36 results
The UK National Recovery Survey: nationally representative survey of people overcoming a drug or alcohol problem
- Ed Day, Ifigeneia Manitsa, Amanda Farley, John F. Kelly
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- Journal:
- BJPsych Open / Volume 10 / Issue 2 / March 2024
- Published online by Cambridge University Press:
- 14 March 2024, e67
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Background
Alcohol or drug (AOD) problems are a significant health burden in the UK population, and understanding pathways to remission is important.
AimsTo determine the UK population prevalence of overcoming an AOD problem and the prevalence and correlates of ‘assisted’ pathways to problem resolution.
MethodStage 1: a screening question was administered in a national telephone survey to provide (a) an estimate of the UK prevalence of AOD problem resolution; and (b) a demographic profile of those reporting problem resolution. Stage 2: social surveying organisation YouGov used the demographic data from stage 1 to guide the administration of the UK National Recovery Survey to a representative subsample from its online panel.
ResultsIn stage 1 (n = 2061), 102 (5%) reported lifetime AOD problem resolution. In the weighted sample (n = 1373) who completed the survey in stage 2, 49.9% reported ‘assisted’ pathway use via formal treatment (35.0%), mutual help (29.7%) and/or recovery support services (22.6%). Use of an assisted pathway was strongly correlated with lifetime AOD diagnosis (adjusted odds ratio [AOR] = 9.54) and arrest in the past year (AOR = 7.88) and inversely correlated with absence of lifetime psychiatric diagnosis (AOR = 0.17). Those with cocaine (AOR = 2.44) or opioid problems (AOR = 3.21) were more likely to use assisted pathways compared with those with primary alcohol problems.
ConclusionNearly three million people have resolved an AOD problem in the UK. Findings challenge the therapeutic pessimism sometimes associated with these problems and suggest a need to learn from community-based self-change that can supplement and enhance existing treatment modalities.
Elemental Composition of Analogs to Mars Return Samples Studied with X-Ray Fluorescence Imaging at NSLS-II
- Juergen Thieme, Joel Hurowitz, Martin Schoonen, K. A. Farley, S. Sherman, John Hill
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- Journal:
- Microscopy and Microanalysis / Volume 24 / Issue S2 / August 2018
- Published online by Cambridge University Press:
- 10 August 2018, pp. 498-499
- Print publication:
- August 2018
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Primary Hypothyroidism Presenting as Growth Delay and Pituitary Enlargement
- John D. Farley, Ellen L. Toth, Edmond A. Ryan
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 15 / Issue 1 / February 1988
- Published online by Cambridge University Press:
- 18 September 2015, pp. 35-37
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We report the case of a young boy being considered for pituitary surgery because of pituitary enlargement found during assessment of growth delay. There was no goitre but he was hypothyroid clinically and biochemically. The finding of an elevated TSH suggested primary thyroid disease with thyrotroph hyperplasia. Treatment with L-thyroxine resulted in prompt resolution of his pituitary enlargement and improvement in his visual fields.
Peter Jordan, Schistosomiasis. The St Lucia project, Cambridge University Press, 1985, 8vo, pp. xv, 442, illus., £35–00
- John Farley
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- Journal:
- Medical History / Volume 30 / Issue 3 / July 1986
- Published online by Cambridge University Press:
- 16 August 2012, p. 367
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Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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Near Infrared Fluorescent and Phosphorescent Organic Light-Emitting Devices
- Yixing Yang, Richard Farley, Timothy Steckler, Jonathan Sommer, Sang Hyun Eom, Kenneth Graham, John Reynolds, Kirk Schanze, Jiangeng Xue
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1154 / 2009
- Published online by Cambridge University Press:
- 31 January 2011, 1154-B05-98
- Print publication:
- 2009
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Organic light-emitting devices (OLEDs) emitting near-infrared (NIR) light have many potential applications, yet the efficiency of these devices remains very low, typically ˜0.1% or less. Here we report efficiency NIR OLEDs based on two fluorescent donor-acceptor-donor oligomers and a phosphorescent Pt-containing organometallic complex. External quantum efficiencies in the range of 0.5–3.8% with emission peak ranging from 700 to 890 nm have been achieved.
A Population-Based Investigation of Invasive Vancomycin-Resistant Enterococcus Infection in Metropolitan Atlanta, Georgia, and Predictors of Mortality
- Bernard C. Camins, Monica M. Farley, John J. Jernigan, Susan M. Ray, James P. Steinberg, Henry M. Blumberg
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 28 / Issue 8 / August 2007
- Published online by Cambridge University Press:
- 02 January 2015, pp. 983-991
- Print publication:
- August 2007
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Background.
