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PubMed1998

[Quantitative cultures in diagnosis of pneumonia--a method for routine practice?].

Quantitative cultures of respiratory secretions represent a valid technique for the diagnosis of ventilator-associated pneumonia. Contamination, colonization and true infection can be differentiated with a reasonable specificity using established cut-offs of bacterial colony counts. Quantitative investigations provide local epidemiological databases as a framework for empirical antimicrobial policies and may also prove helpful in the guidance of individual antimicrobial therapy. Another reasonable indication is HIV-associated pneumonia. However, the use of this technique in routine practice is hampered by the high expertise and experience that will be necessary to be successfully used. Nevertheless, in view of the need to identify bacterial susceptibility patterns, at least large treatment centers should routinely use this most powerful diagnostic technique.

AIDS-Related Opportunistic Infections↗

PubMed1991

Recent trends in expenditures on physicians' services in Canada.

Analysis of Canada's restraints on the growth in volume of physicians' services can help shape the framework and direction of policy development in other countries. This paper analyzes trends in recent expenditures on physicians' services in Canada from 1982 to 1987. Growth in payments to physicians who were paid fee-for-service is broken down into three component parts in Canada nationwide and in four provinces: Ontario, Quebec, Nova Scotia and British Columbia. The three component parts are: (1) growth in the number of services billed; (2) physician service prices; and (3) the mixture of high- and low-priced services billed. Expenditure increases are disaggregated according to some major categories of medical services, both per physician and per capita. Increases in growth in physician payments were explained mainly by increases in prices, while some evidence of an increase in higher priced services per physician was found. The varying payment restraint policies across Canadian provinces were manifested in different patterns with respect to components of payment change. Higher rates of payment and volume growth were found for diagnostic/therapeutic and office medical services than for surgeries, although a few contrary patterns across provinces occurred. Interprovincial utilization growth, both per physician and per capita, was variable. This suggests that Canada's regionally administered system is neither uniform nor monolithic.

Canada↗

PubMed1994

Vaccination in food animal populations.

This report highlights the role of vaccination in the present and future food animal industry in the framework of the disease policy of the European Commission. Vaccination was essential in the virtual eradication of foot-and-mouth disease and classical swine fever, the use of modern marker vaccines opens prospects for eradication of viruses in countries with a high prevalence, and a rebirth of interest in bacterial vaccines is noted, because of the problems of drug resistance and antimicrobial residues. Biotechnology has already led to the development of several new vaccines, and to the improvement of current vaccines, and it still holds great potential for designing basically novel vaccines. Vaccination, thus, is a crucial tool in reducing the enormous economic losses caused by diseases in food animals.

Animal Diseases↗

PubMed2026

Mapping and measuring addiction recovery: Recommended protocols through the PHENX toolkit.

BACKGROUND: Addiction "recovery" has served as a positive conceptual basis for major public health frameworks, communication strategies, and policies. With greater research interest and increasing explication of the recovery construct a multitude of measures have emerged, prompting a need to reach consensus on recommendations to enable better data harmonization and cross-study syntheses. The PhenX (consensus measures for Phenotypes and eXposures) Toolkit (www.phenxtoolkit.org) is a freely accessible catalog of validated protocols designed to promote data comparability across clinical, epidemiological, and genomic research, yet contained no recovery-specific measures. METHOD: In 2024, a Substance Use and Recovery Working Group (SURWG) followed a well-established and detailed PhenX consensus process to identify and recommend protocols suitable for recovery research. Protocols were chosen based on criteria including recovery specificity, brevity, psychometrics, scoring simplicity, and non-proprietary access. The broader scientific community (12 national/regional organizations) provided feedback (respondent N = 86) on the SURWG's preliminary recommendation which was incorporated into final decisions. RESULTS: In 2025, the PhenX Toolkit released 15 new recommended protocols across three broad recovery elements: 1. Biopsychological (post-acute withdrawal; craving), 2. Socio-ecological (social relationships;social network characteristics; substance use goal; recovery identity; recovery capital), 3. Treatment and recovery services (Treatment and Recovery Services Use; Satisfaction; and Happiness in Recovery; Mutual-Help). CONCLUSIONS: This PhenX Toolkit SURWG process resulted in a new Substance Use Recovery Specialty Collection of recommended protocols with specific multidimensional applicability. As such, they provide the field with pre-vetted tools that researchers can employ with some confidence to enhance empirical efficiency and return on national research investment.

