Journal articles on the topic 'Clitic licensing'
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1
Cabré, Teresa, and Antonio Fábregas. "3rd person clitic combinations across Catalan varieties: Consequences of the nature of the dative clitic." Linguistic Review 36, no. 2 (May 26, 2019): 151–90. http://dx.doi.org/10.1515/tlr-2018-2010.
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Abstract This article argues that variation in how 3rd person clitic combinations are solved across Catalan varieties depends on the internal morphosyntactic shape of the dative clitic in each variety. We argue that the dative clitic in Valencian Catalan is an inherently case-marked pronominal form (KP), while non Valencian Catalan varieties, that contain a locative clitic, build the dative as a definite locative pronominal which receives structural case. This allows Valencian Catalan to license each clitic in a different area, while non Valencian Catalan is forced to license a sequence of clitics in the same area, with the result that the two forms compete with each other for the licensing by the same head, leading to surface impoverishment of the sequence. Our analysis provides an explanation of these impoverishments as simple syntactic competition for licensing by the same set of heads, making OCP effects in morphology or syntax unnecessary as analytical devices for such cases.
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Rubin, Edward J. "Obligatory dative clitic-doubling of type III experiencers in Bulgnais." Proceedings of the Linguistic Society of America 3, no. 1 (March 3, 2018): 18. http://dx.doi.org/10.3765/plsa.v3i1.4299.
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The correlation between the position of the Dative experiencer of a type III psych-verb relative to the verb itself and the obligatory vs. optional nature of an associated Dative clitic has seldom been noted in the literature, and it has never previously been explained. This paper presents relevant new data from Bulgnais (Bologna, Italy), and it proposes that these verbs, in the languages that require the Dative clitic with the preverbal Dative experiencer, have an additional strong lexical property beyond inherent Case licensing. Like Case licensing, this property requires feature checking, which is satisfied alternately by the clitic (unmarked word-order) or by the experiencer phrase. Only when the clitic checks the lexically required feature can the full experiencer move to the preverbal position, because otherwise, it is frozen in a postverbal position by its role in checking the mentioned strong lexical feature, which occurs lower in the verbal domain.
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Crousaz, Isabelle De, and Ur Shlonsky. "The Distribution of a Subject Clitic Pronoun in a Franco-Provençal Dialect and the Licensing of Pro." Linguistic Inquiry 34, no. 3 (July 2003): 413–42. http://dx.doi.org/10.1162/002438903322247542.
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We study the distribution of null subjects in one Franco-Provençal variety. These are possible in root declaratives, obligatory in embedded subject position, and impossible in root wh-questions as well as in the company of weather predicates. We approach null subjects indirectly, by investigating the distribution of one subject clitic, arguing that its optionality in some contexts is due to the possibility of moving pro to a peripheral topic position, where formal licensing is not required. We also discuss the circumstances in which an overt complementizer and a robustly inflected verb license pro, rendering the clitic redundant. The comparative interest of this dialect is that it reveals synchronically the three mechanisms of pro licensing available in Romance diachronically. These are (a) association with rich verbal inflection, (b) government by a complementizer, and (c) doubling by a clitic. We contend that the syntax is sensitive to the formal relationship between an XP and a head that these three mechanisms instantiate.
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Ausin, Adolfo, and Francisco J. Fernández-Rubiera. "Decomposing Spanish dative clitics." Borealis – An International Journal of Hispanic Linguistics 10, no. 2 (December 1, 2021): 265–311. http://dx.doi.org/10.7557/1.10.2.6217.
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In Spanish, dative clitics have standardly been analyzed differently from accusative ones. The apparent different constraints that regulate each of these clitic doubling constructions have been at the base of the differing analyses. In this paper, we will argue that in spite of the alleged differences, clitic doubling in Spanish (both accusative and dative) has more in common than meets the eye. In light of a generally neglected structure in which Spanish dative clitics may not show agreement with their plural double (a.k.a. le-for-les), we will argue for a decompositional analysis of Spanish dative clitics. For us, dative clitics instantiate an applicative (Cuervo 2003, a.o.) morpheme which may be combined with a Dº head (Uriagereka 1995). This analysis will allow us not only to explain the le-for-les phenomenon observed, accounting for its distribution and syntactic licensing, but also the definiteness interpretation that an agreeing dative clitic is subject to, in turn providing a uniform account for the parallelisms between accusative (i.e., purely Dº) and dative (i.e., Applicative + optional Dº) clitic doubling. Finally, certain contexts in which les surfaces and that fail to be accounted for under our proposal are provided an account in terms of “harmonic agreement,” while still keeping the analysis proposed to account for both new and old data and observations.
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Rubin, Edward. "PCC Effects with Expletives and Non-Associate Postverbal Subjects in Bolognese." Isogloss. Open Journal of Romance Linguistics 8, no. 2 (February 22, 2022): 1–16. http://dx.doi.org/10.5565/rev/isogloss.128.
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This paper contrasts a Bolognese postverbal subject construction and other grammars with the common Romance one (also in Bolognese) that has longdistance full agreement of the tensed verb and the Case Licensed subject, with an expletive satisfying EPP. In the new Bolognese data, full agreement is absent, a special clitic occurs, and the postverbal subject is person restricted.Lack of subject agreement also raises questions about its licensing.The Minimalist proposal is that grammars like Bolognese can specify a feature set on theexpletive that checks EPP in this data, and that it is thus an independent second nominalin the domain of the sole agreement and Case Licensing probe, T. This specified expletiveis shown to explain all the properties of this data. For the person restrictions and Case Licensing of the postverbal subject, it applies Cyclic/Multiple Agree, the elaboration ofAgree underlying PCCeffects, to the two nominals. The analysis is extended to othergrammars with similar but slightly differing data by simple manipulation of the featureseton the specified expletive and of the clitic inventory of the grammar.
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Gravely, Brian, and Monica Alexandrina Irimia. "DOM co-occurrence restrictions and their repair strategies." Isogloss. Open Journal of Romance Linguistics 8, no. 4 (December 16, 2022): 1–30. http://dx.doi.org/10.5565/rev/isogloss.174.
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Since the pioneering discussion in Ormazabal & Romero (2007), work on PCC-effects that extend beyond clitic clusters has been the focus of much investigative research (Cornilescu 2020, Sheehan 2020, Irimia in press, a.o.). Many of these effects have been shown to arise with animate nominals, in Romance particularly those bearing differential object marking (DOM). More work, however, is needed on documenting how these types of co-occurrence restrictions can be repaired. In this article, we discuss repair strategies in contexts containing DOM from Romanian and Galician as compared to Spanish; we show that an understanding of these facts revolves around the typology of available [person] licensing positions along the clausal spine. We show that Romanian and Galician exhibit multiple licensing positions within various licensing domains, both within and beyond the vP. We also discuss data from both Peninsular and Argentine Spanish that differ in this regard and demonstrate that they have fewer licensing positions than Romanian and Galician.
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Arias, Juan José. "Extraposition in River Plate Spanish. A case of clausal doubling?" Isogloss. Open Journal of Romance Linguistics 8, no. 1 (July 4, 2022): 1–36. http://dx.doi.org/10.5565/rev/isogloss.198.
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This paper explores a set of constructions from River Plate Spanish in which propositional attitude verbs occur both with a third person feminine accusative clitic and a CP in final position (e.g., No me la esperaba que hiciera tanto frío, ‘I didn’t expect it to be so cold’). The data under analysis, which resemble the well-studied phenomenon of extraposition in English (Jespersen 1933, Postal & Pullum 1988, Rosenbaum 1967, Rothstein 1995, 2004, etc.), have not so far received much attention in the study of Spanish syntax. Our conclusion is that the ‘extraposed’ CPs do not constitute cases of right dislocation or right-adjunction but clear instances of clausal doubling, analogous to the well-known process of clitic doubling with accusative DPs characteristic of Argentine Spanish (e.g., Lo vi a Gonzalo, ‘I saw Gonzalo’). Along the lines of Rothstein (1995, 2004), we argue that the mechanism for licensing the CP is predication and we provide evidence against the hypothesis that the clitic is an object expletive.
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Manente, Mara. "Isabelle De Crousaz, Ur Shlonsky, The Distribution of a Subject Clitic Pronoun in a Franco-Provençal Dialect and the Licensing of Pro." Studi Francesi, no. 146 (XLIX | II) (November 1, 2005): 465. http://dx.doi.org/10.4000/studifrancesi.35382.
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Zhu, Jialei. "A more special use of the third person singular pronoun in Shanghainese." Language and Linguistics / 語言暨語言學 24, no. 2 (March 9, 2023): 391–436. http://dx.doi.org/10.1075/lali.00135.zhu.
