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Primary Responsibility (primary + responsibility)
Selected AbstractsTransnational organized crime in West Africa: the additional challengeINTERNATIONAL AFFAIRS, Issue 6 2007ANTONIO L. MAZZITELLI Despite its vast natural and human resources and the undisputed progress made in the last decade towards the establishment of democratic culture and governing systems, West African countries continue to occupy the bottom ranks of the UN Human Development Index. Similarly, many of them score poorly in World Bank and Transparency International indexes that measure good governance. The international mass media have recently highlighted the role played by the West African region in the transatlantic cocaine trade, as well as in the flow of illegal migrants to Europe. Drugs and migrants are, however, just two of the numerous illicit activities that feed the growth of local and transnational criminal organizations, and the establishing of a culture of quick and easy money that is progressively eroding the foundations of any sustainable and well balanced socio-economic development. The pervasive power of the corruption of criminal organizations, coupled with a general crisis by state actors in the administration of justice and enforcement of the rule of law, contribute towards the progressive diminishing of the credibility of the state as the institution entrusted with the prerogatives of guaranteeing security (of people and investments) and dispensing justice. In this context, the case of Guinea Bissau is probably the clearest example of what West African states may face in the near future if the issues of justice and security are not properly and promptly addressed. If primary responsibilities lie with West African governments and institutions, the international community as a whole should also review its approach to development policies by not only mainstreaming the issues of security and justice in their bilateral and multilateral agendas, but also by making it an essential cornerstone of policies and programmes aimed at supporting good governance and the establishment of states ruled by the law. [source] Factors influencing the scope and quality of science and management decisionsFISH AND FISHERIES, Issue 1 2002(The good, the bad, the ugly) Abstract The lecture traces the historical path to overfishing of the world's fish and shellfish stocks, and provides an assessment of marine fish resources in the later half of the 1990s. The basis of overfishing as noted by various fishery scientists is reviewed. Four factors, including institutional paralysis, the rapidity of technological developments, uncertainty of science, and the inability to monitor and enforce regulations are identified as the major problems leading to overfishing. The failure of the world community to deal with extensive overfishing, appears to have motivated managers and scientists to promote a new fishery management paradigm that focuses on a broader set of problems resulting from fishing, and establishes a more conservative decision-making process founded on precautionary principle and uncertainty. The author feels that the evolving paradigm will result in the rebuilding of a number of stocks in the United States, but is less certain of its adoption on a global scale, and whether or not science will play a more useful role in fisheries management. It is noted that the support for fisheries science and the status of fisheries have followed opposite courses. Over the past half century marine science has boomed, diversified and become intellectually and materially enriched, while the number of overfished stocks and ecological disasters has increased. Looking ahead it is expected that fisheries management will move into a more conservative era. The focus of fisheries has moved from full use of ocean resources to establishing yields that take into account the impacts of fisheries on target and non-target species and the ecosystem in general. Although there has been wide-spread abuse in the use of the world's fishery resources and condemnation of the fishing industries, the author feels that the government institutions must bear the primary responsibility for the historical course of fishery management and its failure. [source] ,I'm Home for the Kids': Contradictory Implications for Work,Life Balance of Teleworking MothersGENDER, WORK & ORGANISATION, Issue 5 2008Margo Hilbrecht This study explores the experience of time flexibility and its relationship to work,life balance among married female teleworkers with school-aged children. Drawing from a larger study of teleworkers from a Canadian financial corporation, 18 mothers employed in professional positions discussed work, leisure and their perceptions of work,life balance in in-depth interviews. Telework was viewed positively because flexible scheduling facilitated optimal time management. A key factor was the pervasiveness of caregiving, which could result in ongoing tensions and contradictions between the ethic of care and their employment responsibilities. The ideology of ,intensive mothering' meant that work schedules