Suchergebnisse

Electronic Health Records (EHRs) are a complex knowledge domain. The ability to design EHRs to cope with the changing nature of health knowledge, and to be shareable, has been elusive. A recent pilot study1 tested the applicability of the CEN 13606 as an electronic health record standard. Using openEHR archetypes and tools2, 650 clinical content specifications (archetypes) were created (e.g. for blood pressure) and re-used across all clinical specialties and contexts. Groups of archetypes were aggregated in templates to support clinical information gathering or viewing (e.g. 80 separate archetypes make up the routine antenatal visit record). Over 60 templates were created for use in the emergency department, antenatal care and delivery of an infant, and paediatric hearing loss assessment. The primary goal is to define a logical clinical record architecture for the NHS but potentially, with archetypes as the keystone, shareable EHRs will also be attainable. Archetype and template development work is ongoing, with associated evaluation occurring in parallel.

The dissertation offers a localized, symbolic analysis of the tropes which organize mothers' everyday practice on a remote Tongan atoll. It pays particular attention to the language, meanings and practices associated with 'health'. I argue that as mothers, women are active agents in the invention of Tongan culture, and figure in the production of a national image of traditional modernity. Insofar as Tongan health promotion and medical services include a strong focus on maternal child health issues, mothers are placed at nexus points between 'modern' medicalized ways of perceiving bodies, food, hygiene or risks, and the future generation, their children. As mothers therefore, women are key figures in the interpretation of medical and modernizing messages and directions for social practice. Despite the government's official adoption of Western models for representing health, at the level of everyday life in the village, 'health' is played out differently from the illness treatment and prevention focus associated with biomedicine. Locally, traditional practices, including notions of kinship, gendered roles of motherhood and traditional behaviour, counter the orthodox emphasis of biomedical health, and replace it with a more locally meaningful tropes of "mo'ui lelei" [living well] and "va lelei" [good connections], according to "anga fakatonga" [the 'Tongan way]. Va lelei depends on making and exchanging traditional textiles made from pandanus fibre. Examining rural mother's everyday practices demonstrates the way in which textiles are polysemic, signifying good mothering, but also the obligation of the entire maternal kindred, through life and death. Mothers in this remote and economically under-privileged part of Tonga are what feminist philosopher Ruddick (1989) would call 'good mothers', but their behaviour and priorities differ from her germinal theorising of the work of mothering. In re-inventing WHO-promoted, biomedical notions of health, they use their own cultural practices to be both traditional and modern. In the process protecting their families in the face of state players who use modernity as an excuse to forget to redistribute wealth to the remote areas of Tonga.

What can fish stories tell us about how people live with the complexities of rapid environmental transformations and the local effects of national, globalized, and neoliberal desires for resources? To answer this, I take the Tä'atu fish harvesting ritual and accompanying oral narrative to be an "ecography" that addresses human intimacies and changes on a small atoll in Tonga. This type of analysis draws on traditional ecological, political, and sociological knowledge, as well as geography, history, and cultural symbols, to give a deeper understanding of place and the contemporary experience of people intimate with the local environment as source of food and livelihood. When examined in the light of today's drastically depleted stocks of Pacific pelagic fishes such as skipjack tuna, the ecography of the Tä'atu provides a benchmark for a shift in a human–fish relationship that provided Polynesians with practical and poetic sustenance for hundreds if not thousands of years. At the same time, the myth of the Tä'atu highlights the historic political importance of desire, beauty, and their confluence with bounty, in the production of generations of chiefly privilege and cultural practice. Imbricated with the shifts in human–fish and beauty–bounty relations are lessons for the contemporary chiefly–commoner relationship in Tonga, the last nation to claim status as an uninterrupted Polynesian kingdom, as well as laments for the loss of independence an important food resource offered. Today, as in the past, the Tä'atu is a fishy tale about the geopolitics of various desires.

Global plastics production has reached 380 million metric tons in 2015, with around 40% used for packaging. Plastic packaging is diverse and made of multiple polymers and numerous additives, along with other components, such as adhesives or coatings. Further, packaging can contain residues from substances used during manufacturing, such as solvents, along with non-intentionally added substances (NIAS), such as impurities, oligomers, or degradation products. To characterize risks from chemicals potentially released during manufacturing, use, disposal, and/or recycling of packaging, comprehensive information on all chemicals involved is needed. Here, we present a database of Chemicals associated with Plastic Packaging (CPPdb), which includes chemicals used during manufacturing and/or present in final packaging articles. The CPPdb lists 906 chemicals likely associated with plastic packaging and 3377 substances that are possibly associated. Of the 906 chemicals likely associated with plastic packaging, 63 rank highest for human health hazards and 68 for environmental hazards according to the harmonized hazard classifications assigned by the European Chemicals Agency within the Classification, Labeling and Packaging (CLP) regulation implementing the United Nations' Globally Harmonized System (GHS). Further, 7 of the 906 substances are classified in the European Union as persistent, bioaccumulative, and toxic (PBT), or very persistent, very bioaccumulative (vPvB), and 15 as endocrine disrupting chemicals (EDC). Thirty-four of the 906 chemicals are also recognized as EDC or potential EDC in the recent EDC report by the United Nations Environment Programme. The identified hazardous chemicals are used in plastics as monomers, intermediates, solvents, surfactants, plasticizers, stabilizers, biocides, flame retardants, accelerators, and colorants, among other functions. Our work was challenged by a lack of transparency and incompleteness of publicly available information on both the use and toxicity of numerous substances. The most hazardous chemicals identified here should be assessed in detail as potential candidates for substitution.