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Search Results: 1 - 10 of 6396 matches for " Margaret Adrian "
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Diagnosing Patients with Age-Related Hearing Loss and Tinnitus: Supporting GP Clinical Engagement through Innovation and Pathway Redesign in Audiology Services
Adrian Davis,Pauline A. Smith,Michelle Booth,Margaret Martin
International Journal of Otolaryngology , 2012, DOI: 10.1155/2012/290291
Abstract: The public health challenge of hearing impairment is growing, as age is the major determinant of hearing loss. Almost one in four (22.6%) over 75-year olds reports moderate or severe worry because of hearing problems. There is a 40% comorbidity of tinnitus and balance disorders. Good outcomes depend on early presentation and appropriate referral. This paper describes how the NHS Improvement Programme in England used service improvement methodologies to identify referral pathways and tools which were most likely to make significant improvements in diagnosing hearing loss, effective referrals and better patient outcomes. An audiometric screening device was used in GP surgeries to enable thresholds for effective referrals to be measured in the surgery. Revised referral criteria, the use of this device, new “assess and fit” technology in the audiology clinic, and direct access pathways can transform audiology service delivery so that patient outcomes are measurably better. This, in turn, changes the experience of GPs, so they are more likely to refer patients who can benefit from treatment. At the end of 2011, 51 GP practices in one of the audiology pilot areas had bought HearCheck screeners, a substantial development from the 4 practices who first engaged with the pilot.
Diagnosing Patients with Age-Related Hearing Loss and Tinnitus: Supporting GP Clinical Engagement through Innovation and Pathway Redesign in Audiology Services
Adrian Davis,Pauline A. Smith,Michelle Booth,Margaret Martin
International Journal of Otolaryngology , 2012, DOI: 10.1155/2012/290291
Abstract: The public health challenge of hearing impairment is growing, as age is the major determinant of hearing loss. Almost one in four (22.6%) over 75-year olds reports moderate or severe worry because of hearing problems. There is a 40% comorbidity of tinnitus and balance disorders. Good outcomes depend on early presentation and appropriate referral. This paper describes how the NHS Improvement Programme in England used service improvement methodologies to identify referral pathways and tools which were most likely to make significant improvements in diagnosing hearing loss, effective referrals and better patient outcomes. An audiometric screening device was used in GP surgeries to enable thresholds for effective referrals to be measured in the surgery. Revised referral criteria, the use of this device, new “assess and fit” technology in the audiology clinic, and direct access pathways can transform audiology service delivery so that patient outcomes are measurably better. This, in turn, changes the experience of GPs, so they are more likely to refer patients who can benefit from treatment. At the end of 2011, 51?GP practices in one of the audiology pilot areas had bought HearCheck screeners, a substantial development from the 4 practices who first engaged with the pilot. 1. Introduction In the UK, NHS Audiology services are complex health systems in complex environments. They provide “end-to-end” care with newborn screening, diagnostic assessment of patients, dispensing of hearing aids, and appropriate follow-up to ensure good outcomes are obtained. Historically, audiology services were commonly commissioned from the acute sector and have had a low priority because of the silent and insidious nature of the disability. In addition, the general public do not see hearing impairment as a dramatic health problem requiring urgent intervention. First presentation in the UK is usually to the General Practitioner (GP). Although the majority (80%) of UK patients access their hearing care through the NHS [1], there is also an option to use the independent sector without a GP referral. There are recent initiatives involving screening, for example, by telephone or internet [2], which may in future lead to self-referral without the need for GP involvement. The public health challenge of hearing impairment is growing due to the demographics of the population, as age is the major determinant of hearing loss. Hearing impairment in the UK affects one in ten adults aged 55–74 years. Over the next 15 years hearing impairment will be an increasing population problem, because
The Bull's-Eye Effect: Are Galaxy Walls Observationally Enhanced?
