Understanding treatment-related symptoms, symptom management techniques, and symptom management self-efficacy in a sample of non-muscle invasive bladder cancer patients

The current literature available on bladder cancer symptom management from the perspective of the patients themselves is limited. There is also limited psychosocial research specific to bladder cancer patients and no previous studies have developed and validated measures for bladder cancer patients’ symptom management self-efficacy. The purpose of this study was to investigate non-muscle invasive bladder cancer patients’ health related quality of life through two main study objectives: (1) to describe the treatment related symptoms, reported effectiveness of symptom-management techniques, and the advice a sample of non-muscle invasive bladder cancer patients would convey to physicians and future patients; and (2) to evaluate Lepore’s symptom management self-efficacy measure on a sample of non-muscle invasive bladder cancer patients. Methods. A total of twelve (n=12) non-muscle invasive bladder cancer patients participated in an in-depth interview and a sample of 46 (n=4) non-muscle invasive bladder cancer patients participated in the symptom-management self-efficacy survey. Results. A total of five symptom categories emerged for the participants’ 59 reported symptoms. Four symptom management categories emerged out of the 71 reported techniques. A total of 62% of the participants’ treatment related symptom-management techniques were reported as effective in managing their treatment-related symptoms. Five advice categories emerged out of the in-depth interviews: service delivery; medical advice; physician-patient communication; encouragement; and no advice. An exploratory factor analysis indicated a single-factor structure for the total population and a multiple factor structure for three subgroups: all males, married males, and all married participants. Conclusion. These findings can inform physicians and patients of effective symptom-management techniques thus improving patients’ health-related quality of life. The advice these patients’ impart can improve service-delivery and patient education.^

Public service use by residents of Jackson Hinds Gardens before and after enrollment

Homelessness is associated with high use of public services such as health care and criminal justice services. Intervention designs to reverse homelessness have broadly fallen into two categories: either standard care which employs requisitely addressing the causes of homelessness, or housing first, which emphasizes provision of permanent housing without requisitely addressing the causes of homelessness. Multiple cities have recently commenced housing first interventions. Locally, Houston’s first housing first development is the Jackson Hinds Gardens project. The purpose of this study is to analyze the public service use of residents of housing first in Houston. Residents of Jackson Hinds Gardens who have been enrolled for at least 6 months were evaluated for public service use for an equal amount of time preceding and during their residence at Jackson Hinds. Resident interactions with county health services and criminal justice entities were determined by electronic database searches; these data were supplemented by life experience interview data. Service usage values pre- and post-enrollment at Jackson Hinds Gardens were compared by paired t-test analyses. We found that ER and inpatient usage decreased following enrollment in Jackson Hinds, although these reductions were not significant. In contrast, outpatient care and number of medications significantly increased following enrollment. These analyses inform on the effects of housing first in another major city, as well as informing the ethical considerations regarding housing first versus standard care. ^

Ethnographic and epidemiologic approaches for the programming of prenatal and birth services in Mesa los Hornos, Mexico

The investigator conducted an action-oriented investigation of pregnancy and birth among the women of Mesa los Hornos, an urban squatter slum in Mexico City. Three aims guided the project: (1) To obtain information for improving prenatal and maternity service utilization; (2) To examine the utility of rapid ethnographic and epidemiologic assessment methodologies; (3) To cultivate community involvement in health development.^ Viewing service utilization as a culturally-bound decision, the study included a qualitative phase to explore women's cognition of pregnancy and birth, their perceived needs during pregnancy, and their criteria of service acceptability. A probability-based community survey delineated parameters of service utilization and pregnancy health events, and probed reasons for decisions to use medical services, lay midwives, or other sources of prenatal and labor and delivery assistance. Qualitative survey of service providers at relevant clinics, hospitals, and practices contributed information on service availability and access, and on coordination among private, social security, and public assistance health service sectors. The ethnographic approach to exploring the rationale for use or non-use of services provided a necessary complement to conventional barrier-based assessment, to inform planning of culturally appropriate interventions.^ Information collection and interpretation was conducted under the aegis of an advisory committee of community residents and service agency representatives; the residents' committee formulated recommendations for action based on findings, and forwarded the mandate to governmental social and urban development offices. Recommendations were designed to inform and develop community participation in health care decision-making.^ Rapid research methods are powerful tools for achieving community-based empowerment toward investigation and resolution of local health problems. But while ethnography works well in synergy with quantitative assessment approaches to strengthen the validity and richness of short-term field work, the author strongly urges caution in application of Rapid Ethnographic Assessments. An ethnographic sensibility is essential to the research enterprise for the development of an active and cooperative community base, the design and use of quantitative instruments, the appropriate use of qualitative techniques, and the interpretation of culturally-oriented information. However, prescribed and standardized Rapid Ethnographic Assessment techniques are counter-productive if used as research short-cuts before locale- and subject-specific cultural understanding is achieved. ^

