Face Multiple Problems Research Articles

Assessment of potential soil erosion and sediment yield in the semi-arid N′fis basin (High Atlas, Morocco) using the SWAT model

Arid and semi-arid regions face multiple problems in terms of water management, particularly where surface water is a primary resource. On the northern flank of the High Atlas Mountains (Morocco), deforestation has resulted in soil erosion and siltation of reservoirs. Better characterization of sediment yield is important for reducing the impact of siltation and prolonging the lifespan of dams. The Soil and Water Assessment Tool was used for modeling the N′fis basin in the southern Tensift watershed, leading to a better understanding of the rate of siltation behind Lalla Takerkoust dam. Runoff and sediment yield simulations were evaluated using graphical and statistical methods. The SWAT model performed well in estimating sediment load during the calibration period from 1990 to 2015 (Nash–Sutcliffe efficiency = 0.5–0.62, R2 = 0.5–0.61). The model enabled the determination of soil loss within each hydrological response unit in the watershed. The overall rate was approximately 123 t Ha−1 for an average annual rainfall of 315 mm yr−1. This high yield has to be taken into account for effective water-resources management in the N′fis basin.

Parental Personal Sense of Duty as a Foundation of Pediatric Medical Decision-making.

We describe a model of parental (or more broadly, surrogate) decision-making that includes 5 aspects of decision-making that other models simplify or omit. First, we describe problem structuring recognizing that parents often face multiple potential problems or decisions with multiple potential solutions, rather than a single problem, and the initial challenge is deciding which of the problems to focus on. Second, we discuss sense-making recognizing that difficult decisions are not made in isolation but are often part of a confusing, labyrinthian situation in which disoriented parents must make a series of decisions over time in hopes of getting closer to 1 or more goals. Third, we describe path dependency recognizing that decisions influence what and how decisions are made later. Fourth, we discuss personal sense of duty recognizing that parents and other surrogate decision-makers have central personal roles, self-identities, and relationships with the patient, culminating in a personal sense of duty, such as what they perceive they should do to be in their own judgment a "good parent," which substantially affects their decision-making. Fifth, we describe self-judgments recognizing that parents experience distress when they judge themselves as falling short of their duties or if they think others are judging them for falling short. Clinical practice, medical ethics, and research regarding decision support can all benefit by acknowledging and addressing these key aspects of medical decision-making.

Reviewing outcomes of psychological interventions with torture survivors: Conceptual, methodological and ethical Issues

Torture survivors face multiple problems, including psychological difficulties, whether they are refugees or remain in the country where they were tortured. Provision of rehabilitation varies not only with the needs of survivors and resources available, but also with service models, service provider preferences and the local and country context. Despite increasing efforts in research on effectiveness of psychological interventions with torture survivors, results are inconclusive. We undertook a Cochrane systematic review of psychological, social and welfare provision, with meta-analysis to best estimate efficacy. The process raised conceptual, methodological and ethical issues of relevance to the wider field. We searched very widely, but rejected hundreds of papers which recommended treatment without providing evidence. We found nine randomised controlled trials, from developed and under-resourced settings. All conceptualised survivors' problems in psychiatric terms, using outcomes of post-traumatic stress symptoms, distress, and quality of life, by self-report, with or without translation or unstandardised interpretation, and with little mention of cultural or language issues. None used social or welfare interventions. Four related studies used narrative exposure therapy (NET) in a brief form, and without ensuring a safe setting as recommended. Five used mixed methods, including exposure, cognitive behavioural therapy, and eye movement desensitisation. Combined, the studies showed no immediate improvement in PTSD, distress, or quality of life; at six months follow-up, a minority showed some improvement in PTSD and distress, although participants remained severely affected. While applauding researchers' commitment in running these trials, we raise ethical issues about exposure in particular, and about the effects of shortcomings in methodology, particularly around assessment using unfamiliar cultural frameworks and language, and the lack of concern about dropout which may indicate harm. The issues addressed aid interpretation of existing research, and guide clinical practice as well as future studies evaluating its effectiveness.

