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This article proposes a theoretical model for leaders to use to address organizational human conflict and disruptive behavior in health care organizations. Leadership is needed to improve interpersonal relationships within the workforce. A workforce with a culture of internal conflict will be unable to achieve its full potential to delivery quality patient care.
Widespread interest in global health issues is a common characteristic of students and faculty in schools of public health and schools of medicine. Building on strong university-based and community-based programs in global health, the University of Washington has created a unique Department of Global Health that is housed jointly in its School of Public Health and Community Medicine and its School of Medicine. The creation of this department has generated significant enthusiasm throughout the university and the Seattle community as a new paradigm for addressing global health education, research, and service. Placing the new Department of Global Health in two university schools and finding the appropriate niche for the department among the university's many global health initiatives presented challenges, as well as opportunities. This article describes the goals of the department, the process by which it was created, and what it expects to accomplish.
With the epidemic rise of ESRD in multiple regions of the world, there is an urgent need to implement programs to address this increasing burden of kidney disease. We illustrate a public health approach using the program of the National Kidney Foundation of Singapore that incorporates stepwise primary, secondary, and tertiary strategies for prevention. Components of the program include an aggressive public education program, routine surveillance for kidney disease and associated chronic diseases, the implementation of a disease management program to improve physician practice patterns, and the provision of comprehensive services in the community through a network of Prevention Centers designed to optimize the care of patients at risk for kidney disease. Finally, an equally important aspect is the clinical and epidemiologic research component, because this will provide clear benchmarks to determine the program's effect on ESRD as well as generate information that can be used to identify future directions for this evolving program.
Terrorism, although perhaps known by other names, is not a new phenomenon. It dates back to Roman times and perhaps even further in world history. Caleb Carr says terrorism "is simply the contemporary name given to, and the modern permutation of, warfare deliberately waged against civilians with the purpose of destroying their will to support either their leaders or policies... " In modern times, in the United States, there have been isolated violent acts of citizens against each other, although these acts often were directed toward symbols of the federal government. In the Middle East and other parts of the world, acts of violence against U.S. citizens and military personnel date back into the early 1960's. Some of these acts seem to be almost random in nature. But these events occurred in distant lands of sometimes uncertain locations to the American public, who soon forgot them and their important message. Even though there had been at least one other attempt on the World Trade Center, it was not until 11 September 2001 that successful, large-scale acts of terrorism came to our shores. In 1998, the National Council on Radiation Protection and Measurements (NCRP) formed a Scientific Committee and charged the committee with the task of providing a report on the state of preparation and the potential use by terrorists of radiation and radioactivity. The draft report of the Committee was produced a year in advance of the events of 11 September 2001 and was published in its final form about a month after these terrible events. The report brought together, in one place, information that existed in a number of areas, not all of which were easily accessible. However, there were a number of gaps in the information and in the planning and preparation for such events. These were reflected in a series of recommendations for organization, planning, and training, as well as for research and development in a number of areas. This brief presentation will address a few selected areas that remain a challenge for those preparing for terrorist events involving radioactive materials. More detailed discussions will be provided by the presentations at this NCRP Annual Meeting.
A consistent and transparent risk-informed approach to managing nuclear waste is plagued with different regulators, different rules and regulations for different waste types, different compliance requirements, and indecisions about probabilistic vs. deterministic models. Low-activity waste management is particularly void of a path forward with respect to being risk-informed. Risk assessment is not referenced in the statutes on low-activity waste even though both the U.S. Environmental Protection Agency and U.S. Nuclear Regulatory Commission (U.S. NRC) have policies to apply consistent risk management approaches to all of their programs. The U.S. NRC has developed guidance on the preparation of probabilistic performance assessments for low-activity waste facilities, but there have been no serious takers and a lack of initiative on the part of licensees. Thus, little to no experience exists on risk-informing low-activity waste. The missed opportunities include establishing a risk basis that would allow for simpler, safer, and much less costly alternatives for low-activity waste disposal while enabling society to have the full benefit of radiation technologies. There is hope that congressional action or regulatory rule making will address some of these issues with the result being the adoption of a more general and unified approach to risk-informed regulation of all types of waste. Just as much of the initiative for risk-informed nuclear power came from industry, it must also be the case for nuclear waste. A start would be the adoption of a basic framework of risk assessment in waste management applicable to all types of waste--radioactive and nonradioactive. The "set of triplets" risk assessment framework that is applicable to any kind of risk is an established alternative. It is believed that such a framework with the support of a regulatory structure made compatible through appropriate rulemaking or congressional action, and the experience of the probabilistic performance assessments for the Waste Isolation Pilot Plant and the proposed Yucca Mountain high-level waste repository, could result in the right path forward for the regulation and management of low-activity waste.