Epidemiology of allergic gastroenteritis in socio-culture perspective of rural Egypt

Diarrhea is a major public health problem in developing countries among infants and young children. Not all episodes of diarrhea are confirmed as infectious, suggesting alternate mechanisms. One such is immunoglobulin E (IgE) mediated or allergic diarrhea that can be seen in food allergy. In order to determine the relation between allergic gastroenteritis and feeding practice, a cohort of 152 infants were followed from birth to one year age in a rural community of Egypt between October, 1987 to April, 1988 were analyzed. In multivariate analysis of the data, statistically conclusive higher risk had been observed with presence of factors, like consumption of milk pudding (RR = 7.4, CI = 1.5-36.2 and p = 0.01), infant's age 3-6 months (RR = 7.7, CI = 1.3-45.9 and p = 0.02), infants whose mothers were vaccinated antenatally (RR = 3.1, CI = 1.3-7.0 and p = 1.3-7.0, p = 0.0) and wet-nursed infants (RR = 2.7, CI = 1.1-6.5 and p = 0.02). In contrast, infants who were completely breast-fed (RR = 0.13, CI = 0.02-0.6 and p = 0.01), and infants family owning a television set (RR = 0.29, CI = 0.1-0.6 and p = 0.0) were less likely to develop allergic gastroenteritis. The role of IgE on development of persistent diarrhea was also examined in a nested case-control design. Multivariate analysis revealed a significant association between detection of fecal IgE and development of persistent diarrhea compared to acute diarrhea (OR = 3.32, CI = 1.0-10.9 and p = 0.04) and health or non diarrhea (OR = 4.8, CI = 1.07-21.7 and p = 0.03) controls. ^

MEASURING THE EFFECT OF ILLNESS ON THE EXPECTED REMAINING SERVICE TIME FOR THE ACTIVE DUTY ARMY: A LIFE TABLE APPROACH

A life table methodology was developed which estimates the expected remaining Army service time and the expected remaining Army sick time by years of service for the United States Army population. A measure of illness impact was defined as the ratio of expected remaining Army sick time to the expected remaining Army service time. The variances of the resulting estimators were developed on the basis of current data. The theory of partial and complete competing risks was considered for each type of decrement (death, administrative separation, and medical separation) and for the causes of sick time.^ The methodology was applied to world-wide U.S. Army data for calendar year 1978. A total of 669,493 enlisted personnel and 97,704 officers were reported on active duty as of 30 September 1978. During calendar year 1978, the Army Medical Department reported 114,647 inpatient discharges and 1,767,146 sick days. Although the methodology is completely general with respect to the definition of sick time, only sick time associated with an inpatient episode was considered in this study.^ Since the temporal measure was years of Army service, an age-adjusting process was applied to the life tables for comparative purposes. Analyses were conducted by rank (enlisted and officer), race and sex, and were based on the ratio of expected remaining Army sick time to expected remaining Army service time. Seventeen major diagnostic groups, classified by the Eighth Revision, International Classification of Diseases, Adapted for Use In The United States, were ranked according to their cumulative (across years of service) contribution to expected remaining sick time.^ The study results indicated that enlisted personnel tend to have more expected hospital-associated sick time relative to their expected Army service time than officers. Non-white officers generally have more expected sick time relative to their expected Army service time than white officers. This racial differential was not supported within the enlisted population. Females tend to have more expected sick time relative to their expected Army service time than males. This tendency remained after diagnostic groups 580-629 (Genitourinary System) and 630-678 (Pregnancy and Childbirth) were removed. Problems associated with the circulatory system, digestive system and musculoskeletal system were among the three leading causes of cumulative sick time across years of service. ^

