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Educacin Contnua & Permanente Ciencias Econmicas  

E-print Network

Educación Contínua & Permanente Agronomía Artes Ciencias Ciencias Económicas Ciencias Humanas Derecho Ciencias Políticas y Sociales Enfermería Ingeniería Medicina Medicina Veterinaria y Zootécnia......................................................................11 3. FACULTAD DE CIENCIAS

Prieto, Germán A.



PubMed Central

Existe evidencia suficiente para declarar a la tuberculosis como enfermedad ocupacional en diversos profesionales especialmente entre los trabajadores de salud. En el Per estn 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 an no han sido suficientemente socializados. En este trabajo se presenta informacin 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 legislacin peruana vigente al respecto. PMID:22858771

Mendoza-Ticona, Alberto



Transformational quality in kaiser permanente northern california.  


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

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



Trabajo con Comunidades y Grupos : dominacin y resistencia. Procesos que nos llevan a plantear tareas permanentes y cotidianas  

Microsoft Academic Search

Este trabajo presenta algunas ideas con respecto a las tareas permanentes y cotidianas, que se sugieren considerar en el trabajo colectivo en las comunidades y con los grupos en los que participamos. La convivencia humana, como prctica socio-cultural se convierte en una de las vivencias ms complejas e importantes que son capaces de gestar lo que en el mundo actual

Teresa Cordero Cordero



Determinantal and Permanental Representation of Generalized Fibonacci Polynomials  

E-print Network

In this paper, we give some determinantal and permanental representations of Generalized Fibonacci Polynomials by using various Hessenberg matrices. These results are general form of determinantal and permanental representations of k sequences of the generalized order-k Fibonacci and Pell numbers.

Sahin, Adem



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



John Mattison Chief Medical Information Officer, Kaiser Permanente  

E-print Network

Connect program. Dr. Mattison has consulted internationally on health information technology and interoperability Director and Chief Medical Information Officer, and in 2003 became program director for the HealthJohn Mattison Chief Medical Information Officer, Kaiser Permanente John Mattison currently oversees

Loudon, Catherine


Station GPS permanente IPG Paris DGF Uchile UNAP Iquique  

E-print Network

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

Vigny, Christophe


Diagnostic de la nutrition minrale de prairies permanentes au printemps.  

E-print Network

Agronomie Diagnostic de la nutrition minérale de prairies permanentes au printemps. II. Validation; Dans un précédent article, nous avons proposé une méthode de diagnostic de la nutrition minérale à par aérienne. Des courbes de référence, N en fonction de la biomasse pour la nutrition azotée, P et K en

Paris-Sud XI, Université de


Aide apporte par la tldtection la cartographie des prairies permanentes  

E-print Network

Aide apportée par la télédétection à la cartographie des prairies permanentes Colette M. GIRARD I mise au point d'une méthode de diagnostic et de cartographie des prairies et pâturages appliquée à la guident le seuillage des données satellitaires. Un exemple de cartographie est donné et discuté. Mots clés

Paris-Sud XI, Université de


Kaiser Permanente's "metadata-driven" national clinical intranet.  


This paper describes the approach taken to build Kaiser Permanente's national clinical intranet. A primary objective for the site is to facilitate resource discovery, which is enabled by the use of "metadata", or data (fields and field values) that describe the various resources available. Users can perform full text queries and/or fielded searching against the metadata. Metadata serves as the organizing principle of the site--it is used to index documents, sort search results, and structure the site's table of contents. The site's use of metadata--what it is, how it is created, how it is applied to documents, how it is indexed, how it is presented to the user in the search and the search results interface, and how it is used to construct the table of contents for the web site--will be discussed in detail. The result is that KP's national clinical intranet has coupled the power of Internet-like full text search engines with the power of MedLine-like fielded searching in order to maximize search precision and recall. Organizing content on the site in accordance with the metadata promotes overall consistency. Issues currently under investigation include how to better exploit the power of the controlled terminology within the metadata; whether the value gained is worth the cost of collecting metadata; and how automatic classification algorithms might obviate the need for manual document indexing. PMID:11604755

Dolin, R H; Boles, M; Dolin, R; Green, S; Hanifin, S; Hochhalter, B; Inglesis, R; Ivory, M; Levy, D; Nadspal, K; Rae, M A; Rucks, C J; Snyder, A; Stibolt, T; Stiefel, M; Travis, V



Les mises a pied permanentes au Canada : vue d'ensemble et analyse longitudinale  

Microsoft Academic Search

Les Canadiens sont de plus en plus preoccupes par les mises a pied permanentes, car un grand nombre d'entre eux estiment que l'instabilite d'emploi et la possibilite de perdre son emploi se sont accrues au cours des annees 90. Aussi les gouvernements, qui font face chaque annee a une multitude de mises a pied permanentes, doivent-ils savoir comment reagir pour

Zhengxi Picot Garnett Pyper Wendy Zhengxi Lin Lin



The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators  

Microsoft Academic Search

Objective To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California.Design Longitudinal analysis.Setting 35 medical facilities of Kaiser Permanente Northern California, 1997-2007.Participants 2 523 659 adult members of Kaiser Permanente Northern California.Main outcomes measures Yearly assessment of patient level glycaemic control (HbA1c

Helen Lester; Julie Schmittdiel; Joe Selby; Bruce Fireman; Stephen Campbell; Janelle Lee; Alan Whippy; Philip Madvig



Transparency Matters: Kaiser Permanente's National Guideline Program Methodological Processes  

PubMed Central

Introduction: The practice-guideline process of collecting, critically appraising, and synthesizing available evidence, then developing expert panel recommendations based on appraised evidence, makes it possible to provide high-quality care for patients. Unwanted variability in the quality and rigor of evidence summaries and Clinical Practice Guidelines has been a long-standing challenge for clinicians seeking evidence-based guidance to support patient care decisions. Methods: A multidisciplinary group of stakeholders, with representation from all eight Kaiser Permanente Regions, is responsible for creating National Guidelines. Conducting high-quality systematic reviews and creating clinical guidelines are time-, labor-, and resource-intensive processes, which raises challenges for an organization striving to balance rigor with efficiency. For these reasons, the National Guideline Program elected to allow for the identification, assessment, and possible adoption of existing evidence-based guidelines and systematic reviews using the ADAPTE; Appraisal of Guidelines Research and Evaluation; Assessment of Multiple Systematic Reviews (AMSTAR); and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) frameworks. If no acceptable external guidelines are identified, the Guideline Development Team then systematically searches for relevant high-quality systematic reviews, meta-analyses, and original studies. Existing systematic reviews are assessed for quality using a measurement tool to assess systematic reviews (the AMSTAR systematic review checklist). Study Appraisal: Following the screening and selection process, the included studies (the body of evidence) are critically appraised for quality, using the GRADE methodology, which focuses on four key factors that must be considered when assigning strength to a recommendation: balance between desirable and undesirable effects, quality of evidence, values and preferences, and cost. The evidence is then used to create preliminary clinical recommendations. The strength of these recommendations is graded to reflect the extent to which a guideline panel is confident that the desirable effects of an intervention outweigh undesirable effects (or vice versa) across the range of patients for whom the recommendation is intended. Dissemination: The Care Management Institute disseminates all KP national guidelines to its eight Regions via postings on its Clinical Library Intranet site, a Web-based internal information resource. PMID:22529761

Davino-Ramaya, Carrie; Krause, L Kendall; Robbins, Craig W; Harris, Jeffrey S; Koster, Marguerite; Chan, Wiley; Tom, Gladys I



Comparing logistic regression, support vector machines, and permanental classification methods in predicting hypertension  

PubMed Central

In this paper, we compare logistic regression and 2 other classification methods in predicting hypertension given the genotype information. We use logistic regression analysis in the first step to detect significant single-nucleotide polymorphisms (SNPs). In the second step, we use the significant SNPs with logistic regression, support vector machines (SVMs), and a newly developed permanental classification method for prediction purposes. We also detect rare variants and investigate their impact on prediction. Our results show that SVMs and permanental classification both outperform logistic regression, and they are comparable in predicting hypertension status. PMID:25519351



Determinantal and permanental representation of generalized bivariate Fibonacci p-polynomials  

E-print Network

In this paper, we give some determinantal and permanental representations of generalized bivariate Fibonacci p-polynomials by using various Hessenberg matrices. The results that we obtained are important since generalized bivariate Fibonacci p-polynomials are general form of, for example, bivariate Fibonacci and Pell p-polynomials, second kind Chebyshev polynomials, bivariate Jacobsthal polynomials etc.

Kaygisiz, Kenan




E-print Network

, Italy ISBN: 978-88-907460-4-8 First edition, 19th May 2014 Contributi alla Scuola Permanente per l CLIL: Part I: the learner 83 Margherita Langellotti e Y. L. Teresa Ting Learning ScientificaMente through CLIL: Part II: the teacher 106 #12;Programma Lunedì 22 Ore 15:00 Registrazione Ore 16:30 Saluti e

Spagnolo, Filippo


The Evolution of Health Education: The Kaiser Permanente Southern California Experience  

Microsoft Academic Search

This article conveys the history of establishing the health education program, the current delivery model, and the lessons learned from the process including practical applications for the practice setting. The evolution of health education in Kaiser Permanente reflects its history and describes the continued need for and relevance of health education. The era of the patient as the passive recipient

Martha A. Valencia; Nancy Kingston; Ronald B. Nakamura; Frayne Rosenfield; Mei Ling Schwartz



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

Microsoft Academic Search

Rsum Il serait bon d'instaurer un systme d'ducation permanente formant la synthse des trois types d'ducation formel, non-formel et informel, qui existe dj l'tat embryonnaire. L'observation peut en tre faite au Bnin partir de la formation des enseignants, indicatrice des transformations sociales et culturelles. A l'origine confie chacun des personnages sociaux, l'ducation tait un passage permanent d'initi

Sbastien Agboton; Yaya Mede Moussa




E-print Network

NOTE SUR LES EFFETS DE L'INFUSION PERMANENTE D'UN M?LANGE D'ACIDES GRAS VOLATILS DANS LE RUMEN DU problèmes techniques : infusion permanente et prolongée, dans le rumen, de quantités d'acides gras volatils début de l'infusion, les veaux étaient âgés d'environ 4 mois et pesaient respectivement 95 et 80 kg

Paris-Sud XI, Université de


The Pathways Study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California  

Microsoft Academic Search

ObjectiveWith 2.3million breast cancer survivors in the US today, identification of modifiable factors associated with breast cancer\\u000a recurrence and survival is increasingly important. Only recently new studies have been designed to examine the impact of lifestyle\\u000a factors on prognosis, including Pathways, a prospective study of women with breast cancer in Kaiser Permanente Northern California\\u000a (KPNC).\\u000a \\u000a \\u000a \\u000a MethodsPathways aims to examine the

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



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)



Obesity in the Kaiser Permanente Patient Population and Positive Outcomes of Online Weight-Management Programs  

PubMed Central

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

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



The California Kaiser Permanente Health System: evolving to meet the needs of people with disabilities.  


This review documents the history of one large health system's approach to the enactment of the Americans with Disabilities Act, following the settlement of a lawsuit. This paper represents the various activities within the Kaiser Permanente health system from 2001 to the present that were conducted to improve access and remove architectural, attitudinal, and other barriers for people with disabilities, to educate and train providers concerning culturally competent care for people with disabilities, and to develop patient-centered best practices and models of care for people with disabilities. Health systems can improve care for people with disabilities through organized, multifaceted, andongoing approaches to removal of barriers, provider education and training in culturally competent care, and establishment of patient-centered best practices and models of care. PMID:21122792

Sandel, M Elizabeth; Appelman, Jed; Kotch, Mary Jean; Biter-Mundt, Gina; Lal, Nitasha; Samuels, Shari; Crespo, Yvette



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

USGS Publications Warehouse

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

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



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

PubMed Central

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

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



Patient-physician e-mail communication: the kaiser permanente experience.  


Kaiser Permanente (KP) is a not-for profit health care organization that provides care for approximately 8.7 million members in nine states and the District of Columbia. In 2004, it began implementation of its current electronic health record (EHR), which by 2010, was in use in all KP regions, in both outpatient and inpatient settings. Over the same period, a suite of online services was also implemented. Among these services was a password-protected e-mail system (referred to as secure messaging) that allowed physicians and patients to communicate electronically. Use of secure messaging has increased rapidly. By 2010, 64% of the 3.6 million KP members in northern California had signed up for online access. In 2010, the 7,000 physicians of Northern California KP received 5.8 million secure messages. Secure messaging has been associated with a decrease in office visits, an increase in measurable quality outcomes (at least in primary care), and excellent patient satisfaction. PMID:22043186

Baer, David



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

PubMed Central

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

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



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

PubMed Central

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

Munro, Malcolm G



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



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

PubMed Central

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

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



Dinmica dos usos e coberturas da terra em rea de Preservao Permanente na Bacia Hidrogrfica dos Rios Mogi Guau e Pardo, no perodo entre 1988 e 2002  

Microsoft Academic Search

O objetivo deste trabalho foi estudar a dinmica de uso e ocupao da terra em reas de Preservao Permanente APPs - na Bacia Hidrogrfica dos Rios Mogi Guau e Pardo, estado de So Paulo, de modo a subsidiar a formulao de polticas pblicas. As APPs foram identificadas e mapeadas usando imagens do Landsat-7. O uso antrpico em reas de

Luis Alberto Ambrosio; Maria Do Carmo Ramos Fasiaben; Jener Fernando Leite De Moraes




PubMed Central

El artculo examina el estatuto epistemolgico de la biotica como disciplina acadmica. El autor sostiene que el estatuto epistemolgico de un discurso lo determina la pregunta fundamental que se plantea y la respuesta que se busca, focos integradores del discurso. En el caso de la biotica, la pregunta fundamental es de ndole moral. La biotica es pues una disciplina tica que tiene su hogar epistemolgico en la filosofa. El autor tambin defiende el concepto de ticas aplicadas. Sugiere finalmente que el mtodo de la biotica, sobre todo la que se hace desde nuestras latitudes, debera adoptar el crculo hermenutico como metodologa para su filosofar. PMID:20463860

Ferrer, Jorge Jos



PS2-36: Demographic Variation in Sleep Hygiene Among Adult Kaiser Permanente Northern California Health Plan Members  

PubMed Central

Background/Aims To investigate age, gender, and race-ethnic differences in prevalence of short duration of sleep, frequent problems with sleep, sleep medication use, and effort made to get enough sleep among adult Kaiser Permanente Northern California (KPNC) Health Plan members. Methods Analysis of pooled weighted self-report data from respondents aged 2579 to the 2005 or 2008 KPNC Member Health Survey (17,473 women and 13,976 men). Results Approximately 60% of adults usually get 78.5 hours sleep/day, 11% =9 hours, and 25% <6 hours. Young men and middle-aged men and women are most likely to get <7 hours and men =65 most likely to get = 9 hours. Across age groups, Blacks, Latino/as, and Filipino/as are significantly more likely than non-Hispanic Whites to get < 7 and < 6 hours sleep/day. Across age groups, women are significantly more likely than men to report frequent problems. In gender-specific multiple logistic regression models, chronic stress, financial stress, UI, chronic pain, and obesity (men only) increases risk for frequent sleep problems. Women with frequent sleep problems are significantly more likely than men to have used prescription/OTC sleep medication in past 12 months; among women, non- Hispanic Whites are significantly more likely than other race-ethnic groups to have used sleep medication. Approximately 70% of adults usually try to get enough sleep to feel well-rested. Adults <65 are significantly less likely to try than those =65, and among those <65, men are significantly less likely to try than women. Controlling for age, among women, non-Hispanic Whites are significantly more likely than other race-ethnic groups to try, with little race-ethnic variation among men. Adults who try to get enough sleep are significantly more likely than those who do not to get =7 hours sleep/day. Among those who usually try to get enough sleep, Blacks, Latinos, Filipinos, and Chinese are significantly less likely than non-Hispanic Whites to get =7 hours sleep/day, with Blacks and Filipinos least likely. Conclusions Health plan members need education about the importance of getting enough sleep to maintain good health and functioning and talking with their PCP about frequent sleep problems.

Gordon, Nancy



Como Lo Hago Yo: Myelomeningocele  

PubMed Central

Fortificacin con dico flico es efectiva, pero an falta conciencia en los jvenes. La legalidad del aborto aumenta la importancia de la consulta prenatal. Realizo la ciruga bajo microcoscopio por razones didcticas. Irrigacin continua para reducir la temperatura del tejido. Trato a la plaqueta como tejido viable. No suturo la plaqueta. No cierro msculo. ATB por una semana despus de ciruga. Hidrocefalia: Vlvula en todos los casos de ventriculomegalia. Mdula anclada: Desanclar una sola vez. Chiari II: Revisar la vlvula. Incluir en el seguimiento rendimiento escolar, puede indicar obstruccin de la vlvula o mdula anclada. PMID:24791217

Lazareff, Jorge



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

PubMed Central

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

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



CB3-02: Demographic Differences Between US-born and Foreign-born Asia Pacific Islanders Among the Hepatitis B Patients of Kaiser Permanente, Hawaii  

PubMed Central

Background/Aims Approximately two billion people worldwide have been infected with hepatitis B virus (HBV) and about 350 million live with chronic infection. Over half of all liver cancer cases in the world are attributable to chronic, or persistent, HBV infection. Of US residents chronically infected with HBV, 40% to 70% are foreign-born immigrants, mainly Asian/Pacific Islanders (APIs). Disparity by race exists for APIs which makeup approximately 4% of the U.S. population and more than 2% of these races are affected with chronic HBV. The purpose of this study is to investigate the demographic differences between the foreign-born and US-born HBV infected APIs of Kaiser Permanente, Hawaii (KPHI). Methods This substudy is a part of a prospective, dynamic, longitudinal and observational study, the Chronic Hepatitis Cohort Study (CHeCS). Patients included in this analysis were APIs identified from electronic medical records who met the CHeCS definition for chronic HBV infection at KPHI. Date of birth, race, gender, and country of origin (COO), household income and education were obtained from the Virtual Data Warehouse (VDW) demographic and census tables. Information about the country of origin was also supplemented by surveys and chart abstractions. Results Of the 513 HBV infected APIs, 76% were foreign-born and 24 % were US-born. HBV infected foreign-born APIs were significantly younger than the US-born APIs; approximately 50% of HBV infected foreign-born APIs were in 4059 years old age group compared to 32% of the US-born. Foreign-born APIs also had significantly higher proportion of females (55%) than US-born (50%). Most of the HBV infected APIs had a median household income between 50,000 and 75,000 with no significant differences between the groups. Approximate prevalence was also calculated using the KPHI utilization data. APIs had an overall HBV prevalence of 0.7%; foreign-born APIs had 2.6% and US-born APIs had 0.3% prevalence. Discussion In summary, foreign-born APIs have higher prevalence of chronic HBV infections compared to US-born APIs in Kaiser Permanente Hawaii. Foreign-born APIs infected with HBV are younger and more likely to be females than US-born APIs.

Vijayadeva, Vinutha; Nakasato, Cynthia; Gordon, Stuart; Rupp, Loralee; Lu, Mei; Henkle, Emily; Boscarino, Joseph



PS2-03: Chronic Hepatitis B Testing in US-born and Foreign-born Asia Pacific Islanders of Kaiser Permanente, Hawaii  

PubMed Central

Background/Aims Approximately two billion people worldwide have been infected with hepatitis B virus (HBV) and about 350 million live with chronic infection. Over half of all liver cancer cases in the world are attributable to chronic, or persistent, HBV infection. Of US residents chronically infected with HBV, 40% to 70% are foreign-born immigrants, mainly Asian/Pacific Islanders (APIs). Disparity by race exists for APIs which makeup approximately 4% of the U.S population and more than 2% of these races are affected with chronic HBV. The purpose of this study is to estimate the prevalence of HBV in foreign and US born APIs and test the differences in these groups for testing (HBV DNA or HBsAg), testing positive for HBV, alanine aminotranferase (ALT) level and other demographic variables. Methods Utilization data from Kaiser Permanente, Hawaii (KPHI) was used. All adults (18 yrs and older) with enrollment for any length of time from 2006 to 2008, with at least one health plan encounter and twelve months of continuous enrollment at any time were included. Persons with HBV diagnosis within six months of first encounter were excluded. We limited the analysis to Asians and Pacific Islanders. Date of birth, race, gender, and country of origin (COO), household income and education were obtained from the Virtual Data Warehouse (VDW) demographic and census tables. Results and Discussion Among who met the inclusion criteria (N= 191,335), 69,923 were APIs and of these 68% had information on country of origin. We plan to report the prevalence of HBV in foreign and US born APIs test the difference between the these two groups with respect to testing, testing positive for HBV infection, age, gender, annual income and ALT levels.

Vijayadeva, Vinutha; Lu, Mei; Nakasato, Cynthia; Gordon, Stuart; Rupp, Loralee; Henkle, Emily



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

PubMed Central

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



Self-Management Support to People with Type 2 Diabetes - A comparative study of Kaiser Permanente and the Danish Healthcare System  

PubMed Central

Background Self-management support is considered to be an essential part of diabetes care. However, the implementation of self-management support within healthcare settings has appeared to be challenging and there is increased interest in real world best practice examples to guide policy efforts. In order to explore how different approaches to diabetes care and differences in management structure influence the provision of SMS we selected two healthcare systems that have shown to be comparable in terms of budget, benefits and entitlements. We compared the extent of SMS provided and the self-management behaviors of people living with diabetes in Kaiser Permanente (KP) and the Danish Healthcare System (DHS). Methods Self-administered questionnaires were used to collect data from a random sample of 2,536 individuals with DM from KP and the DHS in 20062007 to compare the level of SMS provided in the two systems and identify disparities associated with educational attainment. The response rates were 75?% in the DHS and 56?% in KP. After adjusting for gender, age, educational level, and HbA1c level, multiple linear regression analyses determined the level of SMS provided and identified disparities associated with educational attainment. Results Receipt of SMS varied substantially between the two systems. More people with diabetes in KP reported receiving all types of SMS and use of SMS tools compared to the DHS (p?



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

ERIC Educational Resources Information Center

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

Kerchner, Charles T.



Dirio Econmico -Universidades Como ser investigador em Portugal  

E-print Network

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

Instituto de Sistemas e Robotica



E-print Network

1 NORMAS GERAIS PARA INGRESSO COMO PORTADOR DE DIPLOMA DE GRADUA??O (BRASIL) PERÍODO 2013.1 PRAZO COMO PORTADOR DE DIPLOMA DE GRADUA??O DO BRASIL I­DAS CONDI??ES Portadores de Diploma de Graduação de; - Certificado de Dispensa de Incorporação; - CPF; Se candidato estrangeiro: - Certificado de


Station GPS permanente IPG Paris DGF Uchile  

E-print Network

type) sealed in bedrock with epoxy-glue. Receptor TRIMBLE NetRS, TRIMBLE Antenna Zephyr geodetic and autonomous energy (battery and solar panel). HISTORIC Semi-permanent GPS station installed since 08­DEC- 2007

Vigny, Christophe



E-print Network

1 NORMAS GERAIS PARA INGRESSO COMO PORTADOR DE DIPLOMA DE GRADUA??O (BRASIL) PERÍODO 2013.2 PRAZO PORTADOR DE DIPLOMA DE GRADUA??O DO BRASIL I­DAS CONDI??ES Portadores de Diploma de Graduação de Cursos; - Certificado de Dispensa de Incorporação; - CPF; Se candidato estrangeiro: - Certificado de Concl


El teatro como reflexin colectiva: Conversacin con Sergio Corrieri  

E-print Network

SPRING 1983 51 El teatro como reflexin colectiva: Conversacin con Sergio Corrieri Gerardo Luzuriaga Sergio Corrieri es el director del renombrado Teatro Escambray, fundado por l y otros teatristas de La Habana en 1968 en la regin del... propios del subdesarrollo. La supersticin, por ejemplo, muy extendida en nuestras zonas rurales; el reparo del campesino, sus dudas ante la colectivizacin del trabajo agrcola, ante el hecho de unir sus esfuerzos con los de otros campesinos, y en...

Luzuriaga, Gerardo



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.



La poesa como elemento de estructura dramtica en Alfonsina  

E-print Network

la luz. La ciudad de Mendoza, ubicada a 1.100 km de la capital federal y al pie de la Cordillera de los Andes que la separa de Chile, tiene una larga tradicin literaria en general y teatral en particular. Como zona de paso entre Buenos Aires y.... Vctima de una enfermedad incurable, se quit la vida arrojndose al mar. Su poesa evoluciona desde el modernismo y el parnasianismo hasta los movimientos de vanguardia: La inquietud del rosal, El dulce dao, Irremediablemente, Languidez, Ocre y...

Navarette, José Francisco



comoR: a software for disease comorbidity risk assessment  

PubMed Central

Background The diagnosis of comorbidities, which refers to the coexistence of different acute and chronic diseases, is difficult due to the modern extreme specialisation of physicians. We envisage that a software dedicated to comorbidity diagnosis could result in an effective aid to the health practice. Results We have developed an R software comoR to compute novel estimators of the disease comorbidity associations. Starting from an initial diagnosis, genetic and clinical data of a patient the software identifies the risk of disease comorbidity. Then it provides a pipeline with different causal inference packages (e.g. pcalg, qtlnet etc) to predict the causal relationship of diseases. It also provides a pipeline with network regression and survival analysis tools (e.g. Net-Cox, rbsurv etc) to predict more accurate survival probability of patients. The input of this software is the initial diagnosis for a patient and the output provides evidences of disease comorbidity mapping. Conclusions The functions of the comoR offer flexibility for diagnostic applications to predict disease comorbidities, and can be easily integrated to highthroughput and clinical data analysis pipelines. PMID:25045465




Microsoft Academic Search

La cultura como conjunto de relaciones humanas que ha transcendido en el tiempo y que le permite al hombre conservar, reproducir, crear nuevos conocimientos y valores para la transformacin de su medio social y cultural, cada da cobra mayor importancia como sostn fundamental para la satisfaccin de las necesidades espirituales y como elemento de influencia directa en la produccin de

Ricardo Basilio Enoa Leyva



Exhaustive mapping of Co-Mo catalytic activity against their compositions in  

E-print Network

. Furthermore, at high pressure and longer time, the third region with a larger catalytic activity appearedExhaustive mapping of Co-Mo catalytic activity against their compositions in growing SWNTs from catalytic CVD with Co-Mo catalyst was systematically investigated and the catalytic activity was mapped

Maruyama, Shigeo



Microsoft Academic Search

El turismo, objeto de diversas disciplinas, es uno de los sectores ms relevantes de la economa mundial, siendo en Espaa la primera industria nacional. En los ltimo aos el turismo cultural se ha revelado como un motor esencial de desarrollo para bastantes territorios. Un caso sobresaliente es el conocido como efecto Guggenheim que desde su creacin en 1997 se ha

Ainhoa Aguirregoitia Martnez



Postcolonialismo como teora de la administracin internacional y su impacto en los negocios internacionales  

Microsoft Academic Search

Este trabajo tiene como objetivo analizar normativamente los discursos del colonialismo y el postcolonialismo como campos de investigacin de la administracin internacional. Los acercamientos tericos postcoloniales critican las representaciones euro cntrico y occidental del mundo no-occidental y llaman la atencin al conocimiento que claman tener del no occidente. Los acercamientos postcoloniales a la administracin internacional tambin tratan de los supuestos

Jos G. Vargas-Hernndez



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

Federal Register 2010, 2011, 2012, 2013, 2014

...populations; (2) reduce fuel loads and maintain the historic fire return interval; (3) improve forest resilience to dwarf mistletoe, root rot, Douglas-fir beetle, and spruce budworm; (4) and maintain the visual integrity of the larger Lake Como...



Castrao qumica como pena, tratamento mdico ou experimento cientfico : consideraes bioticas.  

E-print Network

??Dissertao (mestrado)Universidade de Braslia, Faculdade de Cincias da Sade, Programa de Ps-Graduao em Biotica, 2014. A pedofilia classificada como doena psiquitrica e sua prtica (more)

Maia, Thais Meirelles de Sousa



On Resilience of Multicommodity Dynamical Flow Networks Gustav Nilsson, Giacomo Como, and Enrico Lovisari  

E-print Network

On Resilience of Multicommodity Dynamical Flow Networks Gustav Nilsson, Giacomo Como, and Enrico of the network. Index Terms-- Dynamical flow networks, multicommodity flows, resilience, distributed routing, heterogeneous routing. I. INTRODUCTION In a multicommodity network particles of different classes flow through

Como, Giacomo


Atomic-Scale Structure of CoMoS 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 CoMoS structure present in hydrodesulfurization (HDS) catalysts. Information on the catalytically important edge structures has been obtained by synthesizing single-layer CoMoS 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 Lgsgaard; I Stensgaard; B. S Clausen; H Topse; F Besenbacher



Como preparar un programa de informacion sobre la asistencia economica (Planning a Financial Aid Awareness Program).  

ERIC Educational Resources Information Center

This booklet, written in Spanish, is intended to be used with a set of slides as part of a presentation to students on "How To Apply for Federal Student Aid" ("Como Solicitar la Asistencia Economica Federal para Estudiantes"). The first part of the book is a script based on the slides. After the script is a guide to hosting a financial aid

Department of Education, Washington, DC.


Harold Varmus investido bajo juramento como 14. director del Instituto Nacional del Cncer

Ganador del Premio Nobel, doctor Harold E. Varmus, prest juramento hoy como 14. director del Instituto Nacional del Cncer (NCI). "Es muy estimulante que ests de regreso con nosotros", dijo la secretaria del Departamento de Salud y Servicios Humanos Kathleen Sebelius en la ceremonia de toma de juramento. Hoy se abre un nuevo captulo para el Instituto Nacional del Cncer.


Uso de modelos de simulacin como soporte para la decisin de fertilizacin  

Microsoft Academic Search

La demanda de nutrientes es regulada por los factores definitorios del crecimiento (radiacin, temperatura, genotipo, fecha de siembra, etc.) y por factores limitantes del rendimiento como la disponibilidad de agua (lluvia efectiva, agua acumulada a la siembra, retencin de agua del suelo, sistema radical del cultivo, etc.). En general, aumentar el suministro de nutrientes aumenta el rendimiento hasta que ste

Jorge L. Mercau


Garcinia cambogia - uma espcie vegetal como recurso teraputico contra a obesidade?6  

Microsoft Academic Search

Resumo Atualmente, a obesidade um problema de sade pblica mundial, tanto nos pases desenvolvidos como nos em desenvolvimento, apresentando elevao de sua prevalncia. A transio nutricional um processo de modificaes seqenciais no padro de nutrio e consumo que acompanha mudanas econmicas, sociais e demogrficas, e mudanas do perfil de sade das populaes. Este trabalho objetiva abordar a comprovao

Ana C S Santos; Michelle S Alvarez; Priscila B Brando; Ary G Silva


XPS and TEM Studies of Co-Mo Catalysts on Quartz Substrates for Growth of SWNTs  

E-print Network

metal acetate solutions with a dip-coating method. Critical evidences of catalyst chemical state Engineering, The University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan 2 Department of Mechanical Engineering, The University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan Bimetallic Co-Mo catalysts1

Maruyama, Shigeo



E-print Network

PROPOSTA CURSO DE VERÁN: A DIVULGACI?N COMO PONTE ENTRE CIENCIA E SOCIEDADE 2 e 3 de xullo de 2014 BEATRIZ HERVELLA NOGUEIRA. Licenciada en Ciencias Físicas pola USC e cofundadora de 4gotas atmosfera y CONFERENCIA - ESPECTÁCULO RICARDO PAREDES PAMPÍN. Licenciado en Ciencias Físicas pola USC e profesor de

Fraguela, Basilio B.



Microsoft Academic Search

Neste breve artigo pretendemos apresentar elementos que possam ser sugestivos e indicativos para a fundamentao de uma teoria da educao a partir da compreenso do processo de esclarecimento enquanto processo de emancipao do homem na sociedade contempornea. Sabemos que Jrgen Habermas prope o recurso ao entendimento mtuo como meio para se chegar a um entendimento e se obter um consenso,

Bartolomeu Leite da Silva



K.K. Gan Como03 1 The Ohio State University  

E-print Network

Cycle = 50%? Delay of Trailing Edges BPM Recovered Data Recovered 40 MHz Clock 0 0 0 0 0 1 Input transitions ] leading edges Internal delays ] trailing edges #12;K.K. Gan Como03 8 l Original design for ATLAS of activity in adjacent channels l channels with high threshold can be reduced with 2 pF at noise

Gan, K. K.


La educacion permanente del maestro (Continuing Teacher Education).  

ERIC Educational Resources Information Center

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

Blat, Gimeno J.



Universidad Permanente de la Universidad de Alicante NOTICIAS Y EVENTOS  

E-print Network

Alimentos Solidarios (Publicada 28/10/2013) Aquí puedes consultar los resultados mensuales de las Campañas de Recogida de Alimentos Solidarios del presente curso 2013-2014, que vamos a realizar desde octubre alimentos recogidos se han destinado a la Fundación Banco de Alimentos de Alicante, y al Programa de Acción

Escolano, Francisco


Station GPS permanente IPG Paris DGF Uchile UNAP Iquique  

E-print Network

fence but generally open Security ??? telephone nearby NONO Electric power nearby NONO Solar panels + regulator + solar battery equipment storage available NONO possibility of leaving the equipment without watching YESYES person in charge YESYES NO Prof. Manuel Olcay ( UNAP Iquique)! 84663240 (cel.), (57) 310716

Vigny, Christophe


Station GPS permanente IPG Paris DGF Uchile UNAP Iquique  

E-print Network

, implanted in bedrock (Jurassic andesitic lavas). Inox 30 cm rod (Delmont type) sealed in bedrock with epoxy-glue. Receptor TRIMBLE NetRS, Antenna TRIMBLE Zephyr geodetic and autonomous energy (battery and solar panel

Vigny, Christophe


Station GPS permanente IPG Paris DGF Uchile UNAP Iquique.  

