Somatisation in primary care: experiences of primary care physicians involved in a training program and in a randomised controlled trial

Background: A new intervention aimed at managing patients with medically unexplained symptoms (MUS) based on a specific set of communication techniques was developed, and tested in a cluster randomised clinical trial. Due to the modest results obtained and in order to improve our intervention we need to know the GPs' attitudes towards patients with MUS, their experience, expectations and the utility of the communication techniques we proposed and the feasibility of implementing them. Physicians who took part in 2 different training programs and in a randomised controlled trial (RCT) for patients with MUS were questioned to ascertain the reasons for the doctors' participation in the trial and the attitudes, experiences and expectations of GPs about the intervention. Methods: A qualitative study based on four focus groups with GPs who took part in a RCT. A content analysis was carried out. Results: Following the RCT patients are perceived as true suffering persons, and the relationship with them has improved in GPs of both groups. GPs mostly valued the fact that it is highly structured, that it made possible a more comfortable relationship and that it could be applied to a broad spectrum of patients with psychosocial problems. Nevertheless, all participants consider that change in patients is necessary; GPs in the intervention group remarked that that is extremely difficult to achieve. Conclusion: GPs positively evaluate the communication techniques and the interventions that help in understanding patient suffering, and express the enormous difficulties in handling change in patients. These findings provide information on the direction in which efforts for improving intervention should be directed.

Potential Application of Adsorptive Media to Enhance Phosphorus Uptake in Stormwater Basins and Wetlands at Lake Tahoe : literature review. Report to the University of California Davis Tahoe Research Group

Phosphorus removal by wetlands and basins in Lake Tahoe may be improved through designing these systems to filter storm water through media having higher phosphorus removal capabilities than local parent material. Substrates rich in iron, aluminum and calcium oftentimes have enhanced phosphorus removal. These substrates can be naturally occurring, byproducts of industrial or water treatment processes, or engineered. Phosphorus removal fundamentally occurs through chemical adsorption and/or precipitation and much of the phosphorus can be irreversibly bound. In addition to these standard media, other engineered substrates are available to enhance P removal. One such substrate is locally available in Reno and uses lanthanum coated diatomaceous earth for arsenate removal. This material, which has a high positive surface charge, can also irreversibly remove phosphorus. Physical factors also affect P removal. Specifically, specific surface area and particle shape affect filtration capacity, contact area between water and the surface area, and likelihood of clogging and blinding. A number of substrates have been shown to effectively remove P in case studies. Based upon these studies, promising substrates include WTRs, blast furnace slag, steel furnace slag, OPC, calcite, marble Utelite and other LWAs, zeolite and shale. However, other nonperformance factors such as environmental considerations, application logistics, costs, and potential for cementification narrow the list of possible media for application at Tahoe. Industrial byproducts such as slags risk possible leaching of heavy metals and this potential cannot be easily predicted. Fly ash and other fine particle substrates would be more difficult to apply because they would need to be blended, making them less desirable and more costly to apply than larger diameter media. High transportation costs rule out non-local products. Finally, amorphous calcium products will eventually cementify reducing their effectiveness in filtration systems. Based upon these considerations, bauxite, LWAs and expanded shales/clays, iron-rich sands, activated alumina, marble and dolomite, and natural and lanthanum activated diatomaceous earth are the products most likely to be tested for application at Tahoe. These materials are typically iron, calcium or aluminum based; many have a high specific surface area; and all have low transportation costs. (PDF contains 21 pages)

