Search

Supplemental Digital Content is Available in the Text. Introduction.: Addressing a patient's sexuality and sexual health is an important component of holistic health care, but there are several challenges affecting students' comfort levels. Studies have indicated that patients want to talk about sexual issues, but there is a lack of conversation initiation from the health care providers. Although there is research to indicate that occupational therapists (OTs) are more comfortable than physical therapists (PTs) in discussing sexual issues, both professions report a lack of content within their respective programs. The purpose of this study was to determine comfort levels of OT and PT students when discussing and addressing sexual issues, as well as demographic factors that might influence comfort level and perceived barriers. Methods.: A survey was sent to OT and PT students from 3 different universities inquiring as to the respondent's demographics, academic and clinical training, comfort level with various patient scenarios, and perceived barriers to addressing sexual issues. Mann -Whitney U and Kruskal -Wallis statistical tests were used to analyze the differences in comfort levels between groups of students, and open ended questions were coded into themes based on similarity and frequency of responses. Results.: A total of 128 students completed the survey. Third-year students, regardless of professional program, were more comfortable addressing sexual issues compared with first-year students. The most common barriers to addressing sexual issues with patients included lack of experience and lack of knowledge. Discussion and Conclusion.: Overall, the comfort level was affected by age, academic year, personal demographics, and perceived confidence. Neither geographical location nor religious background had a significant influence on student comfort level. [ABSTRACT FROM AUTHOR]

In this article we highlight the reminiscence of a distinguished Veteran of the Vietnam War. The narrative describes his wartime service in Vietnam and the legacy of these experiences across his military career and subsequent civilian life. The individual profiled is not intended to represent all Veterans who served in the Vietnam War. In fact, this is a very unique individual; a highly educated, career officer and committed Catholic who served in various roles within the United States Army Medical Department. This narrative represents memories and reflections from his military career and in his subsequent post-military civilian life. [ABSTRACT FROM AUTHOR]

Patient and public involvement (PPI) has gained widespread support in health research and health policy circles, but there is little consensus on the precise meaning or justifications of PPI. We argue that an important step towards clarifying the meaning and justification for PPI is to split apart the familiar acronym and draw a distinction between patient and public involvement. Specifically, we argue that patient involvement should refer to the practice of involving individuals in health research or policy on the basis of their experience with a particular condition, while public involvement should refer to the practice of involving individuals in health policy or research based on their status as members of a relevant population. Analyzing cases from the UK, Australia, and the USA, we show how our proposed distinction can deliver much needed clarity to conversations on PPI, while guiding the development and evaluation of future PPI‐based policies. [ABSTRACT FROM AUTHOR]

Through history, American law enforcement has been a profession that necessitated the collection of a substantial and disparate amount of information. This information was and is stored in order to memorialize events, solve problems or crimes and identify, apprehend and prosecute lawbreakers. Until recently, leveraging this vast collection of data was a laborious and time consuming task. This article looks at current and emerging technologies and envisions a future where big data transforms the criminal justice system. The emergence of wearable technologies, new surveillance vehicles, and automated systems coupled with the power of large data warehousing creates an intriguing view into the future of crime fighting and prosecution. This content analysis evaluates the evolution of information management supporting law enforcement, culminating in a review of the literature supporting the digital case file. Further, this analysis purports research opportunities found within the content and literature to-date. [ABSTRACT FROM AUTHOR]

The article discusses aspects of the Family and Medical Leave Act (FMLA) of 1993. It mentions that the act offers five major provisions, which includes 12 weeks leave for serious health problem, maternity leave, paternity leave, family for adoptions, and leave to care the severely ill patient, for employers with over 50 workers must comply. It notes that the act would benefit employees, but only about 47 percent of private sector employees are covered by it. It examines the impact of the FMLA on costs and business productivity.

