Sample records for expanded delivery options

  1. Contraceptive introduction and the management of choice: the role of Cyclofem in Indonesia.

    PubMed

    Simmons, R; Fajans, P; Lubis, F

    1994-05-01

    This paper presents a programmatic perspective on the relationship between the introduction of new contraceptive technology and expanding contraceptive options, using the example of Cyclofem in Indonesia. Past approaches to contraceptive introduction have considered only the characteristics of the new method in the decision-making process. In assessing whether the introduction of a new method actually expands contraceptive choice for women and whether the program has the managerial capabilities to assure quality of care in this process, the authors argue that consideration must be given to all methods within a delivery system and how new technology relates to the management of contraceptive choice. Using this perspective, the authors suggest that choice would not necessarily be expanded with scaled-up service delivery of a new once-a month injectable in the Indonesian public sector context.

  2. Student Perceptions of Web-Based Supplemental Instruction

    ERIC Educational Resources Information Center

    Freeman, Steven A.; Field, Dennis W.

    2004-01-01

    The Internet is changing the way in which education is delivered, and in fact, some predict that the Internet will become the dominant distribution system for distance education and training. Many faculty members are expanding their traditional delivery methods (lecture, laboratory, face-to-face discussion) to include educational options ranging…

  3. Advances in Male Contraception

    PubMed Central

    Page, Stephanie T.; Amory, John K.; Bremner, William J.

    2008-01-01

    Despite significant advances in contraceptive options for women over the last 50 yr, world population continues to grow rapidly. Scientists and activists alike point to the devastating environmental impacts that population pressures have caused, including global warming from the developed world and hunger and disease in less developed areas. Moreover, almost half of all pregnancies are still unwanted or unplanned. Clearly, there is a need for expanded, reversible, contraceptive options. Multicultural surveys demonstrate the willingness of men to participate in contraception and their female partners to trust them to do so. Notwithstanding their paucity of options, male methods including vasectomy and condoms account for almost one third of contraceptive use in the United States and other countries. Recent international clinical research efforts have demonstrated high efficacy rates (90–95%) for hormonally based male contraceptives. Current barriers to expanded use include limited delivery methods and perceived regulatory obstacles, which stymie introduction to the marketplace. However, advances in oral and injectable androgen delivery are cause for optimism that these hurdles may be overcome. Nonhormonal methods, such as compounds that target sperm motility, are attractive in their theoretical promise of specificity for the reproductive tract. Gene and protein array technologies continue to identify potential targets for this approach. Such nonhormonal agents will likely reach clinical trials in the near future. Great strides have been made in understanding male reproductive physiology; the combined efforts of scientists, clinicians, industry and governmental funding agencies could make an effective, reversible, male contraceptive an option for family planning over the next decade. PMID:18436704

  4. Special Education Reform Towards Inclusive Education: Blurring or Expanding Boundaries of Special and Regular Education in China

    ERIC Educational Resources Information Center

    Deng, Meng; Zhu, Xinhua

    2016-01-01

    China has developed a three-tier special education service delivery system consisting of an array of placement options of special schools, special classes and learning in regular classrooms (LRC) (with the LRC as the major initiative) to serve students with disabilities after 1980s responding to the international trend of inclusive education…

  5. Expanding the domain of drug delivery for HIV prevention: exploration of the transdermal route.

    PubMed

    Puri, Ashana; Sivaraman, Arunprasad; Zhang, Wei; Clark, Meredith R; Banga, Ajay K

    2017-01-01

    Constant efforts for HIV prevention using antiretroviral drugs, pre- and postexposure prophylactic agents, and microbicides are being made by researchers. Drug-delivery systems such as oral tablets and coitally dependent vaginal gels are short acting, require daily application, and are associated with user adherence issues, whereas the coitally independent systems such as injectables and biodegradable implants are long acting, lasting several months, during which time the termination of prophylaxis is impractical in case of adverse effects. An effective drug-delivery system to be used for an intermediate duration, if available, would be an attractive alternative option for users in terms of adherence. Transdermal delivery systems, overcoming most of the limitations of the other routes of administration and aiming to provide sustained delivery of drugs through skin, may be explored for HIV prevention. Passive and physical enhancement techniques may be designed strategically to improve the transdermal delivery of HIV preventive agents.

  6. ExpandED Options: Learning beyond High School Walls

    ERIC Educational Resources Information Center

    ExpandED Schools, 2014

    2014-01-01

    Through ExpandED Options by TASC, New York City high school students get academic credit for learning career-related skills that lead to paid summer jobs. Too many high school students--including those most likely to drop out--are bored or see classroom learning as irrelevant. ExpandED Options students live the connection between mastering new…

  7. Data Requirements for Oceanic Processes in the Open Ocean, Coastal Zone, and Cryosphere

    NASA Technical Reports Server (NTRS)

    Nagler, R. G.; Mccandless, S. W., Jr.

    1978-01-01

    The type of information system that is needed to meet the requirements of ocean, coastal, and polar region users was examined. The requisite qualities of the system are: (1) availability, (2) accessibility, (3) responsiveness, (4) utility, (5) continuity, and (6) NASA participation. The system would not displace existing capabilities, but would have to integrate and expand the capabilities of existing systems and resolve the deficiencies that currently exist in producer-to-user information delivery options.

  8. Biological Gene Delivery Vehicles: Beyond Viral Vectors

    PubMed Central

    Seow, Yiqi; Wood, Matthew J

    2009-01-01

    Gene therapy covers a broad spectrum of applications, from gene replacement and knockdown for genetic or acquired diseases such as cancer, to vaccination, each with different requirements for gene delivery. Viral vectors and synthetic liposomes have emerged as the vehicles of choice for many applications today, but both have limitations and risks, including complexity of production, limited packaging capacity, and unfavorable immunological features, which restrict gene therapy applications and hold back the potential for preventive gene therapy. While continuing to improve these vectors, it is important to investigate other options, particularly nonviral biological agents which include bacteria, bacteriophage, virus-like particles (VLPs), erythrocyte ghosts, and exosomes. Exploiting the natural properties of these biological entities for specific gene delivery applications will expand the repertoire of gene therapy vectors available for clinical use. Here, we review the prospects for nonviral biological delivery vehicles as gene therapy agents with focus on their unique evolved biological properties and respective limitations and potential applications. The potential of these nonviral biological entities to act as clinical gene therapy delivery vehicles has already been shown in clinical trials using bacteria-mediated gene transfer and with sufficient development, these entities will complement the established delivery techniques for gene therapy applications. PMID:19277019

  9. Biological gene delivery vehicles: beyond viral vectors.

    PubMed

    Seow, Yiqi; Wood, Matthew J

    2009-05-01

    Gene therapy covers a broad spectrum of applications, from gene replacement and knockdown for genetic or acquired diseases such as cancer, to vaccination, each with different requirements for gene delivery. Viral vectors and synthetic liposomes have emerged as the vehicles of choice for many applications today, but both have limitations and risks, including complexity of production, limited packaging capacity, and unfavorable immunological features, which restrict gene therapy applications and hold back the potential for preventive gene therapy. While continuing to improve these vectors, it is important to investigate other options, particularly nonviral biological agents which include bacteria, bacteriophage, virus-like particles (VLPs), erythrocyte ghosts, and exosomes. Exploiting the natural properties of these biological entities for specific gene delivery applications will expand the repertoire of gene therapy vectors available for clinical use. Here, we review the prospects for nonviral biological delivery vehicles as gene therapy agents with focus on their unique evolved biological properties and respective limitations and potential applications. The potential of these nonviral biological entities to act as clinical gene therapy delivery vehicles has already been shown in clinical trials using bacteria-mediated gene transfer and with sufficient development, these entities will complement the established delivery techniques for gene therapy applications.

  10. Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa

    PubMed Central

    2014-01-01

    Background Clients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods. Methods We examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients. Results Following the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects. Conclusions The intervention failed to improve PMTCT clients’ knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally. PMID:24410922

  11. Technical Aspects of Fecal Microbial Transplantation (FMT).

    PubMed

    Bhutiani, N; Schucht, J E; Miller, K R; McClave, Stephen A

    2018-06-09

    Fecal microbial transplantation (FMT) has become established as an effective therapeutic modality in the treatment of antibiotic-refractory recurrent Clostridium difficile colitis. A number of formulations and methods of delivery of FMT are currently available, each with distinct advantages. This review aims to review donor and patient selection for FMT as well as procedural aspects of FMT to help guide clinical practice. FMT can be obtained in fresh, frozen, lyophilized, and capsule-based formulations for delivery by oral ingestion, nasoenteric tube, colonoscopy, or enema (depending on the formulation used). Choosing the optimal method relies heavily on patient-related factors, including underlying pathology and severity of illness. As potential applications for FMT expand, careful donor screening and patient selection are critical to minimizing risk to patients and physicians. FMT represents an excellent therapeutic option for treatment of recurrent Clostridium difficile colitis and holds promise as a possible treatment modality in a variety of other conditions. The wide array of delivery methods allows for its application in various disease states in both the inpatient and outpatient setting.

  12. 75 FR 66402 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-28

    ... necessary systems capacity to handle the additional traffic associated with the expanded range of strike... Effectiveness of Proposed Rule Change To Expand the Range of Strike Price Intervals for VIX Options October 21... amend Rule 24.9.01(e), Terms of Index Option Contracts, to expand the range of strike price intervals...

  13. 76 FR 72473 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Order Granting Approval of Proposed...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-23

    ... Expanding the Short Term Option Series Program November 17, 2011. I. Introduction On September 28, 2011, The...,\\2\\ a proposed rule change to expand the Short Term Option Program (``Program'') to allow the NASDAQ Options Market (``NOM'' or ``Exchange'') to: (1) Select up to 30 option classes on which Short Term Option...

  14. Microchips and controlled-release drug reservoirs.

    PubMed

    Staples, Mark

    2010-01-01

    This review summarizes and updates the development of implantable microchip-containing devices that control dosing from drug reservoirs integrated with the devices. As the expense and risk of new drug development continues to increase, technologies that make the best use of existing therapeutics may add significant value. Trends of future medical care that may require advanced drug delivery systems include individualized therapy and the capability to automate drug delivery. Implantable drug delivery devices that promise to address these anticipated needs have been constructed in a variety of ways using micro- and nanoelectromechanical systems (MEMS or NEMS)-based technology. These devices expand treatment options for addressing unmet medical needs related to dosing. Within the last few years, advances in several technologies (MEMS or NEMS fabrication, materials science, polymer chemistry, and data management) have converged to enable the construction of miniaturized implantable devices for controlled delivery of therapeutic agents from one or more reservoirs. Suboptimal performance of conventional dosing methods in terms of safety, efficacy, pain, or convenience can be improved with advanced delivery devices. Microchip-based implantable drug delivery devices allow localized delivery by direct placement of the device at the treatment site, delivery on demand (emergency administration, pulsatile, or adjustable continuous dosing), programmable dosing cycles, automated delivery of multiple drugs, and dosing in response to physiological and diagnostic feedback. In addition, innovative drug-medical device combinations may protect labile active ingredients within hermetically sealed reservoirs. Copyright (c) 2010 John Wiley & Sons, Inc.

  15. A Review of Research Methods Used to Examine Employee Assistance Program Delivery Options.

    ERIC Educational Resources Information Center

    Csiernik, Rick

    1995-01-01

    This review of literature on Employee Assistance Programs (EAPs) focuses on EAP delivery options. More than half of the 48 studies reviewed used a case study approach. EAPs provided by on-staff professionals were the most frequently discussed delivery option, although this is not the most dominant form of EAP provision. (SLD)

  16. Communications data delivery system analysis task 2 report : high-level options for secure communications data delivery systems.

    DOT National Transportation Integrated Search

    2012-05-16

    This Communications Data Delivery System Analysis Task 2 report describes and analyzes options for Vehicle to Vehicle (V2V) and Vehicle to Infrastructure (V2I) communications data delivery systems using various communication media (Dedicated Short Ra...

  17. Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss.

    PubMed

    Dalton, Vanessa K; Liang, Angela; Hutton, David W; Zochowski, Melissa K; Fendrick, A Mark

    2015-02-01

    The objective of this study was to estimate the economic consequences of expanding options for early pregnancy loss (EPL) treatment beyond expectant management and operating room surgical evacuation (usual care). We constructed a decision model using a hypothetical cohort of women undergoing EPL management within a 30 day horizon. Treatment options under the usual care arm include expectant management and surgical uterine evacuation in an operating room (OR). Treatment options under the expanded care arm included all evidence-based safe and effective treatment options for EPL: expectant management, misoprostol treatment, surgical uterine evacuation in an office setting, and surgical uterine evacuation in an OR. Probabilities of entering various treatment pathways were based on previously published observational studies. The cost per case was US $241.29 lower for women undergoing treatment in the expanded care model as compared with the usual care model (US $1033.29 per case vs US $1274.58 per case, expanded care and usual care, respectively). The model was the most sensitive to the failure rate of the expectant management arm, the cost of the OR surgical procedure, the proportion of women undergoing an OR surgical procedure under usual care, and the additional cost per patient associated with implementing and using the expanded care model. This study demonstrates that expanding women's treatment options for EPL beyond what is typically available can result in lower direct medical expenditures. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. 48 CFR 47.305-11 - Options in shipment and delivery.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Options in shipment and... CONTRACT MANAGEMENT TRANSPORTATION Transportation in Supply Contracts 47.305-11 Options in shipment and... shipment and delivery, it may be desirable to provide specifically for certain options in the solicitation...

  19. 78 FR 76363 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-17

    ... the Related non-STO), and $1 or greater where the strike price is between $75 and $150. The proposed... expand the Short Term Options Program with respect to non-index options. The text of the proposed rule... proposes to expand the Short Term Options (``STO'') Program for non-index options so that the Exchange may...

  20. Future therapeutic directions; new medications and insulin delivery in a changing world for effective diabetes management.

    PubMed

    Modi, Pankaj

    2009-09-01

    Insulin remains a key to the management of diabetes. The early addition of insulin to oral therapy in type-2 patients is recognized as an effective option that can help improve glycemic control and reduces the complications and contribute to more favorable outcomes. Controlling blood glucose levels within acceptable limits is crucial to the long-term health of patients with diabetes. The benefits of patient education and chronic disease management tools cannot be underestimated as many patients will require education and help in initiation of insulin therapy to achieve glycemic targets. The wide choice of insulin formulations and the ever-expanding range of delivery methods are now available. These methods made insulin administration easier, less painful, more discreet, and more accurate than ever before thus providing important tools to overcome barriers to insulin initiation and improve achievement of glycemic goals. In addition, exciting developments in newer therapeutics have increased the potential for optimal glycemic control. This review discusses how these approaches can help patients manage their diabetes effectively by considering new insulin formulations and delivery devices and newer therapeutics.

  1. Integrating community health workers within Patient Protection and Affordable Care Act implementation.

    PubMed

    Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C; Trinh-Shevrin, Chau

    2015-01-01

    The Patient Protection and Affordable Care Act's (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers' role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers' unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models.

  2. Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation

    PubMed Central

    Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C.; Trinh-Shevrin, Chau

    2015-01-01

    Context The Patient Protection and Affordable Care Act’s (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. Objective This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Results Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers’ role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers’ unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Conclusion Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models. PMID:25414955

  3. Education Savings Accounts: A Promising Way Forward on School Choice. WebMemo. No. 3382

    ERIC Educational Resources Information Center

    Burke, Lindsey M.

    2011-01-01

    Across the country, states are enacting and expanding school choice options for families. This year alone, 12 states and the District of Columbia have implemented new school choice options for children or expanded existing options, leading The Wall Street Journal to label 2011 "The Year of School Choice." Among the many school choice…

  4. Default options and neonatal resuscitation decisions.

    PubMed

    Haward, Marlyse Frieda; Murphy, Ryan O; Lorenz, John M

    2012-12-01

    To determine whether presenting delivery room management options as defaults influences decisions to resuscitate extremely premature infants. Adult volunteers recruited from the world wide web were randomised to receive either resuscitation or comfort care as the delivery room management default option for a hypothetical delivery of a 23-week gestation infant. Participants were required to check a box to opt out of the default. The primary outcome measure was the proportion of respondents electing resuscitation. Data were analysed using χ(2) tests and multivariate logistic regression. Participants who were told the delivery room management default option was resuscitation were more likely to opt for resuscitation (OR 6.54 95% CI 3.85 to 11.11, p<0.001). This effect persisted on multivariate regression analysis (OR 7.00, 95% CI 3.97 to 12.36, p<0.001). Female gender, being married or in a committed relationship, being highly religious, experiences with prematurity, and favouring sanctity of life were significantly associated with decisions to resuscitate. Presenting delivery room options for extremely premature infants as defaults exert a significant effect on decision makers. The information structure of the choice task may act as a subtle form of manipulation. Further, this effect may operate in ways that a decision maker is not aware of and this raises questions of patient autonomy. Presenting delivery room options for extremely premature infants as defaults may compromise autonomous decision-making.

  5. The Whole PIC Catalog: Organization, Planning and Service Delivery Options under JTPA.

    ERIC Educational Resources Information Center

    National Alliance of Business, Inc., Washington, DC.

    This handbook illustrates and discusses organizational options for the delivery of employment and training services within service delivery areas (SDAs) mandated by the Job Training Partnership Act (JTPA) of 1982. Addressed primarily to members of private industry councils (PICs), representatives of local governments, and employment and training…

  6. Hepatocellular carcinoma: early-stage management challenges

    PubMed Central

    Erstad, Derek J; Tanabe, Kenneth K

    2017-01-01

    Hepatocellular carcinoma (HCC) is a major cause of cancer death and is increasing in incidence. This review focuses on HCC surveillance and treatment of early-stage disease, which are essential to improving outcomes. Multiple societies have published HCC surveillance guidelines, but screening efforts have been limited by noncompliance and overall lack of testing for patients with undiagnosed chronic liver disease. Treatment of early-stage HCC has become increasingly complex due to expanding therapeutic options and better outcomes with established treatments. Surgical indications for HCC have broadened with improved preoperative liver testing, neoadjuvant therapy, portal vein embolization, and perioperative care. Advances in post-procedural monitoring have improved efficacies of transarterial chemoembolization and radiofrequency ablation, and novel therapies involving delivery of radiochemicals are being studied in small trials. Finally, advances in liver transplantation have allowed for expanded indications beyond Milan criteria with non-inferior outcomes. More clinical trials evaluating new therapies and multimodal regimens are necessary to help clinicians design better treatment algorithms and improve outcomes. PMID:28721349

  7. Rural and remote care

    PubMed Central

    Marciniuk, Darcy

    2016-01-01

    The challenges of providing quality respiratory care to persons living in rural or remote communities can be daunting. These populations are often vulnerable in terms of both health status and access to care, highlighting the need for innovation in service delivery. The rapidly expanding options available using telehealthcare technologies have the capacity to allow patients in rural and remote communities to connect with providers at distant sites and to facilitate the provision of diagnostic, monitoring, and therapeutic services. Successful implementation of telehealthcare programs in rural and remote settings is, however, contingent upon accounting for key technical, organizational, social, and legal considerations at the individual, community, and system levels. This review article discusses five types of telehealthcare delivery that can facilitate respiratory care for residents of rural or remote communities: remote monitoring (including wearable and ambient systems; remote consultations (between providers and between patients and providers), remote pulmonary rehabilitation, telepharmacy, and remote sleep monitoring. Current and future challenges related to telehealthcare are discussed. PMID:26902542

  8. Buprenorphine – an attractive opioid with underutilized potential in treatment of chronic pain

    PubMed Central

    Khanna, Ish K; Pillarisetti, Sivaram

    2015-01-01

    Despite proven clinical utility, buprenorphine has not been used widely for the treatment of chronic pain. Questions about “ceiling effect” or bell-shaped curve observed for analgesia in preclinical studies and potential withdrawal issues on combining with marketed μ-agonists continue to hinder progress in expanding full potential of buprenorphine in the treatment of cancer and noncancer pain. Mounting evidence from clinical studies and conclusions drawn by a panel of experts strongly support superior safety and efficacy profile of buprenorphine vs marketed opioids. No ceiling on analgesic effect has been reported in clinical studies. The receptor pharmacology and pharmacokinetics profile of buprenorphine is complex but unique and contributes to its distinct safety and efficacy. The buprenorphine pharmacology also allows it to be combined with other μ-receptor opioids for additivity in efficacy. Transdermal delivery products of buprenorphine have been preferred choices for the management of pain but new delivery options are under investigation for the treatment of both opioid dependence and chronic pain. PMID:26672499

  9. 17 CFR 15.00 - Definitions of terms used in parts 15 to 21 of this chapter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... commodity, means the actual commodity as distinguished from a futures or options contract in such commodity... for future delivery or commodity option transactions, or for effecting settlements of contracts for future delivery or commodity option transactions, for and between members of any designated contract...

  10. Contraceptive Practice in Sub-Saharan Africa

    PubMed Central

    Tsui, Amy O.; Brown, Win; Li, Qingfeng

    2017-01-01

    Forty eight of the African continent’s 54 sovereign states are located in the Sub-Saharan Africa (SSA) region, with the government of each defining and shaping its own health services and delivery systems. This paper reviews the trends and patterns of contraceptive practice in the region. Using survey data available from the Demographic and Health Surveys and Performance Monitoring and Accountability 2020, the study finds modern contraceptive practice to be on the rise overall but with much geographic variation. The contraceptive methods most frequently used are injectables and, more recently, implants. Higher levels of use are observed among unmarried sexually active than married females. Although use is rising, contraceptive discontinuation rates are also high. Recent program initiatives discussed include expanding long-acting contraceptive options, promoting and delivering contraceptive methods in the postpartum period, and relying on community health workers for contraceptive outreach and service delivery. SSA’s family planning situation remains challenged by weak health systems which must address competing priorities to manage disease prevention as well as primary health care. Increasing investments in family planning delivery in many SSA countries, however, augur for continued rapid uptake of modern contraception, possibly matching if not outpacing the record of other regions. PMID:29081552

  11. Expanding services in a shrinking economy: desktop document delivery in a dental school library.

    PubMed

    Gushrowski, Barbara A

    2011-07-01

    How can library staff develop and promote a document delivery service and then expand the service to a wide audience? The setting is the library at the Indiana University School of Dentistry (IUSD), Indianapolis. A faculty survey and a citation analysis were conducted to determine potential use of the service. Volume of interlibrary loan transactions and staff and equipment capacity were also studied. IUSD Library staff created a desktop delivery service (DDSXpress) for faculty and then expanded the service to practicing dental professionals and graduate students. The number of faculty using DDSXpress remains consistent. The number of practicing dental professionals using the service is low. Graduate students have been quick to adopt the service. Through careful analysis of capacity and need for the service, staff successfully expanded document delivery service without incurring additional costs. Use of DDSXpress is continually monitored, and opportunities to market the service to practicing dental professionals are being investigated.

  12. Expanding Alternative Delivery Systems.

    ERIC Educational Resources Information Center

    Baltzer, Jan A.

    Alternative educational delivery systems that might be useful to community colleges are considered. The following categories of delivery systems are covered: broadcast delivery systems; copy delivery systems, print delivery systems, computer delivery systems, telephone delivery systems, and satellites. Among the applications for broadcast…

  13. Document Delivery: Evaluating the Options.

    ERIC Educational Resources Information Center

    Ward, Suzanne M.

    1997-01-01

    Discusses options available to libraries for document delivery. Topics include users' needs; cost; copyright compliance; traditional interlibrary loan; types of suppliers; selection criteria, including customer service; new developments in interlibrary loan, including outsourcing arrangements; and the need to evaluate suppliers. (LRW)

  14. Expanding services in a shrinking economy: desktop document delivery in a dental school library

    PubMed Central

    Gushrowski, Barbara A

    2011-01-01

    Question: How can library staff develop and promote a document delivery service and then expand the service to a wide audience? Setting: The setting is the library at the Indiana University School of Dentistry (IUSD), Indianapolis. Method: A faculty survey and a citation analysis were conducted to determine potential use of the service. Volume of interlibrary loan transactions and staff and equipment capacity were also studied. Main results: IUSD Library staff created a desktop delivery service (DDSXpress) for faculty and then expanded the service to practicing dental professionals and graduate students. The number of faculty using DDSXpress remains consistent. The number of practicing dental professionals using the service is low. Graduate students have been quick to adopt the service. Conclusion: Through careful analysis of capacity and need for the service, staff successfully expanded document delivery service without incurring additional costs. Use of DDSXpress is continually monitored, and opportunities to market the service to practicing dental professionals are being investigated. PMID:21753911

  15. 75 FR 77576 - General Regulations and Derivatives Clearing Organizations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-13

    ... Derivatives Clearing Organizations AGENCY: Commodity Futures Trading Commission. ACTION: Notice of proposed... clearing transactions in commodities for future delivery or commodity option transactions, or for effecting settlements of contracts for future delivery or commodity option transactions, for and between members of any...

  16. Expanding Discourse Options through Computer-Mediated Communication: Guiding Learners toward Autonomy

    ERIC Educational Resources Information Center

    Abraham, Lee B.; Williams, Lawrence

    2011-01-01

    This article proposes a multiliteracies-based pedagogical framework for the analysis of computer-mediated discourse (CMD) in order to give students increased access to expanded discourse options that are available in online communication environments and communities (i.e., beyond the classroom). Through the analysis of excerpts and a corpus of…

  17. 77 FR 70893 - Authorization for Non-VA Medical Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-28

    ... professions, Health records, Homeless, Mental health programs, Nursing homes, Reporting and recordkeeping... restrictive modes of healthcare delivery. Although VA has made great strides to expand the delivery of... expand VA's authority to provide non-VA medical services under the non- VA care authority. As amended...

  18. Community Pharmacists' Preferences for Continuing Education Delivery in Australia

    ERIC Educational Resources Information Center

    Mc Namara, Kevin P.; Duncan, Gregory J.; McDowell, Jenny; Marriott, Jennifer L.

    2009-01-01

    Introduction: New technologies such as the Internet offer an increasing number of options for the delivery of continuing education (CE) to community pharmacists. Many of these options are being utilized to overcome access- and cost-related problems. This paper identifies learning preferences of Australian community pharmacists for CE and…

  19. Case management information systems: how to put the pieces together now and beyond year 2000.

    PubMed

    Matthews, Pamela

    2002-01-01

    The case management process is a critical management and operational component in the delivery of customer services across the patient care continuum. Case management has transcended time and will continue to be a viable infrastructure process for successful organizations in the future. A key component of the case management infrastructure is information systems and technology support. Case management challenges include effective deployment and use of systems and technology. As more sophisticated, integrated systems are made available, case managers can use these tools to continue to expand effectively beyond the patient's episodic event to provide greater levels of cradle-to-grave management of healthcare. This article explores methods for defining case management system needs and identifying automation options available to the case manager.

  20. Implementing virtual microscopy improves outcomes in a hematology morphology course.

    PubMed

    Brueggeman, Mauri S; Swinehart, Cheryl; Yue, Mary Jane; Conway-Klaassen, Janice M; Wiesner, Stephen M

    2012-01-01

    In this study, we evaluated the efficacy of virtual microscopy as the primary mode of laboratory instruction in undergraduate level clinical hematology teaching. Distance education (DE) has become a popular option for expanding education and optimizing expenses but continues to be controversial. The challenge of delivering an equitable curriculum to distant locations along with the need to preserve our slide collection directed our effort to digitize the slide sets used in our teaching laboratories. Students enrolled at two performance sites were randomly assigned to either traditional microscopy (TM) or virtual microscopy (VM) instruction. The VM group performed significantly better than the TM group. We anticipate that this approach will play a central role in the distributed delivery of hematology through distance education as new programs are initiated to address workforce shortage needs.

  1. Developing a Web-Based Tool Using Information and Communication Technologies to Expand the Reach and Impact of Photovoice

    ERIC Educational Resources Information Center

    Strack, Robert W.; Orsini, Muhsin Michael; Fearnow-Kenney, Melodie; Herget, Jennifer; Milroy, Jeffrey J.; Wyrick, David L.

    2015-01-01

    Information and communication technologies are opening up vast new arenas for conducting the work of health promotion. Technology-based health promotions expand reach, standardize information and its delivery, provide opportunities for tailoring, create engaging interactivity within content delivery, provide for privacy and autonomy, improve…

  2. Addressing Trauma in Schools: Multitiered Service Delivery Options for Practitioners

    ERIC Educational Resources Information Center

    Reinbergs, Erik J.; Fefer, Sarah A.

    2018-01-01

    Hundreds of thousands of children are confronted with traumatic experiences each year in the United States. As trauma-informed care begins to take hold in schools, school mental health providers (e.g., school psychologists, counselors, and social workers) desire concrete service-delivery options for students affected by trauma. This article…

  3. 31 CFR 1010.605 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., but not limited to, those established to effect transactions in contracts of sale of a commodity for future delivery, options on any contract of sale of a commodity for future delivery, or options on a commodity; and (iv) As applied to mutual funds (as set forth in paragraph (e)(1)(x) of this section) means...

  4. 77 FR 3828 - Self-Regulatory Organizations; The Options Clearing Corporation; Order Granting Approval of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-25

    ... Organizations; The Options Clearing Corporation; Order Granting Approval of Accelerated Delivery of Supplement to the Options Disclosure Document Reflecting Certain Changes to Disclosure Regarding Relative Performance Options January 19, 2012. On August 15, 2011, The Options Clearing Corporation (``OCC'') submitted...

  5. Recommendations to Facilitate Expanded Access to Investigational Therapies for Seriously Ill Patients

    PubMed Central

    Jerome, Rebecca N.; Edwards, Terri L.; Boswell, Haley C.; Bernard, Gordon R.; Harris, Paul A.; Pulley, Jill M.

    2015-01-01

    When clinical trial enrollment is not an option for seriously ill patients whose illnesses have not responded to approved treatment options, those patients and their physicians may consider gaining access to investigational therapies through a pathway established by the Food and Drug Administration (FDA) called expanded access. However, recent events have highlighted the challenging dynamics involved in accessing investigational therapies through expanded access that include a complex interplay of factors involving the patient, physician, drug company, FDA, and, increasingly, social media. The authors offer several potential strategies to streamline what is otherwise an arduous process for all involved. (1) The drug company should prospectively determine whether it will establish an expanded access program for specific drugs. (2) A central clearinghouse for companies should support registration of expanded access drugs for suitable patients. (3) The determination of whether a patient fits criteria would be made by an independent review board of clinicians. (4) An independent coordinating center is needed; academic health centers are ideally suited for that role. (5) Adequate financing of the costs of therapy need to be in place to make expanded access a reality, given frequent lack of payor coverage for therapies. (6) Further enhancement of regulatory pathways, approaches, or rules would promote expanded access. (7) Patients should explicitly acknowledge the limited data available. (8) There should be a shared, secure, technical platform to facilitate expanded access. All the authors’ strategies present important prospects for improving treatment options for the most seriously ill patients. PMID:26445080

  6. [Training and challenges for the health care system in Brazil: an analysis of investments to expand health care service delivery].

    PubMed

    Soares, Adilson

    2007-07-01

    The goal of this study is to discuss the investments made by the Brazilian government to expand health care service delivery in the Unified National Health System (SUS) from 1995 to 2001. The data indicate a mismatch between investments to increase service delivery and maintenance and optimization of the health service network's capacity. The paper concludes that there is a need to guarantee financial maintenance of the system and conduct new investments based on an analysis of the installed capacity and the financial possibilities to guarantee resources for continuous delivery of this additional services supply.

  7. Intentions of Women (18-25 Years Old) to Join the Military: Results of a National Survey.

    ERIC Educational Resources Information Center

    Borack, Jules I.

    In anticipation of the projected decline in the national population of young men and of expanding the role of women in the military, the Navy conducted a national telephone survey to gauge the interest of women and men in joining the military under present conditions and under three alternative options. The options related to expanding the role of…

  8. Unified Program Design: Organizing Existing Programming Models, Delivery Options, and Curriculum

    ERIC Educational Resources Information Center

    Rubenstein, Lisa DaVia; Ridgley, Lisa M.

    2017-01-01

    A persistent problem in the field of gifted education has been the lack of categorization and delineation of gifted programming options. To address this issue, we propose Unified Program Design as a structural framework for gifted program models. This framework defines gifted programs as the combination of delivery methods and curriculum models.…

  9. Proteases as therapeutics

    PubMed Central

    Craik, Charles S.; Page, Michael J.; Madison, Edwin L.

    2015-01-01

    Proteases are an expanding class of drugs that hold great promise. The U.S. FDA (Food and Drug Administration) has approved 12 protease therapies, and a number of next generation or completely new proteases are in clinical development. Although they are a well-recognized class of targets for inhibitors, proteases themselves have not typically been considered as a drug class despite their application in the clinic over the last several decades; initially as plasma fractions and later as purified products. Although the predominant use of proteases has been in treating cardiovascular disease, they are also emerging as useful agents in the treatment of sepsis, digestive disorders, inflammation, cystic fibrosis, retinal disorders, psoriasis and other diseases. In the present review, we outline the history of proteases as therapeutics, provide an overview of their current clinical application, and describe several approaches to improve and expand their clinical application. Undoubtedly, our ability to harness proteolysis for disease treatment will increase with our understanding of protease biology and the molecular mechanisms responsible. New technologies for rationally engineering proteases, as well as improved delivery options, will expand greatly the potential applications of these enzymes. The recognition that proteases are, in fact, an established class of safe and efficacious drugs will stimulate investigation of additional therapeutic applications for these enzymes. Proteases therefore have a bright future as a distinct therapeutic class with diverse clinical applications. PMID:21406063

  10. Medicaid Adult Dental Benefits Increase Use Of Dental Care, But Impact Of Expansion On Dental Services Use Was Mixed.

    PubMed

    Singhal, Astha; Damiano, Peter; Sabik, Lindsay

    2017-04-01

    Dental coverage for adult enrollees is an optional benefit under Medicaid. Thirty-one states and the District of Columbia have expanded eligibility for Medicaid under the Affordable Care Act. Millions of low-income adults have gained health care coverage and, in states offering dental benefits, oral health coverage as well. Using data for 2010 and 2014 from the Behavioral Risk Factor Surveillance System, we examined the impact of Medicaid adult dental coverage and eligibility expansions on low-income adults' use of dental care. We found that low-income adults in states that provided dental benefits beyond emergency-only coverage were more likely to have had a dental visit in the past year, compared to low-income adults in states without such benefits. Among states that provided dental benefits and expanded their Medicaid program, regression-based estimates suggest that childless adults had a significant increase (1.8 percentage points) in the likelihood of having had a dental visit, while parents had a significant decline (8.1 percentage points). One possible explanation for the disparity is that after expansion, newly enrolled childless adults might have exhausted the limited dental provider capacity that was available to parents before expansion. Additional policy-level efforts may be needed to expand the dental care delivery system's capacity. Project HOPE—The People-to-People Health Foundation, Inc.

  11. 24 CFR 3285.502 - Expanding rooms.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... DEVELOPMENT MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.502 Expanding rooms. The support and anchoring systems for expanding rooms must be installed in accordance with designs provided by the home manufacturer or prepared by a registered professional engineer or registered architect, in...

  12. Planning and Implementing Augmentative Communication Service Delivery, 2: Proceedings of the National Planners Conference on Assistive Device Service Delivery.

    ERIC Educational Resources Information Center

    Coston, Caroline A., Ed.

    The document consists of 30 author contributed chapters concerned with augmentative communication service delivery. Chapter titles and authors are: "Communication Options for Persons Who Cannot Speak: Planning for Service Delivery" (David Beukelman); "Planning Service Delivery Systems" (Roland Hahn II); "Planning Ohio's…

  13. 78 FR 4917 - Self-Regulatory Organizations; Financial Industry Regulatory Authority, Inc.; Order Approving...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-23

    ... establish two new optional TRACE data delivery services, TRACE Data Delivery Plus and TRACE Data Delivery... Data Delivery Plus would provide greater access to TRACE trade journal files by allowing an MPID... the free FINRA ADDS service, firms interested in TRACE Data Delivery Plus must subscribe per MPID. To...

  14. Acquiring Enterprise Systems as a Portfolio of Real Options

    DTIC Science & Technology

    2012-04-30

    expanded beyond valuing individual projects by the real options method to the valuation of a portfolio of options. Bardhan , Bagchi, and Soustad (2004... Bardhan , I., Bagchi, S., & Soustad, R. (2004). Prioritizing a portfolio of information technology investment projects. Journal of Management

  15. Group exposure therapy treatment for post-traumatic stress disorder in female veterans.

    PubMed

    Castillo, Diane T; C' de Baca, Janet; Qualls, Clifford; Bornovalova, Marina A

    2012-12-01

    The purpose of this study was to examine the application of a group exposure therapy model, the content of which consisted solely of repeated imaginal exposure during sessions, in a clinical sample of female veterans with post-traumatic stress disorder (PTSD). Establishing group delivery of exposure therapy will expand options, increase efficiency, and introduce group curative factors. Eighty-eight female veterans with PTSD completed a six-session exposure group, three participants per group, as a component of a larger treatment program. The PTSD symptom checklist (PCL) was used as the outcome measure and administered in each session. Pre/post-paired t-tests showed significant improvement in PTSD on the PCL, with 40% of completers showing at least a 10-point drop in the PCL scores. In addition, a repeated measures analysis of variance showed a significant main effect and a significant quadratic equation, with expected initial increases in the PCL followed by a decrease below baseline at session 6. The group exposure treatment protocol showed positive outcomes on PTSD symptoms in a real-world clinical sample of female veterans. The implications include an expansion of exposure treatment choices for veterans with PTSD and increased options for therapists.

  16. The benefits of redesigning Benin's vaccine supply chain.

    PubMed

    Brown, Shawn T; Schreiber, Benjamin; Cakouros, Brigid E; Wateska, Angela R; Dicko, Hamadou M; Connor, Diana L; Jaillard, Philippe; Mvundura, Mercy; Norman, Bryan A; Levin, Carol; Rajgopal, Jayant; Avella, Mélanie; Lebrun, Caroline; Claypool, Erin; Paul, Proma; Lee, Bruce Y

    2014-07-07

    New vaccine introductions have put strains on vaccine supply chains around the world. While increasing storage and transportation may be the most straightforward options, it is also important to consider what financial and operational benefits can be incurred. In 2012, suboptimal vaccine coverage and impending vaccine introductions prompted the Republic of Benin's Ministry of Health (MOH) to explore ways to improve their vaccine supply chain. Working alongside the Beninese MOH, we utilized our computational model, HERMES, to explore the impact on cost and vaccine availability of three possible options: (1) consolidating the Commune level to a Health Zone level, (2) removing the Commune level completely, and (3) removing the Commune level and expanding to 12 Department Stores. We also analyzed the impact of adding shipping loops during delivery. At baseline, new vaccine introductions without any changes to the current system increased the logistics cost per dose ($0.23 to $0.26) and dropped the vaccine availability to 71%. While implementing the Commune level removal scenario had the same capital costs as implementing the Health Zone scenario, the Health Zone scenario had lower operating costs. This increased to an overall cost savings of $504,255 when implementing shipping loops. The best redesign option proved to be the synergistic approach of converting to the Health Zone design and using shipping loops (serving ten Health Posts/loop). While a transition to either redesign or only adding shipping loops was beneficial, implementing a redesign option and shipping loops can yield both lower capital expenditures and operating costs. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. 24 CFR 3285.502 - Expanding rooms.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 5 2011-04-01 2011-04-01 false Expanding rooms. 3285.502 Section 3285.502 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued... DEVELOPMENT MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.502 Expanding rooms. The...

