Fixing America's School Lunch Program: Local Issues, National Challenges, and Global Perspectives on Possible Solutions

The National School Lunch Program (NSLP) has undergone profound changes since its establishment in the 1930s with a primary goal of feeding undernourished school children. Today, the program is under scrutiny for its negative impact on student health and environmental unsustainability. This project investigates the origins of the NSLP, the current status of the program, and opportunities for reform. In view of the program's deficiencies, much can be learned by studying other relevant models for school lunch, such as those used in Italy and France. While recognizing the political realities and budgetary constraints public schools currently confront, the Business Plan applies these lessons in its proposals for rethinking the school lunch program at one Denver public school.

Energy-efficient commercial buildings : the range of possible solutions and their conceptual differences /

"Work Performed Under Contract No. EG-77-C-01-4042."

Medication -related adverse events in older people with dementia:causes and possible solutions

This submission for a PhD by previously published work is based upon six publications in peer reviewed journals, reflecting a 9-year research programme. My research has shown, in a coherent and original way, the difficulty in treating people with dementia with safe and effective medication whilst providing research-founded guidance to develop mechanisms to optimise medication choice and minimise iatrogenic events. A wide range of methods, including systematic reviews, meta-analysis, randomised controlled trials (RCTs), quantitative research and mixed methods were used to generate the data, which supported the exploration of three themes. The first theme, to understand the incidence and causes of medication errors in dementia services, identified that people with dementia may be more susceptible to medication-related iatrogenic disease partly due to inherent disease-related characteristics. One particular area of concern is the use of anti-psychotics to treat the Behavioural and Psychological Symptoms of Dementia (BPSD). The second and third themes, respectively, investigated a novel pharmacological and health services intervention to limit anti-psychotic usage. The second phase found that whilst the glutamate receptor blocker memantine showed some promise, further research was clearly required. The third phase found that anti-psychotic usage in dementia may be higher than official figures suggest and that medication review linking primary and secondary care can limit such usage. My work has been widely cited, reflecting a substantial contribution to the field, in terms of our understanding of the causes of, and possible solutions to limit, medication-related adverse events in people with dementia. More importantly, this work has already informed clinical practice, patients, carers and policy makers by its demonstrable impact on health policy. In particular my research has identified key lines of enquiry for future work and for the development of my own personal research programme to reduce the risk associated with medication in this vulnerable population.

Manganese toxicity in Portuguese Cambisols derived from granite: causes, limitations of soil analyses and possible solutions

Cambisols are the major soil type in Portugal. The yield of annual crops in these soils is generally poor, and the situation is aggravated in wet winters. In the south of Portugal, manganese toxicity has been identified as the major cause of poor growth and leaching as the main reason for the negative effect of rainfall observed in Cambisols derived from granite Manganese toxicity also appears to be present in the Cambisols in other regions of Portugal. Manganese toxicity is cross-related to the magnesium concentration, either in the soil solution or in plant shoots. Therefore soil amendment using dolomitic limestone is needed to overcome the problem. Current soil test methods are unable to predict the level of Mn toxicity. However, new approach using the extraction of soil solution is proposed, although further work is needed to fully implement the method.

Archiving primary data: Solutions for long-term studies

The recent trend for journals to require open access to primary data included in publications has been embraced by many biologists, but has caused apprehension amongst researchers engaged in long-term ecological and evolutionary studies. A worldwide survey of 73 principal investigators (Pls) with long-term studies revealed positive attitudes towards sharing data with the agreement or involvement of the PI, and 93% of PIs have historically shared data. Only 8% were in favor of uncontrolled, open access to primary data while 63% expressed serious concern. We present here their viewpoint on an issue that can have non-trivial scientific consequences. We discuss potential costs of public data archiving and provide possible solutions to meet the needs of journals and researchers.

Cooperative and market-based solutions to pollution abatement problems

This work concerns itself with the possibility of solutions, both cooperative and market based, to pollution abatement problems. In particular, we are interested in pollutant emissions in Southern California and possible solutions to the abatement problems enumerated in the 1990 Clean Air Act. A tradable pollution permit program has been implemented to reduce emissions, creating property rights associated with various pollutants.

Before we discuss the performance of market-based solutions to LA's pollution woes, we consider the existence of cooperative solutions. In Chapter 2, we examine pollutant emissions as a trans boundary public bad. We show that for a class of environments in which pollution moves in a bi-directional, acyclic manner, there exists a sustainable coalition structure and associated levels of emissions. We do so via a new core concept, one more appropriate to modeling cooperative emissions agreements (and potential defection from them) than the standard definitions.