Vancomycin-resistant Enterococcus organisms (VRE) have emerged as common nosocomial pathogens, but few population-based data are available on the impact of invasive VRE infections.
Methods.We assessed the incidence of invasive VRE infections and predictors of mortality among patients identified during prospective, population-based surveillance performed in the metropolitan statistical area (MSA) of Atlanta, Georgia.
Results.From July 1997 through June 2000, a total of 192 patients who resided in the Atlanta MSA developed an invasive VRE infection, for a rate of 1.57 cases per 100,000 person-years. The incidence of invasive VRE disease significantly increased from 0.91 cases per 100,000 person-years during the first year of the study to 1.73 cases per 100,000 person-years during the third year of the study (P<.001). Rates of invasive VRE infection were significantly higher among African American patients than white patients (2.59 vs 0.70 cases per 100,000 person-years; P < .001). Blood was the most common sterile site from which VRE was recovered (161 [83%] of 193 isolates), followed by deep surgical sites (17 [9%]), peritoneal fluid (10 [5%]), pleural fluid (3 [2%]), and cerebrospinal fluid (1 [0.5%]). In multivariate analysis, a Charlson comorbidity index of 5 or greater, previous receipt of antibiotic therapy, having 2 or more sets of blood cultures positive for VRE, and receipt of central parenteral nutrition were independent predictors of mortality, whereas receipt of an antibiotic with in vitro activity against the VRE isolate was associated with a decreased risk of mortality. Molecular typing revealed 38 different pulsed-field gel electrophoresis patterns, but the 2 most common pulsed-field gel electrophoresis types were found at 3 Emory University-affiliated hospitals.
Conclusions.The incidence of invasive VRE infection significantly increased in the Atlanta MSA during the 3-year study period, with significant racial disparities detected. Receipt of an antimicrobial agent with in vitro activity against VRE was associated with a lower mortality rate. Molecular typing results demonstrated polyclonal emergence of VRE in Atlanta.
7 - Adherence to antiretroviral therapy in children and youth
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- By John Farley, University of Maryland School of Medicine, MD
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
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- Book:
- Handbook of Pediatric HIV Care
- Published online:
- 23 December 2009
- Print publication:
- 04 May 2006, pp 206-218
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Summary
Improved health outcomes for HIV-infected children and youth will not be achieved without maximal viral suppression. Highly active antiretroviral therapy (HAART) represents a major breakthrough in HIV management, but not all patients respond optimally to HAART. Non-adherence is well established as a major cause of clinical failure, and intermittent non-adherence is a particular problem. Studies in adults have demonstrated that ≥95% adherence to HAART is necessary for durable suppression of viral load [1–3]. In the presence of selective pressure by antiretroviral agents, high rates of viral replication and viral mutation lead to the development of drug resistance. Mutations conferring resistance against one antiretroviral agent often confer cross-resistance to other agents; poor adherence can render a whole class of antiretroviral drug ineffective.
Although a crucial component of good clinical care, assessment of adherence to HAART in HIV-infected children and youth is challenging and labor intensive. Patient and parent (or other caregiver) characteristics associated with optimal adherence are not well characterized. Studies evaluating interventions to improve adherence in this group are encouraging but few.
HIV as a chronic illness
Pediatric HIV infection is now referred to as the “newest chronic illness in childhood” [4, 5]. Chronic illness alters a person's life by creating permanent changes in daily living. Adherence is a major problem in management of patients with any chronic illness. Non-adherence occurs with half of all medical recommendations made to chronically ill patients [6]. Chronic illness in children presents many unique adherence challenges.
13 - Adherence to antiretroviral therapy in children and youth
- from Part II - General issues in the care of pediatric HIV patients
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- By John Farley, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
-
- Book:
- Textbook of Pediatric HIV Care
- Published online:
- 03 February 2010
- Print publication:
- 28 April 2005, pp 188-196
-
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Summary
Improved health outcomes for HIV-infected children and youth will not be achieved without maximal viral suppression. Highly active antiretroviral therapy (HAART) represents a major breakthrough in HIV management, but not all patients respond optimally to HAART. Non-adherence is well established as a major cause of clinical failure, and intermittent non-adherence is a particular problem. Studies in adults have demonstrated that ≥ 95% adherence to HAART is necessary for durable suppression of viral load [1–3]. In the presence of selective pressure by antiretroviral agents, high rates of viral replication and viral mutation lead to the development of drug resistance. Mutations conferring resistance against one antiretroviral agent often confer cross-resistance to other agents; poor adherence can render a whole class of antiretrovirals ineffective.
