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Kaiser Permanente's Convergent Medical Terminology.  


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

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




PubMed Central

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.

Mendoza-Ticona, Alberto



Person-focused care at Kaiser Permanente.  


Patient-focused care has been described as an extension of patient-centered care, recognizing that patients’ medical needs are best understood and addressed in the context of their entire lives, including their life goals and social, economic, emotional, and spiritual functioning. Kaiser Permanente is expanding its ability to care for members as whole persons, not just as patients, with sensitivity to nonmedical factors in planning and delivering care. We describe emerging examples in several areas: interdisciplinary care planning, behavior change, social care, patient-reported outcome measures, and Total Health. Realizing the vision of person-focused care requires taking every opportunity to fully recognizing that each patient we serve is first and foremost a person. PMID:24626077

Bellows, Jim; Young, Scott; Chase, Alide



An integrated EHR at Northern California Kaiser Permanente  

PubMed Central

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).

Bornstein, S.



Los ?-agonistas adrenérgicos como modificadores metabólicos y su efecto en la producción, calidad e inocuidad de la carne de bovinos y ovinos: una revisión  

Microsoft Academic Search

Resumen. Los ?-agonistas adrenérgicos (?AA) se han utilizado en la producción animal, incluidos los rumiantes, propiciando una The ?-adrenergic Agonists as Metabolic Modifiers and their Effect on Production, Quality and Innocuousness of Beef Cattle and Sheep Meat: a Review Abstract. The ?-adrenergic agonists (?AA), improve animal production because they manipulate the efficiency of food use, affecting carcass characteristics and the

Ignacio A. Domínguez-Vara; Jaime Mondragón-Ancelmo; Manuel González Ronquillo; Félix Salazar-García; José Luis Bórquez-Gastelum; Andrés Aragón-Martínez



Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study  

Microsoft Academic Search

Objective To examine users' attitudes to implementation of an electronic medical record system in Kaiser Permanente Hawaii. Design Qualitative study based on semistructured interviews. Setting Four primary healthcare teams in four clinics, and four specialty departments in one hospital, on Oahu, Hawaii. Shortly before the interviews, Kaiser Permanente stopped implementation of the initial system in favour of a competing one.

J Tim Scott; Thomas G Rundall; Thomas M Vogt; John Hsu



Responding to the Language Challenge: Kaiser Permanente's Approach  

PubMed Central

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

Meyers, Kate; Tang, Gayle; Fernandez, Alicia



Impact of AIDS (Acquired Immunodeficiency Syndrome) on the Kaiser Permanente Medical Care Program: Northern California Region.  

National Technical Information Service (NTIS)

Kaiser Permanente Medical Care Program is a private, nonprofit, health care program that provides prepaid medical and hospital services to more than 5 million people in 16 states and the District of Columbia. Its northern California region serves 25 perce...

B. Fireman C. P. Quesenberry D. Durant J. V. Selby R. A. Hiatt



The Kaiser Permanente Colorado Clinical Pharmacy Anticoagulation Service as a model of modern anticoagulant care  

Microsoft Academic Search

The Clinical Pharmacy Anticoagulation Service (CPAS) at Kaiser Permanente Colorado grew from a single pharmacist assisting a single physician to a comprehensive service staffed by over 20 employees. CPAS provides care for over 7200 patients with each CPAS pharmacist managing all aspects of anticoagulation therapy for 150 to 500 patients. Unique aspects of CPAS include its centralized organization structure, the

Daniel M. Witt



Systemic implementation strategies to improve hypertension: the Kaiser Permanente Southern California experience.  


The past decade has seen hypertension improving in the United States where control is approximately 50%. Kaiser Permanente has mirrored and exceeded these national advances in control. Integrated models of care such as Kaiser Permanente and the Veterans Administration health systems have demonstrated the greatest hypertension outcomes. We detail the story of Kaiser Permanente Southern California (KPSC) to illustrate the success that can be achieved with an integrated health system model that uses implementation, dissemination, and performance feedback approaches to chronic disease care. KPSC, with a large ethnically diverse population of more than 3.6 million, has used a stepwise approach to achieve control rates greater than 85% in those recognized with hypertension. This was accomplished through systemic implementations of specific strategies: (1) capturing hypertensive members into a hypertension registry; (2) standardization of blood pressure measurements; (3) drafting and disseminating an internal treatment algorithm that is evidence-based and is advocating of combination therapy; and (4) a multidisciplinary approach using medical assistants, nurses, and pharmacists as key stakeholders. The infrastructure, support, and involvement across all levels of the health system with rapid and continuous performance feedback have been pivotal in ensuring the follow-through and maintenance of these strategies. The KPSC hypertension program is continually evolving in these areas. With these high control rates and established infrastructure, they are positioned to take on different innovations and study models. Such potential projects are drafting strategies on resistant hypertension or addressing the concerns about overtreatment of hypertension. PMID:24786445

Sim, John J; Handler, Joel; Jacobsen, Steven J; Kanter, Michael H



Health Hazard Evaluation/Toxicity Determination Report 73-135-138, Kaiser Permanente Cement Co., Lucerne Valley, California.  

National Technical Information Service (NTIS)

The National Institute for Occupational Safety and Health (NIOSH) in response to a request received from a representative of employees conducted a health hazard survey to evaluate exposures to free silica, asbestos, and iron oxide at the Kaiser Permanente...

L. B. Larsen



Health Library and Regional Health Library Services of the Kaiser-Permanente Medical Care Program, Northern California Region.  

National Technical Information Service (NTIS)

The Health Library at the Kaiser-Permanente Medical Center, Oakland, California was established in 1969 as one part of a larger research project designed to incorporate health education and health maintenance into a comprehensive medical care program so a...

C. Quay



The Readmission Reduction Program of Kaiser Permanente Southern California--Knowledge Transfer and Performance Improvement  

PubMed Central

In 2011, Kaiser Permanente Northwest Region (KPNW) won the Lawrence Patient Safety Award for its innovative work in reducing hospital readmission rates. In 2012, Kaiser Permanente Southern California (KPSC) won the Transfer Projects Lawrence Safety Award for the successful implementation of the KPNW Region’s “transitional care” bundle to a Region that was almost 8 times the size of KPNW. The KPSC Transition in Care Program consists of 6 KPNW bundle elements and 2 additional bundle elements added by the KPSC team. The 6 KPNW bundle elements were risk stratification, standardized discharge summary, medication reconciliation, a postdischarge phone call, timely follow-up with a primary care physician, and a special transition phone number on discharge instructions. The 2 additional bundle elements added by KPSC were palliative care consult if indicated and a complex-case conference. KPSC has implemented most of the KPNW and KPSC bundle elements during the first quarter of 2012 for our Medicare risk population at all of our 13 medical centers. Each year, KPSC discharges approximately 40,000 Medicare risk patients. After implementation of bundle elements, KPSC Medicare risk all-cause 30-day Healthcare Effectiveness Data and Information Set readmissions observed-over-expected ratio and readmission rates from December 2010 to November 2012 decreased from approximately 1.0 to 0.80 and 12.8% to 11%, respectively.

Tuso, Philip; Huynh, Dan Ngoc; Garofalo, Lynn; Lindsay, Gail; Watson, Heather L; Lenaburg, Douglas L; Lau, Helen; Florence, Brandy; Jones, Jason; Harvey, Patti; Kanter, Michael H



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

SciTech Connect

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.

Edwards, D.; Yoshimura, A.; Butler, D.; Judson, R.; Mason, W.; Napolitano, L.; Mariano, R. [Sandia National Labs., Livermore, CA (United States); Eddy, D.; Schlessinger, L. [Kaiser Permanente, Pasadena, CA (United States)



Promoting policy and environmental change using photovoice in the Kaiser Permanente Community Health Initiative.  


Creative ways must be found to engage both community residents and political leaders around policy and environmental solutions to public health issues. Photovoice is a community-based, participatory approach to documentary photography that provides people with training on photography, ethics, critical discussion, and policy advocacy. Photovoice projects have been implemented across the nation as part of Kaiser Permanente's Community Health Initiative-a community-based obesity prevention effort. This article focuses on the first Photovoice project implemented in three communities in Colorado. Photovoice themes related to healthy eating and active living include a lack of access to healthy food choices in stores and schools, unsafe street crossings and sidewalks, and the need to redevelop certain areas to encourage safe recreation. The involvement of policy leaders in the project combined with several dissemination activities has contributed to healthier food offerings in schools and neighborhoods and city planning efforts that emphasize walkability and access to healthy food, and park revitalization. PMID:19843702

Kramer, Leila; Schwartz, Pamela; Cheadle, Allen; Borton, J Elaine; Wright, Merrick; Chase, Charlie; Lindley, Corina



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

PubMed Central

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

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



Breaching the security of the Kaiser Permanente Internet patient portal: the organizational foundations of information security.  


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

Collmann, Jeff; Cooper, Ted



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


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

Pearl, Robert



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

SciTech Connect

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.

Edwards, D.; Yoshimura, A.; Butler, D.; Judson, R. [and others] [and others



Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data  

PubMed Central

Objective To compare the utilisation of hospital beds in the NHS in England, Kaiser Permanente in California, and the Medicare programme in the United States and California. Design Analysis of routinely available data from 2000 and 2001 on inpatient admissions, lengths of stay, and bed days in populations aged over 65 for 11 leading causes of use of acute beds. Setting Comparison of NHS data with data from Kaiser Permanente in California and the Medicare programme in California and the United States; interviews with Kaiser Permanente staff and visits to Kaiser facilities. Results Bed day use in the NHS for the 11 leading causes is three and a half times that of Kaiser's standardised rate, almost twice that of the Medicare California's standardised rate, and more than 50% higher than the standardised rate in Medicare in the United States. Kaiser achieves these results through a combination of low admission rates and relatively short stays. The lower use of bed days in Medicare in California compared with Medicare in the United States suggests there is a “California effect” as well as a “Kaiser effect” in hospital utilisation. Conclusion The NHS can learn from Kaiser's integrated approach, the focus on chronic diseases and their effective management, the emphasis placed on self care, the role of intermediate care, and the leadership provided by doctors in developing and supporting this model of care.

Ham, Chris; York, Nick; Sutch, Steve; Shaw, Rob



B4-1: An Overview of Kaiser Permanente's Research Program on Genes, Environment, and Health  

PubMed Central

Background/Aims The Research Program on Genes, Environment, and Health (RPGEH) is a large, population-based resource for genetic epidemiology developed by scientists at the Kaiser Permanente (KP) Northern California Division of Research. The goal of this program is to link research data for 500,000 broadly consented health plan members, including longitudinal electronic medical records (EMR), genomic data from biospecimens, and environmental exposure data from surveys and geographic information system (GIS) databases in order to support research on many different health conditions. Methods In 2011, the RPGEH established a state-of-the-art biorepository. The KP clinical lab infrastructure is used to collect and transfer blood samples to the biorepository where saliva, serum, plasma, buffy coat and extracted DNA samples are processed and archived. The biorepository includes a facility for separating blood into components for storage, as well as DNA extraction and normalization. Storage capabilities include ?80 C and ?20 C freezers, an ambient storage unit and LN2 freezers. The biorepository was designed to store blood components for up to 500,000 health plan members. Although initially participant recruitment was by postal mail, electronic methods of recruitment have now been developed. The goal of this effort was to decrease the per person cost of contact and to recruit younger members. By leveraging the KP EMR, blood draw orders are now automatically entered by RPGEH staff for consenting participants. These samples are then stored in the RPGEH biorepository and tracked in a Laboratory Information Management System. Results A survey of adult health plan members has provided data on health-related behaviors and other risk factors for 430,000 RPGEH participants. To date, 190,000 biospecimens from consenting RPGEH participants have been collected. Genome-wide genotyping and telomere length analysis of 100,000 RPGEH participants have been performed. Conclusions At >200,000 participants (with specimens for >100,000 genotyped), the RPGEH is already an extremely unique and valuable resource.

Schaefer, Cathy; Rowell, Sarah; Henderson, Mary; Walter, Lawrence; Sadler, Marianne; Miles, Sunita; Schaffer, Donna; Croen, Lisa; Jorgenson, Eric; Kushi, Lawrence; Quesenberry, Charles



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


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

Hinchman, Josephine; Beno, Luke; Mims, Adrienne



A retrospective analysis of health systems in Denmark and Kaiser Permanente  

PubMed Central

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.

Fr?lich, Anne; Schi?tz, Michaela L; Strandberg-Larsen, Martin; Hsu, John; Krasnik, Allan; Diderichsen, Finn; Bellows, Jim; S?gaard, Jes; White, Karen



Modèle mathématique pour l'étude des équilibres physico-chimiques de permanentes.  


Résumé La plupart des permanentes du commerce sont constituées d'acide thioglycolique (éventuellement associéà l'acide thiolactique), neutralisé par l'ammoniac, elles sont additionnées de carbonate d'ammonium comme tampon. Le système peut etre traité comme la neutralisation d'un mélange d'acides thioglycolique et carbonique par l'ammoniac, et il est complètement défini par trois paramètres, trois concentrations, ou deux concentrations et le pH, ou trois paramètres analytiques indépendants. Les calculs théoriques de l'équilibre sont compliqués du fait qu'il s'agit de l'équilibre de deux diacides faibles neutralisés par une base faible. Un modèle mathématique développé exclusivement par des équations théoriques permet l'interprétation des équilibres et la réalisation des calculs fiable pour la préparation des formules remplissant certaines caractéristiques. Le modèle permet de réaliser facilement des simulations en faisant varier les concentrations, les acides (par la voie des constantes de dissociation) ou d'associer différents acids et/ou bases organiques ou minérales. Une application complémentaire du modèle est de tracer la courbe dérivée à la courbe de neutralisation et de cette façon mesurer l'effet tampon en différents points par la mesure de sa pente. Synopsis Mathematical model for the study of physico-chemical equilibria in permanent wave solutions Most waving lotions on the market are prepared with thioglycolic acid (eventually associated with thiolactic acid) neutralized with ammonium hydroxide and buffered with ammonium bicarbonate. The system can be treated as the neutralization of a mix of carbonic acid and thioglycolic acid by ammonia and it is completely defined by three parameters: three concentrations; or two concentrations and pH; or three independent analytical parameters. Theoretical calculations of the equilibrium are difficult because the equilibrium involves at least two weak acids with a weak base. A mathematical model based exclusively on theoretical considerations allows the interpretation of equilibrium and performs accurate calculations of quantities of ingredients for preparations of permanent wave solutions satisfying special conditions. The model allows simulations by modifying concentrations, the acids (by using dissociation constants) or association between different acids and/or bases, organic or mineral. A complementary application of the model is the construction of a curve derived from the neutralization curve to evaluate the buffer effect at different points by the measure of the slope of the curve. PMID:19456957

Chiodi, F



The Kaiser Permanente Clinician Cultural and Linguistic Assessment Initiative: Research and Development in Patient-Provider Language Concordance  

PubMed Central

Patient–clinician language concordance is a critical component of the language access equation and is considered the gold standard for communication. As a result of lack of validated testing standards, measures, and tools, Kaiser Permanente developed the Clinician Cultural and Linguistic Assessment Initiative to ensure verifiable linguistic proficiency in clinical encounters and has established a standard level whereby the clinician is deemed to have a qualifying level of proficiency in communicating directly with patients independent of an interpreter. Our benchmarking efforts in language concordance have been rooted with the key aim to identify talented bilingual and bicultural clinician workforce and to establish the systems foundation to coordinate appropriate language services. We share accomplishments, lessons learned, and promising practices to inform future efforts in language concordance.

MSN, Gayle Tang; Lanza, Oscar; Rodriguez, Fatima Marinely; Chang, Annie



Measuring the impact of patient counseling in the outpatient pharmacy setting: the research design of the Kaiser permanente\\/USC patient consultation study  

Microsoft Academic Search

This article describes the research methods used to measure the impact of three alternative models of patient counseling in the outpatient pharmacy setting. The study was conducted in pharmacies operated by the Southern California region Kaiser Permanente Medical Care Program. Both random assignment and large-scale geographic area research designs were used. The presentation of the research design includes discussions of

Jeffrey S. McCombs; Marisue Cody; Kathleen Besinque; Gerald Borok; Daniel Ershoff; Susan Groshen; Joel Hay; Kathleen A. Johnson; Michael B. Nichol; Matthew T. Nye



Optimizing treatment of dyslipidemia in patients with coronary artery disease in the managed-care environment (the Rocky Mountain Kaiser Permanente Experience)  

Microsoft Academic Search

Rocky Mountain Kaiser Permanente has taken aggressive steps to ensure optimal treatment of all modifiable cardiac risk factors, especially low-density lipoprotein (LDL) cholesterol, in patients with coronary artery disease. In this article, we are presenting (1) the basic rationale for our approach, (2) the critical steps translating philosophy into practice, and (3) justification for all health plans to pursue a

John A Merenich; Tammy R Lousberg; Stacy H Brennan; Ned B Calonge



The Relationship Between Alcohol Consumption and Glycemic Control Among Patients with Diabetes: The Kaiser Permanente Northern California Diabetes Registry  

PubMed Central

BACKGROUND Alcohol consumption is a common behavior. Little is known about the relationship between alcohol consumption and glycemic control among people with diabetes. OBJECTIVE To evaluate the association between alcohol consumption and glycemic control. DESIGN Survey follow-up study, 1994–1997, among Kaiser Permanente Northern California members. PATIENTS 38,564 adult diabetes patients. MEASUREMENTS Self-reported alcohol consumption, and hemoglobin A1C (A1C), assessed within 1 year of survey date. Linear regression of A1C by alcohol consumption was performed, adjusted for sociodemographic variables, clinical variables, and diabetes disease severity. Least squares means estimates were derived. RESULTS In multivariate-adjusted models, A1C values were 8.88 (lifetime abstainers), 8.79 (former drinkers), 8.90 (<0.1 drink/day), 8.71 (0.1–0.9 drink/day), 8.51 (1–1.9 drinks/day), 8.39 (2–2.9 drinks/day), and 8.47 (?3 drinks/day). Alcohol consumption was linearly (p?

Karter, Andrew J.; Warton, E. Margaret; Doan, Jennifer U.; Weisner, Constance M.



La posesión como hecho punible  

Microsoft Academic Search

Este trabajo estudia el delito de posesión, el cual se extiende semánticamente hasta términos como custodia, mantener disponible, almacenar, etc., y como conminada con la pena se halla la posesión de explosivos, de armas de fuego, de drogas, de pornografía infantil, etc. En este mismo trabajo se analizan, bajo la óptica del Código Penal alemán, cómo las acciones graves o

Friedrich Christian Schroeder



Microsoft Academic Search

En la actualidad debemos considerar imprescindible, como premisa fundamental, la defensa de la persona ante las posibles arbitrariedades de los órganos de poder, así como otras que a menudo vulneran derechos que atañen al ciudadano. Quizás algunos crean que se trata de una quimera inalcanzable, otros, por el contrario, confían que puede ser posible. Sin embargo, considero que mientras los

Liechert García Rojas



PS3-16: Access and Collaboration with the Kaiser Permanente Research Program on Genes, Environment, and Health (RPGEH)  

PubMed Central

Background/Aims The Kaiser Permanente Northern California (KPNC) Research Program on Genes, Environment, and Health (RPGEH) provides a research resource to support investigations of environmental and genetic factors in the development of a wide variety of conditions. While the resource is still evolving with new data collection, it consists of data from surveys and electronic medical records on over 400,000 adult members of KPNC; biospecimens collected and stored on ~200,000 of these individuals; and data from genome-wide and telomere-length assays on ~110,000 of those who have contributed biospecimens; and linkage of these members to environmental, area-level databases. Methods The RPGEH was developed in part with the understanding that it would be made available to the scientific community for appropriate studies. An Access and Collaborations Core has developed procedures for submission of applications for research studies, their review, and decisions on approval and support. Review of proposals by an Applications Review Committee follows a two-step process, with a pre-application to assess feasibility (e.g., adequate numbers of the phenotype: availability of appropriate data, given inclusion criteria) and a full application to assess appropriateness of the study in the RPGEH context. Scientific merit; alignment with RPGEH guiding principles, including ethical, legal, and social implications; consistency with informed consents; potential overlap with prior approvals; and collaboration with a researcher affiliated with the Division of Research are among the criteria for approval. As an alternative for select analyses, genomic and selected phenotypic data will be available in the NIH database of genotypes and phenotypes (dbGaP) for the substantial subset of RPGEH participants who have consented to dbGaP deposition. Results As of October 31, 2012, the RPGEH has received 74 pre-applications and full applications for the use of its resources; only 6 pre-applications were not approved. In 2011–2012, 13 approved applications were funded by NIH and other agencies. Studies currently underway include genome-wide association studies of prostate cancer, bi-polar disorder, multiple sclerosis, and mammographic density. Conclusions Access to the unique and outstanding research resources of the RPGEH balances the mission of promoting research with the need to shepherd finite resources and safeguard member confidentiality.

Schaffer, Donna; Kushi, Lawrence; Henderson, Mary; Clancy, Heather; Somkin, Carol; Quesenberry, Charles; Jorgenson, Eric; Samelson, Allen; Whitmer, Rachel; Habel, Laurel; Barcellos, Lisa



Como Lo Hago Yo: Myelomeningocele  

PubMed Central

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.

Lazareff, Jorge



Health-Plan and Employer-Based Wellness Programs to Reduce Diabetes Risk: The Kaiser Permanente Northern California NEXT-D Study  

PubMed Central

Primary prevention of diabetes is increasingly recognized by both health plans and employers as an important strategy to improve the health of insured populations. As a part of the Natural Experiments in Translation for Diabetes (NEXT-D) network, the Kaiser Permanente Northern California (KPNC) Division of Research is assessing the effectiveness of 2 health plan-initiated programs to prevent the onset of diabetes in patients at high risk. The first study evaluates a telephonic health-coaching program that provides counseling on healthful eating, active living, and weight loss to KPNC members. The second evaluation examines a postpartum glucose screening and educational diabetes prevention program for women with gestational diabetes mellitus that KPNC implemented in 2006. Identifying effective approaches to preventing diabetes will be of value to health care systems, policy makers, and public health officials seeking to understand the roles systems and employers can play in preventing chronic illness.

Brown, Susan D.; Neugebauer, Romain; Adams, Sara R.; Adams, Alyce S.; Wiley, Deanne; Ferrara, Assiamira



A Comparison of Ambulatory Care and Selected Procedure Rates in the Health Care Systems of the Province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States  

Microsoft Academic Search

To determine if there are differences in physician services in different health care systems, we compared ambulatory visit rates and procedure rates for three surgical procedures in the province of Manitoba, Canada; Kaiser Permanente Health Maintenance Organization; and the United States. The KP system, with its single payer and low financial barriers, is not unlike the Canadian system. But, for

Carolyn A. DeCoster; Marvin Smoller; Noralou P. Roos; Edward Thomas




Microsoft Academic Search

El hombre es un ser potencialmente creativo, pues la creatividad se desarrolla a lo largo de toda nuestra vida, haciéndose necesario e importante que los docentes puedan potenciarla desde las primeras edades, correspondiendo a la escuela y a la educación, influir en la expresión creativa de nuestros educandos en la actividad cognoscitiva y para la vida. La creatividad como proceso

Yaina Martínez Viel; Dariela Pérez Obregón



EXAFS Study of Co/Mo Multilayers.  

NASA Astrophysics Data System (ADS)

The reduction of the measured moment in magnetic multilayers relative to the bulk value is a poorly understood phenomenon. This lack of understanding is clearly illustrated by two studies on Co/Mo where the reduced moment is attributed to two very different mechanisms. Sato reports a ``dead layer'', i.e., Co atoms near the Mo layers have no moment or a reduced moment(Noboru Sato, J. Appl. Phys. 63), 3476 (1988), while Wang, et al. report the presence of a non-magnetic compound--Co_7Mo_6.(Y. Wang, et al., J. Mag. Mag. Mater 102), 121 (1991). These studies report different saturation magnetizations for thicker Co layers; however, they agree that crystalline order vanishes as both layer thicknesses decrease and that magnetism decreases greatly for thinner Co layers. We have done structural and magnetic studies(C.L. Foiles, et al., MRS Symposium Proc. 384) (in press) on dc magnetron sputtered Co/Mo multilayers and find that the most striking feature is how the saturation magnetization scales with the apparent coordination number using EXAFS data with a Co standard. Data from the various studies will be compared.

Franklin, M. R.; Foiles, C. L.; Loloee, R.



Management of Lake Como: a multiobjective analysis  

SciTech Connect

This paper describes a heuristic approach for improving the performance of multipurpose reservoirs that have already been in operation for a certain number of years. The main characteristic of the method is that the analyst must first learn from the past experience of the manager and synthesize it into a simple operating rule. Then, the analyst must point out, with the help of the manager, what the acceptable modifications of such a rule are. After this has been accomplished, the optimal improvements of the operating rule can be obtained by using standard optimization techniques. Quite satisfactory results have been obtained by applying this approach to Lake Como (Northern Italy), which has been regulated since the end of World War II. In fact, the method shows that both flood protection on the lake shores and water supply to the downstream agricultural areas can be substantially improved, without lowering the mean yearly electricity production of the downstream run-of-river plants. For this reason the operating rule proposed by the method has been programmed on a microcomputer, which is now used every day by the manager as an essential support for his final decision. This and the fact that other actions suggested by this analysis have indeed been undertaken by the local authorities gave to this study the chance to have a positive and direct impact on the lake management.

Guariso, G.; Rinaldi, S.; Soncini-Sessa, R.



Como Lo Hago Yo: Mielomeningocele En Bolivia  

PubMed Central

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.

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



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

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

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


Co/Mo multilayers deposited by ion-beam sputtering  

NASA Astrophysics Data System (ADS)

Co/Mo multilayers have been prepared by using ion-beam sputtering. The samples had a periodic layered structure and an in-plane easy axis of magnetization. The structures of Co layers were disordered, fcc or fcc + hcp, depending upon the thickness of the Co layer ( tCo), as well as the thickness of the Mo layer ( tMo). A nonmagnetic compound, Co 7Mo 6, was observed to form at the Co/Mo interfaces, unlike compounds found in Co/Mo multilayers prepared by magnetron sputtering. The existence of this compound was considered to be an important reason for the decrease of the saturation magnetization of crystalline samples with tCo < 40 Å, among others. The dependence of the coercivity on tCo and/or tMo was also studied.

Wang, Y.; Cui, F. Z.; Li, W. Z.; Fan, Y. D.



Valorisation of Como Historical Cadastral Maps Through Modern Web Geoservices  

NASA Astrophysics Data System (ADS)

Cartographic cultural heritage preserved in worldwide archives is often stored in the original paper version only, thus restricting both the chances of utilization and the range of possible users. The Web C.A.R.T.E. system addressed this issue with regard to the precious cadastral maps preserved at the State Archive of Como. Aim of the project was to improve the visibility and accessibility of this heritage using the latest free and open source tools for processing, cataloguing and web publishing the maps. The resulting architecture should therefore assist the State Archive of Como in managing its cartographic contents. After a pre-processing consisting of digitization and georeferencing steps, maps were provided with metadata, compiled according to the current Italian standards and managed through an ad hoc version of the GeoNetwork Opensource geocatalog software. A dedicated MapFish-based webGIS client, with an optimized version also for mobile platforms, was built for maps publication and 2D navigation. A module for 3D visualization of cadastral maps was finally developed using the NASA World Wind Virtual Globe. Thanks to a temporal slidebar, time was also included in the system producing a 4D Graphical User Interface. The overall architecture was totally built with free and open source software and allows a direct and intuitive consultation of historical maps. Besides the notable advantage of keeping original paper maps intact, the system greatly simplifies the work of the State Archive of Como common users and together widens the same range of users thanks to the modernization of map consultation tools.

Brovelli, M. A.; Minghini, M.; Zamboni, G.



Morphological investigation of nanostructured CoMo catalysts  

NASA Astrophysics Data System (ADS)

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

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



Instrumentação seletiva na escoliose idiopática em curvas com modificador lombar B e C Selective fusion on idiopathic scoliosis in curves with B and C lumbar modifiers Instrumentación selectiva en la escoliosis idiopática en curvas con modificador lumbar B y C  

Microsoft Academic Search

Objective: to assess the surgical cor- rection of Adolescent Idiopathic Sco- liosis (AIS) with Selective fusion of the thoracic curves with pedicle screws in patients with B and C Lumbar Modi- fier and to verify the magnitude of correction and safety of the technique. Methods: prospective non random- ized case series study of patients with AIS, with Lenke curves 1B,

Roberto Sakamoto Falcon; Cristiano Magalhães Menezes; Marcos Antônio Ferreira Júnior; Daniel de Abreu Oliveira; Saulo Garzedim Freire




Microsoft Academic Search

RESUMEN En el presente estudio se evalúa la levadura Saccharomyces cerevisiae de forma desintegrada (LD) y tres fracciones celulares obtenidas de ella: complejo pared-membrana (FP), núcleo-proteínas (FN) y citoplasma (FC) como aditivo alimentario utilizando al crustáceo Artemia franciscana como modelo de experimentación. Se realizaron dos bioensayos para determinar el efecto que ejercían dichos aditivos en el crecimiento, biomasa seca, supervivencia

Yamilé Comabella; Tsai García-Galano; Olimpia Carrillo; Yadir Mauri


A emergência da categoria “agricultor familiar” como sujeito de direitos na trajetória do sindicalismo rural brasileiro  

Microsoft Academic Search

O processo de reconhecimento dos agricultores familiares como sujeitos de direitos apesar de ser recente quando pensado a partir da trajetória do sindicalismo rural brasileiro demonstra ter suas primeiras raízes ainda na constituição da legislação trabalhista-sindical dos anos de 1930. Visando explorar esse processo o artigo tem por objetivo analisar a emergência dos agricultores familiares como sujeitos de direitos na

Everton Lazzaretti Picolotto



Atomic-Scale Structure of Co–Mo–S Nanoclusters in Hydrotreating Catalysts  

Microsoft Academic Search

By means of scanning tunneling microscopy (STM), it has been possible to obtain the first atomic-scale images of the Co–Mo–S structure present in hydrodesulfurization (HDS) catalysts. Information on the catalytically important edge structures has been obtained by synthesizing single-layer Co–Mo–S nanoclusters using the Au(111) herringbone structure as a template. It is observed that the presence of the Co promoter atoms

J. V Lauritsen; S Helveg; E Lægsgaard; I Stensgaard; B. S Clausen; H Topsøe; F Besenbacher



Investigation of nanoindentation on Co\\/Mo multilayers by the continuous stiffness measurement technique  

Microsoft Academic Search

The mechanical properties of evaporated Co\\/Mo multilayers with periodicity of 4–16 nm were investigated. The microstructures of the films were analyzed using X-ray diffraction and transmission electron microscopy. Continuous stiffness measurement technique was used in the nanoindentation tests to determine the hardness and elastic modulus of the films. A Hall–Petch-like behavior is observed in the Co\\/Mo multilayers, in which the

G. H. Yang; B. Zhao; Y. Gao; F. Pan



XPS characterization of zirconium-promoted CoMo hydrodesulfurization catalysts  

Microsoft Academic Search

CoMo hydrodesulfurization catalysts (HDS) supported on mixed ZrO2-Al2O3 and ZrO2-SiO2 oxides have been prepared via a two-step impregnation using the incipient wetness method. The SBET method, X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS) were used for characterization of the samples. Increasing the ZrO2 content decreases the surface areas and the pore volumes of supported CoMo catalysts. The effect of

S Damyanova; L Petrov; P Grange



Mesoporous molecular sieve MCM-41 supported Co–Mo catalyst for hydrodesulfurization of petroleum resids  

Microsoft Academic Search

In this work, we explored the potential of mesoporous zeolite-supported Co–Mo catalyst for hydrodesulfurization of petroleum resids, atmospheric and vacuum resids at 350–450°C under 6.9MPa of H2 pressure. A mesoporous molecular sieve of MCM-41 type was synthesized; which has SiO2\\/Al2O3 ratio of about 41. MCM-41 supported Co–Mo catalyst was prepared by co-impregnation of Co(NO3)2·6H2O and (NH4)6Mo7O24 followed by calcination and

Kondam Madhusudan Reddy; Boli Wei; Chunshan Song




Microsoft Academic Search

RESUMO - Na área de empréstimo da Ilha da Madeira (13 m de decapeamento) são desenvolvidos um conjunto de medidas conservacionistas desde 1993. Os resultados visuais são lentos e, como estratégia de agilizá-los, desenvolvemos um manejo paisagístico das bordaduras, onde o cinturão vegetal é composto por espécies arbustivas e arbóreas selecionadas em função de sua rusticidade, características plásticas individuais e

Magna Cunha; Ricardo VALCARCEL


Planificación urbana versus autoregulación: la ciudad de Fortaleza (Brasil) como tablero de juego de diferentes agentes  

Microsoft Academic Search

Fortaleza es una ciudad relativamente jóven en cuanto a su importancia como metrópoli regional, caracterizándose sobre todo en las últimas décadas por una muy fuerte dinámica demográfica, económica y política. En este contexto el espacio urbano se ha convertido en una mercancía de alto costo, disputada entre los intereses contradictorios de compañías influentes, especuladores inmobiliarios, políticos y el resto de

Waltraud Rosner; Ulli Vilsmaier



Surface chemistry of model CoMo catalysts supported on planar. gamma. -AlâOâ  

Microsoft Academic Search

We have done some TPD work on our planar model catalysts and a planar aluminium oxide support. Benzene did not adsorb on a planar alumina surface significantly. Benzene adsorbed on the sulfied planar Co-Mo model catalysts significantly and the desorption starts at 450 K. We could not get enough information from this set of data due to evaporated of SiOâ

T. Sahin; W. K. Ford



O papel dos Larídeos como portadores de Salmonella e Listeria spp  

Microsoft Academic Search

Resumo: Tal como noutros países, a população de gaivotas (larídeos) aumentou exponencialmente em Portugal. Para averi- guar as implicações na Saúde Pública deste sobrecrescimento, duzentas e oitenta e cinco amostras de fezes de gaivotas foram analisadas para dois agentes potencialmente patogénicos para o Homem, Salmonella spp. e Listeria sp. Isolou-se Salmonella sp em trinta e sete amostras (13%). Os serotipos

E. L. Duartea; M. M. Guerra; F. M. Bernardo; CIÊNCIAS VETERINÁRIAS


Topical observations on centric diatoms (Bacillariophyceae, Centrales) of Lake Como (N. Italy)  

Microsoft Academic Search

In 2001 a qualitative analysis of the centric diatoms in Lake Como was made. In this work 15 taxa of the genus of Stephanodis- cus, Cyclotella, Melosira, Aulacoseira and Stephanocostis were recorded. Among them the taxa Cyclotella pseudostelligera, C. comensis, C. comensis morphotype minima, C. costei, Stephanodiscus minutulus and Stephanocostis chantaicus were of special in- terest to us with regard




Microsoft Academic Search

1. Introdução Este estudo tem por objetivo fazer uma reflexão, sob a luz da análise do discurso da linha francesa, acerca do humor na literatura, mais precisamente, da linguagem transgressiva que se instaura no discurso literário-teatral em decorrência de fenômenos como ironia e paródia. Esse enfoque será norteado a partir da peça Calabar - o elogio da traição (1973), de

Manuella Felicíssimo


El desarrollo de la creatividad a través del proceso docente como problema social  

Microsoft Academic Search

El artículo tiene como propósito reflejar aspectos sobre el desarrollo de la creatividad en estudiantes de Educación Inicial del Programa Nacional de Formación de Educadores y Educadoras (PNFE). En tal sentido el Problema científico es ¿Cómo perfeccionar los modos de actuación en los estudiantes del PNFE? El Objetivo está dirigido a la Elaboración de una metodología para favorecer el desarrollo

Magaly Sarmiento Romero



Land subsidence and Late Glacial environmental evolution of the Como urban area (Northern Italy)  

Microsoft Academic Search

The Late Glacial and Holocene geological and environmental evolution of the Como lacustrine–palustrine basin has been broadly reconstructed based on (a) the collection and analysis of more than 100 borehole stratigraphies, (b) the drilling of three new shallow boreholes and the analysis of a new geological section and (c) several in situ and laboratory analyses (mineralogical, organic and pollen content,

Valerio Comerci; Sabrina Capelletti; Alessandro M. Michetti; Sabina Rossi; Leonello Serva; Eutizio Vittori



Pregadoras murshidat como agentes de mudança no Marrocos: uma perspectiva comparativa  

Microsoft Academic Search

Resumo As feministas marroquinas tem como objetivo promover posições de poder para as mulheres através da educação, da auto- consciência e do conhecimento de novos direitos legais; e também disseminando informações a respeito do novo código da família e do novo código trabalhista por meio de suas ONGs e grupos comunitários. O ativismo das mulheres contribuiu de maneira significativa para

Moha Ennaji



Un estudio exploratorio sobre el desarrollo de creencias sobre síntomas como señales de hipertensión arterial  

Microsoft Academic Search

Aunque la hipertensión arterial es un trastorno asintomático, muchos pacientes hipertensos están con- vencidos de experimentar síntomas indicadores de los cambios en su tensión arterial (TA), y los con- sejos y prescripciones médicas pueden verse afectados por estas creencias. Diversos estudios han mos- trado que los pacientes hipertensos usan con frecuencia síntomas como indicadores del estado de su tensión arterial

Genoveva Granados Gámez; Jesús Gil Roales-Nieto; José Luis; Ybarra Sagarduy



Hydrologic flowpaths and biogeochemical cycles in the subalpine Como Creek catchment, Colorado Front Range, USA  

NASA Astrophysics Data System (ADS)

An outstanding question for snowmelt-dominated watersheds of the western US are the responses of biogeochemical processes to two major drivers of environmental change: directional changes in climate and increasing dissolved inorganic nitrogen (DIN) deposition in wetfall. In the Colorado Front Range, atmospheric deposition of DIN has increased several-fold in the last 25 years. In response, nitrate concentrations at the alpine Green Lakes 4 (GL4) catchment have increased from 1985 to 2009 by 0.27 ?eq L-1 yr-1. In contrast, we see no directional change in either nitrate concentrations or fluxes in the subalpine Como Creek catchment. We hypothesize that differences in surface/groundwater interactions result in the differing behavior of stream nitrate between the alpine and subalpine catchments that are receiving similar amounts of DIN from atmospheric deposition. For both basins we sampled precipitation, snowpack, snowmelt, surface water, and subsurface waters. All water samples are analyzed for geochemical, nutrient and isotopic (?18O, ?D) composition. Stream chemistry data from the last ten years at Como Creek show increases in nitrate concentration during baseflow conditions and then a sharp decline during snowmelt. In contrast, in the alpine basin there is sharp increase in surface water nitrate during snowmelt. Hydrograph separation at the alpine GL4 using end member mixing analysis (EMMA) shows that stream flow is a mixture of three components, groundwater, talus, and new snowmelt that each contribute to roughly a third of discharge, with talus flow supplying the majority of nitrate. In contrast, and somewhat surprisingly, EMMA shows that for the subalpine Como Creek basin, annual streamflow is a mixture of only two components, groundwater and new snowmelt. During snowmelt the groundwater and snow contributions are nearly equal and subsurface flows dominate the remainder of the year. Newly installed piezometers at Como Creek provide evidence that the basin is largely a losing reach during snowmelt, with water levels in the piezometers increasing 5-7 m. After peak snowmelt however, Como Creek becomes a gaining stream, with piezometer levels dropping. Thus, both EMMA and piezometers show that surface-groundwater interactions are tightly coupled during snowmelt, with snowmelt at Como first replenishing the subsurface water deficit and increasing groundwater levels before contributing to discharge. Thus, in contrast to the alpine GL4 basin, DIN released in snowmelt is assimilated belowground as snowmelt infiltrates the subsurface in the subalpine basin. Interestingly, at the subalpine Como Creek basin, isotopic and geochemical solute concentrations undergo shifts during periods of winter baseflow prior to snowmelt. In winter much of the stream is frozen and we hypothesize that cryo-concentration of solutes and fractionation of isotopes may influence the concentrations of winter stream samples.