Las estelas fronterizas y falsa-puerta como delimitadoras del espacio físico y simbólico en Egipto

El concepto de "frontera" resulta problemático debido al uso corriente que se le da al término. Está naturalizada la noción de una frontera exclusiva: una barrera que divide un territorio A de un territorio no-A, rigiendo el principio aristotélico del tercero excluido. Para el estudio de sociedades de la antigüedad debemos necesariamente desembarazarnos de tales preconceptos. En el presente trabajo nos proponemos observar la factibilidad de utilizar tal concepto para entender las divisiones (no sólo físicas) en el Antiguo Egipto. Teniendo en cuenta el uso reiterado de estelas en la demarcación del espacio proponemos, a partir del estudio de las mismas, interrogarnos acerca de qué es exactamente lo que ellas delimitan y por qué se las utiliza para ello. Los casos testigo de las estelas que marcan el límite de la ciudad de Akhetatón y las llamadas falsa-puerta nos servirán para ilustrar nuestras tesis. Las primeras, erigidas para ser vistas, decretan un límite físico; las segundas, ocultas dentro de tumbas privadas, hacen las veces de límite entre el mundo de los vivos y el de los muertos. En apariencia diferentes, encierran en realidad una misma función: separar regiones cósmicas, manteniendo al Caos fuera del territorio donde reina el Orden.

Las estelas fronterizas y falsa-puerta como delimitadoras del espacio físico y simbólico en Egipto

El concepto de "frontera" resulta problemático debido al uso corriente que se le da al término. Está naturalizada la noción de una frontera exclusiva: una barrera que divide un territorio A de un territorio no-A, rigiendo el principio aristotélico del tercero excluido. Para el estudio de sociedades de la antigüedad debemos necesariamente desembarazarnos de tales preconceptos. En el presente trabajo nos proponemos observar la factibilidad de utilizar tal concepto para entender las divisiones (no sólo físicas) en el Antiguo Egipto. Teniendo en cuenta el uso reiterado de estelas en la demarcación del espacio proponemos, a partir del estudio de las mismas, interrogarnos acerca de qué es exactamente lo que ellas delimitan y por qué se las utiliza para ello. Los casos testigo de las estelas que marcan el límite de la ciudad de Akhetatón y las llamadas falsa-puerta nos servirán para ilustrar nuestras tesis. Las primeras, erigidas para ser vistas, decretan un límite físico; las segundas, ocultas dentro de tumbas privadas, hacen las veces de límite entre el mundo de los vivos y el de los muertos. En apariencia diferentes, encierran en realidad una misma función: separar regiones cósmicas, manteniendo al Caos fuera del territorio donde reina el Orden.

Las estelas fronterizas y falsa-puerta como delimitadoras del espacio físico y simbólico en Egipto

El concepto de "frontera" resulta problemático debido al uso corriente que se le da al término. Está naturalizada la noción de una frontera exclusiva: una barrera que divide un territorio A de un territorio no-A, rigiendo el principio aristotélico del tercero excluido. Para el estudio de sociedades de la antigüedad debemos necesariamente desembarazarnos de tales preconceptos. En el presente trabajo nos proponemos observar la factibilidad de utilizar tal concepto para entender las divisiones (no sólo físicas) en el Antiguo Egipto. Teniendo en cuenta el uso reiterado de estelas en la demarcación del espacio proponemos, a partir del estudio de las mismas, interrogarnos acerca de qué es exactamente lo que ellas delimitan y por qué se las utiliza para ello. Los casos testigo de las estelas que marcan el límite de la ciudad de Akhetatón y las llamadas falsa-puerta nos servirán para ilustrar nuestras tesis. Las primeras, erigidas para ser vistas, decretan un límite físico; las segundas, ocultas dentro de tumbas privadas, hacen las veces de límite entre el mundo de los vivos y el de los muertos. En apariencia diferentes, encierran en realidad una misma función: separar regiones cósmicas, manteniendo al Caos fuera del territorio donde reina el Orden.

