Surviving Domestic Violence: Rebuilding One's Life

The purpose of this study was to contribute to occupational therapists' understanding of the experience of domestic violence, its impact on the lives of women, and the needs of these women as they journey towards independent and abuse-free lives. A phenomenological design was used to explore the experiences of five women living at a battered women's shelter and five women who had been at the shelter and were now living on their own, free of abuse. Five themes emerged to describe the women's experiences of rebuilding their lives: (1) “You owe yourself a life,” (2) “It's really all about connecting the dots,” (3) “I don't have an ounce of time to myself,” (4) “It gets hard,” and (5) “That was the road I traveled but this is now the road that I'm on.” The experiences of these women compel the occupational therapists to pause and reflect upon their role in working with survivor's of domestic violence.     

What does “Getting to ZeroTM Through the Power of One” mean to you?

Hopefully by now you've heard the mantra and are now aware of ASHRM's initiative of “Getting to Zero^TM Through the Power of One.” But what does that mean to you? And how can you forward the message on to your colleagues and coworkers? It's as simple as looking at it this way: “Everyone is a risk manager.”     

The experiences of foundation doctors with dyspraxia: a phenomenological study

Dyspraxia, otherwise known as Developmental Coordination Disorder (DCD), is a specific learning difficulty (SpLD). Its main difficulties manifest as problems with motor coordination, organisation, academic and social difficulties. There are now more students arriving at university with SpLDs, and, therefore, a similar rise may be expected within medical education. There has been no previous research focusing on dyspraxia in doctors. An interpretive phenomenological approach was used. Six UK foundation schools disseminated the announcements. Three participants took part in loosely structured telephone interviews regarding their experiences of undertaking medical school and foundation school with dyspraxia. These were transcribed verbatim and then thematically analysed. The themes could be split into two main categories: “Weakness and Coping Strategies” and “Perspectives of Dyspraxia”. “Weakness” included: clumsiness, organisation and needing extra time. The participants focused on their “Coping Strategies” that included: Ensuring safety, adapted learning preferences and external support. “Perspectives of Dyspraxia” included: diagnosis, career choice, stigma, “normalisation” and the “difference view” or “medical deficit” view of dyspraxia. Doctors with dyspraxia often mask their difficulties through sophisticated coping strategies. These were determined and hardworking individuals who believe that their dyspraxia was a positive aspect of their identity, adopting a “difference view”. They felt further education is needed about dyspraxia to change the perceived stigma. There is now a need for further research in this area.

     

基于多学科管理的β内酰胺酶抑制剂的管控分析与思考

目的:实现抗菌药物的合理使用,降低细菌的耐药率。方法:调取胃肠外科2017-2018年8个季度的哌拉西林钠舒巴坦钠的使用量、肠杆菌科细菌对三代头孢的耐药率以及平均住院日等数据。结果:胃肠外科哌拉西林钠他唑巴坦钠的使用量在前三季度与上年同期比下降;但在第四季度与上年同期比升高。肠杆菌科细菌对三代头孢的耐药率保持稳定。平均住院日同比有明显的减少。结论:完善多科协同管理(AMS)模式,制订感染性疾病路径,建立“抗菌药物监测”、“微生物监测”和“院内感染监测”的三方合作,同时加大公众宣传教育力度,减少β内酰胺酶抑制剂的预防用药。     

Virus Found in Guinea Pig Leukemia

It is now believed that most cases up to now diagnosed as emphysema or chronic bronchitis really belong in a third category, “chronic airways obstruction.” That the introduction of this diagnosis clarifies rather than adds to the confusion prevalent with regard to pulmonary obstructive processes is brought home in terms of the specific problems confronting the clinician in managing his patient.     

Tyler’s Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies.

