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About JohnnyParker
I am Johnny Parker and I am 22. I have studied the weather since I was 5. I have cerebral palsy and my goal is to become a meteorologist.
By: JohnnyParker , 11:13 AM GMT on December 25, 2012
Good Morning and Merry Christmas! At Smithville, MS, the current temperature is 45 and it feels like 45. Highs will continue to range between 42 and 57 with lows between 26 and 41. A Wind Advisory is in effect for North MS until 9am Wednesday morning. Winds out of the Northeast to East at 20-25mph with gusts up to 40mph are expected. Winds will become more northerly tonight. There is a 100% chance of PM thunderstorms on today. Some storms could be strong to severe on Tuesday with the main threats being for large hail, damaging winds of 60-80mph, tornadoes (a few could be strong, long-tracked), heavy rainfall of 2-3 inches, and flash flooding. Timing of these storms across portions of North MS will be from 2pm to 8pm. Dr. Greg Forbes, the severe weather expert at The Weather Channel, is giving a 6 out of 10 on the TOR:CON (Tornado Condition Index) for Central and South MS and 2 out of 10 for North MS for Tuesday. This means that there is a 20%-60% chance of seeing a tornado within a 50 mile radius. At the Regional Rehab Center in Tupelo, MS, the current temperature is 47 and it feels like 44. Todays high is 50 and a low of 34 with a 100% chance of PM thunderstorms/wind. Wednesdays high is 40 with winds out of the Northwest at 25mph.
Now, for your Winter/Severe Weather Update for the Southeast Region. There could be severe weather and winter weather potential around December 24th-27th. Severe weather potential possibly around December 29th-30th, January 2nd, 4th-5th, 2013, and then again around January 8th-9th.
Hope yall are having a great Christmas and I'll have another post tomorrow morning.
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By Lori Egan, The BayonetJune 8, 2011
FORT BENNING, Ga. -- Fort Benning's Sgt. 1st Class Joe Kapacziewski was deployed to Afghanistan when he learned he was one of two recipients of this year's Freedom Award. Gen. Raymond Odierno, commander of U.S. Joint Forces Command and President Barack Obama's pick to be the next Army chief of staff, was the other.
Kapacziewski, a platoon sergeant with 3rd Battalion, 75th Ranger Regiment, is the first enlisted Soldier to receive the award honoring the "sacrifices required to defend liberty, becoming selfless in the willing pursuit to deliver no greater sacrifice in the great cause of freedom," according to the award.
Command Sgt. Maj. Chris Hardy, Maneuver Center of Excellence command sergeant major, said Kapacziewski is the epitome of the Army Values and Ranger Creed.
Hardy has known the 29-year-old since 2007 when Hardy became the Regimental Special Troops Battalion command sergeant major and Kapacziewski was working in the arms room while undergoing physical and occupational therapy for the wounds he received in October 2005.
During a mission in Iraq, Kapacziewski, then a squad leader, "distinguished himself through heroic actions taken while being severely wounded," wrote Command Sgt. Maj. Richard Merritt, who nominated the platoon sergeant for the award.
While on a mission during his fifth deployment, his six-vehicle convoy came under fire during an enemy ambush. Insurgents engaged the Stryker from an overpass using small-arms fire and grenades. A grenade fell through the gunner's hatch and exploded, injuring three Rangers.
Ignoring his life-threatening injuries, Kapacziewski warned his unit of the attack, and directed his vehicle out of the kill zone, Merritt wrote. Only after he ensured the safety of his men did Kapacziewski administer self-aid and let Sgt. Matthew Sanders apply a pressure dressing to his right arm.
Kapacziewski's wife, Kimberly, said she was told it was a miracle he survived.
"Advances in battlefield medicine kept Joe alive," she said. "Ten years earlier, he would have died."
After transferring to Walter Reed Army Medical Center in Washington, and enduring more than 40 surgeries, doctors told Kapacziewski the probability of walking again was slim.
But the doctors didn't consider Kapacziewski's motivation and commitment to continue to lead and be a part of the Army team, Hardy said.
After two more operations on his right foot, Kapacziewski chose to have it amputated because the regimental surgeon said it was his best option for regaining the physical prowess necessary to return to the regiment.
"I couldn't imagine doing anything else," said Kapacziewski, who enlisted in 2001. "The friends, the camaraderie is unlike anything else I've ever experienced."
Transferred to the Ranger Operations Company as cadre, even missing a leg, "he could smoke anyone I knew at running," wrote David Pickard on the Army Facebook page May 19.
The training to become a Ranger is hard, Hardy said, and Kapacziewski motivated the young Soldiers to keep trying.
Kapacziewski swims laps during his lunch hour and competes in triathlons, marathons and relay races. He has run in Operation One Voice's annual 600-mile relay since 2007, ran a 7:10 pace during the 2008 Army Ten-Miler and has run in the New York City Marathon for the last two years for the Lead the Way Fund.
Hardy credits Kapacziewski's intense desire to get back into the fight as a Ranger squad leader with helping him pass the Ranger standards and completing the train-up, which includes the Army physical fitness test, five-mile run, 12-mile road march, Airborne jumps and fast-rope certification.
Hardy remembered Kapacziewski discussing the possibility of injury while deployed.
"If someone breaks his leg while on a mission, he'll have to redeploy for medical treatment," Hardy recalled Kapacziewski saying. "I'll just have to go back to the (forward operating base) and get another leg."
After a medical board's decision to continue Kapacziewski on active duty, he returned to his unit as a squad leader.
"Everyone puts pants on one foot at a time," Kapacziewski said. "I just have a different foot.
"No matter what the position or grade, every (Ranger) needs to meet the Ranger standard."
"There's a photo of Kapacziewski in Afghanistan putting on his prosthetic leg " that's at 10,000 feet," Hardy said.
"When he's faced with adversity, he continues to fight," Hardy said. "If I could create every Soldier in his image, it would be a good outfit."
When Kapacziewski isn't deployed, he visits wounded warriors at Walter Reed and Brooke Army Medical Center in San Antonio.
"They have the most difficult challenge they'll ever have to face " I let them know they aren't alone. Whether it's limb salvage or amputation, we talk about the different options, about staying in the military or getting out. It's harder to find guys who have gone back to the 'line,' but I let them know it's possible," he said.
Sgt. 1st Class Joe Kapacziewski's military awards include the Bronze Star Medal with V device, the Bronze Star Medal, Purple Heart (3rd award), Army Commendation Medal with V device (2nd award), Army Commendation Medal (3rd award), the Ranger Tab, Combat Infantryman Badge, Expert Infantryman Badge and the Senior Parachutist Badge with Jump Star.
Presented by No Greater Sacrifice in Washington, D.C., May 24, the award recognizes service members who have dedicated their lives to defending freedom wherever duty calls. Past recipients are Col. David Sutherland, 2008, Gen. David Petraeus, 2009, and Gen. James Conway, 2010. No Greater Sacrifice, a nonprofit organization created in February 2008, is dedicated to the 50,000 children of our nation's fallen and wounded service members. The Freedom Award is presented annually by the No Greater Sacrifice public charity and is designed to honor the recipient(s) that best represents five core principles:
FREEDOM. NGS honors a man or woman in the U.S. military who is not only committed to the freedom of all Americans but who works tirelessly to promote and support freedom around the globe, especially in areas of conflict.
SACRIFICE. The Freedom Award honors a service member who embraces the sacrifices required to pursue and attain freedom and becomes selfless in his or her willingness to commit all that they possess in the great cause of freedom.
COMMUNITY. The recipient works diligently to build bridges between the military and civilian communities so that we, as civilians, can be more effective in our effort to support Wounded Warriors, the re-entry of veterans and the families of all military personnel.
PATRIOTISM. Regardless of the politics and rhetoric that accompany all military deployments, the recipient rises above the rhetoric and defends the Constitution and the ideals of American freedom at all costs.
ESTEEM. The recipient of the NGS Freedom Award holds the American Soldier, Sailor, Airman or Marine in the highest esteem possible and both recognizes and articulates the need to establish new foundations within the American public to help all service members re-enter our society with grace, dignity, honor and unconditional support of our men and women who wore the uniform of the United States of America.

subset: commoncrawl


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Hotels near Glacier Garden
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- Most bookedibis Styles Luzern
196 people looked at this hotel in the last hour
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"Hotel location is good. Though a distance from the train station, it's just next to panaroma and near to the lion monument and glacier garden. Walking to and fro train station through Hatensteinstrass is a bliss."
A Traveller, Nov 2015, SG
142 people looked at this hotel in the last hour
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"The best thing about this hotel is the view from the lake facing rooms. The hotel has good facilities including spa and indoor swimming pool. The decor is a bit old fashioned but the condition of furnishings is good and well maintained. The breakfast, for which there is additional 35 SF per perso..."
A Traveller, Jun 2016, GB
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"Excellent location 5 star hotel Breakfast buffet 70 francs for 2 people Used it one day then had local breakfast Nice bar in the hotel Great views from our room"
A Traveller, May 2016, US
36 people looked at this hotel in the last hour
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"Pleasant stay overall. The hotel staff was all super friendly and we felt welcomed. However I think the room itself needs to be renovated. The wall is so thin that we can hear the couple next door arguing for 2 hours at night. The sink was not functioning well and the water wasn't going down we h..."