Abstract: Over the past 35 years, the oil and gas industry has developed many technology improvements and operating practices for injecting carbon dioxide (CO2) for enhanced oil recovery (EOR). Over this time, the US oil and gas industry has operated over 13,000 CO2 EOR wells, over 3,500 miles of high pressure CO2 pipelines and has injected over 600 million tons of CO2 without any significant safety or environmental endangerment events. Today, the US produces over 245,000 barrels of oil per day as a direct result of CO2 EOR. This presentation will describe many of the technical improvements and operational practices that have been developed as a result of the oil and gas industry’s experiences with CO 2 EOR. When these technologies and practices are applied, operators can expect facility and wellbore integrity at levels equivalent to those seen for conventional oil an d gas operations. Many of the technologies and practices that have been developed for CO2 EOR may have applicability in carbon capture and storage (CCS) projects, recognizing however, that each project should be designed to meet its site specific conditio ns. The CO2 EOR experiences of the oil and gas industry represent the largest collective base of technical information available on CO2 injection and, as such, provide valuable information for development and implementation of CCS field projects as they move forward. [Copyright &y& Elsevier]

Church attendance is associated with improved health and well-being among older adults, but older adults with functional limitations may have difficulty attending church services. This article examines differences in the association between functional limitations and church attendance in a sample of 987 elderly African American and white individuals. African American and white elderly people without limitations attended church at virtually the same rate (69 percent). Despite their higher scores on religiousness measures, elderly African Americans with one or more limitations were significantly less likely to attend church regularly than were white counterparts. Health status measures did not help explain older African Americans' lower attendance rates. Differences in attendance were associated primarily with educational attainment and cognitive functioning. The article recommends social work intervention to reduce barriers to church attendance for older adults who want to attend services. [ABSTRACT FROM AUTHOR]

This research examined the extent to which religiosity was predictive of level of depression, even after controlling for race, gender, social support, income sufficiency, and physical health. Data were collected using in-home interviews conducted from 1999 to 2001 with 1,000 adults age 65 to 106. Subjects were recruited from a stratified, random sample of Medicare beneficiaries age 65 and older in five central Alabama counties (three rural and two urban). The sample was stratified by county, race, and sex and included balanced numbers of African American males and females and White males and females. Highly religious persons had lower levels of depression, even when controlling for other known covariates, β = -.16, t(972) p < .001. Females reported higher levels of depression, β = .07, t(972) p < .05. Although race was unrelated to depression in the model including gender and religiosity only, African Americans reported fewer symptoms of depression than did Whites when social support, income sufficiency, and physical health were added to the model, β = - .08, t(972) p < .01. Results suggest the importance of health and social service professionals' drawing upon older adults' positive spirituality in professional interventions to prevent and treat depression. [ABSTRACT FROM AUTHOR]

Presents a study which described the occurrence of Eastern equine encephalomyelitis virus (EEEV) infection in a yearling horse raised in southern California. Pathology; Hypotheses investigated to explain the occurrence of EEEV outside its usual range; Surveillance for EEEV in southern California; Molecular comparison of horse and vaccine strains.

Although adolescents are generally healthy, they are at unique psychosocial, cognitive, and physical development stages that can affect their decision-making ability and overall health. This age group often engages in risky behaviors such as unsafe sex, drug abuse, and unhealthy eating habits. Despite these potential risks, adolescents are less likely to seek prompt medical attention, often due to concerns about parental awareness of their health problems and concerns. Objectives: Organizations recommend providing confidential adolescent health care to reduce the consequences of high-risk health behaviors such as substance use, unhealthy eating patterns, and high-risk sexual behaviors. Family physicians are uniquely positioned to provide confidential counseling and care to this vulnerable population but must be trained to provide such care. This study describes the impact of formal and informal training on the knowledge of and comfort level in providing confidential adolescent healthcare among a sample of US Family Medicine residents. Methods: Electronic surveys were distributed to all Family Medicine residents throughout the United States. We used descriptive statistics and χ2 analysis where appropriate to determine the association between resident-reported receipt of training, confidence, and frequency in providing confidential adolescent health care. Results: A total of 714 Family Medicine residents completed the survey. The majority reported no formal training in residency (50.3%). The receipt of formal and informal training in both medical school and residency was associated with a greater degree of comfort in providing confidential adolescent care and a higher likelihood of providing confidential time alone. Those reporting formal training were more likely to always provide confidential care (P = 0.001). Conclusions: Training focused on confidential adolescent health care in medical school or residency was associated with a greater degree of comfort and a higher likelihood of providing confidential adolescent health care. [ABSTRACT FROM AUTHOR]

The author reflects on the concepts of interactive physiology in clinical studies in the U.S. He found out that determining the best ways of visualizing concepts may expose gaps in understanding and help elucidate areas that are not spelled out in literature. He considers this true in some difficult concepts relevant to the case discussion on pleural effusions. He notes that the use of pleural manometry and the measurement of its elastance are areas where literature tends to be inconsistent.

