In the meantime, however, whether self-reported data are used alone or in combination with old race/ethnicity data, users of VA self-reported race data should be aware of the potential selectivity in the self-reported race/ethnic- ity data. As discussed above, about 25% of those who reported Hispanic ethnicity did not report race in the FY2004 VHA data. These individuals may not view them- selves as having racial identity distinct from their ethnicity . They thus may choose either "Other" category for their race or refuse to disclose race when they are given OMB categories. This is shown in 2000 Census data in which over 42% of all those who reported their ethnicity chose "Some other race" compared with only 5.3% of the total population . In the VHA, "Other race" is not pro- vided as a response category and as a result many refused to report race. Regional variations in the completeness of self-reported race/ethnicity data (e.g., 33% in the West vs. 41% in the other three regions) may also reflect not so much systemic failure to enforce the new race/ethnicity data collection standards among VHA facilities in the West as variations in the distribution across regions of non-African American minority groups such as Hispanics, Asians, and individuals of two or more races.
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It is recognised that ethnicity data collection in the UK has historically been of poor quality. Comprehensive and validated ethnicity data collection is essential if we are to reduce inequalities in health and access to health- care services. In order to improve ethnicity data collec- tion, the provision of training is fundamental in order to increase awareness and promote the importance and utility of recording ethnicity data for all staff that col- lect/use the data. Ideally, ethnicity should only be col- lected once by GP or at first hospital visit and linked through healthcare databases and verified at subsequent points of contact. Data collection should be extended to collect additional items such as language, religion and country of origin/birth to account for cultural differ- ences. Only once we have complete and validated ethni- city data can we know the true extent of disparities in healthcare and devise appropriate strategies to combat them. Reducing health inequalities and tailoring current services to meet the needs of BME groups wholly depend upon having accurate and complete ethnicity, without this information we will remain blind to the size and depth of the problem, as a consequence patients with no data will inevitably be left behind.
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there have been some great improvements such as the decline of not known/not stated codes in Finished Consultant Episodes from 23.9% in 2004–05 to 8.6% in 2009–10, HES data remains incomplete . The Quality and Outcomes Framework (QoF) began awarding points (linked to financial incentives) to GP practices collecting ethnicity data on all newly registered patients in 2003. Furthermore, the collection of ethnicity data has been actively encouraged in healthcare for many years. In 2005, the Department of Health produced „A practical guide to ethnic monitoring in the NHS and social care‟ which explained the relevance of data items and provided examples of good practice . The drive towards the collection of complete and reliable ethnicity data stems primarily from the passing of the Race Relations (Amendment) Act (2000) which places responsibility on authorities to not only minimise inequalities but to actively promote equality. October 2010 saw the
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UK ethnic minority patients are reported to be under-represented in clinical trials. Under-representation of any patient group within an Randomised Clinical Trial can bias trial results and subsequent extrapolation into the general population. However, the true extent of ethnic minority representation in RCTs is masked by the poor quality of ethnicity data. This thesis investigates ethnicity data collection in healthcare and the representation of ethnic minority patients in RCTs in the UK. A systematic literature review of ethnicity data collection identified a paucity of published evidence. Self-reported ethnicity was recognised as the optimal method of data collection but training is needed to raise awareness of the importance of such data. Reasons for the gaps in ethnicity data were explored through a healthcare professional survey and focus groups with lay South Asian volunteers. The majority of healthcare professionals agreed it was important to collect ethnicity and emphasised the need for training. The focus groups revealed a willingness to provide these data, subject to being given information regarding their use.
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A number of our respondents did not attempt to collect any form of ethnicity data. In many cases this stemmed from their own or their organisation’s lack of awareness of the importance of the data, and the belief that it was not relevant to patient care or treatment. However, exceptions occurred if the infor- mation was required for participants in a clinical trial or for religious, dietary or communication purposes. Interviews conducted with physicians in the USA revealed that the strongest objection to collecting ethnicity and race data is the belief that it is, or should be, clinically irrelevant. Other barriers that were reported included a lack of resources, concerns about privacy, the legality of collection, and discomfort or resistance on the part of patients and staﬀ (Hasnain- Wynia et al, 2010). These ﬁndings concur with the earlier results reported by Regenstein and Sickler (2006), who found that the single most important barrier to data collection is staﬀ not knowing why it is important. However, this was not reﬂected in our sample, where only one participant expressed the view that it was ‘not relevant to care or treatment.’