Many believe that excessive intake of refined carbohydrates (CHO) plays a major role in the development of obesity/overweight, type 2 diabetes mellitus and insulin resistance, a collection of events commonly referred to as “diabesity,” and have sought natural means to overcome these linked perturbations. As a first approach, planned diets with low portions of refined CHO have become popular. However, these diets do not satisfy everyone; and many are concerned over replacing CHO with more fats. As a second option, addition of soluble fiber to the diet can slow absorption of refined CHO, i.e., lower the glycemic index of foods and overcome or at least ameliorate many of the adverse reactions resulting from increased refined CHO ingestion. Unfortunately, the general public does not favor diets high in fiber content, and various fibers can lead to gastrointestinal problems such as gas and diarrhea. A third choice to favorably influence CHO absorption is to use natural dietary supplements that block or slow CHO absorption in the gastrointestinal tract via inhibiting enzymes necessary for CHO absorption –amylase and alpha-glucosidases. Although a number of natural supplements with anti-amylase activity have been recognized, the most studied and favored one is white kidney bean extract. Animal and human studies clearly show that this agent works in vivo and has clinical utility. This paper reviews many aspects of diabesity and the use of “carb blockers” to prevent and ameliorate the situation. In many respects, carb blockers mimic the beneficial effects of fibers.     

The Case of the Common Duct Cancer

Technology is now available for synthesis of vaccines derived from short amino acid sequences on the surface of a virus or other pathogen. Such small peptide sequences are capable of “recognizing” the entire pathogen and of stimulating effective antibody production. These synthetic vaccines are potentially “medically ideal” agents, whose clinical applicability is now being explored.     

Intersexualität und Differences of Sex Development (DSD)

Intersex is an inherited incongruence of chromosomal, gonadal, and genital sexual characteristics. A typical clinical situation of intersex is the ambiguous genitalia in the newborn. Diagnostics, counseling, and therapy should be offered by specialized multidisciplinary health-care teams. The focus is not only on medical issues but also on psychological, social, and ethical aspects. In the international literature, intersex is now termed “disorders of sex development” (DSD). Alternatively, some authors use “differences of sex development” to underline that patients do not necessarily feel they have a “disorder” but rather a “difference” of sex development compared with normal sex development.     

Early smallpox vaccine manufacturing in the United States: Introduction of the “animal vaccine” in 1870, establishment of “vaccine farms”, and the beginnings of the vaccine industry

For the first 80–90 years after Jenner’s discovery of vaccination in 1796, the main strategy used to disseminate and maintain the smallpox vaccine was arm-to-arm vaccination, also known as Jennerian or humanized vaccination. A major advance occurred after 1860 with the development of what was known as “animal vaccine”, which referred to growing vaccine material from serial propagation in calves before use in humans. The use of “animal vaccine” had several advantages over arm-to-arm vaccination: it would not transmit syphilis or other human diseases, it ensured a supply of vaccine even in the absence of the spontaneous occurrence of cases of cowpox or horsepox, and it allowed the production of large amounts of vaccine. The “animal vaccine” concept was introduced in the United States in 1870 by Henry Austin Martin. Very rapidly a number of “vaccine farms” were established in the U.S. and produced large quantities of “animal vaccine”. These “vaccine farms” were mostly established by medical doctors who saw an opportunity to respond to an increasing demand of smallpox vaccine from individuals and from health authorities, and to make a profit. The “vaccine farms” evolved from producing only smallpox “animal vaccine” to manufacturing several other biologics, including diphtheria- and other antitoxins. Two major incidents of tetanus contamination happened in 1901, which led to the promulgation of the Biologics Control Act of 1902. The US Secretary of the Treasury issued licenses to produce and sell biologicals, mainly vaccines and antitoxins. Through several mergers and acquisitions, the initial biologics licensees eventually evolved into some of the current major American industrial vaccine companies. An important aspect that was never clarified was the source of the vaccine stocks used to manufacture the smallpox “animal vaccines”. Most likely, different smallpox vaccine stocks were repeatedly introduced from Europe, resulting in polyclonal vaccines that are now recognized as “variants” more appropriately than “strains”. Further, clonal analysis of modern “animal vaccines” indicate that they are probably derived from complex recombinational events between different strains of vaccinia and horsepox. Modern sequencing technologies are now been used by us to study old smallpox vaccine specimens in an effort to better understand the origin and evolution of the vaccines that were used to eradicate the smallpox.     

