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  1. Kaiser Permanente Northwest

    Cancer.gov

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

  2. TUBERCULOSIS COMO ENFERMEDAD OCUPACIONAL

    PubMed Central

    Mendoza-Ticona, Alberto

    2014-01-01

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

  3. Kaiser Permanente National Hand Hygiene Program

    PubMed Central

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

    2004-01-01

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

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

    PubMed

    McCreary, Lew

    2010-09-01

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

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

    Cancer.gov

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

  6. Medical imaging equipment service in Kaiser Permanente, Northern California.

    PubMed

    Plasse, R J; Brooks, W G

    1993-01-01

    As the largest department in Biomedical Engineering, Medical Imaging Services (MIS) provides comprehensive equipment service for all imaging modalities in Kaiser Permanente, Northern California Region. MIS is customer-focused and committed to exploring better ways to deliver service, control costs and implement business strategies to meet customers' changing needs. Service extends beyond conventional preventive/corrective maintenance to include technology assessment, regulatory compliance, education and training, and managed vendor relationships. Program enhancements include film processor and solutions service, a second-source parts program, and a machine shop. In recent years, operations expanded to the Kaiser Permanente Northwest Region. Significant savings are available to any healthcare organization willing to embrace a new, expanded view of equipment management.

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

    PubMed Central

    Meyers, Kate; Tang, Gayle; Fernandez, Alicia

    2009-01-01

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

  8. The Kaiser Permanente Northern California Adult Member Health Survey

    PubMed Central

    Gordon, Nancy; Lin, Teresa

    2016-01-01

    Introduction The Kaiser Permanente Northern California (KPNC) Member Health Survey (MHS) is used to describe sociodemographic and health-related characteristics of the adult membership of this large, integrated health care delivery system to monitor trends over time, identify health disparities, and conduct research. Objective To provide an overview of the KPNC MHS and share findings that illustrate how survey statistics and data have been and can be used for research and programmatic purposes. Methods The MHS is a large-scale, institutional review board-approved survey of English-speaking KPNC adult members. The confidential survey has been conducted by mail triennially starting in 1993 with independent age-sex and geographically stratified random samples, with an option for online completion starting in 2005. The full survey sample and survey data are linkable at the individual level to Health Plan and geocoded data. Respondents are assigned weighting factors for their survey year and additional weighting factors for analysis of pooled survey data. Results Statistics from the 1999, 2002, 2005, 2008, and 2011 surveys show trends in sociodemographic and health-related characteristics and access to the Internet and e-mail for the adult membership aged 25 to 79 years and for 6 age-sex subgroups. Pooled data from the 2008 and 2011 surveys show many significant differences in these characteristics across the 5 largest race/ethnic groups in KPNC (non-Hispanic whites, blacks, Latinos, Filipinos, and Chinese). Conclusion The KPNC MHS has yielded unique insights and provides an opportunity for researchers and public health organizations outside of KPNC to leverage our survey-generated statistics and collaborate on epidemiologic and health services research studies. PMID:27548806

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

    PubMed

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

    2014-05-01

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

  10. Making the business case for hospital information systems--a Kaiser Permanente investment decision.

    PubMed

    Garrido, Terhilda; Raymond, Brian; Jamieson, Laura; Liang, Louise; Wiesenthal, Andrew

    2004-01-01

    Further evidence in favor of the clinical IT business case is set forth in Kaiser Permanente's cost/benefit analysis for an electronic hospital information system. This article reviews the business case for an inpatient electronic medical record system, including 36 categories of quantifiable benefits that contribute to a positive cumulative net cash flow within an 8.5 year period. However, the business case hinges on several contingent success factors: leadership commitment, timely implementation, partnership with labor, coding compliance, and workflow redesign. The issues and constraints that impact the potential transferability of this business case across delivery systems raise questions that merit further attention.

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

    USGS Publications Warehouse

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

    1964-01-01

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

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

    SciTech Connect

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

    1996-11-01

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

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

    PubMed Central

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

    2007-01-01

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

  14. Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente

    PubMed Central

    Feachem, Richard G A; Sekhri, Neelam K; White, Karen L

    2002-01-01

    Objective To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California. Methods The adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators. Results The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10%. Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS. Conclusions The widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by underinvestment are not supported by this analysis. Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology. What is already known on this topicComparisons of healthcare systems in different countries have to be undertaken with great care but can be instructiveThe overall healthcare system in the United States is more expensive than the NHS and population health outcomes are no betterThe US healthcare system comprises many discrete and unique subsystems, including the health maintenance organisationsWhat this paper addsAn integrated, non-profit health maintenance organisation in California (Kaiser Permanente), with over six million members, costs about the same as the NHS but performs considerably betterKaiser's superior performance is mainly in prompt and appropriate diagnosis and treatmentThese findings challenge the widely held

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

    PubMed Central

    Collmann, Jeff; Cooper, Ted

    2007-01-01

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

  16. The integration of primary care and behavioral healthcare in northern California Kaiser-Permanente.

    PubMed

    Dea, R A

    2000-01-01

    Integration of behavioral healthcare and primary care has a number of presumed benefits, including better communication between providers and systems, leading to improved patient care. There are studies showing medical cost offsets, although they tend to be in circumscribed research settings. Northern California Kaiser-Permanente has designed a new primary care system providing mental health clinicians on a primary care team. Those clinicians evaluate patients, create treatment plans, provide brief interventions, coordinate care with specialty behavioral healthcare, and consult with primary care physicians. Those physicians also have an increased role in the detection and treatment of behavioral health problems via guidelines developed with behavioral health. Structural changes within the overall system, including regional call centers and computerized clinical information systems, support the integration. Quality programs also support the ongoing improvement of the integration process. There are investment expenses in this type of re-design, but also expected cost savings. An infrastructure is now in place to measure both clinical outcomes, and cost effects of the new model.

  17. Breaching the security of the Kaiser Permanente Internet patient portal: the organizational foundations of information security.

    PubMed

    Collmann, Jeff; Cooper, Ted

    2007-01-01

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

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

    PubMed

    Pearl, Robert

    2014-02-01

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

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

    SciTech Connect

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

    1996-11-01

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

  20. Implementing KDOQI CKD definition and staging guidelines in Southern California Kaiser Permanente.

    PubMed

    Rutkowski, Mark; Mann, Wendy; Derose, Stephen; Selevan, David; Pascual, Noel; Diesto, Jean; Crooks, Peter

    2009-03-01

    We outline the experience of Southern California Kaiser Permanente, a large integrated health maintenance organization, in implementing the chronic kidney disease (CKD) definition and staging guidelines of the Kidney Disease Outcomes Quality Initiative (KDOQI) from 2002 to 2008, including estimated glomerular filtration rate (eGFR) implementation, algorithm for GFR range assignment and reassignment, and practical modifications of CKD staging for population management. We departed from the KDOQI CKD definition and staging as follows: for stages 1 to 2, we required "macroproteinuria" rather than "microalbuminuria" as the marker of kidney damage; for stage 3, we included individuals with macroproteinuria, diabetes mellitus based on diabetic registry, or eGFR + 1/2 age less than 85; and for stage 5, we included only individuals not receiving renal replacement therapy. In an adult population of 2.5 million members, we identified 2.9% (72,005) for CKD population management (0.1%, 0.2%, 1.7%, 0.15%, and 0.01% with stages 1, 2, 3, 4, and 5, respectively). Outpatient visits with a nephrologist in the past 12 months for the prevalent CKD population increased modestly from 2003 to 2008 from 20% to 24%. Nephrologists see a higher risk subset, including 77% of patients with stages 4 to 5, 45% of prevalent patients with CKD stages 1 to 5 with the last urine protein level greater than approximately 1 g, and 21% of patients with stage 3 in the past 12 months, but only 4% of patients with eGFR of 30 to 59 mL/min/1.73 m(2) not meeting our criteria for stage 3. Primary care providers see the majority of patients with stages 1 to 5 in the course of a year (85%) and are aware of kidney disease (79% coded for kidney disease). Other quality indicators during the 12-month window include the following: for patients with prevalent CKD stages 1 to 5, a total of 56% with last blood pressure greater than 129/79 mm Hg, 21% missing qualitative proteinuria, 16% missing angiotensin

  1. The Kaiser Permanente Clinician Cultural and Linguistic Assessment Initiative: research and development in patient-provider language concordance.

    PubMed

    Tang, Gayle; Lanza, Oscar; Rodriguez, Fátima Marinely; Chang, Annie

    2011-02-01

    Patient-clinician language concordance is a critical component of the language access equation and is considered the gold standard for communication. As a result of lack of validated testing standards, measures, and tools, Kaiser Permanente developed the Clinician Cultural and Linguistic Assessment Initiative to ensure verifiable linguistic proficiency in clinical encounters and has established a standard level whereby the clinician is deemed to have a qualifying level of proficiency in communicating directly with patients independent of an interpreter. Our benchmarking efforts in language concordance have been rooted with the key aim to identify talented bilingual and bicultural clinician workforce and to establish the systems foundation to coordinate appropriate language services. We share accomplishments, lessons learned, and promising practices to inform future efforts in language concordance.

  2. How Kaiser Permanente uses video ethnography of patients for quality improvement, such as in shaping better care transitions.

    PubMed

    Neuwirth, Esther B; Bellows, Jim; Jackson, Ana H; Price, Patricia M

    2012-06-01

    Keeping patients and caregivers at the center of quality improvement is critical. Kaiser Permanente's Care Management Institute adapted video ethnography to achieve this aim, using video to capture interviews with-and observations of-patients and caregivers, identify patient-centered improvement opportunities, and communicate them effectively to clinical and administrative leaders and front-line staff. This method is particularly effective for helping understand the needs of frail elders, patients nearing the end of life, those with multiple chronic conditions, and other vulnerable people who are not well represented in focus groups and patient advisory councils. As part of an initiative to improve care transitions for elders with heart failure, video ethnography contributed to greatly reduced thirty-day hospital readmission rates, helping reduce readmissions at one medical center from 13.6 percent to 9 percent in six months. It also helped improve the reliability of the readmissions reduction program. When embedded within an established quality improvement framework, video ethnography can be an effective tool for innovating new solutions, improving existing processes, and spreading knowledge about how best to meet patient needs.

  3. The dartmouth atlas applied to kaiser permanente: analysis of variation in care at the end of life.

    PubMed

    Stiefel, Matt; Feigenbaum, Paul; Fisher, Elliott S

    2008-01-01

    The Dartmouth Atlas method for examination of variation in care at the end of life was replicated by Kaiser Permanente (KP). Variation within KP was analyzed and compared with corresponding Dartmouth Atlas Hospital Referral Regions. Although KP inpatient care use rates were 25% to 30% lower and hospice use rates were higher than in the surrounding communities, there was still two- to four-fold variation in inpatient care use across KP geographic areas. Evidence suggests that more, or more intensive, care for this population is neither necessarily better nor desired by patients. If all California (CA) KP residence areas had the hospital day rate of the average of the lowest three, 2005 decedents would have had more than 50,000 fewer hospital days in their last six months of life. High-intensity care accounts for a large proportion of the overall variation in total costs for this population. This strongly reinforces the focus on appropriate intensive care unit (ICU) use in end-of-life care. Greater emphasis on palliative care approaches for patients with chronic conditions and earlier transition to the use of hospice would create a better match between the expressed desires of patients and the care they receive, thus improving member and family satisfaction as well as quality of care. In addition, earlier transition to hospice in KP could be one important tool for avoiding undesired and nonbeneficial ICU use, given the negative correlation between hospice and ICU use identified in this analysis.Geographic variation in hospital use within KP appears to be correlated with variation in the surrounding communities, even though it is lower on average within KP than outside it. This suggests that KP resource use may be influenced at least in part by broader community practices.

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

    PubMed Central

    2002-01-01

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

  5. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente Nationwide Health Information Network exchange in San Diego: patient selection, consent, and identity matching.

    PubMed

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

    2011-01-01

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

  6. Como Lo Hago Yo: Myelomeningocele

    PubMed Central

    Lazareff, Jorge

    2014-01-01

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

  7. End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve

    PubMed Central

    Sim, John J; Batech, Michael; Danforth, Kim N; Rutkowski, Mark P; Jacobsen, Steven J; Kanter, Michael H

    2017-01-01

    Objectives: The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement. Methods: Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate. Age- and sex-adjusted rates of end-stage renal disease (ESRD) were compared with those in the overall KPSC population. Results: Among 12,394 individuals, 83 (0.7%) reached ESRD. The age- and sex-adjusted relative risk of ESRD was 2.7 times higher compared with the KPSC general population during the same period (94.7 vs 35.4 per 100,000 person-years; p < 0.001). Screening with the Chronic Kidney Disease Epidemiology Collaboration (vs Modification Diet in Renal Diseases) equation would capture 44% fewer individuals and have a higher predictive value for CKD. Of those who had repeated creatinine measurements, only 13% had a urine study performed (32% among patients with confirmed CKD). Conclusion: Our study found a higher incidence of ESRD among individuals captured into the KPSC creatinine safety program. If the Chronic Kidney Disease Epidemiology Collaboration equation were used, fewer people would have been captured while improving the accuracy for diagnosing CKD. Urine testing was low even among patients with confirmed CKD. Our findings demonstrate the importance of a creatinine safety net program in an integrated health system but also suggest opportunities to improve CKD care and screening. PMID:28241912

  8. Modèle mathématique pour l'étude des équilibres physico-chimiques de permanentes.

    PubMed

    Chiodi, F

    1989-12-01

    Résumé La plupart des permanentes du commerce sont constituées d'acide thioglycolique (éventuellement associéà l'acide thiolactique), neutralisé par l'ammoniac, elles sont additionnées de carbonate d'ammonium comme tampon. Le système peut etre traité comme la neutralisation d'un mélange d'acides thioglycolique et carbonique par l'ammoniac, et il est complètement défini par trois paramètres, trois concentrations, ou deux concentrations et le pH, ou trois paramètres analytiques indépendants. Les calculs théoriques de l'équilibre sont compliqués du fait qu'il s'agit de l'équilibre de deux diacides faibles neutralisés par une base faible. Un modèle mathématique développé exclusivement par des équations théoriques permet l'interprétation des équilibres et la réalisation des calculs fiable pour la préparation des formules remplissant certaines caractéristiques. Le modèle permet de réaliser facilement des simulations en faisant varier les concentrations, les acides (par la voie des constantes de dissociation) ou d'associer différents acids et/ou bases organiques ou minérales. Une application complémentaire du modèle est de tracer la courbe dérivée à la courbe de neutralisation et de cette façon mesurer l'effet tampon en différents points par la mesure de sa pente. Synopsis Mathematical model for the study of physico-chemical equilibria in permanent wave solutions Most waving lotions on the market are prepared with thioglycolic acid (eventually associated with thiolactic acid) neutralized with ammonium hydroxide and buffered with ammonium bicarbonate. The system can be treated as the neutralization of a mix of carbonic acid and thioglycolic acid by ammonia and it is completely defined by three parameters: three concentrations; or two concentrations and pH; or three independent analytical parameters. Theoretical calculations of the equilibrium are difficult because the equilibrium involves at least two weak acids with a weak base

  9. Como Lo Hago Yo: Mielomeningocele En Bolivia

    PubMed Central

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

    2014-01-01

    Introducción: Las malformaciones del tubo neural (MTN) representan la segunda causa más frecuente de anomalías congénitas, luego de las cardiopatías. En este grupo se destaca el mielomeningocele (MMC) por su mayor incidencia, y por ser la más incapacitante y la más compleja entre todas las demás malformaciones del sistema nervioso c`entral (SNC). En Bolivia, como en muchos países de Sudamérica, los bajos niveles socio-culturales y la debilidad en el sistema sanitario, hacen que su incidencia y su morbilidad, sean mayores que en las naciones más desarrolladas. Material y Métodos: Se realizó un estudio retrospectivo y descriptivo de 70 casos de MMC, atendidos por un equipo multidisciplinario en el Hospital Universitario Japonés (HUJ) de Santa Cruz de la Sierra, entre 2008-2011. De ellos, 60 fueron intervenidos quirúrgicamente. Resultados: Se realizaron controles prenatales sólo en 27 mujeres (38.6%), diagnosticándose una disrafia espinal en apenas dos casos (7.4%). La edad de ingreso del MMC en su mayoría fue después de las 24 horas (65.6%), predominando su localización en la región lumbosacra (64.3%). De ellos, 67.2% eran abiertos, presentando un 32.9% un daño neurológico motor parcial mientras que 47.1% tenían paraplejia por debajo de la lesión. De los 70 casos, tres (4.3%) no fueron intervenidos, por presentar defectos congénitos severos o estado general grave. Las principales complicaciones posoperatorias inmediatas fueron: dehiscencia de sutura y/o infección de la herida (16.6%), fístula de líquido cefalorraquídeo (LCR) (10%) e infección del SNC (11.7%). La mortalidad general y postoperatoria fue de 7.1% y 3.3%, respectivamente. Al mes de vida presentaban hidrocefalia un 80% de los pacientes operados, colocándose una derivación ventriculoperitoneal (DVP) de presión media. De 9 pacientes que tuvieron un acompanamiento de dos o más años, seis presentaron una médula anclada, que fueron intervenidas quirúrgicamente. Conclusi

  10. The Kaiser Permanente Shoulder Arthroplasty Registry

    PubMed Central

    Ake, Christopher F; Burke, Mary F; Singh, Anshuman; Yian, Edward H; Paxton, Elizabeth W; Navarro, Ronald A

    2015-01-01

    Background and purpose Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry. Patients and methods Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis. The registry included patient characteristics, surgical information, implant data, attrition, and patient outcomes such as surgical site infections, venous thromboembolism, and revision procedures. Results During the study period, 6,336 primary cases were registered. Median follow-up time for all primaries was 3.3 years; 461 cases were lost to follow-up by ending of health plan membership. Primary cases were predominantly female (56%) and white (81%), with an average age of 70 years. The most common reason for surgery was osteoarthritis in 60% of cases, followed by acute fracture (17%) and rotator cuff tear arthropathy (15%). In elective shoulder arthroplasty procedures, 200 all-cause revisions (4%) were reported, with glenoid wear being the most common reason. Interpretation Most arthroplasties were elective procedures: over half performed for osteoarthritis. Glenoid wear was the most common reason for revision of primary shoulder arthroplasty in elective cases. PMID:25727949

  11. LA BIOÉTICA COMO QUEHACER FILOSÓFICO

    PubMed Central

    Ferrer, Jorge José

    2009-01-01

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

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

    PubMed

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

    2016-01-15

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

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

    ERIC Educational Resources Information Center

    Blat, Gimeno J.

    1971-01-01

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

  14. L'education permanente: Principe revolutionnaire et pratiques conservatrices

    NASA Astrophysics Data System (ADS)

    Gelpi, Ettore

    1994-05-01

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

  15. 78 FR 38287 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-26

    ... Forest Service Bitterroot National Forest, Darby Ranger District, Como Forest Health Project AGENCY: Forest Service. ACTION: Notice; Correction. SUMMARY: The Department of Agriculture (USDA), Forest Service, Bitterroot National Forest, Darby Ranger District published a document in the Federal Register of June...

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

    NASA Astrophysics Data System (ADS)

    Forte, J. C.

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

  17. Recrudescence of onchocerciasis in the Comoé valley in Southwest Burkina Faso.

    PubMed

    Koala, Lassane; Nikiema, Achille; Post, Rory J; Paré, Alain Brice; Kafando, Claude Montant; Drabo, François; Traoré, Soungalo

    2017-02-01

    Onchocerciasis control by vector control was instigated in southwest Burkina Faso in January 1969 by ORSTOM/OCCGE, and continued until operations were taken over by the WHO Onchocerciasis Control Programme (OCP) in February 1975, which itself ceased operations in the area in 1989 when onchocerciasis was judged to have been reduced to insignificant levels. Initially (1969-1975) vector immigration maintained unacceptably high levels of transmission, but OCP was much larger than the preceding campaign and in 1975 the Annual Transmission Potential (ATP) dropped below 100 at all sites in the Comoé river valley except Folonzo, which continued to be subject to reinvasion, along with the whole of the Léraba river valley. However, after the southern extension of the OCP in 1979, ATPs dropped below 100 everywhere in the Comoé basin (including the Léraba valley), and further dropped to insignificant levels after the western extension of the OCP in 1985. Thus transmission dropped more quickly in the Comoé river valley than the Léraba river valley (which had been subject to vector reinvasion), and this was also reflected in prevalence of microfilaraemia in the human population. After 1986 prevalence was less than 5% in all villages in the Comoé river valley (except for two, which subsequently dropped to 0% and 3.7% by 1999). However, in 2001 (12 years after the cessation of vector control) the prevalence in one village in the Comoé river valley had increased to 39.6%, and two more had increased above 5% by 2007. New epidemiological surveys in 2011 and 2012 showed that in 13 out of 30 villages in the Comoé river valley prevalence of microfilaraemia was above 5%, although this was not observed in the Léraba river valley where prevalence remained low. This is the first documented case of recrudescence of onchocerciasis in the old OCP area, and the reasons are not clear. It is possible that there has been immigration of parasites with humans or vectors from areas where

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

    NASA Astrophysics Data System (ADS)

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

    2013-07-01

    The study reported in this work takes place since 2009 at the Federal Institute of Education, Science and Technology of Santa Catarina, Campus Araranguá. Our main goal is to help form teachers, training undergraduate students in Natural Sciences with specialization in Physics as science communicators, as well as to promote actions of broader scientific popularization in the region of the town of Araranguá through an Astronomy Club called CA2. Among the actions of scientific popularization that the students promote are: video production, radio broadcasts, lectures, nightly observations, preparation and exhibition of posters, physics teaching for children, continuing education activities for teachers and regular physics teaching using Astronomy as a theme. The Club's teacher education and scientific dissemination work is based on the Theory of Meaningful Learning, always trying to reach the student's predisposition to learn and produce potentially meaningful material, the two essential conditions for meaningful learning to occur. O estudo que este trabalho relata ocorre desde 2009 no Instituto Federal de Educação, Ciência e Tecnologia de Santa Catarina, campus Araranguá. Nele procura-se formar divulgadores científicos durante a formação inicial de docentes do curso de Licenciatura em Ciências da Natureza com habilitação em Física, além de promover ações de divulgação científica para o público geral da região da cidade de Araranguá por meio de um Clube de Astronomia chamado CA² (Clube de Astronomia de Araranguá). Entre as ações de divulgação científica que os licenciandos promovem estão: produção de vídeos, programas de rádio, palestras, observações noturnas, confecção e exposição de pôsteres, ensino de física para crianças, formação continuada de professores em atividades e ensino de Física regular utilizando a Astronomia como tema gerador. O trabalho de formação docente e divulgação científica do Clube fundamenta

  19. Fluid dipping technology of chimpanzees in Comoé National Park, Ivory Coast.

    PubMed

    Lapuente, Juan; Hicks, Thurston C; Linsenmair, K Eduard

    2016-12-21

    Over a 6 month period during the dry season, from the end of October 2014 to the beginning of May 2015, we studied tool use behavior of previously unstudied and non-habituated savanna chimpanzees (Pan troglodytes verus) living in the Comoé National Park, Ivory Coast (CI). We analyzed all the stick tools and leaf-sponges found that the chimpanzees used to forage for ants, termites, honey, and water. We found a particular behavior to be widespread across different chimpanzee communities in the park, namely, dipping for water from tree holes using sticks with especially long brush-tip modifications, using camera traps, we recorded adults, juveniles, and infants of three communities displaying this behavior. We compared water dipping and honey dipping tools used by Comoé chimpanzees and found significant differences in the total length, diameter, and brush length of the different types of fluid-dipping tools used. We found that water dipping tools had consistently longer and thicker brush-tips than honey dipping tools. Although this behavior was observed only during the late dry season, the chimpanzees always had alternative water sources available, like pools and rivers, in which they drank without the use of a tool. It remains unclear whether the use of a tool increases efficient access to water. This is the first time that water dipping behavior with sticks has been found as a widespread and well-established behavior across different age and sex classes and communities, suggesting the possibility of cultural transmission. It is crucial that we conserve this population of chimpanzees, not only because they may represent the second largest population in the country, but also because of their unique behavioral repertoire.

  20. Vulnerability and adaptation to climate change in the Comoe River Basin (West Africa).

    PubMed

    Yéo, Wonnan Eugène; Goula, Bi Tié Albert; Diekkrüger, Bernd; Afouda, Abel

    2016-01-01

    Climate change is impacting water users in many sectors: water supply, farming, industry, hydropower, fishing, housing, navigation and health. Existing situations, like population growth, movement of populations from rural to urban areas, poverty and pollution can aggravate the impacts of climate change. The aim of the study is to evaluate the vulnerability of different water user groups to climate change and define communities' adaptation strategies in the Comoe River Basin. Information was collected on communities' concerns and perception on changes in climate and potential adaptation measures and strategies. Results show that 95 % of the sample in the study communities had heard of it and are aware that climate change is occurring. They have been experiencing changes in economic activity and cropping pattern, reduced water level in rivers, crop failure, delay in cropping season, new pests and diseases, food insecurity, drop in income and decline in crop yield. Results also show that communities employ various adaptation strategies including crops diversification, substitution and calendar redefinition, agroforestry, borrowing from friends and money lenders and increasing fertilizer application.

  1. Kinetic modeling of the SWNT growth by CO disproportionation on CoMo catalysts.

    PubMed

    Monzon, A; Lolli, G; Cosma, S; Mohamed, S B; Resasco, D E

    2008-11-01

    A kinetic model has been developed to describe the growth of single-walled carbon nanotubes (SWNT) in the CoMoCAT method, which is based on the disproportionation of CO on supported CoMo catalysts. The model attempts to capture mathematically the different stages involved in this method: (i) catalyst activation or in-situ creation of active sites, i.e., reduced Co clusters by transformation of CoMoOx precursor species, or oxidized sites; (ii) CO decomposition over active sites, which increases the surface fugacity of carbon until reaching a certain threshold; (iii) nucleation of ordered forms of carbon; (iv) C diffusion (both across the surface and into the metal particle); (v) SWNT growth; (vi) termination, by either deactivation of the catalyst active sites or by increase in the carbon concentration at the metal/SWNT interface, approaching that of the metal/gas interface and eliminating the driving force for diffusion. Previous investigations have only explained the growth termination by the former. Here, we emphasize the possible contribution of the later and propose a novel "hindrance factor" to quantify the effect of nanotube interaction with its surroundings on the growth termination. To test the kinetic model and obtain typical values of the physical parameters, experiments have been conducted on a CoMo/SiO2 catalyst in a laboratory flow reactor, in which the rate of carbon deposition was continuously evaluated by the direct measurement of the CO2 evolution as a function of time. The experimental data are fitted very well with model.

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

    PubMed Central

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

    2012-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Haddab, Mustapha

    1994-05-01

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

  4. Improved quality at Kaiser Permanente through e-mail between physicians and patients.

    PubMed

    Zhou, Yi Yvonne; Kanter, Michael H; Wang, Jian J; Garrido, Terhilda

    2010-07-01

    The American Recovery and Reinvestment Act identified secure patient-physician e-mail messaging as an objective of the meaningful use of electronic health records. In our study of 35,423 people with diabetes, hypertension, or both, the use of secure patient-physician e-mail within a two-month period was associated with a statistically significant improvement in effectiveness of care as measured by the Healthcare Effectiveness Data and Information Set (HEDIS). In addition, the use of e-mail was associated with an improvement of 2.0-6.5 percentage points in performance on other HEDIS measures such as glycemic (HbA1c), cholesterol, and blood pressure screening and control.

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

    NASA Astrophysics Data System (ADS)

    Agboton, Sébastien; Moussa, Yaya Mede

    1994-05-01

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

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

    PubMed Central

    Leinaweaver, Jessaca

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-04-01

    Lake Como (northern Italy) is the deepest Italian lake, reaching a depth of about 425 m. The lambda-shaped lake expands about 45 km in NE-SW direction. Southwards of the hydrologically closed western branch, two sediment cores of 70 m (S1) and 65 m length (S2) were taken in the year 2005 close to the cathedral of Como (Piazza Verdi). The drilling sites are located in the middle of the Southern Alps, some 300 m from the present-day lakeshore. The cores provide the first detailed Late Glacial to Holocene multi-proxy record for the Lake Como basin. Our research is aimed at investigating the environmental and geological evolution of the Insubria Region. The multi-proxy study of the stratigraphic sequences contain geophysical, geotechnical, sedimentological, paleobotanical, and radiocarbon analyses. They have been performed for core S1 and are still in progress on core S2. With this data the working group focuses on two main issues. The first topic is the reconstruction of the natural and anthropogenic processes controlling the ground subsidence in the Como urban area (e.g., Comerci et al., 2007) and another aim is to reconstruct vegetation and land-use dynamics. In particular, 150 samples of vegetal macroremains have been collected in the palustrine deposits along S1 core, down to 31,00 m. Below this depth (dated 14C 12,496 ± 55 yr BP - 15,050 - 14,250 cal yr BP), the amount of plant macroremains in the sediment drops dramatically. The taxonomic determination was carried out on more than 800 macroremains. They are represented by fragments of wood, leaves, needles, seeds, fruits, mosses and tiny charcoals (Motella, 2009, unpublished PhD Thesis). Picea/Larix, Pinus sp., Juniperus with Betula, found in the deeper levels (30.80 - 30.00 m), are the first arboreal taxa that colonized the shores of Lake Como, and show that the reforestation began in this area about 16,000 years ago. During the early Holocene (25.10 m) Abies alba expanded and further upwards the sequence

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

    NASA Astrophysics Data System (ADS)

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

    2008-09-01

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

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

    NASA Astrophysics Data System (ADS)

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

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

  10. In-situ HRTEM study of the reactive carbide phase of Co/MoS2 catalyst.

    PubMed

    Ramos, Manuel; Ferrer, Domingo; Martinez-Soto, Eduan; Lopez-Lippmann, Hugo; Torres, Brenda; Berhault, Gilles; Chianelli, Russell R

    2013-04-01

    Hydrotreatment catalytic operations are commonly performed industrially by layered molybdenum sulfide promoted by cobalt or nickel in order to remove heteroelements (S, N, O) from fossil fuels and biofuels. Indeed, these heteroelements are responsible of the emission of pollutants when these fuels are used in vehicles. In this respect, previous studies made by our research group have shown that the active phase under steady state conditions is partially carbided while strong bending effects of MoS2 slabs were also observed. However, up to now, the morphology of the resulting Co/MoSxCy carbided catalyst has not been fully characterized. In the present study, for the first time, a chemical reaction between the carbon content of a TEM Cu/C grid and a freshly sulfide Co/MoS2 catalyst was in situ observed at 300 °C and 450 °C by HRTEM experimental techniques at ~10 nm of resolution. Results indicate that bending of MoS2 layers occurred due to carbon addition on MoS2 edge sites, as observed in stabilized catalysts after HDS reaction. Using a silicon grid, only cracks of MoS2 slabs were observed without bending effect confirming the role of structural-carbon in this change of morphology.

  11. Hierarchically Porous Electrocatalyst with Vertically Aligned Defect-Rich CoMoS Nanosheets for the Hydrogen Evolution Reaction in an Alkaline Medium.

    PubMed

    Wu, Zexing; Guo, Junpo; Wang, Jie; Liu, Rong; Xiao, Weiping; Xuan, Cuijuan; Xia, Kedong; Wang, Deli

    2017-02-15

    Effective electrocatalysts for the hydrogen evolution reaction (HER) in alkaline electrolytes can be developed via a simple solvothermal process. In this work, first, the prepared CoMoS nanomaterials through solvothermal treatment have a porous, defect-rich, and vertically aligned nanostructure, which is beneficial for the HER in an alkaline medium. Second, electron transfer from cobalt to MoS2 that reduces the unoccupied d orbitals of molybdenum can also enhance the HER kinetics in an alkaline medium. This has been demonstrated via a comparison of the catalytic performances of CoMoS, CoS, and MoS2. Third, the solvothermal treatment time evidently impacts the electrocatalytic activity. As a result, after 24 h of solvothermal treatment, the prepared CoMoS nanomaterials exhibit the lowest onset potential (42 mV) and overpotential (98 mV) for delivering a current density of 10 mA cm(-2) in a 1 M KOH solution. Thus, this study provides a simple method to prepare efficient electrocatalysts for the HER in an alkaline medium.

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

    ERIC Educational Resources Information Center

    Lind, Patricia; Germano, Catherine

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

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

    PubMed Central

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

    2016-01-01

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

  14. Como os Alunos do Ensino Médio da Rede Estadual de São Paulo obtém Conhecimentos Astronômicos?

    NASA Astrophysics Data System (ADS)

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

    2005-08-01

    Atualmente vivencia-se um mundo globalizado onde os computadores e a internet permitiram um acesso rápido e seguro a todo tipo de informação e conhecimento. O presente trabalho visa analisar a maneira pela qual alunos de segundo grau da rede estadual da cidade de São Paulo obtiveram, caso tenham, conhecimentos básicos de astronomia quanto aos fenômenos celestes que os rodeiam, tais como a sucessão dos dias e das estações do ano, além de questioná~los sobre fatos genéricos tais como: o que vem a ser o Sol, o Big Bang, o que ocasionou a extinção dos dinossauros. Para tanto foi elaborado um formulário constando de questões de múltipla escolha, o qual foi aplicado no primeiro colegial diurno da Escola Estadual Guilherme de Almeida. Num espaço amostral de 44 alunos constatou-se que 41% dos alunos adquiriram seus conhecimentos astronômicos na escola e 59% através da mídia em geral. Neste mesmo espaço amostral apenas 11% dos alunos usaram computadores na escola, 41% na residência, 5% no trabalho e 43% não utilizaram. O presente estudo revelou também que para 50% dos alunos o professor jamais utilizou um programa de computador a respeito de astronomia ou fez alguma apresentação sobre o tema. Embora em sua fase inicial este estudo revela claramente que a maioria dos alunos não obtém na escola seus conhecimentos astronômicos, estes provém de fontes não especificamente didático-pedagógicas tais como filmes e revistas populares que não raramente geram conhecimentos incompletos e em muitos casos inclusive falhos.

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2014-04-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2003-08-01

    Para a maioria dos estudantes, sua passagem pelo ensino formal fundamental envolve a transmissão de fatos que devem ser guardados para um exame, a habilidade para lembrar fórmulas e, eventualmente, a repetição de experimentos que devem produzir resultados exigidos pelo professor. O resultado deste modelo de ensino, ao longo dos anos, é conhecido por todos: desconhecimento e descontentamento, por parte dos estudantes, de temas relativos ao papel e aos processos da ciência. Acreditamos que a Astronomia, pelo seu caráter observacional, é uma das áreas do conhecimento que pode contribuir neste cenário. A Fundação Planetário da Cidade do Rio de Janeiro possui um telescópio Meade LX-200 (25cm) que, juntamente com as câmeras CCD ST-7E e ST8E, tem sido utilizado em projetos voltados aos estudantes do ensino médio desde o ano 2000. Tais projetos envolvem a condução de um projeto de pesquisa observacional num nível apropriado, e possibilitam o contato com técnicas e novas tecnologias: computador, software para manipulação de dados e gráficos, programas de tratamento e redução de dados, uso de equipamentos óptico-eletrônicos (telescópio e CCD), bem como o processo de aquisição de conhecimento. Dentro da proposta dos anos anteriores, priorizamos projetos de uma noite, ou seja, procuramos trabalhar com fenômenos que apresentem variabilidade com intervalo de recorrência relativamente curto. Em todos os casos, optamos pela fotometria diferencial, que tem se mostrado bastante eficiente para o céu luminoso como o da cidade do Rio de Janeiro. Neste painel, apresentamos alguns dos projetos desenvolvidos no último ano, com 25 estudantes. Apresentamos os resultados da observação da variável pulsante AI Vel (V = 6,6) e da variável cataclísmica FO Aqr (V = 13,5), e do monitoramento do trânsito da lua de Júpiter, Europa, ocorrido em 30 de abril de 2003. As curvas de luz produzidas para as primeiras estão concordantes com as da literatura, assim

  18. Climatic and anthropogenic forcing of prehistorical vegetation succession and fire dynamics in the Lago di Como area (N-Italy, Insubria)

    NASA Astrophysics Data System (ADS)

    Martinelli, Elisa; Michetti, Alessandro Maria; Colombaroli, Daniele; Mazzola, Eleonora; Motella De Carlo, Sila; Livio, Franz; Gilli, Adrian; Ferrario, Maria Francesca; Höbig, Nicole; Brunamonte, Fabio; Castelletti, Lanfredo; Tinner, Willy

    2017-04-01

    Combined pollen, charcoal and modeling evidence from the Insubria Region suggests that fire was a major driver of late Holocene vegetation change. However, the extent and timing of fire response dynamics are not clear yet. We use lacustrine sediments from Lago di Como (N-Italy, S-Alps) to assess if the reconstructed vegetation and fire dynamics were relevant at large scales and if they coincided in time with those observed at smaller sites. The lake, due to its size (142 km2) and economic potential, was very attractive for early land use and human presence in this area is well documented since ca. 10,000 yrs ago (Mesolithic). We used pollen, plant macrofossils and charcoal to reconstruct the vegetation composition and fire activity. During the Younger Dryas and the Early Holocene until ca. 8000 cal BP natural dynamics prevailed. Subsequently, land use and slash-and-burn activities increased at the Mesolithic-Neolithic transition and became widespread around ca. 6500 cal BP. Microscopic charcoal and numerical analyses demonstrate that anthropogenic fires had a determinant influence on long-term vegetation dynamics at regional scales in Insubria. Microscopic charcoal and pollen and spores indicative of land use show that human pressure intensified after ca. 5300 cal yr BP and even more since ca. 4300 cal yr BP. Our results suggest that important species which disappeared or were strongly reduced by land use and fire (e.g. Abies alba, Tilia, Ulmus) will potentially reestablish in the Lago di Como area and elsewhere in Insubria, if land abandonment initiated in the 1950s will continue.

  19. Hydro-geochemical modeling of subalpine urbanized area: geochemical characterization of the shallow and deep aquifers of the urban district of Como (first results).

    NASA Astrophysics Data System (ADS)

    Terrana, Silvia; Brunamonte, Fabio; Frascoli, Francesca; Ferrario, Maria Francesca; Michetti, Alessandro Maria; Pozzi, Andrea; Gambillara, Roberto; Binda, Gilberto

    2016-04-01

    One of the greatest environmental and social-economics threats is climate change. This topic, in the next few years, will have a significant impact on the availability of water resources of many regions. This is compounded by the strong anthropization of water systems that shows an intensification of conflicts for water resource exploitation. Therefore, it is necessary a sustainable manage of natural resources thorough knowledge of the hosting territories. The development of investigation and data processing methods are essential to reduce costs for the suitable use and protection of resources. Identify a sample area for testing the best approach is crucial. This research aims to find a valid methodology for the characterization, modeling and management of subalpine urban aquifers, and the urban district of Como appears perfect. The city of Como is located at the southern end of the western sector of Lake Como (N Italy). It is a coastal town, placed on a small alluvial plain, therefore in close communication with the lake. The plain is drained by two streams, which are presently artificially buried, and have an underground flow path in the urban section till the mouth. This city area, so, is suitable for this project as it is intensely urbanized, its dimensions is not too extensive and it is characterized by two aquifers very important and little known. These are a shallow aquifer and a deep aquifer, which are important not only for any water supply, but also for the stability of the ground subsidence in the city. This research is also the opportunity to work in a particular well-known area with high scientific significance; however, there is complete absence of information regarding the deep aquifer. Great importance has also the chosen and used of the more powerful open source software for this type of area, such as PHREEQC, EnvironInsite, PHREEQE etc., used for geological and geochemical data processing. The main goal of this preliminary work is the

  20. From Management to Negotiation: Technical and Institutional Innovations for Integrated Water Resource Management in the Upper Comoé River Basin, Burkina Faso

    NASA Astrophysics Data System (ADS)

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

    2009-10-01

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

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

    NASA Astrophysics Data System (ADS)

    Zadunaisky, P. E.

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

  2. EPA se mueve hacia la prohibición de desengrasantes en aerosol y quitamanchas para lavado en seco como una de las primeras acciones reglamentarias conforme a la ley reformada de sustancias químicas

    EPA Pesticide Factsheets

    Comunicado de prensa de EPA: EPA se mueve hacia la prohibición de desengrasantes en aerosol y quitamanchas para lavado en seco como una de las primeras acciones reglamentarias conforme a la ley reformada de sustancias químicas

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

    PubMed Central

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

    2015-01-01

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

  4. Density functional theory analysis of the interplay between Jahn-Teller instability, uniaxial magnetism, spin arrangement, metal-metal interaction, and spin-orbit coupling in Ca3CoMO6 (M = Co, Rh, Ir).

    PubMed

    Zhang, Yuemei; Kan, Erjun; Xiang, Hongjun; Villesuzanne, Antoine; Whangbo, Myung-Hwan

    2011-03-07

    In the isostructural oxides Ca(3)CoMO(6) (M = Co, Rh, Ir), the CoMO(6) chains made up of face-sharing CoO(6) trigonal prisms and MO(6) octahedra are separated by Ca atoms. We analyzed the magnetic and electronic properties of these oxides on the basis of density functional theory calculations including on-site repulsion and spin-orbit coupling, and examined the essential one-electron pictures hidden behind results of these calculations. Our analysis reveals an intimate interplay between Jahn-Teller instability, uniaxial magnetism, spin arrangement, metal-metal interaction, and spin-orbit coupling in governing the magnetic and electronic properties of these oxides. These oxides undergo a Jahn-Teller distortion, but their distortions are weak, so that their trigonal-prism Co(n+) (n = 2, 3) ions still give rise to strong easy-axis anisotropy along the chain direction. As for the d-state split pattern of these ions, the electronic and magnetic properties of Ca(3)CoMO(6) (M = Co, Rh, Ir) are consistent with d(0) < (d(2), d(-2)) < (d(1), d(-1)) but not with (d(2), d(-2)) < d(0) < (d(1), d(-1)). The trigonal-prism Co(3+) ion in Ca(3)Co(2)O(6) has the L = 2 configuration (d(0))(1)(d(2), d(-2))(3)(d(1), d(-1))(2) because of the metal-metal interaction between adjacent Co(3+) ions in each Co(2)O(6) chain, which is mediated by their z(2) orbitals, and the spin-orbit coupling of the trigonal-prism Co(3+) ion. The spins in each CoMO(6) chain of Ca(3)CoMO(6) prefer the ferromagnetic arrangement for M = Co and Rh but the antiferromagnetic arrangement for M = Ir. The octahedral M(4+) ion of Ca(3)CoMO(6) has the (1a)(1)(1e)(4) configuration for M = Rh but the (1a)(2)(1e)(3) configuration for M = Ir, which arises from the difference in the spin-orbit coupling of the M(4+) ions and the Co···M metal-metal interactions.

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

    PubMed Central

    RODRÍGUEZ, Yarimar ROSA; DÍAZ, Nelson VARAS

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Haddab, Mustapha

    1994-01-01

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

  7. Accumuler le capital humain tout au long de la vie: Quels facteurs prédictifs de la participation à la formation permanente?

    NASA Astrophysics Data System (ADS)

    Boudard, Emmanuel; Morlaix, Sophie

    2003-09-01

    This article addresses the main predictors of adult education, using statistical methods different from those generally used by social science researchers. Its aim is twofold. First, it seeks to explain in a simple and comprehensible manner the methodological value of these methods (in relation to the use of structural models); secondly, it demonstrates the concrete usefulness of these methods on the basis of a recent piece of research on the data from the International Adult Literacy Survey (IALS).

  8. Defence SDI - A Useful Current Awareness System (Dissemination Selective de L’Information sur la Defense: Un Systeme Pratique D’Information Permanente).

    DTIC Science & Technology

    1980-09-01

    would yield: Flight characteristics, Flight clothing, Flight control , etc. Mode 3 - accepts the term only if bounded by blank spaces or punctuation. Mode...authorities. A waiting period must be expected and even then "orders" may be refused and DSIS has no control over these circumstances. The U.S. will...aux usagers accredites 5 de i’information scientifique et technique tuuchint les questions de defense, sous torme de publications r~guiieres portant sur

  9. Annual variations in bio-optical properties at the ‘Estación Permanente de Estudios Ambientales (EPEA)’ coastal station, Argentina

    NASA Astrophysics Data System (ADS)

    Lutz, Vivian A.; Subramaniam, Ajit; Negri, Rubén M.; Silva, Ricardo I.; Carreto, José I.

    2006-07-01

    Variations in optical properties at a coastal station (EPEA) off the North coast of Argentina (38° 28' S 57° 41' W) were studied in 2000-2001. Changes observed in the absorption by three components of seawater (phytoplankton, detritus, and chromophoric-dissolved-organic-matter or CDOM) were analysed in relation to changes in environmental conditions (temperature, stability of the water column, irradiance) and changes in the phytoplankton community structure. An annual cycle typical of temperate seas was observed in the stability of the water column, with a strong thermocline in summer and a vertically homogeneous regime in winter. The proportion of detritus absorption at the surface was related to these changes in stability of the water column, being larger in winter due probably to re-suspension from the bottom. Absorption by phytoplankton and CDOM were not related to temperature or the stability of the water column and there was no covariation in absorption by the three seawater components. On the other hand, absorption by phytoplankton was significantly related to the predominant cell-size. The percentage contribution of ultraphytoplankton (<5 μm) to total chlorophyll- a concentration varied between 6% and 46% throughout the year, being the highest during summer. Accordingly, the specific absorption coefficient of phytoplankton at 440 nm (absorption/chlorophyll- a) varied between 0.01 in July (when there was a bloom of the large diatom Coscinodiscus wailesii) and 0.09 m 2 mg Chla-1 in February (when Synechococcus spp. was predominant). The relationship between in situ and 1 km daily satellite estimated OC4V4 chlorophyll- a concentration showed a good correlation ( r2=0.94 for 9 out of the 19 data points where an exact match up could be made). Marked variations were observed when comparing 8 day-9 km binned data with the 19 points. While some of the differences are due to the highly dynamic hydrography of this region, variations in phytoplankton composition also contribute to the difference between in situ and satellite-derived values.

  10. Micoinseticidas e Micoacaricidas no Brasil: Como estamos?

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  11. Como Lo Hago Yo: Lipomas Medulares

    PubMed Central

    Portillo, Santiago

    2014-01-01

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

  12. Magnetares como fuentes para potenciar supernovas superluminosas

    NASA Astrophysics Data System (ADS)

    Bersten, M. C.; Benvenuto, O. G.

    2016-08-01

    Magnetars have been proposed as one of the possible sources to power the light curve of super-luminous supernovae. We have included the energy deposited by a hypothetical magnetar in our one-dimensional hydrodynamical code, and analyzed the dynamical effect on the supernova ejecta. In particular, we present a model for SN 2011kl, the first object associated with a ultra-long-duration gamma-ray burst. Finally, we show its effect on the light curves of hydrogen rich supernovae.

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

    USGS Publications Warehouse

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

    2006-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Dcruz, Noella L.