  18. 48 CFR 252.217-7001 - Surge option.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... sustainable rate of delivery for items in this contract. This delivery schedule shall provide acceleration by month up to the maximum sustainable rate of delivery achievable within the Contractor's existing... than the maximum sustainable delivery rate under paragraph (b)(2) of this clause, nor will the exercise...

  19. 48 CFR 252.217-7001 - Surge option.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... sustainable rate of delivery for items in this contract. This delivery schedule shall provide acceleration by month up to the maximum sustainable rate of delivery achievable within the Contractor's existing... than the maximum sustainable delivery rate under paragraph (b)(2) of this clause, nor will the exercise...

  20. 48 CFR 252.217-7001 - Surge option.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... sustainable rate of delivery for items in this contract. This delivery schedule shall provide acceleration by month up to the maximum sustainable rate of delivery achievable within the Contractor's existing... than the maximum sustainable delivery rate under paragraph (b)(2) of this clause, nor will the exercise...

  1. 48 CFR 252.217-7001 - Surge option.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... sustainable rate of delivery for items in this contract. This delivery schedule shall provide acceleration by month up to the maximum sustainable rate of delivery achievable within the Contractor's existing... than the maximum sustainable delivery rate under paragraph (b)(2) of this clause, nor will the exercise...

  2. 77 FR 73729 - Self-Regulatory Organizations; BOX Options Exchange LLC; Notice of Filing and Immediate...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-11

    ...-Regulatory Organizations; BOX Options Exchange LLC; Notice of Filing and Immediate Effectiveness of a Proposal To Expand the Short Term Options Series Program December 5, 2012. Pursuant to Section 19(b)(1) of... that, on December 4, 2012, BOX Options Exchange LLC (the ``Exchange'') filed with the Securities and...

  3. 76 FR 63691 - Self-Regulatory Organizations; Notice of Filing of Proposed Rule Change by International...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-13

    ... Short Term Options Series Program October 6, 2011. Pursuant to Section 19(b)(1) of the Securities... Proposed Rule Change The Exchange proposes to amend its rules to expand the Short Term Option Series... Term Option Series Program (``STOS Program'') \\3\\ so that the Exchange may select twenty-five option...

  4. 76 FR 72482 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Order Granting Approval of Proposed Rule...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-23

    ... Short Term Option Series Program November 17, 2011. I. Introduction On September 28, 2011, NASDAQ OMX...,\\2\\ a proposed rule change to expand the Short Term Option Program (``Program'') to allow the Exchange to: (1) Select up to 30 option classes on which Short Term Option Series (``STO Series'') may be...

  5. Inferior Vena Cava Filters: Guidelines, Best Practice, and Expanding Indications

    PubMed Central

    DeYoung, Elliot; Minocha, Jeet

    2016-01-01

    Vena caval interruption, currently accomplished by percutaneous image-guided insertion of an inferior vena cava (IVC) filter, is an important therapeutic option in the management of selected patients with venous thromboembolism. The availability of optional (or retrievable) filters, in particular, has altered the practice patterns for IVC filters, with a shift to these devices and expansion of indications for filter placement. As new devices have become available and clinicians have become more familiar and comfortable with IVC filters, the indications for filter placement have continued to evolve and expand. This article reviews current guidelines and expanding indications for IVC filter placement. PMID:27247472

  6. Electrospun fibers for the prevention of human immunodeficiency virus

    NASA Astrophysics Data System (ADS)

    Ball, Cameron

    HIV/AIDS education, testing, and treatment have thus far failed to cease the pandemic spread of the HIV virus. HIV prevention is hindered by a lack of protective options beyond the ABC approach of abstinence, being faithful, and using condoms. One approach to address this inadequacy is to develop antiviral products for vaginal or rectal application that provide receptive partner-initiated protection against viral infection during sex. Such products, termed anti-HIV microbicides, can especially empower young women to take control over their sexual health. This work explored a new approach to anti-HIV microbicides: electrospun fibers for the delivery of small-molecule antiretroviral drugs. Electrospun microbicides are nonwoven fabrics made from polymer-based nanofibers. The wide array of polymers available for electrospinning allowed for the incorporation and release of chemically diverse agents. Since electrospun fibers have an extremely high surface area to volume ratio, they serve as excellent delivery systems for rapid drug delivery of both hydrophilic and hydrophobic agents. The flexibility in the design of electrospun fibers afforded by coaxial electrospinning further enabled the formulation of sustained-release microbicides. To demonstrate the power of electrospinning to deliver drugs over multiple timescales, composite microbicide fabrics were created to provide both rapid and sustained drug release from a single device. This work has produced alternative microbicide formulations, while establishing methods for the thorough characterization of these systems and solutions for the needs of people at risk of HIV infection. By addressing problems in both HIV prevention and drug delivery, this work has expanded our capacity to engineer elegant solutions to complex and pressing global health challenges.

  7. Status and future directions in the management of pancreatic cancer: potential impact of nanotechnology.

    PubMed

    Sielaff, Catherine M; Mousa, Shaker A

    2018-07-01

    Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed at a late stage, has limited treatments, and patients have poor survival rates. It currently ranks as the seventh leading cause of cancer deaths globally and has increasing rates of diagnosis. Improved PDAC treatment requires the development of innovative, effective, and economical therapeutic drugs. The late stage diagnosis limits options for surgical resection, and traditional PDAC chemotherapeutics correlate with increased organ and hematologic toxicity. In addition, PDAC tumor tissue is dense and highly resistant to many traditional chemotherapeutic applications, making the disease difficult to treat and impeding options for palliative care. New developments in nanotechnology may offer innovative options for targeted PDAC therapeutic drug delivery. Nanotechnology can be implemented using multimodality methods that offer increased opportunities for earlier diagnosis, precision enhanced imaging, targeted long-term tumor surveillance, and controlled drug delivery, as well as improved palliative care and patient comfort. Nanoscale delivery methods have demonstrated the capacity to infiltrate the dense, fibrous tumor tissue associated with PDAC, increasing delivery and effectiveness of chemotherapeutic agents and reducing toxicity through the loading of multiple drug therapies on a single nano delivery vehicle. This review presents an overview of nanoscale drug delivery systems and multimodality carriers at the forefront of new PDAC treatments.

  8. Option B+ for prevention of vertical HIV transmission has no influence on adverse birth outcomes in a cross-sectional cohort in Western Uganda.

    PubMed

    Rempis, Eva M; Schnack, Alexandra; Decker, Sarah; Braun, Vera; Rubaihayo, John; Tumwesigye, Nazarius Mbona; Busingye, Priscilla; Harms, Gundel; Theuring, Stefanie

    2017-03-07

    While most Sub-Saharan African countries are now implementing the WHO-recommended Option B+ protocol for prevention of vertical HIV transmission, there is a lack of knowledge regarding the influence of Option B+ exposure on adverse birth outcomes (ABOs). Against this background, we assessed ABOs among delivering women in Western Uganda. A cross-sectional, observational study was performed within a cohort of 412 mother-newborn-pairs in Virika Hospital, Fort Portal in 2013. The occurrence of stillbirth, pre-term delivery, and small size for gestational age (SGA) was analysed, looking for influencing factors related to HIV-status, antiretroviral drug exposure and duration, and other sociodemographic and clinical parameters. Among 302 HIV-negative and 110 HIV-positive women, ABOs occurred in 40.5%, with stillbirth in 6.3%, pre-term delivery in 28.6%, and SGA in 12.2% of deliveries. For Option B+ intake (n = 59), no significant association was found with stillbirth (OR 0.48, p = 0.55), pre-term delivery (OR 0.97, p = 0.92) and SGA (OR 1.5, p = 0.3) compared to seronegative women. Women enrolled on antiretroviral therapy (ART) before conception (n = 38) had no different risk for ABOs than women on Option B+ or HIV-negative women. Identified risk factors for stillbirth included lack of formal education, poor socio-economic status, long travel distance, hypertension and anaemia. Pre-term delivery risk was increased with poor socio-economic status, primiparity, Malaria and anaemia. The occurrence of SGA was influenced by older age and Malaria. In our study, women on Option B+ showed no difference in ABOs compared to HIV-negative women and to women on ART. We identified several non-HIV/ART-related influencing factors, suggesting an urgent need for improving early risk assessment mechanisms in antenatal care through better screening and triage systems. Our results are encouraging with regard to continued universal scale-up of Option B+ and ART programmes.

  9. Supra-plasma expanders: the future of treating blood loss and anemia without red cell transfusions?

    PubMed

    Tsai, Amy G; Vázquez, Beatriz Y Salazar; Hofmann, Axel; Acharya, Seetharama A; Intaglietta, Marcos

    2015-01-01

    Oxygen delivery capacity during profoundly anemic conditions depends on blood's oxygen-carrying capacity and cardiac output. Oxygen-carrying blood substitutes and blood transfusion augment oxygen-carrying capacity, but both have given rise to safety concerns, and their efficacy remains unresolved. Anemia decreases oxygen-carrying capacity and blood viscosity. Present studies show that correcting the decrease of blood viscosity by increasing plasma viscosity with newly developed plasma expanders significantly improves tissue perfusion. These new plasma expanders promote tissue perfusion, increasing oxygen delivery capacity without increasing blood oxygen-carrying capacity, thus treating the effects of anemia while avoiding the transfusion of blood.

  10. A nursing solution to primary care delivery shortfall.

    PubMed

    Carter, Michael; Moore, Phillip; Sublette, Nina

    2018-05-21

    Many countries project that they will have difficulty to meet their demand for primary care based on an inadequate supply of primary care doctors. There are many reasons for this, and they tend to vary by country. The policy options available to these countries are to increase the number of local primary care doctors, recruit doctors from other countries, ration primary care, shift more primary care to specialists, or authorize other disciplines to provide primary care. This article examines lessons learned in the United States over the past 50 years and proposes that expanding the use of nurse practitioners is the best solution when measured by feasibility, costs, ethics, and scope of the care delivered. Using nurse practitioners trained in country meets the World Health Organization global code of practice regarding the international recruitment of health personnel. © 2018 John Wiley & Sons Ltd.

  11. The Role of Health Care Transformation for the Chinese Dream: Powering Economic Growth, Promoting a Harmonious Society.

    PubMed

    Mattke, Soeren; Liu, Hangsheng; Hunter, Lauren E; Gu, Kun; Newberry, Sydne

    2014-12-30

    After having successfully expanded health insurance coverage, China now faces the challenge of building an effective and efficient delivery system to serve its large and aging population. The country finds itself at a crossroads-it can emulate the models of Western countries with their well-known limitations, or embark on an ambitious endeavor to create an innovative and sustainable model. We recommend that China choose the second option and design and implement a health care system based on population health management principles and sophisticated health information technology. Taking this path could yield a triple dividend for China: Health care will contribute to the growth of service sector employment, stimulate domestic demand by unlocking savings, and enable China to export its health system development capabilities to other emerging economies, mirroring its success in building other critical infrastructure. These forces can help turn the Chinese Dream into a reality.

  12. Fully Covered Self-Expandable Metal Stents for Treatment of Both Benign and Malignant Biliary Disorders

    PubMed Central

    Abdel Samie, Ahmed; Theilmann, Lorenz

    2012-01-01

    Transpapillary stents are increasingly being used for biliary strictures, whether benign or malignant. However, there are different stent types and available data is controversial. Recently, completely covered self-expandable metal stents (CSEMSs) have been proposed as an alternative therapeutic option in different biliary indications, including strictures of the distal bile duct, anastomotic stenosis after orthotopic liver transplantation, bile duct leaks, periampullary perforation following endoscopic sphincterotomy (ES), and postsphincterotomy bleeding. Despite the higher costs of these devices, fully covered self-expanding metal stents seem to be a suitable therapeutic option to relief biliary obstruction due to bile duct stenosis, regardless of the underlying cause. PMID:22761543

  13. Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International

    PubMed Central

    Duvall, Susan; Thurston, Sarah; Weinberger, Michelle; Nuccio, Olivia; Fuchs-Montgomery, Nomi

    2014-01-01

    Contraceptive implants offer promising opportunities for addressing the high and growing unmet need for modern contraceptives in sub-Saharan Africa. Marie Stopes International (MSI) offers implants as one of many family planning options. Between 2008 and 2012, MSI scaled up voluntary access to implants in 15 sub-Saharan African countries, from 80,041 implants in 2008 to 754,329 implants in 2012. This 9-fold increase amounted to more than 1.7 million implants delivered cumulatively over the 5-year period. High levels of client satisfaction were attained alongside service provision scale up by using existing MSI service delivery channels—mobile outreach, social franchising, and clinics—to implement strategies that broadened access for underserved clients and maintained service quality. Use of adaptive and context-specific service delivery models and attention to key operational components, including sufficient numbers of trained providers, strong supply chains, diverse financing mechanisms, and implant removal services, underpinned our service delivery efforts. Accounting for 70% of the implants delivered by MSI in 2012, mobile outreach services through dedicated MSI provider teams played a central role in scale-up efforts, fueled in part by the provision of free or heavily subsidized services. Social franchising also demonstrated promise for future program growth, along with MSI clinics. Continued high growth in implant provision between 2011 and 2012 in all sub-Saharan African countries indicates the region's capacity for further service delivery expansion. Meeting the expected rising demand for implants and ensuring long-term sustainable access to the method, as part of a comprehensive method mix, will require continued use of appropriate service delivery models, effective operations, and ongoing collaboration between the private, public, and nongovernmental sectors. MSI's experience can be instructive for future efforts to ensure contraceptive access and choice in sub-Saharan Africa, especially as the global health community works to achieve its Family Planning 2020 (FP2020) commitments to expand family planning access to 120 million new users. PMID:25276564

  14. Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International.

    PubMed

    Duvall, Susan; Thurston, Sarah; Weinberger, Michelle; Nuccio, Olivia; Fuchs-Montgomery, Nomi

    2014-02-01

    Contraceptive implants offer promising opportunities for addressing the high and growing unmet need for modern contraceptives in sub-Saharan Africa. Marie Stopes International (MSI) offers implants as one of many family planning options. Between 2008 and 2012, MSI scaled up voluntary access to implants in 15 sub-Saharan African countries, from 80,041 implants in 2008 to 754,329 implants in 2012. This 9-fold increase amounted to more than 1.7 million implants delivered cumulatively over the 5-year period. High levels of client satisfaction were attained alongside service provision scale up by using existing MSI service delivery channels-mobile outreach, social franchising, and clinics-to implement strategies that broadened access for underserved clients and maintained service quality. Use of adaptive and context-specific service delivery models and attention to key operational components, including sufficient numbers of trained providers, strong supply chains, diverse financing mechanisms, and implant removal services, underpinned our service delivery efforts. Accounting for 70% of the implants delivered by MSI in 2012, mobile outreach services through dedicated MSI provider teams played a central role in scale-up efforts, fueled in part by the provision of free or heavily subsidized services. Social franchising also demonstrated promise for future program growth, along with MSI clinics. Continued high growth in implant provision between 2011 and 2012 in all sub-Saharan African countries indicates the region's capacity for further service delivery expansion. Meeting the expected rising demand for implants and ensuring long-term sustainable access to the method, as part of a comprehensive method mix, will require continued use of appropriate service delivery models, effective operations, and ongoing collaboration between the private, public, and nongovernmental sectors. MSI's experience can be instructive for future efforts to ensure contraceptive access and choice in sub-Saharan Africa, especially as the global health community works to achieve its Family Planning 2020 (FP2020) commitments to expand family planning access to 120 million new users.

  15. 17 CFR 33.4 - Designation as a contract market for the trading of commodity options.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... market for the trading of commodity options. 33.4 Section 33.4 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION REGULATION OF COMMODITY OPTION TRANSACTIONS THAT ARE OPTIONS ON CONTRACTS OF SALE OF A COMMODITY FOR FUTURE DELIVERY § 33.4 Designation as a contract market for the trading...

  16. Expanding the Education Universe: A Fifty-State Strategy for Course Choice

    ERIC Educational Resources Information Center

    Brickman, Michael

    2014-01-01

    After twenty years of expanding school-choice options, state leaders, educators, and families have a new tool: course choice, a strategy for students to learn from unconventional providers that might range from top-tier universities or innovative community colleges to local employers, labs, or hospitals. In "Expanding the Education Universe:…

  17. Advance Planning Briefing for Industry: Sustaining the Warfighter through Battlespace Integration

    DTIC Science & Technology

    1998-05-14

    value, Indefinite Delivery/Indefinite Quantity procurement, and consist of a base year and 4 option years. BRIEFER: COL Alfred J. Estrella ...Indefinite Delivery/Indefinite Quantity procurement, and consist of a base year plus 4 option years. BRIEFER: COL Alfred J. Estrella , Commander, US...MR. ROBERT R. LEHNES DPEO, C3S MR. DENNIS TURNER DIR, CECOM SEC COL ALFRED J. ESTRELLA COMMANDER, ISEC MRS. MAUREEN MACFARLAND DEP DIR, CECOM

  18. Toward a Blueprint for Trauma-Informed Service Delivery in Schools

    ERIC Educational Resources Information Center

    Chafouleas, Sandra M.; Johnson, Austin H.; Overstreet, Stacy; Santos, Natascha M.

    2016-01-01

    Recognition of the benefits to trauma-informed approaches is expanding, along with commensurate interest in extending delivery within school systems. Although information about trauma-informed approaches has quickly burgeoned, systematic attention to integration within multitiered service delivery frameworks has not occurred yet is essential to…

  19. Getting Special Delivery: An Essay about Teaching Sherman Alexie's Short Story "Special Delivery."

    ERIC Educational Resources Information Center

    Simon, Michael

    2003-01-01

    Approaches teaching Sherman Alexie's Short Story "Special Delivery" through mythology and history. Considers how expanding cultural awareness is necessary and educators need to attempt to offer not only a diversity of authors, but a diversity of cultural views as well. (SG)

  20. Smart Columbus : Systems Engineering Management Plan (SEMP) for Smart Columbus Demonstration Program

    DOT National Transportation Integrated Search

    2018-01-16

    The Smart City Demonstration Program is intended to improve access through expanded mobility options in major job centers, enhance visitor experience by better connecting visitors to transportation options, stimulate regional economic prosperity and ...

  1. Negotiating the Digital Library: Document Delivery.

    ERIC Educational Resources Information Center

    Jacobs, Neil; Morris, Anne

    1999-01-01

    The eLib-funded FIDDO (Focused Investigation of Document Delivery Options) project provides library managers/others with information to support policy decisions. Senior libraries were interviewed about the future of document delivery and interviews were analyzed with the support of NUD*IST (Nonnumerical Unstructured Data by Indexing, Searching and…

  2. 75 FR 30451 - Self-Regulatory Organizations; The Options Clearing Corporation; Order Granting Approval of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-01

    ... May 14, 2010. The ODD currently contains general disclosures on the characteristics and risks of...-linked securities. Accordingly, the ODD disclosure only covers the characteristics and risks of options...; Order Granting Approval of Accelerated Delivery of Supplement to the Options Disclosure Document...

  3. 76 FR 8796 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-15

    ... Rule Change To Expand the Short Term Option Series Program February 9, 2011. Pursuant to Section 19(b... Series Program. The text of the proposed rule change is available on the Exchange's Web site http://www... Term Option Series Program (``STOS Program'') \\3\\ so that the Exchange may select fifteen option...

  4. Expanding the Paradigm: Postsecondary Education Options for Individuals with Autism Spectrum Disorder and Intellectual Disabilities

    ERIC Educational Resources Information Center

    Hart, Debra; Grigal, Meg; Weir, Cate

    2010-01-01

    This article will provide an overview of postsecondary education (PSE) options for students with Autism Spectrum Disorder (ASD) and other Intellectual Disabilities (ID). Topics include a historical and philosophical discussion outlining how students with ASD and ID can benefit from postsecondary opportunities, a description of current PSE options,…

  5. Application of Real Options Theory to DoD Software Acquisitions

    DTIC Science & Technology

    2009-02-20

    Future Combat Systems Program. Washington, DC. U.S. Government Printing Office. Damodaran , A. (2007). Investment Valuation : The Options To Expand... valuation methodology, when enhanced and properly formulated around a proposed or existing software investment employing the spiral development approach...THIS PAGE INTENTIONALLY LEFT BLANK iii ABSTRACT The traditional real options valuation methodology, when enhanced and properly formulated

  6. 76 FR 52369 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-22

    ... Proposed Rule Change Relating to Customer Rebates in Penny Pilot Options August 15, 2011. Pursuant to... for the Penny Pilot \\3\\ Options (``Penny Options'') with respect to the Customer Rebate to Add Liquidity. \\3\\ The Penny Pilot was established in March 2008 and in October 2009 was expanded and extended...

  7. Document Delivery for the '90s and Beyond.

    ERIC Educational Resources Information Center

    Fitzsimmons, Joseph J.

    1996-01-01

    The story of the pony express offers lessons for today's document delivery. Pricing, policy, competition, and evolving technology need to be considered. To evaluate future options, researchers need to examine: types of document delivery; benefits of combining outside services with in-house systems; criteria for selecting technologies and…

  8. Distance Synchronous Information Systems Course Delivery

    ERIC Educational Resources Information Center

    Peslak, Alan R.; Lewis, Griffith R.; Aebli, Fred

    2014-01-01

    Teaching computer information systems via distance education is a challenge for both student and faculty. Much research work has been performed on methods of teaching via distance education. Today we are faced with a variety of options for course delivery. Asynchronous delivery via online or lesson instruction still remains most common. But…

  9. Information Delivery Options over Three Decades.

    ERIC Educational Resources Information Center

    Kennedy, H. Edward

    1986-01-01

    The rate of new technology-driven innovations for information delivery has accelerated over the past three decades. New information delivery formats in the 1950s and 1960s included microforms and, in response to demands from librarians, indexing and abstracting services began to make their publications available on this medium. Electronic…

  10. Hydrogen use projections and supply options

    NASA Technical Reports Server (NTRS)

    Manvi, R.; Fujita, T.

    1976-01-01

    Reference and expanded use projections were developed to estimate future hydrogen demand. The rationale in the development of these projections, which estimate the growth of hydrogen usage of approximately 1 X 10 to the fifteenth power Btu in 1973 to approximately 5.5 X 10 to the fifteenth power for reference use and 22 X 10 to the fifteenth power Btu for expanded use projections in year 2000. Primary energy sources required to produce these demands are discussed in the light of transition from a low merchant to high merchant supply option.

  11. 76 FR 56832 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-14

    ... entire universe of U.S. options disseminated by the Options Price Reporting Authority (OPRA). The... unique market data to the public. It was believed that this authority would expand the amount of data...

  12. Lifting options for stratospheric aerosol geoengineering: advantages of tethered balloon systems.

    PubMed

    Davidson, Peter; Burgoyne, Chris; Hunt, Hugh; Causier, Matt

    2012-09-13

    The Royal Society report 'Geoengineering the Climate' identified solar radiation management using albedo-enhancing aerosols injected into the stratosphere as the most affordable and effective option for geoengineering, but did not consider in any detail the options for delivery. This paper provides outline engineering analyses of the options, both for batch-delivery processes, following up on previous work for artillery shells, missiles, aircraft and free-flying balloons, as well as a more lengthy analysis of continuous-delivery systems that require a pipe connected to the ground and supported at a height of 20 km, either by a tower or by a tethered balloon. Towers are shown not to be practical, but a tethered balloon delivery system, with high-pressure pumping, appears to have much lower operating and capital costs than all other delivery options. Instead of transporting sulphuric acid mist precursors, such a system could also be used to transport slurries of high refractive index particles such as coated titanium dioxide. The use of such particles would allow useful experiments on opacity, coagulation and atmospheric chemistry at modest rates so as not to perturb regional or global climatic conditions, thus reducing scale-up risks. Criteria for particle choice are discussed, including the need to minimize or prevent ozone destruction. The paper estimates the time scales and relatively modest costs required if a tethered balloon system were to be introduced in a measured way with testing and development work proceeding over three decades, rather than in an emergency. The manufacture of a tether capable of sustaining the high tensions and internal pressures needed, as well as strong winds, is a significant challenge, as is the development of the necessary pumping and dispersion technologies. The greatest challenge may be the manufacture and launch of very large balloons, but means have been identified to significantly reduce the size of such balloons or aerostats.

  13. Going "social" to access experimental and potentially life-saving treatment: an assessment of the policy and online patient advocacy environment for expanded access.

    PubMed

    Mackey, Tim K; Schoenfeld, Virginia J

    2016-02-02

    Social media is fundamentally altering how we access health information and make decisions about medical treatment, including for terminally ill patients. This specifically includes the growing phenomenon of patients who use online petitions and social media campaigns in an attempt to gain access to experimental drugs through expanded access pathways. Importantly, controversy surrounding expanded access and "compassionate use" involves several disparate stakeholders, including patients, manufacturers, policymakers, and regulatory agencies-all with competing interests and priorities, leading to confusion, frustration, and ultimately advocacy. In order to explore this issue in detail, this correspondence article first conducts a literature review to describe how the expanded access policy and regulatory environment in the United States has evolved over time and how it currently impacts access to experimental drugs. We then conducted structured web searches to identify patient use of online petitions and social media campaigns aimed at compelling access to experimental drugs. This was carried out in order to characterize the types of communication strategies utilized, the diseases and drugs subject to expanded access petitions, and the prevalent themes associated with this form of "digital" patient advocacy. We find that patients and their families experience mixed results, but still gravitate towards the use of online campaigns out of desperation, lack of reliable information about treatment access options, and in direct response to limitations of the current fragmented structure of expanded access regulation and policy currently in place. In response, we discuss potential policy reforms to improve expanded access processes, including advocating greater transparency for expanded access programs, exploring use of targeted economic incentives for manufacturers, and developing systems to facilitate patient information about existing treatment options. This includes leveraging recent legislative attention to reform expanded access through the CURE Act Provisions contained in the proposed U.S. 21st Century Cures Act. While expanded access may not be the best option for the majority of individuals, terminally ill patients and their families nevertheless deserve better processes, policies, and availability to potentially life-changing information, before they decide to pursue an online campaign in the desperate hope of gaining access to experimental drugs.

  14. Buying results? Contracting for health service delivery in developing countries.

    PubMed

    Loevinsohn, Benjamin; Harding, April

    To achieve the health-related Millennium Development Goals, the delivery of health services will need to improve. Contracting with non-state entities, including non-governmental organisations (NGOs), has been proposed as a means for improving health care delivery, and the global experience with such contracts is reviewed here. The ten investigated examples indicate that contracting for the delivery of primary care can be very effective and that improvements can be rapid. These results were achieved in various settings and services. Many of the anticipated difficulties with contracting were either not observed in practice or did not compromise contracting's effectiveness. Seven of the nine cases with sufficient experience (greater than 3 years' elapsed experience) have been sustained and expanded. Provision of a package of basic services by contractors costs between roughly US3 dollars and US6 dollars per head per year in low-income countries. Contracting for health service delivery should be expanded and future efforts must include rigorous evaluations.

  15. Employee Assistance Programs in the 1980s: Expanding Career Options for Counselors.

    ERIC Educational Resources Information Center

    Forrest, Donald V.

    1983-01-01

    Suggests that Employee Assistance Programs (EAPS) offer new and expanded work opportunities for counselors. Reviews the history of EAPS, current philosophy and program components, and implications for counselors as EAPs move from crisis intervention toward prevention. (JAC)

  16. Student Work Safety Guidelines in Roadside Applications and Work Zones : Safety Guidelines for Transportation Researchers

    DOT National Transportation Integrated Search

    2018-01-01

    The Smart City Demonstration Program is intended to improve access through expanded mobility options in major job centers, enhance visitor experience by better connecting visitors to transportation options, stimulate regional economic prosperity and ...

  17. 75 FR 39595 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of a Proposed Rule...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-09

    ... calculated index at about the time that the Short Term Option Series is opened. If the Exchange opens less... Securities Exchange, LLC To Expand and Permanently Establish Its Short Term Option Series Program July 2... proposes to amend its rules to regarding the Short Term Option Series Program. The text of the proposed...

  18. 76 FR 72472 - Self-Regulatory Organizations; International Securities Exchange, LLC; Order Granting Approval of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-23

    ... Short Term Options Series Program November 17, 2011. I. Introduction On September 23, 2011, the...\\ and Rule 19b-4 thereunder,\\2\\ a proposed rule change to expand the Short Term Options Series Program... Exchange may select up to 25 option classes to participate in the STOS Program \\5\\ and list up to 30 Short...

  19. Effectiveness of a Hybrid Classroom in the Delivery of Medical Terminology Course Content

    ERIC Educational Resources Information Center

    Martin, Jeffrey S.; Kreiger, Joan E.; Apicerno, Amy L

    2015-01-01

    Hybrid courses are emerging as a viable option for content delivery across college campuses. In an attempt to maximize learning outcomes while leveraging resources, one institution used several sections of a Medical Terminology course as a pilot. Traditional and hybrid course delivery were compared utilizing a quantitative research method to…

  20. Medicated chewing gum--a potential drug delivery system.

    PubMed

    Chaudhary, Shivang A; Shahiwala, Aliasgar F

    2010-07-01

    Over the years, patient convenience and patient compliance-orientated research in the field of drug delivery has resulted in bringing out potential innovative drug delivery options. Out of which, medicated chewing gum (MCG) offers a highly convenient patient-compliant way of dosing medications, not only for special population groups with swallowing difficulties such as children and the elderly, but also for the general population, including the young generation. In this review, various formulation ingredients, different manufacturing processes, and assessment of in vivo and in vitro drug release from MCG are thoroughly discussed along with the therapeutic potential and limitations of MCG. Readers will gain knowledge about the rationale and prominent formulation and performance evaluation strategies behind chewing gum as a drug delivery system. The availability of directly compressible co-processed gum material enables rapid, safe and low-cost development of MCG as a drug delivery option. By MCG formulation, revitalization of old products and reformulation of new patented products is possible, to differentiate them from upcoming generics competition in the market.

  1. An assessment of the safe delivery incentive program at a tertiary level hospital in Nepal.

    PubMed

    Baral, G

    2012-05-01

    Maternity incentive program of Nepal known as Safe Delivery Incentive Program (SDIP) was introduced nationwide in 2005 with the intention of increasing utilization of professional care at childbirth. The program provided both childbirth service as well as 'cash' to women giving birth in a health facility in addition to incentives to health provider for each delivery attended, either at home or the facility. Due to a lack of uniformity in its implementation and administrative delays, the program was reformed and even extended to many not-for-profit health institutions in early 2007, and implemented as a 'Safer Mother Program' popularly known as "Aama-Suraksha-Karyakram" since January 2009. This is a system research with observational and analytical components. Plausibility design is selected to evaluate the performance-based funding (PBF) as a system level intervention of maternity care using two instruments: Pay-For-Performance and Conditional-Cash-Transfer. It uses interrupted time-series to control for the natural trend. Research tools used are interviews, the focus group discussions and literature review. Numerical data are presented in simple graphs. While online random number generator was used partly, the purposive sampling was used for qualitative data. There is a gross discrepancy in non-targeted service delivery at the tertiary level health facility. Overflooding of maternity cases has hampered gynecological admission and surgical management delaying subspecialty care and junior physicians' training. With the same number and quality of physical facility and human resource, the additional program has put more strains to service providers and administrators. There should be adequate planning and preparation at all levels of health facilities; implementing a new program should not adversely affect another existing service delivery system. For the optional implementation, hospital organogram should be revised; and physical facilities and the low-risk birthing-centers with referral linkages should be expanded.

  2. Crude oil options market found to be efficient

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

    Not Available

    1992-08-17

    This paper reports that the U.S. crude oil options market operates efficiently and does not overreact. The authors, with the JFK School of Government, studied the crude oil options market under a Department of Energy grant. The current market was created in November 1986 when the New York Mercantile Exchange introduced an options contract for delivery of West Texas intermediate crude futures. it has grown greatly since then.

  3. Current issues of RNAi therapeutics delivery and development.

    PubMed

    Haussecker, D

    2014-12-10

    12 years following the discovery of the RNAi mechanism in Man, a number of RNAi therapeutics development candidates have emerged with profiles suggesting that they could become drugs of significant medical importance for diseases like TTR amyloidosis, HBV, solid cancers, and hemophilia. Despite this robust progress, the perception of RNAi therapeutics has been on a roller-coaster ride driven not only by science, but also regulatory trends, the stock markets, and Big Pharma business development decisions [1]. This presentation provides an update on the current state of RNAi therapeutics development with a particular focus on what RNAi delivery can achieve today and key challenges to be overcome to expand therapeutic opportunities. The delivery of RNAi triggers to disease-relevant cell types clearly represents the rate-limiting factor in broadly expanding the applicability of RNAi therapeutics. Today, with at least 3 delivery options (lipid nanoparticles/LNPs, GalNAc-siRNA conjugates, Dynamic PolyConjugates/DPCs) for which profound gene knockdowns have been demonstrated in non-human primates and in the clinic, RNAi therapeutics should in principle be able to address most diseases related to gene expression in the liver. Given the central importance of the liver in systemic physiology, this already represents a significant therapeutic and commercial opportunity rivaling that of e.g. monoclonal antibodies. Beyond the liver, there is a reason to believe that current RNAi therapeutics technologies can address a number of solid tumors (e.g. LNPs), diseases of the eye (e.g. self-delivering RNAi triggers) as well as diseases involving the respiratory epithelium (e.g. aerosolized LNPs), certain phagocytic cells (LNPs), hematopoietic stem cells and their progeny (lentiviral DNA-directed RNAi), vascular endothelial cells (cationic lipoplexes), and certain cell types in the kidney (self-delivering RNAi triggers, DPCs; Table 1). Despite this success, there has been a sense that the applications of RNAi therapeutics are rather limited. This is largely based on the observation that the biodistribution of RNAi formulations is typically more limited compared to small molecules and oral administration is not possible with current technologies. Similarly, the utility of a given RNAi formulation is limited to a few cell types and tissues at most and a universal delivery strategy should remain elusive for the foreseeable future. Therefore, to further expand on the therapeutic utility and patient convenience of RNAi, it is important to overcome a number of delivery-related technical and scientific challenges which will be discussed in this presentation. For systemic applications, these include the necessity for extended blood circulation times, vascular escape (probably the most rewarding inquiry currently), tissue penetration, cellular uptake, and escape into the cytoplasm. In terms of safety, it is important that these formulations do not accumulate in the body, do not cause excessive off-targeting due to 'chemical stickiness' (often useful for purposes of biodistribution), and overcome the physical/biological barriers in a controlled manner. The time for realizing the therapeutic potential of RNAi has come. At the same time, it is important to lay the foundations for the next leg of value creation by overcoming the challenges of delivering RNAi to new cell types. Based on results from exploratory research, the renewed interest in RNAi therapeutics and capital infusion, there is a reason to be optimistic that this can be achieved. Copyright © 2014 Elsevier B.V. All rights reserved.

  4. Specializations in Rehabilitation Counseling: One Program's Vision

    ERIC Educational Resources Information Center

    Bernacchio, Charles; Burker, Eileen J.; Falvo, Donna; Porter, Patricia; Carone, Stacia

    2008-01-01

    The option for specialization is explored to address expanding roles for rehabilitation counselors. Several important considerations are identified for Rehabilitation Counselor Education (RCE) program faculty opting for a specialization. Development of specialty tracks in psychiatric and developmental disabilities are offered as viable options for…

  5. Current Options and Emerging Biomaterials for Periprosthetic Joint Infection.

    PubMed

    Levack, Ashley E; Cyphert, Erika L; Bostrom, Mathias P; Hernandez, Christopher J; von Recum, Horst A; Carli, Alberto V

    2018-04-30

    Infection in the setting of total joint arthroplasty, referred to as periprosthetic joint infection (PJI), is a devastating complication requiring prolonged and costly treatment. The unique environment around an artificial joint and ability of surrounding tissues to sequester bacteria collectively make prevention, diagnosis, and treatment of this condition challenging. In light of the unique pathogenesis of PJI, this review explores the limitations of contemporary treatments and discusses novel treatment options. Recent advancements in local antibiotic delivery platforms for preventing and treating PJI include titanium nanotube arrays, synthetic polymers, resorbable hydrogels, and cyclodextrin-based drug delivery options. In particular, cyclodextrins have facilitated great advancements in other clinical disorders and have demonstrated early promise as a future option in the arena of PJI. Novel treatment modalities for PJI optimize the implant surfaces to prevent bacterial biofilm formation or provide prolonged intra-articular antibiotic dosing to eradicate bacteria.

  6. Nanoparticle Delivery Enhancement With Acoustically Activated Microbubbles

    PubMed Central

    Mullin, Lee B; Phillips, Linsey C; Dayton, Paul A

    2013-01-01

    The application of microbubbles and ultrasound to deliver nanoparticle carriers for drug and gene delivery is an area that has expanded greatly in recent years. Under ultrasound exposure, microbubbles can enhance nanoparticle delivery by increasing cellular and vascular permeability. In this review, the underlying mechanisms of enhanced nanoparticle delivery with ultrasound and microbubbles and various proposed delivery techniques are discussed. Additionally, types of nanoparticles currently being investigated in preclinical studies, as well as the general limitations and benefits of a microbubble-based approach to nanoparticle delivery are reviewed. PMID:23287914

  7. 76 FR 19160 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-06

    ... LLC To Expand the $2.50 Strike Price Program March 31, 2011. Pursuant to Section 19(b)(1) of the... proposes to amend Commentary .07 to NYSE Amex Rule 903 to expand the $2.50 Strike Price Program. The text... expand the current $2.50 Strike Price Program (``Program'')\\3\\ to permit the listing of options with $2...

  8. Design, fabrication, delivery, operation and maintenance of a geothermal power conversion system

    NASA Technical Reports Server (NTRS)

    1980-01-01

    The design, fabrication, delivery, operation and maintenance of an Hydrothermal Power Company 1250 KVA geothermal power conversion system using a helical screw expander as the prime mover is described. Hydrostatic and acceptance testing are discussed.

  9. Health Care Delivery.

    ERIC Educational Resources Information Center

    Starfield, Barbara

    1987-01-01

    The article reviews emerging health care delivery options for handicapped children. Cost structures, quality of care, and future prospects are considered for Health Maintenance Organizations, Preferred Provider Organizations, Tax Supported Direct Service Programs, Hospital-Based Services, and Ambulatory Care Organizations. (Author/DB)

  10. Silk-Based Biomaterials for Sustained Drug Delivery

    PubMed Central

    Yucel, Tuna; Lovett, Michael L.; Kaplan, David L.

    2014-01-01

    Silk presents a rare combination of desirable properties for sustained drug delivery, including aqueous-based purification and processing options without chemical cross-linkers, compatibility with common sterilization methods, controllable and surface-mediated biodegradation into non-inflammatory by-products, biocompatibility, utility in drug stabilization, and robust mechanical properties. A versatile silk-based toolkit is currently available for sustained drug delivery formulations of small molecule through macromolecular drugs, with a promise to mitigate several drawbacks associated with other degradable sustained delivery technologies in the market. Silk-based formulations utilize silk’s well-defined nano- through microscale structural hierarchy, stimuli-responsive self-assembly pathways and crystal polymorphism, as well as sequence and genetic modification options towards targeted pharmaceutical outcomes. Furthermore, by manipulating the interactions between silk and drug molecules, near-zero order sustained release may be achieved through diffusion- and degradation-based release mechanisms. Because of these desirable properties, there has been increasing industrial interest in silk-based drug delivery systems currently at various stages of the developmental pipeline from pre-clinical to FDA-approved products. Here, we discuss the unique aspects of silk technology as a sustained drug delivery platform and highlight the current state of the art in silk-based drug delivery. We also offer a potential early development pathway for silk-based sustained delivery products. PMID:24910193

  11. Toxic Overload: The Waste Disposal Dilemma.

    ERIC Educational Resources Information Center

    Knox, Robert J.