Panama City Fisheries Resources Office: FY 2005 Annual Report

HIGHLIGHTS FOR FY 2005 1. Assisted with a study to assess hurricane impacts to Gulf sturgeon critical foraging habitat. 2. Documented Gulf sturgeon marine movement and habitat use in the Gulf of Mexico. 3. Documented Gulf sturgeon spawning with the collection of fertilized eggs in the Apalachicola River, Florida. 4. Documented Gulf sturgeon spawning with the collection of fertilized eggs in the Yellow River, Florida. 5. Assisted with benthic invertebrate survey at Gulf sturgeon marine foraging grounds. 6. Implemented Gulf Striped Bass Restoration Plan by coordinating the 22nd Annual Morone Workshop, leading the technical committee, transporting broodfish, and coordinating the stocking on the Apalachicola-Chattahoochee-Flint (ACF) river system. 7. Over 87,000 Phase II Gulf striped bass were marked with sequential coded wire tags and stocked in the Apalachicola River. Post-stocking evaluations were conducted at 45 sites in the fall and spring and 8 thermal refuges in the summer. 8. Completed fishery surveys on 4 ponds on Eglin AFB totaling 53 acres, and completed a report with recommendations for future recreational fishery needs. 9. Completed final report for aquatic monitoring at Eglin AFB from 1999 to 2004. 10. Completed a field collection of the endangered Okaloosa darter to be incorporated into a status review to be completed in FY06. 11. Provided technical assistance to the Region 4 National Wildlife Refuge (NWR) program on changes to the fishery conservation targets for the region. Also provided technical assistance to four NWRs (i.e., Okefenokee NWR, Banks Lake NWR, St. Vincent NWR, and St. Marks NWR) relative to hurricanes and recreational fishing. 12. A draft mussel sampling protocol was tested in wadeable streams in Northwest Florida and southwest Georgia, and an associated field guide, poster, and Freshwater Mussel Survey Protocol and Identification workshop were completed in FY05. 13. Implemented recovery plan and candidate conservation actions for 14 listed and candidate freshwater mussels in the Northeast Gulf Watersheds. 14. Initiated or completed multiple stream restoration and watershed management projects. A total of 7.5 stream miles were restored for stream fishes, and 11 miles of coastline were enhanced for sea turtle lighting. A total of 630 acres of wetlands and 2,401 acres of understory habitat were restored. 15. Conducted a watershed assessment to develop a threats analysis for prioritizing restoration, protection, and enhancement to natural resources of Spring Creek, Georgia and Canoe Creek, Florida. 16. Continued the formation of an Unpaved Road Interagency Team of Federal, State, and local agencies in Northwest Florida to promote stream protection and restoration from unpaved road sediment runoff. Began the development of a technical committee agreement. 17. Conducted Alabama Unpaved Road Inventory within the Northeast Gulf Ecosystem. Data collection will be completed during FY06. 18. Finalized the development of two North Florida hydrophysiographic regional curves for use by the Florida Department of Transportation (DOT) and others involved with stream restoration and protection. Initiated the development of the Alabama Coastal Plain Riparian Reference Reach and Regional Curves for use by the Alabama Department of Environmental Management (ADEM). 19. Provided technical assistance in collecting data, analysis, and thesis formulation with Troy University, Alabama, to identify the influence of large woody debris in southeastern coastal plain streams. 20. Completed pre- and post-restoration fish community monitoring at several restoration projects including Big Escambia Creek, Magnolia Creek, and Oyster Lake, Florida. 21. Established a watershed partnership for the Chipola River in Alabama and Florida and expanded development and participation in the Spring Creek Watershed Partnership, Georgia. 22. Continued to identify barriers which inhibit the movement of aquatic species within the Northeast Gulf Ecoregion. 23. Completed a report on road crossing structures in Okaloosa darter streams to guide the closure/repair/maintenance of roads to contribute to recovery of the endangered species. In cooperation with Three Rivers RC&D Council, fish passage sites identified in the report were prioritized for restoration. 24. Monitored Aquatic Nuisance Species in the Apalachicola River and tested the sterility of exotic grass carp. 25. Multiple outreach projects were completed to detail aquatic resources conservation needs and opportunities. Participated in National Fishing Week event, several festivals, and school outreach.

