["Let's put our nursing values and ideals back at the center!"] / « Remettons nos valeurs et idéaux infirmiers au centre ! ¼.

Professor Emerita of Nursing at the University of Connecticut and Editor Emerita of Advances in Nursing Science, Peggy L. Chinn has worked for many years on issues relating to the processes to develop theories. In particular, she has devoted herself to studying the conceptual and philosophical foundations of nursing as a distinct discipline.

Preventing early harsh parenting and toddler behavior problems: The role of neighborhood collective efficacy among low-income Latine families.

Harsh parenting behaviors are alarmingly prevalent during infancy and toddlerhood. From an ecological perspective, predicting and preventing harsh parenting requires probing not only micro- and exosystem-level processes but also the interactions among them. In the current longitudinal study, we examined associations among maternal depressive symptoms, harsh parenting, and neighborhood collective efficacy in 142 low-income Latina mothers and their infants (Mchild age = 14.11 months, SD = 3.60). We hypothesized that there would be a mediated pathway from maternal depressive symptoms to harsh parenting to toddler behavior problems, and that neighborhood collective efficacy would moderate this pathway. As predicted, maternal depressive symptoms predicted toddler behavior problems, and harsh parenting significantly mediated this association. Moreover, neighborhood collective efficacy was a significant moderator such that this indirect pathway was maintained in the context of low neighborhood collective efficacy only. When collective efficacy was high, this pathway was not significant. Results are discussed in terms of the buffering potential of neighborhood collective efficacy. Tentative implications for leveraging neighborhood supports to prevent early harsh parenting are suggested.

Las duras conductas de crianza son alarmantemente prevalentes durante la infancia y la primera etapa de la niñez. Desde una perspectiva ecológica, predecir y prevenir la dura crianza requiere investigar no sólo los procesos de micro niveles y niveles de exosistemas, sino también las interacciones entre ellos. En el presente estudio longitudinal, examinamos las asociaciones entre los síntomas depresivos maternos, la dura crianza y la colectiva efectividad del vecindario en 142 mujeres latinas de bajos recursos económicos y sus infantes (M edad del niño = 14.11 meses, SD = 3.60). Nuestra hipótesis fue que habría un camino mediador entre los síntomas depresivos maternos y la dura crianza y los problemas de conducta del pequeño infante, y que la efectividad colectiva del vecindario moderaría este camino. Tal como se predijo, los síntomas depresivos maternos predijeron los problemas de conducta de los pequeños infantes, y la dura crianza significativamente medió esta asociación. Es más, la efectividad colectiva del vecindario fue un moderador significativo, de tal manera que este indirecto camino se mantuvo sólo dentro del contexto de la baja efectividad colectiva del vecindario. Cuando la efectividad colectiva fue alta, este camino no fue significativo. Los resultados se discuten en términos de la potencialidad amortiguadora de la efectividad colectiva del vecindario. Se sugieren tentativas implicaciones para la nivelación de los apoyos del vecindario para prevenir una temprana dura crianza.

Des comportements de parentage durs sont extrêmement prévalents durant la petite enfance (bébés et jeunes enfants). D'une perspective écologique, prédire et prévenir le parentage dur exige un examen non seulement des processus au niveau du microsystème et de l'exosystème mais aussi des interactions entre ces systèmes. Dans cette étude longitudinale nous avons examiné les liens entre les symptômes dépressifs maternels, le parentage dure et l'efficacité collective du voisinage chez 142 mères hispaniques ayant de faibles revenus et leurs bébés (M âge de l'enfant = 14,11 mois, SD = 3,60). Nous avons pris comme hypothèse qu'il y aurait une voie de médiation des symptômes dépressifs maternels au parentage dur et aux problèmes de comportement du petit enfant, et que l'efficacité collective du voisinage modérerait cette voie. Comme on l'avait prédit les symptômes dépressifs maternels ont prédit les problèmes de comportement du petit enfant, et le parentage dur a médiatisé ce lien. De plus, l'efficacité collective du voisinage s'est avéré être un modérateur important, à un tel point que cette voie indirecte était maintenue dans le contexte d'une efficacité collective de voisinage même faible. Quand l'efficacité collective était élevée cette voie n'était pas importante. Les résultats sont discutés en termes de potentiel de mise en tampon de l'efficacité collective du voisinage. De possibles implications pour tirer partie des soutiens des voisinages afin de prévenir un parentage dur précoce sont suggérées.

