This paper describes an empirical approach to assessing pediatric residents' attitudes, knowledge and skills in primary care behavioral health. Outcomes from that assessment approach are presented from two pediatric residency training programs in the northeastern United States. Thirty-six pediatric residents completed attitudes, knowledge and skills surveys. The survey was developed to align with the American Academy of Pediatrics’ Policy Statement in 2009 citing aspirational competencies for pediatricians in primary care behavioral health. This alignment addressed both learner variables (attitudes, knowledge, and skills) as well as clinical presentations (ADHD, anxiety, depression, and suicide) highlighted in the policy statement. The survey specifically inquired about self-reported confidence and comfort in managing behavioral health concerns using evidence-based practice parameters (attitudes and knowledge) and their measured ability to deliver evidence-based care in response to clinical vignettes (skills). Findings largely revealed no statistically significant differences in attitudes, knowledge or skills between interns and upper-level residents. Training programs can use the approach described in this paper and the assessment instrument with some possible modifications to monitor annual progress and evaluate any changes in didactic and clinical training.

博士(工学) / Doctor of Philosophy in Engineering / 同志社大学 / Doshisha University

No description available.

In humans, various dietary and social factors led to the development of increased brain sizes alongside large adipose tissue stores. Complex reciprocal signaling mechanisms allow for a fine-tuned interaction between the two organs to regulate energy homeostasis of the organism. As an endocrine organ, adipose tissue secretes various hormones, cytokines, and metabolites that signal energy availability to the central nervous system (CNS). Vice versa, the CNS is a critical regulator of adipose tissue function through neural networks that integrate information from the periphery and regulate sympathetic nerve outflow. This review discusses the various reciprocal signaling mechanisms in the CNS and adipose tissue to maintain organismal energy homeostasis. We are focusing on the integration of afferent signals from the periphery in neuronal populations of the mediobasal hypothalamus as well as the efferent signals from the CNS to adipose tissue and its implications for adipose tissue function. Furthermore, we are discussing central mechanisms that fine-tune the immune system in adipose tissue depots and contribute to organ homeostasis. Elucidating this complex signaling network that integrates peripheral signals to generate physiological outputs to maintain the optimal energy balance of the organism is crucial for understanding the pathophysiology of obesity and metabolic diseases such as type 2 diabetes.

No description available.

No description available.

Les sites d'agrégation de ponte (AP) sont des zones où des poissons d'une même espèce se rassemblent pour frayer. En dépit de leur importance dans la reproduction de nombreuses espèces de poissons des récifs coralliens, bien peu de sites d'AP sont gérés. Le but de cette étude est d'améliorer la compréhension générale sur l'écologie des sites d'AP en vue de faciliter la gestion. L'étude, réalisée aux Seychelles, se concentre sur les individus regroupant sur les sites d'AP pour frayer et aussi sur ceux résidant sur ces sites. La télémétrie acoustique et le recensement visuel sous-marin ont, ici, été employé comme principaux outils d'observation des espèces formant des agrégations de reproduction (cordonnier (Siganus sutor), mérou camouflage (Epinephelus polyphekadion) et mérou marbré (E. fuscoguttatus)) et des espèces résidant sur les sites d'AP. Les détections acoustiques ont montré que les individus de S. sutor présentent une grande fidélité à leur site de ponte et une périodicité liée à la période de pleine lune. Par ailleurs, les agrégations de ponte d'E. fuscoguttatus et E. polyphekadion se chevauchent spatialement et temporellement avec une forte périodicité liée à la nouvelle lune. La formation d'AP de E. fuscoguttatus et E. polyphekadion provoque des changements complexes dans l'assemblage de poissons résidents sur le site. L'effet de la phase lunaire sur les assemblages de poissons résidant sur les sites d'AP de S. Sutor apparait être dépendant de l'échelle considérée. Les informations sur la dynamique spatiale et temporelle des espèces étudiée sont utilisées pour proposer des mesures de gestion susceptibles d'améliorer la protection des sites d'AP. / Fish spawning aggregation (FSA) sites are areas where repeated concentration of conspecific fish gathers for the purpose of spawning. Despite of their importance in the reproduction of many coral reef fishes, few FSA sites are actively managed. The aim of this study, conducted in the Seychelles, was to improve general understanding on the ecology of FSA sites to facilitate their management. It focuses on both the individuals that aggregate at FSA sites to spawn and those that are resident at FSA sites. Acoustic telemetry and underwater visual census were used to study three species that form spawning aggregations (spinefoot shoemaker (Siganus sutor), Camouflage grouper (Epinephelus polyphekadion) and Brown-marbled grouper (E. fuscoguttatus)) and the resident fish assemblages at FSA sites. Acoustic detections found individual S. sutor to have high fidelity to individual FSA sites and to show significant periodicity with the full moon period in the timing of their arrival and departure from FSA sites. Conversely, spawning aggregations of E. fuscoguttatus and E. polyphekadion overlapped spatially and temporally, with strong periodicity for spawning aggregation to form with the new moon period. The formation of E. fuscoguttatus and E. polyphekadion FSAs caused complex changes in the fish assemblage that is resident at the FSA site. The effect of lunar phase on the resident fish assemblages at S. sutor FSA sites appeared to be scale-dependent, having greater impact at the larger than the smaller FSA site. Information on the spatial and temporal dynamics of aggregating and resident fish species is used to propose management actions to improve the protection of FSA sites.

