injury and may have considerable impact on shoulder-related quality of life (QoL). If not warranted for initial stabilising surgery, patients are mostly left with little to no post-traumatic rehabilitation. This may be due to lack of evidence......-based exercise programmes. In similar, high-impact injuries (e.g. anterior cruciate ligament tears in the knee) neuromuscular exercise has shown large success in improving physical function and QoL. Thus, the objective of this trial is to compare a nonoperative neuromuscular exercise shoulder programme...... dislocations due to at least one traumatic event will be randomised to 12 weeks of either a standardised, individualised or physiotherapist-supervised neuromuscular shoulder exercise programme or standard care (self-managed shoulder exercise programme). Patients will be stratified according to injury status...

  16. Nuclear energy applications - ethical considerations

    International Nuclear Information System (INIS)

    Hoermann, K.

    1980-01-01

    Following an Austrian referendum in 1978 which showed a small majority against operation of nuclear power stations, the economic penalties involved by this decision are qualitatively discussed, with emphasis on reduced standards of living. Religious considerations are examined and the difficulty of obtaining informed public opinion is stressed. Alternative sources of energy, including nuclear fusion, are briefly referred to. (G.M.E.)

  17. LABORATORY DESIGN CONSIDERATIONS FOR SAFETY.

    Science.gov (United States)

    National Safety Council, Chicago, IL. Campus Safety Association.

    THIS SET OF CONSIDERATIONS HAS BEEN PREPARED TO PROVIDE PERSONS WORKING ON THE DESIGN OF NEW OR REMODELED LABORATORY FACILITIES WITH A SUITABLE REFERENCE GUIDE TO DESIGN SAFETY. THERE IS NO DISTINCTION BETWEEN TYPES OF LABORATORY AND THE EMPHASIS IS ON GIVING GUIDES AND ALTERNATIVES RATHER THAN DETAILED SPECIFICATIONS. AREAS COVERED INCLUDE--(1)…

  18. General B factory design considerations

    International Nuclear Information System (INIS)

    Zisman, M.S.

    1992-12-01

    We describe the general considerations that go into the design of an asymmetric B factory collider. Justification is given for the typical parameters of such a facility, and the physics and technology challenges that arise from these parameter choices are discussed. Cost and schedule issues for a B factory are discussed briefly. A summary of existing proposals is presented, noting their similarities and differences

  19. Practical considerations for effective microendoscopy

    Science.gov (United States)

    Papaioannou, Thanassis; Papazoglou, Theodore G.; Daykhovsky, Leon; Gershman, Alex; Segalowitz, Jacob; Reznik, G.; Beeder, Clain; Chandra, Mudjianto; Grundfest, Warren S.

    1991-07-01

    This paper reports on the application of angioscopic technology to the endoscopy of previously inaccessible body cavities. Necessary instruments including endoscopes, light sources, cameras, video recorders, monitors, and other accessories are described. Practical considerations for effective instrumentation are discussed. An overview of our clinical microendoscopic applications in more than 630 patients is presented.

  20. Smallpox: clinical highlights and considerations for vaccination.

    Directory of Open Access Journals (Sweden)

    Mahoney M

    2003-01-01

    Full Text Available Smallpox virus has gained considerable attention as a potential bioterrorism agent. Recommendations for smallpox (vaccinia vaccination presume a low risk for use of smallpox as a terrorist biological agent and vaccination is currently recommended for selected groups of individuals such as health care workers, public health authorities, and emergency/rescue workers, among others. Information about adverse reactions to the smallpox vaccine is based upon studies completed during the 1950s and 1960s. The prevalence of various diseases has changed over the last four decades and new disease entities have been described during this period. The smallpox vaccination may be contra-indicated in many of these conditions. This has made pre-screening of potential vaccines necessary. It is believed that at present, the risks of vaccine-associated complications far outweigh the potential benefits of vaccination in the general population.

  1. Senior academic physicians and retirement considerations.

    Science.gov (United States)

    Moss, Arthur J; Greenberg, Henry; Dwyer, Edward M; Klein, Helmut; Ryan, Daniel; Francis, Charles; Marcus, Frank; Eberly, Shirley; Benhorin, Jesaia; Bodenheimer, Monty; Brown, Mary; Case, Robert; Gillespie, John; Goldstein, Robert; Haigney, Mark; Krone, Ronald; Lichstein, Edgar; Locati, Emanuela; Oakes, David; Thomsen, Poul Erik Bloch; Zareba, Wojciech

    2013-01-01

    An increasing number of academic senior physicians are approaching their potential retirement in good health with accumulated clinical and research experience that can be a valuable asset to an academic institution. Considering the need to let the next generation ascend to leadership roles, when and how should a medical career be brought to a close? We explore the roles for academic medical faculty as they move into their senior years and approach various retirement options. The individual and institutional considerations require a frank dialogue among the interested parties to optimize the benefits while minimizing the risks for both. In the United States there is no fixed age for retirement as there is in Europe, but European physicians are initiating changes. What is certain is that careful planning, innovative thinking, and the incorporation of new patterns of medical practice are all part of this complex transition and timing of senior academic physicians into retirement. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Orthodontic Treatment Consideration in Diabetic Patients.

    Science.gov (United States)

    Almadih, Ahmed; Al-Zayer, Maryam; Dabel, Sukainh; Alkhalaf, Ahmed; Al Mayyad, Ali; Bardisi, Wajdi; Alshammari, Shouq; Alsihati, Zainab

    2018-02-01

    Although orthodontic treatment is commonly indicated for young healthy individuals, recent trends showed an increase in number of older individuals undergoing orthodontic interventions. The increased age resulted in a proportionate increase in the prevalence of systemic diseases facing dentists during orthodontic procedures, especially diabetes mellitus. This necessitates that dentists should be aware of the diagnosis of diabetes mellitus and its early signs particularly in teeth and oral cavity. It is also essential for them to understand the implications of diabetes on orthodontic treatment and the measures to be considered during managing those patients. In this review, we focused on the impact of diabetes mellitus on orthodontic treatment. We also summarized the data from previous studies that had explained the measures required to be taken into consideration during managing those patients. We included both human and animal studies to review in depth the pathophysiological mechanisms by which diabetes affects orthodontic treatment outcome. In conclusion, this review emphasizes the need to carefully identify early signs and symptoms of diabetes mellitus in patients demanding orthodontic treatment and to understand the considerations to be adopted before and during treating these patients.

  3. Structural considerations in steam generator replacement

    International Nuclear Information System (INIS)

    Bertheau, S.R.; Gazda, P.A.

    1991-01-01

    Corrosion of the tubes and tube-support structures inside pressurized water reactor (PWR) steam generators has led many utilities to consider a replacement of the generators. Such a project is a major undertaking for a utility and must be well planned to ensure an efficient and cost-effective effort. This paper discusses various structural aspects of replacement options, such as total or partial generator replacement, along with their associated pipe cuts; major structural aspects associated with removal paths through the equipment hatch or through an opening in the containment wall, along with the related removal processes; onsite movement and storage of the generators; and the advantages and disadvantages of the removal alternatives. This paper addresses the major structural considerations associated with a steam generator replacement project. Other important considerations (e.g., licensing, radiological concerns, electrical requirements, facilities for management and onsite administrative activities, storage and fabrication activities, and offsite transportation) are not discussed in this paper, but should be carefully considered when undertaking a replacement project

  4. Preconception Care and Prenatal Care

    Science.gov (United States)

    ... Twitter Pinterest Email Print About Preconception Care and Prenatal Care What is preconception care? Preconception care is the ... improve the health of your child. What is prenatal care? Prenatal care is the health care a woman ...

  5. Taking care of Care

    NARCIS (Netherlands)

    Evelien Eggink; Debbie Oudijk; Isolde Woittiez

    2010-01-01

    Original title: Zorgen voor Zorg. The Dutch population will become increasingly older over the coming decades. This will have consequences for the use of care and consequently the demand for staff, especially in the nursing and care sectors (home care, nursing homes and residential care

  6. Predictors for the development of referral-warranted retinopathy of prematurity in the telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study.

    Science.gov (United States)

    Ying, Gui-Shuang; Quinn, Graham E; Wade, Kelly C; Repka, Michael X; Baumritter, Agnieshka; Daniel, Ebenezer

    2015-03-01

    Detection of treatment-requiring retinopathy of prematurity (ROP) involves serial eye examinations. An ROP prediction model using predictive factors could identify high-risk infants and reduce required eye examinations. To determine predictive factors for the development of referral-warranted (RW) ROP. This multicenter observational cohort study included secondary analysis of data from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study. Infants included in the study had a birth weight (BW) of less than 1251 g. Serial ROP examinations of premature infants who had 2 or more ROP examinations. Incidence of RW-ROP (defined as the presence of plus disease, zone I ROP, or ROP stage 3 or greater in either eye) and associations with predictive factors. Among 979 infants without RW-ROP at first study-related eye examination (median postmenstrual age, 33 weeks; range, 29-40 weeks) who underwent at least 2 eye examinations, 149 (15.2%) developed RW-ROP. In a multivariate model, significant predictors for RW-ROP were male sex (odds ratio [OR], 1.80; 95% CI, 1.13-2.86 vs female), nonblack race (OR, 2.76; 95% CI, 1.50-5.08 for white vs black race and OR, 4.81; 95% CI, 2.19-10.6 for other vs black race), low BW (OR, 5.16; 95% CI, 1.12-7.20 for ≤500 g vs >1100 g), younger gestational age (OR, 9.79; 95% CI, 3.49-27.5 for ≤24 weeks vs ≥28 weeks), number of quadrants with preplus disease (OR, 7.12; 95% CI, 2.53-20.1 for 1-2 quadrants and OR, 18.4; 95% CI, 4.28-79.4 for 3-4 quadrants vs no preplus disease), stage 2 ROP (OR, 4.13; 95% CI, 2.13-8.00 vs no ROP), the presence of retinal hemorrhage (OR, 4.36; 95% CI, 1.57-12.1 vs absence), the need for respiratory support (OR, 4.99; 95% CI, 1.89-13.2 for the need for controlled mechanical ventilator; OR, 11.0; 95% CI, 2.26-53.8 for the need for high-frequency oscillatory ventilation vs no respiratory support), and slow weight gain (OR, 2.44; 95% CI, 1.22-4.89 for weight gain ≤12 g/d vs >18 g

  7. When Should We Care About Sustainability? Applying Human Security as the Decisive Criterion

    Directory of Open Access Journals (Sweden)

    Alexander K. Lautensach

    2012-05-01

    Full Text Available It seems intuitively clear that not all human endeavours warrant equal concern over the extent of their sustainability. This raises the question about what criteria might best serve for their prioritisation. We refute, on empirical and theoretical grounds, the counterclaim that sustainability should be of no concern regardless of the circumstances. Human security can serve as a source of criteria that are both widely shared and can be assessed in a reasonably objective manner. Using established classifications, we explore how four forms of sustainability (environmental, economic, social, and cultural relate to the four pillars of human security (environmental, economic, sociopolitical, and health-related. Our findings, based on probable correlations, suggest that the criteria of human security allow for a reliable discrimination between relatively trivial incidences of unsustainable behavior and those that warrant widely shared serious concern. They also confirm that certain sources of human insecurity, such as poverty or violent conflict, tend to perpetuate unsustainable behavior, a useful consideration for the design of development initiatives. Considering that human security enjoys wide and increasing political support among the international community, it is to be hoped that by publicizing the close correlation between human security and sustainability greater attention will be paid to the latter and to its careful definition.

  8. Promotion of nutrition care by Australian fitness businesses: a website analysis.

    Science.gov (United States)

    Barnes, K; Ball, L; Desbrow, B

    2016-11-01

    To investigate the intention of fitness businesses to promote the provision of nutrition care from personal trainers. Cross-sectional evaluation of webpage content. Fitness businesses within two Australian federal electorates were identified using the Fitness Australia list of registered fitness businesses. Inductive content analysis of these fitness business websites and associated social media sites was undertaken to compare website content to the Fitness Australia Position Statement outlining the Roles and Responsibilities of Registered Fitness Professionals. Fitness businesses were classified as 'within scope of practice' if they referred to national nutrition guidelines or dietetic services. 'At risk of being beyond scope' included websites which did not include enough information to definitively state within or beyond scope. Fitness businesses were classified as 'definitely beyond scope of practice' if they advertised nutrition care which clearly extended beyond translation of the national dietary guidelines. Of the businesses reviewed, 15% were within scope despite none referring to a dietitian; 34% were at risk of being beyond scope; and 51% were beyond scope as they advertised nutrition care such as personalized diets without indicating dietetic input. A considerable portion of fitness businesses reviewed advertised their personal trainers as able to provide nutrition care outside the recommended scope of practice. Strategies that help fitness businesses and personal trainers to support clients to have healthy dietary behaviours without extending outside the scope of practice are warranted. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  9. Availability and quality of emergency obstetric care in Gambia's main referral hospital: women-users' testimonies

    Directory of Open Access Journals (Sweden)

    Sundby Johanne

    2009-04-01

    Full Text Available Abstract Background Reduction of maternal mortality ratio by two-thirds by 2015 is an international development goal with unrestricted access to high quality emergency obstetric care services promoted towards the attainment of that goal. The objective of this qualitative study was to assess the availability and quality of emergency obstetric care services in Gambia's main referral hospital. Methods From weekend admissions a group of 30 women treated for different acute obstetric conditions including five main diagnostic groups: hemorrhage, hypertensive disorders, dystocia, sepsis and anemia were purposively selected. In-depth interviews with the women were carried out at their homes within two weeks of discharge. Results Substantial difficulties in obtaining emergency obstetric care were uncovered. Health system inadequacies including lack of blood for transfusion, shortage of essential medicines especially antihypertensive drugs considerably hindered timely and adequate treatment for obstetric emergencies. Such inadequacies also inflated the treatment costs to between 5 and 18 times more than standard fees. Blood transfusion and hypertensive treatment were associated with the largest costs. Conclusion The deficiencies in the availability of life-saving interventions identified are manifestations of inadequate funding for maternal health services. Substantial increase in funding for maternal health services is therefore warranted towards effective implementation of emergency obstetric care package in The Gambia.

  10. Consideraciones sobre las categorías de acceso a la atención en salud y procesos de estigmatización en personas externadas de instituciones de salud mental Considerations on the categories of accessibility to health care and stigmatization process of mental health care outpatient

    Directory of Open Access Journals (Sweden)

    Pamela Garbus

    2010-12-01

    Full Text Available Se considera a la accesibilidad a la atención en salud y los procesos estigmatizantes como una dimensión de un problema complejo que merecen ser analizados en distintos niveles: uno Macrocontextual, uno de Metaprocesos y uno de Microprocesos. Las prácticas de atención en salud deben leerse en la articulación de estas dos categorías y en el entretejido de estos tres niveles de análisis. Los procesos de estigmatización no necesariamente han de convertirse en barreras de acceso al sistema. El estigma también puede operar como facilitador del acceso a partir de la inclusión de estos sujetos en políticas focalizadas. Debemos interrogarnos no solo por las barreras de acceso que existen para una población tal, sino aún ¿cuáles son las características de la accesibilidad a la atención en salud de esta población específica? Muchas de las prácticas que se llevan a cabo con esta población se sostienen en una lógica de victimización que continúa objetivando la locura.It is consider the accessibility of health care and stigmatizing processes as a dimension of a complex problem that deserves to be analyzed at different levels: one Macro context, one of Meta procesess and one of micro procesess. The health care practices should be read in the articulation of these two categories and in the interweaving of these three levels of analysis. Stigmatization processes not necesary become barriers to access to the health system. Stigma can also operate as a facilitator of access whith the inclusion of these subjects in targeted policies. We should inquire not only for access barriers that exist for these population, but still what are the characteristics of accessibility to health care in this specific population? Many of the practices that take place with this population are held in a logic of victimization that continues aiming madness.

  11. Commercial considerations in tissue engineering.

    Science.gov (United States)

    Mansbridge, Jonathan

    2006-10-01

    Tissue engineering is a field with immense promise. Using the example of an early tissue-engineered skin implant, Dermagraft, factors involved in the successful commercial development of devices of this type are explored. Tissue engineering has to strike a balance between tissue culture, which is a resource-intensive activity, and business considerations that are concerned with minimizing cost and maximizing customer convenience. Bioreactor design takes place in a highly regulated environment, so factors to be incorporated into the concept include not only tissue culture considerations but also matters related to asepsis, scaleup, automation and ease of use by the final customer. Dermagraft is an allogeneic tissue. Stasis preservation, in this case cryopreservation, is essential in allogeneic tissue engineering, allowing sterility testing, inventory control and, in the case of Dermagraft, a cellular stress that may be important for hormesis following implantation. Although the use of allogeneic cells provides advantages in manufacturing under suitable conditions, it raises the spectre of immunological rejection. Such rejection has not been experienced with Dermagraft. Possible reasons for this and the vision of further application of allogeneic tissues are important considerations in future tissue-engineered cellular devices. This review illustrates approaches that indicate some of the criteria that may provide a basis for further developments. Marketing is a further requirement for success, which entails understanding of the mechanism of action of the procedure, and is illustrated for Dermagraft. The success of a tissue-engineered product is dependent on many interacting operations, some discussed here, each of which must be performed simultaneously and well.

  12. Considerations Regarding Students’ Social Protection

    Directory of Open Access Journals (Sweden)

    Iuliana Cenar

    2016-01-01

    Full Text Available The paper entitled “Considerations Regarding Students’ Social Protection” addresses the main forms of support offered to students and their families, divided in relation to the aim pursued, which may be relate to stimulating students’ performance and discipline, material and financial support (social assistance, supplementing family income. For these components there were taken into account: the circumstances in which it acquires to status of beneficiary, evolutionary dimensions in terms of beneficiary numbers, the amounts awarded, the need to ensure the complementarities with the informal side of social protection.

  13. Preliminary considerations concerning actinide solubilities

    International Nuclear Information System (INIS)

    Newton, T.W.; Bayhurst, B.P.; Daniels, W.R.; Erdal, B.R.; Ogard, A.E.

    1980-01-01

    Work at the Los Alamos Scientific Laboratory on the fundamental solution chemistry of the actinides has thus far been confined to preliminary considerations of the problems involved in developing an understanding of the precipitation and dissolution behavior of actinide compounds under environmental conditions. Attempts have been made to calculate solubility as a function of Eh and pH using the appropriate thermodynamic data; results have been presented in terms of contour maps showing lines of constant solubility as a function of Eh and pH. Possible methods of control of the redox potential of rock-groundwater systems by the use of Eh buffers (redox couples) is presented

  14. Impact of prenatal care on postpartum child care

    OpenAIRE

    NWARU, BRIGHT

    2007-01-01

    Background: Although prenatal care has come a long way to be regarded as a standard routine care in pregnancy since its formal organization in the early 20th century, with several modifications to its content, it is just of recent that considerable attention was drawn to questions about its effectiveness. This awareness has led to several evaluations of the impact of prenatal care. Initially, these assessments concentrated on the effect of prenatal care on the more traditional outcomes (b...

  15. 28 CFR 51.34 - Expedited consideration.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Expedited consideration. 51.34 Section 51... consideration. (a) When a submitting authority is required under State law or local ordinance or otherwise finds... the submission be given expedited consideration. The submission should explain why such consideration...

  16. 46 CFR 114.550 - Special consideration.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Special consideration. 114.550 Section 114.550 Shipping... consideration. In applying the provisions of this subchapter, the OCMI may give special consideration to... vessel operates must approve any special consideration granted to the vessel. ...

  17. Sustainability considerations for integrated biorefineries.

    Science.gov (United States)

    Azapagic, Adisa

    2014-01-01

    Integrated biorefineries have the potential to contribute towards sustainable production of transportation fuels, energy, and chemicals. However, because there are currently no commercial biorefining plants in operation, it is not clear how sustainable they really are. This paper sets out to examine key issues associated with biorefining that should be considered carefully along the whole supply chain to ensure sustainable development of the sector. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Exemplary Care as a Mediator of the Effects of Caregiver Subjective Appraisal and Emotional Outcomes

    Science.gov (United States)

    Harris, Grant M.; Durkin, Daniel W.; Allen, Rebecca S.; DeCoster, Jamie; Burgio, Louis D.

    2011-01-01

    Purpose: Exemplary care (EC) is a new construct encompassing care behaviors that warrants further study within stress process models of dementia caregiving. Previous research has examined EC within the context of cognitively intact older adult care recipients (CRs) and their caregivers (CGs). This study sought to expand our knowledge of quality of…

  19. Orthodontic treatment considerations in Down syndrome patients

    Directory of Open Access Journals (Sweden)

    Sianiwati Goenharto

    2012-03-01

    Full Text Available Background: Down syndrome is an easily recognized congenital disease anomaly, a common autosomal chromosomal anomaly with high prevalence of malocclusion. Orthodontic treatment demand should be high but it seems difficult to be done because of specific condition of disability. Purpose: The purpose of this literature review was to discribe the orthodontic problems found in Down syndrome patients and several consideration that shoud be done to treat them. Reviews: Many studies report the high prevalence of malocclusion among people with Down syndrome. There is a greater frequency of clas III relationship, crossbite, crowding and also open bite. Several problems might appear in the treatment because of dental, medical, mental, and behavioural factor. Conclusion: It is concluded that orthodonic treatment can be performed in Down syndrome patient, although several difficulties may appear. Good consideration in mental, behavior, medical and also dental condition will influence whether the treatment will success or not. Special care and facilities will support the orthodontic treatment.Latar belakang: Sindroma Down adalah suatu kelainan congenital yang mudah dikenali, merupakan kelaian kromosom autosomal yang cukup banyak terjadi, dengan prevalensi maloklusi cukup tinggi. Seharusnya permintaan akan perawatan ortodonti juga tinggi meskipun tampaknya sulit dilakukan karena adanya kondisi ketidakmampuan/cacat yang spesifik. Tujuan: Tujuan studi pustaka ini adalah untuk menggambarkan problem perawatan ortodonti pada penderita sindroma Down dan pertimbangan apa yang sebaiknya diambil untuk mengatasi masalah tersebut. Tinjauan pustaka: Banyak penelitian melaporkan tentang prevalensi maloklusi yang tinggi pada penderita sindroma Down. Maloklusi yang sering dijumpai adalah relasi klas III, gigitan silang, berdesakan dan juga gigitan terbuka. Problem dapat terjadi saat perawatan ortodonti karena adanya faktor dental, medis, mental dan tingkah laku penderita

  20. Practical Considerations for Clinical PET/MR Imaging.

    Science.gov (United States)

    Galgano, Samuel; Viets, Zachary; Fowler, Kathryn; Gore, Lael; Thomas, John V; McNamara, Michelle; McConathy, Jonathan

    2018-01-01

    Clinical PET/MR imaging is currently performed at a number of centers around the world as part of routine standard of care. This article focuses on issues and considerations for a clinical PET/MR imaging program, focusing on routine standard-of-care studies. Although local factors influence how clinical PET/MR imaging is implemented, the approaches and considerations described here intend to apply to most clinical programs. PET/MR imaging provides many more options than PET/computed tomography with diagnostic advantages for certain clinical applications but with added complexity. A recurring theme is matching the PET/MR imaging protocol to the clinical application to balance diagnostic accuracy with efficiency. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Clinical and financial considerations for implementing an ICU telemedicine program.

    Science.gov (United States)

    Kruklitis, Robert J; Tracy, Joseph A; McCambridge, Matthew M

    2014-06-01

    As the population in the United States increases and ages, the need to provide high-quality, safe, and cost-effective care to the most critically ill patients will be of great importance. With the projected shortage of intensivists, innovative changes to improve efficiency and increase productivity will be necessary. Telemedicine programs in the ICUs (tele-ICUs) are a successful strategy to improve intensivist access to critically ill patients. Although significant capital and maintenance costs are associated with tele-ICUs, these costs can be offset by indirect financial benefits, such as decreased length of stay. To achieve the positive clinical outcomes desired, tele-ICUs must be carefully designed and implemented. In this article, we discuss the clinical benefits of tele-ICUs. We review the financial considerations, including direct and indirect reimbursement and development and maintenance costs. Finally, we review design and implementation considerations for tele-ICUs.

  2. Shaft and tunnel sealing considerations

    International Nuclear Information System (INIS)

    Kelsall, P.C.; Shukla, D.K.

    1980-01-01

    Much of the emphasis of previous repository sealing research has been placed on plugging small diameter boreholes. It is increasingly evident that equal emphasis should now be given to shafts and tunnels which constitute more significant pathways between a repository and the biosphere. The paper discusses differences in requirements for sealing shafts and tunnels as compared with boreholes and the implications for seal design. Consideration is given to a design approach for shaft and tunnel seals based on a multiple component design concept, taking into account the requirements for retrievability of the waste. A work plan is developed for the future studies required to advance shaft and tunnel sealing technology to a level comparable with the existing technology for borehole sealing

  3. Sodium concrete reaction - Structural considerations

    International Nuclear Information System (INIS)

    Ferskakis, G.N.

    1984-01-01

    An overview of the sodium concrete reaction phenomenon, with emphasis on structural considerations, is presented. Available test results for limestone, basalt, and magnetite concrete with various test article configurations are reviewed. Generally, tests indicate reaction is self limiting before all sodium is used. Uncertainties, however, concerning the mechanism for penetration of sodium into concrete have resulted in different theories about a reaction model. Structural behavior may be significant in the progression of the reaction due to thermal-structuralchemical interactions involving tensile cracking, compressive crushing, or general deterioration of concrete and the exposure of fresh concrete surfaces to react with sodium. Structural behavior of test articles and potential factors that could enhance the progression of the reaction are discussed

  4. Biosimilars: Considerations for Oncology Nurses
.

    Science.gov (United States)

    Vizgirda, Vida; Jacobs, Ira

    2017-04-01

    Biosimilars are developed to be highly similar to and treat the same conditions as licensed biologics. As they are approved and their use becomes more widespread, oncology nurses should be aware of their development and unique considerations. This article reviews properties of biosimilars; their regulation and approval process; the ways in which their quality, safety, and efficacy are evaluated; their postmarketing safety monitoring; and their significance to oncology nurses and oncology nursing.
. A search of PubMed and regulatory agency websites was conducted for references related to the development and use of biosimilars in oncology. 
. Because biologics are large, structurally complex molecules, biosimilars cannot be considered generic equivalents to licensed biologic products. Consequently, regulatory approval for biosimilars is different from approval for small-molecule generics. Oncology nurses are in a unique position to educate themselves, other clinicians, and patients and their families about biosimilars to ensure accurate understanding, as well as optimal and safe use, of biosimilars.

  5. Lyme Disease: Emergency Department Considerations.

    Science.gov (United States)

    Applegren, Nathan D; Kraus, Chadd K

    2017-06-01

    Lyme disease (LD) is the most common vector-borne illness in North America. Reported cases of LD have increased from approximately 10,000 cases annually in 1991 to >25,000 cases in 2014. Greater recognition, enhanced surveillance, and public education have contributed to the increased prevalence, as have geographic expansion and the number of infected ticks. Cases are reported primarily in the Northeastern United States, Wisconsin, and Minnesota, with children having the highest incidence of LD among all age groups. The increased incidence and prevalence of LD in the United States makes it increasingly more common for patients to present to the emergency department (ED) for tick bites and LD-related chief complaints, such as the characteristic erythema migrans skin manifestation. We sought to review the etiology of LD, describe its clinical presentations and sequela, and provide a practical classification and approach to ED management of patients with LD-related presentations. In this review, ED considerations for LD are presented and clinical presentations and management of the disease at different stages is discussed. Delayed sequelae that have significant morbidity, including Lyme carditis and Lyme neuroborreliosis, are discussed. Diagnostic tests and management are described in detail. The increasing prevalence and growing geographic reach of Lyme disease makes it critically important for emergency physicians to consider the diagnosis in patients presenting with symptoms suggestive of LD and to initiate appropriate treatment to minimize the potential of delayed sequelae. Special consideration should be made for the epidemiology of LD and a high clinical suspicion should be present for patients in endemic areas or with known exposures to ticks. Emergency physicians can play a critical role in the recognition, diagnosis, and treatment of LD. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. ANESTHETIC CONSIDERATION S IN CHRONIC OBSTRUCTIVE PULMON ARY DISEASE

    Directory of Open Access Journals (Sweden)

    Awati

    2015-03-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a spectrum of diseases that includes emphysema, chronic bronchitis, and small airway disease. It i s characterized by progressive increased resistance to breathing. Patients with marked obstructive pulmonary disease are at increased risk for both intraoperative and Postoperative pulmonary complications. These patients require thorough preoperative prepa ration, meticulous intraoperative management & postoperative care. This article describes anesthetic considerations in a patient with COPD.

  7. Economic considerations in psoriasis management.

    Science.gov (United States)

    Radtke, Marc Alexander; Augustin, Matthias

    2008-01-01

    With a prevalence of 2% to 3%, psoriasis is a very common chronic disease worldwide and generates therapy costs and continuing cost for health insurance and patients and their families. Cost-political changes in health care and the ever increasing health-economic demands in all areas of the health system make it necessary to differentiate between the two when recording the expenses for a disease. The main characteristics of the pharmacoeconomic evaluation are the record of costs, the cost-benefit and cost-effectiveness ratio, and efficiency of various treatment forms. Numerous publications discuss the cost of individual forms of therapy in the treatment of psoriasis, but there are fewer studies on the total cost of psoriasis therapy, especially studies that take both direct and indirect costs into account. The scientific articles on pharmacoeconomy and quality of life in psoriasis have proven (without a doubt) that, despite the lack of a vital threat, psoriasis is highly important to the national economy and to those who have the disease. This justifies appropriate monetary expenditure for treatment. Studies that address the cost of therapies (especially for chronic diseases) will be necessary in the future and will create the required transparency to guarantee reasonable medical care that takes the cost-benefit ratio and the best outcome for the patient's quality of life into account.