Cowie, R. M.; Williams, M. W.; Zeliff, M. M.; Parman, J.



Trophic modifications in Lake Como (N. Italy) caused by the zebra mussel ( Dreissena polymorpha )  

Microsoft Academic Search

A large scale study on the western basin of Lake Como (N. Italy) was started in 1995 to examine the effects of the zebra mussel\\u000a colonization which began in early '90. Our results have been related to '91–92 data (pre-Dreissena period), before the maximum\\u000a colonization of zebra mussel. In spring and summer of the post-Dreissena period total phosphorus, P-PO4, nitrate

A. Binelli; A. Provini; S. Galassi



Megaturbidite deposits in the Holocene basin fill of Lake Como (Southern Alps, Italy)  

Microsoft Academic Search

For the first time, limnogeological investigations have been carried out in Lake Como, the deepest lake of the Alps, combining a bathymetric survey (multibeam Simrad 3000) with a high-resolution seismic reflection study (single-channel 3.5 kHz sub-bottom profiler) and a coring campaign (gravity corer). This data set enables detailed characterization of the sedimentary subsurface in the western branch of the lake, the

Daniela Fanetti; Flavio S. Anselmetti; Emmanuel Chapron; Michael Sturm; Luigina Vezzoli



Interseções entre cultura midiática, cibercultura e gamecultura: o Ragnarök como processo sociocomunicacional e mediador da conscientização ambiental  

Microsoft Academic Search

Os games on-line são estudados na atualidade como mídias interativas complexas. Neste artigo compreendemos os games on-line como resultados das relações entre a cultura midiática, cibercultura e gamecultura. Propomos demonstrar que sua finalidade está na socialização dos jogadores, nos \\

Igor Ramady; Lira de SOUSA; Henrique Paiva de MAGALHÃES



Microsoft Academic Search

Resumen: Revisión bibliográfica sobre el análisis de citas como método para el estudio del uso y las necesidades de información por parte de los investigadores como usuarios de bibliotecas. Una vez comparados los estudios locales basados en las publicaciones de los usuarios potenciales de una biblioteca con los estudios de análisis de citas basados en la bibliografía circulante a nivel

Cristóbal Urbano Salido



Hydrofining of Athabasca derived heavy gas oil over Ni-W and Co-Mo catalysts  

SciTech Connect

The hydrotreatment of heavy gas oil derived from Athabasca bitumen was studied in a trickle bed reactor over Ni-W and Co-Mo zeolite catalyst at 350-425/sup 0/C, 3.55 to 10.44 MPa, and LHSV of 1-4. The effects of temperature and liquid flow rates on the product were investigated. ASTM distillation, aniline point, viscosities and densities of the product oil were measured and correlated with various parameters. Activity of the catalysts for hydrodenitrogenation is compared.

Mann, R.S.; Diaz-real, R.



Characterization of K 2CO 3/Co-MoS 2 catalyst by XRD, XPS, SEM, and EDS  

NASA Astrophysics Data System (ADS)

MoS 2, Co-MoS 2 and K 2CO 3/Co-MoS 2 catalysts have been characterized by X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS). XRD analysis indicates that Co-MoS 2 is a primary phase in K 2CO 3/Co-MoS 2 catalyst and the diffraction lines of Co-MoS 2 are not changed by the addition of K 2CO 3. Co 9S 8 phase is not present at Co/Mo mole ratio of 0.5 using a co-precipitation method for preparation of cobalt-molybdenum catalyst. The binding energies (BEs) of chemical species present on the surface of the catalysts are compared through the course of catalyst preparation. K 2CO 3/Co-MoS 2 catalyst has been investigated as a function of dispersion of K on the surface and exposure to a mixture of carbon monoxide and hydrogen (syngas) by scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS). The distribution of potassium on the surface of the K-promoted catalyst is not uniform.

Iranmahboob, Jamshid; Hill, Donald O.; Toghiani, Hossein



A Utilização da Astronomia como Tema Interdisciplinar e Aplicações de Objetos de Aprendizagem  

NASA Astrophysics Data System (ADS)

Este trabalho visa analisar a possibilidade de relacionar conteúdos aplicados no ensino fundamental e médio de forma interdisciplinar por intermédio da astronomia, com a intervenção de objetos de aprendizagem que possam integrar as disciplinas e a utilização de recursos tecnológicos. Em uma pesquisa prévia com 20 professores de uma escola estadual situada na cidade de Guarulhos foi observado que apenas 25% dos professores utilizam algum recurso tecnológico para o desenvolvimento de conteúdos pertinentes à sua disciplina, tais como sites e softwares educativos, sendo que a maioria absoluta continua ensinando apenas com livros didáticos. A maior parte dos professores apresenta dificuldades em trabalhar sua disciplina de forma interdisciplinar, ou seja, 75% dos professores preferem aplicar os conteúdos seguindo uma hierarquia linear de tópicos, evitando a discussão de temas que de alguma forma estão relacionados. A astronomia pode vir à fascinar o ser humano e despertar sua curiosidade promovendo um maior interesse no aprendizado, podendo favorecer análises interdisciplinares de forma lógica e objetiva, desta forma colocar a astronomia como tema motivador interdisciplinar, pode ser relevante no que se refere ao distanciamento da fragmentação dos conteúdos. No Estado de São Paulo, a implantação da proposta curricular no ensino fundamental e médio mostra claramente a inserção da astronomia na maior parte das séries, principalmente na 6ª série em que todo o bimestre se fala de astronomia.

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



IR study of the interaction of phenol with oxides and sulfided CoMo catalysts for bio-fuel hydrodeoxygenation  

Microsoft Academic Search

The adsorption of phenol on supported sulfide CoMo catalysts and on oxides is investigated using IR spectroscopy. On silica, phenol mainly interacts via hydrogen-bonding, whereas on alumina it dissociates on the acid–base pairs of this oxide leading to the formation of strongly adsorbed phenolates species. On a sulfided CoMo catalyst supported on alumina, phenol dissociates on the support but does

Andrey Popov; Elena Kondratieva; Jean-Pierre Gilson; Laurence Mariey; Arnaud Travert; Francoise Maugé



Co–Mo catalysts for ultra-deep HDS of diesel fuels prepared via synthesis of bimetallic surface compounds  

Microsoft Academic Search

The synthesis of bimetallic Co–Mo compounds from ammonium heptamolybdate, citric acid and cobalt acetate for the preparation of catalysts for the ultra-deep hydrodesulfurization (HDS) of diesel fuel is reported. The structure of the Co–Mo compounds formed in solution and on alumina surfaces was studied by 95Mo, 17O, 13C, and 27Al NMR, FTIR, Raman and XAS spectroscopy. It was found that

Oleg V. Klimov; Anastasiya V. Pashigreva; Martin A. Fedotov; Dmitri I. Kochubey; Yuri A. Chesalov; Galina A. Bukhtiyarova; Alexandr S. Noskov




PubMed Central

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.

Silvia, Mejia-Arango; Clemente, y Zuniga-Gil



La valoraciòn econòmica de bienes y servicios ambientales como herramienta estrategica para la conservaciòn y uso sostenible de los ecosistemas  

Microsoft Academic Search

Resumen El trabajo corresponde a un estudio piloto hacia la implementación de una metodología que permita aproximar el valor monetario de los Bienes y Servicios Ambientales (BSA) ofertados por un ecosistema hídrico, caso “Ciénaga de la Caimanera, municipio de Coveñas, departamento de Sucre-Colombia”, como herramienta estratégica para incentivar la conservación y uso sostenible de los ecosistemas. Avanzar en procesos de




Transformaciones en el Discurso sobre la Epidemia al VIH como una Epidemia Sexuada - Paradojas y Enigmas en la Respuesta Global  

Microsoft Academic Search

Así como el discurso sobre sexualidad experimentó la influencia central de los procesos técnicos y políticos generados por la epidemia, igualmente el discurso global sobre la epidemia de SIDA a lo largo de tres décadas ha sido marcado por estos momentos cambiantes en el discurso sobre la sexualidad y su diversidad. Desde un momento inicial en que el SIDA fue

Carlos F. Cáceres



Microsoft Academic Search

RESUMEN Existen múltiples reportes del efecto genotóxico y cancerígeno del cromo VI, los seres humanos tenemos una permanente exposición a este elemento. Objetivos. Evidencias la genotoxicidad del dicromato de potasio utilizando como sistema biológico a Oreochromis niloticus \\

Zulita Prieto; Julio León-Incio; Carlos Quijano-Jara; Radigud Fernández; Edgardo Polo-Benites; Roger Vallejo-Rodríguez; Luis Villegas-Sanchez


Electrochemical stability of Co-Mo intermetallic compound electrodes for hydrogen oxidation reaction in hot KOH solution  

NASA Astrophysics Data System (ADS)

In order to obtain a hydrogen electrode with high-performance and stability for H 2-O 2 alkaline fuel cells, Brewer-type Co-Mo alloys are manufactured in the 35 to 57 wt.% Mo composition range by an arc-melting method. The electrochemical stability of alloys composed of Co 3Mo and Co 7Mo 6 phases is investigated in hot KOH solution deaerated with N 2 gas by means of electrochemical methods such as cyclic voltammetry, potentiostatic polarization and potentiodynamic polarization. Co-Mo alloy is extensively dissolved because the cobalt in alloy is soluble in hot KOH solution. The dissolution current of the alloys increases with increasing electrolyte temperature, electrolyte concentration and Mo content in the alloy.

Lee, Chang Rae; Kang, Sung Goon


Factors Affecting the use of Dreissena polymorpha as a Bioindicator: the PCB Pollution in Lake Como (N. Italy)  

Microsoft Academic Search

The aim of this study was to assess the PCB pollutionof the South-Western branch of Lake Como by using thezebra mussel (Dreissena polymorpha) as abioindicator since its recent reintroduction. Someenvironmental and physiological variables influencingaccumulation processes of organochlorine compounds inDreissena were investigated because climaticfactors may affect life cycle, reproductive stage andage. PCB levels were highest in the soft tissues ofDreissena close

A. Binelli; S. Galassi; A. Provini



A computa»c~ao numerica como ferramenta para o professor de F¶‡sica do Ensino Medio  

Microsoft Academic Search

A proposta deste trabalhoe apresentar ao professor de F¶‡sica do ensino medio uma forma de empregar recur- sos computacionais para esclarecer e aprofundar conceitos de F¶‡sica que s~ao explorados de forma limitada por n~ao se poder recorrer ao Calculo Diferencial e Integral. O p^endulo simplese usado como prototipo para o trata- mento sugerido. Mostramos que apenas com o aux¶‡lio de

Augusto Cesar; Claudio Gon; Marcus Vinicius; Tovar Costa


Hydrotreatment of Athabasca bitumen derived gas oil over Ni-Mo, Ni-W, and Co-Mo catalysts  

SciTech Connect

The hydrotreatment of Athabasca bitumen derived heavy gas oil containing 4.08% S and 0.49% N was carried out in a trickle bed reactor over Ni-W, Ni-Mo, and Co-Mo catalysts supported on zeolite-alumina-silica at 623-698 K, LHSV of 1-4, gas flow rate 890 m[sup 3][sub H2]/m[sup 3][sub oil] (5,000 sef/bbl), and pressure of 6.89 MPa. Analyses for viscosity, density, aniline point, ASTM mid boiling point distillation, C/H ratio, and percentage of N and S in the final product were carried out to characterize the product oil. The amounts of N and S removed indicated the hydrodenitrogenation and hydrodesulfurization activity of the catalysts. Results of zeolite-alumina-silica-supported catalysts are compared to those obtained with commercially available Ni-Mo, Ni-W, and Co-Mo on [gamma]-alumina. Ni-Mo supported on zeolite-alumina-silica was most active and could remove as much as 99 % S and 89% N present in the oil at 698 K. The data for HDN and HDS fitted the pseudo first order model. The kinetic model is described in detail.

Diaz-Real, R.A.; Mann, R.S.; Sambi, I.S. (Univ. of Ottawa, Ontario (Canada). Dept. of Chemical Engineering)



Comparing the hydrodesulfurization reaction of thiophene on ?-Al 2 O 3 supported CoMo, NiMo and NiW sulfide catalysts  

Microsoft Academic Search

The thiophene hydrodesulfurization (HDS) reaction on ?-Al2O3 supported CoMo, NiMo and NiW sulfide catalysts was compared in order to gain insight into the promoter effect on direct desulfurization\\u000a (DDS) and hydrogenation (HYD) pathways. Ni-promoted Mo (or W) sulfide catalysts favor the hydrogen transfer reactions relative\\u000a to CoMo sulfide catalyst, which facilitates the direct route instead. This different performance and also

Sergio L. González-Cortés



Como funciona un extintor  

NSDL National Science Digital Library

In this Spanish-language chemistry activity, learners use simple materials to explore how fire extinguishers work to put out fires. Safety note: this activity involves the use of a small candle with a burning flame.

Figueroa, Randall; Foundation, Cientec



Outcomes of the Kaiser Permanente Tele-Home Health Research Project  

Microsoft Academic Search

Context Level of acuity and number of referrals for home health care have been escalating exponentially. As referrals continue to increase, health care organizations are encouraged to find more effective methods for providing 0high-quality patient care with cost savings.

Barbara Johnston; Linda Wheeler; Jill Deuser; Karen H. Sousa



Duration of Hospital Stay and Post Myocardial Infarction Morbidity and Mortality: A Kaiser-Permanente Experience  

Microsoft Academic Search

Among 209 evaluable consecutive patients (mean age 57 years) admitted in 1978 and 1979 for acute myocardial infarction, 186 survived. The mean hospital stay of the survivors was 9.7 days. Of these patients, 99 (53%) with complicated myocardial infarction had a mean hospital stay of 11.2 days; 87 (47%) with uncomplicated infarction had a mean stay of 7.9 days.All patients

Achilles Skoulas; Robert G. Alloo; Myron H. Weisbart; Marc A. Manelis



Evaluation Test of the Kaiser Permanente Hospital Waste Incinerator in San Diego.  

National Technical Information Service (NTIS)

A series of emission tests were conducted on a hospital waste incinerator. The hospital waste incinerator burns up to 600 pounds per hour of infectious hospital waste. The objectives of the incinerator emission test were to characterize criteria and selec...

J. McCormack P. Ouchida G. Lew



Evaluation test of the Kaiser permanente hospital waste incinerator in San Diego  

SciTech Connect

A series of emission tests were conducted on a hospital waste incinerator. The hospital waste incinerator burns up to 600 pounds per hour of infectious hospital waste. The objectives of the incinerator emission test were to characterize criteria and selected non-criteria air pollutants released to the atmosphere. The criteria air pollutants were carbon monoxide, total hydrocarbons, sulfur dioxide, oxides of nitrogen, and total particulate matter. In addition, CO{sub 2}, and O{sub 2} were measured. Some of the selected non-criteria air pollutants included dioxins, furans, PCBs, semi-volatile organics, volatile organics, hydrogen chloride, hexavalent chromium, and mercury.

McCormack, J.; Ouchida, P.; Lew, G.



Brief Negotiation Program for Promoting Behavior Change: The Kaiser Permanente Approach to Continuing Professional Development  

Microsoft Academic Search

Background: Behavior change counseling is one of the most difécult and constant challenges faced by health providers. It has a signiécant impact on clinical outcomes as well as patient and provider satisfaction. By encouraging patients to participate in a partnership with health care professionals, Brief Negotiation offers techniques to motivate behavior change successfully. We review the key components of Brief




Phytoplankton assemblage structure and dynamics as indicator [-2pt] of the recent trophic and biological evolution of the western basin of Lake Como (N. Italy)  

Microsoft Academic Search

We studied the phytoplankton assemblage of the western basin of Lake Como (Northern Italy) during 1997. The phytoplankton assemblage was composed of 65 taxa, belonging to six taxonomic groups. Chlorophyta were represented by the highest number of taxa (28) followed by Bacillariophyceae (17), Cyanoprokaryota (9), Dinophyceae (6), Chrysophyceae (3) and Cryptophyta (2). The total assemblage density and biomass ranged from

R. Bettinetti; G. Morabito; A. Provini



Un estudio de los Institutos Nacionales de la Salud indica que dos dosis de vacuna contra los VPH pueden proteger tanto como el tratamiento completo

Dos dosis de Cervarix, la vacuna contra virus del papiloma humano (VPH), fueron tan efectivas como la pauta normal actual de tres dosis después de cuatro años de seguimiento. El estudio de vacuna en Costa Rica, patrocinado por el NCI, fue diseñado para evaluar la eficacia de Cervarix en una población determinada.


Respeito às Normas e Crescimento Econômico: Como Promotores Públicos Garantem o Cumprimento das Leis e Promovem o Crescimento Econômico no Brasil  

Microsoft Academic Search

Esta pesquisa examina como os membros do Ministério Público (MP) brasileiro conseguem que empresas instaladas em território nacional cumpram com a legislação trabalhista e ambiental sem perder a competitividade. Nos casos analisados, promotores e procuradores percebem que os gargalos que dificultam o cumprimento da lei estão freqüentemente fora das empresas infratoras e de suas respectivas cadeias de valor, e que,

Salo Vinocur Coslovsky



Extended x-ray absorption fine structure determination of the structure of cobalt in carbon-supported Co and Co-Mo sulfide hydrodesulfurization catalysts  

SciTech Connect

The structure of the cobalt present in carbon-supported Co and Co-Mo sulfide catalysts was studied by means of x-ray absorption spectroscopy at the Co K-edge and by X-ray photoelectron spectroscopy (XPS). Thiophene hydrodesulfurization activities were used to measure the catalytic properties of these catalysts. By comparison of the EXAFS and XANES spectra of the catalysts with those of Co{sub 9}S{sub 8} and CoS{sub 2} model compounds, it was concluded that all Co atoms in a catalyst prepared with nitrilotriacetic acid as complexing agent were in the Co-Mo-S state, while the Co atoms in a conventionally prepared catalyst were partly present in a Co{sub 9}S{sub 8}-like structure and partly in a Co-Mo-S structure. The Co atoms in the Co-Mo-S state have a distorted 5- to 6-fold sulfur coordination, and on the average, every Co atom is in contact with two Mo atoms at a distance of 2.80 {angstrom}. On the basis of these data, the most likely position for the Co atoms is in front of the square sulfur faces of the MoS{sub 6} trigonal prisms along the edges of the MoS{sub 2} crystallites with two additional sulfur atoms or H{sub 2}S molecules attached.

Bouwens, S.M.A.M.; Koningsberger, D.C.; de Beer, V.H.J.; Prins, R. (Eindhoven Univ. of Technology (Netherlands)); van Veen, J.A.R. (Koninklijke/Shell-Laboratorium, Amsterdam (Netherlands))



MODELO MATEMÁTICO PARA ESTIMAR EL ESPACIAMIENTO ENTRE DRENES SUBTERRÁNEOS EN RÉGIMEN TRANSITORIO Mathematical Model for Estimating Spacing Between Subterranean Drains in Transitory Regime  

Microsoft Academic Search

Para el diseño de sistemas de drenaje subterráneo existen diferentes modelos, tanto para régimen permanente, como transitorio; sin embargo, la mayoría de ellos no se han obtenido para condiciones de suelo y clima semiáridas. Por lo tanto, este trabajo tuvo como objetivo desarrollar una ecuación empírica para régimen transitorio que permitiera determinar el espaciamiento entre drenes paralelos, considerando los intervalos

Pablo Miguel Coras-Merino



Effect of the nature of the additives of metal cations (Sr, Ba, and La) on the properties of CoMo hydrodesulfurization catalysts  

Microsoft Academic Search

The effect of the nature of the support modified with the ions of alkaline earth and rare earth elements (Sr, Ba, and La)\\u000a on the properties of Co-Mo catalysts for the hydrodesulfurization of dibenzothiophene (DBT), 4-methyldibenzothiophene (4-MDBT),\\u000a and 4,6-dimethyldibenzothiophene (4,6-DMDBT) was studied using a set of physicochemical and catalytic techniques. It was found\\u000a that the introduction of modifying additives decreased

E. V. Korneeva; A. S. Ivanova; G. A. Bukhtiyarova; P. V. Aleksandrov; V. I. Zaikovskii; I. P. Prosvirin; A. S. Noskov



Low-cost and high-performance CoMoS4 and NiMoS4 counter electrodes for dye-sensitized solar cells.  


Porous chalcogels CoMoS4 and NiMoS4 made by a facile solution reaction displayed good electrocatalytic activity in the redox reaction of the I(-)/I3(-) shuttle. Dye-sensitized solar cells with these ternary compounds as counter electrodes (CEs) showed photovoltaic performance similar to the devices made with noble metal platinum CE (7.46%). PMID:24022304

Zheng, Xiaojia; Guo, Jiahao; Shi, Yantao; Xiong, Fengqiang; Zhang, Wen-Hua; Ma, Tingli; Li, Can




Microsoft Academic Search

Resumen Desde los años setenta y hasta la fecha muchos países han experimentado crisis bancarias. Estos fenómenos, que han sido ocasionados por un conjunto de factores macro y microeconómicos, tanto internos como externos, se han dado tanto en países desarrollados como en países en vías de desarrollo, demostrado la fragilidad del sistema financiero ante el crecimiento explosivo del volumen de

Mónica Isabel; López Cardoza


Effect of heat treatment on the crystalline structure of martensite in iron-, nickel-, manganese- and silicon-doped Co-W and Co-Mo alloys  

SciTech Connect

X-ray investigation of the crystalline structure of martensite of Co-W-Fe, Co-Mo (Fe, Ni, Mn, Si) single crystals is performed after quenching and preliminary aging in [alpha] and [beta] phases. Continuous decomposition of a and [beta] solid solutions at aging at temperatures 500 700C is observed. In Fe- and Ni-doped alloys the multilayer martensite polytypes are formed. In Co-Mo-Fe and Co-Mo-Ni single crystals such polytypes are found at the satellite stages of decomposition.

Nikolin, B.I.; Babkevich, A.Yu.; Izdkovskaya, T.V.; Petrova, S.N. (Academy of Sciences of Ukraine, Vernadsky, (Ukraine). Institute of Metal Physics)



Fibromialgia: o que é, como diagnosticar e como acompanhar?  

Microsoft Academic Search

SUMMARY The main objective of this article is to review the clinical characteristics, diagnóstic criteria and follow up methods of the fibromyalgia syndrome. The author also presents a brief historical review of the knowledge on this syndrome. It is also commented the necessity of this knowledge divulgation in order to obtain early diagnosis to improve the patients quality of life.

José Eduardo Martinez


Influence of the Additives and The pH On the Cobalt-Molybdenum (Co-Mo) Alloy Electrodeposited On n-TypeSilicon  

NASA Astrophysics Data System (ADS)

In this work, thin films of metal alloys (Co-Mo) have been electrodeposited onto silicon (Si) surface. The effects of two different additives (H3BO3 and Na2CO3) and the pH of the solution on the electrochemically deposited films (morphology, stochiometry…) have been investigated. The properties of the deposits were characterized by using X-Rays Diffraction (XRD), Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray Spectroscopy (EDS). The results show that the morphology and the film composition depend on both the pH of the solution and the additives. The presence of boric acid favors the Mo deposition. Crack-free homogeneous deposits with a low percentage of molybdenum can be easily obtained from high pH bath. The deposits were shown to exhibits a good crystalline structure.

Fekih, Z.; Ghellai, N.; Fortas, G.; Chiboub, N.; Sam, S.; Chabanne-sari, N. E.; Gabouze, N.


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.  


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

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



La biodiversidad como recurso estratégico  

Microsoft Academic Search

Con los nuevos desarrollos y avances ocurridos en los últimos años, vinculados al conocimiento genético, que motivaron que se desarrollara la lectura e interpretación del genoma humano, y que detonaron todo un sin fin de estudios (que se venia realizando a desde tiempos atrás), en los seres vivos del planeta principalmente animales y plantas, posicionaron a la biodiversidad de todo

Edgar Talledos Sánchez



Field Trial of the Efficacy of Dodecavalent Pneumococcal Vaccine at the Kaiser-Permanente Medical Center, San Francisco, California.  

National Technical Information Service (NTIS)

A field trial to assess the efficacy of a dodecavalent pneumococcal vaccine is being carried out. The vaccine has been administered to 6850 persons and 6750 volunteers have received placebo in a double blind fashion according to a computer program of rand...

M. A. Freid



Structure of the molybdenum sulfide phase in carbon-supported Mo and Co-Mo sulfide catalysts as studied by extended x-ray absorption fine structure spectroscopy  

SciTech Connect

The structure and dispersion of the active phase present in carbon-supported Mo and Co-Mo sulfide catalysts were studied by means of Mo K-edge EXAFS. In situ EXAFS measurements were carried out at liquid N{sub 2} temperature on freshly sulfided (at 673 K) catalysts. Due to the high signal-to-noise ratio of the experimental data, detailed information about the structural parameters of the active phase could be obtained. The catalysts probably consist of small MoS{sub 2}-like particles with an average local ordered structure of 5-6 Mo atoms (Mo/C) and 7-8 Mo atoms (Co-Mo/C). Comparison with literature data shows that the MoS{sub 2} dispersion in these carbon-supported catalysts is probably as good as in their alumina-supported counterparts. A detailed EXAFS data analysis shows the presence of carbon neighbors next to the Mo atoms in both catalysts with a Mo-C coordination distance of 2.1 {plus minus} 0.1 {angstrom}.

Bouwens, S.M.A.M.; Prins, R.; de Beer, V.H.J.; Koningsberger, D.C. (Eindhoven Univ. of Technology (Netherlands))



Indicadores de gestión urbana. Los observatorios urbano-territoriales para el desarrollo sostenible. Manizales, Colombia  

Microsoft Academic Search

Los Observatorios para el Desarrollo Sostenible del Municipio de Manizales en Colombia, hacen parte del Sistema de Monitoreo diseñado por el Municipio como apoyo a la gestión urbana local. A partir de los resultados de indicadores económicos, sociales y ambientales, los ciudadanos podrán evaluar de forma permanente el desempeño de programas y proyectos del Plan de Desarrollo Municipal y participar

Luz Stella Velásquez



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

NASA Astrophysics Data System (ADS)

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) ( 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.

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.



La mosca blanca Bemisia tabaci (Gennadius) como plaga y vectora de virus en fríjol común (Phaseolus vulgaris L.) The whitefly Bemisia tabaci (Gennadius) as pest and vector of plant viruses of common bean (Phaseolus vulgaris L.)  

Microsoft Academic Search

2 Resumen. La mosca blanca Bemisia tabaci es una de las plagas más ampliamente distribuidas en regiones tropicales y subtropicales del mundo donde afecta más de 600 especies de plantas cultiva- das y silvestres. Los daños que causa se deben a diversos efectos del insecto en las plantas atacadas, como el debilitamiento de la planta por la extracción de nutrientes;




Dinámica del sistema agroforestal de chagras como eje de la producción indígena en el Trapecio Amazónico (Colombia) Chagras' agroforestal system dynamics as the basis for indigenous production in the Amazonian Trapezium (Colombia)  

Microsoft Academic Search

Resumen: La tradición indígena, la pertenencia a la cuenca Amazónica y la cercanía a un importante centro urbano como Leticia (Amazonas, Colombia) son factores que aportan elementos característicos al sistema de producción de Ciudad Jitoma y lo dife- rencian de otras formas de producción indígena y no-indígena, incluso dentro de la misma región ama- zónica. En el presente estudio se

Luz Amparo Triana-Moreno; Nohra Cecilia Rodríguez; Jesús García


Como Lo Hago Yo: Lipomas Medulares  

PubMed Central

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

Portillo, Santiago



Textile wastewater reuse in northern italy (COMO)  

Microsoft Academic Search

An extensive research programme has been carried out on advanced treatment of secondary effluents discharged by centralized activated sludge treatment plants fed on mixed textile\\/domestic effluents in order to produce a final effluent suitable for reuse in the textile factories. Activated carbon adsorption or membrane filtration (ranging from microfiltration to reverse osmosis) have been investigated at pilot plant scale in

A. Rozzi; F. Malpei; L. Bonomo; R. Bianchi




Microsoft Academic Search

Recibido: 07\\/12\\/04 Aceptado: 01\\/03\\/05 RE SU MEN Mediante la utilización de un muestreo factorial estratificado con 4 repeticiones (3x3x4) se seleccionaron 36 parcelas permanentes de medición en plantaciones de teca en la zona oeste de la cuenca del Canal de Panamá. En la estratifi- cación se emplearon como criterios el incremento medio anual (IMA) en altura total y la pendiente

Manuel Mollinedo; Luis Ugalde; Alfredo Alvarado; Jean Mark Verjans; Luis Carles Rudy



Composantes permanente et transitoire de l'épargne et de l'investissement : une étude empirique des flux internationaux de capitaux au Japon  

Microsoft Academic Search

[eng] Transitory and permanent components of saving and investment: an empirical study of . international capital flows in Japan by Eric Girardin, Lucio Sarno and Mark P. Taylor . This paper presents an empirical study of the difference between the short- and the long-run saving-investment correlation coefficient using quarterly Japanese data, in an attempt to shed light both on the

Mark P. Taylor; Lucio Sarno; Éric Girardin



Du management à la gouvernance ou la permanente réinvention de l’eau tiède (From management to governance the endless process of reinventing the wheel)  

Microsoft Academic Search

Le management est l’art de diriger efficacement une organisation en vue d’atteindre les effets désirés avec le minimum de gaspillage. Outre la rationalisation, cela nécessite du charisme : un manager extrait de l’angoisse de son organisation et y instille de l’enthousiasme. Ainsi défini, et contrairement à une idée reçue, le management n’est pas né dans l’Amérique des années 1920. Il




B4-5: Neighborhood Deprivation and Telomere Length: Preliminary Findings from the Kaiser Permanente Research Program on Genes, Environment, and Health (RPGEH)  

PubMed Central

Background/Aims Shortened telomeres have been associated with numerous adverse health outcomes. In addition, a number of environmental or external exposures, including smoking, air pollution and stress, have been reported to be associated with short telomeres. We sought to examine how neighborhood quality of participants in the RPGEH Genetic Epidemiology Research Study on Adult Health and Aging (GERA) cohort affected telomere length. Methods The GERA cohort is a multi-ethnic cohort (average age = 63 years) of over 100,000 individuals with linked electronic medical records and questionnaire data. Telomere length was determined from a saliva sample in the Blackburn Laboratory using the novel Automated Telomere Length Analysis System (ATLAS) to handle the required high throughput processing of samples. Each sample was assayed six times using qPCR. Relative telomere length (T/S) was obtained from the initial concentrations of the sample telomere (T) with the corresponding sample reference gene (S). The distribution of (T/S) was found to be positively skewed and a log transformation was used to normalize the distribution. The final telomere length end point was the difference in adjusted means of telomere length per standard deviation unit by accounting for age and gender. The NDI is a standardized composite score of neighborhood quality derived from eight 2000 US Census data variables related to poverty/income, occupation, family structure, education and unemployment and normalized to a 100-point scale at the block-group level. Results A higher NDI indicates greater neighborhood deprivation. The NDI was linked with residential address at time of sample collection. We observed a pattern of shorter telomere length with increasing level of neighborhood deprivation. The pattern persisted even after accounting for age, gender, race/ethnicity, smoking, BMI, and the presence of cardiovascular disease, diabetes and other comorbidity. Conclusions Our results suggest that neighborhood can adversely impact telomere length. Future plans will be discussed.

Van Den Eeden, Stephen; Kvale, Mark; Shan, Jun; Lapham, Kyle; Ranatunga, Dilrini; Rowell, Sarah; Sadler, Marianne; Ludwig, Dana; Walter, Lawrence; Whitmer, Rachel; Quesenberry, Charles



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

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.

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



A indústria petroquímica no próximo século: como substituir o petróleo como matéria-prima?  

Microsoft Academic Search

THE PETROCHEMICAL INDUSTRY IN THE NEXT CENTURY: HOW TO REPLACE PETROLEUM AS RAW MATERIAL. The world reserves of petroleum will finish in about 100 years. For a tropical country like Brazil, biomass will be the natural substitute for petroleum. For the best utilization of biomass, it first needs to be separated into its principal components: cellulose, hemicelluloses, lignins, vegetable and

Ulf Schuchardt; Marcelo L. Ribeiro; Adilson R. Gonçalves



Como Lo Hago Yo: Tratamiento Quirurgico Del Mielomeningocele  

PubMed Central

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.

Portillo, Santiago



Las líneas de aluminio neutro como diagnóstico cromosférico  

NASA Astrophysics Data System (ADS)

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.

Fernández Borda, R.; Mauas, P. J. D.



Microsoft Academic Search

Games are widely recognized , without exemption of race, creed and ide- ology. Its origins are traced back to Greece civilization. The Helenic idea of the game appears in the epic of Homer and Hesiod, it was conceived as the notion of Physical power, then it becomes paidea as the innocent game of children. *Este trabajo ha sido financiado por

Carmen Minerva Torres


Como Planear Mi Vida = Make a Life for Yourself.  

ERIC Educational Resources Information Center

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…

Haffner, Debra; Casey, Sean



Microsoft Academic Search

This article aims to reflect about the production and implementation of interactive exercises created with the Hot Potatoes software in Foreign Language classes. These exercises were applied to High School students at Prieto Martinez State School in Curitiba. The activities were made available on a web site and the students accessed them in the school computer laboratory. The Hot Potatoes





Microsoft Academic Search

RESUMEN Cada día que pasa, más países, más profesionales y más empresarios en el contexto global se interesan, estudian y aplican estándares internacionales de información financiera. En Colombia, estudiantes, profesores, profesionales y empresarios, también han venido acercándose al tema, muchos de ellos por necesidad, otros por curiosidad y otros para poder participar en las continuas disertaciones y confrontaciones que se

Helio Fabio Ramirez Echeverry; Luis eduardo Suarez Balaguera



La inulina y derivados como ingredientes claves en alimentos funcionales  

Microsoft Academic Search

e - r e s ). SUMMARY. Inulin and derivates as key ingredients in functional foods. Inulin is a non-digestible carbohydrate that is contained in many vegetables, fruits and cereals. It is industrially produced from the chicory's root (Cichorium intybus) and it is widely used as ingre- dient in functional foods. Inulin and its derivate compounds (oligofructose, fructooligosaccharides) are usually

Lorena Madrigal; Elba Sangronis



COMO: A UML-Based Component Development Methodology  

Microsoft Academic Search

Many organizations have begun to consider implementing applications using reusable components. They envision that writing a component once and reusing it in many subsequent software systems will effectively amortize the development cost among all users. Recent technology advances such as JavaBeans\\/EJB, COM, CORBA, and others spur this interest. However, the systematic development process and practical instructions for building software components

Sang Duck Lee; Young Jong Yang; Eun Sook Cho; Soo Dong Kim; Sung Yul Rhew



Understanding Your Child's Learning Differences = Entienda como aprende su hijo.  

