A comprehensive review of the environmental impacts and human health risks associated with the occurrence of waste pharmaceuticals in water sources of the United States, and policy implications

The occurrence of waste pharmaceuticals has been identified and well documented in water sources throughout North America and Europe. Many studies have been conducted which identify the occurrence of various pharmaceutical compounds in these waters. This project is an extensive review of the documented evidence of this occurrence published in the scientific literature. This review was performed to determine if this occurrence has a significant impact on the environment and public health. This project and review found that pharmaceuticals such as sex hormone drugs, antibiotic drugs and antineoplastic/cytostatic agents as well as their metabolites have been found to occur in water sources throughout the United States at levels high enough to have noticeable impacts on human health and the environment. It was determined that the primary sources of this occurrence of pharmaceuticals were waste water effluent and solid wastes from sewage treatment plants, pharmaceutical manufacturing plants, healthcare and biomedical research facilities, as well as runoff from veterinary medicine applications (including aquaculture). ^ In addition, current public policies of US governmental agencies such as the Environmental Protection Agency (EPA), Food and Drug Administration (FDA), and Drug Enforcement Agency (DEA) have been evaluated to see if they are doing a sufficient job at controlling this issue. Specific recommendations for developing these EPA, FDA, and DEA policies have been made to mitigate, prevent, or eliminate this issue.^ Other possible interventions such as implementing engineering controls were also evaluated in order to mitigate, prevent and eliminate this issue. These engineering controls include implementing improved current treatment technologies such as the advancement and improvement of waste water treatment processes utilized by conventional sewage treatment and pharmaceutical manufacturing plants. In addition, administrative controls such as the use of “green chemistry” in drug synthesis and design were also explored and evaluated as possible alternatives to mitigate, prevent, or eliminate this issue. Specific recommendations for incorporating these engineering and administrative controls into the applicable EPA, FDA, and DEA policies have also been made.^

Chapter 4 A Review of the Availability of and Studies on Spatial Economic Data in Laos

Spatial data are being increasingly used in a wide range of disciplines, a fact that is clearly reflected in the recent trend to add spatial dimensions to the conventional social sciences. Economics is by no means an exception. On one hand, spatial data are indispensable to many branches of economics such as economic geography, new economic geography, or spatial economics. On the other hand, macroeconomic data are becoming available at more and more micro levels, so that academics and analysts take it for granted that they are available not only for an entire country, but also for more detailed levels (e.g. state, province, and even city). The term ‘spatial economics data’ as used in this report refers to any economic data that has spatial information attached. This spatial information can be the coordinates of a location at best or a less precise place name as is used to describe administrative units. Obviously, the latter cannot be used without a map of corresponding administrative units. Maps are therefore indispensible to the analysis of spatial economic data without absolute coordinates. The aim of this report is to review the availability of spatial economic data that pertains specifically to Laos and academic studies conducted on such data up to the present. In regards to the availability of spatial economic data, efforts have been made to identify not only data that has been made available as geographic information systems (GIS) data, but also those with sufficient place labels attached. The rest of the report is organized as follows. Section 2 reviews the maps available for Laos, both in hard copy and editable electronic formats. Section 3 summarizes the spatial economic data available for Laos at the present time, and Section 4 reviews and categorizes the many economic studies utilizing these spatial data. Section 5 give examples of some of the spatial industrial data collected for this research. Section 6 provides a summary of the findings and gives some indication of the direction of the final report due for completion in fiscal 2010.

The Review of the Europe 2020 Strategy: From austerity to prosperity? CEPS Policy Brief No. 322, 28 October 2014

The future of Europe 2020 lies in its ability to become the protagonist of a new season in EU policy, in which countries can apply for more flexibility only if they can prove both structural reform and good governance, argues the author. By establishing a ‘new deal’ among member states, an improved Europe 2020 strategy can help Europe to complete its transition from austerity to prosperity. This Policy Brief makes the case for approaching the mid-term review of Europe 2020 on three different levels: i) the revision and update of the content of the Europe 2020 strategy, including its objectives, targets and major flagship initiatives; ii) the reform of the governance of the strategy; and iii) the repositioning of the strategy at the core of EU policy. The content of the strategy should be revised to include initiatives on infrastructure, the internal market and administrative capacity at all levels of government. The author sets out a number of policy recommendations for the European Commission and the member states to help realise these objectives.