Exploring the feasibility of validating early developmental screening tools for American Indian and Alaska Native children.

Screening children from birth through age 5 is critical to early identification of challenges and referral to intervention to support optimal development. Screening of American Indian and Alaska Native (AIAN) children lags behind that of other children, partly due to the lack of screening tools validated for this population. This study tested the feasibility of an online data collection strategy for use in a future study of the validity of existing screening instruments for AIAN children. Parents of AIAN children in four communities were recruited to complete screeners, provide demographic information, and provide feedback on experiences with online data collection. Participants were given the option of receiving screening results from the local early childhood program through which they were recruited. 240 participants began the process, 183 were enrolled in a partner program and reported a birthdate for at least one AIAN child, 157 had an age-eligible child, 81 began the consent process, 62 consented, and 39 fully completed data collection. Most participants were female and AIAN, the majority reported that online data collection was easy. Collecting screener validation data on a large sample of AIAN children may be able to utilize online data collection tools, with in-person support to facilitate participation.

Un examen de detección en los niños a partir del nacimiento hasta la edad de 5 años es esencial para la temprana identificación de retos y la referencia a intervenciones como apoyo a un desarrollo óptimo. El examen de detección en el caso de niños del grupo Indio Americano y Nativo de Alaska (AIAN) está muy por debajo del de otros niños, en parte debido a la falta de herramientas de detección validadas para esta población. Este estudio puso a prueba la posibilidad de una estrategia electrónica de recolección de datos para uso en un estudio futuro acerca de la validez de los existentes instrumentos de detección para niños AIAN. Se reclutaron progenitores de niños AIAN en cuatro comunidades para completar los exámenes de detección, proveer información demográfica, así como proveer información sobre las experiencias con la recolección electrónica de datos. A los participantes se les dio la opción de recibir los resultados de la detección de parte del programa local para la temprana niñez a través del cual habían sido reclutados. 240 participantes comenzaron el proceso; 183 estaban matriculados en un programa paralelo y reportaron la fecha de nacimiento de por lo menos un niño AIAN; 157 tenían un niño elegible según la edad; 81 comenzaron el proceso de consentimiento; 62 consintieron; 39 completaron en su totalidad la recolección de datos. La mayoría de los participantes eran mujeres y AIAN; la mayoría reportó que la recolección electrónica de datos fue fácil. La recolección de información de validación de la detección en un grupo muestra grande de niños AIAN pudiera ser capaz de utilizar herramientas electrónicas de recolección de datos, con un apoyo presencial para facilitar la participación.

Le dépistage des enfants de la naissance à l'âge de 5 ans est critique pour l'identification précoce des défis et problèmes et l'orientation vers l'intervention afin de soutenir le développement optimal. Le dépistage des enfants d'amérindiens des Etats-Unis et des autochtones d'Alaska est en retard par rapport à celui des autres enfants, en partie du fait du manque d'outils de dépistage validés pour cette population. Cette étude a testé la fiabilité de la stratégie de collecte de données en ligne pour son utilisation pour une étude à venir sur la validité d'instruments de dépistage existants pour les enfants AIAN. Les parents d'enfants AIAN de quatre communautés ont été recrutés afin de remplir des dépistages, d'offrir des renseignements démographiques, et d'offrir des commentaires sur les expériences de collecte de données en ligne. Les participants ont reçu l'option de recevoir les résultats de dépistage d'un programme de petite enfance local au travers duquel ils avaient été recrutés. 240 participants ont commencé le processus. 183 ont été inscrits dans un programme partenaire et ont fait état de la date de naissance d'au moins un enfant AIAN. 157 avait un enfant admissible par l'âge. 81 ont commencé le processus de consentement. 62 ont consenti. 39 ont fini la collecte de données en ligne. La collecte de données de validation du filtre de recherche sur un grand échantillon d'enfants AIAN pourrait utiliser des outils de collecte de données en ligne avec un soutien en personne afin de faciliter la participation.

Community perspectives on developmental screening of American Indian and Alaska Native children.

