Science.gov

Sample records for como modificador permanente

  1. Kaiser Permanente Northwest

    Cancer.gov

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

  2. Kaiser Permanente's Convergent Medical Terminology.

    PubMed

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

    2004-01-01

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

  3. TUBERCULOSIS COMO ENFERMEDAD OCUPACIONAL

    PubMed Central

    Mendoza-Ticona, Alberto

    2014-01-01

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

  4. Transformational quality in Kaiser Permanente Northern California.

    PubMed

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

    2015-01-01

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

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

    PubMed

    McCreary, Lew

    2010-09-01

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

  6. Kaiser Permanente National Hand Hygiene Program

    PubMed Central

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

    2004-01-01

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

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

    Cancer.gov

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

  8. Alphabetisation conscientisante comme base d'une education permanente

    NASA Astrophysics Data System (ADS)

    Ndimurukundo, Nicephore

    1994-05-01

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

  9. Kaiser Permanente Vaccine Study Center: Highlights of 2009–2012

    PubMed Central

    Baxter, Roger; Klein, Nicola P.

    2013-01-01

    The Kaiser Permanente Vaccine Study Center is a specialized research organization in Oakland, California. They have been an active vaccine research group for many years, and have participated in and led a multitude of vaccine studies. This article will review the last three years of research activities. PMID:26343963

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

    PubMed

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

    2001-01-01

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

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

    PubMed Central

    Meyers, Kate; Tang, Gayle; Fernandez, Alicia

    2009-01-01

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

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

    PubMed

    Witt, Daniel M

    2008-01-01

    The Clinical Pharmacy Anticoagulation Service (CPAS) at Kaiser Permanente Colorado grew from a single pharmacist assisting a single physician to a comprehensive service staffed by over 20 employees. CPAS provides care for over 7200 patients with each CPAS pharmacist managing all aspects of anticoagulation therapy for 150 to 500 patients. Unique aspects of CPAS include its centralized organization structure, the use of telepharmacy, collaboration drug therapy management agreement with referring physicians and a robust research agenda. Results of various CPAS research projects have been published in the peer-reviewed medical literature. PMID:18804262

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

    USGS Publications Warehouse

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

    1964-01-01

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

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

    SciTech Connect

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

    1996-11-01

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

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

    PubMed Central

    Chien, Gary W; Abbas, Maher A

    2009-01-01

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

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

    PubMed

    Milch, Mario; Brumley, Richard D

    2005-01-01

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

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

    PubMed Central

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

    2007-01-01

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

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

    USGS Publications Warehouse

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

    1989-01-01

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

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

    PubMed Central

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

    2008-01-01

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

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

    PubMed Central

    Collmann, Jeff; Cooper, Ted

    2007-01-01

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

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

    PubMed

    Pearl, Robert

    2014-02-01

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

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

    SciTech Connect

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

    1996-11-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Hinchman, Josephine; Beno, Luke; Mims, Adrienne

    2006-01-01

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

  5. Streamlining Screening to Treatment: The Hepatitis C Cascade of Care at Kaiser Permanente Mid-Atlantic States.

    PubMed

    Jonas, M Cabell; Rodriguez, Carla V; Redd, Jacquelyn; Sloane, Dana A; Winston, Bradley J; Loftus, Bernadette C

    2016-05-15

    Hepatitis C virus (HCV) screening is recommended for patients at risk and/or born during 1945-1965, but screening gaps persist. This new program screens target populations and enhances care linkage for chronically HCV-infected patients. Kaiser Permanente Mid-Atlantic States created a comprehensive HCV screening pathway, supported by a HCV care coordinator. The testing pathway includes HCV antibody (Ab), automatic HCV RNA for Ab-positive patients, coinfection and liver health tests, vibration-controlled transient elastography (VCTE), and a physician referral. A total of 11 200 patients were screened; 3.25% were HCV Ab positive, and 100% of Ab-positive patients received HCV RNA testing. Of HCV Ab-positive patients, 75.9% had chronic HCV, of which 80.8% underwent VCTE. HCV diagnosis was communicated to 94% of patients, and 70.9% had HCV documented in the electronic health record. The pathway shows promise in closing gaps, including improving HCV RNA testing, communicating diagnoses, and assessing liver fibrosis. Improved testing and linkage could increase curative treatment access. PMID:26908812

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    2002-01-01

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

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

    PubMed Central

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

    2011-01-01

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

  9. Health-plan and employer-based wellness programs to reduce diabetes risk: The Kaiser Permanente Northern California NEXT-D Study.

    PubMed

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

    2013-01-01

    Primary prevention of diabetes is increasingly recognized by both health plans and employers as an important strategy to improve the health of insured populations. As a part of the Natural Experiments in Translation for Diabetes (NEXT-D) network, the Kaiser Permanente Northern California (KPNC) Division of Research is assessing the effectiveness of 2 health plan-initiated programs to prevent the onset of diabetes in patients at high risk. The first study evaluates a telephonic health-coaching program that provides counseling on healthful eating, active living, and weight loss to KPNC members. The second evaluation examines a postpartum glucose screening and educational diabetes prevention program for women with gestational diabetes mellitus that KPNC implemented in 2006. Identifying effective approaches to preventing diabetes will be of value to health care systems, policy makers, and public health officials seeking to understand the roles systems and employers can play in preventing chronic illness. PMID:23369768

  10. [A large network of integrated medical care: the example of Kaiser Permanente in California. First-hand report by a physician].

    PubMed

    Aelony, Yossef; Tschopp, Jean-Marie

    2007-02-21

    The Kaiser Permanente (KP) system of integrated medical care is a unique model of medical organization in the USA which achieves the twin goals of economic efficiency and first-rate care. Organizationally, it is quite different from most health maintenance organizations (HMOs). The doctors remain independent, but in an exclusive marriage with the Kaiser Hospitals and the Kaiser insurance, both of which are non-profit. KP cares for over 8 million members. KP ensures continuity of patient care whether at home, as an outpatient, or when hospitalized, and promotes prevention among healthy members. The integration of all services produces very high indices measuring quality of care, as investigated by both the press and official government agencies at a surprising low cost. The system also was found to be more cost-effective than the National Health System in the United Kingdom. PMID:17424800

  11. THE CONCEPT OF LIFELONG INTEGRATED LEARNING "EDUCATION PERMANENTE" AND SOME IMPLICATIONS FOR UNIVERSITY ADULT EDUCATION. INTERNATIONAL CONGRESS OF UNIVERSITY ADULT EDUCATION OCCASIONAL PAPER, 2. (NEW YORK UNIVERSITY, AUG 5-7, 1967).

    ERIC Educational Resources Information Center

    LIVERIGHT, A.A., ED.

    WORKING PAPERS, PRESENTATIONS, AND DISCUSSIONS AT THE 1967 SEMINAR ON "EDUCATION PERMANENTE" CONVENED BY THE INTERNATIONAL CONGRESS OF UNIVERSITY ADULT EDUCATION INCLUDED UNESCO BACKGROUND MATERIAL ON THE CONCEPT OF LIFELONG INTEGRATED LEARNING, THE NEED AND THE PROSPECTS FOR GREATER FLEXIBILITY AND OUTREACH AT THE UNIVERSITY LEVEL, ANALYSES OF…

  12. Como Lo Hago Yo: Myelomeningocele

    PubMed Central

    Lazareff, Jorge

    2014-01-01

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

  13. What do I do with my morbidly obese patient? A detailed case study of bariatric surgery in kaiser permanente southern california.

    PubMed

    Shafipour, Pouya; Der-Sarkissian, Jack K; Hendee, Fadi N; Coleman, Karen J

    2009-01-01

    Unfortunately, many of the traditional methods for weight loss, such as dietary restriction, exercise, meal replacement, psychosocial and behavioral interventions, and medications, have limited effectiveness in long-term weight maintenance and regulation of chronic diseases such as type 2 diabetes. This has led to the development of surgical approaches to weight loss, generally referred to as bariatric surgery. Most bariatric surgery studies have shown excellent weight-loss rates for up to two years after surgery, with patients losing an average of 61 % of their excess weight (losing 100% of excess weight would return patients to their ideal weight). There is also some evidence that most patients maintain some level of weight loss for up to ten years after surgery. The purpose of this article is to provide primary care physicians and other clinicians with some background regarding bariatric surgical procedures and their risks and benefits. We also summarize the bariatric surgery process at Kaiser Permanente Southern California (KPSC), and then provide a detailed case study as an example of how KPSC screens patients referred for surgery, prepares them for the surgery, and cares for them once they have undergone surgery. PMID:20740104

  14. Risk of Cardiovascular Disease Associated with a Restless Legs Syndrome Diagnosis in a Retrospective Cohort Study from Kaiser Permanente Northern California

    PubMed Central

    Van Den Eeden, Stephen K.; Albers, Kathleen B.; Davidson, Julie E.; Kushida, Clete A.; Leimpeter, Amethyst D.; Nelson, Lorene M.; Popat, Rita; Tanner, Caroline M.; Bibeau, Kristen; Quesenberry, Charles P.

    2015-01-01

    Introduction: Recent cross-sectional studies suggest that restless legs syndrome (RLS) may be associated with an increased prevalence of cardiovascular disease (CVD) comorbidity or risk factors. We evaluated whether primary or secondary RLS was associated with an increased risk of incident cardiovascular disease in a retrospective cohort study within Kaiser Permanente Northern California (KPNC). Methods: We identified members of KPNC with primary RLS and secondary RLS between 1999 and 2008 by an algorithm that incorporated longitudinal clinical records related to the diagnosis and treatment of RLS and comorbidities. We then matched each RLS case with up to 50 individuals with no clinical records of RLS by age, sex, race/ethnicity, zip code, and membership duration. For the analyses we excluded any individual with coronary artery disease (CAD: angina, acute myocardial infarction, coronary revascularization procedure, CAD death), CVD (CAD plus stroke), and hypertension at baseline. New cardiovascular events were determined from clinical records. Follow-up ended at an outcome event, disenrollment from KPNC, or death, whichever occurred earliest. There were over 473,358 person-y of follow-up in this cohort analysis with a mean follow-up time of 3.91 y and range from 6 mo to 12 y. Survival analysis techniques, including survival curves and proportional hazard regression models, were used to assess the association between RLS status and CVD. Results: There were 7,621 primary RLS and 4,507 secondary RLS cases identified and included in the study. In general, primary RLS cases were younger and had less comorbidity than secondary RLS cases. During the follow-up period, CVD was diagnosed in 478 primary RLS cohort members, CAD was diagnosed in 310, and hypertension events were identified in 1,466. Diagnosis in secondary RLS cohort members was made during the follow-up period with 451, 338, and 598 CVD, CAD, and hypertension events, respectively. Subjects with primary RLS had a similar risk of incident CVD (hazard ratio (HR) = 0.95; 95% confidence interval (CI) = 0.86–1.04) and CAD (HR = 0.99; 95% CI = 0.89–1.13) to the comparison cohort, with a slight elevation in the risk of hypertension events (HR = 1.19; 95% CI = 1.12–1.25), after multivariable adjustment. Individuals classified as secondary RLS had a significant increased risk of CVD (HR = 1.33; 95% CI = 1.21–1.46), CAD (HR = 1.40; 95% CI = 1.25–1.56), and hypertension (HR = 1.28; 95% CI = 1.18–1.40). Conclusion: Primary restless legs syndrome (RLS) was not associated with new-onset cardiovascular disease (CVD) or coronary artery disease (CAD) but was associated with a slight increased risk of hypertension. In contrast, secondary RLS was associated with an increased risk of CVD, CAD, and hypertension. Citation: Van Den Eeden SK, Albers KB, Davidson JE, Kushida CA, Leimpeter AD, Nelson LM, Popat R, Tanner CM, Bibeau K, Quesenberry CP. Risk of cardiovascular disease associated with a restless legs syndrome diagnosis in a retrospective cohort study from Kaiser Permanente Northern California. SLEEP 2015;38(7):1009–1015. PMID:26083613

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

    PubMed Central

    2011-01-01

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

  16. Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012–2013

    PubMed Central

    Grytdal, Scott P.; Biggs, Christianne; Cameron, Miriam; Schmidt, Mark; Parashar, Umesh D.; Hall, Aron J.

    2016-01-01

    Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0–98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children <5 years of age (outpatient incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person-years). Outpatient incidence rates of rotavirus, sapovirus, and astrovirus were 2.0, 1.6, 0.6 per 1,000 person-years, respectively; community incidence rates for these viruses were 23.4, 22.5, and 8.5 per 1,000 person-years, respectively. This study provides the first age-group specific laboratory-based community and outpatient incidence rates for norovirus AGE in the U.S. Norovirus was the most frequently detected viral enteropathogen across the age spectrum with the highest rates of norovirus disease observed among young children and, to a lesser extent, the elderly. These data provide a better understanding of the norovirus disease burden in the United States, including variations within different age groups, which can help inform the development, targeting, and future impacts of interventions, including vaccines. PMID:27115485

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

    ERIC Educational Resources Information Center

    Kerchner, Charles T.

    2008-01-01

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

  18. Fraction of the CoMoS phases accessible to NO in Co-Mo hydrodesulfurization catalysts.

    PubMed

    Okamoto, Yasuaki; Kawano, Masatoshi; Kubota, Takeshi

    2003-05-01

    It is established by using Co-Mo model sulfide catalysts, XAFS and FTIR that Co atoms constituting CoMoS phases are not oxidized by NO adsorption and that only 55% of the CoMoS phases is susceptible to NO adsorption even at the maximum coordinative unsaturation attainable under usual HDS reaction conditions (623-673 K). PMID:12772915

  19. Como Lo Hago Yo: Mielomeningocele En Bolivia

    PubMed Central

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

    2014-01-01

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

  20. 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

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

    Cancer.gov

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

  2. LA BIOÉTICA COMO QUEHACER FILOSÓFICO

    PubMed Central

    Ferrer, Jorge José

    2009-01-01

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

  3. Sensitivity of Hydrologic Partitioning to Snowpack Dynamics, Como Creek, CO

    NASA Astrophysics Data System (ADS)

    Barnhart, T. B.; Molotch, N. P.; Harpold, A. A.; Knowles, J. F.; Anderson, S. P.

    2014-12-01

    Snowmelt is the primary source of surface water in the western United States and many other regions on Earth. Climate warming is forecast to impact the amount of precipitation that falls as snow and forms the mountain snowpack. Climate change induced alterations to snowpack translate to changes in snowpack magnitude, the timing of snowmelt, and changes in snowmelt rate. We ask how these perturbations may impact how snowmelt is partitioned between evapotranspiration (ET) and runoff (R) at Como Creek, a snowmelt dominated catchment on the Colorado Front Range. Como Creek is a 4.5 km2 headwater catchment spanning 2900-3560 m and is part of the Niwot Ridge Long Term Ecological Research Station and the Boulder Creek Critical Zone Observatory. We use observations of snow water equivalent (SWE), ET, and precipitation (P) from Niwot Ridge, CO, and discharge from Como Creek to explore relationships between snowpack dynamics and snowmelt partitioning. Measurements of ET are collected adjacent to Como Creek at the Niwot Ridge Ameriflux site and are assumed representative of the hydrologic fluxes in Como Creek. Analyses from point data show that years with higher peak SWE/P ratios partition proportionally more snowmelt to ET (pValue: 0.045). For example, water year (WY) 2005 has a peak SWE/P ratio of 0.49 and a growing season ET normalized by WY precipitation (ET/P) ratio of 0.48 while WY 2008 has a peak SWE/P ratio of 0.83 and an ET/P ratio of 0.82. Observations also show that years that experience later peak SWE (DOY=142) partition proportionally less snowmelt into ET (ET/P=0.42) compared to years that experience earlier peak SWE (DOY=86) and partition proportionally more snowmelt to ET (ET/P=0.56). Further point analyses also suggest that more rapid snowmelt results in proportionally less snowmelt partitioned to ET and more partitioned to runoff. To explore the underlying processes responsible for these relationships at the catchment scale we use the Regional Hydro-Ecologic Simulation System (RHESSys) to model how snowmelt is partitioned between ET and R under observed conditions and under a variety of climate change induced snowmelt timing, magnitude, and rate scenarios.

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

    PubMed

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

    2016-01-15

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

  5. Valorisation of Como Historical Cadastral Maps Through Modern Web Geoservices

    NASA Astrophysics Data System (ADS)

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

    2012-07-01

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

  6. 78 FR 36163 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ... FHP covers approximately 5,640 acres of national forest land between Lake Como and Lost Horse Roads... project area lies between Lake Como Road and Lost Horse Road, about three miles northwest of...

  7. Morphological investigation of nanostructured CoMo catalysts

    NASA Astrophysics Data System (ADS)

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

    2008-04-01

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

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

    ERIC Educational Resources Information Center

    Blat, Gimeno J.

    1971-01-01

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

  9. A sup 57 Co Moessbauer emission spectrometric study of some supported CoMo hydrodesulfurization catalysts

    SciTech Connect

    Veen, J.A.R. van; Hendriks, P.A.J.M.; Beens, H. ); Gerkema, E.; Kraan, A.M. van der )

    1992-01-01

    A suite of 11 CoMo/Al{sub 2}O{sub 4} (and one CoMo/SiO{sub 2}) catalysts has been prepared employing four preparation routes, viz. one sequential-impregnation route and three different coimpregnation routes. Speciation of the Co present in the oxidic precursors (octahedral vs tetrahedral Co) and in the activated, sulfided catalysts (CoMoS, Co{sub 9}S{sub 8}, and unsulfided Co) was effected with the aid of {sup 57}Co Moessbauer emission spectroscopy (MES). A linear relation between the thiophene-hydrodesulfurization (HDS) activity and wt% Co-in-CoMoS was observed for each preparation route, but no unique correlation was found to exist. This was traced to the fact that the preparation routes differ in the amount of CoMoS I and CoMoS II they produce in the activated catalyst. Although these two phases differ in specific activity, CoMoS II being twice as active in thiophene HDS as CoMoS I, they cannot be distinguished on the basis of their Moessbauer parameters. It appears that octahedral Co is easier to sulfide than tetrahedral Co, but a substantial fraction of the latter is also found to be capable of entering CoMoS upon sulfidation. The reduced effectiveness of high-loading catalysts is traced to their being prone to CoMoO{sub 4} formation in the calcination step. A rationalization of this behavior is offered.

  10. On the structural differences between alumina-supported CoMoS type I and alumina-, silica, and carbon-supported CoMoS type II phases studied by XAFS, MES, and XPS

    SciTech Connect

    Bouwens, S.M.A.M.; Zon, F.B.M. van; Veen, J.A.R. van; Koningsberger, D.C. ); Dijk, M.P. van ); Kraan, A.M. van der )

    1994-04-01

    In this study the local structure of the Mo and Co promoter atoms in CoMoS type I and II on alumina, and CoMoS type II on various supports is compared using in situ XAFS spectroscopy as the main technique with XPS and MES in a supporting role. In the CoMoS phase the Co atoms are positioned at the edge of the MoS[sub 2] particles, in the same place as the Mo atoms. The CoMoS phase in all catalysts shows a well defined Co-Mo and a Mo-Co coordination. On alumina the CoMoS type II phase is present as a multilayer structure. The silica-supported CoMoS type II closely resembles its alumina-supported counterpart. However, the Mo-S coordination number, the structural ordering and degree of stacking of the carbon-supported type II CoMoS phase is much more similar to the type I CoMoS phase supported on alumina. This contradicts the common opinion that the CoMoS type II phase is fully sulfided and not chemically bonded to the support. Two different types of Co-sites can be distinguished in the suite of catalysts studied in this paper. A Co-site with an approximately fivefold Co-S coordination and possibly a single Co-Mo coordination is predominant in the least active alumina-supported CoMoS type I and CoMoS type II (with Co/Mo = 0.39 at/at) samples. The other Co-site has a sixfold Co-S coordination with possibly a twofold Co-Mo coordination and has the highest activity for HDS. The latter site constitutes a large part of the Co-sites in silica-supported CoMoS phase II and alumina-supported CoMoS type (II) (with Co/Mo = 0.32) and is exclusively present in the carbon-supported CoMoS phase II. 46 refs., 9 figs., 3 tabs.

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

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    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…

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

    NASA Astrophysics Data System (ADS)

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

    2011-12-01

    An outstanding question for snowmelt-dominated watersheds of the western US are the responses of biogeochemical processes to two major drivers of environmental change: directional changes in climate and increasing dissolved inorganic nitrogen (DIN) deposition in wetfall. In the Colorado Front Range, atmospheric deposition of DIN has increased several-fold in the last 25 years. In response, nitrate concentrations at the alpine Green Lakes 4 (GL4) catchment have increased from 1985 to 2009 by 0.27 μeq L-1 yr-1. In contrast, we see no directional change in either nitrate concentrations or fluxes in the subalpine Como Creek catchment. We hypothesize that differences in surface/groundwater interactions result in the differing behavior of stream nitrate between the alpine and subalpine catchments that are receiving similar amounts of DIN from atmospheric deposition. For both basins we sampled precipitation, snowpack, snowmelt, surface water, and subsurface waters. All water samples are analyzed for geochemical, nutrient and isotopic (δ18O, δD) composition. Stream chemistry data from the last ten years at Como Creek show increases in nitrate concentration during baseflow conditions and then a sharp decline during snowmelt. In contrast, in the alpine basin there is sharp increase in surface water nitrate during snowmelt. Hydrograph separation at the alpine GL4 using end member mixing analysis (EMMA) shows that stream flow is a mixture of three components, groundwater, talus, and new snowmelt that each contribute to roughly a third of discharge, with talus flow supplying the majority of nitrate. In contrast, and somewhat surprisingly, EMMA shows that for the subalpine Como Creek basin, annual streamflow is a mixture of only two components, groundwater and new snowmelt. During snowmelt the groundwater and snow contributions are nearly equal and subsurface flows dominate the remainder of the year. Newly installed piezometers at Como Creek provide evidence that the basin is largely a losing reach during snowmelt, with water levels in the piezometers increasing 5-7 m. After peak snowmelt however, Como Creek becomes a gaining stream, with piezometer levels dropping. Thus, both EMMA and piezometers show that surface-groundwater interactions are tightly coupled during snowmelt, with snowmelt at Como first replenishing the subsurface water deficit and increasing groundwater levels before contributing to discharge. Thus, in contrast to the alpine GL4 basin, DIN released in snowmelt is assimilated belowground as snowmelt infiltrates the subsurface in the subalpine basin. Interestingly, at the subalpine Como Creek basin, isotopic and geochemical solute concentrations undergo shifts during periods of winter baseflow prior to snowmelt. In winter much of the stream is frozen and we hypothesize that cryo-concentration of solutes and fractionation of isotopes may influence the concentrations of winter stream samples.

  13. Cúmulos globulares como trazadores de bimodalidad estelar en galaxias cD

    NASA Astrophysics Data System (ADS)

    Forte, J. C.

    Se muestra que tanto la forma de los perfiles de brillo como de color observados en dos galaxias arquetípicas de tipo cD (NGC 1399 y NGC 4486) son compatibles con la presencia de poblaciones estelares bi-modales que comparten la misma distribución espacial y composición química de las familias dominantes de cúmulos globulares asociadas con ellas. El modelo resultante también predice una variación de la frecuencia específica de los cúmulos como función del radio galactocéntrico. Se discute este resultado en el contexto de una variedad de escenarios astrofísicos que intentan describir la formación de galaxias cD.

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

    NASA Astrophysics Data System (ADS)

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

    2005-08-01

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

  15. The Sefwi-Comoé belt Ghana/Ivory Coast : a major crustal shear zone ?

    NASA Astrophysics Data System (ADS)

    Jessell, Mark

    2010-05-01

    The Palaeoproterozoic Sefwi-Comoé region that straddles Ghana and the Ivory Coast in West Africa has been characterised as resulting from a combination of compression and simple shear during late synkinematic leucogranite intrusion. The analysis of regional geophysical datasets allows us to better define the geometry of the major lithostratigraphic packages and their structural contacts in this region. This analysis reveals a series of well defined leucogranites intrusions enveloped by high strain zones. Recent finite element modelling of two-phase aggregates has shown that we can analyse the geometry of these systems both in terms of their finite defomation and their mechanical contrast. We interpret the geometries we see in the Sefwi-Comoé region as reflecting the activity of a major crustal deformation zone which was dominated by simple shear. The comparison with the modelling suggests a finite shear strain of approximately 5 gamma, which in turn implies a lateral displacement of 400 km across the belt. Our analysis suggests that the leucogranites were already acting as more rigid bodies during the (dextral?) shearing, suggesting that their emplacement was predominantly pre-kinematic, and which has implications for their potential subsequent remobilization by gravitational forces.

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

    NASA Astrophysics Data System (ADS)

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

    2013-07-01

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

  17. Application of the Vic Model to Predict Streamflow in the Como Creek Watershed, Colorado Front Range

    NASA Astrophysics Data System (ADS)

    Zhang, Q.; Williams, M. W.; Cowie, R. M.

    2014-12-01

    Mountains are water towers that provide water security to many billions of people. An outstanding question is how climate change may affect surface-groundwater interactions in snow and ice-covered catchments. To address this question, we applied the Variable Infiltration Capacity (VIC) model to the seasonally snow-covered Como Creek watershed to simulate discharge. The results for the years 2005-2008 show that the simulated discharge approximated the measured data in 2008, while the other years have been underestimated. As for the year 2008, sensitivity analysis shows that the correctly simulated discharge depends greatly on soil depth2, depth3 and Ws. For example, a 1% increase in soil depth2, depth3 or Ws leads to 1.3%, 0.8% and 1.3% increases in the Nash-Sutcliffe efficiency (Er). When depth2 and depth3 increased at the same time, Er increased higher than merely depth2 or depth3. The VIC results suggest that 85% of discharge is from groundwater in this snow-covered catchment. End-member mixing analysis using isotopic and geochemical tracers in 2010 showed that groundwater is the main water source for discharge, suggesting that the VIC modeling results are reasonable. The calibration of the VIC model serves as the basis for future projections in discharge after perturbations such as climate change and increases in the magnitude and timing of wildfires.

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

    Leinaweaver, Jessaca

    2013-01-01

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

  20. Ab initio study of energetics and magnetism of sigma phase in Co-Mo and Fe-Mo systems

    NASA Astrophysics Data System (ADS)

    Pavlů, J.; Vřešťál, J.; Šob, M.

    2016-02-01

    We analyse, from first-principles, the energetics and magnetic ordering of sigma phases in Co-Mo and Fe-Mo systems. Total energy differences between the sigma phase and Standard Element Reference (SER) structures are calculated in the whole concentration range at equilibrium volumes by means of the linear muffin-tin orbitals method in the atomic-sphere approximation (LMTO-ASA), the full-potential linearised augmented-plane waves (FLAPW) method and the pseudopotential approach. They are compared with the enthalpy of formation of sigma phase obtained from the phase equilibria calculations at higher temperature based on the semiempirical CALPHAD (CALculation of PHAse Diagram) method. It turns out that the binary sigma phases are more stable than the weighted average of the sigma phase of elemental constituents and that this stability for Fe-Mo is higher than for Co-Mo. On the other hand it was found that the binary sigma phases do not exhibit any stability with respect to the weighted average of the SER structures. The magnetic configurations in all systems are investigated and the stabilizing effect of magnetic order in sigma phase at 0 K is presented. It turns out that the atomic magnetic moment strongly depends on the type of occupied sublattice and total composition of the alloy.

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

    SciTech Connect

    Diaz-Real, R.A.; Mann, R.S.; Sambi, I.S. . Dept. of Chemical Engineering)

    1993-07-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-04-01

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

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

    NASA Astrophysics Data System (ADS)

    Haddab, Mustapha

    1994-05-01

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

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

    NASA Astrophysics Data System (ADS)

    Meunier, Mathieu

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

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

    NASA Astrophysics Data System (ADS)

    Agboton, Sébastien; Moussa, Yaya Mede

    1994-05-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2008-09-01

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

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

    NASA Astrophysics Data System (ADS)

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

    Las fulguraciones solares son fenómenos transitorios de liberación de energía que se desarrollan en las estructuras magnéticas de las regiones activas del Sol. Las fulguraciones pueden llegar a liberar hasta 1032 erg en 100 seg. en todo el rango electromagnético, y acelerar partículas. En este trabajo mostramos que la ubicación de los abrillantamientos en Hα 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 Hα. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2007-02-01

    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.

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

    SciTech Connect

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

    2007-02-02

    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.

  10. Catalytic hydrodesulfurization and hydrodenitrogenation over Co-Mo on TiO sub 2 -ZrO sub 2 -V sub 2 O sub 5

    SciTech Connect

    Wang, Ikai; Chang, Rey-Chein )

    1989-05-01

    Hydrodesulfurization (HDS) of dibenzothiophene and hydrodenitrogenation (HDN) of aniline over Co-Mo on TiO{sub 2}-ZrO{sub 2}-V{sub 2}O{sub 5} catalysts over Co-Mo on {gamma}-Al{sub 2}O{sub 3} catalysts were investigated and compared in a continuous-flow microreactor at 240-350{degree}C and 3.55 MPa. HDS and HDN activities on Ti/Zr/V-supported catalysts depended on the amounts and the order of impregnation of molybdenum and cobalt. It was found that Ti/Zr/V-supported catalysts has higher HDS and HDN activities than alumina-supported catalysts. The optimal amounts of CoO and MoO{sub 3} on TiO{sub 2}-ZrO{sub 2}-V{sub 2}O{sub 5} were much less than on alumina. Moreover, the mutual inhibition of HDS and HDN over Ti/Zr/V-supported catalysts was less pronounced than that over alumina-supported catalysts. The Ti/Zr/V-supported catalyst was also more active than the commercial catalyst, HR-306, in hydrodesulfurization of petroleum feedstocks.

  11. Surface chemistry of model Co-Mo catalysts supported on planar lambda-Al/sub 2/O/sub 3/: Quarterly technical progress report for period September 1, 1987-November 30, 1987

    SciTech Connect

    Sahin, T.; Ford, W.K.

    1987-01-01

    This report describes the progress made during the first year of the investigations on the surface chemistry of model Co-Mo catalysts supported on planar lambda-Al/sub 2/O/sub 3/, the objectives of which are: (1) develop and characterize a planar lambda-Al/sub 2/O/sub 3/ surface and a model Co-Mo catalysts supported on this lambda-Al/sub 2/O/sub 3/; (2) determine the adsorption characteristics of the model reactant molecules (thiophene for HDS, pyridine for HDN and cyclohexene for HYD) on the surface of the model Co-Mo catalysts; and (3) study the kinetics and mechanisms of the HDS, HDN and HYD reactions on the surface of the model Co-Mo catalyst.

  12. Emergency Care of Patients with Acute Ischemic Stroke in the Kaiser Permanente Southern California Integrated Health System

    PubMed Central

    Sauser-Zachrison, Kori; Shen, Ernest; Ajani, Zahra; Neil, William P; Sangha, Navdeep; Gould, Michael K; Sharp, Adam L

    2016-01-01

    Context: Tissue plasminogen activator (tPA) is underutilized for treatment of acute ischemic stroke. Objective: To determine whether the probability of tPA administration for patients with ischemic stroke in an integrated health care system improved from 2009 to 2013, and to identify predictors of tPA administration. Design: Retrospective analysis of all ischemic stroke presentations to 14 Emergency Departments between 2009 and 2013. A generalized linear mixed-effects model identified patient and hospital predictors of tPA. Main Outcome Measures: Primary outcome was tPA administration; secondary outcomes were door-to-imaging and door-to-needle times and tPA-related bleeding complications. Results: Of the 11,630 patients, 3.9% received tPA. The likelihood of tPA administration increased with presentation in 2012 and 2013 (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.26–2.43; and OR = 2.58; 95% CI = 1.90–3.51), female sex (OR = 1.27; 95% CI = 1.04–1.54), and ambulance arrival (OR = 2.17; 95% CI = 1.76–2.67), and decreased with prior stroke (OR = 0.47; 95% CI = 0.25–0.89) and increased age (OR = 0.98; 95% CI = 0.97–0.99). Likelihood varied by Medical Center (pseudo-intraclass correlation coefficient 13.5%). Among tPA-treated patients, median door-to-imaging time was 15 minutes (interquartile range, 9–23 minutes), and door-to-needle time was 73 minutes (interquartile range, 55–103 minutes). The rate of intracranial hemorrhage was 4.2% and 0.9% among tPA- and non-tPA treated patients (p < 0.001). Conclusion: Acute ischemic stroke care improved over time in this integrated health system. Better understanding of differences in hospital performance will have important quality-improvement and policy implications. PMID:27043833

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

    ERIC Educational Resources Information Center

    Lind, Patricia; Germano, Catherine

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

  14. REFLEXIONS SUR LE DEVELOPPEMENT DE L'EDUCATION PERMANENTE (REFLECTIONS ON THE DEVELOPMENT OF CONTINUING EDUCATION) (TEXT IN FRENCH).

    ERIC Educational Resources Information Center

    SCHWARTZ, B.

