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World Settings (world + setting)
Selected AbstractsLate Presenters with Dextro-transposition of Great Arteries and Intact Ventricular Septum: To Train or Not to Train the Left Ventricle for Arterial Switch Operation?CONGENITAL HEART DISEASE, Issue 6 2009Noor Mohamed Parker MBChB ABSTRACT Objective., We report our experience in managing late presenters (older than 4 weeks) with dextro-transposition of great arteries and intact ventricular septum (d-TGA/IVS) in an effort to achieve successful arterial switch operation (ASO) in a third world setting. Design., We retrospectively reviewed the charts of all late presenters with d-TGA/IVS. Patients were divided into two groups: left ventricular training (LVT) group and non-left ventricular training (non-LVT) group. LVT group underwent pulmonary artery banding and Blalock-Taussig Shunt prior to ASO. Results., Twenty-one late presenters were included in the study. In LVT group, 11 patients with median age of 6 months (range, 1,72 months) underwent LVT. Later, 8 patients with median age of 9.25 months (range, 1.33,84 months) underwent ASO. Prior to ASO, left ventricle (LV) collapse resolved in all and left ventricle to systemic pressure (LV/SP) ratio was 0.81 (range, 0.76,0.95) in 4 patients. Two patients who had LVT for ,14 days required postoperative extracorporeal membrane oxygenation (ECMO) support due to LV dysfunction. Seven patients survived to discharge. In non-LVT group, 10 patients with median age of 2.5 months (range, 1,98 months) underwent ASO. Five patients had LV collapse, and median LV/SP ratio was 0.67 (range, 0.56,1.19) in 5 patients. Seven patients needed ECMO support. Seven patients survived to discharge. Conclusion., Late presenters with d-TGA/IVS, who have LV collapse on echocardiography and/or a LV/SP ratio <0.67 on cardiac catheterization, should be subjected to LVT preferably for duration of longer than 14 days in order to avoid potential ECMO use. [source] ACCESS TO ESSENTIAL MEDICINES: A HOBBESIAN SOCIAL CONTRACT APPROACHDEVELOPING WORLD BIOETHICS, Issue 2 2005RICHARD E. ASHCROFT ABSTRACT Medicines that are vital for the saving and preserving of life in conditions of public health emergency or endemic serious disease are known as essential medicines. In many developing world settings such medicines may be unavailable, or unaffordably expensive for the majority of those in need of them. Furthermore, for many serious diseases (such as HIV/AIDS and tuberculosis) these essential medicines are protected by patents that permit the patent-holder to operate a monopoly on their manufacture and supply, and to price these medicines well above marginal cost. Recent international legal doctrine has placed great stress on the need to globalise intellectual property rights protections, and on the rights of intellectual property rights holders to have their property rights enforced. Although international intellectual property rights law does permit compulsory licensing of protected inventions in the interests of public health, the use of this right by sovereign states has proved highly controversial. In this paper I give an argument in support of states' sovereign right to expropriate private intellectual property in conditions of public health emergency. This argument turns on a social contract argument for the legitimacy of states. The argument shows, further, that under some circumstances states are not merely permitted compulsory to license inventions, but are actually obliged to do so, on pain of failure of their legitimacy as sovereign states. The argument draws freely on a loose interpretation of Thomas Hobbes's arguments in his Leviathan, and on an analogy between his state of War and the situation of public health disasters. [source] A paradigmatic and methodological examination of information systems research from 1991 to 2001INFORMATION SYSTEMS JOURNAL, Issue 3 2004WenShin Chen Abstract., The field of information systems (IS) has evolved for more than three decades. Although many schools of thought have emerged and even become well established, few historical analyses of research paradigms and methodologies have been undertaken. One of the rare exceptions is Orlikowski & Baroudi (1991). Yet, the IS research community has evolved substantially since 1991 in many aspects. A variety of journal outlets have emerged and become well established. More attention has been paid to paradigmatic and methodological issues. Political and professional contexts have also changed noticeably. Therefore, it should be an opportune time for the field to ask: ,What changes are manifested in journal publications?',Is the field making progress regarding pluralism in IS research?',How will the field's publications practices change in the future?' The purpose of this paper is to investigate these questions and, in turn, reflect on the paradigmatic and methodological progress made since 1991. We examined 1893 articles published in eight major IS publication outlets between 1991 and 2001. Our findings suggest that the long-term endeavours of interpretivist researchers might need to continue because the paradigmatic progress appears somewhat inconsequential; positivist research still dominates 81% of published empirical research. In particular, US journals, as opposed to European journals, tend to be more positivist, quantitative, cross-sectional and survey oriented. With respect to research design, survey research is still the most widely used method (41%), although case studies have gained substantial recognition (36%). Further, the increase of qualitative research (30%), empirical studies (61%) and longitudinal cases (33%) at the expense of laboratory experiments (18%) might suggest that IS researchers have become more interested in