Aktionsprogramm Umwelt und Gesundheit (APUG) Umsetzung der Querschnittsmaßnahmen

The German Action Programme “Environment and Health” (APUG) was published in June 1999. It includes two chapters, “Objectives and Intersectoral Measures” and “Media- and Substance-oriented Quality Objectives”, which cover a variety of subjects each of which consists of a large number of different activities. These intersectoral activities are implemented by various authorities and relate to the following topics: environmental health monitoring and reporting; information management; assessment, management and communication of risks; environmental medicine; research on environment and health, and measures to improve cooperation among national authorities. Among the most important activities initiated are a combined National Health and Environmental Survey focusing exclusively on children and teenagers, the establishment of a “Commission on Risks” and a “Commission on Methods and Quality Assurance in Environmental Medicine”, and the development of a guidance document on risk communication, as well as, the implementation of numerous research projects dealing with specific subjects, e.g., the MCS syndrome. Current emphasis is on the topic of “Children, Environment and Health”. A two-day forum on this topic took place in Munich (Germany) in November 2001.The forum gathered scientists, policy makers, the media, and the public including children. An important outcome of the Action Programme is that new structures have been now established that would improve cooperation among authorities at the federal, state and community level and non-governmental organisations.     

Treatment of Meningeal Leukemia

Chemotherapy via the intrathecal and intraventricular routes with the use of up to three drugs plus radiotherapy have produced remissions so prolonged that it is now practical to think of a “cure” rather than simple palliation of this disease. A promising treatment protocol is described in which radiotherapy is combined with and followed by intraventricular methotrexate and cytosine arabinoside.     

Improving performance of long‐term care networks at their initial stage: an empirical study of factors affecting results

Until now very little research has been carried out on the performance of health and human services networks in evolution. In particular, previous studies mainly referred to “centrally governed services networks” in the US context. According to Provan and Kenis (2008), these networks are “lead organization‐governed”, and are different from the “participant‐governed” model or the “network administrative organization (NAO)” solution. We focused our attention on the Apulia region care services networks (Italy). In the last few years, the governance of these networks has passed from the “participant‐governed” model to the NAO approach. We examined how the integration mechanisms work in this type of networks, and if there were challenges to tackle in order to improve their overall performance. These networks were examined at their initial stage, exactly when their governance model moved to a more integrated solution. We collected survey data from 17 health and human services networks out of 45 (38%). The research is carried out by means of statistical methods (OLS). The analysis is cross sectional. The implementation of “rational/technocratic” factors is important but not sufficient to enhance collaboration. The integration at the “professional level” should be kept in mind. In particular, the role of network (case) managers is paramount. Copyright © 2016 John Wiley & Sons, Ltd.     

Wissen umsetzen

It is indisputable that preventive and health-promoting interventions are also effective for older people. In order to put this knowledge into practice, several important questions have to be answered first. Which preventive goals have priority? Which contents have to be conveyed in the context of “healthy ageing”? Which strategies of intervention have proven effective so far? How can older people be addressed in their surroundings? Working Group 3 on “Healthy Ageing” of the German Forum/Platform for Prevention and Health Promotion is currently discussing these questions. The following article presents the proceedings as well as the results of Working Group 3 up to now.     

Nuclear Medicine in Gastroenterology

Visualization of the morphology of the gastrointestinal tract, and of lesions that alter this morphology, is well established. Attention has now turned to the more challenging problems of “visualizing” physiologic processes such as absorption, and of imaging and performing dynamic studies of the pancreas, the liver, and the other components of the hepatobiliary system.     

抓住机遇 增强活力 走妇幼保健院加速发展之路

<正> 妇幼卫生随着社会的不断进步和医学模式的转变,已逐步发展成为卫生事业中不可替代的,与医疗、预防并驾齐驱的独立体系。如何加强县(市)级妇幼保健机构建设,充分发挥妇幼保健中心作用,组织实施辖区内妇幼保健工作规划,检查、督促基层各项妇幼保健任务的落实,指导基层采取新技术、新方法等干预措施,笔者就萧山市妇幼保健院抓住有利机遇,突出保健特色,探索符合县(市)级     

The Sudden Death Syndrome of Infancy

The “crib death” that remains totally unexplained after complete necropsy is beginning to yield its secrets to careful follow-up study. Disclosing a surprisingly consistent pattern of pathologic and epidemiologic features, this research may open the way to eventual prophylaxis. It already provides physicians with the means to relieve parents of the dreadful burden of guilt many now carry.     

