Emotional factors and acceptance of treatment: the relationship of the attitudes of ten parents toward their child and his problem, toward themselves, toward the clinic and the resulting ability to accept treatment

Thesis (M.S.)--Boston Universit

The “P” Isn’t for Privacy: The Conflict Between Bankruptcy Rules and HIPAA Compliance

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) included a now-ubiquitous provision designed to protect the privacy of patients’ protected health information. The provision prohibits covered entities, including health care providers and their agents, from disclosing any demographic information that may identify a patient and that relates to that patient’s medical care. The provision is broad and can include such simple information as which doctor a patient consults or the date of a patient’s consultation with a physician. Unfortunately, such protections become impracticable in the bankruptcy setting. When a health care provider files bankruptcy, it files a host of documents that may inadvertently disclose protected health information. For example, recent patients usually must be given the opportunity to file a claim. To do so, the provider must list them on its initial schedules filed with its petition. These schedules, like almost all bankruptcy filings, become public record and can be found online, resulting in the type of disclosure prohibited by HIPAA. And the problem compounds as the case continues. By walking through the hypothetical Chapter 11 case of a bankrupt fertility clinic, this Note highlights a few of the bankruptcy disclosures that prove particularly risky to protected health information (PHI). It argues that the rigidity of the Federal Rules of Bankruptcy Procedure and Title 11 of the United States Code (the Bankruptcy Code) contravene HIPAA’s privacy rule. It then recommends several opportunities to protect PHI through attorney, court, and legislative action. Specifically, this Note proposes that Congress incorporate specific language aimed at protecting PHI into existing bankruptcy laws. Enacting even a few of the recommendations in this Note would facilitate the protection of PHI and HIPAA compliance

The experience of facilitators and participants of long term condition self-management group programmes: a qualitative synthesis

Objective: Our aim was to systematically review the qualitative literature about the experiences of both facilitators and participants in a range of group-based programmes to support the self-management of long-term conditions. Methods: We searched 7 databases using the terms ‘self-management’, ‘group’ and ‘qualitative’. Full text articles meeting the inclusion criteria were retrieved for review. A thematic synthesis approach was used to analyse the studies. Results: 2126 articles were identified and 24 were included for review. Group participants valued being with similar others and perceived peer support benefits. Facilitators (HCP and lay) had limited group specific training, were uncertain of purpose and prioritised education and medical conformity over supportive group processes and the promotion of self-management agency and engagement. Overall, studies prioritised positive descriptions. Conclusion: Group programmes’ medical self-management focus may reduce their ability to contribute to patient-valued outcomes. Further research is needed to explore this disconnect. Practice implications: This review supports broadening the scope of group-based programmes to foreground shared learning, social support and development of agency. It is of relevance to developers and facilitators of group self-management programmes and their ability to address the burden of long-term conditions

How do facilitators of group programmes for long-term conditions conceptualise self-management support?

Objectives: Increasing self-management skills in people with long-term conditions is widely advocated in policies and guidelines. Group programmes are a common format; yet, how self-management support objectives are enacted in their delivery is poorly understood. Our aim is to explore the perspectives of group programme facilitators. Methods: We undertook thematic analysis of transcribed data from in-depth semi-structured interviews with health professional facilitators (n = 13) from six diverse self-management support group programmes (of obesity, diabetes and chronic obstructive pulmonary disease). Results: Facilitators viewed group programmes as responses to health system pressures, e.g. high patient demand. They focussed on providing in-depth education and instruction on physical health, risks and lifestyle behaviour change and emphasised self-responsibility for behaviour change whilst minimising goal setting and support amongst group participants. There were tensions between facilitators’ professional identity and group leader role

Bromostibine complexes of iron(II): hypervalency and reactivity

The halostibine complexes [CpFe(CO)2(SbMe2Br)][CF3SO3] and [CpFe(CO)2(SbMe2Br)][BF4] both contain significant interactions between the anion and the formally neutral Sb(III) ligand, which simultaneously displays Lewis acidic and Lewis basic properties. The unexpected secondary product [CpFe(CO)(Me2BrSb-?-Br-SbBrMe2)] is formed in the presence of excess ligand, the strongly associated Br– anion bridging the two Sb donors to form a four-membered FeSb2Br ring.<br/