INDUCTING FIRST-YEAR SOCIAL WORK STUDENTS: REFLECTIONS ON A DISCIPLINE-SPECIFIC APPROACH TO ACADEMIC DEVELOPMENT

First-year students at tertiary education institutions face multiple problems including under-preparedness, financial problems and adjustment to university. In response, some universities have introduced generic academic development programmes. In contrast, three educators from the Department of Social Work at the University of the Witwatersrand (UWits) engage in a reflective analysis of a discipline-specific academic development programme. Thematic content analysis was used to analyse transcripts of two focus group interviews with students and reflective reports written by two educators on strategies used to design the programme. Findings suggest that this programme meets the unique needs and professional identity development of Social Work students.

Trends of Technology Education in Compulsory Education in Japan

If we look at an overview of technology education in the world, we realize that technology education in professional education, as well as in ordinary education, plays an important role in supporting the idea of a technology-intensive Japan. This study focused on the trend of technology education in compulsory education in Japan. Compared to technology education in advanced countries, fewer class hours are spent on technology education in compulsory education in Japan. However, various attempts have been made with robots and programming, mostly under the subject “technology and home economics,” at junior high schools. In particular, the future development of programming education implementation can be expected. At the same time, schools face multiple problems, including class hours and a lack of full-time teachers. These problems must be solved to enhance technology education.

An epidemiological cross sectional study to assess the socio demographic profile of rag pickers in an urban slum

Background: Most studies report that waste pickers constitute disadvantaged and vulnerable segments of the population. Third World waste pickers face multiple hazards and problems. Due to their daily contact with garbage, waste pickers are usually associated with dirt, disease, squalor, and perceived as a nuisance, a symbol of backwardness, and even as criminals. They survive in a hostile physical and social environment. Sometimes scavengers face extreme animosity and violence. The present study was carried out to assess the demographic distribution and assess health profile and health status of rag pickers in an urban slum.Methods: The cross-sectional study includes 240 adult population from the urban slum of one of the metropolitan city in India and study was carried out over a period of one year from January 2014 to December 2014. Results: It was seen that out of 240 people interviewed for the study majority were females (60%) and the rest were males. The majority of the subjects were illiterate (83.7%) and a majority of them were Buddhists (58%) by religion. Most of them belonged to the lowest socio-economic class (85.2%). Most of them complained of the following problems like inadequate sanitation, addictions of smoking (100%), alcohol intoxication (69%). Conclusions: From the following study it was seen that the majority of the rag pickers were illiterate, malnourished, most of them worked in this occupation only for monetary basis, lived in conditions of bad sanitation, and had many requirements from the government like good sanitation and rehabilitation to other jobs. Background: Most studies report that waste pickers constitute disadvantaged and vulnerable segments of the population. Third World waste pickers face multiple hazards and problems. Due to their daily contact with garbage, waste pickers are usually associated with dirt, disease, squalor, and perceived as a nuisance, a symbol of backwardness, and even as criminals. They survive in a hostile physical and social environment. Sometimes scavengers face extreme animosity and violence. The present study was carried out to assess the demographic distribution and assess health profile and health status of rag pickers in an urban slum.Methods: The cross-sectional study includes 240 adult population from the urban slum of one of the metropolitan city in India and study was carried out over a period of one year from January 2014 to December 2014. Results: It was seen that out of 240 people interviewed for the study majority were females (60%) and the rest were males. The majority of the subjects were illiterate (83.7%) and a majority of them were Buddhists (58%) by religion. Most of them belonged to the lowest socio-economic class (85.2%). Most of them complained of the following problems like inadequate sanitation, addictions of smoking (100%), alcohol intoxication (69%). Conclusions: From the following study it was seen that the majority of the rag pickers were illiterate, malnourished, most of them worked in this occupation only for monetary basis, lived in conditions of bad sanitation, and had many requirements from the government like good sanitation and rehabilitation to other jobs.

A Model for Analyzing the Performance of Wireless Multi-Hop Networks using a Contention-based CSMA/CA Strategy

Multi-hop networks are a low-setup-cost solution for enlarging an area of network coverage through multi-hop routing. Carrier sense multiple access with collision avoidance (CSMA/CA) is frequently used in multi-hop networks. Multi-hop networks face multiple problems, such as a rise in contention for the medium, and packet loss under heavy-load, saturated conditions, which consumes more bandwidth due to re-transmissions. The number of re-transmissions carried out in a multi-hop network plays a major role in the achievable quality of service (QoS). This paper presents a statistical, analytical model for the end-to-end delay of contention-based medium access control (MAC) strategies. These strategies schedule a packet before performing the back-off contention for both differentiated heterogeneous data and homogeneous data under saturation conditions. The analytical model is an application of Markov chain theory and queuing theory. The M/M/1 model is used to derive access queue waiting times, and an absorbing Markov chain is used to determine the expected number of re-transmissions in a multi-hop scenario. This is then used to calculate the expected end-to-end delay. The prediction by the proposed model is compared to the simulation results, and shows close correlation for the different test cases with different arrival rates.