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In 2001–2002, an attempt was made to increase ethnicity proﬁling in primary care. However, at this time the work involved and the related costs were signiﬁcant deterring factors (Jones and Kai, 2007). Recently, some primary care trusts have invested in the collection of ethnicity data, and these initiatives are supported by the incorporation of ethnicity into the Quality and Outcomes Framework for GPs (although restricted to new patients and only awarded one point) (Race for Health, 2007). Monitoring goals set for London for 2003–2006 by the Department of Health expected all GP practices and other primary care providers to record valid ethnicity codes for 75% of patients by 2005, and expected this ﬁgure to reach 95% by March 2006 (London Health Observatory, 2003). The ‘Professionals Responding to Cancer in Ethnic Diversity’ (PROCEED) project team provided training in competence and cultural awareness for healthcare professionals who were involved in cancer care at primary care level. The issues explored included cancer and ethnic diversity, language and communi- cation, and culture and cancer (Cancer Research UK, 2006).
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populations as recorded in the ethnicity data, the percentage of Oromos reporting mul- tiple ethnicities increased from 2006 until 2011. After this, the percentage declined, so that the estimated proportion of multiple-ethnicity Oromo in 2016 is lower than it was in 2001 (Fig. 10). This decline corresponds temporally to widespread mobilization in Ethiopia and among members of the Oromo diaspora. It is noticeable in Table 5 that the percentage of Oromo reporting multiple ethnicities increased less dramatically be- tween the first and second generation than the corresponding percentage for other eth- nicities (except Amhara). More research is needed to verify these trends, and a fuller comparative analysis of how different Ethiopian ethnicities are mobilized at home and in diaspora is important but beyond the scope of the current study. What is notable in the data is that the proportion of some other Ethiopian groups (Amhara and Harari) reporting multiple ethnicity increased during the same period (Tigrayan multiple ethni- city, however, declined). Ethiopian federalism, redistributing access to power and re- sources in the country along ethno-national lines, has had different impacts on different ethno-national groups within the country and in diaspora. Oromo political unity fostered by the federal system, combined with widespread support in Ethiopia for Oromia Regional State ’ s leadership in their calls for reform, has given Oromo in dias- pora a strong platform on which to engage foreign governments. Oromo organizations in the US pushed for resolutions currently under consideration in the US Congress re- garding democracy and human rights in Ethiopia, suggesting how power reconfigura- tions in Ethiopia might connect to new forms of transnational political engagement.
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The Individual Patient Registration Profile (IPRP) used in Lambeth PCTs collects self-reported ethnicity, religion, language and need for an interpreter in addition to the usual data items such as gender, date of birth, smoking status. Ethnic groups have been expanded for the local community but can be collapsed down to the census 2001 categories . This is an ongoing 3 year project which attempts to collect demographic data, including ethnicity, on a central database (Datanet). The Datanet project is a resource which has been developed to link the IPRP data to research projects. Central Liverpool NHS Primary Care Trust have also carried out patient profiling by collecting detailed ethnicity data including spoken language and read language, as well as additional information about general health and carer information .
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Assessing treatment and outcomes of all diabetic patients registered for primary care is dependent on the extent of ethnicity coding as part of routine care delivery. The UK National Diabetes Audit, which involved 36 PCTs, attempted to analyse data by ethnicity, but this was impossible because recording of ethnicity was below 20 per cent in 32 of the 36 participating PCTs . Several UK reports have attempted to fill this gap using ecological methods. To investigate the impact of ethnicity on diabe- tes prevalence, Goyder and Hammersley  collected data from 19 English practices using EMIS clinical information systems. Information was collected on a range of clinical data, but ethnicity could only be estimated by using data from the 1991 Census based on the resident population. Also in the UK, Hippisley-Cox et al  examined the effect of deprivation and ethnicity on the achievement of quality of care indicators for patients with diabetes in 237 GP practices included in the QRESEARCH general practice database. Because of the lack of recorded ethnicity data, they too used deprivation scores and ethnicity propor- tions derived from the 2001 Census, both linked to the Output Areas associated with each patient's postcode, and showed that patients from high ethnic minority areas had poorer levels of recording of diabetes care. However use of Census data to impute patients' ethnicity introduces obvi- ous inaccuracy. For example, in the UK patients are more likely to be registered with a GP of their own ethnic group, introducing another error in attributing ethnicity to prac- tice populations.
