bluuebunny/crossref_metadata_2025 huggingface dataset:
Lack of correlation between the effective dose of fentanyl sublingual spray for breakthrough cancer pain and the around-the-clock opioid dose
Authors: Nalamachu, MD Srinivas R. , Parikh Neha , Dillaha, MD Larry , Rauck, MD Richard
Published: October 2015

Objective: To examine the relationship between the dose of fentanyl sublingual spray needed to control breakthrough cancer pain (BTCP) and the dose of around-the-clock (ATC) opioid used to control background pain.Design: Analysis was based on the open-label, dose-titration phase (up to 26 days) of a randomized, double-blind, placebo-controlled trial.Patients: Opioid-tolerant cancer patients (aged ≥18 years) with chronic pain of ≤moderate severity in the 24 hours before screening while receiving stable doses of scheduled ATC opioid therapy for ≥1 week and 1 to 4 episodes of BTCP per day.Interventions: Fentanyl sublingual spray was initiated at 100 μg. Dose titration proceeded until a dose was reached that provided adequate pain relief for two consecutive BTCP episodes without intolerable adverse effects (AEs).Results: Overall, 98/130 (75.4 percent) patients completed the dose-titration phase and achieved pain relief, and 73.5 percent of those who completed the titration period attained an effective dose of ≥600 μg (median effective dose, 800 μg). No clinically relevant correlation was found between effective doses of fentanyl sublingual spray for the treatment of BTCP and the ATC opioid doses used to control persistent pain (Spearman rank correlation [rs ] = 0.351, n = 98). Sixty percent of patients reported ≥1 AE during the dose-titration phase. The most common AEs considered related to study treatment were nausea (6.2 percent), somnolence (4.6 percent), dizziness (3.8 percent), and vomiting (3.8 percent).Conclusions: These findings highlight the importance of titrating the dose of fentanyl sublingual spray to optimize dosing for individual patients.
Review article. Buprenorphine in the workers' compensation setting
Authors: Colameco, MD, MEd, FASAM Stephen , Pohl, MD, FASAM Mel
Published: October 2015

Buprenorphine is approved by the Food and Drug Administration for the treatment of chronic pain in low-dose transdermal patch formulations and for the treatment of addiction in high-dose sublingual tablets and films. Clinicians often prescribe these high-dose preparations “off label” for pain management. In the workers' compensation setting, it is particularly important to consider factors such as a) if the injured person has, and is being treated for co-occurring addiction as well as pain; b) if alternative therapies, including opioid withdrawal, were considered prior to initiating buprenorphine treatment; and c) the anticipated duration of treatment. This article reviews buprenorphine's approved indications, formulations, pharmacology, clinical efficacy, and special considerations in the workers' compensation setting.
High ice water content at low radar reflectivity near deep convection – Part 2: Evaluation of microphysical pathways in updraft parcel simulations
Authors: Ackerman A. S. , Fridlind A. M. , Grandin A. , Dezitter F. , Weber M. , Strapp J. W. , Korolev A. V.
Published: October 2015

Abstract. The aeronautics industry has established that a threat to aircraft is posed by atmospheric conditions of substantial ice water content (IWC) where equivalent radar reflectivity (Ze) does not exceed 20–30 dBZ and supercooled water is not present; these conditions are encountered almost exclusively in the vicinity of deep convection. Part 1 (Fridlind et al., 2015) of this two-part study presents in situ measurements of such conditions sampled by Airbus in three tropical regions, commonly near 11 km and −43 °C, and concludes that the measured ice particle size distributions are broadly consistent with past literature with profiling radar measurements of Ze and mean Doppler velocity obtained within monsoonal deep convection in one of the regions sampled. In all three regions, the Airbus measurements generally indicate variable IWC that often exceeds 2 g m-3 with relatively uniform mass median area-equivalent diameter (MMDeq) of 200–300 μm. Here we use a parcel model with size-resolved microphysics to investigate microphysical pathways that could lead to such conditions. Our simulations indicate that homogeneous freezing of water drops produces a much smaller ice MMDeq than observed, and occurs only in the absence of hydrometeor gravitational collection for the conditions considered. Development of a mass mode of ice aloft that overlaps with the measurements requires a substantial source of small ice particles at temperatures of about −10 °C or warmer, which subsequently grow from water vapor. One conceivable source in our simulation framework is Hallett–Mossop ice production; another is abundant concentrations of heterogeneous ice freezing nuclei acting together with copious shattering of water drops upon freezing. Regardless of the production mechanism, the dominant mass modal diameter of vapor-grown ice is reduced as the ice-multiplication source strength increases and as competition for water vapor increases. Both mass and modal diameter are reduced by entrainment and by increasing aerosol concentrations. Weaker updrafts lead to greater mass and larger modal diameters of vapor-grown ice, the opposite of expectations regarding lofting of larger ice particles in stronger updrafts. While stronger updrafts do loft more dense ice particles produced primarily by raindrop freezing, we find that weaker updrafts allow the warm rain process to reduce competition for diffusional growth of the less dense ice expected to persist in convective outflow.
Modelling marine emissions and atmospheric distributions of halocarbons and dimethyl sulfide: the influence of prescribed water concentration vs. prescribed emissions
Authors: Lennartz S. T. , Krysztofiak G. , Marandino C. A. , Sinnhuber B.-M. , Tegtmeier S. , Ziska F. , Hossaini R. , Krüger K. , Montzka S. A. , Atlas E. , Oram D. E. , Keber T. , Bönisch H. , Quack B.
Published: October 2015

