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Unique Position (unique + position)
Selected AbstractsCareer counsellors and occupational contact dermatitisCONTACT DERMATITIS, Issue 4 2003Helen Saunders Career counsellors are in a unique position to provide timely preventive advice to young people at risk of developing occupational contact dermatitis. Career counsellors need to be aware of risk factors for this condition, including atopic eczema, and of high-risk occupations, such as hairdressing. A cross-sectional survey of 82 career counsellors was conducted at an Australian career counsellors' conference. 24 (29%, 95% confidence interval (95% CI) 19,40%) correctly identified eczema as a risk factor. 25 (30%, 95% CI 21,41%) indicated consideration of past skin problems during career counselling. 30 (36%, 95% CI 25,47%) correctly reported at least 1 high-risk occupation, with hairdressing being most frequently identified. Only 3 of the 82 (4%, 95% CI 0,7%) correctly answered all 3 questions. [source] Conservation and management of the Arctic charr: a forward viewECOLOGY OF FRESHWATER FISH, Issue 1 2007C. E. Adams Abstract , In this study, we synthesised the views of 34 participants in a workshop to consider the status and future conservation and management of the Arctic charr (Salvelinus alpinus L.). These are expressed as a series of resolutions deriving from a conference on Arctic charr conservation held in Perth, Scotland in June 2004. Agreed resolutions from the conference were as follows. (i) The unique diversity of Arctic charr should be recognised for the contribution it makes to biodiversity of northern aquatic communities. (ii) The recognition by the public, nongovernmental organisations and national governments of the importance of Arctic charr in northern ecosystems is an important step to the management and protection that should be pursued. (iii) The taxonomic status of highly variable charr populations requires to be reviewed. (iv) There should be a separate system, complementary to the taxonomic one, which systematically catalogues the biological diversity of S. alpinus. (v) The Arctic charr provides a unique natural resource to study the process of evolution and this requires the highest level of protection from anthropogenic effects. (vi) The status of conservation policy for Arctic charr needs to be urgently reviewed to take account of its unique position in the fauna. [source] An Educator's Guide to Teaching Emergency Medicine to Medical StudentsACADEMIC EMERGENCY MEDICINE, Issue 3 2004Wendy C. Coates MD Abstract There is a need for every medical school graduate to handle emergencies as they arise in the daily practice of medicine. Emergency medicine (EM) educators are in a unique position to provide students with basic life support skills, guidance in assessing the undifferentiated patient, and exposure to the specialty of EM during all years of medical school. Emergency physicians can become involved in a variety of education experiences that can supplement the preclinical curriculum and provide access to our specialty at an early stage. A well-designed course in the senior year allows students to develop critical thinking and patient management skills that are necessary for any medical career path. It can ensure that all medical students are exposed to the skills essential for evaluating and stabilizing the acutely ill patient. To implement this type of course, learning objectives and evaluation methods must be set when the curriculum is developed. An effective course combines didactic and clinical components that draw on the strengths of the teaching institution and faculty of the department. A structured clerkship orientation session and system for feedback to students are essential in nurturing the development of student learners. This article provides an approach to assist the medical student clerkship director in planning and implementing EM education experiences for students at all levels of training, with an emphasis on the senior-year rotation. [source] A model of a gp120 V3 peptide in complex with an HIV-neutralizing antibody based on NMR and mutant cycle-derived constraintsFEBS JOURNAL, Issue 3 2000Anat Zvi The 0.5, monoclonal antibody is a very potent strain-specific HIV-neutralizing antibody raised against gp120, the envelope glycoprotein of HIV-1. This antibody recognizes the V3 loop of gp120, which is a major neutralizing determinant of the virus. The antibody,peptide interactions, involving aromatic and negatively charged residues of the antibody 0.5,, were studied by NMR and double-mutant cycles. A deuterated V3 peptide and a Fab containing deuterated aromatic amino acids were used to assign these interactions to specific V3 residues and to the amino acid type and specific chain of the antibody by NOE difference spectroscopy. Electrostatic interactions between negatively charged residues of the antibody Fv and peptide residues were studied by mutagenesis of both antibody and peptide residues and double-mutant cycles. Several interactions could be assigned unambiguously: F96(L) of the antibody interacts with Pro13 of the peptide, H52(H) interacts with Ile7, Ile9 and Gln10 and D56(H) interacts with Arg11. The interactions of the light-chain tyrosines with Pro13 and Gly14 could be assigned to either Y30a(L) and Y32(L), respectively, or Y32(L) and Y49(L), respectively. Three heavy-chain tyrosines interact with Ile7, Ile20 and Phe17. Several combinations of assignments involving Y32(H), Y53(H), Y96(H) and Y100a(H) may satisfy the NMR and mutagenesis constraints, and therefore at this stage the interactions of the heavy-chain tyrosines were not taken into account. The unambiguous assignments [F96(L), H52(H) and D56(H)] and the two possible assignments of the light-chain tyrosines were used to dock the peptide into the antibody-combining site. The peptide converges to a unique position within the binding site, with the RGPG loop pointing into the center of the groove formed by the antibody complementary determining regions while retaining the ,-hairpin conformation and the type-VI RGPG turn [Tugarinov, V., Zvi, A., Levy, R. & Anglister, J. (1999) Nat. Struct. Biol.6, 