Effects of 12 weeks muscle hipetrophy training program in a young male athlete: stydy case

PURPOSE: The main goals of the present study were: 1) to review some recommendations about how to increase lean body mass; 2) to analyse whether following scientific sources of current recommendations, visible changes can be shown or not in a participant (body composition, strength and blood analyses). METHODS: One male athlete completed 12 weeks of resistance training program and following a diet protocol. Some test were determined such as, strength 6RM, blood analyses, skindfold measurements, body perimeters and impedance test. Body composition measurements were taken 3 times during the program (before-T1, after 6 weeks of intervention period-T2 and at the end of the program-T3). On the other hand, strength tests and blood analyses were performed twice (before and after the program). RESULTS: Strength was increased in general; blood analyses showed that Creatine kinase was increased a 104% and Triglycerides level was decreased a 22.5%; in the impedance test, body mass (1.6%), lean body mass (3.5%) and Body mass index (1.7%) were increased, whereas fat mass was decreased (15.5%); relaxed and contracted biceps perimeters were also increased. CONCLUSION: A muscle hypertrophy training program mixed with an appropriate diet during 12 weeks leads to interesting adaptations related to increase in body weight, lean body mass, biceps perimeters, strength and creatine kinase levels, and a decrease in fat mass.

Preparing for and adapting to climate change impacts: Next steps for the Washington state department of National Resources Aquatic Resources Program

In response to a growing body of research on projected climate change impacts to Washington State’s coastal areas, the Washington State Department of Natural Resources’ (DNR) Aquatic Resources Program (the Program) initiated a climate change preparedness effort in 2009 via the development of a Climate Change Adaptation Strategy (the Strategy)i. The Strategy answers the question “What are the next steps that the Program can take to begin preparing for and adapting to climate change impacts in Washington’s coastal areas?” by considering how projected climate change impacts may effect: (1) Washington’s state-owned aquatic landsii, (2) the Program’s management activities, and (3) DNR’s statutorily established guidelines for managing Washington’s state-owned aquatic lands for the benefit of the public. The Program manages Washington’s state-owned aquatic lands according to the guidelines set forth in Revised Code of Washington 79-105-030, which stipulates that DNR must manage state-owned aquatic lands in a manner which provides a balance of the following public benefits: (1) Encouraging direct public uses and access; (2) Fostering water-dependent uses; (3) Ensuring environmental protection; (4) Utilizing renewable resources. (RCW 79-105-030) The law also stipulates that generating revenue in a manner consistent with these four benefits is a public benefit (RCW 79-105-030). Many of the next steps identified in the Strategy build off of recommendations provided by earlier climate change preparation and adaptation efforts in Washington State, most notably those provided by the Preparation and Adaptation Working Group, which were convened by Washington State Executive Order 70-02 in 2007, and those made in the Washington Climate Change Impacts Assessment (Climate Impacts Group, 2009). (PDF contains 4 pages)

Applying Habermas's critical theory to public administration and policy: A case study of Florida Everglades restoration program

The foundation of Habermas's argument, a leading critical theorist, lies in the unequal distribution of wealth across society. He states that in an advanced capitalist society, the possibility of a crisis has shifted from the economic and political spheres to the legitimation system. Legitimation crises increase the more government intervenes into the economy (market) and the "simultaneous political enfranchisement of almost the entire adult population" (Holub, 1991, p. 88). The reason for this increase is because policymakers in advanced capitalist democracies are caught between conflicting imperatives: they are expected to serve the interests of their nation as a whole, but they must prop up an economic system that benefits the wealthy at the expense of most workers and the environment. Habermas argues that the driving force in history is an expectation, built into the nature of language, that norms, laws, and institutions will serve the interests of the entire population and not just those of a special group. In his view, policy makers in capitalist societies are having to fend off this expectation by simultaneously correcting some of the inequities of the market, denying that they have control over people's economic circumstances, and defending the market as an equitable allocator of income. (deHaven-Smith, 1988, p. 14). Critical theory suggests that this contradiction will be reflected in Everglades policy by communicative narratives that suppress and conceal tensions between environmental and economic priorities. Habermas’ Legitimation Crisis states that political actors use various symbols, ideologies, narratives, and language to engage the public and avoid a legitimation crisis. These influences not only manipulate the general population into desiring what has been manufactured for them, but also leave them feeling unfulfilled and alienated. Also known as false reconciliation, the public's view of society as rational, and "conductive to human freedom and happiness" is altered to become deeply irrational and an obstacle to the desired freedom and happiness (Finlayson, 2005, p. 5). These obstacles and irrationalities give rise to potential crises in the society. Government's increasing involvement in Everglades under advanced capitalism leads to Habermas's four crises: economic/environmental, rationality, legitimation, and motivation. These crises are occurring simultaneously, work in conjunction with each other, and arise when a principle of organization is challenged by increased production needs (deHaven-Smith, 1988). Habermas states that governments use narratives in an attempt to rationalize, legitimize, obscure, and conceal its actions under advanced capitalism. Although there have been many narratives told throughout the history of the Everglades (such as the Everglades was a wilderness that was valued as a wasteland in its natural state), the most recent narrative, “Everglades Restoration”, is the focus of this paper.(PDF contains 4 pages)