E-print Network

school of Colchane, Chile. Inox tige (Delmont type) sealed in the top (roof level) of structural building and battery) equipment storage available NONO possibility of leaving the equipment without watching YESYES Benegoni, Basic School of Colchane. A steel mark type IPGP/DGF is sealed on the top of the building

Vigny, Christophe


Mtodo de Fibonacci Como no mtodo da "Golden Section" o procedimento de procura de Fibonacci faz  

E-print Network

Método de Fibonacci Como no método da "Golden Section" o procedimento de procura de Fibonacci faz incerteza varia duma iteração para outra. O procedimento é baseado na sequência de Fibonacci Fn{ } definida acontece com os métodos da procura dicotómica e de "Golden section", o método de Fibonacci requer que o

Instituto de Sistemas e Robotica


Los marginados como personajes: Teatro chileno de la dcada de los sesenta  

E-print Network

factores artsticos. Por el contrario, la seleccin de agonistas se vincula ideo lgicamente con el sistema de valores del grupo productor del discurso teatral y el destinatario del mismo.1 Describir el discurso teatral chileno desde esta perspectiva... un indicador de los intereses polticos del grupo productor dentro del contexto nacional.2 El discurso teatral chileno hegemnicoel reconocido como "representativo"ha sido generalmente el discurso de los sectores medios destinado a los mismos...

Villegas, Juan



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

E-print Network

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

Barbosa, Alberto


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

NASA Astrophysics Data System (ADS)

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

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



Analise do Impacto da Rede Social na Marcac~ao de Fotos como Favoritas no Flickr1  

E-print Network

An´alise do Impacto da Rede Social na Marcac¸~ao de Fotos como Favoritas no Flickr1 Luiz Alves´udo compartilhado por um usu´ario ´e valorado ou disseminado pelos seus contatos na rede social [Bigonha et al. 2010´arios na rede social, procuramos identificar o impacto da rede de contatos na marcac¸~ao de conte´udos como

Cirne, Walfredo


El Internet como fuente de informacin sobre la salud: la visin de estudiantes de Andaluca, Espaa.  


El Internet (la red para usuarios de computadora) puede ser una herramienta til para adolescentes y jvenes en la bsqueda y uso de informacin sobre la salud. Las razones para ello han sido descritas en diversos estudios, sin embargo la confianza en la informacin disponible en el Internet es variable y persisten necesidades de alfabetizacin para su uso. Tanto el sistema de salud como el educativo pueden desempear un papel fundamental para el asesoramiento de la materia. Es necesario conocer las opiniones que tienen los estudiantes de educacin secundaria y de universidad en Andaluca, Espaa, sobre la relacin entre el Internet y la salud, el concepto de salud y la imagen que proyecta el Internet y el 'social media' (medios o redes sociales electrnicos) con relacin a la juventud y su salud. Hemos desarrollado un estudio, usando tcnicas de etnografa virtual: hemos consultado a 55 estudiantes de enseanza secundaria en foros virtuales y a 21 estudiantes universitarios en video entrevistas semi-estructuradas. Los estudiantes aportaron un concepto de salud integral, relacionado con los hbitos de salud fsica y emocional, y con los activos o factores positivos para la salud. Exponen una visin crtica de la utilidad del Internet para la salud, y sobre la calidad y credibilidad de los contenidos de salud en el Internet, manifestando la necesidad de tener asesoramiento y alfabetizacin. Presentan una opinin alternativa, ms positiva que la visin que se da en social media e Internet sobre sus estilos de vida, y sugieren desarrollar al Internet como herramienta para potenciar la conversacin participativa y el aprendizaje en salud. La metodologa empleada en este estudio puede contribuir a probar nuevas formas de investigacin y accin en futuros trabajos sobre la salud con adolescentes y jvenes en Internet. PMID:25024275

Garca, Mariano Hernn; Crdenas, Silvia Toro; Pian, Olga Leralta; Trigueros, Marina Prez; Campos, Raquel Carrasco; Gonzlez, Carmen Lineros




PubMed Central

Introduccion La diabetes mellitus y las demencias constituyen dos problemas crecientes de salud entre la poblacin 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 diabticos libres de demencia pertenecientes al Estudio Nacional de Salud y Envejecimiento en Mxico fueron evaluados a los dos aos de la lnea de base. Se estudi el papel de los factores sociodemogrficos, de otras comorbilidades y del tipo de tratamiento en la conversin a demencia. Resultados Durante la lnea de base 749 sujetos (13.8%) tuvieron diabetes. El riesgo de desarrollar demencia en estos individuos fue el doble (RR, 2.08 IC 95%, 1.592.73). Se encontr un riesgo mayor en individuos de 80 aos y ms (RR 2.44 IC 95%, 1.464.08), en los hombres (RR, 2.25 IC 95%, 1.463.49) y en sujetos con nivel educativo menor de 7 aos. El estar bajo tratamiento con insulina increment el riesgo de demencia (RR, 2.83, IC 95%, 1.585.06). Las otras comorbilidades que aumentaron el riesgo de demencia en los pacientes diabticos fueron la hipertensin (RR, 2.75, IC 95%, 1.864.06) y la depresin (RR, 3.78, 95% IC 2.376.04). Conclusin Los sujetos con diabetes mellitus tienen un riesgo mayor de desarrollar demencia, La baja escolaridad y otras comorbilidades altamente prevalentes en la poblacin Mexicana contribuyen a la asociacin diabetes-demencia. PMID:21948010

Silvia, Meja-Arango; Clemente, y Ziga-Gil



As redes universitrias de difuso das cincias matemticas como fator de desenvolvimento da perspectiva. Uma agenda de pesquisa  

E-print Network

As redes universitárias de difusão das ciências matemáticas como fator de desenvolvimento da)" #12;AS REDES UNIVERSITÁRIAS DA DIFUS?O DA PERSPECTIVA 2 Ghiberti enumera vinte intenções visível (não

Paris-Sud XI, Université de


Utilizao da radiao gama do Cobalto-60 como tratamento quarentenrio de plantas medicinais, aromticas e condimentares desidratadas infestadas por lasioderma serricorne (fabricius, 1792) (coleoptera, anobiidae) e plodia interpunctella (hubner, 1813) (lepidoptera, pyralidae).  

E-print Network

??A pesquisa teve como objetivo a utilizao da radiao gama do Cobalto-60 como tratamento quarentenrio de plantas medicinais, aromticas e condimentares desidratadas infestadas por Lasioderma (more)

Juliana Nazar Alves



Characterization and hydrodesulfurization activity of CoMo catalysts supported on sol-gel prepared Al2O3  

E-print Network

Al2O3 Franck Dumeignila *, Koichi Satoa , Motoyasu Imamuraa , Nobuyuki Matsubayashia , Edmond Payenb-298-61-2371 Email: 1 #12;Abstract A series of CoMo/Al2O3 catalysts was prepared by impregnation on the development of new catalysts. Although Co-Mo-S or Ni- Mo-S catalysts supported on -Al2O3 have been the most

Paris-Sud XI, Université de


Estudio de NIH indica que la actividad fsica en tiempo libre alarga la vida tanto como 4,5 aos

La actividad fsica en tiempo libre est asociada con una expectativa de vida ms larga, aun en un grado de actividad relativamente bajo e independientemente del peso corporal, de acuerdo con un estudio llevado a cabo por un equipo de investigadores del Instituto Nacional del Cncer (NCI), el cual forma parte de los Institutos Nacionales de la Salud, (NIH). El estudio, el cual encontr que las personas que realizaron actividad fsica en tiempo libre ganaron en su expectativa de vida tanto como 4,5 aos, se public el 6 de noviembre de 2012, en la revista PloS Medicine.


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

NASA Astrophysics Data System (ADS)

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

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



[From research on occupational tumors to interventional prevention: use of the OCCAM method at the ASL in Como].  


In the framework of "Occupational Cancers" project of the Lombardy Region, estimates of cancer risk by site and by economic activity for the incidence period 2001-2004 have been produced in the Local Health Unit of Como. Using these estimates a set of cancer cases with possible occupational origin has been determined. This has been carried out using the OCCAM approach, a case control study where incident cases are identified by hospital discharge records, controls are sampled from health population files and occupational histories are obtained by automatic link with social security archives. This has been integrated with the knowledge of firms and the workers' awareness of other cancer cases in the workforce of the same firms. Among 45 cases with potential occupational origin, 24 were established as due to occupation. These cases were referred for compensation. Moreover, carcinogenic risks still present in some firms were identified and appropriate interventions were carried out. PMID:22452094

Aiani, Maria Rita; Bai, Edoardo; Oddone, Enrico; Settimi, Lamberto; Genna, Giovanni; Maternini, Paola; Scaburri, Alessandra; Panizza, Celestino; Crosignani, Paolo



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



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 despus de cuatro aos de seguimiento. El estudio de vacuna en Costa Rica, patrocinado por el NCI, fue diseado para evaluar la eficacia de Cervarix en una poblacin determinada.



Microsoft Academic Search

Las bases de la economa social y de las empresas de participacin se nutren de emprendedores. Ante la actual situacin de recesin y crisis financiera, las empresas de Economa Social que han demostrado ser una opcin estratgica de desarrollo local para la insercin sociolaboral, tienen un importante papel a desarrollar como entidades creadoras de empleo vinculadas a los territorios de




Microsoft Academic Search

Schwanka* * RESUMO Inserida no contexto de Estado em rede e de Governana Pblica, a Administrao Consensual revela-se como a nova face da Administrao Pblica no sculo XXI. Segundo CASTELLS, Estado em rede o Estado caracterizado pelo compartilhamento de autoridade em uma rede. Para LFFLER, governana pblica encerra uma nova gerao de reformas administrativas e de Estado, que tm

Gustavo Justino de Oliveira


La esgrima es tan antigua como el hombre. Desde los primeros adiestramientos de soldados para su supervivencia en las culturas antiguas hasta en nuestros das un  

E-print Network

para su supervivencia en las culturas antiguas hasta en nuestros días un deporte completo y divertido. La esgrima es un deporte orientado a cualquier edad. Completo al usarse todo el cuerpo. Se centra en principiantes como en los más avanzados. Aunque sea un deporte que se practica individualmente, se entrena en

Escolano, Francisco


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



PS3-38: The Kaiser Permanente Northern California Member Health Survey Project  

PubMed Central

Background/Aims We will introduce researchers and administrators to the KP Northern California Member Health Survey Project (MHS) and illustrate how it has been used for research and to monitor population sociodemographic and health-related characteristics over time. Methods This is a self-administered survey of independent stratified random samples of adults conducted every 3 years starting in 1993. Seniors and most race-ethnically diverse medical center service populations are oversampled. Survey data can be linked at the individual level to KP clinical, administrative, and utilization data, including use. Results This Community Benefit-funded survey has been used to monitor KPNC member population characteristics over time, to facilitate research on the membership, and to contribute to community health needs assessment. The MHS captures information about sociodemographic characteristics, health and functional status, behavioral and psychosocial health risks, use of CAM and dietary supplements, IT access (Internet, email, and in 2011, mobile phone and text messaging), and health education modality preferences that is valuable for health research and service planning. Our sample facilitates study of race-ethnic and age group differences in these characteristics. While KPNCs electronic data capture of member race/ethnicity and health characteristics has grown exponentially since the early 2000s, the Member Health Survey, based on self-reported information obtained from a stratified random sample of adult members, remains the most comparable source of KPNC population statistics to other surveys like the BRFSS, CHIS, and NHIS. We will use MHS data from 1993, 1996, 1999, 2002, 2005, 2008, and 2011 to show changes over time among 2579 year olds in selected health behavior risk factors (smoking, obesity, exercise, dietary practices, stress, health beliefs), use of selected CAM modalties, and IT access; age and race-ethnic differences in health risk factors and CAM use; and age-related differences in IT access and preferences for IT-based health education. More information about the survey and survey results can be found at Conclusions Data and statistics from KPNC Member Health Surveys can be useful for researchers and administrators both within and outside KPNC for research and service planning.

Gordon, Nancy; Lin, Teresa



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 difcult and constant challenges faced by health providers. It has a signicant 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





E-print Network

. Jorge Paulo Strogoff de Mattos Patologia Profª. Rita de Cássia Lauria Gonçalves da Silva Radiologia e. Renato de Souza Bravo · Prof. Jorge Paulo Strogoff de Mattos Roberto Carlos Machado ­ Secretário da

Souza, Max O.


Kaiser Permanente National Total Joint Replacement Registry: Aligning Operations With Information Technology  

Microsoft Academic Search

BackgroundA Total Joint Replacement Registry was developed in a large community-based practice to track implant utilization, monitor\\u000a revisions and complications, identify patients during recalls and advisories, and provide feedback on clinical practices.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposesWe describe the development, implementation, and integration of this Total Joint Replacement Registry, highlighting critical\\u000a steps in aligning information technology and operations.\\u000a \\u000a \\u000a \\u000a \\u000a MethodsThe primary Total Joint Replacement Registry

Elizabeth W. Paxton; Maria C. S. Inacio; Monti Khatod; Eric J. Yue; Robert S. Namba



Prediction de l'ornierage lie aux deformations permanentes des enrobes bitumineux  

NASA Astrophysics Data System (ADS)

The objective of this thesis is to develop a tool to predict the behavior of flexible pavements vis-a-vis the rutting phenomenon. Through a literature review, we have come to modify the model according to the validation of the time-temperature superposition principle. The application of this principle leads to a simplification of the methodology for characterizing asphalt mixtures by reducing the minimum number of test from 9 to 6. Work methodology centered around the ESSO model allow the development of a predictive tool, the OPECC tool (Outil de Prdiction de l'volution du Comportement de la Chausse). This tool allows the user to predict the behavior of a pavement structure vis-a-vis rutting and fatigue cracking while integrating different modules that change the mix properties depending on temperature and stress frequency, and as a function of traffic patterns and road structure. This tool, through various simulations and fine-tuned according to measured results on existing roadways, proves its potential to highlight the differences attributed to various stress and design conditions which are part of roadway dimensioning.

Meunier, Mathieu


Caractrisation de la pousse hivernale des prairies per-manentes dans les Pyrnes centrales  

E-print Network

présentés. Mots clés additionnels : Croissance, herbe, Dactylis glomerata, Trifolium repens, montagne and of winter grazing are presented. Additional key-words : Grasses, Dactylis glomerata, Trifolium repens

Paris-Sud XI, Université de


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

NASA Astrophysics Data System (ADS)

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

Haddab, Mustapha



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

E-print Network

1 COMO SE CONECTAR A REDE WIFI DA BIBLIOTECA Para conectar a rede WIFI da biblioteca a partir do controle. #12;2 2º Passo: - Procure o ícone "Rede e Internet" ou o ícone "Conexões de rede"; - Ao abrir-se a internet" abrirá uma janela com os tipos de conexões existentes, você deverá optar pela rede sem fio. #12

Paraná, Universidade Federal do


financi tanto la seccin Hispanoamericana como la revista Tierra Firme. La llegada de Claudio Snchez-Albornoz a la cartera de Estado inaugur una  

E-print Network

70 71 financió tanto la sección Hispanoamericana como la revista Tierra Firme. 15 La llegada de, Madrid, 1989, pp. 546-547. 22 Carta de Américo Castro a la Junta de Relaciones Culturales, Madrid, 30 de, pp. 1071- 1096. 26 Tierra Firme, nº 1, 1935, Madrid, pp. 5-6. 27 Tierra Firme, nº 3-4, 1936, Madrid

Paris-Sud XI, Université de


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

E-print Network

Investigation of Pt, Pt3Co, and Pt3Co?Mo Cathodes for the ORR in a Microfluidic H2?O2 Fuel Cell on the performance and durability of four Pt-based cathode catalysts in a microfluidic H2/O2 fuel cell: commercial unsupported Pt and Pt3Co as well as in-house acid-treated Pt3Co Pt3Co-at and Pt3Co/Mo. Commercial Pt3Co

Kenis, Paul J. A.


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

PubMed Central

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




XAS Study at Mo and Co K-Edges of the Sulfidation of a CoMo / Al2O3 Hydrotreating Catalyst  

NASA Astrophysics Data System (ADS)

Because of its impact on environment, the removal of sulfur is an indispensable step, called hydrotreatment, in the refining of petroleum. One of the most commonly used hydrotreating catalysts is CoMo-type catalyst which is composed of molybdenum disulfide slabs promoted by cobalt atoms (CoMoS phase) and well dispersed on a high specific area alumina. As far as the highest sulfur content allowed in gasoline and diesel is continually decreasing, more and more efficient and active hydrotreating catalysts are required. In order to optimize the reactivity of the CoMo-type catalyst in hydrotreatment, a better understanding of the processes used to produce the active phase (CoMoS slabs) of the catalyst is necessary. The study reported here deals with the sulfiding mechanism of the slabs and the influence of temperature on the phenomenon. Ex situ X-ray absorption spectroscopy (XANES and EXAFS) was used to study the evolution of the structure of CoMo-type catalyst sulfided at various temperatures (from 293 to 873 K). XAS analysis was performed at both molybdenum and cobalt K-edges to obtain a cross-characterization of the sulfidation of the slabs. It evidenced the formation of various compounds, including two molybdenum oxides, MoS3 (or MoS3-like compound) and Co9S8, at specific steps of the sulfiding process. It showed the role of intermediate played by MoS3 (or MoS3-like compound) during the formation of the slabs and the competition between the appearance of promoted slabs (CoMoS phase) and Co9S8. At last, it leaded to the proposal of a mechanism for the sulfidation of the catalyst.

Pichon, C.; Gandubert, A. D.; Legens, C.; Guillaume, D.



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



Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry?  

Microsoft Academic Search

PURPOSE: We sought to evaluate the effectiveness of self-monitoring blood glucose levels to improve glycemic control.SUBJECTS AND METHODS: A cohort design was used to assess the relation between self-monitoring frequency (1996 average daily glucometer strip utilization) and the first glycosylated hemoglobin (HbA1c) level measured in 1997. The study sample included 24,312 adult patients with diabetes who were members of a

Andrew J Karter; Lynn M Ackerson; Jeanne A Darbinian; Ralph B DAgostino; Assiamira Ferrara; Jennifer Liu; Joe V Selby



PS2-34: Communication Barriers and Preferences of Limited English Proficient Chinese Speaking Members in Kaiser Permanente  

PubMed Central

Background/Aims Our aim was to learn about the literacy and communication difficulties and preferences of Limited English Proficient Chinese speakers. Methods This was a self-administered waiting room survey of KP Bilingual Chinese module patients. The study sample includes 1672 patients aged 35+ (775 aged 3559, 897 aged 60+) classified from self-report as Very Limited English Proficient (VLEPs, n = 1242, speaks English not at all or not well) or Limited English Proficient (LEPs, n = 430, speaks English well, but not very well). Results We found: 1) Educational attainment was low overall (approximately 36% had not completed the equivalent of high school, 37% were high school graduates, 15% had some college, and 12% were college graduates), and significantly lower among older patients and within age groups, VLEP versus LEP; (2) 97% of VLEPs and 13% of LEPs do not read English well, 13% of both VLEPs and LEPs do not read Chinese well, and 13% of VLEPs do not read either language well, with older VLEPs having the lowest literacy; (3) 88% of VLEPs and 55% of LEPs usually have trouble understanding letters in English and 43% of VLEPs and 35% of LEPs usually have trouble understanding letters in Chinese; (4) Among VLEPs, 43% preferred print instructions in Chinese, 2% in English, and 55% in both languages; among LEPs: 8% preferred Chinese, 28% English, and 64% both languages; (5) 76% of VLEPs and 42% of LEPs usually have trouble interacting with the KP Call Center on their own; Chinese Call Center agents were desired by 96% of VLEPs and 74% of LEPs; (6) VLEPs are more likely than LEPs to have difficulty understanding instructions (VLEPs: 42% sometimes, 15% usually; LEPs: 25% and 2%) and test results (VLEPs: 41% sometimes, 39% usually; LEPs: 49% and 8%), and more frequently require help from others to understand (VLEPs: 30% sometimes, 60% usually; LEPs 43% and 12%); and (7) VLEPs are less likely than LEPs to use email and Internet, and more likely to need help when doing so. Conclusions Limited English Proficient Chinese patients face many difficulties related to language, literacy, and education in ability to receive and understand health-related communications.

Gordon, Nancy; Tang, Anne



Acta de la Comisin Permanente 7 de Octubre de 2010 Hora de comienzo: 10:45 horas.  

E-print Network

países Irlanda y Eslovaquia. Los peores países con movilidad con sus estudiantes son Portugal, Polonia la movilidad son Italia, Suiza, Croacia, Bosnia, Ucrania, Estonia y Letonia. Los puntos del informe social, duración, transparencia, gobernanza y participación estudiantil, movilidad y reconocimiento. #12

Escolano, Francisco


Difusin de resultados iniciales del Estudio del Tamoxifeno y del Raloxifeno (STAR): el frmaco para el tratamiento de la osteoporosis, raloxifeno, es tan efectivo como el Tamoxifeno en la prevencin de cncer de seno invasor

Los resultados iniciales del Estudio del Tamoxifeno y del Raloxifeno, STAR, demuestran que el frmaco raloxifeno, actualmente utilizado para prevenir y tratar la osteoporosis en mujeres posmenopusicas, funciona tan bien como el tamoxifeno para reducir el riesgo de cncer de seno entre las mujeres posmenopusicas que tienen riesgo elevado de padecer la enfermedad. Preguntas y respuestas


Silvestre Francs, Eva M La Obra Social de Caixa Ontinyent como dinamizadora del desarrollo local en la comarca de laVall Urbieta Iceta, Elisabet Sistemas productivos locales y territorio. Instrumentos para el fomento de la innovacin y el Em-  

E-print Network

la Seguridad Ciudadana como herramienta de revitalización y desarrollo para la comunidad. Yago, participación e identidad. Luces y sombras en el marco de la Iniciativa LEADER Martínez Puche, A. et alii La al desarrollo local. El diario ´La Opinión-El Correo de Zamora´ en la

Escolano, Francisco


Dinmica del sistema agroforestal de chagras como eje de la produccin indgena en el Trapecio Amaznico (Colombia) Chagras' agroforestal system dynamics as the basis for indigenous production in the Amazonian Trapezium (Colombia)  

Microsoft Academic Search

Resumen: La tradicin indgena, la pertenencia a la cuenca Amaznica y la cercana a un importante centro urbano como Leticia (Amazonas, Colombia) son factores que aportan elementos caractersticos al sistema de produccin de Ciudad Jitoma y lo dife- rencian de otras formas de produccin indgena y no-indgena, incluso dentro de la misma regin ama- znica. En el presente estudio se

Luz Amparo Triana-Moreno; Nohra Cecilia Rodrguez; Jess Garca


Como Campus Master of Science in  

E-print Network

; Geophysical Prospecting; 2. Environmental Engineering Hydraulic Engineering and River Basin Reclamation and reclamation plans. Students will increase their understanding of the functioning of ecosystems, learn how


Como Lo Hago Yo: Lipomas Medulares  

PubMed Central

Basados en la experiencia de 82 casos; en 5% se observaron anomalas plvicas asociadas. En los menores de 3 aos el motivo de consulta (85%) fue la tumoracin. En los mayores de 3 aos (42%) tena problemas neurolgicos. Solo el 24% preocupados por la tumoracin. El objetivo de la ciruga es desanclar la mdula y no remover la totalidad del lipoma. El lipoma de filum es el que es mas simple para operar. An cuando la escuela francesa propone operar solamente cuando hay sntomas favorezco ciruga preventiva. Favorezco una segunda ciruga si hay signos de anclaje postoperatorio, an cuando observamos empeoramiento postoperatorio motor en 2.5% de los operados y urolgico a largo plazo en 6% de los operados. PMID:24791218

Portillo, Santiago




E-print Network

(Convalidação de estudos concedida pela Secretaria Estadual de Educação, no Brasil, se concluído no exterior) ou Dispensa de Incorporação 9) Cópia do CPF. III ­ DOS PROCEDIMENTOS A matrícula nesta categoria deverá ser



E-print Network

Convalidação de Estudos concedida pela Secretaria Estadual de Educação, no Brasil. 4) Histórico Escolar da IES do Título de Eleitor. 9) Cópia do Certificado de Dispensa de Incorporação 10) Cópia do CPF. III ­ DOS



E-print Network

Estudos concedida pela Secretaria Estadual de Educação, no Brasil. 4) Histórico Escolar da IES de origem Eleitor. 9) Cópia do Certificado de Dispensa de Incorporação 10) Cópia do CPF. III ­ DOS PROCEDIMENTOS


El turismo como alternativa de crecimiento  

Microsoft Academic Search

Abstract This paper is about the economy,in the tourism sector in the Argentine provinces as an alternative to their growth. It presents a model of specific factors. The economy,consists of two sectors: the public sector and the private sector (the touristic sector). Some distortions in the economy,like taxing on the touristic sector- give rise to an inefficient allocation of resources

Natalia Porto



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



Anlise temporal da transgresso em reas de preservao permanente e uso restrito na Bacia Hidrogrfica do Rio Tijucas para subsidiar as aes de gesto do Comit da Bacia  

Microsoft Academic Search

The maintenance of forests and water resources should be priority of governments of all countries in order to protect and conserve natural resources and biological diversity. Brazilian Forest Code (Law 4.771, of 15.09.1965) establishes criteria for the protection of riparian zone, headwater protection, hilltops and steep hillsides and the National Politics of Water Resource's Law institutes (Law 9.433, of 08.01.1997)

Clarisse Post Darella


Atti della Scuola Permanente per l'Aggiornamento degli Insegnanti di Scienze "Il tempo nella Scienza, la Scienza nel tempo?", Agrigento, 27-31 luglio 2009  

E-print Network

Procarioti dalle mille risorse: nuove scoperte sui metabolismi batterici che utilizzano la luce 26 5 Fabio, 2013 6 10 Mauro Cavallaro La bioluminescenza nei pesci batifili dello Stretto di Messina 64 11

Spagnolo, Filippo


Estudio de mercado para productos ecolgicos: estudio del segmento de demanda de los centros permanentes de consumo en la provincia de Mlaga  

Microsoft Academic Search

This paper presents a study of the demand for organic products in the Costa del Sol (Mlaga province). We offer the results of a survey we carried out through interviews with the heads of esta- blishments and consumption centres: restaurants, hotels, school, hospitals... The study shows the high level of the demand for organic products in the area. Actually this

M. Cenit; A. Alonso; F. Guzmn


La place de l'education des parents dans l'education permanente (The Role of Parent Education in Continuing Education).  

ERIC Educational Resources Information Center

Beginning with the historical background of parent education this international survey report briefly analyzes parental educational needs (defined in terms of parent child communication, family school relations, and the impact of rapid social change); the place of parent education in literacy programs; information services, parental consultations,

Taoufik, Rabah



Microsoft Academic Search

SUMMARY In this article, principles of one model for male and female Science teacher formation are discussed, considering as its basis the dialogical and critical reflection on concepts and practices, between the teacher and his\\/her tutor. The dialogical reflection takes place due to problems located in a concrete environment, which are scrutinized in the light of modern theoretical references regarding



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

ERIC Educational Resources Information Center

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

Haddab, Mustapha



Los mitos como memoria colectiva de Los Pueblos.  

NASA Astrophysics Data System (ADS)

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

Martn, P. T.


[Parenting Information. Informacion Sobre Como Ser Padres Mejores.  

ERIC Educational Resources Information Center

These five booklets, containing information on how parenting can effect children's school achievement, are part of a series of 22 innovative booklets designed specifically to help parents understand and help their children learn. Booklet #1, "Parents--Teach Your Children to Learn [Before They Go to School]," defines intelligence and suggests

Moreno, Steve


Del carnaval como 'metfora' al teatro de carnaval  

E-print Network

particular, al tema de la fiesta, del carnaval y del canbal en la literatura y el teatro. Esta preocupacin se relaciona, a su vez, con el desarrollo de un dilogo entre el teatro y la antropologa, en torno a los dramas sociales, las formas orales o no...

Remedi, Gustavo




E-print Network

); - Título de Eleitor; - Certificado de Dispensa de Incorporação; - CPF. Se candidato estrangeiro juramentada; - Carteira de Identidade; - CPF; - Passaporte, onde deverá constar o visto de estudante



E-print Network

); - Título de Eleitor; - Certificado de Dispensa de Incorporação; - CPF. Se candidato estrangeiro juramentada; - Carteira de Identidade; - CPF; - Passaporte, onde deverá constar o visto de estudante CPF - Cópia do Passaporte com visto de estudante/permanência atualizado (se estrangeiro) #12;



E-print Network

; - Certificado de Dispensa de Incorporação; - CPF; Se candidato estrangeiro: - Certificado de Conclusão de de Identidade; - CPF; - Passaporte, onde deverá constar o visto de estudante / permanência atualizado CPF - Cópia do Certificado de Conclusão do Ensino Médio - Cópia do Passaporte com visto de estudante



E-print Network

; - CPF. Se candidato estrangeiro: - Certificado de Conclusão do Ensino Médio ou equivalente; - Certidão de Nascimento ou Casamento com tradução juramentada; - Carteira de Identidade; - CPF; - Passaporte alunos brasileiros) - Cópia do CPF - Cópia do Passaporte com visto de estudante/permanência atualizado



E-print Network

; - Certificado de Dispensa de Incorporação; - CPF; Se candidato estrangeiro: - Certificado de Conclusão de de Identidade; - CPF; - Passaporte, onde deverá constar o visto de estudante / permanência atualizado Dispensa de Incorporação (Apenas para alunos brasileiros) - Cópia do CPF - Cópia do Certificado de


como instrumento virtual en medicin de la movilidad dental  

Microsoft Academic Search

Summary: Lab View enables the creation of frontal panels on the screen, with specific virtual instruments operating through the mouse or through the keyboard as well as the versatility of allowing the use of the computer screen as a software scenario to control a system for measuring virtual mobility. The system allows the evaluation of anterior-posterior mobility, using L.V.D.T. (Linear

Germn Pineda; Rodolfo vila; Ctedra de Informtica; Aplicacin de LabView


Las redes neuronales como herramientas estadsticas no paramtricas de clasificacin  

Microsoft Academic Search

Recientemente diversos trabajos (ver p.e. Cherkassky, Friedman y Wechsler, 1994; Ripley, 1996) han analizado las relaciones entre redes neurales y tcnicas estadsticas con vencionales. Aunque los resul - tados no son concluyentes, en general las redes neurales han mostrado una capacidad clasificatoria igual o superior que las tcnicas estadsticas, con la ventaja de poderse utilizar independientemente del cumplimiento de los

Alfonso Pitarque; Juan Carlos Ruiz; Juan Francisco Roy



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.


VII Simpsio de Controle Biolgico  

E-print Network

A soberania de uma nao garantida quando ela capaz de produzir os alimentos necessrios para o seu povo; entretanto, imprescindvel que sejam produzidos com uma agricultura sustentvel, permitindo que as reas utilizadas nas atividades agro-pastoris sejam preservadas e livres de substncias que possam alterar o seu equilbrio biolgico, assegurando desse modo a sua utilizao permanente. Estima-se que a populao mundial tenha aumentado em cerca de um bilho de pessoas na dcada de 90 e que haver igual crescimento na primeira dcada do sculo XXI, alcanando cerca de 8,3 bilhes em 2025, acreditando-se numa estabilizao em 10 bilhes no final deste sculo. A sobrevivncia dessa populao se basear, como no passado, nas plantas e principalmente em cereais, para garantir um fornecimento que atenda a todas as suas necessidades. Mesmo considerando-se a manuteno do consumo atual per capita, haver necessidade de um aumento de 52 % na produo mundial de

Poos De Caldas; Mg Brasil; Novos Tempos; Novas Solues


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.




E-print Network

sociales. 2 2 Jiu Jitsu Deporte de competición base de las artes marciales de Judo, Kárate y Aikido. 2 2 Judo Arte marcial en el que aprendemos a hacer uso de nuestra fuerza y al mismo tiempo la del contrario

Autonoma de Madrid, Universidad


Ileitis Microscpica como causa de Diarrea Crnica. Estudio de Casos y Controles  

Microsoft Academic Search

* . RESUMEN INTRODUCCION Observar microscpicamente la mucosa ileal de pacientes con diarrea crnica y encontrarla invadida por linfomononucleares, pese a lo normal de su aspecto endoscpico, motiv llamar a este hallazgo ileitis microscpica. Esta investigacin responde a est la ileitis microscpica asociada a diarrea crnica? MATERIAL Y METODOS Se busc ileitis microscpica en 30 pacientes con diarrea crnica y

Marco Daz Santisteban


Costo de capital con costo del patrimonio apalancado como el riesgo de los escudos fiscales  

Microsoft Academic Search

Se presenta la derivacin de costo de capital bajo la premisa del ahorro de impuestos de riesgo descuento con el costo de capital apalancado. Se demuestra que la formulacin es coherente y se deriva de los principios financieros bsicos. Esta formulacin es vlida para los flujos de caja finitos y perpetuidades sin crecimiento. Adems, se puede calcular sin la circularidad

Joseph Tham; Ignacio Velez Pareja



Este manual foi adaptado do original DSpace Help. COMO NAVEGAR NO REPOSITRIO INSTITUCIONAL DA  

E-print Network

Universidade, utilizando a tecnologia de arquivos abertos sob a filosofia do Movimento de Acesso Aberto à, livros, capítulos de livros, teses, dissertações, trabalhos publicados em anais de eventos, entre outras que são depositados: artigos publicados em periódicos, livros e capítulos de livros, trabalhos

Maier, Rudolf Richard


On Distributed Synthesis of Dynamical Transportation Networks Enrico Lovisari, Giacomo Como, Anders Rantzer, and Ketan Savla  

E-print Network

the network to the optimal steady-state. When instead speed limits are the only control variables of charging tolls and varying speed limits on the links of the network. The goal of the traffic manager California, Los Angeles, CA 90089- 2531. scenarios: if both tolls and speed limits can

Como, Giacomo


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

ERIC Educational Resources Information Center

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

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



Microsoft Academic Search


Pablo Mrquez Escobar



Microsoft Academic Search

In a time where environmental issues are widely di scussed, electric energy generation becomes a huge villain when the matter is emission of greenhouse gases and environmental degradation. Amongst the solutions, the utilization of renewable energy sources is intensified in several parts of the world, Brazil included. Amidst them, the energy produced from the winds (eolic) is intensified demonstrating being

Thiago Fleury; Fernandes de Oliveira; Harlen Incio


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

PubMed Central

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

Laborde, Sarah; Imberger, Jrg; Toussaint, Sandy




Microsoft Academic Search

Non-tillage as an agronomical method in basic grain sustainable production. In the present the agriculture and li- vestock field and specifically the basic grains producer, goes throught the worst crisis in the whole history of Costa Rica. The strong degradation of the natural resourses, linked to the important low yield of the crops, which also coincide with the high cost

Luis A. Rojas



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

PubMed Central

En Nicaragua no hay un plan de forltificacin de alimentos con cido flico. Las madres son muy jvenes. En La Mascota operamos mas de cuarenta nios por ao. Derivacin tarda es un problema. La infeccin 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 mdula. No ceramos la capa de msculo. PMID:24791221

Gonzalez, Juan Bosco



Historia de las matemticas "Esto es matemticas, Jim, pero no como la conocemos."  