However, this leaves the question of implementing pollution abatement programs unanswered. While the existence of a cost-effective permit market equilibrium has long been understood, the implementation of such programs has been difficult. The design of Los Angeles' REgional CLean Air Incentives Market (RECLAIM) alleviated some of the implementation problems, and in part exacerbated them. For example, it created two overlapping cycles of permits and two zones of permits for different geographic regions. While these design features create a market that allows some measure of regulatory control, they establish a very difficult trading environment with the potential for inefficiency arising from the transactions costs enumerated above and the illiquidity induced by the myriad assets and relatively few participants in this market.

It was with these concerns in mind that the ACE market (Automated Credit Exchange) was designed. The ACE market utilizes an iterated combined-value call market (CV Market). Before discussing the performance of the RECLAIM program in general and the ACE mechanism in particular, we test experimentally whether a portfolio trading mechanism can overcome market illiquidity. Chapter 3 experimentally demonstrates the ability of a portfolio trading mechanism to overcome portfolio rebalancing problems, thereby inducing sufficient liquidity for markets to fully equilibrate.

With experimental evidence in hand, we consider the CV Market's performance in the real world. We find that as the allocation of permits reduces to the level of historical emissions, prices are increasing. As of April of this year, prices are roughly equal to the cost of the Best Available Control Technology (BACT). This took longer than expected, due both to tendencies to mis-report emissions under the old regime, and abatement technology advances encouraged by the program. Vve also find that the ACE market provides liquidity where needed to encourage long-term planning on behalf of polluting facilities.

General practitioners’ perceptions of the barriers and solutions to good quality palliative care in dementia

The general practitioner (GP) is in a pivotal position to initiate and adapt care for their patients living with dementia. This study aimed to elicit GPs' perceptions of the potential barriers and solutions to the provision of good-quality palliative care in dementia in their practices. A postal survey of GPs across Northern Ireland was conducted with open-ended items soliciting for barriers in their practices and possible solutions; 40.6% (138/340) were returned completed. Barriers to palliative care in dementia were perceived to be a dementia knowledge deficit for healthcare staff and the public, a resource shortfall within the GP practice and community, poor team coordination alongside inappropriate dementia care provision, and disagreements from and within families. These findings have significant implications for educators and clinicians as enhanced dementia education and training were highlighted as a strong agenda for GPs with the suggestions of dementia awareness programmes for the public.

The Emergency Department: Rising wait times, costs, and possible remedies

Emergency Departments (EDs) and Emergency Rooms (ERs) are designed to manage trauma, respond to disasters, and serve as the initial care for those with serious illnesses. However, because of many factors, the ED has become the doorway to the hospital and a “catch-all net” for patients including those with non-urgent needs. This increase in the population in the ED has lead to an increase in wait times for patients. It has been well documented that there has been a constant and consistent rise in the number of patients that frequent the ED (National Center for Health Statistics, 2002); the wait time for patients in the ED has increased (Pitts, Niska, Xu, & Burt, 2008); and the cost of the treatment in the ER has risen (Everett Clinic, 2008). Because the ED was designed to treat patients who need quick diagnoses and may be in potential life-threatening circumstances, management of time can be the ultimate enemy. If a system was implemented to decrease wait times in the ED, decrease the use of ED resources, and decrease costs endured by patients seeking care, better outcomes for patients and patient satisfaction could be achieved. The goal of this research was to explore potential changes and/or alternatives to relieve the burden endured by the ED. In order to explore these options, data was collected by conducting one-on-one interviews with seven physicians closely tied to a Level 1 ED (Emergency Room physicians, Trauma Surgeons and Primary Care physicians). A qualitative analysis was performed on the responses of one-on-one interviews with the aforementioned physicians. The interviews were standardized, open-ended questions that probe what makes an effective ED, possible solutions to improving patient care in the ED, potential remedies for the mounting problems that plague the ED, and the feasibility of bringing Primary Care Physicians to the ED to decrease the wait times experienced by the patient. From the responses, it is clear that there needs to be more research in this area, several areas need to be addressed, and a variety of solutions could be implemented. The most viable option seems to be making the ED its own entity (similar to the clinic or hospital) that includes urgent clinics as a part of the system, in which triage and better staffing would be the most integral part of its success.^

Trust and Privacy Solutions Based on Holistic Service Requirements

The products and services designed for Smart Cities provide the necessary tools to improve the management of modern cities in a more efficient way. These tools need to gather citizens’ information about their activity, preferences, habits, etc. opening up the possibility of tracking them. Thus, privacy and security policies must be developed in order to satisfy and manage the legislative heterogeneity surrounding the services provided and comply with the laws of the country where they are provided. This paper presents one of the possible solutions to manage this heterogeneity, bearing in mind these types of networks, such as Wireless Sensor Networks, have important resource limitations. A knowledge and ontology management system is proposed to facilitate the collaboration between the business, legal and technological areas. This will ease the implementation of adequate specific security and privacy policies for a given service. All these security and privacy policies are based on the information provided by the deployed platforms and by expert system processing.