    1991-01-01

    The role of the Environmental Protection Agency as ombudsman concerning waste disposal is examined with respect to both the current options of source reduction and recycling as pollution prevention, and alternative approaches that expand upon these current options, particularly with respect to toxic and medical waste. (JJK)

  12. The sales and marketing practices of English-language internet alcohol vendors.

    PubMed

    Williams, Rebecca S; Schmidt, Allison

    2014-03-01

    This study aimed to fill information gaps about the sales and marketing practices of internet alcohol vendors and their implications for addressing youth access and other legal violations. Further, it aimed to expand the limited scientific literature on internet alcohol sales using systematic survey methods to inform future efforts to regulate this industry and prevent sales to minors. The design was a cross-sectional website content analysis survey. [Not applicable]. A total of 105 internet alcohol vendor websites. Six key content analysis topics were explored: products offered, average prices and proportions of vendors using different promotions, policy statements and methods for age verification, payment and delivery. Websites sell and promote a variety of alcohol products, offered as cheaply as $1.93 for a 750-ml bottle. Vendors rely heavily upon age verification methods that are unlikely to prevent sales to minors. Many vendors advertise shipping of products via methods through which it is illegal or against delivery company policies to transport alcohol, and 99% of vendors accept credit cards. Limiting and enforcing delivery and payment options are types of policy interventions that have been used successfully with internet cigarette vendors that may be applicable to internet alcohol vendors as well. Internet alcohol vendor practices are insufficient to prevent sales to minors, and need further regulation and enforcement of existing policies. Their sales practices are similar to those of internet cigarette vendors prior to regulation, and similar regulatory approaches may be effective in reducing internet alcohol sales to minors. © 2013 Society for the Study of Addiction.

  13. The expanding role of aerosols in systemic drug delivery, gene therapy, and vaccination.

    PubMed

    Laube, Beth L

    2005-09-01

    Aerosolized medications have been used for centuries to treat respiratory diseases. Until recently, inhalation therapy focused primarily on the treatment of asthma and chronic obstructive pulmonary disease, and the pressurized metered-dose inhaler was the delivery device of choice. However, the role of aerosol therapy is clearly expanding beyond that initial focus. This expansion has been driven by the Montreal protocol and the need to eliminate chlorofluorocarbons (CFCs) from traditional metered-dose inhalers, by the need for delivery devices and formulations that can efficiently and reproducibly target the systemic circulation for the delivery of proteins and peptides, and by developments in medicine that have made it possible to consider curing lung diseases with aerosolized gene therapy and preventing epidemics of influenza and measles with aerosolized vaccines. Each of these drivers has contributed to a decade or more of unprecedented research and innovation that has altered how we think about aerosol delivery and has expanded the role of aerosol therapy into the fields of systemic drug delivery, gene therapy, and vaccination. During this decade of innovation, we have witnessed the coming of age of dry powder inhalers, the development of new soft mist inhalers, and improved pressurized metered-dose inhaler delivery as a result of the replacement of CFC propellants with hydrofluoroalkane. The continued expansion of the role of aerosol therapy will probably depend on demonstration of the safety of this route of administration for drugs that have their targets outside the lung and are administered long term (eg, insulin aerosol), on the development of new drugs and drug carriers that can efficiently target hard-to-reach cell populations within the lungs of patients with disease (eg, patients with cystic fibrosis or lung cancer), and on the development of devices that improve aerosol delivery to infants, so that early intervention in disease processes with aerosol therapy has a high probability of success.

  14. Entrepreneurship Education. OPTIONS. Expanding Educational Services for Adults.

    ERIC Educational Resources Information Center

    Belcher, James O.; Warmbrod, Catharine P.

    This monograph is part of OPTIONS, a packaged set of materials developed to provide postsecondary administrators, program planners, curriculum developers, counselors, and instructors with up-to-date, reliable information. This volume and two other monographs are intended to enable counselors and instructors to establish and conduct special…

  15. Virus-Based Nanoparticles as Versatile Nanomachines

    PubMed Central

    Koudelka, Kristopher J.; Pitek, Andrzej S.; Manchester, Marianne; Steinmetz, Nicole F.

    2016-01-01

    Nanoscale engineering is revolutionizing the way we prevent, detect, and treat diseases. Viruses have played a special role in these developments because they can function as prefabricated nanoscaffolds that have unique properties and are easily modified. The interiors of virus particles can encapsulate and protect sensitive compounds, while the exteriors can be altered to display large and small molecules in precisely defined arrays. These properties of viruses, along with their innate biocompatibility, have led to their development as actively targeted drug delivery systems that expand on and improve current pharmaceutical options. Viruses are naturally immunogenic, and antigens displayed on their surface have been used to create vaccines against pathogens and to break self-tolerance to initiate an immune response to dysfunctional proteins. Densely and specifically aligned imaging agents on viruses have allowed for high-resolution and noninvasive visualization tools to detect and treat diseases earlier than previously possible. These and future applications of viruses have created an exciting new field within the disciplines of both nanotechnology and medicine. PMID:26958921

  16. Beyond telecommuting: A new paradigm for the effect of telecommunications on travel

    NASA Astrophysics Data System (ADS)

    Niles, J. S.

    1994-09-01

    Conventional wisdom about social and economic behavior holds that the use of telecommunications is a natural substitute for transportation. For example, telephone calls can replace travel to meetings, and facsimile or electronic-mail transmission of documents substitutes for courier or postal delivery. The moving of information can replace the moving of people and goods. Vehicle traffic on the national transportation infrastructure can be replaced by digital traffic on what is now called the national information infrastructure (NII). A leading example is telecommuting. This means using telecommunications to replace commuting between home and work. Telecommuting is an optional way of expanding employees' work locations in those circumstances where it yields both improved organizational performance and employee satisfaction. Telecommuting accounts for 7.6 million U.S. workers as of early 1993, up 15% from the 6.6 million counted in 1992. The growth of telecommuting has been strong for the past five years. No one has identified any reasons to suggest that this growth will abate in the forseeable future.

  17. Information Delivery Options over Three Decades.

    ERIC Educational Resources Information Center

    Kennedy, H. E.

    1986-01-01

    Reviews the development of technological innovations in information delivery, including microforms, electronic processing, online distribution, full-text abstracts online, floppy disks, downloading, vertical integration, electronic publishing, and optical disks. The impact of technology on the information industry and the need to use technology…

  18. Achieving Balance: Secondary Physical Education Gender-Grouping Options

    ERIC Educational Resources Information Center

    Gabbei, Ritchie

    2004-01-01

    This article provides options and a rationale for expanding gender-grouping considerations to include single-gender, coed, and combination strategies for instruction in secondary physical education classes. This rationale is based on empirical evidence that suggests that female students are denied equal opportunity to achieve learning goals during…

  19. Expanding Educational Services for Adults. OPTIONS. Publicity Kit.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. National Center for Research in Vocational Education.

    This publicity kit is intended to provide adult educators with materials for promoting and recruiting students into an adult education program designed according to the OPTIONS model (i.e., programs geared toward teaching the literacy, technical, and entrepreneurship skills that are necessary to adapt to changing labor market conditions resulting…

  20. Understanding women and men's acceptability of current and new HIV prevention technologies in KwaZulu-Natal, South Africa.

    PubMed

    Govender, Eliza; Abdool Karim, Quarraisha

    2018-06-18

    Despite significant advances to the HIV epidemic, prevention remains a challenge globally. Adolescent girls and young women in southern and Eastern Africa are still at high risk of acquiring HIV infection with limited prevention options. The expanding product pipeline of novel drugs and delivery approaches has highlighted the importance of acceptability and uptake of these anti-retroviral based products to realize their full prevention potential. Community engagement is now imperative to inform both product development and uptake; with research directed to understand what potential users are willing to use given the broader cultural-gender context in which HIV prevention product choices are made/negotiated. We conducted ten gender specific discussion groups with 112 participants in three of the eight highest HIV prevalence districts in urban, peri-urban, and rural KwaZulu-Natal. The participants where purposively selected according to age, location and sex. The data was analysed thematically in terms of the key enablers and barriers of accepting three key HIV dosing strategies; the oral pill, the vaginal ring and the injectable among men and women. The study found that women are willing to consider HIV prevention options that align with their current sexual and reproductive health routines, offers the longest duration of protection, and requires minimal/no partner involvement, in contrast most men were not supportive of their partners using of any form of PrEP, irrespective of dosing strategies and formulations as it raised questions of infidelity and side effects on men. The findings is indicative of the complexities of women's product choices, which are often embedded in a system of personal preference on an intrapersonal level, but also of male dominance, gender norms and cultural contexts at an interpersonal level. Understanding this intrapersonal-interpersonal interplay can enhance PrEP messaging and promotion; further highlighting the need to expand biomedical innovations for women initiated technologies.

  1. 78 FR 43882 - Sunshine Act Meeting; Open Commission Meeting; Friday, July 19, 2013

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-22

    ... the delivery of video programming. 2 TITLE: Presentation on LEAD Recommendations and Digital Learning... Five Point Blueprint recommending a national initiative to expand digital learning in K-12 education... teachers at Kenmore are using digital technologies and broadband connectivity to expand learning...

  2. Online Instruction: An Alternative Delivery System for Higher Education

    ERIC Educational Resources Information Center

    Wronkovich, Michael

    2003-01-01

    In an increasingly technological society, delivery systems for professional development and higher education have greatly expanded. Video conferencing and web-based alternatives provide opportunities to extend the college campus far beyond the boundaries traditionally considered feasible. Adult learners have found the convenience of web-based…

  3. Fifteen years of PMTCT HIV and Syphilis outcomes in Haiti from monotherapy to Option B.

    PubMed

    Deschamps, Marie Marcelle; Jannat-Khah, Deanna; Rouzier, Vanessa; Bonhomme, Jerry; Pierrot, Julma; Lee, Myung Hee; Abrams, Elaine; Pape, Jean; McNairy, Margaret L

    2018-05-19

    To evaluate mother and infant outcomes in the largest prevention of mother-to-child-transmission (PMTCT) program in Haiti in order to identify gaps towards elimination of HIV and syphilis. Based on retrospective data from HIV+ pregnant women and their infants enrolled in PMTCT care from 1999-2014, we assessed maternal enrolment in PMTCT, receipt of antiretrovirals before delivery, maternal retention through delivery, as well as infant enrolment in PMTCT, HIV testing, and HIV infection. 4 PMTCT program periods were compared: period 1 (1999-2004, mono ARV), period 2 (2005-2009, dual ARV), period 3 (2010-2012, Option B), and period 4 (Oct 2012-2014, Option B+). Kaplan Meier methods were used to assess retention in PMTCT care. Among 4,665 pregnancies, median age was 27 years and median CD4+ was 494 cells/uL (IQR 328-691). 75% of women received antiretrovirals before delivery and 73% were retained in care through delivery. 22% were lost before delivery, <1% died, and 6% had stillbirths or abortions. 94% of infants born alive enrolled in PMTCT, of whom 92% had complete HIV testing. 161 infants were HIV+, giving a 5.4% HIV transmission rate (9.8%, 4.6%, 5.8%, and 3.6% in periods 1-4). Retention among women through 12 months after PMTCT enrolment did not significantly differ across periods. However, among women who received antiretrovirals at the time of enrolment, retention 12 months later was lower in the Option B+ period (83%) than in periods 2 and 3 (94% and 93%) (p<0.001). Syphilis infection decreased from 16% in period 1 to 8% in period 4, whereas syphilis testing of infants increased from 17% to 91%. Despite dramatic reductions in MTCT in Haiti, interventions are needed to improve retention to achieve MTCT elimination of HIV and syphilis. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  4. Loan Stars: ILL Comes of Age.

    ERIC Educational Resources Information Center

    Jackson, Mary E.

    1998-01-01

    Assesses the changes in interlibrary loan (ILL) practices, and points the way to an ideal future. Discusses patron-initiated document request systems; library-mediated ordering systems; document delivery suppliers; accessing electronic resources; ILL management software; paying ILL invoices; new electronic delivery options; and results of a…

  5. Expanding your gay and lesbian patient base: what savvy medical practices know.

    PubMed

    Kahn, Ellen; Sullivan, Tom

    2008-01-01

    Many medical practices are looking at options to reach out to the gay, lesbian, bisexual, and transgender community as a means of expanding business and improving quality of care. This article sets out steps that any practice can take to market to this community and improve its cultural competence.

  6. Preschool Adequacy and Efficiency in California: Issues, Policy Options, and Recommendations. Monograph

    ERIC Educational Resources Information Center

    Karoly, Lynn A.

    2009-01-01

    Facing mounting evidence that California has fallen behind on many key indicators of educational performance, policymakers and the public share considerable interest in exploring whether California should expand public funding for preschool education. This expanded funding will be most effective if resources can be directed to their most efficient…

  7. 21 CFR 312.305 - Requirements for all expanded access uses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... options; (iii) The criteria for patient selection or, for an individual patient, a description of the... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Requirements for all expanded access uses. 312.305 Section 312.305 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  8. 77 FR 73969 - Expanding the Economic and Innovation Opportunities of Spectrum Through Incentive Auctions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-12

    ...] Expanding the Economic and Innovation Opportunities of Spectrum Through Incentive Auctions AGENCY: Federal... Media Bureau extends the deadline for filing comments and reply comments on the Notice of Proposed... delivery, by commercial overnight courier, or by first-class or overnight U.S. Postal Service mail...

  9. 77 FR 70967 - Authorization for Non-VA Medical Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-28

    ... expand the delivery of healthcare to veterans, VA is, like the rest of the healthcare industry...(a)(2)(B) to expand VA's authority to provide non-VA medical services under the non- VA care... furnished hospital care, nursing home care, domiciliary care, or medical services and who requires medical...

  10. Risk Factors Associated With Complication Rates of Becker-Type Expander Implants in Relation to Implant Survival: Review of 314 Implants in 237 Patients.

    PubMed

    Taboada-Suarez, Antonio; Brea-García, Beatriz; Magán-Muñoz, Fernando; Couto-González, Iván; González-Álvarez, Eduardo

    2015-12-01

    Although autologous tissue reconstruction is the best option for breast reconstruction, using implants is still a reliable and simple method, offering acceptable aesthetic results. Becker-type implants are permanent implants that offer a 1-stage reconstructive option. A retrospective study was carried out in our center reviewing the clinical reports of 237 patients, in whom a total of 314 Becker-type prostheses were implanted. Overall survival was calculated using a Kaplan-Meier estimate. Cox proportional hazard models were used to calculate adjusted hazard ratios. At the end of the study, 214 expanders (68.15%) presented no complications, 40 (12.47%) developed significant capsular contracture, in 27 (8.60%) infection occurred, 24 (7.64%) suffered minor complications, and 9 (2.87%) ruptured. The mean survival time of the expanders was 120.41 months (95% CI: 109.62, 131.19). Radiotherapy, chemotherapy, high Molecular Immunology Borstel, age, mastectomy performed previously to the implant, ductal carcinoma, advanced tumoral stage, experience of the surgeon, and Becker 35-type implants were significantly related to a high number of complications in relation to the survival of the implants. Cox regression analysis revealed that the main risk factors for the survival of expander implants included radiotherapy and surgeon experience. The complication hazard ratio or relative risk caused by these 2 factors was 1.976 and 1.680, respectively. One-stage reconstruction using Becker-type expanders is an appropriate, simple, and reliable option in delayed breast reconstruction in patients who have not received radiotherapy and as long as the procedure is carried out by surgeons skilled in the technique.

  11. 75 FR 57539 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Approving...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ..., will also contain information and analysis of EOW and EOM trading patterns, and index price volatility... similar to regular index options, except the exercise settlement value will be based on the index value...\\ In light of historic Commission concerns about expanding p.m. settlement, CBOE has represented that...

  12. Expanding the Investment Options in an Employer's Retirement Plan: A Success Story.

    ERIC Educational Resources Information Center

    Forsyth, Suzanne; Barker, Paul D.

    1986-01-01

    The American Council on Education's 2-year process of investigation, study, and selection that resulted in the council's movement from TIAA/CREF as its only available retirement plan, to a total of 15 retirement options offered by two insured annuity companies and two mutual fund companies is described. (MLW)

  13. Fast Track Option: An Accelerated Associate's Degree Program.

    ERIC Educational Resources Information Center

    Price, J. Randall

    1998-01-01

    Alternative instructional delivery options such as self-paced and flexible enrollment courses are designed to increase enrollment, promote retention, and encourage student success without lowering academic standards. The Fast Track Associate's Degree Program, developed by a team of faculty, staff, and administrators at Richland Community College,…

  14. Electricity: Today's Technologies, Tomorrow's Alternatives. Teacher's Guide.

    ERIC Educational Resources Information Center

    Electric Power Research Inst., Palo Alto, CA.

    This teaching guide is designed to help teachers develop lesson plans around nine chapters provided in the student textbook. Chapters focus on energy use, energy demand, energy supply, principles of electric power generation, today's generating options, future generating options, electricity storage and delivery, environmental concerns, and making…

  15. Liposomal systems as viable drug delivery technology for skin cancer sites with an outlook on lipid-based delivery vehicles and diagnostic imaging inputs for skin conditions'.

    PubMed

    Akhtar, Naseem; Khan, Riaz A

    2016-10-01

    Skin cancer is among one of the most common human malignancies wide-spread world-over with mortality statistics rising continuously at an alarming rate. The increasing frequency of these malignancies has marked the need for adopting effective treatment plan coupled with better and site-specific delivery options for the desired therapeutic agent's availability at the affected site. The concurrent delivery approaches to cancerous tissues are under constant challenge and, as a result, are evolving and gaining advancements in terms of delivery modes, therapeutic agents and site-specificity of the therapeutics delivery. The lipid-based liposomal drug delivery is an attractive and emerging option, and which is meticulously shaping up beyond a threshold level to a promising, and viable route for the effective delivery of therapeutic agents and other required injuctions to the skin cancer. An update on liposomal delivery of chemotherapeutic agents, natural-origin compounds, photosensitizer, and DNA repair enzymes as well as other desirable and typical delivery modes employed in drug delivery and in the treatment of skin cancers is discussed in details. Moreover, liposomal delivery of nucleic acid-based therapeutics, i.e., small interfering RNA (siRNA), mRNA therapy, and RGD-linked liposomes are among the other promising novel technology under constant development. The current clinical applicability, viable clinical plans, future prospects including transport feasibility of delivery vesicles and imaging techniques in conjunction with the therapeutic agents is also discussed. The ongoing innovations in liposomal drug delivery technology for skin cancers hold promise for further development of the methodology for better, more effective and site-specific delivery as part of the better treatment plan by ensuring faster drug transport, better and full payload delivery with enough and required concentration of the dose. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Market segmentation for multiple option healthcare delivery systems--an application of cluster analysis.

    PubMed

    Jarboe, G R; Gates, R H; McDaniel, C D

    1990-01-01

    Healthcare providers of multiple option plans may be confronted with special market segmentation problems. This study demonstrates how cluster analysis may be used for discovering distinct patterns of preference for multiple option plans. The availability of metric, as opposed to categorical or ordinal, data provides the ability to use sophisticated analysis techniques which may be superior to frequency distributions and cross-tabulations in revealing preference patterns.

  17. Distance Delivery of Nutrition Education as a Method for Providing Continuing Education

    ERIC Educational Resources Information Center

    Unusan, Nurhan; Aiba, Naomi; Yoshiike, Nobuo

    2007-01-01

    Distance learning applications in nutrition education have evolved together with communication technology. Distance delivery is transforming the culture of professional health education by expanding access to learners, introducing novel teaching and learning methods, as well as shifting the paradigm of how instructors and students interact. The…

  18. Libraries 2000: Transforming Libraries Using Document Delivery, Needs Assessment, and Networked Resources.

    ERIC Educational Resources Information Center

    Kleiner, Jane P.; Hamaker, Charles A.

    1997-01-01

    Describes three projects at Louisiana State University libraries designed to utilize document delivery and electronic access to expand collections, identify faculty journal needs, and share resources among academic, public, special, and school libraries. Network developments, grant support, and needs assessment surveys are also discussed.…

  19. Treatment for stable HIV patients in England: can we increase efficiency and improve patient care?

    PubMed

    Adams, Elisabeth; Ogden, David; Ehrlich, Alice; Hay, Phillip

    2014-07-01

    To estimate the costs and potential efficiency gains of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients compared to the costs of hospital pharmacy dispensing and home delivery. We estimated the annual costs per patient (HIV clinic visits and either first-line treatment or a common second-line regimen, with some patients switching to a second-line regimen during the year). The cost of three-, four- and six-monthly clinic appointments and drug supply was estimated assuming hospital dispensing (incurring value-added tax) and home delivery. Three-monthly appointments and hospital drug dispensing (baseline) were compared to other strategies. The baseline was the most costly option (£10,587 if first-line treatment and no switch to second-line regimen). Moving to six-monthly appointments and home delivery yielded savings of £1883 per patient annually. Assuming patients start on different regimens and may switch to second-line therapies, six-monthly appointments and three-monthly home delivery of drugs is the least expensive option and could result in nearly £2000 savings per patient. This translates to annual cost reduction of about £8 million for the estimated 4000 eligible patients not currently on home delivery in London, England. Different appointment schedules and drug supply options should be considered for stable HIV patients based on efficiency gains. However, this should be assessed for individual patients to meet their needs, especially around adherence and patient support. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. Expanding Access to Injectable Contraception: Results From Pilot Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) in 4 African Countries

    PubMed Central

    Stout, Anna; Wood, Siri; Barigye, George; Kaboré, Alain; Siddo, Daouda; Ndione, Ida

    2018-01-01

    PATH partnered with the United Nations Population Fund (UNFPA) and country ministries of health (MOHs) to coordinate pilot introductions of subcutaneous depot medroxyprogesterone acetate (subcutaneous DMPA or DMPA-SC, brand name Sayana Press) in Burkina Faso, Niger, Senegal, and Uganda from July 2014 through June 2016 in order to expand the range of methods available to women, particularly in remote locations. The pilot introductions aimed to answer key questions that would inform decisions about future investments in DMPA-SC and scaling up product availability and service-delivery innovations nationally. These questions included the extent to which DMPA-SC would appeal to first-time users of modern contraception, as well as adolescent girls and young women; whether DMPA-SC would add value to family planning programs or simply replace DMPA-IM or other modern methods; and the trends in injectables use when introducing DMPA-SC (or any injectable) at the community level for the first time. We implemented a multicountry monitoring system to track key indicators, including the number of doses administered by category of user (e.g., new users, by client age group) or delivery channel. Providers generally collected these data using their national programs' standard family planning registers. Data were analyzed for cumulative information and to examine trends over time using Microsoft Power Query for Excel and Tableau. Across the 4 countries, nearly half a million DMPA-SC doses were administered and approximately 135,000 first-time users of modern contraception were reached. Furthermore, 44% of the doses administered in 3 of the countries with data were to adolescent girls and young women under age 25. Switching from DMPA-IM to DMPA-SC was not widespread, ranging from 7% in Burkina Faso to 16% in Uganda. Results from these pilot introductions demonstrate that DMPA-SC has the potential to expand community-level access to injectables, maximize task-sharing strategies, and reach young women and new acceptors of family planning. Considered within the context of each country's setting, training approach, and introduction strategy, these results can help stakeholders in other countries make informed decisions about whether and how to include this contraceptive option in their family planning programs. PMID:29602866

  1. The impact of Federal rehabilitation laws on the expanding role of employee assistance programs in business and industry.

    PubMed

    Farkas, G M

    1989-12-01

    Federal statutory and case law protecting the rights of individuals with disabilities has had a major impact in expanding the occupational options for mentally and physically impaired employees. One serendipitous result of these protections has been the expansion of job opportunities for psychologists in business and industry. This article examines important federal laws and regulations pertaining to the employment rights of the handicapped worker and emphasizes the intricacies involved for psychologists who work in the employee assistance field or who consult with management. The expansion of vocational options for psychologists working with business is traced, and future prospects for psychologists in this area are explored.

  2. Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

    PubMed Central

    Diwanji, Tejan P.; Mohindra, Pranshu; Vyfhuis, Melissa; Snider, James W.; Kalavagunta, Chaitanya; Mossahebi, Sina; Yu, Jen; Feigenberg, Steven

    2017-01-01

    The 21st century has seen several paradigm shifts in the treatment of non-small cell lung cancer (NSCLC) in early-stage inoperable disease, definitive locally advanced disease, and the postoperative setting. A key driver in improvement of local disease control has been the significant evolution of radiation therapy techniques in the last three decades, allowing for delivery of definitive radiation doses while limiting exposure of normal tissues. For patients with locally-advanced NSCLC, the advent of volumetric imaging techniques has allowed a shift from 2-dimensional approaches to 3-dimensional conformal radiation therapy (3DCRT). The next generation of 3DCRT, intensity-modulated radiation therapy and volumetric-modulated arc therapy (VMAT), have enabled even more conformal radiation delivery. Clinical evidence has shown that this can improve the quality of life for patients undergoing definitive management of lung cancer. In the early-stage setting, conventional fractionation led to poor outcomes. Evaluation of altered dose fractionation with the previously noted technology advances led to advent of stereotactic body radiation therapy (SBRT). This technique has dramatically improved local control and expanded treatment options for inoperable, early-stage patients. The recent development of proton therapy has opened new avenues for improving conformity and the therapeutic ratio. Evolution of newer proton therapy techniques, such as pencil-beam scanning (PBS), could improve tolerability and possibly allow reexamination of dose escalation. These new progresses, along with significant advances in systemic therapies, have improved survival for lung cancer patients across the spectrum of non-metastatic disease. They have also brought to light new challenges and avenues for further research and improvement. PMID:28529896

  3. Student Attitudes to Traditional and Online Methods of Delivery

    ERIC Educational Resources Information Center

    Wong, Lily; Fong, Michelle

    2014-01-01

    Rapid developments in education technology have provided educators and students new options in a constantly changing, competitive teaching and learning environment. As the number of online teaching resources continue to increase, research into student attitudes toward traditional and online methods of delivery is important in order to determine…

  4. Will Digital Texts Succeed?

    ERIC Educational Resources Information Center

    Acker, Stephen R.

    2008-01-01

    With faculty changing instructional practices to take advantage of customizable, focused content (and digital delivery of that content), many people assume that digital distribution is the answer to bringing the costs of course content delivery in line. But the picture just isn't that simple. A wide continuum of options is available to faculty and…

  5. Electronic Document Delivery: New Options for Libraries.

    ERIC Educational Resources Information Center

    Leach, Ronald G.; Tribble, Judith E.

    1993-01-01

    Examines commercial electronic document delivery services that are available to academic libraries. Highlights include collection development issues; criteria for selection and evaluation; remote access systems, including CARL UnCover 2, Faxon Finder and Faxon Xpress, ContentsFirst and ArticleFirst, and CitaDel; and on-site access systems,…

  6. PACs: A Framework for Determining Appropriate Service Delivery Options.

    ERIC Educational Resources Information Center

    Blosser, Jean L.; Kratcoski, Annette

    1997-01-01

    Offers speech-language clinicians a framework for team decision making and service delivery by encouraging speech-language pathologists and their colleagues to consider the unique combination of providers, activities, and contexts (PACs) necessary to meet the specific needs of each individual with a communication disorder. Sample cases involving…

  7. Development Strategies for Online Volunteer Training Modules: A Team Approach

    ERIC Educational Resources Information Center

    Robideau, Kari; Vogel, Eric

    2014-01-01

    Volunteers are central to the delivery of 4-H programs, and providing quality, relevant training is key to volunteer success. Online, asynchronous modules are an enhancement to a training delivery menu for adult volunteers, providing consistent, accessible options traditionally delivered primarily face to face. This article describes how Minnesota…

  8. Report of the Field Testing and Validation of Expanding Career Horizons.

    ERIC Educational Resources Information Center

    Fink, Arlene; Kosecoff, Jacqueline

    A three-phase assessment was conducted to field test a curriculum developed to expand career horizons for both young men and young women and to help eliminate sex role stereotyping. Intended for grades 7-14, this curriculum emphasized the increasing options for women in vocational education programs and non-traditional careers. First, the…

  9. 76 FR 19169 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-06

    ... Effectiveness of Proposed Rule Change To Expand the $2.50 Strike Price Program March 31, 2011. Pursuant to... Exchange filed the proposal as a ``non- controversial'' proposed rule change pursuant to Section 19(b)(3)(A... to expand the Exchange's $2.50 Strike Price Program (the ``Program'') to permit the listing of...

  10. Changing Environment and the Academic Medical Center: The Johns Hopkins Hospital.

    ERIC Educational Resources Information Center

    Heyssel, Robert M.

    1989-01-01

    Johns Hopkins Hospital expanded its health care delivery capabilities and strengthened its position in the marketplace by acquisitions of and mergers with other hospitals and a health maintenance organization. The resulting conglomerate has achieved its goals of expanding patient care, broadening the patient base, and enlarging the asset base and…

  11. Questioning LibQUAL+[TM]: Expanding Its Assessment of Academic Library Effectiveness

    ERIC Educational Resources Information Center

    Edgar, William B.

    2006-01-01

    This article examines LibQUAL+[TM]'s instrument, fundamental assumption, and research approach and proposes a functional/technical model of academic library effectiveness. This expanded view of library effectiveness complements LibQUAL+[TM], emphasizing it to be dependent upon users' experience of service delivery, as LibQUAL+[TM] recognizes.…

  12. Considering retail health clinics.

    PubMed

    Mullin, Kathy

    2009-12-01

    By gaining increasing acceptance from consumers and traditional providers, retail-based convenient care clinics have moved from the innovative fringe into the mainstream of healthcare delivery. Nationwide, resourceful administrators are experimenting with retail-based delivery systems, using the clinic's unique attributes to promote wellness, expand accessibility, reduce delivery costs, and enhance brand recognition. This article takes an in-depth look at the convenient care business model, pertinent regulatory issues, and some of the associated benefits and concerns.

  13. Unlocking Solar for Low- and Moderate-Income Residents: A Matrix of

    Science.gov Websites

    community solar could dramatically expand the distributed PV market. A new NREL report analyzes the most Promising Financing Options | Solar Research | NREL Unlocking Solar for Low- and Moderate -Income Residents: A Matrix of Promising Financing Options Unlocking Solar for Low- and Moderate-Income

  14. Applying Marketing in the Public School Setting

    ERIC Educational Resources Information Center

    Pettinga, Deidre M.; Angelov, Azure D. S.; Bateman, David F.

    2015-01-01

    Traditional public schools no longer have a guaranteed market share of students, or tax dollars, based on geographic location. Families with little to no options in the past about where their child would attend school, now have many. In response to the expanding options available to them--in the form of charter schools and vouchers--families today…

  15. Assisted Living in Rural America: Results From a National Survey

    ERIC Educational Resources Information Center

    Hawes, Catherine; Phillips, Charles D.; Holan, Scott; Sherman, Michael; Hutchison, Linnae L.

    2005-01-01

    Expanding the availability of long-term care (LTC) services and making them more responsive to consumer preferences is an important goal, particularly for elderly people living in rural areas who tend to be older and have greater functional limitations but less access to the range of LTC options available in metropolitan areas. One option that…

  16. 77 FR 72426 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-05

    ... Rule Change Regarding the Short Term Option Series Program November 29, 2012. Pursuant to Section 19(b... number of expirations available under the Short Term Option Series Program (``STOS Program''), to allow for the Exchange to delist certain series in the STOS that do not have open interest and to expand the...

  17. No Child Left Behind Educational Options: Availability Expands, But Participation Remains Low. Research Brief

    ERIC Educational Resources Information Center

    Neumann, Michael J.

    2009-01-01

    As required by the No Child Left Behind Act of 2001 (NCLB), most school districts with low-performing schools offer public school choice and supplemental educational services. However, researchers found that, although the total number of students participating in both options has increased substantially since NCLB began, only a small proportion…

  18. Testing of Shelter Design and Industrial Hardening Concepts at the MILL RACE Event.

    DTIC Science & Technology

    1982-01-01

    built. The upgrading consisted of the application of 2-in. thick sheets of expanded polystyrene to the exterior of each of the test walls to be upgraded...was covered with 1-in. thick sheets of expanded polystyrene prior to backfilling (Figure 6-4), and the interior was shored, floor to ceiling, with two...deformations in the vault, despite the fact that no structural upgrading options (shores, or roof cover of expanded polystyrene ) were installed. Thus

  19. Comparing patient and healthcare worker experiences during a dengue outbreak in Singapore: understanding the patient journey and the introduction of a point-of-care test (POCT) toward better care delivery.

    PubMed

    Tan, Qinghui; Hildon, Zoe J-L; Singh, Shweta; Jing, Jin; Thein, Tun Linn; Coker, Richard; Vrijhoef, Hubertus J M; Leo, Yee Sin

    2017-07-19

    In the aftermath of an upsurge in the number of dengue cases in 2013 and 2014, the SD BIOLINE Dengue Duo rapid diagnostic Point-of-Care Test (POCT) kit was introduced in Tan Tock Seng Hospital, Singapore in June 2013. It is known that the success of POCT usage is contingent on its implementation within the health system. We evaluated health services delivery and the Dengue Duo rapid diagnostic test kit application in Singapore from healthcare workers' perspectives and patient experiences of dengue at surge times. Focus group discussions were conducted with dengue patients, from before and after the POCT implementation period. In-depth interviews with semi-structured components with healthcare workers were carried out. A patient centred process mapping technique was used for evaluation, which mapped the patient's journey and was mirrored from the healthcare worker's perspective. Patients and healthcare workers confirmed a wide range of symptoms in adults, making it challenging to determine diagnosis. There were multiple routes to help seeking, and no 'typical patient journey', with patients either presenting directly to the hospital emergency department, or being referred there by a primary care provider. Patients groups diagnosed before and after POCT implementation expressed some differences between speed of diagnoses and attitudes of doctors, yet shared negative feelings about waiting times and a lack of communication and poor information delivery. However, the POCT did not in its current implementation do much to help waiting times. Healthcare workers expressed that public perceptions of dengue in recent years was a major factor in changing patient management, and that the POCT kit was helpful in improving the speed and accuracy of diagnoses. Health service delivery for dengue patients in Singapore was overall perceived to be of an acceptable clinical standard, which was enhanced by the introduction of the POCT. However, improvements can be focused on Adapting to outbreaks by reducing and rendering Waiting experiences more comfortable; Advancing education about symptom recognition, while also Recognising better communication strategies; and Expanding follow-up care options. This is presented as the Dengue AWARE model of care delivery.

  20. Vocational Education Distance Learning Delivery System. Final Report.

    ERIC Educational Resources Information Center

    Hardy, Darcy Walsh

    A project was conducted to identify criteria and procedures for using a distance learning delivery system at the University of Texas TeleLearning Center to teach Health Occupations II to high school seniors. Another objective was expanding the current distance learning program for health occupations to include between 15 and 20 school districts.…

  1. Dental Therapy Assistant: Quality of Restorations Placed and Finished.

    ERIC Educational Resources Information Center

    Heid, Theodore H.; Bair, Jeffrey H.

    The U.S. Army Dental Corps has implemented a new concept of dental care delivery, formally identified as the Improved Dental Care Delivery System. The concept is based on the conservation of professional manpower resources through the use of dental treatment teams employing expanded duty dental assistants. Dental Therapy Assistant (DTA) is the…

  2. Advanced Technology Tech Prep Partnership for Northern Kane Regional Delivery System. Final Report.

    ERIC Educational Resources Information Center

    Elgin Community Coll., IL.

    A 1-year project was undertaken to continue implementation, evaluation, and revision of a model advanced technology partnership between Elgin Community College (ECC) and the Northern Kane Regional Delivery System in Illinois. The model program, which originally included three high schools, was expanded to include five additional high schools in…

  3. Delivery of Instruction via Television. Final Report.

    ERIC Educational Resources Information Center

    Wisconsin State Board of Vocational, Technical, and Adult Education, Madison.

    During 1985, the Wisconsin Board of Vocational, Technical, and Adult Education (VTAE) expanded its delivery of instruction via television. Approximately 3,000 persons at 170 sites throughout the United States and Canada participated in the VTAE's Technical School of the Air. In addition to delivering six to eight courses per semester, the network…

  4. Student's Perspectives on Taking Courses Online, Blended, or a Combination

    ERIC Educational Resources Information Center

    Schifter, Catherine C.; Ifenthaler, Dirk; White, Daniel

    2015-01-01

    Online education has a relatively short history in the grand history of education. With options for online delivery modes developed over the last two decades, understanding student motivations for choosing one option over another will be helpful to any institution of higher education planning new offerings. This reflective paper presents the…

  5. 75 FR 37406 - Order Exempting the Trading and Clearing of Certain Products Related to ETFS Physical Swiss Gold...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-29

    ... to security futures), and in either case cleared through the Options Clearing Corporation (``OCC... contract market or derivatives transaction execution facility for transactions for future delivery in any... of the Options and Security Futures on Gold and Silver Products. In enacting Section 4(c), Congress...

  6. Coupling of FM Systems to Individuals with Unilateral Hearing Loss.

    ERIC Educational Resources Information Center

    Kopun, Judy G.; And Others

    1992-01-01

    This study examined the attenuation characteristics of 5 Frequency Modulation system sound delivery options for 25 adults and children (ages 5-13). Degree of ear canal occlusion was a major factor in degree of attenuation. For children with unilateral hearing impairments, the most acoustically appropriate option was the tube-fitting. (Author/JDD)

  7. Current options and future possibilities for the treatment of dyskinesia and motor fluctuations in Parkinson's disease.

    PubMed

    Cenci, M A; Ohlin, K E; Odin, P

    2011-09-01

    Dyskinesia and motor fluctuations affect up to 90% of patients with Parkinson's disease (PD) within ten years of L-DOPA pharmacotherapy, and represent a major challenge to a successful clinical management of this disorder. There are currently two main treatment options for these complications, namely, deep brain electrical stimulation or continuous infusion of dopaminergic agents. The latter is achieved using either subcutaneous apomorphine infusion or enteric L-DOPA delivery. Some patients also benefit from the antidyskinetic effect of amantadine as an adjunct to L-DOPA treatment. Ongoing research in animal models of PD aims at discovering additional, novel treatment options that can either prevent or reverse dyskinesia and motor fluctuations. Alternative methods of continuous L-DOPA delivery (including gene therapy), and pharmacological agents that target nondopaminergic receptor systems are currently under intense experimental scrutiny. Because clinical response profiles show large individual variation in PD, an increased number of treatment options for dyskinesia and motor fluctuations will eventually allow for antiparkinsonian and antidyskinetic therapies to be tailor-made to the needs of different patients and/or PD subtypes.

