ABSTRACT
People with diabetes often live with other chronic conditions and lead complicated lives. Determining what is the best management decision for a patient requires consideration of each individual's personal, social and biomedical context, what he or she values, the reasons he or she has to value the available options, and the relative contribution of each option in terms of benefits, harms, costs and inconveniences. Empathic conversations between patients and clinicians to diagnose the patient situation that necessitates action and the range of evidence-based actions that best address the situation, so-called shared decision-making, are essential to the personalized care of people with diabetes. The aim of the present review was to present key elements of shared decision-making and propose three different approaches for its application. The first approach focuses on transferring information to patients so that they can make decisions. The second approach, choice, focuses on cultivating the individual's ability to give voice to which choice is best for them. The third approach, conversation, establishes an empathic conversational environment through which the individual with diabetes and their clinician think and talk through how to address the problems of living with diabetes and related illnesses. These approaches are manifest in the design of evidence-based decision aids created to support shared decision-making. In randomized trials, decision aids can efficiently improve patient's knowledge, satisfaction, risk awareness, decisional conflict and involvement. Further research, however, is needed to better understand when and how to promote the empathic conversations, patient, clinician and service and policy contexts necessary to routinely implement shared decision-making in different at scale healthcare systems. In the interim, sufficient evidence and tools exist for persons with diabetes and their clinicians to gain expertise in making decisions together.
Subject(s)
Clinical Decision-Making , Decision Making , Diabetes Mellitus/therapy , Choice Behavior , Decision Support Techniques , Empathy , Forecasting , Health Policy , Humans , Medical Informatics/standards , Pamphlets , Patient Education as Topic/methods , Physician-Patient Relations , Practice Guidelines as Topic , Randomized Controlled Trials as TopicABSTRACT
The present study attempted to assess toxic metal contents (Arsenic, Cadmium, Copper, Cobalt, Chromium, Iron, Manganese, Nickel, Lead and Zinc) in Total Suspended Particulate (TSP) and Particulate Matter less than ten micron (PM10) in three sponge iron industries in Goa (India), one of the famous tourist place on the World map. TSP and PM(10) average concentration in all three sponge iron industries were found to be in the range 401-485 µg/m³ and 135-270 µg/m³ respectively. Amongst all the metals, concentration of iron was the highest in TSP as well as in PM10. Statistical results indicate that proportion of specific metals were found higher in PM10 as compared to the ratio of PM10/TSP ratio. Value of correlation coefficient was found to be significant for Cr-Pb indicating coal burning was the major source contributor.
Subject(s)
Air Pollutants, Occupational/analysis , Iron , Metallurgy , Metals/analysis , Particulate Matter/analysis , Air Pollution, Indoor/analysis , Air Pollution, Indoor/statistics & numerical data , India , Occupational Exposure/analysisABSTRACT
In the present study, the impact of the flyover construction to curb traffic congestion problem has been assessed in terms of traffic decongestion, time saving, fuel saving and emission reduction. A flyover has also been constructed over four signalized junctions in the main commercial area in Nagpur city, India. It was found that about 35% of the total traffic is diverted to the flyover, which results in a reduction of about 32% in the total emission generation. Travel on the flyover resulted in as much as 60-70% saving in time, compared to the travel on the main road, particularly when all the four signals are found to be in the red phase. The loss of fuel for combustion and the associated cost resulting from waiting for the signal to change are also estimated, and these are found to be significant.
Subject(s)
Air Pollutants/adverse effects , Cities , City Planning , Environment , Transportation , Vehicle Emissions/analysis , Air Pollutants/analysis , Gasoline , Humans , India , Motor VehiclesABSTRACT
Air pollution has become a growing problem in megacities and large urban areas through out the globe, and transportation is recognized as the major source of air pollution in many cities, especially in developing countries. Contribution of automobiles is reported in the range of 40 to 80% of the total air pollution. The challenge facing megacities is how to reduce the adverse environmental impacts and other negative effects of transportation without giving up the benefits of mobility. The dilemma becomes most pressing under conditions of rapid urban growth, which is likely to increase travel demand significantly. The paper is aimed at understanding the problem of vehicular pollution vis-a-vis ambient air quality for a highly traffic affected megacity, Delhi, wherein, the contribution of transport sector was estimated to be as high as 72%. An effort has been made to review and evaluate the benefits (in terms of improved air quality) of the technological interventions/policies adopted for vehicular pollution control in Delhi. It also highlights the outcome of the efforts and suggests further improvements thereon. The importance of public participation and awareness are also discussed. The paper focuses on deriving the benefits of the implementation of management strategies, supported by scientific and technical data/interpretation, so that the people can realize and participate in the government's endeavor for clean city drive in a more effective manner.