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Abstract This paper investigates the syntax and semantics of the third person singular pronoun ɦi⁶ in Shanghainese in its non-referential use. Evidence from its phonological dependence and syntactic integration with the preceding host verb is presented to show that the non-referential ɦi⁶ is a clitic. It is further observed that this use of ɦi⁶ requires licensing from the [+subjunctive] feature, echoing Qian (2004) and Jin (2016). However, my analysis diverges from theirs in treating the ɦi⁶ in question as an expletive licensed by the [+subjunctive] feature, rather than a subjunctive marker itself on grounds that it is not obligatory in a subjunctive sentence and that the subjunctivity must always be encoded by other elements in the sentence. ɦi⁶ in this use serves as an emphatic, strengthening the effect of deontic or imperative force in subjunctive contexts. Furthermore, it is shown that the licensing must obey a locality condition, whereby the expletive ɦi⁶ must be licensed by a c-commanding licenser in its local domain. From the perspective of grammaticalization, I propose that ɦi⁶ is going through an intermediate stage of becoming a purely modal functional marker. A final stage of this “upward” grammaticalization can be found in the expletive use of the third person pronoun keoi in Cantonese, which has become a more grammaticalized marker that has scope over the sentence. It is pointed out that the development of the expletive pronoun suggests that being at the right-periphery is a crucial factor in motivating and facilitating grammaticalization in Chinese. Last, a comparison between the non-referential ɦi⁶ and the Mandarin non-referential third person pronoun ta in the V-ta-ge-NP/AP construction is presented, showing that both cases manifest interactions between VP-internal projections and higher functional categories.
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Jheng, Wei-Cherng Sam. "The syntax of nominal modification and complex noun phrases in Siwkolan Amis." Concentric. Studies in Linguistics 48, no. 1 (May 2, 2022): 70–113. http://dx.doi.org/10.1075/consl.21014.jhe.
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Abstract This work investigates the syntax of nominal modification involving the linker a in Siwkolan Amis, one of the dialects of Amis, an Austronesian language spoken in Taiwan. Based on the two observed types of NP-ellipsis patterns and the formal licensing condition, I argue that Amis displays two types of modification. Modifiers in direct modification are functional heads projecting extended functional projections of NP, whereas those in indirect modification are modifier phrases base-generated at [Spec, ModP]. This distinction adds weight to J. Wu’s (2003) view that relative clauses and description-denoting modifiers marked by -ay are clausal modifiers that have a full-fledged CP structure from a cartographic perspective. Furthermore, I argue that a projects the Modifier Phrase (ModP) and is a modificatory clitic endowed with a [+mod] feature that attaches to a head element moving from a lower head position to form a morphological word. Very much in line with Philip (2012), the proposed analysis suggests that a is endowed with an interpretative profile in marking a modification relation between an extended functional projection (a modifier phrase) and a dependent word (a modified noun) in the nominal domain. Issues involved in dealing with the structure of Amis complex noun phrases are discussed.
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Beltrame, Francesco, and Cristiano Chesi. "Why-questions and focus in Italian." Linguistic Review 38, no. 4 (November 26, 2021): 687–726. http://dx.doi.org/10.1515/tlr-2021-2079.
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Abstract In this study we argue that the appropriateness of an answer to a why-question, potentially bearing on multiple contrast classes, is mainly influenced by the focalized argument, which identifies the relevant reference set. The focalization structure, however, interacts in a non-trivial way with the thematic structure and its accessibility, suggesting a general (independent) prominence of the direct object (DO) over the indirect one (IO). In correlation to that, we also observed that DO appears more resistant to extraction compared to IO, while it seems felicitous in a post-IO focalized low position (light NP-shifting). These contrasts are obtained by running five distinct experiments in Italian targeting various dislocation configurations: Four forced choice tasks manipulating leftward dislocation (i) clefting versus (ii) fronting versus (iii) clitic left dislocation and (iv) postverbal reordering (canonical DO IO order vs. IO DO) in ditransitive predicates. Then (v) an acceptability judgment study was administered to assess the difficulty in figuring out a licensing context coherent with the argument ordering, provided in the why-question. To minimize the interacting factors, all sentences included null subjects and a context was provided for each experimental item in the forced choice tasks, introducing the relevant contrast classes.
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Doron, Silvia C. "Compliance of Private Lying-in Clinics as Perceived by Midwives." University of Bohol Multidisciplinary Research Journal 5 (October 10, 2017): 48–60. http://dx.doi.org/10.15631/ubmrj.v5i0.51.
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Private Lying–the clinic is a primary-level health care facility for low-risk childbearing women who have normal status during pregnancy, childbirth, and postpartum. In Bohol province, most Lying–clinics are owned and managed by private practicing registered midwives. Compliance in this study pertains to the capacity of the private Lying-in clinics as to facilities, equipment, and personnel. This study aimed to assess the personal and professional profiles of the respondents, and the compliance status of clinic managers and clinic staff to the DOH licensing and Phil Health Requirements based on the seven areas under study in the operation and management of private Lying- clinics. The researcher formulated survey questions adapted from DOH and Assessment Checklist for licensing birthing facilities. The respondents of the study were clinic managers and staff of the eleven private Lying-in clinics in Bohol which were managed by midwives. The study made use of a quantitative normative survey, and the responses were analyzed through frequency, percentile, weighted mean, and Scheffe’s test. Results showed that all clinic managers and clinic staff were registered midwives, trained, and were excellent in complying with the requirements in the operation and management of private Lying in-clinics. The outcome of this study may serve as the basis for a review of the accreditation requirements of a primary-level health care facility for administration.
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Gusman, Delfina, and Marryo Borry WD. "TUMPAH TINDIH DALAM PROSES PERIZINAN KLINIK PRATAMA DI DINAS PENANAMAN MODAL DAN PELAYANAN TERPADU SATU PINTU KOTA PADANG." UNES Law Review 1, no. 2 (December 26, 2018): 148–56. http://dx.doi.org/10.31933/law.v1i2.23.
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Clinics are health care facilities that provide individual health services that provide basic medical and / or specialist services. Primary Clinic is a clinic that provides basic medical services both general and special. To establish primary clinics until they can operate through a series of licensing processes, namely the Hinder Ordonnantie (HO) Permit, Clinical Establishment Permit (IMK) and Clinical Operational Permit (IOK). The results of the process are overlapping or suggesting requirements that make the process ineffective and inefficient
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Gusman, Delfina, and Marryo Borry. "Health Facility Licensing Dispute." Unnes Law Journal 6, no. 1 (April 30, 2020): 97–118. http://dx.doi.org/10.15294/ulj.v5i2.27707.
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Clinic is a health service facility that organizes individual health services that provide basic and/or specialist medical services. Primary Clinic (Klinik Pratama) is a Clinic that organizes basic medical services both general and specific. To establish a Klinik Pratama so that it can operate through a series of licensing processes namely Nuisance/Hinder Ordonnantie Permit (HO), Establishment Permit Clinic (IMK) and Clinical Operating Permit (IOK). The results of this process are overlapping or repetitive requirements, making the process ineffective and inefficient. This research is intended to analyze the dispute on health facility licensing in Padang City, West Sumatra. This paper analyzes overlapping of clinical licensing. The main problems that analyzed in this paper concerning to analyze and review clinical licensing, analyze licensing regulations at the Padang City level as a basis for recommendations on simplification, deletion and merging of licenses by the Padang City Government.
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Andriyana Maharani and Sentot Imam Suprapto. "Readiness Analysis of Recommendation System for Digital-Based Clinic Operations in Nganjuk District." Journal for Quality in Public Health 5, no. 2 (May 31, 2022): 687–93. http://dx.doi.org/10.30994/jqph.v5i2.374.
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Licensing services provided by the government to the community ideally facilitate the community in its implementation. However, many people still complain about the current state of public services. Licensing services as a form of public service are still considered by the community to be too complicated in applying for permits, because of the many procedures that must be passed so that it takes a long time. The purpose of this research is to exploreanalysis of the readiness of a digital-based clinical operating permit recommendation system in Nganjuk Regency. The design of this study is a qualitative research with a phenomenological approach with the focus of the research directed at exploring the analysis of the readiness of a digital-based clinic operating permit recommendation system in Nganjuk Regency by triangulation. In addition, with a qualitative approach, it is hoped that the situation and problems encountered in these activities can be disclosed. The readiness of the community, especially for those who want to establish clinics and clinic owners in welcoming the application of the recommendation for a digital-based clinic operating permit, is quite good. Where the community is enthusiastic about this program, it can be realized immediately where this digital-based system can make it easier for individuals to apply for a clinic operating permit. Apart from the individual aspect, it is also necessary to prepare education or publication in the form of audio-visual related procedures for conducting digital-based operational permits, as well as related agencies must prepare the system as well as possible. Informants are expected to welcome this digital-based clinic operational permit recommendation program with high enthusiasm and it is hoped that if it is implemented in the future, it will be able to implement it properly and at the same time provide constructive criticism if the program still has shortcomings.
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Rosliana, Rosliana, Juliandi Harahap, Achmad Rifai, and Lucia Lastiur. "The Influence of Health Services Licenses to the Quality of Services at the Capital Investment and Integrated Services Office One Door of the City of Medan." Journal La Medihealtico 2, no. 2 (March 1, 2021): 69–77. http://dx.doi.org/10.37899/journallamedihealtico.v2i2.313.