  8. The Pathways to Advancement Project: How States Can Expand Postsecondary Educational Opportunities for Working Adults. Issue Brief

    ERIC Educational Resources Information Center

    Mazzeo, Christopher; Strawn, Julie; Roberts, Brandon

    2009-01-01

    The Pathways to Advancement initiative was launched by the National Governors Association Center for Best Practices (NGA Center) to help governors and their policy advisors examine options and develop strategies for expanding working adults' access to and completion of postsecondary education. In September 2003, the NGA Center issued a request for…

  9. Expanding the Private School Sector: Government Policy and Private Secondary Schools in Hong Kong, 1988-2001

    ERIC Educational Resources Information Center

    Cheung, Alan C. K.; Randall, E. Vance; Tam, Man-Kwan

    2005-01-01

    This paper addresses the extent to which government policy has helped increase the number and diversity of private secondary schools in Hong Kong, which, in turn, has expanded the options for parental choice. Five indicators were selected to measure this objective. They are as follows: (1) Number of private schools and students enrolled; (2) Types…

  10. Pre- and post-test genetic counseling for chromosomal and Mendelian disorders.

    PubMed

    Fonda Allen, Jill; Stoll, Katie; Bernhardt, Barbara A

    2016-02-01

    Genetic carrier screening, prenatal screening for aneuploidy, and prenatal diagnostic testing have expanded dramatically over the past 2 decades. Driven in part by powerful market forces, new complex testing modalities have become available after limited clinical research. The responsibility for offering these tests lies primarily on the obstetrical care provider and has become more burdensome as the number of testing options expands. Genetic testing in pregnancy is optional, and decisions about undergoing tests, as well as follow-up testing, should be informed and based on individual patients' values and needs. Careful pre- and post-test counseling is central to supporting informed decision-making. This article explores three areas of technical expansion in genetic testing: expanded carrier screening, non-invasive prenatal screening for fetal aneuploidies using cell-free DNA, and diagnostic testing using fetal chromosomal microarray testing, and provides insights aimed at enabling the obstetrical practitioner to better support patients considering these tests. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Dietary Changes by Expanded Food and Nutrition Education Program (EFNEP) Graduates Are Independent of Program Delivery Method.

    ERIC Educational Resources Information Center

    Luccia, Barbara H. D.; Kunkel, Mary E.; Cason, Katherine L.

    2003-01-01

    Expanded Food and Nutrition Education Program graduates (n=1,141) who received either individual (21.3%), group (76.2%), or combined (2.5%) instruction were assessed. Independent of method, participants significantly improved the number of servings consumed from grains, vegetables, dairy, and meat and meat alternatives; total calories consumed;…

  12. Have You Considered Accounting? Opportunities for Women Are Expanding. Career Options Series for Undergraduate Women.

    ERIC Educational Resources Information Center

    Rowes, Barbara

    This booklet is part of a set of self-guidance publications prepared by Catalyst, a national nonprofit organization. It is written specifically for undergraduate women to help them bring their aspirations into focus, develop realistic career goals and plan for career options in fields which, at the managerial and professional levels, have been…

  13. 75 FR 1442 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of a Proposed Rule...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-11

    ... OMX PHLX, Inc. To Amend the $1 Strike Program To Allow Low-Strike LEAPS January 4, 2010. Pursuant to... 1012 (Series of Options Open for Trading) to expand the Exchange's $1 Strike Price Program (``Program'' or ``$1 Strike Program'') \\3\\ to allow listing long-term option series (``LEAPS'') \\4\\ in $1 strike...

  14. Nondegree Options for Expanding a Leadership Portfolio.

    PubMed

    Bleich, Michael R; Jones-Schenk, Jan

    2016-07-01

    Organizational leaders are time-challenged to stay attuned with dynamic health care and business environments, leaving time for professional development at a premium. Beyond interorganizational leadership programs, learning options for nondegree-enhanced education are provided, referencing some of the high-quality, high-volume programs available at no or low cost. J Contin Educ Nurs. 2016;47(7):299-301. Copyright 2016, SLACK Incorporated.

  15. 78 FR 28911 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Approving...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-16

    ... core business hours (e.g., New York Stock Exchange Rule 51(a) and BATS Exchange Rule 1.5(w) mentions... Book Official to suspend trading in an option if the underlying security is halted or suspended in the primary market. The Exchange proposes to expand the authority of the Post Director or Order Book Official...

  16. 75 FR 16887 - Self-Regulatory Organizations; NASDAQ OMX PHLX, Inc.; Order Granting Approval of Proposed Rule...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-02

    ... the Number of Components in the PHLX Semiconductor Sector SM Known as SOX SM , on Which Options are... expand the number of components in the PHLX Semiconductor Sector\\SM\\ known as SOX\\SM\\, on which options... 240.19b-4. \\3\\ PHLX Semiconductor Sector\\SM\\ may also be known as PHLX Semiconductor Index or PHLX...

  17. Evidence from the Private Option: The Arkansas Experience.

    PubMed

    Maylone, Bethany; Sommers, Benjamin D

    2017-02-01

    Issue: Arkansas was the first state to receive approval to expand Medicaid under the Affordable Care Act through a Section 1115 waiver. This approach, known as the "private option," uses Medicaid funds to purchase private health plans on the state’s marketplace. It is intended to promote market competition, continuity of coverage, and greater access to care. Goal: To describe the key features of the private option and evaluate its impact on health care for low-income adults in the state after two years. Methods: Survey data from 2013–2015 that assessed health insurance coverage, access to care, utilization, and self-reported health among low-income adults in Arkansas compared to adults in two other states. Key findings and conclusions: Arkansas’s private option improved access to primary care and prescription medications, reduced reliance on the emergency department, increased use of preventive care, and improved perceptions of quality and health among low-income adults in the state, compared to Texas, which did not expand Medicaid. Arkansas’s benefits were similar to those observed in Kentucky’s traditional Medicaid expansion. Churning in coverage remained a challenge for nearly a quarter of low-income adults each year.

  18. Intracellular Delivery System for Antibody–Peptide Drug Conjugates

    PubMed Central

    Berguig, Geoffrey Y; Convertine, Anthony J; Frayo, Shani; Kern, Hanna B; Procko, Erik; Roy, Debashish; Srinivasan, Selvi; Margineantu, Daciana H; Booth, Garrett; Palanca-Wessels, Maria Corinna; Baker, David; Hockenbery, David; Press, Oliver W; Stayton, Patrick S

    2015-01-01

    Antibodies armed with biologic drugs could greatly expand the therapeutic potential of antibody–drug conjugates for cancer therapy, broadening their application to disease targets currently limited by intracellular delivery barriers. Additional selectivity and new therapeutic approaches could be realized with intracellular protein drugs that more specifically target dysregulated pathways in hematologic cancers and other malignancies. A multifunctional polymeric delivery system for enhanced cytosolic delivery of protein drugs has been developed that incorporates endosomal-releasing activity, antibody targeting, and a biocompatible long-chain ethylene glycol component for optimized safety, pharmacokinetics, and tumor biodistribution. The pH-responsive polymeric micelle carrier, with an internalizing anti-CD22 monoclonal targeting antibody, effectively delivered a proapoptotic Bcl-2 interacting mediator (BIM) peptide drug that suppressed tumor growth for the duration of treatment and prolonged survival in a xenograft mouse model of human B-cell lymphoma. Antitumor drug activity was correlated with a mechanistic induction of the Bcl-2 pathway biomarker cleaved caspase-3 and a marked decrease in the Ki-67 proliferation biomarker. Broadening the intracellular target space by more effective delivery of protein/peptide drugs could expand the repertoire of antibody–drug conjugates to currently undruggable disease-specific targets and permit tailored drug strategies to stratified subpopulations and personalized medicines. PMID:25669432

  19. Roles of Social Movement Organizations for Securing Workers' Safety in Korea: A Case Study of Abolition of the 30-Minute Delivery Guarantee Program in Pizza Delivery Service.

    PubMed

    Park, Ji-Eun; Kim, Myoung-Hee

    2016-07-01

    Many restaurants in Korea maintain quick-delivery service programs to satisfy customers. This service allows delivery workers limited time to deliver, which frequently put them in danger. Most of the workers are young, work part-time, and are rarely organized into trade unions. In this article, through a case study of the social movement to abolish the 30-minute delivery guarantee program of pizza companies in Korea, we argue that social movements involving social movement organizations (SMOs) and individual citizens could serve as a means to rectify this problem. We show how the SMOs developed and expanded the movement using a framing perspective and how the general public became involved through social media. Data was collected via online searching. Interview scripts from key players of SMOs and unofficial documents they provided were also reviewed. Three SMOs primarily led the movement, successfully forming a frame that emphasized social responsibility. SMOs also utilized social media to link their standing frame with unmobilized citizens and to expand the movement. We identified contributing factors and limitations of the movement and drew lessons that could be applied to other sectors where workers are in vulnerable positions. © The Author(s) 2016.

  20. Contribution of Sudanese medical diaspora to the healthcare delivery system in Sudan: exploring options and barriers.

    PubMed

    Abdalla, Fayrouz Mohammed; Omar, Maye Abu; Badr, Elsheikh Elsiddig

    2016-06-30

    Medical diaspora options, including the engagement of expatriate physicians in development efforts within their home country, are being called for to reverse the effects of brain drain from developing countries. This paper presents the results of a study exploring the potential contributions for the Sudanese Medial Diaspora Options to the healthcare delivery system (HCDS) in Sudan, focusing on the options of temporal and permanent returns and the likely obstacles faced in their implementation. This was a cross-sectional study using a mixed methods design including quantitative and qualitative approaches. For the quantitative approach, the study, which focused on the possible contribution of the diaspora to healthcare delivery in Sudan, was based on an online survey using random purposive and snowballing sampling techniques involving 153 Sudanese physicians working in Saudi Arabia and other Gulf States, the United Kingdom, the Republic of Ireland, and the United States of America. The qualitative approach involved in-depth interviews with returnee physicians and key informants in Sudan, focusing on the return experiences, the barriers for return, and the options to improve future contributions. Despite contributions of the Sudanese medical diaspora being of a small scale considering the size of the phenomenon, as well as infrequent and not appropriately organized, their inputs to academia and the links built with overseas institutions and specialist clinical services were nevertheless remarkable. The main barrier to temporal return was inappropriate organization by the local counterparts, while those for permanent return of physicians were poor work environment, insufficient financial payment, unsecured accommodation, and offspring education. The study identified short-term return as a feasible option considering the country's current conditions. Proper coordination mechanisms for short-term returns and facilitation of permanent return through stakeholders' collaboration were proposed to improve diaspora contributions. The potentials of Sudanese medial diaspora contributions to the HCDS in Sudan are promising. Short-term contributions were observed as the best option for the current country situation. Creation of a coordinating body from within the healthcare sector in Sudan to effectively coordinate diaspora contributions is recommended.

  1. Patient-physician communication about early stage prostate cancer: analysis of overall visit structure.

    PubMed

    Henry, Stephen G; Czarnecki, Danielle; Kahn, Valerie C; Chou, Wen-Ying Sylvia; Fagerlin, Angela; Ubel, Peter A; Rovner, David R; Alexander, Stewart C; Knight, Sara J; Holmes-Rovner, Margaret

    2015-10-01

    We know little about patient-physician communication during visits to discuss diagnosis and treatment of prostate cancer. To examine the overall visit structure and how patients and physicians transition between communication activities during visits in which patients received new prostate cancer diagnoses. Forty veterans and 18 urologists at one VA medical centre. We coded 40 transcripts to identify major communication activities during visits and used empiric discourse analysis to analyse transitions between activities. We identified five communication activities that occurred in the following typical sequence: 'diagnosis delivery', 'risk classification', 'options talk', 'decision talk' and 'next steps'. The first two activities were typically brief and involved minimal patient participation. Options talk was typically the longest activity; physicians explicitly announced the beginning of options talk and framed it as their professional responsibility. Some patients were unsure of the purpose of visit and/or who should make treatment decisions. Visits to deliver the diagnosis of early stage prostate cancer follow a regular sequence of communication activities. Physicians focus on discussing treatment options and devote comparatively little time and attention to discussing the new cancer diagnosis. Towards the goal of promoting patient-centred communication, physicians should consider eliciting patient reactions after diagnosis delivery and explaining the decision-making process before describing treatment options. © 2013 John Wiley & Sons Ltd.

  2. Current and emerging lipid-based systems for transdermal drug delivery.

    PubMed

    Singla, Sumeet K; Sachdeva, Vishal

    2015-01-01

    Developing a transdermal drug delivery system is a challenging task considering the selective permeability of the skin and the physicochemical properties the drug must possess to permeate through the skin. Lipid-based drug delivery systems have contributed a great deal in this direction in the last few decades, and thereby have helped to expand the range of therapeutic molecules that can be delivered through the skin in a safe and effective manner. Additionally, vesicular delivery systems such as nanoparticles and emulsions have also played important roles in providing alternative novel approaches for drug delivery. In this article, we will discuss some of the current and future lipid-based systems for transdermal drug delivery along with the associated challenges.

  3. Challenges in oral drug delivery in patients with esophageal dysphagia.

    PubMed

    Kappelle, Wouter F W; Siersema, Peter D; Bogte, Auke; Vleggaar, Frank P

    2016-01-01

    Esophageal dysphagia is a commonly reported symptom with various benign and malignant causes. Esophageal dysphagia can impede intake of oral medication, which often poses a major challenge for both patients and physicians. The best way to address this challenge depends of the cause of dysphagia. The pathophysiology of esophageal dysphagia is discussed, diagnostic tools to determine its cause are reviewed and recent developments in the treatment of esophageal dysphagia are discussed. Alternative options to administer medication in dysphagia are discussed and the appropriateness of them reviewed. Two ways can be followed to allow medication intake in patients with esophageal dysphagia, i.e. altering medication or resolving dysphagia. The latter is generally preferred, since esophageal dysphagia rarely only impedes medication intake. Esophageal resection is possible in more advanced esophageal cancer stages due to advances in neo-adjuvant therapy. Due to recent improvements in intraluminal radiotherapy, it can be expected that this will be the primary treatment in a palliative setting. Temporary self-expandable metal stent placement is a promising new alternative for bougienage in difficult-to-treat benign strictures.

  4. A patient mobility framework that travels: European and United States-Mexican comparisons.

    PubMed

    Laugesen, Miriam J; Vargas-Bustamante, Arturo

    2010-10-01

    To develop a framework that parsimoniously explains divergent patient mobility in the United States and Europe. Review of studies of patient mobility; data from the 2007 Flash Eurobarometer and the 2001 California Health Interview Survey was analyzed; and we reviewed government policies and documents in the United States and Europe. Four types of patient mobility are defined: primary, complementary, duplicative, and institutionalized. Primary exit occurs when people without comprehensive insurance travel because they cannot afford to pay for health insurance or directly finance care, as in the United States and Mexico. Second, people will exit to buy complementary services not covered, or partially covered by domestic health insurance, in both the United States and Europe. Third, in Europe, patient mobility for duplicative services provides faster or better quality treatment. Finally, governments and insurers can encourage institutionalized exit through expanded delivery options and financing. Institutionalized exit is developing in Europe, but uncoordinated and geographically limited in the United States. This parsimonious framework explains patient mobility by considering domestic health system characteristics relating to cost and quality. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  5. Beyond telecommuting: A new paradigm for the effect of telecommunications on travel

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

    Niles, J.S.

    1994-09-01

    Conventional wisdom about social and economic behavior holds that the use of telecommunications is a natural substitute for transportation. For example, telephone calls can replace travel to meetings, and facsimile or electronic-mail transmission of documents substitutes for courier or postal delivery. The moving of information can replace the moving of period and goods. Vehicle traffic on the national transportation infrastructure can be replaced by digital traffic on what is now called the National Information Infrastructure (NII). A leading example is telecommuting. This means using telecommunications to replace commuting between home and work. Telecommuting is an optional way of expanding employees`more » work locations in those circumstances where it yields both improved organizational performance and employee satisfication. Telecommuting accounts for 7.6 million U.S. workers as of early 1993, up 15% from the 6.6 million counted in 1992. The growth of telecommuting has been strong for the past five years. No one has identified any reasons to suggest that this growth will abate in the forseeable future.« less

  6. Stem Cells as Drug Delivery Methods: Application of Stem Cell Secretome for Regeneration

    PubMed Central

    Tran, Christine; Damaser, Margot S.

    2014-01-01

    Mesenchymal stem cells (MSC) are a unique cell population defined by their ability to indefinitely self-renew, differentiate into multiple cell lineages, and form clonal cell populations. It was originally thought that this ability for broad plasticity defined the therapeutic potential of MSCs. However, an expanding body of recent literature has brought growing awareness to the remarkable array of bioactive molecules produced by stem cells. This protein milieu or “secretome” comprises a diverse host of cytokines, chemokines, angiogenic factors, and growth factors. The autocrine/paracrine role of these molecules is being increasingly recognized as key to the regulation of many physiological processes including directing endogenous and progenitor cells to sites of injury as well as mediating apoptosis, scarring, and tissue revascularization. In fact, the immunomodulatory and paracrine role of these molecules may predominantly account for the therapeutic effects of MSCs given that many in vitro and in vivo studies have demonstrated limited stem cell engraftment at the site of injury. While the study of such a vast protein array remains challenging, technological advances in the field of proteomics have greatly facilitated our ability to analyze and characterize the stem cell secretome. Thus, stem cells can be considered as tunable pharmacological storehouses useful for combinatorial drug manufacture and delivery. As a cell-free option for regenerative medicine therapies, stem cell secretome has shown great potential in a variety of clinical applications including the restoration of function in cardiovascular, neurodegenerative, oncologic, and genitourinary pathologies. PMID:25451858

  7. 75 FR 81977 - Order Exempting the Trading and Clearing of Certain Products Related to the CBOE Gold ETF...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... derivatives transaction execution facility for transactions for future delivery in any commodity under section... categorical Section 4(c) exemption to permit options and futures on shares of all or some precious metal commodity-based ETFs to be traded and cleared as options on securities and security futures, respectively...

  8. Diet and Exercise

    MedlinePlus

    ... kids adjust Pregnancy Precautions Fertility Labor and delivery Breastfeeding Risks ... & exercise Stories of Hope During the transplant process, patients face many options and can benefit from ...

  9. 76 FR 19162 - Self-Regulatory Organizations; NASDAQ OMX BX, Inc.; Notice of Filing and Immediate Effectiveness...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-06

    ... Amend the BOX Rules To Expand the $2.50 Strike Price Program March 31, 2011. Pursuant to Section 19(b)(1..., LLC (``BOX'') to expand the $2.50 Strike Price Program. The text of the proposed rule change is... Strike Price Program (``Program'') \\4\\ to permit the listing of options with $2.50 strike price intervals...

  10. 76 FR 32004 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Order Granting Approval of Proposed Rule...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-02

    ...-Regulatory Organizations; NASDAQ OMX PHLX LLC; Order Granting Approval of Proposed Rule Change To Expand the Number of Components in the PHLX Gold/Silver Sector\\SM\\ Known as XAU\\SM\\, on Which Options Are Listed and... Act of 1934 (``Act'') \\1\\ and Rule 19b-4 thereunder,\\2\\ a proposed rule change to expand the number of...

  11. Closing the Excellence Gap: Investigation of an Expanded Talent Search Model for Student Selection into an Extracurricular STEM Program in Rural Middle Schools

    ERIC Educational Resources Information Center

    Assouline, Susan G.; Ihrig, Lori M.; Mahatmya, Duhita

    2017-01-01

    High-potential students from underresourced rural schools face barriers that reduce options for academic advancement, which widens the excellence gap between them and their more affluent, but similar ability peers. The goal of this study was to investigate the effectiveness of an expanded above-level testing model to identify high-potential rural…

  12. Web-Conferencing: An Analysis of Course Delivery Systems on Student Achievement at a Technical College

    ERIC Educational Resources Information Center

    Stanford, Roger John

    2012-01-01

    Web-conferencing software was chosen for course delivery to provide flexible options for students at a two-year technical college. Students used technology to access a live, synchronous microeconomics course over the internet instead of a traditional face-to-face lecture. This investigation studied the impact of implementing web-conferencing…

  13. Penetrating the Blood-Brain Barrier: Promise of Novel Nanoplatforms and Delivery Vehicles.

    PubMed

    Ali, Iqbal Unnisa; Chen, Xiaoyuan

    2015-10-27

    Multifunctional nanoplatforms combining versatile therapeutic modalities with a variety of imaging options have the potential to diagnose, monitor, and treat brain diseases. The promise of nanotechnology can only be realized by the simultaneous development of innovative brain-targeting delivery vehicles capable of penetrating the blood-brain barrier without compromising its structural integrity.

  14. State of Digital Education Options in the areas of Medical Terminology and the History, Theory and Ethics of Medicine

    PubMed Central

    Schochow, Maximilian; Steger, Florian

    2015-01-01

    Background: Institutes of the history of medicine, the theory of medicine, and medical ethics at German institutions of higher learning have created various e-learning options that are based on different learning platforms and tailored to the specific curricular needs of individual teaching. Up to now no valid data has been available about the types of such e-learning options as well as possibilities of future developments thanks to coordinated cooperation among the different institutes. Methods: Of 31 German institutes of the history and theory of medicine and medical ethics that were asked to fill out a questionnaire, 30 answered, which equals a return rate of 97 per cent. The questionnaire was completed between July and August 2012 using a telephone survey. Results: Available to students online, digitally interactive teaching tools have boomed in the course of the last few years at German institutes of the history of medicine, the theory of medicine, and medical ethics. This trend is also reflected in a willingness of more than half of the respective departments (67 per cent) to expand their e-learning options on the basis of previous experience. The offered e-learning systems are accepted very well by the students. 57 per cent of the institutes stated, that 90-100 per cent of the students use the offered systems regularly. E-learning courses for terminology are offered particularly often, this is also reflected in the intended extension of these courses by the majority of institutes which plan to expand their e-learning systems. Conclusions: This article discusses the results of a comprehensive empirical survey about e-learning. It illustrates ways in which individual German institutes plan to expand their e-learning options in the future. Finally, specific proposals for cooperation among institutions (not just online) are introduced, the purpose of which is to produce synergy in e-learning. PMID:26038682

  15. State of Digital Education Options in the areas of Medical Terminology and the History, Theory and Ethics of Medicine.

    PubMed

    Schochow, Maximilian; Steger, Florian

    2015-01-01

    Institutes of the history of medicine, the theory of medicine, and medical ethics at German institutions of higher learning have created various e-learning options that are based on different learning platforms and tailored to the specific curricular needs of individual teaching. Up to now no valid data has been available about the types of such e-learning options as well as possibilities of future developments thanks to coordinated cooperation among the different institutes. Of 31 German institutes of the history and theory of medicine and medical ethics that were asked to fill out a questionnaire, 30 answered, which equals a return rate of 97 per cent. The questionnaire was completed between July and August 2012 using a telephone survey. Available to students online, digitally interactive teaching tools have boomed in the course of the last few years at German institutes of the history of medicine, the theory of medicine, and medical ethics. This trend is also reflected in a willingness of more than half of the respective departments (67 per cent) to expand their e-learning options on the basis of previous experience. The offered e-learning systems are accepted very well by the students. 57 per cent of the institutes stated, that 90-100 per cent of the students use the offered systems regularly. E-learning courses for terminology are offered particularly often, this is also reflected in the intended extension of these courses by the majority of institutes which plan to expand their e-learning systems. This article discusses the results of a comprehensive empirical survey about e-learning. It illustrates ways in which individual German institutes plan to expand their e-learning options in the future. Finally, specific proposals for cooperation among institutions (not just online) are introduced, the purpose of which is to produce synergy in e-learning.

  16. Design and Delivery of Customized Training Programs for New and Expanding Business and Industry.

    ERIC Educational Resources Information Center

    Ghanatabadi, Jolyne; Saylor, Collette

    1988-01-01

    Discusses the six-step process the Des Moines Area Community College (Iowa) uses to design and deliver customized training for new and expanding businesses. Also discusses the New Jobs Training Act that provided tax incentives to those businesses and granted exclusive rights to the state's community colleges to contract for training with them.…

  17. Lessons Learned From A Study Of Genomics-Based Carrier Screening For Reproductive Decision Making.

    PubMed

    Wilfond, Benjamin S; Kauffman, Tia L; Jarvik, Gail P; Reiss, Jacob A; Richards, C Sue; McMullen, Carmit; Gilmore, Marian; Himes, Patricia; Kraft, Stephanie A; Porter, Kathryn M; Schneider, Jennifer L; Punj, Sumit; Leo, Michael C; Dickerson, John F; Lynch, Frances L; Clarke, Elizabeth; Rope, Alan F; Lutz, Kevin; Goddard, Katrina A B

    2018-05-01

    Genomics-based carrier screening is one of many opportunities to use genomic information to inform medical decision making, but clinicians, health care delivery systems, and payers need to determine whether to offer screening and how to do so in an efficient, ethical way. To shed light on this issue, we conducted a study in the period 2014-17 to inform the design of clinical screening programs and guide further health services research. Many of our results have been published elsewhere; this article summarizes the lessons we learned from that study and offers policy insights. Our experience can inform understanding of the potential impact of expanded carrier screening services on health system workflows and workforces-impacts that depend on the details of the screening approach. We found limited patient or health system harms from expanded screening. We also found that some patients valued the information they learned from the process. Future policy discussions should consider the value of offering such expanded carrier screening in health delivery systems with limited resources.

  18. Impact of expanded-duty assistants on cost and productivity in dental care delivery.

    PubMed Central

    Lipscomb, J; Scheffler, R M

    1975-01-01

    Data from an experimental dental program are used to develop a linear programming model of dental care delivery that the authors use to examine the economic implications of introducing expanded-duty dental assistants (EDDA's) in three types of dental practices. The authors examine the changes in productivity and profitability that result from hiring one or more EDDAs and conclude that a dentist in solo practice can more than double his net revenue by hiring one EDDA but will not increase his productivity further by hiring additional EDDAs. Two- and three-dentist groups also can increase revenue by hiring EDDAs, but, beyond a certain point, an inverse relationship exists between the number of auxiliaries hired and net revenue generated. PMID:812848

  19. Technologies for Expanding the Reach of Evidence-Based Interventions: Preliminary Results for Promoting Social-Emotional Development in Early Childhood

    ERIC Educational Resources Information Center

    Baggett, Kathleen M.; Davis, Betsy; Feil, Edward G.; Sheeber, Lisa L.; Landry, Susan H.; Carta, Judith J.; Leve, Craig

    2010-01-01

    In great demand are efficient mechanisms for delivery of evidence-based interventions for promoting social-emotional development and early positive behavior of all children, and especially for those with or at risk for disabilities. The rise of Internet use has created potentially new avenues for intervention delivery, which, when paired with the…

  20. Flexible job options help maintain quality.

    PubMed

    2004-01-01

    Pensions, other benefits adjusted to accommodate part-time work. Expertise of long-time nurses are especially valuable in QA functions. Expanded pool of talent helps offset effects of nursing shortage.

  1. The expanding spectrum of paroxysmal movement disorders: update from clinical features to therapeutics.

    PubMed

    McGovern, Eavan M; Roze, Emmanuel; Counihan, Timothy J

    2018-05-15

    This review will discuss the expanding clinical spectrum of paroxysmal movement disorders and therapeutic options in light of emerging genotypic heterogeneity in these conditions. Paroxysmal movement disorders comprise a heterogeneous group of rare neurological conditions characterized by intermittent episodes of abnormal movement associated with various triggers. As the clinical and genotypic spectrum of these disorders evolves, so also has the range of therapeutic options. Triheptanoin has recently been shown to be a very promising alternative to the ketogenic diet in paroxysmal exercise-induced dyskinesia. Four-aminopyridine is now considered first-line symptomatic therapy for episodic ataxia type-2, with pre-clinical findings indicating cerebellar neuroprotection. In light of the newly emerging therapies, careful clinical phenotyping is needed to ensure diagnostic precision and timely initiation of appropriate therapies.

  2. Stent selection for both biliary and pancreatic strictures caused by chronic pancreatitis: multiple plastic stents or metallic stents?

    PubMed

    Gupta, Rajesh; Reddy, D Nageshwar

    2011-09-01

    Endoscopic stenting is an effective treatment option in the management of both benign biliary strictures and pancreatic ductal strictures. Plastic stents and self-expandable metal stents have been used with variable success for the management of both benign biliary strictures and pancreatic ductal strictures caused by chronic pancreatitis. Fully covered self-expandable metal stents of improved design represent a major technological advance which has added to the endoscopic armamentarium. Both multiple plastic stents and covered self-expandable metal stents have shown promising results. However, data to support the use of self-expandable metal stents over multiple plastic stents or vice versa are still lacking.

  3. An Unusual Complication With the Administration of a Volatile Anesthetic Agent for Status Asthmaticus in the Pediatric Intensive Care Unit: Case Report and Review of the Literature.

    PubMed

    Shutes, Brittany; Frazier, W Joshua; Tobias, Joseph D

    2017-07-01

    In severe cases of status asthmaticus, when conventional therapies fail, volatile anesthetic agents remain a therapeutic option. When delivered outside of the operating room setting, specialized delivery techniques are needed to ensure the safe and effective use of volatile anesthetic agents. We present a 16-year-old adolescent with status asthmaticus who required the therapeutic administration of the volatile anesthetic agent, sevoflurane, in the pediatric intensive care unit (PICU). Although initially effective in reducing bronchospasm, progressive hypercarbia developed due to defective functioning of the carbon dioxide absorber of the anesthesia machine. This failure occurred as the soda lime compartment filled with water accumulated from circuit humidification and continuous albuterol therapy. The role of volatile anesthetic agents in the treatment of status asthmaticus in the PICU is discussed, options for delivery outside of the operating room presented, and potential problems with delivery reviewed.

  4. The Blueprint for a Secure Energy Future: Progress Report

    DTIC Science & Technology

    2012-03-01

    Over the past three years, the Administration has continued to develop and expand America’s high-speed and intercity passenger rail system. In May...2011, DOT announced $2 billion in high-speed rail, bringing our unprecedented investment to $10.1 billion to date. In FY 2011, intercity rail...thousands of jobs, improve and expand travel options, cut energy use and help make our communities more livable. Improving Transportation Choices

  5. The cognitive and neural basis of option generation and subsequent choice.

    PubMed

    Kaiser, Stefan; Simon, Joe J; Kalis, Annemarie; Schweizer, Sophie; Tobler, Philippe N; Mojzisch, Andreas

    2013-12-01

    Decision-making research has thoroughly investigated how people choose from a set of externally provided options. However, in ill-structured real-world environments, possible options for action are not defined by the situation but have to be generated by the agent. Here, we apply behavioral analysis (Study 1) and functional magnetic resonance imaging (Study 2) to investigate option generation and subsequent choice. For this purpose, we employ a new experimental task that requires participants to generate options for simple real-world scenarios and to subsequently decide among the generated options. Correlational analysis with a cognitive test battery suggests that retrieval of options from long-term memory is a relevant process during option generation. The results of the fMRI study demonstrate that option generation in simple real-world scenarios recruits the anterior prefrontal cortex. Furthermore, we show that choice behavior and its neural correlates differ between self-generated and externally provided options. Specifically, choice between self-generated options is associated with stronger recruitment of the dorsal anterior cingulate cortex. This impact of option generation on subsequent choice underlines the need for an expanded model of decision making to accommodate choice between self-generated options.

  6. Monetary Valuations of University Course Delivery: The Case for Face-to-Face Learning Activities in Accounting Education

    ERIC Educational Resources Information Center

    Taplin, Ross; Kerr, Rosy; Brown, Alistair

    2017-01-01

    Student preferences for delivery options were obtained within a monetary framework by asking students to purchase their ideal course structure. Results show that accounting students prefer to spend more on tutorials but purchase less lecture time; the difference due to the higher cost of tutorials compared to lectures. Face-to-face classes were…

  7. A Plan for the Use of Distance Education Delivery Systems Options To Link Culinary Programs at Johnson and Wales University.

    ERIC Educational Resources Information Center

    VanLandingham, Paul G.

    Johnson and Wales University (J&W) found a need to deliver a culinary curriculum at the branch campuses (located in Charleston, South Carolina; Norfolk, Virginia; North Miami, Florida; and St. Maarten, Netherland Antilles) equivalent to that offered at the Providence (Rhode Island) campus. A research project studied what delivery system…

  8. Texaphyrins: Tumor Localizing Redox Active Expanded Porphyrins

    PubMed Central

    Arambula, Jonathan F.; Preihs, Christian; Borthwick, Derric; Magda, Darren; Sessler, Jonathan L.

    2011-01-01

    Texaphyrins, a class of tumor selective expanded porphyrins capable of coordinating large metals, have been found to act as redox mediators within biological systems. This review summarizes studies involving their experimentaluse in cancer chemotherapy. Mechanistic insights involving their presumed mode of action are also described, as well as certain structure activity relationships. Finally, newer texaphyrin-based applications associated with targeted drug delivery are presented. PMID:21355841

  9. Long-term care financing: options for the future.

    PubMed

    Mulvey, Janemarie; Li, Annelise

    2002-01-01

    The aging of the baby boomers will have an enormous impact on the future of long-term care costs. This article projects the magnitude of that impact, discusses sources of financing, and considers the cost and feasibility of three options for financing future long-term care services. The authors investigate the alternatives of increasing personal savings, raising payroll taxes and expanding employer-sponsored private long-term care insurance coverage, respectively.

  10. Single-step simultaneous side-by-side placement of a self-expandable metallic stent with a 6-Fr delivery system for unresectable malignant hilar biliary obstruction: a feasibility study.

    PubMed

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Kudo, Taiki; Abe, Yoko; Kawahata, Shuhei; Kubo, Kimitoshi; Kubota, Yoshimasa; Sakamoto, Naoya

    2015-02-01

    Bilateral self-expandable metallic stent (SEMS) placement for the management of unresectable malignant hilar biliary obstruction (UMHBO) is technically challenging to perform using the existing metallic stents with thick delivery systems. The recently developed 6-Fr delivery systems could facilitate a single-step simultaneous side-by-side placement through the accessory channel of the duodenoscope. The aim of this study was to evaluate the feasibility of this procedure. Between May and September 2013, 13 consecutive patients with UMHBO underwent a single-step simultaneous side-by-side placement of SEMS with the 6-Fr delivery system. The technical success rate, stent patency, and rate of complications were evaluated from the prospectively collected database. Technical success was achieved in 11 (84.6%, 95% confidence interval [CI]: 57.8-95.8) patients. The median procedure time was 25 min. Early and late complications were observed in 23% (one segmental cholangitis and two liver abscesses) and 15% (one segmental cholangitis and one cholecystitis) patients, respectively. Median dysfunction free patency was 263 days (95% CI: 37-263). Five patients (38%) experienced stent occlusion that was successfully managed by endoscopic stent placement. A single-step simultaneous side-by-side placement of SEMS with a 6-Fr delivery system was feasible for the management of UMHBO. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  11. Silk-based delivery systems of bioactive molecules

    PubMed Central

    Numata, Keiji; Kaplan, David L

    2010-01-01

    Silks are biodegradable, biocompatible, self-assemblying proteins that can also be tailored via genetic engineering to contain specific chemical features, offering utility for drug and gene delivery. Silkworm silk has been used in biomedical sutures for decades and has recently achieved Food and Drug Administration approval for expanded biomaterials device utility. With the diversity and control of size, structure and chemistry, modified or recombinant silk proteins can be designed and utilized in various biomedical application, such as for the delivery of bioactive molecules. This review focuses on the biosynthesis and applications of silk-based multi-block copolymer systems and related silk protein drug delivery systems. The utility of these systems for the delivery of small molecule drugs, proteins and genes are reviewed. PMID:20298729

  12. Strategies for the return of science data from in situ vehicles at Titan

    NASA Astrophysics Data System (ADS)

    Spilker, T. R.; Reh, K. R.; Erd, C.; Elliott, J. O.; Mohr, D.; Strange, N. J.

    2009-04-01

    Collaborative studies of the Titan Saturn System Mission (TSSM) in 2008 by ESA and NASA have included examination of strategies for optimizing the science return from that mission concept's proposed in situ elements. The current baselined mission concept calls for an orbiter provided and launched by NASA that would deliver to Titan and support two ESA-provided in situ elements, a lake lander whose science mission duration would be about nine hours, and a montgolfière (hot-air balloon) that would operate at ~10 km altitude in Titan's lower atmosphere for 6-12 months. This architecture has much in common with the highly successful Cassini-Huygens mission. The short-lived lake lander in particular would have a mission profile very similar to that of the Huygens probe, with all science data communications occurring while the NASA orbiter is relatively near Titan. Practical mission profile options for the montgolfière include extended periods when the NASA orbiter is farther from Titan, reducing data rates. Over long periods of time the montgolfière cannot be considered fixed over one location on Titan's surface, and in fact is expected to circumnavigate Titan in less than six months. Thus the schedule of communications windows between the in situ elements and the orbiter cannot be precisely determined far in advance, varying as the balloon literally "rides the wind". Other issues played critical roles in evaluating the many options available early in the studies. Some options for the timing of delivery of the in situ elements yielded more mass capability available for those elements, but their reduced data return due to orbit geometry outweighs the added mass capability. Another delivery option, delivery from Titan orbit, yields reduced delivery mass capability but was thought (before studies) to offer better data relay capability. Studies revealed that this strategy actually decreases the return from the lake lander as compared to options delivering the in situ elements from hyperbolic flybys. This presentation will describe options examined in the TSSM communications strategy studies. Particular attention is given to that chosen for the baseline strategy, with potential returned data volumes that provide generous margins over anticipated data requirements. Many of the results are not unique to Titan alone, but are applicable to in situ missions at any satellite of a giant planet. These collaborative studies were funded by, and performed under the cognizance of, NASA and ESA.

  13. Intervention research to enhance community pharmacists' cognitive services: a systematic review.

    PubMed

    Patwardhan, Pallavi D; Amin, Mohamed E; Chewning, Betty A

    2014-01-01

    Positive impact of community pharmacists' cognitive pharmaceutical services (CPS) is well documented. However, community pharmacists have been slow to expand CPS roles. This systematic review explores how community pharmacy intervention research can help inform efforts to expand cognitive pharmaceutical service delivery. To: 1) identify community pharmacy CPS intervention studies that report data on pharmacist behaviors, either as a final study outcome itself or as a fidelity measure in patient outcome studies, and 2) describe the state of this research to help frame future research agendas. Empirical articles examining improvement or expansion of community pharmacist cognitive services published through December 2010 were searched using various search engines, bibliography searches and authors' libraries. Studies were included if they: 1) reported findings on pharmacist behaviors during cognitive service delivery, 2) employed a minimum of pre-post design or two study arms for pharmacists/pharmacies, and 3) were in community-based pharmacies. A total of 50 studies evaluated impact of community pharmacy based CPS delivery; however, only 21 included a pharmacist behavior outcome measure as a final outcome or as a fidelity measure. The majority (14 out of 21) of studies used a randomized controlled trial design. Nearly half (10 of 21) addressed asthma or tobacco cessation. Limited details were provided about interventions to prepare pharmacists for CPS delivery. The most frequent measures of pharmacist behavior were patient surveys and observation of pharmacists' behavior by secret shoppers; electronic data sets were rarely used. There is a need for well-designed intervention research that evaluates how interventions impact on pharmacist cognitive service behavior. Positive findings from this review reinforce that planned interventions have the potential to improve and expand pharmacist cognitive service delivery; however, more detail is needed in study publications for this potential to be fully realized. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Rate of Perineal Injuries and Episiotomy in a Sample of Women at Maternity Teaching Hospital in Erbil City

    ERIC Educational Resources Information Center

    Ali, Huda Juma'a; Zangana, Jwan M. Sabir

    2016-01-01

    Background and Objectives: Episiotomy is a surgical incision done during the last stages of labor and delivery to expand the opening of the vagina to prevent tearing of the perineum during the delivery of the baby. The objectives of this study are to estimate episiotomy and perineal injury rate, indication for episiotomy and their association with…

  15. Evaluating Student Response to WeBWorK, a Web-Based Homework Delivery and Grading System

    ERIC Educational Resources Information Center

    Roth, Vicki; Ivanchenko, Volodymyr; Record, Nicholas

    2008-01-01

    As the use of web-based homework delivery and checking systems expands, we have greater need to evaluate how students engage with these systems and how changes in the systems influence student behavior. Reported here is the assessment of WeBWorK, an open-source web-based homework program used largely in postsecondary math and science courses, with…

  16. Space Civil Engineering option - A progress report

    NASA Technical Reports Server (NTRS)

    Criswell, Marvin E.; Sadeh, Willy Z.