Humans↗

PubMed2003

The Humber catchment and its coastal area: from UK to European perspectives.

The present water quality of the Humber rivers and coastal zone depends on a complex interplay of factors, including physical ones, such as the underlying geology, which influences soil type, climatic ones, such as the rainfall, which influences runoff, socio-economic ones, which influence present-day human activities in the catchment, and the legacy of former activities, such as contaminated sediments from mining. All of these factors affect the fluxes of nutrients and other contaminants to the rivers and coastal zone. The Water Framework Directive (WFD) requires the production of a river basin management plan intended to lead to the achievement of good chemical and ecological status for all water bodies in the catchment over the next two decades. This paper provides an overview of the current environmental and socio-economic state of the Humber catchment and coastal zone, and broadly examines how socio-economic drivers affect the fluxes of nutrients and contaminants to the coastal zone, using the driver-pressure-state-impact-response (DPSIR) approach. This is followed by an overview of future research, describing the use of scenarios to simulate future fluxes and provide a consistent framework to evaluate potential policies to improve water quality in the estuary. The Humber catchment is one of eight case studies within a European research project, EUROCAT (EVK1-CT-2000-00044), which aims to achieve integrated catchment and coastal zone management by analysing the response of the coastal sea to changes in fluxes of nutrients and contaminants from the catchments. For the Humber case study, the research focuses on the fluxes of two nutrient elements, N and P, and four metal contaminants, As, Cu, Pb and Zn. The project requires the integration of scientific and socio-economic approaches, bringing together quantitative environmental data garnered for individual river catchments and coastal zones in previous research programmes, and local and regional socio-economic data, to aid decision-makers in their search for integrated and sustainable coastal zone management strategies.

Animals↗

PubMed2001

INSIGHT: a framework for determining impacts of changes in land and water policies.

CSIRO Sustainable Ecosystems is constructing a spatially explicit modelling system capable of exploring alternative land and water policy alternatives against plausible price, cost, and climate scenarios for the next 20 years. INSIGHT will be used to identify the likely impacts of land and water policy options on regional economies and structural adjustment. Flowcharts have been constructed for most of the major crop and pasture and associated economic models for commodities produced in the Lachlan River Catchment of New South Wales. This enabled the most important components and interrelationships within these models to be readily identified. The next step has been to construct models at the regional scale that contain the essential elements of the more-detailed point models. The paper describes the progress to date in describing these models, and how they have been integrated into a coordinated agricultural crop production evaluation system.

Agriculture↗

PubMed2002

Risk assessment of hand washing efficacy using literature and experimental data.