331,335]. [source] Systematic review of the perceptions and experiences of accessing health services by adult victims of domestic violenceHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2008Louise Robinson RGN RHV BSc (Hons) MSc Abstract This systematic review synthesises evidence on the perceptions and experiences of adult victims of domestic violence when accessing healthcare services. The review was concerned with disclosure of domestic violence by adult victims when accessing health services, the responses of healthcare professionals to these victims, victims' perceived barriers to support, and the appropriateness of support and referrals. These aims required the review to focus on studies using in-depth qualitative methods to explore victims' perceptions and experiences. A comprehensive systematic search of 12 databases was carried out in June/July 2005. Application of the review protocol and inclusion criteria resulted in 10 studies (conducted in the UK, USA and Australia) being considered eligible for the review. Data were extracted from these studies and a quality assessment completed. Thematic analysis was carried out to enable the identification of recurrent themes within the included studies. Findings indicate that victims of domestic violence experience difficulties when accessing healthcare services. Victims perceive that these difficulties can be attributed to inappropriate responses by healthcare professionals, discomfort with the healthcare environment, perceived barriers to disclosing domestic violence, and a lack of confidence in the outcomes of disclosure to a health professional. The methodological quality of included studies was variable, but no papers were rejected based on quality issues. These results can contribute to and inform a comprehensive assessment of the experiences of adult victims of domestic violence when accessing healthcare services. The health service is in a unique position to contribute towards the assessment and identification of domestic violence and to provide access to appropriate support. The messages of this study are important for policy-makers and practitioners. [source] Medical journals and effective dissemination of health researchHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 4 2001Aravinthan Coomarasamy Clinical medical journals have not been effective in meeting the information needs of practitioners and bridging the gap between clinical research and practice. The slow adoption of results of clinical research is at least partly due to the failure of clinical journals to disseminate information in a way that would motivate practitioners to change practice. Although implementation is primarily a local process, medical journals are in a unique position to advance implementation by modifying their focus and adjusting their contents. Strategies that may be useful include publication of pre-appraised evidence summaries and ,clinical bottom-lines' and giving importance to systematic reviews and large evaluative research articles as they represent higher levels of evidence and have greater potential to change practice. Clinical journals should encourage researchers to consider how and by whom the findings will be used and provide information on implications for implementation such as possible strategies that may work, cost-effectiveness, side-effects and potential barriers to implementation. Medical journal publishers should explore ways to cooperate so that findings of landmark clinical trials could be shared thus reducing the ,scatter' of medical information. Electronic media offers numerous advantages such as quick accessibility and linking of information, and medical journals should capitalize on such innovations. There is a paradigm shift in health care practice as evidence is consciously and explicitly incorporated into individual patient care. Medical journals need to change to reflect this change in practice and provide practitioners with valid and relevant information. [source] A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care settingINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2007M. T. Rosenberg Summary Aims:, Lower urinary tract symptoms (LUTS) are common in both men and women, and are among the most prevalent patient complaints heard by primary care physicians (PCPs). This article aims to provide PCPs with a logical algorithm for the assessment and initiation of treatment for LUTS in the male patient. Results:, Management of LUTS involves a focused history and physical, as well as the assessment of bother. In patients for whom treatment is warranted, a series of decisions regarding therapy should be considered. Male patients commonly suffer from storage and/or voiding symptoms. Treatment of male LUTS is commonly begun with agents that are aimed at remedying the outlet symptoms of benign prostatic hyperplasia (BPH). When this intervention is ineffective or when refractory symptoms persist, consideration should be given to treating the storage symptoms characteristic of overactive bladder (OAB). Discussion:, This article is intended to provide the PCP with a logical guide to the treatment of male LUTS. Benign prostatic hyperplasia and OAB predominate among the causes of these symptoms, and the PCP should be comfortable treating each. Recent data detailing the safety of the use of these treatments in the male patient are reviewed and incorporated into the algorithm. Conclusion:, Primary care physicians are in a unique position to successfully identify and treat male patients with LUTS. With this paper, they now have a tool to approach treatment logically and practically. [source] Using cost-analysis techniques to measure the value of nurse practitioner careINTERNATIONAL NURSING REVIEW, Issue 4 2002D. Vincent PhD Abstract Nurse practitioners are in a unique position to deliver high-quality care to a variety of populations and are being utilized in many countries worldwide. Although certain aspects of the nurse practitioner role may differ from country to country, limited financial support and competition for access to patients make it incumbent on nurse practitioners to document the