A cross-national cross-sectional survey of the attitudes and perceived competence of final-year medicine, nursing and pharmacy students in relation to end-of-life care in dementia

Background:Little is known about the attitudes of healthcare professional students' perceived competence and confidence in treating those with dementia who are at the end of life.Aim:To explore the attitudes of final year medical, nursing and pharmacy students towards people with dementia and to evaluate their perceived competence and confidence dealing with biomedical and psychosocial issues within the context of palliative care provision to patients with dementia.Design:Cross-sectional survey using a questionnaire.Setting/participants:Final-year students in each profession from Queen's University Belfast (Northern Ireland) and the University of Iowa (USA) were recruited.Method:Three versions of an online questionnaire (containing the Attitudes to Dementia Questionnaire and a series of questions on end-of-life care in dementia) were distributed.Results:A total of 368 responses were received (response rate 42.3%). All respondents reported positive attitudes towards people with dementia. US nursing students reported significantly more positive attitudes than the medical students of United States and Northern Ireland. Medical students were more likely to report low confidence in discussing non-medical aspects of dying, whereas nursing students were most likely to feel prepared and confident to do this. Medical and nursing students reported low confidence with aspects of medication-related care; however, data from the pharmacy samples of Northern Ireland and United States suggested that these students felt confident in advising other healthcare professionals on medication-related issues.Conclusions:While healthcare students hold positive attitudes towards people with dementia, some clinical tasks remain challenging and further basic training may be of benefit.

The Role and Effectiveness of Public – Private Partnerships (NHS LIFT) in the Development of Enhanced Primary Care Premises and Services:Report for the National Institute for Health Research Service Delivery and Organisation programme

The research project analysed the role and effectiveness of LIFT via a multi-method study which included semi-structured interviews with policy elites and users, as well as case studies and an exploratory analysis of the financial characteristics of three LIFT Companies. While the team felt that it was able to identify key aspects relating to the advantages and drawbacks surrounding LIFT, some aspects relating to the representativeness of the study was adversely affected by a reluctance of PCTs to participate in the case study analysis and commercial confidentiality restrictions. The study was nonetheless able to identify important issues in relation to the funding and procurement of primary care premises and services.

Narrow-band variable center frequency single-loop and multistage sigma-delta modulators for bandpass signals

Oversampled narrow-band single-loop and multistage resonator-based bandpass sigma-delta (Σ-Δ) modulators that can accommodate different passband center to sampling frequency ratios are reported. These tunable bandpass configurations are designed by analytically determining and subsequently verifying through detailed empirical simulations the required compensation hardware to deliver enhanced noise-shaping. It is demonstrated that comparatively superior in-band signal-to-noise ratios and dynamic ranges are attributed to the inclusion of appropriate digital feedforward and feedback compensators within these structures.

U.W. Percussion and Steel Drum Ensembles, June 2, 2005

Concert Program for U.W. Percussion and Steel Drum Ensembles

Conception and first results of a cross-sectional national study on the demography, disease characteristics and socioeconomics status of the Portuguese patients with multiple sclerosis : the PORT-MS study