    2014-07-01

    estudiantes que escribieran dos ensayos cortos de tres que se proponían. Los ensayos contenían partes descriptivas y conceptuales. Los mismos estaban destinados a servir como herramientas de enseñanza. 62% de los 106 ensayos de 55 estudiantes obtuvo grados A, B o C. 21% de los 47 encuestados que respondieron al cuestionario posterior consideró que los ensayos aumentaron su interés por la astronomía. 49% de los encuestados consideró que los ensayos no eran educacionalmente útiles y que no deben ser propuestos de nuevo. Las respuestas escritas más comunes a nuestra encuesta indicaran que los estudiantes necesitan más orientación y una mejor preparación en la redacción de ensayos exitosos. Dado que los estudiantes encontraron las piezas conceptuales de los ensayos difíciles, en el futuro vamos a ofrecer actividades pertinentes antes de los plazos de redacción para ayudar a los estudiantes a crear ensayos de mayor calidad. Nós ocasionalmente incluímos projetos em nosso curso universitário introdutório centrado no aluno para permitir aos estudantes que pertencem às carreiras não científicas explorar alguns conceitos astronômicos em mais detalhes do que o normal. Tais projetos também enfatizam eventos astronômicos em curso ou futuros. Esperamos que os alunos se sintam mais interessados na astronomia através de projetos ligados a eventos astronômicos. No termo de Primavera de 2012 (EUA), propomos ensaios curtos focados em eclipses, trânsitos e ocultações para promover o raro trânsito de Vênus que ocorreu no dia 5 de junho de 2012. Pedimos aos alunos que escrevessem dois ensaios curtos dentre três que foram propostos. Os ensaios continham partes descritivas e conceituais. Eles foram feitos para servir como ferramentas de ensino. 62% de 106 ensaios de 55 alunos ganhou graus A, B ou C. 21% dos 47 entrevistados que responderam ao levantamento posterior sentiu que os ensaios aumentaram seu interesse na astronomia. 49% dos inquiridos consideraram que os

  15. [Compliance of the guidelines of the Spanish Neurology Society in the treatment of patients with multiple sclerosis].

    PubMed

    Oreja-Guevara, Celia; Río, Jordi; Gobartt, Ana L

    2015-08-16

    Introduccion. El tratamiento de la esclerosis multiple se basa en la administracion de farmacos modificadores de la enfermedad (FAME), utilizados para frenar el curso natural de la enfermedad. Objetivo. Evaluar el grado de cumplimiento de las guias terapeuticas de la Sociedad Española de Neurologia (SEN) de 2010 por parte de los neurologos. Pacientes y metodos. Estudio observacional, retrospectivo y multicentrico de 218 pacientes adultos con esclerosis multiple de al menos cinco años de evolucion y en tratamiento con FAME. Los datos se obtuvieron de la historia clinica y se compararon con las recomendaciones de la SEN. Resultados. Segun las guias de la SEN de 2010, el 82% de los pacientes presentaba respuesta clinica adecuada, y el 18%, respuesta clinica inadecuada al FAME actual; el 94% y 92%, respectivamente, mantuvieron ese tratamiento. Los pacientes en los que la respuesta clinica inadecuada no origino un cambio del FAME actual llevaban en tratamiento mas tiempo y experimentaron con mayor frecuencia progresion de su discapacidad e incremento del numero de brotes. El 48% de los pacientes inicio tratamiento de primera linea con interferon beta-1a, administrado por via subcutanea (29%) o intramuscular (19%), seguido de interferon beta-1b y acetato de glatiramero. Algunos pacientes recibieron tratamientos de segunda linea como segunda/tercera opcion (15% y 28%, respectivamente), pero el uso de estos tratamientos (especialmente natalizumab) solo se generalizo a partir de la cuarta linea de tratamiento. Conclusiones. De acuerdo con las guias de la SEN de 2010, la mayoria de los pacientes tuvo una respuesta clinica adecuada. Un elevado porcentaje de pacientes con respuesta clinica inadecuada continuo con el tratamiento actual.

  16. WOMEN UNIVERSITY GRADUATES IN CONTINUING EDUCATION AND EMPLOYMENT, AN EXPLORATORY STUDY INITIATED BY THE CANADIAN FEDERATION OF UNIVERSITY WOMEN 1966, AND LA FEMME DIPLOMEE FACE A L'EDUCATION PERMANENTE ET AU MONDE DU TRAVAIL.

    ERIC Educational Resources Information Center

    COCKBURN, PATRICIA; RAYMOND, YVONNE R.

    TO MEASURE THE EMPLOYMENT POTENTIAL OF CANADIAN WOMEN UNIVERSITY GRADUATES, TO INTEREST GOVERNMENT IN RETRAINING PROFESSIONAL WOMEN, AND TO ASSESS THE INTEREST OF WOMEN IN CONTINUING THEIR UNIVERSITY EDUCATION, A MAIL SURVEY WAS MADE OF 10,000 MEMBERS OF THE CANADIAN FEDERATION OF UNIVERSITY WOMEN, 500 NON-MEMBER GRADUATES, AND 850 FRENCH-SPEAKING…

  17. El Espanol como Idioma Universal (Spanish as a Universal Language)

    ERIC Educational Resources Information Center

    Mijares, Jose

    1977-01-01

    A proposal to transform Spanish into a universal language because it possesses the prerequisites: it is a living language, spoken in several countries; it is a natural language; and it uses the ordinary alphabet. Details on simplification and standardization are given. (Text is in Spanish.) (AMH)

  18. Cosmic Web of Galaxies in the COMOS Field

    NASA Astrophysics Data System (ADS)

    Darvish, Behnam; Martin, Christopher D.; Mobasher, Bahram; Scoville, Nicholas; Sobral, David; COSMOS science Team

    2017-01-01

    We use a mass complete sample of galaxies with accurate photometric redshifts in the COSMOS field to estimate the density field and to extract the components of the cosmic web. The comic web extraction algorithm relies on the signs and the ratio of eigenvalues of the Hessian matrix and is enable to integrate the density field into clusters, filaments and the field. We show that at z < 0.8, the median star-formation rate in the cosmic web gradually declines from the field to clusters and this decline is especially sharp for satellite galaxies (~1 dex vs. ~0.4 dex for centrals). However, at z > 0.8, the trend flattens out. For star-forming galaxies only, the median star-formation rate declines by ~ 0.3-0.4 dex from the field to clusters for both satellites and centrals, only at z < 0.5. We argue that for satellite galaxies, the main role of the cosmic web environment is to control their star-forming/quiescent fraction, whereas for centrals, it is mainly to control their overall star-formation rate. Given these, we suggest that most satellite galaxies experience a rapid quenching mechanism as they fall from the field into clusters through the channel of filaments, whereas for central galaxies, it is mostly due to a slow quenching process. Our preliminary results highlight the importance of the large-scale cosmic web on the evolution of galaxies.

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

    ERIC Educational Resources Information Center

    Haffner, Debra; Casey, Sean

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

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

    ERIC Educational Resources Information Center

    Center for Population Options, Washington, DC.

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

  1. Como Lo Hago Yo: Tratamiento Quirurgico Del Mielomeningocele

    PubMed Central

    Portillo, Santiago

    2014-01-01

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

  2. Los mitos como memoria colectiva de Los Pueblos.

    NASA Astrophysics Data System (ADS)

    Martín, P. T.

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

  3. [Subclinical hypothyroidism and cardiovascular risk].

    PubMed

    López Rubio, María Antonia; Tárraga López, Pedro Juan; Rodríguez Montes, José Antonio; Frías López, María del Carmen; Solera Albero, Juan; Bermejo López, Pablo

    2015-05-01

    Objetivos: Valorar si el hipotiroidismo subclínico puede comportarse como un factor de riesgo cardiovascular o un modificador del mismo, identificando variables epidemiológicas y riesgo cardiovascular estimado en una muestra de sujetos diagnosticados en la provincia de Albacete. Método: Estudio observacional, descriptivo y transversal realizado en Albacete durante la primera quincena de enero de 2012 en pacientes de ambos géneros con hipotiroidismo subclínico. Se analizaron las siguientes variables: glucemia basal, colesterol total, colesterol HDL, colesterol LDL, triglicéridos, TSH, T4, peso, talla, I.M.C., tensión arterial, antecedentes de patología cardiovascular, factores de riesgo cardiovascular y riesgo cardiovascular estimado. Resultados: Se obtuvieron 326 pacientes, con predominio femenino (79,2 %), menores de 65 años en el 78% y sin factores de riesgo cardiovascular en el 48,61%. La prevalencia de los factores de riesgo cardiovascular identificados fué: tabaquismo (33,2%), diabetes mellitus (24,9%), hipertensión arterial (23,4%), alteraciones lipídicas (28,9%) y fibrilación auricular (4,9 %). No se encontró asociación entre hipotiroidismo subclínico y la mayoría de los parámetros del perfil lipídico que condicionan un perfil pro-aterogénico, salvo con la hipertrigliceridemia. Asimismo, tampoco se constató asociación con riesgo cardiovascular aumentado. Conclusiones: El perfil del paciente con hipotiroidismo subclínico es una mujer de mediana edad sin factores de riesgo cardiovascular en la mitad de casos. Se ha encontrado relación entre hipotiroidismo subclínico e hipertrigliceridemia, pero no con el resto de parámetros del perfil lipídico, otros factores de riesgo cardiovascular o con aumento de dicho riesgo. Sin embargo, un 25% de diabéticos y un 22% de no diabéticos están en situación de riesgo cardiovascular moderado-alto.

  4. [Suicidal Behavior among Portuguese Psychiatry Trainees: Comparison with the European Situation].

    PubMed

    Gama Marques, João; Roberto, Alice; Guerra, Cátia; Pinto da Costa, Mariana; Podlesek, Anja; Beezhold, Julian; Jovanovic, Nikolina; Moscoso, Ana

    2015-01-01

    Introdução: O objectivo deste trabalho foi avaliar a prevalência de ideação suicida e tentativas de suicídio nos médicos internos de psiquiatria de adultos e de psiquiatria da infância e da adolescência em Portugal, e comparar os resultados com a população geral portuguesa e de outros países europeus. Material e Métodos: Enviou-se um questionário estruturado e anónimo, por e-mail, aos 159 internos de psiquiatria de adultos e de psiquiatria da infância e da adolescência do país, questionando antecedentes pessoais de ideação suicida e tentativas de suícidio, bem como antecedentes familiares de tentativas de suicídio falhadas e consumadas. Estas questões fazem parte do Estudo BoSS (Burnout Syndrome Study) realizado em 21 países. A análise dos dados foi feita através do programa informático SPSS v. 19. Resultados: Responderam parcialmente ao questionário 62 internos (40,3%) e 46 (29%) responderam ao questionário na totalidade, constituindo assim a amostra. O ratio feminino:masculino foi de 2:1 e a média de idade de 29 anos. A ideação suicida estava presente na forma passiva em 44% dos inquiridos e na forma activa em 33%; 4,3% referiu tentativas de suicídio prévias. Em relação à história familiar, registou-se 22% de tentativas de suicídio e 13% de suicídio consumado.Discussão: Os resultados obtidos são preocupantes e podem estar associados a factores específicos a que esta população está exposta. Conclusão:ã necessária uma investigação mais aprofundada para se compreender melhor este fenómeno, respectivas causas e potenciais modificadores.

  5. [Organic and functional limitations due to milking phenomenon: a clinical case report].

    PubMed

    Gómez-Henry, Juan Carlos; Rodríguez-Pérez, Francisco Antonio

    2014-01-01

    INTRODUCCIÓN: según series angiográficas, la incidencia del fenómeno de milking oscila entre 0.6 y 4 %, sin embargo, en estudios de autopsias hasta en 85 % se ha identificado puente miocárdico, patognómónico de este trastorno. La malformación del fenómeno de milking no es identificada en la mayoría de las ocasiones, pero puede tener grandes repercusiones. El propósito es ejemplificar un caso de fenómeno de milking con consecuencias de incapacidad permanente y consecuencias laborales. CASO CLÍNICO: hombre de 44 años de edad que laboralmente se ocupaba como peón albañil y peón agrícola. Como antecedentes refirió amigdalectomía y artrosis, tabaquismo de 10 cigarrillos diarios, dos o tres tazas de café diarias y dos o tres copas de vino en fin de semana. Mediante electrocardiograma se identificó ritmo sinusal y bloqueo incompleto de la rama derecha del fascículo atrioventricular. Su frecuencia cardiaca fue de 90 latidos por minuto. Para la prueba de esfuerzo se utilizó el protocolo de Bruce, que se detuvo en el primer estadio debido a crisis hipertensiva y fibrilación auricular paroxística. El cateterismo mostró tronco común izquierdo, arteria coronaria cincunfleja y arteria coronaria derecha sin lesiones, arteria descendente anterior sin lesiones con trayecto intramiocárdico y compresión sistólica en segmento medio, con lo cual se integró el diagnóstico de milking coronario. El paciente requirió incapacidad permanente total con limitación para actividades que necesitaran esfuerzo moderado.

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

    ERIC Educational Resources Information Center

    Garcia, Ricardo L.; Deyoe, Rita Maxine

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

  7. Materials Data on Co(Mo3Se4)4 (SG:1) by Materials Project

    DOE Data Explorer

    Kristin Persson

    2016-02-10

    Computed materials data using density functional theory calculations. These calculations determine the electronic structure of bulk materials by solving approximations to the Schrodinger equation. For more information, see https://materialsproject.org/docs/calculations

  8. Materials Data on Co(MoS2)2 (SG:12) by Materials Project

    DOE Data Explorer

    Kristin Persson

    2016-04-23

    Computed materials data using density functional theory calculations. These calculations determine the electronic structure of bulk materials by solving approximations to the Schrodinger equation. For more information, see https://materialsproject.org/docs/calculations

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

    NASA Astrophysics Data System (ADS)

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

    2015-10-01

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

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

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

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

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

    ERIC Educational Resources Information Center

    Paulu, Nancy; Martin, Margery

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

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    ERIC Educational Resources Information Center

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

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

  14. Spanish Oral Language Guide: Kindergarten Level. Espanol como Segundo Idioma. Teacher's Guide: Level I.

    ERIC Educational Resources Information Center

    Corbell, Gloria; And Others

    This teacher's guide to Spanish language at the kindergarten level includes a recommended subject presentation sequence for the Spanish curriculum, a sample schedule, a grouping of students using three stations, and a classroom layout. The grouping would be effective when at least one-third of the children are Spanish-speaking or bilingual. The…

  15. 78 FR 36163 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ... resilience to dwarf mistletoe, root rot, Douglas-fir beetle, and spruce budworm; (4) and maintain the visual..., thermal cover, old growth, and visual quality. DATES: Comments concerning the scope of the analysis must... resilience to native insects and diseases, and (4) maintain the visual integrity of the larger Lake...

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

    ERIC Educational Resources Information Center

    Rockefeller Foundation, New York, NY.

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

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

    ERIC Educational Resources Information Center

    Perkinson, Kathryn

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

  18. Como escoger una escuela para su hijo (Choosing a School for Your Child).

    ERIC Educational Resources Information Center

    Weston, Susan Perkins

    Step-by-step advice for Spanish-speaking parents on how to choose among available schools for their children is offered in this guidebook. Factors to consider in making the choice are discussed, as well as information on alternatives to the available choices, which include home schooling and working to create new options. After an introductory…

  19. "Como si nada": Enduring violence and diabetes among rural women in Southern Mexico.

    PubMed

    Montesi, Laura

    2017-04-14

    Rural women in Southern Mexico link their diabetes to distressful life experiences rooted in ordinary violence. While much has been written on the use that diabetes sufferers make of their morbid condition as an idiom of distress, I investigate the personal and social effects that such an idiom has on women. As I illustrate, diabetes reflects an ambivalence that helps women to speak about the unspeakable and, at the same time, reinforces their ideas of culpability, namely that they are to blame for both the gendered violence that they endure and the diabetes from which they suffer.

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

    ERIC Educational Resources Information Center

    Diaz-Plaja, Guillermo

    1977-01-01

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

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

    ERIC Educational Resources Information Center

    de la Piedra, Maria Teresa

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Macgillivray, Ian K.

    2006-01-01

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

  4. Materials Data on CoMo (SG:221) by Materials Project

    SciTech Connect

    Kristin Persson

    2016-09-11

    Computed materials data using density functional theory calculations. These calculations determine the electronic structure of bulk materials by solving approximations to the Schrodinger equation. For more information, see https://materialsproject.org/docs/calculations

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

    ERIC Educational Resources Information Center

    Ohrtman, Dennis W.

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

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

    ERIC Educational Resources Information Center

    Dodge, Diane Trister

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

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

    ERIC Educational Resources Information Center

    Kanter, Patsy F.; Darby, Linda B.

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

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

    PubMed Central

    Gonzalez, Juan Bosco

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    NASA Astrophysics Data System (ADS)

    Al-Salihi, Adnan; Asaad, Abdulah

    2002-05-01

    Résumé.L'étude de dispositifs de dénoyage est nécessaire pour l'amélioration de sites avant la construction de certaines structures. L'étude de dispositifs de dénoyage efficaces exige d'estimer la valeur du coefficient de perméabilité in situ. Les relations disponibles pour estimer le coefficient de perméabilité ont été développées sur la base de mesures et de conditions de terrain limitées, et les prédictions varient de plusieurs ordres de grandeur. C'est pourquoi il est nécessaire de réaliser des mesures de perméabilité sur le terrain et de déterminer la relation qui permet le meilleur ajustement de ces mesures avant l'étude du dispositif de dénoyage pour des conditions locales et géologiques spécifiques. Ce papier présente des mesures de perméabilité sur le terrain dans des niveaux calcaires complexes chaotiques et diagénétisés. Il propose également une analyse comparative de plusieurs relations disponibles dans la littérature destinées à prédire le coefficient de perméabilité in situ. L'analyse est faite en conditions permanentes et non permanentes. Les résultats montrent que la valeur du coefficient de perméabilité dépend du niveau de la nappe, qui est affecté par le régime de marées. On montre que l'équation de l'US Navy donne la meilleure corrélation avec les mesures de terrain. Resumen.El diseño de sistemas de desecado es necesario para mejorar las condiciones de un emplazamiento antes de la construcción de determinadas estructuras. El diseño de un sistema eficiente de desecado requiere de la estimación del valor de la permeabilidad in-situ. Las relaciones disponibles para tal fin han sido desarrolladas bajo condiciones y medidas de campo limitadas; sus predicciones varían en algunos órdenes de magnitud. Por tanto, es necesario tomar medidas de permeabilidad en campo y determinar la relación que reproduce mejor dichas medidas como paso previo al diseño de un sistema de desecado en condiciones geol

  11. [Posterior reversible encephalopathy in a case of late-onset eclampsia].

    PubMed

    Castrillo-Sanz, Ana; Mendoza, Amelia; Gutiérrez-Ríos, Raúl; Zamora, M Isabel; Morollón, Noemí; Rodríguez-Sanz, M Fernanda; Duarte, Jacinto

    2013-08-01

    Introduccion. El sindrome de encefalopatia posterior reversible (SEPR) es un sindrome clinico-radiologico de presentacion aguda o subaguda que se caracteriza por la presencia de cefalea, vomitos, crisis epilepticas, trastornos visuales y alteracion del nivel de conciencia asociado a lesiones localizadas fundamentalmente en la sustancia blanca de regiones posteriores cerebrales. Caso clinico. Mujer de 32 años que desarrollo un SEPR en el periodo posparto secundario a eclampsia tardia. La paciente presento 10 dias despues del parto un cuadro clinico consistente en cefalea, crisis epilepticas, ceguera y deterioro del nivel de conciencia. El estudio de imagen con resonancia magnetica confirmo la afectacion de la sustancia blanca de predominio posterior. Conclusiones. Aunque la eclampsia es una entidad tipica del embarazo y puerperio inmediato, es necesario recordar que tambien puede producirse de forma tardia tras el parto y que puede ser la causa de otros sindromes, como el SEPR. Aunque en estos casos el pronostico suele ser favorable, el tratamiento debe ser precoz, efectuando un rapido control de la tension arterial y las convulsiones con el fin de evitar un daño cerebral permanente. Es necesario considerar siempre este sindrome en mujeres con crisis epilepticas u otros sintomas neurologicos durante el posparto.

  12. How Families Teach, Support, Learn, Make Decisions: Ways for Families To Help Children Do Better in School = Como las Familias Ensenan, Apoyan, Aprenden, Toman Decisiones: Como las Familias Ayudan a los Ninos a Mejorar en la Escuela.

    ERIC Educational Resources Information Center

    RMC Research Corp., Hampton, NH.

    This booklet contains ideas about how families can help children in school in the following basic ways by: (1) teaching their children; (2) learning new things to help their children learn; (3) supporting children and the school; and (4) making decisions about what and how children learn. For each of these areas, a chart is included so that…

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

    NASA Astrophysics Data System (ADS)

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

    2008-12-01

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

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

    ERIC Educational Resources Information Center

    Mansfield, Gillian; Poppi, Franca

    2012-01-01

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

  15. International Workshop on Mathematical Methods in Combustion Held in Como, Italy on 18-22 May 1992

    DTIC Science & Technology

    1992-05-01

    Colombo Mr. Ugo Scaglione Mathematical Methods in Combustion Monday, 18 May 1992 Villa Olmo, Room ’ Olimpo " 08.30 Registration 09.15 L De Luca, R...Villa Olmo, Room " Olimpo " 8.50 L. De Luca Introductory Remarks NUMERICAL FUNDAMENTALS M.K. Strelets chairman 09.00 E.S. Oran Limitations and...Villa Olmo, Room " Olimpo " 08.50 L. De Luca Introductory Remarks LINEAR COMBUSTION STABILITY A.G. Merzhanov chairman 09.00 B.V. Novozhilov Combustion

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

    ERIC Educational Resources Information Center

    ACCESS ERIC, Rockville, MD.

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

  17. Estudio de generacion de energia con celdas de combustible con membrana poly diallydimethylammonium chloride (PDADMAC) como polimero de intercambio protonico

    NASA Astrophysics Data System (ADS)

    Nino Galeano, Miguel Angel

    Fuel cells were built with poly diallydimethylammonium chloride or PDADMAC (by its initials in English) as proton exchange membrane and were compared with earlier studies of fuel cells constructed by other methods and / or materials. Also copper, aluminum and nickel were used as electrodes in the electrode membrane ensamble in search of the best performance operational cell. The results of the current were used to justify the use of PDADMAC membranes in 40% volume-volume ratio in different combinations of metals Cu-Al, Ni-Al as electrodes. For the study of conduction performance of membrane electrode ensambles (MEA), copper and aluminum were as cathode and anode for their active behavior as functional electrodes in the experimental cell, walling individually membrane types PDADMAC, PDADMAC + Buffer, PDADMAC + deionized water and PDADMAC + tap water.

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

    PubMed

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Bratosevich, Nicolas

    1967-01-01

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

  20. Las líneas de aluminio neutro como diagnóstico cromosférico

    NASA Astrophysics Data System (ADS)

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

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

  1. Pestivirus emergentes Hobi: impacto en salud animal y su importancia como contaminante de insumos biotecnológicos

    Technology Transfer Automated Retrieval System (TEKTRAN)

    “Hobi-like” viruses are a group of emerging Pestiviruses which affect cattle and water buffaloes and are common contaminants of biological products. After the first detection from Brazilian samples in Germany in 2004, several Hobi-like isolates have been reported in Italy and some countries of Asia....

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

    ERIC Educational Resources Information Center

    Raphael, Doris; Weisman, Douglas

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

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

    ERIC Educational Resources Information Center

    Binns, Helen J.; Ricks, Omar Benton

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

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

    ERIC Educational Resources Information Center

    Dorrego, Maria Elena

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

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

    ERIC Educational Resources Information Center

    Bradley, D.

    1977-01-01

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

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

    ERIC Educational Resources Information Center

    Becerra, Luz María; McNulty, Maria

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Picus, Lawrence O.

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

  9. Deploying an HMO's data warehouse.

    PubMed

    Hollis, J

    1998-07-01

    Kaiser Permanente says it has saved millions of dollars and improved the quality of care with information from its data warehouse. Here's how Kaiser implemented the warehouse four years ago, and how it uses it today.

  10. [Small infundibulectomy versus ventriculotomy in tetralogy of Fallot].

    PubMed

    Bojórquez-Ramos, Julio César

    2013-01-01

    Introducción: en la corrección quirúrgica de la tetralogía de Fallot existe uniformidad en la forma de cerrar el defecto septal, pero variedad en cómo ampliar el tracto de salida del ventrículo derecho, por lo que se compara la evolución clínica posoperatoria temprana de la ampliación del tracto de salida del ventrículo derecho con ventriculotomía clásica e infundibulectomía minima. Métodos: análisis de la base de datos de un servicio de cardiocirugía pediátrica de 2008 a 2011. Se eligieron pacientes con tetralogía de Fallot no compleja sometidos a corrección completa mediante ventriculotomía clásica o infundibulectomía minima. Para el análisis estadístico se obtuvo Anova, χ(2) y prueba exacta de Fisher. Resultados: 55 % fue del sexo masculino, la edad media fue de 43 meses, la ventriculotomía clásica se realizó en 61.7 %, con la que se tuvo mayor nivel máximo de lactato (9.07 adversus 6.8 mmo/L), de magnitud en el índice hemorragia/kg en las primeras 12 horas (39.1 adversus 20.3 mL/kg), de mortalidad (31.03 adversus 5.6 %), de complicaciones exclusivas como insuficiencia renal aguda, hemoneumotórax, neumonía, bloqueo auriculoventricular permanente y falla orgánica múltiple. Conclusiones: la morbimortalidad fue mayor con la ventriculotomía clásica, relacionada posiblemente con el mayor volumen de sangrado.

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

    ERIC Educational Resources Information Center

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

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

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

    PubMed Central

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Carvajal Medina, Nancy Emilce; Roberto Flórez, Eliana Edith

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee; Revilla, Teresa Flores

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

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

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

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

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

    NASA Astrophysics Data System (ADS)

    Lares, M.

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

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

    ERIC Educational Resources Information Center

    Stamp, Isla M.

    1971-01-01

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

  18. National Dam Safety Program. Lake Como Dam (DE 00028), Delaware River Basin, Mill Creek, Kent County, Delaware. Phase I Inspection Report.

    DTIC Science & Technology

    1980-11-01

    J J WILLIAMS DACWl1-80- O -0013 uNCLASSIFIED DAEN/NAP-53842/DEOOS2B-BO/ NL LUIIIIIIEEEE IhIIIIIIIIIIIl IIIIIIIIIIIIIu IIIIIIIIIIIIII EIEIIIIIIIII...PHILADELPHIA PA 1q106 15:5 EST IMGMCOMP S.TO REPLY BY MAILGRAM. SEE RFVERSE SIDE FOR WFSTERN UNION S lOLL FI , ADA096 0bb O * BRIEN AND GERE ENGINEERS INC...Lak -e Cowm nlasfe Dam (DE 00028), Del~iturre River Basin, Un. O classifieINdONRIN M4ill Creek, Kent County, Delare 15m SCEDLEIIAIN/ONRD Phase I

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

    ERIC Educational Resources Information Center

    Mead, Robert G., Jr.

    1981-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Suarez, Rafael

    2003-11-01

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

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

    ERIC Educational Resources Information Center

    Galvez de Bracamonte, Teresa

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

  2. International Workship on Mathematical Methods in Combustion Held in Villa Olmo, Como, Italy on May 18 - 22, 1992. Program and List of Abstracts

    DTIC Science & Technology

    1992-05-22

    Olmo, Room " Olimpo " 08.30 Registration 09.15 L. De Luca, R. Reichenbach, V. Calarese Introductory Remarks ANALYTICAL FUNDAMENTALS B.V. Novozhilov...1 sposea• S etIa1 Tuesday, 19 May 1992 Villa Olmo, Room " Olimpo " 8.50 L. De Luca Introductory Remarks NUMERICAL FUNDAMENTALS A. Quarteroni chairman...Trovati: Numerical Simulation in Combustion: Industry Needs and Perspectives 1730 End of Session I Wednesday, 20 May 1992 Villa Olmo, Room " Olimpo " 08.50 L

  3. El Reto: A Leer America! A Leer Y Escribir Ya! Como Divertirse Leyendo Y Escribiendo. (America Reads Challenge: Read*Write*Now! Activities for Reading and Writing Fun)

    ERIC Educational Resources Information Center

    Kameenui, Edward J.; Simmons, Deborah C.

    Developed by national reading experts for the "America Reads Challenge: Read*Write*Now!" initiative and translated into Spanish, this booklet provides 45 ideas for families, teachers, librarians, and other learning partners to use with all children--including those with disabilities--to help them read well and independently by the end of…

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

    ERIC Educational Resources Information Center

    National PTA, Chicago, IL.

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

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

    ERIC Educational Resources Information Center

    Delfos, Martine F.

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

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

    ERIC Educational Resources Information Center

    Coya, Liliam de Barbosa; Perez-Coffie, Jorge

    1982-01-01

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

  7. The Why, What, and How of a Bilingual Approach for Young Children [and] El Porque, el Cual y el Como de un Enfoque Bilingue para Ninos Preescolares.

    ERIC Educational Resources Information Center

    Flores, Alfredo R.; Riley, Mary Tom

    This guide, in parallel English and Spanish volumes, provides information necessary for implementing bilingual/multicultural programs. Section 1 defines and describes the bilingual approach, examining instructional goals, rationale, philosophical justification, legal foundations, and practical considerations. Section 2 discusses attitudinal…

  8. Finding an Appropriate Preschool for Your Child with Special Needs = Como Encontrar un Programa Pre-escolar para su nino con desabilidades.

    ERIC Educational Resources Information Center

    Bernstein, Sandra; Wonderlick, Mary; Madden, Drina

    This booklet, with English and Spanish versions, provides a step-by-step procedure to help families find an appropriate preschool program in the community for their child with disabilities. The booklet lists six steps for locating a program: (1) decide what kind of program is wanted for the child; (2) complete included form outlining child's needs…

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

    ERIC Educational Resources Information Center

    Melendez Alicea, Juan

    1992-01-01

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

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

    ERIC Educational Resources Information Center

    Bowdy, Matthew A.

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

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

    ERIC Educational Resources Information Center

    Giordano, Rosely

    2000-01-01

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

  12. Como Ayudar a Su Hijo a Tener Exito en la Escuela: Guia para Padres Hispanos (Helping Your Child Find Success at School: A Guide for Hispanic Parents).

    ERIC Educational Resources Information Center

    Hine, Candis Y.

    This pamphlet guides Hispanic parents in helping their children succeed academically, based on findings from a study of 10 high-achieving Puerto Rican high school students. The students described specific family factors which supported and nurtured their academic achievement. Guidelines for parents are extracted from these factors and include: (1)…

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

    ERIC Educational Resources Information Center

    Germano, Jose Willington

    1995-01-01

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

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

    ERIC Educational Resources Information Center

    Dodge, Diane Trister; Heroman, Cate

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

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

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC.

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

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

    ERIC Educational Resources Information Center

    Méndez López, Mariza G.; Peña Aguilar, Argelia

    2013-01-01

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

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

    PubMed Central

    Manucci, Graciela; von Quednow, Enzo

    2014-01-01

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

  18. Prevalence of sarcopenia among community‐dwelling elderly of a medium‐sized South American city: results of the COMO VAI? study

    PubMed Central

    Bielemann, Renata M.; Gonzalez, Maria Cristina; Menezes, Ana Maria B.

    2015-01-01

    Abstract Background There is insufficient data concerning sarcopenia prevalence in South America. The aim of this study was to estimate sarcopenia prevalence and its clinical subgroups in a Southern Brazilian city. Methods A cross‐sectional population‐based study was performed among community‐dwelling elderly aged 60 years or over. Subjects were evaluated according to the European Working Group on Sarcopenia in Older People established criteria. Muscle mass was estimated by calf circumference (CC). Cut‐off CC points were defined by a subsample's dual X‐ray absorptiometry estimation of the appendicular skeletal muscle mass index (ASMI), which was subsequently compared with the values of a young adult population from the same city. Muscle strength was measured by manual dynamometry. Muscle performance was assessed through the 4 m gait speed test. Results The three diagnostic tests were performed in 1291 subjects. CC of ≤34 cm (males) and ≤33 cm (females) were defined as indicatives of low ASMI. The overall sarcopenia prevalence was 13.9% (CI95% 12.0; 15.8%). Its frequency was significantly higher among elderly with low schooling, without a partner, with low socioeconomic status, smokers, inactive, and with low body mass index. A higher prevalence of pre‐sarcopenia was found in the youngest elderly; a higher prevalence of the clinical stages of the syndrome was found in older age groups. Conclusions Approximately one in ten elderly aged 60–69 years was in the preclinical stage of the disease. This is the age group in which public policies should focus to establish early diagnosis and prevent clinical progression of the syndrome. PMID:27493867

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

    ERIC Educational Resources Information Center

    Arboleda Arboleda, Argemiro; Castro Garcés, Ángela Yicely

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Scholes Gillingsde González, Barbara

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Medina T., Rene

    1971-01-01

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

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

    ERIC Educational Resources Information Center

    Mayer, Ellen; Kreider, Holly; Vaughan, Peggy

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

  3. Opportunities and challenges in ovarian cancer research, a perspective from the 11th Ovarian cancer action/HHMT Forum, Lake Como, March 2007.

    PubMed

    Ashworth, Alan; Balkwill, Frances; Bast, Robert C; Berek, Jonathan S; Kaye, Allyson; Boyd, Jeffrey A; Mills, Gordon; Weinstein, John N; Woolley, Katie; Workman, Paul

    2008-03-01

    Advances in surgery and chemotherapy have improved the 5-year survival for patients with epithelial ovarian cancer, but have not impacted on the ultimate rate of cure in a disease that is diagnosed in late stage and that recurs in the majority of patients. "Omic" technologies promise to define genetically driven aberrant signaling pathways in malignant cells, provided that bioinformatic expertise can be focused on a cancer that is neither common nor rare. Molecular therapeutics must be linked to molecular diagnostics to permit individualized therapy. Not only epithelial cancer cells but also stroma, vasculature and the immune response must be targeted. Closer collaboration between academic institutions, biotech and pharma will be required to facilitate this process and to interest the private sector in an orphan disease. New preclinical models may permit more efficient development of drugs and siRNA that can target dormant drug resistant stem cells. Strategies must be developed to deal with the heterogeneity of different grades and histotypes. Identification of women at increased risk will facilitate prevention and early detection in subsets of patients. BRCA1/2 might be sequenced in all ovarian cancer patients to identify new kindreds. Epidemiologic algorithms are being developed and validated. Awareness must be raised that oral contraceptives can reduce risk of developing ovarian cancer by 50%. Early detection is likely to require panels of complementary biomarkers, analyzed by sophisticated statistical techniques, to improve sensitivity while maintaining extremely high specificity. As ovarian cancer becomes a chronic disease, greater emphasis will be placed on the challenges facing survivors.

  4. [Not Available].

    PubMed

    Moreno Villares, José Manuel

    2016-07-12

    El desarrollo durante el periodo fetal y los primeros años de vida se caracteriza por su crecimiento rápido y la maduración de órganos y sistemas. Los cambios tanto en la calidad como en la cantidad de los nutrientes que consumen la mujer embarazada y el niño en ese periodo pueden influir de forma permanente sobre esos órganos en desarrollo. Esos efectos se conocen como "programación" y constituyen un factor importante en la aparición de enfermedades no transmisibles a lo largo de toda la vida, fundamentalmente en la edad adulta; en especial, la enfermedad cardiovascular, el síndrome metabólico y la intolerancia a los hidratos de carbono. Las carencias nutricionales durante el embarazo que ocasionan un crecimiento intrauterino retardado se asocian a un riesgo aumentado de diabetes tipo 2 y de enfermedad coronaria en la descendencia. Esa influencia en la aparición de enfermedades no transmisibles en la vida adulta también está marcada por el tipo y duración de la lactancia y por la alimentación complementaria. La explicación más plausible es que estos factores nutricionales -junto a otros no nutricionales- modifican la expresividad de determinados genes, modificando la respuesta de determinados órganos y tejidos, remodelando su estructura y su función. Estos cambios epigenéticos pueden transmitirse de una generación a la siguiente, por lo que se pone aún más en evidencia la importancia del fenómeno de la programación metabólica temprana. Pero al mismo tiempo abren una ventana de oportunidad a que modificando las pautas de alimentación de la mujer embarazada y del niño pequeño podamos disminuir la carga asociada a este tipo de enfermedades.

  5. Molten carbonate fuel cell product development test

    SciTech Connect

    Scroppo, J.A.; Camara, E.H.; Figueroa, R.A.

    1993-11-01

    M-C Power Corp. will design, fabricate, install, test, and evaluate a 250 kW Proof-of-Concept MCFC Power Plant. The plant will be located at Kaiser Permanente`s San Diego Medical Center; it will be designed and built by Bechtel Corp. Two 250 keV MCFC stacks will be assembled and tested at M-C Power; one stack will be used to support the San Diego field demonstration. This report outlines 6 tasks: project management/permitting, demonstration design, stack manufacturing, BOP fabrication, site work, and testing.

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

    ERIC Educational Resources Information Center

    Stremel, Kathleen

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

  7. [Self-reported experience in patients treated with Hepatitis C direct acting antivirals].

    PubMed

    Cañamares Orbis, Irene; Saez de la Fuente, Javier; Escobar Rodriguez, Ismael; Esteban Alba, Concepción; Such Díaz, Ana; Escobar Rodríguez, Ismael

    2016-11-01

    ,7% de los pacientes como muy bueno o bueno. Conclusiones: La experiencia autorreferida obtenida a través de un contacto directo y permanente con los pacientes permite obtener información sobre aspectos importantes del tratamiento. Creemos que estas herramientas deben incorporarse a los procedimientos de atención farmacéutica como una forma de mantener la continuidad. Además, inducen al paciente a una autoevaluación de diversos aspectos de su propio tratamiento, que pueden ayudar a conseguir una mayor implicación en el mismo y contribuir a conseguir el máximo resultado en salud posible de la farmacoterapia.

  8. The efficacy and safety of natalizumab for the treatment of multiple sclerosis in Portugal: a retrospective study.

    PubMed

    Sousa, L; de Sa, J; Sa, M J; Cerqueira, J J; Martins-Silva, A

    2014-11-01

    Introduccion. Los estudios han demostrado que el natalizumab constituye un tratamiento eficaz contra la esclerosis multiple remitente recurrente (EMRR). Hasta la fecha, no habia datos de pacientes portugueses. Objetivo. Determinar la eficacia y la seguridad del natalizumab en pacientes con EMRR atendidos en la practica clinica ordinaria en Portugal. Pacientes y metodos. Los datos clinicos de adultos con EMRR tratados con natalizumab en centros especializados de neurologia en Portugal se introdujeron de forma retrospectiva en una base de datos para llevar a cabo un analisis entre octubre de 2010 y febrero de 2012. Se analizo el cambio en la tasa anualizada de brotes (TAB), en las puntuaciones de la escala ampliada de discapacidad (EDSS) y en el estado de discapacidad. Resultados. Se admitio un total de 383 pacientes atendidos en 20 centros. Antes de iniciar el tratamiento con natalizumab, la mediana inicial de la EDSS era de 4,0 y la TAB media, de 1,64. La mayor parte de los pacientes ya habia recibido tratamiento contra la esclerosis multiple (93,0%). La duracion media del tratamiento con natalizumab era de 12 meses. El tratamiento propicio reducciones significativas (p < 0,001) de los valores iniciales de la TAB media y de las puntuaciones EDSS en los tratados con el anticuerpo durante >= 12 meses (n = 288) y durante >= 24 meses (n = 160). El natalizumab resulto mas eficaz en los pacientes que presentaban un menor grado de discapacidad (EDSS < 3,0) y en los que no habian recibido ningun tratamiento modificador de la enfermedad. Se notificaron dos casos de leucoencefalopatia multifocal progresiva. No hubo efectos adversos inesperados. Conclusion. El natalizumab presenta una tolerabilidad satisfactoria y se muestra eficaz en la reduccion de las recidivas y la estabilizacion de la EMRR en el marco de la practica clinica ordinaria en Portugal. Conserva su eficacia con el tratamiento continuado y podria ser eficaz especialmente en los pacientes con menos discapacidad y

  9. Trapped in a Local History: Why Did Extramural Fail to Engage in the Era of Engagement?

    ERIC Educational Resources Information Center

    Duke, Chris

    2008-01-01

    Extramural liberal adult education (LAE), as conceived in the particular UK tradition, was doomed by its high-minded origins and its privileged status, and contributed little to the new concepts of "éducation permanente," lifelong learning, the knowledge society, the learning society and region, or to the new understandings of university…

  10. Medical Device Plug-and-Play Interoperability Standards and Technology Leadership

    DTIC Science & Technology

    2013-10-01

    collaborators has included participants from: Kaiser Permanente, Johns Hopkins Medicine, the VA, FDA, NIST, TATRC, university computer and information...LiveData Inc., MITRE Corporation, Lockheed Martin Corporation, IXXAT, Draper Laboratory, NSF/CPS (Cyber Physical Systems), Geisinger Health System...MGH, Johns Hopkins, and the Hospital of the University of Pennsylvania. After a necessary check of the new data for completeness, and consultation

  11. Maternal Infection during Pregnancy and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  12. Area Handbook Series: Ecuador: A Country Study

    DTIC Science & Technology

    1989-12-01

    West, 1975. "Detengamos la violencia : Declaraci6n del Consejo Permanente del Episcopado," Celam [Bogota], 24, No. 202, October-Novem- ber 1985, 18-19...Socialdemocracia en la Mitad del Mundo," Nueva Sociedad [San Salvador], No. 96, July/August 1988, 8-10. Chapter 5 Alexander, RobertJ. "Ecuador

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Larkin, Heather; MacFarland, Nicole S.

    2012-01-01

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

  15. MEDIA ADVISORY: EPA, Justice Department, and State of California to announce major San Francisco Bay Clean Water Act settlement on Apr. 29

    EPA Pesticide Factsheets

    SAN FRANCISCO - Tomorrow, April 29, the U.S. Environmental Protection Agency, U.S. Department of Justice, and the State of California will announce a major Clean Water Act settlement with Lehigh Southwest Cement Co. and Hanson Permanente Cement Inc.

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

    ERIC Educational Resources Information Center

    Bargagliotti, L. Antoinette; And Others

    1991-01-01

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

  17. Antenatal Ultrasound and Risk of Autism Spectrum Disorders

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  18. Multi Attribute Decision Analysis in Public Health - Analyzing Effectiveness of Alternate Modes of Dispensing

    DTIC Science & Technology

    2007-09-01

    businesses, HMOs , Universities and other local governments can help reduce this gap in infrastructure by utilizing previously untapped resources. For...civil service agencies, large businesses, businesses that deal with critical infrastructure, hospitals, colleges and universities or HMOs it will be a...Dispensing, Pre-positioning, Business PODs, Special Needs Population, University PODs, Hotel PODs, Kaiser Permanente, Door to Door Dispensing, USPS, Drive

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  20. Community Resources for Promoting Youth Nutrition and Physical Activity

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  1. International Concepts and Agendas of Lifelong Learning

    ERIC Educational Resources Information Center

    Schuetze, Hans G.

    2006-01-01

    International organisations were the main proponents of Lifelong Learning when the concept was first developed in the early 1970s. Although different organisations used different labels--Lifelong Learning, recurrent education, education permanente--they all emphasised that learning is a lifelong process and that all education should be organised…

  2. Region 11 Health Care and Administration Costs

    DTIC Science & Technology

    2001-09-01

    average length of stay , we’ve used average values drawn from 1999 data representing averages across the Kaiser-Permanente health care system (including the... average length of stay (ALOS). Here, we provide the ALOS for enrollees who used civilian facilities (through the contractor) and those who used the MTF

  3. Does the opinion of the therapeutic team match with psychometric measures during the course of eating disorders?

    PubMed

    Jáuregui-Lobera, I; Garrido-Casals, O; Santiago, M J; Bolaños-Ríos, P; Ruiz-Prieto, I

    2013-01-01

    Introducción: ¿Existe un grupo de variables psicométricas que correlacione con el criterio de un equipo terapéutico interdisciplinar acerca del curso de los trastornos de la conducta alimentaria? Objetivos: El propósito de este estudio fue analizar la correlación entre criterios clínicos de un equipo terapéutico interdisciplinar con respecto al curso de los trastornos de la conducta alimentaria y diferentes criterios psicométricos. Métodos: La evolución fue analizada en una muestra final de 30 pacientes ambulatorios con trastornos de la conducta alimentaria durante los seis primeros meses de tratamiento. Una escala de criterios clínicos (la opinión del equipo terapéutico) y diferentes cuestionarios sobre variables psicológicas, psicopatológicas y relacionadas con la conducta alimentaria fueron utilizadas. Se llevó a cabo un análisis discriminante a fin de encontrar variables con función discriminante para distinguir una buena evolución de otras evoluciones. Resultados: El estrés percibido, autoestima, las variables contenidas en el listado de síntomas de Derogatis, la fusión pensamiento-forma, ansiedad, food craving y la puntuación en el cuestionario de imagen corporal tienen una función discriminante. Comparando los criterios del equipo terapéutico con los resultados de los cuestionarios, un 10% de los pacientes resultaron estar mal clasificados. Discusión: Los resultados ponen de relieve la necesaria y permanente evaluación a llevar a cabo entre los criterios clínicos con respecto a la evolución de los pacientes y el resultado de la medición de diferentes variables psicométricas, tanto psicológicas como psicopatológicas y relacionadas con la conducta alimentaria.

  4. Scientific and technological capabilities in health-related areas: opportunities, challenges, and interactions with the industrial sector.

    PubMed

    Vargas, Marco Antonio; Britto, Jorge

    2016-11-03

    Characterization of the scientific and technological infrastructure in health and its interactions with the industrial sector provides key elements for understanding the dynamics of innovation in health. This study conducts an exploratory analysis of the potentialities and limitations associated with scientific and technological capabilities in the health area in Brazil and the different links between the scientific and industrial sectors in health. The analysis points to important growth in internationally indexed research output, especially in certain areas such as pharmaceutics, public health, genetics, morphology, physiology, and microbiology. There has also been important growth in research groups that interact with the industrial sector in selected areas of health. The study highlights the importance of building more solid and permanent bridges between companies, research institutions, and the health system, linking the knowledge developed in research institutions to the dynamics of the industrial sector in health. Resumo: A caracterização da infraestrutura científica e tecnológica na área da saúde e das suas formas de articulação com a base produtiva representam elementos centrais na compreensão da dinâmica de inovação em saúde. Este estudo faz uma análise exploratória sobre as potencialidades e limitações associadas às capacitações científicas e tecnológicas na área da saúde no Brasil e as formas de articulação entre a base científica e a base produtiva em saúde. A análise aponta para o crescimento expressivo da produção bibliográfica com circulação internacional no campo da saúde, particularmente em determinadas áreas como farmácia, saúde coletiva, genética, morfologia, fisiologia e microbiologia. Além disso, observa-se um crescimento expressivo dos grupos de pesquisa com relacionamentos com o setor produtivo em áreas selecionadas da saúde. Destaca-se a importância da construção de pontes mais sólidas e

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

    PubMed Central

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

    2016-01-01

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

  6. [Appendicovesical fistula treated with elective laparoscopic surgery].