Background: Minimally invasive esophagectomy (MIE) may involve video-assisted thoracoscopic surgery (VATS) for mediastinal esophageal dissection. Usually, VATS requires single-lung ventilation and has associated cardiopulmonary morbidity [1-3]. Alternatively, transhiatal dissection can be performed, although its complications include vocal cord palsy [4], cardiac arrythmias [5], and increased bleeding [5, 6], the latter associated with mortality after esophagectomy [2]. Therefore, the feasibility of MIE using transcervical videoscopic esophageal dissection (TVED) in swine was investigated. A simultaneous laparoscopic and TVED approach may decrease operative time and blood loss while improving visualization and avoiding single-lung ventilation. Methods: Two pigs ( Sus domesticus) underwent two similar procedures. The methods were approved by the authors' Institutional Animal Care and Use Committee (no. A24209) under United States Department of Agriculture guidelines. Steps included a cervical incision to accommodate a modified hand-assist access device. The cervical esophagus was dissected. Trocars were placed through the modified access device, and pneumomediastinum was established. The tracheoesophageal plane was dissected into the thorax and beyond the mid esophagus, on which the pleura of the separate mediastinal compartment inserts itself. Vagal nerves were identified and divided distal to recurrent branches. Standard laparoscopic techniques were used for esophagogastric dissection. After specimen extraction, the animals were euthanized. Results: A full circumferential dissection of the mediastinal esophagus was successfully accomplished in two animals using a single-incision TVED for MIE. Conclusions: A novel technique for mediastinal esophageal dissection using a TVED approach performed with instruments designed for single-port surgery is described. Fortunately, the human lacks the swine's separate mediastinal compartment, and this unique difference should facilitate the human version of this dissection. This approach may avoid the potential morbidity of VATS while providing better visualization and facilitating dissection of the upper mediastinal esophagus compared with either the transhiatal approach or the previously attempted rigid mediastinoscopic approaches [7-9]. [ABSTRACT FROM AUTHOR]

Abstract: Many pluralistic nations are witnessing vigorous debate about multiculturalism. In the U.S., Americans generally embrace principles of ethnic diversity but dislike minorities who express strong ethnic identification. Two experiments examined this seeming contradiction by differentiating between ethnic identity expressed in private vs. public by non-White and White individuals. Then we tested whether individuals'' identity expressions differentially affected perceivers'' construal of their entire ethnic group as legitimately American. Results indicated that at a conscious level, White and non-White ethnic groups were held to the same standard and construed as significantly less American when members expressed their ethnic identity publicly vs. privately. However, at an unconscious level, a double standard emerged: non-White ethnic groups were implicitly rejected as less American if members expressed ethnic identity publicly, while White ethnics were implicitly accepted as legitimate Americans regardless of where they expressed ethnic identity. [Copyright &y& Elsevier]

Two studies examined how perceivers' national identification influences their implicit and explicit attitudes toward White and non-White ethnic groups whose members express their ethnic identity overtly in public or discreetly in private spaces. Results revealed that at a conscious level, White American perceivers' national identification elicited more negative attitudes toward both White and non-White ethnic groups when members embraced their ethnic heritage in public rather than in private. However, at an unconscious level, White perceivers' identification with the national group led to less favorable attitudes toward non-White ethnic groups, but not White ethnic groups, when their group members embraced ethnic identity in public. By integrating research on national identification, ethnic identity expression, and prejudice, the present research highlights some conditions under which majority group members' national identification affects how they perceive ethnic subgroups within the nation.