Although a crucial component of good clinical care, assessment of adherence to HAART in HIV-infected children and youth is challenging and labor intensive. Patient and parent (or other caregiver) characteristics associated with optimal adherence are not well characterized. Studies evaluating interventions to improve adherence in this group are encouraging but few.
HIV as a chronic illness
Pediatric HIV infection is now referred to as the ‘newest chronic illness in childhood’ [4, 5]. Chronic illness alters a person's life by creating permanent changes in daily living. The person must adhere to a medical regimen even though there is no cure, often in the absence of visible symptoms. While our understanding of HIV therapy is evolving, life-long treatment will likely be required.
1 - The PIMS project: vision, achievements, and scope of the data
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- By Paul W. Farris, Professor of Business University of Virginia's Darden Graduate School, John U. Farley, Research Fellow International Business at the Tuck School, Dartmouth College
- Edited by Paul W. Farris, University of Virginia, Michael J. Moore, University of Virginia
-
- Book:
- The Profit Impact of Marketing Strategy Project
- Published online:
- 22 September 2009
- Print publication:
- 04 November 2004, pp 6-27
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Summary
The Profit Impact of Marketing Strategy (PIMS) project, which began in 1972, was one of the most successful and influential partnerships between marketing academics and the private sector. Robert Buzzell, as Executive Director of the Marketing Science Institute, was one of a small group of people who made the PIMS project possible. The program resulted in a unique dataset used to investigate the links among marketing strategy, market structure, and performance. The Marketing Science Institute was a near-perfect organizational platform from which to launch a project that had the ambitious goal of understanding how and why some marketing strategies were more profitable than others. To enable this investigation, PIMS, from the beginning, set a new standard of depth and breadth for panel data collected from operating business units. In this book we have collected a set of original essays that revisit the ideals of the PIMS project. Our purpose is to explore what we learned and, perhaps, what we should or still might learn about researching the connections between marketing strategy and profits.
This does not mean that we are finished with the questions that PIMS helped the field of marketing strategy pose. However, enough time has passed and enough additional evidence has been accumulated that we believe it is appropriate to appraise what was accomplished. Some of the essays will help put the achievement of PIMS into the context of the times (both then and now).
Standardized Emergency Management System and Response to a Smallpox Emergency
- Robert J. Kim-Farley, John T. Celentano, Carol Gunter, Jessica W. Jones, Rogelio A. Stone, Raymond D. Aller, Laurene Mascola, Sharon F. Grigsby, Jonathan E. Fielding
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- Journal:
- Prehospital and Disaster Medicine / Volume 18 / Issue 4 / December 2003
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- 28 June 2012, pp. 313-320
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- December 2003
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The smallpox virus is a high-priority, Category-A agent that poses a global, terrorism security risk because it: (1) easily can be disseminated and transmitted from person to person; (2) results in high mortality rates and has the potential for a major public health impact; (3) might cause public panic and social disruption; and (4) requires special action for public health preparedness. In recognition of this risk, the Los Angeles County Department of Health Services (LAC-DHS) developed the Smallpox Preparedness, Response, and Recovery Plan for LAC to prepare for the possibility of an outbreak of smallpox.
A unique feature of the LAC-DHS plan is its explicit use of the Standardized Emergency Management System (SEMS) framework for detailing the functions needed to respond to a smallpox emergency. The SEMS includes the Incident Command System (ICS) structure (management, operations, planning/intelligence, logistics, and finance/administration), the mutual-aid system, and the multi/interagency coordination required during a smallpox emergency. Management for incident command includes setting objectives and priorities, information (risk communications), safety, and liaison. Operations includes control and containment of a smallpox outbreak including ring vaccination, mass vaccination, adverse events monitoring and assessment, management of confirmed and suspected smallpox cases, contact tracing, active surveillance teams and enhanced hospital-based surveillance, and decontamination. Planning/intelligence functions include developing the incident action plan, epidemiological investigation and analysis of smallpox cases, and epidemiological assessment of the vaccination coverage status of populations at risk. Logistics functions include receiving, handling, inventorying, and distributing smallpox vaccine and vaccination clinic supplies; personnel; transportation; communications; and health care of personnel. Finally, finance/administration functions include monitoring costs related to the smallpox emergency, procurement, and administrative aspects that are not handled by other functional divisions of incident command systems.