A Traveller, Jan 2016, US
31 people looked at this hotel in the last hour
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"Older family run hotel. Our rooms were large and had an alcove with another bed. Perfect for a family with children. Well located, near the bus stop or an easy walk to the city center. Private parking right across the street."
A Traveller, Sep 2015, US
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"Lovely staff - friendly and helpful. Needed hotel as part of weekend visit to see World Rowing Champs."
A Traveller, Jun 2016, GB
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"It's an economical stay - based on the high cost in Lucerne city. However, the hotel did not provide any kettle or glass. We requested and they provided. The room is tiny and packed but the mattress was soft and nice to sleep. The receptionist is only available around 11am - 10pm but we don't use..."
A Traveller, Dec 2015, SG
26 people looked at this hotel in the last hour
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"We enjoyed our 4 night stay at Hotel Rebstock in October. It is beside Lake Lucerne, and easy walking distance to the centre of town. It has a good restaurant and the staff were very helpful. Be aware there may be a small set of stairs from the room to the elevator."
A Traveller, Nov 2015, AU
5 people looked at this hotel in the last hour
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Hand Placing Coin on Stack
Credit: Gregor Schuster
Creative #: a0073-000345b
Licence type: Rights-managedRights-managed products are licensed with restrictions on usage, such as limitations on size, placement, duration of use and geographic distribution. You will be asked to submit information concerning your intended use of the product, which will determine the scope of usage rights granted.
Collection: The Image Bank
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Hand Placing Coin On Stack Stock PhotoAdults Only,Coin,Colour Image,Coloured Background,Grey,Holding,Horizontal,Human Body Part,Human Hand,One Person,One Woman Only,Part Of,Part of a Series,Photography,Savings,Side View,Stack,Studio Shot,US Currency,WealthPhotographer Gregor SchusterCollection: The Image Bank


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- Noisy cabin at highway speeds
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Welcome Michigan Social Workers!
Our Vision:
To build NASW-Michigan into a leading voice in social justice advocacy and the development of statewide social service policy. NASW-Michigan will advance the quality of services provided to client populations by advancing the principles and standing of the social work profession
Our Mission:
NASW is a membership organization with a dual mission to: 1) Promote, develop and protect the practice of social workers; and 2) Seek to enhance the effective functioning and well-being of individuals, families and communities through its work and advocacy.
Interested in helping with the Flint Water Crisis? Click here to find out more.
Now Available: (NEW PRINT JUST IN!)
Starting a Clinical Private Practice: A Guide for Michigan Social Workers ($80). Available to NASW members only.
Click here to order your copy today!
As an increasing number of Michigan social workers look to private practice as a means of providing services to clients, they face many complex and often overwhelming issues. Questions about fee-setting, ethics, supervision, third-party reimbursement, liability and malpractice insurance are among the many concerns frequently voiced. Created specifically for Michigan clinical social workers, this manual addresses many issues and challenges facing the private practitioner, and provides guidelines for establishing and maintaining a successful private practice.


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CMC finds no evidence former Ipswich CEO Carl Wulff engaged in criminal behaviour
- From: The Courier-Mail
- March 15, 2014
THE MISCONDUCT watchdog has found no evidence of criminal behaviour in a probe of deals between an Ipswich City Council chief executive officer, his flash Brisbane apartment and a contractor for Ipswich council.
The probe also found no evidence former Ipswich CEO Carl Wulff had engaged in "official misconduct", the Crime and Misconduct Commission said yesterday.
Ipswich Mayor Paul Pisasale had referred the matter to the CMC last November after The Courier-Mail made inquiries about a rental arrangement involving Mr Wulff and a contractor on Ipswich flood recovery works.
Mr Wulff had rented his $850-a-week apartment in Hamilton to contractor Professional Consulting Group, which had Claude Walker as its Brisbane representative and who lived in the apartment. Council even reimbursed $48,000 of that rent.
A mortgage was also taken out by Mr Walker's wife on Mr Wulff's Hamilton apartment. Mr Wulff in December resigned from council.
Attempts to contact Mr Wulff and Mr Walker yesterday were unsuccessful. Mr Wulff has previously maintained PCG's work with Ipswich, and PCG's decision to rent his apartment was unrelated. Mr Wulff also said he had declared the mortgage, and listed the apartment on his register of interests.
PCG, under its predecessor name, was in 2011 initially a subcontractor for the Coffey Group on flood recovery project for Ipswich council.
Mr Wulff has said he "was involved" in awarding the initial contract to Coffey but not transferring that head contract to PCG in 2012, when the Coffey subsidiary closed.
Ipswich council yesterday said it would consider the CMC report before making any decisions on a review of its code of conduct.
Cr Pisasale thanked the CMC, saying council's "handling of the situation was appropriate given the information at the time".
"At all times council has operated in a fully transparent manner," he said.Originally published as Ipswich CEO cleared of misconduct


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Canadian Cardiovascular Society Access to Care Workshop proceedings and next steps
O'Neill, Blair J
Simpson, Christopher S
The Canadian Journal of Cardiology
On October 24, 2008, the Canadian Cardiovascular Society (CCS) Standing Committee on Access to Care invited clinical practitioners, researchers and administrators from across Canada to provide input on the CCS action plan for 2009/2010. The meeting provided an opportunity for stakeholders to identify initiatives under three CCS priority areas for action: collecting and reporting wait time data, improving systems to improve access, and establishing national networks. Building on the suggestions from this meeting, the Standing Committee drafted an action plan for 2009/2010. This plan includes a lead role for the CCS in facilitating consensus on pan-Canadian data standards and definitions, and using current resources and infrastructure. The CCS and its Standing Committee look forward to continuing to work with stakeholders to promote awareness and adoption of the benchmarks, and to undertake new initiatives that will provide insight into access to care issues along the continuum of care.
Access to care; Cardiovascular care; Wait times data
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Community advocacy groups as a means to address the social environment of female sex workers: a case study in Andhra Pradesh, India
Punyam, Swarup
Pullikalu, Renuka Somanatha
Mishra, Ram Manohar
Sandri, Prashanth
Mutupuru, Balakrishna Prasad
Kokku, Suresh Babu
Parimi, Prabhakar
Journal of Epidemiology and Community Health
To examine the association between the presence of community advocacy groups (CAGs) and female sex workers' (FSWs) access to social entitlements and outcomes of police advocacy.
Data were used from a cross-sectional survey conducted in 2010–2011 among 1986 FSWs and 104 NGO outreach workers from five districts of Andhra Pradesh. FSWs were recruited using a probability-based sampling from 104 primary sampling units (PSUs). A PSU is a geographical area covered by one outreach worker and is expected to have an active CAG as per community mobilisation efforts. The presence of active CAGs was defined as the presence of an active committee or advocacy group in the area (PSU). Outcome indicators included acquisition of different social entitlements and measures of police response as reported by FSWs. Multivariate linear and logistic regression analyses were used to examine the associations.
Areas with active CAGs compared with their counterparts had a significantly higher mean number of FSWs linked to ration cards (12.8 vs 6.8; p<0.01), bank accounts (9.3 vs 5.9; p=0.05) and health insurance (13.1 vs 7.0; p=0.02). A significantly higher percentage of FSWs from areas with active CAGs as compared with others reported that the police treat them more fairly now than a year before (79.7% vs 70.3%; p<0.05) and the police explained the reasons for arrest when arrested the last time (95.7% vs 87%; p<0.05).
FSWs from areas with active CAGs were more likely to access certain social entitlements and to receive a fair response from the police, highlighting the contributions of CAGs in community mobilisation.
Structural interventions; sex workers; HIV prevention intervention; community advocacy; social capital; empowerment; HIV; AIDS; public health; violence; epidemiology; statistics
Related Articles
Donor Funding for Newborn Survival: An Analysis of Donor-Reported Data, 2002–2010
Pitt, Catherine
Lawn, Joy E.
Ranganathan, Meghna
Mills, Anne
Hanson, Kara
PLoS Medicine
With recent increases in development assistance money for maternal and child health, Catherine Pitt and colleagues examine whether foreign aid specifically for newborns has changed, whether it's on par with the burden of newborn deaths worldwide, and how such funding can be tracked.
Neonatal mortality accounts for 43% of global under-five deaths and is decreasing more slowly than maternal or child mortality. Donor funding has increased for maternal, newborn, and child health (MNCH), but no analysis to date has disaggregated aid for newborns. We evaluated if and how aid flows for newborn care can be tracked, examined changes in the last decade, and considered methodological implications for tracking funding for specific population groups or diseases.
Methods and Findings
We critically reviewed and categorised previous analyses of aid to specific populations, diseases, or types of activities. We then developed and refined key terms related to newborn survival in seven languages and searched titles and descriptions of donor disbursement records in the Organisation for Economic Co-operation and Development's Creditor Reporting System database, 2002–2010. We compared results with the Countdown to 2015 database of aid for MNCH (2003–2008) and the search strategy used by the Institute for Health Metrics and Evaluation. Prior to 2005, key terms related to newborns were rare in disbursement records but their frequency increased markedly thereafter. Only two mentions were found of "stillbirth" and only nine references were found to "fetus" in any spelling variant or language. The total value of non-research disbursements mentioning any newborn search terms rose from US$38.4 million in 2002 to US$717.1 million in 2010 (constant 2010 US$). The value of non-research projects exclusively benefitting newborns fluctuated somewhat but remained low, at US$5.7 million in 2010. The United States and the United Nations Children's Fund (UNICEF) provided the largest value of non-research funding mentioning and exclusively benefitting newborns, respectively.
