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Sums of permanental minors using Grassmann algebra  

E-print Network

We show that a formalism proposed by Creutz to evaluate Grassmann integrals provides an algorithm of complexity $O(2^n n^3)$ to compute the generating function for the sum of the permanental minors of a matrix of order $n$. This algorithm improves over the Brualdi-Ryser formula, whose complexity is at least $O(2^{\\frac{5n}{2}})$. In the case of a banded matrix with band width $w$ and rank $n$ the complexity is $O(2^{min(2w, n)} (w + 1) n^2)$. Related algorithms for the matching and independence polynomials of graphs are presented.

Butera, P



Person-Focused Care at Kaiser Permanente  

PubMed Central

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



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



Kaiser Permanente's innovation on the front lines.  


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

McCreary, Lew




E-print Network


Floeter, Sergio Ricardo


John Mattison Chief Medical Information Officer, Kaiser Permanente  

E-print Network

numerous papers in medical informatics, and given seminars on medical informatics at several CaliforniaJohn Mattison Chief Medical Information Officer, Kaiser Permanente John Mattison currently oversees, where he served as director of the Medical/Surgical Intensive Care Unit, and chaired committees

Loudon, Catherine


Station GPS permanente IPG Paris DGF Uchile Tarapaca Univ.  

E-print Network

Station GPS permanente IPG Paris DGF Uchile Tarapaca Univ. Site Name: Arica (University of Tarapaca, Arica ) Author : Ruegg / deChabalier Site Code : UTAR Date installation : 2003 12 03 Coordinates : UTAR, Arica (Chile). Inox 12 cm rod (Delmont type) scealed in concrete at the top of the on the roof Geodetic

Vigny, Christophe


An integrated EHR at Northern California Kaiser Permanente  

PubMed Central

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

Bornstein, S.



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.



Pr-Reitoria de Ensino de Graduao Comisso Permanente do Vestibular  

E-print Network

Pró-Reitoria de Ensino de Graduação Comissão Permanente do Vestibular Campus Prof. João David Vestibular-UFSC/2011, resolve: 1. Alterar o gabarito da Prova 1 ­ Disciplina: MATEMÁTICA AMARELA de 10 para

Floeter, Sergio Ricardo


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



Presença de dentes permanentes irrompidos em escolares da região metropolitana de Porto Alegre  

Microsoft Academic Search

RESUMO Foi realizada uma pesquisa de campo em duas escolas da rede pública estadual de Porto Alegre, com a finalidade de verificar a presença de dentes permanentes irrompidos em crian- ças com faixa etária entre seis a dez anos. Foram examinadas 327 crianças, considerando as variáveis de idade, sexo e raça. Não foi observada diferença significativa para a época de

Karine Squeff; Guilherme Pessoa Cerveira; Luciane Quadrado Closs; Jose Antônio Bosio


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


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

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



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)



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

PubMed Central

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

Chien, Gary W; Abbas, Maher A



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



Patient-Physician E-Mail Communication: The Kaiser Permanente Experience  

PubMed Central

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.



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



Community Implementation and Translation of Kaiser Permanente's Cardiovascular Disease Risk-Reduction Strategy  

PubMed Central

Introduction: Since 2003, Kaiser Permanente (KP) has implemented innovative cardiovascular disease (CVD) risk-reduction clinical practices in Northern and Southern California that emphasize the use of cardioprotective medications—aspirin, angiotensin-converting enzyme inhibitors, and statins—in individuals at very high risk of experiencing heart attacks and strokes. Because an internal KP retrospective analysis demonstrated decreased morbidity and mortality among KP patients with diabetes, there is significant value in implementing this strategy in the broader community population, particularly in safety-net clinics serving the uninsured. Methods: To implement this risk-reduction clinical practice in the community, clinical and programmatic sections of KP had to connect with a set of community partners that share a similar approach of evidence-based prevention. Successful implementation required a well-planned and coordinated collaboration between KP and the community entities that allowed for and supported adaptation in local delivery structures. Results: Forty-six ambulatory clinic sites based at community health centers and in public hospital/health systems in California's safety net have initiated KP's CVD risk-reduction program. This resulted in 1125 community-clinic patients in Southern California and 1120 patients in Northern California receiving their first prescription for at least 1 of the 3 cardiovascular medications within the first 18 months of implementation. KP Colorado, KP Georgia, and KP Northwest are also implementing these strategies in their local communities. Discussion: The results of program initiation demonstrate successful translation of the KP CVD risk-reduction strategy to the broader, non-KP member community: uptake of 46 community clinic sites in 2 KP Regions, with a projection of >11,000 patients being prescribed the 3 cardioprotective medications in subsequent years and in multiple Regions. This may be a model for further spread of CVD prevention measures, and prevention programs for other diseases, to all populations throughout the US, notably underserved communities disproportionately affected by chronic conditions. PMID:21505616

Wong, Winston; Jaffe, Marc; Wong, Michelle; Dudl, R James



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

PubMed Central

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

Hinchman, Josephine; Beno, Luke; Mims, Adrienne



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

PubMed Central

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 <8%), screening for diabetic retinopathy, control of hypertension (systolic blood pressure <140 mm Hg), and screening for cervical cancer. Results Incentives for two indicators—screening for diabetic retinopathy and for cervical cancer—were removed during the study period. During the five consecutive years when financial incentives were attached to screening for diabetic retinopathy (1999-2003), the rate rose from 84.9% to 88.1%. This was followed by four years without incentives when the rate fell year on year to 80.5%. During the two initial years when financial incentives were attached to cervical cancer screening (1999-2000), the screening rate rose slightly, from 77.4% to 78.0%. During the next five years when financial incentives were removed, screening rates fell year on year to 74.3%. Incentives were then reattached for two years (2006-7) and screening rates began to increase. Across the 35 facilities, the removal of incentives was associated with a decrease in performance of about 3% per year on average for screening for diabetic retinopathy and about 1.6% per year for cervical cancer screening. Conclusion Policy makers and clinicians should be aware that removing facility directed financial incentives from clinical indicators may mean that performance levels decline. PMID:20460330



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

Microsoft Academic Search

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

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



Como Lo Hago Yo: Myelomeningocele  

PubMed Central

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

Lazareff, Jorge



A Quality-Improvement Project Use of a Computerized Medical Database and Reminder Letters to Increase Preventive Care Use in Kaiser Permanente Patients  

PubMed Central

Context: Previous studies have suggested that preventive health care measures may be improved by proactive patient-reminder systems and use of electronic medical databases. Objective: Our objective was to use Kaiser Permanente's (KP's) electronic medical databases to improve the preventive health care delivered to KP patients in Honolulu, HI. Design: Patients not seen by their primary care physician in more than one year (“low-utilizing patients”) and overdue for preventive health care services were identified using KP's electronic medical databases. These patients were then sent letters requesting that they obtain these services. Response rates and results of their screening tests were tracked. Results: Of 309 letters sent, 84 (27.2%) patients responded. Of the 260 patients who were reminded of overdue immunizations (tetanus, pneumonia, influenza, or a combination of these), 51 (19.6%) came in to obtain them. Ten of the 37 (27.0%) women overdue for breast cancer screening came in for mammograms. Eleven of the 109 (10.1%) patients overdue for colorectal cancer screening completed fecal occult blood testing. Conclusion: Outreach letters that target low-utilizing patients identified by an electronic medical database may be an efficient and cost-effective way of improving patient use rates of preventive health care. PMID:20740084

Ling, Cecily Y L; Kajioka, Eric; Luu, Van; Phanthawimol, Wipat; Honda, Hitoshi; Kuribayashi, Linda



Informe Especial Supremaca de Concreto Como  

E-print Network

Informe Especial Mayo 2013 Supremacía de Concreto Como Material Estructural Paulo Helene #12;Supremacía de Concreto como Material Estructural* Paulo Helene Prof. Titular da Universidade de São Paulo Asamblea General de la FICEM. 2012. #12;3 supremacía del concreto Por Prof. Paulo Helene * Conferencia

Paraná, Universidade Federal do


Utilidad de los fármacos modificadores de enfermedad (FAME) en el tratamiento de las espondiloartropatías  

Microsoft Academic Search

Disease-modifying antirheumatic drugs (DMARDs), a heterogeneous group of drugs, are widely used in rheumatoid arthritis management. The scientific evidence on the management of spondyloarthropathy with DMARDs is limited and the results are inconclusive. In this article, we review the role of DMARDs in the management of axial involvement in spondyloarthropathies, emphasizing its paradigm, ankylosing spondylitis. We review the data published

Alejandro Prada Ojeda; Teresa Otón Sánchez; Jesús Sanz Sanz



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 : Firmware Version : 0 Date Installed : Date Removed : (dd-MMM-yyyy hh:mm UT) 4. GPS Antenna Information 5. 4

Vigny, Christophe


(SWNTs) CVD [1][2] Co/Mo  

E-print Network

( ) ( ) ( ) * ( ) 1. (SWNTs) CVD 1-2 nm CVD 2 CoMo CO [1][2] Co/Mo [3]CoMo CVD SWNTs CVD 2. 15mm 0.5 mm 2 mm 3.6 mm Mo(0.019-1.9nm) Co(0.034-2.1nm) Cold-wall CVD H2: 100 sccm, Ar: 300 sccm 50 Torr 10 min H2 Ar 30 Torr SWNTs (: 488nm) 3. CVD SWNTs 1 CVD 700 900

Maruyama, Shigeo


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

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

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



PubMed Central

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

Ferrer, Jorge Jose



Lecture Notes, Como 1995 September 6, 1998 Quantum Theory  

E-print Network

Lecture Notes, Como 1995 September 6, 1998 Quantum Theory HANS DE RAEDT Institute for Theoretical. Let us try to reduce the quantum problem to a "classical mechanics problem". According to the rules, The Netherlands E-mail: ABSTRACT The purpose of this set of lectures is to introduce


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 high–throughput and clinical data analysis pipelines. PMID:25045465



Efetividade da reabilitação pulmonar como tratamento coadjuvante da doença pulmonar obstrutiva crônica  

Microsoft Academic Search

3 Introdução: O paciente portador de DPOC diminui sua atividade física global devido a piora progressiva da função pulmonar como conseqüência de qualquer forma de esforço físico por ele realizado. A reabilitação pulmonar (RP) é utilizada nos EUA e Europa como alternativa terapêutica no tratamento da DPOC. Objetivo: Avaliar a efetividade do programa de RP como tratamento coadjuvante da DPOC.





Microsoft Academic Search

En el presente artículo la autora expone como la ciencia y la cultura influye en la identidad rural de la escuela como centro cultural de la comunidad y reconocen el roll de la escuela primaria rural como institución cultural, contribuyendo a una cultura general integral, con la participación de la familia y la comunidad. Se exponen criterios sobre la formación

María Rosa Núñez González



ESTUDIOS DE LA GRAN CHICHIMECA Seminario Permanente de  

E-print Network

y dinámica de una región americana" Sevilla, 5 y 6 de septiembre de 2011 Lugar de celebración Guadalajara. 13:20 Discusión. 14:00 Receso. Martes, 6 de septiembre 3.ª Sesión. Moderador: Mtro. Miguel

Fitze, Patrick


Station GPS permanente IPG Paris DGF Uchile UNAP Iquique  

E-print Network

of the Physical Depart. between 1997.7 and 2005.1 The location was changed in May 2005, because a mask due on the ground pavement between the of Chemical building and the Physical one. UAPB: Tied point located available YEYE SS NO possibility of leaving the equipment without watching YEYE SS NO . possibility

Vigny, Christophe


L'education permanente: Principe revolutionnaire et pratiques conservatrices  

NASA Astrophysics Data System (ADS)

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

Gelpi, Ettore



Servizio Formazione Permanente C.da Santa Croce 17 -Brescia  

E-print Network

Brescia Assessorato alle attività e beni culturali e alla valorizzazione delle identità, culture e lingue University of London) Coffee break Fascismo tra educazione politica ed educazione militare loRenzo ben siécle: les enjeux MiChèle Riot-SARCey (Université Paris 8) Coffee break La costruzione dell'uomo nuovo

Sheldon, Nathan D.


Station GPS permanente IPG Paris DGF Uchile UNAP Iquique.  

E-print Network

from IPGP / DGF network MONUMENTATION Antenna located in the top of the scholar library building, basic concrete pillar (previously reinforced). PG-A1 with GP Topcon antenna, GB-1000 Topcon receiver. HISTORIC working hours telephone nearby NONO Electric power nearby NONO Autonomous energy ­ (solar panel, regulator

Vigny, Christophe


Station GPS permanente IPG Paris DGF Uchile UNAP Iquique  

E-print Network

NetRS, Antenna TRIMBLE Zephyr geodetic and autonomous energy (battery and solar panel). HISTORIC Semi) 4. GPS Antenna Information 4.1 Antenna Type : TRIMBLE / Zephyr geodetic Serial Number : 60142400 #12;Antenna Height (m) : 0.000 (to be verified) Antenna Reference Point : ARP = dhpab Degree Offset from North

Vigny, Christophe


Station GPS permanente IPG Paris DGF Uchile UNAP Iquique  

E-print Network

-glue. Receptor TRIMBLE NetRS, Antenna TRIMBLE Zephyr geodetic and autonomous energy (battery and solar panel Number : Firmware Version : 0 Date Installed : Date Removed : (dd-MMM-yyyy hh:mm UT) #12;4. GPS Antenna Information 4.1 Antenna Type : TRIMBLE / Zephyr geodetic Serial Number : 60145334 Antenna Height (m) : 0

Vigny, Christophe


Oxygen-driven competition between low-dimensional structures of Sr3CoMO6 and Sr3CoMO7-? with M = Ru, Ir.  


We have realized a reversible structure transformation of one-dimensional 1D K4CdCl6-type Sr3CoMO6 with the Co(2+)/M(4+) cation ordering into the two-dimensional 2D double layered Ruddlesden-Popper structure Sr3CoMO7-? with a random distribution of Co and M (with M = Ru, Ir) upon increasing the partial oxygen pressure. The combined soft and hard X-ray absorption spectroscopy studies show that under transformation, Co and M cations were oxidized to Co(3+) and M(5+). During oxidation, high-spin Co(2+) in Sr3CoMO6 first transforms into high-spin Co(3+) in oxygen-deficient Sr3CoMO7-?, and then further transforms into low-spin Co(3+) in fully oxidized Sr3CoMO7 upon further increasing the partial pressure of oxygen. The 1D Sr3CoMO6 compound is magnetically ordered at low temperatures with the magnetic moments lying along the c-axis. Their alignment is parallel for Sr3CoRuO6 and antiparallel for Sr3CoIrO6. The 2D compounds reveal a spin-glass-like behavior related to the random distribution of magnetic cations in the structure. PMID:25111502

Mikhailova, Daria; Reichel, Phillip; Tsirlin, Alexander A; Abakumov, Artem M; Senyshyn, Anatoliy; Mogare, Kailash M; Schmidt, Marcus; Kuo, Chang-Yang; Pao, Chin-Wen; Pi, Tun-Wen; Lee, Jyh-Fu; Hu, Zhiwei; Tjeng, Liu Hao



A model catalyst approach to the effects of the support on Co–Mo hydrodesulfurization catalysts  

Microsoft Academic Search

Co–Mo model sulfide catalysts, in which CoMoS phases are selectively formed, were prepared by means of a CVD technique using Co(CO)3NO as a precursor of Co. It is shown by means of XPS, FTIR and NO adsorption that CoMoS phases form selectively when the Mo content exceeds monolayer loading. A single exposure of MoS2\\/Al2O3 to a vapor of Co(CO)3NO at

Yasuaki Okamoto; Takeshi Kubota




Microsoft Academic Search

El turismo, objeto de diversas disciplinas, es uno de los sectores más relevantes de la economía mundial, siendo en España la primera industria nacional. En los último años 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 creación en 1997 se ha

Ainhoa Aguirregoitia Martínez



Quercus 201 Noviembre 2002 / 39 agua como las copas de los  

E-print Network

S Quercus 201 Noviembre 2002 / 39 agua como las copas de los bosques tropicales, caso de algunos géneros de driópi- dos. Otras han ocupado las aguas freáticas o intersticia- les y muestran todas las mediterránea, y otros ambientes, como las aguas continentales, también pueden ser extraordinariamente ricos (1

Murcia, Universidad de


Castração química como pena, tratamento médico ou experimento científico : considerações bioéticas.  

E-print Network

??Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Bioética, 2014. A pedofilia é classificada como doença psiquiátrica e sua prática… (more)

Maia, Thais Meirelles de Sousa



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

E-print Network

y algunos vertebrados peque- ños y son presa de muchos otros animales (Fig. 1). Estas interacciones calidad de las áreas naturales existentes como de la abundancia y diversidad de plantas y animales nativos

Mazzotti, Frank


Presulfidation of CoMo and NiMoP Catalysts by Ammonium Thiosulfate  

Microsoft Academic Search

Ammonium thiosulfate ((NH4)2S2O3) was used as a sulfiding agent for presulfiding CoMo and NiMoP catalysts. The effect of the amount of (NH4)2S2O3 on hydrodesulfurization (HDS) activity was investigated. For the CoMo series, the use of a proper amount of (NH4)2S2O3 gave a higher HDS activity than when the catalyst was sulfided by H2S. SO42- formed during presulfidation modified the Al2O3

Hui GE; Xuekuan LI; Guofu WANG; Zhangfeng QIN; Zhanjun LÜ; Jianguo WANG



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.


AFINALES DE 1974, despus de una desas-trosa combinacin de enfermedades como el  

E-print Network

alimento y refu- gio del hurón. En 1988, el descubrimiento de las colonias más extensas de perros llaneros(Cynomys ludovicianus) en Norteamérica en la región de Janos- Casas Grandes,nos llevó a proponer este sitio como un área

Nacional Autónoma de México, Universidad


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

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


Autonomia e Motivação em narrativas de aprendizes de português como língua estrangeira1  

Microsoft Academic Search

Neste artigo, discuto os resultados de minha pesquisa dentro do projeto AMFALE - Autonomia em um Modelo Fractal de Aquisição de Língua Estrangeira. Com base em conceitos de autonomia e motivação e na correlação entre eles, analiso narrativas de aprendizes de português como língua estrangeira em Belo Horizonte. Tais análises atestam que a experiência de aprendizagem inserida em uma comunidade

Fernanda Sousa Carvalho


O mercado de carbono como instrumento de conservação da floresta amazônica  

Microsoft Academic Search

Este trabalho analisa a questão ambiental presente nas políticas públicas para a região amazônica, incluindo a Lei de Gestão de Florestas Públicas (Lei 11.284\\/06), sancionada com o objetivo de regulamentar a gestão de florestas públicas no Brasil e promover o desenvolvimento sustentável. O Mecanismo de Desenvolvimento Limpo (MDL) do Protocolo de Kyoto é sugerido como instrumento de conservação florestal. Por

Mariano Rua Lamarca Junior; Cesar Roberto Leite da Silva



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

Microsoft Academic Search

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

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



Como reportar quejas sobre el uso de animales en la enseanza,  

E-print Network

! Como reportar quejas sobre el uso de animales en la enseñanza, investigación, o experimentación animales usados en las investigaciones, la enseñanza o experimentación. El Comité Institucional del Cuidado y Uso de Animales (IACUC) está obligado a investigar cualquier queja relacionada al trato y cuidado

Johnston, Daniel


Los conceptos de "estructura" y "modelo" como ejemplo paradigmtico transdiciplinar en las Ciencias Humanas y Sociales  

E-print Network

1 Los conceptos de "estructura" y "modelo" como ejemplo paradigmático transdiciplinar en las Ciencias Humanas y Sociales Mgster. Ferro, María Virginia. Introducción: Los conceptos de "estructura" y a los diferentes sentidos de "estructura" y "modelo". Luego se presenta bajo la mirada de la Concepción

Paris-Sud XI, Université de


La hipnosis como adjunto en el tratamiento del hábito de fumar. Estudio de caso  

Microsoft Academic Search

Se presenta el caso de una paciente de 33 años con dependencia a la nicotina que lle vaba 9 años fu- mando una media de 35 cigarrillos diarios. Intentó dejarlo hace 3 años pero tuvo una recaída a los seis meses por problemas de ansiedad y continuó con su adicción. El tr atamiento tuvo como objetivo que la paciente dejara

María Elena; Mendoza Figueroa



Optical and structural characterization of the Co/Mo2C/Y system  

NASA Astrophysics Data System (ADS)

We study the thermal behaviour of a tri-layer multilayer, designed by inserting a third material, yttrium, into the previously studied Co/Mo2C system. The system is designed to work at near-normal incidence at the wavelength of 14.1 nm. The theoretical reflectivity of Co-based multilayer (Co/Mo2C/Y system) is improved up to 54% after the addition of yttrium. Two types of multilayers with different orders of yttrium layer are deposited: Co/Mo2C/Y and Co/Y/Mo2C. The samples are annealed up to 600 °C. The multilayers were characterized using hard x-ray and extreme ultraviolet reflectivity, nuclear magnetic resonance (NMR) spectroscopy and x-ray diffraction (XRD). The results show that the reflectivity of the Co/Mo2C/Y multilayer is 27.5% at near normal incidence around 14.6 nm for as-deposited sample, and then it decreases gradually after annealing up to 600 °C. A significant period compression is observed from 300 °C annealing and above. The Co/Y/Mo2C multilayer shows low reflectivity, less than 2.5%. NMR spectra reveal that the pure Co layers are completely mixed with other elements since there is no signal from ferromagnetic Co in the annealing samples of the Co/Mo2C/Y multilayer and all Co/Y/Mo2C samples. Based on the NMR and XRD results, we fit the EUV data for both multilayers with two different models in one period taking into account the formation of the interfacial compounds.

Yuan, Yanyan; Le Guen, Karine; André, Jean-Michel; Wang, Zhanshan; Zhu, Jingtao; Mény, Christian; Jonnard, Philippe



Alejarse como proceso social: ni?os y ancianos <> en Ayacucho1  

PubMed Central

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

Leinaweaver, Jessaca




E-print Network

T-SNAKES Y TRIANGULACI�N DE DELAUNAY COMO M�TODO DE GENERACI�N DE MALLADOS DE ESTRUCTURAS} RESUMEN La segmentación de estructuras anatómicas a partir de imágenes médicas y la reconstrucción de una representación compacta analítica de estas estructuras es un problema retador. Este trabajo utiliza la técnica de

Coto, Ernesto


Mosquito Control Around the Home (Spanish)  

E-print Network

barras de citronela como repelente . Contr olar larvas en criader os a73 Usar peces como Gambusia u otros pecesmosquiteros en cuerpos de agua perma-nentes como lagos y lagunas cuando ?stospuedan sobre vivir en ellos . P eces mosquiteros pueden encontrarse... en otraslagunas , tiendas de mascotas y lugares donde se v ende carnada para la pesca. a73 Usar productos a base de Bacillus thurin gien- sis israeliensis como ?Mosquito Dunks?? para tratar cuerpos de agua permanentes ycontrolar larv as . a73...

Jackman, John A.; Olson, Jimmy K.



Las fulguraciones como manifestación de reconexión en el campo magnético solar  

NASA Astrophysics Data System (ADS)

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

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



PubMed Central

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

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



Embarazo heterotópico en un ciclo de concepción natural presentado como embarazo ectópico roto. Informe de un caso  

Microsoft Academic Search

Resumen Introducción: El embarazo heterotópico se define como ges- tación intrauterina que coexiste con otra de tipo ectópico. Es una entidad rara, en particular en paciente sin antecedentes de tratamiento contra la infertilidad. El objetivo de esta comuni- cación es informar de una paciente sin antecedente de fertili- zación in vitro o de tratamiento para la fertilidad, quien presen- tó

Karla Elena Domínguez-Meléndez; Héctor Sastré-Gómez; Francisco Higuera-Hidalgo; Armando Vargas-Domínguez; Felipe Rafael Zaldívar-Ramírez



Sediment input and evolution of lacustrine deltas: The Breggia and Greggio rivers case study (Lake Como, Italy)  

Microsoft Academic Search

A high-resolution bathymetric survey is combined with Erosion Potential Method to unravel the spatial and time evolution of the deltas formed by the Breggia and Greggio rivers, in western branch of Lake Como (southern Alps, Italy). This data set provides information on changes in the geometry and depositional centres of these deltas from Holocene to Present. The morphology and structure

Daniela Fanetti; Luigina Vezzoli



L'education Permanente: Principe Revolutionnaire et Pratiques Conservatrices (Lifelong Education: Revolutionary Principles and Conservative Practices).  

ERIC Educational Resources Information Center

Reviews the historical formation of the concept of lifelong learning, indicating that it preceded the school and can contribute to policies and strategies designed to increase educational access. Reviews the dynamic between politics and educational activities and argues that a global approach to education is necessary to achieve true educational…

Gelpi, Ettore



An Overview of Health IT @ Kaiser Permanente NIST Health IT Symposium Series Gaithersburg, MD  

E-print Network

: Commonwealth Fund 2012 International Health Policy Survey PercentageofPrimaryCareDoctors Using EHRs April 15 2013 Walter G. Suarez, MD, MPH Executive Director, Health IT Strategy and Policy, Kaiser and Mission Transforming Care through Health IT Mission, Vision, and StrategyHealth IT-enabled Quality


PS1-39: The Kaiser Permanente Northern California Oracle Research Database  

PubMed Central

NCAL developed a pilot Research Database (RDB) in KPNC that contains clinical and administrative data for the 3.3 million current and 10 million past Health Plan members in the KPNC region, with some data that spans a 40 year period. The primary reason to create such a data warehouse is that researchers are often frustrated by the difficulty of finding, extracting, cleaning, interpreting and transforming the data into useful analytical datasets. This is due to the absence of an efficient research data infrastructure that is optimized for the analytical needs of researchers. In the RDB, we have aggregated clinical data from legacy systems, the current electronic health record (EHR) system, various public use datasets, and research datasets into a research data warehouse. Aims The specific aims of the project are: to develop a uniform schema with consistent data definitions and coding, using standardized terminology, that will harmonize aggregated legacy and current KP electronic health records, develop interfaces and extract, transform and load (ETL) processes for the KP electronic medical record system and other clinical systems that will feed data to the NRDB, implement a security model that is compliant with HIPAA and State regulations and KP policies, and develop federated schema with the other KP regions, so that it will be possible to do federated queries of each region’s databases and aggregate the results, while enabling each region to control access to its data. Methods We developed the RDB in Oracle. ETLs to various data sources were developed in SAS, Informatica and PL/SQL. Results The database is available to over 150 KP researchers and programmers in the Division of Research and other KPNC researchers, who are currently engaged in over 250 research projects. The KPNC Virtual Data Warehouse (VDW) has been incorporated into the RDB as a materialized view or data mart. It is a primary example of an analytic data source optimized for research. Updates to the RDB can be reflected immediately in the VDW. Conclusion The RDB, when it is complete, will be a unique and valuable resource for clinical,

Terdiman, Joe; Gul, Jamila



Area Affari Istituzionali, Internazionali e Formazione Divisione Formazione Universitaria e Formazione Permanente  

E-print Network

in European Master in Angiology/Vascular Medicine, avanzata dal Consiglio del Dipartimento di Scienze per master di secondo livello in European Master in Angiology/Vascular Medicine. Il corso per master è Society of the Angiology and Vascular Surgery (MAET) (H), First Faculty of Medicine, Charles University

De Cindio, Fiorella


Area Affari Istituzionali, Internazionali e Formazione Divisione Formazione Universitaria e Formazione Permanente  

E-print Network

in Angiology/Vascular Medicine for the academic year 2013/2014; - In accordance with the decisions passed on 18 DECREES THE FOLLOWING the level two European Masters Course in Angiology/Vascular Medicine is activated), the Medical University of Vienna (A), the Hungarian Society of the Angiology and Vascular Surgery (MAET) (H

De Cindio, Fiorella


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



estudio recomendado aquellos pacientes síntomas específicos tales como: dolor extremidades pseudoclaudicación síntomas atípicos. través información espero pueda enriquecer formación quieran leerlos.  

EPA Pesticide Factsheets

Search instead for estudio recomendado aquellos pacientes síntomas específicos tales como: dolor extremidades pseudoclaudicación síntomas atípicos. través información espero pueda enriquecer formación quieran leerlos. ?