Influence of Gypsum Panels on the Response of Cold-Formed Steel Framed Strap-Braced Walls

In cold-formed steel construction the steel frame is supplemented with either diagonal strap braces or structural sheathing panels (typically steel or wood) to provide overall stability to the structural system and to directly transfer lateral wind and seismic loads through to the foundation as per the design provisions found in AISI S240 (2015) and AISI S400 (2015). Gypsum panels are often specified to provide a fire-resistance rating for the CFS frame, as well as to ensure that adequate sound-proofing exists between adjacent rooms or building units. The engineer may choose to rely on this gypsum to provide additional lateral resistance, as permitted in the AISI Standards. However, in the majority of cases the gypsum panels are considered to be non-structural elements of the building specified by the architect, and as such, are not taken into account in the design of the lateral load carrying system. Whether considered in the design process or not, these gypsum panels do augment the shear resistance of the lateral load carrying system. This study was carried out to evaluate the performance of combined strap-braced / gypsum-sheathed wall systems, with the intent of defining a corresponding design approach. Described herein are the findings of the laboratory phase of the project, comprising 35 wall specimens

Benzocaine and lidocaine induced methemoglobinemia after bronchoscopy: a case report

INTRODUCTION: Methemoglobinemia is a rare cause of hypoxemia, characterized by abnormal levels of oxidized hemoglobin that cannot bind to and transport oxygen. CASE PRESENTATION: A 62-year-old male underwent bronchoscopy where lidocaine oral solution and Hurricaine spray (20% benzocaine) were used. He developed central cyanosis and his oxygen saturation was 85% via pulse oximetry. An arterial blood gas revealed pH 7.45, P(CO2 )42, P(O2 )282, oxygen saturation 85%. Co-oximetry performed revealed a methemoglobin level of 17.5% (normal 0.6–2.5%). The patient was continued on 15 L/minute nonrebreathing face mask and subsequent oxygen saturation improved to 92% within two hours. With hemodynamic stability and improved SpO(2), treatment with methylene blue was withheld. CONCLUSION: Methemoglobinemia is a potentially lethal condition after exposure to routinely used drugs. Physicians should be aware of this complication for early diagnosis and treatment

Citizen-led air pollution reduction in cities (ClairCity) Final evaluation report

"Every day, air pollution and carbon emissions are produced by our commutes to work, by heating our homes, or through our daily lifestyles. Understanding how we live - and the restrictions we face in those choices – is key to improving air quality. Solutions at a local level can make a big difference" - ClairCity855 participants volunteered their time to evaluate the engagement activities. 63% were male, given over half of the evaluators (534) came from the mobile game survey, a tool that traditionally has more male users. The game also appealed to a younger audience than other activities, meaning that overall, 25% of evaluators were aged 16-25 years old. However, given the wide ranging and often targeted activities developed, all age categories are represented in the project. For instance, the workshop activities (Delphi, policy, and stakeholder workshops) attracted 66% of 45-54 year olds and 83% of 55-64 year olds.Overall, participants tended to enjoy the activities in which they took part; the younger the participants, the more likely they were to say that they enjoyed the activity. The activities also had an impact on behaviours, with 74% of participants said that they would now make a change to their lives to improve air quality.The more participants enjoyed the activity, the more they reported that their understanding of air quality had improved. Similarly, the more participants reported that their understanding had improved, the more they reported that they would change their behaviour. Younger people and those with lower education to start with were more likely to say they would change their behaviour. All of these relationships were highly statistically significant.To fully realise the goal of citizen-led air pollution reduction in cities, researchers and policymakers need to work hard to ensure engagement participation is reflective of city demographics. This evaluation shows the importance of designing engagement activities which appeal to a wide variety of audiences to ensure that a broad cross-section of society can participate in engagement with policymaking. The more enjoyable the engagement activities, the more people gain understanding about the issues, and the more likely people are to make a change to their behaviour to reduce air pollution and carbon emissions, and improve the health of our cities. We hope this evaluation report proves useful to other policymakers working towards a future with clean air