Case 1 : Policy Change and Public Health: Obstacles to Advocating for Public Health Interventions

Robin Scherbatsky, a public health nurse at Lambton Public Health in Sarnia, Ontario, plans to advocate for public funding of the more accurate interferon-gamma release assay (IGRA) test for latent tuberculosis infection (LTBI). She wants the IGRA to be covered by the Ontario Health Insurance Plan the same way the tuberculin skin test, which also tests for LTBI, is covered. Although IGRA tests are more expensive than tuberculin skin tests, IGRAs are very accurate and effective at reducing unnecessary treatments given to people falsely diagnosed with LTBI, and this results in cost savings for the public payer. Given that the Ontario government is regarding preventative health interventions as soft targets for reduced funding, Robin is worried about whether her future advocacy activity will be successful. Robin has formed working relationships with local stakeholders such as health facilities, physicians, general practitioners, and nurses through advocating to them about how to test and treat LTBI and tuberculosis. She has to decide how to best advocate for this issue, making sure she has used all available and potential resources. The case aims to provide foundational knowledge of relevant political models and theories by applying them to Robin’s example

Analysis of workplace safety in construction

Den svenska byggindustrin är fylld med risker som äventyrar arbetarnas säkerhet och välbefinnande. Därför undersöker denna studie de risker som dessa arbetare möter i branschen, de strategier som respektive intressenter kan använda för att minska dessa risker, samt de rådande uppfattningarna och attityderna hos intressenterna gentemot branschen. Intervjuer genomfördes med chefer från tre olika byggföretag. Studien undersökte olika säkerhetsfrågor och risker såsom fallolyckor, att bli klämd av tunga material, ergonomiska skador, buller- och kemikalieexponering, samt skärskador från verktyg. Studien utforskar sedan de säkerhetsstrategier som intressenterna kan använda för att minska dessa risker.The Swedish construction industry is fraught with risks that endanger workers safety and wellbeing. Therefore, this research investigates the risks that these workers face in this industry, the strategies that the respective stakeholders can employ to mitigate these risks, and the prevailing perceptions and attitudes by the stakeholders towards the industry. Interviews were conducted with the managers from three different construction companies. The study examined various safety issues and risks such as falls, being crushed by heavy materials, ergonomic injuries, noise and chemical exposure, and cuts from tools. The study then explores the safety strategies that the stakeholders can employ to mitigate these risks

Quality of Local Drainage Systems in Underserved Communities: Assessment Method and Tool using Lidar Data

A properly functioning local stormwater drainage system is essential for mitigating flood economic, health, and safety risks. Failure of a local drainage system occurs when runoff overloads the system and flows into the streets and surrounding low-lying areas. The impacts of these failures include flooding and standing water, which lead to property damage, health risks (e.g., mold, mosquitoes), and pollution (e.g., pesticides, heavy metals carried by the runoff). Local drainage systems are designed to collect and convey stormwater runoff through multiple infrastructure components (such as roadside ditches, drain inlets, pipes, ponds). This study provides a method for evaluating roadside drainage channels using field measurements obtained from mobile lidar (Light Detection and Ranging) scanning systems. We applied this method to evaluate the quality of roadside drainage channels in three underserved communities in Texas. The three communities are the Sunnyside neighborhood in Houston (Harris County), neighborhoods in the City of Rockport (Aransas County), and the Hoehn colonia (Hidalgo County). These communities were selected because they have a history of localized flooding and rely on roadside ditches as their principal infrastructure for runoff control. Ditch conditions were evaluated based on five channel geometric properties (bottom width, channel depth, front slope, back slope, longitudinal slope), the channel’s hydraulic capacity, and the channel’s level of service (LOS). The ditch properties and the LOS are visualized in a geographic information system (GIS). Finally, the ditch properties and LOS were compared across the three communities to determine prevailing failure types

Relation of Plasma Obestatin Levels with BMI and HOMA-IR in Syrian Obese Patients with Type 2 Diabetes