Sociedad de acciones simplificadas, oportunidad de organización y trascendencia para las pequeñas empresas familiares

En el país como en el mundo entero, las pequeñas y medianas empresas representan más del 95% de las entidades económicas que dedicadas a la actividad productiva, en gran mayoría representada por empresas familiares, enfrentan múltiples problemáticas objeto de estudio a través del tiempo, que han dado pie a posibles soluciones enfocadas al proceso de administración y trabajo dentro de la formalidad. Tanto el sector gubernamental como las asociaciones empresariales, han buscado siempre como apoyar a este tipo de unidades económicas a permanecer y ser competitivas en el mundo empresarial. La reforma financiera de 2014, relacionada con las modificaciones a la Ley General de Sociedades Mercantiles en 2016, da origen a la nueva Sociedad de Acciones Simplificada, la cual viene a impactar directamente como una oportunidad a las pequeñas y medianas empresas familiares, pretenden ayudar a fortalecer su economía, ampliar sus oportunidades en la actividad económica y fortaleciéndolas, sirviendo de impulso para trascender y ser más productivas

Networks for Welfare Provision: Getting a Grip on Processes of Social Exclusion by Evaluating Network Effectiveness

AbstractIt has been repeatedly stated that the topic of network effectiveness has often been neglected. This has led to a situation of ‘network euphoria’ amongst practitioners and policymakers with regard to the creation of networks as a means to (re‐)organize welfare provision. Starting from a case study of networks for welfare provision in two Belgian cities, this article focuses on the effectiveness of service delivering networks at the client level, which is understood as the contribution of the network in improving the conditions of life of those being served or targeted by the network. Therefore, we focused on the collective efforts via these networks (e.g. by creating a night shelter or by conducting case consultations) to look after a population of homeless people who face multiple problems and are not able yet to benefit from welfare provision. Our findings revealed that these networks were able to realize a ‘collaborative advantage’ by filling in service gaps and by overcoming fragmentation of care. Nevertheless, these networks equally maintained criteria that restricted the accessibility or usefulness of welfare services provided to homeless people. In the concluding section, we highlight some of the factors that could help us to explain our findings and highlight the tension between the effectiveness of networks at the client level and the effectiveness at the organizational level.

Basic and Technical Considerations on Pond Design and Construction

Fish is one of major sources of dietary protein in Nigeria, as such; private and public fish ponds abound across the country. Fish pond owners across the country face multiple problems such as seepage, ponds overtopped, subsidence, dike crack, reduction and settlement and piping which often results in decline in fish production and loss of investment. Therefore, the problems confronting the farmers must be addressed. To mitigate the problems, pond must be properly designed and constructed. This study assessed the basic and technical parameters needed for adequate pond design and construction. Types of fish pond and its components were included hearting and core; cut-offs; upstream clay blanket; filter blanket; seepage drains; berms and loading berm; upstream and downstream slope protections; and relief well were highlighted. The topography, water source, soils, vegetation and climatology and its important and effects on pond design and construction were examined. This study also examines the parameters needed for safe design and construction. One must keep in mind that the ideal site is not always available. A universal pond design may not be adequate in many situations; therefore, one design is not practically feasible. Deficiencies of the site are often mitigated by making a series of choice of components. Before installing a pond, it is important to remember that no pond will be maintenance free. However, upkeep can be minimized with good design and construction.

Effect of Food Inflation and Global crisis on Indian Economy

India is always confronting growing problem with food productivity combined with its increasing population. India has the highest fluctuations in food inflation of any major Asian economy. Apart from persistent food inflation, policymakers face multiple problems on the agricultural front. The Indian planners, right from the beginning, realised the need to attain self- sufficiency in food grains as one of the important goals in planning. Even though self- sufficiency has been achieved food inflation is still a big problem for the Government. The objective of the study is to identify the causes of food inflation in India since the global crises. The study also provides suggestions to stabilize the food prices and to meet the increasing food demand in future.