Donor attention to newborn survival has increased since 2002, but it appears unlikely that donor aid is commensurate with the 3.0 million newborn deaths and 2.7 million stillbirths each year. We recommend that those tracking funding for other specific population groups, diseases, or activities consider a key term search approach in the Creditor Reporting System along with a detailed review of their data, but that they develop their search terms and interpretations carefully, taking into account the limitations described.
Please see later in the article for the Editors' Summary
Editors' Summary
In 1990, 12 million children—most of them living in developing countries—died before they reached their fifth birthday. Faced with this largely avoidable loss of young lives, in 2000, world leaders set a target of reducing under-five mortality (deaths) to one-third of its 1990 level by 2015 as Millennium Development Goal 4 (MDG4); this goal, together with seven others, aims to eradicate extreme poverty globally. In recent years, progress towards reducing child mortality has accelerated but remains insufficient to achieve MDG4, in part, because progress towards reducing neonatal mortality—deaths during the first 28 days of life—has been particularly slow. Neonatal deaths now account for a greater proportion of global child deaths than in 1990—43% of the 7 million children who died before their fifth birthday in 2011 died during the neonatal period. The major causes of neonatal deaths are complications of preterm and term delivery and infections. Simple interventions such as improved hygiene at birth and advice on breastfeeding can substantially reduce neonatal deaths.
Why Was This Study Done?
To achieve MDG4, more must be done to prevent deaths among newborn babies. One reason that progress in reducing neonatal mortality is slow could be insufficient donor funding (aid) for newborn health. Previous analyses by, for example, Countdown to 2015 (which tracks coverage levels for health interventions that reduce maternal, newborn, and child mortality) indicate that donor funding has increased for maternal, newborn, and child health over the past decade, but how much of this aid directly benefits newborns is unknown. Here, the researchers develop a method for tracking aid flows for newborns and examine changes in this flow over the past decade by applying their new strategy to the Organisation for Economic Co-operation and Development (OECD) Creditor Reporting System (CRS) Aid Activity database. This database collects information about official development assistance for health given (disbursed) to developing countries by member countries of the OECD Development Assistance Committee, international organizations, and some private donors.
What Did the Researchers Do and Find?
The researchers developed a comprehensive set of search terms related to newborn survival by piloting it on the Countdown to 2015 official development assistance database, which covers the years 2003–2008. They then used their list of 24 key terms to search the CRS database from 2002 (the first year for which relatively complete disbursement data are available) to 2010 (the most recent year for which data are available) and classified each retrieved project according to whether its funding activities aimed to benefit newborns exclusively or to improve the health of other population groups as well. The researchers found that key terms related to newborns were rare in disbursement records before 2005 but that their frequency increased markedly thereafter. The total value of non-research disbursements (aid provided for programmatic or advocacy activities) that mentioned any newborn search terms increased from US$38.4 million in 2002 to US$717.1 million in 2010. The value of non-research projects that exclusively benefitted newborns fluctuated; in 2010, it was $US5.7 million. Finally, the US and United Nations Children's Fund (UNICEF) provided the largest value of non-research funding mentioning newborns and exclusively benefitting newborns, respectively.
What Do These Findings Mean?
These findings indicate that the value of aid disbursements mentioning newborns or an activity likely to benefit newborns increased 20-fold between 2002 and 2010 and constituted an increasing proportion of aid for maternal, newborn, and child health. Although this increase may partly reflect increased detail in aid disbursement reporting, it is also likely to reflect an increase in donor attention to newborn survival. The accuracy of these findings is likely to be affected by limitations in the search strategy and in the CRS database, which does not capture aid flows from emerging donors such as China or from many private foundations. Moreover, because these findings take no account of domestic expenditure, they do not provide a comprehensive estimate of the value of resources available in developing countries for newborn health. Nevertheless, investment in newborn survival is unlikely to be commensurate with global newborn mortality. Thus, an expansion of programmatic funding from donors as well as increased governmental support for newborn health in developing countries is urgently needed to catalyze the scale-up of cost-effective interventions to save newborn lives and to meet MDG4.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001332.
The United Nations Childrens Fund (UNICEF) works for children's rights, survival, development, and protection around the world; it provides information on Millennium Development Goal 4 and its Childinfo website provides detailed statistics about child survival and health, including the 2012 report of UN Inter-agency Group of Child Mortality Estimation; its Committing to Child Survival: a Promise Renewed webpage includes links to its 2012 progress report, to a video about progress made in reducing child deaths worldwide, and to stories about child survival in the field
The World Health Organization has information about Millennium Development Goal 4 and about maternal, newborn, child, and adolescent health (some information in several languages)
Countdown to 2015 provides additional information on maternal, newborn, and child survival, including its 2012 report Building a Future for Women and Children
The Healthy Newborn Network (HNN) is a community of more than 70 partner organizations addressing critical knowledge gaps for newborn health providing recent data on newborn survival and analyses of country programs
Information on and access to the Organisation for Economic Co-operation Development Creditor Reporting System Aid Activities database is available
Further information about the Millennium Development Goals is available
Related Articles
A Study of National Physician Organizations' Efforts to Reduce Racial and Ethnic Health Disparities in the United States
Peek, Monica E.
Wilson, Shannon C.
Bussey-Jones, Jada
Lypson, Monica
Cordasco, Kristina
Jacobs, Elizabeth A.
Bright, Cedric
Brown, Arleen F.
Academic medicine : journal of the Association of American Medical Colleges
To characterize national physician organizations' efforts to reduce health disparities and identify organizational characteristics associated with such efforts.
This cross-sectional study was conducted between September 2009 and June 2010. The authors used two-sample t tests and chi-square tests to compare the proportion of organizations with disparity-reducing activities between different organizational types (e.g., primary care versus subspecialty organizations, small [<1,000 members] versus large [>5,000 members]). Inclusion criteria required physician organizations to be (1) focused on physicians, (2) national in scope, and (3) membership based.
The number of activities per organization ranged from 0 to 22. Approximately half (53%) of organizations had 0 or 1 disparity-reducing activities. Organiza-tional characteristics associated with having at least 1 disparity-reducing effort included membership size (88% of large groups versus 58% of small groups had at least 1 activity; P = .004) and the presence of a health disparities committee (95% versus 59%; P < .001). Primary care (versus subspecialty) organizations and racial/ethnic minority physician organizations were more likely to have disparity-reducing efforts, although findings were not statistically significant. Common themes addressed by activities were health care access, health care disparities, workforce diversity, and language barriers. Common strategies included education of physicians/trainees and patients/general public, position statements, and advocacy.
Despite the national priority to eliminate health disparities, more than half of national physician organizations are doing little to address this problem. Primary care and minority physician organizations, and those with disparities committees, may provide leadership to extend the scope of disparity-reduction efforts.
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Development of a National Agreement on Human Papillomavirus Vaccination in Japan: An Infodemiology Study
Nakada, Haruka
Yuji, Koichiro
Tsubokura, Masaharu
Ohsawa, Yukio
Kami, Masahiro
Journal of Medical Internet Research
A national agreement on human papillomavirus (HPV) vaccination was achieved relatively quickly in Japan as compared to the United States and India.
The objective was to identify the role of print and online media references, including references to celebrities or other informants, as factors potentially responsible for the relatively rapid national acceptance of HPV vaccination in Japan.
A method of text mining was performed to select keywords, representing the context of the target documents, from articles relevant to the promotion of HPV vaccination appearing in major Japanese newspapers and Web pages between January 2009 and July 2010. The selected keywords were classified as positive, negative, or neutral, and the transition of the frequency of their appearance was analyzed.
The number of positive and neutral keywords appearing in newspaper articles increased sharply in early 2010 while the number of negative keywords remained low. The numbers of positive, neutral, and negative keywords appearing in Web pages increased gradually and did not significantly differ by category. Neutral keywords, such as "vaccine" and "prevention," appeared more frequently in newspaper articles, whereas negative keywords, such as "infertility" and "side effect," appeared more frequently in Web pages. The extraction of the positive keyword "signature campaign" suggests that vaccine beneficiaries cooperated with providers in promoting HPV vaccination.
The rapid development of a national agreement regarding HPV vaccination in Japan may be primarily attributed to the advocacy of vaccine beneficiaries, supported by advocacy by celebrities and positive reporting by print and online media.
cervical cancer; health policy; human papillomavirus; public health; vaccination
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Randomised controlled trials in plastic surgery: a systematic review of reporting quality
Agha, Riaz Ahmed
Camm, Christian F.
Doganay, Emre
Edison, Eric
Siddiqui, Muhammed R. S.
Orgill, Dennis P.
European Journal of Plastic Surgery
We recently conducted a systematic review of the methodological quality of randomised controlled trials (RCTs) in plastic surgery. In accordance with convention, we are here separately reporting a systematic review of the reporting quality of the same RCTs.
MEDLINE® and the Cochrane Database of Systematic Reviews were searched by an information specialist from 1 January 2009 to 30 June 2011 for the MESH heading 'Surgery, Plastic'. Limitations were entered for English language, human studies and randomised controlled trials. Manual searching for RCTs involving surgical techniques was performed within the results. Scoring of the eligible papers was performed against the 23-item CONSORT Statement checklist. Independent secondary scoring was then performed and discrepancies resolved through consensus.