Background: Obestatin is a novel hormone derived from preproghrelin, which was reported to inhibit appetite and gastric motility. Study Aim: This study aimed to investigate plasma obestatin levels in obese patients with T2D patients, which had not been studied clearly in last researches. Methods: 23 normal weight subjects, 35 obese subjects and 31 obese patients with T2D participated in the study, the body mass index was calculated. Fasting glucose and insulin levels were measured and the homeostasis model assessment of insulin resistance (HOMA-IR) was determined. Plasma obestatin levels were measured with enzyme-linked immune sorbent assay (ELISA). The relationship between plasma obestatin levels and biochemical parameters was also analyzed. Results: Fasting obestatin was significantly lower in obese patients with T2D, comparing to control subjects (mean=6.35 vs12.38ng/ml) and to the non-patients obese group (mean=6.35 vs 7.76 ng/ml). Obestatin levels correlated significantly and negatively with BMI (R=-0. 451; P=0. 01), basal insulin levels (R=-0.737, P&lt;0.0001) and HOMA-IR (R=-0. 764, P&lt;0.0001) in diabetic patients. Conclusion: Our results suggest that obestatin may contribute to body weight regulation, and insulin sensitivity could be affected by obestatin levels. </jats:sec

Analysis of workplace safety in construction

Den svenska byggindustrin är fylld med risker som äventyrar arbetarnas säkerhet och välbefinnande. Därför undersöker denna studie de risker som dessa arbetare möter i branschen, de strategier som respektive intressenter kan använda för att minska dessa risker, samt de rådande uppfattningarna och attityderna hos intressenterna gentemot branschen. Intervjuer genomfördes med chefer från tre olika byggföretag. Studien undersökte olika säkerhetsfrågor och risker såsom fallolyckor, att bli klämd av tunga material, ergonomiska skador, buller- och kemikalieexponering, samt skärskador från verktyg. Studien utforskar sedan de säkerhetsstrategier som intressenterna kan använda för att minska dessa risker.The Swedish construction industry is fraught with risks that endanger workers safety and wellbeing. Therefore, this research investigates the risks that these workers face in this industry, the strategies that the respective stakeholders can employ to mitigate these risks, and the prevailing perceptions and attitudes by the stakeholders towards the industry. Interviews were conducted with the managers from three different construction companies. The study examined various safety issues and risks such as falls, being crushed by heavy materials, ergonomic injuries, noise and chemical exposure, and cuts from tools. The study then explores the safety strategies that the stakeholders can employ to mitigate these risks

The safety of radiofrequency ablation of the great saphenous vein in patients with previous venous thrombosis

BackgroundThe safety of radiofrequency ablation (RFA) of the great saphenous vein (GSV) in patients with previous history of deep venous thrombosis (DVT) has not been determined.MethodsFrom April 2003 to June 2006, 274 patients (68% women; mean age, 60 years ± 15 years) underwent 293 consecutive RFA procedures. In the first 15 months, the temperature probe was maintained at 85°C, with a pullback rate of 2 cm/min (85 limbs, 30%); we subsequently changed the protocol to 90°C and a pullback rate of 2 to 3 cm/min (205 limbs, 70%). We identified 29 patients (10%) with a history of DVT or duplex scan evidence of post-thrombotic venous disease; these were compared with the remaining 264 (90%). Postprocedural acute thrombotic (AT) events were analyzed. By the CEAP classification, 204 limbs (70%) were C2 to C4, and 89 (30%) were C5 to C6. Thirty-seven patients (13%) had a history of superficial thrombophlebitis (SVT). Proximal mean GSV diameter was 0.95 ± 0.29 cm (range, 0.4-2.3 cm). Concomitant procedures included avulsion phlebectomy in 88 limbs (30%) and perforator vein surgery in 4 (1%).ResultsAT events after RFA were detected in 38 limbs (13%), including thrombus protrusion into the sapheno-femoral junction (SFJ) in 24 (8%), common femoral vein in 7 (2.5%), and calf vein DVT in 7 (2.5%). Overall incidence of AT events in limbs with and without evidence of previous DVT was 7% (2 of 29) and 14% (36 of 264), respectively (P = .36). Variables significantly associated with AT events were previous SVT (10 of 37 [27%] vs 28 of 256 [11%], P = .01), a larger GSV diameter (mean 1.1 ± .39 vs 0.93 ± 0.27, P < .01), and first protocol (catheter temperature of 85°C with a slower pullback rate in 18 of 88 [20%] vs 20 of 205 [9.7%], P = .02). Concomitant venous operations were associated with an increase in AT events (23% vs 9%; P < .002). By multivariate analysis, larger proximal GSV diameter and previous SVT remained independently statistically significant (P = .049 and P = .0135, respectively). All AT patients were successfully treated with standard anticoagulation. No pulmonary emboli occurred.ConclusionRFA of the GSV in patients with previous venous thromboembolic events is safe and should be offered as an alternative to surgical procedures. These data demonstrate that AT events increase when larger-diameter GSVs are treated