were closely tied to the rhythms of children's school and leisure activities. The different temporal demands of motherhood and employment resulted in little opportunity for personal leisure. Time ,saved' from not having to commute to an office was reallocated to caregiving, housework or paid employment rather than to time for their self. The women also experienced a traditional gendered division of household labour and viewed telework as a helpful tool for combining their dual roles. Time flexibility enhanced their sense of balancing work and life and their perceived quality of life. At the same time, they did not question whether having the primary responsibility for caregiving while engaged in paid employment at home was fair or whether it was a form of exploitation. [source] Regulation of Injected Ground Water TracersGROUND WATER, Issue 4 2000Skelly A. Holmbeck-Pelham Ground water tracer tests are routinely performed to estimate aquifer flow and transport properties, including the determination of well capture zones, hydrogeologic parameters, and contaminant travel times. Investigators may be unaware of tracer test reporting requirements and may fail to notify their regulatory agency prior to conducting tracer tests. The injection of tracers falls under the jurisdiction of the federal Underground Injection Control (UIC) program, which regulates the introduction of substances into underground sources of drinking water as part of the Safe Drinking Water Act. The UIC program is administered by the U.S. Environmental Protection Agency (EPA) and by states with EPA-approved programs. The federal UIC program requires that tracer tests must not endanger underground sources of drinking water, and all tracer tests must be reported prior to injection. We contacted the UIC program administrator for every state in early 1997. Some states report having more stringent requirements, while some states do not meet minimum federal requirements. Although the primary responsibility for ground water tracer selection and use rests on the investigator, national guidance is required to assure compliance with the UIC program. To assist investigators, we present acceptable tracers that have been identified by two states, Nevada and South Carolina, that require no further regulatory review. [source] ,King of the Sea': The Prince of Wales and the Stuart Monarchy, 1648,1649HISTORY, Issue 308 2007SEAN KELSEY From their outset, the prince of Wales played a politically and symbolically significant part in the English civil wars. But from mid-1646, with Charles I in the hands of his enemies, primary responsibility for the military and diplomatic aspirations of the House of Stuart devolved almost entirely upon the king's eldest son. Indeed, this essential fact was central to the king's own strategic thinking because he had persuaded himself that his opponents must seek an accommodation with him as long as his successor was at large. The threat posed by the prince became violent reality in 1648 when he commissioned a string of mutinies and rebellions across England and Wales and briefly reasserted royal dominion of the seas. Although his martial and maritime escapades came to nothing, they nevertheless gave the prince his first opportunity to wield the instruments of sovereign power in the exercise of an authority independent of his father's. The second civil war also sharpened the contrast between the prince's freedom of action and the king's hapless captivity. The fortunes of the Stuart monarchy had hit rock bottom, but in the eyes of at least some royalists, an obvious solution had also begun to suggest itself. [source] Cell Production and Workplace Innovation in Japan: Toward a New Model for Japanese Manufacturing?INDUSTRIAL RELATIONS, Issue 4 2002Katsuhide Isa This article investigates the current trend toward cell production and other workplace innovations in Japan using a large,scale sampling survey of manufacturing firms and in,depth interviews with four leading electrical and electronic establishments. The quantitative analysis reveals the correlation between the use of cell production and the ratio of female to male workers and production strategy variables, as well as the positive effect of cell production on operating profit rates and ordinary profit rates. The case studies reveal the following points: First, processes and organizations have been decentralized to the degree that individual workshops move toward taking primary responsibility for customer relations, production decisions, and delivery. Corporate headquarters increasingly play a coordinating rather than decision,making role. Second, firms have steadily implemented make,to,order systems by tightening links to suppliers and customers and developing new inventory and cost,control systems. Third, firms have started to implement more performance,based personnel practices. However, considerable variance among firms is observed in complementary changes, particularly personnel innovations. [source] Coaching patients to self-care: a primary responsibility of nursingINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2009Julie Pryor BA