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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. Kaiser Permanente's Convergent Medical Terminology.

    PubMed

    Dolin, Robert H; Mattison, John E; Cohn, Simon; Campbell, Keith E; Wiesenthal, Andrew M; Hochhalter, Brad; LaBerge, Diane; Barsoum, Rita; Shalaby, James; Abilla, Alan; Clements, Robert J; Correia, Carol M; Esteva, Diane; Fedack, John M; Goldberg, Bruce J; Gopalarao, Sridhar; Hafeza, Eza; Hendler, Peter; Hernandez, Enrique; Kamangar, Ron; Kahn, Rafique A; Kurtovich, Georgina; Lazzareschi, Gerry; Lee, Moon H; Lee, Tracy; Levy, David; Lukoff, Jonathan Y; Lundberg, Cyndie; Madden, Michael P; Ngo, Trongtu L; Nguyen, Ben T; Patel, Nikhilkumar P; Resneck, Jim; Ross, David E; Schwarz, Kathleen M; Selhorst, Charles C; Snyder, Aaron; Umarji, Mohamed I; Vilner, Max; Zer-Chen, Roy; Zingo, Chris

    2004-01-01

    This paper describes Kaiser Permanente's (KP) enterprise-wide medical terminology solution, referred to as our Convergent Medical Terminology (CMT). Initially developed to serve the needs of a regional electronic health record, CMT has evolved into a core KP asset, serving as the common terminology across all applications. CMT serves as the definitive source of concept definitions for the organization, provides a consistent structure and access method to all codes used by the organization, and is KP's language of interoperability, with cross-mappings to regional ancillary systems and administrative billing codes. The core of CMT is comprised of SNOMED CT, laboratory LOINC, and First DataBank drug terminology. These are integrated into a single poly-hierarchically structured knowledge base. Cross map sets provide bi-directional translations between CMT and ancillary applications and administrative billing codes. Context sets provide subsets of CMT for use in specific contexts. Our experience with CMT has lead us to conclude that a successful terminology solution requires that: (1) usability considerations are an organizational priority; (2) "interface" terminology is differentiated from "reference" terminology; (3) it be easy for clinicians to find the concepts they need; (4) the immediate value of coded data be apparent to clinician user; (5) there be a well defined approach to terminology extensions. Over the past several years, there has been substantial progress made in the domain coverage and standardization of medical terminology. KP has learned to exploit that terminology in ways that are clinician-acceptable and that provide powerful options for data analysis and reporting. PMID:15360832

  3. 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

  4. 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

  5. PROCEDURE VAE / VAP Universit Blaise Pascal Service Formation Permanente

    E-print Network

    Sart, Remi

    PROCEDURE VAE / VAP Université Blaise Pascal ­ Service Formation Permanente 36 avenue Jean Jaurès.permanente@univ-bpclermont.frUniversité Blaise Pascal ­ Service Formation Permanente 36 avenue Jean Jaurès ­ CS 20001 ­ 63407 CHAMALIERES Cedex-après, retrouvez tous les diplômes délivrés par l'université Blaise Pascal : http

  6. 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

  7. 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

  8. 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.

  9. An integrated EHR at Northern California Kaiser Permanente

    PubMed Central

    Bornstein, S.

    2012-01-01

    As legacy information systems age, transition to newer systems is inevitable, but at times fraught with challenge. This brief article addresses some of the pitfalls, challenges, and benefits we experienced at Kaiser Permanente as we transitioned several key clinical information systems to Epic Systems for our integrated comprehensive Electronic Health Record (EHR). PMID:23646079

  10. Station GPS permanente IPG Paris DGF Uchile UNAP Iquique

    E-print Network

    Vigny, Christophe

    Station GPS permanente IPG Paris DGF Uchile UNAP Iquique Site Name: Cerro Mica (Coastal Cordillera) Author : Carrizo Site Code : MICA Date installation : 2007 12 16 Coordinates : MICA : -21 Tridimentional MICA_XYZ 2044899.6434 5566050.4978 234719.4090 Ellipsoidic MICA_WSU 69.82727839 21

  11. Alphabetisation conscientisante comme base d'une education permanente

    NASA Astrophysics Data System (ADS)

    Ndimurukundo, Nicephore

    1994-05-01

    D'après la pratique et les enseignements vécus, nous pensons qu'une alphabétisation fonctionnelle et conscientisante est susceptible de constituer la base d'une éducation permanente (life long education), à condition que: Une philosophie et une anthropologie de la libération de l'homme soient le fondement de 1'alphabétisation;

  12. Station GPS permanente IPG Paris DGF Uchile UNAP Iquique

    E-print Network

    Vigny, Christophe

    Station GPS permanente IPG Paris DGF Uchile UNAP Iquique Site Name: Pisagua Author : de.12301 1002 DESCRIPTION North Chili I region, Permanent GPS station from IPGP / DGF network MONUMENTATION) scealed in concrete at the top of the pilar PG-A1 antena; receptor Topcon GB1000. HISTORIC Permanent GPS

  13. L'EDUCATION PERMANENTE EN BELGIQUE D'EXPRESSION FRANCAISE ("EDUCATION PERMANENTE" IN THE FRENCH-SPEAKING PARTS OF BELGIUM).

    ERIC Educational Resources Information Center

    DEPREZ, MARCEL

    A NEW CONCEPTION OF ADULT EDUCATION, CLOSELY LINKED WITH TECHNOLOGICAL, POLITICAL, AND SOCIOECONOMIC CHANGES DURING THE FIRST HALF OF THIS CENTURY, HAS BEEN EMERGING IN THE FRENCH SPEAKING AREAS OF BELGIUM. THIS FORM OF EDUCATION ("EDUCATION PERMANENTE") IS IMPORTANT AND NECESSARY AS A MEANS OF HUMANIZING AND DEMOCRATIZING THE WHOLE SOCIETY. THE…

  14. Breast cancer genetics and managed care. The Kaiser Permanente experience.

    PubMed

    Kutner, S E

    1999-12-01

    In 1996, with evolution of the science of cancer genetics and the advent of commercially available BRCA1 and later BRCA2 testing, Kaiser Permanente began to apply these advances in clinical practice. Recommendations for referral to genetic counseling were developed in 1997 as the Clinical Practice Guidelines for Referral for Genetic Counseling for Inherited Susceptibility for Breast and Ovarian Cancer. Implementation of these guidelines with associated protocols in Kaiser Permanente's Northern California Region has occupied the ensuing years and includes dissemination of the high-risk guidelines for breast and ovarian cancer, dissemination of patient and physician educational materials on the breast cancer guidelines, monthly classes and taped healthphone messages for patients, interactive videoconferencing for physicians, a training seminar for medical geneticists who will counsel patients at risk, publication of articles on breast cancer and genetic risk in health plan member- and physician-directed magazines, identification and training of clinical specialists and supporting clinicians to care for patients before and after counseling, individual counseling and testing of patients and families, and development of a data registry. Implementing the guidelines helped us communicate the uncertainty surrounding breast cancer testing, and we were obliged to learn more about ethical, legal, societal, and insurance controversies surrounding genetic testing. Given the lack of effective prevention for breast or ovarian cancer and the difficulty of treatment, the appropriate use of genetics in patient care is essential. In the near future, we will see the need for cancer genetics to become an integral part of practice throughout the spectrum of health care. We at Kaiser Permanente feel that the breast cancer guideline project is the first step in this process. PMID:10630183

  15. Comisso Permanente de Acompanhamento das Polticas de Igualdade de Gnero Relatrio -Reunio 13/11

    E-print Network

    Hanazaki, Natalia

    Comissão Permanente de Acompanhamento das Políticas de Igualdade de Gênero Relatório - Reunião 13 Políticas de Igualdade de Gênero de travestis e transexuais; - Verificar uma data nas primeiras duas semanas

  16. Remarks on the Relations Between the Permanental and Characteristic Polynomials of Fullerenes

    E-print Network

    Bai, Fengshan

    Remarks on the Relations Between the Permanental and Characteristic Polynomials of Fullerenes Qiang of characteristic polynomial of fullerene graph are proposed by Balasubramanian [17]. Then some relations between]. In this paper, some more formulas on ak and bk and the relations between them are given for fullerene graph. 2

  17. Making the business case for hospital information systems--a Kaiser Permanente investment decision.

    PubMed

    Garrido, Terhilda; Raymond, Brian; Jamieson, Laura; Liang, Louise; Wiesenthal, Andrew

    2004-01-01

    Further evidence in favor of the clinical IT business case is set forth in Kaiser Permanente's cost/benefit analysis for an electronic hospital information system. This article reviews the business case for an inpatient electronic medical record system, including 36 categories of quantifiable benefits that contribute to a positive cumulative net cash flow within an 8.5 year period. However, the business case hinges on several contingent success factors: leadership commitment, timely implementation, partnership with labor, coding compliance, and workflow redesign. The issues and constraints that impact the potential transferability of this business case across delivery systems raise questions that merit further attention. PMID:15839526

  18. 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.

  19. Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system

    PubMed Central

    2010-01-01

    Background Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system. Methods Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models. Results More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration. Conclusions More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches. PMID:20374667

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

    PubMed Central

    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

    Context: As part of its longstanding commitment to improve the health of the communities it serves, Kaiser Permanente (KP) established the Community Ambassador Program (CAP) in the Mid-Atlantic States Region. The CAP places KP-employed nurse practitioners, midwives, and physician assistants to work in the safety-net clinics and to share best practices through a long-term community collaboration. Objective: To share the early experiences of the CAP and describe the initial results of the program’s impact on the safety-net clinics. Methods: We conducted an evaluation of 18 safety-net clinics that participated in the CAP in 2012 to determine the program’s early impact in expanding access to care, increasing the capacity of safety-net providers, and improving the quality of care on evidence-based measures in the year following program implementation. The safety-net clinics are comprised of federally qualified health centers, free clinics, and other community-based organizations. The clinics were asked to respond to questions regarding their evidence-based practices promoted by KP and on primary care-related utilization. Results: The Community Ambassadors provided an estimated 32,249 encounters to 11,988 patients. Performance by the Community Ambassadors 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%). Conclusion: The CAP demonstrated some early success in expanding access and improving quality of care on several key measures for certain subpopulations. Despite these achievements, opportunities remain for quality improvement, expanded capacity, and enhanced data reporting infrastructure. PMID:25785638

  1. 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

  2. Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente

    PubMed Central

    Feachem, Richard G A; Sekhri, Neelam K; White, Karen L

    2002-01-01

    Objective To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California. Methods The adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators. Results The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10%. Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS. Conclusions The widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by underinvestment are not supported by this analysis. Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology. What is already known on this topicComparisons of healthcare systems in different countries have to be undertaken with great care but can be instructiveThe overall healthcare system in the United States is more expensive than the NHS and population health outcomes are no betterThe US healthcare system comprises many discrete and unique subsystems, including the health maintenance organisationsWhat this paper addsAn integrated, non-profit health maintenance organisation in California (Kaiser Permanente), with over six million members, costs about the same as the NHS but performs considerably betterKaiser's superior performance is mainly in prompt and appropriate diagnosis and treatmentThese findings challenge the widely held view that the NHS is efficient and that its inadequacies are mainly due to underinvestment PMID:11799029

  3. 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)

  4. 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

  5. Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

    PubMed Central

    Munro, Malcolm G

    2013-01-01

    Acute uterine bleeding unrelated to pregnancy has been defined as bleeding “sufficient in volume as to, in the opinion of the treating clinician, require urgent or emergent intervention.” The Southern California Permanente Medical Group updated its guidelines for the management of this condition on the basis of the best available evidence, as identified in a systematic review of the available literature. Given the paucity of studies evaluating this condition, the guidelines, by necessity, include recommendations largely based on opinion or other sources such as case series that are, in general, categorized as low-quality evidence. Medical interventions with single or combined gonadal steroidal agents administered parenterally or orally show promise, but more high-quality studies are needed to better define the appropriate drugs, dose, and administrative scheduling. There is also some evidence that intrauterine tamponade may be useful in at least selected cases. Special attention must be paid to both diagnosing and treating inherited disorders of hemostasis, such as von Willebrand disease, that may otherwise be underdiagnosed in both adolescent and adult women. PMID:24355890

  6. Optimal Practice Support (OPS) at the Kaiser Permanente Los Angeles Medical Center

    PubMed Central

    Cohen, Nancy A

    2004-01-01

    Control over the practice environment is one determinant of the quality of professional life for physicians. As part of its Quality of Professional Life Initiative, senior leadership at the Kaiser Permanente (KP) Los Angeles Medical Center implemented Optimal Practice Support (OPS) to increase the quality of physicians’ professional lives. In primary as well as specialty ambulatory care departments, OPS is a clinician-focused way to address standards for relaying messages between patients and their physicians; for ensuring consistent availability of support staff; and for preparing examination rooms (ie, setting up for each patient visit and ensuring that the examination room is well stocked with necessary medical supplies). Departments that had been implementing OPS were audited three times during 2002. Compared with results of a 2001 survey, a 2002 survey of quality of physicians’ professional lives showed that 12% more physicians reported believing that the KP Los Angeles Medical Center had been successful in its efforts to improve the quality of physicians’ professional lives. PMID:26704919

  7. 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 defects—a new procedure—was 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 KP’s experience using the new technology. PMID:26705314

  8. 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.

  9. Comparative Health Systems Research among Kaiser Permanente and Other Integrated Delivery Systems: A Systematic Literature Review

    PubMed Central

    Maeda, Jared Lane K; Lee, Karen M; Horberg, Michael

    2014-01-01

    Context: Because of rising health care costs, wide variations in quality, and increased patient complexity, the US health care system is undergoing rapid changes that include payment reform and movement toward integrated delivery systems. Well-established integrated delivery systems, such as Kaiser Permanente (KP), should work to identify the specific system-level factors that result in superior patient outcomes in response to policymakers’ concerns. Comparative health systems research can provide insights into which particular aspects of the integrated delivery system result in improved care delivery. Objective: To provide a baseline understanding of comparative health systems research related to integrated delivery systems and KP. Design: Systematic literature review. Methods: We conducted a literature search on PubMed and the KP Publications Library. Studies that compared KP as a system or organization with other health care systems or across KP facilities internally were included. The literature search identified 1605 articles, of which 65 met the study inclusion criteria and were examined by 3 reviewers. Results: Most comparative health systems studies focused on intra-KP comparisons (n = 42). Fewer studies compared KP with other US (n = 15) or international (n = 12) health care systems. Several themes emerged from the literature as possible factors that may contribute to improved care delivery in integrated delivery systems. Conclusions: Of all studies published by or about KP, only a small proportion of articles (4%) was identified as being comparative health systems research. Additional empirical studies that compare the specific factors of the integrated delivery system model with other systems of care are needed to better understand the “system-level” factors that result in improved and/or diminished care delivery. PMID:24937150

  10. A retrospective analysis of health systems in Denmark and Kaiser Permanente

    PubMed Central

    Frølich, Anne; Schiøtz, Michaela L; Strandberg-Larsen, Martin; Hsu, John; Krasnik, Allan; Diderichsen, Finn; Bellows, Jim; Søgaard, Jes; White, Karen

    2008-01-01

    Background To inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy. Methods Retrospective analysis of secondary data in the Danish Health Care System (DHS) with 5.3 million citizens and the Kaiser Permanente integrated delivery system (KP) with 6.1 million members in California. We used secondary data to compare population characteristics, professional staff, delivery structure, utilisation and quality measures, and direct costs. We adjusted the cost data to increase comparability. Results A higher percentage of KP patients had chronic conditions than did patients in the DHS: 6.3% vs. 2.8% (diabetes) and 19% vs. 8.5% (hypertension), respectively. KP had fewer total physicians and staff compared to DHS, with134 physicians/100,000 individuals versus 311 physicians/100,000 individuals. KP physicians are salaried employees; in contrast, DHS primary care physicians own and run their practices, remunerated by a mixture of capitation and fee-for-service payments, while most specialists are employed at largely public hospitals. Hospitalisation rates and lengths of stay (LOS) were lower in KP, with mean acute admission LOS of 3.9 days versus 6.0 days in the DHS, and, for stroke admissions, 4.2 days versus 23 days. Screening rates also differed: 93% of KP members with diabetes received retinal screening; only 46% of patients in the DHS with diabetes did. Per capita operating expenditures were PPP$1,951 (KP) and PPP $1,845 (DHS). Conclusion Compared to the DHS, KP had a population with more documented disease and higher operating costs, while employing fewer physicians and resources like hospital beds. Observed quality measures also appear higher in KP. However, simple comparisons between health care systems may have limited value without detailed information on mechanisms underlying differences or identifying translatable care improvement strategies. We suggest items for more in-depth analyses that could improve the interpretability of findings and help identify lessons that can be transferred. PMID:19077229

  11. 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

  12. 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

  13. 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

  14. 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

  15. Reporting on a Talk I Gave Some Months Ago, the Headline in "La Opinion," Los Angeles' Premier Spanish Language Newspaper, Declared the City's School System "en crisis permanente." No One Wrote in to Disagree. The Claremont Letter. Volume 3, Issue 1

    ERIC Educational Resources Information Center

    Kerchner, Charles T.

    2008-01-01

    Reporting on a talk the author gave some months ago, the headline in "La Opinion," Los Angeles' premier Spanish language newspaper, declared the city's school system "en crisis permanente." No one wrote in to disagree. Indeed, at the end of "Learning from L.A.: Institutional Change in American Public Education" (Harvard Education Press) the author…

  16. Dirio Econmico -Universidades Como ser investigador em Portugal

    E-print Network

    Instituto de Sistemas e Robotica

    Diário Económico - Universidades Como é ser investigador em Portugal Autor: N.D. Editora: ST e SF - Universidades Como é ser investigador em Portugal Autor: N.D. Editora: ST e SF Id: 1646658 Data Publicação: 19

  17. 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

  18. COVA HealthAware Kaiser Permanente HMO

    E-print Network

    Lewis, Robert Michael

    deductible 20% after deductible $25 PCP $40 specialty Outpatient therapy visits · Occupational and speech therapy 20% after deductible $25 PCP/$35 specialist 20% after deductible $40 · Physical therapy 20% after deductible $35 20% after deductible $40 Applied behavior analysis (ABA) for autism spectrum disorder--ages 2

  19. 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

  20. Como EURAXESS pode ajuda-lo? Charlotte Grawitz, EURAXESS Links Brazil

    E-print Network

    Hanazaki, Natalia

    Como EURAXESS pode ajuda-lo? Charlotte Grawitz, EURAXESS Links Brazil Florianópolis, 17 de novembro Links Brazil - Como Trabalhamos Website e Facebook Newsletter e Publicações Apresentações e Eventos #12;Website (brazil.euraxess.org), Newsletter & Inscrição #12;Eventos EURAXESS Links Brazil EURAXESS Share

  1. K.K. Gan Como05 1 The Ohio State University

    E-print Network

    Gan, K. K.

    Pixel Detector #12;K.K. Gan Como05 2 Outline Introduction Proton Irradiation Studies Production Status Summary #12;K.K. Gan Como05 3 ATLAS Pixel Detector Inner most tracking detector Pixel size: 50O vendor: 1st prototype: 1-2 SMD detached from few boards remove gold under SMD pads 2nd prototype: SMD

  2. Corrector de gramtica para estudiantes autodidactas de ingls como lengua extranjera

    E-print Network

    Martin, Ralph R.

    funcionamiento de un nuevo tipo de corrector grama- tical (el Corrector Gramatical de la UNED),que se fundamenta este corrector gramatical, que incluyera expresiones regulares, podría aplicarse en muchos más casos COMO LENGUA EXTRANJERA 1172 Palabras clave: corrector gramatical, ILE, español como lengua materna

  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... Forest Service Bitterroot National Forest, Darby Ranger District, Como Forest Health Project AGENCY...,640 acres of national forest between Lake Como and Lost Horse roads, about 6 miles northwest of...

  4. Station GPS permanente IPG Paris DGF Uchile UNAP Iquique

    E-print Network

    Vigny, Christophe

    to access the receiver telephone nearby NONO Electric power nearby NONO equipment storage available YESYES NO In the seismo cave possibility of leaving the equipment without watching YESYES NO . person in charge YESYES

  5. 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.

  6. K.K. Gan COMO07 1 Study of the Radiation Hardness of

    E-print Network

    Gan, K. K.

    K.K. Gan COMO07 1 Study of the Radiation Hardness of VCSEL and PIN Arrays Oct 10, 2007 W. Fernando Outline Introduction Radiation hardness of VCSEL arrays Radiation hardness of PIN arrays Summary #12;K planned for Super-LHC in 2015 study radiation-hardness of VCSEL and PIN arrays for the opto-link upgrades

  7. CURSO DE INICIACIN A LA ENSEANZA DEL ESPAOL COMO LENGUA EXTRANJERA-FORMACIN DE PROFESORADO

    E-print Network

    CURSO DE INICIACIÓN A LA ENSEÑANZA DEL ESPAÑOL COMO LENGUA EXTRANJERA-FORMACIÓN DE PROFESORADO, diplomatura o grado)*: o En curso (especificar curso y carrera)*: Otros: *Será necesario acreditar los estudios en curso. FORMALIZACIÓN DE LA MATRÍCULA Para formalizar la matrícula del curso es necesario

  8. CURSO DE INICIACIN A LA ENSEANZA DEL ESPAOL COMO LENGUA EXTRANJERA-FORMACIN DE PROFESORADO

    E-print Network

    Verschure, Paul

    CURSO DE INICIACIÓN A LA ENSEÑANZA DEL ESPAÑOL COMO LENGUA EXTRANJERA-FORMACIÓN DE PROFESORADO o grado)*: En curso (especificar curso y carrera)*: Otros: *Será necesario acreditar los estudios matrícula de los estudios en curso. FORMALIZACIÓN DE LA MATRÍCULA Para formalizar la matrícula del curso es

  9. Novas estratgias comunicativas como fator de qualidade na interao de surdos em um sistema organizacional

    E-print Network

    Barbosa, Alberto

    122 Novas estratégias comunicativas como fator de qualidade na interação de surdos em um sistema formulário web e verificar se o uso de novas estratégias comunicativas melhora a interação dos surdos. Foram (MAC), uma com a interface original do sistema, e outra com o uso de novas estratégias comunicativas

  10. O processo de aquisição das vogais semi-abertas "é, ó" / ?, ? / do portugues (brasileiro) como lingua estrangeira

    E-print Network

    Simoes, Antonio Roberto Monteiro; Kelm, Orlando R.

    1991-09-01

    - guindo as linhas do livro Com licenga! (Simoes 1991), ou seja, por razoes praticas, evita separar o grupo latino como se explica no protocolo experimental. Dois trabalhos que podem ser considerados pioneiros nesta area sao aqueles de Ellison et al... pode ver no manual de orientagao que acompanha o livro. O trabalho experimental dos Professores Lombello e Baleeiro (1983) da Uni- versidade Estadual de Campinas—Unicamp, assim como o trabalho nas escolas secundarias do Texas como aqueles das...

  11. 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

  12. Como os Alunos do Ensino Médio da Rede Estadual de São Paulo obtém Conhecimentos Astronômicos?

    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 rápido e seguro a todo tipo de informação e conhecimento. O presente trabalho visa analisar a maneira pela qual alunos de segundo grau da rede estadual da cidade de São Paulo obtiveram, caso tenham, conhecimentos básicos de astronomia quanto aos fenômenos celestes que os rodeiam, tais como a sucessão dos dias e das estações do ano, além de questioná~los sobre fatos genéricos tais como: o que vem a ser o Sol, o Big Bang, o que ocasionou a extinção dos dinossauros. Para tanto foi elaborado um formulário constando de questões de múltipla escolha, o qual foi aplicado no primeiro colegial diurno da Escola Estadual Guilherme de Almeida. Num espaço amostral de 44 alunos constatou-se que 41% dos alunos adquiriram seus conhecimentos astronômicos na escola e 59% através da mídia em geral. Neste mesmo espaço amostral apenas 11% dos alunos usaram computadores na escola, 41% na residência, 5% no trabalho e 43% não utilizaram. O presente estudo revelou também que para 50% dos alunos o professor jamais utilizou um programa de computador a respeito de astronomia ou fez alguma apresentação sobre o tema. Embora em sua fase inicial este estudo revela claramente que a maioria dos alunos não obtém na escola seus conhecimentos astronômicos, estes provém de fontes não especificamente didático-pedagógicas tais como filmes e revistas populares que não raramente geram conhecimentos incompletos e em muitos casos inclusive falhos.

