“Are you still driving?” Metasynthesis of patient preferences for communication with health care providers

Aim: The aim of this study was to synthesize published qualitative studies to identify older adults' preferences for communication about driving with health care providers.

Background: Health care providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their health care providers.

Design: A qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO, and Web of Science) and grey literature was performed.

Review Methods: Twenty-two published studies representing 518 older adult drivers met the following inclusion criteria: the study (1) was about driving; (2) involved older drivers; (3) was qualitative (rather than quantitative or mixed methods); and (4) contained information on older drivers' perspectives about communication with health care providers.

Results: We identified 5 major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving.

Conclusion: Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Health care providers can respect and empower older drivers—and support their family members—through tactful communication about driving safety and mobility transitions during the life course.     

Prenatal genetic considerations of congenital anomalies of the kidney and urinary tract (CAKUT)

Congenital anomalies of the kidney and urinary tract (CAKUT) constitute 20% of all congenital malformations occurring in one in 500 live births. Worldwide, CAKUT are responsible for 40% to 50% of pediatric and 7% of adult end-stage renal disease. Pathogenic variants in genes causing CAKUT include monogenic diseases such as polycystic kidney disease and ciliopathies, as well as syndromes that include isolated kidney disease in conjunction with other abnormalities. Prenatal diagnosis most often occurs using ultrasonography; however, further genetic diagnosis may be made using a variety of testing strategies. Family history and pathologic examination can also provide information to improve the ability to make a prenatal diagnosis of CAKUT. Here, we provide a comprehensive overview of genetic considerations in the prenatal diagnosis of CAKUT disorders. Specifically, we discuss monogenic causes of CAKUT, associated ultrasound characteristics, and considerations for genetic diagnosis, antenatal care, and postnatal care.     

A simple spatially explicit ideal-free distribution: a model and an experiment

This investigation presents a simple spatially explicit analysis of the ideal-free distribution. The traditional ideal-free distribution assumes discrete sites with definite boundaries, and predicts how many individuals should occupy each site. In contrast, the present analysis assumes that a forager’s gains gradually decline with distance from a site, and asks where in space individuals ought to be. Although many interesting situations may arise, the analysis asks how individuals should position themselves as the distance between two identical sources increases. Nash equilibrium positions should follow a pitchfork pattern as the distance between sites is increased; that is, an individual should maintain a position between two sources when they are close together but should move nearer one of the sources when they are far apart. In addition, the text describes an experimental study that parallels the theoretical analysis. The experiment supports the predicted pitchfork pattern, and provides somewhat weaker support for the predicted differences in ”individual” and ”paired” pitchforks. Received: 14 June 2000 / Revised: 20 September 2000 / Accepted: 7 October 2000     

Sorption of isoxaflutole diketonitrile degradate (DKN) and dicamba in unsaturated soil

When analyzing the sorption characteristics of weakly sorbing or labile pesticides, batch methods tend to yield a high margin of error attributable to errors in concentration measurement and to degradation, respectively. This study employs a recently developed unsaturated transient flow method to determine the sorption of isoxaflutole's herbicidally active diketonitrile degradate (DKN) and dicamba. A 20-cm acrylic column was packed with soils with varied texture that had been uniformly treated with 14C-labeled chemical.The antecedent solution herbicide in equilibrium with sorbed phase herbicide was displaced by herbicide-free water, which was infiltrated into the column. Sorption coefficients, Kd, were obtained from a plot of total herbicide concentration in the soil versus water content in the region where the antecedent solution accumulated. DKN Kd values were approximately 2-3 times (average Kd = 0.71 L kg-1) greater using the unsaturated transient flow method as compared to the batch equilibration method in clay loam (Kd = 0.33 L kg-1), but similar for the two methods in sand (0.12 vs 0.09 L kg-1) soils. Dicamba Kd values were 3 times greater using the unsaturated transient flow method as compared to the batch equilibration method in the clay loam soil (0.38 vs 0.13 L kg-1), however, the Kd values were the same for the two methods in the sand (approximately 0.06 L kg-1). This demonstrates that to determine sorption coefficients for labile hydrophilic pesticides, an unsaturated transient flow method may be a suitable alternative to the batch method. In fact, it may be better in cases where transport models have overpredicted herbicide leaching when batch sorption coefficients have been used.     