cost-effectiveness of their care. Cost analysis, a business tool that can be used by any practitioner in any health care system, was used to examine business practices of an academic-based nurse-managed centre. In order for this tool to be effective, nurse practitioners must become comfortable with using cost-analysis techniques in their practices. Linking outcome data with cost data was found to be one method for explicating the value of nurse practitioner practice. Nurse practitioners must also recognize that they are competing with primary-care physician practices and other primary health-care practices. It is vital for nurse practitioners to document both the quality and the costs of their care in order to compete with physicians and other health care providers, in order to influence policy and other health-care decision makers. [source] Decision-making about artificial feeding in end-of-life care: literature reviewJOURNAL OF ADVANCED NURSING, Issue 1 2008Els Bryon Abstract Title.,Decision-making about artificial feeding in end-of-life care: literature review. Aim., This paper is a report of a review of nurses' roles and their perceptions of these roles in decision-making processes surrounding artificial food and fluid administration in adult patients. Background., Of all caregivers, nurses have the closest and most trusting relationship with severely ill patients and their families during the entire end-of-life care process. As a result, nurses become closely involved in complex ethical decision-making processes concerning artificial administration of food or fluids for these patients. Data sources., We searched seven electronic databases (1990,2007) and examined the reference lists of relevant papers. Review methods., This mixed methods review was conducted with guidance of the United Kingdom Centre for Reviews and Dissemination guidelines on systematic reviews. Results., Although their direct impact is limited, nurses play a significant indirect role during decision-making processes. Because of their unique position, they often initiate decision-making processes, function as patient advocates and provide guidance, information and support to patients and families. Although nurses considered their role to be very valuable, they felt that their role was not always defined clearly or appreciated. Whether nurses experience decision-making processes positively depended on several contextual factors. Conclusion., Given their knowledge and practice skills, nurses are in a prime position to contribute valuably to decision-making processes. Nevertheless, they remain sidelined. For nurses to receive sufficient recognition, their decision-making tasks and responsibilities need to be clarified and made manifest to other participants. [source] Adolescent Depression: Important Facts That MatterJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 2 2000Lisa M. Pullen PhD PURPOSE. To determine if there are differences in adolescent depression using variables of age, gender, smoking, and alcohol use. METHODS. A comparative, descriptive survey design was used. The adolescents (N = 217) completed either the Beck Depression Inventory or the Children's Depression Inventory and a demographic questionnaire. FINDINGS. The 15- to 2 6-year-olds (p = .016), females (p = .003), and smokers (p = .001) scored significantly higher than the 12- to 14-year-olds on depression. The 15- to 16-year-olds who used alcohol were found to be twice as depressed as the nonusers (p = .002). No significant differences were found in the 17- to 19-year-old age group. CONCLUSIONS. This study confirmed depression increased with age, in females, and with smokers. Nurses are in a unique position to provide interventions to promote healthy lifestyles and reduce the likelihood of depression and alcohol and nicotine abuse in adolescents. [source] Introduction: Role of the hospitalist in secondary stroke prevention care,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2008David J. Likosky MD Abstract Stroke is a prevalent and often devastating condition that is likely to affect a growing proportion of the United States population in the coming decades. Individuals who have experienced a stroke or transient ischemic attack are at elevated risk for recurrent events, which are frequently more severe. Therefore, secondary prevention has become the focus of much clinical research and widespread initiatives to deliver evidence-based care. Hospitalists are in a unique position to contribute substantially to these efforts. The 4 articles in this supplement are a call to action for hospital-based physicians. They are based on the conclusions of a panel of hospitalists, neurohospitalists, vascular neurologists, and neurointensivists who met for a roundtable discussion in March 2007. This, the first of the 4 articles, discusses the opportunity for hospitalists to take a leadership role in creating stroke systems of care that integrate secondary stroke prevention with inpatient treatment of acute stroke. The articles that follow will summarize the consensus of roundtable participants on stroke care best practices and their implementation. Journal of Hospital Medicine 2008;3(4 Suppl):S1,S5. © 2008 Society of Hospital Medicine. [source] Rethinking the Business School*JOURNAL OF MANAGEMENT STUDIES, Issue 8 2004Ken Starkey abstract It is ironic that at a moment in history when the business school seems to be enjoying unparalleled success, the role of the business school is being increasingly questioned by some of its leading professors. We examine the debate about the business school and its evolution. While sympathetic to the criticisms levied against the business school we nevertheless suggest a positive future if the business school can build upon its potentially unique position as knowledge space. [source] The clinical nurse leader: a catalyst for improving quality and patient safetyJOURNAL OF NURSING MANAGEMENT, Issue 5 2008FAAN, JOAN M. STANLEY PhD Aim, The clinical nurse leader (CNL®) is a new nursing role introduced by the American Association of Colleges of Nursing (AACN). This paper describes its potential impact in