Thesis (M.S.)--University of Michigan, 1995.

Thesis (M.S.)--University of Michigan, 1995.

Le redressement des entreprises en difficulté, n’est en réalité possible que si les difficultés n’ont pas atteint des proportions importantes au point d’arriver à une cessation d’activité. Le législateur marocain, conscient de la nécessité de la sauvegarde des entreprises, s’est inspiré de la loi française du 1er mars 1984, afin de mettre en place un dispositif légal organisant des procédures de prévention et de règlement amiable, l’accent est mis sur une transparence à l’insu du dirigeant, invité à une collaboration et un dialogue permanent avec les organes internes, le ou les commissaires aux comptes, les représentants des salariés et les associés, ces derniers sont concernés en premier lieu par l’alerte en interne. Le président du tribunal n’interviendra qu’en externe, si l’action concertée entre le dirigeant et les organes internes n’aboutit pas tant qu’il est encore temps. De nouvelles procédures instituées en France, non judiciaires ou judiciaires à caractère confidentiel, préventif ou curatif, ne débuteront que lorsque l’entreprise connaîtra des difficultés juridiques, économiques et financières, sans pour autant négliger la question essentielle relative aux difficultés des entreprises : « être ou ne pas être » en cessation des paiements / The recovery of companies in difficulty, is actually possible if the difficulties have not reached significant proportions point to a cessation of activity. The Moroccan legislator, aware of the need for safeguarding companies, was inspired by the French law of 1 March 1984, in order to put in place a legal mechanism organizing procedures for prevention and amicable settlement, the focus is on transparency without the knowledge of the leader, invited to a collaboration and a permanent dialogue with the internal organs, the commissioner (s) accounts, the employee representatives and the partners, the latter are concerned in the first place by the internal alert. The president of the tribunal will intervene only externally, if the concerted action between the leader and the internal organs does not succeed as long as there is still time. New procedures established in France, non-judicial or confidential, preventive or curative, will not commence when the company will experience legal, economic difficulties and financial, without neglecting the essential question of business difficulties: "to be or not to be" in cessation of payments

Research indicates that tobacco cessation rates are at least doubled when smokers receive assistance from a clinician; receiving tobacco cessation advice from multiple types of clinicians increases quit rates even further.¹ To address a decades-long deficiency in the tobacco cessation training of health professionals in general, a shared curriculum, Rx for Change: Clinician-Assisted Tobacco Cessation, was developed in 1999 as a collaboration of the schools of pharmacy in California.^2,3 Between 2003 and 2005, pharmacy faculty members (n=191) participated in national train-the-trainer workshops designed to equip faculty with the necessary knowledge and skills to implement the Rx for Change curriculum at their academic institutions.⁴ <div><br></div><div> The studies that comprise this dissertation are a logical extension of this national initiative, applying a mixed-methods approach to: (a) evaluate the long-term impact of training pharmacy faculty using the Rx for Change program, (b) delineate recommendations for developing and disseminating shared curricula for health-care programs, and (c) evaluate utilization of the Rx for Change website, which hosts faculty resources and curricular files for download. In combination, these (along with a previously-conducted qualitative study) provide a comprehensive “view” of the long-term impact of this unique shared curriculum. </div><div><br></div><div>Results from the three studies provided evidence for: (1) reach to the majority of pharmacy institutions, (2) a high level of adoption of the Rx for Change in health professional schools, (3) a positive impact on faculty trainees’ careers and their level of confidence for teaching, precepting clinical students, and assisting tobacco users, (4) implementation of the Rx for Change curriculum with a variety of teaching methodologies, and (5) continuity of use within the core curriculum of pharmacy institutions. Seven key factors were found to have contributed to the success of the Rx for Change program, and thus the following are recommended for future shared curriculum developers: (1) appeal to attendees, (2) relate content to clinical practice, (3) deliver live training (in-person), (4) develop high quality materials delivered by experts, (5) meet accreditation standards, (6) provide support for teaching, and (7) demonstrate effectiveness. Data from the website analysis provided evidence for interprofessional reach of the Rx for Change website to educators, learners, and professionals.<br></div>