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The research objective was to analyze the effect of health service licensing policies on service quality at the Medan City Investment Service and One Stop Integrated Services. This research method is mixed methods, amounting to 27 people. The results of the research on the relationship of health service licensing policies with the satisfaction of the online licensing application for the SiCantik Cloud application, it is known that the licensing policy is good quality service with the relationship between physical evidence and satisfaction of the online licensing applicant for the SiCantik Cloud application, it is known that physical evidence of the applicant is satisfied, the relationship of reliability with the satisfaction of the online licensing applicant of the SiCantik application. Cloud, it is known the reliability of the applicant's clinical licensing officer, the relationship of responsiveness with the satisfaction of the online licensing applicant of the SiCantik Cloud application, it is known the responsiveness of the applicant's clinic licensing officer, the guarantee relationship with the satisfaction of the online licensing applicant for the SiCantik Cloud application, it is known that the clinical licensing guarantee of the applicant is satisfied, the relationship of empathy with the satisfaction of the licensing applicant online application SiCantik Cloud, it is known that the empathy of the applicant's clinical licensing officer is satisfied. Research suggestions are expected to the next researchers to prioritize research related to public services, especially health, because health services have a very important role in people's lives.
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Diana Sari, Siska, I. Gusti Ayu Ketut Rachmi Handayani, and Pujiyono. "Government and Aesthetic Beauty Clinic’s Responsibility in Fulfilling the Citizens’ Constitutional Right to the Service of Aesthetic Beauty Clinic in Indonesia." SHS Web of Conferences 54 (2018): 02003. http://dx.doi.org/10.1051/shsconf/20185402003.
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This article studies the government and the esthetic beauty clinic’s responsibility in fulfilling the citizens’ constitutional right in the service of esthetic beauty clinic in Indonesia. The research method is empirical qualitative to the stakeholders of esthetic beauty clinics in ten cities in Indonesia. The result of the research shows that those responsible for fulfilling the citizens’ constitutional right to the service of Esthetic Beauty Clinic in Indonesia are public and private. The government’s responsibility has been mentioned in Article 28D, clause (1) of 1945 Constitution concerning the right to guaranty, law protection and certainty and Article 28H clause (1) related to the right to health and to get healthcare service. The rights fulfillment is accomplished using the legal instrument and the institution of state authorized in licensing, organization, building, supervision, monitoring, and evaluation in the organization of esthetic beauty clinic. The esthetic beauty clinic’ responsibility includes: fault, risk, product, and professional. These responsibilities have not been fulfilled maximally yet because some law infringements are still found, so the government’s intervention should be optimized with the protection of beauty clinic users’ constitutional rights from upstream to downstream and the regulation as well as the authorized institution should be harmonized.
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Peritz, Tiina, and Susan Coffin. "Site Visits Reveal Common Gaps in Instrument Reprocessing and Sterilization at Philadelphia Dental Clinics." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s389—s390. http://dx.doi.org/10.1017/ice.2020.1026.
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Background: Most dental clinics lack resources and oversight related to infection prevention and control (IPC) practices. Few dental clinics undergo inspections by regulatory authorities unless the state licensing authorities receive a specific complaint. Many states, including Pennsylvania, do not have continuing IPC education requirements for dental providers. In 2018–2019, the Philadelphia Department of Public Health (PDPH) received and responded to multiple complaints and concerns related to IPC practices at dental clinics. Complaints were investigated in collaboration with the Pennsylvania Department of State (PADOS). Methods: Unannounced site visits were conducted at 7 Philadelphia dental clinics from December 2018 through September 2019 as part of the public health responses. Clinic evaluations and observations by PDPH certified infection preventionists focused on (1) IPC policies and procedures, (2) staff IPC training, (3) hand hygiene, (4) personal protective equipment, (5) instrument reprocessing and sterilization, (6) injection safety, and (7) environmental cleaning and disinfection. The CDC and the Organization of Safety, Antisepsis and Prevention (OSAP) checklists were adapted for this purpose. Results: Most dental practices we visited were small, unaffiliated, owner-operated clinics. The most common gaps we identified were associated with instrument reprocessing and sterilization practices, including inadequate separation between clean and dirty work areas, limited space and availability of sinks, inappropriate use of glutaraldehyde products for instrument cleaning (n = 3, 43%), extended reuse of cleaning brushes (n = 5, 71%), sterilization or storage of sterilized instruments without appropriate packaging (n = 2, 29%), lack of spore testing or reviewing results (n = 2, 29%), and lack of documentation of sterilizer run cycles and maintenance (n = 7, 100%). Additionally, most clinics did not have well-developed IPC policies and procedures, and staff IPC trainings were neither documented nor conducted annually. Alcohol-based hand sanitizer was often not available at the point of use. Conclusions: In Philadelphia, dental clinics often lacked IPC support and oversight. Lapses across multiple key IPC domains were common. These findings suggest that public health may have a role in providing IPC support to unaffiliated dental clinics. Licensing entities can also serve a role in improving IPC practices by more widely mandating continuing IPC education as part of the dental license renewal process.Funding: NoneDisclosures: None
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Gutierrez-Rexach, Javier. "Pronouns, Clitics and Empty Nouns: 'Pronominality' and Licensing in Syntax (review)." Language 79, no. 4 (2003): 843. http://dx.doi.org/10.1353/lan.2003.0237.
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Haegeman, Liliane. "Les propositions infinitives indépendantes enfantines et la distribution des pronoms objets en français et en néerlandais." Canadian Journal of Linguistics/Revue canadienne de linguistique 45, no. 1-2 (June 2000): 63–96. http://dx.doi.org/10.1017/s0008413100017618.
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AbstractThis article concerns the distribution of clitics in the child root infinitives in French and in Dutch. In the material studied, subject clitics are absent both from French and Dutch root infinitives; object clitics are present in French root infinitives while remaining absent from Dutch root infinitives. It is proposed that this cross-linguistic difference is related to the difference in the licensing site of the object clitics, which is taken to be AgrO in French and AgrS in Dutch. The hypothesis thus casts doubt on proposals according to which clitics are universally base-generated in specialised functional positions in the structure (Sportiche 1996; Schaeffer 1997).
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Turner, Anne M., Blaine Reeder, and James C. Wallace. "A Resource Management Tool for Public Health Continuity of Operations During Disasters." Disaster Medicine and Public Health Preparedness 7, no. 2 (April 2013): 146–52. http://dx.doi.org/10.1017/dmp.2013.24.
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AbstractObjectiveWe developed and validated a user-centered information system to support the local planning of public health continuity of operations for the Community Health Services Division, Public Health - Seattle & King County, Washington.MethodsThe Continuity of Operations Data Analysis (CODA) system was designed as a prototype developed using requirements identified through participatory design. CODA uses open-source software that links personnel contact and licensing information with needed skills and clinic locations for 821 employees at 14 public health clinics in Seattle and King County. Using a web-based interface, CODA can visualize locations of personnel in relationship to clinics to assist clinic managers in allocating public health personnel and resources under dynamic conditions.ResultsBased on user input, the CODA prototype was designed as a low-cost, user-friendly system to inventory and manage public health resources. In emergency conditions, the system can run on a stand-alone battery-powered laptop computer. A formative evaluation by managers of multiple public health centers confirmed the prototype design's usefulness. Emergency management administrators also provided positive feedback about the system during a separate demonstration.ConclusionsValidation of the CODA information design prototype by public health managers and emergency management administrators demonstrates the potential usefulness of building a resource management system using open-source technologies and participatory design principles.(Disaster Med Public Health Preparedness. 2013;0:1–7)
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Dickey, William, and James I. Morrow. "Epilepsy and Driving: Attitudes and Practices among Patients Attending a Seizure Clinic." Journal of the Royal Society of Medicine 86, no. 10 (October 1993): 566–68. http://dx.doi.org/10.1177/014107689308601006.
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Although the loss of freedom to drive is a serious consequence of the diagnosis of epilepsy, it is unclear how well current regulations are understood and adhered to by patients. Using questionnaires completed anonymously, we assessed attitudes and practices among 104 patients with epilepsy. Seventeen (16%) patients were driving, three illegally. In total, eight (8%) patients had at some stage driven illegally, even though seven admitted to having been warned not to do so. Even among the 14 patients currently driving and eligible to do so, only eight (57%) had informed the licensing authority and six (43%) their insurers. Only 34 (33%) patients showed satisfactory knowledge of current regulations, including seven (50%) of those currently driving and 21 (50%) of 42 patients who expressed a wish to drive in the future. Of these 34, only 14 (41%) expressed complete agreement with the regulations. Thus, a significant proportion of patients with epilepsy has driven illegally or has failed to inform the licensing authority or insurers. Understanding of regulations is poor. Less stringent restrictions have been shown to be safe in other countries and might improve compliance.
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Toni, Irmgard, Jutta Hupfer, and Antje Neubert. "33 Off-label use of drugs in paediatric (specialised) outpatient clinics – what has changed between 2009 and 2019?" Archives of Disease in Childhood 108, no. 6 (May 18, 2023): A11.3—A11. http://dx.doi.org/10.1136/archdischild-2023-esdppp.33.
