National Practitioners Research Articles

The National Physical Activity Plan: a call to action from the American Heart Association: a science advisory from the American Heart Association.

The health benefits of regular physical activity and the relation between physical inactivity and chronic disease morbidity and mortality are well established. Also clear is the fact that efforts to increase physical activity at the population level will require collective action by government, nongovernment, for-profit, and nonprofit entities working together at the local, state, and national levels. The US National Physical Activity Plan (NPAP), developed by the National Physical Activity Plan Alliance, of which the American Heart Association (AHA) is a member, is designed to facilitate this collective action, to help organizations from all sectors of society work together to increase physical activity in all segments of the American population. The purposes of this advisory are to summarize the data that describe the health benefits of regular physical activity and the public health burden of low levels of physical activity, to describe the NPAP and the role it will play in increasing population levels of physical activity, and to encourage readers of Circulation to join the AHA’s efforts to promote its implementation. As summarized in Table 1, there is substantial evidence supporting the benefits of regular physical activity to prevent a wide variety of disease conditions and to enhance quality of life. Interestingly, there is less of an appreciation of noncardiovascular benefits of lifestyle physical activity and structured exercise, and this is an area of great opportunity for educating the public and healthcare practitioners. View this table: Table 1. The Health Benefits of Regular Physical Activity Physical inactivity is rapidly becoming a major global concern and is the fourth leading cause of death worldwide.2,3 As noted by Kohl and colleagues, “In view of the prevalence, global reach, and health effect of physical inactivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences.”4 According …

Create a Leadership Legacy (L2) by Developing a Pharmacy Practice Vision

Objective: This article explores the importance of having a vision within pharmacy practice to create a Leadership Legacy (L2). This is shown through the study of current literature and data gathered by the researcher from prominent pharmacists who hold or have held national positions within the profession. The article includes a leadership vision activity that pharmacists can implement. Setting: The research was conducted through extensive one hour interviews with national and international pharmacist practitioners. This data was reviewed for themes and the highlights of the results from four U.S. pharmacists are provided in the article. Practice description: Pharmacists who hold or have held national positions within the profession share their thoughts on their Leadership Legacy (L2). The information pertaining to their specific vision is incorporated into the article. Practice intervention: A vision can guide a pharmacist’s practice and provide ways to navigate goals and outcomes within the profession. Evaluation: Four US pharmacists were asked about their Leadership Legacy (L2). The aspects of an L2 include vision, foundation, intentional focus, meaningful relationships, resiliency, and sustainability. The qualitative data and comments provided by the pharmacists explore their ideas and ways they have incorporated a vision into professional practice. Results: The pharmacists interviewed offered insight into how their specific visions, as well as how they incorporated it into their professional lives. These highlights include wisdom from the various pharmacists and ways to continuously improve the profession in various areas with a vision. Conclusion: Incorporating a vision into practice can allow a pharmacist to have a focus for the intended future. It is a way to ensure that the practice and profession are on track for better outcomes for patients.

Practicalities and challenges in re-orienting the health system in Zambia for treating chronic conditions.

BackgroundThe rapid evolution in disease burdens in low- and middle income countries is forcing policy makers to re-orient their health system towards a system which has the capability to simultaneously address infectious and non-communicable diseases. This paper draws on two different but overlapping studies which examined how actors in the Zambian health system are re-directing their policies, strategies and service structures to include the provision of health care for people with chronic conditions.MethodsStudy methods in both studies included semi-structured interviews with government health officials at national level, and governmental and non-governmental health practitioners operating from community-, primary health care to hospital facility level. Focus group discussions were conducted with staff, stakeholders and caregivers of programmes providing care and support at community- and household levels. Study settings included urban and rural sites.ResultsA series of adaptations transformed the HIV programme from an emergency response into the first large chronic care programme in the country. There are clear indications that the Zambian government is intending to expand this reach to patients with non-communicable diseases. Challenges to do this effectively include a lack of proper NCD prevalence data for planning, a concentration of technology and skills to detect and treat NCDs at secondary and tertiary levels in the health system and limited interest by donor agencies to support this transition.ConclusionThe reorientation of Zambia’s health system is in full swing and uses the foundation of a decentralised health system and presence of local models for HIV chronic care which actively involve community partners, patients and their families. There are early warning signs which could cause this transition to stall, one of which is the financial capability to resource this process.