Wetlands and coastal water quality: Should wetland size matter?

Generally, wetlands are thought to perform water purification functions, removing contaminants as water flows through sediment and vegetation. This paradigm was challenged when Grant et al. (2001) reported that Talbert Salt Marsh (Figure 1.) increased fecal indicator bacteria (FIB) output to coastal waters, contributing to poor coastal water quality. Like most southern California wetlands, Talbert Salt Marsh has been severely degraded. It is a small (10 ha), restored wetland, only 1/100th its original size, and located at the base of a highly urbanized watershed. Is it reasonable to expect that this or any severely altered wetland will perform the same water purification benefits as a natural wetland? To determine how a more pristine southern California coastal wetland attenuated bacterial contaminants, we investigated FIB concentrations entering and exiting Carpinteria Salt Marsh (Figure 2.), a 93 ha, moderate-sized, relatively natural wetland.(PDF contains 4 pages)

The development of the South Carolina Coastal Information Network and portal site: Bringing training opportunities and educational resources to coastal community officials and the public

The South Carolina Coastal Information Network (SCCIN) emerged as a result of a number of coastal outreach institutions working in partnership to enhance coordination of the coastal community outreach efforts in South Carolina. This organized effort, led by the S.C. Sea Grant Consortium and its Extension Program, includes partners from federal and state agencies, regional government agencies, and private organizations seeking to coordinate and/or jointly deliver outreach programs that target coastal community constituents. The Network was officially formed in 2006 with the original intention of fostering intra-and inter- agency communication, coordination, and cooperation. Network partners include the S.C. Sea Grant Consortium, S.C. Department of Health and Environmental Control – Office of Ocean and Coastal Resource Management and Bureau of Water, S.C. Department of Natural Resources – ACE Basin National Estuarine Research Reserve, North Inlet-Winyah Bay National Estuarine Research Reserve, Clemson University Cooperative Extension Service and Carolina Clear, Berkeley-Charleston-Dorchester Council of Governments, Waccamaw Regional Council of Governments, Urban Land Institute of South Carolina, S.C. Department of Archives and History, the National Oceanic and Atmospheric Administration – Coastal Services Center and Hollings Marine Laboratory, Michaux Conservancy, Ashley-Cooper Stormwater Education Consortium, the Coastal Waccamaw Stormwater Education Consortium, the S.C. Chapter of the U.S. Green Building Council, and the Lowcountry Council of Governments. (PDF contains 3 pages)

To pave or not to pave: A social landscape analysis of land use decision-making in the towns of the lamprey watershed

