295 research outputs found
Breast cancer in lesbians and bisexual women: Systematic review of incidence, prevalence and risk studies
No full textThis article is made available through the Brunel Open Access Publishing Fund. © 2013 Meads and Moore; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.Background: The UK Parliamentary Enquiry and USA Institute of Medicine state that lesbians may be at a higher risk of breast cancer but there is insufficient information. Lesbians and bisexual (LB) women have behavioural risk-factors at higher rates compared to heterosexuals such as increased alcohol intake and higher stress levels. Conversely, breast cancer rates are higher in more affluent women yet income levels in LB women are relatively low. This systematic review investigated all evidence on whether there is, or likely to be, higher rates of breast cancer in LB women. Methods: Cochrane library (CDSR, CENTRAL, HTA, DARE, NHSEED), MEDLINE, EMBASE, PsychINFO, CAB abstracts, Web of Science (SCI, SSCI), SIGLE and Social Care Online databases were searched to October 2013. Unpublished research and specific lesbian, gay and bisexual websites were checked, as were citation lists of relevant papers. Included were studies in LB populations reporting breast cancer incidence or prevalence rates, risk model results or risk-factor estimates. Inclusions, data-extraction and quality assessment were by two reviewers with disagreements resolved by discussion. Results: Searches found 198 references. No incidence rates were found. Nine studies gave prevalence estimates - two showed higher, four showed no differences, one showed mixed results depending on definitions, one had no comparison group and one gave no sample size. All studies were small with poor methodological and/or reporting quality. One incidence modelling study suggested a higher rate. Four risk modelling studies were found, one Rosner-Colditz and three Gail models. Three suggested higher and one lower rate in LB compared to heterosexual women. Six risk-factor estimates suggested higher risk and one no difference between LB and heterosexual women. Conclusions: The only realistic way to establish rates in LB women would be to collect sexual orientation within routine statistics, including cancer registry data, or from large cohort studies
Supplemental_File – Supplemental material for Can the current hypodontia care pathway promote shared decision-making?
No full textSupplemental material, Supplemental_File for Can the current hypodontia care pathway promote shared decision-making? by Sophy Barber, Sue Pavitt, David Meads, Balvinder Khambay and Hilary Bekker in Journal of Orthodontics</p
Larry Meads, deputy director of Portland\u27s parks and recreation department, has
No full textLarry Meads, deputy director of Portland\u27s parks and recreation department, has drafted a proposal for a revised dog ordinance that would require owners to leash their animals in the Western Cemetery, the only fenced-in place in Portland where dogs are allowed to go off-leash. David Eaton of the Friends of the Western Cemetery says Meads\u27 proposed alternative to the Western Cemetery, Valley Street, is unacceptable because it is unfenced and therefore unsafe. The Friends of the Parks Commission voted unanimously to endorse the rules, which go before the city\u27s public safety committee on January 8
Analysis of biologically active compounds in meads using HPLC
No full textTato disertační práce je zaměřena na analýzu fenolických sloučenin v medovinách, propolisových tinkturách a ovocných šťávách metodou HPLC s elektrochemickou detekcí.This thesis is aimed at analysis of phenolic compounds in meads, propolis tinctures and fruit juices using HPLC method with electrochemical detection.Katedra analytické chemieDokončená práce s úspěšnou obhajobo
Access to palliative care medicines in the community: an evaluation of practice and costs using case studies of service models in England
No full textBackground: good patient access to medicines at home during the last 12 months of life is critical for effective symptom control, prevention of distress and avoidance of unscheduled and urgent care. Objectives: to undertake an evaluation of patient and carer access to medicines at end-of-life within the context of models of service delivery. Design: evaluative, mixed method case studies of service delivery models, including cost analysis. The unit of analysis was the service delivery model, with embedded sub-units of analysis. Setting: (i) General Practitioner services (ii) Palliative care clinical nurse specialist prescribers (iii) a 24/7 palliative care telephone support line service. Participants: Healthcare professionals delivering end-of-life care; patients living at home, in the last 12 months of life, and their carers. Methods: within each case: Patients/carers completed a structured log on medicines access experiences over an 8-week period. Logs were used as an aide memoire to sequential, semi-structured interviews with patients/carers at study entry, and at four and eight weeks. Healthcare professionals took part in semi-structured interviews focused on their experiences of facilitating access to medicines, including barriers, and facilitating factors. Data on prescribed medicines were extracted from patient records. Detailed contextual data on each case were also collected from a range of documents. Patient, carer and healthcare professional interview data were analysed using Framework Analysis to identify main themes. We estimated prescription costs and budget impact analysis of the different service models. Data were triangulated within each case. Cross-case comparison and logic models were employed to enable systematic comparisons across service delivery types. Findings: accessing medicines is a process characterised by complexity and systems inter-dependency requiring considerable co-ordination work by patients, carers and healthcare professionals. Case studies highlighted differences in speed and ease of access to medicines across service delivery models. Key issues were diversifying the prescriber workforce, the importance of continuity of relationships and team integration, access to electronic prescribing systems, shared records and improved community pharmacy stock. Per patient prescription cost differentials between services were modest but were substantial when accounting for the eligible population over the medium term. Conclusions: experiences of medicines access would be improved through increasing numbers of nurse and pharmacist prescribers, and improving shared inter-professional access to electronic prescribing systems and patient records, within care delivery systems that prioritise continuity of relationships. Community pharmacy stock of palliative care medicines also needs to become more reliable.</p