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).

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



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

yeasty mix of competing discourses. Sometimes the cause is attributed, far less probably, to the proto- feminist disposition of Anne Hutchinson, considered by some to be a cultural heroine martyred by powerful elite male persecutors. Oddly, not enough... contem- plated settlement in New England as if his views would not be problematic there. Como rightly suggests that Howes? case indi- cates the blurred boundaries among competing doctrinal positions within Puritan culture. Whereas Como delves...

William J. Scheick



Nexo casual deve ser comprovado para se caracterizar a responsabilidade do Para ficar caracterizada a responsabilidade subjetiva, assim como a objetiva, alm da  

E-print Network

primeiro grau. Para o tribunal, ficou caracterizada a responsabilidade civil do município, uma vez queNexo casual deve ser comprovado para se caracterizar a responsabilidade do Estado Para ficar caracterizada a responsabilidade subjetiva, assim como a objetiva, além da investigação de culpa do agente, tem

Floeter, Sergio Ricardo


Da 17/01/2014 -11.49h Identifican las sustancias qumicas que las reinas de especies como hormigas, abejas y  

E-print Network

como las abejas, avispas, abejorros y algunas hormigas utilizan la La reina del sexo: por qué solo una puede reproducirse - 1 of 3 dificultades que encontró Darwin", La reina del sexo: por qu

Wenseleers, Tom


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

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


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

Microsoft Academic Search

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

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



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




Occlusal caries diagnosis in permanent teeth: an in vitro study Diagnóstico de cárie oclusal em dentes permanentes: estudo in vitro  

Microsoft Academic Search

The reduction in caries prevalence has not occurred uniformly for all dental surfaces. As the occlusal surfaces are still the most likely sites for the development of lesions, new methods of diagnosis are still being evalu- ated. This study compared a laser fluorescence (LF) system (DIAGNOdent) with the Ekstrand's visual system for in vitro detection of occlusal caries. A total

Braz Oral Res; Gisele Angnes; Vivian Angnes; Rosa Helena; Miranda Grande; Márcio Battistella; Alessandro Dourado Loguercio; Alessandra Reis


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

ERIC Educational Resources Information Center

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

Lind, Patricia; Germano, Catherine


Abdominal Aortic Aneurysmectomy, 1968-1969—A Review of Recent Experience of the Southern California Permanente Medical Group  

PubMed Central

Seventy-three aneurysmectomies were done in the two-year period 1968-1969 for a Health Plan population of 771,000. The mortality in the elective cases was nine percent and in the emergency cases 44 percent. An analysis of the complications and causes of death reveals them to be essentially the same as reported by others. Bleeding and myocardial infarction are the two most common causes of death in emergency operations. Pneumonia and urinary tract infections are the most common complications in successful cases. Comparison of this report of recent experience with reports of cumulative series is difficult. The morbidity and mortality reported here is felt to be representative of current practice. PMID:5314163

Devor, Daniel



la dformation permanente du verre ; les variables taient alors la temprature, et le volume spcifique du verre. M. Marchis arrive  

E-print Network

AU CONTACT ENTRE LE MERCURE ET LES CHLORURES DE POTASSIUM ET DE SODIUM ; Par M. ROTT�. La théorie de normales, c'est-à- dire contenant une molécule-gramme par litre, présentent avec le mercure-calomel (mercure saupoudré de calomel) la même différence de potentiel au contact. Si on désigne par D le mercure

Paris-Sud XI, Université de


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

SciTech Connect

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. [IFP-Lyon, Physics and Analysis Division, Materials Characterization Department, BP3, 69390 Vernaison (France); Guillaume, D. [IFP-Lyon, Catalysis and Separation Division, Heterogeneous Catalysis Department, BP3, 69390 Vernaison (France)



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.



Apresentase neste apndice a definio de categoria cartesiana livremente gerada, apresentada em [Sernadas et al 92e]. Tal como em [Admek et al 90], assumese que  

E-print Network

'')�Mor C P desde que (s:c®c')�Mor C P e (s':c'®c'')�Mor C P ; . ((s':c®c')�(s'':c®c''):c®c'�c'')�Mor C P desde que (s':c®c')�Mor C P e (s'':c®c'')� Mor C P ; pela relação de equivalência induzida pelas, apresentada em [Sernadas et al 92e]. Tal como em [Adámek et al 90], assume­se que Cat denota a categoria de

Lisboa, Universidade Técnica de


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

NASA Astrophysics Data System (ADS)

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

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


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


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

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



La economía social como enfoque metodológico, como objeto de estudio y como disciplina científica  

Microsoft Academic Search

This article continues an article written by the same author and published by CIRIEC-España in 1997 (no. 25). It analyses social economy at three cognitive levels: first, as a social reality (Social Economy); second, as a scientific discipline which studies its previous reality (the science of Social Economy); third, as a methodological approach in social sciences (the approach of Social

Rafael Chaves



Coaching como herramienta de liderazgo para el desarrollo de equipos de alto desempeño en el área de ventas (Coaching like tool of leadership for the development of teams of high acting in the area of sales)  

Microsoft Academic Search

Resumen. El presente artículo busca vincular el coaching como herramienta de liderazgo para el desarrollo de equipos de alto desempeño en el área de ventas. Para cumplir con este propósito se realizó una revisión de bibliografía y documentos publicados en la web sobre a esta temática, que permitieron definir conceptualmente su relación con el coaching y los distintos estilos de

Fidel Moreno



Difusión de resultados iniciales del Estudio del Tamoxifeno y del Raloxifeno (STAR): el fármaco para el tratamiento de la osteoporosis, raloxifeno, es tan efectivo como el Tamoxifeno en la prevención de cáncer de seno invasor

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


Production des prairies permanentes irrigues de Crau et recharge des nappes : tude des relations production/irrigation/drainage en conditions de changement global  

E-print Network

relations production/irrigation/drainage en conditions de changement global Françoise Ruget et Albert par le drainage. Le sujet est composé d'une partie analytique sur deux points qui nécessitent d en conditions irriguées, drainage, recharge de la nappe, Crau, changement climatique #12;

Naud Frédéric



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



La corrosin es un problema permanente en la economa y la industria en general, y en particular, en el entorno ambiental: agua, suelo y atmsfera. Los contaminantes  

E-print Network

particular, en el entorno ambiental: agua, suelo y atmósfera. Los contaminantes provenientes de las descargas humana, alteran la vida acuática y la propia calidad del agua. El control de la corrosión contribuye petroquímica, marítima, vehicular y aeroespacial; agua y energía, incluyendo energías renovables, en diversas


Textile wastewater reuse in northern italy (COMO)  

Microsoft Academic Search

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

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



Como Campus Master of Science in  

E-print Network

, Environmental Protection Plans and Pollution Risk, Engineering and Cooperation or Energy for Global Development. Their expertise will range from the knowledge of modeling of land and ecological systems, to acquisition and analysis of relevant data, geo-referencing and geo-processing, to pollution abatement technologies


Las comunidades locales como estructuras meso1  

Microsoft Academic Search

In between micro and macro levels : meso. If macro is defined by national, state or market regulation, and micro by relational interpersonnal regulation, a major agency of intermediate regulation has been defined as \\

A. Ferrand




Microsoft Academic Search

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

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




E-print Network


DeSante, David F.


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



Pelvic Floor Disorders Network  


... University - Durham, North Carolina University of California at San Diego - San Diego, California Kaiser Permanente (affiliated with UCSD) - San Diego, California Kaiser Permanente - Bellflower (affiliated with UCSD) - Bellflower, ...


Inhalation of hypertonic saline solution as coadjuvant in respiratory physiotherapy to reverse atelectasis in the postoperative of pediatric heart surgery Inalação de solução salina hipertônica como coadjuvante da fisioterapia respiratória para reversão de atelectasia no pós-operatório de cirurgia cardíaca pediátrica  

Microsoft Academic Search

Resumo Criança de 11 meses, sexo feminino, submetida à operação de fechamento de comunicação interventricular, comunicação interatrial e ligadura de canal arterial. Evoluiu no pós- operatório com atelectasia persistente em base pulmonar à direita, não respondendo às manobras fisioterapêuticas convencionais, efetuadas seis vezes ao dia. Após associação, como coadjuvante, da inalação de solução salina hipertônica com NaCl a 6%, imediatamente

Naila Luisa; Saiki da SILVA; Raquel Ferrari PIOTTO; Marcelo Adriano; Ingraci BARBOZA; Ulisses Alexandre; Domingo M. BRAILE



E-print Network

Hoja de Recapturas MoSI Localidad Tamaño de anillo R Temporada (p.ej 2009-10) Página # CODE SEXO EDAD COMO DETERMINAR LA EDAD Y EL SEXO CRÁNEO PROT. CLOAC. PARCH. DE INC. GRASA MUDA CUERP. MUDA PL SEXO Lesión vieja, cicatrizad. Herida o enfermedad PARCH.DEINC. GRASA MUDACUERPO MUDAPL.VUEL. ANILLOS

DeSante, David F.



E-print Network

Hoja de Anillamiento MoSI Localidad Tamaño de anillo Temporada (p.ej. 2009-10) Página # C�DIGO SEXO EDAD COMO DETERMINAR LA EDAD Y EL SEXO CRÁNEO PROT. CLOAC. PARCH. DE INC. GRASA MUDA CUERP. MUDA PL SEXO COMODET. ELSEXO Lesión vieja, cicatrizad. Herida o enfermedad MUDAPL.VUEL. DESGAS.VUEL. PLUMAJEJUV

DeSante, David F.


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

Microsoft Academic Search

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

Joyce Rodrigues da Cruz


[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


Como Solicitar Los Beneficios del Seguro del Desempleo Transcripcin  

E-print Network

depende en los ingresos que ha ganado en un periodo de 12 meses...esto es lo que se le llama ingresos del éste Segundo...usted puede visitar nuestro sitio de Internet y presentar su solicitud en línea O. Busque el enlace de la "Lista de Verificación" en nuestro sitio del Internet. Púlselo e imprímalo. Al


Del carnaval como 'metáfora' al teatro de carnaval  

E-print Network

ocasiones "sus piruetas van llenando la noche de fantasía, todo es color y alegría." Pese a sus "gracias" y burlas es un dios sorprendentemente obediente y burocrático, que se detiene ante los límites y tabúes trazados por la cultura hegemónica ("debe..." (que separa al escenario de la platea y al murguista del público), lo mismo mantiene "la quinta pared" que separa el tablado de la calle. Estas representaciones también se caracterizan por la búsqueda de conformar a las autoridades, por estar...

Remedi, Gustavo



Curetaje cornual como tratamiento conservador del embarazo ectópico accidentado  

Microsoft Academic Search

The classical treatment of cornual ectopic pregnancy is cornual resection or hysterectomy. Currently, a more conservative approach is feasible. We describe a case of cornual ectopic pregnancy treated with tubal cornual curettage and review the various options in the management of this entity. This technique may reduce the risk of uterine rupture in future pregnancies, even though studies on this

Ainhoa Becerro Cortizas; Mikel Gorostidi Pulgar; Iordana Aizpitarte Gorrotxategi; Elisa Ecenarro González-Echavarri; Marina Navarro López




Microsoft Academic Search

ABSTRACT This article uses,the global,commodity,chains,framework,to examine the structure and dynamics of global industries, and the development prospects for nations and firms within them. First, we distinguish between producer- driven and buyer-driven commodity chains, and we put forwardthe hypothe-





Microsoft Academic Search

ABSTRACT This work will analyse the concept ofbeing a woman,and also how the Society expects her behavior tobe. This analysis will be theoretical based on the marginality concept, presented by Natalie Zemon Davis and as a counterpoint, there are two women testimonies, who were born during 20th century, and each one experienced that marginality. The conclusion is: the difference between

Marilza Mestre


O uso de palmadas e surras como prática educativa  

Microsoft Academic Search

Resumo Esta pesquisa identificou as práticas educativas parentais, com ênfase em castigos e punições corporais, por meio do relato de estudantes. Responderam a um questionário com 61 questões, 472 crianças e adolescentes de ambos os sexos e com idade entre oito e 16 anos. A maioria dos participantes relatou que já recebera punições corporais (88,1%) e castigos (64,8%). Sobre punições

Lidia Natalia Dobrianskyj Weber; Ana Paula Viezzer; Olivia Justen Brandenburg



Trombosis venosa profunda como marcador de recidiva de una neoplasia  

Microsoft Academic Search

Background and objectiveThere is a bidirectional association between neoplasia and venous thromboembolism (VTE). However, whether this association has an impact in tumor recurrence is unknown. The aim of the study is to assess the incidence of cancer recurrence after diagnosis of VTE and determine if VTE could be a marker for cancer recurrence.

Montserrat Blanch Alerany; Mariona Calvo Campos; Antonio Romera Villegas; Antonio Pérez-Piqueras Gómez; Santiago Riera Batalla; Marc Antoni Cairols Castellote



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

E-print Network

dentro das chamas. Muitos intelectualmente morrem sem consciência. Para outros, a consciência é a causa mortis. E o que acontece com o teatro, acontece também com o cinema, com a literatura, com a música, com as artes plásticas, etc. O impasse do... do divertimento. As poucas tentativas sérias são ainda superficiais. Em essência permanece um teatro alienado e, mesmo quando se propõe ao contrário, alienante. A esperança é que um novo saia das cinzas. Um teatro que mergulhe com firmeza e decisão...

Peixoto, Fernando



Congressional Information Demystified Bibliography COMO October 15, 2010  

E-print Network

-leg-hist-docs.pdf o Selected Congressional Research Service Reports on Congress and Its Procedures. Part of the Law Research Service Reports on Congress and Its Procedures. Part of Law Librarians' Society of Washington, D of LLSDC's Legislative Source Book. o Selected Congressional

Nair, Sankar


La curva de rendimientos como predictor de expectativas macroeconómicas  

Microsoft Academic Search

La búsqueda de información basada en las diferentes herramientas que el mercado ha desarrollado, ha convertido a la curva de rendimientos en una de las más utilizadas. Diferentes autores a nivel internacional se han preocupado por investigar y extraer información, teniendo en cuenta la formación de expectativas de los agentes sobre las tasas de interés, el comportamiento de diferentes variables

Juan Camilo Rojas



Calix[n]arenos como organocatalisadores para reações de esterificação.  

E-print Network

??This thesis aimed to develop organocatalysers inspired by calix[n]arenes for esterification reactions of organic acids. First the conversion of the esterification reactions of deuterated palmitic… (more)

Ricardo Natalino




Microsoft Academic Search

The possibility of using the wood-tar creosote from Eucalyptus spp in wood preservation was investigated. The wood-tar, obtained as by-product in two industrial and one pilot plant of wood carbonization, was distilled under reduced pressure (2.3 to 3.3 kPa) to give the creosotes. The wood-tar creosotes were tested in laboratory against biodeterioration, in comparison to coal-tar creosote. Although the wood



GEOIDEA - Geotecnologia como instrumento da inclusão digital e educação ambiental  

Microsoft Academic Search

GEOIDEA1 Project (Geo-technology as Instrument of Digital Inclusion and Environmental Education) aims to develop and apply a methodology focused on students digital inclusion through the use of Geographical Information System, in particular, in Geography classes. This work has generated, in digital environment, the means for teaching and learning subjects related to mapping, space technology, environment, for example, themes like watersheds,

Angelica Carvalho Di Maio


Cholesterol-Lowering Drugs May Help After Certain Strokes  


... author, Dr. Alexander Flint, the medical director of neuroscience quality at Kaiser Permanente in Redwood City, Calif. ... Alexander Flint, M.D., Ph.D. medical director, Neuroscience Quality, and local research chair, Kaiser Permanente, Redwood ...


Field technique of permeability tests in highly fissured limestone strata  

NASA Astrophysics Data System (ADS)

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

Al-Salihi, Adnan; Asaad, Abdulah



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.



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

PubMed Central

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

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



Óxido Nítrico: estudios sobre su papel como mediador en diversas funciones fisiológicas y fisiopatológicas  

Microsoft Academic Search

Nitric oxide (NO) is a unique molecule, with neurotransmit ter properties and with many and important functions in the organism. It is synthesized from L-arginina, producing also a molecule of L-citrulina, in a reaction catalyzed by nitric oxide sinthase (NOS), of which there are 3 known isoenzimes: two constitutives (cNOS) and one inducible (iNOS). The production of the iNOS is

Anna B. Alfieri


IDC 2009 Papers 3-5 June, 2009 Como, Italy Designing Wiimprovisation for  

E-print Network

]: General---games. General Terms Design, Experimentation, Human Factors Keywords Mediation, video game results suggest that our video game-based virtual instruments indeed support mediation, while enabling Music Therapy with Children Suffering from Behavioral Disorders Samuel Benveniste, Pierre Jouvelot CRI

Boyer, Edmond


Alphitobius diaperinus como veiculador de Clostridium perfringens em granjas avícolas do interior paulista - Brasil  

Microsoft Academic Search

The Alphitobius diaperinus (lesser mealworm) is considered an important world poultry plague. Due to its behavior characteristics and biological habits that make its control difficult it is considered a vector of pathogenic agents. The objective of this research was to investigate the little mealworm as possible vector of Clostridium perfringens in broiler houses, located in different parts of the state

Juliano VittoriI Rubén; Pablo Schocken-IturrinoI; César Augusto Martins; Gislaine Gomes; Caroline Peters



Microsoft Academic Search

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

Armando Morillo; Omaira Sequera; Ricardo Ramírez




Microsoft Academic Search

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

Mar Bermejo




Microsoft Academic Search

It's evaluated the corrosion of 304 stainless steel and steel 1018, embedded in elaborated specimens of concrete on the basis of norms ASTM C470-87 and C192-81. Were elaborated concrete of ration a\\/c, 0,45 and 0.65 . The specimens were exposed 66 weeks in two aggressive means, solutions to 3,5% of NaCl and 3,5% of Na2SO4. The evaluation was made by





Microsoft Academic Search

SUMMARY The last years increase the interest to know the impact of silvicultural practices on the characteristics and functionality of the red soils under second rotation. In this study changes in soil organic carbon (OC), light fraction organic matter (LF) and weight of the aggregate mean diameter (MWD) were analyzed in relation to the following site preparation practices: a) manual

A. M. Lupi; R. Fernández; M. Conti



Microsoft Academic Search

-1 then the yield increment = 72,5 - 1,38 Nan, if Nan > kg -1 the yield increment = 6 %). Nan was related with the time (years) since the last pasture (r 2 = 0.39). These results suggest that Nan probably is associated with light carbon fractions and can be used to explain the response of maize to




E-print Network

personas que quieren mantener un adecuado tono muscular. 2 �nico Hip Hop /Funky Estilo de baile que hace contacto en el que los contrincantes utilizan únicamente sus puños con guantes. Break Dance Danza urbana

Autonoma de Madrid, Universidad


Influence of the Co/Mo Ratio on the SWNT Synthesis from Carbon Monoxide  

E-print Network

Noda 2 , Hisashi Sugime 3 , Naoto Masuyama 4 , Shigeo Maruyama 5 1 J-Power / The Univ. of Tokyo 2, Y. Tsuji, Y. Murakami, S. Maruyama, Appl. Phys. Lett., 86 (2005) 173106. [2] S. Noda, H. Sugime, T. Osawa, Y. Tsuji, S. Chiashi, Y. Murakami, and S. Maruyama, Carbon, in press. [3] J.E.Herrera, L. Balzano

Maruyama, Shigeo


La Educacion Basada en Competencias como Instrumento de Politica Educativa y Laboral  

Microsoft Academic Search

The objective of this paper is to point out some of the multiple applications of Competence- Based Education (CBE) for the development of persons, organizations and society, or societies, as a whole, beyond its characteristics and benefits traditionally linked to education and labor. The international background of CBE is summarized. Following, an analysis is presented of some of the properties

Juan B. Climent Bonilla



Carmen de Burgos: La educacion de la mujer y la literatura de viajes como genero narrativo  

Microsoft Academic Search

This study analyzes Carmen de Burgos' European travel literature, and focuses on two themes: education and travel literature as a literary genre. An examination of her travel literature reveals two essential elements related to her view of education. The first is the influence that the European educational system had on her way of thinking, particularly with respect to the idea

Esther A Daganzo-Cantens



Nonbinary decoding of structured LDPC codes Daniele Capirone, Giacomo Como, Fabio Fagnani and Federica Garin  

E-print Network

, for given generic LDPC matrices, equivalent generating matrices with lower encoding complexity. On the other encoding. A successful construction uses matrices with a staircase part (i.e. a sub-matrix with ones and hierarchies indicated by the ML analysis are respected. II. ENCODING SCHEMES AND PARITY CHECK MATRICES

Como, Giacomo


Distributed averaging on digital noisy networks Ruggero Carli, Giacomo Como, Paolo Frasca, and Federica Garin  

E-print Network

in the state-upadate a compensation for the quantization error, avoiding its accumulation. We prove almost sure regarded as a significant case study, in order to understand the role of communication constraints in more general problems of distributed computation, in which a network of communicating processors

Como, Giacomo


Opinion fluctuations and persistent disagreement in social networks Daron Acemoglu, Giacomo Como, Fabio Fagnani, Asuman Ozdaglar  

E-print Network

parties or media sources attempting to influence the beliefs in the rest of the society. When the society of homogeneous influence emerges, whereby the stationary beliefs' marginal distributions of most of the regular agents have approximately equal first and second moment. Homogeneous influence in a highly fluid

Como, Giacomo



Microsoft Academic Search

This paper examines the role of syllables as phonetic units (PU) in Portuguese-based continuous speech recognition (CSR) systems. These units have not shown promising results for the English language. This is probably due to the fact that English does not have a trivial syllabic splitting. However, in the Portuguese language these structures are simple and constitute the nucleus on which

Sidney Cerqueira; Bispo dos Santos; Abraham Alcaim


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

ERIC Educational Resources Information Center

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

Diaz-Plaja, Guillermo



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

Microsoft Academic Search

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

Enrique Santamaría



Investigação da infância e crianças como investigadoras: metodologias participativas dos mundos sociais das crianças  

Microsoft Academic Search

In the second modernity the childhood participation is assumed as a fundamental principle to a large extent of the scientific speeches that are produced concerning childhood. The Sociology of Childhood, when considering the children as social actors and as citizens of rights, assumes the question of children's participation as central in the definition of a social statute of childhood and

Natália Fernandes Soares; Manuel Jacinto Sarmento; Catarina Tomás


Planteo de situaciones problemáticas como estrategia integradora en la enseñanza de las ciencias y la tecnología  

Microsoft Academic Search

This paper offers the results of the implementation of an inter- discipline teaching strategy, within the subject of technology. Such proposal deals with topics from other subjects, which are included in the third cycle of EGB, such as natural sciences (physics, chemistry and biology), mathematics and geography. The aim is to favour the integration of the conceptual, procedural and attitudinal

Sandra Vásquez; Patricia Bustos; Graciela Núñez



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 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, Jorg; Toussaint, Sandy



Prescripción electrónica asistida como nueva tecnología para la seguridad del paciente hospitalizado  

Microsoft Academic Search

Concern about patient safety is a priority in the quality policy of health systems. In the pharmacotherapeutic process, from prescription to administration of drugs, failures that cause unwanted effects in patients may occur. This is especially common in patients with multiple pathologies and polypharmacy, common in medical specialities services. To analyze and identify the causes that trigger medical errors is

Elena Villamañán; Alicia Herrero; Rodolfo Álvarez-Sala



Um estudo do poliformismo 5HT2A como elo entre tabagismo e depressão.  

E-print Network

??Objetivo: Verificar a relação entre o polimorfismo genético 5HT2A, tabagismo e depressão. Métodos: Através de um delineamento transversal, duplo-cego, foram selecionados, no período de outubro… (more)

Ana Maria Bellani Migott



Nutrición basada en la evidencia en el cáncer como enfermedad caquectizante  

Microsoft Academic Search

Cachexia is characterized by progressive and involuntary weight loss. Cancer is considered to be a cachexia-inducing disease because of the prevalence and importance of cachexia in malignant neoplastic disease. It is well known that malnutrition frequently contributes to the death of cancer patients. However, before routinely recommending nutritional therapy, the real therapeutic benefits it confers should be identified. The present

E. Cancér Minchot; G. Cánovas Molina; M. Durán Poveda; J. Álvarez Hernández; J. J. Gorgojo Martínez



RESUMO: O estudo teve como objeto analisar algumas caractersticas da produo bibliogrfica sobre a Qualidade  

E-print Network

na Revista Ciencia y Enfermería online, Online Brazilian Journal of Nursing e Revista de Enfermagem published in the online journal Ciencia y Enfermería, online Brazilian Journal of Nursing and The Journal of Nursing of UERJ, with one article each (16.6%). Four articles were published in the Jornal Vascular

Paris-Sud XI, Université de


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

E-print Network

to metal oxide species. The excess CoO exists as nano-sized wetting particles either dispersed at catalyst/SiO2 interfaces, which stabilize these nano-sized metallic Co particles from agglomeration. This study reveals that the stable existence of well-dispersed nano-sized catalytic metal particles

Maruyama, Shigeo


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

Microsoft Academic Search

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

Ana Amélia Camarano; Maria Tereza Pasinato


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

E-print Network

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

Rodrigo de Abreu



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

E-print Network

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

De Abreu, R




Microsoft Academic Search

The transfer of seed storage material from the cotiledons to the embryo axys of soybean seeds (Glycine max (L.) Merrill) was studied. Two lots of cultivar Bragg with germination above 80% and differing in vigor levels, as assessed by the accelerated aging test were used. The initial seed quality was evaluated by moisture content, weight of 1,000 seeds, germination and




E-print Network

is the difference between the end score and beginning score or gain score (how much students improved). The W scores come from the Woodcock Mu?oz Language Survey-Revised which is an assessment used to measure proficiency in English and Spanish. In this case... is the difference between the end score and beginning score or gain score (how much students improved). The W scores come from the Woodcock Mu?oz Language Survey-Revised which is an assessment used to measure proficiency in English and Spanish. In this case...

Olivarez, Enrika



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

Federal Register 2010, 2011, 2012, 2013

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,...




Microsoft Academic Search

The following sociolinguistic investigation presents an analysis of the Costa Rican students' lexicon1. The very fre- quent use of dysphemisms seems to be one characteristic of that variety. Authors like López Morales denoted euphe- misms typical of students' speech; therefore it will be analyzed whether the frequency in the use of euphemisms is comparable to that of dysphemisms. First, the

Tanja Zimmer



Microsoft Academic Search

The use of internet has been commonly associated with a vast list of threats that concern parents, teachers and educators in general. However, the opportunities created by this new media are unquestionable and it appears even irresponsible to prohibit its utilization. In this context, it seems urgent to develop knowledge about these risks, the actual danger they signify and, above

Ana Francisca; Cunha Monteiro


Calibration of fundamental stellar quantities; Proceedings of the Symposium, Como, Italy, May 24-29, 1984  

Microsoft Academic Search

The present conference assesses the state-of-the-art in the choice of standard stars, the calibration of trigonometric parallaxes, the calibration of interferometrically determined binary star properties, stellar rotational velocity determinations, high angular resolution star measurements, approaches to photometric calibrations, and the relation between fundamental parameters and models of stellar atmospheres. Attention is then given to such stellar quantity calibration topics as

D. S. Hayes; L. E. Pasinetti; A. G. D. Philip



Marcapasos diafragmático como alternativa a la ventilación mecánica en el paciente con lesión medular cervical  

Microsoft Academic Search

ObjectiveTo verify that the diaphragmatic pacemaker is a form of respiratory support that can be used to replace a volumetric respirator in cervical spinal injury patients with cervical spinal lesion and diaphragmatic paralysis by means of its comparison with the traditional volumetric respirator.

F. J. Romero-Ganuza; C. Gambarrutta-Malfatti; E. Diez de la Lastra-Buigues; M. Á. Marín-Ruiz; V. E. Merlo-González; A. M. Sánchez-Aranzueque Pantoja; F. J. García-Moreno; J. Mazaira-Álvarez



ALA 2012 Program www.  