This study simulated factors that influence the levels of bacteria on foodservice workers' hands. Relevant data were collected from the scientific literature and from laboratory experiments. Literature information collected included: initial bacterial counts on hands and water faucet spigots, bacterial population changes during hand washing as effected by soap type, sanitizing agent, drying method, and the presence of rings. Experimental data were also collected using Enterobacter aerogenes as a surrogate for transient bacteria. Both literature and experimental data were translated into appropriate discrete or probability distribution functions. The appropriate statistical distribution for each phase of the hand washing process was determined. These distributions were: initial count on hands, beta (2.82, 2.32, 7.5); washing reduction using regular soap, beta (3.01, 1.91, -3.00, 0.60); washing reduction using antimicrobial soap, beta (4.19, 2.99, -4.50, 1.50); washing reduction using chlorhexidine gluconate (CHG), triangular (-4.75, -1.00, 0); reductions from hot air drying, beta (3.52, 1.92, -0.20, 1.00); reduction from paper towel drying, triangular (-2.25, -0.75, 0); reduction due to alcohol sanitizer, gamma (-1.23, 4.42) -5.8; reduction due to alcohol-free sanitizer, gamma (2.22, 5.38) -5.00; and the effect of rings, beta (8.55, 23.35, 0.10, 0.45). Experimental data were fit to normal distributions (expressed as log percentage transfer rate): hand-to-spigot transfer, normal (-0.80, 1.09); spigot to hand, normal (0.36, 0.90). Soap with an antimicrobial agent (in particular, CHG) was observed to be more effective than regular soap. Hot air drying had the capacity to increase the amount of bacterial contamination on hands, while paper towel drying caused a slight decrease in contamination. There was little difference in the efficacy of alcohol and alcohol-free sanitizers. Ring wearing caused a slight decrease in the efficacy of hand washing. The experimental data validated the simulated combined effect of certain hand washing procedures based on distributions derived from reported studies. The conventional hand washing system caused a small increase in contamination on hands vs. the touch-free system. Sensitivity analysis revealed that the primary factors influencing final bacteria counts on the hand were sanitizer, soap, and drying method. This research represents an initial framework from which sound policy can be promulgated to control bacterial transmission via hand contacts.

Bacteria↗

PubMedDate not supplied

Agenda setting within a community-based food security planning process: the influence of power.

OBJECTIVE: To determine the effectiveness of using citizen politics as a framework for empowering citizens to build a community food security agenda. DESIGN: A critical perspective, case study design, and multiple qualitative methods were used. PARTICIPANTS/SETTING: Forty-four participants were purposefully recruited to participate in a community-based planning process called a search conference (SC). Seven additional disenfranchised stakeholders who did not attend the SC were also recruited to participate. PHENOMENON OF INTEREST: To assess how power influenced agenda setting and to determine the extent to which disenfranchised stakeholders' most salient interests were incorporated into the final SC action agendas. ANALYSIS: The constant comparison method, content analysis, and consensus were used to produce the final analysis. RESULTS: Power influenced agenda setting by managing knowledge, problem framing, trust, and consent. Two of seven of disenfranchised stakeholders' most salient interests, including need for adequate food preparation skills and increased availability of locally produced foods, were incorporated into the final SC action agendas. CONCLUSIONS AND IMPLICATIONS: Citizen politics can be used to build a community food security agenda on issues that are not at odds with stakeholders in positions of power. To bring about change on issues in which power differences between groups are substantial, additional theoretical frameworks and public policy-making models are needed.

Adult↗

PubMed1991

Introduction to the special section on seeking new clinical research methods.

This Special Section introduces a new section of the Journal of Consulting and Clinical Psychology that will be periodically offered in future issues under the title "Clinical Research Methods." This introduction describes (a) the section's goals, (b) a conceptual framework and potential areas of methodological development, (c) a summary of the articles in the current Special Section and their evaluation in terms of the conceptual framework, and (d) editorial policies and procedures used to foster innovative development of clinical research methods.

Behavior Therapy↗

PubMed2004

An outline of appropriate risk management in the use of temporary dental nursing staff in practice.

It'll never happen, it might not happen, it shouldn't happen, it happened!The risk of human error represents the greater threat to complex systems such as the delivery of healthcare rather than technical failure. Much of the legislation recently introduced in UK healthcare services, Building a Safer NHS; An Organisation with a Memory and A First Class Service evolved from a growing awareness of adverse incidents occurring in the healthcare setting. In general dental practice the absence of a trained skilled dental nurse with local knowledge of the working environment constitutes a risk to patient safety. Be this through the lack of appropriate selection, training, induction or clinical supervision of an appropriate stand in. Be it due to poor governance, audit or quality control the cost to the practitioner, practice, profession and patient can be high. To mitigate this risk a comprehensive risk management system will be needed in practice. Planning to prevent such risks requires understanding, analysing, managing and costing the risk. Success depends on robust systems for screening, contracting and training of staff within an educated team of safety orientated personnel supported by suitable frameworks for standards, resources, policies, protocols, processes and checks within a clearly identifiable chain of command.