Executive branch review of environmental regulations [microform] : hearings before the Subcommittee on Environmental Pollution of the Committee on Environment and Public Works, United States Senate, Ninety-sixth Congress, first session, February 26 and 27, 1979.

Reuse of record except for individual research requires license from Congressional Information Service, Inc.

The statute law of Kentucky; with notes, prælections, and observations on the public acts. Comprehending also, the laws of Virginia and acts of Parliament in force in this commonwealth; the charter of Virginia, the federal and state constitutions, and so much of the King of England's proclamation in 1763, as relates to the titles to land in Kentucky. Together with a table of reference to the cases adjudicated in the Court of appeals ...

Imprint varies: v. 2-3, Frankfort, (Ken.) Printed for William Hunter, by Johnston & Pleasants. 1810-1811.--v. 4, Frankfort, (Ken.) Printed for William Hunter, by Robert Johnston. 1814.--v. 5, Frankfort, (Ken.) Printed for Butler & Wood. 1819.

Acts of French royal administration concerning Canada, Guiana, the West Indies and Louisiana prior to 1791 /

"Collections of administrative acts referred to": p. 7-11.

Report of review of court decisions.

Mode of access: Internet.

Review, of the report of the case of the Commonwealth versus David Lee Child, for publishing in the Massachusetts Journal a libel on the honorable John Keyes.

At head of title: (From the Concord (Middlesex) Gazette.).

Public report of review of NAO submission #9702.

"August 11, 1998."

State nondiscrimination enforcement efforts in Nebraska : a review of implementation of Public Law 97-35 obligations in Health and Human Services Programs /

Includes bibliographical references.

A systematic review of successes and failures in home telehealth: preliminary results

We conducted a systematic review of the literature to identify studies in home telehealth that compared a home telehealth intervention with a non-telehealth standard/usual care alternative in terms of administrative changes, patient management decisions, patient outcomes, caregiver outcomes, economic impact or social impact on patients. A search of various databases produced 6643 references. Of these 769 papers were selected for more detailed investigation. These papers, combined with hand searching of relevant telehealth journals and cross-referencing of citations in identified publications, resulted in 138 papers referring to 130 projects for review. In this preliminary analysis we used a quality appraisal approach that took into account the study design. An additional analysis of patient numbers was then used to calculate a net evidence score. A large proportion of studies (80%) were randomised controlled trials. Only 22 projects (17%) reported economic data deemed to be sufficient for appraisal. Evidence exists for the clinical effectiveness of home telehealth in diabetes, the general area of mental health, high risk pregnancy monitoring, heart failure and cardiac disease.

A review of the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries

Background: Currently, no review has been completed regarding the information-gathering process for the provision of medicines for self-medication in community pharmacies in developing countries. Objective: To review the rate of information gathering and the types of information gathered when patients present for self-medication requests. Methods: Six databases were searched for studies that described the rate of information gathering and/or the types of information gathered in the provision of medicines for self-medication in community pharmacies in developing countries. The types of information reported were classified as: signs and symptoms, patient identity, action taken, medications, medical history, and others. Results: Twenty-two studies met the inclusion criteria. Variations in the study populations, types of scenarios, research methods, and data reporting were observed. The reported rate of information gathering varied from 18% to 97%, depending on the research methods used. Information on signs and symptoms and patient identity was more frequently reported to be gathered compared with information on action taken, medications, and medical history. Conclusion: Evidence showed that the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries is inconsistent. There is a need to determine the barriers to appropriate information-gathering practice as well as to develop strategies to implement effective information-gathering processes. It is also recommended that international and national pharmacy organizations, including pharmacy academics and pharmacy researchers, develop a consensus on the types of information that should be reported in the original studies. This will facilitate comparison across studies so that areas that need improvement can be identified. © 2013 Elsevier Inc.