    1992-01-01

    Space Civil Engineering is an emerging engineering discipline that focuses on extending and expanding Civil Engineering to the development, operation, and maintenance of infrastructures on celestial bodies. Space Civil Engineering is presently being developed as a new discipline within the Department of Civil Engineering at Colorado State University and with support of the NASA Space Grant College Program. Academic programs geared toward creating Space Civil Engineering Options at both undergraduate and graduate levels are being formulated. Basic ideas and concepts and the current status of the curriculum in the Space Civil Engineering Option primarily at the undergraduate level are presented.

  17. Prehospital control of life-threatening truncal and junctional haemorrhage is the ultimate challenge in optimizing trauma care; a review of treatment options and their applicability in the civilian trauma setting.

    PubMed

    van Oostendorp, S E; Tan, E C T H; Geeraedts, L M G

    2016-09-13

    Exsanguination following trauma is potentially preventable. Extremity tourniquets have been successfully implemented in military and civilian prehospital care. Prehospital control of bleeding from the torso and junctional area's remains challenging but offers a great potential to improve survival rates. This review aims to provide an overview of potential treatment options in both clinical as preclinical state of research on truncal and junctional bleeding. Since many options have been developed for application in the military primarily, translation to the civilian situation is discussed. Medline (via Pubmed) and Embase were searched to identify known and potential prehospital treatment options. Search terms were|: haemorrhage/hemorrhage, exsanguination, junctional, truncal, intra-abdominal, intrathoracic, intervention, haemostasis/hemostasis, prehospital, en route, junctional tourniquet, REBOA, resuscitative thoracotomy, emergency thoracotomy, pelvic binder, pelvic sheet, circumferential. Treatment options were listed per anatomical site: axilla, groin, thorax, abdomen and pelvis Also, the available evidence was graded in (pre) clinical stadia of research. Identified treatment options were wound clamps, injectable haemostatic sponges, pelvic circumferential stabilizers, resuscitative thoracotomy, resuscitative endovascular balloon occlusion of the aorta (REBOA), intra-abdominal gas insufflation, intra-abdominal self-expanding foam, junctional and truncal tourniquets. A total of 70 papers on these aforementioned options was retrieved. No clinical reports on injectable haemostatic sponges, intra-abdominal insufflation or self-expanding foam injections and one type of junctional tourniquets were available. Options to stop truncal and junctional traumatic haemorrhage in the prehospital arena are evolving and may offer a potentially great survival advantage. Because of differences in injury pattern, time to definitive care, different prehospital scenario's and level of proficiency of care providers; successful translation of various military applications to the civilian situation has to be awaited. Overall, the level of evidence on the retrieved adjuncts is extremely low.

  18. Health Savings Accounts: Is an HSA Right for You?

    MedlinePlus

    ... information. The hope is that as health savings accounts and other consumer-directed health care options become more widespread, access to information about cost and quality will expand. Yes, but ...

  19. Progress for the Paralyzed

    MedlinePlus

    ... this page please turn Javascript on. Feature: NIBIB Robotics Progress for the Paralyzed Past Issues / Spring 2013 ... Paralyzed —The expanding options for paralyzed individuals include: robotic arms spinal cord stimulation improved prosthetic limbs restored ...

  20. Whole systems shared governance: a model for the integrated health system.

    PubMed

    Evan, K; Aubry, K; Hawkins, M; Curley, T A; Porter-O'Grady, T

    1995-05-01

    The healthcare system is under renovation and renewal. In the process, roles and structures are shifting to support a subscriber-based continuum of care. Alliances and partnerships are emerging as the models of integration for the future. But how do we structure to support these emerging integrated partnerships? As the nurse executive expands the role and assumes increasing responsibility for creating new frameworks for care, a structure that sustains the point-of-care innovations and interdisciplinary relationships must be built. Whole systems models of organization, such as shared governance, are expanding as demand grows for a sustainable structure for horizontal and partnered systems of healthcare delivery. The executive will have to apply these newer frameworks to the delivery of care to provide adequate support for the clinically integrated environment.

  1. Idaho Bicycle and Pedestrian Transportation

    DOT National Transportation Integrated Search

    1995-01-01

    The Idaho Bicycle and Pedestrian Transportation Plan of Idaho's long range transportation planning process sets the stage for changes in our transportation mix. The plan is about expanding options for personal transportation. Most importantly, it is ...

  2. Method and Apparatus for Remote Delivery and Manipulation of a Miniature Tool Adjacent a Work Piece in a Restricted Space

    DOEpatents

    Sale, Christopher H.; Kaltenbaugh, Daniel R.

    2004-08-10

    An apparatus for remote delivery and manipulation of a miniature tool adjacent a work piece in a restricted space, includes a tool camer, a camage for manipulating the tool carrier relative to the work piece, a first actuator for operating the carnage, and an optional remote secondary operating actuator for operating the first actuator.

  3. Impact of the Placement and Quality of Face-to-Face Meetings in a Hybrid Distance Learning Course

    ERIC Educational Resources Information Center

    Colucci, William; Koppel, Nicole

    2010-01-01

    As online and hybrid courses are becoming a wide-spread option for higher education, researchers are exploring various delivery methods. Hybrid courses involve blending two modes of interaction--both face-to-face as well as online. The exact distribution and timing of face-to-face meetings verse online delivery is a question that instructors have…

  4. The "new genetics": an ethical perspective from family practice.

    PubMed

    Sugiyama, J

    1988-04-01

    The new genetic technologies are becoming increasingly applicable to clinical medicine. At present, however, diagnostic capabilities far exceed treatment options. Pregnancy termination, with its attendant moral-ethical problems, remains the major therapeutic option for mothers bearing fetuses with genetic abnormalities. In this article, the author outlines the major ethical issues facing family physicians, in the context of our expanding genetic diagnostic and therapeutic capabilities, and their possible effects on the traditional physician-patient relationship.

  5. Head Start at Ages 3 and 4 versus Head Start Followed by State Pre-K: Which Is More Effective?

    ERIC Educational Resources Information Center

    Jenkins, Jade Marcus; Farkas, George; Duncan, Greg J.; Burchinal, Margaret; Vandell, Deborah Lowe

    2016-01-01

    As policy-makers contemplate expanding preschool opportunities for low-income children, one possibility is to fund two, rather than one year of Head Start for children at ages 3 and 4. Another option is to offer one year of Head Start followed by one year of pre-k. We ask which of these options is more effective. We use data from the Oklahoma…

  6. Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply

    PubMed Central

    2011-01-01

    The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career choice decision-making process at each medical trainee level to determine best recruitment strategies. Educational debt is an unexpectedly minor determinant for pediatric residents and subspecialty fellows. A two-year fellowship training option may retain the mandatory scholarship component and attract an increasing number of candidate trainees. Diversity, work-life balance, scheduling flexibility to accommodate part-time employment, and reform of conditions for academic promotion all need to be addressed to ensure future growth of the pediatric rheumatology workforce. PMID:21843335

  7. Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply.

    PubMed

    Henrickson, Michael

    2011-01-01

    The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career choice decision-making process at each medical trainee level to determine best recruitment strategies. Educational debt is an unexpectedly minor determinant for pediatric residents and subspecialty fellows. A two-year fellowship training option may retain the mandatory scholarship component and attract an increasing number of candidate trainees. Diversity, work-life balance, scheduling flexibility to accommodate part-time employment, and reform of conditions for academic promotion all need to be addressed to ensure future growth of the pediatric rheumatology workforce.

  8. Experiences using and organizing HIV self-testing.

    PubMed

    Qin, Yilu; Han, Larry; Babbitt, Andrew; Walker, Jennifer S; Liu, Fengying; Thirumurthy, Harsha; Tang, Weiming; Tucker, Joseph D

    2018-01-28

    HIV self-testing (HIVST) is now officially recommended by the WHO, yet much of HIVST evidence to date has focused on quantitative data and hypothetical concerns. Effective scale-up of HIVST in diverse local contexts requires qualitative data from experiences using and organizing HIVST. This qualitative systematic review aims to appraise and synthesize research evidence on experiences using and organizing HIVST. We conducted a systematic search of seven primary literature databases, four gray literature sources, and reference lists reporting qualitative evidence on HIVST. Data extraction and thematic analysis were used to synthesize findings. Quality of studies was assessed using the Critical Appraisal Skills Programme tool. Confidence in review findings was evaluated using the Confidence in the Evidence from Reviews of Qualitative Research approach. The review protocol was registered (CRD42015027607). From 1266 potential articles, we included 18. Four studies were conducted in low-income countries, three in middle-income countries, 10 in high-income countries, and one in multiple countries. Generally, HIVST increased capacity to reach priority populations and expanded opportunities for service delivery. Self-testing was preferred to facility-based testing due to increased convenience and confidentiality, especially among stigmatized populations. HIVST decreased test-associated stigma compared with facility-based testing. HIVST generally empowered people because it provided greater control over individual testing needs. At the same time, HIVST rarely allowed husbands to coerce their wives to test. This review suggests that HIVST should be offered as an additional HIV testing option to expand testing and empower testers. Adapting national policies to incorporate HIVST will be necessary to guide scale-up.

  9. Review article: new drug formulations, chemical entities and therapeutic approaches for the management of ulcerative colitis.

    PubMed

    Ng, S C; Kamm, M A

    2008-10-01

    Treatment options for ulcerative colitis (UC) are expanding with the development of novel drug formulations and dosing regimens and new chemical entities. Although the goals of medical therapy for UC remain unchanged, that is to induce and to maintain remission, focus has also centred on improving patient compliance, modifying the natural course of disease and healing the mucosa. To examine novel formulations, new chemical entities and novel therapeutic approaches to the management of UC. Searches for all studies related to UC treatment in Medline and abstracts from major national and international meetings published in the last 10 years. 5-Aminosalicylic acids (5-ASA) remain the standard first-line treatment for patients with mild to moderately active UC. New formulations with altered delivery, and new dosing regimens have demonstrated possible improvements in efficacy compared with historically available preparations and dosing patterns. Once-daily dosing, micropellet formulations,and high-dose tablets offer enhanced efficacy and improved compliance. 5-ASA is now recognized as a ligand for peroxisome proliferator activated receptor-gamma (PPAR-gamma) and it has a role as a chemo-preventive agent in long-standing UC. New colonic release corticosteroid formulations help to limit systemic toxicity; turmeric, tacrolimus and infliximab have shown promising results. New anti-inflammatory targeted therapies include an anti-CD3 antibody, selective integrin blockers, anti-IL-2 antibody and PPAR-gamma agonists. The evolution of novel oral 5-ASA formulations and dosage regimens,and recent development of new molecules have expanded the therapeutic armamentarium of UC.

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

    Liu, H; Manning, M; Sintay, B

    Purpose: Tumor motion in lung SBRT is typically managed by creating an internal target volume (ITV) based on 4D-CT information. Another option, which may reduce lung dose and imaging artifact, is to use a breath hold (BH) during simulation and delivery. Here we evaluate the reproducibility of tumor position at repeated BH using a newly released spirometry system. Methods: Three patients underwent multiple BH CT’s at simulation. All patients underwent a BH cone beam CT (CBCT) prior to each treatment. All image sets were registered to a patient’s first simulation CT based on local bony anatomy. The gross tumor volumemore » (GTV), and the diaphragm or the apex of the lung were contoured on the first image set and expanded in 1 mm increments until the GTVs and diaphragms on all image sets were included inside an expanded structure. The GTV and diaphragm margins necessary to encompass the structures were recorded. Results: The first patient underwent 2 BH CT’s and fluoroscopy at simulation, the remaining patients underwent 3 BH CT’s at simulation. In all cases the GTV’s remained within 1 mm expansions and the diaphragms remained within 2 mm expansions on repeat scans. Each patient underwent 3 daily BH CBCT’s. In all cases the GTV’s remained within a 2 mm expansions, and the diaphragms (or lung apex in one case) remained within 2 mm expansions at daily BH imaging. Conclusions: These case studies demonstrate spirometry as an effective tool for limiting tumor motion (and imaging artifact) and facilitating reproducible tumor positioning over multiple set-ups and BH’s. This work was partially supported by Qfix.« less

  11. Does quality influence utilization of primary health care? Evidence from Haiti.

    PubMed

    Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

    2018-06-20

    Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

  12. Community-Level Challenges in Implementing a Mixed Delivery Prekindergarten System: A Brief Review of Research and Field Experience. School Community Partnerships Project. Policy Brief I

    ERIC Educational Resources Information Center

    Stephens, Samuel A.

    2014-01-01

    Over the past decade, states have dramatically expanded prekindergarten services (Pre-K), given the evidence that high-quality early childhood education can put children on a path to success in school and later life. To support the expansion, most of those states have adopted a mixed delivery system, developing the new educational opportunities in…

  13. High-Temperature Test Technology

    DTIC Science & Technology

    1987-03-01

    delivery methods are available for a test vehicle (e.g., flatbed )? What potential is there to expand the test area? 4. What provision is there for...Yes[- No-- If "yes," what are the dimensions? What delivery methods are available for a test vehicle (e.g., flatbed )? What potential is there to...or (c) air connections introducing additional convection losses, as required for ia) laminated sheet plastic curing. (b) paper dehydrating. (c) heat

  14. Electrical Connection of Enzyme Redox Centers to Electrodes

    DTIC Science & Technology

    1992-03-20

    concentration in the target organ or the affected physiological function ; and a microcontroller or microprocessor calculating the dose and timing the delivery...followed by introduction of medical feedback loops will allow the pharmaceutical industry to expand its range of drug delivery methods. Today’s primary ...inhalation (derived of the large lung surface area) and continuous, non -invasive administration, in the case of iontophoresis. The use of these

  15. The emerging role of the client in the delivery of primary care to older Americans.

    PubMed Central

    Counte, M A

    1998-01-01

    OBJECTIVE: To address the likely influences, on options faced by older clients, of specific changes in the delivery system and several possible responses to these changes and the changed options, by older persons in the aggregate. STUDY DESIGN: Four specific topics are discussed at length: (1) the probable altered role for the older healthcare client brought on by organizational changes; (2) findings from research on elderly health maintenance behavior and reasons for the increased importance of this issue; (3) the effectiveness of the conventional approach to explaining health services utilization in population studies; and (4) recommendations for future research into the direct or indirect influence of organizational changes in the primary healthcare system on the health-related decisions and behaviors of older persons. PMID:9618677

  16. Developing a Web-based Tool Using Information and Communication Technologies to Expand the Reach and Impact of Photovoice.

    PubMed

    Strack, Robert W; Orsini, Muhsin Michael; Fearnow-Kenney, Melodie; Herget, Jennifer; Milroy, Jeffrey J; Wyrick, David L

    Information and communication technologies are opening up vast new arenas for conducting the work of health promotion. Technology-based health promotions expand reach, standardize information and its delivery, provide opportunities for tailoring, create engaging interactivity within content delivery, provide for privacy and autonomy, improve portability, and lower delivery costs. This commentary describes the ongoing exploration and development of a web-based tool for enhancing the reach and impact of photovoice as a community change intervention. Features of the tool use information and communication technologies that integrate the use of an online learning management system, tailored messaging, gaming technology, interactive features, and the application of social media's power to increase the capacity of communities to employ comprehensive strategies to improve the health of their communities. It will enable individuals and groups to use photos and captions to assess the physical environment, social norms and behaviors of communities; raise community awareness of the factors contributing to ill-health in their communities, mobilize stakeholders, and inform environmental strategies and policy changes. We believe it will enhance the delivery of educational content about conducting photovoice projects, provide features unavailable without the application of information and communication technologies, and will be substantive advancement over existing photovoice resources.

  17. Adapting to a Changing Colorado River: Making Future Water Deliveries More Reliable Through Robust Management Strategies

    NASA Astrophysics Data System (ADS)

    Groves, D.; Bloom, E.; Fischbach, J. R.; Knopman, D.

    2013-12-01

    The U.S. Bureau of Reclamation and water management agencies representing the seven Colorado River Basin States initiated the Colorado River Basin Study in January 2010 to evaluate the resiliency of the Colorado River system over the next 50 years and compare different options for ensuring successful management of the river's resources. RAND was asked to join this Basin Study Team in January 2012 to help develop an analytic approach to identify key vulnerabilities in managing the Colorado River basin over the coming decades and to evaluate different options that could reduce this vulnerability. Using a quantitative approach for planning under uncertainty called Robust Decision Making (RDM), the RAND team assisted the Basin Study by: identifying future vulnerable conditions that could lead to imbalances that could cause the basin to be unable to meet its water delivery objectives; developing a computer-based tool to define 'portfolios' of management options reflecting different strategies for reducing basin imbalances; evaluating these portfolios across thousands of future scenarios to determine how much they could improve basin outcomes; and analyzing the results from the system simulations to identify key tradeoffs among the portfolios. This talk will describe RAND's contribution to the Basin Study, focusing on the methodologies used to to identify vulnerabilities for Upper Basin and Lower Basin water supply reliability and to compare portfolios of options. Several key findings emerged from the study. Future Streamflow and Climate Conditions Are Key: - Vulnerable conditions arise in a majority of scenarios where streamflows are lower than historical averages and where drought conditions persist for eight years or more. - Depending where the shortages occur, problems will arise for delivery obligations for the upper river basin and the lower river basin. The lower river basin is vulnerable to a broader range of plausible future conditions. Additional Investments in Infrastructure and Efficiency Could Improve Performance and Reduce Risk: - Different portfolios of water-supply and demand-reduction options offer performance trade-offs. - Different types of options in the portfolios, such as conservation, desalination, or water banking, would affect future outcomes and costs of implementation. - Analysis of all the portfolios identified important near-term, high-priority options that should be implemented in the near future, including municipal, industrial, and agricultural conservation. Other Solutions May Be Required: - If future hydrologic conditions develop in a manner consistent with the more pessimistic projections, the Basin is increasingly likely to face vulnerable conditions. The region may need to consider additional management options.

  18. Silk-based delivery systems of bioactive molecules.

    PubMed

    Numata, Keiji; Kaplan, David L

    2010-12-30

    Silks are biodegradable, biocompatible, self-assembling proteins that can also be tailored via genetic engineering to contain specific chemical features, offering utility for drug and gene delivery. Silkworm silk has been used in biomedical sutures for decades and has recently achieved Food and Drug Administration approval for expanded biomaterials device utility. With the diversity and control of size, structure and chemistry, modified or recombinant silk proteins can be designed and utilized in various biomedical application, such as for the delivery of bioactive molecules. This review focuses on the biosynthesis and applications of silk-based multi-block copolymer systems and related silk protein drug delivery systems. The utility of these systems for the delivery of small molecule drugs, proteins and genes is reviewed. Copyright © 2010 Elsevier B.V. All rights reserved.

  19. Adaptive reuse in the healthcare industry: repurposing abandoned buildings to serve medical missions.

    PubMed

    Elrod, James K; Fortenberry, John L

    2017-07-11

    Adaptive reuse-the practice of identifying, acquiring, renovating, and placing back into service a building or similar structure for a purpose different than that for which it was originally designed-offers great potential for addressing the spatial expansion needs of healthcare establishments in a unique and mutually beneficial manner. This repurposing approach, however, has received very little attention in the health sciences literature, diminishing the opportunities of those serving in hospitals, medical clinics, and related care providing institutions to acquire an understanding of the practice. The delivery of healthcare services primarily is site based, requiring physical space for physicians, nurses, administrators, and others to carry out the many duties associated with the provision of medical care and attention. But this space often represents a significant expenditure, consuming financial resources which otherwise could be directed toward patient care. Economies on this front are possible through adaptive reuse, permitting more resources to be directed toward mission fulfillment activities. This article directs attention toward adaptive reuse by profiling Willis-Knighton Health System's associated experiences and implementation strategies. Among other things, opportunities and obstacles are discussed, detailed cases are presented, and an operational framework is provided, permitting healthcare providers to understand and make use of this novel practice for addressing spatial expansion needs more affordably. Since space considerations exist throughout the lives of healthcare establishments, providers must ensure an awareness of methods for productively attending to these requirements. Evidenced by Willis-Knighton Health System's associated experiences and outcomes, adaptive reuse presents an option for more economically addressing spatial requirements, fostering opportunities to expand the delivery of health and medical services.

  20. Organic bioelectronics in medicine.

    PubMed

    Löffler, S; Melican, K; Nilsson, K P R; Richter-Dahlfors, A

    2017-07-01

    A major challenge in the growing field of bioelectronic medicine is the development of tissue interface technologies promoting device integration with biological tissues. Materials based on organic bioelectronics show great promise due to a unique combination of electronic and ionic conductivity properties. In this review, we outline exciting developments in the field of organic bioelectronics and demonstrate the medical importance of these active, electronically controllable materials. Importantly, organic bioelectronics offer a means to control cell-surface attachment as required for many device-tissue applications. Experiments have shown that cells readily attach and proliferate on reduced but not oxidized organic bioelectronic materials. In another application, the active properties of organic bioelectronics were used to develop electronically triggered systems for drug release. After incorporating drugs by advanced loading strategies, small compound drugs were released upon electrochemical trigger, independent of charge. Another type of delivery device was used to achieve well-controlled, spatiotemporal delivery of cationic drugs. Via electrophoretic transport within a polymer, cations were delivered with single-cell precision. Finally, organic bioelectronic materials are commonly used as electrode coatings improving the electrical properties of recording and stimulation electrodes. Because such coatings drastically reduce the electrode impedance, smaller electrodes with improved signal-to-noise ratio can be fabricated. Thus, rapid technological advancement combined with the creation of tiny electronic devices reacting to changes in the tissue environment helps to promote the transition from standard pharmaceutical therapy to treatment based on 'electroceuticals'. Moreover, the widening repertoire of organic bioelectronics will expand the options for true biological interfaces, providing the basis for personalized bioelectronic medicine. © 2017 The Association for the Publication of the Journal of Internal Medicine.

  1. Immunotherapy Expands Lung Cancer Treatment Options

    Cancer.gov

    Results from a large clinical trial show combining the immune checkpoint inhibitor pembrolizumab (Keytruda) with chemotherapy helped some patients with advanced cancer live longer. As this Cancer Currents post explains, the results will immediately affect patient care.

  2. What the World Needs Now: More Women in Mathematics and Science.

    ERIC Educational Resources Information Center

    Wallace, Joy

    1989-01-01

    "Expanding Your Horizons in Science and Mathematics" conferences in Berkeley, California, are designed to nurture girls' interest in science and math courses and encourage them to consider nontraditional career options. (TE)

  3. Flexibility and Project Value: Interactions and Multiple Real Options

    NASA Astrophysics Data System (ADS)

    Čulík, Miroslav

    2010-06-01

    This paper is focused on a project valuation with embedded portfolio of real options including their interactions. Valuation is based on the criterion of Net Present Value on the simulation basis. Portfolio includes selected types of European-type real options: option to expand, contract, abandon and temporarily shut down and restart a project. Due to the fact, that in reality most of the managerial flexibility takes the form of portfolio of real options, selected types of options are valued not only individually, but also in combination. The paper is structured as follows: first, diffusion models for forecasting of output prices and variable costs are derived. Second, project value is estimated on the assumption, that no real options are present. Next, project value is calculated with the presence of selected European-type options; these options and their impact on project value are valued first in isolation and consequently in different combinations. Moreover, intrinsic value evolution of given real options with respect to the time of exercising is analysed. In the end, results are presented graphically; selected statistics and risk measures (Value at Risk, Expected Shortfall) of the NPV's distributions are calculated and commented.

  4. Optimal timing of viral load monitoring during pregnancy to predict viraemia at delivery in HIV-infected women initiating ART in South Africa: a simulation study.

    PubMed

    Lesosky, Maia; Glass, Tracy; Mukonda, Elton; Hsiao, Nei-Yuan; Abrams, Elaine J; Myer, Landon

    2017-11-01

    HIV viral load (VL) monitoring is a central tool to evaluate ART effectiveness and transmission risk. There is a global movement to expand VL monitoring following recent recommendations from the World Health Organization (WHO), but there has been little research into VL monitoring in pregnant women. We investigated one important question in this area: when and how frequently VL should be monitored in women initiating ART during pregnancy to predict VL at the time of delivery in a simulated South African population. We developed a mathematical model simulating VL from conception through delivery using VL data from the Maternal and Child Health - Antiretroviral Therapy (MCH-ART) cohort. VL was modelled based on three major compartments: pre-ART VL, viral decay immediately after ART initiation and viral maintenance (including viral suppression and viraemic episodes). Using this simulation, we examined the performance of various VL monitoring schema in predicting elevated VL at delivery. If WHO guidelines for non-pregnant adults were used, the majority of HIV-infected pregnant women (69%) would not receive a VL test during pregnancy. Most models that based VL monitoring in pregnancy on the time elapsed since ART initiation (regardless of gestation) performed poorly (sensitivity <50%); models that based VL measures in pregnancy on the woman's gestation (regardless of time on ART) appeared to perform better overall (sensitivity >60%). Across all permutations, inclusion of pre-ART VL values had a negligible impact on predictive performance (improving test sensitivity and specificity <6%). Performance of VL monitoring in predicting VL at delivery generally improved at later gestations, with the best performing option a single VL measure at 36 weeks' gestation. Development and evaluation of a novel simulation model suggests that strategies to measure VL relative to gestational age may be more useful than strategies relative to duration on ART, in women initiating ART during pregnancy, supporting better integration of maternal and HIV health services. Testing turnaround times require careful consideration, and point-of-care VL testing may be the best approach for measuring VL at delivery. Broadening the scope of this simulation model in the light of current scale up of VL monitoring in high burden countries is important. © 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

  5. Incorporation of Outcome-Based Contract Requirements in a Real Options Approach for Maintenance Planning

    DTIC Science & Technology

    2016-04-30

    focus on novel onshore/offshore and small/large scale wind turbine designs for expanding their operational range and increasing their efficiency at...of maintenance options created by the implementation of PHM in wind turbines . When an RUL is predicted for a subsystem, there are multiple choices...The section titled Example— Wind Turbine With an Outcome-Based Contract presents a case study for a PHM enabled wind turbine with and without an

  6. H-II Transfer Vehicle (HTV) and the Operations Concept for Extravehicular Activity (EVA) Hardware

    NASA Technical Reports Server (NTRS)

    Chullen, Cinda

    2010-01-01

    With the retirement of the Space Shuttle fleet imminent in 2011, a new concept of operations will become reality to meet the transportation challenges of the International Space Station (ISS). The planning associated with the retirement of the Space Shuttle has been underway since the announcement in 2004. Since then, several companies and government entities have had to look for innovative low-cost commercial orbital transportation systems to continue to achieve the objectives of ISS delivery requirements. Several options have been assessed and appear ready to meet the large and demanding delivery requirements of the ISS. Options that have been identified that can facilitate the challenge include the Russian Federal Space Agency's Soyuz and Progress spacecraft, European Space Agency's Automated Transfer Vehicle (ATV), the Japan Aerospace Exploration Agency's (JAXA's) H-II Transfer Vehicle (HTV) and the Boeing Delta IV Heavy (DIV-H). The newest of these options is the JAXA's HTV. This paper focuses on the HTV, mission architecture and operations concept for Extra-Vehicular Activities (EVA) hardware, the associated launch system, and details of the launch operations approach.

  7. H-II Transfer Vehicle (HTV) and the Operations Concept for Extravehicular Activity (EVA) Hardware

    NASA Technical Reports Server (NTRS)

    Chullen, Cinda; Blome, Elizabeth; Tetsuya, Sakashita

    2011-01-01

    With the retirement of the Space Shuttle fleet imminent in 2011, a new operations concept will become reality to meet the transportation challenges of the International Space Station (ISS). The planning associated with the retirement of the Space Shuttle has been underway since the announcement in 2004. Since then, several companies and government entities have had to look for innovative low-cost commercial orbital transportation systems to continue to achieve the objectives of ISS delivery requirements. Several options have been assessed and appear ready to meet the large and demanding delivery requirements of the ISS. Options that have been identified that can facilitate the challenge include the Russian Federal Space Agency's Soyuz and Progress spacecraft, European Space Agency's Automated Transfer Vehicle (ATV), and the Japan Aerospace Exploration Agency's (JAXA s) H-II Transfer Vehicle (HTV). The newest of these options is the JAXA's HTV. This paper focuses on the HTV, mission architecture and operations concept for Extra-Vehicular Activities (EVA) hardware, the associated launch system, and details of the launch operations approach.

  8. Polymeric nanoparticles: potent vectors for vaccine delivery targeting cancer and infectious diseases.

    PubMed

    Bolhassani, Azam; Javanzad, Shabnam; Saleh, Tayebeh; Hashemi, Mehrdad; Aghasadeghi, Mohammad Reza; Sadat, Seyed Mehdi

    2014-01-01

    Nanocarriers with various compositions and biological properties have been extensively applied for in vitro/in vivo drug and gene delivery. The family of nanocarriers includes polymeric nanoparticles, lipid-based carriers (liposomes/micelles), dendrimers, carbon nanotubes, and gold nanoparticles (nanoshells/nanocages). Among different delivery systems, polymeric carriers have several properties such as: easy to synthesize, inexpensive, biocompatible, biodegradable, non-immunogenic, non-toxic, and water soluble. In addition, cationic polymers seem to produce more stable complexes led to a more protection during cellular trafficking than cationic lipids. Nanoparticles often show significant adjuvant effects in vaccine delivery since they may be easily taken up by antigen presenting cells (APCs). Natural polymers such as polysaccharides and synthetic polymers have demonstrated great potential to form vaccine nanoparticles. The development of new adjuvants or delivery systems for DNA and protein immunization is an expanding research field. This review describes polymeric carriers especially PLGA, chitosan, and PEI as vaccine delivery systems.

  9. Human Factors Validation of the AeroForm Tissue Expander System for Breast Reconstruction.

    PubMed

    Kelley, Kathy; Kim, Jennie

    The tissue expansion process using traditional saline expanders is lengthy and uncomfortable. A new technology has been developed, providing a needle-free option implanted after a mastectomy, and is activated by a handheld remote control releasing small amounts (10 cc) of carbon dioxide from an internal reservoir. The expander is gradually filled with CO2 resulting in mechanical stretching of the overlying tissue. The AeroForm System has been evaluated in a series of clinical trials including a randomized, controlled U.S. study comparing the AeroForm System with saline expanders. Results demonstrated patients can safely and reliably dose and complete their expansions in half the time compared to saline expanders. A human factors validation study was conducted in 8 patients to evaluate whether patients could correctly use the device to complete their expansion at home. The sessions were recorded and data on performance, behavioral, and subjective measures were collected and analyzed and submitted to the FDA as part of the U.S. marketing approval. All 8 participants were successful in using the controller to deliver a simulated dose. Participants found the device easy to use and the training material provided adequate to understand use of the controller. For women who choose 2-stage breast reconstruction, a new safe and effective option is available for tissue expansion, offering a convenient and empowering alternative. The human factors validation study conducted confirmed the simplicity of the device and further validated that the device can be used safely and effectively for breast tissue expansion.

  10. Financing and systems barriers to seasonal influenza vaccine delivery in community settings.

    PubMed

    Penfold, Robert B; Rusinak, Donna; Lieu, Tracy A; Shefer, Abigail; Messonnier, Mark; Lee, Grace M

    2011-12-06

    Recommendations for annual seasonal influenza vaccination have expanded to now include >300 million children and adults each year. Community settings have become increasingly important venues for influenza vaccination. We sought to identify barriers to and solutions for expanding influenza vaccination in community settings. Semi-structured telephone interviews were conducted from 01/09 to 06/10 with a range of stakeholders involved in influenza vaccination, including health plans, medical services firms, retail based clinics, pharmacies, schools, and state and local public health immunization programs. Participants (n=65) were asked about barriers and feasible solutions to influenza vaccine delivery to children and adults in community settings. Key themes were identified through iterative coding using a grounded theory approach. Stakeholders identified specific financial barriers to influenza vaccine delivery in 3 major areas: purchase and distribution, delivery, and reimbursement. Limited purchasing power, the uncertain nature of public demand, and unpredictable timing of influenza vaccine supply were important barriers to enhance delivery in community settings. Barriers to delivery included complexities in running off-site clinics, especially in school settings, the need to manage publicly vs. privately purchased vaccines separately, and state-to-state variability in requirements for credentialing, physician oversight, and reporting. Reimbursement barriers included a protracted credentialing process, the need to determine insurance eligibility at point-of-service, and lack of a billing infrastructure in off-site clinics. Opportunities to mitigate financial barriers to influenza vaccine delivery in community settings focused on coordination across providers and the role of public health as a "trusted broker" to overcome existing challenges. Financial and systems barriers hamper the optimal use of community settings to effectively deliver influenza vaccines. Public health partners at the federal, state, and local levels are well-positioned to facilitate the engagement of all stakeholders in this important and complex vaccine delivery system. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Transepidermal drug delivery: a new treatment option for areata alopecia?

    PubMed

    Issa, Maria Claudia Almeida; Pires, Marianna; Silveira, Priscilla; Xavier de Brito, Esther; Sasajima, Cristiane

    2015-02-01

    Transepidermal drug delivery (TED) is a new potential method in dermatology. Permeability alterations induced by ablative fractional resurfacing have been described with the aim to increasing the delivery of different substances into the skin. To evaluate clinical response and side effects of TED in areata alopecia (AA) treatment using ablative fractional methods associated with acoustic pressure ultrasound (US) to deliver triamcinolone solution into the skin. Five cases of AA underwent treatment which comprised of 3 steps: 1) Ablative fractioned RF or CO2 laser 2) topical application of triamcinolone 3) acoustic pressure wave US. The number of sessions varied according to the clinical response, ranging from one to six sessions. All patients had complete recovery of the area treated. Two of them treated with ablative fractional RF + triamcinolone + US had complete response after three and six sessions. The other two treated with ablative fractional CO2 + triamcinolone + US had complete response after one session. Fractioned ablative resurfacing associated with acoustic pressure wave US is a new option to areata alopecia treatment with good clinical result and low incidence of side effects.

  12. Technology and quality of life outcomes.

    PubMed

    Hacker, Eileen Danaher

    2010-02-01

    To discuss recent technological advances in quality of life (QOL) data collection and guidance for use in research and clinical practice. The use of telephone-, computer-, and web/internet-based technologies to collect QOL data, reliability and validity issues, and cost will be discussed, along with the potential pitfalls associated with these technologies. Health care literature and web resources. Technology has provided researchers and clinicians with an opportunity to collect QOL data from patients that were previously not accessible. Most technologies offer a variety of options, such as language choice, formatting options for the delivery of questions, and data management services. Choosing the appropriate technology for use in research and/or clinical practice primarily depends on the purpose for QOL data collection. Technology is changing the way nurses assess QOL in patients with cancer and provide care. As stakeholders in the health care delivery system and patient advocates, nurses must be intimately involved in the evaluation and use of new technologies that impact QOL and/or the delivery of care. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  13. Technology and Quality of Life Outcomes

    PubMed Central

    Hacker, Eileen Danaher

    2010-01-01

    Objectives To discuss recent technological advances in quality of life data collection and guidance for use in research and clinical practice. The use of telephone-, computer-, and web/Internet based technologies to collect quality of life data, reliability and validity issues, and cost will be discussed along with the potential pitfalls associated with these technologies. Data Sources Health care literature and web resources. Conclusion Technology has provided researchers and clinicians with an opportunity to collect QOL data from patients that were previously not accessible. Most technologies offer a variety of options, such as language choice, formatting options for the delivery of questions, and data management services. Choosing the appropriate technology for use in research and/or clinical practice primarily depends on the purpose for QOL data collection. Implications for Nursing Practice Technology is changing the way nurses assess quality of life in patients with cancer and provide care. As stakeholders in the health care delivery system and patient advocates, nurses must be intimately involved in the evaluation and use of new technologies that impact quality of life and/or the delivery of care. PMID:20152578

  14. Self-Expandable Metal Stents and Trans-stent Light Delivery: Are Metal Stents and Photodynamic Therapy Compatible?

    PubMed Central

    Wang, Luo-Wei; Li, Li-Bo; Li, Zhao-Shen; Chen, Yang K; Hetzel, Fred W.; Huang, Zheng

    2008-01-01

    Background and Objectives: Obstructive non-small cell lung cancer and obstructive esophageal cancer are US FDA approved indications of photodynamic therapy (PDT). The usefulness of PDT for the treatment of cholangiocarcinoma is currently under clinical investigation. Endoscopic stenting for lumen restoration is a common palliative intervention for those indications. It is important to assess whether self-expandable metal stents are compatible with trans-stent PDT light delivery. Study Design/Materials and Methods: Direct effects of various components of metal biliary (n = 2), esophageal (n = 2), and bronchial (n = 1) stents on PDT light transmittance and distribution were examined using a point or linear light source (630 or 652 nm diode laser). Resected pig biliary duct and esophageal wall tissues were used to examine the feasibility of PDT light delivery through the fully expanded metal stents. Results: While using a point light source, the metal components (thread and joint) of the stent could cause a significant shadow effect. The liner material (polytetrafluoroethylene or polyurethane) could cause various degrees of light absorption. When the stent was covered with a thin layer of biliary duct and esophageal tissues containing all wall layers, the shadow effect could be mitigated due to tissue scattering. Conclusions: This study clearly demonstrates that it is feasible to combine stenting and PDT for the treatment of luminal lesions. PDT light dose should be adjusted to counteract the reduction of light transmittance caused by the metal and liner materials of stent. PMID:18951422

  15. Biosimilar Drugs for Cancer Emerge

    Cancer.gov

    As the patents on widely used biological drugs to treat cancer expire, biosimilar drugs are being developed for the treatment of patients with cancer. You can learn how biosimilars may expand treatment options in this Cancer Currents blog post.

  16. Expanding Commuter Choice Tax Benefit Options

    DOT National Transportation Integrated Search

    2003-10-01

    According to the US Census, 76.3 percent of U.S. workers drive alone to work. The Internal Revenue Code Section 132(f) provides incentives for employers to encourage alternative mode use, specifically transit and vanpooling, through commuter benefits...

  17. Understanding pave-IR : background, use, and advanced techniques

    DOT National Transportation Integrated Search

    2010-01-01

    Why Has TxDOT Implemented Pave-IR? : Promote more uniform, higher quality pavements : Minimize/eliminate thermal segregation : Expand range of weather conditions for paving : Special Provision 341-024 : Contains option for contractor to use Pave-IR :...

  18. Investigational hormone receptor agonists as ongoing female contraception: a focus on selective progesterone receptor modulators in early clinical development.

    PubMed

    Nelson, Anita L

    2015-01-01

    As efforts are made to continue to increase the safety of contraceptive methods, those without estrogen have attracted new attention. Progestin-only options are available in many delivery systems, but most cause disturbed bleeding patterns. For gynecologic patients, selective progesterone receptor modulators (SPRMs) have been approved for medical abortion, for ovulation suppression in emergency contraception, and for the treatment of heavy menstrual bleeding due to leiomyoma. This article discusses the role of SPRMs in controlling fertility on an ongoing basis with particular emphasis on mifepristone and ulipristal acetate (UPA), since none of the other compounds has progressed out of early Phase I - II testing. It also discusses important information about the mechanisms of action and safety of these two SPRMs. Of all the investigational hormone agonist/antagonists, SPRMs have demonstrated the greatest potential as ongoing female contraceptives. They have the ability to suppress ovulation after initiation of the luteinizing hormone (LH) surge without affecting ovarian production of estrogen or inducing any significant metabolic changes. SPRMs may well be able to provide longer term contraception as oral agents, vaginal rings, and perhaps even intrauterine devices. UPA has the greatest promise. Current research needs to be expanded.