practice. Background, Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources. Method, A naturalistic approach is used to evaluate the impact the CNL has had on outcomes of care. Case studies describe the CNL implementation experiences at three different practice settings within the same geographic region. Results, Cost savings, including improvement on Centers for Medicare and Medicaid Services (CMS) core measures, are realized quickly in settings where the CNL role has been integrated into the care delivery model. Conclusions, With the growing calls for improved outcomes and more cost-effective care, the CNL role provides an opportunity for nursing to lead innovation by maximizing health care quality while minimizing costs. Implications for nursing management, Nursing is in a unique position to address problems that plague the nation's health system. The CNL represents an exciting and promising opportunity for nursing to take a leadership role, in collaboration with multiple practice partners, and implement quality improvement and patient safety initiatives across all health care settings. [source] Factor V Leiden as a Common Genetic Risk Factor for Venous ThromboembolismJOURNAL OF NURSING SCHOLARSHIP, Issue 1 2006McDonald K. Horne III Purpose: To increase nurses' knowledge of the Factor V Leiden (FVL) genetic trait for venous thromboembolism. Organizing Framework: An overview of the history, prevalence, and predisposition of the FVL genetic mutation, including who should be tested and how and in what circumstances people with FVL should be treated. Findings: FVL is the most commonly recognized genetic trait associated with venous thrombosis. It is found predominantly in Caucasian populations. Biochemically it causes "activated protein C resistance (APCR)." The decision to test for FVL depends on whether the information gained will potentially improve the health care of the person or family. For people who have had deep venous thrombosis, testing for FVL will likely not alter treatment approaches. Currently the advantage for testing is primarily limited to asymptomatic family members who carry FVL and who have had deep vein thrombosis. Close relatives who also carry the mutated gene might benefit from prophylactic anticoagulation when their risk of thrombosis is increased by temporary factors such as surgery. Conclusions: Nurses are in a unique position to provide accurate information and counseling when patients and their family members are presented with the results of thrombophilia testing. [source] The Reliability and Validity of Birth CertificatesJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2006Sally Northam Objectives:, To summarize the reliability and validity of birth certificate variables and encourage nurses to spearhead data improvement. Data sources:, A Medline key word search of reliability and validity of birth certificate, and a reference review of more than 60 articles were done. Study selection:, Twenty-four primary research studies of U.S. birth certificates that involved validity or reliability assessment. Data extraction:, Studies were reviewed, critiqued, and organized as either a reliability or a validity study and then grouped by birth certificate variable. Data synthesis:, The reliability and validity of birth certificate data vary considerably by item. Insurance, birthweight, Apgar score, and delivery method are more reliable than prenatal visits, care, and maternal complications. Tobacco and alcohol use, obstetric procedures, and delivery events are unreliable. Birth certificates are not valid sources of information on tobacco and alcohol use, prenatal care, maternal risk, pregnancy complications, labor, and delivery. Conclusions:, Birth certificates are a key data source for identifying causes of increasing U.S. infant mortality but have serious reliability and validity problems. Nurses are with mothers and infants at birth, so they are in a unique position to improve data quality and spread the word about the importance of reliable and valid data. Recommendations to improve data are presented. JOGNN, 35, 3-12; 2006. DOI: 10.1111/J.1552-6909.2006.00016.x [source] Considering the care of the suicidal client and the case for ,engagement and inspiring hope' or ,observations'JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2002J. R. Cutcliffe rmn rgn bsc (hons) phd Psychiatric/mental health (P/MH) nursing has rightly been described as a ,broad church', and one that contains many contested matters and areas of differing opinion. One such contested matter is that of the appropriate care for the person who is at risk of suicide. Recent, albeit limited, debate of this issue has taken place, and the literature, such as it is, indicates two principal (though linked) positions. These can be summarized as the ,engagement and hope inspiration' position and the ,observations' position. Given the P/MH nurse's unique position in providing 24-hour, day-to-day care to suicidal clients and the growing problem of suicide within people who suffer from mental health problems, it is both necessary and perhaps timely to consider this debate in more detail. Accordingly, this paper considers the debate regarding care for suicidal mental health care clients. First, the paper briefly describes the historical policy context of care for the suicidal client. Next, it focuses on ,observations' and concludes that there is a range of well-established, empirically based problems or drawbacks to this approach. Following this, it focuses on ,engagement, inspiring hope' and points out the key processes of engagement: forming a relationship, a human,human connection, conveying acceptance and tolerance, and hearing and understanding. The value and importance of these most fundamental of interpersonal processes is described and alluded to throughout the limited research into care of the suicidal client. The paper then describes the range of criticisms that have been levelled at the engagement,inspiring hope approach and considers these criticisms in more detail. As a result of this detailed examination, the paper then reiterates the need to replace ,observations' with ,engagement,hope inspiration' as