Development of an evidence-based practice guideline for UK public health nurses (health visitors) to use with parents of infants at risk of obesity.

Evidence about effective interventions that reduce obesity risk during infancy is needed. A systematic review of Randomised Controlled Trials (RCTs) of behavioural and non-behavioural interventions which address potential risk factors for childhood overweight and obesity was undertaken to inform a guideline for UK health visitors. The National Institute for Health and Clinical Excellence (NICE) guidelines were followed. The findings were used to develop a guideline which was reviewed internally by a multi-professional Guideline Development Group (GDG) and externally by national experts and practitioners. We identified 35 RCTs reporting behavioural and non-behavioural interventions delivered antenatally and/or during infancy that included infant weight outcomes (e.g. weight-for-length, weight-for-age, weight-for-BMI) or outcomes related to obesity risk (breastfeeding, physical activity, timing of weaning). A number of on-going trials were identified. Good evidence exists for breastfeeding promotion and support interventions. Evidence exists for parental education around responsive feeding, aspects of infant diet and soothing/sleep expectations. These behavioural components informed the guideline, which is freely available on the UK Institute for Health Visiting website. There was equivocal evidence that infants fed lower protein (compared to higher protein) formula milk gained less weight, and this was not incorporated into the guideline. Further research is needed to establish clinically effective interventions for obesity prevention during infancy. Continuous dialogue between commissioners, policy makers, health visitors and parents is essential to inform obesity prevention strategies in the first year of life.

PALLIATIVE EDUCATION FOR UNDERGRADUATE MEDICAL STUDENTS BASED ON THE NATIONAL SURVEY IN JAPAN

BackgroundPalliative care education for undergraduate medical students has not been well established in Japan. A foundation supported our university to have a department of palliative care medicine for undergraduate palliative...

EPA-1463 – EPA guidance and the Future of European Psychiatry

Introduction The European Guidance project provides a series of guidance documents on topics related to quality of mental healthcare and prevention of mental disorders, for which evidence- and consensus-based guidelines are currently lacking. Objectives To provide information on good clinical practice by using problem solving examples, guidelines and quality standards of care to national societies, health authorities and practitioners; to address healthcare gaps and give advice on developing research programs. Aims To describe the development of the European Guidance. Methods Review of the Guidance project and its future activities. Results The ‘EPA Guidance on the quality of mental health services’ provides evidence- and consensus-based recommendations on optimal structures and processes of European mental health services. In a structured process, the retrieved evidence is used as a basis for formulating recommendations. Conclusions The EPA Guidance recommendations may be implemented in European countries as a tool for improving the quality of mental health services. For internationally valid recommendations, high-quality multinational research would be warranted. Considering the multinational nature of the European Union and the increasing role of regional constituents, harmonization of the quality of mental healthcare may be advanced on a supranational level with the help of the European Guidance. Its recommendations may be adapted to national or regional conditions in order to suit the needs, priorities and legislation of the respective European constituents.

Frontiers in Biomedical Engineering and Biotechnology

The 2nd International Conference on Biomedical Engineering and Biotechnology (iCBEB 2013), held in Wuhan on 11–13 October 2013, is an annual conference that aims at providing an opportunity for international and national researchers and practitioners to present the most recent advances and future challenges in the fields of Biomedical Information, Biomedical Engineering and Biotechnology. The papers published by this issue are selected from this conference, which witnesses the frontier in the field of Biomedical Engineering and Biotechnology, which particularly has helped improving the level of clinical diagnosis in medical work.

Cybercrime in the Perspective of the European Legal Framework

This paper analyzes the European legal framework on cybercrime. It focuses on the criminal law framework on cybercrime with a mainly European perspective, based in the new modern challenges that have emerged in the form of cyber-crime as criminal groups have taken effectively advantage of technologies. The growing danger from crimes committed against computers, or against information on computers, is beginning to claim attention in national capitals. In most countries of the European Union, however, existing laws are likely to be unenforceable against such crimes. This lack of legal protection means that businesses and governments must rely solely on technical measures to protect themselves from cyber- crime, with the introduction of new investigative powers and the facilitation of international cooperation.Cybercrime is a term that is used to refer to a broad range of different activities relating to the misuse of data, computer and information systems, and cyberspace for economic, personal or psychological gain. Policy-makers at the EU and at national levels, academics and law enforcement practitioners have put forward different definitions and systems classifying cybercrime as attacks against information systems, online fraud and scam schemes, identity theft, illicit trading or dissemination of illegal content such as child sexual abuse material. The Union should therefore promote policies and legislation that ensure a very high level of network security and allow faster reactions in the event of cyber disruptions or cyber- attacks. DOI: 10.5901/mjss.2013.v4n9p327