The plan was developed and is under frequent review by the LAC-DHS Smallpox Planning Working Group, and is reviewed periodically by the LAC Bioterrorism Advisory Committee, and draws upon the Smallpox Response Plan and Guidelines of the Centers for Disease Control and Prevention (CDC) and recommendations of the Advisory Committee on Immunization Practices (ACIP). The Smallpox Preparedness, Response, and Recovery Plan, with its SEMS framework and ICS structure, now is serving as a model for the development of LAC-DHS plans for responses to other terrorist or natural-outbreak responses.
Chapter One - OVERVIEW: THE ROLE AND RESPONSIBILITY OF GOVERNMENTS IN THE HEALTH SECTOR
- Edited by John W. Peabody, University of California, Los Angeles, M. Omar Rahman, Harvard University, Massachusetts, Paul J. Gertler, RAND Corporation, California, Joyce Mann, University of California, Berkeley, Donna O. Farley, RAND Corporation, California, Jeff Luck, RAND Corporation, California
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- Policy and Health
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- 18 December 2009
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- 28 July 1999, pp 1-29
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Summary
As recently as 1960, a child born into poverty anywhere in the world had only a one-in-four chance of reaching his fifth birthday, while a person age 15 had a life expectancy of 67 years. Today, vaccines protect eight out of ten of the world's children, more than nine out of ten infants will enroll in school, and the average adult will live into his eighth decade. Around the world, the health gains made in the past two generations are arguably the greatest accomplishment of civilization. What makes these gains so remarkable is that they have been accomplished by people living on every continent on the globe—people representing a panoply of cultures, social structures, and values. Amid this diversity, there is a consistent belief that all societies, and the governments that represent them, are responsible for improving the well-being of the population.
In the health sector, this responsibility means understanding the many factors that go into improving people's health. Some of the most important factors—such as national economic development, education, particularly of women, and the creation of technologies that lead to more effective clinical care—lie outside of what is typically viewed as the health sector. Although these factors are not directly involved with the financing, organization, and delivery of health care, they are substantive sectoral inputs into any country's effort to create better health for its population, and, thus, need to be understood in any health policy context.
Index
- Edited by John W. Peabody, University of California, Los Angeles, M. Omar Rahman, Harvard University, Massachusetts, Paul J. Gertler, RAND Corporation, California, Joyce Mann, University of California, Berkeley, Donna O. Farley, RAND Corporation, California, Jeff Luck, RAND Corporation, California
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- Policy and Health
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- 28 July 1999, pp 421-441
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Chapter Three - PRIORITIZING MEDICAL INTERVENTIONS: DEFINING BURDEN OF DISEASE AND COST-EFFECTIVE INTERVENTIONS IN THE PURSUIT OF UNIVERSAL PRIMARY CARE
- Edited by John W. Peabody, University of California, Los Angeles, M. Omar Rahman, Harvard University, Massachusetts, Paul J. Gertler, RAND Corporation, California, Joyce Mann, University of California, Berkeley, Donna O. Farley, RAND Corporation, California, Jeff Luck, RAND Corporation, California
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- Policy and Health
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- 18 December 2009
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- 28 July 1999, pp 74-133
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Summary
OVERVIEW
Prior to 1940, many people argued that medicine offered little to improve health or prolong life. However, since the discovery of sulfonamides in the mid-1930s, a panoply of medications, surgeries, and preventive measures have contributed enormously to human well-being, with new interventions and better therapies being developed every year. Just as important, there is a better understanding of the complex interactions between disease and the environment, between health and economics, and between social development and collective welfare.
Today, scientific investigations have shown that some therapies are effective, safe, and in many cases affordable to even the poorest of individuals. Other therapies are effective but are more expensive and, thus, require careful balancing of the costs and benefits, which vary with location, culture, and social structure. Still others are less efficacious but still are provided in place of more efficacious, better substantiated, and less-expensive interventions.
Choosing the right set of interventions is therefore an increasingly complex task of public policy. In some cases, the evidence for therapies is so overwhelming that all governments should try to make these interventions available as widely as possible; in other cases, the evidence is conflicting or, more commonly, incomplete. Thus, decisions are much harder to make and governments must be more cautious. In addition, whatever choices governments make are inevitably constrained by resources. And what makes choosing among interventions even more complex is that these choices have life-and-death consequences.