    THIS ESSAY DEALS MAINLY WITH THE DEVELOPMENT AND THE POTENTIAL OF CONTINUING HIGHER EDUCATION IN FRANCE. THE BASIC TYPES OF ADULT EDUCATION ARE DISTINGUISHED, AND EDUCATIONAL OBJECTIVES, ADULT CHARACTERISTICS, AND VARIOUS LEARNING PROBLEMS OF ADULTS ARE DISCUSSED. EFFORTS BY THE CENTRE UNIVERSITAIRE DE COOPERATION ECONOMIQUE ET SOCIALE TO PROMOTE…

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

    PubMed Central

    Gordon, Nancy; Tang, Anne

    2013-01-01

    Background/Aims Our aim was to learn about the literacy and communication difficulties and preferences of Limited English Proficient Chinese speakers. Methods This was a self-administered waiting room survey of KP Bilingual Chinese module patients. The study sample includes 1672 patients aged 35+ (775 aged 35–59, 897 aged 60+) classified from self-report as Very Limited English Proficient (VLEPs, n = 1242, speaks English not at all or not well) or Limited English Proficient (LEPs, n = 430, speaks English well, but not very well). Results We found: 1) Educational attainment was low overall (approximately 36% had not completed the equivalent of high school, 37% were high school graduates, 15% had some college, and 12% were college graduates), and significantly lower among older patients and within age groups, VLEP versus LEP; (2) 97% of VLEPs and 13% of LEPs do not read English well, 13% of both VLEPs and LEPs do not read Chinese well, and 13% of VLEPs do not read either language well, with older VLEPs having the lowest literacy; (3) 88% of VLEPs and 55% of LEPs usually have trouble understanding letters in English and 43% of VLEPs and 35% of LEPs usually have trouble understanding letters in Chinese; (4) Among VLEPs, 43% preferred print instructions in Chinese, 2% in English, and 55% in both languages; among LEPs: 8% preferred Chinese, 28% English, and 64% both languages; (5) 76% of VLEPs and 42% of LEPs usually have trouble interacting with the KP Call Center on their own; Chinese Call Center agents were desired by 96% of VLEPs and 74% of LEPs; (6) VLEPs are more likely than LEPs to have difficulty understanding instructions (VLEPs: 42% sometimes, 15% usually; LEPs: 25% and 2%) and test results (VLEPs: 41% sometimes, 39% usually; LEPs: 49% and 8%), and more frequently require help from others to understand (VLEPs: 30% sometimes, 60% usually; LEPs 43% and 12%); and (7) VLEPs are less likely than LEPs to use email and Internet, and more likely to need help when doing so. Conclusions Limited English Proficient Chinese patients face many difficulties related to language, literacy, and education in ability to receive and understand health-related communications.

  16. L'Education Permanente en Italie; Motivations Sociologiques et Perspectives Culturelles (Continuing Education in Italy; Sociological Motives and Cultural Perspectives).

    ERIC Educational Resources Information Center

    Bonacina, Franco

    This review of continuing education in Italy begins by examining some of the growing social and economic pressures conducive to educational change. It then outlines recent developments in educational and instructional television; the objectives and postwar legal basis of mass adult education; and provisions in such areas as literacy education,…

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

    PubMed Central

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

    2013-01-01

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

  18. Telescópio de pequeno porte como suporte ao ensino em cidades com intensa poluição luminosa II

    NASA Astrophysics Data System (ADS)

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

    2003-08-01

    Para a maioria dos estudantes, sua passagem pelo ensino formal fundamental envolve a transmissão de fatos que devem ser guardados para um exame, a habilidade para lembrar fórmulas e, eventualmente, a repetição de experimentos que devem produzir resultados exigidos pelo professor. O resultado deste modelo de ensino, ao longo dos anos, é conhecido por todos: desconhecimento e descontentamento, por parte dos estudantes, de temas relativos ao papel e aos processos da ciência. Acreditamos que a Astronomia, pelo seu caráter observacional, é uma das áreas do conhecimento que pode contribuir neste cenário. A Fundação Planetário da Cidade do Rio de Janeiro possui um telescópio Meade LX-200 (25cm) que, juntamente com as câmeras CCD ST-7E e ST8E, tem sido utilizado em projetos voltados aos estudantes do ensino médio desde o ano 2000. Tais projetos envolvem a condução de um projeto de pesquisa observacional num nível apropriado, e possibilitam o contato com técnicas e novas tecnologias: computador, software para manipulação de dados e gráficos, programas de tratamento e redução de dados, uso de equipamentos óptico-eletrônicos (telescópio e CCD), bem como o processo de aquisição de conhecimento. Dentro da proposta dos anos anteriores, priorizamos projetos de uma noite, ou seja, procuramos trabalhar com fenômenos que apresentem variabilidade com intervalo de recorrência relativamente curto. Em todos os casos, optamos pela fotometria diferencial, que tem se mostrado bastante eficiente para o céu luminoso como o da cidade do Rio de Janeiro. Neste painel, apresentamos alguns dos projetos desenvolvidos no último ano, com 25 estudantes. Apresentamos os resultados da observação da variável pulsante AI Vel (V = 6,6) e da variável cataclísmica FO Aqr (V = 13,5), e do monitoramento do trânsito da lua de Júpiter, Europa, ocorrido em 30 de abril de 2003. As curvas de luz produzidas para as primeiras estão concordantes com as da literatura, assim como os respectivos períodos encontrados (1h20min e 4h48min). No caso do FO Aqr, ficou evidente, também, a modulação decorrente da rotação da anã branca receptora (21min). O erro estimado é de 0,01 magnitude. Propomos uma maior utilização de telescópios de pequeno porte, como suporte ao ensino (médio e superior) em cidades com poluição luminosa. Escolas e Planetários seriam ambientes propícios para a localização do telescópio. Os critérios adotados na escolha dos objetos e o método observacional empregado são também apresentados.

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

    PubMed

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

    2014-04-01

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

  20. Congressional Hispanic Caucus: Como Va?

    ERIC Educational Resources Information Center

    Darrow, Denice

    1978-01-01

    The Caucus aims to develop a national policy on behalf of the Spanish-speaking, and to strengthen the Federal commitment toward Hispanics. The Caucus also plans to serve an educational purpose, informing the Hispanic population about the political process and functioning of government. (NQ)

  1. From management to negotiation: technical and institutional innovations for integrated water resource management in the Upper Comoé River Basin, Burkina Faso.

    PubMed

    Roncoli, Carla; Kirshen, Paul; Etkin, Derek; Sanon, Moussa; Somé, Léopold; Dembélé, Youssouf; Sanfo, Bienvenue J; Zoungrana, Jacqueline; Hoogenboom, Gerrit

    2009-10-01

    This study focuses on the potential role of technical and institutional innovations for improving water management in a multi-user context in Burkina Faso. We focus on a system centered on three reservoirs that capture the waters of the Upper Comoé River Basin and servicing a diversity of users, including a sugar manufacturing company, a urban water supply utility, a farmer cooperative, and other downstream users. Due to variable and declining rainfall and expanding users' needs, drastic fluctuations in water supply and demand occur during each dry season. A decision support tool was developed through participatory research to enable users to assess the impact of alternative release and diversion schedules on deficits faced by each user. The tool is meant to be applied in the context of consultative planning by a local user committee that has been created by a new national integrated water management policy. We contend that both solid science and good governance are instrumental in realizing efficient and equitable water management and adaptation to climate variability and change. But, while modeling tools and negotiation platforms may assist users in managing climate risk, they also introduce additional uncertainties into the deliberative process. It is therefore imperative to understand how these technological and institutional innovations frame water use issues and decisions to ensure that such framing is consistent with the goals of integrated water resource management. PMID:19707708

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

    PubMed

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

    2015-12-16

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

  3. Tailoring (n,m) structure of single-walled carbon nanotubes by modifying reaction conditions and the nature of the support of CoMo catalysts.

    PubMed

    Lolli, Giulio; Zhang, Liang; Balzano, Leandro; Sakulchaicharoen, Nataphan; Tan, Yongqiang; Resasco, Daniel E

    2006-02-01

    The (n,m) population distribution of single-walled carbon nanotubes obtained on supported CoMo catalysts has been determined by photoluminescence and optical absorption. It has been found that the (n,m) distribution can be controlled by varying the gaseous feed composition, the reaction temperature, and the type of catalyst support used. When using CO as a feed over CoMo/SiO2 catalysts, increasing the synthesis temperature results in an increase in nanotube diameter, without a change in the chiral angle. By contrast, by changing the support from SiO2 to MgO, nanotubes with similar diameter but different chiral angles are obtained. Finally, keeping the same reaction conditions but varying the composition of the gaseous feed results in different (n,m) distribution. The clearly different distributions obtained when varying catalysts support and/or reaction conditions demonstrate that the (n,m) distribution is a result of differences in the growth kinetics, which in turn depends on the nanotube cap-metal cluster interaction. PMID:16471791

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

    NASA Astrophysics Data System (ADS)

    Zadunaisky, P. E.

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

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

    PubMed Central

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-05-01

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

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

    PubMed Central

    RODRÍGUEZ, Yarimar ROSA; DÍAZ, Nelson VARAS

    2009-01-01

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

  8. Formation des Enseignants dans une Perspective d'Education Permanente au Benin (Teacher Education from a Lifelong Learning Perspective in Benin).

    ERIC Educational Resources Information Center

    Agboton, Sebastien; Moussa, Yaya Mede

    1994-01-01

    Examines the history of teacher training in Benin, suggesting that a system of lifelong education should be introduced to unite formal and informal education. Discusses radical changes in the role of the teacher and developments in lifelong learning and apprenticeship caused by national and international sociopolitical programs. (11 citations)…

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

    ERIC Educational Resources Information Center

    Haddab, Mustapha

    1994-01-01

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

  10. Micoinseticidas e Micoacaricidas no Brasil: Como estamos?

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  11. Como Lo Hago Yo: Lipomas Medulares

    PubMed Central

    Portillo, Santiago

    2014-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2011-12-01

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

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

    USGS Publications Warehouse

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

    2006-01-01

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

  14. Essays on Eclipses, Transits and Occultations as Teaching Tools in the Introductory Astronomy College Course. (Spanish Title: Ensayos sobre Eclipses, Tránsitos y Ocultaciones Como Herramientas de Enseñanza en el Curso Universitario Introductorio a la Astronomía.) Ensaios sobre Eclipses, Trânsitos e Ocultações Como Ferramentas de Ensino em um Curso Universitário Introdutório de Astromomia

    NASA Astrophysics Data System (ADS)

    Dcruz, Noella L.

    2014-07-01

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

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

    ERIC Educational Resources Information Center

    Haffner, Debra; Casey, Sean

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

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

    ERIC Educational Resources Information Center

    Center for Population Options, Washington, DC.

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

  17. Los colegios como comunidades (Schools as Communities). ERIC Digest.

    ERIC Educational Resources Information Center

    Royal, Mark A.; Rossi, Robert J.

    A good deal of evidence now suggests that a strong sense of community in schools has benefits for both staff members and students, while providing a necessary foundation for school improvement. This digest in Spanish provides an overview of the literature on schools as communities. The digest identifies the elements of community schools, the…

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Fielding, Elizabeth N.

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

  20. Los mitos como memoria colectiva de Los Pueblos.

    NASA Astrophysics Data System (ADS)

    Martín, P. T.

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

  1. Como Lo Hago Yo: Tratamiento Quirurgico Del Mielomeningocele

    PubMed Central

    Portillo, Santiago

    2014-01-01

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

  2. [Parenting Information. Informacion Sobre Como Ser Padres Mejores.

    ERIC Educational Resources Information Center

    Moreno, Steve

    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…

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

    ERIC Educational Resources Information Center

    Garcia, Ricardo L.; Deyoe, Rita Maxine

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

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

    ERIC Educational Resources Information Center

    Worthy, Jo

    2006-01-01

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

  5. Funding Your Education, 2001/2002 = Como Pagar Su Educacion, 2001/2002.

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC. Student Financial Assistance.

    This publication, in English and Spanish, describes the student financial aid programs of the U.S. Department of Education. It outlines things a student should ask about a college and discusses paying for college. Federal student aid includes grants, work-study, and loans. Chapters of this guide provide information on the following: (1) "Education…

  6. Como pagar su educacion, 2002/2003 (How To Pay for Your Education, 2002/2003).

    ERIC Educational Resources Information Center

    Office of Student Financial Assistance (ED), Washington, DC.

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

  7. Como ayudar a su hijo a aprender mathematicas. (Helping Your Child Learn Math).

    ERIC Educational Resources Information Center

    Kanter, Patsy F.; Darby, Linda B.

    Mathematics has become increasingly important in this technological age. That is why it is even more important for children to learn mathematics at home as well as in school. This second edition of Helping Your Children Learn Math is for parents of children in kindergarten through fifth grade. It has been revised to include a variety of activities…

  8. Como Pagar Su Educacion 1999-2000 (Funding Your Education: 1999-2000).

    ERIC Educational Resources Information Center

    Office of Student Financial Assistance (ED), Washington, DC.

    This guide, in Spanish, is for students seeking financial aid for attending a college or career school. The guide uses a question-and-answer format to provide practical information on student financial aid available from the federal government. Questions and answers are organized into the following categories: choosing a school; paying tuition and…

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

    ERIC Educational Resources Information Center

    Borden, Matt

    2002-01-01

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

  10. Como Solicitar la Asistencia Economica Federal para Estudiantes (How To Apply for Federal Student Aid).

    ERIC Educational Resources Information Center

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

    This guide, written in Spanish, discusses reasons for going to college, how to pay for college, and how to apply for federal student aid in a series of brief, clear illustrations. Following outlines of financial benefits of college, college costs, and space to note costs for the student's area, the guide outlines these steps in the application…

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

    ERIC Educational Resources Information Center

    Macgillivray, Ian K.

    2006-01-01

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

  12. Platero como el primer paso liteario (Platero y Yo: A Student's Introduction to Literary Analysis).

    ERIC Educational Resources Information Center

    Ohrtman, Dennis W.

    This instructional guide is to be used by teachers in the instruction of "Platero y Yo," written by Juan Ramon Jimenez, one of Spain's foremost poets. A systematic study is provided of movement throughout the text, by analyzing verb tenses, to help novice Spanish literature students grasp the scholastic and psychological interpretations of poetic…

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

    ERIC Educational Resources Information Center

    Rockefeller Foundation, New York, NY.

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

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

    ERIC Educational Resources Information Center

    Perkinson, Kathryn

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-10-01

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

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

    PubMed

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Dodge, Diane Trister

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

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

    SciTech Connect

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

    1980-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Dodge, Diane Trister

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

  1. Nota sobre el "Se" como Sujeto Indefinido (A Note on "Se" as an Indefinite Subject)

    ERIC Educational Resources Information Center

    Lujan, Marta

    1975-01-01

    Contradicts Pablo Jordan's theory that certain "se" constructions in Spanish are neither passive nor reflexive. It is claimed that syntactic evidence reveals two types of impersonal structures, the impersonal active and the passive reflexive. (Text is in Spanish.) (CK)

  2. 78 FR 38287 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-26

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

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

    ERIC Educational Resources Information Center

    Paulu, Nancy; Martin, Margery

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

  4. Cosmic ray soil moisture observing systems comos in cap fields at El Reno Oklahoma

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Soil water content (SWC) partitions rainfall into runoff and infiltration, modulates surface and atmospheric exchanges of water and energy, affects plant growth and crop yields, and impacts chemical and biological activities of soil, among other things. Thus, SWC, especially over large scales, is a...

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

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

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

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

    ERIC Educational Resources Information Center

    de la Piedra, Maria Teresa

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Worthy, Jo

    2006-01-01

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

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

    PubMed Central

    Gonzalez, Juan Bosco

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    NASA Astrophysics Data System (ADS)

    Al-Salihi, Adnan; Asaad, Abdulah

    2002-05-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2008-12-01

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

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

    ERIC Educational Resources Information Center

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

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

  15. Las líneas de aluminio neutro como diagnóstico cromosférico

    NASA Astrophysics Data System (ADS)

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

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

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

    ERIC Educational Resources Information Center

    Binns, Helen J.; Ricks, Omar Benton

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

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

    ERIC Educational Resources Information Center

    Becerra, Luz María; McNulty, Maria

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Mansfield, Gillian; Poppi, Franca

    2012-01-01

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

  19. Semiconductor measurement technology: Design and testing guides for the COMOS and lateral bipolar-on-SOI test library

    NASA Astrophysics Data System (ADS)

    Marshall, J. C.; Zaghloul, M. E.

    1994-03-01

    Design and testing guides have been developed for the test library from which test chip NIST8 and test wafer NIST9 were derived. They were designed for use in process monitoring and device parameter extraction to evaluate and compare CMOS (Complementary Metal-Oxide-Semiconductor) test structures, including devices and circuits, fabricated on both bulk silicon and SOI (Silicon-on-Insulator), specifically SIMOX (Separation by the IMplantation of OXygen), wafers. The test library consists of both CMOS-on-SOI and lateral bipolar-on-SOI modules. From it, 20 modules were assembled to create CMOS test chip NIST8 that was fabricated using a standard bulk CMOS foundry through the MOSIS service. SOI/SIMOX test wafer NIST9 contains approximately 1000 modules and was also assembled from modules in this test library. Fourteen processing masks are used to fabricate depletion-mode MOSFET's, lateral bipolar devices, and CMOS MOSFET's with source-to-channel ties. The SOI/SIMOX technology file used with the Magic VLSI layout editor was modified to include the layers necessary to generate these 14 processing masks. This modification is discussed, and unique test structure designs are presented.

  20. Como los colegios asignan y utilizan sus recursos? (How Schools Allocate and Use Their Resources). ERIC Digest.

    ERIC Educational Resources Information Center

    Picus, Lawrence O.

    School finance has traditionally concentrated on the distribution of resources to school districts, focusing primarily on the equitable distribution of funds within a state. In recent years, more attention has been paid to the issue of productivity--how effectively school districts use the funds they receive to provide education to students. This…

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

    ERIC Educational Resources Information Center

    Dorrego, Maria Elena

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

  2. Parámetros fundamentales de objetos catalogados como cúmulos estelares en la Nube Mayor de Magallanes

    NASA Astrophysics Data System (ADS)

    Piatti, A. E.

    We present the results of 16 Large Magellanic Cloud (LMC) clusters ob- tained for the first time from CCD Washington CT1 T2 photometry. CMD cluster features turn out to be identifiable when performing annular extrac- tions around their respective centres, once they were cleaned from field star contamination; their main sequences extending from one up to four mag- nitudes downwards. The clusters resulted to be small angular size objects projected or immersed in dense star fields, as judged from their radial stellar density profiles, so that crowding effect could be responsible for the limited magnitude reached in some cases. We estimated their ages from isochrone fitting - along with the E(B - V ) colour excesses - assuming a metallicity of Z = 0.008 ([Fe/H] = -0.4 dex) and a LMC distance modulus of (m - M)o = 18.50 ± 0.10 mag. FULL TEXT IN SPANISH

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

    ERIC Educational Resources Information Center

    Raphael, Doris; Weisman, Douglas

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

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

    ERIC Educational Resources Information Center

    Bratosevich, Nicolas

    1967-01-01

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

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

    ERIC Educational Resources Information Center

    Raphael, Doris; Weisman, Douglas

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

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

    PubMed

    Díaz-Pérez, Julio Alexander; Gómez-Arbeláez, Diego; Hurtado-Gomez, Gabriel Alexander

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Bradley, D.

    1977-01-01

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

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

    ERIC Educational Resources Information Center

    ACCESS ERIC, Rockville, MD.

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

  9. Hydroprocessing of phenothiazine catalyzed by Co-Mo/. gamma. -Al/sub 2/O/sub 3/

    SciTech Connect

    Kwart, H.; Katzer, J.; Horgan, J.

    1982-07-08

    The hydroprocessing of phenothiazine catalyzed by sulfided Co-Mo/..gamma..-Al/sub 2/O/sub 3/ was studied in a batch autoclave at 573/sup 0/K and 6.89 x 10/sup 6/ Pa. Hydrodesulfurization (HDS) occurs much more rapidly than hydrodenitrogenation (HDN) and occurs 10-fold more rapidly than hydrodesulfurization of dibenzothiophene (a similar sulfur-containing compound) and 50-fold more rapidly than hydrodesulfurization of dibenzothiophene with an equimolar concentration of acridine. A one-point adsorption model for the reaction mechanism cannot explain the data; a flat, ring adsorption enhanced by strong involvement of the electrons of the nitrogen atom and with partial hydrogenation followed by ..beta.. elimination is strongly favored.

  10. HIV Patients Less Likely to Get Treatment for Cancer

    MedlinePlus

    ... lack of treatment affected the HIV-infected patients. Michael Silverberg, a research scientist with Kaiser Permanente, pointed ... of Utah School of Medicine, Salt Lake City; Michael Silverberg, Ph.D., MPH, research scientist, division of ...

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

    EPA Science Inventory

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

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

    ERIC Educational Resources Information Center

    National PTA, Chicago, IL.

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

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

    PubMed Central

    Manucci, Graciela; von Quednow, Enzo

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee; Revilla, Teresa Flores

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

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

    ERIC Educational Resources Information Center

    Scholes Gillingsde González, Barbara

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Medina T., Rene

    1971-01-01

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

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

    ERIC Educational Resources Information Center

    Delfos, Martine F.

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

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

    ERIC Educational Resources Information Center

    Giordano, Rosely

    2000-01-01

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

  19. Como los padres ocupados pueden ayudar a sus hijos a aprender y desarrollarse (How Busy Parents Can Help Their Children Learn and Develop). Early Childhood Digest.

    ERIC Educational Resources Information Center

    Mayer, Ellen; Kreider, Holly; Vaughan, Peggy

    Although parents are often very busy with work and family responsibilities, there are many things they can do to help their school-age children learn and develop. This Spanish-language early childhood digest for parents provides tips obtained from parents of first and second graders in the School Transition Study on creative ways to stay involved…

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

    ERIC Educational Resources Information Center

    Acuna, Beatriz Gomez

    2002-01-01

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

  1. Manejando las burlas: Como los padres pueden ayudar a sus hijos (Easing the Teasing: How Parents Can Help Their Children). ERIC Digest.

    ERIC Educational Resources Information Center

    Freedman, Judy S.

    Children who are teased on a school bus, in class, or during recess often do not want to return to school. Unfortunately, teasing can occur anywhere, and it is difficult to prevent--despite the best efforts of parents, teachers, and school administrators to create a more cooperative atmosphere. This Spanish-language Digest discusses different…

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

    PubMed Central

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Bowdy, Matthew A.

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

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

    ERIC Educational Resources Information Center

    Dodge, Diane Trister; Heroman, Cate

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

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

    ERIC Educational Resources Information Center

    Méndez López, Mariza G.; Peña Aguilar, Argelia

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Mead, Robert G., Jr.

    1981-01-01

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

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

    ERIC Educational Resources Information Center

    Tatum, Charles

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

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

    NASA Astrophysics Data System (ADS)

    Lares, M.

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

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

    ERIC Educational Resources Information Center

    Germano, Jose Willington

    1995-01-01

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

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

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

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

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

    Cancer.gov

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

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

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC.

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

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

    PubMed

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

    2014-02-01

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

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

    NASA Astrophysics Data System (ADS)

    Suarez, Rafael

    2003-11-01

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

  15. The Accented EFL Teacher: Classroom Implications (El acento del profesor de inglés como lengua extranjera: implicaciones pedagógicas)

    ERIC Educational Resources Information Center

    Arboleda Arboleda, Argemiro; Castro Garcés, Ángela Yicely

    2012-01-01

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

  16. Effects of training community staff in interventions for substance misuse in dual diagnosis patients with psychosis (COMO study): cluster randomised trial.

    PubMed

    Johnson, S; Thornicroft, G; Afuwape, S; Leese, M; White, I R; Hughes, E; Wanigaratne, S; Miles, H; Craig, T

    2007-11-01

    A cluster randomised controlled trial was used to investigate the effectiveness of training staff in 13 London community mental health teams (CMHTs) to deliver substance misuse interventions to patients with psychosis and comorbid substance misuse ('dual diagnosis'). The primary hypotheses, which were that experimental group patients would spend fewer daysin hospital over 18 months of follow-up and show reduced alcohol and drug consumption, were not confirmed, although confidence intervals were wide for some outcomes. Current UK policy guidance advocates training CMHT professionals to deliver dual diagnosis interventions, but the effectiveness of this strategy has not so far been demonstrated. PMID:17978327

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

    ERIC Educational Resources Information Center

    Melendez Alicea, Juan

    1992-01-01

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

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

    ERIC Educational Resources Information Center

    Galvez de Bracamonte, Teresa

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

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

    ERIC Educational Resources Information Center

    Carvajal Medina, Nancy Emilce; Roberto Flórez, Eliana Edith

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Germano, Jose Willington

    1995-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    Cancer.gov

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

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

    ERIC Educational Resources Information Center

    National PTA, Chicago, IL.

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

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

    ERIC Educational Resources Information Center

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

    2000-01-01

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

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

    ERIC Educational Resources Information Center

    Coya, Liliam de Barbosa; Perez-Coffie, Jorge

    1982-01-01

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

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

    ERIC Educational Resources Information Center

    Stremel, Kathleen

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

  7. Descompresión microvascular en espasmo hemifacial: Reporte de 13 casos y revisión de la literatura

    PubMed Central

    Campero, Alvaro; Herreros, Isabel Cuervo-Arango; Barrenechea, Ignacio; Andjel, Germán; Ajler, Pablo; Rhoton, Albert

    2016-01-01

    Objetivo: El propósito del presente trabajo es presentar los resultados de 13 pacientes con diagnóstico de espasmo hemifacial (EHF), en los cuales se realizó una descompresión microvascular (DMV). Material y Método: Desde Junio de 2005 a Mayo de 2014, 13 pacientes con diagnóstico de EHF fueron intervenidos quirúrgicamente, realizando una DMV. Se evaluó: edad, sexo, tiempo de evolución de la sintomatología, hallazgos intraoperatorios y resultados postoperatorios. Resultados: De los 13 pacientes intervenidos, 7 fueron mujeres y 6 varones. La media de edad fue de 53 años. El tiempo medio entre el inicio de la sintomatología y la intervención quirúrgica osciló entre 3 y 9 años. En todos los casos el EHF era típico, uno de ellos con neuralgia trigeminal concomitante, observándose en todos compresión neurovascular intraoperatoria. Por orden decreciente de frecuencia la causa de la compresión fue arteria cerebelosa anteroinferior, arteria cerebelosa posteroinferior, arteria dolicomega basilar y arteria dolicomega vertebral. El seguimiento postoperatorio fue en promedio de 24 meses. El 62% presentó desaparición postquirúrgica inmediata de la sintomatología preoperatoria, el 30% desaparición tras un período de 3 semanas a 2 meses (8% con mejoría parcial), y en el 8% no hubo mejoría. En cuanto a las complicaciones postoperatorias: 3 pacientes presentaron paresia facial II-III en la escala de House-Brackman (se recuperaron en un período de 6 meses), y 1 paciente presentó fístula de líquido cefalorraquídeo. Ninguno de los pacientes de la serie presentaron hipoacusia transitorio o permanente. Conclusión: La DMV como tratamiento del EHF es un procedimiento efectivo y seguro, que permite la resolución completa de la patología en la mayoría de los casos. PMID:27127708

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

    PubMed

    1997-12-01

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

  9. Antenatal Ultrasound and Risk of Autism Spectrum Disorders

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  10. Mud Nest of Hornero

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  12. Mud Nest of Hornero

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

  13. Community Resources for Promoting Youth Nutrition and Physical Activity

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Bargagliotti, L. Antoinette; And Others

    1991-01-01

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

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

    ERIC Educational Resources Information Center

    Larkin, Heather; MacFarland, Nicole S.

    2012-01-01

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

  17. Maternal Infection during Pregnancy and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    ERIC Educational Resources Information Center

    Larkin, Heather; MacFarland, Nicole S.

    2012-01-01

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

  20. Maternal Infection during Pregnancy and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

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

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

    ERIC Educational Resources Information Center

    Khawajkie, Elizabeth, Ed.; And Others

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

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

    ERIC Educational Resources Information Center

    Patton, Patricia L.; And Others

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

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

    ERIC Educational Resources Information Center

    Lehr, Fran; Osborn, Jean

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Fajardo Mora, Néstor Ricardo

    2014-01-01

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

  8. Moral Responsibility and Confidence as Factors That Influence Teacher Involvement in Educational Change (Responsabilidad moral y confianza como factores que influyen en la participación del profesor en el cambio educativo)

    ERIC Educational Resources Information Center

    López, Cecilio

    2010-01-01

    Various factors that are not easily observed have a strong impact on educational change. In this paper, I examine some of the issues that emerged from the data collected while exploring my informants' perceptions and attitudes towards their changing roles when confronted with curriculum innovation. This research demonstrates that the…

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

    ERIC Educational Resources Information Center

    Correa, Doris

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Chaves, Orlando; Hernández, Fanny

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Buendía Arias, Ximena Paola

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Méndez, Tatiana; García, Andrea

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Paulu, Nancy

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

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

    ERIC Educational Resources Information Center

    Valle, Victor M.

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

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

    SciTech Connect

    de Miranda, I.M.S.S.

    1989-04-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Hoskins, Irene, Ed.

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

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

    ERIC Educational Resources Information Center

    Pacheco, Angel M.; And Others

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

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

    ERIC Educational Resources Information Center

    Baleghizadeh, Sasan; Mortazavi, Mahboobeh

    2014-01-01

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

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

    PubMed Central

    Boutin-Foster, Carla; Milan, Maria; Kanna, Balavenkatesh

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Marson, Izabel Andrade

    1998-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Betts, Harley D.; DeRose, Ronald C.

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Chala Bejarano, Pedro Antonio; Chapetón, Claudia Marcela

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    1998-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Basallo Gómez, Juan Sebastián

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Schwartz, Wendy

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

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

    ERIC Educational Resources Information Center

    Guerrero, Carmen Helena

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

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

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

    ERIC Educational Resources Information Center

    Paulu, Nancy

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

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

    ERIC Educational Resources Information Center

    Mugford, Gerrard; Cuevas, Oscar Ramírez

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Tavarez Da Costa, Pedro

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    1998-01-01

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

  1. The Impact of Conferencing Assessment on EFL Students' Grammar Learning (Impacto de la evaluación mediante conferencias en el aprendizaje de la gramática en estudiantes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Baleghizadeh, Sasan; Zarghami, Zahra

    2012-01-01

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

  2. Estudio del proceso de ebullicion en el interior de un tubo multipuerto extruido en aluminio con mini-canales de geometria triangular usando R32 y R134a como fluidos de trabajo

    NASA Astrophysics Data System (ADS)

    Ramirez Rivera, Francisco Alberto

    The use of multiport mini-channel tubes in compact exchangers has increased in the last few years. They contributing to improve thermal efficient, compactness, energy conservation and required lower refrigerants charge by which reduction of greenhouse gases emission. Those mentioned advantages are very important aspects with regard to modern refrigeration systems design. For that reason, several experimental investigation have been carried out in order to characterize the flow boiling heat transfer process and frictional pressure drop in tubes with parallel channels. Since, the ability to estimate pressure drop and heat transfer coefficient for specific conditions is a fundamental issue to optimise the design of compact heat exchanger. In this study, the characteristics of two- phase flow pressure drop and convective boiling heat transfer have been investigated experimentally inside multiport mini-channel aluminium tube with triangular geometry, hydraulic diameter 0.715 mm and heating length of 1205 mm using R32 and R134a as working fluids. A wide experimental campaign has been carried out to complete an array of measurement under different conditions for both refrigerants studied. The experimental conditions examined included: mass velocity 275-1230 kgm -2s-1, heat flux 0.75-9.30 kWm-2, saturation temperature, 5°C, 7.5°C, 12.5°C, vapour quality 0.012-0.51. The database presented consists of 312 averages values, 223 averages values were recorded for R134a and 89 for R32. The flow boiling averages values were calculated selecting a sample of 40 readings (steps 20s) in stable conditions for all measured variables at each mass velocity tested.

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

    ERIC Educational Resources Information Center

    Lazos, Hector, Comp.

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

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

    ERIC Educational Resources Information Center

    Lazos, Hector

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

  5. Habitus furibundo en el gueto estadounidense1

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

    A handful of the many changes resulting from the Affordable Care Act underscore the need for a geographic understanding of existing and prospective member communities. Health exchanges require that health provider networks are geographically accessible to underserved populations, and nonprofit hospitals nationwide are required to conduct community health needs assessments every three years. Beyond these requirements, health care providers are using maps and spatial analysis to better address health outcomes that are related in complex ways to social and economic factors.Kaiser Permanente is applying geographic information systems, with spatial analytics and map-based visualizations, to data sourced from its electronic medical records and from publicly and commercially available datasets. The results are helping to shape an understanding of the health needs of Kaiser Permanente members in the context of their communities. This understanding is part of a strategy to inform partnerships and interventions in and beyond traditional care delivery settings. PMID:24694317

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

    PubMed

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

    2014-01-01

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

  8. What strategic planning can do for you.

    PubMed

    Valenzuela, Peter

    2007-01-01

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

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

    PubMed

    Krall, Michael; Gerace, Alexander

    2015-01-01

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

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

    PubMed Central

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

    1979-01-01

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

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

    PubMed

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

    2016-04-01

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

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

    PubMed Central

    Sorensen, Herbert J

    2014-01-01

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

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

    SciTech Connect

    Not Available

    1992-11-01

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

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

    SciTech Connect

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

    1992-11-01

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

  15. Associations and lags between air pollution and acute respiratory visits in an ambulatory care setting: 25-month results from the aerosol research and inhalation epidemiological study.