Children are highly regarded and treasured as the future of American Indian and Alaska Native (AIAN) communities. Developmental disorders, however, are more frequently undiagnosed and untreated in AIAN children compared to others in the United States. Developmental screening can help communities ensure that their children reach their full potential, but lack of culturally sensitive and valid screening measures complicates screening among AIAN children. This can, in turn, delay access to early intervention and undermine the ability of AIAN communities to support children's optimal development. This study explored families' and professionals' perceptions of screening systems and processes in AIAN communities and to identify gaps and opportunities. A total of 53 interviews and 23 focus groups were conducted with 157 parents and early childcare professionals in four AIAN communities. A conceptual framework to describe systems of screening for young children was developed by AIAN early childhood program partners and early childhood researchers working together on a Tribal Early Childhood Research Center Community of Learning; this framework guided study design and interview guides. Transcripts were coded for themes in alignment with the conceptual framework; 13 key themes and 81 subthemes were identified. Findings are discussed in terms of implications for enhancing screening efforts in Tribal communities.

Los niños son altamente considerados y apreciados como el futuro de las comunidades de Indios Americanos y Nativos de Alaska (AIAN). Los trastornos en el desarrollo, sin embargo, no son diagnosticados ni tratados a una frecuencia más alta que en el caso de otros en los Estados Unidos. La detección en cuanto al desarrollo puede ayudar a las comunidades a asegurar que sus niños logran su completo potencial, pero la falta de sensibilidad cultural y de válidas medidas de detección complica el proceso de detección entre niños AIAN. Esto puede, a la vez, retrasar el acceso a la temprana intervención y quebrantar la habilidad de las comunidades AIAN de apoyar el óptimo desarrollo de los niños. Este estudio exploró las percepciones que las familias y los profesionales tienen de los sistemas y procesos de detección en comunidades AIAN para identificar vacíos y oportunidades. 53 entrevistas y 23 grupos de enfoque se llevaron a cabo con 157 progenitores y profesionales del temprano cuidado infantil en cuatro comunidades AIAN. Se desarrolló un marco de trabajo conceptual para describir los sistemas de detección para niños pequeños por parte de los asociados de un programa AIAN de temprana niñez e investigadores de la temprana niñez que trabajaban en conjunto en un Centro Tribal Investigativo de la Temprana Niñez y Comunidad de Aprendizaje; este marco de trabajo marcó las pautas para el diseño del estudio y las guías de entrevista. Se codificaron las transcripciones por temas en alineamiento con el marco de trabajo conceptual; se identificaron 13 temas claves y 81 subtemas. Los resultados se discuten en términos de las implicaciones para mejorar los esfuerzos de detección en comunidades tribales.

Les enfants sont tenus en haute estime et précieux puisqu'ils sont l'avenir des communautés d'amérindiens des Etats-Unis et des autochtones d'Alaska (abrégé en anglaise AIAN). Cependant les troubles de comportement restent plus fréquemment non diagnostiqués et non traités chez les enfants AIAN que chez les autres enfants aux Etats-Unis. Le dépistage comportemental peut aider les communautés à s'assurer que leurs enfants atteignent leur plein potentiel mais le manque de mesures de dépistage culturellement adaptées et valides complique le dépistage chez les enfants AIAN. En retour cela peut retarder l'accès à une intervention précoce et compromettre la capacité des communautés AIAM à soutenir le développement optimal des enfants. Cette étude a exploré les perceptions des familles et des professionnels des systèmes de dépistage et des processus dans les communautés AIAN dans le but d'identifier les écarts et les opportunités. 53 entretiens et 23 groupes de discussion ont été organisés avec 157 parents et professionnels de garderies d'enfants dans quatre communautés AIAN. Un cadre conceptuel pour décrire les systèmes de dépistage pour les jeunes enfants a été développé par les partenaires de programmes de la petite enfance et des chercheurs sur la petite enfance travaillant ensemble dans le cadre d'une communauté d'apprentissage du Centre de Recherche sur la Petite Enfance Tribale. Ce cadre a guidé le plan d'étude et les guides de l'entretien. Les transcriptions ont été codées pour des thèmes se conformant au cadre conceptuel et 13 thèmes clés ainsi que 81 sous-thèmes ont été identifiés. Les résultats sont discutés dans le contexte des implications pour l'amélioration des efforts de dépistages dans les communautés tribales.

[American ambitions for the nursing profession]. / Les ambitions américaines pour la profession infirmière.

