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Peer review is conducted by expert panels which often consist of both local and international experts infection xbox order noroxin 400 mg visa. Across government and private funding bodies antibiotics for sinus infection for sale order line noroxin, peer-review processes are often two-staged antibiotic 48 hours contagious purchase noroxin 400mg with visa. In some cases, a local peerreview panel reviews submissions for funding (although this panel usually includes locallybased but internationally recruited experts), then locally reviewed and shortlisted submissions are sent to international peer-review panels. In order to strike a balance between the protection of rights for owners of intellectual property and increased public access to it, Singapore has harmonised its intellectual property and copyright laws with global laws. This is meant to alleviate the concerns of any international investors who are participating or considering engaging in local R&D activities, investment and collaboration. Singapore was ranked second in the world in terms of intellectual property protection by the World Economic Forum and the International Institute for Management Development in 2009 (Singapore Economic Development Board, 2009c). Exploit Technologies is the main technology transfer and science commercialisation body in the country. Its key functions include evaluating technology disclosures, preparing and administering patent applications and maintaining granted patents, all with the common objective of obtaining a patent portfolio which can be licensed. Currently Exploit Technologies manages more than 2, 000 active applications and patents, licensing deals and spin-offs. Universities and hospital groups tend to have their own technology transfer activity (sometimes through divisions called research development and industry liaison offices), and on an externally-sponsored research basis, respect and adhere to the principles of their funders. In general, rights to intellectual property created by the staff and students of universities in Singapore are owned by the university. In an effort to coordinate the technology transfer and science commercialisation activities of various organisations, the Technology Transfer Network ­ a collaborative alliance of technology transfer organisations in the country ­ was formed in 2008 to increase effectiveness in transfer to the industry. The core activities of the national network include: intellectual property cluster mapping; training and certification of technology transfer professionals; marketing; commercialisation advisory services; brokering of networks and collaborations with industry; and engagement in sharing good science commercialisation practices. The framework puts a structure in place to support technology transfer and R&D commercialisation. In addition, a National Framework for Intellectual Property Policies has been developed to facilitate a speedier technology transfer process from academic to private sector institutions, and to help promote indigenous innovation (Government of Singapore, 2007d). Most government and national agencies report on annual spending and sometimes provide highlights and casevignettes of successful projects. The ranking is a composite indicator drawing on peer review, employer review, international staff, international students, staff/student ratio and citations per faculty. The country had 104 researchers per 10, 000 labour force, with 1, 739 patent applications and 941 patents awarded in the same year. Bioprocessing Technology Institute researchers developed a monoclonal antibody that targets undifferentiated human embryonic stem cells and causes them to undergo induced cell death. Genome Institute of Singapore researchers, along with the University of California­ San Francisco, collaborated in developing a novel pharmacological approach to killing colon cancer cells. The results of the research were published in the journal Cancer Cell (Jiang et al. The Institute team is working with other local institutes to develop drug candidates based on the technology. These findings are important for further research to inform the early detection and therapy of colon cancer. In addition, 64 biomedical manufacturing-related patents were applied for, nine were awarded and 26 were owned. Scientific output of articles in top medical journals has increased substantially since before the 1990s. The challenge is retaining foreign star scientists (or at least their engagement) for the longer term. Although recruitment has been going well, the political complexity of biomedical research. Since 2001, government agencies have embarked on an aggressive programme to increase the number of Singaporeans pursuing PhD studies in the biomedical and health sciences through greater provision of scholarships and fellowships, a revamp of the education curriculum to promote life sciences and glitzy advertising campaigns (The Economist, 2004).