Fifty-seven papers met the inclusion criteria. The median CONSORT score was 11.5 out of 23 items (range 5.3–21.0). Items where compliance was poorest included intervention/comparator details (7 %), randomisation implementation (11 %) and blinding (26 %). Journal 2010 impact factor or number of authors did not significantly correlate with CONSORT score (Spearman rho = 0.25 and 0.12, respectively). Only 61 % declared conflicts of interest, 75 % permission from an ethics review committee, 47 % declared sources of funding and 16 % stated a trial registry number. There was no correlation between the volume of RCTs performed in a particular country and reporting quality.
The reporting quality of RCTs in plastic surgery needs improvement. Better education, awareness amongst all stakeholders and hard-wiring compliance through electronic journal submission systems could be the way forward. We call for the international plastic surgical community to work together on these long-standing problems.
Randomised controlled trials; Research methodology; Reporting quality; Consort; Levels of evidence
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Developing a Strategic Plan for Transitioning to Healthcare Knowledge Services Centers (HKSCs)
Goldstein, H. Mark
Coletti, Margaret H.
Journal of hospital librarianship
Facing a negative trend in the form of downsizing, layoffs, and closures, a small committee of hospital librarians in New England was formed in 2004 to provide library advocacy. Between 2008 and 2010, 23 hospital libraries closed in New England. In 2010, the committee shifted its focus from advocacy to a platform for change. This resulted in the creation of the Healthcare Knowledge Services Center (HKSC) Template. The Template is the basis for a 3-phased, 5-year strategic plan to establish several regional pilots, transitioning traditional hospital libraries to healthcare knowledge services centers. This article focuses on Phase One of the strategic plan, Development.
Advocacy; HKSC; healthcare knowledge services center; KM; knowledge management; library closures; strategic plan; template
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Tobacco control: consensus report of the National Medical Association.
Marable, Sharon
Crim, Courtney
Dennis, Gary C.
Epps, Roselyn Payne
Freeman, Harold
Mills, Sherry
Coolchan, Eric T.
Robinson, Lawrence
Robinson, Robert
Cole, Lorraine
Payne, Pamela H.
Journal of the National Medical Association
ISSUES: Tobacco Control remains one of the greatest determinants for reducing the morbidity and mortality of African Americans. OBJECTIVE: To examine the scope and consequences of tobacco use among African Americans and characterize its implications for the National Medical Association physician membership and their patients, and identify policy, education, advocacy and research issues in Tobacco Control for the organization. CONSENSUS PROCESS: Literature review using the MEDLINE database from January 1966 to August 1999 Week 1, searching Medical Subject Heading (MeSH) reading combined with text words "Black" or "African American" and "Tobacco" as a search term, identified 130 articles/110 abstracts published between 1988 and February 1999. The panel selected 61 appropriate articles and a paper summarizing the literature review was developed. The summary paper was used as background material for a formal consensus panel discussion on July 16-17, 1999. Consensus among committee members was reached via mail, fax and e-mail using the summary review paper, annotated bibliographies key informant surveys, and previous NMA resolutions on tobacco control. A formal working session was held on July 16-17, 1999 in which four areas of concentration of issues were determined: Policy, Advocacy, Education and Research. All committee members approved the final report. SUMMARY: Because tobacco control issues in African Americans are both complex and poorly understood, the panel views the NMA's role as pivotal in the coordination of resources and capacity-building to address all four areas identified. Stronger partner-ships with traditional federal and nonprofit agencies associated with tobacco control/advocacy in African Americans as well as nontraditional organizations (i.e., churches, academia, marketing and media organizations) also must occur to strengthen the infra-structure needed to assess needs, design appropriate interventions and evaluate the appropriateness, effectiveness and efficacy of tobacco control efforts in African American communities.
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The Evolution of Advocacy and Orthopaedic Surgery
Sethi, Manish K.
Obremskey, Allie
Sathiyakumar, Vasanth
Gill, John T.
Mather, Richard C.
Clinical Orthopaedics and Related Research
The future direction of American health care has become increasingly controversial during the last decade. As healthcare costs, quality, and delivery have come under intense scrutiny, physicians play evolving roles as "advocates" for both their profession and patients via healthcare policy. Hospital-physician alignment is critical to the future success of advocacy among orthopaedic surgeons, as both hospitals and physicians are key stakeholders in health care and can work together to influence major health policy decisions.
We (1) define the role of advocacy in medicine, specifically within orthopaedic surgery; (2) explore the history of physician advocacy and its evolution; (3) examine the various avenues of involvement for orthopaedic surgeons interested in advocacy; and (4) reflect on the impact of such activities on the future of orthopaedic surgery as it relates to hospital-physician alignment.
We performed a comprehensive review of the literature through a bibliographic search of MEDLINE® and Google Scholar databases from January 2000 to December 2010 to identify articles related to advocacy and orthopaedic surgery.
Advocacy among orthopaedic surgeons is critical in guiding the future of the American healthcare system. In today's world, advocacy necessitates a wider effort to improve healthcare access, quality, and delivery for patients on a larger scale. The nature of physician advocacy among orthopaedic surgeons is grounded in the desire to serve patients and alleviate their suffering. Participation in medical societies and political campaigns are two avenues of involvement.
The increasing role of government in American health care will require a renewed commitment to advocacy efforts from orthopaedic surgeons. The role of advocacy is rapidly redefining the continuum of care to a trinity of clinical excellence, innovative research, and effective advocacy. Failure to recognize this growing role of advocacy limits the impact we can have for our patients.
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Optimizing pediatric clinical care and advocacy in an online era
Dollin, Janet
Canadian Family Physician
To help busy FPs find useful current information and keep up to date on pediatric infectious disease and immunization topics by highlighting the work of one excellent source of reliable information in this area, the Canadian Paediatric Society Infectious Diseases and Immunization Committee.
Composition of the committee
Committee members were appointed to represent the Canadian Paediatric Society, the College of Family Physicians of Canada, the Public Health Agency of Canada, the American Academy of Pediatrics, and the National Advisory Committee on Immunization.
This article highlights important pediatric practice points generated by the Canadian Paediatric Society Infectious Diseases and Immunization Committee at a typical meeting in January 2013 from the perspective of an FP liaison. It also describes the committee's work methods and its background thinking related to the most current and changing issues.
Learn specific online links to updated pediatric infectious disease topics from the detailed content of this report. Topics include caring for kids new to Canada, vaccine-hesitant parents, influenza, human papillomavirus, pertussis, sexually transmitted infections, multidrug-resistant bacteria, and advocacy, among others.
Learn where to find this new and continuously changing information and how to stay evergreen in your knowledge.
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Response to the challenges of pandemic H1N1 in a small island state: the Barbadian experience
Sobers-Grannum, Natasha
Springer, Karen
Ferdinand, Elizabeth
John, Joy St
BMC Public Health
2010;10(Suppl 1):S10.
Having been overwhelmed by the complexity of the response needed for the severe acute respiratory syndrome (SARS) epidemic, public health professionals in the small island state of Barbados put various measures in place to improve its response in the event of a pandemic
Data for this study was collected using Barbados' National Influenza Surveillance System, which was revitalized in 2007. It is comprised of ten sentinel sites which send weekly notifications of acute respiratory illness (ARI) and severe acute respiratory illness (SARI) to the Office of the National Epidemiologist. During the 2009 H1N1 pandemic, meetings of the National Pandemic Planning Committee and the Technical Command Committee were convened. The pharmaceutical and non-pharmaceutical interventions (NPIs) implemented as a result of these meetings form the basis of the results presented in this paper.
On June 3, 2009, Barbados reported its first case of 2009 H1N1. From June until October 2009, there were 155 laboratory confirmed cases of 2009 H1N1, with one additional case occurring in January 2010. For the outbreak period (June-October 2009), the surveillance team received reports of 2,483 ARI cases, compared to 412 cases for the same period in 2008. The total hospitalization rate due to SARIs for the year 2009 was 90.1 per 100,000 people, as compared to 7.3 per 100,000 people for 2008. Barbados' pandemic response was characterized by a strong surveillance system combining active and passive surveillance, good risk communication strategy, a strengthened public and private sector partnership, and effective regional and international collaborations. Community restriction strategies such as school and workplace closures and cancellation of group events were not utilized as public health measures to delay the spread of the virus. Some health care facilities struggled with providing adequate isolation facilities.
The number of confirmed cases was small but the significant surge in ARI and SARI cases indicate that the impact of the virus on the island was moderate. As a result of 2009 H1N1, virological surveillance has improved significantly and local, regional and international partnerships have been strengthened.
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Enhancing Advocacy for Eye Care at National Levels: What Steps to Take for the Next Decade?