    PubMed

    García-Muñoz-Najar, Alejandro; Carrión-Álvarez, Lucía; Medina-García, Manuel; García-González, María Dolores; Pereira-Pérez, Fernando

    2013-01-01

    Antecedentes: la fístula apendicovesical es una complicación infrecuente de la apendicitis aguda en estadio avanzado y representa un tipo poco habitual de fístula enterovesical. La laparotomía exploradora ha sido durante muchos años pieza clave para el diagnóstico y su tratamiento efinitivo, pero actualmente el abordaje laparoscópico se está imponiendo entre diferentes grupos experimentados. Caso clínico: aportamos un nuevo caso de fístula apendicovesical en una mujer de 45 años de edad remitida del servicio de Urología por disuria y leucocituria permanente; finalmente, el diagnóstico se estableció mediante técnica de imagen (tomografía computada) y se resolvió por laparoscopia. Este caso se suma a los 115 casos descritos hasta ahora en la bibliografía y a los cuatro tratados mediante laparoscopia. Discusión: los métodos de imagen convencionales no son fiables para el diagnóstico de fístula enterovesical. La mayoría de los casos de fístula apendicovesical son secundarios a una apendicitis aguda no evidenciada y evolucionada. En la mayor parte de las publicaciones consultadas la laparotomía es una herramienta de diagnóstico de la fístula apendicovesical y, en pocos artículos, se describe la laparoscopia como alternativa diagnóstica y terapéutica. En la bibliografía sólo se encontraron tres artículos que hacen referencia al abordaje laparoscópico con fines terapéuticos. Conclusión: ante la sospecha de comunicación entre el tubo digestivo y el aparato urinario, la tomografía computada es el método diagnóstico de elección, sobre todo si se sospecha una fístula apendicovesical. El abordaje laparoscópico de la fístula apendicovesical puede confirmar el diagnóstico radiológico a la vez que constituye una opción quirúrgica definitiva.

  7. The Preschool Classroom as a Context for Cognitive Development: Type of Teacher Feedback and Children's Metacognitive Control (El aula Preescolar como espacio de desarrollo cognitivo: tipo de feedback docente y control metacognitivo en los niños)

    ERIC Educational Resources Information Center

    Muñoz, Liz; Cruz, Josefina Santa

    2016-01-01

    Introduction: The aim of this work was to determine whether the type of feedback given by the preschool teacher during class impacts the children's metacognitive control. For this purpose, the children's behavior was analyzed while teachers provided feedback during collaborative learning sessions. Method: A quasi-experimental, cross-sectional…

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

    ERIC Educational Resources Information Center

    Baleghizadeh, Sasan; Mortazavi, Mahboobeh

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Basallo Gómez, Juan Sebastián

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Méndez, Tatiana; García, Andrea

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Paulu, Nancy

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  17. The Kindergarten Survival Handbook: The Before School Checklist & a Guide for Parents. (El Manual de Como Sobrevivir El Jardin de Ninos: La Lista Pre-escolar y Una Guia Para Los Padres).

    ERIC Educational Resources Information Center

    Elovson, Allana Cummings

    Written to help parents understand what their children need to know before they start kindergarten, this volume, bound separately in English and Spanish, is intended to help parents become their children's best, as well as their first and most important, teachers. The first part of the book, the before school checklist, is divided into eight…

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

    ERIC Educational Resources Information Center

    Paulu, Nancy

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Lehr, Fran; Osborn, Jean

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

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

    ERIC Educational Resources Information Center

    Correa, Doris

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

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

  3. Informe: Agua potable - la EPA necesita adoptar medidas adicionales para garantizar que los pequeños sistemas de agua comunitarios señalados como graves infractores logren cumplir con las normas

    EPA Pesticide Factsheets

    Informe #16-P-0108, 22 de Marzo de 2016. La EPA puede proteger mejor al público del agua potable contaminada, lo que incluye a casi 200,000 personas en Puerto Rico que todavía carecen de agua potable segura.

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

    ERIC Educational Resources Information Center

    Patton, Patricia L.; And Others

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

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

    ERIC Educational Resources Information Center

    Jiménez Guamán, Laura Verónica

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Valle, Victor M.

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

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

    ERIC Educational Resources Information Center

    Pacheco, Angel M.; And Others

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

    Schwartz, Wendy

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

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

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

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

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

    ERIC Educational Resources Information Center

    Marson, Izabel Andrade

    1998-01-01

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

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

    ERIC Educational Resources Information Center

    Mugford, Gerrard; Cuevas, Oscar Ramírez

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Ramirez Rivera, Francisco Alberto

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

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

    ERIC Educational Resources Information Center

    Guerrero, Carmen Helena

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    López, Cecilio

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Hoskins, Irene, Ed.

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

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

    ERIC Educational Resources Information Center

    Chala Bejarano, Pedro Antonio; Chapetón, Claudia Marcela

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Chaves, Orlando; Hernández, Fanny

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Tavarez Da Costa, Pedro

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Baleghizadeh, Sasan; Zarghami, Zahra

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

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

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

    ERIC Educational Resources Information Center

    Fajardo Mora, Néstor Ricardo

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

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

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

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

    ERIC Educational Resources Information Center

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

    1998-01-01

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

  7. Finding Family Balance: Establishing an Adult Relationship with the Person with a Disability (A Pamphlet for Families) [and] Equilibrio Familiar: Como Establecer una Relacion Adulta con la Persona con Impedimentos (Panfleto para la Familia).

    ERIC Educational Resources Information Center

    Baron, Carla

    Two booklets, in English and Spanish, are addressed to families of disabled adults and offer guidelines for establishing an adult relationship with the disabled individual within the family. Stressed are the importance of helping the disabled adult develop a positive self image, learning to truly listen to the adult as part of improving…

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

    ERIC Educational Resources Information Center

    Buendía Arias, Ximena Paola

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Lazos, Hector, Comp.

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

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

    ERIC Educational Resources Information Center

    Lazos, Hector

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

  11. Habitus furibundo en el gueto estadounidense1

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  13. Physician involvement in disease management as part of the CCM.

    PubMed

    Wallace, Paul J

    2005-01-01

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

  14. Aligning organizational strategic planning and research priorities: the Kaiser experience.

    PubMed

    Miller, B; Crosson, F J

    1997-09-01

    Kaiser Permanente, the largest nonprofit HMO in the country, is a prepaid group practice program which provides comprehensive health benefits coverage to more than 8 million Americans in 17 states and the District of Columbia. The Northern California region of Kaiser Permanente is the largest region with more than 2.6 million members. This article describes the creation of a research effort in the Northern California region to develop a long-range strategic research plan. This effort was initiated in order to align research priorities with organizational strategic planning. The plan's aim was to better guide the process of using research to help the region meet its mission, goals and objectives. Twenty-seven strategic research areas were identified organized into four major categories. The top six strategic research areas are discussed.

  15. Mind-Body Training for At-Risk Populations: Preventive Medicine at its Best.

    PubMed

    Elder, Charles

    2017-01-01

    This article is a companion to "Transcendental meditation and reduced trauma symptoms in female inmates: A randomized controlled pilot study," available at: www.thepermanentejournal.org/issues/2017/6290-meditation.html, and on page 39 and to "Reduced trauma symptoms and perceived stress in male prison inmates through the Transcendental Meditation program: A randomized controlled trial," available at: www.thepermanentejournal.org/issues/2016/fall/6227-incarcerated-healthcare.html and in the Fall 2016 issue of The Permanente Journal.

  16. Response to the Directorate of Health Care Studies and Clinical Investigations Final Report (Revised) Assessing Power Analysis Approaches for the Fort Bragg Evaluation Project

    DTIC Science & Technology

    1993-07-28

    randomly assigned and, additionally, are subject to increasing attrition problems with successive waves. Such circumstances render ambiguous the extent...approximately a 10% improvement in the success rate of a treatment group compared to a control. As arule of thumb, I find that a reasonable effect size...Institute of Alcoholism Risk/Need Project, Ministry of Community and Alcohol Abuse and Social Service, Ontario, Canada Kaiser Permanente Medical Care

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

    SciTech Connect

    Not Available

    1992-11-01

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

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

    SciTech Connect

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

    1992-11-01

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

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

    PubMed

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

    1979-12-01

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

  20. Evidence-Based Workflows for Thyroid and Parathyroid Surgery

    PubMed Central

    Meltzer, Charles; Budayr, Amer; Chavez, Annette; Dlott, Richard; Greif, William; Gurushanthaiah, Deepak; Klonecke, Andrew; Lando, Matthew; Leary, Joyce; Nayak, Sundeep; Niederkohr, Ryan; Park, Judith; Savitz, Alison; Schwartz, Henry

    2016-01-01

    A need exists to reduce care variations by standardizing the practice of thyroid and parathyroid surgery. During the course of a year, a task force developed algorithms representing decision points and workflows based on American Thyroid Association guidelines and three internal studies of surgical practices in the Northern and Southern California Regions of Kaiser Permanente conducted in collaboration with Health Information Technology Transformation & Analytics (HITTA). PMID:27479948

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

    PubMed Central

    Sorensen, Herbert J

    2014-01-01

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

  2. [Cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of rheumatoid arthritis].

    PubMed

    Salinas-Escudero, Guillermo; Vargas-Valencia, Juan; García-García, Erika Gabriela; Munciño-Ortega, Emilio; Galindo-Suárez, Rosa María

    2013-01-01

    Objetivo: analizar la relación costo-efectividad del etanercept en comparación con otras terapias biológicas para tratar la artritis reumatoide moderada o severa en pacientes con falla previa a fármacos antirreumáticos modificadores de la enfermedad. Métodos: se empleó un modelo farmacoeconómico basado en el análisis de decisiones para valorar la evolución clínica con etanercept, infliximab, adalimumab o tocilizumab para tratar artritis reumatoide moderada o severa. Los parámetros de efectividad fueron las tasas de mejoría igual o superior a 20 % (ACR 20) y de mejoría igual o superior a 70 % (ACR 70). Resultados: etanercept tuvo la mayor efectividad terapéutica: en 79.7 % de los pacientes se observó una ACR 20 y en 31.4 %, una ACR 70. También tuvo el menor costo asociado ($149 629.1 por paciente) y fue más costo-efectiva ($187 740.4 por éxito clínico para obtener ACR 20 y $476 525.8 por éxito clínico para obtener ACR 70) que las demás terapias biológicas. Conclusiones: el etanercept fue el fármaco más efectivo y menos costoso, por lo que resulta la opción terapéutica más eficiente, desde el punto de vista de la relación costo-efectividad media y en términos incrementales para el tratamiento de la artritis reumatoide.

  3. Traumatic brain injury in Portugal: trends in hospital admissions from 2000 to 2010.

    PubMed

    Dias, Celeste; Rocha, João; Pereira, Eduarda; Cerejo, António

    2014-01-01

    Introdução: O traumatismo crânio-encefálico tem um impacto sócio-económico considerável, sendo uma importante causa de mobimortalidade, frequentemente causador de incapacidade permanente. Procuramos caracterizar a utilização dos recursos de saúde de adultos com traumatismo crânio-encefálico em Portugal entre 2000-2010. Material e Métodos: Estudo retrospectivo de registos de adultos com código ICD9 de traumatismo crânio-encefálico incluídos na Base-de-Dados Nacional de Grupos Diagnósticos Homogéneos de 2000-2010. Realizamos uma análise estatística descritiva e avaliamos as tendências durante a década. Resultados: Analisamos 72 865 admissões em 111 hospitais, 64,1% do sexo masculino, idade média de 57,9 ± 21,8 anos (18-107). Encontramos uma diminuição no número de traumatismo crânio-encefálico em pacientes jovens e um aumento nos mais velhos. O número de acidentes de trânsito diminuiu e o número de quedas aumentou. Houve um aumento de traumatismos crânio-encefálicos moderados-graves internados: 47,2% em 2000 / 80% em 2010. O número de admissões em Cuidados Intensivos quase duplicou (15,8% vs 29,5%), assim como o número de procedimentos neurocirúrgicos efectuados (8,2% vs 15,2%). A mortalidade total aumentou de 7,1% para 10,6%. Discussão: A diminuição do traumatismo crânio-encefálico observada pode estar associada com as campanhas de prevenção rodoviária, melhoria da rede rodoviária e políticas de saúde. O aumento da mortalidade poderá ser explicado pelo melhor atendimento pré-hospitalar, permitindo que casos mais graves cheguem ao hospital com vida e, embora tratados com mais frequência em Cuidados Intensivos e exigindo procedimentos neurocirúrgicos, vêm a falecer. Por outo lado, o aumento da idade dos doentes presumivelmente com maiores co-morbilidades associadas ao envelhecimento também estará a contribuir para a maior mortalidade. Conclusão: O traumatismo crânio-encefálico em Portugal está a mudar

  4. Measuring integrated care.

    PubMed

    Strandberg-Larsen, Martin

    2011-02-01

    The positive outcomes of coordination of healthcare services are to an increasing extent becoming clear. However the complexity of the field is an inhibiting factor for vigorously designed trial studies. Conceptual clarity and a consistent theoretical frame-work are thus needed. While researchers respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser Permanente has been put forward as an example for European healthcare systems to follow, although the evidence base is far from conclusive. The thesis has five objectives: 1) To contribute to the understanding of the concept of integration in healthcare systems and to identify measurement methods to capture the multi-dimensional aspects of integrated healthcare delivery. 2) To assess the level of integration of the Danish healthcare system. 3) To assess the use of joint health plans as a tool for coordination between the regional and local level in the Danish healthcare system. 4) To compare the inputs and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine the associations between specific organizational factors and clinical integration within each system. The literature was systematically searched to identify methods for measurement of integrated healthcare delivery. A national cross-sectional survey was conducted among major professional stake-holders at five different levels of the Danish healthcare system. The survey data were used to allow for analysis of the level of integration achieved. Data from the survey were

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

    PubMed

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

    2016-06-15

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

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

    PubMed

    Krishna, R

    2009-03-01

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

  7. Successful practices in the use of secure e-mail.

    PubMed

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

    2014-01-01

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

  8. Lessons in redesigning a quality program across the continuum.

    PubMed

    Brown, Diane Storer; Church, Lauri; Heywood, Terry; Hills, John F; McCarthy, Sarah; Serway, Cindy

    2003-01-01

    The Kaiser Permanente North East Bay service area redesigned its quality program beginning in 1995, to better mirror how care was provided across the continuum. The old model had evolved over time, was based on departmental structure, and did not focus on all patient populations. The purpose of this article is to describe the redesign process, the quality model implemented, and future directions, with the hope that the lessons learned will provide other healthcare quality professionals some of the knowledge needed and, perhaps, the courage to "design" their quality programs.

  9. Multifocal Clinical Performance Improvement Across 21 Hospitals

    PubMed Central

    Skeath, Melinda; Whippy, Alan

    2015-01-01

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

  10. Mind-Body Training for At-Risk Populations: Preventive Medicine at its Best

    PubMed Central

    Elder, Charles

    2017-01-01

    This article is a companion to “Transcendental meditation and reduced trauma symptoms in female inmates: A randomized controlled pilot study,” available at: www.thepermanentejournal.org/issues/2017/6290-meditation.html, and on page 39 and to “Reduced trauma symptoms and perceived stress in male prison inmates through the Transcendental Meditation program: A randomized controlled trial,” available at: www.thepermanentejournal.org/issues/2016/fall/6227-incarcerated-healthcare. html and in the Fall 2016 issue of The Permanente Journal. PMID:28241906

  11. Can disease management reduce health care costs by improving quality?

    PubMed

    Fireman, Bruce; Bartlett, Joan; Selby, Joe

    2004-01-01

    Disease management (DM) promises to achieve cost savings by improving the quality of care for chronic diseases. During the past decade the Permanente Medical Group in Northern California has implemented extensive DM programs. Examining quality indicators, utilization, and costs for 1996-2002 for adults with four conditions, we find evidence of substantial quality improvement but not cost savings. The causal pathway--from improved care to reduced morbidity to cost savings--has not produced sufficient savings to offset the rising costs of improved care. We conclude that the rationale for DM programs, like the rationale for any medical treatments, should rest on their effectiveness and value.

  12. Transforming care delivery through health information technology.

    PubMed

    Wheatley, Benjamin

    2013-01-01

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

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

    PubMed

    Bartolotto, Carole

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  15. Healthy behavior change in practical settings.

    PubMed

    Young, Scott

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    North Carolina Partnership for Children, Raleigh.

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

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

    ERIC Educational Resources Information Center

    Abad, José Vicente

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Alibakhshi, Goudarz; Dehvari, Najibeh

    2015-01-01

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

  19. Modèle numérique de terrain comme outil pour contrôler et mesurer l'érosion de ravinsModelos digitales de elevación como un instrumento para seguir y medir erosión por cárcavas

    NASA Astrophysics Data System (ADS)

    Betts, Harley D.; DeRose, Ronald C.

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

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

    ERIC Educational Resources Information Center

    Baron, Carla

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

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

    ERIC Educational Resources Information Center

    Rodriguez, Rodolfo, Comp.

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    de Freitas, Marcos Cezar

    1998-01-01

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

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

    ERIC Educational Resources Information Center

    Williams, Judy; Grierson, Arlene

    2016-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Baylor Coll. of Medicine, Houston, TX.

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

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

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

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

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

    ERIC Educational Resources Information Center

    Cohen, Elena

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

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

    ERIC Educational Resources Information Center

    Khonamri, Fatemeh; Mahmoudi Kojidi, Elahe

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Khonamri, Fatemeh; Salimi, Mahin

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Lopera Medina, Sergio

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Schauber, Holli

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Caicedo, Jefferson

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Viáfara, John Jairo

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Macías, Diego Fernando

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Hernández Méndez, Edith; Reyes Cruz, María del Rosario

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Lopera Medina, Sergio

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Ekundayo, Omowumi Steve Bode

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Rodriguez, Rodolfo, Comp.

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

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

    ERIC Educational Resources Information Center

    Lopez Alonso, A. O.

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

  1. [Secondary hypothyroidism after cervical irradiation: systematic evaluation of thyroid function in follow-up].

    PubMed

    Gonçalves, Sara Monteiro; Ferreira, Brígida Costa; Guardado, Maria João; Marques, Rui; Serra, Tânia; Serra, Maria João; Roda, Domingos; Brandão, Joana; Melo, Gilberto; Lopes, Maria Carmo; Khouri, Leila

    2014-01-01

    Introdução: A disfunção tiroideia constitui uma consequência, por vezes subestimada, da exposição à radiação. O mecanismo subjacente não está claramente esclarecido, mas terá uma origem multifatorial. Os fatores de risco específicos para o desenvolvimento de hipotiroidismo secundário à radioterapia permanecem indeterminados. A irradiação direta da glândula tiroideia pode resultar, com maior frequência, em hipotiroidismo. Este é uma condição irreversível, requerendo monitorização e tratamento permanente. Objetivos: Avaliar a incidência de hipotiroidismo nos doentes portadores de neoplasias da cabeça e pescoço submetidos a irradiação cervical, a título intensivo ou adjuvante, bem como determinar se é justificável a integração no protocolo de seguimento Institucional, de parâmetros laboratoriais (TSH, T3 Livre e T4 Livre) para avaliação da função tiroideia neste grupo de doentes e qual a sua periodicidade. Material e Métodos: Este é um estudo observacional, descritivo, retrospetivo, que engloba um grupo de 376 doentes portadores de neoplasias da cabeça e pescoço, submetidos a tratamento de radioterapia, a título adjuvante ou intensivo, entre os anos de 2007 e 2012, no Instituto Português de Oncologia de Coimbra Francisco Gentil E.P.E. Cumpriram todos os critérios de inclusão 145 doentes. Foram utilizadas escalas de avaliação padronizadas para a definição de hipotiroidismo – LENT-SOMA scales (Late Effects Normal Tissues Subjective Objective Management Analysis). Foi considerada como complicação o hipotiroidismo Grau 1 ou superior. Resultados: Procedeu-se à análise de um grupo de 145 doentes. A localização tumoral mais frequente foi a Laringe (26,9%). Trinta e dois doentes efetuaram radioterapia adjuvante e 113 efetuaram esquemas intensivos. A técnica de radioterapia mais utilizada foi a intensidade modulada (IMRT), efetuada em 86,2% doentes. A taxa de incidência global de hipotiroidismo aos 12 meses foi de

  2. Capelli's theory, Koszul maps, and superalgebras.

    PubMed Central

    Brini, A; Teolis, A G

    1993-01-01

    The straightening laws for the enveloping algebra Ukappa(pl(L)) of the general linear Lie superalgebra of a finite dimensional Z2-graded vector space are investigated. An isomorphism Psi from the supersymmetric algebra Super[L L] of pl(L) to Ukappa(pl(L)) is introduced; the isomorphism Psi maps each bitableau of Super[L L] to the Young-Capelli bitableau of Ukappa(pl(L)) parametrized by the same pair of Young diagrams, both in the permanental case and in the determinantal case. The map Psi is shown to be the inverse of the isomorphism introduced by Koszul [Koszul, J. P. (1981) C.R. Acad. Sci. Paris 292, 139-141]. The set of all costandard determinantal Young-Capelli bitableaux is a basis of Ukappa(pl(L)); this basis acts in a triangular way on the basis of Super[L L]given by the set of all standard permanental bitableaux. PMID:11607438

  3. Roundtable on public policy affecting patient safety.

    PubMed

    Crane, Robert M; Raymond, Brian

    2011-03-01

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

  4. Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

    PubMed

    Monroe, C Douglas; Chin, Karen Y

    2013-05-01

    The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

  5. Measurement and evaluation of national family planning programs.

    PubMed

    Mauldin, W P

    1967-03-01

    presentadas en formularios estandarizados, en las siguienies formas: 1. Informes nensuales por áreas administrativas, sobre los actuales servicios de planeamiento familiar proporcionados en la actualidad, de carácter permanente o de larga duración (al presente, esterilización y IUD de acuerdo a las siguientes características del receptor: residencia, edad, paridad (número de hijos vivos por sexo), y donde se enteró del programa, si es posible "clase";(probablemente educación de la madre, pero posiblemente ocupación del esposo, ingreso, o equivalente); prácticas anticonceptivas anteriores; intervalo; y deseo de tener más hijos. En un programa grande estos datos pueden obtenerse en base a una muestra. 2. Informes mensuales sobre la distribución de suministros anticonceptivos (condones, píldoras, sustancias efervescentes, etc.), los primeros suministros deben ir acompañados de un registro de las características del recipiente, como anteriormente; los suministros subsecuentes se regietrarán sólo en volumen bruto. Esto también se aplicará al ritmo, donde éste método se enseñe a un número considerable de mujeres. 3. Informes regulares sobre las actividades de planeamiento familiar de médicos privados, como una estimación del efecto catalítico del programa del gobierno sobre ci sector privado. 4. Datos generates mensuales, ppr áreas admirtistrativas importantes, sabre: visitas domiciliarias, reuniones, cuñas radiates y televisadas, avisos en los periódicos y personal que trabaja. 5. Para propósitos de seguimiento una entrevi eta de campo cada 6 a 12 meses a cada N mujer de las listas para (1) y (2) arriba, en un total de 300 o 400, para conocer las tasas de continuación y las razones de abandono (ej: desea otro hijo, insatisfecha can ci método, otras). Las mue.stras podrían ser de 300 cada una, con una supuesta experiencia de 6, 12, 18 y 24 meses. B. Un buen conjunto de datos sobre costa (datos sobre cotos actulaes atribuíbles directamente al

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

    NASA Astrophysics Data System (ADS)

    Maddock, Thomas, III.; Vionnet, Leticia Beatriz

    piézométrie initiale unique et à un seul jeu de données de conditions aux limites conduit à un mauvais calcul des prélèvements. Il faut alors utiliser une condition de recharge initiale pour chaque saison. Cette approche peut être réalisée en déterminant des solutions permanentes périodiques, variantes au cours des saisons, mais se répétant d'année en année. Un modèle de nappe régional, précédemment mis au point pour une partie du bassin de la rivière San Pedro (Arizona, États-Unis), a été modifié pour illustrer l'effet de conditions initiales différentes sur des solutions transitoires et sur le calcul des prélèvements. Resumen Se define como "captura" al aumento de recarga y descenso de descarga que tiene lugar cuando se impone un bombeo en un acuífero en estado de equilibrio dinámico. Se suelen utilizar modelos regionales de agua subterránea para calcular la captura en un procedimiento que consta de dos etapas. Una solución en régimen estacionario proporciona la distribución inicial de niveles piezométricos, los flujos a través de los contornos de la región modelada y el punto de partida para el cálculo de la captura. Las soluciones transitorias proporcionan los cambios en los flujos a través de los contornos. La diferencia entre las soluciones estacionaria y transitoria da el valor de la captura. Cuando los cambios estacionales son importantes, la utilización de un único estado inicial de niveles y de flujos en los contornos da lugar a errores en el cálculo de la captura. En este caso debe usarse una condición inicial para cada una de las estaciones. Esto se puede conseguir obteniendo soluciones periódicas estacionarias, que varíen a lo largo de las estaciones, pero que se repitan año a año. Un modelo regional desarrollado previamente para el estudio de una parte de la cuenca del Río San Pedro, en Arizona (EE.UU.) se modificó para ilustrar el efecto que las distintas condiciones iniciales tienen en el cálculo de la

  7. “I Want to Keep the Personal Relationship With My Doctor”: Understanding Barriers to Portal Use among African Americans and Latinos

    PubMed Central

    Allen, Jill Y; Poole, Dolly; Tieu, Lina; Kanter, Michael H; Garrido, Terhilda

    2016-01-01

    Background Despite the widespread implementation of electronic health records (EHRs), there is growing evidence that racial/ethnic minority patients do not use portals as frequently as non-Hispanic whites to access their EHR information online. This differential portal use could be problematic for health care disparities since early evidence links portal use to better outcomes. Objective We sought to understand specific barriers to portal use among African American and Latino patients at Kaiser Permanente, which has had a portal in place for over a decade, and broad uptake among the patient population at large. Methods We conducted 10 focus groups with 87 participants in 2012 and 2013 among African American and Latino Kaiser Permanente members in the mid-Atlantic, Georgia, and Southern California regions. Members were eligible to participate if they were not registered for portal access. Focus groups were conducted within each racial/ethnic group, and each included individuals who were older, had a chronic disease, or were parents (as these are the three biggest users of the portal at Kaiser Permanente overall). We videotaped each focus group and transcribed the discussion for analysis. We used general inductive coding to develop themes for major barriers to portal use, overall and separately by racial/ethnic group. Results We found that lack of support was a key barrier to initiating portal use in our sample—both in terms of technical assistance as well as the fear of the portal eroding existing personal relationships with health care providers. This held true across a range of focus groups representing a mix of age, income, health conditions, and geographic regions. Conclusions Our study was among the first qualitative explorations of barriers to portal use among racial/ethnic subgroups. Our findings suggest that uniform adoption of portal use across diverse patient groups requires more usable and personalized websites, which may be particularly important for

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

    1999-12-01

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

  10. Reflection in action in caring for the dying: applying organizational learning theory to improve communications in terminal care.

    PubMed

    Cherin, D; Enguidanos, S; Brumley, R

    2001-01-01

    Currently, single loop learning is the predominant method of problem solving orientation engaged in by healthcare institutions. This mode of learning is not conductive to fostering needed communications between health care providers and terminal patients. Reflection in action, second loop learning, focuses on deep listening and dialogue and can be critical in opening communications paths between the dying patient and his or her caregivers. This article discusses organizational learning theory and applies the theories double loop learning technique of reflection in action to end-of-life care. The article further explores an exemplar of reflection in action in a Palliative Care Program, and end-of-life home care program at Kaiser Permanente. In order to more effectively meet the needs of terminally ill patients, greater efforts are needed to incorporate second loop learning into the practice of those caring for these patients.

  11. Single-specialty versus multispecialty vascular surgery group model.

    PubMed

    Wixon, Christopher L; Jain, Krishna M; Satiani, Bhagwan

    2013-06-01

    The shift in employment options for vascular surgeons in the current era of major health care reform is being widely debated. After the decision to seek hospital employment or independent practice, the choice of then practicing in a single-specialty or a multispecialty practice remains a difficult decision. Although the trend is toward medium-sized to large-sized groups, only 1.2% of medical practices currently have >11 physicians. Barring the large multispecialty groups, such as Kaiser Permanente, Cleveland Clinic, or Mayo Clinic, most vascular practices are constituted as small groups. Which format prospers will depend on adroit management of financial and intellectual capital and nimbleness in adapting to rapidly changing market conditions. In this report, two practicing vascular surgeons debate the merits of single or multispecialty practice, with a commentary to follow.

  12. Dinámica de pulsares jóvenes

    NASA Astrophysics Data System (ADS)

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

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

  13. Trimble Vrs Concept

    NASA Astrophysics Data System (ADS)

    Luttenberger, C.

    Presenting the Trimble Virtual Reference Station (VRS) concept. High accuracy Real-Time Kinematic Positioning with GPS is one of todaySs most widely used surveying techniques. But, its use is restricted by the effects of the iono- sphere and troposphere which create systematic errors in the raw data. In practice, these mean that the distance between a rover (mobile) receiver and its reference sta- tion has to be quite short in order to work efficiently. The concept of Virtual Reference Stations offers a new opportunity. When used, the systematic errors in the reference station data are either reduced, or eliminated. This not only allows a user to increase the distance at which the rover receiver is located from the reference, it also increases the reliability of the system and reduces the OTF initialization time. The presentation describes the setup of a VRS system, as well the used model to reduce the error influence in such a permanente reference station network.

  14. Is infertility associated with childhood autism?

    PubMed

    Grether, Judith K; Qian, Yinge; Croughan, Mary S; Wu, Yvonne W; Schembri, Michael; Camarano, Loretta; Croen, Lisa A

    2013-03-01

    Concerns persist about a possible link between infertility and risk of autism spectrum disorders (ASD). Interpretation of existing studies is limited by racial/ethnic homogeneity of study populations and other factors. Using a case-control design, we evaluated infertility history and treatment documented in medical records of members of Kaiser Permanente Northern California. Among singletons (349 cases, 1,847 controls), we found no evidence to support an increase in risk of ASD associated with infertility. Among multiple births (21 cases, 54 controls), we found an increased risk associated with infertility history and with infertility evaluations and treatment around the time of index pregnancy conception; however, small sample size and lack of detailed data on treatments preclude firm interpretation of results for multiple births.

  15. Diffusion du champ électromagnétique dans une sphère ferromagnétique conductrice avec hystérésis

    NASA Astrophysics Data System (ADS)

    Saadi, M.; Jellali, F.; Quichaud, G.

    1995-09-01

    This paper deals with the numerical simulation of a hard steel sphere magnetization under a pulsed current through a solenoid. We could show that the association of the induced current and the magnetic hysteresis leads to a permanent trapped flux loop. We could also confirm the existence of this phenomenon by means of experiment. Cet article concerne la simulation numérique de l'aimantation d'une sphère en acier dur par une brève impulsion de courant dans un soléndide. On montre que les courants induits et l'hystérésis magnétique conduisent à un flux d'induction rémanent piégé d'une façon permanente dans cette sphère. On donne également une mise en évidence expérimentale de ce phénomène.

  16. Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care.

    PubMed

    Sallis, Robert E; Matuszak, Jason M; Baggish, Aaron L; Franklin, Barry A; Chodzko-Zajko, Wojtek; Fletcher, Barbara J; Gregory, Andrew; Joy, Elizabeth; Matheson, Gordon; McBride, Patrick; Puffer, James C; Trilk, Jennifer; Williams, Janet

    2016-01-01

    The U.S. population is plagued by physical inactivity, lack of cardiorespiratory fitness, and sedentary lifestyles, all of which are strongly associated with the emerging epidemic of chronic disease. The time is right to incorporate physical activity assessment and promotion into health care in a manner that engages clinicians and patients. In April 2015, the American College of Sports Medicine and Kaiser Permanente convened a joint consensus meeting of subject matter experts from stakeholder organizations to discuss the development and implementation of a physical activity vital sign (PAVS) to be obtained and recorded at every medical visit for every patient. This statement represents a summary of the discussion, recommendations, and next steps developed during the consensus meeting. Foremost, it is a "call to action" for current and future clinicians and the health care community to implement a PAVS in daily practice with every patient.

  17. Streamlining the accounts payable function with EDI.

    PubMed

    Huntley, G; Shride, T; McLure, M L; Moynihan, J J

    1997-01-01

    Kaiser Permanente of Southern California is expanding its use of EDI as a way to enhance the efficiency of its procurement effort and reduce administrative costs. Based on the results of surveys of key suppliers, Kaiser executives identified four EDI-based process improvements: 1) using the X12 832 standard to reconcile contracting data, which can eliminate up to 33 percent of mismatches among purchase orders, invoices, and receiving documents; 2) using procurement cards for many purchases, which can eliminate 20 percent of all invoices and related check payments; 3) using the X12 810 standard to obtain electronic invoices from Kaiser's largest suppliers; and 4) implementing the X12 820 standard, which lowers both supplier and claims payment costs.

  18. A physician prescription for the nursing shortage.

    PubMed

    Cochran, John H

    2010-01-01

    In 2003, the Colorado Permanente Medical Group (CPMG), a 780-member, multispecialty physician group that provides ambulatory and hospital care principally in metropolitan Denver and Boulder, embarked upon a multifaceted program to leverage physician leadership to address the nursing shortage. Designated as the "Preferred Clinical Partner Program" (the PCP Program), CPMG sought to participate in solving the nursing shortage by engaging in a number of initiatives. Through an initial fund of $1 million, over $350,000 was used to fund nursing scholarships, over $150,000 was used to provide advanced training to a select group of health care professionals in a program that may be the first physician-partnered MA-to-LPN and RN-to-BSN initiative, and over $500,000 was devoted to building and expanding nursing simulation laboratories. Currently, the accelerated nursing program graduates approximately 32-35 nurses each year and has admitted its seventh cohort of students. Student retention has been excellent.

  19. Design and coverage of high throughput genotyping arrays optimized for individuals of East Asian, African American, and Latino race/ethnicity using imputation and a novel hybrid SNP selection algorithm.

    PubMed

    Hoffmann, Thomas J; Zhan, Yiping; Kvale, Mark N; Hesselson, Stephanie E; Gollub, Jeremy; Iribarren, Carlos; Lu, Yontao; Mei, Gangwu; Purdy, Matthew M; Quesenberry, Charles; Rowell, Sarah; Shapero, Michael H; Smethurst, David; Somkin, Carol P; Van den Eeden, Stephen K; Walter, Larry; Webster, Teresa; Whitmer, Rachel A; Finn, Andrea; Schaefer, Catherine; Kwok, Pui-Yan; Risch, Neil

    2011-12-01

    Four custom Axiom genotyping arrays were designed for a genome-wide association (GWA) study of 100,000 participants from the Kaiser Permanente Research Program on Genes, Environment and Health. The array optimized for individuals of European race/ethnicity was previously described. Here we detail the development of three additional microarrays optimized for individuals of East Asian, African American, and Latino race/ethnicity. For these arrays, we decreased redundancy of high-performing SNPs to increase SNP capacity. The East Asian array was designed using greedy pairwise SNP selection. However, removing SNPs from the target set based on imputation coverage is more efficient than pairwise tagging. Therefore, we developed a novel hybrid SNP selection method for the African American and Latino arrays utilizing rounds of greedy pairwise SNP selection, followed by removal from the target set of SNPs covered by imputation. The arrays provide excellent genome-wide coverage and are valuable additions for large-scale GWA studies.

  20. Use of electronic health records can improve the health care industry's environmental footprint.

    PubMed

    Turley, Marianne; Porter, Catherine; Garrido, Terhilda; Gerwig, Kathy; Young, Scott; Radler, Linda; Shaber, Ruth

    2011-05-01

    Electronic health records have the potential to improve the environmental footprint of the health care industry. We estimate that Kaiser Permanente's electronic health record system, which covers 8.7 million beneficiaries, eliminated 1,000 tons of paper records and 68 tons of x-ray film, and that it has lowered gasoline consumption among patients who otherwise would have made trips to the doctor by at least three million gallons per year. However, the use of personal computers resulted in higher energy consumption and generated an additional 250 tons of waste. We conclude that electronic health records have a positive net effect on the environment, and that our model for evaluating their impact can be used to determine whether their use can improve communities' health.

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

    PubMed

    Nelson, Joan M; Cook, Paul F

    2008-01-01

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

  2. 2009 Annual National Patient Safety Foundation Congress: conference proceedings.

    PubMed

    Bonacum, Doug; Corrigan, Janet; Gelinas, Lillee; Pinakiewicz, Diane C; Stepnick, Larry

    2009-09-01

    On May 20 to 22, 2009, the National Patient Safety Foundation (NPSF) held its Annual NPSF Patient Safety Congress in National Harbor, Md. Entitled Patient Safety in Challenging Times: Now More Than Ever, A Critical Need, the meeting focused on the need to strengthen efforts to improve patient safety and quality in the midst of the extraordinary economic challenges facing the nation. The Congress was cochaired by the following distinguished individuals: Janet Corrigan, PhD, MBA, president and chief executive officer, National Quality Forum, Lillee Gelinas, RN, MSN, FAAN, vice president and chief nursing officer, VHA, Inc., Doug Bonacum, MBA, BS, vice president for safety management, Kaiser Permanente, and a member of the Board of Directors of NPSF. The main conference was preceded by 3 concurrent day-long workshops: Leadership Day, Patient Safety 101, and Community Engagement from the Patient and Family Perspective. The Congress featured 4 plenary sessions and 35 breakout sessions. This article provides summaries of the plenary sessions.

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

    PubMed Central

    2012-01-01

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

  4. Training providers: beyond the basics of electronic health records

    PubMed Central

    2013-01-01

    Background Training is a critical part of health information technology implementations, but little emphasis is placed on post-implementation training to support day-to-day activities. The goal of this study was to evaluate the impact of post-implementation training on key electronic health record activities. Methods Based on feedback from providers and requests for technical support, we developed two classes designed to improve providers’ effectiveness with the electronic health record. Training took place at Kaiser Permanente, Mid-Atlantic States. The classes focused on managing patient-level information using problem lists and medication lists, as well as efficient documentation and chart review. Both classes used the blended learning method, integrating concrete scenarios, hands-on exercises and take-home materials to reinforce class concepts. To evaluate training effectiveness, we used a case–control study with a 1:4 match on pre-training performance. We measured the usage rate of two key electronic health record functions (problem list and medication list management) for six months before and after training. Change scores were compared using the Wilcoxon sign rank test. Results 36 participants and 144 non-participants were included in the training evaluation. Training participants were more likely to manage both medication lists and problem lists after training. Class material is now being incorporated into an enterprise-wide multi-modal training program available to all providers at Kaiser Permanente in the Mid-Atlantic States. Conclusions Ongoing information technology training is well-received by healthcare providers, who expressed a clear preference for additional training. Training improved use of two important electronic health record features that are included as part of the Meaningful Use criteria. PMID:24295150

  5. Physician-owned Surgical Hospitals Outperform Other Hospitals in the Medicare Value-based Purchasing Program

    PubMed Central

    Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

    2016-01-01

    Background The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals while creating financial incentives for quality improvement and fostering increased transparency. Limited information is available comparing hospital performance across healthcare business models. Study Design 2015 hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Results Of 3089 hospitals with Total Performance Scores (TPS), categories of representative healthcare business models included 104 Physician-owned Surgical Hospitals (POSH), 111 University HealthSystem Consortium (UHC), 14 US News & World Report Honor Roll (USNWR) Hospitals, 33 Kaiser Permanente, and 124 Pioneer Accountable Care Organization affiliated hospitals. Estimated mean TPS for POSH (64.4, 95% CI 61.83, 66.38) and Kaiser (60.79, 95% CI 56.56, 65.03) were significantly higher compared to all remaining hospitals while UHC members (36.8, 95% CI 34.51, 39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included POSH (mean 2.32, p<0.0001), USNWR honorees (mean 2.24, p 0.0140) and UHC members (mean =1.99, p<0.0001) while Kaiser Permanente hospitals had lower case mix value (mean =1.54, p<0.0001). Re-estimation of TPS did not change the original results after adjustment for differences in hospital case mix index. Conclusions The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals may guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. PMID:27502368

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    Andryjowicz, Esteban; Wray, Teresa

    2011-01-01

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

  8. A new web-based system to improve the monitoring of snow avalanche hazard in France

    NASA Astrophysics Data System (ADS)

    Bourova, Ekaterina; Maldonado, Eric; Leroy, Jean-Baptiste; Alouani, Rachid; Eckert, Nicolas; Bonnefoy-Demongeot, Mylene; Deschatres, Michael

    2016-05-01

    Snow avalanche data in the French Alps and Pyrenees have been recorded for more than 100 years in several databases. The increasing amount of observed data required a more integrative and automated service. Here we report the comprehensive web-based Snow Avalanche Information System newly developed to this end for three important data sets: an avalanche chronicle (Enquête Permanente sur les Avalanches, EPA), an avalanche map (Carte de Localisation des Phénomènes d'Avalanche, CLPA) and a compilation of hazard and vulnerability data recorded on selected paths endangering human settlements (Sites Habités Sensibles aux Avalanches, SSA). These data sets are now integrated into a common database, enabling full interoperability between all different types of snow avalanche records: digitized geographic data, avalanche descriptive parameters, eyewitness reports, photographs, hazard and risk levels, etc. The new information system is implemented through modular components using Java-based web technologies with Spring and Hibernate frameworks. It automates the manual data entry and improves the process of information collection and sharing, enhancing user experience and data quality, and offering new outlooks to explore and exploit the huge amount of snow avalanche data available for fundamental research and more applied risk assessment.

  9. Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization.

    PubMed

    Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K

    2013-01-01

    The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

  10. Generating a Taxonomy for Genetic Conditions Relevant to Reproductive Planning

    PubMed Central

    Korngiebel, Diane M; McMullen, Carmit; Amendola, Laura; Berg, Jonathan S; Davis, James V; Gilmore, Marian J; Harding, Cary; Himes, Patricia; Jarvik, Gail P; Kauffman, Tia L; Kennedy, Kathleen; Simpson, Dana Kostiner; Leo, Michael C; Lynch, Frances; Quigley, Denise; Reiss, Jacob A; Richards, C. Sue; Rope, Alan; Schneider, Jennifer L; Goddard, Katrina AB; Wilfond, Benjamin S

    2016-01-01

    As genome or exome sequencing (hereafter genome-scale sequencing) becomes more integrated into standard care, carrier testing is an important possible application. Carrier testing using genome-scale sequencing can identify a large number of conditions, but choosing which conditions/genes to evaluate as well as which results to disclose can be complicated. Carrier testing generally occurs in the context of reproductive decision-making and involves patient values in a way that other types of genetic testing may not. The Kaiser Permanente Clinical Sequencing Exploratory Research program is conducting a randomized clinical trial of preconception carrier testing that allows participants to select their preferences for results from among broad descriptive categories rather than selecting individual conditions. This paper describes 1) the criteria developed by the research team, the return of results committee (RORC), and stakeholders for defining the categories; 2) the process of refining the categories based on input from patient focus groups and validation through a patient survey; and, 3) how the RORC then assigned specific gene-condition pairs to taxonomy categories being piloted in the trial. The development of four categories (serious, moderate/mild, unpredictable, late onset) for sharing results allows patients to select results based on their values without separately deciding their interest in knowing their carrier status for hundreds of conditions. A fifth category, lifespan limiting, was always shared. The lessons learned may be applicable in other results disclosure situations, such as incidental findings. PMID:26889673

  11. Physician Update: Total Health

    PubMed Central

    Tuso, Phillip

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  13. Strategies, Programs and Projects 2008 of the Astrophysical Group "SPACE-Universidad Nacional Mayor De San Marcos, Peru" - Preparing for the IYA2009

    NASA Astrophysics Data System (ADS)

    Vera, Victor; Aguilar, M.; Huisacayna, J.

    2008-05-01

    We present a review of our efforts to introduce astronomy as scientific career in Peru, showing how our astronomy outreach programs have been one of the most important keys to reach our national astronomical scientific goals, remarking the crucial role that the celebration of the IYA2009 must play, in order to promote PhD programmes in astronomy in developing countries. We show the importance of the creation of the Seminario Permanente de Astronomía y Ciencias Espaciales (SPACE) in the Universidad Nacional Mayor de San Marcos, as an academic scientific and cultural center in Peru, to support our 26 years-old "Astronomical Fridays” which are addressed to wide range of public, from schoolchildren to scientists. We also show how important was to rediscover our ancient astronomical cultural past of Incas in order to promote the construction of a Astronomical Center located near Cusco city over 4000 meters above sea level, which includes a tourist-educational observatory, a scientific optical observatory and a solar radio observatory.

  14. Use of sildenafil or other phosphodiesterase inhibitors and risk of melanoma

    PubMed Central

    Pottegård, Anton; Schmidt, Sigrún Alba Johannesdottir; Olesen, Anne Braae; Achacoso, Ninah; Van Den Eeden, Stephen K; Hallas, Jesper; Sørensen, Henrik Toft; Friis, Søren; Habel, Laurel A

    2016-01-01

    Background: Phosphodiesterase 5A inhibitors (PDEIs), a common treatment for erectile dysfunction, were recently linked to an increased risk of melanoma. Methods: We conducted two parallel case–control studies, using the Danish Nationwide Health Registries (DNHR) and the Kaiser Permanente Northern California (KPNC) electronic health records. Identifying men with histologically verified melanoma (cases) matched on birth year to 10 cancer-free controls, we estimated odds ratios (OR) for melanoma associated with high use of PDEIs (⩾100 tablets filled), adjusting for available confounders. Results: We identified 7045 DNHR and 2972 KPNC cases with invasive melanoma. The adjusted OR for invasive melanoma associated with high PDEI use was 1.22 (95% confidence interval (CI), 0.99–1.49) in DNHR and 0.95 (95% CI, 0.78–1.14) in KPNC. Odds ratios were highest for localised invasive melanoma in DNHR (OR, 1.21) and melanoma in situ in KPNC (OR, 1.15), and lowest for non-localised disease in both populations (ORs 0.75 and 0.61, respectively). The increased ORs were slightly attenuated upon adjustment for markers of health-care utilisation. Conclusions: We found little evidence for a causal association between PDEI use and risk of melanoma. The marginally increased risk of early stage disease likely resulted from more frequent health-care contacts among PDEI users. PMID:27529513

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

    PubMed

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

    2013-05-21

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

  16. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System

    PubMed Central

    Durant, Anne Foss; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California’s Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes. PMID:26828076

  17. Vaginal birth after cesarean section: risk of uterine rupture with labor induction.

    PubMed

    Ouzounian, Joseph G; Miller, David A; Hiebert, Christy J; Battista, Leah R; Lee, Richard H

    2011-09-01

    We assessed the rate of uterine rupture in patients undergoing labor induction for attempted vaginal birth after cesarean (VBAC). A retrospective study was performed of data from a computerized database. Deliveries from January 1, 1998, to June 30, 2001, in the Southern California Kaiser Permanente system were reviewed and various perinatal characteristics analyzed. A total of 16,218 patients had a prior low transverse cesarean section. Of these, 6832 (42.1%) had a trial of labor. Successful VBAC occurred in 86% of patients with spontaneous onset of labor and 66% of patients with labor induction ( p < 0.001). The uterine rupture rate was not different between patients with spontaneous or induced labor (1.0% versus 1.2%, p = 0.51). Similarly, there was no significant difference between oxytocin or prostaglandin E2 induction (1.4% versus 1.0%, p = 0.59). In our study, labor induction did not appear to increase the risk of uterine rupture in women attempting VBAC.

