Parent Engagement in Supported Supervised Visitation in Child Welfare

Thesis (Master's)--University of Washington, 2016-06

The other side of the coin: safety of complementary and alternative medicine

Most consumers consider complementary and alternative medicine (CAM) products inherently safe. The growing simultaneous use of CAM products and pharmaceutical drugs by Australian consumers increases the risk of CAM-drug interactions. The Therapeutic Goods Administration (TGA) has a two-tier, risk-based regulatory system for therapeutic goods - CAM products are regulated as low risk products and are assessed for quality and safety; and sponsors of products must hold the evidence for any claim of efficacy made about them. Adverse reactions to CAM products can be classified as intrinsic (innate to the product), or extrinsic (where the risk is not related to the product itself, but results from the failure of good manufacturing practice). Adverse reactions to CAM practices can be classified as risks of commission (which includes removal of medical therapy) and risks of omission (which includes failure to refer when appropriate). While few systematic studies of adverse events with CAM exist, and under-reporting is likely, most CAM products and practices do not appear to present a high risk; their safety needs to be put into the perspective of wider safety issues. A priority for research is to rigorously define the risks associated with both CAM products and practices so that their potential impact on public health can be assessed.

Media, 'Madness' and Ethical Journalism

This article analyses the way newspapers and journalists sometimes fail to acknowledge and resolve some of the contentious ethical dilemmas associated with reporting news. Its focus is on not exploiting and vilifying the vulnerable, especially people with mental illness, through sensationalism and inaccurate and imprecise use of medical terminology such as "psycho ". "schizo" or "lunatic ". Because ethics is central to our understanding of professionalism, this article uses professions and professionalism as benchmarks aginst which to analyse and critique how journalists and newspapers define and report news.Sometimes journalists fail the test of good ethical practice in terms of negative. outdated and inaccurate expressions they use in the news stories they report. Likewise, regulators of news industry standards appear not to recognize and sanction such reporting. The apparent inability to resolve these ethical dilemmas creates a context conducive to tolerance for, not acceptance of. unethical news reporting.

Generation and maturation of dendritic cells for clinical application under serum-free conditions

Monocyte-derived dendritic cells (MoDCs) in clinical use for cancer immunotherapy are ideally generated in serum-free medium (SFM) with inclusion of a suitable maturation factor toward the end of the incubation period. Three good manfacturing practice (GMP) grade SFMs (AIM-V, X-VIVO 15, and X-VIVO 20) were compared with RPMI-1640, supplemented with 10% fetal bovine serum or 10% human serum. DCs generated for 7 days in SFM were less mature and secreted less interleukin (IL) 12p70 and IL-10 than DCs generated in 10% serum. DC yield was comparable in SFMs, and a greater proportion of cells was viable after maturation. Toll-like receptor (TLR) ligands were compared for their ability to induce cytokine secretion under serum-free conditions in the presence of interferon (IFN) gamma. With the exception of Poly I:C, TLR ligands stimulated high levels of IL-10 secretion. High levels of IL-12p70 were induced by two TLR4-mediated stimuli, lipopolysaccharide and Ribomunyl, a clinical-grade bacterial extract. When T-cell responses were compared in allogeneic mixed leukocyte reaction, DCs stimulated with Ribomunyl induced higher levels of IFN gamma than DCs stimulated with the cytokine cocktail: tumor necrosis factor-alpha, IL-1 beta, IL-6, and prostaglandin E-2. In the presence of IL-10 neutralizing antibodies, DC IL-12p70 production and T-cell IFN gamma were increased in vitro. Similarly, DCs stimulated with Ribomunyl, IFN gamma, and anti-IL-10 induced high levels of tetanus toxoid-specific T-cell proliferation and IFN gamma secretion. Thus, MoDCs generated ill SFM efficiently stimulate T-cell IFN gamma production after maturation in the presence of a clinical-grade TLR4 agonist and IL-10 neutralization.

Practical assessment of neural network applications

This paper reports the initial results of a joint research project carried out by Aston University and Lloyd's Register to develop a practical method of assessing neural network applications. A set of assessment guidelines for neural network applications were developed and tested on two applications. These case studies showed that it is practical to assess neural networks in a statistical pattern recognition framework. However there is need for more standardisation in neural network technology and a wider takeup of good development practice amongst the neural network community.