E-print Network

escrito La falta de agua obliga a registrar los períodos de lluvias o inundaciones (almanaques, calendario: en Basora (!), entre Sumer (Irak) y Elam (Iran), por agua Primeros imperios JPP-HdM ­ p. 10/1 #12

Pinasco, Juan Pablo


El Modelo de Estados y Transiciones como Herramienta para el estudio,  

E-print Network

ECOLOGICOS Ejemplos de indicadores Clima Cantidad, distribución y variabilidad de lluvias y temperatura agua, cantidad de materia orgánica Vegetación Dinámica espacio-temporal del estado de referencia



Microsoft Academic Search

In this article we expect to analyze the great amount of changes suffered by touristic sector during the last years. These changes have resulted in the appearance of several new touristic products which have become a complement to the traditional destinies like the beach or inland. Nowadays from a touristic we experct not only to rest but having additional activities

Mara Teresa Pealver Torres



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; Nogus Pedregal



La capacidad de carga psicolgica del turista como indicador del turismo sostenible  

Microsoft Academic Search

La capacidad de carga turstica ostenta un inters creciente dado que se vincula estrechamente con el desarrollo turstico sostenible. Se preten- de justificar la utilidad de este concepto mediante una propuesta metodo- lgica sencilla y eficaz, analizando la capacidad de carga psicolgica del turista. En la aplicacin emprica se detecta que la satisfaccin del turista disminuye cuando los niveles de

Jess Manuel Lpez Bonilla; Luis Miguel; Lpez Bonilla



Microsoft Academic Search

The Autonomous Community of Castilla y Len represents one of the Spanish regions that more is investing in rural tourism as an economic activity that supplements or subs- titutes to the traditional agricultural activities in rural areas. The outstanding growth that experiences this activity of services in the last years, has been favored by the expansion of the demand of

Margarita Rico Gonzlez


O riso como expresso de um posicionamento na cidade: o encontro de Demcrito e Hipcrates  

Microsoft Academic Search

The Pseudo-Hippocratic letters relate the fictitious meeting between Democritus and Hippocrates. This document is the basis which allows us to think about how the hippocratic tradition and Democritus' philosophy treat the concepts of man's and city's health. This paper aims to show some aspects of the relationship between man and the city, given the concept of health present in the

Priscilla Gontijo Leite



1 ANTES DE SALIR DE TU PAS a. Inscrbete como alumno de intercambio o visitante  

E-print Network

A LA UPF a. Asistencia obligatoria a los Días de Orientación y Acogida b. Tu coordinador de movilidad c oficina de movilidad (OMA): Biología Humana Medicina Derecho, Criminología y Relaciones Laborales Economía

Geffner, Hector


Preparado como una iniciativa de NARSTO, esta evaluacin de Ozono (O3  

E-print Network

dependen de herramientas científicas similares (p. ej. redes de monitoreo y modelos) y están mutuamente medidas de mitigación son sociales NARSTO EVALUACI?N DE OZONO RESUMEN EJECUTIVO La Evaluación de Ozono de


Mielopatia por deficincia de vitamina B12 apresentando-se como mielite transversa  

Microsoft Academic Search

Vitamin B12 deficiency may induce neuropathy, myelopathy, dementia and optic neuropathy. The diagnosis is established by vitamin B12, homocysteine and methylmalonic acid measurements. Myelin and axon destruction in the white matter of the spinal cord are observed. The posterior column of the cervical and thoracic level is the most common involved area. The involvement of the anterior column is restricted

Luiz Felipe Rocha Vasconcellos; Rosalie Branco Corra; Leila Chimelli; Fernanda Nascimento; Adriane Baptista Fonseca; Janaina Nagel; Sergio Augusto Pereira Novis; Maurice Vincent




Microsoft Academic Search

RESUMO O presente artigo fundamenta a importncia da Psicologia Cognitiva e a mediao informacional no mbito das organizaes. O avano tecnolgico fez com que processos de gesto, baseados no taylorismo e fordismo, j no respondam s necessidades organizacionais atuais, que so ambientes complexos. Uma nova perspectiva de ao e alterao no arcabouo organizacional pode ser a Psicologia cognitiva, que busca

Domingos Luiz Palma


Tpicos sobre programao de computadores como mtodo educativo no jardim-de-infncia  

E-print Network

apoiam-se fortemente na teoria construtivista de Jean Piaget (o que não é de espantar, já que Papert trabalhou com Piaget na Suíça), pese as necessárias diferenças que apresentam. Contudo, o aspecto essencial

Paris-Sud XI, Université de



E-print Network

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


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


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.


Medidas antropomtricas como predictores del comportamiento lipdico srico en adolescentes con sndrome de Down  

Microsoft Academic Search

Current findings suggest that more attention needs to be gi- ven to the increase in body mass being achieved by disabled populations in general and individuals with mental retarda- tion in particular, to minimize long-term negative health con- sequences. Given that physical activity programs have been reported as one of the most effective ways of improving the health of individuals

Francisco Javier Ordez-Munoz; Manuel Rosety-Rodrguez; Jess Mara Rosety-Rodrguez; Manuel Rosety-Plaza


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

Federal Register 2010, 2011, 2012, 2013, 2014

The Department of Agriculture (USDA), Forest Service, Bitterroot National Forest, Darby Ranger District published a document in the Federal Register of June 17, 2013, concerning notice of intent to prepare an environmental impact statement. The document contained incorrect distance of the project area from Darby,...



Otro gnero de violencia. Reflexiones desde la teora feminista como teora crtica  

Microsoft Academic Search

Entre les aportacions que les teories crtiques dels anys 60 han fet a l'anlisi de la sexualitat, em referir, en particular, a aquelles que es deriven de l's de la teoria feminista com a teoria crtica. Des d'ac, es parla d'una violncia, que noms des d'ac pot ser llegida com a discurs de poder, fent impossibles aquelles lectures que volen

Luisa Posada Kubissa



Papel de los receptores tipo toll en las infecciones virales: el VIH-1 como modelo  

Microsoft Academic Search

The toll-like receptors are an essential component of the innate and adaptive immune response. They are responsible for the recognition of different pathogens agents and trigger responses directed at eliminating the pathogens as well as the development of immunological long-term memory. During viral infections, several different toll-like receptors are activated. These generally induce a protective immune response, but at the

Juan Carlos Hernndez; Carlos Julio Montoya; Silvio Urcuqui-Inchima



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


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

Laborde, Sarah; Imberger, Jrg; Toussaint, Sandy



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

E-print Network

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

Lucea, Rafael


El caduceo como emblema de la medicina: un error de casi cinco siglos  

Microsoft Academic Search

The snake has been associated to healing arts since the ancient times, probably because its skin-change ability and to symbolize that sola dosis facit venenum. The Staff of Aesculapius and the caduceum derivate from worshipping the snake; it is undeniable that both mythological symbols originated from the Life Tree, which represents wisdom and immortality. The inaccuracy of adopting the caduceum

Feliciano Blanco Dvila; Hernn Ramrez Vel


Risco ambiental da aplicao de teres de difenilas polibromadas como retardantes de chama  

Microsoft Academic Search

Environmental risks involved with the application of polybrominated diphenyl ethers as flame retardants Flame retardants are additives of combustible materials, such as plastics, textile, electronic circuitry, wood and paper providing resistance to the combustion process when exposed to fire and high temperature. The main flame retardants used are inorganic chemicals (such as antimony oxides), organic phosphate esters with or without

Cezar Rangel Pestana; Keyller Bastos Borges; Patrcia da Fonseca; Danielle Palma de Oliveira



Iniciativas de Transio e Permacultura, como reestruturao e capacitao de comunidades em Portugal.  

E-print Network

??Mestrado em Gesto e Estratgia Industrial Este trabalho visa abordar o movimento de Iniciativas de Transio, analisando as suas motivaes, baseadas fundamentalmente na insustentabilidade da (more)

Soares, Pedro David Almeida Rebelo



Jogos inteligentes como sistemas abertos: singularizando as possibilidades de interao com desafios lgicos  

Microsoft Academic Search

This work presents, in general way an application of Artificial Intelligence in Education, it simulates how to process the understanding of cognitive stages based in Piagetian tests, making possible, the implementation of multi-agents computerized open challenges. This challenges are part of a platform-environment propose, integrating the Intelligent Systems Laboratory - LSI\\/UFMA and the Laboratory of Studies in Language, Interaction and

Othon de Carvalho; Bastos Filho; Margarete Axt; Luis Carlos; C. Fonseca; Sofiane Labidi; Lucas Nunes Guimares; Andrei Rubina Thomaz



Microsoft Academic Search

Educative games as learning objects for peoples with special needs The use of educative games stands out as a useful tool to teaching\\/learning in many areas and publics. In case of people with special needs this is very important, so besides motivates the students and facilitates the learning, it contributes to their digital inclusion. This article shows all the activities

Raquel Ribeiro Balbino; Luiz Henrique; Mateus Drigo da Silva; Mariane Moreira de Souza; Melise Maria; Veiga de Paul; Fabricia Ferreira de Souza


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.


Cambio estructural en la competitividad ecuatoriana despus de la dolarizacin  

Microsoft Academic Search

Muchos estudios tericos y empricos establecen que una poltica monetaria contractiva tiene efectos negativos en la competitividad y que pueden ser permanentes. El presente artculo busca evidencia de un cambio permanente en la competitividad ecuatoriana con respecto a sus socios comerciales Colombia y Per entre los aos noventa, cuando haba una poltica comercial discrecional, y los aos posteriores a la

Gustavo Solrzano Andrade; Ivn Rivadeneyra Camino; Luis ngel Guamn Lazo



Le GPS : une prcision toute relativiste Table des matires  

E-print Network

). Or celle-ci prédit des effets qui compliquent la synchronisation du système : le potentiel gravitationnel dans les satellites, surveillance permanente de ceux-ci, synchronisation permanente de l'horloge à), consiste à ne rendre possible la synchronisation précise du récepteur avec les satellites qu

Baumann, Pierre


LA UA EN CIFRAS Evolucin series histricas: Alumnado  

E-print Network

horas) 4.140 Universidad Permanente 737 Alumnos enviados Programa Movilidad ERAMUS 255 Otros estudios horas) 2.497 Universidad Permanente 427 Alumnos enviados Programa Movilidad ERAMUS 255 NO EUROPEOS 23 SENECA 40 ERAMUS 122 NO EUROPEOS 20 SENECA 16 Hombre Total 1.327 Alumnos acogidos Programa Movilidad

Escolano, Francisco


Traditional plants as source of functional foods: a review Plantas tradicionales como fuente de alimentos funcionales: una revisin  

Microsoft Academic Search

The aim of this work was to assess the following plants as functional foods that can be found in Mexico: white sapote (Casimiroa edulis), jicama (Pachyrhizus spp.), amaranth (Amaranthus hypochondriacus), sweet fennel (Foeniculum vulgare), oregano (Lippia graveolens), pitahaya (Hylocereus sp.), agave (Agave americana), pelitre (Heliopsis longipes), and purslane (Portulaca oleracea L). The main characteristics, components and active substances, forms of

G. Rivera; V. Bocanegra-Garca; A. Monge



Discriminao como uma das Fontes de Desigualdade de Rendimentos no Mercado de Trabalho das Regies Nordeste e Sudeste  

Microsoft Academic Search

Este artigo analisa a discriminao salarial por gnero e raa dentro das densidades das distribuies de salrio dos setores de atividade, comparando as regies Nordeste e Sudeste. Para este objetivo, foram usados os dados da PNAD 2002 e uma metodologia semiparamtrica estimador de ncleo ponderado e outra paramtrica regresso quantlica. O primeiro mtodo mostra com base em simulaes

Jacqueline Nogueira Cambota; Emerson Lus Lemos Marinho



Dolor durante biopsia de prstata guiada por ultrasonografa transrectal: Comparacin del uso o no de Xilocana gel como anestsico local  

Microsoft Academic Search

Introduction : The prostate biopsy guided by ultrasound is the method of choice for early diagnosis of prostate cancer, is a safe whose main trouble is that it feels discomfort during the procedure. Material and methods : From July 2004 until March 2005 we prospectively studied 114 patients who underwent trans - rectal ultrasound guided needle biopsy of the prostate,

Gilmer A. Daz Prez; Luis Meza Montoya; Carlos Morante Deza; Mariela Pow-Sang Godoy; Vctor Destefano Urrutia



Visualizing the stoichiometry of industrial-style Co-Mo-S catalysts with single-atom sensitivity.  


The functional properties of transition metal dichalcogenides (TMDs) may be promoted by the inclusion of other elements. Here, we studied the local stoichiometry of single cobalt promoter atoms in an industrial-style MoS2-based hydrotreating catalyst. Aberration-corrected scanning transmission electron microscopy and electron energy loss spectroscopy show that the Co atoms occupy sites at the (-100) S?edge terminations of the graphite-supported MoS2 nanocrystals in the catalyst. Specifically, each Co atom has four neighboring S?atoms that are arranged in a reconstructed geometry, which reflects an equilibrium state. The structure agrees with complementary studies of catalysts that were prepared under vastly different conditions and on other supports. In contrast, a small amount of residual Fe in the graphite is found to compete for the S?edge sites, so that promotion by Co is strongly sensitive to the purity of the raw materials. The present single-atom-sensitive analytical method therefore offers a guide for advancing preparative methods for promoted TMD nanomaterials. PMID:25078562

Zhu, Yuanyuan; Ramasse, Quentin M; Brorson, Michael; Moses, Poul G; Hansen, Lars P; Kisielowski, Christian F; Helveg, Stig




Microsoft Academic Search

This work pro vides a clear description of concurrent engineerng as a methodology for putting new product development (NPD) process into practice, and investigates empirically the re- lationship between its use and NPD processes success. Our study al so analyses the impact of top management support on its implantation degree. With this aim, we use a sample of 125 firms,

Valle lvarez



Evaluation of wine vinasses as alternative nutrients in biotechnological processes Evaluacin de vinazas vnicas como nutriente alternativo en procesos biotecnolgicos  

Microsoft Academic Search

Vinasses are acidic effluents with high organic content, including acids, carbohydrates, phenols and unsaturated compounds with high chemical and biological oxygen demand. Their discharge into public watercourses promotes a high and toxic contamination of the medium, resulting in significant environmental problems. However, the search for alternative, financially competitive nutrient sources to carry out biotechnological procedures is particularly interesting, considering that

Jos Manuel Salgado; Noelia Rodrguez; Beln Max; Belinda Prez; Raquel Rodrguez; Sandra Corts; Jos Manuel Domnguez



Los pumas ( Puma concolor) como agentes tafonmicos. Anlisis actualstico de un sitio de matanza en los Andes de Mendoza, Argentina  

Microsoft Academic Search

A taphonomic study of the carcass of an adult guanaco (Lama guanicoe) recently killed and consumed by one or more pumas (Puma concolor) in the Laguna del Diamante reserve (Mendoza province, Argentina) is exposed, and the case is discussed in the light of the available taphonomic information on this agent in America. The carcass was dispersed along more than 30m

A. Sebastin Muoz; Mariana Mondini; Vctor Durn; Alejandra Gasco



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.


La Accin Innovative Training Networks (ITN) tiene como objetivo formar, por medio de una red internacional de centros pblicos y  

E-print Network

. 10:00 Acciones Marie Sklodowska Curie: Convocatorias 2015 Innovative Training Networks (ITN´Enginyeria Química de la Universitat de València. Evaluadora. 13:15 Otras Acciones Marie Sklodowska Curie: próximas - Nivell 3 Avda. Blasco Ibañez, 13 Valencia Horizonte2020 INNOVATIVE TRAINING NETWORKS Marie Sklodowska

Escolano, Francisco



Microsoft Academic Search

SUMMARY An experiment was carried out to study the behavior of the red worm (Eisenia spp.) fed with 5 nutritious substrates based in Moringa oleifera (Lam.) foliage, for the nutritional potentiali- ties, and other agricultural wastes in Trujillo state, Venezuela. A randomized design with repeated measurements and three repli- cates was used. Initially, 1.16kg of biomass in 0.5m3 of substrate

Luis Jos Cov; Danny Eugenio Garca; Alexander Rafael Castro; Mara Gabriela Medina



Aspectos das prticas alimentares e da atividade fsica como determinantes do crescimento do sobrepeso\\/obesidade no Brasil  

Microsoft Academic Search

Data from Brazilian national surveys conduct- ed since the 1970s have indicated an increase in the prevalence of overweight\\/obesity. The two most frequently cited causes of this trend have been dietary changes and reduction in physical activity, characterizing a \\

Cristina Pinheiro Mendona; Luiz Antonio dos Anjos



Sensoriamento remoto como ferramenta auxiliar no combate ocorrncia de dengue na cidade de Vitria-ES  

Microsoft Academic Search

The focus of this research was to know dengue occurrences in Vitria city and to create itineraries of visits to combat targets of dengue occurrence using GIS and remote sensing. Maps of dengue occurrence were developed in the study area using the ArcGIS software, and then the areas with high dengue incidence taxes were observed with Google Earth and identified

Aurlio Azevedo Barreto-Neto


Uso de imagens LANDSAT como subsdio ao estudo da disperso de sedimentos na regio da foz do rio So Francisco  

Microsoft Academic Search

The construction of a sequence of water reservoirs along the lower So 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

Joo Antonio Lorenzzetti; Eduardo Negri


Quid Hinieldus cum Christo : a obra de J.R.R. Tolkien como mediao entre paganismo e cristianismo germnicos  

Microsoft Academic Search

Tolkien's fictional works, comprising mainly Middle-earth 's legendarium , are a unique blend of Western Europe's pagan mythologies and a Weltanschaung that is essentially monotheistic and Christian. It is conceivable that the reason for such an unusual m ix derives from Tolkien's profound knowledge of the Anglo-Saxon literary tradition, in which, as in Ce ltic Christendom, there was a reluctance

Reinaldo Jos Lopes


Como a Petrobras Biocombustveis pode Engajar Agricultores de Pequena Escala Enquanto Promove a Sustentabilidade do Programa de Biodiesel Brasileiro?  

Microsoft Academic Search

A nossa pesquisa indica que a Petrobras Biocombustveis pode ajudar a aliviar a pobreza entre os agricultores familiares de pequena escala, reforando a integrao das partes interessadas no programa brasileiro de biodiesel. Isso corrobora diversos estudos que demonstram a importncia das redes compostas pelas partes interessadas (Rowley, 1997; Roloff, 2008), que podem ser particularmente importantes nos programas que visam integrar

Clovis Zapata; Diego Vazquez-Brust; Jos Plaza-beda



Lista de Exerccios Relatividade 1. Como testaramos um referencial proposto para saber se ele ou no um referencial inercial?  

E-print Network

percorrer a distância de 6,0 anos­luz. (D. Halliday, R. Resnick e J. Walker, Fundamentos de Física, 4a ed Lorentz g for (a) 1,01, (b) 10,0, (c) 100 e (d) 1.000? (D. Halliday, R. Resnick e J. Walker, Fundamentos a velocidade destes múons dos raios cósmicos em relação à Terra. (D. Halliday, R. Resnick e J. Walker

dos Santos, C.A.



Microsoft Academic Search

Evaluation of tropical maize (Zea mays) inbred lines as sources of favorable alleles to improve elite single corn hybrids. Progenitors of three single corn hybrids were crossed with 23 lines with the purpose of identifying donor lines for improving grain yield of AN1 x AN2, SSE232-33-30 x SSE255-18-19 and SSE255-18-19 x M.L.S4-1. Lines per se and their crosses among hybrid

Narciso Vergara Avila; Sergio A. Rodrguez Herrera; Hugo Crdova Orellana



Opinion dynamics and stubbornness through mean-field games Leonardo Stella, Fabio Bagagiolo, Dario Bauso, Giacomo Como.  

E-print Network

of agents in response to repeated interactions among themselves over a social network (see, e.g., [6, Sect) other agents' current beliefs, thus modeling the attractive nature of social influence. Standard models predict, provided that the underlying social network is connected, that a consensus among the agents

Como, Giacomo


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


Second Trimester Maternal Serum Screening  


... Shirley L. Welch, PhD, DABCC, FACB. Director of Chemistry, Kaiser Permanente, NW, Portland, OR. Barkai G, Goldman ... Accessed 2/17/07. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns ...


Important Phone Numbers and Websites Group Number Phone Address Website  

E-print Network

, Chiropractic, Massage and Nutrition Counseling 1-877-335-2746 Kaiser Permanente (HMO) 102607 800-464-4000 P Specialty Health Networks (ASH Networks) discounts on Acupuncture, Chiropractic, Massage and Nutrition

Gleeson, Joseph G.


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

Federal Register 2010, 2011, 2012, 2013, 2014

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



The Four Habits Coding Scheme: Validation of an instrument to assess clinicians communication behavior  

Microsoft Academic Search

ObjectiveTo present preliminary evidence for the reliability and validity of the Four Habits Coding Scheme (4HCS), an instrument based on a teaching model used widely throughout Kaiser Permanente to improve clinicians communication skills.

Edward Krupat; Richard Frankel; Terry Stein; Julie Irish



Research Paper: Disparities in Use of a Personal Health Record in a Managed Care Organization  

Microsoft Academic Search

ObjectivePersonal health records (PHRs) can increase patient access to health care information. However, use of PHRs may be unequal by race\\/ethnicity.DesignThe authors conducted a 2-year cohort study (20052007) assessing differences in rates of registration with, a component of the Kaiser Permanente electronic health record (EHR).MeasurementsAt baseline, 1,777 2559 year old Kaiser Permanente Georgia enrollees, who had not registered with

Douglas W. Roblin; Thomas K. Houston; Jeroan J. Allison; Peter J. Joski; Edmund R. Becker



Solvability of mental health care in the Family Health Strategy: social representation of professionals and users.  


Objective To aprehend the social representations about the solvability in mental health care with users of the Family Health Strategy and professionals of family health teams and of the Center for Psychosocial Care. Method A qualitative study using semi-structured interviews for data collection, and the Alceste software for analysis. This software uses the Hierarchical Descending Classification based on the examination of lexical roots, considering the words as units and providing context in the corpus. Results The representations emerge in two opposing poles: the users require satisfaction with care and the professionals realize the need for improvement of health actions. Although the matricial support in mental health and the home visits are developed, the barriers related to investment in health, continuing education and organization of care persist. Conclusion The different representations enable improvements in customer service, solvability of care and aggregate knowledge and practices in the expanded perspective of health needs in the family, social and therapeutic context.?Objetivo Apreender as representaes sociais sobre resolubilidade do cuidado em sade mental na Estratgia Sade da Famlia de usurios e profissionais de equipes de sade da famlia e Centro de Ateno Psicossocial. Mtodo Estudo qualitativo com uso de entrevista semiestruturada para coleta das informaes e osoftware Alceste para anlise. Este software usa a Classificao Hierrquica Descendente com base no exame das razes lexicais, considerando a palavra como unidade e oferece contextualizao no corpus Resultados As representaes emergem em dois polos antagnicos: usurios referem satisfao com o atendimento e profissionais percebem a necessidade de melhoria das aes de sade. So desenvolvidos matriciamento em sade mental e visita domiciliar, mas persistem entraves relacionados ao investimento em sade, educao permanente e organizao da assistncia. Conclusin As diferentes representaes ensejam melhoria do atendimento, resolubilidade do cuidado e congregam saberes e prticas na perspectiva ampliada das necessidades de sade no contexto familiar, social e teraputico. PMID:25626506

Jorge, Maria Salete Bessa; Vasconcelos, Mardnia Gomes Ferreira; Junior, Euton Freitas de Castro; Barreto, Levi Alves; Rosa, Lianna Ramalho de Sena; de Lima, Leilson Lira



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

ERIC Educational Resources Information Center

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

Dodge, Diane Trister; Heroman, Cate


Impregnacin en polines de hbridos de lamo tomando como referencia polines impregnados de pino Preservative treatment in poles of poplar hybrids taking radiata pine poles as a reference  

Microsoft Academic Search

SUMMARY The behavior difference of poplar utility poles after impregnation was evaluated and the physical and mechanical properties of impregnated wood were characterized using wood coming from the top useful part of the log from three commercial hybrids of poplar, such as: I-214, I-488 and I-63\\/51. Radiata pine utility poles were used as a control. They were impregnated and tested



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

E-print Network

into the endcap cryostat that also houses the electromagnetic and hadronic endcap calorimeters, extending are formed by a struc- ture consisting of a copper tube, acting as the cathode, and an absorber rod acting sit one behind another inside a support tube that forms a structural part of the endcap cryostat

Krieger, Peter


Artria femoral profunda: uma opo como origem de fluxo para derivaes infrageniculares Deep femoral artery: an option as inflow site in infragenicular bypasses  

Microsoft Academic Search

Background: Deep femoral artery can be the most distal technical option as donor site in patients with critical limb ischemia presenting superficial artery occlusion and hostile groins. Objective: To retrospectively assess the deep femoral artery as an inflow site for infragenicular bypass grafts. Methods: From 2000 to 2005, 129 infragenicular bypass grafts with proximal anastomosis located in femoral arteries were

Francisco Cardoso Brochado Neto; Ivan Benaduce Casella; Marcelo Fernando Matielo; Tulia Brasil Simes; Arnaldo Rolim Ricartte; Ricardo Lacerda; Luiz Carlos Bergamo; Roberto Sacilotto


Corticoide sistmico como tratamento de primeira linha da hipertenso pulmonar secundria a sndrome POEMS* Systemic corticosteroids as first-line treatment in pulmonary hypertension associated with POEMS syndrome  

Microsoft Academic Search

The POEMS syndrome is a rare plasma cell disease. Pulmonary hypertension is an infrequent respiratory complication of this syndrome and might be associated with increased levels of various cytokines, chemokines and growth factors as part of the inflammatory phenomena that involve the physiopathology of POEMS syndrome. We present the case of a 54-year-old woman diagnosed with POEMS syndrome and pulmonary

Samia Rached; Rodrigo Abensur Athanazio; Srvulo Azevedo; Dias Jnior; Carlos Jardim; Rogrio Souza


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

E-print Network

volumen; Trejo, este volumen). La selva seca es considerada uno de los ecosiste- mas tropicales más en la Península de Yucatán (Ceballos, 1995; García, 2006; Miles et al., 2006; Trejo, este volumen (García, 2006; Trejo-Vázquez y Dirzo, 2000). En las tierras bajas del Pacifico las selvas en

Nacional Autónoma de México, Universidad


Avaliao do papel dos roedores das espcies Mus musculus e Rattus norvegicus como hospedeiros reservatrios de Leishmania infantum nos concelhos de Sesimbra e Sintra.  

E-print Network

??Dissertao de Mestrado Integrado em Medicina Veterinria A leishmaniose causada por Leishmania infantum uma doena parasitria de cariz zoontico transmitida por insectos flebotomneos, os (more)

Helhazar, Marcos Ferreira



Agrobiodiversity genetic resources conservation for the development of sustainable production systems Conservacin de recursos genticos de la agrobiodiversidad como apoyo al desarrollo de sistemas de produccin sostenibles  

Microsoft Academic Search

Human population growth and environmental changes require the availability of genetic diversity for the development of sustainable, efficient and competitive production systems. This means collection, conservation and characterization of the attributes present in the genetic resources of current important taxa and wild related, and promising species with development potential, which is magnified for a current genetic erosion. It requires complementary

Mario Lobo Arias; Clara Ins; Medina Cano



Microsoft Academic Search

Recibido para revisar agosto 23 de 2006, aceptado febrero 09 de 2007, versin final marzo 29 de 2007 RESUMEN: En este artculo se presenta un estudio experimental sobre la produccin y utilizacin del biodiesel de aceite de higuerilla. El mximo rendimiento de metilsteres en la reaccin de transesterificacin del aceite de higuerilla usado se obtiene bajo las siguientes condiciones: temperatura



Aprovechamiento de bioslidos como abonos orgnicos en pastizales ridos y semiridos Beneficial use of biosolids as organic fertilizers in arid and semiarid rangelands  

Microsoft Academic Search

Biosolids generation data in Mexico and other countries as well as actual trends of biosolids use and disposition are presented. Biosolids types and the biosolids alternatives for use and disposition are described. Data about biosolids composition, including plant nutrients and other elements with toxic potential as well as their variability are shown. Methods of biosolids application and season of application

Pedro Jurado Guerra; Miguel Luna Luna; Rodolfo Barretero Hernndez


A SURGICAL PROCEDURE USING SHEEP AS AN ANIMAL MODEL TO EVALUATE OSSEOINTEGRATION Um procedimento cirrgico utilizando a ovelha como modelo animal para avaliar ossointegrao  

Microsoft Academic Search

The aim of this paper is to describe a technical sequence of procedures, including anesthesia and surgery steps to adopt as standard surgical procedures using an animal model to evaluate the osseointegration phenomenon and perform the histological analysis after animal deaths at different healing times. In a macroscopic analysis the novel coin-shaped design of titanium implants intended to improve the

Alexandre Cunha; Renata Pedrolli Renz; Gleisse Wantowski; Rogrio Belle de Oliveira; Eduardo Blando; Roberto Hbler


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

ERIC Educational Resources Information Center

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

Giordano, Rosely



Sintomatologa depresiva asociada al trabajo como causa de incapacidad temporal en la Comunidad de Madrid Work related depression syntoms as short-term disability cause in Madrid Comunity  

Microsoft Academic Search

Objectives: To calculate the prevalence of mental disorders as cause of short-term disability in Madrid Community and to describe work-related de- pression symptoms by occupation, age and sex. Method: We conducted a descriptive observational study in Madrid Community. Patients in Short-term Disability (STD) paid by The National In- stitute of Social Security (NISS) have been studied. It have been used

Rodrguez Ortiz de Salazar; Garca Parra; Lpez Gmez



LA CAPACIDAD Y EL BIENESTAR SUBJETIVO COMO DIMENSIONES DE ESTUDIO DE LA CALIDAD DE VIDA Capability and Subjective Well-being as Quality-of-Life Study Dimensions  

Microsoft Academic Search

Quality of Life is scientifically worked out as a very extensive construct that involves various meanings but, in general, aims to the search of the explanation of good life, life that is enjoyed and satisfies the people who live it, and produces states of happiness. Thus, it is the person, in his\\/her own perception, the one who evaluates his\\/her own

Beatriz Yasuko; Arita Watanabe



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

ERIC Educational Resources Information Center

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

Ferguson, Susan; Ripley, Suzanne


The Adopt-a-Herring program as a fisheries conservation tool [El programa "adopta un s??balo" como herramienta de conservaci??n en pesquer??as  

USGS Publications Warehouse

Successful conservation depends on a scientifically literate public. We developed the adopt-a-Herring program to educate nonscientists about fisheries and watershed restoration. this interactive educational and outreach project encouraged coastal residents to be involved in local watershed restoration. In the northeastern United States, river herring (Alosa spp.) are an important component of many coastal watersheds and often are the object of conservation efforts. In order to understand river herring spawning behavior and to improve the effectiveness of restoration efforts, our research tracked these fish via radiotelemetry in the Ipswich River, Massachusetts. In our adopt-a-Herring Program, participating stakeholder organizations adopted and named individual tagged river herring and followed their movements online. We also made information available to our adopters on our larger research goals, the mission and activities of other research and management agencies, examples of human actions that adversely affect watersheds, and opportunities for proactive conservation. Research results were communicated to adopters through our project web page and end-of-the-season summary presentations. Both tools cultivated a personal interest in river herring, stimulated discussion about fisheries and watershed restoration, educated participants about the goals and methods of scientists in general, and initiated critical thinking about human activities that advance or impede sustainability.

Frank, H.J.; Mather, M.E.; Muth, R.M.; Pautzke, S.M.; Smith, J.M.; Finn, J.T.



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

ERIC Educational Resources Information Center

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

Stamp, Isla M.



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

E-print Network

. Ruth (eds.) and James W. Lowry (intro. and trans.). Hans Landis: Swiss Anabaptist Martyr in Seventeenth?Century Documents. Millersburg: Ohio Amish Library, 2003. xi + 233 pp. + 18 illus. $14.95. Review by NILES S. ILLICH, TEXAS A&M UNIVERSITY.... In 1614 Hans Landis, a leader of the Swiss Anabaptists, be- came a martyr. His execution by the Swiss catalyzed a Landis mythology, which as the author indicates had at least two general schools: ?Hans Landis as a civilly disobedient leader of a trouble...