  8. Transition care for children with special health care needs.

    Science.gov (United States)

    Davis, Alaina M; Brown, Rebekah F; Taylor, Julie Lounds; Epstein, Richard A; McPheeters, Melissa L

    2014-11-01

    Approximately 750,000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice. Copyright © 2014 by the American Academy of Pediatrics.

  9. Ethical considerations for vaccination programmes in acute humanitarian emergencies

    Science.gov (United States)

    Hardie, Kate; Selgelid, Michael J; Waldman, Ronald J; Strebel, Peter; Rees, Helen; Durrheim, David N

    2013-01-01

    Abstract Humanitarian emergencies result in a breakdown of critical health-care services and often make vulnerable communities dependent on external agencies for care. In resource-constrained settings, this may occur against a backdrop of extreme poverty, malnutrition, insecurity, low literacy and poor infrastructure. Under these circumstances, providing food, water and shelter and limiting communicable disease outbreaks become primary concerns. Where effective and safe vaccines are available to mitigate the risk of disease outbreaks, their potential deployment is a key consideration in meeting emergency health needs. Ethical considerations are crucial when deciding on vaccine deployment. Allocation of vaccines in short supply, target groups, delivery strategies, surveillance and research during acute humanitarian emergencies all involve ethical considerations that often arise from the tension between individual and common good. The authors lay out the ethical issues that policy-makers need to bear in mind when considering the deployment of mass vaccination during humanitarian emergencies, including beneficence (duty of care and the rule of rescue), non-maleficence, autonomy and consent, and distributive and procedural justice. PMID:23599553

  10. Euthanasia of Cattle: Practical Considerations and Application.

    Science.gov (United States)

    Shearer, Jan Keith

    2018-04-17

    Acceptable methods for the euthanasia of cattle include overdose of an anesthetic, gunshot and captive bolt. The use of anesthetics for euthanasia is costly and complicates carcass disposal. These issues can be avoided by use of a physical method such as gunshot or captive bolt; however, each requires that certain conditions be met to assure an immediate loss of consciousness and death. For example, the caliber of firearm and type of bullet are important considerations when gunshot is used. When captive bolt is used, a penetrating captive bolt loaded with the appropriate powder charge and accompanied by a follow up (adjunctive) step to assure death are required. The success of physical methods also requires careful selection of the anatomic site for entry of a “free bullet” or “bolt” in the case of penetrating captive bolt. Disease eradication plans for animal health emergencies necessitate methods of euthanasia that will facilitate rapid and efficient depopulation of animals while preserving their welfare to the greatest extent possible. A portable pneumatic captive bolt device has been developed and validated as effective for use in mass depopulation scenarios. Finally, while most tend to focus on the technical aspects of euthanasia, it is extremely important that no one forget the human cost for those who may be required to perform the task of euthanasia on a regular basis. Symptoms including depression, grief, sleeplessness and destructive behaviors including alcoholism and drug abuse are not uncommon for those who participate in the euthanasia of animals.

  11. Euthanasia of Cattle: Practical Considerations and Application

    Directory of Open Access Journals (Sweden)

    Jan Keith Shearer

    2018-04-01

    Full Text Available Acceptable methods for the euthanasia of cattle include overdose of an anesthetic, gunshot and captive bolt. The use of anesthetics for euthanasia is costly and complicates carcass disposal. These issues can be avoided by use of a physical method such as gunshot or captive bolt; however, each requires that certain conditions be met to assure an immediate loss of consciousness and death. For example, the caliber of firearm and type of bullet are important considerations when gunshot is used. When captive bolt is used, a penetrating captive bolt loaded with the appropriate powder charge and accompanied by a follow up (adjunctive step to assure death are required. The success of physical methods also requires careful selection of the anatomic site for entry of a “free bullet” or “bolt” in the case of penetrating captive bolt. Disease eradication plans for animal health emergencies necessitate methods of euthanasia that will facilitate rapid and efficient depopulation of animals while preserving their welfare to the greatest extent possible. A portable pneumatic captive bolt device has been developed and validated as effective for use in mass depopulation scenarios. Finally, while most tend to focus on the technical aspects of euthanasia, it is extremely important that no one forget the human cost for those who may be required to perform the task of euthanasia on a regular basis. Symptoms including depression, grief, sleeplessness and destructive behaviors including alcoholism and drug abuse are not uncommon for those who participate in the euthanasia of animals.

  12. Energy considerations in real estate appraising

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-04-01

    Purposes of the seminar on the subject, the basis of this report, include the following: (1) to provide the appraiser an opportunity to learn how to identify and analyze the actual physical consumption of energy as well as the energy-saving improvements in properties under appraisal and in comparable sale and lease properties; (2) to help the appraiser in developing methods to keep meaningful records on the energy consumption of subject and comparable properties so as to observe in an orderly way the behavior of buyers, sellers, tenants, landlords, borrowers, and lenders with respect to energy efficiency; and (3) to assist the appraiser in learning to measure the relative sensitivities of the various segments of the market to energy considerations as indicated by differences in sale prices and rentals. To achieve these goals, the seminar employed two case studies, one for a angle-family residence and one for a multi-family building, both in Topeka, Kansas. The case studies are for illustrative purposes only; in applying the lessons of the seminar to their own daily work, students should be careful to develop information that is pertinent to their subject properties and subject areas and not rely on any of the particulars laid out in the cases.

  13. Space Toxicology Challenges and Ethical Considerations

    Science.gov (United States)

    James, John T.

    2010-01-01

    Before delineating specific ways that nanotechnology enterprises might contribute to better management of toxicological risks during spaceflight, I will show how ethical considerations and several theories of justice can be applied to nanotechnology strategic plans. The principles that guide an ethical technical enterprise include autonomy, beneficence, non-maleficence, veracity and justice. Veracity (truth) is the underpinning principle; however, beyond this, proponents of nanotechnology must think carefully about balancing conflicting principles. For example, autonomy must yield to beneficence when fearful individuals simply lack knowledge to appreciate nanotechnology's beneficial advances. Justice is a complex topic upon which I will place six models: utilitarian, distributive, free-exchange/choice, individual dignity (social participation), equity vs. greed, and liberation of the poor. After briefly summarizing each model, I will present what I call an iterative-hybrid model of justice to show specifically how our thinking can be applied to nanotechnology enterprises. Within that broad landscape, I will discuss a single feature: how our early effort to understand health risks of carbon nanotubes fits into the iterative model. Finally, I will suggest ways that nanotechnology might advance our management of toxicological risks during spaceflight, but always with an eye toward how such advances might result in a more just world.

  14. Marfan Syndrome: Clinical, Surgical, and Anesthetic Considerations.

    Science.gov (United States)

    Castellano, José M; Silvay, George; Castillo, Javier G

    2014-09-01

    Marfan syndrome is a multisystem connective tissue disorder, with primary involvement of the cardiovascular, ocular, and skeletal systems. This autosomal heritable disease is mainly attributable to a defect in the FBN1 gene. Clinical diagnosis of Marfan syndrome has been based on the Ghent criteria since 1996. In 2010, these criteria were updated, and the revised guidelines place more emphasis on aortic root dilation, ectopia lentis, and FBN1 mutation testing in the diagnostic assessment of Marfan syndrome. Among its many different clinical manifestations, cardiovascular involvement deserves special consideration, owing to its impact on prognosis. Recent molecular, surgical, and clinical research has yielded profound new insights into the pathological mechanisms that ultimately lead to tissue degradation and weakening of the aortic wall, which has led to exciting new treatment strategies. Furthermore, with the increasing life expectancy of patients with Marfan syndrome, there has been a subtle shift in the spectrum of medical problems. Consequently, this article focuses on recent advances to highlight their potential impact on future concepts of patient care from a clinical, surgical, and anesthetic perspective. © The Author(s) 2013.

  15. Cannabis for Chronic Pain: Challenges and Considerations.

    Science.gov (United States)

    Romero-Sandoval, E Alfonso; Fincham, Jack E; Kolano, Ashley L; Sharpe, Brandi; Alvarado-Vázquez, P Abigail

    2018-04-10

    The National Academies of Sciences, Engineering, and Medicine has found substantial evidence that cannabis (plant) is effective for the treatment of chronic pain in adults, and moderate evidence that oromucosal cannabinoids (extracts, especially nabiximols) improve short-term sleep disturbances in chronic pain. The paradoxical superiority of the cannabis plant over cannabinoid molecules represents a challenge for the medical community and the established processes that define modern pharmacy. The expanding and variable legalization of cannabis in multiple states nationwide represents an additional challenge for patients and the medical community because recreational and medicinal cannabis are irresponsibly overlapped. Cannabis designed for recreational use (containing high levels of active ingredients) is increasingly available to patients with chronic pain who do not find relief with current pharmacologic entities, which exposes patients to potential harm. This article analyzes the available scientific evidence to address controversial questions that the current state of cannabis poses for health-care professionals and chronic pain patients, and sets the basis for a more open discussion about the role of cannabis in modern medicine for pain management. A critical discussion on these points, the legal status of cannabis, and considerations for healthcare providers is presented. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  16. Considerations in change management related to technology.

    Science.gov (United States)

    Luo, John S; Hilty, Donald M; Worley, Linda L; Yager, Joel

    2006-01-01

    The authors describe the complexity of social processes for implementing technological change. Once a new technology is available, information about its availability and benefits must be made available to the community of users, with opportunities to try the innovations and find them worthwhile, despite organizational resistances. The authors reviewed the literature from psychiatry, psychology, sociology, business, and technology to distill common denominators for success and failure related to implementing technology. Beneficial technological innovations that are simple to use and obviously save everyone time and effort are easy to inaugurate. However, innovations that primarily serve management rather than subordinates or front-line utilizers may fail, despite considerable institutional effort. This article reviews and outlines several of the more prominent theoretical models governing successful institutional change. Successful implementation of difficult technological changes requires visionary leadership that has carefully considered the benefits, consulted with influence leaders at all organizational levels to spot unintended consequences and sources of resistance, and developed a detailed plan and continuous quality assurance process to foster implementation over time.

  17. General Considerations on Leisure Services

    Directory of Open Access Journals (Sweden)

    Aurica Grigore

    2009-10-01

    Full Text Available The leisure is a component of standard of living and quality of life, expresses the level of material and spiritual life, without it can’t beheld the multilateral development of the human, enforcing recovery functions of the organism, formative and instructive – educative, cultural andsocial. In pre-modern times, the free time was located on religious holidays and in the rest days established on the basis of religion (Sunday atChristians, Saturday at Jews, etc. The good of the individual towards trends any true democracy has in its structure, along with the materialcomponents and social and spiritual. In the economic and social framework, the reproduction of material conditions of existence is doubled by thehealth care, intelligent, creative force of the society members

  18. TRIGA reactor health physics considerations

    International Nuclear Information System (INIS)

    Johnson, A.G.

    1970-01-01

    The factors influencing the complexity of a TRIGA health physics program are discussed in details in order to serve as a basis for later consideration of various specific aspects of a typical TRIGA health physics program. The health physics program must be able to provide adequate assistance, control, and safety for individuals ranging from the inexperienced student to the experienced postgraduate researcher. Some of the major aspects discussed are: effluent release and control; reactor area air monitoring; area monitoring; adjacent facilities monitoring; portable instrumentation, personnel monitoring. TRIGA reactors have not been associated with many significant occurrences in the area of health physics, although some operational occurrences have had health physics implications. One specific occurrence at OSU is described involving the detection of non-fission-product radioactive particulates by the continuous air monitor on the reactor top. The studies of this particular situation indicate that most of the particulate activity is coming from the rotating rack and exhausting to the reactor top through the rotating rack loading tube

  19. MARKETING CONSIDERATIONS ON BRAND COMMUNITIES

    Directory of Open Access Journals (Sweden)

    A.-C. Budac

    2016-12-01

    Full Text Available Most consumers spend an important part of their free time looking for online information about the brands before taking a decision to purchase. The Internet is the main factor which has led to a considerable increase of the time allotted by consumers for search and comparing information about brands, as a step preceding the decision to purchase and also one of the most important factors that influence the interaction between the brand and the consumer. Although the general trend is that the public to become more active and more involved in the choice of the brand, consumer's responses to its messages obviously depend on cultural, social or economic factors. The work has the purpose to clarify what brand community means and how it appeared - if it was really built from scratch or it has already existed in a latent way and it must only be recognized - the characteristics of successful communities, which of the objectives of the brands can be achieved by means of these groups, what is the role of social media in the development of these communities, what kind of types of mem¬bers are likely to be encountered inside of the online communities and what is their proportion for each and which are the research methodologies that can give support to companies in monitoring these groups.

  20. Ethical Considerations of Preclinical Testing

    Directory of Open Access Journals (Sweden)

    Allen Goldenthal

    2015-12-01

    Full Text Available The numbers of animal tests being conducted are on a sharp incline.  Much of this increase is directly due to our ability to generate transgenic models and knock-outs, thereby increasing the validity of the animal model but not necessarily correlating directly with any translational medical benefits to the human counterpart.  In spite of our best efforts, there still exist species differences that prevent the application directly from animal to human, and in some examples having a completely different and adverse effect from that seen in the animal model. There are several ways in which we can improve the opportunity for a positive test outcome and at the same time reduce the animal usage which is associated with our current animal testing practices. The benefit of the 3R’s is that they encourage us not only to avoid wastage of life but that they require us to provide considerable foresight and extrapolated thought before directly engaging in the preclinical testing phase.

  1. CONSIDERATIONS ON CONSUMER PERCEIVED RISK

    Directory of Open Access Journals (Sweden)

    Laura Catalina Timiras

    2014-12-01

    Full Text Available In this article we identified a number of factors influencing the consumers’ perceived risk. In the first part we conducted a review of the main issues that define the perceived risk by the consumer at the time of purchase, some of the lines of action of the organizations to diminish this risk perception and a number of influencing factors presented in the literature, with significant impact on the intensity with which risk is perceived by consumers. The second part of the article is based on the statistical information regarding e-commerce market, market in which the perceived risk plays an important role in the purchasing decision. Thus, based on available official statistics provided by Eurostat we have revealed the existence of certain links between electronic commerce and orientation towards risk and income levels, age and consumer educational level. The review is not intended to be exhaustive, the study taking into consideration only those links that can be identified from using official statistical data.

  2. Considerations regarding dosimetry in children

    International Nuclear Information System (INIS)

    Gilday, D.L.

    1986-01-01

    The most important consideration when deciding whether or not to perform a nuclear medicine procedure in a child is whether the benefit of the information obtained exceeds the potential risk. In most circumstances the potential benefits are well define. No patient should be studied unless the question to be answered is clearly understood and there is a reasonable change to answer it. To properly perform procedures in children one must not only have a schedule to scale the radiopharmaceutical dose to be administered to the child's body surface area but also one must have an established minimum dose for small babies and infants. There is no point in under-dosing the patient as then the information will not be obtained from the nuclear medicine society. The value of nuclear medicine in the pediatric population cannot be underestimated. It is often the single most important test that can be performed diagnostically. For these reasons it is very important to understand the proper relationship of an adequate study versus the minimization of radiation. 3 references

  3. Enabling fast charging - Vehicle considerations

    Science.gov (United States)

    Meintz, Andrew; Zhang, Jiucai; Vijayagopal, Ram; Kreutzer, Cory; Ahmed, Shabbir; Bloom, Ira; Burnham, Andrew; Carlson, Richard B.; Dias, Fernando; Dufek, Eric J.; Francfort, James; Hardy, Keith; Jansen, Andrew N.; Keyser, Matthew; Markel, Anthony; Michelbacher, Christopher; Mohanpurkar, Manish; Pesaran, Ahmad; Scoffield, Don; Shirk, Matthew; Stephens, Thomas; Tanim, Tanvir

    2017-11-01

    To achieve a successful increase in the plug-in battery electric vehicle (BEV) market, it is anticipated that a significant improvement in battery performance is required to increase the range that BEVs can travel and the rate at which they can be recharged. While the range that BEVs can travel on a single recharge is improving, the recharge rate is still much slower than the refueling rate of conventional internal combustion engine vehicles. To achieve comparable recharge times, we explore the vehicle considerations of charge rates of at least 400 kW. Faster recharge is expected to significantly mitigate the perceived deficiencies for long-distance transportation, to provide alternative charging in densely populated areas where overnight charging at home may not be possible, and to reduce range anxiety for travel within a city when unplanned charging may be required. This substantial increase in charging rate is expected to create technical issues in the design of the battery system and the vehicle's electrical architecture that must be resolved. This work focuses on vehicle system design and total recharge time to meet the goals of implementing improved charge rates and the impacts of these expected increases on system voltage and vehicle components.

  4. Maternal depressive symptomatology in México: National prevalence, care, and population risk profiles.

    Directory of Open Access Journals (Sweden)

    Filipa de Castro

    2015-03-01

    Full Text Available Objective. This study estimates the prevalence of depressive symptomatology (DS in women with children younger than five years of age, examines detection and care rates and probabilities of developing DS based on specific risk profiles. Materials and methods. The sample consists of 7 187 women with children younger than five drawn from the Ensanut 2012. Results. DS prevalence is 19.91%, which means at least 4.6 million children live with mothers who experience depressive symptoms indicative of moderate to severe depression. Rates of detection (17.06% and care (15.19% for depression are low. DS is associated with violence (OR=2.34; IC95% 1.06-5.15, having ≥4 children, having a female baby, older age of the last child, low birth weight, food insecurity, and sexual debut menor que 15 years old (p menor que 0.01. Accumulated probability of DS, taking into consideration all risk factors measured, is 69.76%. It could be reduced to 13.21% through prevention efforts focused on eliminating violence, food insecurity, bias against having a female baby, and low birth weight. Conclusions. DS is a compelling public health problem in Mexico associated with a well-defined set of risk factors that warrant attention and timely detection at various levels of care.

  5. Game theoretic considerations for Kenyan health governance ...

    African Journals Online (AJOL)

    Game theoretic considerations for Kenyan health governance. ... theoretic considerations in their practice in order to achieve market-driven competition ... Key words: Game theory, social capital, good governance, health policy, health systems.

  6. 32 CFR 643.74 - Consideration.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Consideration. 643.74 Section 643.74 National... Licenses § 643.74 Consideration. When a license is granted under the authority of an easement or leasing statute, the same rules will apply in regard to consideration as is applicable to the granting of an...

  7. 5 CFR 330.206 - Job consideration.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Job consideration. 330.206 Section 330..., SELECTION, AND PLACEMENT (GENERAL) Reemployment Priority List (RPL) § 330.206 Job consideration. (a)(1) An eligible employee under § 330.203 is entitled to consideration for positions in the commuting area for...

  8. 32 CFR 643.53 - Consideration.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Consideration. 643.53 Section 643.53 National... Leases § 643.53 Consideration. (a) Unless otherwise authorized by this regulation or directed by the SA, the consideration for a lease of real estate will be the appraised fair market rental value. However...

  9. 15 CFR 2301.5 - Special consideration.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Special consideration. 2301.5 Section... PROGRAM Application Requirements § 2301.5 Special consideration. In accordance with section 392(f) of the Act, the Agency will give special consideration to applications that foster ownership of, operation of...

  10. 46 CFR 169.112 - Special consideration.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Special consideration. 169.112 Section 169.112 Shipping... Provisions § 169.112 Special consideration. In applying the provisions of this part, the Officer in Charge, Marine Inspection, may give special consideration to departures from the specific requirements when...

  11. 49 CFR 260.7 - Priority consideration.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Priority consideration. 260.7 Section 260.7... REHABILITATION AND IMPROVEMENT FINANCING PROGRAM Overview § 260.7 Priority consideration. When evaluating applications, the Administrator will give priority consideration (but not necessarily in the following order...

  12. 46 CFR 175.550 - Special consideration.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Special consideration. 175.550 Section 175.550 Shipping...) GENERAL PROVISIONS § 175.550 Special consideration. In applying the provisions of this subchapter, the OCMI may give special consideration to authorizing departures from the specific requirements when...

  13. Materials considerations in accelerator targets

    International Nuclear Information System (INIS)

    Peacock, H. B. Jr.; Iyer, N. C.; Louthan, M. R. Jr.

    1995-01-01

    Future nuclear materials production and/or the burn-up of long lived radioisotopes may be accomplished through the capture of spallation produced neutrons in accelerators. Aluminum clad-lead and/or lead alloys has been proposed as a spallation target. Aluminum was the cladding choice because of the low neutron absorption cross section, fast radioactivity decay, high thermal conductivity, and excellent fabricability. Metallic lead and lead oxide powders were considered for the target core with the fabrication options being casting or powder metallurgy (PM). Scoping tests to evaluate gravity casting, squeeze casting, and casting and swaging processes showed that, based on fabricability and heat transfer considerations, squeeze casting was the preferred option for manufacture of targets with initial core cladding contact. Thousands of aluminum clad aluminum-lithium alloy core targets and control rods for tritium production have been fabricated by coextrusion processes and successfully irradiated in the SRS reactors. Tritium retention in, and release from, the coextruded product was modeled from experimental and operational data. The model assumed that tritium atoms, formed by the 6Li(n,a)3He reaction, were produced in solid solution in the Al-Li alloy. Because of the low solubility of hydrogen isotopes in aluminum alloys, the irradiated Al-Li rapidly became supersaturated in tritium. Newly produced tritium atoms were trapped by lithium atoms to form a lithium tritide. The effective tritium pressure required for trap or tritide stability was the equilibrium decomposition pressure of tritium over a lithium tritide-aluminum mixture. The temperature dependence of tritium release was determined by the permeability of the cladding to tritium and the local equilibrium at the trap sites. The model can be used to calculate tritium release from aluminum clad, aluminum-lithium alloy targets during postulated accelerator operational and accident conditions. This paper describes

  14. Materials considerations in accelerator targets

    International Nuclear Information System (INIS)

    Peacock, H.B. Jr.; Iyer, N.C.; Louthan, M.R. Jr.

    1994-01-01

    Future nuclear materials production and/or the burn-up of long lived radioisotopes may be accomplished through the capture of spallation produced neutrons in accelerators. Aluminum clad-lead and/or lead alloys has been proposed as a spallation target. Aluminum was the cladding choice because of the low neutron absorption cross section, fast radioactivity decay, high thermal conductivity, and excellent fabricability. Metallic lead and lead oxide powders were considered for the target core with the fabrication options being casting or powder metallurgy (PM). Scoping tests to evaluate gravity casting, squeeze casting, and casting and swaging processes showed that, based on fabricability and heat transfer considerations, squeeze casting was the preferred option for manufacture of targets with initial core cladding contact. Thousands of aluminum clad aluminum-lithium alloy core targets and control rods for tritium production have been fabricated by coextrusion processes and successfully irradiated in the SRS reactors. Tritium retention in, and release from the coextruded product was modeled from experimental and operational data. Newly produced tritium atoms were trapped by lithium atoms to form a lithium tritide. The effective tritium pressure required for trap or tritide stability was the equilibrium decomposition pressure of tritium over a lithium tritide-aluminum mixture. The temperature dependence of tritium release was determined by the permeability of the cladding to tritium and the local equilibrium at the trap sites. The model can be used to calculate tritium release from aluminum clad, aluminum-lithium alloy targets during postulated accelerator operational and accident conditions. This paper describes the manufacturing technologies evaluated and presents the model for tritium retention in aluminum clad, aluminum-lithium alloy tritium production targets

  15. Social marketing: issues for consideration.

    Science.gov (United States)

    Novelli, W D

    1983-01-01

    Few social organizations have been able to incorporate all the essential components of successful marketing, namely, a customer oriented perspective, careful product development, segmented targets and programs, and an interative process of analysis, planning, implementation, and replanning. The lack of resources is part of the problem of moving forward into comprehensive social marketing. Social organizations may use marketing's 4 "Ps" -- product, price, promotion, and place, but often they must also contend with low visibility, lamentable budgets, little research, and lack of continuity. Several general problems confront marketing planners who try to transfer marketing approaches used to sell toothpaste and laundry detergent to promote concepts like family planning, smoking cessation, and nutrition. It has not been possible simply to apply commercial techniques for market analysis and segmentation or product, price, channel, and communication strategy and implementation to social programs. Evaluating program effectiveness is another area where commercial methods fail to readily apply. Contraceptive social marketing programs can point to quantifiable success measures of units sold and revenue received, but generally social marketers must gauge their longterm program objectives such as reduced fertility rates according to intermediary measures such as knowledge change or reported behavior. Currently, organizational design is being studied by several contraceptive social marketing programs. Trained marketing managers in key positions, a systematic marketing planning process, and careful monitoring and control are key program success ingredients that frequently are missing in social agencies where marketing activities and functions may not be fully understood. Many social organizations have established communication functions, but they are not conducive to the broader role that marketing must play if any significant impact is to result. Additionally, in the absence of

  16. Potential to sequester carbon in Canadian forests: Some economic considerations

    International Nuclear Information System (INIS)

    Kooten, G.C. van; Arthur, L.M.; Wilson, W.R.

    1992-01-01

    The potential role of reforestation policies in reducing Canada's contribution to atmospheric CO 2 is examined. The results indicate sequestering carbon by reforestation of forest lands may be a cost-effective means for Canada to offset domestic emissions of CO 2 from other sources, and that planting forests on marginal agricultural lands also warrants consideration. But these policies need to be compared with alternatives for reducing CO 2 emissions to determine their relative cost-effectiveness. It is found that reforestation is more costly than policies to increase the fuel efficiency of automobiles, but economically more efficient than converting vehicles to natural gas. Forestation can make an important contribution to reduced atmospheric accumulation of carbon after the more cost-effective strategy, replacing less fuel-efficient automobiles, is exhausted (i.e. when the marginal costs of automobile emissions increase beyond those of forestation alternatives). Finally, it is demonstrated that, because of its vast forests, Canada is a net carbon sink. 26 refs., 2 figs., 4 tabs

  17. Psychosocial considerations for mass decontamination

    International Nuclear Information System (INIS)

    Lemyre, L.; Johnson, C.; Corneil, W.

    2010-01-01

    Mass exposure to explosions, infectious agents, food-borne illnesses, chemicals or radiological materials may require mass decontamination that have critical psychosocial implications for the public and for both traditional and non-traditional responders in terms of impact and of response. Five main issues are common to mass decontamination events: (i) perception, (ii) somatisation, (iii) media role and communication, (iv) information sharing, (v) behavioural guidance and (vi) organisational issues. Empirical evidence is drawn from a number of cases, including Chernobyl; Goiania, Brazil; the sarin gas attack in Tokyo; the anthrax attacks in the USA; Three Mile Island; and by features of the 2003 severe acute respiratory syndrome pandemic. In this paper, a common platform for mass casualty management is explored and suggestions for mass interventions are proposed across the complete event timeline, from pre-event threat and warning stages through to the impact and reconstruction phases. Implication for responders, health care and emergency infrastructure, public behaviour, screening processes, risk communication and media management are described. (authors)

  18. Percutaneous tracheostomy--special considerations.

    Science.gov (United States)

    Ernst, Armin; Critchlow, Jonathan

    2003-09-01

    Percutaneous tracheostomy is safe and highly effective in well-trained hands in establishing a long-term artificial airway. Most alleged contraindications and some suggestions on how the procedures should be performed likely stem from early trials when only "perfect candidates" were chosen. Most of those contraindications should not be viewed as prohibitions, but as suggestions related to the skill level and training of the operator. We have used this technique in many situations where the small incision and tamponading effect of the tracheostomy tube has been quite beneficial, in selected patients with coagulapathies and severe venous congestion from superior cava syndromes as well as thyroid cancers, and in whom operative approaches would have been difficult. Knowing one's level of expertise and comfort in choosing and rejecting patients and procedures accordingly is the key to keeping PT a procedure with an excellent safety record. As the experience with PT grows, more and more perceived contraindications will disappear. Studies will address the role of PT in children and as a means of establishing emergent airway access. Also, the exact coagulation limits will need to be established. Few contraindications will most likely remain absolute, such as active infections over the proposed entry site, uncontrollable bleeding disorders and excessive ventilatory and oxygenation requirements. In our institution, taking into account these absolute contraindications, fewer than 5% of patients in need of a tracheostomy in the intensive care unit will undergo a primary open procedure.

  19. Conflicting and complementary ethics of animal welfare considerations in reintroductions.

    Science.gov (United States)

    Harrington, Lauren A; Moehrenschlager, Axel; Gelling, Merryl; Atkinson, Rob P D; Hughes, Joelene; Macdonald, David W

    2013-06-01

    Despite differences in focus, goals, and strategies between conservation biology and animal welfare, both are inextricably linked in many ways, and greater consideration of animal welfare, although important in its own right, also has considerable potential to contribute to conservation success. Nevertheless, animal welfare and animal ethics are not always considered explicitly within conservation practice. We systematically reviewed the recent scientific peer-reviewed and online gray literature on reintroductions of captive-bred and wild-caught animals (mammals, birds, amphibians, and reptiles) to quantify the occurrence of animal welfare issues. We considered monitoring that could be indicative of the animal's welfare status and supportive management actions that could improve animal welfare (regardless of whether the aim was explicitly animal-welfare orientated). Potential welfare issues (of variable nature and extent) were recorded in 67% of 199 projects reviewed; the most common were mortality >50%, dispersal or loss of animals, disease, and human conflict. Most (>70%) projects monitored survival, 18% assessed body condition, and 2% monitored stress levels. Animal welfare, explicitly, was referred to in 6% of projects. Supportive actions, most commonly use of on-site prerelease pens and provision of supplemental food or water, were implemented in 79% of projects, although the extent and duration of support varied. Practitioners can address animal-welfare issues in reintroductions by considering the potential implications for individual animals at all stages of the release process using the decision tree presented. We urge practitioners to report potential animal-welfare issues, describe mitigation actions, and evaluate their efficacy to facilitate transparent evaluation of common moral dilemmas and to advance communal strategies for dealing with them. Currently, comparative mortality rates, health risks, postrelease stress, effectiveness of supportive measures

  20. Characteristics of psychiatric patients for whom financial considerations affect optimal treatment provision.

    Science.gov (United States)

    West, Joyce C; Pingitore, David; Zarin, Deborah A

    2002-12-01

    This study assessed characteristics of psychiatric patients for whom financial considerations affected the provision of "optimal" treatment. Psychiatrists reported that for 33.8 percent of 1,228 patients from a national sample, financial considerations such as managed care limitations, the patient's personal finances, and limitations inherent in the public care system adversely affected the provision of optimal treatment. Patients were more likely to have their treatment adversely affected by financial considerations if they were more severely ill, had more than one behavioral health disorder or a psychosocial problem, or were receiving treatment under managed care arrangements. Patients for whom financial considerations affect the provision of optimal treatment represent a population for whom access to treatment may be particularly important.