Some causes of unreliability of fishery statistics on the African great lakes and possible ways of bettering the statistics

This paper is based on a two year's intensive statistical data collection survey on Lake Kyoga, observations made on Lake Victoria over the last decade occasional visits on Lake Albert (Mobutu) and Lake Malawi. World over, scientists have kept doubting the fisheries statistical figures presented by various African countries. Some countries fail to present any figures. This paper, therefore, narrates most of the causes and possible solutions to those problems.

Challenges faced by general practitioners and allied mental health services in providing mental health services in rural Queensland

Objective: To examine the views of rural practitioners concerning issues and challenges in mental health service delivery and possible solutions. Design: A qualitative study using individual semi-structured interviews. Setting: Eight general practices from eight rural Queensland towns, three rural mental health services and two non-government organisations, with interviews being conducted before recent changes in government-subsidised access to allied health practitioners. Participants: A sample of 37 GPs, 19 Queensland Health mental health staff and 18 participants from community organisations. Main outcome measures: Analysis of qualitative themes from questions about the key mental health issues facing the town, bow they might be addressed and what challenges would be faced in addressing them. Results: There was substantial consensus that there are significant problems with inter-service communication and liaison, and that improved collaboration and shared care will form a critical part of any effective solution. Differences between groups reflected differing organisational contexts and priorities, and limitations to the understanding each had of the challenges that other groups were facing. C onclusions: Improvements to mental health staffing and to access to allied health might increase the ability of GPs to meet the needs of less complex patients, but specific strategies to promote better integrated services are required to address the needs of rural and regional patients with complex mental health problems. The current study provides a baseline against which effects of recent initiatives to improve mental health care can be assessed.

Characterising the homeostatic and hedonic markers of the susceptible phenotype

Over the years, approaches to obesity prevention and treatment have gone from focusing on genetic and other biological factors to exploring a diversity of diets and individual behavior modification interventions anchored primarily in the power of the mind, to the recent shift focusing on societal interventions to design ";temptation-proof"; physical, social, and economic environments. In spite of repeated calls to action, including those of the World Health Organization (WHO), the pandemic continues to progress. WHO recently projected that if the current lifestyle trend in young and adult populations around the world persist, by 2012 in countries like the USA, health care costs may amount to as much as 17.7% of the GDP. Most importantly, in large part due to the problems of obesity, those children may be the first generation ever to have a shorter life expectancy than that of their parents. This work presents the most current research and proposals for addressing the pandemic. Past studies have focused primarly on either genetic or behavioral causes for obesity, however today's research indicates that a strongly integrated program is the best prospect for success in overcoming obesity. Furthermore, focus on the role of society in establishing an affordable, accessible and sustainable program for implementing these lifestyle changes is vital, particularly for those in economically challenged situations, who are ultimately at the highest risk for obesity. Using studies from both neuroscience and behavioral science to present a comprehensive overview of the challenges and possible solutions, The brain-to-society approach to obesity prevention focuses on what is needed in order to sustain a healthy, pleasurable and affordable lifestyle.

Education-to-work transitions of aspiring creatives

Despite some segments of the creative industries in Australia performing better than other segments in terms of earnings and employment growth, they all rely on highly skilled workers and face similar workforce challenges. Workers typically experience multiple entry attempts, spells of unemployment, short-term contracts, high degrees of mobility, casual/part-time employment within and outside the creative industries, and pressure to ensure their skills remain relevant. Skills shortages and gaps, an insufficient supply of high quality industry-ready graduates, difficulties in predicting demand for skills, weak linkages between industry and education providers, reliance on overseas talent in some segments, limited opportunities for workers to engage in skill development, and pressure on workers to keep abreast of technological developments are ongoing issues in the creative industries workforce. In response to these concerns, the Australian Research Council, three State Governments, industry, and a large vocational education and training (VET) provider funded Queensland University of Technology (QUT) to conduct the 60Sox project. This three-year project investigated the education, training, and work experiences of aspiring creatives defined as new entrants, recent graduates, and students enrolled in creative industries courses. It involved the largest survey of aspiring creatives ever undertaken in Australia, attracting 507 respondents, and a survey of 50 employers. Using the framework proposed by Hannan, Raffe, and Smyth (1996), this article presents findings from an analysis of the macro and micro labour market outcomes of aspiring creatives using data from the two 60Sox project surveys and publicly available sources. The analysis confirmed that many graduates of creative industries courses who participated in the 60Sox survey and the national surveys for the National Centre for Vocational Education Research and Graduate Careers Australia were struggling to make a successful transition from education to work. This article also discusses the causes of this key finding and possible solutions to address transition issues.