  13. Estimación de pequeñas perturbaciones en satélites geocéntricos como un problema inverso

    NASA Astrophysics Data System (ADS)

    Zadunaisky, P. E.

    El movimiento geocéntrico de un satélite artificial es simulado automáticamente por un sistema de ecuaciones diferenciales de segundo orden que incluyen dos funciones perturbadoras. La primera representa el segundo término del potencial gravitatorio de la Tierra y la segunda corresponde al frenado atmosférico. Asumiendo como conocidas, por hipótesis o por mediciones, la posición y velocidad del satélite en instantes sucesivos se estiman las perturbaciones a intervalos sucesivos por un método determinístico. Para ilustrar el método y comprobar la precisión de nuestros resultados hemos simulado dos ejemplos incluyendo valores conocidos de las perturbaciones que luego comparamos con los resultados de nuestro método. El método puede aplicarse por ejemplo para el intervalo de una revolución satelital lo cual permitiría el diseño inmediato de una maniobra correctiva de la órbita satelital.

  14. Las fulguraciones como manifestación de reconexión en el campo magnético solar

    NASA Astrophysics Data System (ADS)

    Bagalá, L. G.; Mandrini, M. C.; Rovira, M. G.; Démoulin, P.

    Las fulguraciones solares son fenómenos transitorios de liberación de energía que se desarrollan en las estructuras magnéticas de las regiones activas del Sol. Las fulguraciones pueden llegar a liberar hasta 1032 erg en 100 seg. en todo el rango electromagnético, y acelerar partículas. En este trabajo mostramos que la ubicación de los abrillantamientos en H? de diversas fulguraciones está relacionado con las propiedades de las conexiones de las líneas del campo magnético de la región, como se espera por las teorías de reconexión en 3D recientemente desarrolladas (Démoulin et al, 1996a). El campo magnético coronal se extrapola del campo fotosférico observado suponiendo una configuración libre de fuerzas lineal. Por medio de un algoritmo se determinan las regiones donde existe un cambio drástico en la conectividad de las líneas de campo (límites ``cuasi-discontinuos'', o cuasi-separatrices CS). Las CS son bandas abiertas que identifican zonas donde el campo magnético se reconectará con más probabilidad y, siempre que las mismas sean lo suficientemente finas, se producirá allíla liberación de energía proveniente del campo magnético. Hemos encontrado que en todas las regiones fulgurantes estudiadas (Démoulin et al, 1996b) existen CS en los mismos lugares donde se observaron los abrillantamientos en H?. Allídonde coinciden los abrillantamientos con las CS, éstas tienen un espesor menor que 1 Mm. Las líneas de campo coronales extrapoladas de nuestro modelo tienen sus orígenes fotosféricos a ambos lados de las CS, como se espera dados los recientes estudios de reconexión magnética en 3D. Estos resultados ponen a prueba los modelos presentes sobre fulguraciones solares.

  15. codice licenza insegna chiusura toponimo indirizzo civico localit cap prov 256903 TAKE-AWAY C' ERA UNA VOLTA MAI VIA ANZANI 35 COMO 22100 CO

    E-print Network

    UNA VOLTA MAI VIA ANZANI 35 COMO 22100 CO 240881 BAR TAVOLA FREDDA GE-BAR MAI VIA CASTELNUOVO 5 COMO AILANTI 3 MILANO 20156 MI 120931 SELF SERVICE VIVA' DOMENICA VIA ALESSANDRO TADINO 36 MILANO 20124 MI

  16. 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

  17. Proc. of the 12th Int. Conference on Digital Audio Effects (DAFx-09), Como, Italy, September 1-4, 2009

    E-print Network

    Plumbley, Mark

    to produce a high quality representation of audio using similar techniques. Rather than defining newProc. of the 12th Int. Conference on Digital Audio Effects (DAFx-09), Como, Italy, September 1-4, 2009 ESTIMATING PARAMETERS FROM AUDIO FOR AN EG+LFO MODEL OF PITCH ENVELOPES Stephen J. Welburn

  18. A simple combinatorial method to discover Co-Mo binary catalysts that grow vertically aligned single-walled carbon nanotubes

    E-print Network

    Maruyama, Shigeo

    A simple combinatorial method to discover Co-Mo binary catalysts that grow vertically aligned single-walled carbon nanotubes Suguru Noda a,* , Hisashi Sugime a , Toshio Osawa a , Yoshiko Tsuji-ku, Tokyo 113-8656, Japan Abstract A simple yet versatile combinatorial method to discover binary metal

  19. 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).

  20. Kaiser Permanente NCI National Community Oncology Research Program NCORP | Division of Cancer Prevention

    Cancer.gov

    Skip to main content Division of Cancer Prevention Search form Search Main menu Home Major Programs Research Networks Map Alliance of Glycobiologists for Detection of Cancer Barrett's Esophagus Translational Research Network (BETRNet) Cancer Prevention

  1. Alcohol intake, beverage choice, and cancer: a cohort study in a large kaiser permanente population.

    PubMed

    Klatsky, Arthur L; Li, Yan; Nicole Tran, H; Baer, David; Udaltsova, Natalia; Armstrong, Mary Anne; Friedman, Gary D

    2015-01-01

    The authors studied incident cancer risk from 1978 to 1985 and through follow-up in 2012 relative to light-to-moderate and heavy drinking and to the choice of alcoholic beverage in a cohort of 124,193 persons. With lifelong abstainers as referent, heavy drinking (? 3 drinks per day) was associated with increased risk of 5 cancer types: upper airway/digestive tract, lung, female breast, colorectal, and melanoma, with light-to-moderate drinking related to all but lung cancer. PMID:25785639

  2. L'ducation FacuLt de L'ducation permanente

    E-print Network

    Charette, André

    catécHétiQues intervention dans Les groupes et Les organisations (animation) Loisir reLations industrie proFessionneLLe recHercHe opérationneLLe traduction animation pédagogiQue des bibLiotHèQues étudesLLes reLations pubLiQues animation de La vie étudiante enseignement du Français À L

  3. 3/8/2015 Conhea duas gachas que, em realidades distintas, usam o estudo como bandeira pela igualdade de gnero -Zero Hora http://zh.clicrbs.com.br/rs/noticias/noticia/2015/03/conheca-duas-gauchas-que-em-realidades-distintas-usam-o-estudo-como-bandei... 1/5

    E-print Network

    Barbosa, Marcia C. B.

    igualdade de gênero - Zero Hora http://zh.clicrbs.com.br/rs/noticias/noticia/2015/03/conheca-duas-gauchas como bandeira pela igualdade de gênero Da alfabetização ao pósdoutorado, Delaidia e Márcia são exemplos estudo como bandeira pela igualdade de gênero - Zero Hora http

  4. 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

  5. Instrues de utilizao O badge do Centenrio do IST --que se apresenta e configura como um hyperlink para o respectivo website comemorativo

    E-print Network

    Instituto de Sistemas e Robotica

    como um hyperlink para o respectivo website comemorativo --, será a forma oficial de associação dos diversos websites dos serviços e/ou iniciativas do IST ao mesmo, por forma a assegurar uma consistência no canto superior direito do website. Assegure-se --através do visionamento do código-fonte-- que está

  6. COMO SE CONECTAR A REDE WIFI DA BIBLIOTECA Para conectar a rede WIFI da biblioteca a partir do notebook, siga os passos abaixo

    E-print Network

    Paraná, Universidade Federal do

    1 COMO SE CONECTAR A REDE WIFI DA BIBLIOTECA Para conectar a rede WIFI da biblioteca a partir do. Se caso apareça mais opções procure pela "Conectar-se a internet". 3º Passo: - Ao clicar em "Conectar-se as conexões disponíveis para você se conectar: 5º Passo: Ao serem procuradas e exibidas as conexões

  7. 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

  8. Cours Section Titre Jours De Dbut Fin Campus Cours offerts la Facult de l'ducation permanente t 2015

    E-print Network

    Montréal, Université de

    and writing (3b) Ma Je 19:00 21:59 2015-05-05 2015-06-23 Montréal NON ANS 1402T A Business Oral English Ma Je-05-05 2015-06-23 Montréal OUI ANS 1100T A English Communication Skills Lu Me 19:00 21:59 2015-05-04 2015-06-22 Montréal OUI ANS 1100T B English Communication Skills Ma Je 9:00 11:59 2015-05-05 2015-06-23 Montréal OUI

  9. 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…

  10. DE QUOI S'AGIT-IL ? Les mutations permanentes qui caractrisent la formation tant civile que militaire compli-

    E-print Network

    activités de formation civiles et militaires >Planifiez votre formation civile assez tôt INFORMATION www.zivil-militaer de fractionnement sous : www.zivil-militaer.ch Nous vous rendons attentifs au fait que, pour

  11. El seminario permanente "Jueves Mnimos en la Cuesta del Chapiz" es un encuentro semanal de alta divulgacin

    E-print Network

    Fitze, Patrick

    Arquitectura de la Ciudad (LAAC)", adscrito a la Escuela de Estudios Árabes (EEA) del Consejo Superior de nombre, es la sede del Laboratorio de Arqueología y Arquitectura de la Ciudad (LAAC), adscrito a la MÍNIMOS en la Cuesta del Chapiz LABORATORIO DE ARQUEOLOGÍA Y ARQUITECTURA DE LA CIUDAD (LAAC) Carmen de

  12. 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

  13. Tal Como Somos/just as we are: an educational film to reduce stigma toward gay and bisexual men, transgender individuals, and persons living with HIV/AIDS.

    PubMed

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

    2014-04-01

    In this article, the authors describe the development and dissemination of a film-based educational intervention to reduce negative attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS 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 influence attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS. The film and intervention are being disseminated using diffusion of innovations theory through community-based organizations, schools, television broadcasting, and film festivals. PMID:24377496

  14. 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 mA·cm(-2), low onset potential of 90 mV, and small Tafel slope of 50 mV·dec(-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

  15. Mosquito Control Around the Home (Spanish) 

    E-print Network

    Jackman, John A.; Olson, Jimmy K.

    2003-03-17

    mascotas y lugares donde se v ende carnada para la pesca. a73 Usar productos a base de Bacillus thurin gien- sis israeliensis como ?Mosquito Dunks?? para tratar cuerpos de agua permanentes ycontrolar larv as . a73 T ratamientos con aceites pueden aplicarse...

  16. II SEMINARIO Sbado 20 de octubre de 2012

    E-print Network

    Fernández Pascual, Ricardo

    enfoque de género y nuevos itinerarios profesionales en igualdad. En este II Seminario tenemos comoII SEMINARIO PERMANENTE DE AGENTES IGUALDAD Sábado 20 de octubre de 2012 ASPAYM, C/ Infanta Presidenta de la República de Filipinas (Manila, 1947) El II SEMINARIO Agentes de Igualdad pretende ser un

  17. 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.; André, 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 600°C. 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.

  18. 2.2.5 Determinar los enteros n tales que d|n d = n2 Solucion: Como uno de los divisores va a ser siempre el propio n, bus-

    E-print Network

    Cilleruelo, Javier

    2.2.5 Determinar los enteros n tales que d|n d = n2 . Soluci´on: Como uno de los divisores va a ser pareja r tal que dr = n. Si tuviera m´as divisores, el producto ser´ia mayor, y en el que caso que n sea

  19. Curso Terico-Prctico de ICP-MS 2015 Este curso tiene como objetivo proporcionar los conocimientos tericos y prcticos de la tcnica de ICP-MS y revisar sus

    E-print Network

    Curso Teórico-Práctico de ICP-MS 2015 Este curso tiene como objetivo proporcionar los conocimientos marco de la normativa vigente. Durante el curso se mostrarán las ventajas de la técnica, entre las los inconvenientes de la técnica. Este curso se ha estructurado de manera que las clases teóricas se

  20. Essays on Eclipses, Transits and Occultations as Teaching Tools in the Introductory Astronomy College Course. (Spanish Title: Ensayos sobre Eclipses, Tránsitos y Ocultaciones Como Herramientas de Enseñanza en el Curso Universitario Introductorio a la Astronomía.) Ensaios sobre Eclipses, Trânsitos e Ocultações Como Ferramentas de Ensino em um Curso Universitário Introdutório 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 introducción a la astronomía universitario centrado en el alumno para permitir que los estudiantes de carreras no científicas exploren algunos conceptos astronómicos en más detalle que lo habitual. Estos proyectos también ponen en relevancia eventos astronómicos en curso o futuros. Esperamos que los estudiantes se sientan más interesados en la astronomía a través de proyectos vinculados a eventos astronómicos. En el período de primavera de 2012 (EUA), propusimos breves ensayos centrados en los eclipses, tránsitos y ocultaciones para promover el raro tránsito 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 proponían. Los ensayos contenían partes descriptivas y conceptuales. Los mismos estaban destinados a servir como herramientas de enseñanza. 62% de los 106 ensayos de 55 estudiantes obtuvo grados A, B o C. 21% de los 47 encuestados que respondieron al cuestionario posterior consideró que los ensayos aumentaron su interés por la astronomía. 49% de los encuestados consideró que los ensayos no eran educacionalmente útiles y que no deben ser propuestos de nuevo. Las respuestas escritas más comunes a nuestra encuesta indicaran que los estudiantes necesitan más orientación y una mejor preparación en la redacción de ensayos exitosos. Dado que los estudiantes encontraron las piezas conceptuales de los ensayos difíciles, en el futuro vamos a ofrecer actividades pertinentes antes de los plazos de redacción para ayudar a los estudiantes a crear ensayos de mayor calidad. Nós ocasionalmente incluímos projetos em nosso curso universitário introdutório centrado no aluno para permitir aos estudantes que pertencem às carreiras não científicas explorar alguns conceitos astronômicos em mais detalhes do que o normal. Tais projetos também enfatizam eventos astronômicos em curso ou futuros. Esperamos que os alunos se sintam mais interessados na astronomia através de projetos ligados a eventos astronômicos. No termo de Primavera de 2012 (EUA), propomos ensaios curtos focados em eclipses, trânsitos e ocultações para promover o raro trânsito de Vênus que ocorreu no dia 5 de junho de 2012. Pedimos aos alunos que escrevessem dois ensaios curtos dentre três 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 não eram benéficos para a educação e que não devem ser propostos novamente. As resp

  1. 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…

  2. 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.

  3. Influence of the support of CoMo sulfide catalysts and of the addition of potassium and platinum on the catalytic performances for the hydrodeoxygenation of carbonyl, carboxyl, and guaiacol-type molecules

    SciTech Connect

    Centeno, A.; Laurent, E.; Delmon, B.

    1995-07-01

    The present work corresponds to part of a program aimed at upgrading oil obtained by pyrolysis of biomass by hydrotreatment (hydrodeoxygenation HDO). CoMo sulfide catalysts, nonsupported, supported on different supports (alumina, carbon, silica), or modified by K or Pt, were used. The authors used a model reacting mixture containing compounds representative of the molecules that must react to permit a primary stabilisation of the pyrolytic oil: 4-methy lacetophenone (4-MA), diethylsebacate (DES), and guaiacol (GUA). In the reaction of the carbonyl group of the 4-MA it is shown that no important role is played by any acid-base mechanism; dispersion determines the activity. Acidity of the support influences the formation of active sites for decarboxylation and hydrogenation of the carboxyl group of DES. It was confirmed that guaiacol-type molecules lead to coking reactions. The role of acidity in the mechanism of these reactions is confirmed, but the modifications made in the catalysts in this work are still not sufficient to control coke deposition. The catalysts supported on carbon lead to the direct elimination of the methoxyl group of the guaiacol. Carbon, on the whole, seems to be a promising support. This work suggests that appropriate modifications of the hydrotreating catalysts can lead to a more effective process for stabilisation of the bio-oils by reaction with hydrogen. 55 refs., 3 figs., 5 tabs.

  4. Los mitos como memoria colectiva de Los Pueblos.

    NASA Astrophysics Data System (ADS)

    Martín, 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.

  5. Teatro no Brasil: Como transmitir sinais de dentro das chamas.

    E-print Network

    Peixoto, Fernando

    1973-10-01

    intelectualmente morrem sem consciência. Para outros, a consciência é a causa mortis. E o que acontece com o teatro, acontece também com o cinema, com a literatura, com a música, com as artes plásticas, etc. O impasse do teatro, acentuado à partir da crise... sérias são ainda superficiais. Em essência permanece um teatro alienado e, mesmo quando se propõe ao contrário, alienante. A esperança é que um novo saia das cinzas. Um teatro que mergulhe com firmeza e decisão na realidade do país e dela consiga...

  6. Las líneas de aluminio neutro como diagnóstico cromosférico

    NASA Astrophysics Data System (ADS)

    Fernández Borda, R.; Mauas, P. J. D.

    Se presenta un modelo atómico para el cálculo de las lí neas del Aluminio neutro que se forman en la cromósfera solar. En particular, se estudia la línea ? 3961 Å, que, por estar muy próxima a la lí nea H del Ca II y a H? es muy frecuentemente observada. Observaciones en esta lí nea obtenidas con el espectrógrafo a instalarse en el CASLEO, serán utilizadas para el estudio de fulguraciones solares.

  7. 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)

  8. CoMo : a whiteboard that converses about code

    E-print Network

    Sabisch, Andrew Thomas Correa

    2014-01-01

    Software engineers routinely solve problems by brainstorming at whiteboards. Among other modes, they communicate with speech and sketch. Unfortunately, the whiteboard plays the role of a passive medium. It serves only as ...

  9. Del carnaval como 'metáfora' al teatro de carnaval

    E-print Network

    Remedi, Gustavo

    2001-04-01

    más productiva de visualizar el teatro del carnaval, y en general, la práctica teatral en la actualidad. Actuación de la Anti-Murga BCG en el tablado "El Monumental del Control" (Montevideo, 1988). Video del autor. 130 LATIN AMERICAN THEATRE REVIEW... todo espectáculo público. Su carácter 140 LATIN AMERICAN THEATRE REVIEW «if^^PW: Actuación de la Anti-Murga BCG en el tablado "El Monumental del Control" (Montevideo, 1988). Video del autor. aparentemente hedonista o lúdico los pone en la vereda de...

  10. 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…

  11. Lecture Notes, Como 1995 September 6, 1998 Quantum Theory

    E-print Network

    Physics and Materials Science Centre University of Groningen, Nijenborgh 4 NL-9747 AG Groningen on specific applications. Topics treated include exact diago- nalization techniques, variational methods. It is fair to say that at present, there is no quantum simulation method that has the power and general

  12. 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

  13. SERVIO PBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA

    E-print Network

    Hanazaki, Natalia

    Permanente de Acompanhamento das Políticas de Igualdade de Gênero, Assunto: Convocação Convoco V.Sª. para a reunião ordinária da Comissão Permanente de Acompanhamento das Políticas de Igualdade de Gênero Luis Schlatter Junior Presidente da Comissão Permanente de Acompanhamento das Políticas de Igualdade de

  14. 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.

  15. 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,…

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

    NASA Astrophysics Data System (ADS)

    Al-Salihi, Adnan; Asaad, Abdulah

    2002-05-01

    Résumé.L'étude de dispositifs de dénoyage est nécessaire pour l'amélioration de sites avant la construction de certaines structures. L'étude de dispositifs de dénoyage efficaces exige d'estimer la valeur du coefficient de perméabilité in situ. Les relations disponibles pour estimer le coefficient de perméabilité ont été développées sur la base de mesures et de conditions de terrain limitées, et les prédictions varient de plusieurs ordres de grandeur. C'est pourquoi il est nécessaire de réaliser des mesures de perméabilité sur le terrain et de déterminer la relation qui permet le meilleur ajustement de ces mesures avant l'étude du dispositif de dénoyage pour des conditions locales et géologiques spécifiques. Ce papier présente des mesures de perméabilité sur le terrain dans des niveaux calcaires complexes chaotiques et diagénétisés. Il propose également une analyse comparative de plusieurs relations disponibles dans la littérature destinées à prédire le coefficient de perméabilité in situ. L'analyse est faite en conditions permanentes et non permanentes. Les résultats montrent que la valeur du coefficient de perméabilité dépend du niveau de la nappe, qui est affecté par le régime de marées. On montre que l'équation de l'US Navy donne la meilleure corrélation avec les mesures de terrain. Resumen.El diseño de sistemas de desecado es necesario para mejorar las condiciones de un emplazamiento antes de la construcción de determinadas estructuras. El diseño de un sistema eficiente de desecado requiere de la estimación 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 varían en algunos órdenes de magnitud. Por tanto, es necesario tomar medidas de permeabilidad en campo y determinar la relación que reproduce mejor dichas medidas como paso previo al diseño de un sistema de desecado en condiciones geológicas y de emplazamiento específicas. Este artículo presenta medidas de permeabilidad en campo para estratos de calcita caóticos y diagenéticos. También ofrece un análisis comparativo de diversas relaciones disponibles en la bibliografía con el fin de predecir el valor de la permeabilidad in-situ. El análisis se ha hecho tanto en régimen permanente como en estacionario. Los resultados demuestran que la permeabilidad depende del nivel freático, el cual está afectado por las mareas. La ecuación de la Marina estadounidense es la que proporciona una mejor correlación con las medidas de campo.

  17. Como Mantienen la Competividad las Multinacionales de Economias Emergentes? El Case de CEMEX

    E-print Network

    Lucea, Rafael

    La creciente presencia de multinacionales de países emergentes (EMNEs) entre las empresas más importantes del mundo hace necesario entender cuáles son los factores que determinan la sostenibilidad de sus ventajas competitivas ...

  18. ENSEÑANZA DE INGLÉS COMO LENGUAJE EXTRANJERO (EILE) ENGLISH LANGUAGE ACQUISITION FOR ELEMENTARY SCHOOLS IN COSTA RICA 

    E-print Network

    Nelson, Annabelle

    2011-04-27

    in becoming more confident when asking and answering English questions as well as becoming more actively engaged during ESL instruction time. The interactive game features of computer programs and the exploratory quality of the internet motivate students... for the input hypothesis. The Modern Language Journal, 73, 440-464. Liu, M., & Hou, H. (2007). Computer assisted language learning (CALL) in China: Some common concerns. Asian EFL Journal, 19 (1). http://www.asian-efl- journal.com/pta_April_07_ml...

  19. Como atrair skaters para o centro da cidade ALUNOS DO INSTITUTO SUPERIOR TCNICO, EM LISBOA, RESPONDERAM

    E-print Network

    Instituto de Sistemas e Robotica

    de skate montado desde sexta-feira no largo do Inten- dente Pina Manique, em Lis- boa. O pedido era Superior de Belas -Artes , de Lis - boa, e skater, teve a seu cargo as pinturas e criação dos trofeus

  20. Uso de Anfibios como Indicadores del xito de la Restauracin de Ecosistemas 1

    E-print Network

    Mazzotti, Frank

    with non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual web EDIS en . 2. Ken G. Rice, U.S. Geological Survey, 3205 College Ave, Davie, FL 33314, E-mail: ken_g_rice@usgs.gov.; Frank J. Mazzotti, University of Florida, 3205 College

  1. 78 FR 36163 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ...return interval; (3) improve forest resilience to dwarf mistletoe, root rot, Douglas-fir...interval, (3) improve the forest resilience to native insects and diseases, and...forest type, improve general forest resilience to natural disturbances (native...

  2. 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…

  3. 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";…

  4. 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…

  5. El lesbianismo como monstruosidad en El cumpleaños de Alicia de Henry Díaz Vargas

    E-print Network

    Muñ oz, Willy O.

    2002-04-01

    la única función de la mujer es su rol materno: Quiero en tu cuerpo poseer las rosas, el agua de corrientes luminosas, el sol, el cielo azul, la mar dormida, y hacer correr, en raptos amorosos, al través de tus flancos armoniosos las fuentes...

