Spatial aspects of MRSA epidemiology:A case study using stochastic simulation, kernel estimation and SaTScan

The identification of disease clusters in space or space-time is of vital importance for public health policy and action. In the case of methicillin-resistant Staphylococcus aureus (MRSA), it is particularly important to distinguish between community and health care-associated infections, and to identify reservoirs of infection. 832 cases of MRSA in the West Midlands (UK) were tested for clustering and evidence of community transmission, after being geo-located to the centroids of UK unit postcodes (postal areas roughly equivalent to Zip+4 zip code areas). An age-stratified analysis was also carried out at the coarser spatial resolution of UK Census Output Areas. Stochastic simulation and kernel density estimation were combined to identify significant local clusters of MRSA (p<0.025), which were supported by SaTScan spatial and spatio-temporal scan. In order to investigate local sampling effort, a spatial 'random labelling' approach was used, with MRSA as cases and MSSA (methicillin-sensitive S. aureus) as controls. Heavy sampling in general was a response to MRSA outbreaks, which in turn appeared to be associated with medical care environments. The significance of clusters identified by kernel estimation was independently supported by information on the locations and client groups of nursing homes, and by preliminary molecular typing of isolates. In the absence of occupational/ lifestyle data on patients, the assumption was made that an individual's location and consequent risk is adequately represented by their residential postcode. The problems of this assumption are discussed, with recommendations for future data collection.

The health and nutritional status of multiethnic perimenopausal women

An integrated, dual-phase study design assessed the health and nutritional status and practices of African-American (A-A), Caribbean (A-C), and white non-Hispanic (W-A) women during perimenopause (40–55 years). During Phase I, four focus groups (n = 37) of male and female participants discussed the health and social implications of perimenopause. A conceptual framework for the main study (Phase II) was developed from the focus groups' findings, in concert with the main study's specific aims and objectives. ^ The main study, a cross-sectional survey, quantitatively assessed the health and nutritional status of a convenience sample of 109 women (25 A-A, 31 A-C and 53 W-A), who met specific eligibility criteria. Using seven instruments, sociodemographic, dietary, medical, reproductive health, health practice and anthropometric data were collected. ^ The groups were of comparable age, education, and socioeconomic status (SES). Despite these similarities, statistically significant interethnic nutritional status differences were found. Significantly more total energy and energy from fat were consumed by A-A than W-A and A-C women. Also, significantly more A-A and A-C than W-A women were overweight or obese with android-type weight patterning. ^ Overall, iron and calcium Recommended Dietary Allowances (RDA's) were not met by 35% and 68% of participants, respectively. Iron deficiency anemia was reported by 29% of participants while 33% reported heavier menstrual bleeding. Coupled with suboptimal iron intakes, this is likely to present a serious public health problem. Similarly, increased bone demineralization characteristic of perimenopause, coupled with suboptimal calcium intakes could precipitate another public health problem, osteoporosis. ^ Participants had different expectations about the role of medical care during perimenopause. Significantly more white (57%) than black (38% [A-A and AC]) women sought medical attention for symptoms. Whereas Hormone Replacement Therapy (HRT) was prescribed for 25% of them, only 13% were compliant at enrollment. ^ The trends and statistically significant findings of this study have huge public health policy implications. It is imperative that appropriate policies are formulated to ensure that America's ethnically diverse perimenopausal women have ready access to culturally appropriate care. This would optimize their health outcomes, and enhance their quality of life and productive capacities at this critical juncture of their lives. ^

Dean of the school board: An oral history of the distinguished career of G. Holmes Braddock

Effective school board leadership is often an ephemeral ideal in today's highly politicized public education arena. However, effective leadership is necessary in order to ensure a fair and equitable education for all students. This dissertation described and explained one school board member's perspective of his career as a lens from which to view and assess public educational policy making in Miami-Dade County. ^ Now retired after thirty-eight years of service, G. Holmes Braddock is the longest serving, contemporary, urban school board member in the country. Spanning nearly four decades, his perspective provides a comprehensive view of urban education both locally and nationally. The significance of his longevity and the impact of his leadership on educational policy-making was the focus of indepth interviews with Mr. Braddock and other key educational “influentials.” From this transcript data, recurring themes were revealed and categorized. Five elements of his perspective, i.e., teacher professionalization; desegregation; athletics; bilingual education; and his comprehensive leadership role, were identified and analyzed, as were five variables of his perspective, i.e., fairness; integrity; honesty; courage; and the situational context. Other secondary source material, such as excerpts from newspaper articles, school board minutes, and items from Mr. Braddock's own personal effects further augmented and triangulated the data. ^ Given that the purpose of this study was to describe and explain Mr. Braddock's perspective of his school board career, the findings can be understood from two different viewpoints. The elements of Mr. Braddock's perspective describe or characterize his career and represent the significant policy issues in which he demonstrated exceptional vision and leadership. However, taken alone, these elements cannot fully explain his distinguished career. Rather, an analysis of the variables of Mr. Braddock's perspective provides an explanation for the effectiveness of his leadership role. Personality traits such as fairness, integrity, honesty and courage and the impact of the situational context were factors that strongly influenced Mr. Braddock's decision-making. Thus, Mr. Braddock's school board career can be holistically understood as the intersection of person, place and time with significant public education policy issues. ^ The results of this study provide a unique and historical perspective of school board politics in Miami-Dade County. From Mr. Braddock's perspective, we are able to view one individual's leadership role over time and its impact on local public education policy. ^