Aim., To explore the process nurses use to guide and support patients to actively re-establish self-care. Background., The movement of hospitalized patients from less to more independence is primarily a nursing responsibility. Studies of nursing practice in inpatient rehabilitation settings have begun to shed some light on this, but as yet there is limited understanding of the actual skills nurses use to support patients to re-establish self-care. Method., This study used grounded theory. Microanalysis and constant comparative analysis of data collected during interviews with, and observation of, registered and enrolled nurses during everyday nursing practice in five inpatient rehabilitation units facilitated open, axial and selective coding. Relevant literature was woven into the final theory. Findings., To facilitate patient transition from the role of acute care patient to rehabilitation patient actively reclaiming self-care, nurses engaged in a three-phase process known as coaching patients to self-care. The three phases were: easing patients into rehabilitation, maximizing patient effort and providing graduated assistance. Conclusion., Coaching patients to self-care is a primary activity and technology of rehabilitation nursing. Relevance to clinical practice., Patients in a variety of settings would benefit from nurses incorporating coaching skills into their nurse,patient interactions. [source] The quality of patient-orientated Internet information on oral lichen planus: a pilot studyJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2010Pía López-Jornet PhD MD DDS Abstract Objective, This study examines the accessibility and quality Web pages related with oral lichen planus. Methods, Sites were identified using two search engines (Google and Yahoo!) and the search terms ,oral lichen planus' and ,oral lesion lichenoid'. The first 100 sites in each search were visited and classified. The web sites were evaluated for content quality by using the validated DISCERN rating instrument. JAMA benchmarks and ,Health on the Net' seal (HON). Results, A total of 109 000 sites were recorded in Google using the search terms and 520 000 in Yahoo! A total of 19 Web pages considered relevant were examined on Google and 20 on Yahoo! As regards the JAMA benchmarks, only two pages satisfied the four criteria in Google (10%), and only three (15%) in Yahoo! As regards DISCERN, the overall quality of web site information was poor, no site reaching the maximum score. In Google 78.94% of sites had important deficiencies, and 50% in Yahoo!, the difference between the two search engines being statistically significant (P = 0.031). Only five pages (17.2%) on Google and eight (40%) on Yahoo! showed the HON code. Conclusion, Based on our review, doctors must assume primary responsibility for educating and counselling their patients. [source] Community family medicine teachers' perceptions of their teaching roleMEDICAL EDUCATION, Issue 3 2001Karen V Mann Objectives Our study explored community preceptors' perceptions of their teaching role, to better understand effective ambulatory and community-based teaching. Methods Bandura's social cognitive theory and Schön's notion of reflective practice guided conceptual development of an interview exploring preceptors' views of their role, teaching goals, teaching techniques, student assessment practices, factors affecting teaching and learning, and balance of patient and student needs. Preceptors reflected also on a significant personal teaching experience. A total of 17 highly student-rated preceptors participated. A trained interviewer conducted each interview; all were transcribed and subjected to content analysis. Results Preceptors (male, 14; female, 3) described learner-centred approaches, setting goals jointly with the student. Demonstration, guided practice, observation and feedback were integral to the experience. Preceptors saw student comfort in the environment as key to effective learning; they attempted to maximize students' learning and breadth of experience. They wanted students to understand content, ,know-how' and ,being a family physician'. Patients remained the primary responsibility, but learners' needs were viewed as compatible with that responsibility. Many preceptors perceived a professional responsibility as ,role models'. Conclusions Preceptors recognized the dynamic environment in which they taught students, and they described strategies which demonstrated how they adapted their teaching to meet the needs of the learner in that environment. These teachers combined learner-centred approaches with sound educational practices, broad learning experiences, attention to student learning and concern for development of professional expertise and judgement. These findings may assist faculty development in family medicine, and other disciplines, in providing effective ambulatory care teaching. [source] Leadership development: The Role of the President-Board TeamNEW DIRECTIONS FOR COMMUNITY COLLEGES, Issue 123 2003George B. Vaughan Preparing the next generation of community college presidents is a responsibility shared by many. A largely