RESUMO: Introdução e objetivos: Não existia um estudo multicêntrico que descrevesse as características dos doentes com EM, da doença em si, ou do seu tratamento, em Portugal.Métodos: Doentes McDonald 2010 positivos foram sequencialmente recrutados em 7 centros entre Maio e Novembro 2014. Aplicou-se um Caderno de Recolha de Dados incidindo na demografia, doença, educação e emprego (estudo PORT-MS). Resultados: 561 doentes incluídos. Primeiros sintomas aos 30,2±10,5 anos (RRMS 29,2±10, PPMS 39,4±11,7, p<0,001); diagnóstico 3,2±5,3 anos depois (RRMS 3,0±5,1, PPMS 4,9±2,5, p=0,002); tempo de doença após diagnóstico 9,4±7,2 anos (semelhante RRMS no diagnóstico e PPMS); idade atual 42,9±12,4 anos (grupo RRMS no diagnóstico 42,0±12,1, PPMS 52,5±11,3, p<0,001); EDSS atual 2,5 (RRMS 2.0, PPMS 6.0); proporção feminino:masculino é 2,5:1 (RRMS semelhante, PPMS 1,1:1, p<0,05); no diagnóstico RRMS 90,6%, SPMS 0,9%, PPMS 8,6%; 9,5% dos RRMS encontravam-se em SP na inclusão (nomeadamente os com mais idade no diagnóstico e/ou atualidade ou tempo de doença mais prolongado). PPMS mais frequente em doentes diagnosticados mais tardiamente (p<0,001), onde aumenta também ligeiramente a proporção de mulheres na PPMS. Nas últimas décadas: novos casos mostram estabilidade na proporção de géneros e tipos de doença; idade nos primeiros sintomas e no diagnóstico aumentou ligeiramente, tempo entre eles diminuiu ligeiramente. Proporção sob DMT (Maio 2014): global 84,5%; atualmente RRMS 90,4%; SPMS 70,8%; PPMS 36,8%; progressivas agregadas 48%. Tipo de DMT, amostra global: interferões 56,5%, GA 18,4%, Natalizumab 11,6%, Fingolimod 9,7%. Global: economicamente ativos 61,5%, desemprego 13,5%, 74,1% dos não activos estão reformados por doença. Gravidezes após diagnóstico em 15% mulheres. Casos com história familiar positiva 7,8%. Discussão e conclusões: Incluída cerca de 10% da população portuguesa. Resultados congruentes com dados internacionais. Elevada proporção sob DMT, mesmo EDSS alto e formas progressivas. Terapêuticas de segunda linha sub representadas. Doentes jovens e com doença ligeira com vida económica ativa; restantes essencialmente reformados por doença.---------------- ABSTRACT : Background/aims: In Portugal, there wasn’t a multicentric study on the general characteristics (demography, disease milestones, DMT, socioeconomic status) of Multiple Sclerosis patients. Methods: Patients fulfilling McDonald 2010 criteria were sequentially recruited from May to November 2014 in 7 centers and data was systematically collected. Results: 561 patients included. First symptoms occurred at 30,2±10,5 years-old (RRMS 29,2±10, PPMS 39,4±11,7, p<0,001); diagnosis 3,2±5,3 years later (RRMS 3,0±5,1, PPMS 4,9±2,5, p=0,002); 9,4±7,2 years elapsed since diagnosis (similar for those is RRMS at diagnosis and PPMS); current age 42,9±12,4 years-old (group RRMS at diagnosis 42,0±12,1, PPMS 52,5±11,3, p<0,001); current EDSS 2,5 (RRMS 2.0, PPMS 6.0); females to males 2,5:1 (RRMS similar, PPMS 1,1:1, p<0,05); at diagnosis RRMS 90,6%, SPMS 0,9%, PPMS 8,6%; 9,5% of RRMS reached SP at inclusion (those older at diagnosis, in actuality, or with longer follow-up). PPMS more frequente in patients diagnosed at older ages (p<0,001), also slight increase in females. Along the last decades: new cases have showed stable proportions of gender and disease types; age at first symptoms and diagnosis slightly increased, time between them slightly decreased. Proportion on DMT (May 2014): 84,5% of all; 90,4% of currently in RRMS; 70,8% of SPMS; 36,8% of PPMS; 48% of progressive forms together. Type of DMT, all patients: interferons 56,5%, Glatiramer Acetate 18,4%, Natalizumab 11,6%, Fingolimod 9,7%. Economically active 61,5% of all, unemployment 13,5%, 74,1% of non-active are retired due to disease. Females pregnant after diagnosis 15%. Positive family cases in 7,8%. Discussion/Conclusions: 10% of the national MS population collected. Data generally consistente with international reports. Proportion under DMT relatively high in all disease types, but second line therapies underrepresented. Young patients with mild disease have an active economic life. Those not active are essentially retired due to disease.

Finnish Maritime Personnel's Conceptions on Safety Management and Safety Culture

The purpose of this thesis is to explore Finnish maritime personnel’s conceptions of safety management and its relationship with the concept of safety culture. In addition, the aim is to evaluate the impact of the ISM Code on the prevailing safety culture in the Finnish shipping business. A total of 94 interviewees and seven Finnish shipping companies were involved in this study. Thematic interviews were applied as the main research method for the study. The results were analysed qualitatively. The results indicate that maritime safety culture can simultaneously demonstrate features of integration, differentiation and ambiguity. Basically, maritime personnel have a positive attitude towards safety management systems since they consider safety management beneficial and essential in general. However, the study also found considerable criticism among the interviewees. The interviewed maritime personnel did not criticise the ISM Code as such, yet they criticised the way the ISM Code has been applied in practise. In order to understand the multiple perspectives of safety culture more comprehensively, multiple theoretical perspectives and methodological approaches are needed. This study indicates that safety culture and the impacts of the ISM Code should not be unambiguously studied solely quantitative methods or qualitative methods. By examining safety culture from several methodological and theoretical perspectives, one may gain a more versatile and holistic overview of safety culture.