William J. Scheick



Abordagem do tema hipertenso arterial e suas relaes com o tabagismo e a obesidade como forma de avaliao da aquisio e socializao de conhecimentos em Feiras de Cincias  

Microsoft Academic Search

O presente trabalho apresenta a experincia vivenciada por um professor do Ensino Fundamental de Escola Pblica do Paran, na orientao de uma equipe de alunos de 8 srie, em 2008, visando o desenvolvimento de trabalhos em Feiras de Cincias. A temtica da equipe enfoca a hipertenso arterial e seus fatores de risco, tabagismo e obesidade, no municpio de Floresta. Escolheu-se

Eduardo de Almeida Grenier; Celso Ivam Conegero



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

ERIC Educational Resources Information Center

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

Melendez Alicea, Juan



Mapeamento de reas Cafeeiras em imagens de Sensores Orbitais: estudo de caso em Aguanil, Boa Esperana, Campo Belo e Cristais-MG como suporte a estudos regionais  

Microsoft Academic Search

Coffee crop, an important economic and social activity to Brazil, is an agrobusiness segment that has not updated information about the productive profile. The present work comes to add in the sense to develop and\\/or adequate fundamental methods in geotechnologies that may significantly contribute to the study of the coffee crop in Minas Gerais State, allowing to diagnose the geographic

Marco Aurlio Barros


Un acercamiento a la aplicacin de la teora de las inteligencias mltiples (IM) en la clase de ingls como idioma extranjero en el contexto universitario cubano  

Microsoft Academic Search

El desarrollo de habilidades relacionadas con el discurso oral es una de las prioridades de los estudiantes de lenguas extranjeras. La mayora de las veces, la destreza en la comunicacin verbal es lo que mide el conocimiento del alumno de la lengua extranjera (LE) o la segunda lengua (L2) que se est aprendiendo. Hay muchas razones por lo que las

Daniel Cima de Mesa; Adrian Abreus Gonzlez



Ttulo: O Comportamento dos Principais ndices de Preos da Economia Brasileira no Perodo 1999-2005: evidncias da impropriedade do IGP como \\  

Microsoft Academic Search

The analysis presented in this article about the performance of the prices indexes of the Brazilian economy corroborates the hypothesis that the General Index of Price (IGP\\/FGV-RJ), considering its all modalities, became a biased index of Brazilian prices. In the period 1999-2005, the prices changes measured by the IGP were well above those accused by the other indexes of prices

Jos Roberto Ribeiro; Mrio Ferreira Presser


Therapeutic play as a pain relief strategy for children with cancer O brinquedo teraputico como estratgia de alvio da dor em crianas com cncer  

Microsoft Academic Search

Objective: To evaluate pain characteristics and alterations, demonstrated by children hospitalized with cancer, before and after therapeutic play. Methods: A descriptive field research using a quantitative approach conducted at the Pediatric Cancer Clinic of a public hospital, in the city of Sao Paulo. The data included a sample of 16 children aged 3-9 years using analgesic medication. Results: Among the

Michelle Batista; Fabiane de Amorim Almeida


Lista de Exerccios -Polarizao 1. Como podemos observar, as ondas de rdio so quase sempre polarizadas e a luz visvel quase  

E-print Network

. Halliday, R. Resnick e J. Walker, Fundamentos de Física, 4a ed., cap. 38. Probl. 50) (Resposta: 35,3° ) *2, qual é o valor de ? (D. Halliday, R. Resnick e J. Walker, Fundamentos de Física, 4a ed., cap. 38. Probl mais que 60% da intensidade inicial? (Halliday, R. Resnick e J. Walker, Fundamentos de Física, 4a ed

dos Santos, C.A.



Microsoft Academic Search

This paper show a method of classification of the different characteristics of the terrestrial surface to be able to determine the electric conductivity of the land from images obtained by remote sensing.

Ral Ruiz Meza; Alonso S. Monroy; Pacheco J. Ismael; Montoya Tena


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

ERIC Educational Resources Information Center

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

Coya, Liliam de Barbosa; Perez-Coffie, Jorge



Potential misuse of avian density as a conservation metric [Potencial Mal Uso de la Densidad de Aves como un Indicador de Conservaci??n  

USGS Publications Warehouse

Effective conservation metrics are needed to evaluate the success of management in a rapidly changing world. Reproductive rates and densities of breeding birds (as a surrogate for reproductive rate) have been used to indicate the quality of avian breeding habitat, but the underlying assumptions of these metrics rarely have been examined. When birds are attracted to breeding areas in part by the presence of conspecifics and when breeding in groups influences predation rates, the effectiveness of density and reproductive rate as indicators of habitat quality is reduced. It is beneficial to clearly distinguish between individual- and population-level processes when evaluating habitat quality. We use the term reproductive rate to refer to both levels and further distinguish among levels by using the terms per capita fecundity (number of female offspring per female per year, individual level) and population growth rate (the product of density and per capita fecundity, population level). We predicted how density and reproductive rate interact over time under density-independent and density-dependent scenarios, assuming the ideal free distribution model of how birds settle in breeding habitats. We predicted population density of small populations would be correlated positively with both per capita fecundity and population growth rate due to the Allee effect. For populations in the density-dependent growth phase, we predicted no relation between density and per capita fecundity (because individuals in all patches will equilibrate to the same success rate) and a positive relation between density and population growth rate. Several ecological theories collectively suggest that positive correlations between density and per capita fecundity would be difficult to detect. We constructed a decision tree to guide interpretation of positive, neutral, nonlinear, and negative relations between density and reproductive rates at individual and population levels. ?? 2010 Society for Conservation Biology.

Skagen, S.K.; Yackel Adams, A.A.



Habitus furibundo en el gueto estadounidense1  

PubMed Central

Resumen Durante cinco aos, un torbellino cotidiano de tiroteos, apualamientos y asaltos afect a la venta de drogas al aire libre en el vecindario puertorriqueo de Filadelfia, donde residamos y conducamos nuestro trabajo de campo. La industria de los narcticos ha venido a llenar el vaco que dej la desindustrializacin, convirtiendo al antiguo distrito fabril de la ciudad en un mercado de narcticos a cielo abierto que emplea en sus niveles ms bajos a jvenes puertorriqueos y cuyos clientes son principalmente heroinmanos blancos de bajos recursos. La capacidad para movilizar la furia asegura el xito en la economa de las drogas, garantiza proteccin en las crceles y le provee un ingreso mnimo a una poblacin de bajos recursos estigmatizada cuyos miembros frecuentemente reciben diagnsticos mdicos de discapacidad cognitiva. Muchos residentes buscan alianzas en redes sociales que los comprometen a participar en intercambios solidarios de violencia auxiliar. Una dinmica de acumulacin primitiva corporizada mata, hiere, discapacita o encarcela a la mayora de estos empleados de bajo nivel y a sus clientes. Los inflados mrgenes de ganancia alrededor de esta dinmica dependen de la violencia y la coercin. Un habitus furibundo impulsa a los vendedores callejeros a defender violentamente el micro monopolio de poder de sus jefes en la economa subterrnea como si fuese un asunto de diversin. Estos miembros de los niveles ms bajos de la industria del narcotrfico se apresuran a fraguar transacciones comerciales en ausencia de un marco legal en un ambiente de escasez que sin embargo se ve inundado por enormes flujos de dinero, drogas adictivas y armas automticas. Tras las drsticas reformas a los programas de seguridad social, la mano izquierda del Estado, en la forma de los servicios sociales, intenta prolongar los subsidios para individuos vulnerables diagnosticndolos como discapacitados cognitivos permanentes necesitados de fuerte medicacin farmacutica. La mejor manera de asegurar la continuidad de este frgil subsidio resulta ser los estallidos peridicos de violencia autoinfligida. Simultneamente, con la anuencia de la mano derecha del Estado, en las crceles violentas y hacinadas marcadas por formas hostiles de supervisin, la furia se convierte en una valiosa estrategia de proteccin fsica para los internos. En resumen, la violencia expresiva se convierte en una base prctica para el sostenimiento econmico y para forjar el sentido de dignidad entre hombres y mujeres. PMID:24532976

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




Microsoft Academic Search

La relatividad del comportamiento celular y su expresin molecular, obedecen a la obligada interaccin con leyes qumicas y fsicas, en un modelo biolgico multifactorial- multivariable. Por esta razn para poder rastrear in vivo el desarrollo pre-neoplasico y la aparicin de las primeras clulas neoplasicas en mama, se ha diseado la prueba inteligente PDNR-CA1 capaz de cuantificar el nivel de riesgo

Hctor Julio; Daz Vargas


Integrated Personal Health Records: Transformative Tools for Consumer-Centric Care  

Microsoft Academic Search

BACKGROUND: Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this

Don E. Detmer; Meryl Bloomrosen; Brian Raymond; Paul Tang



BE A FLU FIGHTER! 2014 Seasonal Flu Shot Clinics  

E-print Network

BE A FLU FIGHTER! 2014 Seasonal Flu Shot Clinics Have Health Coverage Through Mason? Free Seasonal Flu Shots are Part of Your Wellness Benefit. For faculty and staff who are enrolled in COVA Care, COVA HealthAware, COVA HDHP, and Kaiser Permanente, seasonal flu shots are part of your wellness benefit


Neonatal Hyperbilirubinemia and Risk of Autism Spectrum Disorders  

Microsoft Academic Search

ABSTRACT. Objective. To investigate the association between neonatal hyperbilirubinemia and autism spec- trum disorders (ASD). Methods. We conducted a large case-control study nested within the cohort of singleton term infants born between 1995 and 1998 at a northern California Kaiser Permanente hospital. Case subjects (n,338) were chil- dren with an ASD diagnosis recorded in Kaiser Perma- nente outpatient databases; control

Lisa A. Croen; Cathleen K. Yoshida; Roxana Odouli; Thomas B. Newman



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

E-print Network

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

Hearst, Marti


Rcord de donaciones en la recogida de alimentos de la UPUA Alicante, 9 de marzo de 2012  

E-print Network

Récord de donaciones en la recogida de alimentos de la UPUA Alicante, 9 de marzo de 2012 En la campaña de recogida de alimentos que los alumnos voluntarios de la Universidad Permanente de la de alimentos, un total de 550 unidades de productos, en una iniciativa solidaria que este grupo de

Escolano, Francisco


Coverage comparable to the Tufts University Student Health Insurance Plan means: For all students: The guidelines for Comparable Coverage have been revised as of January  

E-print Network

. The insurance carrier, itself, must be U.S.-based (unless the student is studying outside the United States). 2, and mental health services; and be reasonably accessible to the student in the area where the student attends Program or the Health Safety Net, Kaiser Permanente Insurance and out of state Medicaid programs. 3. Any

Dennett, Daniel


Mud Nest of Hornero  

USGS Multimedia Gallery

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


Situation economique et sociale des immigrants au Canada : recherche et elaboration de donnees a Statistique Canada  

Microsoft Academic Search

Au cours des 25 dernieres annees, on a assiste a une degradation plus ou moins permanente de la situation economique des nouveaux immigrants au Canada. Toutefois, la situation economique des Canadiens de deuxieme generation (les enfants des immigrants) est plus positive. De plus, apres quatre annees passees au Canada et en depit de difficultes economiques, la plupart des immigrants qui

Garnett Picot




E-print Network

visto permanente ou visto temporário de estudante obtido perante o Consulado do Brasil em seu País. 1 naturalidade) e do CPF (para brasileiros ou estrangeiros com visto de permanência no país). 2.4.4Curriculum

Souza, Max O.



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


Compito di Teoria dei sistemi 1) Si consideri il sistema a tempo discreto  

E-print Network

Compito di Teoria dei sistemi 1) Si consideri il sistema a tempo discreto x(t + 1) = -2 3 0 -0.5 x permanente 1 #12;Compito di Teoria dei sistemi 1. Studiare al variare del parametro k la stabilit`a del della struttura della risposta. 2 #12;Compito di Teoria dei Sistemi 1. E' dato il sistema lineare

Monaco, Salvatore



Microsoft Academic Search

El reto que constituye la capacitacin se complejiza en un mundo globalizado donde la actualizacin permanente de los recursos humanos significa ser competitivos en el sector del turismo. Para que este sector pueda cumplir su encargo social y ser realmente la locomotora de la economa cubana, sus instituciones en este caso Formatur y las Escuelas de Hotelera y Turismo- forman

Carlos Alberto Larrinaga Caizares



for Faculty Virginia Tech Department of Human Resources | 300 Turner Street nW, Suite 2300 |  

E-print Network

the premium. The state-wide health plan options are COVA Care Basic with buy-up options, COVA HealthAware with buy-up options, COVA High Deductible Health Plan, Kaiser Permanente HMO, and TRICARE Supplement that must be satisfied before pre-existing conditions are covered. COVA Care is administered by Anthem Blue

Buehrer, R. Michael


LA UA EN CIFRAS Evolucin series histricas: Alumnado  

E-print Network

.064 Universidad Permanente 811 509 Alumnos enviados Programa Movilidad* Mujeres Hombres Total 2.089 3.224 ERASMUS 124 33 NO EUROPEOS 5 1 SENECA 4 4 Alumnos acogidos Programa Movilidad* Mujeres Hombres Total 978 1 programa de movilidad hacen referencia al curso 2009-10 #12;

Escolano, Francisco


LA UA EN CIFRAS Evolucin series histricas: Alumnado  

E-print Network

.086 Universidad Permanente 830 575 Alumnos enviados Programa Movilidad* Mujeres Hombres Total 2.132 939 ERASMUS 362 220 NO EUROPEOS 27 27 SENECA 53 46 Alumnos acogidos Programa Movilidad* Mujeres Hombres Total 845 16 16 *Los datos referidos al programa de movilidad hacen referencia al curso 2010-11 Mujeres Hombres

Escolano, Francisco



E-print Network

of these were year-round residents of the area. Dark-eyed juncos (Junco hyemalis) were the most numerous permanentes del a´rea. Juncos ojo oscuro (Junco hyemalis) fueron los ma´s numerosos, comprendiendo 23% de


Vennetier et al. 2011. Adaptation phnologique P. Alep changement clim. Fort Mditerranenne (32)2 151-167 Adaptation phnologique du pin d'Alep au changement climatique  

E-print Network

dispositif de Font- Blanche comprend une zone d'exclusion permanente de 30% des précipitations, une zone irriguée au printemps et en automne et deux zones témoins, pour simuler les effets du changement climatique ou de champignons en hiver. L'exclusion de pluie a diminué le nombre annuel de cycles de croissance

Boyer, Edmond


In: Proceedings of the International Conference on Disability, Virtual Reality and Associated Technology 2002 (ICDVRAT2000), Vesaprem, Hungary, Sept.17-19, 2002.  

E-print Network

processes in children with ADHD within a HMD virtual classroom and 2. Memory processes in persons with TBI of Psychology 180 North Oakland Ave., Pasadena, CA. 91101, USA 4 Kessler Medical Rehabilitation Research Permanente Medical Group, Dept of Research and Evaluation, 100 South Los Robles Ave., Pasadena, CA. 91101

Shahabi, Cyrus



E-print Network

Claudeville 9165 Secretaria Sra. Zaiduby Parra 9165 Prog. Educ. Permanente Lic. Yulent Bravo 9172. Melisa Martínez 9339 Área Administ. de Sistemas T.S.U. Miguel Laya 9340 Área Procesos Técnicos Sr. Manuel

Vásquez, Carlos


Universit d'Avignon Public concern  

E-print Network Formation Continue et Education Permanente 1, avenue de Saint Jean 84000 AVIGNON Tél : 04 32 74 32 20 - fax protection Politiques publiques · Cinquième risque, autonomie dépen- dance et handicap · L'action des

Naud Frédéric



E-print Network

17TH ANNUAL ROBERT F.E. STIER MEMORIAL LECTURES IN MEDICINE Keynote RICHARD A. DEYO, MD, MPH Kaiser Permanente Professor of Evidence-Based Family Medicine Department of Medicine, Dept. of Public Health & Preventive Medicine, Oregon Health and Science University Thursday, February 21, 2013 at 4:00 PM Free Public

Collins, Gary S.


Centre National pour la Numrisation de Sources Visuelles  

E-print Network

les bases de données de l'archive. « Stockage ». Assurer les fonctions et services de stockage permanente. Mettre en oeuvre une politique inter-établissements en matière de stockage de grande capacité (réseaux de stockage, miroirs). CENTRE NATIONAL DE LA RECHERCHE SCIENTIFIQUE #12;

Boyer, Edmond


Incidence of Parkinson's Disease: Variation by Age, Gender, and Race\\/Ethnicity  

Microsoft Academic Search

The goal of this study was to estimate the incidence of Parkinson's disease by age, gender, and ethnicity. Newly diagnosed Parkinson's disease cases in 1994-1995 were identified among members of the Kaiser Permanente Medical Care Program of Northern California, a large health maintenance organization. Each case met modified standardized criteria\\/Hughes diagnostic criteria as applied by a movement disorder specialist. Incidence

Stephen K. Van Den Eeden; Caroline M. Tanner; Allan L. Bernstein; Robin D. Fross; Amethyst Leimpeter; Daniel A. Bloch; Lorene M. Nelson



Effect of Reproductive Factors and Postmenopausal Hormone Use on the Risk of Amyotrophic Lateral Sclerosis  

Microsoft Academic Search

Objective: To examine the associations of reproductive factors and postmenopausal hormone use with the risk of amyotrophic lateral sclerosis (ALS) among women. Methods: This case-control study was conducted within the Kaiser Permanente Medical Care Program (KPMCP) of Northern California during the years 19962000. Among the 193 postmenopausal women, 62 were incident ALS cases and 131 were controls randomly selected from

Rita A. Popat; Stephen K. Van Den Eeden; Caroline M. Tanner; Allan L. Bernstein; Daniel A. Bloch; Amethyst Leimpeter; Valerie McGuire; Lorene M. Nelson



Universit Paris Descartes Laboratoire MAP 5  

E-print Network

Spécialité : STATISTIQUE Présentée par Adriana CUCU GOGONEL Statistical Post-Processing Methods And Their Implementation On The Ensemble Prediction Systems For Forecasting Temperature In The Use Of The French Electric pour sa bonne humeur permanente et pour ses chansonnettes, Nicolas pour les discussions sport et pas

Paris-Sud XI, Université de


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.



Randomized Controlled Trial of a Low Animal Protein, High Fiber Diet in the Prevention of Recurrent Calcium Oxalate Kidney Stones  

Microsoft Academic Search

Low protein diets are commonly prescribed for patients with idiopathic calcium nephrolithiasis, who account for >80% of new diagnoses of kidney stones. This dietary advice is supported by metabolic studies and epidemiologic observational studies but has not been evaluated in a controlled trial. Using 1983-1985 data from three Northern California Kaiser Permanente Medical Centers, the authors randomly assigned 99 persons

Robert A. Hiatt; Bruce Ettinger; Bette Caan; Charles P. Quesenberry; Debra Duncan; John T. Citron


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


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



Diffraction Theory of Point Processes: Systems with Clumping and Repulsion  

E-print Network

We discuss several examples of point processes (all taken from Hough, Krishnapur, Peres, Vir\\'ag (2009)) for which the autocorrelation and diffraction measures can be calculated explicitly. These include certain classes of determinantal and permanental point processes, as well as an isometry-invariant point process that arises as the zero set of a Gaussian random analytic function.

Michael Baake; Holger Ksters; Robert V. Moody



DISPOSIZIONE N. 138/2014 PROT. N. 0002375 DEL 16/01/2014  

E-print Network

DISPOSIZIONE N. 138/2014 PROT. N. 0002375 DEL 16/01/2014 Programma "LEONARDO DA VINCI" Progetto'Apprendimento Permanente ­ Programma settoriale "Leonardo da Vinci", Sapienza Università di Roma partecipa al progetto di CONTRIBUTO LEONARDO DA VINCI (LdV): Il contributo LdV rappresenta un rimborso delle spese di viaggio

Guidoni, Leonardo



E-print Network

Programma "LEONARDO DA VINCI" Progetto UNIPHARMA-GRADUATES 9 Bando di Concorso 82 contributi per Programma dell'Unione Europea per l'Apprendimento Permanente ­ Programma settoriale "Leonardo da Vinci CONTRIBUTO LEONARDO DA VINCI (LdV): Il contributo LdV rappresenta un rimborso delle spese di viaggio

Guidoni, Leonardo


EuroGP'2001 Julian Miller, Marco Tomassini, Pier Luca Lanzi, Conor Ryan, Andrea G. B. Tettamanzi and W.B. Langdon editors, pages 313--324 Lake Como, Italy,  

E-print Network

kinematic mapping, from target 3­D points (via pairs of stereo video images) to a vector of arm controller system also demands high performance of both mechanical com­ ponents and control software. The many control problems is approximating the inverse kine­ matics of a complex robot limb such as the arm

Fernandez, Thomas


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



Evaluacin 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


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

ERIC Educational Resources Information Center

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

Valle, Victor M.


UTILIZACIN DE ACEITE ESENCIAL DE LEMONGRASS (Cymbopogon citratus Stapf) COMO REPELENTE DE Diuraphis noxia KURDJ. (HEMIPTERA: APHIDIDAE) EN TRIGO. Use of lemongrass (Cymbopogon citratus Stapf) essential oil as a repellent of Diuraphis noxia Kurdj. (Hemiptera: Aphididae) in wheat  

Microsoft Academic Search

A B S T R A C T The use of natural products such as essential oils and plant extracts is an alternative for integrated pest management (IPM). The objective of this work was to evaluate the repellent effect of lemongrass (Cymbopogon citratus Stapf) essential oil on the Russian wheat aphid (Diuraphis noxia Kurdj.) on wheat (Triticum aestivum L.) plants.

Mnica Ricci; Susana Padn; Jorge Ringuelet; Andrea Kahan


Evidncia do co como reservatrio da leptospirose humana: isolamento de um sorovar, caracterizao molecular e utilizao em inqurito sorolgico Evidence of dog as a reservoir for human leptospirosis: a serovar isolation, molecular characterization and its use in a serological survey  

Microsoft Academic Search

Canine leptospirosis has been known as Stuttgart disease since 1898, and dogs are considered to be the second principal source of infection in man. The isolation of a pathogenic serovar from dog urine that was diagnosed clinically and laboratorial as having leptospirosis and its utilization to test serological samples of human and canine cases of leptospirosis, has demonstrated its importance

Claudiomar Soares Brod; Jos Antonio; Guimares Aleixo; Sandra Denise Dorneles; Cludia Pinho; Hartleben Fernandes; Jos Lus Rodrigues Teixeira; Odir Antnio Dellagostin


Sentana Gadea, Eloy Metodologas autrquicas aplicadas al relanzamiento de las polticas de desarrollo local Silvestre Francs, Eva M La Obra Social de Caixa Ontinyent como dinamizadora del desarrollo local en la comarca de laVall  

E-print Network

Sentana Gadea, Eloy Metodologías autárquicas aplicadas al relanzamiento de las políticas de. Yago Martínez, Laura, Gómez Javaloyes, M.; Gisbert, E. y Beltrán S. eGruyere, otra forma de generar Huertos Urbanos: buena praxis en sostenibilidad urbana Martínez Puche, A. et alii La

Escolano, Francisco


Systemic corticosteroids as first-line treatment in pulmonary hypertension associated with the POEMS syndrome* Corticoide sistmico como tratamento de primeira linha da hipertenso pulmonar secundria a sndrome POEMS  

Microsoft Academic Search

The POEMS syndrome is a rare plasma cell disease. Pulmonary hypertension is an infrequent respiratory complication of this syndrome and might be associated with increased levels of various cytokines, chemokines and growth factors as part of the inflammatory phenomena that involve the physiopathology of POEMS syndrome. We present the case of a 54-year-old woman diagnosed with POEMS syndrome and pulmonary

Samia Rached; Rodrigo Abensur Athanazio; Srvulo Azevedo; Dias Jnior; Carlos Jardim; Rogrio Souza


CT findings in Petersen's hernia as a complication of bariatric surgery with a Roux-en-Y gastric bypass Achados tomogrficos na hrnia de Petersen como complicao de cirurgia baritrica com bypass gstrico em Y de Roux  

Microsoft Academic Search

Objectives: To describe tomographic findings in Petersen's hernia associated with laparoscopic Roux-en-Y gastric bypass surgery. Methods: Two radiologists, experts in abdominal radiology, independently and retrospectively reviewed four cases of Petersen's hernia confirmed surgically in three patients, between March 2007 and July 2008, who had undergone laparoscopic Roux-en-Y gastric bypass surgery with an antecolic anastomosis for treating morbid obesity. The main

Mauricio lvares; Salum Ximenes; Ronaldo Hueb Baroni; Ronald Trindade; Rodrigo Abdala; Marcelo de Castro; Jorge Racy; Alberto Goldenberg; Thomas Szego; Almino Cardoso Ramos; Marcelo Buarque de Gusmo Funari


La produccin familiar como alternativa de un desarrollo sostenible para la Amazona; Lecciones aprendidas de iniciativas de uso forestal por productores familiares en la Amazona boliviana, brasilera, ecuatoriana y peruana  

Microsoft Academic Search

Abstract: Between 2005 and 2009, the EU-financed project ForLive set out to analyse promising local forest management initiatives in the Amazon Basin in four countries: Ecuador, Bolivia, Brazil, and Peru. Researchers aimed to identify locally viable practices that benefit livelihoods and ecological stabilisation of landscapes, as well as to define ways to promote these practices as a basis for sound

B. Pokorny; J. Godar; L. Hoch; J. Johnson; Koning de J; G. Medina; R. Steinbrenner; V. Vos; J. Weigelt



El subsoleo como prctica de rehabilitacin de praderas de zacate buffel en condicin regular en la regin central de Sonora, Mxico Ripping as a rehabilitation practice on buffelgrass pastures in regular condition at central Sonora, Mxico  

Microsoft Academic Search

This study was conducted to evaluate the response of buffelgrass (Cenchrus ciliaris (L.) Link) and grama china (Cathestecum brevifolium Swallen) to the application of ripping as a compaction reduction practice to rehabilitate old buffelgrass stands in regular condition at central Sonora, Mexico. Ripping was conducted by triplicate on 400 m-2 plots in June of 1995 by using a three-blade ripper.

Fernando A. Ibarra Flores; Martha H. Martn Rivera; Felipe Ramrez Moreno


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


Proceedings of the 2001 IEEE/ASME International Conference on Advanced Intelligent Mechatronics Systems (AIM 2001), 811 July 2001, Como, Italy, pp. 899-904. Modeling, Design and Control of a Portable  

E-print Network

Proceedings of the 2001 IEEE/ASME International Conference on Advanced Intelligent Mechatronics. Next, two novel methods of stabilization are presented. The design-based method reduces the instability and is cost effective. The control-based method eliminates instability and vibrations and is associated

Papadopoulos, Evangelos


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

ERIC Educational Resources Information Center

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

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


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



Microsoft Academic Search

It was carried out a prospective study of cases and controls with 90 pregnant workers (10% of low birth weight) from 19 to 25 years old, with the objective of evaluating the level of psychosocial work stress according to the Control-Demand and Effort Rewards Imbal- ance models, and to determine associations between the psychoso- cial work stress and its consequences

Mara de Lourdes; Marrero Santos


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.



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

ERIC Educational Resources Information Center

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

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


Care coordination in managed care. Creating a quality continuum for high risk elderly patients.  


The portion of the American population 65 years and older is growing rapidly, and the group 85 years and older is the largest growing segment of our population. The country's largest health maintenance organization, Kaiser Permanente, in Fontana, California, experienced a 9% growth in its membership between 1996 and 1997. Following the Kaiser national Model of Care recommendations, Fontana's Kaiser Permanente created their department of Extended Care Services and implemented programs that coordinated patient care across the continuum to meet the needs of its members who were 65 years and older. The programs included new member screening and orientation, telephonic care coordination, and a volunteer-based care call program. They also developed a medical management model that included a consultative geriatric assessment clinic and a primary care clinic as well as provision of team-based care to members residing in skilled nursing facilities. PMID:9856064

Bailey, M L



Leveraging geographic information systems in an integrated health care delivery organization.  


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. PMID:24694317

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



Physician Involvement in Disease Management as Part of the CCM  

PubMed Central

Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I. PMID:17288075

Wallace, Paul J.



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



Development of disability in chronic obstructive pulmonary disease: beyond lung function  

Microsoft Academic Search

BackgroundCOPD is a major cause of disability, but little is known about how disability develops in this condition.MethodsThe authors analysed data from the Function, Living, Outcomes and Work (FLOW) Study which enrolled 1202 Kaiser Permanente Northern California members with COPD at baseline and re-evaluated 1051 subjects at 2-year follow-up. The authors tested the specific hypothesis that the development of specific

Mark D Eisner; Carlos Iribarren; Paul D Blanc; Edward H Yelin; Lynn Ackerson; Nancy Byl; Theodore A Omachi; Stephen Sidney; Patricia P Katz



CRCHD - Spotlights

CRCHD grantee Gloria D. Coronado, Ph.D., was awarded a grant from the Health Care Systems (HCS) Research Collaboratory on September 25th for her research examining strategies to improve colorectal cancer screening rates among racially and ethnically diverse, and other underserved populations. Coronado, a Mexican American epidemiologist, and one of only eight recipients of the award, is a Merwyn "Mitch" R. Greenlick Endowed Senior Investigator in Health Disparities Research at the Kaiser Permanente Center for Health Research, in Portland, Oregon.



E-print Network

visto permanente ou visto temporário de estudante obtido perante o Consulado do Brasil em seu País. 2.4.4 Fotocópia (em duas vias) do documento oficial de identidade e do CPF (para brasileiros ou estrangeiros com Recolhimento da União - GRU, no Banco do Brasil, em favor da Universidade Federal Fluminense no valor de R$ 60

Souza, Max O.



E-print Network

inscrever-se candidatos residentes no Brasil ou no exterior. Os candidatos com residência permanente Documento de Identidade; Cópia do CPF (Passaporte no caso de residente no exterior); Título de Eleitor com recolhimento da taxa de inscrição no valor de R$ 70,00 (setenta reais) no Banco do Brasil (001), Agência 1607

Lucero, Jorge Carlos


ORDEM DE SERVIO 001/2010-GR Dispe sobre os procedimentos do Edital n 10, de 15  

E-print Network

(GRU) e efetuar o pagamento em dinheiro no Banco do Brasil. Art.4º Documentação exigida: §1º. Cópia da carteira de identidade e do CPF, para brasileiros; §2º. Se estrangeiro, carteira permanente de estrangeiro histórico escolar e do certificado de conclusão do ensino médio, se o curso foi realizado no Brasil; §7º

Paraná, Universidade Federal do



E-print Network

permanente ou visto temporário de estudante obtido perante o Consulado do Brasil em seu País. Exige-se do documento oficial de Identidade e do CPF (para brasileiros ou estrangeiros com visto de permanência no país Recolhimento da União - GRU, no Banco do Brasil, em favor da Universidade Federal Fluminense no valor de R$ 150

Souza, Max O.


Vice-Reitoria Acadmica Programa de Ps Graduao e Pesquisa  

E-print Network

: Nacionalidade: País de Nascimento: Carteira de Identidade: ?rgão Expedidor: D A D O S P E S S O A I S CPF: E Celular PARA ESTRANGEIROS N?O RESIDENTES PERMANENTES NO BRASIL Tipo de Visto** Data de Validade C?DIGOS Ministério do Exército 9 ­ OAB Ordem dos Advogados do Brasil 10 ­ POF Polícia Federal 11 ­ POM Polícia



E-print Network

visto permanente ou visto temporário de estudante obtido perante o Consulado do Brasil em seu País grau. 2.4.3. Histórico escolar. 2.4.4. Fotocópia do documento oficial de identidade e do CPF (para de Guia de Recolhimento da União - GRU, no Banco do Brasil, em favor da Universidade Federal

Souza, Max O.



E-print Network

estrangeiro deverá ter visto permanente ou visto temporário de estudante obtido perante o Consulado do Brasil) e do CPF (para brasileiros ou estrangeiros com visto de permanência no país). 2.4.4 Curriculum vitae através de Guia de Recolhimento da União - GRU, no Banco do Brasil, em favor da Universidade Federal

Souza, Max O.


Universidade de Braslia Instituto de Psicologia  

E-print Network 2. DO N?MERO DE VAGAS 2.1 O número de vagas oferecidas para candidatos residentes no Brasil é: 2 identificado com o nome do processo ­ Edital 02/2013- PGPDS, nome completo e número do CPF, a documentação residentes no Brasil ou no Exterior. Os candidatos com residência permanente no exterior têm número de vagas

Maier, Rudolf Richard


Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer  

Microsoft Academic Search

Despite the benefit of adjuvant hormonal therapy (HT) on mortality among women with breast cancer (BC), many women are non-adherent\\u000a with its use. We investigated the effects of early discontinuation and non-adherence to HT on mortality in women enrolled\\u000a in Kaiser Permanente of Northern California (KPNC). We identified women diagnosed with hormone-sensitive stage IIII BC, 19962007,\\u000a and used automated pharmacy

Dawn L. Hershman; Theresa Shao; Lawrence H. Kushi; Donna Buono; Wei Yann Tsai; Louis Fehrenbacher; Marilyn Kwan; Scarlett Lin Gomez; Alfred I. Neugut



El CELCIT en la formacin teatral latinoamericana  

E-print Network

prcticamente todos los latinoamericanos, EEUU, y Espaa), tiene mayor o menor dinamismo y peso, segn el espritu y accin de los responsables en cada pas. As Venezuela, sitio de nacimiento e irradiacin, donde con altibajos y perodos de indiferencia..., alternados con los de apoyo, el Estado contribuye activamente al sostenimiento de la institucin, lo mismo que en Espaa; y Argentina, donde el grupo responsable ha trabajado con un empuje permanente, constituyen hoy un eje triangular sobre el que reposa...

Gené , Juan Carlos



Wheres the High-Grade Cervical Neoplasia? The Importance of Minimally Abnormal Papanicolaou Diagnoses  

Microsoft Academic Search

%Objective: To characterize the relative contributions of the different abnormal Papanicolaou smear cytologic diagnoses in the Bethesda System to the subsequent histologic diagnosis of high-grade cervical neoplasia.Methods: A total of 46,009 nonpregnant female members of the Kaiser Permanente Health Plan, Northern California Region, were studied prospectively. The main outcome measures included routine Papanicolaou smear diagnoses and subsequent histologic diagnosis of

Walter K. Kinney; M. Michele Manos; Leo B. Hurley; Janice E. Ransley



A Conversation on the Future of Health Care: Integrating Lifestyle MedicinePart 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. PMID:24694319

Sorensen, Herbert J



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



Investigao dos efeitos de substncias liberadas por materiais utilizados no tratamento da Hipersensibilidade Dentinria (Gluma e Biovidro), associados ou no laser fototerapia, na proliferao e diferenciao de clulas mesenquimais de polpa dentria humana.  