Group therapy with international LGBTQ+ clients at the intersection of multiple minority status

Members of sexual/gender minority groups, who are also immigrants and refugees face multiple problems in adapting to their new cultures. Often their sexual interests or gender expression was stigmatised, pathologised, criminalised and persecuted in their home cultures/countries. In this article, we discuss the special problems with acculturation to their new cultures faced by such individuals in a North American milieu. They are at the intersection of multiple minority identities (i.e. ethnic, racial, religious, immigrant, refugee). We provide a model of group therapy for international LGBTQ+ clients who have been persecuted for their sexual/gender minority expressions. Clinical, professional and ethical considerations are explored for dealing with international sexual/gender minority clients in therapy. The conclusion includes recommendations for professional development and for broadening the sphere of knowledge and training in the field.

Behavioral problems in school-aged hearing-impaired children: the influence of sociodemographic, linguistic, and medical factors

The purpose of this study was to examine several behavioral problems in school-aged hearing-impaired children with hearing aids or cochlear implants, compared to normally hearing children. Additionally, we wanted to investigate which sociodemographic, linguistic, and medical factors contributed to the level of behavioral problems, to pinpoint where targeted interventions can take place. This large, retrospective study included a sample of 261 school-aged children (mean age = 11.8 years, SD = 1.6), that consisted of three age- and gender-matched subgroups: 75 with hearing aids, 57 with cochlear implants, and 129 normally hearing controls. Self- and parent-reports concerning reactive and proactive aggression, delinquency, and symptoms of psychopathy, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder were used. In addition, several language and intelligence tests were administered. Hearing-impaired children showed significantly more proactive aggression, symptoms of psychopathy, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder than their normally hearing peers. More behavioral problems were associated with special schools for the deaf, sign (-supported) language, hearing aids (in contrast to cochlear implants), higher age, male gender, lower socioeconomic status, lower intelligence, and delayed language development. Hearing-impaired children face multiple problems regarding their behavior. The outcomes implicate that professionals should be aware of the higher risk of developing behavioral problems, in order to screen, detect, and treat in time. Furthermore, the associated risk and protective factors emphasize that clinicians must always consider the heterogeneity of the group of hearing-impaired children, in order to help and support the individual patient.

Mo1382 Inflammatory Bowel Disease Characteristics Among Ethiopian Jews: A Multicenter Study

Background: Many patients with inflammatory bowel disease (IBD) face multiple problems, including medical, surgical, nutritional, social, psychiatric related to their disease and require a holistic approach to care. To address this need, a multidisciplinary, prompt access IBD clinic was established at McMaster University Medical Centre, Hamilton, Canada. The prevalence of anxiety and depression among the patients attending the clinic is not known. Methods: Interdisciplinary team members consisting of gastroenterologists, surgeon, psychiatrists, nurse practitioner and dietitian providing prompt access holistic care for patients with IBD. All patients with IBD were assessed for demographic characteristics, quality of life using the Short Form-12 (SF-12), and psychological morbidity using the Hospital Anxiety and Depression Scale (HADS). The SF-12 has two components; physical composite score (PCS) and mental composite score (MCS); if either score is ,50 it was considered abnormal. HADS score can range from 0-42 and a score of .11 was considered abnormal. Results: The mean (SD) age of the 67 patients (males, 36%) was 35 (13) yrs. The majority (63%) had received college education. Of them, 40% had full-time employment, 18% had parttime employment, 24% were unemployed and 18% were on disability/sick leave. Of the 67 patients, 45% were in a stable marital relationship, 43% were single and 10% were either divorced or separated. The mean (SD) PCS was 41 (11) and MCS was 43 (12). The PCS was abnormal in 73% and MCS in 65% of the patients. HADS scores indicated that 75% were anxious/ depressed, while 8% had borderline anxiety/depression and 17% had normal scores. HADS scores showed a high degree of correlation with MCS (r=-0.717; p ,0.001) but no relationship to PCS, ESR or CRP. HADS scores were lower in those with higher income (.60,000$/yr) than those with lower income (15±8 vs 21±6; p=0.037); and in those who had full time employment compared to those without (13±7.6 vs 17±8; p=0.05). The PCS showed a negative correlation with ESR (rho=-0.25; p=0.048) and CRP (rho=-0.25; p= 0.05). Only 27% (13/49) of the patients with abnormal HADS score received professional psychiatric help. Conclusions: Patients with IBD have a high prevalence of anxiety and depression. Anxiety and depression was found more often in those with lower income and no full time employment.. HADS score did not show any relationship to disease activity or physical functional capability. Patients with IBD need active evaluation for presence of underlying anxiety or depression.

