Extraordinary Steps Research Articles

Performance-Enhancing Drugs I: Understanding the Basics of Testing for Banned Substances.

Whenever athletes willfully or accidentally ingest performance-enhancing drugs or other banned substances (such as drugs of abuse), markers of those drugs can be detected in biological samples (e.g., biofluids: urine, saliva, blood); in the case of some drugs, that evidence can be apparent for many weeks following the last exposure to the drug. In addition to the willful use of prohibited drugs, athletes can accidentally ingest banned substances in contaminated dietary supplements or foods and inadvertently fail a drug test that could mean the end of an athletic career and the loss of a good reputation. The proliferation of performance-enhancing drugs and methods has required a corresponding increase in the analytical tools and methods required to identify the presence of banned substances in biofluids. Even though extraordinary steps have been taken by organizations such as the World Anti-Doping Agency to limit the use of prohibited substances and methods by athletes willing to cheat, it is apparent that some athletes continue to avoid detection by using alternative doping regimens or taking advantage of the limitations in testing methodologies. This article reviews the testing standards and analytical techniques underlying the procedures used to identify banned substances in biological samples, setting the stage for future summaries of the testing required to establish the use of steroids, stimulants, diuretics, and other prohibited substances.

Government Support of Banks and Bank Lending

The extraordinary steps taken by governments during the 2007-2009 financial crisis to prevent the failure of large financial institutions and support credit availability have invited heated debate. This paper comprehensively reviews empirical assessments of the benefits of those programs — such as their effectiveness in reducing bank failures or supporting new lending — introduces a combined dataset of five key programs that provided term debt or equity to banks in the U.S., and assesses the effects of such support on lending by U.S. banks. The results, using an instrumental variable approach, suggest that bank loans did not increase at institutions receiving government support.

E-COMMERCE EXPERIENCES AND IMPACT ON THE DEVELOPMENT OF PROFESSIONALISM

Nowadays, E-commerce has become so ubiquitous that millions of individuals and small businesses buy and sell things online. Do sellers engage in E-commerce activities just as a hobby and for fun? Or do sellers’ E-commerce experiences shape them to become serious professionals? In this paper, we attempt to examine individual seller’s Ecommerce experiences, understand lessons learned at individual level, and investigate the impact of such experiences on professionalism development. We conduct an exploratory empirical case study by interviewing a local small business on its E-commerce experiences. We report the online seller’s unique eBay experiences. Consistent with the literature, we find that feedback system and reputation building are important institutional mechanism on eBay. The interviewee’s first-hand experiences reveal that the complexity of eBay marketplace and the extraordinary steps eBay take to protect and maintain the marketplace integrity. We also learn the innovations that eBay/PayPal/UPS implemented to encourage E-commerce activity with long-term customers. Overall, this study provides several interesting new business insights on E-commerce. Moreover, this research demonstrates that a seller’s E-commerce experiences transform the individual not only in terms of acquiring a more sophisticated business understanding and increasing business curiosity, but also forming solid work ethics and developing professionalism and self-responsibility.

Developing Electronic Cooperation Tools: A Case From Norwegian Health Care

BackgroundMany countries aim to create electronic cooperational tools in health care, but the progress is rather slow.ObjectiveThe study aimed to uncover how the authoritys’ financing policies influence the development of electronic cooperational tools within public health care.MethodsAn interpretative approach was used in this study. We performed 30 semistructured interviews with vendors, policy makers, and public authorities. Additionally, we conducted an extensive documentation study and participated in 18 workshops concerning information and communication technology (ICT) in Norwegian health care.ResultsWe found that the interorganizational communication in sectors like health care, that have undergone an independent development of their internal information infrastructure would find it difficult to create electronic services that interconnect the organizations because such connections would affect all interconnected organizations within the heterogenic structure. The organizations would, to a large extent, depend on new functionality in existing information systems. Electronic patient records play a central role in all parts of the health care sector and therefore dependence is established to the information systems and theirs vendors. The Norwegian government authorities, which run more than 80% of the Norwegian health care, have not taken extraordinary steps to compensate for this dependency–the government's political philosophy is that each health care institution should pay for further electronic patient record development. However, cooperational tools are complex due to the number of players involved and the way they are intertwined with the overall workflow. The customers are not able to buy new functionalities on the drawing table, while the electronic patient record vendors are not willing to take the economic risk in developing cooperational tools. Thus, the market mechanisms in the domain are challenged. We also found that public projects that were only financed for the first steps of project management could partially explain why many initiatives did not get past the initial planning and specification stages, but were stopped before further development could be made. Vendors were often unwilling to provide further own contribution without guaranteed return.ConclusionsWe propose that the authorities take a coordinating role and provide financial help for development of electronic cooperational tools for health because the regular market mechanisms are insufficient to push these developments to the market. It is, however, critical that the role of users be considered, and for users to decide which developments should go forward.