Autonomy-Centered Healthcare

In this paper, I aim to demonstrate that the consequences of the current United States health insurance scheme on both physician and patient autonomy is dire. So dire, in fact, that the only moral solution is something other than what we have now. The United States healthcare system faces much criticism at present. But my focus is particular: I am interested in the ways in which insurance interferes with physician and patient autonomy. (I do not consider The Affordable Care Act much of a change in this aspect of the system, for it still relies heavily on private insurance, albeit often subsidized.) I will argue in favor of an expansion of the traditional conception of what I call “medical autonomy” or “healthcare autonomy” and the usual role it plays in bioethical discussions. More generally, I show that in morally designing or evaluating any healthcare system, serious attention should be paid to how this system helps foster what I call active autonomy.     

Best practice guidelines for monitoring socioeconomic inequalities in health status: lessons from Scotland

Context: In this article we present “best practice” guidelines for monitoring socioeconomic inequalities in health status in the general population, using routinely collected data. Methods: First, we constructed a set of critical appraisal criteria to assess the utility of routinely collected outcomes for monitoring socioeconomic inequalities in population health status, using epidemiological principles to measure health status and quantify health inequalities. We then selected as case studies three recent “cutting‐edge” reports on health inequalities from the Scottish government and assessed the extent to which each of the following outcomes met our critical appraisal criteria: natality (low birth weight rate, LBW), adult mortality (all‐cause, coronary heart disease [CHD], alcohol‐related, cancer, and healthy life expectancy at birth), cancer incidence, and mental health and well‐being. Findings: The critical appraisal criteria we derived were “completeness and accuracy of reporting”; “reversibility and sensitivity to intervention”; “avoidance of reverse causation”; and “statistical appropriateness.” Of these, the most commonly unmet criterion across the routinely collected outcomes was “reversibility and sensitivity to intervention.” The reasons were that most mortality events occur in later life and that the LBW rate has now become obsolete as a sole indicator of perinatal health. Other outcomes were also judged to fail other criteria, notably alcohol‐related mortality after midlife (“avoidance of reverse causation”); all cancer sites’ incidence and mortality (statistical appropriateness due largely to heterogeneity of SEP gradients across different cancer sites, as well as long latency); and mental health and well‐being (“uncertain reversibility and sensitivity to intervention”). Conclusions: We conclude that even state‐of‐the‐art data reports on health inequalities by SEP have only limited usefulness for most health and social policymakers because they focus on routinely collected outcomes that are not very sensitive to intervention. We argue that more “upstream” outcome measures are required, which occur earlier in the life course, can be changed within a half decade by feasible programs and policies of proven effectiveness, accurately reflect individuals’ future life‐course chances and health status, and are strongly patterned by SEP.     

Stenotrophomonas maltophilia susceptibility to ceftazidime-avibactam combination versus ceftazidime alone

ObjectiveTo compare the minimum inhibitory concentrations (MIC) of the ceftazidime-avibactam (CZA) combination versus ceftazidime alone (TZ) for Stenotrophomonas maltophilia.Patients and methodsMIC comparison was performed by E-tests. We assumed that CZA was more effective in vitro than TZ alone when CZA led to a category change from “Resistant” with TZ alone to “Susceptible” or “Intermediate” with CZA, or if the MIC of CZA was at least 4-fold lower than the MIC of TZ for TZ-susceptible isolates.ResultsFor the 54 clinical isolates included in the study, CZA showed better results in terms of the proportion of susceptible isolates (66.7% vs. 38.9%, P < 0.01), MIC₅₀ (2 μg/mL vs. 12 μg/mL, P < 0.05), and MIC distribution. According to our definition, CZA was also more effective in vitro than TZ alone for 50% of the isolates.ConclusionUsing CZA for empirical treatments in severe or polymicrobial infections with S. maltophilia seems appropriate.     

The child-effect in the new media environment: challenges and opportunities for communication research

Abstract

Most studies on the uses and effects of media and communication by parents and children have focused on how parents influence their children. Socialization theory generally describes how children internalize the rules and norms from their parents, teachers, siblings, media, and others. Socialization is, however, a bidirectional process in which children socialize their parents as well. This “child-effect” is a perspective that has been largely ignored in the social science literature in general, and in media research, in particular. Given recent changes in the media landscape (such as the introduction of smartphones and tablets), we argue that this needs to be investigated now more than ever. In this paper, we aim (1) to give a brief theoretical overview of the “child-effect hypothesis” and (2) to discuss its challenges and opportunities for future research of the relationship between parents and children in media and communication research.