Mo1378 Psychosocial Characteristics of Patients With IBD: Experience From the Mcmaster Interdisciplinary Clinic

Background: Many patients with inflammatory bowel disease (IBD) face multiple problems, including medical, surgical, nutritional, social, psychiatric related to their disease and require a holistic approach to care. To address this need, a multidisciplinary, prompt access IBD clinic was established at McMaster University Medical Centre, Hamilton, Canada. The prevalence of anxiety and depression among the patients attending the clinic is not known. Methods: Interdisciplinary team members consisting of gastroenterologists, surgeon, psychiatrists, nurse practitioner and dietitian providing prompt access holistic care for patients with IBD. All patients with IBD were assessed for demographic characteristics, quality of life using the Short Form-12 (SF-12), and psychological morbidity using the Hospital Anxiety and Depression Scale (HADS). The SF-12 has two components; physical composite score (PCS) and mental composite score (MCS); if either score is ,50 it was considered abnormal. HADS score can range from 0-42 and a score of .11 was considered abnormal. Results: The mean (SD) age of the 67 patients (males, 36%) was 35 (13) yrs. The majority (63%) had received college education. Of them, 40% had full-time employment, 18% had parttime employment, 24% were unemployed and 18% were on disability/sick leave. Of the 67 patients, 45% were in a stable marital relationship, 43% were single and 10% were either divorced or separated. The mean (SD) PCS was 41 (11) and MCS was 43 (12). The PCS was abnormal in 73% and MCS in 65% of the patients. HADS scores indicated that 75% were anxious/ depressed, while 8% had borderline anxiety/depression and 17% had normal scores. HADS scores showed a high degree of correlation with MCS (r=-0.717; p ,0.001) but no relationship to PCS, ESR or CRP. HADS scores were lower in those with higher income (.60,000$/yr) than those with lower income (15±8 vs 21±6; p=0.037); and in those who had full time employment compared to those without (13±7.6 vs 17±8; p=0.05). The PCS showed a negative correlation with ESR (rho=-0.25; p=0.048) and CRP (rho=-0.25; p= 0.05). Only 27% (13/49) of the patients with abnormal HADS score received professional psychiatric help. Conclusions: Patients with IBD have a high prevalence of anxiety and depression. Anxiety and depression was found more often in those with lower income and no full time employment.. HADS score did not show any relationship to disease activity or physical functional capability. Patients with IBD need active evaluation for presence of underlying anxiety or depression.

P321 Vitamin D level doesn't correlate with disease extent and severity in Hungarian patients with inflammatory bowel disease

Background: Many patients with inflammatory bowel disease (IBD) face multiple problems, including medical, surgical, nutritional, social, psychiatric related to their disease and require a holistic approach to care. To address this need, a multidisciplinary, prompt access IBD clinic was established at McMaster University Medical Centre, Hamilton, Canada. The prevalence of anxiety and depression among the patients attending the clinic is not known. Methods: Interdisciplinary team members consisting of gastroenterologists, surgeon, psychiatrists, nurse practitioner and dietitian providing prompt access holistic care for patients with IBD. All patients with IBD were assessed for demographic characteristics, quality of life using the Short Form-12 (SF-12), and psychological morbidity using the Hospital Anxiety and Depression Scale (HADS). The SF-12 has two components; physical composite score (PCS) and mental composite score (MCS); if either score is ,50 it was considered abnormal. HADS score can range from 0-42 and a score of .11 was considered abnormal. Results: The mean (SD) age of the 67 patients (males, 36%) was 35 (13) yrs. The majority (63%) had received college education. Of them, 40% had full-time employment, 18% had parttime employment, 24% were unemployed and 18% were on disability/sick leave. Of the 67 patients, 45% were in a stable marital relationship, 43% were single and 10% were either divorced or separated. The mean (SD) PCS was 41 (11) and MCS was 43 (12). The PCS was abnormal in 73% and MCS in 65% of the patients. HADS scores indicated that 75% were anxious/ depressed, while 8% had borderline anxiety/depression and 17% had normal scores. HADS scores showed a high degree of correlation with MCS (r=-0.717; p ,0.001) but no relationship to PCS, ESR or CRP. HADS scores were lower in those with higher income (.60,000$/yr) than those with lower income (15±8 vs 21±6; p=0.037); and in those who had full time employment compared to those without (13±7.6 vs 17±8; p=0.05). The PCS showed a negative correlation with ESR (rho=-0.25; p=0.048) and CRP (rho=-0.25; p= 0.05). Only 27% (13/49) of the patients with abnormal HADS score received professional psychiatric help. Conclusions: Patients with IBD have a high prevalence of anxiety and depression. Anxiety and depression was found more often in those with lower income and no full time employment.. HADS score did not show any relationship to disease activity or physical functional capability. Patients with IBD need active evaluation for presence of underlying anxiety or depression.