E-print Network

Tumer. Combining Difference Rewards and Hierarchies for Scaling to Large Multiagent Systems Session 3 Learning for a Developing Curious Agent (SP) Scott Proper and Kagan Tumer. Coordination Graphs Dynamic Rewards to Learn a Fully Holonomic Bipedal Walk (SP) Atil Iscen and Kagan Tumer. Multiagent

Steels, Luc


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

Federal Register 2010, 2011, 2012, 2013

...maintain the historic fire return interval; (3) improve forest resilience to dwarf...maintain the historic fire return interval, (3) improve the forest resilience to native...area. Decreasing forest density and maintaining the historic fire return...



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

PubMed Central

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

Gonzalez, Juan Bosco



Macroinvertebrados bentónicos como indicadores de calidad de agua de ríos del sur de Chile  

Microsoft Academic Search

The Damas River Hydrographic Basin (40°39'S, 72°23' W) presents an intense agricultural and cattle ranching activities in 78.2 % of its surface, which has resulted in important inputs of nutrients into the aquatic ecosystem. The objectives of this study were: (a) to analyze the spatial distribution of the benthic macrofauna in the Damas basin, and (b) to determine the feasibility





Microsoft Academic Search

The alcoholism is a relevant problem in public health. The use of alcohol among women has increased as well as the search for treatment. This research proposes the resignification of food to these women, as a harm reduction strategy. The research aimed to study and to discuss the experience of lunchtime as a therapeutic moment, presenting theoretic assumptions, strategies and

Silzeth Schlichting; Maria Cristina Faber Boog; Claudinei José Gomes Campos




E-print Network

Moresco #12;Universidade Federal de Santa Catarina Comissão Permanente do Vestibular Vestibular 2006 .......................................................................................................... 5 2 Dados gerais do Vestibular 2006

Floeter, Sergio Ricardo


Solubilization of curcumin using a selected cyclodextrin.  

E-print Network

??Die Arbeit mit Curcuminoiden, insbesondere mit dem Hauptcurcuminoid Curcumin, ist ein permanentes Bestreben der Mitarbeiter des Departments der Pharmazie an der Universität Oslo, Norwegen. Deren… (more)

Rupp, Alexandra



Resultados do desenvolvimento de um propulsor à plasma no Brasil  

NASA Astrophysics Data System (ADS)

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

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



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

ERIC Educational Resources Information Center

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

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



Microsoft Academic Search

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

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



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

E-print Network

technologies offer to manipulative learning. After analyzing children's cognitive and psychomotorial skills, we has been based on observations of the children using the technology, letting them freely play Interfaces (TUI) are nowadays clear. These physical technologies are suitable for children providing

Baldassarri, Sandra


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

ERIC Educational Resources Information Center

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

Raphael, Doris; Weisman, Douglas


Jornal da Cincia, Ano XXI, no. 595, 13 Abril 2007 Como o Brasil evitar o apago de imagens  

E-print Network

Espacial Internacional e no ainda mais questionável programa de missão tripulada a Marte. No final de 2005 NASA? Não seria melhor fazer um satélite brasileiro com tecnologia americana ou francesa? O tempo se



Microsoft Academic Search

This work makes a study of the sand from Caiuá Sandstones, Paranavaí Formation, abundantly found in the north-west region of Paraná, Brazil, aiming to use it as a minute aggregate for structural concrete. And, based on an adopted procedure, it determines the trace of concrete with this sand, through the sustematic equivalence of the surface area of the aggregate grains,



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

Microsoft Academic Search

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

Ralph Trancoso




Microsoft Academic Search

Water management is influenced by global, national and local issues. Globally, climate change and increasing water demand to meet the world's food demand are having a significant impact in water basins' management and water allocation. Many world rivers are internationally shared and must be managed according to international treaties which commit and enforce states to cooperate equitably. Defining water property

Alberto Garrido Colmenero



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 José Cov; Danny Eugenio García; Alexander Rafael Castro; María Gabriela Medina



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.


Obtenção do copolímero de acrilonitrila e vinil-tetrazol e sua aplicação como inibidor de corrosão para meio ácido.  

E-print Network

??Polímeros heterocíclicos abrangem uma grande variedade de materiais, desde simples polímeros lineares sintetizados a partir de monômeros do tipo heterocíclicos vinílicos até polímeros altamente funcionalizados… (more)

Thiago Santangelo Costa



NIÑOS VIOLENTADOS: EL CINE-DEBATE COMO OPCIÓN TERAPÉUTICA1 Film-discussion as an optional therapy in child abuse  

Microsoft Academic Search

From the characteristics and importance of the film-discussion (actually better known as cineforum or cinematherapy), its efficiency is analyzed with children that suffer domestic violence from a first pilot experience with eleven chil- dren, sons of a group of battered mothers Through nine sessions, there were tackled problems as self-esteem, self-care, values (respect, responsibility, unity,

Teresa Fernández de Juan


Geometria diferencial. Problemas 1 1. Como podriamos definir una variedad con borde? Sugerencia: permite que las cartas sean  

E-print Network

: permite que las cartas sean homeomorfismos o bien sobre un abierto (o bola) de Rn o bien sobre el´iamos haber asumido que todas las cartas son difeomorfismos sobre la bola de radio 1. Probar que tambi´en podr

Enciso, Alberto


Certificamos que Igor Franoze Gevaerd participou como ouvinte na banca de defesa do Trabalho de Concluso de  

E-print Network

de Curso "Futeba! O dono da bola", na data 19/03/2013 às 20h, com duração de 1h. Curitiba, 21 de ouvinte na banca de defesa do Trabalho de Conclusão de Curso "Futeba! O dono da bola", na data 19 de Curso "Futeba! O dono da bola", na data 19/03/2013 às 20h, com duração de 1h. Curitiba, 21 de

Paraná, Universidade Federal do


ECOLOGY, BEHAVIOR AND BIONOMICS As Formigas como Indicadores Biológicos do Impacto Humano em Manguezais da Costa Sudeste da Bahia  

Microsoft Academic Search

Mangroves are common in estuaries along the Atlantic coast of Brazil. Although plant diversity is low, this ecosystem supports a range of animals, offering some resources for non-aquatic organisms. Many insects live in mangroves and, between them, many ant species that are exclusively arboreous. Mangroves throughout the world suffer from high levels of human impact, and this is particularly true




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

E-print Network

parties or media sources attempting to influence the beliefs in the rest of the population. Scaling limits, under the influence of one stubborn agent. The game takes on the form of two partial differential) other agents' current beliefs, thus modeling the attractive nature of social influence. Standard models

Como, Giacomo


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

Microsoft Academic Search

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

Lesbia Meertens; Gloria Naddaf; Adelmo Rodríguez



IDC 2009 Full Papers 3-5 June 2009 Como, Italy Children Designing Together on a Multi-Touch Tabletop  

E-print Network

, Milton Keynes MK7 6AA, UK 2 Department of Psychology, University of Sussex, Brighton BN1 9QH, UK j of participation, and an analysis of how a child's tabletop position affects where he or she touches. A main- tal content. Findings from adult studies of co-located groups have Permission to make digital or hard


Los pumas ( Puma concolor) como agentes tafonómicos. Análisis actualístico 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. Sebastián Muñoz; Mariana Mondini; Víctor Durán; Alejandra Gasco




Microsoft Academic Search

El turismo es una fuente de ingresos muy importante para el crecimiento y desarrollo de la economía de un país directa e indirectamente ya que a través de esta actividad el turista consume ocio, cultura, productos, bienes y servicios. Sin embargo, la realidad actual nos demuestra que el turismo sino tiene en cuenta una serie de variables, provoca un impacto

Germán Ortega Palomo



Microsoft Academic Search

This work pro vides a clear description of concurrent engineeríng 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 Álvarez



Uso de Calcarea carbonica y Baryta carbonica como promotores del incremento en peso en la especie porcina  

Microsoft Academic Search

Using the Systat, version 7.0 (1997). The present work was carried out with the objective of valuing the effect of the medications carbonic Calcareous homeopáticos and carbonic Baryta on the increment of weight in pigs. 72 pigs of the race were worked York-Land of the category it pre-feeds distribuídos in 8 groups (2 controls and 6 experimental) integrated each one

Corzo Roque; Rafael Leandro González; Milton Morales Machado


Complejos quirales derivados de sales de lantánidos (III) como catalizadores enantioselectivos de la condensación nitroaldólica y análogas.  

E-print Network

??S'han sintetitzat derivats de BINOL (2,2'-dihidroxi-1,1'-binaftale) amb substitucio en C-3 i C-3' per grups dialquilaminometil anomenats, genericament, binaftolamines. S'ha evaluat la capacitat coordinant d'aquestes binaftolamines… (more)

Tur Espinosa, Fernando



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

ERIC Educational Resources Information Center

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

Bratosevich, Nicolas



Characterization and Hydrodesulfurization Activity of CoMo Catalysts Supported on Boron-Doped Sol-Gel Alumina  

E-print Network

: +81-298-61-6258, FAX: +81-298-61-2371 E-mail: #12;2 Abstract A series ability toward the C=C double bonds is essential prior to sulfur removal from 4,6-DMDBT. The excellent,6- DMDBT, acidity #12;3 1. Introduction Sulfur-containing compounds in transportation fuels have not only

Boyer, Edmond


Valor de la microcirugía como tratamiento de la infertilidad masculina en la era de la reproducción asistida  

Microsoft Academic Search

SUMMARY The action over the epidimary tube and the deferent blocked conduct with diameter of approx. 0.1 and 0.3 mm respectively, specifies the applications of the microsurgery techniques. The microsurgery may also be needed in some varicocelectomy cases. Over all the subjects and topics related to the microsurgery, its necessary to mention that the most important factors are the practice


El papel actual de la cirugía parcial como estrategia de preservación funcional en el carcinoma de laringe  

Microsoft Academic Search

With the current advances and recent organ preservation protocols for intermediate or advanced stage laryngeal cancer, based on chemotherapy, the role of surgery seemed replaced except for surgical rescue of tumours not responding to these treatments, total laryngectomy being the surgical option. This type of non-surgical treatment is offered as a strategy for organ preservation, as opposed to total laryngectomy.

Juan Pablo Rodrigo; Andrés Coca-Pelaz; Carlos Suárez



Las macrófitas de algunos lagos alto-andinos del Ecuador y su bajo potencial como bioindicadores de eutrofización  

Microsoft Academic Search

Macrophytes from some high Andean lakes of Ecuador and their low potential as bioindica- tors of eutrophication. The occurrence of macrophyte in three high Andean lakes of Ecuador, Lago San Pablo, Laguna La Mica and Lago Cuicocha was recorded in 5-9 transects per lake. The first two lakes are eutrophic, the third is an extremely oligotrophic caldera lake. The dominant

Benjamin Kiersch; Ralf Mühleck; Günter Gunkel


Caminar con y como migrantes para transformar la frontera: foundations for the creation of feminist communities on the border  

Microsoft Academic Search

There are different perspectives and experiences with respect to reading and understanding the United States-Mexico Border\\/Frontera. This paper focuses on the Border\\/Frontera as a space where possibilities and encounters take place and which, if lived in openness and reception, can lead to a vivid interchange that can bring a new way of understanding humanity, culture and differences. Since our Border\\/Frontera

Maria Lourdes Arias Trujillo



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



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

NASA Astrophysics Data System (ADS)

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

Lares, M.


Efectividad del doble test bioquímico como prueba de cribado de síndrome de Down en el segundo trimestre  

Microsoft Academic Search

Several screening tests are available to identify the population at risk of Down syndrome. This population should then be recommended to undergo an invasive technique to obtain a fetal karyotype. In our hospital, screening is done by the combined test (maternal age+nuchal translucency+? subunit of human chorionic gonadotropin [?-HCG]+pregnancy-associated plasma-A [PAPP-A]) during the first trimester of pregnancy. When this test

Ana M. Rubio Lorente; M. José Rodríguez Suárez; María Moreno-Cid García-Suelto; Carmen Pastor Onofre; Tomás Salinas Adelantado; Ana I. Pascual Pedreño; Mazhar Chereki Kaloup



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

Microsoft Academic Search

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

João Antonio Lorenzzetti; Eduardo Negri


Thriving in a Healthcare Setting  

E-print Network

delivery system in the United States. #12;6 Kaiser Permanente as a Leader "Quality health care in America Niche in Medicine Mission Healthcare Model Technology/Metrics Workstyle Practice Pay for Performance

Puglisi, Joseph



E-print Network


Milano-Bicocca, Università



EPA Science Inventory

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



E-print Network

enviados deverão estar no formato doc ou pdf. 3) Perfil dos candidatos: apresentar motivação para-coordenadora do programa Prof. Geison Izidio - Docente permanente do programa 6) Cronograma geral Etapa Data Local

Floeter, Sergio Ricardo


Nacimiento Reservoir San Antonio Reservoir  

E-print Network



Diversity in U.S. Medical Schools: Revitalizing Efforts to Increase Diversity in a Changing Context, 1960s-2000s  

E-print Network

Department of Veterans Affairs for hospital and medical careGeneral Hospital, the San Francisco Veterans Affairs MedicalHospital and Clinics, the Santa Clara Valley Medical Center, the Kaiser Permanente Santa Clara Medical Center, the Palo Alto Veterans Affairs

Lee, Philip R.; Franks, Patricia E.



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

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


Procedure-related miscarriages and down syndrome–affected births: implications for prenatal testing based on women’s preferences 1 1 We thank Virginia Gildengorin, PhD, for statistical support. We also thank Bryna Harwood, MD, James Lewis, MD, Ruth Schaber MD, and David Walton, MD, at Kaiser Permanente, and the following physicians for their participation in this study: Albert L. Brooks, MD, Carol Eades, MD, Chris Grover, MD, Susan Sykes, MD (La Clinica de la Raza); Curtis E. Montgomery, MD, Alex Moy, MD, Lawrence Newman, MD, Laura Norell, MD, M. Ming Quan, MD, Kimberly Sorem, MD, and Jonathan Wong, MD (North East Medical Services)  

Microsoft Academic Search

Objective: To determine how pregnant women of varying ages, races, ethnicities, and socioeconomic backgrounds value procedure-related miscarriage and Down–syndrome-affected birth.Methods: We studied cross-sectionally 534 sociodemographically diverse pregnant women who sought care at obstetric clinics and practices throughout the San Francisco Bay area. Preferences for procedure-related miscarriage and the birth of an infant affected by Down syndrome were assessed using the

Miriam Kuppermann; Robert F Nease; Lee A Learman; Elena Gates; Bruce Blumberg; A. Eugene Washington




Microsoft Academic Search

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

Javier Mosquera Lenti; Abelardo Calderón Rodriguez


Sistemas MIMO como Alternativa para el Control del Efecto Multitrayectoria y de la Interferencia Co-Canal en Sistemas de Radio Móvil Satelital y Terrestre  

Microsoft Academic Search

The Multiple Inputs Multiple Outputs -MIMO- Systems are advan- ced technique both the radio signal fading control, problem associated to multipath effects, and co-channel in- terference mitigation in mobile sys- tems, using array antennas and spa- ce-time processing. 1 This technique lets improve the wireless systems performance and increase its data transmission capacity under dynamic environments. The paper presents both

Alexis Paolo; García Ariza




Microsoft Academic Search

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




Bioconversión anaerobia como una alternativa para la remoción de DQO contenido en aguas residuales del rastro municipal de la Ciudad de Saltillo, Coahuila, México  

Microsoft Academic Search

Start-up of an UASB-hybrid reactor, packed with bauxite at the top, was made for treatment of slaugterhouse wastewater of Saltillo, México. The reactor temperature was controlled at 38 °C. Sludge adaptation was made for 10 days; continuous feeding was then began at organic load rates of 0.9 g COD \\/ L \\/ day. The pH va- lues fluctuated in the

Comunicación Técnica; Jesús Rodríguez; Gerardo J. Sosa; Yolanda Garza



Informação e campanhas de esclarecimento como fatores de sucesso no abandono do tabagismo Information and awareness campaigns as success factors in smoking cessation  

Microsoft Academic Search

Introduction: increase the amount of smokers that decide to quit smoking has been a challenge to health care professionals. The aim of this study is to investigate the roles of information concerning the harmful effects of smoking and the awareness campaigns as success factors in smoking cessation. Methodology: qualitative study in which ten individuals that stopped smoking for over six

Isabel Cristina Echer; Sergio Menna Barreto; José Roberto Goldim; Maria Lucia Tiellet Nunes



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



Microsoft Academic Search

Specialized literature and PCNs consider that rhythmical activities are expressions of the body and content of scholarly physical education (SPE), and that they have great educational value and are essential to the motor, cognitive and social- emotive development. However, there seems to be a prejudice concerning activities which use music, expressions of feelings and emotions, and creativity by professionals of

Cynthia C. Pasqua; M. Tibeau


Aprovechamiento de biosólidos como abonos orgánicos en pastizales áridos y semiáridos 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 Hernández


La reparación del daño como mecanismo de tutela de la persona. Del daño a la salud a los nuevos daños extrapatrimoniales  

Microsoft Academic Search

En la actualidad, el operador del Derecho se enfrenta a dos de los más importantes problemas del nuevo derecho de daños: por un lado, la clasificación del perjuicio y, por el otro, la reparación correspondiente a cada una de sus categorías, que debe estar informada por el principio de reparación integral, y que impone en consecuencia considerar más que las

Milagros Koteich Khatib


A RESPONSABILIDADE CIVIL DO TRANSPORTADOR TERRESTRE NO CONTRATO DE TRANSPORTE DE PESSOAS: o fato de terceiro como possibilidade jurídica de excludente do dever de indenizar  

Microsoft Academic Search

The Civil liability is target of a warm current of the legal discussions. How could no longer be this civil institute also has its own characteristic elements that when perfected, will ultimately generate a duty to indemnify, which were: conduct, causation and damage effective. With regard to the carrier's liability, that no exception to the rule, especially when it is

Diego de Freitas Dantas; Francisco Shimabukuro Júnior


Avaliação do papel dos roedores das espécies Mus musculus e Rattus norvegicus como hospedeiros reservatórios de Leishmania infantum nos concelhos de Sesimbra e Sintra.  

E-print Network

??Dissertação de Mestrado Integrado em Medicina Veterinária A leishmaniose causada por Leishmania infantum é uma doença parasitária de cariz zoonótico transmitida por insectos flebotomíneos, os… (more)

Helhazar, Marcos Ferreira



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

ERIC Educational Resources Information Center

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

Germano, Jose Willington




Microsoft Academic Search

México, posee una ubicación geográfica privilegiada, una enorme biodiversidad, gran cantidad de litorales y características oceanográficas, que le proporcionan un fuerte potencial en materia de turismo y pesca. En particular, para desarrollar exitosamente actividades de pesca deportiva-recreativa, basta mencionar que cuenta con 10,143 kilómetros de litoral y más de 150 lugares donde se realiza ésta actividad. Esto, le proporciona oportunidades

Reyna Ibáñez




Microsoft Academic Search

Históricamente los desarrollos turísticos han generado impactos ambientales y socioculturales negativos en áreas de alta riqueza paisajística en donde, convivían minorías étnicas de manera equilibrada con su entorno. Lo anterior, se atribuye principalmente a que, la capacidad de carga de gran número de destinos turísticos ha sido rebasada, derivada del exceso de visitantes que desean disfrutar el paisaje. Asimismo, el

Reyna María Ibáñez Pérez



A Internet como ferramenta de comunicação no Turismo: um estudo exploratório da utilização de e-mails pelo trading em Ribeirão Preto e seus impactos no Turismo local  

Microsoft Academic Search

In the last years with the growth of the tourism and the evolution of the Internet tools as business boosters, mainly the capacity of communication of the company with the costumers. So that the work of the regional development of tourism can bring results. It's important that the trading members are enabled in several knowledge areas, and also in the



A natural biomembrane as a new proposal for the treatment of pressure ulcers Biomembrana natural como uma nova proposta de tratamento para as úlceras de pressão  

Microsoft Academic Search

Summary Pressure ulcer is a common syndrome of diffi cult treatment among bedridden individuals, with clinical and socioeconomic repercussions. A recently developed natural biomembrane (NBM) as a therapeutic option for leg ulcers with debriding and neo-angiogenic properties encouraged us to apply it as a treatment for pressure ulcers. The authors report the results obtained with the NBM dressing on alternate

Marco Andrey Cipriani Fradea; Adriana Martinelli Salathiela; Eduardo Lopez Mazzucatoa; Joaquim Coutinho Nettob; Norma Tiraboschi Fossa



Una Vez en un Millón de Años: Como Enseñar el Tiempo Geológico  

NSDL National Science Digital Library

Helping students understand the magnitude of geologic time strengthens student understanding of biological concepts; illustrates not just when things happened but also how they are interconnected; and identifies and addresses common misperceptions.

Susan Lewis (Carroll University;); Kristen Lampe (Carroll University;); Andrew Lloyd (Carroll University;)



SÍNDROME DE MOEBIUS RELACIONADA AO USO DO MISOPROSTOL (CYTOTEC®) COMO ABORTIVO Moebius syndrome related to misoprostol (cytotec®) use as an abortifacient  

Microsoft Academic Search

RESUMO A síndrome de Moebius constitui uma doença congênita caracterizada por paralisia dos nervos facial e abducente associada a malformações de membros. Além da etiologia genética, fatores causais de origem ambiental foram propostos devido ao aumento do número de casos da síndrome associados ao emprego de misoprostol durante a gravidez. O misoprostol é o princípio ativo do Cytotec®, uma droga

Renata Cavalcante Barbosa; Marcelo Bezerra Nogueira; Célia Maria Giacheti



Microsoft Academic Search

Recently, both popular and professional publications about health care have begun to express enthusiasm for the Internet as a source of medical information and possibly of psycho- logical support for those with serious illnesses. We review here the published studies that analyze the impact of Internet information on patients receiving radiation therapy. A research project is under development in order

Luis Alberto Pérez Romasanta; Pilar Pérez; María Luisa Vázquez; Ana Alonso; Mercedes Canteli; Pilar Marcos; Manuel Caeiro; Esther Carballo; Iñigo Nieto; Elena Montero; Victor Muñoz


How do experts recognize schizophrenia: the role of the disorganization symptom Como os especialistas reconhecem a esquizofrenia: o papel do sintoma desorganização  

Microsoft Academic Search

Objective: Research on clinical reasoning has been useful in developing expert systems. These tools are based on Artificial Intelligence techniques which assist the physician in the diagnosis of complex diseases. The development of these systems is based on a cognitive model extracted through the identification of the clinical reasoning patterns applied by experts within the clinical decision-making context. This study

Denise Razzouk; Jair de Jesus Mari; Itiro Shirakawa; Jacques Wainer; Daniel Sigulem



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.



Proc. IEEE Int. Conf. on Advanced Video and Signal Based Surveillance, Como, Italy, September 2005 Tracking Motion Objects in Infrared Videos  

E-print Network

Tracking Motion Objects in Infrared Videos Longin Jan Latecki1 , Roland Miezianko1 , Dragoljub Pokrajac2 Abstract We propose motion detection and object tracking method that is particularly suitable for infrared videos. Detection of moving objects in infrared videos is based on changing texture in parts of the view

Latecki, Longin Jan


La Universidad de Maryland se compromete a ofrecer un ambiente laboral y educativo sin conducta sexual indebida, como el acoso sexual, la  

E-print Network

sexo o del sexo opuesto. La conducta sexual indebida puede ser una forma de discriminación por razones de sexo, prohibida por la legislación federal y estatal en materia de discriminación y algunas

Bernstein, Joseph B.


Síndrome de Munchausen por terceiro simulada como alergia alimentar múltipla: relato de caso Munchausen syndrome by proxy simulating food multiple allergy: a case report  

Microsoft Academic Search

Objetivo: Descrever um caso da síndrome de Munchau- sen simulada na forma de alergia alimentar múltipla, cujo diagnóstico pode ter sido retardado, em parte, por alguns resultados de exames subsidiários. Descrição do caso: Paciente do sexo masculino atendido aos 3,5 anos com diarréia e vômitos desde o nascimento. Anterior- mente havia recebido diagnóstico de hiperplasia nodular linfóide no íleo terminal.

Roseli Monteiro Robles; Maria Dirce Benedito; Ulysses Fagundes Neto



Microsoft Academic Search

50 51 Resumen.- Abstract.- Con los procesos de integración educativa de los estudiantes con necesidades educativas especiales (NEE) asociadas o no a discapacidad y el concepto de educación inclusiva, hemos iniciado con un nuevo desafío educativo: educar en y para la diversidad. Dicha educación basada en el tema de los derechos humanos, en el respeto y acogida a las diferencias

Melania Monge


ird-00323354,version1-21Sep2008 El presente volumen se publica con auspicio del Fondo de Poblacin de las Naciones Unidas, como parte de la  

E-print Network Web: Título original en francés: Pionniers brésiliens au Paraguay, �ditions KARTHALA Cristina Carámbula Edición y corrección: Mariana Oeyen Diseño gráfico: Karina Palleros Impresión: AGR ISBN

Paris-Sud XI, Université de


Un curr?culo interdisciplinario de base te?rica para ense?ar ingl?s como segunda lengua1  

PubMed Central

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

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



"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



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

ERIC Educational Resources Information Center

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

Zoreda, Margaret Lee


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

ERIC Educational Resources Information Center

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

Delfos, Martine F.


4 Jornada de Educao em Sensoriamento Remoto no mbito do Mercosul 11 a 13 de agosto de 2004 So Leopoldo, RS, Brasil UTILIZAO DE SENSORIAMENTO REMOTO COMO  

E-print Network

Fundamental e Médio Suely Franco S. Lima1 Rosa Maria D. Gonçalves1 1 Professoras da E.E. "DINORÁ PEREIRA RAMOS High School (E E Profª Dinorá Pereira Ramos Brito), at Environmental Education discipline. The specific Dinorá Pereira Ra


Concentración del fragmento aminoterminal del pro-péptido natriurético cerebral en plasma como marcador biológico predictivo de mortalidad en las neumonías adquiridas en la comunidad.  

E-print Network

??Objetivo: Evaluar la relación entre la concentración plasmática del fragmento aminoterminal del pro-péptido natriurético cerebral (NT-proBNP) en el momento del diagnóstico de neumonía adquirida en… (more)

Tazón Varela, Manuel Antonio



186 VHDL: LENGUAJE PARA S INTESIS Y MODELADO DE CIRCUITOS c El cronograma correspondiente, como resultado de la simulacion, se muestra en la  

E-print Network

â?? on ya se ha introducido en el lavado. vacio: Indica que el tambor estâ?? a vacâ?? �o de agua. lleno: Indica que el tambor ya estâ?? a lleno de agua. clk: Reloj de sincronizaciâ?? on de frecuencia 100 Hz. #12;

Valencia, Universidad de


Aplicações da tomografia de ressonância magnética nuclear como método não-destrutivo para avaliar os efeitos de injúrias mecânicas em goiabas 'Paluma' e 'Pedro Sato'  

Microsoft Academic Search

The present study reports on the potential of the use of the tomography of magnetic resonance, as a non-destructive method, to evaluate the effects of the mechanical injuries in guava fruits. Fruits were harvested at mature stage of Paluma and Pedro Sato cultivars. In impact injury, fruits were allowed to fall freely from a height of 1.2 m, subjecting them

Ben-Hur Mattiuz; Clovis Isberto Biscegli; José Fernando Durigan



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

Microsoft Academic Search

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

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



Como se afecta la descripci\\'on termodin\\'amica de los sistemas f\\'isicos cuando se incluye la gravedad?  

E-print Network

This research aims at revising the thermal concepts and their relationship with the General Theory of Relativity (GRT) and how physical systems are affected when gravity is included in their description thermodynamics. The study found that in the case of light, the entropy in an extreme scenario is proportional to the area, not to the volume. This is due to a reduction of freedom degrees of the system, since the gravity imposes a constraint limiting the number of micro-states which are accessible to the system and this is consistent with the holographic principle.

