Science.gov

Sample records for como modificador permanente

  1. Kaiser Permanente Northwest

    Cancer.gov

    Kaiser Permanente Northwest's Center for Health Research was created to study health maintenance organizations by scientists were recruited from a variety of fields to study a range of health and medical care issues.

  2. Transformational quality in Kaiser Permanente Northern California.

    PubMed

    Adams, Carmen; O'Brien, Roxanne; Scruth, Elizabeth

    2015-01-01

    The evolving nature of health care related to optimizing the quality of patient care while increasing efficiencies presents an opportunity to redesign roles within hospital quality departments to meet these upcoming challenges. Specifically, passage of the Patient Protection and Affordable Care Act and creation of Accountable Care Organizations will require hospitals to carefully monitor patient care outcomes as well as continually seek to improve their processes. An approach used by the Kaiser Permanente Northern California Regional Quality and Regulatory Services Department assisted the 21 hospitals of Kaiser Permanente Northern California to improve quality-of-care outcomes, establish effective assessment teams, and create infrastructure for sustainability. Leadership by a centralized internal consulting group used a model that weighs risk and opportunity against cost and outcomes to support strategic planning as projects and initiatives developed, rather than after they were initiated. This model can assist other organizations in maximizing cost-efficient and -effective performance improvement approaches to clinical and operational excellence. PMID:25539486

  3. TUBERCULOSIS COMO ENFERMEDAD OCUPACIONAL

    PubMed Central

    Mendoza-Ticona, Alberto

    2014-01-01

    Existe evidencia suficiente para declarar a la tuberculosis como enfermedad ocupacional en diversos profesionales especialmente entre los trabajadores de salud. En el Perú están normados y reglamentados los derechos laborales inherentes a la tuberculosis como enfermedad ocupacional, como la cobertura por discapacidad temporal o permanente. Sin embargo, estos derechos aún no han sido suficientemente socializados. En este trabajo se presenta información sobre el riesgo de adquirir tuberculosis en el lugar de trabajo, se revisan las evidencias para declarar a la tuberculosis como enfermedad ocupacional en trabajadores de salud y se presenta la legislación peruana vigente al respecto. PMID:22858771

  4. Kaiser Permanente National Hand Hygiene Program

    PubMed Central

    Barnes, Sue; Barron, Dana; Becker, Linda; Canola, Teresa; Salemi, Charles

    2004-01-01

    Objective: Hand hygiene has historically been identified as an important intervention for preventing infection acquired in health care settings. Recently, the advent of waterless, alcohol-based skin degermer and elimination of artificial nails have been recognized as other important interventions for preventing infection. Supplied with this information, the National Infection Control Peer Group convened a KP Hand Hygiene Work Group, which, in August 2001, launched a National Hand Hygiene Program initiative titled “Infection Control: It’s In Our Hands” to increase compliance with hand hygiene throughout the Kaiser Permanente (KP) organization. Design: The infection control initiative was designed to include employee and physician education as well as to implement standard hand hygiene products (eg, alcohol degermers), eliminate use of artificial nails, and monitor outcomes. Results: From 2001 through September 2003, the National KP Hand Hygiene Work Group coordinated implementation of the Hand Hygiene initiative throughout the KP organization. To date, outcome monitoring has shown a 26% increase in compliance with hand hygiene as well as a decrease in the number of bloodstream infections and methycillin-resistant Staphylococcus aureus (MRSA) infections. As of May 2003, use of artificial nails had been reduced by 97% nationwide. Conclusions: Endorsement of this Hand Hygiene Program initiative by KP leadership has led to implementation of the initiative at all medical centers throughout the KP organization. Outcome indicators to date suggest that the initiative has been successful; final outcome monitoring will be completed in December 2003. PMID:26704605

  5. Kaiser Permanente's innovation on the front lines.

    PubMed

    McCreary, Lew

    2010-09-01

    The Innovation Consultancy, a small team within the health care provider Kaiser Permanente, practices an expansive, service-focused version of innovation that is both rapid and economical in comparison with the conventional version. The team's members observe how health care providers interact with one another, with technology, and with patients, and how the patients respond. They take photographs, draw pictures, write stories, and try to capture experiences from the point of view of everyone involved. During KP MedRite, a project to reduce the error rate in dispensing medication to hospital patients, the team asked nurses what they thought was wrong with the dispensing process. The nurses usually replied, "Nothing". But when given a chance to make self-portraits, they would draw themselves with sad faces and frazzled hair. Interruptions appeared to be the leading cause of errors-so one of the resulting innovations was a bright-yellow sash signaling that its wearer was not to be disturbed. KP's Chris McCarthy founded the Innovation Learning Network to accelerate knowledge transfer among peers in the nonprofit health care industry. One promising process that has emerged, Inflection Navigator, helps patients who've received a frightening diagnosis handle the consequent urgent tasks-follow-up tests, visits to specialists, decision making about treatment and care--with the aid of care coordinators. This innovation and others like it arise from a brand of creativity that transcends the media version of the health care debate. PMID:20821969

  6. Kaiser Permanente Medical Care Programs (KP-MCP)

    Cancer.gov

    The Division of Research within KP-MCP conducts, publishes, and disseminates high-quality epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large.

  7. Alphabetisation conscientisante comme base d'une education permanente

    NASA Astrophysics Data System (ADS)

    Ndimurukundo, Nicephore

    1994-05-01

    D'aprs la pratique et les enseignements vcus, nous pensons qu'une alphabtisation fonctionnelle et conscientisante est susceptible de constituer la base d'une ducation permanente (life long education), condition que: Une philosophie et une anthropologie de la libration de l'homme soient le fondement de 1'alphabtisation;

  8. Responding to the Language Challenge: Kaiser Permanente's Approach

    PubMed Central

    Meyers, Kate; Tang, Gayle; Fernandez, Alicia

    2009-01-01

    Objective: To inform current debates on improving health care quality for patients with limited English proficiency by identifying the drivers and processes for one large health care delivery system's implementation of particular models, key success factors, and remaining challenges for the field. Study Design: A qualitative case study of the Kaiser Permanente (KP) San Francisco Medical Center's approach to developing linguistic access services and subsequent organizationwide initiatives. Methods: We conducted semistructured interviews with eight current and former clinical and administrative leaders from the KP San Francisco Medical Center and national headquarters. Interviews were analyzed for key themes. Results: KP San Francisco Medical Center developed linguistic and cultural services in response to a confluence of external and internal factors, including changing demographics, care quality challenges, and patient and clinician satisfaction issues. Early strategies included development of language-specific care modules focused on Chinese- and Spanish-speaking members while meeting broader linguistic access and cultural-competency needs through a centralized Multicultural Services Center. Additional approaches across KP regions have focused on improving interpreter services, optimizing use of bilingual staff, and creating a translation infrastructure to improve quality and reduce redundancy in written translation efforts. Conclusions: KP's experiences developing linguistic and cultural care and services since the 1990s provide lessons about decision-making processes and approaches that may guide other health systems, insurers, and policy makers striving to improve care quality and safety for patients with limited English proficiency. PMID:20740094

  9. Effect of urban growth on streamflow regimen of Permanente Creek, Santa Clara County, California

    USGS Publications Warehouse

    Harris, E.E.; Rantz, S.E.

    1964-01-01

    This report presents the results of an investigation of the effect of urban growth on the streamflow regimen of Permanente Creek in Mountain View, Santa Clara County, Calif. The data available did not permit a complete study of all hydrologic aspects, but there is conclusive evidence that the volume of storm runoff produced by rainfall on the valley floor has increased substantially as a result of urbanization. In 1945, storm runoff from the 5.12-square mile project area was insufficient to balance channel losses, and the streamflow entering the project area in the Permanente Creek channel was greater than that leaving the area. If, however, total outflow from the project area is considered to be the sum of the streamflow leaving the area plus channel seepage in the area, the ratio of total outflow to inflow was 1:18. By 1958, storm runoff from the project area was far in excess of channel losses and the ratio of total outflow to inflow was 1:70. This increase in outflow is attributed to the fact that urban development during the period 1945 to 1958 increased the extent of impervious surface in the project area from about 4 percent to 19 percent. The effect of urban growth in other basins in Santa Clara County should be investigated before any attempt is made to project the quantitative results of this study to other areas in the county.

  10. Kaiser Permanente-Sandia National Health Care Model: Phase 1 prototype final report. Part 2 -- Domain analysis

    SciTech Connect

    Edwards, D.; Yoshimura, A.; Butler, D.; Judson, R.; Mason, W.; Napolitano, L.; Mariano, R.; Eddy, D.; Schlessinger, L.

    1996-11-01

    This report describes the results of a Cooperative Research and Development Agreement between Sandia National Laboratories and Kaiser Permanente Southern California to develop a prototype computer model of Kaiser Permanente`s health care delivery system. As a discrete event simulation, SimHCO models for each of 100,000 patients the progression of disease, individual resource usage, and patient choices in a competitive environment. SimHCO is implemented in the object-oriented programming language C{sup 2}, stressing reusable knowledge and reusable software components. The versioned implementation of SimHCO showed that the object-oriented framework allows the program to grow in complexity in an incremental way. Furthermore, timing calculations showed that SimHCO runs in a reasonable time on typical workstations, and that a second phase model will scale proportionally and run within the system constraints of contemporary computer technology.

  11. A quarter century of hospice care: the southern california kaiser permanente experience.

    PubMed

    Milch, Mario; Brumley, Richard D

    2005-01-01

    Kaiser Permanente (KP) has been a pioneer in the development of hospice services in the United States. Since 1978, when hospice services were introduced in the KP Southern California Region, they have been gradually expanded to benefit thousands of patients and their families. However, important barriers to timely, appropriate utilization of hospice care remain. A pilot project conducted in our TriCentral Service Area has shown that palliative care-a newer development in end-of-life care-can be cost-effective in addition to being beneficial for patients and their families. Efforts are underway to emulate this model of care at other KP facilities. Availability of both home-based and inpatient palliative care services can expand the number and type of patients who, as they near the end of life, can benefit from effective symptom control and other support. PMID:22811625

  12. Developing Minimally Invasive Surgery Centers Within Kaiser Permanente: The Integrated Multidisciplinary Experience of Los Angeles

    PubMed Central

    Chien, Gary W; Abbas, Maher A

    2009-01-01

    Minimally invasive surgical therapies are growing in type and volume of interventions. As one of the largest health delivery organizations in the US, Kaiser Permanente staff must be aware that the proliferation of these technologies has occurred in parallel within many surgical specialties, with a large variation in level of implementation between different regions and even within regions. In Los Angeles, we have developed the Minimally Invasive Surgery Center, encompassing a multidisciplinary, integrated approach. It unites the effort and expertise of many outstanding practitioners within the organization and consolidates the achievements of many surgical specialties. It also brings together the elements needed to provide the highest level of care to our patients in a safe, efficient, cost-effective environment, with minimal morbidity and best long-term outcome. PMID:21373226

  13. Obesity in the kaiser permanente patient population and positive outcomes of online weight-management programs.

    PubMed

    Bachman, Keith H; Histon, Trina M; Remmers, Carol

    2007-01-01

    We review what is known about the effects of obesity in the Kaiser Permanente (KP) population and discuss outcomes for two nationally available effective online programs, HealthMedia Balance() (Balance) and 10,000 Steps(). Obese KP patients often have health problems related to overweight and report difficulties with self-care, yet with the proper support, they can avail themselves of effective treatment to manage both obesity and associated conditions that affect quality of life. Clinicians should be aware of potential problems with functional status and self-care in their obese patients, provide brief assessment and advice, and refer obese patients to effective national and regional weight-management programs. PMID:21461090

  14. Effects of limestone quarrying and cement-plant operations on runoff and sediment yields in the Upper Permanente Creek basin, Santa Clara County, California

    USGS Publications Warehouse

    Nolan, K.M.; Hill, B.R.

    1989-01-01

    High sediment loads below headwater areas of the Permanente Creek drainage basin, Santa Clara County, California, have caused flood-control problems in downstream lowland areas. Measured sediment yields in Permanente Creek, which drains areas affected by limestone quarrying and cement-plant operations, were 14 times greater than yields from the West Fork Permanente Creek, which primarily drains parkland. Part of this large disparity in yields is the result of higher runoff/unit of drainage area in the Permanente Creek Basin. Results of rainfall-runoff modeling indicate that the tendency for higher runoff from Permanente Creek results from natural differences in basin physiography. Runoff during periods of high streamflow (when most sediment is transported) is dominated by subsurface flow, which is not affected by human activities. Although artificial features created by human activities seem to have had only minor effects on runoff, they apparently have had major effects on sediment availability. Artificial features accounted for 273 acres (89%) of the 307 acres of active erosional landforms mapped in 1984. Increased availability of sediment in the Permanente Creek basin appears to be indicated by elevated intercepts of sediment-transport curves. A comparison of sediment-transport curves for the West Fork Permanente Creek with similar curves for the Permanente Creek basin under natural conditions suggests that the sediment yield from Permanente Creek is about 3.5 times higher than it would be under natural basin conditions. The increased yield apparently is due to an increase in sediment availability rather than an increase in runoff. (USGS)

  15. The Kaiser Permanente Implant Registries: Effect on Patient Safety, Quality Improvement, Cost Effectiveness, and Research Opportunities

    PubMed Central

    Paxton, Elizabeth W; Inacio, Maria CS; Kiley, Mary-Lou

    2012-01-01

    Introduction: Considering the high cost, volume, and patient safety issues associated with medical devices, monitoring of medical device performance is critical to ensure patient safety and quality of care. The purpose of this article is to describe the Kaiser Permanente (KP) implant registries and to highlight the benefits of these implant registries on patient safety, quality, cost effectiveness, and research. Methods: Eight KP implant registries leverage the integrated health care system's administrative databases and electronic health records system. Registry data collected undergo quality control and validation as well as statistical analysis. Results: Patient safety has been enhanced through identification of affected patients during major recalls, identification of risk factors associated with outcomes of interest, development of risk calculators, and surveillance programs for infections and adverse events. Effective quality improvement activities included medical center- and surgeon-specific profiles for use in benchmarking reports, and changes in practice related to registry information output. Among the cost-effectiveness strategies employed were collaborations with sourcing and contracting groups, and assistance in adherence to formulary device guidelines. Research studies using registry data included postoperative complications, resource utilization, infection risk factors, thromboembolic prophylaxis, effects of surgical delay on concurrent injuries, and sports injury patterns. Conclusions: The unique KP implant registries provide important information and affect several areas of our organization, including patient safety, quality improvement, cost-effectiveness, and research. PMID:22745614

  16. Kaiser Permanente Northern California: current experiences with internet, mobile, and video technologies.

    PubMed

    Pearl, Robert

    2014-02-01

    The US health care system has been slow to adopt Internet, mobile, and video technologies, which have the capability to engage patients in their own care, increase patients' access to providers, and possibly improve the quality of care while reducing costs. Nevertheless, there are some pockets of progress, including Kaiser Permanente Northern California (KPNC). In 2008 KPNC implemented an inpatient and ambulatory care electronic health record system for its 3.4 million members and developed a suite of patient-friendly Internet, mobile, and video tools. KPNC has achieved many successes. For example, the number of virtual "visits" grew from 4.1 million in 2008 to an estimated 10.5 million in 2013. This article describes KPNC's experience with Internet, mobile, and video technologies and the obstacles faced by other health care providers interested in embracing them. The obstacles include the predominant fee-for-service payment model, which does not reimburse for virtual visits; the considerable investment needed to deploy these technologies; and physician buy-in. PMID:24493768

  17. The Pathways Study: A Prospective Study of Breast Cancer Survivorship within Kaiser Permanente Northern California

    PubMed Central

    Kwan, Marilyn L.; Ambrosone, Christine B.; Lee, Marion M.; Barlow, Janice; Krathwohl, Sarah E.; Ergas, Isaac Joshua; Ashley, Christine H.; Bittner, Julie R.; Darbinian, Jeanne; Stronach, Keren; Caan, Bette J.; Davis, Warren; Kutner, Susan E.; Quesenberry, Charles P.; Somkin, Carol P.; Sternfeld, Barbara; Wiencke, John K.; Zheng, Shichun; Kushi, Lawrence H.

    2008-01-01

    Objective With 2.3 million breast cancer survivors in the U.S. today, identification of modifiable factors associated with breast cancer recurrence and survival is increasingly important. Only recently new studies have been designed to examine the impact of lifestyle factors on prognosis, including Pathways, a prospective study of women with breast cancer in Kaiser Permanente Northern California (KPNC). Methods Pathways aims to examine the effect on recurrence and survival of 1) lifestyle factors such as diet, physical activity, quality of life, and use of alternative therapies and 2) molecular factors such as genetic polymorphisms involved in metabolism of chemotherapeutic agents. Eligibility includes any woman diagnosed with invasive breast cancer within KPNC, no previous diagnosis of other invasive cancer, age 21 years or older, and ability to speak English, Spanish, Cantonese, or Mandarin. Newly-diagnosed patients are identified daily from electronic pathology records and are enrolled within two months of diagnosis. An extensive baseline interview is conducted, blood and saliva samples are collected, and body measurements are taken. Women are followed for lifestyle updates, treatment, and outcomes by self-report and query of KPNC databases. Results Recruitment began in January 9, 2006, and as of January 16, 2008, 1,539 women have been enrolled along with collection of 1,323 blood samples (86%) and 1,398 saliva samples (91%). Conclusions The Pathways Study will become a rich resource to examine behavioral and molecular factors and breast cancer prognosis. PMID:18478338

  18. Using photovoice as a participatory evaluation tool in Kaiser Permanente's Community Health Initiative.

    PubMed

    Kramer, Leila; Schwartz, Pamela; Cheadle, Allen; Rauzon, Suzanne

    2013-09-01

    Photovoice is a community-based participatory research method that provides participants who traditionally have little voice in community policy decisions, with training in photography, ethics, critical dialogue, photo captioning, and policy advocacy. Photovoice has been used primarily as a needs assessment and advocacy tool and only rarely as a pre-/postintervention evaluation method. This article describes the use of Photovoice as a participatory evaluation method in the Community Health Initiative, a 6-year, multisite community-based obesity prevention initiative, sponsored by Kaiser Permanente. Fifty community participants (including six youth) from six Community Health Initiative communities used photos and captions to identify, from their perspective, the most significant accomplishments from the initiative at both baseline and follow-up. Accomplishments identified included increased access to fresh/healthy food in local neighborhoods; policy changes supporting a "healthy eating, active living" community; increased access to physical activity; changes to the built environment creating increased neighborhood walkability/safety; and leadership development. PMID:23159999

  19. Breaching the Security of the Kaiser Permanente Internet Patient Portal: the Organizational Foundations of Information Security

    PubMed Central

    Collmann, Jeff; Cooper, Ted

    2007-01-01

    This case study describes and analyzes a breach of the confidentiality and integrity of personally identified health information (e.g. appointment details, answers to patients’ questions, medical advice) for over 800 Kaiser Permanente (KP) members through KP Online, a web-enabled health care portal. The authors obtained and analyzed multiple types of qualitative data about this incident including interviews with KP staff, incident reports, root cause analyses, and media reports. Reasons at multiple levels account for the breach, including the architecture of the information system, the motivations of individual staff members, and differences among the subcultures of individual groups within as well as technical and social relations across the Kaiser IT program. None of these reasons could be classified, strictly speaking, as “security violations.” This case study, thus, suggests that, to protect sensitive patient information, health care organizations should build safe organizational contexts for complex health information systems in addition to complying with good information security practice and regulations such as the Health Insurance Portability and Accountability Act (HIPAA) of 1996. PMID:17213500

  20. Initial Kaiser Permanente Southern California Experience Embracing the New Technology of Transcatheter Closure of Atrial Septal Defects

    PubMed Central

    Rosengart, Ronald M; Salem, Morris M; Degner, Timothy L; Sapin, Samuel O

    2004-01-01

    As a result of individual physicians initiative, transcatheter closure of secundum atrial septal defectsa new procedurewas made available to patients in the Kaiser Permanente (KP) Southern California Region soon after the US Food and Drug Administration (FDA) approved use of the AMPLATZER Septal Occluder. This ingenious device and the procedure for its implantation are described along with results of implantation in our initial 51 pediatric and adult patients. These results are compared with other published results. The clinical implications of using this new procedure are major: Many pediatric and adult patients with atrial septal defects can now benefit from nonoperative closure of these defects. On the basis of these observations, we attest to the commitment of Permanente physicians to incorporate technical advances into medical practice and to assess KPs experience using the new technology. PMID:26705314

  1. Kaiser Permanente/Sandia National health care model. Phase I prototype final report. Part 1 - model overview

    SciTech Connect

    Edwards, D.; Yoshimura, A.; Butler, D.; Judson, R.

    1996-11-01

    This report describes the results of a Cooperative Research and Development Agreement between Sandia National Laboratories and Kaiser Permanente Southern California to develop a prototype computer model of Kaiser Permanente`s health care delivery system. As a discrete event simulation, SimHCO models for each of 100,000 patients the progression of disease, individual resource usage, and patient choices in a competitive environment. SimHCO is implemented in the object-oriented programming language C++, stressing reusable knowledge and reusable software components. The versioned implementation of SimHCO showed that the object-oriented framework allows the program to grow in complexity in an incremental way. Furthermore, timing calculations showed that SimHCO runs in a reasonable time on typical workstations, and that a second phase model will scale proportionally and run within the system constraints of contemporary computer technology. This report is published as two documents: Model Overview and Domain Analysis. A separate Kaiser-proprietary report contains the Disease and Health Care Organization Selection Models.

  2. Modle mathmatique pour l'tude des quilibres physico-chimiques de permanentes.

    PubMed

    Chiodi, F

    1989-12-01

    Rsum La plupart des permanentes du commerce sont constitues d'acide thioglycolique (ventuellement associ l'acide thiolactique), neutralis par l'ammoniac, elles sont additionnes de carbonate d'ammonium comme tampon. Le systme peut etre trait comme la neutralisation d'un mlange d'acides thioglycolique et carbonique par l'ammoniac, et il est compltement dfini par trois paramtres, trois concentrations, ou deux concentrations et le pH, ou trois paramtres analytiques indpendants. Les calculs thoriques de l'quilibre sont compliqus du fait qu'il s'agit de l'quilibre de deux diacides faibles neutraliss par une base faible. Un modle mathmatique dvelopp exclusivement par des quations thoriques permet l'interprtation des quilibres et la ralisation des calculs fiable pour la prparation des formules remplissant certaines caractristiques. Le modle permet de raliser facilement des simulations en faisant varier les concentrations, les acides (par la voie des constantes de dissociation) ou d'associer diffrents acids et/ou bases organiques ou minrales. Une application complmentaire du modle est de tracer la courbe drive la courbe de neutralisation et de cette faon mesurer l'effet tampon en diffrents points par la mesure de sa pente. Synopsis Mathematical model for the study of physico-chemical equilibria in permanent wave solutions Most waving lotions on the market are prepared with thioglycolic acid (eventually associated with thiolactic acid) neutralized with ammonium hydroxide and buffered with ammonium bicarbonate. The system can be treated as the neutralization of a mix of carbonic acid and thioglycolic acid by ammonia and it is completely defined by three parameters: three concentrations; or two concentrations and pH; or three independent analytical parameters. Theoretical calculations of the equilibrium are difficult because the equilibrium involves at least two weak acids with a weak base. A mathematical model based exclusively on theoretical considerations allows the interpretation of equilibrium and performs accurate calculations of quantities of ingredients for preparations of permanent wave solutions satisfying special conditions. The model allows simulations by modifying concentrations, the acids (by using dissociation constants) or association between different acids and/or bases, organic or mineral. A complementary application of the model is the construction of a curve derived from the neutralization curve to evaluate the buffer effect at different points by the measure of the slope of the curve. PMID:19456957

  3. Kaiser Permanente Georgia's Experience with Operation Zero: A Group Medical Appointment to Address Pediatric Overweight

    PubMed Central

    Hinchman, Josephine; Beno, Luke; Mims, Adrienne

    2006-01-01

    Context: The rate of overweight (OW) in children in the United States has more than tripled since 1980. The health consequences of pediatric OW include type 2 diabetes and significant illness later in life. Treating pediatric OW is a necessity; however, health care clinicians have minimal access to successful and comprehensive treatment modalities for addressing it. Objective: Kaiser Permanente of Georgia (KPGA) offers a group medical appointment clinic, Operation Zero (O.Z.), as a referral program for preadolescent and adolescent patients who are in the 85th or higher percentile for body mass index (BMI) for their age. The eight-session clinic uses a family-oriented approach and provides a supportive group environment with interactive learning, games, physical activity, and creative problem solving. The goal of the program is to improve lifestyle behaviors for nutrition and physical activity. Clinically, meeting these goals can manifest as reductions in body fat (BF), waist size, and BMI-for-age percentile. Two implementation models help improve dissemination of the program within KPGA. Design: Baseline and eight-week postclinical outcomes for O.Z. participants were analyzed to determine program effectiveness. A retrospective analysis with a control group looked at long-term clinical outcomes to determine weight maintenance. Main outcome measures were weight, BMI-for-age percentile, waist size, and percentage of body fat (%BF). Results: At eight weeks after program completion compared with baseline, there were significant reductions in %BF and waist size for the total sample and specifically for adolescents, preteens, and participants who attended six or more sessions. Among O.Z. participants, there were insignificant increases in weight at six months after program participation and BMI-for-age percentile at one year after participation. At six months, the mean change in weight and BMI in the O.Z. group was statistically less than the mean change in the control group. Conclusions: A structured, family-oriented weight management program is effective in changing measures consistent with improved weight management. PMID:21519478

  4. Wellness Coaching for People With Prediabetes: A Randomized Encouragement Trial to Evaluate Outreach Methods at Kaiser Permanente, Northern California, 2013

    PubMed Central

    Xiao, Hong; Adams, Sara R.; Goler, Nancy; Sanna, Rashel S.; Boccio, Mindy; Bellamy, David J.; Brown, Susan D.; Neugebauer, Romain S.; Ferrara, Assiamira

    2015-01-01

    Introduction Health coaching can improve lifestyle behaviors known to prevent or manage chronic conditions. Little is known about effective ways to encourage health and wellness coaching among people who might benefit. The purpose of this randomized encouragement trial was to assess the relative success of 3 outreach methods (secured email message, telephone message, and mailed letter) on the use of wellness coaching by people with prediabetes. Methods A total of 14,584 Kaiser Permanente Northern California (KPNC) patients with diagnosed prediabetes (fasting plasma glucose, 110–125mg/dL) were randomly assigned to be contacted via 1 of 4 intervention arms from January through May 2013. The uptake rate (making an appointment at the Wellness Coaching Center [WCC]) was assessed, and the association between uptake rate and patient characteristics was examined via multivariable logistic regression. Results The overall uptake rate across intervention arms was 1.9%. Secured email message had the highest uptake rate (3.0%), followed by letters and telephone messages (P < .05 for all pairwise comparisons). No participants in the usual-care arm (ie, no outreach) made an appointment with the WCC. For each year of increased age, the estimated odds of the uptake increased by 1.02 (odds ratio [OR] = 1.02; 95% CI, 1.01–1.04). Women were nearly twice as likely to make an appointment at the WCC as men (OR = 1.87; 95% CI, 1.40–2.51). Conclusion Our results suggest that the WCC can recruit and encourage KPNC members with prediabetes to participate in the WCC. Future research should focus on increasing participation rates in health coaching among patients who may benefit. PMID:26605707

  5. Internet Infrastructures and Health Care Systems: a Qualitative Comparative Analysis on Networks and Markets in the British National Health Service and Kaiser Permanente

    PubMed Central

    2002-01-01

    Background The Internet and emergent telecommunications infrastructures are transforming the future of health care management. The costs of health care delivery systems, products, and services continue to rise everywhere, but performance of health care delivery is associated with institutional and ideological considerations as well as availability of financial and technological resources. Objective To identify the effects of ideological differences on health care market infrastructures including the Internet and telecommunications technologies by a comparative case analysis of two large health care organizations: the British National Health Service and the California-based Kaiser Permanente health maintenance organization. Methods A qualitative comparative analysis focusing on the British National Health Service and the Kaiser Permanente health maintenance organization to show how system infrastructures vary according to market dynamics dominated by health care institutions ("push") or by consumer demand ("pull"). System control mechanisms may be technologically embedded, institutional, or behavioral. Results The analysis suggests that telecommunications technologies and the Internet may contribute significantly to health care system performance in a context of ideological diversity. Conclusions The study offers evidence to validate alternative models of health care governance: the national constitution model, and the enterprise business contract model. This evidence also suggests important questions for health care policy makers as well as researchers in telecommunications, organizational theory, and health care management. PMID:12554552

  6. Storm-runoff generation in the Permanente Creek drainage basin, west central California - An example of flood-wave effects on runoff composition

    USGS Publications Warehouse

    Nolan, K.M.; Hill, B.R.

    1990-01-01

    Variations in the isotopic and chemical composition of storm runoff in the 10.6-km2 Permanente Creek basin, Santa Clara County, California, indicate that changes in water composition lag behind changes in streamflow. This lag occurs even though field observations and rainfall-runoff modeling indicate that much of the storm runoff must be composed of "new" water running off impervious surfaces. The apparent incompatibility posed by the presence of "old" water and the direct and indirect evidence that surface runoff contributes substantially to storm runoff can be explained if initial rises in streamflow result from effects of flood waves. Flood waves composed of old channel water reach downstream locations ahead of the new water derived from impervious areas. By this mechanism, streamflow can rise rapidly in response to surface runoff and still be composed of large amounts of old water. Data collected in Permanente Creek indicate that flood waves can occur even in small basins, at least when those basins contain impervious surfaces. ?? 1990.

  7. Expanding Access to Care and Improving Quality in the Mid-Atlantic States Safety-Net Clinics: Kaiser Permanente's Community Ambassador Program.

    PubMed

    Maeda, Jared Lane K; Bradley, Jacqueline J; Eissler, Sarah R; Lobrano, Marcia; Rubin, Mindy R; Gay, Maritha; Horberg, Michael A; Loftus, Bernadette C

    2015-01-01

    The Community Ambassador Program (CAP) in the Mid-Atlantic States Region places Kaiser Permanente-employed nurse practitioners, midwives, and physician assistants to work in the safety-net clinics and share best practices through a long-term community collaboration. The authors conducted an evaluation of 18 safety-net clinics that participated in the CAP in 2012. The Community Ambassadors provided an estimated 32,249 encounters to 11,988 patients. Performance was at or near 90% for 2 adult quality measures (weight screening and tobacco use assessment). For breast cancer screenings, however, performance among the Community Ambassadors was much lower (48%). The program expanded access and improved quality of care. PMID:25785638

  8. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente Nationwide Health Information Network Exchange in San Diego: Patient Selection, Consent, and Identity Matching

    PubMed Central

    Bouhaddou, Omar; Bennett, Jamie; Cromwell, Tim; Nixon, Graham; Teal, Jennifer; Davis, Mike; Smith, Robert; Fischetti, Linda; Parker, David; Gillen, Zachary; Mattison, John

    2011-01-01

    The Nationwide Health Information Network allow for the secure exchange of Electronic Health Records over the Internet. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente, participated in an implementation of the NwHIN specifications in San Diego, California. This paper focuses primarily on patient involvement. Specifically, it describes how the shared patients were identified, were invited to participate and to provide consent for disclosing parts of their medical record, and were matched across organizations. A total 1,144 were identified as shared patients. Invitation letters containing consent forms were mailed and resulted in 42% participation. Invalid consent forms were a significant issue (25%). Initially, the identity matching algorithms yielded low success rate (5%). However, elimination of certain traits and abbreviations and probabilistic algorithms have significantly increased matching rate. Access to information from external sources better informs providers, improves decisions and efficiency, and helps meet the meaningful use criteria. PMID:22195064

  9. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente Nationwide Health Information Network exchange in San Diego: patient selection, consent, and identity matching.

    PubMed

    Bouhaddou, Omar; Bennett, Jamie; Cromwell, Tim; Nixon, Graham; Teal, Jennifer; Davis, Mike; Smith, Robert; Fischetti, Linda; Parker, David; Gillen, Zachary; Mattison, John

    2011-01-01

    The Nationwide Health Information Network allow for the secure exchange of Electronic Health Records over the Internet. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente, participated in an implementation of the NwHIN specifications in San Diego, California. This paper focuses primarily on patient involvement. Specifically, it describes how the shared patients were identified, were invited to participate and to provide consent for disclosing parts of their medical record, and were matched across organizations. A total 1,144 were identified as shared patients. Invitation letters containing consent forms were mailed and resulted in 42% participation. Invalid consent forms were a significant issue (25%). Initially, the identity matching algorithms yielded low success rate (5%). However, elimination of certain traits and abbreviations and probabilistic algorithms have significantly increased matching rate. Access to information from external sources better informs providers, improves decisions and efficiency, and helps meet the meaningful use criteria. PMID:22195064

  10. Como Lo Hago Yo: Myelomeningocele

    PubMed Central

    Lazareff, Jorge

    2014-01-01

    Fortificación con ádico fólico es efectiva, pero aún falta conciencia en los jóvenes. La legalidad del aborto aumenta la importancia de la consulta prenatal. Realizo la cirugía bajo microcoscopio por razones didácticas. Irrigación continua para reducir la temperatura del tejido. Trato a la plaqueta como tejido viable. No suturo la plaqueta. No cierro músculo. ATB por una semana después de cirugía. Hidrocefalia: Válvula en todos los casos de ventriculomegalia. Médula anclada: Desanclar una sola vez. Chiari II: Revisar la válvula. Incluir en el seguimiento rendimiento escolar, puede indicar obstrucción de la válvula o médula anclada. PMID:24791217

  11. Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

    PubMed Central

    2011-01-01

    Background As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison with care in Kaiser Permanente (KP), an integrated delivery system based in the United States. We investigated population rates of hospitalisation and readmission rates for ambulatory care sensitive, chronic medical conditions in the two systems. Methods Using a historical cohort study design, age and gender adjusted population rates of hospitalisations for angina, heart failure, chronic obstructive pulmonary disease, and hypertension, plus rates of 30-day readmission and mortality were investigated for all individuals aged 65+ in the DHS and KP. Results DHS had substantially higher rates of hospitalisations, readmissions, and mean lengths of stay per hospitalisation, than KP had. For example, the adjusted angina hospitalisation rates in 2007 for the DHS and KP respectively were 1.01/100 persons (95%CI: 0.98-1.03) vs. 0.11/100 persons (95%CI: 0.10-0.13/100 persons); 21.6% vs. 9.9% readmission within 30 days (OR = 2.53; 95% CI: 1.84-3.47); and mean length of stay was 2.52 vs. 1.80 hospital days. Mortality up through 30 days post-discharge was not consistently different in the two systems. Conclusions There are substantial differences between the DHS and KP in the rates of preventable hospitalisations and subsequent readmissions associated with chronic conditions, which suggest much opportunity for improvement within the Danish healthcare system. Reductions in hospitalisations also could improve patient welfare and free considerable resources for use towards preventing disease exacerbations. These conclusions may also apply for similar public systems such as the US Medicare system, the NHS and other systems striving to improve the integration of care for persons with chronic conditions. PMID:22192270

  12. COMO - A Program For Optical Design

    NASA Astrophysics Data System (ADS)

    Vollrath, Wolfgang

    1986-10-01

    COMO is an optical design program of a special orthogonalization type, developed by Prof. H.Marx at Ernst Leitz Wetzlar Company. Not using a merit function, COMO corrects aberrations under equality and inequality constraints not simultaneously but sequentially, the order is chosen by the optical designer. The optimization procedure shows distinctive features compared to other programs. COMO is in use at Leitz since the early 1970's and is now running on HP-1000F and HP-A900 computer systems. In 1974, when it was implemented on a HP-2100, it was probably one of the very first "mainfrawe" optical design programs running on a minicomputer. H.Marx named this program COMO.

  13. Rechenverfahren des optischen Korrektionsprogrammms "COMO". Teil 1.

    NASA Astrophysics Data System (ADS)

    Marx, H.

    1989-03-01

    COMO is a program of an orthogonalization type that was developed in order to achieve that each elementary correction step makes immediate use of the shortest possible step in the system data space even if many rigid boundary conditions are to be taken into account (optimization under constraints). COMO usually does not correct aberrations simultaneously (by minimization), but one after the other. The order is given by the optical designer. For each aberration (paraxial data included) one can either specify a target value or a bandwidth between a lower and an upper limit.

  14. Como Lo Hago Yo: Mielomeningocele En Bolivia

    PubMed Central

    Dabdoub, Carlos F.; Dabdoub, Carlos B.; Villavicencio, Ramiro; Quevedo, Germán

    2014-01-01

    Introducción: Las malformaciones del tubo neural (MTN) representan la segunda causa más frecuente de anomalías congénitas, luego de las cardiopatías. En este grupo se destaca el mielomeningocele (MMC) por su mayor incidencia, y por ser la más incapacitante y la más compleja entre todas las demás malformaciones del sistema nervioso c`entral (SNC). En Bolivia, como en muchos países de Sudamérica, los bajos niveles socio-culturales y la debilidad en el sistema sanitario, hacen que su incidencia y su morbilidad, sean mayores que en las naciones más desarrolladas. Material y Métodos: Se realizó un estudio retrospectivo y descriptivo de 70 casos de MMC, atendidos por un equipo multidisciplinario en el Hospital Universitario Japonés (HUJ) de Santa Cruz de la Sierra, entre 2008-2011. De ellos, 60 fueron intervenidos quirúrgicamente. Resultados: Se realizaron controles prenatales sólo en 27 mujeres (38.6%), diagnosticándose una disrafia espinal en apenas dos casos (7.4%). La edad de ingreso del MMC en su mayoría fue después de las 24 horas (65.6%), predominando su localización en la región lumbosacra (64.3%). De ellos, 67.2% eran abiertos, presentando un 32.9% un daño neurológico motor parcial mientras que 47.1% tenían paraplejia por debajo de la lesión. De los 70 casos, tres (4.3%) no fueron intervenidos, por presentar defectos congénitos severos o estado general grave. Las principales complicaciones posoperatorias inmediatas fueron: dehiscencia de sutura y/o infección de la herida (16.6%), fístula de líquido cefalorraquídeo (LCR) (10%) e infección del SNC (11.7%). La mortalidad general y postoperatoria fue de 7.1% y 3.3%, respectivamente. Al mes de vida presentaban hidrocefalia un 80% de los pacientes operados, colocándose una derivación ventriculoperitoneal (DVP) de presión media. De 9 pacientes que tuvieron un acompanamiento de dos o más años, seis presentaron una médula anclada, que fueron intervenidas quirúrgicamente. Conclusión: En esta serie, el diagnóstico prenatal del MMC fue ocasional y la derivación al HUJ de los recién nacidos con esta malformación fue generalmente tardía. No hubo predominio de género y la mayoría de los casos presentaron sus lesiones en la región lumbar y lumbosacra. La mortalidad general y postoperatoria fue similar a la reportada en la literatura. Pocos enfermos realizaron controles posteriores al alta hospitalaria. Igual que otros países de Sudamérica, las falencias en el sistema público de salud y el nivel sociocultural, son factores determinantes para un mal pronóstico en estos niños. Por sus múltiples complicaciones, el MMC requiere de una especial atención gubernamental, sobre todo de carácter preventivo mediante el uso de ácido fólico en mujeres fértiles, como también de un equipo profesional multidisciplinario, a fin de realizar un tratamiento adecuado y oportuno. Al mismo tiempo, trabajos multicéntricos en hospitales de América Latina, ayudarán al mejor manejo de estos pacientes. PMID:24791220

  15. 15. Como gatehouse (outlet tower) and access bridge, looking west ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. Como gatehouse (outlet tower) and access bridge, looking west from dam crest (Trash rack visible in reservoir pool behind and right of tower) - Bitter Root Irrigation Project, Como Dam, West of U.S. Highway 93, Darby, Ravalli County, MT

  16. Harold Varmus investido bajo juramento como 14.º director d

    Cancer.gov

    Ganador del Premio Nobel, doctor Harold E. Varmus, prestó juramento hoy como 14.º director del Instituto Nacional del Cáncer (NCI).  "Es muy estimulante que estés de regreso con nosotros", dijo la secretaria del Departamento de Salud y Servicios Humanos K

  17. LA BIOÉTICA COMO QUEHACER FILOSÓFICO

    PubMed Central

    Ferrer, Jorge José

    2009-01-01

    El artículo examina el estatuto epistemológico de la bioética como disciplina académica. El autor sostiene que el estatuto epistemológico de un discurso lo determina la pregunta fundamental que se plantea y la respuesta que se busca, focos integradores del discurso. En el caso de la bioética, la pregunta fundamental es de índole moral. La bioética es pues una disciplina ética que tiene su hogar epistemológico en la filosofía. El autor también defiende el concepto de “éticas aplicadas”. Sugiere finalmente que el método de la bioética, sobre todo la que se hace desde nuestras latitudes, debería adoptar el círculo hermenéutico como metodología para su filosofar. PMID:20463860

  18. Recent DDT and PCB contamination in the sediment and biota of the Como Bay (Lake Como, Italy).

    PubMed

    Bettinetti, R; Quadroni, S; Boggio, E; Galassi, S

    2016-01-15

    Due to its peculiar geographical and morphological characteristics, Lake Como (Northern Italy) represents an interesting study-case for investigating the sub-basin scale circulation of persistent organic pollutants (POPs) that, despite being banned since the 1970s, have reached surprisingly high concentrations in some southern alpine lakes as a consequence of their release from melting glaciers in recent years. In particular, the Como Bay, which is located in the city of Como, seems noteworthy because its waters have a longer residence time than the other areas of the lake. The analyses of the historical concentration of PCBs, pp′DDT and its metabolites in a sediment core sampled from the Como Bay covering a time-period from their ban to recent times, showed that the DDTs have never experienced a significant (p < 0.05) decrease over time, with concentrations of the most abundant homologue, pp′DDE, ranging from 27 to 75 ng g(-1) d.w. Conversely PCBs significantly (p < 0.05) decreased towards recent times, reaching concentrations around 80 ng g(-1) d.w. The contribution of high altitude and local sources was recorded also in the food web: both zooplankton and the zooplanktivorous fish agone were mainly contaminated by pp′DDE (81.4 ng g(-1) w.w. and 534.6 ng g(-1) w.w. respectively) and by the PCB metabolite hexa-CB (449.7 ng g(-1) w.w. and 1672.1 ng g(-1) w.w. respectively). The DDT concentrations in the agone (sampled during the years 2006–2009) never exceeded the limits for human consumption in Italy, while concentrations of six selected PCBs exceeded human health advisory recommendations in one of the fish samples analysed, when it was approximately two times higher than the recommended value of 125 ng g(-1) w.w. PMID:26520265

  19. 78 FR 36163 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ...The USDA Forest Service, Bitterroot National Forest will prepare an environmental impact statement (EIS) to document and disclose the effects analysis of the proposed Como Forest Health Project (Como FHP). The Como FHP covers approximately 5,640 acres of national forest land between Lake Como and Lost Horse Roads, about XX miles northwest of Darby in Ravalli County, Montana. The purpose of the......

  20. Morphological investigation of nanostructured CoMo catalysts

    NASA Astrophysics Data System (ADS)

    Pawelec, B.; Castao, P.; Zepeda, T. A.

    2008-04-01

    This work reports the morphological investigation of nanostructured sulfided CoMo catalysts by means of high-resolution transmission electron microscopy (HRTEM). The catalysts were supported on Ti-modified hexagonal mesoporous silica (HMS-Ti) and P-modified HMS-Ti (P/HMS-Ti) materials. The oxide precursors were characterized by specific surface area (S BET), temperature-programmed reduction (TPR), diffuse reflectance infrared Fourier transform spectroscopy in the OH region (DRIFTS-OH) and X-ray photoelectron spectroscopy (XPS) in order to elucidate the influence of the impregnation sequence (successive vs. simultaneous) and the effect of P-incorporation into HMS-Ti material on the morphology of calcined CoMo catalysts. Both TPR and XPS measurements indicate that the catalysts prepared by successive impregnation possess well-dispersed MoO 3 and CoO phases, whereas their counterparts prepared by simultaneous impregnation additionally possess the CoMoO 4 phase. For all sulfided catalysts, the presence of MoS 2 phase with particle size in the range 3.3-4.4 nm was confirmed by HRTEM. Catalytic activity was evaluated in the reaction of hydrodesulfurization (HDS) of dibenzothiophene (DBT) carried out in a flow reactor at 593 K and hydrogen pressure of 5.5 MPa. P-incorporation into the HMS-Ti material led to an overall increase in HDS activity and the hydrogenation ability of the sulfided catalysts. All catalysts proved to be stable during 10 h time-on-stream (TOS) operation. The activity of sulfide catalysts in the target reaction depends linearly on the surface exposure of Co species in the oxide precursors, as determined by XPS, and on the morphology of the sulfide form of catalysts (surface density of MoS 2 particles and their sizes) as determined by HRTEM.

  1. Thermophysical properties of undercooled liquid Co-Mo alloys

    NASA Astrophysics Data System (ADS)

    Han, X. J.; Wei, B.

    2003-05-01

    Using electromagnetic levitation in combination with the oscillating drop technique and drop calorimeter method, the surface tensions and specific heats of undercooled liquid Co-10 wt% Mo, Co-26.3 wt% Mo, and Co-37.6 wt% Mo alloys were measured. The containerless state during levitation produces substantial undercoolings up to 223 K (0.13TL), 213 K (0.13TL) and 110 K (0.07TL) respectively for these three alloys. In their respective undercooling ranges, the surface tensions were determined to be 1895 m 0.31(T m 1744), 1932 m 0.33(T m 1682), and 1989 m 0.34(T m 1607) mN mу. According to the Butler equation, the surface tensions of these three Co-Mo alloys were also calculated, and the results agree well with the experimental data. The specific heats of these three alloys are determined to be 41.85, 43.75 and 44.92 J molу Kу. Based on the determined surface tensions and specific heats, the changes in thermodynamics functions such as enthalpy, entropy and Gibbs free energy are predicted. Furthermore, the crystal nucleation, dendrite growth and Marangoni convection of undercooled Co-Mo alloys are investigated in the light of these measured thermophysical properties.

  2. Desulfurization of benzenethiol on Co?Mo(110) phases

    NASA Astrophysics Data System (ADS)

    Chen, D. A.; Friend, C. M.; Xu, H.

    1998-01-01

    The desulfurization of benzenethiol on Co-covered Mo(110) ( ?Co = 0.25-1.3 ML) produces benzene, H 2 and adsorbed carbon and sulfur. Benzene is formed via adsorbed phenyl thiolate, which is identified by X-ray photoelectron and electron energy loss spectroscopies. Benzene production is attributed to reaction on Co, since it is evolved at a temperature well below that required for sulfur-induced aggregation of Co. The reaction products and mechanisms are qualitatively similar on Co-covered Mo(110) and a range of other transition metal surfaces. The selectivity for benzene production on the 1.3 ML Co overlayer, 65%, is higher than on many surfaces. Furthermore, benzene evolution occurs at a very low temperature, 125 K, on the 1.3 ML Co film. Notably, we did not observe any new products or a dramatic change in reaction temperature or selectivity as a result of Co?Mo interactions or of structural changes in the Co layer. Comparison of the benzene evolution temperature for benzenethiol reaction with that of methane from methanethiol reaction on the close-packed Co overlays indicates that homolytic C?S bond scissions do not control the hydrogenolysis rate, in contrast to reaction on Mo(110) but similar to Ni(111). This difference may be due to hydrogen-induced structural transformations of the Co layer or to hydrogen-assisted C?S bond breaking.

  3. La educacion permanente del maestro (Continuing Teacher Education).

    ERIC Educational Resources Information Center

    Blat, Gimeno J.

    1971-01-01

    This article discusses the importance of continuing education for teachers and various aspects of the problem which should be considered. The role and function of the teacher is discussed; continuing education must assist in developing the teacher's ability to fulfill that role. The ever-changing demands on the teacher mean that the teacher's…

  4. L'education permanente: Principe revolutionnaire et pratiques conservatrices

    NASA Astrophysics Data System (ADS)

    Gelpi, Ettore

    1994-05-01

    Education, whether formal or non-formal, does not always adapt to dynamic cultural change or to shifting social needs, and is thus responsible for the crisis in education and for growing unmet demand. The industrial and technical revolutions have led to the spread of education, which is nonetheless marred by social injustice at national and international levels. A further contradiction is that the interests of the participants are insufficiently considered, and the question should be asked to what extent education violates respect for the rights of individuals and peoples. The educational crisis results also form the world crisis in ideologies, to which education frequently offers a reply which is regrettably academic. Research is restrained in the interests of reinforcing dependency, thus becoming a possible accomplice or prisoner of conservatism. Education is in part responsible for growing inequalities: therein resides the individual and collective challenge to fight against its use as an instrument of domination. The concept of the learner as educator overturns that of our societies in crisis. In order to realise it, a "planetary" approach is necessary, aware of the military and industrial origins of education. The transformation of drill into creativity is an arduous task but more than ever necessary.

  5. Cmulos globulares como trazadores de bimodalidad estelar en galaxias cD

    NASA Astrophysics Data System (ADS)

    Forte, J. C.

    Se muestra que tanto la forma de los perfiles de brillo como de color observados en dos galaxias arquetpicas de tipo cD (NGC 1399 y NGC 4486) son compatibles con la presencia de poblaciones estelares bi-modales que comparten la misma distribucin espacial y composicin qumica de las familias dominantes de cmulos globulares asociadas con ellas. El modelo resultante tambin predice una variacin de la frecuencia especfica de los cmulos como funcin del radio galactocntrico. Se discute este resultado en el contexto de una variedad de escenarios astrofsicos que intentan describir la formacin de galaxias cD.

  6. Interface observation of heat-treated Co/Mo2C multilayers

    NASA Astrophysics Data System (ADS)

    Yuan, Yanyan; Le Guen, Karine; Andr, Jean-Michel; Mny, Christian; Ulhaq, Corinne; Galtayries, Anouk; Zhu, Jingtao; Wang, Zhanshan; Jonnard, Philippe

    2015-03-01

    We study the interface evolution of a series of periodic Co/Mo2C multilayers as a function of the annealing temperature up to 600 C. Different complementary techniques are implemented to get information on the phenomenon taking place at the interfaces of the stack. The periodical structure of Co/Mo2C multilayer is proven by time-of-flight secondary ion mass spectrometry (ToF-SIMS) depth profiles which demonstrate the formation of an oxide layer at both air/stack and stack/substrate interfaces. From Nuclear magnetic resonance (NMR) spectra, we observed the intermixing phenomenon of Co and C atoms for the as-deposited sample, and then at annealing temperature above 300 C Co and C atoms separate from their mixed regions. Comparison of NMR results between Co/Mo2C and Co/C references confirms this phenomenon. This is in agreement with X-ray emission spectroscopy (XES) measurements. Furthermore the calculation of the Co-C, Co-Mo and Mo-C mixing enthalpy using Miedema's model gives a proof of the demixing of Co and C atoms present within the stacks above 300 C. From the transmission electron microscopy (TEM) analysis, we found the presence of some crystallites within the as-deposited sample as well as the mainly amorphous nature of all layers. This is confirmed using X-ray diffraction (XRD) patterns which also demonstrate the growth of crystallites induced upon annealing.

  7. Como os Alunos do Ensino Mdio da Rede Estadual de So Paulo obtm Conhecimentos Astronmicos?

    NASA Astrophysics Data System (ADS)

    da Cunha, W. S.; Voelzke, M. R.; Amaral, L. H.

    2005-08-01

    Atualmente vivencia-se um mundo globalizado onde os computadores e a internet permitiram um acesso rpido e seguro a todo tipo de informao e conhecimento. O presente trabalho visa analisar a maneira pela qual alunos de segundo grau da rede estadual da cidade de So Paulo obtiveram, caso tenham, conhecimentos bsicos de astronomia quanto aos fenmenos celestes que os rodeiam, tais como a sucesso dos dias e das estaes do ano, alm de question~los sobre fatos genricos tais como: o que vem a ser o Sol, o Big Bang, o que ocasionou a extino dos dinossauros. Para tanto foi elaborado um formulrio constando de questes de mltipla escolha, o qual foi aplicado no primeiro colegial diurno da Escola Estadual Guilherme de Almeida. Num espao amostral de 44 alunos constatou-se que 41% dos alunos adquiriram seus conhecimentos astronmicos na escola e 59% atravs da mdia em geral. Neste mesmo espao amostral apenas 11% dos alunos usaram computadores na escola, 41% na residncia, 5% no trabalho e 43% no utilizaram. O presente estudo revelou tambm que para 50% dos alunos o professor jamais utilizou um programa de computador a respeito de astronomia ou fez alguma apresentao sobre o tema. Embora em sua fase inicial este estudo revela claramente que a maioria dos alunos no obtm na escola seus conhecimentos astronmicos, estes provm de fontes no especificamente didtico-pedaggicas tais como filmes e revistas populares que no raramente geram conhecimentos incompletos e em muitos casos inclusive falhos.

  8. Telescpio de pequeno porte como suporte ao ensino em cidades com intensa poluio luminosa II

    NASA Astrophysics Data System (ADS)

    Pereira, P. C. R.; Santos-Jnior, J. M.; Cruz, W. S.

    2003-08-01

    Para a maioria dos estudantes, sua passagem pelo ensino formal fundamental envolve a transmisso de fatos que devem ser guardados para um exame, a habilidade para lembrar frmulas e, eventualmente, a repetio de experimentos que devem produzir resultados exigidos pelo professor. O resultado deste modelo de ensino, ao longo dos anos, conhecido por todos: desconhecimento e descontentamento, por parte dos estudantes, de temas relativos ao papel e aos processos da cincia. Acreditamos que a Astronomia, pelo seu carter observacional, uma das reas do conhecimento que pode contribuir neste cenrio. A Fundao Planetrio da Cidade do Rio de Janeiro possui um telescpio Meade LX-200 (25cm) que, juntamente com as cmeras CCD ST-7E e ST8E, tem sido utilizado em projetos voltados aos estudantes do ensino mdio desde o ano 2000. Tais projetos envolvem a conduo de um projeto de pesquisa observacional num nvel apropriado, e possibilitam o contato com tcnicas e novas tecnologias: computador, software para manipulao de dados e grficos, programas de tratamento e reduo de dados, uso de equipamentos ptico-eletrnicos (telescpio e CCD), bem como o processo de aquisio de conhecimento. Dentro da proposta dos anos anteriores, priorizamos projetos de uma noite, ou seja, procuramos trabalhar com fenmenos que apresentem variabilidade com intervalo de recorrncia relativamente curto. Em todos os casos, optamos pela fotometria diferencial, que tem se mostrado bastante eficiente para o cu luminoso como o da cidade do Rio de Janeiro. Neste painel, apresentamos alguns dos projetos desenvolvidos no ltimo ano, com 25 estudantes. Apresentamos os resultados da observao da varivel pulsante AI Vel (V = 6,6) e da varivel cataclsmica FO Aqr (V = 13,5), e do monitoramento do trnsito da lua de Jpiter, Europa, ocorrido em 30 de abril de 2003. As curvas de luz produzidas para as primeiras esto concordantes com as da literatura, assim como os respectivos perodos encontrados (1h20min e 4h48min). No caso do FO Aqr, ficou evidente, tambm, a modulao decorrente da rotao da an branca receptora (21min). O erro estimado de 0,01 magnitude. Propomos uma maior utilizao de telescpios de pequeno porte, como suporte ao ensino (mdio e superior) em cidades com poluio luminosa. Escolas e Planetrios seriam ambientes propcios para a localizao do telescpio. Os critrios adotados na escolha dos objetos e o mtodo observacional empregado so tambm apresentados.

  9. A Utilizao da Astronomia como Tema Interdisciplinar e Aplicaes de Objetos de Aprendizagem

    NASA Astrophysics Data System (ADS)

    da Silva, L. A.; Voelzke, M. R.

    2008-09-01

    Este trabalho visa analisar a possibilidade de relacionar contedos aplicados no ensino fundamental e mdio de forma interdisciplinar por intermdio da astronomia, com a interveno de objetos de aprendizagem que possam integrar as disciplinas e a utilizao de recursos tecnolgicos. Em uma pesquisa prvia com 20 professores de uma escola estadual situada na cidade de Guarulhos foi observado que apenas 25% dos professores utilizam algum recurso tecnolgico para o desenvolvimento de contedos pertinentes sua disciplina, tais como sites e softwares educativos, sendo que a maioria absoluta continua ensinando apenas com livros didticos. A maior parte dos professores apresenta dificuldades em trabalhar sua disciplina de forma interdisciplinar, ou seja, 75% dos professores preferem aplicar os contedos seguindo uma hierarquia linear de tpicos, evitando a discusso de temas que de alguma forma esto relacionados. A astronomia pode vir fascinar o ser humano e despertar sua curiosidade promovendo um maior interesse no aprendizado, podendo favorecer anlises interdisciplinares de forma lgica e objetiva, desta forma colocar a astronomia como tema motivador interdisciplinar, pode ser relevante no que se refere ao distanciamento da fragmentao dos contedos. No Estado de So Paulo, a implantao da proposta curricular no ensino fundamental e mdio mostra claramente a insero da astronomia na maior parte das sries, principalmente na 6ª srie em que todo o bimestre se fala de astronomia.

  10. The Astronomy Club of Araranguá: Educating Science Teachers as Science Communicators. (Breton Title: Clube de Astronomia de AraranguÁ: a Formação de Professores de Ciências Como Divulgadores Científicos. ) Club de Astronomía de Araranguá: la Formación del Profesorado Como Comunicadores de la Ciencia

    NASA Astrophysics Data System (ADS)

    Damasio, Felipe; Allain, Olivier; Antunes Rodrigues, Adriano

    2013-07-01

    The study reported in this work takes place since 2009 at the Federal Institute of Education, Science and Technology of Santa Catarina, Campus Araranguá. Our main goal is to help form teachers, training undergraduate students in Natural Sciences with specialization in Physics as science communicators, as well as to promote actions of broader scientific popularization in the region of the town of Araranguá through an Astronomy Club called CA2. Among the actions of scientific popularization that the students promote are: video production, radio broadcasts, lectures, nightly observations, preparation and exhibition of posters, physics teaching for children, continuing education activities for teachers and regular physics teaching using Astronomy as a theme. The Club's teacher education and scientific dissemination work is based on the Theory of Meaningful Learning, always trying to reach the student's predisposition to learn and produce potentially meaningful material, the two essential conditions for meaningful learning to occur. O estudo que este trabalho relata ocorre desde 2009 no Instituto Federal de Educação, Ciência e Tecnologia de Santa Catarina, campus Araranguá. Nele procura-se formar divulgadores científicos durante a formação inicial de docentes do curso de Licenciatura em Ciências da Natureza com habilitação em Física, além de promover ações de divulgação científica para o público geral da região da cidade de Araranguá por meio de um Clube de Astronomia chamado CA² (Clube de Astronomia de Araranguá). Entre as ações de divulgação científica que os licenciandos promovem estão: produção de vídeos, programas de rádio, palestras, observações noturnas, confecção e exposição de pôsteres, ensino de física para crianças, formação continuada de professores em atividades e ensino de Física regular utilizando a Astronomia como tema gerador. O trabalho de formação docente e divulgação científica do Clube fundamenta-se na Teoria da Aprendizagem Significativa, sempre procurando alcançar a pré-disposição em aprender e produzir material potencialmente significativo, as duas condições necessárias para que a aprendizagem significativa ocorra. El estudio relatado en este trabajo se lleva a cabo desde 2009 en el Instituto Federal de Educação, Ciência e Tecnología de Santa Catarina, campus Araranguá. En él se busca formar a comunicadores de la ciencia durante la formación inicial de los docentes Licenciatura en Ciencias Naturales con especialidad en Física, y también promover acciones de divulgación científica para el público en general en la región de Araranguá a través de un club de astronomía llamado CA2 (Clube de Astronomia Araranguá). Entres las acciones de los estudiantes que se promueven están: producción de videos, programas de radio, conferencias, observaciones nocturnas, la preparación y exposición de carteles, la educación en física para los niños, actividades de formación permanente del profesorado y enseñanza de la física de con el tema generador Astronomía. El trabajo de la formación del profesorado y la difusión de club científico se basa en la teoría del aprendizaje significativo, buscando siempre la predisposición para aprender y producir material potencialmente significativo, las dos condiciones necesarias para que ocurra el aprendizaje significativo.

  11. Las fulguraciones como manifestacin de reconexin en el campo magntico solar

    NASA Astrophysics Data System (ADS)

    Bagal, L. G.; Mandrini, M. C.; Rovira, M. G.; Dmoulin, P.

    Las fulguraciones solares son fenmenos transitorios de liberacin de energa que se desarrollan en las estructuras magnticas de las regiones activas del Sol. Las fulguraciones pueden llegar a liberar hasta 1032 erg en 100 seg. en todo el rango electromagntico, y acelerar partculas. En este trabajo mostramos que la ubicacin de los abrillantamientos en H? de diversas fulguraciones est relacionado con las propiedades de las conexiones de las lneas del campo magntico de la regin, como se espera por las teoras de reconexin en 3D recientemente desarrolladas (Dmoulin et al, 1996a). El campo magntico coronal se extrapola del campo fotosfrico observado suponiendo una configuracin libre de fuerzas lineal. Por medio de un algoritmo se determinan las regiones donde existe un cambio drstico en la conectividad de las lneas de campo (lmites ``cuasi-discontinuos'', o cuasi-separatrices CS). Las CS son bandas abiertas que identifican zonas donde el campo magntico se reconectar con ms probabilidad y, siempre que las mismas sean lo suficientemente finas, se producir allla liberacin de energa proveniente del campo magntico. Hemos encontrado que en todas las regiones fulgurantes estudiadas (Dmoulin et al, 1996b) existen CS en los mismos lugares donde se observaron los abrillantamientos en H?. Alldonde coinciden los abrillantamientos con las CS, stas tienen un espesor menor que 1 Mm. Las lneas de campo coronales extrapoladas de nuestro modelo tienen sus orgenes fotosfricos a ambos lados de las CS, como se espera dados los recientes estudios de reconexin magntica en 3D. Estos resultados ponen a prueba los modelos presentes sobre fulguraciones solares.

  12. DIABETES MELLITUS COMO FACTOR DE RIESGO DE DEMENCIA EN LA POBLACIÓN ADULTA MAYOR MEXICANA

    PubMed Central

    Silvia, Mejía-Arango; Clemente, y Zúñiga-Gil

    2012-01-01

    Introduccion La diabetes mellitus y las demencias constituyen dos problemas crecientes de salud entre la población adulta mayor del mundo y en particular de los paises en desarrollo. Hacen falta estudios longitudinales sobre el papel de la diabetes como factor de riesgo para demencia. Objetivo Determinar el riesgo de demencia en sujetos Mexicanos con diabetes mellitus tipo 2. Materiales y Metodos Los sujetos diabéticos libres de demencia pertenecientes al Estudio Nacional de Salud y Envejecimiento en México fueron evaluados a los dos años de la línea de base. Se estudió el papel de los factores sociodemográficos, de otras comorbilidades y del tipo de tratamiento en la conversión a demencia. Resultados Durante la línea de base 749 sujetos (13.8%) tuvieron diabetes. El riesgo de desarrollar demencia en estos individuos fue el doble (RR, 2.08 IC 95%, 1.59–2.73). Se encontró un riesgo mayor en individuos de 80 años y más (RR 2.44 IC 95%, 1.46–4.08), en los hombres (RR, 2.25 IC 95%, 1.46–3.49) y en sujetos con nivel educativo menor de 7 años. El estar bajo tratamiento con insulina incrementó el riesgo de demencia (RR, 2.83, IC 95%, 1.58–5.06). Las otras comorbilidades que aumentaron el riesgo de demencia en los pacientes diabéticos fueron la hipertensión (RR, 2.75, IC 95%, 1.86–4.06) y la depresión (RR, 3.78, 95% IC 2.37–6.04). Conclusión Los sujetos con diabetes mellitus tienen un riesgo mayor de desarrollar demencia, La baja escolaridad y otras comorbilidades altamente prevalentes en la población Mexicana contribuyen a la asociación diabetes-demencia. PMID:21948010

  13. Formation des enseignants dans une perspective d'education permanente au benin

    NASA Astrophysics Data System (ADS)

    Agboton, Sbastien; Moussa, Yaya Mede

    1994-05-01

    The history of teacher training in Benin, which provides evidence of social and cultural change, suggests that a system of lifelong education should be introduced which unites formal, non-formal and informal education, all of which already exist in embryo. The education originally given to every member of society was a continuing progression from initiate to initiator, a lifelong education that involved, among other things, knowledge of agricultural production. This traditional system was disrupted by the reorganization of teacher training after 1945. Recurrent training of teachers remained inadequate because of limited external funding for in-service training, the lack of teachers, the suspension of recruitment and the closure of teacher training colleges. The 1975 reform, through the initiative known as Operation Education and Development, envisaged links between school and social environment, allying intellectual work with production. This meant a radical change in the role of the teacher, who was confronted with technical advance and was obliged to enter a difficult continuing process of self-training. Furthermore, population growth and the restrictions imposed by the World Bank have brought about developments in both lifelong learning and apprenticeship. These two elements are brought together under an initiative known as Production Scolaire Artisanale, designed for out-of-school learners and artisans. The author concludes that the creation of a coherent system of voluntary education would be possible in a society that was itself favourably disposed to education.

  14. Quelques facteurs sociaux agissant sur la formation permanente et l'education informelle en Algerie

    NASA Astrophysics Data System (ADS)

    Haddab, Mustapha

    1994-05-01

    This article attempts an analysis of the conditions under which a certain degree of educational pluralism has begun, tentatively, to be seen in Algeria in association with the political and socio-economic changes that have taken place since 1988. After a long period of centralism codified in the National Charter of 1976, during which the public education system had become all but the only provider of education, in demand largely on account of the diplomas and certificates which it awarded, various social factors (including growth in unemployment among young people and those with qualifications, development of voluntary associations, inflexibility of public schools, various effects of the "language conflict" on the educational system, etc.) have since led to the appearance of varying educational activities. Some of these make up for the inadequacy of the public schools; others, less well established, respond to the emergence of the need for "lifelong education" or provide complementary training for social groups which may have a political or religious motivation. These tendencies are limited to the development of voluntary associations in Algeria.

  15. Alejarse como proceso social: niños y ancianos «abandonados» en Ayacucho1

    PubMed Central

    Leinaweaver, Jessaca

    2013-01-01

    En investigaciones previas sobre el acogimiento familiar y la adopción en Ayacucho, se ha podido descubrir cómo los ayacuchanos adquieren y producen relaciones sociales. Mientras negocian creativamente los discursos y espacios construidos simultáneamente por instituciones, comunidades, y estructuras sociales, van adquiriendo nuevas formas de relacionarse. Este artículo discute el proceso opuesto: el deshacerse de relaciones de parentesco, y el proceso social del abandono o alejamiento. Cuando se aleja a una persona de su familia o su comunidad, los que se quedan en ella llegan a entenderse como ciertos tipos de personas. En los estudios de caso discutidos aquí, recopilados a través de una detallada y cuidadosa observación participante y de entrevistas etnográficas grabadas entre 2001 y 2007, se puede ver cómo, después de un alejamiento social, los individuos que alejan se reinterpretan como sujetos que se encuentran superándose o volviéndose modernos, o bien sacrificándose. PMID:25177044

  16. Late Glacial to Holocene environmental variabilities: A new multi-proxy paleolimnological study of sedimentary sequences from Como (northern Italy)

    NASA Astrophysics Data System (ADS)

    Höbig, N.; Martinelli, E.; Motella, S.; Michetti, A. M.; Livio, F.; Tinner, W.; Reicherter, K.; Castelletti, L.

    2012-04-01

    Lake Como (northern Italy) is the deepest Italian lake, reaching a depth of about 425 m. The lambda-shaped lake expands about 45 km in NE-SW direction. Southwards of the hydrologically closed western branch, two sediment cores of 70 m (S1) and 65 m length (S2) were taken in the year 2005 close to the cathedral of Como (Piazza Verdi). The drilling sites are located in the middle of the Southern Alps, some 300 m from the present-day lakeshore. The cores provide the first detailed Late Glacial to Holocene multi-proxy record for the Lake Como basin. Our research is aimed at investigating the environmental and geological evolution of the Insubria Region. The multi-proxy study of the stratigraphic sequences contain geophysical, geotechnical, sedimentological, paleobotanical, and radiocarbon analyses. They have been performed for core S1 and are still in progress on core S2. With this data the working group focuses on two main issues. The first topic is the reconstruction of the natural and anthropogenic processes controlling the ground subsidence in the Como urban area (e.g., Comerci et al., 2007) and another aim is to reconstruct vegetation and land-use dynamics. In particular, 150 samples of vegetal macroremains have been collected in the palustrine deposits along S1 core, down to 31,00 m. Below this depth (dated 14C 12,496 ± 55 yr BP - 15,050 - 14,250 cal yr BP), the amount of plant macroremains in the sediment drops dramatically. The taxonomic determination was carried out on more than 800 macroremains. They are represented by fragments of wood, leaves, needles, seeds, fruits, mosses and tiny charcoals (Motella, 2009, unpublished PhD Thesis). Picea/Larix, Pinus sp., Juniperus with Betula, found in the deeper levels (30.80 - 30.00 m), are the first arboreal taxa that colonized the shores of Lake Como, and show that the reforestation began in this area about 16,000 years ago. During the early Holocene (25.10 m) Abies alba expanded and further upwards the sequence mixed deciduous forests became important. Preliminary results of palynological analyses for a section of the core S2 (35.04 - 18.12 m), show Late Glacial sediments in the depth of 35.04 - 31.16 m, due to vegetation changes related to natural climatic variability, with an alternation of communities typical of cold (Poaceae, Artemisia, Juniperus, Pinus and Betula) and temperate climates (e.g. Quercus). Later, during the Holocene, forests composed by mostly deciduous broadleaves and Abies alba expanded. During the mid and late Holocene human impact increased and modified vegetation. This is shown by the increase of herbs and heliofilous shrubs (26.51 m), typical of deforested spaces for fields and pastures. Human exploitation of wood is represented for example by the dramatic decline of Abies alba (24.97 m). Finally, the increase of Cerealia (19.39 m) is clearly related to intensified agricultural activities. The results of further paleobotanical and geophysical analyses which are in progress will be presented during the conference. Moreover, geochemical measurements (e.g., XRF) will be performed in future for core S2. Researches realized within the project of Italy-Switzerland Cooperation SITINET "Censimento, valorizzazione e messa in rete di siti geologici e archeologici" (Census, increase of value and computerization of geological and archaeological sites). Interreg IV A "Geo-Archeositi dell'Insubria" (Geo-Archaeosites of Insubria).