    PubMed

    Sinclair, Amber Hughes; Tolsma, Dennis

    2004-09-01

    Particulate matter (PM) has been associated with adverse respiratory outcomes in numerous studies that utilized data from emergency room visits, hospital admissions, and mortality records. This study is unique in its investigation of associations of air pollution measures, including components of PM, with health outcomes in an ambulatory-care setting. Visit data were collected from Kaiser Permanente, a not-for-profit health maintenance organization in the metropolitan Atlanta, GA, area. Kaiser Permanente collaborated on the Aerosol Research Inhalation Epidemiological Study (ARIES), which provided detailed information on the characteristics of air pollutants. The Kaiser Permanente study was a time-series investigation of the possible associations between daily levels of suspended PM, inorganic gases, and polar volatile organic compounds and ambulatory care acute visit rates during the 25-month period from August 1, 1998, to August 31, 2000. For this interim analysis, the a priori 0-2 days lagged moving average, as well as the 3-5 days and 6-8 days lagged moving averages, of air quality measures were investigated. Single-pollutant Poisson general linear modeling was used to model daily visit counts for asthma and upper and lower respiratory infections (URI and LRI) by selected air quality metrics, controlling for temporal trends and meteorological variables. Most of the statistically significant positive associations were for the 3-5 days lagged air quality metrics with child asthma and LRI. PMID:15468673

  16. The health care crisis: impact on surgery from a chief executive officer's perspective.

    PubMed

    Pearl, R M

    2001-02-01

    Kaiser Permanente, in conjunction with the surrounding academic institutions, trains 64 surgical residents annually in Northern California. Although the current health care crisis has made resident education increasingly difficult, we are committed to maintaining and expanding our programs. The current health care crisis reflects the effect that for-profit health plans, hospitals, and pharmaceutical groups have had on medicine. Their negative impact has not been simply the extraction of resources from the delivery system to their equity shareholders, but the implementation of an authorization process designed to frustrate and deny. As executive director and chief executive officer of the Permanente Medical Group, I believe that resident training allows us to attract outstanding clinicians, train the physicians of the future, and improve the clinical care of our patients. The multispecialty nature of our medical group and our size allows us to work collaboratively, offer evidence-based approaches, preserve professional independence, and implement innovative programs to increase quality and service. Although it is uncertain how health care will evolve in the future, we at Kaiser Permanente are committed to maintaining and expanding our involvement in the education of the next generation of surgeons. PMID:11177129

  17. Coverage issues and IUD acceptance: a model for managed care.

    PubMed

    Golditch, I

    1996-12-01

    Adverse publicity about IUD-related complications and concerns about litigation have limited patients' requests for and physicians' recommendations of the IUD. For example, the Northern California Permanente Medical Group excluded the copper T380A IUD from its drug formulary until late 1995 because of litigation concerns. At the Kaiser Permanente Medical Center in San Francisco, California, use of the progesterone-releasing IUD (the only IUD available to Kaiser Foundation Health Plan members) has accounted for less than 1% of contraceptive use by members. Fees for insertion have included the acquisition cost of the device plus a small service charge and office visit registration; a sliding scale based on ability to pay has not been available. In 1996, however, IUDs will be covered under the Kaiser Foundation Health Plan's Supplemental Drug Plan, meaning the only charge will be small co-payment for the office visit. This decision was based on acceptance of the IUD within the medical community as a safe and effective contraceptive method, similarity of the IUD to other contraceptive devices covered by the Health Plan, increasing employer group requests for IUD coverage, and Kaiser Permanente physician support for the benefit coverage. If the IUD is to overcome its "image problem," greater efforts must be made to educate health care providers and women about the safety and effectiveness of this method. PMID:8972504

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

    ERIC Educational Resources Information Center

    Zelasko, Nancy; Antunez, Beth

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

  19. Measuring integrated care.

    PubMed

    Strandberg-Larsen, Martin

    2011-02-01

    The positive outcomes of coordination of healthcare services are to an increasing extent becoming clear. However the complexity of the field is an inhibiting factor for vigorously designed trial studies. Conceptual clarity and a consistent theoretical frame-work are thus needed. While researchers respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser Permanente has been put forward as an example for European healthcare systems to follow, although the evidence base is far from conclusive. The thesis has five objectives: 1) To contribute to the understanding of the concept of integration in healthcare systems and to identify measurement methods to capture the multi-dimensional aspects of integrated healthcare delivery. 2) To assess the level of integration of the Danish healthcare system. 3) To assess the use of joint health plans as a tool for coordination between the regional and local level in the Danish healthcare system. 4) To compare the inputs and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine the associations between specific organizational factors and clinical integration within each system. The literature was systematically searched to identify methods for measurement of integrated healthcare delivery. A national cross-sectional survey was conducted among major professional stake-holders at five different levels of the Danish healthcare system. The survey data were used to allow for analysis of the level of integration achieved. Data from the survey were additionally used to investigate the use of joint health planning as a tool for coordination of regional-local healthcare delivery. Analysis of secondary data from the Danish healthcare system and Kaiser Permanente, California were used to compare population characteristics, professional staff, delivery structure, utilisation, quality measures and direct costs. A cross-sectional survey among primary care clinicians in Denmark and in Kaiser Permanente, Northern California was completed to allow for comparison of clinical integration in the two systems and system specific associated factors. In this thesis a conceptual framework and a model for assessment of the conditions for integrations as an intermediate healthcare system outcome are presented. Furthermore, the results show that integrated healthcare delivery can be measured: 24 methods are available and some are highly developed. However, the field is still in its early phase and guidelines for how to proceed are devised. It was confirmed on a national level that integration of care is a widespread challenge, and that only half or less than half of patients in need of integrated services receive such care. Options for decision makers and managers are discussed. From a theoretical perspective joint health plans as applied in Denmark do not match the degree of complexity in the healthcare system. It was therefore in agreement with the theoretical findings when major stakeholders agreed that the joint health plans had not been effective as a tool for coordination. Joint health planning processes should actively engage all stakeholders and a high degree of recurrent feedback are warranted. When comparing Kaiser Permanente, California with the Danish healthcare system, our study suggest that Kaiser Permanente has a population with more documented disease and higher operating costs, and performs better than the Danish healthcare system on the observed quality measures. Substantial differences were found in the perception of clinical integration in the two settings. More primary care clinicians in the Northern California region of Kaiser Permanente reported being part of a clinical integrated environment than did Danish general practitioners. By measuring the level of clinical integration in Kaiser Permanente using the Danish healthcare system as a point of reference our findings support the literature that points to the importance of integrated healthcare delivery as a driver for the performance results of Kaiser Permanente. However caution must be advised before making concrete conclusions due to the complexity of the matter and until more studies have been conducted. With this thesis an initial step has been taken into a new research field. Ongoing research will make it possible to deliver the evidence needed by decision makers, planners and managers - ultimately to benefit the patients. PMID:21299927

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

    ERIC Educational Resources Information Center

    Cohen, Elena

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

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

    ERIC Educational Resources Information Center

    Baylor Coll. of Medicine, Houston, TX.

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

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

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

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

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

    ERIC Educational Resources Information Center

    Ekundayo, Omowumi Steve Bode

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Viáfara, John Jairo

    2011-01-01

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

  5. Metacognitive Awareness and Comprehension Monitoring in Reading Ability of Iranian EFL Learners (Monitoreo de la conciencia metacognitiva y de la comprensión en la habilidad lectora de estudiantes iraníes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Khonamri, Fatemeh; Mahmoudi Kojidi, Elahe

    2011-01-01

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

  6. Teacher Activities and Adolescent Students' Participation in a Colombian EFL Classroom (Actividades de enseñanza y participación de estudiantes adolescentes en una clase de enseñanza de inglés como lengua extranjera en Colombia)

    ERIC Educational Resources Information Center

    Caicedo, Jefferson

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Abad, José Vicente

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Macías, Diego Fernando

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Lopera Medina, Sergio

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Alibakhshi, Goudarz; Dehvari, Najibeh

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Lopez Alonso, A. O.

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

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

    ERIC Educational Resources Information Center

    Schauber, Holli

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Rodriguez, Rodolfo, Comp.

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

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

    ERIC Educational Resources Information Center

    Rodriguez, Rodolfo, Comp.

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

  16. Teachers' Perceptions about Oral Corrective Feedback and Their Practice in EFL Classrooms (Percepciones de los docentes acerca de la retroalimentación correctiva y su práctica en las aulas de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Hernández Méndez, Edith; Reyes Cruz, María del Rosario

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    de Freitas, Marcos Cezar

    1998-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  19. Facilitating Professional Development during International Practicum: Understanding Our Work as Teacher Educators through Critical Incidents (Facilitando el desarrollo profesional durante la práctica internacional: Comprendiendo nuestro trabajo como formadores de profesores a través de incidentes críticos)

    ERIC Educational Resources Information Center

    Williams, Judy; Grierson, Arlene

    2016-01-01

    This collaborative self-study details the experiences of an Australian teacher educator and a Canadian teacher educator, who led teacher candidates on international practicum placements to the Cook Islands and Kenya respectively. Focusing on critical incidents, they collaboratively analyzed dilemmas that occurred when providing professional…

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

    ERIC Educational Resources Information Center

    Baron, Carla

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

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

    ERIC Educational Resources Information Center

    North Carolina Partnership for Children, Raleigh.

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

  2. Effects of Strategy Instruction in an EFL Reading Comprehension Course: A Case Study (Efectos de la instrucción de estrategias en un curso de comprensión de lectura en inglés como lengua extranjera: un estudio de caso)

    ERIC Educational Resources Information Center

    Lopera Medina, Sergio

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Khonamri, Fatemeh; Salimi, Mahin

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    North Carolina Partnership for Children, Raleigh.

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

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

    ERIC Educational Resources Information Center

    Jiménez Guamán, Laura Verónica

    2012-01-01

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

  6. Variation in the use of alternative levels of hospital care for newborns in a managed care organization.

    PubMed Central

    Roblin, D. W.; Richardson, D. K.; Thomas, E.; Fitzgerald, F.; Veintimilla, R.; Hulac, P.; Bemis, G.; Leon, L.

    2000-01-01

    OBJECTIVE(S): To assess the extent to which variation in the use of neonatal intensive care resources in a managed care organization is a consequence of variation in neonatal health risks and/or variation in the organization and delivery of medical care to newborns. STUDY DESIGN: Data were collected on a cohort of all births from four sites in Kaiser Permanente by retrospective medical chart abstraction of the birth admission. Likelihood of admission into a neonatal intensive care unit (NICU) is estimated by logistic regression. Durations of NICU stays and of hospital stay following birth are estimated by Cox proportional hazards regression. RESULTS: The likelihood of admission into NICU and the duration of both NICU care and hospital stay are proportional to the degree of illness and complexity of diagnosis. Adjusting for variation in health risks across sites, however, does not fully account for observed variation in NICU admission rates or for length of hospital stay. One site has a distinct pattern of high rates of NICU admissions; another site has a distinct pattern of low rates of NICU admission but long durations of hospital stay for full-term newborns following NICU admission as well as for all newborns managed in normal care nurseries. CONCLUSIONS: Substantial variations exist among sites in the risk-adjusted likelihood of NICU admission and in durations of NICU stay and hospital stay. Hospital and NICU affiliation (Kaiser Permanente versus contract) or affiliation of the neonatologists (Kaiser Permanente versus contract) could not explain the variation in use of alternative levels of hospital care. The best explanation for these variations in neonatal resource use appears to be the extent to which neonatology and pediatric practices differ in their policies with respect to the management of newborns of minimal to moderate illness. PMID:10737452

  7. Transforming Care Delivery through Health Information Technology

    PubMed Central

    Wheatley, Benjamin

    2013-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  9. Healthy behavior change in practical settings.

    PubMed

    Young, Scott

    2014-01-01

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

  10. Association between Statin Use and Uveitis: Results from the Pacific Ocular Inflammation Study

    PubMed Central

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

    2015-01-01

    Purpose To assess whether there is a protective association between statin use and uveitis diagnosis Design Retrospective, population-based case-control study Methods Medical records of all patients in the Kaiser Permanente Hawaii health plan between January 1, 2006 and December 31, 2007 (N=217,061) were searched electronically for International Classification of Diseases, 9th Revision, diagnosis codes related to uveitis. Chart review was done to confirm incident uveitis diagnosis during the study period. Two control groups were each randomly selected at a 5:1 ratio to cases, and controls were assigned an index date to match their respective case diagnosis date. One control group was selected from the general Kaiser Permanente Hawaii population that had at least one healthcare visit during the study period. Another control group was selected from the population of Kaiser Permanente Hawaii members who had at least one visit to the ophthalmology clinic during the study period. Statin use was defined as filling a prescription for statin medication in the year prior to the diagnosis or index date based on an electronic search of the Kaiser Permanente Hawaii pharmacy database for Generic Product Identification codes. A conditional logistic regression model with clinical diagnosis of uveitis as the outcome was used to assess the relationship between statin use and uveitis. Results One hundred eight incident cases of uveitis were identified. Nineteen percent of uveitis patients had used statin medication in the year prior to diagnosis compared to 30% of patients in the general Kaiser population control (p=0.03) and 38% of patients in the ophthalmology clinic control (p<0.001). Using the general Kaiser population control and adjusting for age, gender, race, and autoimmune diseases, the odds of a statin user developing uveitis were 48% less than the odds of a non-statin user developing uveitis (OR: 0.52, 95% CI: 0.29 to 0.94, p=0.03). Similarly, the odds of developing uveitis were 33% less for statin users compared to non-statin users (OR: 0.67, 95% CI: 0.38 to 1.19, p=0.17) when adjusting for these factors and using the ophthalmology clinic control group. Conclusions Statin use may be protective against the development of uveitis. Several anti-inflammatory and immunomodulatory mechanisms may explain this association. PMID:25597838

  11. Physician leadership in changing times.

    PubMed

    Cochran, Jack; Kaplan, Gary S; Nesse, Robert E

    2014-03-01

    Today, hospitals and physicians are reorganizing themselves in novel ways to take advantage of payment incentives that reward shared accountability for the total health care experience. These delivery system changes will take place with our without physician leadership. To optimize change on behalf of patients, physicians must play a conscious role in shaping future health care delivery organizations. As physician leaders of three of the nation׳s largest integrated health care delivery systems - Kaiser Permanente, Virginia Mason Medical Center, and the Mayo Clinic Health System - we call on physicians to view leadership and the development of leaders as key aspects of their role as patient advocates. PMID:26250084

  12. Multifocal Clinical Performance Improvement Across 21 Hospitals

    PubMed Central

    Skeath, Melinda; Whippy, Alan

    2015-01-01

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

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

    PubMed

    Bartolotto, Carole

    2015-01-01

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

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

    PubMed

    Winter, Peggi

    2016-01-01

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

  15. What Does Professionalism Mean to the Physician?

    PubMed Central

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

    2013-01-01

    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

  16. Perinatal Obstetric Office Depression Screening and Treatment: Implementation in a Health Care System.

    PubMed

    Flanagan, Tracy; Avalos, Lyndsay A

    2016-05-01

    Perinatal depression affects between 12% and 20% of pregnant and postpartum women and is underdiagnosed. The American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force recently recommended universal perinatal depression screening. We discuss challenges to instituting universal screening, describe the development and implementation between 2007 and 2014 of Kaiser Permanente Northern California's successful program, and highlight key measures of success. A quality improvement system approach with four steps guided development: 1) identify and use best practices, 2) identify champions and educate clinicians, 3) use data that drive performance, and 4) streamline office workflow. Clinical success was determined by at least 50% improvement in depression care metrics from diagnosis to 120 days afterward. Depression diagnoses, Patient Health Questionnaire-9 scores, medication dispensation, and treatment for all births in 2014 (N=37,660) were extracted from electronic health records. Ninety-six percent of pregnant and postpartum women were screened at least once. Fourteen percent screened positive for depression (Patient Health Questionnaire-9 score of 10 or greater). Approximately 6% of pregnant and postpartum women had severe depression with a Patient Health Questionnaire-9 of 15 or greater and a depression diagnosis, and 80% of these women received treatment. Forty percent of women with a depression diagnosis demonstrated improved symptoms. Kaiser Permanente Northern California's universal perinatal depression screening program can serve as a model for the feasibility and clinical effectiveness of universal depression screening in obstetric care. PMID:27054937

  17. Roundtable on public policy affecting patient safety.

    PubMed

    Crane, Robert M; Raymond, Brian

    2011-03-01

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

  18. Measurement and evaluation of national family planning programs.

    PubMed

    Mauldin, W P

    1967-03-01

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

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

    NASA Astrophysics Data System (ADS)

    Maddock, Thomas, III.; Vionnet, Leticia Beatriz

    "Capture" is the increase in recharge and the decrease in discharge that occurs when pumping is imposed on an aquifer system that was in a previous state of approximate dynamic equilibrium. Regional groundwater models are usually used to calculate capture in a two-step procedure. A steady-state solution provides an initial-head configuration, a set of flows through the boundaries for the modeled region, and the initial basis for the capture calculation. The transient solutions provide the total change in flows through the boundaries. A difference between the transient and steady-state solutions renders the capture calculation. When seasonality is a modeling issue, the use of a single initial hydraulic head and a single set of boundary flows leads to miscalculations of capture. Instead, an initial condition for each season should be used. This approach may be accomplished by determining steady oscillatory solutions, which vary through the seasons but repeat from year to year. A regional groundwater model previously developed for a portion of the San Pedro River basin, Arizona, USA, is modified to illustrate the effect that different initial conditions have on transient solutions and on capture calculations. Résumé Les "prélèvements" sont constitués par l'augmentation de la recharge et par la diminution de l'écoulement qui se produit lorsqu'un pompage est imposéà un système aquifère qui était auparavant dans un état proche de l'équilibre dynamique. Les modèles régionaux de nappe sont en général utilisés pour calculer les prélèvements dans une procédure à deux étapes. Une solution en régime permanent donne la configuration piézométrique initiale, un jeu de conditions aux limites pour la région modélisée et les données de base pour le calcul des prélèvements. Les solutions transitoires donnent les modifications globales des conditions aux limites. Lorsque des variations saisonnières sont produites en sortie du modèle, le recours à une piézométrie initiale unique et à un seul jeu de données de conditions aux limites conduit à un mauvais calcul des prélèvements. Il faut alors utiliser une condition de recharge initiale pour chaque saison. Cette approche peut être réalisée en déterminant des solutions permanentes périodiques, variantes au cours des saisons, mais se répétant d'année en année. Un modèle de nappe régional, précédemment mis au point pour une partie du bassin de la rivière San Pedro (Arizona, États-Unis), a été modifié pour illustrer l'effet de conditions initiales différentes sur des solutions transitoires et sur le calcul des prélèvements. Resumen Se define como "captura" al aumento de recarga y descenso de descarga que tiene lugar cuando se impone un bombeo en un acuífero en estado de equilibrio dinámico. Se suelen utilizar modelos regionales de agua subterránea para calcular la captura en un procedimiento que consta de dos etapas. Una solución en régimen estacionario proporciona la distribución inicial de niveles piezométricos, los flujos a través de los contornos de la región modelada y el punto de partida para el cálculo de la captura. Las soluciones transitorias proporcionan los cambios en los flujos a través de los contornos. La diferencia entre las soluciones estacionaria y transitoria da el valor de la captura. Cuando los cambios estacionales son importantes, la utilización de un único estado inicial de niveles y de flujos en los contornos da lugar a errores en el cálculo de la captura. En este caso debe usarse una condición inicial para cada una de las estaciones. Esto se puede conseguir obteniendo soluciones periódicas estacionarias, que varíen a lo largo de las estaciones, pero que se repitan año a año. Un modelo regional desarrollado previamente para el estudio de una parte de la cuenca del Río San Pedro, en Arizona (EE.UU.) se modificó para ilustrar el efecto que las distintas condiciones iniciales tienen en el cálculo de la captura.

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

    USGS Publications Warehouse

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

    1996-01-01

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

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

    PubMed

    1999-12-01

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

  2. Maternal Infection During Pregnancy and Autism Spectrum Disorders.

    PubMed

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

    2015-12-01

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

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

    PubMed

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

    2015-12-01

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

  4. Outcomes in Treatment for Intradural Spinal Cord Ependymomas

    SciTech Connect

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

    2007-11-15

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  7. Northwest Simulation Center—Sharpens Clinical and Communication Skills for Individuals and Teams

    PubMed Central

    Ottaviano, Georgina; Washington, Carl

    2009-01-01

    Many authorities have suggested that some variant of team training is likely to reduce human error in operating rooms, Emergency Departments, resuscitation teams and other settings within health care—where human interaction is common, and where breakdowns in communication and teamwork can have critical consequences. The Kaiser Sunnyside Medical Center Regional Simulation Center achieves this end. In particular, simulation prepares people for error-prone, high-risk, or unusual situations. Here, we will cite several scenarios and two actual protocols; five principles for managing critical events; results (2006 People Pulse favorability, 2007–2008 postsimulation survey favorability); Kaiser Permanente Northwest departments trained; strategic initiatives supported including service internalization; collaboration with local and regional community programs; and process transferability. PMID:21373228

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

    PubMed

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

    2013-07-01

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

  9. Evaluation of a career ladder program in an ambulatory care environment.

    PubMed

    Nelson, Joan M; Cook, Paul F

    2008-01-01

    Clinical ladders, or career advancement systems, were designed to enhance professional development, provide a reward system for quality clinical performance, promote quality nursing practice, and improve job satisfaction among nurses. Most of the literature on RN clinical ladder programs is related to the acute care setting, where these programs originated; not much is known about their effectiveness in the ambulatory care environment. The RN Career Ladder at Kaiser Permanente of Colorado was begun by a Labor Management Partnership Committee in 2003, and awards financial incentives to RNs who demonstrate a commitment to continuing education, leadership activities, and program development on a local and regional level. In this study significantly more involvement in leadership, interdisciplinary, and quality improvement activities were found among career ladder nurses than non-career ladder nurses, regardless of their job role. It is not clear whether nursing leaders gravitate toward a career ladder or whether career ladder participation encourages increased participation in leadership activities. PMID:19330969

  10. Successful Practices in the Use of Secure E-mail

    PubMed Central

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

    2014-01-01

    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

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

    PubMed

    Ordonez, J D; Hiatt, R A

    1989-01-01

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

  12. Biokompatible Implantate und Neuentwicklungen in der Gynäkologie

    NASA Astrophysics Data System (ADS)

    Jacobs, Volker R.; Kiechle, Marion

    Für den Einsatz in der Gynäkologie stehen heute eine Vielzahl unterschiedlicher, biokompatibler Materialien und Implantate zur Verfügung. Auf eine Auswahl soll hier näher eingegangen werden, die die verschiedenen Materialien und Bauweisen repräsentieren. So sind Brustimplantate seit fast vier Jahrzehnten im Gebrauch für die Brustvergrösserung und den Brustwiederaufbau. Material, Bauweisen und medizinische Aspekte einschliesslich der kontroversen Diskussion um Silikon werden im folgenden erläutert. Neuere Entwicklungen von Verhütungstechniken für permanente Sterilisation wie den Filshie ClipTM für transabdominalen und den STOPTM für intraluminalen Verschluss der Eileiter oder die intrauterin plazierte Hormonspirale MirenaTM für zeitlich begrenzte Verhütung werden beschrieben. Eine neue Perspektive zur Verhinderung postoperativer intraabdominaler Adhäsionen stellt Spray-GelTM, ein Zweikomponenten Hydrogel aus Polyethylenglykol, dar.

  13. Declining Effectiveness of Herpes Zoster Vaccine in Adults Aged ≥60 Years.

    PubMed

    Tseng, Hung Fu; Harpaz, Rafael; Luo, Yi; Hales, Craig M; Sy, Lina S; Tartof, Sara Y; Bialek, Stephanie; Hechter, Rulin C; Jacobsen, Steven J

    2016-06-15

    Understanding long-term effectiveness of herpes zoster (HZ) vaccine is critical for determining vaccine policy. 176 078 members of Kaiser Permanente ≥60 years vaccinated with HZ vaccine and three matched unvaccinated members were included. Hazard ratios and 95% confidence intervals (CIs) associated with vaccination at each year following vaccination were estimated by Cox regression model. The effectiveness of HZ vaccine decreased from 68.7% (95% CI, 66.3%-70.9%) in the first year to 4.2% (95% CI, -24.0% to 25.9%) in the eighth year. This rapid decline in effectiveness of HZ vaccine suggests that a revaccination strategy may be needed, if feasible. PMID:26908728

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed Central

    2012-01-01

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

  16. Dinámica de pulsares jóvenes

    NASA Astrophysics Data System (ADS)

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

    La observación detallada de los pulsos en varios pulsares jóvenes (τ < 105 yr) permitió detectar varios aumentos en la frecuencia de emisión gliches con cambios permanentes en Δ {˙ Ω} / {˙ Ω}. A través de las ecuaciones de movimiento se investiga, utilizando parametrizaciones simples, la hipótesis de que el ángulo entre Ω y el dipolo magnético M sea responsable de ese comportamiento. Se derivan curvas analíticas para la evolución de Ω (t) y se estudia la posibilidad de describir un conjunto de observables (incluyendo el braking index n) con estos modelos.

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

    PubMed

    Selby, Joe V

    2014-03-01

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

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

    PubMed

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

    2013-03-01

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

  19. Physician Professional Satisfaction and Area of Clinical Practice: Evidence from an Integrated Health Care Delivery System

    PubMed Central

    Caloyeras, John P; Kanter, Michael; Ives, Nicole; Kim, Chong Y; Kanzaria, Hemal K; Berry, Sandra H; Brook, Robert H

    2016-01-01

    Context: For health care reform to succeed, health care systems need a professionally satisfied primary care workforce. Evidence suggests that primary care physicians are less satisfied than those in other medical specialties. Objective: To assess three domains of physician satisfaction by area of clinical practice among physicians practicing in an established integrated health system. Design: Cross-sectional online survey of all Southern California Permanente Medical Group (SCPMG) partner and associate physicians (N = 1034) who were primarily providing clinic-based care in 1 of 4 geographically and operationally distinct Kaiser Permanente Southern California Medical Centers. Main Outcome Measures: Primary measure was satisfaction with one’s day-to-day professional life as a physician. Secondary measures were satisfaction with quality of care and income. Results: Of the 636 physicians responding to the survey (61.5% response rate), on average, 8 in 10 SCPMG physicians reported satisfaction with their day-to-day professional life as a physician. Primary care physicians were only minimally less likely to report being satisfied (difference of 8.2–9.5 percentage points; p < 0.05) than were other physicians. Nearly all physicians (98.2%) were satisfied with the quality of care they are able to provide. Roughly 8 in 10 physicians reported satisfaction with their income. No differences were found between primary care physicians and those in other clinical practice areas regarding satisfaction with quality of care or income. Conclusion: It is possible to create practice settings, such as SCPMG, in which most physicians, including those in primary care, experience high levels of professional satisfaction. PMID:27057819

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    Andryjowicz, Esteban; Wray, Teresa

    2011-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  3. Health Information in Portuguese (português): MedlinePlus

    MedlinePlus

    ... Newborn Care Coping with Your Baby's Crying Como lidar com o choro do bebê - português (Portuguese) Bilingual ... Health Information Translations Stress Coping with Stress Como lidar com o estresse - português (Portuguese) Bilingual PDF Health ...

  4. The Surveillance, Epidemiology, and End Results Cancer Survival Calculator SEER*CSC: Validation in a Managed Care Setting

    PubMed Central

    Feuer, Eric J.; Rabin, Borsika A.; Zou, Zhaohui; Wang, Zhuoqiao; Xiong, Xiaoqin; Ellis, Jennifer L.; Steiner, John F.; Cynkin, Laurie; Nekhlyudov, Larissa; Bayliss, Elizabeth

    2014-01-01

    Background Nomograms for prostate and colorectal cancer are included in the Surveillance, Epidemiology, and End Results (SEER) Cancer Survival Calculator, under development by the National Cancer Institute. They are based on the National Cancer Institute’s SEER data, coupled with Medicare data, to estimate the probabilities of surviving or dying from cancer or from other causes based on a set of patient and tumor characteristics. The nomograms provide estimates of survival that are specific to the characteristics of the tumor, age, race, gender, and the overall health of a patient. These nomograms have been internally validated using the SEER data. In this paper, we externally validate the nomograms using data from Kaiser Permanente Colorado. Methods The SEER Cancer Survival Calculator was externally validated using time-dependent area under the Receiver Operating Characteristic curve statistics and calibration plots for retrospective cohorts of 1102 prostate cancer and 990 colorectal cancer patients from Kaiser Permanente Colorado. Results The time-dependent area under the Receiver Operating Characteristic curve statistics were computed for one, three, five, seven, and 10 year(s) postdiagnosis for prostate and colorectal cancer and ranged from 0.77 to 0.89 for death from cancer and from 0.72 to 0.81 for death from other causes. The calibration plots indicated a very good fit of the model for death from cancer for colorectal cancer and for the higher risk group for prostate cancer. For the lower risk groups for prostate cancer (<10% chance of dying of prostate cancer in 10 years), the model predicted slightly worse prognosis than observed. Except for the lowest risk group for colorectal cancer, the models for death from other causes for both prostate and colorectal cancer predicted slightly worse prognosis than observed. Conclusions The results of the external validation indicated that the colorectal and prostate cancer nomograms are reliable tools for physicians and patients to use to obtain information on prognosis and assist in establishing priorities for both treatment of the cancer and other conditions, particularly when a patient is elderly and/or has significant comorbidities. The slightly better than predicted risk of death from other causes in a health maintenance organization (HMO) setting may be due to an overall healthier population and the integrated management of disease relative to the overall population (as represented by SEER). PMID:25417240

  5. [In situ FTIR and XPS study on selective hydrodesulfurization catalyst of FCC gasoline].