  18. The human factor: the critical importance of effective teamwork and communication in providing safe care.

    PubMed

    Leonard, M; Graham, S; Bonacum, D

    2004-10-01

    Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

  19. Reassurance Against Future Risk of Precancer and Cancer Conferred by a Negative Human Papillomavirus Test

    PubMed Central

    Schiffman, Mark; Katki, Hormuzd A.; Castle, Philip E.; Fetterman, Barbara; Wentzensen, Nicolas; Poitras, Nancy E.; Lorey, Thomas; Cheung, Li C.; Kinney, Walter K.

    2014-01-01

    Primary human papillomavirus (HPV) testing (without concurrent Pap tests) every 3 years is under consideration in the United States as an alternative to the two recommended cervical cancer screening strategies: primary Pap testing every 3 years, or concurrent Pap and HPV testing (“cotesting”) every 5 years. Using logistic regression and Weibull survival models, we estimated and compared risks of cancer and cervical intraepithelial neoplasia grade 3 or worse (CIN3+) for the three strategies among 1011092 women aged 30 to 64 years testing HPV-negative and/or Pap-negative in routine screening at Kaiser Permanente Northern California since 2003. All statistical tests were two sided. Three-year risks following an HPV-negative result were lower than 3-year risks following a Pap-negative result (CIN3+ = 0.069% vs 0.19%, P < .0001; Cancer = 0.011% vs 0.020%, P < .0001) and 5-year risks following an HPV-negative/Pap-negative cotest (CIN3+ = 0.069% vs 0.11%, P < .0001; Cancer = 0.011% vs 0.014%, P = .21). These findings suggest that primary HPV testing merits consideration as another alternative for cervical screening. PMID:25038467

  20. Engaging the Community in the Dissemination, Implementation, and Improvement of Health-Related Research.

    PubMed

    Bodison, Stefanie C; Sankaré, Ibrahima; Anaya, Henry; Booker-Vaughns, Juanita; Miller, Aria; Williams, Pluscedia; Norris, Keith

    2015-12-01

    To help maximize the real-world applicability of available interventions in clinical and community healthcare practice, there has been greater emphasis over the past two decades on engaging local communities in health-related research. While there have been numerous successful community-academic partnered collaborations, there continues to be a need to articulate the common barriers experienced during the evolution of these partnerships, and to provide a roadmap for best practices that engage healthcare providers, patients, families, caregivers, community leaders, healthcare systems, public agencies and academic medical centers. To this end, this paper presents a summary of a forum discussion from the 2014 Southern California Dissemination, Implementation and Improvement (DII) Science Symposium, sponsored by the University of California Los Angeles (UCLA) Clinical Translational Science Institute (CTSI), University of Southern California (USC) CTSI, and Kaiser Permanente. During this forum, a diverse group of individuals representing multiple constituencies identified four key barriers to success in community-partnered participatory research (CPPR) and discussed consensus recommendations to enhance the development, implementation, and dissemination of community health-related research. In addition, this group identified several ways in which the over 60 NIH funded Clinical and Translational Science Institutes across the country could engage communities and researchers to advance DII science.

  1. Improving asthma outcomes in large populations.

    PubMed

    Schatz, Michael; Zeiger, Robert S

    2011-08-01

    This article summarizes our experience using administrative, survey, and telephone information to define asthma severity, impairment, risk, and quality of care in our large Kaiser Permanente population. Our data suggest that the 2-year Healthcare Effectiveness Data and Information Set definition of persistent asthma is a good surrogate for survey-defined persistent asthma, and thus it would be reasonable to direct asthma population management and quality-of-care assessments at patients with Healthcare Effectiveness Data and Information Set-defined persistent asthma for 2 years in a row. For population management, the numbers of short-acting β-agonist (SABA) canisters dispensed and validated tools on mail or telephone surveys have been used to assess asthma impairment. Algorithms based on pharmacy data (SABA canister and oral corticosteroid dispensings and prior emergency hospital care) have been used to assess the risk domain of asthma control. The asthma medication ratio (controllers divided by controllers plus SABAs) has been shown to be related to improved outcomes and is recommended as an asthma quality-of-care marker. It is hoped that outreach to patients and providers based on these indicators will improve asthma outcomes in patients cared for in individual practices, as well as in large health plans.

  2. Making Hospitals Safer for Older Adults: Updating Quality Metrics by Understanding Hospital-Acquired Delirium and Its Link to Falls

    PubMed Central

    Lee, Eric A; Gibbs, Nancy E; Fahey, Linda; Whiffen, Teri L

    2013-01-01

    The medical care of hospitalized geriatric patients must differ from the care of younger adults. Because of reduced “reserve capacity,” hospitalized older adults are at high risk of development of geriatric syndromes such as delirium and falls. Geriatric syndromes often lead to functional decline and dependence. Patients who experience geriatric syndromes in the hospital are more likely to have a longer length of stay, higher risk of readmissions, and worse medical outcomes. Incident delirium in hospitalized geriatric patients has been shown to be preventable by intervening in established risk factors. Prevention of hospital-related falls has not been consistently demonstrated. Analysis from Kaiser Permanente data demonstrated a correlation with delirium and hospital-related falls. We propose that age-specific quality metrics should be made to reduce the risk of the development of geriatric syndromes in hospitalized older adults. By preventing delirium, we believe that health care practitioners can reduce hospital-related falls in geriatric patients and improve the quality of care delivered to hospitalized older adults. An illustrative fictional case study is presented. PMID:24361018

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

    PubMed

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

    1993-01-01

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

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

    PubMed Central

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

    2009-01-01

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

  5. Integrated health care for patients with motor neurone disease.

    PubMed

    Brewah, Helen

    This article presents the findings from a study trip to Kaiser Permanente (KP), a private healthcare provider in the USA. The aim of the trip was to understand how healthcare integration is managed in KP and how this might help patients in the UK with motor neurone disease (MND). This article makes reference to the American and British healthcare systems, identifying the simple differences between health economies, and their impact on health care, with specific reference to MND. The trip was undertaken as part of the author's ongoing work on how patients with MND rate services delivered by the multidisciplinary team (MDT) in the UK. The author's community matron role involves caring for patients with long-term conditions (LTCs) including long-term neurological conditions (LTNCs). In executing this role and in service delivery to patients with LTNCs, specifically MND, the author noticed a lack of robust integration, highlighting the need to consider and address the various contributory factors. This article presents a literature review and analyses the role of the MDT including specialist neurological professionals in executing duties and in delivering healthcare services to patients diagnosed with MND. The implications for practice are also presented along with areas for practice development.

  6. Kaiser captures spirit of games.

    PubMed

    Herreria, J

    1998-01-01

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

  7. Higher Prescription Opioid Dose is Associated With Worse Patient-Reported Pain Outcomes and More Health Care Utilization.

    PubMed

    Morasco, Benjamin J; Yarborough, Bobbi Jo; Smith, Ning X; Dobscha, Steven K; Deyo, Richard A; Perrin, Nancy A; Green, Carla A

    2017-04-01

    Some previous research has examined pain-related variables on the basis of prescription opioid dose, but data from studies involving patient-reported outcomes have been limited. This study examined the relationships between prescription opioid dose and self-reported pain intensity, function, quality of life, and mental health. Participants were recruited from 2 large integrated health systems, Kaiser Permanente Northwest (n = 331) and VA Portland Health Care System (n = 186). To be included, participants had to have musculoskeletal pain diagnoses and be receiving stable doses of long-term opioid therapy. We divided participants into 3 groups on the basis of current prescription opioid dose in daily morphine equivalent dose (MED): low dose (5-20 mg MED), moderate dose (20.1-50 mg MED), and higher dose (50.1-120 mg MED) groups. A statistically significant trend emerged where higher prescription opioid dose was associated with moderately sized effects including greater pain intensity, more impairments in functioning and quality of life, poorer self-efficacy for managing pain, greater fear avoidance, and more health care utilization. Rates of potential alcohol and substance use disorders also differed among groups. Findings from this evaluation reveal significant differences in pain-related and substance-related factors on the basis of prescription opioid dose.

  8. Engaging the Community in the Dissemination, Implementation and Improvement of Health Related Research

    PubMed Central

    Bodison, Stefanie; Sankaré, Ibrahima; Anaya, Henry; Booker-Vaughns, Juanita; Miller, Aria; Williams, Pluscedia; Norris, Keith

    2016-01-01

    To help maximize the real-world applicability of available interventions in clinical and community healthcare practice, there has been greater emphasis over the last two decades on engaging local communities in health-related research. While there have been numerous successful community-academic partnered collaborations, there continues to be a need to articulate the common barriers experienced during the evolution of these partnerships, and to provide a roadmap for best practices that engage health care providers, patients, families, caregivers, community leaders, healthcare systems, public agencies and academic medical centers. To this end, this article presents a summary of a forum discussion from the 2014 Southern California Dissemination, Implementation and Improvement (DII) Science Symposium, sponsored by the University of California Los Angeles (UCLA) Clinical Translational Science Institute (CTSI), University of Southern California (USC) CTSI, and Kaiser Permanente. During this forum, a diverse group of individuals representing multiple constituencies identified four key barriers to success in community-partnered participatory research (CPPR) and discussed consensus recommendations to enhance the development, implementation, and dissemination of community health-related research. In addition, this group identified several ways in which the over 60 NIH funded Clinical and Translational Science Institutes across the country could engage communities and researchers to advance DII science. PMID:26546337

  9. Cohort study of serum total cholesterol and in-hospital incidence of infectious diseases.

    PubMed Central

    Iribarren, C.; Jacobs, D. R.; Sidney, S.; Claxton, A. J.; Feingold, K. R.

    1998-01-01

    A multiethnic cohort of adult members of the Kaiser Permanente Medical Care Program (55300 men and 65271 women) was followed for 15 years (1979-93) to assess the association between total cholesterol and risk of infections (other than respiratory and HIV) diagnosed in the in-patient setting. Using multivariate Cox regression, total cholesterol was inversely and significantly related to urinary tract, venereal, musculo-skeletal, and all infections among men; and to urinary tract, all genito-urinary, septicaemia or bacteraemia, miscellaneous viral site unspecified, and all infections among women. The reduction of risk of all infections associated with a 1 S.D. increase in total cholesterol was 8% in both men (95% CI, 4-12 %) and women (95% CI, 5-11%). For urinary tract infections among men, as for septicaemia or bacteraemia and nervous system infections among women, the risk relation was restricted to persons aged 55-89 years. Nervous system infections were positively related to total cholesterol among women aged 25-54. In both genders, the significant inverse association with all infections persisted after excluding the first 5 years of follow-up. Collectively, these data are suggestive of an inverse association, although not entirely consistent, between total cholesterol and incidence of infections either requiring hospitalization or acquired in the hospital. Further research is needed to elucidate whether these associations are biologically plausible or represent uncontrolled confounding by unmeasured risk factors. PMID:9825784

  10. How does an open house benefit your organization?

    PubMed

    McBride, J

    1989-01-01

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

  11. Innovative technique for large septal perforation repair and radiological evaluation.

    PubMed

    Mocella, S; Muia, F; Giacomini, P G; Bertossi, D; Residori, E; Sgroi, S

    2013-06-01

    La perforazione del setto nasale ha cause molteplici: traumatiche, iatrogene, infettive, degenerative, da abuso di vasocostrittori, da uso di cocaina e di recente anche da chemioterapici antineoplastici. Le perforazioni sono altresì classificate in funzione delle dimensioni e della tipologia del deficit cartilagineo o osteocartilagineo e della sede anteriore, mediana e posteriore. Molteplici tecniche di riparazione chirurgica del danno sono state proposte nel tempo e vengono riassunte nel presente lavoro per tipologia di approccio; i risultati conseguiti, sono soddisfacenti per le perforazioni di piccole e medie dimensioni, ma nelle grandi perforazioni non garantiscono sempre la permanente obliterazione del difetto. Spesso si rende necessario l'utilizzo di tessuti prelevati all'interno delle fosse nasali come i turbinati o il prelievo di cartilagine da altre sedi donatrici come l'orecchio o la costa; le varie tecniche vengono illustrate alla luce della più recente letteratura. Gli Autori hanno valutato i pazienti osservati negli ultimi 8 anni e i risultati chirurgici conseguiti in particolare considerando, gli approcci chirurgici effettuati in approccio aperto o chiuso, endoscopico ed i materiali impiegati. Gli autori propongono tra le varie tecniche impiegate in questa serie di pazienti, una tecnica innovativa utilizzabile con successo in molti dei casi considerati di perforazione settale iatrogena che prevede l'utilizzo del gibbo osteocartilagineo quale sede donatrice, nonché la rinosettoplastica riduttiva quale scelta mirata per ottenere agevolmente lembi di scorrimento mucopericondrale e talora produrre anche un miglioramento estetico morfologico.

  12. Community relations 2.0.

    PubMed

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

    2009-11-01

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

  13. Looking at Graduate Medical Education Through a Different Lens: A Health Care System's Perspective.

    PubMed

    Roemer, Beth M; Azevedo, Theresa; Blumberg, Bruce

    2015-09-01

    In the era of the accountable care organization, U.S. models of physician practice are shifting from the solo, independent practitioner to the physician who is part of a multispecialty group practice or is employed by a health care institution, and from paper-based small offices to practice settings that emphasize technology-enabled, team-based systems of care. In this light, Kaiser Permanente's (KP's) long experience as an integrated, population-based health care delivery system makes it an increasingly relevant model in which to consider how graduate medical education (GME) can best prepare physicians for 21st-century health care. KP's multiple perspectives-as a GME setting, a health care delivery system, a health research enterprise, a community benefit organization, and the nation's largest private, multispecialty group practice of physicians-provide a multifaceted opportunity to consider GME in the context of health care transformation. The authors suggest that all participants in medical education have a role to play in preparing physicians for this future. They recommend that partnerships between universities and health care delivery systems serve as a highly effective model for education; that to better serve the needs of society, medical education institutions must adopt a broad community benefit mindset; and that, when medical groups and other institutions that employ physicians take the baton from GME, they need to commit to ongoing development and lifelong learning to enable their new physicians to reach their full potential.

  14. GENDER DIFFERENCES IN QUALITY OF LIFE AMONG LONG-TERM COLORECTAL CANCER SURVIVORS WITH OSTOMIES

    PubMed Central

    Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Mohler, M. Jane; Hornbrook, Mark C.; Herrinton, Lisa J.; Wendel, Christopher S.; Baldwin, Carol M.; Krouse, Robert S.

    2011-01-01

    Objective To describe how gender shapes the concerns and adaptations of long-term (> 5 years) colorectal cancer (CRC) survivors with ostomies. Design Qualitative study using content analysis of focus group content. Setting Member of Kaiser Permanente, residing in either Oregon, Southwest Washington State, or Northern California. Sample Four female and four male focus groups selected from quantitative survey participants with health-related quality of life (HRQOL) scores in the highest or lowest quartile. Methods Eight focus groups, discussed challenges of living with an ostomy. Content was recorded, transcribed, and analyzed using directive and summative content analysis. Main Research Variables HRQOL domains of physical, psychological, social and spiritual well being. Findings All groups reported avoiding foods that cause gas or rapid transit, and discussed how limiting the amount of food eaten controlled the output. All groups discussed physical activities, getting support from friends and family, and the importance of being resilient. Both genders identified challenges with sexuality/intimacy. Coping and adjustment difficulties were discussed by women with men only discussing these issues to a small extent. Difficulties with sleep were primarily identified by Low HRQOL women. Problems with body image and depression were discussed only by Low HRQOL women. Conclusions Common issues included diet management, physical activity, social support and sexuality. Women with low HRQOL discussed problems with depression, body image, and sleep. Implications for Nursing Application of these gender-based differences can inform educational interventions for CRC survivors with ostomies. PMID:21875846

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

    PubMed

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

    2014-01-01

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

  16. Human Papillomavirus Genotyping After Denaturation of Specimens for Hybrid Capture 2 Testing: Feasibility Study for the HPV Persistence and Progression Cohort†

    PubMed Central

    LaMere, Brandon J.; Kornegay, Janet; Fetterman, Barbara; Sadorra, Mark; Shieh, Jen; Castle, Philip E.

    2009-01-01

    Human papillomavirus (HPV) genotyping could be clinically useful, depending on the results of large, prospective studies like the HPV Persistence and Progression cohort. The cohort is based on genotyping and follow-up of Hybrid Capture-positive women at Kaiser Permanente, Northern California. HPV DNA testing by Hybrid Capture 2 requires denaturation with alkali, possibly damaging the DNA for optimal PCR-based genotyping. A feasibility study was conducted on paired aliquots of anonymized specimens from 100 women with low-grade intraepithelial lesion cytology. Test aliquots were left in denaturant for 10 or 18 hours at 4°C and then neutralized; comparison aliquots were not denatured but diluted to match the timing, temperature, concentration and salt conditions of the treated specimens. The masked aliquots were tested using a commercialized PCR-based assay that detects of 37 HPV genotypes. There was no overall effect of treatment on test positivity or number of types. HPV16 was marginally more likely to be detected in untreated versus treated aliquots (P = 0.09) but HPV45 was marginally more likely to be detected in treated than untreated aliquots (P = 0.07), suggesting that these differences represented chance (intra-test variability). It can be concluded that residual Hybrid Capture-positive specimens can be accurately genotyped by PCR after Hybrid Capture 2 processing. PMID:17673302

  17. A randomized trial to assess effectiveness and cost in clinical practice: rationale and design of the Cholesterol Reduction Intervention Study (CRIS).

    PubMed

    Oster, G; Borok, G M; Menzin, J; Heys, J F; Epstein, R S; Quinn, V; Benson, V V; Dudl, R J; Epstein, A

    1995-02-01

    To compare the effectiveness and costs of two alternative approaches to the treatment of hypercholesterolemia, a prospective randomized trial is being undertaken at Southern California Kaiser Permanente, a large health maintenance organization. Six hundred and twelve patients with postdiet LDL cholesterol (LDL-C) levels in the range of 190-230 mg/dl (or 160-230 mg/dl for those with coronary heart disease or two or more coronary risk factors) were randomized to a stepped-care regimen (initial treatment with niacin followed by other agents if needed) or to initial use of lovastatin, an HMG-CoA reductase inhibitor. All patients are being followed for 1 year. The study seeks to approximate conditions of typical clinical practice: provider compliance with these plans of treatment is encouraged but not enforced and patients pay for medication as they customarily would. Principal outcomes of interest include the proportion of participants who achieve goal LDL-C at one year, the mean change in total cholesterol and LDL-C levels between baseline and the end of follow-up, and the costs of cholesterol-lowering therapy.

  18. Update through 1985 on the incidence of toxic shock syndrome among members of a prepaid health plan.

    PubMed

    Petitti, D B; Reingold, A L

    1989-01-01

    Through hospital records of men and women aged 15-34 years who were members of the Northern California Kaiser-Permanente Medical Care Program, trends in the incidence of toxic shock syndrome (TSS) requiring hospitalization in 1984-1985 were examined, and the results were compared with those for the period 1972-1983. No definite or probable cases of TSS were found in men during either 1984 or 1985. A total of 16 cases of TSS (10 definite and six probable) were found in women in 1984-1985. Ten (71%) of 14 cases for which the menstrual status of the patient could be determined unambiguously from the medical record occurred during menstruation, and two of the four nonmenstrual cases occurred in postpartum women using barrier contraception. Of the 16 cases, 14 (88%) were diagnosed as TSS or probable TSS by the attending physician, although only nine (64%) of the 14 diagnosed cases were given the correct discharge code. While trends in the incidence of TSS requiring hospitalization in women 15-34 years of age generally paralleled changes in the absorbency of available tampons, the contribution of other factors (e.g., changes in the chemical composition of tampons, changes in patterns of tampon use) to these trends could not be assessed.

  19. NFP Investor Conference. Growth is back in sight.

    PubMed

    Haugh, Richard

    2002-06-01

    In a whirlwind of high-stakes meetings in New York City in mid-May, two dozen of the nation's largest hospitals and health systems strutted their stuff with a single goal: securing their future. Their message was clear: back-to-basics works, and now it's time to grow the business. Executives from 23 providers outlined their work on increasing revenue, boosting margins and shoring up balance sheets. They presented their market positions, strategic initiatives and financial results for investment analysts, credit raters and bond traders. The third annual Non-Profit Healthcare Investor Conference was co-sponsored by the American Hospital Association, Health Forum, the Healthcare Financial Management Association and Salomon Smith Barney. The focus on growth doesn't come without challenges Several common themes emerged from the presentations, among them pressure on reimbursement, workforce shortages, liability insurance issues and capacity constraints. Yet executives agree: it all comes down to the basics, and building the strength to keep their missions alive. As Thomas Meier, vice president and treasurer of Oakland, Calif.-based Kaiser Permanente, put it: "No margin, no mission, no más."

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

    PubMed Central

    Krall, Michael; Gerace, Alexander

    2015-01-01

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

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

    PubMed Central

    Schiøtz, Michaela; Frølich, Anne; Krasnik, Allan; Taylor, Warren; Hsu, John

    2012-01-01

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

  2. Prevalence of childhood and adolescent overweight and obesity from 2003 to 2010 in an integrated health care delivery system.

    PubMed

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

    2013-01-01

    An observational study of the Kaiser Permanente Northern California (KPNC) BMI coding distributions was conducted to ascertain the trends in overweight and obesity prevalence among KPNC members aged 2-19 between the periods of 2003-2005 and 2009-2010. A decrease in the prevalence of overweight (-11.1% change) and obesity (-3.6% change) and an increase in the prevalence of healthy weight (+2.7% change) were demonstrated. Children aged 2-5 had the greatest improvement in obesity prevalence (-11.5% change). Adolescents aged 12-19 were the only age group to not show a decrease in obesity prevalence. Of the racial and ethnic groups, Hispanics/Latinos had the highest prevalence of obesity across all age groups. The KPNC prevalence of overweight and obesity compares favorably to external benchmarks, although differences in methodologies limit our ability to draw conclusions. Physician counseling as well as weight management programs and sociodemographic factors may have contributed to the overall improvements in BMI in the KPNC population. Physician training, practice tools, automated BMI reminders and performance feedback improved the frequency and quality of physician counseling. BMI screening and counseling at urgent visits, in addition to well-child care visits, increased the reach and dose of physician counseling.

  3. Can health care teams improve primary care practice?

    PubMed

    Grumbach, Kevin; Bodenheimer, Thomas

    2004-03-10

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

  4. Oral bisphosphonates and colorectal cancer.

    PubMed

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

    2017-03-10

    Use of oral bisphosphonates has been associated with a decreased risk of colorectal cancer (CRC), but the association may be related to residual confounding by healthy lifestyle or body mass index (BMI). Therefore, we conducted a prospective nested case-control study within the Kaiser Permanente, Northern California health system cohort. In total, 12,505 CRC cases were individually matched to 599,534 controls. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression models with adjustment for important covariates extracted from the database. Participants who had ever used oral bisphosphonates were less likely than non-users to be diagnosed with CRC (OR 0.82; 95% CI: 0.74, 0.89). Colon and rectum site-specific associations were similar to the overall association. A stronger inverse association for ever use of bisphosphonates was observed for men (OR 0.63; 95% CI: 0.47, 0.85), however when stratified by previous lower endoscopy, the association was only observed in the participants who did not have a previous lower endoscopy (OR 0.73 (0.64, 0.83)). In conclusion, we found that oral bisphosphonate use was associated with a decreased odds of CRC, however this association may be due to residual confounding by BMI or another confounder.

  5. Incidence of herpes zoster, 1997-2002.

    PubMed Central

    Mullooly, J. P.; Riedlinger, K.; Chun, C.; Weinmann, S.; Houston, H.

    2005-01-01

    We estimated age-specific herpes zoster (HZ) incidence rates in the Kaiser Permanente Northwest Health Plan (KPNW) during 1997-2002 and tested for secular trends and differences between residents of two states with different varicella vaccine coverage rates. The cumulative proportions of 2-year-olds vaccinated increased from 35% in 1997 to 85% in 2002 in Oregon, and from 25% in 1997 to 82% in 2002 in Washington. Age-specific HZ incidence rates in KPNW during 1997-2002 were compared with published rates in the Harvard Community Health Plan (HCHP) during 1990-1992. The overall HZ incidence rate in KPNW during 1997-2002 (369/100,000 person-years) was slightly higher than HCHP's 1990-1992 rate when adjusted for age differences. For children 6-14 years old, KPNW's rates (182 for females, 123 for males) were more than three times HCHP's rates (54 for females, 39 for males). This increase appears to be associated with increased exposure of children to oral corticosteroids. The percentage of KPNW children exposed to oral corticosteroids increased from 2.2% in 1991 to 3.6% in 2002. Oregon residents had slightly higher steroid exposure rates during 1997-2002 than Washington residents. There were significant increases in HZ incidence rates in Oregon and Washington during 1997-2002 among children aged 10-17 years, associated with increased exposure to oral steroids. PMID:15816149

  6. Socioeconomic status, race, and COPD health outcomes

    PubMed Central

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

    2010-01-01

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

  7. Genome-wide association study of prostate-specific antigen levels identifies novel loci independent of prostate cancer

    PubMed Central

    Hoffmann, Thomas J.; Passarelli, Michael N.; Graff, Rebecca E.; Emami, Nima C.; Sakoda, Lori C.; Jorgenson, Eric; Habel, Laurel A.; Shan, Jun; Ranatunga, Dilrini K.; Quesenberry, Charles P.; Chao, Chun R.; Ghai, Nirupa R.; Aaronson, David; Presti, Joseph; Nordström, Tobias; Wang, Zhaoming; Berndt, Sonja I.; Chanock, Stephen J.; Mosley, Jonathan D.; Klein, Robert J.; Middha, Mridu; Lilja, Hans; Melander, Olle; Kvale, Mark N.; Kwok, Pui-Yan; Schaefer, Catherine; Risch, Neil; Van Den Eeden, Stephen K.; Witte, John S.

    2017-01-01

    Prostate-specific antigen (PSA) levels have been used for detection and surveillance of prostate cancer (PCa). However, factors other than PCa—such as genetics—can impact PSA. Here we present findings from a genome-wide association study (GWAS) of PSA in 28,503 Kaiser Permanente whites and 17,428 men from replication cohorts. We detect 40 genome-wide significant (P<5 × 10−8) single-nucleotide polymorphisms (SNPs): 19 novel, 15 previously identified for PSA (14 of which were also PCa-associated), and 6 previously identified for PCa only. Further analysis incorporating PCa cases suggests that at least half of the 40 SNPs are PSA-associated independent of PCa. The 40 SNPs explain 9.5% of PSA variation in non-Hispanic whites, and the remaining GWAS SNPs explain an additional 31.7%; this percentage is higher in younger men, supporting the genetic basis of PSA levels. These findings provide important information about genetic markers for PSA that may improve PCa screening, thereby reducing over-diagnosis and over-treatment. PMID:28139693

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

    PubMed

    Ryder, R E J

    2015-03-01

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

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

    PubMed

    Delbanco, Suzanne F

    2004-01-01

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

  10. Physicians’ Perceptions of Volunteer Service at Safety-Net Clinics

    PubMed Central

    McGeehan, Laura; Takehara, Michael A; Daroszewski, Ellen

    2017-01-01

    Background: Volunteer physicians are crucial for the operation of safety-net clinics, which provide medical care for uninsured and underinsured populations. Thus, identifying ways to maximize the number of physicians volunteering at such clinics is an important goal. Objective: To investigate the perceptions, motivations, functions, and barriers associated with physician volunteering in four safety-net clinics in San Bernardino County, Southern California, a location of great medical need with many barriers to care. Methods: The study participants are physicians belonging to the Southern California Permanente Medical Group who use a combination of discretionary time (during regular work hours) and personal time in evening and weekend hours to volunteer their services. The experimental design incorporates a mixed methodology: an online survey of 31 physicians and follow-up interviews with 8 of them. Results: Physicians conveyed uniformly positive perceptions of their volunteer service, and most were motivated by humanitarian or prosocial desires. Volunteering also provided a protective “escape hatch” from the pressures of the physicians’ regular jobs. Physicians cited few challenges to volunteering. The most common personal barrier was a lack of time. The most common professional barriers were organizational and supply issues at the clinic, along with the patients’ social, transportation, and financial challenges. Conclusion: The results suggest that appealing to physicians’ values and faith, and highlighting the burnout-prevention qualities of volunteering, may be key to recruitment and retention of volunteer physicians who serve underserved and underinsured populations in community clinics. PMID:28241907

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

    PubMed

    Ravanbakhsh, Samine; Batech, Michael; Tejirian, Talar

    2015-10-01

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

  12. Etude par resistivite electrique du comportement d'un alliage amorphe Fe 40Ni 38Mo 4B 18 deforme par traction

    NASA Astrophysics Data System (ADS)

    Hoang, Long Phan; Sacovy, Paulette; Delaplace, Jean

    1983-02-01

    Des rubans d'alliages amorphes Metglas du type Fe 40Ni 38Mo 4B 18 à l'état brut de trempe ont été déformés par traction à la température ambiante et l'on a suivi les variations de la résistance électrique des échantillons au cours de la déformation. Il ressort de ces essais que la déformation plastique qui est de l'ordre de 0.5% avant rupture ne se produit pas de faĉon homogène dans l'échantillon. Les mesures électriques effectuées au cours de la déformation mettent en évidence dans le domaine élastique un effet d'élastorésistance, relativement important ( K ≠ 1); elles montrent que dans le domaine plastique la déformation permanente des échantillons s'accompagne d'une diminution de la résistivité électrique du matériau. Deux hypothèses sont discutées pour expliquer cet effet inattendu, l'un qui fait appel à l'existence de volumes libres, l'autre qui suppose une cristallisation localisée du matériau sous l'effet de la contrainte.

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

    PubMed Central

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

    2013-01-01

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

  14. Oral bisphosphonates and colorectal cancer

    PubMed Central

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

    2017-01-01

    Use of oral bisphosphonates has been associated with a decreased risk of colorectal cancer (CRC), but the association may be related to residual confounding by healthy lifestyle or body mass index (BMI). Therefore, we conducted a prospective nested case-control study within the Kaiser Permanente, Northern California health system cohort. In total, 12,505 CRC cases were individually matched to 599,534 controls. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression models with adjustment for important covariates extracted from the database. Participants who had ever used oral bisphosphonates were less likely than non-users to be diagnosed with CRC (OR 0.82; 95% CI: 0.74, 0.89). Colon and rectum site-specific associations were similar to the overall association. A stronger inverse association for ever use of bisphosphonates was observed for men (OR 0.63; 95% CI: 0.47, 0.85), however when stratified by previous lower endoscopy, the association was only observed in the participants who did not have a previous lower endoscopy (OR 0.73 (0.64, 0.83)). In conclusion, we found that oral bisphosphonate use was associated with a decreased odds of CRC, however this association may be due to residual confounding by BMI or another confounder. PMID:28281559

  15. Are HMO enrollees being attracted by a liberal maternity benefit?

    PubMed

    Hudes, J; Young, C A; Sohrab, L; Trinh, C N

    1980-06-01

    A study of recent birth patterns in the Southern California Region of the Kaiser-Permanente Medical Care Program (KPMCP) suggests that individuals may have been attracted to the Program by a liberal maternity benefit. The attraction is reflected in both the type of members joining KPMCP and the birth rate of those members. Although the KPMCP birth rate has been below that of the general population, new members in their first year of coverage delivered approximatey one third of all KPMCP births in 1977, twice the number of births that would be anticipated from an equal number of members in the plan for one year or more. The maternity copayment of up to $350 did not deter women already pregnant from joining KPMCP. Termination rates for new members who gave birth, however, were no higher than expected. The Pregnancy Disability Amendment of Title VII of the Civil Rights Act of 1964, which became effective April 29, 1979, may alter the maternity benefits offered by alternative insurance carriers. The law could impact KPMCP's enrollment and utilization of obstetric services.

  16. The response of the US Centers for Disease Control and Prevention to the obesity epidemic.

    PubMed

    Dietz, William H

    2015-03-18

    The recognition of the obesity epidemic as a national problem began in 1999 with the Centers for Disease Control and Prevention's (CDC's) publication of a series of annual state-based maps that demonstrated the rapid changes in the prevalence of obesity. Increasing rates of obesity had been noted in earlier CDC studies, but the maps provided evidence of a rapid, nationwide increase. The urgent need to respond to the epidemic led to the identification of state targets and the first generation of interventions for obesity prevention and control. The CDC's role was to provide setting- and intervention-specific guidance on implementing these strategies, and to assess changes in targeted policies and behaviors. The CDC's efforts were augmented by Congressional funding for community initiatives to improve nutrition and increase physical activity. Complementary investments by Kaiser Permanente, the Robert Wood Johnson Foundation, and the Institute of Medicine improved the evidence base and provided policy recommendations that reinforced the need for a multisectoral approach. Legislative, regulatory, and voluntary initiatives enacted by President Obama's administration translated many of the strategies into effective practice. Whether current efforts to address obesity can be sustained will depend on whether they can be translated into greater grass-roots engagement consistent with a social movement.

  17. Genital herpes and its treatment in relation to preterm delivery.

    PubMed

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

    2014-12-01

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

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

    PubMed

    Jacobs, Lee

    2009-01-01

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

  19. History of chronic comorbidity and risk of chemotherapy-induced febrile neutropenia in patients with non-Hodgkin lymphoma not receiving granulocyte colony-stimulating factor prophylaxis.

    PubMed

    Chao, Chun; Rodriguez, Roberto; Page, John H; Yang, Su-Jau; Huynh, Julie; Chia, Victoria M

    2015-01-01

    We conducted a cohort study to examine the association between a wide variety of chronic comorbidities and risk of febrile neutropenia (FN) in patients with non-Hodgkin lymphoma (NHL) from 2000 to 2009 treated with chemotherapy at Kaiser Permanente Southern California. History of comorbidities and FN events were identified using electronic medical records. Cox model adjusting for propensity score was used to determine the association between a comorbid condition and FN. Models that additionally adjusted for cancer stage, baseline absolute neutrophil count, chemotherapy regimen and dose reduction were also evaluated. A total of 2480 patients with NHL were included, and 60% received CHOP/R-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone, with or without rituximab). In total, 236 (9.5%) patients developed FN in the first chemotherapy cycle. Anemia (adjusted hazard ratio [HR] = 1.6, 95% confidence interval [1.2-2.2]), HIV infection (HR = 3.8 [2.0-6.7]) and rheumatoid diseases (HR = 2.4 [1.3-4.0]) were associated with significantly increased risk of FN. These results provide evidence that chronic comorbidity increases the risk of FN.

  20. Kooperative Automation

    NASA Astrophysics Data System (ADS)

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

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

  1. Exploring the Feasibility of Using Electronic Health Records in the Surveillance of Fetal Alcohol Syndrome

    PubMed Central

    Hansen, Craig; Adams, Marvin; Fox, Deborah J.; O'Leary, Leslie A.; Frías, Jaime L.; Freiman, Heather; Meaney, F. John

    2015-01-01

    Background Explore the use of electronic health records (EHRs) in fetal alcohol syndrome (FAS) surveillance systems. Methods Using EHRs we identified diagnoses and anthropometric measurements related to the FAS criteria developed by the Fetal Alcohol Syndrome Surveillance Network (FASSNet) among children aged 0 to 12 years. Results There were 143,393 distinct children aged between 0 and 12 years enrolled in Kaiser Permanente, Georgia, during the study period. Based on diagnoses and anthropometric measurements, 20,101 children met at least one criterion of interest, and when grouped into combinations of different criteria there were 2285 who met GROWTH+CNS criteria, 76 children who met GROWTH+FACE criteria, 107 children who met CNS+FACE criteria, and 93 children who met GROWTH+CNS+FACE criteria. The prevalence of FAS as defined by FASSNet is 1.92 per 1000 children. We linked 17,084 (85.0%) children to their mothers in the health plan; only 3% of mothers of children in the GROWTH+CNS+ FACE group had an indication of alcohol or drugs use, but they had the highest rate of depression (39%). Conclusion Data of utility in identification of FAS are readily available in EHRs and may serve as a basis for intervention with at-risk children and in planning of future FAS surveillance programs. PMID:24591358

  2. Applications of machine learning and data mining methods to detect associations of rare and common variants with complex traits.

    PubMed

    Lu, Ake Tzu-Hui; Austin, Erin; Bonner, Ashley; Huang, Hsin-Hsiung; Cantor, Rita M

    2014-09-01

    Machine learning methods (MLMs), designed to develop models using high-dimensional predictors, have been used to analyze genome-wide genetic and genomic data to predict risks for complex traits. We summarize the results from six contributions to our Genetic Analysis Workshop 18 working group; these investigators applied MLMs and data mining to analyses of rare and common genetic variants measured in pedigrees. To develop risk profiles, group members analyzed blood pressure traits along with single-nucleotide polymorphisms and rare variant genotypes derived from sequence and imputation analyses in large Mexican American pedigrees. Supervised MLMs included penalized regression with varying penalties, support vector machines, and permanental classification. Unsupervised MLMs included sparse principal components analysis and sparse graphical models. Entropy-based components analyses were also used to mine these data. None of the investigators fully capitalized on the genetic information provided by the complete pedigrees. Their approaches either corrected for the nonindependence of the individuals within the pedigrees or analyzed only those who were independent. Some methods allowed for covariate adjustment, whereas others did not. We evaluated these methods using a variety of metrics. Four contributors conducted primary analyses on the real data, and the other two research groups used the simulated data with and without knowledge of the underlying simulation model. One group used the answers to the simulated data to assess power and type I errors. Although the MLMs applied were substantially different, each research group concluded that MLMs have advantages over standard statistical approaches with these high-dimensional data.

  3. Vision and Creation of the American Heart Association Pharmaceutical Roundtable Outcomes Research Centers

    PubMed Central

    Peterson, Eric D.; Spertus, John A.; Cohen, David J.; Hlatky, Mark A.; Go, Alan S.; Vickrey, Barbara G.; Saver, Jeffrey L.; Hinton, Patricia C.

    2015-01-01

    Background The field of outcomes research seeks to define optimal treatment in practice and to promote the rapid, full adoption of efficacious therapies into routine clinical care. The American Heart Association (AHA) formed the AHA Pharmaceutical Roundtable (PRT) Outcomes Research Centers Network to accelerate attainment of these goals. Participating centers were intended to carry out state-of-the-art outcomes research in cardiovascular disease (CVD) and stroke, to train the next generation of investigators, and to support the formation of a collaborative research network. Program After a competitive application process, four AHA PRT Outcomes Research Centers were selected: Duke Clinical Research Institute; Saint Luke’s Mid America Heart Institute; Stanford University-Kaiser Permanente of Northern California; and University of California, Los Angeles. Each center proposed between one and three projects organized around a single theme in CVD or stroke. Additionally, each center will select and train up to six post-doctoral fellows over the next four years, and will participate in cross-collaborative activities among the centers. Conclusions The AHA PRT Outcomes Research Centers Network is designed to further strengthen the field of CVD and stroke outcomes research by fostering innovative research, supporting high quality training, and encouraging center-to-center collaborations. PMID:20031906

  4. Police-Recorded Crime and Perceived Stress among Patients with Type 2 Diabetes: the Diabetes Study of Northern California (DISTANCE).

    PubMed

    Tamayo, Aracely; Mujahid, Mahasin S; Laraia, Barbara; Warton, E Margaret; Blanchard, Samuel D; Kelly, Maggi; Moffet, Howard H; Adler, Nancy; Schillinger, Dean; Karter, Andrew J

    2016-10-01

    While stress has been linked to poor health outcomes, little is known about the impact of objective measures of neighborhood crime on stress in patients with chronic disease. Using the Kaiser Permanente Diabetes Study of Northern California (DISTANCE), we examined associations between police-recorded crime (2005-2007) and stress (Perceived Stress Scale-4) in four large Northern California cities (Oakland, Sacramento, San Francisco, and San Jose). We performed stratified analysis by gender and race/ethnicity using generalized linear regression models. In our study sample (n = 3188, mean age 59, range 30-77), 10 % reported high stress. In adjusted analyses, higher neighborhood all crimes rate was associated with modest increase in high stress for African-American (OR = 1.10; 95 % CI 1.02-1.22) and Latina women (OR = 1.36; 95 % CI 1.10-1.67) and property crime showed similar associations with stress for these groups of women. Visible crime was associated with stress only for Latina women (OR = 1.43; 95 % CI 1.14-1.78). We found no association between crime and stress among men or other racial/ethnic groups of women. High crime levels may disproportionately impact health among certain subpopulations. Studies using additional measures of stress are necessary to differentiate the health impact of crime-related stress from other forms of stressors among individuals living with diabetes.

  5. Can We Predict Individual Combined Benefit and Harm of Therapy? Warfarin Therapy for Atrial Fibrillation as a Test Case

    PubMed Central

    Li, Guowei; Thabane, Lehana; Delate, Thomas; Witt, Daniel M.; Levine, Mitchell A. H.; Cheng, Ji; Holbrook, Anne

    2016-01-01

    Objectives To construct and validate a prediction model for individual combined benefit and harm outcomes (stroke with no major bleeding, major bleeding with no stroke, neither event, or both) in patients with atrial fibrillation (AF) with and without warfarin therapy. Methods Using the Kaiser Permanente Colorado databases, we included patients newly diagnosed with AF between January 1, 2005 and December 31, 2012 for model construction and validation. The primary outcome was a prediction model of composite of stroke or major bleeding using polytomous logistic regression (PLR) modelling. The secondary outcome was a prediction model of all-cause mortality using the Cox regression modelling. Results We included 9074 patients with 4537 and 4537 warfarin users and non-users, respectively. In the derivation cohort (n = 4632), there were 136 strokes (2.94%), 280 major bleedings (6.04%) and 1194 deaths (25.78%) occurred. In the prediction models, warfarin use was not significantly associated with risk of stroke, but increased the risk of major bleeding and decreased the risk of death. Both the PLR and Cox models were robust, internally and externally validated, and with acceptable model performances. Conclusions In this study, we introduce a new methodology for predicting individual combined benefit and harm outcomes associated with warfarin therapy for patients with AF. Should this approach be validated in other patient populations, it has potential advantages over existing risk stratification approaches as a patient-physician aid for shared decision-making PMID:27513986

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

    PubMed

    Kahn, Noah

    2009-01-01

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

  7. La guerra de los Estados Unidos contra la inmigración. Efectos paradójicos1

    PubMed Central

    Massey, Douglas S.; Pren, Karen A.

    2016-01-01

    Resumen A finales de la década de los cincuenta, Estados Unidos permitía la entrada de aproximadamente medio millón de inmigrantes mexicanos al año, de los cuales 450.000 entraban con visados de trabajo temporal y 50.000 llegaban con visados de residentes permanentes. A mediados de los años sesenta, los cambios en la política migratoria de Estados Unidos realizados en nombre de los derechos civiles redujeron drásticamente las oportunidades de entrada legal a Estados Unidos. Se eliminaron los visados de trabajo temporal y se limitaron los visados de residentes a 20.000 por año. Con las oportunidades de entrada legal restringidas, los flujos migratorios ya establecidos simplemente continuaron, fuera de los límites legales, dando comienzo a una inesperada reacción en cadena de eventos que culminaron en una guerra total contra los inmigrantes y el rápido crecimiento -sin precedentes- de población residente no autorizada en Estados Unidos. El presente artículo demuestra que el aumento de inmigración indocumentada en los Estados Unidos y el crecimiento de la población sin papeles son un producto de políticas migratorias y fronterizas mal concebidas. PMID:27076695

  8. Helenistic Encomium: A Reflection on Comics and Rhetoric

    ERIC Educational Resources Information Center

    Helms, Jason

    2009-01-01

    This video reflection starts in a presentation on comics at the Thomas R. Watson Conference last October, which prompted the author to explore the etymology of cosmos and comos through an alternate reading of Gorgias' "Encomium of Helen". The author then works with comos, as revelry, to offer thoughts on comics as a form of multimodal composition…

  9. Street Gangs: The New Urban Insurgency

    DTIC Science & Technology

    2005-03-01

    Caribbean: Sovereignty Under Siege, University Park, PA: Pennsylvania State University Press, 1997; and “El delito como una amenaza geopolítica,” in...Social & Economic Studies, March 2004, pp. 1-33; and “El delito como una amenaza geopolítica,” Clarin.com, 3 de Julio de 2003. Also see Max G

  10. 25. Photographic copy of photograph (Source: Department of Interior. Bureau ...