the principal approach to caring for suicidal mental health clients. [source] Sensory processing disorder: Any of a nurse practitioner's business?JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2009DrNPc, Elise D. Fish Professor of Clinical Health Care for the Underserved, FAAN Stone Foundation, Mary W. Byrne PhD Abstract Purpose: Children who exhibit the confusing symptom patterns associated with sensory processing deficits are often seen first by primary care providers, including family and pediatric nurse practitioners (NPs). The purpose of this article is to alert NPs to the state of the science for these disorders and to the roles NPs could play in filling the knowledge gaps in assessment, treatment, education, and research. Data sources: Literature searches using PubMed and MedLine databases and clinical practice observations. Conclusions: Sensory integration disorders have only begun to be defined during the past 35 years. They are not currently included in the DSM IV standard terminology, and are not yet substantively incorporated into most health disciplines' curricula or practice, including those of the NP. Implications for practice: NPs are in a unique position to test hypothesized terminology for Sensory Processing Disorder (SPD) by contributing precise clinical descriptions of children who match as well as deviate from the criteria for three proposed diagnostic groups: Sensory Modulation Disorder (SMD), Sensory Discrimination Disorder (SDD), and Sensory-Based Motor Disorder (SBMD). Beyond the SPD diagnostic debate, for children with sensory deficit patterns the NP role can incorporate participating in interdisciplinary treatment plans, refining differential diagnoses, providing frontline referral and support for affected children and their families, and making both secondary prevention and critical causal research possible through validation of consistently accepted diagnostic criteria. [source] Fibromyalgia,Management of a misunderstood disorderJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 7 2007Education & Training Flight Commander), Erin L. Peterson RN, FNP (Major; Family Nurse Practitioner Abstract Purpose: The purpose of this article is to review (a) what is currently known about the pathophysiology of fibromyalgia (FM), (b) how to identify patients who are susceptible to this disorder, and (c) the recommended pharmacological and nonpharmacological treatment options. Data sources: Data sources include reviews and original research from scholarly journals and Internet sites. Conclusions: There are approximately 6 million individuals in the United States diagnosed with FM, making it the third most prevalent rheumatologic disorder in this country. Failure to identify a specific causal mechanism for FM has resulted in a shift in the focus of research from etiology to treatment (Baumstark & Buckelew, 2002). Based on the literature, the most successful interventions for reduction of chronic symptoms in the FM patient is a combination of education, psychological assistance, and exercise, along with medications. It is essential that nurse practitioners (NPs) understand the issues and concerns of patients afflicted with this complex disorder. Although the organic etiology of FM syndrome remains unclear, the goals of treatment are to control pain and improve adjustment, well-being, and daily functioning of these patients to the maximum extent possible. Implications for practice: NPs are in a unique position to help identify patients who may be suffering from FM or those diagnosed with FM reporting inadequate relief of symptoms. The incomplete understanding of the biological underpinnings, as well as the multiple symptoms that characterize FM syndrome, make it a challenging disorder to diagnose and treat. It takes time and patience to care for FM patients, and there are no "quick fixes." Diagnosis is made by a combination of patient history, physical examination, laboratory evaluations, and exclusion of other causes of symptoms confused with FM. Understanding the symptomology and recommended treatments will allow NPs to give appropriate care that may include making referrals for multidisciplinary treatment of these complex patients. [source] Student affairs and alumni relationsNEW DIRECTIONS FOR STUDENT SERVICES, Issue 130 2010Patricia A. Rissmeyer The chapter explains the unique position that student affairs administrators have in developing good relationships with alumni and the various strategies that can be used to maintain those connections. [source] New challenges in the management of prolonged survivors of pediatric neuromuscular diseases: A pulmonologist's perspectivePEDIATRIC PULMONOLOGY, Issue 12 2006David J. Birnkrant MD Abstract Many patients with pediatric neuromuscular diseases (NMDs) are now achieving prolonged survival through advances in management of the cardiopulmonary complications of their illnesses. Because respiratory complications are among the main causes of mortality and morbidity in these diseases, pulmonologists are in a unique position to observe and describe the largely unanticipated medical, social, and ethical problems generated when patients with progressive NMDs achieve prolonged survival. For example, prolonged survivors of pediatric NMDs are now experiencing previously rare or unknown medical complications, an unprecedented severity of burden of disease and the potential for prolonged impairment of quality of life. As the patients age, their families must cope with a high level of burden of care. Society's acceptance of the eligibility of these patients to utilize critical care resources, and issues related to the transition of prolonged survivors from pediatric to adult medical providers and venues have resulted in complex practical and ethical issues. In this article, the author, a pediatric pulmonologist closely involved in the care of patients with NMDs, will identify and discuss some of the major medical, social, and ethical implications of prolonged survival among these patients, with an emphasis on Duchenne muscular dystrophy (DMD), the most common of the pediatric NMDs. Pediatr Pulmonol. 