There are more than four million nurses in the United States. In a context marked by the Obamacare vote and by an awareness of the underutilization of nursing potential, the Robert Wood Johnson Foundation, in association with the Institute of Medicine, published an inventory of the nursing situation in the United States in 2011, along with an action plan. In 2016 and 2021, the evaluation of the degree to which these objectives were achieved revealed numerous advances. New strategic directions have been set for the period 2020-2030.

[From Nancy to Dallas, travel diary of a French nurse in the United States]. / Carnet de voyage d'une infirmière française aux États-Unis.

Registered nurse since 2012, Victoire worked for a few years in France, in hand and orthopedic surgery, as well as in Belgium, in oncology. At the end of 2016, she followed her husband who left for a professional opportunity in Dallas, USA. With strength and determination, she went through all the steps to obtain her registered nurse title and practice her profession there. Experience sharing.

A filosofia e as humanidades na formação universitária / Philosophy and humanities in university formation

A entrevista aborda temas como a importância da filosofia e das ciências humanas na formação universitária. A partir de um resgate da trajetória do professor Sérgio Schaefer na Universidade de Santa Cruz do Sul, na condição de professor de Filosofia, a entrevista levanta questões sobre a experiência de construção de uma universidade comunitária, das lutas pelo reconhecimento de espaços de formação para a filosofia e para as ciências humanas nas diferentes áreas do conhecimento, sobre os desafios colocados em tempos de transformações tecnológicas e de afirmação de caminhos pragmáticos no campo da educação para o pensar e o fazer filosofia na Universidade.(AU)

The interview addresses topics such as the importance of philosophy and the humanities in university education. Based on a retrieval of the trajectory of Professor Sérgio Schaefer at the University of Santa Cruz do Sul, as a professor of Philosophy, the interview raises questions about the experience of building a community university, the struggles for the recognition of training spaces for the philosophy and human sciences in different areas of knowledge, about the challenges posed in times of technological changes and the affirmation of pragmatic paths in the field of education for thinking and doing philosophy at the University.(AU)

"Snips and Snails and Puppy Dog Tails": Boys and Behaviour in the USA.

In The Adventures of Tom Sawyer and Huckleberry Finn, Mark Twain introduced two of the most iconic boys in American literature. Tom and Huck become heroic figures, despite their penchant for bad behaviour. Indeed, it is their propensity to be impulsive, break rules and defy authority that win them the day. Today, however, Tom Sawyer and Huck Finn have become the posterboys for a psychiatric disorder, Attention Deficit Hyperactivity Disorder, or ADHD. I trace how and why attitudes about pathological boys' behaviour reversed during the twentieth century, from a focus on shy, introverted, and physically passive boys to the very opposite - boys like Tom and Huck. I argue that, rather than imposing limits on childhood behaviour, we should be more accepting and encouraging of all types of children.

Despite Being "Known, Highly Promiscuous and Active": Presumed Heterosexuality in the USPHS's STD Inoculation Study, 1946-48.

The Sexually Transmitted Disease Inoculation Study of the United States Public Health Service (USPHS) was a short-term deliberate exposure experiment into the prevention of venereal diseases. Between 1946 and 1948, over 1,300 Guatemalan prisoners, psychiatric patients, soldiers, and sex workers were exposed to syphilis, gonorrhoea, and chancroid. USPHS researchers initially proposed hiring sex workers to "naturally" transmit venereal diseases to male subjects who would then be given various prophylaxes. The researchers were interested in studying the effectiveness of new preventative measures. In other words, the USPHS study was designed to transmit venereal diseases heterosexually from an "infected" female body to the men who, it was assumed, were sexually isolated subjects. However, the researchers did record instances of male-to-male disease transmission among their subject populations, instances that challenged the presumption of heterosexuality on which the study was based.

What drives intentional overdose with non-prescription drugs? A cross-sectional study.