  19. BioArtificial polymers

    NASA Astrophysics Data System (ADS)

    Szałata, Kamila; Gumi, Tania

    2017-07-01

    Nowadays, the polymer science has impact in practically all life areas. Countless benefits coming from the usage of materials with high mechanical and chemical resistance, variety of functionalities and potentiality of modification drive to the development of new application fields. Novel approaches of combining these synthetic substances with biomolecules lead to obtain multifunctional hybrid conjugates which merge the bioactivity of natural component with outstanding properties of artificial polymer. Over the decades, an immense progress in bioartificial composites domain allowed to reach a high level of knowledge in terms of natural-like systems engineering, leading to diverse strategies of biomolecule immobilization. Together with different available options, including covalent and noncovalent attachment, come various challenges, related mainly with maintaining the biological activity of fixed molecules. Even though the amount of applications that achieve commercial status is still not substantial, and is expanding continuously in the disciplines like "smart materials," biosensors, delivery systems, nanoreactors and many others. A huge number of remarkable developments reported in the literature present a potential of bioartificial conjugates as a fabrics with highly controllable structure and multiple functionalities, serving as a powerful nanotechnological tool. This novel approach brings closer biologists, chemists and engineers, who sharing their effort and complementing the knowledge can revolutionize the field of bioartificial polymer science.

  20. Consumer Smartphone Apps Marketed for Child and Adolescent Anxiety: A Systematic Review and Content Analysis.

    PubMed

    Bry, Laura Jane; Chou, Tommy; Miguel, Elizabeth; Comer, Jonathan S

    2018-03-01

    Anxiety disorders are collectively the most prevalent mental health problems affecting youth. To increase the reach of mental health care, recent years have seen increasing enthusiasm surrounding mobile platforms for expanding treatment delivery options. Apps developed in academia and supported in clinical trials are slow to reach the consumer marketplace. Meanwhile, proliferation of industry-developed apps on consumer marketplaces has been high. The present study analyzed content within mobile products prominently marketed toward consumers for anxiety in youth. Systematic inventory of the Google Play Store and Apple Store using keyword searches for child and adolescent anxiety yielded 121 apps, which were evaluated on the basis of their descriptive characteristics, mobile functionalities, and adherence to evidence-based treatment principles. Findings revealed that evidence-based treatment content within the sample is scant and few comprehensive anxiety self-management apps were identified. Advanced features that leverage the broader functionalities of smartphone capabilities (e.g., sensors, ecological momentary assessments) were rarely present. Findings underscore the need to increase the prominence and accessibility of quality child anxiety intervention products for consumers. Strategies for improving marketing of supported apps to better penetrate consumer markets are discussed. Copyright © 2017. Published by Elsevier Ltd.

  1. Management of Resistance to Crizotinib in Anaplastic Lymphoma Kinase-Positive Non-Small-cell Lung Cancer.

    PubMed

    Matikas, Alexios; Kentepozidis, Nikolaos; Georgoulias, Vassilis; Kotsakis, Athanasios

    2016-11-01

    During the past decade, the recognition of an ever-expanding list of driver oncogenic mutations in non-small-cell lung cancer has resulted in rapid therapeutic advances. Since the first description of the echinoderm microtubule-associated protein-like 4 anaplastic lymphoma kinase (EML4-ALK) rearrangement in 4% of cases of non-small-cell lung cancer in 2007, a highly potent and selective ALK inhibitor, crizotinib, was developed and approved in record time. However, it soon became apparent that although the responses can be dramatic and durable and primary intrinsic resistance to crizotinib is uncommon, the emergence of secondary resistance is inevitable. Efforts to elucidate the specific mechanisms that confer acquired resistance to crizotinib are underway. These have led to the recognition of the role of secondary resistance mutations, of ALK amplification, and of activation of bypass signaling, all of which contribute to resistance to crizotinib. Moreover, the rapid preclinical and clinical development of multiple second-generation ALK inhibitors that exhibit significant clinical activity against crizotinib-resistant disease has provided multiple options to treating physicians, with the ultimate goal the delivery of tailored medicine. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Recently patented transcatheter aortic valves in clinical trials.

    PubMed

    Neragi-Miandoab, Siyamek; Skripochnik, Edvard; Salemi, Arash; Girardi, Leonard

    2013-12-01

    The most widely used heart valve worldwide is the Edwards Sapien, which currently has 60% of the worldwide transcatheter aortic valve implantation (TAVI) market. The CoreValve is next in line in popularity, encompassing 35% of the worldwide TAVI market. Although these two valves dominate the TAVI market, a number of newer transcatheter valves have been introduced and others are in early clinical evaluation. The new valves are designed to reduce catheter delivery diameter, improve ease of positioning and sealing, and facilitate repositioning or removal. The most recent transcatheter valves for transapical use include Acurate TA (Symetis), Engager (Medtronic), and JenaValve the Portico (St Jude), Sadra Lotus Medical (Boston Scientific), and the Direct Flow Medical. These new inventions may introduce more effective treatment options for high-risk patients with severe aortic stenosis. Improvements in transcatheter valves and the developing variability among them may allow for more tailored approaches with respect to patient's anatomy, while giving operators the opportunity to choose devices they feel more comfortable with. Moreover, introducing new devices to the market will create a competitive environment among producers that will reduce high prices and expand availability. The present review article includes a discussion of recent patents related to Transcatheter Aortic Valves.

  3. Veterinary interventional oncology: from concept to clinic.

    PubMed

    Weisse, Chick

    2015-08-01

    Interventional radiology (IR) involves the use of contemporary imaging modalities to gain access to different structures in order to deliver materials for therapeutic purposes. Veterinarians have been expanding the use of these minimally invasive techniques in animals with a variety of conditions involving all of the major body systems. Interventional oncology (IO) is a growing subspecialty of IR in human medicine used (1) to restore patency to malignant obstructions through endoluminal stenting, (2) to provide dose escalations to tumors without increasing systemic chemotherapy toxicities via superselective transarterial chemotherapy delivery, (3) to stop hemorrhage or reduce blood flow to tumors via transarterial embolization or chemoembolization, and (4) to provide therapies for those cancers with no safe or effective alternative options. This review provides a brief introduction to a few of the techniques currently available to veterinarians for cancer treatment. For each technique, the concept for improved palliation, patient quality of life, or tumor control is presented, followed by the most current veterinary clinical information available. Although promising, more studies will be necessary to determine if veterinary IO will provide the same benefits as has already been demonstrated in oncology care in humans. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Some practical universal noiseless coding techniques, part 2

    NASA Technical Reports Server (NTRS)

    Rice, R. F.; Lee, J. J.

    1983-01-01

    This report is an extension of earlier work (Part 1) which provided practical adaptive techniques for the efficient noiseless coding of a broad class of data sources characterized by only partially known and varying statistics (JPL Publication 79-22). The results here, while still claiming such general applicability, focus primarily on the noiseless coding of image data. A fairly complete and self-contained treatment is provided. Particular emphasis is given to the requirements of the forthcoming Voyager II encounters of Uranus and Neptune. Performance evaluations are supported both graphically and pictorially. Expanded definitions of the algorithms in Part 1 yield a computationally improved set of options for applications requiring efficient performance at entropies above 4 bits/sample. These expanded definitions include as an important subset, a somewhat less efficient but extremely simple "FAST' compressor which will be used at the Voyager Uranus encounter. Additionally, options are provided which enhance performance when atypical data spikes may be present.

  5. Active Time Domain Reflectometry for Tamper Indication in Unattended Safeguards Systems

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

    Sheen, David M.; Smith, Leon E.; Tedeschi, Jonathan R.

    2015-07-14

    The International Atomic Energy Agency (IAEA) continues to expand its use of unattended measurement systems. An increasing number of systems and an expanding family of instruments create challenges in terms of deployment efficiency and the implementation of data authentication measures. In collaboration with the IAEA, tamper-indicating measures to address data-transmission authentication challenges with unattended safeguards systems are under investigation. Pacific Northwest National Laboratory is studying the viability of active time-domain reflectometry (TDR) along two parallel but interconnected paths: (1) swept-frequency TDR as the highly flexible, laboratory gold standard to which field-deployable options can be compared, and (2) a low-cost commerciallymore » available spread-spectrum TDR technology as one option for field implementation. This paper describes the TDR methods under investigation and the associated benchtop test-bed, tampering scenarios of interest,, and viability measurement results to date (e.g., comparison of relative sensitivity to tamper scenarios).« less

  6. Improved specificity of TALE-based genome editing using an expanded RVD repertoire.

    PubMed

    Miller, Jeffrey C; Zhang, Lei; Xia, Danny F; Campo, John J; Ankoudinova, Irina V; Guschin, Dmitry Y; Babiarz, Joshua E; Meng, Xiangdong; Hinkley, Sarah J; Lam, Stephen C; Paschon, David E; Vincent, Anna I; Dulay, Gladys P; Barlow, Kyle A; Shivak, David A; Leung, Elo; Kim, Jinwon D; Amora, Rainier; Urnov, Fyodor D; Gregory, Philip D; Rebar, Edward J

    2015-05-01

    Transcription activator-like effector (TALE) proteins have gained broad appeal as a platform for targeted DNA recognition, largely owing to their simple rules for design. These rules relate the base specified by a single TALE repeat to the identity of two key residues (the repeat variable diresidue, or RVD) and enable design for new sequence targets via modular shuffling of these units. A key limitation of these rules is that their simplicity precludes options for improving designs that are insufficiently active or specific. Here we address this limitation by developing an expanded set of RVDs and applying them to improve the performance of previously described TALEs. As an extreme example, total conversion of a TALE nuclease to new RVDs substantially reduced off-target cleavage in cellular studies. By providing new RVDs and design strategies, these studies establish options for developing improved TALEs for broader application across medicine and biotechnology.

  7. Extended duration orbiter study: CO2 removal and water recovery

    NASA Technical Reports Server (NTRS)

    Marshall, R. D.; Ellis, G. S.; Schubert, F. H.; Wynveen, R. A.

    1979-01-01

    Two electrochemical depolarized carbon dioxide concentrator subsystems were evaluated against baseline lithium hydroxide for (1) the baseline orbiter when expanded to accommodate a crew of seven (mission option one), (2) an extended duration orbiter with a power extension package to reduce fuel cell expendables (mission option two), and (3) an extended duration orbiter with a full capability power module to eliminate fuel cell expendables (mission option three). The electrochemical depolarized carbon dioxide concentrator was also compared to the solid amine regenerable carbon dioxide removal concept. Water recovery is not required for Mission Option One since sufficient water is generated by the fuel cells. The vapor compression distillation subsystem was evaluated for mission option two and three only. Weight savings attainable using the vapor compression distillation subsystem for water recovery versus on-board water storage were determined. Combined carbon dioxide removal and water recovery was evaluated to determine the effect on regenerable carbon dioxide removal subsystem selection.

  8. Fungating wounds: management and treatment options.

    PubMed

    Tandler, Suzanne; Stephen-Haynes, Jackie

    2017-06-22

    This article defines fungating wounds and considers the underlying cause, location and presentation. The clinical challenges presented by fungating wounds are discussed, with reference to evidence-based care delivery. This includes wound assessment, cleansing, debridement and management of malodour, infection, bleeding and exudate. Guidance on the use of wound management dressings is considered in relation to symptom management. The importance of clinical decision-making and educational preparation in the delivery of evidenced-based care for those with fungating wounds is emphasised. A conclusion is made that the clinician can support the patient with a fungating wound by the delivery of evidenced-based care.

  9. Including safety-net providers in integrated delivery systems: issues and options for policymakers.

    PubMed

    Witgert, Katherine; Hess, Catherine

    2012-08-01

    Health care reform legislation has spurred efforts to develop integrated health care delivery systems that seek to coordinate the continuum of health services. These systems may be of particular benefit to patients who face barriers to accessing care or have multiple health conditions. But it remains to be seen how safety-net providers, including community health centers and public hospitals--which have long experience in caring for these vulnerable populations--will be included in integrated delivery systems. This issue brief explores key considerations for incorporating safety-net providers into integrated delivery systems and discusses the roles of state and federal agencies in sup­porting and testing models of integrated care delivery. The authors conclude that the most important principles in creating integrated delivery systems for vulnerable populations are: (1) an emphasis on primary care; (2) coordination of all care, including behavioral, social, and public health services; and (3) accountability for population health outcomes.

  10. Safety of vaginal delivery among dichorionic diamniotic twins over 10 years in a UK teaching hospital.

    PubMed

    Rzyska, Ewelina; Ajay, Bini; Chandraharan, Edwin

    2017-01-01

    To determine whether vaginal delivery among dichorionic diamniotic twins remains a safe option following full implementation of the European Working Time Directive in the UK. A retrospective study was conducted using data for women with dichorionic diamniotic twin pregnancies who attended a teaching hospital in London, UK, for delivery between January 4, 2000, and December 23, 2010. Among 892 women, 474 (53.1%) attempted vaginal delivery, 220 (46.4%) of whom achieved spontaneous vaginal delivery of both twins. Instrumental vaginal delivery was performed among 89 women (18.8%), and 165 (34.8%) women underwent emergency cesarean delivery. Delivery of the second twin by emergency cesarean (n=31) was predominantly for fetal distress (13 [41.9%]) or abnormal lie (10 [32.3%]). A 5-minute Apgar score of 9 or 10 was recorded for 384 (83.7%) of 459 first twins and 369 (82.9%) of 445 second twins, irrespective of the mode of delivery. Vaginal delivery among dichorionic diamniotic twins had a good success rate and a low intrapartum emergency cesarean delivery rate. Training in cardiotocography and intrapartum procedures might further reduce the need for emergency cesarean delivery. © 2016 International Federation of Gynecology and Obstetrics.

  11. Delivery of RNA interference therapeutics using polycation-based nanoparticles.

    PubMed

    Howard, Kenneth Alan

    2009-07-25

    RNAi-based therapies are dependent on extracellular and intracellular delivery of RNA molecules for enabling target interaction. Polycation-based nanoparticles (or polyplexes) formed by self-assembly with RNA can be used to modulate pharmacokinetics and intracellular trafficking to improve the therapeutic efficacy of RNAi-based therapeutics. This review describes the application of polyplexes for extracellular and intracellular delivery of synthetic RNA molecules. Focus is given to routes of administration and silencing effects in animal disease models. The inclusion of functional components into the nanoparticle for controlling cellular trafficking and RNA release is discussed. This work highlights the versatile nature of polycation-based nanoparticles to fulfil the delivery requirements for RNA molecules with flexibility in design to evolve alongside an expanding repertoire of RNAi-based drugs.

  12. Getting PrEPared for HIV Prevention Navigation: Young Black Gay Men Talk About HIV Prevention in the Biomedical Era.

    PubMed

    Mutchler, Matt G; McDavitt, Bryce; Ghani, Mansur A; Nogg, Kelsey; Winder, Terrell J A; Soto, Juliana K

    2015-09-01

    Biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), represent new opportunities to reduce critically high HIV infection rates among young black men who have sex with men (YBMSM). We report results of 24 dyadic qualitative interviews (N=48), conducted in Los Angeles, CA, exploring how YBMSM and their friends view PrEP and PEP. Interviews were analyzed using a grounded theory approach. Participants had widely divergent levels of knowledge about these prevention methods. Misconceptions and mistrust regarding PrEP were common, and concerns were expressed about PrEP-related stigma and the potential for gossip among peers who might assume a person on PrEP was HIV-positive. Yet participants also framed PrEP and PEP as valuable new options within an expanded "tool kit" of HIV prevention strategies that created possibilities for preventing new HIV infections, dating men with a different HIV status, and decreased anxiety about exposure to HIV. We organized themes around four main areas: (1) information and misinformation about biomedical HIV prevention; (2) expectations about PrEP, sexual behavior, and stigma; (3) gossip, disclosure, and "spreading the word" about PrEP and PEP; and (4) the roles of PrEP and PEP in an expanded HIV prevention tool kit. The findings suggest a need for guidance in navigating the increasingly complex array of HIV-prevention options available to YBMSM. Such "prevention navigation" could counter misconceptions and address barriers, such as stigma and mistrust, while helping YBMSM make informed selections from among expanded HIV prevention options.

  13. Scientific Library Offers New Training Options | Poster

    Cancer.gov

    The Scientific Library is expanding its current training opportunities by offering webinars, allowing employees to take advantage of trainings from the comfort of their own offices. Due to the nature of their work, some employees find it inconvenient to attend in-person training classes; others simply prefer to use their own computers. The Scientific Library has been experimenting with webinar sessions since 2016 and expanded the service in 2017. Now, due to the popularity of webinars, it plans to offer even more webinar training sessions.

  14. [A Case of Removable Self-Expandable Metallic Stent(SEMS)Placement for Gastric Tube Stenosis after Esophageal Cancer Resection].

    PubMed

    Yoshikawa, Yukihiro; Yoshikawa, Masato; Kawabata, Ryohei; Yoshida, Yuta; Kawada, Masahiro; Yasuyama, Akinobu; Watase, Chikashi; Koga, Chikato; Hitora, Toshiki; Murakami, Masahiro; Hirota, Masaki; Ikenaga, Masakazu; Shimizu, Junzo; Hasegawa, Junichi

    2015-11-01

    A 68-year-old man underwent esophagectomy for early esophageal cancer. Postoperative upper gastrointestinal series and esophagogastroduodenoscopy showed gastric tube stenosis. To improve passage, a removable self-expandable metallic stent (SEMS) was placed across the stenotic lesion. Two weeks later, the stent was removed, and passage through the gastric tube improved. The patient has no symptoms of stenosis. A removable SEMS could be an option for the treatment of gastric tube stenosis after esophagectomy.

  15. Expanding Demand for Online Higher Education: Surveying Prospective Students

    ERIC Educational Resources Information Center

    Garrett, Richard

    2007-01-01

    The Eduventures survey examined next-generation demand for online postsecondary education, assessing online experience, delivery mode and marketing channels preferences, and perceptions of price, quality and location, identifying key takeaways in each area.

  16. Plan EJ 2014: Resources Tools Development

    EPA Pesticide Factsheets

    EPA's efforts advance the Administrator’s priority of Expanding the Conversation on Environmentalism and Working for Environmental Justice by establishing a new paradigm for the delivery of EPA assistance to minority, low-income, tribal, and indigenous pe

  17. The Expanding Role of the Optometrist.

    ERIC Educational Resources Information Center

    Haffner, Alden N.

    1979-01-01

    Changes in the current health care system impacting upon optometry and optometric care are highlighted including changes in health care organizations and delivery, emerging concepts in health care, and changes in optometry and optometric care. (JMF)

  18. Institutional Change in Delivery of Dental Services: A Marketing Perspective

    PubMed Central

    Capon, Noel

    1982-01-01

    The recent appearance and growth of new delivery systems for dental services is examined from a marketing perspective. Analysis reveals that the growth of low priced, high throughput operations is consistent not only with marketing principles, but with the development of American retail institutions in general. Options for independent dentists in the face of this new competitive environment are discussed. (Am J Public Health 1982; 72:679-683.) PMID:7091457

  19. Evaluation of delivery options for second-stage events.

    PubMed

    Bailit, Jennifer L; Grobman, William A; Rice, Madeline Murguia; Wapner, Ronald J; Reddy, Uma M; Varner, Michael W; Thorp, John M; Caritis, Steve N; Iams, Jay D; Saade, George; Rouse, Dwight J; Tolosa, Jorge E

    2016-05-01

    Cesarean delivery in the second stage of labor is common, whereas the frequency of operative vaginal delivery has been declining. However, data comparing outcomes for attempted operative vaginal delivery vs cesarean in the second stage are scant. Previous studies that examine operative vaginal delivery have compared it to a baseline risk of complications from a spontaneous vaginal delivery and cesarean delivery. However, when a woman has a need for intervention in the second stage, spontaneous vaginal delivery is not an option she or the provider can choose. Thus, the appropriate clinical comparison is cesarean vs operative vaginal delivery. Our objective was to compare outcomes by the first attempted operative delivery (vacuum, forceps vs cesarean delivery) in patients needing second-stage assistance at a fetal station of +2 or below. We conducted secondary analysis of an observational obstetric cohort in 25 academically affiliated US hospitals over a 3-year period. A subset of ≥37 weeks, nonanomalous, vertex, singletons, with no prior vaginal delivery who reached a station of +2 or below and underwent an attempt at an operative delivery were included. Indications included for operative delivery were: failure to descend, nonreassuring fetal status, labor dystocia, or maternal exhaustion. The primary outcomes included a composite neonatal outcome (death, fracture, length of stay ≥3 days beyond mother's, low Apgar, subgaleal hemorrhage, ventilator support, hypoxic encephalopathy, brachial plexus injury, facial nerve palsy) and individual maternal outcomes (postpartum hemorrhage, third- and fourth-degree tears [severe lacerations], and postpartum infection). Outcomes were examined by the 3 attempted modes of delivery. Odds ratios (OR) were calculated for primary outcomes adjusting for confounders. Final mode of delivery was quantified. In all, 2531 women met inclusion criteria. No difference in the neonatal composite outcome was observed between groups. Vacuum attempt was associated with the lowest frequency of maternal complications (postpartum infection 0.2% vs 0.9% forceps vs 5.3% cesarean, postpartum hemorrhage 1.4% vs 2.8% forceps vs 3.8% cesarean), except for severe lacerations (19.1% vs 33.8% forceps vs 0% cesarean). When confounders were taken into account, both forceps (OR, 0.16; 95% confidence interval, 0.05-0.49) and vacuum (OR, 0.04; 95% confidence interval, 0.01-0.17) were associated with a significantly lower odds of postpartum infection. The neonatal composite and postpartum hemorrhage were not significantly different between modes of attempted delivery. Cesarean occurred in 6.4% and 4.4% of attempted vacuum and forceps groups (P = .04). In patients needing second-stage delivery assistance with a station of +2 or below, attempted operative vaginal delivery was associated with a lower frequency of postpartum infection, but higher frequency of severe lacerations. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Evaluation of delivery options for second stage events

    PubMed Central

    Bailit, Jennifer L.; Grobman, William A.; Rice, Madeline Murguia; Wapner, Ronald J.; Reddy, Uma M.; Varner, Michael W.; Thorp, John M.; Caritis, Steve N.; Iams, Jay D.; Saade, George; Rouse, Dwight J.; Tolosa, Jorge E.

    2015-01-01

    Background Cesarean delivery in the second stage of labor is common, whereas the frequency of operative vaginal delivery has been declining. However, data comparing outcomes for attempted operative vaginal delivery in the second stage versus cesarean in the second stage are scant. Previous studies that examine operative vaginal delivery have compared it to a baseline risk of complications from a spontaneous vaginal delivery and cesarean delivery. However, when a woman has a need for intervention in the second stage, spontaneous vaginal delivery is not an option she or the provider can choose. Thus, the appropriate clinical comparison is cesarean versus operative vaginal delivery. Objective Our objective was to compare outcomes by the first attempted operative delivery (vacuum, forceps versus cesarean delivery) in patients needing second stage assistance at a fetal station of +2 or below. Study Design Secondary analysis of an observational obstetric cohort in 25 academically-affiliated U.S. hospitals over a three-year period. A subset of ≥37 weeks, non-anomalous, vertex, singletons, with no prior vaginal delivery who reached a station of +2 or below and underwent an attempt at an operative delivery were included. Indications included for operative delivery were: failure to descend, non-reassuring fetal status, labor dystocia or maternal exhaustion. The primary outcomes included a composite neonatal outcome (death, fracture, length of stay ≥3 days beyond mother’s, low Apgar, subgaleal hemorrhage, ventilator support, hypoxic encephalopathy, brachial plexus injury, facial nerve palsy) and individual maternal outcomes (postpartum hemorrhage, third and fourth degree tears [severe lacerations], and postpartum infection). Outcomes were examined by the three attempted modes of delivery. Odds ratios were calculated for primary outcomes adjusting for confounders. Final mode of delivery was quantified. Results 2531 women met inclusion criteria. Vacuum attempt was associated with the lowest frequency of the neonatal composite (4.2% vs. 6.1% vaginal forceps vs. 6.9% cesarean) and maternal complications (Postpartum infection 0.2% vs. 0.9% forceps vs. 5.3% cesarean, Postpartum hemmorhage 1.4% vs. 2.8% forceps vs. 3.8% cesarean), except for severe lacerations (19.1% vs. 33.8% forceps vs. 0% cesarean). When confounders were taken into account, both forceps (odds ratio 0.16, 95%CI 0.05-0.49) and vacuum (odds ratio 0.04, 95%CI 0.01-0.17) were associated with a significantly lower odds of Post partuminfection. The neonatal composite and Postpartum hemmorhage were not significantly different between modes of attempted delivery. Cesarean occurred in 6.4% and 4.4% of attempted vacuum and forceps groups (P=.04). Conclusion In patients needing second stage delivery assistance with a station of +2 or below, attempted operative vaginal delivery was associated with a lower frequency of Postpartum infection, but higher frequency of severe lacerations. PMID:26596236

  1. Telemetry Options for LDB Payloads

    NASA Technical Reports Server (NTRS)

    Stilwell, Bryan D.; Field, Christopher J.

    2016-01-01

    The Columbia Scientific Balloon Facility provides Telemetry and Command systems necessary for balloon operations and science support. There are various Line-Of-Sight (LOS) and Over-The-Horizon (OTH) systems and interfaces that provide communications to and from a science payload. This presentation will discuss the current data throughput options available and future capabilities that may be incorporated in the LDB Support Instrumentation Package (SIP) such as doubling the TDRSS data rate. We will also explore some new technologies that could potentially expand the data throughput of OTH communications.

  2. Preparing a Sublanguage Grammar

    DTIC Science & Technology

    1991-10-31

    new BNFs based on the Navy CASREP data. Rewriting of BNF Options Rewriting Options for Subordinate Clause Strings Originally, SUB6 and SUB7 were "rare...the CASREP data, we found it necessary to derarify the expansions of SUB6 and SUB7 in CSSTG. An Example or Svibordinate Clauses SUB6 expands to a CS6... SUB7 was derarified to account for the sentences in (7). (7) a. [Testa 4.1]: WHILE DIESEL WAS OPERATING WITH SAC DISENGAGED, SAC LO ALARM SOUNDED. b

  3. CALNPS: Computer Analysis Language Naval Postgraduate School Version

    DTIC Science & Technology

    1989-06-01

    The graphics capabilities were expanded to include hai copy options using the PlotlO and Disspia araplaics libraries. T’\\u di ,pla. !𔃻z1 options are ...8217:c:n of tbhis page All oiher ediiions are obsc,,C I. nclassified Approved for public release; distribution is unlimited. CALNPS Computer Analysis... are now available and the user now has the capability to plot curves from data files from within the CALNPS domain. As CALNPS is a very large program

  4. Real Options in Defense R and D: A Decision Tree Analysis Approach for Options to Defer, Abandon, and Expand

    DTIC Science & Technology

    2016-12-01

    chosen rather than complex ones , and responds to the criticism of the DTA approach. Chapter IV provides three separate case studies in defense R&D...defense R&D projects. To this end, the first section describes the case study method and the advantages of using simple models over more complex ones ...the analysis lacked empirical data and relied on subjective data, the analysis successfully combined the DTA approach with the case study method and

  5. Medication for Military Aircrew: Current Use, Issues, and Strategies for Expanded Options (les medicaments pour les equipaes militaires: Consommation actuelle, questions et strategies pour des options elargies)

    DTIC Science & Technology

    2001-06-01

    HMG-CoA reductase inhibitors, commonly referred to as “statins” (lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin ) d. Others (nicotinic...cholesterol by 2 - 15%. Many statins (pravastatin, atorvastatin , fluvastatin, lovastatin, and simvastatin) have been developed for clinical use and are now...trail making test, or visual memory test.16 There are unpublished data about atorvastatin and pravastatin, in which both showed an increase in

  6. Right Sizing the Force: Restructuring the Marine Light Attack Helicopter (HML/A) Squadron to Better Meet the Emerging Threat

    DTIC Science & Technology

    2009-04-29

    visual coverage armed with responsive, high volume offensive or defensive door mounted machine guns and nearly 3600 weapons coverage. In addition, a fixed...forward gun option and forward firing rocket capacity substantially expand firepower options. Team this crew and machine with the world’s premiere...escort. 1 Headquarters, U. S. Marine Corps, Vision & Strategy 2025, (Washington, DC: Headquarters, U.S. Marine Corps, June 18, 2008), 9. 2 Scott Atwood

  7. Treatment Options by Stage (Gastric Cancer)

    MedlinePlus

    ... surgery, the following procedures may be used: Endoluminal stent placement: A procedure to insert a stent (a thin, expandable tube) in order to keep ... stomach, surgery may be done to place a stent from the esophagus to the stomach or from ...

  8. 21 CFR 312.305 - Requirements for all expanded access uses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... contained in an existing IND if the sponsor of the existing IND grants a right of reference to the IND. (2... therapeutic options that would ordinarily be tried before resorting to the investigational drug or an...

  9. 21 CFR 312.305 - Requirements for all expanded access uses.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... contained in an existing IND if the sponsor of the existing IND grants a right of reference to the IND. (2... therapeutic options that would ordinarily be tried before resorting to the investigational drug or an...

  10. 21 CFR 312.305 - Requirements for all expanded access uses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... contained in an existing IND if the sponsor of the existing IND grants a right of reference to the IND. (2... therapeutic options that would ordinarily be tried before resorting to the investigational drug or an...

  11. 21 CFR 312.305 - Requirements for all expanded access uses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... contained in an existing IND if the sponsor of the existing IND grants a right of reference to the IND. (2... therapeutic options that would ordinarily be tried before resorting to the investigational drug or an...

  12. Discovery of Cationic Polymers for Non-viral Gene Delivery using Combinatorial Approaches

    PubMed Central

    Barua, Sutapa; Ramos, James; Potta, Thrimoorthy; Taylor, David; Huang, Huang-Chiao; Montanez, Gabriela; Rege, Kaushal

    2015-01-01

    Gene therapy is an attractive treatment option for diseases of genetic origin, including several cancers and cardiovascular diseases. While viruses are effective vectors for delivering exogenous genes to cells, concerns related to insertional mutagenesis, immunogenicity, lack of tropism, decay and high production costs necessitate the discovery of non-viral methods. Significant efforts have been focused on cationic polymers as non-viral alternatives for gene delivery. Recent studies have employed combinatorial syntheses and parallel screening methods for enhancing the efficacy of gene delivery, biocompatibility of the delivery vehicle, and overcoming cellular level barriers as they relate to polymer-mediated transgene uptake, transport, transcription, and expression. This review summarizes and discusses recent advances in combinatorial syntheses and parallel screening of cationic polymer libraries for the discovery of efficient and safe gene delivery systems. PMID:21843141

  13. Strategies for drug delivery to the central nervous system by systemic route.

    PubMed

    Kasinathan, Narayanan; Jagani, Hitesh V; Alex, Angel Treasa; Volety, Subrahmanyam M; Rao, J Venkata

    2015-05-01

    Delivery of a drug into the central nervous system (CNS) is considered difficult. Most of the drugs discovered over the past decade are biological, which are high in molecular weight and polar in nature. The delivery of such drugs across the blood-brain barrier presents problems. This review discusses some of the options available to reach the CNS by systemic route. The focus is mainly on the recent developments in systemic delivery of a drug to the CNS. Databases such as Scopus, Google scholar, Science Direct, SciFinder and online journals were referred for preparing this article including 89 references. There are at least nine strategies that could be adopted to achieve the required drug concentration in the CNS. The recent developments in drug delivery are very promising to deliver biologicals into the CNS.

  14. Creating a provider network: fact, fantasy, and future.

    PubMed

    Meeks, J S

    1997-09-01

    Integrated delivery systems should consider multiple options through which to affiliate, with primary care physicians and advanced practice nurses. Caution should be employed to assure that system alignment occurs in an efficient, effective manner.

  15. Treatment Options for Gallbladder Cancer

    MedlinePlus

    ... Cancer.gov on the Managing Cancer Care page. Contact Us More information about contacting us or receiving ... Facebook Twitter Instagram YouTube Google+ LinkedIn GovDelivery RSS CONTACT INFORMATION Contact Us LiveHelp Online Chat MORE INFORMATION ...

  16. Treatment Option Overview (Gallbladder Cancer)

    MedlinePlus

    ... Cancer.gov on the Managing Cancer Care page. Contact Us More information about contacting us or receiving ... Facebook Twitter Instagram YouTube Google+ LinkedIn GovDelivery RSS CONTACT INFORMATION Contact Us LiveHelp Online Chat MORE INFORMATION ...

  17. Implementation of GPS controlled highway construction equipment.

    DOT National Transportation Integrated Search

    2007-04-01

    dozers, motor graders, and excavators is quickly becoming common place in private sector construction because it speeds project delivery and cuts costs. Use of this technology is expanding quickly into other construction equipment areas such as paver...

  18. Retail and Real Estate: The Changing Landscape of Care Delivery.

    PubMed

    Mason, Scott A

    2015-01-01

    By its nature, retail medicine is founded in real estate. That retail medicine has expanded so dramatically in a relatively short period of time has taken people by surprise. This rapid growth of integrating healthcare services into retail real estate begs the question of whether real estate will eventually take on the importance in healthcare delivery that it has in retail. This article advances the view that it will. In the end, what retail and healthcare have in common is that they both reflect the attributes of demanding consumers as part of an experience-based economy, where products and services are sought based on how they fit with their lifestyles and how they make them feel (Pine and Gilmore 1998). Changing the selection process for healthcare services to be more like retail is already expanding how and where healthcare services are delivered.

  19. Prophylactic Therapy for Hereditary Angioedema.

    PubMed

    Longhurst, Hilary; Zinser, Emily

    2017-08-01

    Long-term prophylaxis is needed in many patients with hereditary angioedema and poses many challenges. Attenuated androgens are effective in many but are limited by side effect profiles. There is less evidence for efficacy of tranexamic acid and progestagens; however, the small side effect profile makes tranexamic acid an option for prophylaxis in children and progestagens an option for women. C1 inhibitor is beneficial, but at present requires intravenous delivery and may need dose titration for maximum efficacy. Short-term prophylaxis should be considered for all procedures. New therapies are promising in overcoming many problems encountered with current options for long-term prophylaxis. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Advances in mobile mental health: opportunities and implications for the spectrum of e-mental health services

    PubMed Central

    Chan, Steven; Hwang, Tiffany; Wong, Alice; Bauer, Amy M.

    2017-01-01

    Mobile health (mHealth), telemedicine and other technology-based services facilitate mental health service delivery and may be considered part of an e-mental health (eMH) spectrum of care. Web- and Internet-based resources provide a great opportunity for the public, patients, healthcare providers and others to improve wellness, practice prevention and reduce suffering from illnesses. Mobile apps offer portability for access anytime/anywhere, are inexpensive versus traditional desktop computers, and have additional features (e.g., context-aware interventions and sensors with real-time feedback. This paper discusses mobile mental health (mMH) options, as part of a broader framework of eMH options. The evidence-based literature shows that many people have an openness to technology as a way to help themselves, change behaviors and engage additional clinical services. Studies show that traditional video-based synchronous telepsychiatry (TP) is as good as in-person service, but mHealth outcomes have been rarely, directly compared to in-person and other eMH care options. Similarly, technology options added to in-person care or combined with others have not been evaluated nor linked with specific goals and desired outcomes. Skills and competencies for clinicians are needed for mHealth, social media and other new technologies in the eMH spectrum, in addition to research by randomized trials and study of health service delivery models with an emphasis on effectiveness. PMID:28894744

  1. Process evaluation improves delivery of a nutrition-sensitive agriculture programme in Burkina Faso.

    PubMed

    Nielsen, Jennifer N; Olney, Deanna K; Ouedraogo, Marcellin; Pedehombga, Abdoulaye; Rouamba, Hippolyte; Yago-Wienne, Fanny

    2017-12-26

    Evidence is emerging from rigorous evaluations about the effectiveness of nutrition-sensitive agriculture programmes in improving nutritional outcomes. Additional evidence can elucidate how different programme components and pathways contribute and can be optimized for impact. The International Food Policy Research Institute, with Helen Keller International, designed a comprehensive framework to evaluate the delivery, utilization, and impact of Helen Keller International's enhanced homestead food production programme in Burkina Faso. After 18 months of implementation, a process evaluation was conducted to examine programme impact pathways, using key informant and semistructured interviews with implementing agents and beneficiaries, and with residents of control communities. Data were analyzed by International Food Policy Research Institute and reviewed with project managers and partners through multiple workshops to identify opportunities to strengthen implementation. Findings illuminated gaps between intended and actual delivery schemes, including input constraints, knowledge gaps among community agents in agriculture and young child nutrition practices, and lower than expected activity by community volunteers. In response, staff developed measures to overcome water constraints and expand vegetable and poultry production, retrained volunteers in certain techniques of food production and counselling for nutrition behaviour change, added small incentives to motivate volunteers, and shaped both immediate and long-term changes to the programme model. Working closely with International Food Policy Research Institute on the evaluation activities also expanded the repertoire of research methods and skills of Helen Keller International staff. Process evaluation can strengthen programme delivery, utilization, and design. Collaboration between researchers and implementers can improve programme effectiveness, project staff capacity, and advance delivery science. © 2017 John Wiley & Sons Ltd.

  2. A rapid-exchange monorail stent system for salvage of failing femoropopliteal bypass grafts.

    PubMed

    Jahnke, Thomas; Brossmann, Joachim; Walluscheck, Knut; Heller, Martin; Müller-Hülsbeck, Stefan

    2003-08-01

    To analyze the safety and effectiveness of a new monorail stent system for the treatment of failing femoropopliteal bypass grafts. Acute distal occlusions or stenoses of femoropopliteal bypass grafts were treated with balloon-expandable stents (13 or 18-mm diameter) pre-mounted on a monorail balloon catheter system. The delivery system was assessed subjectively for (1). compatibility with the sheath, (2). lesion crossing potential, (3). radiopacity, (4). flexibility of the catheter, (5). adequacy of stent expansion, and (5). balloon refolding. In 8 failing bypass grafts with distal lesions, the delivery system successfully deployed the stent at the desired location. Sheath compatibility, catheter flexibility, lesion crossing, and stent expansion were rated "excellent" by all examiners for the 18-mm device. Radiopacity of the mounted stent was graded "good" before and during positioning, but only "sufficient" following expansion. For this type of lesion, the investigators rated the overall performance of the device superior to conventional "over-the-wire" systems. The monorail balloon-expandable stent delivery system provides rapid introduction of the device over the guidewire, and its low profile facilitates the use of small sheaths to minimize access-site complications.

  3. DEFENSE HEALTH CARE: Access to Care for Beneficiaries Who Have Not Enrolled in TRICARE’s Managed Care Option

    DTIC Science & Technology

    2006-12-01

    Higher than Medicare Reimbursement Rates CPT codea Procedure or service performed Ratio of TRICARE to Medicare reimbursement 20250 Biopsy ...59350 Hysterorrhaphy of ruptured uterus 1.205 59409 Vaginal delivery only (with or without episiotomy and/or forceps ) 1.184 59410 Vaginal delivery only...with or without episiotomy and/or forceps ); including postpartum car 1.156 59412 External cephalic version, with or without tocolysis 1.139 59414

  4. 3D printing with polymers: Challenges among expanding options and opportunities.