Many of these major sources include foods that can be purchased or prepared in ways that limit the intake of cholesterol infection under eye order noroxin overnight. Cholesterol intake by men averages about 350 mg per day treatment for uti in guinea pigs buy noroxin 400mg mastercard, which exceeds the recommended level of less than 300 mg per day oral antibiotics for acne rosacea buy noroxin online now. However, this effect is reduced when saturated fatty acid intake is low, and the potential negative effects of dietary cholesterol are relatively small compared to those of saturated and trans fatty acids. Moderate evidence shows a relationship between higher intake of cholesterol and higher risk of cardiovascular disease. Consuming less than 300 mg per day of cholesterol can help maintain normal blood cholesterol levels. Consuming less than 200 mg per day can further help individuals at high risk of cardiovascular disease. Calories from Solid Fats and Added Sugars Solid fats As noted previously, fats contain a mixture of different fatty acids, and much research has been conducted on the association between the intake of saturated and trans fatty acids and the risk of chronic disease, especially cardiovascular disease. Most fats with a high percentage of saturated and/ or trans fatty acids are solid at room temperature and are referred to as "solid fats" (Figure 3-3). Common solid fats include butter, beef fat (tallow, suet), chicken fat, pork fat (lard), stick margarine, and shortening. The fat in fluid milk also is considered to be solid fat; milk fat (butter) is solid at room temperature but is suspended in fluid milk by the process of homogenization. Although saturated and trans fatty acids are components of many foods, solid fats are foods themselves or ingredients. The purpose for discussing solid fats in addition to saturated and trans fatty acids is that, apart from the effects of saturated and trans fatty acids on cardiovascular disease risk, solid fats are abundant in the diets of Americans and contribute significantly to excess calorie intake. Solid fats contribute an average of 19 percent of the total calories in American diets, but few essential nutrients and no dietary fiber. Some major food sources of solid fats in the American diet are grain-based desserts (11% of all solid fat intake); pizza (9%); regular (full-fat) cheese (8%); sausage, franks, bacon, and ribs (7%); and fried white potatoes (5%) (Figure 3-5). In addition to being a major contributor of solid fats, moderate evidence suggests an association between the increased intake of processed meats. Reducing these sources of excess solid fats in the diet will result in reduced intake of saturated fatty acids, trans fatty acids, and calories. Added sugars Sugars are found naturally in fruits (fructose) and fluid milk and milk products (lactose). The majority of sugars in typical American diets are sugars added to foods during processing, preparation, or at the table. These "added sugars" sweeten the flavor of foods and beverages and improve their palatability. They also are added to foods for preservation purposes and to provide functional attributes, such as viscosity, texture, body, and browning capacity. In contrast, many foods that contain added sugars often supply calories, but few or no essential nutrients and no dietary fiber. Both naturally occurring sugars and added sugars increase the risk of dental caries. Added sugars contribute an average of 16 percent of the total calories in American diets. Added sugars include high fructose corn syrup, white sugar, brown sugar, corn syrup, corn syrup solids, raw sugar, malt syrup, maple syrup, pancake syrup, fructose sweetener, liquid fructose, honey, molasses, anhydrous dextrose, and crystal dextrose. Reducing the consumption of these sources of added sugars will lower the calorie content of the diet, without compromising its nutrient adequacy. Sweetened foods and beverages can be replaced with those that have no or are low in added sugars. For example, sweetened beverages can be replaced with water and unsweetened beverages. Why calories from solid fats and added sugars are a particular concern Solid fats and added sugars are consumed in excessive amounts, and their intake should be limited. Together, they contribute a substantial portion of the calories consumed by Americans-35 percent on average, or nearly 800 calories per day-without contributing 54. Foods containing solid fats and added sugars are no more likely to contribute to weight gain than any other source of calories in an eating pattern that is within calorie limits.