E-print Network

??A incidncia da hipersensibilidade dentinria (HD) tem aumentado. Agentes dessensibilizantes como o Gluma Desensitizer (Heraeus), ou os Biovidros, bem como tratamentos considerados bioestimuladores como a (more)

Talita Christine Camilo Lopez



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. Rsum Les "prlvements" sont constitus par l'augmentation de la recharge et par la diminution de l'coulement qui se produit lorsqu'un pompage est impos un systme aquifre qui tait auparavant dans un tat proche de l'quilibre dynamique. Les modles rgionaux de nappe sont en gnral utiliss pour calculer les prlvements dans une procdure deux tapes. Une solution en rgime permanent donne la configuration pizomtrique initiale, un jeu de conditions aux limites pour la rgion modlise et les donnes de base pour le calcul des prlvements. Les solutions transitoires donnent les modifications globales des conditions aux limites. Lorsque des variations saisonnires sont produites en sortie du modle, le recours une pizomtrie initiale unique et un seul jeu de donnes de conditions aux limites conduit un mauvais calcul des prlvements. Il faut alors utiliser une condition de recharge initiale pour chaque saison. Cette approche peut tre ralise en dterminant des solutions permanentes priodiques, variantes au cours des saisons, mais se rptant d'anne en anne. Un modle de nappe rgional, prcdemment mis au point pour une partie du bassin de la rivire San Pedro (Arizona, tats-Unis), a t modifi pour illustrer l'effet de conditions initiales diffrentes sur des solutions transitoires et sur le calcul des prlvements. Resumen Se define como "captura" al aumento de recarga y descenso de descarga que tiene lugar cuando se impone un bombeo en un acufero en estado de equilibrio dinmico. Se suelen utilizar modelos regionales de agua subterrnea para calcular la captura en un procedimiento que consta de dos etapas. Una solucin en rgimen estacionario proporciona la distribucin inicial de niveles piezomtricos, los flujos a travs de los contornos de la regin modelada y el punto de partida para el clculo de la captura. Las soluciones transitorias proporcionan los cambios en los flujos a travs de los contornos. La diferencia entre las soluciones estacionaria y transitoria da el valor de la captura. Cuando los cambios estacionales son importantes, la utilizacin de un nico estado inicial de niveles y de flujos en los contornos da lugar a errores en el clculo de la captura. En este caso debe usarse una condicin inicial para cada una de las estaciones. Esto se puede conseguir obteniendo soluciones peridicas estacionarias, que varen a lo largo de las estaciones, pero que se repitan ao a ao. Un modelo regional desarrollado previamente para el estudio de una parte de la cuenca del Ro San Pedro, en Arizona (EE.UU.) se modific para ilustrar el efecto que las distintas condiciones iniciales tienen en el clculo de la captura.

Maddock, Thomas, III.; Vionnet, Leticia Beatriz


So conhecidos os sete parmetros da textualidade , propostos em Beaugrande 1980 e desenvolvidos em Beaugrande & Dressler 1981: por um lado, um conjunto de parmetros associados a circunstncias de produo e de recepo dos textos (intencionalidade , aceitabilidade , informatividade , situacionalidade e intertextualidade ); por outro, coeso e coerncia , entendidas como propriedades centradas no prprio  

Microsoft Academic Search

texto 1 . Esta perspectiva - que constituiu, inequivocamente, um contributo fundamental para a descrio lingustica dos textos - pode hoje ser retomada e desenvolvida em funo de aspectos que tm entretanto sido sublinhados por outros autores. o caso da noo de plano de texto , desenvolvida nomeadamente por Jean-Michel Adam 2 : recuperando e actualizando a dispositio da

Maria Antnia Coutinho


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

ERIC Educational Resources Information Center

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

North Carolina Partnership for Children, Raleigh.


Avaliao Comparativa da Citopatologia Positiva, Colposcopia e Histopatologia: Destacando a Citopatologia como Mtodo de Rastreamento do Cncer do Colo do tero* COMPARATIVE EVALUATION OF THE POSITIVE CYTOLOGY, COLPOSCOPY AND HISTOPATHOL- OGY: EMPHASIZE OF THE CYTOLOGY HOW SCREENING METHODS OF CERVICAL CANCER  

Microsoft Academic Search

SUMMARY - Cervical cancer is the delay health and presents high rate prevalence and represents an important health problem world- wide. The Papanicolaou smear let a precocious diagnosis this cancer and detection of the intraepithelial lesions. The current study is a comparison the Papanicolaou smear (cytopathology), colposcopy and histopathology and to demonstration the importance of the Pap smear. To compare



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.



Microsoft Academic Search

SUMMARY We assessed four crown variables as stem growth estimators in young Austrocedrus chilensis (D.Don)Pic. Serm. Et Bizzarri trees (4 - 30 years old, and 0.05 - 4 meters tall), growing associated to shrubs. The variables were crown length; gross and net crown volume and leaves dry weight. Net crown volume and crown density (dry weight of leaves per unit

Federico Jorge Letourneau; Ernesto Andenmatten; Toms Schlichter


O processo de alcoolizao em populaes indgenas do Alto Rio Negro e as limitaes do CAGE como instrumento de screening para dependncia ao lcool* The process of alcoholization among the indian population of the Upper Rio Negro river and CAGE's limitations as a screening instrument for alcohol dependence  

Microsoft Academic Search

Background: Through a qualitative and interdisciplinary investigation as to the theoretical validity of CAGE as a screening instrument for alcohol dependence among the Upper Rio Negro Indian population, the use of alcohol as a theme among culturally diverse groups is approached by studying the assignment of meanings to drinking and the answers given to CAGE by the interviewed Indians. Methods:



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

ERIC Educational Resources Information Center

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

Cohen, Elena


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.



The Northern California Perinatal Research Unit: A Hybrid Model Bridging Research, Quality Improvement and Clinical Practice  

PubMed Central

Kaiser Permanente (KP) has a long-standing commitment to conduct research and report publicly. Simultaneously, it faces a different imperative: harnessing information systems to leverage internal improvements in outcomes, efficiency, and costs. Now that KP HealthConnect, the KP electronic health record, is fully implemented, research challenges at KP are moving away from issues of data access and toward the mechanisms through which raw data create meaningful clinical knowledge that is based on rigorous research. In this report we describe a model for researchthe Northern California Division of Research Perinatal Research Unitthat leverages internal and external resources to fulfill these twin missions. PMID:20844705

Garrido, Terhilda; Barbeau, Rosemarie



Healthy Behavior Change in Practical Settings  

PubMed Central

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

Young, Scott



Mobilizing resilience and recovery in response to adverse childhood experiences (ACE): a Restorative Integral Support (RIS) case study.  


The Restorative Integral Support (RIS) model is a comprehensive, whole person approach to addressing adversity and trauma. The Adverse Childhood Experiences (ACE) Study conducted by the Centers for Disease Control (CDC) and Kaiser Permanente reveals a relationship between childhood trauma and adult health and social problems. The current empirical case study presents the Committee on the Shelterless (COTS), in Petaluma, CA, as an example of one social service agency employing RIS to break cycles of homelessness. By applying RIS, research-based programming is offered within a culture of recovery that mobilizes resilience through social affiliations. The authors recommend RIS model implementation and research in programs serving populations with ACE backgrounds. PMID:22970786

Larkin, Heather; Beckos, Brooke A; Shields, Joseph J



Post-diagnosis statin use and breast cancer recurrence in a prospective cohort study of early stage breast cancer survivors  

Microsoft Academic Search

PurposeWe examined the association between post-diagnosis statin use (3-hydroxy-3-methylglutaryl-coenzyme A [HMG-CoA] inhibitors)\\u000a and risk of breast cancer recurrence.\\u000a \\u000a \\u000a \\u000a Materials and methodsThe study included 1945 early stage breast cancer survivors participating in the Life After Cancer Epidemiology (LACE) Study.\\u000a Women who were diagnosed from 1997 to 2000 and identified from the Kaiser Permanente Northern California (KPNC) Cancer Registry\\u000a entered the cohort

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



Kaiser's turnaround: hope for other nonprofits?  


After the heady mid-1990's rush of lower premiums, most managed care systems tumbled into a well of red ink. Those hit especially hard were nonprofit MCOs, which have a limited ability to raise capital compared with their nonprofit competitors. However, Kaiser Permanente has reported its first quarterly surplus since 1997, and this has given hope to other nonprofits that they too will soon return to the black. Is this hope justified? Is Kaiser's medicine the right treatment for other integrated systems? PMID:10621094

Pope, T



Prevalence of Childhood Obesity among Young Multiethnic Children from a Health Maintenance Organization in Hawaii  

PubMed Central

Abstract Background Pacific Islander, Asian, and mixed-ethnicity children are not described in national nutrition and health surveys. Methods Data on BMI values of 4608 5- to 8-year-old children available from Kaiser Permanente Hawaii electronic medical records in 2010 were analyzed for prevalence of overweight and obesity and for ethnic differences in BMI and risk for overweight and obesity, controlling for age, sex, neighborhood education level, and on a subset (n=2169) that further controlled for maternal education and maternal age. Kaiser Permanente data allow for reporting of multiple ethnicities. Results Data revealed that 33% of this child population was of mixed ethnic ancestry. Prevalence of overweight and obesity was 32.6% (12.9% overweight and 19.7% obese). However, Samoan children and children of Native Hawaiian, Filipino, and mixed ethnic ancestries had higher levels of overweight and obesity than whites or Asians. Higher neighborhood education level, higher maternal education level, and older maternal age were associated with decreased risk of overweight and obesity, except for children whose mothers were between 21 and 30 years old, who had a higher risk for obesity than those whose mothers were under 20 years of age (odds ratio=1.34). Conclusions Populations of mixed ethnicities in the Pacific region deserve further study related to healthy body size and acculturation to environment and lifestyle. PMID:23373877

Oshiro, Caryn Etsuko Shima; Wilkens, Lynne Ross



Emprego da radiao gama do Cobalto-60 na desinfestao de alguns tipos de raes para alimentao de animais de pequeno porte.  

E-print Network

??As pragas como besouros, caros, traas e fungos dentre outros, geralmente infestam produtos armazenados como: gros, farelos, farinhas, caf, fumo, frutas secas, raes animais, especiarias, (more)

Paula Bergamin Arthur



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

USGS Publications Warehouse

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

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



Gaps in residency training should be addressed to better prepare doctors for a twenty-first-century delivery system.  


Many observers have been concerned about a mismatch between the knowledge, skills, and professional values of newly trained physicians and the requirements of current and future medical practice. We surveyed and interviewed Kaiser Permanente's clinical department chiefs for internal medicine, pediatrics, general surgery, and obstetrics/gynecology to ascertain their views of the perceived gaps in the readiness of newly trained physicians. Nearly half of those surveyed reported deficiencies among new physicians in managing routine conditions or performing simple procedures often encountered in office-based practice. A third of the chiefs noted deficiencies in coordinating care for patients. Filling these and other training gaps will require changes at many levels-from residency programs to Medicare reimbursement policies-to better prepare new physicians for the challenges of working in a health care system evolving to emphasize accountability, quality outcomes, cost control, and information technology. PMID:22068407

Crosson, Francis J; Leu, Jean; Roemer, Beth M; Ross, Murray N



Secure E-mailing Between Physicians and Patients  

PubMed Central

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.



Restorative integral support (RIS) for older adults experiencing co-occurring disorders.  


The restorative integral support (RIS) model is a whole person response that assists people to overcome adversity. The adverse childhood experiences (ACE) Study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention shows the association between stressors in childhood and multiple later-life health and social problems. Older adults experiencing co-occurring disorders are an under-served and vulnerable population where gaps in both practice models and research to inform effective service provision exist. The current empirical case study presents Senior Hope as one social service agency employing RIS to intervene on the linkage between ACEs and co-occurring disorders to assist older adults. RIS usefully articulates the way in which Senior Hope is developing ACE-informed programs that mobilize resilience and recovery to help older adults achieve positive mental health outcomes. Implementation and research on the RIS model is recommended to enhance services for groups with ACE characteristics. PMID:22844693

Larkin, Heather; MacFarland, Nicole S



Successful Practices in the Use of Secure E-mail  

PubMed Central

Physician use of secure e-mail with patients is anticipated to increase under Stage 2 Meaningful Use requirements, but little is known about how physicians can successfully incorporate it into daily work. We interviewed 27 super user physicians at Kaiser Permanente and Group Health who were identified by leaders as being technologically, operationally, and clinically adept and as having high levels of secure e-mail use with patients. They highly valued the use of secure e-mail with patients, despite concerns about a lack of adequate time to respond, and provided tips for using it successfully. They identified benefits that included better care and improved relationships with their patients. PMID:24937149

Johnson, Laura W; Garrido, Terhilda; Christensen, Kate; Handley, Matt



Outcomes in Treatment for Intradural Spinal Cord Ependymomas  

SciTech Connect

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

Volpp, P. Brian [Department of Radiation Oncology, Kaiser Permanente, Los Angeles, CA (United States)], E-mail:; Han, Khanh [Huntington Memorial Medical Center, Pasadena, CA (United States); Kagan, A. Robert; Tome, Michael [Department of Radiation Oncology, Kaiser Permanente, Los Angeles, CA (United States)



Patient-Centered Outcomes Research Institute seeks to find out what works best by involving 'end-users' from the beginning.  


Joe V Selby:A family physician, clinical epidemiologist and health services researcher, Dr Joe V Selby has more than 35 years of experience in patient care, research and administration. He is responsible for identifying strategic issues and opportunities for the Patient Centered Outcomes Research Institute (PCORI) and implementing and administering programs authorized by the PCORI Board of Governors. Dr Selby joined PCORI from Kaiser Permanente (CA, USA) where he was Director of the Division of Research for 13 years and oversaw a department of more than 50 investigators and 500 research staff members working on more than 250 ongoing studies. He was with Kaiser Permanente for 27 years. An accomplished researcher, Dr Selby has authored more than 200 peer-reviewed articles and continues to conduct research, primarily in the areas of diabetes outcomes and quality improvement. His publications cover a spectrum of topics, including effectiveness studies of colorectal cancer screening strategies; treatment effectiveness, population management and disparities in diabetes mellitus; primary care delivery; and quality measurement. Dr Selby was elected to membership in the Institute of Medicine in 2009 and was a member of the Agency for Healthcare Research and Quality study section for Health Care Quality and Effectiveness from 1999 to 2003. A native of Fulton (MI, USA), Dr Selby received his medical degree from Northwestern University (IL, USA) and his master's in public health from the University of California (CA, USA). He was a commissioned officer in the Public Health Service Corps from 1976 to 1983 and received the Commissioned Officer's Award in 1981. PMID:24645685

Selby, Joe V



Temporal Trends in Mortality after Coronary Artery Revascularization in Patients with End-Stage Renal Disease  

PubMed Central

Background: Recent studies that have assessed the comparative effectiveness between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with end-stage renal disease (ESRD) that have included analyses of temporal trends in mortality have noted mixed results. Methods: We conducted an observational longitudinal cohort study of all adults with ESRD undergoing CABG or PCI within Kaiser Permanente Northern California. The primary predictor, index period of revascularization, was categorized into 3 periods: 19961999 (reference), 20002003, and 20042008, with the primary outcome being 3-year all-cause mortality. A multivariable Cox regression model with the assumption of independent censoring was used to determine the adjusted relative risk of the primary predictor. Results: Among 1015 ESRD patients, 3-year mortality showed no significant change in the 20002003 period but was lower during the 20042008 period with an adjusted hazard ratio of 0.66 (95% confidence interval: 0.490.88; trend test p = 0.01). No change in 30-day mortality was noted. Further adjustment for receipt of medications at baseline and after revascularization did not materially affect risk estimates. No significant interactions were observed between the type of revascularization (CABG or PCI) and the period of the index revascularization. Conclusions: Among a high-risk cohort of patients with ESRD and coronary artery disease within Kaiser Permanente Northern California who were referred for coronary revascularization by either CABG or PCI, the relative risk of mortality in the 20042008 period decreased by 34% compared with the 19961999 period, with the benefit primarily in the decrease in late mortality. PMID:25102514

Krishnaswami, Ashok; Leong, Thomas K; Hlatky, Mark A; Chang, Tara I; Go, Alan S



News & Notes Clayton Roberts (studio of Robert Bates) won  

E-print Network

Como in Gravedona on Lake Como. An alumna, Barbara Padilla ('04 MM in Vocal Performance), placed second by filling out a Practice Room Key Form. This year the school will place a charge on your student account

Azevedo, Ricardo


Resultados del Estudio Nacional de Colografa de Tomografa Computarizada: preguntas y respuestas

Estudios anteriores encontraron que la colografa de tomografa computarizada, tambin conocida como colonoscopia virtual, era prometedora como mtodo de examen selectivo de deteccin de cncer colorrectal debido a su precisin, seguridad, rentabilidad y aceptabilidad por parte de los pacientes.


Delirio (PDQ)

Resumen de informacin revisada por expertos acerca del delirio como una complicacin a causa del cncer o su tratamiento. Se discuten los enfoques de los cuidados mdicos de apoyo, asi como farmacolgicos para el manejo del delirio.


Beyond \\  

Microsoft Academic Search

En el capitalismo avanzado, la ciencia y la tcnica se prefiguran como fuerzas productivas fundamentales. Sin embargo, ms all de la mera fagocitacin del saber sistemtico convencional (lgica borrosa, I+D+i) o de lo que Marx categoriz como \\

Francisco Quintana



MorphTrans: un lenguaje y un compilador para especi car y generar m odulos de transferencia  

E-print Network

;ogica avanza- da que es muy parecida a la utilizada en sis- temas de TA comerciales para PC tales como es un avance con res- pecto al mero an#19;alisis morfol#19;ogico y puede ser considerado como una

Forcada, Mikel L.



Microsoft Academic Search

La cultura como conjunto de relaciones humanas que ha transcendido en el tiempo y que le permite al hombre conservar, reproducir, crear nuevos conocimientos y valores para la transformacin de su medio social y cultural, cada da cobra mayor importancia como sostn fundamental para la satisfaccin de las necesidades espirituales y como elemento de influencia directa en la produccin de

Ricardo Enoa Leyva; Florentino Montes de Oca Ruiz



El Mediterrneo europeo: Una imagen de marca comn frente a los pases lejanos para los destinos tradicionalmente tursticos de la Unin Europea  

Microsoft Academic Search

En la actualidad el turismo se configura como uno de los sectores de mayor aportacin al PIB de determinados pases que en pocos aos han visto cmo esta industria es capaz de configurarse como un motor fundamental de su economa. En el marco de la Unin Europea, cabe destacar pases como Francia, Espaa o Italia y podemos incluir tambin a

Mecedes Jimnez Garca



Educacin y equidad. Algunos aportes desde la nocin de educabilidad 1  

Microsoft Academic Search

La gran mayora de los estudios orientados a esclarecer la relacin entre educacin y equidad social coinciden en centrar la atencin en la educacin como una condicin indispensable para el logro de una sociedad ms equitativa. Los argumentos que permiten pensar a la educacin como una instancia previa a la equidad, como su condicin de posibilidad, son muy diversos, y

Nstor Lpez


El desarrollo humano integral, la teora de sistemas y el concepto de competencias en el mbito acadmico universitario Integral human development and the concept of competitions in the university academic environment  

Microsoft Academic Search

RESUMEN: la Educacin puede ser considerada como un proceso social, en el cual cada actividad y cada actor del proceso, deben tender hacia un desarrollo humano integral. En este sentido, el desarrollo humano podra ser visto como un promo - tor y conductor de mejora tanto personal como social. Hoy en da, sin embargo, la economa de libre mercado, es

Comunicacin Tcnica; Hilda L. Crdenas



Microsoft Academic Search

Como su fruto posee alto contenido de vitaminas A, B y C y minerales (potasio, hierro y calcio), es apreciado en EE.UU., Japn y pases de Europa, donde es consumido como fruta fresca en contraestacin, en la industria alimenticia y tambin medicinal por sus propiedades antioxidantes, antiinflamatorias y desinfectantes. Este cultivo es sensible tanto al dficit como al exceso de

H. Das; D. Prez; M. Rodrguez Loustau


A produo de sentidos no jornalismo: da teoria da enunciao a enunciao jornalstica  

Microsoft Academic Search

RESUMO: Este trabalho tem como objetivo fazer uma discusso terica do jornalismo no como um simples repr odutor do real, mas com o um a atividad e que diariamente contribui para a construo social d a realidade . Acreditamo s que a concepo do jorna lismo como um espelho da realidade desconhece a dimenso s imblica da atividade . Ne

Alfredo Vizeu


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). PMID:24862434

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



Mobilidades: um novo direito s cidades/metrpoles? Redes de transporte e produo do espao urbano: Tours e Salvador sobre novos trilhos  

E-print Network

Tema Mobilidades: um novo direito às cidades/metrópoles? Título Redes de transporte e produção do in "Diálogos Brasil França 2012 Construir a metrópole contemporânea, Sao Paulo : Brazil (2012)" #12;Redes de que qualquer espaço pode ser analisado e concebido considerando-o como um lugar, como uma rede ou como

Paris-Sud XI, Université de



Microsoft Academic Search

Se han reconocido a las zeolitas y a los metales o compuestos metlicos como adsorbentes selectivos para cationes y aniones de soluciones acuosas para minimizar el impacto de algunos contaminantes en el medio ambiente. Los xidos como MgO, CaO y ZnO, pueden dispersarse en las cavidades de las zeolitas e incrementar sus propiedades. Actualmente existen diversas formas de aplicacin como,




Textualidad, historia y sujetividad: Gnero y gnero  

E-print Network

historia ya no puede concebirse como el simple recuento del pasado, porque como todo discurso, se ve ahora que tambin es poesa, retrica, ideologa. El reconocer esto ha llevado a un doble cuestionamiento y estrategia en la creacin y en la teora... como si fuera la verdadera verdad. Claro est que muchos dramaturgos latinoamericanos se plantean los mismos problemas, y claro est tambin que el abuso del discurso oficial no es slo cuestin de la mujer. Aun as, hay que tener presente el...

Nigro, Kirsten F.



Otra vez el Festival de las Amricas en Montreal  

E-print Network

introduccin de una nueva teatralidad en nuestro continente. Durante dcadas el teatro latinoamericano estuvo permeado y sujeto al discurso poltico, esto es, el teatro como medio para hacer poltica, lo cual condujo, a nuestro ver, a una especie de... bancarrota teatral doble: por una parte, el teatro no reflexion sobre s mismo, sobre su oficio, sobre su especificidad misma como espectculo y como trabajo sobre el actor y sobre el espacio escnico: nuestras sociedades han cambiado, su discurso...

de Toro, Fernando




E-print Network


Geffner, Hector


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

PubMed Central

An observational study of the Kaiser Permanente Northern California (KPNC) BMI coding distributions was conducted to ascertain the trends in overweight and obesity prevalence among KPNC members aged 219 between the periods of 20032005 and 2009-2010. A decrease in the prevalence of overweight (?11.1% change) and obesity (?3.6% change) and an increase in the prevalence of healthy weight (+2.7% change) were demonstrated. Children aged 25 had the greatest improvement in obesity prevalence (?11.5% change). Adolescents aged 1219 were the only age group to not show a decrease in obesity prevalence. Of the racial and ethnic groups, Hispanics/Latinos had the highest prevalence of obesity across all age groups. The KPNC prevalence of overweight and obesity compares favorably to external benchmarks, although differences in methodologies limit our ability to draw conclusions. Physician counseling as well as weight management programs and sociodemographic factors may have contributed to the overall improvements in BMI in the KPNC population. Physician training, practice tools, automated BMI reminders and performance feedback improved the frequency and quality of physician counseling. BMI screening and counseling at urgent visits, in addition to well-child care visits, increased the reach and dose of physician counseling. PMID:23970960

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



Fetal death ratios in a prospective study compared to state fetal death certificate reporting.  

PubMed Central

A cohort of 6,254 pregnancies surviving at least 20 weeks of gestation was identified through pregnancy testing and follow-up at three Kaiser Permanente medical offices in northern California in 1981-82. Fetal death ratios per 1,000 live births were 12.1 for all fetal deaths versus 5.0 for the subset of fetal deaths reported to the California state registrar. Only fetal deaths resulting in overnight hospitalization of the mother were reported. Seventy-nine percent of fetal deaths over 28 completed weeks since the last menstrual period (LMP) were reported versus only 10 percent between 20 and 28 completed weeks since the LMP. Ninety-three percent of fetuses over 400 grams were reported. The unreported fetal deaths were mainly those perceived by attending physicians as spontaneous abortion, especially missed or incomplete spontaneous abortion. Physicians apparently preferred the label of spontaneous abortion over stillbirth or fetal death whenever fetal maturity could not be substantiated, regardless of prior estimates of the date of the LMP. Fetuses as large and developed as potentially viable infants were the most likely to be reported. PMID:2764206

Goldhaber, M K



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. PMID:23704843

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



Propagation of chaos, Wasserstein gradient flows and toric Kahler-Einstein metrics  

E-print Network

Motivated by a probabilistic approach to Kahler-Einstein metrics we consider a general non-equlibrium statistical mechanics model in Euclidean space consisting of the stochastic gradient flow of a given quasi-convex N particle interaction energy. We show that a deterministic macroscopic evolution equation emerges in the large N-limit of many particles. The proof uses the theory of weak gradient flows on the Wasserstein space and in particular De Georgi's notion of minimizing movements. Applied to the setting of permanental point processes at negative temperature the corresponding limiting evolution equation yields a new drift-diffusion equation, coupled to the Monge-Ampere operator, whose static solutions correspond to toric Kahler-Einstein metrics. This drift-diffusion equation is the gradient flow on the Wasserstein space of probability measures of the K-energy functional in Kahler geometry and it can be seen as a fully non-linear version of various extensively studied dissipative evolution equations and conservations laws, including the Keller-Segal equation and Burger's equation. We also obtain a real probabilistic analog of the complex geometric Yau-Tian-Donaldson conjecture in this setting. In another direction applications to singular pair interactions in 1D are given. Complex geometric aspects of these results will be discussed elsewhere.

Robert J. Berman; Magnus Onnheim



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) = 1.02.5). 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 = 1.24.8), with borderline statistical significance in multivariable analysis (CI = 2.0, CI = 0.914.5). 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. PMID:20616983

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



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. KPs strategic vision is to be a leader in Total Health by making lives better. KP hopes to make lives better by 1) measuring vital signs of health, 2) promoting healthy behaviors, 3) monitoring disease incidence, 4) spreading leading practices, and 5) creating healthy environments with our community partners. Best practices, spread to the communities we serve, will make health care more affordable, prevent preventable diseases, and save lives. PMID:24694316

Tuso, Phillip



Supplement Use and Risk of Cutaneous Squamous Cell Carcinoma  

PubMed Central

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

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



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



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

PubMed Central

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

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



Genetic risk factors for perinatal arterial ischemic stroke.  


The cause of perinatal arterial ischemic stroke is unknown in most cases. We explored whether genetic polymorphisms modify the risk of perinatal arterial ischemic stroke. In a population-based case-control study of 1997-2002 births at Kaiser Permanente Northern California, we identified 13 white infants with perinatal arterial ischemic stroke. Control subjects included 86 randomly selected white infants. We genotyped polymorphisms in nine genes involved in inflammation, thrombosis, or lipid metabolism previously linked with stroke, and compared genotype frequencies in case and control individuals. We tested several polymorphisms: tumor necrosis factor-? -308, interleukin-6, lymphotoxin A, factor V Leiden, methyltetrahydrofolate reductase 1298 and 667, prothrombin 20210, and apolipoprotein E ?2 and ?4 alleles. Patients with perinatal arterial ischemic stroke were more likely than control subjects to demonstrate at least one apolipoprotein E ?4 allele (54% vs 25%, P = 0.03). More patients with perinatal arterial ischemic stroke carried two ?4 alleles than did control subjects (15% vs 2%, P = 0.09), although this finding lacked statistical significance. Proinflammatory and prothrombotic polymorphisms were not associated with perinatal arterial ischemic stroke. The apolipoprotein E polymorphism may confer genetic susceptibility for perinatal arterial ischemic stroke. Larger population-based studies are required to confirm this finding. PMID:23290018

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



Candidate genes and risk for CP: a population-based study.  


Studies suggest that genetic polymorphisms may increase an individual's susceptibility to CP. Most findings have yet to be corroborated in an independent cohort. This case-control study is nested within all 334,333 infants ?36 wk gestation born at Kaiser Permanente Medical Care Program, 1991-2002. We included only non-Hispanic whites who had a neonatal blood sample available. Case patients (n = 138) were identified from medical records to have spastic or dyskinetic CP. Controls (n = 165) were randomly selected from the population. We genotyped polymorphisms previously associated with CP: inducible NOS (iNOS)-231, apolipoprotein E (apoE) ?2 and ?4 alleles, TNF-?-308, IL-8 -251, lymphotoxin 60, endothelial NOS -922, endothelial protein C receptor 219, mannose-binding lectin 54 and 52, factor V Leiden, methyltetrahydrofolate reductase 1298 and 667, prothrombin 20210, and platelet activator inhibitor 11053. Similar to previous reports, the iNOS-231 T allele (25.7 versus 18.9%, p = 0.04) and the apoE ?4 allele (19.3 versus 13.2%, p = 0.04) were more common in patients with CP than in controls. However, there was no statistically significant association between any genetic polymorphism and CP after correction for multiple comparisons. PMID:21857382

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



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 1544 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 1525 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



Socioeconomic status, race, and COPD health outcomes  

PubMed Central

Background Although COPD is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race-ethnicity on health outcomes. Methods We aimed to determine the independent impacts of SES and race-ethnicity on COPD severity status, functional limitations, and acute exacerbations of COPD among patients with access to health care. Data were used from the FLOW cohort study of 1,202 Kaiser Permanente Northern California Medical Care Plan members with COPD. Results Lower educational attainment and household income were consistently related to greater disease severity, poorer lung function, and greater physical functional limitations in cross-sectional analysis. Black race was associated with greater COPD severity, but these differences were no longer apparent after controlling for SES variables and other covariates (comorbidities, smoking, body mass index, and occupational exposures). Both lower education and income were independently related to a greater prospective risk of acute COPD exacerbation (HR 1.5; 95% CI 1.01 to 2.1; and HR 2.1; 95% CI 1.4 to 3.4, respectively). Conclusion Low SES is a risk factor for a broad array of adverse COPD health outcomes. Clinicians and disease management programs should consider SES as a key patient-level marker of risk for poor outcomes. PMID:19854747

Eisner, Mark D.; Blanc, Paul D.; Omachi, Theodore A.; Yelin, Edward H.; Sidney, Stephen; Katz, Patricia P.; Ackerson, Lynn M.; Sanchez, Gabriela; Tolstykh, Irina; Iribarren, Carlos



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

PubMed Central

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

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



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. PMID:19300322

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



Morbidity and medical care utilization of old and very old persons.  

PubMed Central

This report compares the morbidity, health care and drug utilization, and health status of random samples of HMO-enrolled Medicare beneficiaries ages 65-79, and 80 and over. The population represented 3,683 person-years of Kaiser Permanente eligibility (59.2 percent female). Those 80 and over were 20 percent of the person-years (64.1 percent female). The effects of age and sex on morbidity and utilization were analyzed using log linear models that controlled for eligibility, and using two-way analyses of variance of rates. Few differences were found in the morbidity experiences and utilization rates of the two age groups. Indicators of self-reported health status did differ. The findings support the idea that noninstitutionalized very old persons are the healthy survivors of their cohort. Their health care needs may not be much different than younger old persons in terms of the types and amounts of health care services needed. PMID:2211132

Johnson, R E; Mullooly, J P; Greenlick, M R



Straight talk with...Joe Selby.  


The US Supreme Court's ruling in late June to uphold most of the Patient Protection and Affordable Care Act of 2010 decided more than just the fate of the law's individual mandate for health care. It also allowed many of the other provisions of the legislation to safely go ahead. Chief among those was the establishment of a comparative-effectiveness research hub called the Patient-Centered Outcomes Research Institute (PCORI), located in Washington, DC. With a budget of $3.3 billion over the next seven years and an independent status, PCORI is now tasked with creating the evidence base to help patients and doctors make more informed decisions about their medical choices. Leading the fledgling institute is executive director Joe Selby. A family physician and clinical epidemiologist, Selby joined PCORI in July 2011 after 13 years as head of research at Kaiser Permanente, the California-based health provider. Even amid all the uncertainty that surrounded the future of US healthcare reform, Selby, together with PCORI's board of directors, managed to help craft the institute's first research agenda and to fund 50 pilot projects totaling $30 million, all in the spring of this year. Elie Dolgin spoke with Selby to discuss how PCORI will influence the debate about which treatments work best. PMID:22869175

Selby, Joe



Risk factors for proximal humerus fracture.  


This case-control study of proximal humerus fracture included 448 incident female and male cases and 2,023 controls aged 45 years or older identified in five Northern California Kaiser Permanente Medical Centers in 1996-2001. Data were collected by using an interviewer-administered questionnaire. Some factors related to low bone mass, including number of fractures since age 45 years and low dietary calcium intake, were associated with increased risks of fracture, and factors thought to protect against bone loss, such as menopausal hormone therapy and calcium carbonate tablet use, were associated with reduced risks. Fall-related risk factors included previous falls, diabetes mellitus, and difficulty walking in dim light. Possible fall-related risk factors suggested for the first time in this study were seizure medication use (adjusted odds ratio (OR) = 2.80, 95% confidence interval (CI): 1.45, 5.42), depression (OR = 1.34, 95% CI: 0.98, 1.84), almost always using a hearing aid (OR = 1.92, 95% CI: 1.12, 3.31 vs. never prescribed), and left-handedness (OR = 2.36, 95% CI: 1.51, 3.68 vs. right-handedness). Difficulty with activities of daily living and lack of physical activity tended to be associated with increased risk. Prevention of falls among frail, osteoporotic persons would likely reduce the frequency of proximal humerus fracture. PMID:15286021

Chu, Sarah P; Kelsey, Jennifer L; Keegan, Theresa H M; Sternfeld, Barbara; Prill, Mila; Quesenberry, Charles P; Sidney, Stephen



Acceptance of direct physician access to a computer-based patient record in a managed care setting.  