2006; 41:1113,1117. © 2006 Wiley-Liss, Inc. [source] Identification of Cardiovascular Risk: Use of a Cardiovascular-Specific GenogramPUBLIC HEALTH NURSING, Issue 3 2000Frances B Wimbush Ph.D. Cardiovascular disease (CVD) affects nearly 50 million Americans of all ages, races, and educational levels. Many of the risk factors for CVD are modifiable and public health nurses (PHNs) are in unique position to impact this major health problem because of their access to individuals, families, and groups. Addressing this major health problem requires early identification of those at risk for CVD. This article describes the implementation of a cardiovascular-specific genogram (CVSG) which can be used to identify persons at risk for CVD. Rationale for the development of this disease-specific tool and suggestions for its clinical application are discussed. The genogram was distributed to the parents of 100 6th grade students. All of the respondents reported cardiovascular risk factors present in at least one of three generations examined. The risk factors in the two younger generations were at the primary and secondary levels of prevention and were modifiable with intervention. Only the older generation in this sample had tertiary level risk factors. The CVSG can easily be incorporated into all aspects of public health nursing practice, from assessment for case finding to planning and implementing disease management strategies. The CVSG can identify individuals, families, and groups at risk for CVD allowing the nurse to focus attention on those most at risk, and to implement proactive assessment, screening, and educational programs. [source] Natural intramolecular isotope measurements in physiology: elements of the case for an effort toward high-precision position-specific isotope analysis,RAPID COMMUNICATIONS IN MASS SPECTROMETRY, Issue 15 2001J. T. Brenna Chemical information available in organisms can be categorized into three major domains, macromolecular, small molecules, and isotope ratios. Information about physiological state is commonly obtained by qualitative and quantitative analysis in the macromolecular and small molecule domains. Genomics and proteomics are emerging approaches to analysis of macromolecules, and both areas yield definitive information on present physiological state. There is relatively little record of past physiological states of the individual available in these domains. Natural isotopic variability, particularly on an intramolecular level, is likely to retain more physiological history. Because of ubiquitous isotopic fractionation, every stereochemically unique position in every molecule has an isotope ratio that reflects the processes of synthesis and degradation. This fact highlights a vast amount of organismal chemical information that is essentially unstudied. Isotope measurements can be classified according to the chemical complexity of the analyte into bulk, compound-specific, and position-specific or intramolecular levels. Recent advances in analysis of isotope ratios are transforming natural science, and particularly answering questions about ecosystems using bulk methods; however, they have had relatively little impact on physiology. This may be because the vast complexities of physiological questions demand very selective information available in position-specific isotope analysis (PSIA). The relatively few high-precision PSIA studies, based on isotope ratio mass spectrometry (IRMS), have revealed intramolecular isotope ratio differences in pivotal physiological compounds including amino acids, glucose, glycerol, acetate, fatty acids, and purines. The majority of these analyses have been accomplished by laborious offline methods; however, recent advances in instrumentation presage rapid PSIA that will be necessary to attack real physiological problems. Gas-phase pyrolysis has been shown to be an effective method to determine 13C/12C at high precision for molecular fragments, and technologies to extend C-based PSIA to N and other organic elements are emerging. Two related efforts are warranted, (a) development of rapid, convenient, and sensitive methods for high-precision PSIA, a necessary precursor to (b) a concerted investigation into the relationship of metabolic state to intramolecular isotope ratio. Inherent in this latter goal is the need to identify long-lived molecules in long-lived cells that retain a record of early isotopic conditions, as has been shown for post-mortem human neuronal DNA. Using known metabolic precursor-product relationships between intramolecular positions, future studies of physiological isotope fractionation should reveal the relationship of diet and environment to observed isotope ratio. This science of isotope physiology, or simply isotopics, should add an important tool for elucidation of early factors that effect later health, probably the most difficult class of biomedical issues. Copyright © 2001 John Wiley & Sons, Ltd. [source] Struggling with Poverty: Implications for Theory and Policy of Increasing Research on Social Class-Based StigmaANALYSES OF SOCIAL ISSUES & PUBLIC POLICY, Issue 1 2009Wendy R. Williams Low-income people are stigmatized in a number of ways, including being negatively stereotyped and discriminated against both interpersonally and institutionally (see Lott & Bullock, 2007 for a comprehensive review). Yet psychologists have not focused much attention on social class in general, nor on social class-based stigma in particular. This article argues that by resolving three main problems in the literature (the achieved/ascribed discrepancy, the complexity of operationalizing social class, and the seeming lack of identification with one's social class), psychologists are in a unique position to use their knowledge to aid practitioners and policymakers in ameliorating the consequences of poverty. Thus, this article focuses on how better to incorporate social class into the stigma literature and how this research can be linked to social policy initiatives. [source] Apatite fission track thermochronology: an overview of its potential and limitations in geomorphologyBASIN RESEARCH, Issue 2 2000Gunnell The specific time window of apatite fission