Abstract. Marine-produced short-lived trace gases such as dibromomethane (CH2Br2), bromoform (CHBr3), methyliodide (CH3I) and dimethyl sulfide (DMS) significantly impact tropospheric and stratospheric chemistry. Describing their marine emissions in atmospheric chemistry models as accurately as possible is necessary to quantify their impact on ozone depletion and Earth's radiative budget. So far, marine emissions of trace gases have mainly been prescribed from emission climatologies, thus lacking the interaction between the actual state of the atmosphere and the ocean. Here we present simulations with the chemistry climate model EMAC (ECHAM5/MESSy Atmospheric Chemistry) with online calculation of emissions based on surface water concentrations, in contrast to directly prescribed emissions. Considering the actual state of the model atmosphere results in a concentration gradient consistent with model real-time conditions at the ocean surface and in the atmosphere, which determine the direction and magnitude of the computed flux. This method has a number of conceptual and practical benefits, as the modelled emission can respond consistently to changes in sea surface temperature, surface wind speed, sea ice cover and especially atmospheric mixing ratio. This online calculation could enhance, dampen or even invert the fluxes (i.e. deposition instead of emissions) of very short-lived substances (VSLS). We show that differences between prescribing emissions and prescribing concentrations (−28 % for CH2Br2 to +11 % for CHBr3) result mainly from consideration of the actual, time-varying state of the atmosphere. The absolute magnitude of the differences depends mainly on the surface ocean saturation of each particular gas. Comparison to observations from aircraft, ships and ground stations reveals that computing the air–sea flux interactively leads in most of the cases to more accurate atmospheric mixing ratios in the model compared to the computation from prescribed emissions. Calculating emissions online also enables effective testing of different air–sea transfer velocity (k) parameterizations, which was performed here for eight different parameterizations. The testing of these different k values is of special interest for DMS, as recently published parameterizations derived by direct flux measurements using eddy covariance measurements suggest decreasing k values at high wind speeds or a linear relationship with wind speed. Implementing these parameterizations reduces discrepancies in modelled DMS atmospheric mixing ratios and observations by a factor of 1.5 compared to parameterizations with a quadratic or cubic relationship to wind speed.
Wide-banded NTC radiation: local to remote observations by the four Cluster satellites
Authors: Décréau P. M. E. , Aoutou S. , Denazelle A. , Galkina I. , Rauch J.-L. , Vallières X. , Canu P. , Rochel Grimald S. , El-Lemdani Mazouz F. , Darrouzet F.
Published: October 2015

Abstract. The Cluster multi-point mission offers a unique collection of non-thermal continuum (NTC) radio waves observed in the 2–80 kHz frequency range over almost 15 years, from various view points over the radiating plasmasphere. Here we present rather infrequent case events, such as when primary electrostatic sources of such waves are embedded within the plasmapause boundary far from the magnetic equatorial plane. The spectral signature of the emitted electromagnetic waves is structured as a series of wide harmonic bands within the range covered by the step in plasma frequency encountered at the boundary. Developing the concept that the frequency distance df between harmonic bands measures the magnetic field magnitude B at the source (df = Fce, electron gyrofrequency), we analyse three selected events. The first one (studied in Grimald et al., 2008) presents electric field signatures observed by a Cluster constellation of small size (~ 200 to 1000 km spacecraft separation) placed in the vicinity of sources. The electric field frequency spectra display frequency peaks placed at frequencies fs = n df (n being an integer), with df of the order of Fce values encountered at the plasmapause by the spacecraft. The second event, taken from the Cluster tilt campaign, leads to a 3-D view of NTC waves ray path orientations and to a localization of a global source region at several Earth radii (RE) from Cluster (Décréau et al., 2013). The measured spectra present successive peaks placed at fs ~ (n+ 1/2) df. Next, considering if both situations might be two facets of the same phenomenon, we analyze a third event. The Cluster fleet, configured into a constellation of large size (~ 8000 to 25 000 km spacecraft separation), allows us to observe wide-banded NTC waves at different distances from their sources. Two new findings can be derived from our analysis. First, we point out that a large portion of the plasmasphere boundary layer, covering a large range of magnetic latitudes, is radiating radio waves. The radio waves are issued from multiple sources of small size, each related to a given fs series and radiating inside a beam of narrow cone angle, referred to as a beamlet. The beamlets illuminate different satellites simultaneously, at different characteristic fs values, according to the latitude at which the satellite is placed. Second, when an observing satellite moves away from its assumed source region (the plasmapause surface), it is illuminated by several beamlets, issued from nearby sources with characteristic fs values close to each other. The addition of radio waves blurs the spectra of the overall received electric field. It can move the signal peaks such that their position fs satisfiesfs = (n+α) df, with 0 < α < 1. These findings open new perspectives for the interpretation of NTC events displaying harmonic signatures.
Quantifying the influence of CO2 seasonality on future aragonite undersaturation onset
Authors: Sasse T. P. , McNeil B. I. , Matear R. J. , Lenton A.
Published: October 2015