Abstract . Tourism is increasingly recognized as an effective means of achieving peace in world. In this paper tourism’s contribution for peace will be discussed in a broader sense with identification of structural violence as the main cause of Sri Lankan conflict. Structural violence is the process of deprivation of needs. It is characterized politically as repression, and economically by exploitation. The methodology used in this paper to identify ‘how entrepreneurial tourism can contribute to alleviate structural violence’ was basically qualitative. The methodology was based on the grounded theory which portrays the world as being complex and organized by both overt and hidden power structures. It was revealed during the process of data collection that the structural violence was functioning by means of polarization of the social structures such as caste, ethnicity, economic status, nobility, educational status into different strata together with grouping of people into the consequential ends leading to social uneasiness. People engaged in entrepreneurial activities are entrapped in a viscous system of unfair resource allocation and production exploitation operating through intermediaries. The paper suggests that it is necessary to seek remedies to increase the capacity of entrepreneurs to overcome the destructive force of the structural violence.
5. A limitation of this kind of information is that it does not control for other factors which may impact on attainment, so that the ‘ethnicity’ effect identified may simply be a result of other differences between White students and minority ethnic students which impact on attainment. From the literature (e.g. Purcell et al. (2005), Connor et al (1996), Connor et al. (2004)) we know that a number of factors other than ethnicity impact on HE attainment: “The Class of ’99” (Purcell et al. (2005), for instance, finds that prior attainment is an important factor in predicting degree outcome, as well as gender, school characteristics, university and subject studied. Other findings from the same study indicate that those who are reported to be non-disabled, describe themselves as ‘ambitious’ and have a father with a degree, are all also more likely to attain a good class of degree.
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sizes. As we expect there to be heterogeneity in study design, we will utilise a random-effects model (DerSimo- nian and Laird) . Results will be graphically repre- sented utilising forest plots. Heterogeneity will be assessed utilising the Cochrane’s Q (chi-squared test) and I 2 statistics and by visually inspecting the forest plots. If significant heterogeneity exists, we will evaluate whether any specific studies significantly influenced the results by excluding each individual study and examining its impact on the pooled SMD and between-study het- erogeneity. If there are a sufficient number of studies per tissue type (e.g. ten), we will perform meta-regression, in addition to the subgroup analysis according to trauma exposure status of controls. Potential moderators that will be included in the meta-regression will be year of publication, age, sex, trauma type, time since index trauma, developmental stage of trauma exposure, PTSD severity, psychiatric comorbidity, time period of sam- pling (e.g. time of day for acute measures and length of hair sample representing retrospective window for hair sampling), and method used to determine cortisol level (ELISA or LC-MS). Moderators will first be entered indi- vidually and those with a significance level of 0.1 will be entered in a multivariate meta-regression. The meta-re- gression will be conducted using a restricted maximum likelihood (REML) model. To address the issue of statis- tically dependent effect sizes that may arise from mul- tiple methods of cortisol assessment within a study or from either repeated measures within a study that may have a longitudinal design, robust variance estimation procedures in meta-regression will be used. We will evaluate for effect of studies at high ROB and for the ef- fect of study design type by entering the total score and domain sub-scores obtained on the modified NOS and study design type into separate regression models. Fur- ther sensitivity analyses will be performed to assess the influence of studies assessed as having a high ROB, by excluding studies with a high ROB and evaluating the impact on main outcomes. We will assess for small study effects with funnel plots (for analyses with 10 or more studies), and statistical tests for asymmetry (Egger test) will be performed where appropriate. If asymmetry is present, we will perform the trim-and-fill procedure . Data will be analysed with STATA IC version 15.
