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  1. To What Degree Does Provider Performance Affect a Quality Indicator? The Case of Nursing Homes and ADL Change

    ERIC Educational Resources Information Center

    Phillips, Charles D.; Chen, Min; Sherman, Michael

    2008-01-01

    Purpose: This research investigates what factors affect the degree to which nursing home performance explains variance in residents' change in status of activities of daily living (ADL) after admission. Design and Methods: The database included all residents admitted in 2002 to a 10% random sample of nursing homes in the United States.…

  2. Trainee Occupational Therapists Scoring the Barthel ADL.

    PubMed

    Martin, Elizabeth; Nugent, Chris; Bond, Raymond; Martin, Suzanne

    2015-09-01

    Within medical applications there are two main types of information design; paper-based and digital information [1]. As technology is constantly changing, information within healthcare management and delivery is continually being transitioned from traditional paper documents to digital and online resources. Activity of Daily Living (ADL) charts are still predominantly paper based and are therefore prone to "human error" [2]. In light of this, an investigation has taken place into the design for reducing the amount of human error, between a paper based ADL, specifically the Barthel Index, and the same ADL created digitally. The digital ADL was developed as an online platform as this offers the best method of data capture for a large group of participants all together [3]. The aim of the study was to evaluate the usability of the Barthel Index ADL in paper format and then reproduce the same ADL digitally. This paper presents the findings of a study involving 26 participants who were familiar with ADL charts, and used three scenarios requiring them to complete both a paper ADL and a digital ADL. An evaluation was undertaken to ascertain if there were any 'human errors' in completing the paper ADL and also to find similarities/differences through using the digital ADL. The results from the study indicated that 22/26 participants agreed that the digital ADL was better, if not the same as a paper based ADL. Further results indicated that participants rate highly the added benefit of the digital ADL being easy to use and also that calculation of assessment scores were performed automatically. Statistically the digital BI offered a 100 % correction rate in the total calculation, in comparison to the paper based BI where it is more common for users to make mathematical calculation errors. Therefore in order to minimise handwriting and calculation errors, the digital BI proved superior than the traditional paper based method.

  3. Incidence of ADL Disability in Older Persons, Physical Activities as a Protective Factor and the Need for Informal and Formal Care – Results from the SNAC-N Project

    PubMed Central

    Sjölund, Britt-Marie; Wimo, Anders; Engström, Maria; von Strauss, Eva

    2015-01-01

    Background The aim of the study was to examine 1) the incidence of disability in Activities of Daily Living (ADL), in persons 78 years and older 2) explore whether being physical active earlier is a significant predictor of being disability free at follow-up and 3) describe the amount of informal and formal care in relation to ADL-disability. Methods Data were used from a longitudinal community-based study in Nordanstig (SNAC-N), a part of the Swedish National Study on Aging and Care (SNAC). To study objectives 1) and 2) all ADL-independent participants at baseline (N = 307) were included; for objective 3) all participants 78 years and older were included (N = 316). Data were collected at baseline and at 3- and 6-year follow-ups. ADL-disability was defined as a need for assistance in one or more activities. Informal and formal care were measured using the Resource utilization in Dementia (RUD)-instrument. Results The incidence rates for men were similar in the age groups 78-81and 84 years and older, 42.3 vs. 42.5/1000 person-years. For women the incidence rate for ADL-disability increased significantly from the age group 78–81 to the age group 84 years and older, 20.8 vs.118.3/1000 person-years. In the age group 78–81 years, being physically active earlier (aOR 6.2) and during the past 12 month (aOR 2.9) were both significant preventive factors for ADL-disability. Both informal and formal care increased with ADL-disability and the amount of informal care was greater than formal care. The incidence rate for ADL-disability increases with age for women and being physically active is a protective factor for ADL-disability. Conclusion The incidence rate for ADL-disability increases with age for women, and being physical active is a protective factor for ADL-disability. PMID:26407207

  4. Changes in Antibody Levels during and following an Episode of Acute Adenolymphangitis (ADL) among Lymphedema Patients in Léogâne, Haiti

    PubMed Central

    Mues, Katherine E.; Lammie, Patrick J.; Klein, Mitchel; Kleinbaum, David G.; Addiss, David; Fox, LeAnne M.

    2015-01-01

    Introduction Episodes of acute adenolymphangitis (ADL) are often the first clinical sign of lymphatic filariasis (LF). They are often accompanied by swelling of the affected limb, inflammation, fever, and general malaise and lead to the progression of lymphedema. Although ADL episodes have been studied for a century or more, questions still remain as to their etiology. We quantified antibody levels to pathogens that potentially contribute to ADL episodes during and after an episode among lymphedema patients in Léogâne, Haiti. We estimated the proportion of ADL episodes hypothesized to be attributed to specific pathogens. Methods We measured antibody levels to specific pathogens during and following an ADL episode among 41 lymphedema patients enrolled in a cohort study in Léogâne, Haiti. We calculated the absolute and relative changes in antibody levels between the ADL and convalescent time points. We calculated the proportion of episodes that demonstrated a two-fold increase in antibody level for several bacterial, fungal, and filarial pathogens. Results Our results showed the greatest proportion of two-fold changes in antibody levels for the carbohydrate antigen Streptococcus group A, followed by IgG2 responses to a soluble filarial antigen (BpG2), Streptococcal Pyrogenic Exotoxin B, and an antigen for the fungal pathogen Candida. When comparing the median antibody level during the ADL episode to the median antibody level at the convalescent time point, only the antigens for Pseudomonas species (P-value = 0.0351) and Streptolysin O (P-value = 0.0074) showed a significant result. Conclusion Although our results are limited by the lack of a control group and few antibody responses, they provide some evidence for infection with Streptococcus A as a potential contributing factor to ADL episodes. Our results add to the current evidence and illustrate the importance of determining the causal role of bacterial and fungal pathogens and immunological antifilarial

  5. Alternate Communications Spectrum Study (ACSS) for Aviation Data Links (ADL)

    NASA Technical Reports Server (NTRS)

    Matolak, David W.

    2003-01-01

    and parameters that must be selected in the design. Two appendices show example versions and initial results of the first few technical steps in the design approach. Some conclusions are then drawn, and in the final section, recommendations are provided, the most important of which are repeated here: 1. Continue the effort begun here. As detailed in this report, we have only uncovered much of the work that needs to be done in order to provide the foundation for a flexible, high- performance, robust ADL. 2. Seize the opportunity to begin testing in the MLS band. The wide bandwidths and low level of usage of this band make it an ideal one for proof-of-concept type testing. Other (non- aeronautical) organizations are likely to make claims on the band if it is not being used. The primary conclusion is that there is a real and pressing need for a new aviation data link. vi

  6. Does becoming an ADL spousal caregiver increase the caregiver's depressive symptoms?

    PubMed

    Dunkle, Ruth E; Feld, Sheila; Lehning, Amanda J; Kim, Hyunjee; Shen, Huei-Wern; Kim, Min Hee

    2014-11-01

    This study investigated whether transitioning into the role of activities of daily living (ADL) spousal caregiver is associated with increased depressive symptoms for older husbands and wives among a sample of coresiding community-dwelling older couples. Using data from the Health and Retirement Study, we estimated a two-level linear model to examine the association between change in caregiver status and respondents' depressive symptoms at follow-up, controlling for other factors identified in Pearlin's stress process model (PSPM). Results indicate that both husbands and wives who become ADL caregivers have more follow-up depressive symptoms than noncaregivers. Furthermore, wives continuing as caregivers have more follow-up depressive symptoms than wives who do not provide care. Finally, the physical health of the spousal caregiver is related to depressive symptoms at follow-up. We conclude with policy and practice implications of these three main findings. PMID:25651543

  7. The Classic Measure of Disability in Activities of Daily Living Is Biased by Age but an Expanded IADL/ADL Measure Is Not

    PubMed Central

    2010-01-01

    Objectives. To evaluate, by age, the performance of 2 disability measures based on needing help: one using 5 classic activities of daily living (ADL) and another using an expanded set of 14 activities including instrumental activities of daily living (IADL), walking, getting outside, and ADL (IADL/ADL). Methods. Guttman and item response theory (IRT) scaling methods are used with a large (N = 25,470) nationally representative household survey of individuals aged 18 years and older. Results. Guttman scalability of the ADL items increases steadily with age, reaching a high level at ages 75 years and older. That is reflected in an IRT model by age-related differential item functioning (DIF) resulting in age-biased measurement of ADL. Guttman scalability of the IADL/ADL items also increases with age but is lower than the ADL. Although age-related DIF also occurs with IADL/ADL items, DIF is lower in magnitude and balances out without causing age bias. Discussion. An IADL/ADL scale measuring need for help is hierarchical, unidimensional, and unbiased by age. It has greater content validity for measuring need for help in the community and shows greater sensitivity by age than the classic ADL measure. As demand for community services is increasing among adults of all ages, an expanded IADL/ADL measure is more useful than ADL. PMID:20100786

  8. A Process for the Representation of openEHR ADL Archetypes in OWL Ontologies.

    PubMed

    Porn, Alex Mateus; Peres, Leticia Mara; Didonet Del Fabro, Marcos

    2015-01-01

    ADL is a formal language to express archetypes, independent of standards or domain. However, its specification is not precise enough in relation to the specialization and semantic of archetypes, presenting difficulties in implementation and a few available tools. Archetypes may be implemented using other languages such as XML or OWL, increasing integration with Semantic Web tools. Exchanging and transforming data can be better implemented with semantics oriented models, for example using OWL which is a language to define and instantiate Web ontologies defined by W3C. OWL permits defining significant, detailed, precise and consistent distinctions among classes, properties and relations by the user, ensuring the consistency of knowledge than using ADL techniques. This paper presents a process of an openEHR ADL archetypes representation in OWL ontologies. This process consists of ADL archetypes conversion in OWL ontologies and validation of OWL resultant ontologies using the mutation test. PMID:26262167

  9. A Process for the Representation of openEHR ADL Archetypes in OWL Ontologies.

    PubMed

    Porn, Alex Mateus; Peres, Leticia Mara; Didonet Del Fabro, Marcos

    2015-01-01

    ADL is a formal language to express archetypes, independent of standards or domain. However, its specification is not precise enough in relation to the specialization and semantic of archetypes, presenting difficulties in implementation and a few available tools. Archetypes may be implemented using other languages such as XML or OWL, increasing integration with Semantic Web tools. Exchanging and transforming data can be better implemented with semantics oriented models, for example using OWL which is a language to define and instantiate Web ontologies defined by W3C. OWL permits defining significant, detailed, precise and consistent distinctions among classes, properties and relations by the user, ensuring the consistency of knowledge than using ADL techniques. This paper presents a process of an openEHR ADL archetypes representation in OWL ontologies. This process consists of ADL archetypes conversion in OWL ontologies and validation of OWL resultant ontologies using the mutation test.

  10. Modern Statistical Graphs that Provide Insight in Research Results

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Modern statistical graphics offer insight in assessing the results of many common statistical analyses. These ideas, however, are rarely employed in agronomic research articles. This work presents several commonly used graphs, offers one or more alternatives for each, and provides the reasons for pr...

  11. Foamed sand provides improved stimulation results from Devonian Shale

    SciTech Connect

    Strang, D.L.; Norton, J.L.

    1983-11-01

    Generally, water saturations in the Devonian Shale are low. Production records indicate minimal, if any, water in the areas producing gas or gas and oil. This low water saturation appears to be the key to stimulating the shale, especially in the oil-producing areas. The introduction of water in the stimulation fluid appears to reduce the permeability to oil, which is reflected in poorer production. The relative permeability reduction seems to be more of a problem than particle migration or clay swelling and could explain the good initial results from straight nitrogen treatments. However, the lack of a proppant, even with low closure stress, leads to very rapid declines. Water-base stimulation fluids appear to increase water saturation in the Devonian Shale. Use of 90+ quality foam with sand should provide a method of minimizing saturation changes while creating a propped fracture. Initial results indicate this technique provides better sustained production increases in the Devonian Shale. This paper defines areas of production, describes the geology and presents physical data of the Devonian Shale. It also compares results of several types of treatments that have been used in the Devonian Shale. These results indicate 90+ quality foam with sand should provide an improved stimulation technique for this formation.

  12. Firearms in Frail Hands: An ADL or A Public Health Crisis!

    PubMed

    Patel, Dupal; Syed, Quratulain; Messinger-Rapport, Barbara J; Rader, Erin

    2015-06-01

    The incidence of neurocognitive disorders, which may impair the ability of older adults to perform activities of daily living (ADLs), rises with age. Depressive symptoms are also common in older adults and may affect ADLs. Safe storage and utilization of firearms are complex ADLs, which require intact judgment, executive function, and visuospatial ability, and may be affected by cognitive impairment. Depression or cognitive impairment may cause paranoia, delusions, disinhibition, apathy, or aggression and thereby limit the ability to safely utilize firearms. These problems may be superimposed upon impaired mobility, arthritis, visual impairment, or poor balance. Inadequate attention to personal protection may also cause hearing impairment and accidents. In this article, we review the data on prevalence of firearms access among older adults; safety concerns due to age-related conditions; barriers to addressing this problem; indications prompting screening for firearms access; and resources available to patients, caregivers, and health care providers.

  13. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    ERIC Educational Resources Information Center

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  14. Communication of Genetic Test Results to Family and Health Care Providers Following Disclosure of Research Results

    PubMed Central

    Graves, Kristi D.; Sinicrope, Pamela S.; Esplen, Mary Jane; Peterson, Susan K.; Patten, Christi A.; Lowery, Jan; Sinicrope, Frank A.; Nigon, Sandra K.; Borgen, Joyce; Gorin, Sherri Sheinfeld; Keogh, Louise A.; Lindor, Noralane M.

    2014-01-01

    Purpose Few studies have examined methods to promote communication following the return of DNA mismatch repair (MMR) genetic test results obtained during research. The purpose of the present study was to evaluate a telephone protocol for returning research results of MMR gene testing to identify Lynch Syndrome. Methods We invited individuals with known MMR mutations in their family who were enrolled in the Colon Cancer Family Registry at the Mayo Clinic to participate. Participants completed surveys before and 6-months after MMR test result disclosure. Results Among 107 participants, 79% opted to learn their MMR test results; of these, 44 (41%) carried MMR mutations. Post-disclosure, 54% reported screening for any type of cancer. Among carriers, >74% reported communicating results to family; communication was predicted by baseline confidence in coping with the genetic test result (Z=1.97, P=.04). Result disclosure to a physician was predicted by greater perceived cancer risk (Z=2.08, P=.03) and greater intention to share results with family (Z=3.07, P=.002). Conclusions Research vs. clinically-based gene disclosure presents challenges. A telephone disclosure process for the return of research-based results among Lynch syndrome families led to high rates of result uptake and participant communication of results to providers and family members. PMID:24091800

  15. Ambient and smartphone sensor assisted ADL recognition in multi-inhabitant smart environments

    PubMed Central

    Misra, Archan; Cook, Diane

    2016-01-01

    Activity recognition in smart environments is an evolving research problem due to the advancement and proliferation of sensing, monitoring and actuation technologies to make it possible for large scale and real deployment. While activities in smart home are interleaved, complex and volatile; the number of inhabitants in the environment is also dynamic. A key challenge in designing robust smart home activity recognition approaches is to exploit the users' spatiotemporal behavior and location, focus on the availability of multitude of devices capable of providing different dimensions of information and fulfill the underpinning needs for scaling the system beyond a single user or a home environment. In this paper, we propose a hybrid approach for recognizing complex activities of daily living (ADL), that lie in between the two extremes of intensive use of body-worn sensors and the use of ambient sensors. Our approach harnesses the power of simple ambient sensors (e.g., motion sensors) to provide additional ‘hidden’ context (e.g., room-level location) of an individual, and then combines this context with smartphone-based sensing of micro-level postural/locomotive states. The major novelty is our focus on multi-inhabitant environments, where we show how the use of spatiotemporal constraints along with multitude of data sources can be used to significantly improve the accuracy and computational overhead of traditional activity recognition based approaches such as coupled-hidden Markov models. Experimental results on two separate smart home datasets demonstrate that this approach improves the accuracy of complex ADL classification by over 30 %, compared to pure smartphone-based solutions. PMID:27042240

  16. Trends in ADL and IADL Disability in Community-Dwelling Older Adults in Shanghai, China, 1998–2008

    PubMed Central

    2013-01-01

    Objectives. We investigated trends in activities of daily living (ADL) and instrumental activities of daily living (IADL) disability from 1998 to 2008 among elder adults in Shanghai, China. Method. Our data came from 4 waves of the Shanghai Longitudinal Survey of Elderly Life and Opinion (1998, 2003, 2005, and 2008). ADL and IADL disabilities were recorded dichotomously (difficulty vs. no difficulty). The major independent variable was survey year. Covariates included demographics, socioeconomic conditions, family and social support, and other health conditions. Nested random-effect models were applied to estimate trends over time, referenced to 1998. Results. In comparison with the baseline year (1998), older adults in 2008 had lower odds of being ADL disabled, though the effect was no longer statistically significant when other health conditions were taken into account. Elders in 2003, 2005, and 2008 were 20%–26%, 17%–38%, and 53%–64% less likely to be IADL disabled than those in 1998, respectively, depending on the set of covariates included in the model. Discussion. Shanghai elders experienced substantial improvements in both ADL and IADL disability prevalence over the past decade. The trend toward improvement in IADL function is more consistent and substantial than that of ADL function. PMID:23525547

  17. Algorithm integration using ADL (Algorithm Development Library) for improving CrIMSS EDR science product quality

    NASA Astrophysics Data System (ADS)

    Das, B.; Wilson, M.; Divakarla, M. G.; Chen, W.; Barnet, C.; Wolf, W.

    2013-05-01

    Algorithm Development Library (ADL) is a framework that mimics the operational system IDPS (Interface Data Processing Segment) that is currently being used to process data from instruments aboard Suomi National Polar-orbiting Partnership (S-NPP) satellite. The satellite was launched successfully in October 2011. The Cross-track Infrared and Microwave Sounder Suite (CrIMSS) consists of the Advanced Technology Microwave Sounder (ATMS) and Cross-track Infrared Sounder (CrIS) instruments that are on-board of S-NPP. These instruments will also be on-board of JPSS (Joint Polar Satellite System) that will be launched in early 2017. The primary products of the CrIMSS Environmental Data Record (EDR) include global atmospheric vertical temperature, moisture, and pressure profiles (AVTP, AVMP and AVPP) and Ozone IP (Intermediate Product from CrIS radiances). Several algorithm updates have recently been proposed by CrIMSS scientists that include fixes to the handling of forward modeling errors, a more conservative identification of clear scenes, indexing corrections for daytime products, and relaxed constraints between surface temperature and air temperature for daytime land scenes. We have integrated these improvements into the ADL framework. This work compares the results from ADL emulation of future IDPS system incorporating all the suggested algorithm updates with the current official processing results by qualitative and quantitative evaluations. The results prove these algorithm updates improve science product quality.

  18. Percentage of People with at Least One Activities of Daily Living (ADL) Limitation

    MedlinePlus

    ... ADL) Limitation Percentage of People with at Least One Activities of Daily Living (ADL) Limitation This measure ... Age Group Percentage of People with at Least One Activities of Daily Living Limitation by Age Group ...

  19. Quantifying kinematics of purposeful movements to real, imagined, or absent functional objects: Implications for modelling trajectories for robot-assisted ADL tasks**

    PubMed Central

    Wisneski, Kimberly J; Johnson, Michelle J

    2007-01-01

    curvature than in the object imagined and absent conditions. Curvature in the XZ plane of movement was greater than curvature in the XY plane for all movements. Conclusion The implemented minimum jerk trajectory model was not adequate for generating functional trajectories for these ADLs. The deviations caused by object affordance and functional task constraints must be accounted for in order to allow subjects to perform functional task training in robotic therapy environments. The major differences that we have highlighted include trajectory dependence on: object presence, object orientation, and the plane of movement. With the ability to practice ADLs on the ADLER environment we hope to provide patients with a therapy paradigm that will produce optimal results and recovery. PMID:17381842

  20. Testing for neglect in right-hemispheric stroke patients using a new assessment battery based upon standardized activities of daily living (ADL).

    PubMed

    Eschenbeck, Philipp; Vossel, Simone; Weiss, Peter H; Saliger, Jochen; Karbe, Hans; Fink, Gereon R

    2010-10-01

    Spatial neglect is most frequently observed after right-hemispheric stroke and is characterized by a failure to report, to respond, or to orient to stimuli presented to the contralesional side. Although many neglect patients show difficulties in accomplishing activities of daily living (ADL), to date the clinical assessment of neglect is based upon neuropsychological paper-and-pencil tests. Thus, essential information about the patient's functional status may be missed out. Accordingly, we aimed at developing a new neglect test battery that incorporates standardized ADL. Six conventional paper-and-pencil neglect tests and eight standardized ADL with newly developed neglect-specific scoring criteria and cut-off scores were administered to 68 right-hemispheric stroke patients. According to the neuropsychological tests 22 patients showed symptoms suggesting neglect, whereas 17 patients showed symptoms suggesting neglect according to the newly developed neglect test based upon ADL. Neglect-specific impairments in the neuropsychological tests were significantly associated with those in the ADL-based tests, although dissociations were observed in seven patients. Neglect severity (as reflected in the percentage of positive subtests) was comparable for both test batteries and both test instruments showed high interrater reliability. Voxel-based lesion-symptom mapping revealed that the severity of neglect according to the neuropsychological and ADL-based tests was significantly associated with lesions within right fronto-parietal networks. We conclude that the newly developed ADL-based neglect battery provides an economic and ecologically valid tool for the assessment of neglect. The test can be used to assess and quantify neglect in everyday activities, and thus to monitor realistically rehabilitative needs of neglect patients.

  1. Health-related quality of life (HRQOL), activity of daily living (ADL) and depressive mood disorder in temporal lobe epilepsy patients.

    PubMed

    Lehrner, J; Kalchmayr, R; Serles, W; Olbrich, A; Pataraia, E; Aull, S; Bacher, J; Leutmezer, F; Gröppel, G; Deecke, L; Baumgartner, C

    1999-04-01

    We determined the interrelations of chronological age, age at seizure onset, duration of seizure disorder, cognitive functioning (IQ), scales of activities of daily living, depressive mood disorder and measures of health-related quality of life (HRQOL). Furthermore, we investigated the association of the laterality of seizure onset zone and absence/presence of hippocampal atrophy and/or sclerosis (HA/HS) with measures of HRQOL, activities of daily living (ADL) and depressive mood disorder. In the setting of pre-surgical epilepsy evaluation, a sample of 56 patients with temporal lobe epilepsy (TLE) was studied using the Bonner Skalen für Epilepsie (BPSE) and the depression inventory D-S of von Zerssen. Patients reported high levels of dependency on others and poor coping capabilities. Our data also showed specific ADL-behaviour suggesting social withdrawal and isolation. Our results indicate emotional impairment as a major problem in TLE, because 45% of our patients scored in the depressive range of the D-S depression scale. Depression score was found to be a powerful predictor of self-reported quality of life after adjusting for seizure-related variables, demographic variables and cognitive functioning (IQ). The only scale showing a significant laterality effect was ADL-home. No relationship between the dependent measures of HRQOL, ADL-social, ADL-cultural, depressive mood disorder and laterality of the epileptogenic zone or absence/presence of HA/HS was found. HRQOL and depressive mood disorder are strongly interrelated indicating that patients with depressive symptoms report lower quality of life and specific patterns of ADL. HRQOL, ADL and depressive mood disorder are largely independent of biological markers such as laterality of seizure onset zone and absence/presence of HA/HS in TLE.

  2. Effect of a Laboratory Result Pager on Provider Behavior in a Neonatal Intensive Care Unit

    PubMed Central

    Samal, L.; Stavroudis, TA.; Miller, RE.; Lehmann, HP.; Lehmann, CU.

    2011-01-01

    Background A computerized laboratory result paging system (LRPS) that alerts providers about abnormal results (“push”) may improve upon active laboratory result review (“pull”). However, implementing such a system in the intensive care setting may be hindered by low signal-to-noise ratio, which may lead to alert fatigue. Objective To evaluate the impact of an LRPS in a Neonatal Intensive Care Unit. Methods Utilizing paper chart review, we tallied provider orders following an abnormal laboratory result before and after implementation of an LRPS. Orders were compared with a predefined set of appropriate orders for such an abnormal result. The likelihood of a provider response in the post-implementation period as compared to the pre-implementation period was analyzed using logistic regression. The provider responses were analyzed using logistic regression to control for potential confounders. Results The likelihood of a provider response to an abnormal laboratory result did not change significantly after implementation of an LRPS. (Odds Ratio 0.90, 95% CI 0.63–1.30, p-value 0.58) However, when providers did respond to an alert, the type of response was different. The proportion of repeat laboratory tests increased. (26/378 vs. 7/278, p-value = 0.02) Conclusion Although the laboratory result pager altered healthcare provider behavior in the Neonatal Intensive Care Unit, it did not increase the overall likelihood of provider response. PMID:23616885

  3. Provider management strategies of abnormal test result alerts: a cognitive task analysis

    PubMed Central

    Sawhney, Mona K; Wilson, Lindsay; Sittig, Dean F; Espadas, Donna; Davis, Traber; Singh, Hardeep

    2010-01-01

    Objective Electronic medical records (EMRs) facilitate abnormal test result communication through “alert” notifications. The aim was to evaluate how primary care providers (PCPs) manage alerts related to critical diagnostic test results on their EMR screens, and compare alert-management strategies of providers with high versus low rates of timely follow-up of results. Design 28 PCPs from a large, tertiary care Veterans Affairs Medical Center (VAMC) were purposively sampled according to their rates of timely follow-up of alerts, determined in a previous study. Using techniques from cognitive task analysis, participants were interviewed about how and when they manage alerts, focusing on four alert-management features to filter, sort and reduce unnecessary alerts on their EMR screens. Results Provider knowledge of alert-management features ranged between 4% and 75%. Almost half (46%) of providers did not use any of these features, and none used more than two. Providers with higher versus lower rates of timely follow-up used the four features similarly, except one (customizing alert notifications). Providers with low rates of timely follow-up tended to manually scan the alert list and process alerts heuristically using their clinical judgment. Additionally, 46% of providers used at least one workaround strategy to manage alerts. Conclusion Considerable heterogeneity exists in provider use of alert-management strategies; specific strategies may be associated with lower rates of timely follow-up. Standardization of alert-management strategies including improving provider knowledge of appropriate tools in the EMR to manage alerts could reduce the lack of timely follow-up of abnormal diagnostic test results. PMID:20064805

  4. [ADL and actual life styles of all Japanese centenarians as determined by a visitation interview survey].

    PubMed

    Ogihara, R; Maeda, K; Tsujibayashi, K; Tomabechi, K; Ohta, T; Iwabuchi, K; Mano, Y

    2000-03-01

    A visiting interview survey was performed on all centenarians living in Japan to investigate their Activities of Daily Life (ADL). 2,851 centenarians, 92.9% of all subjects completed the interview. They were divided into three groups, good ADL (almost independent in daily life), moderate ADL (almost independent in indoor life), and inferior ADL (bed fast) by the condition of ADL. Some factors of health conditions, family size, frequency of use of public welfare services, and life styles were compared among these three groups. Both the good and the moderate ADL groups accounted for about 20% each, and the inferior ADL group was about 60% of the subjects. The condition of ADL of men was better than that of women. The inferior ADL group showed a significantly higher percentage of chronic diseases. High ratios of cerebral vascular disease and dementia were seen in this group, and many had no teeth. While two thirds of all the centenarians lived at home, over 90% of the good ADL group lived at home. The mode of family size was three including the person oneself. An average of 21% of men and 27% of women used public health welfare services. However 40% of the centenarians in the inferior ADL group used those services. Men had better dietary habits for health than women. The good ADL group showed the most desirable dietary habits among the three groups and had the highest percentage of drinkers and smokers. Men practiced a greater number of ideal habits for longevity than women. Of the ADL groups, centenarians in the good ADL group had the highest percentage of ideal habits for longevity. The centenarians who maintained good ADL had the following characteristics: There were fewer people under medical treatment. They had maintained their own teeth. Almost all of them were living at their home with their family. They had continued good dietary habits and daily life for health and longevity. For the maintenance and improvement of ADL of centenarians, adequate social welfare

  5. Effects of aquatic PNF lower extremity patterns on balance and ADL of stroke patients

    PubMed Central

    Kim, Eun-Kyung; Lee, Dong-Kyu; Kim, Young-Mi

    2015-01-01

    [Purpose] This study investigated the effect of aquatic proprioceptive neuromuscular facilitation (PNF) patterns in the lower extremity on balance and activities of daily living (ADL) in stroke patients. [Subjects] Twenty poststroke participants were randomly assigned to an experimental group (n = 10) or a control group (n = 10). The experimental group performed lower extremity patterns in an aquatic environment, and the control group performed lower extremity patterns on the ground. Both exercises were conducted for 30 minutes/day, 5 days/week for 6 weeks. Balance was measured with the Berg Balance Scale (BBS), Timed Up and Go Test (TUGT), Functional Reach Test (FRT), and One Leg Stand Test (OLST). Activities of daily living were measured with the Functional Independence Measure (FIM). A paired t-test was used to measure pre- and post-experiment differences, and an independent t-test was used to measure between-group differences. [Results] The experimental and control groups showed significant differences for all pre- and post-experiment variables. In the between-group comparison, the experimental group was significantly difference from the control group. [Conclusion] These results indicate that performing aquatic proprioceptive neuromuscular facilitation patterns in the lower extremity enhances balance and ADL in stroke patients. PMID:25642076

  6. Evaluation of a radio based ADL interaction recognition system in a day hospital for old age psychiatry with healthy probands.

    PubMed

    Neuhaeuser, J; Diehl-Schmid, J; Lueth, T C

    2011-01-01

    In this contribution the evaluation of a system called "Eventlogger" is presented, which is installed in a day hospital for old age psychiatry. The Eventlogger is a radio based module with an adjustable communication range, able to recognize interaction of the user with objects or with other people. It is intended to function as a monitoring tool for the users' activities. Due to the demographic change monitoring systems for elderly people become more important. In this paper the "simple activities of daily living" (sADL) is introduced as well as the evaluation for the recognition of sADL in a day hospital for old age psychiatry with healthy probands is presented. Together with the first approaches of post processing for better results it is shown that the system is now ready to be used with patients of the day hospital for old age psychiatry.

  7. SO{sub 2} and NOx trading markets: providing flexibility and results

    SciTech Connect

    Sam Napolitano; Melanie LaCount; Daniel Chartier

    2007-06-15

    Experience with the Acid Rain and NOx Budget Trading Programs demonstrates that cap-and-trade programs are an effective means of achieving broad improvements in air quality. Results demonstrate that the combination of mandatory emissions caps, a viable allowance trading market, rigorous emissions monitoring and reporting protocols, and automatic enforcement provide accountability and ensure results in a cost-effective manner. The market developments discussed in this article demonstrate a successful environmental partnership. With a government focused on results and a private sector motivated to innovate, cap-and trade systems deliver environmental results as efficiently and effectively as possible. 3 refs., 4 figs,

  8. The tool in the brain: apraxia in ADL. Behavioral and neurological correlates of apraxia in daily living.

    PubMed

    Bieńkiewicz, Marta M N; Brandi, Marie-Luise; Goldenberg, Georg; Hughes, Charmayne M L; Hermsdörfer, Joachim

    2014-01-01

    Humans differ from other animals in the way they can skilfully and precisely operate or invent tools to facilitate their everyday life. Tools have dominated our home, travel and work environment, becoming an integral step for our motor skills development. What happens when the part of the brain responsible for tool use is damaged in our adult life due to a cerebrovascular accident? How does daily life change when we lose the previously mastered ability to make use of the objects around us? How do patients suffering from compromised tool use cope with food preparation, personal hygiene, grooming, housework, or use of home appliances? In this literature review we present a state of the art for single and multiple tool use research, with a focus on the impact that apraxia (impaired ability to perform tool-based actions) and action disorganization syndrome (ADS; impaired ability to carry out multi-step actions) have on activities of daily living (ADL). Firstly, we summarize the behavioral studies investigating the impact of apraxia and other comorbidity syndromes, such as neglect or visual extinction, on ADL. We discuss the hallmarks of the compromised tool use in terms of the sequencing of action steps, conceptual errors committed, spatial motor control, and temporal organization of the movement. In addition, we present an up-to-date overview of the neuroimaging and lesion analyses studies that provide an insight into neural correlates of tool use in the human brain and functional changes in the neural organization following a stroke, in the context of ADL. Finally we discuss the current practice in neurorehabilitation of ADL in apraxia and ADS aiming at increasing patients' independence.

  9. Characteristics of Genomic Test Consumers Who Spontaneously Share Results with Their Health Care Provider

    PubMed Central

    Darst, Burcu F.; Madlensky, Lisa; Schork, Nicholas J.; Topol, Eric J.; Bloss, Cinnamon S.

    2013-01-01

    Purpose To evaluate the characteristics of direct-to-consumer (DTC) genomic test consumers who spontaneously shared their test results with their health care provider. Methods Utilizing data from the Scripps Genomic Health Initiative we compared demographic, behavioral, and attitudinal characteristics of DTC genomic test consumers who shared their results with their physician or health care provider versus those who did not share. We also compared genomic risk estimates between the two groups. Results Of 2024 individuals assessed at approximately 6 months post-testing, a total of 540 individuals (26.5%) reported sharing their results with their physician or health care provider. Those who shared were older (p<.001), had a higher income (p=.01), were more likely to be married (p=.005), and more likely to identify with a religion (p=.004). As assessed prior to undergoing testing, sharers also showed higher exercise (p=.003) and lower fat intake (p=.02), and expressed fewer overall concerns about testing (p=.001) and fewer concerns related to the privacy of their genomic information (p=.03). The genomic disease risk estimates disclosed were not associated with sharing. Conclusion In a DTC genomic testing context, physicians and other health care providers may be more likely to encounter patients who are more health conscious and have fewer concerns about the privacy of their genomic information. Genomic risk itself does not appear to be a primary determinant of sharing behavior among consumers. PMID:23384116

  10. Audio Development Laboratory (ADL) User Test Planning Guide

    NASA Technical Reports Server (NTRS)

    Romero, Andy

    2012-01-01

    Test process, milestones and inputs are unknowns to first-time users of the ADL. The User Test Planning Guide aids in establishing expectations for both NASA and non-NASA facility customers. The potential audience for this guide includes both internal and commercial spaceflight hardware/software developers. It is intended to assist their test engineering personnel in test planning and execution. Material covered includes a roadmap of the test process, roles and responsibilities of facility and user, major milestones, facility capabilities, and inputs required by the facility. Samples of deliverables, test article interfaces, and inputs necessary to define test scope, cost, and schedule are included as an appendix to the guide.

  11. Assessing the delivery of patient critical laboratory results to primary care providers.

    PubMed

    Montes, Angelica; Francis, Michelle; Ciulla, Anna P

    2014-01-01

    Approximately 60% to 70% of all health care decisions are based on laboratory test results; therefore, it is important to ensure that patient laboratory results are communicated to the physician in a timely fashion. The objective of this study was to assess the delivery of critical laboratory results in outpatient physician offices in Delaware. Contact information for physician offices was obtained using the Highmark. Blue Cross Blue Shield. physician provider directory. A survey was created using a series of questions regarding the procurement and timely communication of critical laboratory results. Of the offices surveyed, 61.4% indicated that they did not utilize a standard operating procedure specifying who is able to receive the critical laboratory test results and how they should be delivered to the physician. These findings indicate that a change may be necessary to improve the way that critical test results are managed by physician offices. PMID:25219070

  12. Characteristics of genomic test consumers who spontaneously share results with their health care provider.

    PubMed

    Darst, Burcu F; Madlensky, Lisa; Schork, Nicholas J; Topol, Eric J; Bloss, Cinnamon S

    2014-01-01

    The purpose of this study was to evaluate the characteristics of direct-to-consumer (DTC) genomic test consumers who spontaneously shared their test results with their health care provider. Utilizing data from the Scripps Genomic Health Initiative, we compared demographic, behavioral, and attitudinal characteristics of DTC genomic test consumers who shared their results with their physician or health care provider versus those who did not share. We also compared genomic risk estimates between the two groups. Of 2,024 individuals assessed at approximately 6 months post testing, 540 individuals (26.5%) reported sharing their results with their physician or health care provider. Those who shared were older (p < .001), had a higher income (p = .01), were more likely to be married (p = .005), and were more likely to identify with a religion (p = .004). As assessed prior to undergoing testing, sharers also reported higher levels of exercise (p = .003), lower fat intake (p = .02), fewer overall concerns about testing (p = .001), and fewer concerns related to the privacy of their genomic information (p = .03). The genomic disease risk estimates disclosed were not associated with sharing. Thus, in a DTC genomic testing context, physicians and other health care providers may be more likely to encounter patients who are more health conscious and have fewer concerns about the privacy of their genomic information. Genomic risk itself does not appear to be a primary determinant of sharing behavior among consumers. PMID:23384116

  13. Characteristics of genomic test consumers who spontaneously share results with their health care provider.

    PubMed

    Darst, Burcu F; Madlensky, Lisa; Schork, Nicholas J; Topol, Eric J; Bloss, Cinnamon S

    2014-01-01

    The purpose of this study was to evaluate the characteristics of direct-to-consumer (DTC) genomic test consumers who spontaneously shared their test results with their health care provider. Utilizing data from the Scripps Genomic Health Initiative, we compared demographic, behavioral, and attitudinal characteristics of DTC genomic test consumers who shared their results with their physician or health care provider versus those who did not share. We also compared genomic risk estimates between the two groups. Of 2,024 individuals assessed at approximately 6 months post testing, 540 individuals (26.5%) reported sharing their results with their physician or health care provider. Those who shared were older (p < .001), had a higher income (p = .01), were more likely to be married (p = .005), and were more likely to identify with a religion (p = .004). As assessed prior to undergoing testing, sharers also reported higher levels of exercise (p = .003), lower fat intake (p = .02), fewer overall concerns about testing (p = .001), and fewer concerns related to the privacy of their genomic information (p = .03). The genomic disease risk estimates disclosed were not associated with sharing. Thus, in a DTC genomic testing context, physicians and other health care providers may be more likely to encounter patients who are more health conscious and have fewer concerns about the privacy of their genomic information. Genomic risk itself does not appear to be a primary determinant of sharing behavior among consumers.

  14. Results of a survey assessing provider beliefs of adherence barriers to antiplatelet medications.

    PubMed

    Bird, Gary C; Cannon, Christopher P; Kennison, Richard H

    2011-09-01

    The guidelines published by the American College of Cardiology Foundation/American Heart Association provide an evidence-based rationale and continuum of care for patients with unstable angina/non-ST-segment elevation acute coronary syndromes (UA/NSTE-ACS) from acute through to chronic management. Antiplatelet therapy forms an integral part of the care regimen, and a wealth of evidence supports appropriate dual or triple antiplatelet therapy in significantly reducing the frequency of potentially fatal secondary ischemic events. However, as is often the case with long-term therapies, adherence issues become apparent that limit this potential. In this article, we report on the results of a national survey of health care providers involved in the care of UA/NSTE-ACS patients on chronic (posthospital discharge) antiplatelet therapy. Our data reveal that the participants believe costs, lack of patient understanding of their condition or medication, and perception of the value of their therapy are important patient factors that promote nonadherence. Participants indicated that nonadherence occurs more frequently among minority and elderly patients, and less frequently when a caregiver is involved. We also show that deficits of knowledge, competence, and confidence exist in providers who treat patients with UA/NSTE-ACS. These deficits were generally greater in primary/family care providers compared with internal medicine and cardiologists, and for nurse practitioners/physician assistants compared with physicians (MDs/DOs). In addition, providers of all types frequently did not use adherence-improving tools or resources with their staff or patients. Our data suggest that because of its potential impact on patient outcomes, there is a pressing need to improve provider antiplatelet therapy adherence management in UA/NSTE-ACS.

  15. Geological questions and significant results provided by early ERTS-1 data

    NASA Technical Reports Server (NTRS)

    Carter, W. D.

    1972-01-01

    There are no author-identified significant results in this report. The organization for evaluating the uses of Earth Resources Technology Satellite data of the United States and foreign areas is described. The implementation of a system to disseminate the data to the geographical areas of interest is discussed. Brief descriptions are included of data received for the following areas: (1) east coast, (2) central United States, (3) western mountain areas, (4) west coast areas, and (5) Alaska. It is concluded that the multiband approach is useful with each of the bands providing unique and useful information. The difficulties in handling the data if all seven bands are used are examined.

  16. Immunohistochemistry staining for mismatch repair proteins: the endoscopic biopsy material provides useful and coherent results.

    PubMed

    Vilkin, Alex; Leibovici-Weissman, Ya'ara; Halpern, Marisa; Morgenstern, Sara; Brazovski, Eli; Gingold-Belfer, Rachel; Wasserberg, Nir; Brenner, Baruch; Niv, Yaron; Sneh-Arbib, Orly; Levi, Zohar

    2015-11-01

    Immunohistochemistry (IHC) testing for mismatch repair proteins (MMRP) in patients with colorectal cancer can be performed on endoscopic biopsy material or the surgical resection material. Data are continuing to accumulate regarding the deleterious effect of neoadjuvant chemoradiation on MMRP expression. However, despite continuing rise in the use of endoscopic biopsies for IHC, most pathology departments still use mainly the surgical materials for IHC testing. In this study we compared the quality of stains among 96 colon cancer subjects with paired endoscopic and surgical material available for MLH1, MSH2, MSH6, and PMS2 stains (96 × 4, yielding 384 paired stains). Each slide received both a quantitative score (immunoreactivity [0-3] × percent positivity [0-4]) and a qualitative score (absent; weak and focal; strong). The quantitative scores of all MMRP were significantly higher among the endoscopic material (P<.001 for all). In 358 pairs (93.2%), both the endoscopic and operative material stained either strong (322, 83.9%) or absent (36, 9.4%). In 26 pairs (6.8%), the endoscopic material stained strong, whereas the operative material stained focal and weak. No endoscopic biopsy materials stained focal and weak. Our findings indicate that the biopsy material may provide more coherent results. Although these results may indicate that biopsy material provides coherent and useful results, it is yet to be determined if the demonstrated differences pose a real clinical problem in interpreting final results of IHC staining of such kind. Hence, we suggest that when available, the endoscopic material rather than the operative one should serve as the primary substrate for IHC staining.

  17. Preferences for results from genomic microarrays: comparing parents and health care providers.

    PubMed

    Turbitt, E; Halliday, J L; Amor, D J; Metcalfe, S A

    2015-01-01

    Chromosomal microarray (CMA) testing is now performed frequently in paediatric care. Although CMAs improve diagnostic yields, they increase detection of variants of unknown and uncertain clinical significance (VUS). Understanding parents', paediatricians' and genetic health professionals' (GHPs) views regarding variant disclosure may reduce the potential for communication of unwanted information. A questionnaire was designed to compare disclosure preferences of these three groups in Australia. One hundred and forty-seven parents, 159 paediatricians and 69 GHPs hold similar views with at least 89% of respondents certainly or probably favouring disclosure of all categories of variants. However, some differences were observed between health care providers (HCPs: paediatricians and GHPs) and parents, who were less sure of their disclosure preferences. There was consensus among respondent groups that knowledge of a variant of certain clinical significance would provide more practical and emotional utility compared to VUS. Compared to HCPs, parents placed more emphasis on using knowledge of a VUS when considering future pregnancies (p < 0.001). This study may help HCPs anticipate parents' preferences for genomic testing. As whole exome/genome sequencing is integrated into clinical practice, the potential for differing views of parents and HCPs should be considered when developing guidelines for result disclosure.

  18. Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries

    PubMed Central

    2011-01-01

    Background Most prior studies have focused on short-term (≤ 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines. Methods The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop. Results The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline. Conclusions Both the additive and

  19. Results of an Iridium-Based Data Communication System Providing Internet Access to Polar Expeditions

    NASA Astrophysics Data System (ADS)

    Mohammad, A.; Frost, V.; Braaten, D.

    2003-12-01

    ' W) from June 23-July 17, 2003. We measured the reliability, throughput and general performance of this system over periods of up to 24 hours. This included delay, loss, throughput, call drops/up-time, relative signal strengths, connection time and number of connection retries. The system was also successfully tested while moving across the ice sheet at speeds of up to 30 km/h. We were successful in uploading and downloading large files (.2MB to 7.2MB) to the Internet. In combination with a modified Wi-Fi deployment, wireless Internet access was also provided to the entire NorthGRIP camp for a few days. The field experiments have shown that standard Internet protocols combined with MLPPP and Iridium modems can provide Internet access for polar expeditions at useful data rates. The 4-modem configuration we tested was observed to be >90 % efficient, e.g., a 2.5 MB video file was transferred in 35 min. at 9.524 Kb/s. The system had an average up-time of over 90 % and thus is stable and suitable for autonomous operation. Mobile performance results were very similar to that of stationary systems. While the end-to-end network architecture developed to provide Internet access worked well, the system round trip time is significant ( ˜ 1.8 seconds), which can impair real time interactions.

  20. Multi-modal assessment in Alzheimer's disease. ADL in relation to PET, MRI and neuropsychology.

    PubMed

    Souder, E; Saykin, A J; Alavi, A

    1995-09-01

    Alzheimer's disease (AD) causes a deterioration in functional status which may best be understood as a multi-dimensional concept. Results of multi-modal functional assessment in two patients with probable AD and comparable Mini-Mental State Examination scores demonstrated the heterogeneity of disease profiles and individual variations in functional status. Measures included direct assessment of ADL performance (SAILS), self and family perception of "current" and "best ever" functioning (NBFADL-60), neuropsychological test battery, magnetic resonance imaging (MRI) and positron emission tomography (FDG-PET). The multi-modal assessment yielded complementary information, and permitted correlation of physiological and behavioral data. Future studies should examine the potential heuristic and clinical utility of this approach. PMID:7560823

  1. Sodium oxybate therapy provides multidimensional improvement in fibromyalgia: results of an international phase 3 trial

    PubMed Central

    Spaeth, Michael; Bennett, Robert M; Benson, Beverly A; Wang, Y Grace; Lai, Chinglin; Choy, Ernest H

    2012-01-01

    Background Fibromyalgia is characterised by chronic musculoskeletal pain and multiple symptoms including fatigue, multidimensional function impairment, sleep disturbance and tenderness. Along with pain and fatigue, non-restorative sleep is a core symptom of fibromyalgia. Sodium oxybate (SXB) is thought to reduce non-restorative sleep abnormalities. This study evaluated effects of SXB on fibromyalgia-related pain and other symptoms. Methods 573 patients with fibromyalgia according to 1990 American College of Rheumatology criteria were enrolled at 108 centres in eight countries. Subjects were randomly assigned to placebo, SXB 4.5 g/night or SXB 6 g/night. The primary efficacy endpoint was the proportion of subjects with ≥30% reduction in pain visual analogue scale from baseline to treatment end. Other efficacy assessments included function, sleep quality, effect of sleep on function, fatigue, tenderness, health-related quality of life and subject's impression of change in overall wellbeing. Results Significant improvements in pain, sleep and other symptoms associated with fibromyalgia were seen in SXB treated subjects compared with placebo. The proportion of subjects with ≥30% pain reduction was 42.0% for SXB4.5 g/night (p=0.002) and 51.4% for SXB6 g/night (p<0.001) versus 26.8% for placebo. Quality of sleep (Jenkins sleep scale) improved by 20% for SXB4.5 g/night (p≤0.001) and 25% for SXB6 g/night (p≤0.001) versus 0.5% for placebo. Adverse events with an incidence ≥5% and twice placebo were nausea, dizziness, vomiting, insomnia, anxiety, somnolence, fatigue, muscle spasms and peripheral oedema. Conclusion These results, combined with findings from previous phase 2 and 3 studies, provide supportive evidence that SXB therapy affordsimportant benefits across multiple symptoms in subjects with fibromyalgia. PMID:22294641

  2. Design and initial results from a supported education initiative: the Kansas Consumer as Provider program.

    PubMed

    McDiarmid, Diane; Rapp, Charles; Ratzlaff, Sarah

    2005-01-01

    Despite increased attention to consumer-providers, there remains a lack of models that prepare, support, and sustain consumers in provider roles. This article describes the Consumer as Provider (CAP) Training program at the University of Kansas School of Social Welfare, which creates opportunities for individuals with severe psychiatric disabilities to develop knowledge and skills to be effective as human service providers. CAP fosters a partnership between colleges and community mental health centers where students experience classroom and internship activities. Outcome from a 2-year longitudinal study on CAP graduates indicates increased employability, especially in social services field, and higher post-secondary educational involvement.

  3. The Training and Retention of Family Child Care Providers: Evaluation Results.

    ERIC Educational Resources Information Center

    Mueller, Charles W.; Orimoto, Lisa N.

    This report describes a 2-year evaluation of a demonstration program designed to train family child care providers to become economically self-sufficient small business operators. The evaluation report reveals that recruitment was stable and successful; that projects provided training to the targeted number of participants and were quite…

  4. Colorectal cancer screening practices of primary care providers: results of a national survey in Malaysia.

    PubMed

    Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim

    2014-01-01

    The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.

  5. Integrating earth observations and model results provides earlier Famine Early Warning

    NASA Astrophysics Data System (ADS)

    Brown, M. E.; Funk, C. C.; Galu, G.; Choularton, R.

    2007-12-01

    Remote sensing allows us to detect slowly evolving natural hazards such as agricultural drought. Famine early warning systems transform this data into actionable policy information, enabling humanitarian organizations to respond in a timely and appropriate manner. These life saving responses are increasingly important. In 2006, 1 out of 8 people did not have enough to eat, 22 million more people became undernourished, and 22 countries provided 6.5 billion dollars in food aid. The motivation is strong, therefore, to increase the effectiveness of every dollar of food aid provided, ensuring that the assistance arrives sufficiently early to ward off human and economic catastrophe. Properly interpreted remote sensing information reduces the influence of politics in determining the amount and location of aid delivered. In this talk we will review three recent contributions that earth observations have provided to famine early warning: trend identification, increasingly accurate forecasts of food security conditions, and enhanced integration of biophysical and socio-economic data.

  6. Temperature and vibration results from captive-store flight tests provide a reliability improvement tool

    NASA Astrophysics Data System (ADS)

    Calatayud, Richard; Szymkowiak, Edward A.

    The ALQ-131 electronic countermeasure (ECM) system has provided the United States Air Force with proven self-protection for many of its tactical fighter aircraft. The reliability and maintainability (R&M) improvements of the ALQ-131 Block II has produced a system with an mean time between failures (MTBF) of 120 to 180 h and greater than 95 percent availability for the 390 systems in theater during the Persian Gulf war. Classic R&M approaches have gotten the ALQ-131 to this high standard, but improved understanding of the environment experienced by the system will provide the next steps in reliability improvements. The capture of measured response data will provide a basis for development life cycle and customer warranty tests which will guarantee to the customer that the ALQ-131 system will continue to perform reliably from takeoff to landing and from mission to mission through the life of the system.

  7. Health Service Providers in Psychology: Results of the 1978 APA Human Resources Survey.

    ERIC Educational Resources Information Center

    Vandenbos, Gary R.; And Others

    1981-01-01

    Describes characteristics, employment setting, and professional practices of health service-provider psychologists. Discusses their current status in psychology, the distribution of health care practitioners, patterns of specialization in service delivery, and populations being served by these practitioners. (Author/MJL)

  8. Service Providers in Psychology: Results of the 1982 APA Human Resources Survey.

    ERIC Educational Resources Information Center

    VandenBos, Gary R.; Stapp, Joy

    1983-01-01

    Based on a survey of service provider psychologists, describes (1) their age, sex, ethnicity, years since degree licensure, state association membership, and "National Register" listing; (2) primary and secondary employment settings; (3) professional practices; and (4) aspects of independent practice. (GC)

  9. Tick Bite Prophylaxis: Results From a 2012 Survey of Healthcare Providers.

    PubMed

    Perea, A E; Hinckley, A F; Mead, P S

    2015-08-01

    In a recent national survey, over 30% of healthcare providers (HCPs) reported prescribing tick bite prophylaxis in the previous year. To clarify provider practices, we surveyed HCPs to determine how frequently and for what reasons they prescribed tick bite prophylaxis. We included four questions regarding tick bite prophylaxis in the DocStyles 2012 survey, a computer-administered questionnaire of 2205 US primary care physicians, paediatricians and nurse practitioners. Responses in 14 states with high Lyme disease incidence (high LDI) were compared with responses from other states (low LDI). Overall, 56.4% of 1485 providers reported prescribing tick bite prophylaxis at least once in the previous year, including 73.9% of HCPs in high LDI and 48.2% in low LDI states. The reasons given were 'to prevent Lyme disease' (76.9%), 'patients request it' (40.4%) and 'to prevent other tickborne diseases' (29.4%). Among HCPs who provided prophylaxis, 45.2% did so despite feeling that it was not indicated. Given a hypothetical scenario involving a patient with an attached tick, 38.1% of HCPs from high LDI states and 15.1% from low LDI states would prescribe a single dose of doxycycline; 19.0% from high LDI states and 27.5% from low LDI states would prescribe a full course of doxycycline. HCPs prescribe tick bite prophylaxis frequently in areas where Lyme disease is rare and for tickborne diseases for which it has not been shown effective. HCPs may be unaware of current tick bite prophylaxis guidelines or find them difficult to implement. More information is needed regarding the efficacy of tick bite prophylaxis for diseases other than Lyme disease. PMID:25244410

  10. Listeria monocytogenes DNA Glycosylase AdlP Affects Flagellar Motility, Biofilm Formation, Virulence, and Stress Responses

    PubMed Central

    Zhang, Ting; Bae, Dongryeoul

    2016-01-01

    ABSTRACT The temperature-dependent alteration of flagellar motility gene expression is critical for the foodborne pathogen Listeria monocytogenes to respond to a changing environment. In this study, a genetic determinant, L. monocytogenes f2365_0220 (lmof2365_0220), encoding a putative protein that is structurally similar to the Bacillus cereus alkyl base DNA glycosylase (AlkD), was identified. This determinant was involved in the transcriptional repression of flagellar motility genes and was named adlP (encoding an AlkD-like protein [AdlP]). Deletion of adlP activated the expression of flagellar motility genes at 37°C and disrupted the temperature-dependent inhibition of L. monocytogenes motility. The adlP null strains demonstrated decreased survival in murine macrophage-like RAW264.7 cells and less virulence in mice. Furthermore, the deletion of adlP significantly decreased biofilm formation and impaired the survival of bacteria under several stress conditions, including the presence of a DNA alkylation compound (methyl methanesulfonate), an oxidative agent (H2O2), and aminoglycoside antibiotics. Our findings strongly suggest that adlP may encode a bifunctional protein that transcriptionally represses the expression of flagellar motility genes and influences stress responses through its DNA glycosylase activity. IMPORTANCE We discovered a novel protein that we named AlkD-like protein (AdlP). This protein affected flagellar motility, biofilm formation, and virulence. Our data suggest that AdlP may be a bifunctional protein that represses flagellar motility genes and influences stress responses through its DNA glycosylase activity. PMID:27316964

  11. HIV knowledge and attitudes among providers in aging: results from a national survey.

    PubMed

    Hughes, Anne K

    2011-09-01

    Within 5 years, half the U.S. HIV-infected population will be over age 50, and providers caring for older adults must deal with this reality. This study assessed attitudes toward people with HIV/AIDS and knowledge of HIV/AIDS among physicians with a geriatrics specialty, and nurses and social workers who specialize in gerontology. A survey mailed in 2008 to a random sample of U.S. providers yielded a 60% response rate. Main outcome measures included: Knowledge of HIV/AIDS, attitudes toward people with HIV/AIDS, and knowledge of issues related to HIV in older adults. General knowledge of HIV/AIDS was good with scores of 89%, 84%, and 81% for physicians, nurses, and social workers, respectively; groups differed significantly (F(2, 483)=18.626, p<0.0005). Attitudes were positive, with a significant main effect of profession on the attitude subscales (F(4, 952)=6.84, p<0.0005). Eighty-three percent of the sample were unaware that dementia due to HIV may be reversible; no significant differences by profession (χ(2)=4.50, p=0.105). The sample had difficulty ranking the four most common risk factors for HIV infection in older adults, with no significant differences among the professions (F(2, 483)=1.22, p=0.296). Only 6% of the sample correctly ranked all four risk factors. Estimates of the percent of U.S. AIDS cases in people over age 50 varied widely; few answered correctly, with no significant differences by professional group (F(2,319)=2.82, p=0.06). These findings highlight the need for further education among providers who specialize in aging.

  12. Large MOEMS diffraction grating results providing an EC-QCL wavelength scan of 20%

    NASA Astrophysics Data System (ADS)

    Grahmann, Jan; Merten, André; Herrmann, Andreas; Ostendorf, Ralf; Bleh, Daniela; Drabe, Christian; Kamenz, Jörg

    2015-02-01

    Experimental results of a large scanning grating with a diameter of 5mm and 1 kHz scan frequency are discussed. An optical diffraction grating is fabricated on a mirror single crystal silicon plate to scan the first diffraction order in the MIR-wavelength range over a quantum cascade laser facet. Special emphasis is on the development of the grating technology module to integrate it with high accuracy and reproducibility into the IPMS AME75 process flow. The principle EC-QCL setup with the scanning grating is described and first measurement results concerning laser output power and tuning range are presented.