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IntroductionOff-label use is still inevitable for paediatric drug treatment. The aim of this study was to analyse the licensing status of drug prescriptions in German paediatric (specialised) outpatient clinics and to determine changes over a 10-year time course.MethodsCross-sectional, retrospective, monocentric studies were conducted in 2009 and 2019 to assess drug prescriptions regarding their licensing status in 10 (one general and nine specialised) outpatient clinics in Germany. Prevalence and relative frequency of off-label prescriptions were calculated, reasons for off-label prescribing analysed and logistic regression performed to determine influencing factors.Results751 prescriptions of 296 patients in 2009 and 1438 prescriptions of 786 patients in 2019 were examined and classified according to their licensing status. Relative frequency of off-label prescriptions was around 45% without significant change over that decade. Prevalence of off-label prescriptions was 60.1% in 2009 and 53.1% in 2019 and therefore significantly higher in 2009 (p=0.037). The number of prescriptions per patient was significantly higher in 2009 (2.5 ± 2.3 vs. 1.8 ± 1.5, p<0.000), too. Comparison revealed the same high-ranking reasons in every study: off-label use due to indication, overdosing and missing paediatric information.ConclusionsOff-label prescribing still plays an important role in clinical daily routine in paediatrics. Despite numerous regulatory efforts and incentives, no substantial reduction in off-label prescribing could be determined since 2009. Further efforts are needed to generate more evidence-based knowledge about paediatric pharmacotherapy and to treat children as best as possible.
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Schlesinger, Erica, Wesley Geminn, Kenneth C. Hohmeier, and Howard L. Burley Jr. "Development and Implementation of Tennessee Nonresidential Buprenorphine Treatment Guidelines." INNOVATIONS in pharmacy 9, no. 3 (October 19, 2018): 6. http://dx.doi.org/10.24926/iip.v9i3.1317.
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Objective: To describe the recent legislation in Tennessee and subsequent development and implementation of state-wide buprenorphine treatment guidelines.
Practice Innovation: In 2016, Tennessee began licensing office-based opioid treatment (OBOT) clinics. Due to initial licensing criteria, not all providers were required to be licensed with the Department of Mental Health and Substance Abuse Services (TDMHSAS). The gap in licensing made it difficult to ensure an appropriate standard of care was being met by all addiction treatment providers. Therefore, the state developed legislation that allowed for the creation of best practice guidelines to encompass all providers of buprenorphine in the state of Tennessee, not just the licensed OBOT clinics. The guidelines define what the standard of care should entail while treating this vulnerable addiction population.
Results: Tennessee legislation granted the formation of a committee to create the Tennessee Nonresidential Buprenorphine Treatment Guidelines. The committee was comprised of physicians, pharmacists, lawyers, law enforcement, and state officials. The finalized guidelines were published and effective January 1, 2018, and adopted as policy by the boards of medical examiners, osteopathic examination, and pharmacy shortly thereafter. The guidelines are now enforceable by the boards and give them the ability to discipline physicians who practice outside the standard of care.
Conclusion: Tennessee legislation provides a model for other states to take action in combating this opioid crisis by not only increasing access to addiction treatment, but increasing access to quality care.
Article Type: Commentary
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Anguela, Xavier M., and Katherine A. High. "Entering the Modern Era of Gene Therapy." Annual Review of Medicine 70, no. 1 (January 27, 2019): 273–88. http://dx.doi.org/10.1146/annurev-med-012017-043332.
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Gene therapies are gaining momentum as promising early successes in clinical studies accumulate and examples of regulatory approval for licensing increase. Investigators are advancing with cautious optimism that effective, durable, and safe therapies will provide benefit to patients—not only those with single-gene disorders but those with complex acquired diseases as well. While the strategies being translated from the lab to the clinic are numerous, this review focuses on the clinical research that has forged the gene therapy field as it currently stands.
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Maitland, J. E. "An audit of patients who have received Imiquimod cream 5% for the treatment of anogenital warts." International Journal of STD & AIDS 11, no. 4 (April 1, 2000): 268–70. http://dx.doi.org/10.1258/0956462001915697.
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With the licensing of the new drug Imiquimod cream 5% (AldaraTM 3M Health Care) for the treatment of anogenital warts and its inclusion into clinic guidelines, a case note review audit was performed of its use. The treatment of 52 patients was audited. Results showed that clinic guidelines were being followed and that patient outcomes in terms of clearance were at least as good as the quoted rates in the literature. Significant issues included firstly patient education - especially for those who had previously received ablative therapy. Secondly the length of time that therapy would be continued before a patient was deemed to be a non-responder to Imiquimod cream 5%, and if this was the case should the frequency of application be amended from the manufacturer's recommended regime of 3 times a week.
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Prisciandaro, J. "TH-C-352-02: From Licensing to QA, How to Implement HDR Brachytherapy Into Your Clinic." Medical Physics 35, no. 6Part26 (June 2008): 2979–80. http://dx.doi.org/10.1118/1.2962882.
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Williamson, Adam, and Scott Muir. "Loss of consciousness, collapse and associated driving restrictions: a retrospective case note review – an important reminder regarding driving restrictions." Scottish Medical Journal 62, no. 2 (May 2017): 43–47. http://dx.doi.org/10.1177/0036933017694779.
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Background and aims National guidelines outlining medical standards for fitness to drive are provided by The Driver and Vehicle Licensing Agency. We aimed to establish whether patients presenting with collapse or loss of consciousness received documented advice regarding driving restrictions, if appropriate for their working diagnosis. Methods and results A retrospective case note review was undertaken over a four-month period for emergency patients clinically coded as seizure/convulsion (R568) and collapse/syncope (R55X); 163 patients had a primary or working diagnosis on discharge that suggested driving status and restrictions could have been reviewed. Six groupings of diagnoses were noted, and variation was seen amongst documentation for each. Current driving status was documented for 32 patients, and 34 had restriction advice documented; 73% (119 patients) had further investigations or clinic review planned. Conclusion Documentation of driving status and restrictions is poor. This audit serves to remind clinicians of the importance of considering driving status when discharging patients who have presented with collapse or loss of consciousness. Recent high-profile media coverage regarding medical driving restrictions, both locally and nationally, have emphasised the need for knowledge of The Driver and Vehicle Licensing Agency guidance.
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Wisdom, Jennifer P., Susan Knapik, Michael W. Holley, Jayne Van Bramer, Lloyd I. Sederer, and Susan M. Essock. "Best Practices: New York's Outpatient Mental Health Clinic Licensing Reform: Using Tracer Methodology to Improve Service Quality." Psychiatric Services 63, no. 5 (May 2012): 418–20. http://dx.doi.org/10.1176/appi.ps.20120p418.
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Stobbs, N., A. Lillis, and N. Kumar. "E-cigarettes in ENT: what do we need to know?" Journal of Laryngology & Otology 130, no. 6 (April 19, 2016): 512–15. http://dx.doi.org/10.1017/s002221511600102x.
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AbstractBackground:E-cigarette use in the UK is increasing and we are commonly encountering patients in the ENT clinic who are e-cigarette smokers. Currently, there is no regulatory body or licensing for e-cigarettes. This means that the contents, and therefore potential carcinogenic and toxic risks, can vary greatly from product to product. Patients are starting to ask about the risks of e-cigarettes and their use in smoking cessation.Objectives:This review aimed to examine the regulations, trends, and carcinogenic and health risks of e-cigarettes, and summarise the evidence for their use in smoking cessation. It also aimed to provide a general awareness regarding the advice and information that can be safely given to patients.
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Ouellette, Alicia, Arthur Caplan, Kelly Carroll, James W. Fossett, Dyrleif Bjarnadottir, Darren Shickle, and Glenn McGee. "Lessons Across the Pond: Assisted Reproductive Technology in the United Kingdom and the United States." American Journal of Law & Medicine 31, no. 4 (December 2005): 419–46. http://dx.doi.org/10.1177/009885880503100402.
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Scholars of differing political affiliation and the President's Council on Bioethics have called for regulation of assisted reproductive technology (ART) that would emulate many aspects of the regulatory system of the United Kingdom, in particular that of the Human Fertilisation and Embryology Authority. Specifically, scholars and the Council have argued that research in the U.S. involving gametes and human embryos lacks consistent oversight. While the Centers for Disease Control and Prevention (CDC) produces an annual ART success rate report, submission of data is guaranteed only by the promise that non-responders will be noted as such in the appendix of CDC's report, and most ART clinics publish success rates on the Internet in a much more recognized forum: website advertising. Moreover, U.S. law does not require licensing or accreditation of infertility programs and few regulations govern embryo research. While the large majority of clinics report their success rate data, and many follow practice standards and apply for accreditation from private agencies, these practices are strictly voluntary. Clinics failing to report their success rates face no legal consequence.
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Rohovyi, Y., O. Bilo’okiy, and V. Bilo’okiy. "New methodological approaches to improving the preparation of students to take the licensing integrated exam "Krok", the Uniform State Qualification examination, the english language for professional purposes." Bukovinian Medical Herald 26, no. 4 (104) (November 24, 2022): 72–76. http://dx.doi.org/10.24061/2413-0737.xxvi.4.104.2022.13.