Chapter Six - GOVERNMENT AND THE IMPROVEMENT OF HEALTH BEHAVIORS
- Edited by John W. Peabody, University of California, Los Angeles, M. Omar Rahman, Harvard University, Massachusetts, Paul J. Gertler, RAND Corporation, California, Joyce Mann, University of California, Berkeley, Donna O. Farley, RAND Corporation, California, Jeff Luck, RAND Corporation, California
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- Policy and Health
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- 18 December 2009
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- 28 July 1999, pp 232-275
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Summary
OVERVIEW
The ultimate objective of health care services is to improve health status. In Chapter 3, we saw that choosing the right set of clinical interventions is critical to achieving better health within constrained resources. Chapters 4 and 5 discussed ensuring that all people can afford, and have access to, those interventions. In addition, ensuring that the appropriate medical infrastructure and institutions are in place is also key to achieving better health, as we will see in the next chapter.
However, none of these factors is enough to guarantee improvements in health status. Any intervention—whether clinical or enabling—will not improve the health of individuals if the individuals do not choose to take advantage of it, or if providers do not offer the intervention to their patients. For example, a government can decide to fight a measles epidemic by providing immunizations for children, by allocating public subsidies away from curative services and toward the primary preventive care services, and by geographically targeting communities most in need of measles immunization. None of these interventions, however, will improve measles immunizations for children if the parents do not choose to bring their children into the clinics that provide the service and if community health workers are not skilled.
Figure 6.1 expands the relationship presented in Figure 2.1 to show how health policy affects health status and is mediated by changing behaviors of the stakeholders.
Tables
- Edited by John W. Peabody, University of California, Los Angeles, M. Omar Rahman, Harvard University, Massachusetts, Paul J. Gertler, RAND Corporation, California, Joyce Mann, University of California, Berkeley, Donna O. Farley, RAND Corporation, California, Jeff Luck, RAND Corporation, California
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- Policy and Health
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- 18 December 2009
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- 28 July 1999, pp xv-xvi
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Boxes
- Edited by John W. Peabody, University of California, Los Angeles, M. Omar Rahman, Harvard University, Massachusetts, Paul J. Gertler, RAND Corporation, California, Joyce Mann, University of California, Berkeley, Donna O. Farley, RAND Corporation, California, Jeff Luck, RAND Corporation, California
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- Policy and Health
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- 18 December 2009
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- 28 July 1999, pp xix-xx
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Figures
- Edited by John W. Peabody, University of California, Los Angeles, M. Omar Rahman, Harvard University, Massachusetts, Paul J. Gertler, RAND Corporation, California, Joyce Mann, University of California, Berkeley, Donna O. Farley, RAND Corporation, California, Jeff Luck, RAND Corporation, California
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- Policy and Health
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- 28 July 1999, pp xvii-xviii
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Chapter Two - EVIDENCE-BASED POLICY: USING DATA TO INFORM POLICY AND IMPROVE HEALTH OUTCOMES
- Edited by John W. Peabody, University of California, Los Angeles, M. Omar Rahman, Harvard University, Massachusetts, Paul J. Gertler, RAND Corporation, California, Joyce Mann, University of California, Berkeley, Donna O. Farley, RAND Corporation, California, Jeff Luck, RAND Corporation, California
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- Policy and Health
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- 28 July 1999, pp 30-73
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Summary
OVERVIEW
In Chapter 1, we argued that good health policy can have a direct impact on improving health outcomes. Exactly which policy to pursue is decided from a complicated mixture of politics, available funding, and technical expertise. The technical elements of this mixture are determined, to varying degrees, by the evidence available for policymaking. Ideally, policy should always be evidencebased, but this is obviously not always the case. Oftentimes, policy is made without evidence—a situation that demands that policy be evaluated in vivo to determine if it is having its intended impact. Other times, policy is made that ignores the available evidence. Creating evidence-based policy, therefore, faces twin challenges: high-quality data must be used during the policymaking (or policy revision) process, and policy made in the absence of evidence must be implemented cautiously until its impact is properly understood.
Data are important for policy analysis for a simple reason: Better data should generate or lead to better policy. Better policy, in turn, is expected to lead to better health outcomes—the ultimate goal of health policymakers.
Do better data actually guide policymaking? It is not hard to demonstrate that information and scientific investigation are used to inform health policy, and there are many examples of this relationship in Asia. For example, data from observational studies have shown that sexually transmitted diseases (STDs) are associated with cervical cancer and the spread of HIV.
Authors
- Edited by John W. Peabody, University of California, Los Angeles, M. Omar Rahman, Harvard University, Massachusetts, Paul J. Gertler, RAND Corporation, California, Joyce Mann, University of California, Berkeley, Donna O. Farley, RAND Corporation, California, Jeff Luck, RAND Corporation, California
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- Policy and Health
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- 18 December 2009
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- 28 July 1999, pp 419-420
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