Distribution System of China's Industrial Clusters: Case Study of Yiwu China Commodity City

This paper discusses the issue of upgrading industrial clusters from the perspective of external linkages. It is taken for granted that in most developing countries, due to the limited domestic market and poor traditional commercial networks, industrial clusters are able to upgrade only when they are involved in global value chains. However, the rise of China’s industrial clusters challenges this view. Historically, China has had a lot of industrial clusters with their own traditional commercial networks. This fact combined with its huge population resulted in the formation of a unique external linage to China’s industrial clusters after the socialist planning period ended. In concrete terms, since the 1980s, a traditional commercial institution . the transaction market . began to appear in most clusters. These markets within the clusters get connected to those in the cities due to interaction between traditional merchants and local governments. This has resulted in the formation of a powerful market network-based distribution system which has played a crucial role for China’s industrial clusters in responding to exploding domestic demand. This paper explains these features in detail, using Yiwu China Commodity City as a case study.

On the sustainability of a monocentric city : lower transport costs from new transport facilities

This paper proposes a general equilibrium model of a monocentric city based on Fujita and Krugman (1995). Two rates of transport costs per distance and for the same good are introduced. The model assumes that lower transport costs are available at a few points on a line. These lower costs represent new transport facilities, such as high-speed motorways and railways. Findings is that new transport facilities connecting the city and hinterlands strengthen the lock-in effects, which describes whether a city remains where it is forever after being created. Furthermore, the effect intensifies with better agricultural technologies and a larger population in the economy. The relationship between indirect utility and population size has an inverted U-shape, even if new transport facilities are used. However, the population size that maximizes indirect utility is smaller than that found in Fujita and Krugman (1995).

A user-centric approach to service creation and delivery over next generation networks

Next Generation Networks (NGN) provide Telecommunications operators with the possibility to share their resources and infrastructure, facilitate the interoperability with other networks, and simplify and unify the management, operation and maintenance of service offerings, thus enabling the fast and cost-effective creation of new personal, broadband ubiquitous services. Unfortunately, service creation over NGN is far from the success of service creation in the Web, especially when it comes to Web 2.0. This paper presents a novel approach to service creation and delivery, with a platform that opens to non-technically skilled users the possibility to create, manage and share their own convergent (NGN-based and Web-based) services. To this end, the business approach to user-generated services is analyzed and the technological bases supporting the proposal are explained.

Domain-Specific Multi-Modeling of Security Concerns in Service-Oriented Architectures

As a common reference for many in-development standards and execution frameworks, special attention is being paid to Service-Oriented Architectures. SOAs modeling, however, is an area in which a consensus has not being achieved. Currently, standardization organizations are defining proposals to offer a solution to this problem. Nevertheless, until very recently, non-functional aspects of services have not been considered for standardization processes. In particular, there exists a lack of a design solution that permits an independent development of the functional and non-functional concerns of SOAs, allowing that each concern be addressed in a convenient manner in early stages of the development, in a way that could guarantee the quality of this type of systems. This paper, leveraging on previous work, presents an approach to integrate security-related non-functional aspects (such as confidentiality, integrity, and access control) in the development of services.

Multi Domain-Specific Modeling of the Security Concerns of Service-Oriented Architectures

Service-Oriented Architectures (SOA), and Web Services (WS), the technology generally used to implement them, achieve the integration of heterogeneous technologies, providing interoperability, and yielding the reutilization of pre-existent systems. Model-driven development methodologies provide inherent benefits such as increased productivity, greater reuse, and better maintainability, to name a few. Efforts on achieving model-driven development of SOAs already exist, but there is currently no standard solution that addresses non-functional aspects of these services as well. This paper presents an approach to integrate these non-functional aspects in the development of web services, with an emphasis on security.

Dynamic Model-based Management of Service-Oriented Infrastructure.

Models are an effective tool for systems and software design. They allow software architects to abstract from the non-relevant details. Those qualities are also useful for the technical management of networks, systems and software, such as those that compose service oriented architectures. Models can provide a set of well-defined abstractions over the distributed heterogeneous service infrastructure that enable its automated management. We propose to use the managed system as a source of dynamically generated runtime models, and decompose management processes into a composition of model transformations. We have created an autonomic service deployment and configuration architecture that obtains, analyzes, and transforms system models to apply the required actions, while being oblivious to the low-level details. An instrumentation layer automatically builds these models and interprets the planned management actions to the system. We illustrate these concepts with a distributed service update operation.