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Relevance. The problem of high-quality training of specialists in the medical field is a significant issue worldwide, including in Ukraine. It is necessary to achieve a threefold task when forming a highly professional specialist: successful completion of the licensing integrated exam "Krok", improvement of one's practical skills and medical manipulations in the conditions of a simulation center and clinic, and formation of awareness of the practical activity of a doctor thanks to the use of an integrative approach of pathophysiology.Objective. To compare the quality of students' preparation for taking licensing integrated exam "Krok", the Unified State Qualification Exam, and the English language for professional purposes using the classical method and the proposed algorithm, which consists of five stages and makes it possible to provide an integrative approach with the transition from dominant memory stress to thinking and intelligence.Material and methods. We analyzed the effectiveness of preparing students for taking the licensing integrated exam "Krok", the Unified State Qualification Exam, and the English language for professional purposes using the classical method and the proposed algorithm.Results. The proposed analysis of 10 test tasks from the license integrated exam “Krok” database in Ukrainian and 5 test tasks in English for professional purposes in each practical session according to this algorithm. A notebook page for practical classes is divided by a vertical line as follows: 2/3 of the working area and 1/3 field. Next, test tasks are selected from the data bank on the topic of the lesson and 1 test task is written on 1 page in the upper part of the work area, i.e., you need to use 10 pages of the notebook for Ukrainian-language tests and 5 pages for professional English test. At the second stage, the correct answer is marked*. The third stage is to explain in writing why the indicated answer is correct and why each distractor is an incorrect answer. The fourth stage is to underline key words in the test. The fifth stage is to find an explanation of all the terms found in the test, the correct answer and distractors and write them in the fields.Conclusions. The application of the proposed algorithm in 5 stages of analysis of test tasks from the open database licensing integrated exam "Krok" in Ukrainian and test tasks in English for professional purposes allows to improve traditional types of education, to move from classical training of students to passing the license integrated exam "Krok", the Unified State Qualification Exam, English language professional orientation with a predominance of stress on memory (consciousness of the past) to the predominant use of thinking (concepts, judgments, inferences) and intellect (analysis, synthesis, abstraction, concretization, generalization), which will allow understanding the essence of test tasks and contribute to the development of awareness of the essence of the doctor's practical activity.
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Piringer, Martin, Werner Knauder, Kathrin Baumann-Stanzer, Ivonne Anders, Konrad Andre, and Günther Schauberger. "Odour Impact Assessment in a Changing Climate." Atmosphere 12, no. 9 (September 6, 2021): 1149. http://dx.doi.org/10.3390/atmos12091149.
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(1) Background: The impact of odour sources as stock farms on neighbouring residential areas might increase in the future because the relevant climatic parameters will be modified due to climate change. (2) Methodology: Separation distances are calculated for two Central European sites with considerable livestock activity influenced by different orographic and climatic conditions. Furthermore, two climate scenarios are considered, namely, the time period 1981–2010 (present climate) and the period 2036–2065 (future climate). Based on the provided climatic parameters, stability classes are derived as input for local-scale air pollution modelling. The separation distances are determined using the Lagrangian particle diffusion model LASAT. (3) Results: Main findings comprise the changes of stability classes between the present and the future climate and the resulting changes in the modelled odour impact. Model results based on different schemes for stability classification are compared. With respect to the selected climate scenarios and the variety of the stability schemes, a bandwidth of affected separation distances results. (4) Conclusions: The investigation reveals to what extent livestock husbandry will have to adapt to climate change, e.g., with impacts on today’s licensing processes.
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Carr, David B., and Desmond O’Neill. "Mobility and safety issues in drivers with dementia." International Psychogeriatrics 27, no. 10 (June 26, 2015): 1613–22. http://dx.doi.org/10.1017/s104161021500085x.
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ABSTRACTAlthough automobiles remain the mobility method of choice for older adults, late-life cognitive impairment and progressive dementia will eventually impair the ability to meet transport needs of many. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the specific types of assessments that should be applied to older drivers with cognitive impairment, and no gold standard for determining driving fitness or approaching loss of mobility and subsequent counseling. Yet, clinicians are often called upon by patients, their families, health professionals, and driver licensing authorities to assess their patients’ fitness-to-drive and to make recommendations about driving privileges. We summarize the literature on dementia and driving, discuss evidenced-based assessments of fitness-to-drive, and outline the important ethical and legal concerns. We address the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and driver licensing authority referrals that may assist clinicians with an evaluation. Finally, we discuss mobility counseling (e.g. exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients’ social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety.
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Thomas, Rhys H., and Mark O. Cunningham. "Cannabis and epilepsy." Practical Neurology 18, no. 6 (October 18, 2018): 465–71. http://dx.doi.org/10.1136/practneurol-2018-002058.
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Click here to listen to the PodcastThe one-third of people who do not gain seizure control through current treatment options need a revolution in epilepsy therapeutics. The general population appears to be showing a fundamental and rapid shift in its opinion regarding cannabis and cannabis-related drugs. It is quite possible that cannabidiol, licensed in the USA for treating rare genetic epilepsies, may open the door for the widespread legalisation of recreational cannabis. It is important that neurologists understand the difference between artisanal cannabidiol products available legally on the high street and the cannabidiol medications that have strong trial evidence. In the UK in 2018 there are multiple high-profile reports of the response of children taking cannabis-derived medication, meaning that neurologists are commonly asked questions about these treatments in clinic. We address what an adult neurologist needs to know now, ahead of the likely licensing of Epidiolex in the UK in 2019.
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Dickson-Gomez, Julia, Erika Christenson, Margaret Weeks, Carol Galletly, Jennifer Wogen, Antoinette Spector, Madelyn McDonald, and Jessica Ohlrich. "Effects of Implementation and Enforcement Differences in Prescription Drug Monitoring Programs in 3 States: Connecticut, Kentucky, and Wisconsin." Substance Abuse: Research and Treatment 15 (January 2021): 117822182199234. http://dx.doi.org/10.1177/1178221821992349.
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Background and aims: Prescription Drug Monitoring Programs (PDMPs) were designed to curb opioid misuse and diversion by tracking scheduled medications prescribed by medical providers and dispensed by pharmacies. The effects of PDMPs on opioid prescription, misuse and overdose rates have been mixed due in part to variability in states’ PDMPs and difficulties measuring this complexity, and a lack of attention to implementation and enforcement of PDMP components. The current study uses qualitative interviews with key informants from 3 states with different PDMPs, Connecticut, Kentucky and Wisconsin to explore differences in the characteristics of the PDMPs in each state; how they are implemented, monitored and enforced; and unintended negative consequences of these programs. Methods: We conducted in-depth interviews with key informants from each state representing the following sectors: PDMP and pain clinic regulation agencies, Medicaid programs, state licensing boards, pharmacies, emergency medicine departments, pain management clinics, first responders, drug courts, drug treatment programs, medication assisted treatment (MAT) providers, and harm reduction organizations. Interview guides explored participants’ experiences with and opinions of PDMPs according to their roles. Data analysis was conducted using a collaborative, constant comparison method. Results: While all 3 states had mandated registration and reporting requirements, the states differed in the implementation and enforcement of these and the extent to which provider prescribing was monitored. These, in turn, influenced how medical providers perceived the PDMP and changed how providers prescribed opioids. Unintended consequences of state PDMPs included under-prescribing for pain and “dumping” patients who were long term users of opioids or who had developed opioid use disorders and may explain the increase in illicit heroin or opioid use. Conclusion: State PDMPs with similar mandates may differ greatly in implementation and enforcement. These differences are important to consider when determining the effects of PDMPs on opioid misuse and overdose.
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Bergman, Moe, and Minka Hildesheimer. "Forty Years of Audiology in Israel." American Journal of Audiology 3, no. 3 (November 1994): 11–15. http://dx.doi.org/10.1044/1059-0889.0303.11.
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A broad spectrum of audiology programs and services has been developed in Israel over the past 40 years. Tel Aviv University awards bachelor’s and graduate degrees in audiology and speech-language pathology. There is a national licensing program for audiologists and speech-language pathologists who have earned at least a baccalaureate degree and have completed one year of service under the supervision of a senior professional. Well-equipped medical center clinics in the major geographic areas are easily accessible from all parts of the country. Privately operated audiology clinics and offices are run by licensed audiologists, and hearing aid dispensing establishments are staffed mostly by licensed audiologists. An organized national hearing screening program begins with infants and young children in well-baby clinics. Special education programs emphasize integration of children with severe and profound hearing loss in regular classrooms, and volunteer service centers provide supplementary habilitation and social and cultural experiences for such children. Hearing conservation programs for the retired population are carried on in community health maintenance centers for the older adult. Industrial and military hearing conservation programs have been established. Israeli scientists and clinicians engage in both basic and clinical research, and Israel’s professional organizations organize periodic local, national, and international meetings, facilitating significant interaction and collaboration with colleagues and organizations abroad.
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Sinnott, J. D., H. Mahoney, A. S. Wilkinson, and S. J. Broomfield. "Dizziness, driving, and the Driver and Vehicle Licensing Agency: audit of advice given to patients, and design of a patient information leaflet." Journal of Laryngology & Otology 133, no. 09 (August 23, 2019): 822–24. http://dx.doi.org/10.1017/s0022215119001713.
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AbstractBackgroundEvidence from the literature shows that clinicians’ knowledge of rules and legislation surrounding driving can often be poor. A closed-loop audit was conducted to gauge the level of driving advice given to patients with dizziness.MethodsThe clinical notes of 100 patients referred to the vertigo clinic at a tertiary referral centre were retrospectively searched for evidence of driving advice. Education sessions were undertaken and a patient information leaflet was developed before a second cycle of the audit.Results and conclusionThe proportion of patients having documented evidence of receiving driving advice increased from 6.3 per cent to 10.4 per cent. It is therefore clear that, despite this improvement, a significant proportion of patients’ notes did not contain documentation about driving. This is likely because of many reasons, including individual interpretation by clinicians. This paper provides a reminder of the rules, and discusses their interpretation and implementation in an increasingly medicolegal environment.