The relationship between national plant genetic resources programmes and practitioners promoting on-farm management: results from a global survey

A global survey was conducted among a wide range of stakeholders to gain insight into the state of on-farm management (OFM) as a strategy for enhancing the conservation and sustainable use of plant genetic resources for food and agriculture (PGRFA). The results show that OFM is not considered a priority in national PGRFA programmes (NPGRPs), and that OFM practitioners and their organizations are not always aware of, or involved in, NPGRPs. The survey also highlighted the lack of awareness, understanding and collaboration between OFM practitioners and the managers and policy-makers associated with NPGRPs. The outcome of the analysis supports a hypothesis that OFM is, to a large extent, supported by stakeholders who are not directly engaged in the conservation and use of PGRFA, and therefore not associated with NPGRPs. This should be taken into consideration when seeking to improve the performance and impact of national programmes, and their commitment to safeguard PGRFA and contribute to food security, poverty alleviation and sustainable agriculture.

Identifying Transition Teacher Competencies Through Literature Review and Surveys of Experts and Practitioners

We first conducted a synthesis of literature to identify essential transition teacher competencies to guide curriculum development for a personnel preparation program. The synthesis yielded a list of 67 competencies needed by transition teachers. Using the 67 competencies, we next created an electronic survey in which respondents were asked to rate importance of transition teacher competencies. The survey was administered to two groups: national experts and transition practitioners. Expert respondents were 52 individuals. Practitioner respondents were 231 teachers, specialists, or coordinators from five states. Results indicated substantial similarities in ratings across all respondents irrespective of sample membership or service to transition-age individuals with mild/moderate or severe disabilities. Findings are discussed in regard to personnel preparation and targeted knowledge and skills.

Policy and Practice in Japan's New Business Incubation Revolution: A Typology of Incubation Management and Emerging Hybrid Model

Since 2000, Japan has undergone a revolution in new business incubation, investing in national capacity and building hundreds of incubation facilities. This paper contextualizes developments in Japan within international trends, while identifying model incubator types. A typology of incubation management styles is proposed, contextualized within practices in the U.S. and Europe. The paper is based on an original database constructed of all incubators operating in Japan, in addition to survey and interviews with incubator managers and tenant firms. Several findings are evident. Incubation management style and incubation managers (IM) play an important role in supporting start-ups, and the nature of IM resource networks is crucial. Through a review of key policy history in Japan, policy lessons for national, regional and university level practitioners are identified. Case studies examine comparative best practices stimulating university-based new business start-ups in emerging sectors. A hybrid (university-private sector, training-network support) incubation management model has emerged in Japan, one that cultivates a bamboo network root system, supporting an innovative ecosystem for start-ups.

Recalibrating U.S.–Pakistan Relations

Afghanistan is America's longest war. Thousands of U.S. troops and those from nearly 50 other countries have fought in Afghanistan against Taliban and al-Qaeda forces, but it was in nuclear-armed P...

Toward global standards for comparator pharmaceutical products: case studies of amoxicillin, metronidazole, and zidovudine in the Americas.

This study compared in vitro dissolution characteristics and other quality measures of different amoxicillin, metronidazole, and zidovudine products purchased in the Americas to a comparator pharmaceutical product (CPP). These three drugs are classified as Biopharmaceutics Classification System Class I drugs with the possibility that dissolution findings might be used to document bioequivalence. All investigated zidovudine products were found to be in vitro equivalent to the CPP. Only 3 of 12 tested amoxicillin products were found to be in vitro equivalent to the CPP. None of the tested metronidazole products were in vitro equivalent to the CPP. These findings suggest but do not confirm bioinequivalence where in vitro comparisons failed, given that an in vivo blood level study might have confirmed bioequivalence. At times, identifying a CPP in one of the selected markets proved difficult. The study demonstrates that products sold across national markets may not be bioequivalent. When coupled with the challenge of identifying a CPP in different countries, the results of this study suggest the value of an international CPP as well as increased use of BCS approaches as means of either documenting bioequivalence or signaling the need for further in vivo studies. Because of increased movement of medicines across national borders, practitioners and patients would benefit from these approaches.