  13. Summary of analysis results for sediments provided by Texas A and M University

    SciTech Connect

    Conrado, C; Kreek, S A

    1999-08-01

    Two soil samples were received by the Lawrence Livermore National Laboratory (LLNL) from Texas A&M University (TA&M) for the measurement of low-level {sup 226}Ra and {sup 228}Ra. This effort was part of a project conducted by the American Petroleum Institute and Gas Research Institute to measure {sup 226}Ra and {sup 228}Ra in media relevant to offshore oil and gas operations. The two samples were prepared for counting by packaging each in separate, high-precision, polycarbonate containers. The sample material was then compressed inside each container to minimize Rn migration, the sample weight determined, and a head-space-filling insert emplaced to occupy the vacant space above the sample and provide a tight seal against the top of the sample. The containers were then sealed and the samples set aside for 21 days to permit {sup 222}Rn ingrowth. The use of the custom packaging yields counting samples with known cross-sectional area (10.0 cm{sup 2}), density, and thickness.

  14. A dugwell program to provide arsenic-safe water in West Bengal, India: preliminary results.

    PubMed

    Smith, Meera M Hira; Hore, Timir; Chakraborty, Protap; Chakraborty, D K; Savarimuthu, Xavier; Smith, Allan H

    2003-01-01

    In 1982, Dr. K. C. Saha, a dermatologist of Calcutta, West Bengal, identified patients with skin lesions from the district of 24 Parganas, leading him and others to search for a cause. The cause was soon identified to be arsenic in drinking water, but even today, 20 years later, large number of people continue to drink arsenic contaminated water and patients are increasing in number. Project Well is a program chosen for implementation in some villages of North 24 Parganas. Arsenic safe drinking water is provided for adopted villages by constructing shallow, concrete dugwells designed to tap the water of the unconfined aquifer, 20-30 feet below ground level, that contains low levels (< 0.05 mg/L) of arsenic in the target region. The traditional dugwell design is modified by use of tube well hand pumps to withdraw water. The project includes community involvement, programs to increase awareness of the need to drink arsenic safe water, and training in monitoring of dugwell water for arsenic and harmful pathogens. Disinfecting of the water and regulating the water hazard diagram are also included in the training program. The plan is to make the system sustainable at the village level using indigenous labor and materials.

  15. A Query Result Merging Scheme for Providing Energy Efficiency in Underwater Sensor Networks

    PubMed Central

    Kim, Yunsung; Park, Soo-Hyun

    2011-01-01

    Underwater sensor networks are emerging as a promising distributed data management system for various applications in underwater environments, despite their limited accessibility and restricted energy capacity. With the aid of recent developments in ubiquitous data computing, an increasing number of users are expected to overcome low accessibility by applying queries to underwater sensor networks. However, when multiple users send queries to an underwater sensor network in a disorganized manner, it may incur lethal energy waste and problematic network traffic. The current query management mechanisms cannot effectively deal with this matter due to their limited applicability and unrealistic assumptions. In this paper, a novel query management scheme involving query result merging is proposed for underwater sensor networks. The mechanism is based on a relational database model and is adjusted to the practical restrictions affecting underwater communication environments. Network simulations will prove that the scheme becomes more efficient with a greater number of queries and a smaller period range. PMID:22247695

  16. A query result merging scheme for providing energy efficiency in underwater sensor networks.

    PubMed

    Kim, Yunsung; Park, Soo-Hyun

    2011-01-01

    Underwater sensor networks are emerging as a promising distributed data management system for various applications in underwater environments, despite their limited accessibility and restricted energy capacity. With the aid of recent developments in ubiquitous data computing, an increasing number of users are expected to overcome low accessibility by applying queries to underwater sensor networks. However, when multiple users send queries to an underwater sensor network in a disorganized manner, it may incur lethal energy waste and problematic network traffic. The current query management mechanisms cannot effectively deal with this matter due to their limited applicability and unrealistic assumptions. In this paper, a novel query management scheme involving query result merging is proposed for underwater sensor networks. The mechanism is based on a relational database model and is adjusted to the practical restrictions affecting underwater communication environments. Network simulations will prove that the scheme becomes more efficient with a greater number of queries and a smaller period range.

  17. AeroADL: applying the integration of the Suomi-NPP science algorithms with the Algorithm Development Library to the calibration and validation task

    NASA Astrophysics Data System (ADS)

    Houchin, J. S.

    2014-09-01

    A common problem for the off-line validation of the calibration algorithms and algorithm coefficients is being able to run science data through the exact same software used for on-line calibration of that data. The Joint Polar Satellite System (JPSS) program solved part of this problem by making the Algorithm Development Library (ADL) available, which allows the operational algorithm code to be compiled and run on a desktop Linux workstation using flat file input and output. However, this solved only part of the problem, as the toolkit and methods to initiate the processing of data through the algorithms were geared specifically toward the algorithm developer, not the calibration analyst. In algorithm development mode, a limited number of sets of test data are staged for the algorithm once, and then run through the algorithm over and over as the software is developed and debugged. In calibration analyst mode, we are continually running new data sets through the algorithm, which requires significant effort to stage each of those data sets for the algorithm without additional tools. AeroADL solves this second problem by providing a set of scripts that wrap the ADL tools, providing both efficient means to stage and process an input data set, to override static calibration coefficient look-up-tables (LUT) with experimental versions of those tables, and to manage a library containing multiple versions of each of the static LUT files in such a way that the correct set of LUTs required for each algorithm are automatically provided to the algorithm without analyst effort. Using AeroADL, The Aerospace Corporation's analyst team has demonstrated the ability to quickly and efficiently perform analysis tasks for both the VIIRS and OMPS sensors with minimal training on the software tools.

  18. Genome-Wide Analysis of Seed Acid Detergent Lignin (ADL) and Hull Content in Rapeseed (Brassica napus L.).

    PubMed

    Wang, Jia; Jian, Hongju; Wei, Lijuan; Qu, Cunmin; Xu, Xinfu; Lu, Kun; Qian, Wei; Li, Jiana; Li, Maoteng; Liu, Liezhao

    2015-01-01

    A stable yellow-seeded variety is the breeding goal for obtaining the ideal rapeseed (Brassica napus L.) plant, and the amount of acid detergent lignin (ADL) in the seeds and the hull content (HC) are often used as yellow-seeded rapeseed screening indices. In this study, a genome-wide association analysis of 520 accessions was performed using the Q + K model with a total of 31,839 single-nucleotide polymorphism (SNP) sites. As a result, three significant associations on the B. napus chromosomes A05, A09, and C05 were detected for seed ADL content. The peak SNPs were within 9.27, 14.22, and 20.86 kb of the key genes BnaA.PAL4, BnaA.CAD2/BnaA.CAD3, and BnaC.CCR1, respectively. Further analyses were performed on the major locus of A05, which was also detected in the seed HC examination. A comparison of our genome-wide association study (GWAS) results and previous linkage mappings revealed a common chromosomal region on A09, which indicates that GWAS can be used as a powerful complementary strategy for dissecting complex traits in B. napus. Genomic selection (GS) utilizing the significant SNP markers based on the GWAS results exhibited increased predictive ability, indicating that the predictive ability of a given model can be substantially improved by using GWAS and GS.

  19. Genome-Wide Analysis of Seed Acid Detergent Lignin (ADL) and Hull Content in Rapeseed (Brassica napus L.).

    PubMed

    Wang, Jia; Jian, Hongju; Wei, Lijuan; Qu, Cunmin; Xu, Xinfu; Lu, Kun; Qian, Wei; Li, Jiana; Li, Maoteng; Liu, Liezhao

    2015-01-01

    A stable yellow-seeded variety is the breeding goal for obtaining the ideal rapeseed (Brassica napus L.) plant, and the amount of acid detergent lignin (ADL) in the seeds and the hull content (HC) are often used as yellow-seeded rapeseed screening indices. In this study, a genome-wide association analysis of 520 accessions was performed using the Q + K model with a total of 31,839 single-nucleotide polymorphism (SNP) sites. As a result, three significant associations on the B. napus chromosomes A05, A09, and C05 were detected for seed ADL content. The peak SNPs were within 9.27, 14.22, and 20.86 kb of the key genes BnaA.PAL4, BnaA.CAD2/BnaA.CAD3, and BnaC.CCR1, respectively. Further analyses were performed on the major locus of A05, which was also detected in the seed HC examination. A comparison of our genome-wide association study (GWAS) results and previous linkage mappings revealed a common chromosomal region on A09, which indicates that GWAS can be used as a powerful complementary strategy for dissecting complex traits in B. napus. Genomic selection (GS) utilizing the significant SNP markers based on the GWAS results exhibited increased predictive ability, indicating that the predictive ability of a given model can be substantially improved by using GWAS and GS. PMID:26673885

  20. Genome-Wide Analysis of Seed Acid Detergent Lignin (ADL) and Hull Content in Rapeseed (Brassica napus L.)

    PubMed Central

    Wei, Lijuan; Qu, Cunmin; Xu, Xinfu; Lu, Kun; Qian, Wei; Li, Jiana; Li, Maoteng; Liu, Liezhao

    2015-01-01

    A stable yellow-seeded variety is the breeding goal for obtaining the ideal rapeseed (Brassica napus L.) plant, and the amount of acid detergent lignin (ADL) in the seeds and the hull content (HC) are often used as yellow-seeded rapeseed screening indices. In this study, a genome-wide association analysis of 520 accessions was performed using the Q + K model with a total of 31,839 single-nucleotide polymorphism (SNP) sites. As a result, three significant associations on the B. napus chromosomes A05, A09, and C05 were detected for seed ADL content. The peak SNPs were within 9.27, 14.22, and 20.86 kb of the key genes BnaA.PAL4, BnaA.CAD2/BnaA.CAD3, and BnaC.CCR1, respectively. Further analyses were performed on the major locus of A05, which was also detected in the seed HC examination. A comparison of our genome-wide association study (GWAS) results and previous linkage mappings revealed a common chromosomal region on A09, which indicates that GWAS can be used as a powerful complementary strategy for dissecting complex traits in B. napus. Genomic selection (GS) utilizing the significant SNP markers based on the GWAS results exhibited increased predictive ability, indicating that the predictive ability of a given model can be substantially improved by using GWAS and GS. PMID:26673885

  1. Structure design for a Two-DoF myoelectric prosthetic hand to realize basic hand functions in ADLs.

    PubMed

    Hoshigawa, Suguru; Jiang, Yinlai; Kato, Ryu; Morishita, Soichiro; Nakamura, Tatsuhiro; Yabuki, Yoshiko; Yokoi, Hiroshi

    2015-01-01

    Prosthetic hands are desired by those who have lost a hand or both hands not only for decoration but also for the functions to help them with their activities of daily living (ADL). Prosthetic robotic hands that are developed to fully realize the function of a human hand are usually too expensive to be economically available, difficult to operate and maintain, or over heavy for longtime wearing. The aim of this study is therefore to develop a simplified prosthetic hand (sim-PH), which is to be controlled by myoelectric signals from the user, to realize the most important grasp motions in ADL by trading off the cost and performance. This paper reports the structure design of a two-DoF sim-PH with two motors to drive the CM joint of the thumb and the interlocked MP joints of the other four fingers. In order to optimize the structure, the model of the sim-PH was proposed based on which 7 sim-PHs with different structural parameters were manufactured and tested in a pick-and-place experiment. Correspondence analysis of the experimental results clarified the relationship between the hand functions and the shapes of fingers.

  2. Frequency Spectrum for New Aviation Data Links: Initial Study Results

    NASA Technical Reports Server (NTRS)

    Matolak, David W.; Branstetter, James R.

    2004-01-01

    We describe results from an initial study to assess the suitability of various spectral bands for supporting the deployment of new aviation data links (ADL). The study focused on systems and spectral bands that can deliver VHF data link (VDL)-or-higher data rates in a two-way communication setting, including air-ground, ground-air, and air-air modes of operation. In the first part of our paper, we briefly discuss the current situation regarding communications, navigation, and surveillance (CNS) links and existing spectrum, and the well-known need for new aviation data links. We next provide an overview of related systems, and discuss key factors involved in the use of spectrum in various bands for any future integrated CNS data link, addressing primarily the lower few layers of the communications protocol stack. Desired attributes of a new ADL system are discussed, and the beneficial aspects of a particular transmission technique spread spectrum are summarized. We also provide a short list of several example potential spectral regions, and note that while none of the existing systems will likely meet the full range of desired features of a new ADL, several systems and spectral regions offer promise in terms of one or more characteristics. A detailed discussion and evaluation of these spectral regions is proposed as future work. We include a few brief examples to illustrate initial technical results regarding spread spectrum overlay, also a subject for future work.

  3. Vision based assistive technology for people with dementia performing activities of daily living (ADLs): an overview

    NASA Astrophysics Data System (ADS)

    As'ari, M. A.; Sheikh, U. U.

    2012-04-01

    The rapid development of intelligent assistive technology for replacing a human caregiver in assisting people with dementia performing activities of daily living (ADLs) promises in the reduction of care cost especially in training and hiring human caregiver. The main problem however, is the various kinds of sensing agents used in such system and is dependent on the intent (types of ADLs) and environment where the activity is performed. In this paper on overview of the potential of computer vision based sensing agent in assistive system and how it can be generalized and be invariant to various kind of ADLs and environment. We find that there exists a gap from the existing vision based human action recognition method in designing such system due to cognitive and physical impairment of people with dementia.

  4. DIRECT secure messaging as a common transport layer for reporting structured and unstructured lab results to outpatient providers.

    PubMed

    Sujansky, Walter; Wilson, Tom

    2015-04-01

    This report describes a grant-funded project to explore the use of DIRECT secure messaging for the electronic delivery of laboratory test results to outpatient physicians and electronic health record systems. The project seeks to leverage the inherent attributes of DIRECT secure messaging and electronic provider directories to overcome certain barriers to the delivery of lab test results in the outpatient setting. The described system enables laboratories that generate test results as HL7 messages to deliver these results as structured or unstructured documents attached to DIRECT secure messages. The system automatically analyzes generated HL7 messages and consults an electronic provider directory to determine the appropriate DIRECT address and delivery format for each indicated recipient. The system also enables lab results delivered to providers as structured attachments to be consumed by HL7 interface engines and incorporated into electronic health record systems. Lab results delivered as unstructured attachments may be printed or incorporated into patient records as PDF files. The system receives and logs acknowledgement messages to document the status of each transmitted lab result, and a graphical interface allows searching and review of this logged information. The described system is a fully implemented prototype that has been tested in a laboratory setting. Although this approach is promising, further work is required to pilot test the system in production settings with clinical laboratories and outpatient provider organizations. PMID:25766489

  5. Hospital Readmission among Older Adults Who Return Home with Unmet Need for ADL Disability

    ERIC Educational Resources Information Center

    DePalma, Glen; Xu, Huiping; Covinsky, Kenneth E.; Craig, Bruce A.; Stallard, Eric; Thomas, Joseph, III.; Sands, Laura P.

    2013-01-01

    Purpose: This study determined whether returning to the community from a recent hospitalization with unmet activities of daily living (ADL) need was associated with probability of readmission. Methods: A total of 584 respondents to the 1994, 1999, and/or 2004 National Long-Term Care Surveys (NLTCS) who were hospitalized within 90 days prior to the…

  6. Measuring Disability: Application of the Rasch Model to Activities of Daily Living (ADL/IADL).

    ERIC Educational Resources Information Center

    Sheehan, T. Joseph; DeChello, Laurie M.; Garcia, Ramon; Fifield, Judith; Rothfield, Naomi; Reisine, Susan

    2001-01-01

    Performed a comparative analysis of Activities of Daily Living (ADL) items administered to 4,430 older adults and Instrumental Activities of Daily Living administered to 605 people with rheumatoid arthritis scoring both with Likert and Rasch measurement models. Findings show the superiority of the Rasch approach over the Likert method. (SLD)

  7. Targeting adults who provide alcohol to underage youth: results from a national survey of local law enforcement agencies.

    PubMed

    Jones-Webb, Rhonda; Toomey, Traci L; Lenk, Kathleen M; Nelson, Toben F; Erickson, Darin J

    2015-06-01

    We investigated what local enforcement agencies are doing to target adults who provide alcohol to underage youth; what types of enforcement activities are being conducted to target adult providers; and factors that encourage enforcement activities that target adult providers. We surveyed 1,056 local law enforcement agencies in the US and measured whether or not the agency conducted enforcement activities that target adults who provide alcohol to underage youth. We also measured whether certain agency and jurisdiction characteristics were associated with enforcement activities that target adults who provide alcohol to underage youth. Less than half (42%) of local enforcement agencies conducted enforcement efforts targeting adults who provide alcohol to underage youth. Agencies that conducted the enforcement activities targeting adult providers were significantly more likely to have a full time officer specific to alcohol enforcement, a division specific to alcohol enforcement, a social host law, and to perceive underage drinking was very common. Results suggest that targeting social providers (i.e., adults over 21 years of age) will require greater law enforcement resources, implementation of underage drinking laws (e.g., social host policies), and changing perceptions among law enforcement regarding underage drinking. Future studies are needed to identify the most effective enforcement efforts and to examine how enforcement efforts are prospectively linked to alcohol consumption.

  8. Explaining perceived ability among older people to provide care as a result of HIV and AIDS in South Africa.

    PubMed

    Boon, Hermien; James, Shegs; Ruiter, Robert A C; van den Borne, Bart; Williams, Eka; Reddy, Priscilla

    2010-04-01

    In South Africa, older people have become the primary caregivers of children and grandchildren infected or affected by HIV and AIDS. This study explores the determinants of the perceived ability to care for children and grandchildren in the domains of providing nursing care, communicating with (grand) children, generating income and to relax. Structured one-on-one interviews were conducted among 409 isiXhosa speaking older people in two sites in the Eastern Cape Province of South Africa. Results showed that perceived ability among older people to provide nursing care was primarily dependent on the level of knowledge on accessing grants and personal norm towards providing care. Perceived ability to communicate effectively with children and grandchildren was most strongly predicted by a positive attitude towards communication and perceived ability to provide income was influenced by a more negative attitude towards people living with HIV or AIDS. Perceived ability to relax was dependent on more negative attitudes towards communication, lower perceived responsibility to provide income and a higher perceived behaviour control over providing nursing care. The findings of this study add relevant information to understanding the psychosocial context in which older people provide HIV and AIDS related care and support the development of targeted programmes to assist older people in their role as caregiver. PMID:20140795

  9. Health providers' opinions on provider-client relations: results of a multi-country study to test Health Workers for Change.

    PubMed

    Fonn, S; Mtonga, A S; Nkoloma, H C; Bantebya Kyomuhendo, G; daSilva, L; Kazilimani, E; Davis, S; Dia, R

    2001-09-01

    A multi-centre study in four African countries was undertaken to test the acceptability and effectiveness of Health Workers for Change, a methodology to explore provider-client relations within a gender-sensitive context. This intervention addresses the interpersonal component of quality of care. The methodology, consisting of six workshops, was implemented by research teams in Zambia, Senegal, Mozambique and Uganda. It was found to be acceptable within in a range of cultural and primary health care settings. The workshops allowed difficult issues such as prejudice and bribery to be discussed openly, fostered problem solving and the development of practical plans to address problems that could strengthen district health systems.

  10. Health providers' opinions on provider-client relations: results of a multi-country study to test Health Workers for Change.

    PubMed

    Fonn, S; Mtonga, A S; Nkoloma, H C; Bantebya Kyomuhendo, G; daSilva, L; Kazilimani, E; Davis, S; Dia, R

    2001-09-01

    A multi-centre study in four African countries was undertaken to test the acceptability and effectiveness of Health Workers for Change, a methodology to explore provider-client relations within a gender-sensitive context. This intervention addresses the interpersonal component of quality of care. The methodology, consisting of six workshops, was implemented by research teams in Zambia, Senegal, Mozambique and Uganda. It was found to be acceptable within in a range of cultural and primary health care settings. The workshops allowed difficult issues such as prejudice and bribery to be discussed openly, fostered problem solving and the development of practical plans to address problems that could strengthen district health systems. PMID:11599665

  11. Loneliness in elderly individuals, level of dependence in activities of daily living (ADL) and influential factors.

    PubMed

    Hacihasanoğlu, Rabia; Yildirim, Arzu; Karakurt, Papatya

    2012-01-01

    This study has been carried out to investigate the level of loneliness, determine the level of dependence in the ADL and influential factors in the elderly people. This descriptive, cross-sectional study was conducted in 5 Family Healthcare Centers (FHC) located in central Erzincan, Turkey between March and June 2010. The data of the research was collected using a questionnaire that determined the descriptive and UCLA Loneliness Scale (UCLA-LS). Mean score of the UCLA-LS was determined as 51.59 ± 4.44. It was determined that 2% of the elderly ADL were completely dependent, 14.5% were semi-dependent. Factors such as being old, a widow/divorced, having a lower level of education and/or income, living alone, having a chronic disease, poor self-perceived health, lack of visits by relatives or acquaintances, dissatisfaction with the place of living, and being fully dependent while performing daily activities were determined as factors which increased the level of loneliness. Furthermore, factors such as being old, a female, a widow/divorced, living together with a daughter/son, having a chronic disease and poor self-perceived health were found to be influential in dependency. Elderly people who are alone and dependent in fulfilling their ADL should be monitored more closely. PMID:21514680

  12. Quit Smoking Experts’ Opinions toward Quality and Results of Quit Smoking Methods Provided in Tobacco Cessation Services Centers in Iran

    PubMed Central

    Heydari, Gholamreza; Masjedi, Mohammadreza; Ebn Ahmady, Arezoo; Leischow, Scott J.; Lando, Harry A.; Shadmehr, Mohammad B.; Fadaizadeh, Lida

    2015-01-01

    Background: One of the core responsibilities of health system is to treat tobacco dependence. This treatment includes different methods such as simple medical consultation, medication, and telephone counseling. To assess physicians’ opinions towards quality and result of different quit smoking methods provided in tobacco cessation services centers in Iran. Methods: In this cross-sectional and descriptive study, random sampling of all quit centers at country level was used to obtain a representative sample size of 100 physicians. Physicians completed a self-administered questionnaire which contained 10 questions regarding the quality, cost, effect, side effects, and the results of quitting methods using a 5-point Likert-type scale. Percentages, frequencies, mean, T-test, and variance analyses were computed for all study variables. Results: Most experts preferred to use combination quit smoking methods and then Nicotine Replacement Therapy (NRT) with 26 and 23, respectively. The least used methods were quit line and some methods without medication with 3 cases. The method which gained the maximum scores were telephone consultation, acupuncture, Willpower, Champix, combined method, and Interactive Voice Response (IVR) with the mean of 23.3, 23, 22.5, 22, 21.7 and 21.3, respectively. The minimum scores were related to e-cigarette, some methods without medication, and non-NRT medication with the mean of 12.3, 15.8 and 16.2, respectively. There were no significant differences in the mean of scores based on different cities (P = 0.256). Analysis of variance in mean scores showed significant differences in the means scores of different methods (P < 0.000). Conclusions: According to physicians acupuncture, personal methods and Champix are the most effective methods and these methods could be much more feasible and cost effective than other methods. PMID:26425329

  13. Dentists’ Willingness to Provide Expanded HIV Screening in Oral Health Care Settings: Results From a Nationally Representative Survey

    PubMed Central

    Pereyra, Margaret; Parish, Carrigan L.; Abel, Stephen; Messinger, Shari; Singer, Richard; Kunzel, Carol; Greenberg, Barbara; Gerbert, Barbara; Glick, Michael; Metsch, Lisa R.

    2014-01-01

    Objectives. Using a nationally representative survey, we determined dentists’ willingness to provide oral rapid HIV screening in the oral health care setting. Methods. From November 2010 through November 2011, a nationally representative survey of general dentists (sampling frame obtained from American Dental Association Survey Center) examined barriers and facilitators to offering oral HIV rapid testing (n = 1802; 70.7% response). Multiple logistic regression analysis examined dentists’ willingness to conduct this screening and perceived compatibility with their professional role. Results. Agreement with the importance of annual testing for high-risk persons and familiarity with the Centers for Disease Control and Prevention’s recommendations regarding routine HIV testing were positively associated with willingness to conduct such screening. Respondents’ agreement with patients’ acceptance of HIV testing and colleagues’ improved perception of them were also positively associated with willingness. Conclusions. Oral HIV rapid testing is potentially well suited to the dental setting. Although our analysis identified many predictors of dentists’ willingness to offer screening, there are many barriers, including dentists’ perceptions of patients’ acceptance, that must be addressed before such screening is likely to be widely implemented. PMID:24625163

  14. 454 Pyrosequencing and Sanger sequencing of tropical mycorrhizal fungi provide similar results but reveal substantial methodological biases.

    PubMed

    Tedersoo, Leho; Nilsson, R Henrik; Abarenkov, Kessy; Jairus, Teele; Sadam, Ave; Saar, Irja; Bahram, Mohammad; Bechem, Eneke; Chuyong, George; Kõljalg, Urmas

    2010-10-01

    • Compared with Sanger sequencing-based methods, pyrosequencing provides orders of magnitude more data on the diversity of organisms in their natural habitat, but its technological biases and relative accuracy remain poorly understood. • This study compares the performance of pyrosequencing and traditional sequencing for species' recovery of ectomycorrhizal fungi on root tips in a Cameroonian rain forest and addresses biases related to multi-template PCR and pyrosequencing analyses. • Pyrosequencing and the traditional method yielded qualitatively similar results, but there were slight, but significant, differences that affected the taxonomic view of the fungal community. We found that most pyrosequencing singletons were artifactual and contained a strongly elevated proportion of insertions compared with natural intra- and interspecific variation. The alternative primers, DNA extraction methods and PCR replicates strongly influenced the richness and community composition as recovered by pyrosequencing. • Pyrosequencing offers a powerful alternative for the identification of ectomycorrhizal fungi in pooled root samples, but requires careful selection of molecular tools. A well-populated backbone database facilitates the detection of biological and technical artifacts. The pyrosequencing pipeline is available at http://unite.ut.ee/454pipeline.tgz.

  15. Health: support provided and received in advanced old age. A five-year follow-up.

    PubMed

    Armi, F; Guilley, E; Lalive d'Epinay, C J

    2008-02-01

    While research focuses mainly on support provided to the elderly, this paper deals with the very old as a support provider to his family as much as a care recipient from both his family and a formal network. We hypothesize that elders with declining health will try to maintain the provision of services, even when they require and receive help.A total of 340 octogenarians from the Swiss Interdisciplinary Longitudinal Study on the Oldest Old (SWILSOO) were interviewed up to five times over five years (N=1225 interviews). A multilevel model was applied to assess the effects of health, controlled for socio-demographic and family network variables, on the frequency of services that the old persons provided to their family and received from their family and formal networks. Health is operationalized in three statuses: ADL-dependent, ADL-independent frail, and robust.While the recourse to the informal network increased progressively with the process of frailty, the recourse to the formal network drastically increased for ADL-dependent individuals. Being ADL-dependent seriously altered the capacity to provide services, but ADL-independent frail persons were providers with the same frequency as the robust oldest old, showing their ability to preserve a principle of reciprocity in their exchanges with their family network. This continuity of roles may help frail persons to maintain their self-esteem and well-being.

  16. ICPES analyses using full image spectra and astronomical data fitting algorithms to provide diagnostic and result information

    SciTech Connect

    Spencer, W.A.; Goode, S.R.

    1997-10-01

    ICP emission analyses are prone to errors due to changes in power level, nebulization rate, plasma temperature, and sample matrix. As a result, accurate analyses of complex samples often require frequent bracketing with matrix matched standards. Information needed to track and correct the matrix errors is contained in the emission spectrum. But most commercial software packages use only the analyte line emission to determine concentrations. Changes in plasma temperature and the nebulization rate are reflected by changes in the hydrogen line widths, the oxygen emission, and neutral ion line ratios. Argon and off-line emissions provide a measure to correct the power level and the background scattering occurring in the polychromator. The authors` studies indicated that changes in the intensity of the Ar 404.4 nm line readily flag most matrix and plasma condition modifications. Carbon lines can be used to monitor the impact of organics on the analyses and calcium and argon lines can be used to correct for spectral drift and alignment. Spectra of contaminated groundwater and simulated defense waste glasses were obtained using a Thermo Jarrell Ash ICP that has an echelle CID detector system covering the 190-850 nm range. The echelle images were translated to the FITS data format, which astronomers recommend for data storage. Data reduction packages such as those in the ESO-MIDAS/ECHELLE and DAOPHOT programs were tried with limited success. The radial point spread function was evaluated as a possible improved peak intensity measurement instead of the common pixel averaging approach used in the commercial ICP software. Several algorithms were evaluated to align and automatically scale the background and reference spectra. A new data reduction approach that utilizes standard reference images, successive subtractions, and residual analyses has been evaluated to correct for matrix effects.

  17. The Arabidopsis Cell Plate-Associated Dynamin-Like Protein, ADL1Ap, Is Required for Multiple Stages of Plant Growth and Development1

    PubMed Central

    Kang, Byung-Ho; Busse, James S.; Dickey, Carrie; Rancour, David M.; Bednarek, Sebastian Y.

    2001-01-01

    Dynamin and dynamin-like proteins are GTP-binding proteins involved in vesicle trafficking. In soybean, a 68-kD dynamin-like protein called phragmoplastin has been shown to be associated with the cell plate in dividing cells (Gu and Verma, 1996). Five ADL1 genes encoding dynamin-like proteins related to phragmoplastin have been identified in the completed Arabidopsis genome. Here we report that ADL1Ap is associated with punctate subcellular structures and with the cell plate in dividing cells. To assess the function of ADL1Ap we utilized a reverse genetic approach to isolate three separate Arabidopsis mutant lines containing T-DNA insertions in ADL1A. Homozygous adl1A seeds were shriveled and mutant seedlings arrested soon after germination, producing only two leaf primordia and severely stunted roots. Immunoblotting revealed that ADL1Ap expression was not detectable in the mutants. Despite the loss of ADL1Ap, the mutants did not display any defects in cytokinesis, and growth of the mutant seedlings could be rescued in tissue culture by the addition of sucrose. Although these sucrose-rescued plants displayed normal vegetative growth and flowered, they set very few seeds. Thus, ADL1Ap is critical for several stages of plant development, including embryogenesis, seedling development, and reproduction. We discuss the putative role of ADL1Ap in vesicular trafficking, cytokinesis, and other aspects of plant growth. PMID:11351070

  18. Detecting Human Motion: Introducing Step, Fall and ADL Algorithms

    NASA Astrophysics Data System (ADS)

    Vermeiren, Dries; Weyn, Maarten; de Ron, Geert

    Telecare is the term given to offering remote care to elderly and vulnerable people, providing them with the care and reassurance needed to allow them to keep living at home. As telecare is gaining research interests, we'll introduce a system which can be used to monitor the steps, falls and daily activities of high risk populations in this paper. Using this system it is possible for a patient to rehabilitate at home or for elderly to keep living independently in their own house while they are still monitored. This leads to a huge cost reduction in health services and moreover it will make patients satisfied for being able to live at home as long as possible and in all comfort.

  19. The effect of a novel ADL-based training program on performance of activities of daily living and physical fitness.

    PubMed

    Dobek, Jessica C; White, Karen N; Gunter, Katherine B

    2007-01-01

    The purpose of this study was to determine the degree to which a novel training program based on activities of daily living (ADL) would affect performance of ADLs, as well as the fitness of older adults. Fourteen individuals (mean age 82 years) took part in a 10-week control period followed by a 10-week ADL-based training program. Pre- and posttests included the Physical Performance Test (PPT), the Physical Functional Performance-10 (PFP-10), and the Senior Fitness Test (SFT). After the training period, improvements ranging from 7% to 33% (p<.05) were seen on the PPT and PFP-10 and on three items of the SFT. After conversion to standard scores, the magnitude of change in the PPT and the PFP10 was significantly greater (p<.05) than the magnitude of change in the SFT. These data support the idea that this novel ADL-based training program was able to facilitate improved performance of ADLs, as well as select measures of fitness among older adults.

  20. Fabrication of Rare-earth Aluminate (ReAlO3) Glass and Crystalline phases by Aerodynamic Levitation (ADL)

    NASA Astrophysics Data System (ADS)

    Basavalingu, B.; Yoda, Shinichi; Kumar, M. S. Vijaya

    2012-07-01

    Containerless processing by levitation technique has been extensively used for material science and engineering because it suppresses inhomogeneous nucleation from the container wall and helps to produce stable, metastable and glass phases. The containerless levitation technique is widely explored for material processing because of its technological and scientific advantages. Recently, research on bulk glass and glass-ceramics have attracted the attention of material scientists as they are considered as low cost optical materials of the future. In the present study, the formation of bulk spherical glass and crystalline ReAlO _{3}(Re=La-Lu,Y) phases has been investigated due to their unique features in terms of the solidification process from an undercooled melt, glass structure and optical properties. An Aerodynamic levitation (ADL) was used to undercool the melt well below the melting temperature. Sintered bits of ReAlO _{3} sample with a diameter of ~2.5 mm and mass of ~20-25 mg was levitated by an ADL and completely melted by a CO _{2} laser and then the droplet was cooled by turning off the CO _{2} laser and solidified. The surface temperature and solidification process of the levitated droplet was monitored using pyrometer and high speed video camera, respectively. Among the rare earth aluminum perovskites Lanthanum, Neodymium and samarium aluminum perovskites solidified as glass and others YAlO _{3} and Europium to Lutetium aluminum perovskites solidified as crystalline phases. The scanning electron microscopy (SEM) images of cross-sectioned samples, TG/DTA, Transmittance and Refractive Index studies were performed for both glass and crystalline phases. The results of the above studies revealed the formation of glass and crystalline phases directly from the undercooled melt. The glass transition temperature (Tg) gradually increased with increasing ionic radius of the rare-earth elements. The NdAlO _{3} glass phase showed a high refractive index of ~1

  1. Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal.

    PubMed

    Ruiz-Casares, Mónica; Cleveland, Janet; Oulhote, Youssef; Dunkley-Hickin, Catherine; Rousseau, Cécile

    2016-01-01

    Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers' knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40-49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues. PMID:26789844

  2. Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal.

    PubMed

    Ruiz-Casares, Mónica; Cleveland, Janet; Oulhote, Youssef; Dunkley-Hickin, Catherine; Rousseau, Cécile

    2016-01-01

    Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers' knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40-49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues.

  3. Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal

    PubMed Central

    Dunkley-Hickin, Catherine

    2016-01-01

    Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers’ knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40–49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues. PMID:26789844

  4. Direct disk diffusion test using European Clinical Antimicrobial Susceptibility Testing breakpoints provides reliable results compared with the standard method.

    PubMed

    Stokkou, Sofia; Geginat, Gernot; Schlüter, Dirk; Tammer, Ina

    2015-03-01

    Sepsis represents a life-threatening infection requiring the immediate start of antibacterial treatment to reduce morbidity. Thus, laboratories use direct antimicrobial susceptibility testing (AST) to rapidly generate preliminary results from positive blood cultures. As the direct AST has not yet been published to be evaluated with EUCAST breakpoints, the purpose of the study was to investigate the reliability of the direct agar diffusion test to correctly produce AST results from positive monobacterial blood cultures compared with the VITEK2-based definitive AST, when current EUCAST breakpoints were used. A total of 428 isolates from unselected monobacterial routine blood cultures and 110 challenge strains were included. Direct agar diffusion-based and standard VITEK2-based AST of 2803 bacterium-drug combinations yielded a total clinical category agreement of 95.47% with 1.28% very major errors and 3.42% combined major and minor errors. On the species level, very major errors were observed in the species-drug combinations Enterococcus spp.-high-level gentamicin (10.87%) and Staphylococcus spp.-rifampicin (5%), only. No very major errors occurred with Enterobacteriaceae and Pseudomonas aeruginosa. In most species-drug combinations, the direct agar diffusion test using EUCAST breakpoints precisely predicted the result of the definitive antibiotic susceptibility test and, thus, it can be used to optimize empiric antibiotic therapy until definitive results are available. PMID:25883798

  5. A multidisciplinary approach to providing care to adolescents with spinal cord trauma resulting from all-terrain vehicle accidents.

    PubMed

    Rhodes, Leslie N; Weatherford, Blakely; Locke, Lindsey N; Chung, Hoi Sing; Tidwell, Chrisla; Paton, Elizabeth; Lee, Shirleatha

    2015-01-01

    All-terrain vehicle accidents that affect the spine can lead to complex injuries in adolescents. This requires that many subspecialties work together on a multidisciplinary team to improve patient outcomes. Our case presentation will examine the multidisciplinary approach to care required for an 11-year-old adolescent involved in an all-terrain vehicle accident that resulted in traumatic spinal cord injury.

  6. Recombinant envelope protein (rgp90) ELISA for equine infectious anemia virus provides comparable results to the agar gel immunodiffusion.

    PubMed

    Reis, Jenner K P; Diniz, Rejane S; Haddad, João P A; Ferraz, Isabella B F; Carvalho, Alex F; Kroon, Erna G; Ferreira, Paulo C P; Leite, Rômulo C

    2012-03-01

    Equine infectious anemia (EIA) is an important viral infection affecting horses worldwide. The course of infection is accompanied generally by three characteristic stages: acute, chronic and inapparent. There is no effective EIA vaccine or treatment, and the control of the disease is based currently on identification of EIAV inapparent carriers by laboratory tests. Recombinant envelope protein (rgp90) was expressed in Escherichia coli and evaluated via enzyme-linked immunosorbent assay (ELISA). There was an excellent agreement (95.42%) between the ELISA results using rgp90 and agar gel immunodiffusion test results. AGID is considered the "gold-standard" serologic test for equine infectious anemia (EIA). After 1160 serum samples were tested, the relative sensitivity and specificity of the ELISA were 96.1% and 96.4%, respectively. Moreover, analysis diagnostic accuracy of the ELISA was performed. The ELISA proved robust. Furthermore, good reproducibility was observed for the negative controls and, positive controls for all plates tested.

  7. Buprenorphine provides better anaesthetic conditions than butorphanol for field castration in ponies: results of a randomised clinical trial.

    PubMed

    Rigotti, C; De Vries, A; Taylor, P M

    A prospective, randomised, blinded, clinical trial in 47 ponies compared butorphanol and buprenorphine administered intravenously with detomidine prior to castration under anaesthesia. Detomidine 12 μg/kg intravenously was followed by butorphanol 25 μg/kg (BUT) or buprenorphine 5 μg/kg (BUP) before induction of anaesthesia with intravenous ketamine and diazepam. Quality of sedation, induction and recovery from anaesthesia, response to tactile stimulation, and surgical conditions were scored. If anaesthesia was inadequate 'rescue' was given with intravenous ketamine (maximum three doses) followed by intravenous thiopental and detomidine. Time from induction to first rescue, total ketamine dose and number of rescues were recorded. Postoperative locomotor activity was scored and abnormal behaviour noted. Simple descriptive scales were used for all scoring. Data were analysed using two-way analysis of variance, t tests, Mann-Whitney or Fisher's exact tests as appropriate; P<0.05 was considered statistically significant. Cryptorchid animals did not undergo surgery, but castration was successfully completed in 18 BUT and 20 BUP. More incremental ketamine (P=0.0310) and more rescue drugs (P=0.0165) were required in BUT and more postoperative locomotor activity occurred in BUP (P=0.0001). There were no other differences between groups. Both opioids were suitable for premedication prior to castration but buprenorphine appeared to provide better intraoperative analgesia. PMID:25262056

  8. Staff commitment to providing tobacco dependence in drug treatment: Reliability, validity, and results of a national survey.

    PubMed

    Hunt, Jamie J; Cupertino, A Paula; Gajewski, Byron J; Jiang, Yu; Ronzani, Telmo M; Richter, Kimber P

    2014-06-01

    Although most people in treatment for illicit drug use smoke cigarettes, few facilities offer any form of treatment for tobacco dependence. One reason for this may be that drug treatment staff have varying levels of commitment to treat tobacco. We developed and validated a 14-item Tobacco Treatment Commitment Scale (TTCS), using 405 participants in leadership positions in drug treatment facilities. We first conducted a confirmatory factor analysis to evaluate 4 a priori domains suggested by our original set of 38 items-this did not produce a good fit (comparative fit index [CFI] = 0.782, root mean square error of approximation [RMSEA] = 0.067). We then conducted a series of exploratory factor analyses to produce a more precise and reliable scale. The final confirmatory factor analysis indicated a 3-factor solution, produced a good fit (CFI = 0.950, RMSEA = 0.058), and had substantial unified reliability of 0.975. The final TTCS contained 14 items in 3 domains: "Tobacco is less harmful than other drugs," "It's not our job to treat tobacco," and "Tobacco treatment will harm clients." These constructs account for most of the variance in the survey items and emerged as major sentiments driving staff commitment to providing tobacco services. The TTCS can be used to understand the role of staff attitudes in the adoption of tobacco services in this important treatment setting. PMID:24128292

  9. Staff commitment to providing tobacco dependence in drug treatment: Reliability, validity, and results of a national survey.

    PubMed

    Hunt, Jamie J; Cupertino, A Paula; Gajewski, Byron J; Jiang, Yu; Ronzani, Telmo M; Richter, Kimber P

    2014-06-01

    Although most people in treatment for illicit drug use smoke cigarettes, few facilities offer any form of treatment for tobacco dependence. One reason for this may be that drug treatment staff have varying levels of commitment to treat tobacco. We developed and validated a 14-item Tobacco Treatment Commitment Scale (TTCS), using 405 participants in leadership positions in drug treatment facilities. We first conducted a confirmatory factor analysis to evaluate 4 a priori domains suggested by our original set of 38 items-this did not produce a good fit (comparative fit index [CFI] = 0.782, root mean square error of approximation [RMSEA] = 0.067). We then conducted a series of exploratory factor analyses to produce a more precise and reliable scale. The final confirmatory factor analysis indicated a 3-factor solution, produced a good fit (CFI = 0.950, RMSEA = 0.058), and had substantial unified reliability of 0.975. The final TTCS contained 14 items in 3 domains: "Tobacco is less harmful than other drugs," "It's not our job to treat tobacco," and "Tobacco treatment will harm clients." These constructs account for most of the variance in the survey items and emerged as major sentiments driving staff commitment to providing tobacco services. The TTCS can be used to understand the role of staff attitudes in the adoption of tobacco services in this important treatment setting.

  10. A gravimetric approach to providing SI traceability for concentration measurement results of mercury vapor at ambient air levels

    NASA Astrophysics Data System (ADS)

    Ent, Hugo; van Andel, Inge; Heemskerk, Maurice; van Otterloo, Peter; Bavius, Wijnand; Baldan, Annarita; Horvat, Milena; Brown, Richard J. C.; Quétel, Christophe R.

    2014-11-01

    Current measurement and calibration capabilities for mercury vapor in air are maintained at levels of 0.2-40 μg Hg m-3. In this work, a mercury vapor generator has been developed to establish metrological traceability to the international system of units (SI) for mercury vapor measurement results ≤15 ng Hg m-3, i.e. closer to realistic ambient air concentrations (1-2 ng Hg m-3) [1]. Innovations developed included a modified type of diffusion cell, a new measurement method to weigh the loss in (mercury) mass of these diffusion cells during use (ca. 6-8 μg mass difference between successive weighings), and a new housing for the diffusion cells to maximize flow characteristics and to minimize temperature variations and adsorption effects. The newly developed mercury vapor generator system was tested by using diffusion cells generating 0.8 and 16 ng Hg min-1. The results also show that the filter system, to produce mercury free air, is working properly. Furthermore, and most importantly, the system is producing a flow with a stable mercury vapor content. Some additional improvements are still required to allow the developed mercury vapor generator to produce SI traceable mercury vapor concentrations, based upon gravimetry, at much lower concentration levels and reduced measurement uncertainties than have been achieved previously. The challenges to be met are especially related to developing more robust diffusion cells and better mass measurement conditions. The developed mercury vapor generator will contribute to more reliable measurement results of mercury vapor at ambient and background air levels, and also to better safety standards and cost reductions in industrial processes, such as the liquefied natural gas field, where aluminum main cryogenic heat exchangers are used which are particularly prone to corrosion caused by mercury.

  11. Nintendo Wii rehabilitation ("Wii-hab") provides benefits in Parkinson's disease.

    PubMed

    Herz, Nathan B; Mehta, Shyamal H; Sethi, Kapil D; Jackson, Paula; Hall, Patricia; Morgan, John C

    2013-11-01

    Parkinson's disease (PD) impairs both activities of daily living (ADLs) and motor function and has adverse effects on mood in many patients. While dopaminergic medications are quite helpful for motor and ADLs impairments in PD, complementary therapies are also important in helping patients achieve maximum benefits and quality of life. We hypothesized that the Nintendo Wii (Wii) is a useful tool in improving motor and non-motor aspects in patients with PD, given its ability to drive functional movements and interactive nature. We enrolled twenty subjects with early to mid-stage PD in an open-label within-subjects study design where each subject was evaluated at baseline and then re-evaluated after playing the Wii three times per week for four weeks. Subjects were then re-evaluated one month later after not playing the Wii for a month to see if effects carried over. Subjects demonstrated significant improvements in the primary outcome measure (Nottingham Extended Activities of Daily Living Test (NEADL)), quality of life (PDQ-39) and motor function (UPDRS), and a trend toward improved mood (HAM-D) after four weeks of Wii therapy. Follow-up assessments one month later showed continued improvement for quality of life and UPDRS scores. The results demonstrate that Wii therapy provides short-term motor, non-motor, and quality of life benefits in PD. Further studies are needed to determine if there are long-term benefits of Wii therapy in PD. PMID:23968649

  12. Intermittent cardiac overload results in adaptive hypertrophy and provides protection against left ventricular acute pressure overload insult.

    PubMed

    Moreira-Gonçalves, Daniel; Henriques-Coelho, Tiago; Fonseca, Hélder; Ferreira, Rita; Padrão, Ana Isabel; Santa, Cátia; Vieira, Sara; Silva, Ana Filipa; Amado, Francisco; Leite-Moreira, Adelino; Duarte, José Alberto

    2015-09-01

    The present study aimed to test whether a chronic intermittent workload could induce an adaptive cardiac phenotype Chronic intermittent workload induced features of adaptive hypertrophy This was paralleled by protection against acute pressure overload insult The heart may adapt favourably to balanced demands, regardless of the nature of the stimuli. The present study aimed to test whether submitting the healthy heart to intermittent and tolerable amounts of workload, independently of its nature, could result in an adaptive cardiac phenotype. Male Wistar rats were subjected to treadmill running (Ex) (n = 20), intermittent cardiac overload with dobutamine (ITO) (2 mg kg(-1) , s.c.; n = 20) or placebo administration (Cont) (n = 20) for 5 days week(-1) for 8 weeks. Animals were then killed for histological and biochemical analysis or subjected to left ventricular haemodynamic evaluation under baseline conditions, in response to isovolumetric contractions and to sustained LV acute pressure overload (35% increase in peak systolic pressure maintained for 2 h). Baseline cardiac function was enhanced only in Ex, whereas the response to isovolumetric heartbeats was improved in both ITO and Ex. By contrast to the Cont group, in which rats developed diastolic dysfunction with sustained acute pressure overload, ITO and Ex showed increased tolerance to this stress test. Both ITO and Ex developed cardiomyocyte hypertrophy without fibrosis, no overexpression of osteopontin-1 or β-myosin heavy chain, and increased expression of sarcoplasmic reticulum Ca(2+) protein. Regarding hypertrophic pathways, ITO and Ex showed activation of the protein kinase B/mammalian target of rapamycin pathway but not calcineurin. Mitochondrial complex IV and V activities were also increased in ITO and Ex. Chronic submission to controlled intermittent cardiac overload, independently of its nature, results in an adaptive cardiac phenotype. Features of the cardiac overload, such as the duration and

  13. When providers and community leaders define health priorities: the results of a Delphi survey in the canton of Geneva.

    PubMed

    Schopper, D; Ammon, C; Ronchi, A; Rougemont, A

    2000-08-01

    The Delphi method was used to determine the health priorities in one Swiss canton. The opinion of various groups concerned, either as health professionals or as representatives of the general population, was gathered to identify the health determinants and health problems perceived as most important, to clarify the reasons for these choices, and to recommend interventions to be undertaken in order to improve the situation in the identified priority areas. Five panels, including health professionals as well as selected leaders of community groups with no direct involvement in health, were given the opportunity to reply to two rounds of questionnaires. There was a high convergence of opinion on health determinants and problems to be given priority between panels and between the first and second round. Priorities identified are mainly physical problems (cardiovascular disease, respiratory and breast cancer, AIDS, injuries due to road accidents, chronic back pain), psychosocial disorders (depression, suicide, violence in the family, stress), and problems of substance abuse (alcohol and tobacco). Unemployment and social isolation were chosen because of their perceived impact on health. Very few interventions were proposed in the medical technical or research areas. This may be due partly to the fact that good quality care is widely available and accessible in Geneva, whereas preventive programmes have not received enough attention in the past. Through the identified priorities and the proposed activities, a new vision of health emerges which gives more importance to psychosocial problems and the social environment. In this context, health promotion is seen as essential, acknowledging that sustained change in individual behaviours can only occur if the social and cultural context is taken into consideration. In conclusion, the results of this survey show that the Delphi method is a useful tool to reach consensus on health priorities and corresponding activities among a

  14. Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England

    PubMed Central

    Krakower, Douglas S.; Oldenburg, Catherine E.; Mitty, Jennifer A.; Wilson, Ira B.; Kurth, Ann E.; Maloney, Kevin M.; Gallagher, Donna; Mayer, Kenneth H.

    2015-01-01

    Background Antiretroviral treatment for HIV-infection before immunologic decline (early ART) and pre-exposure chemoprophylaxis (PrEP) can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited. Methods Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices. Results Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample), 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01–1.34) and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98–11.2) were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06–1.34), whereas female gender (aOR 0.26, 95% CI 0.10–0.71) was associated

  15. First application of behavoir recognition through the recording of ADL by radio modules in a home.

    PubMed

    Neuhaeuser, J; Proebstl, D; D'Angelo, L T; Lueth, T C

    2012-01-01

    In this contribution the behavior of an elderly couple, recorded by a radio module system in their own home is analyzed. There is an increasing interest in giving elderly people the possibility to live at their own homes as long as possible. Since diseases like dementia are diagnosed through the change of behavior, especially the activities of daily living (ADL), there is a growing need of an objective instrument for measuring behavioral changes. Therefore the Eventlogger was developed and installed for 32 days in a home of an elderly couple. Throughout this paper the outcome of the data collection as well as first steps for analyzing it will be discussed. Furthermore we were able to observe different routines of the diseased and the healthy person. The diseased proband follows a very strict routine whereas the healthy proband routines are dependent on different factors. PMID:23367257

  16. Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada

    PubMed Central

    2011-01-01

    Background Aboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies. Methods In Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the Canadian First Nations Diabetes Clinical Management and Epidemiologic (CIRCLE) study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated). Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities. Results the key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs) and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs. Conclusions Addressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services. Research incorporating patient

  17. Do Health Care Providers Use Online Patient Ratings to Improve the Quality of Care? Results From an Online-Based Cross-Sectional Study

    PubMed Central

    Sander, Uwe

    2016-01-01

    Background Physician-rating websites have become a popular tool to create more transparency about the quality of health care providers. So far, it remains unknown whether online-based rating websites have the potential to contribute to a better standard of care. Objective Our goal was to examine which health care providers use online rating websites and for what purposes, and whether health care providers use online patient ratings to improve patient care. Methods We conducted an online-based cross-sectional study by surveying 2360 physicians and other health care providers (September 2015). In addition to descriptive statistics, we performed multilevel logistic regression models to ascertain the effects of providers’ demographics as well as report card-related variables on the likelihood that providers implement measures to improve patient care. Results Overall, more than half of the responding providers surveyed (54.66%, 1290/2360) used online ratings to derive measures to improve patient care (implemented measures: mean 3.06, SD 2.29). Ophthalmologists (68%, 40/59) and gynecologists (65.4%, 123/188) were most likely to implement any measures. The most widely implemented quality measures were related to communication with patients (28.77%, 679/2360), the appointment scheduling process (23.60%, 557/2360), and office workflow (21.23%, 501/2360). Scaled-survey results had a greater impact on deriving measures than narrative comments. Multilevel logistic regression models revealed medical specialty, the frequency of report card use, and the appraisal of the trustworthiness of scaled-survey ratings to be significantly associated predictors for implementing measures to improve patient care because of online ratings. Conclusions Our results suggest that online ratings displayed on physician-rating websites have an impact on patient care. Despite the limitations of our study and unintended consequences of physician-rating websites, they still may have the potential to

  18. Results.

    ERIC Educational Resources Information Center

    Zemsky, Robert; Shaman, Susan; Shapiro, Daniel B.

    2001-01-01

    Describes the Collegiate Results Instrument (CRI), which measures a range of collegiate outcomes for alumni 6 years after graduation. The CRI was designed to target alumni from institutions across market segments and assess their values, abilities, work skills, occupations, and pursuit of lifelong learning. (EV)

  19. Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counseling (PITC) in Malawi

    PubMed Central

    Ahmed, Saeed; Schwarz, Monica; Flick, Robert; Rees, Chris A.; Harawa, Mwelura; Simon, Katie; Robison, Jeff; Kazembe, Peter N.; Kim, Maria H.

    2016-01-01

    Objective To assess implementation of provider-initiated testing and counseling (PITC) for HIV in Malawi. Methods A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected program data. Results Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5,293/5,615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics, and 49.4% (6,871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71), and inadequate number of HIV counselors (32/71) while providers from inpatient units cited the inability to test on weekends. Conclusions Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests routine PITC is feasible. These results underscore the need to develop clear, standardized PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure, and human resources. PMID:26806378

  20. Fleet Compliance Results for MY 2010/FY 2011, EPAct Alternative Fuel Transportation Program: State and Alternative Fuel Provider Fleet Compliance Annual Report (Brochure)

    SciTech Connect

    Not Available

    2012-03-01

    This annual report summarizes the compliance results of state and alternative fuel provider fleets covered by the Energy Policy Act of 1992 (EPAct) for model year 2010/fiscal year 2011. The U.S. Department of Energy (DOE) regulates covered state and alternative fuel provider (SFP) fleets under the Energy Policy Act of 1992 (EPAct), as amended. For model year (MY) 2010, the compliance rate for the 2911 covered SFP fleets was 100%. Fleets used either Standard Compliance or Alternative Compliance. The 279 fleets that used Standard Compliance exceeded their aggregate MY 2010 acquisition requirements by 61%. The 12 covered fleets that complied using Alternative Compliance exceeded their aggregate MY 2010 petroleum-use-reduction requirements by 89%. Overall, DOE saw modest decreases from MY 2009 in biodiesel fuel use credits earned and in the number of light-duty vehicles (LDVs) acquired. Compared to years before MY 2009, these rates were far lower. Because covered fleets acquired fewer new vehicles overall in MY 2010, the requirement for alternative fuel vehicles (AFVs), which is proportional to new acquisitions, also dropped.

  1. Online self-administered training of PTSD treatment providers in cognitive-behavioral intervention skills: results of a randomized controlled trial.

    PubMed

    Ruzek, Josef I; Rosen, Raymond C; Garvert, Donn W; Smith, Lauren D; Sears, Katharine C; Marceau, Lisa; Harty, Brian; Stoddard, Anne M

    2014-12-01

    Despite potential advantages in scalability and efficiency of web-based training for trauma providers, few controlled trials of feasibility and effectiveness of web-based mental health training have been performed. Our study compared web-based training in 3 intervention skills (motivation enhancement [ME], goal setting [GS], behavioral task assignment [BTA]) with web-based training plus telephone consultation, and a no-training control. The primary outcome measures included objective measures of skills acquisition (standardized patient assessments). Results showed significant differences among the training conditions. The overall tests of differences among the groups were statistically significant for ME and BTA skills (p < .001 and p = .005, respectively), but not for GS (p = .245). The web training plus consultation group improved in ME skills by 0.35 units compared to 0.12 units in the web only group (p < .001) and no change in the control group (p = .001). For BTA skills, the web training plus consultation improved by 0.27 units compared to 0.17 units in the web only group (p = .175) and no change in the control group (p = .004). Overall, these findings support the use of web-based dissemination for large-scale training programs for trauma providers in health care delivery systems. Further studies are needed to clarify the specific role of consultation as an adjunct to web-based training. PMID:25522731

  2. [Results of QC vs QL study (quality of care vs quality of life) 2006-2009. The way of providing hemodialysis and a concomitant therapy].

    PubMed

    Rutkowski, Bolesław; Nowaczyk, Ryszard; Rutkowski, Przemysław; Mierzicki, Piotr

    2011-01-01

    Healthcare development is the fact in the present world. Because of this the improvement of the quality of care and life of patients is of great importance. Since six years in our country, the study concerning quality of life and care of hemodialysed patients (QC vs QL) is performed annually. In three subsequent papers results of studies performed between 2006 and 2009 are summarised. Almost 7000 patients were studies in the analysed period. This was more than 10% of dialysed patients in every year. In the present paper we focused on the hemodialysis modalities and concomitant therapy. The increase of high-flux hemodialysis usage as well as plasmapheresis but not hemodiafiltration was noticed in the analysed period. Adequacy of the therapy was evaluated as Kt/V and was stable in the whole study. Treatment with erythropoesis stimulating agents (ESA) was provided in 100% of dialysis units, the dosage frequency was connected with long acting ESA. Because of changed trends and the payer requirements apart from frequency the route has also changed. The average haemoglobin level reflected European and county guidelines and changed during the observation. Additional help from psychologist and dietician is available in too small number of dialysis units. Summarizing, based on performed analysis the development of hemodialysis treatment and a high level of provided therapy comparable to other European countries was observed in Poland. Support for further development and improvement of renal replacement therapy is needed to achieve also better quality of life of our patients.

  3. Experiences and meanings of integration of TCAM (Traditional, Complementary and Alternative Medical) providers in three Indian states: results from a cross-sectional, qualitative implementation research study

    PubMed Central

    Nambiar, D; Narayan, V V; Josyula, L K; Porter, J D H; Sathyanarayana, T N; Sheikh, K

    2014-01-01

    Objectives Efforts to engage Traditional, Complementary and Alternative Medical (TCAM) practitioners in the public health workforce have growing relevance for India's path to universal health coverage. We used an action-centred framework to understand how policy prescriptions related to integration were being implemented in three distinct Indian states. Setting Health departments and district-level primary care facilities in the states of Kerala, Meghalaya and Delhi. Participants In each state, two or three districts were chosen that represented a variation in accessibility and distribution across TCAM providers (eg, small or large proportions of local health practitioners, Homoeopaths, Ayurvedic and/or Unani practitioners). Per district, two blocks or geographical units were selected. TCAM and allopathic practitioners, administrators and representatives of the community at the district and state levels were chosen based on publicly available records from state and municipal authorities. A total of 196 interviews were carried out: 74 in Kerala, and 61 each in Delhi and Meghalaya. Primary and secondary outcome measures We sought to understand experiences and meanings associated with integration across stakeholders, as well as barriers and facilitators to implementing policies related to integration of Traditional, Complementary and Alternative (TCA) providers at the systems level. Results We found that individual and interpersonal attributes tended to facilitate integration, while system features and processes tended to hinder it. Collegiality, recognition of stature, as well as exercise of individual personal initiative among TCA practitioners and of personal experience of TCAM among allopaths enabled integration. The system, on the other hand, was characterised by the fragmentation of jurisdiction and facilities, intersystem isolation, lack of trust in and awareness of TCA systems, and inadequate infrastructure and resources for TCA service delivery. Conclusions

  4. Analysis of the NASA/MSFC Airborne Doppler Lidar results from San Gorgonio Pass, California

    NASA Technical Reports Server (NTRS)

    Cliff, W. C.; Skarda, J. R.; Renne, D. S.; Sandusky, W. F.

    1984-01-01

    Two days during July of 1981 the NASA/MSFC Airborne Doppler Lidar System (ADLS) was flown aboard the NASA/AMES Convair 990 on the east side of San Gorgonio Pass California, near Palm Springs, to measure and investigate the accelerated atmospheric wind field discharging from the pass. The vertical and horizontal extent of the fast moving atmospheric flow discharging from the San Gorgonio Pass were examined. Conventional ground measurements were also taken during the tests to assist in validating the ADLS results. This particular region is recognized as a high wind resource region and, as such, a knowledge of the horizontal and vertical extent of this flow was of interest for wind energy applications. The statistics of the atmospheric flow field itself as it discharges from the pass and then spreads out over the desert were also of scientific interests. This data provided the first spatial data for ensemble averaging of spatial correlations to compute longitudinal and lateral integral length scales in the longitudinal and lateral directions for both components.

  5. Evidence-Based Practice Knowledge, Use, and Factors that Influence Decisions: Results from an Evidence-Based Practice Survey of Providers in American Indian/Alaska Native Communities

    ERIC Educational Resources Information Center

    Sheehan, Angela; Walrath-Greene, Christine; Fisher, Sylvia; Crossbear, Shannon; Walker, Joseph

    2007-01-01

    Data from the Evidence-based Treatment Survey were used to compare providers serving families in American Indian and Alaska Native communities to their counterparts in non-American Indian/Alaska Native communities on provider characteristics and factors that influence their decision to use evidence-based practices (N = 467). The findings suggest…

  6. The Role of Community Rehabilitation Providers in Employment for Persons with Intellectual and Developmental Disabilities: Results of the 2010-2011 National Survey

    ERIC Educational Resources Information Center

    Domin, Daria; Butterworth, John

    2013-01-01

    Based on the 2010-2011 National Survey of Community Rehabilitation Providers, findings are presented on people with all disabilities and people with intellectual and developmental disabilities (IDD) who are served in employment and nonwork settings by community rehabilitation providers. Findings suggest little change over the past eight years in…

  7. Development of a sensitive loop-mediated isothermal amplification assay that provides specimen-to-result diagnosis of respiratory syncytial virus infection in 30 minutes.

    PubMed

    Mahony, James; Chong, Sylvia; Bulir, David; Ruyter, Alexandra; Mwawasi, Ken; Waltho, Daniel

    2013-08-01

    Rapid isothermal amplification methods have recently been introduced, and some of these methods offer significant advantages over PCR. The objective of this study was to develop a rapid and sensitive multiplex loop-mediated isothermal amplification (M-LAMP) assay for the detection of respiratory syncytial virus subgroups A and B (RSV A and B). We designed six primers each for the matrix gene of RSV A and the polymerase gene of RSV B and developed an M-LAMP assay by using a commercially available master mix and a real-time fluorometer (Genie II; Optigene, United Kingdom) that displays real-time amplification, time to positivity, and amplicon annealing temperature (Tm). The M-LAMP was evaluated against PCR by testing 275 nasopharyngeal (NP) specimens. The final optimized M-LAMP assay had a mean amplification time of 14.2 min (compared with 90 to 120 min for PCR) and had an analytical sensitivity of 1 genome equivalent (ge) for both RSV A and B. Using PCR as a comparator, M-LAMP had a sensitivity of 100% (81/81) and specificity of 100% (194/194). We also evaluated a 3- to 10-min specimen processing method involving vortexing with glass beads and heating to 98°C in M-swab medium (Copan Italia, Brescia, Italy) and found that this rapid processing method allowed detection of 37/41 (90.2%) of positives when we used extracted nucleic acid. In summary, the M-LAMP assay had excellent sensitivity and specificity for detecting RSV A and B in NP specimens and, when coupled with a rapid specimen preparation method, could provide a specimen-to-result diagnosis time of 30 min.

  8. Development of a Sensitive Loop-Mediated Isothermal Amplification Assay That Provides Specimen-to-Result Diagnosis of Respiratory Syncytial Virus Infection in 30 Minutes

    PubMed Central

    Chong, Sylvia; Bulir, David; Ruyter, Alexandra; Mwawasi, Ken; Waltho, Daniel

    2013-01-01

    Rapid isothermal amplification methods have recently been introduced, and some of these methods offer significant advantages over PCR. The objective of this study was to develop a rapid and sensitive multiplex loop-mediated isothermal amplification (M-LAMP) assay for the detection of respiratory syncytial virus subgroups A and B (RSV A and B). We designed six primers each for the matrix gene of RSV A and the polymerase gene of RSV B and developed an M-LAMP assay by using a commercially available master mix and a real-time fluorometer (Genie II; Optigene, United Kingdom) that displays real-time amplification, time to positivity, and amplicon annealing temperature (Tm). The M-LAMP was evaluated against PCR by testing 275 nasopharyngeal (NP) specimens. The final optimized M-LAMP assay had a mean amplification time of 14.2 min (compared with 90 to 120 min for PCR) and had an analytical sensitivity of 1 genome equivalent (ge) for both RSV A and B. Using PCR as a comparator, M-LAMP had a sensitivity of 100% (81/81) and specificity of 100% (194/194). We also evaluated a 3- to 10-min specimen processing method involving vortexing with glass beads and heating to 98°C in M-swab medium (Copan Italia, Brescia, Italy) and found that this rapid processing method allowed detection of 37/41 (90.2%) of positives when we used extracted nucleic acid. In summary, the M-LAMP assay had excellent sensitivity and specificity for detecting RSV A and B in NP specimens and, when coupled with a rapid specimen preparation method, could provide a specimen-to-result diagnosis time of 30 min. PMID:23761156

  9. Risk Factors for Nursing Home Placement in Alzheimer's Disease: A Longitudinal Study of Cognition, ADL, Service Utilization, and Cholinesterase Inhibitor Treatment

    ERIC Educational Resources Information Center

    Wattmo, Carina; Wallin, Asa K.; Londos, Elisabet; Minthon, Lennart

    2011-01-01

    Purpose of the Study: To identify risk factors for early nursing home placement (NHP) in Alzheimer's disease (AD), focusing on the impact of longitudinal change in cognition, activities of daily living (ADL), service utilization, and cholinesterase inhibitor treatment (ChEI). Design and Methods: In an open, 3-year, prospective, multicenter study…

  10. Examination of Children's Recess Physical Activity Patterns Using the Activities for Daily Living-Playground Participation (ADL-PP) Instrument

    ERIC Educational Resources Information Center

    Stellino, Megan Babkes; Sinclair, Christina

    2014-01-01

    Thorough assessment of children's physical activity is essential to efficacious interventions to reduce childhood obesity prevalence. The purpose of this study was to examine children's recess physical activity (RPA) patterns of behavior using the Activities of Daily Living-Playground Participation (ADL-PP: Watkinson et al., 2001)…

  11. Cognitive Impairment as a Strong Predictor of Incident Disability in Specific Adl-Iadl Tasks among Community-Dwelling Elders: The Azuchi Study

    ERIC Educational Resources Information Center

    Dodge, Hiroko H.; Kadowaki, Takashi; Hayakawa, Takehito; Yamakawa, Masanobu; Sekikawa, Akira; Ueshima, Hirotugu

    2005-01-01

    Purpose: We examined differential effects of cognitive impairment on each of the activities of daily living (ADL) and instrumental activities of daily living (IADL) tasks. Design and Methods: In a 3-year follow-up of community-dwelling elderly persons in Azuchi, Japan, we assessed cognition by using the Hasegawa Dementia Scale. We examined (a) the…

  12. EPAct Alternative Fuel Transportation Program: State and Alternative Fuel Provider Fleet Compliance Annual Report; Fleet Compliance Results for MY 2013/FY 2014

    SciTech Connect

    2015-09-01

    Compliance rates for covered state government and alternative fuel provider fleets under the Alternative Fuel Transportation Program (pursuant to the Energy Policy Act or EPAct) are reported for MY 2013/FY 2014 in this publication.

  13. Acceptability, feasibility and challenges of implementing an HIV prevention intervention for people living with HIV/AIDS among healthcare providers in Mozambique: Results of a qualitative study

    PubMed Central

    Jaiantilal, Prafulta; Gutin, Sarah A.; Cummings, Beverley; Mbofana, Francisco; Rose, Carol Dawson

    2015-01-01

    Abstract Despite the Mozambique government's efforts to curb human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), national prevalence is 11.5% and support is needed to expand HIV-related services and improve program quality. Positive prevention (PP) programs, which prioritize HIV prevention with people living with HIV and AIDS (PLHIV), have been recognized as an important intervention for preventing new HIV infections. To address this, an evidence-based PP training intervention was implemented with HIV healthcare providers in Mozambique. This study focuses on the acceptability and feasibility of a PP intervention in HIV clinics from the healthcare provider perspective. In-depth interviews were conducted with 31 healthcare providers from three provinces who participated in PP trainings in Mozambique. Interview data were coded using content analysis. Study data suggest that healthcare providers found PP acceptable, feasible to implement in their HIV work in clinic settings, and valued this strategy to improve HIV prevention. The PP training also led providers to feel more comfortable counseling their patients about prevention, with a more holistic approach that included HIV testing, treatment and encouraging PLHIV to live positively. While overall acceptance of the PP training was positive, several barriers to feasibility surfaced in the data. Patient-level barriers included resistance to disclosing HIV status due to fear of stigma and discrimination, difficulty negotiating for condom use, difficulty engaging men in testing and treatment, and the effects of poverty on accessing care. Providers also identified work environment barriers including high patient load, time constraints, and frequent staff turnover. Recognizing PP as an important intervention, healthcare providers should be trained to provide comprehensive prevention, care and treatment for PLHIV. Further work is needed to explore the complex social dynamics and cultural challenges

  14. Results of an intervention for individuals and families with BRCA mutations: a model for providing medical updates and psychosocial support following genetic testing.

    PubMed

    McKinnon, Wendy; Naud, Shelly; Ashikaga, Taka; Colletti, Rose; Wood, Marie

    2007-08-01

    : Providing medical management updates and long-term support to families with hereditary cancer syndromes in rural areas is a challenge. To address this, we designed a one-day retreat for BRCA1/2 carriers in our region. The retreat included educational updates about medical management, genetic privacy and discrimination, and addressed psychological and family issues. Evaluations completed at the conclusion of the retreat were overwhelmingly positive with requests for a similar event in the future. The impact of this retreat on a variety of health behaviors was assessed. Eligible participants completed questionnaires before and 6 months after the retreat. Questionnaires focused on lifestyle, cancer screening and prevention practices, psychological history and distress, decision-making regarding genetic testing, and family communication issues. For individuals who completed both the pre and post retreat questionnaires, one-half made lifestyle changes and nearly two-thirds increased cancer screening, initiated chemoprevention, completed or planned to complete preventative surgery in the future. We conclude that this type of forum provides a valuable opportunity for BRCA carriers and their families to receive updated medical information, share personal experiences, provide and receive support, as well as change health behaviors.

  15. [The results of a trial in the Socialist Republic of Vietnam of clothing providing mechanical protection against the bites of blood-sucking Diptera].

    PubMed

    Gornostaeva, R M; Zhukova, L I

    1993-01-01

    The tested overalls for protection in hot climate may be recommended only for the protection of people engaged in work involving little movement (fishermen, watchmen, etc.). For wider use of such overalls in hot regions the design should be changed, the alterations are described in the paper. Further trials of the overalls should be carried out with its modified design; this costume provides adequate mechanical protection from the bites of mosquitoes and other blood-sucking Diptera and it will be widely used in the tropics, where blood-sucking Diptera contribute much to infection transmission.

  16. A novel DMD IRES results in a functional N-truncated dystrophin, providing a potential route to therapy for patients with 5’ mutations

    PubMed Central

    Wein, Nicolas; Vulin, Adeline; Sofia Falzarano, Maria; Al-Khalili Szigyarto, Christina; Maiti, Baijayanta; Findlay, Andrew; Heller, Kristin N; Uhlén, Mathias; Bakthavachalu, Baskar; Messina, Sonia; Vita, Giuseppe; Passarelli, Chiara; Gualandi, Francesca; Wilton, Steve D; Rodino-Klapac, Louise; Yang, Lin; Dunn, Diane M.; Schoenberg, Daniel; Weiss, Robert B.; Howard, Michael T.; Ferlini, Alessandra; Flanigan, Kevin M.

    2014-01-01

    Most mutations that truncate the reading frame of the DMD gene cause loss of dystrophin expression and lead to Duchenne muscular dystrophy. However, amelioration of disease severity can result from alternate translation initiation beginning in DMD exon 6 that leads to expression of a highly functional N-truncated dystrophin. This novel isoform results from usage of an internal ribosome entry site (IRES) within exon 5 that is glucocorticoid-inducible. IRES activity is confirmed in patient muscle by both peptide sequencing and ribosome profiling. Generation of a truncated reading frame upstream of the IRES by exon skipping leads to synthesis of a functional N-truncated isoform in both patient-derived cell lines and in a new DMD mouse model, where expression protects muscle from contraction-induced injury and corrects muscle force to the same level as control mice. These results support a novel therapeutic approach for patients with mutations within the 5’ exons of DMD. PMID:25108525

  17. The Glittre-ADL test reflects functional performance measured by physical activities of daily living in patients with chronic obstructive pulmonary disease

    PubMed Central

    Karloh, Manuela; Araujo, Cintia L. P.; Gulart, Aline A.; Reis, Cardine M.; Steidle, Leila J. M.; Mayer, Anamaria F.

    2016-01-01

    ABSTRACT Background The Glittre-ADL test (TGlittre) is a valid and reliable test for the evaluation of functional capacity and involves multiple physical activities of daily living (PADL), which are known to be troublesome to patients with Chronic Obstructive Pulmonary Disease (COPD). However, it is still unknown if this test is also able to reflect the functional performance of patients with COPD. Objective To investigate whether the TGlittre reflects the functional performance of COPD patients and whether the necessary time to complete the TGlittre and the PADL varies according to disease severity. Method Thirty-eight patients with COPD (age 65, SD=7 years; forced expiratory volume in the first second 41.3, SD=15.2% predicted) underwent anthropometric and lung function assessments and were submitted to the TGlittre and PADL measurement. Results TGlittre performance correlated significantly (p<0.05) with PADL variables, such as time sitting (r=0.50), walking (r=-0.46), number of steps taken (r=–0.53), walking movement intensity (r=–0.66), walking energy expenditure (r=-0.50), and total energy expenditure (r=–0.33). TGlittre performance was not significantly different in patients among the Global Initiative for COPD (GOLD) spirometric stages, but walking and sitting time were significantly lower and greater, respectively, in severe and very severe patients compared to those with moderate disease (p<0.05). Conclusion The performance on the TGlittre correlates with walking and sitting time and other real life PADL measurements. The severity of the disease is associated with the differences in the level of physical activity in daily life more than in functional capacity. PMID:27437713

  18. Can repeat injection provide clinical benefit in patients with cervical disc herniation and stenosis when the first epidural injection results only in partial response?

    PubMed

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-07-01

    Epidural steroid injection (ESI) is known to be an effective treatment for neck or radicular pain due to herniated intervertebral disc (HIVD) and spinal stenosis (SS). Although repeat ESI has generally been indicated to provide more pain relief in partial responders after single ESI, there has been little evidence supporting the usefulness of this procedure. The purpose of this study, therefore, was to determine whether repeat ESI at a prescribed interval of 2 to 3 weeks after the first injection would provide greater clinical benefit in patients with partial pain reduction than intermittent ESI performed only when pain was aggravated. One hundred eighty-four patients who underwent transforaminal ESI (TFESI) for treatment of axial neck and radicular arm pain due to HIVD or SS and could be followed up for 1 year were enrolled. We divided the patients into 2 groups. Group A (N = 108) comprised partial responders (numeric rating scale (NRS) ≥ 3 after the first injection) who underwent repeat injection at a prescribed interval of 2 to 3 weeks after the first injection. Group B (N = 76) comprised partial responders who did not receive repeat injection at the prescribed interval, but received intermittent injections only for aggravation of pain. Various clinical data were assessed, including total number of injections during 1 year, NRS duration of <3 during 1 year (NRS < 3 duration), and time interval until pain was increased to require additional injections after repeat injection in Group A, or after first injection in Group B (time to reinjection). Groups A and B were compared in terms of total population, HIVD, and SS. In the whole population, HIVD subgroup, and SS subgroup, patients in Group A required significantly fewer injections to obtain satisfactory pain relief during the 1-year follow-up period. Group A showed a significantly longer time to reinjection and longer NRS < 3 than Group B did. Repeat TFESI conducted at 2- to 3-week intervals

  19. Providers issue brief: alternative providers.

    PubMed

    Rothouse, M

    1999-06-29

    Access by managed care plan enrollees, scope of practice issues and fee reimbursement by Medicaid and third parties such as insurance carriers is the engine that drives legislation recognizing alternative health care providers--chiropractors, acupuncturists, physical therapists, naturopaths, massage therapists, homeopaths, and dietitians and nutritionists. PMID:11073386

  20. Current Practices and the Provider Perspectives on Inconclusive Genetic Test Results for Osteogenesis Imperfecta in Children with Unexplained Fractures: ELSI Implications.

    PubMed

    Youngblom, Emily; Murray, Mitzi Leah; Byers, Peter H

    2016-09-01

    Genetic testing can be used to determine if unexplained fractures in children could have resulted from a predisposition to bone fractures, e.g., osteogenesis imperfecta. However, uncertainty is introduced if a variant of unknown significance (VUS) is identified. Proper interpretation of VUS in these situations is critical because of its influence on clinical care and in court rulings. This study sought to understand how VUS are interpreted and used by practitioners when there is a differential diagnosis including both osteogenesis imperfecta and non-accidental injury.A 15-question survey was emailed to physicians who requested analysis of two genes, COL1A1 and COL1A2, from the University of Washington from 2005-2013 for patient cases involving suspicion of child abuse.Among the 89 participants, responses differed about when genetic testing should be ordered for osteogenesis imperfecta, who should be consulted about utilization of VUS test results, follow-up procedures, and who should receive the VUS results.There are no clear guidelines for how to interpret and follow up on VUS. In the legal setting, misinterpreted VUS could lead to unintended consequences and deleterious ramifications for family members. The need for better practice guidelines to help promote more equitable handling of these sensitive legal cases is clear. PMID:27587455

  1. Deletion of IglH in virulent Francisella tularensis subsp. holarctica FSC200 strain results in attenuation and provides protection against the challenge with the parental strain.

    PubMed

    Straskova, Adela; Cerveny, Lukas; Spidlova, Petra; Dankova, Vera; Belcic, Davor; Santic, Marina; Stulik, Jiri

    2012-02-01

    Francisella tularensis, the causative agent of tularemia, is a highly infectious intracellular pathogen with no licensed vaccine available today. The recent search for genome sequences involved in F. tularensis virulence mechanisms led to the identification of the 30-kb region defined as a Francisella pathogenicity island (FPI). In our previous iTRAQ study we described the concerted upregulation of some FPI proteins in different F. tularensis strains cultivated under stress conditions. Among them we identified the IglH protein whose role in Francisella virulence has not been characterized yet. In this work we deleted the iglH gene in a European clinical isolate of F. tularensis subsp. holarctica FSC200. We showed that the iglH gene is necessary for intracellular growth and escape of F. tularensis from phagosomes. We also showed that the iglH mutant is avirulent in a mouse model of infection and persists in the organs for about three weeks after infection. Importantly, mice vaccinated by infection with the iglH mutant were protected against subcutaneous challenge with the fully virulent parental FSC200 strain. This is the first report of a defined subsp. holarctica FPI deletion strain that provides protective immunity against subsequent subcutaneous challenge with a virulent isolate of F. tularensis subsp. holarctica.

  2. Patient Perceptions of Prejudice and Discrimination by Health Care Providers and its Relationship with Mental Disorders: Results from the 2012 Canadian Community Health-Mental Health Survey Data.

    PubMed

    Marchand, Kirsten; Palis, Heather; Oviedo-Joekes, Eugenia

    2016-04-01

    Using data from a nationally representative survey, the Canadian Community Health Survey-Mental Health, this secondary analysis aimed to determine the prevalence of perceived prejudice by health care providers (HCPs) and its relationship with mental disorders. Respondents accessing HCPs in the prior year were asked if they experienced HCP prejudice. A hypothesis driven multivariable logistic regression analysis was conducted to determine the relationship between type of mental disorders and HCP prejudice. Among the 3006 respondents, 10.9 % perceived HCP prejudice, 62.4 % of whom reported a mental disorder. The adjusted odds of prejudice was highest for respondents with anxiety (OR 3.12; 95 % CI 1.60, 6.07), concurrent mood or anxiety and substance disorders (OR 3.08; 95 % CI 1.59, 5.95) and co-occurring mood and anxiety disorders (OR 2.89; 95 % CI 1.68, 4.97) compared to respondents without any mental disorders. These findings are timely for informing discussions regarding policies to address HCP prejudice towards people with mental disorders.

  3. Can currently available advanced combustion biomass cook-stoves provide health relevant exposure reductions? Results from initial assessment of select commercial models in India.

    PubMed

    Sambandam, Sankar; Balakrishnan, Kalpana; Ghosh, Santu; Sadasivam, Arulselvan; Madhav, Satish; Ramasamy, Rengaraj; Samanta, Maitreya; Mukhopadhyay, Krishnendu; Rehman, Hafeez; Ramanathan, Veerabhadran

    2015-03-01

    Household air pollution from use of solid fuels is a major contributor to the national burden of disease in India. Currently available models of advanced combustion biomass cook-stoves (ACS) report significantly higher efficiencies and lower emissions in the laboratory when compared to traditional cook-stoves, but relatively little is known about household level exposure reductions, achieved under routine conditions of use. We report results from initial field assessments of six commercial ACS models from the states of Tamil Nadu and Uttar Pradesh in India. We monitored 72 households (divided into six arms to each receive an ACS model) for 24-h kitchen area concentrations of PM2.5 and CO before and (1-6 months) after installation of the new stove together with detailed information on fixed and time-varying household characteristics. Detailed surveys collected information on user perceptions regarding acceptability for routine use. While the median percent reductions in 24-h PM2.5 and CO concentrations ranged from 2 to 71% and 10-66%, respectively, concentrations consistently exceeded WHO air quality guideline values across all models raising questions regarding the health relevance of such reductions. Most models were perceived to be sub-optimally designed for routine use often resulting in inappropriate and inadequate levels of use. Household concentration reductions also run the risk of being compromised by high ambient backgrounds from community level solid-fuel use and contributions from surrounding fossil fuel sources. Results indicate that achieving health relevant exposure reductions in solid-fuel using households will require integration of emissions reductions with ease of use and adoption at community scale, in cook-stove technologies. Imminent efforts are also needed to accelerate the progress towards cleaner fuels. PMID:25293811

  4. Coupling 2H and 18O biomarker results provides new insight into palaeohumidity changes in East Africa during the last glacial

    NASA Astrophysics Data System (ADS)

    Hepp, Johannes; Zech, Roland; Tuthorn, Mario; Glaser, Bruno; Rozanski, Kazimierz; Zech, Wolfgang; Zech, Michael

    2015-04-01

    We couple compound-specific δ2H results of leaf wax-derived n-alkanes with compound-specific δ18O results of hemicellulose-derived sugars extracted from the loess-paleosol-sequence Maundi (3° 10'27.5'S, 37° 31'05.8'E) located on the south-eastern slopes of Mt. Kilimanjaro at ~ 2780 m above sea level. This coupled biomarker approach allows inter alia establishing a ca. 100 ka record of the isotopic composition of leaf water. Accordingly, the deuterium-excess of leaf water may serve as a proxy for palaeohumidity. Furthermore, the coupled biomarker approach allows reconstructing the isotopic composition of palaeoprecipitation (by using the slope the local evaporation line derived from a simple Craig-Gordon model). Our results suggest that sedimentary δ2Hleaf-wax records should not be interpreted directly in terms of reflecting δ2Hprec because variable leaf water evaporative enrichment can strongly overprint the δ2Hprec signal. The Maundi δ2Hn-alkane record can be compared with δ2Hwax records from Lake Challa, Lake Tanganyika and Lake Malawi. Accordingly, the Maundi δ2Hn-alkane record is generally in good agreement with the Lake Challa and the Lake Tanganyika δ2Hwax records. However, a clear altitude effect can be seen in the δ2H records (Maundi: 2780 m a.s.l.; Lake Challa: 880 m a.s.l.; Lake Tanganyika: 773 m a.s.l.; Lake Malawi: 474 m a.s.l.). Moreover, the Maundi δ2Hn-alkane record reveals a clear smaller range compared to the other δ2Hwax records. Finally, especially the Lake Malawi δ2Hwax record reveals also clearly different features than the other available δ2Hwax records. These differences resulted in different interpretations of the δ2Hwax records (amount effect vs. source effect). Our coupled δ18Osugar and δ2Hn-alkane approach sheds new light into this discussion. In brief, reconstructed low deuterium-excessleaf-water values during the African Humid Period (AHP) indicate humid climatic conditions. By contrast, higher deuterium

  5. Family perceptions of shared decision-making with health care providers: results of the National Survey of Children With Special Health Care Needs, 2009-2010.

    PubMed

    Smalley, LaQuanta P; Kenney, Mary Kay; Denboba, Diana; Strickland, Bonnie

    2014-08-01

    The Maternal and Child Health Bureau recently revised its measure of family-provider shared decision-making (SDM) to better align with parents' views and the intent of SDM. We sought to assess achievements in meeting the revised measure; examine socio-demographic/health correlates; and determine the relationships between SDM and access to quality health care. We analyzed data for 40,242 children with special health care needs (CSHCN) from the 2009-2010 National Survey of CSHCN and assessed the prevalence of SDM and association with other US CSHCN socio-demographic/health characteristics using bivariate and multivariate methods. Logistic regression was used to determine associations between SDM and having a medical home and preventive medical/dental visits. Approximately 70% of families of CSHCN perceived themselves as shared decision-makers in their child's care. Families of CSHCN with greater functional limitations had twice the odds of lacking SDM than those never affected. Disparities in attainment rates were noted for families with low versus high income (61 vs. 77%), less versus more than high school education (59 vs. 73%), privately insured versus uninsured (76 vs. 57%), and minority versus white race (63 vs. 74%). CSHCN with medical homes had 6 times greater odds of perceived SDM and as much as one and a half times the odds of receiving preventive care than CSHCN without a medical home. Major differences in family SDM perceptions are associated with having a medical home, particularly when characterized by family-centered care. Populations of concern are those with more functionally limited children and increased socio-economic challenges. PMID:24052119

  6. The effect of providing patient-specific electronically monitored antipsychotic medication adherence results on the treatment planning of prescribers of outpatients with schizophrenia.

    PubMed

    Nakonezny, Paul A; Byerly, Matthew J; Pradhan, Amit

    2013-06-30

    Adherence to antipsychotic medication was assessed monthly over a 6-month study period using patient-specific electronic monitoring (EM) of medication bottle opening in 23 outpatients with schizophrenia or schizoaffective disorder. Patient-specific EM adherence results were then shared with the seven participating prescribers, who were surveyed concerning the treatment changes, if any, that they would recommend based on the EM adherence results. Prescribers indicated that they would recommend adherence-related treatment plan changes in 61% of patients, all of whom were ≤80% adherent. The strength of this effect was significantly stronger for psychosocial intervention treatment plan change recommendations than for medication treatment plan change recommendations. Of the psychosocial intervention recommendations, an increase in case management intensity was most often recommended. Of the medication treatment plan recommendations, initiation of a long-acting injectable medication and an increase in dosage of current oral antipsychotic medication were each recommended in only one case. Prescriber recommendations of adherence interventions in this study were not necessarily consistent with major guideline recommendations. Findings suggest the need for further study and dissemination of findings regarding evidence-based adherence assessment and interventions.

  7. Integration of Known DNA, RNA and Protein Biomarkers Provides Prediction of Anti-TNF Response in Rheumatoid Arthritis: Results from the COMBINE Study

    PubMed Central

    Folkersen, Lasse; Brynedal, Boel; Diaz-Gallo, Lina Marcela; Ramsköld, Daniel; Shchetynsky, Klementy; Westerlind, Helga; Sundström, Yvonne; Schepis, Danika; Hensvold, Aase; Vivar, Nancy; Eloranta, Maija-Leena; Rönnblom, Lars; Brunak, Søren; Malmström, Vivianne; Catrina, Anca; Moerch, Ulrik GW; Klareskog, Lars; Padyukov, Leonid; Berg, Louise

    2016-01-01

    OBJECTIVE: In rheumatoid arthritis (RA) several recent efforts have sought to discover means of predicting which patients would benefit from treatment. However, results have been discrepant with few successful replications. Our objective was to build a biobank with DNA, RNA and protein measurements to test the claim that the current state-of-the-art precision medicine will benefit RA patients. METHODS: We collected 451 blood samples from 61 healthy individuals and 185 RA patients initiating treatment, before treatment initiation and at a 3 month follow-up time. All samples were subjected to high-throughput RNA sequencing, DNA genotyping, extensive proteomics and flow cytometry measurements, as well as comprehensive clinical phenotyping. Literature review identified 2 proteins, 52 single-nucleotide polymorphisms (SNPs) and 72 gene-expression biomarkers that had previously been proposed as predictors of Tumor Necrosis Factor (TNF) inhibitor response (ΔDAS28-CRP). RESULTS: From these published TNFi biomarkers we found that 2 protein, 2 SNP and 8 mRNA biomarkers could be replicated in the 59 TNF initiating patients. Combining these replicated biomarkers into a single signature we found that we could explain 51% of the variation in ΔDAS28-CRP. This corresponds to a sensitivity of 0.73 and specificity of 0.78 for the prediction of three month ΔDAS28-CRP better than –1.2. CONCLUSIONS: The COMBINE biobank is currently the largest collection of multi-omics data from RA patients with high potential for discovery and replication. Taking advantage of this we surveyed the current state-of-the-art of drug-response stratification in RA, and identified a small set of previously published biomarkers available in peripheral blood which predicts clinical response to TNF blockade in this independent cohort. PMID:27532898

  8. Long-acting somatostatin analogues provide significant beneficial effect in patients with refractory small bowel angiodysplasia: Results from a proof of concept open label mono-centre trial

    PubMed Central

    Hall, Barry; Breslin, Niall; McNamara, Deirdre

    2015-01-01

    Introduction Small bowel angiodysplasias account for over 50% of causes of small bowel bleeding and carry a worse prognosis than lesions located elsewhere in the gastrointestinal tract. Re-bleeding rates are high even after first-line endoscopic therapy and are associated with high levels of morbidity for affected patients. Small trials of long-acting somatostatin analogues have shown promising results but have not yet been assessed in patients with refractory small bowel disease. Aim The purpose of this study was to assess the effect of long-acting somatostatin analogues in reducing re-bleeding rates and transfusion requirements, and improving haemoglobin levels in patients with refractory small bowel angiodysplasia. Methods Patients with refractory small bowel angiodysplasia were treated with 20 mg of long-acting octreotide for a minimum of three months. Response was assessed according to: rates of re-bleeding, haemoglobin levels, transfusion requirements, and side effects. Results A total of 24 patients were initially treated and 20 received at least three doses. Rates of complete, partial and non-response were 70%, 20% and 10% respectively. Average haemoglobin rates increased from 9.19 g/dl to 11.35 g/dl (p = 0.0027, 95% confidence interval (CI) −3.5 to −1.1) in the group overall and 70% remained transfusion-free after a mean treatment duration of 8.8 months. The rate of adverse events was higher than previously reported at 30%. Conclusion Long-acting somatostatin analogues offer a therapeutic advantage in a significant proportion of patients with small bowel angiodysplasia. With careful patient selection and close observation, a long-acting somatostatin analogue should be considered in all patients with persistent anaemia attributable to refractory disease in conjunction with other standard treatments. PMID:26966525

  9. Gerontechnology: Providing a Helping Hand When Caring for Cognitively Impaired Older Adults—Intermediate Results from a Controlled Study on the Satisfaction and Acceptance of Informal Caregivers

    PubMed Central

    Mitseva, Anelia; Peterson, Carrie Beth; Karamberi, Christina; Oikonomou, Lamprini Ch.; Ballis, Athanasios V.; Giannakakos, Charalampos; Dafoulas, George E.

    2012-01-01

    The incidence of cognitive impairment in older age is increasing, as is the number of cognitively impaired older adults living in their own homes. Due to lack of social care resources for these adults and their desires to remain in their own homes and live as independently as possible, research shows that the current standard care provisions are inadequate. Promising opportunities exist in using home assistive technology services to foster healthy aging and to realize the unmet needs of these groups of citizens in a user-centered manner. ISISEMD project has designed, implemented, verified, and assessed an assistive technology platform of personalized home care (telecare) for the elderly with cognitive impairments and their caregivers by offering intelligent home support services. Regions from four European countries have carried out long-term pilot-controlled study in real-life conditions. This paper presents the outcomes from intermediate evaluations pertaining to user satisfaction with the system, acceptance of the technology and the services, and quality of life outcomes as a result of utilizing the services. PMID:22536230

  10. Providing a diet containing only maintenance levels of energy and protein during the latter stages of pregnancy resulted in a prolonged delivery time during parturition in rats.

    PubMed

    Tanaka, Y; Kadokawa, H

    2012-01-01

    In mammals, a prolonged delivery time during parturition is dangerous for both mother and fetus, although the mechanisms that prolong delivery are unclear. To investigate whether nutrition affects delivery time, we administered two feeds containing maintenance (L-feed) or higher (H-feed) levels of energy and protein at different points during the latter half of pregnancy and compared the effects of the various treatments on delivery time in rats. After the rats had been maintained on the L-feed and then copulated on pro-oestrus (Day 0), pregnant females were randomly allocated to one of three groups: (1) the no-improvement group, which was fed L-feed throughout gestation; (2) the early group, which was fed L-feed until Day 11 of gestation and then switched to H-feed; and (3) the late group, which was fed L-feed until Day 16 of gestation and then switched to H-feed. There was no significant difference in the number of pups among the three groups. However, delivery time was significantly longer in the no-improvement group (73.7±5.2 min) than the early (46.9±5.6 min) and late (55.4±5.5 min) groups. Consuming a maintenance diet during the latter half of pregnancy resulted in a prolonged delivery time.

  11. Reductions in the mitochondrial DNA diversity of coral reef fish provide evidence of population bottlenecks resulting from Holocene sea-level change.

    PubMed

    Fauvelot, C; Bernardi, G; Planes, S

    2003-07-01

    This study investigated the influence of reproductive strategy (benthic or pelagic eggs) and habitat preferences (lagoon or outer slope) on both diversity and genetic differentiation using a set of populations of seven coral reef fish species over different geographic scales within French Polynesia. We hypothesized that a Holocene sea-level decrease contributed to severe reduction of population size for species inhabiting lagoons and a subsequent decrease of genetic diversity. Conversely, we proposed that species inhabiting stable environments, such as the outer slope, should demonstrate higher genetic diversity but also more structured populations because they have potentially reached a migration-genetic drift equilibrium. Sequences of the 5' end of the mitochondrial DNA (mtDNA) control region were compared among populations sampled in five isolated islands within two archipelagos of French Polynesia. For all the species, no significant divergences among populations were found. Significant differences in mtDNA diversity between lagoonal and outer-slope species were demonstrated both for haplotype diversity and sequence divergence but none were found between species with different egg types. Pairwise mismatch distributions suggested rapid population growth for all the seven species involved in this study, but they revealed different distributions, depending on the habitat preference of the species. Although several scenarios can explain the observed patterns, the hypothesis of population size reduction events relative to Holocene sea-level regression and its consequence on French Polynesia coral reefs is the most parsimonious. Outer-slope species have undergone a probable weak and/or old bottleneck (outer reefs persisted during low sea level, leading to reef area reductions), whereas lagoonal species suffered a strong and/or recent bottleneck since Holocene sea-level regression resulted in the drying out of all the atolls that are maximum 70 meters deep. Since

  12. Synergistic antidepressant-like effects between a kappa opioid antagonist (LY2444296) and a delta opioid agonist (ADL5859) in the mouse forced swim test.

    PubMed

    Huang, Peng; Tunis, Julia; Parry, Christopher; Tallarida, Ronald; Liu-Chen, Lee-Yuan

    2016-06-15

    Kappa opioid (KOP) receptor antagonists and delta opioid (DOP) receptor agonists have antidepressant-like effects in animal tests and may be useful for treatment-resistant depression in humans. In this study, we examined whether the combination of a KOP receptor antagonist and a DOP receptor agonist would produce a better than additive effect (i.e. synergy). LY2444296 is a short-acting selective nonpeptide KOP receptor antagonist. ADL5859 is a selective nonpeptide DOP receptor agonist which does not produce seizures and EEG disturbances. Each compound and combinations of the two were examined in the forced swim test (FST) one h post injection, a screening test for antidepressant-like effect, in male adult C57BL/6J mice (Jackson Lab). LY2444296 [subcutaneous (s.c.) injection] at 10 and 30mg/kg, but not 3mg/kg, significantly decreased immobility time in a dose-dependent manner. Intraperitoneal (i.p.) injections of ADL5859 also reduced immobility time dose-dependently at doses of 3 and 10mg/kg, but not at 1mg/kg. An analysis was conducted using the method of Tallarida and Raffa (2010), which employed dose equivalence. The relative potency of the drugs was determined to be LY2444296: ADL5859=1:0.28, which was the dose ratio for combination studies. Six combinations of the two compounds were tested in mice at a fixed dose ratio. We found that LY2444296 and ADL5859 yielded significant synergistic effects for the antidepressant-like effect at the combined dose ranging from 3.84mg/kg to 9.0mg/kg. ADL5859 (10mg/kg), LY2444296 (30mg/kg) and their combined dose (3.84mg/kg) had no effects on locomotor activities. Since the two drugs have distinct pharmacological profiles, such a synergism will allow use of lower doses of both drugs to achieve desired antidepressant effects with fewer side effects. PMID:27044434

  13. Synergistic antidepressant-like effects between a kappa opioid antagonist (LY2444296) and a delta opioid agonist (ADL5859) in the mouse forced swim test.

    PubMed

    Huang, Peng; Tunis, Julia; Parry, Christopher; Tallarida, Ronald; Liu-Chen, Lee-Yuan

    2016-06-15

    Kappa opioid (KOP) receptor antagonists and delta opioid (DOP) receptor agonists have antidepressant-like effects in animal tests and may be useful for treatment-resistant depression in humans. In this study, we examined whether the combination of a KOP receptor antagonist and a DOP receptor agonist would produce a better than additive effect (i.e. synergy). LY2444296 is a short-acting selective nonpeptide KOP receptor antagonist. ADL5859 is a selective nonpeptide DOP receptor agonist which does not produce seizures and EEG disturbances. Each compound and combinations of the two were examined in the forced swim test (FST) one h post injection, a screening test for antidepressant-like effect, in male adult C57BL/6J mice (Jackson Lab). LY2444296 [subcutaneous (s.c.) injection] at 10 and 30mg/kg, but not 3mg/kg, significantly decreased immobility time in a dose-dependent manner. Intraperitoneal (i.p.) injections of ADL5859 also reduced immobility time dose-dependently at doses of 3 and 10mg/kg, but not at 1mg/kg. An analysis was conducted using the method of Tallarida and Raffa (2010), which employed dose equivalence. The relative potency of the drugs was determined to be LY2444296: ADL5859=1:0.28, which was the dose ratio for combination studies. Six combinations of the two compounds were tested in mice at a fixed dose ratio. We found that LY2444296 and ADL5859 yielded significant synergistic effects for the antidepressant-like effect at the combined dose ranging from 3.84mg/kg to 9.0mg/kg. ADL5859 (10mg/kg), LY2444296 (30mg/kg) and their combined dose (3.84mg/kg) had no effects on locomotor activities. Since the two drugs have distinct pharmacological profiles, such a synergism will allow use of lower doses of both drugs to achieve desired antidepressant effects with fewer side effects.

  14. 21. Providence & Worchester RR: Freight house. Providence, Providence Co., ...

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

    21. Providence & Worchester RR: Freight house. Providence, Providence Co., RI. Sec. 4119, mp 185.66 (See HAER no. RI-3 for further documentation on this site.) - Northeast Railroad Corridor, Amtrak route between CT & MA state lines, Providence, Providence County, RI

  15. Impact of passive health status monitoring to care providers and payers in assisted living.

    PubMed

    Alwan, Majd; Sifferlin, Elena Brito; Turner, Beverely; Kell, Steve; Brower, Peter; Mack, David C; Dalal, Siddharth; Felder, Robin A

    2007-06-01

    The objective of this study was to assess the impact of passive health status monitoring on the cost of care, as well as the efficiencies of professional caregivers in assisted living. We performed a case-controlled study to assess economic impact of passive health status monitoring technology in an assisted-living facility. Passive monitoring systems were installed in the assisted-living units of 21 residents to track physiological parameters (heart rate and breathing rate), the activities of daily living (ADLs), and key alert conditions. Professional caregivers were provided with access to the wellness status of the monitored residents they serve. The monitored individuals' cost of medical care was compared to that of an age, gender, and health status matched cohort. Similarly, efficiency and workloads of professional caregivers providing care to the monitored individuals were compared to those of caregivers providing care to the control cohort in the control site. Over the 3-month period of the study, a comparison between the monitored and control cohorts showed reductions in billable interventions (47 vs. 73, p = 0.040), hospital days (7 vs. 33, p = 0.004), and estimated cost of care (21,187.02 dollars vs. 67,753.88 dollars with monitoring cost included, p = 0.034). A comparison between efficiency normalized workloads of monitoring and control sites' caregivers revealed significant differences both at the beginning (0.6 vs. 1.38, p = 0.041) and the end (0.84 vs. 1.94, p = 0.002) of the study. The results demonstrate that monitoring technologies have significantly reduced billable interventions, hospital days, and cost of care to payers, and had a positive impact on professional caregivers' efficiency. PMID:17603830

  16. The development of Korea's new long-term care service infrastructure and its results: focusing on the market-friendly policy used for expansion of the numbers of service providers and personal care workers.

    PubMed

    Chon, Yongho

    2013-01-01

    One of the main reasons for reforming long-term care systems is a deficient existing service infrastructure for the elderly. This article provides an overview of why and how the Korean government expanded long-term care infrastructure through the introduction of a new compulsory insurance system, with a particular focus on the market-friendly policies used to expand the infrastructure. Then, the positive results of the expansion of the long-term care infrastructure and the challenges that have emerged are examined. Finally, it is argued that the Korean government should actively implement a range of practical policies and interventions within the new system.

  17. Is the patient able to watch TV or read the newspaper? A functional semi-structured scale to observe Hemineglect symptoms in Activities of Daily Living (H-ADL).

    PubMed

    Piccardi, L; Magnotti, L; Tanzilli, A; Aloisi, M; Guariglia, P

    2016-01-01

    We developed a functional semi-structured scale to observe Hemineglect symptoms in Activities of Daily Living (H-ADL). The scale could assist clinicians in assessing rehabilitation priorities aimed at correcting any persisting errors or omissions. In addition, the scale could also be used by caregivers to observe patients' progress and improve their participation. Two groups of right brain-damaged patients (25 with hemineglect; 27 without hemineglect) were tested twice: at admission and before discharge from hospital. A control group of healthy individuals matched to patients for age and education and patients' caregivers also participated. Two raters (A; B), experts in neuropsychology, observed patients and healthy individuals using the H-ADL. We found that the H-ADL final scores correlated with the standard hemineglect tests. The three groups differed in performance and differences also emerged between the first and the second assessment, suggesting an improvement due to the remission of hemineglect as a consequence of the treatment. Raters A and B did not differ in their observations, but there were some discrepancies with caregivers' observations. Therefore, although caregivers could help clinicians in detecting persistent hemineglect behaviour, the assessment should be performed by experts in neuropsychology.

  18. Osmotolerance provided by the alternative sigma factors σB and rpoS to Staphylococcus aureus and Escherichia coli is solute dependent and does not result in an increased growth fitness in NaCl containing media.

    PubMed

    Cebrián, G; Arroyo, C; Condón, S; Mañas, P

    2015-12-01

    The aim of this work was to examine the role of the alternative general stress sigma factors σ(B) and rpoS on the ability of Staphylococcus aureus and Escherichia coli, respectively, to grow in liquid and solid media of different osmolarity. For this purpose, S. aureus strain Newman and its isogenic ΔsigB mutant IK84 and E. coli strain BJ4 and its isogenic ΔrpoS mutant BJ4L1 were grown in media (TSBYE) with different concentrations of NaCl. Growth parameters (lag phase duration, growth rate and maximum number of microorganisms) and limiting growth concentrations (Maximum Non-Inhibitory Concentration - MNIC - and Minimum Inhibitory Concentration - MIC-) were determined. The mechanisms underlying the differences observed between parental and mutant strains were also explored. The absence of the sigma factors σ(B) and rpoS led to a decrease in the MNICs and MICs calculated for S. aureus and E. coli, respectively. Conversely, neither σ(B) nor rpoS provided with increased growth fitness to S. aureus and E. coli cells at NaCl concentrations up to 1.36M and 1M, respectively. The decreased osmotolerance of the σ(B) and rpoS deficient strains, as compared to their parental strains, was compensated by the addition of glycine-betaine (1mM) to the growth medium. It was also observed that the decreased tolerance to NaCl of the mutant strains was coincident with a decreased tolerance to sucrose, KCl, and LiCl but not to glycerol, MgCl2, and CaCl2. Results obtained also demonstrate that the increased osmotolerance of stationary growth phase E. coli cells, as compared to exponential growth phase ones, would be due to the activation of both rpoS-independent and rpoS-dependent mechanisms. This work will help to understand the mechanisms of bacterial resistance to osmotic stress and the role of the alternative sigma factors σ(B) and rpoS in this process.

  19. Osmotolerance provided by the alternative sigma factors σB and rpoS to Staphylococcus aureus and Escherichia coli is solute dependent and does not result in an increased growth fitness in NaCl containing media.

    PubMed

    Cebrián, G; Arroyo, C; Condón, S; Mañas, P

    2015-12-01

    The aim of this work was to examine the role of the alternative general stress sigma factors σ(B) and rpoS on the ability of Staphylococcus aureus and Escherichia coli, respectively, to grow in liquid and solid media of different osmolarity. For this purpose, S. aureus strain Newman and its isogenic ΔsigB mutant IK84 and E. coli strain BJ4 and its isogenic ΔrpoS mutant BJ4L1 were grown in media (TSBYE) with different concentrations of NaCl. Growth parameters (lag phase duration, growth rate and maximum number of microorganisms) and limiting growth concentrations (Maximum Non-Inhibitory Concentration - MNIC - and Minimum Inhibitory Concentration - MIC-) were determined. The mechanisms underlying the differences observed between parental and mutant strains were also explored. The absence of the sigma factors σ(B) and rpoS led to a decrease in the MNICs and MICs calculated for S. aureus and E. coli, respectively. Conversely, neither σ(B) nor rpoS provided with increased growth fitness to S. aureus and E. coli cells at NaCl concentrations up to 1.36M and 1M, respectively. The decreased osmotolerance of the σ(B) and rpoS deficient strains, as compared to their parental strains, was compensated by the addition of glycine-betaine (1mM) to the growth medium. It was also observed that the decreased tolerance to NaCl of the mutant strains was coincident with a decreased tolerance to sucrose, KCl, and LiCl but not to glycerol, MgCl2, and CaCl2. Results obtained also demonstrate that the increased osmotolerance of stationary growth phase E. coli cells, as compared to exponential growth phase ones, would be due to the activation of both rpoS-independent and rpoS-dependent mechanisms. This work will help to understand the mechanisms of bacterial resistance to osmotic stress and the role of the alternative sigma factors σ(B) and rpoS in this process. PMID:26256716

  20. Routine failures in the process for blood testing and the communication of results to patients in primary care in the UK: a qualitative exploration of patient and provider perspectives

    PubMed Central

    Litchfield, Ian; Bentham, Louise; Hill, Ann; McManus, Richard J; Lilford, Richard; Greenfield, Sheila

    2015-01-01

    Background The testing and result communication process in primary care is complex. Its successful completion relies on the coordinated efforts of a range of staff in primary care and external settings working together with patients. Despite the importance of diagnostic testing in provision of care, this complexity renders the process vulnerable in the face of increasing demand, stretched resources and a lack of supporting guidance. Methods We conducted a series of focus groups with patients and staff across four primary care practices using process-improvement strategies to identify and understand areas where either unnecessary delay is introduced, or the process may fail entirely. We then worked with both patients and staff to arrive at practical strategies to improve the current system. Results A total of six areas across the process were identified where improvements could be introduced. These were: (1) delay in phlebotomy, (2) lack of a fail-safe to ensure blood tests are returned to practices and patients, (3) difficulties in accessing results by telephone, (4) role of non-clinical staff in communicating results, (5) routine communication of normal results and (6) lack of a protocol for result communication. Conclusions A number of potential failures in testing and communicating results to patients were identified, and some specific ideas for improving existing systems emerged. These included same-day phlebotomy sessions, use of modern technology methods to proactively communicate routine results and targeted training for receptionists handling sensitive data. There remains an urgent need for further work to test these and other potential solutions. PMID:26251507

  1. What HERA May Provide?

    SciTech Connect

    Jung, Hannes; De Roeck, Albert; Bartels, Jochen; Behnke, Olaf; Blumlein, Johannes; Brodsky, Stanley; Cooper-Sarkar, Amanda; Deak, Michal; Devenish, Robin; Diehl, Markus; Gehrmann, Thomas; Grindhammer, Guenter; Gustafson, Gosta; Khoze, Valery; Knutsson, Albert; Klein, Max; Krauss, Frank; Kutak, Krzysztof; Laenen, Eric; Lonnblad, Leif; Motyka, Leszek; /Hamburg U., Inst. Theor. Phys. II /Birmingham U. /Southern Methodist U. /DESY /Piemonte Orientale U., Novara /CERN /Paris, LPTHE /Hamburg U. /Penn State U.

    2011-11-10

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. The HERA accelerator and the HERA experiments H1, HERMES and ZEUS stopped running in the end of June 2007. This was after 15 years of very successful operation since the first collisions in 1992. A total luminosity of {approx} 500 pb{sup -1} has been accumulated by each of the collider experiments H1 and ZEUS. During the years the increasingly better understood and upgraded detectors and HERA accelerator have contributed significantly to this success. The physics program remains in full swing and plenty of new results were presented at DIS08 which are approaching the anticipated final precision, fulfilling and exceeding the physics plans and the previsions of the upgrade program. Most of the analyses presented at DIS08 were still based on the so called HERA I data sample, i.e. data taken until 2000, before the shutdown for the luminosity upgrade. This sample has an integrated luminosity of {approx} 100 pb{sup -1}, and the four times larger statistics sample from HERA II is still in the process of being analyzed.

  2. Associations of quality of life, pain, and self-reported arthritis with age, employment, bleed rate, and utilization of hemophilia treatment center and health care provider services: results in adults with hemophilia in the HERO study

    PubMed Central

    Forsyth, Angela L; Witkop, Michelle; Lambing, Angela; Garrido, Cesar; Dunn, Spencer; Cooper, David L; Nugent, Diane J

    2015-01-01

    Introduction Severe hemophilia and subsequent hemophilic arthropathy result in joint pain and impaired health-related quality of life (HRQoL). Assessment of HRQoL in persons with hemophilia (PWH), including underlying factors that drive HRQoL differences, is important in determining health care resource allocation and in making individualized clinical decisions. Aim To examine potential associations between HRQoL, pain interference, and self-reported arthritis and age, employment, activity, bleed frequency, and hemophilia treatment center and health care professional utilization. Methods PWH (age ≥18 years) from ten countries completed a 5-point Likert scale on pain interference over the previous 4 weeks, the EQ-5D-3L scale (mobility, usual activities, self-care, pain/discomfort, anxiety/depression) including a health-related visual analog scale (0–100, coded as an 11-point categorical response). Results Pain interference (extreme/a lot) was higher in PWH aged >40 years (31%) compared to those aged 31–40 years (27%) or ≤30 years (21%). In an analysis of eight countries with home treatment, PWH who reported EQ-5D mobility issues were less likely to be employed (53% vs 79%, with no mobility issues). Median annual bleed frequency increased with worsening EQ-5D pain or discomfort. The percentage of PWH with inhibitors reporting visual analog scale scores of 80–90–100 was lower (20%) than those without inhibitors (34%). Median bleed frequency increased with pain. Globally, nurse and social worker involvement increased with disability and pain; physiotherapist utilization was moderate regardless of the extent of disability or pain. Conclusion Increased disability and pain were associated with increased age, lower employment, higher reported bleed frequency, and lower HRQoL. PMID:26604708

  3. Forest cover change in the upper Midwestern United States results from both climate and land use change following European settlement: Historical survey and weather records provide robust support for modeling applications

    NASA Astrophysics Data System (ADS)

    Goring, S. J.; Williams, J. W.; McLachlan, J. S.; Dawson, A.; Dietze, M.; Paciorek, C. J.; Mladenoff, D. J.; Record, S.; Cogbill, C. V.; Hooten, M.; Ruid, M.; Jackson, S. T.

    2013-12-01

    Since European settlement, both climate and human land use have acted on forests in the upper Midwestern United States resulting in changes in forest structure and composition. The extent of these changes has been examined locally and at the state level by examining forest records from the Public Lands Survey System (PLSS), but here we bring together records of changing forest composition with weather records from the mid to late 19th century from the 19th Century Forts and Observer's Database. We are able to assign attribution for taxon range and composition shifts in the region to either land use, climate or both. We see that much of the range contraction in the region seen when comparing Forest Inventory and Analysis data with Public Land Survey System data occurs along the prairie margin, with northern forests showing greater stability in both range and composition suggesting a dominant role for land use in structuring regional vegetation. Modern forests are often less diverse than PLSS forests and the mean minimum dissimilarity between modern and PLSS-era forests is significantly higher than the minimum dissimilarity within either the PLSS-era forests or the modern (FIA) forests, indicating the possiblity that our modern forests have already become 'no-analogue' ecosystems.

  4. Arizona's Application Service Provider.

    ERIC Educational Resources Information Center

    Jordan, Darla

    2002-01-01

    Describes the U.S.'s first statewide K-12 application service provider (ASP). The ASP, implemented by the Arizona School Facilities Board, provides access to productivity, communications, and education software programs from any Internet-enabled device, whether in the classroom or home. (EV)

  5. Occupational Therapy in HomEcare Re-ablement Services (OTHERS): results of a feasibility randomised controlled trial

    PubMed Central

    Walker, Marion F; Parry, Ruth H; Latif, Zaid; McGeorge, Ian D; Drummond, Avril E R

    2016-01-01

    Objectives The objective of this study was to test the feasibility of conducting a randomised controlled trial (RCT) of an intervention targeted at activities of daily living (ADL), delivered by an occupational therapist, in homecare reablement. Design Feasibility parallel group RCT. Setting Single-site local authority homecare reablement service. Participants People referred for homecare reablement with ability to consent. Exclusion criteria were as follows: inability to speak English, receiving other community therapy services, needing two or more to assist transfer and receiving end-of-life care. Control ‘Usual care’ was 6 weeks of homecare reablement delivered by social care workers (no routine health professional input). Intervention A targeted ADL programme, delivered by an occupational therapist incorporating goal setting, teaching/practising techniques, equipment/adaptations and provision of advice/support. This was in addition to usual care. Outcome measures Aspects of feasibility including eligibility, recruitment, intervention delivery, attrition and suitability and sensitivity of outcome measures. Participant outcomes were personal and extended ADL, quality of life, falls and use of health and social care services. Results 30 participants were recruited, 15 to each arm, which was 60% of those eligible. Data from 22 (73%) were analysed at 6 months. Of the 15 participants, 13 (86%) received the intervention and were able to set one or more ADL goals. There were improvements from baseline in both groups, although overall improvements were greater in the occupational therapy (OT) intervention group. The biggest threat to feasibility was a change in service configuration during the trial, involving additional occupational therapy input, affecting usual care and recruitment. Conclusions Despite the service reconfiguration, it was feasible to recruit and retain participants, deliver the intervention and collect outcome data that were responsive to

  6. Providing a diet deficient in valine but with excess leucine results in a rapid decrease in feed intake and modifies the postprandial plasma amino acid and α-keto acid concentrations in pigs.

    PubMed

    Gloaguen, M; Le Floc'h, N; Corrent, E; Primot, Y; van Milgen, J

    2012-09-01

    Indispensable AA are involved in the control of feed intake. When a diet deficient in Val is offered to pigs, feed intake is typically reduced. This effect is aggravated when dietary Leu is supplied in excess of the requirement. If an unbalanced supply of branched-chain AA (BCAA) is harmful, an anorectic response may serve as a mechanism to prevent this situation. We verified this hypothesis by measuring the voluntary feed intake of a balanced diet offered during the 30-min period 1 h after ingestion of a test meal deficient or not in Val (Val- and Val+) with an excess of Leu. Twelve and four 6-wk-old crossbred female pigs were used in Exp. 1 and 2, respectively. Prior ingestion of the Val- test meal resulted in a 14% reduction in feed intake compared with that observed after ingestion of the Val+ test meal (P = 0.06) in Exp. 1, indicating that the signal to reduce feed intake occurred within 1 h. It is possible that the plasma concentration of the limiting AA serves as a signal for the dietary AA deficiency. We therefore determined the postprandial plasma concentrations of BCAA and their α-keto acids after ingestion of Val- and Val+ in 4 pigs in Exp. 2. After ingestion of the Val- diet, plasma concentrations of Val and its keto acid were reduced compared with values observed after ingestion of the Val+ diet. The peak concentration occurred earlier after ingestion of the Val- diet compared with that of the Val+ diet. Although the plasma concentration increased after the meal, it declined rapidly in pigs offered Val-, and the Val concentration 4 h after ingestion of the meal was even less than that observed in the fasted state. In conclusion, it appears that the pig is able to detect a deficient supply of Val within 1 h after ingestion. The plasma concentration of Val or its concentration relative to the other BCAA during the postprandial period may act as a signal indicating the AA deficiency.

  7. The Provident Principal.

    ERIC Educational Resources Information Center

    McCall, John R.

    This monograph offers leadership approaches for school principals. Discussion applies the business leadership theory of Warren Bennis and Burt Nanus to the role of the principal. Each of the booklet's three parts concludes with discussion questions. Part 1, "Visions and Values for the Provident Principal," demonstrates the importance of…

  8. Achieving Provider Engagement

    PubMed Central

    Greenfield, Geva; Pappas, Yannis; Car, Josip; Majeed, Azeem; Harris, Matthew

    2014-01-01

    The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda. PMID:25212855

  9. Provider panel presentations.

    PubMed

    Buckelew, Larry C; Harvey, Deborah; Mello, Joe

    2003-08-01

    To wrap up the three big items--attracting talent, the professional nurse role, and our structural disadvantages--I would offer the following take-away thoughts: We ought to do what we can to get our disproportionate share of RNs out of the health care system to work in dialysis. If we work together, we have a shot at making that happen. As an industry, we must exploit our strengths. We have to exploit the pride that comes in the services and the care that we provide. We need to create in a very visual way that difference for nurses who are considering which area of specialty to go into and where to create their careers. We, as providers, have a huge opportunity to create the right environment for our nurses. That's something we own. We have to fix it. We have to create a better place to work for nurses than any place else. We must create a more enriching place for nurses than anywhere else. That's up to us. I know a lot of us on the provider side are doing tons of things to make that happen and we need to keep driving that. We need a level playing field. We've proven the fact that we can deliver clinical outcomes with the best. Now we need help from our biggest customer to make sure we can compete for the resources that are necessary to sustain and improve those clinical outcomes on an ongoing basis. PMID:14533522

  10. Providing Contraception to Adolescents.

    PubMed

    Raidoo, Shandhini; Kaneshiro, Bliss

    2015-12-01

    Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand.

  11. The Provident Sea

    NASA Astrophysics Data System (ADS)

    Cushing, David H.

    1988-09-01

    The Provident Sea describes the history of fish stock management (including whales and seals). The book traces, on the basis of the original scientific material, the history of the management of "the provident sea" up to recent times when problems of over-exploitation have had dramatic effects upon stocks. The need for management arose mainly from the increasing industrialization of capture. Hence the preindustrial fisheries are covered, in particular the old cod fishery on the Grand Bank and the herring fishery in the North Sea, as an essential background to current problems. The origins of fisheries and whaling science are described, as is the development up to 1965 of the science and institution in fisheries, whaling, and sealing. In the sixties and seventies, certain major fishing nations took a heavy harvest of fish stocks using sophisticated and efficient gathering methods. This in turn led to conflict and one consequence was the "Law of the Sea" conference set up to try and resolve these issues.

  12. Radiation safety for anesthesia providers.

    PubMed

    Phillips, Gillian; Monaghan, W Patrick

    2011-06-01

    Many modern diagnostic and surgical procedures rely heavily on the use of ionizing radiation. These procedures include computed tomography, nuclear medicine procedures, interventional radiology, and cardiac catheterization and electrophysiology procedures. Recent trends toward increased patient visits and patients with multiple challenging comorbidities have meant that anesthesia providers are increasingly required to provide services in the ancillary areas using ionizing radiation. As a result, anesthesia providers are at a greater-than-ever risk for excessive radiation doses. An overview of some of the basic principles of radiation biology, radiation physics, and radiation protection and specific guidelines related to radiation exposure and pregnancy are described. The effects of radiation exposure are cumulative and permanent, and an understanding of these principles and practices will help anesthesia providers keep their occupational exposure to a minimum. PMID:21751695

  13. Consumer-directed personal care: comparing aged and non-aged adult recipient health-related outcomes among those with paid family versus non-relative providers.

    PubMed

    Newcomer, Robert; Kang, Taewoon; Faucett, Julia

    2011-10-01

    Risk factors associated with the incidence of recipient injuries, bedsores and contractures, and health care use (i.e., emergency department and hospital use) among aged and non-aged adult personal care recipients are investigated. Data are from a statewide survey of aged and non-aged adult personal assistance service (PAS) recipients (n = 913) in California's In-Home Supportive Services (IHSS) program. This is a consumer-directed PAS program. Outcomes among recipients using relatives (other than spouses or parents) as paid providers are compared with those of recipients having non-relatives as providers. No differences were found by provider-recipient relationships. Non-aged recipients, those in poorer health, those with more than three activities of daily living (ADL) limitations, and those changing providers during the year were all at greater risk for adverse health outcomes. African American, Hispanic, and Asian recipients were at lower risk for injuries and hospital stays than were White recipients. PMID:22106901

  14. 28. Yards north of Branch Avenue Bridge. Providence, Providence Co., ...

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

    28. Yards north of Branch Avenue Bridge. Providence, Providence Co., RI. Sec. 4116, mp 186.25. - Northeast Railroad Corridor, Amtrak route between CT & MA state lines, Providence, Providence County, RI

  15. 27. Yards north of Branch Avenue Bridge. Providence, Providence Co., ...

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

    27. Yards north of Branch Avenue Bridge. Providence, Providence Co., RI. Sec. 4116, mp 186.25. - Northeast Railroad Corridor, Amtrak route between CT & MA state lines, Providence, Providence County, RI

  16. Ecosystem services provided by bats.

    PubMed

    Kunz, Thomas H; Braun de Torrez, Elizabeth; Bauer, Dana; Lobova, Tatyana; Fleming, Theodore H

    2011-03-01

    Ecosystem services are the benefits obtained from the environment that increase human well-being. Economic valuation is conducted by measuring the human welfare gains or losses that result from changes in the provision of ecosystem services. Bats have long been postulated to play important roles in arthropod suppression, seed dispersal, and pollination; however, only recently have these ecosystem services begun to be thoroughly evaluated. Here, we review the available literature on the ecological and economic impact of ecosystem services provided by bats. We describe dietary preferences, foraging behaviors, adaptations, and phylogenetic histories of insectivorous, frugivorous, and nectarivorous bats worldwide in the context of their respective ecosystem services. For each trophic ensemble, we discuss the consequences of these ecological interactions on both natural and agricultural systems. Throughout this review, we highlight the research needed to fully determine the ecosystem services in question. Finally, we provide a comprehensive overview of economic valuation of ecosystem services. Unfortunately, few studies estimating the economic value of ecosystem services provided by bats have been conducted to date; however, we outline a framework that could be used in future studies to more fully address this question. Consumptive goods provided by bats, such as food and guano, are often exchanged in markets where the market price indicates an economic value. Nonmarket valuation methods can be used to estimate the economic value of nonconsumptive services, including inputs to agricultural production and recreational activities. Information on the ecological and economic value of ecosystem services provided by bats can be used to inform decisions regarding where and when to protect or restore bat populations and associated habitats, as well as to improve public perception of bats.

  17. Application service providers in dentistry.

    PubMed

    Schleyer, Titus

    2002-07-01

    ASP practice management systems are a new and potentially useful service for the dental profession. ASP systems have the potential to reduce the time, effort, and expense required to maintain computer-based practice management functions. ASP systems can deliver a rich array of functions at a distance, eliminate concerns about upgrades, back-ups, and server hardware, and make management of client workstations easier. The ASP industry is young, however, and its companies and products will be in constant flux. Practitioners should exercise great caution in selecting an ASP system. If the ASP model proves viable in dentistry over the long term, we can expect to see a growing number of services being delivered over the Internet. Many ASPs exist already that serve many needs of small businesses, such as accounting, personnel management, and supply ordering. Application service provider systems also have the potential to improve communication between dental care providers. The ease of exchanging selected patient information between providers may result in more patient-related information exchange than is currently the case. The quality of dental care can only benefit.

  18. Training Partnerships. Linking Employers & Providers.

    ERIC Educational Resources Information Center

    Carnevale, Anthony P.; And Others

    This document summarizes research on partnerships in training. Part I describes forming linkages between employers and providers as a common business transaction and identifies services available from providers, locating a provider, criteria for selecting a provider, and how to evaluate linkage relationships. Part II describes the providers of…

  19. Digital nerve injuries: epidemiology, results, costs, and impact on daily life.

    PubMed

    Thorsén, Frida; Rosberg, Hans-Eric; Steen Carlsson, Katarina; Dahlin, Lars B

    2012-09-01

    Epidemiology, results of treatment, impact on activity of daily living (ADL), and costs for treatment of digital nerve injuries have not been considered consistently. Case notes of patients of 0-99 years of age living in Malmö municipality, Sweden, who presented with a digital nerve injury and were referred to the Department of Hand Surgery in 1995-2005 were analysed retrospectively. The incidence was 6.2/100 000 inhabitants and year. Most commonly men (75%; median age 29 years) were injured. Isolated nerve injuries and concomitant tendon injuries were equally common. The direct costs (hospital stay, operation, outpatient visits, visits to a nurse and/or a hand therapist) for a concomitant tendon injury was almost double compared with an isolated digital nerve injury (6136 EUR [range, 744-29 689 EUR] vs 2653 EUR [range, 468-6949 EUR]). More than 50% of the patients who worked were injured at work and 79% lost time from work (median 59 days [range 3-337]). Permanent nerve dysfunction for the individual patient with ADL problems and subjective complaints of fumbleness, cold sensitivity, and pain occur in the patients despite surgery. It is concluded that digital nerve injuries, often considered as a minor injury and that affect young people at productive age, cause costs, and disability. Focus should be directed against prevention of the injury and to improve nerve regeneration from different aspects.

  20. Environmental Education Information Providers Directory.

    ERIC Educational Resources Information Center

    1999

    This report directory provides environmental education training resources and related support to education professionals. Surveys were sent to over 60 organizations asking them to self-identify as Environmental Information Providers or Environmental Education Information Providers. This report includes the list of organizations that responded and…

  1. Choosing a primary care provider

    MedlinePlus

    Family doctor - how to choose one; Primary care provider - how to choose one; Doctor - how to choose a family doctor ... A PCP is your main health care provider in non-emergency ... and teach healthy lifestyle choices Identify and treat common ...

  2. Family Day Care Provider Handbook

    ERIC Educational Resources Information Center

    New York State Office of Children and Family Services, 2006

    2006-01-01

    Family day care providers are responsible for creating a high-quality program where children have opportunities to grow, learn and thrive. Part of providing high-quality child care includes complying with the family day care regulations from the New York State Office of Children and Family Services (OCFS). This Handbook will help day care…

  3. Choosing Your Prenatal Care Provider

    MedlinePlus

    ... also called OB) is a doctor who has special education and training to take care of pregnant women ... midwife is a health care provider who has special education and training to take care of women of ...

  4. Ecosystem services provided by waterbirds.

    PubMed

    Green, Andy J; Elmberg, Johan

    2014-02-01

    Ecosystem services are ecosystem processes that directly or indirectly benefit human well-being. There has been much recent literature identifying different services and the communities and species that provide them. This is a vital first step towards management and maintenance of these services. In this review, we specifically address the waterbirds, which play key functional roles in many aquatic ecosystems, including as predators, herbivores and vectors of seeds, invertebrates and nutrients, although these roles have often been overlooked. Waterbirds can maintain the diversity of other organisms, control pests, be effective bioindicators of ecological conditions, and act as sentinels of potential disease outbreaks. They also provide important provisioning (meat, feathers, eggs, etc.) and cultural services to both indigenous and westernized societies. We identify key gaps in the understanding of ecosystem services provided by waterbirds and areas for future research required to clarify their functional role in ecosystems and the services they provide. We consider how the economic value of these services could be calculated, giving some examples. Such valuation will provide powerful arguments for waterbird conservation.

  5. Ancillary Services Provided from DER

    SciTech Connect

    Campbell, J.B.

    2005-12-21

    Distributed energy resources (DER) are quickly making their way to industry primarily as backup generation. They are effective at starting and then producing full-load power within a few seconds. The distribution system is aging and transmission system development has not kept up with the growth in load and generation. The nation's transmission system is stressed with heavy power flows over long distances, and many areas are experiencing problems in providing the power quality needed to satisfy customers. Thus, a new market for DER is beginning to emerge. DER can alleviate the burden on the distribution system by providing ancillary services while providing a cost adjustment for the DER owner. This report describes 10 types of ancillary services that distributed generation (DG) can provide to the distribution system. Of these 10 services the feasibility, control strategy, effectiveness, and cost benefits are all analyzed as in the context of a future utility-power market. In this market, services will be provided at a local level that will benefit the customer, the distribution utility, and the transmission company.

  6. Ecosystem services provided by waterbirds.

    PubMed

    Green, Andy J; Elmberg, Johan

    2014-02-01

    Ecosystem services are ecosystem processes that directly or indirectly benefit human well-being. There has been much recent literature identifying different services and the communities and species that provide them. This is a vital first step towards management and maintenance of these services. In this review, we specifically address the waterbirds, which play key functional roles in many aquatic ecosystems, including as predators, herbivores and vectors of seeds, invertebrates and nutrients, although these roles have often been overlooked. Waterbirds can maintain the diversity of other organisms, control pests, be effective bioindicators of ecological conditions, and act as sentinels of potential disease outbreaks. They also provide important provisioning (meat, feathers, eggs, etc.) and cultural services to both indigenous and westernized societies. We identify key gaps in the understanding of ecosystem services provided by waterbirds and areas for future research required to clarify their functional role in ecosystems and the services they provide. We consider how the economic value of these services could be calculated, giving some examples. Such valuation will provide powerful arguments for waterbird conservation. PMID:23786594

  7. Sensor Network Provides Environmental Data

    NASA Technical Reports Server (NTRS)

    2007-01-01

    The National Biocomputation Center, a joint partnership between the Stanford University School of Medicine's Department of Surgery and NASA's Ames Research Center, is the test bed for much of NASA's research in telemedicine, the remote delivery of medical care. In early 2005, researchers at the National Biocomputation Center formed a spinoff company, Intelesense Technologies, to use the telemedicine sensors to provide integrated global monitoring systems. Intelesense uses the systems to better understand how environments and people are linked, monitor and protect natural resources, predict and adapt to environmental changes, provide for sustainable development, reduce the costs and impacts of natural disasters, and provide an effective and intelligent response to such disasters. Current projects range from protecting the environment to tracking emerging infectious diseases like avian influenza (bird flu) and helping people from around the world connect and interact with each other to better understand their environment and themselves.

  8. Antenna configurations provide polarization diversity

    NASA Technical Reports Server (NTRS)

    Schumacher, C. N.

    1966-01-01

    Compact back-to-back trapezoidal tooth log-periodic /TTLP/ antenna with frequency-independent characteristics is formed by reducing the angle between the two elements of a basic TTLP to zero. The back-to-back antenna, arranged in various configurations, provides monopulse operations in one or two planes and in various polarizations.

  9. Twitter for travel medicine providers.

    PubMed

    Mills, Deborah J; Kohl, Sarah E

    2016-03-01

    Travel medicine practitioners, perhaps more so than medical practitioners working in other areas of medicine, require a constant flow of information to stay up-to-date, and provide best practice information and care to their patients. Many travel medicine providers are unaware of the popularity and potential of the Twitter platform. Twitter use among our travellers, as well as by physicians and health providers, is growing exponentially. There is a rapidly expanding body of published literature on this information tool. This review provides a brief overview of the ways Twitter is being used by health practitioners, the advantages that are peculiar to Twitter as a platform of social media, and how the interested practitioner can get started. Some key points about the dark side of Twitter are highlighted, as well as the potential benefits of using Twitter as a way to disseminate accurate medical information to the public. This article will help readers develop an increased understanding of Twitter as a tool for extracting useful facts and insights from the ever increasing volume of health information.

  10. Mentor Program Provides STEM Options

    ERIC Educational Resources Information Center

    Abdul-alim, Jamaal

    2011-01-01

    The ACE Mentor Program provides early career exposure, mentoring, and scholarships to high school students in an attempt to encourage them to enter one of the three fields that make up the ACE acronym: (1) architecture; (2) construction; and (3) engineering. Founded in 1993 by longtime engineering consultant Charles Thornton, the program is…

  11. Twitter for travel medicine providers.

    PubMed

    Mills, Deborah J; Kohl, Sarah E

    2016-03-01

    Travel medicine practitioners, perhaps more so than medical practitioners working in other areas of medicine, require a constant flow of information to stay up-to-date, and provide best practice information and care to their patients. Many travel medicine providers are unaware of the popularity and potential of the Twitter platform. Twitter use among our travellers, as well as by physicians and health providers, is growing exponentially. There is a rapidly expanding body of published literature on this information tool. This review provides a brief overview of the ways Twitter is being used by health practitioners, the advantages that are peculiar to Twitter as a platform of social media, and how the interested practitioner can get started. Some key points about the dark side of Twitter are highlighted, as well as the potential benefits of using Twitter as a way to disseminate accurate medical information to the public. This article will help readers develop an increased understanding of Twitter as a tool for extracting useful facts and insights from the ever increasing volume of health information. PMID:26988200

  12. Preparing to provide MTM services.

    PubMed

    Glenn, Zandra M; Mahdavian, Soheyla L; Woodard, Todd J

    2015-02-01

    Medication Therapy Management (MTM) has been a way for pharmacist to enhance their position as an integral member of the health care team as the need for improved clinical and economic outcomes in relation to the US health care system became apparent. MTM Certificate training programs are provided by numerous organizations. Collaboration Practice Agreements (CPA) are gaining significance as the role of the pharmacist is expanding in the care of patients as part of a multidisciplinary health care team. One major hurdle that many pharmacists are faced with is receiving reimbursement for the services provided. The Medicare Modernization Act of 2003 recognized that pharmacists play an important role in the management of patient care and that pharmacists bring an expertise and knowledge that will help to identify and resolve patient medication therapy problems.

  13. Volar locking distal radius plates show better short-term results than other treatment options: A prospective randomised controlled trial

    PubMed Central

    Drobetz, Herwig; Koval, Lidia; Weninger, Patrick; Luscombe, Ruth; Jeffries, Paula; Ehrendorfer, Stefan; Heal, Clare

    2016-01-01

    AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation. METHODS A prospective, randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate (n = 29), or another treatment modality (n = 27; cast immobilisation with or without wires or external fixator). Outcomes were measured at 12 wk. Functional outcome scores measured were the Patient-Rated Wrist Evaluation (PRWE) Score; Disabilities of the Arm, Shoulder and Hand and activities of daily living (ADLs). Clinical outcomes were wrist range of motion and grip strength. Radiographic parameters were volar inclination and ulnar variance. RESULTS Patients in the volar locking plate group had significantly better PRWE scores, ADL scores, grip strength and range of extension at three months compared with the control group. All radiological parameters were significantly better in the volar locking plate group at 3 mo. CONCLUSION The present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities. Anatomical reduction was significantly more likely to be preserved in the plating group. Level of evidence: II. PMID:27795951

  14. Calibrating ADL-IADL scales to improve measurement accuracy and to extend the disability construct into the preclinical range: a systematic review

    PubMed Central

    2011-01-01

    Background Interest in measuring functional status among nondisabled older adults has increased in recent years. This is, in part, due to the notion that adults identified as 'high risk' for functional decline portray a state that is potentially easier to reverse than overt disability. Assessing relatively healthy older adults with traditional self-report measures (activities of daily living) has proven difficult because these instruments were initially developed for institutionalised older adults. Perhaps less evident, are problems associated with change scores and the potential for 'construct under-representation', which reflects the exclusion of important features of the construct (e.g., disability). Furthermore, establishing a formal hierarchy of functional status tells more than the typical simple summation of functional loss, and may have predictive value to the clinician monitoring older adults: if the sequence task difficulty is accelerated or out of order it may indicate the need for interventions. Methods This review identified studies that employed item response theory (IRT) to examine or revise functional status scales. IRT can be used to transform the ordinal nature of functional status scales to interval level data, which serves to increase diagnostic precision and sensitivity to clinical change. Furthermore, IRT can be used to rank items unequivocally along a hierarchy based on difficulty. It should be noted that this review is not concerned with contrasting IRT with more traditional classical test theory methodology. Results A systematic search of four databases (PubMed, Embase, CINAHL, and PsychInfo) resulted in the review of 2,192 manuscripts. Of these manuscripts, twelve met our inclusion/exclusion requirements and thus were targeted for further inspection. Conclusions Manuscripts presented in this review appear to summarise gerontology's best efforts to improve construct validity and content validity (i.e., ceiling effects) for scales measuring

  15. Perceptions of patient provider agreements

    PubMed Central

    Albrecht, Jennifer S.; Khokhar, Bilal; Pradel, Françoise; Campbell, Michelle; Palmer, Jacqueline; Harris, Ilene; Palumbo, Francis

    2016-01-01

    Objectives Use of patient provider agreements (PPAs) is increasing, yet there is limited evidence on the effectiveness of PPAs to prevent prescription opioid misuse and diversion, and few guidelines for providers. We conducted eight focus groups to understand patient and prescriber perceptions of PPAs. Methods We recruited 40 patients who had been asked to sign a PPA and 40 prescribers who had administered at least one PPA. We developed topic guides for the two groups based on prior literature. Focus groups were audio-recorded and transcribed verbatim. Two investigators independently performed the content analysis of the transcripts and reached consensus on recurring themes. Key findings PPA use varied according to physician specialty. General practitioners used PPAs the least but reported increasing pressure from liability insurers to use them. Many patients reported signing a PPA in the emergency room of a hospital. Prescribers and patients reported a lack of understanding among patients concerning the purpose and content of the PPA. Prescribers questioned the legal status of the PPA, while patients believed that the PPA was a legal document intended to protect prescribers. Patients and prescribers valued PPA content items differently, although both groups agreed that signing a PPA would not prevent opioid misuse. Conclusions We identified several themes concerning the administration, content, effectiveness and utility of PPAs that highlight areas of research to improve PPAs. We also describe trends requiring further investigation. Understanding content of importance to patients will facilitate the development of a patient-centred PPA. PMID:27293486

  16. Actors: From Audience to Provider

    ERIC Educational Resources Information Center

    Charlier, Bernadette

    2011-01-01

    This article describes and analyzes actors' experiences of distance learning systems in a wide variety of cultural and organizational contexts. In line with the project of this special series of issues, results of research, much of which is longitudinal, allow us to suggest answers to the following questions: Who are the actors of distance…

  17. Perspectives from Marketing Internship Providers

    ERIC Educational Resources Information Center

    Swanson, Scott R.; Tomkovick, Chuck

    2011-01-01

    Internship research published in marketing and business education journals primarily examine student perspectives about internships or reports results based on other business disciplines. To more accurately understand how employers perceive marketing interns and internships, 352 managers located in the Midwestern United States were surveyed.…

  18. Providing global WLCG transfer monitoring

    NASA Astrophysics Data System (ADS)

    Andreeva, J.; Dieguez Arias, D.; Campana, S.; Flix, J.; Keeble, O.; Magini, N.; Molnar, Z.; Oleynik, D.; Petrosyan, A.; Ro, G.; Saiz, P.; Salichos, M.; Tuckett, D.; Uzhinsky, A.; Wildish, T.

    2012-12-01

    The WLCG[1] Transfers Dashboard is a monitoring system which aims to provide a global view of WLCG data transfers and to reduce redundancy in monitoring tasks performed by the LHC experiments. The system is designed to work transparently across LHC experiments and across the various technologies used for data transfer. Currently each LHC experiment monitors data transfers via experiment-specific systems but the overall cross-experiment picture is missing. Even for data transfers handled by FTS, which is used by 3 LHC experiments, monitoring tasks such as aggregation of FTS transfer statistics or estimation of transfer latencies are performed by every experiment separately. These tasks could be performed once, centrally, and then served to all experiments via a well-defined set of APIs. In the design and development of the new system, experience accumulated by the LHC experiments in the data management monitoring area is taken into account and a considerable part of the code of the ATLAS DDM Dashboard is being re-used. The paper describes the architecture of the Global Transfer monitoring system, the implementation of its components and the first prototype.

  19. Environmental standards provide competitive advantage

    SciTech Connect

    Chynoweth, E.; Kirshner, E.

    1993-04-28

    Quality organizations are breaking new ground with the development of international standards for environmental management. These promise to provide the platform for chemical companies wanting to establish their environmental credibility with a global audience. [open quotes]It will be similar to auditing our customers to ISO 9000[close quote], says the environmental manager for a European chemical firm. [open quote]We will only want to deal with people who have got their environmental act together. And we'll be in a better competitive positions[close quote]. The International Organization for Standardization (ISO;Geneva) has set up a taskforce to develop an environmental management standard, which is expected to be completed by the mid-1990s. Observers think the ISO standard will draw heavily on the British Standard Institute's (BSI;London) environmental management standard, BS7750, which will likely be the first system adopted in the world. Published last year, BS7750 has been extensively piloted in the UK (CW, Sept. 30, 1992, p. 62) and is now set to be revised before being offically adopted by BSI. The UK's Chemical Industries Association (CIA;London) is anxious to prevent a proliferation of standards, and its report on BS7750 pilot projects calls for an approach integrating quality, environment, and health and safety. But standard setters, including ISO, appear to be moving in the opposite direction. In the US, the American national Standards Institute (ANSI;Washington) has started work on an environmental management standard.

  20. Do Dogs Provide Information Helpfully?

    PubMed

    Piotti, Patrizia; Kaminski, Juliane

    2016-01-01

    Dogs are particularly skilful during communicative interactions with humans. Dogs' abilities to use human communicative cues in cooperative contexts outcompete those of other species, and might be the result of selection pressures during domestication. Dogs also produce signals to direct the attention of humans towards outside entities, a behaviour often referred to as showing behaviour. This showing behaviour in dogs is thought to be something dogs use intentionally and referentially. However, there is currently no evidence that dogs communicate helpfully, i.e. to inform an ignorant human about a target that is of interest to the human but not to the dog. Communicating with a helpful motive is particularly interesting because it might suggest that dogs understand the human's goals and need for information. In study 1, we assessed whether dogs would abandon an object that they find interesting in favour of an object useful for their human partner, a random novel distractor, or an empty container. Results showed that it was mainly self-interest that was driving the dogs' behaviour. The dogs mainly directed their behaviour towards the object they had an interest in, but dogs were more persistent when showing the object relevant to the human, suggesting that to some extent they took the humans interest into account. Another possibility is that dogs' behaviour was driven by an egocentric motivation to interact with novel targets and that the dogs' neophila might have masked their helpful tendencies. Therefore, in study 2 the dogs had initial access to both objects, and were expected to indicate only one (relevant or distractor). The human partner interacted with the dog using vocal communication in half of the trials, and remaining silent in the other half. Dogs from both experimental groups, i.e. indicating the relevant object or indicating the distractor, established joint attention with the human. However, the human's vocal communication and the presence of the

  1. Do Dogs Provide Information Helpfully?

    PubMed Central

    Piotti, Patrizia; Kaminski, Juliane

    2016-01-01

    Dogs are particularly skilful during communicative interactions with humans. Dogs’ abilities to use human communicative cues in cooperative contexts outcompete those of other species, and might be the result of selection pressures during domestication. Dogs also produce signals to direct the attention of humans towards outside entities, a behaviour often referred to as showing behaviour. This showing behaviour in dogs is thought to be something dogs use intentionally and referentially. However, there is currently no evidence that dogs communicate helpfully, i.e. to inform an ignorant human about a target that is of interest to the human but not to the dog. Communicating with a helpful motive is particularly interesting because it might suggest that dogs understand the human’s goals and need for information. In study 1, we assessed whether dogs would abandon an object that they find interesting in favour of an object useful for their human partner, a random novel distractor, or an empty container. Results showed that it was mainly self-interest that was driving the dogs’ behaviour. The dogs mainly directed their behaviour towards the object they had an interest in, but dogs were more persistent when showing the object relevant to the human, suggesting that to some extent they took the humans interest into account. Another possibility is that dogs’ behaviour was driven by an egocentric motivation to interact with novel targets and that the dogs’ neophila might have masked their helpful tendencies. Therefore, in study 2 the dogs had initial access to both objects, and were expected to indicate only one (relevant or distractor). The human partner interacted with the dog using vocal communication in half of the trials, and remaining silent in the other half. Dogs from both experimental groups, i.e. indicating the relevant object or indicating the distractor, established joint attention with the human. However, the human’s vocal communication and the presence

  2. Chemical analyses of provided samples

    NASA Technical Reports Server (NTRS)

    Becker, Christopher H.

    1993-01-01

    Two batches of samples were received and chemical analysis was performed of the surface and near surface regions of the samples by the surface analysis by laser ionization (SALI) method. The samples included four one-inch optics and several paint samples. The analyses emphasized surface contamination or modification. In these studies, pulsed sputtering by 7 keV Ar+ and primarily single-photon ionization (SPI) by coherent 118 nm radiation (at approximately 5 x 10(exp 5) W/cm(sup 2) were used. For two of the samples, also multiphoton ionization (MPI) at 266 nm (approximately 5 x 10(exp 11) W/cm(sup 2) was used. Most notable among the results was the silicone contamination on Mg2 mirror 28-92, and that the Long Duration Exposure Facility (LDEF) paint sample had been enriched in K and Na and depleted in Zn, Si, B, and organic compounds relative to the control paint.

  3. Organizational culture associated with provider satisfaction

    PubMed Central

    Scammon, Debra L.; Tabler, Jennifer; Brunisholz, Kimberly; Gren, Lisa H.; Kim, Jaewhan; Tomoaia-Cotisel, Andrada; Day, Julie; Farrell, Timothy W.; Waitzman, Norman J.; Magill, Michael K.

    2014-01-01

    Objectives Assess 1) provider satisfaction with specific elements of PCMH; 2) clinic organizational cultures; 3) associations between provider satisfaction and clinic culture. Methods Cross sectional study with surveys conducted in 2011 with providers and staff in 10 primary care clinics implementing their version of a PCMH: Care by Design™. Measures included the Organizational Culture Assessment Instrument (OCAI) and the American Medical Group Association provider satisfaction survey. Results Providers were most satisfied with quality of care (M=4.14; scale=1–5) and interactions with patients (M=4.12) and least satisfied with time spent working (M=3.47), paper work (M =3.45) and compensation (M=3.35). Culture profiles differed across clinics with family/clan and hierarchical the most common. Significant correlations (p ≤ 0.05) between provider satisfaction and clinic culture archetypes included: family/clan negatively correlated with administrative work; entrepreneurial positively correlated with the Time Spent Working dimension; market/rational positively correlated with how practices were facing economic and strategic challenges; and hierarchical negatively correlated with Relationships with Staff and Resource dimensions. Discussion Provider satisfaction is an important metric for assessing experiences with features of a PCMH model. Conclusions Identification of clinic-specific culture archetypes and archetype associations with provider satisfaction can help inform practice redesign. Attention to effective methods for changing organizational culture is recommended. PMID:24610184

  4. Healthcare provider perceptions of clinical prediction rules

    PubMed Central

    Richardson, Safiya; Khan, Sundas; McCullagh, Lauren; Kline, Myriam; Mann, Devin; McGinn, Thomas

    2015-01-01

    Objectives To examine internal medicine and emergency medicine healthcare provider perceptions of usefulness of specific clinical prediction rules. Setting The study took place in two academic medical centres. A web-based survey was distributed and completed by participants between 1 January and 31 May 2013. Participants Medical doctors, doctors of osteopathy or nurse practitioners employed in the internal medicine or emergency medicine departments at either institution. Primary and secondary outcome measures The primary outcome was to identify the clinical prediction rules perceived as most useful by healthcare providers specialising in internal medicine and emergency medicine. Secondary outcomes included comparing usefulness scores of specific clinical prediction rules based on provider specialty, and evaluating associations between usefulness scores and perceived characteristics of these clinical prediction rules. Results Of the 401 healthcare providers asked to participate, a total of 263 (66%), completed the survey. The CHADS2 score was chosen by most internal medicine providers (72%), and Pulmonary Embolism Rule-Out Criteria (PERC) score by most emergency medicine providers (45%), as one of the top three most useful from a list of 24 clinical prediction rules. Emergency medicine providers rated their top three significantly more positively, compared with internal medicine providers, as having a better fit into their workflow (p=0.004), helping more with decision-making (p=0.037), better fitting into their thought process when diagnosing patients (p=0.001) and overall, on a 10-point scale, more useful (p=0.009). For all providers, the perceived qualities of useful at point of care, helps with decision making, saves time diagnosing, fits into thought process, and should be the standard of clinical care correlated highly (≥0.65) with overall 10-point usefulness scores. Conclusions Healthcare providers describe clear preferences for certain clinical prediction

  5. Extensive IT outsourcing: advice from providers.

    PubMed

    Smith, Mike; Whiting, Stacilee

    2007-01-01

    In summary, providers are reporting some benefits related to resources and knowledge, improved service levels/performance and stronger IT staff/leadership. Also, on average, providers are reporting satisfactory experiences with application support and CIO outsourcing. However, not all of their expectations are being met, and some providers have discontinued outsourcing due to unmet expectations. Clearly, outsourcing is an option one must research in depth--it is not for everyone. When one evaluates the results of extensive IT outsourcing, it becomes easier to see what outsourcing mix and firm may be a good match for your organization's needs and expected outcomes. As you decide upon the outsourcing mix and firm that is right for you, providers advise you to pay special attention to contractual arrangements. With adequate research and contractual provisions, organizations can find the outsourcing mix that is right for them.

  6. Germany Provides Higher Education without the Frills

    ERIC Educational Resources Information Center

    Labi, Aisha

    2009-01-01

    In Germany, tuition is low because state governments shoulder a much higher percentage of university budgets than in the United States. As a result, most German universities provide far fewer amenities and services, and require their professors to teach longer hours to larger numbers of students than their American counterparts. Because they are…

  7. Promoting wellness of peer providers through coaching.

    PubMed

    Brice, George H; Swarbrick, Margaret A; Gill, Kenneth J

    2014-01-01

    Peer wellness coaching is workforce innovation that empowers individuals with mental and substance use disorders to achieve recovery. This article briefly describes how this approach can help peer providers develop self-care skills to improve job tenure and promote satisfaction. Promising results of this new approach are presented.

  8. Obstetric Provider Maldistribution: Georgia, USA, 2011.

    PubMed

    Spelke, Bridget; Zertuche, Adrienne D; Rochat, Roger

    2016-07-01

    Objectives In 2010, Georgia had the nation's highest maternal mortality rate, sixteenth highest infant mortality rate, and a waning obstetrician/gynecologist (ob/gyn) workforce. Statewide ob/gyn workforce data, however, masked obstetric-specific care shortages and regional variation in obstetric services. The Georgia Maternal and Infant Health Research Group thereby assessed each Georgia region's obstetric provider workforce to identify service-deficient areas. Methods We identified 63 birthing facilities in the 82 Primary Care Service Areas (PCSAs) outside metropolitan Atlanta and interviewed nurse managers and others to assess the age, sex, and expected departure year of each delivering professional. Using accepted annual delivery rates of 155 per obstetrician (OB), 100 per certified nurse midwife (CNM), and 70 per family medicine physician (FP) we converted obstetric providers into "OB equivalents" to standardize obstetric services available in any given area. Using facility births and computed OB equivalents (contemporary and 2020 estimates), we calculated current and projected average annual births per provider (AABP) for each PCSA, categorizing its obstetric provider workforce as "adequate" (AABP < 144), "at risk" (144 ≤ AABP ≤ 166), or "deficient" (AABP > 166). We mapped results using ArcGIS. Results Of 82 surveyed PCSAs, 52 % (43) were deficient in obstetric care; 16 % (13) had a shortage and 37 % (30) lacked obstetric providers entirely. There were no delivering FPs in 89 % (73) of PCSAs and no CNMs in 70 % (56). If Georgia fails to recruit delivering providers, 72 % (58/77) of PCSAs will have deficient or no obstetric care by 2020. Conclusions Obstetric provider shortages in Georgia hinder access to prenatal and delivery services. Care-deficient areas will expand if recruitment and retention of delivering professionals does not improve.

  9. Do guns provide safety? At what cost?

    PubMed

    Narang, Puneet; Paladugu, Anubha; Manda, Sainath Reddy; Smock, William; Gosnay, Cynthia; Lippmann, Steven

    2010-02-01

    Many people feel that having a gun provides greater safety for them and their family. Actually, having a firearm in the home escalates the risk for death or injury, while using it to shoot someone who endangers the household is much less common. The resultant injuries, deaths, emotional turmoil, and/or disabilities lead to greater utilization of health care and legal/police services. Payment for these expenses is provided by higher insurance premiums and tax rates. This financial aspect has become a part of our country's current political concern over firearm ownership rights, gun violence or regulation, health care costs, the economy, and taxes. PMID:20065902

  10. Research Results

    NASA Astrophysics Data System (ADS)

    2011-12-01

    Research on Global Carbon Emission and Sequestration NSFC Funded Project Made Significant Progress in Quantum Dynamics Functional Human Blood Protein Obtained from Rice How Giant Pandas Thrive on a Bamboo Diet New Evidence of Interpersonal Violence from 129,000 Years Ago Found in China Aptamer-Mediated Efficient Capture and Release of T Lymphocytes on Nanostructured Surfaces BGI Study Results on Resequencing 50 Accessions of Rice Cast New Light on Molecular Breeding BGI Reports Study Results on Frequent Mutation of Genes Encoding UMPP Components in Kidney Cancer Research on Habitat Shift Promoting Species Diversification

  11. Research Results

    NASA Astrophysics Data System (ADS)

    2010-10-01

    Relations found between human memories and similar neural patterns Double Star Program Received the IAA Laurels for Team Achievement Award Prof. Piao's Review Paper Published in Nature Arsenic Trioxide Controls the Fate of the PML-RARα Oncoprotein by Directly Binding PML Setdb2 restricts dorsal organizer territory and regulates left-right asymmetry through suppressing fgf8 activity Short-range scattering in quantum dots Single-molecule magnets may find their use in microelectronics β-Arrestin1 Regulates Zebrafish Hematopoiesis through Binding to YY1 and Relieving Polycomb Group Repression Studies shown gene present and absent complementation may contribute to the heterosis of maize Low frequency genetic variation may determine complex diseases Cation-π interaction playing vital roles in the regulation of integrin affinity, signaling, and biological functions Soybean diversity map may provide important basis for breeding Mutations related to Alzheimer's and rare skin disease

  12. NASA's EOSDIS: options for data providers

    NASA Astrophysics Data System (ADS)

    Khalsa, Siri J.; Ujhazy, John E.

    1995-12-01

    EOSDIS, the data and information system being developed by NASA to support interdisciplinary earth science research into the 21st century, will do more than manage and distribute data from EOS-era satellites. It will also promote the exchange of data, tools, and research results across disciplinary, agency, and national boundaries. This paper describes the options that data providers will have for interacting with the EOSDIS Core System (ECS), the infrastructure of EOSDIS. The options include: using the ECS advertising service to announce the availability of data at the provider's site; submitting a candidate data set to one of the Distributed Active Archive Centers (DAACs); establishing a data server that will make the data accessible via ECS and establishing Local Information Manager (LIM) which would make the data available for multi-site searches. One additional option is through custom gateway interfaces which would provide access to existing data archives. The gateway, data server, and LIM options require the implementation of ECS code at the provider site to insure proper protocols. The advertisement and ingest options require no part of ECS design to reside at the provider site.

  13. Use of diabetes data management software reports by health care providers, patients with diabetes, and caregivers improves accuracy and efficiency of data analysis and interpretation compared with traditional logbook data: first results of the Accu-Chek Connect Reports Utility and Efficiency Study (ACCRUES).

    PubMed

    Hinnen, Deborah A; Buskirk, Ann; Lyden, Maureen; Amstutz, Linda; Hunter, Tracy; Parkin, Christopher G; Wagner, Robin

    2015-03-01

    We assessed users' proficiency and efficiency in identifying and interpreting self-monitored blood glucose (SMBG), insulin, and carbohydrate intake data using data management software reports compared with standard logbooks. This prospective, self-controlled, randomized study enrolled insulin-treated patients with diabetes (PWDs) (continuous subcutaneous insulin infusion [CSII] and multiple daily insulin injection [MDI] therapy), patient caregivers [CGVs]) and health care providers (HCPs) who were naïve to diabetes data management computer software. Six paired clinical cases (3 CSII, 3 MDI) and associated multiple-choice questions/answers were reviewed by diabetes specialists and presented to participants via a web portal in both software report (SR) and traditional logbook (TL) formats. Participant response time and accuracy were documented and assessed. Participants completed a preference questionnaire at study completion. All participants (54 PWDs, 24 CGVs, 33 HCPs) completed the cases. Participants achieved greater accuracy (assessed by percentage of accurate answers) using the SR versus TL formats: PWDs, 80.3 (13.2)% versus 63.7 (15.0)%, P < .0001; CGVs, 84.6 (8.9)% versus 63.6 (14.4)%, P < .0001; HCPs, 89.5 (8.0)% versus 66.4 (12.3)%, P < .0001. Participants spent less time (minutes) with each case using the SR versus TL formats: PWDs, 8.6 (4.3) versus 19.9 (12.2), P < .0001; CGVs, 7.0 (3.5) versus 15.5 (11.8), P = .0005; HCPs, 6.7 (2.9) versus 16.0 (12.0), P < .0001. The majority of participants preferred using the software reports versus logbook data. Use of the Accu-Chek Connect Online software reports enabled PWDs, CGVs, and HCPs, naïve to diabetes data management software, to identify and utilize key diabetes information with significantly greater accuracy and efficiency compared with traditional logbook information. Use of SRs was preferred over logbooks.

  14. Outpatient provider concentration and commercial colonoscopy prices.

    PubMed

    Pozen, Alexis

    2015-01-01

    The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178,433 claims from 169 providers (104 systems). The mean system market share was 76% (SD = 0.34) and the mean real (deflated) price was US$1363 (SD = 374), ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility's bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices.

  15. [Reembursing health-care service provider networks].

    PubMed

    Binder, A; Braun, G E

    2015-03-01

    Health-care service provider networks are regarded as an important instrument to overcome the widely criticised fragmentation and sectoral partition of the German health-care system. The first part of this paper incorporates health-care service provider networks in the field of health-care research. The system theoretical model and basic functions of health-care research are used for this purpose. Furthermore already established areas of health-care research with strong relations to health-care service provider networks are listed. The second part of this paper introduces some innovative options for reimbursing health-care service provider networks which can be regarded as some results of network-oriented health-care research. The origins are virtual budgets currently used in part to reimburse integrated care according to §§ 140a ff. SGB V. Describing and evaluating this model leads to real budgets (capitation) - a reimbursement scheme repeatedly demanded by SVR-Gesundheit (German governmental health-care advisory board), for example, however barely implemented. As a final step a direct reimbursement of networks by the German sickness fund is discussed. Advantages and challenges are shown. The development of the different reimbursement schemes is partially based on models from the USA.

  16. Does a patient-managed insulin intensification strategy with insulin glargine and insulin glulisine provide similar glycemic control as a physician-managed strategy? Results of the START (Self-Titration With Apidra to Reach Target) Study: a randomized noninferiority trial.

    PubMed

    Harris, Stewart B; Yale, Jean-François; Berard, Lori; Stewart, John; Abbaszadeh, Babak; Webster-Bogaert, Susan; Gerstein, Hertzel C

    2014-01-01

    OBJECTIVE Diabetes self-management is universally regarded as a foundation of diabetes care. We determined whether comparable glycemic control could be achieved by self-titration versus physician titration of a once-daily bolus insulin dose in patients with type 2 diabetes who are unable to achieve optimal glycemia control with a basal insulin. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes, an HbA1c level >7% (53 mmol/mol), and either nocturnal hypoglycemia episodes or an insufficient basal insulin glargine level (with or without oral agents) to achieve a fasting plasma glucose level ≤6 mmol/L (108 mg/dL) were studied. Participants all had bolus insulin glulisine added at breakfast and were allocated to either algorithm-guided patient self-titration or physician titration. The primary outcome was an HbA1c level ≤7% (53 mmol/mol) without severe hypoglycemia. RESULTS After a mean (SD) follow-up of 159.4 days (36.2 days), 28.4% of participants in the self-titration arm vs. 21.2% in the physician titration arm achieved an HbA1c level of ≤7% (53 mmol/mol) without severe hypoglycemia (between-group absolute difference 7.2%; 95% CI -3.2 to 17.7). The lower end of this 95% confidence interval was within the predetermined noninferiority boundary of -5% (P noninferiority = 0.011). CONCLUSIONS In stable patients with type 2 diabetes who are receiving doses of basal insulin glargine who require bolus insulin, a simple bolus insulin patient-managed titration algorithm is as effective as a physician-managed algorithm.

  17. Main factors providing specificity of repair enzymes.

    PubMed

    Nevinsky, G A

    2011-01-01

    Specific and nonspecific DNA complex formation with human uracil-DNA glycosylase, 8-oxoguanine-DNA glycosylase, and apurine/apyrimidine endonuclease, as well as with E. coli 8-oxoguanine-DNA glycosylase and RecA protein was analyzed using the method of stepwise increase in DNA-ligand complexity. It is shown that high affinity of these enzymes to any DNA (10(-4)-10(-8) M) is provided by a large number of weak additive contacts mainly with DNA internucleoside phosphate groups and in a less degree with bases of nucleotide links "covered" by protein globules. Enzyme interactions with specific DNA links are comparable in efficiency with weak unspecific contacts and provide only for one-two orders of affinity (10(-1)-10(-2) M), but these contacts are extremely important at stages of DNA and enzyme structural adaptation and catalysis proper. Only in the case of specific DNA individual for each enzyme alterations in DNA structure provide for efficient adjustment of reacting enzyme atoms and DNA orbitals with accuracy up to 10-15° and, as a result, for high reaction rate. Upon transition from nonspecific to specific DNA, reaction rate (k(cat)) increases by 4-8 orders of magnitude. Thus, stages of DNA and enzyme structural adaptation as well as catalysis proper are the basis of specificity of repair enzymes. PMID:21568843

  18. Providing treatment to persons with mental illness.

    PubMed

    Shore, M F; Cohen, M D

    1994-01-01

    The RWJF Program on Chronic Mental illness created centralized mental health authorities in nine cities as a demonstration project. Evaluation teams, selected after the project began, and a national program office, established to provide technical assistance and to communicate progress and results, worked in tandem with the program staff. The project was evaluated as "logic model" to determine the feasibility of centralized authorities and to estimate their effect on various outcomes. One finding was that service reorganization does not cancel out the need to supply funds or mental health care. The problems of delay in the publication of results and of public officials' reluctance to act without "definitive" research data are described, as are the remedies for these difficulties.

  19. Implementation Challenges and Results

    ERIC Educational Resources Information Center

    Walters, Kirk; Sorensen, Nicholas

    2013-01-01

    This paper describes the implementation of the online and f2f summer algebra courses that were delivered in summers 2011 and 2012. These data will be used to frame the impact results presented in an earlier paper. In particular, the paper will provide a detailed picture of how the online course was structured and the types of supports provided to…

  20. Find a Hospice or Palliative Care Provider

    MedlinePlus

    ... use the fields below to enter your search criteria. Zip Code: Radius: 10 20 50 100 miles Provider Name: Organization Type: Please select Hospice Multi-Location Hospice Provider Palliative Care Provider or Sitemap ...

  1. ADVANCED PROTEOMICS AND BIOINFORMATICS TOOLS IN TOXICOLOGY RESEARCH: OVERCOMING CHALLENGES TO PROVIDE SIGNIFICANT RESULTS

    EPA Science Inventory

    This presentation specifically addresses the advantages and limitations of state of the art gel, protein arrays and peptide-based labeling proteomic approaches to assess the effects of a suite of model T4 inhibitors on the thyroid axis of Xenopus laevis.

  2. Aacrao Survey Results: Campuses Provide Supportive Environments for Gay, Lesbian, Bisexual, Transgender (GLBT) Community

    ERIC Educational Resources Information Center

    Journal of American College Health, 2005

    2005-01-01

    A questionnaire about the campus environment for the gay, lesbian, bisexual, and transgendered (GLBT)community yielded responses from 411 institutions in 2003. The findings showed that 382 colleges and universities included sexual orientation in their nondiscrimination policies, up from 347 institutions two years earlier. About 85 percent of the…

  3. Alcohol Education Provided to Opioid Treatment Program Patients: Results of a Nationwide Survey

    ERIC Educational Resources Information Center

    Strauss, Shiela M.; Harris, Gavin; Katigbak, Carina; Rindskopf, David M.; Singh, Sheena; Greenblum, Ilana; Brown, Lawrence S.; Kipnis, Steven; Kritz, Steven A.; Parrino, Mark W.

    2010-01-01

    Alcohol-related problems are especially common among opioid treatment program (OTP) patients, suggesting that educating OTP patients about alcohol and its harmful effects needs to be a priority in OTPs. Using data collected in interviews with a nationwide U.S. sample of OTP directors (N = 200) in 25 states, we identified factors that differentiate…

  4. Could magnetic resonance provide in vivo histology?

    PubMed Central

    Dominietto, Marco; Rudin, Markus

    2014-01-01

    The diagnosis of a suspected tumor lesion faces two basic problems: detection and identification of the specific type of tumor. Radiological techniques are commonly used for the detection and localization of solid tumors. Prerequisite is a high intrinsic or enhanced contrast between normal and neoplastic tissue. Identification of the tumor type is still based on histological analysis. The result depends critically on the sampling sites, which given the inherent heterogeneity of tumors, constitutes a major limitation. Non-invasive in vivo imaging might overcome this limitation providing comprehensive three-dimensional morphological, physiological, and metabolic information as well as the possibility for longitudinal studies. In this context, magnetic resonance based techniques are quite attractive since offer at the same time high spatial resolution, unique soft tissue contrast, good temporal resolution to study dynamic processes and high chemical specificity. The goal of this paper is to review the role of magnetic resonance techniques in characterizing tumor tissue in vivo both at morphological and physiological levels. The first part of this review covers methods, which provide information on specific aspects of tumor phenotypes, considered as indicators of malignancy. These comprise measurements of the inflammatory status, neo-vascular physiology, acidosis, tumor oxygenation, and metabolism together with tissue morphology. Even if the spatial resolution is not sufficient to characterize the tumor phenotype at a cellular level, this multiparametric information might potentially be used for classification of tumors. The second part discusses mathematical tools, which allow characterizing tissue based on the acquired three-dimensional data set. In particular, methods addressing tumor heterogeneity will be highlighted. Finally, we address the potential and limitation of using MRI as a tool to provide in vivo tissue characterization. PMID:24454320

  5. Building a safe care-providing robot.

    PubMed

    Fotoohi, Leila; Gräser, Axel

    2011-01-01

    A service robot especially a care-providing robot, works in the vicinity of a human body and is sometimes even in direct contact with it. Conventional safety methods and precautions in industrial robotics are not applicable to such robots. This paper presents a safety approach for designing the safe care-providing robot FRIEND. The approach is applied in each step of design iteratively to identify and assess the potential hazards during design. The steps are explained briefly in this work. The main contribution of this paper is verification of safety requirements using the Ramadge-Wonham (RW) framework. The greater complexity of the tasks the robot will perform, the more complex is the identification of safety requirements. Use of this framework led us to analyze the requirements and verify them formally, systematically and on a modular basis. In our approach human-robot interaction (HRI) is also modeled by a set of uncontrolled events that may happen any time during operation. Subsequently the safety requirements are modified to consider these interactions. As a result the safety module behaves like a controller, running in parallel with the system, which maintains the system safe and works according to the safety requirements by enabling the admissible sequences of events.

  6. 48 CFR 2945.302 - Providing facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Providing facilities. 2945... GOVERNMENT PROPERTY Providing Government Property to Contractors 2945.302 Providing facilities. The HCA is authorized to make the determination to provide facilities to a contractor as prescribed in FAR 45.302-1(a)(4)....

  7. The Family Day Care Providers' Legal Handbook.

    ERIC Educational Resources Information Center

    Treadwell, Lujuana Wolfe

    Designed specifically for family day care providers in Alameda County, California, this handbook provides legal and business advice thought to be useful as well to providers throughout the United States. A wide range of legal and business issues is covered in 15 brief chapters. Advice is offered on provider-parent contracts, planning for accidents…

  8. Providing better indoor environmental quality brings economicbenefits

    SciTech Connect

    Fisk, William; Seppanen, Olli

    2007-06-01

    This paper summarizes the current scientific evidence that improved indoor environmental quality can improve work performance and health. The review indicates that work and school work performance is affected by indoor temperature and ventilation rate. Pollutant source removal can sometimes improve work performance. Based on formal statistical analyses of existing research results, quantitative relationships are provided for the linkages of work performance with indoor temperature and outdoor air ventilation rate. The review also indicates that improved health and related financial savings are obtainable from reduced indoor tobacco smoking, prevention and remediation of building dampness, and increased ventilation. Example cost-benefit analyses indicate that many measures to improve indoor temperature control and increase ventilation rates will be highly cost effective, with benefit-cost ratios as high as 80 and annual economic benefits as high as $700 per person.

  9. Multicultural Nursing: Providing Better Employee Care.

    PubMed

    Rittle, Chad

    2015-12-01

    Living in an increasingly multicultural society, nurses are regularly required to care for employees from a variety of cultural backgrounds. An awareness of cultural differences focuses occupational health nurses on those differences and results in better employee care. This article explores the concept of culturally competent employee care, some of the non-verbal communication cues among cultural groups, models associated with completing a cultural assessment, and how health disparities in the workplace can affect delivery of employee care. Self-evaluation of the occupational health nurse for personal preferences and biases is also discussed. Development of cultural competency is a process, and occupational health nurses must develop these skills. By developing cultural competence, occupational health nurses can conduct complete cultural assessments, facilitate better communication with employees from a variety of cultural backgrounds, and improve employee health and compliance with care regimens. Tips and guidelines for facilitating communication between occupational health nurses and employees are also provided. PMID:26199294

  10. Back strength and flexibility of EMS providers in practicing prehospital providers.

    PubMed

    Crill, Matthew T; Hostler, David

    2005-06-01

    In the execution of prehospital care duties, an EMS provider may be required to carry equipment and patients over long distances or over multiple flights of stairs at any time of the day. At a minimum, a prehospital provider must have sufficient lower back strength and hamstring flexibility to prevent musculoskeletal injury while lifting. This study administered fitness assessments related to the occupational activities of the prehospital provider with the purpose of describing the incidence of occupational back injury and percentage of providers with known risk factors for back injury. Ninety subjects were tested during a regional EMS conference. Men were significantly taller and heavier than women and had significantly less hamstring flexibility. Body Mass Index was 30.7 +/- 7.2 in men and 28 +/- 5.7 in women. However, no significant differences were noted in an extension test of back strength. When surveyed, 47.8% of subjects reported a back injury in the previous 6 months but only 39.1% of these injuries were sustained while performing EMS duties. While only 13% of these injuries resulted in missed work, 52.2% reported their injury interfered with their daily activities. In spite of the physical nature of the profession, EMS providers in our sample were significantly overweight according to their Body Mass Index and may lack sufficient back strength and flexibilityfor safe execution of their duties. This group of professionals may be at risk for occupational injury and should be targeted for interventions to improve strength and flexibility.

  11. How Do Health Care Providers Diagnose Endometriosis?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose endometriosis? Skip sharing on social media ... under a microscope, to confirm the diagnosis. 1 Health care providers may also use imaging methods to produce ...

  12. How Do Health Care Providers Diagnose Pheochromocytoma?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose pheochromocytoma? Skip sharing on social media links Share this: Page Content A health care provider uses blood and urine tests that measure ...

  13. How Do Health Care Providers Diagnose Hypoparathyroidism?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose hypoparathyroidism? Skip sharing on social media links Share this: Page Content A health care provider will order a blood test to determine ...

  14. 5 CFR 890.910 - Provider information.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Provider information. 890.910 Section 890.910 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS..., and FEHB Benefit Payments § 890.910 Provider information. The hospital provider information used...

  15. 48 CFR 2945.302 - Providing facilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Providing facilities. 2945.302 Section 2945.302 Federal Acquisition Regulations System DEPARTMENT OF LABOR CONTRACT MANAGEMENT GOVERNMENT PROPERTY Providing Government Property to Contractors 2945.302 Providing facilities. The HCA...

  16. 48 CFR 2945.302 - Providing facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Providing facilities. 2945.302 Section 2945.302 Federal Acquisition Regulations System DEPARTMENT OF LABOR CONTRACT MANAGEMENT GOVERNMENT PROPERTY Providing Government Property to Contractors 2945.302 Providing facilities. The HCA...

  17. CSRQ Center Report on Education Service Providers

    ERIC Educational Resources Information Center

    American Institutes for Research, 2006

    2006-01-01

    This consumer guide, for the first time ever, provides comparative ratings on the effectiveness and quality of seven widely adopted Education Service Providers (ESPs)--nonprofit or for-profit organizations that contract with new or existing public, charter, or private schools and/or school districts to provide comprehensive services. This report…

  18. 47 CFR 54.1003 - Provider eligibility.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false Provider eligibility. 54.1003 Section 54.1003 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Mobility Fund § 54.1003 Provider eligibility. (a) Except as provided in § 54.1004, an applicant shall be an...

  19. Group Family Day Care Provider Handbook

    ERIC Educational Resources Information Center

    New York State Office of Children and Family Services, 2006

    2006-01-01

    Group family day care providers need to create high-quality programs where children have opportunities to grow, learn and thrive. Part of providing high-quality child care includes complying with the group family day care regulations from the New York State Office of Children and Family Services (OCFS). This Handbook will help day care providers:…

  20. 48 CFR 445.302 - Providing facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Providing facilities. 445.302 Section 445.302 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE CONTRACT MANAGEMENT GOVERNMENT PROPERTY Providing Government Property to Contractors 445.302 Providing facilities....

  1. 48 CFR 645.302 - Providing facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Providing facilities. 645.302 Section 645.302 Federal Acquisition Regulations System DEPARTMENT OF STATE CONTRACT MANAGEMENT GOVERNMENT PROPERTY Providing Government Property to Contractors 645.302 Providing facilities....

  2. Provider-Independent Use of the Cloud

    NASA Astrophysics Data System (ADS)

    Harmer, Terence; Wright, Peter; Cunningham, Christina; Perrott, Ron

    Utility computing offers researchers and businesses the potential of significant cost-savings, making it possible for them to match the cost of their computing and storage to their demand for such resources. A utility compute provider enables the purchase of compute infrastructures on-demand; when a user requires computing resources a provider will provision a resource for them and charge them only for their period of use of that resource. There has been a significant growth in the number of cloud computing resource providers and each has a different resource usage model, application process and application programming interface (API)-developing generic multi-resource provider applications is thus difficult and time consuming. We have developed an abstraction layer that provides a single resource usage model, user authentication model and API for compute providers that enables cloud-provider neutral applications to be developed. In this paper we outline the issues in using external resource providers, give examples of using a number of the most popular cloud providers and provide examples of developing provider neutral applications. In addition, we discuss the development of the API to create a generic provisioning model based on a common architecture for cloud computing providers.

  3. Suspension System Provides Independent Translation And Rotation

    NASA Technical Reports Server (NTRS)

    Heeg, Jennifer

    1994-01-01

    Spring suspension provides one translational and one rotational degree of freedom. Suspension used to provide for pitching and plunging movements of airfoil in wind tunnel. Translational freedom provided by two thin, flat steel spring tines, clamped at one end to stationary block fixed to ceiling of wind tunnel, and clamped to movable block at other end.

  4. Managed care liability and the capitated provider.

    PubMed

    Reagan, M E

    1995-10-01

    While there have been no reported cases as yet on the subject of ERISA preemption of claims arising from utilization review decisions by providers, it will unquestionably be a significant issue facing providers that participate in capitated arrangements. If preemption is determined not to be available, providers will be exposed to risks from which health plans are currently shielded. Providers conducting utilization review should be following this issue as it develops, but should also be obtaining insurance for this risk to the extent it is available (e.g., it will not be available for punitive damages). Providers should also consider negotiating provisions in their contracts with health plans to the effect that any utilization review conducted by the provider is on behalf of the health plan and that the provider's utilization review activities will be covered under the health plan's liability insurance.

  5. Providing R-Tree Support for Mongodb

    NASA Astrophysics Data System (ADS)

    Xiang, Longgang; Shao, Xiaotian; Wang, Dehao

    2016-06-01

    Supporting large amounts of spatial data is a significant characteristic of modern databases. However, unlike some mature relational databases, such as Oracle and PostgreSQL, most of current burgeoning NoSQL databases are not well designed for storing geospatial data, which is becoming increasingly important in various fields. In this paper, we propose a novel method to provide R-tree index, as well as corresponding spatial range query and nearest neighbour query functions, for MongoDB, one of the most prevalent NoSQL databases. First, after in-depth analysis of MongoDB's features, we devise an efficient tabular document structure which flattens R-tree index into MongoDB collections. Further, relevant mechanisms of R-tree operations are issued, and then we discuss in detail how to integrate R-tree into MongoDB. Finally, we present the experimental results which show that our proposed method out-performs the built-in spatial index of MongoDB. Our research will greatly facilitate big data management issues with MongoDB in a variety of geospatial information applications.

  6. Home deliveries in Indonesia: who provides assistance?

    PubMed

    Thind, Amardeep; Banerjee, Kaberi

    2004-08-01

    Indonesia has set an ambitious target of reducing its maternal mortality rate to 125 maternal deaths per 100,000 live births by the year 2010. This poses formidable challenges in a geographically diverse country where the majority of births occur at home. One option for the Indonesian government in order to reduce its maternal mortality would be to increase rates of skilled assistance for home deliveries. In order to design appropriate policies to achieve this, it is imperative to understand the determinants of use of birth attendants by mothers delivering at home. We use the Andersen Behavioral Model as a theoretical framework to understand the determinants of the use of a trained provider, traditional birth attendant, or no trained assistance during home deliveries in Indonesia. The 1997 Indonesia Demographic and Health Survey (IDHS) was used, and data from the most recent home delivery was abstracted for analysis. Out of a total sample of 10,692 home deliveries, a majority (53%) used the services of a TBA, 40% had a doctor, nurse or midwife in attendance, and only 7% delivered with the help of family and/or friends. A multinomial logit model was used to predict determinants of use. Our results indicate that maternal education, religion, asset index quartile and number of antenatal visits are significant determinants among all choice sets.

  7. Providing smoking cessation programs to homeless youth: the perspective of service providers.

    PubMed

    Shadel, William G; Tucker, Joan S; Mullins, Leslie; Staplefoote, Lynette

    2014-10-01

    There is almost no information available on cigarette smoking among homeless youth, whether they are currently receiving services for smoking cessation, and how to best help them quit. This paper presents data collected from a series of semi-structured telephone interviews with service providers from 23 shelters and drop-in centers serving homeless youth in Los Angeles County about their current smoking cessation programming, interest in providing smoking cessation services to their clients, potential barriers to providing this service, and ways to overcome these barriers. Results indicated that 84% of facilities did not offer smoking cessation services, although nearly all (91%) were interested in doing so. Barriers to implementing formal smoking cessation programs on site included lack of resources (e.g., money, personnel) to support the programs, staff training, and concern that smoking cessation may not be a high priority for homeless youth themselves. Overall, service providers seemed to prefer a less intensive smoking cessation program that could be delivered at their site by existing staff. Data from this formative needs assessment will be useful for developing and evaluating a smoking cessation treatment that could be integrated into the busy, complex environment that characterizes agencies that serve homeless youth. PMID:25012554

  8. Providing smoking cessation programs to homeless youth: the perspective of service providers.

    PubMed

    Shadel, William G; Tucker, Joan S; Mullins, Leslie; Staplefoote, Lynette

    2014-10-01

    There is almost no information available on cigarette smoking among homeless youth, whether they are currently receiving services for smoking cessation, and how to best help them quit. This paper presents data collected from a series of semi-structured telephone interviews with service providers from 23 shelters and drop-in centers serving homeless youth in Los Angeles County about their current smoking cessation programming, interest in providing smoking cessation services to their clients, potential barriers to providing this service, and ways to overcome these barriers. Results indicated that 84% of facilities did not offer smoking cessation services, although nearly all (91%) were interested in doing so. Barriers to implementing formal smoking cessation programs on site included lack of resources (e.g., money, personnel) to support the programs, staff training, and concern that smoking cessation may not be a high priority for homeless youth themselves. Overall, service providers seemed to prefer a less intensive smoking cessation program that could be delivered at their site by existing staff. Data from this formative needs assessment will be useful for developing and evaluating a smoking cessation treatment that could be integrated into the busy, complex environment that characterizes agencies that serve homeless youth.

  9. States wrestle with provider network regulation.

    PubMed

    O'Hare, P K

    1996-08-01

    Across the country, states are considering whether to permit provider network participation in risk-based arrangements. Interest in this issue is driven primarily by market realities and, to a lesser extent, by two recent developments: the National Association of Insurance Commissioners' 1995 recommendation that provider networks entering certain risk arrangements be subject to state insurance regulation and last year's Federal health legislation allowing "provider sponsored networks" (PSNs) to enter Medicare risk contracts. PMID:10158919

  10. Provider documentation of patient education: a lean investigation*

    PubMed Central

    Shipman, Jean P.; Lake, Erica W.; Van Der Volgen, Jessica; Doman, Darrin

    2016-01-01

    Purpose The study evaluates how providers give patient education materials and identifies improvements to comply with Meaningful Use (MU) requirements. Methods Thirty-eight patient-provider interactions in two health care outpatient clinics were observed. Results Providers do not uniformly know MU patient education requirements. Providers have individual preferences and find gaps in what is available. Accessing and documenting patient education varies among providers. Embedded electronic health record (EHR) materials, while available, have technical access barriers. Conclusions Providers' EHR skills and knowledge levels contribute to non-standardized patient education delivery. PMID:27076805

  11. Assessment of Activities of Daily Living, Self-Care, and Independence.

    PubMed

    Mlinac, Michelle E; Feng, Michelle C

    2016-09-01

    Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. In this review article, we (1) review useful clinical tools including a discussion on ways to approach ADL assessment across settings, (2) highlight relevant literature evaluating the relationship between cognitive functioning and ADLs, (3) discuss other biopsychosocial factors affecting ADL performance, (4) provide clinical recommendations for enhancing ADL capacity with an emphasis on self-care tasks (eating, grooming, dressing, bathing and toileting), and (5) identify interventions that treatment providers can implement to reduce the burden of ADL care. PMID:27475282

  12. Providing Internet Access for North Carolina's Libraries.

    ERIC Educational Resources Information Center

    Burgin, Robert

    1996-01-01

    Because North Carolina's telecommunications services have been unable to provide cost-effective, statewide dial-access service to public libraries, the state library has had to identify a suitable alternative for public library network access. This article outlines the state library's efforts to provide access to the Internet and to electronic…

  13. Provider Services Network Project. Draft Final Report.

    ERIC Educational Resources Information Center

    Urban and Rural Systems Associates, San Francisco, CA.

    This draft report on the development and testing of a child care Provider Services Network (PSN) model in Santa Clara County, California, includes a handbook (Manual to Optimize a PSN) designed to provide the State Department of Education and regional or local child care coordinating agencies with information needed to develop PSN optimization…

  14. Health Care Provider Initiative Strategic Plan

    ERIC Educational Resources Information Center

    National Environmental Education & Training Foundation, 2012

    2012-01-01

    This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on…

  15. Learning Providers' Work with Neet Young People

    ERIC Educational Resources Information Center

    Beck, Vanessa

    2015-01-01

    This article investigates the impact of the relationship between learning providers and young people who have experienced Not being in Education, Employment or Training (NEET) on the latters' agency development. Agency is defined as not only bounded but generated by intra-action with relations of force, including learning providers themselves.…

  16. Identifying Mentors' Observations for Providing Feedback

    ERIC Educational Resources Information Center

    Hudson, Peter

    2016-01-01

    Mentors' feedback can assist preservice teachers' development; yet feedback tends to be variable from one mentor to the next. What do mentors observe for providing feedback? In this study, 24 mentors observed a final-year preservice teacher through a professionally video-recorded lesson and provided written notes for feedback. They observed the…

  17. Family Day Care Provider Support Services Directory.

    ERIC Educational Resources Information Center

    Galblum, Trudi W.; Boyer-Shesol, Cathy

    This directory profiles numerous organizational support services for family day care providers in the Kansas City metropolitan area. The first chapter, on operating a family day care home, concerns licensing and registration, the processes of starting and marketing a day care business, zoning and municipal regulation, and substitute providers. The…

  18. 48 CFR 5145.303 - Providing material.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Providing material. 5145.303 Section 5145.303 Federal Acquisition Regulations System DEPARTMENT OF THE ARMY ACQUISITION REGULATIONS GOVERNMENT PROPERTY 5145.303 Providing material. (S-90) Existing Government material on hand...

  19. Adverse effects of prohibiting narrow provider networks.

    PubMed

    Howard, David H

    2014-08-14

    Many insurers participating in the new insurance exchanges are controlling costs by offering plans with narrow provider networks. Proposed regulations would promote network adequacy, but a pro-provider stance may not be inherently pro-consumer or even pro-patient. PMID:25119604

  20. Internet service providers: choosing the right one.

    PubMed

    Turner, P J; Weerakone, S

    2001-10-01

    In order to access the Internet it is necessary to open an account with an Internet Service Provider. This article describes the typical services provided by these companies so that the new subscriber will be in a better position to make an informed choice.

  1. The Children's Home: Providing Services with Options

    ERIC Educational Resources Information Center

    Weaver, Robin

    2007-01-01

    This article describes how The Children's Home of Pittsburgh provides unique, specialized services for infants, children, and their families and seeks to improve not only the range of services available to these special patients, but also the way in which those services are provided. Their innovative healthcare programs have been developed in…

  2. 48 CFR 5145.303 - Providing material.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Providing material. 5145... REGULATIONS GOVERNMENT PROPERTY 5145.303 Providing material. (S-90) Existing Government material on hand or... contractors if it is determined to be in the best interest of the Government per FAR 45.303-1. If the...

  3. 48 CFR 5145.303 - Providing material.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Providing material. 5145... REGULATIONS GOVERNMENT PROPERTY 5145.303 Providing material. (S-90) Existing Government material on hand or... contractors if it is determined to be in the best interest of the Government per FAR 45.303-1. If the...

  4. 48 CFR 5145.303 - Providing material.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Providing material. 5145.303 Section 5145.303 Federal Acquisition Regulations System DEPARTMENT OF THE ARMY ACQUISITION REGULATIONS GOVERNMENT PROPERTY 5145.303 Providing material. (S-90) Existing Government material on hand...

  5. Provider satisfaction in army primary care clinics.

    PubMed

    Byers, V L; Mays, M Z; Mark, D D

    1999-02-01

    The job satisfaction of physicians, nurse practitioners, and physician assistants was assessed during the course of a multicenter study of Army primary care clinics. All providers in nine clinics at three medical centers who were engaged in adult or family care were invited to participate in the study. Questionnaires on job satisfaction and other practice style variables were completed by 26 physicians, 19 nurse practitioners, and 13 physician assistants (46, 76, and 41% of eligible providers, respectively). Analysis revealed a broad range of job satisfaction in the sample. However, average levels of job satisfaction were not significantly different across the three groups of primary care providers. Autonomy and collaboration were significant predictors of job satisfaction. It is clear that changes in health care systems that reduce, or appear to reduce, the primary care provider's autonomy in clinical matters are likely to reduce provider satisfaction as well. PMID:10050571

  6. Management Values Survey Results.

    ERIC Educational Resources Information Center

    Duffy, Barbara; Payne, Ron

    1988-01-01

    Describes results of a survey conducted to compare values of members of the Association for Educational Communications and Technology (AECT) with managers in business and industry. Issues discussed include job satisfaction, opportunities for advancement, attitudes toward management, and salary; a summary of each value system is provided. (LRW)

  7. Ethical Issues in Providing Online Psychotherapeutic Interventions

    PubMed Central

    2000-01-01

    The Internet offers psychotherapists a new communication medium through which they can deliver psychotherapeutic interventions that are appropriate to the medium. Yet online psychotherapy also offers new ethical challenges for therapists interested in providing online psychotherapeutic services. The differences between interactive text-based communication and in-person verbal communication create new ethical challenges not previously encountered in face-to-face therapy. This article will examine the Internet's potential for providing online psychotherapeutic interventions and will review the ethical issues involved with providing interactive text-based psychotherapy. PMID:11720924

  8. Enhancing genomic laboratory reports: A qualitative analysis of provider review

    PubMed Central

    Rahm, Alanna Kulchak; Stuckey, Heather; Green, Jamie; Feldman, Lynn; Zallen, Doris T.; Bonhag, Michele; Segal, Michael M.; Fan, Audrey L.; Williams, Marc S.

    2016-01-01

    This study reports on the responses of physicians who reviewed provider and patient versions of a genomic laboratory report designed to communicate results of whole genome sequencing. Semi‐structured interviews addressed concept communication, elements, and format of example genome reports. Analysis of the coded transcripts resulted in recognition of three constructs around communication of genome sequencing results: (1) Providers agreed that whole genomic sequencing results are complex and they welcomed a report that provided supportive interpretation information to accompany sequencing results; (2) Providers strongly endorsed a report that included active clinical guidance, such as reference to practice guidelines, if available; and (3) Providers valued the genomic report as a resource that would serve as the basis to facilitate communication of genome sequencing results with their patients and families. Providers valued both versions of the report, though they affirmed the need for a provider‐oriented report. Critical elements of the report included clear language to explain the result, as well as consolidated yet comprehensive prognostic information with clear guidance over time for the clinical care of the patient. Most importantly, it appears a report with this design has the potential not only to return results but also serves as a communication tool to help providers and patients discuss and coordinate care over time. © 2016 The Authors. American Journal of Medical Genetics Part A published by Wiley Periodicals, Inc. PMID:26842872

  9. Cash: Advertising Provides Boost to Yearbook Finances.

    ERIC Educational Resources Information Center

    Schweiger, Paul

    1980-01-01

    Indicates that to build a successful yearbook advertising program an adviser must instill enthusiasm and then find students willing to sell advertising. Provides eight guidelines for structuring an advertising sales program. (TJ)

  10. Mounting for diodes provides efficient heat sink

    NASA Technical Reports Server (NTRS)

    1964-01-01

    Efficient heat sink is provided by soldering diodes to metal support bars which are brazed to a ceramic base. Electrical connections between diodes on adjacent bars are made flexible by metal strips which aid in heat dissipation.

  11. Capitated contracting of integrated health provider organizations.

    PubMed

    Bazzoli, G J; Dynan, L; Burns, L R

    This paper examines global capitation of integrated health provider organizations that link physicians and hospitals, such as physician-hospital organizations and management service organizations. These organizations have proliferated in recent years, but their contracting activity has not been studied. We develop a conceptual model to understand the capitated contracting bargaining process. Exploratory multivariate analysis suggests that global capitation of these organizations is more common in markets with high health maintenance organization (HMO) market share, greater numbers of HMOs, and fewer physician group practices. Additionally, health provider organizations with more complex case mix, nonprofit status, more affiliated physicians, health system affiliations, and diversity in physician organizational arrangements are more likely to have global capitation. Finally, state regulation of provider contracting with self-insured employers appears to have spillover effects on health plan risk contracting with health providers. PMID:10711318

  12. Capitated contracting of integrated health provider organizations.

    PubMed

    Bazzoli, G J; Dynan, L; Burns, L R

    This paper examines global capitation of integrated health provider organizations that link physicians and hospitals, such as physician-hospital organizations and management service organizations. These organizations have proliferated in recent years, but their contracting activity has not been studied. We develop a conceptual model to understand the capitated contracting bargaining process. Exploratory multivariate analysis suggests that global capitation of these organizations is more common in markets with high health maintenance organization (HMO) market share, greater numbers of HMOs, and fewer physician group practices. Additionally, health provider organizations with more complex case mix, nonprofit status, more affiliated physicians, health system affiliations, and diversity in physician organizational arrangements are more likely to have global capitation. Finally, state regulation of provider contracting with self-insured employers appears to have spillover effects on health plan risk contracting with health providers.

  13. Concrete "Waffle" Provides Laser Beam Accuracy

    ERIC Educational Resources Information Center

    Building Design and Construction, 1978

    1978-01-01

    A massive concrete "waffle," riding on a bed of specially treated gravel and sand inside another building, provides the structural rigidity needed by the University of Rochester's Laboratory for Laser Energetics. (Author)

  14. Soil chemical insights provided through vibrational spectroscopy

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vibrational spectroscopy techniques provide a powerful approach to study environmental materials and processes. These multifunctional analysis tools can be used to probe molecular vibrations of solid, liquid, and gaseous samples for characterizing materials, elucidating reaction mechanisms, and exam...

  15. NASA Provides Assistance to Trapped Chilean Miners

    NASA Video Gallery

    Responding to a request received through the U.S. Department of State from the Chilean minister of health, NASA will provide advice in nutritional and behavioral sciences to assist miners trapped a...

  16. Are physicians obligated to provide preventive services?

    PubMed

    Belcher, D W

    1990-01-01

    Preventive care is considered a benefit to the patient. Physicians express a positive attitude towards prevention, but their performance of recommended activities is low, as shown in a five-year trial at the Seattle VA Medical Center. The release of the U.S. Preventive Services Task Force's guide to clinical preventive services has provided physicians with authoritative prevention recommendations. While most physicians are specialists with little interest or skill in preventive care, primary care providers do accept an obligation to provide comprehensive care, including prevention. This paper examines the ethical basis for the idea of obligation. External pressures, legal, economic, and organizational, are affecting the physician-patient relationship in ways that encourage a contract mode of medical practice and limit physicians' ability to provide preventive care. As a profession, medicine needs to speak for the health needs of the public. As practitioners, physicians need to seek the welfare of their patients. PMID:2231049

  17. 75 FR 48273 - Technical Service Provider Assistance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-10

    ... provider (TSP) provisions under the Food Security Act of 1985. This document correctly amends those... rule published in the Federal Register of Friday, February 12, 2010 (75 FR 6839). In that document,...

  18. Resource measurement by health care providers.

    PubMed

    Suver, J D; Neumann, B R

    1986-01-01

    The need to use health care resources effectively and efficiently has led to increased interest in developing a "should cost" approach to performance measurement. The development of appropriate standards and the separation of fixed costs into surrogate variable and capacity components can provide a useful tool for managers to measure performance. This article develops a framework for evaluating the utilization of fixed costs in providing output. PMID:10280908

  19. Obstetric Provider Trainees in Georgia: Characteristics and Attitudes About Practice in Obstetric Provider Shortage Areas.

    PubMed

    Smulian, Elizabeth A; Zahedi, Leilah; Hurvitz, Julie; Talbot, Abigail; Williams, Audra; Julian, Zoë; Zertuche, Adrienne D; Rochat, Roger

    2016-07-01

    Objectives In Georgia, 52 % of the primary care service areas outside metropolitan Atlanta have a deficit of obstetric providers. This study was designed to identify factors associated with the likelihood of Georgia's obstetric trainees (obstetrics and gynecology (OB/GYN) residents and certified nurse midwifery (CNM) students) to practice in areas of Georgia that lack obstetric providers and services, i.e. rural Georgia. Methods Pilot-tested electronic and paper surveys were distributed to all of Georgia's OB/GYN residents (N = 95) and CNM students (N = 28). Mixed-methods survey questions assessed characteristics, attitudes, and incentives that might be associated with trainee desire to practice in areas of Georgia that lack obstetric providers and services. Surveys also gathered information about concerns that may prevent trainees from practicing in shortage areas. Univariate and bivariate analyses were performed, and qualitative themes were abstracted from open-ended questions. Results The survey response rate was 87.8 % (108/123). Overall, 24.4 % (19/78) of residents and 53.6 % (15/28) of CNM students expressed interest in practicing in rural Georgia, and both residents and CNM students were more likely to desire to practice in rural Georgia with the offer of any of six financial incentives (P < 0.001). Qualitative themes highlighted trainees' strong concerns about Georgia's political environment as it relates to reproductive healthcare. Conclusions Increasing state-level, rurally-focused financial incentive programs and emphasizing the role of CNMs may alleviate obstetric provider shortages in Georgia.

  20. Driving Cessation and Dementia: Results of the Prospective Registry on Dementia in Austria (PRODEM)

    PubMed Central

    Seiler, Stephan; Schmidt, Helena; Lechner, Anita; Benke, Thomas; Sanin, Guenter; Ransmayr, Gerhard; Lehner, Riccarda; Dal-Bianco, Peter; Santer, Peter; Linortner, Patricia; Eggers, Christian; Haider, Bernhard; Uranues, Margarete; Marksteiner, Josef; Leblhuber, Friedrich; Kapeller, Peter; Bancher, Christian; Schmidt, Reinhold

    2012-01-01

    Objective To assess the influence of cognitive, functional and behavioral factors, co-morbidities as well as caregiver characteristics on driving cessation in dementia patients. Methods The study cohort consists of those 240 dementia cases of the ongoing prospective registry on dementia in Austria (PRODEM) who were former or current car-drivers (mean age 74.2 (±8.8) years, 39.6% females, 80.8% Alzheimer’s disease). Reasons for driving cessation were assessed with the patients’ caregivers. Standardized questionnaires were used to evaluate patient- and caregiver characteristics. Cognitive functioning was determined by Mini-Mental State Examination (MMSE), the CERAD neuropsychological test battery and Clinical Dementia Rating (CDR), activities of daily living (ADL) by the Disability Assessment for Dementia, behavior by the Neuropsychiatric Inventory (NPI) and caregiver burden by the Zarit burden scale. Results Among subjects who had ceased driving, 136 (93.8%) did so because of “Unacceptable risk” according to caregiver’s judgment. Car accidents and revocation of the driving license were responsible in 8 (5.5%) and 1(0.7%) participant, respectively. Female gender (OR 5.057; 95%CI 1.803–14.180; p = 0.002), constructional abilities (OR 0.611; 95%CI 0.445–0.839; p = 0.002) and impairment in Activities of Daily Living (OR 0.941; 95%CI 0.911–0.973; p<0.001) were the only significant and independent associates of driving cessation. In multivariate analysis none of the currently proposed screening tools for assessment of fitness to drive in elderly subjects including the MMSE and CDR were significantly associated with driving cessation. Conclusion The risk-estimate of caregivers, but not car accidents or revocation of the driving license determines if dementia patients cease driving. Female gender and increasing impairment in constructional abilities and ADL raise the probability for driving cessation. If any of these factors also relates to

  1. Research and Practice Communications Between Oral Health Providers and Prenatal Health Providers: A Bibliometric Analysis.

    PubMed

    Skvoretz, John; Dyer, Karen; Daley, Ellen; Debate, Rita; Vamos, Cheryl; Kline, Nolan; Thompson, Erika

    2016-08-01

    Objectives We aimed to examine scholarly collaboration between oral health and prenatal providers. Oral disease is a silent epidemic with significant public health implications for pregnant women. Evidence linking poor oral health during pregnancy to adverse pregnancy and birth outcomes requires oral health and prenatal providers to communicate on the prevention, treatment and co-management matters pertaining to oral health issues among their pregnant patients. The need for inter-professional collaboration is highlighted by guidelines co-endorsed by the American College of Obstetricians and Gynecologists and the American Dental Association, stressing the importance of oral health care during pregnancy. Methods To assess if interdisciplinary communication occurs between oral health and prenatal disciplines, we conducted a network analysis of research on pregnancy-related periodontal disease. Results Social Network analysis allowed us to identify communication patterns between communities of oral health and prenatal professionals via scientific journals. Analysis of networks of citations linking journals in different fields reveals a core-periphery pattern dominated by oral health journals with some participation from medicine journals. However, an analysis of dyadic ties of citation reveals statistically significant "inbreeding" tendencies in the citation patterns: both medical and oral health journals tend to cite their own kind at greater-than-chance levels. Conclusions Despite evidence suggesting that professional collaboration benefits patients' overall health, findings from this research imply that little collaboration occurs between these two professional groups. More collaboration may be useful in addressing women's oral-systemic health concerns that result in adverse pregnancy outcomes.

  2. Family and friends as respite providers.

    PubMed

    Whitlatch, Carol J; Feinberg, Lynn Friss

    2006-01-01

    Consumer-directed service options in home- and community- based care are increasingly available to adults with chronic conditions and cognitive impairments and to their family caregivers. Few studies, however, examine the experience of family caregivers who, when given a choice of providers of respite assistance (i.e., relief from the stress of providing constant care), prefer to hire family or friends rather than service providers. This study describes the in-home respite experience of family caregivers served by California's Caregiver Resource Centers "direct-pay" program who hire family or friends (n = 39) or service providers (n = 77) to provide in-home respite assistance. Findings revealed similarities between the two groups with few exceptions: caregivers who hired family or friends reported poorer physical health, were slightly more satisfied with the respite assistance, and received more hours of respite at a lower unit cost. These findings lend support to consumer-directed respite service options where family caregivers are given flexible alternatives that may act to remove barriers to respite service availability and use.

  3. Teaching antenatal counseling skills to neonatal providers.

    PubMed

    Stokes, Theophil A; Watson, Katie L; Boss, Renee D

    2014-02-01

    Counseling a family confronted with the birth of a periviable neonate is one of the most difficult tasks that a neonatologist must perform. The neonatologist's goal is to facilitate an informed, collaborative decision about whether life-sustaining therapies are in the best interest of this baby. Neonatologists are trained to provide families with a detailed account of the morbidity and mortality data they believe are necessary to facilitate a truly informed decision. Yet these complicated and intensely emotional conversations require advanced communication and counseling skills that our current fellowship-training strategies are not adequately providing. We review educational models for training neonatology fellows to provide antenatal counseling at the threshold of viability. We believe that training aimed at teaching these skills should be incorporated into the neonatal-perinatal medicine fellowship. The optimal approaches for teaching these skills remain uncertain, and there is a need for continued innovation and outcomes-based research.

  4. Patients Provide Recommendations for Improving Patient Satisfaction.

    PubMed

    Moore, Angelo D; Hamilton, Jill B; Krusel, Jessica L; Moore, LeeAntoinette G; Pierre-Louis, Bosny J

    2016-04-01

    National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. PMID:27046182

  5. International nurse education: implications for providers.

    PubMed

    Cecchin, M

    1998-12-01

    This exploratory study conducted in 1996 described the profiles, roles and preparation of twelve South Australian registered nurses in relation to their provision of education programs for nurses from South East Asia. The research showed respondents were well qualified and highly experienced educators whose roles were complex. Their preparation for providing education programs for nurse from South East Asia had been haphazard and inadequate. Consequently respondents considered they were not fully prepared for the providing this specialised education. Career planning and a more strategic approach to the development of specific expertise are essential to support an international approach to nurse education. Nurse education that values intercultural awareness, and is multicultural and global would benefit both local and international students. Development of germane knowledge, skill, attitudes and behaviours is recommended to ensure excellence in the provision of international nurse education. An action research model is proposed as an alternative to traditional professional development to prepare providers of international education. PMID:10095500

  6. Emergency preparedness for home healthcare providers.

    PubMed

    Ruder, Shirley

    2012-06-01

    Unfortunately, disasters occur. We cannot always know the effects ahead of time, but we do know that lives can be lost, property damaged, and public health and home care agencies may not be able to provide the normal standard of care. Studies have shown that disaster preparedness content is limited in U.S. nursing programs (). Given the magnitude of recent natural disasters, such as the Japanese earthquake and tsunami in 2011, these findings are alarming. The increasing demands on healthcare providers in response to emergencies force home healthcare clinicians to identify their roles and responsibilities in emergency preparedness. This article discusses 1 model of disaster response and the role of the home healthcare provider at each stage. It further guides home healthcare nurses in creating a personal and professional plan, enabling them to understand how to minimize the impact of disasters and address the needs of their patients and those close to them.

  7. Preceptor Development: Providing Effective Feedback, Part 2

    PubMed Central

    Wilkinson, Samaneh T.; Phillips, Holly

    2014-01-01

    Abstract An integral part of providing effective feedback to pharmacy residents occurs during the evaluation process. Residency evaluation involves measuring and documenting performance as it relates to standardized residency outcomes, goals, and learning objectives. Evaluations may be formative or summative and include the preceptor’s evaluation of the resident’s performance, the resident’s self-assessments, and the resident’s evaluation of the preceptor and learning experience. Evaluations are more structured than feedback, and they involve documentation of the verbal feedback that was provided throughout the learning experience. This article will focus on the preceptor’s role in providing effective resident evaluations based on specific learning activities. PMID:24958969

  8. Providing paediatric palliative care: collaboration in practice.

    PubMed

    Farrell, M; Sutherland, P

    One of the main aims of palliative care is to enable clients to receive and access services in a way that maximizes their choice in relation to where, when and how they receive care. To achieve this end, it is essential that statutory and voluntary care agencies collaborate to provide an effective range of services. This article offers for consideration the experience of a children's hospice service and a paediatric oncology outreach service who collaborated to provide a service for children requiring paediatric and terminal care. It identifies a number of elements which are important for positive and effective collaboration.

  9. Method for providing a compliant cantilevered micromold

    DOEpatents

    Morales, Alfredo M.; Domeier, Linda A.; Gonzales, Marcela G.; Keifer, Patrick N.; Garino, Terry J.

    2008-12-16

    A compliant cantilevered three-dimensional micromold is provided. The compliant cantilevered micromold is suitable for use in the replication of cantilevered microparts and greatly simplifies the replication of such cantilevered parts. The compliant cantilevered micromold may be used to fabricate microparts using casting or electroforming techniques. When the compliant micromold is used to fabricate electroformed cantilevered parts, the micromold will also comprise an electrically conducting base formed by a porous metal substrate that is embedded within the compliant cantilevered micromold. Methods for fabricating the compliant cantilevered micromold as well as methods of replicating cantilevered microparts using the compliant cantilevered micromold are also provided.

  10. Care for the Health Care Provider.

    PubMed

    Kunin, Sharon Brown; Kanze, David Mitchell

    2016-03-01

    Pretravel care for the health care provider begins with an inventory, including the destination, length of stay, logistical arrangements, type of lodging, food and water supply, team members, personal medical needs, and the needs of the community to be treated. This inventory should be created and processed well in advance of the planned medical excursion. The key thing to remember in one's planning is to be a health care provider during one's global health care travel and not to become a patient oneself. This article will help demonstrate the medical requirements and recommendations for such planning.

  11. Homeless women's experiences of service provider encounters.

    PubMed

    Biederman, Donna J; Nichols, Tracy R

    2014-01-01

    Service providers are gatekeepers to health-sustaining services and resources, although little is known about service encounters from the perspective of homeless women. We conducted in-depth semistructured interviews with 15 homeless women to better understand their experiences of service encounters. Using a phenomenological method, 160 significant statements were extracted from participant transcripts; more positive than negative interactions were reported. The 10 themes that emerged fall along a dehumanizing/humanizing continuum primarily separated by the power participants experienced in the interaction and the trust they felt in the service provider. Implications for nursing practice and research are offered. PMID:24528122

  12. Care for the Health Care Provider.

    PubMed

    Kunin, Sharon Brown; Kanze, David Mitchell

    2016-03-01

    Pretravel care for the health care provider begins with an inventory, including the destination, length of stay, logistical arrangements, type of lodging, food and water supply, team members, personal medical needs, and the needs of the community to be treated. This inventory should be created and processed well in advance of the planned medical excursion. The key thing to remember in one's planning is to be a health care provider during one's global health care travel and not to become a patient oneself. This article will help demonstrate the medical requirements and recommendations for such planning. PMID:26900113

  13. Providing Access to Justice through Service Learning

    ERIC Educational Resources Information Center

    Kubichek, Mary

    2010-01-01

    In the Casper College Legal Service (CCLS) program, Casper College paralegal students, under supervision of pro bono attorneys, use paralegal skills to provide legal services and work product. CCLS is different from other legal clinics; it is not law school based, bar based, or court based. CCLS is paralegal based.

  14. Providing Career Guidance for Young Women.

    ERIC Educational Resources Information Center

    Colby, Pamela G.

    This module is directed at personnel working or planning to work in the areas of guidance, counseling, placement and follow-through in junior and senior high school settings, grades 7-12. The module topic is career guidance for young women of junior and senior high school age, aand the focus will be on providing nonbiased career guidance which…

  15. Providing a Learning-Centered Instructional Environment.

    ERIC Educational Resources Information Center

    Evans, Ruby

    This paper describes efforts made by the faculty at Santa Fe Community College (Florida) to provide a learning-centered instructional environment for students in an introductory statistics class. Innovation in instruction has been stressed as institutions switch from "teacher-centered classrooms" to "student-centered classrooms." The incorporation…

  16. Lessons from VET Providers Delivering Degrees

    ERIC Educational Resources Information Center

    Callan, Victor J.; Bowman, Kaye

    2015-01-01

    This report is focused on the strategic, capability and operational reasons why traditional vocational education and training (VET) providers move to the delivery of higher education qualifications in their own right, in addition to their vocational qualifications. It is particularly interested in associate and bachelor degrees. By undertaking six…

  17. Providing Location Information for Colorado Library Resources.

    ERIC Educational Resources Information Center

    Pearson, Karl M., Jr.

    This report examines the feasibility of developing a Colorado statewide union data base to support cataloging, acquisitions, and interlibrary loan functions. It concludes that any data base developed should focus on providing location information for the state's library materials to support patron access to available resources. The title location…

  18. 75 FR 81832 - Technical Service Provider Assistance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF AGRICULTURE Natural Resources Conservation Service 7 CFR Part 652 Technical Service Provider Assistance CFR Correction In Title 7 of the Code of Federal Regulations, Parts 400 to 699, revised as of Jan. 1, 2010, on...

  19. Providing nursing care in a children's hospice.

    PubMed

    Day, Alison

    Children who are admitted to hospices need specialist treatment that enables them to enjoy their childhood as much as possible while they receive the care they require. Their parents also have particular needs. During Children's Hospice Week, which started on September 21, the Association of Children's Hospices aims to raise awareness of the work done by children's hospices and the services they provide.

  20. Providing Adaptivity in Moodle LMS Courses

    ERIC Educational Resources Information Center

    Despotovic-Zrakic, Marijana; Markovic, Aleksandar; Bogdanovic, Zorica; Barac, Dusan; Krco, Srdjan

    2012-01-01

    In this paper, we describe an approach to providing adaptivity in e-education courses. The primary goal of the paper is to enhance an existing e-education system, namely Moodle LMS, by developing a method for creating adaptive courses, and to compare its effectiveness with non-adaptive education approach. First, we defined the basic requirements…

  1. 78 FR 14034 - Health Insurance Providers Fee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-04

    ... applicable to student health insurance, see Student Health Insurance Coverage, 77 FR 16453, 16455-56 (March... definition of covered entity is also Sec. 2520.101-2(c)(2)(ii)(B) (RIN 1210-AB51). See 76 FR 76222. If and... Internal Revenue Service 26 CFR Part 57 RIN 1545-BL20 Health Insurance Providers Fee AGENCY:...

  2. Providing Windows for Non-Minority Readers

    ERIC Educational Resources Information Center

    Gardner, Roberta

    2008-01-01

    Collecting and presenting children's literature takes on new meaning when the audience is comprised of students who are affluent and represent the dominant culture. As a school librarian, the author of this article believes that children's literature provides a means by which she can introduce the diversity of society into the classroom.…

  3. GEAR UP: Providing Opportunities or Conflict?

    ERIC Educational Resources Information Center

    Walsh, Rachael

    2008-01-01

    Since 1965 the federal government has attempted to provide low socioeconomic status students with equal access to postsecondary education through the Higher Education Act and its multiplicative programmatic efforts. Implemented as one such program in 1998, the Gaining Early Awareness and Readiness for Undergraduate Programs, or GEAR UP, has been…

  4. Modified algesimeter provides accurate depth measurements

    NASA Technical Reports Server (NTRS)

    Turner, D. P.

    1966-01-01

    Algesimeter which incorporates a standard sensory needle with a sensitive micrometer, measures needle point depth penetration in pain tolerance research. This algesimeter provides an inexpensive, precise instrument with assured validity of recordings in those biomedical areas with a requirement for repeated pain detection or ascertaining pain sensitivity.

  5. Districtwide System for Providing Individual Student Support

    ERIC Educational Resources Information Center

    Lewis-Palmer, Teri; Bounds, Monica; Sugai, George

    2004-01-01

    Although schools generally provide safe environments, teachers, staff, parents, and students are concerned with the rising level of disruptive, antisocial behavior (Horner, Sugai, Lewis-Palmer, & Todd, 2001). Only a relatively small number of students in a school building engage in the most serious and/or chronic problem behaviors. However, these…

  6. Legislating for Private Providers: White Paper Dilemmas

    ERIC Educational Resources Information Center

    Evans, G. R.

    2011-01-01

    In November 2010, the British Government, modifying one of the proposals in the Browne Report published in October, decided to allow English universities to charge tuition fees of up to 9,000 British Pounds, while removing almost all the public funding previously provided in the form of a block grant. This had consequences the Government should…

  7. Providing high-quality care for children.

    PubMed

    Taylor, G; Rawson, R

    1997-08-01

    Because home care traditionally has served older patients under Medicare, some providers tend to treat in-home pediatric patients like "little adults." To offer children and their families the specialty care that they require and deserve, one agency limits its services exclusively to pediatrics. PMID:10173116

  8. Healthcare Providers' Treatment of College Smokers

    ERIC Educational Resources Information Center

    Koontz, Jennifer Scott; Harris, Kari Jo; Okuyemi, Kolawole S.; Mosier, Michael C.; Grobe, James; Nazir, Niaman; Ahluwalia, Jasjit S.

    2004-01-01

    About 28% of college students smoke tobacco, and many will continue smoking into adulthood. Although little is known about how to help college students quit smoking. I promising strategy is healthcare providers' advice. To estimate their lifetime receipt of brief advice and to identify characteristics that predict who may receive that advice, 348…

  9. Providing Support for English Language Learner Services

    ERIC Educational Resources Information Center

    Corona, Elia; Armour, Lauren

    2007-01-01

    Encouraging literacy and academic success among English language learners (ELLs) is becoming an increasingly common challenge for educators. In the course of the authors work of training teachers or providing training for implementation of materials, they have found that the resources of the school library media center are invaluable for helping…

  10. 42 CFR 410.134 - Provider qualifications.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical Nutrition Therapy § 410.134 Provider qualifications. For Medicare Part B coverage of MNT, only a registered dietitian or nutrition professional...

  11. 42 CFR 410.134 - Provider qualifications.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical Nutrition Therapy § 410.134 Provider qualifications. For Medicare Part B coverage of MNT, only a registered dietitian or nutrition professional...

  12. 42 CFR 410.134 - Provider qualifications.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical Nutrition Therapy § 410.134 Provider qualifications. For Medicare Part B coverage of MNT, only a registered dietitian or nutrition professional...

  13. 42 CFR 410.134 - Provider qualifications.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical Nutrition Therapy § 410.134 Provider qualifications. For Medicare Part B coverage of MNT, only a registered dietitian or nutrition professional...

  14. 42 CFR 410.134 - Provider qualifications.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical Nutrition Therapy § 410.134 Provider qualifications. For Medicare Part B coverage of MNT, only a registered dietitian or nutrition professional...

  15. 42 CFR 438.214 - Provider selection.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Provider selection. 438.214 Section 438.214 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Structure...

  16. 42 CFR 438.214 - Provider selection.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Provider selection. 438.214 Section 438.214 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Structure...

  17. Management services organizations: providing economies of scale.

    PubMed

    Schaffer, C L

    1998-09-01

    Effective information management and other shared costs can reduce agencies' operating expenses as well as make new products available while providing opportunities to gain a competitive advantage. By taking a close look at ways of controlling documentation, such as the use of a management services organization for information system/computer-based management, agencies can prepare for the challenges of the next century.

  18. EDUCATIONAL OPPORTUNITIES PROVIDED BY COMMUNITY ACTION PROGRAMS.

    ERIC Educational Resources Information Center

    PINNOCK, THEODORE J.

    INFORMAL EDUCATION PRIMARILY INCLUDES EDUCATION FOR EVERYDAY EFFECTIVE LIVING AND DOES NOT NECESSARILY HAVE TO INCLUDE COURSES FOR CREDIT AT THE HIGH SCHOOL AND COLLEGE LEVELS. MILLIONS OF POVERTY STRICKEN PEOPLE CAN BENEFIT FROM THE TYPE OF INFORMAL EDUCATION PROVIDED THROUGH THE OFFICE OF ECONOMIC OPPORTUNITY (OEO) IN SUCH PROGRAMS AS--(1) THE…

  19. 42 CFR 438.214 - Provider selection.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Provider selection. 438.214 Section 438.214 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Structure...

  20. Emergency Food Providers in Southern Illinois.

    ERIC Educational Resources Information Center

    O'Hara, Mary

    This paper examines emergency food provider networks in rural southern Illinois. An overview focuses on recent research reports on hunger in America, official federal emergency food assistance policy and criticisms of that policy, and the role of the private sector in emergency food distribution. The review details the disagreements on policy and…

  1. Creative Places: How RISD Invigorates Providence

    ERIC Educational Resources Information Center

    Mandle, Roger

    2005-01-01

    Institutions like Rhode Island School of Design (RISD) provide New England with cultural wealth in a variety of ways, including the great art and design housed in their museums and their vibrant faculty and student body, which numbers in RISD's case, 1,900 undergraduates and 375 graduate students from the United States and almost 50 countries.…

  2. Providing for Different Rates of Music Learning.

    ERIC Educational Resources Information Center

    Beer, Alice S.; And Others

    1982-01-01

    Discusses ways that elementary music teachers can design class activities which will meet individual needs of mainstreamed special students. Activities described encompass a wide range of difficulty and provide opportunities for individualized, small-group or out-of-class instruction and for creative response. (AM)

  3. NUCLEAR REACTOR SLUG PROVIDED WITH THERMOCOUPLE

    DOEpatents

    Kanne, W.R.

    1958-10-14

    A temperature measuring apparatus is described for use in a reactor. In this invention a cylindrlcal fuel slug is provided with an axial bore in which is disposed a thermocouple. The lead wires extend to a remote indicating device which indicates the temperature in the fuel element measured by the thermocouple.

  4. Estate Planning: Providing for Your Child's Future.

    ERIC Educational Resources Information Center

    Beyer, Henry A.

    1986-01-01

    Parents who wish their handicapped offspring to be financially provided for after their own deaths need to explore several ways of managing and distributing their assets, including: creating a will; disinheritance (to avoid loss of benefits; joint property and life insurance; and trusts and trustees. (CB)

  5. Using the internet to provide psychodynamic psychotherapy.

    PubMed

    Johansson, Robert; Frederick, Ronald J; Andersson, Gerhard

    2013-12-01

    Over the last 15 years, there has been a substantial increase in research and clinical implementations of Internet-delivered, cognitive behavioral therapy (ICBT). Several studies on ICBT have been in the format of guided self-help where a therapist guides the patient throughout the whole treatment. ICBT is typically in the form of self-help material (e.g., text or video) which is provided to a client over the Internet with additional therapist contact by e-mail. ICBT has been shown to be effective for various conditions and, in some studies, has shown to be as effective as face-to-face cognitive behavioral therapy for mild to moderate depression, anxiety disorders, and somatic problems. Recently, the field has expanded to include other orientations including psychodynamic psychotherapy. Currently, there are three randomized controlled trials that have tested the efficacy of psychodynamic psychotherapy delivered in this format. The latest published trial focused on an affect-focused, psychodynamic psychotherapy delivered to a sample of participants with mixed depression and anxiety disorders. This article aims to provide a deeper understanding of the process of providing psychodynamic psychotherapy via the Internet. We will give a detailed description of our latest manual and show how psychotherapeutic work is conducted utilizing this text. Furthermore, we provide examples of dialogue between therapist and client from the online environment. Similarities and differences between psychodynamic psychotherapy delivered over the Internet and in face-to-face formats are discussed.

  6. 44 CFR 206.393 - Providing assistance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Providing assistance. 206.393 Section 206.393 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Fire Suppression Assistance §...

  7. 44 CFR 206.393 - Providing assistance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Providing assistance. 206.393 Section 206.393 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Fire Suppression Assistance §...

  8. 44 CFR 206.393 - Providing assistance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Providing assistance. 206.393 Section 206.393 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Fire Suppression Assistance §...

  9. 44 CFR 206.393 - Providing assistance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Providing assistance. 206.393 Section 206.393 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Fire Suppression Assistance §...

  10. 44 CFR 206.393 - Providing assistance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Providing assistance. 206.393 Section 206.393 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Fire Suppression Assistance §...

  11. An Immunization Education Program for Childcare Providers

    ERIC Educational Resources Information Center

    Hayney, Mary S.; Bartell, Julie C.

    2005-01-01

    The childhood immunization schedule includes at least 17 scheduled immunizations prior to the age of 24 months. Immunization laws require childcare centers to maintain immunization records and enforce immunization standards for children who attend these centers. Childcare providers generally receive little formal education about infectious…

  12. Assessing Training Needs of HIV Program Providers

    ERIC Educational Resources Information Center

    Sleezer, Catherine M.; Spector, Melanie

    2006-01-01

    This article describes a mixed-methods needs assessment, or developmental evaluation, that was conducted for the providers and stakeholders of Oklahoma's community-based organizations (CBOs). The needs assessment, which was the first phase in developing training on outcome monitoring for their HIV prevention programs, relied on three evaluation…

  13. Air Systems Provide Life Support to Miners

    NASA Technical Reports Server (NTRS)

    2014-01-01

    Through a Space Act Agreement with Johnson Space Center, Paragon Space Development Corporation, of Tucson, Arizona, developed the Commercial Crew Transport-Air Revitalization System, designed to provide clean air for crewmembers on short-duration space flights. The technology is now being used to help save miners' lives in the event of an underground disaster.

  14. Providers' Perceptions of Challenges in Obstetrical Care for Somali Women

    PubMed Central

    Lazar, Jalana N.; Johnson-Agbakwu, Crista E.; Davis, Olga I.; Shipp, Michele P.-L.

    2013-01-01

    Background. This pilot study explored health care providers' perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers' experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC). Methods. Individual semi-structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio. Results. While providers did not perceive FGC as a significant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients' resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families. Conclusion. Improving the clinical encounter for both patients and providers entails establishing effective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement. PMID:24223041

  15. PDX experimental results

    SciTech Connect

    Meade, D.; Arunasalam, V.; Barnes, C.

    1981-01-01

    The main objectives of the Poloidal Divertor Experiment (PDX) are to: (1) determine the effectiveness of poloidal divertors in controlling impurities in high temperature plasmas, (2) use the poloidal divertor to provide clean plasmas for confinement and high beta studies, and (3) investigate the effect of cross-section shaping on plasma confinement and MHD properties. In this paper, we report the results obtained during initial divertor operation of the PDX.

  16. Autism Screening Practices among Early Intervention Providers in Indiana

    ERIC Educational Resources Information Center

    Tomlin, Angela; Koch, Steven M; Raches, Christine; Minshawi, Noha F.; Swiezy, Naomi B.

    2013-01-01

    The purpose of this study was to identify current practices in autism spectrum disorder (ASD) screening among early intervention and care providers in Indiana. Participants were asked about their ASD screening practices within the context of overall screening for developmental delays. Results indicated that providers conduct ASD screening less…

  17. "If Only Someone Had Told Me ...": Lessons from Rural Providers

    ERIC Educational Resources Information Center

    Chipp, Cody; Dewane, Sarah; Brems, Christiane; Johnson, Mark E.; Warner, Teddy D.; Roberts, Laura W.

    2011-01-01

    Purpose: Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural…

  18. Gender Patterns in Provider Role Attitudes and Behavior

    ERIC Educational Resources Information Center

    Loscocco, Karyn; Spitze, Glenna

    2007-01-01

    Although much has been written on rapidly changing work and family roles, relatively little is known about the provider side of the work-family nexus. Using data from a study of gender, work, and family among the self-employed, we examine abstract and specific attitudes as well as behavior relating to the provider role. Results show gender…

  19. 48 CFR 2045.370 - Providing Government property (in general).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... result in substantially lower costs to the Government for the items produced or services rendered when... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Providing Government... COMMISSION CONTRACT MANAGEMENT GOVERNMENT PROPERTY Providing Government Property to Contractors...

  20. 48 CFR 2045.370 - Providing Government property (in general).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... result in substantially lower costs to the Government for the items produced or services rendered when... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Providing Government... COMMISSION CONTRACT MANAGEMENT GOVERNMENT PROPERTY Providing Government Property to Contractors...

  1. The $500,000 deduction limitation for remuneration provided by certain health insurance providers. Final regulations.

    PubMed

    2014-09-23

    This document contains final regulations on the application of the $500,000 deduction limitation for remuneration provided by certain health insurance providers under section 162(m)(6) of the Internal Revenue Code (Code). These regulations affect certain health insurance providers providing remuneration that exceeds the deduction limitation.

  2. 28 CFR 58.27 - Automatic expiration of providers' status as approved providers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Automatic expiration of providers' status...) REGULATIONS RELATING TO THE BANKRUPTCY REFORM ACTS OF 1978 AND 1994 § 58.27 Automatic expiration of providers... approved provider immediately prior to the date it last obtained approval to be an approved provider,...

  3. 28 CFR 58.27 - Automatic expiration of providers' status as approved providers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Automatic expiration of providers' status...) REGULATIONS RELATING TO THE BANKRUPTCY REFORM ACTS OF 1978 AND 1994 § 58.27 Automatic expiration of providers... approved provider immediately prior to the date it last obtained approval to be an approved provider,...

  4. Research and Practice Communications Between Oral Health Providers and Prenatal Health Providers: A Bibliometric Analysis.

    PubMed

    Skvoretz, John; Dyer, Karen; Daley, Ellen; Debate, Rita; Vamos, Cheryl; Kline, Nolan; Thompson, Erika

    2016-08-01

    Objectives We aimed to examine scholarly collaboration between oral health and prenatal providers. Oral disease is a silent epidemic with significant public health implications for pregnant women. Evidence linking poor oral health during pregnancy to adverse pregnancy and birth outcomes requires oral health and prenatal providers to communicate on the prevention, treatment and co-management matters pertaining to oral health issues among their pregnant patients. The need for inter-professional collaboration is highlighted by guidelines co-endorsed by the American College of Obstetricians and Gynecologists and the American Dental Association, stressing the importance of oral health care during pregnancy. Methods To assess if interdisciplinary communication occurs between oral health and prenatal disciplines, we conducted a network analysis of research on pregnancy-related periodontal disease. Results Social Network analysis allowed us to identify communication patterns between communities of oral health and prenatal professionals via scientific journals. Analysis of networks of citations linking journals in different fields reveals a core-periphery pattern dominated by oral health journals with some participation from medicine journals. However, an analysis of dyadic ties of citation reveals statistically significant "inbreeding" tendencies in the citation patterns: both medical and oral health journals tend to cite their own kind at greater-than-chance levels. Conclusions Despite evidence suggesting that professional collaboration benefits patients' overall health, findings from this research imply that little collaboration occurs between these two professional groups. More collaboration may be useful in addressing women's oral-systemic health concerns that result in adverse pregnancy outcomes. PMID:27029538

  5. SPACEWAY: Providing affordable and versatile communication solutions

    NASA Technical Reports Server (NTRS)

    Fitzpatrick, E. J.

    1995-01-01

    By the end of this decade, Hughes' SPACEWAY network will provide the first interactive 'bandwidth on demand' communication services for a variety of applications. High quality digital voice, interactive video, global access to multimedia databases, and transborder workgroup computing will make SPACEWAY an essential component of the computer-based workplace of the 21st century. With relatively few satellites to construct, insure, and launch -- plus extensive use of cost-effective, tightly focused spot beams on the world's most populated areas -- the high capacity SPACEWAY system can pass its significant cost savings onto its customers. The SPACEWAY network is different from other proposed global networks in that its geostationary orbit location makes it a truly market driven system: each satellite will make available extensive telecom services to hundreds of millions of people within the continuous view of that satellite, providing immediate capacity within a specific region of the world.

  6. Providing contact cards for relatives following bereavement.

    PubMed

    Clarke, K; Pearson, N

    This article describes the implementation of a Welsh Assembly Government policy to improve customer service and provide an opportunity for relatives to seek further information about the death of a loved one in an acute hospital setting. A new relative-centred pathway has been developed. It offers a single point of contact for recently bereaved relatives and provides an opportunity to discuss any concerns or anxieties in relation to the care and/or treatment in the final hours of their loved one's life. The pathway includes a contact card with the name and number of a designated person and is a more informal, empathetic and person-centred service than the formal complaint process. PMID:20687289

  7. Who provides nursing services in Cambodian hospitals?

    PubMed

    Sakurai-Doi, Yukie; Mochizuki, Noriko; Phuong, Keat; Sung, Chao; Visoth, Pheng; Sriv, Bun; Amara, Sar Rath; Murakami, Hitoshi; Komagata, Tomoko; Fujita, Noriko

    2014-03-01

    In Cambodia, the number of nurses is insufficient and details of nursing services are unknown and undocumented. This research explored who provides nursing service activities in Cambodia. The study was conducted at nine hospitals in Cambodia. Findings indicate that non-invasive medical care such as vital signs taking was designated to nurses. In performing more complex medical interventions, nurses shared the tasks with medical doctors. Conversely, simpler nursing tasks, including maintaining bedside environment/hygiene and supporting patient activities, tasks were shared by nurses with patients' family. This study elucidated an optimal personnel mix and task shared between nurses, doctors and patients' families. There are important implications for nursing legislation related to streamlining the production of nurses to provide an adequate and qualified nursing service in Cambodia. PMID:24661282

  8. Providing Real Research Opoportunities to Undergraduates

    NASA Astrophysics Data System (ADS)

    Ragozzine, Darin

    2016-01-01

    The current approach to undergraduate education focuses on teaching classes which provide the foundational knowledge for more applied experiences such as scientific research. Like most programs, Florida Institute of Technology (Florida Tech or FIT) strongly encourages undergraduate research, but is dominated by content-focused courses (e.g., "Physical Mechanics"). Research-like experiences are generally offered through "lab" classes, but these are almost always reproductions of past experiments: contrived, formulaic, and lacking the "heart" of real (i.e., potentially publishable) scientific research. Real research opportunities 1) provide students with realistic insight into the actual scientific process; 2) excite students far more than end-of-chapter problems; 3) provide context for the importance of learning math, physics, and astrophysics concepts; and 4) allow unique research progress for well-chosen problems. I have provided real research opportunities as an "Exoplanet Lab" component of my Introduction to Space Science (SPS1020) class at Florida Tech, generally taken by first-year majors in our Physics, Astronomy & Astrophysics, Planetary Science, and Astrobiology degree programs. These labs are a hybrid between citizen science (e.g., PlanetHunters) and simultaneously mentoring ~60 undergraduates in similar small research projects. These projects focus on problems that can be understood in the context of the course, but which benefit from "crowdsourcing". Examples include: dividing up the known planetary systems and developing a classification scheme and organizing them into populations (Fall 2013); searching through folded light curves to discover new exoplanets missed by previous pipelines (Fall 2014); and fitting n-body models to all exoplanets with known Transit Timing Variations to estimate planet masses (Fall 2015). The students love the fact that they are doing real potentially publishable research: not many undergraduates can claim to have discovered

  9. Muscle Cells Provide Instructions for Planarian Regeneration

    PubMed Central

    Witchley, Jessica N.; Mayer, Mirjam; Wagner, Daniel E.; Owen, Jared H.; Reddien, Peter W.

    2014-01-01

    Regeneration requires both potential and instructions for tissue replacement. In planarians, pluripotent stem cells have the potential to produce all new tissue. The identities of the cells that provide regeneration instructions are unknown. Here, we report that position control genes (PCGs) that control regeneration and tissue turnover are expressed in a subepidermal layer of nonneoblast cells. These subepidermal cells coexpress many PCGs. We propose that these subepidermal cells provide a system of body coordinates and positional information for regeneration, and identify them to be muscle cells of the planarian body wall. Almost all planarian muscle cells express PCGs, suggesting a dual function: contraction and control of patterning. PCG expression is dynamic in muscle cells after injury, even in the absence of neoblasts, suggesting that muscle is instructive for regeneration. We conclude that planarian regeneration involves two highly flexible systems: pluripotent neoblasts that can generate any new cell type and muscle cells that provide positional instructions for the regeneration of any body region. PMID:23954785

  10. Intraoperative patient information handover between anesthesia providers

    PubMed Central

    Choromanski, Dominik; Frederick, Joel; McKelvey, George Michael; Wang, Hong

    2014-01-01

    Abstract Currently, no reported studies have evaluated intraoperative handover among anesthesia providers. Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and, in many instances, significant intraoperative events are disregarded. An online survey tool was sent to anesthesia providers at US anesthesia residency programs nationwide (120 out of the 132 US programs encompassing around 4500 residents and their academic MDAs) and a smaller survey selection of CRNAs (10 institutions about 300 CRNAs in the metropolitan area of Detroit, MI, USA) to collect information on handover practices. The response rate to this survey (n = 216) was comprised of approximately 5% (n = 71) of the resident population in US anesthesia programs, 5% (n = 87) of MDAs , and 20% (n = 58) of the CRNAs. Out of all respondents (n = 212), 49.1 % had no hand-over protocol at their institution and 88% of respondents who did have institutional handover protocols believed them insufficient for effective patient handover. In addiiton, 84.8% of all responders reported situations where there was insufficient information received during a patient handover. Only 7% of the respondents reported never experiencing complications or mismanagement due to poor or incomplete hand-overs. In contrast, 60% reported rarely having complications, 31% reported sometimes having complications, and 3% reported frequent complications. In conclusion, handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room. Our preliminary study suggests that current intraoperatvive handover practices among anesthesia providers are suboptimal and that national patient handover guidelines are required to improve patient safety. PMID:25332710

  11. Zika Virus: Critical Information for Emergency Providers.

    PubMed

    Shastry, Siri; Koenig, Kristi L; Hirshon, Jon Mark

    2016-08-01

    Zika virus is an arbovirus of the Flaviviridae family. It is primarily a minimally symptomatic mosquito-borne infection. However, with Zika's 2015 to 2016 introduction into the Western Hemisphere and its dramatic and rapid spread, it has become a public health concern, in large part due to congenital abnormalities associated with infection in pregnant women. In early 2016, the World Health Organization declared the microcephaly and other neurologic conditions associated with Zika virus infection a public health emergency of international concern. This article discusses the current epidemiologic and clinical understanding of Zika virus, focusing on critical information needed by emergency providers. PMID:27475021

  12. Icy Schwedeneck field may provide reference

    SciTech Connect

    Not Available

    1985-05-01

    Situated in an icy region of the Baltic Sea, Germany's first offshore field may provide the nation with the reference needed to encroach the arctic market. Production began last winter from one platform in the Schwedeneck-See field, located about three miles off the Baltic Coast. Total reserves have been estimated at more than 18 million bbl. Yearly production by the end of 1986 has been estimated at 294,000 bbl. The first two production platforms were installed in late 1983 in water depths ranging from 50 to 80 ft. Because of the ice hazards inherent in the Baltic, the platforms are concrete designed with steel decks.

  13. Zika Virus: Critical Information for Emergency Providers.

    PubMed

    Shastry, Siri; Koenig, Kristi L; Hirshon, Jon Mark

    2016-08-01

    Zika virus is an arbovirus of the Flaviviridae family. It is primarily a minimally symptomatic mosquito-borne infection. However, with Zika's 2015 to 2016 introduction into the Western Hemisphere and its dramatic and rapid spread, it has become a public health concern, in large part due to congenital abnormalities associated with infection in pregnant women. In early 2016, the World Health Organization declared the microcephaly and other neurologic conditions associated with Zika virus infection a public health emergency of international concern. This article discusses the current epidemiologic and clinical understanding of Zika virus, focusing on critical information needed by emergency providers.

  14. Computerized systems to provide materials selection advice

    SciTech Connect

    Krisher, A.S.

    1996-07-01

    The rapid advance of computer science has increased the ability to store and retrieve information. These new capabilities are beginning to be applied to the problem of providing sound advice to non-specialist engineers who make materials selection decisions. This paper presents an overview of the large scale systems which exist in finished or near finished form and are (or may soon be) available for use by the public. The paper focuses on systems which transfer knowledge taking into account the many qualifications which enter into the reasoning processes of materials/corrosion specialists. The paper discusses both the strengths and limitations of each system.

  15. Sensors Provide Early Warning of Biological Threats

    NASA Technical Reports Server (NTRS)

    2009-01-01

    Early Warning Inc. of Troy, New York, licensed powerful biosensor technology from Ames Research Center. Incorporating carbon nanotubes tipped with single strands of nucleic acid from waterborne pathogens, the sensor can detect even minute amounts of targeted, disease causing bacteria, viruses, and parasites. Early Warning features the NASA biosensor in its water analyzer, which can provide advance alert of potential biological hazards in water used for agriculture, food and beverages, showers, and at beaches and lakes -- within hours instead of the days required by conventional laboratory methods.

  16. Power beaming providing a space power infrastructure

    SciTech Connect

    Bamberger, J.A.; Coomes, E.P.

    1992-08-01

    This study, based on two levels of technology, applies the power beaming concept to four planned satellite constellations. The analysis shows that with currently available technology, power beaming can provide mass savings to constellations in orbits ranging from low earth orbit to geosynchronous orbit. Two constellations, space surveillance and tracking system and space based radar, can be supported with current technology. The other two constellations, space-based laser array and boost surveillance and tracking system, will require power and transmission system improvements before their breakeven specific mass is achieved. A doubling of SP-100 conversion efficiency from 10 to 20/% would meet or exceed breakeven for these constellations.

  17. Systems and Methods for Providing Insulation

    NASA Technical Reports Server (NTRS)

    Golden, Johnny L. (Inventor)

    2015-01-01

    Systems and methods provide a multi-layer insulation (MLI) that includes a plurality of sealed metalized volumes in a stacked arrangement, wherein the plurality of sealed metalized volumes encapsulate a gas therein, with the gas having one of a thermal insulating property, an acoustic insulating property, or a combination insulating property thereof. The MLI also includes at least one spacer between adjacent sealed metalized volumes of the plurality of sealed metalized volumes and a protective cover surrounding the plurality of sealed metalized volumes.

  18. Making friends for hydro: Providing recreational opportunities

    SciTech Connect

    Cosgrove, J.M. )

    1991-07-01

    One northeastern U.S. utility has been forming friendly ties with the public, offering recreation amenities at its hydro projects. As a result, the company has a strong base of public support as it enters relicensing.

  19. Functional Status Assessment of COPD Based on Ability to Perform Daily Living Activities: A Systematic Review of Paper and Pencil Instruments

    PubMed Central

    Monjazebi, Fateme; Dalvandi, Asghar; Ebadi, Abbas; Khankeh, Hamid Reza; Rahgozar, Mahdi; Richter, Jörg

    2016-01-01

    Context: Activity of daily living (ADL) is an important predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). Increasing ADL is important in patients with COPD and assessment of ADL is one of the best ways to evaluate the status of COPD patients. Objectives: The objective of this systematic review was to provide an overview of the psychometric properties of paper and pencil instruments measuring ADL in patients with COPD. Data Sources: English papers published from 1980 to 2014 regarding ADL in patients with COPD were searched in Web of Science, MEDLINE, Google Scholar, Cochrane, PubMed, ProQuest, and CINAHL databases using the following keywords: “COPD”, “ADL”, “activities of daily living”, “daily activities”, “instrument”, “questionnaire”, “paper-and-pencil instruments”, and “measure”. Following the Internet search, manual search was also done to find article references. Study Selection: A total of 186 articles were found. Of those, 31 met the inclusion criteria. Full texts of articles meeting the inclusion criteria were studied. Consensus-based standards for the selection of health measurement instruments”(COSMIN) were used to assess the quality of the studies. Data Extraction: Data extraction form based on research aims developed by researchers and psychometric experts, with 17 questions was used. Results: In these articles, 14 pen and paper instruments were identified for examining ADL in patients with COPD; of which, 4 dealt directly with ADL while 9 assessed other criteria i.e. dyspnea as ADL indicator. The majority of instruments only dealt with two main dimensions of ADL: Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL), and did not consider Advanced Activities of Daily Living (AADL), which is influenced by cultural and motivational factors. Conclusion: Despite several ADL instruments identified, complete psychometric processes have only been done in

  20. Antenna system providing a spherical radiation pattern

    NASA Technical Reports Server (NTRS)

    Sickles, II, Louis (Inventor)

    1993-01-01

    An antenna system provides a substantially spherical radiation pattern about a structure located above ground level, by locating the individual radiation pattern of each of a plurality of individual antennae, each positioned to have a radiation pattern covering only a portion of the desired sphere, and then applying all antenna signals, during either transmission or reception time intervals, through space-diversity and/or time-diversity apparatus, to cause the patterns of all of the antennae to combine into the desired substantially-spherical pattern. The antennae may have substantially hemispherical patterns, with each antenna of a pair thereof being directed in a direction generally opposite to the other antenna of that pair. Time domain multiple access (TDMA) operation of a master system station, with transmission in different time slots for different portions of the coverage sphere, and selection of the strongest received signal from among all of the plurality N of signals simultaneously received by the plurality N of antennae, can provide the desired spherical radiation pattern in both the transmission and reception modes of operation.

  1. Environmental agency providing policy relevant information

    NASA Astrophysics Data System (ADS)

    Urbančič, J.; Cegnar, T.

    2009-09-01

    The environmental protection agencies are the major providers of comprehensive environmental information to the policy-makers and politician. Information designed for policy-makers should be integrated, carefully selected and aggregated, accompanied with appropriate interpretation. During the process of aggregating the purpose of such aggregation should be kept in focus. Meteorological, climatological and hydrological information should be regarded as part of the integral environmental information. In order to enable high compatibility of environmental information with other kind of information GIS approach was introduced as an efficient and easy tool to present various combinations of data. GIS based Environmental atlas with above 100 layers available is an example of such application. EIONET and SEIS are powerful tools to implement reporting obligations and information providing to policy-makers, general and scientific community. Benefits and priorities for SEIS will be outlined. Some examples including implementation of the INSPIRE directive at the national level, environmental report, environmental indicators and country report to the EU, EEA, OECD, EUROSTAT, UNEP and UNFCCC will be presented.

  2. Emergency preparedness for imaging service providers.

    PubMed

    Junk, Robert; Gilk, Tobias

    2005-01-01

    While the images of Hurricane Katrina are still vivid, it is important to draw from them the lessons that can be applied to protect patient care services in the event of other disasters. It is important that healthcare providers anticipate the possibility of these events and plan accordingly. A comprehensive plan involves preparation for a disaster, prioritization of the community's immediate needs to restore critical patient care services first, and prevention of future event impacts. A number of considerations should serve as a starting point for conversations regarding a facility's emergency preparedness plan. These involve identifying potential natural and man-made disasters, utility interruptions, equipment damage, patient transportation, case prioritization, and potential outside resources. Some important points to remember when preparing for substantial wind and flood damage: Follow original equipment manufacturer (OEM) recommendations regarding preemptive equipment power-down/ramp-down,particularly for concerns about storm quenches. For magnetic resonance imaging (MRI) scanners left running, to p off cryogens, if possible. Cover all non-removable equipment with taped-down heavy plastic sheeting to protect against roof failures/leaks. Raise all electronic equipment and emergency response supplies as high off the floor as safely possible to protect against flooding. Provide adequate food and potable water for staff/patients that cannot be evacuated. Prior to the storm, contact vendors to secure options imaging equipment, portable generators, and cryogen service after the storm passes. If power is lost, restore power to the MRI cold-head as quickly as possible.

  3. 76 FR 66132 - Proposed Collection; Comment Request for Travel Service Provider and Carrier Service Provider...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-25

    ... Department of the Treasury (``OFAC'') to handle travel arrangements to, from, and or within Cuba or to provide charter air service to Cuba. Travel service providers are required to collect information on persons traveling on direct flights to Cuba and forward that information to carrier service providers,...

  4. GIRAFFE test results summary

    SciTech Connect

    Yokobori, S.; Arai, K.; Oikawa, H.

    1996-03-01

    A passive system can provide engineered safety features enhancing safety system reliability and plant simplicity. Toshiba has conducted the test Program to demonstrate the feasibility of the SBWR passive safety system using a full-height, integral system test facility GIRAFFE. The test facility GIRAFFE models the SBWR in full height to correctly present the gravity driving head forces with a 1/400 volume scale. The GIRAFFE test Program includes the certification tests of the passive containment cooling system (PCCS) to remove the post-accident decay heat and the gravity driven cooling system (GDCS) to replenish the reactor coolant inventory during a LOCA. The test results have confirmed the PCCS and GDCS design and in addition, have demonstrated the operation of the pCCS with the presence of a lighter-than-steam noncondensable as well as with the presence of a heavier-than-steam, noncondensable. The GIRAFFE test Program has also provided the database to qualify a best estimate thermal-hydraulic computer code TRAC. The post test analysis results have shown that TRAC can accurately predict the PCCS heat removal Performance and the containment pressure response to a LOCA. This paper summarizes the GIRAFFE test results to investigate post-LOCA PCCS heat removal performance and post-test analysis using TRAC.

  5. Optical fiber head for providing lateral viewing

    DOEpatents

    Everett, Matthew J.; Colston, Billy W.; James, Dale L.; Brown, Steve; Da Silva, Luiz

    2002-01-01

    The head of an optical fiber comprising the sensing probe of an optical heterodyne sensing device includes a planar surface that intersects the perpendicular to axial centerline of the fiber at a polishing angle .theta.. The planar surface is coated with a reflective material so that light traveling axially through the fiber is reflected transverse to the fiber's axial centerline, and is emitted laterally through the side of the fiber. Alternatively, the planar surface can be left uncoated. The polishing angle .theta. must be no greater than 39.degree. or must be at least 51.degree.. The emitted light is reflected from adjacent biological tissue, collected by the head, and then processed to provide real-time images of the tissue. The method for forming the planar surface includes shearing the end of the optical fiber and applying the reflective material before removing the buffer that circumscribes the cladding and the core.

  6. Providing Spatial Data for Secondary Analysis

    PubMed Central

    Gutmann, Myron; Witkowski, Kristine; Colyer, Corey; O’Rourke, JoAnne McFarland; McNally, James

    2008-01-01

    Spatially explicit data pose a series of opportunities and challenges for all the actors involved in providing data for long-term preservation and secondary analysis -- the data producer, the data archive, and the data user. We report on opportunities and challenges for each of the three players, and then turn to a summary of current thinking about how best to prepare, archive, disseminate, and make use of social science data that have spatially explicit identification. The core issue that runs through the paper is the risk of the disclosure of the identity of respondents. If we know where they live, where they work, or where they own property, it is possible to find out who they are. Those involved in collecting, archiving, and using data need to be aware of the risks of disclosure and become familiar with best practices to avoid disclosures that will be harmful to respondents. PMID:19122860

  7. Hubble Provides Clear Images of Saturn's Aurora

    NASA Technical Reports Server (NTRS)

    1998-01-01

    This is the first image of Saturn's ultraviolet aurora taken by the Space Telescope Imaging Spectrograph (STIS) on board the Hubble Space Telescope in October 1997, when Saturn was a distance of 810 million miles (1.3 billion kilometers) from Earth. The new instrument, used as a camera, provides more than ten times the sensitivity of previous Hubble instruments in the ultraviolet. STIS images reveal exquisite detail never before seen in the spectacular auroral curtains of light that encircle Saturn's north and south poles and rise more than a thousand miles above the cloud tops.

    Saturn's auroral displays are caused by an energetic wind from the Sun that sweeps over the planet, much like the Earths aurora that is occasionally seen in the nighttime sky and similar to the phenomenon that causes fluorescent lamps to glow. But unlike the Earth, Saturn's aurora is only seen in ultraviolet light that is invisible from the Earths surface, hence the aurora can only be observed from space. New Hubble images reveal ripples and overall patterns that evolve slowly, appearing generally fixed in our view and independent of planet rotation. At the same time, the curtains show local brightening that often follow the rotation of the planet and exhibit rapid variations on time scales of minutes. These variations and regularities indicate that the aurora is primarily shaped and powered by a continual tug-of-war between Saturn's magnetic field and the flow of charged particles from the Sun.

    Study of the aurora on Saturn had its beginnings just seventeen years ago. The Pioneer 11 spacecraft observed a far-ultraviolet brightening on Saturn's poles in 1979. The Saturn flybys of the Voyager 1 and 2 spacecraft in the early 1980s provided a basic description of the aurora and mapped for the first time planets enormous magnetic field that guides energetic electrons into the atmosphere near the north and south poles.

    The first images of Saturn's aurora were provided in 1994-5 by the

  8. Perioperative Care of Prisoners: Providing Safe Care.

    PubMed

    Smith, Francis Duval

    2016-03-01

    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel.

  9. Do drug advertisements provide therapeutic information?

    PubMed

    Stimson, G V

    1977-03-01

    In this study of advertisements appearing in medical periodicals and by direct mail advertising to general practitioners, Dr. Stimson, a sociologist, concludes that from what is intended to provide therapeutic information hardly any therapeutic information is provided. He reminds the reader of the safeguards which surround all drug advertising by law and by the code of practice of the Association of the British Pharmaceutical Industry but these safeguards do not appear to control real or potential sins of omission. Frequently in these advertisements the literature relating to the drug is quoted but Dr. Stimson found that it was difficult to trace all the papers quoted in different types of medical library. (Some references quoted were to unpublished papers but surely the blame should be shared in this situation?) Dr. Stimson also gives a vivid and fascinating glimpse of what he calls the 'images and stereotypes' of the patients who, it is claimed, would benefit from the drug being advertised. Certainly most general practitioners must be aware that when they prescribe that image is displaced by an individual but the portrait gallery is indeed depressing. However, to balance these advertisements drug companies issue data sheets which must be more informative than advertisements and conform to regulations in their format. Unfortunately data sheets are only issued every 15 months whereas the 'average general practitioner is potentially exposed to 1,300 advertisements every month'. In other words, the data sheet and not the advertisement should be the guideline but it arrives too infrequently to offset the lack of therapeutic information contained in advertisements. PMID:870694

  10. Increasing Access to Health Care Providers with Nurse Practitioner Competencies

    ERIC Educational Resources Information Center

    Grace, Del Marjorie

    2014-01-01

    Emergency department visits increased from 102.8 million to 136.1 million in 2009, resulting in crowding and increased wait times, affecting U.S. hospitals' ability to provide safe, timely patient care resulting in dangerous delays and serious health problems shown by research. The purpose of this project was to determine if competencies developed…

  11. Managing Illinois Libraries: Providing Services Customers Value.

    ERIC Educational Resources Information Center

    Walzer, Norman; Stott, Karen; Sutton, Lori

    Public libraries are an important asset in virtually any size community, but especially in small towns where many social institutions are in decline or have left. Libraries increase the quality of life, help attract new residents, and support the quality of life that is essential to attracting businesses. Results from surveys of library users,…

  12. ESR teleradiology survey: results.

    PubMed

    2016-08-01

    With recent developments of teleradiology technology and services, it has become necessary to better evaluate its extent and use among different countries in Europe. With this goal in mind, the ESR launched two specific surveys intended to gather the current state of adoption and implementation of teleradiology in clinical practice. A special focus on differentiating between insourcing teleradiology services among partners of the same organisation and outsourcing to external services was an essential part of the design of these surveys. The first survey was addressed to 44 national societies of different countries in Europe, while the second survey was intended for all practicing radiologist ESR members. While the results of these surveys reported here may provide a wealth of information to better understand the trends in adoption of teleradiology in Europe, they only represent a snapshot at a certain point in time. The rapid development of telecommunication tools as well as a fundamental change in practice and healthcare economics will certainly influence these observations in the upcoming years. These data, however, will provide objective and relevant parameters for supporting the efforts of experts and policy makers in promoting appropriate criteria and guidelines for adequate use of teleradiology in clinical practice. Main Messages • Understand concepts and challenges of teleradiology • Provide insight into current trends and solutions for teleradiology • Compare differences in teleradiolgy strategies between countries in Europe • Establish a reference on statistical data of usage of teleradiology in Europe. PMID:27188379

  13. Hubble Provides Complete View of Jupiter's Auroras

    NASA Technical Reports Server (NTRS)

    1998-01-01

    NASA's Hubble Space Telescope has captured a complete view of Jupiter's northern and southern auroras.

    Images taken in ultraviolet light by the Space Telescope Imaging Spectrograph (STIS) show both auroras, the oval-shaped objects in the inset photos. While the Hubble telescope has obtained images of Jupiter's northern and southern lights since 1990, the new STIS instrument is 10 times more sensitive than earlier cameras. This allows for short exposures, reducing the blurring of the image caused by Jupiter's rotation and providing two to five times higher resolution than earlier cameras. The resolution in these images is sufficient to show the 'curtain' of auroral light extending several hundred miles above Jupiter's limb (edge). Images of Earth's auroral curtains, taken from the space shuttle, have a similar appearance. Jupiter's auroral images are superimposed on a Wide Field and Planetary Camera 2 image of the entire planet. The auroras are brilliant curtains of light in Jupiter's upper atmosphere. Jovian auroral storms, like Earth's, develop when electrically charged particles trapped in the magnetic field surrounding the planet spiral inward at high energies toward the north and south magnetic poles. When these particles hit the upper atmosphere, they excite atoms and molecules there, causing them to glow (the same process acting in street lights).

    The electrons that strike Earth's atmosphere come from the sun, and the auroral lights remain concentrated above the night sky in response to the 'solar wind.'

  14. Providing effective supervision in clinical neuropsychology.

    PubMed

    Stucky, Kirk J; Bush, Shane; Donders, Jacobus

    2010-01-01

    A specialty like clinical neuropsychology is shaped by its selection of trainees, educational standards, expected competencies, and the structure of its training programs. The development of individual competency in this specialty is dependent to a considerable degree on the provision of competent supervision to its trainees. In clinical neuropsychology, as in other areas of professional health-service psychology, supervision is the most frequently used method for teaching a variety of skills, including assessment, report writing, differential diagnosis, and treatment. Although much has been written about the provision of quality supervision in clinical and counseling psychology, very little published guidance is available regarding the teaching and provision of supervision in clinical neuropsychology. The primary focus of this article is to provide a framework and guidance for the development of suggested competency standards for training of neuropsychological supervisors, particularly at the residency level. In this paper we outline important components of supervision for neuropsychology trainees and suggest ways in which clinicians can prepare for supervisory roles. Similar to Falender and Shafranske (2004), we propose a competency-based approach to supervision that advocates for a science-informed, formalized, and objective process that clearly delineates the competencies required for good supervisory practice. As much as possible, supervisory competencies are related to foundational and functional competencies in professional psychology, as well as recent legislative initiatives mandating training in supervision. It is our hope that this article will foster further discussion regarding this complex topic, and eventually enhance training in clinical neuropsychology.

  15. Synonyms Provide Semantic Preview Benefit in English

    PubMed Central

    Schotter, Elizabeth R.

    2013-01-01

    While orthographic and phonological preview benefits in reading are uncontroversial (see Schotter, Angele, & Rayner, 2012 for a review), researchers have debated the existence of semantic preview benefit with positive evidence in Chinese and German, but no support in English. Two experiments, using the gazecontingent boundary paradigm (Rayner, 1975), show that semantic preview benefit can be observed in English when the preview and target are synonyms (share the same or highly similar meaning, e.g., curlers-rollers). However, no semantic preview benefit was observed for semantic associates (e.g., curlers-styling). These different preview conditions represent different degrees to which the meaning of the sentence changes when the preview is replaced by the target. When this continuous variable (determined by a norming procedure) was used as the predictor in the analyses, there was a significant relationship between it and all reading time measures, suggesting that similarity in meaning between what is accessed parafoveally and what is processed foveally may be an important influence on the presence of semantic preview benefit. Why synonyms provide semantic preview benefit in reading English is discussed in relation to (1) previous failures to find semantic preview benefit in English and (2) the fact that semantic preview benefit is observed in other languages even for non-synonymous words. Semantic preview benefit is argued to depend on several factors—attentional resources, depth of orthography, and degree of similarity between preview and target. PMID:24347813

  16. Contingency management: perspectives of Australian service providers.

    PubMed

    Cameron, Jacqui; Ritter, Alison

    2007-03-01

    Given the very positive and extensive research evidence demonstrating efficacy and effectiveness of contingency management, it is important that Australia explore whether contingency management has a role to play in our own treatment context. Qualitative interviews were conducted with 30 experienced alcohol and drug practitioners, service managers and policy-makers in Victoria. Interviewees were selected to represent the range of drug treatment services types and included rural representation. A semi-structured interview schedule, covering their perceptions and practices of contingency management was used. All interviews were transcribed verbatim and analysed using N2 qualitative data analysis program. The majority of key informants were positively inclined toward contingency management, notwithstanding some concerns about the philosophical underpinnings. Concerns were raised in relation to the use of monetary rewards. Examples of the use of contingency management provided by key informants demonstrated an over-inclusive definition: all the examples did not adhere to the key principles of contingency management. This may create problems if a structured contingency management were to be introduced in Australia. Contingency management is an important adjunctive treatment intervention and its use in Australia has the potential to enhance treatment outcomes. No unmanageable barriers were identified in this study. PMID:17364854

  17. Can Economics Provide Insights into Trust Infrastructure?

    NASA Astrophysics Data System (ADS)

    Vishik, Claire

    Many security technologies require infrastructure for authentication, verification, and other processes. In many cases, viable and innovative security technologies are never adopted on a large scale because the necessary infrastructure is slow to emerge. Analyses of such technologies typically focus on their technical flaws, and research emphasizes innovative approaches to stronger implementation of the core features. However, an observation can be made that in many cases the success of adoption pattern depends on non-technical issues rather than technology-lack of economic incentives, difficulties in finding initial investment, inadequate government support. While a growing body of research is dedicated to economics of security and privacy in general, few theoretical studies in this area have been completed, and even fewer that look at the economics of “trust infrastructure” beyond simple “cost of ownership” models. This exploratory paper takes a look at some approaches in theoretical economics to determine if they can provide useful insights into security infrastructure technologies and architectures that have the best chance to be adopted. We attempt to discover if models used in theoretical economics can help inform technology developers of the optimal business models that offer a better chance for quick infrastructure deployment.

  18. Contingency management: perspectives of Australian service providers.

    PubMed

    Cameron, Jacqui; Ritter, Alison

    2007-03-01

    Given the very positive and extensive research evidence demonstrating efficacy and effectiveness of contingency management, it is important that Australia explore whether contingency management has a role to play in our own treatment context. Qualitative interviews were conducted with 30 experienced alcohol and drug practitioners, service managers and policy-makers in Victoria. Interviewees were selected to represent the range of drug treatment services types and included rural representation. A semi-structured interview schedule, covering their perceptions and practices of contingency management was used. All interviews were transcribed verbatim and analysed using N2 qualitative data analysis program. The majority of key informants were positively inclined toward contingency management, notwithstanding some concerns about the philosophical underpinnings. Concerns were raised in relation to the use of monetary rewards. Examples of the use of contingency management provided by key informants demonstrated an over-inclusive definition: all the examples did not adhere to the key principles of contingency management. This may create problems if a structured contingency management were to be introduced in Australia. Contingency management is an important adjunctive treatment intervention and its use in Australia has the potential to enhance treatment outcomes. No unmanageable barriers were identified in this study.

  19. Latest results from Planck

    NASA Astrophysics Data System (ADS)

    Tauber, Jan; sSubmitted Planck Collaboration

    2016-01-01

    This talk will present an overview of the most recent Planck data and results, with emphasis on polarization.The use of CMB polarization data from Planck confirms the best-fit Lambda-CDM model obtained with Planck temperature-only data, and improves the accuracy with which cosmological parameters are determined. The most recent results based on polarized E-mode and B-mode CMB power spectra at large angular scales will be presented, and their implications for the epoch of reionization and primordial gravitational waves.In this talk I will also present the latest analysis of polarized diffuse galactic foreground emissions based on Planck data. Both the synchrotron and dust emission maps obtained from Planck reveal new facets of the galactic interstellar medium. In particular dust emission holds the promise of providing a model of the large-scale 3D shape of the Galactic magnetic field, as well as its small scale behavior.

  20. Provider Use of Collaborative Goal Setting with Glaucoma Patients

    PubMed Central

    Sleath, Betsy; Slota, Catherine; Blalock, Susan J.; Sayner, Robyn; Carpenter, Delesha M.; Muir, Kelly W.; Hartnett, Mary Elizabeth; Robin, Alan L.

    2014-01-01

    Purpose The purpose of this preliminary study was to describe the extent to which providers used collaborative goal setting and individualized assessment with patients who were newly prescribed glaucoma medications. Methods English-speaking glaucoma suspect patients from six ophthalmology clinics who were newly prescribed glaucoma medications had their medical visits video-tape recorded and were interviewed after the visits. The video-tapes were transcribed and coded to examine provider use of collaborative goal setting and individualized assessment. Results Fifty-one patients seeing 12 ophthalmologists participated. Providers gave patients glaucoma treatment options during 37% of the visits; only five providers gave patients treatment options Providers asked for patient treatment preferences in less than 20% of the visits; only two providers asked for patient treatment preferences. Providers were significantly more likely to ask African American patients for their preferences or ideas concerning treatment than non-African American patients (Pearson chi-square= 4.1, p=0.04). Providers were also significantly more likely to ask African American patients about their confidence in using glaucoma medication regularly than non-African American patients (Pearson chi-square=8.2, p=0.004). Providers asked about patient views about glaucoma in less than 20% of the visits; five providers asked patients their views on glaucoma and its treatment. Providers were significantly more likely to ask African American patients about their views of glaucoma than non-African American patients (Pearson chi-square=5.62, p=0.02). Conclusions Eye care providers often did not use collaborative goal setting or conduct individualized assessments of patient views of glaucoma when prescribing treatment for the first time. PMID:24705480

  1. Provider knowledge, attitudes and treatment preferences for early pregnancy failure

    PubMed Central

    Dalton, Vanessa K.; Harris, Lisa H.; Gold, Katherine J.; Kane-Low, Lisa; Schulkin, Jay; Guire, Ken; Fendrick, A. Mark

    2010-01-01

    Objective To describe health care provider knowledge, attitudes and treatment preferences for early pregnancy failure (EPF). Study Design We surveyed 976 obstetrician/gynecologists, midwives and family medicine practitioners on their knowledge and attitudes toward treatment options for EPF, and barriers to adopting misoprostol and office uterine evacuations. We used descriptive statistics to compare practices by provider specialty and logistic regression to identify associations between provider factors and treatment practices. Results Seventy percent of providers have not used misoprostol and 91% have not used an office uterine evacuation to treat EPF in the past 6 months. Beliefs about safety and patient preferences, and prior induced abortion training were significantly associated with use of both of these treatments. Conclusions Increasing education and training on the use of misoprostol and office uterine evacuation, and clarifying patient treatment preferences may increase the willingness of providers to adopt new practices for EPF treatment. PMID:20227674

  2. Providers must plan for accrual of medical malpractice claims.

    PubMed

    Zatorski, R

    1988-11-01

    Because of the change in accounting regulations that requires accrual for certain medical malpractice claims, healthcare providers could soon be experiencing significant effects on their financial results. AICPA Statement Position 87-1, "Accounting for Asserted and Unasserted Medical Malpractice Claims of Health Care Providers and Related Issues," states that if healthcare providers have not transferred all risk for medical malpractice claims arising out of occurrences prior to the financial statement date to a third party, some accrual will be required. Providers need to prepare themselves for the financial problems that could arise from these reporting guidelines. Estimating the potential accrual amounts with advanced planning and extensive data gathering and analysis could lower a healthcare provider's financial risk.

  3. Provide thermogravimetric analysis data to performance assessment

    SciTech Connect

    Gdowski, G.

    1998-01-01

    Recent experimental testing has investigated the effect of a deposited mixed salt on the corrosion of carbon steel in high relative humidity air. This result is compared with previous studies where pure sodium chloride was deposited. There are aspects of the degradation process which are significantly different when the different salts are deposited. With deposited sodium chloride, corrosion occurs almost immediately after introduction of 80% RH air. With deposited mixed salts, there is an initial inhibition of corrosion in 80% RH air. After the initial inhibition period, corrosion occurs at localized regions of the specimen. At longer times, the specimen suffers extensive corrosion. A very porous and non-adherent corrosion product forms and readily spalls. The initial inhibition of the corrosion with the deposited mixed salt is most likely due to the bicarbonate component. Bicarbonate is a known inhibitor of general corrosion of carbon steel [Thomas, 1994] and a promoter of localized corrosion at moderate alkalinity when chloride ions are present [Marsh, 1985]. The results of this testing indicate that the bicarbonate component of thin water layers can initially inhibit corrosion of the carbon steel. With time, however, inhibition is lost. A mechanism for this loss of inhibition is suggested. It is plausible that moderately alkaline bicarbonate aqueous solutions could develop on the surface of a waste package due to Yucca Mountain water contacting the waste packages. Aqueous conditions might develop where carbon steel is susceptible to localized corrosion [Dunn, 1998]. The initial test results presented here suggest that the inhibition of general corrosion, and hence, the promotion of localized corrosion of carbon steel by thin aqueous bicarbonate-chloride layers may not be sustainable. Additional testing is underway to further understand the effects of thin aqueous solution chemistry on carbon steel corrosion.

  4. Bacteria Provide Cleanup of Oil Spills, Wastewater

    NASA Technical Reports Server (NTRS)

    2010-01-01

    Through Small Business Innovation Research (SBIR) contracts with Marshall Space Flight Center, Micro-Bac International Inc., of Round Rock, Texas, developed a phototrophic cell for water purification in space. Inside the cell: millions of photosynthetic bacteria. Micro-Bac proceeded to commercialize the bacterial formulation it developed for the SBIR project. The formulation is now used for the remediation of wastewater systems and waste from livestock farms and food manufacturers. Strains of the SBIR-derived bacteria also feature in microbial solutions that treat environmentally damaging oil spills, such as that resulting from the catastrophic 2010 Deepwater Horizon oil rig explosion in the Gulf of Mexico.

  5. Providing a cure for beta thalassaemia major.

    PubMed

    Chan, L L; Lin, H P; Ariffn, W A; Ariffin, H

    2001-12-01

    The current treatment options for beta thalassaemia major patients include conservative treatment with blood cell transfusions and iron chelation or stem cell transplantation. Regular blood transfusions inevitably lead to multi-organ haemosiderosis and are attended by risks of blood-borne infections. Results from stem cell transplantation are good and suggest that this should be offered as first line therapy when a matched sibling donor is available because the patient is often cured and able to live a normal life. Of 38 Malaysian children who underwent bone marrow or cord blood transplantations using matched sibling donors, 29 (76%) are now cured.

  6. Clinical forensic medicine introduction for healthcare providers.

    PubMed

    Recktenwald, Kathy; Hunsaker, Donna M; Corey, Tracey S; Weakley-Jones, Barbara

    2005-09-01

    Clinical forensic medicine (CFM) is "the application of appropriate forensic practices and principles, heretofore reserved for use by the pathologist at autopsy, to living patients in a clinical setting." "Living forensic" patients include survivors of trauma and potentially catastrophic experiences resulting in injury. CFM arose from "clinically" affirming that not all abuse or assault victims sustain fatal injuries. Appropriate medical documentation and interpretation of physical findings may aid law enforcement and/or social services in the legal evaluation of a case or situation. Additionally, timely collection of pertinent evidence may be performed as the case necessitates.

  7. Providing and financing aged care in Australia

    PubMed Central

    Ergas, Henry; Paolucci, Francesco

    2011-01-01

    This article focuses on the provision and financing of aged care in Australia. Demand for aged care will increase substantially as a result of population aging, with the number of Australians aged 85 and over projected to increase from 400,000 in 2010 to over 1.8 million in 2051. Meeting this demand will greatly strain the current system, and makes it important to exploit opportunities for increased efficiency. A move to greater beneficiary co-payments is also likely, though its extent may depend on whether aged care insurance and other forms of pre-payment can develop. PMID:22312229

  8. The use of free resources in a subscription-based digital library: a case study of the North Carolina AHEC Digital Library

    PubMed Central

    Schell, Mary Beth

    2006-01-01

    Background The North Carolina (NC) Area Health Education Center's (AHEC) Digital Library (ADL) is a web portal designed to meet the information needs of health professionals across the state by pulling together a set of resources from numerous different sources and linking a pool of users to only the resources for which they have eligibility. Although the ADL was designed with the primary purpose of linking health care professionals to a set of licensed resources, the ADL also contains a significant number of links to free resources. These resources are available to any ADL member logging into their ADL account and to guest visitors to the ADL. While there are regular assessments of the subscription resources in the ADL as to utility and frequency of use, up until this point there has been no systematic analysis of the use of the overall set of free resources. It was decided to undertake an examination of the usage of ADL free resources over a 6-month period to analyze the utility of these resources to both ADL members and guests. Methods Each time a resource is accessed through the ADL, it is logged in a table. This study used a SQL query to pull every free resource accessed between November 1, 2005 and April 30, 2006. An additional query also pulled the user information for each free resource accessed. Once the queries of the database were complete, the results were imported into an Excel spreadsheet and analyzed using basic descriptive statistics. Results The vast majority of resource use through the ADL is to licensed resources. There are 2056 free resource URLs in the ADL, to which 1351 were linked out, meaning there was at least one link out to 65% of the free resources. The single most popular free resource was PubMed with 4803 link outs or nearly 20% of the total link outs to free resources. The breakdown of free resource use by different use groups indicates that the highest percentage of use of free resources was by guests followed by institutional

  9. The state of the psychology health service provider workforce.

    PubMed

    Michalski, Daniel S; Kohout, Jessica L

    2011-12-01

    Numerous efforts to describe the health service provider or clinical workforce in psychology have been conducted during the past 30 years. The American Psychological Association (APA) has studied trends in the doctoral education pathway and the resultant effects on the broader psychology workforce. During this period, the creation and growth of the PsyD degree and the formalization of the predoctoral internship placement system (the APPIC Match) have been well noted, but efforts to gain a complete understanding of professional practice are lacking. Specifically, piecemeal research on the provider workforce has led to the study of specific subpopulations using varying approaches and definitions of those providing direct clinical service. Consequently, estimates of the supply and need for health service providers are distinctly divergent and generate protracted debate in organized psychology. The APA membership directory and the APA Doctorate Employment Surveys have traditionally been relied on for workforce analyses. Yet, these data have become characterized by limited generalizability in recent years because of declining survey response rates and the fact that APA member data may not be as representative of the entire psychology health service provider population as they were previously. The 2008 APA Survey of Psychology Health Service Providers targeted these limitations by including nonmember psychologists in the sampling frame. Results revealed emerging themes in the demographics, work settings, and delivery of health services of the psychology health service provider workforce. Future areas of research for APA and organized psychology to undertake in addressing need and demand are suggested.

  10. Osteophagia provide giraffes with phosphorus and calcium?

    PubMed

    Bredin, I P; Skinner, J D; Mitchell, G

    2008-03-01

    The daily requirement for calcium and phosphorus by giraffes to sustain the growth and maintenance of their skeletons is large. The source of sufficient calcium is browse. The source of necessary phosphorus is obscure, but it could be osteophagia, a frequently observed behaviour in giraffes. We have assessed whether bone ingested as a result of osteophagia can be digested in the rumen. Bone samples from cancellous (cervical vertebrae) and dense bones (metacarpal shaft) were immersed in the rumens of five sheep, for a period of up to 30 days, and the effect compared to immersion in distilled water and in artificial saliva for 30 days. Distilled water had no effect on the bones. Dense bone samples were softened by exposure to the saliva and rumen fluid, but did not lose either calcium or phosphorus. In saliva and rumen fluid the cancellous bone samples also softened, and their mass and volume decreased as a result of exposure to saliva, but in neither fluid did they lose significant amounts of calcium and phosphorus. We conclude that although saliva and rumen fluid can soften ingested bones, there is an insignificant digestion of bones in the rumen.

  11. [The applicability of results].

    PubMed

    Marín-León, I

    2015-11-01

    The ultimate aim of the critical reading of medical literature is to use the scientific advances in clinical practice or for innovation. This requires an evaluation of the applicability of the results of the studies that have been published, which begins with a clear understanding of these results. When the studies do not provide sufficient guarantees of rigor in design and analysis, the conditions necessary for the applicability of the results are not met; however, the fact that the results are reliable is not enough to make it worth trying to use their conclusions. This article explains how carrying out studies in experimental or artificial conditions often moves them away from the real conditions in which they claim to apply their conclusions. To evaluate this applicability, the article proposes evaluating a set of items that will enable the reader to determine the likelihood that the benefits and risks reported in the studies will yield the least uncertainty in the clinical arena where they aim to be applied.

  12. Parenting provided by adults with mental retardation.

    PubMed

    Dowdney, L; Skuse, D

    1993-01-01

    Studies assessing the quality of parenting provided by adults with mental retardation present conflicting conclusions. Some consider the majority to be doing reasonably well, whilst others report frequently unsatisfactory caretaking. There are a number of reasons for such different views. First, inconsistent selection criteria make it hard to compare across studies. In particular, sample composition will be influenced by the recruitment source. For example, if parents have been chosen from voluntary educational programmes a rather different picture is likely to be found than if they have been selected from individuals known to, or referred by, statutory agencies. On the whole, authors working with subjects from the former source have been rather more optimistic than those working with parents referred because there were already serious concerns about parenting difficulties or about delayed child development. Secondly, the majority of studies have used poorly defined global measures of parenting, with variable criteria of what constitutes adequate care. Some have concentrated on physical care and hygiene, whilst others have looked for the presence of affection and warmth. A child's reception into care as the sole measure of the quality of parenting is an unsatisfactory criterion because parental retardation has itself occasionally been used as the basis for removal of a child into care, even in the absence of other evidence of neglect or abuse. Thirdly, methodological flaws are found in studies that have used observational assessments of parenting. Such studies have suggested mothers with mental retardation tend to lack interactive skills (such as high levels of praise and imitation, and low restrictiveness) which are known to be associated with optimal child development. Control groups have often not been matched on social and other variables which might be expected to exert a significant influence upon parenting practices. In addition, the generalisability of

  13. Parenting provided by adults with mental retardation.

    PubMed

    Dowdney, L; Skuse, D

    1993-01-01

    Studies assessing the quality of parenting provided by adults with mental retardation present conflicting conclusions. Some consider the majority to be doing reasonably well, whilst others report frequently unsatisfactory caretaking. There are a number of reasons for such different views. First, inconsistent selection criteria make it hard to compare across studies. In particular, sample composition will be influenced by the recruitment source. For example, if parents have been chosen from voluntary educational programmes a rather different picture is likely to be found than if they have been selected from individuals known to, or referred by, statutory agencies. On the whole, authors working with subjects from the former source have been rather more optimistic than those working with parents referred because there were already serious concerns about parenting difficulties or about delayed child development. Secondly, the majority of studies have used poorly defined global measures of parenting, with variable criteria of what constitutes adequate care. Some have concentrated on physical care and hygiene, whilst others have looked for the presence of affection and warmth. A child's reception into care as the sole measure of the quality of parenting is an unsatisfactory criterion because parental retardation has itself occasionally been used as the basis for removal of a child into care, even in the absence of other evidence of neglect or abuse. Thirdly, methodological flaws are found in studies that have used observational assessments of parenting. Such studies have suggested mothers with mental retardation tend to lack interactive skills (such as high levels of praise and imitation, and low restrictiveness) which are known to be associated with optimal child development. Control groups have often not been matched on social and other variables which might be expected to exert a significant influence upon parenting practices. In addition, the generalisability of

  14. Providing Data Access for Interdisciplinary Research

    NASA Astrophysics Data System (ADS)

    Hooper, R. P.; Couch, A.

    2012-12-01

    Developing an interdisciplinary understanding of human and environmental interactions with water requires access to a variety of data kinds collected by various organizations. The CUAHSI Hydrologic Information System (HIS) is a standards-based, services-oriented architecture designed for time-series data. Such data represents an important type of data in water studies. Through the efforts of HIS, a standard transmission language, WaterML2, has been adopted by the Open Geospatial Consortium and is under consideration by the World Meteorologic Organization as an international standards. Web services have also been developed to retrieve data and metadata. HIS is completed with a metadata catalog, hosted by San Diego Supercomputing Center, which indexes more than 20 million time series provided from over 90 different services. This catalog is supported through a hierarchically organized controlled vocabulary that is open for community input and mediation. Data publishers include federal agencies, universities, state agencies, and non-profit organizations such as watershed associations. Accessing data from such a broad spectrum of sources through a uniform service standard promises to truly transform the way in which hydrologic research is done. CUAHSI HIS is a large-scale prototype at this time, but a proposal is under consideration by the National Science Foundation to operationalize HIS through a data facility, tentatively called the CUAHSI Water Data Center. Establishing HIS is an important step to enable research into human-environment interactions with water, but it is only one step. Other data structures will need to be made accessible and interoperable to support this research. Some data—such as two-dimensional GIS coverages—already have widely used standards for transmission and sharing. The US Federal government has long operated a clearinghouse for federal geographic data that is now being augmented with other services such as ArcGIS OnLine. Other data

  15. Shoplifting prevention: providing information through signs

    PubMed Central

    McNees, M. Patrick; Egli, Daniel S.; Marshall, Rebecca S.; Schnelle, John F.; Risley, Todd R.

    1976-01-01

    Shoplifting is one of the most frequent crimes in the United States, yet there is no agreement about effective prevention procedures. Since most prevention strategies are aimed at either increasing public awareness of the severity of the consequences or increasing the threat of detection, procedures that contain these elements were evaluated. Posting signs around a department of a department store pointing out that shoplifting is a crime, etc., partially reduced shoplifting rates. When merchandise that was frequently taken was identified by signs and stars, shoplifting decreased to near zero. Publicity campaigns to inform the public of consequences for shoplifting may produce desirable results, but identifying likely shoplifting targets, which may increase the likelihood of detection, effectively reduces shoplifting rates. PMID:16795530

  16. Finance, providers issue brief: insurer liability.

    PubMed

    Rothouse, M; Stauffer, M

    2000-05-24

    When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those were questions 35 states considered in 1999, and at least 32 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves. PMID:11073416

  17. Finance, providers issue brief: insurer liability.

    PubMed

    Rothouse, M

    1999-07-01

    When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those are questions 29 states considered in 1998, and at least 35 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves. PMID:11073388

  18. Review of Pesticide Education Materials for Health Care Providers Providing Care to Agricultural Workers

    ERIC Educational Resources Information Center

    Hiott, Ann E.; Quandt, Sara A.; Early, Julie; Jackson, David S.; Arcury, Thomas A.

    2006-01-01

    Context: Pesticide exposure is an important environmental and occupational health risk for agricultural workers and their families, but health care providers receive little training in it. Objective: To evaluate the medical resources available to providers caring for patients, particularly farmworkers, exposed to pesticides and to recommend a…

  19. 22 CFR 96.14 - Providing adoption services using other providers.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Providing adoption services using other... ACCREDITATION OF AGENCIES AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Accreditation and Approval Requirements for the Provision of Adoption Services § 96.14 Providing...

  20. 22 CFR 96.14 - Providing adoption services using other providers.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Providing adoption services using other... ACCREDITATION OF AGENCIES AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Accreditation and Approval Requirements for the Provision of Adoption Services § 96.14 Providing...

  1. 22 CFR 96.14 - Providing adoption services using other providers.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Providing adoption services using other... ACCREDITATION OF AGENCIES AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Accreditation and Approval Requirements for the Provision of Adoption Services § 96.14 Providing...

  2. 22 CFR 96.14 - Providing adoption services using other providers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Providing adoption services using other... ACCREDITATION OF AGENCIES AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Accreditation and Approval Requirements for the Provision of Adoption Services § 96.14 Providing...

  3. 22 CFR 96.14 - Providing adoption services using other providers.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Providing adoption services using other... ACCREDITATION OF AGENCIES AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA) Accreditation and Approval Requirements for the Provision of Adoption Services § 96.14 Providing...

  4. Provider Opinions Regarding the Development of a Stigma-Reduction Intervention Tailored for Providers

    ERIC Educational Resources Information Center

    Mittal, Dinesh; Corrigan, Patrick; Drummond, Karen L.; Porchia, Sylvia; Sullivan, Greer

    2016-01-01

    Interventions involving contact with a person who has recovered from mental illness are most effective at reducing stigma. This study sought input from health care providers to inform the design of a contact intervention intended to reduce provider stigma toward persons with serious mental illness. Using a purposive sampling strategy, data were…

  5. Providers' response to child eating behaviors: A direct observation study.

    PubMed

    Tovar, Alison; Vaughn, Amber E; Fallon, Megan; Hennessy, Erin; Burney, Regan; Østbye, Truls; Ward, Dianne S

    2016-10-01

    Child care providers play an important role in feeding young children, yet little is known about children's influence on providers' feeding practices. This qualitative study examines provider and child (18 months -4 years) feeding interactions. Trained data collectors observed 200 eating occasions in 48 family child care homes and recorded providers' responses to children's meal and snack time behaviors. Child behaviors initiating provider feeding practices were identified and practices were coded according to higher order constructs identified in a recent feeding practices content map. Analysis examined the most common feeding practices providers used to respond to each child behavior. Providers were predominately female (100%), African-American (75%), and obese (77%) and a third of children were overweight/obese (33%). Commonly observed child behaviors were: verbal and non-verbal refusals, verbal and non-verbal acceptance, being "all done", attempts for praise/attention, and asking for seconds. Children's acceptance of food elicited more autonomy supportive practices vs. coercive controlling. Requests for seconds was the most common behavior, resulting in coercive controlling practices (e.g., insisting child eat certain food or clean plate). Future interventions should train providers on responding to children's behaviors and helping children become more aware of internal satiety and hunger cues. PMID:27328098

  6. MARTIAN COLORS PROVIDE CLUES ABOUT MARTIAN WATER

    NASA Technical Reports Server (NTRS)

    2002-01-01

    NASA Hubble Space Telescope images of Mars taken in visible and infrared light detail a rich geologic history and provide further evidence for water-bearing minerals on the planet's surface. LEFT This 'true-color' image of Mars shows the planet as it would look to human eyes. It is clearly more earth-toned than usually depicted in other astronomical images, including earlier Hubble pictures. The slightly bluer shade along the edges of the disk is due to atmospheric hazes and wispy water ice clouds (like cirrus clouds) in the early morning and late evening Martian sky. The yellowish-pink color of the northern polar cap indicates the presence of small iron-bearing dust particles. These particles are covering or are suspended in the air above the blue-white water ice and carbon dioxide ice, which make up the polar cap. Accurate colors are needed to determine the composition and mineralogy of Mars. This can tell how water has influenced the formation of rocks and minerals found on Mars today, as well as the distribution and abundance of ice and subsurface liquid water. Confirmation of the presence of certain oxidized (rusted) minerals (processed by heat or water action) would imply the possibility of different, perhaps much more Earth-like, past Martian climate periods. Because the smallest features visible in this image are only about 14 miles (22 km) across, Hubble can track small-scale variations in the distribution of minerals that do not follow global trends. The image was generated from three separate Wide Field and Planetary Camera 2 images acquired at wavelengths of 410, 502, and 673 nanometers, in March 1997. RIGHT A false-color picture taken in infrared light reveals features that cannot be seen in visible light. Hubble's unique infrared view pinpoints variations in the abundance and distribution of unknown water-bearing minerals on the planet. While it has been known for decades that small amounts of water-bearing minerals exist on the planet's surface, the

  7. Martian Colors Provide Clues About Martian Water

    NASA Technical Reports Server (NTRS)

    1999-01-01

    NASA Hubble Space Telescope images of Mars taken in visible and infrared light detail a rich geologic history and provide further evidence for water-bearing minerals on the planet's surface.

    LEFT

    This 'true-color' image of Mars shows the planet as it would look to human eyes. It is clearly more Earth-toned than usually depicted in other astronomical images, including earlier Hubble pictures. The slightly bluer shade along the edges of the disk is due to atmospheric hazes and wispy water ice clouds (like cirrus clouds) in the early morning and late evening Martian sky. The yellowish-pink color of the northern polar cap indicates the presence of small iron-bearing dust particles. These particles are covering or are suspended in the air above the blue-white water ice and carbon dioxide ice, which make up the polar cap.

    Accurate colors are needed to determine the composition and mineralogy of Mars. This can tell how water has influenced the formation of rocks and minerals found on Mars today, as well as the distribution and abundance of ice and subsurface liquid water. Confirmation of the presence of certain oxidized (rusted) minerals (processed by heat or water action) would imply the possibility of different, perhaps much more Earth-like, past Martian climate periods. Because the smallest features visible in this image are only about 14 miles (22 km) across, Hubble can track small-scale variations in the distribution of minerals that do not follow global trends. The image was generated from three separate Wide Field and Planetary Camera 2 images acquired at wavelengths of 410, 502, and 673 nanometers, in March 1997.

    RIGHT

    A false-color picture taken in infrared light reveals features that cannot be seen in visible light. Hubble's unique infrared view pinpoints variations in the abundance and distribution of unknown water-bearing minerals on the planet. While it has been known for decades that small amounts of water-bearing minerals exist on the planet

  8. Buerger’s disease: providing integrated care

    PubMed Central

    Klein-Weigel, Peter; Volz, Theresa Sophie; Zange, Leonora; Richter, Jutta

    2016-01-01

    Buerger’s disease, also known as thromboangiitis obliterans (TAO), is a segmental inflammatory disease affecting small- and medium-sized vessels, which is strongly associated with tobacco use. Although the etiology is still unknown, recent studies suggest an immunopathogenesis. Diagnosis is based on clinical and angiomorphologic criteria, including age, history of smoking, clinical presentation with distal extremity ischemia, and the absence of other risk factors for atherosclerosis, autoimmune disease, hypercoagulable states, or embolic disease. Until now, no causative therapy exists for TAO. The most important therapeutic intervention is smoking cessations and intravenous prostanoid infusions (iloprost). Furthermore, effective analgesia is crucial for the treatment of ischemic and neuropathic pain and might be expanded by spinal cord stimulation. Revascularization procedures do not play a major role in the treatment of TAO due to the distal localization of arterial occlusion. More recently, immunoadsorption has been introduced eliminating vasoconstrictive G-protein-coupled receptor and other autoantibodies. Cell-based therapies and treatment with bosentan were also advocated. Finally, a consequent prevention and treatment of wounds and infections are essential for the prevention of amputations. To achieve better clinical results, integrated care in multidisciplinary and trans-sectoral teams with emphasis on smoking cessation, pain control, wound management, and social care by professionals, social workers, and family members is necessary. PMID:27785045

  9. Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy.

    PubMed

    Stone, Alexander B; Sheinberg, Rosanne; Bertram, Amanda; Seymour, Anastasia Rowland

    2016-04-01

    This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p < .0001). Common reasons cited against using hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use.

  10. Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy.

    PubMed

    Stone, Alexander B; Sheinberg, Rosanne; Bertram, Amanda; Seymour, Anastasia Rowland

    2016-04-01

    This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p < .0001). Common reasons cited against using hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use. PMID:27003489

  11. Providing a Turn for the Better

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Engineers are tasked with designing new systems every day to meet changing or unexpected technical requirements. After the tragic explosion of the Space Shuttle Challenger on January 28, 1986, NASA engineers embarked on a complete overhaul of many of their long-standing quality systems and procedures. When the official cause of the accident was determined to be an O-ring failure in the right Solid Rocket Booster, NASA's Shuttle Program initiated a thorough redesign of the rocket boosters' clevis ends, which are the O-ring's mating surfaces. One of the unique systems that NASA engineers developed as a result of this effort included a heating assembly that is coupled to the outside of the rocket boosters. When the assembly is affixed to the external surface of the boosters, the very nature of its design allows for the warming of the O-rings prior to launch. After the engineers completed the assembly's design, however, they found that it was nearly impossible to tighten the spanner nuts required for attaching the system, given the minimum amount of clearance they had in the limited and confined space. Under these circumstances, the standard wrenches typically used for tightening these types of nuts did not work, and there were no other existing devices to solve the problem. NASA engineers embraced the challenge, developing a torque wrench tool adapter that allowed for a full rotation of spanner nuts in confined spaces. The tool, which is similar to an open-ended crowfoot wrench and a fixed-face spanner wrench, contains two dowel pins that center and lock the wrench onto the nut.

  12. HUBBLE PROVIDES COMPLETE VIEW OF JUPITER'S AURORAS

    NASA Technical Reports Server (NTRS)

    2002-01-01

    NASA's Hubble Space Telescope has captured a complete view of Jupiter's northern and southern auroras. Images taken in ultraviolet light by the Space Telescope Imaging Spectrograph (STIS) show both auroras, the oval- shaped objects in the inset photos. While the Hubble telescope has obtained images of Jupiter's northern and southern lights since 1990, the new STIS instrument is 10 times more sensitive than earlier cameras. This allows for short exposures, reducing the blurring of the image caused by Jupiter's rotation and providing two to five times higher resolution than earlier cameras. The resolution in these images is sufficient to show the 'curtain' of auroral light extending several hundred miles above Jupiter's limb (edge). Images of Earth's auroral curtains, taken from the space shuttle, have a similar appearance. Jupiter's auroral images are superimposed on a Wide Field and Planetary Camera 2 image of the entire planet. The auroras are brilliant curtains of light in Jupiter's upper atmosphere. Jovian auroral storms, like Earth's, develop when electrically charged particles trapped in the magnetic field surrounding the planet spiral inward at high energies toward the north and south magnetic poles. When these particles hit the upper atmosphere, they excite atoms and molecules there, causing them to glow (the same process acting in street lights). The electrons that strike Earth's atmosphere come from the sun, and the auroral lights remain concentrated above the night sky in response to the 'solar wind,' as Earth rotates underneath. Earth's auroras exhibit storms that extend to lower latitudes in response to solar activity, which can be easily seen from the northern U. S. But Jupiter's auroras are caused by particles spewed out by volcanoes on Io, one of Jupiter's moons. These charged particles are then magnetically trapped and begin to rotate with Jupiter, producing ovals of auroral light centered on Jupiter's magnetic poles in both the day and night skies

  13. Implications of HMOs for rural providers and consumers.

    PubMed

    Wellever, A

    1998-01-01

    The impact of the six HMOs studied on rural providers has, to this point, been relatively small. To expand their provider networks in rural areas, the HMOs have been responsive to provider concerns, implementing payment arrangements and utilization management approaches that are acceptable to most rural providers. However, at some sites, changes in HMO and provider relations appear to be on the horizon. These changes include the acceptance of greater financial risk by rural providers and the more aggressive management of costs by the HMOs. With respect to employers, the impact of HMOs have been largely positive. The presence of HMOs in the rural study areas has provided rural employers with new options for structuring health benefits programs. According to some rural employers, health insurance costs have been reduced, or at least constrained, as a result. Rural employers have dealt with employee concerns about access limitations by demanding that HMOs offer broad provider networks and products that permit the use of non-network providers subject to co-payments and deductibles. The impact on rural employees, as evidenced by their responses as well as the views of their employers, has been mixed. Rural employees generally appreciate the broader benefit coverage offered by HMOs as well as reduced paperwork and, sometimes, lower required out-of-pocket contributions toward premiums. However, as with their urban counterparts, rural employees are concerned about restrictions on access to providers of their choice and financial incentives in physician payment arrangements that may discourage the provision of services or the arrangement of referrals.

  14. SALI chemical analysis of provided samples

    NASA Technical Reports Server (NTRS)

    Becker, Christopher H.

    1993-01-01

    SRI has completed the chemical analysis of all the samples supplied by NASA. The final batch of four samples consisted of: one inch diameter MgF2 mirror, control 1200-ID-FL3; one inch diameter neat resin, PMR-15, AO171-IV-55, half exposed and half unexposed; one inch diameter chromic acid anodized, EOIM-3 120-47 aluminum disc; and AO-exposed and unexposed samples of fullerene extract material in powdered form, pressed into In foil for analysis. Chemical analyses of the surfaces were performed by the surface analysis by laser ionization (SALI) method. The analyses emphasize surface contamination or general organic composition. SALI uses nonselective photoionization of sputtered or desorbed atoms and molecules above but close (approximately one mm) to the surface, followed by time-of-flight (TOF) mass spectrometry. In these studies, we used laser-induced desorption by 5-ns pulse-width 355-nm light (10-100 mJ/sq cm) and single-photon ionization (SPI) by coherent 118-nm radiation (at approximately 5 x 10(exp 5) W/sq cm). SPI was chosen primarily for its ability to obtain molecular information, whereas multiphoton ionization (not used in the present studies) is intended primarily for elemental and small molecule information. In addition to these four samples, the Au mirror (EOIM-3 200-11, sample four) was depth profiled again. Argon ion sputtering was used together with photoionization with intense 355-nm radiation (35-ps pulsewidths). Depth profiles are similar to those reported earlier, showing reproducibility. No chromium was found in the sample above noise level; its presence could at most be at the trace level. Somewhat more Ni appears to be present in the Au layer in the unexposed side, indicating thermal diffusion without chemical enhancement. The result of the presence of oxygen is apparently to tie-up/draw out the Ni as an oxide at the surface. The exposed region has a brownish tint appearance to the naked eye.

  15. [Provide comprehensive service for state policy].

    PubMed

    Wu, X

    1991-04-01

    In recent years, Chinese insurance companies introduced family planning (FP) insurance series. These schemes originated from the "one child" and life insurance and accident insurance of the early 1980s, which were established in response to the need that came with the "one child" policy. In order to help relieve the difficulties of rural FP work, the People's Insurance Corporation extended these programs to a series of schemes. These schemes included e.g., and old age security program for the families with 1 daughter only, old age security for families with an only child, and the program for FP workers' personal safety. The purpose of these schemes was to guarantee security in old age for families with few children, to ensure compensation if accident occurs during delivery or as a result of birth control operations; and compensation for FP workers for physical assaults they encountered. As FP organizations have been directly involved in advertising the insurance programs, there has been support from local governments with human and financial resources, and these insurance programs have been expanding every year. The payment of the policy has been either entirely or partially borne by the employers of the insured. In the process of the development of the insurance program, some problems have occurred. 1st, competition between FP organizations and insurance companies have evolved in sponsoring the program for its profit. 2nd, some media reports have confused the payment of premiums with the compulsory levy of undue fees, which in a way, hindered the expansion of program enrollment. 3rd, some local administrations are short of funds to pay for the insurance premiums. 4th, the accrued income from the premiums is lower than the expected sum of the principle and interest if the same funds were deposited in a bank at current interest rate. Therefore, some schemes lack appeal. FP series insurance is a longer term program which will have an important impact on the

  16. [Provide comprehensive service for state policy].

    PubMed

    Wu, X

    1991-04-01

    In recent years, Chinese insurance companies introduced family planning (FP) insurance series. These schemes originated from the "one child" and life insurance and accident insurance of the early 1980s, which were established in response to the need that came with the "one child" policy. In order to help relieve the difficulties of rural FP work, the People's Insurance Corporation extended these programs to a series of schemes. These schemes included e.g., and old age security program for the families with 1 daughter only, old age security for families with an only child, and the program for FP workers' personal safety. The purpose of these schemes was to guarantee security in old age for families with few children, to ensure compensation if accident occurs during delivery or as a result of birth control operations; and compensation for FP workers for physical assaults they encountered. As FP organizations have been directly involved in advertising the insurance programs, there has been support from local governments with human and financial resources, and these insurance programs have been expanding every year. The payment of the policy has been either entirely or partially borne by the employers of the insured. In the process of the development of the insurance program, some problems have occurred. 1st, competition between FP organizations and insurance companies have evolved in sponsoring the program for its profit. 2nd, some media reports have confused the payment of premiums with the compulsory levy of undue fees, which in a way, hindered the expansion of program enrollment. 3rd, some local administrations are short of funds to pay for the insurance premiums. 4th, the accrued income from the premiums is lower than the expected sum of the principle and interest if the same funds were deposited in a bank at current interest rate. Therefore, some schemes lack appeal. FP series insurance is a longer term program which will have an important impact on the

  17. Databases for LDEF results

    NASA Technical Reports Server (NTRS)

    Bohnhoff-Hlavacek, Gail

    1992-01-01

    One of the objectives of the team supporting the LDEF Systems and Materials Special Investigative Groups is to develop databases of experimental findings. These databases identify the hardware flown, summarize results and conclusions, and provide a system for acknowledging investigators, tracing sources of data, and future design suggestions. To date, databases covering the optical experiments, and thermal control materials (chromic acid anodized aluminum, silverized Teflon blankets, and paints) have been developed at Boeing. We used the Filemaker Pro software, the database manager for the Macintosh computer produced by the Claris Corporation. It is a flat, text-retrievable database that provides access to the data via an intuitive user interface, without tedious programming. Though this software is available only for the Macintosh computer at this time, copies of the databases can be saved to a format that is readable on a personal computer as well. Further, the data can be exported to more powerful relational databases, capabilities, and use of the LDEF databases and describe how to get copies of the database for your own research.

  18. Provider practice models in ambulatory oncology practice: analysis of productivity, revenue, and provider and patient satisfaction.

    PubMed

    Buswell, Lori A; Ponte, Patricia Reid; Shulman, Lawrence N

    2009-07-01

    Physicians, nurse practitioners, and physician assistants often work in teams to deliver cancer care in ambulatory oncology practices. This is likely to become more prevalent as the demand for oncology services rises, and the number of providers increases only slightly.

  19. Recent results from LHCf

    NASA Astrophysics Data System (ADS)

    Menjo, H.; Adriani, O.; Berti, E.; Bonechi, L.; Bongi, M.; Castellini, G.; D'Alessandro, R.; Del Prete, M.; Haguenauer, M.; Itow, Y.; Kasahara, K.; Kawade, K.; Makino, Y.; Masuda, K.; Matsubayashi, E.; Mitsuka, G.; Muraki, Y.; Papini, P.; Perrot, A.-L.; Pfeiffer, D.; Ricciarini, S.; Sako, T.; Shimizu, Y.; Sugiura, Y.; Suzuki, T.; Tamura, T.; Tiberio, A.; Torii, S.; Tricomi, A.; Turner, W. C.; Zhou, Q.

    2015-08-01

    The LHCf experiment is one of the LHC forward experiments. The aim of LHCf is to provide critical calibration data of hadronic intraction models used in air shower simulations. The LHCf has completed the operations for p-p collisions with a collision energy of √s = 0.9 and 7 TeV p-p in 2010 and for p-Pb collisions with a collision energy per nucleon of √sNN = 5.02. The recent LHCf result of forward neutron energy spectra at 7 TeV p-p collision and forward π0 spectra at p-Pb collisions are presented in this paper.

  20. Literacy Content Knowledge Expertise among Adult Education Providers in Kentucky

    ERIC Educational Resources Information Center

    Henry, Laurie A.

    2013-01-01

    This paper summarizes the results of a literacy content knowledge survey and assessment administered to adult education providers in Kentucky (n=520). This descriptive study focused on two main goals: 1) to obtain a description of Kentucky adult education programs including instructors' backgrounds, professional preparation, and teaching…

  1. Using Technology to Provide Differentiated Instruction for Deaf Learners

    ERIC Educational Resources Information Center

    Shepherd, Carol M.; Alpert, Madelon

    2015-01-01

    Knowledge is power. Technological devices provide the new pathway to online learning and student retention. This is especially true for deaf learners, who have difficulty learning with the traditional pedagogies used in teaching. Results of studies have indicated that students using the suggested new technologies become more interested and…

  2. 32 CFR 105.11 - Healthcare provider procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... of medical information, and other violations of this guidance are prohibited and may result in... procedures. This section provides guidance on medical management of victims of sexual assault to ensure... medical care for victims of sexual assault covered by this part. (a) Standardized medical care. To...

  3. 32 CFR 105.11 - Healthcare provider procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... of medical information, and other violations of this guidance are prohibited and may result in... procedures. This section provides guidance on medical management of victims of sexual assault to ensure... medical care for victims of sexual assault covered by this part. (a) Standardized medical care. To...

  4. Computer-Aided Techniques for Providing Operator Performance Measures.

    ERIC Educational Resources Information Center

    Connelly, Edward M.; And Others

    This report documents the theory, structure, and implementation of a performance processor (written in FORTRAN IV) that can accept performance demonstration data representing various levels of operator's skill and, under user control, analyze data to provide candidate performance measures and validation test results. The processor accepts two…

  5. The State of the Psychology Health Service Provider Workforce

    ERIC Educational Resources Information Center

    Michalski, Daniel S.; Kohout, Jessica L.

    2011-01-01

    Numerous efforts to describe the health service provider or clinical workforce in psychology have been conducted during the past 30 years. The American Psychological Association (APA) has studied trends in the doctoral education pathway and the resultant effects on the broader psychology workforce. During this period, the creation and growth of…

  6. Providing Counseling for Individuals with Alzheimer's Disease and Their Caregivers

    ERIC Educational Resources Information Center

    Granello, Paul F.; Fleming, Matthew S.

    2008-01-01

    Alzheimer's disease is a progressive condition that results in brain wasting and eventual death. With its increasing diagnosis rate, counselors will likely acquire clients with Alzheimer's disease or their caregivers. Important background information and several practical counseling methods are provided that may assist counselors working with this…

  7. 45 CFR 156.235 - Essential community providers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....235 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... result of violating Federal law: (1) Health care providers defined in section 340B(a)(4) of the PHS...

  8. A Workforce Design Model: Providing Energy to Organizations in Transition

    ERIC Educational Resources Information Center

    Halm, Barry J.

    2011-01-01

    The purpose of this qualitative study was to examine the change in performance realized by a professional services organization, which resulted in the Life Giving Workforce Design (LGWD) model through a grounded theory research design. This study produced a workforce design model characterized as an organizational blueprint that provides virtuous…

  9. Development of a system to provide diagnostics-while-drilling.

    SciTech Connect

    Wise, Jack LeRoy; Jacobson, Ronald David; Finger, John Travis; Mansure, Arthur James; Knudsen, Steven Dell

    2003-06-01

    This report describes development of a system that provides high-speed, real-time downhole data while drilling. Background of the project, its benefits, major technical challenges, test planning, and test results are covered by relatively brief descriptions in the body of the report, with some topics presented in more detail in the attached appendices.

  10. Depression and burnout symptoms among Air Force family medicine providers.

    PubMed

    Varner, Derrick F; Foutch, Brian K

    2014-05-01

    This study investigated the prevalence of depression and burnout symptoms among family medicine providers on active duty in the US Air Force. Results demonstrated that 84% of those surveyed scored positive for degrees of depression symptoms; only sex differences were significant. PMID:24758978

  11. Quality Perception within Corporate E-Learning Providers in Catalonia

    ERIC Educational Resources Information Center

    Sangra, Albert; Fernandez-Michels, Pedro

    2011-01-01

    Purpose: The paper seeks to describe the Catalan corporate e-learning providers from the perspective of quality perception, quality assessment and quality control. Design/methodology/approach: A literature review reveals key aspects of the definition of quality in e-learning. The results of the review constitute the basis for exploratory research…

  12. Providing Homeless Adults with Advantage: A Sustainable University Degree Program

    ERIC Educational Resources Information Center

    Sinatra, Richard; Lanctot, Melissa Kim

    2016-01-01

    A university partnered with the New York City Department of Homeless Services (NYC DHS) to provide cohorts of adults a 60-credit Associate Degree Program in Business Administration over a 2-year period. Results of two cohorts of 30 Advantage Academy Program graduates revealed significant improvement in College Board AccuPlacer (ACPL) Arithmetic…

  13. First results from CARIBU

    NASA Astrophysics Data System (ADS)

    Savard, Guy

    2011-10-01

    The Californium Rare Ion Breeder Upgrade (CARIBU) of the ATLAS superconducting linac facility aims at providing low energy and reaccelerated neutron-rich radioactive beams to address key nuclear physics, astrophysics and application issues. These beams are obtained from fission fragments of a 1 Ci 252Cf source, thermalized and collected into a low-energy particle beam by a helium gas catcher, mass analyzed by an isobar separator, and charge breed to higher charge states for acceleration in ATLAS. The method described is fast and universal and short-lived isotope yield scale essentially with Californium fission yields. The facility is now commissioned and operating with a 100 mCi source which has yielded extracted low-energy mass separated radioactive beams at intensities in excess of 100000 ions per second. Radioactive beams have been charge bred with an efficiency of up to 12% and reaccelerated to 6 MeV/u. Commissioning results, together with the results from first astrophysics experiments at CARIBU using the beams from the 100 mCi source will be presented. The final 1 Ci source is currently under fabrication and is expected to be installed by the end of the year. This work was supported by the US DOE, Office of Nuclear Physics, under contract DE-AC02-06CH11357.

  14. Achieving health care cost containment through provider payment reform that engages patients and providers.

    PubMed

    Ginsburg, Paul B

    2013-05-01

    The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients' total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time. In addition, the models need to evolve to engage beneficiaries, perhaps through incentives for patients to enroll in an accountable care organization and to seek care within that organization's network of providers.

  15. Problems of providing services to people affected by HIV/AIDS: service providers and recipients perspectives.

    PubMed

    Moradi, G; Mohraz, M; Gouya, M M; Dejman, M; Alinaghi, S S; Rahmani, K; Malekafzali-Ardakani, H

    2015-02-25

    This qualitative study aimed to identify the health-care problems of people living with HIV (PLHIV) in 2 large cities: Tehran and Kermanshah. Two main groups of stakeholders - service providers (policy-makers, managers, physicians and counsellors) and service recipients (PLHIV and their relatives) - participated in focus group discussions and in-depth interviews. We identified 24 themes covering the major health problems of PLHIV, including: incomplete and inadequate coverage of health-care services; patients' substance abuse; patients' fear of stigma; occupational burnout of certain service providers; patients' dissatisfaction with some of the services provided by counselling centres/clinics; medical staff's failure to observe confidentiality; and patients' lack of access to required specialized services. The problems and needs identified can inform the design and implementation of health programmes in our country and elsewhere in the Eastern Mediterranean Region.

  16. Private Companies Providing Health Care Price Data: Who Are They and What Information do They Provide?

    PubMed Central

    Phillips, Kathryn A.; Labno, Anna

    2014-01-01

    Summary There is interest in making health care price information more transparent given the increase in enrollment in high-deductible and consumer-directed health plans, and as policy efforts intensify to engage consumers to obtain high value care. We examine the role of private companies that market price transparency tools, primarily to self-insured employers – an important yet understudied topic. What companies exist? How did they emerge? What information do they provide? Where do they get that information? How does the price and quality information provided compare across companies? PMID:25678764

  17. Infant Male Circumcision: Healthcare Provider Knowledge and Associated Factors

    PubMed Central

    Starzyk, Erin J.; Kelley, Michele A.; Caskey, Rachel N.; Schwartz, Alan; Kennelly, Joan F.; Bailey, Robert C.

    2015-01-01

    Background and Objectives The emerging science demonstrates various health benefits associated with infant male circumcision and adult male circumcision; yet rates are declining in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that healthcare providers present evidence-based risk and benefit information for infant male circumcision to parent(s) and guardian(s). The purpose of this study was to assess providers’ level of infant male circumcision knowledge and to identify the associated characteristics. Methods An online survey was administered to healthcare providers in the family medicine, obstetrics, and pediatrics medical specialties at an urban academic health center. To assess infant male circumcision knowledge, a 17 point summary score was constructed to identify level of provider knowledge within the survey. Results Ninety-two providers completed the survey. Providers scored high for the following knowledge items: adverse event rates, protects against phimosis and urinary tract infections, and does not prevent hypospadias. Providers scored lower for items related to more recent research: protection against cervical cancer, genital ulcer disease, bacterial vaginosis, and reduction in HIV acquisition. Two models were constructed looking at (1) overall knowledge about male circumcision, and (2) knowledge about male circumcision reduction in HIV acquisition. Pediatricians demonstrated greater overall infant male circumcision knowledge, while obstetricians exhibited significantly greater knowledge for the HIV acquisition item. Conclusion Providers’ knowledge levels regarding the risks and benefits of infant male circumcision are highly variable, indicating the need for system-based educational interventions. PMID:25635664

  18. Pressure locking test results

    SciTech Connect

    DeWall, K.G.; Watkins, J.C.; McKellar, M.G.; Bramwell, D.

    1996-12-01

    The U.S. Nuclear Regulatory Commission (NRC), Office of Nuclear Regulatory Research, is funding the Idaho National Engineering Laboratory (INEL) in performing research to provide technical input for their use in evaluating responses to Generic Letter 95-07, {open_quotes}Pressure Locking and Thermal Binding of Safety-Related Power-Operated Gate Valves.{close_quotes} Pressure locking and thermal binding are phenomena that make a closed gate valve difficult to open. This paper discusses only the pressure locking phenomenon in a flexible-wedge gate valve; the authors will publish the results of their thermal binding research at a later date. Pressure locking can occur when operating sequences or temperature changes cause the pressure of the fluid in the bonnet (and, in most valves, between the discs) to be higher than the pressure on the upstream and downstream sides of the disc assembly. This high fluid pressure presses the discs against both seats, making the disc assembly harder to unseat than anticipated by the typical design calculations, which generally consider friction at only one of the two disc/seat interfaces. The high pressure of the bonnet fluid also changes the pressure distribution around the disc in a way that can further contribute to the unseating load. If the combined loads associated with pressure locking are very high, the actuator might not have the capacity to open the valve. The results of the NRC/INEL research discussed in this paper show that the relationship between bonnet pressure and pressure locking stem loads appears linear. The results also show that for this valve, seat leakage affects the bonnet pressurization rate when the valve is subjected to thermally induced pressure locking conditions.

  19. Pressure locking test results

    SciTech Connect

    DeWall, K.G.; Watkins, J.C.; McKellar, M.G.; Bramwell, D.

    1996-06-01

    The U.S. Nuclear Regulatory Commission (NRC), Office of Nuclear Regulatory Research, is funding the Idaho National Engineering Laboratory (INEL) in performing research to provide technical input for their use in evaluating responses to Generic Letter 95-07, {open_quotes}Pressure Locking and Thermal Binding of Safety-Related Power-Operated Gate Valves.{close_quotes} Pressure locking and thermal binding are phenomena that make a closed gate valve difficult to open. This paper discusses only the pressure locking phenomenon in a flexible-wedge gate valve; we will publish the results of our thermal binding research at a later date. Pressure locking can occur when operating sequences or temperature changes cause the pressure of the fluid in the bonnet (and, in most valves, between the discs) to be higher than the pressure on the upstream and downstream sides of the disc assembly. This high fluid pressure presses the discs against both seats, making the disc assembly harder to unseat than anticipated by the typical design calculations, which generally consider friction at only one of the two disc/seat interfaces. The high pressure of the bonnet fluid also changes the pressure distribution around the disc in a way that can further contribute to the unseating load. If the combined loads associated with pressure locking are very high, the actuator might not have the capacity to open the valve. The results of the NRC/INEL research discussed in this paper show that the relationship between bonnet pressure and pressure locking stem loads appears linear. The results also show that for this valve, seat leakage affects the bonnet pressurization rate when the valve is subjected to thermally induced pressure locking conditions.

  20. Medicaid Personal Care Services for Children with Intellectual Disabilities: What Assistance Is Provided? When Is Assistance Provided?

    ERIC Educational Resources Information Center

    Elliot, Timothy R.; Patnaik, Ashweeta; Naiser, Emily; Fournier, Constance J.; McMaughan, Darcy K.; Dyer, James A.; Phillips, Charles D.

    2014-01-01

    We report on the nature and timing of services provided to children with an intellectual disability (ID) identified by a new comprehensive assessment and care planning tool used to evaluate children's needs for Medicaid Personal Care Services (PCS) in Texas. The new assessment procedure resulted from a legal settlement with the advocacy…

  1. Comparing Intentions to Use University-Provided vs Vendor-Provided Multibiometric Authentication in Online Exams

    ERIC Educational Resources Information Center

    Levy, Yair; Ramim, Michelle M.; Furnell, Steven M.; Clarke, Nathan L.

    2011-01-01

    Purpose: Concerns for information security in e-learning systems have been raised previously. In the pursuit for better authentication approaches, few schools have implemented students' authentication during online exams beyond passwords. This paper aims to assess e-learners' intention to provide multibiometric data and use of multibiometrics…

  2. 28 CFR 58.26 - Procedures all providers shall follow when applying to become approved providers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., conceal, or cover up by any trick, scheme or device a material fact; (2) Make any materially false...) It is not accompanied by the certification identified in the preceding subsection. (g) The United... accompanying certification is executed by any entity other than a representative of the provider who...

  3. 28 CFR 58.26 - Procedures all providers shall follow when applying to become approved providers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., conceal, or cover up by any trick, scheme or device a material fact; (2) Make any materially false...) It is not accompanied by the certification identified in the preceding subsection. (g) The United... accompanying certification is executed by any entity other than a representative of the provider who...

  4. Providing Services to Survivors of Domestic Violence: A Comparison of Rural and Urban Service Provider Perceptions

    ERIC Educational Resources Information Center

    Eastman, Brenda J.; Bunch, Shelia Grant

    2007-01-01

    Although there is a considerable body of knowledge about domestic violence, a limited proportion focuses on domestic violence in rural settings. Using a nonprobability purposive sampling technique, 93 providers of domestic violence services from rural and urban localities in North Carolina and Virginia were located and asked to complete a…

  5. Accuracy of Marketing Claims by Providers of Stereotactic Radiation Therapy

    PubMed Central

    Narang, Amol K.; Lam, Edwin; Makary, Martin A.; DeWeese, Theodore L.; Pawlik, Timothy M.; Pronovost, Peter J.; Herman, Joseph M.

    2013-01-01

    Purpose: Direct-to-consumer advertising by industry has been criticized for encouraging overuse of unproven therapies, but advertising by health care providers has not been as carefully scrutinized. Stereotactic radiation therapy is an emerging technology that has sparked controversy regarding the marketing campaigns of some manufacturers. Given that this technology is also being heavily advertised on the Web sites of health care providers, the accuracy of providers' marketing claims should be rigorously evaluated. Methods: We reviewed the Web sites of all US hospitals and private practices that provide stereotactic radiation using two leading brands of stereotactic radiosurgery technology. Centers were identified by using data from the manufacturers. Centers without Web sites were excluded. The final study population consisted of 212 centers with online advertisements for stereotactic radiation. Web sites were evaluated for advertisements that were inconsistent with advertising guidelines provided by the American Medical Association. Results: Most centers (76%) had individual pages dedicated to the marketing of their brand of stereotactic technology that frequently contained manufacturer-authored images (50%) or text (55%). Advertising for the treatment of tumors that have not been endorsed by professional societies was present on 66% of Web sites. Centers commonly claimed improved survival (22%), disease control (20%), quality of life (17%), and toxicity (43%) with stereotactic radiation. Although 40% of Web sites championed the center's regional expertise in delivering stereotactic treatments, only 15% of Web sites provided data to support their claims. Conclusion: Provider advertisements for stereotactic radiation were prominent and aggressive. Further investigation of provider advertising, its effects on quality of care, and potential oversight mechanisms is needed. PMID:23633973

  6. Expression of patients' and providers' identities during the medical interview.

    PubMed

    Scholl, Juliann C; Wilson, Jacquee B; Hughes, Patrick C

    2011-08-01

    We apply the Communication Theory of Identity to investigate how patients display their ethnic identities during intercultural patient-provider interactions. Ethnic identity displays play a large part in reflecting patients' and providers' assumptions about the other, as well as their communicative needs. We collected paper-and-pencil responses from a convenience sample of providers and their patients, and conducted a constant comparative analysis of their open-ended reports of a recent intercultural medical interview. The results revealed how both parties viewed their roles in intercultural medical encounters and how they looked for accommodative behaviors from the other party. We draw implications for new applications and future developments of the Communication Theory of Identity and Communication Accommodation Theory. PMID:21263064

  7. Apparatus for providing directional permeability measurements in subterranean earth formations

    DOEpatents

    Shuck, Lowell Z.

    1977-01-01

    Directional permeability measurements are provided in a subterranean earth formation by injecting a high-pressure gas from a wellbore into the earth formation in various azimuthal directions with the direction having the largest pressure drop being indicative of the maximum permeability direction. These measurements are provided by employing an inflatable boot containing a plurality of conduits in registry with a like plurality of apertures penetrating the housing at circumferentially spaced-apart locations. These conduits are, in turn, coupled through a valved manifold to a source of pressurized gas so that the high-pressure gas may be selectively directed through any conduit into the earth formation defining the bore with the resulting difference in the pressure drop through the various conduits providing the permeability measurements.

  8. Providing Formative Feedback From a Summative Computer-aided Assessment

    PubMed Central

    Sewell, Robert D. E.

    2007-01-01

    Objectives To examine the effectiveness of providing formative feedback for summative computer-aided assessment. Design Two groups of first-year undergraduate life science students in pharmacy and neuroscience who were studying an e-learning package in a common pharmacology module were presented with a computer-based summative assessment. A sheet with individualized feedback derived from each of the 5 results sections of the assessment was provided to each student. Students were asked via a questionnaire to evaluate the form and method of feedback. Assessment The students were able to reflect on their performance and use the feedback provided to guide their future study or revision. There was no significant difference between the responses from pharmacy and neuroscience students. Students' responses on the questionnaire indicated a generally positive reaction to this form of feedback. Conclusions Findings suggest that additional formative assessment conveyed by this style and method would be appreciated and valued by students. PMID:17533442

  9. Method for providing uranium with a protective copper coating

    DOEpatents

    Waldrop, Forrest B.; Jones, Edward

    1981-01-01

    The present invention is directed to a method for providing uranium metal with a protective coating of copper. Uranium metal is subjected to a conventional cleaning operation wherein oxides and other surface contaminants are removed, followed by etching and pickling operations. The copper coating is provided by first electrodepositing a thin and relatively porous flash layer of copper on the uranium in a copper cyanide bath. The resulting copper-layered article is then heated in an air or inert atmosphere to volatilize and drive off the volatile material underlying the copper flash layer. After the heating step an adherent and essentially non-porous layer of copper is electro-deposited on the flash layer of copper to provide an adherent, multi-layer copper coating which is essentially impervious to corrosion by most gases.

  10. Latest Electroweak Results from CDF

    SciTech Connect

    Lancaster, Mark

    2010-05-01

    The latest results in electroweak physics from proton anti-proton collisions at the Fermilab Tevatron recorded by the CDF detector are presented. The results provide constraints on parton distribution functions, the mass of the Higgs boson and beyond the Standard Model physics.

  11. Results from SNO

    SciTech Connect

    Chan, Yuen-dat

    2001-10-01

    The Sudbury Neutrino Observatory (SNO) is an underground heavy water Cherenkov detector for studying solar neutrinos. SNO is capable of performing both flavor sensitive and flavor blind measurements of the solar neutrino flux. The first charged current (CC) measurement is found to be: {psi}{sub SNO}{sup CC}({nu}{sub e}) = 1.75 {+-} 0.07(stat.){sub -0.11}{sup +0.12}(sys.) {+-} 0.05 (theor.) x 10{sup 6} cm{sup -2}s{sup -1} and the elastic scattering fluxes (ES) is: {psi}{sub SNO}{sup ES}({nu}{sub x}) = 2.39 {+-} 0.34(stat.){sub -0.14}{sup +0.16} (sys.) x 10{sup 6} cm{sup -2}s{sup -1}. The {psi}{sub SNO}{sup CC}({nu}{sub e}) result, when combined with the high statistics elastic scattering (ES) measurement from Super-Kamiokande, provide a strong evidence for solar neutrino flavor transformation (3.3{sigma}). The deduced total solar neutrino flux is in good agreement with standard solar model predictions. No significant distortion in the energy spectrum is observed.

  12. Medical abortion practices among private providers in Vietnam

    PubMed Central

    Park, Min Hae; Nguyen, Thang Huu; Dang, Anh Thi Ngoc; Ngo, Thoai Dinh

    2013-01-01

    Objective To describe medical abortion (MA) practices among private providers in Vietnam. Methods The study subjects were women (n = 258) undergoing early MA through 12 private providers in Hanoi during February–June 2012. The women were interviewed on the day of their procedure and were followed up by telephone 14 days after mifepristone administration. Results Of the 258 women in the study, 97% used a regimen of mifepristone plus misoprostol; 80% were instructed to administer misoprostol at home. MA resulted in a complete termination in 90.8% of cases. All women were provided with information on potential complications and were instructed to return for a follow-up visit. We successfully followed up 77.5% (n = 200) of participants by telephone, while nearly two-thirds of women returned to the clinic for a follow-up visit. At follow-up, 39.5% of women reported having used a Help line service, while 7% had sought help from a health provider. A high unmet need for postabortion family planning was identified. Conclusion Follow-up of women, postabortion care, and the provision of family planning have been identified as important areas to address for strengthening MA services in the private sector in Vietnam. PMID:24082795

  13. Applying the balanced scorecard in healthcare provider organizations.

    PubMed

    Inamdar, Noorein; Kaplan, Robert S; Bower, Marvin

    2002-01-01

    Several innovative healthcare executives have recently introduced a new business strategy implementation tool: the Balanced Scorecard. The scorecard's measurement and management system provides the following potential benefits to healthcare organizations: It aligns the organization around a more market-oriented, customer-focused strategy It facilitates, monitors, and assesses the implementation of the strategy It provides a communication and collaboration mechanism It assigns accountability for performance at all levels of the organization It provides continual feedback on the strategy and promotes adjustments to marketplace and regulatory changes. We surveyed executives in nine provider organizations that were implementing the Balanced Scorecard. We asked about the following issues relating to its implementation and effect: 1. The role of the Balanced Scorecard in relation to a well-defined vision, mission, and strategy 2. The motivation for adopting the Balanced Scorecard 3. The difference between the Balanced Scorecard and other measurement systems 4. The process followed to develop and implement the Balanced Scorecard 5. The challenges and barriers during the development and implementation process 6. The benefits gained by the organization from adoption and use. The executives reported that the Balanced Scorecard strategy implementation and performance management tool could be successfully applied in the healthcare sector, enabling organizations to improve their competitive market positioning, financial results, and customer satisfaction. This article concludes with guidelines for other healthcare provider organizations to capture the benefits of the Balanced Scorecard performance management system.

  14. Modeling Patients' Acceptance of Provider-delivered E-health

    PubMed Central

    Wilson, E. Vance; Lankton, Nancy K.

    2004-01-01

    Objective: Health care providers are beginning to deliver a range of Internet-based services to patients; however, it is not clear which of these e-health services patients need or desire. The authors propose that patients' acceptance of provider-delivered e-health can be modeled in advance of application development by measuring the effects of several key antecedents to e-health use and applying models of acceptance developed in the information technology (IT) field. Design: This study tested three theoretical models of IT acceptance among patients who had recently registered for access to provider-delivered e-health. Measurements: An online questionnaire administered items measuring perceptual constructs from the IT acceptance models (intrinsic motivation, perceived ease of use, perceived usefulness/extrinsic motivation, and behavioral intention to use e-health) and five hypothesized antecedents (satisfaction with medical care, health care knowledge, Internet dependence, information-seeking preference, and health care need). Responses were collected and stored in a central database. Results: All tested IT acceptance models performed well in predicting patients' behavioral intention to use e-health. Antecedent factors of satisfaction with provider, information-seeking preference, and Internet dependence uniquely predicted constructs in the models. Conclusion: Information technology acceptance models provide a means to understand which aspects of e-health are valued by patients and how this may affect future use. In addition, antecedents to the models can be used to predict e-health acceptance in advance of system development. PMID:15064290

  15. Occupational therapy intervention to inspire self-efficacy in a patient with spinal ataxia and visual disturbance.

    PubMed

    Tohyama, Satsuki; Usuki, Fusako

    2015-02-09

    We report a case of a patient with severe ataxia and visual disturbance due to vitamin E deficiency, whose self-efficacy was inspired by intervention with an appropriate occupational therapy activity. Before the handloom intervention, her severe neurological deficits decreased her activities of daily living (ADL) ability, which made her feel pessimistic and depressed. The use of a handloom, however, inspired her sense of accomplishment because she could perform the weft movement by using her residual physical function, thereby relieving her pessimistic attitude. This perception of capability motivated her to participate in further rehabilitation. Finally, her eager practice enhanced her ADL ability and quality of life (QOL). The result suggests that it is important to provide an appropriate occupational therapy activity that can inspire self-efficacy in patients with chronic refractory neurological disorders because the perception of capability can enhance the motivation to improve performance in general activities, ADL ability and QOL.

  16. Ways and means of providing primary and preventive health services.

    PubMed

    Porter, P J

    1991-01-01

    There exist today a variety of children's health programs that are cost-effective, high-quality, and accessible, and that provide important lessons for communities seeking to improve health care for their children. What is needed is the development of a communications strategy that disseminates this existing knowledge. It has been demonstrated that information in the hands of community leaders results in change and the development of creative programs. Implementation is the goal and social marketing is the methodology. PMID:1685907

  17. Invasive prenatal genetic testing: A Catholic healthcare provider's perspective

    PubMed Central

    Bringman, Jay J.

    2014-01-01

    Invasive prenatal testing is performed for a variety of reasons, but the most common indication is for genetic testing of the fetus. Although many times the information obtained from this type of testing results in selective termination of fetuses with genetic diagnoses, the information itself may be morally neutral. Should a Catholic healthcare provider be willing to perform invasive prenatal testing in the setting of uncertainty with respect to the patient's plans following a diagnosis of a genetic abnormality? PMID:25473130

  18. Overview of MAST results

    NASA Astrophysics Data System (ADS)

    Chapman, I. T.; Adamek, J.; Akers, R. J.; Allan, S.; Appel, L.; Asunta, O.; Barnes, M.; Ben Ayed, N.; Bigelow, T.; Boeglin, W.; Bradley, J.; Brünner, J.; Cahyna, P.; Carr, M.; Caughman, J.; Cecconello, M.; Challis, C.; Chapman, S.; Chorley, J.; Colyer, G.; Conway, N.; Cooper, W. A.; Cox, M.; Crocker, N.; Crowley, B.; Cunningham, G.; Danilov, A.; Darrow, D.; Dendy, R.; Diallo, A.; Dickinson, D.; Diem, S.; Dorland, W.; Dudson, B.; Dunai, D.; Easy, L.; Elmore, S.; Field, A.; Fishpool, G.; Fox, M.; Fredrickson, E.; Freethy, S.; Garzotti, L.; Ghim, Y. C.; Gibson, K.; Graves, J.; Gurl, C.; Guttenfelder, W.; Ham, C.; Harrison, J.; Harting, D.; Havlickova, E.; Hawke, J.; Hawkes, N.; Hender, T.; Henderson, S.; Highcock, E.; Hillesheim, J.; Hnat, B.; Holgate, J.; Horacek, J.; Howard, J.; Huang, B.; Imada, K.; Jones, O.; Kaye, S.; Keeling, D.; Kirk, A.; Klimek, I.; Kocan, M.; Leggate, H.; Lilley, M.; Lipschultz, B.; Lisgo, S.; Liu, Y. Q.; Lloyd, B.; Lomanowski, B.; Lupelli, I.; Maddison, G.; Mailloux, J.; Martin, R.; McArdle, G.; McClements, K.; McMillan, B.; Meakins, A.; Meyer, H.; Michael, C.; Militello, F.; Milnes, J.; Morris, A. W.; Motojima, G.; Muir, D.; Nardon, E.; Naulin, V.; Naylor, G.; Nielsen, A.; O'Brien, M.; O'Gorman, T.; Ono, Y.; Oliver, H.; Pamela, S.; Pangione, L.; Parra, F.; Patel, A.; Peebles, W.; Peng, M.; Perez, R.; Pinches, S.; Piron, L.; Podesta, M.; Price, M.; Reinke, M.; Ren, Y.; Roach, C.; Robinson, J.; Romanelli, M.; Rozhansky, V.; Saarelma, S.; Sangaroon, S.; Saveliev, A.; Scannell, R.; Schekochihin, A.; Sharapov, S.; Sharples, R.; Shevchenko, V.; Silburn, S.; Simpson, J.; Storrs, J.; Takase, Y.; Tanabe, H.; Tanaka, H.; Taylor, D.; Taylor, G.; Thomas, D.; Thomas-Davies, N.; Thornton, A.; Turnyanskiy, M.; Valovic, M.; Vann, R.; Walkden, N.; Wilson, H.; Wyk, L. V.; Yamada, T.; Zoletnik, S.; MAST; MAST Upgrade Teams

    2015-10-01

    The Mega Ampère Spherical Tokamak (MAST) programme is strongly focused on addressing key physics issues in preparation for operation of ITER as well as providing solutions for DEMO design choices. In this regard, MAST has provided key results in understanding and optimizing H-mode confinement, operating with smaller edge localized modes (ELMs), predicting and handling plasma exhaust and tailoring auxiliary current drive. In all cases, the high-resolution diagnostic capability on MAST is complemented by sophisticated numerical modelling to facilitate a deeper understanding. Mitigation of ELMs with resonant magnetic perturbations (RMPs) with toroidal mode number nRMP = 2, 3, 4, 6 has been demonstrated: at high and low collisionality; for the first ELM following the transition to high confinement operation; during the current ramp-up; and with rotating nRMP = 3 RMPs. nRMP = 4, 6 fields cause less rotation braking whilst the power to access H-mode is less with nRMP = 4 than nRMP = 3, 6. Refuelling with gas or pellets gives plasmas with mitigated ELMs and reduced peak heat flux at the same time as achieving good confinement. A synergy exists between pellet fuelling and RMPs, since mitigated ELMs remove fewer particles. Inter-ELM instabilities observed with Doppler backscattering are consistent with gyrokinetic simulations of micro-tearing modes in the pedestal. Meanwhile, ELM precursors have been strikingly observed with beam emission spectroscopy (BES) measurements. A scan in beta at the L-H transition shows that pedestal height scales strongly with core pressure. Gyro-Bohm normalized turbulent ion heat flux (as estimated from the BES data) is observed to decrease with increasing tilt of the turbulent eddies. Fast ion redistribution by energetic particle modes depends on density, and access to a quiescent domain with ‘classical’ fast ion transport is found above a critical density. Highly efficient electron Bernstein wave current drive (1 A W-1) has been achieved

  19. Provider portrayals and patient-provider communication in drama and reality medical entertainment television shows.

    PubMed

    Jain, Parul; Slater, Michael D

    2013-01-01

    Portrayals of physicians on medical dramas have been the subject of research attention. However, such research has not examined portrayals of interactions between physicians and patients, has not compared physician portrayals on medical dramas versus on medical reality programs, and has not fully examined portrayals of physicians who are members of minority groups or who received their education internationally. This study content-analyzes 101 episodes (85 hours) of such programs broadcast during the 2006-2007 viewing season. Findings indicate that women are underrepresented as physicians on reality shows, though they are no longer underrepresented as physicians on dramas. However, they are not as actively portrayed in patient-care interactions as are male physicians on medical dramas. Asians and international medical graduates are underrepresented relative to their proportion in the U.S. physician population, the latter by almost a factor of 5. Many (but certainly not all) aspects of patient-centered communication are modeled, more so on reality programs than on medical dramas. Differences in patient-provider communication portrayals by minority status and gender are reported. Implications for public perception of physicians and expectations regarding provider-patient interaction are discussed. PMID:23581602

  20. Overview of MAST results

    NASA Astrophysics Data System (ADS)

    Counsell, G. F.; Akers, R. J.; Appel, L. C.; Applegate, D.; Axon, K. B.; Baranov, Y.; Brickley, C.; Bunting, C.; Buttery, R. J.; Carolan, P. G.; Challis, C.; Ciric, D.; Conway, N. J.; Cox, M.; Cunningham, G.; Darke, A.; Dnestrovskij, A.; Dowling, J.; Dudson, B.; Dunstan, M. R.; Delchambre, E.; Field, A. R.; Foster, A.; Gee, S.; Gryaznevich, M. P.; Helander, P.; Hender, T. C.; Hole, M.; Howell, D. H.; Joiner, N.; Keeling, D.; Kirk, A.; Lehane, I. P.; Lisgo, S.; Lloyd, B.; Lott, F.; Maddison, G. P.; Manhood, S. J.; Martin, R.; McArdle, G. J.; McClements, K. G.; Meyer, H.; Morris, A. W.; Nelson, M.; O'Brien, M. R.; Patel, A.; Pinfold, T.; Preinhaelter, J.; Price, M. N.; Roach, C. M.; Rozhansky, V.; Saarelma, S.; Saveliev, A.; Scannell, R.; Sharapov, S.; Shevchenko, V.; Shibaev, S.; Stammers, K.; Storrs, J.; Sykes, A.; Tabasso, A.; Tallents, S.; Taylor, D.; Tournianski, M. R.; Turner, A.; Turri, G.; Valovic, M.; Volpe, F.; Voss, G.; Walsh, M. J.; Watkins, J. R.; Wilson, H. R.; Wisse, M.; MAST, the; NBI; ECRH Teams

    2005-10-01

    . Early edge localized mode activity on MAST is associated with the formation of narrow filamentary structures following field lines in the edge. These filaments rotate toroidally with the edge plasma and, away from the X-points, accelerate radially outwards from the edge up to 20 cm. Studies of disruptions on MAST demonstrate a complex evolution of core energy loss and resultant divertor power loads, including phases where the target heat flux width is broadened by a factor of 8. Observations of energetic particle modes driven by super-Alfvénic beam ions provide support for a model for the non-linear evolution of toroidal Alfvén eigenmodes (AEs) forming Bernstein-Green-Krushal waves. The AE activity reduces to low levels with increasing β. Plasma start-up without a central solenoid and in a manner compatible with future large spherical tokamak (ST) devices has been demonstrated using breakdown at a quadrupole magnetic null. Closed flux surface plasmas with peak plasma currents up to 370 kA have been generated and sustained for 0.3 s. New error field correction coils have extended the operational space for low density plasmas and enabled scaling studies of error field induced locked mode formation in the ST.

  1. Adolescent confidentiality: Understanding and practices of health care providers

    PubMed Central

    Wadman, Ruth; Thul, Deborah; Elliott, April S; Kennedy, Andrea Pritchard; Mitchell, Ian; Pinzon, Jorge L

    2014-01-01

    BACKGROUND: Adolescent confidentiality may present practice challenges for health care providers related to family, medical, ethical, legal, social and bureaucratic processes. It is unclear how health care providers understand and practice confidentiality with adolescents in Canada. OBJECTIVE: To investigate the knowledge and practice of health care providers at Alberta Children’s Hospital (Calgary, Alberta), and to inform practice about the adolescent’s right to confidentiality. METHODS: The present study was a voluntary, anonymous online survey. Invitations to participate were sent through the paediatric facility’s electronic mailing list to all currently employed health care providers who potentially engaged in caregiving interactions with adolescents. The survey consisted of 15 closed items and seven open comment items. Closed items were analyzed using descriptive statistics and open comments were analyzed using manifest thematic coding. RESULTS: A total of 389 responses were received, representing health care providers in many disciplines. A variety of practices related to adolescent confidentiality and widespread misunderstanding of this issue were apparent. Respondents’ comments revealed individual and team knowledge gaps regarding adolescent and parent/guardian rights, and the difference between the constructs of consent to treatment and the provision of confidential health care for adolescents. CONCLUSIONS: While health care providers regard confidentiality as paramount, the present survey revealed a wide variation in understanding and practices regarding confidential care for adolescents. This was revealed in both the qualitative and quantitative data. The authors’ recommended strategies to improve the understanding and practice of adolescent confidentiality include: encouraging individuals’ examination of beliefs; postsecondary instruction; knowledge-translation strategies within programs; and institution-directed guidelines and policy. PMID

  2. Determinants of patient choice of healthcare providers: a scoping review

    PubMed Central

    2012-01-01

    Background In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice. Methods We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information. Results Our review shows that patients’ choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics. Conclusions There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several

  3. Doctors’ opinions of information provided by Libyan pharmaceutical company representatives

    PubMed Central

    Alssageer, Mustafa A.; Kowalski, Stefan R.

    2012-01-01

    Objective To examine the opinions of Libyan doctors regarding the quality of drug information provided by pharmaceutical company representatives (PCRs) during detailing visits. Method An anonymous survey was conducted among 1,000 doctors from selected institutes in Tripoli, Benghazi and Sebha. Doctors were asked questions regarding the quality of information provided during drug-detailing visits. Results A questionnaire return rate of 61% (608 returned questionnaires out of 1,000) was achieved. The majority (n=463, 76%) of surveyed participants graded the quality of information provided as average. Approximately, 40% of respondents indicated that contraindications, precautions, interactions and adverse effects of products promoted by PCRs were never or rarely mentioned during promotional visits, and 65% of respondents indicated that an alternative drug to the promoted product was never or rarely mentioned by the representatives. More than 50% of respondents (n=310, 51%) reported that PCRs were not always able to answer all questions about their products. Only seven respondents (1%) believed that PCRs never exaggerated the uniqueness, efficacy or safety of their product. The majority of respondents (n=342, 56%) indicated that verbal information was not always consistent with written information provided. Seven per cent of respondents (n=43) admitted that they did not know whether or not the verbal information provided by PCRs was consistent with written information. Conclusion Doctors believe that the provision of drug information by PCRs in Libya is incomplete and often exaggerated. Pharmaceutical companies should ensure that their representatives are trained to a standard to provide reliable information regarding the products they promote. PMID:23205141

  4. Addiction treatment provider attitudes on staff capacity and evidence-based clinical training: results from a national study.

    PubMed

    Lundgren, Lena; Amodeo, Maryann; Krull, Ivy; Chassler, Deborah; Weidenfeld, Rachel; de Saxe Zerden, Lisa; Gowler, Rebekah; Lederer, Jaime; Cohen, Alexander; Beltrame, Clelia

    2011-01-01

    This national study of addiction-treatment organizations' implementation of evidence-based practices examines: (1) organizational/leadership factors associated with director (n = 212) attitudes regarding staff resistance to organizational change, and (2) organizational/staff factors associated with staff (n = 312) attitudes regarding evidence-based clinical training. Linear regression analyses, controlling for type of treatment unit, leadership/staff characteristics and organizational readiness to change, identified that directors who perceived their organization needed more guidance and had less staff cohesion and autonomy rated staff resistance to organizational change significantly higher. Staff with higher levels of education and greater agreement that their organization supported change had greater preference for evidence-based trainings. Federal addiction treatment policy should both promote education and training of treatment staff and organizational development of treatment CBOs. 

  5. What Program Providers Want Researchers to Know. Research-to-Results Practitioner Insights. Publication # 2009-03

    ERIC Educational Resources Information Center

    Moore, Kristin Anderson

    2009-01-01

    Many researchers would like to be helpful to out-of-school time programs, and practitioners see a need for good research. Yet communication between researchers and practitioners can be a challenge. In a recent series of Roundtables to discuss program needs and research evaluations held with program practitioners, Child Trends obtained important…

  6. Addiction treatment provider attitudes on staff capacity and evidence-based clinical training: results from a national study.

    PubMed

    Lundgren, Lena; Amodeo, Maryann; Krull, Ivy; Chassler, Deborah; Weidenfeld, Rachel; de Saxe Zerden, Lisa; Gowler, Rebekah; Lederer, Jaime; Cohen, Alexander; Beltrame, Clelia

    2011-01-01

    This national study of addiction-treatment organizations' implementation of evidence-based practices examines: (1) organizational/leadership factors associated with director (n = 212) attitudes regarding staff resistance to organizational change, and (2) organizational/staff factors associated with staff (n = 312) attitudes regarding evidence-based clinical training. Linear regression analyses, controlling for type of treatment unit, leadership/staff characteristics and organizational readiness to change, identified that directors who perceived their organization needed more guidance and had less staff cohesion and autonomy rated staff resistance to organizational change significantly higher. Staff with higher levels of education and greater agreement that their organization supported change had greater preference for evidence-based trainings. Federal addiction treatment policy should both promote education and training of treatment staff and organizational development of treatment CBOs.  PMID:21477056

  7. Providing maternal and child health-family planning services to a large rural population: results of the Bohol Project, Philippines.

    PubMed Central

    Williamson, N E; Parado, J P; Maturan, E G

    1983-01-01

    The Bohol Project (1975-1979) sought to improve maternal and child health and to increase the use of family planning among a rural Philippine population of 400,000. Research indicated that maternal and child health (MCH) services did become more available during the Project period and coverage of the priority populations improved. Family planning (FP) use, particularly of less effective methods, increased and fertility declined although some change could have been expected even without the Project. Deaths due to neonatal tetanus were almost eliminated by mortality rates did not decline for a number of reasons, including the fact that services were probably not tailored closely enough to local health problems, especially respiratory diseases. The Project showed that it was possible to increase health and family planning services by using low-cost strategies (such as setting up community drug stores) and by employing paramedical workers, in this case, midwives. Preventive MCH-FP services were not overwhelmed by curative services as had been feared. Perhaps the most significant contributions of the Project were the lessons learned about delivering health and family planning services and conducting evaluation research. In general, if developing countries could maintain well-evaluated field laboratories for working out health and family planning delivery approaches before going nationwide, it is likely that time and money would be saved in the long run. PMID:6848001

  8. Promoting and Providing HPV Vaccination in Hawaii: Barriers Faced by Health Providers.

    PubMed

    Tom, Ashlyn; Robinett, Hali; Buenconsejo-Lum, Lee; Soon, Reni; Hamilton, Michael; Francisco-Natanauan, Pia; Cruz, May Rose Dela; Balajadia, Ronald; Hernandez, Brenda Y

    2016-10-01

    Despite the availability of HPV prophylactic vaccines, uptake has been suboptimal in the US. In the state of Hawaii, HPV vaccine coverage has decreased among females and remains low among males aged 13-17. The reasons for low uptake are unknown and may indicate the existence of critical barriers to HPV vaccination. The purpose of this investigation was to identify policy, system and environmental barriers and promoters of pediatric HPV vaccination in Hawaii. An online 86-item survey addressing knowledge, attitudes, beliefs, practices, and barriers to HPV vaccination was distributed to practicing physicians in Hawaii specializing in Pediatrics, Family Medicine, and Obstetrics-Gynecology. Survey responses were received from a total of 120 physicians. Private practice physicians reported more concerns with vaccine ordering and stocking costs (p < 0.0001), reimbursement levels (p < 0.0001), and insurance coverage (p < 0.0001) compared to physicians in large group practices. Eighty-three percent of providers cited lack of parent knowledge and understanding of HPV infection as a barrier. Over half of physicians (58 %) reported that completion of the 3-dose schedule was a barrier. Most physicians did not use tracking or reminder systems to ensure dose completion. A majority (58 %) of providers cited the lack of school-based vaccination requirements as a barrier. Uptake of HPV vaccination in Hawaii may be impeded by physician perception of parent knowledge and attitudes. Cost-related system barriers are particular barriers among those in private practice. Completion of the 3-dose schedule also remains a challenge. PMID:27038960

  9. 4. View facing southwest showing the Silvertop Diner, Providence Fruit ...

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

    4. View facing southwest showing the Silvertop Diner, Providence Fruit & Produce Building, and Merchants' Cold Storage Warehouse. - Provisions Warehouse Historic District, Kinsley & Harris Avenues, Providence, Providence County, RI

  10. Hand Washing Practices Among Emergency Medical Services Providers

    PubMed Central

    Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

    2015-01-01

    Introduction Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. Methods We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. Results There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Conclusion Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing. PMID:26587098

  11. Model of Providing Assistive Technologies in Special Education Schools

    PubMed Central

    Lersilp, Suchitporn; Putthinoi, Supawadee; Chakpitak, Nopasit

    2016-01-01

    Most students diagnosed with disabilities in Thai special education schools received assistive technologies, but this did not guarantee the greatest benefits. The purpose of this study was to survey the provision, use and needs of assistive technologies, as well as the perspectives of key informants regarding a model of providing them in special education schools. The participants were selected by the purposive sampling method, and they comprised 120 students with visual, physical, hearing or intellectual disabilities from four special education schools in Chiang Mai, Thailand; and 24 key informants such as parents or caregivers, teachers, school principals and school therapists. The instruments consisted of an assistive technology checklist and a semi-structured interview. Results showed that a category of assistive technologies was provided for students with disabilities, with the highest being “services”, followed by “media” and then “facilities”. Furthermore, mostly students with physical disabilities were provided with assistive technologies, but those with visual disabilities needed it more. Finally, the model of providing assistive technologies was composed of 5 components: Collaboration; Holistic perspective; Independent management of schools; Learning systems and a production manual for users; and Development of an assistive technology center, driven by 3 major sources such as Government and Private organizations, and Schools. PMID:26234984

  12. Identifying perceived barriers to videoconferencing by rehabilitation medicine providers.

    PubMed

    Mozer, Roslyn; Bradford, Natalie K; Caffery, Liam J; Smith, Anthony C

    2015-12-01

    The aim of this study was to identify barriers to the utilisation of videoconferencing within a multidisciplinary rehabilitation medicine healthcare team, as the first step towards creating a telerehabilitation service. A survey was developed on videoconference use and barriers to use, and distributed to healthcare providers including rehabilitation medicine societies and allied health societies through an anonymous link to SurveyMonkey(®). There were 254 respondents, practicing primarily in Australia (n = 245), in various healthcare roles. One-hundred and fifty-nine (66%) of respondents used videoconferencing regularly, primarily for their own education. Respondents not currently utilising videoconferencing (n = 82, 34%) ranked the reasons for this and provided free-text responses to explain why this modality was not being utilised in practice. Respondents were reluctant to use videoconferencing because of perceived increase in time needed for video consultations compared to face-to-face consultations, concerns with lack of privacy and confidentiality, and a lack of clinical practice guidelines for video consultation. We believe many barriers to videoconferencing by healthcare providers can be managed with appropriate education and targeted training. Future research studies, which focus on standards and clinical practice guidelines for videoconferencing by healthcare providers, may result in increased utilisation of this modality for healthcare delivery in rehabilitation medicine. PMID:26556061

  13. Medication Therapy Management Services Provided by Student Pharmacists

    PubMed Central

    Hata, Micah; Klotz, Roger; Sylvies, Rick; Hess, Karl; Schwartzman, Emmanuelle; Scott, James

    2012-01-01

    Objectives. To evaluate the impact of student pharmacists delivering medication therapy management (MTM) services during an elective advanced pharmacy practice experience (APPE). Methods. Student pharmacists provided MTM services at community pharmacy APPE sites, documented their recommendations, and then made follow-up telephone calls to patients to determine the impact of the MTM provided. Students were surveyed about the MTM experience. Results. Forty-seven students provided MTM services to 509 patients over 2 years and identified 704 drug-related problems (average of 1.4 problems per patient). About 53% of patients relayed the recommendations to their physician and 205 (75%) physicians accepted the recommendations. Eighty-eight percent of patients reported feeling better about their medications after receiving MTM services. A majority of the students perceived their provision of MTM services as valuable to their patients. Conclusions. Providing MTM services to patients in a pharmacy practice setting allowed student pharmacists to apply skills learned in the doctor of pharmacy (PharmD) curriculum. PMID:22544968

  14. Do naturalistic enclosures provide suitable environments for zoo animals?

    PubMed

    Fàbregas, María C; Guillén-Salazar, Federico; Garcés-Narro, Carlos

    2012-01-01

    Zoo visitors perceive naturalistic enclosures (i.e. those attempting to replicate identifiable parts of the landscape of the species' habitat) as those that best satisfy the biological needs of the animals, and ensure therefore their welfare. However, the provision of a suitable environment with the resources that will allow the animals to satisfy their main biological needs in naturalistic enclosures has never been systematically explored; instead, it has been assumed. In this study we provide evidence that supports the general idea that naturalistic designs provide suitable environments for the animals. For that purpose, we analyzed 1,381 naturalistic and non-naturalistic enclosures in 63 Spanish zoological parks. In order to assess the suitability of the environment provided within each enclosure, a number of aspects related to the animals' main biological requirements were analyzed. We found a relationship between naturalistic designs and the suitability of the environment for the species housed. Most naturalistic enclosures (77.8%) provided suitable environments for their inhabitants. Non-naturalistic ones also had suitable environments, but in a lower percentage (39.7%). These results should be taken into account during zoo inspection and accreditation appointments, where enclosure suitability must be assessed in an accurate and fast manner. In this regard, a naturalistic design can be used as an adjunct indicator of enclosure suitability, but not exclusively, as not every naturalistic enclosure was suitable for the animals, neither as an indispensable one, given that near 40% of non-naturalistic ones were appropriate for the species housed.

  15. Microtubules provide directional information for core PCP function

    PubMed Central

    Matis, Maja; Russler-Germain, David A; Hu, Qie; Tomlin, Claire J; Axelrod, Jeffrey D

    2014-01-01

    Planar cell polarity (PCP) signaling controls the polarization of cells within the plane of an epithelium. Two molecular modules composed of Fat(Ft)/Dachsous(Ds)/Four-jointed(Fj) and a ‘PCP-core’ including Frizzled(Fz) and Dishevelled(Dsh) contribute to polarization of individual cells. How polarity is globally coordinated with tissue axes is unresolved. Consistent with previous results, we find that the Ft/Ds/Fj-module has an effect on a MT-cytoskeleton. Here, we provide evidence for the model that the Ft/Ds/Fj-module provides directional information to the core-module through this MT organizing function. We show Ft/Ds/Fj-dependent initial polarization of the apical MT-cytoskeleton prior to global alignment of the core-module, reveal that the anchoring of apical non-centrosomal MTs at apical junctions is polarized, observe that directional trafficking of vesicles containing Dsh depends on Ft, and demonstrate the feasibility of this model by mathematical simulation. Together, these results support the hypothesis that Ft/Ds/Fj provides a signal to orient core PCP function via MT polarization. DOI: http://dx.doi.org/10.7554/eLife.02893.001 PMID:25124458

  16. Instructing for Results

    ERIC Educational Resources Information Center

    Peterson, Bob

    1978-01-01

    To illustrate the importance of clarity and precision in stating objectives for learning a particular job task, a training consultant provides answers to the previous issue's questionnaire on writing instructional objectives. (MF)

  17. Employer-provided health insurance and hospital mergers.

    PubMed

    Garmon, Christopher

    2013-07-01

    This paper explores the impact of employer-provided health insurance on hospital competition and hospital mergers. Under employer-provided health insurance, employer executives act as agents for their employees in selecting health insurance options for their firm. The paper investigates whether a merger of hospitals favored by executives will result in a larger price increase than a merger of competing hospitals elsewhere. This is found to be the case even when the executive has the same opportunity cost of travel as her employees and even when the executive is the sole owner of the firm, retaining all profits. This is consistent with the Federal Trade Commission's findings in its challenge of Evanston Northwestern Healthcare's acquisition of Highland Park Hospital. Implications of the model are further tested with executive location data and hospital data from Florida and Texas.

  18. Providers' perspectives on treating psychogenic nonepileptic seizures: frustration and hope.

    PubMed

    McMillan, Katharine K; Pugh, Mary Jo; Hamid, Hamada; Salinsky, Martin; Pugh, Jacqueline; Noël, Polly H; Finley, Erin P; Leykum, Luci K; Lanham, Holly J; LaFrance, W Curt

    2014-08-01

    Recent diagnostic and treatment advances in psychogenic nonepileptic seizures (PNES) have the potential to improve care for patients, but little is known about the current state of PNES care delivery in the Veterans Health Administration (VA). We conducted semistructured interviews with 74 health-care clinicians and workers in the VA, eliciting provider perceptions of PNES care. Data were analyzed according to principles of Grounded Theory. The results revealed variation in care and two emergent domain themes of frustration and hope. Frustration was manifest in subthemes including Complexity, Patient Acceptance, Uncertainty About Treatment, Need for Evidence-based Treatment, and Failure of Cross-Disciplinary Collaboration between neurologists and mental health providers. Hope encompassed subthemes of Positive Attitudes, Developing Cross-Disciplinary Treatment, and Specific PNES Care. Increased resources for diagnosing, treating, and researching PNES have improved awareness of the disorder. More research is needed to understand patients' and caregivers' perceptions of PNES care.

  19. Teamwork: building healthier workplaces and providing safer patient care.

    PubMed

    Clark, Paul R

    2009-01-01

    A changing healthcare landscape requires nurses to care for more patients with higher acuity during their shift than ever before. These more austere working conditions are leading to increased burnout. In addition, patient safety is not of the quality or level that is required. To build healthier workplaces where safe care is provided, formal teamwork training is recommended. Formal teamwork training programs, such as that provided by the MedTeams group, TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), or participatory action research programs such as the Healthy Workplace Intervention, have decreased errors in the workplace, increased nurse satisfaction and retention rates, and decreased staff turnover. This article includes necessary determinants of teamwork, brief overviews of team-building programs, and examples of research programs that demonstrate how teamwork brings about healthier workplaces that are safer for patients. Teamwork programs can bring about these positive results when implemented and supported by the hospital system.

  20. Safety Observations Achieve Results

    2000-01-16

    The SOAR web application provides a multi-checklist capability where focused observations can be created to address risk-likely work environments, tasks, etc. The SOAR web application has numerous reports to sort the data by key word, multiple factors (i.e., location, team, behavior, checklist, work environment, etc.), and the highest frequency of behaviors and error-likely predecessors, etc. Other performance indicators are also provided.

  1. Ecosystem function and services provided by the deep sea

    NASA Astrophysics Data System (ADS)

    Thurber, A. R.; Sweetman, A. K.; Narayanaswamy, B. E.; Jones, D. O. B.; Ingels, J.; Hansman, R. L.

    2014-07-01

    The deep sea is often viewed as a vast, dark, remote, and inhospitable environment, yet the deep ocean and seafloor are crucial to our lives through the services that they provide. Our understanding of how the deep sea functions remains limited, but when treated synoptically, a diversity of supporting, provisioning, regulating and cultural services becomes apparent. The biological pump transports carbon from the atmosphere into deep-ocean water masses that are separated over prolonged periods, reducing the impact of anthropogenic carbon release. Microbial oxidation of methane keeps another potent greenhouse gas out of the atmosphere while trapping carbon in authigenic carbonates. Nutrient regeneration by all faunal size classes provides the elements necessary for fueling surface productivity and fisheries, and microbial processes detoxify a diversity of compounds. Each of these processes occur on a very small scale, yet considering the vast area over which they occur they become important for the global functioning of the ocean. The deep sea also provides a wealth of resources, including fish stocks, enormous bioprospecting potential, and elements and energy reserves that are currently being extracted and will be increasingly important in the near future. Society benefits from the intrigue and mystery, the strange life forms, and the great unknown that has acted as a muse for inspiration and imagination since near the beginning of civilization. While many functions occur on the scale of microns to meters and timescales up to years, the derived services that result are only useful after centuries of integrated activity. This vast dark habitat, which covers the majority of the globe, harbors processes that directly impact humans in a variety of ways; however, the same traits that differentiate it from terrestrial or shallow marine systems also result in a greater need for integrated spatial and temporal understanding as it experiences increased use by society. In

  2. Healthcare provider and patient perspectives on diagnostic imaging investigations

    PubMed Central

    Bergh, Anne-Marie; Hoffmann, Willem A.

    2015-01-01

    Background: Much has been written about the patient-centred approach in doctor–patient consultations. Little is known about interactions and communication processes regarding healthcare providers’ and patients’ perspectives on expectations and experiences of diagnostic imaging investigations within the medical encounter. Patients journey through the health system from the point of referral to the imaging investigation itself and then to the post-imaging consultation. Aim and setting: To explore healthcare provider and patient perspectives on interaction and communication processes during diagnostic imaging investigations as part of their clinical journey through a healthcare complex. Methods: A qualitative study was conducted, with two phases of data collection. Twenty-four patients were conveniently selected at a public district hospital complex and were followed throughout their journey in the hospital system, from admission to discharge. The second phase entailed focus group interviews conducted with providers in the district hospital and adjacent academic hospital (medical officers and family physicians, nurses, radiographers, radiology consultants and registrars). Results: Two main themes guided our analysis: (1) provider perspectives; and (2) patient dispositions and reactions. Golden threads that cut across these themes are interactions and communication processes in the context of expectations, experiences of the imaging investigations and the outcomes thereof. Conclusion: Insights from this study provide a better understanding of the complexity of the processes and interactions between providers and patients during the imaging investigations conducted as part of their clinical pathway. The interactions and communication processes are provider–patient centred when a referral for a diagnostic imaging investigation is included. PMID:26245604

  3. Satisfaction With Provider Communication Among Spanish-Speaking Medicaid Enrollees

    PubMed Central

    Mosen, David M.; Carlson, Matthew J.; Morales, Leo S.; Hanes, Pamela P.

    2006-01-01

    Objective To determine if differences between English- and Spanish-speaking parents in ratings of their children’s health care can be explained by need for interpretive services. Methods Using the Consumer Assessment of Health Plans Survey–Child-Survey (CAHPS), reports about provider communication were compared among 3 groups of parents enrolled in a Medicaid managed care health plan: 1) English speakers, 2) Spanish speakers with no self-reported need for interpretive services, and 3) Spanish speakers with self-reported need for interpretive services. Parents were asked to report how well their providers 1) listened carefully to what was being said, 2) explained things in a way that could be understood, 3) respected their comments and concerns, and 4) spent enough time during medical encounters. Multivariate logistic regression was used to compare the ratings of each of the 3 groups while controlling for child’s gender, parent’s gender, parent’s educational attainment, child’s health status, and survey year. Results Spanish-speaking parents in need of interpretive services were less likely to report that providers spent enough time with their children (odds ratio = 0.34, 95% confidence interval = 0.17–0.68) compared to English-speaking parents. There was no statistically significant difference found between Spanish-speaking parents with no need of interpretive services and English-speaking parents. Conclusions Among Spanish- versus English-speaking parents, differences in ratings of whether providers spent enough time with children during medical encounters appear to be explained, in part, by need for interpretive services. No other differences in ratings of provider communication were found. PMID:15548101

  4. Midwifery care and patient-provider communication in maternity decisions

    PubMed Central

    Kozhimannil, Katy B.; Attanasio, Laura B.; Yang, Tony; Avery, Melissa; Declercq, Eugene

    2015-01-01

    Objective To characterize reasons women chose midwives as prenatal care providers and to measure the relationship between midwifery care and patient-provider communication in the U.S. context. Methods Retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011–2012 to a single newborn in a U.S. hospital (n=2400). We used multivariate logistic regression models to characterize women who received prenatal care from a midwife, to describe the reasons for this choice, and to examine the association between midwife-led prenatal care and women’s reports about communication. Results Preference for a female clinician and having a particular clinician assigned was associated with higher odds of midwifery care (AOR=2.65, 95% CI=1.70, 4.14 and AOR=1.63, 95% CI=1.04, 2.58). A woman with midwifery care had lower odds of reporting that she held back questions because her preference for care was different from her provider’s recommendation (AOR=0.46, 95% CI=0.23, 0.89) or because she did not want to be perceived as difficult (AOR=0.48, 95% CI=0.28, 0.81). Women receiving midwifery care also had lower odds of reporting that the provider used medical words were hard for them to understand (AOR=0.58, 95% CI=0.37, 0.91) and not feeling encouraged to discuss all their concerns (AOR=0.54, 95% CI=0.34, 0.89). Conclusions Women whose prenatal care was provided by midwives report better communication compared with those cared for by other types of clinicians. Systems-level interventions, such as assigning a clinician, may improve access to midwifery care and the associated improvements in patient-provider communication in maternity care. PMID:25874874

  5. Exploring Web Search Results Clustering

    NASA Astrophysics Data System (ADS)

    Wang, Xiaoxia; Bramer, Max

    As the number of documents on the web has proliferated, the low precision of conventional web search engines and the flat ranked search results presentation make it difficult for users to locate specific information of interest. Grouping web search results into a hierarchy of topics provides an alternative to the flat ranked list and facilitates searching and browsing. In this paper, we present a brief survey of previous work on web search results clustering and existing commercial search engines using this technique, discuss two key issues of web search results clustering: cluster summarisation and evaluation and propose some directions for future research.

  6. Vascular patterns provide therapeutic targets in aggressive neuroblastic tumors

    PubMed Central

    Tadeo, Irene; Bueno, Gloria; Berbegall, Ana P.; Fernández-Carrobles, M. Milagro; Castel, Victoria; García-Rojo, Marcial; Navarro, Samuel; Noguera, Rosa

    2016-01-01

    Angiogenesis is essential for tumor growth and metastasis, nevertheless, in NB, results between different studies on angiogenesis have yielded contradictory results. An image analysis tool was developed to characterize the density, size and shape of total blood vessels and vascular segments in 458 primary neuroblastic tumors contained in tissue microarrays. The results were correlated with clinical and biological features of known prognostic value and with risk of progression to establish histological vascular patterns associated with different degrees of malignancy. Total blood vessels were larger, more abundant and more irregularly-shaped in tumors of patients with associated poor prognostic factors than in the favorable cohort. Tumor capillaries were less abundant and sinusoids more abundant in the patient cohort with unfavorable prognostic factors. Additionally, size of post-capillaries & metarterioles as well as higher sinusoid density can be included as predictive factors for survival. These patterns may therefore help to provide more accurate pre-treatment risk stratification, and could provide candidate targets for novel therapies. PMID:26918726

  7. Results from Neutrino Oscillations Experiments

    SciTech Connect

    Aguilar-Arevalo, Alexis

    2010-09-10

    The interpretation of the results of early solar and atmospheric neutrino experiments in terms of neutrino oscillations has been verified by several recent experiments using both, natural and man-made sources. The observations provide compelling evidence in favor of the existence of neutrino masses and mixings. These proceedings give a general description of the results from neutrino oscillation experiments, the current status of the field, and some possible future developments.

  8. Bank, leasing agent settle bias claim by HIV service provider.

    PubMed

    1999-12-24

    The Howard Brown Health Center, the largest gay and lesbian health provider in the Midwest, has settled a suit it filed against Hyde Park Bank and Aegis Properties Corp. The center claimed that its repeated attempts to lease space in the Hyde Park Bank building were allegedly refused because the Center's services were "problematic" and could drive away present and future tenants. Aegis Properties Corp., the bank's property management, denies the discrimination charge and states the health center never submitted an application to rent in the building. The health center will receive an undisclosed sum as a result of the settlement.

  9. Method for providing oxygen ion vacancies in lanthanide oxides

    DOEpatents

    Kay, D. Alan R.; Wilson, William G.

    1989-12-05

    A method for desulfurization of fuel gases resulting from the incomplete combustion of sulfur containing hydrocarbons whereby the gases are treated with lanthanide oxides containing large numbers of oxygen-ion vacancies providing ionic porosity which enhances the ability of the lanthanide oxides to react more rapidly and completely with the sulfur in the fuel gases whereby the sulfur in such gases is reduced to low levels suitable for fuels for firing into boilers of power plants generating electricity with steam turbine driven generators, gas turbines, fuel cells and precursors for liquid fuels such as methanol and the like.

  10. An analysis of zoo and aquarium provided teacher professional development

    NASA Astrophysics Data System (ADS)

    Kubarek-Sandor, Joy

    Informal science institutions are a significant provider of science teacher professional development. As pressure continues to critically analyze the work of teachers and their effectiveness in the classroom, it is important to understand how informal science institutions contribute to effective change in teacher science content knowledge and pedagogy. This research study analyzed zoo and aquarium provided teacher professional development to respond to the research questions: How do zoos and aquaria determine and assess their goals for teacher professional development? How do these goals align with effective teacher change for science content knowledge and pedagogy? Theoretical frameworks for high quality teacher professional development, effective evaluation of teacher professional development, and learning in informal science settings guided the research. The sample for the study was AZA accredited zoos and aquariums providing teacher professional development (N=107). Data collection consisted of an online questionnaire, follow-up interviews, and content analysis of teacher professional development artifacts. Analysis revealed that by and large zoos and aquariums are lacking in their provision of science teacher professional development. Most professional development focuses on content or resources, neglecting pedagogy. Assessments mismatch the goals and rely heavily on self-report and satisfaction measures. The results demonstrate a marked difference between those zoos and aquariums that are larger in capacity versus those that are medium to small in size. This may be an area of research for the future, as well as analyzing the education resources produced by zoos and aquariums as these were emphasized heavily as a way they serve teachers.

  11. Providing information promotes greater public support for potable recycled water.

    PubMed

    Fielding, Kelly S; Roiko, Anne H

    2014-09-15

    In spite of the clear need to address water security through sourcing new and alternative water supplies, there has been marked resistance from some communities to the introduction of recycled water for potable use. The present studies tested the effectiveness of providing relatively brief information about the recycled water process and the safety of recycled water on cognitive, emotional and behavioral responses. Three information conditions (basic information or basic information plus information about pollutants in the water, or information that puts the risk of chemicals in the water in perspective) were compared to a no information control condition. Across three experiments there was general support for the hypothesis that providing information would result in more positive cognitive, emotional, and behavioral responses to recycled water. Information increased comfort with potable recycled water and, in general, participants in the information conditions expressed more positive emotions (Experiment 1 & 3), less negative emotions (Experiment 3), more support (Experiment 1 & 3), and lower risk perceptions (Experiment 1 & 3) than those in the no information control condition. Participants who received information also drank more recycled water than control participants (Experiment 1 & 2, although the differences between conditions was not statistically significant) and were significantly more likely to vote in favor of the introduction of a recycled water scheme (Experiment 3). There was evidence, however, that providing information about the level of pollutants in recycled water may lead to ambivalent responses.

  12. Prevention of Surgical Fires: A Certification Course for Healthcare Providers.

    PubMed

    Fisher, Marquessa

    2015-08-01

    An estimated 550 to 650 surgical fires occur annually in the United States. Surgical fires may have severe consequences, including burns, disfigurement, long-term medical care, or death. This article introduces a potential certification program for the prevention of surgical fires. A pilot study was conducted with a convenience sample of 10 anesthesia providers who participated in the education module. The overall objective was to educate surgical team members and to prepare them to become certified in surgical fire prevention. On completion of the education module, participants completed the 50-question certification examination. The mean pretest score was 66%; none of the participants had enough correct responses (85%) to be considered competent in surgical fire prevention. The mean post- test score was 92.80%, with all participants answering at least 85% of questions correct. A paired-samples t test showed a statistically significant increase in knowledge: t (df = 9) = 11.40; P = .001. Results of the pilot study indicate that this course can remediate gaps in knowledge of surgical fire prevention for providers. Their poor performance on the pretest suggests that many providers may not receive sufficient instruction in surgical fire prevention.

  13. Neonicotinoid pesticide exposure impairs crop pollination services provided by bumblebees

    NASA Astrophysics Data System (ADS)

    Stanley, Dara A.; Garratt, Michael P. D.; Wickens, Jennifer B.; Wickens, Victoria J.; Potts, Simon G.; Raine, Nigel E.

    2015-12-01

    Recent concern over global pollinator declines has led to considerable research on the effects of pesticides on bees. Although pesticides are typically not encountered at lethal levels in the field, there is growing evidence indicating that exposure to field-realistic levels can have sublethal effects on bees, affecting their foraging behaviour, homing ability and reproductive success. Bees are essential for the pollination of a wide variety of crops and the majority of wild flowering plants, but until now research on pesticide effects has been limited to direct effects on bees themselves and not on the pollination services they provide. Here we show the first evidence to our knowledge that pesticide exposure can reduce the pollination services bumblebees deliver to apples, a crop of global economic importance. Bumblebee colonies exposed to a neonicotinoid pesticide provided lower visitation rates to apple trees and collected pollen less often. Most importantly, these pesticide-exposed colonies produced apples containing fewer seeds, demonstrating a reduced delivery of pollination services. Our results also indicate that reduced pollination service delivery is not due to pesticide-induced changes in individual bee behaviour, but most likely due to effects at the colony level. These findings show that pesticide exposure can impair the ability of bees to provide pollination services, with important implications for both the sustained delivery of stable crop yields and the functioning of natural ecosystems.

  14. Neonicotinoid pesticide exposure impairs crop pollination services provided by bumblebees.

    PubMed

    Stanley, Dara A; Garratt, Michael P D; Wickens, Jennifer B; Wickens, Victoria J; Potts, Simon G; Raine, Nigel E

    2015-12-24

    Recent concern over global pollinator declines has led to considerable research on the effects of pesticides on bees. Although pesticides are typically not encountered at lethal levels in the field, there is growing evidence indicating that exposure to field-realistic levels can have sublethal effects on bees, affecting their foraging behaviour, homing ability and reproductive success. Bees are essential for the pollination of a wide variety of crops and the majority of wild flowering plants, but until now research on pesticide effects has been limited to direct effects on bees themselves and not on the pollination services they provide. Here we show the first evidence to our knowledge that pesticide exposure can reduce the pollination services bumblebees deliver to apples, a crop of global economic importance. Bumblebee colonies exposed to a neonicotinoid pesticide provided lower visitation rates to apple trees and collected pollen less often. Most importantly, these pesticide-exposed colonies produced apples containing fewer seeds, demonstrating a reduced delivery of pollination services. Our results also indicate that reduced pollination service delivery is not due to pesticide-induced changes in individual bee behaviour, but most likely due to effects at the colony level. These findings show that pesticide exposure can impair the ability of bees to provide pollination services, with important implications for both the sustained delivery of stable crop yields and the functioning of natural ecosystems.

  15. Neonicotinoid pesticide exposure impairs crop pollination services provided by bumblebees

    PubMed Central

    Stanley, Dara A.; Garratt, Michael P.D.; Wickens, Jennifer B.; Wickens, Victoria J.; Potts, Simon G.; Raine, Nigel E.

    2015-01-01

    Recent concern over global pollinator declines has led to considerable research on the effects of pesticides on bees1-5. Although pesticides are typically not encountered at lethal levels in the field, there is growing evidence indicating that exposure to field-realistic levels can have sub-lethal effects on bees affecting their foraging behaviour1,6,7, homing ability8,9 and reproductive success2,5. Bees are essential for the pollination of a wide variety of crops and the majority of wild flowering plants10-12, but until now research on pesticide impacts has been limited to direct effects on bees themselves and not on the pollination services they provide. Here we show the first evidence that pesticide exposure can reduce the pollination services bumblebees deliver to apples, a crop of global economic importance. Colonies exposed to a neonicotinoid pesticide provided lower visitation rates to apple trees and collected pollen less often. Most importantly these pesticide exposed colonies produced apples containing fewer seeds demonstrating a reduced delivery of pollination services. Our results also suggest reduced pollination service delivery is not due to pesticide-induced changes in individual bee behaviour but most likely due to impacts at the colony level. These findings show that pesticide exposure can impair the ability of bees to provide pollination services, with important implications for both the sustained delivery of stable crop yields and the function of natural ecosystems. PMID:26580009

  16. HIV/AIDS and care provider attributions: who's to blame?

    PubMed

    Cobb, M; De Chabert, J T

    2002-08-01

    The discovery of HIV/AIDS prompted a profusion of research focusing on the disease and its causes. Though the bulk of this research emphasizes behavioural risk factors, treatment and disease progression, researcher efforts are beginning to examine the public's attitude toward individuals who are HIV-positive or have developed AIDS. Utilizing Weiner's Attribution Theory, the current study examines the beliefs of social service providers who work directly with individuals affected by HIV/AIDS. Forty-six (28 female and 18 male) HIV/AIDS social service providers from three community-based organizations were asked to read a hypothetical scenario depicting an individual at-risk for HIV/AIDS because of multiple high-risk behaviours. The gender of the target was manipulated and at the conclusion of the scenario participants completed a questionnaire designed to assess attributions. Results of the study show that social service providers who perceive individuals as more responsible for their illness report increased anger, attribute more blame and express less willingness to help those at-risk for HIV/AIDS. This research suggests that despite growing numbers of media campaigns and national distribution of information regarding the disease and its transmission, in general, people continue to stigmatize and place blame on those at-risk.

  17. Autonomous Soaring Flight Results

    NASA Technical Reports Server (NTRS)

    Allen, Michael J.

    2006-01-01

    A viewgraph presentation on autonomous soaring flight results for Unmanned Aerial Vehicles (UAV)'s is shown. The topics include: 1) Background; 2) Thermal Soaring Flight Results; 3) Autonomous Dolphin Soaring; and 4) Future Plans.

  18. Does calcite encrustation in Chara provide a phosphorus nutrient sink?

    PubMed

    Siong, Kian; Asaeda, Takashi

    2006-01-01

    We studied the effect of calcite encrustation in stoneworts (Chara spp.) on P cycling in an aquatic ecosystem. Sequential fractionation was performed to quantify P fractions of the internodes of calcified (Ca-CF) and uncalcified (UCa-CF) Chara fibrosa Agardh ex Bruzelius. Our results showed that Ca-CF was able to store more P and about 14 to 23% of total P in Ca-CF was co-precipitated with encrusted calcite, while only 2 to 3% was found in UCa-CF. Furthermore, in Ca-CF, an increased amount of total P did not result in a higher release of bioavailable water-soluble and sodium hydroxide-extractable P. Extracellular calcification in Chara enhanced nutrient sink for P, provided a further bottom-up control of phytoplankton, and should be regarded as a positive feedback in stabilizing Chara dominance in lakes.

  19. Federated query services provided by the Seamless SAR Archive project

    NASA Astrophysics Data System (ADS)

    Baker, S.; Bryson, G.; Buechler, B.; Meertens, C. M.; Crosby, C. J.; Fielding, E. J.; Nicoll, J.; Youn, C.; Baru, C.

    2013-12-01

    The NASA Advancing Collaborative Connections for Earth System Science (ACCESS) seamless synthetic aperture radar (SAR) archive (SSARA) project is a 2-year collaboration between UNAVCO, the Alaska Satellite Facility (ASF), the Jet Propulsion Laboratory (JPL), and OpenTopography at the San Diego Supercomputer Center (SDSC) to design and implement a seamless distributed access system for SAR data and derived data products (i.e. interferograms). A major milestone for the first year of the SSARA project was a unified application programming interface (API) for SAR data search and results at ASF and UNAVCO (WInSAR and EarthScope data archives) through the use of simple web services. A federated query service was developed using the unified APIs, providing users a single search interface for both archives (http://www.unavco.org/ws/brokered/ssara/sar/search). A command line client that utilizes this new service is provided as an open source utility for the community on GitHub (https://github.com/bakerunavco/SSARA). Further API development and enhancements added more InSAR specific keywords and quality control parameters (Doppler centroid, faraday rotation, InSAR stack size, and perpendicular baselines). To facilitate InSAR processing, the federated query service incorporated URLs for DEM (from OpenTopography) and tropospheric corrections (from the JPL OSCAR service) in addition to the URLs for SAR data. This federated query service will provide relevant QC metadata for selecting pairs of SAR data for InSAR processing and all the URLs necessary for interferogram generation. Interest from the international community has prompted an effort to incorporate other SAR data archives (the ESA Virtual Archive 4 and the DLR TerraSAR-X_SSC Geohazard Supersites and Natural Laboratories collections) into the federated query service which provide data for researchers outside the US and North America.

  20. Fault Management Architectures and the Challenges of Providing Software Assurance

    NASA Technical Reports Server (NTRS)

    Savarino, Shirley; Fitz, Rhonda; Fesq, Lorraine; Whitman, Gerek

    2015-01-01

    Fault Management (FM) is focused on safety, the preservation of assets, and maintaining the desired functionality of the system. How FM is implemented varies among missions. Common to most missions is system complexity due to a need to establish a multi-dimensional structure across hardware, software and spacecraft operations. FM is necessary to identify and respond to system faults, mitigate technical risks and ensure operational continuity. Generally, FM architecture, implementation, and software assurance efforts increase with mission complexity. Because FM is a systems engineering discipline with a distributed implementation, providing efficient and effective verification and validation (V&V) is challenging. A breakout session at the 2012 NASA Independent Verification & Validation (IV&V) Annual Workshop titled "V&V of Fault Management: Challenges and Successes" exposed this issue in terms of V&V for a representative set of architectures. NASA's Software Assurance Research Program (SARP) has provided funds to NASA IV&V to extend the work performed at the Workshop session in partnership with NASA's Jet Propulsion Laboratory (JPL). NASA IV&V will extract FM architectures across the IV&V portfolio and evaluate the data set, assess visibility for validation and test, and define software assurance methods that could be applied to the various architectures and designs. This SARP initiative focuses efforts on FM architectures from critical and complex projects within NASA. The identification of particular FM architectures and associated V&V/IV&V techniques provides a data set that can enable improved assurance that a system will adequately detect and respond to adverse conditions. Ultimately, results from this activity will be incorporated into the NASA Fault Management Handbook providing dissemination across NASA, other agencies and the space community. This paper discusses the approach taken to perform the evaluations and preliminary findings from the research.

  1. Parents’ role in adolescent depression care: primary care provider perspectives

    PubMed Central

    Radovic, Ana; Reynolds, Kerry; McCauley, Heather L.; Sucato, Gina S.; Stein, Bradley D.; Miller, Elizabeth

    2015-01-01

    Objective To understand how primary care providers (PCPs) perceive barriers to adolescent depression care to inform strategies to increase treatment engagement. Study design We conducted semi-structured interviews with 15 PCPs recruited from community pediatric offices with access to integrated behavioral health services (i.e., low system-level barriers to care) who participated in a larger study on treating adolescent depression. Interviews addressed PCP perceptions of barriers to adolescents’ uptake of care for depression. Interviews were audio-recorded, transcribed, and coded for key themes. Results Although PCPs mentioned several adolescent barriers to care, they thought parents played a critical role in assisting adolescents in accessing mental health services. Important aspects of the parental role in accessing treatment included transportation, financial support, and social support. PCP’s perceived that parental unwillingness to accept the depression diagnosis, family dysfunction and trauma were common barriers. PCPs contrasted this with examples of good family support they believed would enable adolescents to attend follow-up appointments and have a “life coach” at home to help monitor for side effects and watch for increased suicidality when starting antidepressants. Conclusions In this PCP population, which had enhanced access to mental health specialists, PCPs primarily reported attitudinal barriers to adolescent depression treatment, focusing mainly on perceived parent barriers. The results of these qualitative interviews provide a framework for understanding PCP perceptions of parental barriers to care, identifying that addressing complex parental barriers to care may be important for future interventions. PMID:26143382

  2. Ranking USRDS provider specific SMRs from 1998-2001

    PubMed Central

    Louis, Thomas A.; Paddock, Susan M.; Ridgeway, Greg

    2009-01-01

    Provider profiling (ranking/percentiling) is prevalent in health services research. Bayesian models coupled with optimizing a loss function provide an effective framework for computing non-standard inferences such as ranks. Inferences depend on the posterior distribution and should be guided by inferential goals. However, even optimal methods might not lead to definitive results and ranks should be accompanied by valid uncertainty assessments. We outline the Bayesian approach and use estimated Standardized Mortality Ratios (SMRs) in 1998-2001 from the United States Renal Data System (USRDS) as a platform to identify issues and demonstrate approaches. Our analyses extend Liu et al. (2004) by computing estimates developed by Lin et al. (2006) that minimize errors in classifying providers above or below a percentile cut-point, by combining evidence over multiple years via a first-order, autoregressive model on log(SMR), and by use of a nonparametric prior. Results show that ranks/percentiles based on maximum likelihood estimates of the SMRs and those based on testing whether an SMR = 1 substantially under-perform the optimal estimates. Combining evidence over the four years using the autoregressive model reduces uncertainty, improving performance over percentiles based on only one year. Furthermore, percentiles based on posterior probabilities of exceeding a properly chosen SMR threshold are essentially identical to those produced by minimizing classification loss. Uncertainty measures effectively calibrate performance, showing that considerable uncertainty remains even when using optimal methods. Findings highlight the importance of using loss function guided percentiles and the necessity of accompanying estimates with uncertainty assessments. PMID:19343106

  3. Ecosystem function and services provided by the deep sea

    NASA Astrophysics Data System (ADS)

    Thurber, A. R.; Sweetman, A. K.; Narayanaswamy, B. E.; Jones, D. O. B.; Ingels, J.; Hansman, R. L.

    2013-11-01

    The deep sea is often viewed as a vast, dark, remote, and inhospitable environment, yet the deep ocean and seafloor are crucial to our lives through the services and provisions that they provide. Our understanding of how the deep sea functions remains limited, but when treated synoptically, a diversity of provisioning, regulating and cultural services become apparent. The biological pump transports carbon from the atmosphere into deep-ocean water masses which are separated over prolonged periods, reducing the impact of anthropogenic carbon release. Microbial oxidation of methane keeps another potent greenhouse gas out of the atmosphere while trapping carbon in authigenic carbonates. Nutrient regeneration by all faunal size classes provides the elements necessary to fuel surface productivity and fisheries, and microbial processes detoxify a diversity of compounds. Each of these processes occur on a very small scale, yet considering the vast area over which they occur they become important for the global functioning of the ocean. The deep sea also provides a diversity of resources, including fish stocks, enormous bioprospecting potential, and elements and energy reserves that are currently being extracted and will be increasingly important in the near future. Society benefits from the intrigue and mystery, the strange life forms, and the great unknown which has acted as a muse for inspiration and imagination since near the beginning of civilization. While many functions occur on the scale of microns to meters and time scales up to years, the derived services that result are only useful after centuries of integrated activity. This vast dark habitat, that covers the majority of the globe, harbors processes that directly impact humans in a diversity of ways, however the same traits that differentiate it from terrestrial or shallow marine systems also result in a greater need for integrated spatial and temporal understanding as it experiences increased use by society.

  4. Derivative financial instruments and nonprofit health care providers.

    PubMed

    Stewart, Louis J; Owhoso, Vincent

    2004-01-01

    This article examines the extent of derivative financial instrument use among US nonprofit health systems and the impact of these financial instruments on their cash flows, reported operating results, and financial risks. Our examination is conducted through a case study of New Jersey hospitals and health systems. We review the existing literature on interest rate derivative instruments and US hospitals and health systems. This literature describes the design of these derivative financial instruments and the theoretical benefits of their use by large health care provider organizations. Our contribution to the literature is to provide an empirical evaluation of derivative financial instruments usage among a geographically limited sample of US nonprofit health systems. We reviewed the audited financial statements of the 49 community hospitals and multi-hospital health systems operating in the state of New Jersey. We found that 8 percent of New Jersey's nonprofit health providers utilized interest rate derivatives with an aggregate principle value of $229 million. These derivative users combine interest rate swaps and caps to lower the effective interest costs of their long-term debt while limiting their exposure to future interest rate increases. In addition, while derivative assets and liabilities have an immaterial balance sheet impact, derivative related gains and losses are a material component of their reported operating results. We also found that derivative usage among these four health systems was responsible for generating positive cash flows in the range of 1 percent to 2 percent of their total 2001 cash flows from operations. As a result of our admittedly limited samples we conclude that interest rate swaps and caps are effective risk management tools. However, we also found that while these derivative financial instruments are useful hedges against the risks of issuing long-term financing instruments, they also expose derivative users to credit, contract

  5. Derivative financial instruments and nonprofit health care providers.

    PubMed

    Stewart, Louis J; Owhoso, Vincent

    2004-01-01

    This article examines the extent of derivative financial instrument use among US nonprofit health systems and the impact of these financial instruments on their cash flows, reported operating results, and financial risks. Our examination is conducted through a case study of New Jersey hospitals and health systems. We review the existing literature on interest rate derivative instruments and US hospitals and health systems. This literature describes the design of these derivative financial instruments and the theoretical benefits of their use by large health care provider organizations. Our contribution to the literature is to provide an empirical evaluation of derivative financial instruments usage among a geographically limited sample of US nonprofit health systems. We reviewed the audited financial statements of the 49 community hospitals and multi-hospital health systems operating in the state of New Jersey. We found that 8 percent of New Jersey's nonprofit health providers utilized interest rate derivatives with an aggregate principle value of $229 million. These derivative users combine interest rate swaps and caps to lower the effective interest costs of their long-term debt while limiting their exposure to future interest rate increases. In addition, while derivative assets and liabilities have an immaterial balance sheet impact, derivative related gains and losses are a material component of their reported operating results. We also found that derivative usage among these four health systems was responsible for generating positive cash flows in the range of 1 percent to 2 percent of their total 2001 cash flows from operations. As a result of our admittedly limited samples we conclude that interest rate swaps and caps are effective risk management tools. However, we also found that while these derivative financial instruments are useful hedges against the risks of issuing long-term financing instruments, they also expose derivative users to credit, contract

  6. The evolution of payoff matrices: providing incentives to cooperate

    PubMed Central

    Akçay, Erol; Roughgarden, Joan

    2011-01-01

    Most of the work in evolutionary game theory starts with a model of a social situation that gives rise to a particular payoff matrix and analyses how behaviour evolves through natural selection. Here, we invert this approach and ask, given a model of how individuals behave, how the payoff matrix will evolve through natural selection. In particular, we ask whether a prisoner's dilemma game is stable against invasions by mutant genotypes that alter the payoffs. To answer this question, we develop a two-tiered framework with goal-oriented dynamics at the behavioural time scale and a diploid population genetic model at the evolutionary time scale. Our results are two-fold: first, we show that the prisoner's dilemma is subject to invasions by mutants that provide incentives for cooperation to their partners, and that the resulting game is a coordination game similar to the hawk–dove game. Second, we find that for a large class of mutants and symmetric games, a stable genetic polymorphism will exist in the locus determining the payoff matrix, resulting in a complex pattern of behavioural diversity in the population. Our results highlight the importance of considering the evolution of payoff matrices to understand the evolution of animal social systems. PMID:21147797

  7. Waist Circumference, Physical Activity, and Functional Impairments in Older U.S. Adults: Results from the NHANES 2005-2010.

    PubMed

    Batsis, John A; Germain, Cassandra M; Vásquez, Elizabeth; Lopez-Jimenez, Francisco; Bartels, Stephen J

    2015-07-01

    Physical activity (PA) improves function in older obese adults. However, body mass index is an unreliable adiposity indicator better reflected by waist circumference (WC). The impact of PA on physical impairment and mobility with high WC is unclear. We performed a secondary data analysis of 4,976 adults ≥ 60 years of age using the National Health and Nutrition Examination Survey (NHANES) 2005-2010. Physical limitations (PL), activities of daily living (ADL) impairments, and PA (low = < 1 day/week or high = > 1 day/week) were self-reported. WC was dichotomized (females: 88 cm; males: 102 cm). Mean age was 70.1 years and 55.1% were female. Prevalence of PL and ADL impairment in the high WC group were 57.7% and 18.8%, respectively, and high PA was present in 53.9%. Among those with high WC, high PA vs. low PA participants were at lower risk of PL (OR 0.58 [0.48-0.70]) and ADL impairment (OR 0.46 [0.32-0.65]). Those with high WC had higher odds of PL irrespective of PA (high PA: OR 1.57 [1.30-1.88]; low PA: OR 1.52 [1.29-1.79]) and ADL impairment (high PA: OR 1.27 [1.02-1.57] and low PA: OR 1.24 [0.99-1.54]). High PA in viscerally obese individuals is associated with impairments.

  8. Postmarket Drug Safety Information for Patients and Providers

    MedlinePlus

    ... Information for Patients and Providers Postmarket Drug Safety Information for Patients and Providers Share Tweet Linkedin Pin ... communication to patients and healthcare providers. Latest Safety Information Index to Drug-Specific Information For patients, consumers, ...

  9. 47 CFR 64.636 - Prohibition of default provider freezes.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... (a) A default provider freeze prevents a change in an iTRS user's default provider selection unless the iTRS user gives the provider from whom the freeze was requested his or her express consent....

  10. 47 CFR 64.636 - Prohibition of default provider freezes.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    .... (a) A default provider freeze prevents a change in an iTRS user's default provider selection unless the iTRS user gives the provider from whom the freeze was requested his or her express consent....

  11. 34. Boston switch interlocking tower. Central Falls, Providence Co., RI. ...

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

    34. Boston switch interlocking tower. Central Falls, Providence Co., RI. Sec. 4116, mp 190.40. - Northeast Railroad Corridor, Amtrak route between CT & MA state lines, Providence, Providence County, RI

  12. 12. Historic view (1929) courtesy of Providence Public Library CONSTRUCTION ...

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

    12. Historic view (1929) courtesy of Providence Public Library CONSTRUCTION PHOTOGRAPH OF STATUE BEING PLACED ON TOP OF MONUMENT; VIEW TO NORTHEAST - World War I Monument, Memorial Square, Providence, Providence County, RI

  13. Communicating Performance Assessments Results - 13609

    SciTech Connect

    Layton, Mark

    2013-07-01

    The F-Area Tank Farms (FTF) and H-Area Tank Farm (HTF) are owned by the U.S. Department of Energy (DOE) and operated by Savannah River Remediation LLC (SRR), Liquid Waste Operations contractor at DOE's Savannah River Site (SRS). The FTF and HTF are active radioactive waste storage and treatment facilities consisting of 51 carbon steel waste tanks and ancillary equipment such as transfer lines, evaporators and pump tanks. Performance Assessments (PAs) for each Tank Farm have been prepared to support the eventual closure of the underground radioactive waste tanks and ancillary equipment. PAs provide the technical bases and results to be used in subsequent documents to demonstrate compliance with the pertinent requirements for final closure of the Tank Farms. The Tank Farms are subject to a number of regulatory requirements. The State regulates Tank Farm operations through an industrial waste water permit and through a Federal Facility Agreement approved by the State, DOE and the Environmental Protection Agency (EPA). Closure documentation will include State-approved Tank Farm Closure Plans and tank-specific closure modules utilizing information from the PAs. For this reason, the State of South Carolina and the EPA must be involved in the performance assessment review process. The residual material remaining after tank cleaning is also subject to reclassification prior to closure via a waste determination pursuant to Section 3116 of the Ronald W. Reagan National Defense Authorization Act of Fiscal Year 2005. PAs are performance-based, risk-informed analyses of the fate and transport of FTF and HTF residual wastes following final closure of the Tank Farms. Since the PAs serve as the primary risk assessment tools in evaluating readiness for closure, it is vital that PA conclusions be communicated effectively. In the course of developing the FTF and HTF PAs, several lessons learned have emerged regarding communicating PA results. When communicating PA results it is

  14. Effects of neurofeedback and computer-assisted cognitive rehabilitation on relative brain wave ratios and activities of daily living of stroke patients: a randomized control trial

    PubMed Central

    Cho, Hwi-Young; Kim, Ki-Tae; Jung, Jin-Hwa

    2016-01-01

    [Purpose] This study investigated the effects of neurofeedback (NFB) and computer-assisted cognitive rehabilitation (CACR) on the relative brain wave ratios and activities of daily living (ADL) of stroke patients. [Subjects and Methods] Forty-four participants were randomly allocated to the NFB (n=14), CACR (n=14), or control (CON) (n=16) groups. Two expert therapists provided the NFB, CACR, and CON groups with traditional rehabilitation therapy in 30-minute sessions, 5 times a week, for 6 weeks. NFB training was provided only to the NFB group and CACR training was provided only to the CACR group. The CON group received traditional rehabilitation therapy only. Before and after 6 weeks of intervention, brain wave and ADL evaluations were performed, and the results were analyzed. [Results] The relative ratio of beta waves, only showed a significant increase in the frontal and parietal areas of the NFB group. Significant changes in ADL were shown by all three groups after the intervention. However, there were no significant differences between the NFB and CACR groups and the CON group. [Conclusion] Our results suggest that CACR and NFB are effective at improving cognitive function and ADL of stroke patients. PMID:27512287

  15. Effects of neurofeedback and computer-assisted cognitive rehabilitation on relative brain wave ratios and activities of daily living of stroke patients: a randomized control trial.

    PubMed

    Cho, Hwi-Young; Kim, Ki-Tae; Jung, Jin-Hwa

    2016-07-01

    [Purpose] This study investigated the effects of neurofeedback (NFB) and computer-assisted cognitive rehabilitation (CACR) on the relative brain wave ratios and activities of daily living (ADL) of stroke patients. [Subjects and Methods] Forty-four participants were randomly allocated to the NFB (n=14), CACR (n=14), or control (CON) (n=16) groups. Two expert therapists provided the NFB, CACR, and CON groups with traditional rehabilitation therapy in 30-minute sessions, 5 times a week, for 6 weeks. NFB training was provided only to the NFB group and CACR training was provided only to the CACR group. The CON group received traditional rehabilitation therapy only. Before and after 6 weeks of intervention, brain wave and ADL evaluations were performed, and the results were analyzed. [Results] The relative ratio of beta waves, only showed a significant increase in the frontal and parietal areas of the NFB group. Significant changes in ADL were shown by all three groups after the intervention. However, there were no significant differences between the NFB and CACR groups and the CON group. [Conclusion] Our results suggest that CACR and NFB are effective at improving cognitive function and ADL of stroke patients. PMID:27512287

  16. Recent results from TRISTAN

    SciTech Connect

    Enomoto, Ryoji

    1997-01-01

    TRISTAN results on {gamma}{gamma} physics from 1994 to 1995 are reviewed in this report. We have systematically investigated jet production, the {gamma}-structure function, and charm pair production in {gamma}{gamma} processes. The results are discussed, and future prospects are presented.

  17. 78 FR 19949 - The $500,000 Deduction Limitation for Remuneration Provided by Certain Health Insurance Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-02

    ... Deduction Limitation for Remuneration Provided by Certain Health Insurance Providers; Proposed Rule #0;#0... Remuneration Provided by Certain Health Insurance Providers AGENCY: Internal Revenue Service (IRS), Treasury... application of the $500,000 deduction limitation for remuneration provided by certain health...

  18. Provider biases and choices: the role of gender.

    PubMed

    Wertz, D C

    1993-09-01

    Genetic counseling provides a unique opportunity to test the influence of gender on moral reasoning. The theories of Carol Gilligan on women's "relationship based" framework for ethical decision making were contrasted with Kohlberg's research on men's resolution of conflicts based on abstract, universal principles in an impersonal and fair manner. Discussion also focussed on the theories of sociologists, such as Kanter's that a profession prestige and income as well as the proportion of women in profession determine the approach to ethical problems. This study reports on survey data in 1985 and 1986 collected from medical geneticists in 19 countries that had at least 10 medical geneticists, with at least one available to distribute questionnaires, and the appropriate geographic distribution. The survey did not include genetic counselors and allied professionals. The questionnaire asked for responses to 14 case studies, 4 questions on genetic screening and access to test results, and 12 questions on the goals and conduct of genetic counseling. 62% responded. Sociodemographic data were also collected and analyzed in stepwise logistic regressions. THe results showed that gender was the single most important determinant of ethical decision making and ethical reasoning. There were gender differences in responses to 6 of the 14 cases and, in the US, for a 7th case: sex selection. In the US, women were 4.4 times more likely to counsel indirectly about XYY fetuses and 3.6 more likely to bring up issues like false paternity or genetic carriers in other family members. Patient autonomy was an issued in a case involving a 25-year-old woman who demanded prenatal diagnosis with no genetic or medical indications and another case involving a couple desiring a son after having 4 daughters. Rights based responses were provided by 49% and relationship based responses by 44%. Gilligan's hypothesis was not supported. Similar results were found in a survey of genetic counselors, who

  19. Training providers: beyond the basics of electronic health records

    PubMed Central

    2013-01-01

    Background Training is a critical part of health information technology implementations, but little emphasis is placed on post-implementation training to support day-to-day activities. The goal of this study was to evaluate the impact of post-implementation training on key electronic health record activities. Methods Based on feedback from providers and requests for technical support, we developed two classes designed to improve providers’ effectiveness with the electronic health record. Training took place at Kaiser Permanente, Mid-Atlantic States. The classes focused on managing patient-level information using problem lists and medication lists, as well as efficient documentation and chart review. Both classes used the blended learning method, integrating concrete scenarios, hands-on exercises and take-home materials to reinforce class concepts. To evaluate training effectiveness, we used a case–control study with a 1:4 match on pre-training performance. We measured the usage rate of two key electronic health record functions (problem list and medication list management) for six months before and after training. Change scores were compared using the Wilcoxon sign rank test. Results 36 participants and 144 non-participants were included in the training evaluation. Training participants were more likely to manage both medication lists and problem lists after training. Class material is now being incorporated into an enterprise-wide multi-modal training program available to all providers at Kaiser Permanente in the Mid-Atlantic States. Conclusions Ongoing information technology training is well-received by healthcare providers, who expressed a clear preference for additional training. Training improved use of two important electronic health record features that are included as part of the Meaningful Use criteria. PMID:24295150

  20. Fault Management Architectures and the Challenges of Providing Software Assurance

    NASA Technical Reports Server (NTRS)

    Savarino, Shirley; Fitz, Rhonda; Fesq, Lorraine; Whitman, Gerek

    2015-01-01

    The satellite systems Fault Management (FM) is focused on safety, the preservation of assets, and maintaining the desired functionality of the system. How FM is implemented varies among missions. Common to most is system complexity due to a need to establish a multi-dimensional structure across hardware, software and operations. This structure is necessary to identify and respond to system faults, mitigate technical risks and ensure operational continuity. These architecture, implementation and software assurance efforts increase with mission complexity. Because FM is a systems engineering discipline with a distributed implementation, providing efficient and effective verification and validation (VV) is challenging. A breakout session at the 2012 NASA Independent Verification Validation (IVV) Annual Workshop titled VV of Fault Management: Challenges and Successes exposed these issues in terms of VV for a representative set of architectures. NASA's IVV is funded by NASA's Software Assurance Research Program (SARP) in partnership with NASA's Jet Propulsion Laboratory (JPL) to extend the work performed at the Workshop session. NASA IVV will extract FM architectures across the IVV portfolio and evaluate the data set for robustness, assess visibility for validation and test, and define software assurance methods that could be applied to the various architectures and designs. This work focuses efforts on FM architectures from critical and complex projects within NASA. The identification of particular FM architectures, visibility, and associated VVIVV techniques provides a data set that can enable higher assurance that a satellite system will adequately detect and respond to adverse conditions. Ultimately, results from this activity will be incorporated into the NASA Fault Management Handbook providing dissemination across NASA, other agencies and the satellite community. This paper discusses the approach taken to perform the evaluations and preliminary findings from the