Abstract. Ocean acidification is a predictable consequence of rising atmospheric carbon dioxide (CO2), and is highly likely to impact the entire marine ecosystem – from plankton at the base of the food chain to fish at the top. Factors which are expected to be impacted include reproductive health, organism growth and species composition and distribution. Predicting when critical threshold values will be reached is crucial for projecting the future health of marine ecosystems and for marine resources planning and management. The impacts of ocean acidification will be first felt at the seasonal scale, however our understanding how seasonal variability will influence rates of future ocean acidification remains poorly constrained due to current model and data limitations. To address this issue, we first quantified the seasonal cycle of aragonite saturation state utilizing new data-based estimates of global ocean-surface dissolved inorganic carbon and alkalinity. This seasonality was then combined with earth system model projections under different emissions scenarios (representative concentration pathways; RCPs 2.6, 4.5 and 8.5) to provide new insights into future aragonite undersaturation onset. Under a high emissions scenario (RCP 8.5), our results suggest accounting for seasonality will bring forward the initial onset of month-long undersaturation by 17 ± 10 years compared to annual-mean estimates, with differences extending up to 35 ± 16 years in the North Pacific due to strong regional seasonality. This earlier onset will result in large-scale undersaturation once atmospheric CO2 reaches 496 ppm in the North Pacific and 511 ppm in the Southern Ocean, independent of emission scenario. This work suggests accounting for seasonality is critical to projecting the future impacts of ocean acidification on the marine environment.
Clay-biodegradable polymer combination for pollutant removal from water
Authors: Mohd Amin M. F. , Heijman S. G. J. , Rietveld L. C.
Published: October 2015

Abstract. In this study, a new treatment alternative is investigated to remove micropollutants from wastewater effectively and in a more cost-effective way. A potential solution is the use of clay in combination with biodegradable polymeric flocculants. Flocculation is viewed as the best method to get the optimum outcome from the combination of clay with starch. Clay is naturally abundantly available and relatively inexpensive compared to the conventional adsorbents used. Experimental studies were carried out with four different clays to select the best clay for further optimisation. The atrazine removal achieved is in the range of 10–99 % based on the clay concentration of 10–50 g L−1. Optimisation of the best clay performer leads towards atrazine reduction of > 99 % with a dosage of 100 mg L−1. The best and underperforming clays were then tested in other experiments with the addition of cationic starch flocculants. In this experiment, the addition of a polymer increased the atrazine removal for the underperforming clay to 46 % with only 10 mg L−1 clay dosages. The clay flocculation test was also performed to test the flocculation efficiency of clays by the polymer. Approximately 80–84 % of the clay is flocculated, which shows exceptional flocculation efficiency in removing both clays and atrazine from the water matrices.
Effects of changes in moisture source and the upstream rainout on stable isotopes in precipitation – a case study in Nanjing, eastern China
Authors: Tang Y. , Pang H. , Zhang W. , Li Y. , Wu S. , Hou S.
Published: October 2015

Abstract. In the Asian monsoon region, variations in the stable isotopic composition of speleothems have often been attributed to the "amount effect". However, an increasing number of studies suggest that the "amount effect" in local precipitation is insignificant or even non-existent. To explore this issue further, we examined the variability of daily stable isotopic composition (δ18O) in precipitation from September 2011 to November 2014 in Nanjing, eastern China. We found that intra-seasonal variations of δ18O during summer were not significantly correlated with local rainfall amount but could be linked to changes in the moisture source location and rainout processes in the source regions. Our findings suggest that the stable isotopes in summer precipitation could signal the location shift of precipitation source regions in the inter-tropical convergence zone (ITCZ) over the course of the monsoon season. As a result, changes in moisture source location and upstream rainout effect should be taken into account when interpreting the stable isotopic composition of speleothems in the Asian monsoon region. In addition, the temperature effect on isotopic variations in non-monsoonal precipitation should also be considered because precipitation in the non-monsoon season accounts for about half of its annual precipitation.
Analysis of a landslide multi-date inventory in a complex mountain landscape: the Ubaye valley case study
Authors: Schlögel R. , Malet J.-P. , Reichenbach P. , Remaître A. , Doubre C.
Published: October 2015