PubMed Central

Kaiser Permanente Mid-Atlantic States has developed a fully integrated outpatient information system which currently runs on an IBM ES9000 on a VM platform written in MUMPS. The applications include Lab, Radiology, Transcription, Appointments. Pharmacy, Encounter tracking, Hospitalizations, Referrals, Phone Advice, Pap tracking, Problem list, Immunization tracking, and Patient demographics. They are department specific and require input and output from a dumb terminal. We have developed a physician's work station to access this information using PC compatible computers running Microsoft Windows and a custom Microsoft Visual Basic 2.0 environment which draws from these 14 applications giving the physician a comprehensive view of all electronic medical records. Through rapid prototyping, voluntary participation, formal training and gradual implementation we have created an enthusiastic response. 95% of our physician PC users access the system each month. The use ranges from 0.2 to 3.0 screens of data viewed per patient visit. This response continues to drive the process toward still greater user acceptance and further practice enhancement. PMID:8130585

Dewey, J. B.; Manning, P.; Brandt, S.



Patient Assessment of Chronic Illness Care (PACIC) and Improved Patient-centered Outcomes for Chronic Conditions  

PubMed Central

Background The Patient Assessment of Chronic Illness Care (PACIC) has potential for use as a patient-centered measure of the implementation of the Chronic Care Model (CCM), but there is little research on the relationship between the PACIC and important behavioral and quality measures for patients with chronic conditions. Objective To examine the relationship between PACIC scores and self-management behaviors, patient rating of their health care, and self-reported quality of life. Design Cross-sectional survey with a 61% response rate. Participants Included in the survey were 4,108 adults with diabetes, chronic pain, heart failure, asthma, or coronary artery disease in the Kaiser Permanente Medical Care program across 7 regions nationally. Measurements The PACIC was the main independent variable. Dependent variables included use of self-management resources, self-management behaviors such as regular exercise, self-reported adherence to medications, patient rating of their health care, and quality of life. Results PACIC scores were significantly, positively associated with all measures (odds ratio [ORs] ranging from 1.20 to 2.36) with the exception of self-reported medication adherence. Conclusions Use of the PACIC, a practical, patient-level assessment of CCM implementation, could be an important tool for health systems and other stakeholders looking to improve the quality of chronic disease care. Electronic supplementary material The online version of this article (doi: 10.1007/s11606-007-0452-5) contains supplementary material, which is available to authorized users. PMID:18030539

Mosen, David M.; Glasgow, Russell E.; Hibbard, Judith; Remmers, Carol; Bellows, Jim



Midline spikes.  


Midline spikes are characterized by spike foci recorded at Cz, Fz, or Pz with amplitude ranging from 20 to 350 microvolts. Out of 7,929 EEGs performed at the Neurodiagnostics Laboratory, Kaiser Permanente Medical Center, Anaheim, California, between 1996 and 2006, 17 EEGs (0.21%) were identified as having interictal midline spikes with or without other epileptiform discharges. Eight EEGs showed midline spikes at Cz, 2 at Fz, 2 at Cz and Fz, 1 at Cz and C3, 1 at Cz, C3, and P3, 1 at Cz and F8, 1 at Cz and T4, and 1 at Cz with 2 Hz generalized spike and slow wave complex. Midline spikes were recorded in 10 males and 7 females. The age ranged from 4 days to 38-years-old with a mean age of 10.8 years. Twelve patients (70.6%) were children. Twelve patients (70.6%) had generalized tonic-clonic seizures and 5 had partial motor seizures. Of the 17 patients, 14 had no known causes, 1 had an agenesis of corpus callosum, 1 had a left frontal arteriovenous malformation, and 1 had a left frontal area stroke. We postulate that the mechanism for the genesis of midline spikes may be heterogeneous. Midline spikes may be triggered by thalamocortical network in a generalized tonic-clonic seizure, or may originate in the parasagittal cortex in a partial motor seizure. PMID:18318416

Yong, T; Chayasirisobhon, S; Yoshina, J S; Tin, S N; Tehrani, K; Skinner, S E; Markus, E; Spurgeon, B D; Gurbani, S



Social organization of self-management support of persons with diabetes: A health systems comparison  

PubMed Central

Objective Identify important organizational elements for providing self-management support (SMS). Design Semi-structured qualitative interviews conducted in two healthcare systems. Setting Kaiser Permanente Northern California and the Danish Health Care System. Subjects 36 managers and healthcare professionals in the two healthcare systems. Main outcome measures Elements important to providing self-management support to persons with diabetes. Results Healthcare professionals provision of SMS was influenced by healthcare system organization and their perceptions of SMS, the capability and responsibility of healthcare systems, and their roles in the healthcare organization. Enabling factors for providing SMS included: strong leadership; aligned incentives; use of an integrated health information technology (HIT) system; multidisciplinary healthcare provider teams; ongoing training for healthcare professionals; outreach; and quality goals. Barriers to providing SMS included lack of collaboration between providers and skeptical attitudes towards prevention and outreach. Conclusions and implications Implementation of SMS can be improved by an understanding of the elements that enhance its provision: (1) initiatives seeking to improve collaboration and integration between providers; (2) implementation of an integrated HIT system; and (3) ongoing training of healthcare professionals. PMID:22839353

Schitz, Michaela; Frlich, Anne; Krasnik, Allan; Taylor, Warren; Hsu, John



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



Le patrimoine astronomique provenal  

NASA Astrophysics Data System (ADS)

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

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



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

PubMed Central

Background A prolonged corrected QT (QTc) interval is a marker for an increased risk of sudden cardiac death. We evaluated the relationship between oral contraceptive (OC) use, type of OC, and QTc interval. Methods We identified 410,782 ECGs performed at Northern California Kaiser Permanente on female patients between 1553 years from January, 1995 to June, 2008. QT was corrected for heart rate using log-linear regression. OC generation (first, second and third) was classified by increasing progestin androgenic potency, while the fourth generation was classified as anti-androgenic. Results Among 410,782 women, 8.4% were on OC. In multivariate analysis after correction for comorbidities, there was an independent shortening effect of OCs overall (slope = ?0.5ms; SE = 0.12, p<0.0002). Users of first and second generation progestins had a significantly shorter QTc than non-users (p<0.0001), while users of fourth generation had a significantly longer QTc than non-users (slope = 3.6ms, SE = 0.35, p<0.0001). Conclusion Overall, OC use has a shortening effect on the QTc. Shorter QTc is seen with first and second generation OC while fourth generation OC use has a lengthening effect on the QTc. Careful examination of adverse event rates in fourth generation OC users is needed. PMID:23879279

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



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)



Assessment of pesticides effects on soil fauna through ecotoxicological tests with Eisenia andrei (Annelida, Oligochaeta) and natural soil fauna community.  

E-print Network

??Os impactos ambientais relacionados ao uso de agrotxicos em reas agrcolas vm sendo considerados como preocupantes nas ltimas dcadas, verificando-se efeitos adversos em diferentes nveis (more)

Maria Edna Tenrio Nunes



Autoanticorpos rgo-especficos e sistmicos em pacientes com lpus eritematoso sistmico juvenil e dermatomiosite juvenil.  

E-print Network

??Objetivo: Ao nosso conhecimento, no h estudos na literatura avaliando simultaneamente um grande nmero de autoanticorpos rgoespecficos, bem como a prevalncia de doenas autoimunes rgoespecficas (more)

Ndia Emi Aikawa



Sndrome ps-poliomielite: aspectos epidemiolgicos e prognsticos.  

E-print Network

??Objetivos: Descrever aspectos clnicos e epidemiolgicos da sndrome ps-poliomielite (SPP) e fatores associados, bem como suas repercusses na capacidade funcional e sua gravidade. Mtodos: (more)

Mnica Tilli Reis Pessa Conde



Dos laboratrios aos pontos de venda: uma anlise da trajetria dos alimentos funcionais e nutrcuticos e da sua repercusso sobre a questo agroalimentar.  

E-print Network

??Alimentos funcionais e nutracuticos so apresentados como alimentos que, alm de suas funes bsicas nutricionais, demonstram benefcios fisiolgicos e/ou reduzem o risco de doenas crnicas. (more)

Marco Antonio Ferreira de Souza



Avaliao estrutural e reologica de emulses simples e multiplas estabilizadas por caseinato de sodio e jatai.  

E-print Network

??Protenas e polissacardeos so amplamente utilizados em emulses alimentcias como agentes emulsificantes e estabilizantes. Entretanto, a presena de ambos biopolmeros em soluo aquosa pode resultar (more)

Fabiana de Assis Perrechil



Calendario de Animales  

NSDL National Science Digital Library

Este Web site contiene links a 12 calendarios (12 meses). Junio contiene siete actividades que combinan matemáticas con explorar diferentes animales. Por ejemplo, los chicos hacen una encuesta sobre animales preferidos, buscan un animal que tenga las zarpas más grandes que sus manos, y dicen tantos animales con manchas como puedan en un minuto. Se puede utilizar como actividad independiente, como actividad para hacer en casa, o como actividad de grupo. Disponible para descargar en formato pdf y en Inglés.




Educao para sustentabilidade : turismo ecopedaggico no Centro de Permacultura Asa Branca e implantao de um espao permacultural na Escola Classe Jardim Botnico.  

E-print Network

??Dissertao (mestrado)Universidade de Braslia, Departamento de Engenharia Florestal, 2011. Este trabalho aborda a Permacultura como estratgia para realizao da educao para sustentabilidade por meio do (more)

Jacintho, Thiago Rocha dos Santos



Santo Daime : um sacramento vivo, uma religio em formao.  

E-print Network

??Tese (doutorado)Universidade de Braslia, Instituto de Cincias Humanas, 2007. A Ayahuasca uma substncia psicoativa formada pela deccoo do cip Banisteriopsis caapi, conhecido como Jagube, (more)

Oliveira, Isabela




E-print Network

Crustacea e Mollusca. Unidade 4: Organismos planctônicos: utilizados como alimento na aquacultura, em (Cirripedia), Mollusca, Urochordata (Ascidiacea), Ectoprocta (Bryozoa) e Echinodermata. Unidade 5: Fauna de

Floeter, Sergio Ricardo


Caractersticas Emocionais e Comportamentais de Adolescentes e Adultos Suspeitos de Praticar Abuso Sexual.  

E-print Network

??OBJETIVO: Caracterizar o perfil emocional e comportamental de adolescentes e adultos suspeitos de praticar abuso sexual, bem como, identificar o respectivo histrico criminal. MTODO: Estudo (more)

Denise Mller Bhm



Isolamento e seleo de fungos celulolticos para hidrlise enzimtica do bagao de cana-de-aucar.  

E-print Network

??Atualmente os processos biotecnolgicos tm conquistado um lugar de destaque no desenvolvimento tecnolgico mundial, tendo as enzimas como as celulases, grande importncia econmica e diferentes (more)

Nara Gustinelli Bortolazzo




E-print Network

Executive Education, 2009 World Bank, Washington, DC: Consultant, 2008 Rockefeller Foundation Bellagio for Advanced Study, September 2005 - June 2006 Rockefeller Foundation Bellagio Center, Lake Como, Italy: Leader

Nagurney, Anna


Taxonomy and phylogeny of clinically important mucoralean fungi.  

E-print Network

??Recientemente, varios estudios han comunicado la creciente incidencia de mucormicosis tanto en pacientes inmunosuprimidos como inmunocompetentes (Bitar et al., 2009; Roden et al., 2005; Saegeman (more)

Alvarez Duarte, Eduardo



Complicaciones gastrointestinales (PDQ)

Resumen de informacin revisada por expertos acerca del estreimiento, impaccin, obstruccin intestinal y diarrea como complicaciones del cncer o su tratamiento. Se discute el manejo de estos problemas.


Planejamento, desenvolvimento e estudos de QSAR-2D e QSAR-3D de derivados 5-nitro-2-tiofilidnicos com atividade frente a Staphylococcus aureus multi-resistente (CEB - Clone Endmico Brasileiro).  

E-print Network

??A reemergncia de algumas bactrias Gram-positivas, em particular, do gnero Staphylococcus, como principal foco causador de infeces hospitalares, tem se intensificado nas ltimas dcadas, e, (more)

Andrea Masunari



Obteno de gorduras low trans por interesterificao quimica.  

E-print Network

??As gorduras trans, principalmente presentes nos alimentos industrializados como biscoitos, gorduras para fritura, margarinas, entre outros, so resultados da hidrogenao parcial, processo utilizado pela indstria (more)

Miluska Castillo Caceres



Caracterizao molecular e perfil de sensibilidade de Candida tropicalis isoladas em corrente sangunea e cateter de pacientes internados em hospitais de ensino.  

E-print Network

??Infeces causadas por Candida tropicalis (C. tropicalis) so associados elevada morbi-mortalidade, e foram consideradas como importantes causas de infeco de corrente sangunea no Hospital (more)

Marcello Mihailenko Chaves Magri



Fadiga no doente com cncer colo-retal: fatores de risco e preditivos.  

E-print Network

??INTRODUO: No existem estudos preditivos sobre fadiga em doentes com cncer colo-retal, embora fadiga seja descrita como freqente na populao oncolgica. OBJETIVO: Identificar os fatores (more)

Dalete Delalibera Corra de Faria Mota



Pginas na memria : livros didticos e narrativas de experincias escolares no brasil (1937-1956).  

E-print Network

??Esta dissertao buscou compreender como os livros didticos integravam a atmosfera poltico-cultural e, especificamente, prticas educativas na escola primria brasileira de meados do sculo XX. (more)

Flvia de Souza Fontineles



Asociacin entre el virus XMRV y enfermedades humanas: preguntas y respuestas

El XMRV es un retrovirus del que se inform por primera vez en 2006 como una causa potencial del cncer de prstata. Est estrechamente relacionado con los virus de leucemia murina, los cuales causan una amplia variedad de cnceres as como enfermedades inmunolgicas y neurolgicas en ratones.


El cambio en las redes : una aproximacin a las relaciones sociales desde el lenguaje, la representacin y la institucionalizacin  

Microsoft Academic Search

Este artculo pretende retomar los planteamientos de Giddens de la doble hermenutica como fundamento epistemolgico para resolver la tensin entre metodologas estructurales cuantitativas como el anlisis de redes sociales y el uso de representaciones sociales y lenguaje para entender la realidad social desde metodologas cualitativas. Esto involucra la discusin de la relacin entre anlisis cualitativo y cuantitativo. Estos debates no

Gabriel Vlez Cuartas



O Repertrio de Habilidades Sociais de profissionais que atuam com vendas no setor comercial de tecnologia da informao e suas implicaes na qualidade da prestao de servios  

Microsoft Academic Search

As organizaes esto buscando sempre mais oferecer produtos e servios de qualidade, atendendo s exigncias, necessidades e desejos dos clientes. O presente estudo teve como objetivo diagnosticar o potencial do mtodo QFD (Desdobramento dda Funo Qualidade), como ferramenta para o desenvolvimento da qualidade nas atividades logsticas de armazenagem e movimentao de produtos no Centro de Distribuio de uma rede varejista

Marcos Macri Olivera


C A L I F O R N I A E N V I R O N M E N T A L P R O T E C T I O N A G E N C Y Boletn de Prensa  

E-print Network

industriales, así como la operación y el mantenimiento de una planta de tratamiento de aguas residuales y el, para 38 operadores, ingenieros y reguladores de plantas de tratamiento de aguas residuales de México plantas de tratamiento de aguas residuales. El curso incluyó temas tales como una revisión general de las


Efectos macroeconmicos de los mercados negros de dlares. El caso del Brasil, 1968-1989  

Microsoft Academic Search

Con la crisis del sistema monetario internacional a principios de los aos setenta, tanto los pases desarrollados como los menos industrializados se vieron en la necesidad de revisar sus regmenes cambiarios, para atender tanto a la propia volatilidad de los mercados internacionales como al grado de apertura y de movilidad de capitales en sus economas. De esta manera surge una

Alejandro Reynoso del Valle



Un mercado paralelo: la produccin de suelo y la promocin inmobiliaria en Oviedo, 1994-2002  

Microsoft Academic Search

En los dos ltimos aos la vivienda se ha convertido en un lugar comn de la poltica y la comunicacin como consecuencia de un alza de su precio que multiplica por diez el IPC. La interpretacin general apunta al solar como causa principal y la solucin es liberalizar el suelo. Sin embargo, en Oviedo se observa que el volumen de

Toms Cortizo lvarez



El impacto macroeconmico del control de importaciones  

Microsoft Academic Search

A pesar de su uso generalizado como instrumento de poltica econmica, tanto en los pases desarrollados (entre las dcadas del treinta y el cincuenta y nuevamente en los aos setenta) como en las naciones en va de desarrollo, los controles directos a las importaciones han tenido una vida terica clandestina. Esto refleja, no slo el recelo de los economistas neo-clsicos

Jos Antonio Ocampo



Paul Krugman y el nuevo comercio internacional  

Microsoft Academic Search

RESUMEN Los mercados internacionales son competitivos no solamente por la disponibilidad de los factores de produccin bsicos, sino por la adaptacin y asimilacin de nuevos elementos constitutivos de los factores como son los correspondientes al capital y a la mano de obra, en lo pertinente a la formacin, preparacin, calificacin y especializacin, as como a la asimilacin de tecnologas pertinentes

Jose Zacarias Mayorga Sanchez; Clemencia Martinez Aldana



Se descifra el origen del XMRV y descartan las afirmaciones de su papel en enfermedades en humanos

Nuevas investigaciones muestran que una asociacin, mencionada en numerosos estudios, entre el retrovirus conocido como XMRV y el cncer de prstata as como el sndrome de fatiga crnica, se debe a contaminacin de laboratorio con un virus que se origin en ratones.



Microsoft Academic Search

O objetivo desse trabalho introduzir a memtica, as investigaes sobre os memes, unidades culturais de imitao que pretensamente so os tomos da cultura e da histria. Partindo de uma analogia com a teoria do gene como nvel fundamental de seleo, popularizada como a teoria do gene egosta, a memtica pretende propor modelos explicativos que podem ser teis para compreender

Ricardo Waizbort


Entrevista: " uma disciplina fundamental.  

E-print Network

· Entrevista: "? uma disciplina fundamental. Como a filosofia" #12;"A matemática é uma disciplina fundamental. Como a filosofia' 9 Helder Coelho tirou um curso de engenharia em que os três primeiros anos eram- critas - a bases de dados de bibliote- cas, permitindo saber, por exemplo, se um livro estava disponível

Instituto de Sistemas e Robotica


Nuestro Instituto

Informacin acerca de nuestra misin como Instituto Nacional del Cncer, as como sobre los diferentes tipos de investigacin que apoya nuestro Instituto, el programa de centros oncolgicos, y sobre el Informe Anual a la Nacin acerca del cncer, el cual es preparado por las principales organizaciones oncolgicas de los Estados Unidos.



Microsoft Academic Search

Resumo : A partir do pressuposto de que o software seja o suporte de uma escrita digital (cf. SOUZA A.G & Carvalho E.P.M. (2006)), este ensaio busca entender como a constituio sgnica do suporte virtual (software ) colabora na construo da realidade percebida por sujeitos em interao, bem como o processo de significao. Orientamos o presente estudo em duas direes:

Aguinaldo Gomes de Souza


Identificacion biologica de repeticiones en secuencias de ADN del genoma humano  

E-print Network

Identificaci´on biol´ogica de repeticiones en secuencias de ADN del genoma humano Marcos A. Foglino caracteres como medio de representaci´on. En particular, el ADN es representado como una secuencia de ADN, es algo de relevante importancia hoy en d´ia. Con el objetivo de aplicar los conceptos

Becher, Verónica


The Emergence and Development of Classical Saxophone Repertoire in Costa Rica  

E-print Network

..................................................................................................................................... 14 A. Carlos Castro, Como un Rio for saxophone and piano .................................................................. 15 B. Analysis of the composition... for Saxophone and Orchestra in 1973; Castro wrote, Como un Ro,1 a composition for alto saxophone and piano in 1989; Mora was commissioned to write Dilogos,2 a chamber music composition for soprano saxophone and multiple percussion in 1994; and Camacho wrote...

Valerio, Jose Javier




Microsoft Academic Search

RESUMEN El procesamiento de imgenes es una herramienta comn para estudiar proble- mas cientficos en muchas reas diferentes, tales como la imagenologa biomdica, televisin, las publicaciones electrnicas, tales como las pginas WEB y la multi- media. Existen muchos sistemas de tratamiento de imgenes en las universidades para la enseanza a un nivel introductorio y en el nivel de postgrado. Muchos



Propuesta de modelo financiero para crecimiento corporativo sostenible  

Microsoft Academic Search

Aspectos como la capacidad tcnica y econmica en la produccin de bienes y servicios, la gestin administrativa y financiera, y las polticas de comercializacin o mercadeo, son determinantes para el crecimiento sostenible de las organizaciones, entendido como un proceso dinmico que tiene efecto en la creacin de valor de las mismas. El objetivo fundamental de este trabajo es definir un

Giovanni E. Reyes; Andrea Briceo M



El papel de la metfora y la analoga en el modelo de la organizacin creadora de conocimiento  

Microsoft Academic Search

En el siguiente trabajo estudiaremos el papel que cumplen los recursos metafricos y analgicos en un modelo especfico perteneciente al campo de las ciencias de la administracin y la produccin, un modelo de gestin del saber organizacional, que es conocido como la organizacin creadora de conocimiento. Consideramos a ste como el primero en incluir en forma metdica a estas figuras

Diego Arvalo



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

Microsoft Academic Search

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

Dalia Plata de Plata


Una evaluacin del Plan de Consolidacin Integral de la Macarena (PCIM)  

Microsoft Academic Search

Este artculo presenta una descripcin de la nueva estrategia de la lucha contra las drogas implementada en Colombia desde el ao 2007. El Salto Estratgico, como ha llamado el gobierno colombiano a este programa, o la Iniciativa de Desarrollo Estratgico, como lo llama USAID (la agencia del gobierno de Estados Unidos para la ayuda a los pases en desarrollo) es

Daniel Meja; Mara Jos Uribe; Ana Mara Ibez



Las estadsticas Oficiales de Turismo: principales lagunas en el contexto nacional e internacional \\/Official Statistics of Tourism: Major Gaps in the National and International Context  

Microsoft Academic Search

En el mbito de las estadsticas de turismo se han producido notables desarrollos en los ltimos aos, tanto por parte del sector pblico como del privado. El actual sistema de estadsticas oficiales de turismo en Espaa se puede considerar como uno de los ms desarrollados en el contexto internacional pero todava persisten importantes lagunas de informacin. La comparabilidad de resultados





Microsoft Academic Search

Analizamos la evolucin del turismo hotelero en el perodo 2001-2008, en las regiones y provincias espaolas, utilizando las estadsticas de pernoctaciones hoteleras como indicador. Presentamos una sntesis de resultados de varios modelos economtricos del turismo regional en Espaa, tanto en lo que respecta a los factores que influyen en el desarrollo turstico como al impacto que el turismo tiene en

M. C. Guisan; E. Aguayo




Microsoft Academic Search

A partir de la dcada de 1980, el patrimonio cultural comienza a ser percibido no slo por su dimensin histrica y cultural, sino tambin como fuente de riqueza y motor de desarrollo econmico, significando que su uso puede y debe ser rentable. Hace poco ms de un cuarto de siglo que en Extremadura se puede hablar de turismo como recurso

Javier Snchez Gonzlez; Jos Antonio Folgado Fernndez; Jos Manuel Hernndez Mogolln



La aventura de la fisica  

Microsoft Academic Search

Con la intencion de realizar una pequena aportacion en la celebracion del ano 2005, proclamado como Ano Internacional de la Fisica, el cuerpo academico de Particulas, Campos y Astrofisica de la Universidad Autonoma de Zacatecas presenta un pequeno esbozo de los trabajos realizados por Einstein en 1905, asi como un conjunto de ensayos sobre electrodinamica clasica, el grupo de Lorentz,

Andrey Chubykalo; Valeri Dvoeglazov; Augusto Espinoza; Alejandro Gutierrez



Ensayo sobre equilibrio general computable: Teora y aplicaciones  

Microsoft Academic Search

Este documento de trabajo presenta un resumen de la literatura conceptual y aplicada sobre modelos de equilibrio general computables (EGC). Se examinan las principales caractersticas de los EGC, las formas en que se construyen, los datos requeridos y mtodos de calibracin, as como sus ventajas y desventajas. Luego se discuten sus principales aplicaciones tanto en el mundo como en Chile.

Ral ORyan; Carlos J. de Miguel; Sebastin Miller



Metodologa para el estudio de mercado de los productos de importacin agrcolas, pecuarios y sus transformados en el sector emergente del municipio Holgun  

Microsoft Academic Search

El proceso de revitalizacin del sector productivo en el municipio de Holgun se inici el 27 de Mayo del 2007, a partir de las orientaciones de las autoridades del territorio sobre el mismo. Teniendo como referencia los cuatros elementos bsicos a desarrollar tales como el incremento de las exportaciones, disminucin de las Importaciones, elevacin de la productividad del trabajo y

Gelmar Garca Vidal; Mirna Lzara Gonzlez Velzquez




Microsoft Academic Search

RESUMEN En el presente estudio se analiza el apoyo social como un recurso protector para el ajuste de los adolescentes. Concretamente, se estudian tanto los efectos directos como los mediadores del apoyo social entre las caractersticas de funcionamiento y comunicacin familiar y el consumo de sustancias de los adolescentes. Con este objetivo, 431 chicos y chicas de 15 a 17

Teresa Isabel Jimnez; Gonzalo Musitu; Sergio Murgui



Tecnologa de informacin e innovacin. Factores clave de la competitividad en las pequeas y medianas empresas  

Microsoft Academic Search

En el presente trabajo se muestran algunas polticas ejecutadas por el gobierno nacional, en funcin de im- pulsar el desarrollo cientfico y tecnolgico del pas, as como las principales limitaciones que presentan las peque- as y medianas empresas (pymes) para acceder a las tecnologas de informacin y comunicacin, tomando como base los resultados de un diagnstico efectuado a 8 pymes

Leal Morantes; Miraidy Elena


To HL Collection > Berkeley, Basement Official  

E-print Network


O'Mahony, Donal E.


REDES-Revista hispana para el anlisis de redes sociales Vol.6,#7, Junio 2009  

E-print Network

REDES- Revista hispana para el análisis de redes sociales Vol.6,#7, Junio 2009 http://revista-redes propone devolverle a la relación social su importancia como unidad básica de las redes sociales, y explorar lo que constituye su "sustancia" considerada aquí como el "motivo" de las relaciones. Las redes

Boyer, Edmond


(DOCFRADIS 1201) Estrategia publicitaria del minorista en las redes sociales. Factores que motivan las compras en la web 2.0  

Microsoft Academic Search

El uso de las redes sociales, como estrategia publicitaria del minorista, favorece la comunicacin interactiva de la marca y sus productos y motiva las compras, en la web 2.0, producindose una revolucin en el paradigma estimulo-respuesta del siglo XXI. El trabajo analiza la potencialidad de la interactividad como estrategia de marca en las redes sociales e identifica los factores clave

Ines Kster Boluda; Natalia Vila Lpez; Asuncin Hernndez Fernndez




Microsoft Academic Search

Tendo em vista os recentes avanos da cincia, sobretudo na rea de manipulao gentica, a questo da clonagem humana surge como um dos grandes desafios a ser encarado. Nesse trabalho buscamos fazer uma anlise no s jurdica, mas tambm tcnica, tica e moral do tema, tendo como ponto de partida um estudo sobre a Biotica, passando pelo surgimento do Biodireito

Bernardo Abreu de Medeiros


UNIVERSIDAD NACIONAL AUTNOMA DE MXICO Nombre del acervo o coleccin: Deporte y Ciencias Aplicadas  

E-print Network

UNIVERSIDAD NACIONAL AUT?NOMA DE M?XICO DGADyR Nombre del acervo o colección: Deporte y Ciencias disciplinas deportivas que se practican en la UNAM, así como las ciencias aplicadas como psicología

Islas, León


Criana: objeto a liberado?  

Microsoft Academic Search

* RESUMO: Lacan (1968-69) abordou a criana como objeto a liberado. Assim, ela cap- turada no gozo, drama em torno do qual a famlia se estrutura. Tais formulaes so questionadas no texto que discute o lugar da criana como objeto de gozo nos tempos atuais. Parte-se da discusso sobre a sociedade da globalizao, cuja lgica se orienta para a

Glaucineia Gomes de Lima



Foreword from the Associate Editor [Historical Corner  

Microsoft Academic Search

The Pavia University is celebrating the 650th anniversary of its foundation. In the framework of many different initiatives, a book, a workshop, and an exhibition were organized as part of the solemn celebrations Pavia 1878, dedicated to Alessandro Volta (Como, Italy, February 18, 1745 - Como, Italy, March 5, 1827). For 41 years - from 1778 up to 1819 -

Giuseppe Pelosi



Entre a utopia e o ceticismo: as potencialidad es do s dirios virtuais no mercado de comunicao nacional  

Microsoft Academic Search

Resumo Os dirios virtuais so elementos-chave para compreender como se articulam as profecias otimistas e pessimistas em consequncia da emergncia de novas mdias e formatos no mercado de comuni cao nacional. Sob a tica da remediao , apresentam- se como uma alternativa unilateralidade imposta pelos meios tradicionais ao introduzirem uma narrativa expressiva similar ao jornalismo literrio aportada no ambiente

Mariana Della; Dea Tavernari


Las representaciones fcticas y cognitivas del relato de entrevistas biogrficas : un anlisis reticular del discurso  

Microsoft Academic Search

Este artculo trata de identificar y relacionar las dimensiones fcticas y cognitivas de un relato biogrfico, entendido como una representacin narrativa. El entrevistado construye su narracin entreverando ambas dimensiones a lo largo del relato. Este artculo propone un mtodo de anlisis reticular del discurso como un procedimiento eficaz para poner de relieve y relacionar ambas dimensiones. A partir de teoras

Carlos Lozares Colina




Microsoft Academic Search

El ACD se encuadra en el marco terico del Anlisis del Discurso, teora que otorga al discurso la dimensin de prctica social. En el ACD se explota esta vertiente social del uso del lenguaje, profundizando en las relaciones sociales e ideolgicas que se establecen entre el texto y el contexto. El discurso se concibe como un concepto tridimensional: discurso como

Raquel Rubio Martn



Microsoft Academic Search

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

Jos Manuel Barrio Terol


As contradies presentes no discurso do atual Programa Nacional de Agroenergia  

Microsoft Academic Search

O Estado retomou as polticas agroenergticas lanando, em 2005, o Programa Nacional de Agroenergia, este programa margeado pelo iderio do desenvolvimento sustentvel. Esse enfoque muitas vezes funciona como uma ideologia, ou seja uma arma para o exerccio do poder do Estado. Sendo assim, o objetivo deste estudo analisar a origem do poder simblico do Estado e entender como

Simone Pereira De Carvalho; Joel Orlando Bevilaqua Marin




Microsoft Academic Search

? Resumo - O objetivo deste trabalho a investigao da crtica feita por Plato poesia mimtica e a todo gnero imitativo, nos livros II, III e X da Repblica, utilizando eventualmente trechos de outros dilogos. Num primeiro registro, cabe uma anlise das causas dessa censura poesia que imitao como conseqncia da Teoria das Idias, e como

Adriana Natrielli



Microsoft Academic Search

RESUMO: Com base na Lingstica Sistmico-Funcional e na Teoria da Estruturao, exploramos o conceito de agncia no discurso de professores de ingls como LE em um frum online no Orkut. Procuramos revelar ideologias materializadas nas postagens dos professores e ilustrar como caractersticas sociais dialogam com o discurso. Focalizamos o tpico 'bad student' em termos de transitividade - para estabelecer papis

Maria Elizabete; Villela SANTIAGO; JL MEURER


Esto os Portugueses a ?votar com os ps?? Alguma evidncia emprica  

Microsoft Academic Search

Como sabido, os movimentos migratrios escala regional so fruto de uma diversidade de factores. Sendo entendidos como uma reaco, por parte da populao, a desvantagens (inaceitveis) de natureza econmica apresentadas pela regio de origem, estes movimentos demogrficos constituem um importante exemplo da chamada ?votao com os ps?. Claramente, a inexistncia (ou a mera ineficcia) de polticas regionais que

Antnio Caleiro




Microsoft Academic Search

RESUMO Introduo: o vrus da hepatite B foi reconhecido como possvel de transmisso ocupacional bem antes do vrus da imunodeficincia adquirida (HIV), porm, foi com o advento da aids que os trabalhadores de enfermagem passaram a se preocupar com a sua prtica, assim como com a utiliza- o de medidas preventivas. Apesar de os vrus da hepatite B e C

Elucir Gir; Marinsia A Prado; Silvia RMS Canini; Miyeko Hayashida


A importncia da presena do farmacutico na farmcia, na resoluo de problemas bsicos da sade The importance of the pharmaceutist presence in the drugstore, in resolution of basic problems of health  

Microsoft Academic Search

SINOPSE Objetivo: Avaliar o efeito da presena do farmacutico no estabelecimento, no s como cumprimento de uma lei federal, mas como forma de melhor orientar a populao na busca da medicao com prescrio mdica. Material e mtodos: Foram visitadas 37 farmcias na cidade de Porto Alegre, RS, no primeiro semestre de 1999. Quatro acadmicos de Medicina visitaram isoladamente cada uma

Geraldo Pereira Jotz


Propriedades de sade de Spirulina spp  

Microsoft Academic Search

Espcies de Spirulina tm sido utilizadas mundialmente na alimentao humana e animal, assim como na ob- teno de aditivos utilizados em formas farmacuticas e alimentos. Esta bactria uma fonte rica em protenas, vitaminas, aminocidos essenciais, minerais, cidos gra- xos poliinsaturados e outros nutrientes, sendo seu prin- cipal uso como suplemento alimentar. As propriedades nutricionais de Spirulina spp. tm sido


Folleto informativo de tecnologa de aguas residuales  

Microsoft Academic Search

La desinfeccin es considerada como el principal mecanismo para la desactivacin o destruccin de organismos patgenos con el fin de prevenir la dispersin de enfermedades transmitidas a travs del agua, tanto a los usuarios aguas abajo como al ambiente. Es muy importante que el agua residual sea tratada adecuadamente antes de realizarse las actividades de desinfeccin para que la accin

Organismo Enfermedad Causada


Utopia e Fico Cientfica: a \\  

Microsoft Academic Search

Minha gerao, cuja infncia e adolescncia transcorreram nas dcadas de 1960 e 1970, assistiu na TV e no cinema muita fico cientfica. De certo modo, minhas expectativas sobre o futuro foram moldadas por sries como Jornada nas Estrelas e filmes como Guerra nas Estrelas. As narrativas de fico cientfica proliferaram ao nosso redor. E nelas, ingenuamente, eu procurei respostas para

Marcos Lobato Martins



Microsoft Academic Search

RESUMO: A comunicao aqui proposta aponta como linha de leitura da poesia de Sophia de Mello Breyner Andresen uma reflexo em torno da presena de ecos da lrica horaciana e da doutrina epicurista, seja como ponto declarado de divergncia, de encontro e acordo, ou mesmo em intertextualidade com autores que trabalharam idias e valores daquela doutrina, principalmente Pessoa - Reis.