  1. Shared care in the follow-up of early-stage melanoma: a qualitative study of Australian melanoma clinicians’ perspectives and models of care

    Directory of Open Access Journals (Sweden)

    Rychetnik Lucie

    2012-12-01

    Full Text Available Abstract Background Patients with early stage melanoma have high survival rates but require long-term follow-up to detect recurrences and/or new primary tumours. Shared care between melanoma specialists and general practitioners is an increasingly important approach to meeting the needs of a growing population of melanoma survivors. Methods In-depth qualitative study based on semi-structured interviews with 16 clinicians (surgical oncologists, dermatologists and melanoma unit GPs who conduct post-treatment follow-up at two of Australia’s largest specialist referral melanoma treatment and diagnosis units. Interviews were recorded, transcribed and analysed to identify approaches to shared care in follow-up, variations in practice, and explanations of these. Results Melanoma unit clinicians utilised shared care in the follow-up of patients with early stage melanoma. Schedules were determined by patients’ clinical risk profiles. Final arrangements for delivery of those schedules (by whom and where were influenced by additional psychosocial, professional and organizational considerations. Four models of shared care were described: (a surgical oncologist alternating with dermatologist (in-house or local to patient; (b melanoma unit dermatologist and other local doctor (e.g. family physician; (c surgical oncologist and local doctor; or (d melanoma physician and local doctor. Conclusions These models of shared care offer alternative solutions to managing the requirements for long-term follow-up of a growing number of patients with stage I/II melanoma, and warrant further comparative evaluation of outcomes in clinical trials, with detailed cost/benefit analyses.

  2. Large Payload Ground Transportation and Test Considerations

    Science.gov (United States)

    Rucker, Michelle A.

    2016-01-01

    , pyrotechnic devices, and high pressure gasses. Ironically, the limiting factor to a national heavy lift strategy may not be the rocket technology needed to throw a heavy payload, but rather the terrestrial infrastructure—roads, bridges, airframes, and buildings—necessary to transport, acceptance test, and process large spacecraft. Failure to carefully consider where and how large spacecraft are manufactured, tested, and launched could result in unforeseen cost to modify existing (or develop new) infrastructure, or incur additional risk due to increased handling operations or eliminating key verifications. Although this paper focuses on the canceled Altair spacecraft as a case study, the issues identified here have wide applicability to other large payloads, including concepts under consideration for NASA’s Evolvable Mars Campaign.

  3. Developing the language of futility in psychiatry with care

    Directory of Open Access Journals (Sweden)

    Willie Pienaar

    2016-10-01

    Full Text Available In psychiatric practice, treatment success is, in many instances, not an achievable goal. Psychiatrists may often not acknowledge treatment failure in their patients and seldom consider that patients may be in situations that share similarities with end-of-life dilemmas in general somatic medicine. In such instances, futile treatment may be continued and patient suffering may be prolonged. Doctors should play a leading role in patient education, diagnosis, promoting best treatment options, motivation and support, but patients should be given the opportunity to take ownership of their illness and their future. In the discipline of psychiatry, physician-assisted suicide may be an option but warrants careful consideration. Contemporary psychiatrists may act paternalistically, refusing to accept the limitations of their scientific skills and/or struggle with the moral good of ‘letting go’ when required. It is arguably the seeming complexity of gauging patients’ understanding (competency, capacity to make informed decisions that perpetuates futile treatment. Most patients, even in the presence of ongoing serious psychiatric illness, are able to give consent. Psychiatrists should be aware of the difference between being alive and living. Ongoing suffering cannot be condoned. The personhood of every patient and his/her bio-psycho-social and spiritual needs should, as far as possible, be respected. Psychiatrists should embrace the realisation of treatment futility and, in some cases, end-of-life decisions and take on the challenge as well as the responsibility of serving patients with mental illness in the best way possible.

  4. Tracheostomy care

    Science.gov (United States)

    Respiratory failure - tracheostomy care; Ventilator - tracheostomy care; Respiratory insufficiency - tracheostomy care ... Before you leave the hospital, health care providers will teach you how ... and suction the tube Keep the air you breathe moist Clean ...

  5. Statistical considerations on safety analysis

    International Nuclear Information System (INIS)

    Pal, L.; Makai, M.

    2004-01-01

    The authors have investigated the statistical methods applied to safety analysis of nuclear reactors and arrived at alarming conclusions: a series of calculations with the generally appreciated safety code ATHLET were carried out to ascertain the stability of the results against input uncertainties in a simple experimental situation. Scrutinizing those calculations, we came to the conclusion that the ATHLET results may exhibit chaotic behavior. A further conclusion is that the technological limits are incorrectly set when the output variables are correlated. Another formerly unnoticed conclusion of the previous ATHLET calculations that certain innocent looking parameters (like wall roughness factor, the number of bubbles per unit volume, the number of droplets per unit volume) can influence considerably such output parameters as water levels. The authors are concerned with the statistical foundation of present day safety analysis practices and can only hope that their own misjudgment will be dispelled. Until then, the authors suggest applying correct statistical methods in safety analysis even if it makes the analysis more expensive. It would be desirable to continue exploring the role of internal parameters (wall roughness factor, steam-water surface in thermal hydraulics codes, homogenization methods in neutronics codes) in system safety codes and to study their effects on the analysis. In the validation and verification process of a code one carries out a series of computations. The input data are not precisely determined because measured data have an error, calculated data are often obtained from a more or less accurate model. Some users of large codes are content with comparing the nominal output obtained from the nominal input, whereas all the possible inputs should be taken into account when judging safety. At the same time, any statement concerning safety must be aleatory, and its merit can be judged only when the probability is known with which the

  6. Key Value Considerations for Consultant Pharmacists.

    Science.gov (United States)

    Meyer, Lee; Perry, Ronald G; Rhodus, Susan M; Stearns, Wendy

    2016-07-01

    Managing the efficiency and costs of residents' drug regimens outside the acute-care hospital and through transitions of care requires a toolbox filled with cost-control tools and careful collaboration among the pharmacy provider(s), facility staff, and the consultant/senior care pharmacist. This article will provide the reader with key long-term care business strategies that affect the profitability of the pharmacy provider in various care settings while, at the same time, ensuring optimal therapy for residents as they transition across levels of care. Readers can take away ideas on how to access critical information, what they can do with this information, and how they can improve the overall care process. Four experts in various aspects of pharmacy management share their insights on pharmacy practice issues including formulary management, performance metrics, short-cycle dispensing challenges/solutions, cost-control measures, facility surveys, billing practices, medication reconciliation, prospective medication reviews, and transitions of care.

  7. The nuclear pacemaker: Is renewed interest warranted

    International Nuclear Information System (INIS)

    Parsonnet, V.; Berstein, A.D.; Perry, G.Y.

    1990-01-01

    From 1973 through 1987, 155 radioisotope-powered nuclear pacemakers were implanted in 132 patients at the Newark Beth Israel Medical Center. The longevity of the first 15 devices, all of which were fixed-rate (VOO) pacemakers, was significantly better than that of 15 lithium-chemistry demand (VVI) pacemakers used as control devices (p = 0.0002). Of the entire cohort of 155 nuclear pacemakers, 136 were VVI devices and 19 were VOO units. The patients with VOO pacemakers needed reoperations more often than did those with VVI pacemakers, chiefly for mode change (p less than 0.001). Power-source failure was observed in only 1 case, but 47 nuclear pacemakers were removed for other reasons, including component malfunction (15 units), mode change (12 units), high pacing thresholds (8 units) and lead or connector problems (5 units). The actuarial survival at 15 years was 99% for power sources and 82% for the entire pacing systems (pulse generators plus leads). The frequency of malignancy was similar to that of the population at large and primary tumor sites were randomly distributed. Deaths most commonly were due to cardiac causes (68%). Thus, nuclear pacemakers are safe and reliable and their greater initial cost appears to be offset by their longevity and the resulting decrease in the frequency of reoperations. It is reasonable to suggest that further use be made of long-lasting nuclear power sources for modern pacemakers and other implantable rhythm-management devices

  8. Measuring Distribution Performance? Benchmarking Warrants Your Attention

    Energy Technology Data Exchange (ETDEWEB)

    Ericson, Sean J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Alvarez, Paul [The Wired Group

    2018-04-13

    Identifying, designing, and measuring performance metrics is critical to securing customer value, but can be a difficult task. This article examines the use of benchmarks based on publicly available performance data to set challenging, yet fair, metrics and targets.

  9. Bioactive endophytes warrant intensified exploration and conservation.

    Science.gov (United States)

    Smith, Stephen A; Tank, David C; Boulanger, Lori-Ann; Bascom-Slack, Carol A; Eisenman, Kaury; Kingery, David; Babbs, Beatrice; Fenn, Kathleen; Greene, Joshua S; Hann, Bradley D; Keehner, Jocelyn; Kelley-Swift, Elizabeth G; Kembaiyan, Vivek; Lee, Sun Jin; Li, Puyao; Light, David Y; Lin, Emily H; Ma, Cong; Moore, Emily; Schorn, Michelle A; Vekhter, Daniel; Nunez, Percy V; Strobel, Gary A; Donoghue, Michael J; Strobel, Scott A

    2008-08-25

    A key argument in favor of conserving biodiversity is that as yet undiscovered biodiversity will yield products of great use to humans. However, the link between undiscovered biodiversity and useful products is largely conjectural. Here we provide direct evidence from bioassays of endophytes isolated from tropical plants and bioinformatic analyses that novel biology will indeed yield novel chemistry of potential value. We isolated and cultured 135 endophytic fungi and bacteria from plants collected in Peru. nrDNAs were compared to samples deposited in GenBank to ascertain the genetic novelty of cultured specimens. Ten endophytes were found to be as much as 15-30% different than any sequence in GenBank. Phylogenetic trees, using the most similar sequences in GenBank, were constructed for each endophyte to measure phylogenetic distance. Assays were also conducted on each cultured endophyte to record bioactivity, of which 65 were found to be bioactive. The novelty of our contribution is that we have combined bioinformatic analyses that document the diversity found in environmental samples with culturing and bioassays. These results highlight the hidden hyperdiversity of endophytic fungi and the urgent need to explore and conserve hidden microbial diversity. This study also showcases how undergraduate students can obtain data of great scientific significance.

  10. Bioactive endophytes warrant intensified exploration and conservation.

    Directory of Open Access Journals (Sweden)

    Stephen A Smith

    2008-08-01

    Full Text Available A key argument in favor of conserving biodiversity is that as yet undiscovered biodiversity will yield products of great use to humans. However, the link between undiscovered biodiversity and useful products is largely conjectural. Here we provide direct evidence from bioassays of endophytes isolated from tropical plants and bioinformatic analyses that novel biology will indeed yield novel chemistry of potential value.We isolated and cultured 135 endophytic fungi and bacteria from plants collected in Peru. nrDNAs were compared to samples deposited in GenBank to ascertain the genetic novelty of cultured specimens. Ten endophytes were found to be as much as 15-30% different than any sequence in GenBank. Phylogenetic trees, using the most similar sequences in GenBank, were constructed for each endophyte to measure phylogenetic distance. Assays were also conducted on each cultured endophyte to record bioactivity, of which 65 were found to be bioactive.The novelty of our contribution is that we have combined bioinformatic analyses that document the diversity found in environmental samples with culturing and bioassays. These results highlight the hidden hyperdiversity of endophytic fungi and the urgent need to explore and conserve hidden microbial diversity. This study also showcases how undergraduate students can obtain data of great scientific significance.

  11. When does atopic dermatitis warrant systemic therapy?

    DEFF Research Database (Denmark)

    Simpson, Eric L; Bruin-Weller, Marjolein; Flohr, Carsten

    2017-01-01

    therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient. METHODS: A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic...... systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy. LIMITATIONS: Our work...

  12. When does atopic dermatitis warrant systemic therapy?

    DEFF Research Database (Denmark)

    Simpson, Eric L; Bruin-Weller, Marjolein; Flohr, Carsten

    2017-01-01

    -specific literature review, referred to guidelines when available, and provided interpretation and expert opinion. RESULTS: We recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing......BACKGROUND: Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. OBJECTIVE: To guide those considering use of systemic...... therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient. METHODS: A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic...

  13. Economic aspects of infertility care: a challenge for researchers and clinicians.

    Science.gov (United States)

    2015-10-01

    Infertility care has improved remarkably over the last few decades and has received growing attention from health care providers. Several treatments, including expensive options such as Assisted Reproductive Techniques, are now widely available for routine clinical use. In most cases, adoption of these treatments has occurred without robust cost-effective analyses. IVF for unexplained infertility and ICSI in the absence of semen abnormalities are two examples of this gradual technology creep. More in-depth economic analyses in the field of infertility are undoubtedly warranted. However, performing these analyses is challenging because infertility care poses a number of unique challenges. Studies of cost-effectiveness are open to criticism because there is a lack of consensus about the outcomes of choice and the appropriate perspective. The use of quality adjusted life years (QALYs) to allow comparisons with other clinical conditions is also controversial because the value associated with infertility care cannot be easily captured in QALYs. Moreover, their use triggers the crucial question of whose QALYs merit consideration-an individual's, a couple's or a child's. In conclusion, economic analysis in infertility represents a peculiar but crucial challenge. If management of infertility is to become an integral part of publicly or privately funded health care systems worldwide, better quality data and a shared vision about the costs and benefits of infertility treatments are needed. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. A systematic review of low back pain and sciatica patients' expectations and experiences of health care.

    Science.gov (United States)

    Hopayian, Kevork; Notley, Caitlin

    2014-08-01

    Previous systematic reviews of patients' experience of health services have used mixed qualitative and quantitative studies. This review focused on qualitative studies, which are more suitable for capturing experience, using modern methods of synthesis of qualitative studies. To describe the experience of health care of low back pain and sciatica patients and the sources of satisfaction or dissatisfaction with special reference to patients who do not receive a diagnosis. A systematic review of qualitative studies. Primary qualitative studies identified from Medline, Embase, CINAHL, and Psychinfo databases. Conceptual themes of patients' experiences. Data collection and analysis were through thematic content analysis. Two reviewers independently screened titles and collected and analyzed data. The authors were in receipt of a Primary Care Research Bursary from National Health Service Suffolk and Norfolk Research Departments, a not-for-profit organization. Twenty-eight articles met the inclusion criteria. Most studies were of high quality. Nine themes emerged: the process and content of care, relationships and interpersonal skills, personalized care, information, the outcome of care, the importance of a diagnosis, delegitimation, recognizing the expert, and service matters. How care was given mattered greatly to patients, with importance given to receiving a perceived full assessment, consideration for the individual's context, good relationships, empathy, and the sharing of information. These aspects of care facilitated the acceptance by some of the limitations of health care and were spread across disciplines. Not having a diagnosis made coping more difficult for some but for others led to delegitimation, a feeling of not being believed. Service matters such as cost and waiting time received little mention. Although much research into the development of chronic low back pain (LBP) has focused on the patient, this review suggests that research into aspects of care

  15. 32 CFR 643.104 - Consideration.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Consideration. 643.104 Section 643.104 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE Permits § 643.104 Consideration. (a) Permits are usually granted on a rent-free basis. (b) The Army is...

  16. Technical specification improvement through safety margin considerations

    International Nuclear Information System (INIS)

    Howard, R.C.; Jansen, R.L.

    1986-01-01

    Westinghouse has developed an approach for utilizing safety analysis margin considerations to improve plant operability through technical specification revision. This approach relies on the identification and use of parameter interrelations and sensitivities to identify acceptable operating envelopes. This paper summarizes technical specification activities to date and presents the use of safety margin considerations as another viable method to obtain technical specification improvement

  17. 29 CFR 1614.305 - Consideration procedures.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Consideration procedures. 1614.305 Section 1614.305 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION FEDERAL SECTOR EQUAL EMPLOYMENT OPPORTUNITY Related Processes § 1614.305 Consideration procedures. (a) Once a petition is filed...

  18. 48 CFR 226.7104 - Other considerations.

    Science.gov (United States)

    2010-10-01

    ... Businesses 226.7104 Other considerations. When planning for contracts for services related to base closure activities at a military installation affected by a closure or realignment under a base closure law... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Other considerations. 226...

  19. Insurance considerations associated with radiation processing

    International Nuclear Information System (INIS)

    Boylan, F.X.

    1979-01-01

    Comments are made on nuclear insurance experience in the United States. The subject is discussed in more detail under the headings: direct physical damage insurance; workers' compensation insurance; third party liability (premises and operations considerations; products considerations); possible alternatives to the existing arrangement. (U.K.)

  20. 7 CFR 1735.92 - Accounting considerations.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Accounting considerations. 1735.92 Section 1735.92... All Acquisitions and Mergers § 1735.92 Accounting considerations. (a) Proper accounting shall be... in the absence of such a commission, as required by RUS based on Generally Accepted Accounting...

  1. Radiological Considerations in the Desgin of Synchrotron Radiation Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Ipe, Nisy E.

    1999-01-06

    As synchrotron radiation (SR) facilities are rapidly being designed and built all over the world, the radiological considerations should be weighed carefully at an early stage in the design of the facility. This necessitates the understanding and identification of beam losses in the machines, especially the storage ring. The potential sources of radiation are photons and neutrons from loss of injected or stored beam, gas bremsstrahlung and synchrotron radiation. Protection against radiation is achieved through the adequate design of the shielding walls of the storage ring and the synchrotron radiation beam lines. In addition safety systems such as stoppers and shutters provide protection in the forward direction for entry into the experimental enclosures. Special care needs to be exercised in the design of SR experimental enclosures to minimize radiation leakage through penetrations and gaps between doors and walls, and doors and floors.

  2. Diet and Blood Pressure Control in Chinese Canadians: Cultural Considerations.

    Science.gov (United States)

    Zou, Ping

    2017-04-01

    Hypertension is highly prevalent in Chinese Canadians and diet has been identified as an important modifiable risk factor for hypertension. The current anti-hypertensive dietary recommendations in hypertension care guidelines lack examination of cultural factors, are not culturally sensitive to ethnic populations, and cannot be translated to Chinese Canadian populations without cultural considerations. Guided by Leininger's Sunrise Model of culture care theory, this paper investigates how cultural factors impact Chinese Canadians' dietary practice. It is proposed that English language proficiency, health literacy, traditional Chinese diet, migration and acculturation, and Traditional Chinese Medicine influence Chinese Canadians' dietary practices. A culturally congruent nursing intervention should be established and tailored according to related cultural factors to facilitate Chinese Canadians' blood pressure control. In addition, further study is needed to test the model adapted from Sunrise Model and understand its mechanism.

  3. Residential Care

    Science.gov (United States)

    ... Kids For Teens For Parents & Teachers Resolving Family Conflicts The Holidays and Alzheimer's Glossary Virtual Library Online ... longer an option Costs Choosing a care setting Types of residential care A good long-term care ...

  4. Palliative Care

    Science.gov (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  5. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  6. Comprehensive Care

    Science.gov (United States)

    ... Comprehensive Care Share this page Facebook Twitter Email Comprehensive Care Understand the importance of comprehensive MS care ... In this article A complex disease requires a comprehensive approach Today multiple sclerosis (MS) is not a ...

  7. Nutrition and Gaelic football: review, recommendations, and future considerations.

    Science.gov (United States)

    Beasley, Kevin J

    2015-02-01

    Gaelic football is the second most popular team sport in Ireland in terms of participation. However, very little research exists on the nutritional considerations for elite male Gaelic footballers. Gaelic football is an intermittent type field game played by two teams of fifteen players. Although amateurs, elite players may train and compete 4-5 times per week and may play for several teams. Research suggests that elite footballers are similar anthropometrically and in fitness to professional soccer players. Work-rate analysis shows that footballers experience longer durations of high-intensity (HI) activity (5-7s) and shorter rest durations than soccer players. Recent data suggests that half-forward/backs perform a greater amount of HI work during games than players in other positions. Fatigue is apparent between the first and second halves and the first and fourth quarters. The limited amount of nutritional studies conducted implies that footballers may be deficient in energy intake and may be at the lower end of recommended carbohydrate intakes to support training. A wide variety of sweat rates have been measured during training, demonstrating the importance of individual hydration strategies. Ergogenic aids such as creatine and caffeine may prove beneficial to performance, although data are extrapolated from other sports. Due to the lack of research in Gaelic football, further population specific studies are required. Future areas of research on the impact of nutrition on Gaelic football performance are examined. In particular, the creation of a test protocol mimicking the activity patterns and intensity of a Gaelic football game is warranted.

  8. Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study.

    Science.gov (United States)

    Catalao, Raquel; Eshetu, Tigist; Tsigebrhan, Ruth; Medhin, Girmay; Fekadu, Abebaw; Hanlon, Charlotte

    2018-05-21

    In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia. A qualitative study was carried out using interviews with purposively sampled service users (n = 13) and caregivers (n = 3) from a community-ascertained cohort of people with epilepsy receiving integrated services in primary care in rural Ethiopia. Interviews followed a topic guide with questions regarding acceptability, satisfaction, barriers to access care, pathways through care and impact of services. Framework analysis was employed to analyse the data. Proximity of the new service in local primary health centers decreased the cost of transportation for the majority of service users thus improving access to services. First-hand experience of services was in some cases associated with a willingness to promote the services and inform others of the existence of effective biomedical treatment for epilepsy. However, most service users and their caregivers continued to seek help from traditional healers alongside biomedical care. Most of the care received was focused on medication provision with limited information provided on how to manage their illness and its effects. Caregivers and service users spoke about the high emotional and financial burden of the disease and lack of ongoing practical and emotional support. The majority of participants reported clinical improvement on medication, which in over half of the participants was associated with ability to return to money generating activities. Task-sharing improved the accessibility of epilepsy care for

  9. Ethical considerations in resource allocation in a cochlear implant program.

    Science.gov (United States)

    Westerberg, Brian D; Pijl, Sipke; McDonald, Michael

    2008-04-01

    To review processes of resource allocation and the ethical considerations relevant to the fair allocation of a limited number of cochlear implants to increasing numbers of potential recipients. Review of relevant considerations. Tertiary referral hospital. Editorial discussion of the ethical issues of resource allocation. Heterogeneity of audiometric thresholds, self-reported disability of hearing loss, age of the potential cochlear implant recipient, cost-effectiveness, access to resources, compliance with follow-up, social support available to the recipient, social consequences of hearing impairment, and other recipient-related factors. In a publicly funded health care system, there will always be a need for decision-making processes for allocation of finite fiscal resources. All candidates for cochlear implantation deserve fair consideration. However, they are a heterogeneous group in terms of needs and expected outcomes consisting of traditional and marginal candidates, with a wide range of benefit from acoustic amplification. We argue that implant programs should thoughtfully prioritize treatment on the basis of need and potential benefit. We reject queuing on the basis of "first-come, first-served" or on the basis of perceived social worth.

  10. Creating Library Interiors: Planning and Design Considerations.

    Science.gov (United States)

    Jones, Plummer Alston, Jr.; Barton, Phillip K.

    1997-01-01

    Examines design considerations for public library interiors: access; acoustical treatment; assignable and nonassignable space; building interiors: ceilings, clocks, color, control, drinking fountains; exhibit space: slotwall display, floor coverings, floor loading, furniture, lighting, mechanical systems, public address, copying machines,…

  11. Safety considerations for compressed hydrogen storage systems

    International Nuclear Information System (INIS)

    Gleason, D.

    2006-01-01

    An overview of the safety considerations for various hydrogen storage options, including stationary, vehicle storage, and mobile refueling technologies. Indications of some of the challenges facing the industry as the demand for hydrogen fuel storage systems increases. (author)

  12. Health physics considerations in decontamination and decommissioning

    International Nuclear Information System (INIS)

    1985-12-01

    These proceedings contain papers on legal considerations, environmental aspects, decommissioning equipment and methods, instrumentation, applied health physics, waste classification and disposal, and project experience. Separate abstracts have been prepared for individual papers

  13. [Theological moral considerations of advance directives].

    Science.gov (United States)

    Virt, G

    1997-01-01

    The forms for advanced directives vary considerably in respect to content and wording. This article intends to develop ethical criteria for such texts, from the moraltheological point of view, also considering the social context.

  14. 32 CFR 643.83 - Consideration.

    Science.gov (United States)

    2010-07-01

    ... consideration in an amount equal to the fair market value as established by recognized appraisal practices. As... thereof, will not require fair market value when the purpose of the easement is to serve the public...

  15. Some considerations on the Tlatelolco Treaty

    International Nuclear Information System (INIS)

    Faria, N.M. de; Goes Fischer, M.D. de

    1981-01-01

    Some considerations related to the Tlatelolco Treaty are focused and so are the role and the position of Brazil in view of the Treaty. Short historical remarks are presented in order to show the commitments of Brazil with the Treaty. Finally, considerations concerned with the validity of the Treaty as the legal instrument to contribute to the security and peace in the World. (Author) [pt

  16. Air quality considerations for stormwater green street design

    International Nuclear Information System (INIS)

    Shaneyfelt, Kathryn M.; Anderson, Andrew R.; Kumar, Prashant; Hunt, William F.

    2017-01-01

    Green streets are increasingly being used as a stormwater management strategy to mitigate stormwater runoff at its source while providing other environmental and societal benefits, including connecting pedestrians to the street. Simultaneously, human exposure to particulate matter from urban transportation is of major concern worldwide due to the proximity of pedestrians, drivers, and cyclists to the emission sources. Vegetation used for stormwater treatment can help designers limit the exposure of people to air pollutants. This goal can be achieved through the deliberate placement of green streets, along with strategic planting schemes that maximize pollutant dispersion. This communication presents general design considerations for green streets that combine stormwater management and air quality goals. There is currently limited guidance on designing green streets for air quality considerations; this is the first communication to offer suggestions and advice for the design of green stormwater streets in regards to their effects on air quality. Street characteristics including (1) the width to height ratio of the street to the buildings, (2) the type of trees and their location, and (3) any prevailing winds can have an impact on pollutant concentrations within the street and along sidewalks. Vegetation within stormwater control measures has the ability to reduce particulate matter concentrations; however, it must be carefully selected and placed within the green street to promote the dispersion of air flow. - Highlights: • Green streets can be used for both stormwater and air quality management. • Design considerations must be made to minimize human exposure to air pollutants. • Urban vegetation can improve air quality with careful selection and placement.

  17. Cancer Screening Considerations and Cancer Screening Uptake for Lesbian, Gay, Bisexual, and Transgender Persons.

    Science.gov (United States)

    Ceres, Marc; Quinn, Gwendolyn P; Loscalzo, Matthew; Rice, David

    2018-02-01

    To describe the current state of cancer screening and uptake for lesbian, gay, bisexual, and transgender (LGBT) persons and to propose cancer screening considerations for LGBT persons. Current and historic published literature on cancer screening and LGBT cancer screening; published national guidelines. Despite known cancer risks for members of the LGBT community, cancer screening rates are often low, and there are gaps in screening recommendations for LGBT persons. We propose evidence-based cancer screening considerations derived from the current literature and extant cancer screening recommendations. The oncology nurse plays a key role in supporting patient preventive care and screening uptake through assessment, counseling, education, advocacy, and intervention. As oncology nurses become expert in the culturally competent care of LGBT persons, they can contribute to the improvement of quality of care and overall well-being of this health care disparity population. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Palliative Care

    Science.gov (United States)

    ... for Patients and Families What Is Palliative Care? Definition Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to ...

  19. Palliative Care.

    Science.gov (United States)

    Swetz, Keith M; Kamal, Arif H

    2018-03-06

    Palliative care prioritizes symptom management and quality of life throughout the course of serious illness. Regardless of whether care is inpatient or outpatient, primary or subspecialty, a solid understanding of the basics of effective communication, symptom management, and end-of-life care is crucial. This article reviews these essentials and provides an overview of current evidence to support patient-centered palliative care.

  20. A maturity model for care pathways

    NARCIS (Netherlands)

    Schriek, M.; Turetken, O.; Kaymak, U.