C., W A Rojas




Microsoft Academic Search

The objective of this study was to know how graduation students from nursing school perceive their quality of life. The approach used was the qualitative mode. The data were collected through individual interviews with five students: to you what means having quality of life; report about personal experiences or experiences that you have observed in your daily routine as a

Oliveira RA; Ciampone MHT; Raquel Aparecida de Oliveira; Maria Helena Trench Ciampone


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



Tratamiento nutricional de la fenilcetonuria  

Microsoft Academic Search

ResumenLa fenilcetonuria (FCU) está causada por la actividad deficiente de la enzima fenilalanina hidroxilasa, necesaria para convertir el aminoácido (AA) esencial fenilalanina (phe) en tirosina. Con objeto de prevenir el daño neurológico es necesaria la adhesión permanente a una dieta pobre en phe, que restringe los alimentos naturales y requiere la ingestión de una fórmula de AA libre de phe

Erin L. MacLeod; Denise M. Ney



UC Davis School of Medicine Match Results 2012  

E-print Network

Med/Swedish Med AURORA CO Boston Univ Med CtrMA Family Medicine BOSTON MA California Hosp Med Ctr Family Medicine LOS ANGELES CA Glendale Adventist Med CtrCA Family Medicine GLENDALE CA Hosp of the Univ of PA Family Medicine PHILADELPHIA PA Kaiser PermanenteOrange CoCA Family Medicine SANTA ANA CA Kaiser

Leistikow, Bruce N.


Intense immunosuppression in chronic progressive multiple sclerosis: the Kaiser study  

Microsoft Academic Search

The value of a short course of intensive immunosuppression with cyclophosphamide in stabilising chronic progressive multiple sclerosis (MS) was examined in a randomised single-blinded, placebo-controlled clinical trial. Forty two patients, from the Kaiser Permanente Medical Care Program, Northern California, were studied. Twenty two patients received a short course of cyclophosphamide in an outpatient neurology clinic until their leucocyte counts fell

W H Likosky; B Fireman; R Elmore; G Eno; K Gale; G B Goode; K Ikeda; J Laster; C Mosher; J Rozance



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



Characteristics of Open Learning Systems.  

ERIC Educational Resources Information Center

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

Wedemeyer, Charles A.


Two owners face new facts of life.  


Two diverse non-profit clients see big changes in the world in which they operate. Can the Philadelphia Zoo maintain its status as one of America's best zoos in the face of leadership changes and a prolonged economic slump within its community? And how will Kaiser Permanente, a health-care giant, meet the challenges of universal "managed" care? PMID:10130462

Russell, J S




Microsoft Academic Search

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

González Flores; Ana Saiz Santos; Euskal Herriko Unibertsitatea


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

Microsoft Academic Search

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

Priya Nambisan



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.



PANEL OF PHYSICIANS HR & Payroll 1/19/2012  

E-print Network

: If you participate with Kaiser Permanente health please seek medical attention with Kaiser at (703' Compensation office as soon as possible. Please note that every employee, even if you are not seeking medical_________________________________________________. _________ I am seeking medical treatment. _________ I am not seeking medical treatment at this time. However


Reflexions entorn la formació de formadors i formadores a Catalunya  

Microsoft Academic Search

Este artículo analiza la situación de la formación de formadores en Cataluña, desde la implantación de la LOGSE hasta hoy. Una descripción del modelo de formación permanente del profesorado que se ha venido aplicando desde entonces y un análisis del modelo de formadores y formadoras que se ha ido desarrollando, constituyen el contexto de los retos que se plantean actualmente

Maria Teresa Colén; Núria Giné Freixes



Life After Cancer Epidemiology (LACE) Study: A cohort of early stage breast cancer survivors (United States)  

Microsoft Academic Search

The Life After Cancer Epidemiology (LACE) Study, a cohort of 2321 early stage breast cancer survivors, was established in 2000 to examine how modifiable behavioral risk factors affect quality of life and long-term survival. Women were recruited primarily from the Kaiser Permanente Northern California Cancer Registry (KPNCAL) and the Utah cancer registry (UCR), United States. Baseline data were collected, on

Bette Caan; Barbara Sternfeld; Erica Gunderson; Ashley Coates; Charles Quesenberry; Martha L. Slattery



Genome-Wide Evaluation of Histone Methylation Changes Associated with Leaf Senescence in Arabidopsis  

E-print Network

Cancer Center, Los Angeles, California, United States of America, 4 Radiation Oncology Department, Kaiser Permanente, Los Angeles, California, United States of America, 5 Department of Molecular, Cell and Developmental Biology, University of California Los Angeles, Los Angeles, California, United States of America

Moret, Bernard


Community Resources for Promoting Youth Nutrition and Physical Activity  

ERIC Educational Resources Information Center

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

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



Body Mass Index and Future Healthcare Costs: A Retrospective Cohort Study  

Microsoft Academic Search

Objective: To assess the relationship between body mass index (BMI) and future healthcare costs.Research Methods and Procedures: We undertook a retrospective cohort study of the relationship between obesity and future healthcare costs at Kaiser Permanente Northwest Division, a large health maintenance organization in Portland, Oregon. Study subjects (n = 1286) consisted of persons who responded to a 1990 health survey

David Thompson; Jonathan B. Brown; Gregory A. Nichols; Patricia J. Elmer; Gerry Oster



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

ERIC Educational Resources Information Center

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

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



Collaboration in Capitated Care: Challenges for Psychology  

Microsoft Academic Search

This article highlights the mutual dependence of disciplines in capitated care systems, with a focus on a sample program at Kaiser Permanente. Challenges for psychology are discussed as they relate to intradiscipline issues, relationships with other psychosocial care disciplines, and broad health care systems issues. The author suggests that psychology's future in capitated care will rest on skills in research,

Cynthia D. Belar



Caffeine Consumption and Menstrual Function  

Microsoft Academic Search

The relation between caffeine intake and menstrual function was examined in 403 healthy premenopausal women who belonged to Kaiser Permanente Medical Care Program in 1990-1991. A telephone interview collected information about caffeinated beverage intake as well as other lifestyle, demographic, occupational, and environmental factors. Subjects collected daily urine samples and completed a daily diary for an average of five menstrual

Laura Fenster; Chris Quale; Kirsten Waller; Gayle C. Windham; Eric P. Elkin; Neal Benowitz; H. Swan


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



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


diant la cintique de croissance des cellules, il s'accompagne, pour tous les inducteurs, d'une  

E-print Network

diesters in human breast MCF-7 cell line. Mol. Cell. Endo. 56, 157-163 Sutherland R.L., Hall R.E. & Taylor-phorbol-13-acetate on proliferation and matura- tion of human breast carcinoma cells (MCF-7) : rela- tionship augmentation permanente des lympho- cytes sanguins (lymphocytose persistante) ou à une affection

Paris-Sud XI, Université de


IUP GCI 1`ere annee 2004/05 PARTIEL Eurocode 1  

E-print Network

charges dans le poteau P1 (15pts) 2.1 Effectuer la liste des charges `a prendre en compte, donner les le poteau P1 pour ces deux types de charges en distinguant les deux directions des poutres. 2 poteau P1. On effectuera ce calcul pour les trois cat´egories de charges : permanentes, d'exploitation et

Gagliardini, Olivier


Am. J. Hum. Genet. 76:276290, 2005 Ethnicity and Human Genetic Linkage Maps  

E-print Network

Am. J. Hum. Genet. 76:276­290, 2005 276 Ethnicity and Human Genetic Linkage Maps Eric Jorgenson,1 of Research, Kaiser Permanente, Oakland, CA Human genetic linkage maps are based on rates of recombination recombination as well as for future linkage studies, especially those involving populations of nonwhite

Tang, Hua


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-722-2667 6191 North State Highway 161, Suite 400 Irving, TX 75038 UC Office of the President

Gleeson, Joseph G.


Measurement and evaluation of national family planning programs.  


RESUMEN: En los últimos quince años diez paises han inaugurado programas nacionales de planeamiento familiar: India, Pakistán, Corea del Sur, Taiwan, Turquía, Malasia, Ceilán, Túez, la República Arabe Unida, y Marruecos. Otros paises, incluyendo Tailandia, Hong Kong, Singapur, Kenya, Barbados, Trinidad y los Estados Unidos, apoyan y/o estimulan actividades de planeamiento familiar. En la mayor parte de los casos la razón fundamental del programa ha sido que si la tasa de crecimiento poblacional disminuyera, aumentaría la tasa de crecimiento económico.Las metas de largo alcance, expresadas típicamente en términos de reducir las de natalidad o de crecimiento, tienen su ejemplo en el propósito de Pakistán de reducir su tasa de crecimiento a 26 para 1970; el de Corea de reducir su tasa de natalidad a 20 para 1971; y el de India de reducir su tasa de natalidad a 25 para 1973.Los objectivos intermedios, que cubren diversos aspectos del pro grama, incluyen metas específicas para un determinado mes a año, considerando personal, la adquisición de anticonceptivos, y el número de usarios por método. Las metas específicas anuales de aceptantes de dispositivos intrauterinos (IUD), para Taiwán, Corea, Túnez, Pakistán e India, son comunes, tanto por la naturaleza del artefacto, como por la facilidad de medición de los que continúan utilizándolos. El programa de evaluación en Taiwán, que trata de medir por diversos medios los efectos inmediatos, mediatos y de largo plazo del programa de planeamiento familiar sirve de modelo. El propósito de la evaiuación de un programa de planeamiento familiar es contribuir a la efectividad y eficiencia del programa, midiendo y analizando su progreso. Las áreas a medir pueden ser clasificadas como- (1) conocimiento acerca de; (2) actitudes hacia; (3) práctica de control de natalidad; y (4) nivel de fecundidad.Un buen sistema de evaluación debería incluir: A. Un buen conjunto de estadísticas de servicio presentadas en formularios estandarizados, en las siguienies formas: 1. Informes nensuales por áreas administrativas, sobre los actuales servicios de planeamiento familiar proporcionados en la actualidad, de carácter permanente o de larga duración (al presente, esterilización y IUD de acuerdo a las siguientes características del receptor: residencia, edad, paridad (número de hijos vivos por sexo), y donde se enteró del programa, si es posible "clase";(probablemente educación de la madre, pero posiblemente ocupación del esposo, ingreso, o equivalente); prácticas anticonceptivas anteriores; intervalo; y deseo de tener más hijos. En un programa grande estos datos pueden obtenerse en base a una muestra. 2. Informes mensuales sobre la distribución de suministros anticonceptivos (condones, píldoras, sustancias efervescentes, etc.), los primeros suministros deben ir acompañados de un registro de las características del recipiente, como anteriormente; los suministros subsecuentes se regietrarán sólo en volumen bruto. Esto también se aplicará al ritmo, donde éste método se enseñe a un número considerable de mujeres. 3. Informes regulares sobre las actividades de planeamiento familiar de médicos privados, como una estimación del efecto catalítico del programa del gobierno sobre ci sector privado. 4. Datos generates mensuales, ppr áreas admirtistrativas importantes, sabre: visitas domiciliarias, reuniones, cuñas radiates y televisadas, avisos en los periódicos y personal que trabaja. 5. Para propósitos de seguimiento una entrevi eta de campo cada 6 a 12 meses a cada N mujer de las listas para (1) y (2) arriba, en un total de 300 o 400, para conocer las tasas de continuación y las razones de abandono (ej: desea otro hijo, insatisfecha can ci método, otras). Las mue.stras podrían ser de 300 cada una, con una supuesta experiencia de 6, 12, 18 y 24 meses. B. Un buen conjunto de datos sobre costa (datos sobre cotos actulaes atribuíbles directamente al programa de planeamiento familiar) fraccionados par áreas principales y cinco a seis

Mauldin, W P



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


Avaliação da utilização de escória granulada de fundição como substituição de parte do cimento em concreto Evaluation of the use of granulated foundry slag as substitution of part of the cement in concrete  

Microsoft Academic Search

This work intends to study the use of the granulated foundry slag as substitution of part of the cement in concrete, through the evaluation of the compressive strength, water absorption by capillary suction and chloride permeability test. The granulated foundry slag is a solid waste generated in the process of cast iron melting, via cupola furnace, which presents amorphous structure,

Juliana S. Reschke; Diana M. Ceccatto; Ângela B. Masuero; Carlos A. M. Moraes; Antônio C. F. Vilela


Limitações na Prática de Exercício Físico como Fator Desencadeante da Obesidade na População de Baixa Renda Limitations in Exertion as a Starting Factor for Obesity in Low Income Population  

Microsoft Academic Search

Obesity is nowadays considered a world epidemic which assaults mainly low income populations, and one of its main causes is sedentarism. However, those individuals have limitations for exertion, which favors obesity development and makes its treatment more difficult. This work aims to comprehend limitations of low income population access to physical exercises practice as part of an obesity treatment. The

Nívea Veiga Almeida; População de Baixa Rend


ACUERDO por el que se emiten las Disposiciones en las materias de Recursos Humanos y del Servicio Profesional de Carrera, as como el Manual Administrativo de Aplicacin General en materia de Recursos Humanos y  

E-print Network

Presupuesto y Responsabilidad Hacendaria; 2, 13, 67, 68, 69 fracciones IV, V y XIV de la Ley del Servicio del Sistema de Registro del Personal Civil del Gobierno Federal, denominado RUSP, publicados en el



Microsoft Academic Search

RESUMO O litoral brasileiro atrai muitas pessoas para o cenário de suas praias, a fim de se realizarem passeios e diferentes atividades turísticas. O turismo cearense se destaca por ser desenvolvido principalmente na costa cearense, em seus 573 Km de extensão. O município de Beberibe com um litoral de aproximadamente 52 km possui diferentes paisagens naturais favoráveis ao desenvolvimento do

Juliana Maria Oliveira Silva



Riesgos y desafíos en la implementación de una indicación geográfica (IG) Las denominaciones de origen (DO) y las indicaciones geográficas (IG) como herramientas para el desarrollo territorial rural con identidad cultural (DTR-IC)  

Microsoft Academic Search

La presente comunicación es resultado de un Estudio Complementario que se está desarrollando en la ciudad de Colonia Caroya, provincia de Córdoba (Argentina) sobre Indicaciones Geográficas (IG) y Desarrollo Territorial Rural con Identidad Cultural (DTR-IC). El trabajo se inserta en el marco de dos proyectos, por un lado, el Proyecto Desarrollo Territorial Rural con Identidad Cultural (DTR-IC) liderado por Claudia

Marcelo Champredonde; A. Benedetto



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.



Fiscal Proxies for Devaluation: A General Review (Substituts fiscaux d'une dévaluation: étude générale) (Políticas fiscales como alternativas a la devaluación: Consideraciones generales)  

Microsoft Academic Search

This paper reviews the still controversial question of whether to use fiscal proxies as a substitute for a formal exchange rate change. The theoretical rationale for a general tax\\/subsidy alternative has been long established, but only in the framework of the goods market. The paper confirms that the equivalence of the two approaches remains intact in a general-equilibrium framework, as

John F. Laker



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

ERIC Educational Resources Information Center

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

Lehr, Fran; Osborn, Jean


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

ERIC Educational Resources Information Center

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

Khawajkie, Elizabeth, Ed.; And Others


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

ERIC Educational Resources Information Center

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

Paulu, Nancy


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

-feature washing machines. I. INTRODUCTION The manufacturing of washing machines has lately been an important issue]. In addition, although horizontal-axis washers have a higher manufacturing cost, [3], they are becoming more Washing Machine during the Spinning Cycle Evangelos Papadopoulos and Iakovos Papadimitriou Department

Papadopoulos, Evangelos


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



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

ERIC Educational Resources Information Center

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

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



Microsoft Academic Search

Objective: To verify the existence of organic lipophylic compounds in silicone oil extracted from human eyes following its use for previous retinal detachment, and to determine the intraocular per- manence time of these substances in the oil. Methods: Concentrations of retinoic acid, retinol, retinal, cholesterol and ?-tocopherol were detected by HPLC in 23 samples of silicone oil extracted from patients



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



The specificity of histones in nucleated erythrocytes  

Microsoft Academic Search

Riassunto Dagli eritrociti del pollo, dellaRana cateasbeiana e del pesceCaranx hippos sono stati isolati gli istoni nella ipotesi che gli eritrociti forniti di nucleo contengano una frazione di istone funzionante come repressore permanente della sintesi degli acidi nucleici. Detti istoni sono stati frazionati ed analizzati nella loro composizione in amino-acidi. In tutte e tre le speci su menzionate è stata

L. J. Edwards; L. S. Hnilica



Tambin estamos en facebook! Biblioteca Conrado F. Asenjo -Recinto de  

E-print Network

Puertorriqueña de las Ciencias de la Salud Historia de la Medicina Colección Bailey K. Ashford 4to piso no impresos acerca de temas de las Ciencias de la Salud en Puerto Rico y en todo el Caribe ... "Somos el Permanente y Reserva de Profesores · Colección de Tesis · Colección Mujer y Salud · Colección de Referencia

Quirk, Gregory J.


Clinical, Epidemiologic, Histopathologic and Molecular Features of an Unexplained Dermopathy  

Microsoft Academic Search

BackgroundMorgellons is a poorly characterized constellation of symptoms, with the primary manifestations involving the skin. We conducted an investigation of this unexplained dermopathy to characterize the clinical and epidemiologic features and explore potential etiologies.MethodsA descriptive study was conducted among persons at least 13 years of age and enrolled in Kaiser Permanente Northern California (KPNC) during 2006–2008. A case was defined

Michele L. Pearson; Joseph V. Selby; Kenneth A. Katz; Virginia Cantrell; Christopher R. Braden; Monica E. Parise; Christopher D. Paddock; Michael R. Lewin-Smith; Victor F. Kalasinsky; Felicia C. Goldstein; Allen W. Hightower; Arthur Papier; Brian Lewis; Sarita Motipara; Mark L. Eberhard



Administrators as agents of change.  


Today's "complete manager" must not only be highly skilled, but must also be responsive to the changing environment, as medical groups shift from traditional provider-based systems to more contemporary consumer-based systems. Administrative leadership style has never been more significant for success, especially the administrator's technique for ushering change into the group. A successful, practical program for change, developed at the Kaiser Permanente Medical Care Program at its Hayward facility, centers on the medical staff leadership conference. PMID:10278458

Fawley, I L



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.


Espace de contrle, espaces de subversion : les townships sud-africains  

E-print Network

Afrique du Sud blanche. Localement, cette division se retrouve dans la morphologie des villes ­ véritable, the township has become something of an urban model even in the post-apartheid era... La pensée sud victorienne de la ville et de la race, caractérisée par une dualité permanente du discours que l'on retrouvera

Paris-Sud XI, Université de


Panorama reflexivo sobre el teatro de grupo en el Perú en la década del 80  

E-print Network

Ismael Contreras y Juana Medina en 1971; hace teatro para niños y jóvenes. Realiza investigación psicológica en este aspecto cuyos resultados ha llevado a congresos especializados. Abeja integra música, danza, canto, la expresión del cuerpo con la... obras para niños y también mimo para adultos. Su tarea de investigación y de innovación es altamente encomiable. La experimentación es su preocupación permanente. Han realizado congresos y festivales internacionales. LOS GRILLOS. En 1963 varios...

Piga, Domingo



El teatro colombiano: Caleidoscopio de nuevos rostros, nuevas voces  

E-print Network

recientes de Buenaventura, El lunar en la frente (1994), Crónica (1995) y El dragón de los mares (1995), bajo la dirección de Jacqueline Vidal. El Colectivo Teatral Matacandelas de Medellín fue elevado a la categoría de Patrimonio Cultural de la ciudad en... futuro del teatro en Colombia. Los programas ofrecidos a nivel de postgrado, la labor de formación y apoyo que se está haciendo a nivel regional (Chocó, Guajira, etc.), los talleres permanentes de laboratorio juvenil, los ciclos de conferencias...

Garavito, Lucí a



Factors Associated with Frailty in Chronically Ill Older Adults  

Microsoft Academic Search

An ex post facto analysis of a secondary dataset examined relationships between physical frailty, depression, and the self-perceived domains of health status and quality-of-life in older adults. The randomized sample included 992 community-dwelling, chronically ill, and functionally impaired adults age 65 and older who received care from a Southern California Kaiser Permanente medical center between 1998 and 2002. Physical frailty

Lynn Hackstaff



Screening Prescription Drugs for Possible Carcinogenicity: Eleven to Fifteen Years of Follow-up1  

Microsoft Academic Search

Using computerized pharmacy records from 1969 to 1973 for a cohort of 143,574 members of the Kaiser Permanente Medical Care Program, we have been testing associations of 215 drugs or drug groups with subsequent incidence of cancer at 56 sites. This paper presents findings with follow-up through 1984. There were 227 statistically significant (P < 0.05, two-tailed) associations: 170 positive,

Joseph V. Selby; Gary D. Friedman; Bruce H. Fireman


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

Microsoft Academic Search

The immediate and long-term effects of a Parent Child Interaction Therapy (PCIT) derived program offered at a Kaiser Permanente facility were evaluated. There were 73 participants in the initial sample and 23 in the 5–6 year follow-up sample. Child behaviors improved significantly immediately following treatment and some improvements were maintained at follow-up. Over 75% of the follow-up participants utilized additional

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



IUP GCI 3`eme annee -Ouvrages et Structures 2000/01 EXAMEN DE BETON ARME  

E-print Network

charges (permanente et d'exploitation) sur le poteau B3. Les charges apport´ees par les ´etages sup´erieurs sur le poteau B3 sont ´evalu´ees `a G = 230 kN et Q = 180 kN. Les trois parties suivantes sont ind du poteau B3 4 points Calculer et dessiner le ferraillage du poteau B3. Partie III : Ferraillage de

Gagliardini, Olivier


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.



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

National Technical Information Service (NTIS)

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

S. D. Ramirez



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

ERIC Educational Resources Information Center

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

Rodriguez, Rodolfo, Comp.


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

ERIC Educational Resources Information Center

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

Rodriguez, Rodolfo, Comp.


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

Microsoft Academic Search

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

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


Age and gender as risk factors for the transmission of HIV in a sample of drug users of Porto Alegre, Brazil Idade e gênero como fatores de risco para a transmissão do HIV em uma amostra de usuários de drogas, Porto Alegre, Brasil  

Microsoft Academic Search

Objective: To verify the association between age and gender regarding HIV seropositivity in drug users who seek public health centers in Porto Alegre, Brazil. Methods: The authors designed a cross-sectional study with a convenience sampling of 695 men and women aged above 15, who reported recent drug use and risk behaviors to HIV exposure. We used a standard questionnaire (CRA,

Raquel De Boni; Flavio Pechansky


Produção de mapas de zonas homólogas de relevo e de uso do solo, a partir de dados de modelos numéricos de terreno e de imagem Quick Bird, como passos intermediários em um diagnóstico da susceptibilidade à erosão, no entorno da usina hidrelétrica Corumbá IV (GO)  

Microsoft Academic Search

The article has objective to present the achieved results with the production of a landforms map used in the reclassification process of the geomorphology, pedology and vegetation thematic charts, and a soil use map, in which both are used like intermediaries steps for erosion process susceptibility geotechnical chart production. The study area is located a surrounding of the hydroelectric Corumbá

Wagner Santos de Almeida; Newton Moreira de Souza; José Camapum de Carvalho


EVALUACIÓN DE CEPAS NATIVAS DE Bacillus thuringiensis COMO UNA ALTERNATIVA DE MANEJO INTEGRADO DE LA POLILLA DEL TOMATE (Tuta absoluta Meyrick; Lepidoptera: Gelechiidae) EN CHILE Evaluation of native strains of Bacillus thuringiensis as an alternative of integrated management of the tomato leaf miner (Tuta absoluta Meyrick; Lepidoptera: Gelechiidae) in Chile  

Microsoft Academic Search

A B S T R A C T The tomato moth (Tuta absoluta Meyrick; Lepidoptera: Gelechiidae) is the most devastating insect pest of tomato (Lycopersicon esculentum Mill.) crops in Chile, producing losses from 60 to 100% in non-insecticide treated fields. Because pests are evolving to resistance levels to convencional insecticides, there is interest for alternative strategies including the use of

Luis Meza-Basso



Perineuroma maligno (tumor maligno de vaina nerviosa periférica, perineural). Estudio inmunohistoquímico de un tumor poco frecuente, utilizando EMA, GLUT1 y Claudina-1, como marcadores de diferenciación perineural Malignant perineurioma (malignant peripheral nerve sheath tumor, perineurial). Immunohistochemical study of an unusual tumor, using EMA, Glut1 and Claudin-1, as perineurial cell differentiation markers  

Microsoft Academic Search

SUMMARY Introduction: Malignant perineurioma (MP) or malig- nant peripheral nerve sheath tumor (MPNST) with perineu- rial differentiation is an unusual tumor. We report a case of MP with immunohistochemical evidence. Material and Methods: A 58 year-old female with a retroperitoneal tumor with no clinical evidence of neurofibromatosis. Results: The tumor presented extensive areas of necrosis and was compo- sed of

Carlos Ortiz-Hidalgo; Armando Carvajal-Dosamantes


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

Microsoft Academic Search

Purpose  We 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 methods  The 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



e-Measures: insight into the challenges and opportunities of automating publicly reported quality measures  

PubMed Central

Using electronic health records (EHR) to automate publicly reported quality measures is receiving increasing attention and is one of the promises of EHR implementation. Kaiser Permanente has fully or partly automated six of 13 the joint commission measure sets. We describe our experience with automation and the resulting time savings: a reduction by approximately 50% of abstractor time required for one measure set alone (surgical care improvement project). However, our experience illustrates the gap between the current and desired states of automated public quality reporting, which has important implications for measure developers, accrediting entities, EHR vendors, public/private payers, and government. PMID:23831833

Garrido, Terhilda; Kumar, Sudheen; Lekas, John; Lindberg, Mark; Kadiyala, Dhanyaja; Whippy, Alan; Crawford, Barbara; Weissberg, Jed



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

Microsoft Academic Search

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

Mary A. Whooley; Barry Stone; Krikor Soghikian



Model-based benefit-risk assessment: can Archimedes help?  


In December 2008, the US Food and Drug Administration issued a new draft Guidance for Industry on Diabetes Mellitus--evaluating cardiovascular risk in new antidiabetic therapies to treat Type 2 diabetes. This guidance comes at a time when recent discussions have focused on delineation of cardiovascular risk reduction for new antidiabetic drugs. Computational tools that can enable early prediction of cardiovascular risk are reviewed with specific reference to Archimedes (Kaiser Permanente), with an aim of proposing a model-based solution and enabling decisions to be made as early as possible in the drug development value chain. PMID:19223878

Krishna, R



Vista Award winners. 94/95.  


Winners. New construction project totaling more than $3: Valley Medical Center, Community Outpatient Center, Renton, WA. Renovation project totaling more than $3 million: Beth Israel Hospital and Children's Hospital (joint project), Medical Care Center, Lexington, MA. Renovation project totaling less than $3 million: The Birthing Center/Lincoln Institute for Women's Health, John C. Lincoln Hospital & Health Center, Phoenix. Honorable mention. Children's Hospital Medical Center Clinical Facility, Cincinnati. Kaiser Permanente Regional Reference Laboratory, Los Angeles. Takopid Indian Health Center, Tacoma, WA. St. Elizabeth Hospital Replacement Facility, Elizabeth, NJ. PMID:10140787



Transforming Care Delivery through Health Information Technology  

PubMed Central

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

Wheatley, Benjamin



Maintaining Subsurface Drip Irrigation Systems (Spanish)  

E-print Network

Los sistemas subsuperficiales de riego por goteo (SDI por sus siglas en ingl?s) pueden distribuir agua a una velocidad de flujo lenta de manera muy uniforme. Un sistema permanente dise?ado apropi- adamente y con el mantenimiento adecuado, debe durar... en cada bloque o zona del campo (Fig. 1). La calidad del agua determina el riesgo relativo que los emisores tendr?n de taparse y otros proble- mas; por lo tanto, deben de considerarse las carac- ter?sticas del agua en el programa de mantenimien...

Enciso, Juan; Porter, Dana; Bordovsky, Jim; Fipps, Guy



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



Ambulatory Computerized Physician Order Entry Implementation  

PubMed Central

As part of a broader effort to identify success factors for implementing computerized physician order entry (CPOE), factors specific to the ambulatory setting were investigated in the field at Kaiser Permanente Northwest. A multidisciplinary team of five qualitative researchers spent seven months at four clinics conducting observations, interviews, and focus groups. The team analyzed the data using a combination of template and grounded theory approaches. The result is a description of fourteen themes, clustered into technology, organizational, personal, and environmental categories. While similar to inpatient study results in many respects, this outpatient CPO investigation generated subtly different themes. PMID:16778992

Ash, Joan S.; Chin, Homer L.; Sittig, Dean F.; Dykstra, Richard



e-Measures: insight into the challenges and opportunities of automating publicly reported quality measures.  