  17. In-situ HRTEM study of the reactive carbide phase of Co/MoS2 catalyst.

    PubMed

    Ramos, Manuel; Ferrer, Domingo; Martinez-Soto, Eduan; Lopez-Lippmann, Hugo; Torres, Brenda; Berhault, Gilles; Chianelli, Russell R

    2013-04-01

    Hydrotreatment catalytic operations are commonly performed industrially by layered molybdenum sulfide promoted by cobalt or nickel in order to remove heteroelements (S, N, O) from fossil fuels and biofuels. Indeed, these heteroelements are responsible of the emission of pollutants when these fuels are used in vehicles. In this respect, previous studies made by our research group have shown that the active phase under steady state conditions is partially carbided while strong bending effects of MoS2 slabs were also observed. However, up to now, the morphology of the resulting Co/MoSxCy carbided catalyst has not been fully characterized. In the present study, for the first time, a chemical reaction between the carbon content of a TEM Cu/C grid and a freshly sulfide Co/MoS2 catalyst was in situ observed at 300 C and 450 C by HRTEM experimental techniques at ~10 nm of resolution. Results indicate that bending of MoS2 layers occurred due to carbon addition on MoS2 edge sites, as observed in stabilized catalysts after HDS reaction. Using a silicon grid, only cracks of MoS2 slabs were observed without bending effect confirming the role of structural-carbon in this change of morphology. PMID:22925737

  18. Annual variations in bio-optical properties at the Estacin Permanente de Estudios Ambientales (EPEA) coastal station, Argentina

    NASA Astrophysics Data System (ADS)

    Lutz, Vivian A.; Subramaniam, Ajit; Negri, Rubn M.; Silva, Ricardo I.; Carreto, Jos I.

    2006-07-01

    Variations in optical properties at a coastal station (EPEA) off the North coast of Argentina (38 28' S 57 41' W) were studied in 2000-2001. Changes observed in the absorption by three components of seawater (phytoplankton, detritus, and chromophoric-dissolved-organic-matter or CDOM) were analysed in relation to changes in environmental conditions (temperature, stability of the water column, irradiance) and changes in the phytoplankton community structure. An annual cycle typical of temperate seas was observed in the stability of the water column, with a strong thermocline in summer and a vertically homogeneous regime in winter. The proportion of detritus absorption at the surface was related to these changes in stability of the water column, being larger in winter due probably to re-suspension from the bottom. Absorption by phytoplankton and CDOM were not related to temperature or the stability of the water column and there was no covariation in absorption by the three seawater components. On the other hand, absorption by phytoplankton was significantly related to the predominant cell-size. The percentage contribution of ultraphytoplankton (<5 ?m) to total chlorophyll- a concentration varied between 6% and 46% throughout the year, being the highest during summer. Accordingly, the specific absorption coefficient of phytoplankton at 440 nm (absorption/chlorophyll- a) varied between 0.01 in July (when there was a bloom of the large diatom Coscinodiscus wailesii) and 0.09 m 2 mg Chla-1 in February (when Synechococcus spp. was predominant). The relationship between in situ and 1 km daily satellite estimated OC4V4 chlorophyll- a concentration showed a good correlation ( r2=0.94 for 9 out of the 19 data points where an exact match up could be made). Marked variations were observed when comparing 8 day-9 km binned data with the 19 points. While some of the differences are due to the highly dynamic hydrography of this region, variations in phytoplankton composition also contribute to the difference between in situ and satellite-derived values.

  19. Accumuler le capital humain tout au long de la vie: Quels facteurs prdictifs de la participation la formation permanente?

    NASA Astrophysics Data System (ADS)

    Boudard, Emmanuel; Morlaix, Sophie

    2003-09-01

    This article addresses the main predictors of adult education, using statistical methods different from those generally used by social science researchers. Its aim is twofold. First, it seeks to explain in a simple and comprehensible manner the methodological value of these methods (in relation to the use of structural models); secondly, it demonstrates the concrete usefulness of these methods on the basis of a recent piece of research on the data from the International Adult Literacy Survey (IALS).

  20. Health Instruction Packages: Permanent Teeth, Dental Deposits, and Dental Instruments. Dientes Permanentes, Depositos Dentales y Instrumentos Dentales.

    ERIC Educational Resources Information Center

    Lind, Patricia; Germano, Catherine

    These five learning modules use text interspersed with illustrations and reinforcement exercises to instruct dental aide and dental hygiene students about jaw bones and gums, dental deposits, and dental instruments. The first four modules were prepared by Patricia Lind in both Spanish and English. "The Gum and Bone of Permanent Teeth" ("La Encia y

  1. Health Instruction Packages: Permanent Teeth, Dental Deposits, and Dental Instruments. Dientes Permanentes, Depositos Dentales y Instrumentos Dentales.

    ERIC Educational Resources Information Center

    Lind, Patricia; Germano, Catherine

    These five learning modules use text interspersed with illustrations and reinforcement exercises to instruct dental aide and dental hygiene students about jaw bones and gums, dental deposits, and dental instruments. The first four modules were prepared by Patricia Lind in both Spanish and English. "The Gum and Bone of Permanent Teeth" ("La Encia y…

  2. Politiques et activites d'education permanente: reflexions sur l'education scientifique et la societe moderne

    NASA Astrophysics Data System (ADS)

    Gelpi, Ettore

    1982-09-01

    Science and technology are presented as necessary tools for participating in the political management of a society, for understanding contemporary problems and the prospect of confronting the exigencies of daily life (work, accommodation, food, etc.) hence the increase in the number of people with a scientific education, over and above professional scientists. Initial training, adult education, the training of oneself: it is a question of actually integrating science education into the principles and practice of Lifelong Education. In order to respond to the emerging demand for science education, the co-operation of scientists, of the world of work and of the public at large is required in defining the objectives of policies in science and technology. The article ends with a series of questions concerning the content and methods of science education.

  3. Tal Como Somos/Just As We Are: An Educational Film to Reduce Stigma towards Gay and Bisexual Men, Transgender Individuals & Persons Living with HIV/AIDS

    PubMed Central

    Ramirez-Valles, Jesus; Kuhns, Lisa M.; Manjarrez, Dianna

    2013-01-01

    In this paper we describe the development and dissemination of a film-based educational intervention to reduce negative attitudes towards gay and bisexual men and transgender women (GBT) and people living with HIV/AIDS (PLWHA) in Latino communities, with a focus on youth. The intervention, Tal Como Somos/Just as We Are, is based on stigma and attribution theories, extensive formative research, and community input. Evaluation findings among educators and school youth suggest the film has the potential to effectively impact attitudes towards GBT and PLWHA. The film and intervention are being disseminated using diffusion of innovations theory through community-based organizations, schools, television broadcasting and film festivals. PMID:24377496

  4. Co-Doped MoS2 Nanosheets with the Dominant CoMoS Phase Coated on Carbon as an Excellent Electrocatalyst for Hydrogen Evolution.

    PubMed

    Dai, Xiaoping; Du, Kangli; Li, Zhanzhao; Liu, Mengzhao; Ma, Yangde; Sun, Hui; Zhang, Xin; Yang, Ying

    2015-12-16

    Highly active and low-cost catalysts for hydrogen evolution reaction (HER) are crucial for the development of efficient water splitting. Molybdenum disulfide (MoS2) nanosheets possess unique physical and chemical properties, which make them promising candidates for HER. Herein, we reported a facile, effective, and scalable strategy by a deposition-precipitation method to fabricate metal-doped (Fe, Co, Ni) molybdenum sulfide with a few layers on carbon black as noble metal-free electrocatalysts for HER. The CoMoS phase after thermal annealing in Co-doped MoS2 plays a crucial role for the enhanced HER. The optimized Co-doped MoS2 catalyst shows superior HER performance with a high exchange current density of 0.03 mAcm(-2), low onset potential of 90 mV, and small Tafel slope of 50 mVdec(-1), which also exhibits excellent stability of 10000 cycles with negligible loss of the cathodic current. The superior HER activity originates from the synergistically structural and electronic modulations between MoS2 and Co ions, abundant defects in the active edge sites, as well as the good balance between active sites and electronic conductivity. Thanks to their ease of synthesis, low cost, and high activity, the Co-doped MoS2 catalysts appear to be promising HER catalysts for electrochemical water splitting. PMID:26599427

  5. Thermal effects on Co/Mo2C multilayer mirrors studied by soft x-ray standing wave enhanced photoemission spectroscopy

    NASA Astrophysics Data System (ADS)

    Giglia, A.; Mukherjee, S.; Mahne, N.; Nannarone, S.; Jonnard, P.; Le Guen, K.; Yuan, Y.-Y.; Andr, J.-M.; Wang, Z.-S.; Li, H.-C.; Zhu, J.-T.

    2013-05-01

    Here is presented the spectroscopic study of the evolution of the first buried interfaces of a B4C capped Co/Mo2C multilayer mirror induced by thermal treatment up to 600C. This kind of study is typically performed to simulate the response of multilayer optics working in extreme conditions, as for instance when irradiated by new high brilliance sources as Free Electron Lasers. In fact, the efficiency of multilayers is related to the optical contrast between the alternating high and low density layers, and then to the degree of interdiffusion and the creation or evolution of interface compounds. The analysis has been performed at the Co L23 edge with different soft x-ray spectroscopic techniques including diffuse and specular reflectivity, total electron and fluorescent yield at the BEAR beamline at Elettra (Trieste) (http://www.elettra.trieste.it/elettra-beamlines/bear.html). The presentation is focused on the spectroscopic results obtained by soft x-ray standing wave enhanced photoemission (XSW) from the Mo 3d, B 1s, C 1s, O 1s core levels by using a photon energy close to the Co L23 edge and corresponding to the first Bragg peak of the multilayer. The experimental results have been compared with simulations to obtain information both on the chemical state (e.g. oxidation state) and interface morphology in terms of profiles of distribution of elements and interdiffusion of B, oxidized B and C in the interface region. In summary, it is possible to conclude in favour of a good stability of the multilayer in the investigated temperature range, as confirmed by the good performance in terms of reflectivity. These results confirm the usefulness of XSW for this kind analysis of multilayer optics.

  6. Detection and identification of pathogenic trypanosome species in tsetse flies along the Comoé River in Côte d’Ivoire

    PubMed Central

    Djohan, Vincent; Kaba, Dramane; Rayaissé, Jean-Baptiste; Dayo, Guiguigbaza-Kossigan; Coulibaly, Bamoro; Salou, Ernest; Dofini, Fabien; Kouadio, Alain De Marie Koffi; Menan, Hervé; Solano, Philippe

    2015-01-01

    In order to identify pathogenic trypanosomes responsible for African trypanosomiasis, and to better understand tsetse-trypanosome relationships, surveys were undertaken in three sites located in different eco-climatic areas in Côte d’Ivoire during the dry and rainy seasons. Tsetse flies were caught during five consecutive days using biconical traps, dissected and microscopically examined looking for trypanosome infection. Samples from infected flies were tested by PCR using specific primers for Trypanosoma brucei s.l., T. congolense savannah type, T. congolense forest type and T. vivax. Of 1941 tsetse flies caught including four species, i.e. Glossina palpalis palpalis, G. p. gambiensis, G. tachinoides and G. medicorum, 513 (26%) were dissected and 60 (12%) were found positive by microscopy. Up to 41% of the infections were due to T. congolense savannah type, 30% to T. vivax, 20% to T. congolense forest type and 9% due to T. brucei s.l. All four trypanosome species and subgroups were identified from G. tachinoides and G. p. palpalis, while only two were isolated from G. p. gambiensis (T. brucei s.l., T. congolense savannah type) and G. medicorum (T. congolense forest, savannah types). Mixed infections were found in 25% of cases and all involved T. congolense savannah type with another trypanosome species. The simultaneous occurrence of T. brucei s.l., and tsetse from the palpalis group may suggest that human trypanosomiasis can still be a constraint in these localities, while high rates of T. congolense and T. vivax in the area suggest a potential risk of animal trypanosomiasis in livestock along the Comoé River. PMID:26035296

  7. Essays on Eclipses, Transits and Occultations as Teaching Tools in the Introductory Astronomy College Course. (Spanish Title: Ensayos sobre Eclipses, Trnsitos y Ocultaciones Como Herramientas de Enseanza en el Curso Universitario Introductorio a la Astronoma.) Ensaios sobre Eclipses, Trnsitos e Ocultaes Como Ferramentas de Ensino em um Curso Universitrio Introdutrio de Astromomia

    NASA Astrophysics Data System (ADS)

    Dcruz, Noella L.

    2014-07-01

    We occasionally include projects in our learner-centered introductory astronomy college course to enable non-science major students explore some astronomical concepts in more detail than otherwise. Such projects also highlight ongoing or upcoming astronomical events. We hope that students will feel more interested in astronomy through projects tied to astronomical events. In Spring 2012, we offered short essays focused on eclipses, transits and occultations to promote the rare transit of Venus that occurred on June 5th, 2012. We asked students to write two short essays from three that were offered. The essays contained descriptive and conceptual parts. They were meant to serve as teaching tools. 62% of 106 essays from 55 students earned A, B or C grades. 21% of 47 feedback survey respondents felt the essays increased their interest in astronomy. 49% of respondents felt that the essays were not educationally beneficial and should not be offered again. The most common written response to our survey indicated that students need more guidance and better preparation in writing successful essays. Since students found the conceptual parts of the essays difficult, in the future we will provide relevant activities prior to essay deadlines to help students create successful essays. Ocasionalmente, incluimos proyectos en nuestro curso de introduccin a la astronoma universitario centrado en el alumno para permitir que los estudiantes de carreras no cientficas exploren algunos conceptos astronmicos en ms detalle que lo habitual. Estos proyectos tambin ponen en relevancia eventos astronmicos en curso o futuros. Esperamos que los estudiantes se sientan ms interesados en la astronoma a travs de proyectos vinculados a eventos astronmicos. En el perodo de primavera de 2012 (EUA), propusimos breves ensayos centrados en los eclipses, trnsitos y ocultaciones para promover el raro trnsito de Venus que se produjo el 5 de junio de 2012. Le pedimos a los estudiantes que escribieran dos ensayos cortos de tres que se proponan. Los ensayos contenan partes descriptivas y conceptuales. Los mismos estaban destinados a servir como herramientas de enseanza. 62% de los 106 ensayos de 55 estudiantes obtuvo grados A, B o C. 21% de los 47 encuestados que respondieron al cuestionario posterior consider que los ensayos aumentaron su inters por la astronoma. 49% de los encuestados consider que los ensayos no eran educacionalmente tiles y que no deben ser propuestos de nuevo. Las respuestas escritas ms comunes a nuestra encuesta indicaran que los estudiantes necesitan ms orientacin y una mejor preparacin en la redaccin de ensayos exitosos. Dado que los estudiantes encontraron las piezas conceptuales de los ensayos difciles, en el futuro vamos a ofrecer actividades pertinentes antes de los plazos de redaccin para ayudar a los estudiantes a crear ensayos de mayor calidad. Ns ocasionalmente inclumos projetos em nosso curso universitrio introdutrio centrado no aluno para permitir aos estudantes que pertencem s carreiras no cientficas explorar alguns conceitos astronmicos em mais detalhes do que o normal. Tais projetos tambm enfatizam eventos astronmicos em curso ou futuros. Esperamos que os alunos se sintam mais interessados na astronomia atravs de projetos ligados a eventos astronmicos. No termo de Primavera de 2012 (EUA), propomos ensaios curtos focados em eclipses, trnsitos e ocultaes para promover o raro trnsito de Vnus que ocorreu no dia 5 de junho de 2012. Pedimos aos alunos que escrevessem dois ensaios curtos dentre trs que foram propostos. Os ensaios continham partes descritivas e conceituais. Eles foram feitos para servir como ferramentas de ensino. 62% de 106 ensaios de 55 alunos ganhou graus A, B ou C. 21% dos 47 entrevistados que responderam ao levantamento posterior sentiu que os ensaios aumentaram seu interesse na astronomia. 49% dos inquiridos consideraram que os ensaios no eram benficos para a educao e que no devem ser propostos novamente. As respostas escritas mais comuns da nossa pesquisa indicaram que os alunos precisam de mais orientao e melhor preparao para escrever ensaios bem sucedidos. Como os alunos consideraram difceis os aspectos conceituais dos ensaios, no futuro iremos fornecer atividades relevantes antes dos ensaios para ajudar os alunos a escrev-los com sucesso.

  8. Percepción de competencia y adiestramiento profesional especializado relativos al VIH/SIDA en estudiantes y profesionales de la salud: el estigma como un indicador de necesidad

    PubMed Central

    RODRÍGUEZ, Yarimar ROSA; DÍAZ, Nelson VARAS

    2009-01-01

    El proceso de estigmatización asume una devaluación de la persona debido a una característica o marca que haya sido identificada socialmente y que permita que se le describa como diferente. Desde que se desató la epidemia del VIH/SIDA, vivir con la enfermedad ha sido señalado de manera social como una marca estigmatizante. Las manifestaciones de dicha estigmatización se han documentado entre profesionales de la salud. Este estigma puede afectar los servicios de salud que las personas que viven con VIH/SIDA reciben de estos profesionales. Los objetivos de esta investigación fueron explorar: 1) la percepción que tienen estudiantes y profesionales de la salud sobre su nivel de competencia para ofrecer servicios a personas que viven con VIH/SIDA, 2) las opiniones de éstos sobre el tipo de adiestramiento profesional recibido y la necesidad del mismo, y 3) la manifestación de actitudes estigmatizantes como indicadores de necesidad de adiestramiento profesional. La muestra total del estudio estuvo compuesta por 80 de diversas profesiones de la salud. Los resultados reflejan que algunos/as de los/as participantes han recibido formación en VIH pero ésta no ha sido suficiente para contrarrestar las nociones estigmatizantes. Discutimos las implicaciones de los resultados para investigaciones futuras y el desarrollo de intervenciones con vías de minimizar las nociones estigmatizantes en los escenarios de salud. PMID:20011236

  9. Quelques Facteurs Sociaux Agissant sur la Formation Permanente et l'Education Informelle en Algerie (Social Factors Acting upon Lifelong Learning and Informal Education in Algeria).

    ERIC Educational Resources Information Center

    Haddab, Mustapha

    1994-01-01

    Analyzes conditions that have led to an increase in private and collective educational initiatives in Algeria, highlighting political and socioeconomic changes since 1988. Indicates that after a long period of a public education monopoly, social factors have led to the development of alternative educational opportunities that are more responsive

  10. Quelques Facteurs Sociaux Agissant sur la Formation Permanente et l'Education Informelle en Algerie (Social Factors Acting upon Lifelong Learning and Informal Education in Algeria).

    ERIC Educational Resources Information Center

    Haddab, Mustapha

    1994-01-01

    Analyzes conditions that have led to an increase in private and collective educational initiatives in Algeria, highlighting political and socioeconomic changes since 1988. Indicates that after a long period of a public education monopoly, social factors have led to the development of alternative educational opportunities that are more responsive…

  11. Glossary of MS Terms

    MedlinePLUS

    ... enfermedad Véase "Fármacos modificadores de la enfermedad" Agudeza visual Capacidad de un ojo para percibir objetos. La ... or fluids are being aspirated into the airway. Visual acuity Clarity of vision. Acuity is measured as ...

  12. Como Lo Hago Yo: Lipomas Medulares

    PubMed Central

    Portillo, Santiago

    2014-01-01

    Basados en la experiencia de 82 casos; en 5% se observaron anomalías pélvicas asociadas. En los menores de 3 años el motivo de consulta (85%) fue la tumoración. En los mayores de 3 años (42%) tenía problemas neurológicos. Solo el 24% preocupados por la tumoración. El objetivo de la cirugía es desanclar la médula y no remover la totalidad del lipoma. El lipoma de filum es el que es mas simple para operar. Aún cuando la escuela francesa propone operar solamente cuando hay síntomas favorezco cirugía preventiva. Favorezco una segunda cirugía si hay signos de anclaje postoperatorio, aún cuando observamos empeoramiento postoperatorio motor en 2.5% de los operados y urológico a largo plazo en 6% de los operados. PMID:24791218

  13. Micoinseticidas e Micoacaricidas no Brasil: Como estamos?

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mycoinsecticides and mycoacaricides can be defined as biopesticide products based on living propagules of entomopathogenic fungi developed for inundative and inoculative biological control of insects and mites. Based on recently published data on global use of entomopathogenic fungi and a proposal f...

  14. How Evapotranspiration And Deep Percolation Impact The Precipitation-Runoff Response, Aquifer Recharge, And Linked Nutrient-Water Cycling At The Subalpine Como Creek Drainage In The Colorado Front Range

    NASA Astrophysics Data System (ADS)

    Zeliff, M. M.; Williams, M. W.; Cowie, R. M.; Burns, S.

    2011-12-01

    Here we evaluate how evapotranspiration (ET) and deep percolation (DP) impact the precipitation-runoff response, aquifer recharge, and linked nutrient-water cycling at the 664-ha sub-alpine Como Creek drainage in the Colorado Front Range. ET is measured continuously using eddy covariance, soil moisture (SM) is measured using 2-m vertical sensor arrays, groundwater (GW) by a series of piezometers, and precipitation (P) is measured daily along with snow-water equivalent (SWE). From 2004 to 2009, annual P averaged 813 mm and ET averaged 590 mm, with ET thus representing 72.5% of annual P. Using multiple linear regression analysis, discharge (Q) was found to be modeled reasonably well with the independent variables of ET (p < 0.01), P (p < 0.01), and SM (p < 0.01). The final linear model had a reasonable fit (r2=0.57) indicating ET, P and SM to be good predictors of Q, with ET and SM having a positive coefficient, and somewhat surprisingly P having a negative coefficient. We found ET to be positively correlated with summer P (r2=0.45), but not well correlated with annual or winter P. Our vertical soil moisture arrays show that summer precipitation over 5 years never penetrated more than 50 cm in depth. Thus, during the summer, water flux in the root zone becomes decoupled from the ground water system and subsequent precipitation does little to contribute to streamflow for the current year, but serves to offset ET, which may explain the decrease in Q with increasing P. Newly installed piezometers (12, at depths ranging from 5 to 30 m) provide evidence that this portion of the basin is largely a loosing reach during snowmelt, with GW in the piezometers increasing 5-7 m. After peak snowmelt however, the reach starts gaining again with piezometer levels dropping. Time series plots reveal a strong relationship between SWE and Q with larger SWE often resulting in larger Q. Thus, surface-groundwater interactions are tightly coupled during snowmelt, with snowmelt first replenishing the subsurface water deficit before contributing to discharge. The deepest two piezometers (18 and 29 m) were not showing any significant water level declines by early August 2011, suggesting that water loss to DP is a potential important component of the water balance in the Como Creek catchment. Wet precipitation chemistry from the National Atmospheric Deposition Program monitors in the basin show that atmospheric deposition of inorganic nitrogen has increased several-fold in the last 25 years. However, in contrast to higher-elevation catchments, which have seen a dramatic increase in the nitrate content of surface waters, we see no such increase in the nitrate content of Como Creek. The reason may be that snowmelt first infiltrates into the subsurface, where ammonium and nitrate are assimilated.

  15. Particle-associated contaminants in street dust, parking lot dust, soil, lake-bottom sediment, and suspended and streambed sediment, Lake Como and Fosdic Lake watersheds, Fort Worth, Texas, 2004

    USGS Publications Warehouse

    Wilson, Jennifer T.; Van Metre, Peter C.; Werth, Charles J.; Yang, Yanning

    2006-01-01

    A previous study by the U.S. Geological Survey of impaired water bodies in Fort Worth, Texas, reported elevated but variable concentrations of particle-associated contaminants (PACs) comprising chlorinated hydrocarbons, polycyclic aromatic hydrocarbons, and trace elements in suspended and bed sediment of lakes and streams affected by urban land use. The U.S. Geological Survey, in cooperation with the City of Fort Worth, collected additional samples during October 2004 to investigate sources of PACs in the watersheds of two impaired lakes: Lake Como and Fosdic Lake. Source materials and aquatic sediment were sampled and analyzed for PACs. Source materials sampled consisted of street dust and soil from areas with residential and commercial land use and parking lot dust from sealed and unsealed parking lots. Aquatic sediment sampled consisted of bottom-sediment cores from the two lakes and suspended and streambed sediment from the influent stream of each lake. Samples were analyzed for chlorinated hydrocarbons (organochlorine pesticides and polychlorinated biphenyls), polycyclic aromatic hydrocarbons, major and trace elements, organic carbon, grain size, and radionuclides.

  16. WOMEN UNIVERSITY GRADUATES IN CONTINUING EDUCATION AND EMPLOYMENT, AN EXPLORATORY STUDY INITIATED BY THE CANADIAN FEDERATION OF UNIVERSITY WOMEN 1966, AND LA FEMME DIPLOMEE FACE A L'EDUCATION PERMANENTE ET AU MONDE DU TRAVAIL.

    ERIC Educational Resources Information Center

    COCKBURN, PATRICIA; RAYMOND, YVONNE R.

    TO MEASURE THE EMPLOYMENT POTENTIAL OF CANADIAN WOMEN UNIVERSITY GRADUATES, TO INTEREST GOVERNMENT IN RETRAINING PROFESSIONAL WOMEN, AND TO ASSESS THE INTEREST OF WOMEN IN CONTINUING THEIR UNIVERSITY EDUCATION, A MAIL SURVEY WAS MADE OF 10,000 MEMBERS OF THE CANADIAN FEDERATION OF UNIVERSITY WOMEN, 500 NON-MEMBER GRADUATES, AND 850 FRENCH-SPEAKING

  17. El Espanol como Idioma Universal (Spanish as a Universal Language)

    ERIC Educational Resources Information Center

    Mijares, Jose

    1977-01-01

    A proposal to transform Spanish into a universal language because it possesses the prerequisites: it is a living language, spoken in several countries; it is a natural language; and it uses the ordinary alphabet. Details on simplification and standardization are given. (Text is in Spanish.) (AMH)

  18. Como reembolsar sus prestamos para estudiantes (Repaying Your Student Loans).

    ERIC Educational Resources Information Center

    Office of Federal Student Aid (ED), Washington, DC.

    This guide, written in Spanish, discusses how to repay student loans. Following a general introduction, the guide discusses the grace period before repayment and repayment requirements. Repayment plans are described for Perkins Loans, Direct Loans, and Federal Family Education Loans. Repayment options are discussed, including consolidation,

  19. Como Lo Hago Yo: Tratamiento Quirurgico Del Mielomeningocele

    PubMed Central

    Portillo, Santiago

    2014-01-01

    En Argentina hay plan de fortificación con ácido fólico. Diagnostico prenatal no siempre es correcto. Cierre según técnica. Cerramos músculo. No favorecemos corpectomía temprana en casos de cifosis. Suturamos la plaqueta. Cerramos el plano muscular. Hidrocefalia: Válvula de derivación, generalmente dentro de los dos primeros meses. Ventriculostomía no está indicada. Chiari II. Laminectomia cervical alta. Siringomielia: Derivación desde la cavidad al peritoneo. PMID:24791219

  20. Make a Life for Yourself = Como Planear Mi Vida.

    ERIC Educational Resources Information Center

    Center for Population Options, Washington, DC.

    This booklet was devised to help Hispanic teenagers develop a life plan. It provides information for making decisions, and is written in both English and Spanish. Tips are provided for setting goals. A sentence-completion task helps the teenager focus on specific issues, and use concrete language when talking about the goals. Specific goals are…

  1. Como Planear Mi Vida = Make a Life for Yourself.

    ERIC Educational Resources Information Center

    Haffner, Debra; Casey, Sean

    This booklet for teenagers about life planning is presented in parallel English and Spanish versions with a special focus on young Hispanics growing up in America. It discusses hopes and dreams that adolescents may have and gives tips for reaching goals. A sentence completion exercise is included to help readers set goals. Four important goals for…

  2. Los mitos como memoria colectiva de Los Pueblos.

    NASA Astrophysics Data System (ADS)

    Martn, P. T.

    Myths are essentially something practical that allows those who believe in them to solve any ambiguity which could come up in their relation with nature. Since they bring information about the condition of the reality to which they belong, they are but the appropriate instrument to insert nature into culture by actually achieving an adaptation to the environment. The purpose of this essay is to show how the deification of plants, animals, and stars, which are present in the daily lives of "Amerindian" people, not only constitutes a source of rich mythology but also turns out to be an effective measure towards the continuity of social groups. Similarities or identifications between human life and the life of plants, animals and stars as well as mutual interplay are somehow present in those myths: stars which create or are changed into human being, animals or plants; human beings who create or are transformed into astral bodies; battles between peoples and stars, etc. On this base, mythology can provide not only keys to show how certain human groups have achieved their adaptation to the environment and how the different social systems and their relations to nature have developed, but also hints of changes which have taken place in other heavenly spheres such as the falling of meteors, the appearance of comets or any other significant events of this kind in the lives of these groups.

  3. Field technique of permeability tests in highly fissured limestone strata

    NASA Astrophysics Data System (ADS)

    Al-Salihi, Adnan; Asaad, Abdulah

    2002-05-01

    Rsum.L'tude de dispositifs de dnoyage est ncessaire pour l'amlioration de sites avant la construction de certaines structures. L'tude de dispositifs de dnoyage efficaces exige d'estimer la valeur du coefficient de permabilit in situ. Les relations disponibles pour estimer le coefficient de permabilit ont t dveloppes sur la base de mesures et de conditions de terrain limites, et les prdictions varient de plusieurs ordres de grandeur. C'est pourquoi il est ncessaire de raliser des mesures de permabilit sur le terrain et de dterminer la relation qui permet le meilleur ajustement de ces mesures avant l'tude du dispositif de dnoyage pour des conditions locales et gologiques spcifiques. Ce papier prsente des mesures de permabilit sur le terrain dans des niveaux calcaires complexes chaotiques et diagntiss. Il propose galement une analyse comparative de plusieurs relations disponibles dans la littrature destines prdire le coefficient de permabilit in situ. L'analyse est faite en conditions permanentes et non permanentes. Les rsultats montrent que la valeur du coefficient de permabilit dpend du niveau de la nappe, qui est affect par le rgime de mares. On montre que l'quation de l'US Navy donne la meilleure corrlation avec les mesures de terrain. Resumen.El diseo de sistemas de desecado es necesario para mejorar las condiciones de un emplazamiento antes de la construccin de determinadas estructuras. El diseo de un sistema eficiente de desecado requiere de la estimacin del valor de la permeabilidad in-situ. Las relaciones disponibles para tal fin han sido desarrolladas bajo condiciones y medidas de campo limitadas; sus predicciones varan en algunos rdenes de magnitud. Por tanto, es necesario tomar medidas de permeabilidad en campo y determinar la relacin que reproduce mejor dichas medidas como paso previo al diseo de un sistema de desecado en condiciones geolgicas y de emplazamiento especficas. Este artculo presenta medidas de permeabilidad en campo para estratos de calcita caticos y diagenticos. Tambin ofrece un anlisis comparativo de diversas relaciones disponibles en la bibliografa con el fin de predecir el valor de la permeabilidad in-situ. El anlisis se ha hecho tanto en rgimen permanente como en estacionario. Los resultados demuestran que la permeabilidad depende del nivel fretico, el cual est afectado por las mareas. La ecuacin de la Marina estadounidense es la que proporciona una mejor correlacin con las medidas de campo.

  4. Como ayudar a su hijo a aprender a leer ingles como segunda lengua. (How Can I Help My Child Learn to Read English as a Second Language.)

    ERIC Educational Resources Information Center

    Garcia, Ricardo L.; Deyoe, Rita Maxine

    Suggestions for ways in which parents can help their children learn to read English are contained in this short booklet written in Spanish. Activities to be performed in the home, such as listening to and talking to the child in any language, reading aloud, reading for oneself, obtaining books for the home, and organizing study time for the child,

  5. Effect of phosphorus and other promoters on CoMo alumina hydrotreating catalysts

    SciTech Connect

    Stanulonis, J.J.; Pedersen, L.A.

    1980-01-01

    One-step impregnation with up to 2.5% by wt of phosphorus in the form of phosphoric acid produced a more active catalyst for hydrodenitrogenation but not for hydrodesulfurization of naphtha by comparison with an American Cyanamid Co. catalyst in which cobalt and molybdenum were supported on alumina. However, one-step impregnation did not guarantee good catalysts. The physical properties of the American Cyanamid and Harshaw Chemical Co. alumina supports were alike, but the activity similarity for both desulfurization and denitrogenation was between the Harshaw and Filtrol Corp. alumina supports. The promoting effects of the phosphoric acid and alumina were physical, but chemical action might also have been present. It appeared that if molybdenum is tied up in crystalline components, either the proper dispersion together with interaction is not achieved or the compounds physically block active sites.

  6. The New Room Arrangement as a Teaching Strategy = La Nueva Organizacion del Salon como Estrategia Educativa.

    ERIC Educational Resources Information Center

    Dodge, Diane Trister

    Many typical classroom behavior problems--running in the classroom, inability to make choices, failure to stick with activities, fighting over toys, and poor use of materials-- can be traced to how the room is arranged and how materials are displayed. By making a few changes in the classroom environment, early childhood teachers can create a…

  7. Co/Mo bimetallic addition to electrolytic manganese dioxide for oxygen generation in acid medium

    PubMed Central

    Delgado, Dario; Minakshi, Manickam; McGinnity, Justin; Kim, Dong-Jin

    2015-01-01

    An efficient electrocatalyst comprising inexpensive and earth-abundant materials for the oxygen evolution reaction (OER) is crucial for the development of water electrolysis. In this work, in-situ addition of cobalt/molybdenum ions to the electrolytic manganese dioxide has been shown to be beneficial for the OER in acid solution as its overpotential performed better (305 mV) than that of the commercial DSA® (341 mV) at 100 mA cm−2. The OER was investigated at ambient temperature in 2 M H2SO4 solution on the modified EMD (MnMoCoO) electrodes. The energy efficiency of the MnMoCoO electrodes improved significantly with the amount of Co in the plating solution. For the electrodeposited catalysts, physico-chemical and electrochemical measurements were conducted including static overpotentials. The better performance of the modified EMD was attributed to an improved charge transfer resistance (Rct; 0.290 Ω cm2), average roughness factor (rf; 429) and decrease in water content in the electrodeposited catalysts. The kinetic parameters obtained on MnMoCoO catalysts were compared and discussed according to the cobalt concentration. PMID:26469204

  8. Spanish Oral Language Guide: Kindergarten Level. Espanol como Segundo Idioma. Teacher's Guide: Level I.

    ERIC Educational Resources Information Center

    Corbell, Gloria; And Others

    This teacher's guide to Spanish language at the kindergarten level includes a recommended subject presentation sequence for the Spanish curriculum, a sample schedule, a grouping of students using three stations, and a classroom layout. The grouping would be effective when at least one-third of the children are Spanish-speaking or bilingual. The

  9. "Las Charlas" como expresion oral diaria ["Chats" as Daily Oral Practice].

    ERIC Educational Resources Information Center

    Borden, Matt

    2002-01-01

    An oral practice system of "chats" in the classroom functions as an extemporaneous speaking exercise or chat (without notes or prompt sheets), occurring between two students for a minute or so at the beginning of class, following which the presenters respond to other students' questions. (CNP)

  10. "Tanto Necesitamos De Aqui Como Necesitamos De Alla": "Leer Juntas" among Mexican Transnational Mothers and Daughters

    ERIC Educational Resources Information Center

    de la Piedra, Maria Teresa

    2011-01-01

    This paper presents part of the results of a qualitative study about literacy practices of Mexican transnational mothers, who live in and frequently cross the border between two countries (the United States and Mexico). Drawing on sociocultural approaches to literacy and literature on transnationalism, I analyze one practice: "leer juntas"

  11. The New Room Arrangement as a Teaching Strategy = La Nueva Organizacion del Salon como Estrategia Educativa.

    ERIC Educational Resources Information Center

    Dodge, Diane Trister

    Many typical classroom behavior problems--running in the classroom, inability to make choices, failure to stick with activities, fighting over toys, and poor use of materials-- can be traced to how the room is arranged and how materials are displayed. By making a few changes in the classroom environment, early childhood teachers can create a

  12. Como Lo Hago Yo: Defectos Del Cierre Del Tubo Neural En Nicaragua

    PubMed Central

    Gonzalez, Juan Bosco

    2014-01-01

    En Nicaragua no hay un plan de forltificación de alimentos con ácido fólico. Las madres son muy jóvenes. En La Mascota operamos mas de cuarenta niños por año. Derivación tardía es un problema. La infección preoperatoria tiene que ser descartada. Vancomicina y Ceftriaxone estan indicadas. Estricta regla de asepsia operatoria. Suturamos la plaqueta para asemejar su forma al cilindro normal de la médula. No ceramos la capa de músculo. PMID:24791221

  13. Co/Mo bimetallic addition to electrolytic manganese dioxide for oxygen generation in acid medium.

    PubMed

    Delgado, Dario; Minakshi, Manickam; McGinnity, Justin; Kim, Dong-Jin

    2015-01-01

    An efficient electrocatalyst comprising inexpensive and earth-abundant materials for the oxygen evolution reaction (OER) is crucial for the development of water electrolysis. In this work, in-situ addition of cobalt/molybdenum ions to the electrolytic manganese dioxide has been shown to be beneficial for the OER in acid solution as its overpotential performed better (305?mV) than that of the commercial DSA() (341?mV) at 100?mA cm(-2). The OER was investigated at ambient temperature in 2?M H2SO4 solution on the modified EMD (MnMoCoO) electrodes. The energy efficiency of the MnMoCoO electrodes improved significantly with the amount of Co in the plating solution. For the electrodeposited catalysts, physico-chemical and electrochemical measurements were conducted including static overpotentials. The better performance of the modified EMD was attributed to an improved charge transfer resistance (Rct; 0.290???cm(2)), average roughness factor (rf; 429) and decrease in water content in the electrodeposited catalysts. The kinetic parameters obtained on MnMoCoO catalysts were compared and discussed according to the cobalt concentration. PMID:26469204

  14. International Perspectives on Affirmative Action. A Bellagio Conference (Lake Como, Italy, August 16-20, 1982).

    ERIC Educational Resources Information Center

    Rockefeller Foundation, New York, NY.

    This volume presents nine papers read at a conference on affirmative action, sponsored by the Rockefeller Foundation and held at Columbia University in August 1982; a preface, summary paper, and list of participants are also included. Each paper addresses the issue of affirmative action within a different country and describes: (1) the policies…

  15. Como si le Falta un Brazo: Latino Immigrant Parents and the Costs of Not Knowing English

    ERIC Educational Resources Information Center

    Worthy, Jo

    2006-01-01

    This study examined the perspectives of Latino/a immigrant parents about the place of English in their lives. The parents described how they had come to the United States with intentions of learning English, but various obstacles made it an overwhelming challenge. The author questions whether, despite rhetoric to the contrary, financially

  16. Contributions of local knowledge to the physical limnology of Lake Como, Italy

    PubMed Central

    Laborde, Sarah; Imberger, Jrg; Toussaint, Sandy

    2012-01-01

    This article shows how local knowledge may be valuably integrated into a scientific approach in the study of large and complex hydrological systems where data collection at high resolution is a challenge. This claim is supported through a study of the hydrodynamics of a large lake where qualitative data collected from professional fishers was combined with theory to develop a hypothesis that was then verified by numerical modeling. First the fishermens narratives were found to describe with accuracy internal wave motions that were evident in water column temperature records, which revealed their practical knowledge of the lakes hydrodynamics. Second, local knowledge accounts emphasized the recurrent formation of mesoscale gyres and return flows in certain zones of the lake in stratified conditions, which did not appear in the physical data because of limitations of sampling resolution. We hypothesized that these features developed predominantly because of the interaction of wind-driven internal motions with the lakes bathymetry, and the Earths rotation in the widest areas of the basin. Numerical simulation results corroborated the fishers descriptions of the flow paths and supported the hypothesis about their formation. We conclude that the collaboration between scientific and local knowledge groups, although an unusual approach for a physical discipline of the geosciences, is worth exploring in the pursuit of a more comprehensive understanding of complex geophysical systems such as large lakes. PMID:22493231

  17. The Struggle for Mexico's First Gay-Straight Alliance: Como una Novela Real

    ERIC Educational Resources Information Center

    Macgillivray, Ian K.

    2006-01-01

    In 2004, a group of high school students at a private American school in Mexico City started the first gay-straight alliance in Mexico. A small group of conservative parents and a Mormon principal organized in opposition. This paper details the students' struggle to keep their club and offers lessons learned about student activism, school change,

  18. Como ayudar a sus hijos a usar la biblioteca (Helping Your Child Use the Library).

    ERIC Educational Resources Information Center

    Perkinson, Kathryn

    Focusing on the cooperative role of parents and public libraries in stimulating reading interests in children of all ages, this booklet addresses the following issues: (1) getting children interested in reading (reading aloud to children; encouraging children to read to you; starting a home library; showing children that you enjoy reading;…

  19. Como pagar to educacion, 2004-2005 (Funding Your Education, 2004-2005).

    ERIC Educational Resources Information Center

    Office of Federal Student Aid (ED), Washington, DC.

    This publication, written in Spanish, describes financial aid programs of the U.S. Department of Education and advises students about paying for college. It outlines things a student should ask about college and how to obtain financial aid, whether grants, work-study, or loans. Chapters provide information on: (1) "Education after High School";…

  20. Como pagar tu educacion, 2003-2004 (How To Pay for Your Education, 2003-2004).

    ERIC Educational Resources Information Center

    Office of Federal Student Aid (ED), Washington, DC.

    This Spanish language booklet discusses paying for college. The guide presents information in question-and-answer form about things an applicant should ask and how to obtain financial aid. It describes the criteria for receiving aid and provides information about complying with aid requirements. The booklet also describes federal Pell grants and…

  1. [Rabdomiosarcoma primario de corazn como causa de sncope recurrente en el adulto].

    PubMed

    Daz-Prez, Julio Alexander; Gmez-Arbelez, Diego; Hurtado-Gomez, Gabriel Alexander

    2011-01-01

    Primary or secondary neoplasms can affect the heart. Secondary are more common. However, primary neoplasms are relevant because is a group with diverse genesis, behavior, treatment and clinical manifestations. We present a case of a 45 year-old woman, with recurrent syncope started 1 year before her first consult. She had palpitations and chest pain. Echocardiography identified a left atrium mass of 2.1x1.8 cm. Endomyocardial biopsy document a primary rhabdomyosarcoma of the heart. The patient dies after a overall-survival of 22 months. This case presented had a good study of its symptoms with an accurate diagnosis and early treatment, which provided prolonged survival of this rare and aggressive neoplasm. PMID:22188886

  2. Co/Mo bimetallic addition to electrolytic manganese dioxide for oxygen generation in acid medium

    NASA Astrophysics Data System (ADS)

    Delgado, Dario; Minakshi, Manickam; McGinnity, Justin; Kim, Dong-Jin

    2015-10-01

    An efficient electrocatalyst comprising inexpensive and earth-abundant materials for the oxygen evolution reaction (OER) is crucial for the development of water electrolysis. In this work, in-situ addition of cobalt/molybdenum ions to the electrolytic manganese dioxide has been shown to be beneficial for the OER in acid solution as its overpotential performed better (305 mV) than that of the commercial DSA® (341 mV) at 100 mA cm-2. The OER was investigated at ambient temperature in 2 M H2SO4 solution on the modified EMD (MnMoCoO) electrodes. The energy efficiency of the MnMoCoO electrodes improved significantly with the amount of Co in the plating solution. For the electrodeposited catalysts, physico-chemical and electrochemical measurements were conducted including static overpotentials. The better performance of the modified EMD was attributed to an improved charge transfer resistance (Rct; 0.290 Ω cm2), average roughness factor (rf; 429) and decrease in water content in the electrodeposited catalysts. The kinetic parameters obtained on MnMoCoO catalysts were compared and discussed according to the cobalt concentration.

  3. 78 FR 38287 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-26

    .... Correction In the Federal Register of June 17, 2013, in FR DOC 2013- 14229 on page 36163 in the second column... FURTHER INFORMATION CONTACT: Sara Grove, South Zone Interdisciplinary Team Leader; West Fork...

  4. Como Ayudar a sus Hijos a Aprender Ciencia (Helping Your Child Learn Science).

    ERIC Educational Resources Information Center

    Paulu, Nancy; Martin, Margery

    Because most parents say they do not or cannot help their children with science, this booklet was designed to help them do so, easily and with pleasure for both parent and child. The introduction presents information on why and how parents should help their children and provides a general orientation to the ideas and activities offered in the…

  5. Informacion Bibliografica Educativa (Bibliographic Educational Information). No. 12.

    ERIC Educational Resources Information Center

    Ministerio de Educacion Nacional, Bogota (Colombia). Centro Nacional de Documentacion e Informacion Pedagogica.

    The document contains six papers in Spanish which focus on the developmental and other aspects of education permanente. The first paper, The Concept of Education Permanente, discusses the concept as a new dimension in the area of education, capable of limiting inequalities in the presentation of education in general. Descriptions of 20…

  6. Insertion of Astronomy as a High School Subject. (Spanish Title: Inserción de Astronomia Como Materia del Ciclo Secundario.) Inserção da Astronomia Como Disciplina Curricular do Ensino Médio

    NASA Astrophysics Data System (ADS)

    Dias, Claudio André C. M.; Santa Rita, Josué R.

    2008-12-01

    Astronomy is considered among the first sciences that man dominated, however, the basic skills for the construction of knowledge, relatively to the contents "Earth and the Universe" are not being developed properly for the majority of students concluding the high school level. The students are concluding this teaching cycle without proper knowledge of several subjects in the area of Astronomy, which are mandatory in the national Curricular National Parameters (PCN). Because of this discrepancy, this work stresses the need of the incorporation of a specific subject of Astronomy in the high school, in order to reduce the gap between what is taught and which should be taught. La Astronomía es considerada una de las primeras ciencias que el hombre dominó. Sin embargo, las habilidades básicas para la construcción del conocimento, relativo al eje temático "Tierra y Universo", no vienen siendo trabajadas adecuadamente con la mayoría de los alumnos que concluyen el ciclo escolar medio. Los alumnos están concluyendo este nivel de enseñanza sin conocimentos de varios temas en el área de Astronomía, que son obligatorios según los Parámetros Curriculares Nacionales (PCN). En virtud de esta discrepancia, este trabajo enfatiza la necesidad de incorporar una disciplina específica de Astronomía em el ciclo medio, em pro de la reducción de las distorsiones entre lo que es enseñado y lo que se debe enseñar. A Astronomia é considerada uma das primeiras ciências que o homem dominou, porém as competências básicas para a construção do conhecimento, relativo ao eixo temático "Terra e Universo", não vêm sendo trabalhadas a contento com a maioria dos alunos que concluem o ensino médio. Os alunos estão concluindo este nível de ensino sem conhecimento de vários temas na área de Astronomia, que são obrigatórios nos Parâmetros Curriculares Nacionais (PCN). Em virtude desta discrepância, este trabalho vem evidenciar a necessidade da incorporação de uma disciplina específica de Astronomia, no ensino médio, em prol da redução das distorções entre o que é ensinado e o que se deve ensinar.

  7. La Traduccion Simultanea como Materia en Una Carrera de Lenguas (Simultaneous Translation as a Course in a Foreign Language Program)

    ERIC Educational Resources Information Center

    Bradley, D.

    1977-01-01

    A description of the foreign language curriculum at the university level in which courses in simultaneous translation are required. The size and composition of the groups are described as well as methods used to develop skill in translating and interpreting. Results are assessed. (Text is in Spanish.) (AMH)

  8. Programa Academico de Dominio de Ingles Como Lengua Extranjera (Academic Program in English as a Foreign Language).

    ERIC Educational Resources Information Center

    Flores Revilla, Maria Teresa; Zoreda, Margaret Lee; Vivaldo Lima, Javier; Blanco Lopez, Guadalupe; Caballero Robles, Teresita del Rosario; Mercau Appiani, Virginia

    The guide presents the newly-developed curriculum of the Universidad Autonoma Metropolitana at Iztapalapa (Mexico) for its program in English as a foreign language. An introductory section provides background information on the initiative to design a new curriculum. The second section presents the principles on which the curriculum and its methods

  9. Contextualizacion y "Expresiones Pragmaticas": "Che" como Senal de Marco (Contextualization and "Pragmatic Expressions": "Che" as Deictic Marker).

    ERIC Educational Resources Information Center

    Carranza, Isolda

    The pragmatic expressions of Argentine Spanish (e.g., "bueno, viste, no? mira") are defined as deictic signals. They are deictic because they indicate elements of the communicative situation: transitions between text segments, conversational roles, or the social relationship between participants. They also signal contextual suppositions and help

  10. Estadsticas de visitas en portales web institucionales como indicador de respuesta del pblico a propuestas de divulgacin

    NASA Astrophysics Data System (ADS)

    Lares, M.

    The presence of institutions on the internet is nowadays very important to strenghten communication channels, both internal and with the general public. The Crdoba Observatory has several web portals, including the official web page, a blog and presence on several social networks. These are one of the fundamental pillars for outreach activities, and serve as communication channel for events and scientific, academic, and outreach news. They are also a source of information for the staff, as well as data related to the Observatory internal organization and scientific production. Several statistical studies are presented, based on data taken from the visits to the official web pages. I comment on some aspects of the role of web pages as a source of consultation and as a quick response to information needs. FULL TEXT IN SPANISH

  11. El doblete D del Sodio como indicador de la actividad cromosfrica en estrellas de la secuencia principal

    NASA Astrophysics Data System (ADS)

    Daz, R. F.; Mauas, P. J. D.

    We study the line profile of the sodium D doublet (5890 A and 5896 A) in dwarf stars with spectral type between M5.5 and F6. We find that the equivalent width of these lines shows a very good correlation with spectral type for stars later than K4. The flux absorbed in this region of the spectrum is then compared with the flux absorbed in the calcium H&K lines -a traditional activity indicator. For stars with (B-V)> 1.15 the correlation between absorbed fluxes is good and hence the sodium doublet is a good activity indicator. Since the doublet is found at longer wavelenghts than the calcium H & K lines, it is particularly useful for the study of chromospheric activity in late-type stars.

  12. Estudio de generacion de energia con celdas de combustible con membrana poly diallydimethylammonium chloride (PDADMAC) como polimero de intercambio protonico

    NASA Astrophysics Data System (ADS)

    Nino Galeano, Miguel Angel

    Fuel cells were built with poly diallydimethylammonium chloride or PDADMAC (by its initials in English) as proton exchange membrane and were compared with earlier studies of fuel cells constructed by other methods and / or materials. Also copper, aluminum and nickel were used as electrodes in the electrode membrane ensamble in search of the best performance operational cell. The results of the current were used to justify the use of PDADMAC membranes in 40% volume-volume ratio in different combinations of metals Cu-Al, Ni-Al as electrodes. For the study of conduction performance of membrane electrode ensambles (MEA), copper and aluminum were as cathode and anode for their active behavior as functional electrodes in the experimental cell, walling individually membrane types PDADMAC, PDADMAC + Buffer, PDADMAC + deionized water and PDADMAC + tap water.

  13. "Tras de un Amoroso Lance" como Estructura Expresiva (The Poem, "Behind the Amorous Cast" as an Expressive Structure).

    ERIC Educational Resources Information Center

    Bratosevich, Nicolas

    1967-01-01

    An analysis of a poem by San Juan de la Cruz (St. John of the Cross), the sixteenth century Spanish mystic, identifies symbols and images, explains themes, and offers a synthesis of his structural patterns. The poem, "Tras de amoroso lance", deals with the theme of the search of the beloved (i.e., the soul) for the lover, and incorporates the…

  14. Significant Learning Experiences for English Foreign Language Students (Experiencias significativas para estudiantes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Becerra, Luz María; McNulty, Maria

    2010-01-01

    This action research examines experiences that students in a grade 10 EFL class had with redesigning a grammar-unit into a topic-based unit. Strategies were formulating significant learning goals and objectives, and implementing and reflecting on activities with three dimensions of Dee Fink's (2003) taxonomy of significant learning: the human…

  15. Tetrahydrothiophene desulfurization on Co-Mo/. gamma. -Al sub 2 O sub 3 : A temporal analysis of products (TAP) investigation

    SciTech Connect

    Moser, W.R.; Rossetti, G.A. Jr. ); Gleaves, J.T.; Ebner, J.R. )

    1991-01-01

    The catalytic reactions of tetrahydrothiophene, thiophene, 1-butene, 1,3-butadiene, and n-butane with hydrogen were studied at low pressure over a commercial cobalt molybdate catalyst. The formation sequence of tetrahydrothiophene desulfurization products was monitored with submilli-second time resolution using the temporal analysis of products (TAP) transient microreactor technique. The TAP experiments showed that butene and were the only hydrocarbon desulfurization products formed, although rapid dehydrogenation to thiophene was also observed. The exceptional time resolution of the TAP spectrometer provided evidence that the butene formed could not be accounted for by a mechanism involving butadiene hydrogenation. The results suggested a desulfurization mechanism for tetrahydrothiophene wherein C{sub 4} hydrocarbon formation proceeds via a surface butene thiolate intermediate produced by a single {beta}-hydride elimination of the intermediate, while rapid C-S bond hydrogenolysis involving surface hydrogen is responsible for butene formation.

  16. The English as a Foreign Language/Lingua Franca Debate: Sensitising Teachers of English as a Foreign Language towards Teaching English as a Lingua Franca (El debate del inglés como lengua extranjera o como lengua franca: sensibilización de docentes de inglés como lengua extranjera hacia la enseñanza del inglés como lengua franca)

    ERIC Educational Resources Information Center

    Mansfield, Gillian; Poppi, Franca

    2012-01-01

    The function of English as a lingua franca for communication needs rethinking in the teaching of English as a foreign language classroom as a consequence of globalisation. The present contribution is an empirical study carried out in an Italian university environment which aims to show how teachers should take on board awareness raising activities…

  17. Caracteristicas de la Instruccion Programada como Tecnica de Ensenanza (Characteristics of Programed Instruction as a Teaching Technique).

    ERIC Educational Resources Information Center

    Dorrego, Maria Elena

    This discussion of programed instruction begins with the fundamental psychological aspects and learning theories behind this teaching method. Negative and positive reinforcement, conditioning, and their relationship to programed instruction are considered. Different types of programs, both linear and branching, are discussed; criticism of the…

  18. How To Start a Family Day Care = Como Iniciar una Guarderia en El Hogar. [Videotape and Viewer's Guide].

    ERIC Educational Resources Information Center

    Raphael, Doris; Weisman, Douglas

    Being a family day care provider is work that requires professional responsibilities and attention to the physical, emotional, and educational well-being of children; listening and responding to parents; and running a business. This videotape, in English- and Spanish-language versions, explores the elements involved in starting up a family day

  19. The Accented EFL Teacher: Classroom Implications (El acento del profesor de ingls como lengua extranjera: implicaciones pedaggicas)

    ERIC Educational Resources Information Center

    Arboleda Arboleda, Argemiro; Castro Garcs, ngela Yicely

    2012-01-01

    This article reports the findings of a research study on how significant having a foreign accent is for non-native English as a foreign language teachers and learners at university level. It points out the perceptions that teachers and students have about the most relevant issues in the teaching and learning processes. Data were collected by means

  20. How Can We Provide Safe Playgrounds? = Como podemos proveer lugares con juegos infantiles que no sean peligrosos para los ninos?

    ERIC Educational Resources Information Center

    ACCESS ERIC, Rockville, MD.

    Outdoor playgrounds can be exciting places where children explore their environment and develop motor and social skills; however, they can also pose serious safety hazards. With the exception of California, no mandatory state or federal standards currently exist regarding manufacture or installation of playground equipment or surfaces. The…

  1. Como ayudar a los padres a prevenir el envenenamiento por plomo (Helping Parents Prevent Lead Poisoning). ERIC Digest.

    ERIC Educational Resources Information Center

    Binns, Helen J.; Ricks, Omar Benton

    Children are at greater risk than adults for lead poisoning because children absorb lead more readily than adults, and a small amount of lead in children's bodies can do a great deal of harm. This Spanish-language Digest summarizes some of the causes and effects of childhood lead poisoning and suggests some lead poisoning prevention strategies

  2. PARTICULATE AIR POLLUTION AND MORBIDITY IN THE CALIFORNIA CENTRAL VALLEY: A HIGH PARTICULATE POLLUTION REGION

    EPA Science Inventory

    The study collected data from monitoring of PM and criteria pollutants (PM10, PM2.5, CO, NO2, ozone, etc.) and mobidity data from Kaiser Permanente. The study then examined the relationship between air pollutants and hospital admissions.

  3. CRN Investigators

    Cancer.gov

    Skip to Main Content Home Contact Us Search CRN Investigators Executive Committee Members Steering Committee Members Executive Committee Members Lawrence H. Kushi, ScD Division of Research, Kaiser Permanente Northern California CRN Principal Investigator,

  4. Planeamiento de la unidad didactica en le ensenanza del ingles como idioma extranjero (Planning the Teaching Unit in the Instruction of English as a Foreign Language).

    ERIC Educational Resources Information Center

    Medina T., Rene

    1971-01-01

    This paper discusses the use of the teaching unit as a means for organization in English-as-a-foreign-language classes. It lists the essential elements in the construction of such a unit: cultural topic, linguistic elements, time period, main objectives, instructional materials, focus, specific activities, intended results, evaluation techniques,…

  5. How To Talk to Your Teens and Children about AIDS = Como hablar con sus adolescentes y sus ninos sobre el SIDA.

    ERIC Educational Resources Information Center

    National PTA, Chicago, IL.

    Two brochures, one in English and one in Spanish, provide parents with basic information that will enable them to educate their children about Acquired Immune Deficiency Syndrome (AIDS). Contents address 11 questions: (1) What is AIDS? (2) How do you get AIDS? (3) How is AIDS not spread? (4) Who can get AIDS? (5) How can you tell if someone has…

  6. "Como Se Dice HIV?" Adapting Human Immunodeficiency Virus Prevention Messages to Reach Homosexual and Bisexual Hispanic Men: The Importance of Hispanic Cultural and Health Beliefs.

    ERIC Educational Resources Information Center

    Bowdy, Matthew A.

    HIV/AIDS prevention messages catered to Anglo homosexual/bisexual men are not effective in teaching preventative behaviors to Hispanic homosexual/bisexual men. Hispanic sociocultural traits associated with homosexuality and bisexuality prevent the effectiveness of these messages. The Hispanic family is also extremely important in influencing…

  7. La Imagen Publica y Professional del Espanol en Yanquilandia - y Como Mejorarla (The Public and Professional Image of Spanish in "Yankee-Land" and How to Improve It).

    ERIC Educational Resources Information Center

    Mead, Robert G., Jr.

    1981-01-01

    Decries the stereotypes and prejudices that affect U. S. relations with the Hispanic world and with its own Hispanic minorities. Points out that these attitudes also affect the study of Spanish as a foreign language and suggests means by which educators can improve the Hispanic image among Anglo Americans. (MES)

  8. "Mastery Learning" Como Metodo Psicoeducativo para Ninos con Problemas Especificos de Aprendizaje. ("Mastery Learning" as a Psychoeducational Method for Children with Specific Learning Problems.)

    ERIC Educational Resources Information Center

    Coya, Liliam de Barbosa; Perez-Coffie, Jorge

    1982-01-01

    "Mastery Learning" was compared with the "conventional" method of teaching reading skills to Puerto Rican children with specific learning disabilities. The "Mastery Learning" group showed significant gains in the cognitive and affective domains. Results suggested Mastery Learning is a more effective method of teaching reading skills to children

  9. Metodo de Archivar las Observaciones del Comportamiento del Nino, Como Guia para Entenderlo Mejor (Methods of Recording Observations of Children's Behavior, A Guide for Better Understanding)

    ERIC Educational Resources Information Center

    Stamp, Isla M.

    1971-01-01

    Copies of the Behaviour Study Technique described in this article may be obtained in English from the Australian Council for Educational Research, Frederick St., Hawthorn, Victoria, Australia 3122. (RY)

  10. Como evalvar la actuacion del profesor en una clase de segundo idioma (How to Evaluate a Teacher in a Second Language Classroom).

    ERIC Educational Resources Information Center

    Galvez de Bracamonte, Teresa

    This guide in Spanish provides performance criteria for evaluating the foreign language teacher. It provides an outline for analyzing the teacher's actions and teaching methods in the classroom. Through the evaluation by an outsider, the teacher can learn his or her faults in the views of others and can improve on them. The aspects to be analyzed

  11. Collaborative Work as an Alternative for Writing Research Articles (El trabajo colaborativo como alternativa para la escritura de artículos investigativos)

    ERIC Educational Resources Information Center

    Carvajal Medina, Nancy Emilce; Roberto Flórez, Eliana Edith

    2014-01-01

    Academic writing in English in our context is a significant aspect that can be innovative when a convergence model of writing stages is used along with collaborative work. This article reports on a study aimed at analyzing how collaborative work relates to undergraduate electronics students' academic writing development in English as a foreign…

  12. La anglofonia y literaturas poscoloniales en la ensenanza de ingles como lengua extranjera (Anglophonism and Postcolonial Literature in Teaching English as a Second Language).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper, written in Spanish, focuses on the instruction of English as a Second Language in the context of cultural understanding, rather than from a purely linguistic point of view. It argues that foreign language instruction should include lessons in the field of sociology, anthropology, history, geography, politics, the arts, and popular

  13. Como Lo Hago Yo: Anomalías del Tubo Neural en Guatemala — Mielomeningocele Unidad de Espina Bífida e Hidrocefalia

    PubMed Central

    Manucci, Graciela; von Quednow, Enzo

    2014-01-01

    En Guatemala nacen por añ 786 niños con defectos de tubo neural. Operamos 65 a 70 niños con mielomenigocele por año. Tenemos equipo multidisciplinario. Recomendamos parto por cesárea. Infección antes de la cirugía es un problema mayor. Derivación tardía es un problema. Disecamos la plaqueta con la técnica clásica. Suturamos la plaqueta para restituir la forma de la médula. Corpectomía en casos de cifósis. Hidrocefalía: Operamos el 80% de los niños. Chiari II: Operamos basados en los síntomas, primero nos aseguramos que la válvula funciona bien. Médula anclada: Operamos basados en los síntomas. PMID:24791216

  14. Un currículo interdisciplinario de base teórica para enseñar inglés como segunda lengua1

    PubMed Central

    Fuentes, Brenda O.; Mas, Francisco Soto; Mein, Erika; Jacobson, Holly E.

    2013-01-01

    Among Hispanic immigrants in the United States (US), learning English is considered necessary for economic and social achievement. As a consequence, there is a high demand for English as a Second Language (ESL) classes. Despite the recognized benefits of ESL programs, both at the individual and social levels, more research is needed to identify education strategies that effectively promote all aspects of learning English as a second language. This article describes an ESL curriculum that incorporates a theory-based pedagogical approach specifically designed for immigrant Hispanic adults on the US-Mexico border region. The article also describes the implementation of the curriculum as well as the results of the evaluation, which was conducted using both quantitative and qualitative methods. Quantitative results indicate that the participants significantly improved their English proficiency (L2). Qualitative results suggest that participants were positively impacted by both the content and pedagogical approaches used by the curriculum. Their experience with the ESL class was positive in general. It can be concluded that the curriculum achieved its objective. This approach could serve as a model for second language teaching for adults. PMID:25284915

  15. A Mo-K edge XAFS study of the metal sulfide-support interaction in (Co)Mo supported alumina and titania catalysts

    SciTech Connect

    Leliveld, R.G.; Dillen, A.J. van; Geus, J.W.; Koningsberger, D.C.

    1997-01-15

    The metal-support interaction in oxidic and sulfided (Co)Mo/Al{sub 2}O{sub 3} and (Co)Mo/TiO{sub 2} catalysts has been studied with X-ray absorption spectroscopy. Analysis of the oxidic catalysts showed that on both Mo/Al{sub 2}O{sub 3} and Mo/TiO{sub 2} the molybdenum oxide particles possess a highly distorted octahedral structure with Mo-O distances ranging from 1.71 {Angstrom} to 1.94 {Angstrom}. The second shell Mo-Mo coordination number of less than 1.0 indicated that the size of the molybdenum oxide particles is very small. Upon addition of Co the particle size is increased to approximately four Mo atoms per particle. EXAFS data analysis showed the presence of second shell Al and Ti neighbours indicating a linkage of the molybdenum oxide particles to the support via Mo-O-X (X = Al or Ti) bonds. Upon sulfidation of the oxidic catalysts small MOS{sub 2} particles are formed with second shell Mo-Mo coordination numbers ranging from 0.8 to 3.9. {Angstrom} Mo-O contribution at 2.0 {Angstrom} was found in the first coordination shell of Mo in the sulfided catalysts. Since the coordination number of this Mo-O contribution correlated with the MOS{sub 2} particle size, deduced from the second shell Mo-Mo coordination number, this Mo-O contribution was assigned as an interfacial Mo-O{sub support} linkage. This Mo-O{sub support} linkage stabilizes; the small MOS{sub 2} particles and prevents them from sintering. It is proposed that the activity of these catalysts can be controlled by optimising the molybdenum sulfide-support interaction, which consists of the observed MO-O{sub support} bonds. 56 refs., 11 figs., 6 tabs.

  16. La efectividad de la educacion a distancia como metodologia en la desarrollo de destrezas de pensamiento (Effectiveness of Distance Education as a Methodology for Developing Thinking Skills).

    ERIC Educational Resources Information Center

    Melendez Alicea, Juan

    1992-01-01

    Presents steps taken in designing, justifying, and implementing an experimental study designed to investigate the effectiveness of distance education as a methodology for developing thinking skills. A discussion reviews major findings of the study by comparing student experiences from multimedia distance education and student experiences from

  17. "O Ensaio como Forma" ou Um Ensaio acerca da Teoria Critica da Sociedade ("The Essay as Form" or An Essay about the Critical Theory of Society).

    ERIC Educational Resources Information Center

    Giordano, Rosely

    2000-01-01

    Illuminates the critical theory project, with themes permeating the theoretical constructions of Frankfurt (Germany). Debates the predominance of positivism in the production of knowledge. Speculates that "the essay as form" constitutes itself as a representation of the concept of the Enlightenment. Concludes with a dialogue between Theodor Adorno…

  18. Estudio de NIH indica que la actividad física en tiempo libre alarga la vida tanto como 4,5 años

    Cancer.gov

    La actividad física en tiempo libre está asociada con una expectativa de vida más larga, aun en un grado de actividad relativamente bajo e independientemente del peso corporal, de acuerdo con un estudio llevado a cabo por un equipo de investigadores del I

  19. Me escuchas? Como conversar con ninos de cuatro a doce anos (Are You Listening to Me? Communicating with Children from Four to Twelve Years Old).

    ERIC Educational Resources Information Center

    Delfos, Martine F.

    Although talking to children is a daily activity for almost everyone at some stage in one's life and an essential activity for professionals who work with children, there is little research on activity. This Spanish-language book describes communication with children between the ages of 4 and 12 years, focusing on open question-and-answer sessions

  20. Cidadania Negada: A Educacao como Instrumento de Combate a Pobreza no Brasil (Denial of Citizenship: Education as a Way to Fight Poverty in Brazil).

    ERIC Educational Resources Information Center

    Germano, Jose Willington

    1995-01-01

    Compares two compensatory social/educational programs developed by the Brazilian government in the last 15 years. States that although one was formulated during the military regime and one during the present government, they both combat poverty and encourage privatization. Concludes that this promotes a process that sees education as social

  1. Sound in ecclesiastical spaces in Cordoba. Architectural projects incorporating acoustic methodology (El sonido del espacio eclesial en Cordoba. El proyecto arquitectonico como procedimiento acustico)

    NASA Astrophysics Data System (ADS)

    Suarez, Rafael

    2003-11-01

    This thesis is concerned with the acoustic analysis of ecclesiastical spaces, and the subsequent implementation of acoustic design methodology in architectural renovations. One begins with an adequate architectural design of specific elements (shape, materials, and textures), with the intention of elimination of acoustic deficiencies that are common in such spaces. These are those deficiencies that impair good speech intelligibility and good musical audibility. The investigation is limited to churches in the province of Cordoba and to churches built after the reconquest of Spain (1236) and up until the 18th century. Selected churches are those that have undergone architectural renovations to adapt them to new uses or to make them more suitable for liturgical use. The thesis attempts to summarize the acoustic analyses and the acoustical solutions that have been implemented. The results are presented in a manner that should be useful for the adoption of a model for the functional renovation of ecclesiastical spaces. Such would allow those involved in architectural projects to specify the nature of the sound, even though somewhat intangible, within the ecclesiastical space. Thesis advisors: Jaime Navarro and Juan J. Sendra Copies of this thesis written in Spanish may be obtained by contacting the advisor, Jaime Navarro, E.T.S. de Arquitectura de Sevilla, Dpto. de Construcciones Arquitectonicas I, Av. Reina Mercedes, 2, 41012 Sevilla, Spain. E-mail address: jnavarro@us.es

  2. Como sacar el mayor partido a una cancion en la clase de espanol (How to Get the Most Out of a Song in a Spanish Class).

    ERIC Educational Resources Information Center

    Acuna, Beatriz Gomez

    2002-01-01

    Although second language textbooks rarely provide songs or many song-related exercises, music excels at alleviating students' tension, enlivening the atmosphere, and offering teachers opportunities to emphasize pedagogical concepts, whether linguistic or cultural. A series of easy-to-use activities is provided that will work with most songs and is…

  3. "Es como uno bomba de tiempo [It's like a time bomb]": A Qualitative Analysis of Perceptions of Diabetes Among First-Degree Relatives of Latino Patients With Diabetes.