The effective use of implicit parallelism through the use of an object-oriented programming language

This thesis explores translating well-written sequential programs in a subset of the Eiffel programming language - without syntactic or semantic extensions - into parallelised programs for execution on a distributed architecture. The main focus is on constructing two object-oriented models: a theoretical self-contained model of concurrency which enables a simplified second model for implementing the compiling process. There is a further presentation of principles that, if followed, maximise the potential levels of parallelism. Model of Concurrency. The concurrency model is designed to be a straightforward target for mapping sequential programs onto, thus making them parallel. It aids the compilation process by providing a high level of abstraction, including a useful model of parallel behaviour which enables easy incorporation of message interchange, locking, and synchronization of objects. Further, the model is sufficient such that a compiler can and has been practically built. Model of Compilation. The compilation-model's structure is based upon an object-oriented view of grammar descriptions and capitalises on both a recursive-descent style of processing and abstract syntax trees to perform the parsing. A composite-object view with an attribute grammar style of processing is used to extract sufficient semantic information for the parallelisation (i.e. code-generation) phase. Programming Principles. The set of principles presented are based upon information hiding, sharing and containment of objects and the dividing up of methods on the basis of a command/query division. When followed, the level of potential parallelism within the presented concurrency model is maximised. Further, these principles naturally arise from good programming practice. Summary. In summary this thesis shows that it is possible to compile well-written programs, written in a subset of Eiffel, into parallel programs without any syntactic additions or semantic alterations to Eiffel: i.e. no parallel primitives are added, and the parallel program is modelled to execute with equivalent semantics to the sequential version. If the programming principles are followed, a parallelised program achieves the maximum level of potential parallelisation within the concurrency model.

Experiences of patients with age-related macular degeneration receiving anti-vascular endothelial growth factor therapy:a qualitative study

The societal cost for the average health authority in the United Kingdom for the care of wet age-related macular degeneration (AMD) has been suggested to be around £7.4 million. It is vital that the best possible care based on the best available evidence is provided to reduce the impact of AMD on patients' lives and the financial cost to the health-care system. This study explored the experiences of AMD patients treated with intravitreal ranibizumab injections. Three semistructured interviews were conducted with seven participants over the course of 18 months. Transcripts were analysed using interpretative phenomenological analysis. Analysis identified four themes: preparing for treatment, the treatment process, patient-provider communication, and results of treatment. Patient experiences highlighted the need to move away from the reliance on letters for information provision, and the need for clearer guidelines about when to cease AMD treatment. Interviews highlighted the need for the inclusion of rigorous qualitative evidence with experiential data in future good clinical practice guideline development for AMD. © The Author(s) 2013.

Using a systems approach in logistics design and planning

The international economic and business environment continues to develop at a rapid rate. Increasing interactions between economies, particularly between Europe and Asia, has raised many important issues regarding transport infrastructure, logistics and broader supply chain management. The potential exists to further stimulate trade provided that these issues are addressed in a logical and systematic manner. However, if this potential is to be realised in practice there is a need to re-evaluate current supply chain configurations. A mismatch currently exists between the technological capability and the supply chain or logistical reality. This mismatch has sharpened the focus on the need for robust approaches to supply chain re-engineering. Traditional approaches to business re-engineering have been based on manufacturing systems engineering and business process management. A recognition that all companies exist as part of bigger supply chains has fundamentally changed the focus of re-engineering. Inefficiencies anywhere in a supply chain result in the chain as a whole being unable to reach its true competitive potential. This reality, combined with the potentially radical impact on business and supply chain architectures of the technologies associated with electronic business, requires organisations to adopt innovative approaches to supply chain analysis and re-design. This paper introduces a systems approach to supply chain re-engineering which is aimed at addressing the challenges which the evolving business environment brings with it. The approach, which is based on work with a variety of both conventional and electronic supply chains, comprises underpinning principles, a methodology and guidelines on good working practice, as well as a suite of tools and techniques. The adoption of approaches such as that outlined in this paper helps to ensure that robust supply chains are designed and implemented in practice. This facilitates an integrated approach, with involvement of all key stakeholders throughout the design process.