Abstract. In the paper we analyse a multi-date landslide inventory prepared for a mountainous area affected by several landslide types with different degrees of activity, we attempt to quantify the uncertainties associated to the mapping, we measure the evolution of morphological indicators and estimate landslide activity and temporal occurrence. The inventory, covering the period 1956–2010, is prepared for the middle section of the Ubaye valley (southern French Alps) based on the analysis of multi-source documents (geomorphological maps, historical reports of landslide events, field surveys, orthophotographs and SAR (synthetic aperture radar) satellite images). The uncertainties derived from the expert interpretation of different sources of information, the landslide morphological features and the affected land covers are taken into account in relation to the source documents. Morphological indicators are calculated to describe quantitatively the evolution of the landslides (length, area, relative elevation, runout distance). Frequency–area density functions are computed to estimate the changes in the landslide distributions and a Poisson model is used to estimate the probability of reactivation of the observed landslides and the occurrence of new failures. The proposed multi-date inventory and the associated statistics provide additional information to the event catalogue managed by the local policy makers.
Preliminary assessment for the use of VORIS as a tool for rapid lava flow simulation at Goma Volcano Observatory, Democratic Republic of the Congo
Authors: Syavulisembo A. M. , Havenith H.-B. , Smets B. , d'Oreye N. , Marti J.
Published: October 2015

Abstract. Assessment and management of volcanic risk are important scientific, economic, and political issues, especially in densely populated areas threatened by volcanoes. The Virunga volcanic province in the Democratic Republic of the Congo, with over 1 million inhabitants, has to cope permanently with the threat posed by the active Nyamulagira and Nyiragongo volcanoes. During the past century, Nyamulagira erupted at intervals of 1–4 years – mostly in the form of lava flows – at least 30 times. Its summit and flank eruptions lasted for periods of a few days up to more than 2 years, and produced lava flows sometimes reaching distances of over 20 km from the volcano. Though most of the lava flows did not reach urban areas, only impacting the forests of the endangered Virunga National Park, some of them related to distal flank eruptions affected villages and roads. In order to identify a useful tool for lava flow hazard assessment at Goma Volcano Observatory (GVO), we tested VORIS 2.0.1 (Felpeto et al., 2007), a freely available software (http://www.gvb-csic.es) based on a probabilistic model that considers topography as the main parameter controlling the lava flow propagation. We tested different parameters and digital elevation models (DEM) – SRTM1, SRTM3, and ASTER GDEM – to evaluate the sensitivity of the models to changes in input parameters of VORIS 2.0.1. Simulations were tested against the known lava flows and topography from the 2010 Nyamulagira eruption. The results obtained show that VORIS 2.0.1 is a quick, easy-to-use tool for simulating lava-flow eruptions and replicates to a high degree of accuracy the eruptions tested when input parameters are appropriately chosen. In practice, these results will be used by GVO to calibrate VORIS for lava flow path forecasting during new eruptions, hence contributing to a better volcanic crisis management.
Nigerian Foreign Policy in a Globalising World: The Imperative of a Paradigm Shift
Authors: OTA EJITU N. , Ecoma Chinyere S.
Published: October 2015

The end of East-West hostilities in 1991 brought to the fore of international relations, some issues that had hitherto either been ignored or trivialised. One of these is the phenomenon commonly referred to as globalisation, which is more or less a euphemism for westernisation. Like colonisation, globalisation is propelled not by any moral considerations or an abstract concept of humanitarianism, but by the more economic exigencies of finding reliable markets for the industrial goods and services of the developed world as well as ready sources of raw materials for the industries of the world’s major economic powers. For developing countries like Nigeria, where political leadership influences not only domestic policies but foreign policy as well, there is a compelling need to embrace the globalisation with cautious optimism. For one thing, globalisation is a powerful force for growth and development. For another, it is a process that presents both challenges and opportunities. Such opportunities, however, must be exploited against the background of a dynamic foreign policy that sees the welfare of Nigerians as its major objective.
Higher Education and the Market
Authors: Hill Catharine
Published: October 2015

Neoclassical economists make the case for profit seeking firms in the private sector because they supply goods and services efficiently, meeting consumer demand at the least possible price and the highest quality. The government also supplies some goods and services directly, and also has made provisions for non-profit firms to do so, recognizing that in some cases for-profit firms will not supply them efficiently, because of a variety of market failures. In the United States, higher education has been one of those services that has traditionally been supplied to a large extent by non-profits and the government sector, and not by the for-profit sector. Over the last few decades, that has been changing radically, with much of the growth in enrollments in higher education taking place in the for-profit sector. Understanding the evolving roles of for-profits, non-profits and the public sector in the provision of higher education over the past several decades is important because they can have public policy implications. The government’s response to market failure, in particular, has welfare implications for both individuals and society.
Suicide Prevention and Follow-Up Services: A Narrative Review
Authors: Ghanbari Behrooz , Malakouti Seyed Kazem , Nojomi Marzieh , Alavi Kaveh , Khaleghparast Shiva
Published: October 2015