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See also Behavioral change interventions Cognitive impairment in adults antibiotic ointment for stye buy noroxin amex, 27-28 infection from bug bite buy noroxin 400 mg fast delivery, 104-105 non prescription antibiotics for acne buy discount noroxin 400mg on-line, 331 breast cancer and, 27-28, 104-105 in children, 27, 105-106 effectiveness of services, 104-106, 331 emotional distress/mental illness and, 5, 58-59 services to address, 10, 82, 104-106, 264-265 Collaborative care model, 204-205 Collaborative Care of Depression, 156 Collocation and integration of services, 158, 190, 195 n. See Patient­provider communication Communities effects of failure to address psychosocial needs of patients on, 67, 68 Copyright National Academy of Sciences. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs 1 Community Cancer Centers Pilot Program, 195, 198, 403 Community care, 6, 44, 374 Community Tracking Study Household Survey, 35 Comprehensive Breast Cancer program, 168 n. See Informational support; Patient and family education Education and training in biopsychosocial approaches. See also specific types of proiders accreditation and licensure standards, 283, 289-290, 291-292, 297, 298, 301-302, 304-305, 308, 311-312 barriers to, 40-41, 308, 310-319 communication skills, 163-164, 311, 315, 317-318 core competencies, 290-291, 297, 299, 307-308, 311-316, 319-320 current practice environment and, 310-311 faculty needs, 316 gender, ethnic, and behavioral considerations, 292 interactive, multicomponent program, 318 interdisciplinary, experiential, statewide program, 318-319 learning collaborative, 319 Copyright National Academy of Sciences. See also Coping skills; Depression; Psychological stress and cognitive impairment, 5, 28, 58-59 economic costs of, 68 effects on cancer patients, 56-60 financial pressures and, 56 and health behavior, 3, 5, 57-58 insurance coverage, 261-267 and motivation, 5, 59-60 needs and services, 10 physical stressors and, 24-25 screening for, 168 and somatic problems, 5, 24-25, 28, 5660, 94 Emotional support. See also Peer support programs; Psychotherapy and counseling beneficial effects, 8, 53, 54, 66, 88-95, 107 competency of providers, 314 counseling and psychotherapy, 10, 91-94 defined, 53 effectiveness of services, 7, 81, 88-95, 154, 191, 196, 204, 206, 332-333 for families and caregivers, 106, 107 formal services, 92, 93, 94, 158, 231 free services, 125-132 health services, 82, 83, 241 informal sources, 83, 90, 261 information resources, 114, 115, 125-132 pharmacological therapies, 10, 94-95 remote providers, 229, 232-233, 235 Employee Assistance Programs, 249 Employment changes, 3, 10, 29, 33, 34, 35, 36-37, 39, 57, 67-68, 82, 114, 314, 359, 365, 375, 383, 385 Empowering Older People to Take Control of Their Health Through EvidenceBased Prevention Programs, 96 n. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs 1 fertileHope, 111 Financial stress. See also Adherence to treatment regimens; Behavioral change interventions; Diet and nutrition; Exercise/physical activity coping skills and, 60 depression and, 5, 37, 52, 57, 58, 59, 204 financial stress and, 34, 55 screening for, 168 self-efficacy and, 38, 59, 66, 87 Health care providers. See also Education and training in biopsychosocial approaches; Workforce; specific types of proiders information resources for, 115 knowledge of psychosocial resources, 5-6, 7, 11 recommendations for, 10-11, 237 Health insurance. See also Reimbursement policies absent or inadequate coverage, 3, 4, 34, 37, 55-56, 237, 261-267 and access to care, 261-268 accreditation standards, 268 capitated payment, 257 and delay in treatment, 34 and emotional/physical well-being, 56 I I Can Cope Program, 119 Illness self-management case management and, 192-193 definitions, 84, 95, 195, 357-358 effective models of care delivery, 96-97, 155-157, 201, 202, 204, 205, 221, 223, 224, 313, 376 Copyright National Academy of Sciences. See Employment changes; Financial stress Individual Cancer Assistance Network, 318 Individuals with Disabilities Education Act, 107, 265 Information and Support Needs Questionnaire, 186-187, 189 Information Needs Measure, 180-181, 189 Informational support. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs 20 Long-term care, 201 Look Good. See also Reimbursement policies assistance in negotiating care from, 135 care coordination program, 172, 191, 257-258, 259 Care Management for High-Cost Beneficiaries, 259 claims paid, 253 coverage for psychosocial services, 13, 17, 35 n. See also Counselors; Psychologists education and training, 303-309 workforce supply, 288 Mental illness. See Illness self-management Management of psychosocial stressors health care system deficits, 40-42 information and education deficits, 37-38 knowledge and skills of health professionals and, 37-38 logistical resources, 39-40 obstacles to, 37-42 Mastery, 52, 107 Material and logistical resources, 7, 10, 82, 102-103, 137, 168, 194, 227. See also indiidual organizations Patient and Caregiver Education program, 113 Patient and family education. See also Informational support free services, 119-125, 229 interventions, 10, 87, 89, 97, 10, 106, 194, 227, 232, 234 monitoring progress in, 16-17, 339 providers, 220 recommendations, 11, 237-238 reimbursement policies, 248 Patient and Liaison Services, 115 Patient Care Monitor, 166, 169, 170, 224, 334 Patient Health Questionnaire, 167, 168 n. See Informational support Patient Information Need Questionnaire, 178-179, 189 Patient Navigation Research Program, 194-195 Patient Needs Assessment Tool, 176-177, 188 Patient­provider communication. See also Decision making on treatment barriers to, 40-41 coached care, 162 cross-cultural, 244-245, 315 current, 160-161 and depression, 161, 315 effective model for, 159-164 and illness self-management, 37, 97 importance, 161-162 interactive videos, 162-163 interventions to improve, 97, 114, 162163, 243-245 key aspects, 159-160 needs assessment and, 172 passive patients, 161 performance measures, 272 policy support, 243-245, 248-249 poor or lack of, 3-4, 5, 37, 38, 40 promoting behavioral change, 98, 99 remote resources, 230, 231 research needs, 161, 333 training providers in, 163-164, 311, 315, 317-318 2 Pediatric cancer patients. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs 2 recommendations, 13, 17-18, 277-278 reimbursement linked to, 12, 242 Personal care services, 10, 82, 104, 230, 236, 262-263, 364 Personal health records, 198 Pew Health Professions Commission, 297 Pharmacotherapies, 94-95, 105, 114, 227, 262-263, 268, 271, 332-333 Phone Buddy Program, 129 Physical stressors, cancer-induced. See also Patient­provider communication continuing education and certification, 18, 164, 296 family medicine, 294 graduate medical education, 164, 293-296 internal medicine and oncology subspecialty, 293-294 medical licensure, 291-292 pediatric training programs, 294-295 psychiatry residency program, 295-296 supply, by specialty, 284-285 undergraduate medical education, 289-291 Picker Institute, 321 Planet Cancer, 115, 130, 232 Policy supports and constraints. See also Performance measurement; Reimbursement policies for availability of services, 260-268 on identifying psychosocial needs, 249-253 information resources on, 115 for interventions, 246-259 on patient­provider communication, 243-245, 248-249 on self-management of illness, 258-259 Post-traumatic stress disorder, 3, 30, 31, 54, 56, 95, 167, 168 n. See also Emotional distress and mental illness adherence to treatment regimen and, 59, 63 n. See also Collocation and integration of services; Delivery of psychosocial health services; Effectiveness research; Psychosocial interventions; indiidual serices availability, 7-8, 81-83, 108-138, 260261, 262-267, 379-380 deficiencies, 5-6 definition, 9, 43-44, 69, 82-83, 359-360 diversity, 82-83 evidence of, effectiveness 7, 81, 85-108 examples of needs and services, 10 free programs, 118-138 importance, 8-9, 66, 68-69 interventions to secure services, 69; See also Care/system navigators; Case management; Referral for psychosocial services; Screening psychosocial problems provider knowledge and attitudes about, 5-6, 7, 11, 40, 41 utilization rates, 190 workforce shortages and maldistribution, 41 Psychosocial interventions. See also Care coordination; Needs assessment; Referral for psychosocial services; Screening psychosocial problems common components, 7 constraints on, 242-259 defined, 9, 354-355 informational, see Informational support needs, 82 Psychosocial Needs Inventory, 178-179, 188 Psychosocial Screen for Cancer, 170-171 Psychosocial services, defined, 9, 84, 354 Psychosocial stressors, 2. See also Emotional distress and mental illness; Psychological stress; Social problems effects on community, 67-68 effects on families, 67 effects on patients, 53-60 obstacles to managing, 37-42 physical, 3, 4-5, 26-29 Psychosocial support, defined, 354 Psychosomatic medicine, 13, 268, 276, 291, 295, 313 Psychotherapy and counseling. See also Peer support programs availability, 118, 262-263 2 child and adolescent, 88 n. See also Performance measurement Quality of Cancer Care Initiative, 200 Quality of care.