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

    25. Photographic copy of photograph (Source: Department of Interior. Bureau of Reclamation. Bitter Root Project History 1931-1962. National Archives, Denver, RG 115, Accession #115-90-039, Box 243. Location of original photo unknown.) View of original construction of Como Dam during 1908 to 1910 - Bitter Root Irrigation Project, Como Dam, West of U.S. Highway 93, Darby, Ravalli County, MT

  11. Dicloruro de paraquat

    EPA Pesticide Factsheets

    El dicloruro de paraquat, comúnmente conocido como “paraquat,” es uno de los herbicidas registrados de mayor uso en los Estados Unidos. El paraquat también se conoce como Gramaxone (un producto popular de uso final

  12. Depressive symptoms and adherence to cardiometabolic therapies across phases of treatment among adults with diabetes: the Diabetes Study of Northern California (DISTANCE)

    PubMed Central

    Bauer, Amy M; Parker, Melissa M; Moffet, Howard H; Schillinger, Dean; Adler, Nancy E; Adams, Alyce S; Schmittdiel, Julie A; Katon, Wayne J; Karter, Andrew J

    2017-01-01

    Objective Among adults with diabetes, depression is associated with poorer adherence to cardiometabolic medications in ongoing users; however, it is unknown whether this extends to early adherence among patients newly prescribed these medications. This study examined whether depressive symptoms among adults with diabetes newly prescribed cardiometabolic medications are associated with early and long-term nonadherence. Patients and methods An observational follow-up of 4,018 adults with type 2 diabetes who completed a survey in 2006 and were newly prescribed oral antihyperglycemic, antihypertensive, or lipid-lowering agents within the following year at Kaiser Permanente Northern California was conducted. Depressive symptoms were examined based on Patient Health Questionnaire-8 scores. Pharmacy utilization data were used to identify nonadherence by using validated methods: early nonadherence (medication never dispensed or dispensed once and never refilled) and long-term nonadherence (new prescription medication gap [NPMG]: percentage of time without medication supply). These analyses were conducted in 2016. Results Patients with moderate-to-severe depressive symptoms had poorer adherence than nondepressed patients (8.3% more patients with early nonadherence, P=0.01; 4.9% patients with longer NPMG, P=0.002; 7.8% more patients with overall nonadherence [medication gap >20%], P=0.03). After adjustment for confounders, the models remained statistically significant for new NPMG (3.7% difference, P=0.02). There was a graded association between greater depression severity and nonadherence for all the models (test of trend, P<0.05). Conclusion Depressive symptoms were associated with modest differences in early and long-term adherence to newly prescribed cardiometabolic medications in diabetes patients. Interventions targeting adherence among adults with diabetes and depression need to address both initiation and maintenance of medication use. PMID:28392679

  13. Genotyping Informatics and Quality Control for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort.

    PubMed

    Kvale, Mark N; Hesselson, Stephanie; Hoffmann, Thomas J; Cao, Yang; Chan, David; Connell, Sheryl; Croen, Lisa A; Dispensa, Brad P; Eshragh, Jasmin; Finn, Andrea; Gollub, Jeremy; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H; Lao, Richard; Lu, Yontao; Ludwig, Dana; Mathauda, Gurpreet K; McGuire, William B; Mei, Gangwu; Miles, Sunita; Mittman, Michael; Patil, Mohini; Quesenberry, Charles P; Ranatunga, Dilrini; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C; Shapero, Michael; Shen, Ling; Shenoy, Tanu; Smethurst, David; Somkin, Carol P; Van Den Eeden, Stephen K; Walter, Lawrence; Wan, Eunice; Webster, Teresa; Whitmer, Rachel A; Wong, Simon; Zau, Chia; Zhan, Yiping; Schaefer, Catherine; Kwok, Pui-Yan; Risch, Neil

    2015-08-01

    The Kaiser Permanente (KP) Research Program on Genes, Environment and Health (RPGEH), in collaboration with the University of California-San Francisco, undertook genome-wide genotyping of >100,000 subjects that constitute the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. The project, which generated >70 billion genotypes, represents the first large-scale use of the Affymetrix Axiom Genotyping Solution. Because genotyping took place over a short 14-month period, creating a near-real-time analysis pipeline for experimental assay quality control and final optimized analyses was critical. Because of the multi-ethnic nature of the cohort, four different ethnic-specific arrays were employed to enhance genome-wide coverage. All assays were performed on DNA extracted from saliva samples. To improve sample call rates and significantly increase genotype concordance, we partitioned the cohort into disjoint packages of plates with similar assay contexts. Using strict QC criteria, the overall genotyping success rate was 103,067 of 109,837 samples assayed (93.8%), with a range of 92.1-95.4% for the four different arrays. Similarly, the SNP genotyping success rate ranged from 98.1 to 99.4% across the four arrays, the variation depending mostly on how many SNPs were included as single copy vs. double copy on a particular array. The high quality and large scale of genotype data created on this cohort, in conjunction with comprehensive longitudinal data from the KP electronic health records of participants, will enable a broad range of highly powered genome-wide association studies on a diversity of traits and conditions.

  14. Automated Assay of Telomere Length Measurement and Informatics for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort.

    PubMed

    Lapham, Kyle; Kvale, Mark N; Lin, Jue; Connell, Sheryl; Croen, Lisa A; Dispensa, Brad P; Fang, Lynn; Hesselson, Stephanie; Hoffmann, Thomas J; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H; Ludwig, Dana; Matsuguchi, Tetsuya; McGuire, William B; Miles, Sunita; Quesenberry, Charles P; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C; Smethurst, David; Somkin, Carol P; Van Den Eeden, Stephen K; Walter, Lawrence; Whitmer, Rachel A; Kwok, Pui-Yan; Risch, Neil; Schaefer, Catherine; Blackburn, Elizabeth H

    2015-08-01

    The Kaiser Permanente Research Program on Genes, Environment, and Health (RPGEH) Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort includes DNA specimens extracted from saliva samples of 110,266 individuals. Because of its relationship to aging, telomere length measurement was considered an important biomarker to develop on these subjects. To assay relative telomere length (TL) on this large cohort over a short time period, we created a novel high throughput robotic system for TL analysis and informatics. Samples were run in triplicate, along with control samples, in a randomized design. As part of quality control, we determined the within-sample variability and employed thresholds for the elimination of outlying measurements. Of 106,902 samples assayed, 105,539 (98.7%) passed all quality control (QC) measures. As expected, TL in general showed a decline with age and a sex difference. While telomeres showed a negative correlation with age up to 75 years, in those older than 75 years, age positively correlated with longer telomeres, indicative of an association of longer telomeres with more years of survival in those older than 75. Furthermore, while females in general had longer telomeres than males, this difference was significant only for those older than age 50. An additional novel finding was that the variance of TL between individuals increased with age. This study establishes reliable assay and analysis methodologies for measurement of TL in large, population-based human studies. The GERA cohort represents the largest currently available such resource, linked to comprehensive electronic health and genotype data for analysis.

  15. A Community-Based Hip Fracture Registry: Population, Methods, and Outcomes

    PubMed Central

    Inacio, Maria C S; Weiss, Jennifer M; Miric, Alex; Hunt, Jessica J; Zohman, Gary L; Paxton, Elizabeth W

    2015-01-01

    Introduction: Hip fracture is associated with substantial morbidity and mortality. A large integrated health care system developed a registry to characterize its current patient population with hip fractures. This report describes the population, methods used, and outcomes of patients registered during the initial three years (2009–2011). Methods: Cases of hip fracture recorded from January 2009 through December 2011 were ascertained using the Kaiser Permanente Hip Fracture Registry. The registry collects information on patient, procedure, surgeon, facility, and surgical outcomes. Outcomes monitored included length of stay, readmissions, mortality, revisions, surgical site infections, deep vein thrombosis, pulmonary embolism, pneumonia, pressure ulcers, dislocations, and myocardial infarction. Results: The population (N = 12,562) was predominantly white (77.8%), women (68.6%), and older (71.6% aged ≥ 75 years), and 32% had at least 5 comorbidities. The average length of follow-up was 1.1 years (standard deviation = 0.9). The most prevalent comorbidities were hypertension (70.8%) and anemia (29.4%). Femoral neck fractures (54.6%) were the most common fracture type. Hemiarthroplasty was the most common procedure (33.1%). Most fractures were treated by medium-volume (10 to 29 cases per year) surgeons (68.4%) at high-volume (≥ 130 cases per year) facilities (63.0%). The 90-day readmission rate was 22.1%, and the mortality rate was 12.3%. The most common postoperative complications were pneumonia (11.4%) and pressure ulcers (2.9%). There were 2.2 revisions per 100 observation years. Conclusion: A hip fracture registry provides important information regarding patient characteristics, intraoperative practices, and postoperative outcomes, which can be analyzed, interpreted, and used to reduce morbidity and mortality. PMID:26057682

  16. Lactation Intensity and Postpartum Maternal Glucose Tolerance and Insulin Resistance in Women With Recent GDM

    PubMed Central

    Gunderson, Erica P.; Hedderson, Monique M.; Chiang, Vicky; Crites, Yvonne; Walton, David; Azevedo, Robert A.; Fox, Gary; Elmasian, Cathie; Young, Stephen; Salvador, Nora; Lum, Michael; Quesenberry, Charles P.; Lo, Joan C.; Sternfeld, Barbara; Ferrara, Assiamira; Selby, Joseph V.

    2012-01-01

    OBJECTIVE To examine the association between breastfeeding intensity in relation to maternal blood glucose and insulin and glucose intolerance based on the postpartum 2-h 75-g oral glucose tolerance test (OGTT) results at 6–9 weeks after a pregnancy with gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS We selected 522 participants enrolled into the Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT), a prospective observational cohort study of Kaiser Permanente Northern California members diagnosed with GDM using the 3-h 100-g OGTT by the Carpenter and Coustan criteria. Women were classified as normal, prediabetes, or diabetes according to American Diabetes Association criteria based on the postpartum 2-h 75-g OGTT results. RESULTS Compared with exclusive or mostly formula feeding (>17 oz formula per 24 h), exclusive breastfeeding and mostly breastfeeding (≤6 oz formula per 24 h) groups, respectively, had lower adjusted mean (95% CI) group differences in fasting plasma glucose (mg/dL) of −4.3 (−7.4 to −1.3) and −5.0 (−8.5 to −1.4), in fasting insulin (μU/mL) of −6.3 (−10.1 to −2.4) and −7.5 (−11.9 to −3.0), and in 2-h insulin of −21.4 (−41.0 to −1.7) and −36.5 (−59.3 to −13.7) (all P < 0.05). Exclusive or mostly breastfeeding groups had lower prevalence of diabetes or prediabetes (P = 0.02). CONCLUSIONS Higher intensity of lactation was associated with improved fasting glucose and lower insulin levels at 6–9 weeks’ postpartum. Lactation may have favorable effects on glucose metabolism and insulin sensitivity that may reduce diabetes risk after GDM pregnancy. PMID:22011407

  17. Accreditation Council for Graduate Medical Education Core Competencies at a Community Teaching Hospital: Is There a Gap in Awareness?

    PubMed Central

    Al-Temimi, Mohammed; Kidon, Michael; Johna, Samir

    2016-01-01

    Context Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in community hospitals without a dedicated residency program are uncommon. Objective Faculty evaluation regarding knowledge of ACGME core competencies before a residency program is started. Design Physicians at the Kaiser Permanente Fontana Medical Center (N = 480) were surveyed for their knowledge of ACGME core competencies before starting new residency programs. Main Outcome Measures Knowledge of ACGME core competencies. Results Fifty percent of physicians responded to the survey, and 172 (71%) of respondents were involved in teaching residents. Of physicians who taught residents and had complete responses (N = 164), 65 (39.7%) were unsure of their knowledge of the core competencies. However, most stated that they provided direct teaching to residents related to the knowledge, skills, and attitudes stated in each of the 6 competencies as follows: medical knowledge (96.3%), patient care (95.7%), professionalism (90.7%), interpersonal and communication skills (86.3%), practice-based learning (85.9%), and system-based practice (79.6%). Physician specialty, years in practice (1–10 vs > 10), and number of rotations taught per year (1–6 vs 7–12) were not associated with knowledge of the competencies (p > 0.05); however, full-time faculty (teaching 10–12 rotations per year) were more likely to provide competency-based teaching. Conclusion Objective assessment of faculty awareness of ACGME core competencies is essential when starting a residency program. Discrepancy between knowledge of the competencies and acclaimed provision of competency-based teaching emphasizes the need for standardized teaching methods that incorporate the values of these competencies. PMID:27768565

  18. Invasive Pneumococcal Disease Among HIV-Infected and HIV-Uninfected Adults in a Large Integrated Healthcare System.

    PubMed

    Marcus, Julia L; Baxter, Roger; Leyden, Wendy A; Muthulingam, Dharushana; Yee, Arnold; Horberg, Michael A; Klein, Daniel B; Towner, William J; Chao, Chun R; Quesenberry, Charles P; Silverberg, Michael J

    2016-10-01

    It is unclear whether HIV-infected individuals remain at higher risk of invasive pneumococcal disease (IPD) compared with HIV-uninfected individuals. We conducted a cohort study of HIV-infected and demographically matched HIV-uninfected adults within Kaiser Permanente Northern California during the period 1996-2011. We used Poisson models to obtain rate ratios (RRs) for incident IPD associated with HIV infection and other risk factors. Among 13,079 HIV-infected and 137,643 HIV-uninfected adults, the IPD rate per 100,000 person-years was 160 (n = 109 events) for HIV-infected and 8 (n = 75 events) for HIV-uninfected subjects, with an adjusted RR of 13.0 [95% confidence interval (CI): 9.1-18.7]. For HIV-infected individuals, IPD incidence per 100,000 person-years decreased by 71% during study follow-up, from 305 in 1996-1999 to 88 in 2010-2011 (p < 0.001), with an adjusted RR of 6.6 (95% CI: 2.7-16.1) compared with HIV-uninfected subjects in 2010-2011. Risk factors for IPD among HIV-infected individuals included black compared with white race/ethnicity, smoking, cancer, and higher HIV RNA levels. The 23-valent pneumococcal polysaccharide vaccination was not associated with a reduced risk of IPD in HIV-infected or HIV-uninfected individuals. Among HIV-infected IPD cases, the most common serotype was 19A (33%), and 59% of serotypes were covered by the 13-valent pneumococcal conjugate vaccine (PCV13). Despite a dramatic decline in IPD incidence for HIV-infected adults since 1996, IPD rates were nearly sevenfold higher compared with HIV-uninfected adults in recent years, even after adjustment for risk factors. Timely antiretroviral therapy initiation, risk reduction strategies, and recent guidelines recommending PCV13 use may further reduce IPD incidence among HIV patients.

  19. Prescribing patterns for thiazide diuretics in a large health maintenance organization: relationship to participation as an ALLHAT clinical center.

    PubMed

    Petitti, Diana B; Xie, Fagen; Barzilay, Joshua I

    2006-10-01

    The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) published its main findings in December, 2002. It recommended thiazide diuretics as a first-line treatment of hypertension. The current study describes the prescribing patterns of thiazide diuretics in four regions of Kaiser Permanente, a large national United States Health Maintenance Organization--two regions that had an ALLHAT clinical center and two that did not. We tested the hypothesis that participation in a clinical trial leads to quicker and greater adoption of study recommendations than non-participation in a trial. The relative percentage of filled outpatient prescriptions for the period 2 or 3 years before the ALLHAT main publication through December 31, 2004 was calculated by region for thiazide-type diuretics and for calcium channel blockers (CCBs), beta-blockers, central alpha-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and other antihypertensive diuretics. In the 2 years after publication of the ALLHAT trial findings, the percentage of all prescriptions for thiazide diuretics increased from 11.2% to 12.4% in the two regions with an ALLHAT clinical site and from 8.9% to 10.1% in the two regions without an ALLHAT clinical site (p > 0.05). The percentage of new prescriptions for thiazide diuretics increased from 13.7% to 16.6% in the two regions with an ALLHAT clinical site and from 10.8% to 13.0% in the two regions without an ALLHAT clinical site (p > 0.05). Participation in a clinical hypertension study does not appear to accelerate adoption of study recommendations.

  20. Colon Cancer Survival With Herbal Medicine and Vitamins Combined With Standard Therapy in a Whole-Systems Approach: Ten-Year Follow-up Data Analyzed With Marginal Structural Models and Propensity Score Methods

    PubMed Central

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

    2014-01-01

    Although localized colon cancer is often successfully treated with surgery, advanced disease requires aggressive systemic therapy that has lower effectiveness. Approximately 30% to 75% of patients with colon cancer use complementary and alternative medicine (CAM), but there is limited formal evidence of survival efficacy. In a consecutive case series with 10-year follow-up of all colon cancer patients (n = 193) presenting at a San Francisco Bay-Area center for Chinese medicine (Pine Street Clinic, San Anselmo, CA), the authors compared survival in patients choosing short-term treatment lasting the duration of chemotherapy/radiotherapy with those continuing long-term. To put these data into the context of treatment responses seen in conventional medical practice, they also compared survival with Pan-Asian medicine + vitamins (PAM+V) with that of concurrent external controls from Kaiser Permanente Northern California and California Cancer Registries. Kaplan-Meier, traditional Cox regression, and more modern methods were used for causal inference—namely, propensity score and marginal structural models (MSMs), which have not been used before in studies of cancer survival and Chinese herbal medicine. PAM+V combined with conventional therapy, compared with conventional therapy alone, reduced the risk of death in stage I by 95%, stage II by 64%, stage III by 29%, and stage IV by 75%. There was no significant difference between short-term and long-term PAM+V. Combining PAM+V with conventional therapy improved survival, compared with conventional therapy alone, suggesting that prospective trials combining PAM+V with conventional therapy are justified. PMID:21964510

  1. The Vitamin D Antenatal Asthma Reduction Trial (VDAART): rationale, design, and methods of a randomized, controlled trial of vitamin D supplementation in pregnancy for the primary prevention of asthma and allergies in children.

    PubMed

    Litonjua, Augusto A; Lange, Nancy E; Carey, Vincent J; Brown, Stacey; Laranjo, Nancy; Harshfield, Benjamin J; O'Connor, George T; Sandel, Megan; Strunk, Robert C; Bacharier, Leonard B; Zeiger, Robert S; Schatz, Michael; Hollis, Bruce W; Weiss, Scott T

    2014-05-01

    There is intense interest in the role of vitamin D in the development of asthma and allergies. However, studies differ on whether a higher vitamin D intake or status in pregnancy or at birth is protective against asthma and allergies. To address this uncertainty, the Vitamin D Antenatal Asthma Reduction Trial (VDAART) was developed. VDAART is a randomized, double-blind, placebo-controlled trial of vitamin D supplementation in pregnant women to determine whether prenatal supplementation can prevent the development of asthma and allergies in women's offspring. A secondary aim is to determine whether vitamin D supplementation can prevent the development of pregnancy complications, such as preeclampsia, preterm birth, and gestational diabetes. Women were randomized to the treatment arm of 4000IU/day of vitamin D3 plus a daily multivitamin that contained 400IU of vitamin D3 or the placebo arm of placebo plus a multivitamin that contained 400IU daily of vitamin D3. Women who were between the gestational ages of 10 and 18 weeks were randomized from three clinical centers across the United States - Boston Medical Center, Washington University in St. Louis, and Kaiser Permanente Southern California Region (San Diego, CA). Supplementation took place throughout pregnancy. Monthly monitoring of urinary calcium to creatinine ratio was performed in addition to medical record review for adverse events. Offspring are being evaluated quarterly through questionnaires and yearly during in-person visits until the 3rd birthday of the child. Ancillary studies will investigate neonatal T-regulatory cell function, maternal vaginal flora, and maternal and child intestinal flora.

  2. Site-specific associations between miRNA expression and survival in colorectal cancer cases

    PubMed Central

    Slattery, Martha L.; Herrick, Jennifer S.; Pellatt, Daniel F.; Mullany, Lila E.; Stevens, John R.; Wolff, Erica; Hoffman, Michael D.; Wolff, Roger K.; Samowitz, Wade

    2016-01-01

    Background MicroRNAs (miRNA) are small non-coding RNA involved in cellular processes, including cell proliferation and angiogenesis. Thus, miRNA expression may alter survival after diagnosis with colorectal cancer (CRC). Results Individuals diagnosed with stage 1 or stage 2 rectal cancer had worse survival than colon cancer cases diagnosed at stage 1 or stage 2. After adjustment for multiple comparisons, no miRNAs were significantly associated with disease stage. Two miRNAs infrequently expressed in the population and not previously reported were associated with survival after diagnosis with colon cancer (miR-1 HR 2.17 95% CI 1.41, 3.36; and miR-101-3p HR 3.51 95% CI 1.72, 7.15). Among those diagnosed with rectal cancer, 201 miRNAs were associated with survival when the FDR q value was < 0.05. Assessment of 105 previously reported miRNAs associated with prognosis showed that four miRNAs influenced colon cancer survival and 17 influenced survival after a diagnosis with rectal cancer when raw p values were considered. Patients and Methods This study includes data from population-based studies of CRC conducted in Utah and the Kaiser Permanente Medical Care Program. A total of 1893 carcinoma and normal paired colorectal mucosa tissue samples were run using the Agilent Human miRNA Microarray V19.0. We assessed miRNA differential expression between paired carcinoma and normal colonic mucosa tissue with CRC- specific survival evaluating stage and site-specific associations after adjusting for age, sex, microsatellite instability tumor status, and AJCC stage. Conclusions MiRNAs dysregulated for both colon and rectal cancer had a greater impact on survival after a diagnosis with rectal cancer. PMID:27517623

  3. Immune Mediated Conditions in Autism Spectrum Disorders

    PubMed Central

    Zerbo, Ousseny; Leong, Albin; Barcellos, Lisa; Bernal, Pilar; Fireman, Bruce; Croen, Lisa A.

    2015-01-01

    We conducted a case-control study among members of Kaiser Permanente Northern California (KPNC) born between 1980 and 2003 to determine the prevalence of immune-mediated conditions in individuals with autism, investigate whether these conditions occur more often than expected, and explore the timing of onset relative to autism diagnosis. Cases were children and young adults with at least two autism diagnoses recorded in outpatient records (n=5,565). Controls were children without autism randomly sampled at a ratio of 5 to 1, matched to cases on birth year, sex, and length of KPNC membership (n=27,825). The main outcomes - asthma, allergies, and autoimmune diseases - were identified from KPNC inpatient and outpatient databases. Chi-square tests were used to evaluate case-control differences. Allergies and autoimmune diseases were diagnosed significantly more often among children with autism than among controls (allergy: 20.6% vs. 17.7%, Crude odds ratio (OR) = 1.22, 95% confidence interval (CI) 1.13 – 1.31; autoimmune disease: 1% vs. 0.76%, OR = 1.36, 95% CI 1.01 – 1.83), and asthma was diagnosed significantly less often (13.7% vs. 15.9%; OR = 0.83, 95% CI 0.76 – 0.90). Psoriasis occurred more than twice as often in cases than in controls (0.34% vs. 0.15%; OR =2.35, 95% CI 1.36 – 4.08). Our results support previous observations that children with autism have elevated prevalence of specific immune-related comorbidities. PMID:25681541

  4. The Vitamin D Antenatal Asthma Reduction Trial (VDAART): Rationale, design, and methods of a randomized, controlled trial of vitamin D supplementation in pregnancy for the primary prevention of asthma and allergies in children

    PubMed Central

    Litonjua, Augusto A.; Lange, Nancy E.; Carey, Vincent J.; Brown, Stacey; Laranjo, Nancy; O’Connor, George T.; Sandel, Megan; Strunk, Robert C.; Bacharier, Leonard B.; Zeiger, Robert S.; Schatz, Michael; Hollis, Bruce W.; Weiss, Scott T.

    2014-01-01

    There is intense interest in the role of vitamin D in the development of asthma and allergies. However, studies differ on whether a higher vitamin D intake or status in pregnancy or at birth is protective against asthma and allergies. To address this uncertainty, the Vitamin D Antenatal Asthma Reduction Trial (VDAART) was developed. VDAART is a randomized, double-blind, placebo-controlled trial of vitamin D supplementation in pregnant women to determine whether prenatal supplementation can prevent the development of asthma and allergies in the women’s offspring. A secondary aim is to determine whether vitamin D supplementation can prevent the development of pregnancy complications, such as preeclampsia, preterm birth, and gestational diabetes. Women were randomized to the treatment arm of 4,000 IU/day of vitamin D3 plus a daily multivitamin that contained 400 IU of vitamin D3 or the placebo arm of placebo plus a multivitamin that contained 400 IU daily of vitamin D3. Women who were between the gestational ages of 10–18 weeks were randomized from three clinical centers across the United States – Boston Medical Center, Washington University in St. Louis, and Kaiser Permanente Southern California Region (San Diego, CA). Supplementation took place throughout pregnancy. Monthly monitoring of urinary calcium to creatinine ratio was performed in addition to medical record review for adverse events. Offspring are being evaluated quarterly through questionnaires and yearly during in-person visits until the 3rd birthday of the child. Ancillary studies will investigate neonatal T-regulatory cell function, maternal vaginal flora, and maternal and child intestinal flora. PMID:24614387

  5. Associations of the Fecal Microbiome With Urinary Estrogens and Estrogen Metabolites in Postmenopausal Women

    PubMed Central

    Fuhrman, Barbara J.; Feigelson, Heather Spencer; Flores, Roberto; Gail, Mitchell H.; Xu, Xia; Ravel, Jacques

    2014-01-01

    Context: The gut microbiota may influence the risk of breast cancer through effects on endogenous estrogens. Objective: The objective of the study was to investigate whether urinary estrogens and estrogen metabolites are associated with the diversity and composition of the fecal microbiome. Design and Setting: This was a cross-sectional study among women enrolled in Kaiser Permanente of Colorado. Participants: A total of 60 women drawn from a random sample of healthy postmenopausal women (aged 55–69 y), without current or recent use of antibiotics or hormone therapy and no history of cancer or gastrointestinal disease participated in the study. Outcome Measures and Methods: Creatinine-standardized urinary estrogens (estrone and estradiol) and 13 hydroxylated estrogen metabolites were measured in spot urines by liquid chromatography-tandem mass spectrometry. The fecal microbiome was assessed using pyrosequencing of 16S rRNA amplicons. General linear models were used to test for associations of diversity and composition of the fecal microbiome with parent estrogen (estrone + estradiol), total estrogens, and estrogen metabolites and the ratio of estrogen metabolites to parent estrogen, which has been predictive of postmenopausal breast cancer risk in previous studies. Results: The ratio of metabolites to parents was directly associated with whole-tree phylogenetic diversity (R = 0.35, P = .01). Relative abundances of the order Clostridiales (R = 0.32, P = .02) and the genus Bacteroides (R = −0.30, P = .03) were also correlated with the ratio of metabolites to parents. Associations were independent of age, body mass index, and study design factors. Conclusions: Our data suggest that women with a more diverse gut microbiome exhibit an elevated urinary ratio of hydroxylated estrogen metabolites to parent estrogen. Further research is warranted to confirm and relate these findings to clinical disease. PMID:25211668

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

    PubMed Central

    Bartolotto, Carole

    2015-01-01

    Americans consume a lot of sugar, primarily from sweeteners that are added to processed foods and beverages. Data from the US Department of Agriculture reveals that in 2013, Americans consumed 22.3 teaspoons of added caloric sweeteners a day, which is significantly more than the American Heart Association’s recommendation. Artificial and alternative sweeteners have also been added to a plethora of foods. These sweeteners range from about 180 times sweeter to as much as 13,000 times sweeter than sugar. Consumption of both sugar and artificial sweeteners may be changing our palates or taste preferences over time, increasing our desire for sweet foods. Unfortunately, the data on this are lacking. In the summer of 2014, a group of 20 people from Kaiser Permanente facilities throughout California agreed to cut out all added sugars and artificial sweeteners for 2 weeks and then complete a survey to determine whether their taste preferences had changed. After the 2-week challenge, 95% of participants (18 out of 19 respondents) found that sweet foods and drinks tasted sweeter or too sweet, 75% (15 out of 20 respondents) found that other foods tasted sweeter, and 95% (19 out of 20 respondents) said moving forward they would use less or even no sugar. Additionally, 86.6% of participants (13 out of 15 respondents) stopped craving sugar after 6 days. Although this was a small survey, the results suggest that using a 2-week sugar challenge can help to reset taste preferences and make consuming less or no sugar easier. Physicians should consider recommending a sugar and artificial sweetener challenge to all their patients, especially those with obesity, diabetes, or cardiovascular disease. PMID:26176574

  7. The electrohydrodynamic instability in homeotropic nematic layers

    NASA Astrophysics Data System (ADS)

    Hertrich, A.; Decker, W.; Pesch, W.; Kramer, L.

    1992-11-01

    We calculate the threshold for electrohydrodynamic convection in homeotropically oriented nematic layers with negative dielectric anistropy that sets in after the bend-Fréedericksz transition to a quasi-planar alignment has taken place. Oblique rolls are found in a larger range than in the case of planar anchoring. The most interesting prediction is that in the weakly nonlinear analysis all roll solution are in fact unstable so that a direct transition to spatio-temporal chaos becomes possible. In the oblique-roll case this may be accompanied by a permanent local rotation of the director bend axis. Application of a planar magnetic field should stabilize the rolls. Nous calculons le seuil d'apparition de convection électrohydrodynamique dans des couches nématiques orientées homéotropiquement possédant une anisotropie diélectrique négative après que la transition de Fréedericksz de type courbure (bend) vers un alignement quasihorizontal ait eu lieu. Des rouleaux obliques sont observés dans un domaine plus grand que dans le cas de conditions aux limites planes. La prédiction la plus intéressante est que dans le cadre d'une analyse faiblement nonlinéaire toutes les solutions de rouleaux sont en fait instables et un passage direct vers un chaos spatio-temporel a lieu. Dans le cas de rouleaux obliques ceci peut être accompagné d'une rotation permanente locale de l'axe directeur de courbure. L'application d'un champ magnétique plan devrait stabiliser les rouleaux.

  8. College graduation reduces vulnerability to STIs/HIV among African-American young adult women.

    PubMed

    Painter, Julia E; Wingood, Gina M; DiClemente, Ralph J; Depadilla, Lara M; Simpson-Robinson, Lashun

    2012-01-01

    African-American women are disproportionately affected by sexually transmitted infections (STIs), including HIV. The Theory of Gender and Power (TGP) posits that socioeconomic exposures, including educational attainment, place women at increased risk for STIs/HIV. This study examined the association between educational attainment and vulnerability to STIs/HIV, as well as potential TGP-driven mediators of this association, among African-American women. Baseline data were assessed from an STI/HIV prevention intervention for African-American women (n = 848) aged 18 to 29 recruited from three Kaiser Permanente Centers in Atlanta, Georgia. Data collection included a survey of demographic, psychosocial, and behavioral measures and self-collected, laboratory-confirmed vaginal swabs for STIs (trichomoniasis, chlamydia, gonorrhea, and human papillomavirus). Multiple regression analyses and multivariate mediation analyses were used to examine the association between educational attainment with a laboratory-confirmed STI and potential TGP mediators. Controlling for age and receipt of public assistance, the odds of an STI diagnosis were 73% lower among participants with a college degree or greater compared with participants who had not completed high school. There were also significant associations between educational attainment and multiple TGP mediators from the sexual division of power and the structure of cathexis. TGP constructs did not mediate the association between educational attainment and laboratory-confirmed STI. The current study suggests that graduating from college may lead to a beneficial reduction in vulnerability to STIs/HIV among African-American women. Findings from this study support expanding structural-level interventions, emphasizing both high school and college graduation, as a means of reducing vulnerability to STIs/HIV among African-American women.

  9. A Novel Method for Estimating Transgender Status Using Electronic Medical Records

    PubMed Central

    Roblin, Douglas; Barzilay, Joshua; Tolsma, Dennis; Robinson, Brandi; Schild, Laura; Cromwell, Lee; Braun, Hayley; Nash, Rebecca; Gerth, Joseph; Hunkeler, Enid; Quinn, Virginia P.; Tangpricha, Vin; Goodman, Michael

    2016-01-01

    Background We describe a novel algorithm for identifying transgender people and determining their male-to-female (MTF) or female-to-male (FTM) identity in electronic medical records (EMR) of an integrated health system. Methods A SAS program scanned Kaiser Permanente Georgia EMR from January 2006 through December 2014 for relevant diagnostic codes, and presence of specific keywords (e.g., “transgender” or “transsexual”) in clinical notes. Eligibility was verified by review of de-identified text strings containing targeted keywords, and if needed, by an additional in-depth review of records. Once transgender status was confirmed, FTM or MTF identity was assessed using a second SAS program and another round of text string reviews. Results Of 813,737 members, 271 were identified as possibly transgender: 137 through keywords only, 25 through diagnostic codes only, and 109 through both codes and keywords. Of these individuals, 185 (68%, 95% confidence interval [CI]: 62-74%) were confirmed as definitely transgender. The proportions (95% CIs) of definite transgender status among persons identified via keywords, diagnostic codes, and both were 45% (37-54%), 56% (35-75%), and 100% (96-100%), respectively. Of the 185 definitely transgender people, 99 (54%, 95% CI: 46-61%) were MTF, 84 (45%, 95% CI: 38-53%) were FTM. For two persons, gender identity remained unknown. Prevalence of transgender people (per 100,000 members) was 4.4 (95% CI: 2.6-7.4) in 2006 and 38.7 (95% CI: 32.4-46.2) in 2014. Conclusions The proposed method of identifying candidates for transgender health studies is low cost and relatively efficient. It can be applied in other similar health care systems. PMID:26907539

  10. Comparative Effectiveness Topics from a Large, Integrated Delivery System

    PubMed Central

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

    2013-01-01

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

  11. Factors influencing variation in physician adenoma detection rates: a theory-based approach

    PubMed Central

    Atkins, Louise; Hunkeler, Enid M.; Jensen, Christopher D.; Michie, Susan; Lee, Jeffrey K.; Doubeni, Chyke A.; Zauber, Ann G.; Levin, Theodore R.; Quinn, Virginia P.; Corley, Douglas A.

    2015-01-01

    Background & Aims Interventions to improve physician adenoma detection rates for colonoscopy have generally not been successful and there are little data on the factors contributing to variation that may be appropriate targets for intervention. We sought to identify factors that may influence variation in detection rates using theory-based tools for understanding behavior. Methods We separately studied gastroenterologists and endoscopy nurses at three Kaiser Permanente Northern California medical centers to identify potentially modifiable factors relevant to physician adenoma detection rate variability using structured group interviews (focus groups) and theory-based tools for understanding behavior and eliciting behavior change: the Capability, Opportunity, and Motivation behavior model; the Theoretical Domains Framework; and the Behavior Change Wheel. Results Nine factors potentially associated with detection rate variability were identified, including six related to capability (uncertainty about which types of polyps to remove; style of endoscopy team leadership; compromised ability to focus during an examination due to distractions; examination technique during withdrawal; difficulty detecting certain types of adenomas; and examiner fatigue and pain), two related to opportunity (perceived pressure due to the number of examinations expected per shift and social pressure to finish examinations before scheduled breaks or the end of a shift), and one related to motivation (valuing a meticulous examination as the top priority). Examples of potential intervention strategies are provided. Conclusions Using theory-based tools, this study identified several novel and potentially modifiable factors relating to capability, opportunity, and motivation that may contribute to adenoma detection rate variability and be appropriate targets for future intervention trials. PMID:26366787

  12. Immune mediated conditions in autism spectrum disorders.

    PubMed

    Zerbo, Ousseny; Leong, Albin; Barcellos, Lisa; Bernal, Pilar; Fireman, Bruce; Croen, Lisa A

    2015-05-01

    We conducted a case-control study among members of Kaiser Permanente Northern California (KPNC) born between 1980 and 2003 to determine the prevalence of immune-mediated conditions in individuals with autism, investigate whether these conditions occur more often than expected, and explore the timing of onset relative to autism diagnosis. Cases were children and young adults with at least two autism diagnoses recorded in outpatient records (n=5565). Controls were children without autism randomly sampled at a ratio of 5 to 1, matched to cases on birth year, sex, and length of KPNC membership (n=27,825). The main outcomes - asthma, allergies, and autoimmune diseases - were identified from KPNC inpatient and outpatient databases. Chi-square tests were used to evaluate case-control differences. Allergies and autoimmune diseases were diagnosed significantly more often among children with autism than among controls (allergy: 20.6% vs. 17.7%, Crude odds ratio (OR)=1.22, 95% confidence interval (CI) 1.13-1.31; autoimmune disease: 1% vs. 0.76%, OR=1.36, 95% CI 1.01-1.83), and asthma was diagnosed significantly less often (13.7% vs. 15.9%; OR=0.83, 95% CI 0.76-0.90). Psoriasis occurred more than twice as often in cases than in controls (0.34% vs. 0.15%; OR=2.35, 95% CI 1.36-4.08). Our results support previous observations that children with autism have elevated prevalence of specific immune-related comorbidities.

  13. Stromal immune infiltration in HIV-related diffuse large B-cell lymphoma is associated with HIV disease history and patient survival

    PubMed Central

    CHAO, Chun; XU, Lanfang; SILVERBERG, Michael J; MARTÍNEZ-MAZA, Otoniel; CHEN, Lie-Hong; CASTOR, Brandon; ABRAMS, Donald I; ZHA, Hongbin D; HAQUE, Reina; SAID, Jonathan

    2015-01-01

    Objective Understanding tumor microenvironment and its impact on prognosis of HIV-related lymphomas may provide insight into novel therapeutic strategies. Design We characterized the relationship between infiltrating immune cells with tumor characteristics, HIV disease history and survival in 80 HIV-related diffuse large B-cell lymphoma (DLBCL) patients diagnosed in the era of combined antiretroviral therapy (1996–2007) at Kaiser Permanente (KP) California. Eighty HIV-unrelated DLBCL patients were included for comparison. Methods Data on patients’ clinical history were obtained from KP’s electronic health records. The density of stromal CD4+, CD8+ and FOXP3+ T cells and CD68+ macrophages, as well as tumor molecular characteristics were examined using immunohistochemistry. The associations between stromal immune infiltration and patient’s clinical history or tumor characteristics were examined using Kruskal Wallis tests or Peasrons’ correlation coefficient. The effect of stromal immune infiltration on two-year mortality was evaluated in multivariable logistic regression. Results Compared to HIV-unrelated DLBCL, patients with HIV-related DLBCL had significantly reduced stromal CD4+ and FOXP3+ T cells, but increased density of macrophages. Increased density of stromal macrophages was correlated with lower circulating CD4 cell count at DLBCL diagnosis. Tumor molecular characteristics, including BCL6, p53 and cMYC expression, but not EBV infection status, were significantly correlated with stromal immune infiltration, particularly FOXP3+ T cells. A higher density of infiltrating CD8+ T cell was significantly associated with reduced mortality in HIV-related DLBCL patients [odds ratio=0.30 (0.09–0.97) for ≥25% vs. <10%]. Conclusion These data provide evidence for the prognostic significance of cytotoxic T cells in determining outcomes of HIV-related lymphoma. PMID:26355571

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

    PubMed

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

    2011-05-09

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

  15. Age-Stratified 5-Year Risks of Cervical Precancer among Women with Enrollment and Newly Detected HPV Infection

    PubMed Central

    Gage, Julia C.; Katki, Hormuzd A.; Schiffman, Mark; Fetterman, Barbara; Poitras, Nancy E.; Lorey, Thomas; Cheung, Li C.; Castle, Philip E.; Kinney, Walter K.

    2014-01-01

    It is unclear whether a woman's age influences her risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) upon detection of HPV. A large change in risk as women age would influence vaccination and screening policies. Among 972,029 women age 30-64 undergoing screening with Pap and HPV testing (Hybrid Capture 2, Qiagen, Germantown, MD, USA) at Kaiser Permanente Northern California (KPNC), we calculated age-specific 5-year CIN3+ risks among women with HPV infections detected at enrollment, and among women with “newly detected” HPV infections at their second screening visit. 57,899 women (6.0%) had an enrollment HPV infection. Among the women testing HPV negative at enrollment with a second screening visit, 16,724 (3.3%) had a newly detected HPV infection at their second visit. Both enrollment and newly detected HPV rates declined with age (p<.001). Women with enrollment vs. newly detected HPV infection had higher 5-year CIN3+ risks: 8.5% vs. 3.9%, (p<.0001). Risks did not increase with age but declined slightly from 30-34 years to 60-64 years: 9.4% vs. 7.4% (p=0.017) for enrollment HPV and 5.1% vs. 3.5% (p=0.014) for newly detected HPV. Among women age 30-64 in an established screening program, women with newly detected HPV infections were at lower risk than women with enrollment infections, suggesting reduced benefit vaccinating women at older ages. Although the rates of HPV infection declined dramatically with age, the subsequent CIN3+ risks associated with HPV infection declined only slightly. The CIN3+ risks among older women are sufficiently elevated to warrant continued screening through age 65. PMID:25136967

  16. A cohort study of cervical screening using partial HPV typing and cytology triage.

    PubMed

    Schiffman, Mark; Hyun, Noorie; Raine-Bennett, Tina R; Katki, Hormuzd; Fetterman, Barbara; Gage, Julia C; Cheung, Li C; Befano, Brian; Poitras, Nancy; Lorey, Thomas; Castle, Philip E; Wentzensen, Nicolas

    2016-12-01

    HPV testing is more sensitive than cytology for cervical screening. However, to incorporate HPV tests into screening, risk-stratification ("triage") of HPV-positive women is needed to avoid excessive colposcopy and overtreatment. We prospectively evaluated combinations of partial HPV typing (Onclarity, BD) and cytology triage, and explored whether management could be simplified, based on grouping combinations yielding similar 3-year or 18-month CIN3+ risks. We typed ∼9,000 archived specimens, taken at enrollment (2007-2011) into the NCI-Kaiser Permanente Northern California (KPNC) HPV Persistence and Progression (PaP) cohort. Stratified sampling, with reweighting in the statistical analysis, permitted risk estimation of HPV/cytology combinations for the 700,000+-woman KPNC screening population. Based on 3-year CIN3+ risks, Onclarity results could be combined into five groups (HPV16, else HPV18/45, else HPV31/33/58/52, else HPV51/35/39/68/56/66/68, else HPV negative); cytology results fell into three risk groups ("high-grade," ASC-US/LSIL, NILM). For the resultant 15 HPV group-cytology combinations, 3-year CIN3+ risks ranged 1,000-fold from 60.6% to 0.06%. To guide management, we compared the risks to established "benchmark" risk/management thresholds in this same population (e.g., LSIL predicted 3-year CIN3+ risk of 5.8% in the screening population, providing the benchmark for colposcopic referral). By benchmarking to 3-year risk thresholds (supplemented by 18-month estimates), the widely varying risk strata could be condensed into four action bands (very high risk of CIN3+ mandating consideration of cone biopsy if colposcopy did not find precancer; moderate risk justifying colposcopy; low risk managed by intensified follow-up to permit HPV "clearance"; and very low risk permitting routine screening.) Overall, the results support primary HPV testing, with management of HPV-positive women using partial HPV typing and cytology.

  17. Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer.

    PubMed

    Livaudais, Jennifer C; Hershman, Dawn L; Habel, Laurel; Kushi, Lawrence; Gomez, Scarlett Lin; Li, Christopher I; Neugut, Alfred I; Fehrenbacher, Louis; Thompson, Beti; Coronado, Gloria D

    2012-01-01

    Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as two or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional-stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC). Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White [NHW]) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use. Our sample included 13,753 women aged 20-79 years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR] = 0.82; [CI] 0.71-0.96 and [OR] = 0.78; [CI] 0.63-0.98, respectively). Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other insured populations and the reasons for under-initiation among these groups need to be explored.

  18. Characterizing Race/Ethnicity and Genetic Ancestry for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort

    PubMed Central

    Banda, Yambazi; Kvale, Mark N.; Hoffmann, Thomas J.; Hesselson, Stephanie E.; Ranatunga, Dilrini; Tang, Hua; Sabatti, Chiara; Croen, Lisa A.; Dispensa, Brad P.; Henderson, Mary; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H.; Ludwig, Dana; Olberg, Diane; Quesenberry, Charles P.; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C.; Sciortino, Stanley; Shen, Ling; Smethurst, David; Somkin, Carol P.; Van Den Eeden, Stephen K.; Walter, Lawrence; Whitmer, Rachel A.; Kwok, Pui-Yan; Schaefer, Catherine; Risch, Neil

    2015-01-01

    Using genome-wide genotypes, we characterized the genetic structure of 103,006 participants in the Kaiser Permanente Northern California multi-ethnic Genetic Epidemiology Research on Adult Health and Aging Cohort and analyzed the relationship to self-reported race/ethnicity. Participants endorsed any of 23 race/ethnicity/nationality categories, which were collapsed into seven major race/ethnicity groups. By self-report the cohort is 80.8% white and 19.2% minority; 93.8% endorsed a single race/ethnicity group, while 6.2% endorsed two or more. Principal component (PC) and admixture analyses were generally consistent with prior studies. Approximately 17% of subjects had genetic ancestry from more than one continent, and 12% were genetically admixed, considering only nonadjacent geographical origins. Self-reported whites were spread on a continuum along the first two PCs, indicating extensive mixing among European nationalities. Self-identified East Asian nationalities correlated with genetic clustering, consistent with extensive endogamy. Individuals of mixed East Asian–European genetic ancestry were easily identified; we also observed a modest amount of European genetic ancestry in individuals self-identified as Filipinos. Self-reported African Americans and Latinos showed extensive European and African genetic ancestry, and Native American genetic ancestry for the latter. Among 3741 genetically identified parent–child pairs, 93% were concordant for self-reported race/ethnicity; among 2018 genetically identified full-sib pairs, 96% were concordant; the lower rate for parent–child pairs was largely due to intermarriage. The parent–child pairs revealed a trend toward increasing exogamy over time; the presence in the cohort of individuals endorsing multiple race/ethnicity categories creates interesting challenges and future opportunities for genetic epidemiologic studies. PMID:26092716

  19. Patient race/ethnicity and patient-physician race/ethnicity concordance in the management of cardiovascular disease risk factors for patients with diabetes.

    PubMed

    Traylor, Ana H; Subramanian, Usha; Uratsu, Connie S; Mangione, Carol M; Selby, Joe V; Schmittdiel, Julie A

    2010-03-01

    OBJECTIVE Patient-physician race/ethnicity concordance can improve care for minority patients. However, its effect on cardiovascular disease (CVD) care and prevention is unknown. We examined associations of patient race/ethnicity and patient-physician race/ethnicity concordance on CVD risk factor levels and appropriate modification of treatment in response to high risk factor values (treatment intensification) in a large cohort of diabetic patients. RESEARCH DESIGN AND METHODS The study population included 108,555 adult diabetic patients in Kaiser Permanente Northern California in 2005. Probit models assessed the effect of patient race/ethnicity on risk factor control and treatment intensification after adjusting for patient and physician-level characteristics. RESULTS African American patients were less likely than whites to have A1C <8.0% (64 vs. 69%, P < 0.0001), LDL cholesterol <100 mg/dl (40 vs. 47%, P < 0.0001), and systolic blood pressure (SBP) <140 mmHg (70 vs. 78%, P < 0.0001). Hispanic patients were less likely than whites to have A1C <8% (62 vs. 69%, P < 0.0001). African American patients were less likely than whites to have A1C treatment intensification (73 vs. 77%, P < 0.0001; odds ratio [OR] 0.8 [95% CI 0.7-0.9]) but more likely to receive treatment intensification for SBP (78 vs. 71%, P < 0.0001; 1.5 [1.3-1.7]). Hispanic patients were more likely to have LDL cholesterol treatment intensification (47 vs. 45%, P < 0.05; 1.1 [1.0-1.2]). Patient-physician race/ethnicity concordance was not significantly associated with risk factor control or treatment intensification. CONCLUSIONS Patient race/ethnicity is associated with risk factor control and treatment intensification, but patient-physician race/ethnicity concordance was not. Further research should investigate other potential drivers of disparities in CVD care.