Assessing Administrative and Political Factors in Implementing a Living Wage Ordinance

Since 2000, the number of living wage ordinances has steadily increased throughout the country. While most of the current research has focused on the beneficial outcomes of living wages, little has been published on their administrative practices. To address this shortcoming, this study focused on the identification of key administrative and political factors involved impacting the implementation of living wage ordinances in Miami-Dade and Broward Counties. The study utilized a triangulation of interviews, surveys, and direct observation. The author conducted interviews of administrators and members of the living wage oversight boards in both counties and observed the monthly meetings held by each county’s oversight board from January 2006 to June 2007. These findings were buttressed with a national survey of senior staff in other living wage communities. The study utilized descriptive statistics, Chi Square, Cronbach’s Alpha, and Spearman’s Rank Correlation Coefficient (Spearman’s rho). Interviews indicated that administrators in Dade and Broward are seriously under-staffed and budgeted. Ambiguities in the enabling ordinances have lead to loopholes that undermine implementation and accountability for participating contractors. Survey results showed that policy ambiguity, organizational politics, and a lack of organizational capacity were significant negative factors in the implementation process while an organizational culture emphasizing consistent enforcement was a positive factor. Without the proper inputs, an organization hinders itself from meeting its outputs and outcomes. This study finds that Broward and Miami-Dade Counties do not provide the necessary administrative support to implement a living wage effectively – in stark contrast to the high hopes and strong political support behind their passage. For a living wage to succeed, it first needs an organizational culture committed to providing the necessary resources for implementation as well as transparent, consistent accountability mechanisms.

Gestão e gerenciamento de resíduos sólidos: diretrizes jurídico-ambientais para a sustentabilidade

rates in the Brazilian cities, which time there is an inexistent theoretical reflection about public policy statement adding the way of Urban Solid Waste (USW) and tailing integrated management plans in the majorly Brazilian cities. The unappropriated solid waste disposal and final pollution result in a strong socioenvironmental problems and material extravagancies that should be used to recycling and reusing waste material, besides bringing immense challenges for the thematic Strategy Urban and Environmental Management it considers the Sustainable City Model. Moreover, this labor projects a discussion about USW problematic through legally and environmentally point of view, including the public environmental policy and the social technologies as resolution tactics. At that time, it reports rights, scientific articles, documents and Environmental Law Doctrine on findings thematic studies, also the propose displays an interdisciplinary research methodology which combines bibliographic method - focusing theory aspects of the legally environmentally guiding principle, public policy and social technologies. Those are theorist features very important to create a Municipal Integrated Solid Waste Management Plan (PMGIRS) - modus operandi of the Federal Law n. 12.305/2010 (National Solid Waste Policy - PNRS). That policy is interesting to receive financial resources from federal government (Cities Ministry; idem, Federal Decree n. 7.404/2010 and Federal Law n. 10.257/2001) helping the preservation of the environment, regional development, generation of jobs and income (art. 6º), in addition broadening spreading’s private companies dedicated to waste management. Consequently, the PNRS contains a set of guidelines and general procedures; it should be an operation of this legal policy contextualized by Social Technologies theory (TS) into social issues, legal, economic and environmental aspects. Therefore, this research notes the possibility of public policy statement implementation over and done with the PNRS by the terms of development and sustainability in the urban space.

A economia criativa como estratégia de desenvolvimento para a cidade de Natal/RN

Globalization, the enormous speed of information exchange, technology updated in a speed never before and the growth of the cultural industry places us in a new reality in which we must adapt ourselves puting issues concerning to culture and technology at the center of development discussions. The Creative Economy, therefore, is inserted in this dicussion bringing these new elements to the center of the debate. The development potential of this new economy are real in Natal / RN, from, especially their link withim tourism. Thus, the intention of the work is to answer the questions: What is the weight of the creative economy in Natal? What are the issues that accelerate or hinder their development? To answer these questions we mapping the creative sectors on Natal’s economy, stressing labor and income figures, exercise already done by national and international organizations. The issues that connect the Creative Economy to education, R & D, cultural policy and tourism is also discussed. The review of the indicators related to these topics will be used to explain how they are configured as obstacle for the development of the creative economy in Natal/RN.