Measuring employee innovation:a review of existing scales and the development of the innovative behavior and innovation support inventories across cultures

Purpose - The paper develops a model of employee innovative behavior conceptualizing it as distinct from innovation outputs and as a multi-faceted behavior rather than a simple count of ‘innovative acts’ by employees. It understands individual employee innovative behaviors as a micro-foundation of firm intrapreneurship that is embedded in and influenced by contextual factors such as managerial, organizational and cultural support for innovation. Building from a review of existing employee innovative behavior scales and theoretical considerations we develop and validate the Innovative Behavior Inventory (IBI) and the Innovation Support Inventory (ISI). Design/methodology/approach – Two pilot studies, a third validation study in the Czech Republic and a fourth cross-cultural validation study using population representative samples from Switzerland, Germany, Italy and the Czech Republic (N=2812 employees and 450 entrepreneurs) were conducted. Findings - Both inventories were reliable and showed factorial, criterion, convergent and discriminant validity as well as cross-cultural equivalence. Employee innovative behavior was supported as comprising of idea generation, idea search, idea communication, implementation starting activities, involving others and overcoming obstacles. Managerial support was the most proximal contextual influence on innovative behavior and mediated the effect of organizational support and national culture. Originality/value - The paper advances our understanding of employee innovative behavior as a multi-faceted phenomenon and the contextual factors influencing it. Where past research typically focuses on convenience samples within a particular country, we offer first robust evidence that our model of employee innovative behavior generalizes across cultures and types of samples. Our model and the IBI and ISI inventories enable researchers to build a deeper understanding of the important micro-foundation underpinning intrapreneurial behavior in organizations and allow practitioners to identify their organizations’ strengths and weaknesses related to intrapreneurship.

The knowledge, attitudes and beliefs of patients and their healthcare professionals around oral dosage form modification: a systematic review of the qualitative literature

Objectives: The objective of this systematic review was to synthesize the available qualitative evidence on the knowledge, attitudes and beliefs of adult patients, healthcare professionals and carers about oral dosage form modification. Design: A systematic review and synthesis of qualitative studies was undertaken, utilising the thematic synthesis approach. Data sources: The following databases were searched from inception to September 2015: PubMed, Medline (EBSCO), EMBASE, CINAHL, PsycINFO, Web of Science, ProQuest Databases, Scopus, Turning Research Into Practice (TRIP), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Citation tracking and searching the references lists of included studies was also undertaken. Grey literature was searched using the OpenGrey database, internet searching and personal knowledge. An updated search was undertaken in June 2016. Review methods: Studies meeting the following criteria were eligible for inclusion; (i) used qualitative data collection and analysis methods; (ii) full-text was available in English; (iii) included adult patients who require oral dosage forms to be modified to meet their needs or; (iv) carers or healthcare professionals of patients who require oral dosage forms to be modified. Two reviewers independently appraised the quality of the included studies using the Critical Appraisal Skills Programme Checklist. A thematic synthesis was conducted and analytical themes were generated. Results: Of 5455 records screened, seven studies were eligible for inclusion; three involved healthcare professionals and the remaining four studies involved patients. Four analytical themes emerged from the thematic synthesis: (i) patient-centred individuality and variability; (ii) communication; (iii) knowledge and uncertainty and; (iv) complexity. The variability of individual patient’s requirements, poor communication practices and lack of knowledge about oral dosage form modification, when combined with the complex and multi-faceted healthcare environment complicate decision making regarding oral dosage form modification and administration. Conclusions: This systematic review has highlighted the key factors influencing the knowledge, attitudes and beliefs of patients and healthcare professionals about oral dosage form modifications. The findings suggest that in order to optimise oral medicine modification practices the needs of individual patients should be routinely and systematically assessed and decision-making should be supported by evidence based recommendations with multidisciplinary input. Further research is needed to optimise oral dosage form modification practices and the factors identified in this review should be considered in the development of future interventions.