Previous suicide attempt is the most important predictor of death by suicide. Thus preventive interventions after attempting to suicide is essential to prevent reattempts. This paper attempts to determine whether phone preventive interventions or other vehicles (postal cards, email and case management) are effective in reattempt prevention and health promotion after discharge by providing an overview of studies on suicide reattempts. The research investigated in this review conducted from 1995 to 2014. A total of 26 cases related to the aim of this research were derived from 36 English articles with the aforementioned keywords Research shows that providing comprehensive aids, social support, and follow-up after discharge can significantly prevent suicide reattempts. Several studies showed that follow-up support (phone calls, crisis cards, mails, postal cards.) after discharge can significantly decrease the risk of suicide. More randomized controlled trials (RCT) are required to determine what factors of follow-up are more effective than other methods.
Factors Affecting Improved Prenatal Screening: A Narrative Review
Authors: Shahhosseini Zohreh , Arabi Hoda , Salehi Azam , Hamzehgardeshi Zeinab
Published: October 2015

BACKGROUND: Prenatal screening deals with the detection of structural and functional abnormalities in the fetus. Health care providers can minimize unintended pregnancy outcomes by providing proper counseling and performing prenatal screening. The purpose of the present review study is to investigate factors affecting improved prenatal screening.

METHODS: The present study is a narrative review searching public databases such as Google Scholar and specialized databases such as Pubmed, Magiran, Scientific Information Database, Elsevier, Ovid and Science Direct as well. Using the keywords “prenatal screening”, “fetus health” and “prenatal counseling”, 70 relevant articles published from 1994 to 2014 were selected. After reviewing the abstracts, the full data from 26 articles were ultimately used for writing the present review study.

RESULTS: Three general themes emerged from reviewing the studies: health care providers' skills, clients' characteristics and ethical considerations, which were the main factors affecting improved prenatal screening.

CONCLUSION: Prenatal screening can be successful if performed by a trained and experienced expert through techniques suitable for the mother's age. Also simultaneously providing proper counseling and giving a full description of the risks and benefits of the procedures for clients is recommended.
Relationship Between Shift Work and Personality Traits of Nurses and Their Coping Strategies
Authors: Farzianpour Fereshteh , Nosrati Saeadeh Ansari , Foroushani Abbas Rahimi , Hasanpour Fateme , Jelodar Zahra Khakdel , Keykale Meysam Safi , Bakhtiari Mohammad , Sadeghi Niusha Shahidi
Published: October 2015

BACKGROUND & OBJECTIVE: Because of social progress, population growth, industrialization, and the requirements of some jobs, a significant percentage of employees are working in shifts. Shift work is considered a threat to health that could have unfavorable effects on various aspects of human life. This study investigated the relationship between shift work and the personality traits of nurses and their coping strategies in a selection of non-governmental hospitals in Tehran in 2014.

METHODS: This applied cross-sectional descriptive research employed the Standard Shift work Index and Eysenck Personality Questionnaire (EPQ) which, after confirmation of its validity and reliability (Cronbach's alpha 0.73), were distributed among 305 nurses from 6 non-governmental hospitals in Tehran selected through cluster random sampling. Data was analyzed in two statistical levels: descriptive and inferential.

RESULTS: Results revealed that 43.6% of the nurses participating in the study were introverted and 56.4% were extroverted. There are significant relationships between age and physical health (P=0.008), sex and physical health (P=0.015), educational level and physical health (P=0.014), sex and cognitive, somatic anxiety (P=0.006), age and social-family status (P=0.001), marital status and social-family status (P=0.001), having a second job and social-family status (P=0.001), educational level and sleep and fatigue (P=0.002), work experience and coping strategies (P=0.044), and sleep and fatigue and personality traits (P=0.032).

CONCLUSION: Complying with the standards of working hours for nurses and avoiding overtime when scheduling, especially for nurses with more work experience, can prevent the severe complications of shift work, enhance health, and ultimately enhance the quality of care. By improving the physical, psychological, and social health of nurses, the quality of patient care can be expected to improve, too.
A Retrospective Study of Causes of Low Vision in Saud Arabia, A Case of Eye World Medical Complex in Riyadh
Authors: Z. Alotaibi Abdullah
Published: October 2015

Vision is the ability of seeing with a definite understanding of features, color and contrast, and to distinguish between objects visually. In the year 1999, the World Health Organization (WHO) and the International Agency for the Prevention of Blindness formulated a worldwide project for the eradication of preventable loss of sight with the subject of “Vision 2020: the Right to Sight”. This global program aims to eradicate preventable loss of sight by the year 2020. This study was conducted to determine the main causes of low vision in Saudi Arabia and also to assess their visual improvement after using low vision aids (LVD).The study is a retrospective study and was conducted in low vision clinic at Eye World Medical Complex in Riyadh, Saudi Arabia. The file medical record of 280 patients attending low vision clinics from February 2008 to June 2010 was included. A data sheet was filled which include: age, gender, cause of low vision, unassisted visual acuity for long distances and short distances, low vision devices needed for long distances and short distances that provides best visual acuity. The result shows that the main cause of low vision was Optic atrophy (28.9%). Retinitis pigmentosa was the second cause of low vision, accounting for 73 patients (26%) followed by Diabetic retinopathy and Macular degeneration with 44 patients (15.7%) and 16 patients (5.7%) respectively. Inter family marriage could be one of the main causes of low vision. Public awareness should be embarked on for enlightenment on ocular diseases result in consanguineous marriage. Also, it is an important issue to start establishing low vision clinics in order to improve the situation.
Primary Health Care Physicians’ Adherence and Attitude Towards Integrated Management of Childhood Illness Guidelines in Alexandria Governorate in Egypt
Authors: El-Ayady Ahmed A. , Meleis Dorreya E. , Ahmed Marwa M. , Ismaiel Rania S.
Published: October 2015