As medics and doctors prepare for deployment to a combat zone, there are countless specified and implied tasks needed to prepare the medical support of an Infantry unit in theater. Appropriately, units spend the lion share of their efforts in trauma training and medical readiness (vaccinations, medication prescriptions, eye glasses, etc.) while ensuring that the sets, kits, and outfits are all fully stocked with the required items needed to execute the mission. Unfortunately, this training and preparation included little on the major challenges units currently face from rabies. With the unfortunate recent death of a soldier from rabies, medical personnel were required to become experts in animal control, the prevention of animal bites and scratches, and the most appropriate treatment of service members with potential exposure to rabid animals. This article will discuss the challenges of rabies management in Afghanistan, appropriate provider and unit preparation to minimize risk of developing rabies, the need for establishment of an animal control team and prerequisite training of soldiers, leaders, and medics before and during deployment. Finally, we will review published guidelines for treating individuals exposed to rabies with a discussion of our units experience with postexposure prophylaxis., (Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.)

Community Engagement (CE) has been presented by bio-ethicists and scientists as a straightforward and unequivocal good which can minimize the risks of exploitation and ensure a fair distribution of research benefits in developing countries. By means of ethnographic fieldwork undertaken in Kenya between 2007 and 2009 we explored how CE is understood and enacted in paediatric vaccine trials conducted by the Kenyan Medical Research Institute and the US Centers for Disease Control (KEMRI/CDC). In this paper we focus on the role of paid volunteers who act as an interface between villagers KEMRI/CDC. Village Reporters' (VRs) position of being both with the community and with KEMRI/CDC is advantageous for the conduct of trials. However it is also problematic in terms of exercising trust, balancing allegiances and representing community views. VRs role is shaped by ambiguities related to their employment status and their dual accountability to researchers and their villages. VRs are understandably careful to stress their commitment to self-less community service since it augments their respectability at community level and opens up opportunities for financial gain and self-development. Simultaneously VRs association with KEMRI/CDC and proximity to trial participants requires them to negotiate implicit and explicit expectations for material and medical assistance in a cultural setting in which much importance is placed on sharing and mutuality. To ensure continuity of productive interactions between VRs, and similar community intermediaries, and researchers, open discussion is needed about the problematic aspects of relational ethics, issues concerning undue influence, power relations and negotiating expectations., (© 2013 Blackwell Publishing Ltd.)

Deep tissue injury (DTI) can rapidly evolve into a higher stage pressure ulcer. Use of pressure-redistribution surfaces is a widely accepted practice for the prevention of pressure ulcers in acute care patients, particularly in departments where care processes limit mobility. A 15-year-old patient developed a sacral DTI 24 hours after completion of a lengthy (12- hour) electrophysiology (EP) study and catheter ablation. A root cause analysis (RCA) conducted to investigate the origin of the hospital-acquired suspected DTI prompted a small investigation to evaluate the pressure-distribution properties of the EP lab surface and an OR table pad. Five healthy adult employee volunteers were evaluated in the supine position by placing a sensing mat between the volunteer and the test surface. Interface pressures (on a scale of 0 mm Hg to 100 mm Hg) were captured after a "settling in" time of 4 minutes, and the number of sensors registering very high pressures (above 90 mm Hg) across the surface were recorded. On the OR table pad, zero to six sensors registered >90 mm Hg compared to two to 20 sensors on the EP lab surface. These data, combined with the acquired DTI, initiated a change in EP lab surfaces. Although interface pressure measurements only provide information about one potential support surface characteristic, it can be helpful during an RCA. Studies to compare the effect of support surfaces in all hospital units on patient outcomes are needed.

Purpose: A community and faith-based intervention with elderly persons and their adult children involving religious, medical, and academic communities is described., Design and Methods: Lifestyle changes and individual and corporate forms of spirituality were affirmed using an expanded Rowe and Kahn model of successful aging. Faculty from academic, medical, state, and religious institutions presented a variety of workshops at a multichurch-sponsored conference that hosted over 500 seniors., Results: Postconference surveys suggested extremely favorable satisfaction rates across all groups represented. The African American religious community provided critical leadership in achieving an excellent African American participation rate., Implications: The model described has the capacity to generate collaborations across denominational, racial, and class barriers, and has the potential of helping to unify the religious community around the important task of promoting successful aging.