897 resultados para Heroin Shortage
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A emergência de questões tecnológicas, sociais e ambientais transformam o ensino das ciências num enorme desafio. A escassez e a contaminação da água, resultante de actividades antropogénicas, perspectiva-se hoje como um problema de futuro. Este tema, parte integrante do programa de Química do 11o Ano, inspirou uma intervenção didáctica baseada numa metodologia de resolução problemas que se pode enquadrar numa abordagem do tipo CTSA. A intervenção proposta, a partir de uma saída de campo que se concretizou na Mina de S. Domingos, teve por objectivos melhorar as aprendizagens realizadas pelos alunos e promover a mudança de atitudes face ao Ambiente e ao consumo de água em particular. Os dados recolhidos, analisados segundo métodos qualitativos e quantitativos, revelaram melhores conhecimentos e atitudes mais favoráveis relativamente à Ciência e à disciplina de Física e Química, e face ao Ambiente e ao consumo de água, reforçando a importância deste tipo de abordagens. ABSTRACT; The emergent technology, social and environmental issues are making the science teaching a huge challenge. The shortage and the contamination of water, as result of anthropogenic activities, are faced today like a future problem. This theme is part of the Chemistry subject curriculum of the eleventh grade level and it inspired a didactic intervention based upon a problem solving methodology that can be framed in a STSE approach. The goals of the proposed intervention, taking Mina de S. Domingos for a field trip, meant to improve the students' learnings and to promote a change of attitudes in relation to the environment and to the water consumption, in particular. The collected data, analyzed according to qualitative and quantitative methods, showed better knowledge and more favorable attitudes towards Science and Physics and Chemistry, as well as regarding the environment and water consumption, enhancing the importance of this kind of approach.
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This poetry collection explores the concepts of addiction and redemption. It does so through a series of vignette-style poems set in the Baltimore and DC area at the height of the heroin epidemic in the United States. Split into three parts, the first addresses the narrator’s initial drug use, the second follows the narrator at the strongest and least hopeful point of his addiction, and the third examines, through various scenes, the narrator’s attempts to find a life free from the confines of addiction. Although dealing with subject matter derived from dark and unfortunate circumstances, the narrator’s heroin addiction serves merely as a catalyst for the various situations that force the narrator to develop emotionally and grow even when trapped in the seemingly inescapable confines of addiction.
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Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica
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Background: Body composition is affected by diseases, and affects responses to medical treatments, dosage of medicines, etc., while an abnormal body composition contributes to the causation of many chronic diseases. While we have reliable biochemical tests for certain nutritional parameters of body composition, such as iron or iodine status, and we have harnessed nuclear physics to estimate the body’s content of trace elements, the very basic quantification of body fat content and muscle mass remains highly problematic. Both body fat and muscle mass are vitally important, as they have opposing influences on chronic disease, but they have seldom been estimated as part of population health surveillance. Instead, most national surveys have merely reported BMI and waist, or sometimes the waist/hip ratio; these indices are convenient but do not have any specific biological meaning. Anthropometry offers a practical and inexpensive method for muscle and fat estimation in clinical and epidemiological settings; however, its use is imperfect due to many limitations, such as a shortage of reference data, misuse of terminology, unclear assumptions, and the absence of properly validated anthropometric equations. To date, anthropometric methods are not sensitive enough to detect muscle and fat loss. Aims: The aim of this thesis is to estimate Adipose/fat and muscle mass in health disease and during weight loss through; 1. evaluating and critiquing the literature, to identify the best-published prediction equations for adipose/fat and muscle mass estimation; 2. to derive and validate adipose tissue and muscle mass prediction equations; and 3.to evaluate the prediction equations along with anthropometric indices and the best equations retrieved from the literature in health, metabolic illness and during weight loss. Methods: a Systematic review using Cochrane Review method was used for reviewing muscle mass estimation papers that used MRI as the reference method. Fat mass estimation papers were critically reviewed. Mixed ethnic, age and body mass data that underwent whole body magnetic resonance imaging to quantify adipose tissue and muscle mass (dependent variable) and anthropometry (independent variable) were used in the derivation/validation