La profesionalización de la enfermería en Argentina : Disputas políticas e institucionales durante el peronismo

Nuestra investigación pretende visualizar el proceso de profesionalización de las enfermeras durante el peronismo desde dos ámbitos profundamente emparentados con espacios políticos peronistas: la Escuela de Enfermas de la Secretaría de Salud Pública (1947) y la Escuela de Enfermeras "7 de mayo" de la Fundación Eva Perón (1950). Conscientes de que este recorte excluye otras escuelas que funcionaron durante este período, los objetivos de este trabajo justifican el acotamiento dado que el interés está centrado en las disputas institucionales entre entidades embanderadas en las nuevas lógicas políticas peronistas

La profesionalización de la enfermería en Argentina : Disputas políticas e institucionales durante el peronismo

Nuestra investigación pretende visualizar el proceso de profesionalización de las enfermeras durante el peronismo desde dos ámbitos profundamente emparentados con espacios políticos peronistas: la Escuela de Enfermas de la Secretaría de Salud Pública (1947) y la Escuela de Enfermeras "7 de mayo" de la Fundación Eva Perón (1950). Conscientes de que este recorte excluye otras escuelas que funcionaron durante este período, los objetivos de este trabajo justifican el acotamiento dado que el interés está centrado en las disputas institucionales entre entidades embanderadas en las nuevas lógicas políticas peronistas

La profesionalización de la enfermería en Argentina : Disputas políticas e institucionales durante el peronismo

Nuestra investigación pretende visualizar el proceso de profesionalización de las enfermeras durante el peronismo desde dos ámbitos profundamente emparentados con espacios políticos peronistas: la Escuela de Enfermas de la Secretaría de Salud Pública (1947) y la Escuela de Enfermeras "7 de mayo" de la Fundación Eva Perón (1950). Conscientes de que este recorte excluye otras escuelas que funcionaron durante este período, los objetivos de este trabajo justifican el acotamiento dado que el interés está centrado en las disputas institucionales entre entidades embanderadas en las nuevas lógicas políticas peronistas

Between Principle and Practicality: A Dynamic Realist Examination of Independence in the Canadian Justice System

This work examines independence in the Canadian justice system using an approach adapted from new legal realist scholarship called ‘dynamic realism’. This approach proposes that issues in law must be considered in relation to their recursive and simultaneous development with historic, social and political events. Such events describe ‘law in action’ and more holistically demonstrate principles like independence, rule of law and access to justice. My dynamic realist analysis of independence in the justice system employs a range methodological tools and approaches from the social sciences, including: historical and historiographical study; public administrative; policy and institutional analysis; an empirical component; as well as constitutional, statutory interpretation and jurisprudential analysis. In my view, principles like independence represent aspirational ideals in law which can be better understood by examining how they manifest in legal culture and in the legal system. This examination focuses on the principle and practice of independence for both lawyers and judges in the justice system, but highlights the independence of the Bar. It considers the inter-relation between lawyer independence and the ongoing refinement of judicial independence in Canadian law. It also considers both independence of the Bar and the Judiciary in the context of the administration of justice, and practically illustrates the interaction between these principles through a case study of a specific aspect of the court system. This work also focuses on recent developments in the principle of Bar independence and its relation to an emerging school of professionalism scholarship in Canada. The work concludes by describing the principle of independence as both conditional and dynamic, but rooted in a unitary concept for both lawyers and judges. In short, independence can be defined as impartiality, neutrality and autonomy of legal decision-makers in the justice system to apply, protect and improve the law for what has become its primary normative purpose: facilitating access to justice. While both independence of the Bar and the Judiciary are required to support access to independent courts, some recent developments suggest the practical interactions between independence and access need to be the subject of further research, to better account for both the principles and the practicalities of the Canadian justice system.

The evolution of public–private partnership in Ireland: a sustainable pathway?

Ireland is a latecomer to Public Private Partnership (PPP) having only adopted it in 1998. Prior to the credit crisis, Ireland followed the UK model with PPPs being implemented in transport, education, housing/urban regeneration and water/wastewater. Having stalled during the credit crisis, PPP has been reactivated recently with the domestic infrastructure stimulus programme . The focus of this paper is on Ireland as a younger participant in PPP and the nexus between adoption patterns and sustainability characteristics of Irish PPP. Using document analysis and exploratory interviews, the paper examines the reasons for Ireland’s interest in PPP which cannot be attributed to economic rationales alone. We consider three explanations: voluntary adoption – where the UK model was closely followed as part of a domestic modernisation agenda; coercive adoption – where PPP policy was forced upon public sector organisations; and institutional isomorphism – where institutional creation and change around PPP was promoted to help public sector organisations gain institutional legitimacy. We find evidence of all three patterns with coercive adoption becoming more relevant in recent years, which is likely to affect sustainability adversely unless incentives for voluntary adoption are strengthened and institutional capacity building is boosted.