  20. Morbidity in Pregnant Women Associated with Unverified Penicillin Allergies, Antibiotic Use, and Group B Streptococcus Infections

    PubMed Central

    Desai, Shilpa H; Kaplan, Michael S; Chen, Qiaoling; Macy, Eric M

    2017-01-01

    Context: The morbidity potentially associated with unverified penicillin allergy in pregnant women, with and without group B streptococcus (GBS) infections, is unknown. Penicillin allergy testing is safe during pregnancy but is done infrequently. Objective: To determine morbidity associated with antibiotic use in a large cohort of pregnant women, with and without an unverified history of penicillin allergy, and with and without GBS. Design: Retrospective. All pregnant women who delivered live infants in Kaiser Permanente Southern California between January 1, 2009, and December 31, 2014, were identified. Main Outcome Measures: Penicillin allergy status at delivery, delivery method, maternal and infant hospital utilization, peripartum antibiotic exposures, new antibiotic-associated adverse drug reactions, and new Clostridium difficile infections. Results: There were 170,379 unique women who had 201,316 pregnancies during the study period. There were 16,084 pregnancies in women with an active, but unverified, penicillin allergy at delivery. There were 42,524 pregnancies in GBS-positive women, and 3500 also had a penicillin allergy. Women with a penicillin allergy, with or without GBS, had significantly (about 10%) higher cesarean section rates and spent significantly more (about 0.1) days in the hospital after delivery. Among GBS-positive women, those with an unverified penicillin allergy were exposed to significantly more cefazolin, clindamycin, vancomycin, and gentamicin and had significantly higher rates of adverse drug reactions associated with all antibiotic use. Conclusions: Unverified penicillin allergy is associated with more hospital utilization and additional morbidity. Penicillin allergy testing of pregnant women with a history of penicillin allergy may help reduce these unwanted outcomes. PMID:28333608

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

    PubMed Central

    2013-01-01

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

  2. Evaluation of four maternal smoking questions.

    PubMed Central

    Kharrazi, M; Epstein, D; Hopkins, B; Kreutzer, R; Doebbert, G; Hiatt, R; Swan, S; Eskenazi, B; Pirkle, J L; Bernert, J T

    1999-01-01

    OBJECTIVE: The authors evaluated four questions about maternal smoking during pregnancy for use on birth certificates. METHODS: Question 1 (yes/no format) and Question 2 (trimester-specific design) were tested among 1171 women who delivered at two Kaiser Permanente medical centers in northern California. Responses to Questions 1 and 2 were compared with smoking information provided by participants in telephone interviews conducted during pregnancy. Question 3 (multiple choice format) and Question 4 (month- and grouped month-specific design) were tested among 900 women who enrolled in a statewide prenatal screening program and who delivered in 20 hospitals in four Central Valley counties. Responses to Questions 3 and 4 were compared with mid-pregnancy serum cotinine levels. The authors evaluated the four questions in terms of conciseness, response rate, data accuracy, and type of data requested. RESULTS: Questions 1 and 2 were the most concise. Response rates could not be calculated for Questions 1 and 2. Response rates were 86.0% for Question 3 and 74.2% for Question 4. Sensitivity was 47.3% for Question 1, 62.1% for Question 2, 83.8% for Question 3, and 86.7% for Question 4. The types of data requested by Questions 2 and 4 seem to best satisfy the needs of the broad audience of birth certificate users. CONCLUSIONS: No single question was clearly superior. The authors propose a combination of Questions 2 and 4, which asks about average number of cigarettes smoked per day in the three months before pregnancy and in each trimester of pregnancy. PMID:9925173

  3. Characterizing Race/Ethnicity and Genetic Ancestry for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort.

    PubMed

    Banda, Yambazi; Kvale, Mark N; Hoffmann, Thomas J; Hesselson, Stephanie E; Ranatunga, Dilrini; Tang, Hua; Sabatti, Chiara; Croen, Lisa A; Dispensa, Brad P; Henderson, Mary; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H; Ludwig, Dana; Olberg, Diane; Quesenberry, Charles P; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C; Sciortino, Stanley; Shen, Ling; Smethurst, David; Somkin, Carol P; Van Den Eeden, Stephen K; Walter, Lawrence; Whitmer, Rachel A; Kwok, Pui-Yan; Schaefer, Catherine; Risch, Neil

    2015-08-01

    Using genome-wide genotypes, we characterized the genetic structure of 103,006 participants in the Kaiser Permanente Northern California multi-ethnic Genetic Epidemiology Research on Adult Health and Aging Cohort and analyzed the relationship to self-reported race/ethnicity. Participants endorsed any of 23 race/ethnicity/nationality categories, which were collapsed into seven major race/ethnicity groups. By self-report the cohort is 80.8% white and 19.2% minority; 93.8% endorsed a single race/ethnicity group, while 6.2% endorsed two or more. Principal component (PC) and admixture analyses were generally consistent with prior studies. Approximately 17% of subjects had genetic ancestry from more than one continent, and 12% were genetically admixed, considering only nonadjacent geographical origins. Self-reported whites were spread on a continuum along the first two PCs, indicating extensive mixing among European nationalities. Self-identified East Asian nationalities correlated with genetic clustering, consistent with extensive endogamy. Individuals of mixed East Asian-European genetic ancestry were easily identified; we also observed a modest amount of European genetic ancestry in individuals self-identified as Filipinos. Self-reported African Americans and Latinos showed extensive European and African genetic ancestry, and Native American genetic ancestry for the latter. Among 3741 genetically identified parent-child pairs, 93% were concordant for self-reported race/ethnicity; among 2018 genetically identified full-sib pairs, 96% were concordant; the lower rate for parent-child pairs was largely due to intermarriage. The parent-child pairs revealed a trend toward increasing exogamy over time; the presence in the cohort of individuals endorsing multiple race/ethnicity categories creates interesting challenges and future opportunities for genetic epidemiologic studies.

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

    Greene, Sharon K; Kulldorff, Martin; Huang, Jie; Brand, Richard J; Kleinman, Kenneth P; Hsu, John; Platt, Richard

    2011-02-28

    Timely detection of clusters of localized influenza activity in excess of background seasonal levels could improve situational awareness for public health officials and health systems. However, no single data type may capture influenza activity with optimal sensitivity, specificity, and timeliness, and it is unknown which data types could be most useful for surveillance. We compared the performance of 10 types of electronic clinical data for timely detection of influenza clusters throughout the 2007/08 influenza season in northern California. Kaiser Permanente Northern California generated zip code-specific daily episode counts for: influenza-like illness (ILI) diagnoses in ambulatory care (AC) and emergency departments (ED), both with and without regard to fever; hospital admissions and discharges for pneumonia and influenza; antiviral drugs dispensed (Rx); influenza laboratory tests ordered (Tests); and tests positive for influenza type A (FluA) and type B (FluB). Four credible events of localized excess illness were identified. Prospective surveillance was mimicked within each data stream using a space-time permutation scan statistic, analyzing only data available as of each day, to evaluate the ability and timeliness to detect the credible events. AC without fever and Tests signaled during all four events and, along with Rx, had the most timely signals. FluA had less timely signals. ED, hospitalizations, and FluB did not signal reliably. When fever was included in the ILI definition, signals were either delayed or missed. Although limited to one health plan, location, and year, these results can inform the choice of data streams for public health surveillance of influenza.

  6. Interpregnancy Interval and Risk of Autism Spectrum Disorders

    PubMed Central

    Yoshida, Cathleen; Gunderson, Erica P.; Dorward, Kaht; Croen, Lisa A.

    2015-01-01

    OBJECTIVE: To determine whether subsequent births after short and long interpregnancy intervals (IPIs) are associated with risk of autism spectrum disorder (ASD). METHOD: We assessed the association between IPI and ASD risk in a cohort of 45 261 children born at Kaiser Permanente Northern California (KPNC) between 2000 and 2009. Children with ASD were identified from International Classification of Diseases, Revision 9 diagnostic codes 299.0, 299.8, and 299.9 recorded in KPNC electronic medical records. IPI was defined as the time from the birth of the first child to the conception of the second child. Survival analysis and logistic regression models were used to evaluate the association between IPI and risk of ASD in second-born children. RESULTS: Children born after an IPI of <12 months or ≥72 months had a 2- to 3-fold increased ASD risk compared with children born after an interval of 36 to 47 months. Respective adjusted hazard ratios (95% confidence intervals) were as follows: <6 months, 3.0 (1.9–4.7); 6 to 8 months, 2.1 (1.4–3.3); 9 to 11 months, 1.9 (1.3–2.1); 12 to 23 months, 1.5 (1.1–2.1); and ≥72 months, 2.4 (1.5–3.7). The results are not explained by maternal BMI or change in BMI between pregnancies or by parental age, maternal antidepressant medication use, or unfavorable events occurring during the first or second pregnancy. CONCLUSIONS: Children born after interpregnancy intervals <2 years or >6 years may be at increased risk of ASD. The mechanism explaining this association is unknown, and more research is needed. PMID:26371204

  7. Diagnostic Prevalence of Ankylosing Spondylitis Using Computerized Health Care Data, 1996 to 2009: Underrecognition in a US Health Care Setting

    PubMed Central

    Curtis, Jeffrey R; Harrold, Leslie R; Asgari, Maryam M; Deodhar, Atul; Salman, Craig; Gelfand, Joel M; Wu, Jashin J; Herrinton, Lisa J

    2016-01-01

    Introduction Few studies have assessed the prevalence and features of axial spondyloarthritis (axSpA) and ankylosing spondylitis in diverse, population-based, community settings. Objectives We used computerized diagnoses to estimate the prevalence of axSpA and ankylosing spondylitis in Kaiser Permanente Northern California (KPNC). Methods We identified persons aged 18 years or older with 1 or more International Classification of Diseases, Ninth Revision (ICD-9) diagnosis Code 720.X (ankylosing spondylitis and other inflammatory spondylopathies) in clinical encounter data from 1996 through 2009 to estimate the prevalence of axSpA and ankylosing spondylitis. We reviewed medical records to confirm the diagnosis in a random sample and estimated the positive predictive value of computerized data to identify confirmed cases using various case definitions. Results In the computerized data, 5568 adults had diagnostic codes indicating axSpA. On the basis of our case-finding approach using a single physician diagnosis code for ICD-9 720.X, the point prevalence of these conditions, standardized to the 2000 US Census, was 2.26 per 1000 persons for axSpA and 1.07 per 1000 for ankylosing spondylitis. Less than half of suspected cases saw a rheumatologist. The most specific algorithm for confirmed ankylosing spondylitis required 2 or more computerized diagnoses assigned by a rheumatologist, with 67% sensitivity (95% confidence interval, 64%–69%) and 81% positive predictive value (95% confidence interval, 79%–83%). Conclusions Observed prevalence in the KPNC population, compared with national estimates for axSpA and ankylosing spondylitis, suggests there is substantial underrecognition of these conditions in routine clinical practice. However, use of computerized data is able to identify true cases of ankylosing spondylitis, facilitating population-based research. PMID:27479952

  8. Evaluation following staggered implementation of the ‘Rethinking Critical Care’ ICU care bundle in a multi-center community setting

    PubMed Central

    Liu, Vincent; Herbert, David; Foss-Durant, Anne; Marelich, Gregory P.; Patel, Anandray; Whippy, Alan; Turk, Benjamin J; Ragins, Arona I; Kipnis, Patricia; Escobar, Gabriel J

    2016-01-01

    Objective To evaluate process metrics and outcomes following implementation of the ‘Rethinking Critical Care’ (RCC) ICU care bundle in a community setting. Design, Setting, and Patients Patients admitted to the intensive care unit (ICU) at three hospitals in the Kaiser Permanente Northern California integrated healthcare delivery system between January 1, 2009 and August 30, 2013. Interventions and Measurements The RCC ICU care bundle is designed to reduce potentially preventable complications by focusing on the management of delirium, sedation, mechanical ventilation, mobility, ambulation, and coordinated care. RCC implementation occurred in a staggered fashion between October 2011 and November 2012. We measured implementation metrics based on electronic medical record data and evaluated the impact of implementation on mortality with multivariable regression models. Main Results We evaluated 24,886 first ICU episodes in 19,872 patients. After implementation, some process metrics (e.g., ventilation start and stop times) were achieved at high rates while others (e.g., ambulation distance), available late in the study period, showed steep increases in compliance. Unadjusted mortality decreased from 12.3% to 10.9% (p-value<0.01) before and after implementation, respectively. The adjusted odds ratio for hospital mortality after implementation was 0.85 (95% confidence interval, 0.73–0.99) and for thirty-day mortality was 0.88 (95% CI, 0.80–0.97) compared with before implementation. However, the mortality rate trends were not significantly different before and after RCC implementation. The mean duration of mechanical ventilation and hospital stay also did not demonstrate incrementally greater declines after implementation. Conclusions RCC implementation was associated with changes in practice and a 12% to 15% reduction in the odds of short-term mortality. However, these findings may represent an evaluation of changes in practices and outcomes still in the mid

  9. Post-licensure safety surveillance study of routine use of tetanus toxoid, reduced diphtheria toxoid and 5-component acellular pertussis vaccine

    PubMed Central

    Baxter, Roger; Hansen, John; Timbol, Julius; Pool, Vitali; Greenberg, David P.; Johnson, David R.; Decker, Michael D.

    2016-01-01

    ABSTRACT An observational post-licensure (Phase IV) retrospective large-database safety study was conducted at Kaiser Permanente, a US integrated medical care organization, to assess the safety of Tetanus Toxoid, Reduced Diphtheria Toxoid and 5-Component Acellular Pertussis Vaccine (Tdap5) administered as part of routine healthcare among adolescents and adults. We evaluated incidence rates of various clinical events resulting in outpatient clinic, emergency department (ED), and hospital visits during various time intervals (windows) following Tdap5 vaccination using 2 pharmacoepidemiological methods (risk interval and historic cohort) and several screening thresholds. Plausible outcomes of interest with elevated incidence rate ratios (IRRs) were further evaluated by reviewing individual patient records to confirm the diagnosis, timing (temporal relationship), alternative etiology, and other health record details to discern possible relatedness of the health events to vaccination. Overall, 124,139 people received Tdap5 vaccine from September 2005 through mid-October 2006, and 203,154 in the comparison cohort received a tetanus and diphtheria toxoid adsorbed vaccine (and no live virus vaccine) during the year prior to initiation of this study. In the outpatient, ED and hospital databases, respectively, we identified 11/26, 179/700 and 187/700 unique health outcomes with IRRs significantly >1.0. Among the same unique health outcomes in the outpatient, ED, and hospital databases, 9, 146, and 385, respectively, had IRRs significantly <1.0. Further scrutiny of the outcomes with elevated IRRs did not reveal unexpected signals of adverse outcomes related to vaccination. In conclusion, Tdap5 vaccine was found to be safe among this large population of adolescents and adults. PMID:27388557

  10. Longitudinal Change in Mammographic Density among ER-Positive Breast Cancer Patients Using Tamoxifen.

    PubMed

    Nyante, Sarah J; Sherman, Mark E; Pfeiffer, Ruth M; Berrington de Gonzalez, Amy; Brinton, Louise A; Bowles, Erin J Aiello; Hoover, Robert N; Glass, Andrew; Gierach, Gretchen L

    2016-01-01

    Tamoxifen-associated mammographic density (MD) reductions are linked to improved breast cancer survival. We evaluated MD at six time points to determine the timing of greatest reduction following tamoxifen initiation. We sampled 40 Kaiser Permanente Northwest estrogen receptor (ER)-positive breast cancer patients from a prior study of MD change, according to tamoxifen use duration and age at diagnosis: <4 years tamoxifen and ≤50 years (N = 6) or >50 years (N = 10) old; ≥4 years tamoxifen and ≤50 years (N = 13) or >50 years (N = 11) old. A single reader evaluated percent MD in the contralateral breast on baseline (pre-diagnosis) and five approximately yearly post-diagnostic (T1 to T5) mammograms. Mean MD change was calculated. Interactions with age (≤50 and >50 years), tamoxifen duration (<4 and ≥4 years), and baseline MD (tertiles) were tested in linear regression models. Overall, the largest MD decline occurred by T1 (mean 4.5%) with little additional decline by T5. Declines differed by tertile of baseline MD (Pinteraction < 0.01). In the highest tertile, the largest reduction occurred by T1 (mean 14.9%), with an additional reduction of 3.6% by T5. Changes were smaller in the middle and lowest baseline MD tertiles, with cumulative reductions of 3.0% and 0.4% from baseline to T5, respectively. There were no differences by age (Pinteraction = 0.36) or tamoxifen duration (Pinteraction = 0.42). Among ER-positive patients treated with tamoxifen and surviving ≥5 years, most of the MD reduction occurred within approximately 12 months of tamoxifen initiation, suggesting that MD measurement at a single time point following tamoxifen initiation can identify patients with substantial density declines.

  11. Elevated BP after AKI.

    PubMed

    Hsu, Chi-yuan; Hsu, Raymond K; Yang, Jingrong; Ordonez, Juan D; Zheng, Sijie; Go, Alan S

    2016-03-01

    The connection between AKI and BP elevation is unclear. We conducted a retrospective cohort study to evaluate whether AKI in the hospital is independently associated with BP elevation during the first 2 years after discharge among previously normotensive adults. We studied adult members of Kaiser Permanente Northern California, a large integrated health care delivery system, who were hospitalized between 2008 and 2011, had available preadmission serum creatinine and BP measures, and were not known to be hypertensive or have BP>140/90 mmHg. Among 43,611 eligible patients, 2451 experienced AKI defined using observed changes in serum creatinine concentration measured during hospitalization. Survivors of AKI were more likely than those without AKI to have elevated BP--defined as documented BP>140/90 mmHg measured during an ambulatory, nonemergency department visit--during follow-up (46.1% versus 41.2% at 730 days; P<0.001). This difference was evident within the first 180 days (30.6% versus 23.1%; P<0.001). In multivariable models, AKI was independently associated with a 22% (95% confidence interval, 12% to 33%) increase in the odds of developing elevated BP during follow-up, with higher adjusted odds with more severe AKI. Results were similar in sensitivity analyses when elevated BP was defined as having at least two BP readings of >140/90 mmHg or those with evidence of CKD were excluded. We conclude that AKI is an independent risk factor for subsequent development of elevated BP. Preventing AKI during a hospitalization may have clinical and public health benefits beyond the immediate hospitalization.

  12. Real-World Experiences With a Direct-Acting Antiviral Agent for Patients With Hepatitis C Virus Infection

    PubMed Central

    Louie, Vincent; Latt, Nyan L; Gharibian, Derenik; Sahota, Amandeep; Yanny, Beshoy T; Mittal, Rasham; Bider-Canfield, Zoe; Cheetham, T Craig

    2017-01-01

    Context Traditional hepatitis C virus treatment was limited by low cure rates, side effects, and stringent monitoring requirements. Sofosbuvir, a direct-acting antiviral agent with a cure rate of 96%, was introduced in 2013. However, trials frequently excluded patients with advanced liver disease and prior treatment experience. This study aims to elucidate the real-world cure rates and sofosbuvir safety profile. Methods A retrospective cohort study was conducted at Kaiser Permanente Southern California involving patients with hepatitis C virus who received sofosbuvir treatment. Patients age 18 years and older were included, and pregnant patients were excluded. The primary end point was sustained virologic response at 12 weeks posttreatment. Secondary end points were safety and medication adherence. Multiple logistic regression analysis was used to compare patients with genotypes 1 and 2 infections. Results Of the 213 study patients, 42.3% had cirrhosis, and 38% were treatment-experienced. Most patients (69.5%) received dual therapy (sofosbuvir + ribavirin), whereas the remainder (30.5%) received triple therapy (sofosbuvir + ribavirin + interferon). The overall rate of sustained virologic response at 12 weeks posttreatment rate was 72.9% for genotype 1 infection, 64.7% in the treatment-experienced subgroup, and 66.7% in the cirrhosis subgroup. Rates of sustained virologic response at 12 weeks posttreatment for genotypes 2 and 3 were 90.8% and 55%, respectively. Most patients experienced anemia and fatigue. Women and patients with a lower baseline viral load were statistically more likely to be cured. Conclusion Real-world cure rates were similar to rates seen in clinical trials for genotype 2 infection and lower for genotype 1 infection. Patients with genotype 1 and 3 infection did better with triple therapy compared with dual therapy. Patients tolerated therapy well with side effects, serious adverse events, and discontinuation rates similar to clinical trials

  13. Elevated BP after AKI

    PubMed Central

    Hsu, Raymond K.; Yang, Jingrong; Ordonez, Juan D.; Zheng, Sijie; Go, Alan S.

    2016-01-01

    The connection between AKI and BP elevation is unclear. We conducted a retrospective cohort study to evaluate whether AKI in the hospital is independently associated with BP elevation during the first 2 years after discharge among previously normotensive adults. We studied adult members of Kaiser Permanente Northern California, a large integrated health care delivery system, who were hospitalized between 2008 and 2011, had available preadmission serum creatinine and BP measures, and were not known to be hypertensive or have BP>140/90 mmHg. Among 43,611 eligible patients, 2451 experienced AKI defined using observed changes in serum creatinine concentration measured during hospitalization. Survivors of AKI were more likely than those without AKI to have elevated BP—defined as documented BP>140/90 mmHg measured during an ambulatory, nonemergency department visit—during follow-up (46.1% versus 41.2% at 730 days; P<0.001). This difference was evident within the first 180 days (30.6% versus 23.1%; P<0.001). In multivariable models, AKI was independently associated with a 22% (95% confidence interval, 12% to 33%) increase in the odds of developing elevated BP during follow-up, with higher adjusted odds with more severe AKI. Results were similar in sensitivity analyses when elevated BP was defined as having at least two BP readings of >140/90 mmHg or those with evidence of CKD were excluded. We conclude that AKI is an independent risk factor for subsequent development of elevated BP. Preventing AKI during a hospitalization may have clinical and public health benefits beyond the immediate hospitalization. PMID:26134154

  14. Heritability of longitudinal changes in coronary-heart-disease risk factors in women twins.

    PubMed Central

    Friedlander, Y; Austin, M A; Newman, B; Edwards, K; Mayer-Davis, E I; King, M C

    1997-01-01

    Numerous studies have demonstrated genetic influences on levels of coronary heart disease (CHD) risk factors, but there also may be genetic effects on the intraindividual variation in these risk factors over time. Changes in risk factors are likely to reflect genetic-environmental interactions and may have important implications for understanding CHD risk. The present study examines the heritability of changes in CHD risk factors, using data from the two examinations by the Kaiser Permanente Women Twins Study, performed a decade apart. The sample consisted of 348 pairs of women twins who participated in both examinations, including 203 MZ pairs and 145 DZ pairs. Average ages at the two examinations were 41 and 51 years, respectively. By means of three different statistical analytic approaches, moderate heritability estimates were demonstrated for changes in LDL cholesterol (h2 = .25-.36) and in HDL cholesterol (h2 = .23-.58), some of which were statistically significant. Although small to moderate heritability estimates were found for systolic blood pressure (.18-.37; P < .05 for some estimates), no genetic influence on changes in diastolic blood pressure was detected. Based on longitudinal twin data in women, this study demonstrates a genetic influence on changes in both lipoprotein risk factors and systolic blood pressure over a decade. In addition to environmental factors, which clearly are operating, the effect of various "variability genes" may be acting independently of the genetic influences on the absolute levels of these risk factors. Both mapping the gene(s) underlying intraindividual variations in these CHD risk factors and understanding their function(s) could lead to targeted intervention strategies to reduce CHD risk among genetically susceptible individuals. PMID:9199573

  15. Mendelian randomization shows a causal effect of low vitamin D on multiple sclerosis risk

    PubMed Central

    Rhead, Brooke; Bäärnhielm, Maria; Gianfrancesco, Milena; Mok, Amanda; Shao, Xiaorong; Quach, Hong; Shen, Ling; Schaefer, Catherine; Link, Jenny; Gyllenberg, Alexandra; Hedström, Anna Karin; Olsson, Tomas; Hillert, Jan; Kockum, Ingrid; Glymour, M. Maria; Alfredsson, Lars

    2016-01-01

    Objective: We sought to estimate the causal effect of low serum 25(OH)D on multiple sclerosis (MS) susceptibility that is not confounded by environmental or lifestyle factors or subject to reverse causality. Methods: We conducted mendelian randomization (MR) analyses using an instrumental variable (IV) comprising 3 single nucleotide polymorphisms found to be associated with serum 25(OH)D levels at genome-wide significance. We analyzed the effect of the IV on MS risk and both age at onset and disease severity in 2 separate populations using logistic regression models that controlled for sex, year of birth, smoking, education, genetic ancestry, body mass index at age 18–20 years or in 20s, a weighted genetic risk score for 110 known MS-associated variants, and the presence of one or more HLA-DRB1*15:01 alleles. Results: Findings from MR analyses using the IV showed increasing levels of 25(OH)D are associated with a decreased risk of MS in both populations. In white, non-Hispanic members of Kaiser Permanente Northern California (1,056 MS cases and 9,015 controls), the odds ratio (OR) was 0.79 (p = 0.04, 95% confidence interval (CI): 0.64–0.99). In members of a Swedish population from the Epidemiological Investigation of Multiple Sclerosis and Genes and Environment in Multiple Sclerosis MS case-control studies (6,335 cases and 5,762 controls), the OR was 0.86 (p = 0.03, 95% CI: 0.76–0.98). A meta-analysis of the 2 populations gave a combined OR of 0.85 (p = 0.003, 95% CI: 0.76–0.94). No association was observed for age at onset or disease severity. Conclusions: These results provide strong evidence that low serum 25(OH)D concentration is a cause of MS, independent of established risk factors. PMID:27652346

  16. Age-stratified 5-year risks of cervical precancer among women with enrollment and newly detected HPV infection.

    PubMed

    Gage, Julia C; Katki, Hormuzd A; Schiffman, Mark; Fetterman, Barbara; Poitras, Nancy E; Lorey, Thomas; Cheung, Li C; Castle, Philip E; Kinney, Walter K

    2015-04-01

    It is unclear whether a woman's age influences her risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) upon detection of HPV. A large change in risk as women age would influence vaccination and screening policies. Among 972,029 women age 30-64 undergoing screening with Pap and HPV testing (Hybrid Capture 2, Qiagen, Germantown, MD) at Kaiser Permanente Northern California (KPNC), we calculated age-specific 5-year CIN3+ risks among women with HPV infections detected at enrollment, and among women with "newly detected" HPV infections at their second screening visit. Women (57,899, 6.0%) had an enrollment HPV infection. Among the women testing HPV negative at enrollment with a second screening visit, 16,724 (3.3%) had a newly detected HPV infection at their second visit. Both enrollment and newly detected HPV rates declined with age (p < 0.001). Women with enrollment versus newly detected HPV infection had higher 5-year CIN3+ risks: 8.5% versus 3.9%, (p < 0.0001). Risks did not increase with age but declined slightly from 30-34 years to 60-64 years: 9.4% versus 7.4% (p = 0.017) for enrollment HPV and 5.1% versus 3.5% (p = 0.014) for newly detected HPV. Among women age 30-64 in an established screening program, women with newly detected HPV infections were at lower risk than women with enrollment infections, suggesting reduced benefit vaccinating women at older ages. Although the rates of HPV infection declined dramatically with age, the subsequent CIN3+ risks associated with HPV infection declined only slightly. The CIN3+ risks among older women are sufficiently elevated to warrant continued screening through age 65.

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

    PubMed Central

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

    2011-01-01

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

  18. Understanding Panel Management: A Comparative Study of an Emerging Approach to Population Care

    PubMed Central

    Neuwirth, Esther (Estee) B; Schmittdiel, Julie A; Tallman, Karen; Bellows, Jim

    2007-01-01

    Context: Panel management is an innovative approach for population care that is tightly linked with primary care. This approach, which is spreading rapidly across Kaiser Permanente, represents an important shift in population-care structure and emphasis, but its potential and implications have not been previously studied. Objective: To inform the ongoing spread of panel management by providing an early understanding of its impact on patients, physicians, and staff and to identify barriers and facilitators. Design: Qualitative studies at four sites, including patient focus groups, physician and staff interviews, and direct observation. Findings: Panel management allows primary care physicians to use dedicated time to direct proactive care for their patients, uses staff support to conduct outreach, and leverages new panel-based information technology tools. Patients reported appreciating the panel management outreach, although some also reported coordination issues. Two of four study sites seemed to provide a more coordinated patient experience of care; factors common to these sites included longer maturation of their panel management programs and a more circumscribed role for outreach staff. Some physicians reported tension in the approach's implementation: All believed that panel management improved care for their patients but many also expressed feeling that the approach added more tasks to their already busy days. Challenges yet to be fully addressed include providing program oversight to monitor for safe and reliable coordination of care and incorporation of self-management support. Conclusion: Subsequent spread of panel management should be informed by these lessons and findings from early adopters and should include continued monitoring of the impact of this rapidly developing approach on quality, patient satisfaction, primary care sustainability, and cost. PMID:21461107

  19. Genotyping Informatics and Quality Control for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort

    PubMed Central

    Kvale, Mark N.; Hesselson, Stephanie; Hoffmann, Thomas J.; Cao, Yang; Chan, David; Connell, Sheryl; Croen, Lisa A.; Dispensa, Brad P.; Eshragh, Jasmin; Finn, Andrea; Gollub, Jeremy; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H.; Lao, Richard; Lu, Yontao; Ludwig, Dana; Mathauda, Gurpreet K.; McGuire, William B.; Mei, Gangwu; Miles, Sunita; Mittman, Michael; Patil, Mohini; Quesenberry, Charles P.; Ranatunga, Dilrini; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C.; Shapero, Michael; Shen, Ling; Shenoy, Tanu; Smethurst, David; Somkin, Carol P.; Van Den Eeden, Stephen K.; Walter, Lawrence; Wan, Eunice; Webster, Teresa; Whitmer, Rachel A.; Wong, Simon; Zau, Chia; Zhan, Yiping; Schaefer, Catherine; Kwok, Pui-Yan; Risch, Neil

    2015-01-01

    The Kaiser Permanente (KP) Research Program on Genes, Environment and Health (RPGEH), in collaboration with the University of California—San Francisco, undertook genome-wide genotyping of >100,000 subjects that constitute the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. The project, which generated >70 billion genotypes, represents the first large-scale use of the Affymetrix Axiom Genotyping Solution. Because genotyping took place over a short 14-month period, creating a near-real-time analysis pipeline for experimental assay quality control and final optimized analyses was critical. Because of the multi-ethnic nature of the cohort, four different ethnic-specific arrays were employed to enhance genome-wide coverage. All assays were performed on DNA extracted from saliva samples. To improve sample call rates and significantly increase genotype concordance, we partitioned the cohort into disjoint packages of plates with similar assay contexts. Using strict QC criteria, the overall genotyping success rate was 103,067 of 109,837 samples assayed (93.8%), with a range of 92.1–95.4% for the four different arrays. Similarly, the SNP genotyping success rate ranged from 98.1 to 99.4% across the four arrays, the variation depending mostly on how many SNPs were included as single copy vs. double copy on a particular array. The high quality and large scale of genotype data created on this cohort, in conjunction with comprehensive longitudinal data from the KP electronic health records of participants, will enable a broad range of highly powered genome-wide association studies on a diversity of traits and conditions. PMID:26092718

  20. Can All Doctors Be Like This? Seven Stories of Communication Transformation Told by Physicians Rated Highest by Patients

    PubMed Central

    Janisse, Tom; Tallman, Karen

    2017-01-01

    Introduction: The top predictors of patient satisfaction with clinical visits are the quality of the physician-patient relationship and the communications contributing to their relationship. How do physicians improve their communication, and what effect does it have on them? This article presents the verbatim stories of seven high-performing physicians describing their transformative change in the areas of communication, connection, and well-being. Methods: Data for this study are based on interviews from a previous study in which a 6-question set was posed, in semistructured 60-minute interviews, to 77 of the highest-performing Permanente Medical Group physicians in 4 Regions on the “Art of Medicine” patient survey. Transformation stories emerged spontaneously during the interviews, and so it was an incidental finding when some physicians identified that they were not always high performing in their communication with patients. Results: Seven different modes of transformation in communication were described by these physicians: a listening tool, an awareness course, finding new meaning in clinical practice, a technologic tool, a sudden insight, a mentor observation, and a physician-as-patient experience. Discussion: These stories illustrate how communication skills can be learned through various activities and experiences that transform physicians into those who are highly successful communicators. All modes result in a change of state—a new way of seeing, of being—and are not just a new tool or a new practice, but a change in state of mind. This state resulted in a marked change of behavior, and a substantial improvement of communication and relationship. PMID:28333605

  1. Design thinking.

    PubMed

    Brown, Tim

    2008-06-01

    In the past, design has most often occurred fairly far downstream in the development process and has focused on making new products aesthetically attractive or enhancing brand perception through smart, evocative advertising. Today, as innovation's terrain expands to encompass human-centered processes and services as well as products, companies are asking designers to create ideas rather than to simply dress them up. Brown, the CEO and president of the innovation and design firm IDEO, is a leading proponent of design thinking--a method of meeting people's needs and desires in a technologically feasible and strategically viable way. In this article he offers several intriguing examples of the discipline at work. One involves a collaboration between frontline employees from health care provider Kaiser Permanente and Brown's firm to reengineer nursing-staff shift changes at four Kaiser hospitals. Close observation of actual shift changes, combined with brainstorming and rapid prototyping, produced new procedures and software that radically streamlined information exchange between shifts. The result was more time for nursing, better-informed patient care, and a happier nursing staff. Another involves the Japanese bicycle components manufacturer Shimano, which worked with IDEO to learn why 90% of American adults don't ride bikes. The interdisciplinary project team discovered that intimidating retail experiences, the complexity and cost of sophisticated bikes, and the danger of cycling on heavily trafficked roads had overshadowed people's happy memories of childhood biking. So the team created a brand concept--"Coasting"--to describe a whole new category of biking and developed new in-store retailing strategies, a public relations campaign to identify safe places to cycle, and a reference design to inspire designers at the companies that went on to manufacture Coasting bikes.

  2. Perceived psychosocial stress and gestational weight gain among women with gestational diabetes

    PubMed Central

    Kubo, Ai; Ferrara, Assiamira; Brown, Susan D.; Ehrlich, Samantha F.; Tsai, Ai-Lin; Quesenberry, Charles P.; Crites, Yvonne; Hedderson, Monique M.

    2017-01-01

    Growing evidence links perceived stress—a potentially modifiable psychosocial risk factor—with health behaviors and obesity. Yet little is known about the relationship between stress during pregnancy and gestational weight gain, particularly among women with pregnancy complications. We conducted a cross-sectional analysis to examine associations between psychosocial stress during pregnancy and gestational weight gain among women with gestational diabetes. We used baseline data from the Gestational Diabetes’s Effects on Moms (GEM) study: 1,353 women with gestational diabetes who delivered a term singleton within Kaiser Permanente Northern California were included. Perceived stress near the time of gestational diabetes diagnosis was measured using the validated Perceived Stress Scale (PSS10). Gestational weight gain was categorized according to the 2009 Institute of Medicine recommendations. Binomial regression analyses adjusted for gestational age and maternal age at the time of gestational diabetes diagnosis, and race/ethnicity and estimated rate ratios (RR) and their 95% confidence interval (CI). Among women with a normal pregravid Body Mass Index (BMI 18.5–24.9 kg/m2), there was a significant association between high (Q4) PSS score and risk of both exceeding and gaining below the Institute of Medicine recommendations compared to those with lower stress (Q1) [adjusted RR = 2.16 95% CI 1.45–3.21; RR = 1.39 95% CI 1.01–1.91, respectively.] Among women with pregravid overweight/obesity (BMI≥25 kg/m2), there was no association. Although the temporal relationship could not be established from this study, there may be a complex interplay between psychosocial stress and gestational weight gain among women with gestational diabetes. Further studies examining stress earlier in pregnancy, risk of developing gestational diabetes and excess/inadequate gestational weight gain are warranted to clarify these complex relationships. PMID:28350836

  3. Understanding Faculty and Trainee Needs Related to Scholarly Activity in a Large, Nonuniversity Graduate Medical Education Program

    PubMed Central

    Becker, Davida; Garth, Hanna; Hollander, Rachel; Klein, Felice; Klau, Marc

    2017-01-01

    Context: Graduate medical education (GME) programs must develop curriculum to ensure scholarly activity among trainees and faculty to meet accreditation requirements and to support evidence-based medicine. Objective: Test whether research-related needs and interests varied across four groups: primary care trainees, specialty trainees, primary care faculty, and specialty faculty. Design: We surveyed a random sample of trainees and faculty in Kaiser Permanente Southern California’s GME programs. We investigated group differences in outcomes using Fisher exact and Kruskal-Wallis tests. Main Outcome Measures: Research experiences, skills, barriers, motivators, and interests in specific research skills development. Results: Participants included 47 trainees and 26 faculty (response rate = 30%). Among primary care faculty, 12 (71%) reported little or no research experience vs 1 (11%) for specialty faculty, 14 (41%) for primary care trainees, and 1 (8%) for specialty trainees (p < 0.001). Submission of research to the institutional review board, an abstract to a conference, or a manuscript for publication in the previous year varied across groups (p = 0.001, p = 0.003, and p < 0.001, respectively). Overall self-reported research skills also differed across groups (p < 0.001). Primary care faculty reported the lowest skill level. Research barriers that differed across groups included other work roles taking priority; desire for work-life balance; and lack of managerial support, research equipment, administrative support, and funding. Conclusion: Faculty and trainees in primary care and specialties have differing research-related needs that GME programs should consider when designing curricula to support scholarly activity. Developing research skills of primary care faculty is a priority to support trainees’ scholarly activity. PMID:28333607

  4. Reproductive Health Outcomes of Insured Women Who Access Oral Levonorgestrel Emergency Contraception

    PubMed Central

    Raine-Bennett, Tina; Merchant, Maqdooda; Sinclair, Fiona; Lee, Justine W.; Goler, Nancy

    2015-01-01

    Objectives To assess the level of risk for women who seek emergency contraception through various clinical routes and the opportunities for improved care provision. Methods This study looked at a retrospective cohort to assess contraception and other reproductive health outcomes among women aged 15-44 who accessed oral levonorgestrel emergency contraception through an office visit or the call center at Kaiser Permanente Northern California from 2010 to 2011. Results Of 21,421 prescriptions, 14,531(67.8%) were accessed through the call center. In the subsequent 12 months, 12,127(56.6%) women had short-acting contraception (pills, patches, rings, depot medroxyprogesterone) dispensed and 2,264(10.6%) initiated very effective contraception (intrauterine contraception, implants, sterilization). Initiation of very effective contraception was similar for women who accessed it through the call center -1,569(10.8%) and office visits – 695(10.1%) (adjusted OR 1.02 95% confidence interval (CI) 0.93-1.13). In the subsequent 6 months, 2,056(9.6%) women became pregnant. Women who accessed emergency contraception through the call center were less likely to become pregnant within 3 months of accessing emergency contraception than woman who accessed it through office visits (adjusted OR 0.82 95% CI 0.72-0.94); however they were more likely to become pregnant within 4-6 months (adjusted OR 1.37 95%CI 1.16-1.60). Among women who were tested for chlamydia and gonorrhea, 689(7.8%) and 928(7.9%) were positive in the 12 months before and after accessing emergency contraception, respectively. Conclusions Protocols to routinely address unmet need for contraception at every call for emergency contraception and all office visits including visits with primary care providers should be investigated. PMID:25751211

  5. Population Variations in Rheumatoid Arthritis Treatment and Outcomes, Northern California, 1998–2009

    PubMed Central

    Herrinton, Lisa J; Harrold, Leslie; Salman, Craig; Liu, Liyan; Goldfien, Robert; Asgari, Maryam; Gelfand, Joel M; Wu, Jashin J; Curtis, Jeffrey R

    2016-01-01

    Objective: To assess variations in rheumatoid arthritis treatment and outcomes at the community level from 1998 through 2009. Methods: The study used computerized data from 16 Kaiser Permanente Northern California Medical Centers. Mixed modeling was used to assess patterns across time and clinic. The analysis accounted for patient demographics, clustering of patients within Medical Centers, and repeated measures of patients over time. The metric used to measure drug use, months of use per patient per year, included both users and nonusers in the denominator, to account for both prevalence and duration of use. Results: Assessment was performed of 28,601 patients with rheumatoid arthritis, with all levels of severity. From 1998 through 2009, methotrexate use doubled in the typical patient to include 23% of the time they were observed; sulfasalazine and hydrochloroquine use declined. By 2008 through 2009, leflunomide and antitumor necrosis factor agents were used by the typical patient 4% and 9% of the time, respectively. Between 1998 and 2009, disease-modifying antirheumatic drug use increased in the typical patient from 38% to 63% of the time, and oral prednisone use declined from 23% to 15% of the time, whereas opioid use initially rose but then fell to 23% of the time. No variations over time were observed for the rate of hospitalized pneumonia or opportunistic infection. Variation across clinics, measured by the difference in drug use between clinics at the 75th and 25th percentiles, was lowest for opioids (25% vs 20% of the time) and greatest for infliximab (< 1% to 3%). Conclusion: Increased use of disease-modifying antirheumatic drugs and declines in prednisone are encouraging. Opioid use may need intervention. PMID:26694020

  6. Complementary and Alternative Therapy Use Before and After Breast Cancer Diagnosis: The Pathways Study

    PubMed Central

    Greenlee, Heather; Kwan, Marilyn L.; Ergas, Isaac Joshua; Sherman, Karen J.; Krathwohl, Sarah E.; Bonnell, Christine; Lee, Marion M.; Kushi, Lawrence H.

    2010-01-01

    Background Many women use complementary and alternative medicine (CAM) to maintain or improve their health. We describe CAM use among the first 1,000 participants enrolled in the Pathways Study, an ongoing prospective cohort study of women diagnosed with breast cancer (BC). Methods Participants, identified by rapid case ascertainment in Kaiser Permanente Northern California, are women ≥21 years diagnosed with first invasive BC. Comprehensive baseline data are collected on CAM use through in-person interviews. Results Study participants include 70.9% non-Hispanic whites, 10.2% Hispanics, 9.0% Asians, 6.5% African-Americans, and 3.4% others. Most women (82.2%) were diagnosed with AJCC stage I/II BC, at average (±SD) age 59.5 (±12.0) years and reported prior use of at least one form of CAM (96.5% of participants). In the five years before diagnosis, CAM therapies used at least weekly by >20% of women included green tea, glucosamine, omega-3 fatty acids, prayer and religion. CAM use was high (86.1% of participants) in the period immediately following diagnosis; 47.5% used botanical supplements, 47.2% used other natural products, 28.8% used special diets, 64.2% used mind-body healing, and 26.5% used body/energy/other treatments. In multivariable analyses, frequent use of each CAM modality before and after diagnosis was associated with use of other CAM modalities and other health behaviors (i.e., high fruit/vegetable intake, lower BMI). Conclusions CAM use before and after BC diagnosis is common in this diverse group of women. Our results emphasize the need for clinicians to discuss CAM use with all BC patients. PMID:19184414

  7. Rubber dam use during routine operative dentistry procedures: findings from the dental PBRN.

    PubMed

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

    2013-04-01

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

  8. Profil épidémiologique de l'insuffisance rénale terminale à l'hôpital Militaire de Rabat, Maroc

    PubMed Central

    Asserraji, Mohammed; Maoujoud, Omar; Belarbi, Marouane; Oualim, Zouhir

    2015-01-01

    L'Insuffisance rénale chronique terminale (IRCT) est un enjeu majeur de sante publique au Maroc à cause de ses conséquences médicales et socioéconomiques. L'objectif de ce travail est d’évaluer le profil épidémiologique de l'IRCT à l'hôpital militaire de rabat, Maroc. Il s'agit d'une enquête rétrospective pendant quatre ans (1er janvier 2007 au 31 décembre 2010). Tous les cas d'IRCT (diminution permanente du débit de filtration glomérulaire (DFG) < 15 ml/min/1.73m2, pendant ≥ 3 mois) ont été inclus. 203 patients ont commencé la dialyse durant cette période, 130 hommes (64%) et 73 femmes (36%), l’âge moyen était de 49,92 ans (06 - 80 ans). la néphropathie d'origine indéterminée représente la première cause d'IRCT dans notre série (27,1%) suivie de la néphropathie diabétique (24,6%), des glomérulonéphrites chroniques (22,7) et de la néphropathie d'origine vasculaire (10,8%). 131 patients (64,5%) n'ont pas eu de suivi néphrologique pré dialytique. une prise en charge globale de cette pathologie est nécessaire. PMID:26309471

  9. Impact of a Care Directives Activity Tab in the Electronic Health Record on Documentation of Advance Care Planning

    PubMed Central

    Turley, Marianne; Wang, Susan; Meng, Di; Kanter, Michael; Garrido, Terhilda

    2016-01-01

    Context: To ensure patient-centered end-of-life care, advance care planning (ACP) must be documented in the medical record and readily retrieved across care settings. Objective: To describe use of the Care Directives Activity tab (CDA), a single-location feature in the electronic health record for collecting and viewing ACP documentation in inpatient and ambulatory care settings, and to assess its association with ACP documentation rates. Design: Retrospective pre- and postimplementation analysis in 2012 and 2013 at Kaiser Permanente Southern California among 113,309 patients aged 65 years and older with ACP opportunities during outpatient or inpatient encounters. Main Outcome Measures: Providers’ CDA use rates and documentation rates of advance directives and physician orders for life-sustaining treatments stratified by CDA use. Results: Documentation rates of advance directives and physician orders for life-sustaining treatments among patients with outpatient and inpatient encounters were 3.5 to 9.6 percentage points higher for patients with CDA use vs those without it. The greatest differences were for orders for life-sustaining treatments among patients with inpatient encounters and for advance directives among patients with outpatient encounters; both were 9.6 percentage points higher among those with CDA use than those without it. All differences were significant after controlling for yearly variation (p < 0.001). Conclusion: Statistically significant differences in documentation rates between patients with and without CDA use suggest the potential of a standardized location in the electronic health record to improve ACP documentation. Further research is required to understand effects of CDA use on retrieval of preferences and end-of-life care. PMID:27057820

  10. Painful diabetic peripheral neuropathy in a managed care setting: patient identification, prevalence estimates, and pharmacy utilization patterns.

    PubMed

    Hartsfield, Cynthia L; Korner, Eli J; Ellis, Jennifer L; Raebel, Marsha A; Merenich, John; Brandenburg, Nancy

    2008-12-01

    The objectives of this study were to validate an algorithm for identifying patients with painful diabetic peripheral neuropathy (pDPN) and demonstrate its practical applications. Using the Kaiser Permanente Colorado Diabetes Registry, an algorithm was developed with selected ICD-9 diagnosis codes combined with automated pharmacy data for medications prescribed for pDPN symptoms. Medical records were reviewed to confirm pDPN presence and to inform algorithm refinement. Prevalence was estimated with a numerator of members with diabetes who had inclusion but no exclusion codes in 2003 (Method 1) and with a numerator of diabetes patients with inclusion codes between 1998 and 2003 who had no subsequent exclusion codes and who remained members in 2003 (Method 2); the denominator was all members with diabetes in 2003. Medication utilization was compared between patients with and without pDPN. A total of 19,577 members with diabetes were identified; 2612 met initial inclusion criteria. Medical record review (n = 298) demonstrated sensitivity of 94%, specificity of 55%, and positive predictive value (PPV) of 64%. Inclusion criteria were modified and pharmacy data eliminated. The revised algorithm identified 1754 additional patients meeting inclusion criteria. Medical record review (n = 190) demonstrated sensitivity of 99%, specificity of 49%, and PPV of 79%. Using the validated algorithm, pDPN prevalence was 113 (Method 1) and 208 (Method 2) per 1000 persons with diabetes. Significant differences were observed in medication prescriptions between patients with and without pDPN. Estimated pDPN prevalence among persons with diabetes was 11%-21% and pDPN patients had greater utilization of selected medications than those without pDPN. Identifying patients with pDPN is a fundamental step for improving disease management and understanding the economic impact of pDPN.