    2016-01-01

    Over the last recent decades, increasing the quality of healthcare services while reducing costs has been among the top concerns in the healthcare landscape. Several healthcare institutions have initiated improvement programs and invested considerably in process orientation and management. Care

  1. Review of Opioid Pharmacogenetics and Considerations for Pain Management.

    Science.gov (United States)

    Owusu Obeng, Aniwaa; Hamadeh, Issam; Smith, Michael

    2017-09-01

    Opioid analgesics are the standards of care for the treatment of moderate to severe nociceptive pain, particularly in the setting of cancer and surgery. Their analgesic properties mainly emanate from stimulation of the μ receptors, which are encoded by the OPRM1 gene. Hepatic metabolism represents the major route of elimination, which, for some opioids, namely codeine and tramadol, is necessary for their bioactivation into more potent analgesics. The highly polymorphic nature of the genes coding for phase I and phase II enzymes (pharmacokinetics genes) that are involved in the metabolism and bioactivation of opioids suggests a potential interindividual variation in their disposition and, most likely, response. In fact, such an association has been substantiated in several pharmacokinetic studies described in this review, in which drug exposure and/or metabolism differed significantly based on the presence of polymorphisms in these pharmacokinetics genes. Furthermore, in some studies, the observed variability in drug exposure translated into differences in the incidence of opioid-related adverse effects, particularly nausea, vomiting, constipation, and respiratory depression. Although the influence of polymorphisms in pharmacokinetics genes, as well as pharmacodynamics genes (OPRM1 and COMT) on response to opioids has been a subject of intense research, the results have been somehow conflicting, with some evidence insinuating for a potential role for OPRM1. The Clinical Pharmacogenetics Implementation Consortium guidelines provide CYP2D6-guided therapeutic recommendations to individualize treatment with tramadol and codeine. However, implementation guidelines for other opioids, which are more commonly used in real-world settings for pain management, are currently lacking. Hence, further studies are warranted to bridge this gap in our knowledge base and ultimately ascertain the role of pharmacogenetic markers as predictors of response to opioid analgesics. © 2017

  2. ACOG Committee Opinion No. 731: Group Prenatal Care.

    Science.gov (United States)

    2018-03-01

    Individual prenatal care is intended to prevent poor perinatal outcomes and provide education to women throughout pregnancy, childbirth, and the postpartum period through a series of one-on-one encounters between a woman and her obstetrician or other obstetric care provider. Concerns regarding increasing health care costs, health care provider availability, dissatisfaction with wait times, and the minimal opportunity for education and support associated with the individual care model have given rise to interest in alternative models of prenatal care. One alternative model, group prenatal care, may be beneficial or preferred for some practice settings and patient populations, although individual prenatal care remains standard practice. Group prenatal care models are designed to improve patient education and include opportunities for social support while maintaining the risk screening and physical assessment of individual prenatal care. Bringing patients with similar needs together for health care encounters increases the time available for the educational component of the encounter, improves efficiency, and reduces repetition. Evidence suggests patients have better prenatal knowledge, feel more ready for labor and delivery, are more satisfied with care in prenatal care groups, and initiate breastfeeding more often. There is no evidence that suggests that group prenatal care causes harm. Individual and group care models warrant additional study with a goal of demonstrating differences in outcomes and identifying populations that benefit most from specific care models.

  3. ACOG Committee Opinion No. 731 Summary: Group Prenatal Care.

    Science.gov (United States)

    2018-03-01

    Individual prenatal care is intended to prevent poor perinatal outcomes and provide education to women throughout pregnancy, childbirth, and the postpartum period through a series of one-on-one encounters between a woman and her obstetrician or other obstetric care provider. Concerns regarding increasing health care costs, health care provider availability, dissatisfaction with wait times, and the minimal opportunity for education and support associated with the individual care model have given rise to interest in alternative models of prenatal care. One alternative model, group prenatal care, may be beneficial or preferred for some practice settings and patient populations, although individual prenatal care remains standard practice. Group prenatal care models are designed to improve patient education and include opportunities for social support while maintaining the risk screening and physical assessment of individual prenatal care. Bringing patients with similar needs together for health care encounters increases the time available for the educational component of the encounter, improves efficiency, and reduces repetition. Evidence suggests patients have better prenatal knowledge, feel more ready for labor and delivery, are more satisfied with care in prenatal care groups, and initiate breastfeeding more often. There is no evidence that suggests that group prenatal care causes harm. Individual and group care models warrant additional study with a goal of demonstrating differences in outcomes and identifying populations that benefit most from specific care models.

  4. Collective Care: Multiple Caregivers and Multiple Care Recipients in Mexican American Families.

    Science.gov (United States)

    Evans, Bronwynne C; Coon, David W; Belyea, Michael J; Ume, Ebere

    2017-07-01

    Specific stressors associated with caregiving in Mexican American (MA) families are not well documented, yet caregiving issues are paramount because informal care for parents is central to their culture. Although MA families who band together to provide care for one member are not unique, the literature does not describe the phenomenon of collective caregiving, which may be widespread but unrecognized. This article describes these understudied families who are poorly served by contemporary health systems because their characteristics are unknown. Descriptive, multisite, longitudinal mixed-methods study of MA caregiving families. We identified three types of collective caregivers: those providing care for multiple family members simultaneously, those providing care successively to several family members, and/or those needing care themselves during their caregiving of others. Collective caregiving of MA elders warrants further investigation. Exploration of collective caregiving may provide a foundation for tailored family interventions.

  5. Improving quality of tuberculosis care in India.

    Science.gov (United States)

    Pai, Madhukar; Satyanarayana, Srinath; Hopewell, Phil

    2014-01-01

    In India, the quality of care that tuberculosis (TB) patients receive varies considerably and is often not in accordance with the national and international standards. In this article, we provide an overview of the third (latest) edition of the International Standards of Tuberculosis Care (ISTC). These standards are supported by the existing World Health Organization guidelines and policy statements pertaining to TB care and have been endorsed by a number of international organizations. We call upon all health care providers in the country to practice TB care that is consistent with these standards, as well as the upcoming Standards for TB Care in India (STCI).

  6. Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study.

    NARCIS (Netherlands)

    Warmelink, J.C.; Cock, T.P. de; Combee, Y.; Rongen, M.; Wiegers, T.A.; Hutton, E.K.

    2017-01-01

    BACKGROUND: A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system

  7. Euthanasia of Cattle: Practical Considerations and Application

    Science.gov (United States)

    Shearer, Jan Keith

    2018-01-01

    type of bullet are important considerations when gunshot is used. When captive bolt is used, a penetrating captive bolt loaded with the appropriate powder charge and accompanied by a follow up (adjunctive) step to assure death are required. The success of physical methods also requires careful selection of the anatomic site for entry of a “free bullet” or “bolt” in the case of penetrating captive bolt. Disease eradication plans for animal health emergencies necessitate methods of euthanasia that will facilitate rapid and efficient depopulation of animals while preserving their welfare to the greatest extent possible. A portable pneumatic captive bolt device has been developed and validated as effective for use in mass depopulation scenarios. Finally, while most tend to focus on the technical aspects of euthanasia, it is extremely important that no one forget the human cost for those who may be required to perform the task of euthanasia on a regular basis. Symptoms including depression, grief, sleeplessness and destructive behaviors including alcoholism and drug abuse are not uncommon for those who participate in the euthanasia of animals. PMID:29673140

  8. [Social inequality in home care].

    Science.gov (United States)

    Möller, A; Osterfeld, A; Büscher, A

    2013-06-01

    Social inequality in Germany is discussed primarily with regard to educational or social welfare issues. There is a political consensus that more action should be taken to ensure equality of chances and fulfillment of basic needs for everyone. In long-term care these considerations have not yet taken place and there are hardly any research studies in this field. However, the startling rise of the need for long-term care will definitely require a discussion of social inequality in various care arrangements. To learn more about social inequality in home care, a qualitative approach was used and 16 home care nurses were interviewed. Our study shows that many care recipients face numerous problems they cannot handle on their own, which may even worsen their situation. In addition, the results reveal that facing social inequalities place a burden on nurses and influence their work performance.

  9. Nursing supervision for care comprehensiveness

    Directory of Open Access Journals (Sweden)

    Lucieli Dias Pedreschi Chaves

    Full Text Available ABSTRACT Objective: To reflect on nursing supervision as a management tool for care comprehensiveness by nurses, considering its potential and limits in the current scenario. Method: A reflective study based on discourse about nursing supervision, presenting theoretical and practical concepts and approaches. Results: Limits on the exercise of supervision are related to the organization of healthcare services based on the functional and clinical model of care, in addition to possible gaps in the nurse training process and work overload. Regarding the potential, researchers emphasize that supervision is a tool for coordinating care and management actions, which may favor care comprehensiveness, and stimulate positive attitudes toward cooperation and contribution within teams, co-responsibility, and educational development at work. Final considerations: Nursing supervision may help enhance care comprehensiveness by implying continuous reflection on including the dynamics of the healthcare work process and user needs in care networks.

  10. Design considerations for medical devices in the home environment.

    Science.gov (United States)

    Kaufman-Rivi, Diana; Collins-Mitchell, Janette; Jetley, Raoul

    2010-01-01

    Patient demographics, economic forces, and technological advancements contribute to the rise in home care services. Advanced medical devices and equipment originally designed for use by trained personnel in hospitals and clinics are increasingly migrating into the home. Unlike the clinical setting, the home is an uncontrolled environment with additional hazards. The compatibility of the device with the recipient's knowledge, abilities, lifestyle, and home environment plays a significant role in their therapy and rehabilitation. The advent of new device technologies such as wireless devices and interoperability of systems lends a new and complex perspective for medical device use in the home that must also be addressed. Adequately assessing and matching the patient and their caregiver with the appropriate device technology while considering the suitability of the home environment for device operation and maintenance is a challenge that relies on good human factors principles. There is a need to address these challenges in the growing home care sector In this article, the authors take a look at some important considerations and design issues for medical devices used in the home care environment.

  11. A pilot study on early home-based intervention through an intelligent baby gym (CareToy) in preterm infants

    DEFF Research Database (Denmark)

    Sgandurra, Giuseppina; Bartalena, Laura; Cecchi, Francesca

    2016-01-01

    BACKGROUND: CareToy is an intelligent system, inspired by baby gyms, aimed to provide an intensive, individualized, home-based and family-centred early intervention (EI) program. AIMS: A pilot study was carried out to explore the feasibility of CareToy intervention in preterm infants, aged 3....... An adequately powered randomized clinical trial is warranted....

  12. Site identification: environmental and radiological considerations

    International Nuclear Information System (INIS)

    Waite, D.A.

    1980-01-01

    Radiological and environmental considerations are recognized as being of utmost importance in planning, siting, licensing, operating, and decommissioning a high-level nuclear waste repository. In such a complex undertaking, it is important to identify the major concerns anticipated to arise in all of these phases in order to address them as early as possible in the program. Three representative activities/studies are summarized which will identify some of the important radiological and environmental considerations which must be addressed through this prolonged sequence of events and will indicate how these considerations are being addressed. It should be emphasized that these are only three of many which could have been chosen. The three key activities/studies are: (1) the NWTS Program criteria for identifying repository sites, (2) the generic guide for preparing environmental evaluations for deep drilling and (3) a preliminary environmental assessment for disposal of mined rock during excavation of a repository

  13. Ethical considerations of therapeutic hypnosis and children.

    Science.gov (United States)

    Etzrodt, Christine M

    2013-04-01

    Historically, therapeutic hypnosis has been met with skepticism within some fields, although acceptance has expanded in recent decades. Development and application of ethical standards and principles has contributed to increased acceptance of hypnosis with children. The Ethics Code of the American Psychological Association (APA, 2002) and the Code of Conduct of the American Society of Clinical Hypnosis (ASCH, 2000) serve as guides to ethical considerations when treating children. From a developmental and practical perspective, children have limited decision-making capacities, therefore special attention should be paid to their rights and welfare. Important ethical considerations relevant to children and hypnosis have emerged, including competence, supervision, informed consent, confidentiality, and boundaries. Considerations are reviewed from a normal and abnormal child development perspective.

  14. Formulary considerations in selection of beta-blockers.

    Science.gov (United States)

    Yedinak, K C

    1993-08-01

    Selection of beta-adrenergic blockers for formulary addition can be a difficult task, especially with the increasing availability of new beta-blockers, as well as the numerous differences in pharmacodynamic and pharmacokinetic properties of currently available agents. Nevertheless, appropriate evaluation of the important characteristics of beta-blockers should allow selection of the most cost-effective agents for formulary addition. Most importantly, differences in efficacy, product formulation and cost should be carefully considered when making formulary decisions. Notably, evidence from clinical trials indicates differences in efficacy among beta-blockers for post-myocardial infarction prophylaxis, situational anxiety, essential tremor, thyrotoxicosis, migraine prophylaxis and prevention of bleeding associated with oesophageal varices. For many clinical situations, it is also important to select an effective agent that is available in both an oral and intravenous formulation, especially for cardioprotection after acute myocardial infarction and for use in supraventricular arrhythmias. In addition, availability of sustained release products and generic formulations should be considered for their potential to increase compliance and decrease cost, respectively. Comparative drug costs, as well as costs associated with decreased compliance, should also be carefully evaluated. Differences in beta-receptor selectivity, duration of action and presence of intrinsic sympathomimetic activity (ISA) are also important considerations in the selection of beta-blockers for formulary consideration. Although degree of selectivity is relative, beta 1-selective agents may be less likely to induce bronchospasm in patients with chronic obstructive pulmonary disease (COPD) and may be less likely to affect glucose homeostasis in patients with diabetes mellitus. Duration of action of a beta-blocker is an important consideration for evaluation of efficacy throughout the recommended

  15. Evaluating care from a care ethical perspective:: A pilot study.

    Science.gov (United States)

    Kuis, Esther E; Goossensen, Anne

    2017-08-01

    Care ethical theories provide an excellent opening for evaluation of healthcare practices since searching for (moments of) good care from a moral perspective is central to care ethics. However, a fruitful way to translate care ethical insights into measurable criteria and how to measure these criteria has as yet been unexplored: this study describes one of the first attempts. To investigate whether the emotional touchpoint method is suitable for evaluating care from a care ethical perspective. An adapted version of the emotional touchpoint interview method was used. Touchpoints represent the key moments to the experience of receiving care, where the patient recalls being touched emotionally or cognitively. Participants and research context: Interviews were conducted at three different care settings: a hospital, mental healthcare institution and care facility for older people. A total of 31 participants (29 patients and 2 relatives) took part in the study. Ethical considerations: The research was found not to be subject to the (Dutch) Medical Research Involving Human Subjects Act. A three-step care ethical evaluation model was developed and described using two touchpoints as examples. A focus group meeting showed that the method was considered of great value for partaking institutions in comparison with existing methods. Reflection and discussion: Considering existing methods to evaluate quality of care, the touchpoint method belongs to the category of instruments which evaluate the patient experience. The touchpoint method distinguishes itself because no pre-defined categories are used but the values of patients are followed, which is an essential issue from a care ethical perspective. The method portrays the insider perspective of patients and thereby contributes to humanizing care. The touchpoint method is a valuable instrument for evaluating care; it generates evaluation data about the core care ethical principle of responsiveness.

  16. Low-water considerations for NPP sites

    International Nuclear Information System (INIS)

    Jensen, J.; Frank, T.; Wahl, T.

    2009-01-01

    In the frame of reactor safety considerations flood protection and the evaluation of low-water events are safety relevant issues. Therefore low-water statistics were performed for the coastal region Cuxhaven and the Elbe river estuary. The consideration of the longitudinal profile of water levels during low-tide in connection with surface water effects, morphodynamic changes of the river and anthropogenic modifications is of importance for conclusions concerning the NPP sites in some distance of the reference tide gauge. The authors performed a statistical low-tide analysis for the NPP sites Brunsbuettel and Brokdorf.

  17. The Role of Water Policy in Mexico : Sustainability, Equity, and Economic Growth Considerations

    OpenAIRE

    Musa Asad; Ariel Dinar

    2006-01-01

    With water in Mexico becoming very scarce spatially and over time, it is now a factor that limits economic activity and social well-being in several regions. The identification of priorities and trade-offs in relation to water allocation requires careful and timely attention to address an ever-growing range of complications arising from the impact of various interlinked considerations, suc...

  18. Critical considerations when planning experimental in vivo studies in dental traumatology

    DEFF Research Database (Denmark)

    Andreasen, Jens O; Andersson, Lars

    2011-01-01

    In vivo studies are sometimes needed to understand healing processes after trauma. For several reasons, not the least ethical, such studies have to be carefully planned and important considerations have to be taken into account about suitability of the experimental model, sample size and optimizing...

  19. Oral adverse effects of gastrointestinal drugs and considerations for dental management in patients with gastrointestinal disorders

    Directory of Open Access Journals (Sweden)

    Ramya Karthik

    2012-01-01

    Full Text Available Gastrointestinal disease is associated with alterations in the mouth or influence the course of the dental diseases, and the dental health care workers are expected to recognize, diagnose, and treat oral conditions associated with gastrointestinal diseases and also provide safe and appropriate dental care for afflicted individuals. Drugs used in the management of these diseases result in oral adverse effects and also are known to interact with those prescribed during dental care. Hence, this article has reviewed the drug considerations and guidelines for drug use during dental management of patients with gastrointestinal diseases.

  20. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

    2014-01-01

    plan beneficiaries, and employers warrants further consideration. PMID:24904218

  1. Virtual care

    DEFF Research Database (Denmark)

    Kamp, Annette; Aaløkke Ballegaard, Stinne

    of retrenchment, promising better quality, empowerment of citizens and work that is smarter and more qualified. Through ethnographic field studies we study the introduction of virtual home care in Danish elderly care, focusing on the implications for relational work and care relations. Virtual home care entails...... the performance of specific home care services by means of video conversations rather than physical visits in the citizens’ homes. As scholars within the STS tradition maintain, technologies do not simply replace a human function; they rather transform care work, redistributing tasks between citizens, technology...... point out how issues of trust and surveillance, which are always negotiated in care relations, are in fact accentuated in this kind of virtual care work. Moreover, we stress that the contemporary institutional context, organization and time schedules have a vast impact on the practices developed....

  2. Beyond operational consideration in a hospital radiopharmacy

    Energy Technology Data Exchange (ETDEWEB)

    Kawada, T [LAC and USC Medical Center, Radiopharmacy Service, Los Angeles, CA (United States); Wolf, W [University of Southern California, School of Pharmacy, Los Angeles, CA (United States)

    1998-08-01

    Hospital radiopharmacies have progressed from the chemistry laboratory in the basement where radioactive solutions were mixed to state of the art pharmaceutical facilities adjacent to nuclear medicine imaging suites. This progress can be attributed to new types of radiopharmaceuticals, advancements in nuclear instrumentation and equipment and competencies of individuals trained in Radiopharmacy practices. We are now entering another phase in the development of radiopharmacies which emphasizes both health care delivery and patient outcomes. Using a pharmaceutical care approach combined with expert pharmaceuticals services, the direct and responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient`s quality of life can be accomplished in radiopharmacies. At a time when the health care system is undergoing momentous change, hospital radiopharmacies are challenged to aggressively pursue a clinically oriented role and to look at how the continued development of radiopharmacies can and should evolve beyond their operational characteristics. (author)

  3. Beyond operational consideration in a hospital radiopharmacy

    International Nuclear Information System (INIS)

    Kawada, T.; Wolf, W.

    1998-01-01

    Hospital radiopharmacies have progressed from the chemistry laboratory in the basement where radioactive solutions were mixed to state of the art pharmaceutical facilities adjacent to nuclear medicine imaging suites. This progress can be attributed to new types of radiopharmaceuticals, advancements in nuclear instrumentation and equipment and competencies of individuals trained in Radiopharmacy practices. We are now entering another phase in the development of radiopharmacies which emphasizes both health care delivery and patient outcomes. Using a pharmaceutical care approach combined with expert pharmaceuticals services, the direct and responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient's quality of life can be accomplished in radiopharmacies. At a time when the health care system is undergoing momentous change, hospital radiopharmacies are challenged to aggressively pursue a clinically oriented role and to look at how the continued development of radiopharmacies can and should evolve beyond their operational characteristics. (author)

  4. Early loss to follow-up of recently diagnosed HIV-infected adults from routine pre-ART care in a rural district hospital in Kenya: a cohort study.

    Science.gov (United States)

    Hassan, Amin S; Fielding, Katherine L; Thuo, Nahashon M; Nabwera, Helen M; Sanders, Eduard J; Berkley, James A

    2012-01-01

    To determine the rate and predictors of early loss to follow-up (LTFU) for recently diagnosed HIV-infected, antiretroviral therapy (ART)-ineligible adults in rural Kenya. Prospective cohort study. Clients registering for HIV care between July 2008 and August 2009 were followed up for 6 months. Baseline data were used to assess predictors of pre-ART LTFU (not returning for care within 2 months of a scheduled appointment), LTFU before the second visit and LTFU after the second visit. Logistic regression was used to determine factors associated with LTFU before the second visit, while Cox regression was used to assess predictors of time to LTFU and LTFU after the second visit. Of 530 eligible clients, 178 (33.6%) were LTFU from pre-ART care (11.1/100 person-months). Of these, 96 (53.9%) were LTFU before the second visit. Distance (>5 km vs. ART LTFU. Distance and marital status were independently associated with LTFU before the second visit, while distance, education status and seasonality showed weak evidence of predicting LTFU after the second visit. HIV disease severity did not predict pre-ART LTFU. A third of recently diagnosed HIV-infected, ART-ineligible clients were LTFU within 6 months of registration. Predictors of LTFU among ART-ineligible clients are different from those among clients on ART. These findings warrant consideration of an enhanced pre-ART care package aimed at improving retention and timely ART initiation. © 2011 Blackwell Publishing Ltd.

  5. Introduction to section 1: financial considerations.

    Science.gov (United States)

    Hannenberg, Alexander A

    2009-03-01

    Achieving fundamental reform of the health care system to improve patient outcomes will take decades of effort and a major shift in financial, medical, and political behaviors that have built up since the beginning of health insurance in the United States. To the extent that the present payment systems contribute to the high cost, poor quality, and lack of accountability that characterizes today's health care delivery system, there is hope that reforms are within reach.

  6. Anaesthetic considerations for paediatric laparoscopy | Lasersohn ...

    African Journals Online (AJOL)

    Children, infants and neonates represent an anaesthetic challenge because of age-specific anatomical and physiological issues. Apart from paediatric-specific anaesthetic considerations, the paediatric anaesthetist must understand the implications of laparoscopic surgery, and prevent and react appropriately to changes ...

  7. Writing about Clients: Ethical Considerations and Options

    Science.gov (United States)

    Sperry, Len; Pies, Ronald

    2010-01-01

    Today, the decision to prepare clinical case material for publication is a decision that cannot be taken lightly. The decision involves reviewing ethical considerations and choosing among various options to safeguard client privacy. Such options include seeking the client's permission, disguising case material, and developing composite case…

  8. Implementing Sustainability Considerations in Packaging Design Curricula

    NARCIS (Netherlands)

    Mulder-Nijkamp, Maaike; de Koeijer, Bjorn; Torn, Isaäc Anthony Robbert-Jan

    2018-01-01

    This study aims to address the structured implementation of sustainability considerations in packaging design processes by proposing a teaching framework for design students. The framework builds upon a four-year research program which aims to deliver insights regarding the environmental burden

  9. 7 CFR 3430.909 - Other considerations.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Other considerations. 3430.909 Section 3430.909 Agriculture Regulations of the Department of Agriculture (Continued) COOPERATIVE STATE RESEARCH, EDUCATION, AND EXTENSION SERVICE, DEPARTMENT OF AGRICULTURE COMPETITIVE AND NONCOMPETITIVE NON-FORMULA FEDERAL...

  10. Ethical Considerations for Data Collection Using Surveys.

    Science.gov (United States)

    Hammer, Marilyn J

    2017-03-01

    Surveys are widely used instruments to collect research data. Although surveys may appear relatively benign and easily unlinked to participants, considerations for the ethical conduct of research with surveys are important. Maintaining scientific rigor is essential. This article explores ethical tenets in relation to informed consent and scientific consent when using surveys.

  11. 44 CFR 331.4 - Special consideration.

    Science.gov (United States)

    2010-10-01

    ... HOMELAND SECURITY PREPAREDNESS PRESERVATION OF THE MOBILIZATION BASE THROUGH THE PLACEMENT OF PROCUREMENT... sells a significant proportion of its production to the Government is generally depressed or has a... hearing of interested parties, will give consideration to appropriate measures applicable to the entire...

  12. Design Criteria Based on Aesthetic Considerations

    DEFF Research Database (Denmark)

    Thomsen, Bente Dahl

    2009-01-01

    Aesthetic criteria for designs are often debated in a very subjective manner which makes it difficult to reach consensus. In order to have a more rational and transparent process, in particular in industrial design, we propose a procedure based on Baumgarten's aesthetic considerations and Thommesen......'s dividing of a form into form elements. The procedure has been tested in student projects....

  13. Adult Learners: Considerations for Education and Training

    Science.gov (United States)

    Kistler, Mark J.

    2011-01-01

    As more and more adults seek out education and training programs to help them become more competitive in the job market, it provides an opportunity for career and technical education. Those who teach adult learners should take into consideration their particular learning traits. This article highlights a framework of core principles to be…

  14. Some considerations on robotics for environmental friendliness

    International Nuclear Information System (INIS)

    Pin, F.G.

    1993-01-01

    This paper presents a series of considerations regarding the use and potential of robotic devices for supporting humans in a variety of tasks, while maintaining, if not improving, environmental friendliness. One of the main considerations brought forward here relates to the type of human-support functions which the robots are, or will be, expected to perform, and from this, a clear differentiation appears between robots designed to replace humans in environments that were engineered in the past for best human functionality, and robots designed to take functions in the future, in environments which could be better engineered for large-scale human-robot synergy. Other considerations discussed involve the ''life-cycle'' cleanliness of robotic systems, including the materials needs for their construction, their operation, their disposal and, more importantly, their energy consumption which will impact the cycle of natural resources utilization. These considerations are discussed using a variety of possible robotic systems applications in contexts varied as manufacturing, energy recovery and production, emergency situations handling, traffic improvement, waste management, agriculture, and space exploration. In all these applications, the operation costs and complexity of the robots seem to vary in inverse proportion to the amount of engineering that is feasible to make the task environment more robot-friendly, but with no seemingly direct impact on the potential for environmental friendliness of the robots

  15. 32 CFR 989.4 - Initial considerations.

    Science.gov (United States)

    2010-07-01

    ... alternatives analyzed in the environmental documents. (f) Pursue the objective of furthering foreign policy and... ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.4 Initial considerations. Air Force personnel will: (a... CATEX from environmental impact analysis (appendix B). (c) Make environmental documents, comments, and...

  16. Topics for Current and Future Consideration

    Science.gov (United States)

    Pappas, James P.; Jerman, Jerry

    2011-01-01

    What lies ahead for nontraditional doctorate programs? What issues should concern administrators, faculty, and scholars? Faculty and administrators raised concerns that the marketplace demand for "nontraditional doctoral programs" would pollute the academic purity and sanctity of traditional programs. The authors provide some considerations for…

  17. Tube temperature rise limits: Boiling considerations

    Energy Technology Data Exchange (ETDEWEB)

    Vanderwater, R.G.

    1952-03-26

    A revision of tube power limits based on boiling considerations was presented earlier. The limits were given on a basis of tube power versus header pressure. However, for convenience of operation, the limits have been converted from tube power to permissible water temperature rise. The permissible {triangle}t`s water are given in this document.

  18. 20 CFR 332.2 - General considerations.

    Science.gov (United States)

    2010-04-01

    ... a female employee be considered to lack remuneration with respect to a day solely because of the... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false General considerations. 332.2 Section 332.2 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT...

  19. Waste management considerations in HTGR recycle operations

    International Nuclear Information System (INIS)

    Pence, D.T.; Shefcik, J.J.; Heath, C.A.

    1975-01-01

    Waste management considerations in the recycle of HTGR fuel are different from those encountered in the recycle of LWR fuel. The types of waste associated with HTGR recycle operations are discussed, and treatment methods for some of the wastes are described

  20. Planning for an ageing population: strategic considerations

    LENUS (Irish Health Repository)

    O'Shea, Dr Eamon

    2005-01-01

    This report presents both the proceedings of the Council’s conference, Planning for an Ageing Population: Strategic Considerations, and the Council’s discussion paper, ‘The Older Population: Information Issues and Deficits’, which was introduced at that conference.\\r\

  1. Design considerations for mechanical face seals

    Science.gov (United States)

    Ludwig, L. P.; Greiner, H. F.

    1980-01-01

    Two companion reports deal with design considerations for improving performance of mechanical face seals, one of family of devices used in general area of fluid sealing of rotating shafts. One report deals with basic seal configuration and other with lubrication of seal.

  2. 15 CFR 1160.4 - Antitrust considerations.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Antitrust considerations. 1160.4 Section 1160.4 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) TECHNOLOGY ADMINISTRATION, DEPARTMENT OF COMMERCE PRODUCTIVITY, TECHNOLOGY AND INNOVATION Promotion of...

  3. 15 CFR 1160.24 - Antitrust considerations.

    Science.gov (United States)

    2010-01-01

    ... Partnership Initiative § 1160.24 Antitrust considerations. (a) The Department of Commerce will offer no opinion on the antitrust merits of the formation of any proposed Strategic Partnership. The Department may..., conduct workshops to discuss the formation of such partnerships in general. Commerce will not select the...

  4. Some considerations on robotics for environmental friendliness

    Energy Technology Data Exchange (ETDEWEB)

    Pin, F.G.

    1993-12-01

    This paper presents a series of considerations regarding the use and potential of robotic devices for supporting humans in a variety of tasks, while maintaining, if not improving, environmental friendliness. One of the main considerations brought forward here relates to the type of human-support functions which the robots are, or will be, expected to perform, and from this, a clear differentiation appears between robots designed to replace humans in environments that were engineered in the past for best human functionality, and robots designed to take functions in the future, in environments which could be better engineered for large-scale human-robot synergy. Other considerations discussed involve the ``life-cycle`` cleanliness of robotic systems, including the materials needs for their construction, their operation, their disposal and, more importantly, their energy consumption which will impact the cycle of natural resources utilization. These considerations are discussed using a variety of possible robotic systems applications in contexts varied as manufacturing, energy recovery and production, emergency situations handling, traffic improvement, waste management, agriculture, and space exploration. In all these applications, the operation costs and complexity of the robots seem to vary in inverse proportion to the amount of engineering that is feasible to make the task environment more robot-friendly, but with no seemingly direct impact on the potential for environmental friendliness of the robots.