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In addition to narrow spectrum antibiotics for sinus infection noroxin 400mg on line the direct effects of violence on health antibiotic for strep throat buy 400 mg noroxin visa, community-level exposure to infection under tooth order noroxin online now violence has been linked to chronic health problems that include asthma, heart disease, ulcers, diabetes and lung disease i For this reason, crime and safety are important public health issues, and an overview of crime and safety information for Durham County from 2014-2016 is presented in this section. After several years of declines in both violent and property crimes, total violent crimes in Durham increased during the period between 2014 and 2016. From 2007 to 2016, violent crimes per 100, 000 residents increased by 21%, from 740 in 2007 to 895 in 2016. Aggravated Assaults, Durham County, 2007-2016 1500 1000 500 0 820 1336 1247 836 656 693 696 755 886 1090 2007 2008 2009 2010 2011 2012 2013 2014 ixxxi 2015 2016 Figure 4. Gang Activity and Crime According to the Gang Crime Report, which reviewed gang-involved crime between 2009 and 2016, there are close to 2, 000 indexed gang members in Durham. Percentage of Gang Involvement in Homicides, Durham County, 2014 ­ 2016 Year 2014 2015 2016 Total Homicides 22 37 43 # gang involved 13 12 33 % 59. During 2015, 24% of middle school and 16% of high students reported carrying a weapon during the past month (defined as gun, knife or club). The percentage of high school students reporting that they had carried a weapon decreased by 33% between 2013 and 2015. Approximately 4% of high school students surveyed had carried a weapon at school during the past 30 days. This represents a 75% reduction in the percent of high school students who reported that they had carried a weapon at school in 2013, down from 16%. During 2015, 30% of middle school students and 49% of high school students surveyed reported the presence of gang activity in their school. Current Initiatives & Activities Bull City United Implemented in November, 2016, this program uses the evidence-based Cure Violence strategy, a public health model that works to reduce shootings and killings in two specific Durham neighborhoods. Two target areas for this initiative were chosen based on an analysis per capita violence in Durham census tracts (McDougald Terrace and Southside communities). Bull City United team members rely on their experiences and relationships to serve as trusted messengers who connect with high risk individuals in order to resolve conflicts and promote peace. Program, an intervention program for youth ages 11-15 that introduces them to the criminal justice system and engages them with a mentor. These factors help to reduce the risk of heart disease, cancer, type 2 diabetes, obesity, osteoporosis and depression or anxiety. The guidelines for adults provide recommendations for both aerobic and muscle-strengthening activities: 150 minutes of moderateor 75 minutes of vigorous intensity aerobic activity per week and strengthening activities on two or more days per week. Primary Data 2016 Durham County Community Health Opinion Survey When asked about specific types of exercise, both the full county and the Hispanic and Latino neighborhood samples reported that structural changes such as better lighting, sidewalks, and crosswalks in addition to more trails, bike lanes, and groups/programs would make them want to walk or bike more. Improvements Needed to Increase Walking Ranked by County Residents, Durham, 2016 Better lighting, sidewalks, crosswalks More trails Walking group/program Reducing crime Not interested Enforcement of traffic rules Other More curb ramps Better health* Nothing-already walk* Time* Motivation* Refused 0% 39. Twenty-seven percent of the Hispanic and Latino neighborhood sample met the recommendation for 150 minutes of moderate-intensity activity per week compared to 61. Despite the substantial difference in physical activity reported between the two samples, the data should be interpreted with caution due to the potential for recall bias. Many respondents had difficulty estimating their average physical activity per week, which may have biased the results of the question. Any real differences between the two samples may stem from a lack of access to exercise facilities among the Hispanic and Latino community compared to the full county sample. One-third of residents do not feel safe walking alone in their neighborhood during the day or at night. Satisfaction has also decreased in the condition of neighborhood streets (59% to 51%), the condition of parks (61% to 51%), and the condition of neighborhood sidewalks (44% to 42%). According to the walkability result, Durham is a car-dependent city and has minimal bike infrastructure. Schools are ideal settings for children to get the recommended amount of physical activity. The increase in teen activities was identified as one of the services needing the most improvement in the community (17.

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