ERIC Educational Resources Information Center

Children who are bright and hard-working, yet find school a struggle, or children who can discuss things they have learned but whose written work is of surprisingly poor quality, might have learning differences that are hindering them from reaching their full potential. Some children are visual learners, others are auditory learners, and others…

Fielding, Elizabeth N.


Las técnicas GPS como herramienta en la gestión ambiental  

Microsoft Academic Search

RESUMEN El presente artículo describe el sistema GPS y sus aplicaciones de manera general y con relación a la gestión ambiental, Se hace referencia a estudios re- lativos a múltiples aplicaciones, estudios que ya se han realizado con un nota- ble éxito. De este artículo se desprende que el sistema GPS es totalmente via- ble en el campo y en

Roberto Rodríguez-Solano Suárez; Santiago Mancebo Quintana


Problematização como estratégia de educação nutricional com adolescentes obesos  

Microsoft Academic Search

Obesity is a public health issue with relevant social determinants in its etiology and where interventions with teenagers encounter com- plex biopsychological conditions. This study evaluated intervention in nutritional education through a problem-posing approach with 22 obese teenagers, treated collectively and individ- ually for eight months. Speech acts were collected through the use of word cards, observer recording, and tape-recording.

Érika Marafon Rodrigues; Maria Cristina Faber Boog



A narrativa como uma técnica de pesquisa fenomenológica  

Microsoft Academic Search

Narrative as a phenomenological research technique.. The focus of this paper is the narrative as a modality of phenomenological research according to Walter Benjamin's conception. Using narratives, the author discusses the theoretical and methodological framework of phenomenology, based on heideggerian ontology and on the phenomenological and existential psychology. The purpose of this discussion is to demonstrate that experience, as a

Elza Dutra



Como Iniciar una Cooperativa (How to Start a Cooperative).  

National Technical Information Service (NTIS)

This is a step-by step detailed guide to forming a cooperative, beginning with promotion, and going on to cover the following topics: The first meeting of potential members; work of the planning committee; second meeting of potential members; work of the ...

I. W. Rust



Como Organizar una Cooperativa (How to Organize a Cooperative).  

National Technical Information Service (NTIS)

Four pamphlets explain co-ops in general, co-ops as businesses, how co-ops succeed and how to form a co-op. Co-ops in the American Private Enterprise System compares co-ops with other businesses. The Business Co-op explains how a co-op can function as a p...



Desulfurization of benzenethiol on Co?Mo(110) phases  

Microsoft Academic Search

The desulfurization of benzenethiol on Co-covered Mo(110) (?Co = 0.25–1.3 ML) produces benzene, H2 and adsorbed carbon and sulfur. Benzene is formed via adsorbed phenyl thiolate, which is identified by X-ray photoelectron and electron energy loss spectroscopies. Benzene production is attributed to reaction on Co, since it is evolved at a temperature well below that required for sulfur-induced aggregation of

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



Geoprocessamento aplicado ao mapeamento dos impactos socioambientais decorrentes das formas de uso da terra nas Áreas de Preservação Permanente (APPs) da Represa de Salto Grande no município de Americana (SP)  

Microsoft Academic Search

The Dam of Salto Grande, occupying an area of 10.5 km2, is located in the hydrographical basin of the Atibaia River, important tributary of the Piracicaba River, in the State of São Paulo. It takes care of, in the present time, to the inhabitants of the cities of Americana, Paulínia and Nova Odessa, that also use the source for activities

Joyce Rodrigues da Cruz


B4-3: Demographic and Behavioral Influences on Telomere Length and Relationship with All-Cause Mortality: Early Results from the Kaiser Permanente Research Program on Genes, Environment, and Health (RPGEH)  

PubMed Central

Background/Aims Telomere shortening is a biomarker of aging, but it is still unclear whether it directly influences aging-related health changes and mortality, or largely reflects the accumulating influences of environmental influences and declining health. Prior studies have reported associations between short telomeres and many health conditions. Mendelian syndromes and heritability studies demonstrate the biological underpinnings of telomere length (TL), yet other studies show that environmental and behavioral factors also influence telomere lengths. Methods As part of the RPGEH, the Genetic Epidemiology Research Study on Adult Health and Aging (GERA), a multi-ethnic cohort (average age = 63 years) has measured TL from saliva samples on over 100,000 individuals with linked electronic medical records. A survey of demographic and behavioral factors was conducted 2 years prior to saliva collection. With these data, we examined demographic relationships with TL, behavioral influences, and relationship of TL with all-cause mortality following sample collection. Results As expected, TL is inversely correlated with age, and women have longer telomeres than men except as young adults. All analyses controlled for age and gender. As seen in other studies, we find significantly longer TL among African Americans than other groups. TL is positively correlated with education and body mass index (BMI), and negatively correlated with cigarette smoking and alcohol consumption. We found no relationship with major depression or stress-related disorders, even when limited to recent episodes. We found that short TL was prospectively associated with mortality, although only those with the shortest TL were at increased risk; the association suggested a critical threshold of short TL determines effects on mortality. The association persisted even after adjustment of the demographic and behavioral factors such as age, sex, race, education, BMI, smoking, and alcohol consumption. Conclusions While this could indicate a direct effect of TL on health, it will also be important to examine the extent of pre-existing morbidities in these individuals to understand their possible role in the pathway between TL and longevity.

Schaefer, Cathy; Sciortino, Stan; Kvale, Mark; Lapham, Kyle; Ranatunga, Dilrini; Rowell, Sarah; Sadler, Marianne; Ludwig, Dana; Walter, Lawrence; Van den Eeden, Stephen; Whitmer, Rachel



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

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,…

Garcia, Ricardo L.; Deyoe, Rita Maxine



Microsoft Academic Search

This paper aims at collecting data that demonstrate the importance of the playful activities in literacy, since plays and ludic activities in according to the scholars are effective experiences that relate to the environment and must be applied in children in school phase. It has searched theoretical fundament for sustentation of ideas, reflections and concepts in expressive authors who approach

Lindaura Morais Azevedo



Microsoft Academic Search

Marine yeasts comprise a group of microorganisms which existence has been questioned. As a result, the knowledge about its physiology and biotechnology use is scarce. The ecological importance of the marine yeasts is due, at least in part, to their contribution in the ocean's organic matter recycling. In addition, they are valuable sources of biological reagents, cell protein, vitamins, pigments,

Mar Bermejo



Erupción cutánea eritematosa como primera manifestación de leucemia linfática prolinfocítica de células T  

Microsoft Academic Search

We present a case of a man 84 years-old, whose presentation feature was a cutaneous inespecific rash, and was diagnosed of T prolymphocy- tic leukaemia (T-PLL). In this review we analize actual aspects concer - ning biology, diagnosis, classification, prognosis and treatment of this rare mature T cell leukaemia.

L. Beltrán Fernández; B. di Martino Ortiz; J. GiI Herrera; J. A. López-Herce; J. de Portugal Alvarez; J. Menárguez Palanca



Envelhecimento, Condições de Vida e Política Previdenciária. Como ficam as mulheres?*1  

Microsoft Academic Search

1 INTRODUÇÃO Historicamente, os sistemas previdenciários foram constituídos com base nos contratos de gênero, onde o homem assumia o papel de provedor e a mulher, o de cuidadora da casa, das crianças, dos idosos, ou seja, dos dependentes. Isso delimitava, claramente, a posição de dependência da mulher para o sistema. Desde a segunda metade do século passado, tem-se observado mudanças

Ana Amélia Camarano; Maria Tereza Pasinato



Microsoft Academic Search

This article has the object to present an analysis about the importance of managerial games as a pedagogic tool in some business ad- ministration programs in Bogotá D.C. In order to achieve this, a bibliographic review of works developed about managerial games was made, both in international and national scopes, as well as a fi eld work in fi ve




Inmigración y barbarie. La construcción social y política del inmigrante como amenaza  

Microsoft Academic Search

Immigration and barbarism. The social and political construction of the immigrant as it threatens This text analyzes the topic of the nowadays close relation between the international migra- tion and the resurgence of the racist ideas and behaviors. To explore the density of this topic, it leaves from a dynamic and constructivist perspective that, insisting on the complexity of the

Enrique Santamaría



El tractocile como tratamiento de mantenimiento en la amenaza de parto prematuro en casos seleccionados  

Microsoft Academic Search

Preterm delivery is one of the main causes of perinatal morbidity and mortality. The management of this entity is an unresolved issue in modern obstetrics, since its incidence has not decreased.Currently, tocolytic treatment in acute episodes of preterm labor is maintained for 48h to induce lung maturation pharmacologically. However, the ideal situation is to prolong pregnancy until a healthy, term

M. Pato; C. Varillas; P. Frade; D. Gómez-Sánchez; L. Castro-Vilar; S. Blanco




Microsoft Academic Search

Sandvik Bioline High-N and 316 LVM are two austenitic stainless steels specially developed to applications as biomaterials. Their localized corrosion resistance were investigated using electrochemical methods including potentiodynamics cyclic polarization and potentiostatic polarization, in a salt solution attenuated by fosfate and in solution for simulated crevices, i. e., solutions planned for tests of crevice corrosion. Sandvik SAF 2507 (a high-performance

C. Ulfvin


Metanol como combustivel: avaliacao da contaminacao atmosferica. (Methanol as fuel: evaluation of atmosphere contamination).  

National Technical Information Service (NTIS)

With the beginning of methanol use as automotive fuel in Sao Paulo city, 1990, Special measurements of methanol, formaldehyde, ethanol and acetaldehyde in atmosphere were realized. Other indicators of air quality such as carbon and ozone monoxide were als...

C. D. Alonso J. Romano M. L. G. Guardani



Fibra solúvel e amido como fontes de carboidratos para terminação de novilhos em confinamento  

Microsoft Academic Search

The effects of starch or neutral detergent soluble fiber associated with two dietary levels of NDF on performance of finishing feedlot beef steers were evaluated in this trial. Twenty-four crossbred ½ Angus x ½ Nellore steers averaging 18 months of age and 329 ± 24 kg of body weight at the beginning of the trial were used. All four diets

Cristian Faturi; Jane Maria Bertocco Ezequiel; Nivia Araujo Fontes; Marcelo Gil Stiaque; Octávio Guilherme da Cruz e Silva




Microsoft Academic Search

Based on the cognitive distinction between tourist and native spaces, the article establishes the anthropological construction of tourism space. Since the early times of tourism in El Puerto as a seaside resort, the beach was both a healthy and a ludic space. The article analyses the causal relation among class society, leisure and health and the histocial conection between tourism

Antonio Miguel; Nogués Pedregal



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

ERIC Educational Resources Information Center

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

Worthy, Jo



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

ERIC Educational Resources Information Center

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…

Paulu, Nancy; Martin, Margery


Reappearance of Human Diphyllobothriasis in a Limited Area of Lake Como, Italy  

Microsoft Academic Search

Background: Very few sporadic cases of autochthonous diphyllobothriasis have been reported in Italy during the past 20 years, probably\\u000a due to the drastic decrease or disappearance of some fish species, mainly Perca fluviatilis L, known as the intermediate host of the infective larval stage of this tapeworm. However, increasing consumption of raw\\u000a or undercooked fish during the last years as

R. Terramocci; L. Pagani; P. Brunati; S. Gatti; A. M. Bernuzzi; M. Scaglia



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

ERIC Educational Resources Information Center

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

Rockefeller Foundation, New York, NY.



Microsoft Academic Search

This work reports investigation results about Didactic and Teaching History Methodology published in Brazil during XX century. Aimed at teachers, the manuals might be taken as sources to investigate the presence of elements which, in specifical historical times, delimited the manners of thought and the manners of developing teaching in this country. The reflections brought by this work are part

Maria Auxiliadora Schmidt; Maria F. Braga Garcia



Microsoft Academic Search

RESUMO A presença cada vez mais marcante das tecnologias de comunicação e informação no cotidiano dos sujeitos tem alertado aos profissionais da educação para a necessidade de construir e utilizar a potencialidade dessas ferramentas. O objetivo deste artigo é mostrar que os pressupostos da Teoria da Complexidade, num ambiente virtual, contribuem de forma decisiva para potencializar a aprendizagem da língua

Dulci Marlise BOETTCHER


Vinhoto e cama de frango como coadjuvantes na compostagem de bagaço de cana de açúcar  

Microsoft Academic Search

Resumo: Atualmente, a agricultura está passando por um proc esso de modernização, trazendo com isso inúmeros fatores negativos que influenciam na degradação do meio ambiente. Dejetos estão sendo jogados em lugares impróprios trazendo danos ao ar, solo e águas. Percebendo a gravidade deste problema, este trabalho foi realiza do visando contribuir para o melhoramento das condições ambientais e propor renda

Fernando Lira; Renato Cassol de Oliveira



Guia Practica: Como Manejar Abejas Africanizadas (Practical Guide: How to Manage Africanized Bees).  

National Technical Information Service (NTIS)

The report discusses beekeeping equipment and methods, including beehive construction and dismantling. Covered are characteristics of African bees as compared with European types. Also, addresses various disease symptoms and general management.

R. Bailey D. Anderson



Geni e o Zepelim X Bola de Sebo : a intertextualidade vista como um procedimento de originalidade  

Microsoft Academic Search

The aim of the comparative analysis between the intertextual variant Geni e o Zepelim , written by Chico Buarque de Holanda, and the basis text Boule de Suif , written by Guy de Maupassant, is to prove that, despite recovering another's discourse, intertextuality adds to the originality of the creation undertaken by the subject's enunciation variant. Such statement is justified

Fernanda Isabel Bitazi


O diafragma como método contraceptivo: a experiência de usuárias de serviços públicos de saúde  

Microsoft Academic Search

This study, started in August 1989, describes the acceptability of diaphragms as part of the daily routine of 194 women enrolled at five public health care centers in Osasco, (Greater São Paulo). Follow-up of the cohort was performed by semestral home interviews until August 1991. Our data indicate that the diaphragm can be a viable alternative within the public health

Suzana Kalckmann; Tania Giacomo do Lago; Regina Maria Barbosa; Wilza Villela; Samuel Goihman



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

ERIC Educational Resources Information Center

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

de la Piedra, Maria Teresa



Fluoroquinolonas respiratorias como antibiótico de primera línea en neumonía adquirida en la comunidad, posición en contra  

Microsoft Academic Search

The newer fluoroquinolones are active against most of the potencial pathogens of community acquired pneumonia (CAP), and have high bioavailability and low toxicity. They could be considered a first line option for CAP. Ciprofloxacin presents low resistance rates for S. pneumoniae, but an increasing incidence of resistance among enterobacteriaceae. Quinolones' resistance is growing, in Hong Kong achieved 13.3%. In Argentina

Autores Alfredo Monteverde; Charles Feldman; Alfredo Monteverde


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

PubMed Central

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.

Gonzalez, Juan Bosco



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

ERIC Educational Resources Information Center

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

Macgillivray, Ian K.




Microsoft Academic Search

Acidulated phosphate rock as phosphorus source in limed and non-limed acid soils Partial acidulation of the phosphate rock (PR) with sulfuric acid (SA) has been successfully used to improve its solubility and increment the agronomic effectiveness of this P source. To prove the efficiency of PR acidulated with SA and\\/or ammonium thiosulfate (ATS), two greenhouse experiments were conducted with potted

Armando Morillo; Omaira Sequera; Ricardo Ramírez



Los derechos de participación como elemento de integración de los inmigrantes  

Microsoft Academic Search

Este informe pretende ofrecer un análisis de la relación entre las diferentes formas de participación social y política de las personas inmigrantes y el proceso de integración en las sociedades de acogida. La integración política de los extranjeros está estrechamente relacionada con los actuales debates sobre la ciudadanía y la inmigración, y se ha convertido en una cuestión emergente en

de Lucas Martín Javier; Añón Roig María José; Galiana Saura Ángeles; García Añón José; Mestre i Mestre Ruth; Miravet Bergón Pablo; Ruiz Sanz Mario; Simó Noguera Carles Xavier; Solanes Corella Ángeles; Torres Pérez Francisco


Utilización de datos de satélite operacionales en Centro América como apoyo en el manejo de desastres  

Microsoft Academic Search

In order for Central American countries to be able to respond to weather related disasters, they need to have strong meteorological forecasting capabilities, knowledge of the current state of the land and water resources, and emergency plans of action. In response to the devastating effects of Hurricane Mitch (October 1998), the United States Agency for International Development funded a project



Fibropapilomatosis oral múltiple como manifestación inicial de Síndrome de Cowden. Caso clínico  

Microsoft Academic Search

Cowden syndrome is a rare hereditary disease included within hamartoma-type gastrointestinal polyposis. It is cha- racterised by associated mucocutaneous anomalies and by the extraordinary tendency to develop malignant neoplasia, mainly in the breast and thyroid. Early diagnosis of the syndrome and adequate tumoral screening in patients with mucocutaneous papillomatosis make it possible to make an earlier diagnosis of associated pathologies

Luis Miguel Capitán Cañadas; José Luis Salinas Sánchez; Sergio Luis Martínez Castillo; Ildefonso Leopoldo Labrot Moleón; David Durán Moreno; Darío Sánchez López; Eduardo Valencia Laseca; Capitán-Cañadas LM; Salinas-Sánchez JL; Martínez-Castillo SL


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

Federal Register 2010, 2011, 2012, 2013

...potential mortality of large diameter ponderosa pine caused by increasing mountain pine beetle populations; (2) reduce fuel loads and...project area to: (1) Reduce potential mountain pine beetle-caused tree mortality in large...



EXAFS Study of the Structure of Co-Mo Hydrodesulfurization Catalysts.  

National Technical Information Service (NTIS)

By analysing the extended X-ray absorption fine structure (EXAFS) of the Mo absorption edge, structural information about both calcined and sulfided Mo/Al sub 2 O sub 3 and Co-Mo/Al sub 2 O sub 3 catalysts has been obtained. The calcined catalysts show on...

B. S. Clausen H. Topsoe R. Candia J. Villadsen B. Lengeler



El embarazo en la adolescencia como problema público: una visión crítica  

Microsoft Academic Search

The present work is a review of the most commonly used arguments to define pregnancy during adolescence as a pub- lic problem: its supposed increase, contribution to acceler- ated population growth, adverse effects on maternal and child health and contribution to the persistence of poverty. Some elements are proposed for an alternative explanation with the intention of defining with more




Percepción de la imagen corporal como aproximación cualitativa al estado de nutrición  

Microsoft Academic Search

Objective. To compare body image perception with body mass index (BMI) calculated from the weight and size de- clared by subjects, and to evaluate its usefulness in classify- ing the nutritional status. Material and methods. A representative sample of the Spanish population was se- lected consisting of 517 males and 483 females older than 15 years of age. Variables were

Herlinda Madrigal-Fritsch; Jokin de Irala-Estévez; Miguel A. Martínez-González; John Kearney; Michael Gibney; J. Alfredo Martínez-Hernández



Propiedades astrofísicas de objetos catalogados como cúmulos estelares en la Nube Menor de Magallanes  

NASA Astrophysics Data System (ADS)

We present the results on the age estimates of 11 Small Magellanic Cloud (SMC) clusters obtained for the first time from CCD Washington CT1 T2 photometry. CMD cluster features - mainly cluster RCs and MSTOs - turn out to be identificable when performing annular extractions around their re- spective centres, once they were cleaned from field star contamination. We estimated ages for the cluster sample using the T1 index, and metallicities from the SGB technique. The resultant ages and metallicities for the control clusters are in excellent agreement with those previously published, thus confirming our present age/metallicity scale. We also confirmed the ages and metallicities derived for the clusters by fitting theoretical isochrones. FULL TEXT IN SPANISH

Piatti, A. E.


Gerenciamento de riscos na prática ortodôntica: como se proteger de eventuais problemas legais  

Microsoft Academic Search

Introdução: A relação profissional-paciente na área de Ortodontia e Ortopedia facial é bas- tante desgastante face à longa duração dos tratamentos e, por causa disso, muitas vezes essa relação pode se deteriorar trazendo prejuízos a ambas as partes. Objetivo: Este trabalho visa informar o leitor, em linguagem acessível, sobre os principais problemas jurídicos que podem envolver o ortodontista em sua

Ricardo Machado Cruz; Carla Pádua



Escuelas sin Drogas. Como Actuar. Edicion 1992. (Schools without Drugs. What Works. 1992 Edition).  

ERIC Educational Resources Information Center

Across the United States, schools and communities have found ways to turn the tide in the battle against drugs. This guidebook describes the methods they have used and the actions they have taken. The first section, "Children and Drugs" outlines the nature and extent of the drug problem and summarizes the latest research on the effects of drugs on…

Department of Education, Washington, DC.


Análisis integral como sistema de medición y gestión de capitales intangibles en organizaciones y territorios  

Microsoft Academic Search

In the knowledge society, it is necessary to have new approaches of measurement and management for all the intangible ones that generate value, not only for companies but also for the national, regional or local territories. The most widespread methods have begun in the business area; these are support to the macro systems implemented in the last years, under the




Resultados do desenvolvimento de um propulsor à plasma no Brasil  

NASA Astrophysics Data System (ADS)

Uma das partes mais importantes de um satélite é o controle de atitude do mesmo. E se tratando de um satélite científico, a atenção para este sistema deve ser redobrada. Uma possibilidade atraente para executar esta tarefa é a propulsão elétrica. Aqui, mostraremos resultados obtidos pelo propulsor à plasma PHALL-01, desenvolvido na Universidade de Brasília entre 2000 e 2003. Este é derivado do propulsor russo SPT-100 (Stationary Plasma Thruster), mas com o emprego inovador de um arranjo de imãs permanentes como fonte do campo magnético, este último o agente da aceleração do plasma. Esta alteração foi motivada pelo objetivo de que o mesmo operasse com o mínimo de potência elétrica. A partir da formulação teórica do mecanismo de aceleração, tendo como base as equações da magnetohidrodinâmica, pode-se obter vínculos sob os quais o propulsor pudesse ser construído. O mais forte destes é o que dita a topologia do campo magnético. Sendo assim, foram realizadas simulações computacionais, que definiram a geometria do propulsor. Após construído, este foi diagnosticado usando-se sondas de Langmuir e analisadores de energia. Como resultados, obtivemos a distribuição espacial da temperatura, densidade e potencial do plasma, bem como a distribuição angular do feixe produzido pelo mesmo em vários regimes de operação. O espectro de energia do feixe de plasma também foi medido, indicando íons de até 560eV. Combinando estes resultados, calculou-se o empuxo do propulsor: 84mN; e o impulso específico: 1083s. Estes demonstram que o mesmo estará qualificado, num futuro próximo, para o emprego no controle de atitude de satélites científicos, ou até mesmo como parte do conjunto propulsor primário, responsáveis pela transferência de órbitas.

Ferreira, I. S.; Ferreira, J. L.



Rapid spread of complex change: a case study in inpatient palliative care  

Microsoft Academic Search

BACKGROUND: Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC). Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report

Richard Penna; Helene Martel; Esther B Neuwirth; Jennifer Rice; Marta I Filipski; Jennifer Green; Jim Bellows



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

ERIC Educational Resources Information Center

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

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



Microsoft Academic Search

SUMMARY Plant tissue culture methodologies were developed five dec- ades ago. However, expensive reagents and faulty technology transfer have prevented farmers in developing countries to ben- efit from these techniques. In Venezuela, cassava (Manihot esculenta Crantz) is a neglected crop harvested by poor farmers in marginal areas. Several constraints plot against large scale cassava cultivation, but the most important ones

Gustavo Romay; Juan Matehus; Armando Gerstl; Rodrigo Rueda; María A. Santana



El Balneario Marítimo como Espacio Utópico: los casos de Portmeirion (Gales), Thorpeness (Inglate rra), Pedernales (España) y Piriápolis (Uruguay)  

Microsoft Academic Search

(Estados Unidos). 1 Esta ponencia dirige la mirada a otro tipo de balneario marítimo, la pequeña colonia de vacaciones establecida por un empresario por motivos utópicos, tratando de construir un espacio de placer para llevar a habitantes y visitantes hacia un estado de perfecta tranquilidad y de aislamiento de los problemas del mundo exterior. Propongo un análisis comparativo de cuatro

Reino Unido


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

SciTech Connect

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

Moser, W.R.; Rossetti, G.A. Jr. (Worcester Polytechnic Institute, MA (USA)); Gleaves, J.T.; Ebner, J.R. (Monsanto Chemical Co., St. Louis, MO (USA))



Adenocarcinoma de colo uterino com disseminação linfática apresentando-se como carcinoma en cuirasse da vulva: relato de caso.  


We report the case of a patient with carcinoma "en cuirasse" of the vulva. Case report: A female patient presented complaining of inguinal lymphadenopathy. Lymph node excision, immunohistochemistry analyses, and further exams showed the presence of cervical adenocarcinoma. The cancer was surgically removed and the patient was treated with radiotherapy and chemotherapy with a good initial response. Some months later she presented with intense edema of the lower limbs, hardening and thickening of the labia majora, and pelvic and genital ulceration. A cutaneous biopsy with subsequent immunohistochemical staining showed lymphatic dissemination of adenocarcinoma to the vulva. Discussion: Carcinoma "en cuirasse" is a rare presentation of cutaneous metastasis in which the affected skin shows hardening and induration, acquiring a sclerodermoid appearance. This is, to the best of our knowledge, the first report in Brazil of carcinoma "en cuirasse" of the vulva associated with cervical adenocarcinoma. PMID:24852775

Silva de Lima, Adma; Casemiro, Karla Patricia; Rovere, Rodrigo Kraft




Microsoft Academic Search

Para llevar a cabo el presente trabajo se partió de una revisión bibliográfica en la cual se sustenta el análisis y la sistematización de los contenidos teóricos referidos. La recogida de información se realiza a través de un conjunto de técnicas complementarias entre sí respondiendo a los objetivos de la investigación. En la obtención de los datos se parte primeramente

Sara Dilaidis Rodríguez Betancourt



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

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…

ACCESS ERIC, Rockville, MD.


Uso de imagens LANDSAT como subsídio ao estudo da dispersão de sedimentos na região da foz do rio São Francisco  

Microsoft Academic Search

The construction of a sequence of water reservoirs along the lower São Francisco river basin has caused a severe change in the supply of water and sediments to the coastal zone. We present in this paper a first attempt to use Landsat data to estimate de Suspended Sediment Content (SSC) of the coastal plume. A simple log model proposed by

João Antonio Lorenzzetti; Eduardo Negri


Insuficiencia respiratoria aguda como forma de debut de síndrome de Lambert-Eaton asociado a carcinoma pulmonar de células pequeñas  

Microsoft Academic Search

The Lambert-Eaton myasthenic syndrome is a rare disorder of neu- romuscular transmission, usually presenting as a paraneoplastic process associated with a small cell lung cancer. Recently, respiratory muscular impairment has been described in these patients. Acute respiratory failu- re as a presenting symptom has been reported in few cases. We present a case of acute ventilatory failure as the first

F. Jover; E. Chiner; J. M. Arriero; J. Signes-Costa; J. Marco; V. Izura




Microsoft Academic Search

Este trabajo resume, por un lado los aportes centrales de una investigación más amplia denominada Políticas Públicas y Formación pa ra el Trabajo en Argentina. Articulaciones de una Política Neoliberal2 , cuyo eje fue e l análisis, desde una perspectiva c rítica, de un Programa focalizado e implementado a escala nacional en la República Argentina - el Proyecto Joven -

Esther Levy


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

ERIC Educational Resources Information Center

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…

Bratosevich, Nicolas



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

ERIC Educational Resources Information Center

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…

Binns, Helen J.; Ricks, Omar Benton


Efecto potenciador de la respuesta inmune contra el Factor de Crecimiento Epidérmico mediante el empleo de liposomas como adyuvante  

Microsoft Academic Search

Enhancing effect on the recombinant Epidermal Growth Factor immune response using liposomes as adjuvant. The use of liposomes as adjuvant in order to potentiate the immune response against epidermal growth factor (EGF) was studied. Firstly, the attention was focused on the influence of phospholipid composition of dehydration- rehydration vesicles (DRV) on the EGF encapsulation efficiency and its release from liposomes.

María del Carmen; Luzardo Lorenzo; Lesly Calderón Domínguez; Isabel Fabiola; Pazos Santos



Microsoft Academic Search

The objective of this experiment was to evaluate the performance of Durofel, a hardness meter (Shore A adapted by Ctifl) and a chromameter Minolta CR 300 measuring ground color as non destructive estimators of firmness in melting flesh peaches. Correlation between firmness, measured with Durofel and measured with a penetrometer, and between firmness and ground color, measured with a chromameter

Claudio O. Budde; Alejandro Tula; Gustavo Polenta; Carlos Lucangeli; Ricardo Murray; Casilla de Correo; Aires Argentina




Microsoft Academic Search

The production of calves from dairy herds reared on whole milk is not economically viable. Different milk substitutes with animal or vegetal protein have been tested, but always showed allergic or practical management problems. The texturized soybean protein is obtained from whole soybean extruded, which takes a better digestibility and an inactivation of allergic principles. The objective of this trial



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

ERIC Educational Resources Information Center

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…

Dorrego, Maria Elena



Microsoft Academic Search

This research explores the role of mailing lists in open source software projects as a tool for knowledge sharing and problem resolution. One of the benefits that firms can derive from using Open Source Software (OSS) is informal development collaboration. The primary tool for collaboration and coordination are group mailing lists, followed by asynchronous discussion forums, bug reports, and chat.

Martínez Torres; M. R. Toral Marín; S. L. Barrero García



Evaluación de los ácidos grasos n-3 de 18 especies de pescados marinos mexicanos como alimentos funcionales  

Microsoft Academic Search

SUMMARY. n-3 fatty acid evaluation in eighteen Mexican ma- rine fishes as functional food. The objective of the present work was to characterize the n-3 fatty acid composition of eighteen spe- cies of Mexican marine fishes and to evaluate their potential as func- tional food. Total lipids and fatty acid (FA) compositions were ob- tained of the edible portion of

Castro-González MI; Ojeda VA


Estudo Reológico de Tintas de Poliuretano Contendo PAni-DBSA Aplicadas como Materiais Absorvedores de Microondas (8-12 GHz)  

Microsoft Academic Search

Resumo: Neste trabalho preparou-se tintas condutoras baseadas em blendas de poliuretano contendo polianilina em diferentes proporções. Estudou-se as influências do método de dopagem da polianilina (PAni) e do tempo de processamento da mistura no comportamento reológico da tinta. Verificou-se que a dopagem, com o ácido dodecilbenzeno sulfônico (DBSA), por processamento reativo (PAni-DBSA-pr) afetou, de maneira mais acentuada, a viscosidade da

Rogério S. Biscaro; Edson C. Botelho; Centro ITA; Técnico Aeroespacial; Marta F. K. Takahashi



International Workshop on Mathematical Methods in Combustion Held in Como, Italy on 18-22 May 1992.  

National Technical Information Service (NTIS)

The overall objective of the Workshop was to try to improve communications and promote cross-fertilizations between applied mathematicians and computational scientists, by pointing out promising directions as well as effective means of interaction. Specif...

L. De Luca, E. S. Oran, M. Q. Brewster, M. K. Strelets, B. V. Novozhilov



Relación entre lípidos séricos y estado de las vitaminas C y E como antioxidantes en adultos mayores venezolanos  

Microsoft Academic Search

RESUMEN. En el envejecimiento se observa tendencia a hiperlipidemias, cambios en la distribución de lipoproteínas y una declinación del sistema de defensa antioxidante del organismo. El objetivo de este estudio fue relacionar concentraciones séricas de colesterol total, fracciones, triglicéridos y Vitaminas C y E. Se evaluaron 61 adultos mayores de 60 años de edad, de enero-marzo, 2006. Se diagnosticó estado

Lesbia Meertens; Gloria Naddaf; Adelmo Rodríguez




Microsoft Academic Search

SUMMARY The effects of vinasse and filter cake compost were evaluated on the chemical properties of the soil, culture nutrition, sugar- cane yield and juice quality, as well as on the comparative anal- ysis of the costs of its use as an organic fertilizer. The experi- ment was carried out in the Pujiltic sugarmill, Chiapas, México. The treatments were vinasse

Gloria I. Hernández Melchor; Sergio Salgado García; David J. Palma López; Luz del C. Lagunes; Mepivoseth Espinoza; Castelán Estrada; Octavio Ruiz Rosado; Lagunes Espinoza



A statistical evaluation of preparation conditions on the performance of Ce-promoted CoMo Fischer-Tropsch catalyst  

Microsoft Academic Search

This paper describes a statistical approach to the optimal selection of preparation conditions for a ceria-promoted Co-Mo\\u000a catalyst used during CO hydrogenation. Eight catalyst samples based on a full factorial design were prepared via incipient\\u000a wetness method. Evaluation was carried out in laboratory packed bed reactor using synthesis gas containing H2:CO=2 at 280 °C and 110 kPa. BET was unaffected

K. Eisenacher; Adesoji A. Adesina



Sistemas de Informação Geográfica como ferramenta para o diagnóstico e gestão de macrobacias no arco do desmatamento na Amazônia  

Microsoft Academic Search

The Amazon basin is rather known by their peculiar ecossystem with high biodiversity spreaded out by a large drainage basin which produces almost 15% of the world's drinking water. The human impacts of deforestation during he last 30 years are responsible for about 653.000Km2 of a clear forest surface shaped and denominated as the deforestation arch. Most of the deforestation

Ralph Trancoso



La dinámica de las publicaciones y las patentes como una aproximación al desarrollo científico y tecnológico de los países  

Microsoft Academic Search

The purpose of this paper is to propose a characterization, different from the traditional ones, of developed and developing countries, in terms of science and technology. First, we identify the generating processes of the publication and patent series of the countries. Then we relate the development stages of the countries (Banze (2000)) with the dynamics of the series. The results

Clemente Forero; Andrés Zambrano




Microsoft Academic Search

Los desastres ocurridos en centros urbanos, no sólo en Colombia (sismo de 1983 en Popayán, el sismo de 1999 en el eje cafetero), sino en otros países del mundo1, han generado interés acerca de las implicaciones de las amenazas en las ciudades. Ante ello el gobierno colombiano ha expresado su preocupación a través de una serie de reformas y leyes

Alexandra Vallejo


Characterization and hydrodesulfurization activity of CoMo catalysts supported on boron-doped sol–gel alumina  

Microsoft Academic Search

A series of hydrodesulfurization (HDS) catalysts was prepared by impregnation of Co and Mo on sol–gel B–Al2O3 supports with B\\/Al ratios of 0, 0.02, 0.04, 0.08, 0.20, 0.32, 0.49, and 0.61. The thiophene HDS and dibenzothiophene (DBT) HDS activities were both maximal for the catalyst with B\\/Al=0.04, with respective values 70 and 42% higher than those for an industrial reference

Franck Dumeignil; Koichi Sato; Motoyasu Imamura; Nobuyuki Matsubayashi; Edmond Payen; Hiromichi Shimada



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

NASA Astrophysics Data System (ADS)

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

Lares, M.


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

ERIC Educational Resources Information Center

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…

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


La ecología espacial como punto de encuentro entre la ecología animal y vegetal. Modelos espacialmente explícitos de dispersión endozoócora  

Microsoft Academic Search

Spatial ecology as a crossroad for animal and plant ecology. An example using spatially explicit models of endozoochorou s seed dispersal. In this article, we use seed-dispersal systems to exemplify the importance of spatial ecology for the study of plant -animal interactions. The study of seed-dispersal systems has been traditionally biased towards their plant component, with a relative disregard for

L. Santamaría; A. R. Larrinaga; A. Arceiz; J. Rodríguez Pérez


Análise da adaptabilidade e da estabilidade de genótipos de trigo como ferramenta auxiliar na recomendação de novas cultivares  

Microsoft Academic Search

The analysis of adaptability and stability of wheat genotypes helps the plant breeder in the recommendation of new cultivars, recommending lines of broad or specific adaptation to environments. This procedure is particularly important in wheat cropping, mainly when the great diversity of environments to which this cereal is submitted in Brazil is taken into consideration. Thus, the objective of this

Eduardo Caierão; Márcio Só e Silva; Pedro Luiz Scheeren; Leo de Jesus Antunes Del Duca; Alfredo do Nascimento Junior; João Leonardo Pires



Evaluation of the Social/Health Maintenance Organization Demonstration.  

National Technical Information Service (NTIS)

The concept of a social health maintenance organization (S/HMO) was investigated at: Kaiser Permanente - Northwest Region, Medicare Plus II, Portland, Oregon; Metropolitan Jewish Geriatric Center, Elderplan, Brooklyn, New York; Ebenezer Society-Group Heal...