  6. Respuesta Multiespectral de la Vegetacin Circundante de Canales Naturales como Posible Fuente de Identificacin de Corrientes

    E-print Network

    Gilbes, Fernando

    componente de los ecosistemas, el estado en que estos se encuentren puede determinar el estado de una zona o de agua en los canales primarios en las redes hídricas y sus ecosistemas son de gran importancia para

  7. Training in dual diagnosis interventions (the COMO Study): Randomised controlled trial

    PubMed Central

    Hughes, Elizabeth; Wanigaratne, Shamil; Gournay, Kevin; Johnson, Sonia; Thornicroft, Graham; Finch, Emily; Marshall, Jane; Smith, Neil

    2008-01-01

    Background Despite the high prevalence of co-morbid substance use among mental health service users (dual diagnosis), very few mental health workers in the UK have had training and/or clinical experience to equip them to deliver targeted interventions to this client group. Method In a randomised controlled trial of training for dual diagnosis interventions, 79 case managers from 12 community mental health teams in South London were randomly allocated to either receive training and follow-up supervision (experimental group) or no training and supervision (control group). Baseline measures of attitude, self-efficacy and knowledge were collected prior to randomisation, and were repeated at 18 months post-training. An intention to treat analysis of follow-up data (adjusted for baseline score for that outcome and team) was performed. Results At 18 months post-training, the AAPPQ (The Alcohol and Alcohol Problems Perception Questionnaire) total score was did not differ significantly between the two groups (adjusted difference 7.43 [95% CI -0.86 to 15.71], p = 0.08). There were significant differences in favour of the experimental group on 2 of the 6 subscales of the AAPPQ: 'adequacy of knowledge and skills in working with alcohol" (adjusted difference 3.598 [95% CI 1.03 to 6.16], p = 0.007) and "self-esteem in working with alcohol" (adjusted difference 3.00 [95% CI 0.46 to 5.54], p = 0.021). In addition there were significant improvements for the experimental group on "Knowledge About Dual Diagnosis" (adjusted difference 2.00 [95% CI 0.80 to 3.22], p = 0.002) and "Self-Efficacy Scale" (adjusted difference 13.55 [95% CI 8.00 to 26.86], p = 0.001). The effect of membership of teams was added to the analysis of covariance and this changed the results for only one variable: "self-esteem working with drinkers" was no longer significant. Conclusion A brief training course in dual diagnosis interventions had a significant effect on secondary measures of knowledge and self-efficacy that was detectable at 18 months post-training. Improvements in attitudes towards working with drinkers and drug users in mental health settings failed to reach statistical significance. Future research should explore the effects of dose of dual diagnosis training, and the successful integration of skills gained into routine care. Trial Registration: ISRCTN98891022 14th March 2007 PMID:18304310

  8. Estabelecimento do Conceito de Temperatura como uma grandeza derivada da Energia e da Entropia

    E-print Network

    Rodrigo de Abreu

    2002-12-12

    Temperature is introduced as a derived concept from energy and entropy. We consider two sub-systems in equilibrium for several configurations. The equality of temperature of the sub-systems is obtained from the equilibrium condition. The isothermal transformation is defined for several configurations and from this definition we obtain the Clausius-Clapeyron equation. We apply the analysis to the ideal gas. The classical ideal gas appears as a limit and the problem of the measurement of temperature is analysed.

  9. Estabelecimento do Conceito de Temperatura como uma grandeza derivada da Energia e da Entropia

    E-print Network

    De Abreu, R

    2002-01-01

    Temperature is introduced as a derived concept from energy and entropy. We consider two sub-systems in equilibrium for several configurations. The equality of temperature of the sub-systems is obtained from the equilibrium condition. The isothermal transformation is defined for several configurations and from this definition we obtain the Clausius-Clapeyron equation. We apply the analysis to the ideal gas. The classical ideal gas appears as a limit and the problem of the measurement of temperature is analysed.

  10. [Rabdomiosarcoma primario de corazón como causa de síncope recurrente en el adulto].

    PubMed

    Díaz-Pérez, Julio Alexander; Gómez-Arbeláez, 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

  11. 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

  12. ENSEÑANZA DE INGLÉS COMO LENGUAJE EXTRANJERO (EILE) ENGLISH LANGUAGE ACQUISITION FOR ELEMENTARY SCHOOLS IN COSTA RICA 

    E-print Network

    Olivarez, Enrika

    2011-04-27

    of current CALL research on second language learners. IEEE International Symposium on IT in Medicine Proceedings, 677-684. Umana Aguilar, J. (2003). Uso de bancos de textos linguisticos para la formacion de traductores. Revista de Filologia y Ling...

  13. JOVENS. DESEMPREGO ENTRE OS 15 E OS 24 ANOS PASSA OS 35% COMO CONSEGUIR

    E-print Network

    Instituto de Sistemas e Robotica

    as questões óbvias. Por Patrícia Silva AlveseAna Cláudia Damas Era um incentivo. Se Catarina Morei- ra fosse-lhe ao telefone. Catarina, com um mestrado em Sistemas de Informação Empresarial e média de 19 valores. "Vemos alguém que não sabe bem o que quer", explica Maria João Que- lhas, consultora da Page Personnel

  14. El monólogo como acto de fe: Estreno en Broadway de Rodolfo Usigli

    E-print Network

    Layera, Ramó n

    1994-10-01

    o político. En un momento en la historia de la humanidad en la que parece primar la ética y la voluntad de la masa Usigli insiste en defender al individuo. Al privilegiar el monólogo y propugnar una búsqueda humanista del ser humano por encima de... el teatro a la vez y que lo que falta es un fondo vivo, nuevo (201). FALL 1994 85 El antídoto que recomienda Usigli ante la influencia de este tipo de teatro alienante, cerebral, carente de verdadero contenido humano, es un teatro que persiga la...

  15. 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???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.

  16. 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

  17. Los marginados como personajes: Teatro chileno de la década de los sesenta

    E-print Network

    Villegas, Juan

    1986-04-01

    menciona que fue minero. Por su parte Don Niiñez afirma: "Yo, en otros tiempos era alentado pa' trabajar. Era tapicero y me iba a ofrecer a las casas. . . . Cuando me robaron las herramientas, ahí me fregaron. Se fue jodiendo don Núñez, se fue jodiendo... basural son recién llegados del campo, los inmigrantes de la ciudad, quienes al abandonar el campo e ingresar a la ciudad no tienen la educación ni las profesiones para triunfar. Por ello, terminan en el basural en el cual no necesitan habilidades...

  18. REPENSANDO Y REDEFINIENDO EL DESARROLLO DE MAESTROS COMO GENERADORES DE CAMBIO

    E-print Network

    , 1980), que se basa en las teorías constructivistas de Jean Piaget, afirmando que el conocimiento desde el punto de vista filosófico y psicológico, especialmente en las voces de Piaget, de Bruner, Dewey y Vygotsky (Saettler, 1990). La teoría de Piaget del desarrollo cognoscitivo propone que los humanos

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ..., thermal cover, old growth, and visual quality. DATES: Comments concerning the scope of the analysis must... standards for coarse woody debris, visual quality objectives, old growth, and thermal and hiding...

  20. 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;…

  1. La Lengua Escrita como Norma Fonetica (The Written Language as Phonetic Norm)

    ERIC Educational Resources Information Center

    Diaz-Plaja, Guillermo

    1977-01-01

    A collectivity can be defined by the verbal instrument which binds it together. By extension of this thought of Marshall MacLuhan, the importance of the written language as normative for the uniformity, universality and preservation of the phonetic system of the language is discussed. (Text is in Spanish.) (AMH)

  2. 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…

  3. 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???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

  4. Buscadores Web (o como pude encontrar la informacin para esta pltica).

    E-print Network

    Rajsbaum, Sergio

    IIMAS-IMATE UNAM 25/10/2005 #12;Contenido · Motivación. · Prehistoria. · Historia. · Arquitectura de un. · Prehistoria. · Historia. · Arquitectura de un buscador web. · RI clásica. · RI en web: Análisis de vínculos · HITS · PageRank #12;Contenido · Motivación. · Prehistoria. · Historia. · Arquitectura de un buscador

  5. UNIVERSIDAD SIMON BOLIVAR DECANATO DE ESTUDIOS PROFESIONALES

    E-print Network

    Vásquez, Carlos

    . Karen Mora de Pernía (Asistente al Decanato de Estudios Profesionales). Invitados Permanentes: Prof Estudiantil). Inasistentes: Profesores: Richard Rivas (Coordinador de Ingeniería Eléctrica) y Roger Corbacho

  6. UNIVERSIDAD SIMON BOLIVAR DECANATO DE ESTUDIOS PROFESIONALES

    E-print Network

    Vásquez, Carlos

    Estudios Profesionales), Richard Rivas (Coordinador de Ingeniería Eléctrica), Oscar González (Coordinador. Karen Mora de Pernía (Asistente al Decanato de Estudios Profesionales). Invitados Permanentes: Prof

  7. Freatmetros. Qu, dnde, cundo y cmo? Jobbagy & Mercau

    E-print Network

    Nacional de San Luis, Universidad

    calidad de la napa para tomar decisiones en agricultura Se propone una estrategia de muestreos de nivel en perforaciones PERMANENTES y muestreos de nivel y calidad en perforaciones TEMPORARIAS Perforaciones PERMANENTES nivel de agua libre generado. Si no hubo colapso es posible que solo haga falta limpiar el fondo sin

  8. Campus UFSC Florianpolis, SC UNIVERSIDADE FEDERAL DE SANTA CATARINA

    E-print Network

    Hanazaki, Natalia

    ) Departamento de Biologia Celular (1) #12;Neuropsicobiologia Neurobiologia Celular e Molecular Áreas de OXIDATIVOS E MECANISMOS DE DEFESA ANTIOXIDANTE (03) PGN-410007 - BIOLOGIA CELULAR DE GLIOMA (02) CFS-3418 Morfológicas: 01 Permanente Depto de Farmacologia: 01 Permanente Depto de Biologia Celular: 01 Colaborador 17

  9. SERVIO PBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA

    E-print Network

    Hanazaki, Natalia

    Permanente de Acompanhamento das Políticas de Igualdade de Gênero, Assunto: Convocação Convoco V.Sª. para a reunião ordinária da Comissão Permanente de Acompanhamento das Políticas de Igualdade de Gênero de Igualdade de Gênero de travestis e transexuais; 4. Discussão de adequação da redação da Resolução

  10. 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)

  11. 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…

  12. 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…

  13. 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…

  14. Como mejorar el PageRank de un arbol Arratia Quesada, A. (a) *; Marijuan, C.(a)**

    E-print Network

    Arratia, Argimiro A.

    ) de la red y cada arco (b,a) E representa la exis- tencia de un v´inculo en la p´agina b con la p´agina(a) = (1-) N + (b,a)E P(b) C(b) (1) donde C(b) es el n´umero de v´inculos en la p´agina b (el exgrado de b en la red. y el sumatorio se extiende a todas las p´aginas b que tienen un v´inculo con la p´agina a

  15. Estadísticas de visitas en portales web institucionales como indicador de respuesta del público a propuestas de divulgación

    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 Córdoba 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

  16. IDC 2009 Short Papers 3-5 June, 2009 Como, Italy User-Oriented Design and Tangible Interaction for

    E-print Network

    Baldassarri, Sandra

    has been based on observations of the children using the technology, letting them freely play children or is so complex to install that it cannot be played anywhere except in the laboratory where], with their StoryMat interactive storytelling space, succeeded in involving pre-school children in physical

  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. 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

  19. 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…

  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. 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

  2. Inteligncia Artificial Gigantes tecnolgicos como a Google e o Facebook apostam tudo na criao de programas que consigam aprender, conversar

    E-print Network

    Instituto de Sistemas e Robotica

    - tha, dotado de inteligência e capaz de aprender com a experiência, dialogar, dizer piadas e até a ficção, com siste- mas operativos dotados não apenas de inteligência e voz, mas também de uma "presença

  3. "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…

  4. 75 FR 21041 - Notice of Determinations Terminating Investigations of Petitions Regarding Eligibility To Apply...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-22

    ...Windsor, Colorado. TA-W-72,077: Perry Slingsby Systems, Inc., Jupiter, Florida, covered by TA-W-72,003: Perry Slingsby Systems, Inc., Jupiter, Florida. TA-W-72,372: Kaiser Permanente, Corona, California,...

  5. Prehospital Evaluation of Effusion, Pneumothorax, & Standstill (PEEPS): Point-of-care Ultrasound in Emergency Medical Services

    E-print Network

    Bhat, Sundeep R.; Johnson, David A.; Pierog, Jessica E.; Zaia, Brita E.; Williams, Sarah R.; Gharahbaghian, Laleh

    2015-01-01

    School of Medicine, Department of Emergency Medicine, Stanford, California Kaiser Permanente Santa Clara Medicalschool Undergraduate Master’s Prior ultrasound experience † Formal education Informal training None EMT, emergency medical

  6. UNIVERSIDAD SIMN BOLVAR VICERRECTORADO ACADMICO

    E-print Network

    Vásquez, Carlos

    EEGG: Lic. Ingrid Salazar Romero. Invitados Permanentes: Prof. André Pillaud (Representante por el Gabaldón y Alan Levy de la Corporación Andina de Fomento (CAF). Se disertará sobre el tema en el contexto

  7. QUELQUES FAITS POUR LES TUDIANTS TRANGERS

    E-print Network

    MATHÉMATIQUES PHYSIQUE PSYCHOLOGIE MARKETING SPORTIF 18:1 RAPPORT ENTRE LES ÉTUDIANTS ET ENSEIGNANTS 19 TAILLE INTEL KAISER PERMANENTE MICROSOFT NIKE PROVIDENCE HEALTH & SERVICES WELLS FARGO WIEDEN AND KENNEDY ZGF

  8. FAKTASINGKAT201516 UNTUK MAHASISWA INTERNASIONAL

    E-print Network

    FISIKA PSIKOLOGI MARKETING OLAHRAGA PRAKTIK BISNIS BERKELANJUTAN 18:1 RASIO MAHASISWA- PENGAJAR 19 UKURAN-PACKARD IBM INTEL KAISER PERMANENTE MICROSOFT NIKE PROVIDENCE HEALTH & SERVICES WELLS FARGO WIEDEN AND KENNEDY

  9. FATOS RPIDOS PARA ALUNOS INTERNACIONAIS

    E-print Network

    GEOGRAFIA ARQUITETURA DE INTERIORES PESQUISA E ESCRITA JURÍDICA MATEMÁTICA FÍSICA PSICOLOGIA MARKETING DE-PACKARD IBM INTEL KAISER PERMANENTE MICROSOFT NIKE PROVIDENCE HEALTH & SERVICES WELLS FARGO WIEDEN AND KENNEDY

  10. UNIVERSIDAD SIMN BOLVAR Informe de la

    E-print Network

    Vásquez, Carlos

    Consejo Directivo Invitados Permanentes Dr. Carlos Amador Representante de Asesoría Jurídica Lic. Daniela Trullás Coordinadora de Apoyo a los Convenios y Programas Internacionales Lic. María Eugenia Gutiérrez Jefe del Departamento de Relaciones Interinstitucionales Lic. Lucy Pires Asistente de la

  11. UNIVERSIDAD SIMON BOLIVAR Decanato de Estudios Profesionales

    E-print Network

    Vásquez, Carlos

    Gianvitorio (Coordinadora de Lic. Física), Andrés Pilloud (Coordinador de Ingeniería Geofísica), Edda, Hotelería y Hospitalidad), Vladimir Strauss (Coordinador de Lic. Matemáticas), Cecilia Murrugarra Licenciatura en Química), Oranys Marín (Coordinador de Lic. Biología). Invitados Permanentes: Lic. Lucy Pires

  12. UNIVERSIDAD SIMON BOLIVAR Decanato de Estudios Profesionales

    E-print Network

    Vásquez, Carlos

    (Coordinadora de Lic. Física), Andrés Pilloud (Coordinador de Ingeniería Geofísica), Edda Rodríguez Turismo, Hotelería y Hospitalidad), María Fátima Pinho (Coordinadora Encargada de Comercio Exterior y Lic. en Comercio Internacional), Oranys Marín (Coordinador de Lic. Biología). Invitados Permanentes

  13. UNIVERSIDAD SIMON BOLIVAR Decanato de Estudios Profesionales

    E-print Network

    Vásquez, Carlos

    (Coordinadora de Lic. Física), Andrés Pilloud (Coordinador de Ingeniería Geofísica), Edda Rodríguez (Coordinadora Encargada de Comercio Exterior y Lic. en Comercio Internacional), Vladimir Strauss (Coordinador de Lic. Matemáticas), Oranys Marín (Coordinador de Lic. Biología). Invitados Permanentes: Kenyer

  14. 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,

  15. SI USTED TIENE DERECHO A TRABAJAR, no deje que nadie se lo quite.

    E-print Network

    SI USTED TIENE DERECHO A TRABAJAR, no deje que nadie se lo quite. Si tiene derecho a trabajar ciudadano de los Estados Unidos o residente permanente o negarse a aceptar documentos válidos por ley. Si se

  16. A review of "Blown by the Spirit: Puritanism and the Emergence of an Antinomian Underground in Pre-Civil War England" by David Como

    E-print Network

    William J. Scheick

    2004-01-01

    , extreme religious discourses arising from within other European Christian denominations de- voted to Reformation theology? David J. Rempel Smucker and John L. Ruth (eds.) and James W. Lowry (intro. and trans.). Hans Landis: Swiss Anabaptist Martyr... in Seventeenth?Century Documents. Millersburg: Ohio Amish Library, 2003. xi + 233 pp. + 18 illus. $14.95. Review by NILES S. ILLICH, TEXAS A&M UNIVERSITY. In 1614 Hans Landis, a leader of the Swiss Anabaptists, be- came a martyr. His execution by the Swiss...

  17. 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…

  18. Desde 1889 Barnard College ha sido reconocida como lder en el campo de la educacin superior para mujeres. La diversidad de nuestra comunidad intelectual y un ambiente

    E-print Network

    por solicitud de admisión a escuelas de posgrado. Programa académico de verano: El verano anterior al asegura que familias de todo tipo de situación económica puedan costear su educación en Barnard. Tod

  19. Desde 1889 Barnard College ha sido reconocida como lder en el campo de la educacin superior para mujeres. La diversidad de nuestra comunidad intelectual y un ambiente

    E-print Network

    cuotas por solicitud de admisión a escuelas de posgrado. Programa académico de verano: El verano anterior norma asegura que familias de todo tipo de situación económica puedan costear su educación en Barnard

  20. 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…

  1. 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…

  2. 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…

  3. October 15, 2005 18:31 Proceedings Trim Size: 9in x 6in como A LIQUID IONIZATION CHAMBER AS MONITOR IN

    E-print Network

    Hörandel, Jörg R.

    radiotherapy. The de- tector consists of 480 individual electronic channels which allow parallel read of a multileaf collimator have been measured and a reconstruction method for individual leaf positions has been is shaped by means of a multileaf collimator (MLC) to adapt the delivered dose to the shape of the tumor

  4. 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…

  5. 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…

  6. 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,…

  7. 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…

  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. Es bien conocido el carcter dinmico de un ecosistema, en el que se pueden encontrar muchos procesos, como la produccin primaria, la fijacin del Nitrgeno, o la

    E-print Network

    Seoane, Javier

    Es bien conocido el carácter dinámico de un ecosistema, en el que se pueden encontrar muchos traducirse en ciclos continuados. Algunos de los ciclos mejor conocidos y de gran relevancia en un ecosistema ecosistema #12;La consideración conjunta de estas y otras propiedades de un ecosistema es lo que se denomina

  10. El acelerado incremento en las ltimas dcadas de impactos ambientales negati-vos como la destruccin y fragmentacin de ambientes naturales, la contamina-

    E-print Network

    Nacional Autónoma de México, Universidad

    selva seca es uno de los ecosistemas más diversos de México. Sin embargo, enfrenta una de las tasas de%, y su tasa de deforestación anual es del 2%, una de las más altas entre los ecosistemas del país

  11. "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…

  12. Nuestro inters como Facultad de Ciencias de la Salud es formar a la poblacin general y a determinados sectores profesionales para salvar vidas. La formacin se

    E-print Network

    Escolano, Francisco

    de PCR y la importancia del factor tiempo. Analizar correctamente una situación de emergencia y cuando alertar a los dispositivos de emergencias. Saber desarrollar las maniobras de RCP básica en Profesorado: acreditado por la American Hearts Association (AHA) y por la Sociedad Española de Medicina de

  13. Ideologies Revealed during the Construction of Meaning in an EFL Class (Ideologías reveladas durante la construcción de significado en una clase de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Fajardo Mora, Néstor Ricardo

    2014-01-01

    This article reports on an interpretive qualitative study conducted at a public university in Bogotá 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…

  14. 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…

  15. 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,…

  16. "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

  17. Finding an Appropriate Preschool for Your Child with Special Needs = Como Encontrar un Programa Pre-escolar para su nino con desabilidades.

    ERIC Educational Resources Information Center

    Bernstein, Sandra; Wonderlick, Mary; Madden, Drina

    This booklet, with English and Spanish versions, provides a step-by-step procedure to help families find an appropriate preschool program in the community for their child with disabilities. The booklet lists six steps for locating a program: (1) decide what kind of program is wanted for the child; (2) complete included form outlining child's needs…

  18. Como pella a las dueñas, tomelo quien podiere”: anacronismo y representación en las adaptaciones cinemáticas del Libro de buen amor dirigidas por Tomás Aznar y Jaime Bayarri

    E-print Network

    Drayson, E. A.

    2015-01-01

    . Allí conoce a Endrina y se enamora de ella. Trotaconventos se apoya en la hipocresía y el engaño para instigar un escenario de violación posible, faltando del manuscrito original y basado en un episodio semejante del Pamphilus latino. Sin embargo, en...

  19. 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…

  20. 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…

  1. October 6, 2007 15:19 WSPC -Proceedings Trim Size: 9in x 6in ComoProceedings PERFORMANCE OF THE ATLAS LIQUID ARGON

    E-print Network

    Krieger, Peter

    OF THE ATLAS LIQUID ARGON FORWARD CALORIMETER IN BEAM TESTS P.KRIEGER Department of Physics, University hermeticity is crucial. The ATLAS Liquid Argon Forward Calorimeter (FCal) is designed primar- ily the resolution on missing transverse energy. The ATLAS FCal is a liquid argon calorimeter that is integrated

  2. 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,…

  3. "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…

  4. 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…

  5. Investigation of Pt, Pt3Co, and Pt3CoMo Cathodes for the ORR in a Microfluidic H2O2 Fuel Cell

    E-print Network

    Kenis, Paul J. A.

    Investigation of Pt, Pt3Co, and Pt3CoÕMo Cathodes for the ORR in a Microfluidic H2ÕO2 Fuel Cell on the performance and durability of four Pt-based cathode catalysts in a microfluidic H2/O2 fuel cell: commercial performed using an acidic microfluidic H2/O2 fuel cell with an analytical platform. The electrolyte flow

  6. 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

  7. 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…

  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. 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

  10. 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…

  11. 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;…

  12. UNIVERSIDAD SIMON BOLIVAR Decanato de Estudios Profesionales

    E-print Network

    Vásquez, Carlos

    el DEP). Invitados Permanentes: Profesores: Kenyer Domínguez (Coordinador de Cooperación Técnica y cual fue aprobada con la inclusión de los puntos 3.1 Representación del DEP ante el Decanato de los eventos de la vida universitaria en su página WEB y durante la programación de la emisora, con

  13. Ecological Nutrition: Redefining Healthy Food in Health Care

    E-print Network

    Klein, Kendra C.

    2013-01-01

    genetically modified organisms. The impetus for Kaiser Permanente's sustainable foodfood packaging like Bisphenol-A and phthalates, use of growth hormones in animal agriculture, and genetically modifiedfood system are increasingly prevalent in Western societies. Pesticides, growth hormones, foodborne illness and genetically modified

  14. Communiqu de presse -Mars 2013 Prolongation de l'exposition Dinosaure, la vie en grand

    E-print Network

    Communiqué de presse - Mars 2013 Prolongation de l'exposition « Dinosaure, la vie en grand » jusqu déjà séduit près de 285 000 visiteurs (au 17 mars 2013). Nourrie des recherches les plus récentes en du gigantisme, en partenariat avec l'Université Permanente de Paris Lundi 18 mars > Gigantisme chez

  15. Universite de Paris-Sud U.F.R. Scientifique d'Orsay

    E-print Network

    Rusu, Irena

    mes recherches, sans l'aide permanente duquel ce travail n'aurait jamais vu le jour. J'ai ´et´e et je´efinie il y a d´ej`a une trentaine d'ann´ees et qui, depuis, ne cesse pas de poser de nouveaux probl

  16. 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...