Population pressure in coastal New Hampshire challenges land use decision-making and threatens the ecological health and functioning of Great Bay, an estuary designated as both a NOAA National Estuarine Research Reserve and an EPA National Estuary Program site. Regional population in the seacoast has quadrupled in four decades resulting in sprawl, increased impervious surface cover and larger lot rural development (Zankel, et.al., 2006). All of Great Bay’s contributing watersheds face these challenges, resulting in calls for strategies addressing growth, development and land use planning. The communities within the Lamprey River watershed comprise this case study. Do these towns communicate upstream and downstream when making land use decisions? Are cumulative effects considered while debating development? Do town land use groups consider the Bay or the coasts in their decision-making? This presentation, a follow-up from the TCS 2008 conference and a completed dissertation, will discuss a novel social science approach to analyze and understand the social landscape of land use decision-making in the towns of the Lamprey River watershed. The methods include semi-structured interviews with GIS based maps in a grounded theory analytical strategy. The discussion will include key findings, opportunities and challenges in moving towards a watershed approach for land use planning. This presentation reviews the results of the case study and developed methodology, which can be used in watersheds elsewhere to map out the potential for moving towns towards EBM and watershed-scaled, land use planning. (PDF contains 4 pages)

A short training program improves the accuracy of portion-size estimates in future dietitians

[EN] The objective of this study was to determine whether a short training program, using real foods, would decreased their portion-size estimation errors after training. 90 student volunteers (20.18±0.44 y old) of the University of the Basque Country (Spain) were trained in observational techniques and tested in food-weight estimation during and after a 3-hour training period. The program included 57 commonly consumed foods that represent a variety of forms (125 different shapes). Estimates of food weight were compared with actual weights. Effectiveness of training was determined by examining change in the absolute percentage error for all observers and over all foods over time. Data were analyzed using SPSS vs. 13.0. The portion-size errors decreased after training for most of the foods. Additionally, the accuracy of their estimates clearly varies by food group and forms. Amorphous was the food type estimated least accurately both before and after training. Our findings suggest that future dietitians can be trained to estimate quantities by direct observation across a wide range of foods. However this training may have been too brief for participants to fully assimilate the application.

The federal photovoltaics commercialization program

The dissertation presents a political and economic history of the federal government's program to commercialize photovoltaic energy for terrestrial use. Chapter 1 is a detailed history of the program. Chapter 2 is a brief review of the Congressional roll call voting literature. Chapter 3 develops PV benefit measures at the state and Congressional district level necessary for an econometric analysis of PV roll call voting. Chapter 4 presents the econometric analysis.

Because PV power was considerably more expensive than conventional power, the program was designed to make PV a significant power source in the long term, emphasizing research and development, although sizeable amounts have been spent for procurement (direct government purchases and indirectly through tax credits). The decentralized R and D program pursued alternative approaches in parallel, with subsequent funding dependent on earlier progress. Funding rose rapidly in the 1970s before shrinking in the 1980s. Tax credits were introduced in 1978, with the last of the credits due to expire this year.

Major issues in the program have been the appropriate magnitude of demonstrations and government procurement, whether decentralized, residential use or centralized utility generation would first be economic, the role of storage in PV, and the role of PV in a utility's generation mix.

Roll call voting on solar energy (all votes analyzed occurred from 1975-1980) was influenced in a cross-sectional sense by all the influences predicted: party and ideology, local economic benefits of the technology, local PV federal spending and manufacturing, and appropriations committee membership. The cross-sectional results for ideology are consistent with the strongly ideological character of solar energy politics and the timing of funding increases and decreases discussed in Chapter 1. Local PV spending and manufacturing was less significant than ideology or the economic benefits of the technology. Because time series analysis of the votes was not possible, it is not possible to test the role of economic benefits to the nation as a whole.

Probability in Quantum Mechanics: The Everett Interpretation and the Decision-Theoretic Program

The Everett interpretation of quantum mechanics is an increasingly popular alternative to the traditional Copenhagen interpretation, but there are a few major issues that prevent the widespread adoption. One of these issues is the origin of probabilities in the Everett interpretation, which this thesis will attempt to survey. The most successful resolution of the probability problem thus far is the decision-theoretic program, which attempts to frame probabilities as outcomes of rational decision making. This marks a departure from orthodox interpretations of probabilities in the physical sciences, where probabilities are thought to be objective, stemming from symmetry considerations. This thesis will attempt to offer evaluations on the decision-theoretic program.