Interdisciplinary, prompt access IBD clinic: The hamilton health science experience

Despite advances in medical management of IBD, patients suffering from IBD follow courses of relapses and remission. Many patients face multiple problems including medical and surgical issues arising from their IBD, as well as nutritional, social, psychiatric, bone health and pain management issues. These require additional information about medical therapy to optimize medication adherence, nutritional counseling, assistance with long term coping strategies, and support with psychosocial issues. This is best achieved though an interdisciplinary approach in order to deliver holistic comprehensive care. We characterized our institution's experience with a novel multidisciplinary IBD clinic Interdisciplinary team members consisted of four gastroenterologists (GI), one colorectal surgeon, two psychiatrists, one nurse practitioner (NP) and a registered dietician. One half day clinic with a GI and an NP was dedicated to complex IBD patients requiring for urgent access and possible changes in medical management. An interdisciplinary clinic for surgical, psychiatric and nutrition consultation was available once per month. Patients requiring urgent access were provided with a contact number during disease relapse; the urgency of access was determined during a telephone screening conducted by the NP who coordinated appropriate laboratory investigations and the next available appointment. Patients were informed that the appointment would be made to see one of the four GI's. Pre and Post patient satisfaction with the clinic score were also collected. 178 patient appointments were scheduled in 33 half-day clinic over period of 10 months. 28% of appointments were for review of recent IBD exacerbation; 20% for psychiatric counseling; 15% for discussion of change in medical management; 17% for nutritional counseling; 8% were urgent follow-up after recent hospitalization as result IBD exacerbation; 3% were pregnancyrelated issues of poor weight gain and change in treatment and the remaining visits were for surgical opinion for multiple complex fistulae and failed medical therapy. Nutritional assessment was conducted for gluten sensitivity, short bowel syndrome, low residue diet, weight gain and weight loss counseling, anemia and constipation. The majority of patients seen for psychiatric counseling had major depressive disorder with generalized anxiety disorder, adjustment and coping disorder, social anxiety, social isolation, one patient with suicidal ideations and one patient with dementia secondary to general medical condition. There was no difference in the pre and post patient satisfaction score; with the pre-scores of 4.72 (0.77) - Mean (SD) and the post score of 4.72 (0.58) - Mean (SD), on scale of 1-5. No Caption available. Management of IBD patients can be complex and diverse, based on each individual's needs during the course of the disease. We intended to assess patient satisfaction with this novel approach, compared to the traditional physician centered clinic model. Patients are accepting a shift from limited access to a primary GI to a team approach which includes a NP. Having prompt access during relapse and an interdisciplinary team approach with non-GI health care providers, working in collaboration with the patient, may improve patient outcomes. (Supported, in part, by an unrestricted grant from the Hamilton Academic Health Sciences Organization)

Developing new diagnostic devices for single cell cancer profiling

Detection of trace numbers of cancer cells is crucial for the recovery of the patients who have undergone drastic chemo or radio therapies. Attempting to diagnose complex cancer phenotypes clinicians face multiple problems, e.g.: the heterogeneity of cancer entities, the plasticity of the genotypes and phenotypes of cancer cells, and the low number of cancer cells relative to the normal cells in post-therapy samples. These problems are approached by molecular genetics studies, molecular biomarkers, imaging and importantly, the development of new devices suited to perform accurate, high-throughput quantitative and qualitative analysis of specimens. Interdisciplinary collaborations and the fusion of basic and applied research aimed towards advancing innovation have led to valuable improvements for clinical diagnostics. This paper highlights current advances in developing microfluidic devices for single cell or small sample analysis in biomedicine.