    PubMed

    Qiherima; Yuan, Hui; Zhang, Yun-hong; Li, Hui-feng; Xu, Guang-tong

    2011-07-01

    Improvement of the selectivity of hydrodesulfurization (HDS) for hydrogenation (HYD) of olefins is crucial to produce sulfur-free (S < 0.001%) gasoline from fluid catalytic-cracked (FCC) gasoline. A series of sulfided CoMo/Al2O3 catalysts with different metal loading were prepared by pore-filling impregnation. MoS2 and COMoS active phases on the surface of sulfided COMo/Al2O3 catalyst were identified and analyzed quantitatively by XPS and in-situ FTIR of adsorbed CO. The results reveal that the increase in COMoS phase on the catalyst surface improves the HDS activity and selectivity. And the HDS selectivity correlates linearly with the ratio of active site number of CoMoS and MoS2, the higher the ratio of active site number of CoMoS and MoS2, the better the HDS selectivity. In situ variable temperature FTIR analysis shows that CoMoS phase has stronger electron accepting ability than MoS2. The strong electron deficient property of CoMoS active sites is the main reason for its excellent HDS activity and selectivity. PMID:21942017

  6. Prevalence of migraine in a diverse community—electronic methods for migraine ascertainment in a large integrated health plan

    PubMed Central

    Pressman, Alice; Jacobson, Alice; Eguilos, Roderick; Gelfand, Amy; Huynh, Cynthia; Hamilton, Luisa; Avins, Andrew; Bakshi, Nandini; Merikangas, Kathleen

    2016-01-01

    Introduction The growing availability of electronic health data provides an opportunity to ascertain diagnosis-specific cases via systematic methods for sample recruitment for clinical research and health services evaluation. We developed and implemented a migraine probability algorithm (MPA) to identify migraine from electronic health records (EHR) in an integrated health plan. Methods We identified all migraine outpatient diagnoses and all migraine-specific prescriptions for a five-year period (April 2008–March 2013) from the Kaiser Permanente, Northern California (KPNC) EHR. We developed and evaluated the MPA in two independent samples, and derived prevalence estimates of medically-ascertained migraine in KPNC by age, sex, and race. Results The period prevalence of medically-ascertained migraine among KPNC adults during April 2008–March 2013 was 10.3% (women: 15.5%, men: 4.5%). Estimates peaked with age in women but remained flat for men. Prevalence among Asians was half that of whites. Conclusions We demonstrate the feasibility of an EHR-based algorithm to identify cases of diagnosed migraine and determine that prevalence patterns by our methods yield results comparable to aggregate estimates of treated migraine based on direct interviews in population-based samples. This inexpensive, easily applied EHR-based algorithm provides a new opportunity for monitoring changes in migraine prevalence and identifying potential participants for research studies. PMID:26069243

  7. Use of an automated database to evaluate markers for early detection of pregnancy.

    PubMed

    Manson, J M; McFarland, B; Weiss, S

    2001-07-15

    The objective of this study was to develop and validate algorithms to detect pregnancies from the time of first clinical recognition by using Kaiser Permanente automated databases from Portland, Oregon. In 1993--1994, the authors evaluated these databases retrospectively to identify markers indicative of initial clinical detection of pregnancy and pregnancy outcomes. Pregnancy markers were found for 99% of the women for whom pregnancy outcomes were included in the automated databases, and pregnancy outcomes were identified for 77% of the women for whom there were pregnancy markers. The earliest marker most predictive of a pregnancy outcome was a positive human chorionic gonadotropin test; least predictive was an obstetric outpatient visit. Medical record review indicated that in a sample of women with pregnancy markers in the database, an estimated 6% of pregnancy outcomes (primarily early fetal deaths and elective terminations) were lost. Pregnancies were first captured in automated databases 6--8 weeks after the last menstrual period, and a combination of a positive human chorionic gonadotropin test and an outpatient obstetric visit was the most sensitive and specific early marker of pregnancy. When combined with automated pharmacy records, these databases may be valuable tools for evaluating prescription drug effects on all major outcomes of clinically recognized pregnancies. PMID:11447053

  8. Pioglitazone has a dubious bladder cancer risk but an undoubted cardiovascular benefit.

    PubMed

    Ryder, R E J

    2015-03-01

    On 8 April 2014, a US jury ordered Takeda and Eli Lilly to pay $9 bn in punitive damages after finding that they had concealed the cancer risks associated with pioglitazone. By contrast, on 28 August 2014, the long-awaited outcome of the 10-year Kaiser Permanente Northern California study was announced. That study was specifically designed to investigate whether patients exposed to pioglitazone were at an increased risk of bladder cancer and found no association; thus, at last, the controversial issue has been resolved. A review, in retrospect, of the story of the proposed link between pioglitazone and bladder cancer reveals flaws at every stage. In 2012, a BMJ editorial, in keeping with some other contemporary reports, stated 'it can confidently be assumed that pioglitazone increases the risk of bladder cancer'. Examination of the information which led to such a statement shows that: 1) the pre-clinical findings of bladder cancer in male rats is not indicative of human risk; 2) there is no association between bladder cancer and pioglitazone in randomized controlled trials, once cases that could not plausibly be related to treatment are removed; and 3) the observational studies that have suggested a link have over-extrapolated from the data: pioglitazone-treated patients had more risk factors for bladder cancer than those not treated with pioglitazone. Meanwhile careful study of randomized controlled trials shows evidence of cardiovascular benefit from pioglitazone in Type 2 diabetes, a condition which results, more than anything, in premature cardiovascular death and morbidity. PMID:25472014

  9. Supplement Use and Risk of Cutaneous Squamous Cell Carcinoma

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2010-07-01

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

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

    PubMed Central

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

    2012-01-01

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

  12. Physician Update: Total Health

    PubMed Central

    Tuso, Phillip

    2014-01-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

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

    2013-01-01

    Background: Empirical research associated with the Kaiser Permanente and Centers for Disease Control and Prevention Adverse Childhood Experiences (ACE) Study has demonstrated that ACE are associated with a range of negative outcomes in adulthood, including physical and mental health disorders and aggressive behavior. Methods: Subjects from 4 different offender groups (N = 151) who were referred for treatment at an outpatient clinic in San Diego, CA, subsequent to conviction in criminal court, completed the ACE Questionnaire. Groups (nonsexual child abusers, domestic violence offenders, sexual offenders, and stalkers) were compared on the incidence of ACE, and comparisons were made between the group offenders and a normative sample. Results: Results indicated that the offender group reported nearly four times as many adverse events in childhood than an adult male normative sample. Eight of ten events were found at significantly higher levels among the criminal population. In addition, convicted sexual offenders and child abusers were more likely to report experiencing sexual abuse in childhood than other offender types. Conclusions: On the basis of a review of the literature and current findings, criminal behavior can be added to the host of negative outcomes associated with scores on the ACE Questionnaire. Childhood adversity is associated with adult criminality. We suggest that to decrease criminal recidivism, treatment interventions must focus on the effects of early life experiences. PMID:23704843

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

    PubMed Central

    2016-01-01

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

  16. How does an open house benefit your organization?

    PubMed

    McBride, J

    1989-01-01

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

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

    PubMed Central

    Kolasinski, Vallerie A; Price, David W

    2015-01-01

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

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

    PubMed Central

    Krall, Michael; Gerace, Alexander

    2015-01-01

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

  19. Risk of Delayed Intracerebral Hemorrhage in Anticoagulated Patients after Minor Head Trauma: The Role of Repeat Cranial Computed Tomography

    PubMed Central

    Swap, Clifford; Sidell, Margo; Ogaz, Raquel; Sharp, Adam

    2016-01-01

    Context: Patients receiving anticoagulant medications who experience minor head injury are at increased risk of an intracerebral hemorrhage (ICH) developing, even after an initial computed tomography (CT) scan of the brain yields normal findings. Conflicting evidence exists regarding the frequency at which delayed bleeding occurs. Objective: To identify the frequency of delayed traumatic ICH in patients receiving warfarin or clopidogrel. Design: We performed a retrospective observational study of adult trauma encounters for anticoagulated patients undergoing head CT at 1 of 13 Kaiser Permanente Southern California Emergency Departments (EDs) between 2007 and 2011. Encounters were identified using structured data from electronic health and administrative records, and then records were individually reviewed for validation of results. Main Outcome Measures: The primary outcome measure was ICH within 60 days of an ED visit with a normal head CT result. Results: Our sample included 443 (260 clopidogrel and 183 warfarin) eligible ED encounters with normal findings of initial head CT. Overall, 11 patients (2.5%, 95% confidence interval [CI] = 1.4%–4.4%) had a delayed ICH, and events occurred at similar rates between the clopidogrel group (6/260, 2.3%, CI 1.1%–5.0%) and warfarin group (5/183, 2.7%, CI 1.2%–6.2%). Conclusion: Trauma patients in the ED who are receiving warfarin or clopidogrel have approximately a 2.5% risk of delayed ICH after an initial normal finding on a head CT. PMID:26901269

  20. Integrated delivery systems: the cure for fragmentation.

    PubMed

    Enthoven, Alain C

    2009-12-01

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

  1. Identification of Susceptibility Loci for Cutaneous Squamous Cell Carcinoma.

    PubMed

    Asgari, Maryam M; Wang, Wei; Ioannidis, Nilah M; Itnyre, Jacqueline; Hoffmann, Thomas; Jorgenson, Eric; Whittemore, Alice S

    2016-05-01

    We report a genome-wide association study of cutaneous squamous cell carcinoma conducted among non-Hispanic white members of the Kaiser Permanente Northern California health care system. The study includes a genome-wide screen of 61,457 members (6,891 cases and 54,566 controls) genotyped on the Affymetrix Axiom European array and a replication phase involving an independent set of 6,410 additional members (810 cases and 5,600 controls). Combined analysis of screening and replication phases identified 10 loci containing single-nucleotide polymorphisms (SNPs) with P-values < 5 × 10(-8). Six loci contain genes in the pigmentation pathway; SNPs at these loci appear to modulate squamous cell carcinoma risk independently of the pigmentation phenotypes. Another locus contains HLA class II genes studied in relation to elevated squamous cell carcinoma risk following immunosuppression. SNPs at the remaining three loci include an intronic SNP in FOXP1 at locus 3p13, an intergenic SNP at 3q28 near TP63, and an intergenic SNP at 9p22 near BNC2. These findings provide insights into the genetic factors accounting for inherited squamous cell carcinoma susceptibility. PMID:26829030

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

    PubMed

    Delbanco, Suzanne F

    2004-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  4. National healthcare capital project benchmarking--an owner's perspective.

    PubMed

    Kahn, Noah

    2009-01-01

    Few sectors of the economy have been left unscathed in these economic times. Healthcare construction has been less affected than residential and nonresidential construction sectors, but driven by re-evaluation of healthcare system capital plans, projects are now being put on hold or canceled. The industry is searching for ways to improve the value proposition for project delivery and process controls. In other industries, benchmarking component costs has led to significant, sustainable reductions in costs and cost variations. Kaiser Permanente and the Construction Industry Institute (CII), a research component of the University of Texas at Austin, an industry leader in benchmarking, have joined with several other organizations to work on a national benchmarking and metrics program to gauge the performance of healthcare facility projects. This initiative will capture cost, schedule, delivery method, change, functional, operational, and best practice metrics. This program is the only one of its kind. The CII Web-based interactive reporting system enables a company to view its information and mine industry data. Benchmarking is a tool for continuous improvement that is capable not only of grading outcomes; it can inform all aspects of the healthcare design and construction process and ultimately help moderate the increasing cost of delivering healthcare. PMID:21165876

  5. A nursing information model process for interoperability.

    PubMed

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

    2015-05-01

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

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

    PubMed Central

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

    2013-01-01

    Objectives. We examined the impact on patient safety if nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) were permitted to provide aspiration abortions in California. Methods. In a prospective, observational study, we evaluated the outcomes of 11 487 early aspiration abortions completed by physicians (n = 5812) and newly trained NPs, CNMs, and PAs (n = 5675) from 4 Planned Parenthood affiliates and Kaiser Permanente of Northern California, by using a noninferiority design with a predetermined acceptable risk difference of 2%. All complications up to 4 weeks after the abortion were included. Results. Of the 11 487 aspiration abortions analyzed, 1.3% (n = 152) resulted in a complication: 1.8% for NP-, CNM-, and PA-performed aspirations and 0.9% for physician-performed aspirations. The unadjusted risk difference for total complications between 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

  7. Kooperative Automation

    NASA Astrophysics Data System (ADS)

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

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

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

    PubMed

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

    2013-01-01

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

  9. Kaiser captures spirit of games.

    PubMed

    Herreria, J

    1998-01-01

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

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

    PubMed

    Ravanbakhsh, Samine; Batech, Michael; Tejirian, Talar

    2015-10-01

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

  11. Overview of the consortium of hospitals advancing research on tobacco (chart)

    PubMed Central

    2012-01-01

    Background The Consortium of Hospitals Advancing Research on Tobacco (CHART) is a network of six projects and a research coordinating unit funded by the National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institutes of Health (NIH) Office of Behavioral and Social Science Research. The CHART projects will assess the effectiveness and cost-effectiveness of smoking cessation interventions initiated during hospitalization and continued post-discharge. Methods/design Along with a seventh project funded previously under the NIH Challenge grants, the CHART projects will assess smoking cessation strategies delivered to approximately 10,000 hospitalized smokers across a geographically diverse group of nearly 20 private, public, academic, and community hospitals. The CHART research coordinating unit at Kaiser Permanente Center for Health Research provides organizational and data coordination support, facilitating the development of common measures for combining data from multiple CHART projects. Discussion The targeted enrollment in CHART, if achieved, will represent the largest, most diverse pooled dataset of hospitalized smokers receiving smoking cessation assistance, and is designed to contribute to the dissemination and implementation of smoking cessation interventions provided by hospital systems. PMID:22852768

  12. Can health care teams improve primary care practice?

    PubMed

    Grumbach, Kevin; Bodenheimer, Thomas

    2004-03-10

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

  13. Electronic Clinical Surveillance to Improve Outpatient Care: Diverse Applications within an Integrated Delivery System.

    PubMed

    Danforth, Kim N; Smith, Andrea E; Loo, Ronald K; Jacobsen, Steven J; Mittman, Brian S; Kanter, Michael H

    2014-01-01

    Efforts to improve patient safety have largely focused on inpatient or emergency settings, but the importance of patient safety in ambulatory care is increasingly being recognized as a key component of overall health care quality. Care gaps in outpatient settings may include missed diagnoses, medication errors, or insufficient monitoring of patients with chronic conditions or on certain medications. Further, care gaps may occur across a wide range of clinical conditions. We report here an innovative approach to improve patient safety in ambulatory settings - the Kaiser Permanente Southern California (KPSC) Outpatient Safety Net Program - which leverages electronic health information to efficiently identify and address a variety of potential care gaps across different clinical conditions. Between 2006 and 2012, the KPSC Outpatient Safety Net Program implemented 24 distinct electronic clinical surveillance programs, which routinely scan the electronic health record to identify patients with a particular condition or event. For example, electronic clinical surveillance may be used to scan for harmful medication interactions or potentially missed diagnoses (e.g., abnormal test results without evidence of subsequent care). Keys to the success of the program include strong leadership support, a proactive clinical culture, the blame-free nature of the program, and the availability of electronic health information. The Outpatient Safety Net Program framework may be adopted by other organizations, including those who have electronic health information but not an electronic health record. In the future, the creation of a forum to share electronic clinical surveillance programs across organizations may facilitate more rapid improvements in outpatient safety. PMID:25848588

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2015-06-15

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

  16. Manual and automated methods for identifying potentially preventable readmissions: a comparison in a large healthcare system

    PubMed Central

    2014-01-01

    Background Identification of potentially preventable readmissions is typically accomplished through manual review or automated classification. Little is known about the concordance of these methods. Methods We manually reviewed 459 30-day, all-cause readmissions at 18 Kaiser Permanente Northern California hospitals, determining potential preventability through a four-step manual review process that included a chart review tool, interviews with patients, their families, and treating providers, and nurse reviewer and physician evaluation of findings and determination of preventability on a five-point scale. We reassessed the same readmissions with 3 M’s Potentially Preventable Readmission (PPR) software. We examined between-method agreement and the specificity and sensitivity of the PPR software using manual review as the reference. Results Automated classification and manual review respectively identified 78% (358) and 47% (227) of readmissions as potentially preventable. Overall, the methods agreed about the preventability of 56% (258) of readmissions. Using manual review as the reference, the sensitivity of PPR was 85% and specificity was 28%. Conclusions Concordance between methods was not high enough to replace manual review with automated classification as the primary method of identifying preventable 30-day, all-cause readmission for quality improvement purposes. PMID:24708889

  17. Clinician’s use of automated reports of estimated glomerular filtration rate: A qualitative study

    PubMed Central

    2012-01-01

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

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

    PubMed Central

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

    2015-01-01

    Objective To determine whether treatments for precancerous cervical lesions were associated with lower pregnancy rates compared to rates in unexposed women and women who had a diagnostic cervical biopsy or colposcopy. Design Matched, retrospective cohort study. Setting Kaiser Permanente Northwest (KPNW), an integrated healthcare delivery system in Oregon and Washington. Patients Women 14 to 53 years old with KPNW enrollment during the period 1998 through 2009. Main Outcome Measure Pregnancy after exposure or index date. Pregnancy was defined using a validated algorithm and electronic medical records data. Results We observed 570 pregnancies following cervical treatment in 4,137 women, 1,533 pregnancies following a diagnostic procedure in 13,767 women, and 7,436 pregnancies in a frequency-matched sample of 81,435 women unexposed to treatment or diagnostic procedures. After adjusting for age and contraceptive use, we observed a higher rate of pregnancies in the treatment group compared to unexposed women (hazard ratio (HR) = 1.42, 95% confidence interval (CI): 1.30–1.55), but no difference in pregnancy rates between the treatment and diagnostic procedure groups (HR = 1.03, 95% CI: 0.93–1.13). Conclusions No adverse effects of cervical procedures on subsequent rates of pregnancy were observed in this cohort with up to twelve years of follow-up time. PMID:25671561

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-09-01

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

  1. Targeted maximum likelihood estimation in safety analysis

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

    Background. Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)–infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM. Methods. Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer. Results. Low CD4 count (<350 cells/mm3) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.28–10.40 and OR, 4.24; 95% CI, 1.16–15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43–5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection. Conclusions. We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression. PMID:23908478

  3. Health-Care Utilization by Prognosis Profile in a Managed Care Setting: Using the Surveillance, Epidemiology and End Results Cancer Survival Calculator SEER*CSC

    PubMed Central

    Ellis, Jennifer L.; Steiner, John F.; Nekhlyudov, Larissa; Feuer, Eric J.; Hankey, Benjamin F.; Cynkin, Laurie; Bayliss, Elizabeth

    2014-01-01

    Background Accurate estimation of the probability of dying of cancer versus other causes is needed to inform goals of care for cancer patients. Further, prognosis may also influence health-care utilization. This paper describes health service utilization patterns of subgroups of prostate cancer and colorectal cancer (CRC) patients with different relative probabilities of dying of their cancer or other conditions. Methods A retrospective cohort of cancer patients from Kaiser Permanente Colorado were divided into three groups using the predicted probabilities of dying of cancer and other causes calculated by the nomograms in the National Cancer Institute Surveillance, Epidemiology and End Results Cancer Survival Calculator. Demographic, disease-related characteristics, and health service utilization patterns were described across subgroups. Results The cohort consisted of 2092 patients (1102 prostate cancer and 990 CRC). A new diagnosis of cancer increased utilization of cancer-related services with rates as high as 9.1/1000 person-days for prostate cancer and 36.2/1000 person-days for CRC. Little change was observed in the number of primary and other specialty care visits from prediagnosis to 1 and 2 years postdiagnosis. Conclusions We found that although a new diagnosis of cancer increased utilization of cancer-related services for an extended time period, the timing of cancer diagnosis did not appear to affect other types of utilization. Future research should assess the reason for the lack of impact of cancer and unrelated comorbid conditions on utilization and whether desired outcomes of care were achieved. PMID:25417241

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

    PubMed Central

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

    2014-01-01

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

  5. Cost of Care for Cancer in a Health Maintenance Organization

    PubMed Central

    Fireman, Bruce H.; Quesenberry, Charles P.; Somkin, Carol P.; Jacobson, Alice S.; Baer, David; West, Dee; Potosky, Arnold L.; Brown, Martin L.

    1997-01-01

    The direct costs of medical care for cancer are examined at Kaiser Permanente (KP) in Northern California. Use data from July 1987 through June 1991 were obtained from KP automated files for all 21,977 KP patients in the Bay Area SEER registry with cancer at one of seven cancer sites. Medical charts were reviewed for a stratified sample of 886 patients. Costs were estimated for initial, continuing, and terminal care, and for all person time within 15 years of diagnosis, by stage at diagnosis. From diagnosis until death or 15 years, long-term costs attributable to cancer were as follows: breast, $35,000; colon, $42,000; rectum, $51,000; lung, $33,000; ovarian, $64,000; prostate, $29,000; and Non-Hodgkin's Lymphoma (NHL), $48,000. The utilization and cost results reported here may be useful in assessing the cost-effectiveness of cancer prevention and control programs, in adjusting capitation rates and budgets, and in estimating the aggregate medical care costs attributable to cancer. PMID:10175613

  6. A Model for Continuing Pharmacy Education

    PubMed Central

    Newlon, Carey; Dickerhofe, Jeannine

    2009-01-01

    Objective To develop and implement a continuing pharmacy education (CPE) program at Kaiser Permanente Colorado (KPCO) Design To address the continuing education needs of its diverse pharmacy staff, an internal continuing pharmacy education (CPE) program was developed. The pharmacy department became an accredited provider by the Accreditation Council for Pharmacy Education (ACPE). Live, interactive, and evidence-based CPE programs, presented by highly qualified internal staff members, utilized videoconferencing and a Web-based learning management system. Cross-accreditation of medical and pharmacy educational programs was offered to KPCO staff members. Assessment Annual needs assessments were conducted to ensure the provision of relevant educational topics and to assess learning needs. To demonstrate outcomes of the CPE programs, 2 methods were utilized: objective effectiveness assessment and knowledge acquisition assessment. This program met the objectives for CPE activities a large majority of the time (usually over 90%), demonstrated statistically significant (p < 0.05) improvement in knowledge from before to after the CPE activity in 11 of 13 questions asked, and minimized the cost to acquire CPE credit for both the pharmacy department and its staff members. Conclusion The KPCO continuing pharmacy education program has developed a high quality and cost-favorable system that has resulted in significant improvements in attendee knowledge. PMID:19777102

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

    PubMed Central

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

    2006-01-01

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

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

    PubMed

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

    2016-03-01

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

  9. Community relations 2.0.

    PubMed

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

    2009-11-01

    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

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

    PubMed

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

    2012-05-01

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

  11. A physician prescription for the nursing shortage.

    PubMed

    Cochran, John H

    2010-01-01

    In 2003, the Colorado Permanente Medical Group (CPMG), a 780-member, multispecialty physician group that provides ambulatory and hospital care principally in metropolitan Denver and Boulder, embarked upon a multifaceted program to leverage physician leadership to address the nursing shortage. Designated as the "Preferred Clinical Partner Program" (the PCP Program), CPMG sought to participate in solving the nursing shortage by engaging in a number of initiatives. Through an initial fund of $1 million, over $350,000 was used to fund nursing scholarships, over $150,000 was used to provide advanced training to a select group of health care professionals in a program that may be the first physician-partnered MA-to-LPN and RN-to-BSN initiative, and over $500,000 was devoted to building and expanding nursing simulation laboratories. Currently, the accelerated nursing program graduates approximately 32-35 nurses each year and has admitted its seventh cohort of students. Student retention has been excellent. PMID:20740134

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

    SciTech Connect

    Reynolds, P.

    1993-01-05

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

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

    PubMed

    Leonard, M; Graham, S; Bonacum, D

    2004-10-01

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

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

    PubMed Central

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

    2009-01-01

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

  15. Low Rate of Perinatal Sepsis in Term Infants of Mothers with Chorioamnionitis.

    PubMed

    Braun, David; Bromberger, Patricia; Ho, Ngoc J; Getahun, Darios

    2016-01-01

    Objective The risk of infection in infants of mothers with chorioamnionitis (CAM) may be lower than previously reported. This study's objective was to determine the incidence of intrapartum fever (IPF) and culture-positive early-onset bacterial neonatal infection (CPEOI) in the late preterm and term infants of mothers with or without CAM and to assess interhospital variation in neonatal infection management. Study Design This retrospective cohort study included mothers and newborns delivered at ≥35 weeks gestation at Kaiser Permanente Southern California Hospitals in 2010 (n = 31,112). Electronic medical and laboratory records from 13 medical centers were examined for maternal temperature, intrapartum, and neonatal antibiotic treatment. Rates for IPF, CAM, and CPEOI were estimated. Rates for starting neonatal antibiotics were calculated. Results The incidence of IPF was 9% and CAM 4%. The overall rate for CPEOI was 0.61/1,000 (95% confidence interval [CI] 0.34, 0.89/1,000). The rate of CPEOI was 4.0/1,000 (95% CI 0.50, 7.5/1,000) in infants born to mothers with CAM. The rate of beginning antibiotics for infants born to mothers with CAM ranged from 7 to 76% between nurseries. Conclusion The rate of CPEOI in infants born to mothers with CAM is lower than previously reported. There is heterogeneity in initiation of neonatal antibiotics by neonatologists. PMID:26352681

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

    PubMed Central

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

    2015-01-01

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

  17. The response of the US Centers for Disease Control and Prevention to the obesity epidemic.

    PubMed

    Dietz, William H

    2015-03-18

    The recognition of the obesity epidemic as a national problem began in 1999 with the Centers for Disease Control and Prevention's (CDC's) publication of a series of annual state-based maps that demonstrated the rapid changes in the prevalence of obesity. Increasing rates of obesity had been noted in earlier CDC studies, but the maps provided evidence of a rapid, nationwide increase. The urgent need to respond to the epidemic led to the identification of state targets and the first generation of interventions for obesity prevention and control. The CDC's role was to provide setting- and intervention-specific guidance on implementing these strategies, and to assess changes in targeted policies and behaviors. The CDC's efforts were augmented by Congressional funding for community initiatives to improve nutrition and increase physical activity. Complementary investments by Kaiser Permanente, the Robert Wood Johnson Foundation, and the Institute of Medicine improved the evidence base and provided policy recommendations that reinforced the need for a multisectoral approach. Legislative, regulatory, and voluntary initiatives enacted by President Obama's administration translated many of the strategies into effective practice. Whether current efforts to address obesity can be sustained will depend on whether they can be translated into greater grass-roots engagement consistent with a social movement. PMID:25581155

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

    PubMed

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

    2016-03-01

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

  19. Prevalence of childhood and adolescent overweight and obesity from 2003 to 2010 in an integrated health care delivery system.

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2015-10-01

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

  1. Family Characteristics Associated with Likelihood of Varicella Vaccination

    PubMed Central

    Weinmann, Sheila; Mullooly, John P; Drew, Lois; Chun, Colleen S

    2016-01-01

    Context: The introduction of the varicella vaccine as a routine pediatric immunization in the US, in 1995, provided an opportunity to assess factors associated with uptake of new vaccines in the member population of the Kaiser Permanente Northwest (KPNW) Health Plan. Objective: Identify factors associated with varicella vaccination in the KPNW population in the first five years after varicella vaccine was introduced. Design: A retrospective cohort of children under age 13 years between June 1995 and December 1999, without a history of varicella disease was identified using KPNW automated data. Membership records were linked to vaccine databases. Cox regression was used to estimate likelihood of varicella vaccination during the study period in relation to age, sex, primary clinician’s specialty, and Medicaid eligibility. For a subset whose parents answered a behavioral health survey, additional demographic and behavioral characteristics were evaluated. Main Outcome Measure: Varicella vaccination. Results: We identified 88,646 children under age 13 years without a history of varicella; 22% were vaccinated during the study period. Varicella vaccination was more likely among children who were born after 1995, were not Medicaid recipients, or had pediatricians as primary clinicians. In the survey-linked cohort, positively associated family characteristics included smaller family size; higher socioeconomic status; and parents who were older, were college graduates, reported excellent health, and received influenza vaccination. Conclusion: Understanding predictors of early varicella vaccine-era vaccine acceptance may help in planning for introduction of new vaccines to routine schedules. PMID:27104589

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

    PubMed

    Bitar, Roger A

    2016-02-01

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

  3. A comparison of maternal outcomes from an alcohol, tobacco, and other drug prevention program for mothers choosing an intervention versus being randomized.

    PubMed

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

    2013-04-01

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

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

    PubMed Central

    Lane-Carlson, Mary-Louise; Kumar, John

    2012-01-01

    Objective: To engage patients in managing their health care especially in relation to a total joint replacement (TJR). With the aging of the American population and the advent of new technology, there is an increase in TJRs. As the pendulum swings from evidence-based medicine to patient-centered medicine, presurgical education is preparing patients for their surgical experience. Most research studies on such education are quantitative in nature, preventing patients' voices from being heard. Methods: Using a success case narrative design, 24 patients mainly from the Kaiser Permanente Downey Medical Center were interviewed regarding their pre- and postsurgical experiences. Results: The study findings demonstrate that patient education, in the form of classes, with recognition of the participants' physical needs, social needs, concrete supports, and psychological needs as well as the willingness of the participants to work with their health care team can promote patient engagement and improved quality of life. Conclusion: The TJR class was found to promote a sense of social connectedness and fostered participants' independence. The results of this study can assist health care professionals to improve their practice by designing presurgical programs to meet the needs of their patients. PMID:23012598

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

    NASA Astrophysics Data System (ADS)

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

    1983-02-01

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

  6. Le patrimoine astronomique provençal

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

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

  7. La guerra de los Estados Unidos contra la inmigración. Efectos paradójicos1

    PubMed Central

    Massey, Douglas S.; Pren, Karen A.

    2016-01-01

    Resumen A finales de la década de los cincuenta, Estados Unidos permitía la entrada de aproximadamente medio millón de inmigrantes mexicanos al año, de los cuales 450.000 entraban con visados de trabajo temporal y 50.000 llegaban con visados de residentes permanentes. A mediados de los años sesenta, los cambios en la política migratoria de Estados Unidos realizados en nombre de los derechos civiles redujeron drásticamente las oportunidades de entrada legal a Estados Unidos. Se eliminaron los visados de trabajo temporal y se limitaron los visados de residentes a 20.000 por año. Con las oportunidades de entrada legal restringidas, los flujos migratorios ya establecidos simplemente continuaron, fuera de los límites legales, dando comienzo a una inesperada reacción en cadena de eventos que culminaron en una guerra total contra los inmigrantes y el rápido crecimiento -sin precedentes- de población residente no autorizada en Estados Unidos. El presente artículo demuestra que el aumento de inmigración indocumentada en los Estados Unidos y el crecimiento de la población sin papeles son un producto de políticas migratorias y fronterizas mal concebidas. PMID:27076695

  8. Delirio (PDQ®)—Versión para profesionales de salud

    Cancer.gov

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

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

    Cancer.gov

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

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

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

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

  11. Resultados del Estudio Nacional de Colografía de Tomografía

    Cancer.gov

    Estudios anteriores encontraron que la colografía de tomografía computarizada, también conocida como colonoscopia virtual, era prometedora como método de examen selectivo de detección de cáncer colorrectal debido

  12. Helenistic Encomium: A Reflection on Comics and Rhetoric

    ERIC Educational Resources Information Center

    Helms, Jason

    2009-01-01

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

  13. Glossary of MS Terms

    MedlinePlus

    ... en la experiencia y no en una teoría científica. Encéfalo (Se le conoce comúnmente como cerebro.) Parte ... el día anterior) como conversaciones, contenido de una lectura o programas de televisión. Las personas con deterioro ...

  14. Aflatoxinas

    Cancer.gov

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

  15. Rethinking Medical Professionalism: The Role of Information Technology and Practice Innovations

    PubMed Central

    Mechanic, David

    2008-01-01

    Context Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics, and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest, and distribute finite resources fairly. Information technology (IT), electronic health records (EHRs), improved models of disease management, and new ways of relating to and sharing responsibility for patients' care can contribute to both professionalism and quality of care. Methods The potential of IT, EHRs, and other practice facilitators for professionalism is assessed through diverse but relevant literatures, examination of relevant websites, and experience in working with medical leaders on renewing professionalism. Findings IT and EHRs are the basis of needed efforts to reinforce medical competence, improve relationships with patients, implement disease management programs, and, by increasing transparency and accountability, help reduce some conflicts of interest. Barriers include the misalignment of goals with payment incentives and time pressures in meeting patients' expectations and practice demands. Implementing IT and EHRs in small, dispersed medical practices is particularly challenging because of short-term financial costs, disruptions in practice caused by learning and adaptation, and the lack of confidence in needed support services. Large organized systems like the VA, Kaiser Permanente, and general practice in the United Kingdom have successfully overcome such challenges. Conclusions IT and the other tools examined in this article are important adjuncts to professional capacities and aspirations. They have potential to help reverse the decline of primary care and make physicians' practices more effective and rewarding. The cooperation, collaboration, and shared responsibility of government, insurers, medical organizations, and physicians, as well as financial and technical support, are needed to implement these tools in the United States' dispersed and fragmented medical care system. PMID:18522615

  16. Adverse Fetal Outcomes Associated with Immunosuppressive Medications for Chronic Immune Mediated Diseases in Pregnancy

    PubMed Central

    Cooper, William O.; Cheetham, T. Craig; Li, De-Kun; Stein, C. Michael; Callahan, S. Todd; Morgan, Thomas M.; Shintani, Ayumi K.; Chen, Ning; Griffin, Marie R.; Ray, Wayne A.

    2014-01-01

    Objective We assessed the risk of adverse fetal outcomes following exposure to individual immunosuppressive drugs in pregnant women with chronic immune mediated diseases. Methods We used health plan data from Tennessee Medicaid and Kaiser Permanente Northern California and Southern California linked with vital records and medical records. Women with inflammatory arthropathies, systemic lupus erythematosus, and inflammatory bowel disease who filled prescriptions for immunosuppressive treatments during pregnancy were included. Major congenital malformations, fetal deaths, and life-threatening neonatal complications were identified from electronic data and validated with medical record review. Results The cohort included 608 infants, including 437 with exposure during pregnancy (402 first trimester, 35 second and third trimester only) and 171 whose mothers filled prescriptions for immunosuppressives before, but not during, pregnancy. There were 25 pregnancies (4.1% of the cohort) with confirmed major congenital malformations, 10 fetal deaths (1.6%), 23 life-threatening neonatal complications among preterm infants (20.4%), and 10 (2.1%) life-threatening complications among term infants. Compared to the reference group (medication treatment before, but not during, pregnancy), the risk ratios for adverse fetal outcomes associated with immunosuppressive use during pregnancy by exposure category included: methotrexate [risk ratio 1.39 (95% confidence interval 0.43,4.53)], tumor necrosis factor inhibitors [0.98 (0.38,2.55)], hydroxychloroquine [1.33 (0.69,2.55)], and other immunosuppressives [0.98, (0.48,1.98)]. Conclusions We found no evidence of a large increase in risk of adverse fetal outcomes from first trimester exposure to immunosuppressive medications, though confidence intervals for risk ratios were wide. Further studies will be needed as use of these medications increases over time. PMID:24504818

  17. Sentinel Lymph Node Biopsy for Patients with Breast Cancer: Five-Year Experience

    PubMed Central

    Godfrey, Richard S; Holmes, Dennis R; Kumar, Anjali S; Kutner, Susan E

    2005-01-01

    Background: Sentinel lymph node biopsy (SLNB) is rapidly gaining acceptance as a diagnostic tool for staging breast cancer. Objective: Analyze trends among surgeons and facilities in Kaiser Permanente Northern California (KPNC) in adopting SLNB to stage cases of breast cancer and assess success in locating the sentinel node. Methods: Retrospective review of data for patients whose breast cancer was staged using SLNB and axillary lymph node dissection between July 1997 through December 2002 at KPNC. Rates of false-negative results were calculated and stratified by surgeons' experience with SLNB. Results: The number of SLNB procedures performed each month increased steadily from fewer than ten (in late 1998) to about 80 per month (in mid-2002) and were done at 17 facilities. Of the 132 surgeons who performed SLNB, most had done fewer than 15 procedures. The false-negative result rate overall was 6.53% (95% CI 4.75%, 8.73%); for surgeons who performed <30 procedures the rate was 8.58% (95% CI 5.52%, 12.60%); for surgeons who performed 20 to 30 procedures the rate was 13.08% (95% CI 7.34%, 20.98%); and for surgeons who performed more than 30 procedures the rate was 5.05% (95% CI 3.07%, 7.78%). Conclusions: SLNB is rapidly being adopted at KPNC to stage cases of breast cancer and surgeons achieve an acceptable 6.53% false-negative result rate overall. The higher false-negative rate for surgeons who performed 20 to 30 procedures suggests that departments should expand efforts to monitor and proctor these surgeons. PMID:21687490

  18. Rubber dam use during routine operative dentistry procedures: findings from the Dental PBRN.

    PubMed

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

    2010-01-01

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

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

    PubMed Central

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

    2015-01-01

    A genome-wide association study of prostate cancer in Kaiser Permanente health plan members (7,783 cases, 38,595 controls; 80.3% non-Hispanic white, 4.9% African-American, 7.0% East Asian, 7.8% Latino) revealed a new independent risk indel rs4646284 at the previously-identified locus 6q25.3 that replicated in PEGASUS (N=7,539) and MEC (N=4,679) (p=1.0×10−19, OR=1.18). Across the 6q25.3 locus, rs4646284 exhibited the strongest association with expression of SLC22A1 (p=1.3×10−23) and SLC22A3 (p=3.2×10−52). At the known 19q13.33 locus rs2659124 (p=1.3×10−13, OR=1.18) nominally replicated in PEGASUS. A risk score of 105 known risk SNPs was strongly associated with prostate cancer (p<1.0×10−8). Comparing the highest to lowest risk score deciles, the OR was 6.22 for non-Hispanic Whites, 5.82 for Latinos, 3.77 for African-Americans, and 3.38 for East Asians. In non-Hispanic whites, the 105 risk SNPs explained ~7.6% of disease heritability. The entire GWAS array explained ~33.4% of heritability, with a 4.3-fold enrichment within DNaseI hypersensitivity sites (p=0.004). PMID:26034056

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

    PubMed Central

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

    2013-01-01

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

  1. Mothers of Children Diagnosed with Attention-Deficit/Hyperactivity Disorder: Health Conditions and Medical Care Utilization in Periods Before and After Birth of the Child

    PubMed Central

    Ray, G. Thomas; Croen, Lisa A.; Habel, Laurel A.