untapped source is the president-board team, which has primary responsibility for campus-based presidential leadership development programs. [source] Perceived barriers to adherence among adolescent renal transplant candidatesPEDIATRIC TRANSPLANTATION, Issue 3 2008Nataliya Zelikovsky Abstract:, Non-adherence to medical regimens is a ubiquitous hindrance to quality health care among adolescent transplant recipients. Identification of potentially modifiable barriers to adherence when patients are listed for organ transplant would help with early intervention efforts to prepare adolescents for the stringent medication regimen post-transplant. Fifty-six adolescents listed for a kidney transplant, mean age 14.27 (s.d. = 2.2; range 11,18 yr), 73.2% male, 62.5% Caucasian participated in a semi-structured interview, the Medical Adherence Measure, to assesses the patient's knowledge of the prescribed regimen, reported adherence (missed and late doses), the system used to organized medications, and who holds the primary responsibility over medication management. Better knowledge of the medication regimen was associated with fewer missed doses (r = ,0.48, p < 0.001). Patients who perceived more barriers had more missed (r = 0.38, p = 0.004) and late (r = 0.47, p < 0.001) doses. Patients who endorsed "just forget," the most common barrier (56.4%), reported significantly more missed (z = ,4.25, p < 0.001) and late (z = ,2.2, p = 0.02) doses. Only one-third of the transplant candidates used a pillbox to organize medications but these patients had significantly better adherence, z = ,2.2, p = 0.03. With regard to responsibility over managing the regimens, adolescents missed fewer doses when their parents were in charge than when they were solely responsible, z = ,2.1, p = 0.04. Interventions developed to prepare transplant candidates for a stringent post-transplant regimen need to focus on ensuring accurate knowledge of as simple a regimen as possible. Use of an organized system such as a pillbox to establish a routine and facilitate tracking of medications is recommended with integration of reminders that may be appealing for this age group. Although individuation is developmentally normative at this age, parent involvement seems critical until the adolescent is able to manage the responsibility more independently. [source] Association of parental pretransplant psychosocial assessment with post-transplant morbidity in pediatric heart transplant recipients,PEDIATRIC TRANSPLANTATION, Issue 5 2006David Stone Abstract:, Because parents assume the primary responsibility for providing ambulatory post-transplant care to pediatric patients, pretransplant psychosocial evaluation in these recipients is usually focused on parents rather than on patients themselves. We sought to determine whether pretransplant parental psychosocial evaluation predicts post-transplant medical outcome at current levels of psychosocial support. We compared relative risk (RR) of rejection and hospitalizations (days of all-cause hospitalization) following initial discharge in patients in ,risk' and ,control' groups defined by their pretransplant parental psychosocial evaluation. We also compared the two groups of patients for the proportion of all outpatient trough cyclosporine A (CSA) or tacrolimus (FK) levels that were <50% of the target level (defined as the mid-therapeutic range level). There were seven patients in the ,risk' group with a median age 0.25 yr (range 0.19,14.7 yr) and total follow up 20.5 patient-yr. There were 21 patients in the ,control' groups with a median age of 2.1 yr (range 0.05,16.2 yr) and total follow up of 71.3 patient-yr. There was no significant difference between the groups in rejection-risk or days of all-cause hospitalization early after transplant (first six months). During the late period (after the first six months), there were 11 rejection episodes in the ,risk' group over 17.4 patient-yr and four rejection episodes in control group over 61.8 patient-yr of follow up. After adjustment for age and race, patients in the ,risk' category had a RR of 3.4 for developing a rejection episode (p = 0.06) and 3.1 for being inpatient (p < 0.001) during the late period. Patients in the risk group were 2.9 times more likely to have subtherapeutic trough levels (<50% target level) of calcineurin inhibitor (CSA or FK) during both early and late periods (p < 0.01 for both periods) after adjustment for patient age and race. We conclude that pretransplant parental psychosocial risk assessment is associated with post-transplant morbidity in children after cardiac transplantation. These patients may benefit from closer outpatient monitoring and a higher level of psychosocial support. [source] Savings from integrating administrative systems for social assistance programmes in RussiaPUBLIC ADMINISTRATION & DEVELOPMENT, Issue 2 2003L. Jerome Gallagher Russian local governments now have primary responsibility for the administration of social assistance programmes thanks to a combination of decentralization of some responsibilities from higher levels of government and the transfer of certain administrative