analysis. Multiple regression and Bland-Altman plot were applied to evaluate the prediction equations. To determine how well the equations identify metabolic illness, English and Scottish health surveys were studied. Statistical analysis using multiple regression and binary logistic regression were applied to assess model fit and associations. Also, populations were divided into quintiles and relative risk was analysed. Finally, the prediction equations were evaluated by applying them to a pilot study of 10 subjects who underwent whole-body MRI, anthropometric measurements and muscle strength before and after weight loss to determine how well the equations identify adipose/fat mass and muscle mass change. Results: The estimation of fat mass has serious problems. Despite advances in technology and science, prediction equations for the estimation of fat mass depend on limited historical reference data and remain dependent upon assumptions that have not yet been properly validated for different population groups. Muscle mass does not have the same conceptual problems; however, its measurement is still problematic and reference data are scarce. The derivation and validation analysis in this thesis was satisfactory, compared to prediction equations in the literature they were similar or even better. Applying the prediction equations in metabolic illness and during weight loss presented an understanding on how well the equations identify metabolic illness showing significant associations with diabetes, hypertension, HbA1c and blood pressure. And moderate to high correlations with MRI-measured adipose tissue and muscle mass before and after weight loss. Conclusion: Adipose tissue mass and to an extent muscle mass can now be estimated for many purposes as population or groups means. However, these equations must not be used for assessing fatness and categorising individuals. Further exploration in different populations and health surveys would be valuable.
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Odpowiedzialność karną lekarza łączy się powszechnie z problematyką błędu medycznego, choć właściwie odpowiada on nie za sam błąd medyczny, jako że prawo karne nie zna przestępstwa polegającego na popełnieniu błędu medycznego, ale za ewentualne jego skutki, które mogą być kwalifikowane jako nieumyślne spowodowanie śmierci, nieumyślne spowodowanie ciężkiego, średniego albo lekkiego uszczerbku na zdrowiu bądź nieumyślne narażenie na niebezpieczeństwo utraty życia albo ciężkiego uszczerbku na zdrowiu. Nie można oczywiście wykluczyć wystąpienia sytuacji, w której lekarz swoim zachowaniem zrealizowałby znamiona typu umyślnego, jednakże na potrzeby niniejszej publikacji przyjęto, że co do zasady lekarz działa w celu ratowania dóbr prawnych, jakimi są życie i zdrowie pacjenta, nie zaś z zamiarem narażenia ich na niebezpieczeństwo bądź naruszenia, a ewentualne negatywne skutki dla życia i pacjenta, powstałe w miejsce lub obok zamierzonego stanu rzeczy, nie są przez niego objęte umyślnością. Kluczowym warunkiem uznania, że czyn popełniony został nieumyślnie jest ustalenie, że sprawca naruszył reguły ostrożnego postępowania, wymagane w danych okolicznościach. W odniesieniu do zawodu lekarza na pierwszy plan wysuwa się wśród nich wymóg stosowania się do wskazań aktualnej wiedzy medycznej. Autorka przekłada ten obowiązek na grunt realiów systemu ochrony zdrowia i rozważa, jaki wpływ na jego niedopełnienie mają okoliczności ograniczonej względami ekonomicznymi dostępności świadczeń zdrowotnych oraz w jaki sposób niedostatek środków finansowych może rzutować na naruszenie przez lekarza reguł ostrożnego postępowania, o których mowa w art. 9 § 2 Kodeksu karnego.
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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica
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The goal of this thesis is to gain more in-depth understanding of employer branding and offer suggestions on how this knowledge could be utilized in the case company. More in detail, the purpose of this research is to provide tools for improving Lindström’s organizational attractiveness and boosting the recruitment and retention of the segment of high-performing sales professionals. A strategy for reaching this particular segment has not been previously drawn and HR-managers believe strongly that it would be very beneficial for the company’s development and growth. The topic of this research is very current for Lindström, but also contributes on general level as companies are competing against each other in attracting, recruiting and retention of skilled workforce in the times of labor shortage. The research is conducted with qualitative methods and the data collection includes primary data through interviews as well as secondary data in the form of analysis on previous research, websites, recruitment material and discussions with Lindström’s HR department. This research provides a good basis for broader examination on the topic and presents development suggestions for the identified challenges. Based on the key findings Lindström’s HR department was advised to increase firm’s visibility, broaden recruitment channels, provide more hands-on knowledge about the sales positions and investigate their possibilities of developing sales reward systems.