Communication and behavioural disorders among children with hearing loss increases risk of mental health disorders

This study examines the mental health and associated risk factors of children with hearing loss. A cross-sectional analysis of the impact of hearing loss among Australian children using data drawn from Wave 1 of the Longitudinal Study of Australian Children (2004) (LSACs) (n=4589). LSACs provides data which assesses family circumstances, children's hearing problems, chronic health conditions, social and emotional difficulties, communications disorders and language, motor skills and educational outcomes. Outcomes for children aged 4-5 years identified with hearing loss (n=93) were compared with 4,496 children without hearing loss. Children with hearing loss showed elevated prevalence across most dimensions of emotional and behavioural difficulties, and on indicators of communication disorders, language and cognitive development, and motor skills. Reduced receptive language skills and increased difficulties understanding others were predictive of increased psychosocial difficulties in children with hearing problems. Australian children with hearing problems face multiple concurrent health and developmental problems. Moreover, children with hearing problems exhibit behavioural problems when they do not understand what is going on around them. Without appropriate interventions, these children are at risk of developing mental health disorders. An epidemiological study of hearing in children is indicated. Children with receptive hearing problems require access to amplification, communication training, and psychosocial support. Attention must also be given to building design to reduce physical barriers to hearing.

Are clinical outcomes in IBD improved by multidisciplinary clinics?

Chronic inflammatory bowel disease (IBD), consisting of Crohn’s disease (CD) and ulcerative colitis (UC), has an incidence of 5 cases per 100,000 population. Despite recent progress in therapy, IBD follows a course of relapses and remissions, with 25%–50% of patients relapsing annually.1 Many patients face multiple problems with these diseases, such as a constant need for information about therapy, medications, nutrition, psychosocial issues, and possible surgical solutions, requiring a multidisciplinary approach.2 In some large centers this has resulted in the formation of multidisciplinary clinics, consisting of some or all of the following experts: gastroenterologists, nurse-educators, psychologists, dietitians, pharmacologists, and colorectal surgeons. The patients can see these experts either in 1 clinic visit or after referral to 1 or more of these disciplines. In addition, patients seen in specialist IBD clinics were provided better care than in nonspecialist clinics.3 Education of IBD patients is crucial for several reasons. At first diagnosis the patient needs to understand that IBD is chronic, needing regular follow-up and requiring compliance with medications administered for treatment as well as to prevent relapses. The nurse or nurse practitioner is an essential part of a multidisciplinary team to supply the patient with this education. Waters et al4 have shown that educated IBD patients display better compliance and visit emergency room less frequently than patient who did not receive formal education. However, formal education did not improve quality of life. Education will also instruct patients when to call about complications of IBD, such as when abscesses, intestinal obstructions, and fistulas appear and whenever the patient does not respond to therapy. Many IBD patients take multiple medications. A pharmacist can assist the patient with questions about drug interactions and their adverse effects. This function is especially important, e.g., at the start of immunosuppressive therapy when the nurse educator and/or the pharmacist can assist the patient with setting up schematic monitoring for adverse effects. The chronic nature of IBD can have a profound effect on the quality of life. Some patients require additional support with coping through counseling. IBD can also affect sexual relationships. Up to 50% of patients with CD in stable heterosexual relationships did not have regular sexual intercourse.5 Depression and anxiety are more common in IBD patients than in controls.6 In fact, recently the Luebeck semistructured Interview for Psychosocial Screening was developed as a rating tool for psychosocial stress in IBD patients.7 Recognition and treatment of depression will help with medical compliance and lifestyle modification. These psychosocial aspects of IBD can be easily dealt with by a psychologist on a multidisciplinary team. Many IBD patients, especially patients with small bowel CD or short gut syndrome, are malnourished and require dietary supplementation and advice.8 Improved caloric intake, calcium and vitamin D supplementation to prevent bone loss, and the avoidance of dairy products if lactoseintolerant require the input of a dietitian. Frequently, consultation with colorectal surgeons is required, not only for a surgical resection of diseased gut, but especially the surgical and medical management of complicated fistulizing CD requires a team effort by both a gastroenterologist and a colorectal surgeon. In summary, the management of patients with chronic IBD frequently requires a multidisciplinary approach. This holistic approach to the patient with IBD will dramatically improve quality of life and the patient–physician relationship. It is expected that these interventions will result in decreased healthcare use, improved knowledge, psychosocial parameters, outcomes, and adherence to medical regimens.