In the course of the process involving several “Cultural Ses- sions”, I gradually developed the understanding of two funda- mental questions. First, the evidence related to the fact that primary genres persist in secondary genres only in a simulated form—and not in a more direct or quite accessible fashion. In other words: accompanying the dialogues existing in films similar to the one we had presented apparently requires a kind of experience different from the most simple one people deal with in everyday life face to face communication. A certain kind of dialogue explored in films as well as in advertisements, in cartoons or in comic strips is not as straightforward as it may seem to people who have benefited from the availability and the access to certain urban literacy practices. Second, the evidence involving the fact that the simulation present in language must be accompanied by simulating new roles in social inter-relation. If it was true—as I believed—that the continuum illiterate- literate should be seen together with the continuum restricted- full literacy, more and more I was convinced that language cer- tainly has to be seen as part of social interplay, but not in a harmonious way, and rather in the sense of conflicting social struggle for hegemony and for full citizen participation, in the sense Cohen (1974: p. xiii) deals with ethnicity as compre- hending “the potency of the normative symbols the individual manipulates in his struggle for power”.
HBAI figures, the use of the HRP was retained as the means of attributing ethnicity to households, families and children for consistency with the published results. By excluding Northern Ireland from the analysis, categories can include all those 2001 Census categories common to both Scotland and England and Wales – that is having a white British and white other category. However, using the hierarchical method outlined above, all white British and white other households and those containing both white British and white other members (but not anyone from any other ethnic group) are all attributed to a general ‘white’ category. Moreover, though there are four mixed categories, the small numbers in any given group meant that all four were aggregated for analysis, even if this is not an entirely desirable approach. It has, for example, been argued that it would be preferable to combine each mixed category with the group to which it shares the minority part – such as attributing white and black Caribbean to Caribbean, and white and Asian to Indian, etc. However, there is not only extensive policy and research interest in the experience of children and families of mixed ethnicity in their own right; in addition, as such children and families tend to represent the most recent generations, and to have relationships with different ethnic groups, it is argued that their experience could be informative about the future experience of ethnic minorities and the durability, or not, of racialised disadvantage. Thus, the decision was taken to treat these mixed categories as distinct from their component groups, even if in some cases, as with the FRS, that meant constructing an aggregate ‘mixed’ group.
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Sexuality and the perception of appropriate adult roles are both issues which need to be addressed. The discussion of sexuality is surrounded by taboos, more so in some communities than others, and people with learning difficulties may have little access to relevant and necessary information. Communication about such issues and about individual needs may also be difficult and this could hamper the disclosure of abuse. Appropriate roles may be perceived differently in individual families; one project worker referred to a parent who would not accept that his daughters had a learning difficulty and was arranging their marriages with partners from abroad. At the same time, the literature shows evidence of other dynamics, particularly within South Asian communities, where marriage may not be seen as an option or there is resistance to the idea of marriage between two people with learning difficulties (CVS 1998), as may indeed be the case within White communities, too. Equally, marriage may be more easily accommodated where the aptitude or skills of the marriage partner are only one part of the whole equation. If marriages are a key part of re-affirming or reflecting kin relationships rather than emotional involvement or attraction between the couple, then South Asian cultures may be more accommodating of disabled people. Without empirical data, however, this remains an interesting but hopeful hypothesis.
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Ethnicity is under attack with the tightening grip of modernization. It is true that we are becoming increasingly interdependent in economic and cultural terms, that there is increase awareness that we are ‘one world’ facing common ecological, political and security problems. Yet this very process of globalization, the very rapidity of the dissolution of the known world, creates a perverse effect. People reach out to the habitual, to the communities where they find familiar faces, voices, sounds, smells, tastes and places. Confronted by the pace of globalization they often need ethnicity more not less. Confused by post-modernity, relativism and the deconstruction of their known world, they reaffirm what they believe to be true at a more local level and education plays an important role in this venture. Ethnicity and ethnic differences have arisen due to many reasons. One of these is through various kinds of coerced migration. Colonial and mercantile powers often brought different peoples to new settings for work on their plantations or to further their commercial interests: for example, ten million African slaves were transshipped across the Atlantic. These patterns of involuntary migration led to complex, often three-way, interactions as indigenous people faced outsiders, who faced other outsiders, who all faced representatives of the colonial powers. The next is phonotypical appearances. Quite often peoples look rather different to one another. In popular language they are white, brown, black or yellow, dark or light skinned, Nordic, Mediterranean, Latin American or Asian – Looking. There are real limits to the manipulative use of identity changes. It is relatively easy to change one’s religion or one’s clothes. It is less easy to change one’s accent, manner and language.