Using electronic health records (EHR) to automate publicly reported quality measures is receiving increasing attention and is one of the promises of EHR implementation. Kaiser Permanente has fully or partly automated six of 13 the joint commission measure sets. We describe our experience with automation and the resulting time savings: a reduction by approximately 50% of abstractor time required for one measure set alone (surgical care improvement project). However, our experience illustrates the gap between the current and desired states of automated public quality reporting, which has important implications for measure developers, accrediting entities, EHR vendors, public/private payers, and government. PMID:23831833

Garrido, Terhilda; Kumar, Sudheen; Lekas, John; Lindberg, Mark; Kadiyala, Dhanyaja; Whippy, Alan; Crawford, Barbara; Weissberg, Jed



Marijuana use and mortality.  

PubMed Central

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

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



What does professionalism mean to the physician?  


Professionalism, which is a core competency for physicians, can be described as a spectrum of behaviors and may have a significant impact on the problems in today's changing health care climate. In this article, we discuss the meaning of professionalism and its role in the Southern California Permanente Medical Group (SCPMG) and consider how it may be applied to integrated care delivery systems such as Kaiser Permanente. To understand professionalism, one must consider Stern's definition, which consists of four principles: excellence, humanism, accountability, and altruism. SCPMG has taken three of these principles-excellence, accountability, and altruism-and divided the fourth, humanism, into another three principles similar to those identified by the University of California Los Angeles Task Force on Professionalism: humanitarianism, respect for others, and honor and integrity. SCPMG has a rich history and culture of promoting clinical excellence and professionalism, as evidenced by the programs and initiatives described throughout this article. Indeed, the SCPMG experience validates professionalism as a core physician competency comprising a set of behaviors that are continually refined. PMID:24355895

Kanter, Michael H; Nguyen, Miki; Klau, Marc H; Spiegel, Nancy H; Ambrosini, Virginia L



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



The Use of Animals as Co-Therapists on a Farm: The Child—Horse Bond in Person-Centered Equine-Assisted Psychotherapy \\/ Der Einsatz von Tieren als Co-Therapeuten auf einem Bauernhof: Die Kind-Pferd-Bindung in einer Personzentrierten Psychotherapie mit Hilfe von Pferden \\/ El Uso de Animales como Co-terapeutas en una Granja: El Vínculo Niño-Caballo en Equino-Psicoterapia Centrada en la Persona \\/ Les Animaux en Tant que Co-thérapeutes: Le Lien entre l'Enfant et le Cheval dans la Psychothérapie Équine Centrée sur la Personne \\/ O Recurso a Animais como Co-terapeutas: O Laço Criança-Cavalo na Hipoterapia Centrada na Pessoa  

Microsoft Academic Search

Animals, particularly horses, assist in therapy with children and adults with severe psychological and behavioral problems. Through the case study of M., a teenager with the diagnosis of severe mental illness, the author argues that therapy involving animals as co-therapists leads the client to a clear reduction in symptoms, through a process of validation, sense of responsibility, increase in self-esteem,

Evelyne Chardonnens



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.



Usina do Trabalho do Ator: um teatro canibal  

E-print Network

em O Mestre Ausente (1994). ,íIcle em O Mestre Ausente (1994). 104 LATIN AMERICAN THEATRE REVIEW também a vida. Reconstruir o passado, inventar fragmentos de... Alcântara como "a Crióla Doida' e Silvana Stein como "a Lavadeira' em Klaxon (1994). Gilberto lele como "Macunaima\\ Roberto Birindelli como "o Estrangeiro", Celina Alcântara como "a Crióla Doida", Silvana Stein como "a Rainha do CarnavaV e Alice...

Icle, Gilberto



Clonagem e expressão da proteína 14-3-3¿1 de Echinococcus granulosus em Escherichia coli.  

E-print Network

??O Echinococcus granulosus é um platelminto parasita da classe Cestoda, que tem, como hospedeiros definitivos, os canídeos, e, como hospedeiros intermediários mais comuns, ungulados domésticos… (more)

Aline Teichmann



Analysis, implementation and validation of a Love mode surface acoustic wave device for its application as sensor of biological processes in liquid media.  

E-print Network

??En las últimas dos décadas, han surgido diferentes tecnologías acústicas para aplicaciones biosensoras como alternativas a tecnologías de detección bien establecidas ¿acústicas o ópticas¿ como… (more)





NSF Publications Database

... es una organizacion internacional concebida como una red distribuida de instituciones cooperantes ... etc.) Puesto que el IAI ha sido visualizado como una red distribuida de instituciones cooperantes ...


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


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

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



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

PubMed Central

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



Integrating prenatal-postnatal smoking interventions into usual care in a health maintenance organization.  


Consistent with the increasing national emphasis on providing health promotion in clinical care settings, Stop Smoking for OuR Kids (STORK), a research-derived, prenatal-postnatal smoking cessation intervention, was implemented throughout prenatal clinics, inpatient postpartum services, and pediatric clinics of Kaiser Permanente Northwest. Process data collected during the project rollout and maintenance to monitor the clinical practices of clinicians and staff members, patient responses to the intervention, and penetration of the intervention into the health maintenance organization priority population of prenatal smokers high-lighted barriers to intervention delivery. These barriers fell into three categories related to the smoking intervention design, clinicians and staff members, and the organization. By monitoring the intervention implementation process, such problems were identified early. This allowed for implementing strategies to overcome many of these barriers and to assess their effectiveness. Keys to implementation success included simplifying the intervention activities, considering stakeholder needs, and providing tangible organizational resources and goals. PMID:14610994

Valanis, Barbara; Labuhn, Karen T; Stevens, Nancy H; Lichtenstein, Edward; Brody, Kathleen K



Submitted to:  

E-print Network

Partnership HealthPlan (Partnership) is a nonprofit Medicaid (Medi-Cal) health plan in Solano, Napa, and Yolo counties in northern California. Formed in 1994, Partnership has 88,000 members and is the only plan serving Medicaid beneficiaries in the three counties. For the Medicaid Value Program (MVP), Partnership implemented a provider-based intervention known as PHASE (Preventing Heart Attacks and Strokes Everyday), which, developed by Kaiser Permanente, aims to improve care for adult diabetic members with hypertension, cardiovascular disease, or depression. PHASE has three goals: • Increasing medication use (specifically aspirin, lipid-lowering medications, ACE inhibitors, and beta blockers) • Increasing laboratory testing, monitoring, and control (of blood pressure, lipids, and blood glucose) • Promoting lifestyle changes (including tobacco cessation, physical activity, healthy eating, and weight management) Seven primary care physicians spanning eight small practices participated in the intervention. 1

Erin Fries Taylor; Dominick Esposito; Kristin Andrews; Marsha Gold; Melanie Bella



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)



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



Practical methods to increase use of advance medical directives  

Microsoft Academic Search

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

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



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

PubMed Central

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

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



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

PubMed Central

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

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



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: 1996–1999 (reference), 2000–2003, and 2004–2008, 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 2000–2003 period but was lower during the 2004–2008 period with an adjusted hazard ratio of 0.66 (95% confidence interval: 0.49–0.88; 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 2004–2008 period decreased by 34% compared with the 1996–1999 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



Questioning the claims from Kaiser  

PubMed Central

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

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




E-print Network

descarboxilasas en patógenos humanos teniendo como modelos de estudio principalmente aCandida albicans y Entamoeba humanos teniendo como modelos de estudio principalmente a Candida albicans y Entamoeba histolytica


Delirio (PDQ®)

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


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

Estudios anteriores encontraron que la colografía de tomografía computarizada, también conocida como colonoscopia virtual, era prometedora como método de examen selectivo de detección de cáncer colorrectal debido a su precisión, seguridad, rentabilidad y aceptabilidad por parte de los pacientes.



Microsoft Academic Search

RESUMO: Trata-se de um estudo qualitativo, fundamentado no Interacionismo Simbólico, tendo como objetivos compreender como os avós experienciaram e\\/ou vivenciaram a prática do aleitamento materno no cotidiano familiar e refletir sobre seus significados. Os dados foram coletados durante uma oficina, tendo como informantes onze avós. Da análise temática, emergiram quatro categorias: \\

Marizete Argolo Teixeira; Rosane Gonçalves Nitschke; Patricia De Gasperi; Mônica Joesting Siedler


Examen de Calificación: Un Enfoque Basado en Casos para Materializar Arquitecturas de Software en Diseños Orientados a Objetos  

Microsoft Academic Search

Las arquitecturas de software posibilitan la toma de decisiones de diseño en etapas tempranas del proceso de desarrollo de software de manera de satisfacer tanto los requerimientos funcionales de un sistema como sus requerimientos de calidad. Como modelos conceptuales las arquitecturas de software admiten múltiples materializaciones orientadas a objetos que sirven como base para lograr la construcción del producto final

Germán Leandro Vázquez



Microsoft Academic Search

O estudo teve como objetivo geral mostrar que há uma relação histórica e teórica para explicar a dificuldade de implementar uma política de crédito para a agricultura familiar e que isso incorre em limitação de seu acesso e aumenta os custos da intermediação financeira. Verificou-se que os programas de crédito como essenciais assim como em qualquer atividade produtiva, mas que

Paulo Cesar Oliveira Gomes; Deise Guadalupe Lima




Microsoft Academic Search

Resumo: O presente estudo sobre o mercado dos medicamentos genéricos visa demonstrar, dentre outras, a gestão da informação como mecanismo de apoio ao monitoramento tecnológico e tomada de decisão, tendo como vetor principal análise de patentes. Este estudo aplica a metodologia de inteligência competitiva no sentido de viabilizar a monitoração de drogas genéricas (ind. farmoquímica), bem como formulações (ind. farmacêutica),

Claudia CANONGIA; Adelaide ANTUNES; Maria de Nazaré PEREIRA



Microsoft Academic Search

En la actualidad el turismo como fenómeno masivo puede ayudar a conservar los frágiles ecosistemas, así como a contribuir al desarrollo del turismo sostenible de las comunidades locales, pero en ocasiones la actividad turística puede impactar negativamente en el ambiente, causando numerosos problemas asociados con los impactos de la actividad turística y recreativa sobre el recurso hídrico como la contaminación

Miriam Marcela Azcurra; Ana Elizabeth de la Puente




Microsoft Academic Search

Existen fuertes argumentos para aseverar que el turismo como actividad económica, contribuye a mejorar el bienestar de las naciones. En este contexto, siguiendo tendencias mundiales, numerosos países buscan fomentar y promover actividades como el turismo deportivo, modalidad que se perfila como el segundo motivo de viajes en 2020. Sin embargo, para lograr un desarrollo exitoso de dicho segmento turístico, los

Reyna María Ibáñez Pérez



Diferencias por sexo en los criterios y estándares de productividad científica y docente en profesores funcionarios en España  

Microsoft Academic Search

El objetivo del presente trabajo es analizar las diferencias en la opinión que tienen los profesores y pro- fesoras universitarios españoles sobre los criterios y estándares de productividad científica, así como el número mínimo en éstos para ser acreditado como Profesor Titular de Universidad (PTU) o como Catedrático de Universidad (CU). Para ello se encuestó a una muestra de 960

Juan Carlos Sierra; Gualberto Buela-Casal; María Paz Bermúdez; Pablo Santos-Iglesias



Captura de satélites durante a formação de Júpiter  

NASA Astrophysics Data System (ADS)

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

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



How does an open house benefit your organization?  


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

McBride, J



Community relations 2.0.  


Before the Internet, organizations had far more time to monitor and respond to community activity, but that luxury is long gone, leaving them in dire need of a coherent outreach strategy, fresh skills, and adaptive tactics. Drawing on the authors' study of more than two dozen firms, this article describes the changes wrought by social media in particular and shows managers how to take advantage of them--lessons that Kaiser Permanente, Domino's, and others learned the hard way. Social media platforms enhance the power of communities by promoting deep relationships, facilitating rapid organization, improving the creation and synthesis of knowledge, and enabling robust filtering of information. The authors cite many examples from the health care industry, where social media participation is vigorous and influential. For instance, members of Sermo, an online network exclusively for doctors, used the site to call attention to and organize against insurers' proposed reimbursement cuts. And on PatientsLikeMe, where people share details about their chronic diseases and the treatments they've pursued, charts and progress curves help members visualize their own complex histories and allow comparisons and feedback among peers. As you modernize your company's approach to community outreach, you'll need to assemble a social media team equipped to identify new opportunities for engagement and prevent brand damage. In the most successful firms the authors studied, community management was a dedicated function, combining marketing, public relations, and information technology skills. PMID:19891388

Kane, Gerald C; Fichman, Robert G; Gallaugher, John; Glaser, John



Immunomodulatory Agents and Risk of Postpartum Multiple Sclerosis Relapses  

PubMed Central

Objective: To determine whether treatment with an interferon beta or glatiramer acetate shortly after delivery reduces the otherwise increased risk of postpartum relapses of multiple sclerosis. Methods: In a retrospective cohort of 112 women with multiple sclerosis and live births from Kaiser Permanente Southern California, complete medical and pharmacy records of the mothers and infants were reviewed. Propensity score-adjusted hazard ratios (HR) of time to first postpartum relapse were calculated. Results: Of 80 women who breastfed little or not at all, 55 (69%) resumed treatment within 1 year postpartum, of whom 26 (47%) relapsed within 6 months postpartum. Resuming treatment within 2 weeks postpartum did not decrease the risk of relapse in the 2 years postpartum compared with women who resumed treatment later in the postpartum year (propensity score-adjusted HR = 1.3, 95% confidence interval = 0.5–3.4, p = 0.6). There was no difference in relapse rates between the groups in the first 6 months postpartum. However, later in the postpartum year those who resumed treatment early had fewer relapses (p = 0.08, Poisson regression). Conclusions: Among women who breastfeed little or not at all, starting treatment with interferon beta or glatiramer acetate within two weeks postpartum does not reduce the risk of postpartum relapse of multiple sclerosis but may reduce the risk of subsequent relapses in the postpartum year. PMID:24626066

Beaber, Brandon Emet; Chi, Margaret D; Brara, Sonu Malik; Zhang, Jian Liang; Langer-Gould, Annette M



Risk factors for pelvis fracture in older persons.  


From 1996 to 2001, the authors undertook a case-control study of 192 pelvis fracture cases (men and women) and 2,402 controls aged > or = 45 years at five Kaiser Permanente medical centers in Northern California. Most information on potential risk factors was obtained by means of an interviewer-administered questionnaire. Number of fractures since age 45 years and a maternal history of hip fracture were associated with increased risks. Several factors thought to protect against loss of bone mass, including recent use of menopausal hormone therapy (adjusted odds ratio (OR) = 0.55, 95% confidence interval (CI): 0.33, 0.91) and high body mass index (weight (kg)/height (m)2; per 5-unit increase, adjusted OR = 0.65, 95% CI: 0.52, 0.81), were associated with decreased risks, while cigarette smoking (adjusted OR = 2.17, 95% CI: 1.34, 3.52) and hysterectomy (adjusted OR = 1.75, 95% CI: 1.15, 2.66) were associated with increased risks. Various conditions related to propensity to fall were associated with increased risks. Most indicators of frailty, including use of walking aids and needing help with or being unable to perform various activities of daily living, conferred increased risks. Thus, low bone mass, frailty, and probably a propensity to fall appear to be associated with increased risk of pelvis fracture. PMID:16221810

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



Case studies of orthopedic surgery in California: the virtues of care coordination versus specialization.  


Two overarching frameworks compete to address the organizational ills of the health care system. One framework diagnoses lack of coordination and prescribes integration and global payment. The other diagnoses loss of focus and prescribes specialization and episode payment. This article, based on research and interviews, assesses how the two frameworks manifest themselves at two high-volume orthopedic hospitals in Irvine, California. The Kaiser Permanente Irvine Medical Center is part of a large and diversified health system. The Hoag Orthopedic Institute is a single-specialty facility jointly owned by the physicians and the hospital. Market outcomes, such as the merger of the Hoag specialty hospital into a larger diversified health system, suggest that Kaiser's focus on coordination of patient care from preadmission to postdischarge is a key factor in its success. But Hoag's specialization also leads to improved efficiencies. The integrated approach appears to be prevailing. At the same time, large diversified organizations might obtain further efficiencies by pursuing service-line strategies as described in this article--for instance, by providing incentives for efficiency and quality for each specialty and type of care. PMID:23650326

Robinson, James C



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

PubMed Central

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

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



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


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

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



Interview with Lawrence Weed, MD-- The Father of the Problem-Oriented Medical Record Looks Ahead  

PubMed Central

I first met Lawrence Weed, MD, in 1972 when I was a third-year medical student at the University of Vermont. To this day I remember his passion for a disciplined approach to medical record documentation to optimize the care provided to each individual patient. Now, 35 years later, I was privileged to meet with Dr Weed at his home in Vermont. We discussed when he first was alerted to the nonscientific approach clinicians use to make decisions on patients. The rest of the interview time was spent with Dr Weed teaching me about the solution that he has spent the last 30 years designing and implementing. This interview is published to complement the editorial in the most recent issue of The Permanente Journal (Spring 2009;13[2]:85-7). We believe that in the era of health care reform and quality improvement initiatives, it is important that the medical community take a close look at Dr Weed's total approach decision-making information support defined in this interview. — Lee Jacobs, MD PMID:20740095

Jacobs, Lee



Kaiser captures spirit of games.  


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

Herreria, J



A randomized trial of prophylactic uterosacral ligament suspension at the time of hysterectomy for Prevention of Vaginal Vault Prolapse (PULS): design and methods.  


The primary aim of this randomized trial is to evaluate whether a standardized uterosacral ligament suspension colpopexy (USLSC), added to a planned hysterectomy for an indication other than pelvic organ prolapse (POP), decreases the rate of subsequent vaginal vault prolapse in women without preoperative symptomatic POP. Secondary aims include comparison of perioperative complications, urinary, bowel and sexual functions between subjects with and without concomitant USLSC. If shown to be beneficial, the cost-effectiveness of prophylactic USLSC at the time of hysterectomy will be evaluated. This trial will be performed at 4 centers across the United States. The data will be analyzed by the data-coordinating center of the Southern California Kaiser Permanente. Standardized questionnaires and objective measurements will be obtained. The patients and providers performing assessments are masked to treatment assignment. The primary outcome, defined as absence of POP at/distal to the hymen on Pelvic Organ Prolapse Quantitative examination, will be determined 12 months post-operatively. Secondary outcomes include: no prolapse symptoms by questionnaires, and no treatment for POP besides the prophylactic study intervention. Additional follow-up occurs annually for a total of 5 years. Accrual is projected to take 3 years. Given cost and morbidity of surgical repair of post-hysterectomy prolapse, preventive strategies are of outmost importance. The risks and benefits of prophylactic USLSC have never been studied prospectively. This trial is designed to determine if USLSC is an appropriate clinical adjunct at the time of hysterectomy, with subsequent reduction of symptomatic POP. PMID:23587538

Alperin, Marianna; Weinstein, Milena; Kivnick, Seth; Duong, Thinh H; Menefee, Shawn



Sustainable health information exchanges: the role of institutional factors  

PubMed Central

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



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


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

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



Physician Update: Total Health  

PubMed Central

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

Tuso, Phillip




E-print Network

We are grateful to the many people who contributed to this report on the Medicaid Value Program. The study was commissioned by the Center for Health Care Strategies, which oversees this project. We are especially grateful to Allison Hamblin, our liaison for this study, and to Melanie Bella and Steve Somers for their thoughtful comments throughout the project. Maureen Hanrahan, Director of Government Programs for Kaiser, and Paul Wallace, of the Kaiser Permanente Care Management Institute, who supported CHCS in this study, also provided valuable encouragement for the evaluation. Among Mathematica Policy Research staff, we particularly want to acknowledge the support of Randy Brown for his advice on all aspects of the project (from its early stages to the final report) and Jim Verdier for his valuable comments on a draft of the final report (as well as the interim report). William Garrett produced the report (sec) and Barbara Geehan edited it. Finally, we are especially grateful to all the grantees for participating in interviews and collecting the data needed to inform this report. Without their hard work, cooperation and support MVP and this evaluation would not exist. While we benefited from the help of others, we alone are responsible for any errors or

Dominick Esposito; Erin Fries Taylor; Kristin Andrews; Marsha Gold; Melanie Bella; Erin Fries; Taylor Acknowledgments; Dominick Esposito; Erin Taylor; Kristin Andrews; Marsha Gold



Psychotherapist mindfulness and the psychotherapy process.  


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

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



Genetic Risk Factors for Perinatal Arterial Ischemic Stroke  

PubMed Central

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

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



Candidate Genes and Risk for Cerebral Palsy: a Population-Based Study  

PubMed Central

Studies suggest 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 weeks 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 nitric oxide synthase (iNOS) -231, apolipoprotein E (apoE) ?2 and ?4 alleles, tumor necrosis factor-? -308, interleukin-8 -251, lymphotoxin 60, endothelial nitric oxide synthase -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% vs. 18.9%, P=0.04) and the apoE ?4 allele (19.3% vs. 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



Servicio de Referencia Digital en Bibliotecas de Ciencia y Tecnología: alternativas para las prestaciones  

E-print Network

Referencia digital: servicio de referencia que se brinda utilizando distintos medios de comunicación digitales para la interacción usuario-referencista. Referencia virtual: “ … servicio de referencia iniciado electrónicamente, a menudo en tiempo real, donde los usuarios emplean computadoras u otra tecnología de Internet para comunicarse con los bibliotecarios, sin estar físicamente presentes. Los canales de comunicación usados frecuentemente en referencia virtual incluyen videoconferencia, servicios de voz en Internet, correo electrónico y mensajería instantánea. Aunque es frecuente la utilización de fuentes en línea para la provisión del servicio de referencia virtual, el uso de fuentes electrónicas en la búsqueda de respuestas no es en sí misma referencia virtual. El seguimiento de las consultas de referencia virtual se hace a menudo por teléfono, fax o correo electrónico, aún cuando esos modos de comunicación no son considerados virtuales” American Library Association. MARS Ad Hoc Committee on Virtual Reference Guidelines. (2003). Draft guidelines for implementing and maintaining virtual services. •Referencia digital •Referencia virtual •Referencia en línea Terminología variada y aún no consolidada: •Ask a librarian (u otro especialista) •Referencia permanente (24/7) •Referencia en tiempo real Los conceptos son bastante diferentes; sin embargo, estas expresiones suelen considerarse intercambiables. En general se aplican a servicios de referencia que utilizan tecnología digital para la comunicación con los usuarios, principalmente a través de Internet. Un glosario de términos relacionados con RD:

Pedro Falcato; Sistemas Asincrónicos; Correo Electrónico


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

PubMed Central

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

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



Health care use by frequent marijuana smokers who do not smoke tobacco.  


Even though marijuana smoke contains carcinogens and more tar than tobacco smoke and marijuana intoxication has been implicated as a risk factor for injuries, relatively little epidemiologic evidence has identified marijuana use as a risk factor for ill health. This study is the first to examine the health effects of smoking marijuana by comparing the medical experience of "daily" marijuana smokers who never smoked tobacco (n = 452) with a demographically similar group of nonsmokers of either substance (n = 450). Marijuana smoking status was determined during multiphasic health checkups at Kaiser Permanente medical centers between July 1979 and December 1985. Medical records were reviewed for as long as 2 years after the checkups. Frequent marijuana smokers had small increased risks of outpatient visits for respiratory illnesses (relative risk [RR] = 1.19; 95% confidence interval [CI] = 1.01, 1.41), injuries (RR = 1.32; CI = 1.10, 1.57), and other types of illnesses (RR = 1.09; CI = 1.02, 1.16) compared with nonsmokers; their risk of being admitted to a hospital was elevated but not statistically significant (RR = 1.51; CI = 0.93, 2.46). Analyses were adjusted for sex, age, race, education, marital status, and alcohol consumption. Daily marijuana smoking, even in the absence of tobacco, appeared to be associated with an elevated risk of health care use for various health problems. PMID:8337854

Polen, M R; Sidney, S; Tekawa, I S; Sadler, M; Friedman, G D



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

PubMed Central

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

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



Childhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndrome  

PubMed Central

Objective: To determine whether childhood obesity is a risk factor for developing pediatric multiple sclerosis (MS) or clinically isolated syndrome (CIS). Methods: Cases were identified through the Kaiser Permanente Southern California (KPSC) Pediatric Acquired Demyelinating Diseases Cohort between 2004 and 2010. For cases, body mass index (BMI) was obtained prior to symptom onset, for the underlying cohort BMI was obtained through the KPSC Children's health study (n = 913,097). Weight classes of normal weight, overweight, moderate obesity, and extreme obesity were assigned based on BMI specific for age and sex. Results: We identified 75 newly diagnosed pediatric cases of MS or CIS, the majority of which were in girls (n = 41, 55%), age 11–18 (n = 54, 72%). Obesity was associated with a significantly increased risk of MS/CIS in girls (p = 0.005 for trend) but not in boys (p = 0.93). The adjusted odds ratio and 95% confidence intervals for CIS/MS among girls was 1.58 (0.71–3.50) for overweight compared to normal weight (reference category), 1.78 (0.70–4.49) for moderately obese, and 3.76 (1.54–9.16) for extremely obese. Moderately and extremely obese cases were more likely to present with transverse myelitis compared with normal/overweight children (p = 0.003). Conclusion: Our findings suggest the childhood obesity epidemic is likely to lead to increased morbidity from MS/CIS, particularly in adolescent girls. PMID:23365063

Brara, Sonu M.; Beaber, Brandon E.; Koebnick, Corinna



Contigüedad y ambigüedad en La secreta obscenidad de cada día  

E-print Network

la intersección de tres campos: política, psicoanálisis, y lenguaje. Entre los tres, La secreta obscenidad de cada día establece nexos marcados por la contigüidad y la ambigüedad y que se expresan como contraste, contradicción, o equívoco. Esas... de La secreta obscenidad de cada día hace resaltar la violencia como forma de resistencia posible en un medio social opresivo, que basa su poder precisamente en la violencia. No obstante, dicha interpretación, como todos los demás elementos del...

Gilmore, Elsa M.



-1 Integrando al agua en las decisiones  

E-print Network

- 1 Integrando al agua en las decisiones Producción y D E F M A M mm/mes Pp Etp ... ¿Cuándo siembro? Rendimiento potencial Oferta vs Demanda ¿Cuanta agua ? ... como me afecta la estación? ... como cambia la demanda de agua? ... como cambia oferta y acceso al agua

Nacional de San Luis, Universidad


Micropartículas poliméricas à base de xilana e Eudragit S-100 contendo mesalazina visando à liberação cólon-específica.  

E-print Network

??Sistemas cólon-específicos têm atraído o interesse da indústria farmacêutica devido à possibilidade de tratarem enfermidades, como as doenças inflamatórias intestinais (DII), que compreendem um problema… (more)

Acarilia Eduardo da Silva




E-print Network

??Introdução: O excesso de tecido adiposo está associado a instalação da síndrome metabólica (SM), reunindo diversas alterações fisiológicas, tais como, intolerância a glicose, dislipidemia, hipertensão… (more)




Características 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 histórico criminal. MÉTODO: Estudo… (more)

Denise Müller Böhm



Avaliação de frações antigênicas da forma metacestódea de Taenia saginata no imunodiagnóstico da neurocisticercose humana.  

E-print Network

??A utilização de metacestódeos de Taenia saginata como antígeno alternativo constitui uma importante ferramenta no sorodiagnóstico da neurocisticercose humana (NC). A reatividade cruzada com indivíduos… (more)

Heliana Batista de Oliveira



De Sociedad de Relaciones Internacionales a Centro Superior de Idiomas de la Universidad de Alicante  

E-print Network

... Cultural Courses, Dancing, Cooking... Sports. Conversation Tandem #12;Accomodation Service: Families ), Rumano y DELE. Examination Center. Como intermediarios. #12;Cultural Activities. Trips, visits


Métodos de fitorremediação e biomonitorização com base em modelos experimentais aplicados ao ensino das ciências.  