Are the Needs of Single Parents Serving in the Air Force Being Met?

The military has taken extraordinary steps in establishing programs to support not only the member serving but their families as well. This article will examine military policy as it impacts single parents serving in the Air Force, highlighting existing programs, and calling for more research on this valuable population.

Pharmacists' knowledge, attitudes, and practices regarding influenza vaccination and treatment of pregnant women

ObjectivesTo understand pharmacists' knowledge, attitudes, and practices regarding vaccination and treatment of pregnant women for seasonal influenza and pandemic 2009 influenza A (H1N1). DesignDescriptive, exploratory, nonexperimental study. SettingUnited States between January 21, 2010, and February 9, 2010. Participants606 pharmacists who participated in the American Pharmacists Association (APhA) Immunization Certificate Training Program and practice in chain, supermarket, mass merchandise, and independent pharmacies. InterventionElectronic survey sent by APhA to 7,356 pharmacists who had participated in its Immunization Certificate Training Program. Main outcome measuresPharmacists' knowledge, attitudes, and practices regarding vaccination and antiviral treatment of pregnant women for seasonal and H1N1 influenza. ResultsRespondents were more likely to recognize that pregnant women are at an increased risk associated with H1N1 influenza (85%) than to recognize the increased risk associated with seasonal influenza (78%). However, respondents were less likely to believe that they have an important role in vaccinating pregnant women compared with the general public (82% vs. 97%) and less likely to agree that 2009 H1N1 vaccine was safe during pregnancy compared with the seasonal influenza vaccine (78% vs. 87%). Pharmacists who had been vaccinated themselves were more likely to recommend vaccination for pregnant patients. Only 38% believed that antiviral medications such as oseltamivir can be given during pregnancy because the benefits outweigh the risks. However, in response to case studies of pregnant women who were candidates for antiviral medications, respondents indicated that they would take extraordinary steps to ensure that pregnant women were either referred for medical assessment or for assistance in obtaining prescribed antiviral medications. ConclusionEducation efforts that focus on the effectiveness and safety of influenza vaccination during pregnancy and the benefits of treating pregnant women with confirmed or suspected influenza with antiviral medications may be useful in improving pharmacists' support of pharmaceutical interventions to reduce the impact of influenza in pregnant women. Pharmacists' personal decisions regarding vaccination may be a marker for their overall assessment of risks and benefits and may influence their recommendations for pregnant patients.

Reclaiming the Meaning of 'Direct Tax'

The history of the litigation in the carriage tax case, Hylton v. United States (1796), including the extraordinary steps taken to present a case to the Supreme Court in which the tax would be ratified, suggests that the case was far more important than the simple amount of revenue at stake. This article explores the motivation behind the imposition of the carriage tax, and its defense in Hylton, as a part of the effort s of Hamilton and his fellow Federalists to create a robust federal government. That federal government would include revenue officers whose loyalties were primarily to the federal government not the state governments, and a federal power to tax that was neither limited to excise and other transaction-based taxes nor constrained by the apportionment clause.