Tobacco use is the leading cause of premature and preventable death in the United States, yet millions of Americans continue to use tobacco. Nursing professionals comprise the largest health care provider group and can help improve tobacco cessation among their patients. The purpose of this doctoral project was to increase nursing staff and advanced practice providers knowledge, skills, and confidence related to tobacco cessation interventions. The project took place in a family medicine clinic in Central Texas. The nursing staff (which included 1 registered nurse and 3 licensed vocational nurses) and advanced practice providers (which included 3 nurse practitioners and one physician assistant) were asked to participate in the project. Knowles' theory of adult learning and Prochaska's transtheoretical model served as the conceptual frameworks for the project. The United States Public Health Service Rx for Change program was used to create 2 posters on tobacco cessation interventions that were presented to staff as an educational intervention. A 10-question knowledge survey and a 15-question skills and confidence survey were administered before and after the education program; 8 nurses completed the survey before the education and 7 nurses completed the survey after the education. For the presurvey, 29% of responses were correct; while for the postsurvey 83% of responses were correct. Results also showed an increase on the 4-point Likert-scale survey measuring the participants' skills and confidence regarding tobacco cessation interventions. The finds of this project will help nurses and advanced practice providers use evidence-based practices to promote smoking cessation, leading to positive social change for patients, families, and communities.

Résumé : Alors que les progrès technologiques repoussent les frontières de la mort, un nouveau débat éthique et légal émerge. Lorsqu’un patient se retrouve en état végétatif et que tout espoir de réhabilitation s’éteint, la communauté médicale propose de cesser les soins de maintien en vie et de ne pas tenter la réanimation en cas d’arrêt cardio-respiratoire. Or, certaines familles, la plupart religieuses, s’opposent à toute cessation des traitements, et en exigent le maintien. Avec l’éclairage des données scientifiques actuelles qui permettent d’accéder à la conscience malgré les apparences, l’état du droit canadien sera examiné. Dans un premier temps, l’auteure examine en quoi la perte apparemment irréversible de la conscience justifie le refus des médecins de poursuivre les soins de maintien en vie. Dans un deuxième temps, elle aborde les droits fondamentaux pouvant être invoqués par les proches au soutien de l’exigence de la poursuite des traitements. Dans un dernier temps, elle évalue les pistes de solution proposées visant à clarifier à qui appartient le pouvoir décisionnel ou à mettre en place un processus de règlement des différends. En arrière-plan de ce débat, la science continue de progresser, avec l’espoir d’un meilleur respect des droits des patients apparemment inconscients dans le futur. // Abstract : As technological progress pushes the boundaries of death, a new ethical and legal debate emerges. When a patient is in a vegetative state and all hope of rehabilitation is gone, the medical community proposes to withdraw life-sustaining treatment and withhold resuscitation. However, some families, in most cases religious, are opposed to withdrawing treatments and request that they be maintained. Keeping in mind recent scientific advances allowing an unprecedented access to consciousness, against all odds, the Canadian legal landscape will be explored. Firstly, the author will examine how irreversible unconsciousness justifies doctors’ refusal to pursue life-sustaining treatment. Secondly, the fundamental rights invoked by the relatives’ to support their requests for life-sustaining treatment will be analyzed. Lastly, solutions aimed at clarifying who has the right to decide or to create a dispute resolution process will be evaluated. The background of this debate is scientific progress, with the hope of improving the respect of presumably unconscious patients’ rights in the future.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, 2011. / ‘Cigarette smoking is a modern day epidemic that poses a substantial health burden’, it has been proven that smokers die on average fourteen years earlier than non smokers as a direct result of their smoking. An abundance of evidence indicates that the health risks associated with cigarette smoking can however be reversed with a sufficient period of abstinence. Thus achieving life-long abstinence must be a health priority for both developing and developed countries (Caponnetto &, Polosa, 2008). Over 80% of smokers express a desire to stop smoking and 35% of them try to stop each year. However, less than 5% are successful in un-aided attempts to quit (American Psychiatric Association, 1995). The greatest challenge facing smokers who wish to quit are nicotine withdrawal symptoms; these include dysphoric or depressed mood, insomnia, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate and increased appetite or weight gain (American Psychiatric Association, 1995). The aim of this double blind placebo controlled quantitative study was to determine the effectiveness of a homoeopathic complex (Caladium seguinum 30 CH, Nux vomica 30 CH and Staphysagria delphinium 30 CH); a tautopathic preparation and the combined effect thereof, in the treatment of nicotine withdrawal syndrome as determined by the Tolerance Dependence Questionnaire, Smoking History and Perceptions of Treatment Questionnaire. Methodology Forty participants recruited by means of convenience sampling were randomly and equally divided into one of four treatment groups, namely tautopathic group, homoeopathic group, combined tautopathic and homoeopathic group and placebo group. The duration of the study was 2 weeks and two consultations with each participant were conducted. The respective interventions were administered in oral spray format; participants were asked to spray their respective preparations directly into their mouth three times daily and to repeat the dose whenever they had a craving for a cigarette. iv Measurements in the form of the Tolerance Dependence Questionnaire (Appendix D), Perceptions of Treatment Questionnaire (Appendix H), and Smoking History (Appendix G) were used to quantify response to treatment. Non-parametric statistical analysis was conducted to analyse the data. Results All four research groups experienced a statistically significant reduction in the amount of cigarettes smoked, favourable perceptions of their response to treatment and improved tolerance. Statistically however when the groups were compared with each other they were similar with respect to their tolerance to nicotine, perception of response to treatment and reduction in amount smoked. Although interventions were statistically similar in terms of effectiveness, the data does suggest that Tautopathy as an intervention warrants exploration. The Tautopathic group achieved the highest reduction in the number of cigarettes smoked when comparing medians (11 less smoked per day), achieved the highest percentage of participants who experienced reduced cravings, and the highest percentage of participants who would continue using the intervention (90% respectively) as well as improvements in 6/9 variables of the Tolerance Dependence Questionnaire. Conclusions The study concludes that each of the four subject groups (including placebo) proved to be successful in aiding the participant to cease smoking. The results showed a significantly positive perception of the participants to the interventions used. The influence of the placebo effect however was very evident in this study; in addition other factors such as the unique method of administration of the medication (oral spray format on demand) the Hawthorn effect and the participants’ desire/commitment to quit smoking may have contributed to the positive results obtained. Notwithstanding the above and although not statistically significant; positive trends within the data do suggest that the Tautopathic approach used in this study should be further investigated in future.