Rabiu, Muhammad Mansur
Al Rajhi, Abdulaziz
Qureshi, Mohammed Babar
Gersbeck, Jennifer
Middle East African Journal of Ophthalmology
The global initiative for the elimination of avoidable blindness by the year 2020-(VISION 2020- The Right to Sight), established in 1999, is a partnership of nongovernmental organizations (NGOs), governments, bilateral organizations, corporate bodies and the World Health Organization. The goal is to eliminate the major causes of avoidable blindness by the year 2020. Significant progress has been made in the last decade. For example, the adoption of three major World Health Assembly resolutions (WHA 56.26, 59.25 and 62.1) requesting governments to increase support and funding for the prevention of blindness and eye care. Additionally, the approval of the VISION 2020 declaration, development of plans and establishment of prevention of blindness committees and a designation of a coordinator by most participating countries represent other major achievements. Furthermore there has been increased political and professional commitment to the prevention of visual impairment and an increase in the provision of high-quality, sustainable eye care. Most of these achievements have been attributed to the advocacy efforts of VISION 2020 at the international level. The full success of this global initiative will likely depend on the extent to which the WHA resolutions are implemented in each country. However, most ratifying countries have not moved forward with implementation of these resolutions. To date, only few countries have shown consistent government support and funding for eye care pursuant to the resolutions. One of the main reasons for this may be inadequate and inappropriate advocacy for eye care at the national level. As such it is believed that the success of VISION 2020 in the next decade will depend on intense advocacy campaigns at national levels. This review identified some of the countries and health programs that have had fruitful advocacy efforts, to determine the factors that dictated success. The review highlights the factors of successful advocacy in two countries (Australia and Pakistan) that secured continued government support. The review further explores the achievements of the HIV/AIDs control network advocacy in securing global and national government support. Common factors for successful advocacy at the national level were identified to include generation of evidence data and effective utilization of the data with an appropriate forum and media to develop a credible relationship with prominent decision makers. Aligning eye care programming to the broad health and development agendas was a useful advocacy effort. Also a broad all-encompassing coalition of all stakeholders provides a solid platform for effective and persistent advocacy for government support of eye care.
Advocacy; Eye Care; Vision 2020
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The DOPPS Practice Monitor: Rationale and Methods for an Initiative to Monitor the New U.S. Bundled Dialysis Payment System
Robinson, Bruce
Fuller, Douglas
Zinsser, Dawn
Albert, Justin
Gillespie, Brenda
Tentori, Francesca
Turenne, Marc
Port, Friedrich
Pisoni, Ronald
American journal of kidney diseases : the official journal of the National Kidney Foundation
A new initiative of the United States (U.S.) Dialysis Outcomes and Practice Patterns Study (DOPPS), the DOPPS Practice Monitor (DPM) provides up-to-date data and analyses to monitor trends in dialysis practice during implementation of the new Centers for Medicare and Medicaid Services (CMS) End-Stage Renal Disease (ESRD) Prospective Payment System (PPS; 2011–2014). We review DPM rationale, design, sampling approach, analytic methods, and facility sample characteristics. Using stratified random sampling, the sample of ~145 U.S. facilities provides results representative nationally and by facility type (dialysis organization size, rural/urban, free-standing/hospital-based), achieving coverage similar to the CMS sample frame at average values and tails of the distributions for key measures and patient characteristics. A publicly available Web report (www.dopps.org/DPM) provides detailed trends including demographic, comorbidity, and dialysis data, medications, vascular access, and quality of life. Findings are updated every 4 months and lagged only 3–4 months. Baseline data are from mid-2010, prior to the new PPS. In sum, the DPM provides timely, representative data to monitor the effects of the expanded PPS on dialysis practice. Findings can serve as an early warning system for possible adverse effects on clinical care and as a basis for community outreach, editorial comment, and informed advocacy.
End-stage renal disease; Prospective Payment System; Quality Incentive Program; Dialysis Outcomes and Practice Patterns Study
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A rapid assessment and response approach to review and enhance Advocacy, Communication and Social Mobilisation for Tuberculosis control in Odisha state, India
Kamineni, Vishnu Vardhan
Turk, Tahir
Wilson, Nevin
Satyanarayana, Srinath
Chauhan, Lakbir Singh
BMC Public Health
Tuberculosis remains a major public health problem in India with the country accounting for 1 in 5 of all TB cases reported globally. An advocacy, communication and social mobilisation project for Tuberculosis control was implemented and evaluated in Odisha state of India. The purpose of the study was to identify the impact of project interventions including the use of 'Interface NGOs' and involvement of community groups such as women's self-help groups, local government bodies, village health sanitation committees, and general health staff in promoting TB control efforts.
The study utilized a rapid assessment and response (RAR) methodology. The approach combined both qualitative field work approaches, including semi-structured interviews and focus group discussions with empirical data collection and desk research.
Results revealed that a combination of factors including the involvement of Interface NGOs, coupled with increased training and engagement of front line health workers and community groups, and dissemination of community based resources, contributed to improved awareness and knowledge about TB in the targeted districts. Project activities also contributed towards improving health worker and community effectiveness to raise the TB agenda, and improved TB literacy and treatment adherence. Engagement of successfully treated patients also assisted in reducing community stigma and discrimination.
The expanded use of advocacy, communication and social mobilisation activities in TB control has resulted in a number of benefits. These include bridging pre-existing gaps between the health system and the community through support and coordination of general health services stakeholders, NGOs and the community. The strategic use of 'tailored messages' to address specific TB problems in low performing areas also led to more positive behavioural outcomes and improved efficiencies in service delivery. Implications for future studies are that a comprehensive and well planned range of ACSM activities can enhance TB knowledge, attitudes and behaviours while also mobilising specific community groups to build community efficacy to combat TB. The use of rapid assessments combined with other complementary evaluation approaches can be effective when reviewing the impact of TB advocacy, communication and social mobilisation activities.
tuberculosis; advocacy; communication; social mobilisation; rapid assessment and review
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KRAS Testing for Anti-EGFR Therapy in Advanced Colorectal Cancer
Ontario Health Technology Assessment Series
Executive Summary
In February 2010, the Medical Advisory Secretariat (MAS) began work on evidence-based reviews of the literature surrounding three pharmacogenomic tests. This project came about when Cancer Care Ontario (CCO) asked MAS to provide evidence-based analyses on the effectiveness and cost-effectiveness of three oncology pharmacogenomic tests currently in use in Ontario.
Evidence-based analyses have been prepared for each of these technologies. These have been completed in conjunction with internal and external stakeholders, including a Provincial Expert Panel on Pharmacogenomics (PEPP). Within the PEPP, subgroup committees were developed for each disease area. For each technology, an economic analysis was also completed by the Toronto Health Economics and Technology Assessment Collaborative (THETA) and is summarized within the reports.
The following reports can be publicly accessed at the MAS website at: www.health.gov.on.ca/mas or at www.health.gov.on.ca/english/providers/program/mas/mas_about.html
Gene Expression Profiling for Guiding Adjuvant Chemotherapy Decisions in Women with Early Breast Cancer: An Evidence-Based and Economic Analysis
Epidermal Growth Factor Receptor Mutation (EGFR) Testing for Prediction of Response to EGFR-Targeting Tyrosine Kinase Inhibitor (TKI) Drugs in Patients with Advanced Non-Small-Cell Lung Cancer: an Evidence-Based and Economic Analysis
K-RAS testing in Treatment Decisions for Advanced Colorectal Cancer: an Evidence-Based and Economic Analysis.
The objective of this systematic review is to determine the predictive value of KRAS testing in the treatment of metastatic colorectal cancer (mCRC) with two anti-EGFR agents, cetuximab and panitumumab. Economic analyses are also being conducted to evaluate the cost-effectiveness of KRAS testing.
Clinical Need: Condition and Target Population
Metastatic colorectal cancer (mCRC) is usually defined as stage IV disease according to the American Joint Committee on Cancer tumour node metastasis (TNM) system or stage D in the Duke's classification system. Patients with advanced colorectal cancer (mCRC) either present with metastatic disease or develop it through disease progression.
KRAS (Kristen-RAS, a member of the rat sarcoma virus (ras) gene family of oncogenes) is frequently mutated in epithelial cancers such as colorectal cancer, with mutations occurring in mutational hotspots (codons 12 and 13) of the KRAS protein. Involved in EGFR-mediated signalling of cellular processes such as cell proliferation, resistance to apoptosis, enhanced cell motility and neoangiogenesis, a mutation in the KRAS gene is believed to be involved in cancer pathogenesis. Such a mutation is also hypothesized to be involved in resistance to targeted anti-EGFR (epidermal growth factor receptor with tyrosine kinase activity) treatments such as cetuximab and panitumumab, hence, the important in evaluating the evidence on the predictive value of KRAS testing in this context.
KRAS Mutation Testing in Advanced Colorectal Cancer
Both cetuximab and panitumumab are indicated by Health Canada in the treatment of patients with metastatic colorectal cancer whose tumours are WT for the KRAS gene. Cetuximab may be offered as monotherapy in patients intolerant to irinotecan-based chemotherapy or in patients who have failed both irinotecan and oxaliplatin-based regimens and who received a fluoropyrimidine. It can also be administered in combination with irinotecan in patients refractory to other irinotecan-based chemotherapy regimens. Panitumumab is only indicated as a single agent after failure of fluoropyrimidine-, oxaliplatin-, and irinotecan-containing chemotherapy regimens.
In Ontario, patients with advanced colorectal cancer who are refractory to chemotherapy may be offered the targeted anti-EGFR treatments cetuximab or panitumumab. Eligibility for these treatments is based on the KRAS status of their tumour, derived from tissue collected from surgical or biopsy specimens. It is believed that KRAS status is not affected by treatments, therefore, for patients for whom surgical tissue is available for KRAS testing, additional biopsies prior to treatment with these targeted agents is not necessary. For patients that have not undergone surgery or for whom surgical tissue is not available, a biopsy of either the primary or metastatic site is required to determine their KRAS status. This is possible as status at the metastatic and primary tumour sites is considered to be similar.