Searching Eyes: Privacy, the State, and Disease Surveillance in America

Searching Eyes is a history of privacy, a value central to the American democratic way of life, and disease surveillance, a core activity critical to the public health mission of intervening as appropriate to protect the populace from preventable causes of illness and death. Public health surveillance is framed as a social practice that is embedded within particular contexts rather than as a purely technical undertaking insulated from politics, law, economics, ethics, and societal forces. The authors cite encounters with tuberculosis (TB), syphilis, HIV/AIDS, and immunization registry efforts to illustrate the pervasive tension in disease surveillance activities that has existed between privacy and the welfare of society since the inception of surveillance in the 19th century. Although public health officials take for granted the long-established disease surveillance system that enables them to monitor the public’s health, such practices are not viewed as positively by the populace who contest the feared intrusion into what is perceived as an American’s right to privacy. Even the medical community, our strongest ally in public health activities, has feared the intrusion and encroachment of the doctor–patient relationship. The well-publicized AIDS struggle in the early 1980s captured our attention as we strived to respond to the political and ethical questions that up until that time, had only received an episodic focus. One drawback of the book is that the authors cover a wide gamut of topics. Consequently, disease-specific topics are presented without adequately providing the necessary background on the disease entity to the reader. Not all readers may fully understand the necessary disease-specific background that would make the discussions of public health intervention understandable. For instance, the chapter on TB presents a history of the disease from the turn of the 20th century. But if the reader were unaware of the public health threat posed by the undiagnosed or nonadherent TB patient, the reader would understandably question the authority of public health practitioners to occasionally take extraordinary steps to ensure that infection is not transmitted within the community. Even without a comprehensive background on specific diseases, this book will interest a wide audience, not only public health practitioners but the medical and legal community with whom we partner. Searching Eye tackles a topic that deserves more of our respective attention, for as noted by the authors, “The vitality of democratic communities necessitates an ongoing effort to negotiate and renegotiate the boundaries between privacy, society’s limiting principle, and public health, which at its best has sought to expand the role of government as a guardian against disease and suffering.” I congratulate the authors on their well-researched and thorough discourse on this core public health activity.

Perioperative management of acute pain in the opioid-dependent patient.

human rights. 2– 4 Noticeable shifts in attitude have occurred in recent years regarding the use of opioids for the treatment of benign and malignancy-related pain. Primary care physicians and pain specialists prescribe opioids to a greater number of patients and in doses appropriate to needs. 3–7 A variety of opioid analgesics and delivery systems have been introduced that have increased patient satisfaction, physician acceptance, and overall use. Concomitant with improvements in pain relief and quality of life, an increasing number of patients are affected by issues related to opioid tolerance and physical dependence. There have been only a small number of published reviews that address the treatment of acute pain in patients with substance abuse disorders, 3–5 and fewer have focused specifically on perioperative pain management in opioid-dependent patients. 6,7 This review outlines factors responsible for opioid tolerance, physical dependence, and addiction and provides perioperative analgesic dosing guidelines for this specialized subset of patients. Many patients who present for surgery and anesthesia may be opioid dependent or at least moderately tolerant to the therapeutic effects of opioid analgesics. 5–7 Causal factors underlying dependency include substance use disorder and, more commonly, legitimate use of opioid analgesics for treatment of chronic benign pain or malignancy-associated pain. Perioperative management of opioid-dependent patients poses a special challenge to primary caregivers, anesthesiologists, and pain specialists alike. This problem emanates from the often-conflicting needs to balance the rights of the patient on one hand and concerns of safety, diversion, and abuse on the

Gotier and Thyrotoxicosis in Sulaimani

The aim of this retrospective study was to elucidate the characteristics of the patients with goiter in Sulaimani teaching hospital. A total of 140 patients entered this study The mean age was 30 years. The female : male ratio was 4:1, and 2/3'd of females were housewives and about 2/3'd of males were self-employed. About half of the cases had goiter of more than a year and 1/3'd of the cases had a positive family history of goiter. Lipidol was a significant factor in the development of thyrotoxicosis . 10% of the cases had emotional upheavals preceding thyrotoxicosis. In conclusion :Goiter is increasing in Sulaimani territory with an increasing costs on the governments and the local health services which requires extra-ordinary steps for propaganda and education to encourage people to use iodized table salts routinely to prevent the disease. The increased incidence of thyrotoxicosis in this area is multifactorial including the very stressful life-style of the people in this mountainous area and the sudden introduction of lipidol to patients with avid, enlarged thyroid gland , and on the top of that the changes in the diet patterns due to sudden opening of free markets in the recent years all might be contributory factors.

The US Decennial Census: Political Questions, Scientific Answers

The US decennial census was initiated in 1790 to facilitate nation‐building tasks, especially that of reconfiguring political representation as the population grew and settled new territories. To this basic task of power distribution have been added other key governmental functions, such as the use of census data in guiding revenue sharing and in the enforcement of nondiscriminatory policies. Throughout its history the census has been the focus of partisan clashes. Following the identification of the “differential undercount” a measure of how census coverage differs across demographic groups and geographic areas–the partisan battles intensified, and in recent decades have come to focus not just on how the census counts are used but how the census data are collected. It has been argued that census methodology could be designed to predetermine given partisan outcomes, and for the 2000 census this charge shifted from “could be” to “is.” The Census Bureau has taken extraordinary steps to demonstrate that no partisan considerations have affected the design or implementation of the census, and that its decisions are based solely on the best technical judgment available.