BACKGROUND: Integrated Management of Childhood Illness (IMCI) is a cost-effective strategy that improves the quality of care provided to under – five children. Alexandria was the first governorate that applied the Integrated Management of Childhood Illness guidelines in Egypt. The aim of this study was to assess the degree of primary health care physicians’ adherence and attitude towards those guidelines after 17 years of application.

METHODS: This cross-sectional study was carried out on a representative sample from the primary health care facilities in Alexandria from which physicians using IMCI guidelines were included in the study. The sample units were chosen randomly from all districts of Alexandria. Observational checklists were developed to assess the degree of adherence of physicians based on the guidelines booklet.

RESULTS: The highest adherence score reported was that of writing disease classification (100%). As regards infants aged up to 2 months, the highest physicians’ adherence score reported was that of jaundice and possible bacterial infection assessment (100 % and 95% respectively). And in spite of its importance, only 85.7% of physicians were complied with weight assessment and its plotting in the growth curve. For children aged from 2 months up to 5 years physicians were generally well complied with the guidelines especially for assessment of dangerous signs and possible bacterial infection.

CONCLUSION: Despite being applied for years, IMCI guidelines still show certain areas of poor adherence, an issue that need further investigation in order to maximize physicians’ adherence and achieve the best of their performance.
Patient Involvement in Safe Delivery: A Qualitative Study
Authors: Olfati ForozUn , Asefzadeh Saeid , Changizi Nasrin , Keramat Afsaneh , Yunesian Masud
Published: October 2015

INTRODUCTION: Patient involvement in safe delivery planning is considered important yet not widely practiced. The present study aimed at identifythe factors that affect patient involvementin safe delivery, as recommended by parturient women.

METHODS: This study was part of a qualitative research conducted by content analysis method and purposive sampling in 2013.The data were collected through 63 semi-structured interviews in4 hospitalsand analyzed using thematic content analysis. The participants in this research were women before discharge and after delivery. Findings were analyzed using Colaizzi's method.

RESULTS: Four categories of factors that could affect patient involvement in safe deliveryemerfed from our analysis: patient-related (true and falsebeliefs, literacy, privacy, respect for patient), illness-related (pain, type of delivery, patient safety incidents), health care professional-relatedand task-related factors (behavior, monitoring &training), health care setting-related (financial aspects, facilities).

CONCLUSION: More research is needed to explore the factors affecting the participation of mothers. It is therefore, recommended to: 1) take notice of mother education, their husbands, midwives and specialists; 2) provide pregnant women with insurance coverage from the outset of pregnancy, especially during prenatal period; 3) form a labor pain committee consisting of midwives, obstetricians, and anesthesiologists in order to identify the preferred painless labor methods based on the existing facilities and conditions, 4) carry out research on observing patients’ privacy and dignity; 5) pay more attention on the factors affecting cesarean
Using Health Information Technology to Reach Patients in Underserved Communities: A Pilot Study to Help Close the Gap With Health Disparities
Authors: Ryan Mark H. , Yoder Jonathan , Flores Sharon K. , Soh Jason , Vanderbilt Allison A.
Published: October 2015

INTRODUCTION: In the current era of medical education and curriculum reform, medical schools across the United States are launching innovative approaches to teaching students in order to improve patient outcomes and increase patient safety. One such innovation is the use information technology (IT) that can be used to disseminate health information, especially for patients with limited access to care. Strategies for using health IT to enhance communication between providers and patients in low-income communities can be incorporated into undergraduate medical education (UME) curriculum.

METHODS: A pilot study was conducted to determine if IT could serve as an effective means of communication with patients at a free clinic where 100% of the patients are uninsured; the clinic is located in an urban setting and primarily serves Latinos, the working poor, and the homeless. An anonymous survey was administered to patients to assess rates of IT ownership, general IT use, and IT use for health and medical information.

RESULTS: The majority of study participants owned a cell phone (92%); one-third used their cell phone to access health or medical information (38%). Most study participants reported using the Internet (72%), and two-thirds had used the Internet to obtain health and medical information (64%). 