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Taylor, D. P., M. Yoshida, K. Fuller, W. V. Giannobile, C. S. Sfeir, W. R. Wagner, and D. H. Kohn. "Translating Dental, Oral, and Craniofacial Regenerative Medicine Innovations to the Clinic through Interdisciplinary Commercial Translation Architecture." Journal of Dental Research 100, no. 10 (April 27, 2021): 1039–46. http://dx.doi.org/10.1177/00220345211009502.
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Few university-based regenerative medicine innovations in the dental, oral, and craniofacial (DOC) space have been commercialized and affected clinical practice in the United States. An analysis of the commercial translation literature and National Institute for Dental and Craniofacial Research’s (NIDCR’s) portfolio identified barriers to commercial translation of university-based DOC innovations. To overcome these barriers, the NIDCR established the Dental Oral Craniofacial Tissue Regeneration Consortium. We provide generalized strategies to inform readers how to bridge the “valley of death” and more effectively translate DOC technologies from the research laboratory or early stage company environment to clinical trials and bring needed innovations to the clinic. Three valleys of death are covered: 1) from basic science to translational development, 2) from translational technology validation to new company formation (or licensing to an existing company), and 3) from new company formation to scaling toward commercialization. An adapted phase-gate model is presented to inform DOC regenerative medicine teams how to involve regulatory, manufacturability, intellectual property, competitive assessments, business models, and commercially oriented funding mechanisms earlier in the translational development process. An Industrial Partners Program describes how to conduct market assessments, industry maps, business development processes, and industry relationship management methods to sustain commercial translation through the later-stage valley of death. Paramount to successfully implementing these methods is the coordination and collaboration of interdisciplinary teams around specific commercial translation goals and objectives. We also provide several case studies for translational projects with an emphasis on how they addressed DOC biomaterials for tissue regeneration within a rigorous commercial translation development environment. These generalized strategies and methods support innovations within a university-based and early stage company-based translational development process, traversing the many funding gaps in dental, oral, and craniofacial regenerative medicine innovations. Although the focus is on shepherding technologies through the US Food and Drug Administration, the approaches are applicable worldwide.
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Laizāne, M., M. Ennītis, N. Bezborodovs, and I. Landsmane. "Childhood risk factors for substance abuse in a clinical sample of adults with attention-deficit / hyperactivity disorder (ADHD) symptoms in an addiction outpatient clinic." European Psychiatry 64, S1 (April 2021): S576. http://dx.doi.org/10.1192/j.eurpsy.2021.1537.
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IntroductionSubstance use disorder (SUD) in patients with ADHD symptoms is associated with a poorer treatment prognosis. The study is aimed to investigate psychosocial risks factors for developing SUD in patients with ADHD.ObjectivesTo examine the associations between self-reported weak academic performance, repetition of a grade, single – parent family, self-reported quality of parent – child relationship, conduct problems in childhood and SUD in adulthood in a sample of outpatients with ADHD symptoms of an addiction medicine clinic in Riga, Latvia.MethodsSelf-report surveys, containing Adult ADHD Self-Report Scale (ASRS-v I.I), were completed by outpatients of addiction clinic, including healthy control subjects (adults without addiction, formally assessed for fitness to drive, firearms licensing etc.). Patients then were examined in relation to childhood risk factors.ResultsSurvey was compleated by 341 outpatients – 98 (28,7%) healthy controls and 243 (71,3%) patients with SUD (mean age, 36,8 and 37,7, respectively; 76,4% males). 62 (18,1%) patients were tested positive for ADHD, of whom 12 (19,4%) were healthy subjects and 50 (80,6%) were with SUD. Data shows connection between conduct problems in childhood (p=0,010), single - parent family (p=0,010), repetition of a grade (p=0,026) and SUD in adults with ADHD symptoms. Comparing patients with and without ADHD symptoms, there was found no significant association between these factors, except for conduct problems (p=0,015).ConclusionsThe study found preliminary evidence that adults with ADHD symptoms who experienced single – parenthood in childhood, had conduct problems or repeated a grade are more likely to develop SUD. Futher investigation is required.
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Manashchuk, N. V., N. V. Chornij, and S. I. Boytsanyuk. "Teaching of the chapter «diseses of the mucouse membrane of the oral cavity» under the conditions of distance learning." PROBLEMS OF UNINTERRUPTED MEDICAL TRAINING AND SCIENCE 42, no. 2 (July 2021): 11–13. http://dx.doi.org/10.31071/promedosvity2021.02.011.
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The pandemic around the world has made adjustments not only in our lives, but also in the educational process in particular. Prolonged quarantine caused by COVID-19 has forced teachers in most higher education institutions to go online. If other higher education institutions could conduct mixed forms of education, the specifics of medical universities, where most classes are held at medical bases of hospitals and clinics, left no choice and focused exclusively on distance education. It is very important that the performance of the department’s distance workload fully meets the planned workload of the departments, all the requirements of the educational process and quality preparation of fifth-year students for the licensing exam KROK 2 and certification of graduates. Relevant changes also affected the teaching of the section «Diseases of the oral mucosa» at the Faculty of Dentistry. According to the working curriculum and regulations on the educational process, classes are held according to the method of a single day and last 6 hours. The Microsoft Teems system was proposed for consideration by the university administration for practical classes and lectures. In addition to the actual online communication, this system provided many different features. In accordance with the decision of the meeting of the department, the following time schedule was approved. А lesson on consideration and discussion of a new topic begins. After that, practical work and a break are provided. Since this course is a final one, a lot of attention should be focused on preparing for the licensing exam. Upon completion of the discipline, students defend their medical history. Photos of the paper version are dumped by the teacher for verification on the university mailbox. Actually, the defense of the story takes place online with a short presentation of the works
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Reis-Neto, Armando, Antonio Meireles, and Marília Cunha-Lignon. "Natural Regeneration of the Mangrove Vegetation on Abandoned Salt Ponds in Ceará, in the Semi-Arid Region of Northeastern Brazil." Diversity 11, no. 2 (February 23, 2019): 27. http://dx.doi.org/10.3390/d11020027.
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The development of the mangrove in Ceará state, northeastern Brazil, is limited by local environmental and climatic factors, associated with the variables that determine the region’s semi-arid climatic conditions. The same conditions also contribute to the installation of artisanal saltworks in estuarine environments. The artisanal production of salt peaked in the 20th century, but with the decline of this activity, the salt evaporation ponds were abandoned, and have been incorporated back into the natural marine-estuarine environment and colonized by mangrove forests. In the early 2000s, however, the expansion of shrimp farming operations impacted this same environment. The present study was based on a spatiotemporal analysis of the natural regeneration of the mangrove vegetation in abandoned salt pond areas in the Brazilian semi-arid region between 1968 and 2009. The integrated analysis of mangrove ecosystem dynamics and the legislation that regulates the licensing of these economic activities identified a number of technical problems in the formulation and execution of the COEMA resolution 02/2002, which permits the installation of shrimp farms in areas dominated by the mangrove. The findings of the present study reinforce the need for a careful reformulation of the Ceará state environmental legislation, in order to guarantee the maximum possible conservation of the coastal zone.
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Grant, R. M., A. D. Carver, and R. L. Sloan. "Multiple Sclerosis in Fife." Scottish Medical Journal 43, no. 2 (April 1998): 44–47. http://dx.doi.org/10.1177/003693309804300206.
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Patients in Fife with multiple sclerosis were identified from three sources: a postal questionnaire to all general practices in Fife, hospital discharge data, rehabilitation service database. A total of 508 patients were identified in a population of 354, 273 giving a crude prevalence rate of 143/100,000. The Standardised Prevalence Rate was 178/100,000. The sex ratio was 2.43 females to males. The prevalence was higher than identified in southern parts of the United Kingdom and similar to northern Scotland A total of 200 (40%) cases were identified as having relapsing-remitting disease and of these 151 were ambulant, making them eligible for treatment with interferon beta-lb under current licensing criteria. Only 90 (60%) of the 151 currently eligible for the drug were under the care of a specialist and almost half the practices felt that they would change their referring habits. These factors may have implications for the workload of specialist clinics.
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Wilson, Sarah, and Gill Pinner. "Driving and dementia: a clinician's guide." Advances in Psychiatric Treatment 19, no. 2 (March 2013): 89–96. http://dx.doi.org/10.1192/apt.bp.111.009555.
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SummaryWith an ageing population and more drivers on the road, the number of drivers with dementia is due to grow exponentially over the next 50 years. Although decisions regarding possession of a driving licence in the UK are made by the Driver and Vehicle Licensing Agency (DVLA), psychiatrists have a duty to advise patients who are unfit to drive to cease driving and to inform the DVLA of patients who pose a risk to the public by continuing to drive when advised not to. This article offers a review of the literature on dementia and driving and summarises the evidence and advice for navigating this minefield. The use of psychological test batteries in clinical practice is discussed, along with the most useful questions to ask in memory clinics. Legal guidance for various countries is considered, as is the important (but often overlooked) issue of helping older people prepare for retirement from driving.
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Simone Shah and Dhanraj Ganapathy. "Awareness and Practice of Radiation Protection Protocols Followed in Dental Clinics-A Survey." International Journal of Research in Pharmaceutical Sciences 12, no. 4 (October 6, 2021): 2297–302. http://dx.doi.org/10.26452/ijrps.v12i4.4859.