Research Question
To determine if there is predictive value of KRAS testing in guiding treatment decisions with anti-EGFR targeted therapies in advanced colorectal cancer patients refractory to chemotherapy.
Research Methods
Literature Search
The Medical Advisory Secretariat followed its standard procedures and on May 18, 2010, searched the following electronic databases: Ovid MEDLINE, EMBASE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and The International Network of Agencies for Health Technology Assessment database.
The subject headings and keywords searched included colorectal cancer, cetuximab, panitumumab, and KRAS testing. The search was further restricted to English-language articles published between January 1, 2009 and May 18, 2010 resulting in 1335 articles for review. Excluded were case reports, comments, editorials, nonsystematic reviews, and letters. Studies published from January 1, 2005 to December 31, 2008 were identified in a health technology assessment conducted by the Agency for Healthcare Research and Quality (AHRQ), published in 2010. In total, 14 observational studies were identified for inclusion in this EBA: 4 for cetuximab monotherapy, 7 for the cetuximab-irinotecan combination therapy, and 3 to be included in the review for panitumumab monotherapy
Inclusion Criteria
English-language articles, and English or French-language HTAs published from January 2005 to May 2010, inclusive.
Randomized controlled trials (RCTs) or observational studies, including single arm treatment studies that include KRAS testing.
Studies with data on main outcomes of interest, overall and progression-free survival.
Studies of third line treatment with cetuximab or panitumumab in patients with advanced colorectal cancer refractory to chemotherapy.
For the cetuximab-irinotecan evaluation, studies in which at least 70% of patients in the study received this combination therapy.
Exclusion Criteria
Studies whose entire sample was included in subsequent publications which have been included in this EBA.
Studies in pediatric populations.
Case reports, comments, editorials, or letters.
Outcomes of Interest
Overall survival (OS), median
Progression-free-survival (PFS), median.
Response rates.
Adverse event rates.
Quality of life (QOL).
Summary of Findings of Systematic Review
Cetuximab or Panitumumab Monotherapy
Based on moderate GRADE observational evidence, there is improvement in PFS and OS favouring patients without the KRAS mutation (KRAS wildtype, or KRAS WT) compared to those with the mutation.
Cetuximab-Irinotecan Combination Therapy
There is low GRADE evidence that testing for KRAS may optimize survival benefits in patients without the KRAS mutation (KRAS wildtype, or KRAS WT) compared to those with the mutation.
However, cetuximab-irinotecan combination treatments based on KRAS status discount any effect of cetuximab in possibly reversing resistance to irinotecan in patients with the mutation, as observed effects were lower than for patients without the mutation. Clinical experts have raised concerns about the biological plausibility of this observation and this conclusion would, therefore, be regarded as hypothesis generating.
Economic Analysis
Cost-effectiveness and budget impact analyses were conducted incorporating estimates of effectiveness from this systematic review. Evaluation of relative cost-effectiveness, based on a decision-analytic cost-utility analysis, assessed testing for KRAS genetic mutations versus no testing in the context of treatment with cetuximab monotherapy, panitumumab monotherapy, cetuximab in combination with irinotecan, and best supportive care.
Of importance to note is that the cost-effectiveness analysis focused on the impact of testing for KRAS mutations compared to no testing in the context of different treatment options, and does not assess the cost-effectiveness of the drug treatments alone.
KRAS status is predictive of outcomes in cetuximab and panitumumab monotherapy, and in cetuximab-irinotecan combination therapy.
While KRAS testing is cost-effective for all strategies considered, it is not equally cost-effective for all treatment options.
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Evaluation of resident attitudes and self-reported competencies in health advocacy
Stafford, Sara
Sedlak, Tara
Fok, Mark C
Wong, Roger Y
BMC Medical Education
The CanMEDS Health Advocate role, one of seven roles mandated by the Royal College of Physicians and Surgeons Canada, pertains to a physician's responsibility to use their expertise and influence to advance the wellbeing of patients, communities, and populations. We conducted our study to examine resident attitudes and self-reported competencies related to health advocacy, due to limited information in the literature on this topic.
We conducted a pilot experience with seven internal medicine residents participating in a community health promotion event. The residents provided narrative feedback after the event and the information was used to generate items for a health advocacy survey. Face validity was established by having the same residents review the survey. Content validity was established by inviting an expert physician panel to review the survey. The refined survey was then distributed to a cohort of core Internal Medicine residents electronically after attendance at an academic retreat teaching residents about advocacy through didactic sessions.
The survey was completed by 76 residents with a response rate of 68%. The majority agreed to accept an advocacy role for societal health needs beyond caring for individual patients. Most confirmed their ability to identify health determinants and reaffirmed the inherent requirements for health advocacy. While involvement in health advocacy was common during high school and undergraduate studies, 76% of residents reported no current engagement in advocacy activity, and 36% were undecided if they would engage in advocacy during their remaining time as residents, fellows or staff. The common barriers reported were insufficient time, rest and stress.
Medical residents endorsed the role of health advocate and reported proficiency in determining the medical and bio-psychosocial determinants of individuals and communities. Few residents, however, were actively involved in health advocacy beyond an individual level during residency due to multiple barriers. Further studies should address these barriers to advocacy and identify the reasons for the discordance we found between advocacy endorsement and lack of engagement.
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Tobacco Industry Manipulation of Tobacco Excise and Tobacco Advertising Policies in the Czech Republic: An Analysis of Tobacco Industry Documents
Shirane, Risako
Smith, Katherine
Ross, Hana
Silver, Karin E.
Williams, Simon
Gilmore, Anna
PLoS Medicine
Risako Shirane and colleagues examined the the Legacy Tobacco Documents Library and found evidence of transnational tobacco company influence over tobacco advertising and excise policy in the Czech Republic, a country with one of the poorest tobacco control records in Europe.
The Czech Republic has one of the poorest tobacco control records in Europe. This paper examines transnational tobacco companies' (TTCs') efforts to influence policy there, paying particular attention to excise policies, as high taxes are one of the most effective means of reducing tobacco consumption, and tax structures are an important aspect of TTC competitiveness.
Methods and Findings
TTC documents dating from 1989 to 2004/5 were retrieved from the Legacy Tobacco Documents Library website, analysed using a socio-historical approach, and triangulated with key informant interviews and secondary data. The documents demonstrate significant industry influence over tobacco control policy. Philip Morris (PM) ignored, overturned, and weakened various attempts to restrict tobacco advertising, promoting voluntary approaches as an alternative to binding legislation. PM and British American Tobacco (BAT) lobbied separately on tobacco tax structures, each seeking to implement the structure that benefitted its own brand portfolio over that of its competitors, and enjoying success in turn. On excise levels, the different companies took a far more collaborative approach, seeking to keep tobacco taxes low and specifically to prevent any large tax increases. Collective lobbying, using a variety of arguments, was successful in delaying the tax increases required via European Union accession. Contrary to industry arguments, data show that cigarettes became more affordable post-accession and that TTCs have taken advantage of low excise duties by raising prices. Interview data suggest that TTCs enjoy high-level political support and continue to actively attempt to influence policy.
There is clear evidence of past and ongoing TTC influence over tobacco advertising and excise policy. We conclude that this helps explain the country's weak tobacco control record. The findings suggest there is significant scope for tobacco tax increases in the Czech Republic and that large (rather than small, incremental) increases are most effective in reducing smoking.
Please see later in the article for the Editors' Summary
Editors' Summary
Every year, about 5 million people die from tobacco-related diseases and, if current trends continue, annual tobacco-related deaths will increase to 10 million by 2030. Faced with this global tobacco epidemic, national and international bodies have drawn up conventions and directives designed to control tobacco. For example, European Union (EU) Directives on tobacco control call for member states to ban tobacco advertising, promotion, and sponsorship and to adopt taxation policies (for example, high levels of tobacco excise tax) aimed at reducing tobacco consumption. Within the EU, implementation of tobacco control policies varies widely but the Czech Republic, which was formed in 1993 when Czechoslovakia split following the 1989 collapse of communism, has a particularly poor record. The Czech Republic, which joined the EU in 2004, is the only EU Member State not to have ratified the World Health Organization's Framework Convention on Tobacco Control, which entered into force in 2005, and its tobacco control policies were the fourth least effective in Europe in 2010.
Why Was This Study Done?
During the communist era, state-run tobacco monopolies controlled the supply of cigarettes and other tobacco products in Czechoslovakia. Privatization of these monopolies began in 1991 and several transnational tobacco companies (TTCs)—in particular, Philip Morris and British American Tobacco—entered the tobacco market in what was to become the Czech Republic. In this socio-historical study, which aims to improve understanding of both effective tobacco excise policy and the ways in which TTCs seek to influence policy in emerging markets, the researchers analyze publically available internal TTC documents and interview key informants to examine efforts made by TTCs to influence tobacco advertising and tobacco excise tax policies in the Czech Republic. A socio-historical study examines the interactions between individuals and groups in a historical context.
What Did the Researchers Do and Find?