obtaining scientific knowledge in real world settings. In summary, we suggest that the field has been dominated by the positivist paradigm, despite calls to the contrary. Indeed, if the field was to truly embrace pluralism, it would have to find ways to fundamentally change the publication practices of the journal system, including the current tenure and promotion system, which pose considerable obstacles for the acceptance of alternative paradigms. [source] How do implementation efforts relate to program adherence? examining the role of organizational, implementer, and program factorsJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 6 2008Jacinda K. Dariotis Widespread replications of evidence-based prevention programs (EBPPs) prompt prevention scientists to examine program implementation adherence in real world settings. Based on Chen's model (1990), we identified five key factors of the implementation system and assessed which characteristics related to program adherence. The sample included 32 EBPPs and results indicate that target recipient responsivity, program material quality, implementer prioritization, community collaborative system support, and parental support significantly relate to program adherence. Several differences reached statistical significance, thereby highlighting the importance of these variables and the need for future studies with larger sample sizes to identify factors related to program adherence adequately. © 2008 Wiley Periodicals, Inc. [source] Emergency Medicine in the Developing World: A Delphi StudyACADEMIC EMERGENCY MEDICINE, Issue 7 2010Peter W. Hodkinson MPhil(EM) ACADEMIC EMERGENCY MEDICINE 2010; 17:765,774 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, Emergency medicine (EM) as a specialty has developed rapidly in the western world, but remains largely immature in developing nations. There is an urgent need for emergency services, but no clear guidelines are available on the priorities for establishing EM in the developing world. This study seeks to establish consensus on key areas of EM development in developing world settings, with respect to scope of EM, staffing needs, training requirements, and research priorities. Methods:, A three-round Delphi study was conducted via e-mail. A panel was convened of 50 EM specialists or equivalent, with experience in or interest in EM in the developing world. In the first round, panelists provided free-text statements on scope, staffing, training, and research priorities for EM in the developing world. A five-point Likert scale was used to rate agreement with the statements in Rounds 2 and 3. Consensus statements are presented as a series of synopsis statements for each of the four major themes. Results:, A total of 168 of 208 statements (81%) had reached consensus at the end of the study. Key areas in which consensus was reached included EM being a specialist-driven service, with substantial role for nonphysicians. International training courses should be adapted to local needs. EM research in developing countries should be clinically driven and focus on local issues of importance. Conclusions:, The scope and function of EM and relationships with other specialties are defined. Unambiguous principles are laid out for the development of the specialty in developing world environments. The next step required in this process is translation into practical guidelines for the development of EM in developing world settings where they may be used to drive policy, protocols, and research. [source] An examination of frequent nursing interventions and outcomes in an adolescent psychiatric inpatient unitINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 5 2009Candace Bobier ABSTRACT:, Little is known about which nursing interventions used in adolescent psychiatric inpatient treatment demonstrate improvements in outcome in the ,real world' setting, despite an increase in external outcomes reporting requirements. This paper examines nursing and other multidisciplinary interventions commonly used at the Youth Inpatient Unit, Christchurch, New Zealand, in relation to improvements in outcomes as measured by the Health of the Nation Outcome Scales for Children and Adolescents, utilizing data gathered prospectively as part of an ongoing quality assurance and outcomes project. We found the majority of interventions investigated were utilized equally across diagnostic groups, although stress management and problem-solving education was used more for patients with mixed affective disorders. Further, the results contribute to growing evidence toward the value of providing medication and problem-solving education to this population. Mental health nurses working with children and adolescents should be supported to utilize and develop their unique skill set to offer targeted interventions and to examine their practice to identify the most valuable interventions for their patients within this developmental context. [source] Ottawa's Byward Market: a festive bone of contention?THE CANADIAN GEOGRAPHER/LE GEOGRAPHE CANADIEN, Issue 3 2001JOHN E. TUNBRIDGE This paper considers recent developments in the revitalization of the Byward Market, with reference to applicable concepts of the ,tourist-historic city' and the ,convivial city. The central objective is to assess its convergence, in specific detail, with the festival marketplace model. Convergence on most dimensions is demonstrated, but shown to be limited by alternative management philosophies and the fractured complexity of a ,real world' setting. The Market's growing real-world centrality is shown to give rise to a range of stakeholder contest beyond a festival marketplace, as specifically defined. It is suggested that this will prove more generally true of evolved traditional markets. [source] | |||||||||||||