  5. Neutron personnel dosimetry considerations for fusion reactors

    International Nuclear Information System (INIS)

    Barton, T.P.; Easterly, C.E.

    1979-07-01

    The increasing development of fusion reactor technology warrants an evaluation of personnel neutron dosimetry systems to aid in the concurrent development of a radiation protection program. For this reason, current state of knowledge neutron dosimeters have been reviewed with emphasis placed on practical utilization and the problems inherent in each type of dosimetry system. Evaluations of salient parameters such as energy response, latent image instability, and minimum detectable dose equivalent are presented for nuclear emulsion films, track etch techniques, albedo and other thermoluminescent dosimetry techniques, electrical conductivity damage effects, lyoluminescence, thermocurrent, and thermally stimulated exoelectron emission. Brief summaries of dosimetry regulatory requirements and intercomparison study results help to establish compliance and recent trends, respectively. Spectrum modeling data generated by the Neutron Physics Division of Oak Ridge National Laboratory for the Princeton Tokamak Fusion Test Reactor (TFTR) Facility have been analyzed by both International Commission on Radiological Protection fluence to dose conversion factors and an adjoint technique of radiation dosimetry, in an attempt to determine the applicability of current neutron dosimetry systems to deuterium and tritium fusion reactor leakage spectra. Based on the modeling data, a wide range of neutron energies will probably be present in the leakage spectra of the TFTR facility, and no appreciable risk of somatic injury to occupationally exposed workers is expected. The relative dose contributions due to high energy and thermal neutrons indicate that neutron dosimetry will probably not be a serious limitation in the development of fusion power

  6. CARBOHYDRATE INTAKE CONSIDERATIONS FOR YOUNG ATHLETES

    Directory of Open Access Journals (Sweden)

    Veronica Montfort-Steiger

    2007-09-01

    Full Text Available Good nutritional practices are important for exercise performance and health during all ages. Athletes and especially growing children engaged in heavy training have higher energy and nutrient requirements compared to their non-active counterparts. Scientific understanding of sports nutrition for the young athlete is lacking behind the growing number of young athletes engaged in sports. Most of the sports nutrition recommendations given to athletic children and adolescents are based on adult findings due to the deficiency in age specific information in young athletes. Therefore, this review reflects on child specific sports nutrition, particularly on carbohydrate intake and metabolism that distinguishes the child athlete from the adult athlete. Children are characterised to be in an insulin resistance stage during certain periods of maturation, have different glycolytic/metabolic responses during exercise, have a tendency for higher fat oxidation during exercise and show different heat dissipation mechanisms compared to adults. These features point out that young athletes may need different nutritional advice on carbohydrate for exercise to those from adult athletes. Sport drinks for example may need to be adapted to children specific needs. However, more research in this area is warranted to clarify sports nutrition needs of the young athlete to provide better and healthy nutritional guidance to young athletes

  7. Noninvasive Brain Stimulation and Personal Identity: Ethical Considerations.

    Science.gov (United States)

    Iwry, Jonathan; Yaden, David B; Newberg, Andrew B

    2017-01-01

    As noninvasive brain stimulation (NIBS) technology advances, these methods may become increasingly capable of influencing complex networks of mental functioning. We suggest that these might include cognitive and affective processes underlying personality and belief systems, which would raise important questions concerning personal identity and autonomy. We give particular attention to the relationship between personal identity and belief, emphasizing the importance of respecting users' personal values. We posit that research participants and patients should be encouraged to take an active approach to considering the personal implications of altering their own cognition, particularly in cases of neurocognitive "enhancement." We suggest that efforts to encourage careful consideration through the informed consent process would contribute usefully to studies and treatments that use NIBS.

  8. Noninvasive Brain Stimulation and Personal Identity: Ethical Considerations

    Directory of Open Access Journals (Sweden)

    Jonathan Iwry

    2017-06-01

    Full Text Available As noninvasive brain stimulation (NIBS technology advances, these methods may become increasingly capable of influencing complex networks of mental functioning. We suggest that these might include cognitive and affective processes underlying personality and belief systems, which would raise important questions concerning personal identity and autonomy. We give particular attention to the relationship between personal identity and belief, emphasizing the importance of respecting users' personal values. We posit that research participants and patients should be encouraged to take an active approach to considering the personal implications of altering their own cognition, particularly in cases of neurocognitive “enhancement.” We suggest that efforts to encourage careful consideration through the informed consent process would contribute usefully to studies and treatments that use NIBS.

  9. Design considerations for Mars transfer vehicles using nuclear thermal propulsion

    Science.gov (United States)

    Emrich, William J.

    1995-01-01

    The design of a Mars Transfer Vehicle (MTV) utilizing nuclear propulsion will require that careful consideration be given to the nuclear radiation environment in which it will operate. The extremely high neutron and gamma fluxes characteristic of nuclear thermal propulsion systems will cause significant heating of the fluid systems in close proximity to the reactor, especially in the lower propellant tanks. Crew radiation doses are also a concern particularly late in a mission when there is less shielding from the propellant tanks. In this study, various vehicle configuration and shielding strategies were examined and the resulting time dependent radiation fields evaluated. A common cluster of three particle bed reactor (PBR) engines were used in all configurations examined. In general, it appears that long, relatively narrow vehicles perform the best from a radiation standpoint, however, good shield optimization will be critical in maintaining a low radiation environment while minimizing the shield weight penalty.

  10. Organisational fundamentals of medical care in catastrophes

    International Nuclear Information System (INIS)

    Ahnefeld, F.W.

    1983-01-01

    The author presents definitions, considerations, and fundamentals of discussion. He starts by listing the institutions, equipment and traning required for medical care and life-saving services in cases of emergency. A central coordination service for medical care and life saving is proposed. The present situation is reviewed, future needs are stated, and the necessary components of a medical service are listed. (DG) [de

  11. Gendered career considerations consolidate from the start of medical education.

    Science.gov (United States)

    Alers, Margret; Verdonk, Petra; Bor, Hans; Hamberg, Katarina; Lagro-Janssen, Antoine

    2014-09-13

    To explore changes in specialty preferences and work-related topics during the theoretical phase of Dutch medical education and the role of gender. A cohort of medical students at Radboudumc, the Netherlands, was surveyed at start (N=612, 69.1% female) and after three years (N=519, 69.2% female), on specialty preferences, full-time or part-time work, motivational factors, and work-life issues. Chi square tests were performed to analyze gender-differences, and logistic regression to explore the influence of gender on considerations. A total of 214 female and 78 male students completed both surveys. After three years, the male students remained highly interested in surgery, but the female students increasingly preferred gynecology. These initial preferences were predictive. Four out of five male students versus three out of five female students continued to show a full-time preference. Women increasingly preferred part-time work. After three years, the combination of work, care, and patient contact motivated female students more, whereas salary remained more important to male students. Female students indicated that their future careers would influence their family life; male students assumed having a family would only affect their partners' careers. Against an international background of the feminization of medicine, our study shows that career considerations are reinforced early in medical studies. Women prefer to work fewer hours and anticipate care tasks more often. Students' preferences reflect Dutch cultural norms about working men and women. Therefore, guidance in choice-making much earlier in medical education can create opportunities.

  12. Retrieving unobserved consideration sets from household panel data

    NARCIS (Netherlands)

    J.E.M. van Nierop; R. Paap (Richard); B. Bronnenberg; Ph.H.B.F. Franses (Philip Hans); M. Wedel (Michel)

    2005-01-01

    textabstractWe propose a new model to describe consideration, consisting of a multivariate probit model component for consideration and a multinomial probit model component for choice, given consideration. The approach allows one to analyze stated consideration set data, revealed consideration set

  13. The fee-for-service shift to bundled payments: financial considerations for hospitals.

    Science.gov (United States)

    Scamperle, Keely

    2013-01-01

    Skyrocketing health care costs are forcing payers to demand delivery efficiencies that preserve and promote quality care while reducing costs. Hospitals are challenged to meet the pressure from payers to deliver value and outcome-based health care while preserving sufficient financial margins. The fee-for-service (FFS) model with its perverse incentives to incur high-volume services is no longer, if ever, sufficient to ensure quality, cost-efficient health care. In response, payers have sought to force the issue through accelerated efforts to bundle payments to providers. It is theorized that by tying together providers throughout the continuum or episode of care for a patient, efficiencies in delivery inclusive of cost reductions will be obtained. This article examines the bundled payment models and the financial considerations for hospital facility providers.

  14. Air quality considerations for stormwater green street design.

    Science.gov (United States)

    Shaneyfelt, Kathryn M; Anderson, Andrew R; Kumar, Prashant; Hunt, William F

    2017-12-01

    Green streets are increasingly being used as a stormwater management strategy to mitigate stormwater runoff at its source while providing other environmental and societal benefits, including connecting pedestrians to the street. Simultaneously, human exposure to particulate matter from urban transportation is of major concern worldwide due to the proximity of pedestrians, drivers, and cyclists to the emission sources. Vegetation used for stormwater treatment can help designers limit the exposure of people to air pollutants. This goal can be achieved through the deliberate placement of green streets, along with strategic planting schemes that maximize pollutant dispersion. This communication presents general design considerations for green streets that combine stormwater management and air quality goals. There is currently limited guidance on designing green streets for air quality considerations; this is the first communication to offer suggestions and advice for the design of green stormwater streets in regards to their effects on air quality. Street characteristics including (1) the width to height ratio of the street to the buildings, (2) the type of trees and their location, and (3) any prevailing winds can have an impact on pollutant concentrations within the street and along sidewalks. Vegetation within stormwater control measures has the ability to reduce particulate matter concentrations; however, it must be carefully selected and placed within the green street to promote the dispersion of air flow. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. [Innovative Prenatal Testing: Clinical Applications and Ethical Considerations].

    Science.gov (United States)

    Huang, Mei-Chih; Lin, Shio-Jean; Chen, Chih-Ling; Huang, Tzu-Jung

    2017-10-01

    The biomedical technology related to prenatal screen/diagnosis has developed rapidly in recent decades. Many prenatal genetic examinations are now available to assist pregnant women to better understand the status and development of their fetus. Moreover, many commercial advertisements for innovative prenatal examinations are now shown in the media. Cell-free DNA Screening (cfDNA screening), a non-invasive prenatal testing (NIPT) procedure, is a safe and high accuracy test that may be done at an earlier gestational age to screen for fetal aneuploidy. The following questions should be considered when applying cfDNA screening in clinical practice: 1. what is cfDNA screening, 2. who are its potential users, and 3. what ethical and policy considerations are associated with this examination? This article provides relevant information, clinical practice guidelines, and ethical / policy considerations related to cfDNA screening. Discussing cases involving different clinical situations helps promote understanding of cfDNA screening and maternal-care quality.

  16. Considerations in Execution of High Temperature Steam Oxidation Testing

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Andrew T. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2014-04-01

    The Fuel Cycle Research and Development program’s Advanced Fuels Campaign is currently supporting a range of experimental efforts aimed at development and qualification of so-called ‘accident tolerant’ nuclear fuel forms. Numerous criteria have been developed by which proposed systems will be investigated; foremost among these will be their resistance to oxidation at high temperatures by steamdominated atmospheres. Experimental characterization of the various proposed systems is currently ongoing at numerous national laboratories as well as at industrial and university partners using a wide range of different laboratory equipment and techniques. This requires consideration of differences that may develop among test protocols due to both intrinsic (e.g. differences between experimental capabilities) and extrinsic (e.g. methodology of test execution) factors. These are essential to understand to provide confidence across institutions in the data collected if it is used to justify resources for further investigation. The focus of this document is to provide an initial discussion of factors that may play a role in governing the observed oxidation of a test sample. It will remain up to the principle investigator to judge whether a specific factor discussed is directly applicable to the system under investigation. The purpose of the specific experiment must also guide determination of whether a given factor requires careful consideration or not.

  17. Supportive care in radiation oncology

    International Nuclear Information System (INIS)

    Rotman, M.; John, M.

    1987-01-01

    The radiation therapist, concerned with the disease process and all the technical intricacies of treatment, has usually not been involved in managing the supportive aspects of caring for the patient. Yet, of the team of medical specialists and allied health personnel required in oncology, the radiation therapist is the one most responsible for overseeing the total care of the cancer patient. At times this might include emotional support, prevention and correction of tissue dysfunction, augmentation of nutrition, metabolic and electrolyte regulation, rehabilitation, and vocational support. This chapter is a brief overview of a considerable volume of literature that has occupied the interest of a rather small group of physicians, nutritionists, and psychologists. The discussion highlights the special management problems of the normal-tissue effects of radiation, the related nutritional aspects of cancer care, and certain emotional and pathologic considerations

  18. Varant Yatırımcısının Volatilite Algısına Etki Eden Faktörler: BIST’de Ampirik Bir Uygulama(Factors Affecting the Volatility Perception of Warrant Investors: An Empirical Research on BIST

    Directory of Open Access Journals (Sweden)

    İsrafil ZOR

    2013-12-01

    Full Text Available The aim of the study is to determine the factors that affect the volatility perception of warrant investors. By using 3.187 daily data of 61 call warrants whose underlying asset is BIST-30 Index and traded on BIST in 2012, firstly efficient option pricing model for the related market is confirmed and then volatilities that equalizes the efficient model prices to market prices are calculated and regression analysis is applied to determine factors that affect the volatility. The results of the analysis are revealed that if the closing price of the underlying asset, the days to maturity of the warrant and Turkish Lira Interbank rate increase, the volatility perceived by investors will decrease. Also, there is positive relationship between the closing price of warrants and the perceived volatility. In addition perceived volatility is higher on Monday and first decrease in inflation after 4 months increase reduces the perceived volatility.

  19. Comfort Care Rounds: a staff capacity-building initiative in long-term care homes.

    Science.gov (United States)

    Wickson-Griffiths, Abigail; Kaasalainen, Sharon; Brazil, Kevin; McAiney, Carrie; Crawshaw, Diane; Turner, Mickey; Kelley, Mary Lou

    2015-01-01

    This article reports a pilot evaluation of Comfort Care Rounds (CCRs)--a strategy for addressing long-term care home staff's palliative and end-of-life care educational and support needs. Using a qualitative descriptive design, semistructured individual and focus group interviews were conducted to understand staff members' perspectives and feedback on the implementation and application of CCRs. Study participants identified that effective advertising, interest, and assigning staff to attend CCRs facilitated their participation. The key barriers to their attendance included difficulty in balancing heavy workloads and scheduling logistics. Interprofessional team member representation was sought but was not consistent. Study participants recognized the benefits of attending; however, they provided feedback on how the scheduling, content, and focus could be improved. Overall, study participants found CCRs to be beneficial to their palliative and end-of-life care knowledge, practice, and confidence. However, they identified barriers and recommendations, which warrant ongoing evaluation. Copyright 2015, SLACK Incorporated.

  20. Magna-field irradiation: physical considerations

    Energy Technology Data Exchange (ETDEWEB)

    Van Dyk, J.

    1983-12-01

    Magna-field radiotherapy in the form of total body, half body and total nodal irradiation is becoming increasingly prominent and involves dosimetric problems that are much more pronounced than they are for conventional field sizes. In this review of the physical considerations of magna-field irradiation, a number of possible alternate methods of producing large radiation fields are outlined, the basic beam dosimetry is reviewed and the factors producing dose variation in the patient are considered. Since the lung contains large regions of low density tissues and has a lower tolerance to radiaiton than most other tissues, special consideration is given to methods of dose determination and dose reduction to this organ. The question of accuracy in dose delivery is briefly discussed and the concept of delivering a radiation dose 'as precisely as readily achievable (APARA), technological and biological factors being taken into account' is introduced.

  1. Ethical Considerations in Research Participation Virality.

    Science.gov (United States)

    Ellis-Barton, Carol

    2016-07-01

    This article seeks to commence and encourage discussion around the upcoming ethical challenges of virality in network structures. When the call for participation in a research project on lupus in Ireland went from an advertisement in a newsletter to a meme (unit of transmissible information) on a closed Facebook page, the ethical considerations of virality were raised. The article analyzes the Association of Internet Researchers guidelines, Facebook policies, and the context of privacy in relation to virality. Virality creates the leverage for methodological pluralism. The nature of the inquiry can determine the method rather than the other way around. Viral ethical considerations are evolving due to the cyber world becoming the primary meme of communication, with flexibility in the researcher's protocol providing opportunities for efficient, cost-effective, and diverse recruitment. © The Author(s) 2016.

  2. Noise Considerations for V/STOL Transports

    Science.gov (United States)

    Kenyon, George C.

    1968-01-01

    Noise consideration may well be as important a factor in future aircraft concept selection as such economic factors as operating cost and profitability. The impact of noise on some of the design and operational aspects of future V/STOL transports is examined in detail, including consideration of configuration, attitude-control system, lift system, and terminal flight pattern. Extended vertical rise of VTOL aircraft as a method of limiting the intense noise exposure to the terminal area is shown to be only partially effective as well as costly. Comparisons are made of noise contours for conceptual V/STOL transports for several PNdB criteria. The variation in extent of affected area with configuration and criterion emphasizes the importance of establishing an "acceptable" noise level for "city-center" operation.

  3. Considerations on the time factor in radiobiology

    International Nuclear Information System (INIS)

    Rossi, H.H.

    1981-01-01

    Although extension of the time period during which a given dose of radiation is administered commonly reduces effectiveness, there are well established instances where the reverse is true. Theoretical considerations are presented which relate reduction or enhancement to the shape of the dose-effect curve. While in many instances these changes of sensitivity may be due to intracellular processes it appears that in the case of carcinogenesis by low doses of neutrons, time dependent intercellular action must be involved. (orig.) [de

  4. Local Anesthetics: Review of Pharmacological Considerations

    Science.gov (United States)

    Becker, Daniel E; Reed, Kenneth L

    2012-01-01

    Local anesthetics have an impressive history of efficacy and safety in medical and dental practice. Their use is so routine, and adverse effects are so infrequent, that providers may understandably overlook many of their pharmacotherapeutic principles. The purpose of this continuing education article is to provide a review and update of essential pharmacology for the various local anesthetic formulations in current use. Technical considerations will be addressed in a subsequent article. PMID:22822998

  5. Paediatricians, social media and blogs: Ethical considerations

    OpenAIRE

    St-Laurent-Gagnon, Thérèse; Coughlin, Kevin W

    2012-01-01

    The use of blogs, Facebook and similar social networking sites is rapidly expanding and, when compared with e-mail, may be having a significantly different impact on the traditional doctor-patient relationship. Characteristics specific to these online platforms have major implications for professional relationships, including the ‘Facebook effect’ (the relative permanence of postings) and the ‘online disinhibition effect’. The present practice point illustrates relevant ethical considerations...

  6. Landscaping Considerations for Urban Stream Restoration Projects

    National Research Council Canada - National Science Library

    Bailey, Pam

    2004-01-01

    ... after restoration and its functionality for public use. The landscaping component of such stream and riparian restoration projects must be emphasized given its importance of visual success and public perception. The purpose of this technical note is to address landscaping considerations associated with urban stream and riparian restoration projects, and provide ideas to managers for enhancing the visual appeal and aesthetic qualities of urban projects.

  7. Considerations on automation of coating machines

    Science.gov (United States)

    Tilsch, Markus K.; O'Donnell, Michael S.

    2015-04-01

    Most deposition chambers sold into the optical coating market today are outfitted with an automated control system. We surveyed several of the larger equipment providers, and nine of them responded with information about their hardware architecture, data logging, level of automation, error handling, user interface, and interfacing options. In this paper, we present a summary of the results of the survey and describe commonalities and differences together with some considerations of tradeoffs, such as between capability for high customization and simplicity of operation.

  8. Stress and food allergy: mechanistic considerations

    OpenAIRE

    Schreier, Hannah M.C.; Wright, Rosalind J.

    2013-01-01

    Recent years have seen a marked increase in food allergy prevalence among children, particularly in Western countries, that cannot be explained by genetic factors alone. This has resulted in an increased effort to identify environmental risk factors underlying food allergies and to understand how these factors may be modified through interventions. Food allergy is an immune-mediated adverse reaction to food. Consequently, considerations of candidate risk factors have begun to focus on environ...

  9. Manufacturing considerations for AMLCD cockpit displays

    Science.gov (United States)

    Luo, Fang-Chen

    1995-06-01

    AMLCD cockpit displays need to meet more stringent requirements compared with AMLCD commercial displays in areas such as environmental conditions, optical performance and device reliability. Special considerations are required for the manufacturing of AMLCD cockpit displays in each process step to address these issues. Some examples are: UV stable polarizers, wide-temperature LC material, strong LC glue seal, ESS test system, gray scale voltage EEPROM, etc.

  10. Human Genome Editing and Ethical Considerations.

    Science.gov (United States)

    Krishan, Kewal; Kanchan, Tanuj; Singh, Bahadur

    2016-04-01

    Editing human germline genes may act as boon in some genetic and other disorders. Recent editing of the genome of the human embryo with the CRISPR/Cas9 editing tool generated a debate amongst top scientists of the world for the ethical considerations regarding its effect on the future generations. It needs to be seen as to what transformation human gene editing brings to humankind in the times to come.

  11. Reactor design considerations for inertial confinement fusion

    International Nuclear Information System (INIS)

    Booth, L.A.

    1979-01-01

    The most challenging reactor design consideration is protection of the cavity wall from the various energy forms as released by the pellet and as affected by the reaction-chamber phenomena. These phenomena depend on both the design and the yield of the pellet, as well as on ambient conditions in the chamber at the time of the pellet microexplosion. The effects on pellet energy-release mechanisms of various reaction chamber atmosphere options are summarized

  12. General aspects of siting and safety considerations

    International Nuclear Information System (INIS)

    Rutgers, E.

    1980-01-01

    The siting process from site selection to the different stages of review by the regulatory body is described. Special attention is payed to the role and responsibilities of the licensing authority. Next, the basic considerations involved in the siting process are reviewed. They include system planning, engineering, safety, environmental impact (including land use) and economics. Case studies illustrating different aspects of the siting process (e.g. site selection) are presented. (orig.)

  13. Intensive Care Nursing And Time Management

    OpenAIRE

    ÖZCANLI, Derya; İLGÜN, Seda

    2008-01-01

    Time is not like other resources, because it can not be bought, sold, stolen, borrowed, stored, saved, multiplied or changed. All it can be done is spent. Time management means the effective use of resources, including time, in such a way that indi- viduals are effective in achieving important personal goals. With the increasing emphasis on efficiency in health care, how a nurse manages her time is an important consideration. Since intensive care nurs- ing is focused on the care and tr...

  14. Cultural Differences in Opportunity Cost Consideration.

    Science.gov (United States)

    Zhang, Ning; Ji, Li-Jun; Li, Ye

    2017-01-01

    Two studies were conducted to investigate cultural differences in opportunity cost consideration between Chinese and Euro-Canadians. Opportunity cost is defined as the cost of a benefit that must be forgone in order to pursue a better alternative (Becker et al., 1974). In both studies, participants read about hypothetical purchase scenarios, and then decided whether they would buy a certain product. Opportunity cost consideration was measured in two ways: (1) participants' thoughts pertaining to other (nonfocal) products while making decisions; (2) participants' decisions not to buy a focal product (Study 1) or a more expensive product (Study 2). Across both indexes, we found that after controlling for individual difference variables and amount of pocket money, Chinese participants in China considered financial opportunity cost more than Euro-Canadians in Study 1. Similar results were observed in Study 2 when comparing Chinese in Canada with Euro-Canadians However, the cultural effect on opportunity cost consideration was confounded by family income in Study 2. Implications for resource management, limitations of the current research and directions for future research are discussed.

  15. Considerations on the modelling of environmental radiocarbon

    International Nuclear Information System (INIS)

    Scott, E.M.; McCartney, M.

    1991-01-01

    Modelling radionuclide transfer within the natural environment involves three general steps: model formulation, its fitting using appropriate experimental data and model validation. The last process typically involves a sensitivity analysis and is used to modify model formulation and to direct future experimental effort. A wide variety of models exists appropriate to a number of different applications. Recently, attention has been directed to the development of principles for establishing local, regional and global upper bounds to doses. Here important considerations in model choice are the spatial detail required within the model, the links between models of differing resolution and the availability of suitable experimental data. We illustrate the model-building stages and discuss the above considerations in transfer modelling using radiocarbon which is produced and released as part of the nuclear fuel cycle. Its long half life of 5730 years, its mobility in the environment and its incorporation into man via the food chain make it of some considerable radiological significance. We consider local modelling of 14 C transfer using a Gaussian plume model, while its global dispersal is modelled using a large globally-averaged compartmental model. The global analysis is used to make short term predictions of 14 C specific activities to 2050 and longer-term predictions over a period of 10,000 years. We discuss the validation of these models and attempt to quantify the sources and magnitudes of the uncertainties in the model predictions. (26 refs., 2 figs.)

  16. Ethical considerations in the management of amyotrophic lateral sclerosis.

    Science.gov (United States)

    Eisen, Andrew; Krieger, Charles

    2013-11-01

    This article examines some of the ethical concerns relevant for the management of amyotrophic lateral sclerosis (ALS). We emphasize the importance for providing a competent assessment of the clinical deficit to correctly identify the disease and to avoid incorrect diagnoses. Conveying the diagnosis to the patient and their family requires empathy and it is important to remain supportive and positive, even in the face of this incurable disease. The essence of care in ALS is to permit the patient to have optimal function for their level of ability. This may require the use of gastrostomy and non-invasive or permanent ventilation. Employment of a multi-disciplinary team will permit optimization of patient care to achieve a good quality of life for as long as possible. The patient should also be informed of the risks associated with unproven therapies and the risks and potential benefits of therapeutic trials. The wishes of patients in regard to gastrostomy, long-term ventilation and end-of life decisions must be considered in an unbiased fashion. Recent advances in the genetics of familial ALS (FALS) have demonstrated some overlap between FALS, sporadic ALS and fronto-temporal lobar dementia (FTLD). The interpretation and dissemination of the results of genetic testing although important can induce confusion, considerable anxiety and guilt in patients and their families and proper counseling is imperative. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Wilderness Preparticipation Evaluation and Considerations for Special Populations.

    Science.gov (United States)

    Joy, Elizabeth; Van Baak, Karin; Dec, Katherine L; Semakula, Barbara; Cardin, Ashlea D; Lemery, Jay; Wortley, George C; Yaron, Michael; Madden, Christopher

    2015-12-01

    Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population- specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports. Copyright © 2015. Published by Elsevier Inc.

  18. Special Considerations in Neonatal Mechanical Ventilation.

    Science.gov (United States)

    Dalgleish, Stacey; Kostecky, Linda; Charania, Irina

    2016-12-01

    Care of infants supported with mechanical ventilation is complex, time intensive, and requires constant vigilance by an expertly prepared health care team. Current evidence must guide nursing practice regarding ventilated neonates. This article highlights the importance of common language to establish a shared mental model and enhance clear communication among the interprofessional team. Knowledge regarding the underpinnings of an open lung strategy and the interplay between the pathophysiology and individual infant's response to a specific ventilator strategy is most likely to result in a positive clinical outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Emerging trends in the outsourcing of medical and surgical care.

    Science.gov (United States)

    Boyd, Jennifer B; McGrath, Mary H; Maa, John

    2011-01-01

    As total health care expenditures are expected to constitute an increasing portion of the US gross domestic product during the coming years, the US health care system is anticipating a historic spike in the need for care. Outsourcing medical and surgical care to other nations has expanded rapidly, and several ethical, legal, and financial considerations require careful evaluation. Ultimately, the balance between cost savings, quality, and patient satisfaction will be the key determinant in the future of medical outsourcing.

  20. Retention in mental health care of Portuguese-speaking patients

    Science.gov (United States)

    Gonçalves, Marta; Cook, Benjamin; Mulvaney-Day, Norah; Alegría, Margarita; Kinrys, Gustavo

    2013-01-01

    We compared service outcomes of dedicated language and cultural competency services in adequacy of care, ER, and inpatient care among Portuguese-speaking patients in ethnic- and non-ethnic-specific behavioral health clinics. We assessed adequacy of mental health care, and use of inpatient emergency department among Portuguese-speaking patients, comparing individuals receiving care from a culturally and linguistically competent mental health care setting (the Portuguese Mental Health Program [PMHP]) with usual mental health care in a community health care system in the USA. Propensity score matching was used to balance patients in treatment and control groups on gender, marital status, age, diagnosis of mental disorder, and insurance status. We used de-identified, longitudinal, administrative data of 854 Portuguese-speaking patients receiving care from the PMHP and 541 Portuguese-speaking patients receiving usual care from 2005–2008. Adequate treatment was defined as receipt of at least eight outpatient psychotherapy visits, or at least four outpatient visits of which one was a psychopharmacological visit. PMHP patients were more likely to receive adequate care. No differences were found in rates of ER use or inpatient mental health care. The present study suggests increased quality of care for patients that have contact with a clinic that dedicates resources specifically to a minority/immigrant group. Advantages of this setting include greater linguistic and cultural concordance among providers and patients. Further research is warranted to better understand the mechanisms by which culturally appropriate mental health care settings benefit minority/immigrant patients. PMID:23427258

  1. Consideration Sets and Their Role in Modelling Doctor Recommendations About Contraceptives.

    Science.gov (United States)

    Fiebig, Denzil G; Viney, Rosalie; Knox, Stephanie; Haas, Marion; Street, Deborah J; Hole, Arne R; Weisberg, Edith; Bateson, Deborah

    2017-01-01

    Decisions about prescribed contraception are typically the result of a consultation between a woman and her doctor. In order to better understand contraceptive choice within this environment, stated preference methods are utilized to ask doctors about what contraceptive options they would discuss with different types of women. The role of doctors is to confine their discussion to a subset of products that best match their patient. This subset of options forms the consideration set from which the ultimate recommendation is made. Given the existence of consideration sets we address the issue of how to model appropriately the ultimate recommendations. The estimated models enable us to characterize doctor recommendations and how they vary with patient attributes and to highlight where recommendations are clear and when they are uncertain. The results also indicate systematic variation in recommendations across different types of doctors, and in particular we observe that some doctors are reluctant to embrace new products and instead recommend those that are more familiar. Such effects are one possible explanation for the relatively low uptake of more cost effective longer acting reversible contraceptives and indicate that further education and training of doctors may be warranted. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  2. Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer.