    2009-01-01

    Background Analyzing health conditions and medical utilization of mothers of children with attention-deficit/hyperactivity disorder (ADHD) can shed light on biological, environmental, and psychosocial factors relating to ADHD. Objective To examine health conditions, health care utilization, and costs of mothers of children with ADHD in periods before the child was diagnosed. Methods Using automated data from Northern California Kaiser Permanente we identified mothers of children with ADHD, mothers of children without ADHD, and mothers of children with asthma. Mothers’ diagnostic clusters, health care utilization, and costs were compared. Mothers of children with ADHD were compared to mothers of children without ADHD and, separately, to mothers of children with asthma. Results Compared to mothers of children without ADHD, mothers of children with ADHD were more likely to be diagnosed with numerous medical and mental health problems in the two years after birth of their child, including depression (Odds Ratio (OR): 1.88), anxiety neuroses (OR: 1.64), obesity (OR: 1.70), and musculoskeletal symptoms (OR: 1.51). Results were similar for the year before delivery. Mothers of children with ADHD also had higher total health care costs per person in the year before ($1003) and the two years after ($953) the birth of their child. Mothers of children with ADHD also were diagnosed with more health conditions and had higher health care costs than mothers of children with asthma. Conclusions Our findings suggest that the likelihood of being diagnosed with ADHD is related to maternal conditions and use of health services that precede the child’s diagnosis. Future studies are needed to clarify whether this is due to biologic, psychosocial, or environmental factors, or a combination. PMID:19106738

  2. The Multigroup Ethnic Identity Measure-Revised: Measurement invariance across racial and ethnic groups

    PubMed Central

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

    2014-01-01

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

  3. Analyzing historical trends in breast cancer biomarker expression: a feasibility study (1947–2009)

    PubMed Central

    Krieger, Nancy; Habel, Laurel A; Waterman, Pamela D; Shabani, Melina; Ellison-Loschmann, Lis; Achacoso, Ninah S; Acton, Luana; Schnitt, Stuart J

    2016-01-01

    BACKGROUND/OBJECTIVES Determining long-term trends in tumor biomarker expression is essential for understanding aspects of tumor biology amenable to change. Limiting the availability of such data, currently used assays for biomarkers are relatively new. For example, assays for the estrogen receptor (ER), which are the oldest, extend back only to the 1970s. METHODS To extend scant knowledge about the feasibility of obtaining long-term data on tumor biomarkers, we randomly selected 60 breast cancer cases (10 per decade) diagnosed between 1947–2009 among women members of the Kaiser Permanente Northern California health plan to obtain and analyze their formalin-fixed paraffin-embedded (FFPE) tumor specimens. For each tumor specimen, we created duplicate tissue microarrays for analysis. RESULTS We located tumor blocks and pathology reports for 50 of the 60 cases (83%), from which we randomly sampled 5 cases per decade for biomarker analysis (n = 30). All 30 cases displayed excellent morphology and exhibited biomarkers compatible with histologic type and grade. Test–retest reliability was also excellent: 100% for ER; 97% for human epidermal growth factor receptor 2 and epidermal growth factor receptor; 93% for progesterone receptor and cytokeratin 5/6; and 90% for Ki67 and molecular phenotype; the kappa statistic was excellent (>0.9) for 4 of the 7 biomarkers, strong (0.6–0.8) for 2, and fair for only 1 (owing to low prevalence). CONCLUSIONS These results indicate immunostaining for biomarkers commonly used to evaluate breast cancer biology and assign surrogate molecular phenotypes can reliably be employed on archival FFPE specimens up to 60 years old. PMID:26807440

  4. Pneumococcal conjugate vaccines and otitis media: an appraisal of the clinical trials.

    PubMed

    Fletcher, Mark A; Fritzell, Bernard

    2012-01-01

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

  5. The effect of bariatric surgery on psychiatric course among patients with bipolar disorder

    PubMed Central

    Ahmed, Ameena T; Warton, E. Margaret; Schaefer, Catherine A; Shen, Ling; McIntyre, Roger S

    2013-01-01

    Objective Bariatric surgery is the most effective therapy for severe obesity. People with bipolar disorder have increased risk of obesity, yet are sometimes considered ineligible for bariatric surgery due to their bipolar disorder diagnosis. This study aimed to determine if bariatric surgery alters the psychiatric course among stable patients with bipolar disorder. Methods A matched cohort study (2006–2009) with mean follow-up of 2.17 years, was conducted within Kaiser Permanente Northern California, a group practice integrated health services delivery organization that provides medical and psychiatric care to 3.3 million people. Participants were 144 severely obese patients with bipolar disorder who underwent bariatric surgery, and 1,440 control patients with bipolar disorder, matched for gender, medical center, and contemporaneous health plan membership. Controls met referral criteria for bariatric surgery. Hazard ratio for psychiatric hospitalization, and change in rate of outpatient psychiatric utilization from baseline to Years 1 and 2, were compared between groups. Results A total of 13 bariatric surgery patients (9.0%) and 153 unexposed to surgery (10.6%) had psychiatric hospitalization during follow-up. In multivariate Cox models adjusting for potential confounding factors, the hazard ratio of psychiatric hospitalization associated with bariatric surgery was 1.03 [95% confidence interval (CI) 0.83–1.23]. In fully saturated multivariate general linear models, change in outpatient psychiatric utilization was not significantly different for surgery patients versus controls, from baseline to Year 1 (−0.4 visits/year, 95% CI: −0.5 to 0.4) or baseline to Year 2 (0.4 visits/year, 95% CI: −0.1 to 1.0). Conclusions Bariatric surgery did not affect psychiatric course among stable patients with bipolar disorder. The results of this study suggest that patients with bipolar disorder who have been evaluated as stable can be considered for bariatric surgery. PMID:23909994

  6. Failure to replicate an association of SNPs in the oxidized LDL receptor gene (OLR1) with CAD

    PubMed Central

    Knowles, Joshua W; Assimes, Themistocles L; Boerwinkle, Eric; Fortmann, Stephen P; Go, Alan; Grove, Megan L; Hlatky, Mark; Iribarren, Carlos; Li, Jun; Myers, Richard; Risch, Neil; Sidney, Stephen; Southwick, Audrey; Volcik, Kelly A; Quertermous, Thomas

    2008-01-01

    Background The lectin-like oxidized LDL receptor LOX-1 (encoded by OLR1) is believed to play a key role in atherogenesis and some reports suggest an association of OLR1 polymorphisms with myocardial infarction (MI). We tested whether single nucleotide polymorphisms (SNPs) in OLR1 are associated with clinically significant CAD in the Atherosclerotic Disease, VAscular FuNction, & Geneti C Epidemiology (ADVANCE) study. Methods ADVANCE is a population-based case-control study of subjects receiving care within Kaiser Permanente of Northern California including a subset of participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. We first resequenced the promoter, exonic, and splice site regions of OLR1 and then genotyped four single nucleotide polymorphisms (SNPs), including a non-synonymous SNP (rs11053646, Lys167Asn) as well as an intronic SNP (rs3736232) previously associated with CAD. Results In 1,809 cases with clinical CAD and 1,734 controls, the minor allele of the coding SNP was nominally associated with a lower odds ratio (OR) of CAD across all ethnic groups studied (minimally adjusted OR 0.8, P = 0.007; fully adjusted OR 0.8, P = 0.01). The intronic SNP was nominally associated with an increased risk of CAD (minimally adjusted OR 1.12, p = 0.03; fully adjusted OR 1.13, P = 0.03). However, these associations were not replicated in over 13,200 individuals (including 1,470 cases) in the Atherosclerosis Risk in Communities (ARIC) study. Conclusion Our results do not support the presence of an association between selected common SNPs in OLR1 and the risk of clinical CAD. PMID:18384690

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

    PubMed Central

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

    2009-01-01

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

  8. A near null variant of 12/15-LOX encoded by a novel SNP in ALOX15 and the risk of coronary artery disease

    PubMed Central

    Assimes, Themistocles L.; Knowles, Joshua W.; Priest, James R.; Basu, Analabha; Borchert, Astrid; Volcik, Kelly A.; Grove, Megan L.; Tabor, Holly K.; Southwick, Audrey; Tabibiazar, Raymond; Sidney, Steve; Boerwinkle, Eric; Go, Alan S.; Iribarren, Carlos; Hlatky, Mark A.; Fortmann, Stephen P.; Myers, Richard M.; Kuhn, Hartmut; Risch, Neil; Quertermous, Thomas

    2008-01-01

    Objective Murine genetic models suggest that function of the 12/15 LOX enzyme promotes atherosclerosis. We tested the hypothesis that exonic and/or promoter single nucleotide polymorphisms (SNPs) in the human 12/15-LOX gene (ALOX15) alter the risk of symptomatic coronary artery disease (CAD). Methods & Results We resequenced ALOX15 and then genotyped a common promoter and a less common novel coding SNP (T560M) in 1809 subjects with CAD and 1734 controls from Kaiser Permanente including a subset of participants of the Coronary Artery Risk Development in Young Adults study. We found no association between the promoter SNP and the risk of CAD. However, heterozygote carriers of the 560M allele had an increased risk of CAD (adjusted OR, 1.62; P=0.02) compared to non-carriers. In vitro studies demonstrated a 20-fold reduction in the catalytic activity of 560M when compared to 560T. We then genotyped T560M in 12974 participants of the Atherosclerosis Risk in Communities study and similarly found that heterozygote carriers had an increased risk of CAD compared to non-carriers (adjusted HR, 1.31; P=0.06). In both population studies, homozygote carriers were rare and associated with a non-significant decreased risk of CAD compared to non-carriers (adjusted OR, 0.55; P=0.63 and HR, 0.93; P=0.9). Conclusions A coding SNP in ALOX15 (T560M) results in a near null variant of human 12/15-LOX. Assuming a co-dominant mode of inheritance, this variant does not protect against CAD. Assuming a recessive mode of inheritance, the effect of this mutation remains unclear, but is unlikely to provide a protective effect to the degree suggested by mouse knockout studies. PMID:17959182

  9. Population Care Management and Team-Based Approach to Reduce Racial Disparities among African Americans/Blacks with Hypertension

    PubMed Central

    Bartolome, Rowena E; Chen, Agnes; Handler, Joel; Platt, Sharon Takeda; Gould, Bernice

    2016-01-01

    Objectives: At Kaiser Permanente, national Equitable Care Health Outcomes (ECHO) Reports with a baseline measurement of 16 Healthcare Effectiveness Data and Information Set measures stratified by race and ethnicity showed a disparity of 8.1 percentage points in blood pressure (BP) control rates between African- American/black (black) and white members. The aims of this study were to describe a population care management team-based approach to improve BP control for large populations and to explain how a culturally tailored, patient-centered approach can address this racial disparity. Methods: These strategies were implemented through: 1) physician-led educational programs on treatment intensification, medication adherence, and consistent use of clinical practice guidelines; 2) building strong care teams by defining individual roles and responsibilities in hypertension management; 3) redesign of the care delivery system to expand access; and 4) programs on culturally tailored communication tools and self-management. Results: At a physician practice level where 65% of patients with hypertension were black, BP control rates (< 140/90 mmHg) for blacks improved from 76.6% to 81.4%, and control rates for whites increased from 82.9% to 84.2%. The racial gap narrowed from 6.3% to 2.8%. As these successful practices continue to spread throughout the program, the health disparity gap in BP control has decreased by 50%, from 8.1% to 3.9%. Conclusion: A sustainable program to collect self-reported race, ethnicity, and language preference data integrated with successful population care management programs provided the foundation for addressing health disparities. Cultural tailoring of a multilevel team-based approach closed the gap for blacks with hypertension. PMID:26824963

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

    PubMed Central

    2013-01-01

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

  11. Population Variations in Rheumatoid Arthritis Treatment and Outcomes, Northern California, 1998–2009

    PubMed Central

    Herrinton, Lisa J; Harrold, Leslie; Salman, Craig; Liu, Liyan; Goldfien, Robert; Asgari, Maryam; Gelfand, Joel M; Wu, Jashin J; Curtis, Jeffrey R

    2016-01-01

    Objective: To assess variations in rheumatoid arthritis treatment and outcomes at the community level from 1998 through 2009. Methods: The study used computerized data from 16 Kaiser Permanente Northern California Medical Centers. Mixed modeling was used to assess patterns across time and clinic. The analysis accounted for patient demographics, clustering of patients within Medical Centers, and repeated measures of patients over time. The metric used to measure drug use, months of use per patient per year, included both users and nonusers in the denominator, to account for both prevalence and duration of use. Results: Assessment was performed of 28,601 patients with rheumatoid arthritis, with all levels of severity. From 1998 through 2009, methotrexate use doubled in the typical patient to include 23% of the time they were observed; sulfasalazine and hydrochloroquine use declined. By 2008 through 2009, leflunomide and antitumor necrosis factor agents were used by the typical patient 4% and 9% of the time, respectively. Between 1998 and 2009, disease-modifying antirheumatic drug use increased in the typical patient from 38% to 63% of the time, and oral prednisone use declined from 23% to 15% of the time, whereas opioid use initially rose but then fell to 23% of the time. No variations over time were observed for the rate of hospitalized pneumonia or opportunistic infection. Variation across clinics, measured by the difference in drug use between clinics at the 75th and 25th percentiles, was lowest for opioids (25% vs 20% of the time) and greatest for infliximab (< 1% to 3%). Conclusion: Increased use of disease-modifying antirheumatic drugs and declines in prednisone are encouraging. Opioid use may need intervention. PMID:26694020

  12. Treatment Intensification and Risk Factor Control: A Quality Improvement Perspective

    PubMed Central

    Selby, Joe V.; Uratsu, Connie S; Fireman, Bruce; Schmittdiel, Julie A; Peng, Tiffany; Rodondi, Nicolas; Karter, Andrew J; Kerr, Eve A.

    2014-01-01

    Background Intensification of pharmacotherapy in persons with poorly controlled chronic conditions has been proposed as a clinically meaningful process measure of quality. Objective To validate measures of treatment intensification by evaluating their associations with subsequent control in hypertension, hyperlipidemia, and diabetes mellitus across 35 medical facility populations in Kaiser Permanente, Northern California. Design Two-level, hierarchical analyses of associations of improvements in facility-level treatment intensification rates from 2001 to 2003 with patient-level risk factor levels at the end of 2003. Patients 515,072 and 626,130 members (age > 20 years) with hypertension, hyperlipidemia, and/or diabetes mellitus in 2001 and 2003, respectively. Measurements Treatment intensification for each risk factor defined as an increase in number of drug classes prescribed, of dosage for at least one drug, or switching to a drug from another class within 3 months of observed poor risk factor control. Results Facility-level improvements in treatment intensification rates between 2001 and 2003 were strongly associated with greater likelihood of being in control at the end of 2003 (p≤0.01 for each risk factor) after adjustment for patient- and facility-level covariates. Compared to facility rankings based solely on control, addition of percentages of poorly controlled patients who received treatment intensification changed 2003 rankings substantially: 14%, 51%, and 29%) of the facilities changed ranks by 5 or more positions for hypertension, hyperlipidemia, and diabetes, respectively. Conclusions Treatment intensification is tightly linked to improved control. Thus, it should be an effective process measure for motivating quality improvement and for measuring clinical performance. PMID:19330888

  13. Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010–2013

    PubMed Central

    Xu, Hairong; Xu, Lanfang; Page, John H; Cannavale, Kim; Sattayapiwat, Olivia; Rodriguez, Roberto; Chao, Chun

    2016-01-01

    Purpose The purpose of this study was to evaluate and characterize the risk of anemia during the course of chemotherapy among patients with five common types of solid tumors. Patients and methods Patients diagnosed with incident cancers of breast, lung, colon/rectum, stomach, and ovary who received chemotherapy were identified from Kaiser Permanente Southern California Health Plan (2010–2012). All clinical data were collected from the health plan’s electronic medical records. Incidence proportions of patients developing anemia and 95% confidence intervals were calculated overall and by anemia severity and type, as well as by stage at cancer diagnosis, and by chemotherapy regimen and cycle. Results A total of 4,426 patients who received chemotherapy were included. Across cancers, 3,962 (89.5%) patients developed anemia during the course of chemotherapy (normocytic 85%, macrocytic 10%, microcytic 5%; normochromic 47%, hyperchromic 44%, hypochromic 9%). The anemia grades were distributed as follows: 58% were grade 1, 34% grade 2, 8% grade 3, and <1% grade 4. The incidence of grade 2+ anemia ranged from 26.3% in colorectal cancer patients to 59.2% in ovarian cancer patients. Incidence of grade 2+ anemia increased from 29% in stage I to 49% in stage IV. Incidence of grade 2+ anemia varied from 18.2% in breast cancer patients treated with cyclophosphamide + docetaxel regimen to 59.7% in patients with ovarian cancer receiving carboplatin + paclitaxel regimen. Conclusion The incidence of moderate-to-severe anemia (hemoglobin <10 g/dL) remained considerably high in patients with solid tumors receiving chemotherapy. The risk of anemia was greater in patients with distant metastasis. PMID:27186078

  14. Dietary practices, alcohol consumption, and smoking behavior: ethnic, sex, and acculturation differences.

    PubMed

    Otero-Sabogal, R; Sabogal, F; Pérez-Stable, E J; Hiatt, R A

    1995-01-01

    Current knowledge is scarce on Latino dietary practices. This study compared the dietary practices, alcohol consumption, and smoking behavior of Latinos and non-Latino whites in two randomly selected samples. Telephone surveys of adults 35-74 years of age from the Kaiser Permanente Medical Care Program (Latinos = 844; non-Latino whites = 510) and from census tract-based areas (Latinos = 806; non-Latino whites = 436) were conducted in the San Francisco Bay Area. Latino ethnicity was a significant predictor of dietary and alcohol consumption practices in multivariate logistic regression models after adjustment for sex, education, age, employment, health insurance, martial status, county of residence, and self-perceived health status. Compared with non-Latino whites, Latinos were significantly less likely to report eating vegetables and more likely to eat rice, beans, and fried foods and to drink whole milk. Less acculturated Latinos were more likely to eat fruits, rice, beans, meat, and fried foods and to drink whole milk than more acculturated Latinos. Latino men were significantly more likely to be binge drinkers, and Latina women were significantly more likely to abstain from drinking alcohol during the month prior to the interview. As Latina women acculturate to the U.S. mainstream, they report more cigarette smoking and alcohol consumption. Although Latinos reported higher levels of selected high-fiber foods, the low consumption of vegetables, widespread use of saturated fat, and the heavy drinking and smoking among Latino men, which are associated with the level of acculturation, may increase the risk for cancer. Educational messages targeting less acculturated Latinos should focus on maintaining their current healthy dietary practices of eating fruits, rice, and beans and decreasing their fat consumption. For more acculturated Latinos, emphasis should be placed on resuming the traditional diet. PMID:8562225

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

    PubMed Central

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

    2002-01-01

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

  16. Preoperative Safety Briefing Project

    PubMed Central

    DeFontes, James; Surbida, Stephanie

    2004-01-01

    Context: Increased media attention on surgical procedures that were performed on the wrong anatomic site or wrong patient has prompted the health care industry to identify and address human factors that lead to medical errors. Objective: To increase patient safety in the perioperative setting, our objective was to create a climate of improved communication, collaboration, team-work, and situational awareness while the surgical team reviewed pertinent information about the patient and the pending procedure. Methods: A team of doctors, nurses, and technicians used human factors principles to develop the Preoperative Safety Briefing for use by surgical teams, a briefing similar to the preflight checklist used by the airline industry. A six-month pilot of the briefing began in the Kaiser Permanente (KP) Anaheim Medical Center in February 2002. Four indicators of safety culture were used to measure success of the pilot: occurrence of wrong-site/wrong procedures, attitudinal survey data, near-miss reports, and nursing personnel turnover data. Results: Wrong-site surgeries decreased from 3 to 0 (300%) per year; employee satisfaction increased 19%; nursing personnel turnover decreased 16%; and perception of the safety climate in the operating room improved from “good” to “outstanding.” Operating suite personnel perception of teamwork quality improved substantially. Operating suite personnel perception of patient safety as a priority, of personnel communication, of their taking responsibility for patient safety, of nurse input being well received, of overall morale, and of medical errors being handled appropriately also improved substantially. Conclusions: Team members who work together and communicate well can quickly detect and more easily avoid errors. The Preoperative Safety Briefing is now standard in many operating suites in the KP Orange County Service Area. The concepts and design of this project are transferable, and similar projects are underway in the Departments of Radiology and of Labor and Delivery at KP Anaheim Medical Center. PMID:26704913

  17. Age-Stratified 5-Year Risks of Cervical Precancer among Women with Enrollment and Newly Detected HPV Infection

    PubMed Central

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

    2014-01-01

    It is unclear whether a woman's age influences her risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) upon detection of HPV. A large change in risk as women age would influence vaccination and screening policies. Among 972,029 women age 30-64 undergoing screening with Pap and HPV testing (Hybrid Capture 2, Qiagen, Germantown, MD, USA) at Kaiser Permanente Northern California (KPNC), we calculated age-specific 5-year CIN3+ risks among women with HPV infections detected at enrollment, and among women with “newly detected” HPV infections at their second screening visit. 57,899 women (6.0%) had an enrollment HPV infection. Among the women testing HPV negative at enrollment with a second screening visit, 16,724 (3.3%) had a newly detected HPV infection at their second visit. Both enrollment and newly detected HPV rates declined with age (p<.001). Women with enrollment vs. newly detected HPV infection had higher 5-year CIN3+ risks: 8.5% vs. 3.9%, (p<.0001). Risks did not increase with age but declined slightly from 30-34 years to 60-64 years: 9.4% vs. 7.4% (p=0.017) for enrollment HPV and 5.1% vs. 3.5% (p=0.014) for newly detected HPV. Among women age 30-64 in an established screening program, women with newly detected HPV infections were at lower risk than women with enrollment infections, suggesting reduced benefit vaccinating women at older ages. Although the rates of HPV infection declined dramatically with age, the subsequent CIN3+ risks associated with HPV infection declined only slightly. The CIN3+ risks among older women are sufficiently elevated to warrant continued screening through age 65. PMID:25136967

  18. Applications of machine learning and data mining methods to detect associations of rare and common variants with complex traits.

    PubMed

    Lu, Ake Tzu-Hui; Austin, Erin; Bonner, Ashley; Huang, Hsin-Hsiung; Cantor, Rita M

    2014-09-01

    Machine learning methods (MLMs), designed to develop models using high-dimensional predictors, have been used to analyze genome-wide genetic and genomic data to predict risks for complex traits. We summarize the results from six contributions to our Genetic Analysis Workshop 18 working group; these investigators applied MLMs and data mining to analyses of rare and common genetic variants measured in pedigrees. To develop risk profiles, group members analyzed blood pressure traits along with single-nucleotide polymorphisms and rare variant genotypes derived from sequence and imputation analyses in large Mexican American pedigrees. Supervised MLMs included penalized regression with varying penalties, support vector machines, and permanental classification. Unsupervised MLMs included sparse principal components analysis and sparse graphical models. Entropy-based components analyses were also used to mine these data. None of the investigators fully capitalized on the genetic information provided by the complete pedigrees. Their approaches either corrected for the nonindependence of the individuals within the pedigrees or analyzed only those who were independent. Some methods allowed for covariate adjustment, whereas others did not. We evaluated these methods using a variety of metrics. Four contributors conducted primary analyses on the real data, and the other two research groups used the simulated data with and without knowledge of the underlying simulation model. One group used the answers to the simulated data to assess power and type I errors. Although the MLMs applied were substantially different, each research group concluded that MLMs have advantages over standard statistical approaches with these high-dimensional data. PMID:25112194

  19. MicroRNA profiles in colorectal carcinomas, adenomas and normal colonic mucosa: variations in miRNA expression and disease progression.

    PubMed

    Slattery, Martha L; Herrick, Jennifer S; Pellatt, Daniel F; Stevens, John R; Mullany, Lila E; Wolff, Erica; Hoffman, Michael D; Samowitz, Wade S; Wolff, Roger K

    2016-03-01

    MiRNAs are small, non-protein-coding RNA molecules that regulate gene expression either by post-transcriptionally suppressing mRNA translation or by mRNA degradation. We examine differentially expressed miRNAs in colorectal carcinomas, adenomas and normal colonic mucosa. Data come from population-based studies of colorectal cancer conducted in Utah and the Kaiser Permanente Medical Care Program. A total of 1893 carcinoma/normal-paired samples and 290 adenoma tissue samples were run on the Agilent Human miRNA Microarray V19.0 which contained 2006 miRNAs. We tested for significant differences in miRNA expression between paired carcinoma/adenoma/normal colonic tissue samples. Fewer than 600 miRNAs were expressed in >80% of people for colonic tissue; of these 86.5% were statistically differentially expressed between carcinoma and normal colonic mucosa using a false discovery rate of 0.05. Roughly half of these differentially expressed miRNAs showed a progression in levels of expression from normal to adenoma to carcinoma tissue. Other miRNAs appeared to be altered at the normal to adenoma stage, while others were only altered at the adenoma to carcinoma stage or only at the normal to carcinoma stage. Evaluation of the Agilent platform showed a high degree of repeatability (r = 0.98) and reasonable agreement with the NanoString platform. Our data suggest that miRNAs are highly dysregulated in colorectal tissue among individuals with colorectal cancer; the pattern of disruption varies by miRNA as tissue progresses from normal to adenoma to carcinoma. PMID:26740022

  20. Developing an Algorithm to Identify History of Cancer Using Electronic Medical Records

    PubMed Central

    Clarke, Christina L.; Feigelson, Heather S.

    2016-01-01

    Introduction/Objective: The objective of this study was to develop an algorithm to identify Kaiser Permanente Colorado (KPCO) members with a history of cancer. Background: Tumor registries are used with high precision to identify incident cancer, but are not designed to capture prevalent cancer within a population. We sought to identify a cohort of adults with no history of cancer, and thus, we could not rely solely on the tumor registry. Methods: We included all KPCO members between the ages of 40–75 years who were continuously enrolled during 2013 (N=201,787). Data from the tumor registry, chemotherapy files, inpatient and outpatient claims were used to create an algorithm to identify members with a high likelihood of cancer. We validated the algorithm using chart review and calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for occurrence of cancer. Findings: The final version of the algorithm achieved a sensitivity of 100 percent and specificity of 84.6 percent for identifying cancer. If we relied on the tumor registry alone, 47 percent of those with a history of cancer would have been missed. Discussion: Using the tumor registry alone to identify a cohort of patients with prior cancer is not sufficient. In the final version of the algorithm, the sensitivity and PPV were improved when a diagnosis code for cancer was required to accompany oncology visits or chemotherapy administration. Conclusion: Electronic medical record (EMR) data can be used effectively in combination with data from the tumor registry to identify health plan members with a history of cancer. PMID:27195308

  1. Immune mediated conditions in autism spectrum disorders.

    PubMed

    Zerbo, Ousseny; Leong, Albin; Barcellos, Lisa; Bernal, Pilar; Fireman, Bruce; Croen, Lisa A

    2015-05-01

    We conducted a case-control study among members of Kaiser Permanente Northern California (KPNC) born between 1980 and 2003 to determine the prevalence of immune-mediated conditions in individuals with autism, investigate whether these conditions occur more often than expected, and explore the timing of onset relative to autism diagnosis. Cases were children and young adults with at least two autism diagnoses recorded in outpatient records (n=5565). Controls were children without autism randomly sampled at a ratio of 5 to 1, matched to cases on birth year, sex, and length of KPNC membership (n=27,825). The main outcomes - asthma, allergies, and autoimmune diseases - were identified from KPNC inpatient and outpatient databases. Chi-square tests were used to evaluate case-control differences. Allergies and autoimmune diseases were diagnosed significantly more often among children with autism than among controls (allergy: 20.6% vs. 17.7%, Crude odds ratio (OR)=1.22, 95% confidence interval (CI) 1.13-1.31; autoimmune disease: 1% vs. 0.76%, OR=1.36, 95% CI 1.01-1.83), and asthma was diagnosed significantly less often (13.7% vs. 15.9%; OR=0.83, 95% CI 0.76-0.90). Psoriasis occurred more than twice as often in cases than in controls (0.34% vs. 0.15%; OR=2.35, 95% CI 1.36-4.08). Our results support previous observations that children with autism have elevated prevalence of specific immune-related comorbidities. PMID:25681541

  2. Understanding Panel Management: A Comparative Study of an Emerging Approach to Population Care

    PubMed Central

    Neuwirth, Esther (Estee) B; Schmittdiel, Julie A; Tallman, Karen; Bellows, Jim

    2007-01-01

    Context: Panel management is an innovative approach for population care that is tightly linked with primary care. This approach, which is spreading rapidly across Kaiser Permanente, represents an important shift in population-care structure and emphasis, but its potential and implications have not been previously studied. Objective: To inform the ongoing spread of panel management by providing an early understanding of its impact on patients, physicians, and staff and to identify barriers and facilitators. Design: Qualitative studies at four sites, including patient focus groups, physician and staff interviews, and direct observation. Findings: Panel management allows primary care physicians to use dedicated time to direct proactive care for their patients, uses staff support to conduct outreach, and leverages new panel-based information technology tools. Patients reported appreciating the panel management outreach, although some also reported coordination issues. Two of four study sites seemed to provide a more coordinated patient experience of care; factors common to these sites included longer maturation of their panel management programs and a more circumscribed role for outreach staff. Some physicians reported tension in the approach's implementation: All believed that panel management improved care for their patients but many also expressed feeling that the approach added more tasks to their already busy days. Challenges yet to be fully addressed include providing program oversight to monitor for safe and reliable coordination of care and incorporation of self-management support. Conclusion: Subsequent spread of panel management should be informed by these lessons and findings from early adopters and should include continued monitoring of the impact of this rapidly developing approach on quality, patient satisfaction, primary care sustainability, and cost. PMID:21461107

  3. Comparative Effectiveness of Etanercept and Adalimumab in Patient Reported Outcomes and Injection-Related Tolerability

    PubMed Central

    Navarro-Millán, Iris; Herrinton, Lisa J.; Chen, Lang; Harrold, Leslie; Liu, Liyan; Curtis, Jeffrey R.

    2016-01-01

    Objective To describe patient preferences in selecting specific biologics and compare clinical response using patient reported outcomes (PROs) among patients with rheumatoid arthritis (RA) started on different anti-tumor necrosis factor (TNF) therapies. Methods Participants were enrollees in Kaiser Permanente Northern California. Patients with RA who had at least two provider visits and started a new anti-TNF therapy from 10/2010–8/2011, were eligible for participation in this longitudinal study. Using a telephone survey, patient preferences in biologic selection and RAPID3, MDHAQ, and SF-12 scores were collected at baseline and at 6 months. Patient scores rating injection/infusion-site burning and stinging (ISBS) were collected at 6 months. Results In all, 267 patients with RA responded to the baseline survey, of whom 57% preferred an injectable biologic, 22% preferred an infused biologic, and 21% had no preference. Motivation for injectable biologics was convenience (92%) and for infusion therapy was dislike or lack of self-efficacy for self-injection (16%). After 6 months of treatment with anti-TNF, 70% of the 177 patients who answered the ISBS question reported ISBS with the last dose; on a scale of 1 (none) to 10 (worst), 41% of these reported a score of 2–5; and 29% reported a score of 6–10. Adalimumab users experienced 3.2 times (95% confidence interval 1.2–8.6) the level of ISBS that etanercept users experienced. There were no significant differences in RAPID3, MDHAQ, or SF-12 scores between etanercept or adalimumab initiators. Conclusion Convenience and fear of self-injection were important considerations to patients selecting a biologic drug. Although more convenient, adalimumab associated with more ISBS than did etanercept, and this rate was higher than reported in clinical trials. At 6 months, PROs did not differ between etanercept and adalimumab users. PMID:27007811

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

    NASA Astrophysics Data System (ADS)

    Singh, Birbikram; Patra, S. K.; Gupta, Raj K.