CONCLUSION: Given the difficulties faced by low income and medically underserved communities in accessing healthcare services, the use of IT tools may improve their’ access to health information in ways that could enhance patient knowledge and self-management, and perhaps positively impact health outcomes. Therefore, it is essential to incorporate use of IT tools in training for medical students and residents to enhance communication with patients in underserved communities.
Association Between Characteristics of Hospitalized Heart Failure Patients With Their Needs
Authors: Polikandrioti Maria , Goudevenos John , Michalis Lampros K. , Koutelekos Ioannis G. , Georgiadi Elpida , Karakostas Constantine , Elisaf Moses
Published: October 2015

INTRODUCTION: During recent years that life expectancy of heart failure patients has been increased, health professionals put more emphasis on assessing their needs in daily clinical practice. The aim of the present study was to explore the association between characteristics of hospitalized heart failure patients with their needs.

METHODS: A sample of 190 hospitalized patients with HF, recruited from public hospitals in Greece, was enrolled in the study. Data were collected by the completion of a questionnaire which included socio-demographic and clinical characteristics and the questionnaire "Needs of hospitalized patients with coronary artery disease" which is consisted of 6 subscales. Statistical methods used were Kruskal wallis-test or Mann-Whitney test and Spearmans' rho coefficient. Multiple regression analysis was performed in order to evaluate the association between patients’ characteristics and the significance of their needs.

RESULTS: 124 (65.3%) of hospitalized heart failure participants were men and 89 (46.8%) of participants were more than 70 years old. 145 (76.3%) had prior experience of hospitalization due to heart failure. The need for support and guidance was statistically significantly associated with the degree of information, (p=<0.001). The need for information from the medical and nursing staff was significantly associated with marital status and degree of information (p=0.001 and p<0.001 respectively). The need for need for being in contact with other patient groups, and ensuring communication with relatives was statistically significantly associated with the professional status and degree of information, (p=0.037 and p=<0.001 respectively). The need for individualized treatment and the need for patient’s personal participation to his/her treatment as well as the need to meet the emotional and physical needs were statistically significant associated with the degree of information, (p=<0.001, p=<0.001 respectively). Lastly, the need to trust the medical and nursing staff was statistically significantly associated with the place of residence and the degree of information, (p=0.023 and p<0.001). These results were confirmed by the multiple linear regression after controlling for potential confounders.

CONCLUSIONS: Information seems to be of vital importance when assessing the needs of heart failure patients. Therefore, providing elaborate information should be an integral part of their therapeutic regimen.
The preliminary reference procedure: challenge or opportunity?
Authors: Hoevenaars Jos
Published: October 2015

The preliminary reference procedure: challenge or opportunity?

This contribution approaches the theme of access to justice from an EU law perspective and deals with the question: to what extent can the preliminary reference procedure serve as an empowering tool for individuals and civil society? The first part of the contribution deals with the structure of the EU legal system and the theoretically empowering function of preliminary references. Based on interviews with litigants and their counsellors, the second part deals with this notion from a sociological and empirical perspective. The analysis reveals the practical obstacles to realizing ones rights by preliminary references, and thus nuances the empowerment thesis found both among legal- and political sciences theories as well as in the legitimating rhetoric by propagators of the EU legal system.
Tenant vs. owner: deriving access to justice from the right to housing
Authors: Moons Nico
Published: October 2015

Tenant vs. owner: deriving access to justice from the right to housing

The right to adequate housing has since long been established in international and European human rights law and has been (constitutionally) incorporated into many domestic legal systems. This contribution focuses on the extent to which this fundamental right influences rental law and the horizontal relationship between tenant and landlord and how it contributes to the tenant’s access to justice. The right to housing certainly accounts for tenant’s rights, but since international and European human rights law evidently centres around state obligations, any possible impact on the position of tenants remains indirect. This is of course different on the national plane. In Belgium, the constitutional right to housing has been implemented through regional Housing Codes, complementing private law measures and creating additional protection to tenants. Nonetheless, many challenges still remain in increasing access to justice for tenants, both top-down and bottom-up: lack of knowledge and complexity of law, imbalance in power and dependency, discrimination, etc.
Challenges and obstacles to access to justice in health care
Authors: Hendriks Aart
Published: October 2015

Challenges and obstacles to access to justice in health care

In the Netherlands, patients have a large number of options to express their dissatisfaction about the services provided by health care providers and can institute all kind of (quasi) legal procedures. None of these procedures was however introduced to ensure patients’ right to access to justice. Access to justice for health care providers confronted with complaints by patients is even less guaranteed. An analysis of Dutch law and practice learns that the access to justice has not found an inroad in the health care sector yet. This is not to suggest that patients lack legal rights, but if access to justice was taken as a yardstick to measures laws against the health care sector, they would have looked differently.
Flora in abandoned fields and adjacent crop fields on rendzina soils in the Zamość region
Authors: Ziemińska-Smyk Marta , Wyłupek Teresa Grażyna , Skwaryło-Bednarz Barbara
Published: October 2015