The Master’s thesis focuses on taxation of employment income of the resident of the Czech Republic who also receives employment income from Canada. The thesis explains elementary principles and concepts related to income taxation of natural persons in the Czech Republic and Canada. The relevant articles of the Convention for the avoidance of double taxation are analysed. Based on the theoretical part of the thesis, a methodology for determination of a model taxpayer’s tax liability is designed with regard to available means of tax optimization.

The housing problem in South Africa is complicated by the cultural diversity and the rapidly changing nature of the population. This indicates a need for research to help to determine "what appropriate housing is" for various sectors of the South African population. Social researchers and design professionals therefore have to combine their efforts to provide house designs that will be appropriate to the housing needs and values of a variety of future occupants. This study focuses on the impact of rapid change in the sociophysical environment (modernization) on people's experience of the quality of their relationship with their home environments. An approach is proposed through which groups of individuals, who share similar needs and requirements regarding their housing, can be identified for inclusion in a process of participatory design. A theoretical framework is developed to account for the variety of perspectives of participants (users, researchers and design professionals) in the design process. Through application of the theoretical framework, a novel approach to the determination of "what to design for whom" is developed. The "modernity fit" concept is introduced to describe the quality of the relationship between people and their housing in terms of a rating of the modernity of both human and housing characteristics. It is proposed that the quality of the relationship or "fit" between the modernity of human characteristics and the modernity of the physical characteristics of the house influences people's experience of their houses. Results of this study indicate that the "modernity fit" concept opens up new avenues for research to assist in the design of housing in developing countries. / Psychology / D. Litt. et Phil. (Psychology)

På grund av oroligheter i världen skedde under år 2015 en kraftig ökning av asylsökande, där ibland även ensamkommande barn. Ökning av ensamkommande barn medförde en boendeproblematik för Sveriges kommuner, vilket lett till behov av flertalet nyuppstartade HVB-hem. Det fanns ett intresse av att studerades hälsofrämjande aktiviteter i kontexten, detta för att förstå dem som en del av en hälsodiskursiv praktik. Detta gjordes utifrån ett sociokulturellt perspektiv på lärande, diskurs analys samt ett helhetsperspektiv på hälsa. Därav har studien genomförts som kvalitativ studie med inspiration ifrån etnografisk forskning. Deltagande observationer utfördes vid tre tillfällen. Observationerna utfördes på två olika avdelningar på ett HVB- hem för ensamkommande pojkar. Genom ett hälsopedagogiskt perspektiv var avsikten med studien att synliggöra hälsodiskurser och dess betydelse för ungdomarnas lärande och skapande av hälsa. Kategorierna för studiens analyserade resultat återspeglar de hälsofrämjande aktiviteter som observerades. Teman för diskussionsdelen framanalyserats med utgångspunkt i studiens valda teorier och utföll i följande sex kategorier: Tidspassning, Vi och dem, Laganda och att ha trevligt ihop, Minskad förtäring av sötsaker, Regelföljning och självständighet samt Dubbla budskap. Av resultatet framkom det att den rådande hälsodiskursen tycks bygga på ett omedvetet helhetsperspektiv på hälsa. Det framkommer genom personalens utsagor att en strävans finns mot att skapa förutsättningar för att ungdomarna att utvecklas till självständiga individer, dock strider detta mot vad som kan ses i den hälsodiskursiva praktiken. Därav kan det tänkas att hälsa är ett ämne som kan behöva lyftas i praktiken. Då det var svårt att hitta relevant forskning i ämnet tycks även behov finnas av att bedriva forskning kring hur insatser på HVB-hem bör utformas för att uppnå ökad självständighet hos ungdomarna. / 2015 saw a sharp rise in unaccompanied children seeking asylum. This is due to turmoil in many parts of the world. The rise has brought housing problems for Sweden’s municipalities, with more housing and treatment facilities started as a result. A study was conducted, motivated by ethnography research. Participants were observed on three occasions, in two separate wards in a HVB resident for unaccompanied boys. Health promoting activities were observed, to gain an understanding of them for use from a pedagogic perspective. This was done using a sociocultural perspective in teaching, study analysis, as well as health in general. Through a health discourse perspective, the purpose of the study was to analyze health awareness in the children. The categories for the analysed results reflected the health promoting activities that were encouraged during the study. The study was analysed using the following six categories Punctuality, Us and them, Team spirit and getting along, Reduced sugar consumption, Following rules and independence, as well as Double standards. The results showed that the current health discourse is founded on a subconsciously overall perspective on health. Housing and HVB resident staff have the aim to create possibilities for the children to develop into independent individuals. It can be seen as a field that needs to be improved in practice, through staff education. Relevant data is lacking, further research is needed into what action is required to help the children reach independence.