  17. Whole-Genome Sequencing of Individuals from a Founder Population Identifies Candidate Genes for

    E-print Network

    Abney, Mark

    , United States of America, 2 Department of Human Genetics, The University of Chicago, Chicago, Illinois, 6 Department of Allergy & Immunology, Kaiser Permanente-Vallejo Medical Center, Vallejo, California is a complex genetic disease caused by a combination of genetic and environmental risk factors. We sought

  18. Forest development following mudflow deposition, Mount St. Helens, Washington

    E-print Network

    Franklin, Jerry

    Forest development following mudflow deposition, Mount St. Helens, Washington Marc H. Weber, Keith eruption of Mount St. Helens using permanent plot data collected along two transects traversing the Cedar'éruption du mont Saint Helens en 1980 à l'aide des données provenant de placettes-échantillons permanentes et

  19. UNIVERSIDAD SIMON BOLIVAR Decanato de Estudios Profesionales

    E-print Network

    Vásquez, Carlos

    Ingeniería de Materiales), Oranys Marín (Coordinador de Lic. Biología), Martín Durán (Coordinador de Mecánica Exterior y Lic. en Comercio Internacional), René Escalante (Coordinador de Lic. Matemáticas), Ana María de Lic. Física), Invitados Permanentes: Profa. Mará Elena Ludeña (Coordinadora del Ciclo Básico del

  20. SERVIO PBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA

    E-print Network

    Floeter, Sergio Ricardo

    SERVIÇO PÚBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA COMISSÃO PERMANENTE DO Saberes e Competências da Universidade Federal de Santa Catarina, instituída pela Portaria 503/2015/GR Reconhecimento de Saberes e Competências ­ RSC Nível III, processo 23080.030626/2015-98, da PROFª MARIA ELZA DE

  1. SERVIO PBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA

    E-print Network

    Floeter, Sergio Ricardo

    SERVIÇO PÚBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA COMISSÃO PERMANENTE DO Saberes e Competências da Universidade Federal de Santa Catarina, instituída pela Portaria 503/2015/GR Reconhecimento de Saberes e Competências ­ RSC Nível III, processo 23080.033046/2015-52, da PROFª MARIA ALICE

  2. SERVIO PBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA

    E-print Network

    Floeter, Sergio Ricardo

    SERVIÇO PÚBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA COMISSÃO PERMANENTE DO Saberes e Competências da Universidade Federal de Santa Catarina, instituída pela Portaria 503/2015/GR Reconhecimento de Saberes e Competências ­ RSC Nível III, processo 23080.027112/2015-55, da PROFª MARCIA MARIA

  3. SERVIO PBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA

    E-print Network

    Floeter, Sergio Ricardo

    SERVIÇO PÚBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA COMISSÃO PERMANENTE DO Saberes e Competências da Universidade Federal de Santa Catarina, instituída pela Portaria 503/2015/GR Reconhecimento de Saberes e Competências ­ RSC Nível III, processo 23080.028136/2015-21, da PROFª SONIA MARIA

  4. SERVIO PBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA

    E-print Network

    Floeter, Sergio Ricardo

    SERVIÇO PÚBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA COMISSÃO PERMANENTE DO Saberes e Competências da Universidade Federal de Santa Catarina, instituída pela Portaria 503/2015/GR Reconhecimento de Saberes e Competências ­ RSC Nível II, processo 23080.032872/2015-84, da PROFª MARIA LUIZA

  5. SERVIO PBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA

    E-print Network

    Floeter, Sergio Ricardo

    SERVIÇO PÚBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA COMISSÃO PERMANENTE DO Saberes e Competências da Universidade Federal de Santa Catarina, instituída pela Portaria 503/2015/GR Educação Tecnológica Celso Suckow da Fonseca; Maria Antônia Ferreira Andrade, SIAPE 1837661, com lotação

  6. SERVIO PBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA

    E-print Network

    Floeter, Sergio Ricardo

    SERVIÇO PÚBLICO FEDERAL UNIVERSIDADE FEDERAL DE SANTA CATARINA COMISSÃO PERMANENTE DO Saberes e Competências da Universidade Federal de Santa Catarina, instituída pela Portaria 503/2015/GR no Universidade Federal de Santa Maria; Laercio Gomes Dantas, SIAPE 1218810, com lotação no Centro Federal de

  7. 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.

  8. Fechas de los cursos para residentes OFERTAS DE CURSOS IDARM

    E-print Network

    Fechas de los cursos para residentes OFERTAS DE CURSOS IDARM PARA RESIDENTES PROGRAMA INTERNACIONAL a través de cursos permanentes realizados en el campus de la Escuela de Postgrado Naval de Monterey. Los de casos diseñados para resaltar los objetivos específicos de aprendizaje. Los cursos para residentes

  9. APPLICATION FOR YOUTH SCIENCE FELLOWSHIP PROGRAM

    E-print Network

    Grossman, Emily

    or honors (e.g. science fairs, volunteer work, after school activities, internships) 3) A personal statement Calculus AB Sam ple #12;Science-related experiences or honors Experience: -Took honors biology -Took honors chemistry -Taking AP biology Volunteering: -Kaiser Permanente 2012-Present Sam ple #12;Personal Statement I

  10. The State of the Art in Automating Usability Evaluation of User Interfaces

    E-print Network

    Hearst, Marti

    The State of the Art in Automating Usability Evaluation of User Interfaces MELODY Y. IVORY fellowship, and Kaiser Permanente. Authors' addresses: M. Y. Ivory, Computer Science Division, University of California, Berkeley, Berkeley, CA 94720-1776; email: ivory@CS.Berkeley.edu; M. A. Hearst, School

  11. 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…

  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, México i...

  13. Brevissima Introduzione a eduKnoppix. Francesco Paparella

    E-print Network

    Paparella, Francesco

    spiega come creare una home directory permanente su di un disco fisso o su di un dispositivo rimovibile e pdf). La distribuzione eduKnoppix non ha bisogno di essere installata sul disco fisso di un anche una procedura di installazione sul disco fisso, che non `e descritta in questo documento. Il mio

  14. Health Care Basics: Choosing the

    E-print Network

    Li, Mo

    2012 Health Care Basics: Choosing the Best Option for Your Health "Creating A More Educated Georgia" #12;Health Care Basics 2 Medical Options for Plan Year 2012 The University System of Georgia's Plan of Regents will offer the following health care options: · Blue Choice HMO · Kaiser Permanente HMO · HSA Open

  15. PROGRAMA ESPECIAL DE TITULACIN EN ARQUITECTURA Descripcin

    E-print Network

    Pérez, Carlos E.

    PROGRAMA ESPECIAL DE TITULACIÓN EN ARQUITECTURA Descripción: El Programa Especial de Titulación (PET) en Arquitectura de la Universidad de Concepción surge el año 2011 bajo el alero de la Facultad de Arquitectura, Urbanismo y Geografía (FAUG), en el marco del Programa de Formación Permanente y Carreras

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

    ERIC Educational Resources Information Center

    Mugford, Gerrard; Cuevas, Oscar Ramírez

    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.…

  17. 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…

  18. 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…

  19. 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…

  20. 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…

  1. Metacognitive Awareness and Comprehension Monitoring in Reading Ability of Iranian EFL Learners (Monitoreo de la conciencia metacognitiva y de la comprensión en la habilidad lectora de estudiantes iraníes de inglés 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…

  2. 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…

  3. 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…

  4. 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…

  5. 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…

  6. 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…

  7. 1 A G E N T E S I N T E L I G E N T E S La Inteligencia Artificial tiene como objetivo el estudio de las entidades inteligentes;

    E-print Network

    Guerra Hernández, Alejandro

    Inteligencia Artificial Filosofía Neuro Ciencias Lingüistica Psicología Cognitiva Figura 1: La Inteligencia, neuro ciencias, lingüistica, filosofía cognitiva, etc. Esta geografía, cabe mencionar, es de suma

  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. 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…

  10. Teacher Activities and Adolescent Students' Participation in a Colombian EFL Classroom (Actividades de enseñanza y participación de estudiantes adolescentes en una clase de enseñanza de inglés 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…

  11. Como Ayudarle a su Hijo con la Tarea Escolar: Una guia para padres de alumnos de escuela primaria y secundaria (Helping Your Child with Homework: For Parents of Elementary and Junior High School-Aged Children).

    ERIC Educational Resources Information Center

    Paulu, Nancy, Ed.; Perkinson, Kathryn, Ed.

    This Spanish-language booklet is designed to provide parents of elementary and junior high school students with an understanding of the purpose and nature of homework along with suggestions for helping their children complete homework assignments successfully. Following a discussion of why teachers assign homework, how homework can help children…

  12. Parents as Partners: Planning Early for Your Children's School Success and College Attendance = Los Padres como Socios: Planificando para el Exito Escolar y la Asistencia al Colegio de Sus Ninos.

    ERIC Educational Resources Information Center

    California State Univ., Long Beach.

    Presented in both the English and Spanish Language versions is a booklet which describes what parents can do at home and in the school to support and encourage their children's success in school and college. Discussion emphasizes the extent to which parents influence their children's attitudes about learning and school, and points out that parent…

  13. The Kindergarten Survival Handbook: The Before School Checklist & a Guide for Parents. (El Manual de Como Sobrevivir El Jardin de Ninos: La Lista Pre-escolar y Una Guia Para Los Padres).

    ERIC Educational Resources Information Center

    Elovson, Allana Cummings

    Written to help parents understand what their children need to know before they start kindergarten, this volume, bound separately in English and Spanish, is intended to help parents become their children's best, as well as their first and most important, teachers. The first part of the book, the before school checklist, is divided into eight…

  14. Parents as Partners: Planning Early for Your Children's School Success and College Attendance. Revised Edition = Los Padres como Socios: Planificando para el Exito Escolar y la Asistencia al Colegio de Sus Ninos. Edicion Revisada.

    ERIC Educational Resources Information Center

    Reyes, Maria; Rothman, Donald

    This booklet, available in English and Spanish, describes what California parents can do at home and in the school to support and encourage their children's success in school and college. Discussion emphasizes the extent to which parents influence their children's attitudes about learning and school, and points out that parent involvement is…

  15. Como ayudar a su hijo con la tarea escolar: Para los padres con ninos en la primaria y la secundaria (Helping Your Child with Homework: For Parents of Children in Elementary through Middle School).

    ERIC Educational Resources Information Center

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

    Homework is an opportunity for children to learn and for families to be involved with their children's education, but helping children with homework is not always easy. This Spanish-language booklet is designed to provide parents of elementary and middle grades students with an understanding of the purpose and nature of homework and offers…

  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. The Implications of Orthographic Intraference for the Teaching and Description of ESL: The Educated Nigerian English Examples (Implicaciones de la Intraferencia Ortográfica para la Enseñanza y Descripción del Inglés como Segunda Lengua: Ejemplos Inglés 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…

  18. 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…

  19. Effects of Strategy Instruction in an EFL Reading Comprehension Course: A Case Study (Efectos de la instrucción de estrategias en un curso de comprensión de lectura en inglés 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…

  20. 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…

  1. 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)…

  2. 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%.

  3. 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…

  4. 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…

  5. 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…

  6. 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…

  7. 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…

  8. 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.)

  9. A Conversation on the Future of Health Care: Integrating Lifestyle Medicine—Part 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

  10. Aula 2, 12/03/04 Algoritmos

    E-print Network

    Mascarenhas, Walter Figueiredo

    /03/04 Passo a Passo · Arquivo pode estar em: disco r´igido, disquete, CD, rede ou internet. Todos s desenho. · Desligar o micro e voltar depois: os dados v~ao para o disco r´igido (lento). Durante o, pouco alterada · Disco r´igido: permanente, lido e escrito com certa freq¨u^encia (lento) #12;MAC0110

  11. 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.

  12. 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.

  13. 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.

  14. A provider's view of prevention approaches in a prepaid group practice.

    PubMed

    Lawrence, D M

    1991-03-15

    Kaiser Permanente's health care delivery system and its efforts to integrate public health preventive medicine and curative medicine are described. The author advocates an increased focus on prepaid delivery systems like Kaiser Permanente as the best vehicle to achieve the full promise of health screening, health education, and life-style modification. Because these systems have brought the proper incentives into alignment, prevention and health promotion have become effective tools to achieve cost containment goals. A number of Kaiser Permanente projects are highlighted that demonstrate integration of public health preventive medicine and curative medicine: the Northern California Region's uniform health appraisal examination, which is linked with health education and counseling; the Colorado Region's breast cancer screening program, which is expected to show a higher rate of early breast cancer detection than in the general population; cooperative efforts with two Northern California towns to reduce smoking through a community-wide project; educational theatre programs aimed at early intervention and education of children before high-risk behaviors have become established life-style; and research projects that are possible because of an integrated program. Also, several forces that could endanger integrated systems including cost control practices of employers and insurers, and public policy such as mandating specific benefits, are noted. PMID:2001575

  15. Earthquakes, Segments, Bends, and Fault-Face Geology: Correlations Within the San Andreas System, California

    NASA Astrophysics Data System (ADS)

    Jachens, R. C.; Simpson, R. W.; Thurber, C. H.; Murray, J. R.

    2006-12-01

    Three-dimensional geologic maps of regions surrounding parts of the San Andreas Fault system reveal correlations between fault face geology and both short- and long-term behavior of the faults. The Loma Prieta fault segment that ruptured during the 1989 M6.9 earthquake, as defined by its aftershocks, closely corresponds to the subsurface reach (80 km long) where a large body of Logan gabbro is truncated at the fault, as defined by its magnetic anomaly. This Jurassic ophiolitic gabbro and its related rocks occupy an unusual fault-bounded basement block within Salinaa, a largely Cretaceous granitic terrane SW of the San Andreas Fault. The along-fault reach of the Logan gabbro also coincides with essentially the entire Santa Cruz Mountains left-bend in the San Andreas Fault. Rejecting a chance coincidence, the position of the Logan gabbro with respect to the left bend implies that the bend is fixed relative to Salinia and that the block NE of the San Andreas Fault has been forced to negotiate around the bend as the blocks moved past each other. Thus the basement rocks of the Logan block appear to define (control?) the Loma Prieta segment in terms both of short-term behavior (earthquakes) and long-term behavior (restraining bend fault geometry). The Parkfield segment of the San Andreas Fault also closely corresponds to a characteristic geologic unit in the NE face of the fault, the greenstone-rich Permanente terrane of the Franciscan Complex. The along-fault subsurface extent of the Permanente terrane at the fault face, as inferred from a recent 3D tomographic wavespeed model, corresponds to the reach filled by the aftershocks of the 2004 Parkfield earthquake. Furthermore, the 2004 co-seismic slip inferred from geodetic observations also coincides with the Permanente terrane at the fault face. To test whether these observations are directly related to the presence of the Permanente terrane along the fault face, we looked at fault behavior at the location of its offset counterpart, which truncates at the Calaveras Fault near Hollister 175 km to the NW. Here, the along-fault subsurface extent of the Permanente terrane, as defined by its gravity and magnetic anomalies, corresponds to the aftershock distribution of the 1979 Coyote Lake earthquake, giving support to the idea that fault-face geology can influence fault behavior and control fault segmentation.

  16. 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. Résumé Les "prélèvements" sont constitués par l'augmentation de la recharge et par la diminution de l'écoulement qui se produit lorsqu'un pompage est imposéà un système aquifère qui était auparavant dans un état proche de l'équilibre dynamique. Les modèles régionaux de nappe sont en général utilisés pour calculer les prélèvements dans une procédure à deux étapes. Une solution en régime permanent donne la configuration piézométrique initiale, un jeu de conditions aux limites pour la région modélisée et les données de base pour le calcul des prélèvements. Les solutions transitoires donnent les modifications globales des conditions aux limites. Lorsque des variations saisonnières sont produites en sortie du modèle, le recours à une piézométrie initiale unique et à un seul jeu de données de conditions aux limites conduit à un mauvais calcul des prélèvements. Il faut alors utiliser une condition de recharge initiale pour chaque saison. Cette approche peut être réalisée en déterminant des solutions permanentes périodiques, variantes au cours des saisons, mais se répétant d'année en année. Un modèle de nappe régional, précédemment mis au point pour une partie du bassin de la rivière San Pedro (Arizona, États-Unis), a été modifié pour illustrer l'effet de conditions initiales différentes sur des solutions transitoires et sur le calcul des prélèvements. Resumen Se define como "captura" al aumento de recarga y descenso de descarga que tiene lugar cuando se impone un bombeo en un acuífero en estado de equilibrio dinámico. Se suelen utilizar modelos regionales de agua subterránea para calcular la captura en un procedimiento que consta de dos etapas. Una solución en régimen estacionario proporciona la distribución inicial de niveles piezométricos, los flujos a través de los contornos de la región modelada y el punto de partida para el cálculo de la captura. Las soluciones transitorias proporcionan los cambios en los flujos a través de los contornos. La diferencia entre las soluciones estacionaria y transitoria da el valor de la captura. Cuando los cambios estacionales son importantes, la utilización de un único estado inicial de niveles y de flujos en los contornos da lugar a errores en el cálculo de la captura. En este caso debe usarse una condición inicial para cada una de las estaciones. Esto se puede conseguir obteniendo soluciones periódicas estacionarias, que varíen a lo largo de las estaciones, pero que se repitan año a año. Un modelo regional desarrollado previamente para el estudio de una parte de la cuenca del Río San Pedro, en Arizona (EE.UU.) se modificó para ilustrar el efecto que las distintas condiciones iniciales tienen en el cálculo de la captura.

  17. 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…

  18. 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…

  19. ...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…

  20. 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…

  1. 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…

  2. 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…

  3. 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…

  4. 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…

  5. 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…

  6. 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…

  7. 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-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:26247072

  8. 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

  9. 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

  10. 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

  11. Healthy Behavior Change in Practical Settings

    PubMed Central

    Young, Scott

    2014-01-01

    The core principle of implementing healthy behavior change is making the healthy choice the easy choice. Putting this motto into practice requires us to remove the barriers that individuals face when trying to live a healthy lifestyle. It is important to look at the bigger picture when helping our patients reach optimal health, looking closely at exercise levels and home life. Environmental factors can cause strain and present challenges for people trying to develop and maintain good health. At the Care Management Institute and at Kaiser Permanente, we are making strides to change default behaviors so optimal lifestyles become the norm, rather than the exception. PMID:25216360

  12. 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

  13. Marijuana use and mortality.

    PubMed Central

    Sidney, S; Beck, J E; Tekawa, I S; Quesenberry, C P; Friedman, G D

    1997-01-01

    OBJECTIVES: The purpose of this study was to examine the relationship of marijuana use to mortality. METHODS: The study population comprised 65171 Kaiser Permanente Medical Care Program enrollees, aged 15 through 49 years, who completed questionnaires about smoking habits, including marijuana use, between 1979 and 1985. Mortality follow-up was conducted through 1991. RESULTS: Compared with nonuse or experimentation (lifetime use six or fewer times), current marijuana use was not associated with a significantly increased risk of non-acquired immunodeficiency syndrome (AIDS) mortality in men (relative risk [RR] = 1.12, 95% confidence interval [CI] = 0.89, 1.39) or of total mortality in women (RR = 1.09, 95% CI = 0.80, 1.48). Current marijuana use was associated with increased risk of AIDS mortality in men (RR = 1.90, 95% CI = 1.33, 2.73), an association that probably was not causal but most likely represented uncontrolled confounding by male homosexual behavior. This interpretation was supported by the lack of association of marijuana use with AIDS mortality in men from a Kaiser Permanente AIDS database. Relative risks for ever use of marijuana were similar. CONCLUSIONS: Marijuana use in a prepaid health care-based study cohort had little effect on non-AIDS mortality in men and on total mortality in women. PMID:9146436

  14. 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 Permanente’s 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

  15. UNIVERSIDAD SIMN BOLVAR CONSEJO DIRECTIVO

    E-print Network

    Vásquez, Carlos

    del día tal y como fue presentado. II. APROBACIÓN DEL ACTA 2011-01 Fue aprobada el acta 2011-01, tal y considerada como privada, y como tal no debería ser accedida por cualquier funcionario. Conocido el mapa

  16. 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

  17. PROGRAMA ESPECIAL DE TITULACIN EN INGENIERA AMBIENTAL Descripcin

    E-print Network

    Pérez, Carlos E.

    para desempeñarse en instituciones públicas y privadas o desarrollarse como un profesional emprendedor instituciones públicas y privadas o desarrollarse como un profesional emprendedor liderando grupos de trabajos

  18. 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.

  19. 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

  20. 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

  1. Experience using radio frequency laptops to access the electronic medical record in exam rooms.

    PubMed Central

    Dworkin, L. A.; Krall, M.; Chin, H.; Robertson, N.; Harris, J.; Hughes, J.

    1999-01-01

    Kaiser Permanente, Northwest, evaluated the use of laptop computers to access our existing comprehensive Electronic Medical Record in exam rooms via a wireless radiofrequency (RF) network. Eleven of 22 clinicians who were offered the laptops successfully adopted their use in the exam room. These clinicians were able to increase their exam room time with the patient by almost 4 minutes (25%), apparently without lengthening their overall work day. Patient response to exam room computing was overwhelmingly positive. The RF network response time was similar to the hardwired network. Problems cited by some laptop users and many of the eleven non-adopters included battery issues, different equipment layout and function, and inadequate training. IT support needs for the RF laptops were two to four times greater than for hardwired desktops. Addressing the reliability and training issues should increase clinician acceptance, making a successful general roll-out for exam room computing more likely. PMID:10566458

  2. Use of Electronic Health Records and Administrative Data for Public Health Surveillance of Eye Health and Vision-Related Conditions

    PubMed Central

    Elliott, Amanda; Davidson, Arthur; Lum, Flora; Chiang, Michael; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E.; Chou, Chiu-Fang

    2014-01-01

    Purpose To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Methods We describe three currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Results Each of the three sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Conclusions Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. PMID:23158225

  3. 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

  4. 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

  5. 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

  6. Use of electronic health records can improve the health care industry's environmental footprint.

    PubMed

    Turley, Marianne; Porter, Catherine; Garrido, Terhilda; Gerwig, Kathy; Young, Scott; Radler, Linda; Shaber, Ruth

    2011-05-01

    Electronic health records have the potential to improve the environmental footprint of the health care industry. We estimate that Kaiser Permanente's electronic health record system, which covers 8.7 million beneficiaries, eliminated 1,000 tons of paper records and 68 tons of x-ray film, and that it has lowered gasoline consumption among patients who otherwise would have made trips to the doctor by at least three million gallons per year. However, the use of personal computers resulted in higher energy consumption and generated an additional 250 tons of waste. We conclude that electronic health records have a positive net effect on the environment, and that our model for evaluating their impact can be used to determine whether their use can improve communities' health. PMID:21555478

  7. 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.

  8. Genetic Services in the KP Southern California Region: Delivering the Promises of Tomorrow Today

    PubMed Central

    Alvarado, Mónica; Shinno, Nancy; Monroe, C Douglas; Jamehdor, Mehdi; Anderson, Kermit

    2006-01-01

    The impact of advances in molecular biology over the past 25 years—especially the completion of the Human Genome Project—touches every branch of medicine and will continue to have profound influence on medical practice. Advances in genetic technology are changing the traditional patient/doctor paradigm. For some medical conditions, current genetic technology and predictive testing enable us to offer medical management before a patient is diagnosed with a disorder. However, advances in genetic technology impose on all clinicians the added requirement of identifying patients who may benefit from having access to this technology. Kaiser Permanente (KP) provides a unique, integrated approach to this challenge by serving as a model for delivery of genetic services. This article outlines the history and current status of genetic services provided in the KP Southern California Region and summarizes current and future developments in medical genetics technology. PMID:21519453

  9. 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

  10. Qualitative Factors in Patients who Die Shortly After Emergency Department Discharge

    PubMed Central

    Gabayan, Gelareh Z.; Sun, Benjamin C.; Asch, Steven M.; Timmermans, Stefan; Sarkisian, Catherine; Yiu, Sau; Lancaster, Elizabeth M.; Poon, K. Trudy; Kellermann, Arthur L.; Ryan, Gery; Miniel, Nicholas J.; Flansbaum, Drew; Hoffman, Jerome R.; Derose, Stephen F.