    PubMed

    Castro-Rivas, Erida; Boutin-Foster, Carla; Milan, Maria; Kanna, Balavenkatesh

    2014-02-01

    Background. The South Bronx, a largely Latino community, has become an epicenter of the diabetes epidemic in New York City. In this community, nondiabetic first-degree relatives of people with diabetes are prime targets for intervention. Therefore, the objective of this study was to explore the knowledge of diabetes and attitudes toward health behavior modification of Latino adults who are first-degree relatives of people with diabetes. Methods. Participants were recruited from three settings in the South Bronx (a community-based organization, a faith-based organization, and a taxi station). The Common Sense Model was used to develop focus-group items. This model provides a framework for exploring illness representations along five domains: identity, cause, consequences, timeline, and perceptions of curability. Responses were transcribed verbatim, and data analysis proceeded in the following order: data immersion, assignment of codes, grouping of key concepts to form categories, and construction of higher-order themes. Results. Of the 115 potential participants identified, 53 were found to be eligible, and 23 of these participated in the focus group. Of these, 20 were Dominicans, 2 were Puerto Ricans, and 1 was Salvadorian. The mean age was 46.39 years, 35% were women, 61% were married, and 26% had less than a high school education. Qualitative analyses resulted in 547 codes that were grouped into 52 concepts, from which 9 categories and 4 overarching themes emerged. The dominant themes were 1) family, genetics, and culture play a major role in the etiology of diabetes; 2) being Latino and having a first-degree relative with diabetes makes getting diabetes inevitable, and, like a time bomb exploding, it is destined to happen; 3) once one develops diabetes, the physical and emotional consequences are devastating and destructive; and 4) diabetes can be "cured" through healthy eating and with insulin. Conclusions.In this study, first-degree relatives of patients with diabetes were knowledgeable about the risks and consequences of diabetes. However, some participants felt that being Latino and having a first-degree relative with diabetes made one destined to have diabetes. Addressing this misperception through culturally tailored interventions has implications for diabetes prevention and may help to stem the diabetes epidemic in Latino communities. PMID:26246756

  4. Como Puede Mejorar el Programa de Educacion Migrante con el Poder e Influencia de los Padres. Parent Power in the Migrant Education Program: How to Make a Difference.

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC.

    The bilingual (English-Spanish) handbook explains the established rights that parents with children enrolled in the Elementary and Secondary Education Act Title I Migrant Education Program have and presents ways in which parents can use these rights to help ensure that their children receive a quality education. Chapters discuss: (1) content of

  5. Building Your Baby's Brain: A Parent's Guide to the First Five Years = Como estimular el cerebro infantil: Una guia para padres de familia.

    ERIC Educational Resources Information Center

    Dodge, Diane Trister; Heroman, Cate

    Noting that all parents can help their baby's brain to grow, this guide, in English- and Spanish-language versions, explores what science has learned about infant brain development and how parents and caregivers can influence cognitive development. Topics covered include: prenatal care, touching your baby, teaching about feelings and self-control,

  6. Geographic Displacement as Spiritual Desolation in Puerto Rican and Chicano Prose Fiction = La Desolacion Espiritual como Resultado del Desplazamiento Geografico en la Prosa Ficcion Puertorriqueno y Chicana.

    ERIC Educational Resources Information Center

    Tatum, Charles

    Geographic displacement as spiritual desolation is a theme that bonds Puerto Rican and Chicano literature. The movement of masses of people to the United States and within the United States itself has had and continues to have severe consequences for the Latino population in this country. Two novels, "Down These Mean Streets" by Piri Thomas and

  7. Tips for Parents on Keeping Children Drug Free = Consejos para Los Padres Sobre Como Mantener a Los Hijos Libres de La Droga.

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC. Office of Intergovernmental and Interagency Affairs.

    Research shows that recent trends in youth drug use have stabilized; however, the rates of use remain at high levels. It has been shown that the earlier drug use is initiated, the more likely a person is to develop drug problems later in life. Youth substance abuse may lead to many other problems that affect not only the child, but also the

  8. "O Ensaio como Forma" ou Um Ensaio acerca da Teoria Critica da Sociedade ("The Essay as Form" or An Essay about the Critical Theory of Society).

    ERIC Educational Resources Information Center

    Giordano, Rosely

    2000-01-01

    Illuminates the critical theory project, with themes permeating the theoretical constructions of Frankfurt (Germany). Debates the predominance of positivism in the production of knowledge. Speculates that "the essay as form" constitutes itself as a representation of the concept of the Enlightenment. Concludes with a dialogue between Theodor Adorno

  9. Uso de exámenes de detección como oportunidad para ayudar a fumadores a dejar el tabaco

    Cancer.gov

    El NCI ha publicado un anuncio de financiamiento para ayudar a estimular la investigación sobre métodos óptimos para dejar de fumar cigarrillos que se entreguen junto con los exámenes de detección.

  10. Interculturalidad y anglofonia en la ensenanza del ingles como lengua extranjera (Interculturalism and Anglophone Studies in the Teaching of English as a Foreign Language).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee; Revilla, Teresa Flores

    This article, written in Spanish, proposes to incorporate the subject "Anglophonism" into the curriculum of English as a Foreign Language (EILE) with a view to providing universities with an intercultural division. It provides a brief summary of John Dewey's philosophy with regard to anthropology, politics, and education. It explains the term…

  11. The Nature of Recognition in TEFL Teachers' Lives (La naturaleza del reconocimiento en la vida de los maestros de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Scholes Gillingsde González, Barbara

    2011-01-01

    This article aims at sharing a vital issue that emerged from the findings of a qualitative research study into collective responses of teachers of English as a foreign language to an extended change process in their Mexican university context from 1989 to 2003. The data generation process employed was comprised of semi-structured interviews as…

  12. How To Talk to Your Teens and Children about AIDS = Como hablar con sus adolescentes y sus ninos sobre el SIDA.

    ERIC Educational Resources Information Center

    National PTA, Chicago, IL.

    Two brochures, one in English and one in Spanish, provide parents with basic information that will enable them to educate their children about Acquired Immune Deficiency Syndrome (AIDS). Contents address 11 questions: (1) What is AIDS? (2) How do you get AIDS? (3) How is AIDS not spread? (4) Who can get AIDS? (5) How can you tell if someone has

  13. Kinetics of hydrodesulfurization on a CoMo/. gamma. -Al/sub 2/O/sub 3/ catalyst. 2: Kinetics of the hydrogenolysis of benzothiophene

    SciTech Connect

    Van Parija, I.A.; Hosten, L.H.; Froment, G.F.

    1986-09-01

    The kinetics of the hydrogenolysis of benzothiophene on a commercial CoMo/..gamma..-Al/sub 2/O/sub 3/ catalyst were studied in a tubular reactor. A sequential design of the experimental program was used for both the model discrimination and precise parameter estimation. Model selection was effectively achieved among 16 rival sets of rate equations of the Hougen-Watson type for both the hydrogenolysis of benzothiophene into ethylbenzene. The procedure was carried out at 513, 533, 553, and 573 K. The concerted surface reaction between benzothiophene or dihydrobenzothiophene and two competitively adsorbed hydrogen atoms was found to be the rate-determining step, a conclusion close to that arrived at in the study of thiophene hydrogenolysis.

  14. Cidadania Negada: A Educacao como Instrumento de Combate a Pobreza no Brasil (Denial of Citizenship: Education as a Way to Fight Poverty in Brazil).

    ERIC Educational Resources Information Center

    Germano, Jose Willington

    1995-01-01

    Compares two compensatory social/educational programs developed by the Brazilian government in the last 15 years. States that although one was formulated during the military regime and one during the present government, they both combat poverty and encourage privatization. Concludes that this promotes a process that sees education as social…

  15. La efectividad de la educacion a distancia como metodologia en la desarrollo de destrezas de pensamiento (Effectiveness of Distance Education as a Methodology for Developing Thinking Skills).

    ERIC Educational Resources Information Center

    Melendez Alicea, Juan

    1992-01-01

    Presents steps taken in designing, justifying, and implementing an experimental study designed to investigate the effectiveness of distance education as a methodology for developing thinking skills. A discussion reviews major findings of the study by comparing student experiences from multimedia distance education and student experiences from…

  16. Ideologies Revealed during the Construction of Meaning in an EFL Class (Ideologas reveladas durante la construccin de significado en una clase de ingls como lengua extranjera)

    ERIC Educational Resources Information Center

    Fajardo Mora, Nstor Ricardo

    2014-01-01

    This article reports on an interpretive qualitative study conducted at a public university in Bogot with 26 pre-service social studies teachers. It is focused on unveiling which ideologies are discovered when they construct the meaning of texts through text-based tasks in an English as a foreign language class. The data were collected by using

  17. Como Comunicarse con la Escuela a Traves de la Correspondencia: Guia para Padres (How To Communicate with the School through Letterwriting: A Parent's Guide).

    ERIC Educational Resources Information Center

    Ferguson, Susan; Ripley, Suzanne

    This guide is intended to help parents understand how a child becomes eligible for special education and related services and how to use letter writing to effectively communicate with the school when necessary. Initial information is presented in question-and-answer format and letters to request services. Sample letters are offered for the parent

  18. Emotions as Learning Enhancers of Foreign Language Learning Motivation (Las emociones como potenciadoras de la motivación en el aprendizaje de una lengua extranjera)

    ERIC Educational Resources Information Center

    Méndez López, Mariza G.; Peña Aguilar, Argelia

    2013-01-01

    The present article reports on a study that explores the effects of the emotional experiences of Mexican language learners on their motivation to learn English. In this qualitative research we present how emotions impact the motivation of university language learners in south Mexico. Results suggest that emotions, both negative and positive,…

  19. Communicacion Expresiva: Como los ninos nos envian mensajes [and] Comunicacion Receptiva: Como los ninos entienden nuestros mensajes [and] Interacciones de Comunicacion: Hacen falta dos. Hojas informativa de DB-LINK (Communication Interactions: It Takes Two [and] Receptive Communication: How Children Understand Your Messages to Them [and] Expressive Communication: How Children Send Their Messages to You. DB-LINK Fact Sheets).

    ERIC Educational Resources Information Center

    Stremel, Kathleen

    This document consists of three separately published fact sheets combined here because of the close relationship of their subject matter. The first fact sheet, "Communication Interactions: It Takes Two" (Kathleen Stremel), defines communication; suggests ways to find opportunities for interactive communication; offers specific suggestions for

  20. Molten carbonate fuel cell product development test

    SciTech Connect

    Scroppo, J.A.; Camara, E.H.; Figueroa, R.A.

    1993-11-01

    M-C Power Corp. will design, fabricate, install, test, and evaluate a 250 kW Proof-of-Concept MCFC Power Plant. The plant will be located at Kaiser Permanente`s San Diego Medical Center; it will be designed and built by Bechtel Corp. Two 250 keV MCFC stacks will be assembled and tested at M-C Power; one stack will be used to support the San Diego field demonstration. This report outlines 6 tasks: project management/permitting, demonstration design, stack manufacturing, BOP fabrication, site work, and testing.

  1. Adapting to change: the advantage of modular clinic design.

    PubMed

    Arsenault, Bruce

    2004-01-01

    Architects have applied modular design concepts for years. Projects benefiting most are those where a few room types are repeated often. Ambulatory care facilities are excellent candidates because this project type typically consists of a large number of rooms that can be standardized. The new Kaiser Permanente Santa Clara Medical Office Building illustrates the benefits and flexibility of modular design. PMID:15287213

  2. Restorative Integral Support (RIS) for Older Adults Experiencing Co-Occurring Disorders

    ERIC Educational Resources Information Center

    Larkin, Heather; MacFarland, Nicole S.

    2012-01-01

    The Restorative Integral Support (RIS) model is a whole person response that assists people to overcome adversity. The Adverse Childhood Experiences (ACE) Study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention shows the association between stressors in childhood and multiple later-life health and social problems.

  3. Maternal Infection during Pregnancy and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Zerbo, Ousseny; Qian, Yinge; Yoshida, Cathleen; Grether, Judith K.; Van de Water, Judy; Croen, Lisa A.

    2015-01-01

    We conducted a nested case-control study including 407 cases and 2,075 frequency matched controls to investigate the association between maternal infections during pregnancy and risk of autism spectrum disorders (ASD). Cases, controls, and maternal infections were ascertained from Kaiser Permanente Northern California clinical databases. No

  4. Engaging Youth in Learning about Healthful Eating and Active Living: An Evaluation of Educational Theater Programs

    ERIC Educational Resources Information Center

    Cheadle, Allen; Cahill, Carol; Schwartz, Pamela M.; Edmiston, John; Johnson, Sarah; Davis, Larry; Robbins, Curtis

    2012-01-01

    Objective: To compare knowledge gains and knowledge retention of healthful eating and active living behaviors in elementary school children participating in Educational Theatre Programs (ETP). Methods: The study sample included 47 schools (2,915 third- or fourth-grade students) in 8 Kaiser Permanente regions. Children's knowledge of 4 healthful…

  5. Engaging Youth in Learning about Healthful Eating and Active Living: An Evaluation of Educational Theater Programs

    ERIC Educational Resources Information Center

    Cheadle, Allen; Cahill, Carol; Schwartz, Pamela M.; Edmiston, John; Johnson, Sarah; Davis, Larry; Robbins, Curtis

    2012-01-01

    Objective: To compare knowledge gains and knowledge retention of healthful eating and active living behaviors in elementary school children participating in Educational Theatre Programs (ETP). Methods: The study sample included 47 schools (2,915 third- or fourth-grade students) in 8 Kaiser Permanente regions. Children's knowledge of 4 healthful

  6. A Study of Physician Knowledge and Experience with Autism in Adults in a Large Integrated Healthcare System

    ERIC Educational Resources Information Center

    Zerbo, Ousseny; Massolo, Maria L.; Qian, Yinge; Croen, Lisa A.

    2015-01-01

    We conducted an online survey of adult health care providers at Kaiser Permanente Northern California and semi-structured interviews with a subset of physicians. The survey assessed providers' ability to recognize autism spectrum disorder (ASD), asked them to rate their autism knowledge, comfort level in treating affected patients, and evaluated

  7. Maternal Infection during Pregnancy and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Zerbo, Ousseny; Qian, Yinge; Yoshida, Cathleen; Grether, Judith K.; Van de Water, Judy; Croen, Lisa A.

    2015-01-01

    We conducted a nested case-control study including 407 cases and 2,075 frequency matched controls to investigate the association between maternal infections during pregnancy and risk of autism spectrum disorders (ASD). Cases, controls, and maternal infections were ascertained from Kaiser Permanente Northern California clinical databases. No…

  8. Meet your senior's online needs to compete in Medicare marketplace.

    PubMed

    1997-12-01

    As more seniors turn to the Internet for health care information and services, is your organization prepared to meet their needs? Kaiser Permanente is reaching the cyber-senior market on the World Wide Web with interactive online services, including discussion groups with providers. PMID:10176065

  9. Untitled

    Cancer.gov

    National Cancer Institute Bethesda, MD Jack F. Hollis, Ph.D. Kaiser Permanente Center for Health Research Portland, OR John R. Hughes, M.D. Professor Department of Psychiatry University of Vermont Burlington, VT David M. Burns, M.D. Professor of Medicine School of Medicine University of California at San Diego San Diego, CA iii Smoking and Tobacco Control Monograph No.

  10. Mud Nest of Hornero

    USGS Multimedia Gallery

    Completed mud nest. End of wet season. Paraguay is home to at least 589 breeding bird species and 120 migratory bird species. Breeding Status: Breeding Permanent Resident. Habitat: Pasture, Second-Growth Shrub and Urban Zones. Estado de ocurrencia: Residente nidificante permanente. Hbitat: P...

  11. Characteristics of Open Learning Systems.

    ERIC Educational Resources Information Center

    Wedemeyer, Charles A.

    The ideal concept of open education would take the form of education permanente, although no present program includes all the features implied by this concept. Up to now the literature on open learning has focused on concern for a learner oriented system. The present focus is on the open learning system itself, with the identification of 10

  12. First Report of Candidatus Liberibacter solanacearum in Tomato Plants in Mexico

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Tomato (Lycopersicon esculentum Mill.) plants exhibiting symptoms that resemble those of permanent yellowing disease (locally known as permanente del tomate) that is associated with phytoplasmas and/or Candidatus Liberibacter solanacearum infection were observed in the state of Sinaloa, Mxico i...

  13. A Study of Physician Knowledge and Experience with Autism in Adults in a Large Integrated Healthcare System

    ERIC Educational Resources Information Center

    Zerbo, Ousseny; Massolo, Maria L.; Qian, Yinge; Croen, Lisa A.

    2015-01-01

    We conducted an online survey of adult health care providers at Kaiser Permanente Northern California and semi-structured interviews with a subset of physicians. The survey assessed providers' ability to recognize autism spectrum disorder (ASD), asked them to rate their autism knowledge, comfort level in treating affected patients, and evaluated…

  14. Antenatal Ultrasound and Risk of Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Grether, Judith K.; Li, Sherian Xu; Yoshida, Cathleen K.; Croen, Lisa A.

    2010-01-01

    We evaluated antenatal ultrasound (U/S) exposure as a risk factor for autism spectrum disorders (ASD), comparing affected singleton children and control children born 1995-1999 and enrolled in the Kaiser Permanente health care system. Among children with ASD (n = 362) and controls (n = 393), 13% had no antenatal exposure to U/S examinations;

  15. Mud Nest of Hornero

    USGS Multimedia Gallery

    Completed mud nest. End of wet season. Paraguay is home to at least 589 breeding bird species and 120 migratory bird species. Breeding Status: Breeding Permanent Resident. Habitat: Pasture, Second-Growth Shrub and Urban Zones. Estado de ocurrencia: Residente nidificante permanente. Hábitat: P...

  16. Ephmrides nautiques 2010 : Ouvrage publi spcialement l'usage des marins

    NASA Astrophysics Data System (ADS)

    Bureau Des Longitudes (Bdl); Institut de Mcanique Cleste Et de Calcul Des Ephmrides (Imcce)

    2009-12-01

    Au sommaire: donnes permanentes sur les signes, les symboles et les notations en usage. Cartes du ciel. Tables d'interpolation, de transformation et de navigation. Tableaux journaliers sur les astres, le point vernal et les toiles, ainsi que sur l'quation du temps,les donnes sur les phases de la lune, les clipses et les plantes.

  17. Ephmrides nautiques 2009 : Ouvrage publi spcialement l'usage des marins

    NASA Astrophysics Data System (ADS)

    Bureau Des Longitudes (Bdl); Institut de Mcanique Cleste Et de Calcul Des Ephmrides (Imcce)

    2008-12-01

    Au sommaire: donnes permanentes sur les signes, les symboles et les notations en usage. Cartes du ciel. Tables d'interpolation, de transformation et de navigation. Tableaux journaliers sur les astres, le point vernal et les toiles, ainsi que sur l'quation du temps,les donnes sur les phases de la lune, les clipses et les plantes.

  18. Ephmrides nautiques 2011 : Ouvrage publi spcialement l'usage des marins

    NASA Astrophysics Data System (ADS)

    Bureau Des Longitudes (Bdl); Institut de Mcanique Cleste Et de Calcul Des Ephmrides (Imcce)

    2010-12-01

    Au sommaire: donnes permanentes sur les signes, les symboles et les notations en usage. Cartes du ciel. Tables d'interpolation, de transformation et de navigation. Tableaux journaliers sur les astres, le point vernal et les toiles, ainsi que sur l'quation du temps,les donnes sur les phases de la lune, les clipses et les plantes.

  19. Joint Venture Arrangement for RN to BSN: A Model of Synergy between Academia and Service.

    ERIC Educational Resources Information Center

    Bargagliotti, L. Antoinette; And Others

    1991-01-01

    Joint venture among educational and practice institutions is well on its way toward becoming the norm in nursing education and practice. Kaiser Permanente and the University of San Francisco School of Nursing offer a venture that allows registered nurses to pursue a bachelor of science in nursing degree. (JOW)

  20. Antenatal Ultrasound and Risk of Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Grether, Judith K.; Li, Sherian Xu; Yoshida, Cathleen K.; Croen, Lisa A.

    2010-01-01

    We evaluated antenatal ultrasound (U/S) exposure as a risk factor for autism spectrum disorders (ASD), comparing affected singleton children and control children born 1995-1999 and enrolled in the Kaiser Permanente health care system. Among children with ASD (n = 362) and controls (n = 393), 13% had no antenatal exposure to U/S examinations;…

  1. Waning Whooping Cough Immunity Blamed in Outbreaks

    MedlinePLUS

    ... the agency says, older children and teenagers are accounting for a growing proportion of cases. A major ... study, researchers with Kaiser Permanente Northern California used information on all kids in their health system, aged 10 and up, who'd received DTaP ...

  2. Community Resources for Promoting Youth Nutrition and Physical Activity

    ERIC Educational Resources Information Center

    Moore, Kelly R.; McGowan, Melissa K.; Donato, Karen A.; Kollipara, Sobha; Roubideaux, Yvette

    2009-01-01

    Childhood obesity is a national public health crisis. The National Diabetes Education Program (NDEP), the National Institutes of Health and Kaiser Permanente have developed community tools and resources for children and families to lower their risk for obesity through healthier, active lifestyles. The authors describe innovative practices and…

  3. Modle numrique de terrain comme outil pour contrler et mesurer l'rosion de ravinsModelos digitales de elevacin como un instrumento para seguir y medir erosin por crcavas

    NASA Astrophysics Data System (ADS)

    Betts, Harley D.; DeRose, Ronald C.

    This paper describes the use of Digital Elevation Models (DEMs), constructed from sequential aerial photographs, as a tool for measuring gully erosion in a geomorphologically unstable environment. The technique is applied to a case study that examines erosion in 26 gullies in two study areas in the upper Waipaoa catchment, eastern North Island, New Zealand. Changes over two consecutive time periods, ranging in length from 14.0 years to 33.2 years, were studied at each site, drawing on available historical aerial photography. Several key aspects of the method used are described and discussed in detail, and recommendations are made for future application of DEMs for assessment of landscape change. DEM-measured gully degradation rates are directly proportional to the square root of the gully area.From this relationship it should be possible to rapidly estimate gully erosion at a catchment scale on the basis of gully areas alone. DEM-based measurement techniques, together with appropriate consideration for the sensitivity of the method, have significant cost and efficiency advantages over manual approaches to erosion measurements.

  4. Metacognitive Awareness and Comprehension Monitoring in Reading Ability of Iranian EFL Learners (Monitoreo de la conciencia metacognitiva y de la comprensin en la habilidad lectora de estudiantes iranes de ingls como lengua extranjera)

    ERIC Educational Resources Information Center

    Khonamri, Fatemeh; Mahmoudi Kojidi, Elahe

    2011-01-01

    We report an investigation on the relationship between metacognitive awareness of reading strategies and comprehension monitoring of language learners in English as a foreign language context. Participants were thirty first year university students majoring in electronics. They completed a questionnaire aimed at discerning the strategies that

  5. The Portrayal of EFLTeachers in Official Discourse: The Perpetuation of Disdain (La imagen de los profesores de inglés como lengua extranjera en el discurso oficial: la perpetuación del desdén)

    ERIC Educational Resources Information Center

    Guerrero, Carmen Helena

    2010-01-01

    The purpose of this article is to offer an interpretation of the images of Colombian English teachers constructed in official discourse, particularly (but not exclusively) in the document "Estándares básicos de competencias en lenguas extranjeras: inglés. Formar en lenguas extranjeras, el reto". This is part of a larger critical…

  6. The Impact of Conferencing Assessment on EFL Students' Grammar Learning (Impacto de la evaluacin mediante conferencias en el aprendizaje de la gramtica en estudiantes de ingls como lengua extranjera)

    ERIC Educational Resources Information Center

    Baleghizadeh, Sasan; Zarghami, Zahra

    2012-01-01

    This article reports on a study that was carried out in order to examine the impact of conferencing assessment on students' learning of English grammar. Forty-two Iranian intermediate university students were randomly assigned to an experimental and a control group. The participants in the experimental group took part in four individual and

  7. A Comparison of Chinese and Colombian University EFL Students Regarding Learner Autonomy (Comparación entre estudiantes universitarios de inglés chinos y colombianos con respecto a su autonomía como aprendices)

    ERIC Educational Resources Information Center

    Buendía Arias, Ximena Paola

    2015-01-01

    This research seeks to gain deeper understanding of learner autonomy in English as a Foreign Language students from different cultures through the identification and analysis of similarities and differences between Chinese and Colombian students from two public universities: Tianjin Foreign Studies University in China and Universidad Surcolombiana…

  8. Systemic Functional Linguistics and Discourse Analysis as Alternatives When Dealing with Texts (La lingüística sistémica funcional y el análisis del discurso como alternativas para trabajar con textos)

    ERIC Educational Resources Information Center

    García Montes, Paula Andrea; Sagre Barboza, Ana María; Lacharme Olascoaga, Alba Isabel

    2014-01-01

    This article presents a case study research with aims to find out which activities, methodological and textual aspects used in a reading strategies course were causing a group of students difficulties when analyzing critically written information. We conducted the study at Universidad de Córdoba (Colombia) with seventh semester students from the…

  9. Exploring Elementary Students' Power and Solidarity Relations in an EFL Classroom (Exploración de las relaciones de poder y solidaridad entre estudiantes de primaria en la clase de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Méndez, Tatiana; García, Andrea

    2012-01-01

    This article derives from a critical discourse analysis study that reports the characteristics of elementary school students' power and solidarity relations in English as a foreign language classroom in Bogotá, Colombia, while we were doing our teaching English as a foreign language practicum. The study was based on theories of power and…

  10. Como ayudar a su hijo durante los primeros anos de la adolescencia: Para los padres con ninos entre las edades de 10 a 14 anos (Helping Your Child through Early Adolescence: For Parents of Children from 10 through 14).

    ERIC Educational Resources Information Center

    Paulu, Nancy

    Recognizing that parents and families can greatly influence the development of their 10- through 14-year-olds, this Spanish-language booklet is part of a national effort to provide parents with the latest research and practical information to help them support their children both at home and in school. The booklet is organized in 13 sections…

  11. Un estudio de evaluacion educativa manipulativos en el aprendizaje de las matematicas con estudiantes hispanos adquiriendo ingles academico como segunda lengua (A Study of the Use of Manipulatives in the Assessment of Mathematics Instruction with ESL Hispanic Students).

    ERIC Educational Resources Information Center

    Lara-Alecio, Rafael; Parker, Richard; Aviles, Claudia; Mason, Samantha; Irby, Beverly J.

    1998-01-01

    As an alternative form of mathematics assessment for use with limited-English-proficient students, 14 mathematics tasks using manipulatives were administered to 45 Hispanic students in grades 1-3 and readministered 2-3 weeks later. Test reliability and validity, task difficulty, and the relationship among test subscales across grades were…

  12. Learning & Growing Together: Understanding and Supporting Your Child's Development = Aprender y crecer juntos: Como comprender y fomentar el desarrollo de sus hijos [with] Tip Sheets: Ideas for Professionals in Programs That Serve Young Children and Their Families.

    ERIC Educational Resources Information Center

    Lerner, Claire; Dombro, Amy Laura; Powers, Stefanie

    Based on the view that the primary caregivers for infants and toddlers are their own best resource for understanding and caring for their child and that parenting is a lifelong learning process, this book provides information and tools to help caregivers build a strong foundation for their child's development. The book, both in English and

  13. Encuentros esteticos deweyanos con la cultura popular anglofona en la ensenanza de ingles como lengua extranjera (EILE). Working Paper (Deweyan Aesthetic Encounters with Anglophone Popular Culture in the Teaching of English as a Foreign Language. Working Paper).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper discusses how the introduction of Anglophone popular culture in the English-as-a-foreign-language class can serve to foster critical aesthetic experiences. It is argued that the popular culture of the hegemonic Anglophone countries is already part of students' lives and for that reason should be included in any critical Anglophone…

  14. Como Trabajar y Vivir en la Realidad: Pasos Basicos Para Jovenes con Incapacidades, sus Padres y sus Profesores (How to Work and Live in the Real World: Basic Steps for Youth with Handicaps and Their Parents and Teachers).

    ERIC Educational Resources Information Center

    Patton, Patricia L.; And Others

    This Spanish version of "How to Work and Live in the Real World: Basic Steps for Youth with Handicaps and Their Parents and Teachers" is for young people with handicaps who are getting ready to graduate from high school and begin working and living in the adult world. The booklet places a special focus on individuals with cultural differences. It…

  15. Coping with Social Change: Programs That Work. Proceedings of a Conference (Acapulco, Mexico, June 1989) = Como enfrentarse al cambio social: programas eficaces. Actas de uno Conferencia (Acapulco, Mexico, Junio de 1989).

    ERIC Educational Resources Information Center

    Hoskins, Irene, Ed.

    Written in English and Spanish, this document contains the proceedings of the 14th International Congress of Gerontology on concerns about the impact of rapid social change on the well-being of older women and families in Latin American and the Caribbean and about effective programs that address the needs of the older populations. The first

  16. Effects of Strategy Instruction in an EFL Reading Comprehension Course: A Case Study (Efectos de la instruccin de estrategias en un curso de comprensin de lectura en ingls como lengua extranjera: un estudio de caso)

    ERIC Educational Resources Information Center

    Lopera Medina, Sergio

    2012-01-01

    Strategy instruction is useful in teaching contexts. This paper examines the effects of strategy instruction in an EFL reading comprehension course carried out with 26 undergraduate students at a Colombian university. As a research method, a case study was implemented. There were three instruments with which to collect data: reading comprehension

  17. Como Promover el Exito de las Ninas y las Minorias en las Ciencias y en las Matematicas. Para Padres/sobre Padres (How To Promote the Science and Mathematics Achievement of Females and Minorities. For Parents/about Parents).

    ERIC Educational Resources Information Center

    Schwartz, Wendy

    Some minority and female students traditionally have not been given the help they need to enroll and succeed in mathematics and science classes. Now, however, various approaches are available to give these students the extra attention they need. Parents can help children develop an interest in science and mathematics by: (1) identifying role…

  18. La lectura literaria como arte de "performance": la teoria transaccional de Louise Rosenblatt y sus implicaciones pedagogicas (The Use of Literature as Performance Art: The Transactional Theory of Louise Rosenblatt and Its Pedagogical Implications).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper focuses on the work that Louise Rosenblatt and her followers in the United States have done to improve the teaching and learning of literature at all educational levels. Although these researchers have focused almost exclusively on the use of literature in the native language, the paper uses transactional theory as a basis for teaching…

  19. La Capacitacion de Docentes Como Prioridad de los Sistemas Educativos de America Latino y al Caribe (In-Service Teacher Training as a Priority of Latin American and Caribbean Educational Systems).

    ERIC Educational Resources Information Center

    Valle, Victor M.

    Whenever top-level officials in Latin American and Caribbean educational systems are approached, the topic of inservice teacher training is presented as a major priority. This paper outlines some ideas about the subject of inservice teacher training as a priority of educational systems in Latin American and Caribbean countries. The most frequent…

  20. Teachers' Beliefs about Assessment in an EFL Context in Colombia (Creencias de los profesores acerca de la evaluación en un contexto de inglés como lengua extranjera en Colombia)

    ERIC Educational Resources Information Center

    Muñoz, Ana Patricia; Palacio, Marcela; Escobar, Liliana

    2012-01-01

    There is evidence that teachers' beliefs on teaching and learning exert an influence on the way they teach and assess learning, and on what students learn. Therefore, it is central that overt attention is devoted to the perceptions teachers have and how they influence teaching and learning. In this article we describe a study on…

  1. EFL Teaching Methodological Practices in Cali (Prácticas metodológicas en la enseñanza de inglés como lengua extranjera en la ciudad de Cali)

    ERIC Educational Resources Information Center

    Chaves, Orlando; Hernández, Fanny

    2013-01-01

    In this article we aim at showing partial results of a study about the profiles of English as a Foreign Language (EFL) teachers in both public and private primary and secondary strata 1-4 schools in Cali, Colombia. Teachers' methodological approaches and practices are described and analyzed from a sample of 220 teachers. Information was gathered…

  2. EFL Students' Perceptions about a Web-Based English Reading Comprehension Course (Percepciones de estudiantes de inglés como lengua extranjera acerca de un curso de comprensión lectora apoyado en la red)

    ERIC Educational Resources Information Center

    Gómez Flórez, Érica; Pineda, Jorge Eduardo; Marín García, Natalia

    2012-01-01

    Web-based distance education is an innovative modality of instruction in Colombia. It is characterized by the separation of the teacher and learners, the use of technological tools and the students' autonomy development. This paper reports the findings of a case study that explores students' perceptions about an English reading…

  3. Como ayudar a su hijo a tener exito en la escuela, con actividades para ninos entre las edades de 5 a 11 anos (Helping Your Child Succeed in School, with Activities for Children Ages 5 through 11).

    ERIC Educational Resources Information Center

    Paulu, Nancy

    At the heart of the No Child Left Behind Act of 2001 is a promise to raise standards for all children and to help all children meet those standards. This Spanish-language booklet provides information that parents can use to help their child succeed in school. Following an introduction, the second section of the booklet, "The Basics," offers

  4. Como ayudar a su hijo durante la edad preescolar, con actividades para los ninos desde el nacimiento hasta los 5 anos (Helping Your Preschool Child, with Activities for Children from Infancy through Age 5).

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC. Office of Intergovernmental and Interagency Affairs.

    The first 5 yeas of a child's life are a time of tremendous physical, emotional, social, and cognitive growth. Noting that research shows that children are more likely to succeed in learning when their families actively support them, this Spanish-language booklet is intended for families and caregivers who want to help their preschool children

  5. Como ayudar a su hijo a ser un buen lector: Con actividades para los ninos desde el nacimiento hasta los 6 anos (Helping Your Child Become a Reader: With Activities for Children from Infancy through Age 6).

    ERIC Educational Resources Information Center

    Lehr, Fran; Osborn, Jean

    When parents and other family members read with their children, help them with homework, talk with their teachers, and participate in school or other learning activities, they give their children a tremendous advantage. The foundation for learning to read is in place long before children enter school and begin formal reading instruction. Families

  6. The Role of Genre-Based Activities in the Writing of Argumentative Essays in EFL (El papel de actividades basadas en gneros en la escritura de ensayos argumentativos en ingls como lengua extranjera)

    ERIC Educational Resources Information Center

    Chala Bejarano, Pedro Antonio; Chapetn, Claudia Marcela

    2013-01-01

    This article presents the findings of an action research project conducted with a group of pre-service teachers of a program in modern languages at a Colombian university. The study intended to go beyond an emphasis on linguistic and textual features in English as a foreign language argumentative essays by using a set of genre-based activities and

  7. Como Prepararse a Tiempo para la Universidad: Un Manual para los Padres de Alumnos que Cursan la Escuela Intermedia (Getting Ready for College Early: A Handbook for Parents of Students in the Middle and Junior High School Years).

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC. Office of Planning, Budget, and Evaluation.

    This Spanish language booklet, also available in English, provides "los cuatro pasos"--four steps that parents and children can take to ensure that students properly prepare for college. Step one discusses why it is important to go to college; reasons include better job opportunities, more earning potential, and the increased variety of jobs one…

  8. La Migracion Como Una Transicion Critica para la Persona en Su Ambiente. Una Interpretacion Organismico Evolutiva. (Migration as a Critical Person-in-Environment Transition: An Organismic-Developmental Interpretation.)

    ERIC Educational Resources Information Center

    Pacheco, Angel M.; And Others

    In order to explore some of the changes and stresses connected with migration and return migration, a study was conducted among migrants returning from the United States mainland to Puerto Rico. The sample consisted of 75 adolescents participating in a Bilingual Education program in Puerto Rico. Data were collected using Psychological Distance

  9. Adult EFL Reading Selection: Influence on Literacy (Procesos de selección de lecturas en estudiantes adultos de inglés como lengua extranjera y su influencia en la habilidad lectora)

    ERIC Educational Resources Information Center

    Basallo Gómez, Juan Sebastián

    2016-01-01

    This paper is about the impact of systematic reading selection used to promote English as foreign language learning in adult students. A qualitative action research methodology was used to carry out this project. Ten class sessions were designed to provide students an opportunity to select texts according to criteria based upon their language…

  10. Kathy Learns How Breastfeeding Can Be Used...To Space Pregnancies. Mother-to-Mother Support = Josefa Aprende como la Lactancia Puede Ser Usada...Para Espaciar los Embarazos. Apoyo Madre a Madre.

    ERIC Educational Resources Information Center

    Magalhaes, Rebecca; Stone-Jimenez, Maryanne; Allen de Smith, Paulina; Smith, Natalia

    These magazine-sized booklets, one in English, one in Spanish, are in cartoon format and designed to be used by people with limited literacy in English or Spanish. They explain how breastfeeding can be used to help space pregnancies, the limitations of its effectiveness as a pregnancy-avoiding method, and that the spacing of pregnancies can be…

  11. Un estudio de evaluacion educativa manipulativos en el aprendizaje de las matematicas con estudiantes hispanos adquiriendo ingles academico como segunda lengua (A Study of the Use of Manipulatives in the Assessment of Mathematics Instruction with ESL Hispanic Students).

    ERIC Educational Resources Information Center

    Lara-Alecio, Rafael; Parker, Richard; Aviles, Claudia; Mason, Samantha; Irby, Beverly J.

    1998-01-01

    As an alternative form of mathematics assessment for use with limited-English-proficient students, 14 mathematics tasks using manipulatives were administered to 45 Hispanic students in grades 1-3 and readministered 2-3 weeks later. Test reliability and validity, task difficulty, and the relationship among test subscales across grades were

  12. O Imperio como Argumento: Um Contraponto entre Joaquim Nabuco e o Bispo D. Jose Mauricio da Rocha (The Empire as Argument: A Counterpoint between Joaquim Nabuco and the Bishop Dom Jose Mauricio da Rocha).

    ERIC Educational Resources Information Center

    Marson, Izabel Andrade

    1998-01-01

    Dialogs with the previous article establishing a comparative analysis between the political acceptance present in the reactionary speech of Dom Jose Mauricio da Rocha and in the monarchist words of Joaquim Nabuco. (PA)

  13. Estudo da utilizacao da biomassa florestal como fonte de produtos quimicos e energia atraves de processos quimicos e biotechnologicos (Utilization of forest biomass for chemicals and energy by chemical and biotechnological processes). Master's thesis

    SciTech Connect

    de Miranda, I.M.S.S.

    1989-04-01

    The chemical composition and the non-structural carbohydrate composition were determined for 1-year-old Eucalyptus globulus Labill trees, grown in an experimental plantation with different nutrient and water supplies (C-trees, where no treatment was made and IL-trees, which received a nutrient supply and irrigation). Leaf carbohydrates were determined for the same conditions. Pulping experiments were made using kraft cooks of eucalyptus wood. The results of the pretreatments are complemented with scanning electron microscopy observations. Average wood composition was: ash 1.6%, total extractives 5.2%, Klason lignin 21.0%, soluble lignin 3.1% (% of o.d. weight). The results did not show statistical significant differences between the two growth conditions. The average wood carbohydrate composition was: glucose 2.7%, frutose 4.1% sucrose 1.3% and starch 0.5%. The average carbohydrate composition of leaves was: glucose 1.0%, frutose 1.7%, sucrose 0.1% and starch 4.1%. The average yield for the kraft wood delinification was 49%. The saccharification of pretreated eucalyptus chips with a steam-explosion pretreatment was: For H2SO4 impregnation 26.6% and for H2O impregnation 44.2%.

  14. A Guide for Reading: How Parents Can Help Their Children Be Ready To Read and Ready To Learn = Guia Para Leer: Como los padres pueden preparar a sus hijos a leer y aprender desde la infancia.

    ERIC Educational Resources Information Center

    White House Initiative on Educational Excellence for Hispanic Americans, Washington, DC.

    As part of the White House Initiative on Educational Excellence for Hispanic Americans, this brochure (in English and Spanish) provides a guide to assist parents in helping their children become ready to read and to learn. The suggestions include: (1) talking to infants/toddlers to help them learn to speak and understand the meaning of words; (2)…

  15. A Guide for Reading: How Parents Can Help Their Children Be Ready To Read and Ready To Learn = Guia Para Leer: Como los padres pueden preparar a sus hijos a leer y aprender desde la infancia.

    ERIC Educational Resources Information Center

    White House Initiative on Educational Excellence for Hispanic Americans, Washington, DC.

    As part of the White House Initiative on Educational Excellence for Hispanic Americans, this brochure (in English and Spanish) provides a guide to assist parents in helping their children become ready to read and to learn. The suggestions include: (1) talking to infants/toddlers to help them learn to speak and understand the meaning of words; (2)

  16. The Impact of Different Types of Journaling Techniques on EFL Learners' Self-Efficacy (El impacto de diferentes tipos de diario en la autosuficiencia de estudiantes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Baleghizadeh, Sasan; Mortazavi, Mahboobeh

    2014-01-01

    This article reports on an investigation of the impact of different methods of journaling on self-efficacy of learners of English as a foreign language. Sixty upper-intermediate Iranian English language learners were randomly assigned to three experimental conditions, namely no-feedback, teacher-feedback, and peer-feedback, and one control…

  17. What Makes a Good Teacher? Children Speak Their Minds=Qu'est-ce qu'un bon maitre? Les enfants ouvrent leur coeur=Como debe ser un buen maestro? Los ninos opinan.

    ERIC Educational Resources Information Center

    Khawajkie, Elizabeth, Ed.; And Others

    This booklet is a product of the UNESCO Associated Schools Project, a network of some 3,800 schools in 131 countries, which conducts pilot projects to promote education for peace, international understanding, and cooperation. Schools taking part in the project participated in an international contest asking for spontaneous reactions to the…

  18. Introversion/Extroversion & Teachers' Perception on Dominican EFL College Students' Performance = La Introversion/Extroversion vs. La Percepcion Profesoral en el Desempeno de Estudiantes Universitarios Dominicanos de Ingles como Lengua Extranjera

    ERIC Educational Resources Information Center

    Tavarez Da Costa, Pedro

    2012-01-01

    This article discusses the relationship between introversion/extroversion and a student's performance (academic achievement) as perceived by Teachers of English as a Foreign Language in three regional centers of the Universidad Autonoma de Santo Domingo. There have been a great number of international studies already published to try to explain…

  19. Developing Academic Literacy and Voice: Challenges Faced by a Mature ESL Student and Her Instructors (Desarrollo del discurso académico y la voz: retos de una estudiante de inglés como segunda lengua y sus profesores)

    ERIC Educational Resources Information Center

    Correa, Doris

    2010-01-01

    Drawing on critical, socio-cultural and sociolinguistic theories of writing, text and voice, this ethnographic study examines the challenges that a mature ESL student and her instructors in a university course on Spanish Language Media face as they co-construct a common understanding of academic literacy and voice in an undergraduate General…

  20. Learning & Growing Together: Understanding and Supporting Your Child's Development = Aprender y crecer juntos: Como comprender y fomentar el desarrollo de sus hijos [with] Tip Sheets: Ideas for Professionals in Programs That Serve Young Children and Their Families.

    ERIC Educational Resources Information Center

    Lerner, Claire; Dombro, Amy Laura; Powers, Stefanie

    Based on the view that the primary caregivers for infants and toddlers are their own best resource for understanding and caring for their child and that parenting is a lifelong learning process, this book provides information and tools to help caregivers build a strong foundation for their child's development. The book, both in English and…

  1. Exploring Authorship Development among Mexican EFL Teacher-Researchers (Exploración sobre el desarrollo de la autoría en los profesores-investigadores de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Trujeque Moreno, Eva Estefania; Encinas Prudencio, Fátima; Thomas-Ruzic, Maria

    2015-01-01

    This article presents a multi-theoretical model to address processes of "authorship development" in the English as a foreign language teaching profession. Working within a sociocultural perspective of second-language teacher education, the authors examined six experienced nonnative English-speaking teacher-researchers. Perceptions of…

  2. The Implications of Orthographic Intraference for the Teaching and Description of ESL: The Educated Nigerian English Examples (Implicaciones de la Intraferencia Ortogrfica para la Enseanza y Descripcin del Ingls como Segunda Lengua: Ejemplos Ingls Nigeriano Formal)

    ERIC Educational Resources Information Center

    Ekundayo, Omowumi Steve Bode

    2015-01-01

    This paper examines orthographic intraference and its implications for teaching and describing English as a second language (ESL). Orthographic intraference is used here to denote instances of single word spelling, acronyms, mix up of homophones, homonyms and compound word spelling arising not from interference but from orthographic rules and

  3. Teachers' Perceptions about Oral Corrective Feedback and Their Practice in EFL Classrooms (Percepciones de los docentes acerca de la retroalimentacin correctiva y su prctica en las aulas de ingls como lengua extranjera)

    ERIC Educational Resources Information Center

    Hernndez Mndez, Edith; Reyes Cruz, Mara del Rosario

    2012-01-01

    Corrective feedback has been discussed mainly in second language acquisition contexts, but less has been done concerning corrective feedback in foreign language settings. In this descriptive study, conducted at a Mexican university, our aims were to identify the perceptions of instructors of English as a foreign language about corrective feedback

  4. When Students Say Far Too Much: Examining Gushing in the ELT Classroom (Cuando los alumnos dicen demasiado: anlisis del uso excesivo de palabras en clases de ingls como lengua extranjera)

    ERIC Educational Resources Information Center

    Mugford, Gerrard; Cuevas, Oscar Ramrez

    2015-01-01

    English foreign-language users often overuse words when faced with difficult situations. Called gushing, such excessive use of words is often legitimately employed by native speakers to express, for instance, gratitude and apologies when a simple "thank you" or "sorry" does not sufficiently convey an interlocutor's feelings.

  5. Teacher Activities and Adolescent Students' Participation in a Colombian EFL Classroom (Actividades de enseanza y participacin de estudiantes adolescentes en una clase de enseanza de ingls como lengua extranjera en Colombia)

    ERIC Educational Resources Information Center

    Caicedo, Jefferson

    2015-01-01

    The present study concerns the activities teachers develop and ninth-graders' participation in responses to those activities. The objectives of this study were to identify and describe the types of teaching activities developed and how students respond to them and to show how the target language is used in the classroom. The data collection was

  6. Los padres como maestros de los ninos. Los padres como recursos para los maestros. Serie E: [E1] logro de la participacion de los padres. cuadernos 1 y 2. Edicion para el maestro. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as Their Children's Teachers. Parents as Resources for Teachers. Series E: Parent Participation, Book 1 and 2. Teacher Edition. Bilingual Education Teacher Training Packets).

    ERIC Educational Resources Information Center

    Lazos, Hector, Comp.

    This guide on training bilingual education teachers focuses on parent participation in school activities. The guide addresses three groups of people: paraprofessionals and non-graduate students, bilingual teachers, and graduate students. Two units are presented, one dealing with the important influence parents have on their child's language

  7. Los padres como maestros de los ninos. Los padres como recursos para los maestros. Serie E: El logro de la participacion de los padres, cuadernos I y II. Edicion para el estudiante. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as the Children's Teachers. Parents as Resources for the Teachers. Series E: Success with Parent Participation, Books I and II. Student Edition. Bilingual Education Teacher Training Packets.)

    ERIC Educational Resources Information Center

    Lazos, Hector

    The student versions of two learning modules for teacher training in bilingual education are part of a series focusing on promoting parent participation in the school system. An introductory section discussing the overall objectives of the materials is followed by two modules, each consisting of introductory sections and two units containing

  8. Habitus furibundo en el gueto estadounidense1

    PubMed Central

    Bourgois, Philippe; Castrillo, Fernando Montero; Hart, Laurie; Karandinos, George

    2014-01-01

    Resumen Durante cinco años, un torbellino cotidiano de tiroteos, apuñalamientos y asaltos afectó a la venta de drogas al aire libre en el vecindario puertorriqueño de Filadelfia, donde residíamos y conducíamos nuestro trabajo de campo. La industria de los narcóticos ha venido a llenar el vacío que dejó la desindustrialización, convirtiendo al antiguo distrito fabril de la ciudad en un mercado de narcóticos a cielo abierto que emplea en sus niveles más bajos a jóvenes puertorriqueños y cuyos clientes son principalmente heroinómanos blancos de bajos recursos. La capacidad para movilizar la furia asegura el éxito en la economía de las drogas, garantiza protección en las cárceles y le provee un ingreso mínimo a una población de bajos recursos estigmatizada cuyos miembros frecuentemente reciben diagnósticos médicos de discapacidad cognitiva. Muchos residentes buscan alianzas en redes sociales que los comprometen a participar en intercambios solidarios de violencia auxiliar. Una dinámica de acumulación primitiva corporizada mata, hiere, discapacita o encarcela a la mayoría de estos empleados de bajo nivel y a sus clientes. Los inflados márgenes de ganancia alrededor de esta dinámica dependen de la violencia y la coerción. Un habitus furibundo impulsa a los vendedores callejeros a defender violentamente el micro monopolio de poder de sus jefes en la economía subterránea como si fuese un asunto de diversión. Estos miembros de los niveles más bajos de la industria del narcotráfico se apresuran a fraguar transacciones comerciales en ausencia de un marco legal en un ambiente de escasez que sin embargo se ve inundado por enormes flujos de dinero, drogas adictivas y armas automáticas. Tras las drásticas reformas a los programas de seguridad social, la mano izquierda del Estado, en la forma de los servicios sociales, intenta prolongar los subsidios para individuos vulnerables diagnosticándolos como discapacitados cognitivos permanentes necesitados de fuerte medicación farmacéutica. La mejor manera de asegurar la continuidad de este frágil subsidio resulta ser los estallidos periódicos de violencia autoinfligida. Simultáneamente, con la anuencia de la mano derecha del Estado, en las cárceles violentas y hacinadas marcadas por formas hostiles de supervisión, la furia se convierte en una valiosa estrategia de protección física para los internos. En resumen, la violencia expresiva se convierte en una base práctica para el sostenimiento económico y para forjar el sentido de dignidad entre hombres y mujeres. PMID:24532976

  9. Developing a data infrastructure for a learning health system: the PORTAL network

    PubMed Central

    McGlynn, Elizabeth A; Lieu, Tracy A; Durham, Mary L; Bauck, Alan; Laws, Reesa; Go, Alan S; Chen, Jersey; Feigelson, Heather Spencer; Corley, Douglas A; Young, Deborah Rohm; Nelson, Andrew F; Davidson, Arthur J; Morales, Leo S; Kahn, Michael G

    2014-01-01

    The Kaiser Permanente & Strategic Partners Patient Outcomes Research To Advance Learning (PORTAL) network engages four healthcare delivery systems (Kaiser Permanente, Group Health Cooperative, HealthPartners, and Denver Health) and their affiliated research centers to create a new national network infrastructure that builds on existing relationships among these institutions. PORTAL is enhancing its current capabilities by expanding the scope of the common data model, paying particular attention to incorporating patient-reported data more systematically, implementing new multi-site data governance procedures, and integrating the PCORnet PopMedNet platform across our research centers. PORTAL is partnering with clinical research and patient experts to create cohorts of patients with a common diagnosis (colorectal cancer), a rare diagnosis (adolescents and adults with severe congenital heart disease), and adults who are overweight or obese, including those with pre-diabetes or diabetes, to conduct large-scale observational comparative effectiveness research and pragmatic clinical trials across diverse clinical care settings. PMID:24821738

  10. NAS Miramar Molten Carbonate Fuel Cell demonstration status

    SciTech Connect

    Scroppo, J.A.

    1996-12-31

    Part of M-C Power`s Technology Development Program, this MCFC power plant is designed to supply 250 kW of electricity to Naval Air Station (NAS) Miramar. It also cogenerates steam for the district heating system. The power plant is a fully integrated unit incorporating an advanced design fuel cell based on years of laboratory tests and a prior field test. This demonstration incorporates many innovative features, one of which is the plate type reformer which processes the natural gas fuel for use in the fuel cell. M-C Power Corp. has completed the design, fabrication, and conditioning of a 250-cell fuel cell stack, which was shipped to the site where it will be installed, tested, and evaluated as a 250 kW Proof-of-Concept MCFC Power Plant. (Originally going to Kaiser Permanente`s Sand Diego Medical Center, it was relocated to Miramar.)

  11. Dinmica de pulsares jvenes

    NASA Astrophysics Data System (ADS)

    Allen, M. P.; Horvath, J. E.

    La observacin detallada de los pulsos en varios pulsares jvenes (? < 105 yr) permiti detectar varios aumentos en la frecuencia de emisin gliches con cambios permanentes en ? {? ?} / {? ?}. A travs de las ecuaciones de movimiento se investiga, utilizando parametrizaciones simples, la hiptesis de que el ngulo entre ? y el dipolo magntico M sea responsable de ese comportamiento. Se derivan curvas analticas para la evolucin de ? (t) y se estudia la posibilidad de describir un conjunto de observables (incluyendo el braking index n) con estos modelos.

  12. What strategic planning can do for you.

    PubMed

    Valenzuela, Peter

    2007-01-01

    Whether it's playing chess or planning for retirement, we all have strategies for different situations in our lives. So why not apply, strategies in our practice ? Companies such as Dell, Wal-Mart, and Home Depot have depended on strategic plans to generatel millions of dollars and guide their organizations into the future. Although most of our practices are not nearly as large as these companies (except maybe Kaiser Permanente), formulating strategies for our practice is vital for future growth. PMID:17494484

  13. Molten carbonate fuel cell product development test environmental assessment/protection plan

    SciTech Connect

    Brunton, Jack; Furukawa, Vance; Frost, Grant; Danna, Mike; Figueroa, Al; Scroppo, Joseph

    1992-11-01

    Objective of proposed action is to conduct a 250-kW product development test of M-C Power Corporation's molten carbonate fuel cell concept, at the Kaiser Permanente San Diego Medical Center. Review of environmental impacts of this test indicate the following: no impact on solid waste disposal, water quality, noise levels, floodplains, wetlands, ecology, historic areas, or socioeconomic resources. Impact on air quality are expected to be positive.

  14. Molten carbonate fuel cell product development test environmental assessment/protection plan

    SciTech Connect

    Not Available

    1992-11-01

    Objective of proposed action is to conduct a 250-kW product development test of M-C Power Corporation`s molten carbonate fuel cell concept, at the Kaiser Permanente San Diego Medical Center. Review of environmental impacts of this test indicate the following: no impact on solid waste disposal, water quality, noise levels, floodplains, wetlands, ecology, historic areas, or socioeconomic resources. Impact on air quality are expected to be positive.

  15. A Comprehensive Health Group Practice Model.

    PubMed

    Pihlstrom, Daniel; White, Danny

    2015-01-01

    Permanente Dental Associates includes 17 offices in the Pacific Northwest. Among the distinguishing characteristics of this model are a predominantly HMO structure and integration of care in a general medical program. Staff dentists are on salary and are largely relieved of the business details of practice. Ultimate control of the system is vested in a group of shareholders--the dentists who practice chairside. One of the shareholder-practitioners discusses his perspective on this system. PMID:26562978

  16. Clinical methods in smoking cessation: description and evaluation of a stop smoking clinic.

    PubMed Central

    Harrup, T; Hansen, B A; Soghikian, K

    1979-01-01

    This study reports the results of the Kaiser-Permanente Stop Smoking Clinic and describes the philosophy and methods employed by the clinic in treating addictive smoking behavior. Of the 1,128 clients who registered for the group program, 57 per cent are abstinent six months after quitting smoking and 47 per cent are abstinent at one year. The clinic methods used are described in detail. They attempt to relate smoking behavior to the larger phenomenon of addiction. PMID:507255

  17. A Conversation on the Future of Health Care: Integrating Lifestyle MedicinePart One: Understanding the Concepts

    PubMed Central

    Sorensen, Herbert J

    2014-01-01

    In response to personal and institutional history and articles published in The Permanente Journal, this article begins a conversation based on the premise that health care will only reach its full potential with the integration of traditional medical care, which relies on the application of pharmacologic and surgical intervention after the development of illness, and lifestyle medicine, the use of optimal nutrition and exercise. PMID:24694319

  18. A Metrics Taxonomy and Reporting Strategy for Rule-Based Alerts.

    PubMed

    Krall, Michael; Gerace, Alexander

    2015-01-01

    An action-oriented alerts taxonomy according to structure, actions, and implicit intended process outcomes using a set of 333 rule-based alerts at Kaiser Permanente Northwest (KPNW) was developed. The authors identified 9 major and 17 overall classes of alerts and developed a specific metric approach for 5 of these classes, including the 3 most numerous ones in KPNW, accounting for 224 (67%) of the alerts. PMID:26057684

  19. Positive Predictive Value of ICD-9 Code for Herpes Zoster Among Children During the Varicella Vaccine Era.

    PubMed

    Weinmann, Sheila; Vandermeer, Meredith; Roberts, Michelle; Mullooly, John; Chun, Colleen

    2016-04-01

    We examined the positive predictive value of the herpes zoster ICD-9 diagnosis code 053 in the Kaiser Permanente Northwest integrated health plan. Among children 0-17 years old, the positive predictive value was 87.1% (95% confidence interval: 84.2-89.6) and 96.8% (95% confidence interval: 95.0-98.1) during the years 1997-2002 and 2005-2009, respectively, using chart review of the medical record as the diagnostic standard. PMID:26658628

  20. CRN Newsletter, July 2003 - Page 2

    Cancer.gov

    The 2003 HMO Research Network Conference was held in Denver in April, which coincided with the beginning of the CRN Renewal. The conference planning team deserves commendation for a stimulating program, marked by three provacative plenary sessions. One of the plenaries was delivered by Ned Calonge, MD, MPH, former CRN Site PI from Kaiser Permanente Colorado, now the Chief Medical Officer for the State of Colorado.

  1. Groundwater capture processes under a seasonal variation in natural recharge and discharge

    NASA Astrophysics Data System (ADS)

    Maddock, Thomas, III.; Vionnet, Leticia Beatriz

    "Capture" is the increase in recharge and the decrease in discharge that occurs when pumping is imposed on an aquifer system that was in a previous state of approximate dynamic equilibrium. Regional groundwater models are usually used to calculate capture in a two-step procedure. A steady-state solution provides an initial-head configuration, a set of flows through the boundaries for the modeled region, and the initial basis for the capture calculation. The transient solutions provide the total change in flows through the boundaries. A difference between the transient and steady-state solutions renders the capture calculation. When seasonality is a modeling issue, the use of a single initial hydraulic head and a single set of boundary flows leads to miscalculations of capture. Instead, an initial condition for each season should be used. This approach may be accomplished by determining steady oscillatory solutions, which vary through the seasons but repeat from year to year. A regional groundwater model previously developed for a portion of the San Pedro River basin, Arizona, USA, is modified to illustrate the effect that different initial conditions have on transient solutions and on capture calculations. Rsum Les "prlvements" sont constitus par l'augmentation de la recharge et par la diminution de l'coulement qui se produit lorsqu'un pompage est impos un systme aquifre qui tait auparavant dans un tat proche de l'quilibre dynamique. Les modles rgionaux de nappe sont en gnral utiliss pour calculer les prlvements dans une procdure deux tapes. Une solution en rgime permanent donne la configuration pizomtrique initiale, un jeu de conditions aux limites pour la rgion modlise et les donnes de base pour le calcul des prlvements. Les solutions transitoires donnent les modifications globales des conditions aux limites. Lorsque des variations saisonnires sont produites en sortie du modle, le recours une pizomtrie initiale unique et un seul jeu de donnes de conditions aux limites conduit un mauvais calcul des prlvements. Il faut alors utiliser une condition de recharge initiale pour chaque saison. Cette approche peut tre ralise en dterminant des solutions permanentes priodiques, variantes au cours des saisons, mais se rptant d'anne en anne. Un modle de nappe rgional, prcdemment mis au point pour une partie du bassin de la rivire San Pedro (Arizona, tats-Unis), a t modifi pour illustrer l'effet de conditions initiales diffrentes sur des solutions transitoires et sur le calcul des prlvements. Resumen Se define como "captura" al aumento de recarga y descenso de descarga que tiene lugar cuando se impone un bombeo en un acufero en estado de equilibrio dinmico. Se suelen utilizar modelos regionales de agua subterrnea para calcular la captura en un procedimiento que consta de dos etapas. Una solucin en rgimen estacionario proporciona la distribucin inicial de niveles piezomtricos, los flujos a travs de los contornos de la regin modelada y el punto de partida para el clculo de la captura. Las soluciones transitorias proporcionan los cambios en los flujos a travs de los contornos. La diferencia entre las soluciones estacionaria y transitoria da el valor de la captura. Cuando los cambios estacionales son importantes, la utilizacin de un nico estado inicial de niveles y de flujos en los contornos da lugar a errores en el clculo de la captura. En este caso debe usarse una condicin inicial para cada una de las estaciones. Esto se puede conseguir obteniendo soluciones peridicas estacionarias, que varen a lo largo de las estaciones, pero que se repitan ao a ao. Un modelo regional desarrollado previamente para el estudio de una parte de la cuenca del Ro San Pedro, en Arizona (EE.UU.) se modific para ilustrar el efecto que las distintas condiciones iniciales tienen en el clculo de la captura.

  2. If Your Child Learns in Two Languages: A Parent's Guide for Improving Educational Opportunities for Children Acquiring English as a Second Language = Si su nino aprende en dos idiomes: Una guia para que las familias sepan como mejorar las oportunidades educativas de los ninos que adquieren el ingles como segunda lengua = Neu lon Ban Hoc Bang Hai Thu Tieng: Chi-nam cua phu-huynh de cai tien co hoi hoc van cua con em dang hoc Anh van nhu sinh ngu thu hai.

    ERIC Educational Resources Information Center

    Zelasko, Nancy; Antunez, Beth

    This guide, in English, Spanish, and Vietnamese, aims to inform parents of students who have learned or are learning English as a Second Language about appropriate approaches for educating children so that they can work with schools to ensure a high quality education for their children. The emphasis is on explaining the laws, schools, and research

  3. How To Talk to Your Doctor (and Get Your Doctor To Talk to You!). An Educational Workshop on Doctor Patient Communication = Como Hablarle a su Doctor (iY que su doctor le hable a usted!). Un seminario educativo sobre la comunicacion entre el doctor y el paciente.

    ERIC Educational Resources Information Center

    Baylor Coll. of Medicine, Houston, TX.

    This workshop, written in both English and Spanish, focuses on improving communication between physician and patient. In the workshop, the trainers will talk about "building bridges" between patient and doctor by understanding the doctor's role and his/her duty to the patient. According to the workshop, a person's doctor should communicate

  4. O Passado como Nacao: Imagens do Imperio nas Falas Reacionarias dos Anos 30 e 40 do Seculo XX: Uma Pequena Arqueologia do Debate Publico e Privado (The Past as Nation: Images of the Empire in the Reactionary Words of the 30s and 40s in the 20th Century: A Small Archaeology of the Public Debate versus the Private One).

    ERIC Educational Resources Information Center

    de Freitas, Marcos Cezar

    1998-01-01

    Suggests an archaeology of the public debate versus the private one in Brazil through analysis of the reactionary speech of a religious leader, Dom Jose Mauricio da Rocha, which produced innumerable representations of the Brazilian Empire. (PA)

  5. Pedagogical Factors That Influence EFL Teaching: Some Considerations for Teachers' Professional Development (Factores pedagógicos que influyen en la enseñanza del inglés como lengua extranjera: algunas consideraciones para el desarrollo profesional de docentes)

    ERIC Educational Resources Information Center

    Abad, José Vicente

    2013-01-01

    In this article we present the results of a qualitative research study on the pedagogical factors that influence English teaching in four public schools of Medellín, Colombia. Twelve teachers were interviewed regarding three linguistic principles: communicative competence, native language effect, and interlanguage. The data analysis led to the…

  6. ...And That's How It All Began: Putting Information about Your Child's Growth, Health and Safety All within Your Reach...Because the First Years Last Forever! = ...Y asi es como empezo todo: Ponemos a su alcance en forma conjunta la informacion sobre el crecimiento, la salud y la seguridad de su hijo...Porque los primeros anos duran para siempre!

    ERIC Educational Resources Information Center

    North Carolina Partnership for Children, Raleigh.

    Smart Start is North Carolina's model early childhood initiative to help all North Carolina children enter school healthy and prepared for success. This resource guide, in Spanish and English versions, is designed to provide parents with information on infant and child development, health care, and resources for further assistance. Presented in an…

  7. Los padres como consejeros o coparticipes en la toma de decisiones. Serie E: [E1] logro de la participacion de los padres. cuaderno 3. Edicion para el maestro. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as Advisors or Participants in Decision Making. Series E: Parent Participation, Book 3. Teacher Edition. Bilingual Education Teacher Training Packet).

    ERIC Educational Resources Information Center

    Rodriguez, Rodolfo, Comp.

    This guide on training bilingual education teachers focuses on parents as advisors in the decision making process at bilingual schools. The two units, "An Introduction to Parent Participation" and "Parent Participation in Educational Decision Making," include objectives, definitions of terms, lists of materials and equipment, and learning…

  8. Los padres como consejeros o coparticipes en la toma de decisiones. Serie E: El logro de la participacion de los padres, cuaderno III. Edicion para el estudiante. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as Advisors or Participants in Decision Making. Series E: Success with Parent Participation, Book III. Student Edition. Bilingual Education Teacher Training Packet).

    ERIC Educational Resources Information Center

    Rodriguez, Rodolfo, Comp.

    The student version of a learning module for teacher training in bilingual education is one of three focusing on promoting parent participation in the school system, and concentrates specifically on the role of parents as counselors and co-participants in decisionmaking. An introductory section discussing the overall objectives of the materials is…

  9. Building Adult Relationships: Are You Treated as an Equal in Your Family? (A Pamphlet for People with Disbilities) [and] Como Establecer Relaciones Adultas: Se Lo Trata a UD. Igual que a Los Demas Adultos en Su Familia? (Un Panfleto para las Personas con Impedimentos).

    ERIC Educational Resources Information Center

    Baron, Carla

    Two booklets, in English and Spanish, are addressed to disabled adults and offer guidelines for building adult relationships within the family. Stressed are the importance of feeling good about oneself, learning to make decisions, and developing good communication skills so that family balance is maintained. Also included are lists of the types of

  10. "Don't Tell My Father": Important Lessons Learned through EFL Classroom Small Talk ("No le digan a mi padre": lecciones importantes aprendidas a través de la comunión fática en el salón de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Ayala González, Gabriela; de Cervantes Orozco, Miguel Adrián Leonel; González Cabrera, Víctor Daniel; Romero Mayora, Faviola; Mugford Fowler, Gerrard Edwin

    2011-01-01

    All too often phatic communion is neglected in the English as a foreign language classroom or relegated to the level of formulaic language which merits little or no attention. In this article we argue that phatic communion plays an important role in establishing, developing and maintaining interpersonal relationships between teacher and learners…

  11. Efectos Especiales de Anclaje (Estudio sobre Regresiones de Juicios Condicionales). Parte 2: Invariancia del Juicio No-Condicional Como Valor Estandar Para el Juicio Condicional (Special Effects of Anchoring (Study of Regression of Conditional Judgements) Part 2: Invariance of Unconditional Judgments as Standard Value for the Conditional Judgment). Publication No. 31.

    ERIC Educational Resources Information Center

    Lopez Alonso, A. O.

    From the best-fit lines corresponding to sets of families of conditional judgements, the constant stimulus family and the constant condition family, both defined for a same scale object, the coordinate values of the point of intersection of both lines (indifference point) are obtained. These values are studied in relation to the mean values of the…

  12. An Exploration of EFL Teachers' Awareness of the Sources of Pedagogical Knowledge in a Teacher Education Program (Una exploración del nivel de conciencia de docentes de inglés como lengua extranjera respecto a las fuentes del conocimiento pedagógico en un programa de formación de docentes)

    ERIC Educational Resources Information Center

    Macías, Diego Fernando

    2013-01-01

    This project set out to investigate the extent to which the sources of English as a foreign language teachers' pedagogical knowledge are acknowledged and addressed in a teacher education program in a public university in Colombia. It involved the participation of teacher educators and novice teachers as well as the analysis of documents. This…

  13. EFL Teenagers' Social Identity Representation in a Virtual Learning Community on Facebook (Representación de la identidad social de los estudiantes adolescentes de inglés como lengua extranjera en una comunidad de aprendizaje virtual en Facebook)

    ERIC Educational Resources Information Center

    Jiménez Guamán, Laura Verónica

    2012-01-01

    In this article I report the findings of a descriptive and interpretative qualitative study carried out in a public school in Bogotá, Colombia. The study aimed at analyzing, describing and exploring teenage students' social identity representation as observed in their participation in a learning community on Facebook. Data were collected from…

  14. ...And That's How It All Began: Putting Information about Your Child's Growth, Health and Safety All within Your Reach...Because the First Years Last Forever! = ...Y asi es como empezo todo: Ponemos a su alcance en forma conjunta la informacion sobre el crecimiento, la salud y la seguridad de su hijo...Porque los primeros anos duran para siempre!

    ERIC Educational Resources Information Center

    North Carolina Partnership for Children, Raleigh.

    Smart Start is North Carolina's model early childhood initiative to help all North Carolina children enter school healthy and prepared for success. This resource guide, in Spanish and English versions, is designed to provide parents with information on infant and child development, health care, and resources for further assistance. Presented in an

  15. Building Adult Relationships: Are You Treated as an Equal in Your Family? (A Pamphlet for People with Disbilities) [and] Como Establecer Relaciones Adultas: Se Lo Trata a UD. Igual que a Los Demas Adultos en Su Familia? (Un Panfleto para las Personas con Impedimentos).

    ERIC Educational Resources Information Center

    Baron, Carla

    Two booklets, in English and Spanish, are addressed to disabled adults and offer guidelines for building adult relationships within the family. Stressed are the importance of feeling good about oneself, learning to make decisions, and developing good communication skills so that family balance is maintained. Also included are lists of the types of…

  16. Motivation Conditions in a Foreign Language Reading Comprehension Course Offering Both a Web-Based Modality and a Face-to-Face Modality (Las condiciones de motivación en un curso de comprensión de lectura en lengua extranjera (LE) ofrecido tanto en la modalidad presencial como en la modalidad a distancia en la web)

    ERIC Educational Resources Information Center

    Lopera Medina, Sergio

    2014-01-01

    Motivation plays an important in role in education. Based on the ten macro-strategies proposed by Dörnyei and Csizér (1998), this article analyzes the motivation conditions in a foreign language reading comprehension course using both a web-based modality and a face-to-face modality. A case study was implemented as the primary research method, and…

  17. EFL Teachers' Perceptions of Continuing Professional Development: A Case of Iranian High School Teachers (La percepción de docentes de inglés como lengua extranjera acerca del desarrollo profesional continuado: el caso de profesores iraníes de bachillerato)

    ERIC Educational Resources Information Center

    Alibakhshi, Goudarz; Dehvari, Najibeh

    2015-01-01

    English, particularly regarding a foreign language teachers' professional development, has been studied in depth. However, it is not known how Iranian English as a foreign language teachers perceive continuing professional development. This study explored the perceptions of Iranian English as a foreign language teachers of continuing professional…

  18. Experiencias interculturales y la pedagogia de la anglofonia en la ensenanza de ingles como lengua extranjera (EILE) desde una perspectiva deweyana. Working Paper (A Deweyan Perspective on Cross-Cultural Experiences and Anglophone Pedagogy in the Teaching of English as a Foreign Language. Working Paper).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper discusses a framework for teaching English as a foreign language that incorporates significant cultural content and fosters critical encounters with Anglophone culture. It reviews relevant contemporary perspectives for understanding cross-cultural processes within the foreign language teaching environment with emphasis on the issue of…

  19. Using the EPOSTL for Dialogic Reflection in EFL Teacher Education (El Uso de EPOSTL para la Reflexión Dialógica en la Educación de los Docentes de Inglés como Lengua Extranjera)

    ERIC Educational Resources Information Center

    Schauber, Holli

    2015-01-01

    For many pre-service English as a Foreign Language (EFL) teachers and their mentors, the theory and practice driven European Portfolio for Student Teachers of Languages (EPOSTL) occupies a prominent and practical role in their preparation programs as a delivery system of core pedagogical skills and knowledge. Interest in the role that dialogical…

  20. For a Child, Life is a Creative Adventure: Supporting Development and Learning through Art, Music, Movement, and Dialogue. A Guide for Parents and Professionals. = Para los ninos, la vida es una aventura creativa: Como estimular el desarrollo y el aprendizaje por medio de las artes visuales, la musica, el movimiento y el dialogo. Guia para padres de familia y profesionales.