Development of a Public Health Nursing Data Infrastructure

An invited group of national public health nursing (PHN) scholars, practitioners, policymakers, and other stakeholders met in October 2010 identifying a critical need for a national PHN data infrastructure to support PHN research. This article summarizes the strengths, limitations, and gaps specific to PHN data and proposes a research agenda for development of a PHN data infrastructure. Future implications are suggested, such as issues related to the development of the proposed PHN data infrastructure and future research possibilities enabled by the infrastructure. Such a data infrastructure has potential to improve accountability and measurement, to demonstrate the value of PHN services, and to improve population health.

PART I: A CRITICAL EXAMINATION OF “THE MYTH OF NUCLEAR DETERRENCE”

Several years ago, Ward Wilson presented in this journal a wide-ranging challenge to what every generation of national security scholars and practitioners since the end of World War II has been taught about nuclear weapons. He asserted that nuclear deterrence amounts to far less than its proponents have claimed and provocatively suggested that nuclear deterrence is a myth. Relying upon both empirical and theoretical objections to nuclear deterrence, he concluded that its failures were clear-cut and indisputable, whereas its successes were speculative. Yet in spite of a flourishing trade in scholarly articles, think tank reports, blog posts, and opinion pieces concerning nuclear deterrence, nobody—including nuclear weapons scholars—has ventured more than a limited critique of Wilson's essay. There are, however, serious shortcomings in Wilson's arguments—deficiencies that make his essay an unpersuasive brief against nuclear deterrence. Wilson's thesis could be correct. His arguments, however, are unlikely to persuade any skeptical members of Congress, upon whom future progress in arms control depends, to reconsider the value they attach to nuclear weapons and nuclear deterrence.

The Flux of EU Law – Interesting Times for Legal Professionals

The author highlights the ever expanding scope of EU law and its relevance for national practitioners by presenting, in different chapters, the various stages of development of the acquis illustrated by case-law characteristic of the respective stages. Regarding classical market regulation, the impact of secondary law on national civil law and procedure is essentially shown through recent consumer protection decisions of the CJEU. The chapter dealing with the protection of fundamental rights examines in particular the “horizontal” legal effects of “rights” and “principles” of the Charter of Fundamental Rights and emphasises the need to check the compatibility of secondary legislation with the Charter since it has been given primary law status by the Lisbon Treaty. A further chapter looks at the area of Freedom, Security and Justice, with mutual recognition as leading principle, where recent CJEU case-law also suggests a strong impact of the Fundamental Rights Charter on both civil and criminal justice cooperation; however it remains to be clarified to which extent the Charter will be applicable even within the part of the proceedings still based on national procedural law.

A Normative Enterprise Architecture for Guiding End-to-End Emergency Response Decision Support

This article examines the underlying architecture guiding the development and use of enterprise decision support systems that maintain the delivery of time critical public services. A normative architecture, developed from comparative cases involving San Mateo County and Mayo Clinic Emergency Medical Services systems, provides a collection of characteristics meant to guide an emergency response system toward a high level of performance and enable optimal decision-making. At a national symposium, academics and practitioners involved in promoting effective emergency response information systems provided validation for the architecture and next steps for enhancing emergency response information systems. Normative architecture characteristics and expert perspectives from the symposium are integrated into a framework that offers an enterprise approach for delivering time-critical emergency response services. This article provides recommendations for navigating toward a more incremental approach in developing enterprise-oriented emergency information services and examines future trends involving the application of normative architectural concepts to real-world emergency medical settings.

CMFE – Community Media Forum Europe

Community Media (CM) have been present in the European landscape for a long time now and have an equally long history of self-organisation. But since 2002 there had been a lack of presence of community media at the European policy level. That is why in 2004 representatives of national federations, media activists, practitioners and academics initiated the Community Media Forum Europe (CMFE), which has been formally established in 2006 as an action-oriented network of CM-related organizations and people to present the potential of CM within the European media landscape. The short history of CMFE is a real story of success. Whereas until 2006 there had not been any relevant reference to community media on the European level at all, community media-related issues are now part of the political agenda, both in the EU and in the CoE. Community media organizations, activists and politicians around Europe can now refer to a resolution on community media of the European Parliament and to a CoE-Declaration. CMFE has developed a flexible strategy of political intervention and expertise, which combines diversity and common principles, openness and effectiveness. Nevertheless there are still serious problems and challenges characterizing the European lobbying work for community media.