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Dissertação (mestrado)—Universidade de Brasília, Centro de Estudos Avançados Multidisciplinares, Programa de Pós-Graduação em Desenvolvimento Sociedade e Cooperação Internacional, 2016.
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International audience
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Hydrocephalus has been known to affect humans since the birth of human medicine as it is described by Hippocrates. The management of this condition is however still dodged by challenges due to a poor understanding of its pathophysiology. The ventriculoperitoneal shunt presents considerable problems especially with respect to infection and shunt malfunction. Low income countries, that currently face the greater burden of paediatric hydrocephalus. experience an increased challenge with ventriculoperitoneal shunts due to a shortage of qualified personnel to handle shunt complications. Recent advances in neuro-endoscopic surgery have presented opportunities for alternative treatment options for hydrocephalus such as endoscopic third ventriculostomy (ETV). This paper explores the alternative views in the pathophysiology of hydrocephalus and how they explain the effectiveness of ETV in treating hydrocephalus arising from a variety of causes.
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On the aggravation of social problems and the shortage of resources, the improvement of evaluation methods and control of its application, requiring more efficiency, efficacy, effectiveness and participation in its management, has been growing. As a result, emerges the importance of studying and developing such methodologies. The overall goal of this dissertation is to know what are the difficults to incorporate the point of view of executers and beneficiaries in evaluation process. To do so, has been done a research characterized as qualitative, with a field strategy using the case study of two social projects called Petrobras Child Program, situated in the metropolitan region of Natal, and Content Analysis technique for analyze the data. The conclusions of this work can assist in improving the process of projects evaluation financed by Petrobras, contributing with its social role, besides the possibility of encouraging a greater participation of other society actors, such as beneficiaries, in the evaluation process
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Background The study upon which this paper is based was undertaken to understand users’ and non-users’ perceptions concerning facilitators and barriers to equitable and universal access to health care in resource-poor countries such as Malawi. In this study, non-users of health services were defined as people who were not in need of health services or those who had stopped using them due to significant barriers. Methods A total of 80 interviews with non-users of health services were conducted in Rumphi, Ntchisi, Phalombe and Blantyre Districts of Malawi. Interviews focused on why informants were not using formal health services at the time of data collection. In order to identify non-users, snowballing was used health surveillance assistants, village headmen and community members also helped. One focus group discussion was also conducted with non-users of health services who were members of the Zion Church. Results Informants described themselves as non-users of health services due to several reasons: cost of health services; long distances to health facilities; poor attitude of health workers; belief in the effectiveness of traditional medicines; old age and their failure to walk. Others were non-users due to their disability; hence they could not walk over long distances or could not communicate effectively with health providers. Some of these non-users were complete non-users, namely members of the Zion Church and those who believed in traditional medicine, and they stated that nothing could be done to transform them into users of health services. Other non-users stated that they could become users if their challenges were addressed e.g. for those who were non-users of health services due to poor attitudes of health workers, they stated that if these health workers were transferred they would be able to access health services. Conclusions Public health education targeting both health workers and non-users, ensuring a functional outreach program and addressing other health system challenges such as shortage of drugs and human resources would assist in transforming non-users into users of health services.
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Like many Americans, African American women often view marriage as an important life goal; however, it is likely that many also view it as one that is out of reach (Dixon, 2009; Wallace, 2014). The present study sought to address this issue by developing a new measure to assess African American women’s experiences in this regard in hopes of shedding light on how it impacts their dating and mating experiences. A total of 251 heterosexual African American women who were either enrolled in college or who had completed some form of postsecondary education completed an online survey assessing a variety of topics including their attitudes and emotions regarding a shortage of marriageable men, their standards to marry, and their willingness to date interracially. Results from this study established preliminary construct validity for a new scale assessing African American women’s attitudes and emotions about the shortage of “marriageable” African American men.