BACKGROUND: Use of overdosage of Non-Prescription Drugs (NPD) among university students is a serious public health issue. However, there are no extensive studies that measured the prevalence of taking more than the recommended dose of NPD and/or identified the risk associated with this behavior among university students. OBJECTIVES: This study was undertaken to assess the prevalence and associated risks of self-overdosage with NPDs in university students in United Arab Emirates (UAE). METHODS: A cross-sectional survey-based study was conducted from January to April 2014, among 2875 students in three randomly selected universities. A structured and validated questionnaire was used to collect the responses of the students. SPSS version 20 was used to analyze the data. RESULTS: Out of 2875 students, only 2355 surveys were fully answered, returned back and included in the present study. Of 2355, more than half (1348; 57.2%) the participants reported using Oral NPD (ONPD) in the past 90 days before conducting the study and were asked to complete the survey. Only 290 (22%) of a total 1348 participants reported taking more than the recommended dose of ONPD in the previous three months before conducting the study. Analgesic/antipyretic (223, 16.5%) and anti-allergic (67, 4.9%) drugs were more than other classes of the ONPD, reported to be taken in a dose, more than the recommended dosage. The most common justifications for taking more than the recommended dose of ONPD among respondents were severe symptoms (6%), the belief that the recommended dose would not be sufficient to relieve the symptom (5%), the belief that a stronger dose would relieve the symptoms faster (11%), and previous experience (4%). Our results identified three risk factors for taking more than the recommended dose of NPD. High frequently drug-users of daily use (OR=3.494, 95% CI: 1.677-7.279) (P<0.001), and students from non-medical colleges had higher odds of taking more than the recommended dosage as compared to students from medical colleges (OR=1.486, 95% CI: 1.060-2.085, P-value<0.05). Furthermore\re, participants with a poly-pharmacy behavior had higher odds of taking overdosage of ONPD than single NPD users (OR=1.918, 95% CI: 1.440-2.555) (P<0.001). CONCLUSION: There are a sizable proportion of university students that use overdosage of NPD, but it is more serious issue when it comes to non-medical student. There is a need for educational programs designed to increase awareness among all university students and to motivate them not to use overdosage of NPD. Further studies are also required to investigate additional explanatory variables that could influence the practice of overdosage with NPD.

An overview of EU and USA intestinal transplant current activity.

AIM OF THE STUDY: To report the current activity of intestinal transplantation in Europe (EU) and Unites States of America (USA), underlining outcomes in the last 5 years and discussing possible trends. PATIENTS AND METHODS: Data review of results was performed through analysis of ITR and UNOS registries, Eurotransplant and newsletter transplant reports, congress abstracts, international published literature, personal communications and hospital web sites. RESULTS: The absence in Europe of a sole organization collecting donors and the presence of many low-volume centers (less than 5 cases/year) makes the difference with USA: in the last 5 years (2010-2014), 222 intestinal/multivisceral transplants have been performed in EU countries (most of them in the UK), while in USA, the number of transplants achieved 634 procedures in the same period of time. Waiting list mortality remains unacceptable in both continents. Improved short-term results, with over 80% survival at 1 year, have been achieved in the busiest transplant centers likely due to immune-induction agents, more recently to innovative cross match strategies and optimizing organ allocation, but long term outcomes are still inferior to other organ transplants. Most long-term survivors were reintegrated to society with self-sustained socioeconomic status. The economic burden for the society is high and related costs are different between USA and EU (and inside Europe between member state's health-care systems), but cost-effectiveness for intestinal transplantation still needs to be proved. CONCLUSION: Overall intestinal transplantation continues to develop in EU and USA together with surgical and medical rehabilitation of patients affected by short gut syndrome.

Links between law enforcement and veterinary animal health: a case study of the United Kingdom and the United States of America.

The anthrax attacks carried out in the United States of America in the latter part of 2001 served as a clarion call to most law enforcement agencies among developed countries as, until this time, they had not recognised the threat posed by the criminal use of pathogens and/or toxins. Law enforcement agencies include the local and federal police, Customs, Immigration and any other agencies that perform a law-enforcing role. That a criminal or terrorist group could commit such an act was considered nearly inconceivable, even though biological weapons had been used against humans and animals in warfare many times over the last several hundred years. Similarly, it is without doubt that the terrorist threat to all societies changed after the events of 11 September 2001 during which the clear intention had been to cause as many fatalities and casualties as possible. As a result, the biological threat to human health became a focus for many governments.