  11. Pregravid Liver Enzyme Levels and Risk of Gestational Diabetes Mellitus During a Subsequent Pregnancy

    PubMed Central

    Xu, Fei; Darbinian, Jeanne; Quesenberry, Charles P.; Ferrara, Assiamira; Hedderson, Monique M.

    2014-01-01

    OBJECTIVE Liver enzymes are independent predictors of type 2 diabetes. Although liver fat content correlates with features of insulin resistance, a risk factor for developing gestational diabetes mellitus (GDM), the relationship between liver enzymes and GDM is unclear. The objective of this study was to assess whether pregravid liver enzyme levels are associated with subsequent risk of GDM. RESEARCH DESIGN AND METHODS A nested case-control study was conducted among women who participated in the Kaiser Permanente Northern California multiphasic health checkup (1984–1996) and had a subsequent pregnancy (1984–2009). Case patients were 256 women who developed GDM. Two control subjects were selected for each case patient and matched for year of blood draw, age at examination, age at pregnancy, and number of intervening pregnancies. RESULTS Being in the highest quartile versus the lowest quartile of γ-glutamyl transferase (GGT) levels was associated with a twofold increased risk of subsequent GDM (odds ratio 1.97 [95% CI 1.14–3.42]), after adjusting for race/ethnicity, prepregnancy BMI, family history of diabetes, and alcohol use. This result was attenuated after adjusting for homeostasis model assessment of insulin resistance (HOMA-IR), fasting status, and rate of gestational weight gain. There was significant interaction between GGT and HOMA-IR; the association with GGT was found among women in the highest tertile of HOMA-IR. Aspartate aminotransferase and alanine aminotransferase were not associated with increased GDM risk. CONCLUSIONS Pregravid GGT level, but not alanine aminotransferase or aspartate aminotransferase level, predicted the subsequent risk of GDM. Markers of liver fat accumulation, such as GGT level, are present years before pregnancy and may help to identify women at increased risk for subsequent GDM. PMID:24795397

  12. An Automated Method for Identifying Individuals with a Lung Nodule Can Be Feasibly Implemented Across Health Systems

    PubMed Central

    Farjah, Farhood; Halgrim, Scott; Buist, Diana S.M.; Gould, Michael K.; Zeliadt, Steven B.; Loggers, Elizabeth T.; Carrell, David S.

    2016-01-01

    Introduction: The incidence of incidentally detected lung nodules is rapidly rising, but little is known about their management or associated patient outcomes. One barrier to studying lung nodule care is the inability to efficiently and reliably identify the cohort of interest (i.e. cases). Investigators at Kaiser Permanente Southern California (KPSC) recently developed an automated method to identify individuals with an incidentally discovered lung nodule, but the feasibility of implementing this method across other health systems is unknown. Methods: A random sample of Group Health (GH) members who had a computed tomography in 2012 underwent chart review to determine if a lung nodule was documented in the radiology report. A previously developed natural language processing (NLP) algorithm was implemented at our site using only knowledge of the key words, qualifiers, excluding terms, and the logic linking these parameters. Results: Among 499 subjects, 156 (31%, 95% confidence interval [CI] 27–36%) had an incidentally detected lung nodule. NLP identified 189 (38%, 95% CI 33–42%) individuals with a nodule. The accuracy of NLP at GH was similar to its accuracy at KPSC: sensitivity 90% (95% CI 85–95%) and specificity 86% (95% CI 82–89%) versus sensitivity 96% (95% CI 88–100%) and specificity 86% (95% CI 75–94%). Conclusion: Automated methods designed to identify individuals with an incidentally detected lung nodule can feasibly and independently be implemented across health systems. Use of these methods will likely facilitate the efficient conduct of multi-site studies evaluating practice patterns and associated outcomes. PMID:27668266

  13. A large multi-ethnic genome-wide association study of prostate cancer identifies novel risk variants and substantial ethnic differences

    PubMed Central

    Hoffmann, Thomas J.; Van Den Eeden, Stephen K.; Sakoda, Lori C.; Jorgenson, Eric; Habel, Laurel A.; Graff, Rebecca E.; Passarelli, Michael N.; Cario, Clinton L.; Emami, Nima C.; Chao, Chun R.; Ghai, Nirupa R.; Shan, Jun; Ranatunga, Dilrini K.; Quesenberry, Charles P.; Aaronson, David; Presti, Joseph; Zhaoming, Wang; Berndt, Sonja I.; Chanock, Stephen J.; McDonnell, Shannon K.; French, Amy J; Schaid, Daniel J; Thibodeau, Stephen N.; Li, Qiyuan; Freedman, Matthew L.; Penney, Kathryn L.; Mucci, Lorelei A.; Haiman, Christopher A.; Henderson, Brian E.; Seminara, Daniela; Kvale, Mark N.; Kwok, Pui-Yan; Schaefer, Catherine; Risch, Neil; Witte, John S.

    2015-01-01

    A genome-wide association study of prostate cancer in Kaiser Permanente health plan members (7,783 cases, 38,595 controls; 80.3% non-Hispanic white, 4.9% African-American, 7.0% East Asian, 7.8% Latino) revealed a new independent risk indel rs4646284 at the previously-identified locus 6q25.3 that replicated in PEGASUS (N=7,539) and MEC (N=4,679) (p=1.0×10−19, OR=1.18). Across the 6q25.3 locus, rs4646284 exhibited the strongest association with expression of SLC22A1 (p=1.3×10−23) and SLC22A3 (p=3.2×10−52). At the known 19q13.33 locus rs2659124 (p=1.3×10−13, OR=1.18) nominally replicated in PEGASUS. A risk score of 105 known risk SNPs was strongly associated with prostate cancer (p<1.0×10−8). Comparing the highest to lowest risk score deciles, the OR was 6.22 for non-Hispanic Whites, 5.82 for Latinos, 3.77 for African-Americans, and 3.38 for East Asians. In non-Hispanic whites, the 105 risk SNPs explained ~7.6% of disease heritability. The entire GWAS array explained ~33.4% of heritability, with a 4.3-fold enrichment within DNaseI hypersensitivity sites (p=0.004). PMID:26034056

  14. Incremental Benefits of Screening Colonoscopy over Sigmoidoscopy in Average-risk Populations: a model-driven analysis

    PubMed Central

    Jeon, Jihyoun; Meza, Rafael; Hazelton, William D.; Renehan, Andrew G.; Luebeck, E. Georg

    2015-01-01

    Purpose Screening colonoscopy and flexible sigmoidoscopy (FSG) reduce the risk of colorectal cancer (CRC), but the magnitude and duration of protection, particularly against right-sided cancer, remain uncertain. We computed the incremental benefit of colonoscopy over FSG using a validated mathematical model, which reflects colorectal neoplasia growth characteristics while allowing uncertainty in endoscopic detection and removal of adenomas. Methods We calibrated models of CRC incidence within a multistage clonal expansion framework to data from: (i) San Francisco-Oakland SEER registry (reference population); and (ii) FSG long-term follow up data from 50,757 individuals after a negative FSG in the Kaiser Permanente system. We compared the residual CRC risks after FSG with full-length colonoscopy. Results Our model mirrors trial data with 10-year CRC risk reductions after FSG screening at age 50 years of approximately one third; the optimal age for a ‘once-only’ FSG exam was between ages 50 to 60 years; and the greater benefit was for men compared with women. There were considerable incremental gains in reduction of CRC risk by colonoscopy compared with FSG with the greatest benefit for screening colonoscopy at age 50 years. These results held up against lowering the right-sided adenoma detection sensitivity by 30%, as well as reducing the curative efficacy of polypectomy throughout the colon. Conclusions Mathematical modeling of CRC screening, which takes account of important aspects of tumor biology, demonstrates superior risk reductions by colonoscopy over FSG. Our predictions provide further rationale for recommending screening colonoscopy in average-risk populations before the age of 60. PMID:25783458

  15. Reliability and Validity of a Survey to Measure Bowel Function and Quality of Life in Long-term Rectal Cancer Survivors

    PubMed Central

    Wendel, Christopher S.; Grant, Marcia; Herrinton, Lisa; Temple, Larissa K. F.; Hornbrook, Mark C.; McMullen, Carmit K.; Bulkley, Joanna E.; Altschuler, Andrea; Krouse, Robert S.

    2014-01-01

    Purpose Examine reliability and validity of a specialized health-related quality of life questionnaire for rectal cancer (RC) survivors (≥5 years post diagnosis). Methods We mailed 1,063 Kaiser Permanente (KP) RC survivors (313 ostomy, 750 anastomosis) a questionnaire containing the Modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O), SF-12v2, Duke–UNC Functional Social Support Questionnaire (FSSQ), and Memorial Sloan-Kettering Cancer Center Bowel Function Index (BFI). We adapted certain BFI items for use by subjects with intestinal ostomies. We evaluated reliability for all instruments with inter-item correlations and Cronbach’s alpha. We assessed construct validity only for the BFI in the ostomy group, because such use has not been reported. Results The overall response rate was 60.5% (577 respondents/953 eligible). Compared to nonresponders, participants were on average 2 years younger and more likely non-Hispanic white, resided in educationally nondeprived areas, and had KP membership through a group. The mCOH-QOL-O, SF-12, and FSSQ were found to be highly reliable for RC survivors. In the ostomy group, BFI Urgency/Soilage and Dietary subscales were found to be reliable, but Frequency was not. Factor analysis supported the construct of Urgency/Soilage and Dietary subscales in the ostomy group, although one item had a moderate correlation with all three factors. The BFI also demonstrated good concurrent validity with other instruments in the ostomy group. Conclusions With possible exception of the BFI Frequency subscale in populations with ostomies, components of our survey can be used for the entire population of RC survivors, no matter whether they received anastomosis or ostomy. PMID:24890826

  16. Skin disorders associated with obesity in children and adolescents: a population-based study.

    PubMed

    Mirmirani, Paradi; Carpenter, Diane M

    2014-01-01

    Obesity in children is a major public health concern in the United States. The objectives of the current study were to determine the prevalence of various groups of cutaneous disorders in obese children and adolescents and to compare the use of dermatology services in obese subjects with that those with a normal body mass index (BMI). This was a retrospective, population-based study at the Kaiser Permanente Northern California Managed Healthcare System. The main outcome measures were the relative risk of cutaneous disorders associated with insulin resistance, androgen excess, bacterial infection, fungal infection, viral infection, inflammation, mechanical changes, and other skin conditions (hidradenitis, hyperhidrosis) in three weight groups (normal, overweight, obese) and the number of dermatology visits. A total of 248,775 subjects were included. Bivariate analyses showed a higher proportion of insulin resistance disorders, bacterial infection, fungal infection, inflammatory disorders, mechanical changes, and other skin conditions in obese subjects than in subjects with a normal BMI (p < 0.001). Disorders of androgen excess and viral infection were significantly less common in obese subjects (p < 0.001). Obese subjects had significantly lower odds of having at least one dermatology encounter than subjects with a normal BMI (odds ratio = 0.92, 95% confidence interval 0.88, 0.96, p = 0.003). Early onset obesity is associated with cutaneous disorders characterized by hyperproliferation, inflammation, bacterial and fungal infection, and mechanical changes but lower rates of disorders of androgen excess and viral infection. The use of dermatology services was not greater in obese patients. Heightened recognition and further analysis of adipose tissue as an endocrine organ that is capable of affecting the skin is warranted.

  17. Applying Sequential Analytic Methods to Self-Reported Information to Anticipate Care Needs

    PubMed Central

    Bayliss, Elizabeth A.; Powers, J. David; Ellis, Jennifer L.; Barrow, Jennifer C.; Strobel, MaryJo; Beck, Arne

    2016-01-01

    Purpose: Identifying care needs for newly enrolled or newly insured individuals is important under the Affordable Care Act. Systematically collected patient-reported information can potentially identify subgroups with specific care needs prior to service use. Methods: We conducted a retrospective cohort investigation of 6,047 individuals who completed a 10-question needs assessment upon initial enrollment in Kaiser Permanente Colorado (KPCO), a not-for-profit integrated delivery system, through the Colorado State Individual Exchange. We used responses from the Brief Health Questionnaire (BHQ), to develop a predictive model for cost for receiving care in the top 25 percent, then applied cluster analytic techniques to identify different high-cost subpopulations. Per-member, per-month cost was measured from 6 to 12 months following BHQ response. Results: BHQ responses significantly predictive of high-cost care included self-reported health status, functional limitations, medication use, presence of 0–4 chronic conditions, self-reported emergency department (ED) use during the prior year, and lack of prior insurance. Age, gender, and deductible-based insurance product were also predictive. The largest possible range of predicted probabilities of being in the top 25 percent of cost was 3.5 percent to 96.4 percent. Within the top cost quartile, examples of potentially actionable clusters of patients included those with high morbidity, prior utilization, depression risk and financial constraints; those with high morbidity, previously uninsured individuals with few financial constraints; and relatively healthy, previously insured individuals with medication needs. Conclusions: Applying sequential predictive modeling and cluster analytic techniques to patient-reported information can identify subgroups of individuals within heterogeneous populations who may benefit from specific interventions to optimize initial care delivery. PMID:27563684

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

    PubMed Central

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

    2014-01-01

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

  19. Glycemic Control and Urinary Incontinence in Women with Diabetes Mellitus

    PubMed Central

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

    2013-01-01

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

  20. Prediction of individual combined benefit and harm for patients with atrial fibrillation considering warfarin therapy: a study protocol

    PubMed Central

    Li, Guowei; Holbrook, Anne; Delate, Thomas; Witt, Daniel M; Levine, Mitchell AH; Thabane, Lehana

    2015-01-01

    Introduction Clinical prediction rules have been validated and widely used in patients with atrial fibrillation (AF) to predict stroke and major bleeding. However, these prediction rules were not developed in the same population, and do not provide the key information that patients and prescribers need at the time anticoagulants are being considered—what is the individual patient-specific risk of both benefit (decreased stroke) and harm (increased major bleeding). In this study, our primary objective is to develop and validate a prediction model for patients’ individual combined benefit and harm outcomes (stroke, major bleeding and neither event) with and without warfarin therapy. Our secondary outcome is all-cause mortality. Methods and analysis We will use data from the Kaiser Permanente Colorado (KPCO) anticoagulation management databases and electronic medical records. Patients with a primary or secondary diagnosis during an ambulatory KPCO medical office visit, emergency department visit, or inpatient stay between 1 January 2005 and 31 December 2012 with no AF diagnosis in the previous 180 days will be included. Patients’ demographic characteristics, laboratory data, comorbidities, warfarin medication data and concurrent use of medication will be used to construct the prediction model. For primary outcomes (stroke with no major bleeding, and major bleeding with no stroke), we will perform polytomous logistic regression to develop a prediction model for patients’ individual combined benefit and harm outcomes, taking neither event group as the reference group. As regards death, we will use Cox proportional hazards regression analysis to build a prediction model for all-cause mortality. Ethics and dissemination This study has been approved by the KPCO Institutional Review Board and the Hamilton Integrated Research Ethics Board. Results from this study will be published in a peer-reviewed journal electronically and in print. The prediction models may aid

  1. Rubber dam use during routine operative dentistry procedures: findings from the Dental PBRN.

    PubMed

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

    2010-01-01

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

  2. Oral Contraceptives and Multiple Sclerosis/Clinically Isolated Syndrome Susceptibility

    PubMed Central

    Hellwig, Kerstin; Chen, Lie H.; Stancyzk, Frank Z.; Langer-Gould, Annette M.

    2016-01-01

    Background The incidence of multiple sclerosis (MS) is rising in women. Objective To determine whether the use of combined oral contraceptives (COCs) are associated with MS risk and whether this varies by progestin content. Methods We conducted a nested case-control study of females ages 14–48 years with incident MS or clinically isolated syndrome (CIS) 2008–2011 from the membership of Kaiser Permanente Southern California. Controls were matched on age, race/ethnicity and membership characteristics. COC use up to ten years prior to symptom onset was obtained from the complete electronic health record. Results We identified 400 women with incident MS/CIS and 3904 matched controls. Forty- percent of cases and 32% of controls had used COCs prior to symptom onset. The use of COCs was associated with a slightly increased risk of MS/CIS (adjusted OR = 1.52, 95%CI = 1.21–1.91; p<0.001). This risk did not vary by duration of COC use. The association varied by progestin content being more pronounced for levenorgestrol (adjusted OR = 1.75, 95%CI = 1.29–2.37; p<0.001) than norethindrone (adjusted OR = 1.57, 95%CI = 1.16–2.12; p = 0.003) and absent for the newest progestin, drospirenone (p = 0.95). Conclusions Our findings should be interpreted cautiously. While the use of some combination oral contraceptives may contribute to the rising incidence of MS in women, an unmeasured confounder associated with the modern woman’s lifestyle is a more likely explanation for this weak association. PMID:26950301

  3. Highly Reliable Procedural Teams: The Journey to Spread the Universal Protocol in Diagnostic Imaging

    PubMed Central

    Ross, Julie; Wolf, Debby; Reece, Kimberly

    2014-01-01

    Context: The Joint Commission’s Universal Protocol has been widely implemented in surgical settings since publication in 2003. The elements improved patient safety in operating rooms, and the same rigor is being applied to procedures occurring in other health care arenas, in particular, diagnostic imaging. Objective: In 2011, Kaiser Permanente West Los Angeles’s Diagnostic Imaging Department desired to adapt previous work on Universal Protocol implementation to improve patient safety in interventional radiology and mammography procedures. Design: The teams underwent human factors training and then adapted key interventions used in surgical suites to their workflows. Time-out posters, use of whiteboards, “glitch books,” and regular audits provided structure to overcome the risks that human factors present. Main Outcome Measures: Staff and physician perceptions of the teamwork and safety climates in their modalities were measured using the Safety Attitudes Questionnaire at baseline and at 18 months after training. Unusual Occurrence Reports were also reviewed to identify events and near misses that could be prevented. Implementation of key process changes were identified as process measures. Results: Perception of the safety climate improved 25% in interventional radiology and 4.5% in mammography. Perception of the teamwork climate decreased 5.4% in interventional radiology and 16.6% in mammography. Unusual occurrences were underreported at baseline, and there is ongoing reluctance to document near misses. Conclusion: This work provides important considerations of the impact of departmental cultures for the implementation of the Universal Protocol in procedural areas. It also reveals unexpected challenges, and requires long-term effort and focus. PMID:24626070

  4. Serum phosphorus and association with anemia among a large diverse population with and without chronic kidney disease

    PubMed Central

    Tran, Lac; Batech, Michael; Rhee, Connie M.; Streja, Elani; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.; Sim, John J.

    2016-01-01

    Background We hypothesized that phosphorus has an effect on anemia in both normal kidney function and early chronic kidney disease (CKD). We sought to determine whether higher phosphorus levels are associated with anemia in a large diverse population without CKD and early CKD. Methods This study is a historical population-based study within the Kaiser Permanente Southern California health system (1 January 1998 to 31 December 2013) among individuals aged 18 years and older with estimated glomerular filtration rate >30 mL/min/1.73 m2 and measurements of serum phosphorus, creatinine and hemoglobin. Individuals were excluded if they had secondary causes of anemia. Odds ratio (OR) estimated for moderate anemia defined as hemoglobin <11 g/dL for both sexes. Mild anemia was defined as <12 g/dL (females) and <13 g/dL (males). Results Among 155 974 individuals, 4.1% had moderate anemia and 12.9% had mild anemia. Serum phosphorus levels ≥3.5 mg/dL were associated with both mild and moderate anemia. Moderate anemia OR (95% confidence interval) was 1.16 (1.04–1.29) for every 0.5 mg/dL phosphorus increase and 1.26 (1.07–1.48) in the highest versus middle phosphorus tertile. Additional independent anemia risk factors, including female sex, Asian race, diabetes, low albumin and low iron saturation, were observed, but did not alter the anemia–phosphorus association. Conclusions Higher phosphorus levels were associated with a greater likelihood for anemia in a population with early CKD and normal kidney function. Phosphorus may be a biomarker for anemia and may affect aspects of hematopoiesis. PMID:26254460

  5. Screening of EEG referrals by neurologists leads to improved healthcare resource utilization.

    PubMed

    Gurbani, Neepa S; Gurbani, Suresh G; Mittal, Meenu; McGuckin, Jeanne S; Tin, Sue Nwe; Tehrani, Keo; Chayasirisobhon, Sirichai

    2006-01-01

    The objective of this study was to determine if screening by a neurologist of all non-neurologist electroencephalogram (EEG) referrals prior to approval reduces the number of inappropriate requests. This retrospective survey included 600 consecutive EEG requisitions referred to the Anaheim Kaiser Permanente Neurodiagnostic Laboratory to rule out epilepsy. Patients with established epilepsy referred for a repeat EEG for management issues were excluded. Three groups of EEG referrals were analyzed. Each group consisted of 200 EEGs (100 pediatric and 100 adult EEGs). The first group was referred directly by non-neurologists, the second group was referred by non-neurologists with scrutiny by a neurologist, and the third group was referred by a neurologist directly. In the pediatric group, the ratio of abnormal EEG vs normal EEG was 1:3.35 in the first group, 1:0.69 in the second group and 1:0.33 in the third group. In the adult group, the ratio of abnormal EEGs vs normal EEGs was 1:2.23 in the first group, 1:0.82 in the second group and 1:0.45 in the third group. In the combined pediatric and adult groups, the ratio of abnormal EEG vs normal EEG was 1:2.70 in the first group, 1:0.75 in the second group and 1:0.39 in the third group. There was a significant difference between the results of the EEGs ordered by non-neurologists directly versus non-neurologists with scrutiny (p=.334, chi-square test). Scrutiny by a neurologist of EEG referrals from non-neurologists led to a reduction in the number of normal EEG results. This suggests that inappropriate EEG requests for non-epileptic patients that yield normal EEG results are significantly reduced with scrutiny. This can help reduce the indiscriminate overuse of EEGs by non-neurologists thereby leading to better utilization of healthcare resources.

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

    PubMed Central

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

    2002-01-01

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

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

    PubMed

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

    2014-01-01

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

  8. MicroRNA profiles in colorectal carcinomas, adenomas and normal colonic mucosa: variations in miRNA expression and disease progression.

    PubMed

    Slattery, Martha L; Herrick, Jennifer S; Pellatt, Daniel F; Stevens, John R; Mullany, Lila E; Wolff, Erica; Hoffman, Michael D; Samowitz, Wade S; Wolff, Roger K

    2016-03-01

    MiRNAs are small, non-protein-coding RNA molecules that regulate gene expression either by post-transcriptionally suppressing mRNA translation or by mRNA degradation. We examine differentially expressed miRNAs in colorectal carcinomas, adenomas and normal colonic mucosa. Data come from population-based studies of colorectal cancer conducted in Utah and the Kaiser Permanente Medical Care Program. A total of 1893 carcinoma/normal-paired samples and 290 adenoma tissue samples were run on the Agilent Human miRNA Microarray V19.0 which contained 2006 miRNAs. We tested for significant differences in miRNA expression between paired carcinoma/adenoma/normal colonic tissue samples. Fewer than 600 miRNAs were expressed in >80% of people for colonic tissue; of these 86.5% were statistically differentially expressed between carcinoma and normal colonic mucosa using a false discovery rate of 0.05. Roughly half of these differentially expressed miRNAs showed a progression in levels of expression from normal to adenoma to carcinoma tissue. Other miRNAs appeared to be altered at the normal to adenoma stage, while others were only altered at the adenoma to carcinoma stage or only at the normal to carcinoma stage. Evaluation of the Agilent platform showed a high degree of repeatability (r = 0.98) and reasonable agreement with the NanoString platform. Our data suggest that miRNAs are highly dysregulated in colorectal tissue among individuals with colorectal cancer; the pattern of disruption varies by miRNA as tissue progresses from normal to adenoma to carcinoma.

  9. Atom optics and space physics: A summary of an 'Enrico Fermi' summer school

    NASA Astrophysics Data System (ADS)

    Arimondo, Ennio; Ertmer, Wolfgang; Rasel, Ernst M.; Schleich, Wolfgang P.

    2008-03-01

    We describe the scientific content of the International School of Physics 'Enrico Fermi' on atom optics and space physics, organized by the Italian Physical Society in Varenna at Lake Como, Italy, 2-13 July 2007.

  10. Encontrando planetas alrededor de otras estrellas

    NASA Video Gallery

    Así como la Tierra gira alrededor del Sol, la estrella más cercana, es posible que otros planetas orbiten las estrellas que se ven en el cielo nocturno. Piensa en todos los planetas del universo qu...

  11. Sistema Solar: de la observación de La Tierra a los planetas gigantes y sus lunas

    NASA Astrophysics Data System (ADS)

    Rodrigo, R.

    La fotoquímica tiene un papel principal en la composición de las atmósferas planetarias. Se examinan diferentes procesos fotoquímicos tanto para atmósferas oxidadas como reductoras, poniendo un especial énfasis en los ciclos químicos más importantes. En este sentido, se presentan diferentes ciclos químicos capaces de producir hidrocarbonos y nitrilos en atmósferas reductoras, así como aquellos capaces de mantener las proporciones de mezcla de las moléculas que contienen oxígeno, tales como CO2, O2 y H2O. También se analizan otros procesos importantes tales como la condensación y procesos de sputtering y de sublimación que han de tenerse en cuenta cuando se realizan modelos sobre la composición atmosférica.

  12. Monóxido de carbono

    EPA Pesticide Factsheets

    La mayoria de los accidentes causados por envenenamiento por monoxido de carbono (CO) se producen en los hogares y estan relacionados a nuestras actividades diarias como cocinar y usar la calefaccion.

  13. Detective científica

    NASA Video Gallery

    La NASA posee muchos detectives que buscan pistas para resolver un misterio como la "detective científica" Monsi Roman. Se asegura de que el agua y el aire a bordo de la Estación Espacial Internaci...

  14. The Impact of Prostate Cancer Treatment-Related Symptoms on Low-Income Latino Couples

    DTIC Science & Technology

    2008-03-01

    preguntas tienen que ver con sus emociones y sus actividades diarias. A6. ¿Durante las últimas 4 semanas, qué parte del tiempo hizo menos de lo...que le hubiera gustado en términos de su trabajo u otras actividades diarias debido a cualquier problema emocional como sentirse deprimido o...hizo usted su trabajo u otras actividades con el mismo cuidado que de costumbre debido a algún problema emocional , como sentirse deprimido o

  15. [The mind-brain problem (II): about consciousness].

    PubMed

    Tirapu-Ustarroz, J; Goni-Saez, F

    2016-08-16

    Introduccion. La conciencia es el resultado de una serie de procesos neurobiologicos en el cerebro y a su vez es un rasgo del nivel de su complejidad. En realidad, el estar y el ser consciente nos situan ante lo que Chalmers ha denominado el 'problema blando' y el 'problema duro' de la conciencia. El primero hace referencia a aspectos como la vigilia, la atencion o el conocimiento, y el segundo a conceptos tan complejos como autoconciencia, 'yo neural' o cognicion social. En este sentido se puede afirmar que el concepto de conciencia como algo unitario plantea problemas de acercamiento a una realidad sumamente compleja. Desarrollo. Planteamos los principales modelos que desde una perspectiva neurocientifica han abordado el tema de la conciencia. Por un lado, los modelos de experiencia consciente de Crick, Edelman y Tononi, y Llinas, y por otro, los modelos y las bases neuronales de la autoconciencia de autores como Damasio (conciencia central y extendida), Tulving (conciencia autonoetica, noetica y cronestesia), el problema de los qualia (Dennett, Popper, Ramachandran) y el modelo de los cognitos (Fuster). Conclusiones. Todos los estimulos que recibimos del mundo externo y de nuestro mundo interno son convertidos y tratados por el cerebro para integrarlos y que formen parte de nuestra identidad. Desde la percepcion de un perro y reconocerlo como tal hasta la comprension de la propia conciencia responden al funcionamiento de estructuras cerebrales, neuronas y sinapsis. Ahora bien, los procesos mas complejos de la conciencia, como la autoconciencia o la empatia, son probablemente procesos emergentes del cerebro.

  16. Prévalence de l'hypertension artérielle dans la population des meuniers de la ville de Lubumbashi, République Démocratique du Congo

    PubMed Central

    Ngombe, Léon Kabamba; Cowgill, Karen; Monga, Ben Bondo; Ilunga, Benjamin Kabyla; Stanis, Wembonyama Okitotsho; Numbi, Oscar Luboya

    2015-01-01

    Introduction L'objectif était de comparer la prévalence de l'hypertension artérielle chez les meuniers dans la ville de Lubumbashi qui sont exposés d'une manière permanente aux bruits des machines de transformation des céréales à la prévalence de l'hypertension artérielle chez un groupe des gardiens. Méthodes Quic'est une étude descriptive transversale qui a concerné 286 meuniers et 115 agents d'une entreprise de gardiennage. Apres un consentement éclairé, un auto questionnaire a été administré aux enquêtés et des mesures de poids, taille, et tension artérielle ont été prises. Résultats La prévalence de l'HTA chez les meuniers était 49.3% et celle des gardes était 20.9%, pour un ratio de prévalence de 2.4. significativement élevée par rapport aux contrôles (49.3% vs 20.9%) et le ratio de prévalence était de 2.4. Les facteurs de risque tels que: l’âge, l'indice de masse corporelle, l'ancienneté, la durée de travail ont été significativement élevés chez les meuniers par rapport aux gardiens. Conclusion Nous avons trouvé une prévalence élevée de l'HTA chez les meuniers. Nos résultats suggèrent que cette prévalence est probablement due à l'environnement du milieu de travail des meuniers (bruits, vibration des machines) et ce dernier constitue un facteur de risque de l'hypertension artérielle. PMID:26889333

  17. Foreword

    NASA Astrophysics Data System (ADS)

    Bouvier, Jérôme; Zahn, Jean-Paul

    Proceedings as much interest as the audience had in listening to the talks and interacting with the speakers, whom we would like to thank here for their disponibility and the excellent quality of their conferences. We also thank all the participants for the friendly atmosphere they brought to the school, the Formation Permanente du CNRS and the Programme National de Physique Stellaire for funding the annual Aussois School on Stellar Physics, and particularly F. Bouillet, N. Thiéry, M. Michel and M. Petit for taking care of all administrative and organisational aspects, as well as the Director and employees of the Centre Paul Langevin for their competence and hospitality; and, last but not least, Jean-Philippe Beaulieu and Daniele Briot for taking and prodiving the pictures.

  18. Circulating Angiopoietins-1 and -2, Angiopoietin Receptor Tie-2 and Vascular Endothelial Growth Factor-A as Biomarkers of Acute Myocardial Infarction: a Prospective Nested Case-Control Study

    PubMed Central

    2011-01-01

    Background Angiogenesis is up-regulated in myocardial ischemia. However, limited data exist assessing the value of circulating angiogenic biomarkers in predicting future incidence of acute myocardial infarction (AMI). Our aim was to examine the association between circulating levels of markers of angiogenesis with risk of incident acute myocardial infarction (AMI) in men and women. Methods We performed a case-control study (nested within a large cohort of persons receiving care within Kaiser Permanente of Northern California) including 695 AMI cases and 690 controls individually matched on age, gender and race/ethnicity. Results Median [inter-quartile range] serum concentrations of vascular endothelial growth factor-A (VEGF-A; 260 [252] vs. 235 [224] pg/mL; p = 0.01) and angiopoietin-2 (Ang-2; 1.18 [0.66] vs. 1.05 [0.58] ng/mL; p < 0.0001) were significantly higher in AMI cases than in controls. By contrast, endothelium-specific receptor tyrosine kinase (Tie-2; 14.2 [3.7] vs. 14.0 [3.1] ng/mL; p = 0.07) and angiopoietin-1 levels (Ang-1; 33.1 [13.6] vs. 32.5 [12.7] ng/mL; p = 0.52) did not differ significantly by case-control status. After adjustment for educational attainment, hypertension, diabetes, smoking, alcohol consumption, body mass index, LDL-C, HDL-C, triglycerides and C-reactive protein, each increment of 1 unit of Ang-2 as a Z score was associated with 1.17-fold (95 percent confidence interval, 1.02 to 1.35) increased odds of AMI, and the upper quartile of Ang-2, relative to the lowest quartile, was associated with 1.63-fold (95 percent confidence interval, 1.09 to 2.45) increased odds of AMI. Conclusions Our data support a role of Ang-2 as a biomarker of incident AMI independent of traditional risk factors. PMID:21672190

  19. Expression Profiles of miRNA Subsets Distinguish Human Colorectal Carcinoma and Normal Colonic Mucosa

    PubMed Central

    Pellatt, Daniel F; Stevens, John R; Wolff, Roger K; Mullany, Lila E; Herrick, Jennifer S; Samowitz, Wade; Slattery, Martha L

    2016-01-01

    OBJECTIVES: MicroRNAs (miRNAs) are small, non-protein-coding RNA molecules that are commonly dysregulated in colorectal tumors. The objective of this study was to identify smaller subsets of highly predictive miRNAs. METHODS: Data come from population-based studies of colorectal cancer conducted in Utah and the Kaiser Permanente Medical Care Program. Tissue samples were available for 1,953 individuals, of which 1,894 had carcinoma tissue and 1,599 had normal mucosa available for statistical analysis. Agilent Human miRNA Microarray V.19.0 was used to generate miRNA expression profiles; validation of expression levels was carried out using quantitative PCR. We used random forest analysis and verified findings with logistic modeling in separate data sets. Important microRNAs are identified and bioinformatics tools are used to identify target genes and related biological pathways. RESULTS: We identified 16 miRNAs for colon and 17 miRNAs for rectal carcinoma that appear to differentiate between carcinoma and normal mucosa; of these, 12 were important for both colon and rectal cancer, hsa-miR-663b, hsa-miR-4539, hsa-miR-17-5p, hsa-miR-20a-5p, hsa-miR-21-5p, hsa-miR-4506, hsa-miR-92a-3p, hsa-miR-93-5p, hsa-miR-145-5p, hsa-miR-3651, hsa-miR-378a-3p, and hsa-miR-378i. Estimated misclassification rates were low at 4.83% and 2.5% among colon and rectal observations, respectively. Among independent observations, logistic modeling reinforced the importance of these miRNAs, finding the primary principal components of their variation statistically significant (P<0.001 among both colon and rectal observations) and again producing low misclassification rates. Repeating our analysis without those miRNAs initially identified as important identified other important miRNAs; however, misclassification rates increased and distinctions between remaining miRNAs in terms of classification importance were reduced. CONCLUSIONS: Our data support the hypothesis that while many miRNAs are

  20. A Study of HPV Typing for the Management of HPV-Positive ASC-US Cervical Cytologic Results

    PubMed Central

    Schiffman, Mark; Vaughan, Laurence; Raine-Bennett, Tina R.; Castle, Philip E.; Katki, Hormuzd A.; Gage, Julia C.; Fetterman, Barbara; Befano, Brian; Wentzensen, Nicolas

    2015-01-01

    Background In US cervical screening, immediate colposcopy is recommended for women with HPV-positive ASC-US (equivocal) cytology. We evaluated whether partial typing by Onclarity™ (BD) might identify HPV-positive women with low enough CIN3+ risk to permit 1-year follow-up instead. Methods The NCI-Kaiser Permanente Northern California Persistence and Progression Cohort includes a subset of 13,890 women aged 21+ with HC2 (Qiagen)-positive ASC-US at enrollment; current median follow-up is 3.0 years. Using stratified random sampling, we typed 2,079 archived enrollment specimens including 329 women subsequently diagnosed with CIN3+, 563 with CIN2, and 1,187 with

  1. A Study of Genotyping for Management of Human Papillomavirus-Positive, Cytology-Negative Cervical Screening Results

    PubMed Central

    Burk, R. D.; Boyle, S.; Raine-Bennett, T.; Katki, H. A.; Gage, J. C.; Wentzensen, N.; Kornegay, J. R.; Aldrich, C.; Tam, T.; Erlich, H.; Apple, R.; Befano, B.; Castle, P. E.

    2014-01-01

    The effective management of women with human papillomavirus (HPV)-positive, cytology-negative results is critical to the introduction of HPV testing into cervical screening. HPV typing has been recommended for colposcopy triage, but it is not clear which combinations of high-risk HPV types provide clinically useful information. This study included 18,810 women with Hybrid Capture 2 (HC2)-positive, cytology-negative results and who were age ≥30 years from Kaiser Permanente Northern California. The median follow-up was 475 days (interquartile range [IQR], 0 to 1,077 days; maximum, 2,217 days). The baseline specimens from 482 cases of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) and 3,517 random HC2-positive noncases were genotyped using 2 PCR-based methods. Using the case-control sampling fractions, the 3-year cumulative risks of CIN3+ were calculated for each individual high-risk HPV type. The 3-year cumulative risk of CIN3+ among all women with HC2-positive, cytology-negative results was 4.6%. HPV16 status conferred the greatest type-specific risk stratification; women with HC2-positive/HPV16-positive results had a 10.6% risk of CIN3+, while women with HC-2 positive/HPV16-negative results had a much lower risk of 2.4%. The next most informative HPV types and their risks in HPV-positive women were HPV33 (5.9%) and HPV18 (5.9%). With regard to the etiologic fraction, 20 of 71 cases of cervical adenocarcinoma in situ (AIS) and adenocarcinoma in the cohort were positive for HPV18. HPV16 genotyping provides risk stratification useful for guiding clinical management; the risk among HPV16-positive women clearly exceeds the U.S. consensus risk threshold for immediate colposcopy referral. HPV18 is of particular interest because of its association with difficult-to-detect glandular lesions. There is a less clear clinical value of distinguishing the other high-risk HPV types. PMID:25339396

  2. p16/Ki-67 Dual Stain Cytology for Detection of Cervical Precancer in HPV-Positive Women

    PubMed Central

    Fetterman, Barbara; Castle, Philip E.; Schiffman, Mark; Wood, Shannon N.; Stiemerling, Eric; Tokugawa, Diane; Bodelon, Clara; Poitras, Nancy; Lorey, Thomas; Kinney, Walter

    2015-01-01

    Background: Human papillomavirus (HPV)–based cervical cancer screening requires triage markers to decide who should be referred to colposcopy. p16/Ki-67 dual stain cytology has been proposed as a biomarker for cervical precancers. We evaluated the dual stain in a large population of HPV-positive women. Methods: One thousand five hundred and nine HPV-positive women screened with HPV/cytology cotesting at Kaiser Permanente California were enrolled into a prospective observational study in 2012. Dual stain cytology was performed on residual Surepath material, and slides were evaluated for dual stain–positive cells. Disease endpoints were ascertained from the clinical database at KPNC. We evaluated the clinical performance of the assay among all HPV-positive women and among HPV-positive, cytology-negative women. We used internal benchmarks for clinical management to evaluate the clinical relevance of the dual stain assay. We evaluated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the dual stain compared with Pap cytology. All statistical tests were two-sided. Results: The dual stain had lower positivity (45.9%) compared with cytology at an ASC-US threshold (53.4%). For detection of CIN2+, the dual stain had similar sensitivity (83.4% vs 76.6%, P = .1), and statistically higher specificity (58.9% vs 49.6%, P < .001), PPV (21.0% vs 16.6%, P < .001), and NPV (96.4% vs 94.2%, P = .01) compared with cytology. Similar patterns were observed for CIN3+. Women with a positive test had high enough risk for referral to colposcopy, while the risk for women with negative tests was below a one-year return threshold based on current US management guidelines. Conclusion: Dual stain cytology showed good risk stratification for all HPV-positive women and for HPV-positive women with normal cytology. Additional follow-up is needed to determine how long dual stain negative women remain at low risk of precancer. PMID:26376685

  3. Study of Women, Infant feeding, and Type 2 diabetes mellitus after GDM pregnancy (SWIFT), a prospective cohort study: methodology and design

    PubMed Central

    2011-01-01

    Background Women with history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes within 5 years after delivery. Evidence that lactation duration influences incident type 2 diabetes after GDM pregnancy is based on one retrospective study reporting a null association. The Study of Women, Infant Feeding and Type 2 Diabetes after GDM pregnancy (SWIFT) is a prospective cohort study of postpartum women with recent GDM within the Kaiser Permanente Northern California (KPNC) integrated health care system. The primary goal of SWIFT is to assess whether prolonged, intensive lactation as compared to formula feeding reduces the 2-year incidence of type 2 diabetes mellitus among women with GDM. The study also examines whether lactation intensity and duration have persistent favorable effects on blood glucose, insulin resistance, and adiposity during the 2-year postpartum period. This report describes the design and methods implemented for this study to obtain the clinical, biochemical, anthropometric, and behavioral measurements during the recruitment and follow-up phases. Methods SWIFT is a prospective, observational cohort study enrolling and following over 1, 000 postpartum women diagnosed with GDM during pregnancy within KPNC. The study enrolled women at 6-9 weeks postpartum (baseline) who had been diagnosed by standard GDM criteria, aged 20-45 years, delivered a singleton, term (greater than or equal to 35 weeks gestation) live birth, were not using medications affecting glucose tolerance, and not planning another pregnancy or moving out of the area within the next 2 years. Participants who are free of type 2 diabetes and other serious medical conditions at baseline are screened for type 2 diabetes annually within the first 2 years after delivery. Recruitment began in September 2008 and ends in December 2011. Data are being collected through pregnancy and early postpartum telephone interviews, self-administered monthly mailed

  4. Part-of-speech tagging for clinical text: wall or bridge between institutions?

    PubMed

    Fan, Jung-wei; Prasad, Rashmi; Yabut, Rommel M; Loomis, Richard M; Zisook, Daniel S; Mattison, John E; Huang, Yang

    2011-01-01

    Part-of-speech (POS) tagging is a fundamental step required by various NLP systems. The training of a POS tagger relies on sufficient quality annotations. However, the annotation process is both knowledge-intensive and time-consuming in the clinical domain. A promising solution appears to be for institutions to share their annotation efforts, and yet there is little research on associated issues. We performed experiments to understand how POS tagging performance would be affected by using a pre-trained tagger versus raw training data across different institutions. We manually annotated a set of clinical notes at Kaiser Permanente Southern California (KPSC) and a set from the University of Pittsburg Medical Center (UPMC), and trained/tested POS taggers with intra- and inter-institution settings. The cTAKES POS tagger was also included in the comparison to represent a tagger partially trained from the notes of a third institution, Mayo Clinic at Rochester. Intra-institution 5-fold cross-validation estimated an accuracy of 0.953 and 0.945 on the KPSC and UPMC notes respectively. Trained purely on KPSC notes, the accuracy was 0.897 when tested on UPMC notes. Trained purely on UPMC notes, the accuracy was 0.904 when tested on KPSC notes. Applying the cTAKES tagger pre-trained with Mayo Clinic's notes, the accuracy was 0.881 on KPSC notes and 0.883 on UPMC notes. After adding UPMC annotations to KPSC training data, the average accuracy on tested KPSC notes increased to 0.965. After adding KPSC annotations to UPMC training data, the average accuracy on tested UPMC notes increased to 0.953. The results indicated: first, the performance of pre-trained POS taggers dropped about 5% when applied directly across the institutions; second, mixing annotations from another institution following the same guideline increased tagging accuracy for about 1%. Our findings suggest that institutions can benefit more from sharing raw annotations but less from sharing pre-trained models for

  5. Dual Recovery among People with Serious Mental Illnesses and Substance Problems: A Qualitative Analysis

    PubMed Central

    Green, Carla A.; Yarborough, Micah T.; Polen, Michael R.; Janoff, Shannon L.; Yarborough, Bobbi Jo H.

    2014-01-01

    Objective Individuals with serious mental illnesses are more likely to have substance-related problems than those without mental health problems. They also face more difficult recovery trajectories as they cope with dual disorders. Nevertheless, little is known about individuals’ perspectives regarding their dual recovery experiences. Methods This qualitative analysis was conducted as part of an exploratory mixed-methods study of mental health recovery. Members of Kaiser Permanente Northwest (a group-model, not-for-profit, integrated health plan) who had serious mental illness diagnoses were interviewed four times over two years about factors affecting their mental health recovery. Interviews were recorded, transcribed, and coded with inductively-derived codes. Themes were identified by reviewing text coded “alcohol or other drugs.” Results Participants (N = 177) were diagnosed with schizophrenia/schizoaffective disorder (n = 75, 42%), bipolar I/II disorder (n = 84, 48%), or affective psychosis (n = 18, 10%). At baseline, 63% (n = 112) spontaneously described addressing substance use as part of their mental health recovery. When asked at follow-up, 97% (n = 171) provided codeable answers about substances and mental health. We identified differing pathways to recovery, including through formal treatment, self-help groups or peer support, “natural” recovery (without the help of others), and continued but controlled use of alcohol. We found three overarching themes in participants’ experiences of recovering from serious mental illnesses and substance-related problems: Learning about the effects of alcohol and drugs provided motivation and a foundation for sobriety; achieving sobriety helped people to initiate their mental health recovery processes; and achieving and maintaining sobriety built self-efficacy, self-confidence, improved functioning and a sense of personal growth. Non-judgmental support from clinicians adopting chronic disease approaches also

  6. PS2-17: Diabetes Social Support Feasibility Pilot Study: Utilizing Mobile Technology and Self-Identified Supporters to Enhance Self-Monitoring of Blood Glucose

    PubMed Central

    Robinson, Brandi; Roblin, Douglas; Hipkens, James; Vupputuri, Suma; McMahon, Kevin

    2010-01-01

    Background and Aims: Self-monitoring of blood glucose (SMBG) is associated with improved glycemic control among patients with type 2 diabetes, however, the practice of daily self-monitoring is not optimal. Telecommunications technology may improve adherence to recommended self-management practices by remotely transmitting automated reminders to motivate patients, and utilizing social networking for peer support. The purpose of this pilot study is to demonstrate the feasibility and usability of mobile technology and the potential added value of social support to improve SMBG frequency and glycemic control among adults with type 2 diabetes. Methods: Adults 25–74 years of age with type 2 DM and an average HbA1c > 8.0% were recruited from Kaiser Permanente Georgia (KPGA) and Oakhurst Medical Center (OMC, a community health clinic) to participate in a 3-month study using wireless technology. Enrollment sessions with presentations on SMBG techniques, use of the wireless technology, and motivational coaching to enhance social support were conducted in November 2009. During the subsequent 3-months, both diabetes patients and their self-selected supporters will receive text messages to their cell phones summarizing a patient’s SMBG frequency and levels. Participants and their supporters will attend a disenrollment session in February 2010 when feasibility and usability will be assessed in focus groups. Results: 6 of 161 eligible diabetes patients at KPGA and 9 of 28 eligible diabetes patients at OMC, and their self-selected supporters, consented to participate. The average age of diabetes patients was 49.3 years. 86.7% (N=13) were African-American; and 33.3% (N=5) were male. Five days after enrollment, 60% (N=9) of patients had connected their wireless transmitters and had current blood glucose data. Follow-up phone calls will be made to ensure that all participants are connected to the wireless technology within 10 days of the enrollment session. Conclusion

  7. Air Pollution and Pulmonary Tuberculosis: A Nested Case–Control Study among Members of a Northern California Health Plan

    PubMed Central

    Smith, Geneé S.; Van Den Eeden, Stephen K.; Garcia, Cynthia; Shan, Jun; Baxter, Roger; Herring, Amy H.; Richardson, David B.; Van Rie, Annelies; Emch, Michael; Gammon, Marilie D.