Watchful Waiting Versus Antibiotics A.S.A.P. Study.  

National Technical Information Service (NTIS)

The study sought to define guidelines for observation and care for suspected neonatal bacterial infection and determine which infections can be managed without antibiotic therapy. The study population consisted of all babies born at six Kaiser Permanente ...

G. J. Escobar



76 FR 20690 - International Consortium of Orthopedic Registries; Public Workshop  

Federal Register 2010, 2011, 2012, 2013

...information regarding the public workshop and registration: Betty Jo Alfstad, Surgical Outcomes and Analysis, Kaiser Permanente, 3033 Bunker Hill Street, B30, San Diego, CA 92109, 858-581-8272, e- mail:; For...



Meeting the Research Challenge: Update on Current Population-level DCIS Research

Meeting the Research Challenges: Update on Current Population-Level DCIS Research Laurel Habel, PhD Division of Research, Kaiser Permanente, Oakland, CA February 2, 2007 NCI Workshop Ductal Carcinoma In Situ: Strategies for Integrating Tumor Biology



EPA Science Inventory

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


Particulate Air Pollution and Morbidity in the California Central Valley: A High Particulate Pollution Region.  

National Technical Information Service (NTIS)

The purpose of this study was to evaluate the relationship between particulate air pollution and morbidity among the Kaiser Permanente (KP) membership who reside in the Central Valley (CV) of California. Daily augmented particulate matter (PM) monitoring ...

S. K. Van Den Eeden C. P. Quesenberry J. Shan F. Lurmann



Web-based Weight Management Programs in an Integrated Health Care Setting: A Randomized, Controlled Trial  

Microsoft Academic Search

Objective: To assess the efficacy of a Web-based tailored behavioral weight management program compared with Web-based information-only weight management materials.Research Methods and Procedures: Participants, 2862 eligible overweight and obese (BMI = 27 to 40 kg\\/m2) members from four regions of Kaiser Permanente’s integrated health care delivery system, were randomized to receive either a tailored expert system or information-only Web-based weight

Kendra Rothert; Victor J. Strecher; Laurie A. Doyle; William M. Caplan; Jodi S. Joyce; Holly B. Jimison; Lya M. Karm; Adrienne D. Mims; Mark A. Roth




Microsoft Academic Search

This article intends to register an analysis of the virtual environm ent of Second Life, for the forms of conflict resolution. But the idea is to start a discussion in the face of virtual environments that are emerging about virtual well, applicability of law in the face of questions concerning the network. Despite no longer mention the proportionality of the

Karla Cristina da Costa; Silva Matos Ferragi



Microsoft Academic Search

C.S. Peirce states that a sign represents only some aspect of an object, which means that no representation can be perfect. The form - or information - grounding the sign's ability to represent its object is always deficient in some measure. If we take the difference between the form of the object and the form represented in the sign to

B. Roy Frieden; Vinicius Romanini



Microsoft Academic Search

This research project studies the effectiveness of a programme of applica- tion of vocabulary learning strategies of English as a foreign language in Secon- dary Education. The combination of Association\\/Elaboration and Keywords is examined when it is used by an experimental group (N=23) against a control group (N=18) with strategic freedom. The programme is beneficial for the low performance group




Abordagem do tema hipertensão arterial e suas relações com o tabagismo e a obesidade como forma de avaliação da aquisição e socialização de conhecimentos em Feiras de Ciências  

Microsoft Academic Search

O presente trabalho apresenta a experiência vivenciada por um professor do Ensino Fundamental de Escola Pública do Paraná, na orientação de uma equipe de alunos de 8ª série, em 2008, visando o desenvolvimento de trabalhos em Feiras de Ciências. A temática da equipe enfoca a hipertensão arterial e seus fatores de risco, tabagismo e obesidade, no município de Floresta. Escolheu-se

Eduardo de Almeida Grenier; Celso Ivam Conegero




Microsoft Academic Search

Phytoliths recovered from pedological profiles in the Teotihuacan Valley, Mexico, as part of a paleoenvironmenal study of the region, are indicators of paleosols as well as fluctuations in the spatial distribution of soils and vegetation through time. In this analysis, grass (Poaceae) phytoliths represented by the subfamilies Pooideae, Panicoideae and Chloridoideae, are considered. A two-stage study included a cross-valley sampling

McClung de Tapia; Héctor Cabadas-Báez; Ernestina Vallejo-Gómez; Jorge Gama-Castro


O Brincar como uma Acao Mediadora no Trabalho Desenvolvido com Criancas Hospitalizadas (Play as a Mediating Activity in Work Developed with Hospitalized Children).  

ERIC Educational Resources Information Center

Describes experiences with hospitalized children through the extension project "Writing and Reading at the University Hospital", State University of Maringa Hospital (Brazil). States the initial project proposal provided educational assistance to the children separated from school due to being in the hospital. Used play and games as an effective…

Goulart, Aurea Maria Paes Leme; de Moraes, Silvia Pereira Gonzaga



Como Lo Hago Yo: Anomal?as del Tubo Neural en Guatemala -- Mielomeningocele Unidad de Espina B?fida e Hidrocefalia  

PubMed Central

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.

Manucci, Graciela; von Quednow, Enzo



Structural and kinetic study of CoMo/. gamma. Al/sub 2/O/sub 3/ hydrodesulfurization catalyst using EXAFS and XANES  

SciTech Connect

In situ Extended X-ray Absorption Fine Structure (EXAFS) and X-ray Absorption Near Edge (XANES) spectroscopies were combined in a study designed to elucidate the molecular structure of molybdenum in CoMo/..gamma..Al/sub 2/O/sub 3/ hydrodesulfurization catalysts. This structure was related to catalytic activity using a model thiophene hydrodesulfurization reaction. Oxide CoMo/..gamma..Al/sub 2/O/sub 3/ was found to consist of tetrahedrally coordinated molybdenum with two or three short Mo = O bonds and one or two oxide ligands with longer Mo-O distances. The catalyst reacts with H/sub 2/S at 25 C with terminal Mo = O species being replaced by sulfur ligands. As the sulfiding temperature is increased, oxysulfides are replaced with a MoS/sub 2/-like phase. No evidence was found of oxysulfides at sulfiding temperatures in excess of 200 C. The first shell sulfur and second shell molybdenum coordination numbers were observed to increase linearly with sulfiding temperature, as was the present MoS/sub 2/-like phase. The MoS/sub 2/-like phase is remarkably similar to MoS/sub 2/, but has a Mo-S coordination number of only four. The second shell coordination is also lower, with only three molybdenum neighbors at 3.16 A. Sulfiding is about 90% complete after two hours at 400 C, with only minor change after 24 hours of sulfiding. This information is consistent with a structural model consisting of small MoS/sub 2/ crystallites of c.a. 10 A if the perimeter molybdenums are considered to have lost labile sulfur. Kinetic EXAFS, XANES and sulfur uptake measurements were made in situ during catalyst sulfiding and HDS. These measurements showed that at high temperature (400 C) the rate of sulfur adsorption onto the catalyst limits the rate of reaction between surface sulfur and molybdenum.

Parham, T.G.



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

SciTech Connect

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

Leliveld, R.G.; Dillen, A.J. van; Geus, J.W.; Koningsberger, D.C. [Univ. of Utrecht (Netherlands)] [Univ. of Utrecht (Netherlands)




Microsoft Academic Search

This paper describes a qualitative methodology for the assessment of rock fall physical risk index at large-scale (1:1000). Through a detailed geologic and geomorphological survey both rock fall deposits and rock fall sources are identified and mapped. Analysis of the rock fall deposits give indications over the temporal frequency and spatial distribution of the phenomenon and point out the most

Medio Ambiente; R. D. V Geoconsulting


Approvechamiento de Desechos para la Generacion de Bio-Gas como Fuente de Energia (Utilization of Residues for the Obtention of Bio-Gas as an Energy Source).  

National Technical Information Service (NTIS)

This report explains the production of methane gas by the process of anaerobic fermentation, from organic sources such as poultry or cow manure. Analyzes the inconveniences at the present of using human excreta. Other sources are: food waste, mud, vegetab...

J. C. Gonzalez B L. A. Munoz V



Simulacion de Temblores como Procesos Estocasticos No Estacionarios (Simulation of Accelerograms as Sample Functions of a Non-Stationary Stochastic Process).  

National Technical Information Service (NTIS)

A procedure for the simulation of accelerograms as sample functions of a non-stationary stochastic process is presented. The frequency content and the amplitude of motion are both considered as evolutionary. The spectral density of the acceleration is rep...

S. Ruiz A. Arias H. Sandoval




Microsoft Academic Search

The objective of the present study was to investigate the interaction between three light qualities (red, white and blue) and two nitrogen levels (IRRI +N and IRRI -N) on the simbiosis Azolla filiculoides - Anabaena azollae through the evaluation of parameters such as: Growth rate of vegetative cells and heterocists, chlorophyll, protein and proline contents and the nitrogenase and nitrate

Javier Mosquera Lenti; Abelardo Calderón Rodriguez


A fauna de Rotallida (Foraminiferida) da borda do recife de Itacimirim, Bahia, Brasil: um estudo comparativo do sedimento e das algas como substrato  

Microsoft Academic Search

This study aimed to compare the Rotaliida fauna (Foraminiferida) that lives in the sediment with that attached on algae from the Itacimirim's reef border, Bahia's north coast. Six samples of sediment and six of algae were collected in sites distributed along the reef border. The first 200 foraminnifers of each sample were selected, identified and the specimens belonging to the

Yonara S. Braga; Altair J. Machado; Simone S. Moraes



Surface Chemistry of Model Co-Mo Catalysts Supported on Planar gamma -Al sub 2 O sub 3 . Annual Technical Progress Report, September 1, 1985-August 31, 1986.  

National Technical Information Service (NTIS)

During the first year major effort was devoted to the building new equipment, modifying the existing equipment and training of the graduate students for the UHV analytical techniques. Meantime some experimental work was also done. The first task, the plan...

T. Sahin W. K. Ford



Antecedentes y presencia de trastornos depresivos como factor de riesgo de ingreso hospitalario en pacientes mayores de 74 años atendidos en un servicio de urgencias  

Microsoft Academic Search

IntroductionDepression is especially frequent in the elderly. In addition to impairing quality of life, this disorder can affect the outcome of medical diseases. The objective is to analyze whether depressive disorders in elderly individuals attending an emergency room for medical complaints constitute a risk factor for admission.

Mónica Suárez-Linares; Jesús Vicente Cobo-Gómez; Francisco Manuel Suárez-García; Elena García-Carreño; Antonio Álvarez-Álvarez



O desenvolvimento compartilhado de impressos como estratégia de educação em saúde junto a trabalhadores de escolas da rede pública do Estado do Rio de Janeiro  

Microsoft Academic Search

This article describes the process and results of an experience with preparing a mural entitled A Day in the Life of the School Lunch Cook, conducted with public school employees in the State of Rio de Janeiro by a team of researchers and students from the Specialization Course in Workers' Health at the Center for Studies on Workers' Health of

Kátia Reis de Souza; Brani Rozemberg; Adriana Kelly-Santos; Nancy Yasuda; Marta Sharapin



Las pasantías del docente de ciencias como estrategia de formación y desarrollo profesional The stage of science teachers as strategies of formation and professional development  

Microsoft Academic Search

This text analises the science teachers comprehention process dealing with the nature and scientific practices from a cooperation model between researches and sciencies teachers. This project is organized by the UNESCO Montevi- deo education, PEDECIBA (development program of basic science) and Admnistra- tion National Education of the Republic Uruguay.




A música como experiência e diferencial mercadológico no turismo: um estudo de caso sobre o trecho Serro a São Gonçalo do Rio Preto - Estrada Real - MG  

Microsoft Academic Search

The search for places, which provide meaningful and unique experiences, is increasing in the tourism activity, and consequently, it is necessary to change the marketing strategy in places and attractions. The musical expression of Minas Gerais is not promoted as cultural contrast, although it is a great tourist attraction. This article suggests the use of the experimental marketing and the

Mariana Helena; Diniz Ferreira; Mileno Dias Marquezini


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

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…

National PTA, Chicago, IL.


O processo de aquisicao das vogais semi-abertas "e,""o" portuges (brasileiro) como lingua estrangeira (Vowels "e" and "o" in Brazilian Portuguese as a Foreign Language).  

ERIC Educational Resources Information Center

Study looks at whether Spanish-speaking learners of Brazilian Portuguese as a foreign language demonstrates advantage or disadvantage in acquisition of semi-open vowels e and o. To research the question, eight students enrolled in first-year Portuguese were given a listening discrimination test composed of 18 minimal pairs to determine the extent…

Simoes, Antonio R. M.; Kelm, Orlando R.



Análise de Componentes Principais em Imagens Multitemporais TM\\/Landsat como Subsídio aos Estudos de Vulnerabilidade à Perda de Solo em Ambiente Semi-Árido  

Microsoft Academic Search

This study shows a methodological approach to evaluate soil losses and environmental vulnerability of the semi-arid regime on the northeast of Brazil. In order to perform this work Landsat\\/TM bands (red and infrared), from distinct hydrological periods were used by PCA (Principal Component Analysis).The results obtained indicate different features of the land use changes, that were categorized on three landscape

Alessandra Rodrigues Gomes; Francisco Dario Maldonado



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

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…

Germano, Jose Willington




Microsoft Academic Search

The present paper deals with the evaluation of the effectiveness of a sample of Sodium dichloroisocyanurate compared with the usual pool c hlorine, calcium hypochlorite, on the mortality of Aedes aegypti larvae, vector of dengue. Laboratory bioassays wer e carried out with the concentrations of 0.6 ppm of Sodium dichloroisocyanurate and 1ppm of swimming pool chlorine, as representing its common

Edmilson Ricardo Gonçalves


Los Residuos de Cosecha como Estrategia para la Alimentacion de Rumiantes Menores (Crop Residues as a Strategy for Small Ruminant Feeding).  

National Technical Information Service (NTIS)

Crop residues and preharvest foliages are being used for small ruminants in intensive and extensive feeding systems. Optimum use of these materials will depend on knowledge of animal requirements, which vary with breed type and production class, and on nu...

W. L. Johnson



On the effects of calcination conditions on the surface and catalytic properties of ?-Al 2O 3-supported CoMo hydrodesulfurization catalysts  

Microsoft Academic Search

A series of alumina-supported cobalt-molybdenum catalysts were prepared by the incipient-wetness method. Different calcination temperatures (673–873K) and durations (2–96h) were used to obtain the catalysts. Samples of the catalysts were characterized by X-ray photoelectron spectroscopy (XPS). Depending on the calcination condition, two forms of molybdenum (Mo4+ and Mo6+) and sulfur (S1 and S2) were identified. The ratio of Mo4+\\/Mo6+ appeared

Y. S. Al-Zeghayer; B. Y. Jibril



Creacion de un programa de ensenanza de espanol como segunda lengua para ninos de edad prescolar (Creating a Spanish as a Second Language Program for Preschool Children).  

ERIC Educational Resources Information Center

Presents suggestions for planning a Spanish as a second language program for preschool children. The rationale and means of implementing the program are considered, and guidelines for teaching vocabulary are discussed. A variety of classroom activities are also presented. (TR)

Rosenbusch, Marcia H.



Commercial scale expanded bed hydroprocessing of Solvent Refined Coal (SRC) extract. October monthly technical progress report. [Ni\\/Mo, Co\\/Mo, Ni\\/W  

Microsoft Academic Search

Catalyst screening runs of two additional commercially available desulfurization\\/denitrogenation catalysts (Ni\\/Mo-B and Ni\\/Mo-C) have been completed. A total of three nickel-molybdenum, two cobalt-molybdenum, and one nickel-tungsten catalyst was included in the catalyst screening program. Within the constraints of the 10-day maximum run duration for individual catalyst screening runs, the nickel-molybdenum catalyst (Ni\\/Mo-A) was the best catalyst tested to date for



Além da Informalidade: Entendendo como os Fiscais e Agentes de Desenvolvimento Promovem a Formalização o Crescimento de Pequenas e Médias Empresas  

Microsoft Academic Search

Na maioria dos países em desenvolvimento, o número de pequenas e médias empresas (PMEs) no setor informal tem crescido continuamente na última década em conseqüência do excesso de regulação e da crescente concorrência internacional. Hoje, nesses locais, o grande desafio para formuladores de políticas e agentes de desenvolvimento é conciliar o crescimento econômico com as normas legais. Por um lado,

Mansueto Almeida



Arejamento Como Medida de Proteccao Contra a Erosao de Cavitacao em Obras Hidraulicas (Aeration to Prevent Cavitation Erosion in Hydraulic Structures).  

National Technical Information Service (NTIS)

The aim of the work is the study of the flow aeration in order to prevent caviation erosion in hydraulic structures. Due to the relevance of the caviation phenomenon within the scope of the present work, a brief description of the physical process is pres...

J. de Saldanha Goncalves Matos



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

ERIC Educational Resources Information Center

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

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


O planejamento estrategico como insumo da qualidade em empresas de energia eletrica. (The strategical planning as quality intake in electric power utilities).  

National Technical Information Service (NTIS)

A methodology for a strategical plan elaboration aiming the electric power distribution sector is shown, including the following steps: thr company business; company goal; environmental analysis; definition of the company behaviour principles, guidelines,...

A. Silva Filho M. L. R. Cordeiro



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

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…

Stremel, Kathleen



Microsoft Academic Search

This focused ethnography explored the beliefs, values, habits and behavioral patterns of diabetic pregnant women who were treated in Hospital Doutor Enrique Tejera, residents of three poor, urban communities in the city of Valencia, Venezuela. The purpose of this study was to find the meaning of self-care for these pregnant women. The Health Analysis, the Theory of Diversity, and the

Carmen Amarilis; Guerra de Castillo; Marta Lucía Vásquez



Using licensed vocational nurses to provide telephone patient instructions in a health maintenance organization.  


A pilot project was initiated at Kaiser Permanente Medical Offices in Fairfield, California, to determine whether licensed vocational nurses, working with registered nurses, can effectively and safely provide selected patient instructions by telephone to adult medical patients. We describe the environment, funding, implementation process, consultants' major findings, and results of the project's impact on staff and operations. PMID:8308555

Buccini, R; Ridings, L E




Microsoft Academic Search

La formación continua de los trabajadores ocupados contribuye al reciclaje permanente y a la adquisición de nuevos conocimientos que les permite adaptarse a un entorno laboral y tecnológico en continuo cambio. Todo ello constituye un elemento fundamental para mejorar la competitividad de las empresas. El objetivo de este trabajo es realizar un estudio comparativo de la situación de España

González Flores; Ana Saiz Santos; Euskal Herriko Unibertsitatea


Assessment of Patient Satisfaction With Telephone and Mail Interventions Provided by a Clinical Pharmacy Cardiac Risk Reduction Service  

Microsoft Academic Search

OBJECTIVE: Kaiser Permanente of Colorado developed a population-based program, the Clinical Pharmacy Cardiac Risk Service (CPCRS), to help close the treatment gap for patients with coronary artery disease. CPCRS provides much of its care via telephone. The purpose of this study was to determine the level of satisfaction among patients in this unique service. METHODS: This was a cross-sectional survey




Microsoft Academic Search

Este artículo presenta un reporte Burkenroad de la empresa “Sociedad Colombiana de Juegos y Apuestas S.A.”, compañía caleña perteneciente al sector de juegos de suerte y azar, cuya actividad es la explotación de apuestas permanentes o chance. Esta empresa nació de la fusión de 18 de las 20 empresas dedicadas a esta actividad en la ciudad de Cali, con el




Dietary Patterns and the Risk of Barrett's Esophagus  

Microsoft Academic Search

The objective of this study was to examine the associations between dietary patterns and the risk of Barrett's esophagus, a precursor to esophageal adenocarcinoma. The authors conducted a case-control study within the Kaiser Permanente Northern California population between 2002 and 2005. Patients with a new diagnosis of Barrett's esophagus (n ¼ 296 cases) were matched to persons with gastroesophageal reflux

Ai Kubo; T. R. Levin; Gladys Block; Gregory J. Rumore; Charles P. Quesenberry; Patricia Buffler; Douglas A. Corley



Identification of Target Bioallergens: Frequency of Specific Aeroallergen Sensitization in an Atopic Population in the Sacramento Region.  

National Technical Information Service (NTIS)

Charts from individuals who filled out a questionnaire and underwent skin testing at Kaiser Permanente clinics in the greater Sacramento area in the year 2000 were pulled for review. 566 subjects had a physician diagnosis of allergic rhinitis or asthma an...

S. Teuber



Determinants of Serum Polychlorinated Biphenyls and Organochlorine Pesticides Measured in Women from the Child Health and Development Study Cohort, 1963-1967  

Microsoft Academic Search

We examined predictors of organochlorine concentrations in serum specimens from women who were pregnant in the 1960s and participated in the Child Health and Development Study in the San Francisco Bay Area of California. That study enrolled pregnant women at the Kaiser- Permanente Medical Facilities, conducted interviews, and drew blood specimens; these specimens were centrifuged and the resulting serum specimens

Rebecca A. James; Irva Hertz-Picciotto; Eric Willman; Jean A. Keller; M. Judith Charles


Effects of Dietary Fiber, Fats, and Meat Intakes on the Risk of Barrett's Esophagus  

Microsoft Academic Search

Animal and human models suggest associations between fat intake, fiber intake, and the risk of esophageal adenocarcinoma. We evaluated whether these factors may act early in the carcinogenic pathway as a risk factor for Barrett's esophagus, a potentially premalignant precursor to esophageal adenocarcinoma using a case-control design within the Kaiser Permanente, Northern California population. Incident Barrett's esophagus cases (n =

Ai Kubo; Gladys Block; Charles P. Quesenberry Jr; Patricia Buffler; Douglas A. Corley




Microsoft Academic Search

RESUMEN: La celiaquía es una patología gastrointestinal causada por una intolerancia total y permanente a las proteínas del gluten. En medicina se están registrando importantes avances para anticipar el diagnóstico de nuevas formas de manifestación de esta patología engañosa y multifacé- tica. En varios países se desarrollan trabajos tendientes a lograr técnicas analíticas más eficientes para cuantificar gluten en alimentos

María Elisa García



Information seeking and social support in online health communities: impact on patients' perceived empathy  

Microsoft Academic Search

ObjectiveMany healthcare organizations (HCOs) including Kaiser Permanente, Johns Hopkins, Cleveland Medical Center, and MD Anderson Cancer Center, provide access to online health communities as part of their overall patient support services. The key objective in establishing and running these online health communities is to offer empathic support to patients. Patients' perceived empathy is considered to be critical in patient recovery,

Priya Nambisan



Plasma pyrolysis for clean medical waste treatment.  


At Kaiser Permanente in San Diego, plasma pyrolysis will be used instead of incineration to treat hospital waste without creating corrosive gases, PVCs or groundwater-contaminating ash. Here's why plasma pyrolysis offers so much promise for waste treatment and why hospitals should follow this project closely. PMID:10113783



Sudden Cardiac Death and the Onset of Myocardial Infarction. Predictive Factors Detected in Multiphasic Health Checkups.  

National Technical Information Service (NTIS)

A case-control study is presented of sudden cardiac death and of myocardial infarction utilizing the computer-stored Kaiser-Permanente Multiphasic Examination data for the period 1964-70. By exploring a variety of variables and attributes measured in subj...

G. D. Friedman



A Conversation on the Future of Health Care: Integrating Lifestyle Medicine--Part One: Understanding the Concepts  

PubMed Central

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.

Sorensen, Herbert J



Study of Population Data to Determine Renal Prevalence and Risk Factors.  

National Technical Information Service (NTIS)

The objective was to develop data about the incidence and prevalence of kidney and urinary tract disease in a defined population (i.e. the denominator group was the subscriber population of the Kaiser-Permanente Medical Care Program for Northern Californi...

G. D. Friedman H. Rubinoff



The Effect of the KP Diet on Hyperactive Children: A Review.  

ERIC Educational Resources Information Center

A review of the effects of the Kaiser-Permanente diet on hyperactivity presents arguments for and against its implementation including B. Feingold's views. An outline of the most carefully designed studies follows. Discussion of findings and suggestions for future research are made by the authors. (Author/CL)

Strukoff, Paul M.; And Others



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

ERIC Educational Resources Information Center

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

Bargagliotti, L. Antoinette; And Others



Antenatal Ultrasound and Risk of Autism Spectrum Disorders  

ERIC Educational Resources Information Center

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;…

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



HMO Research Network National Conference. Held in Atlanta, GA. on April 4-5, 2000. Conference Abstract and Proceedings.  

National Technical Information Service (NTIS)

The Sixth Annual HMO Research Network Conference was held April 4-5, 2000 in Atlanta. The conference was hosted by Kaiser Permanente-Georgia Region and the USQA Center for Health Research and sponsored by the Agency for Healthcare Research and Quality and...

D. D. Tolsma



An Immediate and Long-Term Study of a Temperament and Parent-Child Interaction Therapy Based Community Program for Preschoolers with Behavior Problems  

ERIC Educational Resources Information Center

The immediate and long-term effects of a Parent Child Interaction Therapy (PCIT) derived program offered at a Kaiser Permanente facility were evaluated. There were 73 participants in the initial sample and 23 in the 5-6 year follow-up sample. Child behaviors improved significantly immediately following treatment and some improvements were…

Pade, Hadas; Taube, Daniel O.; Aalborg, Annette E.; Reiser, Paul J.



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

ERIC Educational Resources Information Center

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

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




Microsoft Academic Search

Resumen El objetivo del presente trabajo es presentar las relaciones existentes entre algunas de las actividades forestales actualmente desarrolladas en Forestal Bosques del Plata S.A. y el sistema de información geográfica (SIG) vigente. Con el uso de nuevas tecnologías y capacitación del personal se han desarrollado proyectos de estudios de plantación establecida, instalación de parcelas permanentes, fichas de rodal y

R. Trujillo; R. Pezzutti; S. Schmidt; F. Rodríguez


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

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…

Khawajkie, Elizabeth, Ed.; And Others


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

ERIC Educational Resources Information Center

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

Lehr, Fran; Osborn, Jean


Aplicacion de tecnicas de fosfatacion sobre acero al carbon y aluminio, utilizando como agente oxidante la nitroguanidina. (Application of phosphating techniques to aluminium and carbon steel surfaces using nitro guanidine as oxidizing agent.).  

National Technical Information Service (NTIS)

Phosphate coatings are inorganic crystalline deposits laid down uniformly on properly prepared surfaces by a chemical reaction with the treated base metal. The reaction consists in dissolving some surface metal by acid attack and then causing surface neut...

S. A. Briseno



A utilização da segmentação de imagens-fração como técnica de classificação da cobertura vegetal na região central e entorno da FLONA do Tapajós, utilizando imagem CCD\\/CBERS-2  

Microsoft Academic Search

This work has as main objective the mapping of the vegetable covering in the central area and around of the Tapajós National Forest, located to the south of the city of Santarém-Pará, Brazil. For this purpose, over the 2005 image of sensor CCD\\/CBERS-2 the following digital processings were accomplished: a linear spectral mixture model; segmentation and classification. The application of

Igor da Silva Narvaes; Roberto dos Santos


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

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…

Schwartz, Wendy


Nota científica COMPUESTOS DERIVADOS DE AJO COMO AGENTES INDUCTORES DE BROTACIÓN EN CULTIVO ORGÁNICO DE UVA DE MESA Compounds derived from garlic as bud induction agents in organic farming of table grape  

Microsoft Academic Search

Viticulture is one of the most important economic activities in the Northwest of Mexico. A major obstacle for the economic production is the insufficient period of chilling temperatures. This problem leads to poor budbreak, which results in reduced yields. This problem is aggravated when plants are cultivated using the organic farming system, mostly because there are not organically approved restbreaking

Irasema Vargas-Arispuro; Consuelo Corrales-Maldonado


Surface Chemistry of Model Co-Mo Catalysts Supported on Planar G-Al/sub 2/O/sub 3/: Quarterly Technical Progress Report for Period March 1, 1987 to May 31, 1987.  

National Technical Information Service (NTIS)

Five samples were prepared and characterized by XPS in calcined, reduced and sulfided states. These catalysts will be used to study the adsorption characteristics of thiophene and cyclohexene in the SIMS/TPD chamber. We have done some preliminary TPD expe...

T. Sahin W. K. Ford



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

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…

Zoreda, Margaret Lee


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

ERIC Educational Resources Information Center

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

Marson, Izabel Andrade



El compostaje como tecnologia para el tratamiento de residuos: compostaje de bagazo de sorgo dulce con diferentes fuentes nitrogenadas. (Composting as a waste treatment technology: composting of sweet sorghum bagasse with different nitrogen sources).  

National Technical Information Service (NTIS)

The purpose of this work is to study aerobic solid fermentation of sweet sorghum bagasse in mixture with other additives as nitrogen sources to evaluate the utilization of this material as a substrate for composting. The characteristics of sweet sorghum b...

J. Vicente J. E. Carrasco M. J. Negro



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

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…

Pacheco, Angel M.; And Others



Microsoft Academic Search

Due to the increasing of competitiveness in the different sectors of economy, corporations have been changing the way to lead their business in order to generate better performance and results. In this way, continuous reorganizations of the resources used in the operations have been done, and the real estate as well. The decisions about this resource have been better judged,

Carolina Andrea; Garisto Gregório; João da Rocha


Aproveitamento do melaço e vinhaça de cana-de-açúcar como substrato para produção de biomassa protéica e lipídica por leveduras e bactéria Use of sugar cane molasses and vinasse for proteic and lipidic biomass production by yeast and bacteria  

Microsoft Academic Search

This work evaluated the lipid and protein growth and synthesis capacity by Saccharomyces cerevisiae, Rhodotoruda mucilaginosa, Candida lipolytica, a yeast isolated from vinasse lakes and Corynebacterium glutamicum in 10% molasses and sugar cane crude vinasse. All microorganisms grew both in molasses and vinasse. The highest growth in crude vinasse was performed by R. mucilaginosa (7.05 g\\/L), and in 10% molasses,

Marcia Luciana Cazetta; Maria Antonia


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

ERIC Educational Resources Information Center

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

Patton, Patricia L.; And Others


Evaluación experimental de rodolitos como sustratos vivos para la infauna en el Banco de Abrolhos, Brasil Experimental evaluation of rhodoliths as living substrata for infauna at the Abrolhos Bank, Brazil  

Microsoft Academic Search

Over large areas of the Brazilian continental shelf, coralline algal rhodoliths provide habitats with high community diversity. In order to understand the role of rhodoliths in structuring the poorly studied infauna of these habitats, we determined seasonal patterns of their size and shape related to the associated biota, and experimentally tested the influence of living substrata in the Abrolhos Archipelago

K Santos de Menezes; EM Costa-Paiva; PC Paiva; CRR Ventura


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

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…

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



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

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…

Tavarez Da Costa, Pedro




Microsoft Academic Search

Windbreaks now occupies around 500 hectares in Santa Cruz province (ARGENTINA). Populus nigra is the most common specie for the purposes of sheltering plantations and livestock by wind. Wood treated with certain preservatives provide high quality material, primarily suited for use as a structural and framing timber. The responses of two poplars woods origins was evaluated. Test of available CCA-C

EEA Santa Cruz


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

ERIC Educational Resources Information Center

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

Paulu, Nancy



Microsoft Academic Search

This work presents the analysis of data collected during the accomplishment of a field research in that the technologies of the information and communication were used as education resource for the introductory teaching of the Physics of the Sound. The research was carried through in a public school of average education of the city of Campo Grande, in Mato Grosso

Rodrigo Claudino Diogo; Shirley Takeco Gobara



Como Mejorar la Administracion de la Cooperativa: Con Enfasis en el Ambiente Agricola y Hacia el Director (How to Better Manage Agriculture Cooperatives with a Focus on the Director's Role in Management).  

National Technical Information Service (NTIS)

Improving management of farmer cooperatives provides suggestions for improving the administration of the business matters of cooperatives. The importance of the specifics of the legal structure, and quality of administrative or managerial personnel are em...



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

PubMed Central

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

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



Leveraging Geographic Information Systems in an Integrated Health Care Delivery Organization  

PubMed Central

A handful of the many changes resulting from the Affordable Care Act underscore the need for a geographic understanding of existing and prospective member communities. Health exchanges require that health provider networks are geographically accessible to underserved populations, and nonprofit hospitals nationwide are required to conduct community health needs assessments every three years. Beyond these requirements, health care providers are using maps and spatial analysis to better address health outcomes that are related in complex ways to social and economic factors. Kaiser Permanente is applying geographic information systems, with spatial analytics and map-based visualizations, to data sourced from its electronic medical records and from publicly and commercially available datasets. The results are helping to shape an understanding of the health needs of Kaiser Permanente members in the context of their communities. This understanding is part of a strategy to inform partnerships and interventions in and beyond traditional care delivery settings.

Clift, Kathryn; Scott, Luther; Johnson, Michael; Gonzalez, Carlos



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


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

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




Microsoft Academic Search

L'École Thématique ``Neutrons et Biologie'' s'est tenue du 22 au 26 Mai 2004 à Praz\\/Arly (Haute-Savoie, France), dans le cadre des 12 èmes Journees de la Diffusion Neutronique de la Societe Française de Neutronique. Cette école a ete organisee avec le concours financier du CNRS (formation permanente), du Laboratoire Léon Brillouin (CEA Saclay), de la region Rhône-Alpes, du conseil général

J. Ollivier; E. Farhi; M. Ferrand; M. Benoit



Politische PR und PR-Akteure  

Microsoft Academic Search

\\u000a \\u000a Spin Doctoring, Ereignis- oder Themenmanagement, symbolische Politik, Pseudoereignisse, permanente Kampagnen, Politmarketing\\u000a – dies sind Begriffe aus der laufenden Diskussion über tatsächliche oder vermeintliche Veränderungen in der politischen Kommunikation\\u000a westlicher Länder. Für die einen handelt es sich um notwendige Modernisierungs-, für die anderen um problematische „Amerikanisierungsprozesse“.\\u000a Das Kapitel beleuchet die Merkmale und Besonderheiten der politischen PR aus einer kommunikationswissenschaftlichen Perspektive\\u000a (vgl.

Otfried Jarren; Patrick Donges


Exposure to Nonsteroidal Antiinflammatory Drugs During Pregnancy and Risk of Miscarriage: Population-Based Cohort Study  

Microsoft Academic Search

Objective To evaluate whether prenatal use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with increased risk of miscarriage. Design Population based cohort study. Prenatal use of NSAIDs, aspirin, and paracetamol (acetaminophen) ascertained by in-person interview. Setting Kaiser Permanente Medical Care Program, a healthcare delivery system, in the San Francisco area of the United States. Participants 1055 pregnant women recruited and

De-Kun Li; Liyan Liu; Roxana Odouli



L'impact du tabagisme sur la mortalité des Suisses et sur leur durée de vie en 1988\\/1993  

Microsoft Academic Search

L'élaboration de nouvelles tables de mortalité par l'Office fédéral de la statistique a permis d'estimer l'impact de différentes pathologie ou facteurs de risque sur la durée moyenne de vie de la population résidante permanente en Suisse. Ainsi, les décès attribuables au tabagisme ont pour effet de diminuer l'espérance de vie à la naissance des personnes résidant en Suisse de 2,9

Phillippe Wanner



Marijuana use and cancer incidence (California, United States)  

Microsoft Academic Search

The purpose of this retrospective cohort study was to examine therelationship of marijuana use to cancer incidence. The study populationconsisted of 64,855 examinees in the Kaiser Permanente multiphasic healthcheckup in San Francisco and Oakland (California, United States), between1979-85, aged 15 to 49 years, who completed self-ad-ministered questionnairesabout smoking habits, including marijuana use. Follow-up for cancer incidencewas conducted through 1993 (mean

Stephen Sidney; C. P. Quesenberry; G. D. Friedman; I. S. Tekawa



Risk Factors for Pelvis Fracture in Older Persons  

Microsoft Academic Search

From 1996 to 2001, the authors undertook a case-control study of 192 pelvis fracture cases (men and women) and 2,402 controls aged ? 45 years at five Kaiser Permanente medical centers in Northern California. Most in- formation on potential risk factors was obtained by means of an interviewer-administered questionnaire. Number of fractures since age 45 years and a maternal history

Jennifer L. Kelsey; Mila M. Prill; Theresa H. M. Keegan; Charles P. Quesenberry; Steven Sidney


Simple Rules That Reduce Hospital Readmission  

PubMed Central

To overcome system failures, health care organizations must implement a few simple rules of complex adaptive systems. I describe Transition in Care, Kaiser Permanente Southern California’s program to reduce hospital readmissions, as an example of a program design that meets the principles of complex adaptive systems and enumerate five rules, which must be followed if a health system is to create value for their stakeholders.