A national critical loads framework for atmospheric deposition effects assessment: IV. Model selection,applications, and critical loads mapping

The critical loads approach is emerging as an attractive means for evaluating the effects of atmospheric deposition on sensitive terrestrial and aquatic ecosystems. Various approaches are available for modeling ecosystem responses to deposition and for estimating critical load values. These approaches include empirical and statistical relationships, steady-state and simple process models, and integrated-effects models. For any given ecosystem, the most technically sophisticated approach will not necessarily be the most appropriate for all applications; identification of the most useful approach depends upon the degree of accuracy needed and upon data and computational requirements, biogeochemical processes being modeled, approaches used for representing model results on regional bases, and desired degree of spatial and temporal resolution. Different approaches are characterized by different levels of uncertainty. If the limitations of individual approaches are known, the user can determine whether an approach provides a reasonable basis for decision making. Several options, including point maps, grid maps, and ecoregional maps, are available for presenting model results in a regional context. These are discussed using hypothetical examples for choosing populations and damage limits. The research described in this article has been funded by the US Environmental Protection Agency. This document has been prepared at the EPA Environmental Research Laboratory in Corvallis, Oregon, through contract #68-C8-0006 with ManTech Environmental Technology, Inc., and Interagency Agreement #1824-B014-A7 with the U.S. Department of Energy and at Oak Ridge National Laboratory managed by Martin Marietta Energy Systems, Inc., under Contract DE-AC05-84OR21400 with the US Department of Energy. Environmental Sciences Division Publication No. 3904. It has been subjected to the agency’s peer and administrative review and approved for publication. Mention of trade names or commercial products does not constitute endorsement or recommendation for use.     

A national critical loads framework for atmospheric deposition effects assessment: II. Defining assessment end points,indicators, and functional subregions

The United States Environmental Protection Agency, with support from the US Department of Energy and the National Oceanographic and Atmospheric Administration, has been evaluating the feasibility of an effects-based (critical loads) approach to atmospheric pollutant regulation and abatement. The rationale used to develop three of the six steps in a flexible assessment framework (Strickland and others, 1992) is presented along with a discussion of a variety of implementation approaches and their ramifications. The rationale proposes that it is necessary to provide an explicit statement of the condition of the resource that is considered valuable (assessment end point) because: (1) individual ecosystem components may be more or less sensitive to deposition, (2) it is necessary to select indicators of ecosystem condition that can be objectively measured and that reflect changes in the quality of the assessment end point, and (3) acceptable status (i.e., value of indicator and quality of assessment end point at critical load) must be defined. The rationale also stresses the importance of defining the assessment regions and subregions to improve the analysis and understanding of the indicator response to deposition. Subregional definition can be based on a variety of criteria, including informed judgment or quantitative procedures. It also depends on the geographic scale at which exposure and effects models are accurate and on data availability, resolution, and quality. The research described in this article has been funded by the US Environmental Protection Agency. This document has been prepared at the EPA Environmental Research Laboratory in Corvallis, Oregon, through contract #68-C8-0006 with ManTech Environmental Technology, Inc., and Interagency Agreement #1824-B014-A7 with the US Department of Energy and at Oak Ridge National Laboratory managed by Martin Marietta Energy Systems, Inc., under Contract DE-AC05-84OR21400 with the US Department of Energy. Environmental Sciences Division Publication No. 3903. It has been subjected to the agency’s peer and administrative review and approved for publication. Mention of trade names or commercial products does not constitute endorsement or recommendation for use.     

COORDINATION OF PUBLIC AND PRIVATE AC A CASE STUDY OF LAKE RESTORATION1

ABSTRACT: The potential for joint public and private action for lake restoration is examined using Lake Apopka, Florida, as a case study. Initial calculations indicate that private incentives alone are inadequate to attract investment in a facility to grow and harvest water hyacinths for conversion to methane gas. However, the private externality of water quality improvement associated with harvesting water hyacinths provides a key linkage between the public's water quality objectives and the private gas producer's actions. In order to establish the potential basis for negotiation, the public's willingness-to-pay for environmental services associated with improved water quality is estimated and compared with the estimated subsidy required to induce private action. A conceptual framework is then presented for coordinating actions between private firms and public water management agencies in order to internalize the private externality of water quality improvement while simultaneously achieving the public and private objectives. Results indicate that the subsidization of water hyacinth production and harvesting compares favorably with alternative means of enhancing the water quality of Lake Apopka.     

Interactions of risk analysis and contingency planning in risk management

Risk management entails knowledge of the risk and how best to reduce it; its objective is to minimize losses arising from existing or potential risk. With effective contingency planning, risk analysis and its corollary, consequence analysis, can contribute synergistically to improved risk management. Until recently, risk analysis and contingency or emergency response planning were considered distinct disciplines with little interactive potential. Fortunately, industry now recognizes that linking the two can help ensure public safety as well as preserve the financial integrity of plant owners. Both areas are receiving increased and well-deserved attention; several incidents in recent years have demonstrated that losses could have been greatly reduced if better precautions and procedures had been in place as a result of risk analysis and contingency planning.