E-print Network

??A presente dissertação de doutoramento tem como principais objetivos: identificar plantas aquáticas e semiaquáticas bioindicadoras e/ou fitorremediadoras de urânio (U), na Horta da Vilariça; reproduzir… (more)

Cordeiro, Cristina Guerreiro de Almeida



Análise comparativa de pavimentos dimensionados através dos métodos empírico do DNER e mecanístico e proposta de um catálogo simplificado de pavimentos para a região de Campo Grande (MS).  

E-print Network

??Este estudo tem como objetivo principal comparar estruturas de pavimentos flexíveis projetadas através dos métodos empírico do DNER e mecanístico, considerando-se alguns materiais de pavimentação… (more)

Rogerio Silveira Bezerra Neto



Produção por dip coating e caracterização de revestimentos compósitos de poliuretano/alumina sobre fibras de poliamida 6.  

E-print Network

??Este trabalho teve como objetivo produzir, pela técnica de dip coating contínuo, revestimentos compósitos poliuretano/alumina sobre fibras de poliamida 6. Para tanto, foram produzidas suspensões… (more)

Felipe Antonio Lucca Sánchez



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.




Influencia de la subnutrición proteico-calórica transgeneracional sobre el crecimiento de la descendencia en la rata (Rattus norvegicus albinus var.Wistar).  

E-print Network

??Los factores transgeneracionales o intergeneracionales son definidos como el conjunto de condiciones de naturaleza ambiental experimentados por una generación, que inciden sobre la salud, el… (more)

Cesani Rossi, María Florencia



Melasma extra-facial : avaliação clínica, histopatológica e imuno-histoquímica em estudo caso-controle.  

E-print Network

??Fundamentos: O melasma extra-facial é dermatose freqüente na prática clínica dermatológica. Apresenta características especiais em relação tanto aos aspectos clínicos como aos prováveis fatores etiopatogênicos.… (more)

Clarice Gabardo Ritter




E-print Network

??[pt] Alguns óxidos cerâmicos apresentam Coeficiente de Expansão Térmica Negativa (ETN). Estes materiais usados como compósitos podem controlar a expansão térmica em valores determinados, inclusive… (more)




Body- Building e a confiança e medo no uso dos esteroides anabolizantes: uma análise sociológica.  

E-print Network

??O presente trabalho versa sobre o problema do uso intensivo dos hormônios esteroides anabólicos androgênicos (EAAs), também conhecidos popularmente como esteroides anabolizantes, por homens frequentadores… (more)

Fabiano Almeida da Silva



Órteses em PVC para membro superior: utilização por terapeutas ocupacionais brasileiros, propriedades físicomecânicas e de toxicidade e desempenhos funcional e mioelétrico.  

E-print Network

??As órteses são dispositivos que tem como função, estabilizar, imobilizar, prevenir e corrigir deformidades e maximizar a função e atualmente são confeccionadas em termoplásticos, especialmente… (more)

Larissa Galvão da Silva



Bulimia nerviosa, estilos de afrontamiento y situaciones estresantes.  

E-print Network

??La presente investigación tuvo como objetivo estudiar la relación entre bulimia nerviosa, estilos de afrontamiento y situaciones estresantes. Se realizó una investigación no experimental, participaron… (more)

Echeverría Serrano, Elizabeth



Modelagem termodinamica de equilibrio liquido-liquido em sistemas envolvendo liquidos ionicos com modelos de composição local/contribuição de grupo e estruturas moleculares determinadas via quimica quantica.  

E-print Network

??Líquidos iônicos são sais orgânicos de alto peso molecular que são líquidos a temperatura ambiente. Estas substâncias têm recebido considerável atenção como solventes ecologicamente corretos,… (more)

Rilvia Saraiva de Santiago Aguiar



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 1.0–4.0, 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 0.88–4.0, 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.



Embrace, a model for integrated elderly care: study protocol of a randomized controlled trial on the effectiveness regarding patient outcomes, service use, costs, and quality of care  

PubMed Central

Background Ongoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. The Chronic Care Model (CCM), combined with classification for care needs based on Kaiser Permanente (KP) Triangle, may offer a suitable framework for change. The aim of the present study is to investigate the effectiveness of Embrace, a population-based model for integrated elderly care, regarding patient outcomes, service use, costs, and quality of care. Methods/Design The CCM and the KP Triangle were translated to the Dutch setting and adapted to the full elderly population living in the community. A randomized controlled trial with balanced allocation was designed to test the effectiveness of Embrace. Eligible elderly persons are 75 years and older and enrolled with one of the participating general practitioner practices. Based on scores on the INTERMED-Elderly Self-Assessment and Groningen Frailty Indicator, participants will be stratified into one of three strata: (A) robust; (B) frail; and (C) complex care needs. Next, participants will be randomized per stratum to Embrace or care as usual. Embrace encompasses an Elderly Care Team per general practitioner practice, an Electronic Elderly Record System, decision support instruments, and a self-management support and prevention program – combined with care and support intensity levels increasing from stratum A to stratum C. Primary outcome variables are patient outcomes, service use, costs, and quality of care. Data will be collected at baseline, twelve months after starting date, and during the intervention period. Discussion This study could provide evidence for the effectiveness of Embrace. Trial registration The Netherlands National Trial Register NTR3039 PMID:23782932



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 listener’s benefit only; sound personable, warm, and positive; and not create fear among listeners. Discussion: Establishing linguistic congruence between African Americans and the voices used in automated calls designed to reach them may increase the effectiveness of outreach efforts. PMID:24867548

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



A new concept in radiology QA in a large setting.  


Determining film quality has traditionally been carried out through review and evaluation of exam retakes. At best, such a system will tell which exam areas the technologist repeated most. Kaiser Permanente Northwest has 80 radiologic technologists and 30 radiologists who rotate through film reading. The program developed at Kaiser is directed toward general diagnostic film quality only and uses the services of two full-time quality assurance (QA) technologists. Working together, the radiologist and QA staff have created a standard of diagnostic image quality. A QA radiologist representative is available to work with the QA technologist if inconsistencies are raised. Every other month, a QA technologist makes a random selection for review of 50 exams performed by each technologist. These evaluations cover view rather than exam, with each view judged on its own merit. The purpose is to look for recurring problems in the technologist's performance. Copies of the review sheet go to each technologist's supervisor who forwards a copy to the technologist. Technologists can request help to understand why certain films meet or fail to meet quality standards. The QA technologists are available to give one-on-one help, and they also offer classes and demonstrations. In turn, radiologist fill out quality control (QC) slips as they read exams. The slips help to educate and correct specific problems, and are a direct communication link between radiologist and technologist. The QA program places importance on having the proper tools for taking quality films. The program also provides several levels of accountability although QA technologists are not responsible for its enforcement. Instead, they give feedback to supervisors who enforce performance levels. An appeals process is also in place. The program helps keep image quality acceptable to both hospital radiologists and customer requirements in the industry. In turn, the technologists use it to further their professional development. PMID:10179190

Tomlinson, D; Stapleman, K



Mother-reported sleep, accelerometer-estimated sleep and weight status in Mexican American children: sleep duration is associated with increased adiposity and risk for overweight/obese status.  


We know of no studies comparing parent-reported sleep with accelerometer-estimated sleep in their relation to paediatric adiposity. We examined: (i) the reliability of mother-reported sleep compared with accelerometer-estimated sleep; and (ii) the relationship between both sleep measures and child adiposity. The current cross-sectional study included 303 Mexican American mother-child pairs recruited from Kaiser Permanente Northern California. We measured sleep duration using maternal report and accelerometry and child anthropometrics. Concordance between sleep measures was evaluated using the Bland-Altman method. We conducted zero-ordered correlations between mother-reported sleep, accelerometer-estimated sleep and child BMI z-scores (BMIz). Using linear regression, we examined three models to assess child BMIz with mother-reported sleep (model 1), accelerometer-estimated sleep (model 2) and both sleep measures (model 3). Children had an average age of 8.86 years (SD = 0.82). Mothers reported that their child slept 9.81 ± 0.74 h [95% confidence interval (CI): 9.72, 9.89], compared to 9.58 ± 0.71 h (95% CI: 9.50, 9.66) based on accelerometry. Mother-reported sleep and accelerometer-estimated sleep were correlated (r = 0.33, P < 0.001). BMIz outcomes were associated negatively with mother-reported sleep duration (model 1: ? = -0.13; P = 0.02) and accelerometer-estimated sleep duration (model 2: ? = -0.17; P < 0.01). Accounting for both sleep measures, only accelerometer-measured sleep was related to BMIz (model 3: ? = -0.14, P = 0.02). Each sleep measure was related significantly to adiposity, independent of covariates. Accelerometry appeared to be a more reliable measure of children's sleep than maternal report, yet maternal report may be sufficient to examine the sleep-adiposity relationship when resources are limited. PMID:24329818

Martinez, Suzanna M; Greenspan, Louise C; Butte, Nancy F; Gregorich, Steven E; De Groat, Cynthia L; Deardorff, Julianna; Penilla, Carlos; Pasch, Lauri A; Flores, Elena; Tschann, Jeanne M



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



Association Between Estimated GFR, Health-Related Quality of Life, and Depression Among Older Adults With Diabetes: The Diabetes and Aging Study  

PubMed Central

Background Although chronic kidney disease (CKD) is a highly prevalent condition among older adults with diabetes, the associations between health-related quality of life (HRQOL) and severity of CKD in this population are not well understood. The objective of this study was to assess HRQOL and depressive symptoms across estimated GFR (eGFR) stages. Study Design Cross-sectional. Setting & Participants Participants included 5,805 members of Kaiser Permanente Northern California age 60 or older with diabetes from the 2005–2006 Diabetes Study of Northern California (DISTANCE) survey. Predictor eGFR categories were defined as ?90 (referent category), 75–89, 60–74, 45–59, 30–44 or ?29 ml/min/1.73m2. Outcomes HRQOL was measured using the modified Short Form 8 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Depressive symptoms were measured using the Patient Health Questionnaire 8. Results In unadjusted linear regression analyses, physical (PCS) and mental (MCS) HRQOL scores were significantly lower with worsening eGFR level. However, after adjustment for sociodemographics, diabetes duration, obesity, and cardiovascular comorbidities, and taking into account interactions with proteinuria, none of the eGFR categories were significantly or substantively associated with PCS or MCS score. In both unadjusted and adjusted analyses, higher risk of depressive symptoms was observed among respondents with eGFR ?29 ml/min/1.73m2 (relative risk, 2.02; 95% CI,1.10–3.71; p<0.05) compared with the referent group. However, this eGFR-depression relationship was no longer significant after adjusting for hemoglobin levels. Limitations Participants are part of a single health care delivery system. Conclusions Our findings suggest the need for greater attention to and potential interventions for depression in patients with reduced eGFR. PMID:23746376

Campbell, Kellie Hunter; Huang, Elbert S.; Dale, William; Parker, Melissa M.; John, Priya M.; Young, Bessie A.; Moffet, Howard H.; Laiteerapong, Neda; Karter, Andrew J.



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, patient’s perceived success in achieving program goals, and the patient-level correlates of these outcomes in a voluntary telephonic coaching program at a large integrated health care delivery system in northern California. Methods Kaiser Permanente Northern California patients who participated in a telephonic coaching program in 2011 were sent a cross-sectional survey about their satisfaction with health coaching and perceived success with program goals. We examined associations with patient characteristics. Results The survey response rate was 34%; analyses were based on the 32% who completed the survey. Of those who had completed 2 or more sessions (n = 232 [52%]), most reported being satisfied (70%) or neutral (20%) with the program, and 71% would recommend health coaching. Healthy weight, healthful eating, and physical activity were the most common topics discussed (88%). Adjusting for demographic characteristics, 73% of those who had 2 or more sessions reported that health coaching helped achieve their weight-related goal. Outcomes were positively correlated with patient activation but not consistently correlated with patient demographic characteristics. Conclusion Levels of satisfaction and perceived success with telephonic health coaching provided by a health plan were high and positively correlated with the number of sessions completed and patient activation. Voluntary telephonic health coaching programs should promote retention and assess patients’ activation levels. PMID:24176083

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.



Implementation fidelity in adolescent family-based prevention programs: relationship to family engagement.  


Reliability and validity of intervention studies are impossible without adequate program fidelity, as it ensures that the intervention was implemented as designed and allows for accurate conclusions about effectiveness (Bellg AJ, Borrelli B, Resnick B et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH behavior change consortium. Health Psychol 2004; 23: 443-51). This study examines the relation between program fidelity with family engagement (i.e. satisfaction and participation) in family-based prevention programs for adolescent alcohol, tobacco or other drug use. Families (n = 381) were those with an 11- to 12-year-old child enrolled in Kaiser Permanente in the San Francisco area. Families participated in one of two programs: Strengthening Families Program: For Parents and Youth 10-14 (SFP) (Spoth R, Redmond C, Lepper H. Alcohol initiation outcomes of universal family-focused preventive interventions: one- and two-year follow-ups of a controlled study. J Stud Alcohol Suppl 1999; 13: 103-11) or Family Matters (FM) (Bauman KE, Ennett ST. On the importance of peer influence for adolescent drug use: commonly neglected considerations. Addiction 1996; 91: 185-98). Fidelity was assessed by: (i) adherence to the program manual and (ii) quality of implementation. No relationships were found for FM, a self-directed program. For SFP, higher quality scores were related to higher parent satisfaction. Higher adherence scores were related to higher satisfaction for youth, yet surprisingly to lower satisfaction for parents. Parent sessions involve much discussion, and to obtain high adherence scores, health educators were often required to limit this to implement all program activities. Findings highlight a delivery challenge in covering all activities while allowing parents to engage in mutually supportive behavior. PMID:20142414

Byrnes, Hilary F; Miller, Brenda A; Aalborg, Annette E; Plasencia, Ana V; Keagy, Carolyn D



Dietary Patterns and Breast Cancer Recurrence and Survival Among Women With Early-Stage Breast Cancer  

PubMed Central

Purpose To determine the association of dietary patterns with cancer recurrence and mortality of early-stage breast cancer survivors. Patients and Methods Patients included 1,901 Life After Cancer Epidemiology Study participants diagnosed with early-stage breast cancer between 1997 and 2000 and recruited primarily from the Kaiser Permanente Northern California Cancer Registry. Diet was assessed at cohort entry using a food frequency questionnaire. Two dietary patterns were identified: prudent (high intakes of fruits, vegetables, whole grains, and poultry) and Western (high intakes of red and processed meats and refined grains). Two hundred sixty-eight breast cancer recurrences and 226 all-cause deaths (128 attributable to breast cancer) were ascertained. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs. Results Increasing adherence to a prudent dietary pattern was associated with a statistically significant decreasing risk of overall death (P trend = .02; HR for highest quartile = 0.57; 95% CI, 0.36 to 0.90) and death from non–breast cancer causes (P trend = .003; HR for highest quartile = 0.35; 95% CI, 0.17 to 0.73). In contrast, increasing consumption of a Western dietary pattern was related to an increasing risk of overall death (P trend = .05) and death from non–breast cancer causes (P = .02). Neither dietary pattern was associated with risk of breast cancer recurrence or death from breast cancer. These observations were generally not modified by physical activity, being overweight, or smoking. Conclusion Women diagnosed with early-stage breast cancer might improve overall prognosis and survival by adopting more healthful dietary patterns. PMID:19114692

Kwan, Marilyn L.; Weltzien, Erin; Kushi, Lawrence H.; Castillo, Adrienne; Slattery, Martha L.; Caan, Bette J.



Natural History of Left Ventricular Ejection Fraction in Patients With Heart Failure  

PubMed Central

Background Patients with heart failure (HF) are typically designated as having reduced or preserved ejection fraction (HFREF, HFPEF) because of the importance of left ventricular ejection fraction (LVEF) on therapeutic decisions and prognosis. Such designations are not necessarily static, yet few data exist to describe the natural history of LVEF over time. Methods and Results We identified 2413 patients from Kaiser Permanente Colorado with a primary discharge diagnosis of HF between January 1, 2001, and December 31, 2008, who had ?2 LVEF measurements separated by ?30 days. We used multi-state Markov modeling to examine transitions among HFREF, HFPEF, and death. We observed a total of 8183 transitions. Women were more likely than men to transition from HFREF to HFPEF (hazard ratio, 1.85; 95% confidence interval, 1.38–2.47). Patients who were adherent to ?-blockers were more likely to transition from HFREF to HFPEF (hazard ratio, 1.53; 95% confidence interval, 1.10–2.13) compared with patients who were nonadherent to ?-blockers, whereas angiotensin-converting enzyme or angiotensin II receptor blocker adherence was not associated with LVEF transitions. Patients who had a previous myocardial infarction were more likely to transition from HFPEF to HFREF (hazard ratio, 1.75; 95% confidence interval, 1.26–2.42). Conclusions In this cohort of patients with HF, LVEF is a dynamic factor related to sex, coexisting conditions, and drug therapy. These findings have implications for left ventricular systolic function ascertainment in patients with HF and support evidence-based therapy use, especially ?-blockers. PMID:24129973

Clarke, Christina L.; Grunwald, Gary K.; Allen, Larry A.; Barón, Anna E.; Peterson, Pamela N.; Brand, David W.; Magid, David J.; Masoudi, Frederick A.



Efficacy of an HIV Intervention in Reducing High-Risk HPV, Non-viral STIs, and Concurrency among African-American Women: A Randomized Controlled Trial  

PubMed Central

Objective This trial evaluated the efficacy of an HIV intervention condition, relative to a health promotion condition, in reducing incidence of non-viral STIs (Chlamydia, gonorrhea, trichomoniasis), oncogenic HPV subtypes 16 and 18, sexual concurrency, and other HIV-associated behaviors over a 12-month period. Design Randomized controlled trial. Data analysts blinded to treatment allocation. Setting Kaiser Permanente Georgia Subjects A random sample of 848 African American women Intervention The two 4-hour HIV intervention sessions were based on Social Cognitive Theory and the Theory of Gender and Power. The intervention was designed to enhance participants’ self sufficiency and attitudes and skills associated with condom use. The HIV intervention also encouraged STI testing and treatment of male sex partners, and reducing vaginal douching and individual and male partner concurrency. Main Outcome Measure Incident non-viral STIs. Results In GEE analyses, over the 12-month follow-up, participants in the HIV intervention, relative to the comparison, were less likely to have non-viral incident STIs (OR=0.62; 95% CI, 0.40-0.96; P =.033); and incident high-risk HPV infection (OR=0.37; 95% CI, 0.18-0.77; P = .008), or concurrent male sex partners (OR=0.55; 95% CI, 0.37-0.83; P = .005). Additionally, intervention participants were less likely to report multiple male sex partners, more likely to use condoms during oral sex, more likely to inform their main partner of their STI test results, encourage their main partner to seek STI testing, report that their main partner was treated for STIs, and report not douching. Conclusion This is the first trial to demonstrate that an HIV intervention can achieve reductions in non-viral STIs, high-risk HPV, and individual concurrency. PMID:23673884

Wingood, Gina M.; DiClemente, Ralph J.; Robinson-Simpson, LaShun; Lang, Delia L.; Caliendo, Angela; Hardin, James W.



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



A Mixed Methods Study of Parental Vaccine Decision Making and Parent-Provider Trust  

PubMed Central

Objective To describe parental vaccine decision making behaviors and characterize trust in physician advice among parents with varying childhood vaccination behaviors. Methods Between 2008 and 2011, a mixed methods study was conducted with parents of children aged <4 years who were members of Kaiser Permanente Colorado health plan. Seven focus groups were conducted with vaccine hesitant parents. Based on findings from the focus groups, a survey was developed, pilot tested and mailed to a stratified sample of 854 parents who accepted (n=500), delayed (n=227), or refused (n=127) vaccinations for one of their children. Survey results were analyzed using chi-square tests and multivariable logistic regression. Results Several themes emerged from the focus groups, including: 1) the vaccine decision making process begins prenatally, 2) vaccine decision making is an evolving process, and 3) there is overall trust in the pediatrician, but a lack of trust in the information they provided about vaccines. The survey response rate was 52% (n=443). Parents who refused or delayed vaccines were 2-times more likely to report that they began thinking about vaccines before their child was born, and 8-times more likely to report that they constantly re-evaluate their vaccine decisions than parents who accepted all vaccines. While parents tended to report trusting their pediatrician’s advice on nutrition, behavior and the physical examination, they did not believe their pediatrician provided balanced information on both the benefits and risks of vaccination. Conclusion These results have implications for future interventions to address parental vaccination concerns. Such interventions may be more effective if they are applied early (during pregnancy), often (pregnancy through infancy), and cover both the risks and benefits of vaccination. PMID:24011751

Glanz, Jason M.; Wagner, Nicole M.; Narwaney, Komal J.; Shoup, Jo Ann; McClure, David L.; McCormick, Emily V.; Daley, Matthew F.



Glycemic Control and Urinary Incontinence in Women with Diabetes Mellitus  

PubMed Central

Abstract Background Although many studies have shown that diabetes increases the risk for urinary incontinence, it is unclear whether poor glycemic control in women with diabetes is associated with incontinence. This study aims to determine the relationship between the hemoglobin A1c (HbA1c) level and urinary incontinence in a large, diverse cohort of older women. Methods We examined 6026 older women who responded to a survey (62% response rate) and were enrolled in the Diabetes and Aging Study, an ethnically stratified random sample of patients with diabetes enrolled in Kaiser Permanente Northern California. Our primary independent variable was the mean of all HbA1c measurements in the year preceding the survey. Outcomes included the presence/absence of incontinence and limitations in daily activities due to incontinence. We used modified Poisson regression and ordinal logistic regression models to account for age, race, body mass index, parity, diabetes treatment, duration of diabetes, and comorbidity. Results Sixty-five percent of women reported incontinence (mean age 59±10 years). After adjustment, HbA1c levels were not associated with the presence or absence of incontinence. However, among women reporting incontinence, HbA1c ?9% was associated with more limitations due to incontinence than HbA1c <6% (adjusted odds ratio 1.67, 95% confidence interval: 1.09–2.57). Conclusion In this cross-sectional analysis, HbA1c level is not associated with the presence or absence of incontinence. However, for women with incontinence, poor glycemic control (HbA1c ?9%) is associated with more limitations in daily activities due to incontinence. Longitudinal studies are needed to determine whether improving glycemic control to HbA1c <9% leads to fewer limitations in daily activities due to incontinence. PMID:24032999

Karter, Andrew J.; Thai, Julie N.; Van Den Eeden, Stephen K.; Huang, Elbert S.



Comparative Effectiveness Topics from a Large, Integrated Delivery System  

PubMed Central

Objective: To identify high-priority comparative effectiveness questions directly relevant to care delivery in a large, US integrated health care system. Methods: In 2010, a total of 792 clinical and operational leaders in Kaiser Permanente were sent an electronic survey requesting nominations of comparative effectiveness research questions; most recipients (83%) had direct clinical roles. Nominated questions were divided into 18 surveys of related topics that included 9 to 23 questions for prioritization. The next year, 648 recipients were electronically sent 1 of the 18 surveys to prioritize nominated questions. Surveys were assigned to recipients on the basis of their nominations or specialty. High-priority questions were identified by comparing the frequency a question was selected to an “expected” frequency, calculated to account for the varying number of questions and respondents across prioritization surveys. High-priority questions were those selected more frequently than expected. Results: More than 320 research questions were nominated from 181 individuals. Questions most frequently addressed cardiovascular and peripheral vascular disease; obesity, diabetes, endocrinology, and metabolic disorders; or service delivery and systems-level questions. Ninety-five high-priority research questions were identified, encompassing a wide range of health questions that ranged from prevention and screening to treatment and quality of life. Many were complex questions from a systems perspective regarding how to deliver the best care. Conclusions: The 95 questions identified and prioritized by leaders on the front lines of health care delivery may inform the national discussion regarding comparative effectiveness research. Additionally, our experience provides insight in engaging real-world stakeholders in setting a health care research agenda. PMID:24361013

Danforth, Kim N; Patnode, Carrie D; Kapka, Tanya J; Butler, Melissa G; Collins, Bernadette; Compton-Phillips, Amy; Baxter, Raymond J; Weissberg, Jed; McGlynn, Elizabeth A; Whitlock, Evelyn P



Timely detection of localized excess influenza activity in northern California across patient care, prescription, and laboratory data  

PubMed Central

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 ten 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



Effectiveness of a new health care organization model in primary care for chronic cardiovascular disease patients based on a multifactorial intervention: the PROPRESE randomized controlled trial  

PubMed Central

Background To evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals. Methods/design Experimental study. Randomized clinical trial. Follow-up period: one year. Study setting: primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records. Intervention components: a) Organizational intervention on the patient/professional relationship. Centered on the Chronic Care Model, the Stanford Expert Patient Program and the Kaiser Permanente model: Teamwork, informed and active patient, decision making shared with the patient, recommendations based on clinical guidelines, single electronic medical history per patient that allows the use of indicators for risk monitoring and stratification. b) Formative strategy for professionals: 4 face-to-face training workshops (one every 3 months), monthly update clinical sessions, online tutorial by a cardiologist, availability through the intranet of the action protocol and related documents. Measurements: Blood pressure, blood glucose, HbA1c, lipid profile and smoking. Frequent health care visits. Number of hospitalizations related to vascular disease. Therapeutic compliance. Drug use. Discussion This study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life, number of visits, and number of hospitalizations. Trial registration NCT01826929 PMID:23915267



Communication and Medication Adherence: The Diabetes Study of Northern California  

PubMed Central

Background Poor medication adherence contributes to poor cardiometabolic control and diabetes outcomes. Studies linking patient-provider communication to adherence often use self-reported adherence and have not explored differences across communication domains or therapeutic indications. Methods To investigate associations between patient communication ratings and cardiometabolic medication adherence, we conducted a cross-sectional analysis of 9,377 patients in the Diabetes Study of Northern California (DISTANCE), a race-stratified, random sample of Kaiser Permanente survey respondents. Eligible participants received ?1 oral hypoglycemic, lipid-lowering, or anti-hypertensive medication in the 12 months preceding the survey. Communication was measured with a 4-item Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS) score and 4 items from the Trust in Physicians and Interpersonal Processes of Care instruments. Poor adherence was >20% continuous medication gap for ongoing medications. Using modified least squares regression, we calculated differences in poor adherence prevalence for a 10-point decrease in CAHPS score and comparing higher vs. lower communication ratings on other items, adjusting for necessary sociodemographic and medical confounders derived from a directed acyclic graph. Results In this cohort, 30% had poor cardiometabolic medication adherence. For each 10-point decrease in CAHPS score, the adjusted prevalence of poor adherence increased by 0.9% (p=0.01). Compared with patients offering higher ratings, patients who gave lower ratings for providers’ involving patients in decisions, understanding patients’ problems with treatment, and eliciting confidence and trust were more likely to have poor adherence, with absolute differences of 4% (p=0.04), 5% (p=0.02) and 6% (p=0.03), respectively. Associations between communication and adherence were somewhat larger for hypoglycemic medications than other medications. Conclusions Poor communication ratings were independently associated with objectively measured inadequate cardiometabolic medication adherence, particularly for oral hypoglycemic medications. Future studies should investigate whether improving communication skills among clinicians with poorer patient communication ratings could improve their patients’ cardiometabolic medication adherence and outcomes. PMID:23277199

Ratanawongsa, Neda; Karter, Andrew J.; Parker, Melissa M.; Lyles, Courtney R.; Heisler, Michele; Moffet, Howard H.; Adler, Nancy; Warton, E. Margaret; Schillinger, Dean



Epidemiology of Apnea and Bradycardia Resolution in Premature Infants  

PubMed Central

BACKGROUND: There is little epidemiologic evidence to assess the maturation of respiratory control in premature infants. OBJECTIVE: To measure the success rate or the percentage of infants who have no additional events of various apnea- or bradycardia-free intervals after correcting for gestational age, postmenstrual age of the last apnea or bradycardia event, and the severity of the event. METHODS: This was a retrospective cohort study of infants born at 34 weeks' gestational age or earlier at 1 of 5 Kaiser Permanente Medical Care Program hospitals between 1998 and 2001. The success rates of various apnea- or bradycardia-free intervals were calculated after stratifying according to gestational age, postmenstrual age of the last event, or event severity. RESULTS: Among the 1403 infants identified in this study, 84.2% did not have an apnea event and 78.5% did not have a bradycardia event after they were otherwise ready for discharge. For the entire cohort, a 95% success rate was statistically reached, with a 7-day apnea- or bradycardia-free interval. Infants with a gestational age of 30 weeks or less had a 5% to 15% lower success rate than infants with a gestational age more than 30 weeks for any given apnea- or bradycardia-free interval. The success rate was reduced by an additional 5% to 10% if the last apnea or bradycardia event occurred at a postmenstrual age of more than 36 weeks. Including only the most severe events slightly improved the success rate of a given interval. CONCLUSIONS: The risk of recurrence for apnea or bradycardia differs depending on the gestational age of the infant and the postmenstrual age of the last apnea or bradycardia event. PMID:21746726

Srinivasan, Lakshmi; Escobar, Gabriel J.