    2013-01-01

    Objective Early death after ED discharge may signal opportunities to improve care. Prior studies are limited by incomplete mortality ascertainment and lack of clinically important information in administrative data. Our goal in this hypothesis-generating study was to identify patient and process of care-level themes that may provide possible explanations for early post-discharge mortality. Methods We conducted a qualitative analysis of medical records of adult patients who visited any of six hospitals in an integrated health system (Kaiser Permanente Southern California – KPSC) ED and died within 7 days of discharge in 2007 and 2008. We excluded non-members, visits to non-health plan hospitals, patients receiving or referred to hospice care, and patient with Do Not Resuscitate or Do Not Intubate orders. Under the guidance of two qualitative research scientists, a team of three emergency physicians utilized grounded theory techniques to identify patient clinical presentations and processes of care that serve as potential explanations for poor outcome after discharge. Results The source population consisted of a total of 290,092 members with 446,120 discharges from 6 Kaiser Permanente Southern California EDs in 2007 and 2008. A total of 203 deaths occurred within 7 days of ED discharge (0.05%). Sixty-one randomly chosen cases were reviewed. Patient level themes that emerged included an unexplained persistent acute change in mental status, recent fall, abnormal vital signs, ill appearing presentation, malfunctioning indwelling device, and presenting symptoms remaining at discharge. Process of care factors included a discrepancy in history of present illness, incomplete physical exam, and change of discharge plan by a third party, such as a consulting or admitting physician. Conclusions In this hypothesis-generating study, we used qualitative research techniques to identify clinical and process of care factors in patients who die within 7-days after discharge from an ED. These potential predictors will be formally tested in a future quantitative study. PMID:24033620

  11. Impact of bevacizumab administered dose on overall survival of patients with progressive glioblastoma.

    PubMed

    Levin, Victor A; Mendelssohn, Nancy D; Chan, James; Stovall, Mady C; Peak, Scott J; Yee, Jennie L; Hui, Rita L; Chen, David M

    2015-03-01

    Bevacizumab (BEV, Avastin(®)) produces durable objective radiological responses of 20-26 %, median response durations of 16-18 weeks, and median overall survival (mOS) of 31-40 weeks. While the use of BEV is well-established, the lack of dose-response studies in glioblastoma (GBM) patients raises the question whether current dosing practice is optimal. As a result of differing approaches to BEV dosing that ranged from the FDA approved package insert dose of 10 mg/kg every 2 weeks to 7.5 mg/kg every 3-4 weeks, among physicians within Northern California Kaiser Permanente hospitals over 4+ years, we did an IRB-approved retrospective analysis of patients seen in Northern California Kaiser Permanente facilities and treated with BEV. Between September 1, 2008 and August 31, 2013, 181 patients received BEV for tumor progression/recurrence starting 2.6 weeks after completion of chemoradiation. The integrated BEV administered dose-week (AUCBEV) for all patients had a median AUCBEV of 3.6 mg·wk/kg). Maximum likelihood analysis found patients over 65 years did worse than younger patients (p = 0.004), women lived longer (p = 0.002), and patients treated below the AUCBEV did better than those treated above the median AUCBEV (p = 0.003). mOS for BEV starting 1 month after chemoradiation was 45 versus 68 weeks (p = 0.012) and BEV starting 3 months after chemoradiation was 40 versus 74 weeks (p = 0.0085). Dosing BEV at half the standard dose for progressive/recurrent GBM was at least equivalent to or, maybe better than standard dosing. Unexplained was the observation that females had longer OS with BEV than males. PMID:25575937

  12. UNIVERSIDAD POLITCNICA DE MADRID Facultad de Informtica

    E-print Network

    Fernandez, Thomas

    ellos. En el caso de esta tesis, se utilizará PRODIGY4.0 como planificador base y HAMLET como método de de otros sistemas de aprendizaje (éste es realmente el sistema multi-estrategia EVOCK-HAMLET). En

  13. Deslizamientos, flujos de escombrera y desastres geolgicos similares provenientes de volcanes

    E-print Network

    suelos ya saturados con agua. Usualmente los flujos de escombrera comienzan como pequeñós deslizamientos de suelo que luego se lucúan y aceleran a veloci- dades tan rapidas como 56 km (35 millas) por hora

  14. ltima modificacin: 29-04-2014 11673 -TELFIB -Telecomunicacin por Fibra ptica

    E-print Network

    Politècnica de Catalunya, Universitat

    de los componentes de las redes de transporte ópticas, así como su realización. También estudiarán submarinos, así como las arquitecturas de redes ópticas más relevantes: acceso, área metropolitana (MAN previas Comunicaciones ópticas. Sistemas de Telecomunicaciones. Requisitos #12;Última modificación: 29

  15. MANIFIESTO DE LA RED DE UNIDADES DE IGUALDAD DE GNERO DE LAS UNIVERSIDADES ESPAOLAS PARA LA EXCELENCIA

    E-print Network

    acoso sexual, el acoso por razón de sexo, la trata de mujeres y niñas. La Universidad, como cualquier, como el acoso sexual o el acoso por razón de sexo, formas de violencia hacia las mujeres que #12;causan

  16. 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.

  17. 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).

  18. La nación en escena: Notas sobre el nacionalismo teatral en la historiografía uruguaya del teatro

    E-print Network

    Mandressi, Rafael

    1996-04-01

    . Para avanzar en este terreno, una definición de nación debería ser proporcionada. Pero no es el caso, y ello no se debe tanto a una negligencia metodológica como a la aplicación de un sobreentendido que consiste en considerar esa definición como un..., ese país que según el lingüista Horacio de Marsilio debe ser considerado como un caso de bilingüismo,3 al que Hugo Achugar caracteriza como de "débil homogeneidad" o "relativa heterogeneidad" cultural, es jibarizado por la historiografía del teatro...

  19. 351ENSEANZA DE LAS CIENCIAS, 2001, 19 (3), INVESTIGACIN

    E-print Network

    Campanario, Juan Miguel

    COMO TÚ O UN ALUMNO COMO EL TUYO CON UN LIBRO DE TEXTO COMO ÉSTE? UNA RELACIÓN DE ACTIVIDADES POCO realizarse utilizando los libros de texto de ciencias habi- tuales. Con estas actividades y tareas se intenta profundidad de la información de los libros de textos por parte de los alumnos o que éstos aprendan sobre sus

  20. AGRICULTURE AND NATURAL RESOURCES

    E-print Network

    Minnesota, University of

    applied to Como Zoo for a summer internship working with primates and spent her days taking care for the internship with the Como Zoo," Griffin shares. "I am hoping to apply for a second internship for summer 2014 first summer as a volunteer at the zoo. Griffin completed an internship at the Como zoo in st. Paul

  1. Questioning the claims from Kaiser

    PubMed Central

    Talbot-Smith, Alison; Gnani, Shamini; Pollock, Allyson M; Gray, Denis Pereira

    2004-01-01

    Background: The article by Feachem et al, published in the BMJ in 2002, claimed to show that, compared with the United Kingdom (UK) National Health Service (NHS), the Kaiser Permanente healthcare system in the United States (US) has similar healthcare costs per capita, and performance that is considerably better in certain respects. Aim: To assess the accuracy of Feachem et al's comparison and conclusions. Method: Detailed re-examination of the data and methods used and consideration of the 82 letters responding to the article. Results: Analyses revealed four main areas in which Feachem et al's methodology was flawed. Firstly, the populations of patients served by Kaiser Permanente and by the NHS are fundamentally different. Kaiser's patients are mainly employed, significantly younger, and significantly less socially deprived and so are healthier. Feachem et al fail to adjust adequately for these factors. Secondly, Feachem et al have wrongly inflated NHS costs by omitting substantial user charges payable by Kaiser members for care, excluding the costs of marketing and administration, and deducting the surplus from Kaiser's costs while underestimating the capital charge element of the NHS budget and other costs. They also used two methods of converting currency, the currency rate and a health purchasing power parity conversion. This is double counting. Feachem et al reported that NHS costs were 10% less per head than Kaiser. Correcting for the double currency conversion gives the NHS a 40% cost advantage such that per capita costs are $1161 and $1951 for the NHS and Kaiser, respectively. Thirdly, Feachem et al use non-standardised data for NHS bed days from the Organisation for Economic Cooperation and Development, rather than official Department of Health bed availability and activity statistics for England. Leaving aside the non-comparability of the population and lack of standardisation of the data, the result is to inflate NHS acute bed use and underestimate the efficiency of performance by at least 10%. Similar criticisms apply to their selective use of performance measures. Finally, Feachem et al claim that Kaiser is a more integrated system than the NHS. The NHS provides health care to around 60 million people free at the point of delivery, long-term and psychiatric care, and continuing care after 100 days whereas Kaiser provides care to 6 million people, mainly employed and privately insured. Important functions, such as health protection, education and training of healthcare professionals, and research and development are not included or properly costed in Feachem et al's integrated model. Conclusion: We have re-examined the statements made by Feachem et al and show that the claims are unsupported by the evidence. The NHS is not similar to Kaiser in coverage, costs or performance. PMID:15186560

  2. Incidence of Herpes Zoster Ophthalmicus: Results from the Pacific Ocular Inflammation Study

    PubMed Central

    Borkar, Durga S.; Tham, Vivien M.; Esterberg, Elizabeth; Ray, Kathryn J.; Vinoya, Aleli C.; Parker, John V.; Uchida, Aileen; Acharya, Nisha R.

    2012-01-01

    Purpose To provide a population-based estimate of the incidence of herpes zoster ophthalmicus (HZO) with comparisons across racial, gender, and age groups, as well as to estimate the frequency of postherpetic neuralgia (PHN). Design Retrospective, population-based cohort study Participants All patients enrolled in the Kaiser Permanente Hawaii health plan during the study period (N=217,061). Methods All patient encounters between January 1, 2006 and December 31, 2007 in the electronic medical record of Kaiser Permanente Hawaii were queried for International Classification of Diseases, 9th Edition (ICD9) codes corresponding to HZO. Charts were reviewed to confirm a diagnosis of HZO and to collect information on specific ocular manifestations. Demographic data and information on PHN were collected electronically. Incidence rates were calculated per 100,000 person-years for the entire population, as well as for age-, gender-, and race-specific subgroups. Main Outcome Measure Clinical diagnosis of HZO during the study period. Results One hundred thirty-four cases of HZO were identified in this population of 217,061 people. The overall incidence was 30.9 per 100,000 person-years (95% confidence interval (CI): 25.9–36.6). The incidence rate for the population 65 years of age and over was 104.6 per 100,000 person-years (95% CI: 79.0–135.9), approximately five times the remainder of the population (p<0.001). The most common manifestation of HZO was dermatitis, followed by keratitis and conjunctivitis. The incidence of HZO for Pacific Islanders was 19.0 per 100,000 person-years (95% CI: 12.4– 28.3), which was significantly lower than the rate for non-Pacific Islanders (p=0.007). Twenty-one percent of HZO patients developed PHN. Older age and HZO with keratitis, conjunctivitis, and/or uveitis were found to be risk factors for PHN. Conclusions This study provides a population-based estimate of HZO and highlights differences across various age and racial groups. It also suggests that demographic characteristics may be useful in determining the risk of developing HZO. PMID:23207173

  3. 2009 Annual National Patient Safety Foundation Congress: conference proceedings.

    PubMed

    Bonacum, Doug; Corrigan, Janet; Gelinas, Lillee; Pinakiewicz, Diane C; Stepnick, Larry

    2009-09-01

    On May 20 to 22, 2009, the National Patient Safety Foundation (NPSF) held its Annual NPSF Patient Safety Congress in National Harbor, Md. Entitled Patient Safety in Challenging Times: Now More Than Ever, A Critical Need, the meeting focused on the need to strengthen efforts to improve patient safety and quality in the midst of the extraordinary economic challenges facing the nation. The Congress was cochaired by the following distinguished individuals: Janet Corrigan, PhD, MBA, president and chief executive officer, National Quality Forum, Lillee Gelinas, RN, MSN, FAAN, vice president and chief nursing officer, VHA, Inc., Doug Bonacum, MBA, BS, vice president for safety management, Kaiser Permanente, and a member of the Board of Directors of NPSF. The main conference was preceded by 3 concurrent day-long workshops: Leadership Day, Patient Safety 101, and Community Engagement from the Patient and Family Perspective. The Congress featured 4 plenary sessions and 35 breakout sessions. This article provides summaries of the plenary sessions. PMID:19938320

  4. Reassurance Against Future Risk of Precancer and Cancer Conferred by a Negative Human Papillomavirus Test

    PubMed Central

    Schiffman, Mark; Katki, Hormuzd A.; Castle, Philip E.; Fetterman, Barbara; Wentzensen, Nicolas; Poitras, Nancy E.; Lorey, Thomas; Cheung, Li C.; Kinney, Walter K.

    2014-01-01

    Primary human papillomavirus (HPV) testing (without concurrent Pap tests) every 3 years is under consideration in the United States as an alternative to the two recommended cervical cancer screening strategies: primary Pap testing every 3 years, or concurrent Pap and HPV testing (“cotesting”) every 5 years. Using logistic regression and Weibull survival models, we estimated and compared risks of cancer and cervical intraepithelial neoplasia grade 3 or worse (CIN3+) for the three strategies among 1011092 women aged 30 to 64 years testing HPV-negative and/or Pap-negative in routine screening at Kaiser Permanente Northern California since 2003. All statistical tests were two sided. Three-year risks following an HPV-negative result were lower than 3-year risks following a Pap-negative result (CIN3+ = 0.069% vs 0.19%, P < .0001; Cancer = 0.011% vs 0.020%, P < .0001) and 5-year risks following an HPV-negative/Pap-negative cotest (CIN3+ = 0.069% vs 0.11%, P < .0001; Cancer = 0.011% vs 0.014%, P = .21). These findings suggest that primary HPV testing merits consideration as another alternative for cervical screening. PMID:25038467

  5. Increasing Body Mass Index Is Inversely Related to Groin Hernias.

    PubMed

    Ravanbakhsh, Samine; Batech, Michael; Tejirian, Talar

    2015-10-01

    Few studies describe the relationship between obesity and groin hernias. Our objective was to investigate the correlation between body mass index (BMI) and groin hernias in a large population. Patients with the diagnosis of inguinal or femoral hernia with and without incarceration or strangulation were identified using the Kaiser Permanente Southern California regional database including 14 hospitals over a 7-year period. Patients were stratified by BMI. There were 47,950 patients with a diagnosis of a groin hernia-a prevalence of 2.28 per cent. Relative to normal BMI (20-24.9 kg/m(2)), lower BMI was associated with an increased risk for hernia diagnosis. With increasing BMI, the risk of incarceration or strangulation increased. Additionally, increasing age, male gender, white race, history of hernia, tobacco use history, alcohol use, and higher comorbidity index increased the chance of a groin hernia diagnosis. Complications were higher for women, patients with comorbidities, black race, and alcohol users. Our study is the largest to date correlating obesity and groin hernias in a diverse United States population. Obesity (BMI ? 30 kg/m(2)) is associated with a lower risk of groin hernia diagnosis, but an increased risk of complications. This inverse relationship may be due to limitations of physical exam in obese patients. PMID:26463305

  6. Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization.

    PubMed

    Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K

    2013-01-01

    The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described. PMID:23324507

  7. 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.

  8. Hospital Medicine's Evolution: Literature Search and Interview Study with Practices

    PubMed Central

    Greenwald, Ruth; Novelli, Marianne; Lorence, Tom

    2011-01-01

    Introduction: Hospital medicine is a young specialty that is still evolving. In its early years, research focused on clinical outcomes, efficiency, and cost effectiveness. As the specialty matures, increasing attention is being given to the patient and hospitalist experience with the hospitalist model of care. Methods: In 2008, we conducted a literature search to identify patients' and hospitalists' satisfaction concerns and potential strategies for their resolution. We used our findings to develop a semistructured interview guide as a basis for a wide-ranging discussion with Kaiser Permanente (KP) hospitalists and physician leaders and KP and non-KP subject-matter experts on their priorities, concerns, and successful practices. Results: Respondents identified sustainability and communications in coordinating care as their high-priority concerns with sustainability as the top priority. Within these broad concerns, they identified contributing factors and their interrelationships. Factors influencing sustainability of the hospitalist model include hospitalist scheduling, workload, comanagement responsibilities, and recruitment and retention. Regarding communications in coordinating care, respondents viewed themselves as being in the center of a web involving communication with patients, physicians in other services, nurses, and other hospitalists. Conclusion: Promising approaches have been developed to address sustainability concerns and for communicating with patients, physicians in other services, nurses, and other hospitalists. However, getting reliable feedback on patient satisfaction surveys for individual hospitalists is a continuing challenge. Despite the use of brochures and business cards to introduce themselves to patients and explain their role, there are difficulties in establishing a hospitalist-patient bond. PMID:22058670

  9. 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

  10. Recent exact and asymptotic results for products of independent random matrices

    E-print Network

    Gernot Akemann; Jesper R. Ipsen

    2015-02-16

    In this review we summarise recent results for the complex eigenvalues and singular values of finite products of finite size random matrices, their correlation functions and asymptotic limits. The matrices in the product are taken from ensembles of independent real, complex, or quaternionic Ginibre matrices, or truncated unitary matrices. Additional mixing within one ensemble between matrices and their inverses is also covered. Exact determinantal and Pfaffian expressions are given in terms of the respective kernels of orthogonal polynomials or functions. Here we list all known cases and some straightforward generalisations. The asymptotic results for large matrix size include new microscopic universality classes at the origin and a generalisation of weak non-unitarity close to the unit circle. So far in all other parts of the spectrum the known standard universality classes have been identified. In the limit of infinite products the Lyapunov and stability exponents share the same normal distribution. To leading order they both follow a permanental point processes. Our focus is on presenting recent developments in this rapidly evolving area of research.

  11. 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

  12. A nursing information model process for interoperability.

    PubMed

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

  13. Practices participating in a dental PBRN have substantial and advantageous diversity even though as a group they have much in common with dentists at large

    PubMed Central

    Makhija, Sonia K; Gilbert, Gregg H; Rindal, D Brad; Benjamin, Paul; Richman, Joshua S; Pihlstrom, Daniel J; Qvist, Vibeke

    2009-01-01

    Background Practice-based research networks offer important opportunities to move recent advances into routine clinical practice. If their findings are not only generalizable to dental practices at large, but can also elucidate how practice characteristics are related to treatment outcome, their importance is even further elevated. Our objective was to determine whether we met a key objective for The Dental Practice-Based Research Network (DPBRN): to recruit a diverse range of practitioner-investigators interested in doing DPBRN studies. Methods DPBRN participants completed an enrollment questionnaire about their practices and themselves. To date, more than 1100 practitioners from the five participating regions have completed the questionnaire. The regions consist of: Alabama/Mississippi, Florida/Georgia, Minnesota, Permanente Dental Associates, and Scandinavia (Denmark, Norway, and Sweden). We tested the hypothesis that there are statistically significant differences in key characteristics among DPBRN practices, based on responses from dentists who participated in DPBRN's first network-wide study (n = 546). Results There were statistically significant, substantive regional differences among DPBRN-participating dentists, their practices, and their patient populations. Conclusion Although as a group, participants have much in common with practices at large; their substantial diversity offers important advantages, such as being able to evaluate how practice differences may affect treatment outcomes, while simultaneously offering generalizability to dentists at large. This should help foster knowledge transfer in both the research-to-practice and practice-to-research directions. PMID:19832991

  14. 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

  15. 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

  16. 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], 1.28–10.40 and OR, 4.24; 95% CI, 1.16–15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43–5.14), 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

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

    PubMed

    Frankel, Meir; Chinitz, David; Salzberg, Claudia A; Reichman, Katriel

    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. 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

  19. Traumatismes Oculaires par Petards: Bilan sur Trois Annees

    PubMed Central

    Zouaoui-Kesraoui, N.; Derdour, A.

    2009-01-01

    Summary Les accidents dus aux pétards sont des accidents graves. Leur recrudescence ces dernières années en Algérie, essentiellement durant les fêtes du Mawlid Ennabaoui (fête de la naissance du prophète), mérite à notre sens d'entreprendre des bilans exhaustifs dont celui-ci dans le but d'une sensibilisation de toutes les compétences concernées. Nous avons réuni sur trois années consécutives (2002, 2003, 2004) 60 dossiers de malades ayant subi des accidents oculaires par pétards. Nos patients sont répartis en 42 consultations pour blessures légères et 18 hospitalisations pour blessures graves. Parmi ces derniers, neuf ont présenté des complications et séquelles graves (cinq cas de cécité par atrophie du globe oculaire, trois cas de cécité cornéenne et un cas de cécité par trou maculaire). Dans tous ces cas l'incapacité permanente partielle est au minimum de 30%. Au vu de ces données nous proposons des mesures d'éducation sanitaire et une sensibilisation du grand public aux traumatismes oculaires, par le biais de mé dias appropriés: radio, télévision, affiches. PMID:21991157

  20. 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

  1. 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.

  2. 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

  3. 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

  4. The Case for Unit-Based Teams: A Model for Front-line Engagement and Performance Improvement

    PubMed Central

    Cohen, Paul M; Ptaskiewicz, Mark; Mipos, Debra

    2010-01-01

    Unit-based teams (UBTs)—defined as natural work groups of physicians, managers, and frontline staff who work collaboratively to solve problems, improve performance, and enhance quality—were established by the 2005 national agreement between Kaiser Permanente (KP) and the Coalition of KP Unions. They use established performance-improvement techniques and employee-engagement principles (including social-movement theory) to achieve clinical and operational goals. UBT members identify performance gaps and opportunities within their purview—issues they can address in the course of the day-to-day work, such as workflow or process improvement. By focusing on clear, agreed-on goals, UBTs encourage greater accountability and allow members to perform their full scope of work. UBTs are designed to deliver measurable benefits in clinical outcomes and operations, patient-experience enhancements, and physician-team performance or work life. For many physicians, UBTs will require new ways of engaging with their teams. However, evidence suggests that with organizational and physician support, these teams can achieve their goals. This article presents case examples of successful UBTs' outcomes; physicians' comments on their experience working with teams; an overview of UBTs' employee-engagement principles; and advice on how physicians can support and participate in the work of such teams. PMID:20740124

  5. Prepregnancy cardiometabolic and inflammatory risk factors and subsequent risk of hypertensive disorders of pregnancy

    PubMed Central

    Hedderson, Monique M.; Darbinian, Jeanne A.; Sridhar, Sneha B.; Quesenberry, Charles P.

    2012-01-01

    Objective To examine prepregnancy cardiometabolic and inflammatory markers and subsequent risk of hypertensive disorders of pregnancy. Study Design A retrospective cohort study of 3,380 women who took part in a comprehensive multiphasic health checkup (MHC) exam between 1984 and 1996 and had a subsequent delivery in Kaiser Permanente Northern California. Results 205 women were diagnosed with a hypertensive disorder of pregnancy. Prepregnancy measurements of overweight/obesity (BMI ? 25.0 kg/m2), pre-hypertension and inflammation (leukocytes ? 7.2 103/µL) were independently associated with hypertensive disorder of pregnancy risk [odds ratios (95% confidence intervals): 1.6 (1.2–2.3), 2.1(1.5–2.8) and 1.6 (1.1–2.3), respectively]. Being overweight/obese and having pre-hypertension before pregnancy was associated with a 3.5-fold increased risk of hypertensive disorder of pregnancy compared with women with normal levels of both risk factors. Conclusion Prepregnancy cardiometabolic and inflammation risk profile may help clinicians identify high risk women to target for early intervention or management of hypertensive disorder of pregnancy. PMID:22727352

  6. 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

  7. Comparison of Interviewer-Administered and Automated Self-Administered 24-Hour Dietary Recalls in 3 Diverse Integrated Health Systems.