The researchers analyzed 511 documents (dated 1989 onwards) in the Legacy Tobacco Documents Library website (a collection of internal tobacco industry documents released through US litigation cases) that mentioned tobacco control policies in the Czech Republic. They also analyzed information obtained from sources such as tobacco industry journals and data obtained in 2010 in interviews with key Czech informants (including a tobacco industry representative and a politician). The researchers' analysis of the industry documents indicates that Philip Morris ignored, overturned, and weakened attempts to restrict tobacco advertising and promoted voluntary approaches as an alternative to binding legislation. Importantly, while the internal documents show that Philip Morris lobbied for a specific excise tax (a fixed amount of tax per cigarette, a tax structure that favors the expensive brands that Philip Morris mainly markets), the European strategy employed at that time by British American Tobacco was to lobby for a mixed excise structure that combined an "ad valorem" tax (a tax levied as a proportion of price) and a specific tax, an approach that favors a mixed portfolio of tobacco brands. By contrast, the documents show that TTCs collaborated in trying to keep tobacco taxes low and in trying to prevent any large tax increases. This collective lobbying successfully delayed the tobacco tax increases required as a condition of the Czech Republic's accession to the EU. Finally, the interview data suggest that TTCs had high-level political support in the Czech Republic and continue actively to attempt to influence policy.
What Do These Findings Mean?
These findings provide clear evidence that Philip Morris and British American Tobacco (the two TTCs that have dominated the Czech market since privatization of the tobacco industry) have significantly influenced tobacco advertising and excise policy in the Czech Republic since 1989. The findings, which also suggest that this influence is ongoing, help to explain the Czech Republic's poor tobacco control record, which was reflected in a fall in the real price of cigarettes between 1990 and 2000. More generally, this study provides valuable insight into how TTCs might try to influence policy in other emerging markets. Improvements in global tobacco control, the researchers conclude, will be possible only if efforts are made to protect tobacco control policies from the vested interests of the tobacco industry, a principle enshrined in the WHO Framework Convention on Tobacco control, and if public and political attitudes to the industry shift.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001248.
The World Health Organization provides information about the dangers of tobacco (in several languages) and about its Framework Convention on Tobacco Control
For information about the tobacco industry's influence on policy, see the 2009 World Health Organization report Tobacco interference with tobacco control
The Framework Convention Alliance more information about the FCTC
Details of European Union legislation on excise duty applied to manufactured tobacco and on the manufacture, presentation and sale of tobacco products are available (in several languages)
The Legacy Tobacco Documents Library is a searchable public database of tobacco company internal documents detailing their advertising, manufacturing, marketing, sales, and scientific activities
The UK Centre for Tobacco Control Studies is a network of UK universities that undertakes original research, policy development, advocacy, and teaching and training in the field of tobacco control
SmokeFree, a website provided by the UK National Health Service, offers advice on quitting smoking and includes personal stories from people who have stopped smoking
Smokefree.gov, from the US National Cancer Institute, offers online tools and resources to help people quit smoking and not start again
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Myint, Nyan Win
Kaewkungwal, Jaranit
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Panjapiyakul, Pornpet
Siriwan, Pichit
Mallik, Arun K
Nyein, Soe Lwin
Mu, Thet Thet
Conflict and Health
This study aims to assess the situation of communicable diseases under national surveillance in the Cyclone Nargis-affected areas in Myanmar (Burma) before and after the incident.
Monthly data during 2007, 2008 and 2009 from the routine reporting system for disease surveillance of the Myanmar Ministry of Health (MMOH) were reviewed and compared with weekly reporting from the Early Warning and Rapid Response (EWAR) system. Data from some UN agencies, NGOs and Tri-Partite Core Group (TCG) periodic reviews were also extracted for comparisons with indicators from Sphere and the Inter-Agency Standing Committee.
Compared to 2007 and 2009, large and atypical increases in diarrheal disease and especially dysentery cases occurred in 2008 following Cyclone Nargis. A seasonal increase in ARI reached levels higher than usual in the months of 2008 post-Nargis. The number of malaria cases post-Nargis also increased, but it was less clear if this reflected normal seasonal patterns or was specifically associated with the disaster event. There was no significant change in the occurrence of other communicable diseases in Nargis-affected areas. Except for a small decrease in mortality for diarrheal diseases and ARI in 2008 in Nargis-affected areas, population-based mortality rates for all other communicable diseases showed no significant change in 2008 in these areas, compared to 2007 and 2009. Tuberculosis control programs reached their targets of 70% case detection and 85% treatment success rates in 2007 and 2008. Vaccination coverage rates for DPT 3rd dose and measles remained at high though measles coverage still did not reach the Sphere target of 95% even by 2009. Sanitary latrine coverage in the Nargis-affected area dropped sharply to 50% in the months of 2008 following the incident but then rose to 72% in 2009.
While the incidence of diarrhea, dysentery and ARI increased post-Nargis in areas affected by the incident, the incidence rate for other diseases and mortality rates did not increase, and normal disease patterns resumed by 2009. This suggests that health services as well as prevention and control measures provided to the Nargis-affected population mitigated what could have been a far more severe health impact.
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Who knew? Awareness of being recommended for influenza vaccination among U.S. adults
Maurer, Jürgen
Harris, Katherine M.
Parker, Andrew M.
Influenza and Other Respiratory Viruses
Starting with the 2010–2011 influenza season, the Advisory Committee on Immunization Practices at the U.S. Centers for Disease Control and Prevention recommends annual influenza vaccination to all people aged 6 months and older unless contraindicated.
To measure perceived influenza vaccination recommendation status among U.S. adults (n=2,122) and its association with socio-demographic characteristics and recommendation status during the 2009–2010 pandemic influenza season.
We analyze nationally representative data from longitudinal Internet surveys of U.S. adults conducted in November/December 2009 and September/October 2010.
46.2 percent (95%-CI: 43.3%–49.1%) of U.S. adults correctly reported to be covered by a government recommendation for influenza vaccination during the 2010–2011 vaccination season. Awareness of being covered by a government influenza vaccination recommendation was statistically significantly higher among non-working adults and adults who had been recommended for seasonal vaccination or both seasonal and H1N1 vaccination during the 2009–2010 pandemic influenza vaccination season.
Our results highlight that a majority of U.S. adults does not know that they are recommended for annual influenza vaccination by the government. The fraction of adults who are unaware of their recommendation status is especially large among newly recommended healthy young adults. The universal vaccination recommendations will only be successful if they reach both patients and physicians and lead to changing vaccination practices. The universal nature of the new recommendation simplifies vaccination-related outreach and compliance with government vaccination guidelines considerably, since it does not require any identification of specific recommendation groups based on complex personal or health risk factors.
Influenza; Influenza vaccination; ACIP recommendations; Patient knowledge
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Academics and competing interests in H1N1 influenza media reporting
Mandeville, Kate L
O'Neill, Sam
Brighouse, Andrew
Walker, Alice
Yarrow, Kielan
Chan, Kenneth
Journal of Epidemiology and Community Health
Concerns have been raised over competing interests (CoI) among academics during the 2009 to 2010 A/H1N1 pandemic. Media reporting can influence public anxiety and demand for pharmaceutical products. We assessed CoI of academics providing media commentary during the early stages of the pandemic.
We performed a retrospective content analysis of UK newspaper articles on A/H1N1 influenza, examining quoted sources. We noted when academics made a risk assessment of the pandemic and compared this with official estimations. We also looked for promotion or rejection of the use of neuraminidase inhibitors or H1N1-specific vaccine. We independently searched for CoI for each academic.
Academics were the second most frequently quoted source after Ministers of Health. Where both academics and official agencies estimated the risk of H1N1, one in two academics assessed the risk as higher than official predictions. For academics with CoI, the odds of a higher risk assessment were 5.8 times greater than those made by academics without CoI (Wald p value=0.009). One in two academics commenting on the use of neuraminidase inhibitors or vaccine had CoI. The odds of CoI in academics promoting the use of neuraminidase inhibitors were 8.4 times greater than for academics not commenting on their use (Fisher's exact p=0.005).
There is evidence of CoI among academics providing media commentary during the early H1N1 pandemic. Heightened risk assessments, combined with advocacy for pharmaceutical products to counter this risk, may lead to increased public anxiety and demand. Academics should declare, and journalists report, relevant CoI for media interviews.
Related Articles
From personal tragedy to personal challenge: responses to stigma among sober living home residents and operators
Heslin, Kevin C.
Singzon, Trudy
Aimiuwu, Otaren
Sheridan, Dave
Hamilton, Alison
Sociology of health & illness
Sober living homes for people attempting to maintain abstinence from alcohol and drugs can act as a buffer against the high rates of substance misuse that are endemic to many urban environments. Sober living homes and other group homes for people with disabilities have faced persistent opposition from neighborhood associations, which raises the question of stigma. This article describes the responses of sober living home residents and operators to the threat of stigma across a diverse set of neighborhoods. Ten focus groups were conducted with 68 residents and operators of 35 sober living homes in Los Angeles County, California, between January 2009 and March 2010. Results showed that few residents reported experiences of blatant stigmatization by neighbors; however, they were well aware of the stereotypes that could be ascribed to them. Despite this potential stigma, residents developed valued identities as helpers in their communities, providing advice to neighbors whose family or friends had substance use problems, and organizing community service activities to improve the appearance of their neighborhoods. With their attention to local context, sober living home residents and operators challenge the personal tragedy approach of much traditional advocacy on health-related stigma.
substance use; stigma; community; identity; social support
Related Articles
Recent Developments in Multivitamin/Mineral Research12
Comerford, Kevin B.