Medicines optimisation for young people with juvenile arthritis and other long-term conditions:system-level barriers to engagement

To explore the views of pharmacy and rheumatology stakeholders about system-related barriers to medicines optimisation activities with young people with long-term conditions. A three-phase consensus-building study comprising (1) focus groups with community and hospital pharmacists; (2) semi-structured telephone interviews with lay and professional adolescent rheumatology stakeholders and pharmacy policymakers, and (3) multidisciplinary discussion groups with community and hospital pharmacists and rheumatology staff. Qualitative verbatim transcripts from phases 1 and 2 were subjected to framework analysis. Themes from phase 1 underpinned a briefing for phase 2 interviewees. Themes from phases 1 and 2 generated elements of good pharmacy practice and current/future pharmacy roles for ranking in phase 3. Results from phase 3 prioritisation and ranking exercises were captured on self-completion data collection forms, entered into an Excel spreadsheet and subjected to descriptive statistical analysis. Institutional ethical approval was given by Aston University Health and Life Sciences Research Ethics Committee. Four focus groups were conducted with 18 pharmacists across England, Scotland and Wales (7 hospital, 10 community and 1 community/public health). Fifteen stakeholders took part in telephone interviews (3 pharmacist commissioners; 2 pharmacist policymakers; 2 pharmacy staff members (1 community and 1 hospital); 4 rheumatologists; 1 specialist nurse, and 3 lay juvenile arthritis advocates). Twenty-five participants took part in three discussion groups in adolescent rheumatology centres across England and Scotland (9 community pharmacists; 4 hospital pharmacists; 6 rheumatologists; 5 specialist nurses, and 1 physiotherapist). In all phases of the study, system-level issues were acknowledged as barriers to more engagement with young people and families. Community pharmacists in the focus groups reported that opportunities for engaging with young people were low if parents collected prescriptions alone, which was agreed by other stakeholders. Moreover, institutional/company prescription collection policies – an activity largely disallowed for a young person under 16 without an accompanying parent - were identified by hospital and community pharmacists as barriers to open discussion and engagement. Few community pharmacists reported using Medicines Use Review (England/Wales) or Chronic Medication Service (Scotland) as a medicines optimisation activity with young people; many were unsure about consent procedures. Despite these limitations, rheumatology stakeholders ranked highly the potential of pharmacists empowering young people with general health care skills, such as repeat prescription ordering. The pharmacy profession lacks vision for its role in the care of young people with long-term conditions. Pharmacists and rheumatology stakeholders identified system-level barriers to more engagement with young people who take medicines regularly. We acknowledge that the modest number of participants may have had a specific interest and thus bias for the topic, but this underscores their frank admission of the challenges. Professional guidance and policy, practice frameworks and institutional/company policies must promote flexibility for pharmacy staff to recognise and empower young people who are able to give consent and take responsibility for medicines activities. This will increase mutual confidence and trust, and foster pharmacy’s role in teaching general health care skills. In this way, pharmacists will be able to build long-term relationships with young people and families.

Összegződnek-e az egyéni törekvések? A cselekvés és az eredmény közötti szakadék problémája (Can individual efforts be aggregated? The problem of the action-impact gap)

A szerző arra a kérdésre keresi a választ, hogyan alakulhat ki látványos szakadék az egyéni cselekvések iránya és azok együttes hatása között. A szándékok és tettek hatását felülírhatja a társadalmi gazdasági tényezőkből adódó tehetetlenség: a kritikus tömeg hiánya, szervezeti-infrastrukturális tényezők, kompenzációs hatások, egymás hatását kioltó cselekvések. A szerző a környezettudatosság és az ökológiai lábnyom példáján - ezerfős reprezentatív felmérésre alapozva - mutatja be, hogy az önkéntességre alapozó megközelítés sokszor túlbecsüli a fogyasztó - társadalmi-gazdasági tényezők által korlátozott - lehetőségeit és szuverenitását. _____ Behaviour impact gaps are demonstrably present in everyday life. It is increasingly found that environmental awareness in individuals fails to lead to reductions in the ecological footprint. Intensive agricultural practice reduces biodiversity in the EU even in areas where massive agri-environmental grant schemes are available and applied. Labour market training programmes do not necessarily facilitate job-finding for underprivileged segments of the society. So individual efforts may not add up or induce the expected effect. This outcome appears even for programmes that are successful in attaining the required behavioural change in a target group. The impact of attitudes and individual acts may be wiped out by structural and economic lock-ins such as trade-offs made for the gains, lack of a critical mass of actions, infrastructural deficiencies, or interfering acts of economic actors. The discrepancy between environmental awareness and ecological footprint is used to point out how awareness-raising programmes may miss their targets by overestimating the sovereignty and capabilities of consumers. Consumers are unwillingly locked into unsustainable practices and cannot be moved from that position unless economic and structural premises are also changed.