Kottke, Thomas E



Left-handedness as a risk factor for fractures  

Microsoft Academic Search

Left-handedness has been associated with increased fracture risk in a small number of previous studies. This study reports risks for fractures at the proximal humerus, distal forearm, pelvis, foot, and shaft of the tibia\\/fibula according to handedness in a case-control study conducted from October 1996 to May 2001 among members of Northern California Kaiser Permanente. Handedness was assessed by questionnaire

Crystal M. Luetters; Jennifer L. Kelsey; Theresa H. M. Keegan; Charles P. Quesenberry; Stephen Sidney



Vasectomy and the risk of prostate cancer in a cohort of multiphasic health-checkup examinees: second report  

Microsoft Academic Search

The relationship of vasectomy to prostate cancer was studied in 5,119 men with a self-reported history of vasectomy, identified at multiphasic health checkups undergone during 1977–82 while members of the Northern California Kaiser Permanente Medical Care Program. Three unvasectomized comparison subjects were identified for each vasectomized man, matched for age, race, marital status, and date and location of the examination.

Stephen Sidney; Charles P. Quesenberry; Marianne C. Sadler; Harry A. Guess; Eva G. Lydick; Eugene V. Cattolica



Next generation genome-wide association tool: Design and coverage of a high-throughput European-optimized SNP array  

Microsoft Academic Search

The success of genome-wide association studies has paralleled the development of efficient genotyping technologies. We describe the development of a next-generation microarray based on the new highly-efficient Affymetrix Axiom genotyping technology that we are using to genotype individuals of European ancestry from the Kaiser Permanente Research Program on Genes, Environment and Health (RPGEH). The array contains 674,517 SNPs, and provides

Thomas J. Hoffmann; Mark N. Kvale; Stephanie E. Hesselson; Yiping Zhan; Christine Aquino; Yang Cao; Simon Cawley; Elaine Chung; Sheryl Connell; Jasmin Eshragh; Marcia Ewing; Jeremy Gollub; Mary Henderson; Earl Hubbell; Carlos Iribarren; Jay Kaufman; Richard Z. Lao; Yontao Lu; Dana Ludwig; Gurpreet K. Mathauda; William McGuire; Gangwu Mei; Sunita Miles; Matthew M. Purdy; Charles Quesenberry; Dilrini Ranatunga; Sarah Rowell; Marianne Sadler; Michael H. Shapero; Ling Shen; Tanushree R. Shenoy; David Smethurst; Stephen K. Van den Eeden; Larry Walter; Eunice Wan; Reid Wearley; Teresa Webster; Christopher C. Wen; Li Weng; Rachel A. Whitmer; Alan Williams; Simon C. Wong; Chia Zau; Andrea Finn; Catherine Schaefer; Pui-Yan Kwok; Neil Risch



La mise à la retraite sur le plan personnel et familial  

Microsoft Academic Search

Résumé La prévention des crises de la retraite comporte:-Des mesures sociales: amélioration de la situation financière des retraités et assouplissement des règlements imposant une date fixe-Des mesures personnelles: lutte contre l'esprit routinier et contre une spécialisation excessive, culture permanente et développement d'activités de loisirs susceptibles d'amorcer une seconde carrière-Des mesures morales: acceptation de l'inachevé, de la vieillesse et de la

P. Tournier



Systèmes d'information et résilience des chaînes logistiques globales : Proposition d'un écosystème informationnel  

Microsoft Academic Search

Dans un contexte de crise permanente dont les causes sont multiples et de plus en plus imprévisibles, les entreprises doivent trouver des solutions pour s'adapter et maintenir leur niveau de performance. Cet article s'interroge sur la capacité des systèmes d'information à contribuer à la résilience des chaînes logistiques globales, c'est-à-dire leur capacité à garder un niveau d'efficience constant quels que

K. Evrard-Samuel; S. Ruel; Alain Spalanzani



Konventioneller Aortenbogenersatz  

Microsoft Academic Search

Zusammenfassung  Aortenbogenoperationen waren in der Vergangenheit mit einer hohen Morbidität (transiente (6–38%) und permanente (2–16%) neurologische\\u000a Defizite) und einer hohen Letalität (10-44%) verbunden. Durch eine Optimierung des operativen und perioperativen Managements\\u000a sowie durch die Einführung neuer Operationsstrategien konnten die Ergebnisse in letzter Zeit deutlich verbessert werden. Offene\\u000a chirurgische Eingriffe am Aortenbogen sollten heute vorrangig mittels antegrader selektiver Hirnperfusion über die A. subclavia

E. Weigang; H. von Dellemann; L. O. Conzelmann; M. Czerny; A. Harloff; A. A. Peivandi; N. Kayhan; T. B. Andrási; J. Parker; L. A. Hakami; U. Mehlhorn; C.-F. Vahl



What strategic planning can do for you.  


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

Valenzuela, Peter



Das Modell des integrierten Wissens- und Innovationsmanagements  

Microsoft Academic Search

\\u000a Betrachtet man Google-Search-Trends zu den Themen „Wissensmanagement“ und „Innovationsmanagement“, so muss man feststellen,\\u000a dass diese Themen eigentlich out sind. Die Attraktivität des Themas „Wissensmanagement“ ist seit Jahren rückläufig, Innovationsmanagement\\u000a hat eine permanente relativ geringe Nachfrage die sich in den letzten Jahren plötzlich steigert, aber immer noch relativ gering\\u000a ist. Vor 10 Jahren sah das – zumindest für das Wissensmanagement –

Rolf Franken; Swetlana Franken


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

NASA Astrophysics Data System (ADS)

"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.

Maddock, Thomas, III.; Vionnet, Leticia Beatriz


Measuring integrated care.  


The positive outcomes of coordination of healthcare services are to an increasing extent becoming clear. However the complexity of the field is an inhibiting factor for vigorously designed trial studies. Conceptual clarity and a consistent theoretical frame-work are thus needed. While researchers respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser Permanente has been put forward as an example for European healthcare systems to follow, although the evidence base is far from conclusive. The thesis has five objectives: 1) To contribute to the understanding of the concept of integration in healthcare systems and to identify measurement methods to capture the multi-dimensional aspects of integrated healthcare delivery. 2) To assess the level of integration of the Danish healthcare system. 3) To assess the use of joint health plans as a tool for coordination between the regional and local level in the Danish healthcare system. 4) To compare the inputs and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine the associations between specific organizational factors and clinical integration within each system. The literature was systematically searched to identify methods for measurement of integrated healthcare delivery. A national cross-sectional survey was conducted among major professional stake-holders at five different levels of the Danish healthcare system. The survey data were used to allow for analysis of the level of integration achieved. Data from the survey were additionally used to investigate the use of joint health planning as a tool for coordination of regional-local healthcare delivery. Analysis of secondary data from the Danish healthcare system and Kaiser Permanente, California were used to compare population characteristics, professional staff, delivery structure, utilisation, quality measures and direct costs. A cross-sectional survey among primary care clinicians in Denmark and in Kaiser Permanente, Northern California was completed to allow for comparison of clinical integration in the two systems and system specific associated factors. In this thesis a conceptual framework and a model for assessment of the conditions for integrations as an intermediate healthcare system outcome are presented. Furthermore, the results show that integrated healthcare delivery can be measured: 24 methods are available and some are highly developed. However, the field is still in its early phase and guidelines for how to proceed are devised. It was confirmed on a national level that integration of care is a widespread challenge, and that only half or less than half of patients in need of integrated services receive such care. Options for decision makers and managers are discussed. From a theoretical perspective joint health plans as applied in Denmark do not match the degree of complexity in the healthcare system. It was therefore in agreement with the theoretical findings when major stakeholders agreed that the joint health plans had not been effective as a tool for coordination. Joint health planning processes should actively engage all stakeholders and a high degree of recurrent feedback are warranted. When comparing Kaiser Permanente, California with the Danish healthcare system, our study suggest that Kaiser Permanente has a population with more documented disease and higher operating costs, and performs better than the Danish healthcare system on the observed quality measures. Substantial differences were found in the perception of clinical integration in the two settings. More primary care clinicians in the Northern Califor

Strandberg-Larsen, Martin



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

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…

Zelasko, Nancy; Antunez, Beth


The Full Employment Budget Surplus Concept as a Tool of Fiscal Analysis in the United States (L'excédent budgétaire de plein emploi, instrument de l'analyse budgétaire aux Etats-Unis) (El concepto de superávit presupuestario en pleno empleo como instrumento de análisis fiscal en los Estados Unidos)  

Microsoft Academic Search

The paper describes the concept of the full employment surplus and its method of estimation in the United States and analyzes (1) its general use as a summary measure of budget impact for purposes of policy evaluation and (2) its use in rules that govern the formulation of budgetary policy. The principal emphasis is on the first use of the

Daryl A. Dixon




Microsoft Academic Search

The oil palm industry in Colombia, the fifth world manufacter, generates lignocelulosic waste like the empty fruit bunch (EFB), which remains after removing the fruit of oil palm. Keeping in mind this characteristic, it can be used as substrate for cellulases production. In this study we evaluate the productivity of cellulases through native crop of Trichoderma viride T12 using EFB.


LGF («LIVER GROWTH FACTOR») como factor de proliferación, migración y diferenciación de las células madre neurales y su posible utilidad en enfermedad de Parkinson LGF («LIVER GROWTH FACTOR») as a factor involved in the proliferation, migration and differentiation of neural stem cells: Potential use in Parkinson's disease  

Microsoft Academic Search

Liver growth factor (LGF) promotes the proliferation and regeneration of different cell types, and preliminary studies indicate that LGF might be useful for neuroregenerative therapies. The aim of this work was to study the cell pro- liferative and neurogenic effects of LGF in a 6-OHDA Parkinson's disease (PD) experimental model. Intraventricular infusion of LGF increased bromodeox- yuridine (BrdU) incorporation in



Sintesis y caracterizacion del WxRuySez para la reduccion electroquimica de oxigeno y su posible aplicacion como electrodo en celdas de combustible. (Synthesis and characterization of the WxRuySez from the electrochemical reduction of oxygen and their possible application as electrode in fuel cell).  

National Technical Information Service (NTIS)

In this communication the synthesis of the W(sub 0.03)RuSe(sub 0.47)O(sub 0.3) from the transition metal carbonyl compounds and the chalcogenide in m Xylene, the chemical characterization of the novel material was performed by neutron activation analysis ...

S. D. Ramirez



o sup 14C como tracador do fluxo do carbono assimilado pelas plantas (milho, cana-de-acucar, feijao) e sua liberacao ao solo. ((14)C as tracer in the carbon flow assimilated by the plants (maize, sugar cane, bean) and it liberation to the soil).  

National Technical Information Service (NTIS)

The flow of carbon in three different crops, maize, beans and sugar cane was studied by use of (sup 14)V. The plants were exposed to an atmosphere with a constant concentration of the tracer for 12 hours in a biosynthesis chamber. The detection of the iso...

B. J. F. Paula Eduardo



Avaliacao de Dados Do MSS-LANDSAT-4 Para O Mapeamento Geomorfologico No Semi-Arido COMO Suporte AO Planejamento Regional: Uma Abordagem Integrada (Area-Teste Regiao de Juazeiro-BA) (Evaluation of LANDSAT 4 MSS Data for Geomorphological Mapping in the Semiarid Environment for Regional Planning Purposes: An Integrated Approach (Study Site, the Juazeiro Region)).  

National Technical Information Service (NTIS)

The utilization of LANDSAT-MSS data is evaluated for geomorphological mapping at 1:100 scale in a semiarid environment for regional planning purposes. An integrated mapping approach was used. The study site is located in northern Bahia State and covers ne...

T. Gallottiflorenzano



Validating growth and development of a seabird as an indicator of food availability: Captive-reared Caspian Tern chicks fed ad libitum and restricted diets [La validaci??n del crecimiento y desarrollo de un ave marina como un indicador de la disponibilidad de comida: pichones de Hydrogprogne caspia criados en cautiverio y alimentados ad libitum y dietas restringidas  

USGS Publications Warehouse

For seabirds raising young under conditions of limited food availability, reducing chick provisioning and chick growth rates are the primary means available to avoid abandonment of a breeding effort. For most seabirds, however, baseline data characterizing chick growth and development under known feeding conditions are unavailable, so it is difficult to evaluate chick nutritional status as it relates to foraging conditions near breeding colonies. To address this need, we examined the growth and development of young Caspian Terns (Hydroprogne caspia), a cosmopolitan, generalist piscivore, reared in captivity and fed ad libitum and restricted (ca. one-third lower caloric intake) diets. Ad libitum-fed chicks grew at similar rates and achieved a similar size at fledging as previously documented for chicks in the wild and had energetic demands that closely matched allometric predictions. We identified three general characteristics of food-restricted Caspian Tern chicks compared to ad libitum chicks: (1) lower age-specific body mass, (2) lower age-specific skeletal and feather size, such as wing chord length, and (3) heightened levels of corticosterone in blood, both for baseline levels and in response to acute stress. Effects of diet restriction on feather growth (10-11% slower growth in diet-restricted chicks) were less pronounced than effects on structural growth (37-52% slower growth) and body mass (24% lower at fledging age), apparently due to preferential allocation of food resources to maintain plumage growth. Our results suggest that measurements of chick body mass and feather development (e.g., wing chord or primary length) or measurement of corticosterone levels in the blood would allow useful evaluation of the nutritional status of chicks reared in the wild and of food availability in the foraging range of adults. Such evaluations could also inform demography studies (e.g., predict future recruitment) and assist in evaluating designated piscivorous waterbird conservation (colony) sites. ?? 2011 The Authors. Journal of Field Ornithology ?? 2011 Association of Field Ornithologists.

Lyons, D. E.; Roby, D. D.



Capital Flows as an Offset to Monetary Policy: The German Experience (Les flux de capitaux peuvent-ils mettre en échec la politique monétaire? L'expérience allemande) (Los flujos de capital como neutralizadores de la política monetaria: La experiencia alemana)  

Microsoft Academic Search

Cette étude a pour objet d'établir le rapport existant entre les décisions de politique monétaire prises en Allemagne de 1963 à 1970 et les flux de capitaux et en particulier, d'examiner si le recours aux modifications des coefficients de réserves obligatoires est un moyen efficace de neutraliser les effets de flux de capitaux sur la masse monétaire. Fait important: la

Michael G. Porter



Datura GENUS WEEDS AS AN EPIDEMIOLOGICAL FACTOR OF Alfalfa mosaic virus (AMV), Cucumber mosaic virus (CMV), AND Potato virus Y (PVY) ON SOLANACEUS CROPS Malezas del género Datura como factor epidemiológico del Virus del mosaico de la alfalfa (AMV), Virus del mosaico del pepino (CMV) y Virus Y de la papa (PVY) en Solanáceas cultivadas  

Microsoft Academic Search

A B S T R A C T Plant samples of jimsonweed (Datura stramonium L.) and thornapple (D. ferox L.) were collected to determine the presence of Cucumber mosaic virus (CMV), Alfalfa mosaic virus (AMV), and Potato virus Y (PVY) in Santiago, Chile (33º34' S lat, 70º38' W long, altitude 625 m.o.s.l.), using double stranded RNA (dsRNA) analysis and ELISA.

Juan Ormeño; Paulina Sepúlveda; Ricardo Rojas; Jaime E. Araya


Revolucionarios Silenciosos: Una Resena de la Campana Contra el Hambre que Llevan a Cabo los Cientificos Agricolas (y de Como Pudo Ayudar un Cultivo Desdenado: la Mandioca) (Quiet Revolutionaries: A Look at the Campaign by Agricultural Scientists to Fight Hunger and How the Much Neglected Cassava Could Help).  

National Technical Information Service (NTIS)

Over the next 30 years, yields of the major food crops must double to keep pace with global population growth. The essay tells two related stories about the fight against hunger. It looks at how agricultural researchers worldwide help feed a hungry world....

D. Wigg



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

ERIC Educational Resources Information Center

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

de Freitas, Marcos Cezar



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

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…

Lopez Alonso, A. O.


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

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…

Baylor Coll. of Medicine, Houston, TX.


Jacobsen's catalyst anchored on Al-MCM-41 and NH2 group modified Si-MCM-41 as heterogeneous enantioselective epoxidation catalyst using in situ generated dimethyldioxirane as oxidant Catalizador de Jacobsen inmovilizado en Al-MCM-41 y en Si-MCM-41 modificada con grupos amino y su actividad en la epoxidación enantioselectiva heterogénea utilizando dimetildioxirano generado in situ como oxidante  

Microsoft Academic Search

The enantioselective epoxidation of three prochiral olefins over Jacobsen's catalyst immobilized on Al-MCM-41 and NH2-Si-MCM-41 in the presence of in situ generated DMD as the oxygen source was investigated. Experimental results indicate that the catalyst did not significantly suffer any change in its chemical structure. Therefore, the reusability of catalyst could be successfully achieved when it was immobilized by chemical

Jairo Cubillos; Wolfgang Hölderichb



La geoquímica de Fe, Ti y Al como indicadora de la sedimentación volcanoclástica en la laguna costera de San Quintín, Baja California, México Geochemistry of Fe, Ti and Al as an indicator of volcanoclastic sedimentation in San Quintín coastal lagoon, Baja California, Mexico  

Microsoft Academic Search

The geochemistry of Fe, Ti and Al and the grain-size distribution were studied in 32 surficial sediment samples from San Quintín coastal lagoon (SQCL) in Baja California, in order to identify the presence of volcanoclastic sediment derived from the weathering and erosion of basaltic rocks from the San Quintín volcanic field (SQVF). The composition of the SQVF rocks is characterized

E Navarro; LW Daesslé; VF Camacho-Ibar; MC Ortiz-Hernández; EA Gutiérrez-Galindo


Transforming Care Delivery through Health Information Technology  

PubMed Central

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

Wheatley, Benjamin



Randomized trial of case-finding for depression in elderly primary care patients  

Microsoft Academic Search

OBJECTIVE: To determine the effect of case-finding for depression on frequency of depression diagnoses, prescriptions for antidepressant\\u000a medications, prevalence of depression, and health care utilization during 2 years of follow-up in elderly primary care patients.\\u000a \\u000a \\u000a DESIGN: Randomized controlled trial.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Thirteen primary care medical clinics at the Kaiser Permanente Medical Center, an HMO in Oakland, Calif, were randomly assigned\\u000a to

Mary A. Whooley; Barry Stone; Krikor Soghikian



Straight talk new approaches to healthcare. The healthcare quality equation.  


Though various health organizations may define and approach quality differently, the common denominator is the patient's perspective, experience and outcome. Quality issues should be an important part of health system executives' agenda. Successful quality programs have a number of key ingredients, including decision-reporting tools and business analytics information--which depend on robust information reporting and a system-wide electronic medical record--as well as highly motivated employees and physicians. In this installment of Straight Talk, representatives from two health systems--Kaiser Permanente and Clarian Health Partners--discuss their quality initiatives. PMID:17128953

Evans, Daniel F; Liang, Louise; Judy, Rick; Luallen, Bill; Lopez, Fawn



Roundtable on public policy affecting patient safety.  


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

Crane, Robert M; Raymond, Brian



Marijuana use and mortality.  

PubMed Central

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.

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



Use of physician assistants in a managed health care system.  

PubMed Central

Kaiser Permanente Northwest Region is a prepaid group practice health maintenance organization. Among the employed are 65 physician assistants (PAs) who work in primary care and in certain subspecialties. Kaiser Permanente was one of the first managed health care systems to use PAs and has contributed to the historical documentation of their effectiveness. An interest in experimenting with new forms of health care delivery as well as enabling State legislation has contributed to an expanded role for nonphysician providers. Together with nurse practitioners, PAs comprise 20 percent of the primary care staff and write 25 percent of the prescriptions for the membership. The use of PAs in managed health care settings will likely increase to meet growing primary care demands. Analysts have found the cost of a PA ranges from 25 percent to 53 percent of the cost of a physician. PAs are capable of providing care for 86 percent of the diagnoses seen in outpatient primary care setting, and patient acceptance is high.

Hooker, R S; Freeborn, D K



Subjective assessment of usefulness and appropriate presentation mode of alerts and reminders in the outpatient setting.  

PubMed Central

There is very little known about the limits of alerting in the setting of the outpatient Electronic Medical Record (EMR). We are interested in how users value and prefer such alerts. One hundred Kaiser Permanente primary care clinicians were sent a four-page questionnaire. It contained questions related to the usability and usefulness of different approaches to presenting reminder and alert information. The survey also contained questions about the desirability of six categories of alerts. Forty-three of 100 questionnaires were returned. Users generally preferred an active, more intrusive interaction model for "alerts" and a passive, less intrusive model for order messages and other types of reminders and notifications. Drug related alerts were more highly rated than health maintenance or disease state reminders. Users indicated that more alerts would make the system "more useful" but "less easy to use".

Krall, M. A.; Sittig, D. F.



The New York Academy of Medicine: Current Grey Literature Report  

NSDL National Science Digital Library

The New York Academy of Medicine has been around since 1847, and they have had a distinctly urban mission since their founding. Their online library contains a number of resources for medical doctors and other health care professionals, and the Grey Literature Report is one of the most compelling offerings on their site. The Report was started in 1999, and it was initially intended for internal research purposes. Currently, the Report is now published bimonthly by the Academy Library, and it contains "unindexed materials that are not produced by commercial publishers and are unavailable through normal, commercial distribution channels." The documents include case studies, conference proceedings, fact sheets, government documents, research reports, and white papers. Recent editions of the Report have included timely works from the AARP, the Commonwealth Fund, the John A. Hartford Foundation, and the Kaiser Permanente Institute for Health Policy.


Companies commit to emergency contraception -- have you?  


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



Complications of herpes zoster in cancer patients.  


Abstract Cancer patients tend to have a higher incidence of herpes zoster (HZ), but little is known about their risk of HZ complications. We conducted a retrospective study of 424 newly diagnosed hematologic (HM, n = 140) and solid tumor malignancy (STM, n = 284) patients who developed HZ between January 2001 and December 2006 to measure the frequency and identify risk factors of HZ complications. Patients were adult members of Kaiser Permanente Northern California. HZ diagnosis and complications were confirmed by medical chart review. HM patients with HZ tended to have more HZ complications than STM patients (34% vs 23%, p = 0.02), largely due to more frequent non-pain complications. On multivariate analysis, older age and being male were associated with a higher risk of HZ complications in HM patients; more advanced cancer stage was associated with HZ complications in STM patients. HZ complications are frequent and can present extra disease burden in cancer patients who develop HZ. PMID:24796470

Tran, Trung N; Ray, G Thomas; Horberg, Michael A; Yawn, Barbara P; Castillo, Adrienne L; Saddier, Patricia; Habel, Laurel A



Analysis of the prognosis of minimal and occult breast cancers.  


Of 296 occult breast cancers diagnosed at Kaiser-Permanente Medical Center, Los Angeles, in the last ten years, 80 were classified as minimal and 167 as nonminimal. Minimal cancers were intraductal, lobular in situ, or invasive and 0.5 cm or less in diameter. In the occult-minimal group, no woman had axillary node metastases, and there were no recurrences. In the occult-nonminimal group, 26% of the patients had axillary nodal involvement, with a recurrence rate of 13% and a mortality of 11.6%. Occult breast cancers differed significantly between minimal and nonminimal tumors in both treatment and prognosis. Nonminimal cancers should be treated as any palpable carcinoma. More conservative approaches could be considered for the minimal group, but prospective controlled studies should be done to determine the long-term risks of such treatment. PMID:6651517

Unzeitig, G W; Frankl, G; Ackerman, M; O'Connell, T X



Practical methods to increase use of advance medical directives  

Microsoft Academic Search

OBJECTIVE: To compare the effectiveness of two means for increasing the use of advance medical directives: written materials only versus\\u000a written materials and an educational videotape.\\u000a \\u000a \\u000a DESIGN: Population-based, randomized controlled trial with 3-month follow up.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Kaiser Permanente Colorado Region, a not-for-profit group-model health maintenance organization.\\u000a \\u000a \\u000a \\u000a \\u000a PARTICIPANTS: A population-based sample of all 1,302 members aged 75 years and older who

Jonathan Betz Brown; Arne Beck; Myde Boles; Paul Barrett



The dissemination of clinical practice guidelines over an intranet: an evaluation.  


This study compares two clinical practice guideline dissemination systems. It was hypothesized that placing guidelines on an intranet would make this information easier to retrieve. Retrieval time, retrieval accuracy, and ease of use were empirically evaluated. Sixteen clinicians from Kaiser Permanente volunteered to complete tasks that measured these variables. Time values were significantly longer for tasks completed with intranet guidelines (Intranet = 6.7 minutes, Paper = 5.7 minutes). Tasks completed with paper guidelines had a significantly higher percentage of perfect scores than those completed with the intranet (Paper = 85%, Intranet = 59%). There was no significant difference in reported ease of use. Simply placing clinical information on an electronic system does not guarantee that the information will be easier to retrieve. Such information needs to be fully integrated into the clinical decision making process. Computerizing guidelines may provide a necessary initial step toward this goal, but it does not represent the final solution. PMID:10566503

Stolte, J J; Ash, J; Chin, H



Secure E-mailing Between Physicians and Patients: Transformational Change in Ambulatory Care.  


Secure e-mailing between Kaiser Permanente physicians and patients is widespread; primary care providers receive an average of 5 e-mails from patients each workday. However, on average, secure e-mailing with patients has not substantially impacted primary care provider workloads. Secure e-mail has been associated with increased member retention and improved quality of care. Separate studies associated patient portal and secure e-mail use with both decreased and increased use of other health care services, such as office visits, telephone encounters, emergency department visits, and hospitalizations. Directions for future research include more granular analysis of associations between patient-physician secure e-mail and health care utilization. PMID:24887522

Garrido, Terhilda; Meng, Di; Wang, Jian J; Palen, Ted E; Kanter, Michael H



An HMO survey on mass customization of healthcare delivery for women.  


A telephone survey of 1,000 randomly selected women members of Kaiser Permanente examined preferences for care delivery. The majority of women under age 55 (80%) were interested in scheduling evening or Saturday appointments, and half (50%) of them were willing to switch doctors for this option. Although most (57%) said that physician gender 'did not matter,' women who preferred to see a female physician but were seeing a male were significantly less satisfied than women whose preferences were matched. Half (51%) of women were open to receiving health education in group classes. Information on when care is preferred, by whom, and in what setting sets the stage for mass customization strategies. PMID:10697464

Thompson, M; Nussbaum, R



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

PubMed Central

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.

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



CB4-03: An Eye on the Future: A Review of Data Virtualization Techniques to Improve Research Analytics  

PubMed Central

Background/Aims Integrating data across systems can be a daunting process. The traditional method of moving data to a common location, mapping fields with different formats and meanings, and performing data cleaning activities to ensure valid and reliable integration across systems can be both expensive and extremely time consuming. As the scope of needed research data increases, the traditional methodology may not be sustainable. Data Virtualization provides an alternative to traditional methods that may reduce the effort required to integrate data across disparate systems. Objective Our goal was to survey new methods in data integration, cloud computing, enterprise data management and virtual data management for opportunities to increase the efficiency of producing VDW and similar data sets. Methods Kaiser Permanente Information Technology (KPIT), in collaboration with the Mid-Atlantic Permanente Research Institute (MAPRI) reviewed methodologies in the burgeoning field of Data Virtualization. We identified potential strengths and weaknesses of new approaches to data integration. For each method, we evaluated its potential application for producing effective research data sets. Results Data Virtualization provides opportunities to reduce the amount of data movement required to integrate data sources on different platforms in order to produce research data sets. Additionally, Data Virtualization also includes methods for managing “fuzzy” matching used to match fields known to have poor reliability such as names, addresses and social security numbers. These methods could improve the efficiency of integrating state and federal data such as patient race, death, and tumors with internal electronic health record data. Discussion The emerging field of Data Virtualization has considerable potential for increasing the efficiency of producing research data sets. An important next step will be to develop a proof of concept project that will help us understand to benefits and drawbacks of these techniques.

Richter, Jack; McFarland, Lela; Bredfeldt, Christine



Qualitative Factors in Patients who Die Shortly After Emergency Department Discharge  

PubMed Central

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.

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.



Recent trends in childhood attention-deficit/hyperactivity disorder.  


OBJECTIVE To examine trends in attention-deficit/hyperactivity disorder (ADHD) by race/ethnicity, age, sex, and median household income. DESIGN An ecologic study of trends in the diagnosis of ADHD using the Kaiser Permanente Southern California (KPSC) health plan medical records. Rates of ADHD diagnosis were derived using Poisson regression analyses after adjustments for potential confounders. SETTING Kaiser Permanente Southern California, Pasadena. PARTICIPANTS All children who received care at the KPSC from January 1, 2001, through December 31, 2010 (n = 842 830). MAIN EXPOSURE Period of ADHD diagnosis (in years). MAIN OUTCOME MEASURES Incidence of physician-diagnosed ADHD in children aged 5 to 11 years. RESULTS Rates of ADHD diagnosis were 2.5% in 2001 and 3.1% in 2010, a relative increase of 24%. From 2001 to 2010, the rate increased among whites (4.7%-5.6%; relative risk [RR] = 1.3; 95% CI, 1.2-1.4), blacks (2.6%- 4.1%; RR = 1.7; 95% CI, 1.5-1.9), and Hispanics (1.7%-2.5%; RR = 1.6; 95% CI, 1.5-1.7). Rates for Asian/Pacific Islander and other racial groups remained unchanged over time. The increase in ADHD diagnosis among blacks was largely driven by an increase in females (RR = 1.9; 95% CI, 1.5-2.3). Although boys were more likely to be diagnosed as having ADHD than girls, results suggest the sex gap for blacks may be closing over time. Children living in high-income households were at increased risk of diagnosis. CONCLUSIONS The findings suggest that the rate of ADHD diagnosis among children in the health plan notably has increased over time. We observed disproportionately high ADHD diagnosis rates among white children and notable increases among black girls. PMID:23338799

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



Delirio (PDQ®)

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.


Resultados del Estudio Nacional de Colografía de Tomografía Computarizada: preguntas y respuestas

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 a su precisión, seguridad, rentabilidad y aceptabilidad por parte de los pacientes.


O conhecimento em farmacogenômica pode auxiliar no controle da pressão arterial em pacientes com hipertensão de difícil controle? Is pharmacogenomic knowledge of help in the management of difficult-to-control hypertension?  

Microsoft Academic Search

RESUMO Esta revisão tem como objetivo introduzir conceitos básicos de farmacogenética e de farmacogenômica, além de mostrar exemplos que demonstrem como polimorfismos genéticos podem modular suscetibilidade a doença e resposta às drogas. Aqui, enfocou-se como a farmacogenética\\/farma- cogenômica pode auxiliar no diagnóstico e tratamento da hipertensão de difícil controle. Exemplificando, polimorfismos podem alterar a farmacocinética de drogas usadas no trata-

Valéria C. Sandrim; José Eduardo Tanus-Santos


Múltiples estados de desorden en el etanol sólido  

Microsoft Academic Search

El diagrama de fases del etanol por debajo de los 169 K será presentado. Se mostrará que el etanol puede solidificarse en tres fases con diversos niveles de desorden,(como un vidrio(G), como un vidrio orientacional (OG) y como un cristal de fase rotora (RP)) además de en una fase totalmente cristalina. Las estructuras de estas tres fases serán presentadas tal

R. Fernández-Perea



Investigaciones de Economía de la Educación 6  

Microsoft Academic Search

En este trabajo se estudian los determinantes individuales del capital social en España. El capital social influye en el desarrollo económico, tal y como demuestran numerosos estudios, y se puede definir como la confianza, tanto interpersonal como institucional, y los aspectos positivos de las redes y las normas sociales que faciliten la creación y el mantenimiento de una estructura social

Isabel Neira Gómez; Marta Portela


Rocuronio: ¿tiempo de comienzo o velocidad de acción?  

Microsoft Academic Search

-1 como relajante. Utilizando electromiografía se determinaron: el máximo efecto, tiempo para alcanzar un bloqueo del 80%, tiempo de comienzo, el intervalo entre estos últimos y el bloqueo diferencial durante estas etapas. La velocidad para cada período se calculó como la relación entre el % de blo- queo producido y el tiempo para lograrlo expresándose como %\\/segundo y también la

D. Steinberg



Microsoft Academic Search

O caminho percorrido para que as questões do género e do desenvolvimento e em especial a sua interligação sejam assuntos importantes e alvo de atenção tanto académica como política, foi longo. Várias áreas do conhecimento, como a sociologia, a antropologia e a economia, contribuem para a construção do conhecimento neste domínio, a par de outras mais recentes como os estudos

Vanda Margarida De Jesus Dos Santos Narciso; Pedro Damiao de Sousa Henriques



Prevention of Vertical Transmission of Hepatitis B: An Observation Study  

PubMed Central

Background For mothers with chronic hepatitis B virus (HBV) infection, the US Centers for Disease Control recommend immunoprophylaxis to decrease perinatal transmission; however, its effectiveness and risk factors for failure have not been well studied in community practice. Objective To investigate the effectiveness of a contemporary immunoprophylaxis protocol. Design Observational study. Setting HBV perinatal immunoprophylaxis program within Kaiser Permanente Northern California, an integrated health services delivery organization. Patients 4,446 infants born to 3,253 HBV positive mothers, between 1997-2010. Measurements Compliance with immunoprophylaxis, follow-up testing rates, maternal risk factors for HBV transmission and transmission rates. Results The infant infection rate was 0.75 per 100 births for 1997-2010 (Poisson 95% confidence interval (CI): 0.48-1.10)]. Rates were 3.37 per 100 (95% CI 2.08-5.14) for e-antigen positive mothers; and 0.04 (95% CI 0.001-0.24) for e-antigen negative mothers. Among mothers with viral load testing, the lowest level associated with transmission was 63,200,000 IU/ml. Infection rates per 100 were 3.61 (95% CI 0.75-10.56) among the 83 births to mothers with viral loads ?50,000,000 IU/mL and 0.00 among the 831 births to mothers with viral loads <50,000,000 IU/mL, regardless of e-antigen status. Limitations Testing for HBV immunity and infection was somewhat less complete in earlier years. Viral load testing was only consistently available starting in 2007. Conclusion Pre-natal HBV screening followed by post-natal prophylaxis is highly effective in preventing vertical transmission of HBV. A negative e-antigen status or a viral load of <50,000,000 IU/mL (90.9% of women tested) identifies women at extremely low risk of transmission after immunoprophylaxis who are unlikely to benefit from further interventions. Primary Funding Source Kaiser Permanente Community Benefit Grant (CN-09LShla-01-H); National Institute of Health (K07CA166143-01A1 and KL2TR000143).

Kubo, Ai; Shlager, Lyle; Marks, Amy R.; Lakritz, Dena; Beaumont, Colette; Gabellini, Kim; Corley, Douglas A.



Questioning the claims from Kaiser  

PubMed Central

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.

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



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

PubMed Central

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.

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



Follow-up outcomes of a large cohort of low-risk women with negative imaged liquid-based cytology and negative HPV test results.  


Recently updated cervical screening guidelines have proposed a 5-year screening interval for women aged 30 years and older with "double-negative" Papanicolaou (Pap) and high-risk human papillomavirus (hrHPV) results (DNR); however, published US follow-up data on women with DNR tested with US Food and Drug Administration (FDA) - approved HPV testing are limited to studies from Kaiser Permanente using conventional Pap smear cytology. Between July 2005 and June 2006, 4,112 patients with DNR who were screened with computer-imaged liquid-based cytology (LBC) (ThinPrep) and Hybrid Capture 2 (HC2) hrHPV tests of LBC vial fluid were identified. Cytologic or histopathologic data were available for 3,211 patients who were followed up for a mean 44 months. Among 2,960 patients aged 30 years and older with DNR, follow-up cervical abnormalities of cervical intraepithelial neoplasia (CIN) 3 or more severe (CIN3+) were documented in 5 (0.17%), including 1 endocervical adenocarcinoma. After DNR, CIN+ diagnoses were significantly more likely in women younger than 50 years than in older women. These data are consistent with previously published US and international studies that have consistently documented low rates of histopathologic CIN3+ during years of follow-up after DNR. Large-scale nationwide data are needed to further assess the level of risk of invasive cervical cancer after DNR using different available hrHPV testing methods. PMID:23270896

Zhao, Chengquan; Weng, Baoying; Li, Zaibo; Yang, Huaitao; Austin, R Marshall



Paralytic syndromes in children: epidemiology and relationship to vaccination.  