Economic Impact of Identity Theft in India: Lessons from Western Countries

In this computerized, globalised and internet world our computer collects various types of information’s about every human being and stores them in files secreted deep on its hard drive. Files like cache, browser history and other temporary Internet files can be used to store sensitive information like logins and passwords, names addresses, and even credit card numbers. Now, a hacker can get at this information by wrong means and share with someone else or can install some nasty software on your computer that will extract your sensitive and secret information. Identity Theft posses a very serious problem to everyone today. If you have a driver’s license, a bank account, a computer, ration card number, PAN card number, ATM card or simply a social security number you are more than at risk, you are a target. Whether you are new to the idea of ID Theft, or you have some unanswered questions, we’ve compiled a quick refresher list below that should bring you up to speed. Identity theft is a term used to refer to fraud that involves pretending to be someone else in order to steal money or get other benefits. Identity theft is a serious crime, which is increasing at tremendous rate all over the world after the Internet evolution. There is widespread agreement that identity theft causes financial damage to consumers, lending institutions, retail establishments, and the economy as a whole. Surprisingly, there is little good public information available about the scope of the crime and the actual damages it inflicts. Accounts of identity theft in recent mass media and in film or literature have centered on the exploits of 'hackers' - variously lauded or reviled - who are depicted as cleverly subverting corporate firewalls or other data protection defenses to gain unauthorized access to credit card details, personnel records and other information. Reality is more complicated, with electronic identity fraud taking a range of forms. The impact of those forms is not necessarily quantifiable as a financial loss; it can involve intangible damage to reputation, time spent dealing with disinformation and exclusion from particular services because a stolen name has been used improperly. Overall we can consider electronic networks as an enabler for identity theft, with the thief for example gaining information online for action offline and the basis for theft or other injury online. As Fisher pointed out "These new forms of hightech identity and securities fraud pose serious risks to investors and brokerage firms across the globe," I am a victim of identity theft. Being a victim of identity theft I felt the need for creating an awareness among the computer and internet users particularly youngsters in India. Nearly 70 per cent of Indian‘s population are living in villages. Government of India already started providing computer and internet facilities even to the remote villages through various rural development and rural upliftment programmes. Highly educated people, established companies, world famous financial institutions are becoming victim of identity theft. The question here is how vulnerable the illiterate and innocent rural people are if they suddenly exposed to a new device through which some one can extract and exploit their personal data without their knowledge? In this research work an attempt has been made to bring out the real problems associated with Identity theft in developed countries from an economist point of view.

National and sub-national assessments of soil organic carbon stocks and changes: The GEFSOC modelling system

Soil organic carbon (SOC) plays a vital role in ecosystem function, determining soil fertility, water holding capacity and susceptibility to land degradation. In addition, SOC is related to atmospheric CO, levels with soils having the potential for C release or sequestration, depending on land use, land management and climate. The United Nations Convention on Climate Change and its Kyoto Protocol, and other United Nations Conventions to Combat Desertification and on Biodiversity all recognize the importance of SOC and point to the need for quantification of SOC stocks and changes. An understanding of SOC stocks and changes at the national and regional scale is necessary to further our understanding of the global C cycle, to assess the responses of terrestrial ecosystems to climate change and to aid policy makers in making land use/management decisions. Several studies have considered SOC stocks at the plot scale, but these are site specific and of limited value in making inferences about larger areas. Some studies have used empirical methods to estimate SOC stocks and changes at the regional scale, but such studies are limited in their ability to project future changes, and most have been carried out using temperate data sets. The computational method outlined by the Intergovernmental Panel on Climate Change (IPCC) has been used to estimate SOC stock changes at the regional scale in several studies, including a recent study considering five contrasting eco regions. This 'one step' approach fails to account for the dynamic manner in which SOC changes are likely to occur following changes in land use and land management. A dynamic modelling approach allows estimates to be made in a manner that accounts for the underlying processes leading to SOC change. Ecosystem models, designed for site scale applications can be linked to spatial databases, giving spatially explicit results that allow geographic areas of change in SOC stocks to be identified. Some studies have used variations on this approach to estimate SOC stock changes at the sub-national and national scale for areas of the USA and Europe and at the watershed scale for areas of Mexico and Cuba. However, a need remained for a national and regional scale, spatially explicit system that is generically applicable and can be applied to as wide a range of soil types, climates and land uses as possible. The Global Environment Facility Soil Organic Carbon (GEFSOC) Modelling System was developed in response to this need. The GEFSOC system allows estimates of SOC stocks and changes to be made for diverse conditions, providing essential information for countries wishing to take part in an emerging C market, and bringing us closer to an understanding of the future role of soils in the global C cycle. (C) 2007 Elsevier B.V. All rights reserved.