Virgnia Bazzetti Boechat


Consideraes sobre tcnicas para a implementao de skeletal animation em Jogos 3D  

Microsoft Academic Search

Neste artigo examinamos uma tecnologia de animao conhecida como skeletal animation baseada na juno hierrquica das partes que formam o modelo a ser animado. Esta tecnologia pode ser aplicada a diversos domnios onde a animao de modelos necessria, como a anlise e simulao fsica de estruturas hierrquicas simples e animaes artsticas de modelos e entretenimento (jogos de computador). Para

Mrcio da Silva Camilo; Bernardo Nogueira; Soares Hodge; Rodrigo Pereira Martins; Alexandre Sztajnberg


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

E-print Network

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

Rodrigues, Luís E.T.


Uma Estratgia para a Visualizao do Cu e seus Elementos em Jogos  

Microsoft Academic Search

Resumo Uma visualizao convincente do cu e seus elementos (nuvens, sol, lua, estrelas) fundamental para agregar realismo aos jogos que usam cenrios em ambientes externos. Como uma simulao precisa desses efeitos pode ser computacionalmente muito cara, muitos jogos empregam artifcios, visualizando o cu como texturas mapeadas em esferas e caixas envolventes. Neste trabalho, apresentamos uma estratgia simples para simular



Fractales en ciencia y arte. Discusiones posibles en el marco de las concepciones realistas y antirrealistas en la Filosofa de la Ciencia.  

E-print Network

un lado, la concepción realista de la ciencia, y un autor clave: Ian Hacking en textos clásicos certeza si tanto las entidades como las teorías, son verdaderas o falsas. Para Hacking, la realidad y la torno a fractales, como punto de encuentro entre la ciencia y el arte. Ian Hacking: Un realista muy

Paris-Sud XI, Université de


Tutorial de Pesquisa Bibliogrfica Este Tutorial faz parte da programao de treinamentos  

E-print Network

dados nacionais e internacionais que contêm artigos de revistas, livros, teses e outros documentos. Como primárias. Fontes primárias: São documentos com texto completo, como: livros, artigos com texto completo e, monografias, livros e capítulos de livros, trabalhos apresentados em congressos ou conferências, relatórios

Paraná, Universidade Federal do



E-print Network

aleatoriedad tratada como un recurso computacional juega un rol fundamental en el diseño de algoritmos, en la computacional posibilita soluciones algorítmicas eficientes a problemas cuyas soluciones determininistas polinomial. Ser capaz de modelar la aleatoreidad como un recurso computacional, asociarle clases de problemas

Rapaport, Iván


Aprendizagem colaborativa com suporte computacional: Uma perspectiva histrica  

Microsoft Academic Search

A Aprendizagem Colaborativa com Suporte Computacional (CSCL) um ramo emergente das cincias da aprendizagem que estuda como as pessoas podem aprender em grupo com o auxlio do computador. Como ser visto neste artigo, at mesmo esta simples sentena esconde uma complexidade considervel. A interao da aprendizagem com a tecnologia revela-se bastante complexa. A incluso da colaborao, da mediao pelo

Gerry Stahl; Timothy Koschmann; Dan Suthers




Esse artigo descreve como jovens religiosos e autoridades religiosas de sua comunidade compreendem a sexualidade, considerando suas experincias pessoais e como membros de comunidades religiosas. A anlise pretende contribuir para que polticas pblicas dedicadas promoo da sade sexual da juventude considerem a religiosidade, no contexto de um estado laico e da promoo do direito preveno. Foram realizadas 26 entrevistas abertas e semidirigidas em diferentes comunidades da regio metropolitana da cidade de So Paulo (comunidades catlicas, da umbanda, do candombl e de diferentes denominaes evanglicas) sobre iniciao sexual, casamento, gravidez, contracepo e preveno das DST/Aids, homossexualidade, aborto e direitos humanos. Observou-se como jovens e autoridades religiosas convivem com a tenso entre tradio e modernidade e os distintos discursos sobre a sexualidade. Como sujeitos religiosos (do discurso religioso) e sujeitos sexuais (de discursos sobre sexualidade), devem ser incorporados pelos programas como sujeitos de direito nos termos de sua religiosidade. PMID:21886456

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



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

PubMed Central

Esse artigo descreve como jovens religiosos e autoridades religiosas de sua comunidade compreendem a sexualidade, considerando suas experincias pessoais e como membros de comunidades religiosas. A anlise pretende contribuir para que polticas pblicas dedicadas promoo da sade sexual da juventude considerem a religiosidade, no contexto de um estado laico e da promoo do direito preveno. Foram realizadas 26 entrevistas abertas e semidirigidas em diferentes comunidades da regio metropolitana da cidade de So Paulo (comunidades catlicas, da umbanda, do candombl e de diferentes denominaes evanglicas) sobre iniciao sexual, casamento, gravidez, contracepo e preveno das DST/Aids, homossexualidade, aborto e direitos humanos. Observou-se como jovens e autoridades religiosas convivem com a tenso entre tradio e modernidade e os distintos discursos sobre a sexualidade. Como sujeitos religiosos (do discurso religioso) e sujeitos sexuais (de discursos sobre sexualidade), devem ser incorporados pelos programas como sujeitos de direito nos termos de sua religiosidade. PMID:21886456

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



Impact of Age on Clinicopathological Features and Survival of Patients with Noncardia Gastric Adenocarcinoma  

PubMed Central

Purpose Gastric cancer often occurs in the elderly but is uncommon in young individuals. Whether young patients have different clinical behaviors and outcomes from those of older patients remain unclear. Materials and Methods We identified 1,366 cases of newly diagnosed noncardia gastric adenocarcinoma from the Kaiser Permanente Northern California Cancer Registry between 2000 and 2010. We then compared the clinicopathological features and survival among the different age groups. Results The male : female ratio differed significantly between the younger and older patient groups (0.84 in age <50 years vs. 1.52>60 years, P<0.01). More younger patients were Hispanic (54% patients <40 years vs. 19% patients ?70 years, P<0.0001), while more older patients were Caucasian (49% patients ?70 years vs. 15% patients <40 years; P<0.0001). The diffuse/mixed histological type was more prevalent in younger patients (70% patients <40 years vs. 27% patients ?70 years; P<0.0001), whereas the intestinal type was more frequent in older patients (71% in patients ?70 years vs. 30% in patients <40 years; P<0.0001). Poorly differentiated adenocarcinoma was more common in the younger patients (80% in patients <40 years vs. 60% in patients ?70 years; P=0.016). Survival rates at 1, 2, and 5 years gradually declined with increasing age (overall P=0.0002). Conclusions Young patients with gastric cancer had more aggressive disease but higher overall survival rates than older patients. Younger Hispanic patients and older Caucasian patients were more likely to be diagnosed with gastric cancer. These differences may be due to biological predisposition and/or environmental exposure. PMID:25580355

Bautista, Marita C; Jiang, Sheng-Fang; Armstrong, Mary Anne; Postlethwaite, Debbie



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



Improving Care for Older Adults: A Model to Segment the Senior Population  

PubMed Central

Context: Risk stratification and tailored interventions are key population-level care management strategies among older adults, whose needs range from screening and prevention to end-of-life care. Objective: To validate the Senior Segmentation Algorithm, a tool using administrative and clinical data from the electronic health record to identify each member aged 65 years and older as belonging to 1 of 4 Care Groups with similar needs: those without chronic conditions, with one or more chronic conditions, with advanced illness or end-organ failure, or with extreme frailty or nearing the end of life. Design: Multiple validation methods. Main Outcome Measures: Concordance with physician judgment, stability of segmentation over time, convergence with mortality, hospitalization, and readmission rates, and costs of care. Results: Concordance of the algorithm with physician-assessed segmentation of 1615 Medicare recipients was 85%. After 1 year, approximately 85% of 86,140 surviving seniors remained in the same care group; 3.9% moved to a lower need group; and 11% moved to a higher need group. Six-month and 12-month mortality rates varied substantially across care groups. The algorithm performed similarly to the likelihood of hospitalization score in predicting hospitalization and readmissions. Conclusions: The Senior Segmentation Algorithm accurately identifies older adults in care groups with similar needs, trajectories, and utilization patterns. It is being implemented in all Kaiser Permanente Regions, with the goal of determining key elements of care for members in each group. In addition, future efforts will aim to slow progression to higher need care groups and to identify necessary improvements in delivery system design. PMID:24937151

Zhou, Yi Yvonne; Wong, Warren; Li, Hui



Determinants of serum polychlorinated biphenyls and organochlorine pesticides measured in women from the child health and development study cohort, 1963-1967.  

PubMed Central

We examined predictors of organochlorine concentrations in serum specimens from women who were pregnant in the 1960s and participated in the Child Health and Development Study in the San Francisco Bay Area of California. That study enrolled pregnant women at the Kaiser-Permanente Medical Facilities, conducted interviews, and drew blood specimens; these specimens were centrifuged and the resulting serum specimens were frozen and placed in long-term storage. For the current investigation, organochlorines were measured by dual-column GC-electron capture detection in specimens collected in 1963-1967 from 399 pregnant women during the second and third trimesters. Using multiple linear regression models adjusted for serum lipids, we evaluated factors predicting concentrations of 11 polychlorinated biphenyl (PCB) congeners, their sum, and several pesticides and metabolites. Variables evaluated were age, race, place of birth, date of blood draw, body mass index, occupation, past residence on a farm, parity, and duration of pregnancy at blood draw. Concentrations of highly chlorinated PCBs and the sum of the PCBs increased with age. Concentrations of certain PCB congeners, as well as the sum, were significantly higher among nonwhites and increased with calendar date of blood draw. (italic)p,p(/italic) -DDT and (italic)p,p(/italic) -DDE concentrations were about 50% higher for nonwhites compared with whites and for those born in California or the southeastern United States versus elsewhere in the United States. Higher body mass index was associated with lower concentrations of several PCBs and (italic)p,p(/italic) -DDE but with higher heptachlor epoxide and DDT levels. The increase in use of PCBs during the 1960s is apparently detectable as increasing concentrations in maternal sera between 1963 and 1967. Marked racial and regional differences in serum pesticide levels were likely caused by geographic variation in previous agricultural and vector-control uses. The relationship to body mass index appears to be complex. PMID:12117636

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



Pneumococcal Conjugate Vaccines and Otitis Media: An Appraisal of the Clinical Trials  

PubMed Central

Streptococcus pneumoniae is the predominant otitis media pathogen and its prevention through effective vaccination could diminish childhood illness and antibiotic use. This paper reviews 5 pneumococcal conjugate vaccine (PCV) trials that used otitis media as an endpoint: Northern California Kaiser Permanente (NCKP; vaccine, 7-valent PCV [PCV7]-CRM); Finnish Otitis Media (FinOM; vaccines, PCV7-CRM or PCV7-OMPC); Native American Trial (vaccine, PCV7-CRM); Pneumococcal Otitis Efficacy Trial (POET; vaccine, 11-valent PCV [PCV11]-PD). For the microbiological endpoint, vaccine efficacy against vaccine-serotype pneumococcal otitis media was about 60% across trials. Against the clinical endpoint of all episodes, vaccine efficacy was 7% (PCV7-CRM/NCKP), 6% (PCV7-CRM/FinOM), ?1% (PCV7-OMPC/FinOM), and ?0.4% (PCV7-CRM/Native American Trial); 34% against first episodes of ear, nose, and throat specialist-referral cases (PCV11-PD/POET). Both follow-up through 2 years of age, for the 5 trials, and long-term follow-up, for PCV7-CRM/NCKP and PCV7-CRM/FinOM, demonstrated greater vaccine efficacy against recurrent AOM and tympanostomy-tube placement, suggesting that vaccination against early episodes of AOM may prevent subsequent episodes of complicated otitis media. Although study designs varied by primary endpoint measured, age at follow-up, source of middle-ear fluid for culture, case ascertainment, and type of randomization, each clinical trial demonstrated vaccine efficacy against microbiological and/or clinical otitis media. PMID:22701486

Fletcher, Mark A.; Fritzell, Bernard



Cluster radioactive decay within the preformed cluster model using relativistic mean-field theory densities  

NASA Astrophysics Data System (ADS)

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. CPRVCAN0556-281310.1103/PhysRevC.39.1992 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 P0emp from the experimental data on both the ?- and exotic cluster-decays, specifically of parents in the trans-lead region having doubly magic Pb208 or its neighboring nuclei as daughters. Interestingly, the RMF-densities-based nuclear potential supports the concept of preformation for both the ? and heavier clusters in radioactive nuclei. P0?(emp) for ? decays is almost constant (~10-2-10-3) for all the parent nuclei considered here, and P0c(emp) for cluster decays of the same parents decrease with the size of clusters emitted from different parents. The results obtained for P0c(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.



Health-Related Quality of Life Among Long-Term Rectal Cancer Survivors With an Ostomy: Manifestations by Sex  

PubMed Central

Purpose Intestinal stomas can pose significant challenges for long-term (? 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL). Patients and Methods This was a matched cross-sectional study of long-term RC survivors conducted in three Kaiser Permanente regions. The mailed questionnaire included the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-Ostomy) and Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2). Groups surveyed were permanent ostomates (cases) and those who did not require an ostomy (controls). RC survivors were matched on sex, age, and time since diagnosis. Comparisons between groups used regression analysis with adjustment for age, comorbidity score, history of radiation therapy, income, and work status. Results Response rate was 54% (491 of 909). Cases and controls had similar demographic characteristics. On the basis of the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared with controls, while only female cases reported significantly worse overall HRQOL and psychological well-being. For younger females (< age 75 years), ostomy had a greater impact on physical well-being compared with older females. Based on the SF-36v2, statistically significant and meaningful differences between female cases and controls were observed for seven of the eight scales and on the physical and mental component summary scores. Conclusion Men and women report a different profile of challenges, suggesting the need for targeted or sex-specific interventions to improve HRQOL in this population. This may include focus on physical HRQOL for female ostomy survivors younger than age 75. PMID:19720920

Krouse, Robert S.; Herrinton, Lisa J.; Grant, Marcia; Wendel, Christopher S.; Green, Sylvan B.; Mohler, M. Jane; Baldwin, Carol M.; McMullen, Carmit K.; Rawl, Susan M.; Matayoshi, Eric; Coons, Stephen Joel; Hornbrook, Mark C.



Immunohistochemical Expression of ERG in the Molecular Epidemiology of Fatal Prostate Cancer Study  

PubMed Central

Background Gene fusions between the ERG transcription factor and the androgen-regulated gene TMPRSS2 occur in a subset of prostate cancers and contribute to transformation of prostatic epithelial cells. Prior reports have used FISH or quantitative PCR (QPCR) to determine the presence of TMPRSS2-ERG fusions or ERG expression, respectively. Recently, several groups have reported on immunohistochemistry (IHC) to measure ERG expression, which is much more readily performed in clinical practice. However, the prior studies examining ERG expression by IHC had small samples sizes or they failed to clarify the association of ERG protein expression with important clinico-pathological features or prostate cancer-specific mortality. Methods: To address these deficits, we evaluated ERG expression by IHC in 208 radical prostatectomy samples from the Kaiser Permanente Molecular Epidemiology of Fatal Prostate Cancer (MEFPC) study, a case-control study of prostate-cancer specific mortality. Results Nuclear ERG expression was seen in neoplastic prostate epithelia in 49 of the samples (23.7%). ERG expression in tumor cells was associated with higher tumor stage (OR=2.0, 95% confidence interval 1.04.0, p value= 0.04). ERG immunoreactivity was positively associated with prostate cancer-specific mortality, although the confidence interval was wide (OR=1.9, 95% confidence interval 0.884.0, p value =0.10). Conclusions Our results demonstrate that ERG protein expression is readily quantifiable with an existing commercial antibody. Evaluating ERG protein expression may improve our ability to identify the subset of more aggressive, invasive prostate cancers. PMID:23661613

Weinmann, Sheila; Van Den Eeden, Stephen K.; Haque, Reina; Chen, Chuhe; Richert-Boe, Kathryn; Schwartzman, Jacob; Gao, Lina; Berry, Deborah L.; Kallakury, Bhaskar V.S.; Alumkal, Joshi J.



A 10-year review of quality improvement monitoring in pain management: recommendations for standardized outcome measures.  


Quality measurement in health care is complex and in a constant state of evolution. Different approaches are necessary depending on the purpose of the measurement (e.g., accountability, research, improvement). Recent changes in health care accreditation standards are driving increased attention to measurement of the quality of pain management for improvement purposes. The purpose of this article is to determine what indicators are being used for pain quality improvement, compare results across studies, and provide specific recommendations to simplify and standardize future measurement of quality for hospital-based pain management initiatives. Pain management quality improvement monitoring experience and data from 1992 to 2001 were analyzed from 20 studies performed at eight large hospitals in the United States. Hospitals included: the University of Wisconsin Hospital and Clinics, Madison; Texas Medical Center, Houston; McAllen Medical Center, McAllen, TX; San Francisco General Hospital, San Francisco; Rush-Presbyterian-St. Luke's Medical Center and Northwestern Memorial Hospital, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York; and Kaiser Sunnyside Medical Center of Kaiser Permanente Northwest, Clackamas, OR. Analyses of data led to consensus on six quality indicators for hospital-based pain management. These indicators include: the intensity of pain is documented with a numeric or descriptive rating scale; pain intensity is documented at frequent intervals; pain is treated by a route other than intramuscular; pain is treated with regularly administered analgesics, and when possible, a multimodal approach is used; pain is prevented and controlled to a degree that facilitates function and quality of life; and patients are adequately informed and knowledgeable about pain management. Although there are no perfect measures of quality, longitudinal data support the validity of a core set of indicators that could be used to obtain benchmark data for quality improvement in pain management in the hospital setting. PMID:12454804

Gordon, Debra B; Pellino, Teresa A; Miaskowski, Christine; McNeill, Jeanette Adams; Paice, Judith A; Laferriere, Daniel; Bookbinder, Marilyn



Impacts of Evidence-Based Quality Improvement on Depression in Primary Care: A Randomized Experiment  

PubMed Central

CONTEXT Previous studies testing continuous quality improvement (CQI) for depression showed no effects. Methods for practices to self-improve depression care performance are needed. We assessed the impacts of evidence-based quality improvement (EBQI), a modification of CQI, as carried out by 2 different health care systems, and collected qualitative data on the design and implementation process. OBJECTIVE Evaluate impacts of EBQI on practice-wide depression care and outcomes. DESIGN Practice-level randomized experiment comparing EBQI with usual care. SETTING Six Kaiser Permanente of Northern California and 3 Veterans Administration primary care practices randomly assigned to EBQI teams (6 practices) or usual care (3 practices). Practices included 245 primary care clinicians and 250,000 patients. INTERVENTION Researchers assisted system senior leaders to identify priorities for EBQI teams; initiated the manual-based EBQI process; and provided references and tools. EVALUATION PARTICIPANTS Five hundred and sixty-seven representative patients with major depression. MAIN OUTCOME MEASURES Appropriate treatment, depression, functional status, and satisfaction. RESULTS Depressed patients in EBQI practices showed a trend toward more appropriate treatment compared with those in usual care (46.0% vs 39.9% at 6 months, P = .07), but no significant improvement in 12-month depression symptom outcomes (27.0% vs 36.1% poor depression outcome, P = .18). Social functioning improved significantly (mean score 65.0 vs 56.8 at 12 months, P = .02); physical functioning did not. CONCLUSION Evidence-based quality improvement had perceptible, but modest, effects on practice performance for patients with depression. The modest improvements, along with qualitative data, identify potential future directions for improving CQI research and practice. PMID:16836631

Rubenstein, Lisa V; Meredith, Lisa S; Parker, Louise E; Gordon, Nancy P; Hickey, Scot C; Oken, Carole; Lee, Martin L



Disparities in Stroke Rehabilitation: Results of a Study in an Integrated Health System in Northern California  

PubMed Central

Objective To determine whether there are disparities in postacute stroke rehabilitation based on type of stroke, race/ethnicity, sex/gender, age, socioeconomic status, geographic region, or service area referral patterns in a large integrated health system with multiple levels of care. Design Cohort study tracking rehabilitation services for 365 days after acute hospitalization for a first stroke. Setting The Northern California Kaiser Permanente Health System (approximately 3.3 million membership population) Participants A total of 11,119 patients hospitalized for acute stroke from 1996 to 2003. The cohort includes patients discharged from acute care after a stroke. Postacute care rehabilitation services were evaluated according to the level of care ever-received within the 365 days after discharge from acute care, including inpatient rehabilitation hospital (IRH), skilled nursing facility (SNF), home health and outpatient, or no rehabilitation services. Interventions Not applicable. Main Outcome Measure Service delivery. Results Patients discharged to an IRH had longer lengths of stay in acute care. Patients with hemorrhagic stroke were less likely to be treated in an IRH. Patients whose highest level of rehabilitation was SNF were older and more likely to be women. After adjusting for age and other covariates, women were less likely to go to an IRH than men. Asian and black patients were more likely than white patients to be treated in an IRH or SNF. Also more likely to go to an IRH were patients from higher socioeconomic groups, from urban areas, and from geographic areas close to the regional rehabilitation hospital. Conclusions These results suggest variation in care delivery and extent of postacute care based on differences in patient demographics and geographic factors. Results also varied over time. Some minority populations in this cohort appeared to be more likely to receive IRH care, possibly because of disease severity, family support systems, cultural factors, or differences in referral patterns. PMID:19627870

Sandel, M. Elizabeth; Wang, Hua; Terdiman, Joseph; Hoffman, Jeanne M.; Ciol, Marcia A.; Sidney, Steven; Quesenberry, Charles; Lu, Qi; Chan, Leighton



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 inferencenamely, propensity score and marginal structural models (MSMs), which have not been used before in studies of cancer survival and Chinese herbal medicine. PAM+V combined with conventional therapy, compared with conventional therapy alone, reduced the risk of death in stage I by 95%, stage II by 64%, stage III by 29%, and stage IV by 75%. There was no significant difference between short-term and long-term PAM+V. Combining PAM+V with conventional therapy improved survival, compared with conventional therapy alone, suggesting that prospective trials combining PAM+V with conventional therapy are justified. PMID:21964510

McCulloch, Michael; Broffman, Michael; van der Laan, Mark; Hubbard, Alan; Kushi, Lawrence; Abrams, Donald I.; Gao, Jin; Colford, John M.



Evaluation of the incidence of herpes zoster after concomitant administration of zoster vaccine and polysaccharide pneumococcal vaccine.  


In 2009, a revision to the zoster vaccine package insert was approved stating that the zoster vaccine and the pneumococcal vaccine should not be given concurrently because concomitant use resulted in reduced immunogenicity of the zoster vaccine. We conducted an observational study to evaluate if concomitant vaccination reduces the protective effect of the zoster vaccine. The study was conducted in Kaiser Permanente Southern California. Incidence of herpes zoster (HZ) after vaccination with a zoster vaccine in the population receiving both vaccines on the same day was compared to that in the population receiving a pneumococcal vaccine within one year to 30 days prior to zoster vaccine. Vaccinations and incident HZ cases were identified by electronic health records. The hazard ratio for incident HZ associated with concomitant vs. nonconcomitant vaccination was estimated using the Cox proportional hazard model. There were 56 incident HZ cases in the concomitant vaccination cohort and 58 in the nonconcomitant vaccination cohort, yielding a HZ incidence of 4.54 (95% confidence interval [CI], 3.43-5.89) and 4.51 (95% CI, 3.42-5.83) per 1000 person-years, respectively. The hazard ratio comparing the incidence rate of HZ in the two cohorts was 1.19 (95% CI, 0.81-1.74) in the adjusted analysis. In this study, we found no evidence of an increased risk of HZ in the population receiving zoster vaccine and pneumococcal vaccine concomitantly. The revision of the product information needs to be carefully assessed to avoid introducing barriers to patients and providers who are interested in these two important vaccines. PMID:21435407

Tseng, Hung Fu; Smith, Ning; Sy, Lina S; Jacobsen, Steven J



Common polymorphisms of ALOX5 and ALOX5AP and risk of coronary artery disease  

PubMed Central

Recent human genetic studies suggest that allelic variants of leukotriene pathway genes influence the risk of clinical and subclinical atherosclerosis. We sequenced the promoter, exonic, and splice site regions of ALOX5 and ALOX5AP and then genotyped 7 SNPs in ALOX5 and 6 SNPs in ALOX5AP in 1,552 cases with clinically significant coronary artery disease (CAD) and 1,583 controls from Kaiser Permanente including a subset of participants of the coronary artery risk development in young adults study. A nominally significant association was detected between a promoter SNP in ALOX5 (rs12762303) and CAD in our subset of white/European subjects (adjusted odds ratio per minor allele, log-additive model, 1.32; P = 0.002). In this race/ethnic group, rs12762303 has a minor allele frequency of 15% and is tightly linked to variation at the SP1 variable tandem repeat promoter polymorphism. However, the association between CAD and rs12762303 could not be reproduced in the atherosclerosis risk in communities study (hazard rate ratio per minor allele; 1.08, P = 0.1). Assuming a recessive mode of inheritance, the association was not significant in either population study but our power to detect modest effects was limited. No significant associations were observed between all other SNPs and the risk of CAD. Overall, our findings do not support a link between common allelic variation in or near ALOX5 or ALOX5AP and the risk of CAD. However, additional studies are needed to exclude modest effects of promoter variation in ALOX5 on the risk of CAD assuming a recessive mode of inheritance. PMID:18369664

Knowles, Joshua W.; Priest, Jame s R.; Basu, Analabha; Volcik, Kelly A.; Southwick, Audrey; Tabor, Holly K.; Hartiala, Jaana; Allayee, Hooman; Grove, Megan L.; Tabibiazar, Raymond; Sidney, Stephen; Fortmann, Stephen P.; Go, Alan; Hlatky, Mark; Iribarren, Carlos; Boerwinkle, Eric; Myers, Richard; Risch, Neil; Quertermous, Thomas



Dietary guideline adherence for gastroesophageal reflux disease  

PubMed Central

Background Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disease, and the cost of health care and lost productivity due to GERD is extremely high. Recently described side effects of long-term acid suppression have increased the interest in nonpharmacologic methods for alleviating GERD symptoms. We aimed to examine whether GERD patients follow recommended dietary guidelines, and if adherence is associated with the severity and frequency of reflux symptoms. Methods We conducted a population-based cross-sectional study within the Kaiser Permanente Northern California population, comparing 317 GERD patients to 182 asymptomatic population controls. All analyses adjusted for smoking and education. Results GERD patients, even those with moderate to severe symptoms or frequent symptoms, were as likely to consume tomato products and large portion meals as GERD-free controls and were even more likely to consume soft drinks and tea [odds ratio (OR)?=?2.01 95% confidence interval (CI) 1.12-3.61; OR?=?2.63 95% CI 1.24-5.59, respectively] and eat fried foods and high fat diet. The only reflux-triggering foods GERD patients were less likely to consume were citrus and alcohol [OR?=?0.59; 95% CI: 0.35-0.97 for citrus; OR?=?0.41 95% CI 0.19-0.87 for 1?+?drink/day of alcohol]. The associations were similar when we excluded users of proton pump inhibitors. Conclusions GERD patients consume many putative GERD causing foods as frequently or even more frequently than asymptomatic patients despite reporting symptoms. These findings suggest that, if dietary modification is effective in reducing GERD, substantial opportunities for nonpharmacologic interventions exist for many GERD patients. PMID:25125219



Facilitators and Barriers to Implementing SBIRT in Primary Care in Integrated Health Care Settings.  


ABSTRACT Background: Substance abuse in the United States is a serious public health concern impacting morbidity and mortality. However, systematic screening and intervention has not been widely adopted into routine practice by health care organizations and routine screening and intervention is not currently in place for primary care at Kaiser Permanente Colorado. Therefore, a formative evaluation was conducted to explore and enhance implementation of the Substance Abuse and Mental Health Services Administration (SAMHSA) Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach in the organization. Methods: Key clinical stakeholders, including internal and family medicine physicians, primary care nurses, mental health therapists, chemical dependency clinicians, and clinic-based psychologists provided feedback. Two focus groups were also conducted with patient stakeholders; one in English and one in Spanish. Results: All clinical stakeholders promoted clinic-based psychologists to conduct brief intervention and determine referral to treatment as the optimal implementation program. Inclusion of the patient perspective also highlighted the importance of considering this perspective in implementation. Both patient groups were generally supportive of SBIRT, especially the educational value of screening questions defining healthy drinking limits, however, English-speaking patients noted privacy concerns and Spanish-speaking patients noted frequently being asked about drug or alcohol use. Organizationally, systems exist to facilitate drug and alcohol use screening, intervention, and referral to treatment. However, physician time, alignment with other priorities, and lack of consistent communication were noted potential barriers to SBIRT implementation. Conclusions: Clinicians expressed concerns about competing priorities and the need for organizational leadership involvement for successful SBIRT implementation. A unique suggestion for successful implementation is to utilize existing primary care clinic-based psychologists to conduct brief intervention and facilitate referral to treatment. Patient stakeholders supported universal screening but cultural differences in opinions and current experience were noted, indicating the importance of including this perspective when evaluating implementation potential. PMID:25127073

Rahm, Alanna Kulchak; Boggs, Jennifer M; Martin, Carmen; Price, David W; Beck, Arne; Backer, Thomas E; Dearing, James W



Toward a Trustworthy Voice: Increasing the Effectiveness of Automated Outreach Calls to Promote Colorectal Cancer Screening among African Americans  

PubMed Central

Introduction: Colorectal cancer screening rates are lower among African-American members of Kaiser Permanente Colorado (KPCO) than among members of other races and ethnicities. This study evaluated use of a linguistically congruent voice in interactive voice response outreach calls about colorectal cancer screening as a strategy to increase call completion and response. Methods: After an initial discussion group to assess cultural acceptability of the project, 6 focus groups were conducted with 33 KPCO African-American members. Participants heard and discussed recordings of 5 female voices reading the same segment of the standard-practice colorectal cancer message using interactive voice response. The linguistic palette included the voices of a white woman, a lightly accented Latina, and 3 African-American women. Results: Participants strongly preferred the African-American voices, particularly two voices. Participants considered these voices the most trustworthy and reported that they would be the most effective at increasing motivation to complete an automated call. Participants supported the use of African-American voices when designing outgoing automated calls for African Americans because the sense of familiarity engendered trust among listeners. Participants also indicated that effective automated messages should provide immediate clarity of purpose; explain why the issue is relevant to African Americans; avoid sounding scripted; emphasize that the call is for the listeners benefit only; sound personable, warm, and positive; and not create fear among listeners. Discussion: Establishing linguistic congruence between African Americans and the voices used in automated calls designed to reach them may increase the effectiveness of outreach efforts. PMID:24867548

Albright, Karen; Richardson, Terri; Kempe, Karin L; Wallace, Kristin



Feasibility of self-collection of fecal specimens by randomly sampled women for health-related studies of the gut microbiome  

PubMed Central

Background The field of microbiome research is growing rapidly. We developed a method for self-collection of fecal specimens that can be used in population-based studies of the gut microbiome. We conducted a pilot study to test the feasibility of our methods among a random sample of healthy, postmenopausal women who are members of Kaiser Permanente Colorado (KPCO). We aimed to collect questionnaire data, fecal and urine specimens from 60 women, aged 5569, who recently had a normal screening mammogram. We designed the study such that all questionnaire data and specimens could be collected at home. Results We mailed an invitation packet, consent form and opt-out postcard to 300 women, then recruited by telephone women who did not opt-out. Verbally consented women were mailed an enrollment package including a risk factor questionnaire, link to an online diet questionnaire, specimen collection kit, and instructions for collecting stool and urine. Specimens were shipped overnight to the biorepository. Of the 300 women mailed an invitation packet, 58 (19%) returned the opt-out postcard. Up to 3 attempts were made to telephone the remaining women, of whom 130 (43%) could not be contacted, 23 (8%) refused, and 12 (4%) were ineligible. Enrollment packages were mailed to 77 women, of whom 59 returned the risk factor questionnaire and specimens. We found no statistically significant differences between enrolled women and those who refused participation or could not be contacted. Conclusions We demonstrated that a representative sample of women can be successfully recruited for a gut microbiome study; however, significant personal contact and carefully timed follow-up from the study personnel are required. The methods employed by our study could successfully be applied to analytic studies of a wide range of clinical conditions that have been postulated to be influenced by the gut microbial population. PMID:24690120



Comparing individual-based and household-based measures of social class to assess class inequalities in women's health: a methodological study of 684 US women  

PubMed Central

STUDY OBJECTIVE: To describe and compare magnitude of class inequalities in women's health detected with four occupation-based class measures: individual, conventional household (male dominant), gender neutral household, and combined household. DESIGN: Cross sectional study, using health data obtained by physical examination, laboratory analysis, and self report. SETTING: A large pre-paid health maintenance organisation in Oakland, CA (US). PARTICIPANTS: 686 women (90% white) enrolled in Examination II of the Kaiser Permanente Women Twins Study (1989-1990). MAIN RESULTS: The proportion of women categorised as "working class" equalled 45, 30, and 21 per cent, respectively, for the individual level, gender neutral household, and conventional household class measures. Class inequalities in health, comparing women categorised as working class with non-working class, generally were stronger using the gender neutral household class measure, compared with the conventional household or individual class measure; in the case of "fair or poor" health, the respective odds ratios and 95% confidence intervals (adjusted for age and marital status) were 1.9 (1.1, 3.4), 1.5 (0.9, 2.5), and 1.3 (0.8, 2.2), while for high post-load glucose levels, they were 1.7 (1.1, 2.6), 1.2 (0.8, 1.7), and 1.3 (0.9, 1.8). The combined household class measure yielded effect estimates comparable to those of the gender neutral household class measure but with less precision, because of smaller strata. CONCLUSIONS: Epidemiological studies concerning class inequalities in women's health should use the gender neutral household class measure or, if sample size is sufficiently large, the combined household class measure. PMID:10616673

Krieger, N.; Chen, J. T.; Selby, J. V.



