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PubMed1998

The relation between acquisition of a theory of mind and the capacity to hold in mind.

Building on earlier work by Pascual-Leone (1970) and Case (1985), Olson (1989; 1993) set out a theory showing how a series of incremental changes in capacity for "holding in mind" could account, in part, for children's acquisition of a theory of mind. Following Piaget (1951) infants were said to employ schemata for maintaining relations with objects and events in the presence of those events. At about 18 months children became capable of holding in mind an object so as to free the perceptual system to perceive a second object and form a relation between the two, allowing for what Piaget called the "symbolic function" and what Olson described as predication. At around 4 years, the period examined in the present study, children were said to acquire the ability to represent that predicative relation as a belief or as true or false. That was the stage at which children were said to possess a theory of mind. The present study tested the hypothesized relation between development of a theory of mind and increasing computational resources. Three-, four-, and five-year-old children's performance on a pair of theory of mind tasks was compared with that on a pair of dual processing tasks designed on the basis of Baddeley's (1986) model of working memory. The resulting correlations, as high as r = .64 between the tasks, suggest that changes in capacity to hold in mind allow the expression of, and arguably the formation of, a theory of mind.

Age Factors↗
PubMed2006

Understanding partnerships in developing disabled entrepreneurs through participatory action research.

PURPOSE: The paper reports on a community disability entrepreneurship project in Khayelitsha and Nyanga, Cape Town, South Africa. Disabled people, Disabled People South Africa ( a national organization made up by disabled people's organizations), a non-governmental organisation and occupational therapists from the University of Cape Town collaborated with the focus to achieve economic empowerment of disabled people though the establishment of micro-enterprises. METHOD: Participatory Action Research strategies, which informed and monitored the effective development of the community disability entrepreneurship project, were carefully integrated with the existing principles of community development. RESULTS: The participatory action research process provided an opportunity for shared learning and development. This article reports on the challenges and strategies faced by disabled people in the quest to establish themselves as entrepreneurs. The challenges that were identified through analysis from the experiences of participants were starting with nothing, lack of capacity and complexity of establishing working relationships. The strategies used were building group identity and developing capacity together. Indicators of positive outcome that emerged from an inductive content analysis are presented and discussed.

Community Participation↗
PubMed2001

Deep soil compaction as a method of ground improvement and to stabilization of wastes and slopes with danger of liquefaction, determining the modulus of deformation and shear strength parameters of loose rock.

For the stabilization of dumps with the construction of hidden dams and for building ground improvement, for instance for traffic lines over dumps, nearly all applied compaction methods have the aim to reduce the pore volume in the loose rock. With these methods, a homogenization of the compacted loose rock will be obtained too. The compaction methods of weight compaction by falling weight, compaction by vibration and compaction by blasting have been introduced, and their applications and efficiencies have been shown. For the estimation of the effective depth of the compaction and for a safe planning of the bearing layer, respectively, the necessary material parameters have to be determined for each deep compaction method. Proposals for the determination of these parameters have been made within this paper. In connection with the stabilization of flow-slide-prone dump slopes, as well as for the improvement of dump areas for the use as building ground, it is necessary to assess the deformation behavior and the bearing capacity. To assess the resulting building ground improvement, deformation indexes (assessment of the flow-prone layer) and strength indexes (assessment of the bearing capacity) have to be determined with soil mechanical tests. Förster and Lersow, [Patentschrift DE 197 17 988. Verfahren, auf der Grundlage last- und/oder weggesteuerter Plattendruckversuche auf der Bohrlochsohle, zur Ermittlung des Spannungs-Verformungs-Verhaltens und/oder von Deformationsmoduln und/oder von Festigkeitseigenschaften in verschiedenen Tiefen insbesondere von Lockergesteinen und von Deponiekörpern in situ; Förster W, Lersow M. Plattendruckversuch auf der Bohrlochsohle, Ermittlung des Spannungs-Verformungs-Verhaltens von Lockergestein und Deponiematerial Braunkohle--Surface Mining, 1998;50(4): 369-77; Lersow M. Verfahren zur Ermittlung von Scherfestigkeitsparametern von Lockergestein und Deponiematerial aus Plattendruckversuchen auf der Bohrlochsohle. Braunkohle--Surface Mining, 1995;51(1):39-47] improved a direct procedure, the so-called plate-loading test. With this improved procedure, it is possible to produce profiles of deformation parameters and shear-strength parameters of the loose rock. On this basis the settlement behavior and the bearing behavior of the ground can be described. The PDV-BS cone-penetration test and the pressiometer test are compared and the reliability of the soil mechanical indexes are assessed critically. The PDV-BS can be used as a calibration test for cone penetration tests as well as for the calibration of pressiometer tests. With the application of a PDV-BS and a pressiometer test in combination in a testing field, the anisotropy properties of the loose rock can be proved.

