Framing and Claiming the Homelessness Problem

Despite a recent upsurge of interest in the issue, homelessness is a problem of long standing in American society. This article traces how several forces catalyzed the problem\u27s re-entrance onto the political agenda in the 1980s. It then reviews the ongoing debate over homelessness causes and cures as a struggle for problem ownership that has complicated the choices of public policymakers. The final section examines various descriptive attributes that figure into the dispute over how to define homelessness and influence the nature of the public policy response to it

Pamela: development of the RF system for a non-relativistic non-scaling FFAG

The PAMELA project(Particle Accelerator For MEdical Applications) currently consists of the design of a particle therapy facility. The project, which is in the design phase, contains Non-Scaling FFAG, particle accelerator capable of rapid beam acceleration, giving a pulse repetition rate of 1kHz, far beyond that of a conventional synchrotron. To realise the repetition rate, a key component of the accelerator is the rf accelerating system. The combination of a high energy gain per turn and a high repetition rate is a significant challenge. In this paper, options for the rf system of the proton ring and the status of development are presented

Training for impact : the socio-economic impact of a fit for purpose health workforce on communities

Across the globe, a "fit for purpose" health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are:1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively participate in the education process.2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes.3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists.4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services.5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions.6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries.In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment

Progress on the Co-Pyrolysis of Coal and Biomass

In this chapter, the synergistic mechanism and the resulting influence during co-pyrolysis of coal and biomass, are summarized. The properties of coal and biomass, the release and migration of alkali and alkaline earth metals (AAEMs), the interaction between volatile and char, the characteristics of the resulting volatiles, and the physicochemical structure and reactivity of co-pyrolysis char, are also analyzed. In addition, the influence of AAEMs on the properties of the co-pyrolysis products is reviewed. Moreover, the analysis of the co-pyrolysis industry demonstration is also mentioned. Finally, this chapter also proposes some additional possibilities, based on further literature research

Initial Clinical Experience with Swiss LithoClast Trilogy During Percutaneous Nephrolithotomy

Introduction and Objective: Current available lithotrites have clinical stone clearance rates averaging 24 to 32 mm2/minute. The objective of this study was to critically evaluate the initial experience with the Swiss LithoClast® Trilogy lithotrite during percutaneous nephrolithotomy (PCNL). Methods: We prospectively enrolled patients with a minimum of 15 mm of stone in axial diameter at three locations (Indiana University, University of California Davis, and University of California San Diego) scheduled to undergo PCNL for nephrolithiasis over a 60-day trial period. We assessed objective measures of stone clearance time, stone clearance rate, device malfunction, stone-free rate, and complications. Each surgeon also evaluated subjective parameters from each case related to the use of Trilogy on a 1 to 10 scale (10 = extremely effective), and compared it with their usual lithotrite on a 1 to 5 scale (5 = much better). Results: We included 43 patients and had 7 bilateral (16.3%) cases, for a total of 50 renal units. One case was a mini-PCNL. Two cases experienced device malfunctions requiring troubleshooting but no transition to another lithotrite. The mean stone clearance rate was 68.9 mm2/minute. The stone-free rate on postoperative imaging was 67.6% (25 of 37 patients with available imaging). The lowest subjective rating was the ergonomic score of 6.7, and the highest subjective rating was the ease of managing settings score of 9.2. The surgeon impressions of ultrasound (7.3), ballistics (8.1), combination of ultrasound and ballistics (8.7), and suction (8.4) were high. One patient experienced an intraoperative renal pelvis perforation, one patient required a blood transfusion, one patient had a pneumothorax requiring chest tube placement, and one patient had a renal artery pseudoaneurysm requiring endovascular embolization. Conclusions: This multi-institutional study evaluated a new and efficient combination lithotrite that was perceived by surgeons to be highly satisfactory, with an excellent safety and durability profile

Some psychological and social characteristics of patients hospitalized for rheumatoid arthritis, hypertension, and duodenal ulcer

This study has compared male patients in a Veterans Administration Hospital with rheumatoid arthritis, hypertension, duodenal ulcer, and certain surgical conditions with their brothers and brothers-in-law. With regard to achievement, desire for change and impulsive behavior, the ulcer patients were high and the rheumatoid arthritics were low. With regard to perception of parents the rheumatoids reported themselves similar to their fathers but more influenced by their mothers while the surgical patients were more influenced by their fathers. In the area of happiness the ulcer patients appear to have led quite happylives, possibly even happier than the non-hospitalized controls while the hypertensives are most unhappy. The perception discrepancy measure suggested that the rheumatoids communicate poorly with their relatives about their hurt feelings. And finally, the measures of aggressive and impulsive behavior separated the four groups of patients from their brothers and brothers-in-law and from each other in a way that is both striking and replicable.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31962/1/0000004.pd

Rainfall variability at decadal and longer time scales: signal or noise?