    ERIC Educational Resources Information Center

    Cohen, Elena

    Recognizing that creativity facilitates children's learning and development, the Head Start Program Performance Standards require Head Start programs to include opportunities for creative self-expression. This guide with accompanying videotape, both in English- and Spanish- language versions, encourages and assists adults to support children's…

  1. The Impact of a Teacher Development Program for Strategic Reading on EFL Teachers' Instructional Practice (El impacto de un programa de desarrollo profesional en lectura estratégica en la práctica instruccional de docentes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Khonamri, Fatemeh; Salimi, Mahin

    2010-01-01

    Research on teacher development has been the focus of attention in recent decades. The overall aim of this study was to explore the impact of reading strategy training on high school teachers' reading instructional practices. The study was conducted in the EFL context of Iran. To meet this aim, four EFL high school teachers voluntarily took…

  2. Pronunciation Instruction and Students' Practice to Develop Their Confidence in EFL Oral Skills (La instrucción de la pronunciación y la práctica de los estudiantes para el desarrollo de la confianza en habilidades orales en inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Tlazalo Tejeda, Ana Cristina; Basurto Santos, Nora M.

    2014-01-01

    The aim of this article is to inform on research intended to find out how pronunciation instruction of English as a foreign language was handled in the language classroom with elementary students and also understand if pronunciation instruction had an impact on students' confidence when using it. In order to do this, a qualitative case study was…

  3. How Do EFL Student Teachers Face the Challenge of Using L2 in Public School Classrooms? (Cmo enfrentan los docentes practicantes de ingls como lengua extranjera el reto de usar una segunda lengua en las aulas de clase de la escuela pblica?)

    ERIC Educational Resources Information Center

    Vifara, John Jairo

    2011-01-01

    As an EFL Student teachers' advisor, I had constantly perceived that they regarded using the target language with their pupils inside their classroom as a challenge. That is why I became interested in investigating how thirteen student teachers in Tunja public schools faced this issue. While participants were involved in a reflective teaching

  4. Does Consuming Sugar and Artificial Sweeteners Change Taste Preferences?

    PubMed

    Bartolotto, Carole

    2015-01-01

    Americans consume 22.3 teaspoons of added caloric sweeteners a day. Sweeteners range from 180 to 13,000 times sweeter than sugar. In summer 2014, 20 people from Kaiser Permanente California facilities cut out all added sugars and artificial sweeteners for 2 weeks: 95% of participants found that sweet foods and drinks tasted sweeter or too sweet, 75% found that other foods tasted sweeter, and 95% said moving forward they would use less or even no sugar. Additionally, 86.6% of participants stopped craving sugar after 6 days. PMID:26176574

  5. Multifocal Clinical Performance Improvement Across 21 Hospitals.

    PubMed

    Crawford, Barbara; Skeath, Melinda; Whippy, Alan

    2015-01-01

    Improving quality and safety across an entire healthcare system in multiple clinical areas within a short time frame is challenging. We describe our experience with improving inpatient quality and safety at Kaiser Permanente Northern California. The foundations of performance improvement are a four-wheel drive approach and a comprehensive driver diagram linking improvement goals to focal areas. By the end of 2011, substantial improvements occurred in hospital-acquired infections (central-lineassociated bloodstream infections and Clostridium difficile infections); falls; hospital-acquired pressure ulcers; high-alert medication and surgical safety; sepsis care; critical care; and The Joint Commission core measures. PMID:26247072

  6. Multifocal Clinical Performance Improvement across 21 Hospitals.

    PubMed

    Crawford, Barbara; Skeath, Melinda; Whippy, Alan

    2013-08-27

    Improving quality and safety across an entire healthcare system in multiple clinical areas within a short time frame is challenging. We describe our experience with improving inpatient quality and safety at Kaiser Permanente Northern California. The foundations of performance improvement are a "four-wheel drive" approach and a comprehensive driver diagram linking improvement goals to focal areas. By the end of 2011, substantial improvements occurred in hospital-acquired infections (central-line-associated bloodstream infections and Clostridium difficile infections); falls; hospital-acquired pressure ulcers; high-alert medication and surgical safety; sepsis care; critical care; and The Joint Commission core measures. PMID:24001267

  7. Managing E-mail Interactions with Patients: A Discussion with Clinicians in Evaluating the Personal Health Link Project

    PubMed Central

    Serrato, Carl A; Retecki, Sally

    2004-01-01

    One software feature in the Personal Health Link (PHL) Project allows members of Kaiser Permanente to send secure e-mail messages to clinicians and staff. As an early step in the PHL evaluation process, a group of primary care physicians met to discuss their opinions and experiences with e-mail interactions with patients and to suggest strategies for effectively managing these e-mail interactions. Most clinicians spoke from their experience with e-mail interactions with patients in a conventional e-mail environment; only one clinician in the group was using PHL. PMID:26705166

  8. Transforming Care Delivery through Health Information Technology

    PubMed Central

    Wheatley, Benjamin

    2013-01-01

    The slow but progressive adoption of health information technology (IT) nationwide promises to usher in a new era in health care. Electronic health record systems provide a complete patient record at the point of care and can help to alleviate some of the challenges of a fragmented delivery system, such as drug-drug interactions. Moreover, health IT promotes evidence-based practice by identifying gaps in recommended treatment and providing clinical decision-support tools. In addition, the data collected through digital records can be used to monitor patient outcomes and identify potential improvements in care protocols. Kaiser Permanente continues to advance its capability in each of these areas. PMID:23596377

  9. Towards a Role for Clinical Pathology Diagnostics for Childhood Maltreatment

    PubMed Central

    Bearer, EL; Ji, J; Trickett, P; Kaplan, CD; Mennen, F

    2015-01-01

    Recent reports from the Center for Disease Control and Kaiser Permanente demonstrate that early life adverse experience leads to morbidity and mortality in adulthood. To date there are no objective tests that help care-givers or local child protective services make informed decisions for children with a history of abuse, neglect or trauma. This is the first report from a new group of trans-disciplinary investigators describing a new approach to identify the biological impact of childhood maltreatment using clinical pathology testing. Such new quantitative measurements will be useful to identify children at risk for poor mental and physical health outcomes and to follow response to interventions. PMID:26640822

  10. Using a High-Performance Planning Model to Increase Levels of Functional Effectiveness Within Professional Development.

    PubMed

    Winter, Peggi

    2016-01-01

    Nursing professional practice models continue to shape how we practice nursing by putting families and members at the heart of everything we do. Faced with enormous challenges around healthcare reform, models create frameworks for practice by unifying, uniting, and guiding our nurses. The Kaiser Permanente Practice model was developed to ensure consistency for nursing practice across the continuum. Four key pillars support this practice model and the work of nursing: quality and safety, leadership, professional development, and research/evidence-based practice. These four pillars form the foundation that makes transformational practice possible and aligns nursing with Kaiser Permanente's mission. The purpose of this article is to discuss the pillar of professional development and the components of the Nursing Professional Development: Scope and Standards of Practice model (American Nurses Association & National Nursing Staff Development Organization, 2010) and place them in a five-level development framework. This process allowed us to identify the current organizational level of practice, prioritize each nursing professional development component, and design an operational strategy to move nursing professional development toward a level of high performance. This process is suggested for nursing professional development specialists. PMID:26457816

  11. Genome-wide association study identifies ABCG2 (BCRP) as an allopurinol transporter and a determinant of drug response

    PubMed Central

    Wen, CC; Yee, SW; Liang, X; Hoffmann, TJ; Kvale, MN; Banda, Y; Jorgenson, E; Schaefer, C; Risch, N; Giacomini, KM

    2015-01-01

    The first-line treatment of hyperuricemia, which causes gout, is allopurinol. The allopurinol response is highly variable, with many users failing to achieve target serum uric acid (SUA) levels. No genome-wide association study (GWAS) has examined the genetic factors affecting allopurinol effectiveness. Using 2,027 subjects in Kaiser Permanentes Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort, we conducted a GWAS of allopurinol-related SUA reduction, first in the largest ethnic group, non-Hispanic white (NHW) subjects, and then in a stratified transethnic meta-analysis. ABCG2, encoding the efflux pump BCRP, was associated with SUA reduction in NHW subjects (P = 2 10?8), and a missense allele (rs2231142) was associated with a reduced response (P = 3 10?7) in the meta-analysis. Isotopic uptake studies in cells demonstrated that BCRP transports allopurinol and genetic variants in ABCG2 affect this transport. Collectively, this first GWAS of allopurinol response demonstrates that ABCG2 is a key determinant of response to the drug. PMID:25676789

  12. The effects of an Electronic Medical Record on patient care: clinician attitudes in a large HMO.

    PubMed Central

    Marshall, P. D.; Chin, H. L.

    1998-01-01

    OBJECTIVE: The purpose of this study is to examine the attitudes of clinicians in a large HMO toward the effect of an outpatient Electronic Medical Record system on the quality of patient care. Attitudes toward a Results Reporting system and an online charting and ordering system are also compared. DESIGN: A cross-sectional study was performed using a survey of Kaiser Permanente Northwest clinicians. In addition, interviews were conducted with the physician leaders of the clinical departments at Kaiser Permanente Northwest. MEASUREMENTS: Clinician attitudes are measured regarding the effects of a Results Reporting system and an online charting and ordering system on the overall quality of patient care and other care-related indices. RESULTS: Most clinicians feel that the outpatient Electronic Medical Record has improved the overall quality of patient care, with 72% reporting an improvement with the use of the Results Reporting system, and 60% reporting an improvement with the use of the online charting and ordering system. On average, clinicians feel that the EMR has also improved the quality of the patient-clinician interaction, the ability to coordinate the care of patients with other departments, the ability to detect medication errors, the timeliness of referrals, and the ability to act on test results in a timely fashion. CONCLUSION: Clinicians perceive an improvement in patient care as a result of using an outpatient Electronic Medical Record system. Clinicians have higher opinions, however, of the effects of a Results Reporting system compared to an online charting and ordering system. PMID:9929200

  13. Roundtable on public policy affecting patient safety.

    PubMed

    Crane, Robert M; Raymond, Brian

    2011-03-01

    On April 15, 2010, patient safety experts were assembled to discuss the adequacy of the public policy response to the Institute of Medicine report "To Err is Human" 10 years after its publication. The experts concluded that additional government actions should be considered. Actions that deserve consideration include the development of an educational campaign to improve public and provider understanding of the issue as a means to support change similar to successful public health campaigns, support the evolution of payment reform away from fee for service, create a clearer aim or goal for patient safety activities, support the development and use of better safety measures to judge status and improvement, and support for additional learning of what works particularly on implementation issues. Participants included: Moderator Robert Crane, senior advisor, Kaiser Permanente Participants Doug Bonacum, vice president, Safety Management, Kaiser Permanente Janet Corrigan, PhD, president and CEO, National Quality Forum Helen Darling, MA, president and CEO, National Business Group on Health Susan Edgman-Levitan, PA, executive director, John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital David M. Lawrence, MD, MPH, chairman and CEO (Retired), Kaiser Foundation Health Plan and Hospitals, Inc Lucian Leape, MD, adjunct professor of Health Policy, Harvard School of Public Health Diane C. Pinakiewicz, president, National Patient Safety Foundation Robert M. Wachter, MD, professor and associate chairman, Department of Medicine, University of California, San Francisco. PMID:22026014

  14. Measurement and evaluation of national family planning programs.

    PubMed

    Mauldin, W P

    1967-03-01

    RESUMEN: En los últimos quince años diez paises han inaugurado programas nacionales de planeamiento familiar: India, Pakistán, Corea del Sur, Taiwan, Turquía, Malasia, Ceilán, Túez, la República Arabe Unida, y Marruecos. Otros paises, incluyendo Tailandia, Hong Kong, Singapur, Kenya, Barbados, Trinidad y los Estados Unidos, apoyan y/o estimulan actividades de planeamiento familiar. En la mayor parte de los casos la razón fundamental del programa ha sido que si la tasa de crecimiento poblacional disminuyera, aumentaría la tasa de crecimiento económico.Las metas de largo alcance, expresadas típicamente en términos de reducir las tasa.de de natalidad o de crecimiento, tienen su ejemplo en el propósito de Pakistán de reducir su tasa de crecimiento a 26 para 1970; el de Corea de reducir su tasa de natalidad a 20 para 1971; y el de India de reducir su tasa de natalidad a 25 para 1973.Los objectivos intermedios, que cubren diversos aspectos del pro grama, incluyen metas específicas para un determinado mes a año, considerando personal, la adquisición de anticonceptivos, y el número de usarios por método. Las metas específicas anuales de aceptantes de dispositivos intrauterinos (IUD), para Taiwán, Corea, Túnez, Pakistán e India, son comunes, tanto por la naturaleza del artefacto, como por la facilidad de medición de los que continúan utilizándolos. El programa de evaluación en Taiwán, que trata de medir por diversos medios los efectos inmediatos, mediatos y de largo plazo del programa de planeamiento familiar sirve de modelo. El propósito de la evaiuación de un programa de planeamiento familiar es contribuir a la efectividad y eficiencia del programa, midiendo y analizando su progreso. Las áreas a medir pueden ser clasificadas como- (1) conocimiento acerca de; (2) actitudes hacia; (3) práctica de control de natalidad; y (4) nivel de fecundidad.Un buen sistema de evaluación debería incluir: A. Un buen conjunto de estadísticas de servicio presentadas en formularios estandarizados, en las siguienies formas: 1. Informes nensuales por áreas administrativas, sobre los actuales servicios de planeamiento familiar proporcionados en la actualidad, de carácter permanente o de larga duración (al presente, esterilización y IUD de acuerdo a las siguientes características del receptor: residencia, edad, paridad (número de hijos vivos por sexo), y donde se enteró del programa, si es posible "clase";(probablemente educación de la madre, pero posiblemente ocupación del esposo, ingreso, o equivalente); prácticas anticonceptivas anteriores; intervalo; y deseo de tener más hijos. En un programa grande estos datos pueden obtenerse en base a una muestra. 2. Informes mensuales sobre la distribución de suministros anticonceptivos (condones, píldoras, sustancias efervescentes, etc.), los primeros suministros deben ir acompañados de un registro de las características del recipiente, como anteriormente; los suministros subsecuentes se regietrarán sólo en volumen bruto. Esto también se aplicará al ritmo, donde éste método se enseñe a un número considerable de mujeres. 3. Informes regulares sobre las actividades de planeamiento familiar de médicos privados, como una estimación del efecto catalítico del programa del gobierno sobre ci sector privado. 4. Datos generates mensuales, ppr áreas admirtistrativas importantes, sabre: visitas domiciliarias, reuniones, cuñas radiates y televisadas, avisos en los periódicos y personal que trabaja. 5. Para propósitos de seguimiento una entrevi eta de campo cada 6 a 12 meses a cada N mujer de las listas para (1) y (2) arriba, en un total de 300 o 400, para conocer las tasas de continuación y las razones de abandono (ej: desea otro hijo, insatisfecha can ci método, otras). Las mue.stras podrían ser de 300 cada una, con una supuesta experiencia de 6, 12, 18 y 24 meses. B. Un buen conjunto de datos sobre costa (datos sobre cotos actulaes atribuíbles directamente al programa de planeamiento familiar) fraccionados par áreas principales y cinco a seis categorías de costos importantes tales coma: adminietración, personal de campo, publicidad, suministros, etc. C. Un buen conjunto de dates globales sobre la distribución de los suministros comerciales que puedan llegar tan cerca como sea posible del último consumidor, to cual significa probablemente obtener información de los mayoristas. D. Una encuesta de conocimientos, actitudes y prácticas (KAP) para una evaluación general cada dos años. Las preguntas básicas (además de las antes mencionadas y estatus marital y étnico cuando sea pertinente) son: actitud hacia e interés por la anticoncepción, número de niños por sexo, deseo de tener más hijos, prácticas anticonceptivas, experiencia sobre abortos, tal vez historia de embarazo (especialmente si esta producirá una tasa de fecundidad válida), aprobación del programa gubernamental (para uso politico), y si está actualmente embarazada (la única y mejor pregunta cuya respuesta habla del efecto sobre la tasa de natalidad). Administrativamente, la responsabilidad por la evalucion debe estar cerca al director, se debe tomar provisiones para obtener informes regulares (meneulaes) y especiales dirigidos a preguntar sobre política. El corolario es que el jefe de evaluación debe tener la confianza del director y debe estar al día en cuanto a las decisiones sabre la politics a seguir. Su trabajo consiste en extractar los aspectos principales que funcionan bien y los no operantes. En cuanto a costos, la evaluación debe hacerse sobre no más del 10 par ciento del costa del programa en paises pequeños (de menos de 30 milliones) y sabre no más del 5 per ciento en paises más grandes.Para medir en que forma el programa satisface el criterio final-la magnitud en que cambia la fecundidad-se debe realizar un trabajo más elaborado en el centro (Universidades, Consejos de población, etc.) para desarrollar una forma (a formas) segura de traducir las estadísticas de servicio en práticas y tal vez aún datos sobre suministro comercial en datos sabre tasas de natalidad. Esto incluye, par ejemplo, los esfuerzos para consolidar observaciones coma "cinco años-mujer de usa de IUD, a 400 condones equivalen a la prevención de un nacimiento," y esfuerzos como los de Pakistán de calcular tasas coma "años de protección de una pareja contra el embarazo."In the belief that a decrease in the rate of population growth will increase economic development, more than ten countries have inaugurated family planning programs in the past fifteen years. To provide a model for measuring the immediate, intermediate, and long-term effects of any such program, the authors use the Taiwan evaluation.The model suggests that a good system of evaluation should include monthly statistics on (1) participants, who are grouped by characteristics; (2) the distribution of supplies, reported at first by the characteristics of recipients, but after by gross volume only; (3) family planning activities of private physicians to measure the catalytic effect on the private sector; (4) new contacts and amount of advertising in mass media; (5) costs broken down by areas and by cost categories; and (6) distribution of commercial supplies. In addition, the program should conduct 300-400 interviews every 6-12 months to learn the rates of continuation and the rates and reasons for discontinuation. Finally, a KAP survey should be conducted every two years.The administration of the evaluation should be close to the director for policy decisions and for the ultimate work of evaluation-the finding of new ways to measure the main goal of change in fertility by the translation of statistics on Services provided and commercial supplies into birth rate data. PMID:21279762

  15. Large-scale right-slip displacement on the East San Francisco Bay Region fault system, California: Implications for location of late Miocene to Pliocene Pacific plate boundary

    NASA Astrophysics Data System (ADS)

    McLaughlin, R. J.; Sliter, W. V.; Sorg, D. H.; Russell, P. C.; Sarna-Wojcicki, A. M.

    1996-02-01

    A belt of northwardly younging Neogene and Quaternary volcanic rocks and hydrothermal vein systems, together with a distinctive Cretaceous terrane of the Franciscan Complex (the Permanente terrane), exhibits about 160 to 170 km of cumulative dextral offset across faults of the East San Francisco Bay Region (ESFBR) fault system. The offset hydrothermal veins and volcanic rocks range in age from .01 Ma at the northwest end to about 17.6 Ma at the southeast end. In the fault block between the San Andreas and ESFBR fault systems, where volcanic rocks are scarce, hydrothermal vein system ages clearly indicate that the northward younging thermal overprint affected these rocks beginning about 18 Ma. The age progression of these volcanic rocks and hydrothermal vein systems is consistent with previously proposed models that relate northward propagation of the San Andreas transform to the opening of an asthenospheric window beneath the North American plate margin in the wake of subducting lithosphere. The similarity in the amount of offset of the Permanente terrane across the ESFBR fault system to that derived by restoring continuity in the northward younging age progression of volcanic rocks and hydrothermal veins suggests a model in which 80-110 km of offset are taken up 8 to 6 Ma on a fault aligned with the Bloomfield-Tolay-Franklin-Concord-Sunol-Calaveras faults. An additional 50-70 km of cumulative slip are taken up ? 6 Ma by the Rogers Creek-Hayward and Concord-Franklin-Sunol-Calaveras faults. An alternative model in which the Permanente terrane is offset about 80 km by pre-Miocene faults does not adequately restore the distribution of 8-12 Ma volcanic rocks and hydrothermal veins to a single northwardly younging age trend. If 80-110 km of slip was taken up by the ESFBR fault system between 8 and 6 Ma, dextral slip rates were 40-55 mm/yr. Such high rates might occur if the ESFBR fault system rather than the San Andreas fault acted as the transform margin at this time. Major transpression across the boundary between the Pacific and North American plates at about 3 to 5 Ma would have resulted in the transfer of significant slip back to the San Francisco Peninsula segment of the San Andreas fault. Since that time, the ESFBR fault system has continued to slip at rates of 11-14 mm/yr. If this interpretation is valid, the ESFBR fault system was the Pacific-North American plate boundary between 8 and 6 Ma, and this boundary has migrated both eastward and westward with time, in response to changing plate margin geometry and plate motions.

  16. Large-scale right-slip displacement on the East San Francisco Bay Region fault system, California: Implications for location of late Miocene to Pliocene Pacific plate boundary

    USGS Publications Warehouse

    McLaughlin, R.J.; Sliter, W.V.; Sorg, D.H.; Russell, P.C.; Sarna-Wojcicki, A. M.

    1996-01-01

    A belt of northwardly younging Neogene and Quaternary volcanic rocks and hydrothermal vein systems, together with a distinctive Cretaceous terrane of the Franciscan Complex (the Permanente terrane), exhibits about 160 to 170 km of cumulative dextral offset across faults of the East San Francisco Bay Region (ESFBR) fault system. The offset hydrothermal veins and volcanic rocks range in age from .01 Ma at the northwest end to about 17.6 Ma at the southeast end. In the fault block between the San Andreas and ESFBR fault systems, where volcanic rocks are scarce, hydrothermal vein system ages clearly indicate that the northward younging thermal overprint affected these rocks beginning about 18 Ma. The age progression of these volcanic rocks and hydrothermal vein systems is consistent with previously proposed models that relate northward propagation of the San Andreas transform to the opening of an asthenospheric window beneath the North American plate margin in the wake of subducting lithosphere. The similarity in the amount of offset of the Permanente terrane across the ESFBR fault system to that derived by restoring continuity in the northward younging age progression of volcanic rocks and hydrothermal veins suggests a model in which 80-110 km of offset are taken up 8 to 6 Ma on a fault aligned with the Bloomfield-Tolay-Franklin-Concord-Sunol-Calaveras faults. An additional 50-70 km of cumulative slip are taken up ??? 6 Ma by the Rogers Creek-Hayward and Concord-Franklin-Sunol-Calaveras faults. An alternative model in which the Permanente terrane is offset about 80 km by pre-Miocene faults does not adequately restore the distribution of 8-12 Ma volcanic rocks and hydrothermal veins to a single northwardly younging age trend. If 80-110 km of slip was taken up by the ESFBR fault system between 8 and 6 Ma, dextral slip rates were 40-55 mm/yr. Such high rates might occur if the ESFBR fault system rather than the San Andreas fault acted as the transform margin at this time. Major transpression across the boundary between the Pacific and North American plates at about 3 to 5 Ma would have resulted in the transfer of significant slip back to the San Francisco Peninsula segment of the San Andreas fault. Since that time, the ESFBR fault system has continued to slip at rates of 11-14 mm/yr. If this interpretation is valid, the ESFBR fault system was the Pacific-North American plate boundary between 8 and 6 Ma, and this boundary has migrated both eastward and westward with time, in response to changing plate margin geometry and plate motions.

  17. Ranked Levels of Influence Model: Selecting Influence Techniques to Minimize IT Resistance

    PubMed Central

    Bartos, Christa E.; Butler, Brian S.; Crowley, Rebecca S.

    2010-01-01

    Implementation of electronic health records (EHR), particularly computerized physician/provider order entry systems (CPOE), is often met with resistance. Influence presented at the right time, in the right manner, may minimize resistance or at least limit the risk of complete system failure. Combining established theories on power, influence tactics, and resistance, we developed the Ranked Levels of Influence model. Applying it to documented examples of EHR/CPOE failures at Cedars-Sinai and Kaiser Permanente in Hawaii, we evaluated the influence applied, the resistance encountered, and the resulting risk to the system implementation. Using the Ranked Levels of Influence model as a guideline, we demonstrate that these system failures were associated with the use of hard influence tactics that resulted in higher levels of resistance. We suggest that when influence tactics remain at the soft tactics level, the level of resistance stabilizes or de-escalates and the system can be saved. PMID:20176135

  18. The mediating sex-specific effect of psychological distress on the relationship between adverse childhood experiences and current smoking among adults

    PubMed Central

    2012-01-01

    Background Research suggests that ACEs have a long-term impact on the behavioral, emotional, and cognitive development of children. These disruptions can lead to adoption of unhealthy coping behaviors throughout the lifespan. The present study sought to examine psychological distress as a potential mediator of sex-specific associations between adverse childhood experiences (ACEs) and adult smoking. Method Data from 7,210 Kaiser-Permanente members in San Diego California collected between April and October 1997 were used. Results Among women, psychological distress mediated a significant portion of the association between ACEs and smoking (21% for emotional abuse, 16% for physical abuse, 15% for physical neglect, 10% for parental separation or divorce). Among men, the associations between ACEs and smoking were not significant. Conclusions These findings suggest that for women, current smoking cessation strategies may benefit from understanding the potential role of childhood trauma. PMID:22788356

  19. Maternal Infection During Pregnancy and Autism Spectrum Disorders.

    PubMed

    Zerbo, Ousseny; Qian, Yinge; Yoshida, Cathleen; Grether, Judith K; Van de Water, Judy; Croen, Lisa A

    2015-12-01

    We conducted a nested case-control study including 407 cases and 2,075 frequency matched controls to investigate the association between maternal infections during pregnancy and risk of autism spectrum disorders (ASD). Cases, controls, and maternal infections were ascertained from Kaiser Permanente Northern California clinical databases. No overall association between diagnoses of any maternal infection during pregnancy and ASD was observed [adjusted odds ratio (ORadj)=1.15, 95% confidence interval (CI) 0.92-1.43]. However, women with infections diagnosed during a hospital admission (ORadj=1.48, 95% CI 1.07-2.04), particularly bacterial infections (ORadj=1.58, 95% CI 1.06-2.37), were at increased risk of delivering a child with ASD. Multiple infections during pregnancy were associated with ASD (ORadj=1.36, 95% CI 1.05-1.78). PMID:24366406

  20. Comparison of type II and type I diabetics treated for end-stage renal disease in a large prepaid health plan population.

    PubMed

    Ordonez, J D; Hiatt, R A

    1989-01-01

    From 1978 through 1984, the incidence of treated end-stage renal disease (ESRD) secondary to diabetic nephropathy increased from 3 to 19 per million population among the membership of the Kaiser Permanente Medical Care Program in Northern California. Forty-eight percent had type II diabetes. Among 66 type II diabetics retinopathy was less severe and hypertension was more frequent than among 50 type I diabetics. Blacks were represented in a higher proportion than expected from their proportion of the health plan membership. Among type II diabetics who developed ESRD, once proteinuria occurred, nephropathy progressed at the same rate observed in type I diabetics. This observation suggests that the clinical progression of diabetic nephropathy may be similar for both types of diabetes after the development of proteinuria, but requires prospectively collected data for confirmation. PMID:2739829

  1. Preventing Antibiotic Resistance: The Next Step

    PubMed Central

    Ritterman, Jeffrey B

    2006-01-01

    There is universal agreement that the emergence of antibiotic-resistant bacteria is a significant health problem, leading to preventable morbidity and mortality. Kaiser Permanente (KP) has made great strides in improving the antibiotic-prescribing behavior of its physicians, thereby limiting the emergence of antibiotic resistance in the clinical setting. This, however, is only a beginning. Greater than 70% of the antibiotics used in the United States are for nontherapeutic purposes in animal feed. The resulting emergence of resistant bacteria that cause human disease is described. I propose a campaign throughout KP to broaden our prevention efforts by phasing out meat, dairy, poultry, and fish products raised using antibiotic feed additives. PMID:21519468

  2. Perinatal Patient Safety Project

    PubMed Central

    Nunes, Julie; McFerran, Sharon

    2005-01-01

    The Perinatal Patient Safety Project (PPSP) was created as a systemic strategy for creating high-reliability perinatal units by preventing identified causes of perinatal events in the clinical setting. With developmental funding from a Garfield grant, implementation of the PPSP has been completed at four pilot sites in the Kaiser Permanente Northern California (KPNC) Region. Its success has resulted in implementation at all perinatal units in the KPNC Region as well as being promoted by National Risk Management for nationwide implementation. PPSP emphasizes structured communication, multidisciplinary rounds, a definition of fetal well-being, and practicing for emergencies. Steps taken to create high reliability perinatal care include improved communication, patient safety focus, and satisfaction among perinatal patients, providers, and staff. PMID:21660157

  3. Outcomes in Treatment for Intradural Spinal Cord Ependymomas

    SciTech Connect

    Volpp, P. Brian Han, Khanh; Kagan, A. Robert; Tome, Michael

    2007-11-15

    Purpose: Spinal cord ependymomas are rare tumors, accounting for <2% of all primary central nervous system tumors. This study assessed the treatment outcomes for patients diagnosed with spinal cord ependymomas within the Southern California Kaiser Permanente system. Methods and Materials: We studied 23 patients treated with surgery with or without external beam radiotherapy (EBRT). The local and distant control rates and overall survival rates were determined. Results: The overall local control, overall recurrence, and 9-year overall survival rate was 96%, 17.4%, and 63.9%, respectively. Conclusions: The results of our study indicate that en bloc gross total resection should be the initial treatment, with radiotherapy reserved primarily for postoperative cases with unfavorable characteristics such as residual tumor, anaplastic histologic features, or piecemeal resection. Excellent local control and overall survival rates can be achieved using modern microsurgical techniques, with or without local radiotherapy.

  4. Improving Blood Pressure Control in a Large Multiethnic California Population Through Changes in Health Care Delivery, 2004–2012

    PubMed Central

    Handler, Joel; Wall, Hilary K.; Kanter, Michael H.

    2014-01-01

    The Kaiser Permanente Southern California (Kaiser) health care system succeeded in improving hypertension control in a multiethnic population by adopting a series of changes in health care delivery. Data from the Healthcare Effectiveness Data and Information Set (HEDIS) was used to assess blood pressure control from 2004 through 2012. Hypertension control increased overall from 54% to 86% during that period, and 80% or more in every subgroup, regardless of race/ethnicity, preferred language, or type of health insurance plan. Health care delivery changes improved hypertension control across a large multiethnic population, which indicates that health care systems can achieve a clinical target goal of 70% for hypertension control in their populations. PMID:25357259

  5. Improving blood pressure control in a large multiethnic California population through changes in health care delivery, 2004-2012.

    PubMed

    Shaw, Kate M; Handler, Joel; Wall, Hilary K; Kanter, Michael H

    2014-01-01

    The Kaiser Permanente Southern California (Kaiser) health care system succeeded in improving hypertension control in a multiethnic population by adopting a series of changes in health care delivery. Data from the Healthcare Effectiveness Data and Information Set (HEDIS) was used to assess blood pressure control from 2004 through 2012. Hypertension control increased overall from 54% to 86% during that period, and 80% or more in every subgroup, regardless of race/ethnicity, preferred language, or type of health insurance plan. Health care delivery changes improved hypertension control across a large multiethnic population, which indicates that health care systems can achieve a clinical target goal of 70% for hypertension control in their populations. PMID:25357259

  6. Is infertility associated with childhood autism?

    PubMed

    Grether, Judith K; Qian, Yinge; Croughan, Mary S; Wu, Yvonne W; Schembri, Michael; Camarano, Loretta; Croen, Lisa A

    2013-03-01

    Concerns persist about a possible link between infertility and risk of autism spectrum disorders (ASD). Interpretation of existing studies is limited by racial/ethnic homogeneity of study populations and other factors. Using a case-control design, we evaluated infertility history and treatment documented in medical records of members of Kaiser Permanente Northern California. Among singletons (349 cases, 1,847 controls), we found no evidence to support an increase in risk of ASD associated with infertility. Among multiple births (21 cases, 54 controls), we found an increased risk associated with infertility history and with infertility evaluations and treatment around the time of index pregnancy conception; however, small sample size and lack of detailed data on treatments preclude firm interpretation of results for multiple births. PMID:22777105

  7. Companies commit to emergency contraception -- have you?

    PubMed

    1999-12-01

    Despite the efforts of the medical community, as well as promotional efforts by pharmaceutical companies, relatively few women in the US have heard of emergency contraceptives (ECs). Gynetics, marketer of Preven, plans to file a new drug application for a levonorgestrel EC by the end of 1999, with an anticipated approval in the second half of 2000. Women's Capital Corp., marketer of Plan B, is also aiming for a national commercial launch of its product. According to a recently published acceptability study, women will use ECs when they are made available. A survey among 235 women at 13 Kaiser Permanente medical offices in San Diego, California, regarding their experiences with ECs showed that 91% were satisfied with ECs, and 97% said they would use ECs for emergencies only--dispelling fears that women would forego use of ongoing contraception. About 70% of the women who participated in the study were using a contraceptive method when they requested ECs. PMID:12295558

  8. Sustaining engagement and partnership: model of enhancing cultural capital among nonaffiliated IRB members.

    PubMed

    Hung, Yvonne; Ayala, Armida; Morales, Francisco; Frierman-Hunt, Gina; Moreno, Alva; Nwachuku, Ijeoma

    2013-07-01

    Although federal regulations require the presence of at least one nonaffiliated member on the roster of an institutional review board (IRB), little research exists about how to foster their participation and satisfaction. Guided by principles of justice and diversity, the Kaiser Permanente Southern California IRB adapted the sociological concept of "cultural capital" to develop training and support with its nonaffiliated IRB members. Using in-depth qualitative interviews with four past and current nonaffiliated IRB members, we describe how our initial and ongoing activities enhanced their ability to analyze, communicate, and complete the ethical review of research. This case study is situated in the gaps of existing research about nonaffiliated IRB members by providing insights into how to sustain their engagement while protecting the rights of research volunteers, particularly from vulnerable communities. PMID:23933774

  9. A Study of Physician Knowledge and Experience with Autism in Adults in a Large Integrated Healthcare System.

    PubMed

    Zerbo, Ousseny; Massolo, Maria L; Qian, Yinge; Croen, Lisa A

    2015-12-01

    We conducted an online survey of adult health care providers at Kaiser Permanente Northern California and semi-structured interviews with a subset of physicians. The survey assessed providers' ability to recognize autism spectrum disorder (ASD), asked them to rate their autism knowledge, comfort level in treating affected patients, and evaluated training and resource needs. 922 providers completed the survey (response rate 25.3 %), and 9 were interviewed by telephone regarding their autism training and experiences caring for patients with autism. Most providers reported lacking skills and tools to care for this adult patient population. A high proportion of adult providers were not aware that they had patients with ASD. These findings underscore the need to educate physicians caring for adults with ASD. PMID:26334872

  10. Computers in the examining room: the patient's perspective.

    PubMed Central

    Aydin, C. E.; Rosen, P. N.; Jewell, S. M.; Felitti, V. J.

    1995-01-01

    CompuHx* is an Interactive Health Appraisal System (IHAPS) used in the examining room at Kaiser-Permanente's San Diego Department of Preventive Medicine to record patient information, assist in diagnosis, and provide a legible summary of findings. The purpose of the present project was to examine the impact of computer use in the examining room on patient satisfaction with the Health Appraisal experience. Survey results showed no significant differences in patient satisfaction between patients whose examiners used CompuHx and those whose examiners did not. These findings indicate that, in the eyes of the patients surveyed, clinician use of a computer in the examining room did not depersonalize their relationship with the clinician, nor did it enhance satisfaction with the thoroughness of the exam or confidence in the examiner's findings. PMID:8563407

  11. Source rock potential of Franciscan complex: the galloping gourmet and the hydrocarbon kitchen

    SciTech Connect

    Larue, D.K. Underwood, M.B.

    1986-04-01

    Previous workers suggested that western North America was characterized by coastal upwelling during much of the Mesozoic and Cenozoic Eras. Areas of coastal upwelling are commonly characterized by excellent source rocks - because high-quality organic matter is preserved in oxygen-minimum zones - and by high sedimentation rates. The Franciscan complex, of Jurassic to Miocene age, records part of the interaction between Pacific oceanic plates and the North American continental margin. The Franciscan complex is an amalgam of terranes, most of which represent deposition in deep to intermediate-depth waters on oceanic lithosphere and trench-related continental margin facies. The authors analyzed the source rock potential of Franciscan complex rocks using Rock-Eval pyrolysis techniques. Turbiditic mudstones of the eastern belt Franciscan complex contain moderate amounts of total organic carbon (TOC about 1%), but have low volatile contents as indicated by hydrogen and oxygen indexes. TOC is 1-3% for organic matter in argillaceous melange matrix of the coastal belt of northern California, the Permanente terrane, and San Simeon; however, volatile content is low. The Calera limestone of the Permanente terrane was deposited under locally anoxic conditions, probably on a mid-Pacific seamount, and later accreted to North America. It contains from 0 to 7% TOC, and volatile content is low. Significant volatile content is found only in turbiditic mudstones of the coastal belt Franciscan, northern California, where TOC averages about 1% in Type III kerogens. Slates locally bearing blue amphiboles, lawsonite, jadeite, and limestones tectonically interleaved with slates in melange on Cedros Island, Baja California, contain up to several percent TOC, but are extremely depleted in volatiles.

  12. A Comprehensive Assessment Across the Healthcare Continuum: Risk of Hospital-Associated Clostridium difficile Infection Due to Outpatient and Inpatient Antibiotic Exposure.

    PubMed

    Tartof, Sara Y; Rieg, Gunter K; Wei, Rong; Tseng, Hung Fu; Jacobsen, Steven J; Yu, Kalvin C

    2015-12-01

    BACKGROUND Limitations in sample size, overly inclusive antibiotic classes, lack of adjustment of key risk variables, and inadequate assessment of cases contribute to widely ranging estimates of risk factors for Clostridium difficile infection (CDI). OBJECTIVE To incorporate all key CDI risk factors in addition to 27 antibiotic classes into a single comprehensive model. DESIGN Retrospective cohort study. SETTING Kaiser Permanente Southern California. PATIENTS Members of Kaiser Permanente Southern California at least 18 years old admitted to any of its 14 hospitals from January 1, 2011, through December 31, 2012. METHODS Hospital-acquired CDI cases were identified by polymerase chain reaction assay. Exposure to major outpatient antibiotics (10 classes) and those administered during inpatient stays (27 classes) was assessed. Age, sex, self-identified race/ethnicity, Charlson Comorbidity Score, previous hospitalization, transfer from a skilled nursing facility, number of different antibiotic classes, statin use, and proton pump inhibitor use were also assessed. Poisson regression estimated adjusted risk of CDI. RESULTS A total of 401,234 patients with 2,638 cases of incident CDI (0.7%) were detected. The final model demonstrated highest CDI risk associated with increasing age, exposure to multiple antibiotic classes, and skilled nursing facility transfer. Factors conferring the most reduced CDI risk were inpatient exposure to tetracyclines and first-generation cephalosporins, and outpatient macrolides. CONCLUSIONS Although type and aggregate antibiotic exposure are important, the factors that increase the likelihood of environmental spore acquisition should not be underestimated. Operationally, our findings have implications for antibiotic stewardship efforts and can inform empirical and culture-driven treatment approaches. Infect. Control Hosp. Epidemiol. 2015;36(12):1409-1416. PMID:26387888

  13. Recent trends in childhood attention-deficit/hyperactivity disorder.

    PubMed

    Getahun, Darios; Jacobsen, Steven J; Fassett, Michael J; Chen, Wansu; Demissie, Kitaw; Rhoads, George G

    2013-03-01

    OBJECTIVE To examine trends in attention-deficit/hyperactivity disorder (ADHD) by race/ethnicity, age, sex, and median household income. DESIGN An ecologic study of trends in the diagnosis of ADHD using the Kaiser Permanente Southern California (KPSC) health plan medical records. Rates of ADHD diagnosis were derived using Poisson regression analyses after adjustments for potential confounders. SETTING Kaiser Permanente Southern California, Pasadena. PARTICIPANTS All children who received care at the KPSC from January 1, 2001, through December 31, 2010 (n=842830). MAIN EXPOSURE Period of ADHD diagnosis (in years). MAIN OUTCOME MEASURES Incidence of physician-diagnosed ADHD in children aged 5 to 11 years. RESULTS Rates of ADHD diagnosis were 2.5% in 2001 and 3.1% in 2010, a relative increase of 24%. From 2001 to 2010, the rate increased among whites (4.7%-5.6%; relative risk [RR]=1.3; 95% CI, 1.2-1.4), blacks (2.6%- 4.1%; RR=1.7; 95% CI, 1.5-1.9), and Hispanics (1.7%-2.5%; RR=1.6; 95% CI, 1.5-1.7). Rates for Asian/Pacific Islander and other racial groups remained unchanged over time. The increase in ADHD diagnosis among blacks was largely driven by an increase in females (RR=1.9; 95% CI, 1.5-2.3). Although boys were more likely to be diagnosed as having ADHD than girls, results suggest the sex gap for blacks may be closing over time. Children living in high-income households were at increased risk of diagnosis. CONCLUSIONS The findings suggest that the rate of ADHD diagnosis among children in the health plan notably has increased over time. We observed disproportionately high ADHD diagnosis rates among white children and notable increases among black girls. PMID:23338799

  14. PS3-29: Impact of BMI and Change in BMI on Progression from Normotension to Prehypertension or Hypertension in Patients Ages 317

    PubMed Central

    Parker, Emily; OConnor, Patrick; Kharbanda, Elyse; Adams, Kenneth; Sinaiko, Alan; Margolis, Karen; Greenspan, Louise; Magid, David; Daley, Matthew; Sherwood, Nancy

    2013-01-01

    Background/Aims Overweight and obesity among US children and adolescents is an important public health problem. Conditions associated with obesity, such as type 2 diabetes, hypertension, and hypercholesterolemia, are becoming more common in children. This study examined the relationship between changes in BMI percentile and incident prehypertension and hypertension in a cohort of children and adolescents. Methods Study subjects were 23,578 patients, ages 317, with three or more outpatient primary care visits between 2007 and 2010 at HealthPartners Medical Group, Kaiser Permanente Colorado, or Kaiser Permanente Northern California. Data were extracted from electronic health records (EHR). Change in BMI was defined as: increase, decrease, stayed obese, stayed overweight, and stayed healthy weight using established BMI percentile cut-points. Incident prehypertension and hypertension were defined using blood pressures and diagnosis codes from the EHR. We used time-dependent Cox proportional hazards models to estimate the hazard of change in BMI percentile with incident prehypertension and hypertension. Results Over a median 2.6 years follow-up, there were 7,232 cases of incident prehypertension, 148 diagnoses of incident hypertension, and 107 additional cases of incident hypertension based on blood pressure data from the EHR. Seventy-one prehypertensives went on to develop hypertension. Those who stayed obese, stayed overweight, and increased BMI had increased hazard of incident prehypertension (1.96, 1.39, and 1.49, respectively) and increased hazard of incident hypertension (3.61, 1.21, and 1.83, respectively) compared with those who stayed healthy weight. Conclusions Persistently high BMI or increasing BMI over time was associated with pronounced increase in risk of both incident prehypertension and hypertension. Future research should examine factors associated with the development and recognition of hypertension.

  15. Regional Expansion of Minimally Invasive Surgery for Hysterectomy: Implementation and Methodology in a Large Multispecialty Group

    PubMed Central

    Andryjowicz, Esteban; Wray, Teresa

    2011-01-01

    Introduction: Approximately 600,000 hysterectomies are performed in the US each year, making hysterectomy the second most common major operation performed in women. Several methods can be used to perform this procedure. In 2009, a Cochrane Review concluded “that vaginal hysterectomy should be performed in preference to abdominal hysterectomy, where possible. Where vaginal hysterectomy is not possible, a laparoscopic approach may avoid the need for an abdominal hysterectomy. Risks and benefits of different approaches may however be influenced by the surgeon's experience. More research is needed, particularly to examine the long-term effects of the different types of surgery.” This article reviews the steps that a large multispecialty group used to teach non-open hysterectomy methods to improve the quality of care for their patients and to decrease the number of inpatient procedures and therefore costs. The percentages of each type of hysterectomy performed yearly between 2005 and 2010 were calculated, as well as the length of stay (LOS) for each method. Methods: A structured educational intervention with both didactic and hands-on exercises was created and rolled out to 12 medical centers. All patients undergoing hysterectomy for benign conditions through the Southern California Permanente Medical Group (a large multispecialty group that provides medical care to Kaiser Permanente patients in Southern California) between 2005 and 2010 were included. This amounted to 26,055 hysterectomies for benign conditions being performed by more than 350 obstetrician/gynecologists (Ob/Gyns). Results: More than 300 Ob/Gyns took the course across 12 medical centers. On the basis of hospital discharge data, the total number of hysterectomies, types of hysterectomies, and LOS for each type were identified for each year. Between 2005 and 2010, the rate of non-open hysterectomies has increased 120% (from 38% to 78%) and the average LOS has decreased 31%. PMID:22319415

  16. Differences in the Genetic Susceptibility to Age-Related Macular Degeneration Clinical Subtypes

    PubMed Central

    Shen, Ling; Hoffmann, Thomas J.; Melles, Ronald B.; Sakoda, Lori C.; Kvale, Mark N.; Banda, Yambazi; Schaefer, Catherine; Risch, Neil; Jorgenson, Eric

    2015-01-01

    Purpose We compared across age-related macular degeneration (AMD) subtypes the effect of AMD risk variants, their predictive power, and heritability. Methods The prevalence of AMD was estimated among active non-Hispanic white Kaiser Permanente Northern California members who were at least 65 years of age as of June 2013. The genetic analysis included 5,170 overall AMD cases ascertained from electronic health records (EHR), including 1,239 choroidal neovascularization (CNV) cases and 1,060 nonexudative AMD cases without CNV, and 23,130 controls of non-Hispanic white ancestry from the Kaiser Permanente Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. Imputation was based on the 1000 Genomes Project reference panel. Results The narrow-sense heritability due to common autosomal single nucleotide polymorphisms (SNPs) was 0.37 for overall AMD, 0.19 for AMD unspecified, 0.20 for nonexudative AMD, and 0.60 for CNV. For the 19 previously reported AMD risk loci, the area under the receiver operating characteristic (ROC) curve was 0.675 for overall AMD, 0.640 for AMD unspecified, 0.678 for nonexudative AMD, and 0.766 for CNV. The individual effects on the risk of AMD for 18 of the 19 SNPs were in a consistent direction with those previously reported, including a protective effect of the APOE ε4 allele. Conversely, the risk of AMD was significantly increased in carriers of the ε2 allele. Conclusions These findings provide an independent confirmation of many of the previously identified AMD risk loci, and support a potentially greater role of genetic factors in the development of CNV. The replication of established associations validates the use of EHR in genetic studies of ophthalmologic traits. PMID:26176866

  17. Oral Bisphosphonate Exposure and the Risk of Upper Gastrointestinal Cancers

    PubMed Central

    Vogtmann, Emily; Corley, Douglas A.; Almers, Lucy M.; Cardwell, Chris R.; Murray, Liam J.; Abnet, Christian C.

    2015-01-01

    The association between oral bisphosphonate use and upper gastrointestinal cancer has been controversial. Therefore, we examined the association with esophageal and gastric cancer within the Kaiser Permanente, Northern California population. A total of 1,011 cases of esophageal (squamous cell carcinoma and adenocarcinoma) and 1,923 cases of gastric adenocarcinoma (cardia, non-cardia and other) diagnosed between 1997 and 2011 from the Kaiser Permanente, Northern California cancer registry were matched to 49,886 and 93,747 controls, respectively. Oral bisphosphonate prescription fills at least one year prior to the index date were extracted. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between prospectively evaluated oral bisphosphonate use with incident esophageal and gastric cancer diagnoses with adjustment for potential confounders. After adjustment for potential confounders, no significant associations were found for esophageal squamous cell carcinoma (OR 0.88; 95% CI: 0.51, 1.52), esophageal adenocarcinoma (OR 0.68; 95% CI: 0.37, 1.24), or gastric non-cardia adenocarcinoma (OR 0.83, 95% CI: 0.59, 1.18), but we observed an adverse association with gastric cardia adenocarcinoma (OR 1.64; 95% CI: 1.07, 2.50). In conclusion, we observed no association between oral bisphosphonate use and esophageal cancer risk within a large community-based population. A significant association was detected with gastric cardia and other adenocarcinoma risk, although this needs to be replicated. PMID:26445463

  18. Transforming and Sustaining the Care Environment

    PubMed Central

    Goldfisher, Anne M.; Hounslow, Barbara; Blank, Judi

    2014-01-01

    Background: Caring Science Theory and Practices have been part of the Kaiser Permanente's Strategic Priority for Kaiser Permanente Northern Region since 2010. Their goal is to ensure the continued spread across the medical center of practices guided by the Caring Sciences framework that fosters caring-healing environments and that reinforce helping-trusting relationships between caregivers and between caregivers and patients. Methods: Gaining senior-level leader sponsorship is an essential element to integrate and sustain a program in our culture and obtain successful outcomes. The senior level leader sponsorship for HeartMath consists of Chris Boyd, senior vice-president/area manager; Sue G. Murphy, chief operating officer; Anne M. Goldfisher, chief nursing officer; and Barbara Hounslow, care experience leader. Effectively selecting the HeartMath Trainers was essential in helping ensure that the program outcomes were obtained. The four key elements determined in the trainer selection process were (1) trainers selected in contextual alignment with our strategic goals; (2) leveraged key leader/RN staff relationships in trainer selection; (3) trainers committed to advance culture of Caring Science with HeartMath; the chief nursing officer becoming a trainer, emphasizing consistent leadership support. In planning and implementing the training program, an infrastructure was set up to focus on specific units and service lines. This included developing a pull message addressing the aspects of staffing realities and the training process. As lessons were learned, adjustments were made in process to suit the culture. A plan was constructed to support the staff on the units to sustain their practice after the training. Outcomes: During a 12-month period, more than 400 nurses, leaders, and other support staff trained. The response was overwhelmingly positive. The participant perceptions at program completion are described in the Results section. Other benefits included improved relationships between nursing staff and leaders. The trainers reported being deeply impacted on both professional and personal levels. Results: Of the 400 participants trained from June 2011 to June 2012, 263 completed both the pre and post surveys. Eight of the 14 metrics showed statistically significant changes. They were work attitude, goal clarity, communication effectiveness, time pressure, intention to quit, strategic understanding, and productivity. Improvements were also noted in well-being, quality of life, impacts on patient satisfaction, safety, and reduction of absenteeism.

  19. Physician Update: Total Health

    PubMed Central

    Tuso, Phillip

    2014-01-01

    As an integrated prepaid health care system, Kaiser Permanente (KP) is in a unique position to demonstrate that affordability in health care can be achieved by disease prevention. During the past decade, KP has significantly improved the quality care outcomes of its members with preventable diseases. However, because of an increase in the incidence of preventable disease, and the potential long-term and short-term costs associated with the treatment of preventable disease, KP has developed a new strategy called Total Health to meet the current and future needs of its patients. Total Health means healthy people in healthy communities. KPs strategic vision is to be a leader in Total Health by making lives better. KP hopes to make lives better by 1) measuring vital signs of health, 2) promoting healthy behaviors, 3) monitoring disease incidence, 4) spreading leading practices, and 5) creating healthy environments with our community partners. Best practices, spread to the communities we serve, will make health care more affordable, prevent preventable diseases, and save lives. PMID:24694316

  20. Captura de satlites durante a formao de Jpiter

    NASA Astrophysics Data System (ADS)

    Winter, O. C.; Vieira Neto, E.; Yokoyama, T.

    2003-08-01

    O planeta Jupiter apresenta um grande nmero de satlites irregulares. As caractersticas das rbitas destes objetos indicam que os mesmos no teriam se formado ao redor do planeta que se encontram. As teorias existentes so de que estes objetos teriam se formado em uma regio distante do planeta e sua evoluo dinmica os teria levado a uma captura gravitacional pelo planeta. Tendo em vista que o processo de captura gravitacional sem efeitos dissipativos no produz uma captura permanente, estudamos o processo de captura durante o estgio de formao do planeta. Realizamos simulaes numricas para os casos de satlites prgrados e retrgrados que inicialmente se encontram ao redor de Jupiter com sua massa atual e ento, evoluimos a integrao voltando no tempo de modo que o planeta sofra uma reduo em sua massa (de 100% para 10% de sua massa atual) e verificamos o instante em que o satlites escapa do planeta (quando sua energia do problema de dois corpos se torna positiva). Assim, analisando o problema inverso no tempo, obtivemos em qual estgio de formao de Jupiter aquele hipottico satlite teria sido capturado. Os resultados mostram que os satlites retrgrados so capturados assim que entram na regio delimitada pela esfera de Hill do planeta, enquanto que os satlites prgrados s so capturados quando entram numa regio bem mais prxima ao planeta, uma frao da esfera de Hill.

  1. Can health care teams improve primary care practice?

    PubMed

    Grumbach, Kevin; Bodenheimer, Thomas

    2004-03-10

    In health care settings, individuals from different disciplines come together to care for patients. Although these groups of health care personnel are generally called teams, they need to earn true team status by demonstrating teamwork. Developing health care teams requires attention to 2 central questions: who is on the team and how do team members work together? This article chiefly focuses on the second question. Cohesive health care teams have 5 key characteristics: clear goals with measurable outcomes, clinical and administrative systems, division of labor, training of all team members, and effective communication. Two organizations are described that demonstrate these components: a private primary care practice in Bangor, Me, and Kaiser Permanente's Georgia region primary care sites. Research on patient care teams suggests that teams with greater cohesiveness are associated with better clinical outcome measures and higher patient satisfaction. In addition, medical settings in which physicians and nonphysician professionals work together as teams can demonstrate improved patient outcomes. A number of barriers to team formation exist, chiefly related to the challenges of human relationships and personalities. Taking small steps toward team development may improve the work environment in primary care practices. PMID:15010447

  2. Factors associated with frailty in chronically ill older adults.

    PubMed

    Hackstaff, Lynn

    2009-01-01

    An ex post facto analysis of a secondary dataset examined relationships between physical frailty, depression, and the self-perceived domains of health status and quality-of-life in older adults. The randomized sample included 992 community-dwelling, chronically ill, and functionally impaired adults age 65 and older who received care from a Southern California Kaiser Permanente medical center between 1998 and 2002. Physical frailty represents a level of physiologic vulnerability and functional loss that results in dependence on others for basic, daily living needs (Fried et al., 2001). The purpose of the study was to identify possible intervention junctures related to self-efficacy of older adults in order to help optimize their functionality. Multivariate correlation analyses showed statistically significant positive correlations between frailty level and depression (r = .18; p = < .05), number of medical conditions (r = .09; p = < .05), and self-rated quality-of-life (r = .24; p = < .05). Frailty level showed a statistically significant negative correlation with self-perceived health status (r = -.25; p = < .05). Notably, no statistically significant correlation was found between age and frailty level (r = -.03; p = < .05). In linear regression, self-perceived health status had a partial variance with frailty level (part r = -.18). The significant correlations found support further research to identify interventions to help vulnerable, older adults challenge self-perceived capabilities so that they may achieve optimum functionality through increased physical activity earlier on, and increased self-efficacy to support successful adaptation to aging-related losses. PMID:20182990

  3. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study

    PubMed Central

    Li, De-Kun; Liu, Liyan; Odouli, Roxana

    2003-01-01

    Objective To evaluate whether prenatal use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with increased risk of miscarriage. Design Population based cohort study. Prenatal use of NSAIDs, aspirin, and paracetamol (acetaminophen) ascertained by in-person interview. Setting Kaiser Permanente Medical Care Program, a healthcare delivery system, in the San Francisco area of the United States. Participants 1055 pregnant women recruited and interviewed immediately after their positive pregnancy test. Median gestational age at entry to the study was 40 days. Main outcome measures Pregnancy outcomes up to 20 weeks of gestation. Results 53 women (5%) reported prenatal NSAID use around conception or during pregnancy. After adjustment for potential confounders, prenatal NSAID use was associated with an 80% increased risk of miscarriage (adjusted hazard ratio 1.8 (95% confidence interval 1.0 to 3.2)). The association was stronger if the initial NSAID use was around the time of conception or if NSAID use lasted more than a week. Prenatal aspirin use was similarly associated with an increased risk of miscarriage. However, prenatal use of paracetamol, pharmacologically different from NSAIDs and aspirin, was not associated with increased risk of miscarriage regardless of timing and duration of use. Conclusion Prenatal use of NSAIDs and aspirin increased the risk of miscarriage. These findings need confirmation in studies designed specifically to examine the apparent association. PMID:12919986

  4. Integrated delivery systems: the cure for fragmentation.

    PubMed

    Enthoven, Alain C

    2009-12-01

    Our healthcare system is fragmented, with a misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources. Fragmentation adversely impacts quality, cost, and outcomes. Eliminating waste from unnecessary, unsafe care is crucial for improving quality and reducing costs--and making the system financially sustainable. Many believe this can be achieved through greater integration of healthcare delivery, more specifically via integrated delivery systems (IDSs). An IDS is an organized, coordinated, and collaborative network that links various healthcare providers to provide a coordinated, vertical continuum of services to a particular patient population or community. It is also accountable, both clinically and fiscally, for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve them. The marketplace already contains numerous styles and degrees of integration, ranging from Kaiser Permanente-style full integration, to more loosely organized individual practice associations, to public-private partnerships. Evidence suggests that IDSs can improve healthcare quality, improve outcomes, and reduce costs--especially for patients with complex needs--if properly implemented and coordinated. No single approach or public policy will fix the fragmented healthcare system, but IDSs represent an important step in the right direction. PMID:20088632

  5. A Comparison of Maternal Outcomes from an Alcohol, Tobacco, and Other Drug Prevention Program for Mothers Choosing an Intervention versus Being Randomized

    PubMed Central

    Byrnes, Hilary F.; Miller, Brenda A.; Laborde, Nicole

    2012-01-01

    Self-determination theory and substantial research findings suggest that more desirable outcomes may occur when participants are able to choose their prevention or treatment interventions, as having a choice may lead to greater motivation and feelings of self-efficacy. The present study examined the influence of having a choice of family-based prevention programs for youth alcohol, tobacco, and drug use on mothers’ communication outcomes. Families (N=496) were those with an 11–12 year old enrolled in Kaiser Permanente medical centers at one of four locations. Results from multivariate repeated measures analyses supported the importance of having a choice for improved communication outcomes. As compared to families who were randomly assigned to a program, those allowed to choose showed improved tobacco specific and peer pressure communication, with marginally improved alcohol communication. No differences were found between the groups for general communication. Results suggest that allowing mothers to participate in decisions about health-related interventions for their teens may lead to better outcomes. PMID:22505572

  6. Haptic medicine.

    PubMed

    Mason, Cindy; Mason, Earl

    2009-01-01

    The paper introduces haptic medicine--healthcare based on loving touch for healing and preventing disease. We describe the effects of loving touch (a square inch of our skin has over 1000 nerves) on the body, brain and mind. We describe two web-based health education and media projects. The first, HYPERLINK "http://www.21stcenturymed.org" www.21stcenturymed.org is a place for health practitioners to start learning about touch and resources. The second project, Humans Without Borders, is a multi-lingual self help education website for everyday people. Teaching materials for these projects are based on our previous work with a form of haptic medicine known as psychophysiophilosophy with patients at Stanford Hospital, Kaiser Permanente and Lucille Packard Children's Hospital. We describe psychophysiophilosophy, relate motherly love to recent discoveries in neurosciences and give hints on ways to increase motherly love in each of us. We present a plan for moving into the future by re-introducing haptic medicine into our daily lives through self-help and as an adjunct for current physician practice. There is an exercise in self-help for the reader and an appendix of recent clinical research with profound benefits on the use of human touch for over 40 conditions. PMID:19745495

  7. Long-term Health Outcomes in Survivors of Childhood Cancer Diagnosed Between 1990 and 2000 in a Large US Integrated Health Care System.

    PubMed

    Chao, Chun; Xu, Lanfang; Bell, Elizabeth; Cooper, Roberto; Mueller, Lisa

    2016-03-01

    We evaluated the long-term health outcomes of childhood cancer survivors (CCS) using data from the Kaiser Permanente Southern California (KPSC) health plan, whose members have similar health care coverage. Five-year survivors of invasive cancer diagnosed at ages 0 to 18 years between 1990 and 2000 at KPSC were identified and followed to December 31, 2010. A group of KPSC members without history of cancer were 10:1 matched to each CCS for comparison. Health outcomes of interest included mortality, second cancer, and chronic comorbidities. Incidence rate ratio (IRR) was estimated using multivariable Poisson regression. Cumulative incidence of each health condition over time was calculated. A total of 652 CCS and 6520 noncancer subjects were included. Compared with the noncancer subjects, IRR was significantly elevated among CCS for mortality (IRR=14.1), second cancer (IRR=10.0), cerebrovascular disease (IRR=10.1), dyslipidemia (IRR=1.9), hearing/vision loss (IRR=5.1), heart disease (IRR=3.9), hypogonadism (IRR=4.2), renal failure (IRR=13.4), and thyroid disorder (IRR=6.4). Approximately 40% of CCS developed at least 1 chronic health condition within 15 years of cancer diagnosis. Cumulative incidence curves showed different risk trajectories of various comorbidities which may inform screening schedule. These data suggested that CCS treated in a more contemporary era continued to experience substantial disease burden in their adolescent and young adulthood. PMID:26808371

  8. Comparison of HIV Virologic Failure Rates Between Patients with Variable Adherence to Three Antiretroviral Regimen Types.

    PubMed

    Gordon, Lindsay L; Gharibian, Derenik; Chong, Karen; Chun, Helen

    2015-07-01

    Medication adherence is a major determinant of antiretroviral (ARV) treatment success and a significant challenge for HIV-positive patients, yet a well-defined adherence threshold to maintain virologic suppression on current ARV regimens remains unclear. The present study evaluated 1915 Kaiser Permanente Southern California HIV-positive patients on one of three regimen types: (1) emtricitabine-tenofovir-efavirenz (FTC-TDF-EFV); (2) emtricitabine-tenofovir (FTC-TDF) and raltegravir (RAL); and (3) FTC-TDF and a boosted protease inhibitor, either darunavir (DRV) or atazanavir (ATV), to compare virologic failure rates between patients with varying levels of adherence to the regimens. Medication possession ratios (MPRs) were calculated to determine adherence, and HIV RNA PCR levels drawn 12-18 months after the initial pharmacy claim for the measured drug were used to determine virologic failure, which was defined as two consecutive HIV RNA PCR measurements ?200 copies/mL. Adherence was inversely related to virologic failure, with an 80-90% MPR threshold resulting in no more than 3.5% virologic failure rate. In comparison, ?90% MPR yielded no more that 1.1% virologic failure rate. Although the gold-standard adherence threshold for older ARV regimens has been 95%, an 80-90% MPR appears sufficient to maintain virologic suppression in patients treated with these three ARV regimen types. PMID:26114665

  9. Traumatismes Oculaires par Petards: Bilan sur Trois Annees

    PubMed Central

    Zouaoui-Kesraoui, N.; Derdour, A.

    2009-01-01

    Summary Les accidents dus aux ptards sont des accidents graves. Leur recrudescence ces dernires annes en Algrie, essentiellement durant les ftes du Mawlid Ennabaoui (fte de la naissance du prophte), mrite notre sens d'entreprendre des bilans exhaustifs dont celui-ci dans le but d'une sensibilisation de toutes les comptences concernes. Nous avons runi sur trois annes conscutives (2002, 2003, 2004) 60 dossiers de malades ayant subi des accidents oculaires par ptards. Nos patients sont rpartis en 42 consultations pour blessures lgres et 18 hospitalisations pour blessures graves. Parmi ces derniers, neuf ont prsent des complications et squelles graves (cinq cas de ccit par atrophie du globe oculaire, trois cas de ccit cornenne et un cas de ccit par trou maculaire). Dans tous ces cas l'incapacit permanente partielle est au minimum de 30%. Au vu de ces donnes nous proposons des mesures d'ducation sanitaire et une sensibilisation du grand public aux traumatismes oculaires, par le biais de m dias appropris: radio, tlvision, affiches. PMID:21991157

  10. A large multi-ethnic genome-wide association study of prostate cancer identifies novel risk variants and substantial ethnic differences

    PubMed Central

    Hoffmann, Thomas J.; Van Den Eeden, Stephen K.; Sakoda, Lori C.; Jorgenson, Eric; Habel, Laurel A.; Graff, Rebecca E.; Passarelli, Michael N.; Cario, Clinton L.; Emami, Nima C.; Chao, Chun R.; Ghai, Nirupa R.; Shan, Jun; Ranatunga, Dilrini K.; Quesenberry, Charles P.; Aaronson, David; Presti, Joseph; Zhaoming, Wang; Berndt, Sonja I.; Chanock, Stephen J.; McDonnell, Shannon K.; French, Amy J; Schaid, Daniel J; Thibodeau, Stephen N.; Li, Qiyuan; Freedman, Matthew L.; Penney, Kathryn L.; Mucci, Lorelei A.; Haiman, Christopher A.; Henderson, Brian E.; Seminara, Daniela; Kvale, Mark N.; Kwok, Pui-Yan; Schaefer, Catherine; Risch, Neil; Witte, John S.

    2015-01-01

    A genome-wide association study of prostate cancer in Kaiser Permanente health plan members (7,783 cases, 38,595 controls; 80.3% non-Hispanic white, 4.9% African-American, 7.0% East Asian, 7.8% Latino) revealed a new independent risk indel rs4646284 at the previously-identified locus 6q25.3 that replicated in PEGASUS (N=7,539) and MEC (N=4,679) (p=1.010?19, OR=1.18). Across the 6q25.3 locus, rs4646284 exhibited the strongest association with expression of SLC22A1 (p=1.310?23) and SLC22A3 (p=3.210?52). At the known 19q13.33 locus rs2659124 (p=1.310?13, OR=1.18) nominally replicated in PEGASUS. A risk score of 105 known risk SNPs was strongly associated with prostate cancer (p<1.010?8). Comparing the highest to lowest risk score deciles, the OR was 6.22 for non-Hispanic Whites, 5.82 for Latinos, 3.77 for African-Americans, and 3.38 for East Asians. In non-Hispanic whites, the 105 risk SNPs explained ~7.6% of disease heritability. The entire GWAS array explained ~33.4% of heritability, with a 4.3-fold enrichment within DNaseI hypersensitivity sites (p=0.004). PMID:26034056

  11. Le patrimoine astronomique provenal

    NASA Astrophysics Data System (ADS)

    Rous, M.; Figon, P.; Guyot, S.

    2012-12-01

    L'OSU OAMP/Institut Pythas porte les missions de conservation, inventaire et valorisation du patrimoine. Suite la fusion de l'Observatoire de Marseille et du Laboratoire d'Astronomie Spatiale en 2000 pour crer le Laboratoire d'Astrophysique de Marseille, le dmnagement des quipes sur le site de Chteau-Gombert en 2008 a soulev le problme du devenir des collections des deux sites d'origine. Nous ferons le bilan des actions passes en matire de conservation et de valorisation de ce riche patrimoine : versement l'inventaire gnral du Ministre de la Culture, classement de 22 instruments au titre des Monuments Historiques, inventaire et numrisation des archives anciennes, montage d'expositions et ralisation du catalogue Telescopium, 400 ans de lunettes et de tlescopes. Nous prsenterons les actions en cours: mesures de conservation prventive, inventaire des archives et des instruments. Nous parlerons enfin des projets: cration d'un espace d'exposition permanente, participation des expositions temporaires.

  12. Strategies, Programs and Projects 2008 of the Astrophysical Group "SPACE-Universidad Nacional Mayor De San Marcos, Peru" - Preparing for the IYA2009

    NASA Astrophysics Data System (ADS)

    Vera, Victor; Aguilar, M.; Huisacayna, J.

    2008-05-01

    We present a review of our efforts to introduce astronomy as scientific career in Peru, showing how our astronomy outreach programs have been one of the most important keys to reach our national astronomical scientific goals, remarking the crucial role that the celebration of the IYA2009 must play, in order to promote PhD programmes in astronomy in developing countries. We show the importance of the creation of the Seminario Permanente de Astronomía y Ciencias Espaciales (SPACE) in the Universidad Nacional Mayor de San Marcos, as an academic scientific and cultural center in Peru, to support our 26 years-old "Astronomical Fridays which are addressed to wide range of public, from schoolchildren to scientists. We also show how important was to rediscover our ancient astronomical cultural past of Incas in order to promote the construction of a Astronomical Center located near Cusco city over 4000 meters above sea level, which includes a tourist-educational observatory, a scientific optical observatory and a solar radio observatory.