    PubMed

    Thompson, Frances E; Dixit-Joshi, Sujata; Potischman, Nancy; Dodd, Kevin W; Kirkpatrick, Sharon I; Kushi, Lawrence H; Alexander, Gwen L; Coleman, Laura A; Zimmerman, Thea P; Sundaram, Maria E; Clancy, Heather A; Groesbeck, Michelle; Douglass, Deirdre; George, Stephanie M; Schap, TusaRebecca E; Subar, Amy F

    2015-06-15

    Twenty-four-hour dietary recalls provide high-quality intake data but have been prohibitively expensive for large epidemiologic studies. This study's goal was to assess whether the web-based Automated Self-Administered 24-Hour Recall (ASA24) performs similarly enough to the standard interviewer-administered, Automated Multiple-Pass Method (AMPM) 24-hour dietary recall to be considered a viable alternative. In 2010-2011, 1,081 adults from 3 integrated health systems in Detroit, Michigan; Marshfield, Wisconsin; and Kaiser-Permanente Northern California participated in a field trial. A quota design ensured a diverse sample by sex, age, and race/ethnicity. Each participant was asked to complete 2 recalls and was randomly assigned to 1 of 4 protocols differing by type of recall and administration order. For energy, the mean intakes were 2,425 versus 2,374 kcal for men and 1,876 versus 1,906 kcal for women by AMPM and ASA24, respectively. Of 20 nutrients/food groups analyzed and controlling for false discovery rate, 87% were judged equivalent at the 20% bound. ASA24 was preferred over AMPM by 70% of the respondents. Attrition was lower in the ASA24/AMPM study group than in the AMPM/ASA24 group, and it was lower in the ASA24/ASA24 group than in the AMPM/AMPM group. ASA24 offers the potential to collect high-quality dietary intake information at low cost with less attrition. PMID:25964261

  8. Wet deposition of mercury within the vicinity of a cement plant before and during cement plant maintenance

    NASA Astrophysics Data System (ADS)

    Rothenberg, Sarah E.; McKee, Lester; Gilbreath, Alicia; Yee, Donald; Connor, Mike; Fu, Xuewu

    2010-03-01

    Hg species (total mercury, methylmercury, reactive mercury) in precipitation were investigated in the vicinity of the Lehigh Hanson Permanente Cement Plant in the San Francisco Bay Area, CA., USA. Precipitation was collected weekly between November 29, 2007 and March 20, 2008, which included the period in February and March 2008 when cement production was minimized during annual plant maintenance. When the cement plant was operational, the volume weighted mean (VWM) and wet depositional flux for total Hg (Hg T) were 6.7 and 5.8 times higher, respectively, compared to a control site located 3.5 km east of the cement plant. In February and March, when cement plant operations were minimized, levels were approximately equal at both sites (the ratio for both parameters was 1.1). Due to the close proximity between the two sites, meteorological conditions (e.g., precipitation levels, wind direction) were similar, and therefore higher VWM Hg T levels and Hg T deposition likely reflected increased Hg emissions from the cement plant. Methylmercury (MeHg) and reactive Hg (Hg(II)) were also measured; compared to the control site, the VWM for MeHg was lower at the cement plant (the ratio = 0.75) and the VWM for Hg(II) was slightly higher (ratio = 1.2), which indicated the cement plant was not likely a significant source of these Hg species to the watershed.

  9. Behavioral health consultation and primary care: lessons learned.

    PubMed

    Robinson, Patricia J; Strosahl, Kirk D

    2009-03-01

    This article provides an overview of 20 years of professional experiences with developing and implementing a model for integrating behavioral health services into primary care. The Primary Care Behavioral Health (PCBH) model is designed to provide immediate access to behavioral care for a large number of primary care patients by positioning a behavioral health consultant in the exam room area to function as a core member of the primary care team. In an initial era of discovery, the authors were directly involved in developing and testing a variety of new approaches to providing behavioral health services in general medicine. In a second era focused on feasibility, the authors worked with Kaiser Permanente, the United States Air Force and Navy, the Veteran's Administration, and the Bureau of Primary Care to system test this innovative model of integrated care. Now in an era devoted to dissemination, the authors review the various roles formal research, system level quality improvement initiatives and stakeholder analysis play in promoting integrated care. The authors also describe current efforts to (1) create a tool that helps systems develop integration targets and (2) use the PCBH model as a platform for teaching medical residents and behavioral health providers to work together in a redesigned primary care team model. PMID:19184376

  10. Prevalence of Childhood and Adolescent Overweight and Obesity from 2003 to 2010 in an Integrated Health Care Delivery System

    PubMed Central

    Gee, Scott; Ackerson, Lynn; Woo, Dewey; Howell, Amanda

    2013-01-01

    An observational study of the Kaiser Permanente Northern California (KPNC) BMI coding distributions was conducted to ascertain the trends in overweight and obesity prevalence among KPNC members aged 2–19 between the periods of 2003–2005 and 2009-2010. A decrease in the prevalence of overweight (?11.1% change) and obesity (?3.6% change) and an increase in the prevalence of healthy weight (+2.7% change) were demonstrated. Children aged 2–5 had the greatest improvement in obesity prevalence (?11.5% change). Adolescents aged 12–19 were the only age group to not show a decrease in obesity prevalence. Of the racial and ethnic groups, Hispanics/Latinos had the highest prevalence of obesity across all age groups. The KPNC prevalence of overweight and obesity compares favorably to external benchmarks, although differences in methodologies limit our ability to draw conclusions. Physician counseling as well as weight management programs and sociodemographic factors may have contributed to the overall improvements in BMI in the KPNC population. Physician training, practice tools, automated BMI reminders and performance feedback improved the frequency and quality of physician counseling. BMI screening and counseling at urgent visits, in addition to well-child care visits, increased the reach and dose of physician counseling. PMID:23970960

  11. Immunization and Bell's palsy in children: a case-centered analysis.

    PubMed

    Rowhani-Rahbar, Ali; Klein, Nicola P; Lewis, Ned; Fireman, Bruce; Ray, Paula; Rasgon, Barry; Black, Steven; Klein, Jerome O; Baxter, Roger

    2012-05-01

    Bell's palsy (BP) is an acute and idiopathic paralysis of the facial nerve, with an estimated incidence ranging from 11.5 per 100,000 person-years to 53.3 per 100,000 person-years in different populations. BP has been reported following immunization with inactivated trivalent influenza vaccine (TIV) and hepatitis B virus (HBV) vaccine. Epidemiologic studies examining this association among children are lacking. From 2001 through 2006, all children aged ?18 years diagnosed with BP within the Kaiser Permanente Northern California population were identified using International Classification of Diseases, Ninth Revision, code 351.0. All electronically identified cases were reviewed and adjudicated by an otolaryngologist (n = 233). Using a case-centered approach, the authors examined the risk of BP during 3 risk intervals. Immunization with TIV (odds ratio (OR) = 0.7, 95% confidence interval (CI): 0.2, 2.8), HBV vaccine (OR = 0.8, 95% CI: 0.2, 2.4), or any vaccine (treating all vaccines combined; OR = 0.9, 95% CI: 0.6, 1.4) was not associated with increased risk of BP 1-28 days after immunization. Similarly, no association was found between vaccines and BP during the periods 1-14 and 29-56 days following immunization. Results of this study suggest that there is no association between immunization and BP in children. PMID:22411861

  12. Rapid assessment of influenza vaccination coverage among HMO members--northern California influenza seasons, 2001-02 through 2004-05.

    PubMed

    2005-07-15

    The Vaccine Safety Datalink (VSD) is a collaborative project involving CDC and eight health maintenance organizations (HMOs) in the United States. Computerized data on vaccination, medical outcomes, and patient demographics are collected and linked under a standard protocol at multiple HMOs. Beginning with the 2003-04 influenza season, the VSD team and one of the HMOs, Kaiser Permanente Northern California (KPNC), established an automated system for rapid detection of potentially adverse events after vaccinations among its members. During the 2004-05 influenza season, in response to the influenza vaccine shortfall and resulting prioritization of vaccine distribution, this rapid analysis system also was used to assess influenza vaccination coverage weekly among KPNC members. The results indicated that KPNC followed Advisory Committee on Immunization Practices (ACIP) prioritization guidelines by targeting influenza vaccination to children aged 6-23 months and adults aged >/=65 years. For the 2005-06 influenza season, the rapid analysis system should be expanded to include data from additional HMOs and more detailed information on vaccinees (e.g., high risk for influenza complications) to better characterize influenza vaccination coverage during the 2005-06 influenza season on a weekly basis. PMID:16015219

  13. 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. KP’s 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

  14. Good Sources of Nutrients: Vitamin A 

    E-print Network

    Scott, Amanda; Replogle, Jacqueline

    2008-08-28

    A for your health May help prevent: Night blindness? Upper respiratory infections? Certain types of cancer? Where is vitamin A found? Vitamin A is a nutrient found in a variety of animal and plant foods. Here are some examples of vitamin A rich... preparados para desayuno, fortalecidos? Cereales cocidos tal como la avena, fortalecidos? Grupo de verduras Hortalizas de color amarillo, naranja y rojo oscuros, ? tales como zanahorias, camotes y pimentones Verduras de color verde oscuro tales como...

  15. UNIVERSIDAD DE SANTIAGO DE CHILE FACULTAD DE CIENCIA

    E-print Network

    construcciones geométricas, así como también la discusión reflexiva sobre las particularidades de las propiedades deberán contar con regla, compás y transportador para realizar las construcciones geométricas. #12

  16. Tumores de hipófisis—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del tumor de hipófisis, así como referencias a estudios clínicos, investigación y otros temas relacionados.

  17. Festival Report: Otra vez el Festival de las Américas en Montreal

    E-print Network

    de Toro, Fernando

    1988-10-01

    materia al teatro, pero no el teatro como medio para aquélla. Estas tres obras, y lo mismo podríamos decir de Off Off Off de Alberto Kurapel, o de Las dos Fridas del grupo mexicano, es el juego teatral, el teatro como arte, como trabajo, como textura... político, y su devastador efecto en el público procede no del contenido, del mensaje de ese discurso, sino de cómo ese mensaje está vehiculado: es arte, ludicidad, teatralidad constante, integración de la palabra y el gesto: el juego en el sentido de la...

  18. Complicaciones gastrointestinales (PDQ)—Versión para pacientes

    Cancer.gov

    Resumen de información revisada por expertos acerca del estreñimiento, impacción, obstrucción intestinal y diarrea como complicaciones del cáncer o su tratamiento. Se discute el manejo de estos problemas.

  19. ECOLOGA APLICADA Y CAMBIO Grado en Biologa

    E-print Network

    Rey Benayas, José María

    cambios que las actividades humanas producen en los ecosistemas así como de las herramientas principales Módulo I: Biodiversidad, servicios ecosistémicos y huella ecológica: - Biodiversidad, ecosistemas y

  20. Linfoma—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento del linfoma, así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados con este tipo de cáncer.

  1. 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.

  2. 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.

  3. ARTIGO INTERNET Equipa do IST sugere nova forma de matria escura

    E-print Network

    Instituto de Sistemas e Robotica

    teoria de Einstein, é algo que preocupa os cientistas desde há muito tempo. Agora, uma nova teoria da gravitação conseguiu reproduzir as previsões de Einstein, evitando ao mesmo tempo singularidades como o Big Bang ou como as no interior de buracos negros. Num artigo a ser publicado na prestigiada «Physical

  4. D.G. SCOTT HUBBARD D.G. Scott Hubbard es el Director del Centro de Investigacin de NASA

    E-print Network

    Cardeñosa, Jesús

    D.G. SCOTT HUBBARD D.G. Scott Hubbard es el Director del Centro de Investigación de NASA Ames en Investigación NASA. Previamente a su nombramiento como Director de Ames, fue Vice- Director de Investigación en NASA Ames. Sirvió recientemente como único representante de NASA en la Comisión de Investigación del

  5. Jos M. Mndez A. Departamento de Fsica, CINVESTAV-IPN.

    E-print Network

    Méndez Alcaraz, José Miguel

    físicos más importantes del siglo XIX, Thomas Young y Hermann von Helmholtz, iniciaran sus carreras como de la física son el enunciado de la conservación de la energía por Robert Meyer y Hermann von Helmholtz, así como la teoría del movimiento browniano de Einstein. Meyer observó que la sangre de los

  6. Adaptac~ao ao Contexto em Sistemas de Comunicac~ao Heterogeneos

    E-print Network

    Rodrigues, Luís E.T.

    . Considerem-se por exemplo aplicac¸ ~oes cooperativas multi-utilizador tais como os jogos em rede ou aplicac¸~oes cooperativas multi-utilizador (tais como os jogos on-line). Embora a maioria das concretizac¸~oes actuais destes jogos se baseiem em arquitecturas cliente-servidor, foram j´a de- Este trabalho foi

  7. 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…

  8. Politecnico di Milano Facolt`a di Ingegneria dell'Informazione

    E-print Network

    Di Caro, Gianni

    Politecnico di Milano Facolt`a di Ingegneria dell'Informazione POLO REGIONALE DI COMO Corso di di percorsi per il movimento di oggetti a terra Relatore: Prof. Marco Colombetti Correlatori: Prof;#12;Politecnico di Milano Facolt`a di Ingegneria dell'Informazione POLO REGIONALE DI COMO Master of Science

  9. Superficies y Vaco 15, 9-12, diciembre de 2002 Sociedad Mexicana de Ciencia de Superficies y de Vaco Estudio de pelculas delgadas de Cd1-x Znx Te, para 0

    E-print Network

    Meléndez Lira, Miguel Angel

    libre (CSVT-FE, por sus siglas en ingles) usando la coevaporación de CdTe y ZnTe. La incorporación del, tales como Epitaxia de haces moleculares (MBE, por sus siglas en ingles) [5], y deposito químico de metalorgánicos al vacío (MOCVD, por sus siglas en ingles) [6]. Utilizando técnicas baratas, tales como transporte

  10. 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.

  11. http://www.rsef.org REF Diciembre 2006 1. Introduccin

    E-print Network

    Rey Juan Carlos, Universidad

    la mecáni- ca estadística se encuentran notables físicos como Ludwig Boltzmann (1844-1906), James Clerk Maxwell (1831-1879) y Josiah Willard Gibbs (1839-1903). A Boltzmann y a Gibbs se les considera aproximación de los llamados colectivos (microcanónico, canónico y gran canónico) y a Boltzmann como precursor

  12. Livestock as Ecosystem Engineers for Grassland Bird Habitat in the Western Great Plains of North America

    E-print Network

    Stapp, Paul

    ingeniero de los ecosistemas en los pastizales semia´ridos, pero las practicas de manejo que existen ganado como ingeniero de ecosistemas y en los beneficios y las consecuencias de la heterogeneidad basada heterogeneidad. El utilizar ganado como ingeniero de los ecosistemas para alterar la estructura de la vegetacio

  13. AARRTTCCUULLOO Las forestaciones rioplatenses

    E-print Network

    Nacional de San Luis, Universidad

    los ecosistemas brin- dan, tales como la provisión de agua potable o la regulación hidrológica de compromisos con servicios esenciales que los ecosistemas brindan, tales como la provisión de agua potable o la revisan las consecuencias de este tipo de transformaciones sobre la dinámica del agua en los ecosistemas y

  14. 1. Perspectiva Histrica As primeiras tentativas de

    E-print Network

    Neto, Gastão Bierrenbach Lima

    .1 Thomas Wright e Kant · 1.2 William Herschel · 1.3 Pierre Laplace · 1.4 Lorde Rosse · 1.5 William Huggins Wright Via Láctea como um disco I. Kant Universos ilhas como discos achatados W. Herschel Morfologia dosLeonard Euler Lavoisier W. Herschel Modelo da Galáxia a partir de contagens de estrelas Newton #12;Tópicos · 1

  15. 74 Fisheries vol 36 no 2 february 2011 www.fisheries.org ABSTRACT: The aquarium trade moves thousands of species around the

    E-print Network

    Olden, Julian D.

    pathway in the Pacific Northwest Tratado de Comercio en Acuarios como una vía de invasión en el Pacífico noroeste RESUMEN:El Tratado de Comercio en Acuarios mueve miles de especies en todo el mundo y organismos presente contribución se reporta la primera investigación sobre el tratado de especies ornamentales como

  16. Introduo aos Sinais Pedro M. Q. Aguiar, Lus M. B. Almeida

    E-print Network

    Almeida, Luis B.

    de um sinal a |x(t)|2 (ou |x(n)|2 ). A energia total de um sinal é então denida como o integral (ou denições permitem classicar cada sinal como pertencendo a uma das seguintes classes: · Energia total nita, i.e., E Energia

  17. A PA C I F I C N O R T H W E S T E X T E N S I O N P U B L I C AT I O N P N W 3 9 5 S Recetas de salsa para

    E-print Network

    Tullos, Desiree

    alimentos con bajo nivel de ácido, como cebollas y pimientos, con alimentos ácidos, como tomates o fruta salsa Tomates para ensalada #12;3 Pimientos Elija pimientos de buena calidad. Los pimientos van de suaves a muy picantes en sabor. Los pimientos muy picantes generalmente son pequeños (1 a 3

  18. 2015, Proyecto de Opinin Pblica de Amrica Latina www.AmericasBarometer.org

    E-print Network

    unión civil. En años recientes, matrimonios entre personas del mismo sexo han sido reconocidos sexo. Por ejemplo, este año el Congreso peruano finalmente votó en contra de una ley de unión. Como consecuencia, las parejas del mismo sexo pueden registrar sus uniones en la Corte como uniones

  19. UNIVERSIDAD DE SANTIAGO DE CHILE. FACULTAD DE CIENCIA.

    E-print Network

    ACTITUDES EN EL ALUMNADO DE EDUCACIÓN MEDIA HACIA LA FISICA COMO CIENCIA, EN RELACIÓN AL SEXO Y NIVEL DE ALUMNADO DE EDUCACIÓN MEDIA HACIA LA FISICA COMO CIENCIA, EN RELACIÓN AL SEXO Y NIVEL DE ESCOLARIDAD. MARÍA POR SEXO Y GÉNERO?........................ 18 7.2.1. LA ESCUELA Y LA REPRODUCCION DE ESTEREOTIPOS

  20. 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

  1. Diego Campos, Construction Manager de Ferrovial Agroman en la recin creada Direccin de Energa, se desplaz a Dinamarca en

    E-print Network

    Greff, Isabelle

    eólico marino de Butendiek, a 32 kilómetros de la isla de Sylt, en el área alemana del Mar del Norte Dirección de Energía, han debido especializarse en diferentes áreas para afrontar proyectos como los del Mar del Nor- te, teniendo en cuenta factores como oleaje, viento, profundidad del mar, fauna marina, etc

  2. na universidade Faculdades abrem as portas, no Vero, aos alunos do secundrio para os ajudar

    E-print Network

    Instituto de Sistemas e Robotica

    ajudar a escolher o curso e viver uma semana como um estudante universitário. Como é ser médico? O que em pleno a vida académi- ca. Por vezes, mudam de ideias quando percebem que o curso não era bem incluir dormida, mas também exis- tem alguns gratuitos. Os pais procuram cada vez mais este tipo de

  3. La modulacin tonal en las formas musicales del Flamenco: propiedades de preferencia e hibridacin armnica

    E-print Network

    Díaz-Báñez, José Miguel

    Francisco J. Escobar Borrego Profesor Titular de Literatura Universidad de Sevilla Resumen: En este trabajo otras áreas de conocimiento tales como Historia, Antropología, Psicología, Sociología, Literatura o humanísticos como historia o la literatura, podemos decir que actualmente existe un gran interés en el mundo

  4. FINES DEL SERVICIO El Servicio de Publicaciones es una unidad administrativa y

    E-print Network

    Acacio, Manuel

    general para la promoción, producción y difusión del libro (BOE, 14/03/1975), en lo no dero- gado por la consignar en toda clase de libros y folletos el número ISBN, así como su actualización. · Orden de 25 de acceso a cualquier usua- rio. · Con rampa de carga/descarga, tanto para recepción de materiales como para

  5. PubMed

    Silva, Cristiane Gonçalves da; Santos, Alessandro Oliveira; Licciardi, Daniele Carli; Paiva, Vera; Parker, Richard

    2008-01-01

    Esse artigo descreve como jovens religiosos e autoridades religiosas de sua comunidade compreendem a sexualidade, considerando suas experiências pessoais e como membros de comunidades religiosas. A análise pretende contribuir para que políticas públicas dedicadas à promoção da saúde sexual da juventude considerem a religiosidade, no contexto de um estado laico e da promoção do direito à prevenção. Foram realizadas 26 entrevistas abertas e semidirigidas em diferentes comunidades da região metropolitana da cidade de São Paulo (comunidades católicas, da umbanda, do candomblé e de diferentes denominações evangélicas) sobre iniciação sexual, casamento, gravidez, contracepção e prevenção das DST/Aids, homossexualidade, aborto e direitos humanos. Observou-se como jovens e autoridades religiosas convivem com a tensão entre tradição e modernidade e os distintos discursos sobre a sexualidade. Como sujeitos religiosos (do discurso religioso) e sujeitos sexuais (de discursos sobre sexualidade), devem ser incorporados pelos programas como sujeitos de direito nos termos de sua religiosidade. PMID:21886456

  6. Religiosidade, juventude e sexualidade: entre a autonomia e a rigidez1

    PubMed Central

    Silva, Cristiane Gonçalves da; Santos, Alessandro Oliveira; Licciardi, Daniele Carli; Paiva, Vera; Parker, Richard

    2009-01-01

    Esse artigo descreve como jovens religiosos e autoridades religiosas de sua comunidade compreendem a sexualidade, considerando suas experiências pessoais e como membros de comunidades religiosas. A análise pretende contribuir para que políticas públicas dedicadas à promoção da saúde sexual da juventude considerem a religiosidade, no contexto de um estado laico e da promoção do direito à prevenção. Foram realizadas 26 entrevistas abertas e semidirigidas em diferentes comunidades da região metropolitana da cidade de São Paulo (comunidades católicas, da umbanda, do candomblé e de diferentes denominações evangélicas) sobre iniciação sexual, casamento, gravidez, contracepção e prevenção das DST/Aids, homossexualidade, aborto e direitos humanos. Observou-se como jovens e autoridades religiosas convivem com a tensão entre tradição e modernidade e os distintos discursos sobre a sexualidade. Como sujeitos religiosos (do discurso religioso) e sujeitos sexuais (de discursos sobre sexualidade), devem ser incorporados pelos programas como sujeitos de direito nos termos de sua religiosidade. PMID:21886456

  7. Age-stratified 5-year risks of cervical precancer among women with enrollment and newly detected HPV infection.

    PubMed

    Gage, Julia C; Katki, Hormuzd A; Schiffman, Mark; Fetterman, Barbara; Poitras, Nancy E; Lorey, Thomas; Cheung, Li C; Castle, Philip E; Kinney, Walter K

    2015-04-01

    It is unclear whether a woman's age influences her risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) upon detection of HPV. A large change in risk as women age would influence vaccination and screening policies. Among 972,029 women age 30-64 undergoing screening with Pap and HPV testing (Hybrid Capture 2, Qiagen, Germantown, MD) at Kaiser Permanente Northern California (KPNC), we calculated age-specific 5-year CIN3+ risks among women with HPV infections detected at enrollment, and among women with "newly detected" HPV infections at their second screening visit. Women (57,899, 6.0%) had an enrollment HPV infection. Among the women testing HPV negative at enrollment with a second screening visit, 16,724 (3.3%) had a newly detected HPV infection at their second visit. Both enrollment and newly detected HPV rates declined with age (p?

  8. 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 Commission’s 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 Angeles’s 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

  9. Complementary and Alternative Therapy Use Before and After Breast Cancer Diagnosis: The Pathways Study

    PubMed Central

    Greenlee, Heather; Kwan, Marilyn L.; Ergas, Isaac Joshua; Sherman, Karen J.; Krathwohl, Sarah E.; Bonnell, Christine; Lee, Marion M.; Kushi, Lawrence H.