Anisotropy↗
PubMed1998

Develop and strengthen public health law.

The rule of law consists of one of the key requirements to implement policy reforms. The new global health policy, "Health for All in the 21st Century", indicates the role of public health law to attain its values and objectives. This article studies the status retained to secure both international and national law in the new policy, and identifies two initiatives to be undertaken by WHO to develop and strengthen public health law. The usefulness and efficiency of international law depend on national capacities to implement law. Thus, this article concludes that the Organization should adopt international legal instruments and that it should, simultaneously, assist Member States to build institutional and human capacity in public health law. However, these initiatives require that all Member States confirm political determination to link economic and social reforms with legislative reforms.

Ethics↗
PubMed2006

Building community-based short-term psychosocial counseling capacity for cancer patients and their families: the Individual Cancer Assistance Network (ICAN) model.

Research studies show that 30% of cancer patients experience significant disease-related psychosocial distress, which is often under-recognized and undertreated. To satisfy the need for increased capacity to deliver accessible, affordable, community-based psychosocial counseling for cancer patients and their families, the Bristol-Myers Squibb Foundation developed the Individual Cancer Assistance Network (ICAN) demonstration project. Results of a 3-phase evaluation in diverse community settings in Florida show that ICAN effectively provided "cancer sensitivity"; training for social workers preparing them to deliver short-term individualized psychosocial counseling, on a sliding fee scale, to cancer patients and their families, and to market it effectively to oncologists and the community.

Adaptation, Psychological↗
PubMedDate not supplied

Mentorship and competencies for applied chronic disease epidemiology.

To understand the potential and establish a framework for mentoring as a method to develop professional competencies of state-level applied chronic disease epidemiologists, model mentorship programs were reviewed, specific competencies were identified, and competencies were then matched to essential public health services. Although few existing mentorship programs in public health were identified, common themes in other professional mentorship programs support the potential of mentoring as an effective means to develop capacity for applied chronic disease epidemiology. Proposed competencies for chronic disease epidemiologists in a mentorship program include planning, analysis, communication, basic public health, informatics and computer knowledge, and cultural diversity. Mentoring may constitute a viable strategy to build chronic disease epidemiology capacity, especially in public health agencies where resource and personnel system constraints limit opportunities to recruit and hire new staff.

Chronic Disease↗
PubMedDate not supplied

Medicare: a strategy for quality assurance.

This paper has outlined a strategy proposed by an IOM study committee for a quality review and assurance program for Medicare. The committee intended that such a program respond to several major issues, including: the burdens of harm of poor quality of care (poor performance of clinicians in both technical and interpersonal ways, unnecessary and inappropriate services, and lack of needed and appropriate services); difficulties and incentives presented by the organization and financing of healthcare; the state of scientific knowledge; the problems of adversarial, punitive, and burdensome external QA activities and the need to foster successful internal, organization-based QA programs; the adequacy of quality review and assurance methods and tools; and the human and financial resources for quality assurance. In comparison with the existing federal peer review organization program, the IOM's proposed program is intended to focus far more directly on quality assurance, cover all major settings of care, emphasize both a wide range of patient outcomes and the process of care, and have a greatly expanded program evaluation component and greater public oversight and accountability. In laying out the details of such a program, the IOM committee advanced 10 recommendations to support its proposed program. Two of these call for the Secretary of DHHS to support and expand research and educational activities designed to improve the nation's knowledge base and capacity for quality assurance. Finally, the committee emphasized both the extraordinary challenges of quality assurance and the diversity of support for addressing those challenges, noting that patients, providers, and societal agents all have a responsibility in this regard. Building the nation's capacity through additional research and expanded educational efforts is a major cornerstone of the entire enterprise.

Medicare↗
PubMedDate not supplied

Composition of fuel stores and digestive limitations to fuel deposition rate in the long-distance migratory thrush nightingale, Luscinia luscinia.