AFFIRMATIVE ACTION AND LOCAL GOVERNMENTS: THE VIEWS OF CITY COUNCIL AND SCHOOL BOARD MEMBERS

This paper explores the attitudes regarding affirmative action of 112 members of city councils and school boards in twelve American cities. In‐depth interviews with these officials reveal widespread support for affirmative action policies generally and for more moderate approaches to affirmative action in particular. Our analysis suggests that more aggressive forms of affirmative action—establishing quotas in hiring and setasides when awarding contracts—are especially opposed by conservatives and those in high prestige occupations and by school board members who are wary of giving priority to social justice over securing highly qualified teachers. Our analysis also suggests that extensive support for more moderate forms of affirmative action—giving preference to qualified minority candidates, requiring minority participation by companies that do business with the city, training and mentoring persons from disadvantaged groups, and taking extraordinary steps to recruit blacks and women into public offices—is rooted in concerns about morality and justice.

Law and ethics

Abstract A Massachusetts doctor… [refused] to take extraordinary steps to keep alive a comatose patient suffering from irreversible brain damage… The doctor, who is at Massachusetts General Hospital in Boston, acted against the wishes of the patient's daughter, who has sued the hospital and the doctors over the issue. (Kolata, 1995, p. A 1)

Coordination of Responsibilities of Organizations in Disasters

There are two principal aspects of disaster preparedness. First the daily around the clock routine already existing in ambulance services, hospitals, police forces, firebrigade, voluntary humanitarian organizations, etc. These organizations are occupied daily with accidents, each within their own areas of responsibility, and often in cooperation with each other.Where people are hurt, medical care will have priority over damage of materials and property. So resuscitation and transport are basic factors in most accidents.Second, according to the definition of disaster, the problems created by accidents of various types will exceed these daily operating resources. The community must take extraordinary steps to provide rescue and first aid to the victims, and provide fire control, police control, transportation, etc.

Experimental studies in natural groundwater recharge dynamics: Assessment of recent advances in instrumentation

To quantify and model the natural groundwater-recharge process, two sites in south-central Kansas, U.S.A., were instrumented with various modern sensors and data microloggers. The atmospheric-boundary layer and the unsaturated and saturated soil zones were monitored as a unified regime. Data from the various sensors were collected using microloggers in combination with magnetic-cassette tape, graphical and digital recorders, analog paper-tape recorders, and direct observations to evaluate and automate data collection and processing. Atmospheric sensors included an anemometer, a tipping-bucket raingage, an air-temperature thermistor, a relative-humidity probe, a net radiometer, and a barometric-pressure transducer. Sensors in the unsaturated zone consisted of soil-temperature thermocouples, tensiometers coupled with pressure transducers and dial gages, gypsum blocks, and a neutron moisture probe operated by an observer. The saturated-zone sensors consisted of a water-level pressure transducer, a conventional float gage connected to a variable potentiometer, soil thermocouples, and a number of multiple-depth piezometers. Evaluation of the operation of these sensors and recorders indicated that certain types of equipment such as pressure transducers are very sensitive to environmental conditions. Extraordinary steps had to be taken to protect some of the equipment, whereas other equipment seemed to be reliable under all conditions. Based on such experiences, a number of suggestions aimed at improving such investigations are outlined.

An Economic Analysis of the Impossibility Doctrine

ONE of the primary functions of contract law is the enforcement of contracts which have been reached in the absence of duress. Yet in some situations the courts have shown themselves willing to discharge parties from their contractual obligations. One of the most important of these situations is dealt with by the doctrine of impossibility.1 According to this doctrine, failure to fulfill contractual obligations may result in discharge of the contract, rather than breach, if the contract has become physically impossible to perform-for example, if the individual who was to have performed the contract has died-or if the cost of carrying out the contract has risen to such an extent that performance has become uneconomical-for example, if, after it had burned down, extraordinary steps were required to reconstruct a factory in time to fulfill a In a recent paper, Richard A. Posner and Andrew M. Rosenfield2 (henceforth P-R) have argued that . . the proper criterion for evaluating the rules of contract law [and, therefore, the doctrine of impossibility] is that of economic efficiency.3 In particular, P-R interpreted this criterion to imply that ... discharge should be allowed where the promisee is the superior risk bearer; [whereas] if the promisor is the superior risk bearer, nonperformance should be treated as a breach of contract. 4 Although I accept the general, economic approach taken by P-R, I feel

The Transits of Venus in 1874 and 1882

The Transits of Venus in 1874 and 1882