Elizabeth. A. Praton,Adrian L. Melott,Margaret Q. McKee
Physics , 1996, DOI: 10.1086/310567
Abstract: We investigate a distortion in redshift-space which causes galaxies to appear to lie in walls concentric about the observer, forming a rough bull's-eye pattern. We simulate what an observer would see in a thin slice of redshift-space, including a magnitude limit and constant slice angle. The result is an enhanced ring of galaxies encircling the observer at a distance roughly corresponding to the peak of the selection function. This ring is an artificial enhancement of weak features in real-space. This may explain visually prominent features such as the ``Great Wall'' and periodicity found in deep narrow fields.
Blockade of lymphotoxin-beta receptor signaling reduces aspects of Sj?gren's syndrome in salivary glands of non-obese diabetic mice
Margaret K Gatumu, Kathrine Skarstein, Adrian Papandile, Jeffrey L Browning, Roy A Fava, Anne Bolstad
Arthritis Research & Therapy , 2009, DOI: 10.1186/ar2617
Abstract: The course of SS-like disease was followed in NOD mice that were given lymphotoxin-beta receptor-immunoglobulin fusion protein (LTβR-Ig) starting at 9 weeks of age. Treatment was given as a single weekly dose for 3, 7, or 10 weeks. Age-matched NOD mice treated with mouse monoclonal IgG1, or not treated at all, were used as controls. The severity of inflammation, cellular composition, and lymphoid neogenesis in the submandibular glands were determined by immunohistochemistry. Mandibular lymph nodes were also studied. Saliva flow rates were measured, and saliva was analyzed by a multiplex cytokine assay. The salivary glands were analyzed for CXCL13, CCL19, and CCL21 gene expression by quantitative polymerase chain reaction.Treatment with LTβR-Ig prevented the increase in size and number of focal infiltrates normally observed in this SS-like disease. Compared with the controls, the submandibular glands of LTβR-Ig-treated mice had fewer and smaller T- and B-cell zones and fewer high endothelial venules per given salivary gland area. Follicular dendritic cell networks were lost in LTβR-Ig-treated mice. CCL19 expression was also dramatically inhibited in the salivary gland infiltrates. Draining lymph nodes showed more gradual changes after LTβR-Ig treatment. Saliva flow was partially restored in mice treated with 10 LTβR-Ig weekly injections, and the saliva cytokine profile of these mice resembled that of mice in the pre-disease state.Our findings show that blocking the LTβR pathway results in ablation of the lymphoid organization in the NOD salivary glands and thus an improvement in salivary gland function.Sj?gren syndrome (SS) is a chronic autoimmune disorder characterized by lymphocytic infiltrates of the exocrine glands. Patients present clinical symptoms of dry eyes and dry mouth. The exocrinopathy may occur alone (primary SS) or in association with another autoimmune disorder (secondary SS) such as rheumatoid arthritis or systemic lupus erythematosus [1]. Inflammato
Study protocol: a pragmatic randomised controlled trial of a 12-week physical activity and nutritional education program for overweight Aboriginal and Torres Strait Islander women
Karla J Canuto, Robyn A McDermott, Margaret Cargo, Adrian J Esterman
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-655
Abstract: The trial objective is to evaluate the effectiveness of a structured 12-week physical activity group program with nutritional advice. The design is a pragmatic randomised controlled trial. This study protocol describes the implementation and evaluation of the program. Participants are randomised into either an intervention or waitlisted group. The waitlisted group have a 12 month waiting period before commencing the 12-week program. Participant data is collected at baseline, 12, 24 and 52 weeks. Participants are Aboriginal and Torres Strait Islander women, aged 18-64 years with a waist circumference greater than 80 centimetres residing in Adelaide. The primary outcome measure is WC change immediately post program from baseline. Secondary outcomes include short term and long term changes in WC, weight, blood pressure, fasting blood glucose, insulin, insulin resistance (calculated HOMA), haemoglobin A1C (HbA1C), triglycerides and C-reactive protein (CRP). Behavioural and psychosocial surveys are administered to assess physical activity, dietary intake and the participant's motivation, self-efficacy and perceived social support for physical activity. Qualitative interviews focusing on participants' motivation, enablers and barriers to healthy eating and physical activity will be undertaken. Implementation fidelity and participation are also assessed.The Aboriginal and Torres Strait Islander Women's Fitness Program (WFP) is designed to provide a rigorous physiological and client-based evaluation of a structured 12-week program aimed to increase metabolic fitness and reduce WC in this high risk population. Evaluation results aim to provide the support necessary to design programs that are accessible, affordable and effective at reducing WC, while also improving the metabolic profile of overweight Aboriginal and Torres Strait Islander women.Australian New Zealand Clinical Trials Registry ACTRN12610000224022The Australian 2004-5 National Health Survey demonstrates that adu