During their autumn migratory phase, thrush nightingales (Luscinia luscinia) previously starved for 2 d were allowed to refuel under three different ambient temperature conditions (-7 degrees, 7 degrees, and 22 degrees C). During the refueling period, as well as during the preceding control and starvation periods, food intake, body mass, and feces production were monitored. In addition, daily energy expenditure was measured during the refueling period. The compilation of the energy balance during the refueling period revealed an energy density of the deposited tissue of 33.6 kJ g-1. Assuming that the deposited tissue consists of fat and protein exclusively, with energy densities of 39.6 and 5.5 kJ g-1 wet mass, respectively, we estimated the deposited tissue to consist of 82% fat and 18% wet protein (6% dry protein and 12% water). Nitrogen balances during control, starvation, and refueling phases and during a period of prolonged and complete starvation indicated that 5% of the nutrient stores consisted of dry protein. Our results support recent findings that nutrient stores for migration often contain protein in addition to fat and consequently are 15%-25% less energy rich than pure fat stores. These proteins might be stored as muscle or other functional tissue and may be required to support the extra mass of the stores and/or reflect an incapacity of the metabolic machinery to catabolize far exclusively. Fuel deposition rate was positively related with ambient temperature, whereas food intake rate was unaffected by temperature. These results indicate that the rate of fuel deposition is limited by a ceiling in food intake rate; when this ceiling is reached, fuel deposition rate is negatively affected by daily energy expenditure rate. To a certain extent, the ceiling in food intake rate varies depending on feeding conditions over the previous days. These variations in food intake capacity probably reflect the building and breakdown of gut tissues and/or gut enzyme systems and might be insensible and not evolutionary adaptive. Significant energetic costs, however, are probably associated with the maintenance of gut tissues. It is therefore feasible that changes in digestive capacity are regulated and are directed at energy economization.

Analysis of Variance↗
PubMed2004

Organising and financing for sexual and reproductive health and rights: the perspective of an NGO activist turned donor.

This paper is a reflection on some of the successess and challenges that followed in the aftermath of the International Conference on Population and Development (ICPD) Cairo, 1994, and the capacity of civil society and of donors to address them. It is written with two voices--from my experience as an NGO activist for sexual and reproductive rights since the early 1980s and my experience as a programme officer for a donor for the last 18 months. It calls for a focus on implementation of services within public health and education systems, the need to deepen the capacities of activists and build new leaders, and the value of alliances with other movements whose goals are also being challenged by macro-economic forces and fundamentalist movements. At national level, I suggest three major goals: monitoring public sector spending, strengthening public health system capacity for implementation, and advocacy and community organisation to enable shifts in public understanding of sexual and reproductive rights. Lastly, as regards funding, it calls for dialogue about funding issues between NGOs and donors, for donors to increase national capacity development in the global south and for all those committed to change in relation to sexual and reproductive health and rights to commit themselves for the long haul, given the slow pace of change.

Financing, Organized↗
PubMed2007

Addressing the human resources crisis: a case study of the Namibian health service.

BACKGROUND: This paper addresses an important practical challenge to staff management. In 2000 the United Nations committed themselves to the ambitious targets embodied in the Millennium Development Goals (MDGs). Only five years later, it was clear that poor countries were not on track to achieve them. It was also clear that achieving the three out of the eight MDGs that concern health would only be possible if the appropriate human resources (HR) were in place. METHODS: We use a case study based on semi-structured interview data to explore the steps that Namibia, a country facing severe health problems that include an alarmingly high AIDS infection rate, has taken to manage its health workers. RESULTS: In the fifteen years since independence, Namibia has patiently built up a relatively good strategic framework for health policy in the context of government policy as a whole, including strong training arrangements at every level of health staffing, and it has brought HIV/AIDS under the strategic umbrella through its National Strategic Plan for HIV/AIDS. Its major weakness is that it has not kept pace with the rise in HIV/AIDS and TB infection: the community counselling service, still at the pilot stage at the time of this study, was the only specific response. That has created a tension between building long-term capacity in a strategic context and responding to the short-term demands of the AIDS and TB crisis, which in turn affects the ability of HR to contribute to improving health outcomes. CONCLUSION: It is suggested that countries like Namibia need a new paradigm for staffing their health services. Building on the existing strategic framework, it should target the training of 'mid-level cadres'. Higher-level cadres should take on the role of supporting and monitoring the mid-level cadres. To do that, they will need management training and a performance management framework for staff support and monitoring.

Journal Article↗
PubMed1995

A framework for establishing integrated reproductive health training.