track thermochronology (AFTT) places it in a unique position to offer continuous time,temperature baseline histories for relatively stable shield, rift and passive margin environments, spanning several geological eras. Fission tracks anneal partially at temperatures between ,110 °C and ,60 °C and thereby provide information on residence times within specific levels of the crust. Most samples collected from these terrains, however, are usually found to have cooled out of the apatite partial annealing zone (APAZ) by the mid-Cenozoic at the latest. Owing to the stability, at geological timescales, of tracks at temperatures <60 °C (i.e. within depths of 0,2.5 km at normal geothermal gradients), a significant loss of resolution must therefore be reckoned with at shallow, although geomorphologically crucial, crustal depths. Indeed, the Neogene and Quaternary are understood to have been most influential in generating the scenery of today, and a use of radiometric and stratigraphic techniques in a nested, multisystem approach can assist in bridging the resolution gap. This paper examines and illustrates, mostly with original examples, the uses and limitations of AFTT in addressing the response of Earth surface systems to event patterns in global tectonics, the controls of lithology and structure on denudation rates, the origin and evolution of passive margin escarpments, the mass-balanced reconstruction of palaeoelief, the use of apatites as tracers for understanding provenance in sediment routing systems, and the tempo (or episodicity) of denudation as postulated by W. M. Davis' canons of the ,geographical cycle'. Alongside efforts towards standardizing the supply of analytically robust AFT results in the laboratory, a more standardized geoscientific interpretation of AFT data is also desirable in order to build a consistent world base of geomorphic rates which can be made available to , and used with confidence by , non-AFTT specialists. [source] THE ETHICS OF INTERCOUNTRY ADOPTION: WHY IT MATTERS TO HEALTHCARE PROVIDERS AND BIOETHICISTSBIOETHICS, Issue 7 2010SARAH JONES ABSTRACT The goal of this paper is both modest and ambitious. The modest goal is to show that intercountry adoption should be considered by ethicists and healthcare providers. The more ambitious goal is to introduce the many ethical issues that intercountry adoption raises. Intercountry adoption is an alternative to medical, assisted reproduction option such as in vitro fertilization (IVF), intracytoplasmic sperm injection, third party egg and sperm donation and surrogacy. Health care providers working with assisted reproduction are in a unique position to introduce their clients to intercountry adoption; however, providers should only do so if intercountry adoption is ethically equal or superior to the alternatives. This paper first presents a brief history of intercountry adoption. The second section compares intercountry adoption with medical alternatives. The third section examines the unique ethical challenges that are not shared by other medical alternatives. The final section concludes that it is simplistic for a healthcare provider to promote intercountry adoption unconditionally; however, in situation where intercountry adoption is practiced conscientiously it poses no greater ethical concern than several medical alternatives. This conclusion is preliminary and is intended as a start for further discussion. [source] Measuring corporate environmental performance: the trade-offs of sustainability ratingsBUSINESS STRATEGY AND THE ENVIRONMENT, Issue 4 2010Magali Delmas Abstract Socially responsible investing (SRI) represents an investment process that reflects environmental and social preferences. The financial industry is in a unique position to move corporations towards corporate sustainability. However, there is often little transparency regarding the metrics used to evaluate corporate social and environmental performance and the trade-offs involved in the evaluation. In this paper we discuss the various trade-offs of sustainability screening methodologies. We show that the rating of companies varies significantly according to whether the screening is based on toxic releases and regulatory compliance or on the quality of environmental policy and disclosure. We base our analysis on the evaluation of the performance of 15 firms in the chemical sector. The analysis indicates that firms that have the most advanced reporting and environmental management practices tend also to have higher levels of toxic releases and lower environmental compliance. We provide methodological recommendations to help stakeholders evaluate corporate environmental performance. Copyright © 2010 John Wiley & Sons, Ltd and ERP Environment. [source] Human rights commissions and public policy: The role of the Canadian Human Rights Commission in advancing sexual orientation equality rights in CanadaCANADIAN PUBLIC ADMINISTRATION/ADMINISTRATION PUBLIQUE DU CANADA, Issue 2 2008Annette Nierobisz The case study is informed by commission annual reports, speeches by past chief commissioners, presentations by the commission to parliamentary committees, and an examination of 442 sexual orientation complaints closed by the commission by 2005. The study shows that, from its inception, the commission had a simple and consistent message: sexual orientation should not be the basis for denying individuals employment, services or benefits. Using a variety of strategies, the CHRC facilitated the incorporation of this message into the Canadian Human Rights Act by promoting the designation of sexual orientation as a prohibited ground of discrimination. Subsequently, the commission became actively involved in securing equal access to employment-related benefits in the federal sphere for same-sex couples and also added its voice in support of legal recognition of same-sex marriage. The authors conclude by discussing how the unique position of human rights commissions gives them the potential to play an important role in public policy development, even when there may be a lack of political will or public support. Sommaire: Le présent article examine l'aptitude des