Acute flaccid paralysis is a standard outcome for detection of poliomyelitis globally and an ongoing potential vaccine-associated adverse event concern for polio, influenza, and meningococcal vaccines. No systematic population-based data on the epidemiologic and clinical features of this condition, or its potential association with immunization, have been reported from the United States. The present retrospective cohort study of acute flaccid paralysis in the Southern and Northern California Kaiser Permanente Health Care Plans was conducted using computerized diagnosis data and medical record review of potential cases among children aged 1 month to <15 years and diagnosed from January 1, 1992 through December 31, 1998. In all, 3297 potential cases were identified; of these, 2682 cases (81%) did not meet the case definition, and of the remaining 615 cases, 245 (7% of the total) were included. The incidence of disease was 1.4 per 100,000 children/year (95% confidence interval = 1.2-1.6); predicting approximately 844 children/year in the United States. Disease incidence did not vary with season or sex, varied inversely with age, and declined 28% during the study period. No cases of vaccine-associated acute flaccid paralysis were identified. In nonendemic countries, ongoing acute flaccid paralysis surveillance is often conducted, because of the risk of poliovirus importation, but this practice may be difficult to justify, given low disease incidence and breadth of clinical presentation. PMID:20159431

Zangwill, Kenneth M; Yeh, Sylvia H; Wong, Emily J; Marcy, S Michael; Eriksen, Eileen; Huff, Kenneth R; Lee, Martin; Lewis, Edwin M; Black, Steven B; Ward, Joel I



Potential Risk Factors for Cutaneous Squamous Cell Carcinoma include Oral Contraceptives: Results of a Nested Case-Control Study  

PubMed Central

Recently, a population-based case-control study observed a 60% increased odds ratio (OR) for cutaneous squamous cell carcinoma (SCC) among women who had ever used oral contraceptives (OCs) compared with non users (95% confidence interval (CI) = 1.0–2.5). To further characterize the putative association between OC use and SCC risk, we conducted a nested case-control study using a large retrospective cohort of 111,521 Kaiser Permanente Northern California members. Multivariable conditional logistic regression was used to estimate ORs and CIs adjusting for known and hypothesized SCC risk factors. Pre-diagnostic OC use was associated with a statistically significant increased OR for SCC in univariate analysis (OR = 2.4, CI = 1.2–4.8), with borderline statistical significance in multivariable analysis (CI = 2.0, CI = 0.91–4.5). Given the high incidence of SCC in the general population and the prevalent use of OCs among women in the United States, there is a need for more large, carefully designed epidemiologic studies to determine whether the observed association between OC use and SCC can be replicated and to better understand the etiologic basis of an association if one exists.

Asgari, Maryam M.; Efird, Jimmy T.; Warton, E. Margaret; Friedman, Gary D.



Five-Year Experience of Human Papillomavirus DNA and Papanicolaou Test Cotesting  

PubMed Central

Objective To estimate the 5-year age group-specific test positives for Papanicolaou (Pap) tests and human papillomavirus (HPV) testing in a large, general screening population of women 30 and older. Methods Using data from Kaiser Permanente Northern California, a large health maintenance organization that introduced cotesting in 2003, we evaluated the cotesting results overall and by 5-year age groups. Women (n=580,289) who opted for and underwent cotesting (n cotests=812,598) between January, 2003 and April, 2008 were included in the analysis. Pap tests interpreted as atypical squamous cells of undetermined significance (ASC-US) or more severe were considered to be positive. Women were tested for carcinogenic HPV using an assay approved by the U.S. Food and Drug Administration. Binomial exact 95% confidence intervals (CI) were calculated. Results Overall, 6.27% (CI = 6.21%–6.32%) of cotests were assay positive, and only 3.99% (CI = 3.94%–4.03%) cotests had normal cytology and were assay-positive. By comparison, 5.18% (CI = 5.13%–5.23%) of cotests had ASC-US or more severe cytology, and 2.87% (CI = 2.84%–2.91%) of cotests had ASC-US or more severe cytology and were assay-negative. Conclusions In a general screening population, concerns about excessive HPV test positives among women 30 and older are not borne out.

Castle, Philip E.; Fetterman, Barbara; (ASCP), SCT; Poitras, Nancy; Lorey, Thomas; Shaber, Ruth; Kinney, Walter



Making Hospitals Safer for Older Adults: Updating Quality Metrics by Understanding Hospital-Acquired Delirium and Its Link to Falls  

PubMed Central

The medical care of hospitalized geriatric patients must differ from the care of younger adults. Because of reduced “reserve capacity,” hospitalized older adults are at high risk of development of geriatric syndromes such as delirium and falls. Geriatric syndromes often lead to functional decline and dependence. Patients who experience geriatric syndromes in the hospital are more likely to have a longer length of stay, higher risk of readmissions, and worse medical outcomes. Incident delirium in hospitalized geriatric patients has been shown to be preventable by intervening in established risk factors. Prevention of hospital-related falls has not been consistently demonstrated. Analysis from Kaiser Permanente data demonstrated a correlation with delirium and hospital-related falls. We propose that age-specific quality metrics should be made to reduce the risk of the development of geriatric syndromes in hospitalized older adults. By preventing delirium, we believe that health care practitioners can reduce hospital-related falls in geriatric patients and improve the quality of care delivered to hospitalized older adults. An illustrative fictional case study is presented.

Lee, Eric A; Gibbs, Nancy E; Fahey, Linda; Whiffen, Teri L



Making the Hospital Safer for Older Adult Patients: A Focus on the Indwelling Urinary Catheter  

PubMed Central

The needs of hospitalized geriatric patients differ from the needs of hospitalized younger adults. In an attempt to improve systems of care for the older adult, the Centers for Medicare and Medicaid Services classified urinary tract infections related to the use of indwelling urinary catheters (IUC) as one of eight “never events.” The insertion of an IUC is a commonly performed procedure that can cause an array of iatrogenic complications. In addition, the placement of an IUC without medical indication is a risk factor for prolonged hospitalization and inpatient mortality. Foley catheterization has been documented as a culprit in urosepsis and as being associated with geriatric syndromes such as delirium and functional impairment. This article will discuss the indications for the IUC, the complications that can occur because of the IUC, and comment on the Kaiser Permanente Southern California Region's efforts to minimize the unnecessary use of the IUC. Thoughtful and judicious use of the IUC, such as minimizing the use of urinary catheterization, either by not inserting an IUC or by removing it as soon as it is no longer needed, will most likely reduce inpatient morbidity and improve the health of the hospitalized older adult.

Lee, Eric A; Malatt, Camille



Next generation genome-wide association tool: design and coverage of a high-throughput European-optimized SNP array.  


The success of genome-wide association studies has paralleled the development of efficient genotyping technologies. We describe the development of a next-generation microarray based on the new highly-efficient Affymetrix Axiom genotyping technology that we are using to genotype individuals of European ancestry from the Kaiser Permanente Research Program on Genes, Environment and Health (RPGEH). The array contains 674,517 SNPs, and provides excellent genome-wide as well as gene-based and candidate-SNP coverage. Coverage was calculated using an approach based on imputation and cross validation. Preliminary results for the first 80,301 saliva-derived DNA samples from the RPGEH demonstrate very high quality genotypes, with sample success rates above 94% and over 98% of successful samples having SNP call rates exceeding 98%. At steady state, we have produced 462 million genotypes per week for each Axiom system. The new array provides a valuable addition to the repertoire of tools for large scale genome-wide association studies. PMID:21565264

Hoffmann, Thomas J; Kvale, Mark N; Hesselson, Stephanie E; Zhan, Yiping; Aquino, Christine; Cao, Yang; Cawley, Simon; Chung, Elaine; Connell, Sheryl; Eshragh, Jasmin; Ewing, Marcia; Gollub, Jeremy; Henderson, Mary; Hubbell, Earl; Iribarren, Carlos; Kaufman, Jay; Lao, Richard Z; Lu, Yontao; Ludwig, Dana; Mathauda, Gurpreet K; McGuire, William; Mei, Gangwu; Miles, Sunita; Purdy, Matthew M; Quesenberry, Charles; Ranatunga, Dilrini; Rowell, Sarah; Sadler, Marianne; Shapero, Michael H; Shen, Ling; Shenoy, Tanushree R; Smethurst, David; Van den Eeden, Stephen K; Walter, Larry; Wan, Eunice; Wearley, Reid; Webster, Teresa; Wen, Christopher C; Weng, Li; Whitmer, Rachel A; Williams, Alan; Wong, Simon C; Zau, Chia; Finn, Andrea; Schaefer, Catherine; Kwok, Pui-Yan; Risch, Neil



Design and coverage of high throughput genotyping arrays optimized for individuals of East Asian, African American, and Latino race/ethnicity using imputation and a novel hybrid SNP selection algorithm.  


Four custom Axiom genotyping arrays were designed for a genome-wide association (GWA) study of 100,000 participants from the Kaiser Permanente Research Program on Genes, Environment and Health. The array optimized for individuals of European race/ethnicity was previously described. Here we detail the development of three additional microarrays optimized for individuals of East Asian, African American, and Latino race/ethnicity. For these arrays, we decreased redundancy of high-performing SNPs to increase SNP capacity. The East Asian array was designed using greedy pairwise SNP selection. However, removing SNPs from the target set based on imputation coverage is more efficient than pairwise tagging. Therefore, we developed a novel hybrid SNP selection method for the African American and Latino arrays utilizing rounds of greedy pairwise SNP selection, followed by removal from the target set of SNPs covered by imputation. The arrays provide excellent genome-wide coverage and are valuable additions for large-scale GWA studies. PMID:21903159

Hoffmann, Thomas J; Zhan, Yiping; Kvale, Mark N; Hesselson, Stephanie E; Gollub, Jeremy; Iribarren, Carlos; Lu, Yontao; Mei, Gangwu; Purdy, Matthew M; Quesenberry, Charles; Rowell, Sarah; Shapero, Michael H; Smethurst, David; Somkin, Carol P; Van den Eeden, Stephen K; Walter, Larry; Webster, Teresa; Whitmer, Rachel A; Finn, Andrea; Schaefer, Catherine; Kwok, Pui-Yan; Risch, Neil



The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: the DISTANCE Study  

PubMed Central

OBJECTIVE To assess the the association of limited English proficiency (LEP) and physician language concordance with patient reports of clinical interactions. METHODS Cross-sectional survey of 8,638 Kaiser Permanente Northern California patients with diabetes. Patient responses were used to define English proficiency and physician language concordance. Quality of clinical interactions was based on 5 questions drawn from validated scales on communication, 2 on trust, and 3 on discrimination. RESULTS Respondents included 8,116 English-proficient and 522 LEP patients. Among LEP patients, 210 were language concordant and 153 were language discordant. In fully-adjusted models, LEP patients were more likely than English-proficient patients to report suboptimal interactions on 3 out of 10 outcomes, including 1 communication and 2 discrimination items. In separate analyses, LEP-discordant patients were more likely than English-proficient patients to report suboptimal clinician-patient interactions on 7 out of 10 outcomes, including 2 communication, 2 trust, and 3 discrimination items. In contrast, LEP-concordant patients reported similar interactions to English-proficient patients. CONCLUSIONS Reports of suboptimal interactions among patients with LEP were more common among those with language discordant physicians. PRACTICE IMPLICATIONS Expanding access to language concordant physicians may improve clinical interactions among patients with LEP. Quality and performance assessments should consider physician-patient language concordance.

Schenker, Yael; Karter, Andrew J.; Schillinger, Dean; Warton, E. Margaret; Adler, Nancy E.; Moffet, Howard H.; Ahmed, Ameena T.; Fernandez, Alicia



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

PubMed Central

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.

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



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

PubMed Central

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.

Greenwald, Ruth; Novelli, Marianne; Lorence, Tom



Physician-initiated follow-up contact improves patient satisfaction, provides opportunities to improve care.  


Numerous studies have shown that follow-up contact with patients after they have received care in the ED can move the needle upward on patient satisfaction surveys. Many organizations give this responsibility to ancillary staff, but an initiative involving all 22 EDs within Kaiser Permanente's northern California region is challenging the treating providers to initiate this follow-up. Three years into the initiative, ED directors indicate that while obtaining physician buy-in of the practice was initially challenging, most now view the approach as an opportunity to improve care. A pilot of the approach found that there is little difference between phone contact and e-mail communications, although e-mail contact is much more efficient. Most providers take advantage of a web-based tool to make follow-up contact with patients via e-mail. The approach is a HIPAA-complaint process that enables providers to include confidential medical information within the e-mail communications. Providers say the follow-up contact gives them an opportunity to reinforce important medical instructions and to answer any questions the patient may have neglected to ask during the medical emergency. Administrators recommend that ED managers interested in implementing postED-visit contacts establish attainable goals for their providers and publish performance figures as means to improve adoption of the practice. PMID:23776992



Patients' attitudes about the use of placebo treatments: telephone survey  

PubMed Central

Objective To examine the attitudes of US patients about the use of placebo treatments in medical care. Design One time telephone surveys. Setting Northern California. Participants 853 members of Kaiser Permanente Northern California, aged 18-75, who had been seen by a primary care provider for a chronic health problem at least once in the prior six months. Results The response rate was 53.4% (853/1598) of all members who were eligible to participate, and 73.2% (853/1165) of all who could be reached by telephone. Most respondents (50-84%) judged it acceptable for doctors to recommend placebo treatments under conditions that varied according to doctors’ level of certainty about the benefits and safety of the treatment, the purpose of the treatment, and the transparency with which the treatment was described to patients. Only 21.9% of respondents judged that it was never acceptable for doctors to recommend placebo treatments. Respondents valued honesty by physicians regarding the use of placebos and believed that non-transparent use could undermine the relationship between patients and physicians. Conclusions Most patients in this survey seemed favorable to the idea of placebo treatments and valued honesty and transparency in this context, suggesting that physicians should consider engaging with patients to discuss their values and attitudes about the appropriateness of using treatments aimed at promoting placebo responses in the context of clinical decision making.



Increased risk for respiratory distress among white, male, late preterm and term infants  

PubMed Central

Objective: To determine whether race/ethnicity and sex independently increase risk of respiratory distress syndrome (RDS) in late preterm and term infants. Study Design: Using a cohort design, we studied the risk of RDS associated with race/ethnicity and sex in infants with gestational age (GA) 34 to 42 weeks born between 1 January 2000 and 31 December 2009 (n=286?454) within 12 hospitals in the Northern California Kaiser Permanente Medical Care Program. Result: Male sex (adjusted odds ratio (aOR) 1.68; 95% confidence interval 1.45 to 1.93) and White race/ethnicity (vs Asians (aOR 0.57; 95% confidence interval 0.47 to 0.70), Blacks (aOR 0.66; 95% confidence interval 0.50 to 0.87), and Hispanics (aOR 0.76; 95% confidence interval 0.64 to 0.90)) independently increase risk for RDS regardless of GA. A GA <39 weeks, operative delivery, maternal diabetes, and chorioamnionitis also increased RDS risk in this cohort. Conclusion: Male sex and White race/ethnicity independently increase risk for RDS in late preterm and term infants. Timing of elective delivery should acknowledge these risks.

Anadkat, J S; Kuzniewicz, M W; Chaudhari, B P; Cole, F S; Hamvas, A



Vaginal birth after cesarean section: risk of uterine rupture with labor induction.  


We assessed the rate of uterine rupture in patients undergoing labor induction for attempted vaginal birth after cesarean (VBAC). A retrospective study was performed of data from a computerized database. Deliveries from January 1, 1998, to June 30, 2001, in the Southern California Kaiser Permanente system were reviewed and various perinatal characteristics analyzed. A total of 16,218 patients had a prior low transverse cesarean section. Of these, 6832 (42.1%) had a trial of labor. Successful VBAC occurred in 86% of patients with spontaneous onset of labor and 66% of patients with labor induction ( p < 0.001). The uterine rupture rate was not different between patients with spontaneous or induced labor (1.0% versus 1.2%, p = 0.51). Similarly, there was no significant difference between oxytocin or prostaglandin E2 induction (1.4% versus 1.0%, p = 0.59). In our study, labor induction did not appear to increase the risk of uterine rupture in women attempting VBAC. PMID:21424988

Ouzounian, Joseph G; Miller, David A; Hiebert, Christy J; Battista, Leah R; Lee, Richard H



Engaging Patients in Managing Their Health Care: Patient Perceptions of the Effect of a Total Joint Replacement Presurgical Class  

PubMed Central

Objective: To engage patients in managing their health care especially in relation to a total joint replacement (TJR). With the aging of the American population and the advent of new technology, there is an increase in TJRs. As the pendulum swings from evidence-based medicine to patient-centered medicine, presurgical education is preparing patients for their surgical experience. Most research studies on such education are quantitative in nature, preventing patients' voices from being heard. Methods: Using a success case narrative design, 24 patients mainly from the Kaiser Permanente Downey Medical Center were interviewed regarding their pre- and postsurgical experiences. Results: The study findings demonstrate that patient education, in the form of classes, with recognition of the participants' physical needs, social needs, concrete supports, and psychological needs as well as the willingness of the participants to work with their health care team can promote patient engagement and improved quality of life. Conclusion: The TJR class was found to promote a sense of social connectedness and fostered participants' independence. The results of this study can assist health care professionals to improve their practice by designing presurgical programs to meet the needs of their patients.

Lane-Carlson, Mary-Louise; Kumar, John



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


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

Delbanco, Suzanne F



Developing guidelines for cervical cancer prevention in the face of diagnostic complexity.  


Adoption of new cervical cancer screening guidelines by the American Cancer Society and others in 2012 required new guidelines for the management of abnormal screening and follow-up tests. The American Society for Colposcopy and Cervical Pathology led a consensus conference including 26 professional organizations and agencies that developed new management guidelines. These guidelines are risk-based and derive from analysis of approximately 1.4 million women screened by the Kaiser Permanente Northern California medical group, with risk assessment in collaboration with NCI. New guidelines provide guidance for the conservative management of young women, for women with unsatisfactory Papanicolaou (Pap) tests and tests with limited transformation zone component, for women with discordant Pap and human papillomavirus (HPV) co-testing results, and for the incorporation of HPV 16/18 genotyping results into management decisions. The increasing number of available tests and the increasingly nuanced understanding of risk mean that clinicians will need to offset the complexity of diagnostic and treatment algorithms with technology and specialization. PMID:24616540

Massad, L Stewart



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

SciTech Connect

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.

Reynolds, P. [California Dept. of Health Services, Berkeley, CA (United States)



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


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

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



Detection of pelvic inflammatory disease: development of an automated case-finding algorithm using administrative data.  


ICD-9 codes are conventionally used to identify pelvic inflammatory disease (PID) from administrative data for surveillance purposes. This approach may include non-PID cases. To refine PID case identification among women with ICD-9 codes suggestive of PID, a case-finding algorithm was developed using additional variables. Potential PID cases were identified among women aged 15-44 years at Group Health (GH) and Kaiser Permanente Colorado (KPCO) and verified by medical record review. A classification and regression tree analysis was used to develop the algorithm at GH; validation occurred at KPCO. The positive predictive value (PPV) for using ICD-9 codes alone to identify clinical PID cases was 79%. The algorithm identified PID appropriate treatment and age 15-25 years as predictors. Algorithm sensitivity (GH = 96.4%; KPCO = 90.3%) and PPV (GH = 86.9%; KPCO = 84.5%) were high, but specificity was poor (GH = 45.9%; KPCO = 37.0%). In GH, the algorithm offered a practical alternative to medical record review to further improve PID case identification. PMID:22144849

Satterwhite, Catherine L; Yu, Onchee; Raebel, Marsha A; Berman, Stuart; Howards, Penelope P; Weinstock, Hillard; Kleinbaum, David; Scholes, Delia



Detection of Pelvic Inflammatory Disease: Development of an Automated Case-Finding Algorithm Using Administrative Data  

PubMed Central

ICD-9 codes are conventionally used to identify pelvic inflammatory disease (PID) from administrative data for surveillance purposes. This approach may include non-PID cases. To refine PID case identification among women with ICD-9 codes suggestive of PID, a case-finding algorithm was developed using additional variables. Potential PID cases were identified among women aged 15–44 years at Group Health (GH) and Kaiser Permanente Colorado (KPCO) and verified by medical record review. A classification and regression tree analysis was used to develop the algorithm at GH; validation occurred at KPCO. The positive predictive value (PPV) for using ICD-9 codes alone to identify clinical PID cases was 79%. The algorithm identified PID appropriate treatment and age 15–25 years as predictors. Algorithm sensitivity (GH = 96.4%; KPCO = 90.3%) and PPV (GH = 86.9%; KPCO = 84.5%) were high, but specificity was poor (GH = 45.9%; KPCO = 37.0%). In GH, the algorithm offered a practical alternative to medical record review to further improve PID case identification.

Satterwhite, Catherine L.; Yu, Onchee; Raebel, Marsha A.; Berman, Stuart; Howards, Penelope P.; Weinstock, Hillard; Kleinbaum, David; Scholes, Delia



Developing a network of community health centers with a common electronic health record: description of the Safety Net West Practice-based Research Network (SNW-PBRN).  


In 2001, community health center (CHC) leaders in Oregon established an organization to facilitate the integration of health information technology, including a shared electronic health record (EHR), into safety net clinics. The Oregon Community Health Information Network (shortened to OCHIN as other states joined) became a CHC information technology hub, supporting a network-wide EHR with one master patient index, now linked across >40 safety net organizations serving >900,000 patients with nearly 800,000 distinct CHC visits. Recognizing the potential of OCHIN's multiclinic network and comprehensive EHR database for conducting safety net-based research, OCHIN leaders and local researchers formed the Safety Net West practice-based research network (PBRN). The Safety Net West "community- based laboratory," based at OCHIN, is positioned to become an important resource for many studies including: evaluation of the real-time impact of health care reform on uninsured populations; development of new models of primary care delivery; dissemination and translation of interventions from other EHR-based systems (e.g., Kaiser Permanente) into the community health setting; and analyses of factors influencing disparities in health and health care access. We describe the founding of Safety Net West, its infrastructure development, current projects, and the future goals of this community-based PBRN with a common EHR. PMID:21900444

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



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

PubMed Central

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

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



2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors.  


A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group's goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus-negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21-24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up. PMID:23635684

Massad, L Stewart; Einstein, Mark H; Huh, Warner K; Katki, Hormuzd A; Kinney, Walter K; Schiffman, Mark; Solomon, Diane; Wentzensen, Nicolas; Lawson, Herschel W



2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors.  


A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group's goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus-negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21-24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up. PMID:23519301

Massad, L Stewart; Einstein, Mark H; Huh, Warner K; Katki, Hormuzd A; Kinney, Walter K; Schiffman, Mark; Solomon, Diane; Wentzensen, Nicolas; Lawson, Herschel W



Hepatitis B testing and vaccination among adults with sexually transmitted infections in a large managed care organization.  


Data on viral hepatitis B (HBV) testing and vaccination in primary care settings among persons at sexual risk for HBV infection have been sparse. We examined rates and factors associated with HBV serologic testing and vaccination rates in adults infected with sexually transmitted infections. We conducted a retrospective cohort study of adults diagnosed with chlamydia, gonorrhea, or syphilis in Kaiser Permanente Southern California in 2008-2011. The vaccine series initiation was examined in subjects who were tested susceptible. The 90-day hepatitis B surface antigen (HBsAg) testing rate was 28.1% in 15 357 adults. Testing rates increased through the study period. Only 8.8% of patients received both HBsAg and hepatitis B surface antibody tests to determine prior exposure and susceptibility to HBV. Among those who were tested susceptible, 116 (10.6%) subjects initiated the vaccine series. In multivariable logistic regression analysis, the odds of receiving testing was inversely associated with female sex, black race, other/unknown race, or having prespecified chronic comorbidities. In survival analysis, adults aged 25-34 years and ?55 years were more likely to initiate hepatitis B vaccine series compared with those aged 18-24 years. There are missed opportunities in HBV testing and vaccination in primary care. Implementation of provider decision-making support tools in the electronic medical record system may potentially improve hepatitis B testing and vaccination rates. PMID:24571863

Hechter, Rulin C; Jacobsen, Steven J; Luo, Yi; Nomura, Jim H; Towner, William J; Tartof, Sara Y; Tseng, Hung Fu



Captura de satélites durante a formação de Júpiter  

NASA Astrophysics Data System (ADS)

O planeta Jupiter apresenta um grande número de satélites irregulares. As características das órbitas destes objetos indicam que os mesmos não teriam se formado ao redor do planeta que se encontram. As teorias existentes são de que estes objetos teriam se formado em uma região distante do planeta e sua evolução dinâmica os teria levado a uma captura gravitacional pelo planeta. Tendo em vista que o processo de captura gravitacional sem efeitos dissipativos não produz uma captura permanente, estudamos o processo de captura durante o estágio de formação do planeta. Realizamos simulações numéricas para os casos de satélites prógrados e retrógrados que inicialmente se encontram ao redor de Jupiter com sua massa atual e então, evoluimos a integração voltando no tempo de modo que o planeta sofra uma redução em sua massa (de 100% para 10% de sua massa atual) e verificamos o instante em que o satélites escapa do planeta (quando sua energia do problema de dois corpos se torna positiva). Assim, analisando o problema inverso no tempo, obtivemos em qual estágio de formação de Jupiter aquele hipotético satélite teria sido capturado. Os resultados mostram que os satélites retrógrados são capturados assim que entram na região delimitada pela esfera de Hill do planeta, enquanto que os satélites prógrados só são capturados quando entram numa região bem mais próxima ao planeta, uma fração da esfera de Hill.

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



Physician Update: Total Health  

PubMed Central

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.

Tuso, Phillip



Le patrimoine astronomique provençal  

NASA Astrophysics Data System (ADS)

L'OSU OAMP/Institut Pythéas porte les missions de conservation, inventaire et valorisation du patrimoine. Suite à la fusion de l'Observatoire de Marseille et du Laboratoire d'Astronomie Spatiale en 2000 pour créer le Laboratoire d'Astrophysique de Marseille, le déménagement des équipes sur le site de Château-Gombert en 2008 a soulevé le problème du devenir des collections des deux sites d'origine. Nous ferons le bilan des actions passées en matière de conservation et de valorisation de ce riche patrimoine : versement à l'inventaire général du Ministère de la Culture, classement de 22 instruments au titre des Monuments Historiques, inventaire et numérisation des archives anciennes, montage d'expositions et réalisation du catalogue Telescopium, 400 ans de lunettes et de télescopes. Nous présenterons les actions en cours: mesures de conservation préventive, inventaire des archives et des instruments. Nous parlerons enfin des projets: création d'un espace d'exposition permanente, participation à des expositions temporaires.

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



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)

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.

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



OBAYA (obesity and adverse health outcomes in young adults): feasibility of a population-based multiethnic cohort study using electronic medical records  

PubMed Central

Background Although obesity is a risk factor for many chronic diseases, we have only limited knowledge of the magnitude of these associations in young adults. A multiethnic cohort of young adults was established to close current knowledge gaps; cohort demographics, cohort retention, and the potential influence of migration bias were investigated. Methods For this population-based cross-sectional study, demographics, and measured weight and height were extracted from electronic medical records of 1,929,470 patients aged 20 to 39 years enrolled in two integrated health plans in California from 2007 to 2009. Results The cohort included about 84.4% of Kaiser Permanente California members in this age group who had a medical encounter during the study period and represented about 18.2% of the underlying population in the same age group in California. The age distribution of the cohort was relatively comparable to the underlying population in California Census 2010 population, but the proportion of women and ethnic/racial minorities was slightly higher. The three-year retention rate was 68.4%. Conclusion These data suggest the feasibility of our study for medium-term follow-up based on sufficient membership retention rates. While nationwide 6% of young adults are extremely obese, we know little to adequately quantify the health burden attributable to obesity, especially extreme obesity, in this age group. This cohort of young adults provides a unique opportunity to investigate associations of obesity-related factors and risk of cancer in a large multiethnic population.



Reassurance against future risk of precancer and cancer conferred by a negative human papillomavirus test.  


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

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



Traumatismes Oculaires par Petards: Bilan sur Trois Annees  

PubMed Central

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.

Zouaoui-Kesraoui, N.; Derdour, A.



A randomized trial to assess effectiveness and cost in clinical practice: rationale and design of the Cholesterol Reduction Intervention Study (CRIS).  


To compare the effectiveness and costs of two alternative approaches to the treatment of hypercholesterolemia, a prospective randomized trial is being undertaken at Southern California Kaiser Permanente, a large health maintenance organization. Six hundred and twelve patients with postdiet LDL cholesterol (LDL-C) levels in the range of 190-230 mg/dl (or 160-230 mg/dl for those with coronary heart disease or two or more coronary risk factors) were randomized to a stepped-care regimen (initial treatment with niacin followed by other agents if needed) or to initial use of lovastatin, an HMG-CoA reductase inhibitor. All patients are being followed for 1 year. The study seeks to approximate conditions of typical clinical practice: provider compliance with these plans of treatment is encouraged but not enforced and patients pay for medication as they customarily would. Principal outcomes of interest include the proportion of participants who achieve goal LDL-C at one year, the mean change in total cholesterol and LDL-C levels between baseline and the end of follow-up, and the costs of cholesterol-lowering therapy. PMID:7743787

Oster, G; Borok, G M; Menzin, J; Heys, J F; Epstein, R S; Quinn, V; Benson, V V; Dudl, R J; Epstein, A



Parental age and risk of bipolar disorder in offspring.  


We investigated prospectively documented parental age and bipolar disorder (BD) in a multi-ethnic birth cohort. The study was based on a nested case-control design from the Child Health and Development Study (CHDS) birth cohort from 1959 to 1966. Potential cases with BD were ascertained by database linkages between CHDS, Kaiser Permanente Medical Care Plan (KPNC), and Alameda County Behavioral Health Care Services, and mailed questionnaires. Consensus diagnoses with the SCID for DSM-IV-TR were made. The total number of BD cases was 94. Controls (N=746) were selected from the birth cohort and matched on date of birth, sex, and KPNC membership or residence in Alameda County. For every 10-year increment of paternal age, there was no significant association with BD, adjusting for maternal age. There was also no significant association between maternal age, modeled in 10-year increments, and risk of BD after adjustment for paternal age and maternal race, although there was a suggestion for a protective relationship between increasing maternal age and BD with psychotic features. These findings suggest that if advanced paternal age is a risk factor for BD, the strength of the relationship is small. PMID:23790979

Brown, Alan; Bao, Yuanyuan; McKeague, Ian; Shen, Ling; Schaefer, Catherine



Birth Weight and Neurocognition in Schizophrenia Spectrum Disorders  

PubMed Central

Low birth weight is associated with both schizophrenia and neurocognitive impairment. Yet, to our knowledge, no previous study has examined the relationship between lower birth weight and neurocognitive deficits in schizophrenia spectrum disorders (SSD). In this preliminary study, we investigated the relationship using a broad neuropsychological battery in cases with SSD and matched control subjects. The sample consisted of all subjects in the Developmental Insult and Brain Anomaly in Schizophrenia study, a nested case-control investigation developed from a large birth cohort, which followed subjects longitudinally. Case ascertainment was based on computerized record linkages between the birth cohort members and the Kaiser Permanente Medical Care Plan, and all diagnoses were confirmed by consensus diagnosis following the Diagnostic Interview for Genetic Studies. Lower birth weight was associated with impairment in executive function, working memory, generalized intellectual function, and neuromotor function in cases with SSD but not in control subjects. No deficits were observed in verbal memory for either group. These results support the hypothesis that lower birth weight plays a role in neuropsychological disruptions in SSD and that the antecedents of lower birth weight may have a greater impact on these disruptions in SSD than in controls. These data may facilitate a better understanding of the etiopathogenesis of the cognitive underpinnings of SSD.

Freedman, David; Bao, Yuanyuan; Kremen, William S.; Vinogradov, Sophia; McKeague, Ian W.; Brown, Alan S.



Association between maternal inflammatory bowel disease and adverse perinatal outcomes.  


Objective:To examine whether inflammatory bowel disease (IBD) is associated with ischemic/inflammatory conditions during pregnancy.Study Design:A retrospective cohort study using the 2000 to 2012 Kaiser Permanente Southern California maternally-linked medical records (n=395?781). The two major subtypes of IBD, ulcerative colitis and Crohn's diseases were studied. Adjusted odds ratios (ORs) were used to quantify the associations.Result:A pregnancy complicated by IBD was associated with increased incidence of small-for-gestational age birth (OR=1.46, 95% confidence interval (CI)=1.14 to 1.88), spontaneous preterm birth (OR=1.32, 95% CI=1.00 to 1.76) and preterm premature rupture of membranes (OR=1.95, 95% CI=1.26 to 3.02). Further stratifying by IBD subtypes, only ulcerative colitis was significantly associated with increased incidence of ischemic placental disease, spontaneous preterm birth and preterm premature rupture of membranes.Conclusion:The findings underscore the potential impact of maternal IBD on adverse perinatal outcomes. Clinicians should be aware that the association between IBD and adverse perinatal outcome varies by IBD subtypes. PMID:24651735

Getahun, D; Fassett, M J; Longstreth, G F; Koebnick, C; Langer-Gould, A M; Strickland, D; Jacobsen, S J



The Life Cycle of Clinical Decision Support (CDS): CDS Theory and Practice from Request to Maintenance  

PubMed Central

The promise of Clinical Decision Support (CDS) has always been to transform patient care and improve patient safety with delivery of timely and appropriate recommendations that are both patient-specific and more often than not appropriately actionable. However, the users of CDS, providers, are frequently bombarded with inappropriate and inapplicable CDS that is frequently neither informational, integrated into the workflow, patient-specific, and may present out of date and irrelevant recommendations. The life cycle of Clinical Decision Support begins with a request for CDS, continues with design and implementation, and concludes with ongoing knowledge maintenance. This State of the Practice will look at how using the best science and latest knowledge regarding CDS can create request and maintenance processes that work in the real world. Dr. David Bates will present the best science and knowledge behind CDS that works. Dr.’s Joseph Kannry and Thomas Yackel will present case studies of CDS requests and design processes that use this science to generate useful, useable, and timely patient-specific recommendations. Dr. Tonya Hongsermeier will present best practices in knowledge maintenance. Finally, Dr. Michael Krall will present a case study of knowledge maintenance from Kaiser Permanente that results in appropriate and up-to-date CDS.

Kannry, Joseph; Bates, David; Hongsermeier, Tonya; Krall, Michael; Yackel, Thomas



Post-diagnosis Statin Use and Breast Cancer Recurrence in a Prospective Cohort Study of Early Stage Breast Cancer Survivors  

PubMed Central

PURPOSE We examined the association between post-diagnosis statin use (3-hydroxy-3-methylglutaryl-coenzyme A [HMG-CoA] inhibitors) and risk of breast cancer recurrence. MATERIALS AND METHODS The study included 1945 early-stage breast cancer survivors participating in the Life After Cancer Epidemiology (LACE) Study. Women who were diagnosed from 1997 to 2000 and identified from the Kaiser Permanente Northern California (KPNC) Cancer Registry entered the cohort on average two years post-diagnosis. Information on statin use was obtained from the KPNC pharmacy database. A total of 210 breast cancer recurrences were reported and verified by medical record review. Cox proportional hazard models were used to estimate rate ratios (RR) and 95% confidence intervals (CI). RESULTS The mean duration of statin use in the cohort among those who initiated use post-diagnosis was 1.96 years, and lipophilic statins were mainly used (97.8%). Starting statins after diagnosis was suggestive of a decreased risk of breast cancer recurrence (RR = 0.67; 95% CI: 0.39–1.13). Risk of recurrence decreased with increasing duration of statin use after diagnosis (p linear trend = 0.02). CONCLUSION Our findings provide initial support for an inverse association between post-diagnosis, lipophilic statin use and risk of breast cancer recurrence.

Kwan, Marilyn L.; Habel, Laurel A.; Flick, E. Dawn; Quesenberry, Charles P.; Caan, Bette



Psychotherapist mindfulness and the psychotherapy process.  


[Correction Notice: An erratum for this article was reported in Vol 47(2) of Psychotherapy: Theory, Research & Practice (see record 2010-13424-005). the order of authorship and the affiliations of the authors was incorrectly printed. The correct order and affiliations are as follows: Noah Bruce, Shauna L. Shapiro, Michael J. Constantino, and Rachel Manber; Kaiser Permanente, Santa Clara University, University of Massachusetts, Stanford University] A psychotherapist's ability to relate to his or her patients is essential for decreasing patient suffering and promoting patient growth. However, the psychotherapy field has identified few effective means for training psychotherapists in this ability. In this conceptual article, we propose that mindfulness practice may be a means for training psychotherapists to better relate to their patients. We posit that mindfulness is a means of self-attunement that increases one's ability to attune to others (in this case, patients) and that this interpersonal attunement ultimately helps patients achieve greater self-attunement that, in turn, fosters decreased symptom severity, greater well-being, and better interpersonal relationships. PMID:22402003

Bruce, Noah; Bruce, Noah G; Shapiro, Shauna L; Constantino, Michael J; Manber, Rachel



Effectiveness and Reach of the FLU-FIT Program in an Integrated Health Care System: A Multisite Randomized Trial  

PubMed Central

Objectives. We tested the effectiveness of offering home fecal immunochemical tests (FITs) during influenza vaccination clinics to increase colorectal cancer screening (CRCS). Methods. In a clinical trial at Kaiser Permanente Northern California influenza clinics in Redwood City, Richmond, South San Francisco, Union City, and Fresno, we randomly assigned influenza clinic dates to intervention (FIT offered) or control (FIT not offered) and compared subsequent CRCS activity. Results. Clinic staff provided FITs to 53.9% (1805/3351) of intervention patients aged 50 to 75 years. In the intent-to-treat analysis, 26.9% (900/3351) and 11.7% (336/2884) of intervention and control patients completed an FIT, respectively, within 90 days of vaccination (P???.001). The adjusted odds ratio for completing FIT in the intervention versus the control arm was 2.75 (95% confidence interval?=?2.40, 3.16). In the per protocol analysis, 35.4% (648/1830) of patients given FIT and 13.3% (588/4405) of patients not given FIT completed FIT within 90 days of vaccination (P???.001). Conclusions. This intervention may increase CRCS among those not reached by other forms of CRCS outreach. Future research should include the extent to which these programs can be disseminated and implemented nationally.