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The radiographic examination is one of the principal diagnostic methods used in all fields of medical services and contributes to the promotion of the health. Accordingly, a certain amount of radiation is inevitably delivered to patients during normal radiographic procedures. Repeated radiation doses utilized in dental treatment might be harmful to the patients and thus a thorough knowledge on radiation protection protocols are mandatory for dental clinicians. The aim of this study was to investigate the knowledge, awareness and practice of general dentists practicing in the Chennai regarding radiation prevention protocols undertaken in their area of work. The study was a questionnaire based cross-sectional study. A total of 200 dentists were contacted to participate in the study. The target population entailed were general dentists practicing in Chennai. A Pretested questionnaire was mailed to the respondents following informed consent. The data were extracted from the responses and analyzed. The total response rate recovered was 75 % and the respondents comprised of 54 males & 96 females respectively. Only 49% of the general dentists followed the position & distance rule for radiographic procedures appropriately. The results showed that the knowledge, awareness of the general dentists regarding radiation prevention protocols in Chennai were satisfactory. However, the practice regarding radiation protection protocols were inadequate. To ensure the implementation of radiation prevention protocols, strict protocols must be followed by the licensing and monitoring authorities about the use of the equipment emitting radiation and rigorous health education programs should be initiated to sensitize the clinicians.
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Petrova, E., and I. Yushmanov. "Study of Socio-Hygienic Aspects of Osteopathic Healthcare Delivery in Big Cities." Russian Osteopathic Journal, no. 3-4 (December 30, 2016): 11–20. http://dx.doi.org/10.32885/2220-0975-2016-3-4-11-20.
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Introduction. At the present time osteopathy is considered as a branch of official medicine. The experience accumulated by osteopaths has already proven the effectiveness of this treatment method. In the context of intensive development of the specialty it became necessary to justify scientifically organizational andЕ. Е. Петрова, И. Г. Юшмановmethodological approaches in osteopathic healthcare delivery. In order to do that it is relevant to carry out socio- hygienic analysis of osteopathic healthcare delivery to patients.The object of the researh. To study socio-hygienic aspects of osteopathic healthcare delivery in big cities on the basis of the medical information analysis.Methods. Socio-hygienic and organizational aspects of osteopathic healthcare appealability were studied on the basis of a sample of medical histories of 1 624 patients who received treatment in osteopathic clinics. Every 13th patient card was selected in random manner. The information about each patient was registered in a specially elaborated research protocol. 121 patient cards were examined. In order to hold content-analysis of the information about the clinics declaring osteopathic healthcare delivery in public sources of the Internet, a protocol («Clinic’s passport») for collecting and grouping the data was elaborated. In total 163 sites of clinics were examined.Results. In St. Petersburg 243 medical organizations (including organizations which have branches) and three nonmedical organizations declared osteopathic healthcare delivery. Medical organizations in most cases have osteopath’s consulting rooms (88 %). At the same time in 17,2 % of clinics which declare osteopathic healthcare delivery, there are no osteopaths.Conclusion. In order to regulate the services of osteopathic healthcare delivery it is necessary to establish licensing of osteopathic medical activity.
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REES, F., A. Packham, C. Blake, E. Hills, G. Scutt, and A. St Clair-Jones. "P604 Can we reduce intravenous monoclonal antibody observation times without compromising patient safety? A single centre retrospective observational study." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S504—S505. http://dx.doi.org/10.1093/ecco-jcc/jjz203.732.
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Abstract Background Monoclonal antibodies (MAbs) are integral to inflammatory bowel disease (IBD) management. The administration of intravenous (IV) MAbs, infliximab and vedolizumab, for Brighton and Sussex University Hospital patients is via an outpatient clinic. Licensing specifies lengthy observation times; infliximab for induction (infusion 1 to 3) and maintenance (infusion 4 onwards) requires 1 to 2 h observation. Vedolizumab for induction (infusion 1 to 2) requires 2 h observation and maintenance (infusion 3 onwards) 1-h observation. This can affect waiting times; 33% UK patients waited longer than two weeks for infliximab. A reduction in observation times could improve capacity but needs to be done without compromising patient safety. Methods A single centre observational study was conducted. Retrospective data were collected on all current patients receiving infliximab or vedolizumab at BSUH. Data were collected over 12 weeks (April to July 2019); patients seen twice in this period were included once. The presence of reaction from current and previous infusions was determined by patient questioning and patient records review. Reaction occurrence, nature and management were recorded. There is not a grading system for IBD infusion-related reactions. To standardise we used the cancer Common Terminology Criteria for Adverse Events; grade 3 and above is designated severe (grade 5 being death). Results For infliximab 130 patients were reviewed with 2607 infusions administered in total. For vedolizumab 69 patients were reviewed with 557 infusions administered in total. Due to the small sample size significance could not be reached. The survival plot indicates high levels of ‘no reactions’ observed in the first 4 infusions of infliximab 97.7% (+1.6%, -4.7%), and first 3 infusions of vedolizumab 96.9% (+2.3%, −8.8%). Considering capacity over 12 weeks, for infliximab a minimum of 121 could be recouped and 64 h for vedolizumab. Extrapolated this could equate to 740 h per year. Conclusion All reactions occurred within three infusions, were non-severe and managed within the infusion clinic. By removing the observation period from infusion 4 onwards, infusion clinic capacity could be increased but further data from multiple centres are required to prove significance.
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Sanoja-Flores, *Luzalba, *Bruno Paiva, Juan A. Flores-Montero, Noemi Puig, Leire Burgos, Omar García, Felipe Prosper, et al. "Next Generation Flow (NGF): A High Sensitive Technique to Detect Circulating Peripheral Blood (PB) Clonal Plasma Cells (cPC) in Patients with Newly Diagnosed of Plasma Cell Neoplasms (PCN)." Blood 126, no. 23 (December 3, 2015): 4180. http://dx.doi.org/10.1182/blood.v126.23.4180.4180.
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Abstract Introduction: Previous studies have shown that cPC can be detected in PB by conventional flow cytometry (FC) in around 70% of multiple myeloma (MM) and 37% of monoclonal gammopathy of undetermined significance (MGUS) patients at diagnosis. Its presence in MGUS has been associated with a higher risk of malignant transformation. We here investigated the utility and sensitivity of the EuroFlow-IMF NGF-MM minimal residual disease (MRD) approach for detecting circulating cPC in PB of patients with PCN. Methods: A total of 137 samples (including 71 PB and 66 bone marrow -BM- paired samples) from 71 newly-diagnosed PCN patients (37 MGUS; 21 MM; 5 SMM and 8 solitary plasmacytomas -SP-), plus 6 PB samples from healthy controls, were studied. Samples were processed following the EuroFlow Bulk Lysis Standard Operating Protocol (SOP) and stained with the EuroFlow-IMF MM MRD panel (Tube 1:CD138BV421/CD27BV510/CD38FITC/CD56PE/CD45PerCP-Cy5.5/CD19PE-Cy7/CD117APC/CD81APC-C750, and; Tube 2: identical to Tube 1 except for CyKappaAPC/CyLambdaAPC-C750). A median of 10.6 x106 events (range: 1.7 x106 - 15.7x106) were measured for PB samples using a FACSCanto II (BD Biosciences, San Jose, USA) instrument. Data were analyzed using the Infinicyt software (version 1.8.0RC6; Cytognos SL, Salamanca, Spain). Risk stratification of MGUS patients was established by the Mayo Clinic index. ROC analysis was used to define a cut-off to distinguish between MM and MGUS cases according to the percentage and absolute number of circulating PB cPC. Results: Overall, cPC were detected in the PB of all MM and SMM cases studied (100%) and more than half of MGUS patients (60%; p=0.005), while constantly absent in the eight patients with SP. Upon classifying MGUS patients according to the Mayo Clinic Index (n=32), positive PB samples were found in 25%, 62% and 73% of cases with scores of 0, 1 and 2, respectively. Median (range) percentage and absolute cPC numbers (per µL) were of 13 to 16 and 10 to 200 times lower (p<0.0001) in MGUS -0.0002% (<0.0001%-0.05450%) and 0.011 cPC/µL (range: <0.0001 cPC/µL -3.2 cPC/µL)- than in SMM -0.0026% (0.00020%-0.23%) and 0.14 cPC/µL (range: 0.022 cPC/µL - 14.58 cPC/µL) and MM -0.0033% (0.00064%-1.05%) and 2.01 cPC/µL (range: 0.043 cPC/µL -103.8 cPC/µL)-, respectively. Interestingly, a clear relationship was found between the presence of circulating cPC in PB of both MGUS, SMM and MM cases, and BM involvement by >60% of cPCs within the PC BM compartment (R2 = 0.75; n=66). The cut-off obtained to distinguish between MM and MGUS cases according to the percentage and absolute number of cPCs circulating in PB was