Review: Canada among Nations 2007

CANADA AMONG NATIONS 2007 What Room for Manoeuvre? Jean Daudelin and Daniel Schwanen, editors Montreal and Kingston: McGiIl- Queen' s University Press, 2008. xvi, 328pp, $29.95 paper (ISBN 978o773533974)Now in its 23rd year, the Canada Among Nations series has proven to be an indispensable source for any serious student of Canadian foreign policy. The latest volume, co-edited by Carleton University's Jean Daudelin and the Centre for International Governance Innovation's Daniel Schwanen, upholds the high standards of scholarship and practical utility that readers have come to expect from some of Canada's leading foreign policy analysts and practitioners.The approach of this year's editors is ambitious. Thirteen separate chapters (and 17 different writers) have been commissioned around one very specific question: how much room does Canada have to manoeuvre in world politics? The editors also aim to prove that, contrary to the opinions of scholars who emphasize the constraints faced by national foreign policy practitioners, the phenomenon of globalization has in fact increased the opportunities for Canada to make its own way on the world stage. That they are not entirely successful in either case is neither surprising nor crucial to the overall utility ofthe volume: What Room for Manoeuvre? is valuable to the scholarly and policy communities because of its breadth as well as the quality of some of the individual pieces.The editors divide the book into four sections. Their provocative introduction is followed by six chapters that examine the opportunities and constraints faced by policy players in Ottawa, three that consider Canada's room for manoeuvre on the world stage, and then four that focus on North America. They contend that there are six elements that can affect a state's ability to effect change: the extent of its willingness to trade off the constraints of multilateral engagement for the opportunities created by membership in international organizations and institutions; the ability of its government to establish a truly national foreign policy; the impact of its global reputation; its international capacity, defined in terms of human, military, and political resources, and infrastructure; the global socioeconomic context; and, finally, less controllable factors such as geography.In this context, argue the editors, so long as Canada acts rationally, improves its relationship with the United States, takes advantage of its membership in international organizations and institutions, invests in its foreign policymaking capacity, and accepts that any room for manoeuvre will necessarily be constrained by a changing external environment, Ottawa can indeed play a significant role in the world.A number of the contributors agree. In examining Canadian international economic policy, Wendy Dobson of the University of Toronto argues, for example, that have lots of room for manoeuvre if we are focused and imaginative, anticipate change, and prepare to seek new sources of growth if old ones flag (31). University of Ottawa professors Jeremy de Beer and Michael Geist argue that Canada can lead in the development of a global intellectual property regime. Historica Foundation president Colin Robertson writes that, with effort, Canada has significant room for manoeuvre in its relations with the United States. …

Maintenance of Certification for Orthopaedic Surgeons

The American Board of Medical Specialties (ABMS) has declared that each of its member boards must show that the profession sets its standards, monitors its performance, and is improving the practice of patient-centered evidence-based medicine1,2. In the early 1990s, a series of highly publicized events increased public concerns regarding the competence of physicians. The medical liability insurance crisis further eroded public trust in our health-care system. In 2000, the Institute of Medicine published a book, To Err Is Human: Building a Safer Health Care System , which stated that between 44,000 and 98,000 Americans die each year as a result of preventable errors3. Most of these preventable medical errors are “caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.”3 A second publication by the Institute of Medicine noted that the health care system frequently fails to translate knowledge into practice4. It was further noted that “[a] highly fragmented delivery system … results in poorly designed care processes characterized by unnecessary duplication of services.”4 Furthermore, it has been shown that 3% of hospitalized patients risk experiencing a hospital error and that those who experience an error in treatment or care have a 25% chance of death. This amounts to 1.16 million preventable “patient safety instances,” with over 200,000 patients dying each year from potentially preventable problems5. The public's interest and concern regarding quality issues in health care have resulted in the establishment of many programs, including the National Practitioners' Databank, the National Quality Forum, and the Agency for Health Care Research and Quality. Additionally, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) and the Centers for Medicare and Medicaid Services (CMS) have become more interested in the quality …