    Science.gov (United States)

    Wiener, Lori; Weaver, Meaghann Shaw; Bell, Cynthia J; Sansom-Daly, Ursula M

    2015-01-09

    Medical providers are trained to investigate, diagnose, and treat cancer. Their primary goal is to maximize the chances of curing the patient, with less training provided on palliative care concepts and the unique developmental needs inherent in this population. Early, systematic integration of palliative care into standard oncology practice represents a valuable, imperative approach to improving the overall cancer experience for adolescents and young adults (AYAs). The importance of competent, confident, and compassionate providers for AYAs warrants the development of effective educational strategies for teaching AYA palliative care. Just as palliative care should be integrated early in the disease trajectory of AYA patients, palliative care training should be integrated early in professional development of trainees. As the AYA age spectrum represents sequential transitions through developmental stages, trainees experience changes in their learning needs during their progression through sequential phases of training. This article reviews unique epidemiologic, developmental, and psychosocial factors that make the provision of palliative care especially challenging in AYAs. A conceptual framework is provided for AYA palliative care education. Critical instructional strategies including experiential learning, group didactic opportunity, shared learning among care disciplines, bereaved family members as educators, and online learning are reviewed. Educational issues for provider training are addressed from the perspective of the trainer, trainee, and AYA. Goals and objectives for an AYA palliative care cancer rotation are presented. Guidance is also provided on ways to support an AYA's quality of life as end of life nears.

  3. Caring about caring: developing a model to implement compassionate relationship centred care in an older people care setting.

    Science.gov (United States)

    Dewar, Belinda; Nolan, Mike

    2013-09-01

    This study actively involved older people, staff and relatives in agreeing a definition of compassionate relationship-centred care and identifying strategies to promote such care in acute hospital settings for older people. It was a major component of a three year programme (the Leadership in Compassionate Care Programme, LCCP) seeking to integrate compassionate care across practice and educational environments. Compassionate caring and promoting dignity are key priorities for policy, practice and research worldwide, being central to the quality of care for patients and families, and job satisfaction for staff. Therapeutic relationships are essential to achieving excellence in care but little is known about how to develop and sustain such relationships in a culture that increasingly focuses on throughput and rapid turnover. The study used appreciative inquiry and a range of methods including participant observation, interviews, story telling and group discussions to actively engage older people, relatives and staff. A process of immersion crystallization was used to analyze data with staff as co-analysts. The study adds considerably to the conceptualization of compassionate, relationship-centred care and provides a model to aid staff deliver such care in practice, based on 'appreciative caring conversations' that enable all parties to gain two forms of 'person and relational knowledge' about 'who people are and what matters to them' and 'how people feel about their experience'. Such knowledge enables staff, patients and carers to 'work together to shape the way things are done'. The study generated a model called the 7 'C's that captures in detail the factors necessary to promote 'appreciative caring conversations'. The study demonstrates that engaging in 'appreciative caring conversations' promotes compassionate, relationship-centred care but that these conversations involve practitioners taking risks. Such 'relational practices' must therefore be valued and

  4. Managing care.

    Science.gov (United States)

    Sandifer, Q D

    1997-09-01

    The terms 'managed care' and 'disease management' are gaining common usage in the health service but their meaning is not widely understood. Managed care is a generic term describing any health care system that integrates the financing and delivery of medical care. Its growth in the United States has been driven by pressure to control costs, and there is circumstantial evidence that costs are slowing as a result of better management of resources. However, it is not clear how much of this is due to managed care, the selection of more favourable enrollees to health plans or other factors. Research evidence is limited, and that available is constrained by the rapidly changing nature of managed care. In the United States a bewildering variety of managed care arrangements have emerged, although several common characteristics can be identified: limited choice of physician providers; controlled access to secondary care; selective contracting; financial incentives; quality management; and utilization management. All are present in the National Health Service (NHS), which exemplifies a nationalized managed care system. Disease management is an extension of managed care that takes a global approach to patient care by attempting to co-ordinate resources across the entire health care delivery system throughout the life cycle of the disease. This is poorly developed in the NHS, so that the attention of commercial organizations has been attracted. However, concern has been expressed about the implications of commercial involvement: the fragmentation of general medical services; effect of for-profit status; and use of patient-based data. Recent policy developments could allow disease management to develop within the NHS.

  5. Employee Care

    OpenAIRE

    Zavadilová, Eva

    2014-01-01

    The theme of the bachelor's thesis is the issue of employee care and related provision of employee benefits. The main objective is to analyze the effective legislation and characterize the basic areas of employee care. First of all, the thesis focuses on the matter of employee care and related legislation analyzing the working conditions, professional growth of the employees, catering of employees and special conditions for some employees. Furthermore, the special attention is paid to the vol...

  6. Esthetic considerations in management of shortleaf pine

    Science.gov (United States)

    Robert H. Stignani

    1986-01-01

    Application of esthetic concerns in the management of shortleaf pine or any species should be predicated on a systematic approach. Many mitigation techniques are available, but those selected will need to be carefully tailored to the specific situation and to the unique characteristics of plant communities and landforms involved. Some additional costs should be...

  7. Legal Considerations in Clinical Decision Making.

    Science.gov (United States)

    Ursu, Samuel C.

    1992-01-01

    Discussion of legal issues in dental clinical decision making looks at the nature and elements of applicable law, especially malpractice, locus of responsibility, and standards of care. Greater use of formal decision analysis in clinical dentistry and better research on diagnosis and treatment are recommended, particularly in light of increasing…

  8. HIV testing and informed consent - ethical considerations

    African Journals Online (AJOL)

    donation; and the protection of third parties, including the health care worker. .... closest available relative or, in the case of a minor, the consent of the medical ... case informed consent to the taking of blood is obviously mandatory. . Blood ...

  9. Care of radiation accidents

    International Nuclear Information System (INIS)

    Renz, K.

    1983-01-01

    The small probability of a serious radiation accident happening dispenses neither the plants where radiation exposure occurs nor the employers' liability insurance associations from their obligation to make provision for such cases. On the other hand, the efforts involved in such preventive measures must be kept within reasonable limits. As a result of these considerations a concept for taking care of radiation accidents was developed that is based on already existing institutions. The most attention was demanded by questions of organization, logistics, communication and information. The syndrome appearing after acute whole-body irradiation is known. This syndrome in its different stages and the relative therapeutic measures form the basis for the organization of the care of radiation accidents. (orig./MG) [de

  10. Mobile health units. Design and implementation considerations.

    Science.gov (United States)

    Murphy, D C; Klinghoffer, I; Fernandez-Wilson, J B; Rosenberg, L

    2000-11-01

    The decision to provide health care services with a mobile van is one which educational and service facilities are increasingly pursuing. The benefits include: The potential to increase the availability of services to underserved populations where access to care is perceived to be one reason for underuse of available services. The opportunity to increase and broaden the educational experiences of students in a training program. The opportunity to develop a sense of social responsibility in the health care provider. The process of deciding to pursue a van purchase is complicated, and administrators may best be served by obtaining experienced consultants to help them fully comprehend the issues involved. After the decision to purchase a mobile unit is made, it is necessary to focus on van requirements and design to meet federal, state, and city codes concerning motor vehicles and health requirements. Some modifications of one's standard practices are needed because of these codes. Being aware of them in advance will allow a smooth project completion. This article provides information about some of the steps required to implement a mobile unit. The approximate time from initial concept to van delivery was 1 year, with one fully dedicated project coordinator working to assure the project's success in such a short time frame. Seeing the gratified personnel and students who serve the children on the "Smiling Faces, Going Places" Mobile Dental Van of the NYUCD (see Figure 2), and knowing the children would otherwise not have received such services, allows the health care professionals involved to feel the development of this van is an exciting mechanism for delivery of health care to individuals who would otherwise go without.

  11. Medical Students' Attitudes towards Health Care for People with Intellectual Disabilities: A Qualitative Study

    Science.gov (United States)

    Ryan, Travis A.; Scior, Katrina

    2016-01-01

    Background: People with intellectual disabilities experience serious health inequalities (e.g. they die younger than people without intellectual disabilities). Medical students' attitudes towards health care for this population warrant empirical attention because, as tomorrow's doctors, they will affect the health inequalities that people with…

  12. Critical considerations when planning experimental in vivo studies in dental traumatology.

    Science.gov (United States)

    Andreasen, Jens O; Andersson, Lars

    2011-08-01

    In vivo studies are sometimes needed to understand healing processes after trauma. For several reasons, not the least ethical, such studies have to be carefully planned and important considerations have to be taken into account about suitability of the experimental model, sample size and optimizing the accuracy of the analysis. Several manuscripts of in vivo studies are submitted for publication to Dental Traumatology and rejected because of inadequate design, methodology or insufficient documentation of the results. The authors have substantial experience in experimental in vivo studies of tissue healing in dental traumatology and share their knowledge regarding critical considerations when planning experimental in vivo studies. © 2011 John Wiley & Sons A/S.

  13. Transition to Office-based Obstetric and Gynecologic Procedures: Safety, Technical, and Financial Considerations.

    Science.gov (United States)

    Peacock, Lisa M; Thomassee, May E; Williams, Valerie L; Young, Amy E

    2015-06-01

    Office-based surgery is increasingly desired by patients and providers due to ease of access, overall efficiency, reimbursement, and satisfaction. The adoption of office-based surgery requires careful consideration of safety, efficacy, cost, and feasibility within a providers practice. This article reviews the currently available data regarding patient and provider satisfaction as well as practical considerations of staffing, equipment, and supplies. To aid the practitioner, issues of office-based anesthesia and safety with references to currently available national guidelines and protocols are provided. Included is a brief review of billing, coding, and reimbursement. Technical procedural aspects with information and recommendations are summarized.

  14. Copper surfaces are associated with significantly lower concentrations of bacteria on selected surfaces within a pediatric intensive care unit.

    Science.gov (United States)

    Schmidt, Michael G; von Dessauer, Bettina; Benavente, Carmen; Benadof, Dona; Cifuentes, Paulina; Elgueta, Alicia; Duran, Claudia; Navarrete, Maria S

    2016-02-01

    Health care-associated infections result in significant patient morbidity and mortality. Although cleaning can remove pathogens present on hospital surfaces, those surfaces may be inadequately cleaned or recontaminated within minutes. Because of copper's inherent and continuous antimicrobial properties, copper surfaces offer a solution to complement cleaning. The objective of this study was to quantitatively assess the bacterial microbial burden coincident with an assessment of the ability of antimicrobial copper to limit the microbial burden associated with 3 surfaces in a pediatric intensive care unit. A pragmatic trial was conducted enrolling 1,012 patients from 2 high acuity care units within a 249-bed tertiary care pediatric hospital over 12 months. The microbial burden was determined from 3 frequently encountered surfaces, regardless of room occupancy, twice monthly, from 16 rooms, 8 outfitted normally and 8 outfitted with antimicrobial copper. Copper surfaces were found to be equivalently antimicrobial in pediatric settings to activities reported for adult medical intensive care units. The log10 reduction to the microbial burden from antimicrobial copper surfaced bed rails was 1.996 (99%). Surprisingly, introduction of copper objects to 8 study rooms was found to suppress the microbial burden recovered from objects assessed in control rooms by log10 of 1.863 (73%). Copper surfaces warrant serious consideration when contemplating the introduction of no-touch disinfection technologies for reducing burden to limit acquisition of HAIs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Liquid metal corrosion considerations in alloy development

    International Nuclear Information System (INIS)

    Tortorelli, P.F.; DeVan, J.H.

    1984-01-01

    Liquid metal corrosion can be an important consideration in developing alloys for fusion and fast breeder reactors and other applications. Because of the many different forms of liquid metal corrosion (dissolution, alloying, carbon transfer, etc.), alloy optimization based on corrosion resistance depends on a number of factors such as the application temperatures, the particular liquid metal, and the level and nature of impurities in the liquid and solid metals. The present paper reviews the various forms of corrosion by lithium, lead, and sodium and indicates how such corrosion reactions can influence the alloy development process

  16. NPP control command: Considerations for the future

    International Nuclear Information System (INIS)

    Trapp, J.P.

    1998-01-01

    Recent years have seen considerable improvements in the performance available from instrumentation, computerized data acquisition and processing systems, signal processing and related display processing systems. This progress implies the need for a complete rethink of the approach to future surveillance, control and protection systems for use with nuclear reactors, especially regarding new reactor systems. These new systems will in the future need to ensure full compatibility between safety improvements and the enhanced economic competitively of nuclear power. This paper presents an exercise covering the main functions that can as of now be considered for future applications in this field. (author)

  17. Consideration of Fugitive Emissions from Grain Elevators

    Science.gov (United States)

    This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  18. Safety considerations in the design of PFBR

    International Nuclear Information System (INIS)

    Vaidyanathan, G.; Om Pal Singh; Govindarajan, S.; Chellapandi, P.; Chetal, S.C.; Shankar Singh, R.; Bhoje, S.B.

    1996-01-01

    Prototype Fast Breeder Reactor (PFBR) is a 500 MWe reactor under design in India. The overall safety approach adopted is based on the defence-in-depth principle. Design features have been incorporated to minimize occurrence of unsafe conditions. A plant protection system comprising reliable core monitoring to detect the off-normal condition, a reliable shutdown system to ensure safe shutdown and a passive decay heat removal system are provided. Containment is provided to prevent any release of radioactivity to the environment in case of failure of the protective devices. This paper provides a brief outline of the safety considerations in the design of PFBR. (author). 5 refs, 1 tab

  19. Aesthetic considerations in algorithmic and generative composition

    Science.gov (United States)

    Hagan, Kerry L.

    Models of chance operations, random equations, stochastic processes, and chaos systems have inspired composers as historical as Wolfgang Amadeus Mozart. As these models advance and new processes are discovered or defined, composers continue to find new inspirations for musical composition. Yet, the relative artistic merits of some of these works are limited. This paper explores the application of extra-musical processes to the sonic arts and proposes aesthetic considerations from the point of view of the artist. Musical examples demonstrate possibilities for working successfully with algorithmic and generative processes in sound, from formal decisions to synthesis.

  20. Team building: conceptual, methodological, and applied considerations.

    Science.gov (United States)

    Beauchamp, Mark R; McEwan, Desmond; Waldhauser, Katrina J

    2017-08-01

    Team building has been identified as an important method of improving the psychological climate in which teams operate, as well as overall team functioning. Within the context of sports, team building interventions have consistently been found to result in improvements in team effectiveness. In this paper we review the extant literature on team building in sport, and address a range of conceptual, methodological, and applied considerations that have the potential to advance theory, research, and applied intervention initiatives within the field. This involves expanding the scope of team building strategies that have, to date, primarily focused on developing group cohesion. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Chemical considerations in severe accident analysis

    International Nuclear Information System (INIS)

    Malinauskas, A.P.; Kress, T.S.

    1988-01-01

    The Reactor Safety Study presented the first systematic attempt to include fission product physicochemical effects in the determination of expected consequences of hypothetical nuclear reactor power plant accidents. At the time, however, the data base was sparse, and the treatment of fission product behavior was not entirely consistent or accurate. Considerable research has since been performed to identify and understand chemical phenomena that can occur in the course of a nuclear reactor accident, and how these phenomena affect fission product behavior. In this report, the current status of our understanding of the chemistry of fission products in severe core damage accidents is summarized and contrasted with that of the Reactor Safety Study

  2. Criticality safety and facility design considerations

    International Nuclear Information System (INIS)

    Waltz, W.R.

    1991-06-01

    Operations with fissile material introduce the risk of a criticality accident that may be lethal to nearby personnel. In addition, concerns over criticality safety can result in substantial delays and shutdown of facility operations. For these reasons, it is clear that the prevention of a nuclear criticality accident should play a major role in the design of a nuclear facility. The emphasis of this report will be placed on engineering design considerations in the prevention of criticality. The discussion will not include other important aspects, such as the physics of calculating limits nor criticality alarm systems

  3. Justification and radiology: Some ethical considerations

    International Nuclear Information System (INIS)

    Sia, S.

    2009-01-01

    This paper, which seeks to address the issue of justification in radiology, intends firstly to comment on the current discussion of the ethical foundation of radiological practice that focuses on the move from utilitarianism to the rights-centred criterion. Secondly, and this constitutes the bulk of the paper, it aims to offer a philosophical perspective, which is hoped will lead to a consideration of certain specific areas in ethical decision-making in the attempts here to deal with the main issue of justification in radiology. (authors)

  4. Implantable intraocular pressure monitoring systems: Design considerations

    KAUST Repository

    Arsalan, Muhammad; Ouda, Mahmoud H.; Marnat, Loic; Shamim, Atif; Salama, Khaled N.

    2013-01-01

    Design considerations and limitations of implantable Intraocular Pressure Monitoring (IOPM) systems are presented in this paper. Detailed comparison with the state of the art is performed to highlight the benefits and challenges of the proposed design. The system-on-chip, presented here, is battery free and harvests energy from incoming RF signals. This low-cost design, in standard CMOS process, does not require any external components or bond wires to function. This paper provides useful insights to the designers of implantable wireless sensors in terms of design choices and associated tradeoffs. © 2013 IEEE.

  5. Justification and radiology: some ethical considerations.

    Science.gov (United States)

    Sia, Santiago

    2009-07-01

    This paper, which seeks to address the issue of justification in radiology, intends firstly to comment on the current discussion of the ethical foundation of radiological practice that focuses on the move from utilitarianism to the rights-centred criterion. Secondly, and this constitutes the bulk of the paper, it aims to offer a philosophical perspective, which is hoped will lead to a consideration of certain specific areas in ethical decision-making in the attempts here to deal with the main issue of justification in radiology.

  6. Implantable intraocular pressure monitoring systems: Design considerations

    KAUST Repository

    Arsalan, Muhammad

    2013-12-01

    Design considerations and limitations of implantable Intraocular Pressure Monitoring (IOPM) systems are presented in this paper. Detailed comparison with the state of the art is performed to highlight the benefits and challenges of the proposed design. The system-on-chip, presented here, is battery free and harvests energy from incoming RF signals. This low-cost design, in standard CMOS process, does not require any external components or bond wires to function. This paper provides useful insights to the designers of implantable wireless sensors in terms of design choices and associated tradeoffs. © 2013 IEEE.

  7. Paediatricians, social media and blogs: Ethical considerations.

    Science.gov (United States)

    St-Laurent-Gagnon, Thérèse; Coughlin, Kevin W

    2012-05-01

    The use of blogs, Facebook and similar social networking sites is rapidly expanding and, when compared with e-mail, may be having a significantly different impact on the traditional doctor-patient relationship. Characteristics specific to these online platforms have major implications for professional relationships, including the 'Facebook effect' (the relative permanence of postings) and the 'online disinhibition effect'. The present practice point illustrates relevant ethical considerations and provides guidance to paediatricians and others concerning the prudent professional and personal use of social networking media.

  8. Isolation and confinement - Considerations for colonization

    Science.gov (United States)

    Akins, F. R.

    1978-01-01

    This paper discusses three types of isolation (sensory/perceptual, temporal, and social) that could adversely affect mankind in space. The literature dealing with laboratory and field experiments relevant to these areas is summarized and suggestions are given for dealing with these problems within the space colony community. Also, consideration is given to the potential effects of physical confinement and the need for usable space. Finally, a modification of Maslow's hierarchy of needs is proposed as a theoretical framework to understand and investigate mankind's psychological needs in space.

  9. Review of specific radiological accident considerations

    International Nuclear Information System (INIS)

    Elder, J.

    1984-01-01

    Specific points of guidance provided in the forthcoming document A Guide to Radiological Accident Considerations for Siting and Design of Nonreactor Nuclear Facilities are discussed. Of these, the following are considered of particular interest to analysts of hypothetical accidents: onsite dose limits; population dose, public health effects, and environmental contamination as accident consequences which should be addressed; risk analysis; natural phenomena as accident initiators; recommended dose models; multiple organ equivalent dose; and recommended methods and parameters for source terms and release amount calculations. Comments are being invited on this document, which is undergoing rewrite after the first stage of peer review

  10. Environmental considerations for alternative fusion reactor blankets

    International Nuclear Information System (INIS)

    Johnson, A.B. Jr.; Young, J.R.

    1975-01-01

    Comparisons of alternative fusion reactor blanket/coolant systems suggest that environmental considerations will enter strongly into selection of design and materials. Liquid blankets and coolants tend to maximize transport of radioactive corrosion products. Liquid lithium interacts strongly with tritium, minimizing permeation and escape of gaseous tritium in accidents. However, liquid lithium coolants tend to create large tritium inventories and have a large fire potential compared to flibe and solid blankets. Helium coolants minimize radiation transport, but do not have ability to bind the tritium in case of accidental releases. (auth)

  11. Design considerations for a gas microcontroller

    Science.gov (United States)

    Ritter, D. A.

    1986-01-01

    Some of the design problems that are now being addressed in consideration of a microcontroller for the upcoming GAS payload are discussed. Microcontrollers will be used to run the experiments and to collect and store the data from those experiments. Some of the requirements for a microcontroller are to be small, lightweight, have low power consumption, and high reliability. Some of the solutions that were developed to meet these design requirements are discussed. At present, the experiment is still in the design stage and the final design may change from what is presented here. The search for new integrated circuits which will do all that is needed all in one package continues.

  12. Pin care

    Science.gov (United States)

    ... Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Pin care URL of this page: //medlineplus.gov/ency/patientinstructions/000481.htm Pin care To use the sharing features on this page, please enable JavaScript. Broken bones can be fixed in surgery with metal ...

  13. Modeling Unobserved Consideration Sets for Household Panel Data

    NARCIS (Netherlands)

    J.E.M. van Nierop; R. Paap (Richard); B. Bronnenberg; Ph.H.B.F. Franses (Philip Hans)

    2000-01-01

    textabstractWe propose a new method to model consumers' consideration and choice processes. We develop a parsimonious probit type model for consideration and a multinomial probit model for choice, given consideration. Unlike earlier models of consideration ours is not prone to the curse of

  14. Consideration of beam plasma ion-source

    International Nuclear Information System (INIS)

    Sano, Fumimichi; Kusano, Norimasa; Ishida, Yoshihiro; Ishikawa, Junzo; Takagi, Toshinori

    1976-01-01

    Theoretical and experimental analyses and their comparison were made on the plasma generation and on the beam extraction for the beam plasma ion-source. The operational principle and the structure of the ion-source are explained in the first part. Considerations are given on the electron beam-plasma interaction and the resulting generation of high frequency or microwaves which in turn increases the plasma density. The flow of energy in this system is also explained in the second part. The relation between plasma density and the imaginary part of frequency is given by taking the magnetic flux density, the electron beam energy, and the electron beam current as parameters. The relations between the potential difference between collector and drift tube and the plasma density or the ion-current are also given. Considerations are also given to the change of the plasma density due to the change of the magnetic flux density at drift tube, the change of the electron beam energy, and the change of the electron beam current. The third part deals with the extraction characteristics of the ion beam. The structure of the multiple-aperture electrode and the relation between plasma density and the extracted ion current are explained. (Aoki, K.)

  15. Some considerations on stochastic neutron populations (u)

    International Nuclear Information System (INIS)

    Souto, Francisco J.; Prinja, Anil K.

    2010-01-01

    The neutron population in a multiplying body containing a weak random source may depart considerably from its average or expected value. The resulting behavior of the system is then unpredictable and a fully stochastic description of the neutron population becomes necessary. Stochastic considerations are especially important when dealing with pulsed reactors or in the case of criticality excursions in the presence of a weak source. Using the theory of discrete-state continuous-time Markov processes, and subject to some physical approximations, Bell (I) obtained approximate solutions for the neutron number probability distributions (pdf), with and without an intrinsic rapdom neutron source, that were valid at late times and/ large neutron populations. In recent work (4), we obtained exact solutions for Bell's model problem, and in this paper we use these exact probability distributions to: (I) assess the accuracy of Bell's asymptotic solutions and show how the latter follow from the exact solutions, (2) rigorously examine the probability of obtaining a divergent chain reaction, and (3) demonstrate the existence of an abrupt transition from a stochastic to a deterministic phase with increasing source strength.

  16. Ideological Considerations in Official Dubbing in Iran

    Directory of Open Access Journals (Sweden)

    Masood Khoshsaligheh

    2016-02-01

    Full Text Available In our globalizing world, audiovisual products are understandably considered tools that advertise their original language and culture. Most societies do not stand any interference from the outside, especially if it considerably opposes the socio-cultural norms. Translation is a practice of cross-cultural communication which most often complies with the socio-cultural guidelines and norms of the recipient society. However, translated products might face resistance as they can be regarded threatening and hostile by the ruling gatekeepers. Given the dramatic disparities between most languages and cultures, translators are not the only decision-makers and other agents have pivotal roles in the process of adapting the translated product to the dominant conventions and socio-cultural norms. This paper aims at shedding some light on the role which agents play in the process of dubbing, both for public access national television and for private home distribution. The study explores the effects of preliminary and operational norms, and cultural appropriation conducted at both textual and visual levels through a method including interview data and textual analysis. The results show that foreign movies dubbed into Persian in the religious context of the contemporary Iran are strictly controlled both before the process of dubbing and during and after the process of dubbing due to a number of socio-cultural, political, and ideological considerations.

  17. Day Care Legal Handbook: Legal Aspects of Organizing and Operating Day Care Programs.

    Science.gov (United States)

    Aikman, William F.

    This guide for providers of day care services presents information on business regulations and other legal considerations affecting for-profit and not-for-profit day care programs. Three basic topics covered are: (1) choosing the type of organization (sole proprietorship, partnership or corporation), (2) forming the organization, and (3) operating…

  18. Zika Virus: Obstetric and Pediatric Anesthesia Considerations.

    Science.gov (United States)

    Tutiven, Jacqueline L; Pruden, Benjamin T; Banks, James S; Stevenson, Mario; Birnbach, David J

    2017-06-01

    As of November 2016, the Florida Department of Health (FDH) and the Centers for Disease Control and Prevention have confirmed more than 4000 travel-related Zika virus (ZIKV) infections in the United States with >700 of those in Florida. There have been 139 cases of locally acquired infection, all occurring in Miami, Florida. Within the US territories (eg, Puerto Rico, US Virgin Islands), >30,000 cases of ZIKV infection have been reported. The projected number of individuals at risk for ZIKV infection in the Caribbean and Latin America approximates 5 million. Similar to Dengue and Chikungunya viruses, ZIKV is spread to humans by infected Aedes aegypti mosquitoes, through travel-associated local transmission, via sexual contact, and through blood transfusions. South Florida is an epicenter for ZIKV infection in the United States and the year-round warm climate along with an abundance of mosquito vectors that can harbor the flavivirus raise health care concerns. ZIKV infection is generally mild with clinical manifestations of fever, rash, conjunctivitis, and arthralgia. Of greatest concern, however, is growing evidence for the relationship between ZIKV infection of pregnant women and increased incidence of abnormal pregnancies and congenital abnormalities in the newborn, now medically termed ZIKA Congenital Syndrome. Federal health officials are observing 899 confirmed Zika-positive pregnancies and the FDH is currently monitoring 110 pregnant women with evidence of Zika infection. The University of Miami/Jackson Memorial Hospital is uniquely positioned just north of downtown Miami and within the vicinity of Liberty City, Little Haiti, and Miami Beach, which are currently "hot spots" for Zika virus exposure and transmissions. As the FDH works fervently to prevent a Zika epidemic in the region, health care providers at the University of Miami and Jackson Memorial Hospital prepare for the clinical spectrum of ZIKV effects as well as the safe perioperative care of the

  19. Do systematic reviews on pediatric topics need special methodological considerations?

    Science.gov (United States)

    Farid-Kapadia, Mufiza; Askie, Lisa; Hartling, Lisa; Contopoulos-Ioannidis, Despina; Bhutta, Zulfiqar A; Soll, Roger; Moher, David; Offringa, Martin

    2017-03-06

    Systematic reviews are key tools to enable decision making by healthcare providers and policymakers. Despite the availability of the evidence based Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA-2009 and PRISMA-P 2015) statements that were developed to improve the transparency and quality of reporting of systematic reviews, uncertainty on how to deal with pediatric-specific methodological challenges of systematic reviews impairs decision-making in child health. In this paper, we identify methodological challenges specific to the design, conduct and reporting of pediatric systematic reviews, and propose a process to address these challenges. One fundamental decision at the outset of a systematic review is whether to focus on a pediatric population only, or to include both adult and pediatric populations. Both from the policy and patient care point of view, the appropriateness of interventions and comparators administered to pre-defined pediatric age subgroup is critical. Decisions need to be based on the biological plausibility of differences in treatment effects across the developmental trajectory in children. Synthesis of evidence from different trials is often impaired by the use of outcomes and measurement instruments that differ between trials and are neither relevant nor validated in the pediatric population. Other issues specific to pediatric systematic reviews include lack of pediatric-sensitive search strategies and inconsistent choices of pediatric age subgroups in meta-analyses. In addition to these methodological issues generic to all pediatric systematic reviews, special considerations are required for reviews of health care interventions' safety and efficacy in neonatology, global health, comparative effectiveness interventions and individual participant data meta-analyses. To date, there is no standard approach available to overcome this problem. We propose to develop a consensus-based checklist of essential items which

  20. Patient-facing Technology for Identification of COPD in Primary Care

    Directory of Open Access Journals (Sweden)

    David Kevin Ahern

    2016-07-01

    to share and discuss their results with their providers. Results from the semistructured interviews indicated that participants perceived the Lung Age app as intuitive and easy to use. These results demonstrate that tablet computers and mHealth apps can be used to deploy acceptable and useable electronic risk assessments in primary care settings. Future research focused on the impact and outcomes of patient-centered, mHealth apps for risk screening in primary care is warranted.