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In this study cross-section data was used to analyze the effect of farmers’ demographic, socioeconomic and institutional setting, market access and physical attributes on the probability and intensity of tissue culture banana (TCB) adoption. The study was carried out between July 2011 and November 2011. Both descriptive (mean, variance, promotions) and regression analysis were used in the analysis. A double hurdle regression model was fitted on the data. Using multistage sampling technique, four counties and eight sub-locations were randomly selected. Using random sampling technique, three hundred and thirty farmers were selected from a list of banana households in the selected sub-locations. The adoption level of tissue culture banana (TCB) was about 32%. The results also revealed that the likelihood of TCB adoption was significantly influenced by: availability of TCB planting material, proportion of banana income to the total farm income, per capita household expenditure and the location of the farmer in Kisii County; while those that significantly influenced the intensity of TCB adoption were: occupation of farmers, family size, labour source, farm size, soil fertility, availability/access of TCB plantlets to farmers, distance to banana market, use of manure in planting banana, access to agricultural extension services and index of TCB/non-TCB banana cultivar attributes which were scored by farmers. Compared to West Pokot County, farmers located in Bungoma County are more significantly and likely to adopt TCB technology. Therefore, the results of the study suggest that the probability of adoption and intensity of the use of TCB should be enhanced. This can be done by taking cognizance of these variables in order to meet the priority needs of the smallholder farmers who were the target group. This would lead to alleviating banana shortage in the region for enhanced food security. Subsequently, actors along the banana value chain are encouraged to target the intervention strategies based on the identified farmer, farm and institutional characteristics for enhanced impact on food provision. Opening up more TCB multiplication centres in different regions will make farmers access the TCB technology for enhanced impact on the target population.
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Resumen La Evaluación Múlticriterio (EMC), integra las diferentes dimensiones de una realidad en un sólo marco de análisis, para brindar un acercamiento de la gestión del recurso hídrico en los cantones Barva, Santa Bárbara y San Rafael de Heredia, con el objetivo de generar las políticas hídricas locales adecuadas. Esta estructura metodológica presenta una gran transparencia como herramienta en la toma de decisiones, identificando claramente los diferentes actores involucrados, describiendo, al mismo tiempo los problemas de gestión del recurso hídrico en la zona; a la vez que permite delimitar los conflictos sociales y mostrar diferentes posibilidades para su solución a través de compromisos y diálogo entre las partes. De éste diálogo emergen soluciones concretas, estructuradas como políticas locales hídricas, tales como: Planes de Gestión Hídrica, Inversión Pública y Privada, Coordinación Institucional, Reforma Institucional/legal. La zona presenta una atmósfera conflictiva alrededor de la gestión del agua y por tanto en la estructuración de políticas hídricas locales. Esta conflictividad ‘sectorial’(es decir por cantón) se superpone a una extraordinaria conflictividad ‘territorial’. La escasez o competencia sobre el agua se fundamenta en unas demandas crecientes que son expresión de un proceso de desarrollo urbano y turístico acelerado y desordenado. Abstract The Evaluation Multi-criteria analysis (EMA), integrates the different dimensions of a reality in an analysis mark, to offer an approach of the administration of the hydric resources in the Heredia´s cities of Barva, Santa Bárbara and San Rafael, with the objective of generating the local adequate hydrics policies. This methodological structure presents a great transparency like tool in the taking of decisions, identifying the different involved actors clearly, describing, at the same time, the problems of administration of the hydric resources in the area; and at the same time, it allows to define the social conflicts, as showing different possibilities for their solution through commitments and dialogue among the parts. Of this dialogue concrete solutions they emerge, structured as hydrics local policies, such as: Plans of hydric management, Public and Private Investment, Institutional Coordination, Institucional/legal reforms. The area presents a conflicting atmosphere around the administration of the water and therefore in the structuring of local hydrics policies. This conflict 'sectorial' (to say for canton) it is superimposed to an extraordinary 'territorial' conflict. The shortage or competition for water are based in some growing demands that are expression of a process of quick and disordered urban and tourist development.