Dental Assistants↗

PubMed1999

The missed session in psychodynamic group psychotherapy.

Missed sessions in group psychotherapy are often overlooked or not talked about, thus forfeiting an important therapeutic opportunity. Group members miss meetings for many different reasons, be they the result of real-life events or clinically driven occurrences. Missed sessions can have important emotional and metaphorical meanings for the missing member, the other group members, and the leader. Countertransference difficulties may interfere with optimal exploration of the many meanings of missed sessions. Five clinical examples illustrate meanings that may reside in the missed session. A cancellation policy that provides a framework for such exploration is recommended.

Appointments and Schedules↗

PubMed1998

Analysis of third-party certification approaches using an occupational health and safety conformity-assessment model.

The occupational health and safety conformity-assessment model presented in this article was developed (1) to analyze 22 public and private programs to determine the extent to which these programs use third parties in conformity-assessment determinations, and (2) to establish a framework to guide future policy developments related to the use of third parties in occupational health and safety conformity-assessment activities. The units of analysis for this study included select Occupational Safety and Health Administration programs and standards, International Organization for Standardization-based standards and guidelines, and standards and guidelines developed by nongovernmental bodies. The model is based on a 15-cell matrix that categorizes first-, second-, and third-party activities in terms of assessment, accreditation, and accreditation-recognition activities. The third-party component of the model has three categories: industrial hygiene/safety testing and sampling; product, equipment, and laboratory certification; and, occupational health and safety management system registration/certification. Using the model, 16 of the 22 programs were found to have a third-party component in their conformity-assessment structure. The analysis revealed that (1) the model provides a useful means to describe and analyze various third-party approaches, (2) the model needs modification to capture aspects of traditional governmental conformity-assessment/enforcement activities, and (3) several existing third-party conformity-assessment systems offer robust models that can guide future third-party policy formulation and implementation activities.

Accreditation↗

PubMed1991

Family and community: changing roles in an aging society.

A holistic approach to the provision of social care of the elderly can best meet their future needs for assistance. In this paper, the concept of social care is delineated, and a systemwide model presented. This model emphasizes the interrelatedness of the component parts--informal, mediating, and formal--and the need for well-articulated linkages among them. Trends affecting future demand for care, and the ability of family and community to respond, are discussed. Although the family will retain an important role, some of its functions may shift to formal care in the decades ahead. Within the proposed framework, a research and policy agenda is suggested.

Aged↗

PubMed2006

Health service providers' perceptions of barriers to tuberculosis care in Russia.

The Russian Federation has witnessed a marked rise in rates of tuberculosis (TB) over the past decade. Public health TB control institutions remain broadly modelled along pre-1990 lines despite substantial programmes of investment and advocacy in implementing the World Health Organization's 'Directly Observed Treatment--short course' (DOTS) strategy. In 2002, we undertook a qualitative study to explore health care providers' perceptions of existing barriers to access to TB services in Samara Oblast in Russia. Six focus group discussions were conducted with physicians and nurses from facilities in urban and rural areas. Data were analyzed using a framework approach for applied policy research. Barriers to access to care were identified in interconnected areas: barriers associated with the health care system, care process barriers, barriers related to wider contextual issues, and barriers associated with patients' personal characteristics and behaviour. In the health care system, insufficient funding was identified as an underlying problem resulting in a decrease in screening coverage, low salaries, staff shortages, irregularities in drug supplies and outdated infrastructure. Suboptimal collaboration with general health services and social services limits opportunities for care and social support to patients. Worsening socioeconomic conditions were seen both as a cause of TB and a major obstacle to access to care. Behavioural characteristics were identified as an important barrier to effective care and treatment, and health staff favoured compulsory treatment for 'noncompliant' patients and involvement of the police in defaulter tracing. TB was profoundly associated with stigma and this resulted in delays in accessing care and barriers to ensuring treatment success.