commissions des droits de la personne à encourager les changements dans la politique publique en mettant l'accent sur la Commission canadienne des droits de la personne (CCDP) et son rôle dans la promotion des droits à l'égalité en matière d'orientation sexuelle au Canada. L' étude de cas tire ses informations des rapports annuels de la commission, des allocutions prononcées par d'anciens présidents de la commission, des présentations faites par la commission aux comités parlementaires, et d'un examen de 442 plaintes relatives à l'orientation sexuelle traitées par la commission jusqu'en 2005. L' étude indique que, depuis sa création, la commission avait un message simple et unanime : l'orientation sexuelle ne devrait pas être un motif invoqué pour refuser de l'emploi, des services ou des avantages sociaux à des particuliers. Grâce à diverses stratégies, la CCDP a facilité l'intégration de ce message à la Loi canadienne sur les droits de la personne en faisant en sorte que l'orientation sexuelle soit désignée comme un motif de discrimination interdit. Par la suite, la commission a été active sur la scène fédérale pour assurer que les conjoints de même sexe bénéficient de l' égalité d'accès aux avantages liés à l'emploi, et elle a également soutenu la reconnaissance légale du mariage des conjoints de même sexe. En conclusion, les auteurs discutent la position unique des commissions des droits de la personne qui leur offre le potentiel de jouer un rôle important dans l' élaboration des politiques gouvernementales, même avec un manque de volonté politique ou de soutien public. [source] L -Lysine Monohydrochloride Syrup Concentration using a Membrane Hybrid Process of Ultrafiltration and Vacuum Membrane DistillationCHEMICAL ENGINEERING & TECHNOLOGY (CET), Issue 11 2008O. Bakhtiari Abstract The development of energy saving membrane separation processes is finding a unique position in process industries. One of the important areas where they are employed is the biotechnology industry. This industry has its own specifications and requirements, e.g., levels of diluteness, thermal, chemical and shear fragility. Membrane separation processes have the characteristics necessary to match these specifications and needs. In this research, the determination of the experimental concentration of L -Lysine monohydrochloride (L -lysine-HCl) syrup was investigated using ultrafiltration (UF) and vacuum membrane distillation (VMD) hybrid membrane processes. Four parameters that are known to have significant influence on the UF process were examined, i.e., pressure difference across the membrane, feed concentration of L -lysine-HCl, feed velocity on the membrane surface, and pH. For the VMD unit, pressure difference and pH were replaced with feed temperature and vacuum pressure on the permeate side of membrane. Each process was carried out separately and the results were used to design a bench-scale process. In order to save time and money, the Taguchi method of experimental design was employed. The effects of feed concentration, pressure difference across the membrane, feed velocity on the membrane surface, and pH on the target variable, i.e., the membrane flux, in the UF process were 39.93, 38.65, 9.36, and 9.59,%, respectively. For the VMD process, these values were 64.79, 22.16, 6.21, and 2.14,% for feed temperature, feed concentration, vacuum pressure on the permeate side, and feed velocity on the membrane surface, respectively. [source] Characterization within and around the Limbal Epithelial CryptACTA OPHTHALMOLOGICA, Issue 2007AM YEUNG Purpose: The Limbal Epithelial Crypt (LEC) is an anatomical structure that is found between the junction of the cornea and sclera and is in a unique position to make it an ideal structure to examine further. Previous studies have demonstrated the LEC to have properties that suggest it may be a stem cell niche. Basal cells of the LEC are significantly smaller than basal cells found in adjacent rete pegs, and morphologically they have a higher nuclear:cytoplasmic ratio. We set out to examine LEC further by exploring the surrounding LEC matrix proteins, and with known differentiation markers. Methods: Donated corneo-sclero rims were cut into eight equal sized pieces and frozen. Each piece was cut into 7,m serial sections, and was examined by microscopy for LEC structures. Identified LEC was collected on slides and stored until they were fixed in acetone and processed by standard immunofluorescence techniques for each differentiation marker. Results: Tenacin C was more positively taken up by the basement membrane of the LEC compared with the surrounding limbus. In addition, staining for desmoglein was negative against isolated small subpopulations of cells within the basal regions of the LEC. Conclusions: The LEC structure demonstrates properties that may identify this as a possible stem cell niche. Further studies are necessary to determine the significance of the LEC in its role in stem cell maintenance. [source] Fostering self-esteem: exploring adult recollections on the influence of foster parentsCHILD & FAMILY SOCIAL WORK, Issue 4 2008Nikki Luke ABSTRACT Foster parents are in a unique position to improve the self-esteem of children in their care, which may be lower than that of their non-fostered peers. According to Harter's dual-influence model, both general support or attachment and domain-specific support contribute to self-esteem. The current study used this model to explore the ways in which foster parents had influenced the self-esteem of a sample of five adults with differing foster care experiences. Retrospective interviews were used to gather memories of high self-esteem from time spent in foster care. A thematic analysis of the interview transcripts supported Harter's model, and provided a number of examples of ways in which foster parents could boost children's self-esteem. The model was further extended to show the importance of ,normality' and inclusion for this sample of fostered adults. Further research on this topic is recommended with a view to widening the scope of foster carer training beyond attachment theory. [source] | ||||||||||||||||||||||||||||||||||