    2010-07-01

    We have studied the (ground-state) cluster radioactive decays within the preformed cluster model (PCM) of Gupta and collaborators [R. K. Gupta, in Proceedings of the 5th International Conference on Nuclear Reaction Mechanisms, Varenna, edited by E. Gadioli (Ricerca Scientifica ed Educazione Permanente, Milano, 1988), p. 416; S. S. Malik and R. K. Gupta, Phys. Rev. CPRVCAN0556-281310.1103/PhysRevC.39.1992 39, 1992 (1989)]. The relativistic mean-field (RMF) theory is used to obtain the nuclear matter densities for the double folding procedure used to construct the cluster-daughter potential with M3Y nucleon-nucleon interaction including exchange effects. Following the PCM approach, we have deduced empirically the preformation probability P0emp from the experimental data on both the α- and exotic cluster-decays, specifically of parents in the trans-lead region having doubly magic Pb208 or its neighboring nuclei as daughters. Interestingly, the RMF-densities-based nuclear potential supports the concept of preformation for both the α and heavier clusters in radioactive nuclei. P0α(emp) for α decays is almost constant (~10-2-10-3) for all the parent nuclei considered here, and P0c(emp) for cluster decays of the same parents decrease with the size of clusters emitted from different parents. The results obtained for P0c(emp) are reasonable and are within two to three orders of magnitude of the well-accepted phenomenological model of Blendowske-Walliser for light clusters.

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

    SciTech Connect

    Singh, BirBikram; Patra, S. K.; Gupta, Raj K.

    2010-07-15

    We have studied the (ground-state) cluster radioactive decays within the preformed cluster model (PCM) of Gupta and collaborators [R. K. Gupta, in Proceedings of the 5th International Conference on Nuclear Reaction Mechanisms, Varenna, edited by E. Gadioli (Ricerca Scientifica ed Educazione Permanente, Milano, 1988), p. 416; S. S. Malik and R. K. Gupta, Phys. Rev. C 39, 1992 (1989)]. The relativistic mean-field (RMF) theory is used to obtain the nuclear matter densities for the double folding procedure used to construct the cluster-daughter potential with M3Y nucleon-nucleon interaction including exchange effects. Following the PCM approach, we have deduced empirically the preformation probability P{sub 0}{sup emp} from the experimental data on both the alpha- and exotic cluster-decays, specifically of parents in the trans-lead region having doubly magic {sup 208}Pb or its neighboring nuclei as daughters. Interestingly, the RMF-densities-based nuclear potential supports the concept of preformation for both the alpha and heavier clusters in radioactive nuclei. P{sub 0}{sup a}lpha{sup (emp)} for alpha decays is almost constant (approx10{sup -2}-10{sup -3}) for all the parent nuclei considered here, and P{sub 0}{sup c(emp)} for cluster decays of the same parents decrease with the size of clusters emitted from different parents. The results obtained for P{sub 0}{sup c(emp)} are reasonable and are within two to three orders of magnitude of the well-accepted phenomenological model of Blendowske-Walliser for light clusters.

  6. Validity of women's self-reports of cancer screening test utilization in a managed care population.

    PubMed

    Caplan, Lee S; McQueen, David V; Qualters, Judith R; Leff, Marilyn; Garrett, Carol; Calonge, Ned

    2003-11-01

    This study was undertaken to examine the validity of self-reported data on breast and cervical cancer screening behavior. An abbreviated version of the Behavioral Risk Factor Surveillance System telephone survey, including questions on mammography, clinical breast examination (CBE), and Papanicolaou test utilization, was administered to a sample of 480 women aged 40-74 years, enrolled in Kaiser Permanente Colorado for at least 5 years. Screening information reported in the telephone interview was compared with that abstracted from respondents' medical records. The vast majority of women had a mammogram, CBE, and Pap test according to both self-report and medical record. Sensitivity for determining whether her last test was within 2 years (3 years for Pap test) exceeded 95% for all, whereas specificities were <55%. The percentage of overall agreement between self-reported and recorded information was 88.4% (kappa = 0.62) for mammography, 87.9% (kappa = 0.45) for CBE, and 87.2% (kappa = 0.54) for Pap test. Pearson correlations between self-reported and recorded information for specific time interval since most recent mammogram, CBE, and Pap test were 0.72, 0.58, and 0.65, respectively. Correlation increased greatly when time interval was allowed to vary by +/-1 year. In most cases of disagreement, the self-report underestimated the time since last screening. These results suggest that self-reporting of breast and cervical cancer screening is fairly accurate in this managed care population, although women tend to underestimate the time since their last screening. PMID:14652278

  7. Perinatal oxytocin increases the risk of offspring bipolar disorder and childhood cognitive impairment

    PubMed Central

    Freedman, David; Brown, Alan S.; Shen, Ling; Schaefer, Catherine A.

    2014-01-01

    Background We tested the hypothesis that perinatal oxytocin, given to pregnant women to induce labor, is related to offspring bipolar disorder (BP) and worse childhood cognitive performance among offspring. We also tested the association between childhood cognition and later BP. Methods A population-based birth cohort derived from the Child Health and Development Study (CHDS) which included nearly all pregnant women receiving obstetric care from the Kaiser Permanente Medical Care Plan, Northern California Region (KPNC) between1959–1966. Prospectively obtained medical and offspring cognitive performance were used. Potential cases with BP from the cohort were identified by database linkages. This protocol identified 94 cases who were matched 1:8 to controls. Results Perinatal oxytocin was associated with a 2.4 times increased odds of later BP. Oxytocin was also associated with decreased performance on the Raven Matrices, but not on the Peabody Picture Vocabulary Test (PPVT). Childhood cognition was not associated with later BP. Limitations Loss to follow-up must be considered in all birth cohort studies. Additionally, the childhood cognitive battery did not include tests related to multiple domains of cognition which have been associated with later BP. A third limitation is the modest sample size of those exposed to oxytocin. Conclusions This study provides evidence for a potentially important perinatal risk factor for BP and cognitive impairment in childhood. While the association between perinatal oxytocin and offspring BP must be viewed cautiously until further studies can attempt to replicate the result, it lends support to the broader view that neurodevelopmental factors contribute to BP. PMID:25462398

  8. Colon Cancer Survival With Herbal Medicine and Vitamins Combined With Standard Therapy in a Whole-Systems Approach: Ten-Year Follow-up Data Analyzed With Marginal Structural Models and Propensity Score Methods

    PubMed Central

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

    2014-01-01

    Although localized colon cancer is often successfully treated with surgery, advanced disease requires aggressive systemic therapy that has lower effectiveness. Approximately 30% to 75% of patients with colon cancer use complementary and alternative medicine (CAM), but there is limited formal evidence of survival efficacy. In a consecutive case series with 10-year follow-up of all colon cancer patients (n = 193) presenting at a San Francisco Bay-Area center for Chinese medicine (Pine Street Clinic, San Anselmo, CA), the authors compared survival in patients choosing short-term treatment lasting the duration of chemotherapy/radiotherapy with those continuing long-term. To put these data into the context of treatment responses seen in conventional medical practice, they also compared survival with Pan-Asian medicine + vitamins (PAM+V) with that of concurrent external controls from Kaiser Permanente Northern California and California Cancer Registries. Kaplan-Meier, traditional Cox regression, and more modern methods were used for causal inference—namely, propensity score and marginal structural models (MSMs), which have not been used before in studies of cancer survival and Chinese herbal medicine. PAM+V combined with conventional therapy, compared with conventional therapy alone, reduced the risk of death in stage I by 95%, stage II by 64%, stage III by 29%, and stage IV by 75%. There was no significant difference between short-term and long-term PAM+V. Combining PAM+V with conventional therapy improved survival, compared with conventional therapy alone, suggesting that prospective trials combining PAM+V with conventional therapy are justified. PMID:21964510

  9. Stroke and Bleeding Risk Associated With Antithrombotic Therapy for Patients With Nonvalvular Atrial Fibrillation in Clinical Practice

    PubMed Central

    An, JaeJin; Niu, Fang; Lang, Daniel T; Jazdzewski, Kristin P; Le, Paul T; Rashid, Nazia; Meissner, Brian; Mendes, Robert; Dills, Diana G; Aranda, Gustavus; Bruno, Amanda

    2015-01-01

    Background The quality of antithrombotic therapy for patients with nonvalvular atrial fibrillation during routine medical care is often suboptimal. Evidence linking stroke and bleeding risk with antithrombotic treatment is limited. The purpose of this study was to evaluate the associations between antithrombotic treatment episodes and outcomes. Methods and Results A retrospective longitudinal observational cohort study was conducted using patients newly diagnosed with nonvalvular atrial fibrillation with 1 or more stroke risk factors (CHADS2 ≥1) in Kaiser Permanente Southern California between January 1, 2006 and December 31, 2011. A total of 1782 stroke and systemic embolism (SE) and 3528 major bleed events were identified from 23 297 patients during the 60 021 person-years of follow-up. The lowest stroke/SE rates and major bleed rates were observed in warfarin time in therapeutic range (TTR) ≥55% episodes (stroke/SE: 0.87 [0.71 to 1.04]; major bleed: 4.91 [4.53 to 5.28] per 100 person-years), which was similar to the bleed rate in aspirin episodes (4.95 [4.58 to 5.32] per 100 person-years). The warfarin TTR ≥55% episodes were associated with a 77% lower risk of stroke/SE (relative risk=0.23 [0.18 to 0.28]) compared to never on therapy; and the warfarin TTR <55% and on-aspirin episodes were associated with a 20% lower and with a 26% lower risk of stroke/SE compared to never on therapy, respectively. The warfarin TTR <55% episodes were associated with nearly double the risk of a major bleed compared to never on therapy (relative risk=1.93 [1.74 to 2.14]). Conclusions Continuation of antithrombotic therapy as well as maintaining an adequate level of TTR is beneficial to prevent strokes while minimizing bleeding events. PMID:26187996

  10. Predicting Mortality in Older Adults with Kidney Disease: A Pragmatic Prediction Model

    PubMed Central

    Weiss, Jessica W.; Platt, Robert W.; Thorp, Micah L.; Yang, Xiuhai; Smith, David H.; Petrik, Amanda; Eckstrom, Elizabeth; Morris, Cynthia; O’Hare, Ann M.; Johnson, Eric S.

    2014-01-01

    Background/Objectives Older adults with chronic kidney disease (CKD) and their healthcare providers face difficult decisions about treatments that may be sensitive to prognosis. We developed mortality risk prediction models for older adults with CKD which included comorbidities and measures of health status/utilization not associated with particular co-morbid conditions (non-disease-specific measures). Design Retrospective cohort study Setting Kaiser Permanente Northwest (KPNW) Health Maintenance Organization Participants 4,054 patients with severe CKD (estimated glomerular filtration rate <30 ml/min/1.73m2), including 1,915patients aged 65-79 and 2,139 aged ≥80 years who received care at KPNW between 2000-2008. Measurements We used Cox proportional hazards analysis to examine the association between selected patient characteristics and all-cause mortality and to generate age-group specific risk prediction models. Predicted and observed risks were evaluated by quintile.Predictors from our Cox models were translated into a points-based system. We used internal validation to provide best estimates of how these models might perform in an external population. Results Our risk prediction models used 16 characteristics to identify patients with the highest risk of mortality at 2 years for adults ages 65-79 and ≥80. Predicted and observed risks agreed within 5% for each quintile; a 4-5 fold increase in 2-year predicted mortality risk was observed between highest and lowest quintiles. The c-statistics for each model (0.68-0.69) indicated effective discrimination without evidence of significant overfit (slope shrinkage 0.06-0.09). Models for each age group performed similarly for mortality prediction at 6 months and 2 years in terms of discrimination and calibration. Conclusion When validated, these risk prediction models may be helpful in supporting discussions about prognosis and treatment decisions sensitive to prognosis in older adults with CKD in real-world clinical settings. PMID:25739329

  11. Design thinking.

    PubMed

    Brown, Tim

    2008-06-01

    In the past, design has most often occurred fairly far downstream in the development process and has focused on making new products aesthetically attractive or enhancing brand perception through smart, evocative advertising. Today, as innovation's terrain expands to encompass human-centered processes and services as well as products, companies are asking designers to create ideas rather than to simply dress them up. Brown, the CEO and president of the innovation and design firm IDEO, is a leading proponent of design thinking--a method of meeting people's needs and desires in a technologically feasible and strategically viable way. In this article he offers several intriguing examples of the discipline at work. One involves a collaboration between frontline employees from health care provider Kaiser Permanente and Brown's firm to reengineer nursing-staff shift changes at four Kaiser hospitals. Close observation of actual shift changes, combined with brainstorming and rapid prototyping, produced new procedures and software that radically streamlined information exchange between shifts. The result was more time for nursing, better-informed patient care, and a happier nursing staff. Another involves the Japanese bicycle components manufacturer Shimano, which worked with IDEO to learn why 90% of American adults don't ride bikes. The interdisciplinary project team discovered that intimidating retail experiences, the complexity and cost of sophisticated bikes, and the danger of cycling on heavily trafficked roads had overshadowed people's happy memories of childhood biking. So the team created a brand concept--"Coasting"--to describe a whole new category of biking and developed new in-store retailing strategies, a public relations campaign to identify safe places to cycle, and a reference design to inspire designers at the companies that went on to manufacture Coasting bikes. PMID:18605031

  12. Association between Physical Activity and Depressive Symptoms: Midlife Women in SWAN

    PubMed Central

    Dugan, Sheila A.; Bromberger, Joyce T.; Segawa, Eisuke; Avery, Elizabeth; Sternfeld, Barbara

    2014-01-01

    Introduction The relationship of physical activity (PA) and positive mood has been the focus of considerable research, primarily cross-sectional. This study was done to evaluate the relationship between PA and high depressive symptoms across time and to examine whether being physically active attenuates the risk of depressive symptoms in midlife women. Methods The present study is a longitudinal observation study of the menopausal transition in a multiethnic population. Ten years of data on 2891 women were analyzed. The participants were women from seven geographic areas nationwide, aged 42 to 52 years at baseline, still menstruating and not using exogenous reproductive hormones. Physical activity was measured with the Kaiser Permanente Physical Activity Scale (KPAS). The main outcome measure, depressive symptoms, was assessed with the Center for Epidemiological Studies Depression Scale (CES-D) with primary outcome CES-D score of 16 or higher. Results In mixed effect logistic regression models adjusted for covariates, compared to inactivity, physical activity Meeting PA Guidelines (approximating public health guidelines) and physical activity Below PA Guidelines were each associated with lower risk of High Depressive Symptoms (CES-D score of 16 or higher) [odds ratio (OR) =0.52, 95% confidence intervals (CI) 0.40-0.70; OR =0.81, 95% CI 0.67-0.98, respectively] across 10 years. Being married, Japanese and Hispanic ethnicity, current smoking, reporting very upsetting life events, using anti-depressive medications, having hot flashes, and high BMI were all positively associated with High Depressive Symptoms, while high social support was negatively associated. Conclusions Higher PA was associated with lower levels of depressive symptoms persistently over ten years independent of potential confounders. Our findings suggest that reaching moderate intensity PA levels during midlife may be protective against depressive symptoms. PMID:24914519

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

    PubMed Central

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

    2013-01-01

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

  14. QL-10NEURO-ONCOLOGY TELEMEDICINE FOLLOW-UP VISITS

    PubMed Central

    Green, Richard; Woyshner, Emily

    2014-01-01

    We report our 18 month experience with the use of a videoconferencing system to perform neuro-oncology follow-up visits. The Neuro-oncology Program at the Kaiser Permanente-Los Angeles Medical center serves the majority of Kaiser HMO patients in the Southern California region. We installed a videoconferencing system (Cisco TelePresence EX90, Cisco Systems, San Jose, CA) in our office in Los Angeles and in a medical office building in Anaheim, CA at a distance of 35 miles. Established neuro-oncology patients from Orange County chose between in-person and remote visits. Patients were seated in an examination room and the neuro-oncology provider alerted by text page. A focused history and physical examination was performed, followed by desktop sharing of clinical and laboratory data using an electronic medical record (Epic Systems Corporation, Verona, WI) and of neuroimages (Phillips iSite PACS, Andover, MA). Patients were asked, but not required, to complete an anonymous online 16 question satisfaction survey after each visit. Visits were performed by either a neuro-oncologist (179) or a Physician's Assistant (12). Of the 191 visits, 174 included evaluation of neuroimaging and 77 included evaluation of response to ongoing chemotherapy. During 12 visits chemotherapy was initiated, and during 15 visits the chemotherapy regimen was changed based on imaging findings. One-hundred and eleven surveys (58% of visits) were completed. Patients reported a high level of satisfaction with the visits (average 9.6, on a 1-10 scale). The average estimated travel time saved was 118 minutes per visit. Four surveys reported technical problems and 1 indicated a preference for an in-person visit. No adverse events could be attributed to use of the telemedicine system. These data suggest that neuro-oncology follow-up visits can be practiced safely and effectively using a telemedicine system, with high levels of patient satisfaction.

  15. Too far ahead of the IT curve?

    PubMed

    Glaser, John P

    2007-01-01

    Peachtree Healthcare has major IT infrastructure problems, and CEO Max Berndt is struggling to find the right fix. He can go with a single set of systems and applications that will provide consistency across Peachtree's facilities but may not give doctors enough flexibility. Or he can choose service-oriented architecture (SOA), a modular design that will allow Peachtree to standardize incrementally and selectively but poses certain risks as a newer technology. What should he do? Four experts comment on this fictional case study, authored by John P. Glaser, CIO for Partners HealthCare System. George C. Halvorson, the chairman and CEO of Kaiser Permanente, warns against using untested methodologies such as SOA in a health care environment, where lives are at stake. He says Peachtree's management must clarify its overall IT vision before devising a plan to achieve each of its objectives. Monte Ford, the chief information officer at American Airlines, says Peachtree can gradually replace its old systems with SOA. An incremental approach, he points out, would not only minimize risk but also enhance flexibility and control, and would allow IT to shift priorities along the way. Randy Heffner, a vice president at Forrester Research who focuses on technology architectures for computer-based business systems, thinks SOA's modular approach to business design would best meet Peachtree's need for flexibility. He says that Peachtree's CIO sees SOA as a new product category but should instead view it as a methodology. John A. Kastor, a professor at the University of Maryland School of Medicine, questions the goal of standardized care. He argues that it would be difficult to persuade doctors, many of whom are fiercely independent, to follow rigid patterns in their work. PMID:17642124

  16. 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

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

    2013-01-01

    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

  17. Oral Contraceptives and Multiple Sclerosis/Clinically Isolated Syndrome Susceptibility

    PubMed Central

    Hellwig, Kerstin; Chen, Lie H.; Stancyzk, Frank Z.; Langer-Gould, Annette M.

    2016-01-01

    Background The incidence of multiple sclerosis (MS) is rising in women. Objective To determine whether the use of combined oral contraceptives (COCs) are associated with MS risk and whether this varies by progestin content. Methods We conducted a nested case-control study of females ages 14–48 years with incident MS or clinically isolated syndrome (CIS) 2008–2011 from the membership of Kaiser Permanente Southern California. Controls were matched on age, race/ethnicity and membership characteristics. COC use up to ten years prior to symptom onset was obtained from the complete electronic health record. Results We identified 400 women with incident MS/CIS and 3904 matched controls. Forty- percent of cases and 32% of controls had used COCs prior to symptom onset. The use of COCs was associated with a slightly increased risk of MS/CIS (adjusted OR = 1.52, 95%CI = 1.21–1.91; p<0.001). This risk did not vary by duration of COC use. The association varied by progestin content being more pronounced for levenorgestrol (adjusted OR = 1.75, 95%CI = 1.29–2.37; p<0.001) than norethindrone (adjusted OR = 1.57, 95%CI = 1.16–2.12; p = 0.003) and absent for the newest progestin, drospirenone (p = 0.95). Conclusions Our findings should be interpreted cautiously. While the use of some combination oral contraceptives may contribute to the rising incidence of MS in women, an unmeasured confounder associated with the modern woman’s lifestyle is a more likely explanation for this weak association. PMID:26950301

  18. HIV Infection Status, Immunodeficiency, and the Incidence of Non-Melanoma Skin Cancer

    PubMed Central

    2013-01-01

    Background The incidence of non-melanoma skin cancers (NMSCs), including basal cell (BCC) or squamous cell carcinoma (SCC), is not well documented among HIV-positive (HIV+) individuals. Methods We identified 6560 HIV+ and 36 821 HIV-negative (HIV−) non-Hispanic white adults who were enrolled and followed up in Kaiser Permanente Northern California from 1996 to 2008. The first biopsy-proven NMSCs diagnosed during follow-up were identified from pathology records. Poisson models estimated rate ratios that compared HIV+ (overall and stratified by recent CD4 T-cell counts and serum HIV RNA levels) with HIV− subjects and were adjusted for age, sex, smoking history, obesity diagnosis history, and census-based household income. Sensitivity analyses were adjusted for outpatient visits (ie, a proxy for screening). All statistical tests were two-sided. Results The NMSC incidence rate was 1426 and 766 per 100 000 person-years for HIV+ and HIV− individuals, respectively, which corresponds with an adjusted rate ratio of 2.1 (95% confidence interval [CI] = 1.9 to 2.3). Similarly, the adjusted rate ratio for HIV+ vs HIV− subjects was 2.6 (95% CI = 2.1 to 3.2) for SCCs, and it was 2.1 (95% CI = 1.8 to 2.3) for BCCs. There was a statistically significant trend of higher rate ratios with lower recent CD4 counts among HIV+ subjects compared with HIV− subjects for SCCs (P trend < .001). Adjustment for number of outpatient visits did not affect the results. Conclusion HIV+ subjects had a twofold higher incidence rate of NMSCs compared with HIV− subjects. SCCs but not BCCs were associated with immunodeficiency. PMID:23291375

  19. Reliability and Validity of a Survey to Measure Bowel Function and Quality of Life in Long-term Rectal Cancer Survivors

    PubMed Central

    Wendel, Christopher S.; Grant, Marcia; Herrinton, Lisa; Temple, Larissa K. F.; Hornbrook, Mark C.; McMullen, Carmit K.; Bulkley, Joanna E.; Altschuler, Andrea; Krouse, Robert S.

    2014-01-01

    Purpose Examine reliability and validity of a specialized health-related quality of life questionnaire for rectal cancer (RC) survivors (≥5 years post diagnosis). Methods We mailed 1,063 Kaiser Permanente (KP) RC survivors (313 ostomy, 750 anastomosis) a questionnaire containing the Modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O), SF-12v2, Duke–UNC Functional Social Support Questionnaire (FSSQ), and Memorial Sloan-Kettering Cancer Center Bowel Function Index (BFI). We adapted certain BFI items for use by subjects with intestinal ostomies. We evaluated reliability for all instruments with inter-item correlations and Cronbach’s alpha. We assessed construct validity only for the BFI in the ostomy group, because such use has not been reported. Results The overall response rate was 60.5% (577 respondents/953 eligible). Compared to nonresponders, participants were on average 2 years younger and more likely non-Hispanic white, resided in educationally nondeprived areas, and had KP membership through a group. The mCOH-QOL-O, SF-12, and FSSQ were found to be highly reliable for RC survivors. In the ostomy group, BFI Urgency/Soilage and Dietary subscales were found to be reliable, but Frequency was not. Factor analysis supported the construct of Urgency/Soilage and Dietary subscales in the ostomy group, although one item had a moderate correlation with all three factors. The BFI also demonstrated good concurrent validity with other instruments in the ostomy group. Conclusions With possible exception of the BFI Frequency subscale in populations with ostomies, components of our survey can be used for the entire population of RC survivors, no matter whether they received anastomosis or ostomy. PMID:24890826

  20. The Vitamin D Antenatal Asthma Reduction Trial (VDAART): Rationale, design, and methods of a randomized, controlled trial of vitamin D supplementation in pregnancy for the primary prevention of asthma and allergies in children

    PubMed Central

    Litonjua, Augusto A.; Lange, Nancy E.; Carey, Vincent J.; Brown, Stacey; Laranjo, Nancy; O’Connor, George T.; Sandel, Megan; Strunk, Robert C.; Bacharier, Leonard B.; Zeiger, Robert S.; Schatz, Michael; Hollis, Bruce W.; Weiss, Scott T.

    2014-01-01

    There is intense interest in the role of vitamin D in the development of asthma and allergies. However, studies differ on whether a higher vitamin D intake or status in pregnancy or at birth is protective against asthma and allergies. To address this uncertainty, the Vitamin D Antenatal Asthma Reduction Trial (VDAART) was developed. VDAART is a randomized, double-blind, placebo-controlled trial of vitamin D supplementation in pregnant women to determine whether prenatal supplementation can prevent the development of asthma and allergies in the women’s offspring. A secondary aim is to determine whether vitamin D supplementation can prevent the development of pregnancy complications, such as preeclampsia, preterm birth, and gestational diabetes. Women were randomized to the treatment arm of 4,000 IU/day of vitamin D3 plus a daily multivitamin that contained 400 IU of vitamin D3 or the placebo arm of placebo plus a multivitamin that contained 400 IU daily of vitamin D3. Women who were between the gestational ages of 10–18 weeks were randomized from three clinical centers across the United States – Boston Medical Center, Washington University in St. Louis, and Kaiser Permanente Southern California Region (San Diego, CA). Supplementation took place throughout pregnancy. Monthly monitoring of urinary calcium to creatinine ratio was performed in addition to medical record review for adverse events. Offspring are being evaluated quarterly through questionnaires and yearly during in-person visits until the 3rd birthday of the child. Ancillary studies will investigate neonatal T-regulatory cell function, maternal vaginal flora, and maternal and child intestinal flora. PMID:24614387

  1. Dietary guideline adherence for gastroesophageal reflux disease

    PubMed Central

    2014-01-01

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

  2. Effect of Health Beliefs on Delays in Care for Abnormal Cervical Cytology in a Multiethnic Population

    PubMed Central

    Nelson, Karin; Geiger, Ann M; Mangione, Carol M

    2002-01-01

    CONTEXT Women from racial and ethnic minorities in the United States have higher rates of cervical cancer and present with later stage disease compared to whites. Delays in care for abnormal Papanicolaou (Pap) smears can lead to missed cases of cervical cancer or late-stage presentation and may be one explanation for these differences. OBJECTIVE To determine if race and ethnicity, health beliefs, and cancer knowledge are associated with delays in care for abnormal Pap smears. DESIGN, PARTICIPANTS, AND SETTING We conducted a mailed survey with telephone follow-up of all women with an abnormal Pap smear who received care at Kaiser Permanente Los Angeles Medical Center between October 1998 and October 1999 (n = 1,049). MEASUREMENTS AND MAIN RESULTS A delay in care was defined as not attending the first scheduled clinic visit to follow up on an abnormal Pap smear, or requiring multiple contact attempts, including a certified letter, to schedule a follow-up visit. Our response rate was 70% (n = 733) and the sample was 51% Latina. Spanish-speaking Latinas and women of Asian descent were more likely to endorse fatalistic beliefs and misconceptions about cancer. Thirteen percent of the sample delayed follow-up on their abnormal Pap smear. Women who delayed care were more fatalistic and endorsed more misconceptions about cervical cancer. Delays in care were not independently associated with race and ethnicity. CONCLUSIONS Health beliefs and cancer knowledge differed by race and ethnicity among women in a large managed care organization. Fatalistic health beliefs and misconceptions about cancer, but not race and ethnicity, were independently associated with delays in care. PMID:12220368

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

    PubMed Central

    2012-01-01

    Background Although obesity is a risk factor for many chronic diseases, we have only limited knowledge of the magnitude of these associations in young adults. A multiethnic cohort of young adults was established to close current knowledge gaps; cohort demographics, cohort retention, and the potential influence of migration bias were investigated. Methods For this population-based cross-sectional study, demographics, and measured weight and height were extracted from electronic medical records of 1,929,470 patients aged 20 to 39 years enrolled in two integrated health plans in California from 2007 to 2009. Results The cohort included about 84.4% of Kaiser Permanente California members in this age group who had a medical encounter during the study period and represented about 18.2% of the underlying population in the same age group in California. The age distribution of the cohort was relatively comparable to the underlying population in California Census 2010 population, but the proportion of women and ethnic/racial minorities was slightly higher. The three-year retention rate was 68.4%. Conclusion These data suggest the feasibility of our study for medium-term follow-up based on sufficient membership retention rates. While nationwide 6% of young adults are extremely obese, we know little to adequately quantify the health burden attributable to obesity, especially extreme obesity, in this age group. This cohort of young adults provides a unique opportunity to investigate associations of obesity-related factors and risk of cancer in a large multiethnic population. PMID:22909293

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

    PubMed Central

    2014-01-01

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

  5. Exposure to Antiretroviral Therapy and Risk of Cancer in HIV-infected Persons

    PubMed Central

    CHAO, Chun; LEYDEN, Wendy A.; XU, Lanfang; HORBERG, Michael A.; KLEIN, Daniel; TOWNER, William J.; QUESENBERRY, Charles P.; ABRAMS, Donald I.; SILVERBERG, Michael J.

    2015-01-01

    Objective The incidence of certain non-AIDS-defining cancers (NADC) in HIV patients has been reported to have increased in the combination antiretroviral therapy (ART) era. Studies are needed to directly evaluate the effect of ART use on cancer risk. Design We followed 12,872 HIV+ Kaiser Permanente members whose complete ART history was known for incident cancers between 1996-2008. Methods Cancers, identified from SEER-based cancer registries, were grouped as AIDS-defining cancers (ADC), infection-related NADC or infection-unrelated NADC. We also evaluated the most common individual cancer types. Rate ratios (RR) for ART use (yes/no) and cumulative duration of any ART, PI and NNRTI therapy were obtained from Poisson models adjusting for demographics, pre-treatment or recent CD4 count and HIV RNA levels, years known HIV-infected, prior antiretroviral use, HIV risk, smoking, alcohol/drug abuse, overweight/obesity, and calendar year. Results The cohort experienced 32,368 person-yrs (py) of ART, 21,249 py of PI therapy, and 15,643 py of NNRTI therapy. The mean follow-up duration was 4.5 years. ADC rates decrease with increased duration of ART use [RR/year=0.61, 95% CI (0.56-0.66)]; the effect was similar by therapy class. ART, PI or NNRTI therapy duration was not associated with infection-related or infection-unrelated NADC [RR/year ART=1.00 (0.91-1.11) and 0.96 (0.90-1.01), respectively], except a higher anal cancer risk with longer PI therapy [RR/year=1.16 (1.02-1.31)]. Conclusions No therapy class-specific effect was found for ADC. ART exposure was generally not associated with NADC risk, except for long term use of PI, which might be associated with increased anal cancer risk. PMID:22951631

  6. Maternal Hyperglycemia During Pregnancy Predicts Adiposity of the Offspring

    PubMed Central

    Ferrara, Assiamira; Windham, Gayle C.; Greenspan, Louise C.; Deardorff, Julianna; Hiatt, Robert A.; Quesenberry, Charles P.; Laurent, Cecile; Mirabedi, Anousheh S.; Kushi, Lawrence H.

    2014-01-01

    OBJECTIVE To investigate associations between maternal pregnancy hyperglycemia, gestational diabetes mellitus (GDM), and offspring adiposity. RESEARCH DESIGN AND METHODS We evaluated these associations in a longitudinal study of 421 mother-daughter pairs at Kaiser Permanente Northern California. Maternal pregnancy glucose values were obtained from maternal medical records. Outcomes included three measures of girls’ adiposity, measured annually: 1) ≥85th age-specific percentile for BMI; 2) percent body fat (%BF); and 3) waist-to-height ratio (WHR). RESULTS Adjusting for maternal age at delivery, race/ethnicity, pregravid BMI, girl’s age, and girl’s age at onset of puberty, having a mother with GDM increased a girl’s risk of having a BMI ≥85th percentile or having %BF or WHR in the highest quartile (Q4), compared with those in the lowest quintile of blood glucose (odds ratio [OR] 3.56 [95% CI 1.28–9.92]; OR 3.13 [95% CI 1.08–9.09]; and OR 2.80 [95% CI 1.00–7.84], respectively). There was a significant interaction between the presence of GDM and pregravid BMI; girls whose mothers had both risk factors had the highest odds of having a BMI ≥85th percentile (OR 5.56 [95%CI 1.70–18.2]; Q4 %BF, OR 6.04 [95%CI 1.76–20.7]; and Q4 WHR, OR 3.60 [95%CI 1.35–9.58]). Similar, although weaker, associations were found in the association between hyperglycemia and offspring adiposity. CONCLUSIONS Girls who were exposed to maternal GDM or hyperglycemia in utero are at higher risk of childhood adiposity; risk increases if the mother is overweight or obese. Screening and intervention for this high-risk group is warranted to slow the intergenerational transmission of obesity and its sequelae. PMID:25150158

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

    PubMed

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

    2010-08-01

    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

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

    PubMed Central

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

    2010-01-01

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

  9. The HIV Care Cascade Measured Over Time and by Age, Sex, and Race in a Large National Integrated Care System.

    PubMed

    Horberg, Michael Alan; Hurley, Leo Bartemeier; Klein, Daniel Benjamin; Towner, William James; Kadlecik, Peter; Antoniskis, Diana; Mogyoros, Miguel; Brachman, Philip Sigmund; Remmers, Carol Louise; Gambatese, Rebecca Claire; Blank, Jackie; Ellis, Courtney Georgiana; Silverberg, Michael Jonah

    2015-11-01

    HIV care cascades can evaluate programmatic success over time. However, methodologies for estimating cascade stages vary, and few have evaluated differences by demographic subgroups. We examined cascade performance over time and by age, sex, and race/ethnicity in Kaiser Permanente, providing HIV care in eight US states and Washington, DC. We created cascades for HIV+ members' age ≥13 for 2010-2012. We measured "linkage" (a visit/CD4 within 90 days of being diagnosed for new patients; ≥1 medical visit/year if established); "retention" (≥2 medical visits ≥60 days apart); filled ART (filled ≥3 months of combination ART); and viral suppression (HIV RNA <200 copies/mL last measured in year). The cascades were stratified by calendar year, sex, age, and race/ethnicity. We found men had statistically (p < 0.05) higher percent linkage, filled ART, and viral suppression for 2010 and 2011 but not for 2012. Women had significantly greater retention for all years. Annually, older age was associated (p < 0.05) with retention, filled ART, and viral suppression but not linkage. Latinos had greater (p < 0.05) retention than whites or blacks in all years, with similar retention comparing blacks and whites. Filled ART and viral suppression was increased (p < 0.05) for whites compared with all racial/ethnic groups in all years. Cascade methodology requiring success at upstream stages before measuring success at later stages (i.e., "dependent" methodology) underreported performance by up to 20% compared with evaluating each stage separately ("independent"). Thus, care results improved over time, but significant differences exist by patient demographics. Specifically, retention efforts should be targeted toward younger patients and blacks; women, blacks, and Latinos require greater ART prescribing. PMID:26505968

  10. Evaluating a comprehensive outpatient clinical information system: a case study and model for system evaluation.

    PubMed Central

    Chin, H. L.; McClure, P.

    1995-01-01

    Decisions about information system implementation are often justified through a cost-benefit analysis. The ability to improve efficiency and outcomes while decreasing costs through information systems--by allowing for multiple and instant simultaneous access to information, through data monitoring and altering, through automation of protocols, and by collecting information for population-based health care as opposed to individual illness-care--are all potential benefits of a comprehensive clinical information system. Measuring the quantitative impact of these system improvements, however, is difficult. Doing a complete cost-benefit analysis of a comprehensive clinical information system is unrealistic due to the many assumptions necessary and the multiple confounding factors that are involved. In our Clinical Information Systems deployment in Kaiser Permanente, Northwest Region, we have elected not to do a detailed cost-benefit analysis. Instead, we have done an evaluation, based on success criteria, of a pilot implementation of a vendor-supplied system. This evaluation is based on clinician acceptance, system usage, technical factors, and quantitative effects on physician productivity. We also considered qualitative factors such as relationship with and responsiveness of the system vendor. We are moving ahead to regionalize this clinical information system based on such an evaluation of our pilot project. This paper outlines the approach that we have taken in evaluating our implementation of this system. It may provide some guidance for organizations on how to make a decision about whether or not to regionalize a clinical information system based on the evaluation of a pilot-site implementation. PMID:8563382

  11. Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin

    PubMed Central

    Schelonka, Lee P; SaBell, Margaret A

    2015-01-01

    Purpose This study aimed to determine whether switching from balanced salt solution (BSS) to vancomycin 20 g/mL BSS for incision hydration and eye pressurization reduces the rate of postcataract endophthalmitis. Methods This was a patient safety/quality improvement project, including all patients undergoing cataract surgery at the Kaiser Permanente Colorado Ophthalmology Department from January 2002 to December 2014. Throughout the study, patients received vancomycin 20 μg/mL in the irrigating solution. During the baseline period from 2002 to 2005, surgeons pressurized eyes and hydrated incisions with plain BSS. During the intervention period from 2006 through 2014, surgeons switched from BSS to the vancomycin/BSS irrigating solution for eye pressurization and incision hydration. Results A total of 57,263 cataract operations were performed by 24 surgeons at seven surgical centers: 12,400 in the baseline period and 44,863 in the intervention period. The rate of post-cataract endophthalmitis declined significantly from 5/12,400 (rate: 0.4/1,000) in the baseline period to 1/44,863 (rate: 0.022/1,000) during the intervention period (odds ratio [OR]: 18.1, 95% confidence interval [CI]: 2.11–154.9; χ2=13.5, P=0.00024). Accounting for an estimated 2.05-fold risk reduction due to confounding variables, the risk reduction attributed to the intervention remained significant: (adjusted OR: 8.78, 95% CI: 1.73–44.5; χ2=10.06, P=0.0015). Since 2009, we have not experienced any cases of postcataract endophthalmitis after 32,753 operations. Conclusion We experienced a significant reduction in postcataract endophthalmitis when we switched from BSS to the vancomycin/BSS irrigating solution for incision hydration and eye pressurization. The pharmacokinetics profile indicates that this switch was important for effective prophylaxis. PMID:26229425

  12. Genotyping Informatics and Quality Control for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort.

    PubMed

    Kvale, Mark N; Hesselson, Stephanie; Hoffmann, Thomas J; Cao, Yang; Chan, David; Connell, Sheryl; Croen, Lisa A; Dispensa, Brad P; Eshragh, Jasmin; Finn, Andrea; Gollub, Jeremy; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H; Lao, Richard; Lu, Yontao; Ludwig, Dana; Mathauda, Gurpreet K; McGuire, William B; Mei, Gangwu; Miles, Sunita; Mittman, Michael; Patil, Mohini; Quesenberry, Charles P; Ranatunga, Dilrini; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C; Shapero, Michael; Shen, Ling; Shenoy, Tanu; Smethurst, David; Somkin, Carol P; Van Den Eeden, Stephen K; Walter, Lawrence; Wan, Eunice; Webster, Teresa; Whitmer, Rachel A; Wong, Simon; Zau, Chia; Zhan, Yiping; Schaefer, Catherine; Kwok, Pui-Yan; Risch, Neil

    2015-08-01

    The Kaiser Permanente (KP) Research Program on Genes, Environment and Health (RPGEH), in collaboration with the University of California-San Francisco, undertook genome-wide genotyping of >100,000 subjects that constitute the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. The project, which generated >70 billion genotypes, represents the first large-scale use of the Affymetrix Axiom Genotyping Solution. Because genotyping took place over a short 14-month period, creating a near-real-time analysis pipeline for experimental assay quality control and final optimized analyses was critical. Because of the multi-ethnic nature of the cohort, four different ethnic-specific arrays were employed to enhance genome-wide coverage. All assays were performed on DNA extracted from saliva samples. To improve sample call rates and significantly increase genotype concordance, we partitioned the cohort into disjoint packages of plates with similar assay contexts. Using strict QC criteria, the overall genotyping success rate was 103,067 of 109,837 samples assayed (93.8%), with a range of 92.1-95.4% for the four different arrays. Similarly, the SNP genotyping success rate ranged from 98.1 to 99.4% across the four arrays, the variation depending mostly on how many SNPs were included as single copy vs. double copy on a particular array. The high quality and large scale of genotype data created on this cohort, in conjunction with comprehensive longitudinal data from the KP electronic health records of participants, will enable a broad range of highly powered genome-wide association studies on a diversity of traits and conditions. PMID:26092718

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

    PubMed Central

    Bartolotto, Carole

    2015-01-01

    Americans consume a lot of sugar, primarily from sweeteners that are added to processed foods and beverages. Data from the US Department of Agriculture reveals that in 2013, Americans consumed 22.3 teaspoons of added caloric sweeteners a day, which is significantly more than the American Heart Association’s recommendation. Artificial and alternative sweeteners have also been added to a plethora of foods. These sweeteners range from about 180 times sweeter to as much as 13,000 times sweeter than sugar. Consumption of both sugar and artificial sweeteners may be changing our palates or taste preferences over time, increasing our desire for sweet foods. Unfortunately, the data on this are lacking. In the summer of 2014, a group of 20 people from Kaiser Permanente facilities throughout California agreed to cut out all added sugars and artificial sweeteners for 2 weeks and then complete a survey to determine whether their taste preferences had changed. After the 2-week challenge, 95% of participants (18 out of 19 respondents) found that sweet foods and drinks tasted sweeter or too sweet, 75% (15 out of 20 respondents) found that other foods tasted sweeter, and 95% (19 out of 20 respondents) said moving forward they would use less or even no sugar. Additionally, 86.6% of participants (13 out of 15 respondents) stopped craving sugar after 6 days. Although this was a small survey, the results suggest that using a 2-week sugar challenge can help to reset taste preferences and make consuming less or no sugar easier. Physicians should consider recommending a sugar and artificial sweetener challenge to all their patients, especially those with obesity, diabetes, or cardiovascular disease. PMID:26176574

  14. Profil épidémiologique de l'insuffisance rénale terminale à l'hôpital Militaire de Rabat, Maroc

    PubMed Central

    Asserraji, Mohammed; Maoujoud, Omar; Belarbi, Marouane; Oualim, Zouhir

    2015-01-01

    L'Insuffisance rénale chronique terminale (IRCT) est un enjeu majeur de sante publique au Maroc à cause de ses conséquences médicales et socioéconomiques. L'objectif de ce travail est d’évaluer le profil épidémiologique de l'IRCT à l'hôpital militaire de rabat, Maroc. Il s'agit d'une enquête rétrospective pendant quatre ans (1er janvier 2007 au 31 décembre 2010). Tous les cas d'IRCT (diminution permanente du débit de filtration glomérulaire (DFG) < 15 ml/min/1.73m2, pendant ≥ 3 mois) ont été inclus. 203 patients ont commencé la dialyse durant cette période, 130 hommes (64%) et 73 femmes (36%), l’âge moyen était de 49,92 ans (06 - 80 ans). la néphropathie d'origine indéterminée représente la première cause d'IRCT dans notre série (27,1%) suivie de la néphropathie diabétique (24,6%), des glomérulonéphrites chroniques (22,7) et de la néphropathie d'origine vasculaire (10,8%). 131 patients (64,5%) n'ont pas eu de suivi néphrologique pré dialytique. une prise en charge globale de cette pathologie est nécessaire. PMID:26309471

  15. Prediction of individual combined benefit and harm for patients with atrial fibrillation considering warfarin therapy: a study protocol

    PubMed Central

    Li, Guowei; Holbrook, Anne; Delate, Thomas; Witt, Daniel M; Levine, Mitchell AH; Thabane, Lehana

    2015-01-01

    Introduction Clinical prediction rules have been validated and widely used in patients with atrial fibrillation (AF) to predict stroke and major bleeding. However, these prediction rules were not developed in the same population, and do not provide the key information that patients and prescribers need at the time anticoagulants are being considered—what is the individual patient-specific risk of both benefit (decreased stroke) and harm (increased major bleeding). In this study, our primary objective is to develop and validate a prediction model for patients’ individual combined benefit and harm outcomes (stroke, major bleeding and neither event) with and without warfarin therapy. Our secondary outcome is all-cause mortality. Methods and analysis We will use data from the Kaiser Permanente Colorado (KPCO) anticoagulation management databases and electronic medical records. Patients with a primary or secondary diagnosis during an ambulatory KPCO medical office visit, emergency department visit, or inpatient stay between 1 January 2005 and 31 December 2012 with no AF diagnosis in the previous 180 days will be included. Patients’ demographic characteristics, laboratory data, comorbidities, warfarin medication data and concurrent use of medication will be used to construct the prediction model. For primary outcomes (stroke with no major bleeding, and major bleeding with no stroke), we will perform polytomous logistic regression to develop a prediction model for patients’ individual combined benefit and harm outcomes, taking neither event group as the reference group. As regards death, we will use Cox proportional hazards regression analysis to build a prediction model for all-cause mortality. Ethics and dissemination This study has been approved by the KPCO Institutional Review Board and the Hamilton Integrated Research Ethics Board. Results from this study will be published in a peer-reviewed journal electronically and in print. The prediction models may aid in patient-physician shared decision-making when they are considering warfarin therapy. PMID:26546146

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

    PubMed Central

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  18. Hydrodécyclisation du méthylcyclopentane et isomérisation des hexanes acycliques sur un catalyseur à 0,2 % de Pt sur Al{2}O{3} irradié par un champ microonde

    NASA Astrophysics Data System (ADS)

    Medjram, M. S.; Rouainia, M.; Garin, F.

    2005-05-01

    Pour évaluer l'action du champ électromagnétique micro-onde sur la réaction, les propriétés et la préparation des catalyseurs, nous avons disposé d'un réacteur placé dans une cavité résonnante permettant de mesurer la plupart des grandeurs expérimentales importantes qui définissent la réaction et les conditions dans lesquelles l'irradiation micro-onde est effectuées. Parmi celles ci figure le champ électrique, la puissance apportée au système et la température. Les résultats obtenus pour les réactions d'hydrogénolyse du méthylcyclopentane font apparaître qu'indépendamment du mode de chauffage et quelle que soit la conversion, la distribution des produits formés est identique pour les deux systèmes et les rapports des différents hexanes obtenus obéissent à la règle statistique d'ouverture des liaisons C-C du cycle méthylcyclopentane. Par contre, lors des réactions d'isomérisation du méthyl-2pentane, méthyl-3pentane et n-hexane, la sélectivité globale en isomères est plus élevée lorsque la réaction a lieu en présence d'un champ micro-onde. A la suite de ces expériences il a été démontré que le catalyseur est modifié lors de son irradiation micro-onde et que cette modification est permanente.

  19. Effect of Advancing Age and Multiple Chronic Conditions on Mortality in Patients with End-Stage Renal Disease after Implantable Cardioverter-Defibrillator Placement

    PubMed Central

    Krishnaswami, Ashok; Kiley, Mary-Lou; Anthony, Faith F; Chen, Yuexin; Chen, Jason; Rajagopal, Sumanth; Liu, Taylor I; Young, Charlie; Paxton, Elizabeth W

    2016-01-01

    Context: There is insufficient information on the effect that advancing age and multiple chronic conditions (MCC) have on mortality after placement of an implantable cardioverter-defibrillator in patients with end-stage renal disease (ESRD) vs non-ESRD. Objective: To assess whether a differential effect of age and MCC exists between ESRD and non-ESRD. Design: Population-based, retrospective cohort study using data from the national Kaiser Permanente Cardiac Device Registry of patients who underwent placement of an implantable cardioverter-defibrillator between January 1, 2007, and December 31, 2013. Main Outcome Measures: All-cause mortality. Results: Of 7825 patients with implantable cardioverter-defibrillator placement, ESRD-affected patients constituted 4.0% of the cohort (n = 311), were similar in age (p = 0.91), and presented with a larger comorbidity burden (3.3 ± 1.3 vs 2.4 ± 1.5, p < 0.001). The effect of advancing age (every 5 years) on mortality in the ESRD cohort (hazard ratio [HR] = 1.11, 95% confidence interval [CI] = 1.03–1.20) was less than in the non-ESRD cohort (HR = 1.28, 95% CI = 1.25–1.32). Similarly, the effect of each additional comorbidity in the ESRD cohort was less (HR = 1.04, 95% CI = 0.91–1.19) than in the non-ESRD group (HR = 1.20, 95% CI = 1.16–1.25). Lastly, ESRD was independently associated with a 3-fold greater hazard of mortality. Conclusions: Advancing age and increasing number of MCC have a differential effect on mortality risk in patients with ESRD compared with their non-ESRD counterparts. Future studies should focus on assessment of nonlinear relationships of age, MCC, and naturally occurring clusters of MCC on mortality. PMID:26562307

  20. Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability

    PubMed Central

    Katon, Wayne; Unützer, Jürgen; Wells, Kenneth; Jones, Loretta

    2013-01-01

    Objective To describe the history and evolution of the collaborative depression care model and new research aimed at enhancing dissemination. Method Four keynote speakers from the 2009 NIMH Annual Mental Health Services Meeting collaborated in this article in order to describe the history and evolution of collaborative depression care, adaptation of collaborative care to new populations and medical settings, and optimal ways to enhance dissemination of this model. Results Extensive evidence across 37 randomized trials has shown the effectiveness of collaborative care vs. usual primary care in enhancing quality of depression care and in improving depressive outcomes for up to 2 to 5 years. Collaborative care is currently being disseminated in large health care organizations such as the Veterans Administration and Kaiser Permanente, as well as in fee-for-services systems and federally funded clinic systems of care in multiple states. New adaptations of collaborative care are being tested in pediatric and ob-gyn populations as well as in populations of patients with multiple comorbid medical illnesses. New NIMH-funded research is also testing community-based participatory research approaches to collaborative care to attempt to decrease disparities of care in underserved minority populations. Conclusion Collaborative depression care has extensive research supporting the effectiveness of this model. New research and demonstration projects have focused on adapting this model to new populations and medical settings and on studying ways to optimally disseminate this approach to care, including developing financial models to incentivize dissemination and partnerships with community populations to enhance sustainability and to decrease disparities in quality of mental health care. PMID:20851265

  1. Home hospice acupuncture: a preliminary report of treatment delivery and outcomes.

    PubMed

    Kaufman, Karen; Salkeld, Ellen J

    2008-01-01

    In recent years, complementary and alternative medicine modalities, including acupuncture, have been incorporated intohospice careboth to address symptom distress and to enhance quality of life. Beginning in 1997, Kaiser Permanente Northwest Hospice began offering limited acupuncture services to hospice patients and, in some cases, their caregivers. Data collection-comprising a chart review (n = 71) and in-depth interviews with the two program acupuncturists-was initiated to explore in a preliminary fashion both the processes involved in acupuncture delivery and outcomes associated with this intervention. Information culled from the patient charts (representing the year 2003) revealed a median age of 68.5 years, a cancer diagnosis in 63% of cases, and a median hospice length of stay of 102 days. The most commonly cited chief complaints presented to the acupuncturists included pain (70%), anxiety (45%), shortness of breath (27%), and nausea/vomiting (14%). Patients received a median of three acupuncture treatments; excellent or good results were noted in the charts of 34% of patients whose chief complaint was pain, in 31% of anxiety chief complaints, in 22% of shortness-of-breath chief complaints, and in 29% for nausea/vomiting chief complaints. The program acupuncturists described their practice with this group of patients as a departure from how they treat patients in a typical practice context. They described a greater focus on providing comfort through ameliorating symptoms and a diminished focus on more holistic goals, which often are typical elements in an acupuncture intervention. Nonetheless, acupuncturists also observed instances of outcomes in psychologic, social, and spiritual domains, regardless of whether these outcomes were the principal focus of treatment. These data add to the accumulating anecdotal reports suggesting that acupuncture is a promising adjunctive therapy for those nearing the end of life in the home hospice setting. More in-depth and precise assessment is warranted to comprehensively evaluate acupuncture as a viable adjunct to current usual and customary hospice care. PMID:21369508

  2. Effectiveness of bisphosphonate use and risk of contralateral breast cancer and recurrence in women with early-stage breast cancer treated with tamoxifen.

    PubMed

    Kwan, Marilyn L; Shi, Jiaxiao M; Habel, Laurel A; Song, Jun; Chung, Joanie W-L; Avila, Chantal C; Schottinger, Joanne E; Cheetham, T Craig; Fletcher, Suzanne W; Haque, Reina

    2016-04-01

    The effectiveness of bisphosphonates (BP) in reducing risk of second breast cancer and recurrence in observational studies has been minimally studied. We examined the association of oral BP use on risk of contralateral breast cancer (CBC) and recurrence in 16,781 women diagnosed with early-stage breast cancer from 1996 to 2007, treated with tamoxifen, and followed through December 31, 2009 at Kaiser Permanente Northern California (KPNC, n = 8857) and Southern California (KPSC, n = 7924). Sociodemographic, clinical, and pharmacy information were extracted from electronic medical records and cancer registries. CBC was identified from cancer registries, and recurrences from electronic health records and chart reviews. Multivariate Cox regression models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) treating BP use and hormonal therapy as time-varying variables. After mean 6.4 years of follow-up, 494 (3.0 %) women developed CBC. BP use post-breast cancer diagnosis (>93 % alendronate) ranged from 14.5 to 24.9 % at both study sites. Overall, there was no association of BP use with reduced risk of CBC (ever use, HR = 0.96; 95 % CI 0.67-1.38 and continuous use, HR = 1.03; 95 % CI 0.88, 1.20). Similar null associations were observed for recurrence (ever use, HR = 0.98; 95 % CI 0.82, 1.17 and continuous use, HR = 1.00; 95 % CI 0.92, 1.09). Associations varied somewhat by site yet confidence intervals overlapped. BP use was not associated with reduced risk of recurrence or new primary disease among women diagnosed with early breast cancer and treated with tamoxifen. PMID:27002508

  3. Provider beliefs about diabetes treatment have little impact on glycemic control of their patients with diabetes

    PubMed Central

    LeBlanc, Erin S; Rosales, A Gabriela; Kachroo, Sumesh; Mukherjee, Jayanti; Funk, Kristine L; Schneider, Jennifer L; Nichols, Gregory A

    2015-01-01

    Objective To improve the health of people with diabetes, it is essential to identify why patients experience extended periods of poor glycemic control before therapeutic intensification. Research design and methods We surveyed 252 primary care providers at Kaiser Permanente Northwest to determine their beliefs about the glycemic goals of their patients, treatment intensification behavior, and barriers to achieving optimal glycemic control. We linked the responses of 149 providers to the health records of their 18 346 patients with diabetes. Results Patient glycemic levels were not related to either individualized glycemic goals or provider intensification behavior. Providers’ beliefs about diabetic treatment and glycated hemoglobin (HbA1c) goals were poorly associated with patient HbA1c levels. Providers identified patients’ resistance to lifestyle behaviors and taking insulin, lack of medication adherence, and psychosocial issues as the main barriers to optimal glycemic control. Lack of time to care for complex patients was also a barrier. Providers who agreed that “current research did not support A1C levels <7%” were less likely to have patients with HbA1c levels <7% (OR=0.87, 95% CI 0.78 to 0.97) and patients of providers who disagreed that “some patients will have an A1C >9% no matter what I do” were 16% more likely to have patients with HbA1c <7% (1.16, 1.03 to 1.30) compared with providers who were neutral about those statements. Conclusions Given the consistency of HbA1c levels across providers despite differences in beliefs and intensification behaviors, these barriers may be best addressed by instituting changes at the system level (ie, instituting institutional glycemic targets or outreach for dysglycemia) rather than targeting practice patterns of individual providers. PMID:25741443

  4. Association Between Anti-TNF-α Therapy and Interstitial Lung Disease

    PubMed Central

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

    2013-01-01

    Background Anti-TNF-α 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-α 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-α 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-α 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-α 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-α 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-α 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

  5. The prevalence, incidence and natural history of primary sclerosing cholangitis in an ethnically diverse population

    PubMed Central

    2011-01-01

    Background Primary sclerosing cholangitis (PSC) is a rare chronic cholestatic liver disease often associated with inflammatory bowel diseases (IBD). Current epidemiological data are limited to studies of predominantly Caucasian populations. Our aim was to define the epidemiology of PSC in a large, ethnically diverse US population. Methods The Northern California Kaiser Permanente (KP) database includes records from over 3 million people and was searched for cases of PSC between January 2000 and October 2006. All identified charts were reviewed for diagnosis confirmation, IBD co-morbidity, and major natural history endpoints. Results We identified 169 (101 males) cases fulfilling PSC diagnostic criteria with a mean age at diagnosis of 44 years (range 11-81). The age-adjusted point prevalence was 4.15 per 100,000 on December 31, 2005. The age-adjusted incidence per 100,000 person-years was not significantly greater in men 0.45 (95% CI 0.33 - 0.61) than women 0.37 (95% CI 0.26 - 0.51). IBD was present in 109/169 (64.5%) cases and was significantly more frequent in men than women with PSC (73.3% and 51.5%, respectively, p = 0.005). The cumulative average yearly mortality rate was 1.9%. Age and serum sodium, creatinine and bilirubin at diagnosis and albumin at last entry were identified as significant factors associated with death, liver transplant or cholangiocarcinoma. Conclusions The incidence and prevalence of PSC observed in a representative Northern California population are lower compared to previous studies in Caucasian populations and this might reflect differences in the incidence of PSC among various ethnic groups. PMID:21767410

  6. Risk of Revision Following Total Hip Arthroplasty: Metal-on-Conventional Polyethylene Compared with Metal-on-Highly Cross-Linked Polyethylene Bearing Surfaces

    PubMed Central

    Paxton, Elizabeth; Cafri, Guy; Havelin, Leif; Stea, Susanna; Pallisó, Francesc; Graves, Stephen; Hoeffel, Daniel; Sedrakyan, Art

    2014-01-01

    The results of randomized controlled trials and systematic reviews have suggested reduced radiographic wear in highly cross-linked polyethylene compared with conventional polyethylene in primary total hip arthroplasty. However, longer-term clinical results have not been thoroughly examined, to our knowledge. The purpose of this study was to compare the risk of revision for metal-on-conventional and metal-on-highly cross-linked total hip arthroplasty bearing surfaces with use of a distributed data network of six national and regional registries (Kaiser Permanente, HealthEast, the Emilia-Romagna region in Italy, the Catalan region in Spain, Norway, and Australia). Inclusion criteria were osteoarthritis as the primary diagnosis, cementless implant fixation, and a patient age of forty-five to sixty-four years. These criteria resulted in a sample of 16,571 primary total hip arthroplasties. Multivariate meta-analysis was performed with use of linear mixed models, with survival probability as the unit of analysis. The results of a fixed-effects model suggested that there was insufficient evidence of a difference in risk of revision between bearing surfaces (hazard ratio, 1.20 [95% confidence interval, 0.80 to 1.79]; p = 0.384). Highly cross-linked polyethylene does not appear to have a reduced risk of revision in this subgroup of total hip arthroplasty patients. Arthroplasties involving highly cross-linked polyethylene do not appear to have an increased risk of revision in this subgroup of total hip arthroplasty patients. PMID:25520415

  7. Distribution of hepatitis C virus genotypes in a diverse US integrated health care population.

    PubMed

    Manos, M Michele; Shvachko, Valentina A; Murphy, Rosemary C; Arduino, Jean Marie; Shire, Norah J

    2012-11-01

    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

  8. Functional and pharmacological induced structural changes of the cystic fibrosis transmembrane conductance regulator in the membrane solved using SAXS.

    PubMed

    Baroni, Debora; Zegarra-Moran, Olga; Moran, Oscar

    2015-04-01

    The cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel is a membrane-integral protein that belongs to the ATP-binding cassette superfamily. Mutations in the CFTR gene cause cystic fibrosis in which salt, water, and protein transports are defective in various tissues. To investigate the conformation of the CFTR in the membrane, we applied the small-angle x-ray scattering (SAXS) technique on microsomal membranes extracted from NIH/3T3 cells permanentely transfected with wild-type (WT) CFTR and with CFTR carrying the ΔF508 mutation. The electronic density profile of the membranes was calculated from the SAXS data, assuming the lipid bilayer electronic density to be composed by a series of Gaussian shells. The data indicate that membranes in the microsome vesicles, that contain mostly endoplasmic reticulum membranes, are oriented in the outside-out conformation. Phosphorylation does not change significantly the electronic density profile, while dephosphorylation produces a significant modification in the inner side of the profile. Thus, we conclude that the CFTR and its associated protein complex in microsomes are mostly phosphorylated. The electronic density profile of the ΔF508-CFTR microsomes is completely different from WT, suggesting a different assemblage of the proteins in the membranes. Low-temperature treatment of cells rescues the ΔF508-CFTR protein, resulting in a conformation that resembles the WT. Differently, treatment with the corrector VX-809 modifies the electronic profile of ΔF508-CFTR membrane, but does not recover completely the WT conformation. To our knowledge, this is the first report of a direct physical measurement of the structure of membranes containing CFTR in its native environment and in different functional and pharmacological conditions. PMID:25274064

  9. Bone Health History in Breast Cancer Patients on Aromatase Inhibitors

    PubMed Central

    Kwan, Marilyn L.; Lo, Joan C.; Tang, Li; Laurent, Cecile A.; Roh, Janise M.; Chandra, Malini; Hahn, Theresa E.; Hong, Chi-Chen; Sucheston-Campbell, Lara; Hershman, Dawn L.; Quesenberry, Charles P.; Ambrosone, Christine B.; Kushi, Lawrence H.; Yao, Song

    2014-01-01

    A cross-sectional study was performed to assess bone health history among aromatase inhibitor (AI) users before breast cancer (BC) diagnosis, which may impact fracture risk after AI therapy and choice of initial hormonal therapy. A total of 2,157 invasive BC patients initially treated with an AI were identified from a prospective cohort study at Kaiser Permanente Northern California (KPNC). Data on demographic and lifestyle factors were obtained from in-person interviews, and bone health history and clinical data from KPNC clinical databases. The prevalence of osteoporosis and fractures in postmenopausal AI users was assessed, compared with 325 postmenopausal TAM users. The associations of bone health history with demographic and lifestyle factors in AI users were also examined. Among all initial AI users, 11.2% had a prior history of osteoporosis, 16.3% had a prior history of any fracture, and 4.6% had a prior history of major fracture. Postmenopausal women who were taking TAM as their initial hormonal therapy had significantly higher prevalence of prior osteoporosis than postmenopausal AI users (21.5% vs. 11.8%, p<0.0001). Among initial AI users, the associations of history of osteoporosis and fracture in BC patients with demographic and lifestyle factors were, in general, consistent with those known in healthy older women. This study is one of the first to characterize AI users and risk factors for bone morbidity before BC diagnosis. In the future, this study will examine lifestyle, molecular, and genetic risk factors for AI-induced fractures. PMID:25354083

  10. Immune Mediated Conditions in Autism Spectrum Disorders

    PubMed Central

    Zerbo, Ousseny; Leong, Albin; Barcellos, Lisa; Bernal, Pilar; Fireman, Bruce; Croen, Lisa A.

    2015-01-01

    We conducted a case-control study among members of Kaiser Permanente Northern California (KPNC) born between 1980 and 2003 to determine the prevalence of immune-mediated conditions in individuals with autism, investigate whether these conditions occur more often than expected, and explore the timing of onset relative to autism diagnosis. Cases were children and young adults with at least two autism diagnoses recorded in outpatient records (n=5,565). Controls were children without autism randomly sampled at a ratio of 5 to 1, matched to cases on birth year, sex, and length of KPNC membership (n=27,825). The main outcomes - asthma, allergies, and autoimmune diseases - were identified from KPNC inpatient and outpatient databases. Chi-square tests were used to evaluate case-control differences. Allergies and autoimmune diseases were diagnosed significantly more often among children with autism than among controls (allergy: 20.6% vs. 17.7%, Crude odds ratio (OR) = 1.22, 95% confidence interval (CI) 1.13 – 1.31; autoimmune disease: 1% vs. 0.76%, OR = 1.36, 95% CI 1.01 – 1.83), and asthma was diagnosed significantly less often (13.7% vs. 15.9%; OR = 0.83, 95% CI 0.76 – 0.90). Psoriasis occurred more than twice as often in cases than in controls (0.34% vs. 0.15%; OR =2.35, 95% CI 1.36 – 4.08). Our results support previous observations that children with autism have elevated prevalence of specific immune-related comorbidities. PMID:25681541

  11. Traumatismes Oculaires par Petards: Bilan sur Trois Annees

    PubMed Central

    Zouaoui-Kesraoui, N.; Derdour, A.

    2009-01-01

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

  12. MicroRNA profiles in colorectal carcinomas, adenomas and normal colonic mucosa: variations in miRNA expression and disease progression

    PubMed Central

    Slattery, Martha L.; Herrick, Jennifer S.; Pellatt, Daniel F.; Stevens, John R.; Mullany, Lila E.; Wolff, Erica; Hoffman, Michael D.; Samowitz, Wade S.; Wolff, Roger K.

    2016-01-01

    MiRNAs are small, non-protein-coding RNA molecules that regulate gene expression either by post-transcriptionally suppressing mRNA translation or by mRNA degradation. We examine differentially expressed miRNAs in colorectal carcinomas, adenomas and normal colonic mucosa. Data come from population-based studies of colorectal cancer conducted in Utah and the Kaiser Permanente Medical Care Program. A total of 1893 carcinoma/normal-paired samples and 290 adenoma tissue samples were run on the Agilent Human miRNA Microarray V19.0 which contained 2006 miRNAs. We tested for significant differences in miRNA expression between paired carcinoma/adenoma/normal colonic tissue samples. Fewer than 600 miRNAs were expressed in >80% of people for colonic tissue; of these 86.5% were statistically differentially expressed between carcinoma and normal colonic mucosa using a false discovery rate of 0.05. Roughly half of these differentially expressed miRNAs showed a progression in levels of expression from normal to adenoma to carcinoma tissue. Other miRNAs appeared to be altered at the normal to adenoma stage, while others were only altered at the adenoma to carcinoma stage or only at the normal to carcinoma stage. Evaluation of the Agilent platform showed a high degree of repeatability (r = 0.98) and reasonable agreement with the NanoString platform. Our data suggest that miRNAs are highly dysregulated in colorectal tissue among individuals with colorectal cancer; the pattern of disruption varies by miRNA as tissue progresses from normal to adenoma to carcinoma. PMID:26740022

  13. Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis

    PubMed Central

    Gold, Rachel; Esterberg, Elizabeth; Hollombe, Celine; Arkind, Jill; Vakarcs, Patricia A; Tran, Huong; Burdick, Tim; DeVoe, Jennifer E; Horberg, Michael A

    2016-01-01

    Context: Guideline-discordant imaging to evaluate incident low back pain is common. Objective: We compared rates of guideline-discordant imaging in patients with low back pain in two care delivery systems with differing abilities to track care through an electronic health record (EHR), and in their patients’ insurance status, to measure the association between these factors and rates of ordered low back imaging. Design: We used data from two Kaiser Permanente (KP) Regions and from OCHIN, a community health center network. We extracted data on imaging performed after index visits for low back pain from June 1, 2011, to May 31, 2012, in these systems. Adjusted logistic regression measured associations between system-level factors and imaging rates. Main Outcome Measures: Imaging rates for incident low back pain using 2 national quality metrics: Clinical Quality Measure 0052, a measure for assessing Meaningful Use of EHRs, and the Healthcare Effectiveness Data and Information Set measure “Use of Imaging Studies for Low Back Pain.” Results: Among 19,503 KP patients and 2694 OCHIN patients with incident low back pain, ordered imaging was higher among men and whites but did not differ across health care systems. OCHIN’s publicly insured patients had higher rates of imaging compared with those with private or no insurance. Conclusion: Rates of ordered imaging to evaluate incident low back pain among uninsured OCHIN patients were lower than in KP overall; among insured OCHIN patients, rates were higher than in KP overall. Research is needed to establish causality and develop interventions. PMID:26934626

  14. Validation of pediatric diabetes case identification approaches for diagnosed cases by using information in the electronic health records of a large integrated managed health care organization.

    PubMed

    Lawrence, Jean M; Black, Mary Helen; Zhang, Jian L; Slezak, Jeff M; Takhar, Harpreet S; Koebnick, Corinna; Mayer-Davis, Elizabeth J; Zhong, Victor W; Dabelea, Dana; Hamman, Richard F; Reynolds, Kristi

    2014-01-01

    We explored the utility of different algorithms for diabetes case identification by using electronic health records. Inpatient and outpatient diagnosis codes, as well as data on laboratory results and dispensing of antidiabetic medications were extracted from electronic health records of Kaiser Permanente Southern California members who were less than 20 years of age in 2009. Diabetes cases were ascertained by using the SEARCH for Diabetes in Youth Study protocol and comprised the "gold standard." Sensitivity, specificity, positive and negative predictive values, accuracy, and the area under the receiver operating characteristic curve (AUC) were compared in 1,000 bootstrapped samples. Based on data from 792,992 youth, of whom 1,568 had diabetes (77.2%, type 1 diabetes; 22.2%, type 2 diabetes; 0.6%, other), case identification accuracy was highest in 75% of bootstrapped samples for those who had 1 or more outpatient diabetes diagnoses or 1 or more insulin prescriptions (sensitivity, 95.9%; positive predictive value, 95.5%; AUC, 97.9%) and in 25% of samples for those who had 2 or more outpatient diabetes diagnoses and 1 or more antidiabetic medications (sensitivity, 92.4%; positive predictive value, 98.4%; AUC, 96.2%). Having 1 or more outpatient type 1 diabetes diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification, code 250.x1 or 250.x3) had the highest accuracy (94.4%) and AUC (94.1%) for type 1 diabetes; the absence of type 1 diabetes diagnosis had the highest accuracy (93.8%) and AUC (93.6%) for identifying type 2 diabetes. Information in the electronic health records from managed health care organizations provides an efficient and cost-effective source of data for childhood diabetes surveillance. PMID:24100956

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

    PubMed Central

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

    2010-01-01

    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

  16. Predicting the Risk of Clostridium difficile Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts

    PubMed Central

    Kuntz, Jennifer L; Smith, David H; Petrik, Amanda F; Yang, Xiuhai; Thorp, Micah L; Barton, Tracy; Barton, Karen; Labreche, Matthew; Spindel, Steven J; Johnson, Eric S

    2016-01-01

    Introduction: Increasing morbidity and health care costs related to Clostridium difficile infection (CDI) have heightened interest in methods to identify patients who would most benefit from interventions to mitigate the likelihood of CDI. Objective: To develop a risk score that can be calculated upon hospital admission and used by antimicrobial stewards, including pharmacists and clinicians, to identify patients at risk for CDI who would benefit from enhanced antibiotic review and patient education. Methods: We assembled a cohort of Kaiser Permanente Northwest patients with a hospital admission from July 1, 2005, through December 30, 2012, and identified CDI in the six months following hospital admission. Using Cox regression, we constructed a score to identify patients at high risk for CDI on the basis of preadmission characteristics. We calculated and plotted the observed six-month CDI risk for each decile of predicted risk. Results: We identified 721 CDIs following 54,186 hospital admissions—a 6-month incidence of 13.3 CDIs/1000 patient admissions. Patients with the highest predicted risk of CDI had an observed incidence of 53 CDIs/1000 patient admissions. The score differentiated between patients who do and do not develop CDI, with values for the extended C-statistic of 0.75. Predicted risk for CDI agreed closely with observed risk. Conclusion: Our risk score accurately predicted six-month risk for CDI using preadmission characteristics. Accurate predictions among the highest-risk patient subgroups allow for the identification of patients who could be targeted for and who would likely benefit from review of inpatient antibiotic use or enhanced educational efforts at the time of discharge planning. PMID:26845084

  17. Elevated BP after AKI.

    PubMed

    Hsu, Chi-Yuan; Hsu, Raymond K; Yang, Jingrong; Ordonez, Juan D; Zheng, Sijie; Go, Alan S

    2016-03-01

    The connection between AKI and BP elevation is unclear. We conducted a retrospective cohort study to evaluate whether AKI in the hospital is independently associated with BP elevation during the first 2 years after discharge among previously normotensive adults. We studied adult members of Kaiser Permanente Northern California, a large integrated health care delivery system, who were hospitalized between 2008 and 2011, had available preadmission serum creatinine and BP measures, and were not known to be hypertensive or have BP>140/90 mmHg. Among 43,611 eligible patients, 2451 experienced AKI defined using observed changes in serum creatinine concentration measured during hospitalization. Survivors of AKI were more likely than those without AKI to have elevated BP-defined as documented BP>140/90 mmHg measured during an ambulatory, nonemergency department visit-during follow-up (46.1% versus 41.2% at 730 days; P<0.001). This difference was evident within the first 180 days (30.6% versus 23.1%; P<0.001). In multivariable models, AKI was independently associated with a 22% (95% confidence interval, 12% to 33%) increase in the odds of developing elevated BP during follow-up, with higher adjusted odds with more severe AKI. Results were similar in sensitivity analyses when elevated BP was defined as having at least two BP readings of >140/90 mmHg or those with evidence of CKD were excluded. We conclude that AKI is an independent risk factor for subsequent development of elevated BP. Preventing AKI during a hospitalization may have clinical and public health benefits beyond the immediate hospitalization. PMID:26134154

  18. Association of Age to Mortality and Repeat Revascularization in End-Stage Renal Disease Patients: Implications for Clinicians and Future Health Policies

    PubMed Central

    Krishnaswami, Ashok; Alloggiamento, Thomas; Forman, Daniel E; Leong, Thomas K; Go, Alan S; McCulloch, Charles E

    2016-01-01

    Background: The clinical effects of age occur over an age continuum, yet age as a primary predictor is often analyzed using arbitrary age cut-points. Objective: To assess whether transformation of a continuous variable such as age using a spline function can uncover nonlinear associations between age and cardiovascular outcomes. Design: Observational retrospective cohort study in 1015 Kaiser Permanente Northern California patients with end-stage renal disease after index coronary revascularization. Age, the primary predictor, was modeled by 5 different techniques: 1) dichotomized at 65 years or older; 2) at 80 years or older (as a sensitivity analysis); 3) categorized as younger than 55 years (reference), 55 to 64, 65 to 74, and 75 years or older; 4) linear (every 5 years) variable; and 5) nonlinear by transformation into a cubic spline. Age categories were changed in a sensitivity analysis. Main Outcome Measures: Primary and secondary outcomes were all-cause mortality and repeat revascularization, respectively. Results: Graphical assessment demonstrated that age dichotomized at either 65 years and older or 80 years and older led to loss of information. Categorized age underestimated or overestimated risk at the extremes of age. A sensitivity analysis demonstrated that an arbitrary change in the age category led to a different conclusion. Age modeled linearly adequately represented mortality risk but was suboptimal with repeat revascularization. Only the cubic spline demonstrated the nonlinear association between age and repeat revascularization. Conclusion: Employing the continuous variable age as a case study, we have demonstrated that the use of flexible transformations, such as spline functions, can unearth clinically meaningful associations that would not have been possible otherwise. Future research should determine whether incorporation of these methods can improve decision making at a population level. PMID:26934624

  19. Patient attitudes about the clinical use of placebo: qualitative perspectives from a telephone survey

    PubMed Central

    Ortiz, Robin; Chandros Hull, Sara; Colloca, Luana

    2016-01-01

    Objectives To examine qualitative responses regarding the use of placebo treatments in medical care in a sample of US patients. Survey studies suggest a deliberate clinical use of placebos by physicians, and prior research has found that although most US patients find placebo use acceptable, the rationale for these beliefs is largely unknown. Setting Members of the Outpatient Clinic at the Kaiser Permanente Northern California interviewed research participants who had been seen for a chronic health problem at least once in the prior 6 months. Participants 853 women (61%) and men, white (58%) and non-white participants aged 18–75 years. Primary and secondary outcomes Qualitative responses on perceptions of placebo use from one-time telephone surveys were analysed for common themes and associations with demographic variables. Results Prior results indicated that a majority of respondents felt it acceptable for doctors to recommend placebo treatments. Our study found that a lack of harm (n=291, 46.1%) and potential benefit (n=250, 39.6%) were the most common themes to justify acceptability of placebo use. Responses citing potential benefit were associated with higher education (r=0.787; p<0.024). Of the minority of respondents who judged it never acceptable for doctors to recommend placebo treatments, the most often referenced rationale was obligation of the doctor to do more (n=102, 48.3%). Additional themes emerged around the issue of whether a doctor was transparent about placebo use, including honesty, patient's right to know and power of the mind. Older age was associated with likelihood to cite overall physician, as opposed to treatment, related themes (r=0.753; p<0.002). Conclusions Participants seem to appreciate and understand the lack of harm and potential benefit associated with placebo treatments, while valuing the role of the physician and the patient in its implementation. PMID:27044586

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

    PubMed

    Greene, Sharon K; Kulldorff, Martin; Huang, Jie; Brand, Richard J; Kleinman, Kenneth P; Hsu, John; Platt, Richard

    2011-02-28

    Timely detection of clusters of localized influenza activity in excess of background seasonal levels could improve situational awareness for public health officials and health systems. However, no single data type may capture influenza activity with optimal sensitivity, specificity, and timeliness, and it is unknown which data types could be most useful for surveillance. We compared the performance of 10 types of electronic clinical data for timely detection of influenza clusters throughout the 2007/08 influenza season in northern California. Kaiser Permanente Northern California generated zip code-specific daily episode counts for: influenza-like illness (ILI) diagnoses in ambulatory care (AC) and emergency departments (ED), both with and without regard to fever; hospital admissions and discharges for pneumonia and influenza; antiviral drugs dispensed (Rx); influenza laboratory tests ordered (Tests); and tests positive for influenza type A (FluA) and type B (FluB). Four credible events of localized excess illness were identified. Prospective surveillance was mimicked within each data stream using a space-time permutation scan statistic, analyzing only data available as of each day, to evaluate the ability and timeliness to detect the credible events. AC without fever and Tests signaled during all four events and, along with Rx, had the most timely signals. FluA had less timely signals. ED, hospitalizations, and FluB did not signal reliably. When fever was included in the ILI definition, signals were either delayed or missed. Although limited to one health plan, location, and year, these results can inform the choice of data streams for public health surveillance of influenza. PMID:21312219

  1. Chronic kidney disease and risk of renal cell carcinoma: differences by race

    PubMed Central

    Hofmann, Jonathan N.; Corley, Douglas A.; Zhao, Wei K.; Colt, Joanne S.; Shuch, Brian; Chow, Wong-Ho; Purdue, Mark P.

    2015-01-01

    Background The incidence of renal cell carcinoma in the United States differs by race/ethnicity. To better understand these disparities, we conducted a nested case-control study investigating renal cell carcinoma risk factors across racial/ethnic groups within the Kaiser Permanente Northern California health care network. Methods Our study included 3,136 renal cell carcinoma cases (2,152 white, 293 black, 425 Hispanic, 255 Asian) diagnosed between 1998 and 2008 and 31,031 individually matched controls (21,478 white, 2,836 black, 4,147 Hispanic, 2,484 Asian). Risk of renal cell carcinoma was assessed in relation to smoking status, body mass index (BMI), hypertension, and chronic kidney disease. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression, and population attributable risk (PAR) to estimate by race the proportion of cases attributable to hypertension and chronic kidney disease. Results The association between chronic kidney disease and renal cell carcinoma differed markedly by race (Pinteraction<0.001), with associations observed among blacks (OR=10.4 [95% CI=6.0–17.9]), Asians (5.1 [2.2–11.7]), and Hispanics (2.3 [1.1–4.6]) but not whites (1.1 [0.6–1.9]). Hypertension, high BMI, and smoking were associated with renal cell carcinoma, but findings generally did not differ by race. Relative to other racial/ethnic groups, blacks had the highest proportion of renal cell carcinoma incidence attributable to hypertension and chronic kidney disease (combined, PAR=37%; hypertension only, PAR=27%; chronic kidney disease, PAR=10%). Conclusions Our findings suggest that hypertension and chronic kidney disease likely have contributed to the observed excess in renal cell carcinoma incidence among blacks compared with whites. PMID:25393631

  2. Examining the influence of beta blockers and ACE inhibitors on the risk for breast cancer recurrence: results from the LACE cohort.

    PubMed

    Ganz, Patricia A; Habel, Laurel A; Weltzien, Erin K; Caan, Bette J; Cole, Steven W

    2011-09-01

    There is increasing interest in the relationship between host lifestyle factors and the outcomes of cancer treatment. Behavioral factors, comorbid conditions, and non-cancer-related pharmaceutical exposures may affect breast cancer (BC) outcomes. We used observational data from the LACE Study cohort (women with early stage BC from the Kaiser Permanente Northern California Cancer Registry) to examine the association between beta blockers (BBs) and/or angiotensin-converting enzyme inhibitors (ACEi) and BC recurrence, BC-specific mortality, and overall mortality. Among 1,779 women, there were 292 BC recurrences, 174 BC deaths, and 323 total deaths. 23% were exposed to either a BB and/or an ACEi. These drugs were associated with older age, postmenopausal status, tamoxifen therapy, greater pre-diagnosis BMI, hypertension, and diabetes. In Cox proportional hazards models, ACEi exposure was associated with BC recurrence (HR 1.56, 95% CI 1.02, 2.39, P = 0.04), but not cause-specific or overall mortality. Combined ACEi and BB were associated with overall mortality (HR 1.94, 95% CI 1.22, 3.10, P = 0.01). BB exposure was associated with lower hazard of recurrence and cause-specific mortality. However, there was no evidence of a dose response with either medication. For recurrence and cause-specific mortality, BB combined with ACEi was associated with a lower HR for the outcome than when ACEi alone was used. These hypothesis generating findings suggest that BC recurrence and survival were associated with exposure to two commonly used classes of anti-hypertensive medications. These observations need to be confirmed and suggest that greater attention should focus on the potential role of these commonly used medications in BC outcomes. PMID:21479924

  3. Gastrointestinal Disease Outbreak Detection Using Multiple Data Streams from Electronic Medical Records

    PubMed Central

    Huang, Jie; Abrams, Allyson M.; Gilliss, Debra; Reed, Mary; Platt, Richard; Huang, Susan S.; Kulldorff, Martin

    2012-01-01

    Abstract Background: Passive reporting and laboratory testing delays may limit gastrointestinal (GI) disease outbreak detection. Healthcare systems routinely collect clinical data in electronic medical records (EMRs) that could be used for surveillance. This study's primary objective was to identify data streams from EMRs that may perform well for GI outbreak detection. Methods: Zip code-specific daily episode counts in 2009 were generated for 22 syndromic and laboratory-based data streams from Kaiser Permanente Northern California EMRs, covering 3.3 million members. Data streams included outpatient and inpatient diagnosis codes, antidiarrheal medication dispensings, stool culture orders, and positive microbiology tests for six GI pathogens. Prospective daily surveillance was mimicked using the space-time permutation scan statistic in single and multi-stream analyses, and space-time clusters were identified. Serotype relatedness was assessed for isolates in two Salmonella clusters. Results: Potential outbreaks included a cluster of 18 stool cultures ordered over 5 days in one zip code and a Salmonella cluster in three zip codes over 9 days, in which at least five of six cases had the same rare serotype. In all, 28 potential outbreaks were identified using single stream analyses, with signals in outpatient diagnosis codes most common. Multi-stream analyses identified additional potential outbreaks and in one example, improved the timeliness of detection. Conclusions: GI disease-related data streams can be used to identify potential outbreaks when generated from EMRs with extensive regional coverage. This process can supplement traditional GI outbreak reports to health departments, which frequently consist of outbreaks in well-defined settings (e.g., day care centers and restaurants) with no laboratory-confirmed pathogen. Data streams most promising for surveillance included microbiology test results, stool culture orders, and outpatient diagnoses. In particular, clusters of microbiology tests positive for specific pathogens could be identified in EMRs and used to prioritize further testing at state health departments, potentially improving outbreak detection. PMID:22429155

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

    PubMed Central

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

    2011-01-01

    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

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

    PubMed Central

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

    2015-01-01

    Summary We know of no studies comparing parent-reported sleep with accelerometer-estimated sleep in their relation to pediatric adiposity. We examined: 1) the reliability of mother-reported sleep compared with accelerometer-estimated sleep, and 2) the relationship between both sleep measures and child adiposity. The current cross-sectional study included 304 Mexican American mother-child pairs recruited from Kaiser Permanente Northern California. We measured sleep duration, using maternal report and accelerometry, and child anthropometrics. Concordance between sleep measures was evaluated using the Bland-Altman method. We conducted zero-ordered correlations between mother-reported sleep, accelerometer-estimated sleep and child BMI z-scores (BMIz). Using linear regression, we examined three models to assess child BMIz with mother-reported sleep (model 1), accelerometer-estimated sleep (model 2), and both sleep measures (model 3). Children had an average age of 8.86 years (SD= .82). Mothers reported that their child slept 9.81 ± 0.74 (95% CI: 9.72, 9.89) hours, compared to 9.58 ± 0.71 (95% CI: 9.50, 9.66) hours based on accelerometry. Mother-reported sleep and accelerometer-estimated sleep were correlated (r = 0.33, p < 0.001). BMIz outcomes were negatively associated with mother-reported sleep duration (model 1: β = −0.13; P = .02) and accelerometer-estimated sleep duration (model 2: β = −0.17; P < .01). Accounting for both sleep measures, only accelerometer-measured sleep was related to BMIz (model 3: β = −0.14, P = .02). Each sleep measure was significantly related to adiposity, independent of covariates. Accelerometry appeared to be a more reliable measure of children’s sleep than maternal report, yet maternal report may be sufficient to examine the sleep-adiposity relationship when resources are limited. PMID:24329818

  6. Association of beverage consumption with obesity in Mexican American children

    PubMed Central

    Beck, Amy L; Tschann, Jeanne; Butte, Nancy F; Penilla, Carlos; Greenspan, Louise C

    2015-01-01

    Objective To determine the association of beverage consumption with obesity in Mexican American school-aged children. Design Cross-sectional study using the baseline data from a cohort study. Mothers and children answered questions about the frequency and quantity of the child’s consumption of soda, diet soda, other sugar-sweetened beverages, 100% fruit juice, milk and water. The questions were adapted from the Youth/Adolescent FFQ. Children were weighed and measured. Data were collected on the following potential confounders: maternal BMI, household income, maternal education, maternal occupational status, maternal acculturation, child physical activity, child screen time and child fast-food consumption. Logistic regression was used to examine the association between servings (240 ml) of each beverage per week and obesity (BMI ≥ 95th percentile). Setting Participants were recruited from among enrolees of the Kaiser Permanente Health Plan of Northern California. Data were collected via an in-home assessment. Subjects Mexican American children (n 319) aged 8–10 years. Results Among participants, 20% were overweight and 31% were obese. After controlling for potential confounders, consuming more servings of soda was associated with increased odds of obesity (OR = 1·29; P < 0·001). Consuming more servings of flavoured milk per week was associated with lower odds of obesity (OR = 0·88; P = 0·004). Consumption of other beverages was not associated with obesity in the multivariate model. Conclusions Discouraging soda consumption among Mexican American children may help reduce the high obesity rates in this population. PMID:23308395

  7. Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer.

    PubMed

    Livaudais, Jennifer C; Hershman, Dawn L; Habel, Laurel; Kushi, Lawrence; Gomez, Scarlett Lin; Li, Christopher I; Neugut, Alfred I; Fehrenbacher, Louis; Thompson, Beti; Coronado, Gloria D

    2012-01-01

    Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as two or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional-stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC). Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White [NHW]) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use. Our sample included 13,753 women aged 20-79years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR]=0.82; [CI] 0.71-0.96 and [OR]=0.78; [CI] 0.63-0.98, respectively). Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other insured populations and the reasons for under-initiation among these groups need to be explored. PMID:21922245

  8. Dietary antioxidants, fruits and vegetables, and the risk of Barrett’s esophagus

    PubMed Central

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

    2009-01-01

    OBJECTIVE The present study evaluated the associations between antioxidants, fruit and vegetable intakes and the risk of Barrett’s esophagus, a potential precursor to esophageal adenocarcinoma. METHODS We conducted a case-control study within the Kaiser Permanente Northern California population. Incident Barrett’s esophagus cases (n=296) were matched to persons with gastroesophageal reflux disease (GERD) (GERD controls, n=308) and to population controls (n=309). Nutrient intake was measured using a validated 110-item food frequency questionnaire. The antioxidant results were stratified by dietary vs. total intake of antioxidants. RESULTS Comparing cases to population controls, dietary intake of vitamin C and beta-carotene were inversely associated with the risk of Barrett’s esophagus [4th vs. 1st quartile, adjusted odds ratio [OR]=0.48 95% confidence interval [CI] (0.26–0.90); OR=0.56 95%CI(0.32–0.99), respectively], and the inverse association was strongest for vitamin E [OR=0.25 95%CI (0.11–0.59)]. The inverse trends for antioxidant index (total and dietary) and fruit and vegetable intake were statistically significant, while most total intakes were not associated with reduced risk. The use of antioxidant supplements did not influence the risk of Barrett’s esophagus, and antioxidants and fruits and vegetables were inversely associated with a GERD diagnosis. CONCLUSION Dietary antioxidants, fruit and vegetable are inversely associated with the risk of Barrett’s esophagus, while no association was observed for supplement intake. Our results suggest that fruits and vegetables themselves or associated undetected confounders may influence early events in the carcinogenesis of esophageal adenocarcinoma. PMID:18494834

  9. Effects of dietary fiber, fats, and meat intakes on the risk of Barrett’s Esophagus

    PubMed Central

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

    2009-01-01

    Animal and human models suggest associations between fat intake, fiber intake and the risk of esophageal adenocarcinoma. We evaluated whether these factors may act early in the carcinogenic pathway as a risk factor for Barrett’s esophagus, a potentially premalignant precursor to esophageal adenocarcinoma using a case-control design within the Kaiser Permanente, Northern California population. Incident Barrett’s esophagus cases (n=296) were matched to persons with gastroesophageal reflux disease (GERD) (n=308), and to population controls (n=309). Higher intakes of omega-3-fatty-acids (cases vs. population controls; OR=0.46, 95% CI 0.22–0.97, 4th vs. 1st quartiles of intake), polyunsaturated fat, total fiber (OR=0.34, 95% CI 0.15–0.76), and fiber from fruits and vegetables (OR=0.47 95% CI 0.25–0.88) were associated with a lower risk of Barrett’s esophagus. Higher meat intakes were associated with a lower risk of long-segment Barrett’s esophagus (OR=0.25, 95% CI 0.09–0.72). In contrast, higher trans-fat intakes were associated with increased risk (OR=1.11; 95% CI 1.03–1.21 per gram/day). Total fat intake, barbecued foods, and fiber intake from sources other than fruits and vegetables were not associated with Barrett’s esophagus. Future studies to evaluate whether dietary interventions might influence the risk of Barrett’s esophagus or esophageal adenocarcinoma in high risk persons are needed. PMID:19838934

  10. Impact of a Care Directives Activity Tab in the Electronic Health Record on Documentation of Advance Care Planning

    PubMed Central

    Turley, Marianne; Wang, Susan; Meng, Di; Kanter, Michael; Garrido, Terhilda

    2016-01-01

    Context: To ensure patient-centered end-of-life care, advance care planning (ACP) must be documented in the medical record and readily retrieved across care settings. Objective: To describe use of the Care Directives Activity tab (CDA), a single-location feature in the electronic health record for collecting and viewing ACP documentation in inpatient and ambulatory care settings, and to assess its association with ACP documentation rates. Design: Retrospective pre- and postimplementation analysis in 2012 and 2013 at Kaiser Permanente Southern California among 113,309 patients aged 65 years and older with ACP opportunities during outpatient or inpatient encounters. Main Outcome Measures: Providers’ CDA use rates and documentation rates of advance directives and physician orders for life-sustaining treatments stratified by CDA use. Results: Documentation rates of advance directives and physician orders for life-sustaining treatments among patients with outpatient and inpatient encounters were 3.5 to 9.6 percentage points higher for patients with CDA use vs those without it. The greatest differences were for orders for life-sustaining treatments among patients with inpatient encounters and for advance directives among patients with outpatient encounters; both were 9.6 percentage points higher among those with CDA use than those without it. All differences were significant after controlling for yearly variation (p < 0.001). Conclusion: Statistically significant differences in documentation rates between patients with and without CDA use suggest the potential of a standardized location in the electronic health record to improve ACP documentation. Further research is required to understand effects of CDA use on retrieval of preferences and end-of-life care. PMID:27057820

  11. Validity of Diagnostic Codes and Laboratory Tests of Liver Dysfunction to Identify Acute Liver Failure Events

    PubMed Central

    Re, Vincent Lo; Carbonari, Dena M.; Forde, Kimberly A.; Goldberg, David; Lewis, James D.; Haynes, Kevin; Leidl, Kimberly B. F.; Reddy, K. Rajender; Roy, Jason; Sha, Daohang; Marks, Amy R.; Schneider, Jennifer L.; Strom, Brian L.; Corley, Douglas A.

    2015-01-01

    Purpose Identification of acute liver failure (ALF) is important for post-marketing surveillance of medications, but the validity of using ICD-9 diagnoses and laboratory data to identify these events within electronic health records is unknown. We examined positive predictive values (PPVs) of hospital ICD-9 diagnoses and laboratory tests of liver dysfunction for identifying ALF within a large, community-based integrated care organization. Methods We identified Kaiser Permanente Northern California health plan members (2004–2010) with a hospital discharge diagnosis suggesting ALF (ICD-9 570, 572.2, 572.4, 572.8, 573.3, 573.8, or V42.7) plus an inpatient international normalized ratio ≥1.5 (off warfarin) and total bilirubin ≥5.0 mg/dL. Hospital records were reviewed by hepatologists to adjudicate ALF events. PPVs for confirmed outcomes were determined for individual ICD-9 diagnoses, diagnoses plus prescriptions for hepatic encephalopathy treatment, and combinations of diagnoses in the setting of coagulopathy and hyperbilirubinemia. Results Among 669 members with no pre-existing liver disease, chart review confirmed ALF in 62 (9%). Despite the presence of co-existing coagulopathy and hyperbilirubinemia, individual ICD-9 diagnoses had low PPVs (range, 5%–15%); requiring prescriptions for encephalopathy treatment did not increase PPVs of these diagnoses (range, 2%–23%). Hospital diagnoses of other liver disorder (ICD-9 573.8) plus hepatic coma (ICD-9 572.2) had high PPV (67%; 95% CI, 9%-99%) but only identified 2 (3%) ALF events. Conclusions Algorithms comprising relevant hospital diagnoses, laboratory evidence of liver dysfunction, and prescriptions for hepatic encephalopathy treatment had low PPVs for confirmed ALF events. Studies of ALF will need to rely on medical records to confirm this outcome. PMID:25866286

  12. Practical Methods to Increase Use of Advance Medical Directives

    PubMed Central

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

    1999-01-01

    OBJECTIVE To compare the effectiveness of two means for increasing the use of advance medical directives: written materials only versus written materials and an educational videotape. DESIGN Population-based, randomized controlled trial with 3-month follow up. SETTING Kaiser Permanente Colorado Region, a not-for-profit group-model health maintenance organization. PARTICIPANTS A population-based sample of all 1,302 members aged 75 years and older who used the Franklin Medical Office, excluding 55 persons who died or disenrolled during the study period or were identified by their physicians as blind or cognitively impaired. INTERVENTIONS All subjects were mailed a 10-page cartoon-illustrated educational pamphlet on patient choices, a selection of Colorado advance medical directive forms, and a guide to their completion; 619 subjects also were mailed a 20-minute videotape on advance directives. Both groups had access to a study nurse for assistance in completing and placing advance medical directives. MEASUREMENTS AND MAIN RESULTS The main outcome measure is the proportion of subjects who placed a directive in their medical record for the first time. Placement rates increased almost identically, from 21.2% to 35.0% in the written materials-only group and from 18.9% to 32.6% in the group receiving the videotape (95% confidence interval for difference −0.04, 0.04, p = .952). CONCLUSIONS In an elderly population with a substantial baseline placement rate, mailing of written materials substantially increased placement of an advance directive in the medical record, but the addition of a videotape did not. Mailing the video did increase the use of treatment trials and made patients more aware of reasons not to use advance directives. PMID:9893087

  13. Influence of preparation conditions on the physico-chemical properties of unsupported sulfide-catalysts and relationship to catalytic activity

    SciTech Connect

    Breysse, M.; Frety, R.; Vrinat, M.

    1982-09-01

    The catalytic properties of unsupported CoMo and Mo sulfides catalysts are related to their structural and textural properties. It was found that hydrogenolysis activity, hydrogenation selectivity and stability are related to textural and structural properties of Mo and CoMo catalysts. The hydrogenolysis intrinsic activity and the stability decrease when the surface area increases, whereas hydrogenation selectivity increases. Formation of a mixed CoMoS phase increases the hydrogenolysis activity and the stability, but decreases the hydrogenation selectivity. Catalysts highly selective in hydrogenation are not stable. (JMT)

  14. Detective científica - Duration: 30 seconds.

    NASA Video Gallery

    La NASA posee muchos detectives que buscan pistas para resolver un misterio como la "detective científica" Monsi Roman. Se asegura de que el agua y el aire a bordo de la Estación Espacial Internaci...

  15. Encontrando planetas alrededor de otras estrellas - Duration: 30 seconds.

    NASA Video Gallery

    Así como la Tierra gira alrededor del Sol, la estrella más cercana, es posible que otros planetas orbiten las estrellas que se ven en el cielo nocturno. Piensa en todos los planetas del universo qu...

  16. Carcinoma de tumor primario desconocido—Versión para profesionales de salud

    Cancer.gov

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

  17. 2. FRONT ELEVATION OF CAR LOOKING SOUTH WITH CONDUCTOR, ROY ...

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

    2. FRONT ELEVATION OF CAR LOOKING SOUTH WITH CONDUCTOR, ROY HARVEY AT THE WHEEL - Como-Harriet Streetcar Line & Trolley Car No. 265, Forty-second Street West at Queen Avenue, Minneapolis, Hennepin County, MN

  18. 5. INTERIOR VIEW LOOKING FROM AISLE TOWARDS THE CONDUCTORS SEAT ...

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

    5. INTERIOR VIEW LOOKING FROM AISLE TOWARDS THE CONDUCTORS SEAT TO THE FRONT - Como-Harriet Streetcar Line & Trolley Car No. 265, Forty-second Street West at Queen Avenue, Minneapolis, Hennepin County, MN

  19. 5. Downstream face of Rock Creek Diversion Dam, looking west ...

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

    5. Downstream face of Rock Creek Diversion Dam, looking west (Diversion into Irrigation District canal) - Bitter Root Irrigation Project, Rock Creek Diversion Dam, One mile east of Como Dam, west of U.S. Highway 93, Darby, Ravalli County, MT

  20. 3. Upstream face of Rock Creek Diversion Dam, closeup of ...

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

    3. Upstream face of Rock Creek Diversion Dam, close-up of gates, looking southeast - Bitter Root Irrigation Project, Rock Creek Diversion Dam, One mile east of Como Dam, west of U.S. Highway 93, Darby, Ravalli County, MT