Association Between Anti-TNF-? Therapy and Interstitial Lung Disease  

PubMed Central

Background Anti-TNF-? agents have been hypothesized to increase the risk of interstitial lung disease (ILD), including its most severe manifestation, pulmonary fibrosis. Methods We conducted a cohort study among autoimmune disease patients who were members of Kaiser Permanente Northern California, 1998–2007. We obtained therapies from pharmacy data and diagnoses of ILD from review of X-ray and computed tomography reports. We compared new users of anti-TNF-? agents to new users of non-biologic therapies using Cox proportional hazards analysis to adjust for baseline propensity scores and time-varying use of glucocorticoids. We also made head-to-head comparisons between anti-TNF-? agents. Results Among the 8,417 persons included in the analysis, 38 (0.4%) received a diagnostic code for ILD by the end of follow-up, including 23 of 4,200 (0.5%) who used anti-TNF-? during study follow-up, and 15 of 5,423 (0.3%) who used only non-biologic therapies. The age- and gender-standardized incidence rate of ILD, per 100 person-years, was 0.21 (95% CI 0–0.43) for rheumatoid arthritis and appreciably lower for other autoimmune diseases. Compared to use of non-biologic therapies, use of anti-TNF-? therapy was not associated with a diagnosis of ILD among RA patients (adjusted hazard ratio, 1.03; 95% CI 0.51–2.07). Nor did head-to-head comparisons across anti-TNF-? agents suggest important differences in risk, although the number of cases available for analysis was limited. Conclusion The study provides evidence that compared to non-biologic therapies anti-TNF-? therapy does not increase the occurrence of ILD among patients with autoimmune diseases, and informs research design of future safety studies of ILD. PMID:23359391

Herrinton, Lisa J.; Harrold, Leslie R.; Liu, Liyan; Raebel, Marsha A.; Taharka, Ananse; Winthrop, Kevin L.; Solomon, Daniel H.; Curtis, Jeffrey R.; Lewis, James D.; Saag, Kenneth G.



Familial aggregation of Parkinson's disease in a multiethnic community-based case-control study.  


To assess the familial aggregation of Parkinson's disease (PD), we compared the cumulative incidence of PD among first-degree relatives of PD cases and controls. We identified newly diagnosed patients with PD (n = 573) during 1994 to 1995 within Kaiser Permanente Medical Care Program of Northern California and recruited 496 cases (87%) for the case-control study. Of 720 eligible controls matched by birth year and sex to cases, 541 (75%) agreed to participate. Information on family history of PD and other neurodegenerative diseases was obtained by in-person structured interview. We used the reconstructed cohort approach that provides a better estimate of the risk. The cumulative incidence of PD was significantly higher among relatives of PD patients compared with relatives of controls (2.0 vs. 0.7%; relative risk (RR) = 3.4, 95% confidence interval (CI) 1.9-5.9; P = 0.0001). The degree of familial aggregation was higher among first-degree relatives of Hispanic PD cases compared with Hispanic controls (3.7% vs. 0.4%; RR = 8.5, 95% CI 1.0-68.9) than it was among non-Hispanic Caucasian cases and controls (2.0% vs. 0.8%; RR = 2.7, 95% CI 1.5-5.1; P = 0.02). The familial aggregation of PD was stronger among the siblings of PD cases (RR = 5.4, 95% CI 1.8-16.0) than among parents (RR = 2.7, 95% CI 1.3-5.2). The incidence and familial aggregation of PD is highest among Hispanics, warranting further studies of genetic and environmental risk factors in the Hispanic population. PMID:20842689

Shino, Michael Y; McGuire, Valerie; Van Den Eeden, Stephen K; Tanner, Caroline M; Popat, Rita; Leimpeter, Amethyst; Bernstein, Allan L; Nelson, Lorene M



Improving Blood Pressure Control through a Clinical Pharmacist Outreach Program in Diabetes Patients in Two-High Performing Health Systems: The Adherence and Intensification of Medications (AIM) Cluster Randomized Controlled Pragmatic Trial  

PubMed Central

Background Even in high performing health systems, some hypertensive patients with diabetes have persistent poor blood pressure (BP) control. Medication nonadherence and lack of medication intensification contribute to this poor control. We examined whether the Adherence and Intensification of Medications (AIM) intervention, a targeted pharmacist-led intervention that combined state-of-the-art elements found in efficacy studies to lower BP, could improve BP among diabetes patients with persistent hypertension and poor refill adherence or insufficient medication intensification. Methods and Results We conducted a prospective, multi-site cluster randomized pragmatic trial with randomization of 16 primary care teams at five medical centers (3 Veterans Affairs [VA] and 2 Kaiser Permanente [KP]) to the AIM intervention or usual care. The primary outcome was the relative change in systolic blood pressure (SBP) measurements, comparing 1,797 eligible intervention team patients to 2,303 eligible control team patients, between the 6-months preceding and the 6-months following the 14-month intervention period. We examined shorter-term changes in SBP as a secondary outcome. In our primary analysis, the intervention group SBP change from 6-months prior to 6-months after the 14-month intervention period was approximately the same as the control group, declining approximately 9 mm Hg in both groups. SBP lowering occurred more rapidly among eligible intervention team patients, with mean SBPs 2.4 mm Hg lower (95% CI: ?3.4 to ?1.5; p<.001) immediately after the intervention than those achieved by eligible control patients. Conclusions The AIM program more rapidly lowered SBPs among eligible intervention patients, but there was no significant difference in blood pressure between intervention and control patients 6 months following the intervention period. These findings show the importance of rigorously evaluating in different real-life clinical settings programs found in efficacy trials to be effective before urging their widespread adoption in all settings. PMID:22570370

Heisler, Michele; Hofer, Timothy P.; Schmittdiel, Julie A.; Selby, Joe V.; Klamerus, Mandi L.; Bosworth, Hayden B.; Bermann, Martin; Kerr, Eve A.



The Falling Rate of Positive Penicillin Skin Tests from 1995 to 2007  

PubMed Central

Background: Data on the rate of positive penicillin skin test (PenST) results over time in large populations are rare. The factors that influence positive PenST results are incompletely understood. Objectives: We sought to correlate demographic variables to the rate of positive PenST results over time in a large group of patients with a history of penicillin allergy. Methods: Results from the first test for all patients tested for penicillin allergy in the Kaiser Permanente Health Care Program in San Diego County, CA, between 1995 and 2007 are reported. All patients were tested with penicillin, penicilloyl-poly-lysine, penilloate, penicilloate, and amoxicillin. Results: There were 255 positive PenST results in 3469 individuals. The rate of positive PenST results declined from >10% to <5% during the 13 years studied. The positive PenST result rate could be accounted for by the year of testing (R2 = 0.56; p = 0.003) without any significant contribution from the patient's age or the time since reaction (TSR). If the TSR was ?13 years, the relative risk of a positive PenST result was 2.1 (95% confidence interval = 1.6–2.8). If the study subject's age was ?38 years, the relative risk of a positive PenST result was 2.1 (95% confidence interval = 1.6–2.7). Females reported higher rates of penicillin allergy history than males did (11% compared with 6.6%; p < 0.0001), but there were no significant sex differences in the rate of positive PenST results. Conclusions: There has been a steady decline in the proportion of positive PenST results between 1995 and 2007, independent of study subject age and TSR. Increasing age and increasing TSR were associated with a lower rate of positive PenST results. PMID:21373225

Macy, Eric; Schatz, Michael; Lin, CK; Poon, Kwun-Yee



Mindfulness-Based Stress Reduction in an Integrated Care Delivery System: One-Year Impacts on Patient-Centered Outcomes and Health Care Utilization  

PubMed Central

Background: Mindfulness-based stress reduction (MBSR) programs have demonstrated clinical effectiveness for both mental and physical health conditions. Less research exists on health services utilization, self-efficacy, or work productivity outcomes. Objective: To assess one-year outcomes of MBSR in patients with chronic pain, chronic illness, or stress-related problems, measuring functional status, pain, self-efficacy, depression, anxiety, somatization, psychological distress, work productivity, and changes in health services utilization. Methods: A prospective single cohort design evaluated an eight-week MBSR program for Kaiser Permanente Colorado members. Patient-reported measures were collected at baseline, eight weeks, and one year following MBSR. Differences in health services utilization were compared from six months before MBSR to six months following the one-year anniversary of MBSR. Results: Most of the 38 participants were white (28; 74%), female (30; 79%), employed part-time (35; 92%), and average age 52.6 years, with multiple comorbidities (averaging 16.4 unique diagnoses), the most common being joint or back pain (28; 74%) and psychological disorder (20; 53%). Repeated measures analyses at 8 weeks (n = 26) and at 1 year (n = 24) showed significant improvements in self-reported mental and physical function, pain, psychological symptoms, and self-efficacy, but not work productivity. Significant decreases at 1 year were observed for visits in primary care (?50%, p < 0.0001), specialty care (?38%, p = 0.0004), and the Emergency Department (?50%, p = 0.04), and for hospital admissions (?80%, p = 0.02). Conclusion: The MBSR program was associated with improvements in several patient-centered outcomes over 1 year and reductions in health services utilization up to 18 months.

McCubbin, Tracy; Dimidjian, Sona; Kempe, Karin; Glassey, Melissa S; Ross, Colleen; Beck, Arne



PS2-39: Key Challenges and Decisions in the Development of HMO Death Data  

PubMed Central

Background The mortality status of an HMO’s members, whether a person is alive or dead, is critically important to health care research. The uses of mortality status include determination of causes of death, death rates, and for selection of study cohorts. Unlike other clinical activity and health statuses, mortality status cannot be determined solely with a health plan’s internal data, even for well-defined populations, because health plan members often die outside of the plan’s care delivery and claims payment systems. For such members, determination of mortality status and date of death requires linkage of health plan data to external sources of mortality data, such as state death certificate or federal Social Security data. This person-level statistical linkage is a complex, multi-step process that involves many decisions, assumptions, and choosing of priorities. Even when death data from internal systems is available, internal data sources can disagree, likewise requiring complex decisions to determine a member’s “true” mortality status. Methods This presentation highlights key challenges and decisions points in the development of death data logic at Kaiser Permanente Northern California (KPNC). Results Key decisions in KPNC’s death data logic include: handling internal membership data with conflicting personal identifiers, e.g., multiple Social Security Numbers associated with a single Medical Record Number; ranking, grading, and selecting from multiple matches between internal and external data; finding members with multiple MRNs; using utilization contact dates and membership activity dates to evaluate death records, judging reliability of internal health plan data, setting thresholds and criteria for confidence scoring, selecting between multiple possible dates of death, chart validation of final death data. Conclusions The development of death data logic at KPNC is a complex process that requires intricate decisions, careful analysis, and a higher degree of discretionary judgment than is typical of building other data areas. The quality of final results depends upon validation and iterative improvements to the process.

Gul, Jamila; Ng, Daniel; Tao, Wei; Zuo, Daxin



Diagnosis, Comorbidities and Management of Irritable Bowel Syndrome in Patients in a Large Health Maintenance Organization  

PubMed Central

Background Irritable bowel syndrome (IBS) imposes significant clinical and economic burdens. We aimed to characterize patterns of practice for patients with IBS who were members of a large health maintenance organization, analyzing point of diagnosis, testing, comorbidities and treatment. Methods Members of Kaiser Permanente Northern California who were diagnosed with IBS were matched to controls by age, sex, and period of enrollment. We compared rates of testing, comorbidities and interventions. Results From 1995 to 2005, IBS was diagnosed in 141,295 patients (mean age 46, SD 17 years; 74% female). Internists made 68% of diagnoses, gastroenterologists 13%, and others 19%. Lower endoscopy did not usually precede IBS diagnosis. Patients with IBS were more likely than controls to have blood, stool, endoscopic and radiologic tests, and to undergo abdominal or pelvic operations (ORs 1.5–10.7, all P<0.0001). Only 2.7% were tested for celiac disease and only 1.8% were eventually diagnosed with inflammatory bowel disease. Chronic pain syndromes, anxiety and depression were more common among IBS patients than controls (ORs 2.7–4.6, all P<0.0001). Many patients with IBS were treated with anxiolytics (61%) and antidepressants (55%). Endoscopic and radiologic testing were most strongly associated with having IBS diagnosed by a gastroenterologist. Psychotropic medication use was most strongly associated with female sex. Conclusions In a large, managed care cohort, most diagnoses of IBS were made by generalists, often without endoscopic evaluation. Patients with IBS had consistently higher rates of testing, chronic pain syndromes, psychiatric comorbidity and operations than controls. Most patients with IBS were treated with psychiatric medications. PMID:21871250

Ladabaum, Uri; Boyd, Erin; Zhao, Wei K.; Mannalithara, Ajitha; Sharabidze, Annie; Singh, Gurkirpal; Chung, Elaine; Levin, Theodore R.



Quality of Life among Women Recently Diagnosed with Invasive Breast Cancer: The Pathways Study  

PubMed Central

Purpose Few studies have assessed quality of life (QOL) of women diagnosed with breast cancer within the first few weeks of their initial diagnosis. We describe QOL among 950 women recently diagnosed with invasive breast cancer. Methods Starting in January 2006, we invited women aged ?21 years who were diagnosed with first primary invasive breast cancer within Kaiser Permanente Northern California (KPNC) to enroll in the Pathways Study, a prospective study of breast cancer survivorship. QOL was measured using the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), along with sociodemographic and social support information. Clinical characteristics were obtained from the KPNC cancer registry and electronic medical record. We used multivariable linear regression models to identify factors associated with QOL scores calculated from the FACT-B. Results The mean age ± SD of the sample was 59.6 years (±11.9 years), and the mean time ± SD from diagnosis until interview was 8.0 weeks (±3.2 weeks). Younger age at diagnosis was associated with lower scores in all QOL domains (p<0.01), and later stage at diagnosis was associated with lower scores in all domains (p<0.05) except for social well-being. Higher levels of social support were associated with higher QOL except for physical well-being (p<0.05). These associations were stronger within two months of breast cancer diagnosis. Conclusion Quality of life as influenced by a diagnosis of breast cancer is an important factor in cancer survivorship. Age, stage at diagnosis, and social support are key factors in this important variable. PMID:20140494

Kwan, Marilyn L.; Ergas, Isaac Joshua; Somkin, Carol P.; Quesenberry, Charles P.; Neugut, Alfred I.; Hershman, Dawn L.; Mandelblatt, Jeanne; Pelayo, Michael P.; Timperi, Allegra W.; Miles, Sunita Q.; Kushi, Lawrence H.



Genital herpes and its treatment in relation to preterm delivery.  


To examine the risks of genital herpes and antiherpes treatment during pregnancy in relation to preterm delivery (PTD), we conducted a multicenter, member-based cohort study within 4 Kaiser Permanente regions: northern and southern California, Colorado, and Georgia. The study included 662,913 mother-newborn pairs from 1997 to 2010. Pregnant women were classified into 3 groups based on genital herpes diagnosis and treatment: genital herpes without treatment, genital herpes with antiherpes treatment, and no herpes diagnosis or treatment (unexposed controls). After controlling for potential confounders, we found that compared with being unexposed, having untreated genital herpes during first or second trimester was associated with more than double the risk of PTD (odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.80, 2.76). The association was stronger for PTD due to premature rupture of membrane (OR = 3.57, 95% CI: 2.53, 5.06) and for early PTD (?35 weeks gestation) (OR = 2.87, 95% CI: 2.22, 3.71). In contrast, undergoing antiherpes treatment during pregnancy was associated with a lower risk of PTD compared with not being treated, and the PTD risk was similar to that observed in the unexposed controls (OR = 1.11, 95% CI: 0.89, 1.38). The present study revealed increased risk of PTD associated with genital herpes infection if left untreated and a potential benefit of antiherpes medications in mitigating the effect of genital herpes infection on the risk of PTD. PMID:25392064

Li, De-Kun; Raebel, Marsha A; Cheetham, T Craig; Hansen, Craig; Avalos, Lyndsay; Chen, Hong; Davis, Robert



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



Rubber dam use during routine operative dentistry procedures: findings from The Dental PBRN  

PubMed Central

SUMMARY Rubber dam use during operative dentistry procedures has been quantified based on questionnaires completed by dentists. However, to our knowledge there are no reports based on use during actual clinical procedures other than in dental materials studies, and none based on routine care. Our objectives were to: (1) quantify how commonly the rubber dam is used during operative dentistry procedures; (2) test the hypothesis that certain dentist-, restoration- and patient-level factors are associated with its use. A total of 229 dentist practitioner-investigators in “The Dental Practice-Based Research Network (DPBRN)” participated. DPBRN comprises five regions: Alabama/Mississippi, Florida/Georgia, Minnesota, Permanente Dental Associates, and Scandinavia. Practitioner-investigators collected data on 9,890 consecutive restorations done in previously-unrestored tooth surfaces from 5,810 patients. Most dentists (63%) did not use a rubber dam for any restoration in the study. A rubber dam was used for only 12% of restorations, 83% of which were used in one DPBRN region. With region accounted for, no other dentist characteristics were significant. A multi-level multiple logistic regression of rubber dam use was done with restoration- and patient-level variables modeled simultaneously. In this multi-variable context, these restoration-level characteristics were statistically significant: tooth-arch type, restoration classification, and reason for placing the restoration. These patient-level characteristics were statistically significant: ethnicity, dental insurance, and age. These results, obtained from actual clinical procedures rather than questionnaires, document a low prevalence of usage of rubber dam during operative dentistry procedures. Usage varied with certain dentist-, restoration-, and patient-level characteristics. PMID:20945739

Gilbert, Gregg H.; Litaker, Mark S.; Pihlstrom, Daniel J.; Amundson, Craig W.; Gordan, Valeria V.



The multigroup ethnic identity measure-revised: measurement invariance across racial and ethnic groups.  


The Multigroup Ethnic Identity Measure-Revised (MEIM-R), a brief instrument assessing affiliation with one's ethnic group, is a promising advance in the ethnic identity literature. However, equivalency of its measurement properties across specific racial and ethnic groups should be confirmed before using it in diverse samples. We examined (a) the psychometric properties of the MEIM-R, including factor structure, measurement invariance, and internal consistency reliability, and (b) levels of and differences in ethnic identity across multiple racial and ethnic groups and subgroups. Asian (n = 630), Black/African American (n = 58), Hispanic (n = 240), multiethnic (n = 160), and White (n = 375) women completed the MEIM-R as part of the "Gestational diabetes' Effect on Moms" diabetes prevention trial in the Kaiser Permanente Northern California health care setting (N = 1,463; M age = 32.5 years, SD = 4.9). Multiple-groups confirmatory factor analyses provided provisional evidence of measurement invariance, i.e., an equal, correlated 2-factor structure, equal factor loadings, and equal item intercepts across racial and ethnic groups. Latent factor means for the 2 MEIM-R subscales, exploration and commitment, differed across groups; effect sizes ranging from small to large generally supported the notion of ethnic identity as more salient among people of color. Pending replication, good psychometric properties in this large and diverse sample of women support the future use of the MEIM-R. Preliminary evidence of measurement invariance suggests that the MEIM-R could be used to measure and compare ethnic identity across multiple racial and ethnic groups. PMID:24188656

Brown, Susan D; Unger Hu, Kirsten A; Mevi, Ashley A; Hedderson, Monique M; Shan, Jun; Quesenberry, Charles P; Ferrara, Assiamira



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

PubMed Central

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

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



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



Changes in vitamin and mineral supplement use after breast cancer diagnosis in the Pathways Study: a prospective cohort study  

PubMed Central

Background Vitamin and mineral supplement use after a breast cancer diagnosis is common and controversial. Dosages used and the timing of initiation and/or discontinuation of supplements have not been clearly described. Methods We prospectively examined changes in use of 17 vitamin/mineral supplements in the first six months following breast cancer diagnosis among 2,596 members (28% non-white) of Kaiser Permanente Northern California. We used multivariable logistic regression to examine demographic, clinical, and lifestyle predictors of initiation and discontinuation. Results Most women used vitamin/mineral supplements before (84%) and after (82%) diagnosis, with average doses far in excess of Institute of Medicine reference intakes. Over half (60.2%) reported initiating a vitamin/mineral following diagnosis, 46.3% discontinuing a vitamin/mineral, 65.6% using a vitamin/mineral continuously, and only 7.2% not using any vitamin/mineral supplement before or after diagnosis. The most commonly initiated supplements were calcium (38.2%), vitamin D (32.01%), vitamin B6 (12.3%) and magnesium (11.31%); the most commonly discontinued supplements were multivitamins (17.14%), vitamin C (15.97%) and vitamin E (45.62%). Higher education, higher intake of fruits/vegetables, and receipt of chemotherapy were associated with initiation (p-values <0.05). Younger age and breast-conserving surgery were associated with discontinuation (p-values <0.05). Conclusions In this large cohort of ethnically diverse breast cancer patients, high numbers of women used vitamin/mineral supplements in the 6 months following breast cancer diagnosis, often at high doses and in combination with other supplements. The immediate period after diagnosis is a critical time for clinicians to counsel women on supplement use. PMID:24884705



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-naïve, but skilled in laparoscopy. The laparoscopic group underwent an initial 7-day mentorship period. Surgical proficiency was measured by various operative and pathological outcome variables. Data were evaluated using comparative statistics and multivariate analysis. Results: A total of 420 and 549 RARPs were performed by the robotics and laparoscopic groups, respectively. Operative times were longer in the laparoscopic group (p = 0.002), but estimated blood loss was similar. The robotics group had a significantly better overall positive surgical margin rate of 19.9% compared to the laparoscopic group (27.8%) (p = 0.005). Both groups showed improvements in operative and pathological parameters as they accrued experience, and achieved similar results towards the end of the study. Conclusions: Robot-naïve laparoscopic surgeons may achieve similar outcomes to robotic surgeons relatively early after a graduated mentorship period. This study may apply to a community-based practice in which multiple urologists with varied training backgrounds are granted robot privileges. PMID:24282463

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



Tumor markers and rectal cancer: support for an inflammation-related pathway  

PubMed Central

Inflammation may be a key element in the etiology of colorectal cancer (CRC). In this study we examine associations between factors related to inflammation and specific rectal cancer mutations. A population-based study of 750 rectal cancer cases with interview and tumor DNA were compared to 1205 population-based controls. Study participants were from Utah and the Northern California Kaiser Permanente Medical Care Program. Tumor DNA was analyzed for TP53 and KRAS2 mutations and CpG Island methylator phenotype (CIMP). We assessed how these tumor markers were associated with use of anti-inflammatory drugs, polymorphisms in the IL6 genes (rs1800795 and rs1800796), and dietary antioxidants. Ibuprofen-type drugs, IL6 polymorphisms (rs1800796), and dietary alpha tocopherol and lycopene significantly altered likelihood of having a TP53 mutation. This was especially true for TP53 transversion mutations and dietary antioxidants (OR for beta carotene 0.51 95% CI 0.27,0.97, p trend 0.03; alpha tocopherol 0.41 95% CI 0.20,0.84, p trend 0.02) Beta carotene and ibuprofen significantly altered risk of KRAS2 tumors. The associations between lutein and tocopherol and TP53 and KRAS2 mutations were modified by IL6 genotype. These results suggest that inflammation-related factors may have unique associations with various rectal tumor markers. Many factors involved in an inflammation related pathway were associated with TP53 mutations and some dietary factors appeared to be modified by IL6 genotype. PMID:19452524

Slattery, Martha L.; Wolff, Roger K.; Herrick, Jennifer; Caan, Bette J.; Samowitz, Wade



Combined analysis of O6-methylguanine-DNA methyltransferase protein expression and promoter methylation provides optimized prognostication of glioblastoma outcome  

PubMed Central

Background Promoter methylation of the DNA repair gene, O-6-methylguanine-DNA methyltransferase (MGMT), is associated with improved treatment outcome for newly diagnosed glioblastoma (GBM) treated with standard chemoradiation. To determine the prognostic significance of MGMT protein expression as assessed by immunohistochemistry (IHC) and its relationship with methylation, we analyzed MGMT expression and promoter methylation with survival in a retrospective patient cohort. Methods We identified 418 patients with newly diagnosed GBM at University of California Los Angeles Kaiser Permanente Los Angeles, nearly all of whom received chemoradiation, and determined MGMT expression by IHC, and MGMT promoter methylation by methylation-specific PCR (MSP) and bisulfite sequencing (BiSEQ) of 24 neighboring CpG sites. Results With use of the median percentage of cells staining by IHC as the threshold, patients with <30% staining had progression-free survival (PFS) of 10.9 months and overall survival (OS) of 20.5 months, compared with PFS of 7.8 months (P < .0001) and OS of 16.7 months (P < .0001) among patients with ?30% staining. Inter- and intrareader correlation of IHC staining was high. Promoter methylation status by MSP was correlated with IHC staining. However, low IHC staining was frequently observed in the absence of promoter methylation. Increased methylation density determined by BiSEQ correlated with both decreased IHC staining and increased survival, providing a practical semiquantitative alternative to MSP. On the basis of multivariate analysis validated by bootstrap analysis, patients with tandem promoter methylation and low expression demonstrated improved OS and PFS, compared with the other combinations. Conclusions Optimal assessment of MGMT status as a prognostic biomarker for patients with newly diagnosed GBM treated with chemoradiation requires determination of both promoter methylation and IHC protein expression. PMID:23328811

Lalezari, Shadi; Chou, Arthur P.; Tran, Anh; Solis, Orestes E.; Khanlou, Negar; Chen, Weidong; Li, Sichen; Carrillo, Jose A.; Chowdhury, Reshmi; Selfridge, Julia; Sanchez, Desiree E.; Wilson, Ryan W.; Zurayk, Mira; Lalezari, Jonathan; Lou, Jerry J.; Ormiston, Laurel; Ancheta, Karen; Hanna, Robert; Miller, Paul; Piccioni, David; Ellingson, Benjamin M.; Buchanan, Colin; Mischel, Paul S.; Nghiemphu, Phioanh L.; Green, Richard; Wang, He-Jing; Pope, Whitney B.; Liau, Linda M.; Elashoff, Robert M.; Cloughesy, Timothy F.; Yong, William H.; Lai, Albert



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

PubMed Central

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

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



A economia brasileira 1930-1964  

Microsoft Academic Search

Este capítulo abarca um longo período entre marcado por três golpes de estado. O primeiro golpe, em 1930, determinou o fim da República Velha e o início de um período de quinze anos de preeminência política de Getúlio Vargas, primeiro como chefe do Governo Provisório, depois como presidente eleito indiretamente de acordo com as regras da Constituição de 1934 e,

Marcelo de Paiva Abreu




Microsoft Academic Search

O presente estudo tem por objetivo verificar como as correntes artísticas responderam ao estabelecimento da ditadura militar no Brasil. Nosso objeto é a produção artística engajada do primeiro período de regime militar, de 1964 a 1968 (do golpe ao AI- 5). É necessário determinar o nível de engajamento de diferentes grupos artísticos e como os suportes foram utilizados para esta

Rodrigo Medina Zagni



Microsoft Academic Search

Resumo : Ao utilizar o cinema como fonte histórica, precisamos enfocar também aquilo que não é filme: o autor, a produção, o público, a crítica. Neste sentido este artigo analisa a repercussão do filme Lamarca (1994) no jornal Folha de S. Paulo . Encontramos questões como, por exemplo, a polícia militar de São Paulo fazendo um outro filme para contrapor

Marco Alexandre de AGUIAR



Diferenciación en la prestación de servicios de Medicina Prepagada y Plan Obligatorio de Salud POS. (Caso de estudio)  

Microsoft Academic Search

El Sistema Nacional de Salud, que regulaba la atención y coberturas en salud en todo el territorio nacional, se había estructurado como un modelo de operación determinado por el Estado colombiano, unía todas las modalidades de servicios de salud existentes prestados por instituciones tan variadas como empresas privadas, las cuales constituían su propio servicio para sus empleados; ejemplo: cajas de

Julio Hernando Lozano; Alexandra Lozano Marmolejo; Demóstenes Lozano Gubbay



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

Microsoft Academic Search

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

Dalia Plata de Plata



Microsoft Academic Search

Resumo Propondo-se o concreto como alternativa construtiva de estruturas destinadas a guarda e conservação de alimentos como parte da solução das questões relacionadas à preservação e viabilidade do crescimento da população mundial, não obstante dos conceitos de uma engenharia sustentável, onde a durabilidade torna-se sine qua non e, por meio dos métodos de dosagem desenvolvidos pelos pesquisadores do LMABC (Laboratório

Sandra Maria de Lima; Jefferson Benedicto; Libardi Libório



Chemical and structural evaluation of moringa seeds  

Microsoft Academic Search

Resumo - A moringa (Moringa oleifera Lam.) é uma planta que vem sendo utilizada como agente clarificante no tratamento de água em substituição aos sais de alumínio. Este trabalho teve como objetivo determinar a composi- ção química e a morfologia das sementes da Moringa oleifera. As análises químicas revelaram um considerável teor de proteína e lipídio nas sementes. Os cotilédones

Maria Izabel Gallão; Leandro Fernandes Damasceno; Edy Sousa de Brito



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

El XMRV es un retrovirus del que se informó por primera vez en 2006 como una causa potencial del cáncer de próstata. Está estrechamente relacionado con los virus de leucemia murina, los cuales causan una amplia variedad de cánceres así como enfermedades inmunológicas y neurológicas en ratones.