  13. Risk Factors for Anal HPV Infection and Anal Precancer in HIV-Infected Men Who Have Sex With Men

    PubMed Central

    Schwartz, Lauren M.; Castle, Philip E.; Follansbee, Stephen; Borgonovo, Sylvia; Fetterman, Barbara; Tokugawa, Diane; Lorey, Thomas S.; Sahasrabuddhe, Vikrant V.; Luhn, Patricia; Gage, Julia C.; Darragh, Teresa M.; Wentzensen, Nicolas

    2013-01-01

    Background.?Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM. Methods.?Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer. Results.?Low CD4 count (<350 cells/mm3) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.2810.40 and OR, 4.24; 95% CI, 1.1615.51, respectively). History of smoking (OR, 2.71 95% CI, 1.435.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection. Conclusions.?We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression. PMID:23908478

  14. Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver

    PubMed Central

    Taylor, Diana; Desai, Sheila; Upadhyay, Ushma D.; Waldman, Jeff; Battistelli, Molly F.; Drey, Eleanor A.

    2013-01-01

    Objectives. We examined the impact on patient safety if nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) were permitted to provide aspiration abortions in California. Methods. In a prospective, observational study, we evaluated the outcomes of 11?487 early aspiration abortions completed by physicians (n?=?5812) and newly trained NPs, CNMs, and PAs (n?=?5675) from 4 Planned Parenthood affiliates and Kaiser Permanente of Northern California, by using a noninferiority design with a predetermined acceptable risk difference of 2%. All complications up to 4 weeks after the abortion were included. Results. Of the 11?487 aspiration abortions analyzed, 1.3% (n?=?152) resulted in a complication: 1.8% for NP-, CNM-, and PA-performed aspirations and 0.9% for physician-performed aspirations. The unadjusted risk difference for total complications between NPCNMPA and physician groups was 0.87 (95% confidence interval [CI]?=?0.45, 1.29) and 0.83 (95% CI?=?0.33, 1.33) in a propensity scorematched sample. Conclusions. Abortion complications were clinically equivalent between newly trained NPs, CNMs, and PAs and physicians, supporting the adoption of policies to allow these providers to perform early aspirations to expand access to abortion care. PMID:23327244

  15. Hot tub use during pregnancy and the risk of miscarriage.

    PubMed

    Li, De-Kun; Janevic, Teresa; Odouli, Roxana; Liu, Liyan

    2003-11-15

    To examine whether hot tub or whirlpool bath use during pregnancy increases the risk of miscarriage, the authors conducted a 1996-1998 population-based prospective cohort study at the Kaiser Permanente Medical Care Program in Oakland, California. Of 2729 eligible women, 1063 completed the interview. Miscarriage before 20 weeks of gestation was ascertained for all participants. Information on hot tub or whirlpool bath use was obtained during an in-person interview conducted early in the pregnancy. A Cox proportional hazards model was used to estimate the hazard ratio after adjustment for potential confounders. Compared with nonuse, use of a hot tub or whirlpool bath after conception was associated with a twofold increased risk of miscarriage (adjusted hazard ratio (aHR) = 2.0, 95% confidence interval: 1.3, 3.1). The risk seemed to increase with increasing frequency of use (aHR = 1.7 for less than once a week, aHR = 2.0 for once a week, and aHR = 2.7 for more than once a week) and with use during early gestation (aHR = 2.3 for initial use within the first 4 weeks of the last menstrual period and aHR = 1.5 for initial use after 4 weeks of the last menstrual period). Findings suggest an association between use of a hot tub or whirlpool bath during early pregnancy and the risk of miscarriage. PMID:14607798

  16. Tackling 30-Day, All-Cause Readmissions with a Patient-Centered Transitional Care Bundle.

    PubMed

    Rice, Yvonne B; Barnes, Carol Ann; Rastogi, Rahul; Hillstrom, Tami J; Steinkeler, Cara N

    2016-02-01

    In 2008, Kaiser Permanente Northwest identified the transition from hospital to home as a pivotal quality improvement opportunity and used multiple patient-centered data collection methods to identify unmet needs contributing to preventable readmissions. A transitional care bundle that crosses care settings and organizational functions was developed to meet needs expressed by patients. It comprises 5 elements: risk stratification, a specialized phone number for discharged patients, timely postdischarge follow-up, standardized patient discharge instructions and same-day discharge summaries, and pharmacist-supported medication reconciliation. The transitional care bundle has been in place for 6 years. Readmission rates decreased from 12.1% to 10.6%, Hospital Consumer Assessment of Healthcare Providers and Systems scores for the discharge instruction composite moved from below the 50(th) to above the 90(th) national percentile, average time to the first postdischarge appointment decreased from 9.7 days to 5.3 days, and error rates on the discharge medication list decreased from 57% to 21% (P<.0001 for all). The program, which continues to evolve to address sustainability challenges and organizational initiatives, suggests the potential of a multicomponent, patient-centered care bundle to address the complex, interrelated drivers of preventable readmissions. (Population Health Management 2016;19:56-62). PMID:25919315

  17. Low Socioeconomic Status is Associated with Increased Risk for Hypoglycemia in Diabetes Patients: the Diabetes Study of Northern California (DISTANCE)

    PubMed Central

    Berkowitz, Seth A.; Karter, Andrew J.; Lyles, Courtney R.; Liu, Jennifer Y.; Schillinger, Dean; Adler, Nancy E.; Moffet, Howard H.; Sarkar, Urmimala

    2014-01-01

    Background Social risk factors for hypoglycemia are not well understood. Methods Cross-sectional analysis from the DISTANCE study, a multi-language, ethnically-stratified random sample of adults in the Kaiser Permanente Northern California diabetes registry, conducted in 2005-2006 (response rate 62%). Exposures were income and educational attainment; outcome was patient report of severe hypoglycemia. To test the association, we used multivariable logistic regression to adjust for demographic and clinical factors. Results 14,357 patients were included. Reports of severe hypoglycemia were common (11%), and higher in low-income vs. high-income (16% vs. 8.8) and low-education vs. high-education (11.9% vs. 8.9%) groups. In multivariable analysis, incomes of less than $15,000 (OR 1.51 95%CI 1.19-1.91), $15,000-$24,999 (OR 1.57 95%CI 1.27-1.94), and high school or less education (OR 1.42, 95% CI 1.24-1.63) were associated with increased hypoglycemia, similar to insulin use (OR 1.44 95%CI 1.19-1.74). Conclusions Low income and educational attainment are important risk factors for hypoglycemia. PMID:24858863

  18. Engaging the Community in the Dissemination, Implementation, and Improvement of Health-Related Research.

    PubMed

    Bodison, Stefanie C; Sankar, Ibrahima; Anaya, Henry; Booker-Vaughns, Juanita; Miller, Aria; Williams, Pluscedia; Norris, Keith

    2015-12-01

    To help maximize the real-world applicability of available interventions in clinical and community healthcare practice, there has been greater emphasis over the past two decades on engaging local communities in health-related research. While there have been numerous successful community-academic partnered collaborations, there continues to be a need to articulate the common barriers experienced during the evolution of these partnerships, and to provide a roadmap for best practices that engage healthcare providers, patients, families, caregivers, community leaders, healthcare systems, public agencies and academic medical centers. To this end, this paper presents a summary of a forum discussion from the 2014 Southern California Dissemination, Implementation and Improvement (DII) Science Symposium, sponsored by the University of California Los Angeles (UCLA) Clinical Translational Science Institute (CTSI), University of Southern California (USC) CTSI, and Kaiser Permanente. During this forum, a diverse group of individuals representing multiple constituencies identified four key barriers to success in community-partnered participatory research (CPPR) and discussed consensus recommendations to enhance the development, implementation, and dissemination of community health-related research. In addition, this group identified several ways in which the over 60 NIH funded Clinical and Translational Science Institutes across the country could engage communities and researchers to advance DII science. PMID:26546337

  19. Maintenance of Certification Part IV Quality-Improvement Project for Hypertension Control: A Preliminary Retrospective Analysis

    PubMed Central

    Kolasinski, Vallerie A; Price, David W

    2015-01-01

    Context: A Maintenance of Certification Part IV project was created on the basis of an existing, multifaceted hypertension improvement program. Objective: To evaluate the impact of the Maintenance of Certification project, the effects of the improvement options on blood pressure control in hypertensive patients, and the participants’ perception of the workload related to participation in the project. Design: Nonexperimental retrospective analysis. Setting: Kaiser Permanente hospitals and medical office buildings in Northern California. Intervention: Participants used one or more options from a defined menu of strategies to attempt to increase the percentage of hypertensive patients on their patient panels who had controlled blood pressure. Main Outcome Measure: Proportion of hypertensive patients with blood pressure ≤ 139/89 mm Hg. Results: Fifty-two American Board of Family Medicine and 19 American Board of Internal Medicine certified physicians completed projects. Mean panel blood pressure control improved from 79.49% (standard deviation [SD] = 11.32) to 84.64% (SD = 7.80). The choice of improvement option was not associated with the level of improvement or with the participants’ perception of the workload related to completing the project. Conclusion: Project participants improved the care of their patients without an increased perceived burden to their practice. We found no association between the choice of improvement option and either the level of improvement or the perception of workload. PMID:25785642

  20. A Metrics Taxonomy and Reporting Strategy for Rule-Based Alerts

    PubMed Central

    Krall, Michael; Gerace, Alexander

    2015-01-01

    Context: Because institutions rely on rule-based alerts as an important component of their safety and quality strategies, they should determine whether the alerts achieve the expected benefit. Objective: To develop and to test a method of reporting outcome metrics for rule-based electronic health record alerts on a large scale. Methods: We empirically developed an action-oriented alerts taxonomy according to structure, actions, and implicit intended process outcomes using a set of 333 rule-based alerts at Kaiser Permanente Northwest. Next we developed a method for producing metrics reports for alert classes. Finally, we applied this method to alert taxa. Main Outcome Measures: Outcome measures were the successful development of a rule-based alerts taxonomy and the demonstration of its application in a reporting strategy. Results: We identified 9 major and 17 overall classes of alerts. We developed a specific metric approach for 5 of these classes, including the 3 most numerous ones in our institution, accounting for 224 (67%) of our alerts. Some alert classes do not readily lend themselves to this approach. Conclusions: We developed a taxonomy for rule-based alerts and demonstrated its application in developing outcome metrics reports on a large scale. This information allows tuning or retiring alerts and may inform the need to develop complementary or alternative approaches to address organizational imperatives. A method that assigns alerts to classes each amenable to a particular reporting strategy could reduce the difficulty of producing metrics reports. PMID:26057684

  1. Looking at Graduate Medical Education Through a Different Lens: A Health Care System's Perspective.

    PubMed

    Roemer, Beth M; Azevedo, Theresa; Blumberg, Bruce

    2015-09-01

    In the era of the accountable care organization, U.S. models of physician practice are shifting from the solo, independent practitioner to the physician who is part of a multispecialty group practice or is employed by a health care institution, and from paper-based small offices to practice settings that emphasize technology-enabled, team-based systems of care. In this light, Kaiser Permanente's (KP's) long experience as an integrated, population-based health care delivery system makes it an increasingly relevant model in which to consider how graduate medical education (GME) can best prepare physicians for 21st-century health care. KP's multiple perspectives-as a GME setting, a health care delivery system, a health research enterprise, a community benefit organization, and the nation's largest private, multispecialty group practice of physicians-provide a multifaceted opportunity to consider GME in the context of health care transformation. The authors suggest that all participants in medical education have a role to play in preparing physicians for this future. They recommend that partnerships between universities and health care delivery systems serve as a highly effective model for education; that to better serve the needs of society, medical education institutions must adopt a broad community benefit mindset; and that, when medical groups and other institutions that employ physicians take the baton from GME, they need to commit to ongoing development and lifelong learning to enable their new physicians to reach their full potential. PMID:26177528

  2. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System.

    PubMed

    Foss Durant, Anne; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California's Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes. PMID:26828076

  3. Kaiser captures spirit of games.

    PubMed

    Herreria, J

    1998-01-01

    With a multi-media campaign, Kaiser Permanente blitzed its market area by becoming a sponsor of the Nike World Masters Games. The advertising campaign promoted Kaiser as the exclusive health care sponsor. Company officials are counting on this campaign to leverage the health care institution's commitment to the community. In addition to the advertising, Kaiser searched for local athletes to represent its "play the sports for life" theme. As part of a promotion to award 200 athlete sponsorships to the Games, Kaiser's own master athletes were invited to tell their stories. Some of the members shared stories about such topics as experiencing an accident, receiving assistance from a Kaiser physician and incorporating a lifestyle of sport for rehabilitation. From the hundreds of letters received, two members and one employee were selected for the television spots. The sporting event reinforces Kaiser's philosophy of fitness-oriented lifestyles among its members. The Nike World Masters Games are the largest participatory multi-sport competition in the world, gathering together more than 25,000 men and women from more than 100 countries. PMID:10186402

  4. The health status of adults on the autism spectrum.

    PubMed

    Croen, Lisa A; Zerbo, Ousseny; Qian, Yinge; Massolo, Maria L; Rich, Steve; Sidney, Stephen; Kripke, Clarissa

    2015-10-01

    Compared to the general pediatric population, children with autism have higher rates of co-occurring medical and psychiatric illnesses, yet very little is known about the general health status of adults with autism. The objective of this study was to describe the frequency of psychiatric and medical conditions among a large, diverse, insured population of adults with autism in the United States. Participants were adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. Autism spectrum disorder cases (N = 1507) were adults with autism spectrum disorder diagnoses (International Classification of Diseases-9-Clinical Modification codes 299.0, 299.8, 299.9) recorded in medical records on at least two separate occasions. Controls (N = 15,070) were adults without any autism spectrum disorder diagnoses sampled at a 10:1 ratio and frequency matched to cases on sex and age. Adults with autism had significantly increased rates of all major psychiatric disorders including depression, anxiety, bipolar disorder, obsessive-compulsive disorder, schizophrenia, and suicide attempts. Nearly all medical conditions were significantly more common in adults with autism, including immune conditions, gastrointestinal and sleep disorders, seizure, obesity, dyslipidemia, hypertension, and diabetes. Rarer conditions, such as stroke and Parkinson's disease, were also significantly more common among adults with autism. Future research is needed to understand the social, healthcare access, and biological factors underlying these observations. PMID:25911091

  5. Population Effects of Influenza A(H1N1) Pandemic among Health Plan Members, San Diego, California, USA, October–December 2009

    PubMed Central

    2016-01-01

    Lacking population-specific data, activity of seasonal and pandemic influenza is usually tracked by counting the number of diagnoses and visits to medical facilities above a baseline. This type of data does not address the delivery of services in a specific population. To provide population-specific data, this retrospective study of patients with influenza-like illness, influenza, and pneumonia among members of a Kaiser Permanente health plan in San Diego, California, USA, during October–December 2009 was initiated. Population data included the number of outpatients accessing healthcare; the number of patients diagnosed with pneumonia; antimicrobial therapy administered; number of patients hospitalized with influenza, influenza-like illness, or pneumonia; level of care provided; and number of patients requiring specialized treatments (e.g., oxygen, ventilation, vasopressors). The rate of admissions specific to weeks and predictions of 2 epidemiologic models shows the strengths and weaknesses of those tools. Data collected in this study may improve planning for influenza pandemics. PMID:26812131

  6. Quality and Cost Evaluation of a Medical Financial Assistance Program

    PubMed Central

    Conner, Douglas A; Beck, Arne; Clarke, Christina; Wright, Leslie; Narwaney, Komal; Bermingham, Neysa W

    2013-01-01

    Background: Kaiser Permanente Colorado has been responding to the financial challenges of its members by providing a medical financial assistance (MFA) program since 1992. However, there have been no evaluations of the effect of this program on members use of health services or their health outcomes. Methods: A prospective cohort study of 308 MFA program members who were enrolled between May 16, 2008, and May 16, 2009, examined changes in their use of health services, costs, and self-reported physical and mental health after enrollment in the MFA program. Use of services was analyzed with multiple regression, and costs of services with generalized linear models. Results: MFA increased members access to health services. There were no changes in physical or mental health status. For each health care visit before the MFA award, patients used the health care system 0.23 visits less. The MFA amount was not associated with an increase or decrease in use. There was no significant difference in total overall cost. Hospital costs were lower, but costs for clinic visits, pharmacy services, phone calls, and radiology services were significantly higher, resulting in service cost neutrality, possibly because financial barriers before MFA award led to accumulated demand for services. Conclusions: Use of services decreased after MFA was received. There was no significant change in total service cost. MFA improved members ability to pay for medical services and increased their satisfaction with health services. PMID:23596366

  7. Outdoor Falls Among Middle-Aged and Older Adults: A Neglected Public Health Problem

    PubMed Central

    Li, Wenjun; Keegan, Theresa H.M.; Sternfeld, Barbara; Sidney, Stephen; Quesenberry, Charles P.; Kelsey, Jennifer L.

    2006-01-01

    Objectives. Although risk factors for indoor falls among older individuals have been well studied, little is known about the etiology of outdoor falls. We examined risk factors for outdoor falls among middle-aged and older adults. Methods. We analyzed data on the most recent fall during the past year among participants aged 45 years and older in the control group (N=2193) of a case–control study of fractures. The study was conducted at 5 Northern California Kaiser Permanente Medical Centers between 1996 and 2001. Results. Falls occurred outdoors more often than indoors among most age groups. Study participants who reported more leisure-time physical activity had a higher risk for outdoor falls, and participants who were in poorer health had a greater risk for indoor falls. Most outdoor falls (73%) were precipitated by environmental factors, such as uneven surfaces and tripping or slipping on objects, and usually occurred on sidewalks, curbs, and streets. Walking (47.3%) was the most common fall-related activity. Conclusions. Outdoor falls among adults aged 45 years and older were frequently attributable to modifiable environmental factors. With the widespread promotion of active lifestyles among older people, improvements in their outdoor environment are urgently needed. PMID:16735616

  8. Medication Exposure in Pregnancy Risk Evaluation Program

    PubMed Central

    Andrade, Susan E.; Davis, Robert L.; Cheetham, T. Craig; Cooper, William O.; Li, De-Kun; Amini, Thushi; Beaton, Sarah J.; Dublin, Sascha; Hammad, Tarek A.; Pawloski, Pamala A.; Raebel, Marsha A.; Smith, David H.; Staffa, Judy A.; Toh, Sengwee; Dashevsky, Inna; Haffenreffer, Katherine; Lane, Kimberly; Platt, Richard; Scott, Pamela E.

    2011-01-01

    To describe a program to study medication safety in pregnancy, the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). MEPREP is a multi-site collaborative research program developed to enable the conduct of studies of medication use and outcomes in pregnancy. Collaborators include the U.S. Food and Drug Administration and researchers at the HMO Research Network, Kaiser Permanente Northern and Southern California, and Vanderbilt University. Datasets have been created at each site linking healthcare data for women delivering an infant between January 1, 2001 and December 31, 2008 and infants born to these women. Standardized data files include maternal and infant characteristics, medication use, and medical care at 11 health plans within 9 states; birth certificate data were obtained from the state departments of public health. MEPREP currently involves more than 20 medication safety researchers and includes data for 1,221,156 children delivered to 933,917 mothers. Current studies include evaluations of the prevalence and patterns of use of specific medications and a validation study of data elements in the administrative and birth certificate data files. MEPREP can support multiple studies by providing information on a large, ethnically and geographically diverse population. This partnership combines clinical and research expertise and data resources to enable the evaluation of outcomes associated with medication use during pregnancy. PMID:22002179

  9. Up and comers: Lt. Cmdr. Robert J. Burg, Maura Loughlin Carley, Pete Delgado, John P. Glaser, Glen Nessel, Kevin Potter, Laura J. Redoutey, Vicki Romero, Nancy Schlichting, Paul Viviano, Greg Wozniak, Lorraine Zippiroli.

    PubMed

    Pallarito, K; Kenkel, P J; Lutz, S; Gardner, E; Taravella, S; Packer, J; Nemes, J; Greene, J; Berg, E; Wagner, M

    1991-08-12

    Modern Healthcare's 1991 Up and Comers, the fifth annual group, are scattered all over the map, from Boston to the Bay Area, from Flint, Mich., to El Paso, Texas. They work in managed care, associations and specialty hospitals; one even administers the office that cares for members of Congress. At least two are "healthcare brats" whose fathers managed hospitals. One spent time working in a salmon cannery; another was a Peace Corps volunteer in Swaziland. Despite their differences, they share many common traits. They are bright, committed and know how to motivate and involve others. Maura Loughlin Carley, an area administrator for Kaiser Permanente Foundation Health Plans, put it best when she said her goal is to "hire the best people, develop them and keep them happy." They're also committed to seeking new ways to improve healthcare delivery. As Kevin Potter said, "What keeps me humble is that there's so much that I'm learning every day." Each of these emerging leaders is making a mark on the healthcare industry. They were chosen from a field of almost 50 candidates, all 40 or younger, compiled by the editorial staff of Modern Healthcare and readers. PMID:10160762

  10. Genetic Risk Factors for Perinatal Arterial Ischemic Stroke

    PubMed Central

    Gelfand, Amy A.; Croen, Lisa A.; Torres, Anthony R.; Wu, Yvonne W.

    2012-01-01

    The cause of perinatal arterial ischemic stroke is unknown in most cases. We explored whether genetic polymorphisms modify the risk of perinatal arterial ischemic stroke. In a population-based case-control study of 19972002 births at Kaiser Permanente Northern California, we identified 13 white infants with perinatal arterial ischemic stroke. Controls included 86 randomly selected white infants. We genotyped polymorphisms in 9 genes involved in inflammation, thrombosis or lipid metabolism that have been previously linked with stroke, and compared genotype frequencies in case and control individuals. We tested the following polymorphisms: TNF-?-308, IL-6, lymphotoxin A, factor V Leiden, MTHFR 1298 and 667, prothrombin 20210, and apolipoprotein E ?2 and ?4 alleles. Patients with perinatal arterial ischemic stroke were more likely than controls to have at least one apolipoprotein E ?4 allele (54% vs. 25%, p=0.03). More patients with perinatal arterial ischemic stroke carried two ?4 alleles than did controls (15% vs. 2%, p=0.09), though this finding was not statistically significant. Proinflammatory and prothrombotic polymorphisms were not associated with perinatal arterial ischemic stroke in this small study. The apolipoprotein E polymorphism may confer genetic susceptibility for perinatal arterial ischemic stroke. Larger population-based studies are needed to confirm this finding. PMID:23290018

  11. Infections Requiring Hospitalization as Predictors of Pediatric-Onset Crohn's Disease and Ulcerative Colitis

    PubMed Central

    Abramson, Oren; Heyman, Melvin B.; Bayless, Theodore M.; Li, De-Kun; Winthrop, Kevin; Herrinton, Lisa J.

    2015-01-01

    Objectives. To assess the relationship between infections and the risk of pediatric-onset inflammatory bowel disease (IBD). Methods. We conducted a nested case-control study of 501 incident cases aged ≤17 years and 9,442 controls who were members of Kaiser Permanente Northern California for at least one consecutive year between 1996 and 2006. IBD was confirmed and the incidence date was adjudicated by pediatric gastroenterologists. Hospitalized infections were identified from the principal diagnosis code of electronic inpatient records. Medications to treat infections were identified during the hospitalization. Conditional logistic regression was used to assess the associations between hospitalized infections, medications, and Crohn's disease and ulcerative colitis. Results. In the year prior to diagnosis, both hospitalized infection of any system (OR 6.3; 95% CI 1.6–23.9) and hospitalized intestinal infection (OR 19.4; 95% CI 2.6–143.2) were associated with CD. Hospitalized infections of any system were inversely associated with UC after excluding the year prior to diagnosis (OR 0.4; 95% CI 0.2–0.9). No UC case had a hospitalized gastrointestinal infection prior to diagnosis. Conclusion. Infections appear to play opposite roles prior to the diagnosis of CD and UC. Infections may be associated with an increased risk of CD and a decreased risk of UC. PMID:26074957

  12. Generating a taxonomy for genetic conditions relevant to reproductive planning.

    PubMed

    Korngiebel, Diane M; McMullen, Carmit K; Amendola, Laura M; Berg, Jonathan S; Davis, James V; Gilmore, Marian J; Harding, Cary O; Himes, Patricia; Jarvik, Gail P; Kauffman, Tia L; Kennedy, Kathleen A; Simpson, Dana Kostiner; Leo, Michael C; Lynch, Frances L; Quigley, Denise I; Reiss, Jacob A; Richards, C Sue; Rope, Alan F; Schneider, Jennifer L; Goddard, Katrina A B; Wilfond, Benjamin S

    2016-03-01

    As genome or exome sequencing (hereafter genome-scale sequencing) becomes more integrated into standard care, carrier testing is an important possible application. Carrier testing using genome-scale sequencing can identify a large number of conditions, but choosing which conditions/genes to evaluate as well as which results to disclose can be complicated. Carrier testing generally occurs in the context of reproductive decision-making and involves patient values in a way that other types of genetic testing may not. The Kaiser Permanente Clinical Sequencing Exploratory Research program is conducting a randomized clinical trial of preconception carrier testing that allows participants to select their preferences for results from among broad descriptive categories rather than selecting individual conditions. This paper describes (1) the criteria developed by the research team, the return of results committee (RORC), and stakeholders for defining the categories; (2) the process of refining the categories based on input from patient focus groups and validation through a patient survey; and (3) how the RORC then assigned specific gene-condition pairs to taxonomy categories being piloted in the trial. The development of four categories (serious, moderate/mild, unpredictable, late onset) for sharing results allows patients to select results based on their values without separately deciding their interest in knowing their carrier status for hundreds of conditions. A fifth category, lifespan limiting, was always shared. The lessons learned may be applicable in other results disclosure situations, such as incidental findings. © 2016 Wiley Periodicals, Inc. PMID:26889673

  13. A nursing information model process for interoperability.

    PubMed

    Chow, Marilyn; Beene, Murielle; O'Brien, Ann; Greim, Patricia; Cromwell, Tim; DuLong, Donna; Bedecarr, Diane

    2015-05-01

    The ability to share nursing data across organizations and electronic health records is a key component of improving care coordination and quality outcomes. Currently, substantial organizational and technical barriers limit the ability to share and compare essential patient data that inform nursing care. Nursing leaders at Kaiser Permanente and the U.S. Department of Veterans Affairs collaborated on the development of an evidence-based information model driven by nursing practice to enable data capture, re-use, and sharing between organizations and disparate electronic health records. This article describes a framework with repeatable steps and processes to enable the semantic interoperability of relevant and contextual nursing data. Hospital-acquired pressure ulcer prevention was selected as the prototype nurse-sensitive quality measure to develop and test the model. In a Health 2.0 Developer Challenge program from the Office of the National Coordinator for Health, mobile applications implemented the model to help nurses assess the risk of hospital-acquired pressure ulcers and reduce their severity. The common information model can be applied to other nurse-sensitive measures to enable data standardization supporting patient transitions between care settings, quality reporting, and research. PMID:25656515

  14. Are HMO enrollees being attracted by a liberal maternity benefit?

    PubMed

    Hudes, J; Young, C A; Sohrab, L; Trinh, C N

    1980-06-01

    A study of recent birth patterns in the Southern California Region of the Kaiser-Permanente Medical Care Program (KPMCP) suggests that individuals may have been attracted to the Program by a liberal maternity benefit. The attraction is reflected in both the type of members joining KPMCP and the birth rate of those members. Although the KPMCP birth rate has been below that of the general population, new members in their first year of coverage delivered approximatey one third of all KPMCP births in 1977, twice the number of births that would be anticipated from an equal number of members in the plan for one year or more. The maternity copayment of up to $350 did not deter women already pregnant from joining KPMCP. Termination rates for new members who gave birth, however, were no higher than expected. The Pregnancy Disability Amendment of Title VII of the Civil Rights Act of 1964, which became effective April 29, 1979, may alter the maternity benefits offered by alternative insurance carriers. The law could impact KPMCP's enrollment and utilization of obstetric services. PMID:7401712

  15. Exploring the Feasibility of Using Electronic Health Records in the Surveillance of Fetal Alcohol Syndrome

    PubMed Central

    Hansen, Craig; Adams, Marvin; Fox, Deborah J.; O'Leary, Leslie A.; Fras, Jaime L.; Freiman, Heather; Meaney, F. John

    2015-01-01

    Background Explore the use of electronic health records (EHRs) in fetal alcohol syndrome (FAS) surveillance systems. Methods Using EHRs we identified diagnoses and anthropometric measurements related to the FAS criteria developed by the Fetal Alcohol Syndrome Surveillance Network (FASSNet) among children aged 0 to 12 years. Results There were 143,393 distinct children aged between 0 and 12 years enrolled in Kaiser Permanente, Georgia, during the study period. Based on diagnoses and anthropometric measurements, 20,101 children met at least one criterion of interest, and when grouped into combinations of different criteria there were 2285 who met GROWTH+CNS criteria, 76 children who met GROWTH+FACE criteria, 107 children who met CNS+FACE criteria, and 93 children who met GROWTH+CNS+FACE criteria. The prevalence of FAS as defined by FASSNet is 1.92 per 1000 children. We linked 17,084 (85.0%) children to their mothers in the health plan; only 3% of mothers of children in the GROWTH+CNS+ FACE group had an indication of alcohol or drugs use, but they had the highest rate of depression (39%). Conclusion Data of utility in identification of FAS are readily available in EHRs and may serve as a basis for intervention with at-risk children and in planning of future FAS surveillance programs. PMID:24591358

  16. How does an open house benefit your organization?

    PubMed

    McBride, J

    1989-01-01

    Major corporations are emphasizing the importance of evaluating marketing and public relations functions more and more these days. However, while companies do report using various evaluation tools, they do not report the findings of their evaluation studies quite so often. Furthermore, evaluations of special events like open houses are all too often limited to the subjective assessments of a few key senior managers. This article reports on an evaluation of an open house using research methods, which produce a more objective and therefore more accurate measure of the special event. Since the article is intended to be a model for others to follow, the methods used to conduct the evaluation are explained. The article describes (1) how many and who attended the open house at Kaiser Permanente's Park Sierra Medical Offices in Riverside, California (employees, current Health Plan members and prospective enrollees); (2) what the attendees' perceptions were of the event and the company organizing it; (3) whether or not they learned anything at the open house; and more. PMID:10295621

  17. Sustainable health information exchanges: the role of institutional factors

    PubMed Central

    2013-01-01

    The transfer of patient information between the domains of community and hospital influences the quality, continuity and cost of health care. To supply the need for information flow between community and hospital, computerized Health Information Exchange (HIE) systems have evolved. This paper examines the institutional forces that shape HIE development in Israel and in the United States. In Israel, the vertically integrated Clalit health services developed a different solution for HIE than was developed in the non-vertically integrated Maccabi and Meuhedet health funds. In the United States the fragmented nature of providers outside of specific networks such as parts of the Kaiser Permanente and Veterans Administration system have dictated a very different evolution of information flow between community and hospital. More broadly, we consider how institutional factors shape (and will shape) the development of HIEs in different contexts. This paper applies institutional analysis to explain the emergence of different patterns of development of HIE systems in each of the environments. The institutional analysis in this paper can be used to anticipate the future success or failure of incentives to promote digital information sharing at transition of care. PMID:23692711

  18. Developing a Network of Community Health Centers with a Common Electronic Health Record: Description of the Safety Net West Practice-based Research Network (SNW-PBRN)

    PubMed Central

    DeVoe, Jennifer E.; Gold, Rachel; Spofford, Mark; Chauvie, Susan; Muench, John; Turner, Ann; Likumahuwa, Sonja; Nelson, Christine

    2012-01-01

    In 2001, community health center (CHC) leaders in Oregon established an organization to facilitate the integration of health information technology, including a shared electronic health record (EHR), into safety net clinics. The Oregon Community Health Information Network (shortened to OCHIN as other states joined) became a CHC information technology hub, supporting a network-wide EHR with one master patient index, now linked across >40 safety net organizations serving >900,000 patients with nearly 8,000,000 distinct CHC visits. Recognizing the potential of OCHIN’s multi-clinic network and comprehensive EHR database for conducting safety net-based research, OCHIN leaders and local researchers formed the Safety Net West practice-based research network (PBRN). The Safety Net West “community-based laboratory,” based at OCHIN, is positioned to become an important resource for many studies including: evaluation of the real-time impact of health care reform on uninsured populations; development of new models of primary care delivery; dissemination and translation of interventions from other EHR-based systems (e.g., Kaiser Permanente) into the community health setting; and analyses of factors influencing disparities in health and health care access. We describe the founding of Safety Net West, its infrastructure development, current projects, and the future goals of this community-based PBRN with a common EHR. PMID:21900444

  19. Population Effects of Influenza A(H1N1) Pandemic among Health Plan Members, San Diego, California, USA, October-December 2009.

    PubMed

    Bitar, Roger A

    2016-02-01

    Lacking population-specific data, activity of seasonal and pandemic influenza is usually tracked by counting the number of diagnoses and visits to medical facilities above a baseline. This type of data does not address the delivery of services in a specific population. To provide population-specific data, this retrospective study of patients with influenza-like illness, influenza, and pneumonia among members of a Kaiser Permanente health plan in San Diego, California, USA, during October-December 2009 was initiated. Population data included the number of outpatients accessing healthcare; the number of patients diagnosed with pneumonia; antimicrobial therapy administered; number of patients hospitalized with influenza, influenza-like illness, or pneumonia; level of care provided; and number of patients requiring specialized treatments (e.g., oxygen, ventilation, vasopressors). The rate of admissions specific to weeks and predictions of 2 epidemiologic models shows the strengths and weaknesses of those tools. Data collected in this study may improve planning for influenza pandemics. PMID:26812131

  20. Malignant melanoma slide review project: Patients from non-Kaiser hospitals in the San Francisco Bay Area. Final report

    SciTech Connect

    Reynolds, P.

    1993-01-05

    This project was initiated, in response to concerns that the observed excess of malignant melanoma among employees of Lawrence Livermore National Laboratory (LLNL) might reflect the incidence of disease diagnostically different than that observed in the general population. LLNL sponsored a slide review project, inviting leading dermatopathology experts to independently evaluate pathology slides from LLNL employees diagnosed with melanoma and those from a matched sample of Bay Area melanoma patients who did not work at the LLNL. The study objectives were to: Identify all 1969--1984 newly diagnosed cases of malignant melanoma among LLNL employees resident in the San Francisco-Oakland Metropolitan Statistical Area, and diagnosed at facilities other than Kaiser Permanente; identify a comparison series of melanoma cases also diagnosed between 1969--1984 in non-Kaiser facilities, and matched as closely as possible to the LLNL case series by gender, race, age at diagnosis, year of diagnosis, and hospital of diagnosis; obtain pathology slides for the identified (LLNL) case and (non-LLNL) comparison patients for review by the LLNL-invited panel of dermatopathology experts; and to compare the pathologic characteristics of the case and comparison melanoma patients, as recorded by the dermatopathology panel.

  1. Porcelain Gallbladder: No Longer an Indication for Prophylactic Cholecystectomy.

    PubMed

    Chen, Gao L; Akmal, Yasir; DiFronzo, Andrew L; Vuong, Brooke; O'Connor, Victoria

    2015-10-01

    Porcelain gallbladder (PG) was historically associated with gallbladder cancer (GBC), (range 12-62%, largest series n = 26). Presently, cholecystectomy is still performed in many patients with PG. The objective of this study was to determine the incidence of GBC in patients with radiographic diagnosis of PG. We conducted a retrospective chart review of the Kaiser Permanente southern California electronic medical record database and identified patients with radiographic diagnosis of PG between 2008 and 2013. Extracted were patient demographics, imaging modality, symptoms, surgical and observational outcomes, and pathology results. Out of 192 PG patients, 102 underwent cholecystectomy, and 90 were observed. None of the patients in the surgery group had GBC on pathology review, and none of the observed patients developed GBC during follow-up (mean 3.5 years). In the surgery group, 82 per cent of the patients were asymptomatic with a perioperative complication rate of 10.7 per cent. Among symptomatic patients, the complication rate was 16.7 per cent. Rate of conversion to open surgery was 5 per cent. Complications led to eight endoscopic or percutaneous interventions and five additional operations. PG is not associated with increased risk of GBC but is associated with high risk of postoperative complications. Cholecystectomy should not be recommended in asymptomatic patients with PG. PMID:26463284

  2. Parental Decline of Pneumococcal Vaccination and Risk of Pneumococcal Related Disease in Children

    PubMed Central

    Glanz, Jason M.; McClure, David L.; O'Leary, Sean T.; Narwaney, Komal J.; Magid, David J.; Daley, Matthew F.; Hambidge, Simon J.

    2010-01-01

    Background An increasing number of parents are choosing to decline immunizations for their children. This study examined the association between the parental decision to decline pneumococcal conjugate (PCV7) vaccinations and the risk of hospitalization due to pneumococcal disease or lobar pneumonia in children. Methods We conducted a case-control study nested within a cohort of children enrolled in the Kaiser Permanente Colorado (KPCO) health plan between 2004 and 2009. Each child hospitalized with pneumococcal disease or lobar pneumonia (n=106) was matched to 4 randomly selected controls (n=401). Cases were matched to controls by age, sex, high-risk status, calendar time, and length of enrollment in KPCO. Disease status and parental vaccination decisions were validated with medical record review. Cases and controls were classified as vaccine decliners or vaccine acceptors. Results Among 106 cases, there were 6 (6%) PCV7 vaccine decliners; among 401 controls, there were 4 (1%) vaccine decliners. Children of parents who declined PCV7 immunization were 6.5 times (OR=6.5; 95% CI=1.7, 24.5) more likely to be hospitalized for invasive pneumococcal disease or lobar pneumonia than vaccinated children. Conclusions Parental decline of pneumococcal vaccination apparently increases the risk for hospitalization due to pneumococcal disease or lobar pneumonia in children. Providers can use this information when helping parents weigh the benefits and risks of immunizing their children. PMID:21145372

  3. Suzanne F. Delbanco on the Leapfrog Group and employer purchasing power. Interview by Pamela K. Scarrow.

    PubMed

    Delbanco, Suzanne F

    2004-01-01

    Suzanne F. Delbanco, PhD MPH, is the first executive director of The Leapfrog Group, founded by the Business Roundtable. The Leapfrog Group's goal is to mobilize employer purchasing power to initiate breakthrough improvements in the safety, quality, and overall value of healthcare for American consumers. The group's growing consortium of more than 155 Fortune 500 companies and other large private and public healthcare purchasers provides health benefits to more than 34 million Americans; these companies spend more than 62 billion dollars on healthcare annually. Dr. Delbanco is a member of the National Committee for Quality Assurance Purchaser Advisory Council and a board member of Bridges to Excellence. Before joining The Leapfrog Group, she was a senior manager at the Pacific Business Group on Health (PBGH), where she worked on the quality team. Prior to joining PBGH, she worked on reproductive health policy and the changing healthcare marketplace initiative at the Henry J. Kaiser Family Foundation. She has also consulted on health insurance coverage in the temporary employment industry and on the first statewide survey in California of MediCal beneficiaries, and worked as a community Liaison for Kaiser Permanente during the establishment of one of California's first County Organized Health Systems. She holds a PhD in public policy from the Goldman School of Public PoLicy and a MPH from the School of Public Health at the University of California, Berkeley. PMID:15468651

  4. Supplement Use and Risk of Cutaneous Squamous Cell Carcinoma

    PubMed Central

    Asgari, Maryam M.; Chren, Mary-Margaret; Warton, E. Margaret; Friedman, Gary D.; White, Emily

    2011-01-01

    BACKGROUND Laboratory and epidemiologic studies suggest that certain dietary supplements may alter risk of cutaneous squamous cell carcinoma (SCC). OBJECTIVE To examine the association between supplement use and SCC risk. METHODS Cases (n= 415) were defined as Kaiser Permanente Northern California (KPNC) members with a pathology-verified SCC in 2004 and controls (n=415) were age, gender, and race-matched members with no previous history of skin cancer. Supplement use and SCC risk factors were ascertained by questionnaire. Associations of SCC with use of multivitamins, vitamins A, C, D and E, and grape seed extract were estimated as odds ratios (OR) and 95% confidence intervals (CI) using conditional logistic regression. Models were adjusted for SCC risk factors and other supplement use. RESULTS Grape seed extract users had a significantly decreased risk of cutaneous SCC (adjusted OR = 0.26, CI: 0.08-0.89, p=0.031). Multivitamin use was associated with a borderline significant reduction in SCC risk (adjusted OR = 0.71, CI: 0.51-1.00, p= 0.049). Use of vitamins A, C, D, and E was not associated with SCC risk. LIMITATIONS The data may be prone to recall and selection bias due to the case-control design. No information was obtained on dose or duration of supplement use. CONCLUSIONS Use of grape seed extract may be associated with a decreased risk of cutaneous SCC. The other supplements included in our study did not reveal clear associations with SCC risk. PMID:21664718

  5. Autoimmune diseases prior to the diagnosis of multiple sclerosis: a population-based case-control study.

    PubMed

    Langer-Gould, A; Albers, K B; Van Den Eeden, S K; Nelson, L M

    2010-07-01

    The objective of this study was to determine whether patients with multiple sclerosis (MS) are more likely to have other autoimmune disorders particularly prior to the diagnosis of MS. We conducted a population-based case-control study of patients enrolled in the Northern California Kaiser Permanente Medical Care Program. Electronic clinical records through 2005 were used to ascertain incident and prevalent MS cases and identify the presence and timing of 44 other diagnoses. Controls were matched 5:1 for gender, age, and Kaiser membership characteristics. We identified 5296 MS cases (including 924 diagnosed between 2001 and 2004) and 26,478 matched controls. Prior to MS diagnosis, cases were more likely than controls to have uveitis (OR = 3.2, 95%; CI 1.7-5.7), inflammatory bowel disease (IBD, OR = 1.7; 95%CI 1.2-2.5), and Bell's palsy (OR = 3.2; 95%CI 1.2-8.3). Cases were also more likely to develop Guillain- Barr syndrome (GBS, OR = 5.0; 95%CI 1.6-15.4) and bullous pemphigoid (OR = 6.7; 95%CI 1.5-29.9). Cases were not more likely than controls to have or to develop rheumatoid arthritis, lupus or thyroiditis. MS may share environmental triggers, genetic susceptibilities and/or alterations in immune homeostasis with IBD and uveitis, but not with other autoimmune disorders. PMID:20463037

  6. Targeted maximum likelihood estimation in safety analysis

    PubMed Central

    Lendle, Samuel D.; Fireman, Bruce; van der Laan, Mark J.

    2013-01-01

    Objectives To compare the performance of a targeted maximum likelihood estimator (TMLE) and a collaborative TMLE (CTMLE) to other estimators in a drug safety analysis, including a regression-based estimator, propensity score (PS)based estimators, and an alternate doubly robust (DR) estimator in a real example and simulations. Study Design and Setting The real data set is a subset of observational data from Kaiser Permanente Northern California formatted for use in active drug safety surveillance. Both the real and simulated data sets include potential confounders, a treatment variable indicating use of one of two antidiabetic treatments and an outcome variable indicating occurrence of an acute myocardial infarction (AMI). Results In the real data example, there is no difference in AMI rates between treatments. In simulations, the double robustness property is demonstrated: DR estimators are consistent if either the initial outcome regression or PS estimator is consistent, whereas other estimators are inconsistent if the initial estimator is not consistent. In simulations with near-positivity violations, CTMLE performs well relative to other estimators by adaptively estimating the PS. Conclusion Each of the DR estimators was consistent, and TMLE and CTMLE had the smallest mean squared error in simulations. PMID:23849159

  7. Oral Contraceptive Use and the ECG: Evidence of an Adverse QT Effect on Corrected QT Interval

    PubMed Central

    Sedlak, Tara; Shufelt, Chrisandra; Iribarren, Carlos; Lyon, Liisa L; Merz, C. Noel Bairey

    2013-01-01

    Background A prolonged corrected QT (QTc) interval is a marker for an increased risk of sudden cardiac death. We evaluated the relationship between oral contraceptive (OC) use, type of OC, and QTc interval. Methods We identified 410,782 ECGs performed at Northern California Kaiser Permanente on female patients between 15–53 years from January, 1995 to June, 2008. QT was corrected for heart rate using log-linear regression. OC generation (first, second and third) was classified by increasing progestin androgenic potency, while the fourth generation was classified as anti-androgenic. Results Among 410,782 women, 8.4% were on OC. In multivariate analysis after correction for comorbidities, there was an independent shortening effect of OCs overall (slope = −0.5ms; SE = 0.12, p<0.0002). Users of first and second generation progestins had a significantly shorter QTc than non-users (p<0.0001), while users of fourth generation had a significantly longer QTc than non-users (slope = 3.6ms, SE = 0.35, p<0.0001). Conclusion Overall, OC use has a shortening effect on the QTc. Shorter QTc is seen with first and second generation OC while fourth generation OC use has a lengthening effect on the QTc. Careful examination of adverse event rates in fourth generation OC users is needed. PMID:23879279

  8. Ten strategies to lower costs, improve quality, and engage patients: the view from leading health system CEOs.

    PubMed

    Cosgrove, Delos M; Fisher, Michael; Gabow, Patricia; Gottlieb, Gary; Halvorson, George C; James, Brent C; Kaplan, Gary S; Perlin, Jonathan B; Petzel, Robert; Steele, Glenn D; Toussaint, John S

    2013-02-01

    Patient-centeredness--the idea that care should be designed around patients' needs, preferences, circumstances, and well-being--is a central tenet of health care delivery. For CEOs of health care organizations, patient-centered care is also quickly becoming a business imperative, with payments tied to performance on measures of patient satisfaction and engagement. In A CEO Checklist for High-Value Health Care, we, as executives of eleven leading health care delivery institutions, outlined ten key strategies for reducing costs and waste while improving outcomes. In this article we describe how implementation of these strategies benefits both health care organizations and patients. For example, Kaiser Permanente's Healthy Bones Program resulted in a 30 percent reduction in hip fracture rates for at-risk patients. And at Virginia Mason Health System in Seattle, nurses reorganized care patterns and increased the time they spent on direct patient care to 90 percent. Our experiences show that patient-engaged care can be delivered in ways that simultaneously improve quality and reduce costs. PMID:23381525

  9. Etude par resistivite electrique du comportement d'un alliage amorphe Fe 40Ni 38Mo 4B 18 deforme par traction

    NASA Astrophysics Data System (ADS)

    Hoang, Long Phan; Sacovy, Paulette; Delaplace, Jean

    1983-02-01

    Des rubans d'alliages amorphes Metglas du type Fe 40Ni 38Mo 4B 18 à l'état brut de trempe ont été déformés par traction à la température ambiante et l'on a suivi les variations de la résistance électrique des échantillons au cours de la déformation. Il ressort de ces essais que la déformation plastique qui est de l'ordre de 0.5% avant rupture ne se produit pas de faĉon homogène dans l'échantillon. Les mesures électriques effectuées au cours de la déformation mettent en évidence dans le domaine élastique un effet d'élastorésistance, relativement important ( K ≠ 1); elles montrent que dans le domaine plastique la déformation permanente des échantillons s'accompagne d'une diminution de la résistivité électrique du matériau. Deux hypothèses sont discutées pour expliquer cet effet inattendu, l'un qui fait appel à l'existence de volumes libres, l'autre qui suppose une cristallisation localisée du matériau sous l'effet de la contrainte.

  10. Pregnancy after Treatment for Cervical Cancer Precursor Lesions in a Retrospective Matched Cohort

    PubMed Central

    Naleway, Allison L.; Weinmann, Sheila; Krishnarajah, Girishanthy; Arondekar, Bhakti; Fernandez, Jovelle; Swamy, Geeta; Myers, Evan

    2015-01-01

    Objective To determine whether treatments for precancerous cervical lesions were associated with lower pregnancy rates compared to rates in unexposed women and women who had a diagnostic cervical biopsy or colposcopy. Design Matched, retrospective cohort study. Setting Kaiser Permanente Northwest (KPNW), an integrated healthcare delivery system in Oregon and Washington. Patients Women 14 to 53 years old with KPNW enrollment during the period 1998 through 2009. Main Outcome Measure Pregnancy after exposure or index date. Pregnancy was defined using a validated algorithm and electronic medical records data. Results We observed 570 pregnancies following cervical treatment in 4,137 women, 1,533 pregnancies following a diagnostic procedure in 13,767 women, and 7,436 pregnancies in a frequency-matched sample of 81,435 women unexposed to treatment or diagnostic procedures. After adjusting for age and contraceptive use, we observed a higher rate of pregnancies in the treatment group compared to unexposed women (hazard ratio (HR) = 1.42, 95% confidence interval (CI): 1.301.55), but no difference in pregnancy rates between the treatment and diagnostic procedure groups (HR = 1.03, 95% CI: 0.931.13). Conclusions No adverse effects of cervical procedures on subsequent rates of pregnancy were observed in this cohort with up to twelve years of follow-up time. PMID:25671561

  11. Clinicians use of automated reports of estimated glomerular filtration rate: A qualitative study

    PubMed Central

    2012-01-01

    Background There is a growing awareness in primary care of the importance of identifying patients with chronic kidney disease (CKD) so that they can receive appropriate clinical care; one method that has been widely embraced is the use of automated reporting of estimated glomerular filtration rate (eGFR) by clinical laboratories. We undertook a qualitative study to examine how clinicians use eGFR in clinical decision making, patient communication issues, barriers to use of eGFR, and suggestions to improve the clinical usefulness of eGFR reports. Methods Our study used qualitative methods with structured interviews among primary care clinicians including both physicians and allied health providers, recruited from Kaiser Permanente Northwest, a non-profit health maintenance organization. Results We found that clinicians generally held favorable views toward eGFR reporting but did not use eGFR to replace serum creatinine in their clinical decision-making. Clinicians used eGFR as a tool to help identify CKD, educate patients about their kidney function and make treatment decisions. Barriers noted by several clinicians included a desire for greater education regarding care for patients with CKD and tools to facilitate discussion of eGFR findings with patients. Conclusions The manner in which clinicians use eGFRs appears to be more complex than previously understood, and our study illustrates some of the efforts that might be usefully undertaken (e.g. specific clinician education) when encouraging further promulgation of eGFR reporting and usage. PMID:23173944

  12. 25. Photographic copy of photograph (Source: Department of Interior. Bureau ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    25. Photographic copy of photograph (Source: Department of Interior. Bureau of Reclamation. Bitter Root Project History 1931-1962. National Archives, Denver, RG 115, Accession #115-90-039, Box 243. Location of original photo unknown.) View of original construction of Como Dam during 1908 to 1910 - Bitter Root Irrigation Project, Como Dam, West of U.S. Highway 93, Darby, Ravalli County, MT

  13. Asociación de XMRV con enfermedades humanas se debe a contaminación

    Cancer.gov

    Nuevas investigaciones muestran que una asociación, mencionada en numerosos estudios, entre el retrovirus conocido como XMRV y el cáncer de próstata así como el síndrome de fatiga crónica, se debe a contaminación de laboratorio con un virus que se originó en ratones.

  14. Aflatoxinas

    Cancer.gov

    Las aflatoxinas son un tipo de toxinas producidas por ciertos hongos en cultivos agrícolas como el maíz, los cacahuates o el maní, la semilla de algodón y los frutos secos (de cáscara dura como las nueces).

  15. Delirio (PDQ)—Versión para profesionales de salud

    Cancer.gov

    Resumen de información revisada por expertos acerca del delirio como una complicación a causa del cáncer o su tratamiento. Se discuten los enfoques de los cuidados médicos de apoyo, asi como farmacológicos para el manejo del delirio.

  16. Helenistic Encomium: A Reflection on Comics and Rhetoric

    ERIC Educational Resources Information Center

    Helms, Jason

    2009-01-01

    This video reflection starts in a presentation on comics at the Thomas R. Watson Conference last October, which prompted the author to explore the etymology of cosmos and comos through an alternate reading of Gorgias' "Encomium of Helen". The author then works with comos, as revelry, to offer thoughts on comics as a form of multimodal composition…

  17. Helenistic Encomium: A Reflection on Comics and Rhetoric

    ERIC Educational Resources Information Center

    Helms, Jason

    2009-01-01

    This video reflection starts in a presentation on comics at the Thomas R. Watson Conference last October, which prompted the author to explore the etymology of cosmos and comos through an alternate reading of Gorgias' "Encomium of Helen". The author then works with comos, as revelry, to offer thoughts on comics as a form of multimodal composition

  18. Resultados del Estudio Nacional de Colografía de Tomografía

    Cancer.gov

    Estudios anteriores encontraron que la colografía de tomografía computarizada, también conocida como colonoscopia virtual, era prometedora como método de examen selectivo de detección de cáncer colorrectal debido

  19. Mltiples estados de desorden en el etanol slido

    NASA Astrophysics Data System (ADS)

    Fernndez-Perea, R.

    El diagrama de fases del etanol por debajo de los 169 K ser presentado. Se mostrar que el etanol puede solidificarse en tres fases con diversos niveles de desorden,(como un vidrio(G), como un vidrio orientacional (OG) y como un cristal de fase rotora (RP)) adems de en una fase totalmente cristalina. Las estructuras de estas tres fases sern presentadas tal y como se deducen a partir de diversas medidas de difraccin de neutrones al igual que las proporciones de los ismeros de dicho material en las fases desordenadas y se compararn con los resultados de la fase cristalina y del lquido superenfriado. Igualmente diversas medidas sobre su dinmica sern presentadas, tanto de dispersin de neutrones, como de capacidad calorfica y de medidas dielctricas y comparadas con modelos tericos y simulaciones para tratar de explicar los procesos de relajacin observados y las transiciones entre las diversas fases.

  20. The Impact on Emergency Department Visits for Respiratory Illness During the Southern California Wildfires

    PubMed Central

    Dohrenwend, Paul B.; Le, Minh V.; Bush, Jeff A.; Thomas, Cyril F.

    2013-01-01

    Introduction: In 2007 wildfires ravaged Southern California resulting in the largest evacuation due to a wildfire in American history. We report how these wildfires affected emergency department (ED) visits for respiratory illness. Methods: We extracted data from a Kaiser Permanente database for a single metropolitan community ED. We compared the number of visits due to respiratory illness at time intervals of 2 weeks before and during the time when the fires were burning. We counted the total number of patients with chief complaint of dyspnea, cough, and asthma and final international classification of disease 9 coding diagnosis of asthma, bronchitis, chronic obstructive pulmonary disease and respiratory syndrome, and analyzed data for both total number and proportion of ED visits. We evaluated the data using Early Aberration Reporting System software to determine significant single-visit increases compared to expected counts. We also analyzed the average length of ED stay. Data on air quality were extracted from the http://www.airnow.gov site. Results: There were significant differences between pre-fire and fire period average visit counts for the chief complaints of dyspnea and asthma. Dypnea complaints increased by 3.2 visits per day. During the fire the diagnoses of asthma increased significantly by 2.6 patients per day. Air quality reached air quality index values of 300, indicating very unhealthy conditions. Average ED length of stay times remained unchanged during the fire period compared to the pre-fire period. Conclusion: The 2007 Southern California wildfires caused significant surges in the volume of ED patients seeking treatment for respiratory illness. Disaster plans should prepare for these surges when future wildfires occur. PMID:23599837

  1. Improved Blood Pressure Control Associated With a Large-Scale Hypertension Program

    PubMed Central

    Jaffe, Marc G.; Lee, Grace A.; Young, Joseph D.; Sidney, Stephen; Go, Alan S.

    2014-01-01

    Importance Hypertension control for large populations remains a major challenge. Objective To describe a large-scale hypertension program in northern California and to compare rates of hypertension control of the program to statewide and national estimates. Design, Setting, and Patients The Kaiser Permanente Northern California (KPNC) Hypertension program included a multi-faceted approach to blood pressure control. Patients identified with hypertension within an integrated health care delivery system in northern California from 20012009 were included. The comparison group included insured patients in California between 20062009 who were included in the Healthcare Effectiveness Data and Information Set (HEDIS) commercial measurement by California health insurance plans participating in the National Committee for Quality Assurance (NQCA) quality measure reporting process. A secondary comparison group was the reported national mean NCQA HEDIS commercial rates of hypertension control from 20012009 from health plans that participated in the NQCA HEDIS quality measure reporting process. Main Outcome Measure Hypertension control as defined by NCQA HEDIS. Results The KPNC hypertension registry established in 2001 included 349,937 patients and grew to 652,763 by 2009. The NCQA HEDIS commercial measurement for hypertension control increased from 44% to 80% during the study period. In contrast, the national mean NCQA HEDIS commercial measurement increased modestly from 55.4% to 64.1%. California mean NCQA HEDIS commercial rates of hypertension were similar to those reported nationally from 20062009. (63.4% to 69.4%). Conclusion and Relevance Among adults diagnosed with hypertension, implementation of a large-scale hypertension program was associated with a significant increase in hypertension control compared with state and national control rates. PMID:23989679

  2. Preoperative Safety Briefing Project

    PubMed Central

    DeFontes, James; Surbida, Stephanie

    2004-01-01

    Context: Increased media attention on surgical procedures that were performed on the wrong anatomic site or wrong patient has prompted the health care industry to identify and address human factors that lead to medical errors. Objective: To increase patient safety in the perioperative setting, our objective was to create a climate of improved communication, collaboration, team-work, and situational awareness while the surgical team reviewed pertinent information about the patient and the pending procedure. Methods: A team of doctors, nurses, and technicians used human factors principles to develop the Preoperative Safety Briefing for use by surgical teams, a briefing similar to the preflight checklist used by the airline industry. A six-month pilot of the briefing began in the Kaiser Permanente (KP) Anaheim Medical Center in February 2002. Four indicators of safety culture were used to measure success of the pilot: occurrence of wrong-site/wrong procedures, attitudinal survey data, near-miss reports, and nursing personnel turnover data. Results: Wrong-site surgeries decreased from 3 to 0 (300%) per year; employee satisfaction increased 19%; nursing personnel turnover decreased 16%; and perception of the safety climate in the operating room improved from good to outstanding. Operating suite personnel perception of teamwork quality improved substantially. Operating suite personnel perception of patient safety as a priority, of personnel communication, of their taking responsibility for patient safety, of nurse input being well received, of overall morale, and of medical errors being handled appropriately also improved substantially. Conclusions: Team members who work together and communicate well can quickly detect and more easily avoid errors. The Preoperative Safety Briefing is now standard in many operating suites in the KP Orange County Service Area. The concepts and design of this project are transferable, and similar projects are underway in the Departments of Radiology and of Labor and Delivery at KP Anaheim Medical Center. PMID:26704913

  3. Design thinking.

    PubMed

    Brown, Tim

    2008-06-01

    In the past, design has most often occurred fairly far downstream in the development process and has focused on making new products aesthetically attractive or enhancing brand perception through smart, evocative advertising. Today, as innovation's terrain expands to encompass human-centered processes and services as well as products, companies are asking designers to create ideas rather than to simply dress them up. Brown, the CEO and president of the innovation and design firm IDEO, is a leading proponent of design thinking--a method of meeting people's needs and desires in a technologically feasible and strategically viable way. In this article he offers several intriguing examples of the discipline at work. One involves a collaboration between frontline employees from health care provider Kaiser Permanente and Brown's firm to reengineer nursing-staff shift changes at four Kaiser hospitals. Close observation of actual shift changes, combined with brainstorming and rapid prototyping, produced new procedures and software that radically streamlined information exchange between shifts. The result was more time for nursing, better-informed patient care, and a happier nursing staff. Another involves the Japanese bicycle components manufacturer Shimano, which worked with IDEO to learn why 90% of American adults don't ride bikes. The interdisciplinary project team discovered that intimidating retail experiences, the complexity and cost of sophisticated bikes, and the danger of cycling on heavily trafficked roads had overshadowed people's happy memories of childhood biking. So the team created a brand concept--"Coasting"--to describe a whole new category of biking and developed new in-store retailing strategies, a public relations campaign to identify safe places to cycle, and a reference design to inspire designers at the companies that went on to manufacture Coasting bikes. PMID:18605031

  4. MicroRNA profiles in colorectal carcinomas, adenomas and normal colonic mucosa: variations in miRNA expression and disease progression.

    PubMed

    Slattery, Martha L; Herrick, Jennifer S; Pellatt, Daniel F; Stevens, John R; Mullany, Lila E; Wolff, Erica; Hoffman, Michael D; Samowitz, Wade S; Wolff, Roger K

    2016-03-01

    MiRNAs are small, non-protein-coding RNA molecules that regulate gene expression either by post-transcriptionally suppressing mRNA translation or by mRNA degradation. We examine differentially expressed miRNAs in colorectal carcinomas, adenomas and normal colonic mucosa. Data come from population-based studies of colorectal cancer conducted in Utah and the Kaiser Permanente Medical Care Program. A total of 1893 carcinoma/normal-paired samples and 290 adenoma tissue samples were run on the Agilent Human miRNA Microarray V19.0 which contained 2006 miRNAs. We tested for significant differences in miRNA expression between paired carcinoma/adenoma/normal colonic tissue samples. Fewer than 600 miRNAs were expressed in >80% of people for colonic tissue; of these 86.5% were statistically differentially expressed between carcinoma and normal colonic mucosa using a false discovery rate of 0.05. Roughly half of these differentially expressed miRNAs showed a progression in levels of expression from normal to adenoma to carcinoma tissue. Other miRNAs appeared to be altered at the normal to adenoma stage, while others were only altered at the adenoma to carcinoma stage or only at the normal to carcinoma stage. Evaluation of the Agilent platform showed a high degree of repeatability (r = 0.98) and reasonable agreement with the NanoString platform. Our data suggest that miRNAs are highly dysregulated in colorectal tissue among individuals with colorectal cancer; the pattern of disruption varies by miRNA as tissue progresses from normal to adenoma to carcinoma. PMID:26740022

  5. Elevated BP after AKI.

    PubMed

    Hsu, Chi-Yuan; Hsu, Raymond K; Yang, Jingrong; Ordonez, Juan D; Zheng, Sijie; Go, Alan S

    2016-03-01

    The connection between AKI and BP elevation is unclear. We conducted a retrospective cohort study to evaluate whether AKI in the hospital is independently associated with BP elevation during the first 2 years after discharge among previously normotensive adults. We studied adult members of Kaiser Permanente Northern California, a large integrated health care delivery system, who were hospitalized between 2008 and 2011, had available preadmission serum creatinine and BP measures, and were not known to be hypertensive or have BP>140/90 mmHg. Among 43,611 eligible patients, 2451 experienced AKI defined using observed changes in serum creatinine concentration measured during hospitalization. Survivors of AKI were more likely than those without AKI to have elevated BP-defined as documented BP>140/90 mmHg measured during an ambulatory, nonemergency department visit-during follow-up (46.1% versus 41.2% at 730 days; P<0.001). This difference was evident within the first 180 days (30.6% versus 23.1%; P<0.001). In multivariable models, AKI was independently associated with a 22% (95% confidence interval, 12% to 33%) increase in the odds of developing elevated BP during follow-up, with higher adjusted odds with more severe AKI. Results were similar in sensitivity analyses when elevated BP was defined as having at least two BP readings of >140/90 mmHg or those with evidence of CKD were excluded. We conclude that AKI is an independent risk factor for subsequent development of elevated BP. Preventing AKI during a hospitalization may have clinical and public health benefits beyond the immediate hospitalization. PMID:26134154

  6. Does Consuming Sugar and Artificial Sweeteners Change Taste Preferences?

    PubMed Central

    Bartolotto, Carole

    2015-01-01

    Americans consume a lot of sugar, primarily from sweeteners that are added to processed foods and beverages. Data from the US Department of Agriculture reveals that in 2013, Americans consumed 22.3 teaspoons of added caloric sweeteners a day, which is significantly more than the American Heart Association’s recommendation. Artificial and alternative sweeteners have also been added to a plethora of foods. These sweeteners range from about 180 times sweeter to as much as 13,000 times sweeter than sugar. Consumption of both sugar and artificial sweeteners may be changing our palates or taste preferences over time, increasing our desire for sweet foods. Unfortunately, the data on this are lacking. In the summer of 2014, a group of 20 people from Kaiser Permanente facilities throughout California agreed to cut out all added sugars and artificial sweeteners for 2 weeks and then complete a survey to determine whether their taste preferences had changed. After the 2-week challenge, 95% of participants (18 out of 19 respondents) found that sweet foods and drinks tasted sweeter or too sweet, 75% (15 out of 20 respondents) found that other foods tasted sweeter, and 95% (19 out of 20 respondents) said moving forward they would use less or even no sugar. Additionally, 86.6% of participants (13 out of 15 respondents) stopped craving sugar after 6 days. Although this was a small survey, the results suggest that using a 2-week sugar challenge can help to reset taste preferences and make consuming less or no sugar easier. Physicians should consider recommending a sugar and artificial sweetener challenge to all their patients, especially those with obesity, diabetes, or cardiovascular disease. PMID:26176574

  7. Comparative Effectiveness of Etanercept and Adalimumab in Patient Reported Outcomes and Injection-Related Tolerability

    PubMed Central

    Navarro-Millán, Iris; Herrinton, Lisa J.; Chen, Lang; Harrold, Leslie; Liu, Liyan; Curtis, Jeffrey R.

    2016-01-01

    Objective To describe patient preferences in selecting specific biologics and compare clinical response using patient reported outcomes (PROs) among patients with rheumatoid arthritis (RA) started on different anti-tumor necrosis factor (TNF) therapies. Methods Participants were enrollees in Kaiser Permanente Northern California. Patients with RA who had at least two provider visits and started a new anti-TNF therapy from 10/2010–8/2011, were eligible for participation in this longitudinal study. Using a telephone survey, patient preferences in biologic selection and RAPID3, MDHAQ, and SF-12 scores were collected at baseline and at 6 months. Patient scores rating injection/infusion-site burning and stinging (ISBS) were collected at 6 months. Results In all, 267 patients with RA responded to the baseline survey, of whom 57% preferred an injectable biologic, 22% preferred an infused biologic, and 21% had no preference. Motivation for injectable biologics was convenience (92%) and for infusion therapy was dislike or lack of self-efficacy for self-injection (16%). After 6 months of treatment with anti-TNF, 70% of the 177 patients who answered the ISBS question reported ISBS with the last dose; on a scale of 1 (none) to 10 (worst), 41% of these reported a score of 2–5; and 29% reported a score of 6–10. Adalimumab users experienced 3.2 times (95% confidence interval 1.2–8.6) the level of ISBS that etanercept users experienced. There were no significant differences in RAPID3, MDHAQ, or SF-12 scores between etanercept or adalimumab initiators. Conclusion Convenience and fear of self-injection were important considerations to patients selecting a biologic drug. Although more convenient, adalimumab associated with more ISBS than did etanercept, and this rate was higher than reported in clinical trials. At 6 months, PROs did not differ between etanercept and adalimumab users. PMID:27007811

  8. Toward a Trustworthy Voice: Increasing the Effectiveness of Automated Outreach Calls to Promote Colorectal Cancer Screening among African Americans

    PubMed Central

    Albright, Karen; Richardson, Terri; Kempe, Karin L; Wallace, Kristin

    2014-01-01

    Introduction: Colorectal cancer screening rates are lower among African-American members of Kaiser Permanente Colorado (KPCO) than among members of other races and ethnicities. This study evaluated use of a linguistically congruent voice in interactive voice response outreach calls about colorectal cancer screening as a strategy to increase call completion and response. Methods: After an initial discussion group to assess cultural acceptability of the project, 6 focus groups were conducted with 33 KPCO African-American members. Participants heard and discussed recordings of 5 female voices reading the same segment of the standard-practice colorectal cancer message using interactive voice response. The linguistic palette included the voices of a white woman, a lightly accented Latina, and 3 African-American women. Results: Participants strongly preferred the African-American voices, particularly two voices. Participants considered these voices the most trustworthy and reported that they would be the most effective at increasing motivation to complete an automated call. Participants supported the use of African-American voices when designing outgoing automated calls for African Americans because the sense of familiarity engendered trust among listeners. Participants also indicated that effective automated messages should provide immediate clarity of purpose; explain why the issue is relevant to African Americans; avoid sounding scripted; emphasize that the call is for the listeners benefit only; sound personable, warm, and positive; and not create fear among listeners. Discussion: Establishing linguistic congruence between African Americans and the voices used in automated calls designed to reach them may increase the effectiveness of outreach efforts. PMID:24867548

  9. Genotyping Informatics and Quality Control for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort.

    PubMed

    Kvale, Mark N; Hesselson, Stephanie; Hoffmann, Thomas J; Cao, Yang; Chan, David; Connell, Sheryl; Croen, Lisa A; Dispensa, Brad P; Eshragh, Jasmin; Finn, Andrea; Gollub, Jeremy; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H; Lao, Richard; Lu, Yontao; Ludwig, Dana; Mathauda, Gurpreet K; McGuire, William B; Mei, Gangwu; Miles, Sunita; Mittman, Michael; Patil, Mohini; Quesenberry, Charles P; Ranatunga, Dilrini; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C; Shapero, Michael; Shen, Ling; Shenoy, Tanu; Smethurst, David; Somkin, Carol P; Van Den Eeden, Stephen K; Walter, Lawrence; Wan, Eunice; Webster, Teresa; Whitmer, Rachel A; Wong, Simon; Zau, Chia; Zhan, Yiping; Schaefer, Catherine; Kwok, Pui-Yan; Risch, Neil

    2015-08-01

    The Kaiser Permanente (KP) Research Program on Genes, Environment and Health (RPGEH), in collaboration with the University of California-San Francisco, undertook genome-wide genotyping of >100,000 subjects that constitute the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. The project, which generated >70 billion genotypes, represents the first large-scale use of the Affymetrix Axiom Genotyping Solution. Because genotyping took place over a short 14-month period, creating a near-real-time analysis pipeline for experimental assay quality control and final optimized analyses was critical. Because of the multi-ethnic nature of the cohort, four different ethnic-specific arrays were employed to enhance genome-wide coverage. All assays were performed on DNA extracted from saliva samples. To improve sample call rates and significantly increase genotype concordance, we partitioned the cohort into disjoint packages of plates with similar assay contexts. Using strict QC criteria, the overall genotyping success rate was 103,067 of 109,837 samples assayed (93.8%), with a range of 92.1-95.4% for the four different arrays. Similarly, the SNP genotyping success rate ranged from 98.1 to 99.4% across the four arrays, the variation depending mostly on how many SNPs were included as single copy vs. double copy on a particular array. The high quality and large scale of genotype data created on this cohort, in conjunction with comprehensive longitudinal data from the KP electronic health records of participants, will enable a broad range of highly powered genome-wide association studies on a diversity of traits and conditions. PMID:26092718

  10. Longitudinal Study of New and Prevalent Use of Self-Monitoring of Blood Glucose

    PubMed Central

    Karter, Andrew J.; Parker, Melissa M.; Moffet, Howard H.; Spence, Michele M.; Chan, James; Ettner, Susan L.; Selby, Joe V.