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In Kenya, ethnicity has been one of the social problems since independence. It cuts across all sectors of the economy including education. Ethnicity is wit- nessed in forms of recruitment, promotion, transfer and deployment of lec- turers and other non-teaching members of staff. In the universities there is ethnic consideration in recruitment of Chairs of the Council, Vice Chancel- lors and their Deputies and other top leaders. Politicians in many cases have tried to influence appointments of the top leaderships of public universities. The public universities have more lecturers and the non-teaching staff from the local ethnic group. Ethnicity has also impacted university students as well, especially when electing their student leaders. This paper examines the causes of ethnicity and some of the recommendations on how to tackle the vice. Some of the recommendations include empowering the National Cohesion and Integration Commission (NCIC) and vetting of Vice Chancellors and Council members.
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Given this risk of racialisation, it is not helpful to refine an ethnic classification scheme in a way that allows further assumptions to be made about the importance of culture and genetics when neither are measured and environment continues to be ignored. For example, the analysis in Chapter 3 showed that, while a South Asian group had a greater risk of indicators of CHD, once the group was broken down into constituent parts this only applied to the Pakistani or Bangladeshi group - Indian or African Asian people had the same rate as white people. In addition, within the Indian or African Asian group Muslims had a high rate of indicators o f CHD, while Hindus and Sikhs had low rates. While this approach is useful in uncovering the extent to which convenient assumptions of similarity within obviously heterogeneous groups were false, it could be suggested that these findings mean we can use the term ‘Muslim heart disease’, or ‘Pakistani and Bangladeshi heart disease’, rather than ‘South Asian heart disease’, to describe the situation. And explanations can be sought in assumptions about Muslim, Pakistani and Bangladeshi cultural practices or their shared evolutionary history. This potential results from the use o f un-theorised and apparently emergent ethnic classifications that allow ethnicity to be treated as a natural and fixed division between social groups, and the description of ethnic difference in health to become their explanation (Sheldon and Parker 1992). Explanations are, consequently, based on cultural stereotypes or suppositions about genetic differences, rather than attempting to directly assess the nature and importance of such factors, the contexts in which they operate and their association with health outcomes.
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Medical prognostication is an evaluative component of medicine that encompasses the science of estimating the complication and recurrence of disease and predictive survival of patients . Medical prognosis plays an increasing role in health care outcome. Many factors, including tumor grade, tumor size, and lymph node status may influence or correlate with prognosis for breast cancer patients. Different types of breast cancer can be identified based on the existence or lack of certain receptors (i.e., estrogen, progesterone, her2 receptors) . Triple-negative breast cancer (TNBC) is characterized by a lack of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) expression [3, 5, 7, 10, 11, 12, 17, 23]. Previous and current studies suggest that TNBC patients tend to have worse prognosis compared to non-TNBC counterparts . In addition, those studies suspect that the incidence of breast cancer, and prognosis in TNBC women, differ according to ethnicity.
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1.7 Section 3 tests the factors associated with pupil outcomes using hierarchical (multilevel) statistical modelling. The model specification includes both pupil- level (gender, FSM eligibility, SEN status, attendance rate, ethnicity, prior attainment, etc.) and school-level variables (proportion of pupils living in areas of multiple deprivation, primary language medium, etc.) and uses data from 2009/2010 to 2015/2016. The models were designed to establish, from administrative data, the principal determinants of pupil outcomes in PtS schools. They also served to determine which groups (by gender, ethnicity, FSM status, etc.) have seen the largest changes in their performance over time, with an emphasis on the period before and after the introduction of SCC. 1.8 The final section (Section 4) provides evidence on the extent to which school-
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