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. PMID:21276605

Kinney, Walter; Fetterman, Barbara; Cox, J. Thomas; Lorey, Thomas; Flanagan, Tracy; Castle, Philip E.



Changes in Body Mass Index and Stoma Related Problems in the Elderly  

PubMed Central

Objectives Weight gain can cause retraction of an intestinal stoma, possibly resulting in difficulty with wafer and pouch fit, daily care challenges, and discomfort. This cross-sectional study examined the association between body mass index (BMI) and ostomy-related problems among long-term (>5 years post-diagnosis) colorectal cancer (CRC) survivors. Materials and Methods CRC survivors from three Kaiser Permanente Regions completed a mailed survey. The response rate for those with an ostomy was 53% (283/529). Questions included stoma-related problems and time to conduct daily ostomy care. Poisson regression evaluated associations between report of problems and change in BMI. Our analysis sample included 235 survivors. Results Sample was 76% ?65 years of age. Since their surgeries, BMI remained stable in 44% (ST), decreased in 20% (DE), and increased in 35% (IN) of survivors. Compared to ST, male IN (RR 2.15 [1.094.25]) and female DE (RR 5.06 [1.2625.0]) were more likely to spend more than 30 minutes per day on stoma care. IN (vs. ST) were more likely to report interference with clothing (RR 1.51 [1.062.17]) and other stoma-related problems (RR 2.32 [1.304.14]). Survivors who were obese at time of survey were more likely to report interference with clothing (RR 1.88 [1.382.56]) and other stoma-related problems (RR 1.68 [1.072.65]). Conclusion A change in BMI is associated with ostomy-related problems among long-term CRC survivors. Equipment and care practices may need to be adapted for changes in abdominal shape. Health care providers should caution that a significant increase or decrease in BMI may cause ostomy-related problems. PMID:24071496

Skeps, Raymond; McMullen, Carmit K.; Wendel, Christopher S.; Bulkley, Joanna; Grant, Marcia; Mohler, Jane; Hornbrook, Mark C.; Krouse, Robert S.; Herrinton, Lisa J.



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


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

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



The Predictors of PatientPhysician Race and Ethnic Concordance: A Medical Facility Fixed-Effects Approach  

PubMed Central

Objective To examine the predictors of patientphysician race/ethnicity concordance among diabetes patients in an integrated delivery system. Data Source Kaiser Permanente's Northern California Diabetes Registry of 2005. Study Design Logistic regression predicted concordance for each racial/ethnic group. Availability of a concordant physician, whether a patient chose their physician, and patient language were main explanatory variables. Data Collection/Extraction Methods The study population consisted of 109,745 patients and 1,750 physicians. Principal Findings Patients who chose their physicians were more likely to have a same race/ethnicity physician with OR of 2.2 (95 percent CI 1.742.82) for African American patients, 1.71 (95 percent CI 1.442.04) for Hispanic patients, 1.11 (95 percent CI 1.041.18) for white patients, and 1.38 (95 percent CI 1.23, 1.55) for Asian patients. Availability of a same race/ethnicity physician was also a predictor of concordance for African American patients (OR 2.7; 95 percent CI 2.452.98) and marginally significant for Hispanic patients (OR 1.02; 95 percent CI 1.011.02), white patients (OR 1.02; 95 percent CI 1.001.04), and Asian patients (OR 1.05; 95 percent CI 1.03, 1.07). Limited English language was a strong predictor of concordance for Hispanic patients (OR 4.81; 95 percent CI 4.25.51) and Asian patients (OR 9.8; 95 percent CI 7.7, 12.6). Conclusion Patient language, preferences, and the racial composition of the physician workforce predict race/ethnicity concordance. PMID:20337734

Traylor, Ana H; Schmittdiel, Julie A; Uratsu, Connie S; Mangione, Carol M; Subramanian, Usha



Achieving proficiency with robot-assisted radical prostatectomy: Laparoscopic-trained versus robotics-trained surgeons  

PubMed Central

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

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



Timely detection of localized excess influenza activity in Northern California across patient care, prescription, and laboratory data.  


Timely detection of clusters of localized influenza activity in excess of background seasonal levels could improve situational awareness for public health officials and health systems. However, no single data type may capture influenza activity with optimal sensitivity, specificity, and timeliness, and it is unknown which data types could be most useful for surveillance. We compared the performance of 10 types of electronic clinical data for timely detection of influenza clusters throughout the 2007/08 influenza season in northern California. Kaiser Permanente Northern California generated zip code-specific daily episode counts for: influenza-like illness (ILI) diagnoses in ambulatory care (AC) and emergency departments (ED), both with and without regard to fever; hospital admissions and discharges for pneumonia and influenza; antiviral drugs dispensed (Rx); influenza laboratory tests ordered (Tests); and tests positive for influenza type A (FluA) and type B (FluB). Four credible events of localized excess illness were identified. Prospective surveillance was mimicked within each data stream using a space-time permutation scan statistic, analyzing only data available as of each day, to evaluate the ability and timeliness to detect the credible events. AC without fever and Tests signaled during all four events and, along with Rx, had the most timely signals. FluA had less timely signals. ED, hospitalizations, and FluB did not signal reliably. When fever was included in the ILI definition, signals were either delayed or missed. Although limited to one health plan, location, and year, these results can inform the choice of data streams for public health surveillance of influenza. PMID:21312219

Greene, Sharon K; Kulldorff, Martin; Huang, Jie; Brand, Richard J; Kleinman, Kenneth P; Hsu, John; Platt, Richard



Bone Health History in Breast Cancer Patients on Aromatase Inhibitors  

PubMed Central

A cross-sectional study was performed to assess bone health history among aromatase inhibitor (AI) users before breast cancer (BC) diagnosis, which may impact fracture risk after AI therapy and choice of initial hormonal therapy. A total of 2,157 invasive BC patients initially treated with an AI were identified from a prospective cohort study at Kaiser Permanente Northern California (KPNC). Data on demographic and lifestyle factors were obtained from in-person interviews, and bone health history and clinical data from KPNC clinical databases. The prevalence of osteoporosis and fractures in postmenopausal AI users was assessed, compared with 325 postmenopausal TAM users. The associations of bone health history with demographic and lifestyle factors in AI users were also examined. Among all initial AI users, 11.2% had a prior history of osteoporosis, 16.3% had a prior history of any fracture, and 4.6% had a prior history of major fracture. Postmenopausal women who were taking TAM as their initial hormonal therapy had significantly higher prevalence of prior osteoporosis than postmenopausal AI users (21.5% vs. 11.8%, p<0.0001). Among initial AI users, the associations of history of osteoporosis and fracture in BC patients with demographic and lifestyle factors were, in general, consistent with those known in healthy older women. This study is one of the first to characterize AI users and risk factors for bone morbidity before BC diagnosis. In the future, this study will examine lifestyle, molecular, and genetic risk factors for AI-induced fractures. PMID:25354083

Kwan, Marilyn L.; Lo, Joan C.; Tang, Li; Laurent, Cecile A.; Roh, Janise M.; Chandra, Malini; Hahn, Theresa E.; Hong, Chi-Chen; Sucheston-Campbell, Lara; Hershman, Dawn L.; Quesenberry, Charles P.; Ambrosone, Christine B.; Kushi, Lawrence H.; Yao, Song



Patient Barriers to Mammography Identified During a Reminder Program.  


Abstract Background: Patient mammogram reminders are effective at increasing screening, but patient barriers remain. We evaluated patient characteristics and reported barriers for their association with mammogram completion after a reminder program. Methods: This retrospective cohort study used data from electronic records and a subgroup survey. Participants were female Kaiser Permanente Northwest health maintenance organization (HMO) members aged 50-69 who were 20 months past their last mammogram (index date) and had received a reminder intervention (n?=?4708). A mailed survey was completed by 340 of 667 (50.2%) women who received it. The intervention was a "mammogram due soon" postcard 20 months after the last mammogram, followed by up to two automated phone calls and one live call for nonresponders. The outcome was mammogram completion at 10 months after index date. Results: Characteristics associated with lower mammogram completion rates were aged <60 (odds ratio [OR] 0.69, p?

Feldstein, Adrianne C; Perrin, Nancy; Rosales, A Gabriela; Schneider, Jennifer; Rix, Mary M; Glasgow, Russell E



Breast Cancer Screening in an Insured Population: Whom Are We Missing?  

PubMed Central

Introduction: Kaiser Permanente Colorado is an integrated health care system that uses automatic reminder programs and reduces barriers to access preventive services, including financial barriers. Breast cancer screening rates have not improved during the last five years, and rates differ between subgroups: for example, black and Latina women have lower rates of mammography screening than other racial groups. Methods: We retrospectively evaluated data from 47,946 women age 52 to 69 years who had continuous membership for 24 months but had not undergone mammography. Poisson regression models estimated relative risk for the impact of self-identified race/ethnicity, socioeconomic characteristics, health status, and use of health care services on screening completion. Results: The distribution of race/ethnicity among unscreened women was 55.5% white, 7.0% Latina, and 3.7% black, but race/ethnicity data were missing for 29%. Of these, no record of race/ethnicity was available for 86.7%, and for 5.1%, the data request was recorded but the women declined to identify their race/ethnicity. Nonwhite ethnicity increased risk of screening failure if black, Latina, other (eg, American Indian), or missing race/ethnicity. Population-attributable risks were low for minorities compared with the group for whom race/ethnicity data was missing. A greater number of office visits in any setting was associated with greater likelihood of undergoing mammography. Women with missing race/ethnicity data had fewer visits and were less likely to have an identified primary care physician. Conclusions: Greater improvement in mammography screening rates could be achieved in our population by increasing screening among women with missing race/ethnicity data, rather than by targeting those who are known to be of racial/ethnic minorities. Efforts to address screening disparities have been refocused on inreach and outreach to our missing women. PMID:23596367

Kempe, Karin L; Larson, Rebecca Sam; Shetterley, Susan; Wilkinson, Andra



Efficacy of Phototherapy for Newborns with Hyperbilirubinemia: A Cautionary Example of an Instrumental Variable Analysis  

PubMed Central

Background Use of instrumental variables is gaining popularity as a method of controlling for confounding by indication in observational studies of treatments. Objectives To illustrate how unmeasured instrument-level treatment substitution can distort effect size estimates using as an example an instrumental variable analysis of phototherapy for neonatal jaundice. Design Retrospective cohort study. Setting Northern California Kaiser Permanente Hospitals. Patients The authors studied 20,731 newborns ?2000 g and ?35 weeks' gestation born 19952004 with a qualifying total serum bilirubin (TSB) level within 3 mg/dL of the 2004 American Academy of Pediatrics (AAP) phototherapy threshold who did not have a positive direct antiglobulin test. Measurements The intervention was inpatient phototherapy within 8 hours of the qualifying TSB. The outcome was a TSB level exceeding the AAP exchange transfusion threshold <48 hours from the qualifying TSB. The instrumental variable was a measure of the frequency of phototherapy use at the newborn's birth hospital. The unmeasured substituted treatment was supplementation with infant formula, assessed by chart review in a sample from the same cohort. Results In total, 128 infants (0.62%) exceeded the exchange transfusion threshold. Logistic and propensity analyses yielded crude odds ratios of ?0.5 for phototherapy efficacy, decreasing to ?0.2 with control for confounding by indication. Instrumental variable analyses suggested much greater phototherapy efficacy (e.g., odds ratios of 0.020.05). However, chart reviews revealed greater use of infant formula (which also lowers bilirubin levels) in hospitals that used more phototherapy (r = 0.56; P = 0.02), an association not present at the individual level (r = 0.13). Conclusions Instrumental variable analyses may provide biased estimates of treatment efficacy if there are cointer-ventions or confounders associated with treatment at the level of the instrument, even when these associations may not exist in individuals. PMID:21859678

Newman, Thomas B.; Vittinghoff, Eric; McCulloch, Charles E.



Characteristics of Resistant Hypertension in a Large Ethnically Diverse Hypertension Population of an Integrated Health System  

PubMed Central

Objective To evaluate the prevalence and characterize resistant hypertension from a large representative population with successful hypertension management and reliable health information. Patient and Methods We performed a cross sectional study using clinical encounter, laboratory, and administrative information from the Kaiser Permanente Southern California health system during 1/1/200612/31/2007. From individuals age >17 years with hypertension, resistant hypertension was identified and prevalence determined. Multivariable logistic regression was used to calculate odds ratios (OR) with adjustments for demographics, clinical variables, and medication use. Results Among 470,386 hypertensive individuals, 12.8% were identified as resistant representing15.3% of those on medications. Overall, 37,061 (7.9%) had uncontrolled hypertension while on ? 3 medicines. OR (95% confidence interval) for resistant hypertension were greater for black race (1.68, 1.621.75), older age (1.11, 1.101.11 for every 5 year increase), males (1.06, 1.031.10), and obesity (1.46, 1.421.51). Medication adherence rates were higher in resistant hypertension (93 vs 90%, p<0.001). Chronic kidney disease (1.84, 1.781.90), diabetes (1.58, 1.531.63), and cardiovascular disease (1.34, 1.301.39) were also associated with higher risk for resistant hypertension. Conclusion Within a more standardized hypertension treatment environment, we observed a rate of resistant hypertension comparable to past studies using more fragmented data sources. Past observations have been limited due to non-representative populations, reliability of the data, heterogeneity of the treatment environments, and less than ideal control rates. This cohort which was established with an electronic medical record based approach has the potential to provide a better understanding of resistant hypertension and outcomes. PMID:24079679

Sim, John J.; Bhandari, Simran K.; Shi, Jiaxiao; In Liu, Lu A.; Calhoun, David A.; McGlynn, Elizabeth A.; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.



Prostate Cancer Screening Trends in a Large, Integrated Health Care System  

PubMed Central

Background: As the debate over the effectiveness of prostate-specific antigen (PSA) screening for prostate cancer continues, it is increasingly important to understand how PSA screening occurs in general-practice settings. Methods: We conducted a retrospective cohort study within Kaiser Permanente Southern California, a large integrated health care system. Men aged 35 years and older at baseline, in 1998, were eligible. The proportion of men who underwent PSA screening was estimated and compared across groups defined by patient and physician characteristics. We also evaluated trends in screening across time and serum PSA levels for all subgroups. Results: Of 2,061,047 men, 572,306 (28%) underwent PSA screening from 1998 through 2007. Patterns of PSA screening varied modestly by age, race, and physician. The lowest frequencies of screening occurred among men younger than age 45 years (19%) and men ages 85 years and older (13%). PSA screening was most common among white men (33.5%) and in men seen by physicians of the same race/ethnicity (32%), compared with men with physicians of disparate race/ethnicity (26%, p < 0.001). PSA screening increased over time for all racial/ethnic groups and among men age 75 years and older but decreased over time for men younger than age 75 years old. Conclusions: Nearly 1 in 4 eligible men underwent PSA screening from 1998 through 2007, and screening varied only modestly by patient and physician characteristics. Estimates of the frequency of PSA screening in general-practice settings can inform the debate and provide useful insight as to how changes in cancer screening guidelines would alter practice patterns in an increasingly integrated health care environment. PMID:23012592

Wallner, Lauren; Frencher, Stanley; Hsu, Jin-Wen; Loo, Ronald; Huang, Joice; Nichol, Michael; Jacobsen, Steven



Risk of Revision Following Total Hip Arthroplasty: Metal-on-Conventional Polyethylene Compared with Metal-on-Highly Cross-Linked Polyethylene Bearing Surfaces: International Results from Six Registries.  


The results of randomized controlled trials and systematic reviews have suggested reduced radiographic wear in highly cross-linked polyethylene compared with conventional polyethylene in primary total hip arthroplasty. However, longer-term clinical results have not been thoroughly examined, to our knowledge. The purpose of this study was to compare the risk of revision for metal-on-conventional and metal-on-highly cross-linked total hip arthroplasty bearing surfaces with use of a distributed data network of six national and regional registries (Kaiser Permanente, HealthEast, the Emilia-Romagna region in Italy, the Catalan region in Spain, Norway, and Australia). Inclusion criteria were osteoarthritis as the primary diagnosis, cementless implant fixation, and a patient age of forty-five to sixty-four years. These criteria resulted in a sample of 16,571 primary total hip arthroplasties. Multivariate meta-analysis was performed with use of linear mixed models, with survival probability as the unit of analysis. The results of a fixed-effects model suggested that there was insufficient evidence of a difference in risk of revision between bearing surfaces (hazard ratio, 1.20 [95% confidence interval, 0.80 to 1.79]; p = 0.384). Highly cross-linked polyethylene does not appear to have a reduced risk of revision in this subgroup of total hip arthroplasty patients. Arthroplasties involving highly cross-linked polyethylene do not appear to have an increased risk of revision in this subgroup of total hip arthroplasty patients. PMID:25520415

Paxton, Elizabeth; Cafri, Guy; Havelin, Leif; Stea, Susanna; Pallis, Francesc; Graves, Stephen; Hoeffel, Daniel; Sedrakyan, Art



A Multidisciplinary Approach to Transition Care: A Patient Safety Innovation Study  

PubMed Central

Introduction: Patients with complex medical care needs often embark on multiple care transitions over an extended period of time. As these patients or their caregivers often become the chief source of communication for complex medical situations, each transition can create an opportunity for health care errors. Combining the efforts of the established departments of Chronic Care Coordination (CCC), Clinical Pharmacy Call Center (CPCC), and Continuing Care, Kaiser Permanente Colorado created programs to further safe care transitions. Methods: Two key goals for safe care transitions were established: 1) reductions in medication errors and 2) increased follow-up with care plans. To achieve these goals, communication plans targeted at medication reconciliation, patient education, and coordination of outpatient recommendations were established. Expected outcomes included reductions in medication errors, decreased Emergency Department and hospital admissions, decreased readmissions, and increased outpatient follow-up and medication compliance. Results: A review of medication-reconciliation records for intervention patients indicated that >90% of all discharge summaries contained at least one potential drug-related problem including duplicative drugs, omitted therapy, and medication contraindications. After skilled nursing facility discharge, patients who were transitioned by CPCC clinical pharmacists were: 1) 78% less likely to die; 2) 29% less likely to need an Emergency Department visit; and 3) 17% more likely to follow up with primary physicians and clinicians than were patients in the usual care group. Health care cost savings for patients seen by the CCC program demonstrated, conservatively, an annualized per patient savings of $5276. For 763 patients enrolled in 2003, this amounts to an estimated, annualized savings of $4,025,588. Conclusions: Patients are becoming more informed and involved in their care, but they require ongoing education and coaching to become effective advocates for themselves. Identification of unintended medication discrepancies and potential drug-related problems and increased follow-up during care transitions can improve patient safety and quality of care while saving health care resources. PMID:21412475

McGaw, Jeryl; Conner, Douglas A; Delate, Thomas M; Chester, Elizabeth A; Barnes, Carol Ann



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. PMID:22429155

Huang, Jie; Abrams, Allyson M.; Gilliss, Debra; Reed, Mary; Platt, Richard; Huang, Susan S.; Kulldorff, Martin



The Vitamin D Antenatal Asthma Reduction Trial (VDAART): rationale, design, and methods of a randomized, controlled trial of vitamin D supplementation in pregnancy for the primary prevention of asthma and allergies in children.  


There is intense interest in the role of vitamin D in the development of asthma and allergies. However, studies differ on whether a higher vitamin D intake or status in pregnancy or at birth is protective against asthma and allergies. To address this uncertainty, the Vitamin D Antenatal Asthma Reduction Trial (VDAART) was developed. VDAART is a randomized, double-blind, placebo-controlled trial of vitamin D supplementation in pregnant women to determine whether prenatal supplementation can prevent the development of asthma and allergies in women's offspring. A secondary aim is to determine whether vitamin D supplementation can prevent the development of pregnancy complications, such as preeclampsia, preterm birth, and gestational diabetes. Women were randomized to the treatment arm of 4000IU/day of vitamin D3 plus a daily multivitamin that contained 400IU of vitamin D3 or the placebo arm of placebo plus a multivitamin that contained 400IU daily of vitamin D3. Women who were between the gestational ages of 10 and 18 weeks were randomized from three clinical centers across the United States - Boston Medical Center, Washington University in St. Louis, and Kaiser Permanente Southern California Region (San Diego, CA). Supplementation took place throughout pregnancy. Monthly monitoring of urinary calcium to creatinine ratio was performed in addition to medical record review for adverse events. Offspring are being evaluated quarterly through questionnaires and yearly during in-person visits until the 3rd birthday of the child. Ancillary studies will investigate neonatal T-regulatory cell function, maternal vaginal flora, and maternal and child intestinal flora. PMID:24614387

Litonjua, Augusto A; Lange, Nancy E; Carey, Vincent J; Brown, Stacey; Laranjo, Nancy; Harshfield, Benjamin J; O'Connor, George T; Sandel, Megan; Strunk, Robert C; Bacharier, Leonard B; Zeiger, Robert S; Schatz, Michael; Hollis, Bruce W; Weiss, Scott T



Adverse Fetal Outcomes Associated with Immunosuppressive Medications for Chronic Immune Mediated Diseases in Pregnancy  

PubMed Central

Objective We assessed the risk of adverse fetal outcomes following exposure to individual immunosuppressive drugs in pregnant women with chronic immune mediated diseases. Methods We used health plan data from Tennessee Medicaid and Kaiser Permanente Northern California and Southern California linked with vital records and medical records. Women with inflammatory arthropathies, systemic lupus erythematosus, and inflammatory bowel disease who filled prescriptions for immunosuppressive treatments during pregnancy were included. Major congenital malformations, fetal deaths, and life-threatening neonatal complications were identified from electronic data and validated with medical record review. Results The cohort included 608 infants, including 437 with exposure during pregnancy (402 first trimester, 35 second and third trimester only) and 171 whose mothers filled prescriptions for immunosuppressives before, but not during, pregnancy. There were 25 pregnancies (4.1% of the cohort) with confirmed major congenital malformations, 10 fetal deaths (1.6%), 23 life-threatening neonatal complications among preterm infants (20.4%), and 10 (2.1%) life-threatening complications among term infants. Compared to the reference group (medication treatment before, but not during, pregnancy), the risk ratios for adverse fetal outcomes associated with immunosuppressive use during pregnancy by exposure category included: methotrexate [risk ratio 1.39 (95% confidence interval 0.43,4.53)], tumor necrosis factor inhibitors [0.98 (0.38,2.55)], hydroxychloroquine [1.33 (0.69,2.55)], and other immunosuppressives [0.98, (0.48,1.98)]. Conclusions We found no evidence of a large increase in risk of adverse fetal outcomes from first trimester exposure to immunosuppressive medications, though confidence intervals for risk ratios were wide. Further studies will be needed as use of these medications increases over time. PMID:24504818

Cooper, William O.; Cheetham, T. Craig; Li, De-Kun; Stein, C. Michael; Callahan, S. Todd; Morgan, Thomas M.; Shintani, Ayumi K.; Chen, Ning; Griffin, Marie R.; Ray, Wayne A.



The Safety and Effectiveness of Mail Order Pharmacy Use in Diabetes Patients  

PubMed Central

Background Research suggests mail order pharmacy use is associated with greater medication adherence and CVD risk factor control. However, no research has examined the potential impact of mail order pharmacy use on patient safety and utilization. Objective To compare safety and utilization outcomes in patients using mail order vs. local pharmacies. Subjects 17,217 Kaiser Permanente Northern California (KPNC) adult diabetes patients prescribed new cardiometabolic medications in 2006. Research Design Cross-sectional, observational study. Measures Outcomes included any all-cause and preventable hospitalizations and emergency department (ED) visits; laboratory tests for monitoring persistent medications; and overlapping days supply of contraindicated medications. Multivariate logistic regression results were stratified by patient age and converted to adjusted predicted percentages. Results Overall, there were few differences in outcomes between mail order and local pharmacy users. Patients < 65 using mail order had fewer ED visits (34.0% vs. 40.2%; p<.001); preventable ED visits (7.8% vs. 9.6%; p<.01); and serum creatinine laboratory monitoring tests after ACE/ARB or diuretic initiation (41.4% vs. 47.2%; p<.01). Among patients ?65, mail order users had fewer preventable ED visits (13.4% vs. 16.3%; p<.01); but more occurrences of overlapping days supply of contraindicated medications (1.1% vs. 0.7%; p<.01). Conclusions Mail order pharmacy use is not associated with adverse outcomes in most diabetes patients, and is associated with lower ED use. Interventions to increase mail order pharmacy use may be an important strategy for improving care; however, these interventions should employ a patient-centered approach that is sensitive to primary and preventive care access. PMID:24511986

Schmittdiel, Julie A.; Karter, Andrew J.; Dyer, Wendy; Chan, James; Duru, O. Kenrik



Patient Satisfaction and Perceived Success with a Telephonic Health Coaching Program: The Natural Experiments for Translation in Diabetes (NEXT-D) Study, Northern California, 2011  

PubMed Central

Introduction Health coaching can improve lifestyle behaviors known to prevent or manage chronic conditions such as diabetes. However, little is known about the patient experience with telephonic coaching programs in real-world care settings. We examined patient satisfaction, patients perceived success in achieving program goals, and the patient-level correlates of these outcomes in a voluntary telephonic coaching program at a large integrated health care delivery system in northern California. Methods Kaiser Permanente Northern California patients who participated in a telephonic coaching program in 2011 were sent a cross-sectional survey about their satisfaction with health coaching and perceived success with program goals. We examined associations with patient characteristics. Results The survey response rate was 34%; analyses were based on the 32% who completed the survey. Of those who had completed 2 or more sessions (n = 232 [52%]), most reported being satisfied (70%) or neutral (20%) with the program, and 71% would recommend health coaching. Healthy weight, healthful eating, and physical activity were the most common topics discussed (88%). Adjusting for demographic characteristics, 73% of those who had 2 or more sessions reported that health coaching helped achieve their weight-related goal. Outcomes were positively correlated with patient activation but not consistently correlated with patient demographic characteristics. Conclusion Levels of satisfaction and perceived success with telephonic health coaching provided by a health plan were high and positively correlated with the number of sessions completed and patient activation. Voluntary telephonic health coaching programs should promote retention and assess patients activation levels. PMID:24176083

Goler, Nancy C.; Sanna, Rashel S.; Boccio, Mindy; Bellamy, David J.; Brown, Susan D.; Neugebauer, Romain S.; Ferrara, Assiamira; Wiley, Deanne M.; Schmittdiel, Julie A.



Evolution of the Active Phase of CoMo/Al2O3 Catalysts under Industrial Conditions: a High-Pressure MES Study  

SciTech Connect

The behavior of CoMo/Al2O3 catalysts sulfided in H2S/H2 gas mixture, under industrial conditions, was investigated using Moessbauer emission spectroscopy (MES). An intermediate Co-Mo phase is formed after increasing the sulfidation pressure to 4 MPa, favoring the Co-Mo-S phase formation. An increase in the quadrupole splitting value of the Co-sulfide species after treatment at 573 K is proposed as a prerequisite for the formation of ideal Co-Mo-S structures.

Dugulan, A.I.; Overweg, A.R.; Craje, M.W.J.; Kearley, G.J. [Interfaculty Reactor Institute, Delft University of Technology, 2629 JB Delft (Netherlands)




PubMed Central

En la investigacin con animales existen cuestionamientos ticos tanto en el uso como modelos de enfermedades humanas y requisito previo para ensayos en humanos como en la introduccin de modificaciones genticas. Algunos de estos cuestionamientos son: no representar exactamente la condicin humana como modelos, realizar pruebas de toxicidad con grave dao para los animales, alterar su naturaleza mediante modificaciones genticas, riesgos de la introduccin de organismos genticamente modificados. El uso de animales en investigacin para beneficio humano, impone al ser humano la responsabilidad moral de respetarlo, no hacindoles sufrir innecesariamente, al estar trabajando con seres vivientes y sentientes. PMID:23338641

Yunta, Eduardo Rodrguez



Pensamiento Lascasiano e Indigenismo en la Narrativa de Rosario Castellanos  

E-print Network

Castellanos. Por ello, se puede citar lo que comenta Aurby respecto a que en el estado chiapaneco ??tanto la di?cesis como el Estado y la sociedad?son como San Crist?bal: de Las Casas? (129). Es, a trav?s del indigenismo, que se va a estudiar la influencia... lascasiana, como se analizar? en este trabajo de disertaci?n. Cabe mencionar que la sociedad ?Blackfriars Hall? de la Universidad de Oxford fund? en el 2008 el instituto ?Fray Bartolom? de las Casas Centro de Derechos Humanos? ( aseverando...

Adams, Elia T



La consagracin del mito en la epopeya mexicana: La Malinche de Celestino Gorostiza  

E-print Network

FALL 1985 33 La consagracin del mito en la epopeya mexicana: La Malinche de Celestino Gorostiza Isis Quinteros Los estudiosos del drama como gnero literario han sealado en varias ocasiones la estrecha relacin que histricamente ha vinculado...

Quinteros, Isis



Portflio do Discente: Resgatando uma Experincia no Curso de Medicina da UNIMONTES.  

E-print Network

??A avaliao e os instrumentos avaliativos continuam sendo um grande desafio no processo ensino-aprendizagem. Partindo desse entendimento, esta pesquisa tem como objetivo conhecer a importncia[Otilia (more)

Maria de Fatima Silveira Lopes Cruz



Prurito (PDQ)

Resumen de informacin revisada por expertos acerca del prurito (picazn de la piel) como complicacin a causa del cncer y su tratamiento. Se discuten los enfoques del manejo y tratamiento del prurito.


Complicaciones orales de la quimioterapia y la radioterapia a la cabeza y el cuello (PDQ)

Resumen de informacin revisada por expertos acerca de las complicaciones orales, como la mucositis y la disfuncin de la glndula salival, que se presentan en pacientes de cncer tratados con quimioterapia y radioterapia dirigida a la cabeza y el cuello.


Tomografa computarizada (TC) y exploraciones para cncer

Hoja informativa que describe el procedimiento y la tecnologa de exploraciones con tomografa computarizada as como sus usos para el diagnstico, para exmenes de deteccin y para tratamiento del cncer.



E-print Network

los fundamentos relacionados con los distintos sistemas de telefonía celular, tales como los sistemas operativos. Interfaces terrestres. Sistemas CEPT, SPADE, SCPC,VSAT. Redes satelizares de datos. #12;III

Vásquez, Carlos


Instantnea del cncer de esfago

Informacin sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cncer de esfago; as como ejemplos de actividades del NCI y adelantos en la investigacin de este tipo de cncer.


Instantnea del cncer de prstata

Informacin sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre el cncer de prstata; as como ejemplos de actividades del NCI y adelantos en la investigacin de este tipo de cncer.


Para mi el teatro es un ascesis, una cura de adelgazamiento': Entrevista a Mario Vargas Llosa  

E-print Network

usted al libre tratamiento que hacen los teatristas de las piezas dramticas. Cul es su postura como autor respecto al tratamiento del texto por parte del director, eso que una escritora argentina llam canibalismo amoroso? Yo considero que el...

Espinosa Domí nguez, Carlos



Usina do Trabalho do Ator: um teatro canibal  

E-print Network

, especialmente composta e executada ao vivo. Mundu, mais uma vez, e talvez de maneira mais profunda, usa a ideia da antropofagia ou do canibalismo cultural como modo de realizao. Todas as influncias possveis foram incorporadas. O carnaval, mais uma vez...

Icle, Gilberto



Transplante: Qu necesito saber?  

E-print Network

Transplante: ¿Qué necesito saber? Proporcionado como un servicio para nuestros pacientes por The Transplant Center, Massachusetts General Hospital #12;Bienvenido al Massachusetts General Hospital y las metas de los transplantes

Mootha, Vamsi K.



PubMed Central

El presente trabajo reflexiona sobre el fundamento filosfico de la biotica como disciplina, mtodo y movimiento desde su contexto histrico y en relacin con el contexto social y cultural de la vivencia latinoamericana. PMID:20209030

Yunta, Eduardo Rodriguez



Pear seedling production by double grafting in quince using japons as rootstock.  

E-print Network

??Plantas de pereira quando enxertadas em marmeleiros apresentam porte reduzido. O marmeleiro Japons poderia ser uma opo como porta-enxerto, no entanto pesquisas revelaram incompatibilidade ainda (more)

Karine Ester Seifert




E-print Network

??As cianobactrias constituem um grupo de organismos procariontes freqentemente referidos como algas azuis. Estes organismos fazem parte do fitoplncton natural, principalmente de gua doce. No (more)

Tlia Carvalho de Freitas



Instantnea de los cnceres de hgado y de las vas biliares

Informacin sobre las tendencias de incidencia, mortalidad y financiamiento del NCI sobre los cnceres de hgado y de las vas biliares; as como ejemplos de actividades del NCI y adelantos en la investigacin de estos tipos de cncer.


Atividades melanognica, genotxica e antiproliferativa de extratos de Brosimum gaudichaudii Trcul e Dorstenia brasiliensis Lam induzidas por radiao UVA.  

E-print Network

??As furanocumarinas lineares ou psoralenos so fotossensibilizadores empregados na dermatologia associados a ultravioleta A no tratamento de doenas como o vitiligo. A fotoquimioterapia tem reaes (more)

Adriana Elias Pires Quevedo