Experimental Assessment of Cardiovascular Physiology in the Chick Embryo.

High resolution assessment of cardiac functional parameters is crucial in translational animal research. The chick embryo is a historically well-used in vivo model for cardiovascular research due to its many practical advantages, and the conserved form and function of the chick and human cardiogenesis programs. This review aims to provide an overview of several different technical approaches for chick embryo cardiac assessment. Doppler echocardiography, optical coherence tomography, micro-magnetic resonance imaging, micro-particle image velocimetry, real-time pressure monitoring, and associated issues with the techniques will be discussed. Alongside this discussion, we also highlight recent advances in cardiac function measurements in chick embryos. This article is protected by copyright. All rights reserved

Impact of chronic renal insufficiency on the early and late clinical outcomes of carotid artery stenting using serum creatinine vs glomerular filtration rate

Background—This study analyzed the impact of chronic renal insufficiency (CRI) on early and late clinical outcomes of carotid artery stenting (CAS) using serum creatinine and glomerular filtration rate (GFR). Study Design—There were 313 CAS patients classified into 3 groups: normal (serum creatinine \u3c1.5 mg/dL or GFR ≥ 60 mL/min/1.73 m2 ); moderate CRI, and severe CRI (serum creatinine ≥3 or GFR \u3c 30 mL/min/1.73 m2 ). Major adverse events ([MAE] stroke, death, and myocardial infarction) were compared for all groups. Results—Using serum creatinine, perioperative stroke rates for normal, moderate, and severe CRI were: 5%, 0%, and 25%, respectively, (p = 0.05) vs 4.6%, 3.7%, and 11.1%, respectively, (p = 0.44) using GFR. The perioperative MAE rates for symptomatic patients were 9.3% and 0% (p = 0.355) and 2% and 5.9% (p = 0.223) for asymptomatic patients for normal and moderate/severe CRI, respectively, using serum creatinine vs 8.1% and 7.8%, respectively, for symptomatic patients and 2.5% and 3%, respectively, for asymptomatic patients using GFR. At a mean followup of 21 months, late MAE rates in normal vs moderate/severe CRI patients were 8.2% and 14%, respectively, (p = 0.247) using serum creatinine vs 6.6% and 13.3%, respectively, (p = 0.05) using GFR. Late MAE rates for symptomatic patients in normal vs moderate/severe CRI were: 8.7% vs 27%, respectively, (p = 0.061) using serum creatinine and 5.7% vs 18.8%, respectively, (p = 0.026) using GFR. Late death rate was 0.55% in normal vs 7.6% (p = 0.002) for moderate/severe CRI. Freedom from MAE at 3 years in symptomatic patients was 81% in normal and 46% in moderate/severe CRI (p = 0.0198). A multivariate Cox regression analysis showed that a GFR of \u3c 60 mL/min/1.73 m2 had an odds ratio of 1.6 (p = 0.222) of having a MAE after CAS. Conclusions—The GFR was more sensitive in detecting late MAE after CAS. Carotid artery stenting in moderate CRI patients can be done with a satisfactory perioperative outcome; however, late death was significan