Focus Groups↗

PubMed1990

Public philosophy: distinction without authority.

An assumed core of normative ethical principles may constitute a philosophically proper framework within which public policy should be formulated, but it seldom provides any substantive solutions. To generate public policy on bioethical issues, participants still need to confront underlying philosophical controversies. Professional philosophers' proper role in that process is to clarify major philosophical options, to press wider-ranging consistency questions, and to bring more parties into the philosophical debate itself by arguing for particular substantive claims. Though questions of fact that mediate final policy conclusions frequently fall outside philosophical competence, one sort of fact, lack of political support, should seldom cause philosophers to stand aside; philosophers still have an important role as critics of culture, politics, and profession. They have no authority, however, on even the philosophical presuppositions of public policy.

Advisory Committees↗

PubMed2000

The Children's Health Insurance Program: expanding the framework to evaluate state goals and performance.

A comprehensive framework was devised to evaluate the State Children's Health Insurance Program (SCHIP) established in 1997. The framework relies on a number of potential measures and data sources for reviewing the program information recorded by states in SCHIP applications, particularly their strategic objectives and proposed performance measures. The analysis reveals that the states propose a wide range of objectives and measures and that there is considerable variation among the states. Overall, states' SCHIP plans tend to stress program enrollment and access to services but fail to emphasize the type and quality of services children receive once they are enrolled in the program. A broader conceptual framework is needed for policy makers, advocates, and researchers to make a full assessment of state goals and SCHIP performance.

Child↗

PubMed1994

Mandated AA attendance for recidivist drinking drivers: ideology, organization, and California criminal justice practices.

This paper examines 2877 municipal court drunk driving cases sampled from 1982 to 1989 in four California sites. Recidivist drinking drivers were those charged with driving under the influence and having two or more drunk driving convictions on their records. In two sites, virtually no AA referrals were made. In the others, in addition to jail terms and fines, judges ordered attendance at meetings of AA for 37-41% of cases. Referral to AA was unrelated to blood alcohol level or number of prior drinking driving convictions. In one AA-referring site, the data indicate that over 75% of drinking drivers convicted in the 1988-89 period were referred to AA by a judge or county probation or parole officer. These findings suggest that, as a whole, California sentencing policies lack a coherent framework. Instead of reflecting information on program effectiveness and offenders' needs, variation in sentencing appears to mark differences in local fiscal circumstances, levels of jail crowding and ideological orientations of judges and other officials. It is suggested that referral practices could have an adverse impact on both individuals' alcohol problems and on recovery programs.

Adult↗

PubMed2005

The dilemma of past success: insiders' views on the future of the international family planning movement.

Many observers believe that the international family planning movement has played a significant role in reducing fertility levels and slowing population growth in the developing world. Yet the perceived success of family planning programs recently has led some researchers to formulate questions about their relevance and future place on the development policy agenda. Within a framework derived from the sociological literature on social movements, we use interviews and focus-group discussions with insiders in the field of population studies to examine current perspectives on the status and future of the family planning movement, factors contributing to its declining international visibility, and possible responses from the family planning field. Informants cited four possible courses of action for the movement: (1) forming strategic alliances with other movements, specifically HIV/AIDS prevention; (2) redefining the family planning message to mobilize and strengthen support; (3) improving service delivery to broaden public acceptance and contraceptive method use; and (4) nurturing new leadership. The future course of the movement--whether it be one of cooptation by overlapping movements or revitalization--requires waiting until its full history can be written.

Family Planning Services↗