    PubMed

    Stansbury, Jeffrey W; Idacavage, Mike J

    2016-01-01

    Additive manufacturing, which is more colloquially referred to as 3D printing, is quickly approaching mainstream adoption as a highly flexible processing technique that can be applied to plastic, metal, ceramic, concrete and other building materials. However, taking advantage of the tremendous versatility associated with in situ photopolymerization as well as the ability to select from a variety of preformed processible polymers, 3D printing predominantly targets the production of polymeric parts and models. The goal of this review is to connect the various additive manufacturing techniques with the monomeric and polymeric materials they use while highlighting emerging material-based developments. Modern additive manufacturing technology was introduced approximately three decades ago but this review compiles recent peer-reviewed literature reports to demonstrate the evolution underway with respect to the various building techniques that differ significantly in approach as well as the new variations in polymer-based materials being employed. Recent growth of 3D printing has been dramatic and the ability of the various platform technologies to expand from rapid production prototypic models to the greater volume of readily customizable production of working parts is critical for continued high growth rates. This transition to working part production is highly dependent on adapting materials that deliver not only the requisite design accuracy but also the physical and mechanical properties necessary for the application. With the weighty distinction of being called the next industrial revolution, 3D printing technologies is already altering many industrial and academic operations including changing models for future healthcare delivery in medicine and dentistry. Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  5. Hybrid options for treating cardiac disease.

    PubMed

    Umakanthan, Ramanan; Leacche, Marzia; Zhao, David X; Gallion, Anna H; Mishra, Prabodh C; Byrne, John G

    2011-01-01

    The options for treating heart disease have greatly expanded during the course of the last 2 1/2 decades with the advent of hybrid technology. The hybrid option for treating cardiac disease implies using the technology of both interventional cardiology and cardiac surgery to treat cardiac disease. This rapidly developing technology has given rise to new and creative techniques to treat cardiac disease involving coronary artery disease, coronary artery disease and cardiac valve disease, and atrial fibrillation. It has also led to the establishment of new procedural suites called hybrid operating rooms that facilitate the integration of technologies of interventional cardiology catheterization laboratories with those of cardiac surgery operating rooms. The development of hybrid options for treating cardiac disease has also greatly augmented teamwork and collaboration between interventional cardiologists and cardiac surgeons. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Re-Evaluating Progression in an Era of Progress: A Review of First- and Second-Line Treatment Options in Anaplastic Lymphoma Kinase-Positive Non-Small Cell Lung Cancer.

    PubMed

    Castellanos, Emily H; Horn, Leora

    2016-06-01

    : The advent of crizotinib, the first small molecule inhibitor against anaplastic lymphoma kinase (ALK), has led to impressive advances in the care of patients with advanced ALK-rearranged non-small cell lung cancer. The development of second-generation ALK inhibitors, starting with the recent U.S. Food and Drug Administration approval of ceritinib, promises to expand the therapeutic landscape for this cohort of patients. With increasing use of molecularly targeted therapy options, it has been observed that disease progression in patients receiving targeted agents has a heterogeneous biology, manifesting as either oligoprogressive or widely progressive disease, which may require development of innovative treatment strategies. This review discusses the first- and second-generation ALK inhibitors approved or in clinical development, as well as the novel challenges and approaches to disease progression in patients on targeted agents. The identification of driver mutations in non-small cell lung cancer (NSCLC), most prominently epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), has expanded treatment options for a significant cohort of patients. However, the success of targeted agents has brought new challenges, particularly regarding management of progression. Progression manifests heterogeneously, and management of oligoprogression may differ from diffusely progressive disease. Multiple options for treatment at progression exist, and it is becoming evident that selecting the best avenue of care requires understanding the biology and potential drivers of disease progression. This review discusses the array of treatment options available for patients with ALK-positive NSCLC, as well as evaluation and treatment of progressive disease. ©AlphaMed Press.

  7. Re-Evaluating Progression in an Era of Progress: A Review of First- and Second-Line Treatment Options in Anaplastic Lymphoma Kinase-Positive Non-Small Cell Lung Cancer

    PubMed Central

    Castellanos, Emily H.

    2016-01-01

    The advent of crizotinib, the first small molecule inhibitor against anaplastic lymphoma kinase (ALK), has led to impressive advances in the care of patients with advanced ALK-rearranged non-small cell lung cancer. The development of second-generation ALK inhibitors, starting with the recent U.S. Food and Drug Administration approval of ceritinib, promises to expand the therapeutic landscape for this cohort of patients. With increasing use of molecularly targeted therapy options, it has been observed that disease progression in patients receiving targeted agents has a heterogeneous biology, manifesting as either oligoprogressive or widely progressive disease, which may require development of innovative treatment strategies. This review discusses the first- and second-generation ALK inhibitors approved or in clinical development, as well as the novel challenges and approaches to disease progression in patients on targeted agents. Implications for Practice: The identification of driver mutations in non-small cell lung cancer (NSCLC), most prominently epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), has expanded treatment options for a significant cohort of patients. However, the success of targeted agents has brought new challenges, particularly regarding management of progression. Progression manifests heterogeneously, and management of oligoprogression may differ from diffusely progressive disease. Multiple options for treatment at progression exist, and it is becoming evident that selecting the best avenue of care requires understanding the biology and potential drivers of disease progression. This review discusses the array of treatment options available for patients with ALK-positive NSCLC, as well as evaluation and treatment of progressive disease. PMID:27053502

  8. Diatoms: a biotemplating approach to fabricating drug delivery reservoirs.

    PubMed

    Chao, Joshua T; Biggs, Manus J P; Pandit, Abhay S

    2014-11-01

    Biotemplating is a rapidly expanding subfield that utilizes nature-inspired systems and structures to create novel functional materials, and it is through these methods that the limitations of current engineering practices may be advanced. The diatom is an exceptional template for drug delivery applications, owing largely to its highly-ordered pores, large surface area, species-specific architecture, and flexibility for surface modifications. Diatoms have been studied in a wide range of biomedical applications and their potential as the next frontier of drug delivery has yet to be fully exploited. In this editorial, the authors aim to review the use of diatoms in the delivery of poorly water-soluble drugs as reported in the literature, discuss the progress and advancements that have been made thus far, identify the shortcomings and limitations in the field, and, lastly, present their expert opinion and convey the future outlook on biotemplating approaches for drug delivery.

  9. Polymeric nanoparticles

    PubMed Central

    Bolhassani, Azam; Javanzad, Shabnam; Saleh, Tayebeh; Hashemi, Mehrdad; Aghasadeghi, Mohammad Reza; Sadat, Seyed Mehdi

    2014-01-01

    Nanocarriers with various compositions and biological properties have been extensively applied for in vitro/in vivo drug and gene delivery. The family of nanocarriers includes polymeric nanoparticles, lipid-based carriers (liposomes/micelles), dendrimers, carbon nanotubes, and gold nanoparticles (nanoshells/nanocages). Among different delivery systems, polymeric carriers have several properties such as: easy to synthesize, inexpensive, biocompatible, biodegradable, non-immunogenic, non-toxic, and water soluble. In addition, cationic polymers seem to produce more stable complexes led to a more protection during cellular trafficking than cationic lipids. Nanoparticles often show significant adjuvant effects in vaccine delivery since they may be easily taken up by antigen presenting cells (APCs). Natural polymers such as polysaccharides and synthetic polymers have demonstrated great potential to form vaccine nanoparticles. The development of new adjuvants or delivery systems for DNA and protein immunization is an expanding research field. This review describes polymeric carriers especially PLGA, chitosan, and PEI as vaccine delivery systems. PMID:24128651

  10. Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine.

    PubMed

    Bailey, Heather; Townsend, Claire L; Semenenko, Igor; Malyuta, Ruslan; Cortina-Borja, Mario; Thorne, Claire

    2013-07-01

    To investigate the scale-up of antenatal combination antiretroviral therapy (cART) in Ukraine since this became part of the national policy for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV). Data on 3535 HIV-positive pregnant women who were enrolled into the Ukraine European Collaborative Study in 2008-2010 were analysed. Factors associated with receipt of zidovudine monotherapy (AZTm) - rather than cART - and rates of mother-to-child transmission (MTCT) of HIV were investigated. cART coverage increased significantly, from 22% of deliveries in 2008 to 61% of those in 2010. After adjusting for possible confounders, initiation of antenatal AZTm - rather than cART - was associated with cohabiting (versus being married; adjusted prevalence ratio, aPR: 1.09; 95% confidence interval, CI: 1.02-1.16), at least two previous live births (versus none; aPR: 1.22; 95% CI: 1.11-1.35) and a diagnosis of HIV infection during the first or second trimester (versus before pregnancy; aPR: 1.11; 95% CI: 1.03-1.20). The overall MTCT rate was 4.1% (95% CI: 3.4-4.9); 42% (49/116) of the transmissions were from the 8% (n = 238) of women without antenatal ART. Compared with AZTm, cART was associated with a 70% greater reduction in the risk of MTCT (adjusted odds ratio: 0.30; 95% CI: 0.16-0.56). Between 2008 and 2010, access to antenatal cART improved substantially in Ukraine, but implementation of the World Health Organization's Option-B policy was slow. For MTCT to be eliminated in Ukraine, improvements in the retention of women in HIV care and further roll-out of Option B are urgently needed.

  11. Chimeric Human Skin Substitute Tissue: A Novel Treatment Option for the Delivery of Autologous Keratinocytes.

    PubMed

    Rasmussen, Cathy A; Allen-Hoffmann, B Lynn

    2012-04-01

    For patients suffering from catastrophic burns, few treatment options are available. Chimeric coculture of patient-derived autologous cells with a "carrier" cell source of allogeneic keratinocytes has been proposed as a means to address the complex clinical problem of severe skin loss. Currently, autologous keratinocytes are harvested, cultured, and expanded to form graftable epidermal sheets. However, epidermal sheets are thin, are extremely fragile, and do not possess barrier function, which only develops as skin stratifies and matures. Grafting is typically delayed for up to 4 weeks to propagate a sufficient quantity of the patient's cells for application to wound sites. Fully stratified chimeric bioengineered skin substitutes could not only provide immediate wound coverage and restore barrier function, but would simultaneously deliver autologous keratinocytes to wounds. The ideal allogeneic cell source for this application would be an abundant supply of clinically evaluated, nontumorigenic, pathogen-free, human keratinocytes. To evaluate this potential cell-based therapy, mixed populations of a green fluorescent protein-labeled neonatal human keratinocyte cell line (NIKS) and unlabeled primary keratinocytes were used to model the allogeneic and autologous components of chimeric monolayer and organotypic cultures. Relatively few autologous keratinocytes may be required to produce fully stratified chimeric skin substitute tissue substantially composed of autologous keratinocyte-derived regions. The need for few autologous cells interspersed within an allogeneic "carrier" cell population may decrease cell expansion time, reducing the time to patient application. This study provides proof of concept for utilizing NIKS keratinocytes as the allogeneic carrier for the generation of bioengineered chimeric skin substitute tissues capable of providing immediate wound coverage while simultaneously supplying autologous human cells for tissue regeneration.

  12. Treatment Options for Intraocular (Uveal) Melanoma

    MedlinePlus

    ... Cancer.gov on the Managing Cancer Care page. Contact Us More information about contacting us or receiving ... Facebook Twitter Instagram YouTube Google+ LinkedIn GovDelivery RSS CONTACT INFORMATION Contact Us LiveHelp Online Chat MORE INFORMATION ...

  13. Treatment Option Overview (Intraocular [Uveal] Melanoma)

    MedlinePlus

    ... Cancer.gov on the Managing Cancer Care page. Contact Us More information about contacting us or receiving ... Facebook Twitter Instagram YouTube Google+ LinkedIn GovDelivery RSS CONTACT INFORMATION Contact Us LiveHelp Online Chat MORE INFORMATION ...

  14. 48 CFR 1552.216-73 - Fixed rates for services-indefinite delivery/indefinite quantity contract.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... options, the clause should be modified to reflect the information and data for the base period and any... above cover all expenses, including report preparation, salaries, overhead, general and administrative...

  15. Drug-Loaded Nanoparticle Systems And Adult Stem Cells: A Potential Marriage For The Treatment Of Malignant Glioma?

    PubMed Central

    Auffinger, Brenda; Morshed, Ramin; Tobias, Alex; Cheng, Yu; Ahmed, Atique U; Lesniak, Maciej S

    2013-01-01

    Despite all recent advances in malignant glioma research, only modest progress has been achieved in improving patient prognosis and quality of life. Such a clinical scenario underscores the importance of investing in new therapeutic approaches that, when combined with conventional therapies, are able to effectively eradicate glioma infiltration and target distant tumor foci. Nanoparticle-loaded delivery systems have recently arisen as an exciting alternative to improve targeted anti-glioma drug delivery. As drug carriers, they are able to efficiently protect the therapeutic agent and allow for sustained drug release. In addition, their surface can be easily manipulated with the addition of special ligands, which are responsible for enhancing tumor-specific nanoparticle permeability. However, their inefficient intratumoral distribution and failure to target disseminated tumor burden still pose a big challenge for their implementation as a therapeutic option in the clinical setting. Stem cell-based delivery of drug-loaded nanoparticles offers an interesting option to overcome such issues. Their ability to incorporate nanoparticles and migrate throughout interstitial barriers, together with their inherent tumor-tropic properties and synergistic anti-tumor effects make these stem cell carriers a good fit for such combined therapy. In this review, we will describe the main nanoparticle delivery systems that are presently available in preclinical and clinical studies. We will discuss their mechanisms of targeting, current delivery methods, attractive features and pitfalls. We will also debate the potential applications of stem cell carriers loaded with therapeutic nanoparticles in anticancer therapy and why such an attractive combined approach has not yet reached clinical trials. PMID:23594406

  16. Three CEOs, Three Futures.

    ERIC Educational Resources Information Center

    Berry, John N., III

    1998-01-01

    Interviews with three CEOs--UMI (University Microfilms International), OCLC (Online Computer Library Center), and Gale Research--focus on outlooks for information and libraries. Discusses expanded educational Web services/courseware, library role in delivery, electronic dissertation publishing, digital data conversion, thesauri/indexing, union…

  17. Evolution of the scientific literature on drug delivery: A 1974-2015 bibliometric study.

    PubMed

    Robert, C; Wilson, C S; Venuta, A; Ferrari, M; Arreto, C-D

    2017-08-28

    This study charts the growth of the drug delivery literature published during 1974-2015 from journals indexed in the Science Citation Index Expanded database. The growth of publications on drug delivery paralleled the total scientific publications for three decades (1974-2003); however, from 2004 to 2015 it exploded fourfold, while the total increased only 1.75 fold. Industrialized countries (USA, UK, Germany, Japan, Italy, France and Canada) were the most prolific during the first decades, but in 2014-2015 China, India and South Korea ranked 1st, 3rd and 4th respectively among the productive countries. The number of participating countries increased fivefold (from 19 to 96). During the last 15years, the journals targeted by drug delivery research increased nearly 2.4 fold (416 to 1001) and three journals (Journal of Controlled Release, Advanced Drug Delivery Reviews, and International Journal of Pharmaceutics) published nearly one-fifth of the drug delivery research in 2014-2015. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Particulate delivery systems for biodefense subunit vaccines.

    PubMed

    Bramwell, Vincent W; Eyles, Jim E; Oya Alpar, H

    2005-06-17

    Expanding identification of potentially protective subunit antigens and correlates of protection has provided a basis for the introduction of safer vaccines. Despite encouraging results in animal models, the significant potential of particulate delivery systems in vaccine design has not yet translated into effective vaccines available for use in humans. This review article will focus on the current status of the development of particulate vaccines, mainly liposomes and bio-degradable polymers, against potential agents for biowarfare: plague, anthrax, botulinum, and smallpox; and filoviruses: Marburg and Ebola.

  19. Facilitating earlier transfer of care from acute stroke services into the community.

    PubMed

    Robinson, Jennifer

    This article outlines an initiative to reduce length of stay for stroke patients within an acute hospital and to facilitate earlier transfer of care. Existing care provision was remodelled and expanded to deliver stroke care to patients within a community bed-based intermediate care facility or intermediate care at home. This new model of care has improved the delivery of rehabilitation through alternative and innovative ways of addressing service delivery that meet the needs of the patients.

  20. A guide to transportation funding options : a web site development project, final report, June 30, 2008.

    DOT National Transportation Integrated Search

    2008-06-01

    As our nations transportation demand continues to grow due to population increases and an expanded : economy, elected officials at all levels of government are faced with difficult decisions regarding : mechanisms to adequately fund the maintenanc...

  1. Determining a sustainable and economically optimal wastewater treatment and discharge strategy.

    PubMed

    Hardisty, Paul E; Sivapalan, Mayuran; Humphries, Robert

    2013-01-15

    Options for treatment and discharge of wastewater in regional Western Australia (WA) are examined from the perspective of overall sustainability and social net benefit. Current practice in the state has typically involved a basic standard of treatment deemed to be protective of human health, followed by discharge to surface water bodies. Community and regulatory pressure to move to higher standards of treatment is based on the presumption that a higher standard of treatment is more protective of the environment and society, and thus is more sustainable. This analysis tests that hypothesis for Western Australian conditions. The merits of various wastewater treatment and discharge strategies are examined by quantifying financial costs (capital and operations), and by monetising the wider environmental and social costs and benefits of each option over an expanded planning horizon (30 years). Six technical treatment-disposal options were assessed at a test site, all of which met the fundamental criterion of protecting human health. From a financial perspective, the current business-as-usual option is preferred - it is the least cost solution. However, valuing externalities such as water, greenhouse gases, ecological impacts and community amenity, the status quo is revealed as sub-optimal. Advanced secondary treatment with stream disposal improves water quality and provides overall net benefit to society. All of the other options were net present value (NPV) negative. Sensitivity analysis shows that the favoured option outperforms all of the others under a wide range of financial and externality values and assumptions. Expanding the findings across the state reveals that moving from the identified socially optimal level of treatment to higher (tertiary) levels of treatment would result in a net loss to society equivalent to several hundred million dollars. In other words, everyone benefits from improving treatment to the optimum point. But society, the environment, and the Corporation are all worse off when treatment levels are pushed beyond what is economic and sustainable. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. Collimated proton pencil-beam scanning for superficial targets: impact of the order of range shifter and aperture

    NASA Astrophysics Data System (ADS)

    Bäumer, C.; Janson, M.; Timmermann, B.; Wulff, J.

    2018-04-01

    To assess if apertures shall be mounted upstream or downstream of a range shifting block if these field-shaping devices are combined with the pencil-beam scanning delivery technique (PBS). The lateral dose fall-off served as a benchmark parameter. Both options realizing PBS-with-apertures were compared to the uniform scanning mode. We also evaluated the difference regarding the out-of-field dose caused by interactions of protons in beam-shaping devices. The potential benefit of the downstream configuration over the upstream configuration was estimated analytically. Guided by this theoretical evaluation a mechanical adapter was developed which transforms the upstream configuration provided by the proton machine vendor to a downstream configuration. Transversal dose profiles were calculated with the Monte-Carlo based dose engine of the commercial treatment planning system RayStation 6. Two-dimensional dose planes were measured with an ionization chamber array and a scintillation detector at different depths and compared to the calculation. Additionally, a clinical example for the irradiation of the orbit was compared for both PBS options and a uniform scanning treatment plan. Assuming the same air gap the lateral dose fall-off at the field edge at a few centimeter depth is 20% smaller for the aperture-downstream configuration than for the upstream one. For both options of PBS-with-apertures the dose fall-off is larger than in uniform scanning delivery mode if the minimum accelerator energy is 100 MeV. The RayStation treatment planning system calculated the width of the lateral dose fall-off with an accuracy of typically 0.1 mm–0.3 mm. Although experiments and calculations indicate a ranking of the three delivery options regarding lateral dose fall-off, there seems to be a limited impact on a multi-field treatment plan.

  3. Expanding educational capacity through an innovative practice-education partnership.

    PubMed

    Murray, Teri A

    2007-07-01

    This article describes a unique demonstration project using a collaborative practice and education partnership to expand baccalaureate student education capacity by 75% in an accelerated nursing program. Components of the project include using hospital-paid (donated) master's clinicians as clinical faculty; using online course delivery for the non-clinical theory nursing courses, thereby decreasing the need for classroom space; employing a Web instructional designer to convert the existing master's nurse educator program to an online format in an effort to increase the pipeline of nursing faculty; renovating existing space to expand the nursing skills laboratory; and purchasing equipment and supplies for the simulated patient environment modules in the expanded skills laboratory space. Both formative and summative measures will be used to evaluate the project, which is expected to produce 24 additional workforce-ready baccalaureate-prepared RNs in 15 months.

  4. Delivering Breast Reconstruction Information to Patients: Women Report on Preferred Information Delivery Styles and Options.

    PubMed

    Webb, Carmen; Sharma, Vishal; Temple-Oberle, Claire

    2018-02-01

    To discover missed opportunities for providing information to women undergoing breast reconstruction in an effort to decrease regret and improve patient education, teaching modalities, and satisfaction. Thirty- to 45-minute semi-structured interviews were conducted exploring patient experiences with information provision on breast reconstruction. Purposeful sampling was used to include women with a variety of reconstruction types at different time points along their recovery. Using grounded theory methodology, 2 independent reviewers analyzed the transcripts and generated thematic codes based on patient responses. BREAST-Q scores were also collected to compare satisfaction scores with qualitative responses. Patients were interested in a wide variety of topics related to breast reconstruction including the pros and cons of different options, nipple-sparing mastectomies, immediate breast reconstruction, oncological safety/monitoring and the impact of chemotherapy and radiotherapy, secondary procedures (balancing, nipple reconstruction), post-operative recovery, and long-term expectations. Patients valued accessing information from multiple sources, seeing numerous photographs, being guided to reliable information online, and having access to a frequently asked questions file or document. Information delivery via interaction with medical personnel and previously reconstructed patients was most appreciated. Compared with BREAST-Q scores for satisfaction with the plastic surgeon (mean: 95.7, range: 60-100), informational satisfaction scores were lower at 74.7 (50-100), confirming the informational gaps expressed by interviewees. Women having recently undergone breast reconstruction reported key deficiencies in information provided prior to surgery and identified preferred information delivery options. Addressing women's educational needs is important to achieve appropriate expectations and improve satisfaction.

  5. Computational Trials: Unraveling Motility Phenotypes, Progression Patterns, and Treatment Options for Glioblastoma Multiforme

    PubMed Central

    Raman, Fabio; Scribner, Elizabeth; Saut, Olivier; Wenger, Cornelia; Colin, Thierry; Fathallah-Shaykh, Hassan M.

    2016-01-01

    Glioblastoma multiforme is a malignant brain tumor with poor prognosis and high morbidity due to its invasiveness. Hypoxia-driven motility and concentration-driven motility are two mechanisms of glioblastoma multiforme invasion in the brain. The use of anti-angiogenic drugs has uncovered new progression patterns of glioblastoma multiforme associated with significant differences in overall survival. Here, we apply a mathematical model of glioblastoma multiforme growth and invasion in humans and design computational trials using agents that target angiogenesis, tumor replication rates, or motility. The findings link highly-dispersive, moderately-dispersive, and hypoxia-driven tumors to the patterns observed in glioblastoma multiforme treated by anti-angiogenesis, consisting of progression by Expanding FLAIR, Expanding FLAIR + Necrosis, and Expanding Necrosis, respectively. Furthermore, replication rate-reducing strategies (e.g. Tumor Treating Fields) appear to be effective in highly-dispersive and moderately-dispersive tumors but not in hypoxia-driven tumors. The latter may respond to motility-reducing agents. In a population computational trial, with all three phenotypes, a correlation was observed between the efficacy of the rate-reducing agent and the prolongation of overall survival times. This research highlights the potential applications of computational trials and supports new hypotheses on glioblastoma multiforme phenotypes and treatment options. PMID:26756205

  6. A Comprehensive Assessment of Four Options for Financing Health Care Delivery in Oregon

    PubMed Central

    White, Chapin; Eibner, Christine; Liu, Jodi L.; Price, Carter C.; Leibowitz, Nora; Morley, Gretchen; Smith, Jeanene; Edlund, Tina; Meyer, Jack

    2017-01-01

    Abstract This article describes four options for financing health care for residents of the state of Oregon and compares the projected impacts and feasibility of each option. The Single Payer option and the Health Care Ingenuity Plan would achieve universal coverage, while the Public Option would add a state-sponsored plan to the Affordable Care Act (ACA) Marketplace. Under the Status Quo option, Oregon would maintain its expansion of Medicaid and subsidies for nongroup coverage through the ACA Marketplace. The state could cover all residents under the Single Payer option with little change in overall health care costs, but doing so would require cuts to provider payment rates that could worsen access to care, and implementation hurdles may be insurmountable. The Health Care Ingenuity Plan, a state-managed plan featuring competition among private plans, would also achieve universal coverage and would sever the employer–health insurance link, but the provider payment rates would likely be set too high, so health care costs would increase. The Public Option would be the easiest of the three options to implement, but because it would not affect many people, it would be an incremental improvement to the Status Quo. Policymakers will need to weigh these options against their desire for change to balance the benefits with the trade-offs. PMID:29057151

  7. Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species.

    PubMed

    Sobel, J D; Sobel, R

    2018-06-22

    Clinicians are increasingly challenged by patients with refractory vulvovaginal candidiasis (VVC) caused by azole-resistant Candida species. Fluconazole resistant C.albicans is a growing and perplexing problem following years of indiscriminate drug prescription and unnecessary drug exposure and for which there are few therapeutic alternatives. Regrettably, although the azole class of drugs has expanded, new classes of antifungal drugs have not been forthcoming, limiting effective treatment options in patients with azole resistant Candida vaginitis. Areas covered: This review covers published data on epidemiology, pathophysiology and treatment options for women with azole-resistant refractory VVC. Expert opinion: Fluconazole resistant C.albicans adds to the challenge of azole resistant non-albicans Candida spp. Both issues follow years of indiscriminate drug prescription and unnecessary fluconazole exposure. Although an understanding of azole resistance in yeast has been established, this knowledge has not translated into useful therapeutic advantage. Treatment options for such women with refractory symptoms are extremely limited. New therapeutic options and strategies are urgently needed to meet this challenge of azole drug resistance.

  8. Applying Real Options for Evaluating Investments in ERP Systems

    NASA Astrophysics Data System (ADS)

    Nakagane, Jun; Sekozawa, Teruji

    This paper intends to verify effectiveness of real options approach for evaluating investments in Enterprise Resource Planning systems (ERP) and proves how important it is to disclose shadow options potentially embedded in ERP investment. The net present value (NPV) method is principally adopted to evaluate the value of ERP. However, the NPV method assumes no uncertainties exist in the object. It doesn't satisfy the current business circumstances which are filled with dynamic issues. Since the 1990s the effectiveness of option pricing models for Information System (IS) investment to solve issues in the NPV method has been discussed in the IS literature. This paper presents 3 business cases to review the practical advantages of such techniques for IS investments, especially ERP investments. The first case is EDI development. We evaluate the project by a new approach with lighting one of shadow options, EDI implementation. In the second case we reveal an ERP investment has an “expanding option” in a case of eliminating redundancy. The third case describes an option to contract which is deliberately slotted in ERP development to prepare transferring a manufacturing facility.

  9. Converting existing real estate assets to cash through off-balance sheet financing.

    PubMed

    Cella, M D

    1994-01-01

    Hospitals are realizing that they can tap hidden equity tied up in their medical office buildings and other ancillary facilities and use the capital to grow their core health care business, retool patient rooms, purchase equipment, technology, and physician practices, or simply pay down debt. Through selling their ancillary real estate assets, they can generate much-needed capital liquidity, yet still retain the control they need through restrictive covenants on uses and tenancies, repurchase options, rights of first refusal, and master leasing with creative options to expand or contract.

  10. 48 CFR 42.1502 - Policy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... single-agency task order and delivery order contracts, the contracting officer may require performance... ADMINISTRATION AND AUDIT SERVICES Contractor Performance Information 42.1502 Policy. (a) Past performance... orders with a period of performance, including options, exceeding one year. These evaluations are...

  11. Innovative approaches for increasing transportation options for people with disabilities in Florida.

    DOT National Transportation Integrated Search

    2010-04-01

    Accessible, affordable, and reliable transportation is a critical component to community inclusion. : Having access to the community is the key to many aspects of independence and self-sufficiency. : Floridas transportation delivery system is very...

  12. Positioning Medical Assistants for a Greater Role in the Era of Health Reform.

    PubMed

    Chapman, Susan A; Marks, Angela; Dower, Catherine

    2015-10-01

    Medical assistants (MAs) are one of the fastest-growing occupations in the United States. As of 2014 there were about 585,000 MAs in the United States, and the Bureau of Labor Statistics projected the MA workforce to grow by 29% from 2012 to 2022. The MA population is primarily female, ethnically and racially diverse, and paid about $15.01 per hour. MAs are primarily educated in private schools, many at for-profit institutions. The MA curriculum and length of training can be quite varied and can lead to uneven preparation for practice. Traditionally, the MA role has involved a limited clinical role and little involvement with team care, particularly in larger practices or clinics. Medical groups, clinics, and health systems are now taking a new look at MAs and how they can play a greater role in reforming health care delivery models. Expanded roles for MAs might include health coach, referral coordinator, disease registry manager, and health screener using protocols. In expanding MA roles, education and regulatory issues need to be addressed by the provider community including current inconsistent regulation and certification requirements and the lack of preparation for expanded roles in traditional MA training programs. MAs are well positioned to help address challenges in the health care delivery system including improving access to care while reducing overall cost. Successful model practices using MAs in expanded roles need further formal evaluation and replication across practice settings.

  13. Forecasting the demand for privatized transport : what economic regulators should know and why

    DOT National Transportation Integrated Search

    2001-09-01

    While public-private partnerships in the delivery of transport infrastructures and services is expanding, there is also growing evidence of the lack of appreciation of the importance of demand forecasting in preparing and monitoring these partnership...

  14. 76 FR 24006 - Notice of Proposed Information Collection Requests

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-29

    ... provide low-income parents residing in the District of Columbia with expanded options for the education of... authorizing statute requires the mandated evaluation to address changes in parents' school involvement and... DEPARTMENT OF EDUCATION Notice of Proposed Information Collection Requests AGENCY: Department of...

  15. Human factors research needs for the Intelligent Vehicle Initiative (IVI) program : summary report

    DOT National Transportation Integrated Search

    2004-10-01

    This report is about expanding options for personal transportation. In particular, it is about making the changes needed in America's transportation system to encourage greater use of human-powered travel modes. It is about two of the oldest and simp...

  16. University Child Care Proposal.

    ERIC Educational Resources Information Center

    Eastern Michigan Univ., Ypsilanti.

    Options for expanding child care services to Eastern Michigan University students, staff, and faculty are presented by the special assistant to the university vice president for university marketing and student affairs. The university's policy statement concerning child care services is considered, along with the relationship of these services to…

  17. Water Reuse and Soil Column Studies for Alternative Water Resource Development

    EPA Science Inventory

    The National Risk Management Research Laboratory (NRMRL) of the U.S. Environmental Protection Agency’s (EPA) Office of Research and Development (ORD) has developed a holistic water research program in order to identify engineering and management options for safe and expanded use ...

  18. Time-Domain Reflectometry for Tamper Indication in Unattended Monitoring Systems for Safeguards

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

    Tedeschi, Jonathan R.; Smith, Leon E.; Moore, David E.

    2014-12-01

    The International Atomic Energy Agency (IAEA) continues to expand its use of unattended, remotely monitored measurement systems. An increasing number of systems and an expanding family of instruments create challenges in terms of deployment efficiency and the implementation of data authentication measures. Pacific Northwest National Laboratory (PNNL) leads a collaboration that is exploring various tamper-indicating (TI) measures that could help to address some of the long-standing detector and data-transmission authentication challenges with IAEA’s unattended systems. PNNL is investigating the viability of active time-domain reflectometry (TDR) along two parallel but interconnected paths: (1) swept-frequency TDR as the highly flexible, laboratory goldmore » standard to which field-deployable options can be compared, and (2) a low-cost commercially available spread-spectrum TDR technology as one option for field implementation. This report describes PNNL’s progress and preliminary findings from the first year of the study, and describes the path forward.« less

  19. Recent clinical trials in valvular heart disease.

    PubMed

    Kiss, Daniel; Anwaruddin, Saif

    2017-07-01

    With widespread adoption of transcatheter aortic valve replacement, there has been a change in the approach to management of valvular heart disease. New interest has taken hold in transcatheter therapies for valvular heart disease, as well as research into pathophysiology and progression of disease. Additionally, several key trials have further refined our understanding of surgical management of valvular heart disease. This review will elucidate recent clinical trial data leading to changes in practice. There have been several landmark trials expanding the indications for transcatheter aortic valve replacement. Additionally, although still early, trials are beginning to demonstrate the feasibility and safety of transcatheter mitral valves. Options for transcatheter management of right-sided valvular disease continue to evolve, and these are areas of active investigation. The emergence of novel therapies for valvular heart disease has expanded the management options available, allowing physicians to better individualize treatment of patients with valvular heart disease. This review will focus on the recent (within 2 years) trials in this field of interest.

  20. Improving the Design of a Conservation Reserve for a Critically Endangered Species

    PubMed Central

    2017-01-01

    Setting aside protected areas is a key strategy for tackling biodiversity loss. Reserve effectiveness depends on the extent to which protected areas capture both known occurrences and areas likely to support the species. We assessed the effectiveness of the existing reserve network for Leadbeater’s Possum (Gymnobelideus leadbeateri) and other forest-dependent species, and compared the existing reserve system to a set of plausible reserve expansion options based on area targets implied in a recent Population Viability Analysis (PVA). The existing Leadbeater’s Reserve and surrounding reserve system captured 7.6% and 29.6% of cumulative habitat suitability, respectively, across the landscape. Expanded reserve scenarios captured 34% to 62% of cumulative habitat suitability. We found acute trade-offs between conserving Leadbeater’s Possum habitat and conserving habitat of other forest-dependent species. Our analysis provides a template for systematically expanding and evaluating reserve expansion options in terms of trade-offs between priority species’ needs. PMID:28121984

  1. Next step in antibiotic stewardship: Pharmacist-provided penicillin allergy testing.

    PubMed

    Gugkaeva, Z; Crago, J S; Yasnogorodsky, M

    2017-08-01

    Penicillin allergy limits therapeutic options for patients but often disappears over time, leaving patients erroneously labelled allergic and leading to the utilization of broad-spectrum and more expensive antibiotics. Penicillin allergy can be effectively assessed via skin testing. To improve patient access to penicillin allergy testing by implementing a pharmacist-provided service in a hospital setting. Beta-lactams remain a mainstream therapy for many infections due to their effectiveness, low side effects and affordability. Typically, patient access to penicillin allergy testing is limited by the availability of allergy specialists, who traditionally perform such testing. A pharmacist-provided penicillin allergy testing service was implemented at our hospital in 2015 and became a powerful antibiotic stewardship tool. Removing penicillin allergy from patient profiles significantly expanded therapeutic options, expedited discharges and reduced costs of care. Pharmacists can expand patient access to penicillin allergy testing. Pharmacist-provided penicillin allergy testing permitted optimized antibiotic treatment and expedited discharges. © 2017 John Wiley & Sons Ltd.

  2. Age correction in monitoring audiometry: method to update OSHA age-correction tables to include older workers

    PubMed Central

    Dobie, Robert A; Wojcik, Nancy C

    2015-01-01

    Objectives The US Occupational Safety and Health Administration (OSHA) Noise Standard provides the option for employers to apply age corrections to employee audiograms to consider the contribution of ageing when determining whether a standard threshold shift has occurred. Current OSHA age-correction tables are based on 40-year-old data, with small samples and an upper age limit of 60 years. By comparison, recent data (1999–2006) show that hearing thresholds in the US population have improved. Because hearing thresholds have improved, and because older people are increasingly represented in noisy occupations, the OSHA tables no longer represent the current US workforce. This paper presents 2 options for updating the age-correction tables and extending values to age 75 years using recent population-based hearing survey data from the US National Health and Nutrition Examination Survey (NHANES). Both options provide scientifically derived age-correction values that can be easily adopted by OSHA to expand their regulatory guidance to include older workers. Methods Regression analysis was used to derive new age-correction values using audiometric data from the 1999–2006 US NHANES. Using the NHANES median, better-ear thresholds fit to simple polynomial equations, new age-correction values were generated for both men and women for ages 20–75 years. Results The new age-correction values are presented as 2 options. The preferred option is to replace the current OSHA tables with the values derived from the NHANES median better-ear thresholds for ages 20–75 years. The alternative option is to retain the current OSHA age-correction values up to age 60 years and use the NHANES-based values for ages 61–75 years. Conclusions Recent NHANES data offer a simple solution to the need for updated, population-based, age-correction tables for OSHA. The options presented here provide scientifically valid and relevant age-correction values which can be easily adopted by OSHA to expand their regulatory guidance to include older workers. PMID:26169804

  3. Age correction in monitoring audiometry: method to update OSHA age-correction tables to include older workers.

    PubMed

    Dobie, Robert A; Wojcik, Nancy C

    2015-07-13

    The US Occupational Safety and Health Administration (OSHA) Noise Standard provides the option for employers to apply age corrections to employee audiograms to consider the contribution of ageing when determining whether a standard threshold shift has occurred. Current OSHA age-correction tables are based on 40-year-old data, with small samples and an upper age limit of 60 years. By comparison, recent data (1999-2006) show that hearing thresholds in the US population have improved. Because hearing thresholds have improved, and because older people are increasingly represented in noisy occupations, the OSHA tables no longer represent the current US workforce. This paper presents 2 options for updating the age-correction tables and extending values to age 75 years using recent population-based hearing survey data from the US National Health and Nutrition Examination Survey (NHANES). Both options provide scientifically derived age-correction values that can be easily adopted by OSHA to expand their regulatory guidance to include older workers. Regression analysis was used to derive new age-correction values using audiometric data from the 1999-2006 US NHANES. Using the NHANES median, better-ear thresholds fit to simple polynomial equations, new age-correction values were generated for both men and women for ages 20-75 years. The new age-correction values are presented as 2 options. The preferred option is to replace the current OSHA tables with the values derived from the NHANES median better-ear thresholds for ages 20-75 years. The alternative option is to retain the current OSHA age-correction values up to age 60 years and use the NHANES-based values for ages 61-75 years. Recent NHANES data offer a simple solution to the need for updated, population-based, age-correction tables for OSHA. The options presented here provide scientifically valid and relevant age-correction values which can be easily adopted by OSHA to expand their regulatory guidance to include older workers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Solar PV leasing in Singapore: enhancing return on investments with options

    NASA Astrophysics Data System (ADS)

    Song, Shuang; Poh, K. L.

    2017-05-01

    Renewable energy is getting more important nowadays as an alternative to traditional energies. Solar energy, according to Energy Market Authority, is the most viable in the context of Singapore compared to other renewable energy sources due to land constraints. In light of the increasing adoption of solar power in Singapore, this paper focuses on solar PV leasing using a case study. This paper assesses the prospect for solar PV leasing companies in Singapore through the lens of embedded real options. The recent news that solar power is becoming the cheapest form of new electricity presents the leasing company an option to expand the scale of solar PV system. Taking into account this option, the Net Present Value (NPV) of the investment increased significantly compared to the case without real options. Technological developments result in a continuously changing environment with uncertainties. Thus, decision makers need to be aware of the inherent risk associated and identify options to maximize NPV. This upside potential is realized by exercising the managerial flexibility and exploiting the uncertainty. The paper enables solar energy planners to consider possible managerial flexibilities under uncertainties, showing how option thinking can be incorporated in the valuation of solar energy.