Ackerson, Lynn M.; Gomez, Vicky; Walsh, Judith M. E.; Green, Lawrence W.; Levin, Theodore R.; Somkin, Carol P.



Medication Exposure in Pregnancy Risk Evaluation Program  

PubMed Central

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

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



The human factor: the critical importance of effective teamwork and communication in providing safe care.  


Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described. PMID:15465961

Leonard, M; Graham, S; Bonacum, D



Community-based incidence of acute renal failure  

PubMed Central

There is limited information about the true incidence of acute renal failure (ARF). Most studies could not quantify disease frequency in the general population as they are hospital-based and confounded by variations in threshold and the rate of hospitalization. Earlier studies relied on diagnostic codes to identify non-dialysis requiring ARF. These underestimated disease incidence since the codes have low sensitivity. Here we quantified the incidence of non-dialysis and dialysis-requiring ARF among members of a large integrated health care delivery system –Kaiser Permanente of Northern California. Non-dialysis requiring ARF was identified using changes in inpatient serum creatinine values. Between 1996 and 2003, the incidence of non-dialysis requiring ARF increased from 322.7 to 522.4 whereas that of dialysis-requiring ARF increased from 19.5 to 29.5 per 100 000 person-years. ARF was more common in men and among the elderly, although those aged 80 years or more were less likely to receive acute dialysis treatment. We conclude that the use of serum creatinine measurements to identify cases of non-dialysis requiring ARF resulted in much higher estimates of disease incidence compared with previous studies. Both dialysis-requiring and non-dialysis requiring ARFs are becoming more common. Our data underscore the public health importance of ARF.

Hsu, C-y; McCulloch, CE; Fan, D; Ordonez, JD; Chertow, GM; Go, AS



The risk of acute renal failure in patients with chronic kidney disease  

PubMed Central

Few studies have defined how the risk of hospital-acquired acute renal failure varies with the level of estimated glomerular filtration rate (GFR). It is also not clear whether common factors such as diabetes mellitus, hypertension and proteinuria increase the risk of nosocomial acute renal failure independent of GFR. To determine this we compared 1,746 hospitalized adult members of Kaiser Permanente Northern California who developed dialysis-requiring acute renal failure with 600,820 hospitalized members who did not. Patient GFR was estimated from the most recent outpatient serum creatinine measurement prior to admission. The adjusted odds ratios were significantly and progressively elevated from 1.95 to 40.07 for stage 3 through stage 5 patients (not yet on maintenance dialysis) compared to patients with estimated GFR in the stage 1 and 2 range. Similar associations were seen after controlling for inpatient risk factors. Pre-admission baseline diabetes mellitus, diagnosed hypertension and known proteinuria were also independent risk factors for acute kidney failure. Our study shows that the propensity to develop in-hospital acute kidney failure is another complication of chronic kidney disease whose risk markedly increases even in the upper half of stage 3 estimated GFR. Several common risk factors for chronic kidney disease also increase the peril of nosocomial acute kidney failure.

Hsu, CY; Ordonez, JD; Chertow, GM; Fan, D; McCulloch, CE; Go, AS



Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease  

PubMed Central

To determine whether acute renal failure (ARF) increases the long-term risk of progressive chronic kidney disease (CKD), we studied the outcome of patients whose initial kidney function was normal or near normal but who had an episode of dialysis-requiring ARF and did not develop end-stage renal disease within 30 days following hospital discharge. The study encompassed 556,090 adult members of Kaiser Permanente of Northern California hospitalized over an 8 year period, who had pre-admission estimated glomerular filtration rates (eGFR) equivalent to or greater than 45 ml/min/1.73 m2 and who survived hospitalization. After controlling for potential confounders such as baseline level of eGFR and diabetes status, dialysis-requiring ARF was independently associated with a 28-fold increase in the risk of developing stage 4 or 5 CKD and more than a twofold increased risk of death. Our study shows that in a large, community-based cohort of patients with pre-existing normal or near normal kidney function, an episode of dialysis-requiring ARF was a strong independent risk factor for a long-term risk of progressive CKD and mortality.

Lo, Lowell J.; Go, Alan S.; Chertow, Glenn M.; McCulloch, Charles E.; Fan, Dongjie; Ordonez, Juan D.; Hsu, Chi-yuan



Adverse Childhood Experiences and Adult Criminality: How Long Must We Live before We Possess Our Own Lives?  

PubMed Central

Background: Empirical research associated with the Kaiser Permanente and Centers for Disease Control and Prevention Adverse Childhood Experiences (ACE) Study has demonstrated that ACE are associated with a range of negative outcomes in adulthood, including physical and mental health disorders and aggressive behavior. Methods: Subjects from 4 different offender groups (N = 151) who were referred for treatment at an outpatient clinic in San Diego, CA, subsequent to conviction in criminal court, completed the ACE Questionnaire. Groups (nonsexual child abusers, domestic violence offenders, sexual offenders, and stalkers) were compared on the incidence of ACE, and comparisons were made between the group offenders and a normative sample. Results: Results indicated that the offender group reported nearly four times as many adverse events in childhood than an adult male normative sample. Eight of ten events were found at significantly higher levels among the criminal population. In addition, convicted sexual offenders and child abusers were more likely to report experiencing sexual abuse in childhood than other offender types. Conclusions: On the basis of a review of the literature and current findings, criminal behavior can be added to the host of negative outcomes associated with scores on the ACE Questionnaire. Childhood adversity is associated with adult criminality. We suggest that to decrease criminal recidivism, treatment interventions must focus on the effects of early life experiences.

Reavis, James A; Looman, Jan; Franco, Kristina A; Rojas, Briana



Kooperative Automation  

NASA Astrophysics Data System (ADS)

Das Aufgabenspektrum moderner Assistenzsyseme erstreckt sich von der Steigerung des Fahrkomforts bis hin zur Übernahme aktiver Sicherheitsfunktionen. Selbst komplexe Systeme wie die adaptive Fahrgeschwindigkeitsregelung ACC (Adaptive Cruise Control, vgl. Kap. 32), die wie viele weitere Innovationen in der Fahrzeugindustrie einst der automobilen Oberklasse vorbehalten war, dringen derzeit über die Mittelklasse in den Massenmarkt vor und beginnen, die Öffentlichkeit für die mit hoher Automatisierung einhergehenden Veränderungen und Herausforderungen zu sensibilisieren. Denn so beeindruckend die Leistungsfähigkeit moderner Fahrerassistenzsysteme auch ist, so verursacht sie doch ein Dilemma: Mit der Übernahme von primären Fahraufgaben durch Fahrerassistenzsysteme werden vom Fahrer neue und erweiterte Bedienfähigkeiten erwartet. Zum einen muss er ein mentales Modell eines jeden vorhandenen Assistenzsystems mit dessen spezifscher Mensch-Maschine-Schnittstelle aufbauen und dessen funktionale Grenzen verinnerlichen. Zum anderen muss er, nachdem er einen Teil seiner Fahraufgabe an ein Assistenzsystem übertragen hat, die (teil-)automatisierte Funktion überwachen, die Handlungen des Systems antizipieren und eine permanente Bereitschaft zur Rückübernahme der durch die Assistenzfunktion ausgeführten Fahraufgabe aufweisen. Die Rückübernahme geschieht entweder willentlich, wenn die Unterstützung nicht nach des Fahrers Vorstellung verläuft, oder sie ist obligatorisch, wenn die Assistenzfunktion an ihre funktionalen Grenzen stößt und explizit zur Übernahme auffordert.

Hakuli, Stephan; Bruder, Ralph; Flemisch, Frank O.; Löper, Christian; Rausch, Herbert; Schreiber, Michael; Winner, Hermann


Cáncer de hígado

Información acerca del cáncer de hígado, lo cual incluye temas como tratamiento, prevención, genética, causas, exámenes selectivos de detección, estudios clínicos y estadísticas del Instituto Nacional del Cáncer.


Complicaciones gastrointestinales (PDQ®)

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.



Microsoft Academic Search

Resumo: A preocupação com questões ambientais tem crescido nos últimos anos motivada, principalmente, pela busca da sociedade por conhecimentos que apontem amenização e soluções de problemas tanto em áreas urbanas como rurais. Diante desta preocupação e utilizando como base teórico-metodológica a Geomorfologia Ambiental, este trabalho apresenta um estudo geoambiental do curso médio da bacia hidrográfica do rio Verde, localizado no

Maristela Moresco Mezzomo; Andreia Quintão Soares



Microsoft Academic Search

Resumen: La conocida en Argentina como Teoría o tesis de los dos demonios se ha utilizado para, si no justificar, sí al menos querer dar una explica - ción simplista al advenimiento del golpe del gene- ral Videla y la consiguiente dictadura conocida en Argentina como el Proceso. El artículo analiza los discursos e imágenes sobre cada uno de los

José Manuel Barrio Terol


Helenistic Encomium: A Reflection on Comics and Rhetoric  

ERIC Educational Resources Information Center

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…

Helms, Jason



Entrevista a Gao Xingjian, premio Nobel de Literatura  

Microsoft Academic Search

Profundamente filosófico, Gao Xingjian, premio Nobel de Literatura, evoca la huida como protección ante el despotismo y la agresividad del autoritarismo político. Exiliado en París desde hace veinte años, Gao recurre a la creación literaria como forma de huida de la ideología y de otros “ismos” que pervierten al ser humano y le despojan de su libertad.

Dani Triadó



HERRAMIENTAS GERENCIALES PARA EL POSICIONAMIENTO DE LA EMPRESA SOSTENIBLE Y EL MARKETING ECOLÓGICO Management tools and positioning of sustainable enterprises and marketing ecological  

Microsoft Academic Search

RESUMEN La civilización humana está direccionando su acción comercial hacia el componente ecológico, tomando como principio la gerencia para proyectarse al mercado verde es decir, productos que generen menor impacto ambiental. La presente investigación tuvo como objetivo determinar las herramientas gerenciales para el posicionamiento de la empresa sostenible y el marketing ecológico. Este trabajo de investigación fue descriptivo, transeccional y

Dalia Plata de Plata


Another city is possible  

Microsoft Academic Search

Resumo: Este texto visa a alertar para a urgência de se projetar outra organização da cidade moderna. Da forma como a cidade se estruturou na modernidade, tornou-se inviável para a convivência humana. Em função de sua opção pelo mercado e pelo consumismo numa sociedade de desiguais, de incluídos-excluídos, a cidade morre todos os dias um pouco como espaço de convivência,

Euclides Redin; Rosane Romanini


El futuro de la Medicina General en Europa. Desarrollo y Modelos Conceptuales. I Parte  

Microsoft Academic Search

o me gusta hacer de aprendiz de brujo pero intentare exponer lo que veo, que a buen seguro no es como lo verán otros compañe- ros y con toda certeza será distinto de lo que ocurra en un sector extraordinariamente dinámico como el sanitario y sometido a la influencia de tantos factores, desde los sociales a los políticos y económicos





Microsoft Academic Search

La depresión es un problema serio de salud que puede afectar a personas de todas las edades, incluyendo a niños y adolescentes. Generalmente se define como una experiencia en la que persiste una disposición de ánimo triste o irritable, así como también anhedonia, una pérdida de la habilidad de experimentar placer en casi todas las actividades. Incluye también una gama



Microsoft Academic Search

1. INTRODUÇÃO Todas as industrias que utilizam a madeira como matéria-prima, têm ao final do processamento uma grande quantidade de resíduos, tanto na industria como na floresta. Na maioria das vezes esses resíduos industriais, constituem-se num grave problema, devido à quantidade, dispersão e dificuldade de manuseio que os mesmos apresentam. Por outro lado, exigem grandes áreas para armazenamento ou simplesmente

Antonio José Migliorini



Microsoft Academic Search

Resumen. La Fisuración Inducida por Hidrógeno (FIH), es uno de los fenómenos de corrosión bajo tensión más habitual en aquellas aplicaciones industriales que se encuentran en contacto con este elemento químico, como sucede en oleoductos, gasoductos, reactores de hydrotreating, etc. Existen numerosos estudios referentes al transporte y acumulación de hidrógeno en el metal, así como a la variación de propiedades

A. Cayón; J. A. Álvarez; F. Gutiérrez-Solana




Microsoft Academic Search

É notória a crescente importância das medidas técnicas, sanitárias e fitossanitárias às exportações brasileiras de produtos agrícolas, tais como: certificação de origem, avaliação de conformidade, normas e procedimentos técnicos, etc. Essas medidas têm sido formalizadas em notificações aos acordos TBT e SPS da OMC, vigentes desde 1995. Cabe ressaltar, no entanto, que essas medidas podem servir como barreiras protecionistas quando

Braulio Martins Bueno; Orlando Monteiro da Silva



Caracterización del mercado de energía elétrica para usuarios no regulados en Colombia  

Microsoft Academic Search

En este artículo se presenta un análisis sobre las características del mercado de energía para usuarios no regulados en Colombia, el cual puede ser considerado como un sub-mercado dentro del mercado global de energía eléctrica en Colombia. En este análisis se incluye un indicador de concentración de mercado (Herfindahl-Hirschman), así como los porcentajes de participación en cubrimiento de demanda y

Ana Cecilia Escudero; Sergio Botero Botero




Microsoft Academic Search

En la actualidad estamos asistiendo a un ejercicio de ingeniería social consistente en presentar, como un hecho, como conocimiento de sentido común, la contrapos ición violentos\\/demócratas. Se considera incuestionable que violencia y democracia forman una antinomia, dos formas de abordar las cuestiones políticas opuestas y mutu amente excluyentes. Un trabajo paralelo es el que se está haciendo en relación a




Gobierno corporativo, un desafio reciente para la gerencia estratégica empresarial  

Microsoft Academic Search

El Gobierno Corporativo en Colombia es visto, como la oportunidad que tienen nuestras empresas de acceder y competir abiertamente en los mercados internacionales, esto en razón a que muchos inversionistas las consideran como las palabras mágicas que abren o cierran puertas en los negocios internacionales, la transparencia, la probidad, las buenas prácticas empresariales, y el control, se han convertido en

A. M Cano Morales




Microsoft Academic Search

Este trabajo revisa el significado y los alcances del concepto de calidad en el ámbito estatal, su rol en el paradigma administrativo conocido como nueva gerencia pública, los modelos más importantes, las particularidades de los gobiernos en Latinoamérica y varios de los proyectos de incorporación de programas de calidad en ellos. Su realización se basó tanto en investigación documental como




El papel del gobierno en el desarrollo económico: una reflexión a partir de la experiencia  

Microsoft Academic Search

RESUMEN El trabajo expone el aprendizaje obtenido como producto de años de trabajo guberna- mental buscando opciones para impulsar el desarrollo económico competitivo de Jalisco. Se resumen los objetivos prioritarios que guiarían la política económica, así como las estrategias definidas para alcanzarlos; se examinan algunas de las herramientas aplica- das para motivar la cooperación orientada a lograr eficiencia colectiva en

Laura Guevara Domínguez


El gobierno de la educación en Inglaterra y Perú: una mirada comparada desde la economía política  

Microsoft Academic Search

Durante los últimos treinta años, el gobierno de la educación, como el de otros sectores, ha experimentado cambios importantes que han redefinido las escalas en las que se gobiernan los servicios educativos, así como quiénes son los actores responsables de dichos servicios. Este trabajo explora tales cambios en dos casos particulares, Inglaterra y el Perú, dos contextos cuya poca similitud

María Balarín




Microsoft Academic Search

En los últimos años se ha discutido el papel de los gobiernos subnacionales como entes tomadores de decisiones y generadores de política en diversos ámbitos, considerando que las prácticas novedosas y la participación de diversos actores gubernamentales y no gubernamentales son un factor detonante del desarrollo en el diseño e implementación de política pública. Estas nuevas formas —entendidas como innovación—

Mario E. Ibarra Cortés; Erika García Méndez



Habilidades Sociais e Problemas de Comportamento de Pré- Escolares: Comparando Avaliações de Mães e de Professoras Preschooler's Social Skills and Behavior Problems: Comparison between Mother and Teacher Assessments  

Microsoft Academic Search

Resumo Este estudo comparou avaliações de mães e professoras, sobre habilidades sociais e problemas de comportamento de crianças, identificadas pelas professoras, como tendo problemas de comportamento. Participaram mães e professoras de 24 crianças com problemas de comportamento e 24 crianças indicadas como sendo socialmente habilidosas. Foram utilizados o Questionário de Comportamentos Socialmente Adequados e a Escala Comportamental Infantil, versões para

Alessandra Turini Bolsoni-Silva; Edna Maria Marturano; Verônica Aparecida Pereira; Jair Wagner de Souza Manfrinato


PUBLIC HEALTH AND ENVIRONMENTAL POLLUTION: PRECAUTIONARY PARADIGMS Saúde pública e poluição ambiental: paradigmas precautórios  

Microsoft Academic Search

RESUMO Objetivos: Apresentar reflexões envolvendo perspectivas ambientais, saúde pública e ações antropogênicas relacionadas ao crescente consumo decorrente do modernismo instaurado no mundo. Síntese de dados: O paradigma precautório surge como constatação e reconhecimento propiciado pelas incertezas científicas e avaliação inadequada dos impactos das atividades humanas que contribuíram para a degradação ambiental e prejudicaram a saúde humana. Tendo como base o

Aldo Pacheco Ferreira



Microsoft Academic Search

El presente trabajo se realizó en una entidad dedicada a la prestación de servicios logísticos, el cual posee Certificado el Sistema de Gestión de la Calidad en lo adelante (SGC) según la NC ISO 9001\\/2008. Se trazó como objetivo diagnosticar el Sistema de Gestión de la Calidad, Tomando como guía la NC ISO 9001\\/2008. Para el desarrollo de esta investigación

Arles Segura Maturell




Microsoft Academic Search

El trabajo fue realizado en la Villa Mirador de Mayabe con el propósito de diagnosticar el sistema de gestión de la calidad que presenta la entidad, teniendo presente la Norma Cubana ISO 9001: 2008, así como valorar el funcionamiento de los elementos que estructura la Gestión Estratégica de la entidad como proceso rector y punto de partida de la gestión

Yunelsy Ortiz Chávez; Amaury Ricardo Garrido Tapia




Microsoft Academic Search

El trabajo que aquí se presenta ha tenido como objetivo analizar, a través de métodos etnográficos, los comportamientos de niños y niñas de cinco años en el denominado juego sociodramático para comprobar si se percibían diferencias en relación al género. El planteamiento teórico del que hemos partido ha sido el enfoque socio-cultural (Vygotski, Elkonin, Bruner) que entiende este juego como

Emma Lobato



Microsoft Academic Search

Cuando una mujer se queda embarazada, es habitual escuchar cómo se le pregunta si sabe si será niño o niña. Es como si todo lo que un embarazo conlleva, se redujera a esa cuestión, considerada como lo crucial, lo más importante. Y nos preguntamos, ¿ por qué necesitamos saber el sexo del bebé?, ¿no es más importante preguntar por la

Nuria María Palanco López



Prevalencia y características de los síntomas externalizantes en la infancia. Diferencias de género  

Microsoft Academic Search

En este trabajo se exponen las características de los síndromes empíricos de tipo externali- zante, así como su prevalencia en una muestra clínica pediátrica. Se utilizó como instrumento el Inventario Clínico Infantil (ICI), basado en la segunda parte del Child Behavior Checklist (CBCL), que evalúa comportamientos y emociones. Se ha aplicado a 300 niños y niñas de eda- des comprendidas

Concepción López-Soler; Maravillas Castro Sáez; Mavi Alcántara López; Visitación Fernández Fernández; José A. López Pina



EFECTO DEL GATUÑO SOBRE LA FERTILIDAD DEL SUELO Y LA BIOMASA HERBÁCEA EN PASTIZALES DEL CENTRO DE MÉXICO Effect of Catclaw Mimosa on Soil Fertility and Forage Yield in Rangelands in Central Mexico  

Microsoft Academic Search

RESUMEN El trabajo se realizó durante los años 2002 y 2003, en los estados de Aguascalientes y Jalisco, con el objetivo de evaluar el efecto del gatuño (Mimosa monancistra) en el grado de asociación de algunas variables edáficas, como pH, materia orgánica (MO), fósforo, calcio y magnesio, así como la cantidad de biomasa herbácea en tres sitios con diferente grado

Ernesto Flores; Juan Frías; Pedro Jurado; Víctor Olalde; Juan de Dios Figueroa; Arturo Valdivia; Edmundo García



Microsoft Academic Search

RESUMO: RESUMO: RESUMO: RESUMO: RESUMO: A enfermagem é reconhecida como uma das ocupações com alto risco de estresse e adoecimento. Os distúrbios musculoesqueléticos ganham proporção cada vez maior entre esses profissionais. Este estudo tem como objetivo apresentar algumas proposições sobre a relação do estresse e dos fatores psicossociais do trabalho na ocorrên- cia de distúrbio musculoesquelético e caracterizar o Modelo

Tânia Solange; Bosi de Souza; Rosane Harter


Uma Análise Tipológica da Dinâmica dos Arranjos e Sistemas Produtivos e Inovativos Locais (Aspil?S) Do Nordeste do Brasil  

Microsoft Academic Search

O presente trabalho tem como objetivo apresentar a dinâmica produtiva e inovativa dos Arranjos e Sistemas Produtivos e Inovativos Locais (ASPILs), tendo como foco os ASPILs nordestinos. Para tanto, foi utilizado o arcabouço da teoria evolucionária tendo por base o conceito de Sistema Nacional de Inovação do qual gerou a conceituação de ASPIL. Assim, buscou-se apresentar a dinâmica de arranjos

Diogo Araújo Sampaio


ORIGENS DA FORMAÇÃO AGRÁRIA SUL RIO-GRANDENSE NO CONTEXTO BRASILEIRO Apresentação Oral-Estrutura, Evolução e Dinâmica do s Sistemas Agroalimentares e Cadeias Agroindustriais  

Microsoft Academic Search

Resumo Partindo-se do pressuposto que a dinâmica do desenvolvimento rural de uma região é historicamente orientada, impõe-se a neces sidade de um aprofundado conhecimento acerca dos processos que contribuíram para a sua formação agrária. Neste sentido, o presente trabalho tem como objetivo inci tar a uma reflexão sobre a questão agrária e como ela tem condicionado a dinâmica do desenvolvimento



28. Modelamiento y Simulación de Fenómenos Astronómicos bajo un Enfoque Sistémico1  

Microsoft Academic Search

La Dinámica de Sistemas como herramienta metodológica para el modelamiento y simulación de fenómenos complejos, surge como una buena alternativa para el tratamiento de determinados fenómenos astronómicos y astrofísicos, a partir de un proceso de comprensión y construcción de un modelo matemático aprovechando las oportunidades que ofrece el pensamiento sistémico y la visualización de su comportamiento dinámico a partir de

Hugo Hernando; Andrade Sosa; Carlos Jaime; Barrios Hernández; Orlando José Katime Santrich


El profesional sanitario y el Código Penal (y II)  

Microsoft Academic Search

En esta segunda parte se abordan otros delitos recogidos por el Código Penal1 en los que se puede ver involucrado el profesional que ejerce la Medicina General. Son temas de gran actualidad social, y en cierto modo controvertidos, como la eutanasia (aun- que el Código Penal no la nombra de forma directa), y delitos novedosos, como los relativos a la

Pastor Bravo MM; Rodes Lloret F; Rubio Lucas


La contradicción entre identidad vivida e identificación jurídico-política  

Microsoft Academic Search

Este artículo quiere llamar la atención de los antropólogos españoles sobre una contradicción implícita, por no decir sepultada, en los discursos sobre la identidad. Se trata de la contradicción entre la identidad como expresión de lo vivido y la identidad como quimera, y a la vez, estigma clasificatorio. Si bien, varias opiniones tratan de hacer pasar lo segundo por lo

Ignasi Terradas i Saborit



Armonización legislativa en materia societaria en el Mercosur: una necesidad o una quimera?  

Microsoft Academic Search

La década del noventa puede ser sencillamente indicada como hito en cuanto a un desmesurado proceso globalizador en marcha. La llamada aldea global presenta un desarrollo cada vez más veloz que involucra distintas variables. Como consecuencia inmediata de tal realidad se destaca un notable incremento de los negocios internacionales, en especial en todo lo relativo a los espacios integrados. Aparece

Sara Lidia Feldstein de Cárdenas; Luciana Scotti; Mónica Rodriguez; Flavia Medina; Vera Baez Peña Wirt; Yamila Cárdenas


Caracterización espectroscópica de hielos de interés atmosférico y astrofísico  

Microsoft Academic Search

En años recientes se ha incrementado el estudio de procesos físicos y químicos que tienen lugar en la superficie o el interior de hielos, tanto en medios astrofísicos como en la atmósfera terrestre y en otros cuerpos del sistema solar. Se ha comprobado que las partículas heladas actúan como catalizadores de reacciones químicas, que no ocurrirían en su ausencia. En

R. Escribano



Produção de gramíneas do gênero Brachiaria sob níveis de sombreamento  

Microsoft Academic Search

RESUMO - O trabalho foi realizado com o objetivo de avaliar a produção de B. decumbens cv. Basilisk e B. brizantha, cultivares Marandu e Xaraés, sob diferentes níveis de sombreamento. Utilizou-se delineamento em blocos casualizados com esquema de parcelas subdivididas, considerando os níveis de sombreamento (0, 50, 70%) como parcela e as espécies ou cultivares como subparcelas. Sementes das gramíneas

Janaina Azevedo Martuscello; Liana Jank; Miguel Marques Gontijo Neto; Valdemir Antônio Laura; Daniel de Noronha Figueiredo Vieira Cunha



Resistencia a la flexión de vigas laminadas con tres especies de madera tropical mexicana  

Microsoft Academic Search

La madera aserrada tiene un comportamiento estructural adecuado; sin embargo, hay factores que influyen negativamente en su uso; tales como, los defectos anatómicos, la escasez de piezas grandes y la extracción de volúmenes insuficientes. Para subsanar estas limitaciones, se puede considerar como alternativa la fabricación de vigas laminadas, las cuales se forman con láminas de madera pegadas con algún tipo

Artículo de Investigación; Omar Araujo Molina; Miguel Cerón Cardeña; Mario Chan Martín; Manuel Azueta García




Microsoft Academic Search

RESUMEN. Después del accidente minero de Aznalcóllar (25\\/04\\/98) se llevaron a cabo las labores de recuperación de los suelos, consistentes en: a) la remoción de los lodos depositados sobre la superficie de los mismos, así como de una capa de suelo contaminado de hasta 20 cm de profundidad, y b) la aplicación de enmiendas. Como consecuencia de estas labores, quedaron

F. Moreno; I. F. Girón; F. Cabrera


Psicologia e bioética: diálogos  

Microsoft Academic Search

RESUMO O presente artigo discute questões acerca das intersecções entre a psicologia e a bioética. Muitos dos dilemas envolvendo a psicologia já são enfrentados por profissionais que atuam na saúde. Porém há aspectos teóricos importantes a serem considerados no estudo da psi- cologia hoje, como os dilemas morais comuns ao desenvolvimento humano em meio aos avanços tecnológicos tais como reprodução

Hericka Zogbi Jorge Dias; Gabriel José Chittó Gauer; Rachel Rubin; Alessandro Valério Dias




NSDL National Science Digital Library

En este juego de cartas los jugadores practican suma, razonar y lógica al mismo tiempo que buscan grupos de cartas que sumen 10 (como por ejemplo 5, 4 y 1). Incluye una variante más difícil. Disponible como página web, en archivo pdf, y en Inglés.




Eating disorders prevention based on visual literacy and psycho-education: a preliminar study  

Microsoft Academic Search

RESUMEN El presente estudio tuvo como objetivo evaluar dos programas de prevención primaria de trastor- nos alimentarios, uno de ellos basado en la formación de audiencias críticas hacia la publicidad televisiva y el otro en una estrategia psicoeducativa, en diecinueve adolescentes mujeres estu- diantes de primero de secundaria. La selección de las muestras fue intencional, considerándose como criterio de inclusión

Rosalía Rodríguez de Elías; Gilda Gómez Peresmitré



Síntesis y caracterización de materiales híbridos orgánico-inorgánicos de APS\\/PDMS  

Microsoft Academic Search

El uso de 3-aminopropiltrietoxi silano (APS) como precursor inorgánico en la síntesis de materiales híbridos, en sustitución de otros alcóxidos tradicionales como el tetraetilortosilicato (TEOS), abre la posibilidad de incorporar grupos amino reacti- vos en la red tridimensional. Estos grupos pueden ser utilizados para anclar diferentes compuestos orgánicos al material. Por otro lado, la rápida velocidad de hidrólisis del APS,



On Language, Mathematical Concepts and the Scientific Discourse  

Microsoft Academic Search

Resumo: Os conceitos matemáticos, fundamentais em todo processo de interação da Matemática com outras ciências, como a Física, a Filosofia, a Lógica e as Ciências Econômicas, guardam as chaves para a compreensão de suas estruturas e teorias, bem como para a compreensão do discurso matemático e, de modo mais amplo, para a compreensão do discurso científico. Neste trabalho refletimos sobre

Tadeu Fernandes de Carvalho


Recubrimientos sol-gel obtenidos por deposición electroforética (EPd) sobre metales  

Microsoft Academic Search

El proceso sol-gel es un método de gran interés para la producción de películas vítreas sobre metales, que actúan como barrera protectora frente a la oxidación y aumentan su resistencia a la corrosión. Se han obtenido recubrimientos inorgánicos e híbridos de distintas composiciones sobre distintos metales usando técnicas como inmersión, centrifugado y pulverización. Aunque estos métodos proporcionan recubrimientos con buenas




Microsoft Academic Search

O objetivo principal deste trabalho foi analisar o termo de consentimento para laqueadura de trompas perante a autonomia do corpo da mulher analisando-se os princípios e garantias constitucionais conseguidos a duras penas ao longo de muitos anos. Teve como método uma pesquisa bibliográfica envolvendo legislação e Doutrina, bem como contato direto com instituições e profissionais habilitados na área da saúde

Marcelo Nunes Apolinário; Carmen Liliam Rodrigues Arnoni




Microsoft Academic Search

RESUMO: O presente trabalho tem a finalidade de discutir a questão da cidadania no contexto de gênero no feminino, diante do Estado e de uma sociedade que têm como princípios um viés masculino, que implica múltiplas exclusões além do privado - como excluir as mulheres dos aspectos políticos, sociais e econômicos - , limitações e privações políticas, econômicas e sociais.

Walfrido Nunes de Menezes


As relações da Revista Estudos Feministas com os movimentos de mulheres  

Microsoft Academic Search

R R R R Resumo esumo esumo esumo esumo: Este artigo tem como objetivo refletir sobre o diálogo da REF, nesses últimos 15 anos, com os movimentos de mulheres no Brasil. Recupera os temas dos diversos dossiês que, em grande medida, focaram temáticas de extrema relevância e atualidade para a agenda política do feminismo. Resgata alguns desses dossiês como exemplos

Leila Linhares Barsted



Mulheres \\  

Microsoft Academic Search

Na virada do século XIX para o XX, o problema dos crimes sexuais transformou-se numa das maiores preocupações das autoridades públicas brasileiras. Vistos como uma das faces negativas do estágio de evolução da civilização ocidental, explicados enfaticamente como produtos da dissolução dos costumes resultante de \\

Carlos Martins Júnior


Associação movimento solidário colméia : um espaço para o resgate da cidadania das mulheres  

Microsoft Academic Search

Este trabalho tem como objetivo apresentar dados de uma investigação que o Grupo de Pesquisa Sexualidade e Escola (GESE) da Fundação Universidade Federal do Rio Grande (FURG) vem realizando junto às integrantes da Associação Movimento Solidário Colméia. Foram realizados vários encontros que funcionaram como um espaço narrativo em que as mulheres participaram ouvindo, contando e contrapondo histórias e fatos de

Guiomar Freitas Soares



Un Sistema de Control de Acceso para la Distribución de Contenidos Multimedia  

Microsoft Academic Search

La distribución de contenidos multimedia ha surgido como un nuevo mercado en expansión ofrecido por los proveedores de red, definiendo in- fraestructuras de acceso a los recursos capaces de soportar tanto accesos inalám- bricos como mediante cableado. Aunque estas infraestructuras han sido amplia- mente estudiadas en los últimos años, el principal objetivo de estos trabajos estaba centrado más en el

M. Sánchez; G. López; O. Cánovas; J. A. Sánchez; A. F. Gómez-Skarmeta



Microsoft Academic Search

Resumo: O texto discute questões relacionadas à formação inicial no curso de licenciatura em Artes Visuais na Faculdade de Artes do Paraná, focando-se nas percepções das alunas sobre as aulas de arte nos espaços escolares e seus estágios curriculares. Entende-se a formação inicial como parte do processo de profissionalização, na qual é possível perceber a maneira como os alunos pensam

Sônia Tramujas Vasconcellos


Gestión para el desarrollo local sostenible en Granjas Agroindustriales y Empresas Azucareras del MINAZ de la provincia de Cienfuegos  

Microsoft Academic Search

La investigación se realizó en las entidades del MINAZ, teniendo como título: “Gestión para el desarrollo local sostenible en Granjas Agroindustriales y Empresas Azucareras del MINAZ en la provincia de Cienfuegos”. Tiene como objetivo general proponer un sistema de gestión ambiental integral que permita valorar e implantar las políticas de desarrollo local sostenible de las granjas agroindustriales y empresas azucareras

Eduardo Julio López Bastida; Mileisy Balbis Morejón



Contribución a los sistemas integrados de gestión desde la perspectiva del directivo  

Microsoft Academic Search

El presente artículo tiene como objetivo mostrar una propuesta de un modelo y procedimiento para la implantación de un sistema integrado de gestión. Sustenta el marco teórico referencial de esta investigación, el análisis realizado de los criterios de algunos autores sobre el concepto de integración y sistema integrado de gestión (SIG), así como en las concepciones teóricas actuales sobre algunas

Elizabeth Guilarte Barinaga




Microsoft Academic Search

Tendo em vista os recentes avanços da ciência, sobretudo na área de manipulação genética, a questão da clonagem humana surge como um dos grandes desafios a ser encarado. Nesse trabalho buscamos fazer uma análise não só jurídica, mas também técnica, ética e moral do tema, tendo como ponto de partida um estudo sobre a Bioética, passando pelo surgimento do Biodireito

Bernardo Abreu de Medeiros


Um Novo Método de Dimensionamento de Reforços de Pavimentos Flexíveis Considerando a Reflexão de Fendas  

Microsoft Academic Search

RESUMO No presente trabalho é proposto um método de dimensionamento de reforços de pavimentos flexíveis, considerando como critérios de ruína o aparecimento de fendas à superfície da camada de desgaste, resultantes da reflexão do fendilhamento existente nas camadas betuminosas do pavimento existente, bem como o fendilhamento por fadiga. O método proposto baseia-se no dimensionamento estrutural corrente, acrescido duma verificação do

Jorge C. Pais; Paulo A. A. Pereira




Microsoft Academic Search

En este artículo se propone un modelo cognitivo de Creatividad Artificial, planteando la sinestesia como pilar fundamental de dicho modelo. Para ello mostraremos en primer lugar las relaciones entre sinestesia, lenguaje, metáfora y creatividad. Veremos como la sinestesia es común a todos los humanos a través de dos vías (experimentos realizados con poblaciones normales y mediante un análisis de la

Eurídice Cabañes Martínez



Microsoft Academic Search

El P. Antonio Soler tuvo al menos un hermano que también era músico y compositor: Mateo Soler, que actuó como fagotista de la Real Capilla en Madrid de 1780 a 1799, año en que murió. Damos cuenta de los pormenores biográficos tanto familiares como profesionales que hemos podido averiguar sobre este músico olvidado, del que incluso se conserva una sonata

Guy Bourligueux



Asociación entre el virus XMRV y enfermedades humanas: preguntas y respuestas

El XMRV es un retrovirus del que se informó por primera vez en 2006 como una causa potencial del cáncer de próstata. Está estrechamente relacionado con los virus de leucemia murina, los cuales causan una amplia variedad de cánceres así como enfermedades inmunológicas y neurológicas en ratones.