Microsoft Academic Search

RESUMEN El uso de dispositivos intrauterinos con levonorgestrel (DIU-LNG) además de su efecto anticoncepti- vo, disminuye significativamente el sangrado uterino. Esto hace que los DIU-LNG expresen beneficios tales como el control del sangrado uterino, especialmente en metrorragias o menometrorragias por enfermedades orgánicas como miomatosis uterina. Sin embargo, en nuestro medio existen dudas sobre los beneficios reales de estos métodos y




E-print Network

ha constituido como un instrumento populista que en la práctica no ha generado canales reales de considerada como un derecho. Entre otros, el caso de Nicaragua es notable, donde la participación ciudadana3 y definiciones generales, art.4, Definiciones básicas. Ley de Participación Ciudadana, República de Nicaragua. 4

Paris-Sud XI, Université de


The chemistry of flower rewards -- Oncidium (Orchidaceae)  

Microsoft Academic Search

A maioria dos estudos sobre polinização focalizam as interações que envolvem recompensas como néctar e pólen. Nosso grupo de pesquisa, entretanto tem se dedicado à química de recompensas florais como resinas e óleos florais. Neste trabalho, estamos relatando a composição química dos óleos florais de Oncidium pubes que contêm di e triacilglicerois nos quais o glicerol está esterificado com um

Mariza G. Reis; Aparecida D. de Faria; Volker Bittrich; Maria do Carmo; Anita J. Marsaioli



Nota de prensa CSIC c o m u n i c a c i n  

E-print Network

mecanismo de virus como el �bola y el dengue Un trabajo del CSIC muestra que la transparencia de estos Las infecciones hemorr�gicas virales est�n distribuidas por todo el mundo, con ejemplos como el �bola


Instituto de Ciencia de Materiales de Madrid  

E-print Network

como ondas en lugar de como pequeñas bolas... ¿Cómo?: Aquí las leyes de Newton y del electromagnetismo 446, 60 (2007) Cada pequeña bola en la imagen corresponde a un átomo visto con


Universidades regionales y la sociedad de aprendizaje: funciones e influencia en las políticas y prácticas educativas  

Microsoft Academic Search

Las funciones de las universidades regionales no se deben infravalorar en cuanto a su influencia (económica, política, social y cultural) dentro de cada región. Este estudio analiza una universidad regional y se sirve de esa institución como ejemplo para ilustrar tanto la influencia de la universidad en la región, como el impacto que la universidad regional ha podido ejercer en

Margarita Pavlova; Mark Gurevich




Microsoft Academic Search

ReSUmO: Os gêneros textuais, como ações vivas de linguagem e, constantemente, mutáveis realizadas por sujeitos sociais, constituem-se de número e aspecto ilimitado mediante as infindáveis situações, funções e facetas do agir humano. Atrelados a objetivos da lingüística em refletir sobre o uso da linguagem como ferramenta para o desenvolvimento humano (DOLZ & SCHNEUWLY, 2004), propomos com esse trabalho apresentar reflexões

Maria Ilza ZIRONDI



Microsoft Academic Search

A madeira sempre foi utilizada estruturalmente na construção civil na forma sólida, com baixo grau de processamento e inovação tecnológica e, muitas vezes, em outros componentes como em pisos, paredes e telhados. Entretanto, a mudança nos padrões adotados envolveu o aperfeiçoamento da tecnologia, bem como a mudança do conceito estético e funcional requerido nas construções. Dessa forma, surgiram as vigas

Alexsandro Bayestorff da Cunha; Jorge Luis; Monteiro de Matos




Microsoft Academic Search

La labor docente más que una profesión que se enseña en instituciones educativas, -donde muchas veces los propios profesionales que fungen como docentes- no fueron preparados para desempeñar el rol, la docencia debe ser más un principio que brote desde la verdadera vocación, fidelidad y convicción de la labor como tal. Actualmente, un profesional egresado, ejerce el rol de docente

Idana Berosca Rincón Soto




Microsoft Academic Search

O turismo, diferente de outras áreas, constitui-se de um ramo de atividades executadas por pessoas que, em determinadas situações, tornam-se turistas. Como a área de estudo, o turismo é recente e vem sendo matéria de pesquisa em diversos campos com mais tradição como a sociologia, a economia, a geografia, a psicologia, dentre outras. Principalmente pelo fato de ser um campo

José Gustavo Ferreira Candelária




Microsoft Academic Search

Analizamos la evolución del turismo hotelero en el período 2001-2008, en las regiones y provincias españolas, utilizando las estadísticas de pernoctaciones hoteleras como indicador. Presentamos una síntesis de resultados de varios modelos econométricos del turismo regional en España, tanto en lo que respecta a los factores que influyen en el desarrollo turístico como al impacto que el turismo tiene en

M. C. Guisan; E. Aguayo




Microsoft Academic Search

A cidade de Maceió em Alagoas constitui uma cidade litorânea da Região Nordeste do Brasil dotada de beleza natural tais como praias e lagoas, as quais constituem atrativos para o turismo tanto nacional como internacional. Todavia, nesta o crescimento do setor turístico tem sido afetado pela poluição dos recursos ambientais, mais especificamente o despejo do esgoto em praias e lagoas.

Eliane Aparecida Pereira De Abreu; Agnaldo Gomes da Silva; Gilberto Gomes Da Silva Junior; Rebecca Suzannah Nascimento De Melo



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 producción básicos, sino por la adaptación y asimilación de nuevos elementos constitutivos de los factores como son los correspondientes al capital y a la mano de obra, en lo pertinente a la formación, preparación, calificación y especialización, así como a la asimilación de tecnologías pertinentes

Jose Zacarias Mayorga Sanchez; Clemencia Martinez Aldana




Microsoft Academic Search

Esta investigación tiene como objetivo conocer los factores que influyen en la toma de decisiones de financiamiento a largo plazo en la industria metalmecánica del Valle del Cauca (Colombia), hasta ahora no explorados. Se realiza un estudio para el periodo 2000-2006, utilizando como método, el análisis de la estructura financiera y la aplicación de un modelo econométrico de Datos de




Derechos humanos, universalismo, universalidad y particularismos culturales  

Microsoft Academic Search

La mundialización factual como consecuencia de la revolución de las técnicas de comunicación. Congruencia directa entre el sujeto humano individual y la humanidad global (los medias: instantaneidad mundial de la información perceptible por cada individuo miembro de la humanidad; internet: de individuo a individuo directamente a escala mundial). La globalización como respuesta a una percepción planetaria de las amenazas contra

Jean-Luc Chabot



La evaluación del desempeño de las empresas privatizadas en Colombia: ¿Coincide con la experiencia internacional?  

Microsoft Academic Search

Este estudio pretende evaluar si las empresas que fueron privatizadas en Colombia durante los años 1990 mejoraron sustancialmente su productividad y rentabilidad, como consecuencia de los cambios gerenciales que se debieron dar, o si por el contrario, continuaron en niveles similares, contrariando la hipótesis de que los nuevos dueños propiciarían cambios sustanciales en su estrategia, como lo demuestra la experiencia

Héctor Ochoa Díaz; Jaime Andrés Collazos Rodríguez



Lecciones de la investigación económica sobre el rol del sector privado en educación  

Microsoft Academic Search

El artículo presenta los elementos conceptuales necesarios para comprender el rol económico del estado y del sector privado en educación. Posteriormente describe las ventajas y defectos de la gestión de establecimientos educacionales tanto por parte de agentes privados como de agentes públicos, así como los beneficios y problemas de la competencia y el financiamiento público vía \\

Pablo González




Microsoft Academic Search

El precio internacional del café, como el de la mayoría de los productos primarios se ha caracterizado por la inestabilidad y las grandes fluctuaciones. La formación del precio del café verde es un proceso complejo que depende de una multiplicidad de variables, como la calidad y disponibilidad del producto, el lugar de origen, el sitio de compra, las expectativas de

Franz Alonso Hamann S



Gestión por competencias: importante para las pymes maquila de pantalón en índigo en la ciudad de Bogotá  

Microsoft Academic Search

Este artículo presenta una revisión de literatura internacional y nacional, sobre temas como el de competencias, los tipos de competencias, competencias laborales y proceso de implementación de la gestión por competencias. Adicionalmente, se muestra la reseña sobre la gestión por competencias en Colombia, así como la metodología utilizada para el trabajo de campo con relación al tema del artículo y

Nathalia Andrea Martínez Valero; Juan Carlos Rincón Gaviria




Microsoft Academic Search

El presente estudio aborda la problemática a las que se enfrentan los micros y pequeños empresarios del ramo textil en la zona comercial e industrial de Moroleón y Uriangato, que tan competitivos son con otros fabricantes nacionales, así como la afectación que tienen con la competencia de productos importados, así como de productos de dudosa procedencia (importación ilegal o robados)

Crescenciano Tinoco Tinoco; Eugenio Guzman Soria



Contribuies e limites do conceito de campo sindical: uma reflexo a partir do caso Sophie Broud1  

E-print Network

, que seria dotado de l�gicas, modos de funcionamento, quest�es e refer�ncias pr�prias. As organiza", bem como pela exist�ncia de dom�nios de pr�ticas pr�prias, ligadas � dimens�o mais institucional do l�gicas pr�prias que hoje atravessam o sindicalismo. Como observou Bernard Lahire, "nem todo

Boyer, Edmond


Dez anos de viagens a “terras” estrangeiras: miradas de um geógrafo sobre as histórias que os cientistas sociais nos contam de si próprios  

Microsoft Academic Search

Uma incursão pelas histórias disciplinares das ciências sociais, tendo como base as histórias que geógrafos, antropólogos, sociólogos e historiadores nos contam de si próprios, é o que se desenvolve neste trabalho. Essas histórias disciplinares, normalmente editadas pelos vieses corporativos, são aqui reunidas, cotejadas e avaliadas, com o intuito de revelar os interesses e origens comuns, bem como os personagens compartilhados

Marcos Bernardino de Carvalho



Utopia e Ficção Científica: a \\  

Microsoft Academic Search

Minha geração, cuja infância e adolescência transcorreram nas décadas de 1960 e 1970, assistiu na TV e no cinema muita ficção científica. De certo modo, minhas expectativas sobre o futuro foram moldadas por séries como Jornada nas Estrelas e filmes como Guerra nas Estrelas. As narrativas de ficção científica proliferaram ao nosso redor. E nelas, ingenuamente, eu procurei respostas para

Marcos Lobato Martins


The representation of the «other-woman» in the screens: filmic contents in television and co-education  

Microsoft Academic Search

RESUMEN La importancia de los Medios Audiovisuales en la educación de sus espectadores, entendida ésta como la influyente contribución que las representaciones del mundo de los primeros hacen a la construcción de las cosmovisiones e identidades de los segundos, es indudable en las sociedades actuales. Los omnipresentes «Mass Media» representan «la realidad», funcionando como fuentes de interpretaciones de todo lo

Jorge Belmonte Arocha; Silvia Guillamón Carrasco


Contadores eletronicos no laboratorio didatico. Parte I. Montagem e aplicacoes (Electronic counter in undergraduate laboratories. Part I. Assembly and applications)  

Microsoft Academic Search

Mostramos, inicialmente, como montar um contador eletronico digital de 4 d´ igitos, utilizando componentes de baixo custo e facilmente encontrados no comercio especializado. Em seguida, mostramos, tambem, como um contador em associacao com um cristal oscilador de 1 MHz pode ser utilizado para medir com precisao intervalos de tempo na faixa de microssegundos, decimos de milissegundos e milissegundos. Exemplos de

R. Hessel; C. S. de Oliveira; G. A. Santarine; D. R. Vollet


Estão os Portugueses a ?votar com os pés?? Alguma evidência empírica  

Microsoft Academic Search

Como é sabido, os movimentos migratórios à escala regional são fruto de uma diversidade de factores. Sendo entendidos como uma reacção, por parte da população, a desvantagens (inaceitáveis) de natureza económica apresentadas pela região de origem, estes movimentos demográficos constituem um importante exemplo da chamada ?votação com os pés?. Claramente, a inexistência (ou a mera ineficácia) de políticas regionais que

António Caleiro



Compartiendo el paisaje En Belice existen cinco especies de gato silvestre, los  

E-print Network

principalmente en bosques y humedales en donde cazan diferentes animales; tales como gibnut (tepezcuintle hogar y cazan diferentes animales, particularmente aquellos de mayor tamaño como venados y pecaríes animales de mayor tamaño. Los pumas son felinos grandes con cabezas menos anchas que de los jaguares. Las

Mazzotti, Frank


United States Department of the Interior , Oscar L. Chapman, Secretary Fish and Wildli fe Service, Albert M. D~, Director  

E-print Network

del hombre consiste tanto de productoa vegetales como animales y au r~girnen alimenticio var!a de nuestros animales proviene del mundo vegetal, aunque un animal carn!voro, como por ejemplo el perro, consume carne crucla. Los son animales a la vez omn!varos y carn!voros. Algunas especies tienen


La Pennsula Ibrica, otro probable lugardedomesticacindeloscaballos  

E-print Network

Después de animales como pe- rros, ovejas, cabras y cerdos, le llegó al turno a los caballos. De embocados para montarlos o para utilizarlos como animales de tiro. A pesar de esa idea ya acep- tada también

Tradacete, Pedro


Sazonalidade dos ductos secretores e óleo essencial de Foeniculum vulgare var. vulgare Mill. (Apiaceae)  

Microsoft Academic Search

RESUMO: Este trabalho teve como objetivo analisar os ductos secretores e o óleo essencial das folhas de Foeniculum vulgare em diferentes épocas do ano. Para esta fi nalidade, foram realizados estudos de caracterização anatômica, bem como anatomia comparada dos ductos secretores e testes histoquímicos das folhas. O óleo essencial foi obtido de folhas e frutos, por hidrodestilação em aparelho de

L. A. Sousa; J. C. R. Albuquerque; M. N. Leite; M. B. Stefanini



Social BPM definito come lo sforzo di eseguire processi di  

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Politecnico di Milano Polo Territoriale di Como via Natta 14, 22100 Como PARTNER INTERNAZIONALI OMG Progetto BPM4People Future Strategies Inc. PARTNER ITALIANI Università di Trento COMITATO SCIENTIFICO Marco Claudio Bartolini, IT Marco Brambilla, ITALY Piero Fraternali, ITALY Fabio Casati, Italy Florian Daniel



Microsoft Academic Search

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





Microsoft Academic Search

RESUMO: por que os meninos são mais indicados do que as meninas como alunos com necessidades educacionais especiais por seus professores (proporção de 2\\/3 contra 1\\/3)? Este estudo teve por objetivo comparar a descrição de professores de meninos e meninas identificados por eles como alunos com necessidades educacionais especiais. Os dados foram coletados a partir da coleção de 351 cadastros

Enicéia Gonçalves MENDES; Gerusa Ferreira LOURENÇO




Microsoft Academic Search

Introdução Considerando que a percepção dos papéis sexuais faz parte do processo de socialização da criança e que esta acaba assumindo crenças, habilidades, comportamentos e atitudes de acordo com o seu sexo, este estudo teve como objetivo investigar em que medida os estereótipos de papéis sexuais estão afetando as crianças e como elas estão reagindo aos mesmos. Buscou-se ainda verificar

Fabiana Cristina de Souza


Los procesos territoriales del Occidente de México, 1823-1917  

Microsoft Academic Search

El territorio mexicano y particularmente el del occidente, durante el periodo 1823-1917 registró grandes transformaciones en la configuración de sus unidades geopolíticas, tanto en el nivel de las entidades federativas como al interior de ellas; lo cual se interpreta como el resultado de intereses y luchas regionales que se han venido manifestando en la modificación y cambios de ciertas unidades

Hirineo Martínez Barragán




Microsoft Academic Search

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

Mario E. Ibarra Cortés; Erika García Méndez




Microsoft Academic Search

En prácticamente todos los países de la región las nuevas leyes de aguas que se formulan luego de más de 30 a 40 años de promulgadas, algunas ya aprobadas como la de México, Brasil, Venezuela y Perú y otras en debate como la del Ecuador, tienen sendos artículos que establecen la creación de organizaciones de gestión de recursos hídricos por

Axel C. Dourojeanni




Microsoft Academic Search

Este trabajo pone en el centro de la discusión al turismo como actividad económica en la ciudad de Zacatecas de igual manera busca integrar a los actores fundamentales a la planeación estratégica de esta área tan importante para el desarrollo del Estado. Como lo manifiesta el propio Gobierno del Estado en su plan Estatal de Desarrollo (GODEZAC, 2005, 40-41) se

Guadalupe Margarita González Hernández; Leonel Álvarez Yáñez; Jesús Becerra Villegas




Microsoft Academic Search

En este documento el lector tiene la oportunidad de conocer el desarrollo de las políticas públicas de los derechos humanos en México, así como las diferentes etapas que se han venido elaborando desde hace más de 20 años. El gobierno ha modificado y adaptado las demandas internas y del exterior entorno al tema. Como resultado de esas presiones hoy existen

José Manuel Velázquez Gutiérrez



Importancia de la conectividad en el analisis de ensayos de bombeo en medios heterogeneos  

E-print Network

y como se mide la conectividad? ...'Connectividad'... estructuras conectadas espacialmente que 3 / 21 #12;�Que es y como se mide la conectividad? ...'Connectividad'... estructuras conectadas'... estructuras conectadas espacialmente que favorecen el flujo y reducen el tiempo de llegada de un soluto

Politècnica de Catalunya, Universitat


Representacin del Conocimiento para la Composicin Musical  

E-print Network

Meta-modelo EV como herramienta genérica para representar estructuras basadas en el tiempo de forma definitiva se trata de disponer una serie de elementos formando estructuras superiores, y con éstas ordenar. Podemos observar el proceso de composición musical como una construcción arquitectónica de estructuras

Miranda, Eduardo Reck


Bioethical reflections on sexuality and human reproduction  

Microsoft Academic Search

El control de natalidad ofrecido por los contraceptivos modernos, asociados a una mayor presencia de la mujer como ser autónomo, ha dejado claro a la sociedad que tener en cuenta determinadas decisiones relativas a la sexualidad como naturalmente buena o mala, ya no concierne a la moralidad emergente. Ellos han comenzado a reconocer que el comportamiento ético en las prácticas

José Eduardo de Siquiera



Movimentos sociais, sindicato e imigrao Um estudo sobre o movimento dos trabalhadores sem-documentos na  

E-print Network

9 Movimentos sociais, sindicato e imigração Um estudo sobre o movimento dos trabalhadores sem] Resumo: Este artigo tem como objeto o recente movimento dos trabalhadores sem- documentos que ocorreu na experiência de greve, que teve como protagonistas cerca de vinte trabalhadores sem-documentos apoiados pela

Paris-Sud XI, Université de


Turismo y territorio en México. Alternativas en el Altiplano Potosino  

Microsoft Academic Search

En México, el turismo se perfila como la actividad que genera mayores ingresos económicos después del petróleo y las remesas. No obstante, en los últimos años se ha desgastado la imagen de algunos centros litorales más conocidos como Acapulco y Cancún. La necesidad de reducir los efectos ambientales y sociales motivados por el consumo intensivo de escasos espacios geográficos para

Valente Vázquez Solís; Paz Benito del Pozo



Los soles truncos en el Teatro Tapia  

E-print Network

de sus sueños irrealizables. Gilda Galán, como Inés, la hermana fea, es la única que se enfrenta con el mundo de afuera. Iris Martínez, como Emilia la soñadora, vivifica sus sueños en el mundo de un pasado imaginario o de su poesía conservada en el...

Frankenthaler, Marilyn R.



Utility of Dynamic-Landscape Metapopulation Models for Sustainable Forest Management  

E-print Network

´acticas de manejo de bosques. Como estudio de caso utilizamos a Certhia americana en bosques boreales del norte de Ontario. Seleccionamos a Certhia americana como un indicador potencial de sustentabilidad of forest management practices. We used the Brown Creeper (Certhia amer- icana) in the boreal forests

Burgman, Mark



Microsoft Academic Search

Tendo em vista os recentes avanços da ciência, sobretudo na área de manipulação genética, a questão da clonagem humana surge como um dos grandes desafios a ser encarado. Nesse trabalho buscamos fazer uma análise não só jurídica, mas também técnica, ética e moral do tema, tendo como ponto de partida um estudo sobre a Bioética, passando pelo surgimento do Biodireito

Bernardo Abreu de Medeiros


Costos generados por la violencia armada en Colombia: 1993-2003  

Microsoft Academic Search

Este documento incluye un ejercicio de valoración de los costos tanto directos como indirectos que la violencia armada ha impuesto a la economía nacional entre los años 1999 y 2003. Entre los costos considerados se cuentan aquellos generados por el daño a infraestructura energética, vial y aeroportuaria, por fenómenos como el secuestro, al extorsión, el narcotráfico, el desplazamiento forzado, el




La relación entre corrupción y narcotráfico: un análisis general y algunas referencias a Colombia  

Microsoft Academic Search

La relación entre corrupción y el desarrollo de la industria de drogas ilegales y del narcotráfico en un país es circular. La corrupción es simultáneamente causa y efecto de dichos desarrollos. tanto la corrupción como el narcotráfico muchas veces son resultado de porcesos de deslegitimación del régimen político y de deterioro de las instituciones sociales tanto civiles como oficiales y

Francisco Thoumi



PUBLIC HEALTH AND ENVIRONMENTAL POLLUTION: PRECAUTIONARY PARADIGMS Saúde pública e poluição ambiental: paradigmas precautórios  

Microsoft Academic Search

RESUMO Objetivos: Apresentar reflexões envolvendo perspectivas ambientais, saúde pública e ações antropogênicas relacionadas ao crescente consumo decorrente do modernismo instaurado no mundo. Síntese de dados: O paradigma precautório surge como constatação e reconhecimento propiciado pelas incertezas científicas e avaliação inadequada dos impactos das atividades humanas que contribuíram para a degradação ambiental e prejudicaram a saúde humana. Tendo como base o

Aldo Pacheco Ferreira



E-print Network

/blogindio/medio-ambiente/staff/turbina-mas-chica-que-un-centa... #12;Relacionado ( como-saludables) Salchichas 'baby poop'... tan extremas como saludables (/blogindio/medio-ambiente/staff/salchichas-baby-poop

Chiao, Jung-Chih



Microsoft Academic Search

RESUMO: O transtorno do Déficit de Atenção\\/Hiperatividade (TDAH) representa umas das principais causas de procura em centros de saúde mental e neurologia de crianças e adolescentes. Pode-se destacar como sendo as principais características de crianças com TDHA a desatenção, a hiperatividade e impulsividade. O presente artigo tem como objetivo demonstrar que a criança com TDAH apresenta um padrão motor e

Adriana Garcia



Microsoft Academic Search

RESUMO: as habilidades sociais vêm sendo amplamente reconhecidas como importante componente do processo de escolarização especialmente dos alunos com deficiência mental. A revisão da literatura evidencia escassez de pesquisas que focalizam a inclusão desses alunos no sistema regular de ensino. Considerando tal situação, este estudo teve como objetivos: avaliar e comparar o desempenho social (habilidades sociais e problemas de comportamento)

Andréa Regina Rosin-PINOLA; Zilda Aparecida; Pereira DEL PRETTE; Almir DEL PRETTE



Microsoft Academic Search

Los cactus del género Opuntia son muy importantes en Méjico especialmente en las areas semi áridas y áridas donde pocos otros cultivos economicos pueden florecer. Historicamente estas plantas han sido utilizadas como alimento, forraje para ganado, en la manufactura de productos medicinales, cosméticos, tintes y como barreras limitrofes naturales. Asimismo, la fruta del cactus (tuna) constituye un importante componente de



Helenistic Encomium: A Reflection on Comics and Rhetoric  

ERIC Educational Resources Information Center

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

Helms, Jason



Nuestro Instituto

Información acerca de nuestra misión como Instituto Nacional del Cáncer, así como sobre los diferentes tipos de investigación que apoya nuestro Instituto, el programa de centros oncológicos, y sobre el Informe Anual a la Nación acerca del cáncer, el cual es preparado por las principales organizaciones oncológicas de los Estados Unidos.


As influências do positivismo e do higienismo nos primórdios da Educação Física Brasileira e na Ginástica Nacional Br asileira (capoeira) The influences of positivism and hygienism in the first stages of Brazilian Physical Education and in Brazilian National Gymnastics (capoeira) Las influencias del positivismo y del higienismo en las primeras etapas de la Educación Física Brasileña y en la Gimnástica Nacional Brasileña (capoeira)  

Microsoft Academic Search

RESUMO: Este trabalho analisa as influências dos pensamentos filosóficos do positivismo e do higienismo nos primórdios da Educação Física e da Capoeira no Brasil. Trata-se do resultado de uma pesquisa histórica baseada em fontes primárias. Os parâmetros metodo- lógicos tiveram como referencial analítico os estudos de documentos encontrados em arquivos públicos, bem como de levantamentos bibliográficos e estudos correlacionais. Tem

Sergio Luiz de Souza


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

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



Múltiples estados de desorden en el etanol sólido  

NASA Astrophysics Data System (ADS)

El diagrama de fases del etanol por debajo de los 169 K será presentado. Se mostrará que el etanol puede solidificarse en tres fases con diversos niveles de desorden,(como un vidrio(G), como un vidrio orientacional (OG) y como un cristal de fase rotora (RP)) además de en una fase totalmente cristalina. Las estructuras de estas tres fases serán presentadas tal y como se deducen a partir de diversas medidas de difracción de neutrones al igual que las proporciones de los isómeros de dicho material en las fases desordenadas y se compararán con los resultados de la fase cristalina y del líquido superenfriado. Igualmente diversas medidas sobre su dinámica serán presentadas, tanto de dispersión de neutrones, como de capacidad calorífica y de medidas dieléctricas y comparadas con modelos teóricos y simulaciones para tratar de explicar los procesos de relajación observados y las transiciones entre las diversas fases.

Fernández-Perea, R.