    2010-01-01

    Background Many women use complementary and alternative medicine (CAM) to maintain or improve their health. We describe CAM use among the first 1,000 participants enrolled in the Pathways Study, an ongoing prospective cohort study of women diagnosed with breast cancer (BC). Methods Participants, identified by rapid case ascertainment in Kaiser Permanente Northern California, are women ?21 years diagnosed with first invasive BC. Comprehensive baseline data are collected on CAM use through in-person interviews. Results Study participants include 70.9% non-Hispanic whites, 10.2% Hispanics, 9.0% Asians, 6.5% African-Americans, and 3.4% others. Most women (82.2%) were diagnosed with AJCC stage I/II BC, at average (±SD) age 59.5 (±12.0) years and reported prior use of at least one form of CAM (96.5% of participants). In the five years before diagnosis, CAM therapies used at least weekly by >20% of women included green tea, glucosamine, omega-3 fatty acids, prayer and religion. CAM use was high (86.1% of participants) in the period immediately following diagnosis; 47.5% used botanical supplements, 47.2% used other natural products, 28.8% used special diets, 64.2% used mind-body healing, and 26.5% used body/energy/other treatments. In multivariable analyses, frequent use of each CAM modality before and after diagnosis was associated with use of other CAM modalities and other health behaviors (i.e., high fruit/vegetable intake, lower BMI). Conclusions CAM use before and after BC diagnosis is common in this diverse group of women. Our results emphasize the need for clinicians to discuss CAM use with all BC patients. PMID:19184414

  10. 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

  11. 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

  12. 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 2006–2011 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 1–19 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

  13. Risk Factors of Lymphedema in a Prospective Breast Cancer Survivorship Study: The Pathways Study

    PubMed Central

    Kwan, Marilyn L.; Darbinian, Jeanne; Schmitz, Kathryn H.; Citron, Rebecca; Partee, Paula; Kutner, Susan E.; Kushi, Lawrence H.

    2010-01-01

    Objective To determine the incidence of breast cancer-related lymphedema (BCRL) during the early survivorship period, and demographic, lifestyle, and clinical factors associated with BCRL development. Design The Pathways Study, a prospective cohort study of breast cancer survivors with a mean follow-up of 20.9 months. Setting Kaiser Permanente Northern California (KPNC) Medical Care Program. Participants 997 women diagnosed from January 2006 to October 2007 with primary invasive breast cancer and at least 21 years of age at diagnosis, had no prior history of any cancer, and spoke English, Spanish, or Chinese. Main Outcome Measures Clinical indication of BCRL as determined from outpatient or hospitalization diagnostic codes, outpatient procedural codes, and durable medical equipment orders. Results 133 women (13.3%) had a clinical indication of BCRL, with a mean time to diagnosis of 8.3 months (range: 0.7–27.3). Being African American (HR = 1.93; 95% CI: 1.00–3.72) or more educated (p trend = 0.03) was associated with an increased risk of BCRL. Removal of at least one lymph node (HR = 1.04; 95% CI: 1.02–1.07) was associated with increased risk, yet no significant association was observed for type of lymph node surgery. Being obese at breast cancer diagnosis was suggestive of an elevated risk (HR = 1.43; 95% CI: 0.88–2.31). Conclusions In a large cohort study, BCRL occurs among a substantial proportion of early breast cancer survivors. Our findings agree with previous studies on the increased risk of BCRL with removal of lymph nodes and being obese, yet point to differential risk by race/ethnicity. PMID:21079093

  14. Increased Asthma Risk and Asthma-Related Health Care Complications Associated With Childhood Obesity

    PubMed Central

    Black, Mary Helen; Zhou, Hui; Takayanagi, Miwa; Jacobsen, Steven J.; Koebnick, Corinna

    2013-01-01

    Asthma is the most common chronic condition of childhood, yet the relationship between obesity and asthma risk and the impact of obesity on clinical asthma outcomes are not well understood. For this population-based, longitudinal study, demographic and clinical data were extracted from administrative and electronic health records of 623,358 patients aged 6–19 years who were enrolled in the Kaiser Permanente Southern California health plan in 2007–2011. Crude asthma incidence ranged from 16.9 per 1,000 person-years among normal-weight youth to 22.3 per 1,000 person-years among extremely obese youth. The adjusted risks of asthma for overweight, moderately obese, and extremely obese youth relative to those of normal weight youth were 1.16 (95% confidence interval: 1.13, 1.20), 1.23 (95% confidence interval: 1.19, 1.28), and 1.37 (95% confidence interval: 1.32, 1.42), respectively (Ptrend < 0.0001). The relationship between obesity and asthma risk was strongest in Asian/Pacific Islanders and in the youngest girls (aged 6–10 years), compared with other groups. Among youth who developed asthma, those who were moderately or extremely obese had more frequent asthma exacerbations requiring emergency department services and/or treatment with oral corticosteroids. In conclusion, obese youth are not only more likely to develop asthma, but they may be more likely to have severe asthma, resulting in a greater need for health care utilization and aggressive asthma treatment. PMID:23924576

  15. Incidence of Scleritis and Episcleritis: Results From the Pacific Ocular Inflammation Study

    PubMed Central

    Homayounfar, Gelareh; Nardone, Natalie; Borkar, Durga S.; Tham, Vivien M.; Porco, Travis C.; Enanoria, Wayne T.A.; Parker, John V.; Vinoya, Aleli C.; Uchida, Aileen; Acharya, Nisha R.

    2013-01-01

    Purpose To ascertain the incidence of scleritis and episcleritis in a Hawaiian population and describe variations by age, sex, and race. Design Retrospective, population-based cohort study. Methods All electronic medical records for enrollees in Kaiser Permanente Hawaii (n = 217 061) from January 1, 2006 to December 31, 2007 were searched for International Classification of Diseases, 9th Edition (ICD-9) codes associated with ocular inflammation. Chart review was conducted to verify a clinical diagnosis of scleritis or episcleritis. Confirmed cases were used to calculate incidence rates per 100 000 person-years. Ninety-five percent confidence intervals (CI) were calculated for each incidence rate, including age-, sex-, and race-specific rates, using bias-corrected Poisson regression. To assess for confounding, a multivariate analysis adjusting for age, sex, and race was also performed. Results Of 217 061 eligible patients, 17 incident scleritis cases and 93 incident episcleritis cases were confirmed. The overall incidence rates of scleritis and episcleritis were 4.1 (95% CI: 2.6-6.6) and 21.7 (95% CI: 17.7-26.5) cases per 100 000 person-years, respectively. Women were overrepresented among scleritis patients (P = .049). Pacific Islanders were the most underrepresented racial group among cases of scleritis and episcleritis (P = .006, P = .001). Blacks had the highest incidence of scleritis (P = .004). Conclusions These results provide a population-based estimate of the incidence of scleritis and episcleritis in a diverse population and highlight differences in patients' demographic characteristics. Differences in incidence by sex and race raise questions about genetic and environmental influences on the development of these conditions. PMID:23891336

  16. PS2-11: Validation of KRAS Mutation Testing Across Five Certified Laboratories

    PubMed Central

    Feigelson, Heather; Rahm, Alanna Kulchak; Funk, Kellyan; Kauffman, Tia; Johnson, Monique; Richards, Carolyn Sue; LeMarchand, Loic; Goddard, Katrina

    2011-01-01

    KRAS mutation testing helps oncologists decide whether patients diagnosed with metastatic colorectal cancer (CRC) should be treated with epidermal growth factor receptor (EGFR) inhibitors. These drugs block the EGFR signaling pathway in tumor cells, and thus can slow tumor progression. Mutated KRAS is found in 30–45% of all CRC tumors, with mutations occurring at codons 12 and 13 being the most common. Patients with a mutated KRAS found in tumor tissue show limited clinical response to EGFR inhibitor therapy. Several factors can influence the results of KRAS mutation testing in tumor specimens. Variation can result from tumor heterogeneity, sample handling, DNA preparation, and differences in assay design and methodology. The purpose of this study was to evaluate comparability of KRAS test results among five labs currently used to determine KRAS mutation status of colorectal cancer specimens in a large multi-center study. Three commercial labs (Genzyme, Clarient, Quest Diagnostics), one clinical lab (Henry Ford Health System), and one research lab (Oregon Health Sciences University) were contracted to analyze KRAS mutational status; all are Clinical Laboratory Improvement Amendments (CLIA) certified. Twenty formalin-fixed paraffin-embedded (FFPE) human CRC samples that had been previously tested for KRAS mutations were selected based on mutation status (7 wild type samples, 7 with codon 12 mutations, and 6 with codon 13 mutations) from two clinical settings (Kaiser Permanente Colorado and Northwest). To ensure sufficient sample quantity, only surgical specimens from colon resections were used. Before being sent to each lab, the FFPE samples were reviewed by a pathologist to determine that the sample was of sufficient quality and quantity for testing. We asked each lab to use their standard clinical testing procedures. Clarient uses a polymerase chain reaction (PCR) method for mutation detection, Genzyme uses single nucleotide primer extension assay with fragment analysis by capillary electrophoresis, and the other three labs all use sequencing. Preliminary data (n=11 samples tested to date) suggests good agreement across laboratories despite differences in mutation detection methodologies.

  17. Lactation Intensity and Postpartum Maternal Glucose Tolerance and Insulin Resistance in Women With Recent GDM

    PubMed Central

    Gunderson, Erica P.; Hedderson, Monique M.; Chiang, Vicky; Crites, Yvonne; Walton, David; Azevedo, Robert A.; Fox, Gary; Elmasian, Cathie; Young, Stephen; Salvador, Nora; Lum, Michael; Quesenberry, Charles P.; Lo, Joan C.; Sternfeld, Barbara; Ferrara, Assiamira; Selby, Joseph V.

    2012-01-01

    OBJECTIVE To examine the association between breastfeeding intensity in relation to maternal blood glucose and insulin and glucose intolerance based on the postpartum 2-h 75-g oral glucose tolerance test (OGTT) results at 6–9 weeks after a pregnancy with gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS We selected 522 participants enrolled into the Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT), a prospective observational cohort study of Kaiser Permanente Northern California members diagnosed with GDM using the 3-h 100-g OGTT by the Carpenter and Coustan criteria. Women were classified as normal, prediabetes, or diabetes according to American Diabetes Association criteria based on the postpartum 2-h 75-g OGTT results. RESULTS Compared with exclusive or mostly formula feeding (>17 oz formula per 24 h), exclusive breastfeeding and mostly breastfeeding (?6 oz formula per 24 h) groups, respectively, had lower adjusted mean (95% CI) group differences in fasting plasma glucose (mg/dL) of ?4.3 (?7.4 to ?1.3) and ?5.0 (?8.5 to ?1.4), in fasting insulin (?U/mL) of ?6.3 (?10.1 to ?2.4) and ?7.5 (?11.9 to ?3.0), and in 2-h insulin of ?21.4 (?41.0 to ?1.7) and ?36.5 (?59.3 to ?13.7) (all P < 0.05). Exclusive or mostly breastfeeding groups had lower prevalence of diabetes or prediabetes (P = 0.02). CONCLUSIONS Higher intensity of lactation was associated with improved fasting glucose and lower insulin levels at 6–9 weeks’ postpartum. Lactation may have favorable effects on glucose metabolism and insulin sensitivity that may reduce diabetes risk after GDM pregnancy. PMID:22011407

  18. 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

  19. 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 3 months), 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

  20. 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

  1. 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

  2. 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, patient’s 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

  3. 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 0–1) and 4.0 (range 1–5), 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 = 1.03–2.21). Higher perceived benefits (OR=1.46, 95% CI = 1.13–1.90) and one or more PCP visits (OR= 5.82, 95% CI = 3.87–8.74) 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

  4. TRENDS IN TIME TO CONFIRMATION AND RECOGNITION OF NEW-ONSET HYPERTENSION, 2002–2006

    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 1–2 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 (2002–2006) 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

  5. Risk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study

    PubMed Central

    Exalto, Lieza G; Biessels, Geert Jan; Karter, Andrew J; Huang, Elbert S; Katon, Wayne J; Minkoff, Jerome R; Whitmer, Rachel A

    2015-01-01

    Background Patients with type 2 diabetes (T2DM) are twice as likely to develop dementia though it’s difficult to predict who has the highest future risk. We created and validated a practical summary risk score providing an individualized estimate of the 10-year dementia risk in T2DM patients. Methods Two longitudinal cohorts T2DM patients aged 60 + with ten years follow-up were used to create (Diabetes and Aging Study N=29,961) and validate (Pathways Study N=2,413) the risk score. We built our prediction model by evaluating 45 candidate predictors using Cox proportional hazard models and developed a point system for the risk score based on the size of the predictor’s beta coefficient. Model prediction was tested by discrimination and calibration methods. Dementia risk per sum score was calculated with Kaplan-Meier estimates. Findings Microvascular disease, diabetic foot, cerebrovascular disease, cardiovascular disease, acute metabolic events, depression, age and education most strongly predicted dementia and constitute the risk score (c-statistic= 0.73 creation cohort, c statistic =0.74 validation cohort). There was a 15-fold difference (5% vs. 73%) in observed dementia risk between the lowest (-1) and the highest (?12) sum score. Interpretation This is the first risk score capable of predicting 10-year individualized dementia risk in patients with T2DM. The risk score can be used to increase vigilance for cognitive deterioration and to selection of high risk patients for clinical trials. Funding NIH DK081796, Kaiser Permanente Community Benefit grant, Utrecht University high potential grant, VIDI grant 91711384 from ZonMw and Fulbright Fellowship. PMID:24622366

  6. 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

  7. Apolipoprotein E ?2 Is Associated with New Hemorrhage Risk in Brain Arteriovenous Malformations

    PubMed Central

    Pawlikowska, Ludmila; Poon, K.Y. Trudy; Achrol, Achal S.; McCulloch, Charles E.; Ha, Connie; Lum, Kristen; Zaroff, Jonathan G.; Ko, Nerissa U.; Johnston, S. Claiborne; Sidney, Stephen; Marchuk, Douglas A.; Lawton, Michael T.; Kwok, Pui-Yan; Young, William L.

    2015-01-01

    OBJECTIVE Patients with brain arteriovenous malformation (AVM) are at life-threatening risk of intracranial hemorrhage (ICH). Identification of genetic variants associated with increased new ICH risk would facilitate risk stratification and guide therapeutic intervention. METHODS Brain AVM patients evaluated at University of California, San Francisco or Kaiser Permanente Northern California were followed longitudinally. Primary outcome was new ICH after diagnosis; censoring events were any AVM treatment or last follow-up examination. The association of ApoE ?2 and ?4 genotype with new ICH was evaluated by Kaplan-Meier survival analysis and further characterized via a Cox proportional hazards model. RESULTS We genotyped 284 brain AVM patients (50% women; 57% Caucasian; median follow-up time, 0.3 yr) including 18 patients with a history of new ICH). ApoE ?2, but not ApoE ?4 genotype, was associated with new ICH (P = 0.0052). ApoE ?2 carriers had fivefold increased risk of new ICH (hazard ratio, 5.09; 95% confidence interval, 1.46–17.7; P = 0.010; Cox proportional hazards model adjusting for race/ethnicity and clinical presentation). Subset analysis in the largest homogenous ethnic subcohort (Caucasians) confirmed the increased risk of new ICH in ApoE ?2 carriers (hazard ratio, 8.71; 95% confidence interval, 1.4–53.9; P = 0.020; multivariate model adjusting for clinical presentation). CONCLUSION ApoE genotype may influence the risk of ICH in the natural course of brain AVM. The identification of genetic predictors of ICH risk may facilitate estimation of AVM natural history risk and individualize clinical decision-making and therapeutic recommendations. PMID:16639317

  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 listener’s 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. Achieving proficiency with robot-assisted radical prostatectomy: Laparoscopic-trained versus robotics-trained surgeons

    PubMed Central

    Kim, Brian; Chang, Allen; Kaswick, Jennifer; Derboghossians, Armen; Jung, Howard; Slezak, Jeff; Wuerstle, Melanie; Williams, Stephen G.; Chien, Gary W.

    2013-01-01

    Background Initiating a robotics program is complex, in regards to achieving favourable outcomes, effectively utilizing an expensive surgical tool, and granting console privileges to surgeons. We report the implementation of a community-based robotics program among minimally-invasive surgery (MIS) urologists with and without formal robotics training. Methods: From August 2008 to December 2010 at Kaiser Permanente Southern California, 2 groups of urologists performing robot-assisted radical prostatectomy (RARP) were followed since the time of robot acquisition at a single institution. The robotics group included 4 surgeons with formal robotics training and the laparoscopic group with another 4 surgeons who were robot-naïve, but skilled in laparoscopy. The laparoscopic group underwent an initial 7-day mentorship period. Surgical proficiency was measured by various operative and pathological outcome variables. Data were evaluated using comparative statistics and multivariate analysis. Results: A total of 420 and 549 RARPs were performed by the robotics and laparoscopic groups, respectively. Operative times were longer in the laparoscopic group (p = 0.002), but estimated blood loss was similar. The robotics group had a significantly better overall positive surgical margin rate of 19.9% compared to the laparoscopic group (27.8%) (p = 0.005). Both groups showed improvements in operative and pathological parameters as they accrued experience, and achieved similar results towards the end of the study. Conclusions: Robot-naïve laparoscopic surgeons may achieve similar outcomes to robotic surgeons relatively early after a graduated mentorship period. This study may apply to a community-based practice in which multiple urologists with varied training backgrounds are granted robot privileges. PMID:24282463

  10. 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

  11. 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 inference—namely, 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

  12. 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

  13. 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

  14. Familial Aggregation of Parkinson’s 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 Parkinson’s 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 1994–1995 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 1.9–5.9; 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 1.0–68.9) than it was among non-Hispanic Caucasian cases and controls (2.0% versus 0.8%; RR=2.7, 95% CI 1.5–5.1) (p=0.02). The familial aggregation of PD was stronger among the siblings of PD cases (RR=5.4, 95% CI 1.8–16.0) than among parents (RR=2.7, 95% CI 1.3–5.2). 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

  15. 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

  16. 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 (2009–2011). 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

  17. Obesity during childhood and adolescence increases susceptibility to multiple sclerosis after accounting for established genetic and environmental risk factors

    PubMed Central

    Gianfrancesco, Milena A.; Acuna, Brigid; Shen, Ling; Briggs, Farren B.S.; Quach, Hong; Bellesis, Kalliope H.; Bernstein, Allan; Hedstrom, Anna K.; Kockum, Ingrid; Alfredsson, Lars; Olsson, Tomas; Schaefer, Catherine; Barcellos, Lisa F.

    2014-01-01

    Objective To investigate the association between obesity and multiple sclerosis (MS) while accounting for established genetic and environmental risk factors. Methods Participants included members of Kaiser Permanente Medical Care Plan, Northern California Region (KPNC) (1,235 MS cases and 697 controls). Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CI). Body mass index (BMI) or body size was the primary predictor of each model. Both incident and prevalent MS cases were studied. Results In analyses stratified by gender, being overweight at age 10 and 20 were associated with MS in females (p<0.01). Estimates trended in the same direction for males, but were not significant. BMI in 20’s demonstrated a linear relationship with MS (p-trend=9.60 × 10?4), and a twofold risk of MS for females with a BMI ? 30 kg/m2 was observed (OR = 2.15, 95% CI 1.18, 3.92). Significant associations between BMI in 20’s and MS in males were not observed. Multivariate modeling demonstrated that significant associations between BMI or body size with MS in females persisted after adjusting for history of infectious mononucleosis and genetic risk factors, including HLA-DRB1*15:01 and established non-HLA risk alleles. Interpretation Results show that childhood and adolescence obesity confer increased risk of MS in females beyond established heritable and environmental risk factors. Strong evidence for a dose-effect of BMI in 20’s and MS was observed. The magnitude of BMI association with MS is as large as other known MS risk factors. PMID:25263833

  18. 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

  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. Comparative safety of infliximab and etanercept on the risk of serious infections – Does the association vary by patient characteristics?

    PubMed Central

    Toh, Sengwee; Li, Lingling; Harrold, Leslie R.; Bayliss, Elizabeth A.; Curtis, Jeffrey R.; Liu, Liyan; Chen, Lang; Grijalva, Carlos G.; Herrinton, Lisa J.

    2012-01-01

    Purpose Infliximab, a chimeric monoclonal anti-TNF? antibody, has been found to increase the risk of serious infections compared with the TNF receptor fusion protein etanercept in some studies. It is unclear whether the risk varies by patient characteristics. We conducted a study to address this question. Methods We identified members of Kaiser Permanente Northern California who initiated infliximab (n=793) or etanercept (n=2,692) in 1997–2007. Using a Cox model, we estimated the propensity score-adjusted hazard ratio (HR) and 95% confidence interval (CI) of serious infections requiring hospitalization or opportunistic infections comparing infliximab with etanercept following treatment initiation. We tested whether the adjusted HR differed by age, sex, race/ethnicity, body mass index, and smoking status. Results The crude incidence rate of serious infections per 100 person-years was 5.4 (95% CI: 3.8, 7.5) in patients <65 years and 16.0 (10.4, 23.4) in patients ?65 years during the first three months following treatment initiation. Compared with etanercept, the adjusted HR during this period was elevated for infliximab in patients <65 years (HR 3.01; 95% CI: 1.49, 6.07), but not in those ?65 years (HR 0.94; 0.41, 2.13). Findings did not suggest that the HR varied by other patient characteristics examined. Conclusions An increased risk of serious infections associated with infliximab relative to etanercept did not appear to be modified by patients’ sex, race/ethnicity, body mass index, or smoking status. There was an indication that the increased risk might be limited to patients <65 years. Additional studies are warranted to verify or refute this finding. PMID:22411435

  1. 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.

  2. 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

  3. 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

  4. National Practice Recommendations for Hematuria: How to Evaluate in the Absence of Strong Evidence?

    PubMed Central

    Loo, Ronald; Whittaker, Joel; Rabrenivich, Violeta

    2009-01-01

    Hematuria is one of the most common conditions confronting clinical urologists and is present in many genitourinary pathology conditions. Although researchers have studied hematuria symptoms in an effort to determine the best diagnostic pathway, the existing lack of scientific evidence has created variations in clinical practice. The literature does not provide enough evidence to significantly alter the need to assess these patients. Consequently, many patients with microscopic or gross hematuria undergo low-yield workups that include invasive testing and imaging with radiation. In 2007, a national group of Kaiser Permanente (KP) urology chiefs agreed that national practice recommendations were needed to address existing variations in the management and workup of hematuria. Using a KP guideline methodology, the group reached a consensus agreement on the following recommendations: 1) referral to urology is recommended for all people with gross hematuria or high-grade hematuria (>50 red blood cells per high-power field [RBCs/HPF]) on a single urinalysis (UA); 2) referral to urology and urologic evaluation is recommended for men or women with asymptomatic microscopic hematuria or symptomatic hematuria that produces >3 RBCs/HPF on two of three properly performed and collected urinalyses; and 3) voided urinary cytology should be eliminated from asymptomatic hematuria screening protocol. The test is not sensitive enough to obviate further workup if findings are negative, and elimination of this screening test is estimated to save millions of dollars across the US. Hematuria on a UA should be reported as 0 to 3 RBC/HPF, 4 to 10 RBC/HPF, 11 to 25 RBC/HPF, 26 to 50 RBC/HPF, >50 RBC/HPF, or gross hematuria. This approach will also reduce radiation exposure. PMID:21373244

  5. 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]: 2.11–154.9; ?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: 1.73–44.5; ?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

  6. 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

  7. 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

  8. Prevalence of Diabetes in U.S. Youth in 2009: The SEARCH for Diabetes in Youth Study

    PubMed Central

    Pettitt, David J.; Talton, Jennifer; Dabelea, Dana; Divers, Jasmin; Imperatore, Giuseppina; Lawrence, Jean M.; Liese, Angela D.; Linder, Barbara; Mayer-Davis, Elizabeth J.; Pihoker, Catherine; Saydah, Sharon H.; Standiford, Debra A.; Hamman, Richard F.