Supporting patient access to medicines in community palliative care on-line survey of health professionals’ practice, perceived effectiveness and influencing factors
No full textBackground: patient access to medicines at home during the last year of life is critical for symptom control, but is thought to be problematic. Little is known about healthcare professionals’ practices in supporting timely medicines access and what influences their effectiveness. The purpose of the study was to evaluate health professionals’ medicines access practices, perceived effectiveness and influencing factors.Methods: on-line questionnaire survey of health care professionals (General Practitioners, Community Pharmacists, community-based Clinical Nurse Specialists and Community Nurses) delivering end-of-life care in primary and community care settings in England. Quantitative data were analysed using descriptive statistics. Results: 1327 responses were received. All health professional groups are engaged in supporting access to prescriptions, using a number of different methods. GPs remain a predominant route for patients to access new prescriptions in working hours. However, nurses and, increasingly, primary care-based pharmacists are also actively contributing. However, only 42% (160) of Clinical Nurse Specialists and 27% (27) of Community Nurses were trained as prescribers. The majority (58% 142) of prescribing nurses and pharmacists did not have access to an electronic prescribing system. Satisfaction with access to shared patient records to facilitate medicines access was low: 39% (507) were either Not At All or only Slightly satisfied. Out-of-hours specialist cover was reported by less than half (49%; 656) and many General Practitioners and pharmacists lacked confidence advising about out-of-hours services. Respondents perceived there would be a significant improvement in pain control if access to medicines was greater. Those with shared records access reported significantly lower pain estimates for their caseload patients.Conclusions: action is required to support a greater number of nurses and pharmacists to prescribe end-of-life medicines. Solutions are also required to enable shared access to patient records across health professional groups. Coverage and awareness of out-of-hours services to access medicines needs to be improved.<br/
EXOGEN ultrasound bone healing system for long bone fractures with non-union or delayed healing: a NICE medical technology guidance
No full textOpen Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.This article has been made available through the Brunel Open Access Publishing Fund.A routine part of the process for developing National Institute for Health and Care Excellence (NICE) medical technologies guidance is a submission of clinical and economic evidence by the technology manufacturer. The Birmingham and Brunel Consortium External Assessment Centre (EAC; a consortium of the University of Birmingham and Brunel University) independently appraised the submission on the EXOGEN bone healing system for long bone fractures with non-union or delayed healing. This article is an overview of the original evidence submitted, the EAC’s findings, and the final NICE guidance issued.The Birmingham and Brunel Consortium is funded by NICE to act as an External Assessment Centre for the Medical Technologies Evaluation Programme
The Medium Extended Air Defense System : a renaissance in trans-Atlantic armaments cooperation?
No full textThe Medium Extended Air Defense System (MEADS) is the only theater missile defense system being developed within NATO to defend forward-deployed maneuver forces and NATO territory from theater ballistic missile attack. To gain the extra funding needed to keep this expensive TMD system alive, and to improve its reputation for reliability in Alliance weapon programs, the United States convinced NATO Europe that MEADS would be the model for triggering a "renaissance in armaments cooperation." To NATO Europe, however, MEADS became a litmus test of America's credibility as a future armaments partner. MEADS' european partners threatened to end armaments cooperation and pursue a policy of European self-sufficiency, which might undermine NATO's cohesion, if MEADS should fail because of U.S. political and bureaucratic interests. This thesis examines U.S. and European decision-making concerning whether MEADS becomes the model for future trans-Atlantic armaments cooperation or the impetus for fragmenting NATO cohesion. It concludes that the West's common strategic interest in maintaining stability on the European continent and in countering the increasing menace from the proliferation of WMD and ballistic missiles will prevent a failed MEADS from threatening the near-term viability of the fifty year old trans-Atlantic alliance.Approved for public release; distribution is unlimited.U.S. Navy (U.S.N.) author.http://archive.org/details/themediumextende109451360
Organized Pseudolegal Commercial Arguments in Canadian Inter-Partner Family Law Court Disputes
No full textThis article addresses the phenomenon of Organized Pseudolegal Commercial Arguments (OPCA) from the lens of inter-partner disputes. The author begins by briefly reviewing the history of OPCA in Canada, and then proceeds to conduct a Canada-wide survey of OPCA judgments that involve inter-spouse conflict. One of the primary cases focused on is the Alberta judgment, Meads v. Meads. The author finds that there are few OPCA judgments to draw from, which he concludes is a result of the character of OPCA pseudolegal concepts. These concepts are typically intended to target government and institutional actors, rather than private individuals, meaning that these arguments are ill suited to family law situations
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