116 resultados para Socioeconomic Aspects.


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It presents questions that have arisen as a result of more than 20 years of collecting the data for the Bach Bibliography. Taking editions of The Well-Tempered Clavier as an example and using figures and graphs extracted from the Bach Bibliography, Tomita explores the various facets of the work's reception including its market appeal, the ambitions that steered its editors and publishers, and trends in its interpretation.

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PURPOSE: The impact of medical school culture on medical students has been well studied, but little documentation exists regarding how medical faculty experience the culture in which they work. In an ongoing project, the National Initiative on Gender, Culture and Leadership in Medicine, the authors are investigating how the existing culture of academic medical institutions supports all faculty members' ability to function at their highest potential. METHOD: The authors conducted a qualitative study of faculty in five disparate U.S. medical schools. Faculty in different career stages and diverse specialties were interviewed regarding their perceptions and experiences in academic medicine. Analysis was inductive and data driven. RESULTS: Relational aspects of the culture emerged as a central theme for both genders across all career categories. Positive relationships were most evident with patients and learners. Negative relational attributes among faculty and leadership included disconnection, competitive individualism, undervaluing of humanistic qualities, deprecation, disrespect, and the erosion of trust. CONCLUSIONS: The data suggest that serious problems exist in the relational culture and that such problems may affect medical faculty vitality, professionalism, and general productivity and are linked to retention. Efforts to create and support trusting relationships in medical schools might enhance all faculty members' efforts to optimally contribute to the clinical, education, and research missions of academic medicine. Future work will document the outcomes of a five-school collaboration to facilitate change in the culture to support the productivity of all medical faculty. © 2009 Association of American Medical Colleges.

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Event-related potentials (ERPs) and other electroencephalographic (EEG) evidence show that frontal brain areas of higher and lower socioeconomic status (SES) children are recruited differently during selective attention tasks. We assessed whether multiple variables related to self-regulation (perceived mental effort) emotional states (e.g., anxiety, stress, etc.) and motivational states (e.g., boredom, engagement, etc.) may co-occur or interact with frontal attentional processing probed in two matched-samples of fourteen lower-SES and higher-SES adolescents. ERP and EEG activation were measured during a task probing selective attention to sequences of tones. Pre- and post-task salivary cortisol and self-reported emotional states were also measured. At similar behavioural performance level, the higher-SES group showed a greater ERP differentiation between attended (relevant) and unattended (irrelevant) tones than the lower-SES group. EEG power analysis revealed a cross-over interaction, specifically, lower-SES adolescents showed significantly higher theta power when ignoring rather than attending to tones, whereas, higher-SES adolescents showed the opposite pattern. Significant theta asymmetry differences were also found at midfrontal electrodes indicating left hypo-activity in lower-SES adolescents. The attended vs. unattended difference in right midfrontal theta increased with individual SES rank, and (independently from SES) with lower cortisol task reactivity and higher boredom. Results suggest lower-SES children used additional compensatory resources to monitor/control response inhibition to distracters, perceiving also more mental effort, as compared to higher-SES counterparts. Nevertheless, stress, boredom and other task-related perceived states were unrelated to SES. Ruling out presumed confounds, this study confirms the midfrontal mechanisms responsible for the SES effects on selective attention reported previously and here reflect genuine cognitive differences.

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Research has consistently shown that family caregivers have a variety of unmet needs, despite comprehensive professional support for caregivers being a central aim of palliative care. This sub-study of a larger randomized controlled trial sought feedback from 47 primary family caregivers of advanced cancer patients who had recently commenced home palliative care. During semi-structured interviews in their homes, family caregivers were asked to comment on the key challenges associated with their role and whether they could identify challenges. These were associated with their own ill health, family circumstances, insufficient skills to manage patient symptoms, limited time for themselves and inadequate support from health professionals. Despite these challenges, 60% of family caregivers were readily able to identify positive aspects of the role. Previous research has tended to focus on the negative impact of caregiving. The extent to which the positive aspects buffer the negative aspects of the role warrants further exploration, as does the long-term impact of the caregiver role on those who are unable to recognize positive elements.

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The traditional training of surgeons focused exclusively on developing knowledge, clinical expertise, and technical (surgical) skills. However, analyses of the reasons for adverse events in surgery have revealed that many underlying causes originate from behavioural or non-technical aspects of performance (eg, poor communication among members of the surgical team) rather than from a lack of surgical (ie, technical) skills. Therefore, technical skills appear to be necessary but not sufficient to ensure patient safety. Paying attention to non-technical skills, such as team working, leadership, situation awareness, decision making, and communication, will increase the likelihood of maintaining high levels of error-free performance. Identification and training of non-technical skills has been developed for high-risk careers, such as civil aviation and nuclear power. Only recently, training in non-technical skills has been adopted by the surgical world and anaesthetists. Non-technical skills need to be tailored to the environment where they are used, and eye surgery has some substantial differences compared with other surgical areas, for example, high volume of surgery, use of local anaesthetics, and very sophisticated equipment. This review highlights the need for identification of the non-technical skills relevant to eye surgeons and promotion of their use in the training of eye surgeons.