  1. New tools for an old trade: a socio-technical appraisal of how electronic decision support is used by primary care practitioners.

    Science.gov (United States)

    Peiris, David; Usherwood, Tim; Weeramanthri, Tarun; Cass, Alan; Patel, Anushka

    2011-11-01

    This article explores Australian general practitioners' (GPs) views on a novel electronic decision support (EDS) tool being developed for cardiovascular disease management. We use Timmermans and Berg's technology-in-practice approach to examine how technologies influence and are influenced by the social networks in which they are placed. In all, 21 general practitioners who piloted the tool were interviewed. The tool occupied an ill-defined middle ground in a dialectical relationship between GPs' routine care and factors promoting best practice. Drawing on Lipsky's concept of 'street-level bureaucrats', the tool's ability to process workloads expeditiously was of greatest appeal to GPs. This feature of the tool gave it the potential to alter the structure, process and content of healthcare encounters. The credibility of EDS tools appears to be mediated by fluid notions of best practice, based on an expert scrutiny of the evidence, synthesis via authoritative guidelines and dissemination through trusted and often informal networks. Balanced against this is the importance of 'soft' forms of knowledge such as intuition and timing in everyday decision-making. This resonates with Aristotle's theory of phronesis (practical wisdom) and may render EDS tools inconsequential if they merely process biomedical data. While EDS tools show promise in improving health practitioner performance, the socio-technical dimensions of their implementation warrant careful consideration. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  2. Cost considerations for long-term ecological monitoring

    Science.gov (United States)

    Caughlan, L.; Oakley, K.L.

    2001-01-01

    For an ecological monitoring program to be successful over the long-term, the perceived benefits of the information must justify the cost. Financial limitations will always restrict the scope of a monitoring program, hence the program’s focus must be carefully prioritized. Clearly identifying the costs and benefits of a program will assist in this prioritization process, but this is easier said than done. Frequently, the true costs of monitoring are not recognized and are, therefore, underestimated. Benefits are rarely evaluated, because they are difficult to quantify. The intent of this review is to assist the designers and managers of long-term ecological monitoring programs by providing a general framework for building and operating a cost-effective program. Previous considerations of monitoring costs have focused on sampling design optimization. We present cost considerations of monitoring in a broader context. We explore monitoring costs, including both budgetary costs, what dollars are spent on, and economic costs, which include opportunity costs. Often, the largest portion of a monitoring program budget is spent on data collection, and other, critical aspects of the program, such as scientific oversight, training, data management, quality assurance, and reporting, are neglected. Recognizing and budgeting for all program costs is therefore a key factor in a program’s longevity. The close relationship between statistical issues and cost is discussed, highlighting the importance of sampling design, replication and power, and comparing the costs of alternative designs through pilot studies and simulation modeling. A monitoring program development process that includes explicit checkpoints for considering costs is presented. The first checkpoint occurs during the setting of objectives and during sampling design optimization. The last checkpoint occurs once the basic shape of the program is known, and the costs and benefits, or alternatively the cost

  3. Advancing Neurologic Care in the Neonatal Intensive Care Unit with a Neonatal Neurologist

    Science.gov (United States)

    Mulkey, Sarah B.; Swearingen, Christopher J.

    2014-01-01

    Neonatal neurology is a growing sub-specialty area. Given the considerable amount of neurologic problems present in the neonatal intensive care unit, a neurologist with expertise in neonates is becoming more important. We sought to evaluate the change in neurologic care in the neonatal intensive care unit at our tertiary care hospital by having a dedicated neonatal neurologist. The period post-neonatal neurologist showed a greater number of neurology consultations (Pneurology encounters per patient (Pneurology became part of the multi-disciplinary team providing focused neurologic care to newborns. PMID:23271754

  4. Consideration of aging in probabilistic safety assessment

    International Nuclear Information System (INIS)

    Titina, B.; Cepin, M.

    2007-01-01

    Probabilistic safety assessment is a standardised tool for assessment of safety of nuclear power plants. It is a complement to the safety analyses. Standard probabilistic models of safety equipment assume component failure rate as a constant. Ageing of systems, structures and components can theoretically be included in new age-dependent probabilistic safety assessment, which generally causes the failure rate to be a function of age. New age-dependent probabilistic safety assessment models, which offer explicit calculation of the ageing effects, are developed. Several groups of components are considered which require their unique models: e.g. operating components e.g. stand-by components. The developed models on the component level are inserted into the models of the probabilistic safety assessment in order that the ageing effects are evaluated for complete systems. The preliminary results show that the lack of necessary data for consideration of ageing causes highly uncertain models and consequently the results. (author)

  5. Considerations about mediative in initial petition

    Directory of Open Access Journals (Sweden)

    Maria das Vitórias Nunes Silva Lourenço

    2013-12-01

    Full Text Available This paper presents considerations about Initial Petition, textual/discursive genre, which is a genre circumscribed in the judicial domain with relation to the Commitment. For this purpose, this article exposes the text plan of the Initial Petition from the postulations of Adam (2011. In the same way, it studies the mediative frameworks based on Guentchéva (1994, 1996, which develop the notion of mediative grammatical categories, that permits the linguistic marking of distance and engagement of the enunciator with regard to the information expressed. It evidences the relevance of the use of mediated constructions in the judicial text, as they function as attenuated strategies to the responsibility of the producer of the text with what is said, and at the same time points to a discourse of authority through the entrance of the sources of law.

  6. Design considerations for ITER toroidal field coils

    International Nuclear Information System (INIS)

    Kalsi, S.S.; Lousteau, D.C.; Miller, J.R.

    1987-01-01

    The International Thermonuclear Experimental Reactor (ITER) is a new tokamak design project with joint participation from Europe, Japan, the Union of Soviet Socialist Republics (U.S.S.R.), and the United States. This paper describes a magnetic and mechanical design methodology for toroidal field (TF) coils that employs Nb 3 Sn superconductor technology. Coil winding is sized by using conductor concepts developed for the U.S. TIBER concept. Manifold concepts are presented for the complete cooling system. Also included are concepts for the coil structural arrangement. The effects of in-plane and out-of-plane loads are included in the design considerations for the windings and case. Concepts are presented for reacting these loads with a minimum amount of additional structural material. Concepts discussed in this paper could be considered for the ITER TF coils

  7. Materials Lifecycle and Environmental Consideration at NASA

    Science.gov (United States)

    Clark-Ingram, Marceia

    2010-01-01

    The aerospace community faces tremendous challenges with continued availability of existing material supply chains during the lifecycle of a program. Many obsolescence drivers affect the availability of materials: environmental safety ahd health regulations, vendor and supply economics, market sector demands,and natural disasters. Materials selection has become increasingly more critical when designing aerospace hardware. NASA and DoD conducted a workshop with subject matter experts to discuss issues and define solutions for materials selections during the lifecycle phases of a product/system/component. The three primary lifecycle phases were: Conceptualization/Design, Production & Sustainment, and End of life / Reclamation. Materials obsolescence and pollution prevention considerations were explored for the aforementioned lifecycle phases. The recommended solutions from the workshop are being presented.

  8. Opening up education - some pedagogical considerations

    DEFF Research Database (Denmark)

    Bang, Jørgen; Dalsgaard, Christian; Kjær, Arne

    2016-01-01

    would we need universities? Libraries could do the job!” In order to open up education, we need to develop a pedagogical framework for knowledge building to supplement the tradition for knowledge acquisition in higher education. In this article we present our strategic considerations for organising......In the “Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions” from September 25, 2013 the Commission advocated strongly to ‘Opening up Education’ through ‘Innovative teaching and learning for all...... through new Technologies and Open Educational Resources’. We strongly support this vision for the future and aim at realising it within a Danish context with a population of five million. However, we also retain a certain scepticism and remember the saying of David Wiley: “If content is all we need, why...

  9. Current Considerations About the Elderly and Firearms

    Science.gov (United States)

    Mertens, Brian

    2012-01-01

    In the United States, more than 17 million people aged 65 years or older own a firearm. They have the highest rate of suicide by a firearm, and recent data suggest that a disproportionate number apply to carry a concealed weapon. At least one new handgun has been designed and marketed for older people. Memory, thinking, and judgment as well as physical and behavioral competence issues related to an elderly person's safe operation of a motor vehicle apply to firearms, too. Gun availability can pose a particular risk to those with dementia and to their caretakers. The elderly constitute a substantial and rapidly growing population and market segment for whom the public health implications of firearm production, promotion, access, ownership, and use merit consideration. PMID:22390501

  10. Magnet design considerations for Tokamak fusion reactors

    International Nuclear Information System (INIS)

    Purcell, J.R.; Chen, W.; Thomas, R.

    1976-01-01

    Design problems for superconducting ohmic heating and toroidal field coils for large Tokamak fusion reactors are discussed. The necessity for making these coils superconducting is explained, together with the functions of these coils in a Tokamak reactor. Major problem areas include materials related aspects and mechanical design and cryogenic considerations. Projections and comparisons are made based on existing superconducting magnet technology. The mechanical design of large-scale coils, which can contain the severe electromagnetic loading and stress generated in the winding, are emphasized. Additional major tasks include the development of high current conductors for pulsed applications to be used in fabricating the ohmic heating coils. It is important to note, however, that no insurmountable technical barriers are expected in the course of developing superconducting coils for Tokamak fusion reactors. (Auth.)

  11. Technical considerations during disinfection by UV

    International Nuclear Information System (INIS)

    Ekhtiarzadeh, Z.; Sadeghpur, H.

    2002-01-01

    The use of new methods for treatment of water and wastewater in the country is one the rise and therefore the theoretical and practical knowledge of the industry's engineers should increase simultaneously. Ultraviolet is one of the new technologies used both for treatment of water as well as wastewater. The UV disinfection system consists of different components such as the lamp, ballast and the lamp fixtures. Each has a specification, which should be taken into account prior to design, order and purchase. The subject of price is also among the important considerations. The article presents figures cost comparison in various sections. It does not try to either approve or reject other disinfection systems such as chlorination, but the writer believes that any method should find its own practice and conditions of use, and the disinfection system designers should opt for the best system suited to their plans and avoid limiting themselves to a single one

  12. Psychosocial considerations about children and radiological events

    International Nuclear Information System (INIS)

    Lemyre, L.; Corneil, W.; Johnson, C.; Boutette, P.

    2010-01-01

    Children are identified as a vulnerable population in the case of radiological events because of their increased physical sensitivity to radiation and its impact on critical development stages. Using a comprehensive integrated risk framework, psychosocial risk protective factors are discussed in a social ecology paradigm. Children have been shown to be both vulnerable and resilient; they are both easily impressionable and also quick to adapt and learn. Psychosocial interventions during, after and most efficiently before an event can improve outcome, especially if they involve parents and schools, media and work organisations. Public education through children should be encouraged to increase knowledge of radiation and strategies to minimise exposure and irradiation. Children can become vectors of prevention, preparedness and mitigation through information and behavioural rehearsal. Special consideration must therefore be given to education, school programmes, practice rehearsal and media exposure. (authors)

  13. Practical design considerations for photovoltaic power station

    Science.gov (United States)

    Swanson, T. D.

    Aspects of photovoltaic (PV) technology are discussed along with generic PV design considerations, taking into account the resource sunlight, PV modules and their reliability, questions of PV system design, the support structure subsystem, and a power conditioning unit subsystem. A description is presented of two recent projects which demonstrate the translation of an idea into actual working PV systems. A privately financed project in Denton, Maryland, went on line in early December, 1982, and began providing power to the local utility grid. It represents the first intermediate size, grid-connected, privately financed power station in the U.S. Based on firm quotes, the actual cost of this system is about $13/W peak. The other project, called the PV Breeder, is an energy independent facility which utilizes solar power to make new solar cells. It is also the first large industrial structure completely powered by the sun.

  14. Liquid Hydrogen Sensor Considerations for Space Exploration

    Science.gov (United States)

    Moran, Matthew E.

    2006-01-01

    The on-orbit management of liquid hydrogen planned for the return to the moon will introduce new considerations not encountered in previous missions. This paper identifies critical liquid hydrogen sensing needs from the perspective of reliable on-orbit cryogenic fluid management, and contrasts the fundamental differences in fluid and thermodynamic behavior for ground-based versus on-orbit conditions. Opportunities for advanced sensor development and implementation are explored in the context of critical Exploration Architecture operations such as on-orbit storage, docking, and trans-lunar injection burn. Key sensing needs relative to these operations are also examined, including: liquid/vapor detection, thermodynamic condition monitoring, mass gauging, and leak detection. Finally, operational aspects of an integrated system health management approach are discussed to highlight the potential impact on mission success.

  15. Design considerations for prepress color proof measurement

    Science.gov (United States)

    Spooner, David L.

    1993-06-01

    For our purposes, we needed colorimetric measurements or, better yet, spectral reflectance data. Our survey of commercially available instruments identified one spectrocolorimeter, the Hunter PICS (manufactured by Hunter Associates Laboratory, Inc.), which could be programmed to automatically measure the color (and spectral reflectance) of large numbers of samples on a proof sheet. After an evaluation of this instrument, which included measuring over 10,000 exhibits, it was decided that the unit did not fully meet our needs. This resulted in a decision to integrate another instrument, the Byk-Gardner Color Machine (manufactured by Byk-Gardner, Inc.), with an x-y positioning mechanism. This paper describes the design considerations used in the development of our color measurement system.

  16. Nuclear energy: considerations about nuclear trade

    International Nuclear Information System (INIS)

    Goes Fischer, M.D. de.

    1988-01-01

    A general view of historical aspects of nuclear energy and the arrangements to assure its use for peaceful purposes are presented. Then the internal character of nuclear energy in a juride context is demonstrated; some consideration about the international organizations and conventions and the Brazilian Legislation in the nuclear area are examined. It also deals with the political aspects of nuclear trade and the function of IAEA in this are. Furthermore the restrictions imposed by Non-Proliferation Treaty-NPT, the objectures of the Tlatelolco Treaty and ''London Club'' guidelines. Afterwards the bilateral cooperation under taken by countries and its agreements are discussed. Besides some aspects of agreements made between United States, France Germany and Brazil are discussed [pt

  17. CONSIDERATIONS ON TRANSACTIONS OF FOREIGN TRADE

    Directory of Open Access Journals (Sweden)

    Paliu-Popa Lucia

    2009-05-01

    Full Text Available In the complex connection process of national economies to global economy flows, an important role has the foreign trade, which in recent decades has become, in the market economy conditions, one of the factors determining for economic growth. Foreign trade, as a separate branch of the national economy is an important factor of economic growth, caused by the internationalization of business and determining for the process of globalization. For Romania, a country still in transition and recent member of the European Union is particularly important to enhance the participation to international trade in goods and services, but also attracting foreign investments in the economy as the main possibilities for the re-industry and restructuring the national economy in order to creation and maintenance of sustainable competitive advantages. Starting from these considerations, in this article I addressed/aproached the theoretical aspects of foreign trade, without omitting intracomunity purchases and deliveries of goods.

  18. Reprocessing considerations for a developing country

    International Nuclear Information System (INIS)

    This paper describes some of the alternatives for dealing with spent fuel that face a developing country. It then discusses the considerations that affect decisions on the size and siting of reprocessing plants, and shows how small plants may be suitable in countries without the means to transport spent fuel easily. The paper also outlines the reasons for reprocessing in India, and describes the development of India's reprocessing capability. It shows how the economic conditions in India, such as low skilled labour costs, make reprocessing plants of 100 to 200 tonnes U/yr capacity economic, and includes a table giving technical data on a 100 t U/yr national plant for inclusion in the reference cases used by INFCE Working Group 4

  19. Considerations for emotion-aware consumer products.

    Science.gov (United States)

    van den Broek, Egon L; Westerink, Joyce H D M

    2009-11-01

    Emotion-aware consumer products require reliable, short-term emotion assessment (i.e., unobtrusive, robust, and lacking calibration). To explore the feasibility of this, an experiment was conducted where the galvanic skin response (GSR) and three electromyography (EMG) signals (frontalis, corrugator supercilii, and zygomaticus major) were recorded on 24 participants who watched eight 2-min emotion inducing film fragments. The unfiltered psychophysiological signals were processed and six statistical parameters (i.e., mean, absolute deviation, standard deviation, variance, skewness, and kurtosis) were derived for each 10-s interval of the film fragment. For each physiological signal, skewness and kurtosis discriminated among affective states, accompanied by other parameters, depending on the signal. The skewness parameter also showed to indicate mixed emotions. Moreover, a mapping of events in the fragments on the signals showed the importance of short-term emotion assessment. Hence, this research identified generic features, denoted important considerations, and illustrated the feasibility of emotion-aware consumer products.

  20. Considerations about our approach to obstetric psychoprophylaxis.

    Science.gov (United States)

    Cerutti, R; Volpe, B; Sichel, M P; Sandri, M; Sbrignadello, C; Fede, T

    1983-01-01

    Usually the term "obstetric psychoprophylaxis" refers to a specific method or technique. We prefer to consider it as a procedure that involves on one side the woman, the child and its family, and on the other the services entitled to give pre- and post-natal assistance. In order to realize this, a reformation of our methodological parameters and a critical analysis of the results obtained are required. In the courses of obstetric psychoprophylaxis that are held in the Department of Obstetrics and Gynaecology of the University of Padua we take into consideration the following themes: - Methodological approach - Professional training of the staff - Significance of psychosocial culture in the management of the pregnancy by the health services.

  1. Considerations for high-brightness electron sources

    International Nuclear Information System (INIS)

    Jameson, R.A.

    1990-01-01

    Particle accelerators are now used in many areas of physics research and in industrial and medical applications. New uses are being studied to address major societal needs in energy production, materials research, generation of intense beams of radiation at optical and suboptical wavelengths, treatment of various kinds of waste, and so on. Many of these modern applications require a high intensity beam at the desired energy, along with a very good beam quality in terms of the beam confinement, aiming, or focusing. Considerations for ion and electron accelerators are often different, but there are also many commonalties, and in fact, techniques derived for one should perhaps more often be considered for the other as well. We discuss some aspects of high-brightness electron sources here from that point of view. 6 refs

  2. Making Sense of Varying Standards of Care: The Experiences of Staff Working in Residential Care Environments for Adults with Learning Disabilities

    Science.gov (United States)

    Hutchison, Andrew; Kroese, Biza Stenfert

    2016-01-01

    Research evidence reveals that adults with learning disabilities who live in residential care facilities are being exposed to considerable variation in the standards of care they receive. High profile cases of substandard care have also raised concerns regarding the appropriateness of existing care provisions and practices. While attempts have…

  3. Systems considerations in seismic margin evaluations

    International Nuclear Information System (INIS)

    Buttermer, D.R.

    1987-01-01

    Increasing knowledge in the geoscience field has led to the understanding that, although highly unlikely, it is possible for a nuclear power plant to be subjected to earthquake ground motion greater than that for which the plant was designed. While it is recognized that there are conservatisms inherent in current design practices, interest has developed in evaluating the seismic risk of operating plants. Several plant-specific seismic probabilistic risk assessments (SPRA) have been completed to address questions related to the seismic risk of a plant. The results from such SPRAs are quite informative, but such studies may entail a considerable amount of expensive analysis of large portions of the plant. As an alternative to an SPRA, it may be more practical to select an earthquake level above the design basis for which plant survivability is to be demonstrated. The principal question to be addressed in a seismic margin evaluation is: At what ground motion levels does one have a high confidence that the probability of seismically induced core damage is sufficiently low? In a seismic margin evaluation, an earthquake level is selected (based on site-specific geoscience considerations) for which a stable, long-term safe shutdown condition is to be demonstrated. This prespecified earthquake level is commonly referred to as the seismic margin earthquake (SME). The Electric Power Research Institute is currently supporting a research project to develop procedures for use by the utilities to allow them to perform nuclear plant seismic margin evaluations. This paper describes the systems-related aspects of these procedures

  4. Economic and developmental considerations for pharmacogenomic technology.

    Science.gov (United States)

    Vernon, John A; Johnson, Scott J; Hughen, W Keener; Trujillo, Antonio

    2006-01-01

    The pharmaceutical industry's core business is the innovation, development and marketing of new drugs. Pharmacogenetic (PG) testing and technology has the potential to increase a drug's value in many ways. A critical issue for the industry is whether products in development should be teamed with genetic tests that could segment the total population into responders and non-responders. In this paper we use a cost-effectiveness framework to model the strategic decision-making considerations by pharmaceutical manufacturers as they relate to drug development and the new technology of PG (the science of using genetic markers to predict drug response). In a simple, static, one-period model we consider three drug development strategies: a drug is exclusively developed and marketed to patients with a particular genetic marker; no distinguishing among patients based on the expression of a genetic marker is made (traditional approach); and a strategy whereby a drug is marketed to patients both with and without the genetic marker but there is price discrimination between the two subpopulations. We developed three main principles: revenues under a strategy targeting only the responder subpopulation will never generate more revenue than that which could have been obtained under a traditional approach; total revenues under a targeted PG strategy will be less than that under a traditional approach but higher than a naive [corrected] view would believe them to be; and a traditional [corrected] approach will earn the same total revenues as a price discrimination strategy, assuming no intermarket arbitrage. While these principles relate to the singular (and quite narrow) consideration of drug revenues, they may nevertheless partially explain why PG is not being used as widely as was predicted several years ago when the technology first became available, especially in terms of pharmaceutical manufacturer-developed tests.

  5. Synthetic vision systems: operational considerations simulation experiment

    Science.gov (United States)

    Kramer, Lynda J.; Williams, Steven P.; Bailey, Randall E.; Glaab, Louis J.

    2007-04-01

    Synthetic vision is a computer-generated image of the external scene topography that is generated from aircraft attitude, high-precision navigation information, and data of the terrain, obstacles, cultural features, and other required flight information. A synthetic vision system (SVS) enhances this basic functionality with real-time integrity to ensure the validity of the databases, perform obstacle detection and independent navigation accuracy verification, and provide traffic surveillance. Over the last five years, NASA and its industry partners have developed and deployed SVS technologies for commercial, business, and general aviation aircraft which have been shown to provide significant improvements in terrain awareness and reductions in the potential for Controlled-Flight-Into-Terrain incidents / accidents compared to current generation cockpit technologies. It has been hypothesized that SVS displays can greatly improve the safety and operational flexibility of flight in Instrument Meteorological Conditions (IMC) to a level comparable to clear-day Visual Meteorological Conditions (VMC), regardless of actual weather conditions or time of day. An experiment was conducted to evaluate SVS and SVS-related technologies as well as the influence of where the information is provided to the pilot (e.g., on a Head-Up or Head-Down Display) for consideration in defining landing minima based upon aircraft and airport equipage. The "operational considerations" evaluated under this effort included reduced visibility, decision altitudes, and airport equipage requirements, such as approach lighting systems, for SVS-equipped aircraft. Subjective results from the present study suggest that synthetic vision imagery on both head-up and head-down displays may offer benefits in situation awareness; workload; and approach and landing performance in the visibility levels, approach lighting systems, and decision altitudes tested.

  6. Compulsion in family planning: the fundamental considerations.

    Science.gov (United States)

    Pethe, V P

    1979-03-01

    Focus is on some of the basic issues and considerations involved in the question of compulsion in family planning, which in terms of current contraceptive technology, only means compulsory sterilization. Pressures have been increasing to implement more stringent measures to control population growth in most of the developing countries throughout the world. During the Emergency in India (1975-1977) the government at that time, along with some individuals and groups, deemed it necessary to adopt the drastic measure of compulsory sterilization. The six sections of the discussion deal with the following: 1) compulsory family planning as rational or ethical choice basic issues; 2) neo-Malthusian thesis on compulsion - fallacies, dangers and inadequacies; 3) ethical and philosophical problems - premise of irresponsible procreation; 4) individual rights versus societal interests; 5) elitism in social policy and cost benefit considerations; and 6) international consensus against compulsion. All forums, under the auspices of the United Nations, of which India is a member, have rejected coercion and reiterated repeatedly that every individual has a basic human right to decide how many children to have and at what intervals. The most recent forum to endorse the human right to family size was the World Population Conference held at Bucharest in 1974. The 14 conditions spelled out by the United Nations Fund for Population Activity for effecting a free and responsible choice in family size may form a sound basis for a comprehensive policy concerning family planning in India. The coercive measures adopted during the Emergency are responsible for a backlash in India and retarding the progress of the family planning movement.

  7. Considerations on the DEMO pellet fuelling system

    Energy Technology Data Exchange (ETDEWEB)

    Lang, P.T., E-mail: peter.lang@ipp.mpg.de [Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching (Germany); Day, Ch. [Karlsruhe Institute of Technology, 76021 Karlsruhe (Germany); Fable, E. [Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching (Germany); Igitkhanov, Y. [Karlsruhe Institute of Technology, 76021 Karlsruhe (Germany); Köchl, F. [Association EURATOM-Ö AW/ATI, Atominstitut, TU Wien, 1020 Vienna (Austria); Mooney, R. [Culham Centre for Fusion Energy, Culham Science Centre, Oxfordshire OX14 3DB (United Kingdom); Pegourie, B. [CEA, IRFM, 13108 Saint-Paul-lez-Durance (France); Ploeckl, B. [Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching (Germany); Wenninger, R. [Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching (Germany); EFDA, Garching (Germany); Zohm, H. [Max-Planck-Institut für Plasmaphysik, Boltzmannstr. 2, 85748 Garching (Germany)

    2015-10-15

    Graphical abstract: - Highlights: • Considerations are made for a core particle fuelling system covering all DEMO requirements. • Particle deposition beyond the pedestal top is needed to achieve efficient fuelling. • Conventional pellet technology enabling launching from the torus inboard side can be used. • Efforts have been taken for integrating a suitable pellet guiding system into the EU DEMO model. • In addition, further techniques bearing potential for advanced fuelling performance are considered. - Abstract: The Demonstration Fusion Power Reactor DEMO is the step foreseen to bridge the gap between ITER and the first commercial fusion power plant. One key element in the European work plan for DEMO is the elaboration of a conceptual design for a suitable core particle fuelling system. First considerations for such a system are presented in this contribution. Following the well-considered ITER solution, most analysis performed in this study assumes conventional pellet technology will be used for the fuelling system. However, taking advantage of the less compressed time frame for the DEMO project, several other techniques thought to bear potential for advanced fuelling performance are considered as well. In a first, basic analysis all actuation parameters at hand and their implications on the fuelling performance were considered. Tentative transport modeling of a reference scenario strongly indicates only particles deposited inside the plasma pedestal allow for efficient fuelling. Shallow edge fuelling results in an unbearable burden on the fuel cycle. Sufficiently deep particle deposition seems technically achievable, provided pellets are launched from the torus inboard at sufficient speed. All components required for a DEMO pellet system capable for high speed inboard pellet launch are already available or can be developed in due time with reasonable efforts. Furthermore, steps to integrate this solution into the EU DEMO model are taken.

  8. Synthetic Vision Systems - Operational Considerations Simulation Experiment

    Science.gov (United States)

    Kramer, Lynda J.; Williams, Steven P.; Bailey, Randall E.; Glaab, Louis J.

    2007-01-01

    Synthetic vision is a computer-generated image of the external scene topography that is generated from aircraft attitude, high-precision navigation information, and data of the terrain, obstacles, cultural features, and other required flight information. A synthetic vision system (SVS) enhances this basic functionality with real-time integrity to ensure the validity of the databases, perform obstacle detection and independent navigation accuracy verification, and provide traffic surveillance. Over the last five years, NASA and its industry partners have developed and deployed SVS technologies for commercial, business, and general aviation aircraft which have been shown to provide significant improvements in terrain awareness and reductions in the potential for Controlled-Flight-Into-Terrain incidents/accidents compared to current generation cockpit technologies. It has been hypothesized that SVS displays can greatly improve the safety and operational flexibility of flight in Instrument Meteorological Conditions (IMC) to a level comparable to clear-day Visual Meteorological Conditions (VMC), regardless of actual weather conditions or time of day. An experiment was conducted to evaluate SVS and SVS-related technologies as well as the influence of where the information is provided to the pilot (e.g., on a Head-Up or Head-Down Display) for consideration in defining landing minima based upon aircraft and airport equipage. The "operational considerations" evaluated under this effort included reduced visibility, decision altitudes, and airport equipage requirements, such as approach lighting systems, for SVS-equipped aircraft. Subjective results from the present study suggest that synthetic vision imagery on both head-up and head-down displays may offer benefits in situation awareness; workload; and approach and landing performance in the visibility levels, approach lighting systems, and decision altitudes tested.

  9. Considerations on the DEMO pellet fuelling system

    International Nuclear Information System (INIS)

    Lang, P.T.; Day, Ch.; Fable, E.; Igitkhanov, Y.; Köchl, F.; Mooney, R.; Pegourie, B.; Ploeckl, B.; Wenninger, R.; Zohm, H.