Dealing with locally-driven degradation: A quick start option under REDD+
Margaret M Skutsch, Arturo Torres, Tuyeni H Mwampamba, Adrian Ghilardi, Martin Herold
Carbon Balance and Management , 2011, DOI: 10.1186/1750-0680-6-16
Abstract: Degradation - the (anthropogenic) loss of biomass in 'forests which remain forests' [1] - is one of the five components included in international policy on Reduced Emissions from Deforestation and Degradation (REDD+), the others being deforestation, forest enhancement, sustainable management of forests (SFM) and conservation [2]. In many ways, degradation is the least understood component of REDD+. In the literature on REDD+, 'degradation' is often implicitly used to refer to the effects of selective logging (legal or illegal) in humid tropical forests [3-6]. This is only one of the processes by which degradation occurs however. Low level chronic degradation occurs in a variety of forest types, and is quite possibly a much larger contributor to global carbon emissions than degradation by selective logging, as it occurs over much wider areas. Low-level degradation results from continuous over-exploitation of forests by communities for their livelihood needs, particularly for grazing, but also for shifting cultivation and in some places for fuel. It is more prevalent and widespread in dry forests than in rainforest because of the higher population densities of these areas [7]. A third major cause of degradation, besides commercial selective logging and local-driven low level chronic degradation, is escaped manmade fire. This may occur in a variety of forest types, and is particularly difficult to deal with in REDD+ because in some ecosystems, fire is a natural element and essential for their long run maintenance [8].Although these major types of degradation can be easily recognized, it has proven very difficult to define degradation in terms which can be used in the international agreements, and more importantly, which allow measurement and carbon accounting.This paper provides a short review of the technical challenges involved in defining degradation specifically for the purposes of REDD+, and suggests an approach that would enable countries to start measuring the c
A population-based lifestyle intervention to promote healthy weight and physical activity in people with cardiac disease: The PANACHE (Physical Activity, Nutrition And Cardiac HEalth) study protocol
Janice Sangster, Susan Furber, Margaret Allman-Farinelli, Marion Haas, Philayrath Phongsavan, Andy Mark, Adrian Bauman
BMC Cardiovascular Disorders , 2010, DOI: 10.1186/1471-2261-10-17
Abstract: This research will determine the efficacy of a telephone-delivered lifestyle intervention, promoting healthy weight and physical activity, in people with CVD in urban and rural settings. The control group will also act as a replication study of a previously proven physical activity intervention, to establish whether those findings can be repeated in different urban and rural locations. The cost-effectiveness and acceptability of the intervention to CR staff and participants will also be determined.This study is a randomised controlled trial. People referred for CR at two urban and two rural Australian hospitals will be invited to participate. The intervention (healthy weight) group will participate in four telephone delivered behavioural coaching and goal setting sessions over eight weeks. The coaching sessions will be on weight, nutrition and physical activity and will be supported by written materials, a pedometer and two follow-up booster telephone calls. The control (physical activity) group will participate in a six week intervention previously shown to increase physical activity, consisting of two telephone delivered behavioural coaching and goal setting sessions on physical activity, supported by written materials, a pedometer and two booster phone calls. Data will be collected at baseline, eight weeks and eight months for the intervention group (baseline, six weeks and six months for the control group). The primary outcome is weight change. Secondary outcomes include physical activity, sedentary time and nutrition habits. Costs will be compared with outcomes to determine the relative cost-effectiveness of the healthy weight and physical activity interventions.This study addresses a significant gap in public health practice by providing evidence for the efficacy and cost-effectiveness of a low cost, low contact, high reach intervention promoting healthy weight and physical activity among people with CVD in rural and urban areas in Australia. The replication a