    2008-01-01

    OBJECTIVE We sought to assess longitudinal association between self-monitoring of blood glucose (SMBG) and glycemic control in diabetic patients from an integrated health plan (Kaiser Permanente Northern California). RESEARCH DESIGN AND METHODS Longitudinal analyses of glycemic control among 1) 16,091 patients initiating SMBG (new-user cohort) and 2) 15,347 ongoing users of SMBG (prevalent-user cohort). SMBG frequency was based on pharmacy use (number of blood glucose test strips dispensed), and glycemic control was based on HbA1c (A1C). In the new-user cohort, ANCOVA models (pre- and posttest design) were used to assess the effect of initiating SMBG. In the prevalent-user cohort, repeated-measure, mixed-effects models with random-intercept and time-dependent covariates were used to assess changes in SMBG and A1C. All models were stratified by therapy (no medications, oral agents only, or insulin) and adjusted for baseline A1C, sociodemographics, insulin injection frequency, comorbidity index, medication adherence, smoking status, health care use, and provider specialty. RESULTS Greater SMBG practice frequency among new users was associated with a graded decrease in A1C (relative to nonusers) regardless of diabetes therapy (P < 0.0001). Changes in SMBG frequency among prevalent users were associated with an inverse graded change in A1C only among pharmacologically treated patients (P < 0.0001). CONCLUSIONS These observational findings are consistent with short-term benefits of initiating SMBG practice for all patients but continuing benefits only for pharmacologically treated patients. Differences in effectiveness between new versus prevalent users of SMBG have implications for guideline development and interpretation of observational outcomes data. PMID:16873776

  11. Analyzing historical trends in breast cancer biomarker expression: a feasibility study (1947–2009)

    PubMed Central

    Krieger, Nancy; Habel, Laurel A; Waterman, Pamela D; Shabani, Melina; Ellison-Loschmann, Lis; Achacoso, Ninah S; Acton, Luana; Schnitt, Stuart J

    2016-01-01

    BACKGROUND/OBJECTIVES Determining long-term trends in tumor biomarker expression is essential for understanding aspects of tumor biology amenable to change. Limiting the availability of such data, currently used assays for biomarkers are relatively new. For example, assays for the estrogen receptor (ER), which are the oldest, extend back only to the 1970s. METHODS To extend scant knowledge about the feasibility of obtaining long-term data on tumor biomarkers, we randomly selected 60 breast cancer cases (10 per decade) diagnosed between 1947–2009 among women members of the Kaiser Permanente Northern California health plan to obtain and analyze their formalin-fixed paraffin-embedded (FFPE) tumor specimens. For each tumor specimen, we created duplicate tissue microarrays for analysis. RESULTS We located tumor blocks and pathology reports for 50 of the 60 cases (83%), from which we randomly sampled 5 cases per decade for biomarker analysis (n = 30). All 30 cases displayed excellent morphology and exhibited biomarkers compatible with histologic type and grade. Test–retest reliability was also excellent: 100% for ER; 97% for human epidermal growth factor receptor 2 and epidermal growth factor receptor; 93% for progesterone receptor and cytokeratin 5/6; and 90% for Ki67 and molecular phenotype; the kappa statistic was excellent (>0.9) for 4 of the 7 biomarkers, strong (0.6–0.8) for 2, and fair for only 1 (owing to low prevalence). CONCLUSIONS These results indicate immunostaining for biomarkers commonly used to evaluate breast cancer biology and assign surrogate molecular phenotypes can reliably be employed on archival FFPE specimens up to 60 years old. PMID:26807440

  12. Perinatal oxytocin increases the risk of offspring bipolar disorder and childhood cognitive impairment

    PubMed Central

    Freedman, David; Brown, Alan S.; Shen, Ling; Schaefer, Catherine A.

    2014-01-01

    Background We tested the hypothesis that perinatal oxytocin, given to pregnant women to induce labor, is related to offspring bipolar disorder (BP) and worse childhood cognitive performance among offspring. We also tested the association between childhood cognition and later BP. Methods A population-based birth cohort derived from the Child Health and Development Study (CHDS) which included nearly all pregnant women receiving obstetric care from the Kaiser Permanente Medical Care Plan, Northern California Region (KPNC) between1959–1966. Prospectively obtained medical and offspring cognitive performance were used. Potential cases with BP from the cohort were identified by database linkages. This protocol identified 94 cases who were matched 1:8 to controls. Results Perinatal oxytocin was associated with a 2.4 times increased odds of later BP. Oxytocin was also associated with decreased performance on the Raven Matrices, but not on the Peabody Picture Vocabulary Test (PPVT). Childhood cognition was not associated with later BP. Limitations Loss to follow-up must be considered in all birth cohort studies. Additionally, the childhood cognitive battery did not include tests related to multiple domains of cognition which have been associated with later BP. A third limitation is the modest sample size of those exposed to oxytocin. Conclusions This study provides evidence for a potentially important perinatal risk factor for BP and cognitive impairment in childhood. While the association between perinatal oxytocin and offspring BP must be viewed cautiously until further studies can attempt to replicate the result, it lends support to the broader view that neurodevelopmental factors contribute to BP. PMID:25462398

  13. A Community-Based Hip Fracture Registry: Population, Methods, and Outcomes

    PubMed Central

    Inacio, Maria C S; Weiss, Jennifer M; Miric, Alex; Hunt, Jessica J; Zohman, Gary L; Paxton, Elizabeth W

    2015-01-01

    Introduction: Hip fracture is associated with substantial morbidity and mortality. A large integrated health care system developed a registry to characterize its current patient population with hip fractures. This report describes the population, methods used, and outcomes of patients registered during the initial three years (20092011). Methods: Cases of hip fracture recorded from January 2009 through December 2011 were ascertained using the Kaiser Permanente Hip Fracture Registry. The registry collects information on patient, procedure, surgeon, facility, and surgical outcomes. Outcomes monitored included length of stay, readmissions, mortality, revisions, surgical site infections, deep vein thrombosis, pulmonary embolism, pneumonia, pressure ulcers, dislocations, and myocardial infarction. Results: The population (N = 12,562) was predominantly white (77.8%), women (68.6%), and older (71.6% aged ? 75 years), and 32% had at least 5 comorbidities. The average length of follow-up was 1.1 years (standard deviation = 0.9). The most prevalent comorbidities were hypertension (70.8%) and anemia (29.4%). Femoral neck fractures (54.6%) were the most common fracture type. Hemiarthroplasty was the most common procedure (33.1%). Most fractures were treated by medium-volume (10 to 29 cases per year) surgeons (68.4%) at high-volume (? 130 cases per year) facilities (63.0%). The 90-day readmission rate was 22.1%, and the mortality rate was 12.3%. The most common postoperative complications were pneumonia (11.4%) and pressure ulcers (2.9%). There were 2.2 revisions per 100 observation years. Conclusion: A hip fracture registry provides important information regarding patient characteristics, intraoperative practices, and postoperative outcomes, which can be analyzed, interpreted, and used to reduce morbidity and mortality. PMID:26057682

  14. Employment Status and Quality of Life in Recently Diagnosed Breast Cancer Survivors

    PubMed Central

    Timperi, Allegra W.; Ergas, Isaac Joshua; Rehkopf, David H.; Roh, Janise M.; Kwan, Marilyn L.; Kushi, Lawrence H.

    2012-01-01

    Objective Breast cancer survivors are less likely to be employed than similar healthy women, yet effects of employment on the well-being of survivors are largely unknown. In a prospective cohort study of 2,013 women diagnosed from 20062011 with invasive breast cancer in Kaiser Permanente Northern California, we describe associations between hours worked per week and change in employment with quality of life (QOL) from diagnosis through active treatment. Methods Participants completed information on employment status and QOL approximately 2-months and 8-months post-diagnosis. QOL was assessed by the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B). Multivariable linear regression models adjusted for potential confounders including demographic, diagnostic, and medical care factors to examine associations between employment and QOL. Results At baseline, overall well-being was higher for women who worked at least some hours per week compared to women who were not working. Women working 119 hours per week at baseline also had higher functional well-being compared to women who were not working. There was a significant, positive association between hours worked per week and physical and social well-being. At the six-month follow-up, women working at least 20 hours per week had higher physical and functional well-being than those not working. Lower scores for physical and functional well-being were observed among women who stopped working during the six-month follow-up period. Conclusions Continuing to work after a breast cancer diagnosis may be beneficial to multiple areas of QOL. Strategies to help women continue working through treatment should be explored. PMID:22912069

  15. Treatment patterns for ductal carcinoma in situ from 2000-2010 across six integrated health plans.

    PubMed

    Feigelson, Heather Spencer; Carroll, Nikki M; Weinmann, Sheila; Haque, Reina; Yu, Chu-Ling; Butler, Melissa G; Waitzfelder, Beth; Wrenn, Michelle G; Capra, Angela; McGlynn, Elizabeth A; Habel, Laurel A

    2015-01-01

    Considerable debate exists about the optimal treatment of ductal carcinoma in situ (DCIS). Using electronic data sources, we examined first course treatment patterns among women aged 18 years and older diagnosed with DCIS between 2000-2010 from six Kaiser Permanente (KP) regions. We calculated the proportion of patients receiving breast conserving surgery (BCS), BCS plus radiation therapy, unilateral mastectomy, bilateral mastectomy, and hormone therapy. Multinomial logistic regression was used to assess the association between patient characteristics and treatment. We included 9,437 women: 1,086 (11.5%) African-American; 1,455 (15.4%) Asian; 918 (9.7%) Hispanic; and 5,978 (63.3%) non-Hispanic white. Most cases (42.2%) received BCS plus radiation as their initial treatment. Nearly equal numbers of women received BCS without radiation (28.5%) or unilateral mastectomy (24.6%). Use of bilateral mastectomy was uncommon (4.7%), and most women (72.2%) did not receive hormone therapy has part of their first course treatment. We observed statistically significant differences in treatment patterns for DCIS by KP region and patient age. Predictably, nuclear grade and the presence of comorbidities were associated with first course treatment for DCIS. We observed statistically significant increases in BCS plus radiation therapy and bilateral mastectomy over time. Although still uncommon, the frequency of bilateral mastectomy increased from 2.7% in 2000 to 7.0% in 2010. We also observed differences in treatment by race/ethnicity. Our findings help illustrate the complex nature of DCIS treatment in the United States, and highlight the need for evidence based guidelines for DCIS care. PMID:25625043

  16. Population Care Management and Team-Based Approach to Reduce Racial Disparities among African Americans/Blacks with Hypertension

    PubMed Central

    Bartolome, Rowena E; Chen, Agnes; Handler, Joel; Platt, Sharon Takeda; Gould, Bernice

    2016-01-01

    Objectives: At Kaiser Permanente, national Equitable Care Health Outcomes (ECHO) Reports with a baseline measurement of 16 Healthcare Effectiveness Data and Information Set measures stratified by race and ethnicity showed a disparity of 8.1 percentage points in blood pressure (BP) control rates between African- American/black (black) and white members. The aims of this study were to describe a population care management team-based approach to improve BP control for large populations and to explain how a culturally tailored, patient-centered approach can address this racial disparity. Methods: These strategies were implemented through: 1) physician-led educational programs on treatment intensification, medication adherence, and consistent use of clinical practice guidelines; 2) building strong care teams by defining individual roles and responsibilities in hypertension management; 3) redesign of the care delivery system to expand access; and 4) programs on culturally tailored communication tools and self-management. Results: At a physician practice level where 65% of patients with hypertension were black, BP control rates (< 140/90 mmHg) for blacks improved from 76.6% to 81.4%, and control rates for whites increased from 82.9% to 84.2%. The racial gap narrowed from 6.3% to 2.8%. As these successful practices continue to spread throughout the program, the health disparity gap in BP control has decreased by 50%, from 8.1% to 3.9%. Conclusion: A sustainable program to collect self-reported race, ethnicity, and language preference data integrated with successful population care management programs provided the foundation for addressing health disparities. Cultural tailoring of a multilevel team-based approach closed the gap for blacks with hypertension. PMID:26824963

  17. QL-10NEURO-ONCOLOGY TELEMEDICINE FOLLOW-UP VISITS

    PubMed Central

    Green, Richard; Woyshner, Emily

    2014-01-01

    We report our 18 month experience with the use of a videoconferencing system to perform neuro-oncology follow-up visits. The Neuro-oncology Program at the Kaiser Permanente-Los Angeles Medical center serves the majority of Kaiser HMO patients in the Southern California region. We installed a videoconferencing system (Cisco TelePresence EX90, Cisco Systems, San Jose, CA) in our office in Los Angeles and in a medical office building in Anaheim, CA at a distance of 35 miles. Established neuro-oncology patients from Orange County chose between in-person and remote visits. Patients were seated in an examination room and the neuro-oncology provider alerted by text page. A focused history and physical examination was performed, followed by desktop sharing of clinical and laboratory data using an electronic medical record (Epic Systems Corporation, Verona, WI) and of neuroimages (Phillips iSite PACS, Andover, MA). Patients were asked, but not required, to complete an anonymous online 16 question satisfaction survey after each visit. Visits were performed by either a neuro-oncologist (179) or a Physician's Assistant (12). Of the 191 visits, 174 included evaluation of neuroimaging and 77 included evaluation of response to ongoing chemotherapy. During 12 visits chemotherapy was initiated, and during 15 visits the chemotherapy regimen was changed based on imaging findings. One-hundred and eleven surveys (58% of visits) were completed. Patients reported a high level of satisfaction with the visits (average 9.6, on a 1-10 scale). The average estimated travel time saved was 118 minutes per visit. Four surveys reported technical problems and 1 indicated a preference for an in-person visit. No adverse events could be attributed to use of the telemedicine system. These data suggest that neuro-oncology follow-up visits can be practiced safely and effectively using a telemedicine system, with high levels of patient satisfaction.

  18. Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability

    PubMed Central

    Katon, Wayne; Unützer, Jürgen; Wells, Kenneth; Jones, Loretta

    2013-01-01

    Objective To describe the history and evolution of the collaborative depression care model and new research aimed at enhancing dissemination. Method Four keynote speakers from the 2009 NIMH Annual Mental Health Services Meeting collaborated in this article in order to describe the history and evolution of collaborative depression care, adaptation of collaborative care to new populations and medical settings, and optimal ways to enhance dissemination of this model. Results Extensive evidence across 37 randomized trials has shown the effectiveness of collaborative care vs. usual primary care in enhancing quality of depression care and in improving depressive outcomes for up to 2 to 5 years. Collaborative care is currently being disseminated in large health care organizations such as the Veterans Administration and Kaiser Permanente, as well as in fee-for-services systems and federally funded clinic systems of care in multiple states. New adaptations of collaborative care are being tested in pediatric and ob-gyn populations as well as in populations of patients with multiple comorbid medical illnesses. New NIMH-funded research is also testing community-based participatory research approaches to collaborative care to attempt to decrease disparities of care in underserved minority populations. Conclusion Collaborative depression care has extensive research supporting the effectiveness of this model. New research and demonstration projects have focused on adapting this model to new populations and medical settings and on studying ways to optimally disseminate this approach to care, including developing financial models to incentivize dissemination and partnerships with community populations to enhance sustainability and to decrease disparities in quality of mental health care. PMID:20851265

  19. Dietary practices, alcohol consumption, and smoking behavior: ethnic, sex, and acculturation differences.

    PubMed

    Otero-Sabogal, R; Sabogal, F; Prez-Stable, E J; Hiatt, R A

    1995-01-01

    Current knowledge is scarce on Latino dietary practices. This study compared the dietary practices, alcohol consumption, and smoking behavior of Latinos and non-Latino whites in two randomly selected samples. Telephone surveys of adults 35-74 years of age from the Kaiser Permanente Medical Care Program (Latinos = 844; non-Latino whites = 510) and from census tract-based areas (Latinos = 806; non-Latino whites = 436) were conducted in the San Francisco Bay Area. Latino ethnicity was a significant predictor of dietary and alcohol consumption practices in multivariate logistic regression models after adjustment for sex, education, age, employment, health insurance, martial status, county of residence, and self-perceived health status. Compared with non-Latino whites, Latinos were significantly less likely to report eating vegetables and more likely to eat rice, beans, and fried foods and to drink whole milk. Less acculturated Latinos were more likely to eat fruits, rice, beans, meat, and fried foods and to drink whole milk than more acculturated Latinos. Latino men were significantly more likely to be binge drinkers, and Latina women were significantly more likely to abstain from drinking alcohol during the month prior to the interview. As Latina women acculturate to the U.S. mainstream, they report more cigarette smoking and alcohol consumption. Although Latinos reported higher levels of selected high-fiber foods, the low consumption of vegetables, widespread use of saturated fat, and the heavy drinking and smoking among Latino men, which are associated with the level of acculturation, may increase the risk for cancer. Educational messages targeting less acculturated Latinos should focus on maintaining their current healthy dietary practices of eating fruits, rice, and beans and decreasing their fat consumption. For more acculturated Latinos, emphasis should be placed on resuming the traditional diet. PMID:8562225

  20. More comprehensive discussion of CRC screening associated with higher screening

    PubMed Central

    Mosen, David M.; Feldstein, Adrianne C.; Perrin, Nancy; Rosales, A. Gabriela; Smith, David H.; Liles, Elizabeth G.; Schneider, Jennifer L.; Myers, Ronald E.; Elston-Lafata, Jennifer

    2013-01-01

    OBJECTIVE Examine association of comprehensiveness of colorectal cancer (CRC) screening discussion by PCPs with completion of CRC screening. STUDY DESIGN Observational study in Kaiser Permanente Northwest, a group-model health maintenance organization. METHODS 883 participants overdue for CRC screening received an automated telephone call (ATC) between April and June 2009 encouraging CRC screening. Between January and March 2010, participants completed a survey on PCPs discussion of CRC screening and patient beliefs regarding screening. Primary outcome measure: receipt of CRC screening (assessed by electronic medical record [EMR], 9 months after ATC). Primary independent variable: comprehensiveness of CRC screening discussion by PCPs (7-item scale). Secondary independent variables: perceived benefits of screening (4-item scale assessing respondents agreement with benefits of timely screening) and primary care utilization (EMR; 9 months after ATC). The independent association of variables with CRC screening was assessed with logistic regression. RESULTS Average scores for comprehensiveness of CRC discussion and perceived benefits were 0.4 (range 01) and 4.0 (range 15), respectively. 28.2% (n=249) completed screening, 84% of whom had survey assessments after their screening date. Of screeners, 95.2% completed the fecal immunochemical test (FIT). More comprehensive discussion of CRC screening was associated with increased screening (OR=1.51, 95% CI = 1.032.21). Higher perceived benefits (OR=1.46, 95% CI = 1.131.90) and one or more PCP visits (OR= 5.82, 95% CI = 3.878.74) were also associated with increased screening. CONCLUSIONS More comprehensive discussion of CRC screening was independently associated with increased CRC screening. Primary care utilization was even more strongly associated with CRC screening, irrespective of discussion of CRC screening. PMID:23725359

  1. Natural History of Left Ventricular Ejection Fraction in Patients With Heart Failure

    PubMed Central

    Clarke, Christina L.; Grunwald, Gary K.; Allen, Larry A.; Barón, Anna E.; Peterson, Pamela N.; Brand, David W.; Magid, David J.; Masoudi, Frederick A.

    2013-01-01

    Background Patients with heart failure (HF) are typically designated as having reduced or preserved ejection fraction (HFREF, HFPEF) because of the importance of left ventricular ejection fraction (LVEF) on therapeutic decisions and prognosis. Such designations are not necessarily static, yet few data exist to describe the natural history of LVEF over time. Methods and Results We identified 2413 patients from Kaiser Permanente Colorado with a primary discharge diagnosis of HF between January 1, 2001, and December 31, 2008, who had ≥2 LVEF measurements separated by ≥30 days. We used multi-state Markov modeling to examine transitions among HFREF, HFPEF, and death. We observed a total of 8183 transitions. Women were more likely than men to transition from HFREF to HFPEF (hazard ratio, 1.85; 95% confidence interval, 1.38–2.47). Patients who were adherent to β-blockers were more likely to transition from HFREF to HFPEF (hazard ratio, 1.53; 95% confidence interval, 1.10–2.13) compared with patients who were nonadherent to β-blockers, whereas angiotensin-converting enzyme or angiotensin II receptor blocker adherence was not associated with LVEF transitions. Patients who had a previous myocardial infarction were more likely to transition from HFPEF to HFREF (hazard ratio, 1.75; 95% confidence interval, 1.26–2.42). Conclusions In this cohort of patients with HF, LVEF is a dynamic factor related to sex, coexisting conditions, and drug therapy. These findings have implications for left ventricular systolic function ascertainment in patients with HF and support evidence-based therapy use, especially β-blockers. PMID:24129973

  2. Physician as Healer, Leader and Partner: Tackling the Nursing Shortage

    PubMed Central

    Cochran, John H; Fahy, Patricia K; Bansek, Jill C; Smith, Linda

    2004-01-01

    Context: Physicians have been notably silent on the nursing shortage in spite of articles that have suggested that physician behavior is one of the causes of job dissatisfaction among professional nurses. In addition to the role of healer, the physicians of the Colorado Permanente Medical Group (CPMG) are expected to have the additional responsibilities of being both leaders in health care and strong clinical partners with the nursing staff. CPMG has embarked upon a program to leverage physician leadership to address the nursing shortage through multiple avenues. We expect not only to increase the number of nurses in the future, but also to enhance their careers by being their Preferred Clinical Partner. Objective: To describe a model for engaging physicians in becoming active participants in solving the nursing shortage through leadership and partnering. Results: The Preferred Clinical Partner Program has been developed to address the nursing shortage in multiple ways. We have significantly increased the number of scholarships available for nursing students as well as funding and developing additional educational programs to meet the needs of nurses entering from various points in their lives and educational journeys. We have also enhanced programs around physicians serving as teachers and mentors in the education and long-term development of health care team members. And finally, we are clarifying leadership and partnership expectations for physicians and developing very specific physician-nurse relationship training programs to try to solidify the long-term sustainability of careers of these important members of our health care team. Conclusions: Physician groups that take an active role by opting-in to nursing shortage issues will benefit by having an engaged, professional, compassionate nurse on their health care team. PMID:26704608

  3. Dietary antioxidants, fruits and vegetables, and the risk of Barrett’s esophagus

    PubMed Central

    Kubo, Ai; Levin, T.R.; Block, Gladys; Rumore, Gregory J.; Quesenberry, Charles P.; Buffler, Patricia; Corley, Douglas A.

    2009-01-01

    OBJECTIVE The present study evaluated the associations between antioxidants, fruit and vegetable intakes and the risk of Barrett’s esophagus, a potential precursor to esophageal adenocarcinoma. METHODS We conducted a case-control study within the Kaiser Permanente Northern California population. Incident Barrett’s esophagus cases (n=296) were matched to persons with gastroesophageal reflux disease (GERD) (GERD controls, n=308) and to population controls (n=309). Nutrient intake was measured using a validated 110-item food frequency questionnaire. The antioxidant results were stratified by dietary vs. total intake of antioxidants. RESULTS Comparing cases to population controls, dietary intake of vitamin C and beta-carotene were inversely associated with the risk of Barrett’s esophagus [4th vs. 1st quartile, adjusted odds ratio [OR]=0.48 95% confidence interval [CI] (0.26–0.90); OR=0.56 95%CI(0.32–0.99), respectively], and the inverse association was strongest for vitamin E [OR=0.25 95%CI (0.11–0.59)]. The inverse trends for antioxidant index (total and dietary) and fruit and vegetable intake were statistically significant, while most total intakes were not associated with reduced risk. The use of antioxidant supplements did not influence the risk of Barrett’s esophagus, and antioxidants and fruits and vegetables were inversely associated with a GERD diagnosis. CONCLUSION Dietary antioxidants, fruit and vegetable are inversely associated with the risk of Barrett’s esophagus, while no association was observed for supplement intake. Our results suggest that fruits and vegetables themselves or associated undetected confounders may influence early events in the carcinogenesis of esophageal adenocarcinoma. PMID:18494834

  4. Effects of dietary fiber, fats, and meat intakes on the risk of Barrett’s Esophagus

    PubMed Central

    Kubo, Ai; Block, Gladys; Quesenberry, Charles P.; Buffler, Patricia; Corley, Douglas A.

    2009-01-01

    Animal and human models suggest associations between fat intake, fiber intake and the risk of esophageal adenocarcinoma. We evaluated whether these factors may act early in the carcinogenic pathway as a risk factor for Barrett’s esophagus, a potentially premalignant precursor to esophageal adenocarcinoma using a case-control design within the Kaiser Permanente, Northern California population. Incident Barrett’s esophagus cases (n=296) were matched to persons with gastroesophageal reflux disease (GERD) (n=308), and to population controls (n=309). Higher intakes of omega-3-fatty-acids (cases vs. population controls; OR=0.46, 95% CI 0.22–0.97, 4th vs. 1st quartiles of intake), polyunsaturated fat, total fiber (OR=0.34, 95% CI 0.15–0.76), and fiber from fruits and vegetables (OR=0.47 95% CI 0.25–0.88) were associated with a lower risk of Barrett’s esophagus. Higher meat intakes were associated with a lower risk of long-segment Barrett’s esophagus (OR=0.25, 95% CI 0.09–0.72). In contrast, higher trans-fat intakes were associated with increased risk (OR=1.11; 95% CI 1.03–1.21 per gram/day). Total fat intake, barbecued foods, and fiber intake from sources other than fruits and vegetables were not associated with Barrett’s esophagus. Future studies to evaluate whether dietary interventions might influence the risk of Barrett’s esophagus or esophageal adenocarcinoma in high risk persons are needed. PMID:19838934

  5. Mothers of Children Diagnosed with Attention-Deficit/Hyperactivity Disorder: Health Conditions and Medical Care Utilization in Periods Before and After Birth of the Child

    PubMed Central

    Ray, G. Thomas; Croen, Lisa A.; Habel, Laurel A.

    2009-01-01

    Background Analyzing health conditions and medical utilization of mothers of children with attention-deficit/hyperactivity disorder (ADHD) can shed light on biological, environmental, and psychosocial factors relating to ADHD. Objective To examine health conditions, health care utilization, and costs of mothers of children with ADHD in periods before the child was diagnosed. Methods Using automated data from Northern California Kaiser Permanente we identified mothers of children with ADHD, mothers of children without ADHD, and mothers of children with asthma. Mothers’ diagnostic clusters, health care utilization, and costs were compared. Mothers of children with ADHD were compared to mothers of children without ADHD and, separately, to mothers of children with asthma. Results Compared to mothers of children without ADHD, mothers of children with ADHD were more likely to be diagnosed with numerous medical and mental health problems in the two years after birth of their child, including depression (Odds Ratio (OR): 1.88), anxiety neuroses (OR: 1.64), obesity (OR: 1.70), and musculoskeletal symptoms (OR: 1.51). Results were similar for the year before delivery. Mothers of children with ADHD also had higher total health care costs per person in the year before ($1003) and the two years after ($953) the birth of their child. Mothers of children with ADHD also were diagnosed with more health conditions and had higher health care costs than mothers of children with asthma. Conclusions Our findings suggest that the likelihood of being diagnosed with ADHD is related to maternal conditions and use of health services that precede the child’s diagnosis. Future studies are needed to clarify whether this is due to biologic, psychosocial, or environmental factors, or a combination. PMID:19106738

  6. Prediction of individual combined benefit and harm for patients with atrial fibrillation considering warfarin therapy: a study protocol

    PubMed Central

    Li, Guowei; Holbrook, Anne; Delate, Thomas; Witt, Daniel M; Levine, Mitchell AH; Thabane, Lehana

    2015-01-01

    Introduction Clinical prediction rules have been validated and widely used in patients with atrial fibrillation (AF) to predict stroke and major bleeding. However, these prediction rules were not developed in the same population, and do not provide the key information that patients and prescribers need at the time anticoagulants are being considered—what is the individual patient-specific risk of both benefit (decreased stroke) and harm (increased major bleeding). In this study, our primary objective is to develop and validate a prediction model for patients’ individual combined benefit and harm outcomes (stroke, major bleeding and neither event) with and without warfarin therapy. Our secondary outcome is all-cause mortality. Methods and analysis We will use data from the Kaiser Permanente Colorado (KPCO) anticoagulation management databases and electronic medical records. Patients with a primary or secondary diagnosis during an ambulatory KPCO medical office visit, emergency department visit, or inpatient stay between 1 January 2005 and 31 December 2012 with no AF diagnosis in the previous 180 days will be included. Patients’ demographic characteristics, laboratory data, comorbidities, warfarin medication data and concurrent use of medication will be used to construct the prediction model. For primary outcomes (stroke with no major bleeding, and major bleeding with no stroke), we will perform polytomous logistic regression to develop a prediction model for patients’ individual combined benefit and harm outcomes, taking neither event group as the reference group. As regards death, we will use Cox proportional hazards regression analysis to build a prediction model for all-cause mortality. Ethics and dissemination This study has been approved by the KPCO Institutional Review Board and the Hamilton Integrated Research Ethics Board. Results from this study will be published in a peer-reviewed journal electronically and in print. The prediction models may aid in patient-physician shared decision-making when they are considering warfarin therapy. PMID:26546146

  7. Rethinking Medical Professionalism: The Role of Information Technology and Practice Innovations

    PubMed Central

    Mechanic, David

    2008-01-01

    Context Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics, and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest, and distribute finite resources fairly. Information technology (IT), electronic health records (EHRs), improved models of disease management, and new ways of relating to and sharing responsibility for patients' care can contribute to both professionalism and quality of care. Methods The potential of IT, EHRs, and other practice facilitators for professionalism is assessed through diverse but relevant literatures, examination of relevant websites, and experience in working with medical leaders on renewing professionalism. Findings IT and EHRs are the basis of needed efforts to reinforce medical competence, improve relationships with patients, implement disease management programs, and, by increasing transparency and accountability, help reduce some conflicts of interest. Barriers include the misalignment of goals with payment incentives and time pressures in meeting patients' expectations and practice demands. Implementing IT and EHRs in small, dispersed medical practices is particularly challenging because of short-term financial costs, disruptions in practice caused by learning and adaptation, and the lack of confidence in needed support services. Large organized systems like the VA, Kaiser Permanente, and general practice in the United Kingdom have successfully overcome such challenges. Conclusions IT and the other tools examined in this article are important adjuncts to professional capacities and aspirations. They have potential to help reverse the decline of primary care and make physicians' practices more effective and rewarding. The cooperation, collaboration, and shared responsibility of government, insurers, medical organizations, and physicians, as well as financial and technical support, are needed to implement these tools in the United States' dispersed and fragmented medical care system. PMID:18522615

  8. Familial Aggregation of Parkinsons Disease in a Multiethnic Community-Based Case-Control Study

    PubMed Central

    Shino, Michael Y.; McGuire, Valerie; Van Den Eeden, Stephen K.; Tanner, Caroline M.; Popat, Rita; Leimpeter, Amethyst; Bernstein, Allan L.; Nelson, Lorene M.

    2010-01-01

    To assess the familial aggregation of Parkinsons disease (PD), we compared the cumulative incidence of PD among first-degree relatives of PD cases and controls. We identified newly diagnosed patients with PD (n=573) during 19941995 within Kaiser Permanente Medical Care Program (KPMPC) of Northern California and recruited 496 cases (87%) for the case-control study. Of 720 eligible controls matched by birth year and sex to cases, 541 (75%) agreed to participate. Information on family history of PD and other neurodegenerative diseases was obtained by in-person structured interview. We used the reconstructed cohort approach which provides a better estimate of the risk. The cumulative incidence of PD was significantly higher among relatives of PD patients compared to relatives of controls (2.0 versus 0.7%; RR=3.4, 95% CI 1.95.9; p=0.0001). The degree of familial aggregation was higher among first degree relatives of Hispanic PD cases compared to Hispanic controls (3.7% versus 0.4%; RR=8.5, 95% CI 1.068.9) than it was among non-Hispanic Caucasian cases and controls (2.0% versus 0.8%; RR=2.7, 95% CI 1.55.1) (p=0.02). The familial aggregation of PD was stronger among the siblings of PD cases (RR=5.4, 95% CI 1.816.0) than among parents (RR=2.7, 95% CI 1.35.2). The incidence and familial aggregation of PD is highest among Hispanics, warranting further studies of genetic and environmental risk factors in the Hispanic population. PMID:20842689

  9. Oral Contraceptives and Multiple Sclerosis/Clinically Isolated Syndrome Susceptibility

    PubMed Central

    Hellwig, Kerstin; Chen, Lie H.; Stancyzk, Frank Z.; Langer-Gould, Annette M.

    2016-01-01

    Background The incidence of multiple sclerosis (MS) is rising in women. Objective To determine whether the use of combined oral contraceptives (COCs) are associated with MS risk and whether this varies by progestin content. Methods We conducted a nested case-control study of females ages 14–48 years with incident MS or clinically isolated syndrome (CIS) 2008–2011 from the membership of Kaiser Permanente Southern California. Controls were matched on age, race/ethnicity and membership characteristics. COC use up to ten years prior to symptom onset was obtained from the complete electronic health record. Results We identified 400 women with incident MS/CIS and 3904 matched controls. Forty- percent of cases and 32% of controls had used COCs prior to symptom onset. The use of COCs was associated with a slightly increased risk of MS/CIS (adjusted OR = 1.52, 95%CI = 1.21–1.91; p<0.001). This risk did not vary by duration of COC use. The association varied by progestin content being more pronounced for levenorgestrol (adjusted OR = 1.75, 95%CI = 1.29–2.37; p<0.001) than norethindrone (adjusted OR = 1.57, 95%CI = 1.16–2.12; p = 0.003) and absent for the newest progestin, drospirenone (p = 0.95). Conclusions Our findings should be interpreted cautiously. While the use of some combination oral contraceptives may contribute to the rising incidence of MS in women, an unmeasured confounder associated with the modern woman’s lifestyle is a more likely explanation for this weak association. PMID:26950301

  10. Hydrodécyclisation du méthylcyclopentane et isomérisation des hexanes acycliques sur un catalyseur à 0,2 % de Pt sur Al{2}O{3} irradié par un champ microonde

    NASA Astrophysics Data System (ADS)

    Medjram, M. S.; Rouainia, M.; Garin, F.

    2005-05-01

    Pour évaluer l'action du champ électromagnétique micro-onde sur la réaction, les propriétés et la préparation des catalyseurs, nous avons disposé d'un réacteur placé dans une cavité résonnante permettant de mesurer la plupart des grandeurs expérimentales importantes qui définissent la réaction et les conditions dans lesquelles l'irradiation micro-onde est effectuées. Parmi celles ci figure le champ électrique, la puissance apportée au système et la température. Les résultats obtenus pour les réactions d'hydrogénolyse du méthylcyclopentane font apparaître qu'indépendamment du mode de chauffage et quelle que soit la conversion, la distribution des produits formés est identique pour les deux systèmes et les rapports des différents hexanes obtenus obéissent à la règle statistique d'ouverture des liaisons C-C du cycle méthylcyclopentane. Par contre, lors des réactions d'isomérisation du méthyl-2pentane, méthyl-3pentane et n-hexane, la sélectivité globale en isomères est plus élevée lorsque la réaction a lieu en présence d'un champ micro-onde. A la suite de ces expériences il a été démontré que le catalyseur est modifié lors de son irradiation micro-onde et que cette modification est permanente.

  11. The effect of bariatric surgery on psychiatric course among patients with bipolar disorder

    PubMed Central

    Ahmed, Ameena T; Warton, E. Margaret; Schaefer, Catherine A; Shen, Ling; McIntyre, Roger S

    2013-01-01

    Objective Bariatric surgery is the most effective therapy for severe obesity. People with bipolar disorder have increased risk of obesity, yet are sometimes considered ineligible for bariatric surgery due to their bipolar disorder diagnosis. This study aimed to determine if bariatric surgery alters the psychiatric course among stable patients with bipolar disorder. Methods A matched cohort study (2006–2009) with mean follow-up of 2.17 years, was conducted within Kaiser Permanente Northern California, a group practice integrated health services delivery organization that provides medical and psychiatric care to 3.3 million people. Participants were 144 severely obese patients with bipolar disorder who underwent bariatric surgery, and 1,440 control patients with bipolar disorder, matched for gender, medical center, and contemporaneous health plan membership. Controls met referral criteria for bariatric surgery. Hazard ratio for psychiatric hospitalization, and change in rate of outpatient psychiatric utilization from baseline to Years 1 and 2, were compared between groups. Results A total of 13 bariatric surgery patients (9.0%) and 153 unexposed to surgery (10.6%) had psychiatric hospitalization during follow-up. In multivariate Cox models adjusting for potential confounding factors, the hazard ratio of psychiatric hospitalization associated with bariatric surgery was 1.03 [95% confidence interval (CI) 0.83–1.23]. In fully saturated multivariate general linear models, change in outpatient psychiatric utilization was not significantly different for surgery patients versus controls, from baseline to Year 1 (−0.4 visits/year, 95% CI: −0.5 to 0.4) or baseline to Year 2 (0.4 visits/year, 95% CI: −0.1 to 1.0). Conclusions Bariatric surgery did not affect psychiatric course among stable patients with bipolar disorder. The results of this study suggest that patients with bipolar disorder who have been evaluated as stable can be considered for bariatric surgery. PMID:23909994

  12. Effectiveness of ?-Blockers in Heart Failure With Left Ventricular Systolic Dysfunction and Chronic Kidney Disease

    PubMed Central

    CHANG, TARA I.; YANG, JINGRONG; FREEMAN, JAMES V.; HLATKY, MARK A.; GO, ALAN S.

    2014-01-01

    Background Establishing medication effectiveness outside of a randomized trial requires careful study design to mitigate selection bias. Previous observational studies of ?-blockers in patients with chronic kidney disease and heart failure have had methodologic limitations that may have introduced bias. We examined whether initiation of ?-blocker therapy was associated with better outcomes among patients with chronic kidney disease and newly diagnosed heart failure with left ventricular systolic dysfunction. Methods and Results We identified 668 adults in the Kaiser Permanente Northern California system from 2006 to 2008 with chronic kidney disease, incident heart failure, left ventricular systolic dysfunction, and no previous ?-blocker use. We defined chronic kidney disease as estimated glomerular filtration rate <60 mL min?1 1.73 m?2 or proteinuria, and we excluded patients receiving dialysis. We used extended Cox regression to assess the association of treatment with death and the combined end point of death or heart failure hospitalization. Initiation of ?-blocker therapy was associated with a significantly lower crude risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.350.63), but this association was attenuated and no longer significant after multivariable adjustment (HR 0.75, CI 0.511.12). ?-Blocker therapy was significantly associated with a lower risk of death or heart failure hospitalization even after adjustment for potential confounders (HR 0.67, CI 0.510.88). Conclusions ?-Blocker therapy is associated with lower risk of death or heart failure hospitalization among patients with chronic kidney disease, incident heart failure, and left ventricular systolic dysfunction. PMID:23482078

  13. Treatment Intensification and Risk Factor Control: A Quality Improvement Perspective

    PubMed Central

    Selby, Joe V.; Uratsu, Connie S; Fireman, Bruce; Schmittdiel, Julie A; Peng, Tiffany; Rodondi, Nicolas; Karter, Andrew J; Kerr, Eve A.

    2014-01-01

    Background Intensification of pharmacotherapy in persons with poorly controlled chronic conditions has been proposed as a clinically meaningful process measure of quality. Objective To validate measures of treatment intensification by evaluating their associations with subsequent control in hypertension, hyperlipidemia, and diabetes mellitus across 35 medical facility populations in Kaiser Permanente, Northern California. Design Two-level, hierarchical analyses of associations of improvements in facility-level treatment intensification rates from 2001 to 2003 with patient-level risk factor levels at the end of 2003. Patients 515,072 and 626,130 members (age > 20 years) with hypertension, hyperlipidemia, and/or diabetes mellitus in 2001 and 2003, respectively. Measurements Treatment intensification for each risk factor defined as an increase in number of drug classes prescribed, of dosage for at least one drug, or switching to a drug from another class within 3 months of observed poor risk factor control. Results Facility-level improvements in treatment intensification rates between 2001 and 2003 were strongly associated with greater likelihood of being in control at the end of 2003 (p≤0.01 for each risk factor) after adjustment for patient- and facility-level covariates. Compared to facility rankings based solely on control, addition of percentages of poorly controlled patients who received treatment intensification changed 2003 rankings substantially: 14%, 51%, and 29%) of the facilities changed ranks by 5 or more positions for hypertension, hyperlipidemia, and diabetes, respectively. Conclusions Treatment intensification is tightly linked to improved control. Thus, it should be an effective process measure for motivating quality improvement and for measuring clinical performance. PMID:19330888

  14. Gastrointestinal Disease Outbreak Detection Using Multiple Data Streams from Electronic Medical Records

    PubMed Central

    Huang, Jie; Abrams, Allyson M.; Gilliss, Debra; Reed, Mary; Platt, Richard; Huang, Susan S.; Kulldorff, Martin

    2012-01-01

    Abstract Background: Passive reporting and laboratory testing delays may limit gastrointestinal (GI) disease outbreak detection. Healthcare systems routinely collect clinical data in electronic medical records (EMRs) that could be used for surveillance. This study's primary objective was to identify data streams from EMRs that may perform well for GI outbreak detection. Methods: Zip code-specific daily episode counts in 2009 were generated for 22 syndromic and laboratory-based data streams from Kaiser Permanente Northern California EMRs, covering 3.3 million members. Data streams included outpatient and inpatient diagnosis codes, antidiarrheal medication dispensings, stool culture orders, and positive microbiology tests for six GI pathogens. Prospective daily surveillance was mimicked using the space-time permutation scan statistic in single and multi-stream analyses, and space-time clusters were identified. Serotype relatedness was assessed for isolates in two Salmonella clusters. Results: Potential outbreaks included a cluster of 18 stool cultures ordered over 5 days in one zip code and a Salmonella cluster in three zip codes over 9 days, in which at least five of six cases had the same rare serotype. In all, 28 potential outbreaks were identified using single stream analyses, with signals in outpatient diagnosis codes most common. Multi-stream analyses identified additional potential outbreaks and in one example, improved the timeliness of detection. Conclusions: GI disease-related data streams can be used to identify potential outbreaks when generated from EMRs with extensive regional coverage. This process can supplement traditional GI outbreak reports to health departments, which frequently consist of outbreaks in well-defined settings (e.g., day care centers and restaurants) with no laboratory-confirmed pathogen. Data streams most promising for surveillance included microbiology test results, stool culture orders, and outpatient diagnoses. In particular, clusters of microbiology tests positive for specific pathogens could be identified in EMRs and used to prioritize further testing at state health departments, potentially improving outbreak detection. PMID:22429155

  15. Mother-reported sleep, accelerometer-estimated sleep, and weight status in Mexican American children: Sleep duration is associated with increased adiposity and risk for overweight/obese status

    PubMed Central

    Martinez, Suzanna M.; Greenspan, Louise C.; Butte, Nancy F.; Gregorich, Steven E.; de Groat, Cynthia L.; Deardorff, Julianna; Penilla, Carlos; Pasch, Lauri A.; Flores, Elena; Tschann, Jeanne M.

    2015-01-01

    Summary We know of no studies comparing parent-reported sleep with accelerometer-estimated sleep in their relation to pediatric adiposity. We examined: 1) the reliability of mother-reported sleep compared with accelerometer-estimated sleep, and 2) the relationship between both sleep measures and child adiposity. The current cross-sectional study included 304 Mexican American mother-child pairs recruited from Kaiser Permanente Northern California. We measured sleep duration, using maternal report and accelerometry, and child anthropometrics. Concordance between sleep measures was evaluated using the Bland-Altman method. We conducted zero-ordered correlations between mother-reported sleep, accelerometer-estimated sleep and child BMI z-scores (BMIz). Using linear regression, we examined three models to assess child BMIz with mother-reported sleep (model 1), accelerometer-estimated sleep (model 2), and both sleep measures (model 3). Children had an average age of 8.86 years (SD= .82). Mothers reported that their child slept 9.81 ± 0.74 (95% CI: 9.72, 9.89) hours, compared to 9.58 ± 0.71 (95% CI: 9.50, 9.66) hours based on accelerometry. Mother-reported sleep and accelerometer-estimated sleep were correlated (r = 0.33, p < 0.001). BMIz outcomes were negatively associated with mother-reported sleep duration (model 1: β = −0.13; P = .02) and accelerometer-estimated sleep duration (model 2: β = −0.17; P < .01). Accounting for both sleep measures, only accelerometer-measured sleep was related to BMIz (model 3: β = −0.14, P = .02). Each sleep measure was significantly related to adiposity, independent of covariates. Accelerometry appeared to be a more reliable measure of children’s sleep than maternal report, yet maternal report may be sufficient to examine the sleep-adiposity relationship when resources are limited. PMID:24329818

  16. Association of beverage consumption with obesity in Mexican American children

    PubMed Central

    Beck, Amy L; Tschann, Jeanne; Butte, Nancy F; Penilla, Carlos; Greenspan, Louise C

    2015-01-01

    Objective To determine the association of beverage consumption with obesity in Mexican American school-aged children. Design Cross-sectional study using the baseline data from a cohort study. Mothers and children answered questions about the frequency and quantity of the child’s consumption of soda, diet soda, other sugar-sweetened beverages, 100% fruit juice, milk and water. The questions were adapted from the Youth/Adolescent FFQ. Children were weighed and measured. Data were collected on the following potential confounders: maternal BMI, household income, maternal education, maternal occupational status, maternal acculturation, child physical activity, child screen time and child fast-food consumption. Logistic regression was used to examine the association between servings (240 ml) of each beverage per week and obesity (BMI ≥ 95th percentile). Setting Participants were recruited from among enrolees of the Kaiser Permanente Health Plan of Northern California. Data were collected via an in-home assessment. Subjects Mexican American children (n 319) aged 8–10 years. Results Among participants, 20% were overweight and 31% were obese. After controlling for potential confounders, consuming more servings of soda was associated with increased odds of obesity (OR = 1·29; P < 0·001). Consuming more servings of flavoured milk per week was associated with lower odds of obesity (OR = 0·88; P = 0·004). Consumption of other beverages was not associated with obesity in the multivariate model. Conclusions Discouraging soda consumption among Mexican American children may help reduce the high obesity rates in this population. PMID:23308395

  17. Failure to replicate an association of SNPs in the oxidized LDL receptor gene (OLR1) with CAD

    PubMed Central

    Knowles, Joshua W; Assimes, Themistocles L; Boerwinkle, Eric; Fortmann, Stephen P; Go, Alan; Grove, Megan L; Hlatky, Mark; Iribarren, Carlos; Li, Jun; Myers, Richard; Risch, Neil; Sidney, Stephen; Southwick, Audrey; Volcik, Kelly A; Quertermous, Thomas

    2008-01-01

    Background The lectin-like oxidized LDL receptor LOX-1 (encoded by OLR1) is believed to play a key role in atherogenesis and some reports suggest an association of OLR1 polymorphisms with myocardial infarction (MI). We tested whether single nucleotide polymorphisms (SNPs) in OLR1 are associated with clinically significant CAD in the Atherosclerotic Disease, VAscular FuNction, & Geneti C Epidemiology (ADVANCE) study. Methods ADVANCE is a population-based case-control study of subjects receiving care within Kaiser Permanente of Northern California including a subset of participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. We first resequenced the promoter, exonic, and splice site regions of OLR1 and then genotyped four single nucleotide polymorphisms (SNPs), including a non-synonymous SNP (rs11053646, Lys167Asn) as well as an intronic SNP (rs3736232) previously associated with CAD. Results In 1,809 cases with clinical CAD and 1,734 controls, the minor allele of the coding SNP was nominally associated with a lower odds ratio (OR) of CAD across all ethnic groups studied (minimally adjusted OR 0.8, P = 0.007; fully adjusted OR 0.8, P = 0.01). The intronic SNP was nominally associated with an increased risk of CAD (minimally adjusted OR 1.12, p = 0.03; fully adjusted OR 1.13, P = 0.03). However, these associations were not replicated in over 13,200 individuals (including 1,470 cases) in the Atherosclerosis Risk in Communities (ARIC) study. Conclusion Our results do not support the presence of an association between selected common SNPs in OLR1 and the risk of clinical CAD. PMID:18384690

  18. Common polymorphisms of ALOX5 and ALOX5AP and risk of coronary artery disease

    PubMed Central

    Knowles, Joshua W.; Priest, Jame s R.; Basu, Analabha; Volcik, Kelly A.; Southwick, Audrey; Tabor, Holly K.; Hartiala, Jaana; Allayee, Hooman; Grove, Megan L.; Tabibiazar, Raymond; Sidney, Stephen; Fortmann, Stephen P.; Go, Alan; Hlatky, Mark; Iribarren, Carlos; Boerwinkle, Eric; Myers, Richard; Risch, Neil; Quertermous, Thomas

    2009-01-01

    Recent human genetic studies suggest that allelic variants of leukotriene pathway genes influence the risk of clinical and subclinical atherosclerosis. We sequenced the promoter, exonic, and splice site regions of ALOX5 and ALOX5AP and then genotyped 7 SNPs in ALOX5 and 6 SNPs in ALOX5AP in 1,552 cases with clinically significant coronary artery disease (CAD) and 1,583 controls from Kaiser Permanente including a subset of participants of the coronary artery risk development in young adults study. A nominally significant association was detected between a promoter SNP in ALOX5 (rs12762303) and CAD in our subset of white/European subjects (adjusted odds ratio per minor allele, log-additive model, 1.32; P = 0.002). In this race/ethnic group, rs12762303 has a minor allele frequency of 15% and is tightly linked to variation at the SP1 variable tandem repeat promoter polymorphism. However, the association between CAD and rs12762303 could not be reproduced in the atherosclerosis risk in communities study (hazard rate ratio per minor allele; 1.08, P = 0.1). Assuming a recessive mode of inheritance, the association was not significant in either population study but our power to detect modest effects was limited. No significant associations were observed between all other SNPs and the risk of CAD. Overall, our findings do not support a link between common allelic variation in or near ALOX5 or ALOX5AP and the risk of CAD. However, additional studies are needed to exclude modest effects of promoter variation in ALOX5 on the risk of CAD assuming a recessive mode of inheritance. PMID:18369664

  19. A near null variant of 12/15-LOX encoded by a novel SNP in ALOX15 and the risk of coronary artery disease

    PubMed Central

    Assimes, Themistocles L.; Knowles, Joshua W.; Priest, James R.; Basu, Analabha; Borchert, Astrid; Volcik, Kelly A.; Grove, Megan L.; Tabor, Holly K.; Southwick, Audrey; Tabibiazar, Raymond; Sidney, Steve; Boerwinkle, Eric; Go, Alan S.; Iribarren, Carlos; Hlatky, Mark A.; Fortmann, Stephen P.; Myers, Richard M.; Kuhn, Hartmut; Risch, Neil; Quertermous, Thomas

    2008-01-01

    Objective Murine genetic models suggest that function of the 12/15 LOX enzyme promotes atherosclerosis. We tested the hypothesis that exonic and/or promoter single nucleotide polymorphisms (SNPs) in the human 12/15-LOX gene (ALOX15) alter the risk of symptomatic coronary artery disease (CAD). Methods & Results We resequenced ALOX15 and then genotyped a common promoter and a less common novel coding SNP (T560M) in 1809 subjects with CAD and 1734 controls from Kaiser Permanente including a subset of participants of the Coronary Artery Risk Development in Young Adults study. We found no association between the promoter SNP and the risk of CAD. However, heterozygote carriers of the 560M allele had an increased risk of CAD (adjusted OR, 1.62; P=0.02) compared to non-carriers. In vitro studies demonstrated a 20-fold reduction in the catalytic activity of 560M when compared to 560T. We then genotyped T560M in 12974 participants of the Atherosclerosis Risk in Communities study and similarly found that heterozygote carriers had an increased risk of CAD compared to non-carriers (adjusted HR, 1.31; P=0.06). In both population studies, homozygote carriers were rare and associated with a non-significant decreased risk of CAD compared to non-carriers (adjusted OR, 0.55; P=0.63 and HR, 0.93; P=0.9). Conclusions A coding SNP in ALOX15 (T560M) results in a near null variant of human 12/15-LOX. Assuming a co-dominant mode of inheritance, this variant does not protect against CAD. Assuming a recessive mode of inheritance, the effect of this mutation remains unclear, but is unlikely to provide a protective effect to the degree suggested by mouse knockout studies. PMID:17959182

  20. Characteristics of Newly Enrolled Members of an Integrated Delivery System after the Affordable Care Act

    PubMed Central

    Bayliss, Elizabeth A; Ellis, Jennifer L; Strobel, Mary Jo; McQuillan, Deanna B; Petsche, Irena B; Barrow, Jennifer C; Beck, Arne

    2015-01-01

    Context: Little is known about the health status and care needs of new enrollees in health plans since implementation of the Affordable Care Act. Objective: To describe characteristics of new members of an integrated delivery system during early phases of implementation of the act. Design: Descriptive analysis of ongoing collection of operational data. Main Outcome Measures: The 11-question Brief Health Questionnaire, which was administered to new members of Kaiser Permanente Colorado who had benefits effective on or after January 1, 2014. Bivariate analyses compared characteristics of new enrollees by benefit. Results: Of 89,289 newly enrolled non-Medicare members, 22,548 (25.3%) completed the Brief Health Questionnaire between January 1, 2014, and August 31, 2014. Of these, 3593 respondents were insured through Medicaid, 9434 through the individual health exchange, and 9521 through primarily commercial plans. Of Medicaid, exchange, and commercial members, 19.5%, 7.1%, and 5.3%, respectively, self-reported fair or poor health; 12.9%, 2.0%, and 3.3% of each group self-reported 2 or more Emergency Department visits during the previous year; and 8.1%, 4.3%, and 4.4% self-reported an inpatient admission during the previous year. During the preceding year, 31.5% of Medicaid, 30.8% of exchange, and 12.6% of commercial members were uninsured longer than 8 months. Conclusion: Systematic collection of patients self-reported information can enhance traditional approaches to initiating care, inform operational planning, and describe newly enrolled populations. Newly enrolled Medicaid beneficiaries may have more initial health care needs than new exchange or commercial members; however, health differences between the latter two groups are subtle. PMID:26057681

  1. Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients.

    PubMed

    Braithwaite, Dejana; Tammemagi, C Martin; Moore, Dan H; Ozanne, Elissa M; Hiatt, Robert A; Belkora, Jeff; West, Dee W; Satariano, William A; Liebman, Michael; Esserman, Laura

    2009-03-01

    The objective of this study was to determine whether comorbidity, or pre-existing conditions, can account for some of the disparity in survival between African-American and white breast cancer patients. A historical cohort study was conducted of 416 African-American and 838 white women diagnosed with breast cancer between 1973 and 1986, and followed through 1999 in the Kaiser Permanente Northern California Medical Care Program. Information on comorbidity, tumor characteristics and breast cancer treatment was obtained from medical records, and Surveillance, Epidemiology and End Results, Northern California Cancer Center Registry. Associations between comorbidity and survival were analyzed with multiple Cox proportional hazards regression. Over a mean follow-up of 9 years, African Americans had higher overall crude mortality than whites: 165 (39.7%) versus 279 (33.3%), respectively. When age, race, tumor characteristics and breast cancer treatment were controlled, the presence of hypertension was associated with all cause survival [hazard ratio (HR) = 1.33, 95% confidence intervals (CI) 1.07-1.67] and it accounted for 30% of racial disparity in this outcome. Hypertension-augmented Charlson Comorbidity Index was a significant predictor of survival from all causes (HR = 1.32, 95%CI 1.18-1.49), competing causes (HR = 1.52, 95%CI 1.32-1.76) and breast cancer specific causes (HR = 1.18, 95%CI 1.03-1.35). In conclusion, hypertension has prognostic significance in relation to survival disparity between African-American and white breast cancer patients. If our findings are replicated in contemporary cohorts, it may be necessary to include hypertension in the Charlson Comorbidity Index and other comorbidity measures. PMID:19058216

  2. Adverse Fetal Outcomes Associated with Immunosuppressive Medications for Chronic Immune Mediated Diseases in Pregnancy

    PubMed Central

    Cooper, William O.; Cheetham, T. Craig; Li, De-Kun; Stein, C. Michael; Callahan, S. Todd; Morgan, Thomas M.; Shintani, Ayumi K.; Chen, Ning; Griffin, Marie R.; Ray, Wayne A.

    2014-01-01

    Objective We assessed the risk of adverse fetal outcomes following exposure to individual immunosuppressive drugs in pregnant women with chronic immune mediated diseases. Methods We used health plan data from Tennessee Medicaid and Kaiser Permanente Northern California and Southern California linked with vital records and medical records. Women with inflammatory arthropathies, systemic lupus erythematosus, and inflammatory bowel disease who filled prescriptions for immunosuppressive treatments during pregnancy were included. Major congenital malformations, fetal deaths, and life-threatening neonatal complications were identified from electronic data and validated with medical record review. Results The cohort included 608 infants, including 437 with exposure during pregnancy (402 first trimester, 35 second and third trimester only) and 171 whose mothers filled prescriptions for immunosuppressives before, but not during, pregnancy. There were 25 pregnancies (4.1% of the cohort) with confirmed major congenital malformations, 10 fetal deaths (1.6%), 23 life-threatening neonatal complications among preterm infants (20.4%), and 10 (2.1%) life-threatening complications among term infants. Compared to the reference group (medication treatment before, but not during, pregnancy), the risk ratios for adverse fetal outcomes associated with immunosuppressive use during pregnancy by exposure category included: methotrexate [risk ratio 1.39 (95% confidence interval 0.43,4.53)], tumor necrosis factor inhibitors [0.98 (0.38,2.55)], hydroxychloroquine [1.33 (0.69,2.55)], and other immunosuppressives [0.98, (0.48,1.98)]. Conclusions We found no evidence of a large increase in risk of adverse fetal outcomes from first trimester exposure to immunosuppressive medications, though confidence intervals for risk ratios were wide. Further studies will be needed as use of these medications increases over time. PMID:24504818

  3. Applications of machine learning and data mining methods to detect associations of rare and common variants with complex traits.

    PubMed

    Lu, Ake Tzu-Hui; Austin, Erin; Bonner, Ashley; Huang, Hsin-Hsiung; Cantor, Rita M

    2014-09-01

    Machine learning methods (MLMs), designed to develop models using high-dimensional predictors, have been used to analyze genome-wide genetic and genomic data to predict risks for complex traits. We summarize the results from six contributions to our Genetic Analysis Workshop 18 working group; these investigators applied MLMs and data mining to analyses of rare and common genetic variants measured in pedigrees. To develop risk profiles, group members analyzed blood pressure traits along with single-nucleotide polymorphisms and rare variant genotypes derived from sequence and imputation analyses in large Mexican American pedigrees. Supervised MLMs included penalized regression with varying penalties, support vector machines, and permanental classification. Unsupervised MLMs included sparse principal components analysis and sparse graphical models. Entropy-based components analyses were also used to mine these data. None of the investigators fully capitalized on the genetic information provided by the complete pedigrees. Their approaches either corrected for the nonindependence of the individuals within the pedigrees or analyzed only those who were independent. Some methods allowed for covariate adjustment, whereas others did not. We evaluated these methods using a variety of metrics. Four contributors conducted primary analyses on the real data, and the other two research groups used the simulated data with and without knowledge of the underlying simulation model. One group used the answers to the simulated data to assess power and type I errors. Although the MLMs applied were substantially different, each research group concluded that MLMs have advantages over standard statistical approaches with these high-dimensional data. PMID:25112194

  4. Patient Satisfaction and Perceived Success with a Telephonic Health Coaching Program: The Natural Experiments for Translation in Diabetes (NEXT-D) Study, Northern California, 2011

    PubMed Central

    Goler, Nancy C.; Sanna, Rashel S.; Boccio, Mindy; Bellamy, David J.; Brown, Susan D.; Neugebauer, Romain S.; Ferrara, Assiamira; Wiley, Deanne M.; Schmittdiel, Julie A.

    2013-01-01

    Introduction Health coaching can improve lifestyle behaviors known to prevent or manage chronic conditions such as diabetes. However, little is known about the patient experience with telephonic coaching programs in real-world care settings. We examined patient satisfaction, patients perceived success in achieving program goals, and the patient-level correlates of these outcomes in a voluntary telephonic coaching program at a large integrated health care delivery system in northern California. Methods Kaiser Permanente Northern California patients who participated in a telephonic coaching program in 2011 were sent a cross-sectional survey about their satisfaction with health coaching and perceived success with program goals. We examined associations with patient characteristics. Results The survey response rate was 34%; analyses were based on the 32% who completed the survey. Of those who had completed 2 or more sessions (n = 232 [52%]), most reported being satisfied (70%) or neutral (20%) with the program, and 71% would recommend health coaching. Healthy weight, healthful eating, and physical activity were the most common topics discussed (88%). Adjusting for demographic characteristics, 73% of those who had 2 or more sessions reported that health coaching helped achieve their weight-related goal. Outcomes were positively correlated with patient activation but not consistently correlated with patient demographic characteristics. Conclusion Levels of satisfaction and perceived success with telephonic health coaching provided by a health plan were high and positively correlated with the number of sessions completed and patient activation. Voluntary telephonic health coaching programs should promote retention and assess patients activation levels. PMID:24176083

  5. Risk of Revision Following Total Hip Arthroplasty: Metal-on-Conventional Polyethylene Compared with Metal-on-Highly Cross-Linked Polyethylene Bearing Surfaces

    PubMed Central

    Paxton, Elizabeth; Cafri, Guy; Havelin, Leif; Stea, Susanna; Pallis, Francesc; Graves, Stephen; Hoeffel, Daniel; Sedrakyan, Art

    2014-01-01

    The results of randomized controlled trials and systematic reviews have suggested reduced radiographic wear in highly cross-linked polyethylene compared with conventional polyethylene in primary total hip arthroplasty. However, longer-term clinical results have not been thoroughly examined, to our knowledge. The purpose of this study was to compare the risk of revision for metal-on-conventional and metal-on-highly cross-linked total hip arthroplasty bearing surfaces with use of a distributed data network of six national and regional registries (Kaiser Permanente, HealthEast, the Emilia-Romagna region in Italy, the Catalan region in Spain, Norway, and Australia). Inclusion criteria were osteoarthritis as the primary diagnosis, cementless implant fixation, and a patient age of forty-five to sixty-four years. These criteria resulted in a sample of 16,571 primary total hip arthroplasties. Multivariate meta-analysis was performed with use of linear mixed models, with survival probability as the unit of analysis. The results of a fixed-effects model suggested that there was insufficient evidence of a difference in risk of revision between bearing surfaces (hazard ratio, 1.20 [95% confidence interval, 0.80 to 1.79]; p = 0.384). Highly cross-linked polyethylene does not appear to have a reduced risk of revision in this subgroup of total hip arthroplasty patients. Arthroplasties involving highly cross-linked polyethylene do not appear to have an increased risk of revision in this subgroup of total hip arthroplasty patients. PMID:25520415

  6. Changes in vitamin and mineral supplement use after breast cancer diagnosis in the Pathways Study: a prospective cohort study

    PubMed Central

    2014-01-01

    Background Vitamin and mineral supplement use after a breast cancer diagnosis is common and controversial. Dosages used and the timing of initiation and/or discontinuation of supplements have not been clearly described. Methods We prospectively examined changes in use of 17 vitamin/mineral supplements in the first six months following breast cancer diagnosis among 2,596 members (28% non-white) of Kaiser Permanente Northern California. We used multivariable logistic regression to examine demographic, clinical, and lifestyle predictors of initiation and discontinuation. Results Most women used vitamin/mineral supplements before (84%) and after (82%) diagnosis, with average doses far in excess of Institute of Medicine reference intakes. Over half (60.2%) reported initiating a vitamin/mineral following diagnosis, 46.3% discontinuing a vitamin/mineral, 65.6% using a vitamin/mineral continuously, and only 7.2% not using any vitamin/mineral supplement before or after diagnosis. The most commonly initiated supplements were calcium (38.2%), vitamin D (32.01%), vitamin B6 (12.3%) and magnesium (11.31%); the most commonly discontinued supplements were multivitamins (17.14%), vitamin C (15.97%) and vitamin E (45.62%). Higher education, higher intake of fruits/vegetables, and receipt of chemotherapy were associated with initiation (p-values <0.05). Younger age and breast-conserving surgery were associated with discontinuation (p-values <0.05). Conclusions In this large cohort of ethnically diverse breast cancer patients, high numbers of women used vitamin/mineral supplements in the 6months following breast cancer diagnosis, often at high doses and in combination with other supplements. The immediate period after diagnosis is a critical time for clinicians to counsel women on supplement use. PMID:24884705

  7. CA5-04: Identifying Pregnancy Episodes in the Vaccine Safety Datalink

    PubMed Central

    Naleway, Allison; Gold, Rachel; Henninger, Michelle; Kurosky, Samantha; Riedlinger, Karen; Nordin, James; Kharbanda, Elyse; Weintraub, Eric

    2012-01-01

    Background/Aims The need for research on the safety of vaccination during pregnancy is widely recognized. Large, population-based data systems like the Vaccine Safety Datalink (VSD) may be useful for this research, but identifying pregnancies using electronic medical record (EMR) and claims data can be challenging. Methods We modified an existing pregnancy identification algorithm originally developed by Kaiser Permanente Northwest to identify pregnancy outcomes and dates using the standardized VSD data files. We validated the algorithm by calculating the percent agreement in pregnancy outcome type, end date, and gestational age between the algorithm and manual medical record review. At each site, we randomly sampled 15 episodes within four outcome type strata (live births, spontaneous abortions, elective abortions, and other pregnancy outcomes) for a total of 60 episodes per site. Seven of eight VSD sites participated. Results We identified 595,929 pregnancy episodes ending in 20022006 among women 1255 years of age. Of these pregnancies, 75% ended in live births, 12% in spontaneous abortions, and 9% in elective abortions. We were able to confirm a pregnancy on or near the algorithm-specified pregnancy start and end dates for 99% of live births, 93% of spontaneous abortions, 92% of elective abortions, and 90% of other outcomes. The agreement between the algorithm-identified and the abstractor- indentified outcome date ranged from 70% (elective abortion) to 96% (live birth) depending on outcome type. When gestational age was available in the EMR, agreement ranged from 82% (other) to 98% (live birth) depending on outcome type. Discussion The VSD algorithm accurately identifies pregnancy episodes across participating sites using the standardized VSD data files. Additional manual record review may be needed to improve the precision of the pregnancy date estimates depending on specific study needs. This algorithm will allow us to conduct large, population-based studies of the safety of vaccination during pregnancy.

  8. The Vitamin D Antenatal Asthma Reduction Trial (VDAART): Rationale, design, and methods of a randomized, controlled trial of vitamin D supplementation in pregnancy for the primary prevention of asthma and allergies in children

    PubMed Central

    Litonjua, Augusto A.; Lange, Nancy E.; Carey, Vincent J.; Brown, Stacey; Laranjo, Nancy; O’Connor, George T.; Sandel, Megan; Strunk, Robert C.; Bacharier, Leonard B.; Zeiger, Robert S.; Schatz, Michael; Hollis, Bruce W.; Weiss, Scott T.

    2014-01-01

    There is intense interest in the role of vitamin D in the development of asthma and allergies. However, studies differ on whether a higher vitamin D intake or status in pregnancy or at birth is protective against asthma and allergies. To address this uncertainty, the Vitamin D Antenatal Asthma Reduction Trial (VDAART) was developed. VDAART is a randomized, double-blind, placebo-controlled trial of vitamin D supplementation in pregnant women to determine whether prenatal supplementation can prevent the development of asthma and allergies in the women’s offspring. A secondary aim is to determine whether vitamin D supplementation can prevent the development of pregnancy complications, such as preeclampsia, preterm birth, and gestational diabetes. Women were randomized to the treatment arm of 4,000 IU/day of vitamin D3 plus a daily multivitamin that contained 400 IU of vitamin D3 or the placebo arm of placebo plus a multivitamin that contained 400 IU daily of vitamin D3. Women who were between the gestational ages of 10–18 weeks were randomized from three clinical centers across the United States – Boston Medical Center, Washington University in St. Louis, and Kaiser Permanente Southern California Region (San Diego, CA). Supplementation took place throughout pregnancy. Monthly monitoring of urinary calcium to creatinine ratio was performed in addition to medical record review for adverse events. Offspring are being evaluated quarterly through questionnaires and yearly during in-person visits until the 3rd birthday of the child. Ancillary studies will investigate neonatal T-regulatory cell function, maternal vaginal flora, and maternal and child intestinal flora. PMID:24614387

  9. TRENDS IN TIME TO CONFIRMATION AND RECOGNITION OF NEW-ONSET HYPERTENSION, 20022006

    PubMed Central

    Selby, Joe V.; Lee, Janelle; Swain, Bix E; Tavel, Heather M.; Ho, P. Michael; Margolis, Karen L.; O'Connor, Patrick J.; Fine, Lawrence; Schmittdiel, Julie A.; Magid, David. J.

    2010-01-01

    Achieving full benefits of blood pressure control in populations requires prompt recognition of previously undetected hypertension. In 2003, JNC VII provided definitions of hypertension and recommended that single elevated readings be confirmed within 12 months. We sought to determine whether the time required to confirm and recognize (i.e., diagnose and/or treat) new-onset hypertension decreased from 2002 to 2006 for adult members of two large integrated health care delivery systems, Kaiser Permanente Northern California and Colorado. Using electronically stored office blood pressure readings, physician diagnoses and pharmacy prescriptions, we identified 200,587 patients with new-onset hypertension (20022006) marked by two consecutive elevated blood pressure readings in previously undiagnosed, untreated members. Mean confirmation intervals (time from the first to second consecutive elevated reading) declined steadily from 103 to 89 days during this period. For persons recognized within 12 months following confirmation, the mean interval to recognition declined from 78 to 61 days. However, only 33% of individuals were recognized within 12 months. One third were never recognized during observed follow-up. For these patients, most subsequent blood pressure recordings were not elevated. Higher initial blood pressure levels, history of previous cardiovascular disease, and older age were associated with shorter times to recognition. Times to confirmation and recognition of new-onset hypertension have become shorter in recent years, especially for patients with higher cardiovascular disease risk. Variability in office-based blood pressure readings suggests that further improvements in recognition and treatment may be achieved with more specific automated approaches to identifying hypertension. PMID:20733092

  10. Maternal Hyperglycemia During Pregnancy Predicts Adiposity of the Offspring

    PubMed Central

    Ferrara, Assiamira; Windham, Gayle C.; Greenspan, Louise C.; Deardorff, Julianna; Hiatt, Robert A.; Quesenberry, Charles P.; Laurent, Cecile; Mirabedi, Anousheh S.; Kushi, Lawrence H.