The challenge for the next decade will be to make quality family planning services accessible to all sexually active couples who want them. The key to fulfilling this goal is the need to rapidly increase the availability of quality voluntary family planning services globally. This paper presents a framework for integrated reproductive health training which provides a mechanism for ensuring a continuous sustainable supply of qualified trainers and service providers. The paper discusses the approach used by JHPIEGO, a Johns Hopkins University program for international education in reproductive health, to build up national training capacity through the development of integrated reproductive health training. This approach may be seen as a network of pathways linking the national system of higher education, the health care system, the political system and cultural norms to strengthen reproductive health policy, training and services. National integrated reproductive health training includes: updated national policies and service guidelines, pre-service training in health professional schools to prepare students to provide family planning services upon graduation; in-service training for practicing health professionals to improve family planning skills for immediate application on the job; and development of clinical training sites at service delivery points already providing family planning/reproductive health services.

Family Planning Services↗
PubMed1992

A strategy for promoting improved pharmaceutical use: the International Network for Rational Use of Drugs.

Over the last decade, pharmaceutical selection, procurement, distribution, and financing have improved as a result of essential drugs programs. However, despite improved availability, pharmaceuticals are frequently used irrationally. The International Network for the Rational Use of Drugs (INRUD) has been established to help address this problem. The Network joins core groups of researchers from four African and three Asian countries with support groups in Boston, Sweden, WHO, and Australia. The activities of the Network are supported by multilateral, bilateral, foundation donors and by Management Sciences for Health. INRUD functions as a participatory organization in which members are involved in decision-making. The primary objective of the Network is to identify through a coordinated set of country-based research projects a set of effective interventions to recommend as policy options for the promotion of rational drug use. In developing these research projects, INRUD stresses the importance of a multi-disciplinary perspective for adequately understanding the reasons underlying inappropriate use of drugs. To better enable country groups to utilize strong research methodologies and to blend the strengths of multiple disciplines effectively, a major activity of the Network thus far has been the building of local research capacity.

Africa↗
PubMedDate not supplied

The neuropsychology of aging.

There are three general categories of causes of the cognitive decline associated with aging: disuse, disease, and aging per se. People tend to use certain skills or abilities less with age and, thus, those skills decline due to the disuse. Physical illnesses tend to increase with age, which will tend to compromise cognitive functioning. Further, there are actual neurobiological changes with age that will contribute to deterioration of cognitive abilities. Variability of performance between different individuals within an age group increases with age due to each of these three major contributing factors to age decline. The best defense against age-related cognitive deterioration is practice. Practice tends to mitigate the effects of aging by not allowing disuse to occur. In addition, practice can overcompensate for age effects by building a larger reserve capacity to offset any real neurobiological effects of age. Practice can also lead to compensatory strategies in which alternative way of maintaining performance levels are found.

Aged↗
PubMed2005

Challenges and opportunities for enhancing biotechnology and technology transfer in developing countries.

Biotechnological innovation is gaining increased recognition as an important tool for improving global health. The challenge, however, lies in defining the role of technology transfer to develop therapies for diseases prevalent in developing countries. During the past decade, a large disparity emerged between the developed and developing world in accessing affordable medicines because of the pharmaceutical industry's focus on health areas bearing greatest profits. Discussed herein are several mechanisms that provide partial solutions to this challenge. The Office of Technology Transfer of the US National Institutes of Health has increased its technology licensing pertaining to neglected diseases to partners in developing regions. Establishing partnerships through the transfer of technologies and assisting indigenous institutions build R and D capacity may positively impact policies on protection of intellectual property rights and increase multinational company investments in lesser-developed countries. This will most probably result in the development of more accessible therapies for those in need.

Biotechnology↗
PubMed2003

The co-evolution of individual behaviors and social institutions.

We present agent-based simulations of a model of a deme-structured population in which group differences in social institutions are culturally transmitted and individual behaviors are genetically transmitted. We use a standard extended fitness accounting framework to identify the parameter space for which this co-evolutionary process generates high levels of group-beneficial behaviors. We show that intergroup conflicts may explain the evolutionary success of both: (a) altruistic forms of human sociality towards unrelated members of one's group; and (b) group-level institutional structures such as food sharing which have emerged and diffused repeatedly in a wide variety of ecologies during the course of human history. Group-beneficial behaviors may evolve if (a) they inflict sufficient fitness costs on outgroup individuals and (b) group-level institutions limit the individual fitness costs of these behaviors and thereby attenuate within-group selection against these behaviors. Thus, the evolutionary success of individually costly but group-beneficial behaviors in the relevant environments during the first 90,000 years of anatomically modern human existence may have been a consequence of distinctive human capacities in social institution building.

Altruism↗