BACKGROUND: Behavioral interventions to address the complex medical and HIV risk reduction needs of HIV-seropositive (HIV-positive) injection drug users (IDUs) are urgently needed. We describe the development of Interventions for Seropositive Injectors-Research and Evaluation (INSPIRE), a randomized controlled trial of an integrated intervention for HIV-positive IDUs, and the characteristics of the baseline sample. METHODS: HIV-positive IDUs were recruited from community settings in 4 US cities. After completing a baseline assessment, participants who attended the first session were randomly assigned to (1) a 10-session peer mentoring intervention designed to improve utilization of HIV care, to improve adherence to HIV medications, and to reduce sexual and injection risk or (2) an 8-session videotape control. Periodic follow-up for 12 months is ongoing. RESULTS: A total of 1161 HIV-positive IDUs completed the baseline assessment, and 966 (83%) were randomized. Retention rates are greater than 80% for all follow-up periods. Approximately 79% of baseline participants reported a recent medical visit, 49% were taking highly active antiretroviral therapy, and 19% had an undetectable viral load. Use of injection and noninjection substances was prevalent, and sexual and injection risks were each reported by more than 25% of participants. CONCLUSION: There is a need for an integrated intervention for HIV-positive IDUs, and these data show the acceptability of such an approach.
Children with spastic cerebral palsy (CP) often suffer pain as a result of their spasms. Some studies have suggested that the pain experienced by these children may be poorly controlled or respond poorly to treatment. Limited research is available that addresses the treatment of pain due to spasms in children. Therefore, clinicians do not have empirical evidence to guide their decisions. Many current treatment options have not been tested for their effect on pain. Previous research has been guided more by the ability of these treatments to increase functional abilities. Pain also is an important indicator of quality of life; however, this has been overlooked in research.
Population structure is a well-known confounder in statistical genetics, particularly in genome-wide association studies (GWAS), where it can lead to inflated test statistics and spurious associations. Traditional methods, such as principal components (PCs), commonly used to adjust for population structure, are limited in capturing fine-scale, non-linear patterns that arise from recent demographic events - patterns that are crucial for understanding rare variant effects. To address this challenge, we propose a novel method called SPectral Components (SPCs), which leverages identity-by-descent (IBD) graphs to capture and transform local, non-linear fine-scale population structure into continuous representations that can be seamlessly integrated into genetic analysis pipelines. Using both simulated datasets and empirical data from the UK Biobank (N ≈ 420,000), we demonstrate that SPCs outperform PCs in adjusting for fine-scale population structure. In simulations, SPCs explained over 90% of the fine-scale population structure with fewer components, while PCs captured less than 5%. In the UK Biobank, SPCs reduced the inflation of p-values in the GWAS of an environmental-driven phenotype by 12% compared to PCs, while maintaining a similar performance to PCs in height, a highly heritable phenotype. Additionally, SPCs improved rare variant association analyses, reducing genomic inflation (e.g., from 7.6 to 1.2 in one analysis), and provided more accurate heritability estimates. Spatial autocorrelation analysis further confirmed the ability of SPCs to account for environmental effects, reducing Moran's I for both environmental and heritable phenotypes more effectively than PCs. Overall, our findings demonstrate that SPCs provide a robust, scalable adjustment for recent population structure, offering a powerful alternative or complement to PCs in large-scale biobank studies.