    2014-01-01

    OBJECTIVE To investigate associations between maternal pregnancy hyperglycemia, gestational diabetes mellitus (GDM), and offspring adiposity. RESEARCH DESIGN AND METHODS We evaluated these associations in a longitudinal study of 421 mother-daughter pairs at Kaiser Permanente Northern California. Maternal pregnancy glucose values were obtained from maternal medical records. Outcomes included three measures of girls’ adiposity, measured annually: 1) ≥85th age-specific percentile for BMI; 2) percent body fat (%BF); and 3) waist-to-height ratio (WHR). RESULTS Adjusting for maternal age at delivery, race/ethnicity, pregravid BMI, girl’s age, and girl’s age at onset of puberty, having a mother with GDM increased a girl’s risk of having a BMI ≥85th percentile or having %BF or WHR in the highest quartile (Q4), compared with those in the lowest quintile of blood glucose (odds ratio [OR] 3.56 [95% CI 1.28–9.92]; OR 3.13 [95% CI 1.08–9.09]; and OR 2.80 [95% CI 1.00–7.84], respectively). There was a significant interaction between the presence of GDM and pregravid BMI; girls whose mothers had both risk factors had the highest odds of having a BMI ≥85th percentile (OR 5.56 [95%CI 1.70–18.2]; Q4 %BF, OR 6.04 [95%CI 1.76–20.7]; and Q4 WHR, OR 3.60 [95%CI 1.35–9.58]). Similar, although weaker, associations were found in the association between hyperglycemia and offspring adiposity. CONCLUSIONS Girls who were exposed to maternal GDM or hyperglycemia in utero are at higher risk of childhood adiposity; risk increases if the mother is overweight or obese. Screening and intervention for this high-risk group is warranted to slow the intergenerational transmission of obesity and its sequelae. PMID:25150158

  11. Embrace, a model for integrated elderly care: study protocol of a randomized controlled trial on the effectiveness regarding patient outcomes, service use, costs, and quality of care

    PubMed Central

    2013-01-01

    Background Ongoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. The Chronic Care Model (CCM), combined with classification for care needs based on Kaiser Permanente (KP) Triangle, may offer a suitable framework for change. The aim of the present study is to investigate the effectiveness of Embrace, a population-based model for integrated elderly care, regarding patient outcomes, service use, costs, and quality of care. Methods/Design The CCM and the KP Triangle were translated to the Dutch setting and adapted to the full elderly population living in the community. A randomized controlled trial with balanced allocation was designed to test the effectiveness of Embrace. Eligible elderly persons are 75 years and older and enrolled with one of the participating general practitioner practices. Based on scores on the INTERMED-Elderly Self-Assessment and Groningen Frailty Indicator, participants will be stratified into one of three strata: (A) robust; (B) frail; and (C) complex care needs. Next, participants will be randomized per stratum to Embrace or care as usual. Embrace encompasses an Elderly Care Team per general practitioner practice, an Electronic Elderly Record System, decision support instruments, and a self-management support and prevention program combined with care and support intensity levels increasing from stratum A to stratum C. Primary outcome variables are patient outcomes, service use, costs, and quality of care. Data will be collected at baseline, twelve months after starting date, and during the intervention period. Discussion This study could provide evidence for the effectiveness of Embrace. Trial registration The Netherlands National Trial Register NTR3039 PMID:23782932

  12. Hepatitis C screening trends in a large integrated health system

    PubMed Central

    Linas, Benjamin P.; Hu, Haihong; Barter, Devra M.; Horberg, Michael

    2014-01-01

    Background As new hepatitis C virus (HCV) therapies emerge, only 112% of individuals are screened in the U.S. for HCV infection. Presently, HCV screening trends are unknown. Methods We utilized the Kaiser Permanente Mid-Atlantic States (KPMAS) data repository to investigate HCV antibody screening between 1/1/2003 and 12/31/2012. We identified the proportion screened for HCV and 5-year cumulative incidence of screening, the screening positivity rate, the provider types performing HCV screening, patient-level factors associated with being screened, and trends in screening over time. Results 444,594 patients met the inclusion criteria. Overall, 15.8% of the cohort was ever screened for HCV. Adult primary care and obstetrics and gynecology providers performed 75.9% of all screening. The overall test positivity rate was 3.8%. Screening was more frequent in younger age groups (p<0.0001) and those with a documented history of illicit drug use (p<0.0001). Patients with missing drug use history (46.7%) were least likely to be screened (p<0.0001). While the rate of HCV screening increased in the later years of the study, among those enrolled in KPMAS 20092012, only 11.8% were screened by the end of follow-up. Conclusion Screening for HCV is increasing, but remains incomplete. Targeting screening to those with a history of injection drug will not likely expand screening, as nearly half of patients have no documented drug use history. Routine screening is likely the most effective approach to expand HCV screening. PMID:24486288

  13. Colon Cancer Survival With Herbal Medicine and Vitamins Combined With Standard Therapy in a Whole-Systems Approach: Ten-Year Follow-up Data Analyzed With Marginal Structural Models and Propensity Score Methods

    PubMed Central

    McCulloch, Michael; Broffman, Michael; van der Laan, Mark; Hubbard, Alan; Kushi, Lawrence; Abrams, Donald I.; Gao, Jin; Colford, John M.

    2014-01-01

    Although localized colon cancer is often successfully treated with surgery, advanced disease requires aggressive systemic therapy that has lower effectiveness. Approximately 30% to 75% of patients with colon cancer use complementary and alternative medicine (CAM), but there is limited formal evidence of survival efficacy. In a consecutive case series with 10-year follow-up of all colon cancer patients (n = 193) presenting at a San Francisco Bay-Area center for Chinese medicine (Pine Street Clinic, San Anselmo, CA), the authors compared survival in patients choosing short-term treatment lasting the duration of chemotherapy/radiotherapy with those continuing long-term. To put these data into the context of treatment responses seen in conventional medical practice, they also compared survival with Pan-Asian medicine + vitamins (PAM+V) with that of concurrent external controls from Kaiser Permanente Northern California and California Cancer Registries. Kaplan-Meier, traditional Cox regression, and more modern methods were used for causal inferencenamely, propensity score and marginal structural models (MSMs), which have not been used before in studies of cancer survival and Chinese herbal medicine. PAM+V combined with conventional therapy, compared with conventional therapy alone, reduced the risk of death in stage I by 95%, stage II by 64%, stage III by 29%, and stage IV by 75%. There was no significant difference between short-term and long-term PAM+V. Combining PAM+V with conventional therapy improved survival, compared with conventional therapy alone, suggesting that prospective trials combining PAM+V with conventional therapy are justified. PMID:21964510

  14. Bone Health History in Breast Cancer Patients on Aromatase Inhibitors

    PubMed Central

    Kwan, Marilyn L.; Lo, Joan C.; Tang, Li; Laurent, Cecile A.; Roh, Janise M.; Chandra, Malini; Hahn, Theresa E.; Hong, Chi-Chen; Sucheston-Campbell, Lara; Hershman, Dawn L.; Quesenberry, Charles P.; Ambrosone, Christine B.; Kushi, Lawrence H.; Yao, Song

    2014-01-01

    A cross-sectional study was performed to assess bone health history among aromatase inhibitor (AI) users before breast cancer (BC) diagnosis, which may impact fracture risk after AI therapy and choice of initial hormonal therapy. A total of 2,157 invasive BC patients initially treated with an AI were identified from a prospective cohort study at Kaiser Permanente Northern California (KPNC). Data on demographic and lifestyle factors were obtained from in-person interviews, and bone health history and clinical data from KPNC clinical databases. The prevalence of osteoporosis and fractures in postmenopausal AI users was assessed, compared with 325 postmenopausal TAM users. The associations of bone health history with demographic and lifestyle factors in AI users were also examined. Among all initial AI users, 11.2% had a prior history of osteoporosis, 16.3% had a prior history of any fracture, and 4.6% had a prior history of major fracture. Postmenopausal women who were taking TAM as their initial hormonal therapy had significantly higher prevalence of prior osteoporosis than postmenopausal AI users (21.5% vs. 11.8%, p<0.0001). Among initial AI users, the associations of history of osteoporosis and fracture in BC patients with demographic and lifestyle factors were, in general, consistent with those known in healthy older women. This study is one of the first to characterize AI users and risk factors for bone morbidity before BC diagnosis. In the future, this study will examine lifestyle, molecular, and genetic risk factors for AI-induced fractures. PMID:25354083

  15. Practical Methods to Increase Use of Advance Medical Directives

    PubMed Central

    Brown, Jonathan Betz; Beck, Arne; Boles, Myde; Barrett, Paul

    1999-01-01

    OBJECTIVE To compare the effectiveness of two means for increasing the use of advance medical directives: written materials only versus written materials and an educational videotape. DESIGN Population-based, randomized controlled trial with 3-month follow up. SETTING Kaiser Permanente Colorado Region, a not-for-profit group-model health maintenance organization. PARTICIPANTS A population-based sample of all 1,302 members aged 75 years and older who used the Franklin Medical Office, excluding 55 persons who died or disenrolled during the study period or were identified by their physicians as blind or cognitively impaired. INTERVENTIONS All subjects were mailed a 10-page cartoon-illustrated educational pamphlet on patient choices, a selection of Colorado advance medical directive forms, and a guide to their completion; 619 subjects also were mailed a 20-minute videotape on advance directives. Both groups had access to a study nurse for assistance in completing and placing advance medical directives. MEASUREMENTS AND MAIN RESULTS The main outcome measure is the proportion of subjects who placed a directive in their medical record for the first time. Placement rates increased almost identically, from 21.2% to 35.0% in the written materials-only group and from 18.9% to 32.6% in the group receiving the videotape (95% confidence interval for difference −0.04, 0.04, p = .952). CONCLUSIONS In an elderly population with a substantial baseline placement rate, mailing of written materials substantially increased placement of an advance directive in the medical record, but the addition of a videotape did not. Mailing the video did increase the use of treatment trials and made patients more aware of reasons not to use advance directives. PMID:9893087

  16. Immune mediated conditions in autism spectrum disorders.

    PubMed

    Zerbo, Ousseny; Leong, Albin; Barcellos, Lisa; Bernal, Pilar; Fireman, Bruce; Croen, Lisa A

    2015-05-01

    We conducted a case-control study among members of Kaiser Permanente Northern California (KPNC) born between 1980 and 2003 to determine the prevalence of immune-mediated conditions in individuals with autism, investigate whether these conditions occur more often than expected, and explore the timing of onset relative to autism diagnosis. Cases were children and young adults with at least two autism diagnoses recorded in outpatient records (n=5565). Controls were children without autism randomly sampled at a ratio of 5 to 1, matched to cases on birth year, sex, and length of KPNC membership (n=27,825). The main outcomes - asthma, allergies, and autoimmune diseases - were identified from KPNC inpatient and outpatient databases. Chi-square tests were used to evaluate case-control differences. Allergies and autoimmune diseases were diagnosed significantly more often among children with autism than among controls (allergy: 20.6% vs. 17.7%, Crude odds ratio (OR)=1.22, 95% confidence interval (CI) 1.13-1.31; autoimmune disease: 1% vs. 0.76%, OR=1.36, 95% CI 1.01-1.83), and asthma was diagnosed significantly less often (13.7% vs. 15.9%; OR=0.83, 95% CI 0.76-0.90). Psoriasis occurred more than twice as often in cases than in controls (0.34% vs. 0.15%; OR=2.35, 95% CI 1.36-4.08). Our results support previous observations that children with autism have elevated prevalence of specific immune-related comorbidities. PMID:25681541

  17. Too far ahead of the IT curve?

    PubMed

    Glaser, John P

    2007-01-01

    Peachtree Healthcare has major IT infrastructure problems, and CEO Max Berndt is struggling to find the right fix. He can go with a single set of systems and applications that will provide consistency across Peachtree's facilities but may not give doctors enough flexibility. Or he can choose service-oriented architecture (SOA), a modular design that will allow Peachtree to standardize incrementally and selectively but poses certain risks as a newer technology. What should he do? Four experts comment on this fictional case study, authored by John P. Glaser, CIO for Partners HealthCare System. George C. Halvorson, the chairman and CEO of Kaiser Permanente, warns against using untested methodologies such as SOA in a health care environment, where lives are at stake. He says Peachtree's management must clarify its overall IT vision before devising a plan to achieve each of its objectives. Monte Ford, the chief information officer at American Airlines, says Peachtree can gradually replace its old systems with SOA. An incremental approach, he points out, would not only minimize risk but also enhance flexibility and control, and would allow IT to shift priorities along the way. Randy Heffner, a vice president at Forrester Research who focuses on technology architectures for computer-based business systems, thinks SOA's modular approach to business design would best meet Peachtree's need for flexibility. He says that Peachtree's CIO sees SOA as a new product category but should instead view it as a methodology. John A. Kastor, a professor at the University of Maryland School of Medicine, questions the goal of standardized care. He argues that it would be difficult to persuade doctors, many of whom are fiercely independent, to follow rigid patterns in their work. PMID:17642124

  18. Timely detection of localized excess influenza activity in Northern California across patient care, prescription, and laboratory data.

    PubMed

    Greene, Sharon K; Kulldorff, Martin; Huang, Jie; Brand, Richard J; Kleinman, Kenneth P; Hsu, John; Platt, Richard

    2011-02-28

    Timely detection of clusters of localized influenza activity in excess of background seasonal levels could improve situational awareness for public health officials and health systems. However, no single data type may capture influenza activity with optimal sensitivity, specificity, and timeliness, and it is unknown which data types could be most useful for surveillance. We compared the performance of 10 types of electronic clinical data for timely detection of influenza clusters throughout the 2007/08 influenza season in northern California. Kaiser Permanente Northern California generated zip code-specific daily episode counts for: influenza-like illness (ILI) diagnoses in ambulatory care (AC) and emergency departments (ED), both with and without regard to fever; hospital admissions and discharges for pneumonia and influenza; antiviral drugs dispensed (Rx); influenza laboratory tests ordered (Tests); and tests positive for influenza type A (FluA) and type B (FluB). Four credible events of localized excess illness were identified. Prospective surveillance was mimicked within each data stream using a space-time permutation scan statistic, analyzing only data available as of each day, to evaluate the ability and timeliness to detect the credible events. AC without fever and Tests signaled during all four events and, along with Rx, had the most timely signals. FluA had less timely signals. ED, hospitalizations, and FluB did not signal reliably. When fever was included in the ILI definition, signals were either delayed or missed. Although limited to one health plan, location, and year, these results can inform the choice of data streams for public health surveillance of influenza. PMID:21312219

  19. Profil épidémiologique de l'insuffisance rénale terminale à l'hôpital Militaire de Rabat, Maroc

    PubMed Central

    Asserraji, Mohammed; Maoujoud, Omar; Belarbi, Marouane; Oualim, Zouhir

    2015-01-01

    L'Insuffisance rénale chronique terminale (IRCT) est un enjeu majeur de sante publique au Maroc à cause de ses conséquences médicales et socioéconomiques. L'objectif de ce travail est d’évaluer le profil épidémiologique de l'IRCT à l'hôpital militaire de rabat, Maroc. Il s'agit d'une enquête rétrospective pendant quatre ans (1er janvier 2007 au 31 décembre 2010). Tous les cas d'IRCT (diminution permanente du débit de filtration glomérulaire (DFG) < 15 ml/min/1.73m2, pendant ≥ 3 mois) ont été inclus. 203 patients ont commencé la dialyse durant cette période, 130 hommes (64%) et 73 femmes (36%), l’âge moyen était de 49,92 ans (06 - 80 ans). la néphropathie d'origine indéterminée représente la première cause d'IRCT dans notre série (27,1%) suivie de la néphropathie diabétique (24,6%), des glomérulonéphrites chroniques (22,7) et de la néphropathie d'origine vasculaire (10,8%). 131 patients (64,5%) n'ont pas eu de suivi néphrologique pré dialytique. une prise en charge globale de cette pathologie est nécessaire. PMID:26309471

  20. Characterizing Race/Ethnicity and Genetic Ancestry for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort.

    PubMed

    Banda, Yambazi; Kvale, Mark N; Hoffmann, Thomas J; Hesselson, Stephanie E; Ranatunga, Dilrini; Tang, Hua; Sabatti, Chiara; Croen, Lisa A; Dispensa, Brad P; Henderson, Mary; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H; Ludwig, Dana; Olberg, Diane; Quesenberry, Charles P; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C; Sciortino, Stanley; Shen, Ling; Smethurst, David; Somkin, Carol P; Van Den Eeden, Stephen K; Walter, Lawrence; Whitmer, Rachel A; Kwok, Pui-Yan; Schaefer, Catherine; Risch, Neil

    2015-08-01

    Using genome-wide genotypes, we characterized the genetic structure of 103,006 participants in the Kaiser Permanente Northern California multi-ethnic Genetic Epidemiology Research on Adult Health and Aging Cohort and analyzed the relationship to self-reported race/ethnicity. Participants endorsed any of 23 race/ethnicity/nationality categories, which were collapsed into seven major race/ethnicity groups. By self-report the cohort is 80.8% white and 19.2% minority; 93.8% endorsed a single race/ethnicity group, while 6.2% endorsed two or more. Principal component (PC) and admixture analyses were generally consistent with prior studies. Approximately 17% of subjects had genetic ancestry from more than one continent, and 12% were genetically admixed, considering only nonadjacent geographical origins. Self-reported whites were spread on a continuum along the first two PCs, indicating extensive mixing among European nationalities. Self-identified East Asian nationalities correlated with genetic clustering, consistent with extensive endogamy. Individuals of mixed East Asian-European genetic ancestry were easily identified; we also observed a modest amount of European genetic ancestry in individuals self-identified as Filipinos. Self-reported African Americans and Latinos showed extensive European and African genetic ancestry, and Native American genetic ancestry for the latter. Among 3741 genetically identified parent-child pairs, 93% were concordant for self-reported race/ethnicity; among 2018 genetically identified full-sib pairs, 96% were concordant; the lower rate for parent-child pairs was largely due to intermarriage. The parent-child pairs revealed a trend toward increasing exogamy over time; the presence in the cohort of individuals endorsing multiple race/ethnicity categories creates interesting challenges and future opportunities for genetic epidemiologic studies. PMID:26092716

  1. Association Between Anti-TNF-? Therapy and Interstitial Lung Disease

    PubMed Central

    Herrinton, Lisa J.; Harrold, Leslie R.; Liu, Liyan; Raebel, Marsha A.; Taharka, Ananse; Winthrop, Kevin L.; Solomon, Daniel H.; Curtis, Jeffrey R.; Lewis, James D.; Saag, Kenneth G.

    2013-01-01

    Background Anti-TNF-? agents have been hypothesized to increase the risk of interstitial lung disease (ILD), including its most severe manifestation, pulmonary fibrosis. Methods We conducted a cohort study among autoimmune disease patients who were members of Kaiser Permanente Northern California, 19982007. We obtained therapies from pharmacy data and diagnoses of ILD from review of X-ray and computed tomography reports. We compared new users of anti-TNF-? agents to new users of non-biologic therapies using Cox proportional hazards analysis to adjust for baseline propensity scores and time-varying use of glucocorticoids. We also made head-to-head comparisons between anti-TNF-? agents. Results Among the 8,417 persons included in the analysis, 38 (0.4%) received a diagnostic code for ILD by the end of follow-up, including 23 of 4,200 (0.5%) who used anti-TNF-? during study follow-up, and 15 of 5,423 (0.3%) who used only non-biologic therapies. The age- and gender-standardized incidence rate of ILD, per 100 person-years, was 0.21 (95% CI 00.43) for rheumatoid arthritis and appreciably lower for other autoimmune diseases. Compared to use of non-biologic therapies, use of anti-TNF-? therapy was not associated with a diagnosis of ILD among RA patients (adjusted hazard ratio, 1.03; 95% CI 0.512.07). Nor did head-to-head comparisons across anti-TNF-? agents suggest important differences in risk, although the number of cases available for analysis was limited. Conclusion The study provides evidence that compared to non-biologic therapies anti-TNF-? therapy does not increase the occurrence of ILD among patients with autoimmune diseases, and informs research design of future safety studies of ILD. PMID:23359391

  2. Pneumococcal conjugate vaccines and otitis media: an appraisal of the clinical trials.

    PubMed

    Fletcher, Mark A; Fritzell, Bernard

    2012-01-01

    Streptococcus pneumoniae is the predominant otitis media pathogen and its prevention through effective vaccination could diminish childhood illness and antibiotic use. This paper reviews 5 pneumococcal conjugate vaccine (PCV) trials that used otitis media as an endpoint: Northern California Kaiser Permanente (NCKP; vaccine, 7-valent PCV [PCV7]-CRM); Finnish Otitis Media (FinOM; vaccines, PCV7-CRM or PCV7-OMPC); Native American Trial (vaccine, PCV7-CRM); Pneumococcal Otitis Efficacy Trial (POET; vaccine, 11-valent PCV [PCV11]-PD). For the microbiological endpoint, vaccine efficacy against vaccine-serotype pneumococcal otitis media was about 60% across trials. Against the clinical endpoint of all episodes, vaccine efficacy was 7% (PCV7-CRM/NCKP), 6% (PCV7-CRM/FinOM), -1% (PCV7-OMPC/FinOM), and -0.4% (PCV7-CRM/Native American Trial); 34% against first episodes of ear, nose, and throat specialist-referral cases (PCV11-PD/POET). Both follow-up through 2 years of age, for the 5 trials, and long-term follow-up, for PCV7-CRM/NCKP and PCV7-CRM/FinOM, demonstrated greater vaccine efficacy against recurrent AOM and tympanostomy-tube placement, suggesting that vaccination against early episodes of AOM may prevent subsequent episodes of complicated otitis media. Although study designs varied by primary endpoint measured, age at follow-up, source of middle-ear fluid for culture, case ascertainment, and type of randomization, each clinical trial demonstrated vaccine efficacy against microbiological and/or clinical otitis media. PMID:22701486

  3. Effectiveness of a new health care organization model in primary care for chronic cardiovascular disease patients based on a multifactorial intervention: the PROPRESE randomized controlled trial

    PubMed Central

    2013-01-01

    Background To evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals. Methods/design Experimental study. Randomized clinical trial. Follow-up period: one year. Study setting: primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records. Intervention components: a) Organizational intervention on the patient/professional relationship. Centered on the Chronic Care Model, the Stanford Expert Patient Program and the Kaiser Permanente model: Teamwork, informed and active patient, decision making shared with the patient, recommendations based on clinical guidelines, single electronic medical history per patient that allows the use of indicators for risk monitoring and stratification. b) Formative strategy for professionals: 4 face-to-face training workshops (one every 3months), monthly update clinical sessions, online tutorial by a cardiologist, availability through the intranet of the action protocol and related documents. Measurements: Blood pressure, blood glucose, HbA1c, lipid profile and smoking. Frequent health care visits. Number of hospitalizations related to vascular disease. Therapeutic compliance. Drug use. Discussion This study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life, number of visits, and number of hospitalizations. Trial registration NCT01826929 PMID:23915267

  4. Sentinel Lymph Node Biopsy for Patients with Breast Cancer: Five-Year Experience

    PubMed Central

    Godfrey, Richard S; Holmes, Dennis R; Kumar, Anjali S; Kutner, Susan E

    2005-01-01

    Background: Sentinel lymph node biopsy (SLNB) is rapidly gaining acceptance as a diagnostic tool for staging breast cancer. Objective: Analyze trends among surgeons and facilities in Kaiser Permanente Northern California (KPNC) in adopting SLNB to stage cases of breast cancer and assess success in locating the sentinel node. Methods: Retrospective review of data for patients whose breast cancer was staged using SLNB and axillary lymph node dissection between July 1997 through December 2002 at KPNC. Rates of false-negative results were calculated and stratified by surgeons' experience with SLNB. Results: The number of SLNB procedures performed each month increased steadily from fewer than ten (in late 1998) to about 80 per month (in mid-2002) and were done at 17 facilities. Of the 132 surgeons who performed SLNB, most had done fewer than 15 procedures. The false-negative result rate overall was 6.53% (95% CI 4.75%, 8.73%); for surgeons who performed <30 procedures the rate was 8.58% (95% CI 5.52%, 12.60%); for surgeons who performed 20 to 30 procedures the rate was 13.08% (95% CI 7.34%, 20.98%); and for surgeons who performed more than 30 procedures the rate was 5.05% (95% CI 3.07%, 7.78%). Conclusions: SLNB is rapidly being adopted at KPNC to stage cases of breast cancer and surgeons achieve an acceptable 6.53% false-negative result rate overall. The higher false-negative rate for surgeons who performed 20 to 30 procedures suggests that departments should expand efforts to monitor and proctor these surgeons. PMID:21687490

  5. Cluster radioactive decay within the preformed cluster model using relativistic mean-field theory densities

    SciTech Connect

    Singh, BirBikram; Patra, S. K.; Gupta, Raj K.

    2010-07-15

    We have studied the (ground-state) cluster radioactive decays within the preformed cluster model (PCM) of Gupta and collaborators [R. K. Gupta, in Proceedings of the 5th International Conference on Nuclear Reaction Mechanisms, Varenna, edited by E. Gadioli (Ricerca Scientifica ed Educazione Permanente, Milano, 1988), p. 416; S. S. Malik and R. K. Gupta, Phys. Rev. C 39, 1992 (1989)]. The relativistic mean-field (RMF) theory is used to obtain the nuclear matter densities for the double folding procedure used to construct the cluster-daughter potential with M3Y nucleon-nucleon interaction including exchange effects. Following the PCM approach, we have deduced empirically the preformation probability P{sub 0}{sup emp} from the experimental data on both the alpha- and exotic cluster-decays, specifically of parents in the trans-lead region having doubly magic {sup 208}Pb or its neighboring nuclei as daughters. Interestingly, the RMF-densities-based nuclear potential supports the concept of preformation for both the alpha and heavier clusters in radioactive nuclei. P{sub 0}{sup a}lpha{sup (emp)} for alpha decays is almost constant (approx10{sup -2}-10{sup -3}) for all the parent nuclei considered here, and P{sub 0}{sup c(emp)} for cluster decays of the same parents decrease with the size of clusters emitted from different parents. The results obtained for P{sub 0}{sup c(emp)} are reasonable and are within two to three orders of magnitude of the well-accepted phenomenological model of Blendowske-Walliser for light clusters.

  6. Predicting the Risk of Clostridium difficile Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts

    PubMed Central

    Kuntz, Jennifer L; Smith, David H; Petrik, Amanda F; Yang, Xiuhai; Thorp, Micah L; Barton, Tracy; Barton, Karen; Labreche, Matthew; Spindel, Steven J; Johnson, Eric S

    2016-01-01

    Introduction: Increasing morbidity and health care costs related to Clostridium difficile infection (CDI) have heightened interest in methods to identify patients who would most benefit from interventions to mitigate the likelihood of CDI. Objective: To develop a risk score that can be calculated upon hospital admission and used by antimicrobial stewards, including pharmacists and clinicians, to identify patients at risk for CDI who would benefit from enhanced antibiotic review and patient education. Methods: We assembled a cohort of Kaiser Permanente Northwest patients with a hospital admission from July 1, 2005, through December 30, 2012, and identified CDI in the six months following hospital admission. Using Cox regression, we constructed a score to identify patients at high risk for CDI on the basis of preadmission characteristics. We calculated and plotted the observed six-month CDI risk for each decile of predicted risk. Results: We identified 721 CDIs following 54,186 hospital admissionsa 6-month incidence of 13.3 CDIs/1000 patient admissions. Patients with the highest predicted risk of CDI had an observed incidence of 53 CDIs/1000 patient admissions. The score differentiated between patients who do and do not develop CDI, with values for the extended C-statistic of 0.75. Predicted risk for CDI agreed closely with observed risk. Conclusion: Our risk score accurately predicted six-month risk for CDI using preadmission characteristics. Accurate predictions among the highest-risk patient subgroups allow for the identification of patients who could be targeted for and who would likely benefit from review of inpatient antibiotic use or enhanced educational efforts at the time of discharge planning. PMID:26845084

  7. Stroke and Bleeding Risk Associated With Antithrombotic Therapy for Patients With Nonvalvular Atrial Fibrillation in Clinical Practice

    PubMed Central

    An, JaeJin; Niu, Fang; Lang, Daniel T; Jazdzewski, Kristin P; Le, Paul T; Rashid, Nazia; Meissner, Brian; Mendes, Robert; Dills, Diana G; Aranda, Gustavus; Bruno, Amanda

    2015-01-01

    Background The quality of antithrombotic therapy for patients with nonvalvular atrial fibrillation during routine medical care is often suboptimal. Evidence linking stroke and bleeding risk with antithrombotic treatment is limited. The purpose of this study was to evaluate the associations between antithrombotic treatment episodes and outcomes. Methods and Results A retrospective longitudinal observational cohort study was conducted using patients newly diagnosed with nonvalvular atrial fibrillation with 1 or more stroke risk factors (CHADS2 ≥1) in Kaiser Permanente Southern California between January 1, 2006 and December 31, 2011. A total of 1782 stroke and systemic embolism (SE) and 3528 major bleed events were identified from 23 297 patients during the 60 021 person-years of follow-up. The lowest stroke/SE rates and major bleed rates were observed in warfarin time in therapeutic range (TTR) ≥55% episodes (stroke/SE: 0.87 [0.71 to 1.04]; major bleed: 4.91 [4.53 to 5.28] per 100 person-years), which was similar to the bleed rate in aspirin episodes (4.95 [4.58 to 5.32] per 100 person-years). The warfarin TTR ≥55% episodes were associated with a 77% lower risk of stroke/SE (relative risk=0.23 [0.18 to 0.28]) compared to never on therapy; and the warfarin TTR <55% and on-aspirin episodes were associated with a 20% lower and with a 26% lower risk of stroke/SE compared to never on therapy, respectively. The warfarin TTR <55% episodes were associated with nearly double the risk of a major bleed compared to never on therapy (relative risk=1.93 [1.74 to 2.14]). Conclusions Continuation of antithrombotic therapy as well as maintaining an adequate level of TTR is beneficial to prevent strokes while minimizing bleeding events. PMID:26187996

  8. Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin

    PubMed Central

    Schelonka, Lee P; SaBell, Margaret A

    2015-01-01

    Purpose This study aimed to determine whether switching from balanced salt solution (BSS) to vancomycin 20 g/mL BSS for incision hydration and eye pressurization reduces the rate of postcataract endophthalmitis. Methods This was a patient safety/quality improvement project, including all patients undergoing cataract surgery at the Kaiser Permanente Colorado Ophthalmology Department from January 2002 to December 2014. Throughout the study, patients received vancomycin 20 ?g/mL in the irrigating solution. During the baseline period from 2002 to 2005, surgeons pressurized eyes and hydrated incisions with plain BSS. During the intervention period from 2006 through 2014, surgeons switched from BSS to the vancomycin/BSS irrigating solution for eye pressurization and incision hydration. Results A total of 57,263 cataract operations were performed by 24 surgeons at seven surgical centers: 12,400 in the baseline period and 44,863 in the intervention period. The rate of post-cataract endophthalmitis declined significantly from 5/12,400 (rate: 0.4/1,000) in the baseline period to 1/44,863 (rate: 0.022/1,000) during the intervention period (odds ratio [OR]: 18.1, 95% confidence interval [CI]: 2.11154.9; ?2=13.5, P=0.00024). Accounting for an estimated 2.05-fold risk reduction due to confounding variables, the risk reduction attributed to the intervention remained significant: (adjusted OR: 8.78, 95% CI: 1.7344.5; ?2=10.06, P=0.0015). Since 2009, we have not experienced any cases of postcataract endophthalmitis after 32,753 operations. Conclusion We experienced a significant reduction in postcataract endophthalmitis when we switched from BSS to the vancomycin/BSS irrigating solution for incision hydration and eye pressurization. The pharmacokinetics profile indicates that this switch was important for effective prophylaxis. PMID:26229425

  9. Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer.

    PubMed

    Livaudais, Jennifer C; Hershman, Dawn L; Habel, Laurel; Kushi, Lawrence; Gomez, Scarlett Lin; Li, Christopher I; Neugut, Alfred I; Fehrenbacher, Louis; Thompson, Beti; Coronado, Gloria D

    2012-01-01

    Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as two or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional-stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC). Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White [NHW]) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use. Our sample included 13,753 women aged 20-79years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR]=0.82; [CI] 0.71-0.96 and [OR]=0.78; [CI] 0.63-0.98, respectively). Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other insured populations and the reasons for under-initiation among these groups need to be explored. PMID:21922245

  10. A Mixed Methods Study of Parental Vaccine Decision Making and Parent-Provider Trust

    PubMed Central

    Glanz, Jason M.; Wagner, Nicole M.; Narwaney, Komal J.; Shoup, Jo Ann; McClure, David L.; McCormick, Emily V.; Daley, Matthew F.

    2013-01-01

    Objective To describe parental vaccine decision making behaviors and characterize trust in physician advice among parents with varying childhood vaccination behaviors. Methods Between 2008 and 2011, a mixed methods study was conducted with parents of children aged <4 years who were members of Kaiser Permanente Colorado health plan. Seven focus groups were conducted with vaccine hesitant parents. Based on findings from the focus groups, a survey was developed, pilot tested and mailed to a stratified sample of 854 parents who accepted (n=500), delayed (n=227), or refused (n=127) vaccinations for one of their children. Survey results were analyzed using chi-square tests and multivariable logistic regression. Results Several themes emerged from the focus groups, including: 1) the vaccine decision making process begins prenatally, 2) vaccine decision making is an evolving process, and 3) there is overall trust in the pediatrician, but a lack of trust in the information they provided about vaccines. The survey response rate was 52% (n=443). Parents who refused or delayed vaccines were 2-times more likely to report that they began thinking about vaccines before their child was born, and 8-times more likely to report that they constantly re-evaluate their vaccine decisions than parents who accepted all vaccines. While parents tended to report trusting their pediatrician’s advice on nutrition, behavior and the physical examination, they did not believe their pediatrician provided balanced information on both the benefits and risks of vaccination. Conclusion These results have implications for future interventions to address parental vaccination concerns. Such interventions may be more effective if they are applied early (during pregnancy), often (pregnancy through infancy), and cover both the risks and benefits of vaccination. PMID:24011751

  11. Population Variations in Rheumatoid Arthritis Treatment and Outcomes, Northern California, 1998–2009

    PubMed Central

    Herrinton, Lisa J; Harrold, Leslie; Salman, Craig; Liu, Liyan; Goldfien, Robert; Asgari, Maryam; Gelfand, Joel M; Wu, Jashin J; Curtis, Jeffrey R

    2016-01-01

    Objective: To assess variations in rheumatoid arthritis treatment and outcomes at the community level from 1998 through 2009. Methods: The study used computerized data from 16 Kaiser Permanente Northern California Medical Centers. Mixed modeling was used to assess patterns across time and clinic. The analysis accounted for patient demographics, clustering of patients within Medical Centers, and repeated measures of patients over time. The metric used to measure drug use, months of use per patient per year, included both users and nonusers in the denominator, to account for both prevalence and duration of use. Results: Assessment was performed of 28,601 patients with rheumatoid arthritis, with all levels of severity. From 1998 through 2009, methotrexate use doubled in the typical patient to include 23% of the time they were observed; sulfasalazine and hydrochloroquine use declined. By 2008 through 2009, leflunomide and antitumor necrosis factor agents were used by the typical patient 4% and 9% of the time, respectively. Between 1998 and 2009, disease-modifying antirheumatic drug use increased in the typical patient from 38% to 63% of the time, and oral prednisone use declined from 23% to 15% of the time, whereas opioid use initially rose but then fell to 23% of the time. No variations over time were observed for the rate of hospitalized pneumonia or opportunistic infection. Variation across clinics, measured by the difference in drug use between clinics at the 75th and 25th percentiles, was lowest for opioids (25% vs 20% of the time) and greatest for infliximab (< 1% to 3%). Conclusion: Increased use of disease-modifying antirheumatic drugs and declines in prednisone are encouraging. Opioid use may need intervention. PMID:26694020

  12. Determinants of serum polychlorinated biphenyls and organochlorine pesticides measured in women from the child health and development study cohort, 1963-1967.

    PubMed Central

    James, Rebecca A; Hertz-Picciotto, Irva; Willman, Eric; Keller, Jean A; Charles, M Judith

    2002-01-01

    We examined predictors of organochlorine concentrations in serum specimens from women who were pregnant in the 1960s and participated in the Child Health and Development Study in the San Francisco Bay Area of California. That study enrolled pregnant women at the Kaiser-Permanente Medical Facilities, conducted interviews, and drew blood specimens; these specimens were centrifuged and the resulting serum specimens were frozen and placed in long-term storage. For the current investigation, organochlorines were measured by dual-column GC-electron capture detection in specimens collected in 1963-1967 from 399 pregnant women during the second and third trimesters. Using multiple linear regression models adjusted for serum lipids, we evaluated factors predicting concentrations of 11 polychlorinated biphenyl (PCB) congeners, their sum, and several pesticides and metabolites. Variables evaluated were age, race, place of birth, date of blood draw, body mass index, occupation, past residence on a farm, parity, and duration of pregnancy at blood draw. Concentrations of highly chlorinated PCBs and the sum of the PCBs increased with age. Concentrations of certain PCB congeners, as well as the sum, were significantly higher among nonwhites and increased with calendar date of blood draw. (italic)p,p(/italic) -DDT and (italic)p,p(/italic) -DDE concentrations were about 50% higher for nonwhites compared with whites and for those born in California or the southeastern United States versus elsewhere in the United States. Higher body mass index was associated with lower concentrations of several PCBs and (italic)p,p(/italic) -DDE but with higher heptachlor epoxide and DDT levels. The increase in use of PCBs during the 1960s is apparently detectable as increasing concentrations in maternal sera between 1963 and 1967. Marked racial and regional differences in serum pesticide levels were likely caused by geographic variation in previous agricultural and vector-control uses. The relationship to body mass index appears to be complex. PMID:12117636

  13. PS1-18: Feasibility of Implementing Screening Brief Intervention and Referral to Treatment (SBIRT) Within Multiple Health Settings

    PubMed Central

    Boggs, Jennifer; Rahm, Alanna Kulchak; Martin, Carmen; Beck, Arne; Price, David; Backer, Thomas; Gunter, Maggie; Ahmedani, Brian; Dearing, James

    2013-01-01

    Background/Aims Screening for alcohol and drug use has been identified as a high prevention priority for primary care by the US Preventive Services Task force; however, such screening is not routinely performed. SBIRT is a framework for population-based screening and intervention with the primary goal of reducing risky substance use before it progresses to dependence. There has been limited uptake of SBIRT in any large health system, thus the Substance Abuse and Mental Health Services Administration (SAMHSA) is supporting a series of studies, led by Kaiser Permanente Colorado (KPCO), to determine strategies to promote large-scale implementation. Qualitative examination of the feasibility of implementing SBIRT in primary care settings was previously conducted at KPCO; a continuation of this work at Henry Ford (HF) and Lovelace Health System (LHS) is currently being conducted. Methods Individual interviews and focus groups will use selective and snowball sampling of clinical leaders and staff, with the goal to assess value placed on systematized substance use screening in primary care, feasibility of implementing SBIRT, potential barriers, solutions, and facilitators to implementation, and strategies for gaining stakeholder support. Episodic profiles or debriefing reports will be generated shortly after every interview with leaders and staff at LHS and HF to facilitate iterative analysis. Results Qualitative findings from KPCO indicated the following key influencers: scope of practice, particularly for nurses, medical assistants and front desk staff; competing priorities for primary care physicians; and relationships between primary care, behavioral health, and chemical dependency departments. Interviews to be completed at LHS and HF will assess general feasibility as well as investigate whether KPCOs findings generalize to other health systems. Additionally, interviews will focus on the impact of patient cultural differences for SBIRT, where HF, LHS, and KPCO have distinct racial and ethnic patient populations. Conclusions The goal is to provide a more comprehensive understanding of the facilitators and barriers to SBIRT implementation across multiple health systems.

  14. PS2-47: Systematic Stakeholder Assessment to Determine Facilitators of and Barriers to SBIRT Implementation in Multiple Integrated Health Systems

    PubMed Central

    Rahm, Alanna Kulchak; Boggs, Jennifer; Martin, Carmen; Beck, Arne; Pearson, Marilyn; Backer, Thomas; Ahmedani, Brian

    2014-01-01

    Background/Aims The US Preventive Services Task Force has identified alcohol and drug use screening as a high priority in primary care. SBIRT is a framework for population based screening and brief intervention with the goal of reducing substance use before it progresses to dependence. There has been limited uptake of SBIRT in any large health system, thus SAMHSA has supported a series of studies, led by Kaiser Permanente Colorado (KPCO), to determine strategies to promote large scale SBIRT implementation. Methods A qualitative examination of SBIRT feasibility and subsequent pilot testing within KPCO primary care guided a series of additional stakeholder interviews at Henry Ford Health System (HFHS) to assess feasibility of SBIRT implementation in additional organizations. Qualitative interviews were conducted with a broad spectrum of HFHS stakeholders using snowball sampling. A total of 28 HFHS stakeholders were interviewed. Interviews were conducted telephonically by trained interviewers from KPCO and lasted approximately 30 minutes. Interviews were digitally recorded and transcribed. After each interview, a detailed summary was generated and used to create the initial code book for analysis of interview transcripts. Results While current screening, brief intervention, and referral to treatment processes for substance use were noted in HFHS, they were inconsistent and no systematic policies exist. Many facilitators for SBIRT implementation within HFHS were noted including: population, recent implementation of depression screening in primary care, and EMR tools to facilitate documentation. Barriers to SBIRT implementation included time and competing demands for primary care providers, access to treatment, and follow-up processes for positive screens. All stakeholders were supportive of pilot implementation of SBIRT within HFHS with adequate attention to barriers and facilitators. Conclusions This project successfully demonstrated the value of gaining stakeholder perspectives in order to facilitate successful implementation of SBIRT in large integrated health systems and provides a systematic protocol for gathering this data.

  15. Highly Reliable Procedural Teams: The Journey to Spread the Universal Protocol in Diagnostic Imaging

    PubMed Central

    Ross, Julie; Wolf, Debby; Reece, Kimberly

    2014-01-01

    Context: The Joint Commissions Universal Protocol has been widely implemented in surgical settings since publication in 2003. The elements improved patient safety in operating rooms, and the same rigor is being applied to procedures occurring in other health care arenas, in particular, diagnostic imaging. Objective: In 2011, Kaiser Permanente West Los Angeless Diagnostic Imaging Department desired to adapt previous work on Universal Protocol implementation to improve patient safety in interventional radiology and mammography procedures. Design: The teams underwent human factors training and then adapted key interventions used in surgical suites to their workflows. Time-out posters, use of whiteboards, glitch books, and regular audits provided structure to overcome the risks that human factors present. Main Outcome Measures: Staff and physician perceptions of the teamwork and safety climates in their modalities were measured using the Safety Attitudes Questionnaire at baseline and at 18 months after training. Unusual Occurrence Reports were also reviewed to identify events and near misses that could be prevented. Implementation of key process changes were identified as process measures. Results: Perception of the safety climate improved 25% in interventional radiology and 4.5% in mammography. Perception of the teamwork climate decreased 5.4% in interventional radiology and 16.6% in mammography. Unusual occurrences were underreported at baseline, and there is ongoing reluctance to document near misses. Conclusion: This work provides important considerations of the impact of departmental cultures for the implementation of the Universal Protocol in procedural areas. It also reveals unexpected challenges, and requires long-term effort and focus. PMID:24626070

  16. Dietary guideline adherence for gastroesophageal reflux disease

    PubMed Central

    2014-01-01

    Background Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disease, and the cost of health care and lost productivity due to GERD is extremely high. Recently described side effects of long-term acid suppression have increased the interest in nonpharmacologic methods for alleviating GERD symptoms. We aimed to examine whether GERD patients follow recommended dietary guidelines, and if adherence is associated with the severity and frequency of reflux symptoms. Methods We conducted a population-based cross-sectional study within the Kaiser Permanente Northern California population, comparing 317 GERD patients to 182 asymptomatic population controls. All analyses adjusted for smoking and education. Results GERD patients, even those with moderate to severe symptoms or frequent symptoms, were as likely to consume tomato products and large portion meals as GERD-free controls and were even more likely to consume soft drinks and tea [odds ratio (OR) = 2.01 95% confidence interval (CI) 1.12-3.61; OR = 2.63 95% CI 1.24-5.59, respectively] and eat fried foods and high fat diet. The only reflux-triggering foods GERD patients were less likely to consume were citrus and alcohol [OR = 0.59; 95% CI: 0.35-0.97 for citrus; OR = 0.41 95% CI 0.19-0.87 for 1 + drink/day of alcohol]. The associations were similar when we excluded users of proton pump inhibitors. Conclusions GERD patients consume many putative GERD causing foods as frequently or even more frequently than asymptomatic patients despite reporting symptoms. These findings suggest that, if dietary modification is effective in reducing GERD, substantial opportunities for nonpharmacologic interventions exist for many GERD patients. PMID:25125219

  17. Improving Blood Pressure Control through a Clinical Pharmacist Outreach Program in Diabetes Patients in Two-High Performing Health Systems: The Adherence and Intensification of Medications (AIM) Cluster Randomized Controlled Pragmatic Trial

    PubMed Central

    Heisler, Michele; Hofer, Timothy P.; Schmittdiel, Julie A.; Selby, Joe V.; Klamerus, Mandi L.; Bosworth, Hayden B.; Bermann, Martin; Kerr, Eve A.

    2013-01-01

    Background Even in high performing health systems, some hypertensive patients with diabetes have persistent poor blood pressure (BP) control. Medication nonadherence and lack of medication intensification contribute to this poor control. We examined whether the Adherence and Intensification of Medications (AIM) intervention, a targeted pharmacist-led intervention that combined state-of-the-art elements found in efficacy studies to lower BP, could improve BP among diabetes patients with persistent hypertension and poor refill adherence or insufficient medication intensification. Methods and Results We conducted a prospective, multi-site cluster randomized pragmatic trial with randomization of 16 primary care teams at five medical centers (3 Veterans Affairs [VA] and 2 Kaiser Permanente [KP]) to the AIM intervention or usual care. The primary outcome was the relative change in systolic blood pressure (SBP) measurements, comparing 1,797 eligible intervention team patients to 2,303 eligible control team patients, between the 6-months preceding and the 6-months following the 14-month intervention period. We examined shorter-term changes in SBP as a secondary outcome. In our primary analysis, the intervention group SBP change from 6-months prior to 6-months after the 14-month intervention period was approximately the same as the control group, declining approximately 9 mm Hg in both groups. SBP lowering occurred more rapidly among eligible intervention team patients, with mean SBPs 2.4 mm Hg lower (95% CI: ?3.4 to ?1.5; p<.001) immediately after the intervention than those achieved by eligible control patients. Conclusions The AIM program more rapidly lowered SBPs among eligible intervention patients, but there was no significant difference in blood pressure between intervention and control patients 6 months following the intervention period. These findings show the importance of rigorously evaluating in different real-life clinical settings programs found in efficacy trials to be effective before urging their widespread adoption in all settings. PMID:22570370

  18. Automated Assay of Telomere Length Measurement and Informatics for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort.

    PubMed

    Lapham, Kyle; Kvale, Mark N; Lin, Jue; Connell, Sheryl; Croen, Lisa A; Dispensa, Brad P; Fang, Lynn; Hesselson, Stephanie; Hoffmann, Thomas J; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H; Ludwig, Dana; Matsuguchi, Tetsuya; McGuire, William B; Miles, Sunita; Quesenberry, Charles P; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C; Smethurst, David; Somkin, Carol P; Van Den Eeden, Stephen K; Walter, Lawrence; Whitmer, Rachel A; Kwok, Pui-Yan; Risch, Neil; Schaefer, Catherine; Blackburn, Elizabeth H

    2015-08-01

    The Kaiser Permanente Research Program on Genes, Environment, and Health (RPGEH) Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort includes DNA specimens extracted from saliva samples of 110,266 individuals. Because of its relationship to aging, telomere length measurement was considered an important biomarker to develop on these subjects. To assay relative telomere length (TL) on this large cohort over a short time period, we created a novel high throughput robotic system for TL analysis and informatics. Samples were run in triplicate, along with control samples, in a randomized design. As part of quality control, we determined the within-sample variability and employed thresholds for the elimination of outlying measurements. Of 106,902 samples assayed, 105,539 (98.7%) passed all quality control (QC) measures. As expected, TL in general showed a decline with age and a sex difference. While telomeres showed a negative correlation with age up to 75 years, in those older than 75 years, age positively correlated with longer telomeres, indicative of an association of longer telomeres with more years of survival in those older than 75. Furthermore, while females in general had longer telomeres than males, this difference was significant only for those older than age 50. An additional novel finding was that the variance of TL between individuals increased with age. This study establishes reliable assay and analysis methodologies for measurement of TL in large, population-based human studies. The GERA cohort represents the largest currently available such resource, linked to comprehensive electronic health and genotype data for analysis. PMID:26092717

  19. Effectiveness of bisphosphonate use and risk of contralateral breast cancer and recurrence in women with early-stage breast cancer treated with tamoxifen.

    PubMed

    Kwan, Marilyn L; Shi, Jiaxiao M; Habel, Laurel A; Song, Jun; Chung, Joanie W-L; Avila, Chantal C; Schottinger, Joanne E; Cheetham, T Craig; Fletcher, Suzanne W; Haque, Reina

    2016-04-01

    The effectiveness of bisphosphonates (BP) in reducing risk of second breast cancer and recurrence in observational studies has been minimally studied. We examined the association of oral BP use on risk of contralateral breast cancer (CBC) and recurrence in 16,781 women diagnosed with early-stage breast cancer from 1996 to 2007, treated with tamoxifen, and followed through December 31, 2009 at Kaiser Permanente Northern California (KPNC, n = 8857) and Southern California (KPSC, n = 7924). Sociodemographic, clinical, and pharmacy information were extracted from electronic medical records and cancer registries. CBC was identified from cancer registries, and recurrences from electronic health records and chart reviews. Multivariate Cox regression models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) treating BP use and hormonal therapy as time-varying variables. After mean 6.4 years of follow-up, 494 (3.0 %) women developed CBC. BP use post-breast cancer diagnosis (>93 % alendronate) ranged from 14.5 to 24.9 % at both study sites. Overall, there was no association of BP use with reduced risk of CBC (ever use, HR = 0.96; 95 % CI 0.67-1.38 and continuous use, HR = 1.03; 95 % CI 0.88, 1.20). Similar null associations were observed for recurrence (ever use, HR = 0.98; 95 % CI 0.82, 1.17 and continuous use, HR = 1.00; 95 % CI 0.92, 1.09). Associations varied somewhat by site yet confidence intervals overlapped. BP use was not associated with reduced risk of recurrence or new primary disease among women diagnosed with early breast cancer and treated with tamoxifen. PMID:27002508

  20. Rubber dam use during routine operative dentistry procedures: findings from the Dental PBRN.

    PubMed

    Gilbert, Gregg H; Litaker, Mark S; Pihlstrom, Daniel J; Amundson, Craig W; Gordan, Valeria V

    2010-01-01

    Rubber dam use during operative dentistry procedures has been quantified based on questionnaires completed by dentists. However, based on the knowledge of the authors of the current study, there are no reports based on use during actual clinical procedures other than in dental materials studies and none based on routine care. The objectives of the current study were to: 1) quantify how commonly the rubber dam is used during operative dentistry procedures; 2) test the hypothesis that certain dentist, restoration and patient-level factors are associated with its use. A total of 229 dentist practitioner-investigators in The Dental Practice-Based Research Network (DPBRN) participated. DPBRN comprises five regions of the USA: Alabama/Mississippi, Florida/Georgia, Minnesota, Permanente Dental Associates and Scandinavia. Practitioner-investigators collected data on 9,890 consecutive restorations done in previously unrestored tooth surfaces from 5,810 patients. Most dentists (63%) did not use a rubber dam for any restoration in this study. A rubber dam was used for only 12% of restorations, 83% of which were used in one DPBRN region. With regions accounted for, no other dentist characteristics were significant. A multi-level multiple logistic regression of rubber dam use was done with restoration and patient-level variables modeled simultaneously. In this multi-variable context, these restoration-level characteristics were statistically significant: tooth-arch type, restoration classification and reason for placing the restoration. These patient-level characteristics were statistically significant: ethnicity, dental insurance and age. These results, obtained from actual clinical procedures rather than questionnaires, document a low prevalence of usage of the rubber dam during operative dentistry procedures. Usage varied with certain dentist, restoration and patient-level characteristics. PMID:20945739

  1. The prevalence, incidence and natural history of primary sclerosing cholangitis in an ethnically diverse population

    PubMed Central

    2011-01-01

    Background Primary sclerosing cholangitis (PSC) is a rare chronic cholestatic liver disease often associated with inflammatory bowel diseases (IBD). Current epidemiological data are limited to studies of predominantly Caucasian populations. Our aim was to define the epidemiology of PSC in a large, ethnically diverse US population. Methods The Northern California Kaiser Permanente (KP) database includes records from over 3 million people and was searched for cases of PSC between January 2000 and October 2006. All identified charts were reviewed for diagnosis confirmation, IBD co-morbidity, and major natural history endpoints. Results We identified 169 (101 males) cases fulfilling PSC diagnostic criteria with a mean age at diagnosis of 44 years (range 11-81). The age-adjusted point prevalence was 4.15 per 100,000 on December 31, 2005. The age-adjusted incidence per 100,000 person-years was not significantly greater in men 0.45 (95% CI 0.33 - 0.61) than women 0.37 (95% CI 0.26 - 0.51). IBD was present in 109/169 (64.5%) cases and was significantly more frequent in men than women with PSC (73.3% and 51.5%, respectively, p = 0.005). The cumulative average yearly mortality rate was 1.9%. Age and serum sodium, creatinine and bilirubin at diagnosis and albumin at last entry were identified as significant factors associated with death, liver transplant or cholangiocarcinoma. Conclusions The incidence and prevalence of PSC observed in a representative Northern California population are lower compared to previous studies in Caucasian populations and this might reflect differences in the incidence of PSC among various ethnic groups. PMID:21767410

  2. Chronic kidney disease and risk of renal cell carcinoma: differences by race

    PubMed Central

    Hofmann, Jonathan N.; Corley, Douglas A.; Zhao, Wei K.; Colt, Joanne S.; Shuch, Brian; Chow, Wong-Ho; Purdue, Mark P.

    2015-01-01

    Background The incidence of renal cell carcinoma in the United States differs by race/ethnicity. To better understand these disparities, we conducted a nested case-control study investigating renal cell carcinoma risk factors across racial/ethnic groups within the Kaiser Permanente Northern California health care network. Methods Our study included 3,136 renal cell carcinoma cases (2,152 white, 293 black, 425 Hispanic, 255 Asian) diagnosed between 1998 and 2008 and 31,031 individually matched controls (21,478 white, 2,836 black, 4,147 Hispanic, 2,484 Asian). Risk of renal cell carcinoma was assessed in relation to smoking status, body mass index (BMI), hypertension, and chronic kidney disease. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression, and population attributable risk (PAR) to estimate by race the proportion of cases attributable to hypertension and chronic kidney disease. Results The association between chronic kidney disease and renal cell carcinoma differed markedly by race (Pinteraction<0.001), with associations observed among blacks (OR=10.4 [95% CI=6.0–17.9]), Asians (5.1 [2.2–11.7]), and Hispanics (2.3 [1.1–4.6]) but not whites (1.1 [0.6–1.9]). Hypertension, high BMI, and smoking were associated with renal cell carcinoma, but findings generally did not differ by race. Relative to other racial/ethnic groups, blacks had the highest proportion of renal cell carcinoma incidence attributable to hypertension and chronic kidney disease (combined, PAR=37%; hypertension only, PAR=27%; chronic kidney disease, PAR=10%). Conclusions Our findings suggest that hypertension and chronic kidney disease likely have contributed to the observed excess in renal cell carcinoma incidence among blacks compared with whites. PMID:25393631

  3. Validity of Diagnostic Codes and Laboratory Tests of Liver Dysfunction to Identify Acute Liver Failure Events

    PubMed Central

    Re, Vincent Lo; Carbonari, Dena M.; Forde, Kimberly A.; Goldberg, David; Lewis, James D.; Haynes, Kevin; Leidl, Kimberly B. F.; Reddy, K. Rajender; Roy, Jason; Sha, Daohang; Marks, Amy R.; Schneider, Jennifer L.; Strom, Brian L.; Corley, Douglas A.

    2015-01-01

    Purpose Identification of acute liver failure (ALF) is important for post-marketing surveillance of medications, but the validity of using ICD-9 diagnoses and laboratory data to identify these events within electronic health records is unknown. We examined positive predictive values (PPVs) of hospital ICD-9 diagnoses and laboratory tests of liver dysfunction for identifying ALF within a large, community-based integrated care organization. Methods We identified Kaiser Permanente Northern California health plan members (2004–2010) with a hospital discharge diagnosis suggesting ALF (ICD-9 570, 572.2, 572.4, 572.8, 573.3, 573.8, or V42.7) plus an inpatient international normalized ratio ≥1.5 (off warfarin) and total bilirubin ≥5.0 mg/dL. Hospital records were reviewed by hepatologists to adjudicate ALF events. PPVs for confirmed outcomes were determined for individual ICD-9 diagnoses, diagnoses plus prescriptions for hepatic encephalopathy treatment, and combinations of diagnoses in the setting of coagulopathy and hyperbilirubinemia. Results Among 669 members with no pre-existing liver disease, chart review confirmed ALF in 62 (9%). Despite the presence of co-existing coagulopathy and hyperbilirubinemia, individual ICD-9 diagnoses had low PPVs (range, 5%–15%); requiring prescriptions for encephalopathy treatment did not increase PPVs of these diagnoses (range, 2%–23%). Hospital diagnoses of other liver disorder (ICD-9 573.8) plus hepatic coma (ICD-9 572.2) had high PPV (67%; 95% CI, 9%-99%) but only identified 2 (3%) ALF events. Conclusions Algorithms comprising relevant hospital diagnoses, laboratory evidence of liver dysfunction, and prescriptions for hepatic encephalopathy treatment had low PPVs for confirmed ALF events. Studies of ALF will need to rely on medical records to confirm this outcome. PMID:25866286

  4. Effect of Health Beliefs on Delays in Care for Abnormal Cervical Cytology in a Multiethnic Population

    PubMed Central

    Nelson, Karin; Geiger, Ann M; Mangione, Carol M

    2002-01-01

    CONTEXT Women from racial and ethnic minorities in the United States have higher rates of cervical cancer and present with later stage disease compared to whites. Delays in care for abnormal Papanicolaou (Pap) smears can lead to missed cases of cervical cancer or late-stage presentation and may be one explanation for these differences. OBJECTIVE To determine if race and ethnicity, health beliefs, and cancer knowledge are associated with delays in care for abnormal Pap smears. DESIGN, PARTICIPANTS, AND SETTING We conducted a mailed survey with telephone follow-up of all women with an abnormal Pap smear who received care at Kaiser Permanente Los Angeles Medical Center between October 1998 and October 1999 (n = 1,049). MEASUREMENTS AND MAIN RESULTS A delay in care was defined as not attending the first scheduled clinic visit to follow up on an abnormal Pap smear, or requiring multiple contact attempts, including a certified letter, to schedule a follow-up visit. Our response rate was 70% (n = 733) and the sample was 51% Latina. Spanish-speaking Latinas and women of Asian descent were more likely to endorse fatalistic beliefs and misconceptions about cancer. Thirteen percent of the sample delayed follow-up on their abnormal Pap smear. Women who delayed care were more fatalistic and endorsed more misconceptions about cervical cancer. Delays in care were not independently associated with race and ethnicity. CONCLUSIONS Health beliefs and cancer knowledge differed by race and ethnicity among women in a large managed care organization. Fatalistic health beliefs and misconceptions about cancer, but not race and ethnicity, were independently associated with delays in care. PMID:12220368

  5. OBAYA (obesity and adverse health outcomes in young adults): feasibility of a population-based multiethnic cohort study using electronic medical records

    PubMed Central

    2012-01-01

    Background Although obesity is a risk factor for many chronic diseases, we have only limited knowledge of the magnitude of these associations in young adults. A multiethnic cohort of young adults was established to close current knowledge gaps; cohort demographics, cohort retention, and the potential influence of migration bias were investigated. Methods For this population-based cross-sectional study, demographics, and measured weight and height were extracted from electronic medical records of 1,929,470 patients aged 20 to 39 years enrolled in two integrated health plans in California from 2007 to 2009. Results The cohort included about 84.4% of Kaiser Permanente California members in this age group who had a medical encounter during the study period and represented about 18.2% of the underlying population in the same age group in California. The age distribution of the cohort was relatively comparable to the underlying population in California Census 2010 population, but the proportion of women and ethnic/racial minorities was slightly higher. The three-year retention rate was 68.4%. Conclusion These data suggest the feasibility of our study for medium-term follow-up based on sufficient membership retention rates. While nationwide 6% of young adults are extremely obese, we know little to adequately quantify the health burden attributable to obesity, especially extreme obesity, in this age group. This cohort of young adults provides a unique opportunity to investigate associations of obesity-related factors and risk of cancer in a large multiethnic population. PMID:22909293

  6. Rubber dam use during routine operative dentistry procedures: findings from The Dental PBRN

    PubMed Central

    Gilbert, Gregg H.; Litaker, Mark S.; Pihlstrom, Daniel J.; Amundson, Craig W.; Gordan, Valeria V.

    2010-01-01

    SUMMARY Rubber dam use during operative dentistry procedures has been quantified based on questionnaires completed by dentists. However, to our knowledge there are no reports based on use during actual clinical procedures other than in dental materials studies, and none based on routine care. Our objectives were to: (1) quantify how commonly the rubber dam is used during operative dentistry procedures; (2) test the hypothesis that certain dentist-, restoration- and patient-level factors are associated with its use. A total of 229 dentist practitioner-investigators in The Dental Practice-Based Research Network (DPBRN) participated. DPBRN comprises five regions: Alabama/Mississippi, Florida/Georgia, Minnesota, Permanente Dental Associates, and Scandinavia. Practitioner-investigators collected data on 9,890 consecutive restorations done in previously-unrestored tooth surfaces from 5,810 patients. Most dentists (63%) did not use a rubber dam for any restoration in the study. A rubber dam was used for only 12% of restorations, 83% of which were used in one DPBRN region. With region accounted for, no other dentist characteristics were significant. A multi-level multiple logistic regression of rubber dam use was done with restoration- and patient-level variables modeled simultaneously. In this multi-variable context, these restoration-level characteristics were statistically significant: tooth-arch type, restoration classification, and reason for placing the restoration. These patient-level characteristics were statistically significant: ethnicity, dental insurance, and age. These results, obtained from actual clinical procedures rather than questionnaires, document a low prevalence of usage of rubber dam during operative dentistry procedures. Usage varied with certain dentist-, restoration-, and patient-level characteristics. PMID:20945739

  7. Effect of Advancing Age and Multiple Chronic Conditions on Mortality in Patients with End-Stage Renal Disease after Implantable Cardioverter-Defibrillator Placement

    PubMed Central

    Krishnaswami, Ashok; Kiley, Mary-Lou; Anthony, Faith F; Chen, Yuexin; Chen, Jason; Rajagopal, Sumanth; Liu, Taylor I; Young, Charlie; Paxton, Elizabeth W

    2016-01-01

    Context: There is insufficient information on the effect that advancing age and multiple chronic conditions (MCC) have on mortality after placement of an implantable cardioverter-defibrillator in patients with end-stage renal disease (ESRD) vs non-ESRD. Objective: To assess whether a differential effect of age and MCC exists between ESRD and non-ESRD. Design: Population-based, retrospective cohort study using data from the national Kaiser Permanente Cardiac Device Registry of patients who underwent placement of an implantable cardioverter-defibrillator between January 1, 2007, and December 31, 2013. Main Outcome Measures: All-cause mortality. Results: Of 7825 patients with implantable cardioverter-defibrillator placement, ESRD-affected patients constituted 4.0% of the cohort (n = 311), were similar in age (p = 0.91), and presented with a larger comorbidity burden (3.3 1.3 vs 2.4 1.5, p < 0.001). The effect of advancing age (every 5 years) on mortality in the ESRD cohort (hazard ratio [HR] = 1.11, 95% confidence interval [CI] = 1.031.20) was less than in the non-ESRD cohort (HR = 1.28, 95% CI = 1.251.32). Similarly, the effect of each additional comorbidity in the ESRD cohort was less (HR = 1.04, 95% CI = 0.911.19) than in the non-ESRD group (HR = 1.20, 95% CI = 1.161.25). Lastly, ESRD was independently associated with a 3-fold greater hazard of mortality. Conclusions: Advancing age and increasing number of MCC have a differential effect on mortality risk in patients with ESRD compared with their non-ESRD counterparts. Future studies should focus on assessment of nonlinear relationships of age, MCC, and naturally occurring clusters of MCC on mortality. PMID:26562307

  8. MicroRNA profiles in colorectal carcinomas, adenomas and normal colonic mucosa: variations in miRNA expression and disease progression

    PubMed Central

    Slattery, Martha L.; Herrick, Jennifer S.; Pellatt, Daniel F.; Stevens, John R.; Mullany, Lila E.; Wolff, Erica; Hoffman, Michael D.; Samowitz, Wade S.; Wolff, Roger K.

    2016-01-01

    MiRNAs are small, non-protein-coding RNA molecules that regulate gene expression either by post-transcriptionally suppressing mRNA translation or by mRNA degradation. We examine differentially expressed miRNAs in colorectal carcinomas, adenomas and normal colonic mucosa. Data come from population-based studies of colorectal cancer conducted in Utah and the Kaiser Permanente Medical Care Program. A total of 1893 carcinoma/normal-paired samples and 290 adenoma tissue samples were run on the Agilent Human miRNA Microarray V19.0 which contained 2006 miRNAs. We tested for significant differences in miRNA expression between paired carcinoma/adenoma/normal colonic tissue samples. Fewer than 600 miRNAs were expressed in >80% of people for colonic tissue; of these 86.5% were statistically differentially expressed between carcinoma and normal colonic mucosa using a false discovery rate of 0.05. Roughly half of these differentially expressed miRNAs showed a progression in levels of expression from normal to adenoma to carcinoma tissue. Other miRNAs appeared to be altered at the normal to adenoma stage, while others were only altered at the adenoma to carcinoma stage or only at the normal to carcinoma stage. Evaluation of the Agilent platform showed a high degree of repeatability (r = 0.98) and reasonable agreement with the NanoString platform. Our data suggest that miRNAs are highly dysregulated in colorectal tissue among individuals with colorectal cancer; the pattern of disruption varies by miRNA as tissue progresses from normal to adenoma to carcinoma. PMID:26740022

  9. The HIV Care Cascade Measured Over Time and by Age, Sex, and Race in a Large National Integrated Care System.

    PubMed

    Horberg, Michael Alan; Hurley, Leo Bartemeier; Klein, Daniel Benjamin; Towner, William James; Kadlecik, Peter; Antoniskis, Diana; Mogyoros, Miguel; Brachman, Philip Sigmund; Remmers, Carol Louise; Gambatese, Rebecca Claire; Blank, Jackie; Ellis, Courtney Georgiana; Silverberg, Michael Jonah

    2015-11-01

    HIV care cascades can evaluate programmatic success over time. However, methodologies for estimating cascade stages vary, and few have evaluated differences by demographic subgroups. We examined cascade performance over time and by age, sex, and race/ethnicity in Kaiser Permanente, providing HIV care in eight US states and Washington, DC. We created cascades for HIV+ members' age ≥13 for 2010-2012. We measured "linkage" (a visit/CD4 within 90 days of being diagnosed for new patients; ≥1 medical visit/year if established); "retention" (≥2 medical visits ≥60 days apart); filled ART (filled ≥3 months of combination ART); and viral suppression (HIV RNA <200 copies/mL last measured in year). The cascades were stratified by calendar year, sex, age, and race/ethnicity. We found men had statistically (p < 0.05) higher percent linkage, filled ART, and viral suppression for 2010 and 2011 but not for 2012. Women had significantly greater retention for all years. Annually, older age was associated (p < 0.05) with retention, filled ART, and viral suppression but not linkage. Latinos had greater (p < 0.05) retention than whites or blacks in all years, with similar retention comparing blacks and whites. Filled ART and viral suppression was increased (p < 0.05) for whites compared with all racial/ethnic groups in all years. Cascade methodology requiring success at upstream stages before measuring success at later stages (i.e., "dependent" methodology) underreported performance by up to 20% compared with evaluating each stage separately ("independent"). Thus, care results improved over time, but significant differences exist by patient demographics. Specifically, retention efforts should be targeted toward younger patients and blacks; women, blacks, and Latinos require greater ART prescribing. PMID:26505968

  10. Antidepressants and testicular cancer

    PubMed Central

    Friedman, Gary D.; Schwalbe, Joan; Achacoso, Ninah; Meng, Maxwell V.; Kroenke, Candyce H.; Habel, Laurel A.