Les attaques à la fièvre charbonneuse perpétrés aux États-Unis d'Amérique à la fin de l'année 2001 ont lancé un signal d'alerte à la plupart des agences chargées de l'application des lois des pays développés, qui n'avaient jusqu'alors pas pris conscience des menaces posées par l'utilisation criminelle des agents pathogènes et/ou des toxines. Les agences chargées de l'application des lois sont notamment les forces de police locales et fédérales, les services des douanes, les services d'immigration et toute autre agence gouvernementale chargée du maintien de l'ordre et de la justice. Il était pratiquement inconcevable qu'un groupe criminel ou terroriste puisse commettre un tel acte, même si des armes biologiques avaient déjà été utilisées contre les populations humaines et animales au cours de certains conflits armés des siècles précédents. De même, il va sans dire que la menace terroriste pesant sur les sociétés dans leur ensemble a pris un nouveau visage après les événements du 11 septembre 2001, dont le but était clairement de faire le plus de victimes possible et de tuer le plus grand nombre de personnes possible. En conséquence, la menace biologique pesant sur la santé publique est devenue un domaine central d'attention pour nombre de gouvernements.

Los ataques con la bacteria del carbunco perpetrados en los Estados Unidos de América a finales de 2001 marcaron un antes y un después para la mayoría de los cuerpos de seguridad de los países desarrollados, que hasta la fecha no habían advertido la amenaza que planteaba el uso de patógenos y/o toxinas con fines criminales. Forman parte de los cuerpos de seguridad las fuerzas de policía local y federal, los cuerpos de aduanas, inmigración y demás instituciones cuya función consiste en velar por el cumplimiento de la ley. Que un grupo delictivo o terrorista pudiera cometer semejante acto era algo prácticamente inconcebible, aun cuando en los últimos siglos hayan menudeado los ejemplos de utilización de armas biológicas contra la población humana o animal como instrumento de guerra. Análogamente, no cabe duda alguna de que la amenaza terrorista que planea sobre todas las sociedades cambió a partir de los acontecimientos del 11 de septiembre de 2001, en los que la intención era claramente de causar tantos muertos y heridos como fuera posible. A resultas de aquello, las amenazas biológicas para la salud humana pasaron a ser una de las preocupaciones cardinales de muchos gobiernos.

A brief history of biological weapons programmes and the use of animal pathogens as biological warfare agents.

Any one of thousands of different microorganisms that affect the health and safety of the world's populations of humans, animals and plants could potentially be weaponised; that is undergo research and development whose aim is to create species or strains that could serve as deadly payloads for spray systems, bombs, rockets or missiles. However, many historical studies of warfare have made it clear that only a few species of bacteria and viruses have been weaponised. As is made clear in this paper, of the pathogens weaponised in the 20th century by Japan, the Union of Soviet Socialist Republics (USSR), the United States and Iraq, most were zoonotic pathogens. If a nation or terrorist group were to acquire biological weapons in the future, it is most likely that their payload would be a zoonotic pathogen.

Chacun des milliers de microorganismes différents qui affectent la santé et la sécurité des populations humaines, animales et végétales de la planète peut être transformé en arme biologique, c'est-à-dire faire l'objet de procédures de recherche et développement visant à mettre au point des espèces ou souches destinées à charger des systèmes d'épandage, des bombes, des roquettes ou des missiles à puissance létale. Néanmoins, de nombreuses études historiques sur les armements démontrent que le nombre de bactéries et de virus effectivement militarisés est limité. L'auteur explique que la plupart des agents pathogènes militarisés au cours du xxe siècle par le Japon, l'Union des Républiques soviétiques socialistes (URSS), les États-Unis et l'Irak étaient de nature zoonotique. Si une nation ou un groupe terroriste devait acquérir des armes biologiques à l'avenir, la charge utilisée serait probablement constituée d'agents pathogènes zoonotiques.

En potencia, cualquiera de los miles de microorganismos distintos que afectan a la salud y seguridad de las poblaciones mundiales de humanos, animales o plantas puede ser convertido en un arma, o dicho de otro modo: servir de objeto de investigación y experimentación con el propósito de crear especies o cepas que puedan constituir la carga mortífera de sistemas de vaporización, bombas, cohetes o misiles. Con todo, numerosos estudios de historia de la guerra dejan patente que solo unas pocas especies de virus y bacterias han sido efectivamente transformadas en armas. Como deja claro el autor, la mayoría de los patógenos que en el siglo xx convirtieron en arma el Japón, la Unión de Repúblicas Socialistas Soviéticas (URSS), los Estados Unidos y el Iraq eran zoonóticos. Si en el futuro una nación o un grupo terrorista hubiera de procurarse armas biológicas, lo más probable es que estas estuvieran cargadas con un patógeno zoonótico.