    2016-01-01

    Background: Ecologic analyses, case–case comparisons, and animal experiments suggest positive associations between air pollution and tuberculosis. Objectives: We evaluated this hypothesis in a large sample, which yielded results that are applicable to the general population. Methods: We conducted a case–control study nested within a cohort of Kaiser Permanente of Northern California members. All active pulmonary tuberculosis (TB) cases newly diagnosed between 1996 and 2010 (n = 2,309) were matched to two controls (n = 4,604) by age, sex, and race/ethnicity on the index date corresponding with the case diagnosis date. Average individual-level concentrations of carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5) and 10 μm (PM10) for 2 years before diagnosis/entry into the study were estimated using measurements from the California Air Resources Board monitor closest to the participant’s residence. Results: In single-pollutant adjusted conditional logistic regression models, the pulmonary TB odds ratios (95% confidence intervals) for the highest quintile (vs. lowest) were 1.50 (95% CI: 1.15, 1.95) for CO and 1.42 (95% CI: 1.10, 1.84) for NO2. Corresponding estimates were higher among never [1.68 (95% CI: 1.26, 2.24)] than ever [1.19 (95% CI: 0.74, 1.92)] smokers for CO. In contrast, for NO2, estimates were higher among ever [1.81 (95% CI: 1.13, 2.91)] than never [1.29 (95% CI: 0.97, 1.71)] smokers. O3 was inversely associated for smokers [0.66 (95% CI: 0.43, 1.02)] and never smokers [0.65 (95% CI: 0.52, 0.81)]. No other consistent patterns were observed. Conclusions: In this first, to our knowledge, U.S. nested case–control study on air pollution and pulmonary TB, we observed positive associations with ambient CO and NO2, which require confirmation. Citation: Smith GS, Van Den Eeden SK, Garcia C, Shan J, Baxter R, Herring AH, Richardson DB, Van Rie A, Emch M

  8. [Eating habits, physical activity and socioeconomic level in university students of Chile].

    PubMed

    Rodríguez, Fernando; Palma, Ximen; Romo, Angela; Escobar, Daniela; Aragú, Bárbara; Espinoza, Luis; McMillan, Norman; Gálvez, Jorge

    2013-01-01

    Introducción: Los estudiantes universitarios son vulnerables a una mala nutrición, no consumen meriendas entre las comidas, no desayunan, ayunan por largas horas, prefieren la comida rápida y además no realizan ejercicios físicos. La población universitaria es considerada la población adulto joven clave para la promoción y prevención de salud para las futuras generaciones, por lo que es trascendental identificar la situación actual nutricional y la frecuencia de actividad física de los universitarios. Objetivos: Determinar los factores que intervienen en la elección de los alimentos y la frecuencia de actividad física en estudiantes universitarios. Métodos: Se evaluaron 799 voluntarios de cuatro universidades de la quinta región de Chile. Se aplicó un instrumento para determinar el nivel de actividad física y de hábitos alimentarios, el test kidmed para determinar la adherencia a la dieta mediterránea y un instrumento Adimark para determinar el nivel socioeconómico de los sujetos. Finalmente se realizó una evaluación antropométrica para determinar IMC, masa grasa y masa muscular. Resultados: La inactividad física es mayor en mujeres que en hombres y plantean que la principal razón para no hacer ejercicio es la falta de tiempo y la pereza. En ambos sexos no leen las etiquetas nutricionales y tienen una media adherencia a la dieta mediterránea. Discusión: Existen bajos conocimientos de nutrición que provocan una mala calidad en la alimentación de los sujetos y no existe motivación para realizar mayor actividad física. El nivel socioeconómico no tiene relación con los hábitos alimentarios ni con la actividad física, por lo que es necesario integrar programas regulares y permanentes de vida sana en todas las universidades.

  9. Non-viral Opportunistic Infections in New Users of TNF Inhibitor Therapy: Results of the SAfety Assessment of Biologic ThERapy (SABER) Study

    PubMed Central

    Baddley, John W.; Winthrop, Kevin L.; Chen, Lang; Liu, Liyan; Grijalva, Carlos G; Delzell, Elizabeth; Beukelman, Timothy; Patkar, Nivedita M.; Xie, Fenglong; Saag, Kenneth G.; Herrinton, Lisa J.; Solomon, Daniel H.; Lewis, James D.; Curtis, Jeffrey R.

    2014-01-01

    Objectives To determine among patients with autoimmune diseases in the United States whether the risk of non-viral opportunistic infections (OIs) was increased among new users of tumor necrosis factor-alpha inhibitors (TNFI), when compared to users of non-biologic agents used for active disease. Methods We identified new users of TNFI among cohorts of rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis-psoriatic arthritis-ankylosing spondylitis (PsO-PsA-AS) patients during 1998–2007 using combined data from Kaiser Permanente Northern California, two pharmaceutical assistance programs for the elderly, Tennessee Medicaid, and US Medicaid/Medicare programs. We compared incidence of non-viral OIs among new TNFI users and patients initiating non-biologic disease modifying drugs (DMARDs) overall and within each disease cohort. Cox regression models were used to compare propensity-score and steroid- adjusted OI incidence between new TNFI and non-biologic DMARD users. Results Within a cohort of 33,324 new TNFI users we identified 80 non-viral OIs, the most common of which was pneumocystosis (n=16). In the combined cohort, crude rates of non-viral OIs among new users of TNFI as compared to those initiating non-biologic DMARDs was 2.7 verus 1.7 per 1000-person years[adjusted hazard ratio (aHR): 1.6, 95% CI: 1.0, 2.6)]. Baseline corticosteroid use was associated with non-viral OIs (aHR 2.5, 95% CI: 1.5, 4.0). In the RA cohort, rates of non-viral OIs among new users of infliximab were higher when compared to patients newly starting non-biologic DMARDs (aHR 2.6, 95% CI 1.2, 5.6) or new etanercept users (aHR 2.9, 95% CI: 1.5, 5.4). Conclusions In the US, the rate of non-viral OIs was higher among new users of TNFI with autoimmune diseases as compared to non-biologic DMARD users. PMID:23852763

  10. Association between the initiation of anti-TNF therapy and the risk of herpes zoster

    PubMed Central

    Winthrop, Kevin L.; Baddley, John W.; Chen, Lang; Liu, Liyan; Grijalva, Carlos G.; Delzell, Elizabeth; Beukelman, Timothy; Patkar, Nivedita M.; Xie, Fenglong; Saag, Kenneth G.; Herrinton, Lisa J.; Solomon, Daniel H.; Lewis, James D.; Curtis, Jeffrey R.

    2013-01-01

    Importance Herpes zoster (HZ) reactivation disproportionately affects patients with rheumatoid arthritis (RA). It is unclear whether anti-tumor necrosis factor (anti-TNF) therapy elevates HZ risk, and whether monoclonal antibodies carry greater risk than etanercept. Objectives To ascertain whether initiation of anti-TNF therapy compared with non-biologic comparators is associated with increased HZ risk Design, Setting, and Patients We identified new users of anti-TNF therapy among cohorts of rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis-psoriatic arthritis-ankylosing spondylitis (PsO-PsA-AS) patients during 1998–2007 within a large US multi-institutional collaboration combining data from Kaiser Permanente Northern California, Pharmaceutical Assistance Contract for the Elderly, Tennessee Medicaid, and national Medicaid/Medicare programs. We compared HZ incidence between new anti-TNF users and patients initiating non-biologic disease modifying drugs (DMARDs) within each inflammatory disease cohort (last participant follow-up Dec 31, 2007). Within these cohorts, we used Cox regression models to compare propensity-score adjusted HZ incidence between new anti-TNF and non-biologic DMARD users while controlling for baseline corticosteroid use. Main Outcome Measure Incidence of herpes zoster cases occurring after initiation of new anti- TNF or non-biologic DMARD therapy Results Among 32,208 new users of anti-TNF therapy, we identified 310 HZ cases. Crude incidence rates among anti-TNF users for RA, IBD, and PsO-PsA-AS were 12.1/1000 pt-yrs, (95% CI 10.7–13.6), 11.3/1000 (95% CI 7.7–16.7), and 4.4/1000 (95% CI 2.8–7.0) respectively. Baseline use of corticosteroids of > 10mg/day was associated with elevated risk [adjusted HR 2.13 (1.64, 2.75) compared with no baseline use. For RA patients, adjusted incidence rates were similar between anti-TNF and nonbiologic DMARD initiators [adjusted HR 1.00 (95% CI 0.77–1.29) and comparable between

  11. Part-of-speech tagging for clinical text: wall or bridge between institutions?

    PubMed Central

    Fan, Jung-wei; Prasad, Rashmi; Yabut, Rommel M.; Loomis, Richard M.; Zisook, Daniel S.; Mattison, John E.; Huang, Yang

    2011-01-01

    Part-of-speech (POS) tagging is a fundamental step required by various NLP systems. The training of a POS tagger relies on sufficient quality annotations. However, the annotation process is both knowledge-intensive and time-consuming in the clinical domain. A promising solution appears to be for institutions to share their annotation efforts, and yet there is little research on associated issues. We performed experiments to understand how POS tagging performance would be affected by using a pre-trained tagger versus raw training data across different institutions. We manually annotated a set of clinical notes at Kaiser Permanente Southern California (KPSC) and a set from the University of Pittsburg Medical Center (UPMC), and trained/tested POS taggers with intra- and inter-institution settings. The cTAKES POS tagger was also included in the comparison to represent a tagger partially trained from the notes of a third institution, Mayo Clinic at Rochester. Intra-institution 5-fold cross-validation estimated an accuracy of 0.953 and 0.945 on the KPSC and UPMC notes respectively. Trained purely on KPSC notes, the accuracy was 0.897 when tested on UPMC notes. Trained purely on UPMC notes, the accuracy was 0.904 when tested on KPSC notes. Applying the cTAKES tagger pre-trained with Mayo Clinic’s notes, the accuracy was 0.881 on KPSC notes and 0.883 on UPMC notes. After adding UPMC annotations to KPSC training data, the average accuracy on tested KPSC notes increased to 0.965. After adding KPSC annotations to UPMC training data, the average accuracy on tested UPMC notes increased to 0.953. The results indicated: first, the performance of pre-trained POS taggers dropped about 5% when applied directly across the institutions; second, mixing annotations from another institution following the same guideline increased tagging accuracy for about 1%. Our findings suggest that institutions can benefit more from sharing raw annotations but less from sharing pre-trained models

  12. Nursing Responses to Transcultural Encounters: What Nurses Draw on When Faced with a Patient from Another Culture

    PubMed Central

    Cang-Wong, Celeste; Murphy, Susan O; Adelman, Toby

    2009-01-01

    Objective: We explored nurses' experiences when they encounter patients from cultures other than their own and their perception of what helps them deliver culturally competent care. Methods: Registered nurses from all shifts and units at Kaiser Permanente Santa Clara Medical Center were invited to complete a questionnaire. Within the time frame allowed, 111 nurses participated by returning completed questionnaires. A descriptive survey was conducted using a questionnaire that contained multiple-choice, fill-in-the-blank, and open-ended items. Results: A large majority of respondents reported that they drew on prior experience, including experience with friends and family, and through their education and training, and more than half also included travel experience and information obtained through the Internet and news media. They also expressed a desire for more training and continuing education, exposure to more diverse cultures, and availability of more interpreters. When respondents were asked to enumerate the cultures from which their patients have come, their answers were very specific, revealing that these nurses understood culture as going beyond ethnicity to include religious groups, sexual orientation, and social class (eg, homeless). Discussion: Our research confirmed our hypothesis that nurses are drawing heavily on prior experience, including family experiences and experiences with friends and coworkers from different cultures. Our findings also suggest that schools of nursing are providing valuable preparation for working with diverse populations. Our research was limited to one geographic area and by our purposeful exclusion of a demographic questionnaire. We recommend that this study be extended into other geographic areas. Our study also shows that nurses are drawing on their experiences in caring for patients from other cultures; therefore, we recommend that health care institutions consider exposing not only nurses but also other health care

  13. Primary Care DirectConnect: How the Marriage of Call Center Technology and the EMR Brought Dramatic Results—A Service Quality Improvement Study

    PubMed Central

    Bowman, Brent; Smith, Scott

    2010-01-01

    Of the key Health Plan patient satisfaction measures used in Kaiser Permanente Colorado, ease of contacting the physician's office with a medical question was consistently rated as the lowest quarterly patient satisfaction measure. Furthermore, medical office staff had become dissatisfied with their inability to contact patients who had previously left messages. In addition to the shear volume of messages, the return calls were often unanswered, leading to subsequent attempts to reach patients, creating additional work for medical office staff. DirectConnect—the project name for a system and set of processes focused on improving patient satisfaction with the ability to contact Primary Care delivery teams by telephone—focuses on isolating medical advice calls from the other types of calls handled by the centralized Call Center. The system identifies the patient using his/her unique electronic medical record number, then automatically routes medical advice calls directly to the appropriate Primary Care Physician (PCP) or staff. The clinician may then evaluate and respond to the patient's need quickly, thus managing more of their panel's requests in real time. How is DirectConnect different from simply having the patient contact their PCP's office directly? The primary difference is “one-number” convenience that allows all patients to dial one number to access their PCP's team. In addition, calls are routed to various staff as available to reduce long telephone queues and wait times. The DirectConnect system has resulted in statistically significant improvement in key service quality measures. Patient satisfaction improved from a pre-implementation nine quarter mean of 55.9% to a post-implementation 12 quarter mean of 70.2%. Fourteen percent to 17% of all Primary Care calls are now handled by the patient's home medical office team, creating a 54% improvement in the centralized Call Center's speed of answering calls in the first quarter post implementation

  14. Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema Following Phacoemulsification Surgery

    PubMed Central

    Shorstein, Neal H.; Liu, Liyan; Waxman, Michael D.; Herrinton, Lisa J.

    2015-01-01

    PURPOSE To study the relationship of chemoprophylaxis and other factors on the occurrence of acute, clinical postoperative macular edema. DESIGN Retrospective cohort study. The drug regimens consisted of postoperative topical prednisolone acetate (PA) alone or with nonsteroidal anti-inflammatory drug (PA+NSAID) or intraoperative subconjunctival injection of 2 mg triamcinolone acetonide (TA) alone. PARTICIPANTS Patients undergoing phacoemulsification at Kaiser Permanente, Diablo Service Area, Northern California, 2007–2013. METHODS Incident macular edema diagnoses recorded 5–120 days after phacoemulsification, with visual acuity 20/40 or worse and evidence of macular thickening by optical coherence tomography were identified. Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained from logistic regression analysis, conditioned on the surgeon and adjusted for year, patient age and race, diabetic retinopathy, other ocular comorbidities, systemic comorbidity and posterior capsular rupture. MAIN OUTCOME MEASURES Incident rates of acute, clinical, postoperative macular edema. RESULTS We confirmed 118 cases among 16,070 cataract surgeries (incidence, 0.73%). Compared with PA alone, the OR for the relationship of macular edema with PA+NSAID was 0.45 (95% CI, 0.21–0.95) and for TA injection was 1.21 (95% CI, 0.48–3.06). The frequency of intraocular pressure spikes ≥30 mm Hg between postoperative days 16 – 45 was 0.6% in the topical PA group, 0.3% for topical PA+NSAID (p=0.13) and 0.8% for TA (p=0.52). African-American race was associated with risk of macular edema (OR, 2.86; 95% CI, 1.41–5.79). CONCLUSIONS Adding prophylactic NSAID to PA was associated with a reduced risk of macular edema with visual acuity 20/40 or worse. Risk and safety of TA injection was similar to PA alone. Further research is needed on the prognostic significance of postoperative macular edema, the role of prophylaxis, risk in African-Americans, and the effectiveness of

  15. The impact of SHS exposure on health status and exacerbations among patients with COPD

    PubMed Central

    Eisner, Mark D; Iribarren, Carlos; Yelin, Edward H; Sidney, Stephen; Katz, Patricia P; Sanchez, Gabriela; Blanc, Paul D

    2009-01-01

    Secondhand smoke (SHS) is a major contributor to indoor air pollution. Because it contains respiratory irritants, it may adversely influence the clinical course of persons with chronic obstructive pulmonary disease (COPD). We used data from nonsmoking members of the FLOW cohort of COPD (n = 809) to elucidate the impact of SHS exposure on health status and exacerbations (requiring emergency department visits or hospitalization). SHS exposure was measured by a validated survey instrument (hours of exposure during the past week). Physical health status was measured by the SF-12 Physical Component Summary Score and disease-specific health-related quality of life (HRQL) by the Airways Questionnaire 20-R. Health care utilization for COPD was determined from Kaiser Permanente Northern California computerized databases. Compared to no SHS exposure, higher level SHS exposure was associated with poorer physical health status (mean score decrement −1.78 points; 95% confidence interval [CI] −3.48 to −0.074 points) after controlling for potential confounders. Higher level SHS exposure was also related to poorer disease-specific HRQL (mean score increment 0.63; 95% CI 0.016 to 1.25) and less distance walked during the Six-Minute Walk test (mean decrement −50 feet; 95% CI −102 to 1.9). Both lower level and higher level SHS exposure was related to increased risk of emergency department (ED) visits (hazard ratio [HR] 1.40; 95% CI 0.96 to 2.05 and HR 1.41; 95% CI 0.94 to 2.13). Lower level and higher level SHS exposure were associated with a greater risk of hospital-based care for COPD, which was a composite endpoint of either ED visits or hospitalizations for COPD (HR 1.52; 95% CI 1.06 to 2.18 and HR 1.40; 95% CI 0.94 to 2.10, respectively). In conclusion, SHS was associated with poorer health status and a greater risk of COPD exacerbation. COPD patients may comprise a vulnerable population for the health effects of SHS. PMID:19516915

  16. Pacific Tracker 2 - expert system (PacTrac2-ES) behavioural assessment and intervention tool for the Pacific Kids DASH for Health (PacDASH) study.

    PubMed

    Novotny, Rachel; Nigg, Claudio; McGlone, Katalina; Renda, Gloria; Jung, Noah; Matsunaga, Masako; Karanja, Njeri

    2013-10-01

    The Pacific Tracker (PacTrac) is a computer program designed to analyse food intakes of individuals from the Pacific Region. PacTrac's original output included servings of daily intake of food groups according to the United States Food Guide Pyramid, nutrient intake recommendations, and a comparison to other national nutrition recommendations. PacTrac was made available for public use through the Hawaii Foods website (hawaiifoods.hawaii.edu). PacTrac2 is an updated and expanded version of PacTrac that uses the United States MyPyramid/MyPlate food groups in household units of daily intake, rather than servings. In addition, the PacTrac2 includes a physical activity analysis tool which quantifies minutes of physical activities and their intensities based on energy estimates from the compendium of physical activity and research on children. An Expert System (ES) - a computerised decision tree to guide behaviour change - was developed using information on self-efficacy and stage of readiness to change, and the fruit and vegetable intake and physical activity information from PacTrac2. The ES produces reports for the child, the parent/guardian, and the child's physician with child-specific strategies, targeted behavioural information, and feedback tailored to the child. PacTrac2-ES was designed for the Pacific Kids DASH for Health (PacDASH) intervention study, conducted in the Kaiser Permanente health care system in Hawaii. The intervention is based on the child's self-efficacy and stage of readiness to change intake of fruits and vegetables and physical activity, with a goal of maintaining body weight to prevent obesity. The intervention is complemented with stage-based mailers addressing the environment for physical activity and fruit and vegetable intake and newsletters that address related behaviours (sedentary activity and a DASH eating approach). This project is the first to expand the PacTrac to contain children's foods and physical activities from the Pacific

  17. Cretaceous planktic foraminiferal biostratigraphy of the Calera Limestone, Northern California, USA

    USGS Publications Warehouse

    Sliter, W.V.

    1999-01-01

    shale occurs at or near the boundary between the G. ferreolensis and G. algerianus Zone in the late Aptian. This black layer, or Thalmann Event as named here, seems to represent the sedimentary expression, at the scale of Permanente Terrane, of a global perturbation of the carbon cycle.

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

    PubMed

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

    2014-06-01

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

  19. Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of ‘forced abstinence’ for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231). Methods/Design The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW) and at Oregon Health & Science University (OHSU) hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR) follow-up calls, compared to usual care inpatient counseling (UC). In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed seven-day abstinence at

  20. [Evaluation of hearing in patients with multiresistant tuberculosis].

    PubMed

    Ribeiro, Leandro; Sousa, Claudia; Sousa, Aida; Ferreira, Catarina; Duarte, Raquel; Faria E Almeida, António; Condé, Artur

    2015-01-01

    Introdução: A tuberculose multirresistente e a extensivamente resistente constituem atualmente a principal ameaça ao controlo da tuberculose a nível mundial. O seu tratamento exige o uso de um esquema terapêutico com fármacos de segunda linha por um período mínimo de 20 meses, onde se incluem aminoglicosídeos durante um período de cerca de oito meses. Estes estão associados a alterações cocleovestibulares permanentes. Material e Métodos: Estudo transversal que pretende avaliar a função auditiva em indivíduos que terminaram tratamento por tuberculose multirresistente (com esquema que incluia aminoglicosídeos) no Centro de Referência Regional para a Tuberculose Multirresistente da Sub-Região de Saúde do Norte entre os anos de 2009 e 2012. Os doentes que preencheram os critérios de inclusão foram convocados para a realização de: exame objetivo otorrinolaringológico, audiograma tonal e vocal, otoemissões acústicas por produtos de distorção nas frequências de 2000-5000 Hz e timpanograma. Resultados: Entre 2009 e 2012 foram referenciados 27 casos para o Centro de Referência para a tuberculose multirresistente da Região Norte, tendo-se verificado cinco óbitos. Dos 22 indivíduos convocados, compareceram 11. Estes possuíam idades compreendidas entre os 31 e os 59 anos (41 ± 10). A amicacina foi usada em 80% e a capreomicina nos restantes. Seis (60%) dos utentes estudados apresentaram surdez neurossensorial. As otoemissões acústicas foram negativas em todos os doentes com hipoacúsia neurossensorial, o que confirma a sua origem coclear. Discussão/ Conclusão: Os resultados deste estudo sugerem a necessidade de existir uma monitorização audiológica mais frequente nos indivíduos com tuberculose multirresistente tratados com aminoglicosídeos permitindo detectar mais precocemente a perda auditiva.

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

    PubMed Central

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

    2012-01-01

    Background Morgellons is a poorly characterized constellation of symptoms, with the primary manifestations involving the skin. We conducted an investigation of this unexplained dermopathy to characterize the clinical and epidemiologic features and explore potential etiologies. Methods A descriptive study was conducted among persons at least 13 years of age and enrolled in Kaiser Permanente Northern California (KPNC) during 2006–2008. A case was defined as the self-reported emergence of fibers or materials from the skin accompanied by skin lesions and/or disturbing skin sensations. We collected detailed epidemiologic data, performed clinical evaluations and geospatial analyses and analyzed materials collected from participants' skin. Results We identified 115 case-patients. The prevalence was 3.65 (95% CI = 2.98, 4.40) cases per 100,000 enrollees. There was no clustering of cases within the 13-county KPNC catchment area (p = .113). Case-patients had a median age of 52 years (range: 17–93) and were primarily female (77%) and Caucasian (77%). Multi-system complaints were common; 70% reported chronic fatigue and 54% rated their overall health as fair or poor with mean Physical Component Scores and Mental Component Scores of 36.63 (SD = 12.9) and 35.45 (SD = 12.89), respectively. Cognitive deficits were detected in 59% of case-patients and 63% had evidence of clinically significant somatic complaints; 50% had drugs detected in hair samples and 78% reported exposure to solvents. Solar elastosis was the most common histopathologic abnormality (51% of biopsies); skin lesions were most consistent with arthropod bites or chronic excoriations. No parasites or mycobacteria were detected. Most materials collected from participants' skin were composed of cellulose, likely of cotton origin. Conclusions This unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of

  2. Is Migraine a Risk Factor for Pediatric Stroke?

    PubMed Central

    Gelfand, Amy A.; Fullerton, Heather J.; Jacobson, Alice; Sidney, Stephen; Goadsby, Peter J.; Kurth, Tobias; Pressman, Alice

    2015-01-01

    Importance Our understanding of risk factors for childhood stroke is incomplete. In adults, migraine with aura is associated with a two-fold increase in ischemic stroke risk. Objective In this cohort study we examine the association between migraine and stroke among children in Kaiser Permanente Northern California (KPNC). Design, Setting, and Participants Children ages 2-17 years who were members of KPNC for ≥6 months between1997-2007 were included. Migraine cohort members had one or more of: an ICD-9 code for migraine, migraine listed as a significant health problem, or a prescription for a migraine-specific medication. The comparison group was children with no evidence of headache. Main outcome measures stroke incidence rates and incidence rate ratios (IR). Results Among the 1,566,952 children within KPNC during the study period, 88,164 had migraine, and 1,323,142 had no evidence of headache. Eight migraineurs had a stroke (3 [38%] hemorrhagic; 5 [63%]ischemic). Eighty strokes occurred in children without headache, (53 [66%]hemorrhagic;27 [34%] ischemic). The ischemic stroke incidence rate was 0.9/100,000 person-years in migraineurs vs. 0.4/100,000 person-years in those without headache; IR 2.0 (95% CI 0.8-5.2). A post-hoc analysis of adolescents (12-17 years) showed an increased risk of ischemic stroke among those with migraine; IR 3.4(95% CI 1.2-9.5). The hemorrhagic stroke incidence rate was 0.5/100,000 person-years in migraineurs and 0.9/100,000 person-years in those without headache; IR 0.6 (95% CI 0.2-2.0). Conclusions There was no statistically significant increase in hemorrhagic or ischemic stroke risk in pediatric migraineurs in this cohort study. A post-hoc analysis found that ischemic stroke risk was significantly elevated in adolescents with migraine. Future studies should focus on identifying risk factors for ischemic stroke among adolescent migraineurs. Based on adult data, we recommend that migraine aura status should be studied as a possible

  3. Captura de satélites durante a formação de Júpiter

    NASA Astrophysics Data System (ADS)

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

    2003-08-01

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

  4. PS2-19: Developing an Automated Surveillance for Fetal Alcohol Syndrome Using Electronic Medical Records

    PubMed Central

    Hansen, Craig; Adams, Marvin

    2012-01-01

    Background/Aims Prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disabilities. The full diagnosis of Fetal alcohol syndrome (FAS) requires assessment of: prenatal exposure to alcohol, facial dysmorphology by a geneticist, restricted growth parameters, and central nervous system (CNS) abnormalities as denoted by small head circumference/structural anomalies, neurological deficits, and/or significant functional deficits. Using integrated information available at one source, we assessed the feasibility of developing an FAS surveillance system using the Kaiser Permanente Georgia (KPGA) Health Plan EMR. Methods Using EMRs, we extracted relevant information on the three main areas of FAS case definition (facial features, restricted growth, and CNS abnormalities). This was done among children up to the age of 10 years at the time of the diagnosis (including birth). Due to lack of ICD-9 codes for many of the facial features, we scanned the physician progress notes for relevant terms. These data were synthesized and applied to the FAS case definition algorithm. Results (at the time of the submission – these results may change with further analyses):Overall, preliminary analyses showed that 23,678 children met either the criteria for growth restriction (n=5,052) or CNS abnormalities (17,296). Of these children, 1,330 met the criteria for both growth restriction and CNS abnormalities. An algorithm is to conduct text string searches for facial dysmorphic features within physician progress notes among these 1,330 children is under development and results will be presented at the HMORN conference. Results on linking these children to mothers, along with alcohol use during pregnancy will also be presented. Discussion Development of a surveillance system for FAS using EMRs is challenging. Information on two (CNS and growth) of the three main criteria can be extracted to create a pool of potential FAS cases, while information on

  5. [GASTROSTOMY POSITIVELY AFFECTS NUTRITIONAL STATUS AND DIMINISHES HOSPITAL DAYS IN PATIENTS WITH INBORN ERRORS OF METABOLISM].

    PubMed

    Guillén-López, Sara; Vela-Amieva, Marcela; Juárez-Cruz, Merit Valeria; González-Zamora, José Francisco; Monroy-Santoyo, Susana; Belmont-Martínez, Leticia

    2015-07-01

    Introducción: el tratamiento nutricional de los pacientes con errores innatos del metabolismo (EIM) implica el uso permanente de fórmulas modificadas en aminoácidos cuyas características organolépticas pueden dificultar su aceptación por vía oral. Estos pacientes pueden tener alteraciones gastrointestinales y requieren el uso constante de medicamentos, lo cual complica la adherencia al tratamiento, comprometiéndose con ello su estado nutricional y el control de la enfermedad. La gastrostomía es una alternativa para facilitar la alimentación y el tratamiento, pero existen controversias sobre su uso. Objetivo: comparar el estado nutricional y la duración de las hospitalizaciones antes y después de la realización de la gastrostomía en un grupo de pacientes con EIM. Métodos: análisis retrospectivo de datos antropométricos, número de internamientos por descompensación metabólica y su duración en pacientes pediátricos con EIM antes y después de la gastrostomía. Resultados: se analizaron 16 niños; 40% con defectos del propionato, 25% con alteraciones del ciclo de la urea y 35% con otros EIM. Después de la gastrostomía, la proporción de pacientes eutróficos aumentó del 6 al 56% y la desnutrición disminuyó del 94 al 44%. Después de la gastrostomía, la duración de los periodos hospitalarios disminuyó significativamente de 425 a 131 días (p = 0.011); el número de internamientos disminuyó de 33 antes de la intervención a 17, sin embargo, esta diferencia no tuvo significación estadística. Conclusión: en esta muestra, la gastrostomía mejoró el estado nutricional en 56% de los pacientes con EIM, y redujo significativamente los días de hospitalización por descompensación metabólica.

  6. Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study

    PubMed Central

    Naleway, Allison; Swamy, Geeta; Krishnarajah, Girishanthy; Arondekar, Bhakti; Fernandez, Jovelle; Myers, Evan

    2017-01-01

    Objective To examine whether surgical procedures involving the uterine cervix were associated with pregnancy outcomes, including preterm birth, low birth weight, cesarean delivery and pregnancy loss. Design Population-based observational study nested in retrospective matched cohort Setting Kaiser Permanente Northwest integrated health plan in Oregon/Washington, U.S.A. Population Female health plan members age 14–53 years with documented pregnancies from 1998–2009. Women with prior excisional and ablative cervical surgical procedures (N = 322) were compared to women unexposed to cervical procedures (N = 4,307) and, separately, to those having undergone only diagnostic/biopsy procedures (N = 847). Methods Using log-linear regression models, we examined risk of adverse pregnancy outcomes in relation to prior excisional or ablative cervical surgical procedures. We stratified excisional procedures by excision thickness. We evaluated for confounding by age, body mass index, race, smoking history, previous preterm birth, and parity. Results We found a positive association between excisional treatment > = 1.0 cm and the outcomes preterm birth and low birth weight (preterm birth unadjusted risk ratio [RR] = 2.15, 95% confidence interval [CI] 1.16–3.98 for excisions ≥1.0 cm compared to unexposed women), particularly in women who delivered within one year of surgery (RR = 3.26, 95% CI 1.41–7.53). There was no clear association between excisional treatment and cesarean delivery, and treated women did not have a substantially higher risk of dysfunctional labor. Ablative treatment was not associated with low birth weight, preterm birth, or cesarean delivery but was associated with pregnancy loss (RR = 1.43, 95% CI 1.05–1.93 vs. unexposed women). Analyses using the diagnostic procedures comparison group produced similar results. Conclusion Women with > = 1.0 cm excisional treatment had elevated risk of preterm birth and low birth weight when compared to unexposed

  7. C-A5-04: A Simple, Accurate SAS Algorithm for Electronic Abstraction of Race from Digitized Progress Notes

    PubMed Central

    Roblin, Douglas; Joski, Peter; Ren, Junling; Farmer, Robert; Baldwin, David; Carrell, David; Hart, Gene; Pardee, Roy; Bachman, Donald

    2010-01-01

    Background and Aims: Individual-level race/ethnicity is important for research into causes and consequences of health disparities. For various non-research reasons, it has rarely been collected on enrollees in integrated delivery systems. Individual-level race/ethnicity can be found in medical record documentation. Manual abstraction on large numbers of medical records is costly. We developed a simple SAS algorithm for electronic abstraction of white and African American race from digitized progress notes and evaluated its accuracy by comparing electronically abstracted race with other data sources. Methods: A simple SAS algorithm, based on text search strings (e.g. white male, African American woman), scanned digitized progress notes for provider face-to-face visits from 2005 through July 2009 in Kaiser Permanente Georgia’s (KPG) and Group Health Cooperative’s (GHC) electronic medical record systems. White and African American race was abstracted. If the patient had more than 1 visit with abstracted race, the patient was classified using the earliest visit. Abstracted race was linked at the individual-level to survey datasets with self-reported race (2005 survey of working age adults, 2007 survey of adults with hypertension, 2000–2005 Medicare surveys) and mother’s race on 2000–2006 birth certificates. White and African American race was abstracted from GHC progress notes from 2005 through July 2009 using the same algorithm and compared to self-reported race on health risk appraisals. Accuracy of the SAS algorithm was assessed by overall proportion matching race from the other datasets, Cohen’s kappa, and McNemar’s test. Results: White or African American race was electronically abstracted for 56,261 KPG and 6,427 GHC enrollees. Abstracted race matched race from the other datasets in 97–99% of enrollees. Cohen’s kappas were highly significant (p<0.05), ranging from 0.939 ± 0.013 (N=657 matches with hypertension survey records) to 0.994 ± 0

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

    PubMed Central

    Detmer, Don; Bloomrosen, Meryl; Raymond, Brian; Tang, Paul

    2008-01-01

    Background Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable. Discussion While there is a spectrum of dominant PHR models, (standalone, tethered, integrated), the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders. Summary Integrated PHRs promote active, ongoing

  9. PubMed

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

    2008-01-01

    Esse artigo descreve como jovens religiosos e autoridades religiosas de sua comunidade compreendem a sexualidade, considerando suas experiências pessoais e como membros de comunidades religiosas. A análise pretende contribuir para que políticas públicas dedicadas à promoção da saúde sexual da juventude considerem a religiosidade, no contexto de um estado laico e da promoção do direito à prevenção. Foram realizadas 26 entrevistas abertas e semidirigidas em diferentes comunidades da região metropolitana da cidade de São Paulo (comunidades católicas, da umbanda, do candomblé e de diferentes denominações evangélicas) sobre iniciação sexual, casamento, gravidez, contracepção e prevenção das DST/Aids, homossexualidade, aborto e direitos humanos. Observou-se como jovens e autoridades religiosas convivem com a tensão entre tradição e modernidade e os distintos discursos sobre a sexualidade. Como sujeitos religiosos (do discurso religioso) e sujeitos sexuais (de discursos sobre sexualidade), devem ser incorporados pelos programas como sujeitos de direito nos termos de sua religiosidade.

  10. Múltiples estados de desorden en el etanol sólido

    NASA Astrophysics Data System (ADS)

    Fernández-Perea, R.

    El diagrama de fases del etanol por debajo de los 169 K será presentado. Se mostrará que el etanol puede solidificarse en tres fases con diversos niveles de desorden,(como un vidrio(G), como un vidrio orientacional (OG) y como un cristal de fase rotora (RP)) además de en una fase totalmente cristalina. Las estructuras de estas tres fases serán presentadas tal y como se deducen a partir de diversas medidas de difracción de neutrones al igual que las proporciones de los isómeros de dicho material en las fases desordenadas y se compararán con los resultados de la fase cristalina y del líquido superenfriado. Igualmente diversas medidas sobre su dinámica serán presentadas, tanto de dispersión de neutrones, como de capacidad calorífica y de medidas dieléctricas y comparadas con modelos teóricos y simulaciones para tratar de explicar los procesos de relajación observados y las transiciones entre las diversas fases.

  11. [Arterial pathology in migraine: endothelial dysfunction and structural changes in the brain and systemic vasculature].

    PubMed

    Larrosa-Campo, Davinia; Ramón-Carbajo, César; Álvarez-Escudero, Rocío; Cernuda-Morollón, Eva; García-Cabo, Carmen; Pascual, Julio

    2015-10-01

    Introduccion. La fisiopatologia subyacente a la asociacion entre migraña y otras enfermedades vasculares sistemicas no aterotromboticas no se conoce con certeza. La disfuncion endotelial se ha propuesto como nexo comun. A su vez, la disfuncion endotelial se considera como precursora de cambios estructurales en las paredes arteriales. Objetivo. Revisar el conocimiento actual acerca de las alteraciones funcionales (disfuncion endotelial) y estructurales (rigidez arterial y cambios ateroescleroticos) del lecho arterial asociadas a la migraña. Desarrollo. Estudios de marcadores biologicos de disfuncion endotelial en sangre periferica, vasorreactividad sistemica y cerebral, calculo de indices de rigidez arterial y visualizacion directa de cambios macroscopicos en la pared arterial han mostrado diferencias entre pacientes con y sin migraña, asi como entre los distintos subtipos de migraña. Conclusiones. La disfuncion endotelial, como precursora de cambios estructurales a nivel arterial, se postula como sustrato de la patologia vascular asociada a la migraña. La alteracion de marcadores biologicos es sugestiva de disfuncion endotelial en los pacientes con migraña; sin embargo, la correlacion con estudios de vasorreactividad no permite establecer conclusiones definitivas. Los datos disponibles no permiten concluir que la migraña se asocie con alteraciones macroscopicas fuera del lecho arterial cerebral.

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

    PubMed Central

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

    2009-01-01

    Esse artigo descreve como jovens religiosos e autoridades religiosas de sua comunidade compreendem a sexualidade, considerando suas experiências pessoais e como membros de comunidades religiosas. A análise pretende contribuir para que políticas públicas dedicadas à promoção da saúde sexual da juventude considerem a religiosidade, no contexto de um estado laico e da promoção do direito à prevenção. Foram realizadas 26 entrevistas abertas e semidirigidas em diferentes comunidades da região metropolitana da cidade de São Paulo (comunidades católicas, da umbanda, do candomblé e de diferentes denominações evangélicas) sobre iniciação sexual, casamento, gravidez, contracepção e prevenção das DST/Aids, homossexualidade, aborto e direitos humanos. Observou-se como jovens e autoridades religiosas convivem com a tensão entre tradição e modernidade e os distintos discursos sobre a sexualidade. Como sujeitos religiosos (do discurso religioso) e sujeitos sexuais (de discursos sobre sexualidade), devem ser incorporados pelos programas como sujeitos de direito nos termos de sua religiosidade. PMID:21886456

  13. [Gorlin syndrome in the paediatric age].

    PubMed

    Roncalés-Samanes, P; Peña-Segura, J L; Fernando-Martínez, R; Fuertes-Rodrigo, C; García-Oguiza, A; López-Pisón, J

    2014-04-01

    Introduccion. El sindrome de Gorlin (SG) es un trastorno de herencia autosomica dominante asociado a mutaciones en el gen PTCH1, cuya principal caracteristica es la aparicion de carcinomas basocelulares, unido a anomalias esqueleticas, queratoquistes odontogenicos y tumores intracraneales. Caso clinico. Niña de 3 años y 10 meses, ingresada por ataxia aguda. Destacan como antecedentes personales retraso psicomotor y como antecedentes familiares la sospecha de SG en la madre por quiste maxilar. En la exploracion, se aprecia macrocefalia con frente prominente e hipertelorismo, asi como nevo. Se solicita estudio genetico de SG, en el que se detecta la mutacion c.930delC en el exon 6 del gen PTCH1 en heterocigosis. Conclusiones. En el SG hay un aumento de la susceptibilidad al desarrollo de carcinomas basocelulares y es preciso un estrecho control dermatologico. Es necesario un seguimiento neurologico clinico y de imagen, mediante resonancia magnetica, para el diagnostico precoz de tumores intracraneales, fundamentalmente el meduloblastoma. Tambien son caracteristicos los queratoquistes odontogenicos, otras alteraciones cutaneas, fibromas cardiacos y ovaricos, asi como anomalias esqueleticas, que precisan controles clinicos y de imagen periodicos, y tratamiento en caso de ser necesarios, pero debe evitarse la radiacion. El SG es un trastorno poco frecuente, que se debe sospechar ante la presencia de alteraciones caracteristicas. Es necesario un seguimiento multidisciplinar, asi como establecer un protocolo de actuacion, para un temprano diagnostico y tratamiento de las complicaciones potencialmente graves derivadas de esta enfermedad.

  14. [Brain asymmetry and dopamine: beyond motor implications in Parkinson's disease and experimental hemiparkinsonism].

    PubMed

    Segarra, A B; Banegas, I; Prieto, I; Ramirez-Sanchez, M

    2016-11-01

    Introduccion. La asimetria cerebral se puede definir como la existencia de diferencias funcionales, anatomicas o neuroquimicas entre los dos hemisferios cerebrales. Se trata de un fenomeno dinamico modulable por factores endogenos y exogenos. Su significado funcional esta apenas aclarado y solo lo esta en algunos casos muy concretos como, por ejemplo, la relacion existente entre el contenido cerebral lateralizado de dopamina y sus efectos motores, que se manifiesta especialmente en la enfermedad de Parkinson. Desarrollo. El contenido asimetrico cerebral de dopamina no solo da lugar a efectos motores lateralizados, sino que se extiende a consecuencias autonomicas y de conducta igualmente lateralizadas. De hecho, la enfermedad de Parkinson se caracteriza por sintomas motores unilaterales, que surgen en las fases iniciales de la enfermedad, y por otros sintomas no motores, como alteraciones autonomicas o cognitivas, que tambien se manifiestan de forma lateralizada. Conclusiones. La asimetria cerebral ha sido un aspecto infravalorado a la hora de analizar la patogenia de las enfermedades cerebrales, y solo en determinados casos, como en la enfermedad de Parkinson, se ha profundizado parcialmente en su estudio. Sin embargo, se ha puesto en evidencia que es necesario considerar este fenomeno para la adecuada comprension de algunas patologias cerebrales, como es el caso de la enfermedad de Parkinson.

  15. Unsupported catalysts in the production of olefins

    SciTech Connect

    Kreuter, W.; Wernicke, H.

    1980-07-01

    A description is given of a process for the production of olefins in two stages wherein, in the first stage, a heavy petroleum fraction is hydrogenated essentially in the liquid phase in the presence of hydrogen and a hydrogenation catalyst and, in the second stage, the thus-hydrogenated fraction is subjected to thermal cracking in the vapor phase in the presence of steam, the improvement which comprises employing as the hydrogenation catalyst a support-free catalyst consisting essentially of at least one of Co-Mo, Ni-Mo, Co-Mo sulfide, Ni-Co-Mo sulfide, Ni-Mo sulfide, Ni-Co sulfide, Co-mo oxide, Ni-Co-Mo oxide, Ni-Mo oxide, Ni-Co oxide, Ni-W sulfide, Ni-W oxide, or organometallic complexes of aforementioned metallic mixtures.

  16. M S MOLECULARES Rumo aos limites da miniaturiza o - (Molecular Magnets - towards the limits of miniaturization)

    SciTech Connect

    Reis, Mario S; Moreira Dos Santos, Antonio F

    2010-01-01

    Por s culos, acreditou-se que o magnetismo s se manifestava em metais, como aqueles contendo ferro; hoje, a imagem mais comum de um m talvez seja a daquelas plaquinhas flex veis coladas geladeira com propagandas dos mais diversos tipos. O leitor conseguiria imaginar um material puramente org nico daqueles que formam os seres vivos como magn tico? E m s do tamanho de mol culas? fato: ambos existem. Esses novos materiais, conhecidos como magnetos moleculares, descobertos e desenvolvidos em v rios laborat rios do mundo, j re nem longa lista de aplica es, do tratamento do c ncer a refrigeradores ecol gicos, passando pela transmiss o de eletricidade sem perda de calor e a fabrica o de computadores extremamente velozes.

  17. Estudio teórico de la desorción de Na y K de SiO2 estimulada por la acción de fotones o electrones

    NASA Astrophysics Data System (ADS)

    Domínguez Ariza, D.; López, N.; Illas, F.; Pacchioni, G.; Madey, T. E.

    Se ha estudiado el mecanismo de generación de sodio y potasio atómico a partir de muestras de SiO2 utilizando cálculos basados tanto en la teoría del funcional de la densidad como en métodos post-Hartree Fock, así como en el método de cluster para modelar el sólido. Como consecuencia del estudio se han propuesto distintos caminos posibles para la desorción, estimulada por la acción de fotones o electrones, de sodio y potasio desde el óxido de silicio, proporcionando por lo tanto una explicación a la atmósfera tenue de sodio y potasio de La Luna.

  18. DESAFÍOS ÉTICOS DE LA INVESTIGACIÓN CON ANIMALES, MANIPULACIÓN GENÉTICA

    PubMed Central

    Yunta, Eduardo Rodríguez

    2012-01-01

    En la investigación con animales existen cuestionamientos éticos tanto en el uso como modelos de enfermedades humanas y requisito previo para ensayos en humanos como en la introducción de modificaciones genéticas. Algunos de estos cuestionamientos son: no representar exactamente la condición humana como modelos, realizar pruebas de toxicidad con grave daño para los animales, alterar su naturaleza mediante modificaciones genéticas, riesgos de la introducción de organismos genéticamente modificados. El uso de animales en investigación para beneficio humano, impone al ser humano la responsabilidad moral de respetarlo, no haciéndoles sufrir innecesariamente, al estar trabajando con seres vivientes y sentientes. PMID:23338641

  19. Primera aproximación a la estructura interna de Plutón

    NASA Astrophysics Data System (ADS)

    Steren, G. A.; Carranza, G. J.; Hubbard, W. B.

    En el presente trabajo se propuso estudiar la estructura interna actual del planeta Plutón. El modelo que se planteó es del tipo de estructura no-diferenciada. Se incluyó como fuente de calor interna la radioactividad y como único mecanismo de transporte de la energía a la conducción. Se encontró que el planeta estaría compuesto por una mezcla de roca (65% en masa) y hielo de agua (35%). Este simple modelo permite inferir que una estructura más realista para Plutón debería incluir también a la convección como mecanismo de transporte. Ello además permitiría avanzar de modo más firme en el estado de diferenciación del planeta, que casi seguramente sea más complejo que el adoptado.

  20. Raízes pós-mitológicas da Astronomia Clássica

    NASA Astrophysics Data System (ADS)

    di Bartolo, L.; Villas da Rocha, J. F.

    2004-02-01

    Apresentamos como a invenção de um modelo astronômico e cosmológico fundado em causas naturais foi um processo gestado num ambiente cultural específico, o do advento do pensamento pós-mitológico, que tem como sua raiz mais funda a trajetória particular da Grécia Antiga, com ênfase na resolução de uma grave crise social e a evolução do mundo clássico para o contexto espiritual de um império universal.