    2014-01-01

    Purpose Re-examine association of fluoxetine and paroxetine with risk of testicular cancer noted in drug screening, with four years more follow-up and expanded study of these and other antidepressant drugs. Methods In the Kaiser Permanente Medical Care Program in northern California, 906 men with testicular cancer diagnosed August 1996December 2010 were compared with 38,253 matched controls with race/ethnicity recorded regarding receipt of antidepressant drugs at least two years before diagnosis or control index date. Analyses emphasized duration of use and histological subgroups. Results With control for race/ethnicity and use of other antidepressant drugs, odds ratios (OR) and 95% confidence intervals (CI) for associations with testicular cancer were: fluoxetine 1.22 (0.881.71), paroxetine 1.19 (0.781.83), and 1.21 (0.921.58) for all SSRIs. There was no statistically significant association with risk of all testicular cancers or their histologic subtypes for any individual drug or for tricyclics or all antidepressants combined except for citalopram with all testicular cancers 2.55 (1.434.52) and those of mixed histology 4.36 (1.5012.68) and nefazodone with embryonal cancers 9.79 (1.8551.81). These could readily be chance findings in the context of the many analyses that were performed. Duration of use was not associated with risk for the drugs and drug groups with sufficient numbers of exposed cases for analysis. Conclusions We found little evidence to support a testicular carcinogenic effect of fluoxetine, paroxetine, or other antidepressant drugs but a weakly positive association is not ruled out. The signals in prior screening may have been due to chance and/or uncontrolled confounding. PMID:24276357

  11. The Multigroup Ethnic Identity Measure-Revised: Measurement invariance across racial and ethnic groups

    PubMed Central

    Brown, Susan D.; Unger Hu, Kirsten A.; Mevi, Ashley A.; Hedderson, Monique M.; Shan, Jun; Quesenberry, Charles P.; Ferrara, Assiamira

    2014-01-01

    The Multigroup Ethnic Identity Measure-Revised (MEIM-R), a brief instrument assessing affiliation with one’s ethnic group, is a promising advance in the ethnic identity literature. However, equivalency of its measurement properties across specific racial and ethnic groups should be confirmed before using it in diverse samples. We examined a) the psychometric properties of the MEIM-R including factor structure, measurement invariance, and internal consistency reliability, and b) levels of and differences in ethnic identity across multiple racial and ethnic groups and subgroups. Asian (n = 630), Black/African American (n = 58), Hispanic (n = 240), multiethnic (n = 160), and White (n = 375) women completed the MEIM-R as part of the “Gestational diabetes’ Effect on Moms” diabetes prevention trial in the Kaiser Permanente Northern California health care setting (N = 1,463; M age 32.5 years, SD = 4.9). Multiple-groups confirmatory factor analyses provided provisional evidence of measurement invariance, i.e., an equal, correlated two-factor structure, equal factor loadings, and equal item intercepts across racial and ethnic groups. Latent factor means for the two MEIM-R subscales, exploration and commitment, differed across groups; effect sizes ranging from small to large generally supported the notion of ethnic identity as more salient among people of color. Pending replication, good psychometric properties in this large and diverse sample of women support the future use of the MEIM-R. Preliminary evidence of measurement invariance suggests that the MEIM-R could be used to measure and compare ethnic identity across multiple racial and ethnic groups. PMID:24188656

  12. Association between Physical Activity and Depressive Symptoms: Midlife Women in SWAN

    PubMed Central

    Dugan, Sheila A.; Bromberger, Joyce T.; Segawa, Eisuke; Avery, Elizabeth; Sternfeld, Barbara

    2014-01-01

    Introduction The relationship of physical activity (PA) and positive mood has been the focus of considerable research, primarily cross-sectional. This study was done to evaluate the relationship between PA and high depressive symptoms across time and to examine whether being physically active attenuates the risk of depressive symptoms in midlife women. Methods The present study is a longitudinal observation study of the menopausal transition in a multiethnic population. Ten years of data on 2891 women were analyzed. The participants were women from seven geographic areas nationwide, aged 42 to 52 years at baseline, still menstruating and not using exogenous reproductive hormones. Physical activity was measured with the Kaiser Permanente Physical Activity Scale (KPAS). The main outcome measure, depressive symptoms, was assessed with the Center for Epidemiological Studies Depression Scale (CES-D) with primary outcome CES-D score of 16 or higher. Results In mixed effect logistic regression models adjusted for covariates, compared to inactivity, physical activity Meeting PA Guidelines (approximating public health guidelines) and physical activity Below PA Guidelines were each associated with lower risk of High Depressive Symptoms (CES-D score of 16 or higher) [odds ratio (OR) =0.52, 95% confidence intervals (CI) 0.40-0.70; OR =0.81, 95% CI 0.67-0.98, respectively] across 10 years. Being married, Japanese and Hispanic ethnicity, current smoking, reporting very upsetting life events, using anti-depressive medications, having hot flashes, and high BMI were all positively associated with High Depressive Symptoms, while high social support was negatively associated. Conclusions Higher PA was associated with lower levels of depressive symptoms persistently over ten years independent of potential confounders. Our findings suggest that reaching moderate intensity PA levels during midlife may be protective against depressive symptoms. PMID:24914519

  13. Estudio terico de la desorcin de Na y K de SiO2 estimulada por la accin de fotones o electrones

    NASA Astrophysics Data System (ADS)

    Domnguez Ariza, D.; Lpez, N.; Illas, F.; Pacchioni, G.; Madey, T. E.

    Se ha estudiado el mecanismo de generacin de sodio y potasio atmico a partir de muestras de SiO2 utilizando clculos basados tanto en la teora del funcional de la densidad como en mtodos post-Hartree Fock, as como en el mtodo de cluster para modelar el slido. Como consecuencia del estudio se han propuesto distintos caminos posibles para la desorcin, estimulada por la accin de fotones o electrones, de sodio y potasio desde el xido de silicio, proporcionando por lo tanto una explicacin a la atmsfera tenue de sodio y potasio de La Luna.

  14. Hacer frente - La vida día a día

    Cancer.gov

    Información que trata sobre la vida diaria durante el tratamiento del cáncer. Incluye aspectos como mantener la rutina diaria, regresar al trabajo, la fe y la espiritualidad y los retos económicos.

  15. Detective cientfica - Duration: 30 seconds.

    NASA Video Gallery

    La NASA posee muchos detectives que buscan pistas para resolver un misterio como la "detective cientfica" Monsi Roman. Se asegura de que el agua y el aire a bordo de la Estacin Espacial Internaci...

  16. Control del dolor: Apoyo para las personas con cncer

    Cancer.gov

    Libro sobre el control del dolor en pacientes con cncer. Cubre los mtodos y medicinas, as como los efectos fsicos y emocionales del dolor. Es una adaptacin cultural para el pblico de habla hispana del libro en ingls Pain Control.

  17. Formaldehdo

    Cancer.gov

    El formaldehdo es una sustancia qumica inflamable, incolora y de olor fuerte que se produce a nivel industrial y se usa para la construccin de materiales como tableros de partculas, madera contrachapada y otros productos de madera prensada.

  18. 1,3-butadieno

    Cancer.gov

    El 1,3-butadieno es un gas incoloro a temperatura ambiente con olor similar a la gasolina. Se usa para fabricar productos de caucho sinttico, como neumticos o llantas, resinas, plsticos y otras sustancias qumicas.

  19. Carcinoma de tumor primario desconocido—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del carcinoma de tumor primario desconocido, así como referencias a estudios clínicos y otros temas relacionados.

  20. Significado de los cambios en la prstata: Gua de salud para los hombres

    Cancer.gov

    Esta gua contiene informacin sobre los sntomas y factores de riesgo del cncer de prstata y el anlisis del antgeno prosttico especfico (PSA). Tambin hace referencia a otras enfermedades como prstata agrandada y prostatitis.

  1. Tomografa computarizada (TC) y exploraciones para cncer

    Cancer.gov

    Hoja informativa que describe el procedimiento y la tecnologa de exploraciones con tomografa computarizada as como sus usos para el diagnstico, para exmenes de deteccin y para tratamiento del cncer.

  2. Instantnea del cncer de prstata

    Cancer.gov

    Informacin sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cncer de prstata; as como ejemplos de actividades del NCI y adelantos en la investigacin de este tipo de cncer.

  3. Instantnea del cncer de rin

    Cancer.gov

    Informacin sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cncer de rin; as como ejemplos de actividades del NCI y adelantos en la investigacin de este tipo de cncer.

  4. Lo que usted debe saber antes de dar sus tejidos para investigacin mdica

    Cancer.gov

    Contiene informacin sobre las cosas que usted debe saber y tener en cuenta al tomar una decisin de donar sus tejidos para investigacin. El tejido puede incluir materiales de su cuerpo tales como piel, cabello, uas, sangre y orina.

  5. Neoplasias mieloproliferativas y síndromes mielodisplásicos—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento de las neoplasias mieloproliferativas, así como referencias a estudios clínicos y otros temas relacionados.

  6. Atom optics and space physics: A summary of an 'Enrico Fermi' summer school

    NASA Astrophysics Data System (ADS)

    Arimondo, Ennio; Ertmer, Wolfgang; Rasel, Ernst M.; Schleich, Wolfgang P.

    2008-03-01

    We describe the scientific content of the International School of Physics 'Enrico Fermi' on atom optics and space physics, organized by the Italian Physical Society in Varenna at Lake Como, Italy, 2-13 July 2007.

  7. Encontrando planetas alrededor de otras estrellas - Duration: 30 seconds.

    NASA Video Gallery

    Así como la Tierra gira alrededor del Sol, la estrella más cercana, es posible que otros planetas orbiten las estrellas que se ven en el cielo nocturno. Piensa en todos los planetas del universo qu...

  8. Tumores carcinoides gastrointestinales—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del tumor carcinoide gastrointestinal, así como referencias a estudios clínicos y otros temas relacionados.

  9. AVALIAO DA PRESENA DE ENDOSSIMBIONTES Cardinium em DIFERENTES ESPCIES DE ARTRPODES.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A presena de endossimbiontes do gnero Cardinium em alguns grupos de artrpodes foi recentemente relatada e relacionada com diversas alteraes reprodutivas em seus hospedeiros, tais como feminilizao de caros, partenognese em parasitides, incompatibilidade citoplasmtica e aumento da fecundida...

  10. 5. INTERIOR VIEW LOOKING FROM AISLE TOWARDS THE CONDUCTORS SEAT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. INTERIOR VIEW LOOKING FROM AISLE TOWARDS THE CONDUCTORS SEAT TO THE FRONT - Como-Harriet Streetcar Line & Trolley Car No. 265, Forty-second Street West at Queen Avenue, Minneapolis, Hennepin County, MN

  11. Razes ps-mitolgicas da Astronomia Clssica

    NASA Astrophysics Data System (ADS)

    di Bartolo, L.; Villas da Rocha, J. F.

    2004-02-01

    Apresentamos como a inveno de um modelo astronmico e cosmolgico fundado em causas naturais foi um processo gestado num ambiente cultural especfico, o do advento do pensamento ps-mitolgico, que tem como sua raiz mais funda a trajetria particular da Grcia Antiga, com nfase na resoluo de uma grave crise social e a evoluo do mundo clssico para o contexto espiritual de um imprio universal.

  12. Pacific Tracker 2 - expert system (PacTrac2-ES) behavioural assessment and intervention tool for the Pacific Kids DASH for Health (PacDASH) study.

    PubMed

    Novotny, Rachel; Nigg, Claudio; McGlone, Katalina; Renda, Gloria; Jung, Noah; Matsunaga, Masako; Karanja, Njeri

    2013-10-01

    The Pacific Tracker (PacTrac) is a computer program designed to analyse food intakes of individuals from the Pacific Region. PacTrac's original output included servings of daily intake of food groups according to the United States Food Guide Pyramid, nutrient intake recommendations, and a comparison to other national nutrition recommendations. PacTrac was made available for public use through the Hawaii Foods website (hawaiifoods.hawaii.edu). PacTrac2 is an updated and expanded version of PacTrac that uses the United States MyPyramid/MyPlate food groups in household units of daily intake, rather than servings. In addition, the PacTrac2 includes a physical activity analysis tool which quantifies minutes of physical activities and their intensities based on energy estimates from the compendium of physical activity and research on children. An Expert System (ES) - a computerised decision tree to guide behaviour change - was developed using information on self-efficacy and stage of readiness to change, and the fruit and vegetable intake and physical activity information from PacTrac2. The ES produces reports for the child, the parent/guardian, and the child's physician with child-specific strategies, targeted behavioural information, and feedback tailored to the child. PacTrac2-ES was designed for the Pacific Kids DASH for Health (PacDASH) intervention study, conducted in the Kaiser Permanente health care system in Hawaii. The intervention is based on the child's self-efficacy and stage of readiness to change intake of fruits and vegetables and physical activity, with a goal of maintaining body weight to prevent obesity. The intervention is complemented with stage-based mailers addressing the environment for physical activity and fruit and vegetable intake and newsletters that address related behaviours (sedentary activity and a DASH eating approach). This project is the first to expand the PacTrac to contain children's foods and physical activities from the Pacific Region and to use current US MyPyramid/MyPlate food and physical activity analysis and guidance systems, and to develop and implement an Expert System for fruits, vegetables and physical activity of 5-8-year-old children. The PacTrac2-ES was used in the PacDASH study and will be used for other programs to promote healthy eating and physical activity of children in the Pacific Region. PMID:23601394

  13. Integrated Personal Health Records: Transformative Tools for Consumer-Centric Care

    PubMed Central

    Detmer, Don; Bloomrosen, Meryl; Raymond, Brian; Tang, Paul

    2008-01-01

    Background Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable. Discussion While there is a spectrum of dominant PHR models, (standalone, tethered, integrated), the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders. Summary Integrated PHRs promote active, ongoing patient collaboration in care delivery and decision making. With some exceptions, however, the integrated PHR model is still a theoretical framework for consumer-centric health care. The authors pose questions that need to be answered so that the field can move forward to realize the potential of integrated PHRs. How can integrated PHRs be moved from concept to practical application? Would a coordinating body expedite this progress? How can existing initiatives and policy levers serve as catalysts to advance integrated PHRs? PMID:18837999

  14. Non-viral Opportunistic Infections in New Users of TNF Inhibitor Therapy: Results of the SAfety Assessment of Biologic ThERapy (SABER) Study

    PubMed Central

    Baddley, John W.; Winthrop, Kevin L.; Chen, Lang; Liu, Liyan; Grijalva, Carlos G; Delzell, Elizabeth; Beukelman, Timothy; Patkar, Nivedita M.; Xie, Fenglong; Saag, Kenneth G.; Herrinton, Lisa J.; Solomon, Daniel H.; Lewis, James D.; Curtis, Jeffrey R.

    2014-01-01

    Objectives To determine among patients with autoimmune diseases in the United States whether the risk of non-viral opportunistic infections (OIs) was increased among new users of tumor necrosis factor-alpha inhibitors (TNFI), when compared to users of non-biologic agents used for active disease. Methods We identified new users of TNFI among cohorts of rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis-psoriatic arthritis-ankylosing spondylitis (PsO-PsA-AS) patients during 19982007 using combined data from Kaiser Permanente Northern California, two pharmaceutical assistance programs for the elderly, Tennessee Medicaid, and US Medicaid/Medicare programs. We compared incidence of non-viral OIs among new TNFI users and patients initiating non-biologic disease modifying drugs (DMARDs) overall and within each disease cohort. Cox regression models were used to compare propensity-score and steroid- adjusted OI incidence between new TNFI and non-biologic DMARD users. Results Within a cohort of 33,324 new TNFI users we identified 80 non-viral OIs, the most common of which was pneumocystosis (n=16). In the combined cohort, crude rates of non-viral OIs among new users of TNFI as compared to those initiating non-biologic DMARDs was 2.7 verus 1.7 per 1000-person years[adjusted hazard ratio (aHR): 1.6, 95% CI: 1.0, 2.6)]. Baseline corticosteroid use was associated with non-viral OIs (aHR 2.5, 95% CI: 1.5, 4.0). In the RA cohort, rates of non-viral OIs among new users of infliximab were higher when compared to patients newly starting non-biologic DMARDs (aHR 2.6, 95% CI 1.2, 5.6) or new etanercept users (aHR 2.9, 95% CI: 1.5, 5.4). Conclusions In the US, the rate of non-viral OIs was higher among new users of TNFI with autoimmune diseases as compared to non-biologic DMARD users. PMID:23852763

  15. Metabolic Dyslipidemia and Risk of Coronary Heart Disease in 28,318 Adults With Diabetes Mellitus and Low-Density Lipoprotein Cholesterol <100mg/dl.

    PubMed

    Rana, Jamal S; Liu, Jennifer Y; Moffet, Howard H; Solomon, Matthew D; Go, Alan S; Jaffe, Marc G; Karter, Andrew J

    2015-12-01

    The risk of future coronary heart disease (CHD) in subjects with diabetes and "metabolic dyslipidemia" (high triglyceride [TGs] and low high-density cholesterol levels) remains a matter of concern. Little is known regarding the risk of CHD for this phenotype with low-density lipoprotein cholesterol (LDL-C) levels <100mg/dl. We analyzed a diabetes cohort of 28,318 members (aged 30 to 90years) of Kaiser Permanente Northern California during 2002 to 2011 (192,356 person-years [p-y] follow-up), with LDL-C levels <100mg/dl and without known CHD. We compared the incidence and hazard ratios (HRs) for CHD events in groups using Cox models: normal high-density lipoprotein (HDL) and TG (reference; n= 7,278, 25.7%); normal HDL and high TG (?150mg/dl; n= 4,484,15.8%); low HDL (?50mg/dl for women and ?40mg/dl for men) and normal TG (n= 4,048, 14.3%); low HDL and high TG (metabolic dyslipidemia; n= 12,508, 44%). Patients with metabolic dyslipidemia had the highest age-adjusted CHD events/1,000 p-y (12.7/1,000 p-y and 19.0/1,000 p-y for women and men, respectively). After multivariate adjustment for age, gender, ethnicity, hypertension, smoking, statin use, duration of diabetes, and hemoglobin A1c, we observed an increased CHD risk in women (HR 1.35, 95% confidence interval 1.14 to 1.60) and men (HR 1.62, 95% confidence interval 1.43 to 1.83) with metabolic dyslipidemia compared to those with normal HDL and TG. Even in subjects with an LDL-C <100mg/dl, presence of metabolic dyslipidemia in adults with diabetes is associated with an increased risk of CHD. In conclusion, effective CHD prevention strategies are needed for adults with diabetes and metabolic dyslipidemia. PMID:26428026

  16. Patient-Physician Interaction and Quality of Life in Recently Diagnosed Breast Cancer Patients

    PubMed Central

    Kwan, Marilyn L.; Tam, Emily K.; Ergas, Isaac J.; Rehkopf, David H.; Roh, Janise M.; Lee, Marion M.; Somkin, Carol P.; Stewart, Anita L.; Kushi, Lawrence H.

    2013-01-01

    Introduction Few studies have explored how patient-physician interactions influence patients’ quality of life (QOL). In a prospective cohort study of 1,855 women diagnosed with invasive breast cancer in the Kaiser Permanente Northern California (KPNC) Medical Care Program from 2006 to 2011, we examined associations between patient-physician interactions during cancer treatment and QOL, overall and by racial/ethnic group. Methods Participants completed the Interpersonal Processes of Care (IPC) Survey at approximately eight months post-diagnosis to assess specific domains of the patient-physician interaction during the months after cancer diagnosis. Domains included: compassion, elicited concerns, explained results, decided together, lack of clarity, discrimination due to race/ethnicity, and disrespectful office staff. The Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) was completed concurrently to measure QOL. Linear regression models examined the association of IPC with QOL, first adjusting for patient covariates including age, race, clinical factors, and psychosocial measures and then for physician characteristics such as age, sex, race/ethnicity, and specialty. Results For all participants (n=1,855), IPC scores suggesting greater lack of clarity, discrimination due to race/ethnicity, and disrespectful office staff in patient-physician interactions were associated with lower QOL (p<0.01). IPC scores suggesting physicians demonstrating compassion, eliciting concerns, or explaining results were associated with higher QOL (p<0.01). Among Whites (n=1,306), only the associations with higher QOL remained. African Americans (n=110) who reported higher scores on physician compassion and elicited concerns had higher QOL, whereas higher scores for disrespectful office staff had lower QOL. No associations were observed among Asians (n=201) and Hispanics (n=186). After further adjustment for physician factors, the associations among Whites remained whereas those among African Americans disappeared. Conclusion In the breast cancer treatment setting, characteristics of the patient-physician interaction as perceived by the patient are associated with QOL, yet were not specific to patient race/ethnicity. PMID:23715629

  17. PS2-10: Economic Impact of Electronic Health Information Exchange

    PubMed Central

    Bredfeldt, Christine

    2013-01-01

    Background/Aims More than 40% of outpatient visits involve a transition in care. Effectively coordinating care across providers is critical to reducing healthcare costs and improving patient safety and quality of care. Electronic health information exchange (eHIE) facilitates coordination of care by enabling information transfer across providers and medical clinics. By increasing care coordination, eHIE is expected to reduce healthcare costs resulting from redundant lab tests and radiology studies. In this study, we examine the economic consequences of eHIE in the context of x-ray imaging for bone fractures. Methods We have previously demonstrated that eHIE is associated with a significant reduction in follow-up x-ray imaging for patients with bone fractures of the extremities. This retrospective cohort study of Kaiser Permanente Mid-Atlantic States (KPMAS) members compared the rate of duplicate x-rays in patients with a diagnosis of bone fractures from the Emergency Department (ED) or from outpatient care between 2006 and 2010. Here, we use the Medicare fee schedule to estimate costs for all imaging events, including x-rays, CT scans and MRIs, during the two month period following the initial fracture diagnosis. We estimate total cost by identifying all relevant radiology procedures during the two months following the index event and assigning costs based on published estimates for each procedure. Results The study included 5680 patients from KPMAS with bone fractures diagnoses. 38% of patients were initially seen in the ED, while 62% of patients were seen in outpatient care. The median cost of imaging procedures in the month after diagnosis was $30.60. Patients who received diagnosis and follow-up care at facilities that did not have active eHIE cost the healthcare system 1.7 times as much as patients who received diagnosis and follow-up care at institutions that electronically shared radiology data between facilities and providers. Conclusions eHIE reduces healthcare costs related to duplication of diagnostic tests, specifically imaging studies. Next steps will be to evaluate the impact of different eHIE access methods on its effectiveness.

  18. Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy

    PubMed Central

    Pearson, Michele L.; Selby, Joseph V.; Katz, Kenneth A.; Cantrell, Virginia; Braden, Christopher R.; Parise, Monica E.; Paddock, Christopher D.; Lewin-Smith, Michael R.; Kalasinsky, Victor F.; Goldstein, Felicia C.; Hightower, Allen W.; Papier, Arthur; Lewis, Brian; Motipara, Sarita; Eberhard, Mark L.

    2012-01-01

    Background Morgellons is a poorly characterized constellation of symptoms, with the primary manifestations involving the skin. We conducted an investigation of this unexplained dermopathy to characterize the clinical and epidemiologic features and explore potential etiologies. Methods A descriptive study was conducted among persons at least 13 years of age and enrolled in Kaiser Permanente Northern California (KPNC) during 20062008. A case was defined as the self-reported emergence of fibers or materials from the skin accompanied by skin lesions and/or disturbing skin sensations. We collected detailed epidemiologic data, performed clinical evaluations and geospatial analyses and analyzed materials collected from participants' skin. Results We identified 115 case-patients. The prevalence was 3.65 (95% CI?=?2.98, 4.40) cases per 100,000 enrollees. There was no clustering of cases within the 13-county KPNC catchment area (p?=?.113). Case-patients had a median age of 52 years (range: 1793) and were primarily female (77%) and Caucasian (77%). Multi-system complaints were common; 70% reported chronic fatigue and 54% rated their overall health as fair or poor with mean Physical Component Scores and Mental Component Scores of 36.63 (SD?=?12.9) and 35.45 (SD?=?12.89), respectively. Cognitive deficits were detected in 59% of case-patients and 63% had evidence of clinically significant somatic complaints; 50% had drugs detected in hair samples and 78% reported exposure to solvents. Solar elastosis was the most common histopathologic abnormality (51% of biopsies); skin lesions were most consistent with arthropod bites or chronic excoriations. No parasites or mycobacteria were detected. Most materials collected from participants' skin were composed of cellulose, likely of cotton origin. Conclusions This unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of life. No common underlying medical condition or infectious source was identified, similar to more commonly recognized conditions such as delusional infestation. PMID:22295070

  19. Associations Between Physical Activity and Cardiometabolic Risk Factors Assessed in a Southern California Health Care System, 20102012

    PubMed Central

    Coleman, Karen J.; Ngor, Eunis; Reynolds, Kristi; Sidell, Margo; Sallis, Robert E.

    2014-01-01

    Introduction Risk factors associated with many chronic diseases can be improved through regular physical activity. This study investigated whether cross-sectional associations between physical activity, assessed by the Exercise Vital Sign (EVS), and cardiometabolic risk factors can be detected in clinical settings. Methods We used electronic records from Kaiser Permanente Southern California members (N = 622,897) to examine the association of EVS category with blood pressure, fasting glucose, random glucose, and glycosylated hemoglobin. Adults aged 18 years or older with at least 3 EVS measures between April 2010 and December 2012, without comorbid conditions, and not taking antihypertension or glucose-lowering medications were included. We compared consistently inactive (EVS = 0 min/wk for every measure) with consistently active (EVS ?150 min/wk) and irregularly active (EVS 1149 min/wk or not meeting the consistently active or inactive criteria) patients. Separate linear regression analyses were conducted controlling for age, sex, race/ethnicity, body mass index, and smoking status. Results Consistently active women had lower systolic (?4.60 mm Hg; 95% confidence interval [CI], ?4.70 to ?4.44) and diastolic (?3.28 mm Hg; 95% CI, ?3.40 to ?3.17) blood pressure than inactive women. Active men had lower diastolic blood pressure than inactive men. Consistently active patients (women, ?5.27 mg/dL [95% CI, ?5.56 to ?4.97]; men, ?1.45 mg/dL [95% CI, ?1.75 to ?1.16] and irregularly active patients (women, ?4.57 mg/dL [95% CI, ?4.80 to ?4.34]; men, ?0.42 mg/dL [95% CI, ?0.66 to ?0.19]) had lower fasting glucose than consistently inactive patients. Consistently active and irregularly active men and women also had favorable random glucose and HbA1c compared with consistently inactive patients. Conclusion Routine clinical physical activity assessment may give health care providers additional information about their patients cardiometabolic risk factors. PMID:25523350

  20. The Morningside Initiative: Collaborative Development of a Knowledge Repository to Accelerate Adoption of Clinical Decision Support

    PubMed Central

    Greenes, Robert; Bloomrosen, Meryl; Brown-Connolly, Nancy E.; Curtis, Clayton; Detmer, Don E; Enberg, Robert; Fridsma, Douglas; Fry, Emory; Goldstein, Mary K; Haug, Peter; Hulse, Nathan; Hongsermeier, Tonya; Maviglia, Saverio; Robbins, Craig W; Shah, Hemant

    2010-01-01

    The Morningside Initiative is a public-private activity that has evolved from an August, 2007, meeting at the Morningside Inn, in Frederick, MD, sponsored by the Telemedicine and Advanced Technology Research Center (TATRC) of the US Army Medical Research Materiel Command. Participants were subject matter experts in clinical decision support (CDS) and included representatives from the Department of Defense, Veterans Health Administration, Kaiser Permanente, Partners Healthcare System, Henry Ford Health System, Arizona State University, and the American Medical Informatics Association (AMIA). The Morningside Initiative was convened in response to the AMIA Roadmap for National Action on Clinical Decision Support and on the basis of other considerations and experiences of the participants. Its formation was the unanimous recommendation of participants at the 2007 meeting which called for creating a shared repository of executable knowledge for diverse health care organizations and practices, as well as health care system vendors. The rationale is based on the recognition that sharing of clinical knowledge needed for CDS across organizations is currently virtually non-existent, and that, given the considerable investment needed for creating, maintaining and updating authoritative knowledge, which only larger organizations have been able to undertake, this is an impediment to widespread adoption and use of CDS. The Morningside Initiative intends to develop and refine (1) an organizational framework, (2) a technical approach, and (3) CDS content acquisition and management processes for sharing CDS knowledge content, tools, and experience that will scale with growing numbers of participants and can be expanded in scope of content and capabilities. Intermountain Healthcare joined the initial set of participants shortly after its formation. The efforts of the Morningside Initiative are intended to serve as the basis for a series of next steps in a national agenda for CDS. It is based on the belief that sharing of knowledge can be highly effective as is the case in other competitive domains such as genomics. Participants in the Morningside Initiative believe that a coordinated effort between the private and public sectors is needed to accomplish this goal and that a small number of highly visible and respected health care organizations in the public and private sector can lead by example. Ultimately, a future collaborative knowledge sharing organization must have a sustainable long-term business model for financial support. PMID:21603282

  1. Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization

    PubMed Central

    Yian, Edward; Zhou, Hui; Schreiber, Ariyon; Sodl, Jeff; Navarro, Ron; Singh, Anshuman; Bezrukov, Nikita

    2016-01-01

    Context: Surgical treatment for proximal humerus fractures has increased exponentially. Recent health care policies incentivize centers to reduce hospital readmission rates. Better understanding of risk factors for readmission and early mortality in this population will assist in identifying favorable risk-benefit patient profiles. Objective: To identify incidence and risk factors of 30-day hospital readmission rate and 1-year mortality rate after open surgery of proximal humerus fractures. Design: Retrospective cohort analysis from Kaiser Permanente Southern California Region database. Methods: Using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes, all operative proximal humerus fractures were validated. Hospital readmission, one-year mortality, and demographic and medical data were collected. A logistic regression test was performed to assess potential risk factors for outcomes. Results: From 1387 surgical patients, the 30-day all-cause readmission rate was 5.6%. Forty percent of hospital read-missions were due to surgery-related reasons. Severe liver disease (odds ratio [OR], 3.48, 95% confidence interval [CI] = 1.428.55) and LACE (length of stay, acuity of admission, comorbidities, and number of Emergency Department visits in the previous 6 months) index score ? 10 (OR, 4.47, 95% CI = 2.547.86) were independent risk factors of readmission on multivariate analysis. The 1-year mortality rate was 4.86%. Multivariate analysis showed length of hospital stay (OR 1.11, 95% CI = 1.051.19), cancer (OR 3.38, 95% CI = 1.617.10), 30-day readmission (OR 3.31, 95% CI = 1.348.21), and Charlson comorbidity index greater than or equal to 4 (OR 13.94, 95% CI = 4.4044.17) predicted higher mortality risk. Conclusion: After open treatment of proximal humerus fractures, there was a 5.6% all-cause 30-day hospital readmission rate. Surgical complications accounted for 40% of read-missions. Severe liver disease and LACE score correlated best with postoperative 30-day readmission risk. Length of hospital stay, preexisting cancer, 30-day readmission, and Charlson comorbidity index were predictive of 1-year mortality. PMID:26824962

  2. Dual Recovery among People with Serious Mental Illnesses and Substance Problems: A Qualitative Analysis

    PubMed Central

    Green, Carla A.; Yarborough, Micah T.; Polen, Michael R.; Janoff, Shannon L.; Yarborough, Bobbi Jo H.

    2014-01-01

    Objective Individuals with serious mental illnesses are more likely to have substance-related problems than those without mental health problems. They also face more difficult recovery trajectories as they cope with dual disorders. Nevertheless, little is known about individuals’ perspectives regarding their dual recovery experiences. Methods This qualitative analysis was conducted as part of an exploratory mixed-methods study of mental health recovery. Members of Kaiser Permanente Northwest (a group-model, not-for-profit, integrated health plan) who had serious mental illness diagnoses were interviewed four times over two years about factors affecting their mental health recovery. Interviews were recorded, transcribed, and coded with inductively-derived codes. Themes were identified by reviewing text coded “alcohol or other drugs.” Results Participants (N = 177) were diagnosed with schizophrenia/schizoaffective disorder (n = 75, 42%), bipolar I/II disorder (n = 84, 48%), or affective psychosis (n = 18, 10%). At baseline, 63% (n = 112) spontaneously described addressing substance use as part of their mental health recovery. When asked at follow-up, 97% (n = 171) provided codeable answers about substances and mental health. We identified differing pathways to recovery, including through formal treatment, self-help groups or peer support, “natural” recovery (without the help of others), and continued but controlled use of alcohol. We found three overarching themes in participants’ experiences of recovering from serious mental illnesses and substance-related problems: Learning about the effects of alcohol and drugs provided motivation and a foundation for sobriety; achieving sobriety helped people to initiate their mental health recovery processes; and achieving and maintaining sobriety built self-efficacy, self-confidence, improved functioning and a sense of personal growth. Non-judgmental support from clinicians adopting chronic disease approaches also facilitated recovery. Conclusions Irrespective of how people achieved sobriety, quitting or severely limiting use of substances was important to initiating and continuing mental health recovery processes. Substance abuse treatment approaches that are flexible, reduce barriers to engagement, support learning about effects of substances on mental health and quality of life, and adopt a chronic disease model of addiction may increase engagement and success. Peer-based support like Alcoholics or Narcotics Anonymous can be helpful for people with serious mental illnesses, particularly when programs accept use of mental health medications. PMID:25491440

  3. Primary Care DirectConnect: How the Marriage of Call Center Technology and the EMR Brought Dramatic Results-A Service Quality Improvement Study.

    PubMed

    Bowman, Brent; Smith, Scott

    2010-01-01

    Of the key Health Plan patient satisfaction measures used in Kaiser Permanente Colorado, ease of contacting the physician's office with a medical question was consistently rated as the lowest quarterly patient satisfaction measure. Furthermore, medical office staff had become dissatisfied with their inability to contact patients who had previously left messages. In addition to the shear volume of messages, the return calls were often unanswered, leading to subsequent attempts to reach patients, creating additional work for medical office staff.DirectConnect-the project name for a system and set of processes focused on improving patient satisfaction with the ability to contact Primary Care delivery teams by telephone-focuses on isolating medical advice calls from the other types of calls handled by the centralized Call Center. The system identifies the patient using his/her unique electronic medical record number, then automatically routes medical advice calls directly to the appropriate Primary Care Physician (PCP) or staff. The clinician may then evaluate and respond to the patient's need quickly, thus managing more of their panel's requests in real time.How is DirectConnect different from simply having the patient contact their PCP's office directly? The primary difference is "one-number" convenience that allows all patients to dial one number to access their PCP's team. In addition, calls are routed to various staff as available to reduce long telephone queues and wait times.The DirectConnect system has resulted in statistically significant improvement in key service quality measures. Patient satisfaction improved from a pre-implementation nine quarter mean of 55.9% to a post-implementation 12 quarter mean of 70.2%. Fourteen percent to 17% of all Primary Care calls are now handled by the patient's home medical office team, creating a 54% improvement in the centralized Call Center's speed of answering calls in the first quarter post implementation-making no additions to medical office staffing levels. The efficiencies gained by directly connecting medical advice-seeking patients with their Primary Care team resulted in an estimated savings of 198 and 247 cumulative hours per week in unnecessary telephone work for Call Center and medical office staff regionwide. PMID:20740112

  4. Initiation of tumor necrosis factor-α antagonists and the risk of hospitalization for infection in patients with autoimmune diseases

    PubMed Central

    Grijalva, Carlos G.; Chen, Lang; Delzell, Elizabeth; Baddley, John W.; Beukelman, Timothy; Winthrop, Kevin L.; Griffin, Marie R.; Herrinton, Lisa J.; Liu, Liyan; Ouellet-Hellstrom, Rita; Patkar, Nivedita M; Solomon, Daniel H.; Lewis, James D.; Xie, Fenglong; Saag, Kenneth G.; Curtis, Jeffrey R.

    2012-01-01

    Context Although tumor necrosis factor alpha (TNF-α) antagonists are increasingly used in place of non-biologic comparator medications, their safety profile remains incomplete. Objectives To determine whether initiation of TNF-α antagonists compared with non-biologic comparators is associated with an increased risk of serious infections. Design, setting and patients Within a US multi-institutional collaboration, we assembled retrospective cohorts (1998–2007) of patients with rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis, psoriatic arthritis or ankylosing spondylitis (PsO-PsA-AS) combining data from Kaiser Permanente Northern California, New Jersey and Pennsylvania Pharmaceutical Assistance programs, Tennessee Medicaid and National Medicaid/Medicare. TNF-α antagonists and non-biologic regimens were compared in disease specific-propensity score (PS) matched cohorts using Cox regression models with non-biologics as reference. Baseline glucocorticoid use was evaluated as a separate covariate. Main outcome measure Infections requiring hospitalization (serious infections) during the first 12 months after initiation of TNF-α antagonists or non-biologic regimens. Results Study cohorts included 10484 RA, 2323 IBD and 3213 PsO-PsA-AS PS-matched pairs using TNF-α antagonists and comparator medications. Overall, we identified 1171 serious infections, most of which (53%) were pneumonia and skin and soft tissue infections. Among RA patients, serious infection hospitalization rates were 8.16 (TNF-α antagonists) and 7.78 (comparator regimens) per 100 person-years (adjusted hazard ratio [aHR]: 1.07 (95% CI: 0.93–1.23)). Among IBD patients, rates were 10.91 and 9.60 per 100 person-years (aHR: 1.13, (0.85–1.50)). Among PsO-PsA-AS patients, rates were 5.41 and 5.19 per 100 person-years (aHR: 1.10, (0.80–1.53)). Among RA patients, infliximab was associated with a significant increase in serious infections compared with etanercept and adalimumab (aHRs: 1.27 (1.08–1.49) and 1.23 (1.02–1.48)). Baseline glucocorticoid use was associated with a dose-dependent increase in infections. Conclusions Among patients with autoimmune diseases, compared to treatment with non-biologic regimens, initiation of TNF-α antagonists was not associated with an increased risk of hospitalizations for serious infections. PMID:22056398

  5. Comparing virtual consults to traditional consults using an electronic health record: an observational casecontrol study

    PubMed Central

    2012-01-01

    Background Patients have typically received health care through face-to-face encounters. However, expansion of electronic communication and electronic health records (EHRs) provide alternative means for patient and physicians to interact. Electronic consultations may complement regular healthcare by providing better, faster, cheaper processes for diagnosing, treating, and monitoring health conditions. Virtual consultation between physicians may provide a method of streamlining care, potentially saving patients the time and expense of added visits. The purpose of this study was to compare physician usage and patient satisfaction with virtual consultations (VCs) with traditional consultations (TCs) facilitated within an EHR. Methods We conducted an observational casecontrol survey study within Kaiser Permanente, Colorado. A sample of patients who had VCs requested by physicians (N = 270) were matched with patients who had TCs requested by physicians (N = 270), by patient age, gender, reason for the consult, and specialty department. These patients (VC and TC), were invited to participate in a satisfaction survey. In addition, 205 primary care physicians who submitted a VC or TC were surveyed. Results During the study period, 58,146 VC or TC were requested (TC = 96.3%). Patients who completed a satisfaction survey (267 out of 540 patients, 49.4% response rate) indicated they were satisfied with their care, irrespective of the kind of consult (mean 10-point Likert score of 8.5). 88 of 205 primary care physicians surveyed (42.9%) returned at least one survey; VC and TC survey response rates and consulted departments were comparable (p = 0.13). More TCs than VCs requested transfer of patient care (p = 0.03), assistance with diagnosis (p = 0.04) or initiating treatment (p =0.04). Within 3 weeks of the consultation request, 72.1% of respondents reported receiving information from VCs, compared with 33.9% of the TCs (p < 0.001). Utility of information provided by consultants and satisfaction with consultations did not differ between VCs and TCs. Conclusions Referring physicians received information from consultants more quickly from VCs compared with TCs, but the value and application of information from both types of consultations were similar. VCs may decrease the need for face-to-face specialty encounters without a decrease in the patients perception of care. PMID:22769592

  6. A Pilot Whole Systems Clinical Trial of Traditional Chinese Medicine and Naturopathic Medicine for the Treatment of Temporomandibular Disorders

    PubMed Central

    Hammerschlag, Richard; Calabrese, Carlo; Mist, Scott; Aickin, Mikel; Sutherland, Elizabeth; Leben, Joseph; DeBAR, Lynn; Elder, Charles; Dworkin, Samuel F.

    2008-01-01

    Abstract Objectives To assess the feasibility and acceptability of studying whole systems of Traditional Chinese Medicine (TCM) and Naturopathic medicine (NM) in the treatment of temporomandibular disorders (TMD), and to determine whether there is indication to support further research. Design A pilot study using a randomized controlled clinical trial design of whole system TCM and NM versus state-of-the-art specialty care (SC). Setting/location Kaiser Permanente Northwest (KPNW), and practitioner offices in Portland, Oregon. Subjects One hundred and sixty (160) women 2555 years of age attending a KPNW TMD specialty clinic. Interventions Whole system TCM and NM, and KPNW TMD clinic SC; the intervention protocols were designed to model the individually tailored type of community care offered in alternative medicine practices in Portland and in the KPNW TMD clinic, using protocols that enhanced similarities among practitioners within each system and permitted full descriptions of the treatments provided. Outcome measures TMD was ascertained using the Research Diagnostic Criteria/TMD; outcomes were self-reported worst and average facial pain and interference with activities (scaled 010 where 10 is worst). Results Of 948 consecutive eligible patients, 160 were randomized to one of three arms; 128 provided endpoint data. TCM and NM demonstrated significantly greater in-treatment reductions for worst facial pain compared to SC (adjusted regression analysis; higher negative values indicate greater improvement,?=??1.11??0.43, p?=?0.010 and??1.02??0.45, p?=?0.025 for TCM and NM, respectively, compared to SC) and at 3 months post-treatment (?1.07??0.51, p?=?0.037 and??1.27??0.54, p?=?0.019 for TCM and NM versus SC, respectively). Additionally, TCM provided significantly greater decreases in average pain than SC; NM provided significantly greater decreases than SC or TCM in TMD-related psychosocial interference. Conclusions These alternative medicine approaches each resulted in significantly greater reduction of pain and psychosocial interference than SC. Further research on the potential benefits of traditional whole systems of medicine for TMD appears warranted. PMID:18564953

  7. Nursing Responses to Transcultural Encounters: What Nurses Draw on When Faced with a Patient from Another Culture

    PubMed Central

    Cang-Wong, Celeste; Murphy, Susan O; Adelman, Toby

    2009-01-01

    Objective: We explored nurses' experiences when they encounter patients from cultures other than their own and their perception of what helps them deliver culturally competent care. Methods: Registered nurses from all shifts and units at Kaiser Permanente Santa Clara Medical Center were invited to complete a questionnaire. Within the time frame allowed, 111 nurses participated by returning completed questionnaires. A descriptive survey was conducted using a questionnaire that contained multiple-choice, fill-in-the-blank, and open-ended items. Results: A large majority of respondents reported that they drew on prior experience, including experience with friends and family, and through their education and training, and more than half also included travel experience and information obtained through the Internet and news media. They also expressed a desire for more training and continuing education, exposure to more diverse cultures, and availability of more interpreters. When respondents were asked to enumerate the cultures from which their patients have come, their answers were very specific, revealing that these nurses understood culture as going beyond ethnicity to include religious groups, sexual orientation, and social class (eg, homeless). Discussion: Our research confirmed our hypothesis that nurses are drawing heavily on prior experience, including family experiences and experiences with friends and coworkers from different cultures. Our findings also suggest that schools of nursing are providing valuable preparation for working with diverse populations. Our research was limited to one geographic area and by our purposeful exclusion of a demographic questionnaire. We recommend that this study be extended into other geographic areas. Our study also shows that nurses are drawing on their experiences in caring for patients from other cultures; therefore, we recommend that health care institutions consider exposing not only nurses but also other health care professionals to different cultures by creating activities that involve community projects in diverse communities, offering classes or seminars on different cultures and having an active cultural education program that would reach out to nurses. The experiences provided by such activities and programs would help nurses become more sensitive to the differences between cultures and not immediately judge patients or make assumptions about them. PMID:20740086

  8. PS3-20: Prevalence of Obesity and Extreme Obesity in Children Aged Three to Five Years

    PubMed Central

    Lo, Joan; Maring, Benjamin; Chandra, Malini; Daniels, Stephen; Sinaiko, Alan; Daley, Matthew; Sherwood, Nancy; Kharbanda, Elyse; Parker, Emily; Adams, Kenneth; Prineas, Ronald

    2013-01-01

    Background/Aims Early childhood adiposity may have significant later health effects, highlighting the importance of early recognition in young children. This study examines the prevalence and recognition of obesity and severe obesity in preschool-aged children. Methods The electronic medical record was used to examine body mass index (BMI), height, sex, and race/ ethnicity in 42,559 children aged 35 years 20072010 within Kaiser Permanente Northern California. Normal BMI (BMI <85th percentile); overweight (BMI 85th94th percentile); obesity (BMI ?95th percentile); and extreme obesity (BMI ?99th percentile or BMI ?1.295th BMI percentile) were classified using the 2000 Center for Disease Control and Prevention growth charts. Provider recognition of elevated BMI was examined for obese children aged 5 years. Results Among 42,559 children, 12.4% (2,698 of 21,720) of boys and 10.0% (2,077 of 20,839) of girls had BMI ?95th percentile. The prevalence was highest among Hispanics (18.2%, 982 of 5,397 boys and 15.2%, 760 of 4,988 girls), followed by blacks (12.4%, 161 of 1,138 boys and 12.7%, 154 of 1,216 girls). A positive trend existed between BMI category and median height percentile, with obesity rates highest in the highest height quintile. The proportion with BMI ?99th percentile was 3.9% (1,670 of 42,559), nearly two-fold higher for boys (66.8%, 1,116 of 1,670) versus girls (33.2%, 554 of 1,670), and identified a larger proportion of children compared to BMI ?1.2 95th BMI percentile (1.6%, P <0.001). Among those aged 5 years, 77.9% of obese children (1082 of 1389) had provider diagnosis of obesity or elevated BMI, increasing to 84.5% (424 of 502) among the subset with severe obesity. Conclusions Obesity and severe obesity are evident as early as age 35 years, with race/ ethnic trends similar to older children. This study underscores the need for continued recognition and contextualization of early childhood obesity in order to develop effective strategies for early weight management.

  9. B2-5: Spectrum of Obesity and Extreme Obesity in a Diverse Population of Children and Adolescents

    PubMed Central

    Greenspan, Louise; Chandra, Malini; Daniels, Stephen; Maring, Benjamin; Sinaiko, Alan; Parker, Emily; Sherwood, Nancy; Daley, Matthew; Kharbanda, Elyse; Adams, Kenneth; Prineas, Ronald

    2013-01-01

    Background/Aims The aim of the study was to examine the prevalence of obesity and extreme obesity in school-aged children using three classifications based on body mass index (BMI): BMI percentile, percentage above the 95th percentile and Z score, and the association of BMI stratification with elevated blood pressure. Methods This was a retrospective study of 117,618 children aged 617 years receiving well-child care in Kaiser Permanente Northern California between July 2007 and December 2010. Blood pressure, BMI and other data were extracted from electronic records. Results The prevalence of BMI >95th percentile ranged from 14.5% (4,395 of 30,235) in whites and 14.3% (2,287 of 16,033) in Asians to 22.3% (1,809 of 8,124) in blacks and 25.8% (5,734 of 22,187) in Hispanics. For boys, the highest prevalence was in Hispanics (29.2%, 3,346 of 11,452), followed by blacks (21.0%, 879 of 4,193); for girls, the highest prevalence was in blacks (23.7%, 930 of 3,931) and then Hispanics (22.2%, 2,388 of 10,735). For extreme obesity, a threshold of BMI ?120% of the 95th BMI percentile identified the largest proportion of children (5.6%, 6,532 of 117,618) compared to BMI ?99th percentile (3.8%, 4,488 of 117,618) and BMI Z score ?3.0 (0.1%, 83 of 117,618). Stratification of BMI by percentage above the 95th percentile demonstrated a graded relationship between obesity severity and risk of elevated blood pressure. Conclusions The prevalence of obesity and extreme obesity in children varied by age, gender and race/ethnicity, with the highest prevalence among Hispanics followed by black children. Compared to BMI thresholds based on the 99th BMI percentile or BMI Z score of 3, classification by BMI ?120% of the 95th BMI percentile identified a greater percentage of severely obese children in whom additional health risk-stratification was achieved by further categorizing based on percentage above the 95th BMI percentile. This classification approach may be useful for obesity management in clinical practice, public health surveillance, and research.

  10. Study of Women, Infant feeding, and Type 2 diabetes mellitus after GDM pregnancy (SWIFT), a prospective cohort study: methodology and design

    PubMed Central

    2011-01-01

    Background Women with history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes within 5 years after delivery. Evidence that lactation duration influences incident type 2 diabetes after GDM pregnancy is based on one retrospective study reporting a null association. The Study of Women, Infant Feeding and Type 2 Diabetes after GDM pregnancy (SWIFT) is a prospective cohort study of postpartum women with recent GDM within the Kaiser Permanente Northern California (KPNC) integrated health care system. The primary goal of SWIFT is to assess whether prolonged, intensive lactation as compared to formula feeding reduces the 2-year incidence of type 2 diabetes mellitus among women with GDM. The study also examines whether lactation intensity and duration have persistent favorable effects on blood glucose, insulin resistance, and adiposity during the 2-year postpartum period. This report describes the design and methods implemented for this study to obtain the clinical, biochemical, anthropometric, and behavioral measurements during the recruitment and follow-up phases. Methods SWIFT is a prospective, observational cohort study enrolling and following over 1, 000 postpartum women diagnosed with GDM during pregnancy within KPNC. The study enrolled women at 6-9 weeks postpartum (baseline) who had been diagnosed by standard GDM criteria, aged 20-45 years, delivered a singleton, term (greater than or equal to 35 weeks gestation) live birth, were not using medications affecting glucose tolerance, and not planning another pregnancy or moving out of the area within the next 2 years. Participants who are free of type 2 diabetes and other serious medical conditions at baseline are screened for type 2 diabetes annually within the first 2 years after delivery. Recruitment began in September 2008 and ends in December 2011. Data are being collected through pregnancy and early postpartum telephone interviews, self-administered monthly mailed questionnaires (3-11 months postpartum), a telephone interview at 6 months, and annual in-person examinations at which a 75 g 2-hour OGTT is conducted, anthropometric measurements are obtained, and self- and interviewer-administered questionnaires are completed. Discussion This is the first, large prospective, community-based study involving a racially and ethnically diverse cohort of women with recent GDM that rigorously assesses lactation intensity and duration and examines their relationship to incident type 2 diabetes while accounting for numerous potential confounders not assessed previously. PMID:22196129

  11. A3-5: Research-Operations Partnerships to Improve the Quality and Affordability of Care

    PubMed Central

    Gould, Michael; Nguyen, Huong; Sharp, Adam; Hahn, Erin; Tang, Tania; Mittman, Brian; Jacobsen, Steven; Kanter, Michael

    2014-01-01

    Background/Aims A learning health care organization requires visionary leadership to achieve the triple aim of better health, better care, and improved affordability. Effective research-operations partnerships (ROPs) can facilitate improvement efforts. Although ROPs are not novel, the process of establishing sustainable collaborations and overcoming challenges to achieve shared objectives is not well described. Methods In 2012, the executive leadership of Kaiser Permanente Southern California (KPSC) made a multi-million dollar investment by creating the Care Improvement Research Team (CIRT) within the Department of Research and Evaluation. Members of this team developed and refined ideas about ROPs by reviewing published literature, conducting semi-structured interviews with key operational leaders, consulting with experts, and sponsoring an all-day retreat on this theme. Results Key elements of the initiative include: (1) recruitment of health care researchers with complementary clinical and methodological experience, supported by an expert consultant in implementation science; (2) selection of research questions that are clearly aligned with organizational priorities; (3) development of strong, sustainable relationships with key stakeholders across multiple levels of the organization, through outreach and embedding of researchers in operational work groups; (4) dedication of internal funds to cover effort of research support staff; (5) creation of a strategic plan to define roles, responsibilities, and goals that allow for measurement of the program’s success. Key challenges to overcome include: (1) limited availability of external funds to support research that addresses operational imperatives; (2) mismatched timelines and incentives; (3) legal constraints that hamper data sharing between research and operations; and (4) balancing research rigor with operational relevance. Conclusions Prioritizing competing initiatives, identifying opportunities for early success, and aligning operational priorities with research opportunities will require continued effort. Given the austere external funding environment, novel ways to support delivery system science are needed. The creation of the CIRT at KPSC represents a strategic investment from visionary leaders who embody the credo to “be the best at getting better” and who recognize that the development of strong and sustainable ROPs will be invaluable if we are to achieve the triple aim.

  12. A Study of Genotyping for Management of Human Papillomavirus-Positive, Cytology-Negative Cervical Screening Results

    PubMed Central

    Burk, R. D.; Boyle, S.; Raine-Bennett, T.; Katki, H. A.; Gage, J. C.; Wentzensen, N.; Kornegay, J. R.; Aldrich, C.; Tam, T.; Erlich, H.; Apple, R.; Befano, B.; Castle, P. E.

    2014-01-01

    The effective management of women with human papillomavirus (HPV)-positive, cytology-negative results is critical to the introduction of HPV testing into cervical screening. HPV typing has been recommended for colposcopy triage, but it is not clear which combinations of high-risk HPV types provide clinically useful information. This study included 18,810 women with Hybrid Capture 2 (HC2)-positive, cytology-negative results and who were age ?30 years from Kaiser Permanente Northern California. The median follow-up was 475 days (interquartile range [IQR], 0 to 1,077 days; maximum, 2,217 days). The baseline specimens from 482 cases of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) and 3,517 random HC2-positive noncases were genotyped using 2 PCR-based methods. Using the case-control sampling fractions, the 3-year cumulative risks of CIN3+ were calculated for each individual high-risk HPV type. The 3-year cumulative risk of CIN3+ among all women with HC2-positive, cytology-negative results was 4.6%. HPV16 status conferred the greatest type-specific risk stratification; women with HC2-positive/HPV16-positive results had a 10.6% risk of CIN3+, while women with HC-2 positive/HPV16-negative results had a much lower risk of 2.4%. The next most informative HPV types and their risks in HPV-positive women were HPV33 (5.9%) and HPV18 (5.9%). With regard to the etiologic fraction, 20 of 71 cases of cervical adenocarcinoma in situ (AIS) and adenocarcinoma in the cohort were positive for HPV18. HPV16 genotyping provides risk stratification useful for guiding clinical management; the risk among HPV16-positive women clearly exceeds the U.S. consensus risk threshold for immediate colposcopy referral. HPV18 is of particular interest because of its association with difficult-to-detect glandular lesions. There is a less clear clinical value of distinguishing the other high-risk HPV types. PMID:25339396

  13. Association between the initiation of anti-TNF therapy and the risk of herpes zoster

    PubMed Central

    Winthrop, Kevin L.; Baddley, John W.; Chen, Lang; Liu, Liyan; Grijalva, Carlos G.; Delzell, Elizabeth; Beukelman, Timothy; Patkar, Nivedita M.; Xie, Fenglong; Saag, Kenneth G.; Herrinton, Lisa J.; Solomon, Daniel H.; Lewis, James D.; Curtis, Jeffrey R.

    2013-01-01

    Importance Herpes zoster (HZ) reactivation disproportionately affects patients with rheumatoid arthritis (RA). It is unclear whether anti-tumor necrosis factor (anti-TNF) therapy elevates HZ risk, and whether monoclonal antibodies carry greater risk than etanercept. Objectives To ascertain whether initiation of anti-TNF therapy compared with non-biologic comparators is associated with increased HZ risk Design, Setting, and Patients We identified new users of anti-TNF therapy among cohorts of rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis-psoriatic arthritis-ankylosing spondylitis (PsO-PsA-AS) patients during 19982007 within a large US multi-institutional collaboration combining data from Kaiser Permanente Northern California, Pharmaceutical Assistance Contract for the Elderly, Tennessee Medicaid, and national Medicaid/Medicare programs. We compared HZ incidence between new anti-TNF users and patients initiating non-biologic disease modifying drugs (DMARDs) within each inflammatory disease cohort (last participant follow-up Dec 31, 2007). Within these cohorts, we used Cox regression models to compare propensity-score adjusted HZ incidence between new anti-TNF and non-biologic DMARD users while controlling for baseline corticosteroid use. Main Outcome Measure Incidence of herpes zoster cases occurring after initiation of new anti- TNF or non-biologic DMARD therapy Results Among 32,208 new users of anti-TNF therapy, we identified 310 HZ cases. Crude incidence rates among anti-TNF users for RA, IBD, and PsO-PsA-AS were 12.1/1000 pt-yrs, (95% CI 10.713.6), 11.3/1000 (95% CI 7.716.7), and 4.4/1000 (95% CI 2.87.0) respectively. Baseline use of corticosteroids of > 10mg/day was associated with elevated risk [adjusted HR 2.13 (1.64, 2.75) compared with no baseline use. For RA patients, adjusted incidence rates were similar between anti-TNF and nonbiologic DMARD initiators [adjusted HR 1.00 (95% CI 0.771.29) and comparable between all three anti-TNF therapies studied. Conclusions and Relevance Among patients with RA and other select inflammatory diseases, those who initiated anti-TNF therapies were not at higher risk for HZ compared to patients who initiated non-biologic treatment regimens. PMID:23462785

  14. Cretaceous planktic foraminiferal biostratigraphy of the Calera Limestone, Northern California, USA

    USGS Publications Warehouse

    Sliter, W.V.

    1999-01-01

    The Calera Limestone is the largest, most stratigraphically extensive limestone unit of oceanic character included in the Franciscan Complex of northern California. The aim of this paper is to place the Calera Limestone at its type locality (Rockaway Beach, Pacifica) in a high-resolution biostratigraphy utilizing planktic foraminifers studied in thin section. A section, about 110 m-thick, was measured from the middle thrust slice exposed by quarrying on the southwest side of Calera Hill at Pacifica Quarry. Lithologically, the section is divided in two units; a lower unit with 73 m of black to dark-grey limestone, black chert and tuff, and an upper unit with 36.8 m of light-grey limestone and medium-grey chert. Two prominent black-shale layers rich in organic carbon occur 11 m below the top of the lower black unit and at the boundary with overlying light-grey unit, yielding a total organic content (TOC) of 4.7% and 1.8% t.w., respectively. The fossiliferous Calera Limestone section measured at Pacifica Quarry, from the lower black shale, contains eleven zones and three subzones that span approximately 26 m.y. from the early Aptian to the late Cenomanian. The zones indentified range from the Globigerinelloides blowi Zone to the Dicarinella algeriana Subzone of the Rotalipora cushmani Zone. Within this biostratigraphic interval, the Ticinella bejaouaensis and Hedbergella planispira Zones at the Aptian/Albian boundary are missing as are the Rotalipora subticinensis Subzone of the Biticinella breggiensis Zone and the overlying Rotalipora ticinensis Zone in the late Albian owing both to low-angle thrust faulting and to unconformities. The abundance and preservation of planktic foraminifers are poor in the lower part and improve only within the upper G. algerianus Zone. The faunal relationship indicate that the lower black shale occurs in the upper part of the G. blowi Zone and correlates with the Selli Event recognized at global scale in the early Aptian. The upper black shale occurs at or near the boundary between the G. ferreolensis and G. algerianus Zone in the late Aptian. This black layer, or Thalmann Event as named here, seems to represent the sedimentary expression, at the scale of Permanente Terrane, of a global perturbation of the carbon cycle.

  15. Differences in Response to Antiretroviral Therapy by Sex and Hepatitis C Infection Status.

    PubMed

    Marcus, Julia L; Leyden, Wendy A; Chao, Chun R; Xu, Lanfang; Quesenberry, Charles P; Tien, Phyllis C; Klein, Daniel B; Towner, William J; Horberg, Michael A; Silverberg, Michael J

    2015-07-01

    Hepatitis C virus (HCV) co-infection and biological sex may each affect response to antiretroviral therapy (ART), yet no studies have examined HIV-associated outcomes by both HCV status and sex. We conducted a cohort study of HIV-infected adults initiating ART in Kaiser Permanente California during 1996-2011. We used piecewise linear regression to assess CD4 changes by sex and HCV status over 5 years. We used Cox regression to estimate hazard ratios (HR) by sex and HCV status for HIV RNA <500 copies/mL over 1 year, and for AIDS and death over the follow-up period. Among 12,865 subjects, there were 154 HIV/HCV-co-infected women, 1000 HIV/HCV-co-infected men, 1088 HIV-mono-infected women, and 10,623 HIV-mono-infected men. CD4 increases were slower in the first year for HIV/HCV-co-infected women (75 cells/?L) and men (70 cells/?L) compared with HIV-mono-infected women (145 cells/?L) and men (120 cells/?L; p<0.001). After 5 years, women had higher CD4 than men in both HIV-mono-infected (598 vs. 562 cells/?L, p=0.003) and HIV/HCV-co-infected individuals (567 vs. 509 cells/?L, p=0.003). Regardless of sex, HIV/HCV co-infection was associated with 40% higher mortality [95% confidence interval (CI): 1.2-1.6] compared with HIV mono-infection, but was not associated with AIDS (HR 1.1, 95% CI: 0.9-1.3) or achieving HIV RNA <500 copies/mL (HR 1.0, 95% CI: 0.9-1.1). HIV/HCV-co-infected men and women have slower CD4 recovery after starting ART and have increased mortality compared with HIV-mono-infected men and women. HCV should be aggressively treated in HIV/HCV-co-infected adults, regardless of sex. PMID:26061798

  16. A3-1: The Just Do It Playbook for Implementation Science

    PubMed Central

    Sharp, Adam; Nguyen, Huong; Hahn, Erin; Tang, Tania; Mittman, Brian; Kanter, Michael; Jacobsen, Steve; Gould, Michael

    2014-01-01

    Background/Aims There are over 60 published implementation science frameworks, and despite the advantages of each, none were designed to help clinicians and administrators to standardize and prioritize initiatives, implement programs efficiently, and evaluate with sufficient rigor. Methods In order to address these limitations, the Care Improvement Research Team (CIRT) at Kaiser Permanente Southern California blended implementation and behavior change frameworks into a structured process to help clinicians, operations leaders and researchers to standardize their approach and accomplish collaborative goals. To develop the “Just Do It Playbook,” we performed a pragmatic literature review, compared and synthesized published frameworks, and iteratively refined a set of steps for identifying, diagnosing and correcting gaps in care. Results The Just Do It Playbook can be simplified into four distinct steps: 1) describe the topic that needs improvement, 2) identify what or who needs to change, 3) develop an implementation strategy to facilitate change, and 4) evaluate the effectiveness of the strategy. The first step helps to prioritize the topic of interest and identifies whether there is a gap between current and best practices. Second, describing what or who needs to improve will enable identification of barriers or facilitators to change. The third step identifies strategies to promote best practices by using established behavior change theories as well as clearly defined and measurable outcomes. The final step evaluates the outcomes, costs and sustainability of the strategy, as well as the need to discontinue efforts, modify and re-evaluate, or disseminate to other settings. Conclusions In a learning health care system, there are many potential targets for improvement, and many strategies for implementation and evaluation. One way to simplify the complexities that inherently exist in health system improvement is to adopt a standardized approach. As clinicians, administrators and researchers forge meaningful collaborations, a standard process can improve the understanding of competing priorities, define roles and responsibilities, and integrate established scientific frameworks in a way that is efficient and sustainable. The Just Do It Playbook will need to be tested and adapted to individual projects, but will provide a platform to build embedded research into a functional operational standard.

  17. C4-3: Implementation of a Screening Brief Intervention and Referral to Treatment (SBIRT) Protocol in Primary Care

    PubMed Central

    Rahm, Alanna Kulchak; Martin, Carmen; Boggs, Jennifer; Price, David; Beck, Arne; Dearing, James; Backer, Thomas

    2013-01-01

    Background/Aims Substance abuse in the United States is a serious public health concern; however, routine screening is inconsistent in primary care. In partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), Kaiser Permanente Colorado (KPCO) implemented the Screening Brief Intervention and Referral to Treatment (SBIRT) protocol in one primary care clinic over a 3-month period in order to determine staff perceptions, barriers, and solutions for wide-scale implementation. Methods Based on prior feasibility studies, clinic staff were engaged in order to anticipate barriers and solutions to improve implementation success. A quantitative survey of team functioning and clinic priority for implementing SBIRT was also conducted prior to implementation. Screening was conducted by front desk staff of all adult Health Maintenance Visits (ages 1964 years) using a 3-question paper questionnaire, followed by Brief Intervention delivered by the behavioral medicine specialist (BMS) in the case of positive screening result. This workflow was determined by the clinic despite prior feasibility results indicating optimal workflow consisting of screening by Medical Assistants and Nurses during the rooming process due to multiple competing demands from the organization during the implementation period. Results A total of 1097 eligible patients were seen during the 3-month implementation, 321 (29%) were screened for alcohol use, and 15 (5%) required additional Brief Intervention with the BMS. Positive results of implementation included improved awareness by physicians of alcohol use, better communication among members of the care team, and integration of the BMS as a resource for the care team. Barriers included patient resistance, competing demands on the clinic, and lack of information on screening recorded in the medical record. Post-study debriefing with primary care and BMS staff led to a commitment by clinic leadership and staff to revise workflow and explore regional implementation strategies. Solutions include additional training regarding clinical utility of screening and options for normalizing screening for patients and solutions for recording screening in the EMR. Conclusions Through continued use of SBIRT, this clinic will also demonstrate the value of screening for drug and alcohol use to the region in order to promote wider dissemination.

  18. Prévalence de l'hypertension artérielle dans la population des meuniers de la ville de Lubumbashi, République Démocratique du Congo

    PubMed Central

    Ngombe, Léon Kabamba; Cowgill, Karen; Monga, Ben Bondo; Ilunga, Benjamin Kabyla; Stanis, Wembonyama Okitotsho; Numbi, Oscar Luboya

    2015-01-01

    Introduction L'objectif était de comparer la prévalence de l'hypertension artérielle chez les meuniers dans la ville de Lubumbashi qui sont exposés d'une manière permanente aux bruits des machines de transformation des céréales à la prévalence de l'hypertension artérielle chez un groupe des gardiens. Méthodes Quic'est une étude descriptive transversale qui a concerné 286 meuniers et 115 agents d'une entreprise de gardiennage. Apres un consentement éclairé, un auto questionnaire a été administré aux enquêtés et des mesures de poids, taille, et tension artérielle ont été prises. Résultats La prévalence de l'HTA chez les meuniers était 49.3% et celle des gardes était 20.9%, pour un ratio de prévalence de 2.4. significativement élevée par rapport aux contrôles (49.3% vs 20.9%) et le ratio de prévalence était de 2.4. Les facteurs de risque tels que: l’âge, l'indice de masse corporelle, l'ancienneté, la durée de travail ont été significativement élevés chez les meuniers par rapport aux gardiens. Conclusion Nous avons trouvé une prévalence élevée de l'HTA chez les meuniers. Nos résultats suggèrent que cette prévalence est probablement due à l'environnement du milieu de travail des meuniers (bruits, vibration des machines) et ce dernier constitue un facteur de risque de l'hypertension artérielle. PMID:26889333

  19. Effect of Femoral Head Size on Metal-on-HXLPE Hip Arthroplasty Outcome in a Combined Analysis of Six National and Regional Registries

    PubMed Central

    Allepuz, Alex; Havelin, Leif; Barber, Thomas; Sedrakyan, Art; Graves, Stephen; Bordini, Barbara; Hoeffel, Daniel; Cafri, Guy; Paxton, Elizabeth

    2014-01-01

    Background: HXLPE (highly cross-linked polyethylene) has greater wear resistance compared with UHMWPE (ultra-high molecular weight polyethylene), which may contribute to improving the outcomes of total hip arthroplasty with a large femoral head. However, no information is available regarding the effect of femoral head size on the survivorship of HXLPE hip prostheses. The aim of the present study was to provide evidence regarding whether femoral head size has an effect on the risk of revision when an HXLPE liner is used on a metal head. Methods: A distributed health data network was developed by the ICOR (International Consortium of Orthopaedic Registries). Six national and regional registries are participating in this network: Kaiser Permanente, HealthEast, the Emilia-Romagna region in Italy, the Catalan region in Spain, Norway, and Australia. Data from each registry were standardized and provided at an aggregate level for each of the variables of interest. Patients with osteoarthritis who were forty-five to sixty-four years of age and had undergone uncemented total hip arthroplasty were included in the present study. Analyses were performed on the basis of individual patient profiles, utilizing the variables collected from each registry. The outcome of interest was the time to the first revision (for any reason). Survival probabilities and their standard errors were extracted from each registry for each unique combination of the covariates and were combined through multivariate meta-analysis utilizing linear mixed models to compare survivorship for <32-mm, 32-mm, and >32-mm femoral head sizes. Results: A total of 14,372 total hip arthroplasties were included in the study. The five-year rate of revision surgery varied from 1.9% to 3.2% among registries. The risk of revision did not differ significantly between <32-mm and 32-mm head sizes (HR [hazard ratio] = 0.91, 95% CI [confidence interval] = 0.69 to 1.19) or between >32-mm and 32-mm sizes (HR = 1.05, 95% CI = 0.70 to 1.55). Conclusions: The results of our study provide relevant data to orthopaedic surgeons deciding on the use of a larger articulation in a metal-on-polyethylene bearing. A larger head diameter should not be considered a detriment to device survival when an HXLPE liner is used. However, efforts to force the use of a large-size implant appear unsupported, as similar survivorship was observed for all head diameter groups. PMID:25520414

  20. Study protocol: The back pain outcomes using longitudinal data (BOLD) registry

    PubMed Central

    2012-01-01

    Background Back pain is one of the most important causes of functional limitation, disability, and utilization of health care resources for adults of all ages, but especially among older adults. Despite the high prevalence of back pain in this population, important questions remain unanswered regarding the comparative effectiveness of commonly used diagnostic tests and treatments in the elderly. The overall goal of the Back pain Outcomes using Longitudinal Data (BOLD) project is to establish a rich, sustainable registry to describe the natural history and evaluate prospectively the effectiveness, safety, and cost-effectiveness of interventions for patients 65 and older with back pain. Methods/design BOLD is enrolling 5,000 patients???65?years old who present to a primary care physician with a new episode of back pain. We are recruiting study participants from three integrated health systems (Kaiser-Permanente Northern California, Henry Ford Health System in Detroit and Harvard Vanguard Medical Associates/ Harvard Pilgrim Health Care in Boston). Registry patients complete validated, standardized measures of pain, back pain-related disability, and health-related quality of life at enrollment and 3, 6 and 12?months later. We also have available for analysis the clinical and administrative data in the participating health systems electronic medical records. Using registry data, we will conduct an observational cohort study of early imaging compared to no early imaging among patients with new episodes of back pain. The aims are to: 1) identify predictors of early imaging and; 2) compare pain, functional outcomes, diagnostic testing and treatment utilization of patients who receive early imaging versus patients who do not receive early imaging. In terms of predictors, we will examine patient factors as well as physician factors. Discussion By establishing the BOLD registry, we are creating a resource that contains patient-reported outcome measures as well as electronic medical record data for elderly patients with back pain. The richness of our data will allow better matching for comparative effectiveness studies than is currently possible with existing datasets. BOLD will enrich the existing knowledge base regarding back pain in the elderly to help clinicians and patients make informed, evidence-based decisions regarding their care. PMID:22554166