functions from state enterprises to municipalities. Over the past few years, there has also been a distinct shift to means-testing of social assistance. This article reports on the results of a pilot project undertaken to improve the efficiency of programme administration conducted in the city of Arzamas (pop. 110,000). The municipal administration promotes it as a programme to ease client burden and improve access to benefits. Specifically, the pilot introduced a unified application form for all the major social assistance programmes in the city and required, regardless of how many programmes are applied for, that applicants visit only one office and supply one set of documents verifying their eligibility for assistance. Benefit processing is also consolidated. Staff efficiency improvements are substantial: under the one-window system, 127 benefits are processed per month per staff member, while 85 benefits were processed per month per staff member under the old administrative system. Impressive time savings for clients were also observed: the statistically average client saves between 1.3 and 2.4 hours, depending on the degree to which a client was able to coordinate documentation collection and trips to the benefit agencies under the old system. The total potential time saved by clients as a result of the one-window reforms is between 4100 and 7600 person hours per month. Copyright © 2002 John Wiley & Sons, Ltd. [source] ML08 CONDUCTING A REVIEW , THE IMPORTANCE OF PROCESSANZ JOURNAL OF SURGERY, Issue 2007A. F. Merry Reviews of practice tend to arise out of conflict between the person reviewed and the organisation requesting the review, usually after a failure of the two parties to resolve their differences at a lower level. It follows that legal challenges are likely, and this has been borne out by experience. Such challenges will generally be based on alleged failures in process. Furthermore, being reviewed is exceptionally stressful for any doctor and creates serious risks to his or her health and reputation. It is essential that these risks are minimized and that all parties emerge from the review believing that the process has been impartial, professional, confidential and fair. The key is to engage a senior lawyer with appropriate experience and expressly charge him or her (in writing) with the responsibility for process. This lawyer must be independent (the reviewing organisation's own lawyers are not appropriate for this position), directly accountable to the chair of the review panel, and have unrestricted time for this task. He or she should be present at all meetings between the panel and the reviewed doctor and should revise all documents produced by the panel. The panel chair should assign the primary responsibility for reviewing the professional competence of the doctor to other panel members and should focus instead on ,chairing', on process, and on the wider (or ,big picture') issues which surround the review. Previous experience in reviews is essential for this role. [source] National Growth in Simulation Training within Emergency Medicine Residency Programs, 2003,2008ACADEMIC EMERGENCY MEDICINE, Issue 11 2008Yasuharu Okuda MD Abstract Objectives:, The use of medical simulation has grown dramatically over the past decade, yet national data on the prevalence and growth of use among individual specialty training programs are lacking. The objectives of this study were to describe the current role of simulation training in emergency medicine (EM) residency programs and to quantify growth in use of the technology over the past 5 years. Methods:, In follow-up of a 2006 study (2003 data), the authors distributed an updated survey to program directors (PDs) of all 179 EM residency programs operating in early 2008 (140 Accreditation Council on Graduate Medical Education [ACGME]-approved allopathic programs and 39 American Osteopathic Association [AOA]-accredited osteopathic programs). The brief survey borrowed from the prior instrument, was edited and revised, and then distributed at a national PDs meeting. Subsequent follow-up was conducted by e-mail and telephone. The survey concentrated on technology-enhanced simulation modalities beyond routine static trainers or standardized patient-actors (high-fidelity mannequin simulation, part-task/procedural simulation, and dynamic screen-based simulation). Results:, A total of 134 EM residency programs completed the updated survey, yielding an overall response rate of 75%. A total of 122 (91%) use some form of simulation in their residency training. One-hundred fourteen (85%) specifically use mannequin-simulators, compared to 33 (29%) in 2003 (p < 0.001). Mannequin-simulators are now owned by 58 (43%) of the programs, whereas only 9 (8%) had primary responsibility for such equipment in 2003 (p < 0.001). Fifty-eight (43%) of the programs reported that annual resident simulation use now averages more than 10 hours per year. Conclusions:, Use of medical simulation has grown significantly in EM residency programs in the past 5 years and is now widespread among training programs across the country. [source] | |||||||||||||