Incontinencia fecal funcional en niños  

Microsoft Academic Search

ResumenLa incontinencia fecal se define como la evacuación de deposiciones fecales en un lugar inadecuado. Este molesto síntoma es el origen de malestar y turbación considerables tanto para el niño o niña como para su familia. La incontinencia fecal pediátrica puede dividirse en dos categorías principales: (1) Incontinencia fecal orgánica resultante, por ejemplo, de malformaciones anorrectales o anomalías neurógenas; (2)

Marloes E. J. Bongers; Marc A. Benninga



Logística inversa, un enfoque con responsabilidad social empresarial  

Microsoft Academic Search

resumen el presente artículo tiene como objetivo realizar un análisis de la relación entre la logística inversa y la responsabilidad social como estrategia para reducir los impactos en el medio ambiente y aumentar los beneficios sociales y la seguridad en los empleados, clientes y comunidad. para alcanzar los objetivos, se consideran los temas de logística inversa y responsabilidad social desde

Rodrigo Andrés Gómez Montoya; Alexander Alberto Correa Espinal; Laura Sofía Vásquez Herrera



Chômage des jeunes et fonctionnement du marché du travail : les cas français et suédois  

Microsoft Academic Search

[spa] Desocupación de los jóvenes y funcionamiento del mercado laboral : el caso francés y el sueco - En Francia como en Suecia, el desempleo de los jóvenes de menos de 25 años aumentó como consecuencia de los choques macroeconómicos de los años setenta y ochenta. No obstante, este choque ha sido mucho más fuerte en Francia y ha sido

Yves Bourdet; Inga Persson



O CLIMATÉRIO E SUA RELAÇÃO COM A SAÚDE E O AMBIENTE DE TRABALHO The Climacterium and its relation to health and work environment  

Microsoft Academic Search

RESUMO O período do climatério é caracterizado por sinais e sintomas que podem repercutir de algum modo na vida de mulheres, tanto do ponto de vista familiar como profissional. Este estudo teve como objetivo analisar as interferências dos problemas vivenciados pela mulher no climatério e suas relações com a saúde e o ambiente de trabalho. Tratou-se de uma pesquisa exploratória-descritiva

Sandra Mar; Brasil Soares; Ana Maria Fontenelle Catri; Raimunda Magalhães da Silva; Mirna Albuquerque Frota


O telescópio remoto do Observatório Abrahão de Moraes - Obelix  

Microsoft Academic Search

Foi desenvolvido um telescópio totalmente automático situado no Observatório Abrahão de Moraes, em Valinhos-SP, que possibilita observações remotas via Internet tanto para fins profissionais como didáticos. Usando um programa navegador da WWW, o observador tem acesso a páginas interativas que permitem não só apontar o telescópio e receber as imagens, como também controlar a abertura e o fechamento da cúpula,

N. L. Neres; J. C. Raffaelli; G. A. Medina Tanco; J. E. Horvath; R. Maluhy; A. Martins; M. I. V. Orselli



Múltiples estados de desorden en el etanol sólido  

NASA Astrophysics Data System (ADS)

El diagrama de fases del etanol por debajo de los 169 K será presentado. Se mostrará que el etanol puede solidificarse en tres fases con diversos niveles de desorden,(como un vidrio(G), como un vidrio orientacional (OG) y como un cristal de fase rotora (RP)) además de en una fase totalmente cristalina. Las estructuras de estas tres fases serán presentadas tal y como se deducen a partir de diversas medidas de difracción de neutrones al igual que las proporciones de los isómeros de dicho material en las fases desordenadas y se compararán con los resultados de la fase cristalina y del líquido superenfriado. Igualmente diversas medidas sobre su dinámica serán presentadas, tanto de dispersión de neutrones, como de capacidad calorífica y de medidas dieléctricas y comparadas con modelos teóricos y simulaciones para tratar de explicar los procesos de relajación observados y las transiciones entre las diversas fases.

Fernández-Perea, R.


Efficacy of an HIV Intervention in Reducing High-Risk HPV, Non-viral STIs, and Concurrency among African-American Women: A Randomized Controlled Trial  

PubMed Central

Objective This trial evaluated the efficacy of an HIV intervention condition, relative to a health promotion condition, in reducing incidence of non-viral STIs (Chlamydia, gonorrhea, trichomoniasis), oncogenic HPV subtypes 16 and 18, sexual concurrency, and other HIV-associated behaviors over a 12-month period. Design Randomized controlled trial. Data analysts blinded to treatment allocation. Setting Kaiser Permanente Georgia Subjects A random sample of 848 African American women Intervention The two 4-hour HIV intervention sessions were based on Social Cognitive Theory and the Theory of Gender and Power. The intervention was designed to enhance participants’ self sufficiency and attitudes and skills associated with condom use. The HIV intervention also encouraged STI testing and treatment of male sex partners, and reducing vaginal douching and individual and male partner concurrency. Main Outcome Measure Incident non-viral STIs. Results In GEE analyses, over the 12-month follow-up, participants in the HIV intervention, relative to the comparison, were less likely to have non-viral incident STIs (OR=0.62; 95% CI, 0.40-0.96; P =.033); and incident high-risk HPV infection (OR=0.37; 95% CI, 0.18-0.77; P = .008), or concurrent male sex partners (OR=0.55; 95% CI, 0.37-0.83; P = .005). Additionally, intervention participants were less likely to report multiple male sex partners, more likely to use condoms during oral sex, more likely to inform their main partner of their STI test results, encourage their main partner to seek STI testing, report that their main partner was treated for STIs, and report not douching. Conclusion This is the first trial to demonstrate that an HIV intervention can achieve reductions in non-viral STIs, high-risk HPV, and individual concurrency.

Wingood, Gina M.; DiClemente, Ralph J.; Robinson-Simpson, LaShun; Lang, Delia L.; Caliendo, Angela; Hardin, James W.



Communication and Medication Adherence: The Diabetes Study of Northern California  

PubMed Central

Background Poor medication adherence contributes to poor cardiometabolic control and diabetes outcomes. Studies linking patient-provider communication to adherence often use self-reported adherence and have not explored differences across communication domains or therapeutic indications. Methods To investigate associations between patient communication ratings and cardiometabolic medication adherence, we conducted a cross-sectional analysis of 9,377 patients in the Diabetes Study of Northern California (DISTANCE), a race-stratified, random sample of Kaiser Permanente survey respondents. Eligible participants received ?1 oral hypoglycemic, lipid-lowering, or anti-hypertensive medication in the 12 months preceding the survey. Communication was measured with a 4-item Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS) score and 4 items from the Trust in Physicians and Interpersonal Processes of Care instruments. Poor adherence was >20% continuous medication gap for ongoing medications. Using modified least squares regression, we calculated differences in poor adherence prevalence for a 10-point decrease in CAHPS score and comparing higher vs. lower communication ratings on other items, adjusting for necessary sociodemographic and medical confounders derived from a directed acyclic graph. Results In this cohort, 30% had poor cardiometabolic medication adherence. For each 10-point decrease in CAHPS score, the adjusted prevalence of poor adherence increased by 0.9% (p=0.01). Compared with patients offering higher ratings, patients who gave lower ratings for providers’ involving patients in decisions, understanding patients’ problems with treatment, and eliciting confidence and trust were more likely to have poor adherence, with absolute differences of 4% (p=0.04), 5% (p=0.02) and 6% (p=0.03), respectively. Associations between communication and adherence were somewhat larger for hypoglycemic medications than other medications. Conclusions Poor communication ratings were independently associated with objectively measured inadequate cardiometabolic medication adherence, particularly for oral hypoglycemic medications. Future studies should investigate whether improving communication skills among clinicians with poorer patient communication ratings could improve their patients’ cardiometabolic medication adherence and outcomes.

Ratanawongsa, Neda; Karter, Andrew J.; Parker, Melissa M.; Lyles, Courtney R.; Heisler, Michele; Moffet, Howard H.; Adler, Nancy; Warton, E. Margaret; Schillinger, Dean



Tumor Necrosis Factor Alpha Inhibitor Therapy and Cancer Risk In Chronic Immune Mediated Diseases  

PubMed Central

Background We compared the incidence of cancer following tumor necrosis factor alpha antagonists (TNF-I) therapy to that with commonly used alternative therapies across multiple immune mediated diseases. Methods The Safety Assessment of Biologic thERapy (SABER) study used data from national Medicaid & Medicare, Kaiser Permanente Northern California, TennCare, and pharmacy benefits plans for Medicare beneficiaries in New Jersey and Pennsylvania. Propensity score adjusted hazard ratios (HR) and 95% confidence intervals (CI) were computed to estimate the relative rates of cancer, comparing TNF-I users to alternative disease modifying therapies. The cancer finding algorithm had a positive predictive value ranging from 31% for any leukemia to 89% for female breast cancer. Results We included 29,555 patients with rheumatoid arthritis (13,102 person-years), 6,357 patients with inflammatory bowel disease (1,508 person-years), 1,298 patients with psoriasis (371 person-years), and 2,498 patients with psoriatic arthritis (618 person-years). The incidence of any solid cancer was not elevated in rheumatoid arthritis (HR 0.80, CI 0.59-1.08), inflammatory bowel disease (HR 1.42, CI 0.47-4.26), psoriasis (HR 0.58, CI 0.10-3.31) or psoriatic arthritis (HR 0.74, CI 0.20-2.76) during TNF-I therapy compared to disease specific alternative therapy. Among patients with rheumatoid arthritis, the incidence of any of the ten most common cancers in the United States and nonmelanoma skin cancer was not increased with TNF-I therapy compared to methotrexate failure. Conclusions Short-term cancer risk was not elevated among patients treated with TNF-I therapy relative to commonly used therapies for immune mediated chronic inflammatory diseases in this study.

Haynes, Kevin; Beukelman, Timothy; Curtis, Jeffrey R; Newcomb, Craig; Herrinton, Lisa J; Graham, David J; Solomon, Daniel H; Griffin, Marie R; Chen, Lang; Liu, Liyan; Saag, Kenneth G; Lewis, James D



Alcohol consumption is inversely associated with adherence to diabetes self-care behaviours  

PubMed Central

Aims Our aim was to examine the associations of alcohol consumption with six diabetes self-care behaviours. Methods We determined levels of alcohol consumption and examined associations between alcohol consumption and six self-care behaviours in 65 996 adults with diabetes who received care through Kaiser Permanente Northern California and who responded to a 1994?1997 survey. Adherence with recommendations for self monitoring of blood glucose, HbA1c testing, and diabetes medications were determined from electronic records; smoking and use of diet and exercise to treat diabetes were self reported. Multiple logistic regression models were used to determine the associations between alcohol consumption (average number of drinks/day in the past year) and the probability of adherence to each self-care behaviour. Results Current alcohol consumption was reported by 50.8% of adults with diabetes. In adjusted models, we observed a gradient of increasing risk for poor adherence to diabetes self-care behaviours with increasing alcohol consumption, starting with those who consume even one drink a day. Former drinkers had the greatest compliance with each self-care behaviour, except for current smoking. Conclusions Alcohol consumption is a marker for poorer adherence to diabetes self-care behaviours. These findings highlight the importance of routine assessment of alcohol intake in people with diabetes, particularly as half of adults with diabetes consume alcohol. Given extant evidence that moderate alcohol intake may have cardiovascular benefits for patients with diabetes, examination of the trade-offs between cardiovascular benefits vs. potential risk of lower adherence with self-care behaviours deserves study.

Ahmed, A. T.; Karter, A. J.; Liu, J.



Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients  

PubMed Central

Purpose While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system. Patients and Methods We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy. Results We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent. Conclusion Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.

Hershman, Dawn L.; Kushi, Lawrence H.; Shao, Theresa; Buono, Donna; Kershenbaum, Aaron; Tsai, Wei-Yann; Fehrenbacher, Louis; Lin Gomez, Scarlett; Miles, Sunita; Neugut, Alfred I.



Heterogeneity of Diabetes Outcomes Among Asians and Pacific Islanders in the U.S.  

PubMed Central

OBJECTIVE Ethnic minorities with diabetes typically have lower rates of cardiovascular outcomes and higher rates of end-stage renal disease (ESRD) compared with whites. Diabetes outcomes among Asian and Pacific Islander subgroups have not been disaggregated. RESEARCH DESIGN AND METHODS We performed a prospective cohort study (1996–2006) of patients enrolled in the Kaiser Permanente Northern California Diabetes Registry. There were 64,211 diabetic patients, including whites (n = 40,286), blacks (n = 8,668), Latinos (n = 7,763), Filipinos (n = 3,572), Chinese (n = 1,823), Japanese (n = 951), Pacific Islanders (n = 593), and South Asians (n = 555), enrolled in the registry. We calculated incidence rates (means ± SD; 7.2 ± 3.3 years follow-up) and created Cox proportional hazards models adjusted for age, educational attainment, English proficiency, neighborhood deprivation, BMI, smoking, alcohol use, exercise, medication adherence, type and duration of diabetes, HbA1c, hypertension, estimated glomerular filtration rate, albuminuria, and LDL cholesterol. Incidence of myocardial infarction (MI), congestive heart failure, stroke, ESRD, and lower-extremity amputation (LEA) were age and sex adjusted. RESULTS Pacific Islander women had the highest incidence of MI, whereas other ethnicities had significantly lower rates of MI than whites. Most nonwhite groups had higher rates of ESRD than whites. Asians had ~60% lower incidence of LEA compared with whites, African Americans, or Pacific Islanders. Incidence rates in Chinese, Japanese, and Filipinos were similar for most complications. For the three macrovascular complications, Pacific Islanders and South Asians had rates similar to whites. CONCLUSIONS Incidence of complications varied dramatically among the Asian subgroups and highlights the value of a more nuanced ethnic stratification for public health surveillance and etiologic research.

Kanaya, Alka M.; Adler, Nancy; Moffet, Howard H.; Liu, Jennifer; Schillinger, Dean; Adams, Alyce; Ahmed, Ameena T.; Karter, Andrew J.



Skin disorders associated with obesity in children and adolescents: a population-based study.  


Obesity in children is a major public health concern in the United States. The objectives of the current study were to determine the prevalence of various groups of cutaneous disorders in obese children and adolescents and to compare the use of dermatology services in obese subjects with that those with a normal body mass index (BMI). This was a retrospective, population-based study at the Kaiser Permanente Northern California Managed Healthcare System. The main outcome measures were the relative risk of cutaneous disorders associated with insulin resistance, androgen excess, bacterial infection, fungal infection, viral infection, inflammation, mechanical changes, and other skin conditions (hidradenitis, hyperhidrosis) in three weight groups (normal, overweight, obese) and the number of dermatology visits. A total of 248,775 subjects were included. Bivariate analyses showed a higher proportion of insulin resistance disorders, bacterial infection, fungal infection, inflammatory disorders, mechanical changes, and other skin conditions in obese subjects than in subjects with a normal BMI (p < 0.001). Disorders of androgen excess and viral infection were significantly less common in obese subjects (p < 0.001). Obese subjects had significantly lower odds of having at least one dermatology encounter than subjects with a normal BMI (odds ratio = 0.92, 95% confidence interval 0.88, 0.96, p = 0.003). Early onset obesity is associated with cutaneous disorders characterized by hyperproliferation, inflammation, bacterial and fungal infection, and mechanical changes but lower rates of disorders of androgen excess and viral infection. The use of dermatology services was not greater in obese patients. Heightened recognition and further analysis of adipose tissue as an endocrine organ that is capable of affecting the skin is warranted. PMID:24329996

Mirmirani, Paradi; Carpenter, Diane M



Characteristics of 44 Cervical Cancers Diagnosed Following Pap-Negative, High Risk HPV-Positive Screening in Routine Clinical Practice  

PubMed Central

Objective To characterize the cervical cancers diagnosed following a Pap-negative, high risk human papillomavirus (HPV)-positive (Pap?/HPV+) screen in routine clinical practice. Methods Using data from Kaiser Permanente Northern California, we investigated the cases of cervical cancer diagnosed between January, 2003 through January, 2009 following Pap?/HPV+ screen. Two cervical specimens were routinely collected for cervical cancer screening, one for conventional cytology and the other for high risk HPV testing using Hybrid Capture 2 (Qiagen). Results Forty-four women (median age at diagnosis = 44 years) were diagnosed with primary invasive cervical cancer with a recent history of one or more Pap?/HPV+ screens. Twenty-six women had one Pap?/HPV+ screen preceding the diagnosis of cancer, 15 had two, and three had three. There were 16 squamous cancers, one small cell cancer, 24 adenocarcinomas, 2 adenosquamous carcinomas, and one case with separate invasive squamous and adenocarcinoma. FIGO Stage was IA in 11 women, IB in 31 women and IIA in 2 women. Treatment included a pelvic node dissection in 230, 2 (6.7%) of whom had positive nodes. Conclusions HPV testing contributes to early cervical cancer diagnosis detection in women with negative Pap tests. Most women in this cohort have early stage, node negative, treatable and potentially curable disease. Adenocarcinoma predominated as might be expected because cytology misses these cancers and their precursors. The majority of cancers were diagnosed following a single Pap?/HPV+ screen, suggesting that effective triage to colposcopy of women with a Pap?/HPV+ screen would be preferable to retesting in one year as currently recommended.

Kinney, Walter; Fetterman, Barbara; Cox, J. Thomas; Lorey, Thomas; Flanagan, Tracy; Castle, Philip E.



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

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.

McCulloch, Michael; Broffman, Michael; van der Laan, Mark; Hubbard, Alan; Kushi, Lawrence; Abrams, Donald I.; Gao, Jin; Colford, John M.



Gastrointestinal Disease Outbreak Detection Using Multiple Data Streams from Electronic Medical Records  

PubMed Central

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.

Huang, Jie; Abrams, Allyson M.; Gilliss, Debra; Reed, Mary; Platt, Richard; Huang, Susan S.; Kulldorff, Martin



Distribution of hepatitis C virus genotypes in a diverse US integrated health care population.  


Hepatitis C virus (HCV) genotypes influence response to therapy, and recently approved direct-acting antivirals are genotype-specific. Genotype distribution information can help to guide antiviral development and elucidate infection patterns. HCV genotype distributions were studied in a diverse cross-section of patients in the Northern California Kaiser Permanente health plan. Associations between genotype and race/ethnicity, age, and sex were assessed with multivariate logistic regression models. The 10,256 patients studied were median age 56 years, 62% male, 55% White non-Hispanic. Overall, 70% were genotype 1, 16% genotype 2, 12% genotype 3, 1% genotype 4, <1% genotype 5, and 1% genotype 6. Blacks (OR 4.5 [3.8-5.5]) and Asians (OR 1.2 [1.0-1.4]) were more likely to have genotype 1 than 2/3 versus non-Hispanic Whites. Women less likely had genotype 1 versus 2/3 than did men (OR 0.86 [0.78-0.94]). Versus non-Hispanic Whites, Asians (OR 0.38 [0.31-0.46]) and Blacks (OR 0.73 [0.63-0.84]) were less likely genotype1a than 1b; Hispanics (OR 1.3 [1.1-1.5]) and Native Americans (OR 1.9 [1.2-2.8]) more likely had genotype 1a than 1b. Patients age ?65 years less likely had genotype 1a than 1b versus those age 45-64 (OR 0.34 [0.29-0.41]). The predominance of genotype 1 among all groups studied reinforces the need for new therapies targeting this genotype. Racial/ethnic variations in HCV genotype and subtype distribution must be considered in formulating new agents and novel strategies to successfully treat the diversity of hepatitis C patients. PMID:22997077

Manos, M Michele; Shvachko, Valentina A; Murphy, Rosemary C; Arduino, Jean Marie; Shire, Norah J



Neighborhood Deprivation and Change in BMI Among Adults With Type 2 Diabetes  

PubMed Central

OBJECTIVE To compare associations between neighborhood deprivation and measures of BMI change among adults with type 2 diabetes. RESEARCH DESIGN AND METHODS Using data from the Kaiser Permanente Diabetes Study of Northern California (DISTANCE) survey, we estimated the association between neighborhood deprivation and two measures of BMI change over 3 years: 1) a continuous measure and 2) a categorical measure of clinically substantive BMI loss or gain (?7% of baseline BMI) versus stable BMI. The sample included 13,609 adults. RESULTS On average, there was little change in BMI (?0.12, SD 3.07); 17.0 and 16.1% had clinically substantive BMI loss or gain, respectively, at follow-up. There was a positive association between neighborhood deprivation and BMI change for adults in the most versus least-deprived quartile of neighborhood deprivation (? = 0.22, P = 0.02) in adjusted models. In addition, relative to the least-deprived quartile (Q1), adults in more-deprived quartiles of neighborhood deprivation were more likely to experience either substantive BMI loss (Q2 relative risk ratio 1.19, 95% CI 1.00–1.41; Q3 1.20, 1.02–1.42; Q4 1.30, 1.08–1.55) or gain (Q2 1.25, 1.04–1.49; Q3 1.24, 1.04–1.49; Q4 1.45, 1.20–1.75). CONCLUSIONS Greater neighborhood deprivation was positively associated with BMI change among adults with diabetes as well as with clinically substantive BMI loss or gain. Findings stress the importance of allowing for simultaneous associations with both gain and loss in future longitudinal studies of neighborhood deprivation and weight change, which may be particularly true for studies of patients with diabetes for whom both weight loss and gain have health implications.

Stoddard, Pamela J.; Laraia, Barbara A.; Warton, E. Margaret; Moffet, Howard H.; Adler, Nancy E.; Schillinger, Dean; Karter, Andrew J.



Elevated Rates of Diabetes in Pacific Islanders and Asian Subgroups  

PubMed Central

OBJECTIVE We estimated the prevalence and incidence of diabetes among specific subgroups of Asians and Pacific Islanders (APIs) in a multiethnic U.S. population with uniform access to care. RESEARCH DESIGN AND METHODS This prospective cohort analysis included 2,123,548 adult members of Kaiser Permanente Northern California, including 1,704,363 with known race/ethnicity (white, 56.9%; Latino, 14.9%; African American, 8.0%; Filipino, 4.9%; Chinese, 4.0%; multiracial, 2.8%; Japanese, 0.9%; Native American, 0.6%; Pacific Islander, 0.5%; South Asian, 0.4%; and Southeast Asian, Korean, and Vietnamese, 0.1% each). We calculated age-standardized (to the 2010 U.S. population) and sex-adjusted diabetes prevalence at baseline and incidence (during the 2010 calendar year). Poisson models were used to estimate relative risks. RESULTS There were 210,632 subjects with prevalent diabetes as of 1 January 2010 and 15,357 incident cases of diabetes identified during 2010. The crude diabetes prevalence was 9.9% and the incidence was 8.0 cases per 1,000 person-years and, after standardizing by age and sex to the 2010 U.S. Census, 8.9% and 7.7 cases per 1,000 person-years. There was considerable variation among the seven largest API subgroups. Pacific Islanders, South Asians, and Filipinos had the highest prevalence (18.3, 15.9, and 16.1%, respectively) and the highest incidence (19.9, 17.2, and 14.7 cases per 1,000 person-years, respectively) of diabetes among all racial/ethnic groups, including minorities traditionally considered high risk (e.g., African Americans, Latinos, and Native Americans). CONCLUSIONS High rates of diabetes among Pacific Islanders, South Asians, and Filipinos are obscured by much lower rates among the large population of Chinese and several smaller Asian subgroups.

Karter, Andrew J.; Schillinger, Dean; Adams, Alyce S.; Moffet, Howard H.; Liu, Jennifer; Adler, Nancy E.; Kanaya, Alka M.



Individuals Receiving Addiction Treatment: Are Medical Costs of their Family Members Reduced?  

PubMed Central

Aims To examine whether alcohol and other drug (AOD) treatment of the individual with AOD disorders is related to reduced medical costs of family members. Methods Using Kaiser Permanente Northern California administrative databases we matched AOD treatment patients with health plan members without AOD disorders on age, gender, and utilization criteria; we identified family members of each group. We measured abstinence at 1-year post-intake and examined health care costs per member-month of family members of AOD patients and of controls through 5 years post-intake. We used generalized estimating equation methods to examine differences in average medical cost per member-month for each year, between family members of abstinent and non-abstinent AOD patients and control family members. We used multilevel models to examine the 4-year trajectories of cost subsequent to measuring abstinence status, controlling for pre-intake cost, age, gender and family size. Results AOD patients’ family members had significantly higher costs and more psychiatric and medical conditions than control family members in the pre-treatment year. At 2-5 years post-intake, each year family members of AOD patients who were abstinent at 1 year had similar average per member-month medical costs as control family members (e.g., difference at year 5=$2.63; p>.82), whereas average per member-month costs of family members of non-abstinent patients were higher (e.g., difference at year 5=$35.59; p=.06). Family members of AOD patients who were not abstinent at 1 year, had a trajectory of increasing medical cost (slope=$10.32; p=.03) relative to control family members. Conclusions Successful AOD treatment is related to medical cost reductions for family members; these reductions may be considered a proxy for improved health.

Weisner, Constance; Parthasarathy, Sujaya; Moore, Charles; Mertens, Jennifer R.



Early Start: An Integrated Model of Substance Abuse Intervention for Pregnant Women  

PubMed Central

Untreated perinatal substance abuse is associated with serious adverse maternal and neonatal outcomes. Historically, many barriers have prevented pregnant women from seeking treatment. Early Start (ES) breaks new ground by sidestepping these barriers with a fully integrated service delivery model. ES is the largest HMO-based prenatal substance-abuse program in the United States targeting all pregnant women seen at Kaiser Permanente Northern California (KPNC) prenatal clinics, currently screening more than 39,000 women each year. The program is based on the premise that substance abuse is a treatable disease and addresses it in a nonjudgmental, accepting manner. A substance-abuse counselor is located in each obstetrics clinic providing accessible one-to-one counseling to pregnant women screened at risk for alcohol, tobacco, or drug use as part of the routine prenatal care package offered to all patients. A 2006 ES study, sponsored by the Kaiser Foundation Research Institute, evaluated program effectiveness in terms of its impact on neonatal and maternal outcomes. Preliminary results that included 49,986 KPNC patients indicate that compared with pregnant women whose results on screening for substance use were positive but who were untreated, ES-treated women had significantly lower rates on a number of outcome measures. The originality and transferability of ES has led to both local and national recognition. Universal screening of all pregnant women with access to an integrated model of substance-abuse treatment should be the standard of care for every prenatal patient because of the significant benefits for mothers and their babies.

Taillac, Cosette; Goler, Nancy; Armstrong, Mary Anne; Haley, Kathleen; Osejo, Veronica



Correlates of Quality of Life in Older Adults With Diabetes  

PubMed Central

OBJECTIVE To evaluate associations between health-related quality of life (HRQL) and geriatric syndromes, diabetes complications, and hypoglycemia in older adults with diabetes. RESEARCH DESIGN AND METHODS A race-stratified random sample of 6,317 adults with type 2 or type 1 diabetes, aged 60 to 75 years, enrolled in Kaiser Permanente Northern California, who completed a survey that included a HRQL instrument based on the Short Form 8-item health survey. Administrative records were used to ascertain diagnoses of geriatric syndromes, diabetes complications, and hypoglycemia. Associations were estimated between HRQL and exposures in exposure-specific and combined exposure models (any syndrome, any complication, or hypoglycemia). Conservatively, differences of ?3 points were considered the minimally important difference in HRQL scores. RESULTS HRQL was lower with nearly all exposures of interest. The lowest physical HRQL was associated with amputation. In combined exposure models, geriatric syndromes (?5.3 [95% CI ?5.8 to ?4.8], P < 0.001) and diabetes complications (?3.5 [?4.0 to ?2.9], P < 0.001) were associated with lower physical HRQL. The lowest mental HRQL was associated with depression, underweight (BMI <18 kg/m2), amputation, and hypoglycemia. In combined exposure models, only hypoglycemia was associated with lower mental HRQL (?4.0 [?7.0 to ?1.1], P = 0.008). CONCLUSIONS Geriatric syndromes and hypoglycemia are associated with lower HRQL to a comparable degree as diabetes complications. Addressing geriatric syndromes and avoiding hypoglycemia should be given as high a priority as preventing diabetes complications in older adults with diabetes.

Laiteerapong, Neda; Karter, Andrew J.; Liu, Jennifer Y.; Moffet, Howard H.; Sudore, Rebecca; Schillinger, Dean; John, Priya M.; Huang, Elbert S.



Place matters: Neighborhood deprivation and cardiometabolic risk factors in the Diabetes Study of Northern California (DISTANCE) Social Science & Medicine  

PubMed Central

While neighborhood deprivation is associated with prevalence of chronic diseases, it is not well understood whether neighborhood deprivation is also associated with cardiometabolic risk factors among adults with chronic disease. Subjects (n=19,804) from the Diabetes Study of Northern California (DISTANCE) cohort study, an ethnically stratified, random sample of members of Kaiser Permanente Northern California (KPNC), an integrated managed care consortium, with type 2 diabetes who completed a survey between 2005 and 2007 and who lived in a 19 county study area were included in the analyses. We estimated the association between a validated neighborhood deprivation index (NDI) and four cardiometabolic risk factors: body mass index (BMI= kg/m2), glycosylated hemoglobin (A1c), low-density lipoproteins (LDL) and systolic blood pressure (SBP) using multilevel models. Outcomes were modeled in their continuous form and as binary indicators of poor control (severe obesity: BMI ?35, poor glycemic control: A1c ?9%, hypercholesterolemia: LDL ?130 mg/dL, and hypertension: SBP ?140 mmHg). BMI, A1c and SBP increased monotonically across quartiles of NDI (p<0.001 in each case); however, LDL was significantly associated with NDI only when comparing the most to the least deprived quartile. NDI remained significantly associated with BMI and A1c after adjusting for individual level factors including income and education. A linear trend (p<0.001) was observed in the relative risk ratios for dichotomous indicators of severe obesity, poor glycemic control, and 2 or more poorly controlled cardiometabolic risk factors across NDI quartile. In adjusted models, higher levels of neighborhood deprivation were positively associated with indicators of cardiometabolic risk among adults with diabetes, suggesting that neighborhood level deprivation may influence individual outcomes. However, longitudinal data are needed to test the causal direction of these relationships.

Laraia, Barbara A.; Karter, Andrew J.; Warton, E. Margaret; Schillinger, Dean; Moffet, Howard H.; Adler, Nancy



Rethinking Medical Professionalism: The Role of Information Technology and Practice Innovations  

PubMed Central

Context Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics, and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest, and distribute finite resources fairly. Information technology (IT), electronic health records (EHRs), improved models of disease management, and new ways of relating to and sharing responsibility for patients' care can contribute to both professionalism and quality of care. Methods The potential of IT, EHRs, and other practice facilitators for professionalism is assessed through diverse but relevant literatures, examination of relevant websites, and experience in working with medical leaders on renewing professionalism. Findings IT and EHRs are the basis of needed efforts to reinforce medical competence, improve relationships with patients, implement disease management programs, and, by increasing transparency and accountability, help reduce some conflicts of interest. Barriers include the misalignment of goals with payment incentives and time pressures in meeting patients' expectations and practice demands. Implementing IT and EHRs in small, dispersed medical practices is particularly challenging because of short-term financial costs, disruptions in practice caused by learning and adaptation, and the lack of confidence in needed support services. Large organized systems like the VA, Kaiser Permanente, and general practice in the United Kingdom have successfully overcome such challenges. Conclusions IT and the other tools examined in this article are important adjuncts to professional capacities and aspirations. They have potential to help reverse the decline of primary care and make physicians' practices more effective and rewarding. The cooperation, collaboration, and shared responsibility of government, insurers, medical organizations, and physicians, as well as financial and technical support, are needed to implement these tools in the United States' dispersed and fragmented medical care system.

Mechanic, David



More comprehensive discussion of CRC screening associated with higher screening  

PubMed Central

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.

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



HIV Infection Status, Immunodeficiency, and the Incidence of Non-Melanoma Skin Cancer  

PubMed Central

Background The incidence of non-melanoma skin cancers (NMSCs), including basal cell (BCC) or squamous cell carcinoma (SCC), is not well documented among HIV-positive (HIV+) individuals. Methods We identified 6560 HIV+ and 36 821 HIV-negative (HIV?) non-Hispanic white adults who were enrolled and followed up in Kaiser Permanente Northern California from 1996 to 2008. The first biopsy-proven NMSCs diagnosed during follow-up were identified from pathology records. Poisson models estimated rate ratios that compared HIV+ (overall and stratified by recent CD4 T-cell counts and serum HIV RNA levels) with HIV? subjects and were adjusted for age, sex, smoking history, obesity diagnosis history, and census-based household income. Sensitivity analyses were adjusted for outpatient visits (ie, a proxy for screening). All statistical tests were two-sided. Results The NMSC incidence rate was 1426 and 766 per 100 000 person-years for HIV+ and HIV? individuals, respectively, which corresponds with an adjusted rate ratio of 2.1 (95% confidence interval [CI] = 1.9 to 2.3). Similarly, the adjusted rate ratio for HIV+ vs HIV? subjects was 2.6 (95% CI = 2.1 to 3.2) for SCCs, and it was 2.1 (95% CI = 1.8 to 2.3) for BCCs. There was a statistically significant trend of higher rate ratios with lower recent CD4 counts among HIV+ subjects compared with HIV? subjects for SCCs (P trend < .001). Adjustment for number of outpatient visits did not affect the results. Conclusion HIV+ subjects had a twofold higher incidence rate of NMSCs compared with HIV? subjects. SCCs but not BCCs were associated with immunodeficiency.



Cluster radioactive decay within the preformed cluster model using relativistic mean-field theory densities  

SciTech Connect

We have studied the (ground-state) cluster radioactive decays within the preformed cluster model (PCM) of Gupta and collaborators [R. K. Gupta, in Proceedings of the 5th International Conference on Nuclear Reaction Mechanisms, Varenna, edited by E. Gadioli (Ricerca Scientifica ed Educazione Permanente, Milano, 1988), p. 416; S. S. Malik and R. K. Gupta, Phys. Rev. C 39, 1992 (1989)]. The relativistic mean-field (RMF) theory is used to obtain the nuclear matter densities for the double folding procedure used to construct the cluster-daughter potential with M3Y nucleon-nucleon interaction including exchange effects. Following the PCM approach, we have deduced empirically the preformation probability P{sub 0}{sup emp} from the experimental data on both the alpha- and exotic cluster-decays, specifically of parents in the trans-lead region having doubly magic {sup 208}Pb or its neighboring nuclei as daughters. Interestingly, the RMF-densities-based nuclear potential supports the concept of preformation for both the alpha and heavier clusters in radioactive nuclei. P{sub 0}{sup a}lpha{sup (emp)} for alpha decays is almost constant (approx10{sup -2}-10{sup -3}) for all the parent nuclei considered here, and P{sub 0}{sup c(emp)} for cluster decays of the same parents decrease with the size of clusters emitted from different parents. The results obtained for P{sub 0}{sup c(emp)} are reasonable and are within two to three orders of magnitude of the well-accepted phenomenological model of Blendowske-Walliser for light clusters.

Singh, BirBikram; Patra, S. K.; Gupta, Raj K. [Institute of Physics, Sachivalaya Marg, Bhubaneswar 751005 (India); Department of Physics, Panjab University, Chandigarh 160014 (India)



Changes in vitamin and mineral supplement use after breast cancer diagnosis in the Pathways Study: a prospective cohort study  

PubMed Central

Background Vitamin and mineral supplement use after a breast cancer diagnosis is common and controversial. Dosages used and the timing of initiation and/or discontinuation of supplements have not been clearly described. Methods We prospectively examined changes in use of 17 vitamin/mineral supplements in the first six months following breast cancer diagnosis among 2,596 members (28% non-white) of Kaiser Permanente Northern California. We used multivariable logistic regression to examine demographic, clinical, and lifestyle predictors of initiation and discontinuation. Results Most women used vitamin/mineral supplements before (84%) and after (82%) diagnosis, with average doses far in excess of Institute of Medicine reference intakes. Over half (60.2%) reported initiating a vitamin/mineral following diagnosis, 46.3% discontinuing a vitamin/mineral, 65.6% using a vitamin/mineral continuously, and only 7.2% not using any vitamin/mineral supplement before or after diagnosis. The most commonly initiated supplements were calcium (38.2%), vitamin D (32.01%), vitamin B6 (12.3%) and magnesium (11.31%); the most commonly discontinued supplements were multivitamins (17.14%), vitamin C (15.97%) and vitamin E (45.62%). Higher education, higher intake of fruits/vegetables, and receipt of chemotherapy were associated with initiation (p-values <0.05). Younger age and breast-conserving surgery were associated with discontinuation (p-values <0.05). Conclusions In this large cohort of ethnically diverse breast cancer patients, high numbers of women used vitamin/mineral supplements in the 6 months following breast cancer diagnosis, often at high doses and in combination with other supplements. The immediate period after diagnosis is a critical time for clinicians to counsel women on supplement use.



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

PubMed Central

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.

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



Prevalence and incidence of adult attention deficit/hyperactivity disorder in a large managed care population.  


Abstract Objectives: To estimate longitudinal trends in prevalence and incidence rates of adult ADHD 2006-2009. Research design and methods: Kaiser Permanente Southern California (KPSC) electronic medical records were analyzed to assess prevalence and incidence rates for adult ADHD. Trends over time were estimated and compared using three case definitions (ADHD diagnosis only [DX], ADHD DX and ?2 FDA-approved ADHD prescriptions [DX?+?RX], and ADHD DX and ?1 behavioral therapy visit [DX?+?BT]). Main outcome measures: Prevalence and incidence rates of adult ADHD. Results: Prevalence ranged from 151 (DX?+?RX) to 312 (DX) cases per 100,000 members in 2006, increasing to 239 (DX?+?RX) and 415 (DX) cases in 2009. Prevalence based on DX?+?BT declined from 185 in 2006 to 94 cases per 100,000 in 2009. In 2006, incidence ranged from 15 (DX?+?BT) to 68 (DX) cases per 100,000 person-years. Incidence rates remained stable throughout the study period. Stratified analyses based on DX?+?RX revealed only slight variations by gender, but sharp differences by age, with younger adults demonstrating a higher prevalence overall as well as dramatic increases over the study period. Prevalence was highest among Caucasians, increasing substantially across all race groups