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The commercial production of vanillin from sodium lignosulfonate under highly alkaline conditions, catalyzed by Cu2+ at elevated temperature and pressures up to 10 bar, has been simulated in a 3-L stirred reactor. Initially, the process was operated in the presence of nitrogen in dead-end mode, and it was shown that vanillin and vanillic acid were formed by hydrolysis at temperatures of 120, 140, and 160 °C. At the two higher temperatures, the amount of vanillin produced was the same. Subsequently, experiments were conducted at the same elevated pressures and temperatures with addition of air or oxygen-enriched air once the temperature in the reactor had reached temperatures similar to those used when only hydrolysis occurred. In this case, the concentration of vanillin at 140 and 160 °C was equal to that due to hydrolysis, and the subsequent 2-fold increase was due to oxidation. In addition, both vanillic acid and acetovanillone (which has rarely been reported) were produced, as was hydrogen. Thus, for the first time, it has been shown that the production of vanillin (and other compounds) from sodium lignosulfonate at elevated temperatures involves hydrolysis and oxidation, with hydrolysis starting at just above 100 °C, that is, much lower than has previously been reported. Approximately 50% is produced by each mechanism. In addition, the orders of the reactions of the different steps were estimated, and the reaction mechanisms are discussed.

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Purpose: To evaluate the influence of socioeconomic factors on visual acuity before cataract surgery. ?Methods: The medical case notes of 240 consecutive patients listed for cataract surgery from January 1, 2010, at Grampian University Hospital, Aberdeen, were reviewed retrospectively. Patients with ocular comorbidity were excluded. Demographics, postal codes, and visual acuity were recorded. Scottish Index of Multiple Deprivation was used to determine the deprivation rank. Home location was classified as urban or rural. The effect of these parameters on preoperative visual acuity was investigated using chi-square tests or Fisher exact test as appropriate. ?Results: A total of 184 patients (mean 75 years) were included. A total of 127 (69%) patients had visual acuity of 6/12 or better. An association was found between affluence and preoperative visual acuity of 6/12 or better (?2trend = 4.97, p = 0.03), with a significant rising trend across quintile of deprivation. There was no evidence to suggest association between geographical region and preoperative visual acuity (p = 0.63). ?Conclusion: Affluence was associated with good visual acuity (6/12 or better) before cataract surgery. There was no difference in preoperative visual acuity between rural and urban populations.

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Objective: To investigate the effect of socioeconomic deprivation on cornea graft survival in the United Kingdom.

Design: Retrospective cohort study.

Participants: All the recipients (n = 13?644) undergoing their first penetrating keratoplasty (PK) registered on the United Kingdom Transplant Registry between April 1999 and March 2011 were included.

Methods: Data of patients' demographic details, indications, graft size, corneal vascularization, surgical complication, rejection episodes, and postoperative medication were collected at the time of surgery and 1, 2, and 5 years postoperatively. Patients with endophthalmitis were excluded from the study. Patients' home postcodes were used to determine the socioeconomic status using a well-validated deprivation index in the United Kingdom: A Classification of Residential Neighborhoods (ACORN). Kaplan–Meier survival and Cox proportional hazards regression were used to evaluate the influence of ACORN categories on 5-year graft survival, and the Bonferroni method was used to adjust for multiple comparisons.

Main Outcome Measures: Patients' socioeconomic deprivation status and corneal graft failure.

Results: A total of 13?644 patients received their first PK during the study periods. A total of 1685 patients (13.36%) were lost to follow-up, leaving 11?821 patients (86.64%) for analysis. A total of 138 of the 11?821 patients (1.17%) developed endophthalmitis. The risk of graft failure within 5 years for the patients classified as hard-pressed was 1.3 times that of the least deprived (hazard ratio, 1.3; 95% confidence interval, 1.1–1.5; P = 0.003) after adjusting for confounding factors and indications. There were no statistically significant differences between the causes of graft failure and the level of deprivation (P = 0.14).

Conclusions: Patients classified as hard-pressed had an increased risk of graft failure within 5 years compared with the least deprived patients.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article

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An underground work (such as a tunnel or a cavern) has many, well known, environmental qualities such as: no physical barriers crossing the land, less maintenance costs than an analogous surface structure, less expenses for heating and conditioning; a localized emission of noise, gas, dust during operation and, finally, a better protection against seismic actions.
It cannot be forgotten, anyway, that some negative environmental features are present such as, for example, : perturbation, pollution and drainage of the groundwater; settlements; disposal of waste rock.
In the paper the above mentioned concepts are discussed and analysed to give a global overview of all this aspects.