The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews

Background
First generation migrants are reportedly at higher risk of mental ill-health compared to the settled population. This paper systematically reviews and synthesizes all reviews on the mental health of first generation migrants in order to appraise the risk factors for, and explain differences in, the mental health of this population.
Methods
Scientific databases were searched for systematic reviews (inception-November 2015) which provided quantitative data on the mental ill-health of first generation migrants and associated risk factors. Two reviewers screened titles, abstracts and full text papers for their suitability against pre-specified criteria, methodological quality was assessed.
Results
One thousand eight hundred twenty articles were identified, eight met inclusion criteria, which were all moderate or low quality. Depression was mostly higher in first generation migrants in general, and in refugees/asylum seekers when analysed separately. However, for both groups there was wide variation in prevalence rates, from 5 to 44 % compared with prevalence rates of 8–12 % in the general population. Post-Traumatic Stress Disorder prevalence was higher for both first generation migrants in general and for refugees/asylum seekers compared with the settled majority. Post-Traumatic Stress Disorder prevalence in first generation migrants in general and refugees/ asylum seekers ranged from 9 to 36 % compared with reported prevalence rates of 1–2 % in the general population. Few studies presented anxiety prevalence rates in first generation migrants and there was wide variation in those that did. Prevalence ranged from 4 to 40 % compared with reported prevalence of 5 % in the general population. Two reviews assessed the psychotic disorder risk, reporting this was two to three times more likely in adult first generation migrants. However, one review on the risk of schizophrenia in refugees reported similar prevalence rates (2 %) to estimates of prevalence among the settled majority (3 %). Risk factors for mental ill-health included low Gross National Product in the host country, downward social mobility, country of origin, and host country.
Conclusion
First generation migrants may be at increased risk of mental illness and public health policy must account for this and influencing factors. High quality research in the area is urgently needed as is the use of culturally specific validated measurement tools for assessing migrant mental health.

Self-harm, suicide and risk: helping people who self-harm. Final report of a working group.

The focus of this report is to enquire into and report on why people harm and kill themselves and to consider the role (including the limits of the role) that psychiatrists and other mental healthcare professionals play in their care and treatment. The experiences and views of people who harm themselves as well as those of their carers, health professionals and third-sector workers are central to this enquiry. As there is much policy and guidance on self-harm and suicide prevention, the report does not attempt to retrace this same ground but rather examines the evidence of practice on the ground, including the implementation of the National Institute for Health and Clinical Excellence (NICE) guidelines on self-harm (National Collaborating Centre for Mental Health, 2004). This report is the second in the Royal College of Psychiatristsââ,¬â"¢ programme of work on the broad issue of risk. The College report Rethinking Risk to Others was published in July 2008 (Royal College of Psychiatrists, 2008a) and a new Working Group was set up under the chairmanship of John, Lord Alderdice, to examine risk, self-harm and suicide. This clinical issue is an integral part of the role of the psychiatrist in ensuring the good care and treatment of patients. Our central theme is that the needs, care, well-being and individual human dilemma of the person who harms themselves should be at the heart of what we as clinicians do. Public health policy has a vital role to play and psychiatrists must be involved and not leave these crucial political and managerial decisions to those who are not professionally equipped to appreciate the complexities of self-harm and suicide. But we must never forget that we are not just dealing with social phenomena but with people who are often at, and beyond the limit of what they can emotionally endure. Their aggressive acts towards themselves can be difficult to understand and frustrating to address, but this is precisely why psychiatrists need to be involved to bring clarity to the differing causes for the self-destructive ways in which people act and to assist in managing the problems for the people concerned, including family, friends and professional carers, who sometimes find themselves at the end of their tether in the face of such puzzling and destructive behaviour.

Parental alcohol use and resilience in young people: A study of family, peer and school processes

Funded by HSC R&D Division, Public Health Agency Parental alcohol misuse or ‘hidden harm’ presents a very significant challenge to public health policy and practice in the UK and internationally. A parent’s alcohol problems can have a profound impact on their children. Children depend on their family to meet their physical, psychological and social needs, their economic security and well-being, all of which can be jeopardised by parents misusing substances (NACD, 2011). The prevalence of parental alcohol misuse is extremely difficult to estimate, due to the ‘hidden’ nature of the problem within the family unit. Approximately 40,000 children in Northern Ireland are estimated to live with parental alcohol misuse (DHSSPS, 2008). In the UK, 30% of children (3.3 to 3.5 million) under 16 years, live with at least one binge drinking parent and 22% of children (2.6. million) with a hazardous drinker (Manning et al., 2009).