    2015-01-01

    Graphical abstract: - Highlights: • Considerations are made for a core particle fuelling system covering all DEMO requirements. • Particle deposition beyond the pedestal top is needed to achieve efficient fuelling. • Conventional pellet technology enabling launching from the torus inboard side can be used. • Efforts have been taken for integrating a suitable pellet guiding system into the EU DEMO model. • In addition, further techniques bearing potential for advanced fuelling performance are considered. - Abstract: The Demonstration Fusion Power Reactor DEMO is the step foreseen to bridge the gap between ITER and the first commercial fusion power plant. One key element in the European work plan for DEMO is the elaboration of a conceptual design for a suitable core particle fuelling system. First considerations for such a system are presented in this contribution. Following the well-considered ITER solution, most analysis performed in this study assumes conventional pellet technology will be used for the fuelling system. However, taking advantage of the less compressed time frame for the DEMO project, several other techniques thought to bear potential for advanced fuelling performance are considered as well. In a first, basic analysis all actuation parameters at hand and their implications on the fuelling performance were considered. Tentative transport modeling of a reference scenario strongly indicates only particles deposited inside the plasma pedestal allow for efficient fuelling. Shallow edge fuelling results in an unbearable burden on the fuel cycle. Sufficiently deep particle deposition seems technically achievable, provided pellets are launched from the torus inboard at sufficient speed. All components required for a DEMO pellet system capable for high speed inboard pellet launch are already available or can be developed in due time with reasonable efforts. Furthermore, steps to integrate this solution into the EU DEMO model are taken.

  10. Fibromyalgia syndrome: considerations for dental hygienists.

    Science.gov (United States)

    Walters, Amber; Tolle, Susan L; McCombs, Gayle M

    2015-04-01

    Fibromyalgia syndrome (FMS) is a neurosensory disorder characterized by widespread musculoskeletal pain. Typically persistent fatigue, depression, limb stiffness, non-refreshing sleep and cognitive deficiencies are also experienced. Oral symptoms and pain are common, requiring adaptations in patient management strategies and treatment interventions. Appropriate dental hygiene care of patients suffering with this disorder is contingent upon an understanding of disease epidemiology, pathophysiology, clinical characteristics, oral signs and symptoms, as well as treatment approaches. With this information dental hygienists will be better prepared to provide appropriate and effective treatment to patients with FMS. Copyright © 2015 The American Dental Hygienists’ Association.

  11. Radiation monitoring considerations for radiobiology facilities

    International Nuclear Information System (INIS)

    McClelland, T.W.; McFall, E.D.

    1976-01-01

    Battelle, Pacific Northwest Laboratories, conducts a wide variety of radiobiology and radioecology research in a number of facilities on the Hanford Reservation. Review of radiation monitoring problems associated with storage, plant and animal experiments, waste handling and sterile facilities shows that careful monitoring, strict procedural controls and innovative techniques are required to minimize occupational exposure and control contamination. Although a wide variety of radioactivity levels are involved, much of the work is with extremely low level materials. Monitoring low level work is mundane and often impractical but cannot be ignored in today's ever tightening controls

  12. Animal experimentations: Part I: General considerations

    Directory of Open Access Journals (Sweden)

    T K Pal

    2015-01-01

    Full Text Available All materials, in the form of drugs or devices, which are intended for human use are required to be tested first in suitable animals. Many biological understandings are established on various modes of cruelties on animals. This observational notes guide us to accept or modify or even reject materials for ultimate human use. The science of experiments on animals gives us the remedial solutions to many of our human sufferings. This unique and important discipline is in need of proper understanding for selection of suitable number of animals and its proper care in captivity, and further refinements of code of conducts and ethical issues.

  13. Economic considerations in magnetic resonance imaging

    International Nuclear Information System (INIS)

    Freedman, G.S.; Stephens, W.H.

    1986-01-01

    In considering the financial aspects of MRI imaging, the authors try to incorporate the consequences of the acquisition of the hardware, as well as the problems of the ongoing operations. In many ways, an MRI facility, when isolated, has the characteristics of a new venture capital project. Many risks have not been determined, and some can only be approximated from their experience in other diagnostic imaging fields. The exercise of developing a break-even analysis is an essential component of decision making under the restructured financial system resulting from diagnosis-related groups. Moreover, since current payment for an investigational device is limited to cost recovery, careful documentation is needed for reimbursement

  14. Burnout in the nursing home health care aide: A systematic review

    Directory of Open Access Journals (Sweden)

    Sarah L. Cooper

    2016-09-01

    Conclusion: Factors associated with burnout in health care aides are similar to those reported among nurses, although the level of evidence and low methodological rigor of these studies suggest more robust study designs are warranted. Our findings suggest research focused on this important but largely invisible group of care providers could yield important advances in understanding burnout in this group and yield potential interventions to buffer burnout and its consequences. Without mitigating the effects of burnout on nursing home health care aides, vulnerable older adults in residential care are at risk.

  15. Enhancing the care navigation model: potential roles for health sciences librarians

    Science.gov (United States)

    Huber, Jeffrey T.; Shapiro, Robert M.; Burke, Heather J.; Palmer, Aaron

    2014-01-01

    This study analyzed the overlap between roles and activities that health care navigators perform and competencies identified by the Medical Library Association's (MLA's) educational policy statement. Roles and activities that health care navigators perform were gleaned from published literature. Once common roles and activities that health care navigators perform were identified, MLA competencies were mapped against those roles and activities to identify areas of overlap. The greatest extent of correspondence occurred in patient empowerment and support. Further research is warranted to determine the extent to which health sciences librarians might assume responsibility for roles and activities that health care navigators perform. PMID:24415921

  16. Continuing Care

    Science.gov (United States)

    ... Can’t Grandma Remember My Name? Artwork for Purchase Support Articles Ten Signs of Caregiver Stress Therapeutic ... loved one with Alzheimer’s may be a difficult decision. It is best to make decisions about care ...

  17. Hospice Care

    Science.gov (United States)

    ... Volunteer Donate Search Heart.org Search Get Your Local Info Find out what is happening at your ... your care. Other team members may include a music therapist, physical therapist, speech therapist or occupational therapist. ...

  18. Home Care

    Science.gov (United States)

    ... are part of home healthcare agencies. You may benefit from home care if you are dealing with ... it will trigger an emergency response or checkup phone call. Newer technologies ... or mobile testing technology (home diagnostics), including x-rays and ...

  19. Pregnant teenagers' group: contributions to prenatal care.

    Science.gov (United States)

    Queiroz, Maria Veraci Oliveira; Menezes, Giselle Maria Duarte; Silva, Thaís Jormanna Pereira; Brasil, Eysler Gonçalves Maia; Silva, Raimunda Magalhães da

    2017-06-05

    To describe changes in nurses' care following the implementation of a group of pregnant teenagers in prenatal care based on the expectations and experiences of pregnant teenagers. Qualitative and descriptive study conducted from February to November 2013 at a Primary Care Unit in Fortaleza, Ceará, Brazil, through focus groups with 16 adolescents from the group of pregnant women in the second or third trimester of pregnancy. The analysis identified central ideas and units of meanings that formed the categories. The strategy of a group of pregnant teenagers, which provides a space for coexistence and the establishment of ties encourages these individuals to talk about their needs, re-signifying their ties. Educational strategies to promote self-care of pregnant teenagers and care for their babies involve the sharing of experiences, doubts and beliefs. Considerations and suggestions of the adolescents contributed to guide nurses' practice and provide a strategic space of care and support for pregnant adolescents in primary care.

  20. Whipple procedure: patient selection and special considerations

    Directory of Open Access Journals (Sweden)

    Tan-Tam C

    2016-07-01

    Full Text Available Clara Tan-Tam,1 Maja Segedi,2 Stephen W Chung2 1Department of Surgery, Bassett Healthcare, Columbia University, Cooperstown, New York, NY, USA; 2Department of Hepatobiliary and Pancreatic Surgery and Liver Transplant, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada Abstract: At the inception of pancreatic surgery by Dr Whipple in 1930s, the mortality and morbidity risk was more than 20%. With further understanding of disease processes and improvements in pancreas resection techniques, the mortality risk has decreased to less than 5%. Age and chronic illnesses are no longer a contraindication to surgical treatment. Life expectancy and quality of life at a later age have improved, making older patients more likely to receive pancreatic surgery , thereby also putting emphasis on operative patient selection to minimize complications. This review summarizes the benign and malignant illnesses that are treated with pancreas operations, and innovations and improvements in pancreatic surgery and perioperative care, and describes the careful selection process for patients who would benefit from an operation. These indications are not reserved only to Whipple operation, but to pancreatectomies as well.Keywords: pancreaticoduodenectomy, mortality, morbidity, cancer, trauma, pancreatitis

  1. Anesthetic considerations for pediatric electroconvulsive therapy.

    Science.gov (United States)

    Franklin, Andrew D; Sobey, Jenna H; Stickles, Eric T

    2017-05-01

    Electroconvulsive therapy is being used more frequently in the treatment of many chronic and acute psychiatric illnesses in children. The most common psychiatric indications for pediatric electroconvulsive therapy are refractory depression, bipolar disorder, schizophrenia, catatonia, and autism. In addition, a relatively new indication is the treatment of pediatric refractory status epilepticus. The anesthesiologist may be called upon to assist in the care of this challenging and vulnerable patient population. Unique factors for pediatric electroconvulsive therapy include the potential need for preoperative anxiolytic and inhalational induction of anesthesia, which must be weighed against the detrimental effects of anesthetic agents on the evoked seizure quality required for a successful treatment. Dexmedetomidine is likely the most appropriate preoperative anxiolytic as oral benzodiazepines are relatively contraindicated. Methohexital, though becoming less available at many institutions, remains the gold standard for induction of anesthesia for pediatric electroconvulsive therapy though ketamine, propofol, and sevoflurane are becoming increasingly viable options. Proper planning and communication between the multidisciplinary teams involved in the care of children presenting for electroconvulsive therapy treatments is vital to mitigating risks and achieving the greatest therapeutic benefit. © 2017 John Wiley & Sons Ltd.

  2. The older orthopaedic patient: general considerations.

    Science.gov (United States)

    Potter, Jane F

    2004-08-01

    People older than 65 years are more likely to need elective and emergent orthopaedic surgery compared with younger persons. They also experience significant benefits. Although age-related changes increase the risk of perioperative complications, understanding those changes allows prevention or at least early recognition and treatment when problems arise. Because of comorbidities, older persons take more medications that need to be managed in the perioperative period. Care could be simplified if patients were to bring their medications to the preoperative evaluation. Central nervous system sensitivity to certain pain medications (meperidine and propoxyphene) means that these drugs are best avoided as good alternatives exist (morphine and oxycodone). Adverse reactions to drugs are an important cause of acute confusion (delirium) that often complicates orthopaedic care. Early mobilization after surgery, avoiding certain drugs, avoiding restraints (including Foley catheters), attending to hydration, promoting normal sleep, compensating for sensory disorders, and stimulating daytime activities can prevent delirium. Patients with dementia are more likely to have delirium develop and, like many older people, will present special challenges in communication and decision making. Including family members in discussions may be helpful in ensuring truly informed consent.

  3. Anesthesia considerations in the obese gravida.

    LENUS (Irish Health Repository)

    Tan, Terry

    2011-12-01

    Obesity is associated with serious morbidity during pregnancy, and obese women also are at a high risk of developing complications during labor, leading to an increased risk for instrumental and Cesarean deliveries. The engagement of the obstetrical anesthetist in the management of this group of high-risk patients should be performed antenatally so that an appropriate management strategy can be planned in advance to prevent an adverse outcome. Good communication between all care providers is essential. The obese patient in labor should be encouraged to have a functioning epidural catheter placed early in labor. Apart from providing analgesia and alleviating physiological derangements during labor, the presence of a functioning epidural catheter can also be used to induce anesthesia quickly in the event of an emergency cesarean section, thus avoiding a general anesthesia, which has exceedingly high risks in the obese parturient. Successful management of the obese patient necessitates a comprehensive strategy that encompasses a multidisciplinary and holistic approach from all care-providers.

  4. Detailed statistical analysis plan for the Danish Palliative Care Trial (DanPaCT)

    DEFF Research Database (Denmark)

    Johnsen, Anna Thit; Petersen, Morten Aagaard; Gluud, Christian

    2014-01-01

    BACKGROUND: Advanced cancer patients experience considerable symptoms, problems, and needs. Early referral of these patients to specialized palliative care (SPC) could offer improvements. The Danish Palliative Care Trial (DanPaCT) investigates whether patients with metastatic cancer will benefit...

  5. Mapping the scope of occupational therapy practice in palliative care: A European Association for Palliative Care cross-sectional survey.

    Science.gov (United States)

    Eva, Gail; Morgan, Deidre

    2018-05-01

    Occupational therapists play an integral role in the care of people with life-limiting illnesses. However, little is known about the scope of occupational therapy service provision in palliative care across Europe and factors influencing service delivery. This study aimed to map the scope of occupational therapy palliative care interventions across Europe and to explore occupational therapists' perceptions of opportunities and challenges when delivering and developing palliative care services. A 49-item online cross-sectional survey comprised of fixed and free text responses was securely hosted via the European Association for Palliative Care website. Survey design, content and recruitment processes were reviewed and formally approved by the European Association for Palliative Care Board of Directors. Descriptive statistics and thematic analysis were used to analyse data. Setting/respondents: Respondents were European occupational therapists whose caseload included palliative care recipients (full-time or part-time). In total, 237 valid responses were analysed. Findings demonstrated a consistency in occupational therapy practice in palliative care between European countries. Clinician time was prioritised towards indirect patient care, with limited involvement in service development, leadership and research. A need for undergraduate and postgraduate education was identified. Organisational expectations and understanding of the scope of the occupational therapy role constrain the delivery of services to support patients and carers. Further development of occupational therapy in palliative care, particularly capacity building in leadership and research activities, is warranted. There is a need for continuing education and awareness raising of the role of occupational therapy in palliative care.

  6. Considerations in Starting Climate Change Research

    Science.gov (United States)

    Long, J. C. S.; Morgan, G.; Hamburg, S.; Winickoff, D. E.

    2014-12-01

    Many have called for climate engineering research because the growing risks of climate change and the geopolitical and national security risks of climate remediation technologies are real. As the topic of climate engineering remains highly controversial, national funding agencies should evaluate even modest outdoor climate engineering research proposals with respect to societal, legal, and risk considerations in making a decision to fund or not to fund. These concerns will be extremely difficult to coordinate internationally if they are not first considered successfully on a national basis. Assessment of a suite of proposed research projects with respect to these considerations indicates we would learn valuable lessons about how to govern research by initiating a few exemplar projects. The first time an issue arrives it can be very helpful if it there are specific cases, not a broad class of projects. A good first case should be defensible and understandable, fit within the general mandate of existing research programs, have negligible physical risk, small physical scale and short duration. By focusing on a specific case, the discussion can be held with limits and help to establish some track record in dealing with a controversial subject and developing a process for assigning appropriate scrutiny and outreach. Even at an early stage, with low risk, small-scale experiments, obtaining broad-based advice will aid in dealing with the controversies. An independent advisory body can provide guidance about a wide spectrum of physical and social risks of funding the experiment compared to societal benefit of gaining understanding. Clearly identifying the research as climate engineering research avoids sending research down a path that might violate public trust and provide an important opportunity to grow governance and public engagement at an early stage. Climate engineering research should be seen in the context of all approaches to dealing with the climate problem

  7. Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use.

    Science.gov (United States)

    Pont, Lisa G; Raban, Magda Z; Jorgensen, Mikaela L; Georgiou, Andrew; Westbrook, Johanna I

    2018-06-08

    The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines. A cross-sectional analysis of eMAR data. 71 RAC facilities in New South Wales and the Australian Capital Territory, Australia. Permanent residents living in a participating facility on 1 October 2015. None. Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis. The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic. The extent of polypharmacy (69.75-100% of residents), hyper-polypharmacy (38.81-76.19%) and use of antipsychotic medicines (0-75.6%) varied considerably across the 71 facilities. Using eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy and antipsychotic medicine use across 71 RAC facilities. Further investigation into the policies and practices of facilities performing above or below expected levels is warranted to understand variation and drive quality improvement.

  8. Obstructive sleep apnea: management considerations in psychiatric patients

    Directory of Open Access Journals (Sweden)

    Heck T

    2015-10-01

    Full Text Available Taryn Heck,1 Monica Zolezzi21Pharmacy Department, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada; 2Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, QatarAbstract: Psychiatric disorders and obstructive sleep apnea (OSA are often comorbid. However, there is limited information on the impact of psychotropic medications on OSA symptoms, on how to manage psychiatric pharmacotherapy in patients presenting with OSA, or on the effectiveness and challenges of OSA treatments in patients with comorbid mental illness. As such, the objective of this article is to provide an overview of some epidemiological aspects of OSA and treatment considerations in the management of OSA in individuals with comorbid psychiatric disorders. Predefined keywords were used to search for relevant literature in electronic databases. Data show that OSA is particularly prevalent in patients with psychiatric disorders. The medical care that patients with these comorbidities require can be challenging, as some of the psychiatric medications used by these patients may exacerbate OSA symptoms. As such, continuous positive airway pressure continues to be the first-line treatment, even in patients with psychiatric comorbidity. However, more controlled studies are required, particularly to determine continuous positive airway pressure compliance in patients with mental illness, the impact of treating OSA on psychiatric symptoms, and the impact of the use of psychotropic medications on OSA symptoms.Keywords: obstructive sleep apnea, psychiatric disorders, comorbidity, psychotropic medications

  9. The ethics in qualitative health research: special considerations.

    Science.gov (United States)

    Peter, Elizabeth

    2015-09-01

    A sound knowledge of the nature of qualitative research, along with an appreciation of some special ethical considerations, is needed for rigorous reviews to be conducted. The overall character of qualitative research is described with an emphasis on the tendency of qualitative researchers to explore sensitive topics using theoretically informed methods. A number of specific features of qualitative that require additional ethical attention and awareness are also examined including the following: 1) participants are frequently quite vulnerable and require protection because the data collection methods, such as in-depth interviews, can delve into personally and politically charged matters; 2) naturalistic observation can raise concerns regarding privacy and consent; 3) the potential for the identifiability of the results of this research may require extra efforts to maintain confidentiality. Ultimately, Reseach Ethics Committee members must be knowledgeable about qualitative approaches to be able to assess the potential harms and benefits in a protocol carefully. Without this knowledge gaining ethics approval can be overly difficult for researchers and the best practices for protecting human participants can be overlooked.

  10. Pharmacoeconomic Considerations in Treating Actinic Keratosis: An Update.

    Science.gov (United States)

    Vale, Spencer M; Hill, Dane; Feldman, Steven R

    2017-02-01

    Actinic keratosis is one of the most common dermatological diagnoses worldwide, especially among the elderly, fair-skinned, and immunocompromised, and is associated with a risk of transformation to skin cancer. With actinic keratosis and skin cancer prevalence increasing as the aged population expands in the US, optimizing treatment strategies may produce cost savings for the healthcare system. Since the time of our last review in 2008, investigation of the economic considerations in treating actinic keratosis has advanced. To provide an update of treatment cost effectiveness and to review factors relating to the costs of care, we conducted a systematic review of pharmacoeconomic publications since December 2008. We identified 11 pharmacoeconomic studies, with one cost-of-treatment, five cost-effectiveness, and five cost-utility analyses. Photodynamic therapy (PDT) was well tolerated and produced a favorable cosmetic outcome in most studies. Ingenol mebutate, the newest but most expensive topical field therapy, 5-fluorouracil, and PDT were the most cost-effective treatments in our review. Patient adherence to therapy and the management of adverse effects were significant contributors to treatment costs. In the US, treatment guidelines and formalized cost-effectiveness analyses for actinic keratosis are absent from the recent literature. Future pharmacoeconomic investigation will depend on up-to-date comparative efficacy data, as well as clarification of rates of, and management strategies for, adverse effects, therapeutic non-adherence, and lesion recurrence.

  11. Bridging Body and Mind: Considerations for Trauma-Informed Yoga.

    Science.gov (United States)

    Justice, Lauren; Brems, Christiane; Ehlers, Karrie

    2018-02-08

    Individuals who suffer from trauma-related symptoms are a unique population that could benefit from the mind-body practice of yoga-or have their symptoms reactivated by it, depending on the type of yoga. Trauma-informed yoga (TIY), that is, yoga adapted to the unique needs of individuals working to overcome trauma, may ameliorate symptoms by creating a safe, tailored practice for students to learn how to respond, rather than react, to symptoms and circumstances. Yoga not thus adapted, on the other hand, may increase reactivity and activate symptoms such as hyperarousal or dissociation. This article reports on expert input about adapting yoga for individuals with trauma, with special considerations for military populations. Eleven experts, recruited based on literature review and referrals, were interviewed in person or via telephone and asked seven questions about trauma-informed yoga. Verbatim transcripts were subjected to open-coding thematic analysis and a priori themes. Findings revealed that TIY needs to emphasize beneficial practices (e.g., diaphragmatic breath and restorative postures), consider contraindications (e.g., avoiding sequences that overly engage the sympathetic nervous system), adapt to limitations and challenges for teaching in unconventional settings (e.g., prisons, VA hospitals), and provide specialized training and preparation (e.g., specialized TIY certifications, self-care of instructors/therapists, adaptions for student needs). TIY for veterans must additionally consider gender- and culture-related barriers, differing relationships to pain and injury, and medication as a barrier to practice.

  12. Vision impairment and corrective considerations of civil airmen.

    Science.gov (United States)

    Nakagawara, V B; Wood, K J; Montgomery, R W

    1995-08-01

    Civil aviation is a major commercial and technological industry in the United States. The Federal Aviation Administration (FAA) is responsible for the regulation and promotion of aviation safety in the National Airspace System. To guide FAA policy changes and educational programs for aviation personnel about vision impairment and the use of corrective ophthalmic devices, the demographics of the civil airman population were reviewed. Demographic data from 1971-1991 were extracted from FAA publications and databases. Approximately 48 percent of the civil airman population is equal to or older than 40 years of age (average age = 39.8 years). Many of these aviators are becoming presbyopic and will need corrective devices for near and intermediate vision. In fact, there has been approximately a 12 percent increase in the number of aviators with near vision restrictions during the past decade. Ophthalmic considerations for prescribing and dispensing eyewear for civil aviators are discussed. The correction of near and intermediate vision conditions for older pilots will be a major challenge for eye care practitioners in the next decade. Knowledge of the unique vision and environmental requirements of the civilian airman can assist clinicians in suggesting alternative vision corrective devices better suited for a particular aviation activity.

  13. Culture, context and community: ethical considerations for global nursing research.

    Science.gov (United States)

    Harrowing, J N; Mill, J; Spiers, J; Kulig, J; Kipp, W

    2010-03-01

    High-quality research is essential for the generation of scientific nursing knowledge and the achievement of the Millennium Development Goals. However, the incorporation of Western bioethical principles in the study design may not be suitable, sufficient or relevant to participants in low-income countries and may indeed be harmful and disrespectful. Before engaging in global health studies, nurses must consider carefully the cultural and social context and values of the proposed setting in order to situate the research within the appropriate ethical framework. The purpose of this paper was to examine the ethical principles and considerations that guide health research conducted in international settings using the example of a qualitative study of Ugandan nurses and nurse-midwives by a Canadian researcher. The application of Western bioethical principles with their emphasis on autonomy fails to acknowledge the importance of relevant contextual aspects in the conduct of global research. Because ethics is concerned with how people interact and live together, it is essential that studies conducted across borders be respectful of, and congruent with, the values and needs of the community in which it occurs. The use of a communitarian ethical framework will allow nurse scientists to contribute to the elimination of inequities between those who enjoy prosperity and good health, and those who do not.

  14. Social considerations of inflammatory bowel disease in Southern Israel.

    Science.gov (United States)

    Taylor, Jonathan; Neff, Chase

    2017-07-17

    Chronic diseases pose unique social challenges beyond traditional health considerations that require specific attention. In this report, we examine the case of a middle-aged woman with ulcerative colitis, living in Southern Israel. Trust between the patient and physician is shown to positively influence a variety of therapeutic outcomes and should be considered a fundamental component of successful care. In context of the military conflict between Israel and Gaza, the needs of patients with chronic diseases cannot be forgotten. The work environment is also identified as an area of particular concern, as a supportive work environment is essential in order to maintain satisfaction in the workplace and sustain a high quality of life. Out-of-pocket costs for medications are confirmed to be a significant barrier to adherence. Better understanding of patients’ financial capabilities, along with affordable therapeutic interventions, will alleviate healthcare-related financial burdens and improve health outcomes. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. The ethics in qualitative health research: special considerations

    Directory of Open Access Journals (Sweden)

    Elizabeth Peter

    2015-09-01

    Full Text Available Abstract A sound knowledge of the nature of qualitative research, along with an appreciation of some special ethical considerations, is needed for rigorous reviews to be conducted. The overall character of qualitative research is described with an emphasis on the tendency of qualitative researchers to explore sensitive topics using theoretically informed methods. A number of specific features of qualitative that require additional ethical attention and awareness are also examined including the following: 1 participants are frequently quite vulnerable and require protection because the data collection methods, such as in-depth interviews, can delve into personally and politically charged matters; 2 naturalistic observation can raise concerns regarding privacy and consent; 3 the potential for the identifiability of the results of this research may require extra efforts to maintain confidentiality. Ultimately, Reseach Ethics Committee members must be knowledgeable about qualitative approaches to be able to assess the potential harms and benefits in a protocol carefully. Without this knowledge gaining ethics approval can be overly difficult for researchers and the best practices for protecting human participants can be overlooked.

  16. Pharmacoeconomics of inhaled anesthetic agents: considerations for the pharmacist.

    Science.gov (United States)

    Chernin, Eric L

    2004-10-15

    Types of economic analyses used for inhaled anesthetic agents, factors to consider in calculating the cost of inhaled anesthetics, limitations of pharmacoeconomic studies of these agents, and strategies for controlling inhaled anesthetic costs are discussed. Inhaled anesthetic agents comprise a substantial component of drug budgets. Calculation of the cost of administering an inhaled anesthetic should take into consideration the cost per mL, potency, waste, concentration and duration of gas delivery, fresh gas flow rate, molecular weight, and density. The use of newer inhaled anesthetic agents with low solubility in blood and tissue provides a more rapid recovery from anesthesia than older, more soluble agents, and also provides the same level of control of depth of anesthesia at a lower fresh gas flow rate and possibly a lower cost than older agents at a higher fresh gas flow rate. A more rapid recovery may facilitate fast-track recovery and yield cost savings if it allows the completion of additional surgical cases or allows a reduction in personnel overtime expenses. Interpretation of pharmacoeconomic studies of inhaled anesthetics requires an appreciation of the limitations in methodology and ability to extrapolate results from one setting to another. Pharmacists' efforts to reduce anesthetic waste and collaborate with anesthesiologists to improve the use of these agents can help contain costs, but improving scheduling and efficiency in the operating room has a greater potential to reduce operating room costs. Much can be done to control costs of anesthetic agents without compromising availability of these agents and patient care.

  17. Economic considerations in the use of inhaled anesthetic agents.

    Science.gov (United States)

    Golembiewski, Julie

    2010-04-15

    To describe the components of and factors contributing to the costs of inhaled anesthesia, basis for quantifying and comparing these costs, and practical strategies for performing pharmacoeconomic analyses and reducing the costs of inhaled anesthetic agents. Inhaled anesthesia can be costly, and some of the variable costs, including fresh gas flow rates and vaporizer settings, are potential targets for cost savings. The use of a low fresh gas flow rate maximizes rebreathing of exhaled anesthetic gas and is less costly than a high flow rate, but it provides less control of the level of anesthesia. The minimum alveolar concentration (MAC) hour is a measure that can be used to compare the cost of inhaled anesthetic agents at various fresh gas flow rates. Anesthesia records provide a sense of patterns of inhaled anesthetic agent use, but the amount of detail can be limited. Cost savings have resulted from efforts to reduce the direct costs of inhaled anesthetic agents, but reductions in indirect costs through shortened times to patient recovery and discharge following the judicious use of these agents are more difficult to demonstrate. The patient case mix, fresh gas flow rates typically used during inhaled anesthesia, availability and location of vaporizers, and anesthesia care provider preferences and practices should be taken into consideration in pharmacoeconomic evaluations and recommendations for controlling the costs of inhaled anesthesia. Understanding factors that contribute to the costs of inhaled anesthesia and considering those factors in pharmacoeconomic analyses and recommendations for use of these agents can result in cost savings.

  18. Facilitating the formation of accountable care organizations in rural areas.

    Science.gov (United States)

    Baloh, Jure; Zhu, Xi; Vaughn, Tom; MacKinney, A Clinton; Mueller, Keith J; Ullrich, Fred; Nattinger, Matthew

    2014-07-01

    This Policy Brief presents characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries. Doing so provides considerations for provider organizations contemplating creating rural-based ACOs. Key Findings. (1) Previous organizational integration and risk-sharing experience facilitated ACO formation. (2) Use of an electronic health record system fostered core ACO capabilities, including care coordination and population health management. (3) Partnerships across the care continuum supported utilization of local health care resources.

  19. Aquarius study - engineering and economic considerations

    International Nuclear Information System (INIS)

    Griffin, Roger F.

    1970-01-01

    The two previous papers described the scope of the Aquarius Study and the various applications considered in evaluating the use of nuclear explosives for the development of water resources in Arizona. Surface storage behind a dam created with the use of nuclear explosives was selected for the major effort, primarily because it could afford the most valid direct comparison between nuclear and conventional methods. In this paper I will focus on the engineering and economic considerations involved in developing and evaluating three concepts for constructing a rockfill dam using nuclear explosives. Engineering development and economic evaluation of the concepts was the principal responsibility of Bechtel Corporation as a consultant in the study to the Arizona Atomic Energy Commission. We depended heavily on information supplied by the Federal participants, notably the U.S. Bureau of Reclamation for site data and the U.S. AEC*s Lawrence Radiation Laboratory for information on nuclear explosives effects. Since the study report has not yet been published and additional material is still forthcoming, some of the information I will present, such as the cost estimates, may be subject to change and should be considered preliminary. (author)

  20. Transnasal endoscopy: Technical considerations, advantages and limitations.

    Science.gov (United States)

    Atar, Mustafa; Kadayifci, Abdurrahman

    2014-02-16

    Transnasal endoscopy (TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way, TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope. Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.