published_or_final_version / abstract / Nursing Studies / Master / Master of Philosophy

The incidence of smoking among mentally ill people is very high. Smokers have a 50%, rate of mental illness diagnosis compared with 23% rate for general population. To address this problem, the purpose of this project was to plan a smoking cessation program for patients in a mental health facility. The theoretical foundation for this project was based on the theory of planned behavior, which identifies the predictive nature of smoking and the benefits that can be derived from implementing a systematic approach for change. The project question examined the effectiveness of smoking cessation program using educational support, pharmacological strategies, and bi-weekly meetings to help patients in a mental health hospital to decrease smoking behavior. The project design was based on use of smoking questionnaires, the Hooked on Nicotine Checklist (HONC), effective pharmacological strategies, educational support, and counseling treatments to evaluate symptoms of dependency. The key results of this project included the creation of a plan that could foster reduction in illness, improved quality of life, and reduced costs related to the onset of major illness in this vulnerable population. This data collection process focused on a qualitative design in which selected professionals were asked to review the materials and answer questions. This project could increase awareness of the issue of smoking; in addition, this project could equip nurses with the tools to deliver evidence based interventions for tobacco dependence that may significantly reduce tobacco use. This project has the implications for positive social change through its potential to improve the health of people with mental illnesses. It also creates a safe and healthy environment in mental health facilities for patients who do not smoke.

While smoking prevalence among the general Canadian population has declined to 17%, declining rates have not been achieved equitably across all sub-populations (Statistics Canada, 2011). Smoking prevalence is particularly high among blue-collar workers, and individuals employed in the construction industry have the highest smoking prevalence (34%, Conference Board of Canada, 2013). Though studies have attempted to understand these disparities and how to combat them, research is necessary to understand the social contexts in which construction workers smoke. This study sought to understand these contexts by exploring experiences and meaning of smoking. Semi-structured, in-depth interviews were conducted with 14 construction workers living and working in Southern Ontario. Qualitative inductive analysis was conducted in three phases: (1) simultaneous data gathering and generating nodes, (2) coding and subgroup analysis, and (3) limited theory development. Grounded theory approach to analysis identified six main categories encompassing various subthemes. These included: day-to-day workplace experiences, experience of smoking, reasons for smoking, sociability of smoking, mechanisms associated with continued smoking, and experiences with quitting or cutting back. Sub-group analyses identified differences between participants depending on age, skill level (unskilled worker versus skilled tradesperson), and job sector (residential versus commercial/industrial). Social theories and concepts identified in the literature review were referred to, including the Social Contextual model by Sorensen and colleagues (2004). A potential set of contextual factors and modifying mechanisms that may be impacting construction worker’s tobacco use on or off jobsites are presented. The findings indicate that smoking is a complex issue among construction workers. For many, smoking goes hand-in-hand with working. Smoking is a social experience, and common on worksites. Workers experience various smoking policies on different jobsites. Policies may or may not be followed or enforced. Smoking has different meanings for different workers. However, factors external to the workplace must also be considered (e.g. partner smoking status). Supports that could be offered in workplace contexts include incentives, coverage of quitting aids, and limiting smoking (e.g. smoke-free policy). These findings have implications for policy and practice. Further research, including collaborative intervention development, is necessary to address high and persistent rates of tobacco use among construction workers.