A continuum theory of dielectric relaxation within liquid crystal materials is described and used to model the response of dual frequency materials to single pulse voltage waveforms. The equations governing the anisotropic axis (director) angle, electric field, and induced polarizations are solved numerically to investigate pulsed addressing of a model zenithally bistable liquid crystal device. By suitably tailoring the voltage pulse, it is found to be possible to switch between both bistable states. For short pulses the high frequency components of the leading edge of the voltage pulse excites the perpendicular polarization and forces the director to lie parallel to the cell substrates. For longer voltage pulses the constant dc component of the voltage pulse excites the parallel polarization causing the director to lie perpendicular to the substrates. It is also found that reducing rotational viscosity and increasing the achievable dielectric anisotropies (particularly the high frequency value) can significantly reduce the operating voltages of such a device.
We experimentally demonstrate novel structures for the realization of registers of atomic qubits: We trap neutral atoms in one- and two-dimensional arrays of far-detuned dipole traps obtained by focusing a red-detuned laser beam with a microfabricated array of microlenses. We are able to selectively address individual trap sites due to their large lateral separation of 125 microm. We initialize and read out different internal states for the individual sites. We also create two interleaved sets of trap arrays with adjustable separation, as required for many proposed implementations of quantum gate operations.
A strategy was developed for the high-throughput localization of unknown expressed proteins in Nicotiana benthamiana. Libraries of random, partial cDNAs fused to the 5' or 3' end of the gene for green fluorescent protein (GFP) were expressed in planta using a vector based on Tobacco mosaic virus. Viral populations were screened en masse on inoculated leaves using a confocal microscope fitted with water-dipping lenses. Each viral infection site expressed a unique cDNA-GFP fusion, allowing several hundred cDNA-GFP fusions to be screened in a single day. More than half of the members of the library carrying cDNA fusions to the 5' end of gfp that expressed fluorescent fusion proteins displayed discrete, noncytosolic, subcellular localizations. Nucleotide sequence determination of recovered cDNA sequences and subsequent sequence searches showed that fusions of GFP to proteins that had a predicted subcellular "address" became localized with high fidelity. In a subsequent screen of >20,000 infection foci, 12 fusion proteins were identified that localized to plasmodesmata, a subcellular structure for which very few protein components have been identified. This virus-based system represents a method for high-throughput functional genomic study of plant cell organelles and allows the identification of unique proteins that associate with specific subcompartments within organelles.
The light-addressable potentiometric sensor (LAPS) measures localized photo-induced currents from a silicon wafer, which are dependent on the local surface potential and on the intensity of the light pointer. In this study the ability of the LAPS to record extracellular potentials of adherent cells was investigated. Time dependent LAPS photocurrent signals that correlated in time with contractions were recorded from beating cardiac myocytes cultured on LAPS surfaces. Signals could be recorded both when the LAPS was biased to working points where the photocurrent was maximally sensitive to potential changes and when it was biased to working points where the photocurrent was insensitive to changes in surface potential. Therefore, signals could not be predominantly created by changes in extracellular potential and might be related to mechanical contractions. One possible explanation might be, that the cell-induced modulation of photocurrents arose as a result of cell shape changes. Such alterations in cell shape might have focused and defocused the light pointer and, thus, modulated its intensity. To further test this hypothesis, height changes of beating cardiac myocytes were measured with an atomic force microscope (AFM). They were found to match well with signals derived from LAPS measurements. Therefore, it can be concluded, that LAPS signals were mainly determined by the periodic changes in shape of beating heart cells, and this interference precludes the measurements of extracellular electrophysiological potentials from these cells.
We analyze the radiated emissions from a low power electrosurgical unit (ESU). Measurements at a 3-meter distance are performed in order to find a suitable measurement setup intended to reproduce realistically the real working ESU behavior in a test lab. The broad-band and narrow-band characteristics of the perturbation are studied in order to address the other equipment immunity.