    2014-01-01

    OBJECTIVE To estimate the prevalence of diabetes in U.S. youth aged <20 years in 2009 and to estimate the total number of youth with diabetes in the U.S. by age, race/ethnicity, and diabetes type. RESEARCH DESIGN AND METHODS To address one of its primary aims, the SEARCH for Diabetes in Youth Study identified youth aged <20 years on 31 December 2009 with physician-diagnosed diabetes in selected areas of Colorado, Ohio, South Carolina, and Washington, among health plan members of Kaiser Permanente Southern California and among American Indians living on reservations in Arizona and New Mexico. Diabetes was classified as type 1, type 2, or other. Race/ethnicity was by self-report. RESULTS From a population of 3,458,974 youth aged <20 years, 7,695 youth with diabetes were identified (2.22/1,000): 6,668 with type 1 diabetes (1.93/1,000), 837 with type 2 diabetes (0.24/1,000), and 190 (0.05/1,000) with other diabetes types. Prevalence increased with age, was slightly higher in females than males, and was most prevalent in non-Hispanic White and least prevalent in Asian/Pacific Islanders, with Native American and black youth having the highest prevalence of type 2 diabetes. An estimated 191,986 U.S. youth aged <20 years have diabetes; 166,984 type 1 diabetes, 20,262 type 2 diabetes, and 4,740 other types. CONCLUSIONS Diabetes, one of the leading chronic diseases in childhood, affects >190,000 (1 of 433) youth aged <20 years in the U.S., with racial and ethnic disparities seen in diabetes prevalence, overall and by diabetes type. PMID:24041677

  9. DESAFÍOS ÉTICOS DE LA INVESTIGACIÓN CON ANIMALES, MANIPULACIÓN GENÉTICA

    PubMed Central

    Yunta, Eduardo Rodríguez

    2012-01-01

    En la investigación con animales existen cuestionamientos éticos tanto en el uso como modelos de enfermedades humanas y requisito previo para ensayos en humanos como en la introducción de modificaciones genéticas. Algunos de estos cuestionamientos son: no representar exactamente la condición humana como modelos, realizar pruebas de toxicidad con grave daño para los animales, alterar su naturaleza mediante modificaciones genéticas, riesgos de la introducción de organismos genéticamente modificados. El uso de animales en investigación para beneficio humano, impone al ser humano la responsabilidad moral de respetarlo, no haciéndoles sufrir innecesariamente, al estar trabajando con seres vivientes y sentientes. PMID:23338641

  10. Los albaniles, Novel and Play: A Two-Time Winner

    E-print Network

    Grossman, Lois S.

    1976-04-01

    area. A note to the reader explains that all of the scenes in the building, except the discovery of the body, take place before the crime and all the scenes at the precinct take place after, i.e., during the investigation. He adds: Las violaciones de... tiempo y de espacio que cometen los personajes al cruzar del área policial a la zona del edificio, o viceversa, deben entenderse como eso: como violaciones cronológicas y espaciales, como súbitos rompimientos que sólo justifica la unidad psicológica...

  11. Estudio teórico de la desorción de Na y K de SiO2 estimulada por la acción de fotones o electrones

    NASA Astrophysics Data System (ADS)

    Domínguez Ariza, D.; López, N.; Illas, F.; Pacchioni, G.; Madey, T. E.

    Se ha estudiado el mecanismo de generación de sodio y potasio atómico a partir de muestras de SiO2 utilizando cálculos basados tanto en la teoría del funcional de la densidad como en métodos post-Hartree Fock, así como en el método de cluster para modelar el sólido. Como consecuencia del estudio se han propuesto distintos caminos posibles para la desorción, estimulada por la acción de fotones o electrones, de sodio y potasio desde el óxido de silicio, proporcionando por lo tanto una explicación a la atmósfera tenue de sodio y potasio de La Luna.

  12. STABILITY ANALYSIS OF TRANSPORTATION NETWORKS WITH MULTISCALE DRIVER DECISIONS

    E-print Network

    Como, Giacomo

    STABILITY ANALYSIS OF TRANSPORTATION NETWORKS WITH MULTISCALE DRIVER DECISIONS GIACOMO COMO equilibria is analyzed for dynamical transportation networks in which the drivers' route choices of indistinguishable drivers commuting between a common origin/destination pair in an acyclic transportation network

  13. Instantánea de los cánceres de cerebro y del sistema nervioso central

    Cancer.gov

    Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre los cánceres de cerebro y del sistema nervioso central; así como ejemplos de actividades del NCI y adelantos en la investigación de estos tipos de cáncer.

  14. Investigación sobre el cáncer de páncreas

    Cancer.gov

    Instantánea del cáncer de páncreas Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cáncer de páncreas; así como ejemplos de actividades del NCI y adelantos en la investigación de este tipo de cáncer.

  15. Cáncer colorrectal—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento, la prevención, las causas y los exámenes de detección del cáncer de colon y recto, así como referencias a estudios clínicos, estadísticas y otros temas relacionados.

  16. Mxico -Presidencia de la Repblica | Sala de Prensa http://www.presidencia.gob.mx/prensa/?contenido=32287&imprimir=true 1 of 8 10/23/2007 02:29 PM

    E-print Network

    Coello, Carlos A. Coello

    interés por la ciencia por parte de los padres de familia y de algunos maestros es algo determinante. Como sociedad debemos despertar cada día más la curiosidad científica. La escuela debe hacer que las materias de

  17. UNIVERSIDAD DE GRANADA E.T.S. DE INGENIER ' IA INFORM '

    E-print Network

    Granada, Universidad de

    ' ON E INTELIGENCIA ARTIFICIAL ESCUELA T ' ECNICA SUPERIOR DE INGENIER ' IA INFORM ' ATICA UNIVERSIDAD DE mostrado durante el desarrollo de esta memoria, as'i como a mis hermanos y al resto de mi familia. Por

  18. Leucemia—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento de la leucemia, así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados con este tipo de cáncer.

  19. Instantánea del cáncer de tiroides

    Cancer.gov

    Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cáncer de tiroides; así como ejemplos de actividades del NCI y adelantos en la investigación de este tipo de cáncer.

  20. Mosquito Control Around the Home (Spanish) 

    E-print Network

    Jackman, John A.; Olson, Jimmy K.

    2008-08-05

    cuando ?stos puedan sobrevivir en ellos. Peces mosquiteros pueden encontrarse en otras la- gunas, tiendas de mascotas y lugares donde se vende carnada para la pesca. ? Usar productos a base de Bacillus thuringiensis israe- liensis como ?Mosquito Dunks...

  1. Se entiende por lenguaje sexista, no incluyente o no integrador el uso exclusivo de uno de los dos gneros (habitualmente el masculino) para

    E-print Network

    especificación de sexo o construcciones impersonales : o Los investigadores el personal investigador o Como brillantes Algunas mentes brillantes Sustituir las construcciones copulativas que exijan un adjetivo en masculino por otras construcciones: ej. tener o sentir + sustantivo o construcciones reflexivas o

  2. LA TEORIA CHERN-SIMONS DESDE EL PUNTO DE VISTA DE LA MECANICA CUANTICA

    E-print Network

    Gelca, Razvan

    Uribe Texas Tech University University of Michigan EN LO SIGUENTE EXPLICAMOS COMO LAS CONSTRUCCIONES DE y 3-variedades que satisfacen las propriedades de los invariantes de Witten. Su construcci´on es

  3. Qué tipos hay de estudios clínicos

    Cancer.gov

    Información sobre los diversos tipos de estudios clínicos de cáncer, como son los estudios de tratamiento, de prevención, de exámenes selectivos de detección, de cuidados médicos de apoyo y de cuidados paliativos.

  4. Delirio (PDQ)—Versión para pacientes

    Cancer.gov

    Resumen de información revisada por expertos acerca del delirio como una complicación del cáncer o su tratamiento. Se tratan enfoques de los cuidados médicos de apoyo y los abordajes farmacológicos para el manejo del delirio.

  5. Prurito (PDQ)—Versión para pacientes

    Cancer.gov

    Resumen de información revisada por expertos acerca del prurito (picazón de la piel) como complicación a causa del cáncer y su tratamiento. Se discuten los enfoques del manejo y tratamiento del prurito.

  6. Base de datos integral del NCI - PDQ®

    Cancer.gov

    Base de datos del NCI que contiene la información más reciente sobre prevención, exámenes de detección y tratamiento del cáncer, así como sumarios sobre genética, cuidados de apoyo y medicina complementaria y alternativa, y estudios clínicos.

  7. 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.

  8. 4 Fsica na Escola, v. 5, n. 2, 2004 Alguns nmeros possuem caractersticas que

    E-print Network

    de Aguiar, Marcus A. M.

    . 2, 2004 e a Seqüência de Fibonacci cera de família de boa estirpe, ficou também conhecido como Fibonacci, que significa, literalmente, "filho de boa gente". Pois esse Fibonacci publicou, em 1202, um

  9. Dolor (PDQ)—Versión para profesionales de salud

    Cancer.gov

    Resumen de información revisada por expertos acerca del dolor como una complicación a causa del cáncer o su tratamiento. Se discuten enfoques sobre el manejo y tratamiento del dolor relacionado con el cáncer.

  10. Fatiga (PDQ)—Versión para profesionales de salud

    Cancer.gov

    Resumen de información revisada por expertos acerca de la fatiga, una afección caracterizada por extremo cansancio e incapacidad para funcionar por la falta de energía, que a menudo se observa como una complicación del cáncer y su tratamiento.

  11. El uso de la tecnologa en el estudio de la vulnerabilidad a los "desastres naturales" para

    E-print Network

    Gilbes, Fernando

    · Evaluar la distribución de la actividad humana y los usos de suelos · Visita de campo a Culebra y Saint;Conclusiones contexto local (2) 3. La forma como se distribuye la actividad humana y los usos del suelo

  12. Development of Real Time FloodDevelopment of Real Time FloodDevelopment of Real Time FloodDevelopment of Real Time Flood Prediction Capabilities in Puerto RicoPrediction Capabilities in Puerto Rico

    E-print Network

    Gilbes, Fernando

    ) ­ Parámetros de Green-Ampt asignados al mapa de texturas de suelos (SSURGO) Características del canal y los parámetros · Objetivo: Determinar cual parámetro del suelo es más sensitivo y como afecta el

  13. Subprograma de Sistemas de Informacin Geogrfica

    E-print Network

    Gilbes, Fernando

    permite evaluar las características ambientales y físicas de los terrenos? Presencia de: Suelos Sistemas y la clasificación de suelo. #12;Metodología ¿Como el PRI brinda información sobre los planes de

  14. Investigación sobre el cáncer de vejiga

    Cancer.gov

    Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cáncer de vejiga; así como ejemplos de actividades del NCI y adelantos en la investigación de este tipo de cáncer.

  15. Cáncer de vesícula biliar—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento del cáncer de vesícula biliar, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  16. Fig.2: Annual-mean sea surface temperature and surface currents, from the Simple Ocean Data Assimilation (SODA) Reanalysis. Note the strong SST gradient in the Atlantic known as the Angola-Benguela front. To its north, at approximately 10E/10S, lies the A

    E-print Network

    Zuidema, Paquita

    Assimilation (SODA) Reanalysis. Note the strong SST gradient in the Atlantic known as the Angola-Benguela front Oceánicos (SODA). Nótese el fuerte gradiente de SST en el Atlántico, conocido como el frente Angola

  17. Cáncer de esófago—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento, la prevención y los exámenes de detección del cáncer de esófago, así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados con este tipo de cáncer.

  18. Cáncer de vesícula biliar—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del cáncer de vesícula biliar, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  19. Cáncer de esófago—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento, la prevención y los exámenes de detección del cáncer de esófago, así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados con este tipo de cáncer.

  20. Cáncer de pulmón—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento, la prevención, las causas y los exámenes de detección del cáncer de pulmón, así como referencias a estudios clínicos, investigación, estadísticas y otros temas

  1. Cáncer de riñón—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del cáncer de riñón, así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados con este tipo de cáncer.

  2. Cáncer de hígado y de conducto biliar—Versión para profesionales de salud

    Cancer.gov

    Información del NCI para profesionales de salud sobre el tratamiento, la prevención y los exámenes de detección del cáncer de hígado y de conducto biliar, así como referencias a estudios clínicos, investigación y otros temas.

  3. Cáncer de estómago—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento, la prevención, las causas y los exámenes de detección del cáncer de estómago (gástrico), así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados.

  4. Cáncer de vulva—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del cáncer de vulva, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  5. Cáncer de testículo—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento, las causas y los exámenes de detección del cáncer de testículo, así como referencias a estudios clínicos, investigación y otros temas.

  6. Cáncer de testículo—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento, las causas y los exámenes de detección del cáncer de testículo, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  7. Cáncer de intestino delgado—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del cáncer de intestino delgado, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  8. Instantánea de los cánceres de hígado

    Cancer.gov

    Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre los cánceres de hígado y de las vías biliares; así como ejemplos de actividades del NCI y adelantos en la investigación de estos tipos de cáncer.

  9. Óxido de etileno

    Cancer.gov

    A temperatura ambiente, el óxido de etileno es un gas incoloro, inflamable y de olor dulce. Se usa principalmente para producir otras sustancias químicas, como anticongelantes.El hollín es un subproducto de la combustión incompleta de materiales orgánicos

  10. Cáncer de piel—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento, la prevención, las causas, los exámenes de detección y los estudios clínicos del cáncer de piel, así como referencias a otros temas relacionados con este tipo de cáncer.

  11. Cáncer de páncreas—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del cáncer de páncreas, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  12. Cáncer de piel—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento, la prevención, las causas y los exámenes de detección del cáncer de piel, así como referencias a estudios clínicos, investigación y otros temas.

  13. Cáncer de ano—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del cáncer de ano, así como referencias a estudios clínicos y otros temas relacionados con este tipo de cáncer.

  14. Cáncer de pene—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del cáncer de pene, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  15. Cáncer de hueso—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del cáncer de hueso (óseo), así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  16. Cáncer de hueso—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento del cáncer de hueso (óseo), así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  17. Cáncer de ovario, de trompa de Falopio y primario de peritoneo—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento, la prevención, la genética, las causas y los exámenes de detección del cáncer de ovario, así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados.

  18. Cáncer de tiroides—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del cáncer de tiroides, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  19. Cáncer de hígado y de conducto biliar—Versión para pacientes

    Cancer.gov

    Información del NCI sobre el tratamiento, la prevención y los exámenes de detección del cáncer de hígado y de conducto biliar, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer

  20. Cáncer de cuello uterino—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento, la prevención, las causas y los exámenes de detección del cáncer de cuello uterino, así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados.

  1. Cáncer de paratiroides—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento del cáncer de paratiroides, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  2. Cáncer de cuello uterino—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento, la prevención, las causas y los exámenes de detección del cáncer de cuello uterino, así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados.

  3. Cáncer de paratiroides—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento del cáncer de paratiroides, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  4. Cáncer de seno (mama)—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento, la prevención, la genética, las causas y los exámenes de detección del cáncer de seno (mama), así como referencias a estudios clínicos, investigación, estadísticas y temas relacionados.

  5. Julio Durán-Cerda: 1914-1994

    E-print Network

    Bravo-Elizondo, Pedro

    1994-10-01

    efectiva que lo transmitió a sus alumnos, algunos de cuyos nombres son ya conocidos por sus investigaciones y publicaciones en dicho campo como Loren Zeller, Dennis Peni, Gerardo Luzuriaga, Grínor Rojo, Juan Villegas, Jorge Febles, Juan Rodríguez, John...

  6. Instantánea del cáncer de esófago

    Cancer.gov

    Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cáncer de esófago; así como ejemplos de actividades del NCI y adelantos en la investigación de este tipo de cáncer.

  7. Inmunoterapia: Uso del sistema inmunitario para tratar el cáncer

    Cancer.gov

    Resumen de los métodos de inmunoterapia utilizados para tratar el cáncer, tales como el uso de anticuerpos monoclonales, transferencia celular adoptiva, vacunas de tratamiento contra el cáncer y sustancias modificadoras de la respuesta inmunitaria.

  8. El Instituto Nacional del Cáncer de EE. UU. y Perú firman una Declaración de Intención

    Cancer.gov

    El Instituto Nacional del Cáncer y la República del Perú firmaron una declaración de intención para compartir el interés en fomentar la investigación biomédica de oncología, basándose en la colaboración mutua de ambas entidades, así como el objetivo común

  9. Instantánea del cáncer de pulmón

    Cancer.gov

    Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cáncer de pulmón; así como ejemplos de actividades del NCI y adelantos en la investigación de este tipo de cáncer.

  10. Instantánea del cáncer de seno (mama)

    Cancer.gov

    Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cáncer de seno (mama); así como ejemplos de actividades del NCI y adelantos en la investigación de este tipo de cáncer.

  11. Metadrama y subjetividad en tres obras de José Luis Ramos Escobar

    E-print Network

    Irizarry, Guillermo B.

    2001-04-01

    identidades desplazantes: lo aberrante (la mujer promiscua, la pedofilia, la homosexualidad, el sexo como intercambio de bienes). La novela no pasa juicio de este comportamiento sino que lo pone al mismo nivel de ficción que los mal llamados...

  12. Neuroblastoma—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento y los exámenes de detección del neuroblastoma, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  13. Instantánea de los cánceres infantiles

    Cancer.gov

    Información sobre la incidencia y mortalidad del cáncer en los niños, tendencias en el financiamiento del NCI para la investigación del cáncer infantil; así como ejemplos de actividades y adelantos en la investigación relevantes para esta población.

  14. Neuroblastoma—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento y los exámenes de detección del neuroblastoma, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  15. Control del dolor: Apoyo para las personas con cáncer

    Cancer.gov

    Libro sobre el control del dolor en pacientes con cáncer. Cubre los métodos y medicinas, así como los efectos físicos y emocionales del dolor. Es una adaptación cultural para el público de habla hispana del libro en inglés Pain Control.

  16. Formaldehído

    Cancer.gov

    El formaldehído es una sustancia química inflamable, incolora y de olor fuerte que se produce a nivel industrial y se usa para la construcción de materiales como tableros de partículas, madera contrachapada y otros productos de madera prensada.

  17. 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 sintético, como neumáticos o llantas, resinas, plásticos y otras sustancias químicas.

  18. Cáncer de la corteza suprarrenal—Versión para pacientes

    Cancer.gov

    Información del Instituto Nacional del Cáncer sobre el tratamiento del carcinoma de corteza suprarrenal, así como referencias a estudios clínicos, investigación y otros temas relacionados con este tipo de cáncer.

  19. Instantánea del cáncer de riñón

    Cancer.gov

    Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cáncer de riñón; así como ejemplos de actividades del NCI y adelantos en la investigación de este tipo de cáncer.

  20. Instantánea del cáncer de endometrio

    Cancer.gov

    Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cáncer de endometrio; así como ejemplos de actividades del NCI y adelantos en la investigación de este tipo de cáncer.

  1. Ensino superior perdeu quase um quinto

    E-print Network

    Instituto de Sistemas e Robotica

    , a intenção era pagar as propinas com o dinheiro dos subsídios de férias e de Natal. Como entretanto esse dinheiro foi cortado deixou de ter condições", conta. O presidente do Conselho Coorde- nador dos Institutos

  2. Tiragem: 114574 Pas: Portugal

    E-print Network

    Instituto de Sistemas e Robotica

    aeroespacial contou ao Dinheiro Vivo quais são as expectativas Texto: Rafaela Burd Relvas I spy in the night a expedição e contou ao Dinheiro Vivo quais são as expectativas. O bichinho nasceu com filmes como a Guerra

  3. El blog Cancer Currents está ahora disponible en español

    Cancer.gov

    Como parte de nuestros esfuerzos para que pacientes, proveedores de servicios médicos e investigadores cuenten con información oportuna, fidedigna y científica sobre el cáncer, ahora ofrecemos en español artículos selectos del blog Cancer Currents.

  4. Lo que usted debe saber antes de dar sus tejidos para investigación médica

    Cancer.gov

    Contiene información sobre las cosas que usted debe saber y tener en cuenta al tomar una decisión de donar sus tejidos para investigación. El tejido puede incluir materiales de su cuerpo tales como piel, cabello, uñas, sangre y orina.

  5. Quantum and classical properties of the fields generated by two interlinked second-order non-linear interactions

    E-print Network

    Paris, Matteo G. A.

    -linear interactions ALESSIA ALLEVIy,z, ALESSANDRA ANDREONIy,z, MARIA BONDANIy, ALESSANDRO FERRARO*, MATTEO G. A. PARIS'Insubria, Como, Italy *Dipartimento di Fisica, Universita` di Milano, Italy **Dipartimento di Fisica ``A. Volta

  6. Significado de los cambios en la próstata: Guía de salud para los hombres

    Cancer.gov

    Esta guía contiene información sobre los síntomas y factores de riesgo del cáncer de próstata y el análisis del antígeno prostático específico (PSA). También hace referencia a otras enfermedades como próstata agrandada y prostatitis.

  7. Prurito –para profesionales de salud (PDQ®)

    Cancer.gov

    Resumen de información revisada por expertos acerca del prurito (picazón de la piel) como complicación a causa del cáncer y su tratamiento. Se discuten los enfoques del manejo y tratamiento del prurito.

  8. Instantánea del cáncer de páncreas

    Cancer.gov

    Información sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cáncer de páncreas; así como ejemplos de actividades del NCI y adelantos en la investigación de este tipo de cáncer.

  9. FORMA DE REGISTRO INDIVIDUAL Primer Nombre: Apellido

    E-print Network

    actividad física de ¡Camine a Través de Tejas! por el propósito de la salud personal. Entiendo que debo tener aprobación médica de mi profesional de salud si yo: * tengo problemas crónicos de la salud como

  10. Cáncer de estómago–para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento, la prevención, las causas y los exámenes de detección del cáncer de estómago (gástrico), así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados.

  11. Cáncer de ovario, de trompa de Falopio y primario de peritoneo–para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento, la prevención, la genética, las causas y los exámenes de detección del cáncer de ovario, así como referencias a estudios clínicos, investigación, estadísticas y otros temas relacionados.

  12. EVALUACIN Y CREACIN DE DOS CORREDORES ECOLGICOS: UTILIZANDO SISTEMAS DE INFORMACIN GEOGRFICA

    E-print Network

    Gilbes, Fernando

    Departamento de Salud Ambiental Escuela Graduada de Salud Pública Recinto de Ciencias Médicas Universidad de contribución a la salud) utilizadas en la valoración de estos espacios a escala local y regional se usará como

  13. Cáncer de cabeza y cuello–para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento, la prevención, las causas y los exámenes de detección de los cánceres de cabeza y cuello, así como referencias a estudios clínicos, investigaciones, estadísticas y temas relacionados.

  14. Excma. Sra. D Margarita Salas y Falgueras Canero (Asturias), 30 de noviembre de 1938.

    E-print Network

    Cardeñosa, Jesús

    Investigación en el Centro de Biología Molecular "Severo Ochoa" (CSIC-UAM). Ha sido Profesora ad honorem de distinciones, como el Severo Ochoa de Investigación de la Fundación Ferrer (1986), Carlos J. Finlay de UNESCO

  15. Enfermedad trofoblástica de la gestación—Versión para profesionales de salud

    Cancer.gov

    Información del Instituto Nacional del Cáncer para profesionales de salud sobre el tratamiento de la enfermedad trofoblástica de la gestación, así como referencias a estudios clínicos y otros temas relacionados.

  16. Cannabis y canabinoides (PDQ)—Versión para pacientes

    Cancer.gov

    Resumen de información revisada por expertos sobre el uso del Cannabis y canabinoides para el tratamiento de los efectos secundarios relacionados con el tratamiento del cáncer como la náusea y el vómito.

  17. Cannabis y canabinoides (PDQ)—Versión para profesionales de salud

    Cancer.gov

    Resumen de información revisada por expertos de información sobre el uso del Cannabis y canabinoides para el tratamiento de los efectos secundarios relacionados con el tratamiento del cáncer como la náusea y el vómito.

  18. 76 FR 6136 - Change in Bank Control Notices; Acquisitions of Shares of a Bank or Bank Holding Company

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-03

    ...Potomac, Maryland; David P. Como, Napa, California; Charles Turnbaugh, Baltimore, Maryland; Robert L. Gossard, Burlingame, California; and Terrance M. Davis, Dillon Beach, California; to acquire voting shares of HarVest BanCorp,...

  19. Tomografía computarizada (TC) y exploraciones para cáncer

    Cancer.gov

    Hoja informativa que describe el procedimiento y la tecnología de exploraciones con tomografía computarizada así como sus usos para el diagnóstico, para exámenes de detección y para tratamiento del cáncer.

  20. La necesidad de cohetes más veloces - Duration: 31 seconds.

    NASA Video Gallery

    Los cohetes utilizados por la NASA son excelentes, pero no nos pueden llevar muy lejos ni muy rápido a aquellos lugares a los que todavía no llegamos, como Marte, o más lejos. Una solución posible ...