Occupational risk of overweight and obesity: an analysis of the Australian Health Survey
Margaret A Allman-Farinelli, Tien Chey, Dafna Merom, Adrian E Bauman
Journal of Occupational Medicine and Toxicology , 2010, DOI: 10.1186/1745-6673-5-14
Abstract: Secondary analyses of the National Health Survey in Australia (2005) were conducted for working age adults (20 to 64 years). Linear and logistic regression models using BMI as either dichotomous or continuous response were computed for occupation type. Model 1 was age-adjusted, Model 2 adjusted for age and socioeconomic variables and Model 3 adjusted for age, socioeconomic variables and lifestyle behaviours. All models were stratified by gender.Age-adjusted data indicated that men in associate professional (OR 1.34, 95% CI 1.10-1.63) and intermediate production and transport (OR 1.24 95% CI 1.03-1.50) occupations had a higher risk of BMI ≥ 25 kg/m2 than those without occupation, and women in professional (OR 0.71, 95% CI 0.61-0.82), management (OR 0.72, 95% CI 0.56-0.92) and advanced clerical and service occupations (OR 0.73 95% CI 0.58-0.93) had a lower risk. After adjustment for socioeconomic factors no occupational group had an increased risk but for males, professionals, tradesmen, laborers and elementary clerical workers had a lower risk as did female associate professionals and intermediate clerical workers. Adjustment for lifestyle factors explained the lower risk in the female professional and associate professionals but failed to account for the lower odds ratios in the other occupations.The pattern of overweight and obesity among occupations differs by gender. Healthy lifestyle behaviors appear to protect females in professional and associate professional occupations from overweight. For high-risk occupations lifestyle modification could be included in workplace health promotion programs. Further investigation of gender-specific occupational behaviors and additional lifestyle behaviors to those assessed in the current Australian Health Survey, is indicated.The global epidemic of obesity continues to worsen and the ready availability of cheap energy-dense foods and increasing sedentary lifestyle are considered likely causes [1]. There have also been changes
Workplace mistreatment: Health, working environment and social and economic factors  [PDF]
Margaret Hodgins
Health (Health) , 2014, DOI: 10.4236/health.2014.65057
Abstract:

Objective: To explore patterns of workplace mistreatment, relationships with health and with selected workplace, economic and social factors in 34 countries. Methods: Secondary data analysis of the European Working Conditions Survey. Results: Patterns of ill treatment (across occupational groups, and sectors) were broadly consistent with smaller, less representative studies. Prevalence was lower than many studies but corresponds with estimates of serious mistreatment. Mistreatment increases the risk of both physical and mental ill health and is associated with a range of work environment factors. Mistreatment is more prevalent in countries with smaller gender gaps, better performance on the GINI index for income inequality and for countries with specific anti-bullying legislation. Conclusions: Mistreatment in work is complex, and interventions are required at the level of the organization. Implementation issues need to be addressed, as specific anti-bullying legislation does not appear to provide sufficient protection.

What Is a Good Legislative Definition?  [PDF]
Adrian Sgarbi
Beijing Law Review (BLR) , 2013, DOI: 10.4236/blr.2013.41004
Abstract:

When normative authorities (that is to say, “Legislators”) assume the task of assigning the meaning of normative texts, they use, fundamentally, two techniques: these are called “interpretative laws” and “legislative definitions”. In this study, relating to the research “problems of production and normative performance”, we deal with the analysis of definitions in the legal field.

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