I have assembled traditional ways to think about human needs and power along with empirical data to support a mental model of human values. The hierarchy of needs from the world of psychology and the hierarchy of power from the world of diplomacy provide a structure for the model. The empirical data collected from several nations over the last three decades support the structure. Furthermore, an examination of specific trends in this data for specific values indicates that it is not impossible to achieve a sustainable world driven by sustainable values. A world that will be defined by its successful movement toward the "triple bottom line," a term articulated by John Elkington, is a world in which economic prosperity, environmental protection, and social equity are aligned. To say that the model allows one to address terrorism is based on the assumption that the lack of social equity or the perception of that lack determines the likelihood of terrorism.
BACKGROUND: Effective transition to adult services is required by an increasing number of children with ongoing needs. AIM: To identify practices that promote continuity at transition between child and adult services. METHODS: Systematic examination of the evidence from two search strategies yielding 5319 items. RESULTS: Only three of the 126 appraised items had strong external validity. A large range of different practices, which focused on the service, the young person and the family, were identified. Practices within the service addressed structural, process and outcome components. CONCLUSION: Four transition models are proposed for testing.
Current challenges facing haemophilia care were identified and reviewed by an interdisciplinary group of experts in haemostasis and thrombosis, infectious disease, epidemiology, pharmacoeconomics and public health who met in February 2005 in Brussels. The outcome of this meeting was a series of consensus recommendations proposed to address the following three challenges: (i) developing the next generation of haemophilia specialists; (ii) reducing the risk that emerging pathogens present to safe haemophilia care and (iii) providing haemophilia care in an environment of cost constraint. It is intended that these consensus recommendations will form the basis of a concerted effort by leading haemophilia clinicians to secure future resources for the development and improvement of haemophilia care throughout Europe.
There is a national commitment to ensuring that, regardless of where patients live, they should be provided with an acceptable level of service in terms of quality, effectiveness and accessibility. Because of differences in the distributions of their populations, rural and urban areas present quite different challenges for the optimal design of health services and social care. However, this has not been fully acknowledged in the development of national policies to unify service standards. The problems of providing services in sparsely populated areas are not new. However, until the case for a rural premium in English health resource allocation is accepted, rural agencies must either tolerate lower levels of services (an option made difficult by the introduction of national service standards) or develop very different approaches to service delivery. To date, there has been little systematic knowledge about the extent of innovative rural practice, a paucity of evaluation of such initiatives and few opportunities to disseminate learning from one area to another. The present paper begins to address this deficit. Drawing upon a review of the formal literature and a comprehensive evaluation of projects developed within a rural Health Action Zone, it presents a typology of innovative responses at the health/social care interface. Examples of service innovations which fall into six broad categories are provided. These not only suggest possibilities for the transfer of good practice, but also the potential for future research.
AIM: This paper reports a study describing nurses' conceptions of how the spiritual dimension is addressed in psychiatric patient-nurse relationships. BACKGROUND: In psychiatric care, it is essential that patient-nurse relationships be built on a holistic view. In this context, nursing research shows that there is a lack of integration of the spiritual dimension. METHOD: Twelve strategically selected psychiatric nurses were interviewed and analysed using a phenomenographic approach. The data were collected in 2003. FINDINGS: The main findings were three descriptive categories: being a good carer, recognizing the spiritual dimension, and regarding the spiritual dimension as difficult to capture in patient-nurse relationships. The first descriptive category shows that nurses deal with spirituality by behaving as good carers. Those included in the second descriptive category reveal nurses who are aware of patients' spiritual needs and who deal with these needs in different ways. The third descriptive category consists of conceptions revealing lack of knowledge of patients' spiritual needs, both in abstract and real terms. CONCLUSIONS: Further research is needed to explore how patients describe their own spiritual needs, and how nursing staff can learn to be aware of and understand their own spirituality, thus enabling them to detect, discuss, clarify and deal with the concept of spirituality in patient-nurse relationships.