Advances in Nutrition
The 2010 Dietary Guidelines Advisory Committee was charged with the task of investigating the effects of multivitamin/mineral supplements on healthy populations and also on those with chronic disease. The evidence from which the committee prepared its conclusions was graded on 5 fundamental criteria: quality, consistency, quantity, clinical impact, and generalizability. The committee concluded that for the general healthy population, evidence was insufficient to make a multivitamin/mineral recommendation. On the other hand, the committee noted the value of some supplemental nutrients for at-risk populations such as iron, folic acid, and vitamin B-12. However, most of the studies referenced for the research used the conventional, all-encompassing, and oversimplified definition of a multivitamin/mineral as being a supplement containing 3 or more vitamins with or without minerals. In the few years since the committee released its 2010 report, several randomized clinical trials showing the benefits of daily multivitamin/mineral supplementation have been completed using supplements containing at least 10 or more vitamins and/or minerals, but there also continues to be some reports that do not find benefit from such supplements. Furthermore, several steps have been taken to advance the science behind these supplements so that consumers, physicians, and government agencies can all have more confidence in understanding the role of supplemental nutrition in the American diet. This review provides new evidence from 2010 onward addressing the committee's primary concerns about multivitamin/mineral research in regard to improving public health. It also includes several recent studies that may be of interest to future committees indicating the potential benefits of these supplements on improving the cognitive performance and mental well-being of healthy populations.
Related Articles
Self-Advocacy and Cancer: A Concept Analysis
Hagan, Teresa L.
Donovan, Heidi S.
Journal of advanced nursing
This paper is a report of an analysis of the concept of self-advocacy among individuals with cancer to clarify its meaning, to differentiate this meaning with related concepts and to unify understanding of the concept in cancer research and practice.
Cancer survivors are increasingly required to assume an active role in their healthcare. A thorough analysis of how survivors advocate for themselves is a crucial aspect in supporting survivors' ability to engage and manage their care throughout all stages of cancer survivorship.
Walker and Avant's eight-step process of conducting a concept analysis was used.
Data Sources
PubMed, PsycINFO and CINAHL databases were searched for articles, reviews, editorials and gray literature directly addressing self-advocacy.
Review Methods
A broad inquiry into the literature from 1960 – 2012 that produces a definition of self-advocacy. Model and contrary cases of self-advocacy demonstrate the concept's application and intricacies.
Antecedents to self-advocacy include particular personal characteristics, learned skills and attainable support. The essential element of self-advocacy and what differentiates it from related concepts, is the internalization of these antecedent resources into self-advocacy thoughts and actions while incorporating personal values and priorities in a way that upholds the survivors' goals and beliefs. A full realization of self-advocacy facilitates a cancer survivor attaining a strong self-concept, sense of control and adaptation to a life with cancer.
Self-advocacy is a process of internalizing skills and resources to act in a way that supports survivors' needs and goals.
self-advocacy; advocacy; cancer survivorship; nursing; concept analysis
Related Articles
Residents as health advocates: The development, implementation and evaluation of a child advocacy initiative at the University of Toronto (Toronto, Ontario)
Au, Hosanna
Harrison, Megan
Ahmet, Alexandra
Orsino, Angela
Beck, Carolyn E
Tallett, Susan
Gans, Marvin
Birken, Catherine S
Paediatrics & Child Health
Advocacy is an integral part of a paediatrician's role. The Royal College of Physicians and Surgeons of Canada has identified advocacy as one of the essential Canadian Medical Education Directives for Specialists competencies, and participation in child advocacy work as an important component of paediatric residency training. The objective of the present paper was to describe the development, implementation and evaluation of the first four years of the child advocacy initiative at the University of Toronto (Toronto, Ontario).
Ideas for community child advocacy projects were generated through a literature review, and a link to a local elementary school was identified. Teacher and parent focus groups were conducted to identify areas for resident involvement. Workshops were then developed, implemented and evaluated by paediatric residents.
Six child advocacy projects between 2001 and 2004 were conducted based on results from the focus groups. These included annual clothing drives, as well as workshops for parents and children about nutrition, safety, parenting, illness management and basic first aid. More than 95% of parents reported that the workshops were useful or very useful, more than 92% felt that they learned something new and more than 83% wanted the residents to return for further workshops. Teachers and residents gave positive informal feedback.
Through the child advocacy initiative, paediatric residents had the opportunity to develop skills in advocacy, learn about the determinants of child health and become community partners in advocating for children. Such an initiative can be incorporated into the residency curriculum to help residents develop competency in advocacy.
Advocacy; Community; Medical Education; Paediatrics; Residency
Related Articles
Creating a Provincial Family Council to Engage Youth and Families in Child & Youth Mental Health Systems
Davidson, Jana
Wiens, Sandy
Anderson, Keli
Journal of the Canadian Academy of Child and Adolescent Psychiatry
To create a mechanism in British Columbia (BC) for youth and families to directly engage with key provincial committees that develop policy and implement service delivery for child and youth mental health.
In 2009, a plan was initiated to increase the involvement and influence of youth and families in research, policy, practices and programs related to child and youth mental health. This initiative, led by a provincial family advocacy society in partnership with representatives from health services and government, resulted in the establishment of the Provincial Family Council for Child and Youth Mental Health (PFC). Formation of the PFC occurred in two phases: initially, a Working Group co-chaired by a parent and a youth was tasked with developing the Terms of Reference and framework for the PFC; phase two involved ensuring important constituencies/demographics and competencies were represented in the membership of the PFC. Result: The Provincial Family Council is officially endorsed by the provincial government and is informing key provincial committees in British Columbia.
In BC, the PFC is the vehicle through which youth and families can now work in partnership with "the system" to promote and improve the mental health of BC's children and youth.
early intervention; parenting; partnerships; family engagement; intervention précoce; rôle des parents; partenariat; engagement de la famille
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"The Simien Mountains" Top 5 Page for this destination Gonder Sports & Outdoors Tip by SirRichard
Gonder Sports & Outdoors: 2 reviews and 6 photos
If you like trekking and good landscapes, the Simien Mountains is a must while in Ethiopia. Gonder is usually the BaseCamp, the place from where to organize the trip. 2-3 days is enough to see it all. You will find guys offering you trips by the streets. If you want a more organized thing, try at a the travel agency in the Quara Hotel, in the gardens hut.
Don't try to find better deals in Debark (the closest village) as Debark is but a road junction. If you are travelling alone, you may join a group.
July-August is rainy season, so the landscapes are cloudy and the tracks muddy. And it rains often. But the landscapes are greener. January to April is high season.
There is not much fauna to be seen, but some monkeys and goats are usual.
Equipment: If you can't or don't want to do the trip, in the Gonder-Aksum bus trip you will pass near the Simiens and have wonderful landscpaes too.
Theme: Hiking
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I am not sure if I was hacked or not (or how I would know for sure if I was hacked) The formatting of all my posts is gone. Every post is now one giant paragraph and I am having trouble fixing this mess. I haven't backed up my work yet because the blog is new. (Yes, I changed my password).
Website: TumbleWeedDeals.com


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S&P 500 index has its best year since 1997
NEW YORK -- The stock market closed out a record year with more all-time highs on Tuesday, giving U.S. indexes their biggest annual gains in almost two decades.
The Standard & Poor's 500 index notched its best year since 1997; The Dow Jones industrial average rose the most since 1995.
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represents the distribution of a quadratic form for multivariate normal z.
- To use QuadraticFormDistribution, you first need to load the Multivariate Statistics Package using Needs["MultivariateStatistics`"].
- QuadraticFormDistribution is the distribution of for real-valued × symmetric positive definite matrix a, length- vector b, scalar c, and -dimensional multivariate normal vector z.
- QuadraticFormDistribution can be used with such functions as Mean and RandomReal.


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updated 08/22/2014 AT 4:15 PM ET
•originally published 08/22/2014 AT 12:30 PM ET
Instead, the pets surprised Zanoni by quickly becoming enamored with one another. The video above shows the adorable behavior that has become normal for this animal odd couple. Apparently, Earnestine and Gertrude often spend their days cuddling together and exchanging sweet, interspecies kisses.
It's just the kind of "awww" you need to start the weekend off right.


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KPM-400 Automatic horizontal labeling machine
I. Introduction
KPM-400 is suitable for round or cylindrical product which can be vertically transported. It is featured by high labeling precision, stable operation, neat, no bubble, no wrinkle. The qualified rate can reach 99%. It is no bottle no labeling. Besides, if the label size is different,it can be adjustable in certain scope. The whole machine is easy to move can be matched with ribbon code printer,bottle unscrambler, turn table and inkjet printer ect.
II. Application Range
1. Power: round or cylindrical product, tube or injection which can not be vertically transported
2. Label application: adhesive paper/ transparent label inroll
3. Roll inner diameter: 76mm
4. Roll outer diameter≤300mm
5. Measuring accuracy: <1%
6. Label size: 10≤width≤80mm, length≥20mm
III. Technical parameter
1. Production capacity: 1800-18000 B/H
2. Product size: 9≤ product diametre ≤25mm product height≤200mm
3. Labeling precision error: ±1mm (include product and label error)
4. Power supply: 220V 50Hz, 1.0KW
5. Machine size: 2000mm*1300mm*170mm