BUILDING CAPACITY IN REFLECTIVE PRACTICE: A TIERED MODEL OF STATEWIDE SUPPORTS FOR LOCAL HOME-VISITING PROGRAMS.

This preliminary study examines an initiative to further develop capacity in reflective practice among public health home visitors and their supervisors. A Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Expansion Grant to the Minnesota Department of Health funded the development of a tiered structure to support reflective practice within county public health agencies throughout the state. Study data revealed a general consensus among individuals at all levels of the county programs that state supports were adequate to implement reflective practice. Although there were no significant changes in home-visitor and supervisor scores on a standardized measure linked to reflective functioning and reflective practice, a majority of home visitors and supervisors perceived that their knowledge and skills in reflective practice had increased during the evaluation period. A standardized measure of employee burnout did not reveal significant changes in either "depersonalization" (indicating burnout) or "personal accomplishment" (a mitigating factor in burnout) subscales; however, home visitor "emotional exhaustion" subscale scores did increase over the evaluation period. In contrast to the subscale results, home visitors reported a sense of accomplishment in their reflective work and that they value "releasing" emotions in a safe environment during reflective supervision.

Value and payment for oncology in the United States.

Rather than focus on reducing prices for innovative biopharmaceuticals, insurers in the United States are changing methods of payment for oncologists in order to moderate the growth in cancer drug expenditures. The desire is for a better pattern of utilization and expenditures without adversely affecting incentives for research and development. After an overview of the contemporary discussions of price and value, this paper describes three initiatives to influence the selection and management of oncology drugs. This includes initiatives to reduce the profit margins earned by oncologists as part of the purchasing of office-infused biopharmaceuticals; "episode-of-care" payments that bundle into a single fee the reimbursement for care management and specialty drugs; and payment methods that case rates for physician care management activities with cost-based reimbursement for the oncology drugs.

Mass administration of the antimalarial drug mefloquine to Guantánamo detainees: a critical analysis.

Recently, evidence has emerged from an unusual form of mass drug administration practised among detainees held at US Naval Station Guantánamo Bay, Cuba ('Guantánamo'), ostensibly as a public health measure. Mefloquine, an antimalarial drug originally developed by the US military, whose use is associated with a range of severe neuropsychiatric adverse effects, was administered at treatment doses to detainees immediately upon their arrival at Guantánamo, prior to laboratory testing for malaria and irrespective of symptoms of disease. In this analysis, the history of mefloquine's development is reviewed and the indications for its administration at treatment doses are discussed. The stated rationale for the use of mefloquine among Guantánamo detainees is then evaluated in the context of accepted forms of population-based malaria control. It is concluded that there was no plausible public health indication for the use of mefloquine at Guantánamo and that based on prevailing standards of care, the clinical indications for its use are decidedly unclear. This analysis suggests the troubling possibility that the use of mefloquine at Guantánamo may have been motivated in part by knowledge of the drug's adverse effects, and points to a critical need for further investigation to resolve unanswered questions regarding the drug's potentially inappropriate use.

Théoriser la violence en Améerique: Retour sur trente ans d'ethnographie.

PHILIPPE BOURGOIS THEORIZING VIOLENCE IN THE AMERICAS A THIRTY-YEAR ETHNOGRAPHIC RETROSPECTIVE: This thirty year retrospective analysis of violence at my fieldwork sites in the Americas (Nicaragua, El Salvador, Costa Rica, Panama, USA) explores the importance and difficulty of recognizing the continuities of violence across historical eras as an ethnographer. Expanding on the continuum of violence concept, I propose the utility of identifying the mutually reinforcing interface of three overlapping categories of invisible violence: structural, symbolic and normalized. If theory is meant to help us see more, then theorizing violence through a continuum of categories of invisibility is useful because it contravenes the political effects of the contemporary hyper-visibility of interpersonal and petty criminal street violence. The increasing global reach of a punitive version of corporate neoliberalism over the past two decades has lumpenized large sectors of the urban and rural poor. Recognizing the links between categories of invisible violence in this globalized context of social inequality explains the demobilization of class-based demands for economic redistribution and populist support for physically repressive forms of governmentality that punish the poor deemed unworthy.