of 0.0009% and 0.055 cPC/µL with a sensitivity of 93% and 86%, and a specificity of 75% and 75% for relative and absolute numbers, respectively. Conclusions: The EuroFlow-IMF NGF-MM MRD panel and approach are well-suited for high sensitive detection of circulating cPC in the PB of virtually every newly-diagnosed MM and SMM patient and the majority of MGUS cases, particularly among MGUS at higher risk of malignant progression; interestingly in both patients groups, the presence of PB involvement and its levels were closely associated with the degree of involvement of the BM PC compartment by cPC. * Both authors have contributed similarly to this work and they should both be considered as first author. Disclosures Paiva: EngMab AG: Research Funding; Celgene: Consultancy; Janssen: Consultancy; Millenium: Consultancy; Binding Site: Consultancy; Sanofi: Consultancy; BD Bioscience: Consultancy; Onyx: Consultancy. Puig:Janssen: Consultancy; The Binding Site: Consultancy. Mateos:Celgene: Consultancy, Honoraria; Takeda: Consultancy; Onyx: Consultancy; Janssen-Cilag: Consultancy, Honoraria. Durie:Celgene: Consultancy; Onyx: Consultancy; Takeda: Consultancy; Johnson and Johnson: Consultancy. van Dongen:BD Biosciences (cont'd): Other: Laboratory Services in the field of technical validation of EuroFlow-OneFlow antibody tubes in dried format. The Laboratory Services are provided by the Laboratory of Medical Immunology, Dept. of Immunology, Erasmus MC, Rotterdam, NL; Cytognos: Patents & Royalties: Licensing of IP on Infinicyt software, Patents on EuroFlow-based flowcytometric Diagnosis and Classification of hematological malignancies, Patents on MRD diagnostics, and Patents on PID diagnostics. ; Cytognos (continued): Patents & Royalties: Royalty income for EuroFlow Consortium. The Infinicyt software is provided to all EuroFlow members free-of-charge.Licensing of Patent on detection of IgE+ B-cells in allergic diseases. Royalties for Dept. of Immunology, Erasmus MC, Rotterdam, NL; DAKO: Patents & Royalties: Licensing of IP and Patent on Split-Signal FISH. Royalties for Dept. of Immunology, Erasmus MC, Rotterdam, NL; InVivoScribe: Patents & Royalties: Licensing of IP and Patent on BIOMED-2-based methods for PCR-based Clonality Diagnostics.. Royalty income for EuroClonality-BIOMED-2 Consortium ; Immunostep: Patents & Royalties: Licensing of IP and Patents on immunobead-based dection of fusion proteins in acute leukemias and other tumors. Royalties for Dept. of Immunology, Erasmus MC and for EuroFlow Consortium ; BD Biosciences: Other: Educational Services: Educational Lectures and Educational Workshops (+ related travelling costs). The lectures and workshops fully focus on the scientific achievements of the EuroFlow Consortium (No advertisement of products of BD Biosciences). , Patents & Royalties: Licensing of IP and Patent on EuroFlow-based flowcytometric Diagnosis and Classification of hematological malignancies; Royalty income for EuroFlow Consortium.; Roche: Consultancy, Other: Laboratory Services in the field of MRD diagnostics, provided by the Laboratory of Medical Immunology, Dept. of Immunology, Erasmus MC, Rotterdam, NL.. San Miguel:Janssen-Cilag: Honoraria; Onyx: Honoraria; Millennium: Honoraria; Bristol-Myers Squibb: Honoraria; Celgene: Honoraria; Novartis: Honoraria; Sanofi-Aventis: Honoraria.
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Lenjani, Basri, Merima Šišić, Verica Mišanović, Kenan Ljuhar, and Dardan Lenjani. "Challenges and Problems Affecting the Development Emergency Medical Services in Kosovo." Albanian Journal of Trauma and Emergency Surgery 5, no. 2 (July 20, 2021): 825–29. http://dx.doi.org/10.32391/ajtes.v5i2.245.
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Emergency medical service is organized as a separate field of health activities in order to provide uninterrupted emergency medical care for citizens who due to illness or injury have directly threatened the life, certain organs or certain parts of the body respectively cut the optimal time of occurrence of the emergency until the start of the final treatment process. Emergence clinic for 2020. Year ED over 100. 000-cases. The emergency health system doesn’t have a consolidated network and integrated emergency medical services. Emergency health services in Europe are being challenged by changes in life dynamics, scientific advancements, which do increase the request to further improve the way of delivering emergency services. Health-system resilience can be defined as the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises, to maintain core functions when a crisis hits, and—informed by lessons learned during the crisis to reorganize if conditions require it. Emergency clinic today at UCCK offers an area of 507m2, with 22 beds in the living room (1 bed per 100,000 population). Compliance with the law on emergency medical care, support, and improvement of EMS creating a special budget for EMS. EMS Independence (Decentralization). Budget, Management, accreditation, initiation of a project of systematization doctors of nurses in an integrated system. Regulation of administrative and legal infrastructure for EMS. The increase in salary (during holidays, weekends), shortening working hours for EMS, beneficial path (stress, risk, complexity, infections, first contact with the patient), the extension of annual leave. Functionalization of the Permanent National Center for Education EMS training, licensing, relicensing (medical staff) Quality control or EMS quality.
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Ramsey, Laura B., Laura Janke, Mathew Edick, Cheng Cheng, Richard T. Williams, Charles J. Sherr, William E. Evans, and Mary V. Relling. "Host Thiopurine Methyltransferase Status Affects Mercaptopurine Antileukemic Effectiveness." Blood 120, no. 21 (November 16, 2012): 3560. http://dx.doi.org/10.1182/blood.v120.21.3560.3560.
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Abstract Abstract 3560 Thiopurines are routinely used to treat many hematopoietic malignancies, including acute lymphoblastic leukemia (ALL), as well as inflammatory and autoimmune diseases. Common polymorphic null alleles among humans in thiopurine methyltransferase (TPMT) render 1 in 400 patients equivalent to homozygous knock-outs (−/−), 10% of patients equivalent to hemizygous (+/−), and 90% of patients comparable to wild-type (+/+) status for TPMT enzyme activity. TPMT activity is inversely related to the accumulation of active thioguanine nucleotide metabolites among patients, resulting in a higher risk for myelosuppressive adverse effects if routine doses are given to −/− compared to +/− compared to +/+ patients. However, the impact of the host TPMT polymorphism on antileukemic efficacy in the clinic is less clear. We generated a murine model of ALL by transducing bone marrow cells of Arf-null mice on the 129X1SvJ background (Tpmt +/+) with a retroviral vector encoding p185 BCR-ABL and luciferase, and culturing them for 7–10 days. We injected 2000 BCR-ABL+ pro/pre-B cells into Tpmt-deficient (−/−), heterozygous (+/−), or wild type (+/+) unconditioned syngenic recipients and compared the antileukemic efficacy when treating with a relatively low dose of mercaptopurine (equivalent to 7–9 mg/m2—such as would be tolerated by patients homozygous for null TPMT alleles). Treatment was started one day after injection of leukemia cells and continued for 70 days or until mice were sacrificed due to moribund state (usually due to illness from leukemia). To mimic clinically relevant treatment regimens, methotrexate was injected intraperitoneally (IP) at 1 mg/kg, once a week. Mercaptopurine was administered in the drinking water at 10 mg/L, for an estimated delivered dose of 2 – 2.5 mg/kg/day of mercaptopurine. Erythrocyte TPMT activity segregated by Tpmt genotype as expected and was comparable to the differences observed in patients: 0.6 U/ml in Tpmt −/−, 6.7 U/ml in Tpmt +/−, and 11.6 U/ml in Tpmt +/+ mice (p =0.008, n=2 for each genotype). As expected, the median survival (± standard error) was similar among Tpmt genotypes in untreated mice: 16 (± 0.4) days for Tpmt +/+, 17 (± 0.7) days for Tpmt +/−, and 18 (± 0.4) days for Tpmt −/−. The difference in leukemia-free survival by Tpmt genotype was profound: at 30 days after the start of treatment, 5% (± 9%) of Tpmt +/+ mice, 47% (± 26%) of Tpmt +/− mice, and 85% (± 14%) of Tpmt −/− mice were surviving (p = 5×10−8, Figure), indicating a substantial impact of host Tpmt status on thiopurine antileukemic effectiveness. In vivo imaging of luciferase-marked ALL cells confirmed an intermediate response phenotype for the Tpmt heterozygous mice (p = 0.00001). With higher doses (closer to the doses tolerated by patients homozygous for wild-type alleles, equivalent to 50–70 mg/m2/day), leukemia-free survival improved in the Tpmt +/+ and Tpmt +/− mice, comparable to the survival of Tpmt −/− mice treated with the low dose of mercaptopurine. These findings support the notion that germline polymorphisms in Tpmt, even in the heterozygous state, affect not only host tissue toxicity, but antitumor effectiveness as well. Disclosures: Evans: St. Jude Children's Research Hospital: Dr. William Evans receives a portion of the income St. Jude receives from licensing patent rights related to TPMT polymorphisms., Dr. William Evans receives a portion of the income St. Jude receives from licensing patent rights related to TPMT polymorphisms. Patents & Royalties. Relling:St. Jude Children's Research Hospital: Dr. Mary Relling receives a portion of the income St. Jude receives from licensing patent rights related to TPMT polymorphisms and GGH polymorphisms., Dr. Mary Relling receives a portion of the income St. Jude receives from licensing patent rights related to TPMT polymorphisms and GGH polymorphisms. Patents & Royalties; Sigma-Tau Pharmaceuticals: Research Funding.