A floristic inventory of segetal flora was carried out in abandoned fields and adjacent crop fields on rendzina soils in the Zamość region in the year 2010. This study found a total of 130 weed species belonging to 30 botanical families. The following families were represented most frequently: Asteraceae, Fabaceae, Poaceae, Lamiaceae, Scrophulariaceae, and Brassicaceae. In the segetal flora, apophytes are dominant (55% of the total flora), with the highest number of meadow and xerothermic grassland species among them. Archeophytes (38%) predominate in the group of anthropophytes. The species characterized by the highest constancy classes and reaching the highest cover indices posed the greatest threat to crops in the study area. The following weeds are most frequently found in fallow fields: Consolida regalis, Cichorium intybus, and Sinapis arvensis, while Papaver rhoeas is the greatest threat to cereal crops grown on rendzina soils.
Severe Weather Effects on Water Quality in Central Arizona
Authors: Barry Michelle , Chiu Chao‐An , Westerhoff Paul
Published: October 2015

Extreme weather events affect surface water supplies. Water quality measurements in Central Arizona were used to quantify changes in dissolved organic carbon (DOC) and turbidity following dust storms, floods, and drought‐associated wildfires. This article describes specific extreme events, quantifies changes in DOC and turbidity, and discusses the effects of water quality changes on treatment processes and public perceptions of water quality. Study findings show a co‐occurrence of some dust storm events (high particulate matter) and increased surface water turbidity, attenuation of high DOC loads following upper watershed storm events, significant increases in total organic carbon and turbidity following severe flooding in 2005, and differing effects of upland and lowland wildfires on water quality. Finally, a means to mitigate these effects on both perceived and actual water quality by integrating information from radar systems, stream gauge readings, and online water quality analyzers is suggested.
Everyday Citizenship: Identity Claims and Their Reception
Authors: Hopkins Nick , Reicher Stephen D. , van Rijswijk Wendy
Published: October 2015

Citizenship involves being able to speak and be heard as a member of the community. This can be a formal right (e.g., a right to vote). It can also be something experienced in everyday life. However, the criteria for being judged a fellow member of the community are multiple and accorded different weights by different people. Thus, although one may self-define alongside one’s fellows, the degree to which these others reciprocate depends on the weight they give to various membership criteria. This suggests we approach everyday community membership in terms of an identity claims-making process in which first, an individual claims membership through invoking certain criteria of belonging, and second, others evaluate that claim. Pursuing this logic we report three experiments investigating the reception of such identity-claims. Study 1 showed that in Scotland a claim to membership of the national ingroup was accepted more if couched in terms of place of birth and ancestry rather than just in terms of one’s subjective identification. Studies 2 and 3 showed that this differential acceptance mattered for the claimant’s ability to be heard as a community member. We discuss the implications of these studies for the conceptualization of community membership and the realization of everyday citizenship rights.
Moralization and the 2012 U.S. presidential election campaign
Authors: Brandt Mark J. , Wisneski Daniel C. , Skitka Linda J.
Published: October 2015

People vary in the extent to which they imbue an attitude with moral conviction; however, little is known about what makes an issue transform from a relatively non-moral preference to a moral conviction. In the context of the 2012 U.S. presidential election, we test if affect and beliefs (thoughts about harms and benefits) are antecedents or consequences of participants’ moral conviction about their candidate preferences, or are some combination of both. Using a longitudinal design in the run-up to the election, we find that, overall, affect is both an antecedent and consequence, and beliefs about harms and benefits are only consequences, of changes in moral conviction related to candidate preferences. The affect results were consistent across liberals, conservatives, and moderates; however, the role of beliefs showed some differences between ideologues (liberals and conservatives) and moderates.
Flood Resilience Strategies Protect Utilities in Uncertain Times
Authors: Goldbloom‐Helzner David , McFeely Mikko
Published: October 2015

Flooding is an ongoing hazard for water utilities and populations. Successful flood mitigation strategies can prevent the worst effects of these events on water and wastewater systems.
Manage Filter Assets for Media Performance and Capital Planning
Authors: Moore Randy , Miller Roger D. , Bassett Tad , Siegfried Stephen
Published: October 2015

Filters are a water treatment plant's last barrier for particulate and microbial contamination. Filter asset management can maximize filter service life, maintain optimal performance, and allow proactive budgeting.
Use Best Practices to Optimize Filter Performance
Authors: Martin Barb , Linder Kevin
Published: October 2015

Filtration is an essential component of a multibarrier approach to safe drinking water. Optimized filter performance and maintenance of filter integrity will help protect public health.
Las demasiadas aplicaciones: parámetros e indicadores para seleccionar las TopAPP de lectura para niños
Authors: García-Rodríguez Araceli , Gómez-Díaz Raquel
Published: October 2015

La falta de criterios que permitan la evaluación de las aplicaciones de lectura para niños hace que sea complicada la labor de seleccionar las mejores. En el artículo se analizan los elementos que se incluyen en las aplicaciones de lectura infantil así como la manera de evaluarlos de una forma objetiva y sistemática. Para ello ofrece un listado de indicadores estructurados en parámetros que a su vez se agrupan en las dimensiones de forma y contenido. Se propone además un modelo de plantilla que recoge los aspectos fundamentales a evaluar y la indicación de aquellos que son recomendables u obligatorios.