Sweet cherry: composition, postharvest preservation, processing and trends for its future use

Background Sweet cherries (Prunus avium L.) are a nutritious fruit which are rich in polyphenols and have high antioxidant potential. Most sweet cherries are consumed fresh and a small proportion of the total sweet cherries production is value added to make processed food products. Sweet cherries are highly perishable fruit with a short harvest season, therefore extensive preservation and processing methods have been developed for the extension of their shelf-life and distribution of their products. Scope and Approach In this review, the main physicochemical properties of sweet cherries, as well as bioactive components and their determination methods are described. The study emphasises the recent progress of postharvest technology, such as controlled/modified atmosphere storage, edible coatings, irradiation, and biological control agents, to maintain sweet cherries for the fresh market. Valorisations of second-grade sweet cherries, as well as trends for the diversification of cherry products for future studies are also discussed. Key Findings and Conclusions Sweet cherry fruit have a short harvest period and marketing window. The major loss in quality after harvest include moisture loss, softening, decay and stem browning. Without compromising their eating quality, the extension in fruit quality and shelf-life for sweet cherries is feasible by means of combination of good handling practice and applications of appropriate postharvest technology. With the drive of health-food sector, the potential of using second class cherries including cherry stems as a source of bioactive compound extraction is high, as cherry fruit is well-known for being rich in health-promoting components.

Burnout em profissionais da saúde portugueses: Uma análise a nível nacional

Introdução: O burnout é uma síndrome psicológica, caracterizada por elevada exaustão emocional, elevada despersonalização e baixa realização profissional, que conduz à erosão dos valores pessoais, profissionais e de saúde. Este estudo reporta a prevalência do burnout em profissionais de saúde Portugueses. Material e Métodos: Os níveis de burnout foram estimados pelo Maslach Burnout Inventory - Human Services Survey numa escala ordinal de zero (nunca) a seis (sempre) pontos. A amostra foi constituída por 1 262 enfermeiros e 466 médicos com médias de idade de 36,8 anos (DP = 12,2) e 38,7 (DP = 11,0), respetivamente. Os participantes foram provenientes de todos os distritos nacionais (35% Lisboa; 18% Porto; 6% Aveiro, 6% Setúbal, 5% Coimbra; 5% regiões autónomas), com atuação em meio hospitalar (54%), centros de saúde (Unidade de Saúde Familiar - 30%; Unidades de Cuidados de Saúde Primários - 8%) e outras instituições públicas/privadas (8%). Resultados: A análise dos níveis de burnout revelou que ambas as categorias profissionais apresentaram níveis moderados a elevados de burnout (M = 3,0; DP = 1,7) não sendo significativas as diferenças entre as duas profissões. Vila Real (M = 3,8; SD = 1,7) e a Madeira (M = 2,5; DP = 1,5) são as regiões onde os níveis de burnout são mais e menos elevados, respetivamente. Os níveis de burnout não diferiram significativamente entre Hospitais, Unidades de Cuidados de Saúde Personalizados e Unidades de Saúde Familiares. Os profissionais com maior tempo na função são menos acometidos por burnout (r = -0,15) não ocorrendo associação significativa com a duração da jornada de trabalho (r = 0,04). A má qualidade das condições de trabalho foi o melhor preditor do burnout (r = -0,35). Discussão: A ocorrência da síndrome de burnout em profissionais de saúde portugueses é frequente, estando associada à percepção de más condições de trabalho e à menor duração do tempo de serviço. A incidência de burnout apresenta diferenças regionais que podem estar associadas ao aumento do stress imposto pelo exercício da profissão em condições sub-ótimas para a prestação dos cuidados de saúde. Os resultados alertam para a necessidade de intervenções para melhorar as condições de trabalho e formação inicial dos profissionais de saúde de forma a garantir a qualidade do serviço prestado aos utentes e o bem-estar pessoal destes profissionais. Conclusões: A nível nacional, entre 2011 e 2013, 21,6% dos profissionais de saúde apresentaram burnout moderado e 47,8% burnout elevado. A perceção de más condições de trabalho foi o principal preditor da ocorrência de burnout nos profissionais de saúde Portugueses.

Otoneurological Evaluation: Current Good Practice.

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