Rainfall variability occurs over a wide range of temporal scales. Knowledge and understanding of such variability can lead to improved risk management practices in agricultural and other industries. Analyses of temporal patterns in 100 yr of observed monthly global sea surface temperature and sea level pressure data show that the single most important cause of explainable, terrestrial rainfall variability resides within the El Nino-Southern Oscillation (ENSO) frequency domain (2.5-8.0 yr), followed by a slightly weaker but highly significant decadal signal (9-13 yr), with some evidence of lesser but significant rainfall variability at interclecadal time scales (15-18 yr). Most of the rainfall variability significantly linked to frequencies tower than ENSO occurs in the Australasian region, with smaller effects in North and South America, central and southern Africa, and western Europe. While low-frequency (LF) signals at a decadal frequency are dominant, the variability evident was ENSO-like in all the frequency domains considered. The extent to which such LF variability is (i) predictable and (ii) either part of the overall ENSO variability or caused by independent processes remains an as yet unanswered question. Further progress can only be made through mechanistic studies using a variety of models

A pilot study combining individual-based smoking cessation counseling, pharmacotherapy, and dental hygiene intervention

BACKGROUND: Dentists are in a unique position to advise smokers to quit by providing effective counseling on the various aspects of tobacco-induced diseases. The present study assessed the feasibility and acceptability of integrating dentists in a medical smoking cessation intervention. METHODS: Smokers willing to quit underwent an 8-week smoking cessation intervention combining individual-based counseling and nicotine replacement therapy and/or bupropion, provided by a general internist. In addition, a dentist performed a dental exam, followed by an oral hygiene treatment and gave information about chronic effects of smoking on oral health. Outcomes were acceptability, global satisfaction of the dentist's intervention, and smoking abstinence at 6-month. RESULTS: 39 adult smokers were included, and 27 (69%) completed the study. Global acceptability of the dental intervention was very high (94% yes, 6% mostly yes). Annoyances at the dental exam were described as acceptable by participants (61% yes, 23% mostly yes, 6%, mostly no, 10% no). Participants provided very positive qualitative comments about the dentist counseling, the oral exam, and the resulting motivational effect, emphasizing the feeling of oral cleanliness and health that encouraged smoking abstinence. At the end of the intervention (week 8), 17 (44%) participants reported smoking abstinence. After 6 months, 6 (15%, 95% CI 3.5 to 27.2) reported a confirmed continuous smoking abstinence. DISCUSSION: We explored a new multi-disciplinary approach to smoking cessation, which included medical and dental interventions. Despite the small sample size and non-controlled study design, the observed rate was similar to that found in standard medical care. In terms of acceptability and feasibility, our results support further investigations in this field. TRIAL REGISTRATION NUMBER: ISRCTN67470159

A Research Agenda for Helminth Diseases of Humans: Intervention for Control and Elimination

Recognising the burden helminth infections impose on human populations, and particularly the poor, major intervention programmes have been launched to control onchocerciasis, lymphatic filariasis, soil-transmitted helminthiases, schistosomiasis, and cysticercosis. The Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to review helminthiases research and identify research priorities and gaps. A summary of current helminth control initiatives is presented and available tools are described. Most of these programmes are highly dependent on mass drug administration (MDA) of anthelmintic drugs (donated or available at low cost) and require annual or biannual treatment of large numbers of at-risk populations, over prolonged periods of time. The continuation of prolonged MDA with a limited number of anthelmintics greatly increases the probability that drug resistance will develop, which would raise serious problems for continuation of control and the achievement of elimination. Most initiatives have focussed on a single type of helminth infection, but recognition of co-endemicity and polyparasitism is leading to more integration of control. An understanding of the implications of control integration for implementation, treatment coverage, combination of pharmaceuticals, and monitoring is needed. To achieve the goals of morbidity reduction or elimination of infection, novel tools need to be developed, including more efficacious drugs, vaccines, and/or antivectorial agents, new diagnostics for infection and assessment of drug efficacy, and markers for possible anthelmintic resistance. In addition, there is a need for the development of new formulations of some existing anthelmintics (e.g., paediatric formulations). To achieve ultimate elimination of helminth parasites, treatments for the above mentioned helminthiases, and for taeniasis and food-borne trematodiases, will need to be integrated with monitoring, education, sanitation, access to health services, and where appropriate, vector control or reduction of the parasite reservoir in alternative hosts. Based on an analysis of current knowledge gaps and identification of priorities, a research and development agenda for intervention tools considered necessary for control and elimination of human helminthiases is presented, and the challenges to be confronted are discussed

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes