Thirty Years of Change: How Subdivisions on Stilts have Altered A Southeast Louisiana Parish\u27s Coast, Landscape and People

In thirty years, the number of second homes for recreation fishers in coastal Terrebonne Parish has grown from 244 in the late 1970s to an estimated 2,500 in 2005. This thesis considers the ramifications of the tourism boom along the parish\u27s historically isolated and undeveloped coastline. Four coastal communities are examined: (1) Montegut, Pointe-aux-Chenes and Isle de Jean Charles; (2) Cocodrie and Chauvin; (3) Dulac; and (4) Dularge and Theriot. The research question is twofold: Why has coastal tourism been allowed to develop in the fragile wetlands that protect residents from dangerous storms?; and What does tourism development mean for the indigenous American Indian and Cajun people who live along the coast? The author argues the proliferation of recreation fishing camps has had a serious dislocating effect on coastal Terrebonne\u27s population, and the ongoing development of the tourism industry will devastate culturally rich bayou regions

Strategies of Influence: How Corporate Power Directs and Constrains the FDA

This paper is about the Food and Drug Administration, and the tactics that regulated – and sometimes unregulated – industries use to influence that agency’s decision-making process. Many of these tactics are legal; others are illegal, but difficult to recognize and police. In virtually every case, the purpose of these tactics is to undermine the neutral and detached scientific processes to which the FDA aspires, in order to advance the financial interests of regulated industries. While some of the details recounted herein are gravely disturbing, even outrageous, the purpose of this paper is not to moralize, but to identify these tactics and assess them in a neutral fashion, in order that they may offer some lesson about the systemic structures that created the

Maine Horseshoe Crab (Limulus polyphemus) Spawning Surveys, 2004

The Maine Horseshoe Crab Surveys were begun in 2001 to establish quantitative baseline data and determine whether horseshoe crab (Limulus polyphemus) populations are stable or declining. Spawning counts were conducted at sites from Casco Bay (southern Maine) to Frenchman’s Bay (downeast), to establish an index of relative abundance. Few (relatively) abundant populations remain in Maine at Middle Bay (Harpswell/Brunswick), Thomas Point (Brunswick), and in the Damariscotta River. Healthy but less abundant populations persist in the Bagaduce River (Brooksville/ Sedgwick) and in Taunton Bay (Hancock/Franklin/Sullivan). An intensive tagging study has been conducted on Taunton Bay, which offers a natural population with no known history of harvest, and which is effectively closed to immigration and emigration by the physical characteristics of the Bay. During four field seasons, 6176 observations have been logged on 3883 individuals (2595 males, 1288 females; 66.8%, 33.2%). Returns by the 2001 tag year class have varied between 8.7 and 7.5 % in subsequent years. Females comprised 28% (of 116) of the returning 2001 tagged animals in 2002, and 33% (of 113) in 2003, but declined to only 13% (of 100) returning in 2004—just 1% of the original 2001 tag year class of 1333 (individuals). A cause has not yet been attributed, but adult molting is suspected. However, unless adult molting is confirmed, mortality must be assumed instead. Return rates of individuals tagged in 2001 were analyzed to evaluate spawning site fidelity. While return rates from year to year did not exceed 8.7% of the original tag year class of 1333 individuals, 22% of the individuals were observed again in the years from 2002 to 2004. Similarly, observations for 2004 were analyzed to determine the ratio of new individuals to those observed that had been tagged in the three prior years. In 2004, there were 1384 observations of 915 individuals (592 males, 323 females) at the tagging site, of which 25% had been tagged in prior field seasons. This suggests that a significant number of the adult horseshoe crabs in the vicinity of Shipyard Point may now be tagged, and each additional season of data will increase the value of the existing data for understanding the population dynamics of horseshoe crabs in Taunton Bay, and other sites in Maine

Biological Evaluation of Novel Synthesized 2, 5-disubstituted-1, 3, 4-oxadiazole derivatives

Synthesis of a series of various 2, 5-disubstituted-1, 3, 4-oxadiazole derivatives (7a-7v) have been done previously. These novel synthesized derivatives (7a-7v) have been tested for their antibacterial activity against Gram +ve S. aureus and Gram -ve E. Coli bacterias by broth dilution method. A comparative study has been done for all derivatives.  Based on the visual turbidity, the  MIC of the evaluated molecules has been studied, the evaluation concentration was used single therefore, the exact MIC could not determined and results are represented in less than and more than based on growth of microorganism. To get more exact MIC of the tested molecules need to be evaluated at low concentration. Further testing for all compounds at lower concentrations is required to compare their activity with standard Streptomycin at its MIC to get exact MIC the synthesized compounds. Previously novel synthesized derivatives are; 2-(phenoxymethyl)-5-phenyl-1, 3, 4-oxadiazole (7a), 4-(5-(phenoxymethyl)-1, 3, 4-oxadiazol-2-yl)aniline  (7b), 3-(5-(phenoxymethyl)-1, 3, 4-oxadiazol-2-yl) aniline (7c), 2-(5-(phenoxymethyl)-1, 3, 4-oxadiazol-2-yl)phenol (7d), 2, 4-dinitro-6-(5-(phenoxymethyl)-1, 3, 4-oxadiazol-2-yl)phenol (7e), 2-(4-(methylthio)benzyl)-5-(phenoxymethyl)-1,3,4-oxadiazole (7f), 2-((2, 4-dichlorophenoxy) methyl)-5-phenyl-1,3,4-oxadiazole (7g), 4-(5-((2, 4-dichlorophenoxy) methyl)-1,3,4-oxadiazol-2-yl)aniline (7h), 3-(5-((2, 4-dichlorophenoxy) methyl)-1,3,4-oxadiazol-2-yl)aniline (7i), 2-(5-((2, 4-dichlorophenoxy) methyl)-1, 3, 4-oxadiazol-2-yl)phenol (7j), 2-(5-((2, 4-dichlorophenoxy) methyl)-1,3,4-oxadiazol-2-yl)-4,6-dinitrophenol (7k), 2-((2,4-dichlorophenoxy) methyl)-5-(4-(methylthio)benzyl)-1,3,4-oxadiazole (7l), (Z)-2-((2, 4-dichlorophenoxy) methyl)-5-styryl-1,3,4-oxadiazole (7m), (S)-4-(2-(5-((2,4-dichlorophenoxy) methyl)-1, 3, 4-oxadiazol-2-yl)propyl)phenol (7n), 2-((4-nitrophenoxy) methyl)-5-phenyl-1, 3, 4-oxadiazole (7o), 4-(5-((4-nitrophenoxy)methyl)-1,3,4-oxadiazol-2-yl)aniline (7p), 3-(5-((4-nitrophenoxy)methyl)-1,3,4-oxadiazol-2-yl)aniline (7q), 2-(5-((4-nitrophenoxy)methyl)-1,3,4-oxadiazol-2-yl)phenol (7r), 2, 4-dinitro-6-(5-((4-nitrophenoxy)methyl)-1,3,4-oxadiazol-2-yl)phenol (7s), 2-(4-(methylthio) benzyl)-5-((4-nitrophenoxy) methyl)-1,3,4-oxadiazole (7t), (Z)-2-((4-nitrophenoxy)methyl)-5-styryl-1,3,4-oxadiazole (7u) and 5-((2, 4-dichlorophenoxy) methyl)-1,3,4-oxadiazole-2-thiol (7v)

Emergency Care Handover (ECHO study) across care boundaries : the need for joint decision making and consideration of psychosocial history

Background: Inadequate handover in emergency care is a threat to patient safety. Handover across care boundaries poses particular problems due to different professional, organisational and cultural backgrounds. While there have been many suggestions for standardisation of handover content, relatively little is known about the verbal behaviours that shape handover conversations. This paper explores both what is communicated (content) and how this is communicated (verbal behaviours) during different types of handover conversations across care boundaries in emergency care. Methods: Three types of interorganisational (ambulance service to emergency department (ED) in ‘resuscitation’ and ‘majors’ areas) and interdepartmental handover conversations (referrals to acute medicine) were audio recorded in three National Health Service EDs. Handover conversations were segmented into utterances. Frequency counts for content and language forms were derived for each type of handover using Discourse Analysis. Verbal behaviours were identified using Conversation Analysis. Results: 203 handover conversations were analysed. Handover conversations involving ambulance services were predominantly descriptive (60%–65% of utterances), unidirectional and focused on patient presentation (75%–80%). Referrals entailed more collaborative talk focused on the decision to admit and immediate care needs. Across all types of handover, only 1.5%–5% of handover conversation content related to the patient's social and psychological needs. Conclusions: Handover may entail both descriptive talk aimed at information transfer and collaborative talk aimed at joint decision-making. Standardisation of handover needs to accommodate collaborative aspects and should incorporate communication of information relevant to the patient's social and psychological needs to establish appropriate care arrangements at the earliest opportunity

Synthesis of 2, 5-disubstituted-1, 3, 4-oxadiazole derivatives

Synthesis of a series of various 2, 5-disubstituted-1, 3, 4-oxadiazole derivatives (7a-7u) have been done. Synthesis of a series of intermediates (3a-3c and 5a-5c) have been also done, ethyl-2-phenoxyacetate (3a), ethyl 2-(2, 4-dichlorophenoxy)acetate (3b), ethyl 2-(4-nitrorophenoxy) acetate (3c), 2-phenoxyacetohydrazide (5a), 2-(2, 4-dichlorophenoxy) acetohydrazide (5b), 2-(4-nitrophenoxy)acetohydrazide (5c), and final product (7a-7u), 2-(phenoxymethyl)-5-phenyl-1, 3, 4-oxadiazole (7a), 4-(5-(phenoxymethyl)-1, 3, 4-oxadiazol-2-yl)aniline  (7b), 3-(5-(phenoxymethyl)-1, 3, 4-oxadiazol-2-yl) aniline (7c), 2-(5-(phenoxymethyl)-1, 3, 4-oxadiazol-2-yl)phenol (7d), 2, 4-dinitro-6-(5-(phenoxymethyl)-1, 3, 4-oxadiazol-2-yl)phenol (7e), 2-(4-(methylthio)benzyl)-5-(phenoxymethyl)-1,3,4-oxadiazole (7f), 2-((2, 4-dichlorophenoxy) methyl)-5-phenyl-1,3,4-oxadiazole (7g), 4-(5-((2, 4-dichlorophenoxy) methyl)-1,3,4-oxadiazol-2-yl)aniline (7h), 3-(5-((2, 4-dichlorophenoxy) methyl)-1,3,4-oxadiazol-2-yl)aniline (7i), 2-(5-((2, 4-dichlorophenoxy) methyl)-1, 3, 4-oxadiazol-2-yl)phenol (7j), 2-(5-((2, 4-dichlorophenoxy) methyl)-1,3,4-oxadiazol-2-yl)-4,6-dinitrophenol (7k), 2-((2,4-dichlorophenoxy) methyl)-5-(4-(methylthio)benzyl)-1,3,4-oxadiazole (7l), (Z)-2-((2, 4-dichlorophenoxy) methyl)-5-styryl-1,3,4-oxadiazole (7m), (S)-4-(2-(5-((2,4-dichlorophenoxy) methyl)-1, 3, 4-oxadiazol-2-yl)propyl)phenol (7n), 2-((4-nitrophenoxy) methyl)-5-phenyl-1, 3, 4-oxadiazole (7o), 4-(5-((4-nitrophenoxy)methyl)-1,3,4-oxadiazol-2-yl)aniline (7p), 3-(5-((4-nitrophenoxy)methyl)-1,3,4-oxadiazol-2-yl)aniline (7q), 2-(5-((4-nitrophenoxy)methyl)-1,3,4-oxadiazol-2-yl)phenol (7r), 2, 4-dinitro-6-(5-((4-nitrophenoxy)methyl)-1,3,4-oxadiazol-2-yl)phenol (7s), 2-(4-(methylthio) benzyl)-5-((4-nitrophenoxy)methyl)-1,3,4-oxadiazole (7t), (Z)-2-((4-nitrophenoxy)methyl)-5-styryl-1,3,4-oxadiazole (7u) and 5-((2, 4-dichlorophenoxy)methyl)-1,3,4-oxadiazole-2-thiol (7v)

The quality of communication about older patients between hospital physicians and general practitioners: a panel study assessment

<p>Abstract</p> <p>Background</p> <p>Optimal care of patients is dependent on good professional interaction between general practitioners and general hospital physicians. In Norway this is mainly based upon referral and discharge letters. The main objectives of this study were to assess the quality of the written communication between physicians and to estimate the number of patients that could have been treated at primary care level instead of at a general hospital.</p> <p>Methods</p> <p>This study comprised referral and discharge letters for 100 patients above 75 years of age admitted to orthopaedic, pulmonary and cardiological departments at the city general hospital in Trondheim, Norway. The assessments were done using a Delphi technique with two expert panels, each with one general hospital specialist, one general practitioner and one public health nurse using a standardised evaluation protocol with a visual analogue scale (VAS). The panels assessed the quality of the description of the patient's actual medical condition, former medical history, signs, medication, Activity of Daily Living (ADL), social network, need of home care and the benefit of general hospital care.</p> <p>Results</p> <p>While information in the referral letters on actual medical situation, medical history, symptoms, signs and medications was assessed to be of high quality in 84%, 39%, 56%, 56% and 39%, respectively, the corresponding information assessed to be of high quality in discharge letters was for actual medical situation 96%, medical history 92%, symptoms 60%, signs 55% and medications 82%. Only half of the discharge letters had satisfactory information on ADL. Some two-thirds of the patients were assessed to have had large health benefits from the general hospital care in question. One of six patients could have been treated without a general hospital admission. The specialists assessed that 77% of the patients had had a large benefit from the general hospital care; however, the general practitioners assessment was only 59%. One of four of the discharge letters did not describe who was responsible for follow-up care.</p> <p>Conclusion</p> <p>In this study from one general hospital both referral and discharge letters were missing vital medical information, and referral letters to such an extent that it might represent a health hazard for older patients. There was also low consensus between health professionals at primary and secondary level of what was high benefit of care for older patients at a general hospital.</p

The Impact of Duty Hours on Resident Self Reports of Errors

BACKGROUND: Resident duty hour limitations aim, in part, to reduce medical errors. Residents’ perceptions of the impact of duty hours on errors are unknown. OBJECTIVE: To determine residents’ self-reported contributing factors, frequency, and impact of hours worked on suboptimal care practices and medical errors. DESIGN: Cross-sectional survey. SUBJECTS: 164 Internal Medicine Residents at the University of California, San Francisco. MEASUREMENTS AND RESULTS: Residents were asked to report the frequency and contributing factors of suboptimal care practices and medical errors, and how duty hours impacted these practices and aspects of resident work-life. One hundred twenty-five residents (76%) responded. The most common suboptimal care practices were working while impaired by fatigue and forgetting to transmit information during sign-out. In multivariable models, residents who felt overwhelmed with work (p = 0.02) and who reported spending >50% of their time in nonphysician tasks (p = 0.002) were more likely to report suboptimal care practices. Residents reported work-stress (a composite of fatigue, excessive workload, distractions, stress, and inadequate time) as the most frequent contributing factor to medical errors. In multivariable models, only engaging in suboptimal practices was associated with self-report of higher risk for medical errors (p < 0.001); working more than 80 hours per week was not associated with suboptimal care or errors. CONCLUSION: Our findings suggest that administrative load and work stressors are more closely associated with resident reports of medical errors than the number of hours work. Efforts to reduce resident duty hours may also need to address the nature of residents’ work to reduce errors

Communication in healthcare: a narrative review of the literature and practical recommendations

aims: Effective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialized and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare. Design: Narrative literature review. Methods:A search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (MeSH)terms ‘communication’, ‘primary health care’, ‘correspondence’, ‘patient safety’, ‘patient handoff’ and ‘continuity of patient care’. Reviewers screened 4609 records and 462 full texts were checked according following inclusion criteria: (1) publication between January 1985 and March 2014, (2) availability as full text in English, (3) categorization as original research, reviews, meta-analyses or letters to the editor. Results:A total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences. Conclusions: There is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow-up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver