Evaluating the Strength of School Tobacco Policies: The Development of a Practical Rating System

ERIC Educational Resources Information Center

Boyce, Jennifer C.; Mueller, Nancy B.; Hogan-Watts, Melissa; Luke, Douglas A.

2009-01-01

Background: School tobacco control policies vary widely in their strength, extensiveness, and enforcement. Currently, no standardized method exists to assess the comprehensiveness of school tobacco policies. The purpose of this study was to develop a new practical rating system for school tobacco policies, assess its reliability, and present…

Science Curriculum Resource Handbook: A Practical Guide for K-12 Science Curriculum.

ERIC Educational Resources Information Center

Cheek, Dennis W., Ed.; And Others

This handbook is one of a series of practical references for curriculum developers, education faculty, veteran teachers, and student teachers. The handbook is designed to provide basic information on the background of the science curriculum, and current information on publications, standards, and special materials for K-12 science. Part 1 contains…

AAC services for multilingual populations: South African service provider perspectives.

PubMed

Tönsing, Kerstin M; van Niekerk, Karin; Schlünz, Georg I; Wilken, Ilana

In South Africa, many persons in need of augmentative and alternative communication (AAC) come from multilingual backgrounds. There is as yet a limited evidence base (locally and internationally) for the provision of AAC services to multilingual populations. The perspectives of service providers can assist in gaining an understanding of current practices and the factors that influence these. The study aimed to obtain the perspectives of AAC service providers about practices in providing AAC systems and AAC intervention to clients from multilingual backgrounds. Fifteen AAC service providers were purposefully chosen to participate in one of three focus groups - two face-to-face and one online focus group. Data from the face-to-face focus groups was transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. Four overarching themes were identified, namely (a) current practices, (b) factors influencing current practices, (c) service provides' orientation towards different language options in AAC intervention, and (d) needs and desired developments regarding AAC technology. This paper reports on the first three themes. Service providers reported their practices to range from a focus on L1 exclusively, L2 exclusively, to a multilingual (sequential or simultaneous) approach. The South African language context, family language preferences and choices, service provider skill and knowledge, as well as AAC technology were identified as factors influencing their practices. Although many viewed access to multiple languages through AAC as positive, they also expressed concerns and reservations about providing multilingual AAC services. Although service providers in general saw the need to give clients from multilingual backgrounds access to multiple languages using AAC, this did not always translate into multilingual AAC practices. Both extrinsic factors (e.g. the lack of appropriate AAC devices, software and apps giving access to non-English languages) and intrinsic factors (service providers' language competency and their beliefs about the cognitive demands of multilingual AAC systems) influenced their practices and choices. Appropriate AAC service delivery to multilingual populations in South Africa would require not only appropriate AAC technology developments, but also research evidence to establish the efficacy of multilingual AAC interventions for clients with a variety of characteristics. Copyright © 2018 Elsevier Inc. All rights reserved.

Emotion Socialization and Ethnicity: An Examination of Practices and Outcomes in African American, Asian American, and Latin American Families

PubMed Central

Morelen, Diana; Thomassin, Kristel

2013-01-01

The current review paper summarizes the literature on parental emotion socialization in ethnically diverse families in the United States. Models of emotion socialization have been primarily developed using samples of European American parents and children. As such, current categorizations of “adaptive” and “maladaptive” emotion socialization practices may not be applicable to individuals from different ethnic backgrounds. The review examines current models of emotion socialization, with particular attention paid to the demographic breakdown of the studies used to develop these models. Additionally, the review highlights studies examining emotion socialization practices in African American, Asian American, and Latin American families. The review is synthesized with summarizing themes of similarities and differences across ethnic groups, and implications for culturally sensitive research and practice are discussed. PMID:23766738

What Do Teachers Need? An Exploration of Evidence-Informed Practice for Classroom Assessment in Ontario

ERIC Educational Resources Information Center

Cooper, Amanda; Klinger, Don A.; McAdie, Patricia

2017-01-01

Background: Within the realm of public education, there is a well-known "knowledge to practice gap" on current conceptions of classroom assessment. A collaborative research project undertaken by the Elementary Teachers' Federation of Ontario (ETFO) and a research team at Queen's University explored the roots of this gap from the…

Representing Voices from the Life-World in Evidence-Based Practice

ERIC Educational Resources Information Center

Kovarsky, Dana

2008-01-01

Background: Current models of evidence-based practice marginalize and even silence the voices of those who are the potential beneficiaries of assessment and intervention. These missing voices can be found in the reflections of clients on their own life-world experiences. Aims: This paper examines how voices from the life-world are silenced in…

University Students' Involvement in Body Piercing and Adherence to Safe Piercing Practices: Do Males and Females Differ?

ERIC Educational Resources Information Center

King, Keith A.; Vidourek, Rebecca A.

2007-01-01

Background: Health concerns of body piercing include infection, scarring, allergic reactions, pain, and disease. Current gaps in the research include students' perceived piercing risks and safe piercing practices. Purpose: The purpose of this study was to examine university students' involvement in body piercing, risk consideration and adherence…

Combining the Best of Two Worlds: A Conceptual Proposal for Evidence-Informed School Improvement

ERIC Educational Resources Information Center

Brown, Chris; Schildkamp, Kim; Hubers, Mireille D.

2017-01-01

Background: Data-based decision-making (DBDM) and research-informed teaching practice (RITP) are key to teacher and school improvement. Currently, however, DBDM and RITP represent two distinct approaches to developing evidence-informed practice (EIP) and do not correspond to the all-encompassing notion of EIP envisaged by many academics and…

A National Survey of Mental Health Screening and Assessment Practices in Juvenile Correctional Facilities

ERIC Educational Resources Information Center

Swank, Jacqueline M.; Gagnon, Joseph C.

2017-01-01

Background: Mental health screening and assessment is crucial within juvenile correctional facilities (JC). However, limited information is available about the current screening and assessment procedures specifically within JC. Objective: The purpose of the current study was to obtain information about the mental health screening and assessment…

Current Evaluation of Upper Oesophageal Sphincter Opening in Dysphagia Practice: An International SLT Survey

ERIC Educational Resources Information Center

Regan, Julie; Walshe, Margaret; McMahon, Barry P.

2012-01-01

Background: The assessment of adequate upper oesophageal sphincter (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS…

Associations of Trying to Lose Weight, Weight Control Behaviors, and Current Cigarette Use among US High School Students

ERIC Educational Resources Information Center

Johnson, Jonetta L.; Eaton, Danice K.; Pederson, Linda L.; Lowry, Richard

2009-01-01

Background: Approximately one-quarter of high school students currently use cigarettes. Previous research has suggested some youth use smoking as a method for losing weight. The purpose of this study was to describe the association of current cigarette use with specific healthy and unhealthy weight control practices among 9th-12th grade students…

Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges

PubMed Central

Salem, Haitham; Nagpal, Caesa; Pigott, Teresa; Teixeira, Antonio Lucio

2017-01-01

Background: Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies. Method: We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies. Conclusion: Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent. PMID:27928948

Advanced Practice Registered Nurses and Physician Assistants in Sleep Centers and Clinics: A Survey of Current Roles and Educational Background

PubMed Central

Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E.; Rogers, Ann E.

2014-01-01

Study Objectives: To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Methods: Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Results: Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through “on the job” training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. Conclusions: APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap. Citation: Colvin L, Cartwright Ann, Collop N, Freedman N, McLeod D, Weaver TE, Rogers AE. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. J Clin Sleep Med 2014;10(5):581-587. PMID:24812545

Knowledge-in-Action between Rules and Experiences: Lessons from High Performance Sport for Physical Education

ERIC Educational Resources Information Center

Loquet, Monique

2011-01-01

Background: Most of the current work in physical education champions a culture of "off-beat" educational practices over more traditional and accepted methods. However, in this paper we claim that in order for a student to gain a quality physical education, practices and methods used for novices need to be closely linked to those used by…

Policy Implications of Education Informatics

ERIC Educational Resources Information Center

Carr, Jo Ann; O'Brien, Nancy P.

2010-01-01

Background/Context: This concluding article identifies the policy implications of education informatics and explores impacts of current copyright laws, legislative structures, publishing practices, and education organizations. Synthesizing the discussions in the preceding articles, this article highlights the importance of designing information…

Evaluation of high intensity sheeting for overhead highway signs.

DOT National Transportation Integrated Search

1974-01-01

The current practice in Virginia is to reflectorize and illuminate all overhead highway signs because of their important role in the safe and orderly flow of traffic. Reflectorization is obtained by using reflective sheeting as background and legend ...

Current State of Inclusion of Children with Special Needs in Child Care Programmes in One Canadian Province

ERIC Educational Resources Information Center

Wiart, Lesley; Kehler, Heather; Rempel, Gwen; Tough, Suzanne

2014-01-01

Background: Access to quality child care is an important support for families with children with disabilities. The objectives of this study were to determine: (1) the current state of inclusion of children with special needs in child care programmes, and (2) the presence of child care staff practices and programme characteristics that support…

NCAA strength and conditioning coach demographics, current practice trends and common injuries of athletes during strength and conditioning sessions.

PubMed

Waryasz, Gregory R; Daniels, Alan H; Gil, Joseph A; Suric, Vladimir; Eberson, Craig P

2016-10-01

NCAA strength and conditioning coaches are responsible for the day-to-day conditioning and strength training of collegiate athletes. NCAA regulations will likely require all strength and conditioning coaches to have a strength and conditioning certification. NCAA strength and conditioning coaches have varied philosophies on exercise programming based on educational background. The study aims to further evaluate the backgrounds and exercise philosophies of NCAA strength and conditioning coaches. A survey (Survey Monkey®, Palo Alto, CA, USA) was distributed to NCAA strength and conditioning professionals to evaluate their education background, current practice trends, use of specific equipment and footwear, and what injuries occurred during sessions. Of the 208 survey participants, 77.9% were male with an average age of 34.5±9.1 years old. An exercise-related bachelor's degree was held by 80.4% and an exercise-related master's degree by 72.4%. Over 89% had a strength and conditioning certification. Having a master's, bachelor's, or type strength and conditioning certification had no difference in 1-repetition maximal practice with athletes. Lower extremity injuries made up the highest percentage (58.9%) of injuries seen by NCAA Strength and Conditioning Coaches than lumbar spine injuries (16.7%). The five most common injuries reported during workouts were lumbar strain (N.=431, 14.7%), hamstring strain (N.=332, 11.3%), ankle sprain (N.=299, 10.2%), patellar tendonitis (N.=232, 7.9%), and shin splints (N.=226, 7.7%). Collegiate education and certifications have impact on practice patterns of strength and conditioning coaches in the NCAA.

Web-based credential monitoring instantly flags health professionals with fraudulent licenses or criminal backgrounds.

PubMed

Haddad, Matthew

2009-01-01

An alarming number of practicing medical professionals and healthcare staffers across the nation may have criminal backgrounds, jeopardizing the health of hundreds of millions of patients and compromising the integrity of healthcare in this country. An investigation conducted by The Los Angeles Times found that an extraordinary number of nurses in California with criminal backgrounds had been allowed to continue working in healthcare facilities for years--their crimes virtually swept under the rug. This article suggests that continuous monitoring of healthcare credentials can mitigate the potential harm posed by credentialing fraud, recommending 24/7 monitoring in real-time as opposed to once every year or two as is the current practice. This would include verification of provider licenses, Drug Enforcement Administration certification, Office of Inspector General status, and criminal offenses. Automatic and continuous monitoring of licenses and other databases for changes and lapses, and reports on issues that are uncovered, help to prevent harmful acts on the part of healthcare providers with questionable backgrounds.

Patterns of Food Parenting Practices and Children's Intake of Energy-Dense Snack Foods.

PubMed

Gevers, Dorus W M; Kremers, Stef P J; de Vries, Nanne K; van Assema, Patricia

2015-05-27

Most previous studies of parental influences on children's diets included just a single or a few types of food parenting practices, while parents actually employ multiple types of practices. Our objective was to investigate the clustering of parents regarding food parenting practices and to characterize the clusters in terms of background characteristics and children's intake of energy-dense snack foods. A sample of Dutch parents of children aged 4-12 was recruited by a research agency to fill out an online questionnaire. A hierarchical cluster analysis (n = 888) was performed, followed by k-means clustering. ANOVAs, ANCOVAs and chi-square tests were used to investigate associations between cluster membership, parental and child background characteristics, as well as children's intake of energy-dense snack foods. Four distinct patterns were discovered: "high covert control and rewarding", "low covert control and non-rewarding", "high involvement and supportive" and "low involvement and indulgent". The "high involvement and supportive" cluster was found to be most favorable in terms of children's intake. Several background factors characterized cluster membership. This study expands the current knowledge about parental influences on children's diets. Interventions should focus on increasing parental involvement in food parenting.

Current Proceedings in the Molecular Dissection of Hepatocellular Adenomas: Review and Hands-on Guide for Diagnosis

PubMed Central

Goltz, Diane; Fischer, Hans-Peter

2015-01-01

Molecular dissection of hepatocellular adenomas has brought forward a diversity of well-defined entities. Their distinction is important for routine practice, since prognosis is tightly related to the individual subgroup. Very recent activity has generated new details on the molecular background of hepatocellular adenoma, which this article aims to integrate into the current concepts of taxonomy. PMID:26404250

Current Proceedings in the Molecular Dissection of Hepatocellular Adenomas: Review and Hands-on Guide for Diagnosis.

PubMed

Goltz, Diane; Fischer, Hans-Peter

2015-09-02

Molecular dissection of hepatocellular adenomas has brought forward a diversity of well-defined entities. Their distinction is important for routine practice, since prognosis is tightly related to the individual subgroup. Very recent activity has generated new details on the molecular background of hepatocellular adenoma, which this article aims to integrate into the current concepts of taxonomy.

Orientation and mobility training for adults with low vision: a new standardized approach

PubMed Central

Ballemans, Judith; Kempen, Gertrudis IJM

2013-01-01

Background: Orientation and mobility training aims to facilitate independent functioning and participation in the community of people with low vision. Objective: (1) To gain insight into current practice regarding orientation and mobility training, and (2) to develop a theory-driven standardized version of this training to teach people with low vision how to orientate and be safe in terms of mobility. Study of current practice: Insight into current practice and its strengths and weaknesses was obtained via reviewing the literature, observing orientation and mobility training sessions (n = 5) and interviewing Dutch mobility trainers (n = 18). Current practice was mainly characterized by an individual, face-to-face orientation and mobility training session concerning three components: crystallizing client’s needs, providing information and training skills. A weakness was the lack of a (structured) protocol based on evidence or theory. New theory-driven training: A new training protocol comprising two face-to-face sessions and one telephone follow-up was developed. Its content is partly based on the components of current practice, yet techniques from theoretical frameworks (e.g. social-cognitive theory and self-management) are incorporated. Discussion: A standardized, tailor-made orientation and mobility training for using the identification cane is available. The new theory-driven standardized training is generally applicable for teaching the use of every low-vision device. Its acceptability and effectiveness are currently being evaluated in a randomized controlled trial. PMID:22734105

Addressing Prediabetes in Childhood Obesity Treatment Programs: Support from Research and Current Practice

PubMed Central

Grow, H. Mollie; Fernandez, Cristina; Lukasiewicz, Gloria J.; Rhodes, Erinn T.; Shaffer, Laura A.; Sweeney, Brooke; Woolford, Susan J.; Estrada, Elizabeth

2014-01-01

Abstract Background: Type 2 diabetes mellitus (T2DM) and prediabetes have increased in prevalence among overweight and obese children, with significant implications for long-term health. There is little published evidence on the best approaches to care of prediabetes among overweight youth or the current practices used across pediatric weight management programs. Methods: This article reviews the literature and summarizes current practices for screening, diagnosis, and treatment of prediabetes at childhood obesity treatment centers. Findings regarding current practice were based on responses to an online survey from 28 pediatric weight management programs at 25 children's hospitals in 2012. Based on the literature reviewed, and empiric data, consensus support statements on prediabetes care and T2DM prevention were developed among representatives of these 25 children's hospitals' obesity clinics. Results: The evidence reviewed demonstrates that current T2DM and prediabetes diagnostic parameters are derived from adult-based studies with little understanding of clinical outcomes among youth. Very limited evidence exists on preventing progression of prediabetes. Some evidence suggests that a significant proportion of obese youth with prediabetes will revert to normoglycemia without pharmacological management. Evidence supports lifestyle modification for children with prediabetes, but further study of specific lifestyle changes and pharmacological treatments is needed. Conclusion: Evidence to guide management of prediabetes in children is limited. Current practice patterns of pediatric weight management programs show areas of variability in practice, reflecting the limited evidence base. More research is needed to guide clinical care for overweight youth with prediabetes. PMID:25055134

Viable Short-Term Directed Energy Weapon Naval Solutions: A Systems Analysis of Current Prototypes

DTIC Science & Technology

2013-06-01

Background and Issues for Congress 2013). The current DDG-51 electrical plant consists of three Gas Turbine Generator Sets ( GTGs ) rated at 2500 kW each...the generator rating (currently 2500kW), the practice is to have a minimum of two GTGs on line at all times to ensure continuity of service should...there be a system fault, or casualty to one of the GTGs (Mahoney, et al. 2010). This operation of at least two generators at all times essentially

Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study

PubMed Central

Harding, Alex; Rosenthal, Joe; Al-Seaidy, Marwa; Gray, Denis Pereira; McKinley, Robert K

2015-01-01

Background Health care is increasingly provided in general practice. To meet this demand, the English Department of Health recommends that 50% of all medical students should train for general practice after qualification. Currently 19% of medical students express general practice as their first career choice. Undergraduate exposure to general practice positively influences future career choice. Appropriate undergraduate exposure to general practice is therefore highly relevant to workforce planning Aim This study seeks to quantify current exposure of medical students to general practice and compare it with past provision and also with postgraduate provision. Design and setting A cross-sectional questionnaire in the UK. Method A questionnaire regarding provision of undergraduate teaching was sent to the general practice teaching leads in all UK medical schools. Information was gathered on the amount of undergraduate teaching, how this was supported financially, and whether there was an integrated department of general practice. The data were then compared with results from previous studies of teaching provision. The provision of postgraduate teaching in general practice was also examined. Results General practice teaching for medical students increased from <1.0% of clinical teaching in 1968 to 13.0% by 2008; since then, the percentage has plateaued. The total amount of general practice teaching per student has fallen by 2 weeks since 2002. Medical schools providing financial data delivered 14.6% of the clinical curriculum and received 7.1% of clinical teaching funding. The number of departments of general practice has halved since 2002. Provision of postgraduate teaching has tripled since 2000. Conclusion Current levels of undergraduate teaching in general practice are too low to fulfil future workforce requirements and may be falling. Financial support for current teaching is disproportionately low and the mechanism counterproductive. Central intervention may be required to solve this. PMID:26009536

Defining and Applying a Functionality Approach to Intellectual Disability

ERIC Educational Resources Information Center

Luckasson, R.; Schalock, R. L.

2013-01-01

Background: The current functional models of disability do not adequately incorporate significant changes of the last three decades in our understanding of human functioning, and how the human functioning construct can be applied to clinical functions, professional practices and outcomes evaluation. Methods: The authors synthesise current…

Shame as a Cultural Artifact: A Call for Self-Awareness and Reflexivity in Personality Assessment.

PubMed

Aschieri, Filippo

2016-01-01

It has become common for assessors to face therapeutic impasses and dilemmas when practicing within the Therapeutic Assessment (TA) model. This is due to the explicit goal of producing therapeutic changes in clients. In this article the author discusses the importance of assessors being aware of how their clinical practices relate to their assessment outcomes. To enhance such awareness, the author reviews the characteristics of psychological assessment practices as derived from 3 paradigms developed almost 1.5 centuries ago in Europe by the forefathers of psychology as a scientific discipline. Current assessment practices are deeply ingrained in specific cultural, social, and political frameworks originating in these paradigms. Being aware of such a historical and cultural background might help the assessor avoid blindly reenacting the values, norms, and latent relational schemas implied by different assessment methods, and instead use assessment tools as potent aids in the service of clients' change. Finally, the author illustrates how the experience of clients' shame in psychological assessment might also be understood as a by-product of the specific cultural and historical background of certain common assessment practices.

Veterinary career ambitions correlate with gender and past experience, with current experience influencing curricular perspectives.

PubMed

Kinnison, T; May, S A

2013-03-23

The Royal Veterinary College's 'Teaching Quality Survey' was completed by 261 recent graduates (six months after graduation) from 2005 to 2011 (26.8 per cent response rate). The results were used to compare veterinarians' background information with current position and career ambition, and to investigate perceptions of curriculum balance. There was a significant difference between males' and females' current positions and career ambitions with comparatively lower percentages of females in farm animal and farm and equine practices. There was also a significant difference between individuals from different childhood areas; individuals from urban areas preferred small animal practice, in comparison to those from rural areas who are more likely to choose farm animal practices. Compared with their peers, individuals engaged in a specific area of work tend to think that their area was under-represented in the professional curriculum. Taken alongside the feminisation and urbanisation of the profession, the results of this study indicate that food animal careers need to be promoted as an attractive option for new graduates and those going into mixed practice initially. Also, those involved in curriculum design using graduate surveys should take into account the current careers of the respondents in order to avoid biased results.

Are South African Speech-Language Therapists adequately equipped to assess English Additional Language (EAL) speakers who are from an indigenous linguistic and cultural background? A profile and exploration of the current situation

PubMed Central

Mdlalo, Thandeka; Flack, Penelope

2016-01-01

This article presents the results of a survey conducted on Speech-Language Therapists (SLTs) regarding current practices in the assessment of English Additional Language (EAL) speakers in South Africa. It forms part of the rationale for a broader (PhD) study that critiques the use of assessment instruments on EAL speakers from an indigenous linguistic and cultural background. This article discusses an aspect of the broader research and presents the background, method, findings, discussion and implications of the survey. The results of this survey highlight the challenges of human and material resources to, and the dominance of English in, the profession in South Africa. The findings contribute to understanding critical factors for acquiring reliable and valid assessment results with diverse populations, particularly the implications from a cultural and linguistic perspective. PMID:27247254

Paediatric Palliative Care and Intellectual Disability--A Unique Context

ERIC Educational Resources Information Center

Duc, Jacqueline K.; Herbert, Anthony Robert; Heussler, Helen S.

2017-01-01

Background: Paediatric palliative care is a nuanced area of practice with additional complexities in the context of intellectual disability. There is currently minimal research to guide clinicians working in this challenging area of care. Method: This study describes the complex care of children with life-limiting conditions and intellectual…

Picture This

ERIC Educational Resources Information Center

Dillon, Robert

2012-01-01

Images can be powerful tools for change, but without compelling images of the future of education, everyone will be forced to use the images of the past. The problem is that schools can't be built on old images: they must reflect current best practices that infuse technology, relationships, background knowledge, culturally responsive texts, and…

Speech-Language Therapists' Process of Including Significant Others in Aphasia Rehabilitation

ERIC Educational Resources Information Center

Hallé, Marie-Christine; Le Dorze, Guylaine; Mingant, Anne

2014-01-01

Background: Although aphasia rehabilitation should include significant others, it is currently unknown how this recommendation is adopted in speech-language therapy practice. Speech-language therapists' (SLTs) experience of including significant others in aphasia rehabilitation is also understudied, yet a better understanding of clinical…

School Bullying and Current Educational Practice: Re-Imagining Theories of Educational Transformation

ERIC Educational Resources Information Center

Jacobson, Ronald B.

2007-01-01

Background/Context: Bullying within schools continues despite thoughtful and well-researched anti-bullying strategies deployed against it. The bulk of research targeted toward understanding and eradicating bullying within schools is of an empirical nature. In other words, through data collection, questionnaires, interviews, ethnography,…

Tensions and Challenges in China's Education Policy Borrowing

ERIC Educational Resources Information Center

Tan, Charlene

2016-01-01

Background: This article critically discusses the key tensions and challenges arising from the educational policy borrowing in China, through its current education reform. Focussing on the new curriculum reform (NCR), the paper highlights the interactions and conflicts between foreign and local ideologies and practices. Sources of evidence: The…

77 FR 37051 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-20

...). Background and Brief Description For the current study, the National Institute for Occupational Safety and... policies, procedures, practices) and workers compensation (WC) injury/illness outcomes. The study will be... elements with particularly high impact on WC losses will be identified in this study and disseminated to...

Autopsy in Islam and current practice in Arab Muslim countries.

PubMed

Mohammed, Madadin; Kharoshah, Magdy A

2014-03-01

Autopsy, or post-mortem examination, is the dissection of a dead body. It is performed for many reasons. Attitudes toward dead bodies vary with religious beliefs and cultural and geographical backgrounds. We have carried out an extensive literature review to determine the Islamic view and current practice of Autopsy, in at least four Arab countries which published their experiences. Several research articles have studied the history of Islamic Autopsy as well as the current situation and legal debates about it. The overwhelming conclusion is that data is lacking. More must be published from Arabic Muslim countries and more research done to correct misconceptions. We also recommend more application of non-invasive Autopsy. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Building SAWE Capability as an ANSI Accredited Standards Developer

NASA Technical Reports Server (NTRS)

Cerro, Jeffrey A.; Davis, Ed; Peterson, Eric; Griffiths, William T.; Brooks, Andy; Stratton, Bonnie; Attar, Jose

2014-01-01

This paper presents a 2014 status of the Society of Allied Weight Engineers' process towards becoming an Accredited Standards Developer (ASD) under certification by the United States American National Standards Institute (ANSI). Included is material from the committee's 2013 International presentation, current status, and additional general background material. The document strives to serve as a reference point to assist SAWE Recommended Practice and Standards developers in negotiating United States Standards Strategy, international standards strategy, and the association of SAWE standards and recommended practices to those efforts. Required procedures for SAWE to develop and maintain Recommended Practices and ANSI/SAWE Standards are reviewed.

Some anatomical and physiological aspects of anal sexual practices.

PubMed

Agnew, J

1985-01-01

Anal manipulation and penetration produce stimulation enjoyed as sexual by some people. Although this type of sexual activity is not new, the current social climate of sexual freedom and experimentation has brought it out into the open. This paper reviews some of the anatomical, physiological, and behavioral aspects of this variation of human sexual gratification, and provides the practicing professional, who has to deal with questions on anal sexuality, with information on the subject and suitable background material and literature references for further study.

Medical students' attitudes towards general practice and factors affecting career choice: a questionnaire study

PubMed Central

Garnham, Laura

2014-01-01

Background The current issue of general practice recruitment is a significant challenge and concern. In order to address this, it is vital to understand medical students' attitudes towards general practice and what influences their choice of intended career. Method We used a questionnaire study to examine these attitudes across all years at Imperial College Medical School and to understand what a group of London medical students' current intended career choices were. Results We found that only 13% of students ranked general practice as their first choice career despite having a generally realistic and positive attitude towards the speciality. They highlighted that the main influence on future career choice was interest in the specific speciality and that lifestyle factors did not seem to be so important. Conclusion Exposure to general practice, primary care research and student GP societies might play some part in increasing interest, but more work is needed to understand why students are rejecting general practice and what we can do collectively to attract students into choosing a career in primary care. PMID:25949732

The evolution of eLearning background, blends and blackboard....

PubMed

Sleator, Roy D

2010-01-01

This review of eLearning is divided into three sections: the first charts the evolution of eLearning from early correspondence courses to the current computer mediated approaches to distributed learning. The second section deals with the concept of blended learning; combining best practice in face-to-face and online learning. The final section focuses on current platform technologies in eLearning and outlines the strengths and weaknesses of learning management systems such as Blackboard.

Children of La Frontera: Binational Efforts To Serve Mexican Migrant and Immigrant Students.

ERIC Educational Resources Information Center

Flores, Judith LeBlanc, Ed.

This book includes 20 chapters that provide background on the historical and current context of U.S.-Mexico relations and education in Mexico, examine existing binational educational and health programs, and describe effective practices for teaching Mexican migrant and immigrant students and working with families from Mexico. Following a foreword…

Exploring How Institutional Structures and Practices Influence English Learners' Opportunity to Learn Social Studies

ERIC Educational Resources Information Center

Heafner, Tina L.; Plaisance, Michelle

2016-01-01

Background/Context: Current research addresses the marginalization of social studies and trends in teaching English learners (ELs) in monolingual schools; however, few studies have examined the way in which support services provided to ELs impact their exposure to social studies instruction. Purpose/Objective/Research Question/Focus of Study:…

Computers in Life Science Education. Volume 5, 1988.

ERIC Educational Resources Information Center

Computers in Life Science Education, 1988

1988-01-01

Designed to serve as a means of communication among life science educators who anticipate or are currently using microcomputers as an educational tool, this volume of newsletters provides background information and practical suggestions on computer use. Over 80 articles are included. Topic areas include: (1) using a personal computer in a plant…

Religious Youths' Motivations for Reading Complex, Religious Texts

ERIC Educational Resources Information Center

Rackley, Eric D.

2016-01-01

Background/Context: Research confirms that religion is a significant part of the lives of American youths, that religious texts are an essential part of their experiences in the world, and that as part of their everyday cultural practices, religious youths demonstrate strong commitments to reading religious texts. Currently, however, the field of…

A Randomised Controlled Trial of PEGASUS, a Psychoeducational Programme for Young People with High-Functioning Autism Spectrum Disorder

ERIC Educational Resources Information Center

Gordon, Kate; Murin, Marianna; Baykaner, Ozlem; Roughan, Laura; Livermore-Hardy, Vaan; Skuse, David; Mandy, Will

2015-01-01

Background: Psychoeducation is an essential component of postdiagnostic care for people with ASD (autism spectrum disorder), but there is currently no evidence base for clinical practice. We designed, manualised and evaluated PEGASUS (psychoeducation group for autism spectrum understanding and support), a group psychoeducational programme aiming…

Health Education Teacher Resource Handbook: A Practical Guide for K-12 Health Education.

ERIC Educational Resources Information Center

Mahoney, Beverly Saxton, Ed.; Olsen, Larry K., Ed.

This handbook provides background information on the health curriculum, as well as current, comprehensive information on publications, standards, and special materials for K-12 health education. The manual begins with an introduction, by P. Bruce Uhrmacher, which provides an overview of the ideologies and philosophies that have affected curriculum…

Internationalizing Higher Education: The Development of Practice and Policy in South Africa

ERIC Educational Resources Information Center

Dolby, Nadine

2010-01-01

Background/Context: Internationalization has moved from the periphery to the core of many universities' policies, mission statements, and strategic plans. In contrast to earlier paradigms of internationalization, the current period is significantly shaped by the global dominance of capitalism, the rise of the audit and accountability culture, and…

Ability as an Additional Support Need: Scotland's Inclusive Approach to Gifted Education

ERIC Educational Resources Information Center

Sutherland, Margaret; Stack, Niamh

2014-01-01

The present paper provides an overview of the current national legislation, policies, curriculum and practice relating to gifted education within Scotland. It begins by providing an overview of the national context and historical background that, to this day, underpin the egalitarian ethos that permeates Scottish education. We discuss how…

Social Networks and Parent Motivational Beliefs: Evidence from an Urban School District

ERIC Educational Resources Information Center

Curry, Katherine A.; Jean-Marie, Gaëtane; Adams, Curt M.

2016-01-01

Background: Despite devotion of substantial resources and effort to increase parent/school partnerships, gaps remain between policy rhetoric and practice, especially in high-poverty communities. Current research focuses on parent involvement or effects of parent motivational beliefs on parent choice for behavior; however, it does not address the…

Bringing Faith to Campus: Religious and Spiritual Space, Time, and Practice at Stanford University

ERIC Educational Resources Information Center

Karlin-Neumann, Patricia; Sanders, Joanne

2013-01-01

This essay examines how Stanford University, secular in its origins, yet with a church at its center, addresses the religious and spiritual concerns of current students, whether from traditional or innovative religious backgrounds. Identified religious and spiritual needs prompt questions about the balance between the spiritual health and…

Why We Need a Structured Abstract in Education Research

ERIC Educational Resources Information Center

Mosteller, Frederick; Nave, Bill; Miech, Edward J.

2004-01-01

Background: Approximately 1,100 education journals collectively publish more than 20,000 education research articles each year. Under current practice, no systematic way exists to move the research findings from these studies into the hands of the millions of education practitioners and policymakers in the United States who might use them.…

The History of the Democratic Adult Education Movement in Spain

ERIC Educational Resources Information Center

Oliver, Esther; Tellado, Itxaso; Yuste, Montserrat; Larena-Fernández, Rosa

2016-01-01

Background/Context: Traditional adult education in Spain treated the learner as a mere object that could be shaped by the educator. Although current practices of the democratic adult education movement in Spain reveals a completely opposite standpoint on adult education, there has been little analysis of the several influences converging and…

Teacher Feedback during Active Learning: Current Practices in Primary Schools

ERIC Educational Resources Information Center

van den Bergh, Linda; Ros, Anje; Beijaard, Douwe

2013-01-01

Background: Feedback is one of the most powerful tools, which teachers can use to enhance student learning. It appears dif?cult for teachers to give qualitatively good feedback, especially during active learning. In this context, teachers should provide facilitative feedback that is focused on the development of meta-cognition and social learning.…

Head Start Classrooms and Children's School Readiness Benefit from Teachers' Qualifications and Ongoing Training

ERIC Educational Resources Information Center

Son, Seung-Hee Claire; Kwon, Kyong-Ah; Jeon, Hyun-Joo; Hong, Soo-Young

2013-01-01

Background: Teacher qualifications have been emphasized as a basis of professional development to improve classroom practices for at-risk children's school readiness. However, teacher qualifications have often not been compared to another form of professional development, in-service training. Objective: The current study attempts to investigate…

Cultural Competence and Social Work Education: Moving toward Assessment of Practice Behaviors

ERIC Educational Resources Information Center

Jani, Jayshree S.; Osteen, Philip; Shipe, Stacy

2016-01-01

Social work educators are responsible for ensuring that future practitioners are culturally competent and have the ability to work effectively with people from different backgrounds. The purpose of this article is to address the current limitations in measuring cultural competence and to report the results of a qualitative study examining…

Asian Shades of Spirituality: Implications for Multicultural School Counseling

ERIC Educational Resources Information Center

Hanna, Fred J.; Green, Alan

2004-01-01

In the current practice of school counseling, little consideration is given to the spiritual background of students of Asian cultures. Although there is a body of literature on Asian culture in counseling, the authors could find remarkably few articles pertaining to counseling students in the context of Asian religious and spiritual traditions. In…

Expansive Openness in Teacher Practice

ERIC Educational Resources Information Center

Kimmons, Royce

2016-01-01

Background/Context: Previous work on the use of open educational resources in K-12 classrooms has generally focused on issues related to cost. The current study takes a more expansive view of openness that also accounts for adaptation and sharing in authentic classroom contexts. Purpose/Objective/Research Question/Focus of Study The study seeks to…

Computers in Life Science Education. Volumes 1 through 4, 1984-1987.

ERIC Educational Resources Information Center

Modell, Harold, Ed.

1987-01-01

Designed to serve as a means of communication among life science educators who anticipate or are currently using microcomputers as an educational tool, these four volumes of newsletters provide background information and practical suggestions on computer use in over 80 articles. Topic areas include: (1) teaching physiology and other life sciences…

A Whole School Approach: Collaborative Development of School Health Policies, Processes, and Practices

ERIC Educational Resources Information Center

Hunt, Pete; Barrios, Lisa; Telljohann, Susan K.; Mazyck, Donna

2015-01-01

Background: The Whole School, Whole Community, Whole Child (WSCC) model shows the interrelationship between health and learning and the potential for improving educational outcomes by improving health outcomes. However, current descriptions do not explain how to implement the model. Methods: The existing literature, including scientific articles,…

Use of Outcome Measurement by Paediatric AHPs in Northern Ireland

ERIC Educational Resources Information Center

Harron, Anita; Titterington, Jill

2016-01-01

Background: Professional standards advocate routine use of outcome measurement (OM) in the practice of allied health professionals (AHPs). Historically, OM has focused on impairment and its immediate constraints on activity, while current policy encourages the development and addition of impact-based OM. There appears to be an assumption at this…

A Standard of Knowledge for the Professional Practice of Toxicology

PubMed Central

Kinter, Lewis B.; Kelman, Bruce

2015-01-01

Background Employers, courts, and the general public judge the credibility of professionals based on credentials such as academic degrees, publications, memberships in professional organizations, board certifications, and professional registrations. However, the relevance and merit of these credentials can be difficult to determine objectively. Board certification can be a reliable indicator of proficiency if the certifying organization demonstrates, through regularly scheduled independent review, that its processes meet established standards and when a certificate holder is required to periodically demonstrate command of a body of knowledge that is essential to current professional practice. Objective We report herein a current Standard of Knowledge in general toxicology compiled from the experience and opinions of 889 certified practicing professional toxicologists. Discussion An examination is the most commonly used instrument for testing a certification candidate’s command of the body of knowledge. However, an examination-based certification is only creditable when the body of knowledge, to which a certification examination tests, is representative of the current knowledge, skills, and capabilities needed to effectively practice at the professional level. Thus, that body of knowledge must be the current “Standard of Knowledge” for the profession, compiled in a transparent fashion from current practitioners of the profession. Conclusion This work was conducted toward ensuring the scientific integrity of the products produced by professional toxicologists. Citation Hulla JE, Kinter LB, Kelman B. 2015. A Standard of Knowledge for the professional practice of toxicology. Environ Health Perspect 123:743–748; http://dx.doi.org/10.1289/ehp.1408643 PMID:25782181

Integrated bio-fluorescence sensor.

PubMed

Thrush, Evan; Levi, Ofer; Ha, Wonill; Wang, Ke; Smith, Stephen J; Harris, James S

2003-09-26

Due to the recent explosion in optoelectronics for telecommunication applications, novel optoelectronic sensing structures can now be realized. In this work, we explore the integration of optoelectronic components towards miniature and portable fluorescence sensors. The integration of these micro-fabricated sensors with microfluidics and capillary networks may reduce the cost and complexity of current research instruments and open up a world of new applications in portable biological analysis systems. A novel optoelectronic design that capitalizes on current vertical-cavity surface-emitting laser (VCSEL) technology is explored. Specifically, VCSELs, optical emission filters and PIN photodetectors are fabricated as part of a monolithically integrated near-infrared fluorescence detection system. High-performance lasers and photodetectors have been characterized and integrated to form a complete sensor. Experimental results show that sensor sensitivity is limited by laser background. The laser background is caused by spontaneous emission emitted from the side of the VCSEL excitation source. Laser background will limit sensitivity in most integrated sensing designs due to locating excitation sources and photodetectors in such close proximity, and methods are proposed to reduce the laser background in such designs so that practical fluorescent detection limits can be achieved.

Herd health status and management practices on 16 Irish suckler beef farms

PubMed Central

2013-01-01

Background There have been few studies published internationally which document herd health management practices in suckler beef herds and no published Irish studies. The study objective was to document herd health status and management practices on sixteen Irish suckler beef herds over a two year period (2009–2010). The farms used in the study were part of the Teagasc BETTER farm beef programme. The mean (s.d.) herd size, stocking rate and farm size was 68 cows (27.6), 2.0 LU/ha (0.3) and 64.3 (21.6) adjusted hectares, respectively. Two questionnaires were designed; 1) a farmer questionnaire to collect information on farm background and current herd health control practices and 2) a veterinary questionnaire to collect information on the extent of animal health advice given by veterinarians to their clients and identification of any on-farm herd health issues. Results Dystocia, calf pneumonia, and calf diarrhoea, in that order, were identified as the primary herd health issues in these Irish suckler beef herds. In addition, substantial deficiencies in biosecurity practices were also identified on these farms. Conclusions The findings of this study may serve as the focus for future research in animal health management practices in Irish suckler beef herds. PMID:24195997

Childhood socioeconomic status and race are associated with adult sleep.

PubMed

Tomfohr, Lianne M; Ancoli-Israel, Sonia; Dimsdale, Joel E

2010-01-01

Race and current socioeconomic status (SES) are associated with sleep. Parental education, a commonly studied component of childhood SES, is predictive of adult health outcomes; yet, its impact on adult sleep remains unclear. In this study, the sleep of 128 Black and White adults was investigated. Participants with lower childhood SES (assessed via parental education) spent more time in Stage 2 sleep and less time in slow-wave sleep (SWS) than those with higher childhood SES. In addition, women from low childhood SES backgrounds took longer to fall asleep than women from high SES backgrounds. Black participants spent less time in SWS than their White counterparts, and an Age × Race interaction was detected in the prediction of subjective sleep quality. Results were not mediated via current SES or health practices.

"Best practice" in inflammatory bowel disease: an international survey and audit.

PubMed

Van Der Eijk, Ingrid; Verheggen, Frank W.; Russel, Maurice G.; Buckley, Martin; Katsanos, Kostas; Munkholm, Pia; Engdahl, Ingemar; Politi, Patrizia; Odes, Selwyn; Fossen, Jan; Stockbrügger, Reinhold W.

2004-04-01

Background: An observational study was conducted at eight university and four district hospitals in eight countries collaborating in clinical and epidemiological research in inflammatory bowel disease (IBD) to compare European health care facilities and to define current "best practice" with regard to IBD. Methods: The approach used in this multi-national survey was unique. Existing quality norms, developed for total hospital care by a specialized organization, were restricted to IBD-specific care and adapted to the frame of reference of the study group. In each center, these norms were surveyed by means of questionnaires and professional audits in all participating centers. The collected data were reported to the center, compared to data from other hospitals, and used to benchmark. Group consensus was reached with regard to defining current "best practice". Results: The observations in each center involved patient-oriented processes, technical and patient safety, and quality of the medical standard. Several findings could be directly implemented to improve IBD care in another hospital (benchmarks). These included a confidential relationship between health care worker(s) and patients, and availability of patient data. Conclusions: The observed benchmarks, in combination with other subjectively chosen "positive" procedures, have been defined as current "best practice in IBD", representing practical guidelines towards better quality of care in IBD.

Learning Analytics and Educational Data Mining in Practice: A Systematic Literature Review of Empirical Evidence

ERIC Educational Resources Information Center

Papamitsiou, Zacharoula; Economides, Anastasios A.

2014-01-01

This paper aims to provide the reader with a comprehensive background for understanding current knowledge on Learning Analytics (LA) and Educational Data Mining (EDM) and its impact on adaptive learning. It constitutes an overview of empirical evidence behind key objectives of the potential adoption of LA/EDM in generic educational strategic…

Preschool Daily Patterns of Physical Activity Driven by Location and Social Context

ERIC Educational Resources Information Center

Schlechter, Chelsey R.; Rosenkranz, Richard R.; Fees, Bronwyn S.; Dzewaltowski, David A.

2017-01-01

Background: Preschool children are recommended to spend at least 15 minutes/hour (25% time) in light-to-vigorous physical activity (total physical activity, TPA). Preschool provider practices, such as whether children are put in small group or whole-group activities, are likely to affect children's TPA levels during preschool. The current study…

Realistic Job Previews: Can a Procedure to Reduce Turnover Also Influence the Relationship between Abilities and Performance?

ERIC Educational Resources Information Center

Wanous, John P.

1978-01-01

The current state of theory, research, and practice in realistic job previews (RJP) for recruitment is still immature. RJPs have been used to reduce employee turnover, but not necessarily to influence the job performance of newcomers. This research looks at the background, research results, and unanswered issues. (Author/RK)

Forests and water: effects of forest management on floods, sedimentation, and water supply

Treesearch

Henry W. Anderson; Marvin D. Hoover; Kenneth G. Reinhart

1976-01-01

From the background of more than 100 years' collective experience in watershed research and from comprehensive review of the literature of forest hydrology, the authors summarize what is known about the forest's influence on the water resource, particularly the effects of current forestry practices. They first examine the fundamental hydrologic processes in...

Consumer Evaluation of Educational Programs: Using Questionnaires Completed by Alumni.

ERIC Educational Resources Information Center

Copeland, H. L.; Hewson, M.; Weiker, G.

This paper describes a method used to evaluate 48 medical residency programs at one institution. It presents the background rationale, logistics, and results obtained by surveying alumni, in the context of their current practice, for relevant data on the value of their training experience. Surveys were sent for 3 years to all alumni of Cleveland…

Early Steps to School Success (ESSS): Examining Pathways Linking Home Visiting and Language Outcomes

ERIC Educational Resources Information Center

Iruka, Iheoma U.; Brown, Deborah; Jerald, Judith; Blitch, Kimberly

2018-01-01

Background: Improving the home environment and parenting practices to support children's early development and learning is a key focus of many. Home visiting is one potential strategy to improve the home environment and parenting; however, more data about current programmatic efforts is needed, especially for children with multiple risks living in…

Is Self-Explanation Worth the Time? A Comparison to Additional Practice

ERIC Educational Resources Information Center

McEldoon, Katherine L.; Durkin, Kelley L.; Rittle-Johnson, Bethany

2013-01-01

Background: Self-explanation, or generating explanations to oneself in an attempt to make sense of new information, can promote learning. However, self-explaining takes time, and the learning benefits of this activity need to be rigorously evaluated against alternative uses of this time. Aims: In the current study, we compared the effectiveness of…

Factors influencing the choice of a career in food-animal practice among recent graduates and current students of Texas A&M University, College of Veterinary Medicine.

PubMed

Lenarduzzi, Roland; Sheppard, Guy A; Slater, Margaret R

2009-01-01

Concerns about a shortage of large and mixed-animal veterinarians have been discussed in the profession. To better understand veterinary career choices among currently enrolled veterinary students (classes of 2007-2010) and recent graduate veterinarians in Texas (classes of 2002-2006), an online survey was developed. The objectives were to examine: (1) the respondents' backgrounds, demographic data, and experiences; (2) the respondents' working conditions and rural lifestyle considerations; (3) the respondents' perceptions of large/mixed-animal practice; and (4) the factors that have influenced respondents' career choices. The response rate was 37% (390/1,042). Overall, 72% of students and 55% of recent graduates were interested in large/mixed-animal practice. More than 70% of respondents indicated that veterinary practitioners had the strongest personal influence on career choices. Respondents who were no longer interested in large/mixed-animal practice, or who had never been interested, reported no experience with large animals (42% and 64%, respectively) as the most common reason for their lack of interest. Previous and current interest in large/mixed-animal practice were associated with working in a large/mixed-animal practice, any agricultural experience, and working for at least 6 months on a farm or ranch. Any 4-H experience increased the likelihood of previous interest, while being married decreased the likelihood of current interest. Student contact with practitioners (82%) and financial considerations (77%) were most commonly cited as factors that would make a career in large/mixed-animal practice more attractive. Rural lifestyle drawbacks influenced respondents' career choices. Many forms of agricultural experience may expose and encourage students to consider large/mixed-animal practice.

Minority students in the science classroom: Issues of language, class, race, culture and pedagogy

NASA Astrophysics Data System (ADS)

Sweeney, Aldrin Edward

A considerable proportion of the educationally at-risk students in the K-12 public education system is composed of minority students, either in terms of cultural background, linguistic background, and frequently, both. In particular, satisfactory levels of achievement in science are not being attained by these students. The concerns of this study center on examining and understanding the reasons underlying this situation, with a view to suggesting how these problems of underachievement in science might be addressed. Previous and ongoing educational research concerning these issues suggest that such underachievement may be due to current pedagogical practices which seem to actively discourage these students from achieving any significant measure of academic, educational or professional success. The purpose of this study is thus to explore the beliefs and pedagogical practices of science teachers as they relate to minority students, especially those minority students for whom English is not a first language and who have limited English proficiency (LEP). In the course of this study, the terminology 'minority students' will refer to and be inclusive of cultural and/or language minorities, i.e. those students who differ from the mainstream white American student in terms of cultural background and a native language other than English. Culturally derived usages of non-standard forms of English (e.g. Black English Vernacular) also will be subsumed within this definition of cultural and language minority students. Particular attention will be given to emergent issues relating to current pedagogical practices, also to the science teacher beliefs and epistemological rationales underlying such practices. In exploring these beliefs and pedagogical practices, the study also will seek to delineate and to understand the various problems which are being encountered in the teaching of science to minority students. As the result of exploring the beliefs and pedagogical practices of science teachers as they relate to minority students, it is intended that the completed study will contribute toward the development and elaboration of a substantive pedagogical content knowledge base for science teachers of cultural and language minority students. It is anticipated that the development of such a knowledge base will be of practical assistance to science teachers in their pedagogical decisions such that a greater inclusion of these students in the science discourse community may be attained.

Effective Strategies for Achieving Scope of Practice Reform in Pennsylvania

PubMed Central

Carthon, J. Margo Brooks; Nicely, Kelly Wiltse; Sarik, Danielle Altares; Fairman, Julie

2017-01-01

Background Current regulatory impediments prohibit advanced practice registered nurses from practicing to their full capacity. Purpose To examine the process of successful removal of scope of practice barriers in Pennsylvania under the Rx4PA legislation introduced in 2007. Method We used qualitative research techniques, including purposeful sampling of participants. Twelve stakeholder informed interviews were conducted between October 2013 and May 2014. Participants were closely involved with the development of the Rx4PA legislation. Thematic content analysis was performed to analyze our interviews. Discussion Interviews identified overarching themes, including the importance of leveraging years of grass roots advocacy, identifying political allies, and recognizing mutually beneficial compromises. Conclusions The combination of timing, careful political maneuvering, and compromise were key to scope of practice reform in Pennsylvania and may be useful strategies for other states seeking similar practice changes. PMID:27502393

Current and future risks of asbestos exposure in the Australian community

PubMed Central

2016-01-01

Background Australia mined asbestos for more than 100 years and manufactured and imported asbestos products. There is a legacy of in situ asbestos throughout the built environment. Methods The aim of this study was to identify the possible sources of current and future asbestos exposure from the built environment. Telephone interviews with environmental health officers, asbestos removalists, and asbestos assessors in Australia sought information about common asbestos scenarios encountered. Results There is a considerable amount of asbestos remaining in situ in the Australian built environment. Potential current and future sources of asbestos exposure to the public are from asbestos-containing roofs and fences, unsafe asbestos removal practices, do-it-yourself home renovations and illegal dumping. Conclusion This research has highlighted a need for consistent approaches in the regulation and enforcement of safe practices for the management and removal of asbestos to ensure that in situ asbestos in the built environment is managed appropriately. PMID:27611196

Primary Care Practice Transformation Is Hard Work

PubMed Central

Crabtree, Benjamin F.; Nutting, Paul A.; Miller, William L.; McDaniel, Reuben R.; Stange, Kurt C.; Jaén, Carlos Roberto; Stewart, Elizabeth

2010-01-01

Background Serious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a patient-centered medical home present even greater challenges and require more effective approaches. Methods Our research team conducted a series of National Institutes of Health funded descriptive and intervention projects to understand organizational change in primary care practice settings, emphasizing a complexity science perspective. The result was a developmental research effort that enabled the identification of critical lessons relevant to enabling practice change. Results A summary of findings from a 15-year program of research highlights the limitations of viewing primary care practices in the mechanistic terms that underlie current or traditional approaches to quality improvement. A theoretical perspective that views primary care practices as dynamic complex adaptive systems with “agents” who have the capacity to learn, and the freedom to act in unpredictable ways provides a better framework for grounding quality improvement strategies. This framework strongly emphasizes that quality improvement interventions should not only use a complexity systems perspective, but also there is a need for continual reflection, careful tailoring of interventions, and ongoing attention to the quality of interactions among agents in the practice. Conclusions It is unlikely that current strategies for quality improvement will be successful in transforming current primary care practice to a patient-centered medical home without a stronger guiding theoretical foundation. Our work suggests that a theoretical framework guided by complexity science can help in the development of quality improvement strategies that will more effectively facilitate practice change. PMID:20856145

Articulating current service development practices: a qualitative analysis of eleven mental health projects

PubMed Central

2014-01-01

Background The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. Methods Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. Results Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. Conclusions This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial. PMID:24438471

Engaging participants in a complex intervention trial in Australian General Practice

PubMed Central

Perkins, David; Harris, Mark F; Tan, Jocelyn; Christl, Bettina; Taggart, Jane; Fanaian, Mahnaz

2008-01-01

Background The paper examines the key issues experienced in recruiting and retaining practice involvement in a large complex intervention trial in Australian General Practice. Methods Reflective notes made by research staff and telephone interviews with staff from general practices which expressed interest, took part or withdrew from a trial of a complex general practice intervention. Results Recruitment and retention difficulties were due to factors inherent in the demands and context of general practice, the degree of engagement of primary care organisations (Divisions of General Practice), perceived benefits by practices, the design of the trial and the timing and complexity of data collection. Conclusion There needs to be clearer articulation to practices of the benefits of the research to participants and streamlining of the design and processes of data collection and intervention to fit in with their work practices. Ultimately deeper engagement may require additional funding and ongoing participation through practice research networks. Trial Registration Current Controlled Trials ACTRN12605000788673 PMID:18700984

Assessing the Readiness of Nursing Sectors in Low- and Middle-Income Countries to Adopt Holistic Practice: Rwanda as Exemplar.

PubMed

Rosa, William

Over the past several years, holistic nursing education has become more readily available to nurses working in high-income nations, and holistic practice has become better defined and promoted through countless organizational and governmental initiatives. However, global nursing community members, particularly those serving in low- and middle-income countries (LMICs) within resource-constrained health care systems, may not find holistic nursing easily accessible or applicable to practice. The purpose of this article is to assess the readiness of nursing sectors within these resource-constrained settings to access, understand, and apply holistic nursing principles and practices within the context of cultural norms, diverse definitions of the nursing role, and the current status of health care in these countries. The history, current status, and projected national goals of professional nursing in Rwanda is used as an exemplar to forward the discussion regarding the readiness of nurses to adopt holistic education into practice in LMICs. A background of holistic nursing practice in the United States is provided to illustrate the multifaceted aspects of support necessary in order that such a specialty continues to evolve and thrive within health care arenas and the communities it cares for.

Authoritarian parenting attitudes and social origin: The multigenerational relationship of socioeconomic position to childrearing values.

PubMed

Friedson, Michael

2016-01-01

Support for authoritarian approaches to parenting, including corporal punishment, is known to be elevated among individuals with low current levels of socioeconomic attainment. The objectives of this study are: (1) to determine whether authoritarian parenting dispositions are related to disadvantages in one's social background, in addition to one's present socioeconomic standing; and (2) to distinguish, in this regard, between support for spanking and other authoritarian parenting dispositions. Ordered logit models, applied to General Social Survey data concerning a nationally representative sample of US adults, are used to examine relationships of authoritarian parenting dispositions to the socioeconomic positions that respondents currently occupy and in which they were raised. It is found that support for spanking (N=10,725) and valuing of obedience (N=10,043) are inversely related to the socioeconomic status (SES) of one's family of origin, and that these associations are robust to controls for one's current SES. A disadvantaged family background is found to increase support for spanking most among those with high current SES. Strong associations (robust to controls for SES indicators) are additionally found between African-American racial identity and support for authoritarian parenting. Prior research indicates that authoritarian parenting practices such as spanking may be harmful to children. Thus, if the parenting attitudes analyzed here translate into parenting practices, then this study's findings may point to a mechanism for the intergenerational transmission of disadvantages. Copyright © 2015 Elsevier Ltd. All rights reserved.

Distinct Influences of Mothers and Fathers on Kindergartners' Numeracy Performance: The Role of Math Anxiety, Home Numeracy Practices, and Numeracy Expectations

ERIC Educational Resources Information Center

del Río, M. Francisca; Susperreguy, Maria Ines; Strasser, Katherine; Salinas, Viviana

2017-01-01

The current study analyzed maternal and paternal differential influences on numeracy performance in kindergarten children. Participants were 180 Chilean children from backgrounds of low and high socioeconomic status (SES), their mothers, and their fathers. A path analysis was used to explore the influences of both maternal and paternal numeracy…

Pedagogical Content Knowledge of Experts and Novices--What Knowledge Do They Activate When Analyzing Science Lessons?

ERIC Educational Resources Information Center

Krepf, Matthias; Plöger, Wilfried; Scholl, Daniel; Seifert, Andreas

2018-01-01

In the current debate on pedagogical content knowledge (PCK), the term is used to refer to the context-specific knowledge that teachers activate when reflecting on practice. Against the background of this debate, we conducted an empirical study and sought to answer the question of which knowledge experts and novices activated in assessing a…

An Exploration of Clinical Psychology's Response to Parental Bereavement in Adults with Intellectual Disability

ERIC Educational Resources Information Center

Irwin, Lynn; O'Malley, Grace; Neelofur, Shazia; Guerin, Suzanne

2017-01-01

Background: The dearth of literature regarding how or when to intervene when an adult with intellectual disability is bereaved may impede clinical practice; this study therefore aimed to explore the current clinical psychology response, so as to enhance understanding of the role of the profession in supporting grief within this population. Method:…

Catechol-O-Methyltransferase "Val[superscript 158]Met" Genotype, Parenting Practices and Adolescent Alcohol Use: Testing the Differential Susceptibility Hypothesis

ERIC Educational Resources Information Center

Laucht, Manfred; Blomeyer, Dorothea; Buchmann, Arlette F.; Treutlein, Jens; Schmidt, Martin H.; Esser, Gunter; Jennen-Steinmetz, Christine; Rietschel, Marcella; Zimmermann, Ulrich S.; Banaschewski, Tobias

2012-01-01

Background: Recently, first evidence has been reported for a gene-parenting interaction (G x E) with regard to adolescent alcohol use. The present investigation set out to extend this research using the catechol-O-methyltransferase ("COMT") "Val[superscript 158]Met" polymorphism as a genetic susceptibility factor. Moreover, the current study…

Virtual Environments Overview

DTIC Science & Technology

2009-04-01

Gabbard (2008), p. 36 The extensions of our framework to opportunities and instantiations respect this admonition in focusing on uses of this...points above, which we found in reviewing other public reports on the current state and issues with analytic practice (notably Treverton & Gabbard , 2008...agencies, with differing backgrounds and expertise will need to work together to unravel tomorrow’s threats, which Treverton & Gabbard (2008) likened

The Use of Adventure Therapy in Community-Based Mental Health: Decreases in Problem Severity among Youth Clients

ERIC Educational Resources Information Center

Tucker, Anita R.; Javorski, Steve; Tracy, Julie; Beale, Bobbi

2013-01-01

Background: There is an increasing need to identify effective mental health treatment practices for children and adolescents in community-based settings, due to current mixed findings of existing interventions. This study looked at adventure therapy (AT) as a viable option to meet this need. Objective: Using a sample of 1,135 youth from a…

Cost-Effectiveness Analysis of Current Practice and Parent Intervention for Children under 3 Years Presenting with Expressive Language Delay

ERIC Educational Resources Information Center

Gibbard, Deborah; Coglan, Louisa; MacDonald, John

2004-01-01

Background: Parents and professionals can both play a role in improving children's expressive language development and a number of alternative models of delivery exist that involve different levels of input by these two groups. However, these alternative treatments have not been subject to rigorous comparative analysis in terms of both cost and…

Cutaneous T cell lymphoma: Current practices in blood assessment and the utility of T-cell receptor Vβ chain restriction

PubMed Central

Gibson, Juliet F; Huang, Jing; Liu, Kristina J; Carlson, Kacie R; Foss, Francine; Choi, Jaehyuk; Edelson, Richard; Hussong, Jerry W.; Mohl, Ramsey; Hill, Sally; Girardi, Sally

2016-01-01

Background Accurate quantification of malignant cells in the peripheral blood of patients with cutaneous T cell lymphoma (CTCL) is important for early detection, prognosis, and monitoring disease burden. Objective Determine the spectrum of current clinical practices; critically evaluate elements of current ISCL B1 and B2 staging criteria; and assess the potential role of TCR-Vβ analysis by flow cytometry. Methods We assessed current clinical practices by survey, and performed a retrospective analysis of 161 patients evaluated at Yale (2011-2014) to compare the sensitivity, specificity, PPV, and NPV of parameters for ISCL B2 staging. Results There was heterogeneity in clinical practices among institutions. ISCL B1 criteria did not capture five Yale cohort patients with immunophenotypic abnormalities who later progressed. TCR-Vβ testing was more specific than PCR and aided diagnosis in detecting clonality, but was of limited benefit in quantification of tumor burden. Limitations Because of limited follow-up involving a single center, further investigation will be necessary to conclude whether our proposed diagnostic algorithm is of general clinical benefit. Conclusion We propose further study of “modified B1 criteria”: CD4/CD8 ratio ≥5, %CD4+/CD26- ≥ 20%, %CD4+/CD7- ≥ 20%, with evidence of clonality. TCR-Vβ testing should be considered in future diagnostic and staging algorithms. PMID:26874819

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 2. Results: Primary care management and community orientation.

PubMed

Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

2010-03-01

At the WONCA Europe conference 2009 the recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' was presented. It is a background paper and reference manual, providing advocacy of general practice/family medicine (GP/FM) in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In this second article, the results for the core competencies 'primary care management' and 'community orientation' are presented. Though there is a large body of research on various aspects of 'primary care management', it represents a very scattered rather than a meta view. Many studies focus on care for specific diseases, the primary/secondary care interface, or the implications of electronic patient records. Cost efficiency or process indicators of quality are current outcomes. Current literature on community orientation is mainly descriptive, and focuses on either care for specific diseases, or specific patient populations, or on the uptake of preventive services. Most papers correspond poorly to the WONCA concept. For both core competencies, there is a lack of research with a longitudinal perspective and/or relevant health or quality of life outcomes as well as research on patients' preferences and education for organizational aspects of GP/FM.

Projected cancer risks potentially related to past, current, and future practices in paediatric CT in the United Kingdom, 1990–2020

PubMed Central

Journy, Neige M Y; Lee, Choonsik; Harbron, Richard W; McHugh, Kieran; Pearce, Mark S; Berrington de González, Amy

2017-01-01

Background: To project risks of developing cancer and the number of cases potentially induced by past, current, and future computed tomography (CT) scans performed in the United Kingdom in individuals aged <20 years. Methods: Organ doses were estimated from surveys of individual scan parameters and CT protocols used in the United Kingdom. Frequencies of scans were estimated from the NHS Diagnostic Imaging Dataset. Excess lifetime risks (ELRs) of radiation-related cancer were calculated as cumulative lifetime risks, accounting for survival probabilities, using the RadRAT risk assessment tool. Results: In 2000–2008, ELRs ranged from 0.3 to 1 per 1000 head scans and 1 to 5 per 1000 non-head scans. ELRs per scan were reduced by 50–70% in 2000–2008 compared with 1990–1995, subsequent to dose reduction over time. The 130 750 scans performed in 2015 in the United Kingdom were projected to induce 64 (90% uncertainty interval (UI): 38–113) future cancers. Current practices would lead to about 300 (90% UI: 230–680) future cancers induced by scans performed in 2016–2020. Conclusions: Absolute excess risks from single exposures would be low compared with background risks, but even small increases in annual CT rates over the next years would substantially increase the number of potential subsequent cancers. PMID:27824812

Best Practices for Robotic Surgery Programs

PubMed Central

Goldenberg, David; Winder, Joshua S.; Juza, Ryan M.; Lyn-Sue, Jerome R.

2017-01-01

Background and Objectives: Robotic surgical programs are increasing in number. Efficient methods by which to monitor and evaluate robotic surgery teams are needed. Methods: Best practices for an academic university medical center were created and instituted in 2009 and continue to the present. These practices have led to programmatic development that has resulted in a process that effectively monitors leadership team members; attending, resident, fellow, and staff training; credentialing; safety metrics; efficiency; and case volume recommendations. Results: Guidelines for hospitals and robotic directors that can be applied to one's own robotic surgical services are included with examples of management of all aspects of a multispecialty robotic surgery program. Conclusion: The use of these best practices will ensure a robotic surgery program that is successful and well positioned for a safe and productive environment for current clinical practice. PMID:28729780

Autism and vaccination-the current evidence.

PubMed

Miller, Lisa; Reynolds, Joni

2009-07-01

The purpose of this article is to review relevant background literature regarding the evidence linking thimerosal-containing vaccine and the measles, mumps, and rubella vaccine to autism. Rigorous scientific studies have not identified links between autism and either thimerosal-containing vaccine or the measles, mumps, and rubella vaccine. Nurses are often in the position of providing advice regarding vaccines in their formal practice areas as well as in their daily lives. Families need current and credible evidence to make decisions for their children. Excellent vaccine information resources are available online.

Maintenance of Certification: How Performance in Practice Changes Improve Tobacco Cessation in Addiction Psychiatrists’ Practice

PubMed Central

Ford, James H.; Oliver, Karen A.; Giles, Miriam; Cates-Wessel, Kathryn; Krahn, Dean; Levin, Frances R.

2017-01-01

Background and Objectives In 2000, the American Board of Medical Specialties implemented the Maintenance of Certification (MOC), a structured process to help physicians identify and implement a quality improvement project to improve patient care. This study reports on findings from an MOC Performance in Practice (PIP) module designed and evaluated by addiction psychiatrists who are members of the American Academy of Addiction Psychiatry (AAAP). Method A 3-phase process was utilized to recruit AAAP members to participate in the study. The current study utilized data from 154 self-selected AAAP members who evaluated the effectiveness of the MOC Tobacco Cessation PIP. Results Of the physicians participating, 76% (n 120) completed the Tobacco PIP. A paired t-test analysis revealed that reported changes in clinical measure documentation were significant across all six measures. Targeted improvement efforts focused on a single clinical measure. Results found that simple change projects designed to improve clinical practice led to substantial changes in self-reported chart documentation for the selected measure. Conclusions The current findings suggest that addiction psychiatrists can leverage the MOC process to improve clinical care. PMID:27973746

Perspectives and limitations of QKD integration in metropolitan area networks.

PubMed

Aleksic, Slavisa; Hipp, Florian; Winkler, Dominic; Poppe, Andreas; Schrenk, Bernhard; Franzl, Gerald

2015-04-20

Quantum key distribution (QKD) systems have already reached a reasonable level of maturity. However, a smooth integration and a wide adoption of commercial QKD systems in metropolitan area networks has still remained challenging because of technical and economical obstacles. Mainly the need for dedicated fibers and the strong dependence of the secret key rate on both loss budget and background noise in the quantum channel hinder a practical, flexible and robust implementation of QKD in current and next-generation optical metro networks. In this paper, we discuss these obstacles and present approaches to share existing fiber infrastructures among quantum and classical channels. Particularly, a proposal for a smooth integration of QKD in optical metro networks, which implies removing spurious background photons caused by optical transmitters, amplifiers and nonlinear effects in fibers, is presented and discussed. We determine and characterize impairments on quantum channels caused by many classical telecom channels at practically used power levels coexisting within the same fiber. Extensive experimental results are presented and indicate that a practical integration of QKD in conventional optical metro networks is possible.

The History of Preconception Care: Evolving Guidelines and Standards

PubMed Central

Moos, Merry-K.; Curtis, Michele

2006-01-01

This article explores the history of the preconception movement in the United States and the current status of professional practice guidelines and standards. Professionals with varying backgrounds (nurses, nurse practitioners, family practice physicians, pediatricians, nurse midwives, obstetricians/gynecologists) are in a position to provide preconception health services; standards and guidelines for numerous professional organizations, therefore, are explored. The professional nursing organization with the most highly developed preconception health standards is the American Academy of Nurse Midwives (ACNM); for physicians, it is the American College of Obstetricians and Gynecologists (ACOG). These guidelines and standards are discussed in detail. PMID:16710764

Current practices in vestibular schwannoma management: a survey of American and Canadian neurosurgeons.

PubMed

Fusco, Matthew R; Fisher, Winfield S; McGrew, Benjamin M; Walters, Beverly C

2014-12-01

Comprehensive therapy for vestibular schwannomas has changed dramatically over the past fifty years. Previously, neurosurgeons were most likely to treat these tumors via an independent surgical approach. Currently, many neurosurgeons treat vestibular schwannomas employing an interdisciplinary team approach with neuro-otologists and radiation oncologists. This survey aims to determine the current treatment paradigm for vestibular schwannomas among American and Canadian neurosurgeons, with particular attention to the utilization of a team approach to the surgical resection of these lesions. A seventeen part survey questionnaire was sent by electronic mail to residency trained members of the American Association of Neurological Surgeons currently practicing in Canada or the United States. Questions were divided into groups regarding physician background, overall practice history, recent practice history, opinions on treatment paradigms, and experience with an interdisciplinary team approach. Seven hundred and six responses were received. The vast majority of neurosurgeons surgically resect vestibular schwannomas as part of an interdisciplinary team (85.7%). Regional variations were observed in the use of an interdisciplinary team: 52.3% of responding neurosurgeons who surgically treat vestibular schwannomas without neuro-otologists currently practice in the South (no other region represented more than 15.4% of this group, p=0.02). Surgeons who have treated >50 vestibular schwannomas show a trend towards more frequent utilization of an interdisciplinary approach than less experienced surgeons, but this did not reach statistical significance. The majority of neurosurgeons in the United States and Canada surgically resect vestibular schwannomas via an interdisciplinary approach with the participation of a neuro-otologist. Neurosurgeons in the South appear more likely to surgically treat these tumors alone than neurosurgeons in other regions of the U.S. and Canada. Copyright © 2014 Elsevier B.V. All rights reserved.

Education in the Wake of Healthcare Reform: Increasing Primary Care Usage by Individuals Currently Reliant upon Emergency Departments for Care

ERIC Educational Resources Information Center

Tannebaum, Michael; Wilkin, Holley A.; Keys, Jobia

2014-01-01

Background: The Affordable Care Act (ACA) was introduced, in part, to increase access to primary care, which has been shown to provide patients with myriad health benefits. Objective: To increase primary care usage by understanding the beliefs about primary and emergency care most salient to those whose healthcare-seeking practices may be impacted…

Is There a Typology of Teacher and Leader Responders to Call and Do They Cluster in Different Types of Schools? A Two-Level Latent Class Analysis of Call Survey Data

ERIC Educational Resources Information Center

Bowers, Alex J.; Blitz, Mark; Modeste, Marsha; Salisbury, Jason; Halverson, Richard R.

2017-01-01

Background: Across the recent research on school leadership, leadership for learning has emerged as a strong framework for integrating current theories, such as instructional, transformational, and distributed leadership as well as effective human resource practices, instructional evaluation, and resource allocation. Yet, questions remain as to…

The Development of Early Literacy in Steiner- and Standard-Educated Children

ERIC Educational Resources Information Center

Cunningham, Anna J.; Carroll, Julia M.

2011-01-01

Background: There is evidence that children who are taught to read later in childhood (age 6-7) make faster progress in early literacy than those who are taught at a younger age (4-5 years), as is current practice in the UK. Aims: Steiner-educated children begin learning how to read at age 7, and have better reading-related skills at the onset of…

Tanzania: Background and Current Conditions

DTIC Science & Technology

2010-07-23

persons with albinism and women persisted. Female genital mutilation (FGM), especially of young girls, continued to be practiced. Trafficking in...35%; Zanzibar /islands over 99% Muslim Literacy: Male, 77.5%; Female , 66.2% (2003) Under-5 Mortality: 165 deaths/1,000 live births HIV/AIDS adult...infection rate: 6.2% (2007) Life Expectancy, years at birth: Male, 50.5 Female , 53.5 (2009 est.) Sources: CIA World Factbook 2010. Tanzania

A cross-sectional study of knowledge and practice of pelvic floor exercises during pregnancy and associated symptoms of stress urinary incontinence in North-East Scotland.

PubMed

Whitford, Heather M; Alder, Beth; Jones, Martyn

2007-06-01

to establish levels of knowledge about pelvic floor exercises during pregnancy; reported practice of pelvic floor exercises in pregnancy; and prevalence of stress urinary incontinence in a sample of women in the third trimester of pregnancy. structured cross-sectional interview survey. pregnant women over the age of 16 years and more than 30 weeks gestation attending antenatal clinics in North-East Scotland. Of 350 women who agreed to participate, 289 (82.6%) were interviewed between July 1999 and March 2000. 225 women (77.9%) reported being given or obtaining information about pelvic floor exercises in the current pregnancy. Books were the most frequently mentioned source of information. Midwives were the health professionals most likely to give information about pelvic floor exercises. Younger women, first-time mothers and those from more deprived backgrounds were less likely to report having information about the exercises. A third of women (n=90, 31.1%) said that they would have liked more information about the exercises. Practice of the exercises during pregnancy was reported by just over half the sample (n=156, 54.0%) and more than once a day by 26.3% (n=76). Younger women, and those from more deprived backgrounds, were less likely to report the practice of exercises. No difference was found in reported practice according to parity. More than half (n=157, 54.3%) of the women reported incontinence during the current pregnancy. No relationship was found between reported practice of pelvic floor exercises and stress urinary incontinence. the number of women who indicated a desire for more information and the low number who reported practice of the exercises suggest that improvements could be made. The gaps in information provision and practice suggest areas for future health promotion about the exercises, particularly by midwives, as not all women are seen by a physiotherapist during pregnancy. Reported levels of incontinence during pregnancy confirm previous findings and highlight the prevalence of incontinence in pregnancy.

Reevalution of background iodine-129 concentrations in water from the Snake River Plain Aquifer, Idaho, 2003

USGS Publications Warehouse

Cecil, L. DeWayne; Hall, L. Flint; Green, Jaromy R.

2003-01-01

Background concentrations of iodine-129 (129I, half-life = 15.7 million years) resulting from natural production in the earth?s atmosphere, in situ production in the earth by spontaneous fission of uranium-238(238U), and fallout from nuclear weapons tests conducted in the 1950s and 1960s were reevaluated on the basis of 52 analyses of ground- and surface-water samples collected from the eastern Snake River Plain in southeastern Idaho. The background concentration estimated using the results of a subset of 30 ground-water samples analyzed in this reevaluation is 5.4 attocuries per liter (aCi/L; 1 aCi = 10-18 curies) and the 95-percent nonparametric confidence interval is 5.2 to 10.0 aCi/L. In a previous study, a background 129I concentration was estimated on the basis of analyses of water samples from 16 sites on or tributary to the eastern Snake River Plain. At the 99-percent confidence level, background concentrations of 129I in that study were less than or equal to 8.2 aCi/L. During 1993?94, 34 water samples from 32 additional sites were analyzed for 129I to better establish the background concentrations in surface and ground water from the eastern Snake River Plain that is presumed to be unaffected by wastedisposal practices at the Idaho National Engineering and Environmental Laboratory (INEEL). Surface water contained larger 129I concentrations than water from springs and wells contained. Because surface water is more likely to be affected by anthropogenic fallout and evapotranspiration, background 129I concentrations were estimated in the current research using the laboratory results of ground-water samples that were assumed to be unaffected by INEEL disposal practices.

Specialization and the Current Practices of General Surgeons

PubMed Central

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

The path to impact of operational research on tuberculosis control policies and practices in Indonesia

PubMed Central

Probandari, Ari; Widjanarko, Bagoes; Mahendradhata, Yodi; Sanjoto, Hary; Cerisha, Ancila; Nungky, Saverina; Riono, Pandu; Simon, Sumanto; Farid, Muhammad Noor; Giriputra, Sardikin; Putra, Artawan Eka; Burhan, Erlina; Wahyuni, Chatarina U.; Mustikawati, Dyah; Widianingrum, Christina; Tiemersma, Edine W.; Alisjahbana, Bachti

2016-01-01

Background Operational research is currently one of the pillars of the global strategy to control tuberculosis. Indonesia initiated capacity building for operational research on tuberculosis over the last decade. Although publication of the research in peer-reviewed journals is an important indicator for measuring the success of this endeavor, the influence of operational research on policy and practices is considered even more important. However, little is known about the process by which operational research influences tuberculosis control policy and practices. Objective We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. Design Using a qualitative study design, we conducted in-depth interviews of 50 researchers and 30 policy makers/program managers and performed document reviews. Transcripts of these interviews were evaluated while applying content analysis. Results Operational research contributed to tuberculosis control policy and practice improvements, including development of new policies, introduction of new practices, and reinforcement of current program policies and practices. However, most of these developments had limited sustainability. The path from the dissemination of research results and recommendations to policy and practice changes was long and complex. The skills, interests, and political power of researchers and policy makers, as well as health system response, could influence the process. Conclusions Operational research contributed to improving tuberculosis control policy and practices. A systematic approach to improve the sustainability of the impact of operational research should be explored. PMID:26928217

Teachers' perceptions on primary science teaching

NASA Astrophysics Data System (ADS)

Kijkuakul, Sirinapa

2018-01-01

This qualitative research aimed to review what primary teachers think about how to teach science in rural school contexts. Three primary schools in Thailand were purposively chosen for this study. Eleven primary science teachers of these schools were the research participants. Questionnaires, interviews, and observations were implemented to reveal the primary school teachers' educational backgrounds, science teaching context, and need for self-driven professional development. Content and discourse analysis indicated that the non-science educational background and the science teaching context implied a need for self-driven professional development. The non-science educational background teachers were generally unfamiliar with the current national science curriculum, and that they would not be comfortable when the researcher observed their science teaching practice. They also believed that experimentation was the only one strategy for teaching science, and that the priority for their teaching support was teaching media rather than their understanding of scientific concepts or teaching strategies. As implication of this research, subsequent developments on science teacher profession in rural context, therefore, need to promote teachers' understandings of nature of science and technological and pedagogical content knowledge. In addition, they should be challenged to practice on critically participatory action research for academic growth and professional learning community.

Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background.

PubMed

Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E; Rogers, Ann E

2014-05-15

To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through "on the job" training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap.

The education of informationists, from the perspective of a library and information sciences educator

PubMed Central

Detlefsen, Ellen G.

2002-01-01

This article explores the background of, and some of the current models for the education of, the individuals known as “informationists.” A definition, an historical overview, and a literature review are followed by a description of the current practices in a variety of institutions and organizations. A series of five “case reports” illustrates some of the possible tracks that individuals seeking education as informationists may follow. A proposal for a rigorous planning process is made, followed by a list of recommendations for this planning process. PMID:11838461

Searches for Randomized Controlled Trials of Drugs in MEDLINE and EMBASE Using Only Generic Drug Names Compared with Searches Applied in Current Practice in Systematic Reviews

ERIC Educational Resources Information Center

Waffenschmidt, Siw; Guddat, Charlotte

2015-01-01

Background: It is unclear which terms should be included in bibliographic searches for randomized controlled trials (RCTs) of drugs, and identifying relevant drug terms can be extremely laborious. The aim of our analysis was to determine whether a bibliographic search using only the generic drug name produces sufficient results for the generation…

The natural history of Charcot's neuroarthropathy.

PubMed

Nielson, David L; Armstrong, David G

2008-01-01

The goal of this article is to outline the progression of Charcot's neuroarthropathy. A historical background is detailed, with an emphasis on the current trends in the literature. Acute Charcot's neuroarthropathy requires a prompt diagnosis with the proper practical offloading methods of the affected limb. This, coupled with directed medical and surgical approaches designed to prevent or mitigate deformities, may subsequently reduce the risk of amputation in this high-risk population.

Effects of Dental 3D Multimedia System on the Performance of Junior Dental Students in Preclinical Practice: A Report from China

ERIC Educational Resources Information Center

Hu, Jian; Yu, Hao; Shao, Jun; Li, Zhiyong; Wang, Jiawei; Wang, Yining

2009-01-01

Background: Computer-assisted tools are rarely adopted for dental education in China. In China, 3D digital technology, such as Virtual Reality Systems, are often rejected in the dental field due to prohibitive pricing. There is also a reluctance to move away from traditional patterns of dental education. Objective: The current study is one of a…

Current Practices for Training Staff to Accommodate Youth with Special Health Care Needs in the 4-H Camp Setting

ERIC Educational Resources Information Center

Mouton, Lauren; Bruce, Jacklyn

2013-01-01

The theory of inclusion is the foundation for the study reported here; inclusion is a focus not only of formal education, but also of nonformal educational settings such as 4-H. Ideally, 4-H camps are designed to serve youth of all backgrounds and abilities. By accommodating youth with special health care needs, 4-H camps are effectively meeting…

Human resource management in general practice: survey of current practice.

PubMed Central

Newton, J; Hunt, J; Stirling, J

1996-01-01

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters of practice managers reported having received some type of formal training in staff management. CONCLUSION: This study shows that practice size is a major factor associated with differences in the organization and management of staffing. Any initiatives which increase the scale of primary care functions and services would have to address the issues of communication and coordination that might be associated with such a change. PMID:8855013

Significance chasing in research practice: Causes, consequences, and possible solutions

PubMed Central

Ware, Jennifer J.; Munafò, Marcus R.

2016-01-01

Background and Aims The low reproducibility of findings within the scientific literature is a growing concern. This may be due to many findings being false positives, which in turn can misdirect research effort and waste money. Methods We review factors that may contribute to poor study reproducibility and an excess of ‘significant’ findings within the published literature. Specifically, we consider the influence of current incentive structures, and the impact of these on research practices. Results The prevalence of false positives within the literature may be attributable to a number of questionable research practices, ranging from the relatively innocent and minor (e.g., unplanned post hoc tests), to the calculated and serious (e.g., fabrication of data). These practices may be driven by current incentive structures (e.g. pressure to publish), alongside the preferential emphasis placed by journals on novelty over veracity. There are a number of potential solutions to poor reproducibility, such as new publishing formats that emphasise the research question and study design, rather than the results obtained. This has the potential to minimise significance chasing and non-publication of null findings. Conclusions Significance chasing, questionable research practices, and poor study reproducibility are the unfortunate consequence of a “publish or perish” culture and a preference among journals for novel findings. It is likely that top-down change implemented by those with the ability to modify current incentive structure (e.g., funders and journals) will be required to address problems of poor reproducibility. PMID:25040652

Juvenile offenders: competence to stand trial.

PubMed

Soulier, Matthew

2012-12-01

This article details the legal background and assists the reader in the preparation and practical conduct of evaluations regarding juvenile adjudicative competency. The material is presented to be useful as a guide to direct questions of competency and covers aspects of evaluation that include: legal standard for competency to stand trial, developmental immaturity, current practice in juvenile competency to stand trial, forensic evaluation of juvenile competency to stand trial, organizing the evaluation, collateral sources of information, psychiatric evaluation of juvenile adjudicative competency, assessment of mental disorder and intellectual disability, assessment of developmental status, assessment of functional abilities for adjudicative competence, and reaching the forensic opinion. Copyright © 2012 Elsevier Inc. All rights reserved.

Exploring perinatal shift-to-shift handover communication and process: an observational study.

PubMed

Poot, Else P; de Bruijne, Martine C; Wouters, Maurice G A J; de Groot, Christianne J M; Wagner, Cordula

2014-04-01

Loss of situation awareness (SA) by health professionals during handover is a major threat to patient safety in perinatal care. SA refers to knowing what is going on around. Adequate handover communication and process may support situation assessment, a precursor of SA. This study describes current practices and opinions of perinatal handover to identify potential improvements. Structured direct observations of shift-to-shift patient handovers (n = 70) in an academic perinatal setting were used to measure handover communication (presence and order of levels of SA: current situation, background, assessment and recommendation) and process (duration, interruptions/distractions, eye contact, active inquiry and reading information back). Afterwards, receivers' opinions of handover communication (n = 51) were measured by means of a questionnaire. All levels of SA were present in 7% of handovers, the current situation in 86%, the background in 99%, an assessment in 24% and a recommendation in 46%. In 77% of handovers the background was mentioned first, followed by the current situation. Forty-four per cent of handovers took 2 minutes or more per patient. In 52% distractions occurred, in 43% there was no active inquiry, in 32% no eye contact and in 97% information was not read back. The overall mean of the receivers' opinions of handover communication was 4.1 (standard deviation ± 0.7; scale 1-5, where 5 is excellent). Perinatal handovers are currently at risk for inadequate situation assessment because of variability and limitations in handover communication and process. However, receivers' opinions of handover communication were very positive, indicating a lack of awareness of patient safety threats during handover. Therefore, the staff's awareness of current limitations should be raised, for example through video reflection or simulation training. © 2013 John Wiley & Sons, Ltd.

The RICORDO approach to semantic interoperability for biomedical data and models: strategy, standards and solutions

PubMed Central

2011-01-01

Background The practice and research of medicine generates considerable quantities of data and model resources (DMRs). Although in principle biomedical resources are re-usable, in practice few can currently be shared. In particular, the clinical communities in physiology and pharmacology research, as well as medical education, (i.e. PPME communities) are facing considerable operational and technical obstacles in sharing data and models. Findings We outline the efforts of the PPME communities to achieve automated semantic interoperability for clinical resource documentation in collaboration with the RICORDO project. Current community practices in resource documentation and knowledge management are overviewed. Furthermore, requirements and improvements sought by the PPME communities to current documentation practices are discussed. The RICORDO plan and effort in creating a representational framework and associated open software toolkit for the automated management of PPME metadata resources is also described. Conclusions RICORDO is providing the PPME community with tools to effect, share and reason over clinical resource annotations. This work is contributing to the semantic interoperability of DMRs through ontology-based annotation by (i) supporting more effective navigation and re-use of clinical DMRs, as well as (ii) sustaining interoperability operations based on the criterion of biological similarity. Operations facilitated by RICORDO will range from automated dataset matching to model merging and managing complex simulation workflows. In effect, RICORDO is contributing to community standards for resource sharing and interoperability. PMID:21878109

Putting principals back into practice: an evaluation of a re-entry course for vocationally trained doctors.

PubMed Central

Baker, M; Williams, J; Petchey, R

1997-01-01

BACKGROUND: Current recruitment difficulties in general practice have sharpened the interest of the profession in non-principals. No re-entry course for general practice has previously been run in the UK. AIM: To design and evaluate a re-entry course for general practice. METHOD: A re-entry course was developed to help doctors return to general practice as principals. A telephone interview was carried out with each delegate prior to their attendance on the course and was repeated one month and six months after the course to measure any change in career intentions and the perceived benefit of attending the course. RESULTS: Six months after the course, 11 out of 14 delegates had taken positive steps to return to general practice or had increased their time commitment to medicine. This contrasts with only one of the control group having made any steps to change career. CONCLUSION: The course was evaluated and found to be beneficial, particularly in terms of increasing the confidence of the delegates. PMID:9463984

Experiences and Attitudes Among Psychiatric Mental Health Advanced Practice Nurses in the Use of Telemental Health: Results of an Online Survey.

PubMed

Baird, Martha B; Whitney, Lucinda; Caedo, Cassie E

Telemental health (TMH) growth is driven by recent trends in health delivery systems and disparities in access to mental health services. There are currently no standard educational guidelines to prepare psychiatric mental health advanced practice nurses (PMH-APRNs) in TMH delivery. To survey practicing PMH-APRNs across the United States about their experiences and attitudes about use of TMH. Eighty-three participants from the American Psychiatric Nurses Association online discussion board completed a nine-item survey. Length of time practicing as a PMH-APRN, TMH use in practice, populations served, and TMH background. A majority had been practicing as a PMH-APRN for less than a decade and had used TMH, although most reported no prior education or training in this delivery method. Participants did indicate a desire for TMH education. This survey affirms the prevalence of TMH use among PMH-APRN providers, lack of formal training, and necessity for standardized educational guidelines in TMH delivery.

Inefficiencies and high-value improvements in U.S. cervical cancer screening practice: A cost-effectiveness analysis

PubMed Central

Kim, Jane J.; Campos, Nicole G.; Sy, Stephen; Burger, Emily A.; Cuzick, Jack; Castle, Philip E.; Hunt, William C.; Waxman, Alan; Wheeler, Cosette M.

2016-01-01

Background Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of non-compliance in the screening process compared to recommended guidelines are uncertain. Objective To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements. Design Model-based cost-effectiveness analysis. Data Sources New Mexico HPV Pap Registry; medical literature. Target Population Cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Societal. Interventions Current cervical cancer screening practice; improved compliance to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals. Outcome Measures Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs Results of Base-Case Analysis Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect c4mpliance to a 3-yearly screening interval and to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100,000 per QALY gained); together, the INMB increased to $1,645. Results of Sensitivity Analysis Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds. Limitations The impact of HPV vaccination was not considered. Conclusions The added health benefit of improving compliance to guidelines, especially the 3-yearly interval for cytology screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice. Funding Source U.S. National Cancer Institute. PMID:26414147

Five key players shape institution's ethical character.

PubMed

Craig, R P; Middleton, C J; O'Connell, L J

1986-05-01

Various individuals or groups play important roles in achieving moral insight and direction in a health care facility. The administration, medical and nursing staffs, the professional theologian, and the bishop all contribute unique perspectives to the complex process of developing an institution's ethical character. An institutional ethics committee's (IEC's) effectiveness depends largely on the administrator's ability to support educational programming in ethics for the entire staff, coordinate ethical reflection throughout the organization, and shape ethically informed policy based on an IEC's practical experience. The medical staff brings its scientific background and practical experience to ethical issues under a committee's consideration, and nurses offer valuable insights based on their close contact with patients and family. The theologian provides resources and background on Catholic tradition as well as information on current theological developments. The IEC also should maintain a relationship with the local bishop whose duty is to articulate the Church's positions in health care ethics. Forthright dialogue among all parties is central to the IEC's task.

Patient-centred care in general dental practice - a systematic review of the literature

PubMed Central

2014-01-01

Background Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care (PCC). Quality improvement is an important feature of the current dental contract reforms in England, with “patient experience” likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice. Methods A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice. Results Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework. Conclusions This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients’ views should be central to this research. PMID:24902842

Future Prospects of Health Management Systems Using Cellular Phones

PubMed Central

Kim, Hun-Sung; Hwang, Yunji; Lee, Jae-Ho; Oh, Hye Young; Kim, Yi-Jun; Kwon, Hyeon Yoon; Kang, Hyoseung; Kim, Hyunah; Park, Rae Woong

2014-01-01

Abstract Background: Cellular phones enable communication between healthcare providers and patients for prevention, diagnosis, and treatment of diseases. However, few studies have examined the user-friendliness or effectiveness of cellular phone-based medical informatics (CPBMI) for healthcare. Materials and Methods: This study investigated the use of CPBMI to identify its current status within the medical field, advantages and disadvantages, practicability, clinical effectiveness, costs, and cost-saving potential. Results: CPBMI was validated in terms of practicality and provision of medical benefits. It is critical to use CPBMI in accordance with the different features of each disease and condition. Use of CPBMI is expected to be especially useful for patients with chronic disease. Conclusions: We discussed the current status of the clinical use, benefits, and risks of CPBMI. CPBMI and information technology–based health management tools are anticipated to become useful and effective components of healthcare management in the future. PMID:24693986

State of family medicine practice in Lebanon

PubMed Central

Helou, Mariana; Rizk, Grace Abi

2016-01-01

Background: Many difficulties are encountered in family medicine practice and were subject to multinational studies. To date, no study was conducted in Lebanon to assess the challenges that family physicians face. This study aims to evaluate the family medicine practice in Lebanon stressing on the difficulties encountered by Lebanese family physicians. Materials and Methods: A questionnaire was sent to all 96 family medicine physicians practicing in Lebanon. Participants answered questions about characteristics of family medicine practice, evaluation of the quality of work, identification of obstacles, and their effect on the medical practice. Results: The response rate was 59%, and the average number of years of practice was 10.7 years. Physicians complain mainly of heavy load at work, too many bureaucratic tasks, demanding patients, and being undervalued by the specialists. Most physicians are able to adapt between their professional and private life. Conclusion: Despite all the obstacles encountered, Lebanese family physicians have a moderate satisfaction toward their practice. They remain positive and enthusiastic about their profession. Until the ministry of public health revises its current health system, the primary care profession in Lebanon will remain fragile as a profession. PMID:27453843

Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study

PubMed Central

Whitford, David L; Hickey, Anne; Horgan, Frances; O'Sullivan, Bernadette; McGee, Hannah; O'Neill, Desmond

2009-01-01

Background Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. Methods Postal survey of random sample of general practitioners undertaken (N = 204; 46% response). Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. Results Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. Conclusion General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care. PMID:19402908

Medical students’ attitudes and perspectives regarding novel computer-based practical spot tests compared to traditional practical spot tests

PubMed Central

Wijerathne, Buddhika; Rathnayake, Geetha

2013-01-01

Background Most universities currently practice traditional practical spot tests to evaluate students. However, traditional methods have several disadvantages. Computer-based examination techniques are becoming more popular among medical educators worldwide. Therefore incorporating the computer interface in practical spot testing is a novel concept that may minimize the shortcomings of traditional methods. Assessing students’ attitudes and perspectives is vital in understanding how students perceive the novel method. Methods One hundred and sixty medical students were randomly allocated to either a computer-based spot test (n=80) or a traditional spot test (n=80). The students rated their attitudes and perspectives regarding the spot test method soon after the test. The results were described comparatively. Results Students had higher positive attitudes towards the computer-based practical spot test compared to the traditional spot test. Their recommendations to introduce the novel practical spot test method for future exams and to other universities were statistically significantly higher. Conclusions The computer-based practical spot test is viewed as more acceptable to students than the traditional spot test. PMID:26451213

Figures of merit for detectors in digital radiography. II. Finite number of secondaries and structured backgrounds.

PubMed

Pineda, Angel R; Barrett, Harrison H

2004-02-01

The current paradigm for evaluating detectors in digital radiography relies on Fourier methods. Fourier methods rely on a shift-invariant and statistically stationary description of the imaging system. The theoretical justification for the use of Fourier methods is based on a uniform background fluence and an infinite detector. In practice, the background fluence is not uniform and detector size is finite. We study the effect of stochastic blurring and structured backgrounds on the correlation between Fourier-based figures of merit and Hotelling detectability. A stochastic model of the blurring leads to behavior similar to what is observed by adding electronic noise to the deterministic blurring model. Background structure does away with the shift invariance. Anatomical variation makes the covariance matrix of the data less amenable to Fourier methods by introducing long-range correlations. It is desirable to have figures of merit that can account for all the sources of variation, some of which are not stationary. For such cases, we show that the commonly used figures of merit based on the discrete Fourier transform can provide an inaccurate estimate of Hotelling detectability.

Current practice of diabetes education in children and adolescents with type 1 diabetes in Germany and Austria: analysis based on the German/Austrian DPV database.

PubMed

Konrad, K; Vogel, C; Bollow, E; Fritsch, M; Lange, K; Bartus, B; Holl, R W

2016-11-01

Diabetes education of patients and/or parents is an essential part of diabetes care with effects on diabetes outcome. The objective of our study was to describe the current practice of diabetes education in Germany and Austria with regard to training frequency, patient age, migration background and diabetes therapy in a large cohort of pediatric patients with diabetes mellitus type 1 (T1DM). We analyzed data from pediatric T1DM patients with diabetes training in 2013 and complete data available for treatment year in the multicenter Diabetes Patienten Verlaufsdokumentation (DPV) registry using sas 9.4. In 2013 21 871 pediatric patients with T1DM were documented [52.4% male, age: 12.70 (9.35-15.30) yr (median (interquartile range)], diabetes duration: 3.80 (1.45-7.00) yr, migration background: 21.4%, twice daily injections: 5.5%, multiple daily injections: 52.5%, insulin-pump therapy: 42%. Of these 32.31% were trained in 2013. Younger patients and their parents were trained more intensely and more frequently as inpatients compared with older patients (0-6 vs. 6-12 and 12-18 yr: teaching units: 13.07 vs. 12.05 and 9.79; inpatient: 79% vs. 72% and 70%). There was also a difference in training frequency with regard to migration background. Severe hypoglycemia or ketoacidosis resulted in intensification of training (4.0 vs. 2.0%; 7.8 vs. 3.1%). Centre-specific education tools were used frequently alone or in combination with published, standardized education programs. Training frequency was highest in younger patients and during the first year of diabetes. Acute complications resulted in more frequent diabetes training, indicating that currently many education sessions take place in consequence to these complications. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

SUBSTANCE USE SCREENING AND INTERVENTIONS IN DENTAL CLINICS: SURVEY OF PRACTICE-BASED RESEARCH NETWORK DENTISTS ON CURRENT PRACTICES, POLICIES, AND BARRIERS

PubMed Central

Wright, Shana; Matthews, Abigail G.; Rotrosen, John; Shelley, Donna; Buchholz, Matthew P.; Curro, Frederick A.

2013-01-01

Background Dental visits represent an opportunity to identify and assist patients with substance use, but little is known about how dentists are addressing tobacco, alcohol and illicit drugs. We surveyed dentists to learn about the role their practices might play in providing substance use screening and interventions. Methods A 41-item, web-based survey was distributed to all 210 dentists active in the PEARL dental practice-based research network. The questionnaire assessed clinic policies and current practices, attitudes, and perceived barriers to providing services for tobacco, alcohol, and illicit drug use. Results 143 dentists completed the survey (68% response rate). While screening was common, fewer were providing follow-up counseling or referrals for substance use. Insufficient knowledge/training was the most frequently cited barrier to intervention. Many dentists said they would offer assistance for tobacco (67%) or alcohol or illicit drugs (52%) if reimbursed; an affirmative response was more likely among those who saw publicly insured patients. Conclusions Dentists recognize the importance of screening for substance use, but lack clinical training and systems that could facilitate intervention. Practice Implications If barriers were reduced through changes in reimbursement, education, and systems-level support, our findings indicate that dentists may be willing to address substance use, including use of alcohol and illicit drugs as well as tobacco. PMID:23729460

Certification of international allied professionals in cardiac pacing and electrophysiology: Opportunities?

PubMed Central

Chiu, Christine

2010-01-01

Allied professionals with diverse backgrounds and training are essential to the delivery of quality care to patients with heart rhythm disorders. There is a growing worldwide demand for defined educational requirements and certification pathways to ensure uniformity of knowledge and competence of those practicing in electrophysiology. The present viewpoint article reviews the current deficiencies of education and training, and advocates for the establishment of certification pathways by professional societies. PMID:20101363

Rotation Rate Sensing via Magnetostatic Surface Wave Propagation on a Thick Yig Ring.

DTIC Science & Technology

1979-12-03

Introduction . . . . . . . . . . . 1 Background . . . . . . . . I Statement of the Problem. o o . 4 Plan of Attack. o. . o o o • 4 Sequence of...crystal growth process. It was subsequently suggested that the thin film disfiguration problem could be avoided by ma- chining the desired ring...sensor provide any practical advantages that would make it a better choice over current rate sensing schemes? Plan of Attack This thesis concerns itself

Science and football: evaluating the influence of science on performance.

PubMed

Drust, B; Green, M

2013-01-01

The scientific study of football has its origins in the early research completed in the 1970's. Since these early efforts the available scientific knowledge base related to football has developed substantially. The ability of this scientific information to influence practice in the day-to-day activity of football organisations, especially elite teams, has been largely taken for granted. The close examination of this impact can lead to more uncertainty regarding the usefulness of the scientific data to the sport. Few articles are available that have attempted to critique the link between science and football practice. As such, the aims of this article are 2-fold; (i) to examine the historical background to "science and football" and to analyse the influence of sports science research on the current practice of coaches and practitioners within the sport and (ii) to identify potential ways to increase the influence of scientific research on practice in the "real world".

Essential Elements for a Pharmacy Practice Mentoring Program

PubMed Central

Hardy, Yolanda M.; Jarvis, Courtney; Stoner, Steven C.; Pitlick, Matthew; Hilaire, Michelle L.; Hanes, Scott; Carey, Katherine; Burke, Jack; Lodise, Nicole M.

2013-01-01

Formal guidelines for mentoring faculty members in pharmacy practice divisions of colleges and schools of pharmacy do not exist in the literature. This paper addresses the background literature on mentoring programs, explores the current state of mentoring programs used in pharmacy practice departments, and provides guidelines for colleges and schools instituting formal mentoring programs. As the number of pharmacy colleges and schools has grown, the demand for quality pharmacy faculty members has dramatically increased. While some faculty members gain teaching experience during postgraduate residency training, new pharmacy practice faculty members often need professional development to meet the demands of their academic responsibilities. A mentoring program can be 1 means of improving faculty success and retention. Many US colleges and schools of pharmacy have developed formal mentoring programs, whereas several others have informal processes in place. This paper discusses those programs and the literature available, and makes recommendations on the structure of mentoring programs. PMID:23519448

Selected methods for quantification of community exposure to aircraft noise

NASA Technical Reports Server (NTRS)

Edge, P. M., Jr.; Cawthorn, J. M.

1976-01-01

A review of the state-of-the-art for the quantification of community exposure to aircraft noise is presented. Physical aspects, people response considerations, and practicalities of useful application of scales of measure are included. Historical background up through the current technology is briefly presented. The developments of both single-event and multiple-event scales are covered. Selective choice is made of scales currently in the forefront of interest and recommended methodology is presented for use in computer programing to translate aircraft noise data into predictions of community noise exposure. Brief consideration is given to future programing developments and to supportive research needs.

Working with Practicing Teachers in a High-Stakes Teaching Context to Rethink Their Pedagogical Practices with Children of Diverse Backgrounds

ERIC Educational Resources Information Center

Brown, Christopher P.; Weber, Natalie Babiak

2016-01-01

The public education system in the United States continues to struggle in educating children of diverse backgrounds. Many have addressed this issue by documenting how certain practices teach children particular types of knowledge and skills. This developmental focus on what should be happening to children of diverse backgrounds tends to ignore the…

An evaluation of an ICCD imager of dynamic range expansion technique and application of insitu procedures for life-time extension

NASA Technical Reports Server (NTRS)

Currie, D. G.

1982-01-01

Research toward practical implementation of the Intensified Charge Coupled Device (ICCD) as a photon-counting array detector for astronomy is reported. The first area of concentration was to determine the rate and extent of the lifetime limiting damage to the CCD caused by the impact of high energy electrons, and to find whether various methods of annealing the damage were productive. The second effort was to determine the performance of the ICCD in a photon-counting mode to produce extended dynamic range measurements. There are two main effects that appear as the practical results of the electron damage to the CCD. One is an increase in the leakage current, i.e., the normal thermal generation of charge carriers in the silicon that provides a background dark signal that adds to the light produced image. In an undamaged CCD, the leakage current is usually fairly uniform across the photosensitive area of the silicon chip, with the exception of various bright pixels which have an anomalous leakage current well above the overall level.

Food Parenting: A Selective Review of Current Measurement and an Empirical Examination To Inform Future Measurement

PubMed Central

Kiefner, Allison

2013-01-01

Abstract Background Interactions between parents and children in regard to food are an important part of the development of food preferences and intake patterns for children. The measurement of this complex and multidimensional construct is very challenging. Methods This article examines the current status of measurement in this domain in a selective review, considers qualitative input from parents and adolescents in an empirical examination of the topic, and makes concrete recommendations for the future. Results Qualitatively, there were important differences between what the adolescents reported that their parents did to impact their eating habits, what parents of younger children report they currently do, and what researchers typically measure in research on parental feeding practices. Conclusions On the basis of these empirical findings and our review of the literature, we recommend that food parenting be measured on three levels: Feeding styles (e.g., authoritative), food parenting practices (e.g., restriction), and specific feeding behaviors (e.g., putting food out of the child's reach). Specific recommendations for future study are given for each level of measurement. PMID:23944922

Protocol for the New Medicine Service Study: a randomized controlled trial and economic evaluation with qualitative appraisal comparing the effectiveness and cost effectiveness of the New Medicine Service in community pharmacies in England

PubMed Central

2013-01-01

Background Medication non-adherence is considered an important cause of morbidity and mortality in primary care. This study aims to determine the effectiveness, cost effectiveness and acceptability of a complex intervention delivered by community pharmacists, the New Medicine Service (NMS), compared with current practice in reducing non-adherence to, and problems with, newly prescribed medicines for chronic conditions. Methods/design Research subject group: patients aged 14 years and above presenting in a community pharmacy for a newly prescribed medicine for asthma/chronic obstructive pulmonary disease (COPD); hypertension; type 2 diabetes or anticoagulant/antiplatelet agents in two geographical regions in England. Design: parallel group patient-level pragmatic randomized controlled trial. Interventions: patients randomized to either: (i) current practice; or (ii) NMS intervention comprising pharmacist-delivered support for a newly prescribed medicine. Primary outcomes: proportion of adherent patients at six, ten and 26 weeks from the date of presenting their prescriptions at the pharmacy; cost effectiveness of the intervention versus current practice at 10 weeks and 26 weeks; in-depth qualitative understanding of the operationalization of NMS in pharmacies. Secondary outcomes: impact of NMS on: patients’ understanding of their medicines, pharmacovigilance, interprofessional and patient-professional relationships and experiences of service users and stakeholders. Economic analysis: Trial-based economic analysis (cost per extra adherent patient) and long-term modeling of costs and health effects (cost per quality-adjusted-life-year) will be conducted from the perspective of National Health Service (NHS) England, comparing NMS with current practice. Qualitative analysis: a qualitative study of NMS implementation in different community settings, how organizational influences affect NMS delivery, patterns of NMS consultations and experiences of professionals and patients participating in NMS, and patients receiving current practice. Sample size: 250 patients in each treatment arm would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a reduction in patient-reported non-adherence from 20% to 10% in the NMS arm compared with current practice, assuming a 20% drop-out rate. Discussion At the time of submission of this article, 58 community pharmacies have been recruited and the interventions are being delivered. Analysis has not yet been undertaken. Trial registration Current controlled trials: ISRCTN23560818 Clinical Trials US (clinicaltrials.gov): NCT01635361 PMID:24289059

Design Guidelines and Criteria for User/Operator Transactions with Battlefield Automated Systems. Volume 5. Background Literature

DTIC Science & Technology

1981-02-01

the machine . ARI’s efforts in this area focus on human perfor- mance problems related to interactions with command and control centers, and on issues...improvement of the user- machine interface. Lacking consistent design principles, current practice results in a fragmented and unsystematic approach to system...complexity in the user- machine interface of BAS, ARI supported this effort for develop- me:nt of an online language for Army tactical intelligence

Music-supported therapy for stroke motor recovery: theoretical and practical considerations.

PubMed

Chen, Joyce L

2018-05-08

Music may confer benefits for well-being and health. What is the state of knowledge and evidence for a role of music in supporting the rehabilitation of movements after stroke? In this brief perspective, I provide background context and information about stroke recovery in general, in order to spark reflection and discussion for how we think music may impact motor recovery, given the current clinical milieu. © 2018 New York Academy of Sciences.

Drinking Patterns, Gender and Health I: Attitudes and Health Practices

PubMed Central

Polen, Michael R.; Green, Carla A.; Perrin, Nancy A.; Anderson, Bradley M.; Weisner, Constance M.

2012-01-01

Background Despite considerable research, relationships among gender, alcohol consumption, and health remain controversial, due to potential confounding by health-related attitudes and practices associated with drinking, measurement challenges, and marked gender differences in drinking. We examined gender/alcohol consumption differences in health-related attitudes and practices, and evaluated how these factors affected relationships among gender, alcohol consumption, and health status. Methods A stratified random sample of adult health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). Using MANCOVAs and adjusting for health-related attitudes, values, and practices, we examined gender differences in relationships between alcohol consumption and health. Results More frequent heavy drinking was associated with worse health-related attitudes and values, worse feelings about visiting the doctor, and worse health-related practices. Relationships between health-related practices and alcohol use differed by gender, and daily or almost daily heavy drinking was associated with significantly lower physical and mental health for women compared to men. Drinking status (lifelong abstainers, former drinkers, and level of regular alcohol consumption) was related to health status and vitality, even after adjusting for health-related attitudes, values, and practices. Relationships did not differ by gender. Former drinkers reported lower physical and mental health status than either lifelong abstainers or current drinkers. Conclusions Drinking status is independently related to physical health, mental health, and vitality, even after controlling for the health-related attitudes, values, and practices expected to confound these relationships. Among current drinkers, women who engage in very frequent heavy drinking have worse physical and mental health than their male counterparts. PMID:23946720

Tolerance of ambiguity, perfectionism and resilience are associated with personality profiles of medical students oriented to rural practice.

PubMed

Eley, Diann S; Leung, Janni K; Campbell, Narelle; Cloninger, C Robert

2017-05-01

Resilience, coping with uncertainty and learning from mistakes are vital characteristics for all medical disciplines - particularly rural practice. Levels of coping constructs were examined in medical students with and without a rural background or an interest in rural practice. Cross-sectional surveys identified two personality profiles, and their association with levels of Tolerance of Ambiguity, Resilience, Perfectionism-High Standards and Concern over mistakes as constructs indicative of coping. Medical students (N = 797) were stratified by rural background and degree of rural interest. Mediation analysis tested the effect of personality profile on levels of the coping constructs. More (72%) rural background students had Profile 1 which was associated with higher levels of Tolerance of Ambiguity, High standards, and Resilience, but lower Concern over mistakes. Non-rural background students reporting a strong rural interest also had Profile 1 (64%) and similar levels of coping constructs. Personality profile mediated the association between rural interest and levels of coping constructs regardless of background. Having a rural background or strong rural interest are associated with a personality profile that indicates a better capacity for coping. Personality may play a part in an individual's interest in rural practice. Rural workforce initiatives through education should encourage and nurture students with a genuine interest in rural practice - regardless of background.

Recruitment and Hiring Strategies of Private Practitioners and Implications for Practice Management Training of Veterinary Students.

PubMed

Kogan, Lori R; Hellyer, Peter W; Stewart, Sherry M; Dowers, Kristy L

2015-01-01

Hiring new employees is one of the most important and difficult decisions all veterinary practice managers and owners face. In an effort to improve hiring decisions, many employers are choosing to screen potential employees more thoroughly through the use of interviews, background checks, personality assessments, and online research including social and professional networking websites. The current study reports results from an anonymous online survey created to evaluate practicing veterinarians' attitudes and practices related to the use of recruitment and hiring tools. Results suggest that, compared to those in other professions, veterinarians underutilize these evaluative tools. The profession could benefit from more opportunities for both practitioners and veterinary students to learn how to utilize a broader range of hiring and recruitment techniques. One area of particular and growing concern is the use of Internet social media for evaluation of potential employees. Despite the fairly low number of participants who indicated they currently research applicants online, a significant number plan to implement this practice in the future. Many students are unaware of how their online postings can affect their future job possibilities and career. It is therefore important to designate time within continuing education programs and professional veterinary curricula to educate these populations about hiring and recruitment tool options and about how to manage their personal Internet interactions (especially social media) to enhance and maintain their professional image (e-professionalism).

The current evidence base for the feasibility of 48-hour continuous subcutaneous infusions (CSCIs): A systematically-structured review

PubMed Central

Dickman, Andrew; Mason, Stephen; Ellershaw, John

2018-01-01

Background A continuous subcutaneous infusion (CSCI) is an effective method of multiple drug administration commonly encountered in end of life care when the oral route is compromised. At present, current practice is to limit syringe driver infusion time to a maximum of 24 hours as dictated by available chemical stability data. However, the ability to deliver prescribed medication by a CSCI over 48 hours may have numerous benefits in both patient care and health service resource utilisation. Aim To examine and present the current evidence base for the stability of 48-hour multiple-drug CSCIs in current clinical practice. Design A systematically-structured review following PRISMA guidelines. Data sources Three electronic databases and the grey literature were searched with no time limits. Empirical studies reporting data on the chemical stability of continuous subcutaneous infusions or solutions stored in polypropylene syringes were included. Results Twenty-one empirical studies were included in this review reporting chemical compatibility and stability of 32 discrete combinations of twenty-four drugs tested at a variety of different drug concentrations. The majority of combinations reported were assessed as being chemically compatible. The greatest risk of clinically significant chemical degradation was observed with midazolam. Only one study reported the microbiological stability of the solution examined. Conclusions There is currently limited evidence for the physical, chemical and microbiological stability of solutions for continuous subcutaneous infusion over a period of 48 hours. More stability data is required before the use of 48-hour CSCIs can be evaluated for use within clinical practice. PMID:29538455

The new era of postgraduate certified general practice training in Japan.

PubMed

Takamura, Akiteru

2016-09-01

This paper describes the background to, and the recent evolution of general practice as a recognised medical specialism in Japan (2015), and the evolution of a system of training to support this development. We, the general practitioners (GPs) in Japan have not been recognised as one body of medical specialists and have been training in our own way. A new certified training system will commence in 2018, authorised by a new third organisation, the Japanese Medical Specialty Board. An effective educational system has been developed for medical graduates that have a career intention in general practice that is distinct from other basic medical fields, but collaborates with them. A challenge exists to provide clarity to the Japanese population about what the specialty of general practice is, and what professionals in general practice can do for them. Japan currently has approximately 500 certified GPs and it is unclear at present what numbers will eventually be required. This paper reviews some of the challenges facing the development of general practice from the perspective of the Japan Primary Care Association.

Medical student selection criteria and socio-demographic factors as predictors of ultimately working rurally after graduation.

PubMed

Puddey, Ian B; Mercer, Annette; Playford, Denese E; Riley, Geoffrey J

2015-04-14

We have previously demonstrated that both coming from a rural background and spending a year-long clinical rotation in our Rural Clinical School (RCS) have independent and additive effects to increase the likelihood of medical students practicing rurally following graduation. The current study assesses the extent to which medical school selection criteria and/or the socio-demographic profile of medical students may further facilitate or hamper the selection of students ultimately destined for the rural medical workforce. The study comprised 729 students, admitted from secondary school since 1999 and having graduated by 2011, whose actual workplace location in 2014 was classified as either urban or rural using the Australian Health Practitioner Regulation Agency database. Selection factors on entry (score from a standardised interview, percentile scores for the 3 components of the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and prior academic performance as assessed by the Australian Tertiary Admissions Rank) together with socio-demographic factors (age, gender, decile for the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD)), were examined in relation to ultimate rural destination of practice. In logistic regression, those practicing in a rural location in 2014 were more likely to have come from the lower 6 IRSAD deciles (OR 2.75, 95% CI 1.44, 5.23, P = 0.002), to be older (OR 1.86, 95% CI 1.09, 3.18, p = 0.023) and to have a lower UMAT-3 (Non-verbal communication) score (OR 0.98, 95% CI 0.97, 0.99, P = 0.005). After further controlling for either rural background or RCS participation, only age and UMAT-3 remained as independent predictors of current rural practice. In terms of the socio-demographic profiles of those selected for medical school entry from secondary school, only older age weakly augmented the selection of graduates likely to ultimately work in a rural destination. Among the selection factors, having achieved higher scores in UMAT-3 tended to mitigate this outcome. The major focus in attempts to grow the rural medical workforce should therefore remain on recruiting medical students from a rural background together with providing maximal opportunity for prolonged immersion in rural clinical environments during their training.

Current debates on end-of-life sedation: an international expert elicitation study.

PubMed

Papavasiliou, Evangelia Evie; Payne, Sheila; Brearley, Sarah

2014-08-01

End-of-life sedation, though increasingly prevalent and widespread internationally, remains one of the most highly debated medical practices in the context of palliative medicine. This qualitative study aims to elicit and record the perspectives of leading international palliative care experts on current debates. Twenty-one professionals from diverse backgrounds, sharing field-specific knowledge/expertise defined by significant scholarly contribution on end-of-life sedation, were recruited. Open-ended, semi-structured interviews, following a topic-oriented structure reflecting on current debates, were conducted. Results were analysed using thematic content analysis. Three main aspects of sedation were identified and discussed as potentially problematic: (a) continuous deep sedation as an extreme facet of end-of-life sedation, (b) psycho-existential suffering as an ambivalent indication for sedation and (c) withdrawal or withholding of artificial nutrition and hydration as potentially life-shortening. On these grounds, concerns were reported over end-of-life sedation being morally equivalent to euthanasia. Considerable emphasis was placed on intentions as the distinguishing factor between end-of-life acts, and protective safeguards were introduced to distance sedation from euthanasia. This study shows that, despite the safeguards introduced, certain aspects of sedation, including the intentions associated with the practice, are still under question, parallels being drawn between end-of-life sedation and euthanasia. This reaffirms the existence of a grey area surrounding the two practices, already evidenced in countries where euthanasia is legalized. More clarity over the issues that generate this grey area, with their causes being uncovered and eliminated, is imperative to resolve current debates and effectively inform research, policy and practice of end-of-life sedation.

Removal of Differential Capacitive Interferences in Fast-Scan Cyclic Voltammetry.

PubMed

Johnson, Justin A; Hobbs, Caddy N; Wightman, R Mark

2017-06-06

Due to its high spatiotemporal resolution, fast-scan cyclic voltammetry (FSCV) at carbon-fiber microelectrodes enables the localized in vivo monitoring of subsecond fluctuations in electroactive neurotransmitter concentrations. In practice, resolution of the analytical signal relies on digital background subtraction for removal of the large current due to charging of the electrical double layer as well as surface faradaic reactions. However, fluctuations in this background current often occur with changes in the electrode state or ionic environment, leading to nonspecific contributions to the FSCV data that confound data analysis. Here, we both explore the origin of such shifts seen with local changes in cations and develop a model to account for their shape. Further, we describe a convolution-based method for removal of the differential capacitive contributions to the FSCV current. The method relies on the use of a small-amplitude pulse made prior to the FSCV sweep that probes the impedance of the system. To predict the nonfaradaic current response to the voltammetric sweep, the step current response is differentiated to provide an estimate of the system's impulse response function and is used to convolute the applied waveform. The generated prediction is then subtracted from the observed current to the voltammetric sweep, removing artifacts associated with electrode impedance changes. The technique is demonstrated to remove select contributions from capacitive characteristics changes of the electrode both in vitro (i.e., in flow-injection analysis) and in vivo (i.e., during a spreading depression event in an anesthetized rat).

Nursing Practice Environment and Outcomes for Oncology Nursing

PubMed Central

Shang, Jingjing; Friese, Christopher R.; Wu, Evan; Aiken, Linda H.

2012-01-01

Background It is commonly assumed that oncology nurses experience high job-related burnout and high turnover because their work involves inherent stressors such as caring for patients with serious and often life-threatening illness. Objectives The objectives of this study were to examine the differences in outcomes such as job dissatisfaction and burnout between oncology nurses and medical-surgical nurses, and to identify factors that affect oncology nurse outcomes. Methods A secondary analysis of nurse survey data collected in 2006 including 4047 nurses from 282 hospitals in 3 states was performed; t test and χ2 test compared differences between oncology nurses and medical-surgical nurses in nurse outcomes and their assessments of nurse practice environment, as measured by the Practice Environment Scale of the Nursing Work Index. Logistic regression models estimated the effect of nurse practice environment on 4 nurse-reported outcomes: burnout, job dissatisfaction, intention to leave the current position, and perceived quality of care. Results Oncology nurses reported favorable practice environments and better outcomes than did medical-surgical nurses. All 4 subscales of the Practice Environment Scale of the Nursing Work Index studied were significantly associated with outcomes. Specifically, nurses who reported favorable nursing foundations for quality of care (eg, active in-service or preceptorship programs) were less likely to report burnout and leave their current position. Conclusions Better practice environments, including nurse foundations for quality care, can help to achieve optimal nurse outcomes. Implications for Practice Improving hospital practice environments holds significant potential to improve nurse well-being, retention, and quality of care. Specifically, hospitals should consider preceptor programs and continuing education and increase nurses’ participation in hospital decision making. PMID:22751101

Review of Refugee Mental Health Interventions Following Resettlement: Best Practices and Recommendations

PubMed Central

Murray, Kate E; Davidson, Graham R; Schweitzer, Robert D

2013-01-01

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psycho-educational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement. PMID:20950298

Review of refugee mental health interventions following resettlement: best practices and recommendations.

PubMed

Murray, Kate E; Davidson, Graham R; Schweitzer, Robert D

2010-10-01

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement. © 2010 American Orthopsychiatric Association.

Cooper-Harper Experience Report for Spacecraft Handling Qualities Applications

NASA Technical Reports Server (NTRS)

Bailey, Randall E.; Jackson, E. Bruce; Bilimoria, Karl D.; Mueller, Eric R.; Frost, Chad R.; Alderete, Thomas S.

2009-01-01

A synopsis of experience from the fixed-wing and rotary-wing aircraft communities in handling qualities development and the use of the Cooper-Harper pilot rating scale is presented as background for spacecraft handling qualities research, development, test, and evaluation (RDT&E). In addition, handling qualities experiences and lessons-learned from previous United States (US) spacecraft developments are reviewed. This report is intended to provide a central location for references, best practices, and lessons-learned to guide current and future spacecraft handling qualities RDT&E.

Navy Irregular Warfare and Counterterrorism Operations: Background and Issues for Congress

DTIC Science & Technology

2015-09-25

practices in which suspects were sent to the U.S. detention facility at Guantanamo Bay, Cuba, or secret CIA prisons. The process ordinarily begins with...But prototype DCS mini-subs cannot fit inside the current shelter design. As a result , a modernization program will stretch the DDS units by 50...In June 2014, the SWCS program was re-baselined as a result of significant cost and schedule overruns. Less than a year after this re-baselining, the

[Genetic and epigenetic aspects of celiac disease].

PubMed

Kocsis, Dorottya; Béres, Nóra; Veres, Gábor; Szabó, Dolóresz; Müller, Katalin Eszter; Arató, András; Juhász, Márk

2014-01-19

Genetic background of coeliac disease has been subjects to intensive research since decades. However, only results of HLA phenotyping have been taken over to routine clinical practice. Meanwhile, data on the role of epigenetical factors in the manifestation of diseases have been emerging. In coeliac disease, there are several questions both in the fields of genetics and epigenetics yet to be answered. In this review, a cross section of current knowledge on these issues is presented with special interest regarding the future clinical applications.

Utilizing the permafrost on Mars

NASA Technical Reports Server (NTRS)

Phillips, L.

1985-01-01

It is noted that analogy between earth landforms resulting from the presence of permafrost has led to the suggestion that ground ice or water was at one time present on Mars. Only a regolith sample will confirm this. With these technologies as background, and known locations of subsurface water, development of a water supply base on Mars can then assume validity and significance. Current practices in terrestrial periglacial environments may be applicable to the Martian situation, taking into account site specific modifications of these techniques.

Reconsidering nutrition science: critical reflection with a cultural lens

PubMed Central

2014-01-01

Background European culture gave birth to modern science as a means to investigate and explain the natural world. The biomedical disciplines that have since emerged, including nutrition, presuppose a web of basic presuppositions, background assumptions and implicit cultural values that are often overlooked and escape peer review. These "hidden subjectivities" are widely taken-for-granted while exerting a powerful hold on the scope, direction and patterns of disciplinary thought. Nutrition science currently has no accepted means of collectively attending to hidden subjectivities embedded within its methods and practice. Here I propose that directing inquiry into these dimensions holds potential to advance our discipline. Methods This critically reflective approach emerged from critical theory and the practice of cross-cultural engagement (CCE). CCE deliberately seeks out and critically engages food and health understandings of non-European cultures. Its protocol includes cognitive frameshifting, a practice of temporarily stepping outside of habitual thought patterns and into a non-biomedical framework of background assumptions. A cultural lens metaphor derives from CCE practice and is forwarded here as a viable means for restoring critically reflective attention to hidden subjectivities while also inviting further CCE practice within the discipline. Results Critical reflection with a cultural lens allows cognitive attachments to materialism, reductionism, mechanistic thought, naïve realism, control over nature and pervasive subject-object dichotomies between mind and matter, scientist and nature, experience and reality, among many others to become more available for critical consideration. Culturally diverse food and health understandings otherwise dismissed as "unscientific" or held in abeyance gain value as alternative assumptive frameworks and cognitive models that can be temporarily inhabited for further intercultural reflection and insight. Conclusion Critical reflection with a cultural lens allows reconsideration of nutrition science in light of its culturally specific origin and foundation. This perspective can advance the discipline in two ways. First, it extends skeptical inquiry into hidden subjectivities that are otherwise implicit and seldom given over to critical consideration. Second, it can broaden scholarly inquiry through deliberate attempts to cross cognitive boundaries and empathically inhabit different cognitive worlds. This developmental practice holds potential to both deepen and broaden disciplinary inquiry. PMID:24886077

Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice.

PubMed

Apekey, Tanefa A; McSorley, Gerry; Tilling, Michelle; Siriwardena, A Niroshan

2011-04-01

Leadership and innovation are currently seen as essential elements for the development and maintenance of high-quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Self-administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Sixty-three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P < 0.001). Apart from clinical audit and significant event analysis, quality improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.

Professional Experiences of International Medical Graduates Practicing Primary Care in the United States

PubMed Central

Nunez-Smith, Marcella; Bernheim, Susannah May; Berg, David; Gozu, Aysegul; Curry, Leslie Ann

2010-01-01

Background International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited. Objective To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US. Design Qualitative study based on in-depth in-person interviews. Participants Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut. Approach A standardized interview guide was used to explore professional experiences of IMGs. Key Results Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of “the deal”; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace. Conclusions Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs’ experiences may also improve the experiences of an increasingly diverse healthcare workforce. PMID:20502974

Test result communication in primary care: a survey of current practice

PubMed Central

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

2015-01-01

Background The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. Methods We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Results Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. Conclusions The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the handling of samples and the reporting of results. Our findings will inform our continuing work with patients and staff to develop, implement and evaluate improvements to existing systems of managing the testing and result communication process. PMID:26243888

Compassion Fatigue and Burnout Amongst Clinicians: A Medical Exploratory Study

PubMed Central

Bhutani, Jaikrit; Bhutani, Sukriti; Balhara, Yatan Pal Singh; Kalra, Sanjay

2012-01-01

Background: Compassion fatigue is a broad term comprising of two components – burnout and secondary traumatic stress. The current study is aimed at identifying ‘burnout’ and ‘compassion fatigue’ among clinicians involved in care of individuals suffering from medical illness. Materials and Methods: A total of 60 clinicians were included in the study. A semi-structured questionnaire was administered to gather information related to personal, professional, anthropometric, and metabolic profile of the study participants. Professional Quality of Life Scale (ProQoL Version V) was used to assess burnout, compassion satisfaction and secondary traumatic stress. Analysis was carried out using the SPSS version 19.0. Results: The mean age of clinicians was 46.68±11.06 (range 26-67 years). Burnout score was significantly higher in those involved in diabetology practice. Similarly, compassion satisfaction score was greater among those with greater years of practice as well as among those in private practice. Clinicians who reported a poor working condition, as opposed to good, had more burnout and less compassion satisfaction. Conclusion: The current study suggests that it is important to find out ways of decreasing burnout and compassion fatigue among clinicians. PMID:23723540

Developing the role of Swedish advanced practice nurse (APN) through a blended learning master's program: Consequences of knowledge organisation.

PubMed

Bergström, Peter; Lindh, Viveca

2018-01-01

This paper reports on a research study conducted with a group of nurses in Sweden enrolled in a newly developed blended learning master's programme to become advanced practice nurses (APNs). As background, the paper presents the regional needs the programme is intended to address and describes how the programme was designed. The aim was to understand how, from students' perspective, the nurse master's programme structured knowledge for their future position as APNs. The research question focuses on how the master's programme prepares students by meeting their diverse needs for knowledge. Empirical material was collected at two times during the students' first and second years of study through semi-structured qualitative interviews. The findings highlight the process in which these master's students gained a more advanced identity of becoming APNs. This process demonstrates how students perceive their current position as nurses based on a discourse of knowledge in relation to the practical and theoretical knowledge they encounter in the master's programme. This article concludes by recommending that attention should be paid to developing APN role models in the current Swedish healthcare system. Copyright © 2017 Elsevier Ltd. All rights reserved.

Contradictory Literacy Practices of Mexican-Background Students: An Ethnography From the Rural Midwest

ERIC Educational Resources Information Center

Godina, Heriberto

2004-01-01

This ethnographic study explores the contradictory literacy practices of 10 high school students of Mexican background from the rural Midwest. The author uses the term "Mexican background" to encompass both settled Mexican Americans and recent-immigrant Mexicanos. Literacy is investigated through English and Spanish in a sociocultural…

Driving safety in elderly individuals.

PubMed

Marottoli, R A

1993-05-01

Driving safety in elderly individuals is becoming an increasingly important issue in geriatrics and in medical practice. The number of elderly drivers is increasing as the population ages, and especially as current generations of female drivers age. Concern is raised about their safe operation of motor vehicles because of the increasing likelihood with advancing age of developing conditions that may adversely affect the visual, cognitive, and motor abilities integral to driving. But this issue is not only a medical one, since there are social and political components as well. This discussion will describe the background of this issue, focus on the changes that may occur with aging and their potential relationship to driving ability, and, finally, will outline an approach that physicians may employ in their practice.

Harnessing and blending the power of two research networks to improve prevention science and public health practice

PubMed Central

Vanderpool, Robin C.; Brownson, Ross C.; Mays, Glen P.; Crosby, Richard A.; Wyatt, Stephen W.

2015-01-01

Strategic collaborations are essential in moving public health research and practice forward1, particularly in light of escalating fiscal and environmental challenges facing the public health community. This commentary provides background and context for an emerging partnership between two national networks, Prevention Research Centers (PRCs) and Public Health Practice-Based Research Networks (PBRNs), to impact public health practice. Supported by CDC, PRCs are celebrating over 25 years of transdisciplinary applied prevention research grounded in community and stakeholder engagement. Public Health PBRNs, funded by the Robert Wood Johnson Foundation, conduct innovative public health services and systems research with public health agencies and community partners to improve public health decision-making. By utilizing each of the networks’ respective strengths and resources, collaborative ventures between PRCs and Public Health PBRNs can enhance the translation of applied prevention research to evidence-based practice and empirically investigate novel public health practices developed in the field. Three current PRC-Public Health PBRNs projects are highlighted and future research directions are discussed. Improving the interconnectedness of prevention research and public health practice is essential to improve the health of the Nation. PMID:24237918

Spectator electric fields, de Sitter spacetime, and the Schwinger effect

NASA Astrophysics Data System (ADS)

Giovannini, Massimo

2018-03-01

During a de Sitter stage of expansion, the spectator fields of different spin are constrained by the critical density bound and by further requirements determined by their specific physical nature. The evolution of spectator electric fields in conformally flat background geometries is occasionally concocted by postulating the existence of ad hoc currents, but this apparently innocuous trick violates the second law of thermodynamics. Such a problem occurs, in particular, for those configurations (customarily employed for the analysis of the Schwinger effect in four-dimensional de Sitter backgrounds) leading to an electric energy density which is practically unaffected by the expansion of the underlying geometry. The obtained results are compared with more mundane situations where Joule heating develops in the early stages of a quasi-de Sitter phase.

Reasoning and Data Representation in a Health and Lifestyle Support System.

PubMed

Hanke, Sten; Kreiner, Karl; Kropf, Johannes; Scase, Marc; Gossy, Christian

2017-01-01

Case-based reasoning and data interpretation is an artificial intelligence approach that capitalizes on past experience to solve current problems and this can be used as a method for practical intelligent systems. Case-based data reasoning is able to provide decision support for experts and clinicians in health systems as well as lifestyle systems. In this project we were focusing on developing a solution for healthy ageing considering daily activities, nutrition as well as cognitive activities. The data analysis of the reasoner followed state of the art guidelines from clinical practice. Guidelines provide a general framework to guide clinicians, and require consequent background knowledge to become operational, which is precisely the kind of information recorded in practice cases; cases complement guidelines very well and helps to interpret them. It is expected that the interest in case-based reasoning systems in the health.

Hydrologic and chemical-quality data from four rural basins in Guilford County, North Carolina, 1985-88

USGS Publications Warehouse

Hill, C.L.

1989-01-01

An investigation was begun in 1984 in Guilford County, North Carolina, to monitor water quality and soil erosion in basins with various land-management practices. Hydrologic and chemical-quality data were collected from four rural drainage basins, including two agricultural basins (7.4 and 4.8 acres) cultivated in tobacco and small grains, a mixed rural land-use basin (665 acres) currently under standard land-management practices, and a forested control basin (44 acres) characterizing background conditions. Mean concentrations of total nitrite plus nitrate were 1.0 milligrams per liter from the agricultural basin under standard land-management practices. This was nearly 10 times greater than concentrations from the forested basin. Records of streamflow discharge, chemical quality, ground-water levels, precipitation, and farming activities collected from October 1984 through September 1988 at one or more of the basins are also presented in this report.

Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece

PubMed Central

2011-01-01

Background Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. Methods The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). Results The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). Conclusions The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete. PMID:22145678

Developing scientist leaders for tumultuous times.

PubMed

Woteki, Catherine E

2005-01-01

Leadership is a quality that can be learned. It is a behavior that one practices, and, after lots of practice, it becomes a habit. This is a lesson I learned from my father, who was a career pilot in the US Air Force and instilled this into me and my siblings from a very early age. It is also something I have learned in observing others. I have frequently asked why some people from certain disciplinary backgrounds seem to have an advantage in the leadership area. Think of the backgrounds of our Presidents, for example; so many of them have been attorneys. Members of Congress, as well, also frequently come from that disciplinary background. Key decision makers in government frequently come from economics backgrounds. I have also asked why this is the case. Frequently, the answer seems to be that these disciplines define themselves as being those that create leaders, not that they limit their members' aspirations. Why are so few veterinarians in leadership positions? It seems quite a paradox that they are not. The assets of an education in veterinary medicine are many. The education provides a very broad background in systems biology, medicine, and public health. There are many career paths for veterinarians. Most choose private practice, but, beyond that, career paths exist in industry, particularly the biomedical industry; in trade associations; in government and industry research; and in public health and regulatory positions. There are also many opportunities in academia, certainly in colleges of veterinary medicine but, beyond that, also in human medicine and in the biology disciplines. International opportunities also exist in governmental and non-governmental organizations, such as the Food and Agriculture Organization at the United Nations and the World Health Organization, and in advocacy and lobbying. Veterinarians are also making news these days. The emerging zoonotic diseases that have seized headlines in papers around the world give prominence to veterinarians and the skills they bring to bear in fighting current outbreaks and preventing future outbreaks of these diseases, such as SARS, Ebola, West Nile virus, and even HIV/AIDS.

Effects of Desiccation Practices of Cultured Atlantic Oysters (Crassostrea virginica) on Vibrio spp. in Portersville Bay, Alabama, USA.

PubMed

Grodeska, Stephanie M; Jones, Jessica L; Arias, Covadonga R; Walton, William C

2017-08-01

The expansion of off-bottom aquaculture to the Gulf of Mexico has raised public health concerns for human health officials. High temperatures in the Gulf of Mexico are associated with high levels of Vibrio parahaemolyticus and Vibrio vulnificus. Routine desiccation practices associated with off-bottom aquaculture expose oysters to ambient air, allowing Vibrio spp. to proliferate in the closed oyster. Currently, there is limited research on the length of time needed for Vibrio spp. levels in desiccated oysters to return to background levels, defined as the levels found in oysters that remain continually submersed and not exposed to ambient air. This study determined the time needed to return V. parahaemolyticus, V. vulnificus, and Vibrio cholerae levels to background levels in oysters exposed to the following desiccation practices: 3-h freshwater dip followed by 24-h ambient air exposure, 27-h ambient air exposure, and control. All oysters were submerged at least 2 weeks prior to the beginning of each trial, with the control samples remaining submerged for the duration of each trial. Vibrio spp. levels were enumerated from samples collected on days 0, 1, 2, 3, 7, 10, and 14 after resubmersion using a three-tube most-probable-number enrichment followed by BAX PCR. V. cholerae levels were frequently (92%) below the limit of detection at all times, so they were not statistically analyzed. V. parahaemolyticus and V. vulnificus levels in the 27-h ambient air exposure and the 3-h freshwater dip followed by 24-h ambient air exposure samples were significantly elevated compared with background samples. In most cases, the Vibrio spp. levels in oysters in both desiccation treatments remained elevated compared with background levels until 2 or 3 days post-resubmersion. However, there was one trial in which the Vibrio spp. levels did not return to background levels until day 7. The results of this study provide scientific support that oyster farmers should be required to implement a minimum 7-day resubmersion regimen. This length of time allowed the Vibrio spp. levels to become not significantly different across all treatments.

Physician tracking in sub-Saharan Africa: current initiatives and opportunities

PubMed Central

2014-01-01

Background Physician tracking systems are critical for health workforce planning as well as for activities to ensure quality health care - such as physician regulation, education, and emergency response. However, information on current systems for physician tracking in sub-Saharan Africa is limited. The objective of this study is to provide information on the current state of physician tracking systems in the region, highlighting emerging themes and innovative practices. Methods This study included a review of the literature, an online search for physician licensing systems, and a document review of publicly available physician registration forms for sub-Saharan African countries. Primary data on physician tracking activities was collected as part of the Medical Education Partnership Initiative (MEPI) - through two rounds over two years of annual surveys to 13 medical schools in 12 sub-Saharan countries. Two innovations were identified during two MEPI school site visits in Uganda and Ghana. Results Out of twelve countries, nine had existing frameworks for physician tracking through licensing requirements. Most countries collected basic demographic information: name, address, date of birth, nationality/citizenship, and training institution. Practice information was less frequently collected. The most frequently collected practice fields were specialty/degree and current title/position. Location of employment and name and sector of current employer were less frequently collected. Many medical schools are taking steps to implement graduate tracking systems. We also highlight two innovative practices: mobile technology access to physician registries in Uganda and MDNet, a public-private partnership providing free mobile-to-mobile voice and text messages to all doctors registered with the Ghana Medical Association. Conclusion While physician tracking systems vary widely between countries and a number of challenges remain, there appears to be increasing interest in developing these systems and many innovative developments in the area. Opportunities exist to expand these systems in a more coordinated manner that will ultimately lead to better workforce planning, implementation of the workforce, and better health. PMID:24754965

Understanding and meeting injection device needs in multiple sclerosis: a survey of patient attitudes and practices

PubMed Central

Verdun di Cantogno, Elisabetta; Russell, Susan; Snow, Tom

2011-01-01

Background: All established disease-modifying drugs for multiple sclerosis require parenteral administration, which can cause difficulties for some patients, sometimes leading to suboptimal adherence. A new electronic autoinjection device has been designed to address these issues. Methods: Patients with relapsing multiple sclerosis currently receiving subcutaneous or intramuscular interferon beta-1a, interferon beta-1b, or glatiramer acetate completed an online questionnaire (July 4–25, 2008) that surveyed current injection practices, experiences with current injection methods, and impressions and appeal of the new device. Results: In total, 422 patients completed the survey, of whom 44% used autoinjectors, 43% prefilled syringes, and 13% syringes and vials; overall, 66% currently self-injected. Physical and psychological barriers to self-injection included difficulty with injections, needle phobia, and concerns over correct injection technique. Only 40% of respondents were “very satisfied” with their current injection method. The new electronic autoinjector was rated as “very appealing” by 65% of patients. The benefits of the new device included the ability to customize injection settings and to review dosing history. Conclusion: New technologies may help patients overcome physical and psychological barriers to self-injection. The combination of a reliable and flexible autoinjection device with dose-monitoring technology may improve communication between health care professionals and patients, and improve treatment adherence. PMID:21573048

Interdisciplinary Research Career Development: Building Interdisciplinary Research Careers in Women's Health Program Best Practices

PubMed Central

Bodurtha, Joann; Nagel, Joan D.

2011-01-01

Abstract Background The Office of Research on Women's Health (ORWH) and the National Institutes of Health (NIH) Institutes and Centers and the Agency for Health Care Research and Quality (AHRQ) have sponsored an interdisciplinary research career development program in five funding cycles since 2000 through a K12 mechanism titled “Building Interdisciplinary Research Careers in Women's Health (BIRCWH).” As of 2010, 407 scholars have been supported in interdisciplinary women's health research and a total of 63 BIRCWH program awards have been made to 41 institutions across the U.S. Methods In an effort to share practical approaches to interdisciplinary research training, currently funded BIRCWH sites were invited to submit 300-word bullet-point style summaries describing their best practices in interdisciplinary research training following a common format with an emphasis on practices that are innovative, can be reproduced in other places, and advance women's health research. Results and Conclusions Twenty-six program narratives provide unique perspectives along with common elements and themes in interdisciplinary research training best practices. PMID:21923414

Patterns of Yoga Practice and Physical Activity Following a Yoga Intervention for Adults With or at Risk for Type 2 Diabetes

PubMed Central

Alexander, Gina; Innes, Kim E.; Bourguignon, Cheryl; Bovbjerg, Viktor E.; Kulbok, Pamela; Taylor, Ann Gill

2012-01-01

Background The current study described patterns of yoga practice and examined differences in physical activity over time between individuals with or at risk for type 2 diabetes who completed an 8-week yoga intervention compared with controls. Methods A longitudinal comparative design measured the effect of a yoga intervention on yoga practice and physical activity, using data at baseline and postintervention months 3, 6, and 15. Results Disparate patterns of yoga practice occurred between intervention and control participants over time, but the subjective definition of yoga practice limits interpretation. Multilevel model estimates indicated that treatment group did not have a significant influence in the rate of change in physical activity over the study period. While age and education were not significant individual predictors, the inclusion of these variables in the model did improve fit. Conclusions Findings indicate that an 8-week yoga intervention had little effect on physical activity over time. Further research is necessary to explore the influence of yoga on behavioral health outcomes among individuals with or at risk for type 2 diabetes. PMID:22232506

Estimate of Cosmic Muon Background for Shallow Underground Neutrino Detectors

NASA Astrophysics Data System (ADS)

Casimiro, E.; Simão, F. R. A.; Anjos, J. C.

One of the severe limitations in detecting neutrino signals from nuclear reactors is that the copious cosmic ray background imposes the use of a time veto upon the passage of the muons to reduce the number of fake signals due to muon-induced spallation neutrons. For this reason neutrino detectors are usually located underground, with a large overburden. However there are practical limitations that do restrain from locating the detectors at large depths underground. In order to decide the depth underground at which the Neutrino Angra Detector (currently in preparation) should be installed, an estimate of the cosmogenic background in the detector as a function of the depth is required. We report here a simple analytical estimation of the muon rates in the detector volume for different plausible depths, assuming a simple plain overburden geometry. We extend the calculation to the case of the San Onofre neutrino detector and to the case of the Double Chooz neutrino detector, where other estimates or measurements have been performed. Our estimated rates are consistent.

Colour preferences of juvenile turbot (Scophthalmus maximus).

PubMed

Li, Xian; Chi, Liang; Tian, Huiqin; Meng, Lingjie; Zheng, Jimeng; Gao, Xiaolong; Liu, Ying

2016-03-15

The background colour of aquaculture tanks is normally chosen based on practical experience and/or observations of fish behaviour and the growth rates achieved. However, some farmed species, including turbot, are sentient and can show a preference for a particular environment. In the current study, a self-referent colour preference device was developed and the self-referent colour preference of farmed fish investigated. In experiment 1, the background colour preference of juvenile turbot cultured under a grey background for >3months post-incubation was evaluated. Based on these results, in experiment 2, juvenile turbot were adapted to blue, pink, white, or black backgrounds for 50days and their preferences established. Meanwhile, the growth rates, feed intake, and metabolic rates (including oxygen consumption rate, and ammonia excretion rate) of the turbot were evaluated. The results showed that turbot farmed under a grey background, or after long-term white, blue, pink and black colour adaptation, always displayed a preference for a white background and a dislike for black, red, or brown backgrounds, although their body colour was greyish. Long-term adaptation influenced the frequency of juveniles selecting white, black, pink or blue backgrounds. They showed the highest growth rate, feed intake, and metabolic rates under blue and white backgrounds, and the lowest under a black background in accordance with their preferences shown in experiment 1. Although it is unclear how turbot determine their self-referent colour preferences over such a short period of time, these results indicate that dark colours are unsuitable for the aquaculture of turbot culture in terms of the welfare of the fish. Copyright © 2016 Elsevier Inc. All rights reserved.

Saudi views on consenting for research on medical records and leftover tissue samples

PubMed Central

2010-01-01

Background Consenting for retrospective medical records-based research (MR) and leftover tissue-based research (TR) continues to be controversial. Our objective was to survey Saudis attending outpatient clinics at a tertiary care hospital on their personal preference and perceptions of norm and current practice in relation to consenting for MR and TR. Methods We surveyed 528 Saudis attending clinics at a tertiary care hospital in Saudi Arabia to explore their preferences and perceptions of norm and current practice. The respondents selected one of 7 options from each of 6 questionnaires. Results Respondents' mean (SD) age was 33 (11) years, 42% were males, 56% were patients, 84% had ≥ secondary school education, and 10% had previously volunteered for research. Respectively, 40% and 49% perceived that the norm is to conduct MR and TR without consent and 38% and 37% with general or proposal-specific consent; the rest objected to such research. There was significant difference in the distribution of choices according to health status (patients vs. companions) for MR (adjusted Kruskal-Wallis test P = 0.03) but not to age group, gender, education level, or previous participation in research (unadjusted P = 0.02 - 0.59). The distributions of perceptions of current practice and norm were similar (unadjusted Marginal Homogeneity test P = 0.44 for MR and P = 0.89 for TR), whereas the distributions of preferences and perceptions of norm were different (adjusted P = 0.09 for MR and P = 0.02 for TR). The distributions of perceptions of norm, preferences, and perceptions of current practice for MR were significantly different from those of TR (adjusted P < 0.009 for all). Conclusions We conclude that: 1) there is a considerable diversity among Saudi views regarding consenting for retrospective research which may be related to health status, 2) the distribution of perceptions of norm was similar to the distribution of perceptions of current practice but different from that of preferences, and 3) MR and TR are perceived differently in regard to consenting. PMID:20955580

Workplace discrimination: experiences of practicing physicians.

PubMed Central

Coombs, Alice A. Tolbert; King, Roderick K.

2005-01-01

BACKGROUND: In response to a growing concern regarding physician discrimination in the workplace, this study was developed to: (1) describe the types of discrimination that exist for the practicing physician and (2) determine which groups of physicians are more likely to experience the various forms of discrimination. METHODS: Surveys were mailed to 1930 practicing physicians in Massachusetts. Participants were asked if they had encountered discrimination, how significant the discrimination was against a specific group, the frequency of personal discrimination, and the type of discrimination. Factor analysis identified four types of discrimination: career advancement, punitive behaviors, practice barriers and hiring barriers. RESULTS: A total of 445 responses were received (a 24% response rate). Sixty-three percent of responding physicians had experienced some form of discrimination. Respondents were women (46%), racial/ethnic minorities (42%) and international medical graduates (IMGs) (40%). In addition, 26% of those classified as white were also IMGs. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant. Almost 27% of males acknowledged that gender bias against females was very or somewhat significant. IMGs were more likely to indicate that discrimination against IMGs was significant in their current organization. Of U.S. medical graduates (USMGs) 44% reported that discrimination against IMGs in their current organization was significant. Nonwhites were more likely to report that discrimination based on race/ethnicity was significant. Nearly 29% of white respondents also believed that such discrimination was very or somewhat significant. CONCLUSIONS: Physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status. Images Figure 3 Figure 4 Figure 5 PMID:15868767

General and Specific Approaches to Media Parenting: A Systematic Review of Current Measures, Associations with Screen-Viewing, and Measurement Implications

PubMed Central

Edwards, Mark J.; Urbanski, Carly R.; Sebire, Simon J.

2013-01-01

Abstract Background Parent-focused interventions may help to reduce youth screen-viewing (SV). This review synthesized current information on the links between parenting styles, parenting practices, and youth SV with a focus on measurement. Methods A systematic review of electronic databases was conducted. Results In all, 29 of 1189 studies met the inclusion criteria. Parenting practices were divided into rule and nonrule-based practices. Seven rules: (1) Limits on total time (n studies=23); (2) limits on time of day (n=7); (3) content restriction (n=11); (4) mealtime rules (n=2); (5) parental supervision (n=3); (6) contingent screentime (n=3); and (7) no-TV policy (n=1) were reported. Two nonrule-based practices were reported: Co-viewing (n=6) and encouragement to view (n=2). Three studies (10.3%) provided information on parenting styles. Only 12 studies (41.4%) provided information on the reliability/validity of the outcome measure, 15 (51.7%) studies provided information on the reliability/validity of the parenting measure, and 6 (20.7%) provided information on the reliability/validity of both outcome and exposure measures. Conclusions There is mixed evidence that parenting styles and media-related parenting practices are associated with youth SV. The assessment of parental influence of youth media use is hampered by the diversity of measures that have been used. There is a need for new measures that assess a range of media parenting practices that are relevant to multiple forms of SV. PMID:23944925

Challenges to laboratory hematology practice: Egypt perspective.

PubMed

Rizk, S H

2018-05-01

Laboratory hematology is an integral part of all clinical laboratories along the extensive healthcare facilities in Egypt. The aim of this review is to portrait the laboratory hematology practice in Egypt including its unique socioeconomic background, blood disease pattern, education and training, regulatory oversight, and the related challenges. Current practice varies widely between different parts of the healthcare system in terms of the range of tests, applied techniques, workforce experience, and quality of service. The national transfusion service (NBTS) in Egypt has been recently upgraded and standardized according to the World Health Organization (WHO) guidelines. Formal postgraduate education roughly follows the British system. Laboratory hematology specialization is achieved through 2-3 years masters' degree followed by 2-4 years doctorate degree in clinical pathology with training and research in hematology. Improvement of laboratory hematology education is recently undergoing a reform as a part of the modernization of higher education policy and following the standards developed by the National Quality Assurance and Accreditation Agency (NQAAA). Accreditation of medical laboratories is recently progressing with the development of the "Egyptian Accreditation Council" (EGAC) as the sole accreditation body system and training of assessors. Current laboratory system has many challenges, some are related to the inadequate system performance, and others are unique to laboratory hematology issues. The rapid technological advances and therapeutic innovations in hematology practice call for an adapting laboratory system with continuous upgrading. © 2018 John Wiley & Sons Ltd.

Practices related to postpartum uterine involution in the Western Highlands of Guatemala

PubMed Central

Radoff, K.A.; Thompson, Lisa M.; Bly, KC; Romero, Carolina

2013-01-01

Background Guatemala has the third highest level of maternal mortality in Latin America. Postpartum haemorrhage is the main cause of maternal mortality. In rural Guatemala, most women rely on Traditional Birth Attendants (TBAs) during labour, delivery, and the postpartum period. Little is known about current postpartum practices that may contribute to uterine involution provided by Mam- and Spanish-speaking TBAs in the Western Highlands of Guatemala. Methods a qualitative study was conducted with 39 women who participated in five focus groups in the San Marcos Department of Guatemala. Questions regarding postpartum practices were discussed during four focus groups of TBAs and one group of auxiliary nurses. Results three postpartum practices believed to aid postpartum uterine involution were identified: use of the chuj (Mam) (Spanish, temazcal), a traditional wood-fired sauna-bath used by Mam-speaking women; herbal baths and teas; and administration of biomedicines. Conclusions TBAs provide the majority of care to women during childbirth and the postpartum period and have developed a set of practices to prevent and treat postpartum haemorrhage. Integration of these practices may prove an effective method to reduce maternal morbidity and mortality in the Western Highlands of Guatemala. PMID:22762787

A Review of Cochrane Systematic Reviews of Interventions Relevant to Orthoptic Practice.

PubMed

Rowe, Fiona J; Elliott, Sue; Gordon, Iris; Shah, Anupa

2017-09-01

To present an overview of the range of systematic reviews on intervention trials pertinent to orthoptic practice, produced by the Cochrane Eyes and Vision group (CEV). We searched the 2016 Cochrane Library database (31.03.2016) to identify completed reviews and protocols of direct relevance to orthoptic practice. These reviews are currently completed and published, available on www.thecochranelibrary.com (free to UK health employees) or via the CEV website (http://eyes.cochrane.org/) . We found 27 completed CEV reviews across the topics of strabismus, amblyopia, refractive errors, and low vision. Seven completed CEV protocols addressed topics of strabismus, amblyopia, refractive errors, low vision, and screening. We found 3 completed Cochrane Stroke reviews addressing visual field loss, eye movement impairment, and age-related vision loss. The systematic review process presents an important opportunity for any clinician to contribute to the establishment of reliable, evidence-based orthoptic practice. Each review has an abstract and plain language summary that many non-clinicians find useful, followed by a full copy of the review (background, objectives, methods, results, discussion) with a conclusion section that is divided into implications for practice and implications for research. The current reviews provide patients/parents/carers with information about various different conditions and treatment options, but also provide clinicians with a summary of the available evidence on interventions, to use as a guide for both clinical practice and future research planning. The reviews identified in this overview highlight the evidence available for effective interventions for strabismus, amblyopia, refractive errors, and low vision or stroke rehabilitation as well as the gaps in the evidence base. Thus, a demand exists for future robust, randomized, controlled trials of such interventions of importance in orthoptic practice.

Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs

PubMed Central

Derksen, Frans AWM; Hartman, Tim C olde; Bensing, Jozien M; Lagro-Janssen, Antoine LM

2016-01-01

Background Current daily general practice has become increasingly technical and somatically oriented (where attention to patients’ feelings is decreased) due to an increase in protocol-based guidelines. Priorities in GP–patient communication have shifted from a focus on listening and empathy to task-oriented communication. Aim To explore what barriers GPs experience when applying empathy in daily practice, and how these barriers are managed. Design and setting Thirty Dutch GPs with sufficient heterogeneity in sex, age, type of practice, and rural or urban setting were interviewed. Method The consolidated criteria for reporting qualitative research (COREQ) were applied. The verbatim transcripts were then analysed. Results According to participating GPs, the current emphasis on protocol-driven care can be a significant barrier to genuineness in communication. Other potential barriers mentioned were time pressures and constraints, and dealing with patients displaying ‘unruly behaviour’ or those with personality disorders. GPs indicated that it can be difficult to balance emotional involvement and professional distance. Longer consulting times, smaller practice populations, and efficient practice organisation were described as practical solutions. In order to focus on a patient-as-person approach, GPs strongly suggested that deviating from guidelines should be possible when necessary as an element of good-quality care. Joining intercollegiate counselling groups was also discussed. Conclusion In addition to practical solutions for barriers to behaving empathically, GPs indicated that they needed more freedom to balance working with protocols and guidelines, as well as a patient-as-person and patient-as-partner approach. This balance is necessary to remain connected with patients and to deliver care that is truly personal. PMID:27884917

Sicily statement on evidence-based practice

PubMed Central

Dawes, Martin; Summerskill, William; Glasziou, Paul; Cartabellotta, Antonino; Martin, Janet; Hopayian, Kevork; Porzsolt, Franz; Burls, Amanda; Osborne, James

2005-01-01

Background A variety of definitions of evidence-based practice (EBP) exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP) means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC"). Discussion Evidence-Based Practice has evolved in both scope and definition. Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources. Health care professionals must be able to gain, assess, apply and integrate new knowledge and have the ability to adapt to changing circumstances throughout their professional life. Curricula to deliver these aptitudes need to be grounded in the five-step model of EBP, and informed by ongoing research. Core assessment tools for each of the steps should continue to be developed, validated, and made freely available. Summary All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide 'best practice'. PMID:15634359

Cardiovascular disease risk scores in the current practice: which to use in rheumatoid arthritis?

PubMed

Purcarea, A; Sovaila, S; Gheorghe, A; Udrea, G; Stoica, V

2014-01-01

Cardiovascular disease (CVD) is the highest prevalence disease in the general population (GP) and it accounts for 20 million deaths worldwide each year. Its prevalence is even higher in rheumatoid arthritis. Early detection of subclinical disease is critical and the use of cardiovascular risk prediction models and calculators is widely spread. The impact of such techniques in the GP was previously studied. Despite their common background and similarities, some disagreement exists between most scores and their importance in special high-risk populations like rheumatoid arthritis (RA), having a low level of evidence. The current article aims to single out those predictive models (models) that could be most useful in the care of rheumatoid arthritis patients.

Cardiovascular disease risk scores in the current practice: which to use in rheumatoid arthritis?

PubMed Central

Purcarea, A; Sovaila, S; Gheorghe, A; Udrea, G; Stoica, V

2014-01-01

Cardiovascular disease (CVD) is the highest prevalence disease in the general population (GP) and it accounts for 20 million deaths worldwide each year. Its prevalence is even higher in rheumatoid arthritis. Early detection of subclinical disease is critical and the use of cardiovascular risk prediction models and calculators is widely spread. The impact of such techniques in the GP was previously studied. Despite their common background and similarities, some disagreement exists between most scores and their importance in special high-risk populations like rheumatoid arthritis (RA), having a low level of evidence. The current article aims to single out those predictive models (models) that could be most useful in the care of rheumatoid arthritis patients. PMID:25713603

Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians

PubMed Central

Ramsay, Jean; Rutterford, Clare; Gregory, Alison; Dunne, Danielle; Eldridge, Sandra; Sharp, Debbie; Feder, Gene

2012-01-01

Background Domestic violence affects one in four women and has significant health consequences. Women experiencing abuse identify doctors and other health professionals as potential sources of support. Primary care clinicians agree that domestic violence is a healthcare issue but have been reluctant to ask women if they are experiencing abuse. Aim To measure selected UK primary care clinicians’ current levels of knowledge, attitudes, and clinical skills in this area. Design and setting Prospective observational cohort in 48 general practices from Hackney in London and Bristol, UK. Method Administration of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), comprising five sections: responder profile, background (perceived preparation and knowledge), actual knowledge, opinions, and practice issues. Results Two hundred and seventy-two (59%) clinicians responded. Minimal previous domestic violence training was reported by participants. Clinicians only had basic knowledge about domestic violence but expressed a positive attitude towards engaging with women experiencing abuse. Many clinicians felt poorly prepared to ask relevant questions about domestic violence or to make appropriate referrals if abuse was disclosed. Forty per cent of participants never or seldom asked about abuse when a woman presented with injuries. Eighty per cent said that they did not have an adequate knowledge of local domestic violence resources. GPs were better prepared and more knowledgeable than practice nurses; they also identified a higher number of domestic violence cases. Conclusion Primary care clinicians’ attitudes towards women experiencing domestic violence are generally positive but they only have basic knowledge of the area. Both GPs and practice nurses need more comprehensive training on assessment and intervention, including the availability of local domestic violence services. PMID:22947586

The status of health communication: education and employment outlook for a growing field.

PubMed

McKeever, Brooke Weberling

2014-12-01

Using an online survey of health communication practitioners and academics (N = 372), this study investigates the educational background (degrees, knowledge, skills, and coursework) perceived to be important for employment in health communication. It provides an update on what may be needed in terms of graduate education, as well as which areas may be emerging as most important in the field. The purpose is to inform students, educators, administrators, and practitioners about the current status and possible future trends in health communication education and practice.

Adaptive Optics Communications Performance Analysis

NASA Technical Reports Server (NTRS)

Srinivasan, M.; Vilnrotter, V.; Troy, M.; Wilson, K.

2004-01-01

The performance improvement obtained through the use of adaptive optics for deep-space communications in the presence of atmospheric turbulence is analyzed. Using simulated focal-plane signal-intensity distributions, uncoded pulse-position modulation (PPM) bit-error probabilities are calculated assuming the use of an adaptive focal-plane detector array as well as an adaptively sized single detector. It is demonstrated that current practical adaptive optics systems can yield performance gains over an uncompensated system ranging from approximately 1 dB to 6 dB depending upon the PPM order and background radiation level.

iPhone and iPad Use in Orthopedic Surgery

PubMed Central

Duncan, Scott F. M.; Hendawi, Tariq K.; Sperling, John; Kakinoki, Ryosuke; Hartsock, Landon

2015-01-01

Background Thousands of healthcare mobile applications (apps) are available, and physicians are increasingly recognizing that mobile technology can improve their workflow and allow them to practice medicine in a better and/or more efficient manner. Methods This article highlights apps compatible with the iPhone and iPad and their utility to the busy orthopedic surgeon. Results Currently available apps address every aspect of healthcare: patient management, reference, education, and research. Conclusion Key aspects of helpful apps include low cost (preferably free), a user-friendly interface, and simplicity. PMID:25829881

Continuous Glucose Monitoring in Subjects with Type 1 Diabetes: Improvement in Accuracy by Correcting for Background Current

PubMed Central

Youssef, Joseph El; Engle, Julia M.; Massoud, Ryan G.; Ward, W. Kenneth

2010-01-01

Abstract Background A cause of suboptimal accuracy in amperometric glucose sensors is the presence of a background current (current produced in the absence of glucose) that is not accounted for. We hypothesized that a mathematical correction for the estimated background current of a commercially available sensor would lead to greater accuracy compared to a situation in which we assumed the background current to be zero. We also tested whether increasing the frequency of sensor calibration would improve sensor accuracy. Methods This report includes analysis of 20 sensor datasets from seven human subjects with type 1 diabetes. Data were divided into a training set for algorithm development and a validation set on which the algorithm was tested. A range of potential background currents was tested. Results Use of the background current correction of 4 nA led to a substantial improvement in accuracy (improvement of absolute relative difference or absolute difference of 3.5–5.5 units). An increase in calibration frequency led to a modest accuracy improvement, with an optimum at every 4 h. Conclusions Compared to no correction, a correction for the estimated background current of a commercially available glucose sensor led to greater accuracy and better detection of hypoglycemia and hyperglycemia. The accuracy-optimizing scheme presented here can be implemented in real time. PMID:20879968

The interrelationships of wellness, public health, and chiropractic

PubMed Central

Hawk, Cheryl

2005-01-01

Abstract Objectives To explicate the relationships among the definitions and practices of chiropractic, wellness and public health and to make recommendations for strengthening these relationships. Background Public health-related topics comprise less than 2% of chiropractic coursework at most chiropractic colleges, and few connections currently exist between chiropractic and public health practice. The concept of well-ness is common to both, and might serve to bridge the gap between the individual health services provided by chiropractors and the community health services provided by public health agencies. Conclusion It is time for chiropractic to join the public health movement to improve the health and promote wellness not just in their patient populations, but in their communities, and demonstrate their commitment to patient wellness by integrating their efforts with the healthcare mainstream. PMID:19674661

International survey of vestibular rehabilitation therapists by the Barany Society Ad Hoc Committee on Vestibular Rehabilitation Therapy.

PubMed

Cohen, Helen S; Gottshall, Kim R; Graziano, Mariella; Malmstrom, Eva-Maj; Sharpe, Margaret H

2009-01-01

The goal of this study was to determine how occupational and physical therapists learn about vestibular rehabilitation therapy, their educational backgrounds, referral patterns, and their ideas about entry-level and advanced continuing education in vestibular rehabilitation therapy. The Barany Society Ad Hoc Committee for Vestibular Rehabilitation Therapy invited therapists around the world to complete an E-mail survey. Participants were either known to committee members or other Barany Society members, known to other participants, identified from their self-listings on the Internet, or volunteered after reading notices published in publications read by therapists. Responses were received from 133 therapists in 19 countries. They had a range of educational backgrounds, practice settings, and referral patterns. Few respondents had had any training about vestibular rehabilitation during their professional entry-level education. Most respondents learned about vestibular rehabilitation from continuing education courses, interactions with their colleagues, and reading. All of them endorsed the concept of developing standards and educating therapists about vestibular anatomy and physiology, vestibular diagnostic testing, vestibular disorders and current intervention strategies. Therefore, the Committee recommends the development of international standards for education and practice in vestibular rehabilitation therapy.

Evaluating the professional libraries of practicing physical therapists

PubMed Central

Brown, Suzanne R.; Roush, James R.; Lamkin, Alyson R.; Perrakis, Rena; Kronenfeld, Michael R.

2007-01-01

Background and Purpose: The primary objective of this study was to explore the use of information resources by a sample of physical therapists. Methods: A qualitatively designed study using structured individual interviews, examination of professional libraries, and identification of information resources was initiated in three sites (Southern California, Arizona, and Georgia). Participants included forty physical therapists with between five and twenty years of experience. Results: The Internet and continuing education activities appeared to be the primary information sources for the physical therapists surveyed. The personal professional libraries of participants were limited in scope and contained titles copyrighted more than ten years ago. Access to peer-reviewed journals in the sample was limited primarily to those received as a benefit of professional association membership. Discussion and Conclusions: Participants did not maintain current print professional information resources. The majority of books in the personal and workplace professional libraries held copyrights dating from the time of the participants' enrollment in an entry-level physical therapy program. Medical librarians may play an important role in shifting physical therapy towards evidence-based practice by collaborating in professional development for this group. Physical therapy educators and professional leaders should support current public collections of physical therapy-related information resources to encourage the movement towards an evidence-based practice model in physical therapy. PMID:17252068

Toward Advancing Nano-Object Count Metrology: A Best Practice Framework

PubMed Central

Boyko, Volodymyr; Meyers, Greg; Voetz, Matthias; Wohlleben, Wendel

2013-01-01

Background: A movement among international agencies and policy makers to classify industrial materials by their number content of sub–100-nm particles could have broad implications for the development of sustainable nanotechnologies. Objectives: Here we highlight current particle size metrology challenges faced by the chemical industry due to these emerging number percent content thresholds, provide a suggested best-practice framework for nano-object identification, and identify research needs as a path forward. Discussion: Harmonized methods for identifying nanomaterials by size and count for many real-world samples do not currently exist. Although particle size remains the sole discriminating factor for classifying a material as “nano,” inconsistencies in size metrology will continue to confound policy and decision making. Moreover, there are concerns that the casting of a wide net with still-unproven metrology methods may stifle the development and judicious implementation of sustainable nanotechnologies. Based on the current state of the art, we propose a tiered approach for evaluating materials. To enable future risk-based refinements of these emerging definitions, we recommend that this framework also be considered in environmental and human health research involving the implications of nanomaterials. Conclusion: Substantial scientific scrutiny is needed in the area of nanomaterial metrology to establish best practices and to develop suitable methods before implementing definitions based solely on number percent nano-object content for regulatory purposes. Strong cooperation between industry, academia, and research institutions will be required to fully develop and implement detailed frameworks for nanomaterial identification with respect to emerging count-based metrics. Citation: Brown SC, Boyko V, Meyers G, Voetz M, Wohlleben W. 2013. Toward advancing nano-object count metrology: a best practice framework. Environ Health Perspect 121:1282–1291; http://dx.doi.org/10.1289/ehp.1306957 PMID:24076973

16 CFR 1406.2 - Background.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Background. 1406.2 Section 1406.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS COAL AND WOOD BURNING... Consumer Product Safety Commission disclose a number of incidents involving coal and wood burning...

16 CFR 1406.2 - Background.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Background. 1406.2 Section 1406.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS COAL AND WOOD BURNING... Consumer Product Safety Commission disclose a number of incidents involving coal and wood burning...

16 CFR 1406.2 - Background.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Background. 1406.2 Section 1406.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS COAL AND WOOD BURNING... Consumer Product Safety Commission disclose a number of incidents involving coal and wood burning...

16 CFR 1406.2 - Background.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Background. 1406.2 Section 1406.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS COAL AND WOOD BURNING... Consumer Product Safety Commission disclose a number of incidents involving coal and wood burning...

The Italian cross-sectional survey of the management of bone metastasis: ZeTa study

PubMed Central

Santini, Daniele; Bertoldo, Francesco; Dell'Aquila, Emanuela; Cecchini, Isabella; Fregosi, Stefania; Bortolussi, Paolo

2012-01-01

Background Several studies have emphasized the importance of the maintenance of bone health in a comprehensive cancer care. However, no survey about approach to bone metastasis care is currently available. The ZeTa study provides a picture of the Italian oncologists' therapeutics habits in this area, in a real clinical-practice scenario. Design This study was based on online questionnaire-based interviews to Italian oncologists that included 145 questions. The aim was to collect information on the treatment of bone metastasis, the current use of bisphosphonates, the awareness of guidelines and the concerns about ONJ, the use of vitamin D supplementation. Results 445 oncologists were contacted, 283 agreed to participate. The results show that the current management of bone metastasis is still sub-optimal, as the recommendations from current clinical guidelines are not completely followed by all specialists. Conclusions This survey highlights the urgent need to improve management of bone metastasis in cancer patients. PMID:26909253

Balance Assessment Practices and Use of Standardized Balance Measures Among Ontario Physical Therapists

PubMed Central

Sibley, Kathryn M.; Straus, Sharon E.; Inness, Elizabeth L.; Salbach, Nancy M.

2011-01-01

Background Balance impairment is a significant problem for older adults, as it can influence daily functioning. Treating balance impairment in this population is a major focus of physical therapist practice. Objective The purpose of this study was to document current practices in clinical balance assessment and compare components of balance assessed and measures used across practice areas among physical therapists. Design This was a cross-sectional study. Methods A survey questionnaire was mailed to 1,000 practicing physical therapists in Ontario, Canada. Results Three hundred sixty-nine individuals completed the survey questionnaire. More than 80% of respondents reported that they regularly (more than 60% of the time) assessed postural alignment, static and dynamic stability, functional balance, and underlying motor systems. Underlying sensory systems, cognitive contributions to balance, and reactive control were regularly assessed by 59.6%, 55.0%, and 41.2% of the respondents, respectively. The standardized measures regularly used by the most respondents were the single-leg stance test (79.1%), the Berg Balance Scale (45.0%), and the Timed “Up & Go” Test (27.6%). There was considerable variation in the components of balance assessed and measures used by respondents treating individuals in the orthopedic, neurologic, geriatric, and general rehabilitation populations. Limitations The survey provides quantitative data about what is done to assess balance, but does not explain the factors influencing current practice. Conclusions Many important components of balance and standardized measures are regularly used by physical therapists to assess balance. Further research, however, is needed to understand the factors contributing to the relatively lower rates of assessing reactive control, the component of balance most directly responsible for avoiding a fall. PMID:21868613

'The child that tiire doesn't give you, God won't give you either.' The role of Rotheca myricoides in Somali fertility practices.

PubMed

Mire, Sada

2016-12-01

The paper introduces the Baanashada Dumarka, a Somali fertility therapy carried out by a spirit medium, known locally as 'Alaqad. Baanashada is aimed at women whose fertility issues are believed to be caused by spirits. The study also explores a component of the Baanashada, namely, the use of tiire (Rotheca myricoides), or the butterfly bush. Although Rotheca myricoides is known to possess a number of medicinal components as confirmed by studies of modern science, so far, there exist no studies on its potential (or lack of) fertility effects. Hence, the alleged fertility benefits of the butterfly bush need examining. In 2008 a British Somali woman died of herbs placed in her cervix by a traditional healer in Somaliland. This piece of information indicated not only the role of herbal medicine in fertility practices, but also the popularity of traditional reproductive medicine beyond border, class or educational background. Yet, current research into Somali women's health focuses mainly on Female Genital Mutilation (FGM), examined often without the context of wider cultural practices. This paper, however, suggests that rituals, beliefs and material culture play a paramount role in women's practices. For example, as explored elsewhere, the wagar, a wooden and sacred object made of the African olive, is critical for fertility practices. The current paper illuminates further the significance of reproduction practices in Somali society and the potential continuity of traditions associated with the perpetuation of kinship. It concludes that fertility rituals are part of a wider context of interaction with sacred landscapes, objects and archaeological sites, often associated with past legends in the Horn of Africa.

RE-DEFINING THE ROLES OF SENSORS IN OBJECTIVE PHYSICAL ACTIVITY MONITORING

PubMed Central

Chen, Kong Y.; Janz, Kathleen F.; Zhu, Weimo; Brychta, Robert J.

2011-01-01

Background As physical activity researchers are increasingly using objective portable devices, this review describes current state of the technology to assess physical activity, with a focus on specific sensors and sensor properties currently used in monitors and their strengths and weakness. Additional sensors and sensor properties desirable for activity measurement and best practices for users and developers also are discussed. Best Practices We grouped current sensors into three broad categories for objectively measuring physical activity: associated body movement, physiology, and context. Desirable sensor properties for measuring physical activity and the importance of these properties in relationship to specific applications are addressed, and the specific roles of transducers and data acquisition systems within the monitoring devices are defined. Technical advancements in sensors, microcomputer processors, memory storage, batteries, wireless communication, and digital filters have made monitors more usable for subjects (smaller, more stable, and longer running time) and for researchers (less costly, higher time resolution and memory storage, shorter download time, and user-defined data features). Future Directions Users and developers of physical activity monitors should learn about the basic properties of their sensors, such as range, accuracy, precision, while considering the data acquisition/filtering steps that may be critical to data quality and may influence the desirable measurement outcome(s). PMID:22157770

Projected cancer risks potentially related to past, current, and future practices in paediatric CT in the United Kingdom, 1990-2020.

PubMed

Journy, Neige M Y; Lee, Choonsik; Harbron, Richard W; McHugh, Kieran; Pearce, Mark S; Berrington de González, Amy

2017-01-03

To project risks of developing cancer and the number of cases potentially induced by past, current, and future computed tomography (CT) scans performed in the United Kingdom in individuals aged <20 years. Organ doses were estimated from surveys of individual scan parameters and CT protocols used in the United Kingdom. Frequencies of scans were estimated from the NHS Diagnostic Imaging Dataset. Excess lifetime risks (ELRs) of radiation-related cancer were calculated as cumulative lifetime risks, accounting for survival probabilities, using the RadRAT risk assessment tool. In 2000-2008, ELRs ranged from 0.3 to 1 per 1000 head scans and 1 to 5 per 1000 non-head scans. ELRs per scan were reduced by 50-70% in 2000-2008 compared with 1990-1995, subsequent to dose reduction over time. The 130 750 scans performed in 2015 in the United Kingdom were projected to induce 64 (90% uncertainty interval (UI): 38-113) future cancers. Current practices would lead to about 300 (90% UI: 230-680) future cancers induced by scans performed in 2016-2020. Absolute excess risks from single exposures would be low compared with background risks, but even small increases in annual CT rates over the next years would substantially increase the number of potential subsequent cancers.

An extended field test of the WHO severe malnutrition guidelines in hospitals in developing countries: preliminary observations.

PubMed

Deen, J L; Weber, M; Qazi, S; Fontaine, O

2003-01-01

The WHO has published guidelines for the inpatient management of severe malnutrition. A qualitative study in hospitals in developing countries is being conducted to document the re-organisation of the clinical ward and support services required to implement these guidelines and to gain an impression of the feasibility and sustainability of such a re-organisation. Following a postal survey of experts in the management of malnutrition in children in developing countries, hospitals were contacted and asked if they were interested to participate in the study. If so, they were requested to submit background information about admission patterns, the frequency of malnutrition, and current practice. Based on this information, hospitals are selected for a preliminary visit. Following this, and the final selection, a paediatrician conducts three visits to the study hospital over a one-year period to appraise the current practice, assist the health staff in recognising the strengths and shortcomings of their current management, help them find locally appropriate solutions, support the implementation process through a participatory approach and assess the outcome. A structured survey instrument is used to guide the assessment and identification of problems. Results of the first visit, which documents the existing situation, and changes identified by staff and implemented during the second visit are presented.

A systematic review of psychosocial interventions for adult refugees and asylum seekers.

PubMed

Tribe, Rachel H; Sendt, Kyra-Verena; Tracy, Derek K

2017-05-09

Europe is in the midst of the largest refugee migration since the Second World War; there is an urgent need to provide an updated systematic review of the current best evidence for managing mental distress in refugee populations. The aim of this review is to provide an exhaustive summary of the current literature on psychosocial interventions, both trauma- and non-trauma-focused, for refugee populations experiencing post-traumatic stress disorder (PTSD), depressive or anxiety symptoms. To produce recommendations for future research and current clinical practice. Searches were conducted in PubMed, PsychINFO (Hosted by Ovid), PILOTS and Social Services Abstracts; 5305 articles were screened and 40 were included. This review found medium to high quality evidence supporting the use of narrative exposure therapy (NET). A lack of culturally adapted treatments was apparent and there was less evidence to support standard cognitive behavioural therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR) and multidisciplinary treatments. NET produced positive outcomes in refugees from a diverse range of backgrounds and trauma types. There is a general dearth of research in all intervention types: further research should include more "real-world" multidisciplinary interventions that better model clinical practice. Recommendations for evaluating local need, and creating a culturally sensitive workforce are discussed.

Informed consent for MRI and fMRI research: Analysis of a sample of Canadian consent documents

PubMed Central

2011-01-01

Background Research ethics and the measures deployed to ensure ethical oversight of research (e.g., informed consent forms, ethics review) are vested with extremely important ethical and practical goals. Accordingly, these measures need to function effectively in real-world research and to follow high level standards. Methods We examined approved consent forms for Magnetic Resonance Imaging (MRI) and functional Magnetic Resonance Imaging (fMRI) studies approved by Canadian research ethics boards (REBs). Results We found evidence of variability in consent forms in matters of physical and psychological risk reporting. Approaches used to tackle the emerging issue of incidental findings exposed extensive variability between and within research sites. Conclusion The causes of variability in approved consent forms and studies need to be better understood. However, mounting evidence of administrative and practical hurdles within current ethics governance systems combined with potential sub-optimal provision of information to and protection of research subjects support other calls for more scrutiny of research ethics practices and applicable revisions. PMID:21235768

The physician as a patient educator. From theory to practice.

PubMed Central

McCann, D. P.; Blossom, H. J.

1990-01-01

Patient nonadherence to therapeutic regimens is a serious issue in the practice of medicine. Empiric studies done by professionals from diverse backgrounds have shown that physicians who use educational strategies can be effective in gaining the cooperation of patients to follow their recommendations. The educational model that currently is most familiar to physicians and the one they use most frequently when educating patients is pedagogy, the theoretic basis for teaching children. Andragogy, a theoretic basis for teaching adults, is now being suggested by medical educators as an alternative model. To illustrate the clinical relevance and application of the andragogic approach, studies focusing on physician behaviors associated with behavioral measures of adherence were reviewed, analyzed, and categorized according to a framework called the "ADULT" model. Physicians in a postgraduate training program who have had exposure to this framework and have incorporated it into their practices report less difficulty functioning as patient educators. The systematic use of this approach can have a positive effect on patient adherence. PMID:2202158

Women's work. Maintaining a healthy body weight.

PubMed

Welch, Nicky; Hunter, Wendy; Butera, Karina; Willis, Karen; Cleland, Verity; Crawford, David; Ball, Kylie

2009-08-01

This study describes women's perceptions of the supports and barriers to maintaining a healthy weight among currently healthy weight women from urban and rural socio-economically disadvantaged areas. Using focus groups and interviews, we asked women about their experiences of maintaining a healthy weight. Overwhelmingly, women described their healthy weight practices in terms of concepts related to work and management. The theme of 'managing health' comprised issues of managing multiple responsibilities, time, and emotions associated with healthy practices. Rural women faced particular difficulties in accessing supports at a practical level (for example, lack of childcare) and due to the gendered roles they enacted in caring for others. Family background (in particular, mothers' attitudes to food and weight) also appeared to influence perceptions about healthy weight maintenance. In the context of global increases in the prevalence of obesity, the value of initiatives aimed at supporting healthy weight women to maintain their weight should not be under-estimated. Such initiatives need to work within the social and personal constraints that women face in maintaining good health.

The Current Landscape of Transitions of Care Practice Models: A Scoping Review.

PubMed

Rochester-Eyeguokan, Charmaine D; Pincus, Kathleen J; Patel, Roshni S; Reitz, Shirley J

2016-01-01

Transitions of care (TOC) are a set of actions to ensure patient coordination and continuity of care as patients transfer between different locations or levels. During transitions associated with chronic or acute illness, vulnerable patients may be placed at risk with fragmented systems compromising their health and safety. In addition, poor care transitions also have an enormous impact on health care spending. The primary objective of this scoping review is to summarize the current landscape of practice models that deliver TOC services in the United States. The secondary objective is to use the information to characterize the current state of best practice models. A search of the PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, International Pharmaceutical Abstracts, National Center for Biotechnology Information at the U.S. National Library of Medicine, and Cochrane Library databases (January 1, 2000-April 13, 2015) for articles pertaining to TOC models, limited to U.S. studies published in the English language with human subjects, gleaned 1362 articles. An additional 26 articles were added from the gray literature. Articles meeting inclusion criteria underwent a second review and were categorized into four groups: background information, original TOC research articles not evaluating practice model interventions, original TOC research articles describing practice models, and systematic or Cochrane reviews. The reviewers met weekly to discuss the challenges and resolve disagreements regarding literature reviews with consensus before progressing. A total of 188 articles describing TOC practice models met the inclusion criteria. Despite the strengths of several quality TOC models, none satisfied all the components recommended by leading experts. Multimodal interventions by multidisciplinary teams appear to represent a best practice model for TOC to improve patient outcomes and reduce readmissions, but one size does not fit all. Best model TOC services must include services along the TOC continuum: pretransition and posttransition, as well as at home and in outpatient health care settings. Studies clearly show that single-modal interventions are rarely successful in reducing readmissions and that successful TOC services must be multimodal and multidisciplinary, and continue throughout the care transition. Utilizing best practice TOC models described in this article as a starting point, practitioners interested in developing their own TOC program should test these tools in new practice environments and add to the body of literature by publishing their findings. © 2016 Pharmacotherapy Publications, Inc.

Practices and opinions on nitrous oxide/oxygen sedation from dentists licensed to perform relative analgesia in Brazil

PubMed Central

2012-01-01

Background Relative analgesia (RA), defined as the use of inhalation sedation with nitrous oxide and oxygen, is one of the most common pharmacological behavior management techniques used to provide sedation and analgesia for dental patients. This study aimed to assess RA licensed Brazilian dentists’ practices and opinions about nitrous oxide/oxygen sedation in the dental setting. Methods A cross sectional national survey was conducted with 281 dentists who were certified to perform RA, using an electronically mailed self-administered questionnaire containing closed questions about their practices and opinions regarding RA. Practice and opinion were individually analyzed by descriptive statistics. Non-parametric tests assessed the relationships between RA practice and independent variables. To test the interplay between practices and opinions, a k-means clusters analysis was used to divide the group for statistical comparisons. Results The response rate was 45.2%. Women made up 64.6% of the respondents, the mean age was 39.1 years (SD = 9.8), and the mean time since graduation in dentistry was 16 years (SD = 9.7). Seventy-seven percent of respondents reported the use of RA in clinical practice, most of them ‘sometimes’ (53.5%), and focusing more on adult patients. Patients with certain physical or mental deficiencies were indications associated with RA practice. ‘Equipment acquisition’ (p < 0.001) and ‘living in Southeast and South regions’ (p < 0.02) were also associated with RA practice. The scores for dentists’ opinions ranged from 15 to 41 points (mean 29.2, SD = 5.6), based on nine items scored from 1 to 5. Two clusters representing more favorable (n = 65) and less favorable (n = 55) opinions were established. Dentists who were women (p = 0.04), practiced RA in dental settings (p < 0.01) or practiced it frequently (p < 0.001), had more favorable opinions about RA. Conclusion Most of the RA licensed Brazilian dentists interviewed currently use RA. Current practice of RA and frequency of use determined the degree of favorable opinion about this inhalation sedation among this group of respondents. PMID:22808942

The Effects of a Warm or Chilly Climate Toward Socioeconomic Diversity on Academic Motivation and Self-Concept.

PubMed

Browman, Alexander S; Destin, Mesmin

2016-02-01

Persistent academic achievement gaps exist between university students from high and low socioeconomic status (SES) backgrounds. The current research proposes that the extent to which a university is perceived as actively supporting versus passively neglecting students from diverse socioeconomic backgrounds can influence low-SES students' academic motivation and self-concepts. In Experiments 1 and 2, low-SES students exposed to cues suggestive of an institution's warmth toward socioeconomic diversity demonstrated greater academic efficacy, expectations, and implicit associations with high academic achievement compared with those exposed to cues indicating institutional chilliness. Exploring the phenomenology underlying these effects, Experiment 3 demonstrated that warmth cues led low-SES students to perceive their socioeconomic background as a better match with the rest of the student body and to perceive the university as more socioeconomically diverse than did chilliness cues. Contributions to our understanding of low-SES students' psychological experiences in academic settings and practical implications for academic institutions are discussed. © 2015 by the Society for Personality and Social Psychology, Inc.

Reducing lighting energy use in retail display windows

NASA Astrophysics Data System (ADS)

Freyssinier, Jean Paul; Frering, Daniel; Taylor, Jennifer; Narendran, Nadarajah; Rizzo, Patricia

2006-08-01

A field study was conducted at three clothing stores to validate previous laboratory findings indicating that colored LEDs used as background display lighting could: 1) lower the power demand of accent lighting by up to 50 percent; and 2) provide greater attention capture and visual appeal than current lighting practice. Blue LEDs provided a colored background for window mannequins by illuminating white backdrops. Eliminating fluorescent general lighting and reducing the number and wattage of halogen accent lamps in the display windows reduced the lighting power demand by up to 50 percent. During an eight-week period, more than 700 shoppers rated the attractiveness, eye-catching ability, comfort, and visibility of four different lighting conditions. The results of this field study showed that by introducing color contrast between the displayed objects and the background, the power demand of the accent lighting could be reduced by up to 50 percent without sacrificing visual appeal, visibility, ability to capture the attention of shoppers, and the ability to see the colors of the objects on display. Furthermore, the sales of the products on display were not affected by the 50 percent reduction in lighting.

Figures in clinical trial reports: current practice & scope for improvement

PubMed Central

Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

2007-01-01

Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Results Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. Conclusion There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used. PMID:18021449

What Do Mothers Think about Concurrent Breastfeeding and Smoking?

PubMed Central

Bogen, Debra L.; Davies, Erin D.; Barnhart, Wesley C.; Lucero, Cynthia A.; Moss, Deborah R.

2008-01-01

Background According to newer AAP policies, smoking is not contraindicated with breastfeeding, yet smokers initiate and maintain breastfeeding less than non-smokers. Objectives 1) Describe maternal knowledge and 2) attitudes regarding concurrent breastfeeding and smoking or nicotine replacement therapy (NRT) and 3) evaluate the association between maternal smoking and infant feeding practices. Methods Mothers bringing children <13 months old for an appointment completed a 24-item, anonymous survey which addressed knowledge, attitudes and practices about concurrent breastfeeding and smoking/NRT. Results Among 204 survey completers, 63% were African American, 52% had never breastfed and 54% had never smoked. Knowledge: Regardless of smoking status, 19% were aware of the recommendation to smoke after breastfeeding; most did not know that nicotine gum (42%) or patch (40%) transfers less or about the same amount of nicotine into breast milk than smoking a pack per day. Attitudes: Most mothers (80%) believe that women should not smoke any cigarettes if breastfeeding; current smokers (25%) were more likely than former (10%) or never smokers (11%) to find it acceptable to smoke one or more cigarettes per day (p=.03). Only 2% found it acceptable to use NRT while breastfeeding. Practice: Among ever breastfeeders, 10% stopped breastfeeding because of smoking. Over half of recent or current smokers reported that smoking impacted their infant feeding decision. Conclusions Mothers in this sample believe that women who smoke or take NRT should not breastfeed. Smoking status impacted women’s infant feeding practices. Correction of misinformation could increase breastfeeding rates. PMID:18501868

Insights into Ergonomics Among Dental Professionals of a Dental Institute and Private Practitioners in Hubli–Dharwad Twin Cities, India

PubMed Central

Kalghatgi, Shrivardhan; Prasad, Kakarla Veera Venkata; Chhabra, Kumar Gaurav; Deolia, Shravani; Chhabra, Chaya

2014-01-01

Background To assess the knowledge, attitude, and practice of ergonomics among dental professionals of Hubli–Dharwad twin cities, India. Methods Investigator-developed, self-administered, closed-ended questionnaire assessing knowledge, attitude, and practices regarding ergonomics during dental practice was filled in by undergraduates, house surgeons, postgraduates, and faculty members of dental institutions and private practitioners from Hubli–Dharwad twin cities. Results Data were collected from a total of 250 participants, 50 belonging to each academic group. Overall mean knowledge, attitude, and practice scores were 52%, 75%, and 55%, respectively. Significant correlation was found for age with attitude (χ2 = 10.734, p = 0.030) and behavior (χ2 = 12.984, p = 0.011). Marital status was significantly associated with all the three domains; knowledge (χ2 = 29.369, p = 0.000), attitude (χ2 = 29.023, p = 0.000), and practices (χ2 = 13.648, p = 0.009). Conclusion Participants had considerable awareness and behavior toward ergonomics in dental practice. The high attitude score indicates stronger acceptance of ergonomics principles and guidelines during routine dental procedures. The current study highlights the situation of ergonomics in dental practice in the form of knowledge, attitude, and practices. PMID:25516809

Using quality experts from manufacturing to transform primary care.

PubMed

Steiner, Rose M; Walsworth, David T

2010-01-01

Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality and process improvement. Michigan uses quality experts from the manufacturing industry who are educated regarding the health care environment, which enables them to perform as quality-improvement coaches (QICs) in primary-care practices. In this case study, ninety-six quality experts were trained to coach primary-care practices, with 53 currently assigned to offices, and others assisting as needed. Practice teams and QICs identify gaps in care and office practices with the use of assorted quality-improvement tools. Reports are made monthly to describe clinical and process measures and methods used. Michigan has 33 practices engaged, involving 205 physicians and 40 midlevel providers. The teaming of quality experts from the manufacturing industry with primary-care office providers and staff resulted in office efficiency, improved care provided, and progress toward attainment of a patient-centered medical home (PCMH). Quality experts from manufacturing volunteered to coach for improvements in primary care. The efforts of QICs have been successful. Because the QICs are volunteers, sustainability of the Michigan Improving Performance in Practice program is a challenge.

Locum doctors in general practice: motivation and experiences.

PubMed Central

McKevitt, C; Morgan, M; Hudson, M

1999-01-01

BACKGROUND: There is evidence of dissatisfaction with locum doctors' performance, but little is known about doctors who work as locums in general practice or about their experiences of this work. AIM: To describe the motivations and experiences of doctors providing locum cover in general practices. METHOD: A postal questionnaire survey distributed to locums through organizations such as locum groups, commercial agencies, and general practices. RESULTS: Questionnaires were returned by 111 doctors currently working as locums in general practice. Four main reasons for working as a locum GP were: as a short-term option while between posts, to gain experience of different practices before commitment to one practice, to balance work and family or other commitments, to continue part-time work after retirement. One-quarter of responders intended to continue working as a locum indefinitely. The drawbacks of locum work included frustration with low status, lack of security, and difficulty accessing structured training and education. CONCLUSION: Locum doctors in general practice are a heterogeneous group that includes those who have chosen this type of work. The doctors who intend to continue as locums indefinitely represent a useful resource in primary care whose ability to provide short-term cover could be maximized. The need to control the quality of 'freelance' doctors should not overshadow the need to control the quality of their working environments. PMID:10621983

Study of solid state photomultiplier

NASA Technical Reports Server (NTRS)

Hays, K. M.; Laviolette, R. A.

1987-01-01

Available solid state photomultiplier (SSPM) detectors were tested under low-background, low temperature conditions to determine the conditions producing optimal sensitivity in a space-based astronomy system such as a liquid cooled helium telescope in orbit. Detector temperatures varied between 6 and 9 K, with background flux ranging from 10 to the 13th power to less than 10 to the 6th power photons/square cm-s. Measured parameters included quantum efficiency, noise, dark current, and spectral response. Experimental data were reduced, analyzed, and combined with existing data to build the SSPM data base included herein. The results were compared to analytical models of SSPM performance where appropriate models existed. Analytical models presented here were developed to be as consistent with the data base as practicable. Significant differences between the theory and data are described. Some models were developed or updated as a result of this study.

[The medical autonomy of elderly in Taiwan].

PubMed

Chen, Kai-Li; Chen, Ching-Huey

2014-10-01

The elderly population is increasing rapidly in Taiwan. With the average life expectancy on the rise, the elderly have become major consumers of healthcare products and services. Factors that influence respect for autonomy, a core value of medical ethics, may be related to family, society, and the medical culture. Especially in patients who are already elderly, aging causes declines in physical, mental and societal capacities. Practicing a respect for patient autonomy is particularly challenging for healthcare professionals in Taiwan due the unique culture background of elderly Taiwanese patients. This article reviews and integrates the literature related to the issue of patient autonomy and elaborates on medical decision-making among elderly patients in Taiwan in the contexts of: the disadvantages faced by the elderly, the background of Chinese culture, and the current medical decision-making environment. A few suggestions are proposed to help preserve the medical-decision-making autonomy of elderly patients in Taiwan.

Understanding Prolonged Cessation From Heroin Use: Findings From a Community-Based Sample

PubMed Central

Weiss, Linda; Gass, Jonathon; Egan, James E.; Ompad, Danielle C.; Trezza, Claudia; Vlahov, David

2014-01-01

Background There is abundant literature describing heroin initiation, co-morbidities, and treatment. Few studies focus on cessation, examining the factors that motivate and facilitate it. Methods The CHANGE study utilized mixed methods to investigate heroin cessation among low-income New York City participants. This paper describes findings from qualitative interviews with 20 former and 11 current heroin users. Interviews focused on background and current activities, supports, drug history, cessation attempts, and motivators and facilitators to cessation. Results Participants found motivation for cessation in improved quality of life; combination of treatment, strategic avoidance of triggers, and engagement in alternative activities, including support groups, exercise, and faith-based practice. Several reported that progress toward goals served as motivators that increased confidence and facilitated cessation. Ultimatums were key motivators for some participants. Beyond that, they could not articulate factors that distinguished successful from unsuccessful cessation attempts, although data suggest that those who were successful could describe more individualized and concrete—rather than general—motivators and strategies. Conclusions Our findings indicate that cessation may be facilitated by multifaceted and individualized strategies, suggesting a need for personal and comprehensive approaches to treatment. PMID:25052788

Predicting the performance of linear optical detectors in free space laser communication links

NASA Astrophysics Data System (ADS)

Farrell, Thomas C.

2018-05-01

While the fundamental performance limit for optical communications is set by the quantum nature of light, in practical systems background light, dark current, and thermal noise of the electronics also degrade performance. In this paper, we derive a set of equations predicting the performance of PIN diodes and linear mode avalanche photo diodes (APDs) in the presence of such noise sources. Electrons generated by signal, background, and dark current shot noise are well modeled in PIN diodes as Poissonian statistical processes. In APDs, on the other hand, the amplifying effects of the device result in statistics that are distinctly non-Poissonian. Thermal noise is well modeled as Gaussian. In this paper, we appeal to the central limit theorem and treat both the variability of the signal and the sum of noise sources as Gaussian. Comparison against Monte-Carlo simulation of PIN diode performance (where we do model shot noise with draws from a Poissonian distribution) validates the legitimacy of this approximation. On-off keying, M-ary pulse position, and binary differential phase shift keying modulation are modeled. We conclude with examples showing how the equations may be used in a link budget to estimate the performance of optical links using linear receivers.

Lights, camera, education! The potentials of forum theatre in a learning disability nursing program.

PubMed

McClimens, Alex; Scott, Rachel

2007-04-01

Learning disability nurse education, with a current emphasis on inclusive practice and a history of listening to the person with the disability, is well placed to take advantage of more 'experimental' forms of classroom teaching. In this article we argue for the use of forum theatre as a method of addressing topics from practice within an educational setting. Based on our emergent and exploratory work with students we detail at length the theoretical background that supports such an approach and contextualise the issues with reference to a short piece of drama we have used successfully with different student groups. We feel that the success of this method is due to the involvement of students in directing their own education as well as the inclusion of individuals labelled with learning disability as an integral part of the process.

Extended morphological processing: a practical method for automatic spot detection of biological markers from microscopic images.

PubMed

Kimori, Yoshitaka; Baba, Norio; Morone, Nobuhiro

2010-07-08

A reliable extraction technique for resolving multiple spots in light or electron microscopic images is essential in investigations of the spatial distribution and dynamics of specific proteins inside cells and tissues. Currently, automatic spot extraction and characterization in complex microscopic images poses many challenges to conventional image processing methods. A new method to extract closely located, small target spots from biological images is proposed. This method starts with a simple but practical operation based on the extended morphological top-hat transformation to subtract an uneven background. The core of our novel approach is the following: first, the original image is rotated in an arbitrary direction and each rotated image is opened with a single straight line-segment structuring element. Second, the opened images are unified and then subtracted from the original image. To evaluate these procedures, model images of simulated spots with closely located targets were created and the efficacy of our method was compared to that of conventional morphological filtering methods. The results showed the better performance of our method. The spots of real microscope images can be quantified to confirm that the method is applicable in a given practice. Our method achieved effective spot extraction under various image conditions, including aggregated target spots, poor signal-to-noise ratio, and large variations in the background intensity. Furthermore, it has no restrictions with respect to the shape of the extracted spots. The features of our method allow its broad application in biological and biomedical image information analysis.

Optical Design Considerations for Efficient Light Collection from Liquid Scintillation Counters

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bernacki, Bruce E.; Douglas, Matthew; Erchinger, Jennifer L.

2015-01-01

Liquid scintillation counters measure charged particle-emitting radioactive isotopes and are used for environmental studies, nuclear chemistry, and life science. Alpha and beta emissions arising from the material under study interact with the scintillation cocktail to produce light. The prototypical liquid scintillation counter employs low-level photon-counting detectors to measure the arrival of the scintillation light produced as a result of the dissolved material under study interacting with the scintillation cocktail. For reliable operation the counting instrument must convey the scintillation light to the detectors efficiently and predictably. Current best practices employ the use of two or more detectors for coincidence processingmore » to discriminate true scintillation events from background events due to instrumental effects such as photomultiplier tube dark rates, tube flashing, or other light emission not generated in the scintillation cocktail vial. In low background liquid scintillation counters additional attention is paid to shielding the scintillation cocktail from naturally occurring radioactive material (NORM) present in the laboratory and within the instruments construction materials. Low background design is generally at odds with optimal light collection. This study presents the evolution of a light collection design for liquid scintillation counting in a low background shield. The basic approach to achieve both good light collection and a low background measurement is described. The baseline signals arising from the scintillation vial are modeled and methods to efficiently collect scintillation light are presented as part of the development of a customized low-background, high sensitivity liquid scintillation counting system.« less

The school curriculum for ethnic minority pupils: A contribution to a debate

NASA Astrophysics Data System (ADS)

Saunders, Malcolm

1980-03-01

This paper discusses some of the canicular needs of children of migrant parents in the United Kingdom (in particular those of South Asian and West Indian origins), against the background of current provision. The author argues the merits of a "cultural accommodation" strategy and outlines the "human rights" model of education which that strategy implies. He then analyses three major problem areas faced by children of migrant workers: conflicts of identity, communication difficulties, and unequal access to employment opportunities. In a final section, tentative but practical suggestions are given of how the school curriculum can address these problems.

National Athletic Trainers' Association Position Statement: Management of Sport Concussion

PubMed Central

Broglio, Steven P.; Cantu, Robert C.; Gioia, Gerard A.; Guskiewicz, Kevin M.; Kutcher, Jeffrey; Palm, Michael; McLeod, Tamara C. Valovich

2014-01-01

Objective: To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions. Background: An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity. Athletic trainers are commonly the first medical providers available onsite to identify and evaluate these injuries. Recommendations: The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations. PMID:24601910

Medicinal cannabis in oncology.

PubMed

Engels, Frederike K; de Jong, Floris A; Mathijssen, Ron H J; Erkens, Joëlle A; Herings, Ron M; Verweij, Jaap

2007-12-01

In The Netherlands, since September 2003, a legal medicinal cannabis product, constituting the whole range of cannabinoids, is available for clinical research, drug development strategies, and on prescription for patients. To date, this policy, initiated by the Dutch Government, has not yet led to the desired outcome; the amount of initiated clinical research is less than expected and only a minority of patients resorts to the legal product. This review aims to discuss the background for the introduction of legal medicinal cannabis in The Netherlands, the past years of Dutch clinical experience in oncology practice, possible reasons underlying the current outcome, and future perspectives.

A Holistic Framework to Improve the Uptake and Impact of eHealth Technologies

PubMed Central

van Limburg, Maarten; Ossebaard, Hans C; Kelders, Saskia M; Eysenbach, Gunther; Seydel, Erwin R

2011-01-01

Background Many eHealth technologies are not successful in realizing sustainable innovations in health care practices. One of the reasons for this is that the current development of eHealth technology often disregards the interdependencies between technology, human characteristics, and the socioeconomic environment, resulting in technology that has a low impact in health care practices. To overcome the hurdles with eHealth design and implementation, a new, holistic approach to the development of eHealth technologies is needed, one that takes into account the complexity of health care and the rituals and habits of patients and other stakeholders. Objective The aim of this viewpoint paper is to improve the uptake and impact of eHealth technologies by advocating a holistic approach toward their development and eventual integration in the health sector. Methods To identify the potential and limitations of current eHealth frameworks (1999–2009), we carried out a literature search in the following electronic databases: PubMed, ScienceDirect, Web of Knowledge, PiCarta, and Google Scholar. Of the 60 papers that were identified, 44 were selected for full review. We excluded those papers that did not describe hands-on guidelines or quality criteria for the design, implementation, and evaluation of eHealth technologies (28 papers). From the results retrieved, we identified 16 eHealth frameworks that matched the inclusion criteria. The outcomes were used to posit strategies and principles for a holistic approach toward the development of eHealth technologies; these principles underpin our holistic eHealth framework. Results A total of 16 frameworks qualified for a final analysis, based on their theoretical backgrounds and visions on eHealth, and the strategies and conditions for the research and development of eHealth technologies. Despite their potential, the relationship between the visions on eHealth, proposed strategies, and research methods is obscure, perhaps due to a rather conceptual approach that focuses on the rationale behind the frameworks rather than on practical guidelines. In addition, the Web 2.0 technologies that call for a more stakeholder-driven approach are beyond the scope of current frameworks. To overcome these limitations, we composed a holistic framework based on a participatory development approach, persuasive design techniques, and business modeling. Conclusions To demonstrate the impact of eHealth technologies more effectively, a fresh way of thinking is required about how technology can be used to innovate health care. It also requires new concepts and instruments to develop and implement technologies in practice. The proposed framework serves as an evidence-based roadmap. PMID:22155738

Prevention of hospital-acquired thrombosis from a primary care perspective: a qualitative study

PubMed Central

Litchfield, Ian; Fitzmaurice, David; Apenteng, Patricia; Harrison, Sian; Heneghan, Carl; Ward, Alison; Greenfield, Sheila

2016-01-01

Background Although there is considerable risk for patients from hospital-acquired thrombosis (HAT), current systems for reducing this risk appear inefficient and have focused predominantly on secondary care, leaving the role of primary care underexplored, despite the onset of HAT often occurring post-discharge. Aim To gain an understanding of the perspectives of primary care clinicians on their contribution to the prevention of HAT. Their current role, perceptions of patient awareness, the barriers to better care, and suggestions for how these may be overcome were discussed. Design and setting Qualitative study using semi-structured interviews in Oxfordshire and South Birmingham, England. Method Semi-structured telephone interviews with clinicians working at practices of a variety of size, socioeconomic status, and geographical location. Results A number of factors that influenced the management of HAT emerged, including patient characteristics, a lack of clarity of responsibility, limited communication and poor coordination, and the constraints of limited practice resources. Suggestions for improving the current system include a broader role for primary care supported by appropriate training and the requisite funding. Conclusion The role of primary care remains limited, despite being ideally positioned to either raise patient awareness before admission or support patient adherence to the thromboprophylaxis regimen prescribed in hospital. This situation may begin to be addressed by more robust lines of communication between secondary and primary care and by providing more consistent training for primary care staff. In turn, this relies on the allocation of appropriate funds to allow practices to meet the increased demand on their time and resources. PMID:27266864

A Nationwide Survey of Patient Centered Medical Home Demonstration Projects

PubMed Central

Bitton, Asaf; Martin, Carina

2010-01-01

Background The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Design Cross-sectional key-informant interviews. Participants Leaders from existing PCMH demonstration projects with external payment reform. Measurements We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. Results A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified—consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Conclusion Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows. Electronic supplementary material The online version of this article (doi:10.1007/s11606-010-1262-8) contains supplementary material, which is available to authorized users. PMID:20467907

To assess whether indoor residual spraying can provide additional protection against clinical malaria over current best practice of long-lasting insecticidal mosquito nets in The Gambia: study protocol for a two-armed cluster-randomised trial

PubMed Central

2011-01-01

Background Recently, there has been mounting interest in scaling-up vector control against malaria in Africa. It needs to be determined if indoor residual spraying (IRS with DDT) will provide significant marginal protection against malaria over current best practice of long-lasting insecticidal nets (LLINs) and prompt treatment in a controlled trial, given that DDT is currently the most persistent insecticide for IRS. Methods A 2 armed cluster-randomised controlled trial will be conducted to assess whether DDT IRS and LLINs combined provide better protection against clinical malaria in children than LLINs alone in rural Gambia. Each cluster will be a village, or a group of small adjacent villages; all clusters will receive LLINs and half will receive IRS in addition. Study children, aged 6 months to 13 years, will be enrolled from all clusters and followed for clinical malaria using passive case detection to estimate malaria incidence for 2 malaria transmission seasons in 2010 and 2011. This will be the primary endpoint. Exposure to malaria parasites will be assessed using light and exit traps followed by detection of Anopheles gambiae species and sporozoite infection. Study children will be surveyed at the end of each transmission season to estimate the prevalence of Plasmodium falciparum infection and the prevalence of anaemia. Discussion Practical issues concerning intervention implementation, as well as the potential benefits and risks of the study, are discussed. Trial Registration ISRCTN01738840 - Spraying And Nets Towards malaria Elimination (SANTE) PMID:21663656

Management of obstetric postpartum hemorrhage: a national service evaluation of current practice in the UK

PubMed Central

Al Wattar, Bassel H; Tamblyn, Jennifer A; Parry-Smith, William; Prior, Mathew; Van Der Nelson, Helen

2017-01-01

Background Postpartum hemorrhage (PPH) continues to be one of the major causes of maternal mortality and morbidity in obstetrics. Variations in practice often lead to adverse maternity outcomes following PPH. Our objective was to assess the current practice in managing PPH in the UK. Methods We performed a national multicenter prospective service evaluation study over one calendar month and compared the current performance to national standards for managing PPH. We used a standardized data collection tool and collected data on patients’ demographics, incidence of PPH, estimated blood loss (EBL), prophylactic and treatment measures, onset of labor, and mode of delivery. Results We collected data from 98 obstetric units, including 3663 cases of primary PPH. Fifty percent of cases were minor PPH (EBL 500–1000 mL, n=1900/3613, 52.6%) and the remaining were moderate PPH (EBL >1000 to <2000 mL, n=1424/3613, 39.4%) and severe PPH (EBL >2000 mL, n=289/3613, 8%). The majority of women received active management of the third stage of labor (3504/3613, 97%) most commonly with Syntometrine intramuscular (1479/3613, 40.9%). More than half required one additional uterotonic agent (2364/3613, 65.4%) most commonly with Syntocinon intravenous infusion (1155/2364, 48.8%). There was a poor involvement of consultant obstetricians and anesthetists in managing PPH cases, which was more prevalent when managing major PPH (p=0.0001). Conclusion There are still variations in managing PPH in the UK against national guidelines. More senior doctor involvement and regular service evaluation are needed to improve maternal outcomes following PPH. PMID:28176919

Current Cytology Practices in Korea: A Nationwide Survey by the Korean Society for Cytopathology

PubMed Central

Oh, Eun Ji; Jung, Chan Kwon; Kim, Dong-Hoon; Kim, Han Kyeom; Kim, Wan Seop; Jin, So-Young; Yoon, Hye Kyoung

2017-01-01

Background Limited data are available on the current status of cytology practices in Korea. This nationwide study presents Korean cytology statistics from 2015. Methods A nationwide survey was conducted in 2016 as a part of the mandatory quality-control program by the Korean Society for Cytopathology. The questionnaire was sent to 208 medical institutions performing cytopathologic examinations in Korea. Individual institutions were asked to submit their annual cytology statistical reports and gynecologic cytology-histology correlation data for 2015. Results Responses were obtained from 206 medical institutions including 83 university hospitals, 87 general hospitals, and 36 commercial laboratories. A total of 8,284,952 cytologic examinations were performed in 2015, primarily in commercial laboratories (74.9%). The most common cytology specimens were gynecologic samples (81.3%). Conventional smears and liquid-based cytology were performed in 6,190,526 (74.7%) and 2,094,426 (25.3%) cases, respectively. The overall diagnostic concordance rate between cytologic and histologic diagnoses of uterine cervical samples was 70.5%. Discordant cases were classified into three categories: category A (minimal clinical impact, 17.4%), category B (moderate clinical impact, 10.2%), and category C (major clinical impact, 1.9%). The ratio of atypical squamous cells of undetermined significance to squamous intraepithelial lesion was 1.6 in university hospitals, 2.9 in general hospitals, and 4.9 in commercial laboratories. Conclusions This survey reveals the current status and trend of cytology practices in Korea. The results of this study can serve as basic data for the establishment of nationwide cytopathology policies and quality improvement guidelines in Korean medical institutions. PMID:28950443

Breakout session: Diversity, cultural competence, and patient trust.

PubMed

Dy, Christopher J; Nelson, Charles L

2011-07-01

The patient population served by orthopaedic surgeons is becoming increasingly more diverse, but this is not yet reflected in our workforce. As the cultural diversity of our patient population grows, we must be adept at communicating with patients of all backgrounds. WHERE ARE WE NOW?: Efforts to improve the diversity of our workforce have been successful in increasing the number of female residents, but there has been no improvement in the number of African American and Hispanic residents. There is currently no centralized effort to recruit minority and female students to the specialty of orthopaedic surgery. The American Academy of Orthopaedic Surgeons has been leading workshops to train residents and practicing surgeons in communication skills and cultural competency. WHERE DO WE NEED TO GO?: We must train the current generation of orthopaedic surgeons to become adept at interacting with patients of all backgrounds. While initiatives for crosscultural communication in orthopaedic surgery have been established, they have not yet been universally incorporated into residency training and Continuing Medical Education programs. HOW DO WE GET THERE?: We must continue to recruit the brightest students of all backgrounds, with a concerted effort to provide equal opportunities for early guidance to all trainees. Opportunities to improve diversity among orthopaedic surgeons exist at many stages in a future physician's career path, including "shadowing" in high school and college and continuing with mentorship in medical school. Additional resources should be dedicated to teaching residents about the immediate relevancy of cultural competency, and faculty should model these proficiencies during their patient interactions.

Pathogen reduction co-benefits of nutrient best management practices

PubMed Central

Wainger, Lisa A.; Barber, Mary C.

2016-01-01

Background Many of the practices currently underway to reduce nitrogen, phosphorus, and sediment loads entering the Chesapeake Bay have also been observed to support reduction of disease-causing pathogen loadings. We quantify how implementation of these practices, proposed to meet the nutrient and sediment caps prescribed by the Total Maximum Daily Load (TMDL), could reduce pathogen loadings and provide public health co-benefits within the Chesapeake Bay system. Methods We used published data on the pathogen reduction potential of management practices and baseline fecal coliform loadings estimated as part of prior modeling to estimate the reduction in pathogen loadings to the mainstem Potomac River and Chesapeake Bay attributable to practices implemented as part of the TMDL. We then compare the estimates with the baseline loadings of fecal coliform loadings to estimate the total pathogen reduction potential of the TMDL. Results We estimate that the TMDL practices have the potential to decrease disease-causing pathogen loads from all point and non-point sources to the mainstem Potomac River and the entire Chesapeake Bay watershed by 19% and 27%, respectively. These numbers are likely to be underestimates due to data limitations that forced us to omit some practices from analysis. Discussion Based on known impairments and disease incidence rates, we conclude that efforts to reduce nutrients may create substantial health co-benefits by improving the safety of water-contact recreation and seafood consumption. PMID:27904807

MRI-guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations.

PubMed

Larson, Paul S; Willie, Jon T; Vadivelu, Sudhakar; Azmi-Ghadimi, Hooman; Nichols, Amy; Fauerbach, Loretta Litz; Johnson, Helen Boehm; Graham, Denise

2017-07-01

The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

Following the funding trail: Financing, nurses and teamwork in Australian general practice

PubMed Central

2011-01-01

Background Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policy-makers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate. Methods This three year, multimethod study undertook rapid appraisal of 25 general practices and year-long studies in seven practices where a change was introduced to the role of the nurse. Data collected included interviews with nurses (n = 36), doctors (n = 24), and managers (n = 22), structured observation of the practice nurse (51 hours of observation), and detailed case studies of the change process in the seven year-long studies. Results Despite specific fee-for-service funding being available, only 6% of nurse activities generated such a fee. Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice. Conclusions Interprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms. These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice. PMID:21329506

[Study on the method for the determination of trace boron, molybdenum, silver, tin and lead in geochemical samples by direct current arc full spectrum direct reading atomic emission spectroscopy (DC-Arc-AES)].

PubMed

Hao, Zhi-hong; Yao, Jian-zhen; Tang, Rui-ling; Zhang, Xue-mei; Li, Wen-ge; Zhang, Qin

2015-02-01

The method for the determmation of trace boron, molybdenum, silver, tin and lead in geochemical samples by direct current are full spectrum direct reading atomic emission spectroscopy (DC-Arc-AES) was established. Direct current are full spectrum direct reading atomic emission spectrometer with a large area of solid-state detectors has functions of full spectrum direct reading and real-time background correction. The new electrodes and new buffer recipe were proposed in this paper, and have applied for national patent. Suitable analytical line pairs, back ground correcting points of elements and the internal standard method were selected, and Ge was used as internal standard. Multistage currents were selected in the research on current program, and each current set different holding time to ensure that each element has a good signal to noise ratio. Continuous rising current mode selected can effectively eliminate the splash of the sample. Argon as shielding gas can eliminate CN band generating and reduce spectral background, also plays a role in stabilizing the are, and argon flow 3.5 L x min(-1) was selected. Evaporation curve of each element was made, and it was concluded that the evaporation behavior of each element is consistent, and combined with the effects of different spectrographic times on the intensity and background, the spectrographic time of 35s was selected. In this paper, national standards substances were selected as a standard series, and the standard series includes different nature and different content of standard substances which meet the determination of trace boron, molybdenum, silver, tin and lead in geochemical samples. In the optimum experimental conditions, the detection limits for B, Mo, Ag, Sn and Pb are 1.1, 0.09, 0.01, 0.41, and 0.56 microg x g(-1) respectively, and the precisions (RSD, n=12) for B, Mo, Ag, Sn and Pb are 4.57%-7.63%, 5.14%-7.75%, 5.48%-12.30%, 3.97%-10.46%, and 4.26%-9.21% respectively. The analytical accuracy was validated by national standards and the results are in agreement with certified values. The method is simple, rapid, is an advanced analytical method for the determination of trace amounts of geochemical samples' boron, molybdenum, silver, tin and lead, and has a certain practicality.

Current practices in corrosion, surface characterization, and nickel leach testing of cardiovascular metallic implants.

PubMed

Nagaraja, Srinidhi; Di Prima, Matthew; Saylor, David; Takai, Erica

2017-08-01

In an effort to better understand current test practices and improve nonclinical testing of cardiovascular metallic implants, the Food and Drug Administration (FDA) held a public workshop on Cardiovascular Metallic Implants: corrosion, surface characterization, and nickel leaching. The following topics were discussed: (1) methods used for corrosion assessments, surface characterization techniques, and nickel leach testing of metallic cardiovascular implant devices, (2) the limitations of each of these in vitro tests in predicting in vivo performance, (3) the need, utility, and circumstances when each test should be considered, and (4) the potential testing paradigms, including acceptance criteria for each test. In addition to the above topics, best practices for these various tests were discussed, and knowledge gaps were identified. Prior to the workshop, discussants had the option to provide feedback and information on issues relating to each of the topics via a voluntary preworkshop assignment. During the workshop, the pooled responses were presented and a panel of experts discussed the results. This article summarizes the proceedings of this workshop and background information provided by workshop participants. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. J Biomed Mater Res Part B: Appl Biomater, 105B: 1330-1341, 2017. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

PS1-10: How Can the Same Practice Be Classified as Having 2 and 900 MDs? NAMCS Data Collection in a Changing Ambulatory Care Environment

PubMed Central

Halley, Meghan; Gillespie, Katherine; Rendle, Katharine; Luft, Harold

2014-01-01

Background/Aims Since 1973, the National Ambulatory Medical Care Survey (NAMCS), administered by the National Center for Health Statistics (NCHS) has been widely used in studies of ambulatory care. With the growth in large multispecialty practices – including many members of the HMORN – there is a need to understand how NAMCS data are collected and whether current processes yield accurate and reliable data. NAMCS collects data from physicians about their practices and abstracts a sample of patient visit records. This study reports on the physician component. Methods In collaboration with NCHS, nine physicians were randomly sampled from a multispecialty clinic using standard NAMCS recruitment procedures; eight physicians were eligible and agreed to participate. Using their standard protocols, three Field Representatives (FRs) conducted NAMCS physician interviews while a trained ethnographer (MH, KR) observed and audio-recorded each interview. Transcripts and field notes were analyzed using a grounded theory approach to identify key themes. Results Data have been collected and analyzed. They are currently undergoing standard confidentiality review by NCHS. However, this process has been delayed due to the government shutdown. We fully anticipate that results will be released in time for presentation at the HMORN conference. Conclusions Though we are precluded from disseminating results at this time, we will provide a full report of our results in our HMORN conference presentation.

Exploring the Role of Usability in the Software Process: A Study of Irish Software SMEs

NASA Astrophysics Data System (ADS)

O'Connor, Rory V.

This paper explores the software processes and usability techniques used by Small and Medium Enterprises (SMEs) that develop web applications. The significance of this research is that it looks at development processes used by SMEs in order to assess to what degree usability is integrated into the process. This study seeks to gain an understanding into the level of awareness of usability within SMEs today and their commitment to usability in practice. The motivation for this research is to explore the current development processes used by SMEs in developing web applications and to understand how usability is represented in those processes. The background for this research is provided by the growth of the web application industry beyond informational web sites to more sophisticated applications delivering a broad range of functionality. This paper presents an analysis of the practices of several Irish SMEs that develop web applications through a series of case studies. With the focus on SMEs that develop web applications as Management Information Systems and not E-Commerce sites, informational sites, online communities or web portals. This study gathered data about the usability techniques practiced by these companies and their awareness of usability in the context of the software process in those SMEs. The contribution of this study is to further the understanding of the current role of usability within the software development processes of SMEs that develop web applications.

Undergraduate teaching in UK general practice: a geographical snapshot

PubMed Central

Derbyshire, Helen; Rees, Eliot; Gay, Simon P; McKinley, Robert K

2014-01-01

Background Learning in general practice is an essential component of undergraduate medical education; currently, on average, 13% of clinical placements in the UK are in general practice. However, whether general practice can sustainably deliver more undergraduate placements is uncertain. Aim To identify the geographical distribution of undergraduate teaching practices and their distance from the host medical school. Design and setting National survey of all medical schools in the UK. Method All 33 UK medical schools were invited to provide the postcodes of their undergraduate teaching practices. These were collated, de-duplicated, and mapped. The distance in kilometres and journey times by car and public transport between each medical school and its teaching practices was estimated using Transport Direct (www.transportdirect.info). The postcodes of every practice in the UK were obtained from the UK’s health departments. Results All 33 UK medical schools responded; 4392 practices contributed to teaching, with a median (minimum–maximum) of 142 (17–385) practices per school. The median (minimum–maximum) distance between a school and a teaching practice was 28 km (0–1421 km), 41 (0:00–23:26) minutes’ travel by car and 1 hour 12 (0:00–17:29) minutes’ travel by public transport. All teaching practices were accessible by public transport in one school and 90–99% were in a further four schools; 24 schools had >20% of practices that were inaccessible by public transport. Conclusion The 4392 undergraduate teaching general practices are widely distributed and potentially any practice, no matter how isolated, could contribute to undergraduate education. However, this is, at the price of a considerable travel burden. PMID:24868071

Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey

PubMed Central

2014-01-01

Background As health care has increased in complexity and health care teams have been offered as a solution, so too is there an increased need for stronger interprofessional collaboration. However the intraprofessional factions that exist within every profession challenge interprofessional communication through contrary paradigms. As a contender in the conservative spinal health care market, factions within chiropractic that result in unorthodox practice behaviours may compromise interprofessional relations and that profession’s progress toward institutionalization. The purpose of this investigation was to quantify the professional stratification among Canadian chiropractic practitioners and evaluate the practice perceptions of those factions. Methods A stratified random sample of 740 Canadian chiropractors was surveyed to determine faction membership and how professional stratification could be related to views that could be considered unorthodox to current evidence-based care and guidelines. Stratification in practice behaviours is a stated concern of mainstream medicine when considering interprofessional referrals. Results Of 740 deliverable questionnaires, 503 were returned for a response rate of 68%. Less than 20% of chiropractors (18.8%) were aligned with a predefined unorthodox perspective of the conditions they treat. Prediction models suggest that unorthodox perceptions of health practice related to treatment choices, x-ray use and vaccinations were strongly associated with unorthodox group membership (X2 =13.4, p = 0.0002). Conclusion Chiropractors holding unorthodox views may be identified based on response to specific beliefs that appear to align with unorthodox health practices. Despite continued concerns by mainstream medicine, only a minority of the profession has retained a perspective in contrast to current scientific paradigms. Understanding the profession’s factions is important to the anticipation of care delivery when considering interprofessional referral. PMID:24512507

Staff Perception on Biomedical or Health Care Waste Management: A Qualitative Study in a Rural Tertiary Care Hospital in India

PubMed Central

Joshi, Rita; Shah, Harshada; Sharma, Megha; Pathak, Ashish; Macaden, Ragini; Stålsby Lundborg, Cecilia

2015-01-01

Background Health care or biomedical waste, if not managed properly, can be of high risk to the hospital staff, the patients, the community, public health and the environment, especially in low and middle income settings where proper disposal norms are often not followed. Our aim was to explore perceptions of staff of an Indian rural tertiary care teaching hospital on hospital waste management. Method A qualitative study was conducted using 10 focus group discussions (FGDs), with different professional groups, cleaning staff, nurses, medical students, doctors and administrators. The FGD guide included the following topics: (i) role of Health Care Waste Management (HCWM) in prevention of health care associated infections, (ii) awareness of and views about HCWM-related guidelines/legislation, (iii) current HCWM practices, (iv) perception and preparedness related to improvements of the current practices, and (v) proper implementation of the available guidelines/legislation. The FGDs were recorded, transcribed verbatim, translated to English (when conducted in Hindi) and analysed using content analysis. Results Two themes were identified: Theme (A), ‘Challenges in integration of HCWM in organizational practice,’ with the categories (I) Awareness and views about HCWM, (II) Organizational practices regarding HCWM, and (III) Challenges in Implementation of HCWM; and Theme (B), ‘Interventions to improve HCWM,’ with three categories, (I) Educational and motivational interventions, (II) Organizational culture change, and (III) Policy-related interventions. Conclusion A gap between knowledge and actual practice regarding HCWM was highlighted in the perception of the hospital staff. The participants suggested organizational changes, training and monitoring to address this. The information generated is relevant not merely to the microsystem studied but to other institutions in similar settings. PMID:26023783

Perceptions about Training during Endocrinology Residency Programs in India over the Years: A Cross-sectional Study (PEER India Study)

PubMed Central

Khandelwal, Deepak; Dutta, Deep; Singla, Rajiv; Surana, Vineet; Aggarwal, Sameer; Gupta, Yashdeep; Kalra, Sanjay; Khadgawat, Rajesh; Tandon, Nikhil

2017-01-01

Background: Residents' perception on quality of endocrinology training in India is not known. This study aimed to evaluate the perceptions about endocrinology residency programs in India among current trainees as compared to practicing endocrinologists. Methods: Trainees attending a preconference workshop at the annual conference of Endocrine Society of India (ESI) were given a questionnaire designed to evaluate their perceptions on their training. These evaluated the reasons for choosing endocrinology, their experiences during residency, and career plans. Practicing endocrinologists attending ESICON with at least 5-year experience were evaluated as controls. Results: Questionnaires from 63 endocrine trainees and 78 practicing endocrinologists were analyzed. Endocrinology is perceived to be the super-specialty with the best quality of life (QOL) but fair with regard to financial remuneration. Among current trainees, 61.89%, 31.74%, and 34.91% are satisfied with training in clinical endocrinology, laboratory endocrinology, and clinical/translational research, respectively. The corresponding figures for practicing endocrinologists are 71.78%, 25.63%, and 30.75%, respectively. Exposure to national endocrinology conferences during their endocrinology residency was adequate. However, exposure to international endocrinology conferences, research publications, project writing, and grant application are limited. Laboratory endocrinology is rated as the most neglected aspect during endocrine residency. Most of the trainees want to establish their own clinical practice in the long run. Very few trainees (17.46%) wish to join the medical education services. Conclusion: There is a good perception of QOL in endocrinology in spite of average financial remuneration. There is dissatisfaction with the quality of training in laboratory endocrinology and clinical research. Very few endocrine trainees consider academics as a long-term career option in India. PMID:28459024

Research teaching in learning disability nursing: Exploring the views of student and registered learning disability nurses.

PubMed

Northway, Ruth; Parker, Michelle; James, Neil; Davies, Lynsey; Johnson, Kaye; Wilson, Sally

2015-12-01

Whilst there is a need to develop the research base within learning disability nursing it is also significant that currently there is little published data as to how research is taught to this group of nurses. To increase understanding of how research is currently taught to learning disability nurses within the UK. A survey design was used. The research was undertaken at a conference held in the UK in March 2014. 310 learning disability nurses attending the conference of which 212 completed the free text question. This comprised student nurses (n=158), registered nurses working in practice settings (n=25) and registered nurses working in educational institutions (n=24). Five participants did not specify their background. Participants were invited to complete a questionnaire that included a free text question regarding the teaching of research to learning disability nurses: it is the responses to this question that are reported in this paper. Responses were transcribed and thematically analysed. Eight themes emerged: Teaching approach--the good and the bad; finding the right level; right from the start; we need more time; generic versus specialist; there's not enough; getting research into practice; and what should we focus on? Variations exist in terms of the timing of research education, the teaching approaches used, and hence the quality of student experience. Of particular concern is the apparent gap between research teaching and the use of research in practice, and the reported lack of support for research within practice settings. However, enthusiasm for research is evident and hence recommendations are made both to enhance teaching and to strengthen links with practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Current-limited electron beam injection

NASA Technical Reports Server (NTRS)

Stenzel, R. L.

1977-01-01

The injection of an electron beam into a weakly collisional, magnetized background plasma was investigated experimentally. The injected beam was energetic and cold, the background plasma was initially isothermal. Beam and plasma dimensions were so large that the system was considered unbounded. The temporal and spatial evolution of the beam-plasma system was dominated by collective effects. High-frequency electrostatic instabilities rapidly thermalized the beam and heated the background electrons. The injected beam current was balanced by a return current consisting of background electrons drifting toward the beam source. The drift between electrons and ions gave rise to an ion acoustic instability which developed into strong three-dimensional turbulence. It was shown that the injected beam current was limited by the return current which is approximately given by the electron saturation current. Non-Maxwellian electron distribution functions were observed.

Plastic Surgeons’ Perceptions of the Affordable Care Act: Results of a National Survey

PubMed Central

Israel, Jacqueline S.; Chen, Jenny T.; Rao, Venkat K.

2015-01-01

Background: The Affordable Care Act (ACA) aims to expand coverage to the uninsured, improve quality, and contain costs. The goal of this study was to ascertain how plastic surgeons perceive the ACA. Methods: An electronic questionnaire was e-mailed to members of the American Society of Plastic Surgeons between May and June 2014. The survey was anonymous and voluntary and included questions to assess understanding and opinions of the ACA. Results: The survey was sent to 3070 members of the American Society of Plastic Surgeons, and the response rate was 17%. Sixty-eight percent agree or strongly agree that they understand the basic concepts of the ACA. The majority of respondents disagree (38% strongly disagree, 31% disagree) with the notion that the ACA will positively affect their practice, and 51% agree with the statement, “I do not support the ACA, and I believe it did too much.” Two thirds (66%) believe that the ACA deserves a grade of D or F. When answers were analyzed across demographics, 42% of respondents with “Academic” practice background identify with the statement, “I support the ACA but I think it needs more work,” compared to 15% of those who selected “Solo Practice” (p <0.001). Conclusions: The ACA will affect all specialties, including plastic surgery. The results of this survey suggest that many plastic surgeons believe that they have a baseline understanding of current health-care reform. The majority of surveyed surgeons do not support the Act. It is imperative that plastic surgeons possess the knowledge of the ACA; its changes, both current and impending, will likely affect patient mix, coverage of procedures, and reimbursement. PMID:25674374

Orthographic Competence among Multilingual School Children: Writing Moroccan Arabic in France

ERIC Educational Resources Information Center

Weth, Constanze

2015-01-01

This paper presents children's writing in their vernacular family language, Moroccan Arabic. It first provides some background to the family and school literacies of nine-year-old children of Moroccan Arabic (MA) background growing up in France with French literacy practices at school and Written Arabic literacy practices in the home. The paper…

Predicting Rural Practice Using Different Definitions to Classify Medical School Applicants as Having a Rural Upbringing

ERIC Educational Resources Information Center

Owen, John A.; Conaway, Mark R.; Bailey, Beth A.; Hayden, Gregory F.

2007-01-01

Purpose: This study determines the relationship between a medical school applicant's rural background and the likelihood of rural practice using different definitions of rural background. Methods: Cohort study of 599 physicians who entered the University of Virginia School of Medicine in 1990-1995 and graduated in 1994-1999. The…

Exclusionary Discipline Practices across Students' Racial/Ethnic Backgrounds and Disability Status: Findings from the Pacific Northwest

ERIC Educational Resources Information Center

Vincent, Claudia G.; Sprague, Jeffrey R.; Tobin, Tary J.

2012-01-01

We examined 2009-2010 data on exclusionary discipline practices from one state in the Pacific Northwest of the United States across students' racial/ethnic backgrounds and disability status. Our focus was on proportionate representation in exclusionary discipline actions and in the duration of those disciplinary actions. Descriptive outcomes…

Intercultural policy in times of crisis: theory and practice in the case of Turin, Italy.

PubMed

Caponio, Tiziana; Donatiello, Davide

2017-01-01

In this article we analyse how interculturalism, intended as a new paradigm of immigrant integration policies, has been taking shape in an Italian city, i.e. Turin, in the context of the current economic crisis. We argue for the necessity of going beyond official statements on intercultural policy by undertaking a comparative analysis of policy practices in three Neighbourhood Houses (NHs, Case del quartiere ), which are defined by the Municipality as open and intercultural spaces in which associations and citizens can develop activities aimed at expressing different cultural backgrounds, fostering participation and supporting social inclusion. The study shows how the three NHs pursue different approaches - social, cultural or more political - to interculturalism, somewhat reflecting the social and structural context in which the three NHs were established, as well as problem definitions and policy frames of the founding organisations.

[Background and practical use of the assessment of identity development in adolescence (AIDA)].

PubMed

Birkhölzer, Marc; Goth, Kirstin; Schrobildgen, Christian; Schmeck, Klaus; Schlüter-Müller, Susanne

2015-01-01

A paradigm shift towards early detection and intervention of personality disorders in adolescence to prevent persistent and chronic suffering is currently taking place. Aside further distinct areas of impaired psychosocial integrity, disturbed identity development is seen as one core component of personality disorders. Thus, the detection of early antecedents of impaired identity development is an important step to allow for early intervention. The self-report questionnaire Assessment of Identity Development in Adolescence (AIDA) is a reliable and valid diagnostic instrument to detect disturbed identity development. This questionnaire allows for global assessment of identity and a differentiation in fundamental subdomains as well and distinguishes between identity diffusion on one side and consolidated and stable identity on the other. In clinical practice, it supports the differentiation between severely disturbed identity as the core component of personality disorders and identity crisis or stable identity development that can be found in other mental disorders.

Self-Medication in University Students from the City of Mansoura, Egypt.

PubMed

Helal, R M; Abou-ElWafa, H S

2017-01-01

Background . Self-medication is a common practice in developed and developing countries. Objectives . To explore the prevalence of self-medication practices among university students, probable reasons, symptoms requiring self-medication, and sources of advice. Methods . A descriptive cross-sectional study was carried out in Mansoura University, Egypt, and included 1st and last year students of both medical and nonmedical faculties. Results . Prevalence of self-medication was 62.9%. Younger age, female, medical, and ever-married students and those having home pharmacy tended to self-medicate more than their peers with significant difference between them. Being medical student, being from urban area, having good current health condition, being careless about health, and having drugs stored at home pharmacy were independently associated with the likelihood of self-medicating. Conclusion . Prevalence of self-medication among university students is high which constitutes a health problem that needs intervention.

Self-Medication in University Students from the City of Mansoura, Egypt

PubMed Central

2017-01-01

Background. Self-medication is a common practice in developed and developing countries. Objectives. To explore the prevalence of self-medication practices among university students, probable reasons, symptoms requiring self-medication, and sources of advice. Methods. A descriptive cross-sectional study was carried out in Mansoura University, Egypt, and included 1st and last year students of both medical and nonmedical faculties. Results. Prevalence of self-medication was 62.9%. Younger age, female, medical, and ever-married students and those having home pharmacy tended to self-medicate more than their peers with significant difference between them. Being medical student, being from urban area, having good current health condition, being careless about health, and having drugs stored at home pharmacy were independently associated with the likelihood of self-medicating. Conclusion. Prevalence of self-medication among university students is high which constitutes a health problem that needs intervention. PMID:28479921

Language competence in forensic interviews for suspected child sexual abuse.

PubMed

Fontes, Lisa A; Tishelman, Amy C

2016-08-01

Forensic interviews with children for suspected child sexual abuse require meeting children "where they are" in terms of their developmental level, readiness to disclose, culture, and language. The field lacks research indicating how to accommodate children's diverse cultural and linguistic backgrounds. This article focuses on language competence, defined here as the ability of an organization and its personnel (in this case, Child Advocacy Centers and forensic interviewers) to communicate effectively with clients regardless of their preferred language(s). In this qualitative study, 39 U.S. child forensic interviewers and child advocacy center directors discussed their experiences, practices, and opinions regarding interviews with children and families who are not native speakers of English. Topics include the importance of interviewing children in their preferred language, problems in interpreted interviews, bilingual interviews, and current and recommended procedures. Recommendations for practice and further research are included. Copyright © 2016 Elsevier Ltd. All rights reserved.

A comparison of patients with major depressive disorder recruited through newspaper advertising versus consultation referrals for clinical drug trials.

PubMed

Miller, C A; Hooper, C L; Bakish, D

1997-01-01

Difficulties in recruiting patients for clinical trials have plagued investigators for many years. One concern is the generalizability of clinical trial results to community practice, that is, whether volunteers recruited through advertising are homogeneous with those seeking treatment in a clinical setting. This article retrospectively compares the baseline characteristics of patients recruited through newspaper advertisements with those recruited through consultation referrals by reviewing the charts of 54 patients enrolled in two clinical trials for major depressive disorder (MDD). We examined demographic data, background information, clinical histories, and baseline status. Results indicated homogeneity for most variables. The consultation group was significantly more likely to have had previous treatment for the current episode of depression. These results suggest that, although the advertisement and consultation groups were very similar, the drug naivety of the advertisement group may make them a preferred source in terms of generalizability to community practice.

[Prof. Michiharu Matsuoka, founder of the Department of Orthopaedic Surgery at Kyoto University and his achievements in orthopaedic surgery in the Meiji era of Japan (Part 5, Faculty members and training of doctors from Nagoya)].

PubMed

Hirotani, Hayato

2010-09-01

During the years when Dr. M. Matsuoka was professor of the Department of Orthopaedic Surgery, Kyoto Medical School, Kyoto Imperial University (June, 1907-January, 1914), seven doctors worked as his faculty members and founded the base of the current development and reputation of the Department. After resignation from their academic positions, they served in orthopaedic practice in several areas in Japan where orthopaedic surgery was not well recognized. In addition, Prof. Matsuoka trained three doctors from the Aichi Prefectural Medical College (School of Medicine, Nagoya University) in the orthopaedic practice, including x-ray technique and they contributed to the development of orthopaedic surgery in the areas of Nagoya city and Tokai. Backgrounds and achievements of these ten doctors are described.

[Delegation yes, substitution no!].

PubMed

Schroeder, A

2014-08-01

The aging of society leads on the one hand to increasing case numbers and on the other hand to a reduction in the number of physicians available for patient treatment. The delegation and substitution of medical duties as a tried and tested method is increasingly being recommended in order to compensate for the lack of physicians. The Berufsverband der Deutschen Urologen (BDU, Professional Association of German Urologists) supports the guiding principle of the Bundesärztekammer (Federal Medical Council) of "delegation yes, substitution no" and rejects a substitution of medical duties by non-medical academic health personnel. Against the background of the demographic changes, the increasing need for treatment and the current deficiency of junior physicians, a more extensive inclusion of well-qualified and experienced non-medical personnel by the delegation of medically responsible duties (medical scope of practice) can be an appropriate measure to maintain a good medical service in practices, hospitals and nursing homes.

Theranostics in nuclear medicine practice.

PubMed

Yordanova, Anna; Eppard, Elisabeth; Kürpig, Stefan; Bundschuh, Ralph A; Schönberger, Stefan; Gonzalez-Carmona, Maria; Feldmann, Georg; Ahmadzadehfar, Hojjat; Essler, Markus

2017-01-01

The importance of personalized medicine has been growing, mainly due to a more urgent need to avoid unnecessary and expensive treatments. In nuclear medicine, the theranostic approach is an established tool for specific molecular targeting, both for diagnostics and therapy. The visualization of potential targets can help predict if a patient will benefit from a particular treatment. Thanks to the quick development of radiopharmaceuticals and diagnostic techniques, the use of theranostic agents has been continually increasing. In this article, important milestones of nuclear therapies and diagnostics in the context of theranostics are highlighted. It begins with a well-known radioiodine therapy in patients with thyroid cancer and then progresses through various approaches for the treatment of advanced cancer with targeted therapies. The aim of this review was to provide a summary of background knowledge and current applications, and to identify the advantages of targeted therapies and imaging in nuclear medicine practices.

Theranostics in nuclear medicine practice

PubMed Central

Yordanova, Anna; Eppard, Elisabeth; Kürpig, Stefan; Bundschuh, Ralph A; Schönberger, Stefan; Gonzalez-Carmona, Maria; Feldmann, Georg; Ahmadzadehfar, Hojjat; Essler, Markus

2017-01-01

The importance of personalized medicine has been growing, mainly due to a more urgent need to avoid unnecessary and expensive treatments. In nuclear medicine, the theranostic approach is an established tool for specific molecular targeting, both for diagnostics and therapy. The visualization of potential targets can help predict if a patient will benefit from a particular treatment. Thanks to the quick development of radiopharmaceuticals and diagnostic techniques, the use of theranostic agents has been continually increasing. In this article, important milestones of nuclear therapies and diagnostics in the context of theranostics are highlighted. It begins with a well-known radioiodine therapy in patients with thyroid cancer and then progresses through various approaches for the treatment of advanced cancer with targeted therapies. The aim of this review was to provide a summary of background knowledge and current applications, and to identify the advantages of targeted therapies and imaging in nuclear medicine practices. PMID:29042793

Thinking styles and doctors' knowledge and behaviours relating to acute coronary syndromes guidelines

PubMed Central

Sladek, Ruth M; Bond, Malcolm J; Huynh, Luan T; Chew, Derek PB; Phillips, Paddy A

2008-01-01

Background How humans think and make decisions is important in understanding behaviour. Hence an understanding of cognitive processes among physicians may inform our understanding of behaviour in relation to evidence implementation strategies. A personality theory, Cognitive-Experiential Self Theory (CEST) proposes a relationship between different ways of thinking and behaviour, and articulates pathways for behaviour change. However prior to the empirical testing of interventions based on CEST, it is first necessary to demonstrate its suitability among a sample of healthcare workers. Objectives To investigate the relationship between thinking styles and the knowledge and clinical practices of doctors directly involved in the management of acute coronary syndromes. Methods Self-reported doctors' thinking styles (N = 74) were correlated with results from a survey investigating knowledge, attitudes, and clinical practice, and evaluated against recently published acute coronary syndrome clinical guidelines. Results Guideline-discordant practice was associated with an experiential style of thinking. Conversely, guideline-concordant practice was associated with a higher preference for a rational style of reasoning. Conclusion Findings support that while guidelines might be necessary to communicate evidence, other strategies may be necessary to target discordant behaviours. Further research designed to examine the relationships found in the current study is required. PMID:18439250

Drug reimportation practices in the United States

PubMed Central

Bhosle, Monali J; Balkrishnan, Rajesh

2007-01-01

Background Drug reimportation is perceived as a costs-cutting strategy by Americans. Nonetheless, issues such as drug safety and efficacy prevent legalization of the practice. With the contradictory views from supporters and opponents, debate on drug reimportation continues to snowball. The objective of this commentary is to discuss issues regarding drug reimportation practices in the United States (US). It also examines policy implications and potential solutions of the controversy. Findings Comparatively inexpensive drugs available across the border help Americans relieve the burden of medication costs. Consequently, the volume of reimported drugs entering the US has considerably increased. However, these practices are illegal and legalization of drug reimportation is a political debate. While safety is the most important barrier for legalization, this concern does not seem to affect growing number of Americans who are getting their prescriptions filled from across the border. Canadians oppose legalization of reimportation in the US as it could exacerbate the problem of medication shortage in Canada. Summary Currently, legalization of dug reimportation has wedged between the arguments by different groups. Until the US government finds a solution to reduce medication costs, it seems to be impossible to stop Americans from buying the comparatively inexpensive medications available across the border. PMID:18360614

Ask not what personalized medicine can do for you--ask what you can do for personalized medicine.

PubMed

Budin-Ljøsne, Isabelle; Harris, Jennifer R

2015-01-01

Personalized medicine (PM) aims to offer tailored health care to individuals on the basis of their genetic profile. This paper explores the types of behaviors and practices that citizens are expected to adopt under PM, examines whether such expectations are realistic, and proposes strategies that could support citizens in the adoption of these behaviors. Recent reports from national and international medical organizations and funders of PM are reviewed to investigate the types of behaviors and practices that citizens are expected to adopt under PM. These behaviors are examined in light of the current knowledge regarding citizen involvement in health care. Under PM, citizens are expected to be much more educated, proactive, and engaged in their health care than under conventional medical models. Actualizing such behaviors and practices may, however, be difficult or even unattainable for some groups of citizens. Educating citizens in PM, as proposed in the reports, is important but may not suffice for the adoption of new behaviors and practices by a majority of citizens. Approaches taking into consideration the heterogeneity of backgrounds, abilities, and resources among citizens are needed and include modifying reimbursement and pricing mechanisms, diversifying research, and developing low-cost PM programs.

Tracing organizing principles: learning from the history of systems biology.

PubMed

Green, Sara; Wolkenhauer, Olaf

2013-01-01

With the emergence of systems biology, the identification of organizing principles is being highlighted as a key research aim. Researchers attempt to "reverse engineer" the functional organization of biological systems using methodologies from mathematics, engineering and computer science while taking advantage of data produced by new experimental techniques. While systems biology is a relatively new approach, the quest for general principles of biological organization dates back to systems theoretic approaches in early and mid-twentieth century. The aim of this paper is to draw on this historical background in order to increase the understanding of the motivation behind the search for general principles and to clarify different epistemic aims within systems biology. We pinpoint key aspects of earlier approaches that also underlie the current practice. These are i) the focus on relational and system-level properties, ii) the inherent critique of reductionism and fragmentation of knowledge resulting from overspecialization, and iii) the insight that the ideal of formulating abstract organizing principles is complementary to, rather than conflicting with, the aim of formulating detailed explanations of biological mechanisms. We argue that looking back not only helps us understand the current practice but also points to possible future directions for systems biology.

Neonatal extravasation injury: prevention and management in Australia and New Zealand-a survey of current practice

PubMed Central

2013-01-01

Background Extravasation injury remains an important cause of iatrogenic injury in neonatal intensive care. This study aims to describe the current approach to extravasation injury (EI) prevention and management in Neonatal Intensive Care Units (NICUs) in Australia and New Zealand. Methods A literature review regarding extravasation injury in the newborn was carried out to inform questionnaire design. An internet-based survey was then conducted with the clinical directors of the 27 tertiary NICUs in Australia and New Zealand. Results The survey received a 96% response rate. Approximately two thirds of Australian and New Zealand NICUs have written protocols for prevention and management of extravasation injury. Considerable practice variation was seen for both prevention and treatment of EI. 92% of units had experienced cases of significant EI. Conclusions Australian and New Zealand tertiary neonatal units clearly recognise EI as an important cause of iatrogenic morbidity and mortality. Significant variation still exists among units with regards to guidelines for both prevention and management of EI. We recommend that neonatal staff should remain vigilant, ensuring that guidelines for the prevention and treatment of EI are available, and rigorously followed. PMID:23497004

Accelerating language acquisition.

PubMed

Fowler, W; Ogston, K; Roberts-Fiati, G; Swenson, A

1993-01-01

How much can the development of language and other skills be accelerated in the general population? High correlations between early verbal and mental competencies and parent and teacher language socialization practices suggest enormous potential for widespread improvement. Here we report follow-up research in progress in studies of late adolescent children from diverse ethnic and educational backgrounds who participated in a language enrichment programme during infancy in the home or day-care. In 39 of 44 home-stimulated children located to date (nearly all from college-educated families) 62-93% were: in gifted or advanced programmes, obtaining high grades, avid readers and skilled in writing (over half read before school and wrote creative material independently) and generally highly skilled in verbal, mathematical and other academic domains. They also excelled socially and in sports, and showed intellectual independence. Additional subjects and data (on competence, later experiences and Scholastic Aptitude Test [SAT] scores) are currently being collected. Preliminary data analyses suggest that although early language enrichment can in the short term easily increase competence in all groups well beyond norms generated by current socialization practices, long-term outcomes are a complex function of developmental dynamics between the early, complex, foundation of high skills and motivation for learning, and the interaction with facilitative parental resources.

Rubber dam use during root canal treatment: findings from The Dental Practice-Based Research Network

PubMed Central

Anabtawi, Mona F.; Gilbert, Gregg H.; Bauer, Michael R.; Reams, Gregg; Makhija, Sonia K.; Benjamin, Paul L.; Williams, O. Dale

2012-01-01

Background The Dental Practice-Based Research Network (DPBRN) provides a venue to investigate whether certain procedures are performed routinely. Study objectives were to: (1) quantify rubber dam use during root canal treatment (RCT) among general dentists; (2) test the hypothesis that certain dentist or practice characteristics are associated with its use. Methods DPBRN practitioner-investigators participated in a questionnaire that included items about rubber dam use and other forms of isolation during root RCT. DPBRN Enrollment Questionnaire data provided certain practitioner and practice characteristics. Results A total of 729 practitioners responded (74%); 524 were general dentists and indicated they do RCT and the percentage of RCT in which they use a rubber dam. Of these 524, 44% use rubber dam for all RCTs; 24% use it for 51%–99% of RCTs; 17% use it for 1%–50%; 15% never use it during RCT. Usage varied significantly by geographic region and practice type. Cotton rolls and other forms of isolation were also reported. Conclusions Similar to other reports in the literature, not all DPBRN general dentists use a rubber dam during RCT. Clinical implications Because the current clinical standard of care is to use a rubber dam during RCT, increasing its use may be important. PMID:23372134

Leading nurses in dire straits: head nurses' navigation between nursing and leadership roles.

PubMed

Sørensen, Erik E; Delmar, Charlotte; Pedersen, Birthe D

2011-05-01

The present study reports selected findings from a doctoral study exploring the negotiation between nursing and leadership in hospital head nurses' leadership practice. The importance of bringing a nursing background into leadership is currently under debate. In spite of several studies of nursing and clinical leadership, it is still unclear how nurses' navigate between nursing and leadership roles. An 11-month-long ethnographic study of 12 head nurses' work: five worked at a first line level and seven at a department level. At the first line level, leadership practices were characterized by an inherent conflict between closeness and distance to clinical practice; at the department level practises were characterized by 'recognition games'. On both levels, three interactive roles were identified, that of clinician, manager and a hybrid role. Where clinician or manager roles were assumed, negotiation between roles was absent, leading to reactive, adaptive and isolated practices. The hybrid role was associated with dialectical negotiation of roles leading to stable and proactive practices. Nursing leadership practises depend on leaders' negotiation of the conflicting identities of nurse and leader. Successful nursing leaders navigate between nursing and leadership roles while nourishing a double identity. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

Current Methods in Health Behavior Research Among U.S. Community College Students: A Review of the Literature

PubMed Central

Pokhrel, Pallav; Little, Melissa A.; Herzog, Thaddeus A.

2016-01-01

The majority of health behavior research involving college students in the United States has focused on 4-year college students. Two-year or community college students have been less studied, although a significant proportion of U.S. undergraduates, primarily those from disadvantaged socioeconomic and/or racial/ethnic background, are enrolled in community colleges. Thus, there is a need to enhance health behavior and health promotion research among community college students. This study systematically reviewed 42 published, peer-reviewed health behavior studies conducted among U.S. community college students in order to determine the current state of research in the area with regard to behaviors studied, research designs used, recruitment and data collection strategies practiced, rates of student participation, and characteristics of the participants represented. Findings identified the methodological limitations of current research and suggested optimal recruitment and data collection methods suitable for various research needs. Findings are discussed in the context of enhancing health behavior research among U.S. community college students. PMID:24227658

[Is it Possible to Arouse Interest in a Career in Traumatology with a Curricular Course in Medical School?

PubMed

Meder, A; Lammerding-Köppel, M; Zundel, S; Stöckle, U; Bahrs, C; Gonser, C

2016-12-01

Background: There is a serious lack of young doctors in trauma surgery, which has intensified in recent years. The reasons are complex. Studies have shown that the interest in starting a career in surgery significantly decreases during medical school. To counteract the lack of young talent in the clinic, interest in the subject should be aroused in medical school. The aim of the present study was to evaluate current teaching at our university, where trauma surgery is a curricular subject with mandatory attendance for all medical students. Material and Methods: The current curriculum is intended for medicine students in their fifth year. The curriculum comprises lectures, practical courses and observation modules held in small groups. Students are provided with an experienced surgeon as teacher and mentor for the whole week. A teaching and training centre is available for the practical courses. In an anonymised questionnaire, students were asked about their overall assessment and the training success of practical and theory-oriented modules, as well as their specific interest in traumatology. Results: The evaluated curriculum gave very good results, with an overall rating of 1.53 (average) on a 6-point Likert scale in the overall assessment. It could be shown that students previously not interested in starting a career in trauma surgery showed significantly more interest in the subject after the curriculum. The practical parts scored best in the individual assessment. Conclusion: We showed that intensive teaching can arouse interest in traumatology in students who had been indifferent to orthopaedics and traumatology. Georg Thieme Verlag KG Stuttgart · New York.

The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families

PubMed Central

Shah, Prakesh S.; McDonald, Sarah D.; Barrett, Jon; Synnes, Anne; Robson, Kate; Foster, Jonathan; Pasquier, Jean-Charles; Joseph, K.S.; Piedboeuf, Bruno; Lacaze-Masmonteil, Thierry; O'Brien, Karel; Shivananda, Sandesh; Chaillet, Nils; Pechlivanoglou, Petros

2018-01-01

Background: Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. Methods: Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems. Three broad clusters of projects will be undertaken. Cluster 1 will focus on quality-improvement efforts that use the Evidence-based Practice for Improving Quality method to evaluate information from the CPTBN database and review the current literature, then identify potentially better health care practices and implement identified strategies. Cluster 2 will assess the impact of current practices and practice changes in maternal, perinatal and neonatal care on maternal, neonatal and neurodevelopmental outcomes. Cluster 3 will evaluate the effect of preterm birth on babies, their families and the health care system by integrating CPTBN data, parent feedback, and national and provincial database information in order to identify areas where more parental support is needed, and also generate robust estimates of resource use, cost and cost-effectiveness around preterm neonatal care. Interpretation: These collaborative efforts will create a flexible, transdisciplinary, evaluable and informative research and quality-improvement platform that supports programs, projects and partnerships focused on improving outcomes of preterm neonates. PMID:29348260

Practice of Physical Activity among Future Doctors: A Cross Sectional Analysis

PubMed Central

Rao, Chythra R; Darshan, BB; Das, Nairita; Rajan, Vinaya; Bhogun, Meemansha; Gupta, Aditya

2012-01-01

Background: Non communicable diseases (NCD) will account for 73% of deaths and 60% of the global disease burden by 2020. Physical activity plays a major role in the prevention of these non-communicable diseases. The stress involved in meeting responsibilities of becoming a physician may adversely affect the exercise habits of students. So, the current study aimed to study the practice of physical activity among undergraduate medical students. Methods: A cross sectional study was conducted among 240 undergraduate medical students. Quota sampling method was used to identify 60 students from each of the four even semesters. A pre-tested, semi-structured questionnaire was used to collect the data. Statistical Package for Social Sciences (SPSS) version 16 was used for data entry and analysis and results are expressed as percentages and proportions. Results: In our study, 55% were 20 to 22 years old. Over half of the students were utilizing the sports facilities provided by the university in the campus. Majority of students 165 (69%) had normal body mass index (BMI), (51) 21% were overweight, while 7 (3%) were obese. Of the 62% who were currently exercising, the practice of physical activity was more among boys as compared to girls (62% v/s 38%). Lack of time 46 (60.5%), laziness (61.8%), and exhaustion from academic activities (42%) were identified as important hindering factors among medical students who did not exercise. Conclusion: A longitudinal study to follow-up student behavior throughout their academic life is needed to identify the factors promoting the practice of physical activity among students. PMID:22708033

Quality pharmacy services and key performance indicators in Polish NICUs: a Delphi approach.

PubMed

Krzyżaniak, Natalia; Pawłowska, Iga; Bajorek, Beata

2018-03-31

Background Currently, there is no literature describing what a quality level of practice entails in Polish neonatal intensive care units (NICUs), nor are there any means of currently measuring the quality of pharmaceutical care provided to NICU patients. Objective To identify a set of essential pharmacist roles and pharmacy-relevant key performance indicators (KPI's) suitable for Polish neonatal intensive units (NICUs). Setting Polish hospital pharmacies and NICUs. Method Using a modified Delphi technique, potential KPI's structured along Donabedian's domains as well as pharmacy services were presented to an expert panel of stakeholders. Two online, consecutive Delphi rounds, were completed by panellists between August and September 2017. Main outcome measure To identify the minimum level of pharmacy services that should be consistently provided to NICU patients. Results A total of 16 panellists contributed to the expert panel. Overall, consensus of 75% was reached for 23 indicators and for 28 roles. When considering pharmacy services for the NICU, the experts were found to highly value traditional pharmacy roles, such as dispensing and extemporaneous compounding, however, they were still eager for roles in the other domains, such as educational and clinical services, to be listed as essential for NICU practice. Panellists were found to positively value the list of indicators presented, and excluded only 9 out of the total list. Conclusion There is a need for future research to establish a minimum standard of practice for Polish pharmacists to encourage the progression and standardisation of hospital pharmacy services to meet the level of practice seen in NICUs worldwide.

Effectiveness Modelling and Economic Evaluation of Primary HPV Screening for Cervical Cancer Prevention in New Zealand

PubMed Central

Lew, Jie-Bin; Simms, Kate; Smith, Megan; Lewis, Hazel; Neal, Harold; Canfell, Karen

2016-01-01

Background New Zealand (NZ) is considering transitioning from 3-yearly cervical cytology screening in women 20–69 years (current practice) to primary HPV screening. We evaluated HPV-based screening in both HPV-unvaccinated women and cohorts offered HPV vaccination in New Zealand (vaccination coverage ~50%). Methods A complex model of HPV transmission, vaccination, cervical screening, and invasive cervical cancer was extensively validated against national population-based datasets. Sixteen potential strategies for HPV screening were considered. Results Most primary HPV strategies were more effective than current practice, for both unvaccinated women and cohorts offered vaccination. The optimal strategy for both groups was 5-yearly HPV screening in women aged 25–69 years with partial genotyping for HPV 16/18 and referral to colposcopy, and cytological triage of other oncogenic types. This is predicted to reduce cervical cancer incidence and mortality by a further 12–16% and to save 4–13% annually in program costs (excluding overheads). The findings are sensitive to assumptions about future adherence to initiating screening at 25 years. Conclusion Primary HPV screening with partial genotyping would be more effective and less costly than the current cytology-based screening program, in both unvaccinated women and cohorts offered vaccination. These findings have been considered in a review of cervical screening in NZ. PMID:27187495

Defining the Role of the Pharmacy Technician and Identifying Their Future Role in Medicines Optimisation

PubMed Central

Boughen, Melanie; Sutton, Jane; Fenn, Tess

2017-01-01

Background: Traditionally, pharmacy technicians have worked alongside pharmacists in community and hospital pharmacy. Changes within pharmacy provide opportunity for role expansion and with no apparent career pathway, there is a need to define the current pharmacy technician role and role in medicines optimisation. Aim: To capture the current roles of pharmacy technicians and identify how their future role will contribute to medicines optimisation. Methods: Following ethical approval and piloting, an online survey to ascertain pharmacy technicians’ views about their roles was undertaken. Recruitment took place in collaboration with the Association of Pharmacy Technicians UK. Data were exported to SPSS, data screened and descriptive statistics produced. Free text responses were analysed and tasks collated into categories reflecting the type of work involved in each task. Results: Responses received were 393 (28%, n = 1380). Results were organised into five groups: i.e., hospital, community, primary care, General Practitioner (GP) practice and other (which included HM Prison Service). Thirty tasks were reported as commonly undertaken in three or more settings and 206 (84.7%, n = 243) pharmacy technicians reported they would like to expand their role. Conclusions: Tasks core to hospital and community pharmacy should be considered for inclusion to initial education standards to reflect current practice. Post qualification, pharmacy technicians indicate a significant desire to expand clinically and managerially allowing pharmacists more time in patient-facing/clinical roles. PMID:28970452

Supernatural impotence: historical review with anthropological and clinical implications.

PubMed

Margolin, J; Witztum, E

1989-12-01

The historical and cultural background of the belief in supernatural impotence is presented, emphasizing its possible implications for clinical practice. A brief historical survey of the concept in Judaism and Christianity is followed by a short anthropological survey of supernatural impotence in different ethnic subcultures in Israel. A case demonstration exemplifies the connection between understanding the patient's cultural background and beliefs and the clinical competence of the therapist. The relationship between the clinical-therapeutic process in psychiatric practice and knowledge of the patient's cultural background and beliefs is stressed.

Clinical pharmacokinetics: perceptions of hospital pharmacists in Qatar about how it was taught and how it is applied.

PubMed

Kheir, Nadir; Awaisu, Ahmed; Gad, Hoda; Elazzazy, Shereen; Jibril, Farah; Gajam, Mawadda

2015-12-01

The application of clinical pharmacokinetics (PK) is essential when providing pharmaceutical care. Appropriate application of PK monitoring results in improved patient outcomes including decreased mortality, length of treatment, length of hospital stay, and adverse effects of drug therapy. Despite the well-documented evidence of benefits of clinical PK services, many pharmacists find it challenging to apply PK in clinical practice. To evaluate pharmacists' training backgrounds, attitude, practices, and perceived barriers pertaining to the application of PK in clinical practice in Qatar. All hospitals under Hamad Medical Corporation, the main healthcare provider in Qatar. This was a cross-sectional, descriptive study that was conducted between October 2012 and January 2013, using a self-administered web-based survey. Pharmacists were eligible to participate if they: (1) were working as full-time hospital pharmacists and; (2) have been in practice for at least 1 year. PK contents learned in undergraduate curriculum; perception towards the PK contents and instructions received in the undergraduate curriculum and; application of PK in current clinical practice. A total of 112 pharmacists responded to the questionnaire. The majority of the respondents (n = 91; 81.3 %) reported that they had received PK course(s) in their undergraduate curriculum. Similarly, the majority (70-80 %) of them agreed that the undergraduate PK courses or contents they received were important and relevant to their current practice. The pharmacists identified spending more time on dispensing and inventory issues rather than clinical practice, scarce resources, and manual rather than computerized PK calculations as some of the barriers they encountered in learning about PK and its application. The characteristics of the surveyed pharmacists such as gender, age, highest academic degree, and country of graduation did not influence the pharmacists' perception and attitudes towards PK teaching and application (p > 0.05). PK course contents were perceived to lack depth and relevance to practice, and pharmacist had no experiential training that included aspects of PK. These, and other issues, result in poor application of PK in practice.

The Ontario printed educational message (OPEM) trial to narrow the evidence-practice gap with respect to prescribing practices of general and family physicians: a cluster randomized controlled trial, targeting the care of individuals with diabetes and hypertension in Ontario, Canada

PubMed Central

Zwarenstein, Merrick; Hux, Janet E; Kelsall, Diane; Paterson, Michael; Grimshaw, Jeremy; Davis, Dave; Laupacis, Andreas; Evans, Michael; Austin, Peter C; Slaughter, Pamela M; Shiller, Susan K; Croxford, Ruth; Tu, Karen

2007-01-01

Background There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM); however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message. Methods/design The design is a large, simple, factorial, unblinded cluster-randomized controlled trial. PEMs will be distributed with informed, a quarterly evidence-based synopsis of current clinical information produced by the Institute for Clinical Evaluative Sciences, Toronto, Canada, and will be sent to all eligible general and family practitioners in Ontario. There will be three replicates of the trial, with three different educational messages, each aimed at narrowing a specific evidence-practice gap as follows: 1) angiotensin-converting enzyme inhibitors, hypertension treatment, and cholesterol lowering agents for diabetes; 2) retinal screening for diabetes; and 3) diuretics for hypertension. For each of the three replicates there will be three intervention groups. The first group will receive informed with an attached postcard-sized, short, directive "outsert." The second intervention group will receive informed with a two-page explanatory "insert" on the same topic. The third intervention group will receive informed, with both the above-mentioned outsert and insert. The control group will receive informed only, without either an outsert or insert. Routinely collected physician billing, prescription, and hospital data found in Ontario's administrative databases will be used to monitor pre-defined prescribing changes relevant and specific to each replicate, following delivery of the educational messages. Multi-level modeling will be used to study patterns in physician-prescribing quality over four quarters, before and after each of the three interventions. Subgroup analyses will be performed to assess the association between the characteristics of the physician's place of practice and target behaviours. A further analysis of the immediate and delayed impacts of the PEMs will be performed using time-series analysis and interventional, auto-regressive, integrated moving average modeling. Trial registration number Current controlled trial ISRCTN72772651. PMID:18039361

School travel mode, parenting practices and physical activity among UK Year 5 and 6 children

PubMed Central

2014-01-01

Background School travel mode and parenting practices have been associated with children’s physical activity (PA). The current study sought to examine whether PA parenting practices differ by school travel mode and whether school travel mode and PA parenting practices are associated with PA. Methods 469 children (aged 9-11) wore accelerometers from which mean weekday and after-school (3.30 to 8.30 pm) minutes of moderate-to-vigorous intensity PA (MVPA) and counts per minute (CPM) were derived. Mode of travel to and from school (passive vs. active) and PA parenting practices (maternal and paternal logistic support and modelling behaviour) were child-reported. Results Children engaged in an average of 59.7 minutes of MVPA per weekday. Active travel to school by girls was associated with 5.9 more minutes of MVPA per day compared with those who travelled to school passively (p = 0.004). After-school CPM and MVPA did not differ by school travel mode. There was no evidence that physical activity parenting practices were associated with school travel mode. Conclusions For girls, encouraging active travel to school is likely to be important for overall PA. Further formative research may be warranted to understand how both parental logistic support and active travel decisions are operationalized in families as a means of understanding how to promote increased PA among pre-adolescent children. PMID:24739338

Knowledge, Practices and Attitudes Towards Adverse Drug Reaction Reporting by Private Practitioners from Klang Valley in Malaysia

PubMed Central

Agarwal, Renu; Daher, Aqil Mohammad; Mohd Ismail, Nafeeza

2013-01-01

Background: The study aimed to determine current status of knowledge, practices, and attitudes towards adverse drug reaction (ADR) reporting among private practitioners in Klang region of Malaysia. Methods: A total of 238 private practitioners in Klang valley were distributed a questionnaire consisting of seven questions, two knowledge-related, two practice-related and three attitude-related. Each favourable and unfavourable response was given a score of 1 and 0 respectively. Total score of 70% or more for each domain was considered “satisfactory” whereas less than 70% as “unsatisfactory”. Results: One hundred forty-five participants completed questionnaire. Knowledge assessment showed 83.4% responses stating that ADR reporting helps to identify safe drugs and 91.7% responded that it measures ADR incidence. Regarding practices, 76.6% respondents were willing to report only if confident that reaction is an ADR. Regarding attitudes, 81.9%, 66.9% and 23.5% participants showed complacency, ignorance, and indifference respectively. Unsatisfactory knowledge, practices, and attitudes were observed in 57.2%, 56.6%, and 73.1% respondents respectively. Satisfactory knowledge was significantly higher in respondent with higher qualification with odds ratio of 2.96 with 95% confidence interval of 1.48–5.93. Conclusion: The study showed unsatisfactory level of knowledge, practices, and attitudes towards ADR reporting among high proportion of private practitioners in Klang valley, Malaysia. PMID:23983578

Will genomic selection be a practical method for plant breeding?

PubMed Central

Nakaya, Akihiro; Isobe, Sachiko N.

2012-01-01

Background Genomic selection or genome-wide selection (GS) has been highlighted as a new approach for marker-assisted selection (MAS) in recent years. GS is a form of MAS that selects favourable individuals based on genomic estimated breeding values. Previous studies have suggested the utility of GS, especially for capturing small-effect quantitative trait loci, but GS has not become a popular methodology in the field of plant breeding, possibly because there is insufficient information available on GS for practical use. Scope In this review, GS is discussed from a practical breeding viewpoint. Statistical approaches employed in GS are briefly described, before the recent progress in GS studies is surveyed. GS practices in plant breeding are then reviewed before future prospects are discussed. Conclusions Statistical concepts used in GS are discussed with genetic models and variance decomposition, heritability, breeding value and linear model. Recent progress in GS studies is reviewed with a focus on empirical studies. For the practice of GS in plant breeding, several specific points are discussed including linkage disequilibrium, feature of populations and genotyped markers and breeding scheme. Currently, GS is not perfect, but it is a potent, attractive and valuable approach for plant breeding. This method will be integrated into many practical breeding programmes in the near future with further advances and the maturing of its theory. PMID:22645117

Arid Green Infrastructure for Water Control and Conservation ...

EPA Pesticide Factsheets

Green infrastructure is an approach to managing wet weather flows using systems and practices that mimic natural processes. It is designed to manage stormwater as close to its source as possible and protect the quality of receiving waters. Although most green infrastructure practices were first developed in temperate climates, green infrastructure also can be a cost-effective approach to stormwater management and water conservation in arid and semi-arid regions, such as those found in the western and southwestern United States. Green infrastructure practices can be applied at the site, neighborhood and watershed scales. In addition to water management and conservation, implementing green infrastructure confers many social and economic benefits and can address issues of environmental justice. The U.S. Environmental Protection Agency (EPA) commissioned a literature review to identify the state-of-the science practices dealing with water control and conservation in arid and semi-arid regions, with emphasis on these regions in the United States. The search focused on stormwater control measures or practices that slow, capture, treat, infiltrate and/or store runoff at its source (i.e., green infrastructure). The material in Chapters 1 through 3 provides background to EPA’s current activities related to the application of green infrastructure practices in arid and semi-arid regions. An introduction to the topic of green infrastructure in arid and semi-arid regions i

Important Poisonous Plants in Tibetan Ethnomedicine

PubMed Central

Ma, Lijuan; Gu, Ronghui; Tang, Li; Chen, Ze-E; Di, Rong; Long, Chunlin

2015-01-01

Tibetan ethnomedicine is famous worldwide, both for its high effectiveness and unique cultural background. Many poisonous plants have been widely used to treat disorders in the Tibetan medicinal system. In the present review article, some representative poisonous plant species are introduced in terms of their significance in traditional Tibetan medicinal practices. They are Aconitum pendulum, Strychnos nux-vomica, Datura stramonium and Anisodus tanguticus, for which the toxic chemical constituents, bioactivities and pharmacological functions are reviewed herein. The most important toxins include aconitine, strychnine, scopolamine, and anisodamine. These toxic plants are still currently in use for pain-reduction and other purposes by Tibetan healers after processing. PMID:25594733

Method for technology-delivered healthcare measures.

PubMed

Kramer-Jackman, Kelli Lee; Popkess-Vawter, Sue

2011-12-01

Current healthcare literature lacks development and evaluation methods for research and practice measures administered by technology. Researchers with varying levels of informatics experience are developing technology-delivered measures because of the numerous advantages they offer. Hasty development of technology-delivered measures can present issues that negatively influence administration and psychometric properties. The Method for Technology-delivered Healthcare Measures is designed to systematically guide the development and evaluation of technology-delivered measures. The five-step Method for Technology-delivered Healthcare Measures includes establishment of content, e-Health literacy, technology delivery, expert usability, and participant usability. Background information and Method for Technology-delivered Healthcare Measures steps are detailed.

Assessing subject privacy and data confidentiality in an emerging region for clinical trials: United Arab Emirates.

PubMed

Nair, Satish Chandrasekhar; Ibrahim, Halah

2015-01-01

Pharmaceutical sponsored clinical trials, formerly conducted predominantly in the United States and Europe, have expanded to emerging regions, including the Middle East. Our study explores factors influencing clinical trial privacy and confidentiality in the United Arab Emirates. Factors including concept familiarity, informed consent compliance, data access, and preservation, were analyzed to assess current practices in the Arab world. As the UAE is an emerging region for clinical trials, there is a growing need for regulations related to data confidentiality and subject privacy. Informational and decisional privacy should be viewed within the realms of Arab culture and religious background.

Kurt Goldstein and his nonlocationist thoughts on aphasia-a pioneer of early network theories at the beginning of the twentieth century?

PubMed

Joswig, Holger; Hildebrandt, Gerhard

2017-07-01

In between Carl Wernicke's locationist aphasia concept from 1874 and Norman Geschwind's new connectionist model of human brain functions in 1965, little notice was taken of the historical debate on aphasia and brain plasticity. Interestingly, Kurt Goldstein made long-forgotten, but highly relevant remarks on the connectionist model and thereby served as an important connecting link between Wernicke and Geschwind. With the original contributions of Goldstein and contemporary authors, we analyzed the historical background of the aphasia debate in the time period between Wernicke and Geschwind, which still influences current aphasia concepts and neurosurgical practice of today.

Testing Bell's inequality with cosmic photons: closing the setting-independence loophole.

PubMed

Gallicchio, Jason; Friedman, Andrew S; Kaiser, David I

2014-03-21

We propose a practical scheme to use photons from causally disconnected cosmic sources to set the detectors in an experimental test of Bell's inequality. In current experiments, with settings determined by quantum random number generators, only a small amount of correlation between detector settings and local hidden variables, established less than a millisecond before each experiment, would suffice to mimic the predictions of quantum mechanics. By setting the detectors using pairs of quasars or patches of the cosmic microwave background, observed violations of Bell's inequality would require any such coordination to have existed for billions of years-an improvement of 20 orders of magnitude.

Implementation Strategies for Gender-Sensitive Public Health Practice: A European Workshop.

PubMed

Oertelt-Prigione, Sabine; Dalibert, Lucie; Verdonk, Petra; Stutz, Elisabeth Zemp; Klinge, Ineke

2017-11-01

Providing a robust scientific background for the focus on gender-sensitive public health and a systematic approach to its implementation. Within the FP7-EUGenMed project ( http://eugenmed.eu ) a workshop on sex and gender in public health was convened on February 2-3, 2015. The experts participated in moderated discussion rounds to (1) assemble available knowledge and (2) identify structural influences on practice implementation. The findings were summarized and analyzed in iterative rounds to define overarching strategies and principles. The participants discussed the rationale for implementing gender-sensitive public health and identified priorities and key stakeholders to engage in the process. Communication strategies and specific promotion strategies with distinct stakeholders were defined. A comprehensive list of gender-sensitive practices was established using the recently published taxonomy of the Expert Recommendations for Implementing Change (ERIC) project as a blueprint. A clearly defined implementation strategy should be mandated for all new projects in the field of gender-sensitive public health. Our tool can support researchers and practitioners with the analysis of current and past research as well as with the planning of new projects.

A Study of Vehicle Structural Layouts in Post-WWII Aircraft

NASA Technical Reports Server (NTRS)

Sensmeier, Mark D.; Samareh, Jamshid A.

2004-01-01

In this paper, results of a study of structural layouts of post-WWII aircraft are presented. This study was undertaken to provide the background information necessary to determine typical layouts, design practices, and industry trends in aircraft structural design. Design decisions are often predicated not on performance-related criteria, but rather on such factors as manufacturability, maintenance access, and of course cost. For this reason, a thorough understanding of current best practices in the industry is required as an input for the design optimization process. To determine these best practices and industry trends, a large number of aircraft structural cutaway illustrations were analyzed for five different aircraft categories (commercial transport jets, business jets, combat jet aircraft, single engine propeller aircraft, and twin-engine propeller aircraft). Several aspects of wing design and fuselage design characteristics are presented here for the commercial transport and combat aircraft categories. A great deal of commonality was observed for transport structure designs over a range of eras and manufacturers. A much higher degree of variability in structural designs was observed for the combat aircraft, though some discernable trends were observed as well.

Variation in CAD Secondary Prevention Prescription among Outpatient Cardiology Practices: Insights from the NCDR®

PubMed Central

Maddox, Thomas M.; Chan, Paul S.; Spertus, John A.; Tang, Fengming; Jones, Phil; Ho, P. Michael; Bradley, Steven M.; Tsai, Thomas T.; Bhatt, Deepak L.; Peterson, Pamela N.

2014-01-01

Objectives This study assesses practice variation of secondary prevention medication prescription among coronary artery disease (CAD) patients treated in outpatient practices participating in the NCDR® PINNACLE Registry®. Background Among patients with CAD, secondary prevention with a combination of beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and statins reduces cardiac mortality and myocardial infarction (MI). Accordingly, every CAD patient should receive the combination of these medications for which they are eligible. However, little is known about current prescription patterns of these medications and the variation in use among outpatient cardiology clinics. Methods Using data from NCDR® PINNACLE Registry®, a national outpatient cardiology practice registry, we assessed medication prescription patterns among eligible CAD patients between July 2008 and December 2010. Overall rates of prescription and variation by practice were calculated, adjusting for patient characteristics. Results Among 156,145 CAD patients in 58 practices, 103,830 (66.5%) were prescribed the optimal combination of medications for which they were eligible. The median rate of optimal combined prescription by practice was 73.5% and varied from 28.8% to 100%. After adjustment for patient factors, the practice median rate ratio for prescription was 1.25 (95% CI 1.2,1.32), indicating a 25% likelihood that 2 random practices would differ in treating identical CAD patients. Conclusions Among a national registry of CAD patients treated in outpatient cardiology practices, over one-third of patients failed to receive their optimal combination of secondary prevention medications. Significant variation was observed across practices, even after adjusting for patient characteristics, suggesting that quality improvement efforts may be needed to support more uniform practice. PMID:24184238

Provision of foot health services for people with rheumatoid arthritis in New South Wales: a web-based survey of local podiatrists

PubMed Central

2013-01-01

Background It is unclear if podiatric foot care for people with rheumatoid arthritis (RA) in New South Wales (NSW) meets current clinical recommendations. The objective of this study was to survey podiatrists’ perceptions of the nature of podiatric foot care provision for people who have RA in NSW. Methods An anonymous, cross-sectional survey with a web-based questionnaire was conducted. The survey questionnaire was developed according to clinical experience and current foot care recommendations. State registered podiatrists practising in the state of NSW were invited to participate. The survey link was distributed initially via email to members of the Australian Podiatry Association (NSW), and distributed further through snowballing techniques using professional networks. Data was analysed to assess significant associations between adherence to clinical practice guidelines, and private/public podiatry practices. Results 86 podiatrists participated in the survey (78% from private practice, 22% from public practice). Respondents largely did not adhere to formal guidelines to manage their patients (88%). Only one respondent offered a dedicated service for patients with RA. Respondents indicated that the primary mode of accessing podiatry was by self-referral (68%). Significant variation was observed regarding access to disease and foot specific assessments and treatment strategies. Assessment methods such as administration of patient reported outcome measures, vascular and neurological assessments were not conducted by all respondents. Similarly, routine foot care strategies such as prescription of foot orthoses, foot health advice and footwear were not employed by all respondents. Conclusions The results identified issues in foot care provision which should be explored through further research. Foot care provision in NSW does not appear to meet the current recommended standards for the management of foot problems in people who have RA. Improvements to foot care could be undertaken in terms of providing better access to examination techniques and treatment strategies that are recommended by evidence based treatment paradigms. PMID:23972081

Complementary and alternative medicine: a survey of its use in pediatric cardiology

PubMed Central

Adams, Denise; Whidden, Ashley; Honkanen, Meeri; Dagenais, Simon; Clifford, Tammy; Baydala, Lola; King, W. James

2014-01-01

Background The use of complementary and alternative medicine is high among children and youth with chronic illnesses, including patients with cardiac conditions. Our goal was to assess the prevalence and patterns of such use among patients presenting to academic pediatric cardiology clinics in Canada. Methods A survey instrument was developed to inquire about current or previous use of complementary and alternative medicine products and practices, including indications, beliefs, sources of information and whether this use was discussed with physicians. Between February and July 2007, the survey was administered to patients (or their parents/guardians) presenting to 2 hospital-based cardiology clinics: the Stollery Children’s Hospital in Edmonton, Alberta, and the Children’s Hospital of Eastern Ontario in Ottawa, Ontario. Results At the Stollery Children’s Hospital, 64.1% of the 145 respondents had used complementary and alternative medicine compared with 35.5% of the 31 respondents at the Children’s Hospital of Eastern Ontario (p = 0.003). Overall, the most common products in current use were multivitamins (70.6%), vitamin C (22.1%), calcium (13.2%), unspecified “cold remedies” (11.8%) and fish oil or omega-3 fatty acids (11.8%). The most common practices in current use were massage (37.5%), faith healing (25.0%), chiropractic (20.0%), aromatherapy (15.0%) and Aboriginal healing (7.5%). Many patients (44.9%) used complementary and alternative medicine products at the same time as conventional prescription drugs. Concurrent use was discussed with physicians or pharmacists by 64.3% and 31.3% of respondents, respectively. Interpretation Use of complementary and alternative medicine products and practices was high among patients seen in the pediatric cardiology clinics in our study. Most respondents believed that the use of these products and practices was helpful; few reported harms and many did not discuss this use with their physicians, increasing the potential for interactions with prescribed medications. PMID:25485246

Current situation and future plans in radioactive waste management in Mexico

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lopez, H.; Jimenez, M.

1992-01-01

A brief introduction is offered in this document in order to explain the importance which is given in Mexico to the safe management of radioactive wastes. The Secretaria de Energia, Minas e Industria Paraestatal is the organization responsible for this issue. Also, a brief historical background is offered so as to understand the evolution of these activities since they were originated. This background allows us to describe the present situation, which consists in a substantial change in the volume of produced radioactive wastes; in other words, before the present situation only the, nuclear wastes from the application of radioisotopes weremore » generated whereas currently, with the starting of commercial operation of the first unit of Laguna Verde Nuclear Power Plant (LVNPP), large volumes of industrial radioactive wastes are being generated. A mention is given as well of the acquired experience during more than 20 years of waste management and of the technologies which have been applied or practiced in the use and disposal of such wastes. Finally, some general trends in relation to the future planning are indicated, which essentially consist in the siting and characterization of a site so as to, design and construct a permanent disposal facility in order to dispose the operational radioactive wastes from LVNPP.« less

Role of Private-Public Partnership in Health Education: A Survey of Current Practices in Udaipur City, Rajasthan, India

PubMed Central

Reddy, Jaddu J.; Multani, Suraj; Bhat, Nagesh; Sharma, Ashish; Singh, Sopan; Patel, Rahul

2013-01-01

Background: The concept of a public-private partnership (PPP) has been proposed as a potential model for providing education services besides public finance and public delivery. The present study was conducted to survey the current practices of Private-Public Partnership (PPP) in health education in Udaipur city, Rajasthan, India. Methods: A questionnaire survey was conducted among organizations involved exclusively and actively in health education in Udaipur city, Rajasthan, India. The pretested self designed structured questionnaire consisted of 21 items pertaining to the current practices of private-public partnership (PPP) in health education. Descriptive statistics were used to describe the data. Results: On the basis of inclusion criteria, 50 personnel from 2 private dental colleges, 1 private medical college, 2 Non Government Organizations (NGOs) and 1 health museum were selected. Only 15 (30%) of participants agreed that they have a written reference policy that outlines the services they provide to the general public. Regarding the collection of health education materials available, majority 35 (70%) had printed books followed by audio visual (AV) materials (slides, videos, audio cassettes) [22 (44%)]. 35 (70%) of participants reported that they loan only pamphlets and broachers to the public. Thirty four (68%) of participants provide information about oral health. Only 23 (46%) of participants reported that their institution/organization undergo periodic evaluation. Conclusions: Results of this survey show that that most of the PPP were involved in delivering health education, mostly concentrated on general health. Only few of them were involved in oral health education. The role of PPP in health education is integral to the effort of promoting a healthier population. This effort continues the trend and broadens the scope of involvement for further studies. PMID:24130954

Restrictions on the use of e-cigarettes in public and private places—current practice and support among adults in Great Britain

PubMed Central

McNeill, Ann; Arnott, Deborah; Cheeseman, Hazel

2017-01-01

Abstract Background Debates around policies regulating e-cigarette use make it important to obtain an overview of current practice, people’s attitudes and correlates of policy support. Aims were to assess (i) current practices for e-cigarette use in homes and workplaces; (ii) characteristics associated with allowing e-cigarette use in the home; and (iii) level of, and characteristics associated with, support for extending smoke-free legislation to include e-cigarettes. Methods Online survey in 2016, n = 11 389 adults in Great Britain. Descriptives for all measures; multivariable logistic regressions assessed correlates of allowing e-cigarette use and support for extension of legislation. Results Most (79%) reporting on workplace policies reported some level of restrictions on e-cigarette use. Small majorities would not allow e-cigarette use in their home (58%) and supported an extension of smoke-free legislation (52%; 21% opposed). Allowing use was less likely and supporting an extension more likely among men, respondents from a higher socio-economic status, ex-smokers, never-smokers, non-users of e-cigarettes and respondents with increased perceived harm of e-cigarettes or nicotine (all P < 0.001). Older respondents were less likely to allow use and to support an extension and Labour voters more likely to allow use. Conclusions In Great Britain, the majority of workplaces has policies restricting e-cigarette use. Over half of adults would not allow use of e-cigarettes in their home and support prohibiting the use of e-cigarettes in smoke-free places. Adjusting for socio-demographics, more restrictive attitudes are more common among never-smokers, never-users and those with increased perception of relative harms of e-cigarettes or nicotine as cause of smoking-related illness. PMID:28339940

An audit of immunofixation requesting practices at a South African referral laboratory

PubMed Central

Rampursat, Yashna

2014-01-01

Background It is common practice in most chemical pathology laboratories for reflective immunofixation electrophoresis (IFE) to occur following the detection or suspicion of a paraprotein on serum protein electrophoresis (SPEP). The chemical pathology laboratory at Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa, is currently the only non-private laboratory in the KwaZulu Natal province that performs SPEP analysis, with current practice requiring that the clinician request IFE following suggestion by the laboratory after a suspicious SPEP result. Objectives To review the current process for IFE at IALCH in the context of reflective testing and to examine the use of the alpha-2-globulin/alpha-1-globulin ratio as a predictor of a positive IFE result. Methods Data for 1260 consecutive SPEP tests performed at the IALCH National Health Laboratory Service were collected between February and July 2011. SPEP and IFE were performed with a Sebia Hydrasys automated electrophoresis system. The alpha-2-globulin/alpha-1-globulin ratio was calculated using density of corresponding fractions on SPEP. Results Analysis revealed that of the 1260 SPEPs performed during the analysis period, 304 IFEs were suggested by the reviewing pathologist. A total of 45 (15%) of the suggested IFEs were subsequently requested by the attending clinicians. Almost half (46.5%) (n = 20) of the suggested IFEs that were performed revealed the presence of a paraprotein. There was no statistically-significant difference between the alpha-2-globulin/alpha-1-globulin ratio for patients with positive or negative IFEs (p-value = 0.2). Conclusions This study reveals the need for reflective addition of IFE testing by the laboratory following suspicious findings on SPEP. PMID:29043173

Current practices in library/informatics instruction in academic libraries serving medical schools in the western United States: a three-phase action research study

PubMed Central

2013-01-01

Background To conduct a systematic assessment of library and informatics training at accredited Western U.S. medical schools. To provide a structured description of core practices, detect trends through comparisons across institutions, and to identify innovative training approaches at the medical schools. Methods Action research study pursued through three phases. The first phase used inductive analysis on reported library and informatics skills training via publicly-facing websites at accredited medical schools and the academic health sciences libraries serving those medical schools. Phase Two consisted of a survey of the librarians who provide this training to undergraduate medical education students at the Western U.S. medical schools. The survey revealed gaps in forming a complete picture of current practices, thereby generating additional questions that were answered through the Phase Three in-depth interviews. Results Publicly-facing websites reviewed in Phase One offered uneven information about library and informatics training at Western U.S. medical schools. The Phase Two survey resulted in a 77% response rate. The survey produced a clearer picture of current practices of library and informatics training. The survey also determined the readiness of medical students to pass certain aspects of the United States Medical Licensure Exam. Most librarians interacted with medical school curricular leaders through either curricula committees or through individual contacts. Librarians averaged three (3) interventions for training within the four-year curricula with greatest emphasis upon the first and third years. Library/informatics training was integrated fully into the respective curricula in almost all cases. Most training involved active learning approaches, specifically within Problem-Based Learning or Evidence-Based Medicine contexts. The Phase Three interviews revealed that librarians are engaged with the medical schools' curricular leaders, they are respected for their knowledge and teaching skills, and that they need to continually adapt to changes in curricula. Conclusions This study offers a long overdue, systematic view of current practices of library/informatics training at Western U.S. medical schools. Medical educators, particularly curricular leaders, will find opportunities in this study's results for more productive collaborations with the librarians responsible for library and informatics training at their medical schools. PMID:24007301

Precautionary Practices of Respiratory Therapists and Other Health-Care Practitioners Who Administer Aerosolized Medications

PubMed Central

Tsai, Rebecca J; Boiano, James M; Steege, Andrea L; Sweeney, Marie H

2015-01-01

BACKGROUND: Respiratory therapists (RTs) and other health-care workers are potentially exposed to a variety of aerosolized medications. The National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers describes current exposure control practices and barriers to using personal protective equipment during administration of selected aerosolized medications. METHODS: An anonymous, multi-module, web-based survey was conducted among members of health-care professional practice organizations representing RTs, nurses, and other health-care practitioners. A module on aerosolized medications included submodules for antibiotics (amikacin, colistin, and tobramycin), pentamidine, and ribavirin. RESULTS: The submodules on antibiotics, pentamidine, and ribavirin were completed by 321, 227, and 50 respondents, respectively, most of whom were RTs. The relatively low number of ribavirin respondents precluded meaningful interpretation of these data and may reflect the rare use of this drug. Consequently, analysis focused on pentamidine, classified by NIOSH as a hazardous drug, and the antibiotics amikacin, colistin, and tobramycin, which currently lack authoritative safe handling guidelines. Respondents who administered pentamidine were more likely to adhere to good work practices compared with those who administered the antibiotics. Examples included training received on safe handling procedures (75% vs 52%), availability of employer standard procedures (82% vs 55%), use of aerosol delivery devices equipped with an expiratory filter (96% vs 53%) or negative-pressure rooms (61% vs 20%), and always using respiratory protection (51% vs 13%). CONCLUSIONS: Despite the availability of safe handling guidelines for pentamidine, implementation was not universal, placing workers, co-workers, and even family members at risk of exposure. Although the antibiotics included in this study lack authoritative safe handling guidelines, prudence dictates that appropriate exposure controls be used to minimize exposure to the antibiotics and other aerosolized medications. Employers and employees share responsibility for ensuring that precautionary measures are taken to keep exposures to all aerosolized medications as low as practicable. PMID:26152473

Reconsidering nutrition science: critical reflection with a cultural lens.

PubMed

Hassel, Craig A

2014-05-02

European culture gave birth to modern science as a means to investigate and explain the natural world. The biomedical disciplines that have since emerged, including nutrition, presuppose a web of basic presuppositions, background assumptions and implicit cultural values that are often overlooked and escape peer review. These "hidden subjectivities" are widely taken-for-granted while exerting a powerful hold on the scope, direction and patterns of disciplinary thought. Nutrition science currently has no accepted means of collectively attending to hidden subjectivities embedded within its methods and practice. Here I propose that directing inquiry into these dimensions holds potential to advance our discipline. This critically reflective approach emerged from critical theory and the practice of cross-cultural engagement (CCE). CCE deliberately seeks out and critically engages food and health understandings of non-European cultures. Its protocol includes cognitive frameshifting, a practice of temporarily stepping outside of habitual thought patterns and into a non-biomedical framework of background assumptions. A cultural lens metaphor derives from CCE practice and is forwarded here as a viable means for restoring critically reflective attention to hidden subjectivities while also inviting further CCE practice within the discipline. Critical reflection with a cultural lens allows cognitive attachments to materialism, reductionism, mechanistic thought, naïve realism, control over nature and pervasive subject-object dichotomies between mind and matter, scientist and nature, experience and reality, among many others to become more available for critical consideration. Culturally diverse food and health understandings otherwise dismissed as "unscientific" or held in abeyance gain value as alternative assumptive frameworks and cognitive models that can be temporarily inhabited for further intercultural reflection and insight. Critical reflection with a cultural lens allows reconsideration of nutrition science in light of its culturally specific origin and foundation. This perspective can advance the discipline in two ways. First, it extends skeptical inquiry into hidden subjectivities that are otherwise implicit and seldom given over to critical consideration. Second, it can broaden scholarly inquiry through deliberate attempts to cross cognitive boundaries and empathically inhabit different cognitive worlds. This developmental practice holds potential to both deepen and broaden disciplinary inquiry.

The impact of patient record access on appointments and telephone calls in two English general practices: a population-based study

PubMed Central

Fitton, Caroline; Fitton, Richard; Hannan, Amir; Morgan, Lawrie; Halsall, David

2014-01-01

Background Government policy expects all patients who wish to have online record access (RA) by 2015. We currently have no knowledge of the impact of patient record access on practice workload. Setting Two urban general practices in Manchester. Question What is the impact of patient RA on telephone calls and appointments in UK general practice? Method We asked patients in two urban general practices who used RA whether it had increased or decreased their use of the practice over the previous year. Using practice data, we calculated the change in appointments, telephone calls and staff cost. We also estimated the reduction in environmental costs and patient time. Results An average of 187 clinical appointments (of which 87 were with doctors and 45 with nurses) and 290 telephone calls were saved. If 30% of patients used RA at least twice a year, these figures suggest that a 10 000-patient practice would save 4747 appointments and 8020 telephone calls per year. Assuming a consultation rate of 5.3% annually, that equates to a release of about 11% of appointments per year, with significant resource savings for patients and the environment. Discussion This is the first such study in the UK. It shows similar results to a study in the USA. We discuss the study limitations, including the issue of patient recall, nature of the practices studied and nature of early adopter patients. Strengths include combining national data, practice data and local reflection. We are confident that the savings observed are the result of RA rather than other factors. We suggest that RA can be part of continuous practice improvement, given its benefits and the support it offers for patient confidence, self-care and shared decision-making. PMID:25949705

Rationale, design and methods of the Study of Work and Pain (SWAP): a cluster randomised controlled trial testing the addition of a vocational advice service to best current primary care for patients with musculoskeletal pain (ISRCTN 52269669)

PubMed Central

2014-01-01

Background Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. Methods/Design This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. Discussion This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. Trial registration Current Controlled Trials ISRCTN52269669. PMID:25012813

Photogrammetry and optical methods in structural dynamics - A review

NASA Astrophysics Data System (ADS)

Baqersad, Javad; Poozesh, Peyman; Niezrecki, Christopher; Avitabile, Peter

2017-03-01

In the last few decades, there has been a surge of research in the area of non-contact measurement techniques. Photogrammetry has received considerable attention due to its ability to achieve full-field measurement and its robustness to work in testing environments and on testing articles in which using other measurement techniques may not be practical. More recently, researchers have used this technique to study transient phenomena and to perform measurements on vibrating structures. The current paper reviews the most current trends in the photogrammetry technique (point tracking, digital image correlation, and target-less approaches) and compares the applications of photogrammetry to other measurement techniques used in structural dynamics (e.g. laser Doppler vibrometry and interferometry techniques). The paper does not present the theoretical background of the optical techniques, but instead presents the general principles of each approach and highlights the novel structural dynamic measurement concepts and applications that are enhanced by utilizing optical techniques.

Updates and knowledge gaps in cholesteatoma research.

PubMed

Kuo, Chin-Lung; Shiao, An-Suey; Yung, Matthew; Sakagami, Masafumi; Sudhoff, Holger; Wang, Chih-Hung; Hsu, Chyong-Hsin; Lien, Chiang-Feng

2015-01-01

The existence of acquired cholesteatoma has been recognized for more than three centuries; however, the nature of the disorder has yet to be determined. Without timely detection and intervention, cholesteatomas can become dangerously large and invade intratemporal structures, resulting in numerous intra- and extracranial complications. Due to its aggressive growth, invasive nature, and the potentially fatal consequences of intracranial complications, acquired cholesteatoma remains a cause of morbidity and death for those who lack access to advanced medical care. Currently, no viable nonsurgical therapies are available. Developing an effective management strategy for this disorder will require a comprehensive understanding of past progress and recent advances. This paper presents a brief review of background issues related to acquired middle ear cholesteatoma and deals with practical considerations regarding the history and etymology of the disorder. We also consider issues related to the classification, epidemiology, histopathology, clinical presentation, and complications of acquired cholesteatoma and examine current diagnosis and management strategies in detail.

Development of Prototype HTS Components for Magnetic Suspension Applications

NASA Technical Reports Server (NTRS)

Haldar, P.; Hoehn, J., Jr.; Selvamanickam, V.; Farrell, R. A.; Balachandran, U.; Iyer, A. N.; Peterson, E.; Salazar, K.

1996-01-01

We have concentrated on developing prototype lengths of bismuth and thallium based silver sheathed superconductors by the powder-in-tube approach to fabricate high temperature superconducting (HTS) components for magnetic suspension applications. Long lengths of mono and multi filament tapes are presently being fabricated with critical current densities useful for maglev and many other applications. We have recently demonstrated the prototype manufacture of lengths exceeding 1 km of Bi-2223 multi filament conductor. Long lengths of thallium based multi-filament conductor have also been fabricated with practical levels of critical current density and improved field dependence behavior. Test coils and magnets have been built from these lengths and characterized over a range of temperatures and background fields to determine their performance. Work is in progress to develop, fabricate and test HTS windings that will be suitable for magnetic suspension, levitation and other electric power related applications.

Position and speed control of brushless DC motors using sensorless techniques and application trends.

PubMed

Gamazo-Real, José Carlos; Vázquez-Sánchez, Ernesto; Gómez-Gil, Jaime

2010-01-01

This paper provides a technical review of position and speed sensorless methods for controlling Brushless Direct Current (BLDC) motor drives, including the background analysis using sensors, limitations and advances. The performance and reliability of BLDC motor drivers have been improved because the conventional control and sensing techniques have been improved through sensorless technology. Then, in this paper sensorless advances are reviewed and recent developments in this area are introduced with their inherent advantages and drawbacks, including the analysis of practical implementation issues and applications. The study includes a deep overview of state-of-the-art back-EMF sensing methods, which includes Terminal Voltage Sensing, Third Harmonic Voltage Integration, Terminal Current Sensing, Back-EMF Integration and PWM strategies. Also, the most relevant techniques based on estimation and models are briefly analysed, such as Sliding-mode Observer, Extended Kalman Filter, Model Reference Adaptive System, Adaptive observers (Full-order and Pseudoreduced-order) and Artificial Neural Networks.

Microalgal cultivation with biogas slurry for biofuel production.

PubMed

Zhu, Liandong; Yan, Cheng; Li, Zhaohua

2016-11-01

Microalgal growth requires a substantial amount of chemical fertilizers. An alternative to the utilization of fertilizer is to apply biogas slurry produced through anaerobic digestion to cultivate microalgae for the production of biofuels. Plenty of studies have suggested that anaerobic digestate containing high nutrient contents is a potentially feasible nutrient source to culture microalgae. However, current literature indicates a lack of review available regarding microalgal cultivation with biogas slurry for the production of biofuels. To help fill this gap, this review highlights the integration of digestate nutrient management with microalgal production. It first unveils the current status of microalgal production, providing basic background to the topic. Subsequently, microalgal cultivation technologies using biogas slurry are discussed in detail. A scale-up scheme for simultaneous biogas upgrade and digestate application through microalgal cultivation is then proposed. Afterwards, several uncertainties that might affect this practice are explored. Finally, concluding remarks are put forward. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Illness, culture and religion--issues of intercultural medical ethics and nursing ethics].

PubMed

Körtner, Ulrich H J

2007-01-01

Should modern medicine be allowed to do what it is capable of? And what role are religious norms and attitudes to play in both the medical course of life and the bioethical discourse of modern societies? Questions like these are subject of current intercultural medical and nursing ethics. Religious attitudes not only influence the cultural and political surroundings of medical research but also exert a practical influence on the health and illness attitudes of the individual. Coming before moral judgement should be the endeavour to understand one's counterpart, namely the patient, and his/her socio-cultural background. The question to be answered is how therapy and nursing can best be applied within the given socio-cultural framework without those responsible denying their own medical premises or their own concepts of nursing. Intercultural medical and nursing ethics provide an important contribution to the current debate on integration.

Endpoints and cutpoints in head and neck oncology trials: methodical background, challenges, current practice and perspectives.

PubMed

Hezel, Marcus; von Usslar, Kathrin; Kurzweg, Thiemo; Lörincz, Balazs B; Knecht, Rainald

2016-04-01

This article reviews the methodical and statistical basics of designing a trial, with a special focus on the process of defining and choosing endpoints and cutpoints as the foundations of clinical research, and ultimately that of evidence-based medicine. There has been a significant progress in the treatment of head and neck cancer in the past few decades. Currently available treatment options can have a variety of different goals, depending e.g. on tumor stage, among other factors. The outcome of a specific treatment in clinical trials is measured using endpoints. Besides classical endpoints, such as overall survival or organ preservation, other endpoints like quality of life are becoming increasingly important in designing and conducting a trial. The present work is based on electronic research and focuses on the solid methodical and statistical basics of a clinical trial, on the structure of study designs and on the presentation of various endpoints.

Final Report of the NASA Office of Safety and Mission Assurance Agile Benchmarking Team

NASA Technical Reports Server (NTRS)

Wetherholt, Martha

2016-01-01

To ensure that the NASA Safety and Mission Assurance (SMA) community remains in a position to perform reliable Software Assurance (SA) on NASAs critical software (SW) systems with the software industry rapidly transitioning from waterfall to Agile processes, Terry Wilcutt, Chief, Safety and Mission Assurance, Office of Safety and Mission Assurance (OSMA) established the Agile Benchmarking Team (ABT). The Team's tasks were: 1. Research background literature on current Agile processes, 2. Perform benchmark activities with other organizations that are involved in software Agile processes to determine best practices, 3. Collect information on Agile-developed systems to enable improvements to the current NASA standards and processes to enhance their ability to perform reliable software assurance on NASA Agile-developed systems, 4. Suggest additional guidance and recommendations for updates to those standards and processes, as needed. The ABT's findings and recommendations for software management, engineering and software assurance are addressed herein.

Using Mindfulness- and Acceptance-Based Treatments With Clients From Nondominant Cultural and/or Marginalized Backgrounds: Clinical Considerations, Meta-Analysis Findings, and Introduction to the Special Series.

PubMed

Fuchs, Cara; Lee, Jonathan K; Roemer, Lizabeth; Orsillo, Susan M

2013-02-01

A growing body of research suggests that mindfulness- and acceptance-based principles can increase efforts aimed at reducing human suffering and increasing quality of life. A critical step in the development and evaluation of these new approaches to treatment is to determine the acceptability and efficacy of these treatments for clients from nondominant cultural and/or marginalized backgrounds. This special series brings together the wisdom of clinicians and researchers who are currently engaged in clinical practice and treatment research with populations who are historically underrepresented in the treatment literature. As an introduction to the series, this paper presents a theoretical background and research context for the papers in the series, highlights the elements of mindfulness- and acceptance-based treatments that may be congruent with culturally responsive treatment, and briefly outlines the general principles of cultural competence and responsive treatment. Additionally, the results of a meta-analysis of mindfulness- and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds are presented. Our search yielded 32 studies totaling 2,198 clients. Results suggest small (Hedges' g=.38, 95% CI=.11 - .64) to large (Hedges' g=1.32, 95% CI=.61 - 2.02) effect sizes for mindfulness- and acceptance-based treatments, which varied by study design.

Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general practice

PubMed Central

2013-01-01

Background Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. Methods This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. Results The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives – re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. Conclusions The current discourse of implementation science as planned system change did not match organisational reality in this critical case of improvement in general practice. Complexity concepts translated in human terms as complex responsive processes of relating fit the pattern of change more accurately. They do not provide just another fashionable blueprint for change but inform how researchers, policymakers and providers participate in improving healthcare. PMID:23617833

Survey of Sterile Admixture Practices in Canadian Hospital Pharmacies: Part 1. Methods and Results

PubMed Central

Warner, Travis; Nishi, Cesilia; Checkowski, Ryan; Hall, Kevin W.

2009-01-01

Background: The 1996 Guidelines for Preparation of Sterile Products in Pharmacies of the Canadian Society of Hospital Pharmacists (CSHP) represent the current standard of practice for sterile compounding in Canada. However, these guidelines are practice recommendations, not enforceable standards. Previous surveys of sterile compounding practices have shown that actual practice deviates markedly from voluntary practice recommendations. In 2004, the United States Pharmacopeia (USP) published its “General Chapter <797> Pharmaceutical Compounding—Sterile Preparations”, which set a more rigorous and enforceable standard for sterile compounding in the United States. Objectives: To assess sterile compounding practices in Canadian hospital pharmacies and to compare them with current CSHP recommendations and USP chapter <797> standards. Methods: An online survey, based on previous studies of sterile compounding practices, the CSHP guidelines, and the chapter <797> standards, was created and distributed to 193 Canadian hospital pharmacies. Results: A total of 133 pharmacies completed at least part of the survey, for a response rate of 68.9%. All respondents reported the preparation of sterile products. Various degrees of deviation from the practice recommendations were noted for virtually all areas of the CSHP guidelines and the USP standards. Low levels of compliance were most notable in the areas of facilities and equipment, process validation, and product testing. Availability in the central pharmacy of a clean room facility meeting or exceeding the criteria of International Organization for Standardization (ISO) class 8 is a requirement of the chapter <797> standards, but more than 40% of responding pharmacies reported that they did not have such a facility. Higher levels of compliance were noted for policies and procedures, garbing requirements, aseptic technique, and handling of hazardous products. Part 1 of this series reports the survey methods and results relating to policies, personnel, raw materials, storage and handling, facilities and equipment, and garments. Part 2 will report results relating to preparation of aseptic products, expiry dating, labelling, process validation, product testing and release, documentation, records, and disposal of hazardous pharmaceuticals. It will also highlight some of the key areas where there is considerable opportunity for improvement. Conclusion: This survey identified numerous deficiences in sterile compounding practices in Canadian hospital pharmacies. Awareness of these deficiencies may create an impetus for critical assessment and improvements in practice. PMID:22478875

Survey of Sterile Admixture Practices in Canadian Hospital Pharmacies: Part 2. More Results and Discussion

PubMed Central

Warner, Travis; Nishi, Cesilia; Checkowski, Ryan; Hall, Kevin W

2009-01-01

Background: The 1996 Guidelines for Preparation of Sterile Products in Pharmacies of the Canadian Society of Hospital Pharmacists (CSHP) represent the current standard of practice for sterile compounding in Canada. However, these guidelines are practice recommendations, not enforceable standards. Previous surveys of sterile compounding practices have shown that actual practice deviates markedly from voluntary practice recommendations. In 2004, the United States Pharmacopeia (USP) published its “General Chapter <797> Pharmaceutical Compounding—Sterile Preparations”, which set a more rigorous and enforceable standard for sterile compounding in the United States. Objectives: To assess sterile compounding practices in Canadian hospital pharmacies and to compare them with current CSHP recommendations and USP chapter <797> standards. Methods: An online survey, based on previous studies of sterile compounding practices, the CSHP guidelines, and the chapter <797> standards, was created and distributed to 193 Canadian hospital pharmacies. Results: A total of 133 pharmacies completed at least part of the survey, for a response rate of 68.9%. All respondents reported the preparation of sterile products. Various degrees of deviation from the practice recommendations were noted for virtually all areas of the CSHP guidelines and the USP standards. Low levels of compliance were most notable in the areas of facilities and equipment, process validation, and product testing. Availability in the central pharmacy of a clean room facility meeting or exceeding the criteria of International Organization for Standardization (ISO) class 8 is a requirement of the chapter <797> standards, but more than 40% of responding pharmacies reported that they did not have such a facility. Higher levels of compliance were noted for policies and procedures, garbing requirements, aseptic technique, and handling of hazardous products. The survey methods for this study and results relating to policies, personnel, raw materials, storage and handling, facilities and equipment, and garments were reported in Part 1. Part 2 reports results relating to preparation of aseptic products, expiry dating, labelling, process validation, product testing and release, documentation, records, and disposal of hazardous pharmaceuticals. It also highlights some of the key areas where there is considerable opportunity for improvement. Conclusion: This survey identified numerous deficiencies in sterile compounding practices in Canadian hospital pharmacies. Awareness of these deficiencies may create an impetus for critical assessment and improvements in practice. PMID:22478890

Investigation of the Effects of Facility Background Pressure on the Performance and Voltage-Current Characteristics of the High Voltage Hall Accelerator

NASA Technical Reports Server (NTRS)

Kamhawi, Hani; Huang, Wensheng; Haag, Thomas; Spektor, Rostislav

2014-01-01

The National Aeronautics and Space Administration (NASA) Science Mission Directorate In-Space Propulsion Technology office is sponsoring NASA Glenn Research Center to develop a 4 kW-class Hall thruster propulsion system for implementation in NASA science missions. A study was conducted to assess the impact of varying the facility background pressure on the High Voltage Hall Accelerator (HiVHAc) thruster performance and voltage-current characteristics. This present study evaluated the HiVHAc thruster performance in the lowest attainable background pressure condition at NASA GRC Vacuum Facility 5 to best simulate space-like conditions. Additional tests were performed at selected thruster operating conditions to investigate and elucidate the underlying physics that change during thruster operation at elevated facility background pressure. Tests were performed at background pressure conditions that are three and ten times higher than the lowest realized background pressure. Results indicated that the thruster discharge specific impulse and efficiency increased with elevated facility background pressure. The voltage-current profiles indicated a narrower stable operating region with increased background pressure. Experimental observations of the thruster operation indicated that increasing the facility background pressure shifted the ionization and acceleration zones upstream towards the thrusters anode. Future tests of the HiVHAc thruster are planned at background pressure conditions that are expected to be two to three times lower than what was achieved during this test campaign. These tests will not only assess the impact of reduced facility background pressure on thruster performance, voltage-current characteristics, and plume properties; but will also attempt to quantify the magnitude of the ionization.

Genome-wide identification of genes involved in growth and fermentation activity at low temperature in Saccharomyces cerevisiae.

PubMed

Salvadó, Zoel; Ramos-Alonso, Lucía; Tronchoni, Jordi; Penacho, Vanessa; García-Ríos, Estéfani; Morales, Pilar; Gonzalez, Ramon; Guillamón, José Manuel

2016-11-07

Fermentation at low temperatures is one of the most popular current winemaking practices because of its reported positive impact on the aromatic profile of wines. However, low temperature is an additional hurdle to develop Saccharomyces cerevisiae wine yeasts, which are already stressed by high osmotic pressure, low pH and poor availability of nitrogen sources in grape must. Understanding the mechanisms of adaptation of S. cerevisiae to fermentation at low temperature would help to design strategies for process management, and to select and improve wine yeast strains specifically adapted to this winemaking practice. The problem has been addressed by several approaches in recent years, including transcriptomic and other high-throughput strategies. In this work we used a genome-wide screening of S. cerevisiae diploid mutant strain collections to identify genes that potentially contribute to adaptation to low temperature fermentation conditions. Candidate genes, impaired for growth at low temperatures (12°C and 18°C), but not at a permissive temperature (28°C), were deleted in an industrial homozygous genetic background, wine yeast strain FX10, in both heterozygosis and homozygosis. Some candidate genes were required for growth at low temperatures only in the laboratory yeast genetic background, but not in FX10 (namely the genes involved in aromatic amino acid biosynthesis). Other genes related to ribosome biosynthesis (SNU66 and PAP2) were required for low-temperature fermentation of synthetic must (SM) in the industrial genetic background. This result coincides with our previous findings about translation efficiency with the fitness of different wine yeast strains at low temperature. Copyright © 2016 Elsevier B.V. All rights reserved.

Investigation of the Effects of Facility Background Pressure on the Performance and Voltage-Current Characteristics of the High Voltage Hall Accelerator

NASA Technical Reports Server (NTRS)

Kamhawi, Hani; Huang, Wensheng; Haag, Thomas; Spektor, Rostislav

2014-01-01

The National Aeronautics and Space Administration (NASA) Science Mission Directorate In-Space Propulsion Technology office is sponsoring NASA Glenn Research Center to develop a 4 kW-class Hall thruster propulsion system for implementation in NASA science missions. A study was conducted to assess the impact of varying the facility background pressure on the High Voltage Hall Accelerator (HiVHAc) thruster performance and voltage-current characteristics. This present study evaluated the HiVHAc thruster performance in the lowest attainable background pressure condition at NASA GRC Vacuum Facility 5 to best simulate space-like conditions. Additional tests were performed at selected thruster operating conditions to investigate and elucidate the underlying physics that change during thruster operation at elevated facility background pressure. Tests were performed at background pressure conditions that are three and ten times higher than the lowest realized background pressure. Results indicated that the thruster discharge specific impulse and efficiency increased with elevated facility background pressure. The voltage-current profiles indicated a narrower stable operating region with increased background pressure. Experimental observations of the thruster operation indicated that increasing the facility background pressure shifted the ionization and acceleration zones upstream towards the thruster's anode. Future tests of the HiVHAc thruster are planned at background pressure conditions that are expected to be two to three times lower than what was achieved during this test campaign. These tests will not only assess the impact of reduced facility background pressure on thruster performance, voltage-current characteristics, and plume properties; but will also attempt to quantify the magnitude of the ionization and acceleration zones upstream shifting as a function of increased background pressure.

A Readout Integrated Circuit (ROIC) employing self-adaptive background current compensation technique for Infrared Focal Plane Array (IRFPA)

NASA Astrophysics Data System (ADS)

Zhou, Tong; Zhao, Jian; He, Yong; Jiang, Bo; Su, Yan

2018-05-01

A novel self-adaptive background current compensation circuit applied to infrared focal plane array is proposed in this paper, which can compensate the background current generated in different conditions. Designed double-threshold detection strategy is to estimate and eliminate the background currents, which could significantly reduce the hardware overhead and improve the uniformity among different pixels. In addition, the circuit is well compatible to various categories of infrared thermo-sensitive materials. The testing results of a 4 × 4 experimental chip showed that the proposed circuit achieves high precision, wide application and high intelligence. Tape-out of the 320 × 240 readout circuit, as well as the bonding, encapsulation and imaging verification of uncooled infrared focal plane array, have also been completed.

Implications of Dual Practice among Health Workers: A Systematic Review

PubMed Central

MOGHRI, Javad; RASHIDIAN, Arash; ARAB, Mohammad; AKBARI SARI, Ali

2017-01-01

Background: Mixed health care systems to work simultaneously on both public and private facilities, is common today. This phenomenon referred to as dual practice (DP), has potential implications for access, quality, cost and equity of health services. This paper aimed to review systematically studies that assess the implications of DP among health workers. Methods: MEDLINE, EMBASE, and The Cochrane library were searched for obtaining published literature between Feb 1990 and May 2014. Google and Google Scholars, organizational websites, and reference lists of relevant papers searched to get grey literature. Only studies concentrated on consequences and impacts of DP among health professionals and conducted using “randomized controlled trials”, “non-randomized controlled trials”, “controlled before and after studies”, or “interrupted time series” were eligible for inclusion. Results: From 3242 records, we focused on 19 studies, which aimed to assess effects and impacts of dual practice. After that, the current understanding of DP positive and negative implications was categorized and discussed based on two perspectives. Conclusion: There has been a propensity to over-reliance on theoretical methods in predicting the implications of this phenomenon. Almost all of the mentioned implications are based on theoretical predictions undermined in the broader literature. Furthermore, assessing the current literature showed positive and negative impacts of DP on different parts of the health system and various dimensions of service delivery. These implications are contexted specific and may vary from system to system. PMID:28451549

In their own words: The experience of professional nurses in a Northern Vietnamese women's hospital.

PubMed

Ng'ang'a, Njoki; Byrne, Mary Woods; Ngo, Toan Anh

2014-01-01

Abstract Background: Nurses in Vietnam, as is typical of many low-income countries, are hampered from impacting health outcomes by low occupational status, overcrowded hospitals and few career development opportunities. In order to understand the current practice environment encountered by nurses in Vietnam in the most realistic way, we listened to the voices of nurses currently performing nursing roles in Vietnam. The purpose of this study was to explore the emic (insider) perspectives on cultural meaning applied by nurses at a northern Vietnamese women's hospital to influence professional practice and interpret experience. A micro-ethnography approach was used. Seven nurses and one Vice Dean of a school of nursing were interviewed. Data collection consisted of open-ended interviews, participant observation and journal recordings. Spradley's (1979, 1980) Development Research Sequence was used to guide data collection and analysis. Five themes emerged. These were the big number of patients is a burden for nurses; nurses do not, cannot make their own decisions (but they can and do); my feeling depends on doctor's feeling; nurses learn more from doctor; and just a few nurses can attend the [Vietnamese Nurses Association] meeting. The experiences described by the nurses and the Vice Dean of a nursing school reflect the challenges of practicing nursing in one Vietnamese hospital and the resourcefulness of nurses in overcoming those challenges. Recurrent themes highlight the need to better position nurses in Vietnam to advance toward full expression of the professional nursing role.

Hawai‘i Physician Workforce Assessment 2010

PubMed Central

Dall, Tim; Sakamoto, David

2012-01-01

Background National policy experts have estimated that the United States will be 15–20% short of physicians by the year 2020. In 2008, the Big Island of Hawai‘i was found to be 15% short of physicians. The current article describes research to determine the physician supply and demand across the State of Hawai‘i. Methods The researchers utilized licensure lists, all available sources of physician practice location information, and contacted provider offices to develop a database of practicing physicians in Hawai‘i. A statistical model based on national utilization of physician services by age, ethnicity, gender, insurance, and obesity rates was used to estimate demand for services. Using number of new state licenses per year, the researchers estimated the number of physicians who enter the Hawai‘i workforce annually. Physician age data were used to estimate retirements. Results Researchers found 2,860 full time equivalents of practicing, non-military, patient-care physicians in Hawai‘i (excluding those still in residency or fellowship programs). The calculated demand for physician services by specialty indicates a current shortage of physicians of over 600. This shortage may grow by 50 to 100 physicians per year if steps are not taken to reverse this trend. Physician retirement is the single largest element in the loss of physicians, with population growth and aging playing a significant role in increasing demand. Discussion Study findings indicate that Hawai‘i is 20% short of physicians and the situation is likely to worsen if mitigating steps are not taken immediately. PMID:22737636

CUORE and Background Reduction Case Studies for CUPID

NASA Astrophysics Data System (ADS)

Sakai, Michinari; Gozlukluoglu, Nihal; Huang, Huan; Cuore Collaboration

2017-09-01

CUORE (Cryogenic Underground Observatory for Rare Events) is a bolometric experiment at cryogenic temperatures currently in operation to search for neutrinoless double beta decay. Successful detection of this extremely rare process requires stringent control of radioactive backgrounds of the experiment as well as the detector itself. Great care was taken in CUORE to select the materials and various parts that comprise the current detector. However next-generation neutrinoless double beta decay experiments face a challenge to further reduce backgrounds in order to probe more deeply into the effective Majorana neutrino mass phase space. In this presentation we will review the sensitivity and background budget for the currently running experiment CUORE, as well as the target sensitivity and background goals for the next generation experiment CUPID that will cover the inverted neutrino mass hierarchy. We will explore simulation based R&D case studies for background reduction and lay out achievable background reduction levels using possible materials and feasible geometries in the context of CUPID. National Science Foundation.

Professional and spatial mobility of osteopathic physicians.

PubMed

Hassinger, E W; Gill, L S; Hobbs, D J; Hageman, R L

1979-12-01

The study examines changes in location of osteopathic and medical doctors in a 20-county area of rural Missouri over a 14-year period. Losses of osteopathic physicians were greater than medical doctors. However, there was a convergence over the 14-year period in background characteristics of the two types of physicians. The finding of greater spatial mobility of DOs is placed in the context of professional mobility of osteopathy. It is also argued that as practice opportunities for DOs increase, background factors associated with early socialization become more influential in choice of practice sites. The relationship of practice opportunities to choice of practice sites can be extended to foreign medical school graduates and "new health practitioners."

Profession of neuropsychology in Latin America.

PubMed

Arango-Lasprilla, Juan Carlos; Stevens, Lillian; Morlett Paredes, Alejandra; Ardila, Alfredo; Rivera, Diego

2017-01-01

The purpose of this study was to analyze characteristics of individuals working in the profession of neuropsychology in Latin America in order to understand their background, professional training, current work situation, assessment and diagnostic procedures used, rehabilitation techniques employed, population targeted, teaching responsibilities, and research activities. A total of 808 professionals working in neuropsychology from 17 countries in Latin America completed an online survey between July 2013 and January 2014. The majority of participants were female and the mean age was 36.76 years (range 21-74 years). The majority of professionals working in neuropsychology in Latin America have a background in psychology, with some additional specialized training and supervised clinical practice. Over half work in private practice, universities, or private clinics and are quite satisfied with their work. Those who identify themselves as clinicians primarily work with individuals with learning problems, ADHD, mental retardation, TBI, dementia, and stroke. The majority respondents cite the top barrier in the use of neuropsychological instruments to be the lack of normative data for their countries. The top perceived barriers to the field include: lack of academic training programs, lack of clinical training opportunities, lack of willingness to collaborate between professionals, and lack of access to neuropsychological instruments. There is a need in Latin America to increase regulation, improve graduate curriculums, enhance existing clinical training, develop professional certification programs, validate existing neuropsychological tests, and create new, culturally-relevant instruments.

Virtual Convergence: Exploring Culture and Meaning in Playscapes

ERIC Educational Resources Information Center

Abrams, Sandra Schamroth; Rowsell, Jennifer; Merchant, Guy

2017-01-01

Background: Research into digital practices and cultures repeatedly calls attention to the complexity of communication spaces and meaning-making practices. With the blurring of boundaries between online and offline, these entangled practices involve the interweaving of human, material, semiotic, and discursive practices. Purpose: This introductory…

TU-F-BRD-01: Biomedical Informatics for Medical Physicists

DOE Office of Scientific and Technical Information (OSTI.GOV)

Phillips, M; Kalet, I; McNutt, T

Biomedical informatics encompasses a very large domain of knowledge and applications. This broad and loosely defined field can make it difficult to navigate. Physicists often are called upon to provide informatics services and/or to take part in projects involving principles of the field. The purpose of the presentations in this symposium is to help medical physicists gain some knowledge about the breadth of the field and how, in the current clinical and research environment, they can participate and contribute. Three talks have been designed to give an overview from the perspective of physicists and to provide a more in-depth discussionmore » in two areas. One of the primary purposes, and the main subject of the first talk, is to help physicists achieve a perspective about the range of the topics and concepts that fall under the heading of 'informatics'. The approach is to de-mystify topics and jargon and to help physicists find resources in the field should they need them. The other talks explore two areas of biomedical informatics in more depth. The goal is to highlight two domains of intense current interest--databases and models--in enough depth into current approaches so that an adequate background for independent inquiry is achieved. These two areas will serve as good examples of how physicists, using informatics principles, can contribute to oncology practice and research. Learning Objectives: To understand how the principles of biomedical informatics are used by medical physicists. To put the relevant informatics concepts in perspective with regard to biomedicine in general. To use clinical database design as an example of biomedical informatics. To provide a solid background into the problems and issues of the design and use of data and databases in radiation oncology. To use modeling in the service of decision support systems as an example of modeling methods and data use. To provide a background into how uncertainty in our data and knowledge can be incorporated into modeling methods.« less

Examples of Holistic Good Practices in Promoting and Protecting Mental Health in the Workplace: Current and Future Challenges

PubMed Central

Sivris, Kelly C.; Leka, Stavroula

2015-01-01

Background While attention has been paid to physical risks in the work environment and the promotion of individual employee health, mental health protection and promotion have received much less focus. Psychosocial risk management has not yet been fully incorporated in such efforts. This paper presents good practices in promoting mental health in the workplace in line with World Health Organization (WHO) guidance by identifying barriers, opportunities, and the way forward in this area. Methods Semistructured interviews were conducted with 17 experts who were selected on the basis of their knowledge and expertise in relation to good practice identified tools. Interviewees were asked to evaluate the approaches on the basis of the WHO model for healthy workplaces. Results The examples of good practice for Workplace Mental Health Promotion (WMHP) are in line with the principles and the five keys of the WHO model. They support the third objective of the WHO comprehensive mental health action plan 2013–2020 for multisectoral implementation of WMHP strategies. Examples of good practice include the engagement of all stakeholders and representatives, science-driven practice, dissemination of good practice, continual improvement, and evaluation. Actions to inform policies/legislation, promote education on psychosocial risks, and provide better evidence were suggested for higher WMHP success. Conclusion The study identified commonalities in good practice approaches in different countries and stressed the importance of a strong policy and enforcement framework as well as organizational responsibility for WMHP. For progress to be achieved in this area, a holistic and multidisciplinary approach was unanimously suggested as a way to successful implementation. PMID:26929841

Electronic information and clinical decision support for prescribing: state of play in Australian general practice

PubMed Central

Robertson, Jane; Moxey, Annette J; Newby, David A; Gillies, Malcolm B; Williamson, Margaret; Pearson, Sallie-Anne

2011-01-01

Background. Investments in eHealth worldwide have been mirrored in Australia, with >90% of general practices computerized. Recent eHealth incentives promote the use of up to date electronic information sources relevant to general practice with flexibility in mode of access. Objective. To determine GPs’ access to and use of electronic information sources and computerized clinical decision support systems (CDSSs) for prescribing. Methods. Semi-structured interviews were conducted with 18 experienced GPs and nine GP trainees in New South Wales, Australia in 2008. A thematic analysis of interview transcripts was undertaken. Results. Information needs varied with clinical experience, and people resources (specialists, GP peers and supervisors for trainees) were often preferred over written formats. Experienced GPs used a small number of electronic resources and accessed them infrequently. Familiarity from training and early clinical practice and easy access were dominant influences on resource use. Practice time constraints meant relevant information needed to be readily accessible during consultations, requiring integration or direct access from prescribing software. Quality of electronic resource content was assumed and cost a barrier for some GPs. Conclusions. The current Australian practice incentives do not prescribe which information resources GPs should use. Without integration into practice computing systems, uptake and routine use seem unlikely. CDSS developments must recognize the time pressures of practice, preference for integration and cost concerns. Minimum standards are required to ensure that high-quality information resources are integrated and regularly updated. Without standards, the anticipated benefits of computerization on patient safety and health outcomes will be uncertain. PMID:21109619

Influences on students’ career decisions concerning general practice: a focus group study

PubMed Central

Nicholson, Sandra; Hastings, Adrian Michael; McKinley, Robert Kee

2016-01-01

Background Despite concerns about recruitment to UK general practice, there has been no concerted educational intervention to address them. Aim To better understand how medical students’ perceptions of their experiences of their undergraduate curriculum may affect choosing general practice as a career. Design and setting Qualitative study comprising focus groups of a total of 58 students from a range of medical schools across the UK. Method A range of UK medical schools students were invited by email to participate in focus groups and return a questionnaire detailing their current career choice to facilitate sampling students with varied career preferences. Students late in their studies were sampled as they were likely to be considering future careers. Focus group discussions were audiotaped, transcribed, and anonymised for both school and participant, then thematically analysed. Perceived differences in medical school culture, curriculum philosophy, design, and intent were explored. Results Six focus groups (58 students) were convened. Some student participants’ career aspirations were strongly shaped by family and home, but clinical placements remained important in confirming or refuting these choices. High-quality general practice attachments are a powerful attractor to general practice and, when they reflect authentic clinical practice, promote general practice careers. GP tutors can be powerful, positive role models. Students’ comments revealed conflicting understandings about general practice. Conclusion Attracting rather than coercing students to general practice is likely to be more effective at changing their career choices. Early, high-quality, ongoing and, authentic clinical exposure promotes general practice and combats negative stereotyping. It is recommended that increasing opportunities to help students understand what it means to be a ‘good GP’ and how this can be achieved are created. PMID:27578812

Predictors of Success for Electronic Health Record Implementation in Small Physician Practices

PubMed Central

Ancker, J.S.; Singh, M.P.; Thomas, R.; Edwards, A.; Snyder, A.; Kashyap, A.; Kaushal, R.

2013-01-01

Background The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them. PMID:23650484

Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study

PubMed Central

2011-01-01

Background Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development. Methods Questionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026) and 7 (N = 1819). Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation), and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake) and activity behavior (i.e., physical activity and sedentary time) at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics. Results Several child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior) and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these practices showed associations with desirable behavior for normal eaters. By contrast, stimulation to eat healthy worked particularly well for children with a deviant eating style or a high BMI. Conclusion Although most energy balance-related parenting practices were associated with desirable behaviors, some practices showed associations with undesirable child behavior and weight outcomes. Only parental stimulation showed desirable associations with regard to both diet and activity behavior. The interaction between parenting and child characteristics in the association with behavior calls for parenting that is tailored to the individual child. PMID:21401954

Numerical simulation of large-scale field-aligned current generation from finite-amplitude magnetosonic waves

NASA Technical Reports Server (NTRS)

Yamauchi, M.

1994-01-01

A two-dimensional numerical simulation of finite-amplitude magnetohydrodynamic (MHD) magnetosonic waves is performed under a finite-velocity background convection condition. Isothermal cases are considered for simplicity. External dissipation is introduced by assuming that the field-aligned currents are generated in proportion to the accumulated charges. The simulation results are as follows: Paired field-aligned currents are found from the simulated waves. The flow directions of these field-aligned currents depend on the angle between the background convection and the wave normal, and hence two pairs of field-aligned currents are found from a bowed wave if we look at the overall structure. The majority of these field-aligned currents are closed within each pair rather than between two wings. These features are not observed under slow background convection. The result could be applied to the cusp current system and the substorm current system.

The state of cell block variation and satisfaction in the era of molecular diagnostics and personalized medicine

PubMed Central

Crapanzano, John P.; Heymann, Jonas J.; Monaco, Sara; Nassar, Aziza; Saqi, Anjali

2014-01-01

Background: In the recent past, algorithms and recommendations to standardize the morphological, immunohistochemical and molecular classification of lung cancers on cytology specimens have been proposed, and several organizations have recommended cell blocks (CBs) as the preferred modality for molecular testing. Based on the literature, there are several different techniques available for CB preparation-suggesting that there is no standard. The aim of this study was to conduct a survey of CB preparation techniques utilized in various practice settings and analyze current issues, if any. Materials and Methods: A single E-mail with a link to an electronic survey was distributed to members of the American Society of Cytopathology and other pathologists. Questions pertaining to the participants’ practice setting and CBs-volume, method, quality and satisfaction-were included. Results: Of 95 respondents, 90/95 (94%) completed the survey and comprise the study group. Most participants practice in a community hospital/private practice (44%) or academic center (41%). On average, 14 CBs (range 0-50; median 10) are prepared by a laboratory daily. Over 10 methods are utilized: Plasma thrombin (33%), HistoGel (27%), Cellient automated cell block system (8%) and others (31%) respectively. Forty of 90 (44%) respondents are either unsatisfied or sometimes satisfied with their CB quality, with low-cellular yield being the leading cause of dissatisfaction. There was no statistical significance between the three most common CB preparation methods and satisfaction with quality. Discussion: Many are dissatisfied with their current method of CB preparation, and there is no consistent method to prepare CBs. In today's era of personalized medicine with an increasing array of molecular tests being applied to cytological specimens, there is a need for a standardized protocol for CB optimization to enhance cellularity. PMID:24799951

Knowledge, attitude and practice of contraception in rural kashmir.

PubMed

Hayat, Humera; Khan, Parwez Sajad; Imtiyaz, Bhat; Hayat, Gazala; Hayat, Rehana

2013-12-01

Human fertility is determined by many factors such as customs, morals and habits of social groups with regard to marital obligation of life. Acceptance of family planning methods varies within and between societies and there are many factors which are responsible for such variation at community, family and individual level. Socioeconomic environment, culture and education are few of them that play a vital role. Jammu and Kashmir state in general and Kashmir valley in particular is a Muslim-dominated population with traditionally a conservative society. Apart from family customs and influence of the elders, religious background has always been behind the passive resistance, or at the best indifference towards contraception. This study makes an attempt to assess the knowledge, attitude and practice of contraception in rural Kashmir. To assess the knowledge, attitude and practice of contraception in rural Kashmir. Community-based Cross-Sectional study. December 2006 to May 2008. 1900 currently married women in the age group of 15-49 years of age. Rural households. 1900 currently married women, aged 15-49 years, selected by multi-stage random sampling technique from three districts of Kashmir valley who were interviewed at home using a pretested oral questionnaire. The assessment of various socioeconomic and other variables made as per the available standard procedures and scales. Percentage, Chi square test and Bivariate analysis. Knowledge of the contraceptive methods was fairly good especially for terminal methods i.e. female sterilization (97.7 %). Main source of information on contraception was obtained from mass media (60.4 %). Contraceptive practice was significantly related to number of living children, literacy, socioeconomic status and type of family. What is needed is to promote and stress contraceptive methods and their advantages using mass media approach and to explore more and more participation of private sector.

The Impact of the "Getting Practical: Improving Practical Work in Science" Continuing Professional Development Programme on Teachers' Ideas and Practice in Science Practical Work

ERIC Educational Resources Information Center

Abrahams, Ian; Reiss, Michael J.; Sharpe, Rachael

2014-01-01

Background: Despite the widespread use of practical work in school it has been recognised that more needs to be done to improve its effectiveness in developing conceptual understanding. The "Getting Practical" CPD (Continuing Professional Development) programme was designed to contribute towards an improvement in the effectiveness of…

21 CFR 110.5 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 110.5 Section...) FOOD FOR HUMAN CONSUMPTION CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING, PACKING, OR HOLDING HUMAN FOOD General Provisions § 110.5 Current good manufacturing practice. (a) The criteria and...

Assessing fitness-to-practice of overseas-trained health practitioners by Australian registration & accreditation bodies

PubMed Central

2012-01-01

Background Assessment of fitness-to-practice of health professionals trained overseas and who wish to practice in Australia is undertaken by a range of organisations. These organisations conduct assessments using a range of methods. However there is very little published about how these organisations conduct their assessments. The purpose of the current paper is to investigate the methods of assessment used by these organisations and the issues associated with conducting these assessments. Methods A series of semi-structured interviews was undertaken with a variety of organisations who undertake assessments of overseas-trained health professionals who wish to practice in Australia. Content analysis of the interviews was used to identify themes and patterns. Results Four themes were generated from the content analysis of the interviews: (1) assessing; (2) process; (3) examiners; and (4) cost-efficiency. The themes were interconnected and each theme also had a number of sub-themes. Conclusions The organisations who participated in the present study used a range of assessment methods to assess overseas trained health professionals. These organisations also highlighted a number of issues, particularly related to examiners and process issues, pre- and post-assessment. Organisations demonstrated an appreciation for ongoing review of their assessment processes and incorporating evidence from the literature to inform their processes and assessment development. PMID:23020885

Creating the Evidence through Comparative Effectiveness Research for Interprofessional Education and Collaborative Practice by Deploying a National Intervention Network and a National Data Repository

PubMed Central

Pechacek, Judith; Cerra, Frank; Brandt, Barbara; Lutfiyya, May Nawal; Delaney, Connie

2015-01-01

Background: There is currently a resurgence of interest in interprofessional education and collaborative practice (IPECP) and its potential to positively impact health outcomes at both the patient level and population level, healthcare delivery, and health professions education. This resurgence of interest led to the creation of the National Center on Interprofessional Collaborative Practice and Education in October 2012. Methods: This paper describes three intertwined knowledge generation strategies of the National Center on Interprofessional Practice and Education: (1) the development of a Nexus Incubator Network, (2) the undertaking of comparative effectiveness research, and (3) the creation of a National Center Data Repository. Results: As these strategies are implemented over time they will result in the production of empirically grounded knowledge regarding the direction and scope of the impact, if any, of IPECP on well-defined health and healthcare outcomes including the possible improvement of the patient experience of care. Conclusions: Among the motivating factors for the National Center and the three strategies adopted and addressed herein is the need for rigorously produced, scientifically sound evidence regarding IPECP and whether or not it has the capacity to positively affect the patient experience of care, the health of populations, and the per capita cost of healthcare. PMID:27417753

Exploring Vocational Evaluation Practices following Traumatic Brain Injury

PubMed Central

Dillahunt-Aspillaga, Christina; Jorgensen Smith, Tammy; Hanson, Ardis; Ehlke, Sarah; Stergiou-Kita, Mary; Dixon, Charlotte G.; Quichocho, Davina

2015-01-01

Background. Individuals with traumatic brain injury (TBI) face many challenges when attempting to return to work (RTW). Vocational evaluation (VE) is a systematic process that involves assessment and appraisal of an individual's current work-related characteristics and abilities. Objective. The aims of this study are to (1) examine demographic and employment characteristics of vocational rehabilitation providers (VRPs), (2) identify the specific evaluation methods that are used in the VE of individuals with TBI, and (3) examine the differences in assessment method practices based upon evaluator assessment preferences. Methods. This exploratory case study used a forty-six-item online survey which was distributed to VRPs. Results. One hundred and nine VRPs accessed the survey. Of these, 74 completed the survey. A majority of respondents were female (79.7%), Caucasian (71.6%), and holding a master's degree (74.3%), and more than half (56.8%) were employed as state vocational rehabilitation counselors (VRCs). In addition, over two-thirds (67.6%) were certified rehabilitation counselors (CRCs). Respondents reported using several specific tools and assessments during the VE process. Conclusions. Study findings reveal differences in use of and rationales for specific assessments amongst VRPs. Understanding VRP assessment practices and use of an evidence-based framework for VE following TBI may inform and improve VE practice. PMID:26494945

Facilitating the learning process in design-based learning practices: an investigation of teachers' actions in supervising students

NASA Astrophysics Data System (ADS)

Gómez Puente, S. M.; van Eijck, M.; Jochems, W.

2013-11-01

Background: In research on design-based learning (DBL), inadequate attention is paid to the role the teacher plays in supervising students in gathering and applying knowledge to design artifacts, systems, and innovative solutions in higher education. Purpose: In this study, we examine whether teacher actions we previously identified in the DBL literature as important in facilitating learning processes and student supervision are present in current DBL engineering practices. Sample: The sample (N=16) consisted of teachers and supervisors in two engineering study programs at a university of technology: mechanical and electrical engineering. We selected randomly teachers from freshman and second-year bachelor DBL projects responsible for student supervision and assessment. Design and method: Interviews with teachers, and interviews and observations of supervisors were used to examine how supervision and facilitation actions are applied according to the DBL framework. Results: Major findings indicate that formulating questions is the most common practice seen in facilitating learning in open-ended engineering design environments. Furthermore, other DBL actions we expected to see based upon the literature were seldom observed in the coaching practices within these two programs. Conclusions: Professionalization of teachers in supervising students need to include methods to scaffold learning by supporting students in reflecting and in providing formative feedback.

DRG coding practice: a nationwide hospital survey in Thailand

PubMed Central

2011-01-01

Background Diagnosis Related Group (DRG) payment is preferred by healthcare reform in various countries but its implementation in resource-limited countries has not been fully explored. Objectives This study was aimed (1) to compare the characteristics of hospitals in Thailand that were audited with those that were not and (2) to develop a simplified scale to measure hospital coding practice. Methods A questionnaire survey was conducted of 920 hospitals in the Summary and Coding Audit Database (SCAD hospitals, all of which were audited in 2008 because of suspicious reports of possible DRG miscoding); the questionnaire also included 390 non-SCAD hospitals. The questionnaire asked about general demographics of the hospitals, hospital coding structure and process, and also included a set of 63 opinion-oriented items on the current hospital coding practice. Descriptive statistics and exploratory factor analysis (EFA) were used for data analysis. Results SCAD and Non-SCAD hospitals were different in many aspects, especially the number of medical statisticians, experience of medical statisticians and physicians, as well as number of certified coders. Factor analysis revealed a simplified 3-factor, 20-item model to assess hospital coding practice and classify hospital intention. Conclusion Hospital providers should not be assumed capable of producing high quality DRG codes, especially in resource-limited settings. PMID:22040256

Current Sheet Formation in a Conical Theta Pinch Faraday Accelerator with Radio-frequency Assisted Discharge

NASA Technical Reports Server (NTRS)

Polzin, Kurt A.; Hallock, Ashley K.; Choueiri, Edgar Y.

2008-01-01

Data from an inductive conical theta pinch accelerator are presented to gain insight into the process of inductive current sheet formation in the presence of a preionized background gas produced by a steady-state RF-discharge. The presence of a preionized plasma has been previously shown to allow for current sheet formation at lower discharge voltages and energies than those found in other pulsed inductive accelerator concepts, leading to greater accelerator efficiencies at lower power levels. Time-resolved magnetic probe measurements are obtained for different background pressures and pulse energies to characterize the effects of these parameters on current sheet formation. Indices are defined that describe time-resolved current sheet characteristics, such as the total current owing in the current sheet, the time-integrated total current ('strength'), and current sheet velocity. It is found that for a given electric field strength, maximums in total current, strength, and velocity occur for one particular background pressure. At other pressures, these current sheet indices are considerably smaller. The trends observed in these indices are explained in terms of the principles behind Townsend breakdown that lead to a dependence on the ratio of the electric field to the background pressure. Time-integrated photographic data are also obtained at the same experimental conditions, and qualitatively they compare quite favorably with the time-resolved magnetic field data.

Selective pathology fellowships: diverse, innovative, and valuable subspecialty training.

PubMed

Iezzoni, Julia C; Ewton, April; Chévez-Barrios, Patricia; Moore, Stephen; Thorsen, Linda M; Naritoku, Wesley Y

2014-04-01

Although selective pathology fellowships have a long-standing history of developing trainees with advanced expertise in specific areas of pathology other than those of the American Board of Pathology-certified subspecialties, the widespread interest in this training continues to grow. To describe the historical background and current status of selective pathology fellowships, and to provide examples of 3 programs. In addition, Accreditation Council for Graduate Medical Education (ACGME)-accredited programs and nonaccredited programs in Selective Pathology are compared. ACGME data banks and publicly available online materials were used. Program directors of the fellowships examples in this paper provided program-specific information. Additionally, an online survey of the program directors and program coordinators of ACGME-accredited programs and nonaccredited programs in selective pathology was performed. There are currently 76 ACGME-accredited selective pathology programs. The programs are distributed between 3 major categories: surgical pathology, focused anatomic pathology, and focused clinical pathology. Although the vast majority of programs are concerned that their funding source may be cut in the next 3 years, most programs will not change the number of fellowship positions in their programs. Program requirements devoted specifically and solely to selective pathology have been developed and are in effect. The value of this training is recognized not only by pathologists, but by clinicians as well, in both academia and private practice. Importantly, the diversity and innovation inherent in selective pathology allow these programs to adeptly address new subspecialty areas and technologic advances in the current and evolving practice of pathology.

Hydrothermal vents and methane seeps: Rethinking the sphere of influence

USGS Publications Warehouse

Levin, Lisa A.; Baco, Amy; Bowden, David; Colaco, Ana; Cordes, Erik E.; Cunha, Marina; Demopoulos, Amanda W.J.; Gobin, Judith; Grupe, Ben; Le, Jennifer; Metaxas, Anna; Netburn, Amanda; Rouse, Greg; Thurber, Andrew; Tunnicliffe, Verena; Van Dover, Cindy L.; Vanreusel, Ann; Watling, Les

2016-01-01

Although initially viewed as oases within a barren deep ocean, hydrothermal vent and methane seep communities are now recognized to interact with surrounding ecosystems on the sea floor and in the water column, and to affect global geochemical cycles. The importance of understanding these interactions is growing as the potential rises for disturbance from oil and gas extraction, seabed mining and bottom trawling. Here we synthesize current knowledge of the nature, extent and time and space scales of vent and seep interactions with background systems. We document an expanded footprint beyond the site of local venting or seepage with respect to elemental cycling and energy flux, habitat use, trophic interactions, and connectivity. Heat and energy are released, global biogeochemical and elemental cycles are modified, and particulates are transported widely in plumes. Hard and biotic substrates produced at vents and seeps are used by “benthic background” fauna for attachment substrata, shelter, and access to food via grazing or through position in the current, while particulates and fluid fluxes modify planktonic microbial communities. Chemosynthetic production provides nutrition to a host of benthic and planktonic heterotrophic background species through multiple horizontal and vertical transfer pathways assisted by flow, gamete release, animal movements, and succession, but these pathways remain poorly known. Shared species, genera and families indicate that ecological and evolutionary connectivity exists among vents, seeps, organic falls and background communities in the deep sea; the genetic linkages with inactive vents and seeps and background assemblages however, are practically unstudied. The waning of venting or seepage activity generates major transitions in space and time that create links to surrounding ecosystems, often with identifiable ecotones or successional stages. The nature of all these interactions is dependent on water depth, as well as regional oceanography and biodiversity. Many ecosystem services are associated with the interactions and transitions between chemosynthetic and background ecosystems, for example carbon cycling and sequestration, fisheries production, and a host of non-market and cultural services. The quantification of the sphere of influence of vents and seeps could be beneficial to better management of deep-sea environments in the face of growing industrialization.

21 CFR 225.1 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Current good manufacturing practice. 225.1 Section...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR MEDICATED FEEDS General Provisions § 225.1 Current good manufacturing practice. (a) Section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act...

21 CFR 210.1 - Status of current good manufacturing practice regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Status of current good manufacturing practice... SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING, PROCESSING, PACKING, OR HOLDING OF DRUGS; GENERAL § 210.1 Status of current good manufacturing practice regulations...

21 CFR 226.1 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Current good manufacturing practice. 226.1 Section...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR TYPE A MEDICATED ARTICLES General Provisions § 226.1 Current good manufacturing practice. (a) The criteria in §§ 226.10 through 226.115, inclusive...

Connecting Schools and Families: Understanding the Influence of Home Literacy Practices

ERIC Educational Resources Information Center

Curry, Daphney L.; Reeves, Emily; Mcintyre, Christina J.

2016-01-01

Home literacy practices are extremely important in developing early language and literacy skills. Children from lower socioeconomic status (SES) backgrounds may be at risk, not because their family literacy practices are inferior, but because their culturally defined literacy practices may not be consistent with school literacy expectations. To…

Culturally Responsive Evaluation Meets Systems-Oriented Evaluation

ERIC Educational Resources Information Center

Thomas, Veronica G.; Parsons, Beverly A.

2017-01-01

The authors of this article each bring a different theoretical background to their evaluation practice. The first author has a background of attention to culturally responsive evaluation (CRE), while the second author has a background of attention to systems theories and their application to evaluation. Both have had their own evolution of…

Impact of Antimicrobial Stewardship on Physician Practice in a Geriatric Facility

PubMed Central

Kassett, Nina; Sham, Rosalind; Aleong, Rosanne; Yang, Daisy; Kirzner, Michael; Craft, Aidlee

2016-01-01

Background There is a paucity of literature describing the implementation of antimicrobial stewardship programs (ASPs) in long-term care (LTC) facilities. The current study evaluated the impact of an ASP that was implemented across a geriatric facility, which included an inpatient specialty hospital and an LTC facility. The program included prospective audits with feedback, multidisciplinary education, information technology interventions, and guideline development. Objective To investigate the impact of the ASP on physicians’ prescribing practices in this geriatric facility. Methods Utilization data for antibiotics commonly used to treat urinary tract infections were retrieved for the period September 1, 2011, to August 31, 2013. The study examined whether there were significant changes in overall antibiotic use, ciprofloxacin use, and physician prescribing behaviour after program implementation in September 2012. Results There was no significant change in the total number of antibiotic prescriptions for urinary tract infections in the hospital or the LTC facility after ASP implementation. Significant reductions were seen in the average days of therapy initially prescribed and the actual days of therapy after ASP implementation in the LTC facility but not the hospital. Across both facilities, significant reductions were seen in the number of ciprofloxacin prescriptions. Conclusions The current study showed that an ASP can affect physicians’ antibiotic prescribing behaviour and antibiotic usage in an LTC environment. PMID:28123192

Interest in dental implantology and preferences for implant therapy: a survey of Victorian dentists.

PubMed

Cheung, M C; Kao, Plh; Lee, N; Sivathasan, D; Vong, C W; Zhu, J; Polster, A; Darby, I

2016-12-01

The purpose of this study was to gauge dentists' interest, knowledge and training in implantology, and to compare their treatment preferences with current literature. Subsequently, this information may be used to evaluate implantology education pathways. A cross-sectional postal survey of 600 randomly selected dentists registered with the Dental Practice Board of Victoria was conducted. Respondents were asked about background, interest and training in implantology, and implant treatment preferences. Results were analysed according to primary practice location, decade of graduation and attendance at continuing professional development (CPD) programmes. One hundred and seventy-six questionnaires were included for analysis. In general, dentists rate their implant knowledge, interest and enjoyment in restoring implants favourably. No differences were found between city and country practitioners, and different graduation decades. The level of CPD significantly influenced treatment preferences. Practitioners were generally unwilling to treat patients taking bisphosphonates, or to perform grafting procedures. Most dentists provide common services to treat peri-implant conditions. Direct-to-fixture is the most popular fixture-abutment connection. Overall, there is a high level of implant knowledge corresponding to current evidence in the literature. Level of CPD attendance is the most important factor in dentists' willingness to provide more implant therapy options. © 2016 Australian Dental Association.

A horizon scan of future threats and opportunities for pollinators and pollination.

PubMed

Brown, Mark J F; Dicks, Lynn V; Paxton, Robert J; Baldock, Katherine C R; Barron, Andrew B; Chauzat, Marie-Pierre; Freitas, Breno M; Goulson, Dave; Jepsen, Sarina; Kremen, Claire; Li, Jilian; Neumann, Peter; Pattemore, David E; Potts, Simon G; Schweiger, Oliver; Seymour, Colleen L; Stout, Jane C

2016-01-01

Background. Pollinators, which provide the agriculturally and ecologically essential service of pollination, are under threat at a global scale. Habitat loss and homogenisation, pesticides, parasites and pathogens, invasive species, and climate change have been identified as past and current threats to pollinators. Actions to mitigate these threats, e.g., agri-environment schemes and pesticide-use moratoriums, exist, but have largely been applied post-hoc. However, future sustainability of pollinators and the service they provide requires anticipation of potential threats and opportunities before they occur, enabling timely implementation of policy and practice to prevent, rather than mitigate, further pollinator declines. Methods.Using a horizon scanning approach we identified issues that are likely to impact pollinators, either positively or negatively, over the coming three decades. Results.Our analysis highlights six high priority, and nine secondary issues. High priorities are: (1) corporate control of global agriculture, (2) novel systemic pesticides, (3) novel RNA viruses, (4) the development of new managed pollinators, (5) more frequent heatwaves and drought under climate change, and (6) the potential positive impact of reduced chemical use on pollinators in non-agricultural settings. Discussion. While current pollinator management approaches are largely driven by mitigating past impacts, we present opportunities for pre-emptive practice, legislation, and policy to sustainably manage pollinators for future generations.

A horizon scan of future threats and opportunities for pollinators and pollination

PubMed Central

Dicks, Lynn V.; Paxton, Robert J.; Baldock, Katherine C.R.; Barron, Andrew B.; Chauzat, Marie-Pierre; Freitas, Breno M.; Goulson, Dave; Jepsen, Sarina; Kremen, Claire; Li, Jilian; Neumann, Peter; Pattemore, David E.; Potts, Simon G.; Schweiger, Oliver; Seymour, Colleen L.; Stout, Jane C.

2016-01-01

Background. Pollinators, which provide the agriculturally and ecologically essential service of pollination, are under threat at a global scale. Habitat loss and homogenisation, pesticides, parasites and pathogens, invasive species, and climate change have been identified as past and current threats to pollinators. Actions to mitigate these threats, e.g., agri-environment schemes and pesticide-use moratoriums, exist, but have largely been applied post-hoc. However, future sustainability of pollinators and the service they provide requires anticipation of potential threats and opportunities before they occur, enabling timely implementation of policy and practice to prevent, rather than mitigate, further pollinator declines. Methods.Using a horizon scanning approach we identified issues that are likely to impact pollinators, either positively or negatively, over the coming three decades. Results.Our analysis highlights six high priority, and nine secondary issues. High priorities are: (1) corporate control of global agriculture, (2) novel systemic pesticides, (3) novel RNA viruses, (4) the development of new managed pollinators, (5) more frequent heatwaves and drought under climate change, and (6) the potential positive impact of reduced chemical use on pollinators in non-agricultural settings. Discussion. While current pollinator management approaches are largely driven by mitigating past impacts, we present opportunities for pre-emptive practice, legislation, and policy to sustainably manage pollinators for future generations. PMID:27602260

Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations' approach.

PubMed

Wathuta, Jane

2016-11-10

The United Nations's (UN) sustainable development goals (SDGs) include the target (3.3) of ending the HIV/AIDS epidemic by 2030. A major challenge in this regard is to curb the incidence of HIV among adolescents, the number two cause of their death in Africa. In Eastern and Southern Africa, they are mainly infected through heterosexual transmission. Research findings about parental influence on the sexual behavior of their adolescent children are reviewed and findings indicate that parental communication, monitoring and connectedness contribute to the avoidance of risky sexual behavior in adolescents. This article evaluates the extent to which these three dimensions of parenting have been factored in to current HIV prevention recommendations relating to adolescent boys and girls. Four pertinent UN reports are analyzed and the results used to demonstrate that the positive role of parents or primary caregivers vis-à-vis risky sexual behavior has tendentially been back-grounded or even potentially undermined. A more explicit inclusion of parents in adolescent HIV prevention policy and practice is essential - obstacles notwithstanding - enabling their indispensable partnership towards ending an epidemic mostly driven by sexual risk behavior. Evidence from successful or promising projects is included to illustrate the practical feasibility and fruitfulness of this approach.

Current UK practices in the management of subacromial impingement

PubMed Central

Drury, Colin; Tait, Gavin R

2015-01-01

Background Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. Methods BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Results Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Conclusions Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections. PMID:27582972

Blood doping by cobalt. Should we measure cobalt in athletes?

PubMed Central

Lippi, Giuseppe; Franchini, Massimo; Guidi, Gian Cesare

2006-01-01

Background Blood doping is commonplace in competitive athletes who seek to enhance their aerobic performances through illicit techniques. Presentation of the hypothesis Cobalt, a naturally-occurring element with properties similar to those of iron and nickel, induces a marked and stable polycythemic response through a more efficient transcription of the erythropoietin gene. Testing the hypothesis Although little information is available so far on cobalt metabolism, reference value ranges or supplementation in athletes, there is emerging evidence that cobalt is used as a supplement and increased serum concentrations are occasionally observed in athletes. Therefore, given the athlete's connatural inclination to experiment with innovative, unfair and potentially unhealthy doping techniques, cobalt administration might soon become the most suited complement or surrogate for erythropoiesis-stimulating substances. Nevertheless, cobalt administration is not free from unsafe consequences, which involve toxic effects on heart, liver, kidney, thyroid and cancer promotion. Implications of the hypothesis Cobalt is easily purchasable, inexpensive and not currently comprehended within the World Anti-Doping Agency prohibited list. Moreover, available techniques for measuring whole blood, serum, plasma or urinary cobalt involve analytic approaches which are currently not practical for antidoping laboratories. Thus more research on cobalt metabolism in athletes is compelling, along with implementation of effective strategies to unmask this potentially deleterious doping practice PMID:16863591

Resources and practices to help graduate students and postdoctoral fellows write statements of teaching philosophy.

PubMed

Kearns, Katherine D; Sullivan, Carol Subiño

2011-06-01

Graduate students and postdoctoral fellows currently encounter requests for a statement of teaching philosophy in at least half of academic job announcements in the United States. A systematic process for the development of a teaching statement is required that integrates multiple sources of support, informs writers of the document's purpose and audience, helps writers produce thoughtful statements, and encourages meaningful reflection on teaching and learning. This article for faculty mentors and instructional consultants synthesizes practices for mentoring graduate students, postdoctoral fellows, and junior faculty members as they prepare statements of teaching philosophy. We review background information on purposes and audiences, provide writing resources, and synthesize empirical research on the use of teaching statements in academic job searches. In addition, we integrate these resources into mentoring processes that have helped graduate students in a Health Sciences Pedagogy course to collaboratively and critically examine and write about their teaching. This summary is intended for faculty mentors and instructional consultants who want to refine current resources or establish new mentoring programs. This guide also may be useful to graduate students, postdoctoral fellows, and junior faculty members, especially those who lack mentoring or who seek additional resources, as they consider the many facets of effective teaching.

Awareness and practice of emergency contraception at a private university in Nigeria.

PubMed

Awoleke, Jacob Olumuyiwa; Adanikin, Abiodun Idowu; Awoleke, Adeola; Odanye, Moyinoluwa

2015-06-04

The pursuit of formal education now causes many people in developing countries to marry later in life, thereby leading to increased premarital sex and unintended pregnancies. Efforts have been made to characterize awareness and use of emergency contraception (EC) among undergraduate students in public universities in Nigeria; however, it is not known if students in private tertiary institutions adopt different practices or if having an affluent family background plays a role. This pilot study therefore aimed to assess the awareness and use of EC among students at a private Nigerian university toward assisting education planners in developing strategies in improving students' reproductive well-being. Out of 94 female students, 42 (44.7%) had sexual experience, but only 32 (34.0%) were currently sexually active. Six students (6.4%) had had unwanted pregnancies, of which all but one were terminated. Fifty-seven respondents (60.6%) were aware of EC, though only 10 (10.6%) ever practiced it. The greatest source of EC information was from health workers and peers; the lowest source was family or relatives. Most respondents desired orientation and availability of EC on campus. EC awareness among the students was predicted by upper social class background (adjusted odds ratio [OR], 2.73; 95% confidence interval [CI], 1.06-7.45) and upbringing in the Federal Capital Territory (adjusted OR, 4.45; 95% CI, 1.56-14.22). Though awareness of EC was higher among the private university students in this study than at most public universities, there was no difference in EC usage. A high pregnancy termination rate was observed; dilatation and curettage were mainly adopted. In Nigeria, youth-friendly reproductive health information and access should not be limited to government-owned tertiary institutions but also extended to private ones.

Committee Opinion no. 513: vaginal placement of synthetic mesh for pelvic organ prolapse.

PubMed

2011-12-01

Since 2004, use of synthetic mesh has increased in vaginal surgery for the treatment of pelvic organ prolapse. However, concerns exist about the safety and efficacy of transvaginally placed mesh. Based on the currently available limited data, although many patients undergoing mesh-augmented vaginal repairs heal well without problems, there seems to be a small but significant group of patients who experience permanent and life-altering sequelae, including pain and dyspareunia, from the use of vaginal mesh. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society provide background information on the use of vaginally placed mesh for the treatment of pelvic organ prolapse and offer recommendations for practice.

Vaginal placement of synthetic mesh for pelvic organ prolapse.

PubMed

2012-01-01

Since 2004, use of synthetic mesh has increased in vaginal surgery for the treatment of pelvic organ prolapse. However, concerns exist about the safety and efficacy of transvaginally placed mesh. Based on the currently available limited data, although many patients undergoing mesh-augmented vaginal repairs heal well without problems, there seems to be a small but significant group of patients who experience permanent and life-altering sequelae, including pain and dyspareunia, from the use of vaginal mesh. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society provide background information on the use of vaginally placed mesh for the treatment of pelvic organ prolapse and offer recommendations for practice.

Interference of magnesium corrosion with tetrazolium-based cytotoxicity assays.

PubMed

Fischer, Janine; Prosenc, Marc H; Wolff, Martin; Hort, Norbert; Willumeit, Regine; Feyerabend, Frank

2010-05-01

Magnesium (Mg) alloys are promising materials for the development of biodegradable implants. However, the current in vitro test procedures for cytotoxicity, cell viability and proliferation are not always suitable for this class of materials. In this paper we show that tetrazolium-salt-based assays, which are widely used in practice, are influenced by the corrosion products of Mg-based alloys. Corroded Mg converts tetrazolium salts to formazan, leading to a higher background and falsifying the results of cell viability. Tetrazolium-based assays are therefore not a useful tool for testing the cytotoxicity of Mg in static in vitro assays. Copyright (c) 2009 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

75 FR 49233 - Amendments to Form ADV

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

...The Securities and Exchange Commission is adopting amendments to Part 2 of Form ADV, and related rules under the Investment Advisers Act, to require investment advisers registered with us to provide new and prospective clients with a brochure and brochure supplements written in plain English. These amendments are designed to provide new and prospective advisory clients with clearly written, meaningful, current disclosure of the business practices, conflicts of interest and background of the investment adviser and its advisory personnel. Advisers must file their brochures with us electronically and we will make them available to the public through our Web site. The Commission also is withdrawing the Advisers Act rule requiring advisers to disclose certain disciplinary and financial information.

Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium†

PubMed Central

Kennedy, Ann B.; Cambron, Jerrilyn A.; Sharpe, Patricia A.; Travillian, Ravensara S.; Saunders, Ruth P.

2016-01-01

Background Massage therapists are at times unclear about the definition of massage therapy, which creates challenges for the profession. It is important to investigate the current definitions and to consider the field as a whole in order to move toward clarity on what constitutes the constructs within the profession. Purpose To determine how a sample of experts understand and describe the field of massage therapy as a step toward clarifying definitions for massage and massage therapy, and framing the process of massage therapy practice. Setting A two-day symposium held in 2010 with the purpose of gathering knowledge to inform and aid in the creation of massage therapy best practice guidelines for stress and low back pain. Participants Thirty-two experts in the field of massage therapy from the United States, Europe, and Canada. Design Qualitative analysis of secondary cross-sectional data using a grounded theory approach. Results Three over-arching themes were identified: 1) What is massage?; 2) The multidimensional nature of massage therapy; and 3) The influencing factors on massage therapy practice. Discussion The data offered clarifying definitions for massage and massage therapy, as well as a framework for the context for massage therapy practice. These clarifications can serve as initial steps toward the ultimate goal of creating new theory for the field of massage therapy, which can then be applied in practice, education, research, and policy. Conclusions Foundational research into how experts in the profession understand and describe the field of massage therapy is limited. Understanding the potential differences between the terms massage and massage therapy could contribute to a transformation in the profession in the areas of education, practice, research, policy and/or regulation. Additionally, framing the context for massage therapy practice invites future discussions to further clarify practice issues. PMID:27648109

Reverse Current Shock Induced by Plasma-Neutral Collision

NASA Astrophysics Data System (ADS)

Wongwaitayakornkul, Pakorn; Haw, Magnus; Li, Hui; Li, Shengtai; Bellan, Paul

2017-10-01

The Caltech solar experiment creates an arched plasma-filled flux rope expanding into low density background plasma. A layer of electrical current flowing in the opposite direction with respect to the flux rope current is induced in the background plasma just ahead of the flux rope. Two dimensional spatial and temporal measurements by a 3-dimensional magnetic vector probe demonstrate the existence of this induced current layer forming ahead of the flux rope. The induced current magnitude is 20% of the magnitude of the current in the flux rope. The reverse current in the low density background plasma is thought to be a diamagnetic response that shields out the magnetic field ahead of the propagation. The spatial and magnetic characteristics of the reverse current layer are consistent with similar shock structures seen in 3-dimensional ideal MHD numerical simulations performed on the Turquoise supercomputer cluster using the Los Alamos COMPutational Astrophysics Simulation Suite. This discovery of the induced diamagnetic current provides useful insights for space and solar plasma.

21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false What is current good manufacturing practice for... HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR POSITRON EMISSION TOMOGRAPHY DRUGS (Eff. 12-12-2011) General Provisions § 212.2 What is current good manufacturing practice for...

21 CFR 1271.150 - Current good tissue practice requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Current good tissue practice requirements. 1271... HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.150 Current good tissue practice requirements. (a) General. This subpart D and subpart C of this part set...

Robotic Surgery

PubMed Central

Lanfranco, Anthony R.; Castellanos, Andres E.; Desai, Jaydev P.; Meyers, William C.

2004-01-01

Objective: To review the history, development, and current applications of robotics in surgery. Background: Surgical robotics is a new technology that holds significant promise. Robotic surgery is often heralded as the new revolution, and it is one of the most talked about subjects in surgery today. Up to this point in time, however, the drive to develop and obtain robotic devices has been largely driven by the market. There is no doubt that they will become an important tool in the surgical armamentarium, but the extent of their use is still evolving. Methods: A review of the literature was undertaken using Medline. Articles describing the history and development of surgical robots were identified as were articles reporting data on applications. Results: Several centers are currently using surgical robots and publishing data. Most of these early studies report that robotic surgery is feasible. There is, however, a paucity of data regarding costs and benefits of robotics versus conventional techniques. Conclusions: Robotic surgery is still in its infancy and its niche has not yet been well defined. Its current practical uses are mostly confined to smaller surgical procedures. PMID:14685095

Linguistic Predictors of Cultural Identification in Bilinguals

PubMed Central

Schroeder, Scott R.; Lam, Tuan Q.; Marian, Viorica

2016-01-01

Most of the world's population has knowledge of at least two languages. Many of these bilinguals are also exposed to and identify with at least two cultures. Because language knowledge enables participation in cultural practices and expression of cultural beliefs, bilingual experience and cultural identity are interconnected. However, the specific links between bilingualism and cultural identity remain largely unidentified. The current study examined which aspects of bilingualism relate to identification with first- and second-language cultures. Two-hundred-and-nine bilinguals completed a questionnaire probing linguistic background and cultural affiliations. Regression analyses indicated that cultural identification was predicted by age of language acquisition, language proficiency, foreign-accentedness, and contexts of long-term language immersion and current language exposure. Follow-up analyses revealed that the language-culture relations were mediated by the age and manner in which the second language was acquired. These findings are situated within a proposed framework of bilingual cultural identity. By identifying features of bilingualism that are relevant for cultural identity, the current research increases our understanding of the relationship between language and culture. PMID:28936014

Substance consumption in adolescents with and without an immigration background: a representative study-What part of an immigration background is protective against binge drinking?

PubMed

Donath, Carolin; Baier, Dirk; Graessel, Elmar; Hillemacher, Thomas

2016-11-14

Representative data indicate that adolescents with an immigration background show less harmful patterns of consumption, for example, they practice binge drinking less often. It remains to be shown whether this also applies to substances such as tobacco and cannabis and if the "healthier" patterns of consumption are permanent or if they gradually disappear as the level of integration increases. Using representative data, the current study was designed to a) present the epidemiology of the consumption of alcohol, tobacco, and cannabis of adolescents with and without an immigration background in 2013 and b) to analyze which immigration-specific variables predict problematic alcohol consumption in adolescents with an immigration background. A representative, written survey was administered to 9512 students in the 9th grade from Lower Saxony, Germany in 2013 by the "Kriminologisches Forschungsinstitut Niedersachsen (KfN)." Data were collected from 1763 adolescents with an immigration background regarding their cultural, structural, social, and identificative integration. These variables were introduced as predictors in a multiple logistic regression analysis with binge drinking during the last 30 days as the dependent variable. Compared with German adolescents without an immigration background, significantly fewer adolescents with an immigration background had already tried alcohol, but they were significantly more likely to report experience with cigarettes and cannabis. In the group of adolescents with an immigration background, the percentage of binge drinkers fluctuated by country of origin (p < .001). In the regression model, binge drinking was associated with a lower targeted school leaving certificate (p < .001), not living on social welfare (p = .038), and the strong assimilation (p = .015) of the adolescent. Binge drinking was negatively associated with attitudes that favored segregation (p < .001) and a stronger attachment of the parents to the traditions of their country of origin (p = .003). It cannot be confirmed that adolescents with an immigration background generally show less harmful patterns of consumption. Distinctions have to be made regarding the substance, the adolescent's country of origin, and the level of assimilation or segregation of the adolescent and his/her family.

75 FR 27327 - National Institute on Disability and Rehabilitation Research (NIDRR)-Disability and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-14

... Centers (RRTCs)-- Effective Vocational Rehabilitation (VR) Service Delivery Practices Catalog of Federal... priority for an RRTC on Effective Vocational Rehabilitation (VR) Service Delivery Practices. The Assistant... priority. Effective Vocational Rehabilitation (VR) Service Delivery Practices Background: The...

Analyzing the Teaching of Professional Practice

ERIC Educational Resources Information Center

Moss, Pamela A.

2011-01-01

Background/Context: Based on their case studies of preparation for professional practice in the clergy, teaching, and clinical psychology, Grossman and colleagues (2009) identified three key concepts for analyzing and comparing practice in professional education--representations, decomposition, and approximations--to support professional educators…

Permaculture: Dreamworld or Breakthrough?

ERIC Educational Resources Information Center

Johns, Maria

1992-01-01

Compares present agriculture practices to permaculture farming techniques, presents a historical perspective of permaculture and where these techniques are being successfully practiced around the world. Inserts (vignettes) enumerate the principles of permaculture and the background of Bill Mollison who conceptualized this farming practice. (MCO)

Film and Visual Perception

ERIC Educational Resources Information Center

Giltrow, David

1978-01-01

One practical method which development film makers can adopt to increase comprehension of important scenes is to eliminate extraneous background information by putting it out of focus, or by shooting against plain backgrounds. (Author/STS)

Water Consumption in European Children: Associations with Intake of Fruit Juices, Soft Drinks and Related Parenting Practices

PubMed Central

Mantziki, Krystallia; Renders, Carry M.; Seidell, Jaap C.

2017-01-01

Background: High intake of fruit juices and soft drinks contributes to excessive weight gain and obesity in children. Furthermore, parenting practices play an important role in the development of children’s dietary habits. The way parents play this role in the development of their children’s choices of beverages is still unclear. Objectives: To study the associations: (1) of both fruit juices and soft drinks consumption with water consumption of children and (2) The associations between parenting practices towards fruit juices and soft drinks and water consumption of children. Design: Cross-sectional data from 6 to 8 year old children from seven European communities (n = 1187) were collected. Associations among fruit juices, soft drinks, the respective parenting practices and the child’s water consumption were assessed by parental questionnaires. Results: The consumption of water was inversely associated with that of soft drinks but not with the consumption of fruit juices. The child’s water intake was favorably influenced when stricter parenting practices towards soft drinks were adopted (e.g., less parental allowance, low home availability and high parental self-efficacy in managing intake). There was less influence observed of parenting practices towards fruit juices. Fruit juices were consumed more often than soft drinks. Conclusions: Low consumption of soft drinks—and not of fruit juices—was associated with high water consumption in children in the current study. Moreover, parenting practices towards both fruit juices and soft drinks were associated with the water intake of the children, irrespective of their socio-economic status. PMID:28561769

Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain

PubMed Central

2014-01-01

Background Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of adherence to the national CPG for low back pain by Dutch physical therapists. Methods We systematically developed a program to improve adherence to the Dutch physical therapy guidelines for low back pain. Based on multi-method formative research, we formulated program and change objectives. Selected theory-based methods of change and practical applications were combined into an intervention program. Implementation and evaluation plans were developed. Results Formative research revealed influential determinants for physical therapists and practice quality managers. Self-regulation was appropriate because both the physical therapists and the practice managers needed to monitor current practice and make and implement plans for change. The program stimulated interaction between practice levels by emphasizing collective goal setting. It combined practical applications, such as knowledge transfer and discussion-and-feedback, based on theory-based methods, such as consciousness raising and active learning. The implementation plan incorporated the wider environment. The evaluation plan included an effect and process evaluation. Conclusions Intervention Mapping is a useful framework for formative data in program planning in the field of clinical guideline implementation. However, a decision aid to select determinants of guideline adherence identified in the formative research to analyse the problem may increase the efficiency of the application of the Intervention Mapping process. PMID:24428945

Water Consumption in European Children: Associations with Intake of Fruit Juices, Soft Drinks and Related Parenting Practices.

PubMed

Mantziki, Krystallia; Renders, Carry M; Seidell, Jaap C

2017-05-31

Background : High intake of fruit juices and soft drinks contributes to excessive weight gain and obesity in children. Furthermore, parenting practices play an important role in the development of children's dietary habits. The way parents play this role in the development of their children's choices of beverages is still unclear. Objectives : To study the associations: (1) of both fruit juices and soft drinks consumption with water consumption of children and (2) The associations between parenting practices towards fruit juices and soft drinks and water consumption of children. Design : Cross-sectional data from 6 to 8 year old children from seven European communities ( n = 1187) were collected. Associations among fruit juices, soft drinks, the respective parenting practices and the child's water consumption were assessed by parental questionnaires. Results : The consumption of water was inversely associated with that of soft drinks but not with the consumption of fruit juices. The child's water intake was favorably influenced when stricter parenting practices towards soft drinks were adopted (e.g., less parental allowance, low home availability and high parental self-efficacy in managing intake). There was less influence observed of parenting practices towards fruit juices. Fruit juices were consumed more often than soft drinks. Conclusions : Low consumption of soft drinks-and not of fruit juices-was associated with high water consumption in children in the current study. Moreover, parenting practices towards both fruit juices and soft drinks were associated with the water intake of the children, irrespective of their socio-economic status.

Application of a faith-based integration tool to assess mental and physical health interventions

PubMed Central

Saunders, Donna M.; Leak, Jean; Carver, Monique E.; Smith, Selina A.

2017-01-01

Background To build on current research involving faith-based interventions (FBIs) for addressing mental and physical health, this study a) reviewed the extent to which relevant publications integrate faith concepts with health and b) initiated analysis of the degree of FBI integration with intervention outcomes. Methods Derived from a systematic search of articles published between 2007 and 2017, 36 studies were assessed with a Faith-Based Integration Assessment Tool (FIAT) to quantify faith-health integration. Basic statistical procedures were employed to determine the association of faith-based integration with intervention outcomes. Results The assessed studies possessed (on average) moderate, inconsistent integration because of poor use of faith measures, and moderate, inconsistent use of faith practices. Analysis procedures for determining the effect of FBI integration on intervention outcomes were inadequate for formulating practical conclusions. Conclusions Regardless of integration, interventions were associated with beneficial outcomes. To determine the link between FBI integration and intervention outcomes, additional analyses are needed. PMID:29354795

Core informatics competencies for clinical and translational scientists: what do our customers and collaborators need to know?

PubMed Central

Valenta, Annette L; Meagher, Emma A; Tachinardi, Umberto

2016-01-01

Since the inception of the Clinical and Translational Science Award (CTSA) program in 2006, leaders in education across CTSA sites have been developing and updating core competencies for Clinical and Translational Science (CTS) trainees. By 2009, 14 competency domains, including biomedical informatics, had been identified and published. Since that time, the evolution of the CTSA program, changes in the practice of CTS, the rapid adoption of electronic health records (EHRs), the growth of biomedical informatics, the explosion of big data, and the realization that some of the competencies had proven to be difficult to apply in practice have made it clear that the competencies should be updated. This paper describes the process undertaken and puts forth a new set of competencies that has been recently endorsed by the Clinical Research Informatics Workgroup of AMIA. In addition to providing context and background for the current version of the competencies, we hope this will serve as a model for revision of competencies over time. PMID:27121608

Six ways of experiencing information literacy in nursing: the findings of a phenomenographic study.

PubMed

Forster, Marc

2015-01-01

Information literacy plays a vital role in evidence-based practice in nursing. However there is currently little evidence to show how being information literate is actually experienced by nurses and therefore information literacy educational interventions are not genuinely evidence-based. Are they promoting the appropriate knowledge and skills to help nurses find and use the research evidence they need? To investigate how being information literate is experienced by nurses. To use the insights obtained to develop a description of the parameters of information literacy in nursing, including those of its role and value in evidence-based practice. Phenomenography. 41 UK nurses of varying experience, specialism and background. Open-ended interviews. 7 contexts in which information literacy is experienced, were mapped out and 6 representative ways of being an information literate nurse, in increasing levels of depth and sophistication, were described. These findings may form the basis of future evidence-based information literacy education programmes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Prevalence of Parental Smoking and Predictors of Cessation: A Study in the South Carolina Pediatric Practice Research Network

PubMed Central

Roberts, James R.; Basco, William T.; Hulsey, Thomas C.; Ebeling, Myla D.; O’Brien, Elizabeth; Alberg, Anthony J.

2015-01-01

Background Secondhand smoke exposure harms children. The objectives of the study were to determine the prevalence of secondhand smoke exposure in children ≤2 years and determine the predictors of smoking and smoking cessation in parents. Methods We surveyed parents of children ≤2 years of age, asking about parental smoking patterns, interest in quitting and children’s respiratory symptoms. Data were analyzed with chi-square and multiple logistic regression. Results Thirteen percent were current smokers and 18% had quit. The most common reason for quitting was being pregnant (42%). Children’s respiratory symptoms did not predict quitting. Parents on Medicaid were more likely to smoke than those on private insurance (OR = 5.7, 95% CI = 2.0–16.5) and less likely to quit (OR = 0.2, 95% CI = 0.1–0.9). Conclusion Having a new baby may be a motivator for parents to quit. We must address socioeconomic factors to develop a successful intervention in pediatric practices. PMID:25520365

3D printing in neurosurgery: A systematic review

PubMed Central

Randazzo, Michael; Pisapia, Jared M.; Singh, Nickpreet; Thawani, Jayesh P.

2016-01-01

Background: The recent expansion of three-dimensional (3D) printing technology into the field of neurosurgery has prompted a widespread investigation of its utility. In this article, we review the current body of literature describing rapid prototyping techniques with applications to the practice of neurosurgery. Methods: An extensive and systematic search of the Compendex, Scopus, and PubMed medical databases was conducted using keywords relating to 3D printing and neurosurgery. Results were manually screened for relevance to applications within the field. Results: Of the search results, 36 articles were identified and included in this review. The articles spanned the various subspecialties of the field including cerebrovascular, neuro-oncologic, spinal, functional, and endoscopic neurosurgery. Conclusions: We conclude that 3D printing techniques are practical and anatomically accurate methods of producing patient-specific models for surgical planning, simulation and training, tissue-engineered implants, and secondary devices. Expansion of this technology may, therefore, contribute to advancing the neurosurgical field from several standpoints. PMID:27920940

Interleukin and interleukin receptor gene polymorphisms in inflammatory bowel diseases susceptibility.

PubMed

Magyari, Lili; Kovesdi, Erzsebet; Sarlos, Patricia; Javorhazy, Andras; Sumegi, Katalin; Melegh, Bela

2014-03-28

Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), represents a group of chronic inflammatory disorders caused by dysregulated immune responses in genetically predisposed individuals. Genetic markers are associated with disease phenotype and long-term evolution, but their value in everyday clinical practice is limited at the moment. IBD has a clear immunological background and interleukins play key role in the process. Almost 130 original papers were revised including meta-analysis. It is clear these data are very important for understanding the base of the disease, especially in terms of clinical utility and validity, but text often do not available for the doctors use these in the clinical practice nowadays. We conducted a systematic review of the current literature on interleukin and interleukin receptor gene polymorphisms associated with IBD, performing an electronic search of PubMed Database from publications of the last 10 years, and used the following medical subject heading terms and/or text words: IBD, CD, UC, interleukins and polymorphisms.

Interleukin and interleukin receptor gene polymorphisms in inflammatory bowel diseases susceptibility

PubMed Central

Magyari, Lili; Kovesdi, Erzsebet; Sarlos, Patricia; Javorhazy, Andras; Sumegi, Katalin; Melegh, Bela

2014-01-01

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), represents a group of chronic inflammatory disorders caused by dysregulated immune responses in genetically predisposed individuals. Genetic markers are associated with disease phenotype and long-term evolution, but their value in everyday clinical practice is limited at the moment. IBD has a clear immunological background and interleukins play key role in the process. Almost 130 original papers were revised including meta-analysis. It is clear these data are very important for understanding the base of the disease, especially in terms of clinical utility and validity, but text often do not available for the doctors use these in the clinical practice nowadays. We conducted a systematic review of the current literature on interleukin and interleukin receptor gene polymorphisms associated with IBD, performing an electronic search of PubMed Database from publications of the last 10 years, and used the following medical subject heading terms and/or text words: IBD, CD, UC, interleukins and polymorphisms. PMID:24695754

Comparison of software packages for detecting differential expression in RNA-seq studies

PubMed Central

Seyednasrollah, Fatemeh; Laiho, Asta

2015-01-01

RNA-sequencing (RNA-seq) has rapidly become a popular tool to characterize transcriptomes. A fundamental research problem in many RNA-seq studies is the identification of reliable molecular markers that show differential expression between distinct sample groups. Together with the growing popularity of RNA-seq, a number of data analysis methods and pipelines have already been developed for this task. Currently, however, there is no clear consensus about the best practices yet, which makes the choice of an appropriate method a daunting task especially for a basic user without a strong statistical or computational background. To assist the choice, we perform here a systematic comparison of eight widely used software packages and pipelines for detecting differential expression between sample groups in a practical research setting and provide general guidelines for choosing a robust pipeline. In general, our results demonstrate how the data analysis tool utilized can markedly affect the outcome of the data analysis, highlighting the importance of this choice. PMID:24300110

Comparison of software packages for detecting differential expression in RNA-seq studies.

PubMed

Seyednasrollah, Fatemeh; Laiho, Asta; Elo, Laura L

2015-01-01

RNA-sequencing (RNA-seq) has rapidly become a popular tool to characterize transcriptomes. A fundamental research problem in many RNA-seq studies is the identification of reliable molecular markers that show differential expression between distinct sample groups. Together with the growing popularity of RNA-seq, a number of data analysis methods and pipelines have already been developed for this task. Currently, however, there is no clear consensus about the best practices yet, which makes the choice of an appropriate method a daunting task especially for a basic user without a strong statistical or computational background. To assist the choice, we perform here a systematic comparison of eight widely used software packages and pipelines for detecting differential expression between sample groups in a practical research setting and provide general guidelines for choosing a robust pipeline. In general, our results demonstrate how the data analysis tool utilized can markedly affect the outcome of the data analysis, highlighting the importance of this choice. © The Author 2013. Published by Oxford University Press.

Current and future health care professionals attitudes toward and knowledge of statistics: How confidence influences learning

PubMed Central

Baghi, Heibatollah; Kornides, Melanie L.

2014-01-01

Background Health care professionals require some understanding of statistics to successfully implement evidence based practice. Developing competency in statistical reasoning is necessary for students training in health care administration, research, and clinical care. Recently, the interest in healthcare professional's attitudes toward statistics has increased substantially due to evidence that these attitudes can hinder professionalism developing an understanding of statistical concepts. Methods In this study, we analyzed pre- and post-instruction attitudes towards and knowledge of statistics obtained from health science graduate students, including nurses and nurse practitioners, enrolled in an introductory graduate course in statistics (n = 165). Results and Conclusions Results show that the students already held generally positive attitudes toward statistics at the beginning of course. However, these attitudes—along with the students’ statistical proficiency—improved after 10 weeks of instruction. The results have implications for curriculum design and delivery methods as well as for health professionals’ effective use of statistics in critically evaluating and utilizing research in their practices. PMID:25419256

Overweight perception: associations with weight control goals, attempts and practices among Chinese female college students

PubMed Central

Tanenbaum, Hilary C.; Felicitas, Jamie Q.; Li, Yawen; Tobias, Malaika; Chou, Chih-Ping; Palmer, Paula H.; Spruijt-Metz, Donna; Reynolds, Kim D.; Johnson, C. Anderson; Xie, Bin

2015-01-01

Background Concurrent with the dramatic cultural and economic shifts occurring as Mainland China becomes increasingly “Westernized,” the weight perceptions, ideal body weight, and weight management goals and practices of Chinese females have also undergone significant changes. Objective To investigate relationships between overweight status, weight perception patterns, and weight management goals and practices in Chinese female college students. Design/Participants/Setting A cross-sectional analysis was conducted with data from 902 female subjects aged 18 to 25 years participating in the China Seven Cities Study, a health promotion and smoking prevention study conducted in Mainland China in 2003. Main Outcome Measures/ Statistical Analyses Logistic regression models were used to explore associations between overweight status, weight perception, specific weight management goals and practices, and current levels of vigorous-intensity physical activity and food consumption. Results Based on World Health Organization standards for Asian adults, 16.7% of college females were overweight or obese, although 50.8% considered themselves to be “too heavy.” Among participants perceiving themselves as overweight (n=458), 69.2% (n=371) were inaccurate, and did not meet criteria for overweight or obese. The percentage of participants attempting weight loss was 48.2%, and 33.1% wanted to maintain their current weight. Attempts to lose or maintain weight were related to actual and perceived weight status, but not to increased vigorous-intensity physical activity or fruit and vegetable intake, nor to decreased consumption of sweets, soda, Western fast foods and fried foods. Only 21.5% of participants desiring weight loss or maintenance reported using a combination of vigorous-intensity physical activity and a reduced fat and calorie diet, while 20.2% tried extreme methods such as fasting, using diet pills, vomiting, or smoking. Conclusions Our findings underscore the need to promote healthy weight management practices among Chinese female college students, with an emphasis on diet and physical activity strategies that encourage balance rather than extremes. PMID:26260670

Prevalence of urinary tract infection in acutely unwell children in general practice: a prospective study with systematic urine sampling

PubMed Central

O’Brien, Kathryn; Edwards, Adrian; Hood, Kerenza; Butler, Christopher C

2013-01-01

Background Urinary tract infection (UTI) in children may be associated with long-term complications that could be prevented by prompt treatment. Aim To determine the prevalence of UTI in acutely ill children ≤ 5 years presenting in general practice and to explore patterns of presenting symptoms and urine sampling strategies. Design and setting Prospective observational study with systematic urine sampling, in general practices in Wales, UK. Method In total, 1003 children were recruited from 13 general practices between March 2008 and July 2010. The prevalence of UTI was determined and multivariable analysis performed to determine the probability of UTI. Result Out of 597 (60.0%) children who provided urine samples within 2 days, the prevalence of UTI was 5.9% (95% confidence interval [CI] = 4.3% to 8.0%) overall, 7.3% in those < 3 years and 3.2% in 3–5 year olds. Neither a history of fever nor the absence of an alternative source of infection was associated with UTI (P = 0.64; P = 0.69, respectively). The probability of UTI in children aged ≥3 years without increased urinary frequency or dysuria was 2%. The probability of UTI was ≥5% in all other groups. Urine sampling based purely on GP suspicion would have missed 80% of UTIs, while a sampling strategy based on current guidelines would have missed 50%. Conclusion Approximately 6% of acutely unwell children presenting to UK general practice met the criteria for a laboratory diagnosis of UTI. This higher than previously recognised prior probability of UTI warrants raised awareness of the condition and suggests clinicians should lower their threshold for urine sampling in young children. The absence of fever or presence of an alternative source of infection, as emphasised in current guidelines, may not rule out UTI in young children with adequate certainty. PMID:23561695

Data sharing by scientists: Practices and perceptions

USGS Publications Warehouse

Tenopir, C.; Allard, S.; Douglass, K.; Aydinoglu, A.U.; Wu, L.; Read, E.; Manoff, M.; Frame, M.

2011-01-01

Background: Scientific research in the 21st century is more data intensive and collaborative than in the past. It is important to study the data practices of researchers - data accessibility, discovery, re-use, preservation and, particularly, data sharing. Data sharing is a valuable part of the scientific method allowing for verification of results and extending research from prior results. Methodology/Principal Findings: A total of 1329 scientists participated in this survey exploring current data sharing practices and perceptions of the barriers and enablers of data sharing. Scientists do not make their data electronically available to others for various reasons, including insufficient time and lack of funding. Most respondents are satisfied with their current processes for the initial and short-term parts of the data or research lifecycle (collecting their research data; searching for, describing or cataloging, analyzing, and short-term storage of their data) but are not satisfied with long-term data preservation. Many organizations do not provide support to their researchers for data management both in the short- and long-term. If certain conditions are met (such as formal citation and sharing reprints) respondents agree they are willing to share their data. There are also significant differences and approaches in data management practices based on primary funding agency, subject discipline, age, work focus, and world region. Conclusions/Significance: Barriers to effective data sharing and preservation are deeply rooted in the practices and culture of the research process as well as the researchers themselves. New mandates for data management plans from NSF and other federal agencies and world-wide attention to the need to share and preserve data could lead to changes. Large scale programs, such as the NSF-sponsored DataNET (including projects like DataONE) will both bring attention and resources to the issue and make it easier for scientists to apply sound data management principles. ?? 2011 Tenopir et al.

Data Sharing by Scientists: Practices and Perceptions

PubMed Central

Tenopir, Carol; Allard, Suzie; Douglass, Kimberly; Aydinoglu, Arsev Umur; Wu, Lei; Read, Eleanor; Manoff, Maribeth; Frame, Mike

2011-01-01

Background Scientific research in the 21st century is more data intensive and collaborative than in the past. It is important to study the data practices of researchers – data accessibility, discovery, re-use, preservation and, particularly, data sharing. Data sharing is a valuable part of the scientific method allowing for verification of results and extending research from prior results. Methodology/Principal Findings A total of 1329 scientists participated in this survey exploring current data sharing practices and perceptions of the barriers and enablers of data sharing. Scientists do not make their data electronically available to others for various reasons, including insufficient time and lack of funding. Most respondents are satisfied with their current processes for the initial and short-term parts of the data or research lifecycle (collecting their research data; searching for, describing or cataloging, analyzing, and short-term storage of their data) but are not satisfied with long-term data preservation. Many organizations do not provide support to their researchers for data management both in the short- and long-term. If certain conditions are met (such as formal citation and sharing reprints) respondents agree they are willing to share their data. There are also significant differences and approaches in data management practices based on primary funding agency, subject discipline, age, work focus, and world region. Conclusions/Significance Barriers to effective data sharing and preservation are deeply rooted in the practices and culture of the research process as well as the researchers themselves. New mandates for data management plans from NSF and other federal agencies and world-wide attention to the need to share and preserve data could lead to changes. Large scale programs, such as the NSF-sponsored DataNET (including projects like DataONE) will both bring attention and resources to the issue and make it easier for scientists to apply sound data management principles. PMID:21738610

Rural origin plus a rural clinical school placement is a significant predictor of medical students' intentions to practice rurally: a multi-university study.

PubMed

Walker, Judith H; Dewitt, Dawn E; Pallant, Julie F; Cunningham, Christine E

2012-01-01

Health workforce shortages are a major problem in rural areas. Australian medical schools have implemented a number of rural education and training interventions aimed at increasing medical graduates' willingness to work in rural areas. These initiatives include recruiting students from rural backgrounds, delivering training in rural areas, and providing all students with some rural exposure during their medical training. However there is little evidence regarding the impact of rural exposure versus rural origin on workforce outcomes. The aim of this study is to identify and assess factors affecting preference for future rural practice among medical students participating in the Australian Rural Clinical Schools (RCS) Program. Questionnaires were distributed to 166 medical students who had completed their RCS term in 2006; 125 (75%) responded. Medical students were asked about their preferred location and specialty for future practice, their beliefs about rural work and life, and the impact of the RCS experience on their future rural training and practice preferences. Almost half the students (47%; n=58) self-reported a 'rural background'. Significantly, students from rural backgrounds were 10 times more likely to prefer to work in rural areas when compared with other students (p<0.001). For those preferring general practice, 80% (n=24) wished to do so rurally. Eighty-five per cent (n=105) of students agreed that their RCS experience increased their interest in rural training and practice with 62% (n=75) of students indicating a preference for rural internship/basic training after their RCS experience. A substantial percentage (86%; n=108) agreed they would consider rural practice after their RCS experience. This baseline study provides significant evidence to support rural medical recruitment and retention through education and training, with important insights into the factors affecting preference for future rural practice. By far the most significant predictor of rural practice intention is recruitment of students with a rural background who also undertake an RCS placement. This research also demonstrates significant demand for post-graduate rural training places, including specialty places, as RCS graduates become junior doctors and vocational trainees.

Focal plane infrared readout circuit with automatic background suppression

NASA Technical Reports Server (NTRS)

Pain, Bedabrata (Inventor); Yang, Guang (Inventor); Sun, Chao (Inventor); Shaw, Timothy J. (Inventor); Wrigley, Chris J. (Inventor)

2002-01-01

A circuit for reading out a signal from an infrared detector includes a current-mode background-signal subtracting circuit having a current memory which can be enabled to sample and store a dark level signal from the infrared detector during a calibration phase. The signal stored by the current memory is subtracted from a signal received from the infrared detector during an imaging phase. The circuit also includes a buffered direct injection input circuit and a differential voltage readout section. By performing most of the background signal estimation and subtraction in a current mode, a low gain can be provided by the buffered direct injection input circuit to keep the gain of the background signal relatively small, while a higher gain is provided by the differential voltage readout circuit. An array of such readout circuits can be used in an imager having an array of infrared detectors. The readout circuits can provide a high effective handling capacity.

Clinical balance assessment: perceptions of commonly-used standardized measures and current practices among physiotherapists in Ontario, Canada

PubMed Central

2013-01-01

Background Balance impairment is common in multiple clinical populations, and comprehensive assessment is important for identifying impairments, planning individualized treatment programs, and evaluating change over time. However, little information is available regarding whether clinicians who treat balance are satisfied with existing assessment tools. In 2010 we conducted a cross-sectional survey of balance assessment practices among physiotherapists in Ontario, Canada, and reported on the use of standardized balance measures (Sibley et al. 2011 Physical Therapy; 91: 1583-91). The purpose of this study was to analyse additional survey data and i) evaluate satisfaction with current balance assessment practices and standardized measures among physiotherapists who treat adult or geriatric populations with balance impairment, and ii) identify factors associated with satisfaction. Methods The questionnaire was distributed to 1000 practicing physiotherapists. This analysis focuses on questions in which respondents were asked to rate their general perceptions about balance assessment, the perceived utility of individual standardized balance measures, whether they wanted to improve balance assessment practices, and why. Data were summarized with descriptive statistics and utility of individual measures was compared across clinical practice areas (orthopaedic, neurological, geriatric or general rehabilitation). Results The questionnaire was completed by 369 respondents, of which 43.4% of respondents agreed that existing standardized measures of balance meet their needs. In ratings of individual measures, the Single Leg Stance test and Berg Balance Scale were perceived as useful for clinical decision-making and evaluating change over time by over 70% of respondents, and the Timed Up-and-Go test was perceived as useful for decision-making by 56.9% of respondents and useful for evaluating change over time by 62.9% of respondents, but there were significant differences across practice groups. Seventy-nine percent of respondents wanted to improve their assessments, identifying individual, environmental and measure-specific barriers. The most common barriers were lack of time and knowledge. Conclusions This study offers new information on issues affecting the evaluation of balance in clinical settings from a broad sample of physiotherapists. Continued work to address barriers by specific practice area will be critical for the success of any intervention attempting to implement optimal balance assessment practices in the clinical setting. PMID:23510277

Evaluating an audit and feedback intervention for reducing antibiotic prescribing behaviour in general dental practice (the RAPiD trial): a partial factorial cluster randomised trial protocol

PubMed Central

2014-01-01

Background Antibiotic prescribing in dentistry accounts for 9% of total antibiotic prescriptions in Scottish primary care. The Scottish Dental Clinical Effectiveness Programme (SDCEP) published guidance in April 2008 (2nd edition, August 2011) for Drug Prescribing in Dentistry, which aims to assist dentists to make evidence-based antibiotic prescribing decisions. However, wide variation in prescribing persists and the overall use of antibiotics is increasing. Methods RAPiD is a 12-month partial factorial cluster randomised trial conducted in NHS General Dental Practices across Scotland. Its aim is to compare the effectiveness of individualised audit and feedback (A&F) strategies for the translation into practice of SDCEP recommendations on antibiotic prescribing. The trial uses routinely collected electronic healthcare data in five aspects of its design in order to: identify the study population; apply eligibility criteria; carry out stratified randomisation; generate the trial intervention; analyse trial outcomes. Eligibility was determined on contract status and a minimum level of recent NHS treatment provision. All eligible dental practices in Scotland were simultaneously randomised at baseline either to current audit practice or to an intervention group. Randomisation was stratified by single-handed/multi-handed practices. General dental practitioners (GDPs) working at intervention practices will receive individualised graphical representations of their antibiotic prescribing rate from the previous 14 months at baseline and an update at six months. GDPs could not be blinded to their practice allocation. Intervention practices were further randomised using a factorial design to receive feedback with or without: a health board comparator; a supplementary text-based intervention; additional feedback at nine months. The primary outcome is the total antibiotic prescribing rate per 100 courses of treatment over the year following delivery of the baseline intervention. A concurrent qualitative process evaluation will apply theory-based approaches using the Consolidated Framework for Implementation Research to explore the acceptability of the interventions and the Theoretical Domains Framework to identify barriers and enablers to evidence-based antibiotic prescribing behaviour by GDPs. Discussion RAPiD will provide a robust evaluation of A&F in dentistry in Scotland. It also demonstrates that linked administrative datasets have the potential to be used efficiently and effectively across all stages of an randomised controlled trial. Trial registration Current Controlled Trials ISRCTN49204710 PMID:24758164

Mature-age entrants to medical school: a controlled study of sociodemographic characteristics, career choice and job satisfaction.

PubMed

Harth, S C; Biggs, J S; Thong, Y H

1990-11-01

A comparison of 121 mature-age and 270 normal-age entrants who graduated from the University of Queensland Medical School between 1972 and 1987 shows that mature-age entrants are some 7 years older, are more likely to come from public (state) schools and less likely to have parents in professional/technical occupations. Otherwise, the two groups were similar in terms of gender, marital status, number of children, ethnic background and current practice location. The educational background of mature-age entrants prior to admission includes 44.6% with degrees in health-science areas and 31.4% with degrees in non-health areas. Reasons for delayed entry of mature-age entrants include late consideration of medicine as a career (34.7%), financial problems (31.4%), dissatisfaction with previous career (30.6%), poor academic results (19.8%), or a combination of the above factors. Motivations to study medicine include family influences (more so in normal-age entrants), altruistic reasons (more so in mature-age entrants) and a variety of personal/social factors such as intellectual satisfaction, prestige and financial security (similar for both groups) and parental expectations (more so in normal-age entrants). Mature-age entrants experienced greater stress throughout the medical course, especially with regard to financial difficulties, loneliness/isolation from the students and family problems (a greater proportion were married with children). While whole-course grades were similar in both groups, normal-age entrants tended to win more undergraduate honours/prizes and postgraduate diplomas/degrees, including specialist qualifications. Practice settings were similar in terms of group private practice, hospital/clinic practice or medical administration, but there was a greater proportion of mature-age entrants in solo private practice, and a smaller proportion in teaching/research. If given the time over, some two-thirds of both groups would choose medicine as a career. Reasons for job satisfaction include helping patients, intellectual stimulation and financial rewards. Reasons for dissatisfaction include pressure of work, red-tape/paperwork, 'doctor-bashing', long working hours, emotional strain, financial pressure, unfulfilled career expectations and irritation with trivial medical complaints.

Clustering of diet- and activity-related parenting practices: cross-sectional findings of the INPACT study

PubMed Central

2013-01-01

Background Various diet- and activity-related parenting practices are positive determinants of child dietary and activity behaviour, including home availability, parental modelling and parental policies. There is evidence that parenting practices cluster within the dietary domain and within the activity domain. This study explores whether diet- and activity-related parenting practices cluster across the dietary and activity domain. Also examined is whether the clusters are related to child and parental background characteristics. Finally, to indicate the relevance of the clusters in influencing child dietary and activity behaviour, we examined whether clusters of parenting practices are related to these behaviours. Methods Data were used from 1480 parent–child dyads participating in the Dutch IVO Nutrition and Physical Activity Child cohorT (INPACT). Parents of children aged 8–11 years completed questionnaires at home assessing their diet- and activity-related parenting practices, child and parental background characteristics, and child dietary and activity behaviours. Principal component analysis (PCA) was used to identify clusters of parenting practices. Backward regression analysis was used to examine the relationship between child and parental background characteristics with cluster scores, and partial correlations to examine associations between cluster scores and child dietary and activity behaviours. Results PCA revealed five clusters of parenting practices: 1) high visibility and accessibility of screens and unhealthy food, 2) diet- and activity-related rules, 3) low availability of unhealthy food, 4) diet- and activity-related positive modelling, and 5) positive modelling on sports and fruit. Low parental education was associated with unhealthy cluster 1, while high(er) education was associated with healthy clusters 2, 3 and 5. Separate clusters were related to both child dietary and activity behaviour in the hypothesized directions: healthy clusters were positively related to obesity-reducing behaviours and negatively to obesity-inducing behaviours. Conclusion Parenting practices cluster across the dietary and activity domain. Parental education can be seen as an indicator of a broader parental context in which clusters of parenting practices operate. Separate clusters are related to both child dietary and activity behaviour. Interventions that focus on clusters of parenting practices to assist parents (especially low-educated parents) in changing their child’s dietary and activity behaviour seems justified. PMID:23531232

Basics of Bayesian methods.

PubMed

Ghosh, Sujit K

2010-01-01

Bayesian methods are rapidly becoming popular tools for making statistical inference in various fields of science including biology, engineering, finance, and genetics. One of the key aspects of Bayesian inferential method is its logical foundation that provides a coherent framework to utilize not only empirical but also scientific information available to a researcher. Prior knowledge arising from scientific background, expert judgment, or previously collected data is used to build a prior distribution which is then combined with current data via the likelihood function to characterize the current state of knowledge using the so-called posterior distribution. Bayesian methods allow the use of models of complex physical phenomena that were previously too difficult to estimate (e.g., using asymptotic approximations). Bayesian methods offer a means of more fully understanding issues that are central to many practical problems by allowing researchers to build integrated models based on hierarchical conditional distributions that can be estimated even with limited amounts of data. Furthermore, advances in numerical integration methods, particularly those based on Monte Carlo methods, have made it possible to compute the optimal Bayes estimators. However, there is a reasonably wide gap between the background of the empirically trained scientists and the full weight of Bayesian statistical inference. Hence, one of the goals of this chapter is to bridge the gap by offering elementary to advanced concepts that emphasize linkages between standard approaches and full probability modeling via Bayesian methods.

Developmental Activities that Lead to Dropout and Investment in Sport

ERIC Educational Resources Information Center

Wall, Michael; Cote, Jean

2007-01-01

Background: Studies suggest that expert performance in sport is the result of long-term engagement in a highly specialized form of training termed deliberate practice. The relationship between accumulated deliberate practice and performance predicts that those who begin deliberate practice at a young age accumulate more practice hours over time…

Developing Principles of Physical Education Teacher Education Practice through Self-Study

ERIC Educational Resources Information Center

Fletcher, Tim

2016-01-01

Background: The articulation of specific principles of teacher education practice allows teacher educators to make explicit the beliefs, values, and actions that shape their practice. Engaging in processes to articulate the principles that guide practice is beneficial not only for teacher educators and their colleagues but also for students. There…

Closing the Gap between Research Evidence and Clinical Practice: Jordanian Nurses' Perceived Barriers to Research Utilisation

ERIC Educational Resources Information Center

Al Khalaileh, Murad; Al Qadire, Mohammad; Musa, Ahmad S.; Al-Khawaldeh, Omar A.; Al Qudah, Hani; Alhabahbeh, Atalla

2016-01-01

Background: The nursing profession is a combination of theory and practical skill, and nurses are required to generate and develop knowledge through implementing research into clinical practice. Considerable number of barriers could hind implementing research findings into practice. Barriers to research utilisation are not identified in the…

Self-Assessment of Practice Performance: Development of the ABIM Practice Improvement Module (PIM[superscript SM])

ERIC Educational Resources Information Center

Duffy, F. Daniel; Lynn, Lorna A.; Didura, Halyna; Hess, Brian; Caverzagie, Kelly; Grosso, Louis; Lipner, Rebecca A.; Holmboe, Eric S.

2008-01-01

Background: Quality measurement and improvement in practice are requirements for Maintenance of Certification by the American Board of Medical Specialties boards and a component of many pay for performance programs. Objective: To describe the development of the American Board of Internal Medicine (ABIM) Practice Improvement Module (PIM[superscript…

Cultural models of self and social class disparities at organizational gateways and pathways.

PubMed

Townsend, Sarah Sm; Truong, Mindy

2017-12-01

Attaining a college degree has traditionally been assumed to be key to upward social and professional mobility. However, college graduates from working-class backgrounds achieve less career success in professional, white-collar workplaces compared to those from middle-class backgrounds. Using a cultural models approach, we examine how the independent cultural beliefs and practices promoted by professional organizations disadvantage people from working-class backgrounds, who espouse interdependent beliefs and practices. Our review illustrates how this disadvantage can manifest in two ways. First, despite relative equality in objective qualifications, it can occur at organizational gateways (e.g., interview and hiring decisions). Second, even after people from working-class backgrounds gain access to an organization, it can occur along organizational pathways (e.g., performance evaluations and assignment to high-profile tasks). Copyright © 2017. Published by Elsevier Ltd.

"Gaining Power through Education": Experiences of Honduran Students from High Poverty Backgrounds

ERIC Educational Resources Information Center

Mather, Peter C.; Zempter, Christy; Ngumbi, Elizabeth; Nakama, Yuki; Manley, David; Cox, Haley

2017-01-01

This is a study of students from high-poverty backgrounds attending universities in Honduras. Based on a series of individual and focus group interviews, the researchers found students from high-poverty backgrounds face numerous practical challenges in persisting in higher education. Despite these challenges, participants succeeded due to a…

[Using an employee survey as a means of quality assurance in newborn hearing screening].

PubMed

Depenbrock, A; Matulat, P; am Zehnhoff-Dinnesen, A

2013-03-01

Studies drawing information not only from technical data but also from surveying human resources behind the universal newborn hearing screening (UNHS) appear to be a rarity. This study aims at showing how the state of both knowledge and practical skills among the screening staff are essential aspects in future quality management. A self-developed questionnaire was sent to hospital staff addressing a total of 710 nurses who were registered as having undertaken a UNHS training course. Questions were aimed at aspects of organization, personal practical skills, current problems and improvement possibilities. High rates of occupancy, lack of trained personnel, technical issues and background noise disturbances were considered to be factors that increased time pressure and slowed down procedures. Of the participants 16 % considered communicating a "refer" result to parents a difficult step and 8 % felt insecure when explaining the aims and procedures to parents. There was a high interest in further training sessions. This survey served well to reveal aspects of improvement in screening procedures and meeting staff needs. The training sessions should outline practical aspects of conducting screening and also professional, sensitive communication to parents.

Wildlife conservation and reproductive cloning.

PubMed

Holt, William V; Pickard, Amanda R; Prather, Randall S

2004-03-01

Reproductive cloning, or the production of offspring by nuclear transfer, is often regarded as having potential for conserving endangered species of wildlife. Currently, however, low success rates for reproductive cloning limit the practical application of this technique to experimental use and proof of principle investigations. In this review, we consider how cloning may contribute to wildlife conservation strategies. The cloning of endangered mammals presents practical problems, many of which stem from the paucity of knowledge about their basic reproductive biology. However, situations may arise where resources could be targeted at recovering lost or under-represented genetic lines; these could then contribute to the future fitness of the population. Approaches of this type would be preferable to the indiscriminate generation of large numbers of identical individuals. Applying cloning technology to non-mammalian vertebrates may be more practical than attempting to use conventional reproductive technologies. As the scientific background to cloning technology was pioneered using amphibians, it may be possible to breed imminently threatened amphibians, or even restore extinct amphibian species, by the use of cloning. In this respect species with external embryonic development may have an advantage over mammals as developmental abnormalities associated with inappropriate embryonic reprogramming would not be relevant.

The dentist’s role in promoting community water fluoridation

PubMed Central

Melbye, Molly L.R.; Armfield, Jason M.

2013-01-01

Background and Overview Community water fluoridation is an important public health intervention that reduces oral health disparities and increases the health of the population. Promotion of its safety and effectiveness is critical to maintaining its widespread acceptance and ensuring its continued use. Dentists are a potentially important source of knowledge regarding the oral health benefits and safety of water fluoridation. However, few dentists regularly discuss fluorides, and water fluoridation in particular, with patients. The authors aim to describe and discuss the role and importance of dentists’ promotion of public water fluoridation, barriers to dentists’ involvement and some approaches that might influence dentists to promote water fluoridation more actively. Conclusions and Practice Implications Ongoing promotion of fluoridation by dentists is a key factor in ensuring sustained municipal water fluoridation. However, current undergraduate dental curricula do not adequately prepare dentists for this role, and continuing dental education may be insufficient to change clinical practice. Although smoking-cessation literature can shed some light on how to proceed, changing dentists’ practice behavior remains a largely unstudied topic. Dental associations are a key resource for dentists, providing information that can assist them in becoming advocates for water fluoridation. PMID:23283928

Precepting the medical assistant practicum: expectations and rewards: an evaluation of preceptors' opinions.

PubMed

Wilson, Adam B; Fegan, Frank; Romence, Blase; Uhe, Kendra; Dionne, Barbara

2011-01-01

This study investigated the opinions of preceptors on select topics relevant to the benefits and rewards of precepting medical assisting (MA) students. A 35-item questionnaire was distributed to volunteer MA preceptors over the course of 1 year. Survey items prompted participants for information concerning background and previous experiences with MA students, as well as gathered opinions on the benefits, issues, and rewards of preceptorships. Of the preceptors who gave evidence of their credentials, 98.43% were either practicing certified medical assistants (CMA-AAMA) or nurses. Respectively, 80.85% of CMAs and 80.00% of nurses felt that students provided the office with extra help and placed no financial burden on the practice. Approximately 44% ranked free continuing medical education (CME) credits as the most important reward. Written responses identified thank-you notes as an important demonstration of service, acknowledgment, and appreciation. MA preceptors consider students a beneficial aspect of their practice because they lighten strenuous workloads and stimulate preceptors to remain current in their professional fields. Noncompensated MA preceptors value both extrinsic (e.g., free CME credits) and intrinsic rewards (e.g., feedback and thank-you cards) and suggested that intrinsic rewards were of greater value.

The power of partnership to shape the future of nursing: the evolution of the clinical nurse leader.

PubMed

Tornabeni, Jolene; Miller, Judith Fitzgerald

2008-07-01

This article describes the evolution of the clinical nurse leader role and demonstrates the vital nature of partnerships between academia and practice in the design and implementation of this new role. The health care system as it exists in the United States may put patients at risk in terms of safety and quality of care. Nursing leadership from across the US recognized a need for nursing practice and academia to work in partnership to develop workable and effective solutions. The vision was of a nurse generalist who would be prepared to address the complexities that make the current systems dysfunctional. Review, share experiences and discuss the benefits of engaging stakeholders with broad and diverse viewpoints. Engaging a group of stakeholders with diverse backgrounds, varied world views and experiences for the purpose of developing common mutually beneficial goals, creates synergy and greater commitment to the goals, which results in success. The power of partnership in the development and implementation of the CNL is evident. Old ways of trying to 'go it alone' are no longer viable in a complex health care environment. With continued collaboration, practice and academia can continue to confront challenges and develop effective solutions.

School Food Practices of Prospective Teachers

ERIC Educational Resources Information Center

Rossiter, Melissa; Glanville, Theresa; Taylor, Jennifer; Blum, Ilya

2007-01-01

Background: Schoolteachers can affect students' eating habits in several ways: through nutrition knowledge, positive role modeling, and avoidance of unhealthy classroom food practices. In this study, the knowledge, attitudes, and eating behaviors of prospective teachers as determinants of intended classroom food practices and the school…

Evaluating Cost-Effectiveness of Interventions that Affect Fertility and Childbearing: How Health Effects are Measured Matters

PubMed Central

Goldhaber-Fiebert, Jeremy D.; Brandeau, Margaret L.

2015-01-01

Background Current guidelines for economic evaluations of health interventions define relevant outcomes as those accruing to individuals receiving interventions. Little consensus exists on counting health impacts on current and future fertility and childbearing. Objective To characterize current practices for counting such health outcomes. Design We developed a framework characterizing health interventions with direct and/or indirect effects on fertility and childbearing and how such outcomes are reported. We identified interventions spanning the framework and performed a targeted literature review for economic evaluations of these interventions. For each article, we characterized how the potential health outcomes from each intervention were considered, focusing on QALYs associated with fertility and childbearing. Results We reviewed 108 studies, identifying seven themes: 1) Studies were heterogeneous in reporting outcomes. 2) Studies often selected outcomes for inclusion that tend to bias toward finding the intervention to be cost-effective. 3) Studies often avoided the challenges of assigning QALYs for pregnancy and fertility by instead considering cost per intermediate outcome. 4) Even for the same intervention, studies took heterogeneous approaches to outcome evaluation. 5) Studies employed multiple, competing rationales for whether and how to include fertility-related QALYs and whose QALYs to include. 6) Studies examining interventions with indirect effects on fertility typically ignored such QALYs. 7) Even recent studies had these shortcomings. Limitations The review was targeted rather than systematic. Conclusions Economic evaluations inconsistently consider QALYs from current and future fertility and childbearing in ways that frequently appear biased towards the interventions considered. As the Panel on Cost-Effectiveness in Health and Medicine updates its guidelines, making the practice of cost-effectiveness analysis more consistent is a priority. Our study contributes to harmonizing methods in this respect. PMID:25926281

Body mass index gain between ages 20-40 years and lifestyle characteristics of men at ages 40-60 years: The Adventist Health Study-2

PubMed Central

Japas, Claudio; Knutsen, Synnøve; Dehom, Salem; Dos Santos, Hildemar; Tonstad, Serena

2014-01-01

Background Obesity increases risk of premature disease, and may be associated with unfavorable lifestyle changes that add to risk. This study analyzed the association of midlife BMI change with current lifestyle patterns among multiethnic men. Methods Men aged 40-60 years (n=9864) retrospectively reported body weight between ages 20-40 years and current dietary, TV, physical activity and sleep practices in the Adventist Health Study II, a study of church-goers in the US and Canada. In multivariate logistic regression analysis, odds ratios for BMI gain were calculated for each lifestyle practice controlling for sociodemographic and other lifestyle factors and current BMI. Results Men with median or higher BMI gain (2.79 kg/m2) between ages 20-40 years were more likely to consume a non-vegetarian diet, and engage in excessive TV watching and little physical activity and had a shorter sleep duration compared to men with BMI gain below the median (all p<0.001). In multivariate logistic analysis current BMI was significantly associated with all lifestyle factors in multivariate analyses (all p≤0.005). BMI gain was associated with lower odds of vegetarian diet (odds ratio [OR] 0.939; 95% confidence interval [CI] 0.921-0.957) and of physical activity ≥150 minutes/week (OR 0.979, 95% CI 0.960-0.999). Conclusions These findings imply that diet and less physical activity are associated with both gained and attained BMI, while inactivity (TV watching) and short sleep duration correlated only with attained BMI. Unhealthy lifestyle may add risk to that associated with BMI. Longitudinal and intervention studies are needed to infer causal relationships. PMID:25434910

Assessment of Current Inservice Inspection and Leak Monitoring Practices for Detecting Materials Degradation in Light Water Reactors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anderson, Michael T.; Simonen, Fredric A.; Muscara, Joseph

2016-09-01

An assessment was performed to determine the effectiveness of existing inservice inspection (ISI) and leak monitoring techniques, and recommend improvements, as necessary, to the programs as currently performed for light water reactor (LWR) components. Information from nuclear power plant (NPP) aging studies and from the U. S. Nuclear Regulatory Commission’s Generic Aging Lessons Learned (GALL) report (NUREG-1801) was used to identify components that have already experienced, or are expected to experience, degradation. This report provides a discussion of the key aspects and parameters that constitute an effective ISI program and a discussion of the basis and background against which themore » effectiveness of the ISI and leak monitoring programs for timely detection of degradation was evaluated. Tables based on the GALL components were used to systematically guide the process, and table columns were included that contained the ISI requirements and effectiveness assessment. The information in the tables was analyzed using histograms to reduce the data and help identify any trends. The analysis shows that the overall effectiveness of the ISI programs is very similar for both boiling water reactors (BWRs) and pressurized water reactors (PWRs). The evaluations conducted as part of this research showed that many ISI programs are not effective at detecting degradation before its extent reached 75% of the component wall thickness. This work should be considered as an assessment of NDE practices at this time; however, industry and regulatory activities are currently underway that will impact future effectiveness assessments. A number of actions have been identified to improve the current ISI programs so that degradation can be more reliably detected.« less

Lethal Injection for Execution: Chemical Asphyxiation?

PubMed Central

Zimmers, Teresa A; Sheldon, Jonathan; Lubarsky, David A; López-Muñoz, Francisco; Waterman, Linda; Weisman, Richard; Koniaris, Leonidas G

2007-01-01

Background Lethal injection for execution was conceived as a comparatively humane alternative to electrocution or cyanide gas. The current protocols are based on one improvised by a medical examiner and an anesthesiologist in Oklahoma and are practiced on an ad hoc basis at the discretion of prison personnel. Each drug used, the ultrashort-acting barbiturate thiopental, the neuromuscular blocker pancuronium bromide, and the electrolyte potassium chloride, was expected to be lethal alone, while the combination was intended to produce anesthesia then death due to respiratory and cardiac arrest. We sought to determine whether the current drug regimen results in death in the manner intended. Methods and Findings We analyzed data from two US states that release information on executions, North Carolina and California, as well as the published clinical, laboratory, and veterinary animal experience. Execution outcomes from North Carolina and California together with interspecies dosage scaling of thiopental effects suggest that in the current practice of lethal injection, thiopental might not be fatal and might be insufficient to induce surgical anesthesia for the duration of the execution. Furthermore, evidence from North Carolina, California, and Virginia indicates that potassium chloride in lethal injection does not reliably induce cardiac arrest. Conclusions We were able to analyze only a limited number of executions. However, our findings suggest that current lethal injection protocols may not reliably effect death through the mechanisms intended, indicating a failure of design and implementation. If thiopental and potassium chloride fail to cause anesthesia and cardiac arrest, potentially aware inmates could die through pancuronium-induced asphyxiation. Thus the conventional view of lethal injection leading to an invariably peaceful and painless death is questionable. PMID:17455994

Performance, Facility Pressure Effects, and Stability Characterization Tests of NASA's Hall Effect Rocket with Magnetic Shielding Thruster

NASA Technical Reports Server (NTRS)

Kamhawi, Hani; Huang, Wensheng; Haag, Thomas; Yim, John; Herman, Daniel; Peterson, Peter Y.; Williams, George J.; Gilland, James; Hofer, Richard; Mikellides, Ioannis

2016-01-01

NASA's Hall Effect Rocket with Magnetic Shielding (HERMeS) 12.5 kW Technology Demonstration Unit-1 (TDU-1) has been the subject of extensive technology maturation in preparation for flight system development. Part of the technology maturation effort included experimental evaluation of the TDU-1 thruster with conducting and dielectric front pole cover materials in two different electrical configurations. A graphite front magnetic pole cover thruster configuration with the thruster body electrically tied to cathode, and an alumina front pole cover thruster configuration with the thruster body floating were evaluated. Both configurations were also evaluated at different facility background pressure conditions to evaluate background pressure effects on thruster operation. Performance characterization tests found that higher thruster performance was attained with the graphite front pole cover configuration with the thruster electrically tied to cathode. A total thrust efficiency of 68% and a total specific impulse of 2,820 s was demonstrated at a discharge voltage of 600 V and a discharge power of 12.5 kW. Thruster stability regimes were characterized with respect to the thruster discharge current oscillations and with maps of the discharge current-voltage-magnetic field (IVB). Analysis of TDU-1 discharge current waveforms found that lower normalized discharge current peak-to-peak and root mean square magnitudes were attained when the thruster was electrically floated with alumina front pole covers. Background pressure effects characterization tests indicated that the thruster performance and stability were mostly invariant to changes in the facility background pressure for vacuum chamber pressure below 1×10-5 Torr-Xe (for thruster flow rates of 20.5 mg/s). Power spectral density analysis of the discharge current waveforms showed that increasing the vacuum chamber background pressure resulted in a higher discharge current dominant breathing mode frequency. Finally, IVB maps of the TDU-1 thruster indicated that the discharge current became more oscillatory with higher discharge current peak-to-peak and RMS values with increased facility background pressure at lower thruster mass flow rates; thruster operation at higher flow rates resulted in less change to the thruster's IVB characteristics with elevated background pressure.

Which functionalities are available in the electronic health record systems used by French general practitioners? An assessment study of 15 systems.

PubMed

Darmon, David; Sauvant, Rémy; Staccini, Pascal; Letrilliart, Laurent

2014-01-01

Whereas an unprecedented effort is currently under way worldwide for the implementation of electronic health record (EHR) systems, their capabilities are poorly understood, especially in primary care. The objective of this study was to assess the main functionalities of the EHR systems used in French general practices. Among the 20 EHR systems marketed in France, we assessed the 15 systems used by more than 1500 general practitioners in the Provence-Alpes-Côte d'Azur region in the southeast part of France. Each EHR system was assessed in a general practice office, using two clinical vignettes describing virtual patient consultations. The evaluation criteria were derived from the EuroRec requirements for EHR system quality. The assessment scale included 37 criteria grouped into three sets: background data, consultation data, and exchange functionalities. The scoring system used, totalling 64 points, was based on the validation of the criteria and was adjusted based on the possibility of standardising the data. A high score indicated a good EHR system quality. The median global score was 32 points out of a possible 64 (range: 20-39). The median score was 12 points out of 22 (range: 6-15) for the background data set, 16 points out of 32 (range: 9-22) for the consultation data set, and four points out of 10 (range: 0-6) for the exchange functionalities. No association was found between the number of users and the assessment score of the EHR systems (p=0.79). One third of the EHR systems lacked a problem list and only one of them supported the episode of care. Functionalities noticeably vary among the EHR systems currently used in French primary care. Whereas these systems are globally very focused on drug prescriptions, several core functionalities are frequently lacking. They are also poorly interoperable for healthcare professionals and patients. Further research is necessary to assess their actual use. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Disseminating research findings: what should researchers do? A systematic scoping review of conceptual frameworks

PubMed Central

2010-01-01

Background Addressing deficiencies in the dissemination and transfer of research-based knowledge into routine clinical practice is high on the policy agenda both in the UK and internationally. However, there is lack of clarity between funding agencies as to what represents dissemination. Moreover, the expectations and guidance provided to researchers vary from one agency to another. Against this background, we performed a systematic scoping to identify and describe any conceptual/organising frameworks that could be used by researchers to guide their dissemination activity. Methods We searched twelve electronic databases (including MEDLINE, EMBASE, CINAHL, and PsycINFO), the reference lists of included studies and of individual funding agency websites to identify potential studies for inclusion. To be included, papers had to present an explicit framework or plan either designed for use by researchers or that could be used to guide dissemination activity. Papers which mentioned dissemination (but did not provide any detail) in the context of a wider knowledge translation framework, were excluded. References were screened independently by at least two reviewers; disagreements were resolved by discussion. For each included paper, the source, the date of publication, a description of the main elements of the framework, and whether there was any implicit/explicit reference to theory were extracted. A narrative synthesis was undertaken. Results Thirty-three frameworks met our inclusion criteria, 20 of which were designed to be used by researchers to guide their dissemination activities. Twenty-eight included frameworks were underpinned at least in part by one or more of three different theoretical approaches, namely persuasive communication, diffusion of innovations theory, and social marketing. Conclusions There are currently a number of theoretically-informed frameworks available to researchers that can be used to help guide their dissemination planning and activity. Given the current emphasis on enhancing the uptake of knowledge about the effects of interventions into routine practice, funders could consider encouraging researchers to adopt a theoretically-informed approach to their research dissemination. PMID:21092164

Chest radiography practice in critically ill patients: a postal survey in the Netherlands

PubMed Central

Graat, Marleen E; Hendrikse, Karin A; Spronk, Peter E; Korevaar, Johanna C; Stoker, Jaap; Schultz, Marcus J

2006-01-01

Background To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. Methods Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU. Results From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). Conclusion There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy. PMID:16848892

Capturing patient experience: a qualitative study of implementing real-time feedback in primary care

PubMed Central

Carter, Mary; Davey, Antoinette; Wright, Christine; Elmore, Natasha; Newbould, Jenny; Roland, Martin; Campbell, John; Burt, Jenni

2016-01-01

Background In recent years, hospitals have made use of new technologies, such as real-time feedback, to collect patient experience information. This approach is currently rarely used in primary care settings, but may provide practices with a useful tool that enables them to take prompt, focused action to improve their services. Aim To identify the factors inhibiting and enabling the implementation of real-time feedback in general practices. Design and setting Qualitative study embedded within an exploratory trial (July 2014 to February 2015) of a real-time feedback intervention targeting patient experience in general practices in south-west England and Cambridgeshire. Method Semi-structured interviews (n = 22) and focus groups (n = 4, total of 28 attendees) with practice staff were audiorecorded, transcribed, and analysed thematically, using a framework based on constructs from normalisation process theory. Results Staff engagement with real-time feedback varied considerably, and staff made sense of real-time feedback by comparing it with more familiar feedback modalities. Effective within-team communication was associated with positive attitudes towards real-time feedback. Timing of requests for feedback was important in relation to patient engagement. Real-time feedback may offer potential as a means of informing practice development, perhaps as a component of a wider programme of capturing and responding to patients’ comments. Conclusion Successful implementation of real-time feedback requires effective communication across the practice team to engender thorough engagement. Feedback processes should be carefully introduced to fit with existing patient and practice routines. Future studies should consider making real-time feedback content relevant to specific practice needs, and support participation by all patient groups. PMID:27621292

Enhancing the quality of antibiotic prescribing in Primary Care: Qualitative evaluation of a blended learning intervention

PubMed Central

2010-01-01

Background The Stemming the Tide of Antibiotic Resistance (STAR) Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial. Methods Semi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis. Results The majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data. Conclusion Participants regarded this complex blended learning intervention acceptable and feasible, and reported wide-ranging, positive changes in attitudes and clinical practice as a result of participating in the STAR Educational Program. Trial registration Current Controlled Trials ISRCTN63355948 PMID:20459655

Traditional beliefs and practices in the postpartum period in Fujian Province, China: a qualitative study

PubMed Central

Raven, Joanna H; Chen, Qiyan; Tolhurst, Rachel J; Garner, Paul

2007-01-01

Background Zuo yuezi is the month postpartum in China associated with a variety of traditional beliefs and practices. We explored the current status of zuo yuezi from social, cultural and western medical perspectives. Methods We interviewed family members (36) and health workers (8) in Fujian Province, selecting one rural and one rapidly developing urban county. We asked about their traditional beliefs and their behaviour postpartum. We used a framework approach to identify main themes. We categorised reported behaviour against their probable effects on health, drawing on Western standards. Results Respondents reported that zuo yuezi was commonly practiced in urban and rural families to help the mother regain her strength and protect her future health. Zuo yuezi included: dietary precautions, such as eating more food and avoiding cold food; behavioural precautions, such as staying inside the home, avoiding housework and limiting visitors; hygiene precautions, such as restricting bathing and dental hygiene; and practices associated with infant feeding, including supplementary feeding and giving honeysuckle herb to the infant. Respondents reported that the main reasons for adhering to these practices were respect for tradition, and following the advice of elders. Categorised against Western medical standards, several zuo yuezi practices are beneficial, including eating more, eating protein rich food, avoiding housework, and daily vulval and perineal hygiene. A few are potentially harmful, including giving honeysuckle herb, and avoiding dental hygiene. Some women reported giving infants supplementary feeds, although zuo yuezi emphasises breast feeding. Conclusion Zuo yuezi is an important ritual in Fujian. In medical terms, most practices are beneficial, and could be used by health staff to promote health in this period. Further research on reported potentially harmful practices, such as supplements to breast feeding, is needed. PMID:17584930

Infection as a Background to Safety: Source Material for Teaching.

ERIC Educational Resources Information Center

Wyatt, H. V.

1986-01-01

Offers selections from papers which illustrate accidents, epidemics, and bad practices which could be used as background material for lessons on laboratory safety. Advocates the need for instruction on pathogenicity and infectivity. (ML)

Adaptive reference update (ARU) algorithm. A stochastic search algorithm for efficient optimization of multi-drug cocktails

PubMed Central

2012-01-01

Background Multi-target therapeutics has been shown to be effective for treating complex diseases, and currently, it is a common practice to combine multiple drugs to treat such diseases to optimize the therapeutic outcomes. However, considering the huge number of possible ways to mix multiple drugs at different concentrations, it is practically difficult to identify the optimal drug combination through exhaustive testing. Results In this paper, we propose a novel stochastic search algorithm, called the adaptive reference update (ARU) algorithm, that can provide an efficient and systematic way for optimizing multi-drug cocktails. The ARU algorithm iteratively updates the drug combination to improve its response, where the update is made by comparing the response of the current combination with that of a reference combination, based on which the beneficial update direction is predicted. The reference combination is continuously updated based on the drug response values observed in the past, thereby adapting to the underlying drug response function. To demonstrate the effectiveness of the proposed algorithm, we evaluated its performance based on various multi-dimensional drug functions and compared it with existing algorithms. Conclusions Simulation results show that the ARU algorithm significantly outperforms existing stochastic search algorithms, including the Gur Game algorithm. In fact, the ARU algorithm can more effectively identify potent drug combinations and it typically spends fewer iterations for finding effective combinations. Furthermore, the ARU algorithm is robust to random fluctuations and noise in the measured drug response, which makes the algorithm well-suited for practical drug optimization applications. PMID:23134742

Mapping HPV Vaccination and Cervical Cancer Screening Practice in the Pacific Region-Strengthening National and Regional Cervical Cancer Prevention

PubMed Central

Obel, J; McKenzie, J; Buenconsejo-Lum, LE; Durand, AM; Ekeroma, A; Souares, Y; Hoy, D; Baravilala, W; Garland, SM; Kjaer, SK; Roth, A

2015-01-01

Objective To provide background information for strengthening cervical cancer prevention in the Pacific by mapping current human papillomavirus (HPV) vaccination and cervical cancer screening practices, as well as intent and barriers to the introduction and maintenance of national HPV vaccination programmes in the region. Materials and Methods A cross-sectional questionnaire-based survey among ministry of health officials from 21 Pacific Island countries and territories (n=21). Results Cervical cancer prevention was rated as highly important, but implementation of prevention programs were insufficient, with only two of 21 countries and territories having achieved coverage of cervical cancer screening above 40%. Ten of 21 countries and territories had included HPV vaccination in their immunization schedule, but only two countries reported coverage of HPV vaccination above 60% among the targeted population. Key barriers to the introduction and continuation of HPV vaccination were reported to be: (i) Lack of sustainable financing for HPV vaccine programs; (ii) Lack of visible government endorsement; (iii) Critical public perception of the value and safety of the HPV vaccine; and (iv) Lack of clear guidelines and policies for HPV vaccination. Conclusion Current practices to prevent cervical cancer in the Pacific Region do not match the high burden of disease from cervical cancer. A regional approach, including reducing vaccine prices by bulk purchase of vaccine, technical support for implementation of prevention programs, operational research and advocacy could strengthen political momentum for cervical cancer prevention and avoid risking the lives of many women in the Pacific. PMID:25921158

A Canadian perspective on anterior cervical discectomies: practice patterns and preferences

PubMed Central

Bennardo, Michael; Farrokhyar, Forough; Martyniuk, Amanda; Reddy, Kesava

2018-01-01

Background The purpose of this study is to elucidate the current practice patterns of Canadian neurosurgeons with regards to anterior cervical discectomy (ACD). Methods A one-page questionnaire was sent out using SurveyMonkey to all neurosurgeon members of the Canadian Neurological Sciences Federation (CNSF). End points were surgeon preference for ACD surgical method, graft source, the length of collar usage and the recommended time before returning to work. Results Response rate was 74.0%. Of the responders, 75.0% performed single level ACD and 18.3% had completed spine fellowships. The majority (68.2%) chose ACD with fusion and plating (ACDFP) as their preferred method with allograft being the most popular choice of fusion material (44.3%). Most of the respondents did not prescribe collars (60.9%) and when they did, hard collar was prescribed most often (76.9%) and AspenTM collar was the most popular choice (67.7%). The majority of surgeons chose ‘other’ as their response for length of time for collar use (40.0%) while allowing them to take their collars off at night (78.1%). Most of the surgeons recommended physiotherapy post-operatively (58.1%) and time to physiotherapy was 6–8 weeks. Recommended back to work time was 6 weeks for 44.9% of respondents. In the cross analysis, surgeons who performed ACDF were more likely to prescribe collars (50%, P=0.01) versus surgeons who performed ACDFP (21.7%, P=0.01). Conclusions Our survey is an up to date description of current practice patterns for ACD amongst Canadian neurosurgeons. PMID:29732425

In Their Own Words: The Experience of Professional Nurses in a Northern Vietnamese Women's Hospital.

PubMed

Ng'ang'a, Njoki; Byrne, Mary W; Anh Ngo, Toan

2014-04-11

Abstract Background Nurses in Vietnam, as is typical of many low-income countries, are hampered from impacting health outcomes by low occupational status, overcrowded hospitals and few career development opportunities. In order to understand the current practice environment encountered by nurses in Vietnam in the most realistic way, we listened to the voices of nurses currently performing nursing roles in Vietnam. Purpose The purpose of this study was to explore the emic (insider) perspectives on cultural meaning applied by nurses at a northern Vietnamese women�s hospital to influence professional practice and interpret experience. Design A micro-ethnography approach was used. Methods Seven nurses and one vice-Dean of a school of nursing were interviewed. Data collection consisted of open-ended interviews, participant observation and journal recordings. Spradley�s (1979, 1980) Development Research Sequence was used to guide data collection and analysis. Results/Findings Five themes emerged. These were the big number of patients is a burden for nurses; nurses do not, cannot make their own decisions (but they can and do); my feeling depends on doctor's feeling; nurses learn more from doctor; and just a few nurses can attend the [Vietnamese Nurses Association] meeting. Conclusion The experiences described by the nurses and the vice-Dean of a nursing school reflect the challenges of practicing nursing in one Vietnamese hospital and the resourcefulness of nurses in overcoming those challenges. Recurrent themes highlight the need to better position nurses in Vietnam to advance towards full expression of the professional nursing role.

Osteopathic educators' attitudes towards osteopathic principles and their application in clinical practice: A qualitative inquiry.

PubMed

Kasiri-Martino, Hannah; Bright, Philip

2016-02-01

The implicit use of overarching osteopathic principles (OP) in clinical practice is a regulatory requirement; agreed definition of what constitutes such principles remains elusive. The profession currently faces questions of identity and relevance in the face of evidence-informed healthcare. This study sought to investigate the opinions and experiences of practising osteopathic educators as to how OP are relevant to clinical practice in isolation and to the profession as a whole. A qualitative approach employing grounded theory to explore the views of current practitioners involved in osteopathic education. Nine practising osteopaths were selected for the study using initially purposive then theoretical sampling. Semi-structured interviews were used to gather data, audio-recorded, transcribed verbatim and anonymised. Data was analysed and interpreted using a thematic framework approach and conceptually modelled. Triangulation was completed; peer corroboration for high-level themes and participant confirmation for transcript authenticity was obtained. Two polarised concepts emerged: (1) OP benefit the profession and (2) OP limit or jeopardize the profession. These emanated from different perceptions of the identity of osteopathy: (1) osteopathy as a philosophy or (2) osteopathy as a manual therapy with a philosophical background. The osteopathic profession faces the danger of being divided on the basis of ideological differences from within. The increasing criticality applied to UK healthcare behoves the osteopathic profession to clarify its aims, guiding 'principles' and underlying values. This could be problematic in light of the divergence of views, leading to a situation of either settling these differences or irrevocably fracturing the profession. Copyright © 2015 Elsevier Ltd. All rights reserved.

Surgical Education and Health Care Reform: Defining the Role and Value of Trainees in an Evolving Medical Landscape.

PubMed

Fayanju, Oluwadamilola M; Aggarwal, Reena; Baucom, Rebeccah B; Ferrone, Cristina R; Massaro, David; Terhune, Kyla P

2017-03-01

Health care reform and surgical education are often separated functionally. However, especially in surgery, where resident trainees often spend twice as much time in residency and fellowship than in undergraduate medical education, one must consider their contributions to health care. In this short commentary, we briefly review the status of health care in the United States as well as some of the recent and current changes in graduate medical education that pertain to surgical trainees. This is a perspective piece that draws on the interests and varied background of the multiinstitutional and international group of authors. The authors propose 3 main areas of focus for research and practice- (1) accurately quantifying the care provided currently by trainees, (2) determining impact to trainees and hospital systems of training parameters, focusing on long-term outcomes rather than short-term outcomes, and (3) determining practice models of education that work best for both health care delivery and trainees. The authors propose that surgical education must align itself with rather than separate itself from overall health care reform measures and even individual hospital financial pressures. This should not be seen as additional burden of service, but rather practical education in training as to the pressures trainees will face as future employees. Rethinking the contributions and training of residents and fellows may also synergistically work to impress to hospital administrators that providing better, more focused and applicable education to residents and fellows may have long-term, strategic, positive impacts on institutions.

The Hospitalist Perspective on Opioid Prescribing: A Qualitative Analysis

PubMed Central

Calcaterra, Susan L.; Drabkin, Anne D.; Leslie, Sarah E.; Doyle, Reina; Koester, Stephen; Frank, Joseph W.; Reich, Jennifer A.; Binswanger, Ingrid A.

2016-01-01

Background Pain is a frequent symptom among patients in the hospital. Pain management is a key quality indicator for hospitals and hospitalists are encouraged to frequently assess and treat pain. Optimal opioid prescribing, described as safe, patient-centered and informed opioid prescribing, may be at odds with the priorities of current hospital care, which focuses on patient-reported pain control rather than the potential long-term consequences of opioid use. Objective We aimed to understand physicians’ attitudes, beliefs and practices towards opioid prescribing during hospitalization and discharge. Design In-depth, semi-structured interviews Setting Two university hospitals, a safety-net hospital, a Veterans Affairs hospital, and a private hospital located in Denver, Colorado or Charleston, South Carolina. Participants Hospitalists (N=25) Measurements We systematically analyzed transcribed interviews and identified emerging themes using a team-based mixed inductive and deductive approach. Results Although hospitalists felt confident in their ability to control acute pain using opioid medications, they perceived limited success and satisfaction when managing acute exacerbations of chronic pain with opioids. Hospitalists recounted negative sentinel events which altered opioid prescribing practices in both the hospital setting and at the time of hospital discharge. Hospitalists described prescribing opioids as a pragmatic tool to facilitate hospital discharges or prevent readmissions. At times, this left them feeling conflicted about how this practice could impact the patient over the long term. Conclusions Strategies to provide adequate pain relief to hospitalized patients, which allow hospitalists to safely and optimally prescribe opioids while maintaining current standards of efficiency, are urgently needed. PMID:27157317

Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study

PubMed Central

Blakeman, Tom; Protheroe, Joanne; Chew-Graham, Carolyn; Rogers, Anne; Kennedy, Anne

2012-01-01

Background Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management. Aim To explore processes underpinning the implementation of CKD management in primary care. Design and setting Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester. Method Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data. Results A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions. Conclusion Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity. PMID:22520910

76 FR 76736 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-08

... Project Survey of Rapid Influenza Diagnostic Test (RIDT) Practices in Laboratories-NEW--the Office of...). Background and Brief Description The Survey of Rapid Influenza Diagnostic Testing Practices in Laboratories is a national systematic study investigating rapid influenza diagnostic testing practices in clinical...

Tracing Interacting Literacy Practices in Master's Dissertation Writing

ERIC Educational Resources Information Center

Kaufhold, Kathrin

2017-01-01

Academic literacy practices are increasingly varied, influenced by the diverse education and language backgrounds of students and staff, interdisciplinary approaches, and collaborations with non-university groups such as business partners. Completing a master's dissertation thus requires students to negotiate literacy practices associated with…

WestREN: a description of an Irish academic general practice research network

PubMed Central

2010-01-01

Background Primary care research networks have been established internationally since the 1960s to enable diverse practitioners to engage in and develop research and education and implement research evidence. The newly established Western Research and Education Network (WestREN) is one such network consisting of a collaboration between the Discipline of General Practice at NUI Galway and 71 West of Ireland general practices. In September 2009 all member practices were issued with a questionnaire with two objectives: to describe the structure and characteristics of the member practices and to compare the results to the national profile of Irish general practice. Methods A postal survey was used followed by one written and one email reminder. Results A response rate of 73% (52/71) was achieved after two reminders. Half of practices were in a rural location, one quarter located in an urban setting and another quarter in a mixed location. Ninety-four per cent of general practitioners practice from purpose-built or adapted premises with under 6% of practices being attached to the general practitioner's residence. Over 96% of general practitioners use appointment systems with 58% using appointment only. All practices surveyed were computerised, with 80% describing their practices as 'fully computerised'. Almost 60% of general practitioners are coding chronic diagnoses with 20% coding individual consultations. Twenty-five per cent of general practitioners were single-handed with the majority of practices having at least two general practitioners, and a mean number of general practitioners of 2.4. Ninety-two per cent of practices employed a practice nurse with 30% employing more than one nurse. Compared to the national profile, WestREN practices appear somewhat larger, and more likely to be purpose-built and in rural areas. National trends apparent between 1982 and 1992, such as increasing computerisation and practice nurse availability, appear to be continuing. Conclusions WestREN is a new university-affiliated general practice research network in Ireland. Survey of its initial membership confirms WestREN practices to be broadly representative of the national profile and has provided us with valuable information on the current and changing structure of Irish general practice. PMID:20925958

Learning Patterns in Music Practice: Links between Disposition, Practice Strategies and Outcomes

ERIC Educational Resources Information Center

StGeorge, Jennifer Mary; Holbrook, Allyson Patricia; Cantwell, Robert H.

2012-01-01

Research into musical practice has over recent decades focused on the technical and organisational strategies employed by novices and experts. What has been less studied are the background factors or influences on the quality of this music practice. Drawing on interview data collected from 66 children and adults from a mixed methods project, we…

The Working Practices and Clinical Experiences of Paediatric Speech and Language Therapists: A National UK Survey

ERIC Educational Resources Information Center

Pring, Tim; Flood, Emma; Dodd, Barbara; Joffe, Victoria

2012-01-01

Background: The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. Aims: To investigate the working practices and…

The Transfer of Learning from Play Practices to Game Play in Young Adult Soccer Players

ERIC Educational Resources Information Center

Holt, Josh E.; Ward, Phillip; Wallhead, Tristan L.

2006-01-01

Background: Physical educators and coaches face an ongoing problem of presenting fun and enjoyable practices that also provide efficient learning of technical and tactical sports skills. Effective instruction also promotes the transfer of learning from practice tasks to the real game. Play Practice (PP) describes a structure for teaching sports…

Background Noise Acceptance and Personality Factors Involved in Library Environment Choices by College Students

ERIC Educational Resources Information Center

Gordon-Hickey, Susan; Lemley, Trey

2012-01-01

For decades, academic libraries made efforts to provide study environments differing in acoustic environment. The present study aimed to provide an evidence basis for this practice by comparing background noise acceptance and personality factors of two groups of college-aged students self identified as preferring quiet or background noise when…

Redefining the stormwater first flush phenomenon.

PubMed

Bach, Peter M; McCarthy, David T; Deletic, Ana

2010-04-01

The first flush in urban runoff has been an important, yet disputed phenomenon amongst many researchers. The vast differences in the evidence could be solely due to limitations of the first flush current definition and the approach used for its assessment. There is a need for revisiting the first flush theory in the light of its practical applications to urban drainage management practices. We propose that a catchment's first flush behaviour is to be quantified by the runoff volume required to reduce a catchment's stormwater pollutant concentrations to background levels. The proposed method for assessment of this runoff volume starts by finding the average catchment pollutant concentrations for a given increment of discharged volume using a number of event pollutographs. Non-parametric statistics are then used to establish the characteristic pollutograph by pooling statistically indifferent runoff increments (known as slices) together. This allows the identification of the catchment's initial and background pollutant concentrations and for quantification of the first flush volume and its strength. The novel technique was used on seven catchments around Melbourne, Australia, with promising results. Sensitivity to the chosen increment of runoff (for which mean concentrations are calculated) indicated that when dealing with discrete flow-weighted water quality data, a suitable slice size should closely match the flow-weighting of samples. The overall sensitivity to runoff increment and level of significance was found to be negligible. Further research is needed to fully develop this method. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

How To Make Innovations Practical

ERIC Educational Resources Information Center

Janssen, Fred; Westbroek, Hanna; Doyle, Walter; van Driel, Jan

2013-01-01

Background/Context: A fundamental tension has long existed between school reform proposals and actual teaching practice. Despite a large literature on teacher change, the discontinuity between innovation and practice continues and many attempts to reform teaching fail to be enacted in most classrooms. Purpose/Objective/Research Question/Focus of…

Respiratory viral infections in children with asthma: do they matter and can we prevent them?

PubMed Central

2012-01-01

Background Asthma is a major public health problem with a huge social and economic burden affecting 300 million people worldwide. Viral respiratory infections are the major cause of acute asthma exacerbations and may contribute to asthma inception in high risk young children with susceptible genetic background. Acute exacerbations are associated with decreased lung growth or accelerated loss of lung function and, as such, add substantially to both the cost and morbidity associated with asthma. Discussion While the importance of preventing viral infection is well established, preventive strategies have not been well explored. Good personal hygiene, hand-washing and avoidance of cigarette smoke are likely to reduce respiratory viral infections. Eating a healthy balanced diet, active probiotic supplements and bacterial-derived products, such as OM-85, may reduce recurrent infections in susceptible children. There are no practical anti-viral therapies currently available that are suitable for widespread use. Summary Hand hygiene is the best measure to prevent the common cold. A healthy balanced diet, active probiotic supplements and immunostimulant OM-85 may reduce recurrent infections in asthmatic children. PMID:22974166

76 FR 47593 - Guidance for Small Business Entities on Current Good Manufacturing Practice for Positron Emission...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-05

...] Guidance for Small Business Entities on Current Good Manufacturing Practice for Positron Emission... entitled ``PET Drugs--Current Good Manufacturing Practice (CGMP); Small Entity Compliance Guide.'' FDA has... consistent with FDA's good guidance practices regulation (21 CFR 10.115). The guidance represents the Agency...

21 CFR 129.1 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 129.1 Section... Current good manufacturing practice. The applicable criteria in part 110 of this chapter, as well as the..., methods, practices, and controls used in the processing, bottling, holding, and shipping of bottled...

Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice

PubMed Central

2013-01-01

Background Gout is estimated to affect 1.4% of adults in the UK. Appropriate and timely management is essential to reduce the risk of further flares, complications, and to reduce cardiovascular disease risk. The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR/BHPR) and the European League Against Rheumatism (EULAR) have published guidance regarding the management of gout, thereby providing standards against which performance can be measured. This audit was designed to assess the extent to which patients diagnosed with gout in one primary care medical practice in North Staffordshire, UK, are managed in accordance with current best practice guidelines, and to identify strategies for improvement where appropriate. Methods Audit criteria were derived from the EULAR and BSR/BHPR guidelines; standards were set arbitrarily, but with consideration of patient comorbidity and other factors which may influence concordance. An electronic search of the practice records was performed to identify adults with a diagnosis of gout. Medical record review with a descriptive analysis was undertaken to assess the extent to which medical management adhered to the predefined standards. Results Of the total ≥18 year-old practice population (n = 8686), 305 (3%) patient records included a diagnosis of gout. Of these, 74% (n = 226) had an electronic record of serum uric acid (SUA), and 11% (n = 34) and 53% (n = 162) a measure of estimated glomerular filtration rate (eGFR) ever and serum glucose since diagnosis respectively. 34% (n = 105) of patients had ever taken urate-lowering therapy with 25% (n = 77) currently prescribed this at the time of data extraction. Dose adjustment and monitoring of treatment according to SUA was found to be inadequate. Provision of lifestyle advice and consideration of comorbidities was also lacking. Conclusions The primary care management of gout in this practice was not concordant with national and international guidance, a finding consistent with previous studies. This demonstrates that the provision of guidelines alone is not sufficient to improve the quality of gout management and we identify possible strategies to increase guideline adherence. PMID:24225170

Pitfalls of Counterfactual Thinking in Medical Practice: Preventing Errors by Using More Functional Reference Points

PubMed Central

Petrocelli, John V.

2013-01-01

Background Counterfactual thinking involves mentally simulating alternatives to reality. The current article reviews literature pertaining to the relevance counterfactual thinking has for the quality of medical decision making. Although earlier counterfactual thought research concluded that counterfactuals have important benefits for the individual, there are reasons to believe that counterfactual thinking is also associated with dysfunctional consequences. Of particular focus is whether or not medical experience, and its influence on counterfactual thinking, actually informs or improves medical practice. It is hypothesized that relatively more probable decision alternatives, followed by undesirable outcomes and counterfactual thought responses, can be abandoned for relatively less probable decision alternatives. Design and Methods Building on earlier research demonstrating that counterfactual thinking can impede memory and learning in a decision paradigm with undergraduate students, the current study examines the extent to which earlier findings can be generalized to practicing physicians (N=10). Participants were asked to complete 60 trials of a computerized Monty Hall Problem simulation. Learning by experience was operationalized as the frequency of switch-decisions. Results Although some learning was evidenced by a general increase in switch-decision frequency across block trials, the extent of learning demonstrated was not ideal, nor practical. Conclusions A simple, multiple-trial, decision paradigm demonstrated that doctors fail to learn basic decision-outcome associations through experience. An agenda for future research, which tests the functionality of reference points (other than counterfactual alternatives) for the purposes of medical decision making, is proposed. Significance for public health The quality of healthcare depends heavily on the judgments and decisions made by doctors and other medical professionals. Findings from this research indicate that doctors fail to learn basic decision-outcome associations through experience, as evidenced by the sample’s tendency to select the optimal decision strategy in only 50% of 60 trials (each of which was followed by veridical feedback). These findings suggest that professional experience is unlikely to enhance the quality of medical decision making. Thus, this research has implications for understanding how doctors’ reactions to medical outcomes shape their judgments and affect the degree to which their future treatment intentions are consistent with clinical practice guidelines. The current research is integrated with earlier research on counter-factual thinking, which appears to be a primary element inhibiting the learning of decision-outcome associations. An agenda for future research is proposed. PMID:25170495

Maternal–Child Microbiome: Specimen Collection, Storage and Implications for Research and Practice

PubMed Central

Jordan, Sheila; Baker, Brenda; Dunn, Alexis; Edwards, Sara; Ferranti, Erin; Mutic, Abby D.; Yang, Irene; Rodriguez, Jeannie

2017-01-01

Background The maternal microbiome is a key contributor to the development and outcomes of pregnancy and the health status of both mother and infant. Significant advances are occurring in the science of the maternal and child microbiome and hold promise in improving outcomes related to pregnancy complications, child development, and chronic health conditions of mother and child. Objectives The purpose of the paper is to review site-specific considerations in the collection and storage of maternal and child microbiome samples and its implications for nursing research and practice. Approach Microbiome sampling protocols were reviewed and synthesized. Precautions across sampling protocols were also noted. Results Oral, vaginal, gut, placental, and breastmilk are viable sources for sampling the maternal and/or child microbiome. Prior to sampling special considerations need to be addressed related to various factors including current medications, health status, and hygiene practices. Proper storage of samples will avoid degradation of cellular and DNA structures vital for analysis. Discussion Changes in the microbiome throughout the perinatal, postpartum and childhood periods are dramatic and significant to outcomes of the pregnancy and the long-term health of mother and child. Proper sampling techniques are required to produce reliable results from which evidence-based practice recommendations will be built. Ethical and practical issues surrounding study design and protocol development must also be considered when researching vulnerable groups such as pregnant women and infants. Nurses hold the responsibility to both perform the research and to translate findings from microbiome investigations for clinical use. PMID:28252577

Exploring accountability of clinical ethics consultants: practice and training implications.

PubMed

Weise, Kathryn L; Daly, Barbara J

2014-01-01

Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice.

Beyond ADHD: How Well Are We Doing?

PubMed Central

Stein, Ruth EK; Storfer-Isser, Amy; Kerker, Bonnie D.; Garner, Andrew; Szilagyi, Moira; Hoagwood, Kimberly E.; O’Connor, Karen G.; Horwitz, Sarah McCue

2017-01-01

Background and Objectives There has been increasing emphasis on the role of the pediatrician with respect to behavioral, learning and mental health (MH) issues, and developmental behavioral rotations are now required in pediatric residency programs. We sought to examine whether this newer emphasis on MH is reflected in pediatricians’ reports of their current practices. Methods Data from two Periodic Surveys (PS) conducted in 2004 and 2013 by the American Academy of Pediatrics (AAP) were examined to see whether there were differences in self-reported behaviors of usually inquiring/screening, treating/managing/co-managing, or referring patients for ADHD, anxiety, depression, behavioral problems or learning problems. We examined patterns for all practicing members and for those who practiced general pediatrics exclusively. Results There were few changes over the decade in the percentage who inquired or screened among all clinicians; among those exclusively practicing general pediatrics, the percentage who inquired or screened increased about 10% for ADHD and depression. ADHD remained the only condition for which the majority of respondents treated/managed/co-managed (57%). While there was some increase in the percentages who treated other conditions, the other conditions were usually treated by < 30% of respondents. A similar pattern of results was observed in analyses adjusted for physician, practice, and patient characteristics. Conclusions Despite the changing nature of pediatric practice and increased efforts to emphasize the importance of behavior, learning and MH, the pediatric community appears to be making little progress toward providing for the long-term behavioral, learning and MH needs of children and adolescents in its care. PMID:26514649

GPs’ job satisfaction: doctors who chose general practice early or late

PubMed Central

Lambert, Trevor; Smith, Fay; Goldacre, Michael

2013-01-01

Background In the UK many practising GPs did not choose general practice as their first choice of career when they originally graduated as doctors. Aim To compare job satisfaction of GPs who chose general practice early or later in their career. Design and setting Questionnaires were sent to all UK-trained doctors who graduated in selected years between 1993 and 2000. Method Questionnaires were sent to the doctors 1, 3, 7 and 10 years after graduation. Results Of all 3082 responders working in general practice in years 7 and 10, 38% had first specified general practice as their preferred career when responding 1 year after graduation, 19% by year 3, 21% by year 5, and 22% after year 5. Job satisfaction was high and, generally, there was little difference between the first three groups (although, when different, the most positive responses were from the earliest choosers); but there were slightly lower levels of job satisfaction in the ‘more than 5 years’ group. For example, in response to the statement ‘I find enjoyment in my current post’, the percentages agreeing in the four groups, respectively, were 91.5%, 91.1%, 91.0% and 88.2%. In response to ‘I am doing interesting and challenging work’ the respective percentages were 90.2%, 88.0%, 86.6% and 82.6%. Conclusions Job satisfaction levels were generally high among the late choosers as well as the early choosers. On this evidence, most doctors who turn to general practice, after preferring another specialty in their early career, are likely to have a satisfying career. PMID:24267855

Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.

PubMed

von Babo, Michelle; Chmiel, Corinne; Müggler, Simon Andreas; Rakusa, Julia; Schuppli, Caroline; Meier, Philipp; Fischler, Manuel; Urner, Martin

2018-01-01

Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients. This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

Sinning against nature: the theory of background conditions

PubMed Central

Blackford, R

2006-01-01

Debates about the moral and political acceptability of particular sexual practices and new technologies often include appeals to a supposed imperative to follow nature. If nature is understood as the totality of all phenomena or as those things that are not artificial, there is little prospect of developing a successful argument to impugn interference with it or sinning against it. At the same time, there are serious difficulties with approaches that seek to identify "proper" human functioning. An alternative approach is to understand interference with nature as acting in a manner that threatens basic background conditions to human choice. Arguably, the theory of background conditions helps explain much of the hostility to practices and technologies that allegedly sin against nature. The theory does not, however, entail that appeals to nature are relevant or rational. Such appeals should be subjected to sceptical scrutiny. Indeed, the theory suggests that arguments against practices and technologies that can be seen as contrary to nature sometimes exercise a psychological attraction that is disproportional to their actual cogency. PMID:17074819

Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems

PubMed Central

2013-01-01

Background This article reviews the current debate on developmental trauma disorder (DTD) with respect to formalizing its diagnostic criteria. Victims of abuse, neglect, and maltreatment in childhood often develop a wide range of age-dependent psychopathologies with various mental comorbidities. The supporters of a formal DTD diagnosis argue that post-traumatic stress disorder (PTSD) does not cover all consequences of severe and complex traumatization in childhood. Discussion Traumatized individuals are difficult to treat, but clinical experience has shown that they tend to benefit from specific trauma therapy. A main argument against inclusion of formal DTD criteria into existing diagnostic systems is that emphasis on the etiology of the disorder might force current diagnostic systems to deviate from their purely descriptive nature. Furthermore, comorbidities and biological aspects of the disorder may be underdiagnosed using the DTD criteria. Summary Here, we discuss arguments for and against the proposal of DTD criteria and address implications and consequences for the clinical practice. PMID:23286319

Redesign of a computerized clinical reminder for colorectal cancer screening: a human-computer interaction evaluation

PubMed Central

2011-01-01

Background Based on barriers to the use of computerized clinical decision support (CDS) learned in an earlier field study, we prototyped design enhancements to the Veterans Health Administration's (VHA's) colorectal cancer (CRC) screening clinical reminder to compare against the VHA's current CRC reminder. Methods In a controlled simulation experiment, 12 primary care providers (PCPs) used prototypes of the current and redesigned CRC screening reminder in a within-subject comparison. Quantitative measurements were based on a usability survey, workload assessment instrument, and workflow integration survey. We also collected qualitative data on both designs. Results Design enhancements to the VHA's existing CRC screening clinical reminder positively impacted aspects of usability and workflow integration but not workload. The qualitative analysis revealed broad support across participants for the design enhancements with specific suggestions for improving the reminder further. Conclusions This study demonstrates the value of a human-computer interaction evaluation in informing the redesign of information tools to foster uptake, integration into workflow, and use in clinical practice. PMID:22126324

Current Advances in Lanthanide‐Doped Upconversion Nanostructures for Detection and Bioapplication

PubMed Central

Chen, Cailing

2016-01-01

Along with the development of science and technology, lanthanide‐doped upconversion nanostructures as a new type of materials have taken their place in the field of nanomaterials. Upconversion luminescence is a nonlinear optical phenomenon, which absorbs two or more photons and emits one photon. Compared with traditional luminescence materials, upconversion nanostructures have many advantages, such as weak background interference, long lifetime, low excitation energy, and strong tissue penetration. These interesting nanostructures can be applied in anticounterfeit, solar cell, detection, bioimaging, therapy, and so on. This review is focused on the current advances in lanthanide‐doped upconversion nanostructures, covering not only basic luminescence mechanism, synthesis, and modification methods but also the design and fabrication of upconversion nanostructures, like core–shell nanoparticles or nanocomposites. At last, this review emphasizes the application of upconversion nanostructure in detection and bioimaging and therapy. Learning more about the advances of upconversion nanostructures can help us better exploit their excellent performance and use them in practice. PMID:27840794

The odd couple: using biomedical and intersectional approaches to address health inequities

PubMed Central

Hankivsky, Olena; Doyal, Lesley; Einstein, Gillian; Kelly, Ursula; Shim, Janet; Weber, Lynn; Repta, Robin

2017-01-01

ABSTRACT Background: Better understanding and addressing health inequities is a growing global priority. Objective: In this paper, we contribute to the literature examining complex relationships between biological and social dimensions in the field of health inequalities. Specifically, we explore the potential of intersectionality to advance current approaches to socio-biological entwinements. Design: We provide a brief overview of current approaches to combining both biological and social factors in a single study, and then investigate the contributions of an intersectional framework to such work. Results: We offer a number of concrete examples of how intersectionality has been used empirically to bring both biological and social factors together in the areas of HIV, post-traumatic stress disorder, female genital circumcision/mutilation/cutting, and cardiovascular disease. Conclusion: We argue that an intersectional approach can further research that integrates biological and social aspects of human lives and human health and ultimately generate better and more precise evidence for effective policies and practices aimed at tackling health inequities. PMID:28641056

Breast MRI radiogenomics: Current status and research implications.

PubMed

Grimm, Lars J

2016-06-01

Breast magnetic resonance imaging (MRI) radiogenomics is an emerging area of research that has the potential to directly influence clinical practice. Clinical MRI scanners today are capable of providing excellent temporal and spatial resolution, which allows extraction of numerous imaging features via human extraction approaches or complex computer vision algorithms. Meanwhile, advances in breast cancer genetics research has resulted in the identification of promising genes associated with cancer outcomes. In addition, validated genomic signatures have been developed that allow categorization of breast cancers into distinct molecular subtypes as well as predict the risk of cancer recurrence and response to therapy. Current radiogenomics research has been directed towards exploratory analysis of individual genes, understanding tumor biology, and developing imaging surrogates to genetic analysis with the long-term goal of developing a meaningful tool for clinical care. The background of breast MRI radiogenomics research, image feature extraction techniques, approaches to radiogenomics research, and promising areas of investigation are reviewed. J. Magn. Reson. Imaging 2016;43:1269-1278. © 2015 Wiley Periodicals, Inc.

Position and Speed Control of Brushless DC Motors Using Sensorless Techniques and Application Trends

PubMed Central

Gamazo-Real, José Carlos; Vázquez-Sánchez, Ernesto; Gómez-Gil, Jaime

2010-01-01

This paper provides a technical review of position and speed sensorless methods for controlling Brushless Direct Current (BLDC) motor drives, including the background analysis using sensors, limitations and advances. The performance and reliability of BLDC motor drivers have been improved because the conventional control and sensing techniques have been improved through sensorless technology. Then, in this paper sensorless advances are reviewed and recent developments in this area are introduced with their inherent advantages and drawbacks, including the analysis of practical implementation issues and applications. The study includes a deep overview of state-of-the-art back-EMF sensing methods, which includes Terminal Voltage Sensing, Third Harmonic Voltage Integration, Terminal Current Sensing, Back-EMF Integration and PWM strategies. Also, the most relevant techniques based on estimation and models are briefly analysed, such as Sliding-mode Observer, Extended Kalman Filter, Model Reference Adaptive System, Adaptive observers (Full-order and Pseudoreduced-order) and Artificial Neural Networks. PMID:22163582

Palliative Care in Huntington Disease: Personal Reflections and a Review of the Literature

PubMed Central

Tarolli, Christopher G.; Chesire, Amy M.; Biglan, Kevin M.

2017-01-01

Background Huntington disease is a fatal, autosomal dominant, neurodegenerative disorder manifest by the triad of a movement disorder, behavioral disturbances, and dementia. At present, no curative or disease modifying therapies exist for the condition and current treatments are symptomatic. Palliative care is an approach to care that focuses on symptom relief, patient and caregiver support, and end of life care. There is increasing evidence of the benefit of palliative care throughout the course of neurodegenerative conditions including Parkinson disease and amyotrophic lateral sclerosis. However, beyond its application at the end of life, little is known about the role of palliative care in Huntington disease. Methods In this article, we discuss what is known about palliative care in Huntington disease, specifically related to early disease burden, caregiver burnout, advance care planning, and end of life care. Results We provide a review of the current literature and discuss our own care practices. Discussion We conclude by discussing questions that remain unanswered and positing ideas for future work in the field. PMID:28428907

Apprenticeship in science research: whom does it serve?

NASA Astrophysics Data System (ADS)

Davies, Paul

2016-12-01

This article advances the thinking of Thompson, Conaway and Dolan's "Undergraduate students' development of social, cultural, and human capital in a network research experience". Set against a background of change in the biosciences, and participation, it firstly explores ideas of what it means to be a scientist, then challenges the current view of the apprenticeship model of career trajectory, before going onto to consider the nature of participation in communities of practice and issues related to underrepresented minority groups in science. Central to this analysis is the place that the notion of habitus plays in thinking about shaping future scientists and the how this can both support, but also suppress, opportunities for individuals through a maintenance of the status quo.

[Haemolytic uremic syndrome and thrombotic thrombocytopenic purpura: classification based on molecular etiology and review of recent developments in diagnostics].

PubMed

Prohászka, Zoltán

2008-07-06

Haemolytic uremic syndrome and thrombotic thrombocytopenic purpura are overlapping clinical entities based on historical classification. Recent developments in the unfolding of the pathomechanisms of these diseases resulted in the creation of a molecular etiology-based classification. Understanding of some causative relationships yielded detailed diagnostic approaches, novel therapeutic options and thorough prognostic assortment of the patients. Although haemolytic uremic syndrome and thrombotic thrombocytopenic purpura are rare diseases with poor prognosis, the precise molecular etiology-based diagnosis might properly direct the therapy of the affected patients. The current review focuses on the theoretical background and detailed description of the available diagnostic possibilities, and some practical information necessary for the interpretation of their results.

Dysfunctional adipose tissue and low-grade inflammation in the management of the metabolic syndrome: current practices and future advances

PubMed Central

van Greevenbroek, Marleen M. J.; Schalkwijk, Casper G.; Stehouwer, Coen D.A.

2016-01-01

The ongoing worldwide obesity epidemic makes the metabolic syndrome an increasingly important entity. In this review, we provide a short background on the metabolic syndrome, we discuss recent developments in the three main options that have been identified for intervention in the metabolic syndrome, i.e. lifestyle and surgical and pharmacological interventions, and we focus on different views in the literature and also include our own viewpoints on the metabolic syndrome. In addition, we discuss some emerging treatment targets for adipose tissue dysfunction and low-grade inflammation, i.e. activation of the inflammasome and the complement system, and consider some selected opportunities for intervention in these processes. PMID:27803798

The design of automatic software testing module for civil aviation information system

NASA Astrophysics Data System (ADS)

Qi, Qi; Sun, Yang

2018-05-01

In this paper, the practical innovation design is carried out according to the urgent needs of the automatic testing module of civil aviation information system. Firstly, the background and significance of the automatic testing module of civil aviation information system is expounded, and the current research status of automatic testing module and the advantages and disadvantages of related software are analyzed. Then, from the three aspects of macro demand, module functional requirement and module nonfunctional demand, we further study the needs of automatic testing module of civil aviation information system. Finally, from the four aspects of module structure, module core function, database and security, we have made an innovative plan for the automatic testing module of civil aviation information system.

Vertically aligned carbon nanofiber electrode arrays for nucleic acid detection

NASA Astrophysics Data System (ADS)

Arumugam, Prabhu U.; Yu, Edmond; Riviere, Roger; Meyyappan, M.

2010-10-01

We present electrochemical detection of DNA targets that corresponds to Escherichia coli O157:H7 16S rRNA gene using a nanoelectrode array consisting of vertically aligned carbon nanofiber (VACNF) electrodes. Parylene C is used as gap filling 'matrix' material to avoid high temperature processing in electrode construction. This easy to deposit film of several micron heights provides a conformal coating between the high aspect ratio VACNFs with negligible pin-holes. The low background currents show the potential of this approach for ultra-sensitive detection. Consistent and reproducible electrochemical-signals are achieved using a simple electrode preparation. This simple, reliable and low-cost approach is a forward step in developing practical sensors for applications like pathogen detection, early cancer diagnosis and environmental monitoring.

75 FR 52627 - Disenrollment Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-27

... program that has been discontinued. It also amends the regulation to reflect current VA practice and to... conform with current VA practice, which does not disenroll veterans based on their failure to file VA Form 10-10EZ. Current practice is reflected in current paragraph (d)(3)(iv). Removing paragraph (d)(5)(iii...

"Care": Moral Concept or Merely an Organisational Suffix?

ERIC Educational Resources Information Center

Clapton, J.

2008-01-01

Background: Over recent decades, a couple of interesting trends have occurred in regard to human services practices in Australia. First, there has been a significant shift from practices that previously have intentionally responded to emerging and continuing human need within communities to practices that are now managed within a context of…

Belonging in a Videogame Space: Bridging Affinity Spaces and Communities of Practice

ERIC Educational Resources Information Center

Abrams, Sandra Schamroth; Lammers, Jayne C.

2017-01-01

Background: Focusing on ways a common endeavor brings people together, Gee offered the concept of affinity spaces, which suggests that open participation without exclusion or membership is possible. This theory contrasts with Lave and Wenger's communities of practice, which called attention to situated, hierarchical participatory practices.…

An Experimental Test of Parenting Practices as a Mediator of Early Childhood Physical Aggression

ERIC Educational Resources Information Center

Brotman, Laurie Miller; O'Neal, Colleen R.; Huang, Keng-Yen; Gouley, Kathleen Kiely; Rosenfelt, Amanda; Shrout, Patrick E.

2009-01-01

Background: Parenting practices predict early childhood physical aggression. Preventive interventions that alter parenting practices and aggression during early childhood provide the opportunity to test causal models of early childhood psychopathology. Although there have been several informative preventive intervention studies that test mediation…

Teachers Implementing Entrepreneurship Education: Classroom Practices

ERIC Educational Resources Information Center

Ruskovaara, Elena; Pihkala, Timo

2013-01-01

Purpose: This study aims to highlight the entrepreneurship education practices teachers use in their work. Another target is to analyze how these practices differ based on a number of background factors. Design/methodology/approach: This article presents a quantitative analysis of 521 teachers and other entrepreneurship education actors. The paper…

Preschool Teachers' Endorsement of Instructional Practices: An Interprofessional Exploration

ERIC Educational Resources Information Center

Koutsoftas, Anthony D.; Dubasik, Virginia L.; Moss DiDonato, Alicia

2017-01-01

Background: Preschool teacher's instructional practices are one component of high-quality early education classrooms that have the potential to directly influence young children's school readiness and success; therefore, the type and quality of instructional practices used by preschool teachers should be explored. Purpose: The purpose of this…

78 FR 33853 - Announcement for the National Registry of Evidence-Based Programs and Practices (NREPP): Open...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-05

... Practices (NREPP): Open Submission Period for Fiscal Year 2014 Background The Substance Abuse and Mental... DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration (SAMHSA) Announcement for the National Registry of Evidence-Based Programs and Practices (NREPP): Open...

"Re-story-ing" Our Restorative Practices

ERIC Educational Resources Information Center

Rundell, Frida

2007-01-01

A metaphor for crossing a frontier into a new territory is explored. The restorative justice principles as used by the United Nations and the International Institute for Restorative Practices (IIRP) help to translate into restorative practice principles. An action research project in South Africa provides the background to an evaluation process.…

Current Strategies for Managing Providers Infected with Bloodborne Pathogens

PubMed Central

Turkel, Sarah; Henderson, David K.

2016-01-01

Background In 1991 CDC issued guidelines to reduce risks for provider-to-patient transmission of bloodborne pathogens. These guidelines, unchanged since 1991, recommend management strategies for hepatitis B ‘e’ antigen-positive providers and for providers infected with human immunodeficiency virus (HIV); they do not address hepatitis-C-virus (HCV)-infected providers. Objective We summarize current state practices and surveyed state health departments to determine: 1) if state policies have been modified since 1991; 2), if state laws require prospective notification of patients and/or expert review panels to manage infected providers; 3) the frequency with which infected-providers issues come to the attention of state health departments; and 4) how state health departments intervene. Methods We reviewed all 50 states’ laws and guidelines to determine current practices and conducted a structured telephone survey of all state health departments. Results Whereas only 19 states require infected providers to notify patients of the providers’ bloodborne pathogen infection, these 19 states require notification under highly varied circumstances. Only ten of 50 state health department officials identified these issues as requiring significant departmental effort. No state law or guideline incorporates information about providers’ viral burdens as part of the risk assessment. Only 3/50 States have modified policies or laws since initial passage; and only 1/50 discusses the management of HCV-infected providers.. Conclusions These results identify a need for incorporating contemporary scientific information into guidelines and also suggest that infected-provider issues are not occurring commonly, are not being detected, or that they are being managed at levels below the state health department. PMID:21515972

Cost-effectiveness and resource implications of aggressive action on TB in China, India and South Africa: a combined analysis of nine models

PubMed Central

Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein MGJ; Kimerling, Michael E; White, Richard G; Vassall, Anna

2017-01-01

BACKGROUND The End TB Strategy sets global goals of reducing TB incidence and mortality by 50% and 75% respectively by 2025. We assessed resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. METHODS We examined intervention scenarios developed in consultation with country stakeholders, which scaled-up existing interventions to high but feasible coverage by 2025. Nine independent TB modelling groups collaborated to estimate policy outcomes, and we costed each scenario by synthesizing service utilization estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health impact and resource implications for 2016–2035, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios to a base case representing continued current practice. FINDINGS Incremental TB service costs differed by scenario and country, and in some cases more than doubled current funding needs. In general, expanding TB services substantially reduced patient-incurred costs; and in India and China this produced net cost-savings for most interventions under a societal perspective. In all countries, expanding TB care access produced substantial health gains. Compared to current practice, most intervention approaches appeared highly cost-effective when compared to conventional cost-effectiveness thresholds. INTERPRETATION Expanding TB services appears cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, though funding needs challenge affordability. Further work is required to determine the optimal intervention mix for each country. PMID:27720689

A Quasi-Experimental Study Examining New York State's Tobacco-Free Regulation: Effects on Clinical Practice Behaviors

PubMed Central

Laschober, Tanja C.

2013-01-01

Background On July 24, 2008, New York State (NYS) became the first state to require all state-funded or state-certified substance use disorder (SUD) treatment organizations to be 100% tobacco-free and offer tobacco cessation (TC) treatment. Methods The current study used a quasi-experimental, non-equivalent control group design with a pretest and posttest to examine the effect of the NYS tobacco-free regulation on three clinical practice behaviors (use of TC-related intake procedures, use of guideline recommended counseling for TC, and pharmacotherapy availability) in a diverse sample of SUD treatment programs. Repeated cross-sectional data were collected from NYS counselors (experimental group) and non-NYS counselors (control group) approximately 4 months pre-regulation (N = 282 and 659, respectively) and 10-12 months post-regulation (N = 364 and 733, respectively). Results Using mixed-effects models, results at pre-regulation indicate no group differences in the three clinical practice behaviors. However, significant post-regulation effects were found such that the experimental group reports greater use of TC-related intake procedures, guideline recommended counseling, and availability of pharmacotherapy than the control group. Additionally, the experimental but not the control group shows increases in all three clinical practice behaviors from pre-regulation to post-regulation. Conclusions We conclude that the NYS tobacco-free regulation had a significant and positive effect on promoting patient TC efforts among counselors. PMID:23428317

Knowledge, use and ecology of golden thistle (Scolymus hispanicus L.) in Central Spain

PubMed Central

2009-01-01

Background This paper assesses the current ethnobotanical knowledge, use and management of Scolymus hispanicus L. in two localities of Central Spain and the relation with its natural abundance. It also addresses the influence of sociodemographic factors such as age, gender and time living in the village in the variation of knowledge and practice levels. Methods During 2007 and 2008, 99 semi-structured interviews and a questionnaire were made to a random stratified sample by sex and age, asking them about their traditional knowledge and practices (use and gathering) of Scolymus hispanicus. A knowledge and practice (KP) index was created based on the answers to the questionnaire. Results and Discussion Scolymus hispanicus is still gathered and consumed by 20% and 35% of the informants, respectively. According to the KP index, the knowledge and practice level is similar in both villages. Age and time living in the village are the factors that better explain the variability in the KP level. People living for more than ten years in the village and those older than 60 years have the highest knowledge level, whereas the younger than 19 the lowest. Conclusions Our data suggests that the prevalence of ethnobotanical knowledge and uses depends more on the cultural importance of the plant and the transmission of such popular knowledge than on the resource's abundance. PMID:20028498

Tobacco as a social currency: cigarette gifting and sharing in China.

PubMed

Rich, Zachary C; Xiao, Shuiyuan

2012-03-01

China produces and consumes more tobacco than any other country in the world and as such is at the forefront of the world tobacco epidemic. Many studies have recently emerged that directly or indirectly reference the acts of giving and sharing cigarettes as a major contributor to China's high tobacco usage. The goal of this report is to review relevant literature relating to sharing and gifting cigarettes as well as provide useful historic and cultural contexts. Important differences between the act of giving individual cigarettes and the gifting of packaged cigarettes are explored as well as explanations for how both these practices have influenced current tobacco control efforts. Available Chinese and English sources on gifting and sharing cigarettes in China published between 1991 and 2011 were reviewed and discussed with a cultural and historical background. The practices of gifting and sharing cigarettes strongly contribute to smoking initiation as well as failure to quit smoking among Chinese males. Historical and cultural roots have reinforced these practices and hampered efforts to reduce tobacco use in China. Traditional tobacco control efforts should be combined with culture-specific approaches to reduce tobacco usage in China. The regular exchange of cigarettes normalizes smoking across society and promotes tobacco's acceptability. Great efforts should be taken not only to minimize these practices among males but also to discourage their adoption by females.

21 CFR 113.5 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 113.5 Section... CONTAINERS General Provisions § 113.5 Current good manufacturing practice. The criteria in §§ 113.10, 113.40..., methods, practices, and controls used by the commercial processor in the manufacture, processing, or...

Magnetic imager and method

DOEpatents

Powell, J.; Reich, M.; Danby, G.

1997-07-22

A magnetic imager includes a generator for practicing a method of applying a background magnetic field over a concealed object, with the object being effective to locally perturb the background field. The imager also includes a sensor for measuring perturbations of the background field to detect the object. In one embodiment, the background field is applied quasi-statically. And, the magnitude or rate of change of the perturbations may be measured for determining location, size, and/or condition of the object. 25 figs.

Tuberculosis Management Practices of Private Practitioners in Pune Municipal Corporation, India

PubMed Central

Bharaswadkar, Sandeep; Kanchar, Avinash; Thakur, Narendra; Shah, Shubhangi; Patnaik, Brinda; Click, Eleanor S.; Kumar, Ajay M. V.; Dewan, Puneet Kumar

2014-01-01

Background Private Practitioners (PP) are the primary source of health care for patients in India. Limited representative information is available on TB management practices of Indian PP or on the efficacy of India’s Revised National Tuberculosis Control Programme (RNTCP) to improve the quality of TB management through training of PP. Methods We conducted a cross-sectional survey of a systematic random sample of PP in one urban area in Western India (Pune, Maharashtra). We presented sample clinical vignettes and determined the proportions of PPs who reported practices consistent with International Standards of TB Care (ISTC). We examined the association between RNTCP training and adherence to ISTC by calculating odds ratios and 95% confidence intervals. Results Of 3,391 PP practicing allopathic medicine, 249 were interviewed. Of these, 55% had been exposed to RNTCP. For new pulmonary TB patients, 63% (158/249) of provider responses were consistent with ISTC diagnostic practices, and 34% (84/249) of responses were consistent with ISTC treatment practices. However, 48% (120/249) PP also reported use of serological tests for TB diagnosis. In the new TB case vignette, 38% (94/249) PP reported use of at least one second line anti-TB drug in the treatment regimen. RNTCP training was not associated with diagnostic or treatment practices. Conclusion In Pune, India, despite a decade of training activities by the RNTCP, high proportions of providers resorted to TB serology for diagnosis and second-line anti-TB drug use in new TB patients. Efforts to achieve universal access to quality TB management must account for the low quality of care by PP and the lack of demonstrated effect of current training efforts. PMID:24897374

Antibiotics in urinary-tract infections. Sustained change in prescribing habits by practice test and self-reflection: a mixed methods before-after study.

PubMed

Kuehlein, T; Goetz, K; Laux, G; Gutscher, A; Szecsenyi, J; Joos, S

2011-06-01

BACKGROUND The German guideline recommends trimethoprim (TMP) for the treatment of uncomplicated lower-urinary-tract infections (uLUTI) in primary care. In the authors' research network, the participating general practitioners (GPs) were asked why they prescribe mostly quinolones instead. The GPs stated the perception of a high rate of therapy failure of TMP and strongly rejected the guideline. OBJECTIVE To examine prescribing behaviour for uLUTI and whether a practice test of TMP might effect a change in prescribing habits. METHODS The study was conducted using observational and qualitative elements. A first focus-group (n=6) assessed reasons for current prescribing behaviour. In a 3-month practice test, patients with uLUTI were prescribed TMP (150 mg twice for 3 days). In a second focus group, the GPs (n=12) were presented with the results of the practice test. RESULTS The first focus group revealed that prescribing was mainly driven by former hospital training and what was perceived as common therapy. GPs felt no need to change a successful regimen. In the practice test, TMP had a success rate of 94% (84 episodes of uLUTI). The second focus group revealed that the practice test had strongly changed opinions in favour of TMP. Self-reflection and ownership of data acquisition were seen as major contributions for change in prescribing. After the test period, TMP remained the antibiotic most often prescribed. CONCLUSION Internal evidence and peer-group opinion are strong determinants for clinical decisions. A self-conducted practice test, together with self-reflection in a peer group, strongly supports the process of change.