  5. Evaluating technology service options.

    PubMed

    Blumberg, D F

    1997-05-01

    Four service and support options are available to healthcare organizations for maintaining their growth arsenals of medical and information technology. These options include maintaining and servicing all equipment using a facility-based biomedical engineering and MIS service department; using a combination of facility-based service and subcontracted service; expanding facility-based biomedical and MIS service departments to provide service to other healthcare organizations to achieve economies of scale; and outsourcing all maintenance, repair, and technical support services. Independent service companies and original equipment manufacturers (OEMs) are offering healthcare organizations a wider array of service and support capabilities than ever before. However, some health systems have successfully developed their own independent service organizations to take care of their own--and other healthcare organizations'--service and support needs.

  6. Development In Drug Targeting And Delivery In Cervical Cancer.

    PubMed

    Aggarwal, Urvashi; Goyal, Amit Kumar; Rath, Goutam

    2017-10-09

    Cervical cancer is the second most common cancer in women. Standard treatment options available for cervical cancer including chemotherapy, surgery and radiation therapy associated with their own side effects and toxicities. Tumor-targeted delivery of anticancer drugs is perhaps one of the most appropriate strategies to achieve optimal outcomes from treatment and improve quality of life. Recently nanocarriers based drug delivery systems owing to their unique properties have been extensively investigated for anticancer drug delivery. In addition to that addressing the anatomical significance of cervical cancer, various local drug delivery strategies for the cancer treatment are introduced like: gels, nanoparticles, polymeric films, rods and wafers, lipid based nanocarrier. Localized drug delivery systems allows passive drug targeting results in high drug concentration at the target site. Further they can be tailor made to achieve both sustained and controlled release behavior, substantially improving therapeutic outcomes and minimizing side effects. This review summarizes the meaningful advances in drug delivery strategies to treat cervical cancer. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  7. When all seems lost: management of refractory constipation-Surgery, rectal irrigation, percutaneous endoscopic colostomy, and more.

    PubMed

    Wilkinson-Smith, V; Bharucha, A E; Emmanuel, A; Knowles, C; Yiannakou, Y; Corsetti, M

    2018-05-01

    While the pharmacological armamentarium for chronic constipation has expanded over the past few years, a substantial proportion of constipated patients do not respond to these medications. This review summarizes the pharmacological and behavioral options for managing constipation and details the management of refractory constipation. Refractory constipation is defined as an inadequate improvement in constipation symptoms evaluated with an objective scale despite adequate therapy (ie, pharmacological and/or behavioral) that is based on the underlying pathophysiology of constipation. Minimally invasive (ie, rectal irrigation and percutaneous endoscopic colostomy) and surgical therapies are used to manage refractory constipation. This review appraises these options, and in particular, percutaneous endoscopic colostomy, which as detailed by an article in this issue, is a less invasive option for managing refractory constipation than surgery. While these options benefit some patients, the evidence of the risk: benefit profile for these therapies is limited. © 2018 John Wiley & Sons Ltd.

  8. Introduction strategies raise key questions.

    PubMed

    Finger, W R; Keller, S

    1995-09-01

    Key issues that must be considered before a new contraceptive is introduced center on the need for a trained provider to begin or terminate the method, its side effects, duration of use, method's ability to meet users' needs and preferences, and extra training or staff requirements. Logistics and economic issues to consider are identifying a dependable way of effectively supplying commodities, planning extra services needed for the method, and cost of providing the method. Each contraceptive method presents a different side effect pattern and burdens the service delivery setting differently. The strategy developed to introduce or expand the 3-month injectable Depo-Provera (DMPA) can be used for any method. It includes a needs assessment and addresses regulatory issues, service delivery policies and procedures, information and training, evaluation, and other concerns. Viet Nam's needs assessment showed that Norplant should not be introduced until the service delivery system becomes stronger. Any needs assessment for expansion of contraceptive services should cover sexually transmitted disease/HIV issues. A World Health Organization strategy helps officials identify the best method mix for local situations. Introductory strategies must aim to improve the quality of family planning programs and expand choices. Many begin by examining existing data and conducting interviews with policymakers, users, providers, and women's health advocates. Introductory programs for Norplant focus on provider training, adequate counseling and informed consent for users, and ready access to removal. They need a well-prepared service delivery infrastructure. The first phase of the DMPA introductory strategy for the Philippines comprised a social marketing campaign and DMPA introduction at public clinics in 10 pilot areas with strong service delivery. Successful AIDS prevention programs show that people tend to use barrier methods when they are available. USAID is currently studying whether or not women in developing countries will use the female condom.

  9. NWEA Professional Learning

    ERIC Educational Resources Information Center

    Northwest Evaluation Association, 2016

    2016-01-01

    This comprehensive brochure presents how the Northwest Evaluation Association's professional development offerings--plus flexible delivery options designed for busy lives--can make it easier to utilize data. This brochure explores a range of workshops, coaching, online learning, and professional development packages to meet educators' needs and…

  10. 78 FR 140 - Self-Regulatory Organizations; The Options Clearing Corporation; Notice of Filing and Immediate...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-02

    ...\\ thereunder so that the proposal was effective upon filing with the Commission. The Commission is publishing... initial Delivery Orders (``DO'') for a variety of reasons (e.g., DK, wrong quantity, wrong security, wrong...

  11. Optimization of European call options considering physical delivery network and reservoir operation rules

    NASA Astrophysics Data System (ADS)

    Cheng, Wei-Chen; Hsu, Nien-Sheng; Cheng, Wen-Ming; Yeh, William W.-G.

    2011-10-01

    This paper develops alternative strategies for European call options for water purchase under hydrological uncertainties that can be used by water resources managers for decision making. Each alternative strategy maximizes its own objective over a selected sequence of future hydrology that is characterized by exceedance probability. Water trade provides flexibility and enhances water distribution system reliability. However, water trade between two parties in a regional water distribution system involves many issues, such as delivery network, reservoir operation rules, storage space, demand, water availability, uncertainty, and any existing contracts. An option is a security giving the right to buy or sell an asset; in our case, the asset is water. We extend a flow path-based water distribution model to include reservoir operation rules. The model simultaneously considers both the physical distribution network as well as the relationships between water sellers and buyers. We first test the model extension. Then we apply the proposed optimization model for European call options to the Tainan water distribution system in southern Taiwan. The formulation lends itself to a mixed integer linear programming model. We use the weighing method to formulate a composite function for a multiobjective problem. The proposed methodology provides water resources managers with an overall picture of water trade strategies and the consequence of each strategy. The results from the case study indicate that the strategy associated with a streamflow exceedence probability of 50% or smaller should be adopted as the reference strategy for the Tainan water distribution system.

  12. 7 CFR 3405.6 - Scope of program.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... new ideas and techniques. (v) Expand competence with new methods of information delivery, such as... and agricultural sciences higher education programs. A proposal may request support for acquiring new... the food and agricultural sciences unless limited by determinations as specified in the annual program...

  13. 7 CFR 3406.11 - Scope of a teaching proposal.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... new subjects, or new applications of knowledge, pertaining to the food and agricultural sciences. (2... new ideas and techniques. (v) Expand competence with new methods of information delivery, such as... Agriculture Regulations of the Department of Agriculture (Continued) COOPERATIVE STATE RESEARCH, EDUCATION...

  14. 7 CFR 3405.6 - Scope of program.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... new subjects, or new applications of knowledge, pertaining to the food and agricultural sciences. (2... new ideas and techniques. (v) Expand competence with new methods of information delivery, such as... and agricultural sciences higher education programs. A proposal may request support for acquiring new...

  15. Alternative Fuels Data Center: Kern County Schools Expands CNG Station for

    Science.gov Websites

    23, 2016 Photo of a truck Fair Oaks Farm Harnesses the Power of Natural Gas from Cow Manure July 9 . 17, 2011 Natural Gas Powers Milk Delivery Trucks in Indiana Aug. 20, 2011 Reynolds Logistics Reduces

  16. University Degree: A Requirement for Canadian Nurses by the Year 2000.

    ERIC Educational Resources Information Center

    Ellerton, Mary-Lou; Downe-Wamboldt, B.

    1984-01-01

    Indicates that university preparation will be a minimum requirement for nurses entering the profession in Canada by the year 2000. Discusses the expanding role of nurses in the health care delivery system and the benefits of a liberal education. (JAC)

  17. Critical Media Literacy Is Not an Option

    ERIC Educational Resources Information Center

    Kellner, Douglas; Share, Jeff

    2007-01-01

    This article explores the theoretical underpinnings of critical media literacy and analyzes four different approaches to teaching it. Combining cultural studies with critical pedagogy, we argue that critical media literacy aims to expand the notion of literacy to include different forms of media culture, information and communication technologies…

  18. Has "No Child" Left behind the Constitution?

    ERIC Educational Resources Information Center

    McColl, Ann

    2005-01-01

    The No Child Left Behind (NCLB) Act, the 2001 reauthorization of President Lyndon Johnson's Elementary and Secondary Education Act of 1965, symbolizes all things good and bad in education. While its basic concepts--accountability for results, research-based education programs, increased parental options, and expanded local control and…

  19. Expanding career options.

    PubMed

    Benton, D; Ramprogus, Y

    1996-10-23

    The changing nature of today's employment environment means that nurses must be prepared to develop within roles and through lateral career moves. To coincide with the establishment of the Health Care Practice Research Centre at the University of Northumberland, this report describes the innovative approaches to career management being developed there.

  20. Expanding Cervical Cancer Screening and Treatment in Tanzania: Stakeholders’ Perceptions of Structural Influences on Scale-Up

    PubMed Central

    Giattas, Mary Rose; Sahasrabuddhe, Vikrant V.; Jolly, Pauline E.; Martin, Michelle Y.; Usdan, Stuart Lawrence; Kohler, Connie; Lisovicz, Nedra

    2015-01-01

    Tanzania has the highest burden of cervical cancer in East Africa. This study aims to identify perceived barriers and facilitators that influence scale-up of regional and population-level cervical cancer screening and treatment programs in Tanzania. Convenience sampling was used to select participants for this qualitative study among 35 key informants. Twenty-eight stakeholders from public-sector health facilities, academia, government, and nongovernmental organizations completed in-depth interviews, and a seven-member municipal health management team participated in a focus group discussion. The investigation identified themes related to the infrastructure of health services for cervical cancer prevention, service delivery, political will, and sociocultural influences on screening and treatment. Decentralizing service delivery, improving access to screening and treatment, increasing the number of trained health workers, and garnering political will were perceived as key facilitators for enhancing and initiating screening and treatment services. In conclusion, participants perceived that system-level structural factors should be addressed to expand regional and population-level service delivery of screening and treatment. Implications for Practice: Tanzanian women have a high burden of cervical cancer. Understanding the perceived structural factors that may influence screening coverage for cervical cancer and availability of treatment may be beneficial for program scale-up. This study showed that multiple factors contribute to the challenge of cervical cancer screening and treatment in Tanzania. In addition, it highlighted systematic developments aimed at expanding services. This study is important because the themes that emerged from the results may help inform programs that plan to improve screening and treatment in Tanzania and potentially in other areas with high burdens of cervical cancer. PMID:25926351

  1. Maturation of the infant microbiome community structure and function across multiple body sites and in relation to mode of delivery.

    PubMed

    Chu, Derrick M; Ma, Jun; Prince, Amanda L; Antony, Kathleen M; Seferovic, Maxim D; Aagaard, Kjersti M

    2017-03-01

    Human microbial communities are characterized by their taxonomic, metagenomic and metabolic diversity, which varies by distinct body sites and influences human physiology. However, when and how microbial communities within each body niche acquire unique taxonomical and functional signatures in early life remains underexplored. We thus sought to determine the taxonomic composition and potential metabolic function of the neonatal and early infant microbiota across multiple body sites and assess the effect of the mode of delivery and its potential confounders or modifiers. A cohort of pregnant women in their early third trimester (n = 81) were prospectively enrolled for longitudinal sampling through 6 weeks after delivery, and a second matched cross-sectional cohort (n = 81) was additionally recruited for sampling once at the time of delivery. Samples across multiple body sites, including stool, oral gingiva, nares, skin and vagina were collected for each maternal-infant dyad. Whole-genome shotgun sequencing and sequencing analysis of the gene encoding the 16S rRNA were performed to interrogate the composition and function of the neonatal and maternal microbiota. We found that the neonatal microbiota and its associated functional pathways were relatively homogeneous across all body sites at delivery, with the notable exception of the neonatal meconium. However, by 6 weeks after delivery, the infant microbiota structure and function had substantially expanded and diversified, with the body site serving as the primary determinant of the composition of the bacterial community and its functional capacity. Although minor variations in the neonatal (immediately at birth) microbiota community structure were associated with the cesarean mode of delivery in some body sites (oral gingiva, nares and skin; R 2 = 0.038), this was not true for neonatal stool (meconium; Mann-Whitney P > 0.05), and there was no observable difference in community function regardless of delivery mode. For infants at 6 weeks of age, the microbiota structure and function had expanded and diversified with demonstrable body site specificity (P < 0.001, R 2 = 0.189) but without discernable differences in community structure or function between infants delivered vaginally or by cesarean surgery (P = 0.057, R 2 = 0.007). We conclude that within the first 6 weeks of life, the infant microbiota undergoes substantial reorganization, which is primarily driven by body site and not by mode of delivery.

  2. Maturation of the Infant Microbiome Community Structure and Function Across Multiple Body Sites and in Relation to Mode of Delivery

    PubMed Central

    Chu, Derrick M.; Ma, Jun; Prince, Amanda L.; Antony, Kathleen M.; Seferovic, Maxim D.; Aagaard, Kjersti M.

    2017-01-01

    Human microbial communities are characterized by their taxonomic, metagenomic, and metabolic diversity, which varies by distinct body sites and influences human physiology. However, when and how microbial communities within each body niche acquire unique taxonomical and functional signatures in early life remains underexplored. We thus sought to assess the taxonomic composition and potential metabolic function of the neonatal and early infant microbiota across multiple body sites, and assess the impact of mode of delivery and its potential confounders or modifiers. A cohort of pregnant women in their early 3rd trimester (n=81) were prospectively enrolled for longitudinal sampling through 6 weeks post-delivery, and a second matched cross-sectional cohort (n=81) was additionally recruited for sampling once at delivery. Samples were collected for each maternal-infant dyad across multiple body sites, including stool, oral gingiva, nares, skin and vagina. 16S rRNA gene sequencing analysis and whole genome shotgun sequencing was performed to interrogate the composition and function of the neonatal and maternal microbiota. We found that the neonatal microbiota and its associated functional pathways were relatively homogenous across all body sites at delivery, with the notable exception of neonatal meconium. However, by 6 weeks, the infant microbiota structure and function had significantly expanded and diversified, with body site serving as the primary determinant of the bacterial community composition and its functional capacity. Although minor variations in the neonatal (immediately at birth) microbiota community structure were associated with Cesarean delivery in some body sites (oral, nares, and skin; R2 = 0.038), this was not true in neonatal stool (meconium, Mann-Whitney p>0.05) and there was no observable difference in community function regardless of delivery mode. By 6 weeks of age, the infant microbiota structure and function had expanded and diversified with demonstrable body site specificity (p<0.001, R2 = 0.189), and no discernable differences in neither community structure nor function by Cesarean delivery were identifiable (p=0.057, R2 = 0.007). We conclude that within the first 6 weeks of life, the infant microbiota undergoes significant reorganization that is primarily driven by body site and not by mode of delivery. PMID:28112736

  3. Reversal of Vascular Calcification and Aneurysms in a Rat Model Using Dual Targeted Therapy with EDTA- and PGG-Loaded Nanoparticles

    PubMed Central

    Nosoudi, Nasim; Chowdhury, Aniqa; Siclari, Steven; Karamched, Saketh; Parasaram, Vaideesh; Parrish, Joe; Gerard, Patrick; Vyavahare, Narendra

    2016-01-01

    Degeneration of elastic lamina and vascular calcification are common features of vascular pathology such as aortic aneurysms. We tested whether dual therapy with targeted nanoparticles (NPs) can remove mineral deposits (by delivery of a chelating agent, ethylene diamine tetraacetic acid (EDTA)) and restore elastic lamina (by delivery of a polyphenol, pentagalloyl glucose (PGG)) to reverse moderate aneurysm development. EDTA followed by PGG NP delivery led to reduction in macrophage recruitment, matrix metalloproteinase (MMP) activity, elastin degradation and calcification in the aorta as compared to delivery of control blank NPs. Such dual therapy restored vascular elastic lamina and improved vascular function as observed by improvement in circumferential strain. Therefore, dual targeted therapy may be an attractive option to remove mineral deposits and restore healthy arterial structures in moderately developed aneurysms. PMID:27698934

  4. Review of applications of microneedling in dermatology

    PubMed Central

    Iriarte, Christopher; Awosika, Olabola; Rengifo-Pardo, Monica; Ehrlich, Alison

    2017-01-01

    Microneedling (MN) is a novel therapeutic modality in dermatology. Through physical trauma from needle penetration, MN induces a wound healing cascade with minimal damage to the epidermis. This allows for enhancement in the absorption of mainstay topical therapies across the thick stratum corneum. MN has become increasingly utilized over the last several years as it is a relatively simple procedure that is cost-effective, well tolerated, and offers both cosmetic and therapeutic benefits. The ability to treat localized areas of disease has led to numerous studies gauging its potential in focal diseases of inflammation, dyschromia, and photodamage. This review discusses the principles and evidence behind the expanding applications of MN. It has shown promising results as an adjuvant therapy for enhanced drug delivery in the treatment of atrophic scars, alopecia, actinic keratoses, and disorders of pigmentation such as melasma. The efficacy in treatment of vitiligo remains limited. Overall, the procedure has few adverse sequelae compared to other therapies, is highly efficacious, and is a viable resurfacing option for skin of color. Future research is needed to determine the frequency, interval, and specific device settings that foster optimal results. Additionally, large controlled trials are needed to shed light on the utility of MN as an evidence-based regimen for the treatment of various dermatologic conditions. PMID:28848356

  5. Expanding contraceptive choice in the developing world: lessons from the Lao People's Democratic Republic and the Republic of Zambia.

    PubMed

    d'Arcangues, Catherine M; Ba-Thike, Katherine; Say, Lale

    2013-12-01

    Women need different forms of contraception over their lifetime. In the developed world, they have access to some 20 different methods. In developing countries, only a few options are available. This paper focuses on four under-used methods: intrauterine devices, implants, emergency contraception and female condoms. It examines reasons for their low uptake, strategies used for their adoption, and challenges in sustaining these efforts, in two countries: Laos and Zambia. In-country documentation and reports from international partners were reviewed; questionnaires were sent and interviews carried out with ministry officials, senior providers, and local representatives of international organisations and international non-governmental organisations. In Laos, the family planning programme is relatively young; its challenges include ensuring the sustainability of services and supplies, improving the quality of IEC to dispel misconceptions surrounding contraception, and developing novel distribution systems to reach rural populations. Zambia has a much older programme, which lost ground in the face of competing health priorities. Its challenges include strengthening the supply chain management, coordinating the multiple groups of providers and ensuring the sustainability of services in rural areas. The contrast offered by Laos and Zambia illustrates the importance of regular evaluation to identify priority areas for improving contraceptive delivery.

  6. Monomorphous Plurihormonal Pituitary Adenoma of Pit-1 Lineage in a Giant Adolescent with Central Hyperthyroidism.

    PubMed

    Pereira, Bernardo Dias; Raimundo, Luísa; Mete, Ozgur; Oliveira, Ana; Portugal, Jorge; Asa, Sylvia L

    2016-03-01

    Thyrotropin (TSH)-secreting pituitary adenomas are exceedingly rare at the pediatric age and no cases of co-secretion with other pituitary hormones in these tumors have been described in this age range. We present a case of a monomorphous plurihormonal pituitary adenoma that co-secreted TSH and GH in a pediatric patient. A 13-year-old male presented with increasing height velocity (17.75 cm/year, 9.55SD), weight loss, and visual impairment. Initial biochemical evaluations revealed secondary hyperthyroidism. A giant pituitary tumor compressing the surrounding structures was detected by magnetic resonance, and a transsphenoidal surgery was initially performed. Pathological examinations revealed an atypical, monomorphous plurihormonal Pit-1 lineage tumor with mixed features of silent subtype 3 adenoma and acidophil stem cell adenoma. In the postoperative period, secondary hyperthyroidism recurred with high levels of both GH and IGF1. In addition, due to tumor re-growth, a multimodality treatment plan was undertaken including surgery, somatostatin analogs, and radiotherapy. We report the first pediatric case of a plurihormonal TSH- and GH-secreting pituitary adenoma, further expanding the clinical manifestations of pediatric pituitary tumors. Comprehensive pathological evaluation and close follow-up surveillance are crucial to the prompt delivery of the best therapeutic options in the context of this particularly aggressive pituitary tumor.

  7. Treatment and prevention of HIV infection with long-acting antiretrovirals.

    PubMed

    Benítez-Gutiérrez, Laura; Soriano, Vicente; Requena, Silvia; Arias, Ana; Barreiro, Pablo; de Mendoza, Carmen

    2018-05-01

    Current antiretroviral therapy allows to achieve and sustain maximal suppression of HIV replication in most treated patients. As result, the life expectancy of HIV-infected persons has improved dramatically and is nowadays similar to that of the HIV-negative population. However, oral antiretrovirals have to be taken daily and indefinitely to avoid resumption of HIV replication and selection of drug resistance. Unfortunately, drug adherence is often suboptimal and tends to decline over time. Areas covered: New drugs, formulations and delivery systems are being developed for extended-release of antiretrovirals. At this time, intramuscular cabotegravir and rilpivirine, dapivirine vaginal rings and tenofovir alafenamide subdermal implants are the products in more advanced stages of clinical development. Their pharmacokinetics/dynamics and safety/efficacy are reviewed. Expert commentary: In the absence of eradicative therapy for individuals with HIV infection and protective vaccines for persons at risk, long-term antiretroviral therapy is the best approach for preventing disease progression in patients and halting transmissions, either as result of 'treatment as prevention' for HIV carriers or 'pre-exposure prophylaxis' for uninfected individuals at risk. In all these scenarios, the advent of long-acting antiretrovirals will expand options for overcoming the challenge of suboptimal drug adherence and reduce the burden of HIV infection.

  8. Pregnancy in autosomal recessive polycystic kidney disease.

    PubMed

    Banks, Nicole; Bryant, Joy; Fischer, Roxanne; Huizing, Marjan; Gahl, William A; Gunay-Aygun, Meral

    2015-03-01

    Autosomal recessive polycystic kidney disease (ARPKD) is the most common childhood-onset ciliopathy. As treatments improve, more women are reaching reproductive age, but little is known about ARPKD and pregnancy. In our ongoing study on ARPKD and other ciliopathies, 12 females over 18 years of age were identified and systematically evaluated. Six had children; four carried pregnancies and delivered, one used assisted reproductive technology and had a surrogate carry the pregnancy, and one adopted. We report the outcomes of four pregnancies with live birth deliveries and two women who chose alternate family building options. Patient one was diagnosed at 6 months, and at age 21 had a pregnancy complicated by transient worsening of renal function (creatinine increase from 1.15 to 1.78 mg/dL). Patient two was diagnosed with ARPKD at age seven and had an uncomplicated pregnancy at age 23. Patient three was diagnosed incidentally with ARPKD at age 23, 3 months after completion of an uncomplicated pregnancy. Patient four who had an uncomplicated pregnancy at age 33 was diagnosed with ARPKD at age 46. Women with ARPKD face reproductive decisions largely bereft of information about the pregnancies of other ARPKD patients. We report four cases of pregnancy and ARPKD to expand current knowledge and encourage further research.

  9. The costs of introducing a malaria vaccine through the expanded program on immunization in Tanzania.

    PubMed

    Hutton, Guy; Tediosi, Fabrizio

    2006-08-01

    This report presents an approach to costing the delivery of a malaria vaccine through the expanded program on immunization (EPI), and presents the predicted cost per dose delivered and cost per fully immunized child (FIC) in Tanzania, which are key inputs to the cost-effectiveness analysis. The costs included in the analysis are those related to the purchase of the vaccine taking into account the wastage rate; the costs of distributing and storing the vaccine at central, zonal, district, and facility level; those of managing the vaccination program; the costs of delivery at facility level (including personnel, syringes, safety boxes, and waste management); and those of additional training of EPI personnel and of social mobilization activities. The average cost per FIC increases almost linearly from US 4.2 dollars per FIC at a vaccine price of US 1 dollars per dose to US 31.2 dollars at vaccine price of US 10 dollars per dose. The marginal cost is approximately 5% less than the average cost. Although the vaccine price still determines most of the total delivery costs, the analysis shows that other costs are relevant and should be taken into account before marketing the vaccine and planning its inclusion into the EPI.

  10. Going Digital

    ERIC Educational Resources Information Center

    Violino, Bob

    2007-01-01

    Looking to save money--and, in many cases, improve stakeholder communication--several community colleges now are producing a variety of formerly paper products electronically. Administrators say the practice is improving efficiencies, providing for the delivery of critical information in a timely manner, and creating more options for students and…

  11. 77 FR 41432 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-13

    ... and quality; enrollment of individuals and providers; and descriptions of good and modern behavioral... needed behavioral health services. Outreach and education regarding enrollment in QHPs or expanded... triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these...

  12. Librarians as Community Partners: An Outreach Handbook

    ERIC Educational Resources Information Center

    Smallwood, Carol, Ed.

    2010-01-01

    Including 66 focused snapshots of outreach in action, this resource reflects the creative solutions of librarians searching for new and innovative ways to build programs that meet customer needs while expanding the library's scope into the community. This contributed volume includes: (1) A huge array of program options for partnering with other…

  13. Technologically Enhanced Archival Collections: Using the Buddy System

    ERIC Educational Resources Information Center

    Holz, Dayna

    2006-01-01

    Based in the context of challenges faced by archives when managing digital projects, this article explores options of looking outside the existing expertise of archives staff to find collaborative partners. In teaming up with other departments and organizations, the potential scope of traditional archival digitization projects is expanded beyond…

  14. Evaluation Options for Family Resource Centers.

    ERIC Educational Resources Information Center

    Horsch, Karen, Ed.; Weiss, Heather B., Ed.

    Family resource centers (FRC) are emerging as a promising program approach to solving urgent social problems. Evaluation plays an important role in learning how these programs work, what their impact is, and whether they should be expanded. However, FRCs pose unique challenges to evaluation. This report considers the challenges to evaluating FRCs,…

  15. Family-Friendly Policies and the Research University

    ERIC Educational Resources Information Center

    Quinn, Kate; Lange, Sheila Edwards; Olswang, Steven G.

    2004-01-01

    Institutions of higher education nationwide have been adopting policies to help faculty members with primary caregiving roles to attain tenure, and much research has been devoted to their effectiveness. The range of policies and programs has expanded dramatically since the 1970s. Among the options now available are family leave, elder-care…

  16. Teaching Statistics with Minitab II.

    ERIC Educational Resources Information Center

    Ryan, T. A., Jr.; And Others

    Minitab is a statistical computing system which uses simple language, produces clear output, and keeps track of bookkeeping automatically. Error checking with English diagnostics and inclusion of several default options help to facilitate use of the system by students. Minitab II is an improved and expanded version of the original Minitab which…

  17. Regional Impacts of extending inorganic and organic cloud chemistry with AQCHEM-KMT

    EPA Science Inventory

    Starting with CMAQ version 5.1, AQCHEM-KMT has been offered as a readily expandable option for cloud chemistry via application of the Kinetic PreProcessor (KPP). AQCHEM-KMT treats kinetic mass transfer between the gas and aqueous phases, ionization, chemical kinetics, droplet sc...

  18. Alternative Pathways into University: Are Tertiary Preparation Programs a Viable Option?

    ERIC Educational Resources Information Center

    Chesters, Jenny; Rutter, Kerry; Nelson, Karen; Watson, Louis

    2018-01-01

    During the past three decades, the student populations of Australian universities have become more heterogeneous as the higher education sector expanded and new alternative entry pathways were established. Broadening access to university study and, therefore, to professional and semi-professional occupations, provides avenues for social mobility.…

  19. E-Approval Plans in Research Libraries

    ERIC Educational Resources Information Center

    Pickett, Carmelita; Tabacaru, Simona; Harrell, Jeanne

    2014-01-01

    Research libraries have long invested in approval plan services, which offer an economical way to acquire scholarly and scientific publications. Traditional approval plans have evolved and now enable libraries to expand their e-book offerings to better serve researchers. Publishers offer a myriad of e-book purchasing options. These range from…

  20. Media and the Small College-Try Cable.

    ERIC Educational Resources Information Center

    Hay, Ellen A.

    Cable television's local access option may be a way for colleges and universities to expand their media offerings. For example, some institutions are using cable capabilities to broadcast direct and inservice instruction or to provide hands-on training for broadcast students. A small private liberal arts college in Iowa successfully uses cable…

  1. Tough Call: Is No Child Left behind Constitutional?

    ERIC Educational Resources Information Center

    McColl, Ann

    2005-01-01

    The No Child Left Behind (NCLB) Act, the 2001 reauthorization of the Elementary and Secondary Education Act, has become a symbol of all things good and bad in education. While the basic concepts of the legislation--accountability for results, research-based education programs, increased parental options, and expanded local control and…

  2. Theme Parks: Program Variety and Employment Options.

    ERIC Educational Resources Information Center

    Samuels, Jack B.

    1983-01-01

    This article describes a number of privately operated theme parks, explains why the parks have been successful, and looks at career opportunities for leisure professionals in this expanding area. Implications for recreation education are pointed out, and names and addresses of major companies in the theme park business are provided. (PP)

  3. Entrepreneurship Success Stories: Implications for Teaching and Learning. Practice Application Brief No. 3.

    ERIC Educational Resources Information Center

    Brown, Bettina Lankard

    Societal trends and personal characteristics are facilitating movement from corporate to self-employment. The entrepreneurship movement is characterized by several trends that are influencing the way people work: such as younger workers expecting shorter-term commitments to work, expanding career options, opening of worldwide operations, and…

  4. Expanding Options for Handicapped Persons Receiving Vocational Education.

    ERIC Educational Resources Information Center

    West Virginia Coll. of Graduate Studies, Institute.

    Resulting from a West Virginia training institute, the document provides guidelines (in outline form) for stimulating change in vocational education for handicapped students at the secondary level. Section I on the operational world provides a basis for developing sound organization needed for proper implementation of the guidelines. Steps geared…

  5. Reducing Depression in Pregnancy: Designing Multimodel Interventions.

    ERIC Educational Resources Information Center

    Cunningham, Maddy; Zayas, Luis H.

    2002-01-01

    High levels of stress on low-income, inner-city women from ethnic minority groups often causes both poor maternal functioning and infant development outcomes. This article reviews literature that proposes using several social work treatment options instead a single approach to reduce maternal depression, expand mothers' social networks, and…

  6. Advancing urban sustainability theory and action: Challenges and opportunities

    Treesearch

    Daniel L. Childers; Steward T.A. Pickett; J. Morgan Grove; Laura Ogden; Alison Whitmer

    2014-01-01

    Urban ecology and its theories are increasingly poised to contribute to urban sustainability, through both basic understanding and action. We present a conceptual framework that expands the Industrial → Sanitary → Sustainable City transition to include non-sanitary cities, "new cities", and various permutations of transition options for...

  7. Customization of Education through Online Learning

    ERIC Educational Resources Information Center

    Rayburn, Kalim

    2011-01-01

    The educational opportunities provided through connectivity to the internet that did not previously exist make way for many opportunities to expand curricular options. Through the use of technology and the internet students are able to receive education through a tailored learning approach delivered via online resources. The purpose of this study…

  8. From Entry to Practice to Advanced Nurse Practitioner - The Progression of Competencies and How They Assist in Delivery of eHealth Programs for Healthy Ageing.

    PubMed

    Rodger, Daragh; Hussey, Pamela

    2017-01-01

    Most of the health issues encountered in persons of older age are the result of one or more chronic diseases. The evidence base reports that chronic diseases can be prevented or delayed by engaging in healthy behaviors. Education provides a cost effective intervention on both economic grounds in addition to delivery of optimal patient outcomes. Information and Communication Technology (ICT) increasingly is viewed as a critical utility in eHealth delivery, providing scope for expanding online education facilities for older persons. Developing nursing competencies in the delivery of eHealth solutions to deliver user education programs therefore makes sense. This chapter discusses nursing competencies on the development of targeted eHealth programs for healthy ageing. The role of Advanced Nurse Practitioner in Ireland and its associated competency set identifies how a strong action learning model can be designed to deliver eHealth educational programs for effective delivery of healthy ageing in place.

  9. Towards elimination of mother-to-child transmission of HIV: performance of different models of care for initiating lifelong antiretroviral therapy for pregnant women in Malawi (Option B+).

    PubMed

    van Lettow, Monique; Bedell, Richard; Mayuni, Isabell; Mateyu, Gabriel; Landes, Megan; Chan, Adrienne K; van Schoor, Vanessa; Beyene, Teferi; Harries, Anthony D; Chu, Stephen; Mganga, Andrew; van Oosterhout, Joep J

    2014-01-01

    Malawi introduced a new strategy to improve the effectiveness of prevention of mother-to-child HIV transmission (PMTCT), the Option B+ strategy. We aimed to (i) describe how Option B+ is provided in health facilities in the South East Zone in Malawi, identifying the diverse approaches to service organization (the "model of care") and (ii) explore associations between the "model of care" and health facility-level uptake and retention rates for pregnant women identified as HIV-positive at antenatal (ANC) clinics. A health facility survey was conducted in all facilities providing PMTCT/antiretroviral therapy (ART) services in six of Malawi's 28 districts to describe and compare Option B+ service delivery models. Associations of identified models with program performance were explored using facility cohort reports. Among 141 health facilities, four "models of care" were identified: A) facilities where newly identified HIV-positive women are initiated and followed on ART at the ANC clinic until delivery; B) facilities where newly identified HIV-positive women receive only the first dose of ART at the ANC clinic, and are referred to the ART clinic for follow-up; C) facilities where newly identified HIV-positive women are referred from ANC to the ART clinic for initiation and follow-up of ART; and D) facilities serving as ART referral sites (not providing ANC). The proportion of women tested for HIV during ANC was highest in facilities applying Model A and lowest in facilities applying Model B. The highest retention rates were reported in Model C and D facilities and lowest in Model B facilities. In multivariable analyses, health facility factors independently associated with uptake of HIV testing and counselling (HTC) in ANC were number of women per HTC counsellor, HIV test kit availability, and the "model of care" applied; factors independently associated with ART retention were district location, patient volume and the "model of care" applied. A large variety exists in the way health facilities have integrated PMTCT Option B+ care into routine service delivery. This study showed that the "model of care" chosen is associated with uptake of HIV testing in ANC and retention in care on ART. Further patient-level research is needed to guide policy recommendations.

  10. Towards elimination of mother-to-child transmission of HIV: performance of different models of care for initiating lifelong antiretroviral therapy for pregnant women in Malawi (Option B+)

    PubMed Central

    van Lettow, Monique; Bedell, Richard; Mayuni, Isabell; Mateyu, Gabriel; Landes, Megan; Chan, Adrienne K; van Schoor, Vanessa; Beyene, Teferi; Harries, Anthony D; Chu, Stephen; Mganga, Andrew; van Oosterhout, Joep J

    2014-01-01

    Introduction Malawi introduced a new strategy to improve the effectiveness of prevention of mother-to-child HIV transmission (PMTCT), the Option B+ strategy. We aimed to (i) describe how Option B+ is provided in health facilities in the South East Zone in Malawi, identifying the diverse approaches to service organization (the “model of care”) and (ii) explore associations between the “model of care” and health facility–level uptake and retention rates for pregnant women identified as HIV-positive at antenatal (ANC) clinics. Methods A health facility survey was conducted in all facilities providing PMTCT/antiretroviral therapy (ART) services in six of Malawi's 28 districts to describe and compare Option B+ service delivery models. Associations of identified models with program performance were explored using facility cohort reports. Results Among 141 health facilities, four “models of care” were identified: A) facilities where newly identified HIV-positive women are initiated and followed on ART at the ANC clinic until delivery; B) facilities where newly identified HIV-positive women receive only the first dose of ART at the ANC clinic, and are referred to the ART clinic for follow-up; C) facilities where newly identified HIV-positive women are referred from ANC to the ART clinic for initiation and follow-up of ART; and D) facilities serving as ART referral sites (not providing ANC). The proportion of women tested for HIV during ANC was highest in facilities applying Model A and lowest in facilities applying Model B. The highest retention rates were reported in Model C and D facilities and lowest in Model B facilities. In multivariable analyses, health facility factors independently associated with uptake of HIV testing and counselling (HTC) in ANC were number of women per HTC counsellor, HIV test kit availability, and the “model of care” applied; factors independently associated with ART retention were district location, patient volume and the “model of care” applied. Conclusions A large variety exists in the way health facilities have integrated PMTCT Option B+ care into routine service delivery. This study showed that the “model of care” chosen is associated with uptake of HIV testing in ANC and retention in care on ART. Further patient-level research is needed to guide policy recommendations. PMID:25079437

  11. Cardiac myxoma in pregnancy: a comprehensive review

    PubMed Central

    Yuan, Shi-Min

    2015-01-01

    Objective Cardiac myxoma in pregnancy is rare and the clinical characteristics of this entity have been insufficiently elucidated. This article aims to describe the treatment options and the risk factors responsible for the maternal and feto-neonatal prognoses. Methods A comprehensive search of the literature of cardiac myxoma in pregnancy was conducted and 44 articles with 51 patients were included in the present review. Results Transthoracic echocardiography was the most common diagnostic tool for the diagnosis of cardiac myxoma during pregnancy. Cardiac myxoma resection was performed in 95.9% (47/49); while no surgical resection was performed in 4.1% (2/49) patients (P=0.000). More patients had an isolated cardiac myxoma resection in comparison to those with a concurrent or staged additional cardiac operation [87.2% (41/47) vs. 12.8% (6/47), P=0.000]. A voluntary termination of the pregnancy was done in 7 (13.7%) cases. In the remaining 31 (60.8%) pregnant patients, cesarean section was the most common delivery mode representing 61.3% and vaginal delivery was more common accounting for 19.4%. Cardiac surgery was performed in the first, second and third trimester in 5 (13.9%), 14 (38.9%) and 17 (47.2%) patients, respectively. No patients died. In the delivery group, 20 (76.9%) neonates were event-free survivals, 4 (15.4%) were complicated and 2 (7.7%) died. Neonatal prognoses did not differ between the delivery modes, treatment options, timing of cardiac surgery and sequence of cardiac myxoma resection in relation to delivery. Conclusion The diagnosis of cardiac myxoma in pregnancy is important. Surgical treatment of cardiac myxoma in the pregnant patients has brought about favorable maternal and feto-neonatal outcomes in the delivery group, which might be attributable to the shorter operation duration and non-emergency nature of the surgical intervention. Proper timing of cardiac surgery and improved cardiopulmonary bypass conditions may result in even better maternal and feto-neonatal survivals. PMID:26313731

  12. Robot Electronics Architecture

    NASA Technical Reports Server (NTRS)

    Garrett, Michael; Magnone, Lee; Aghazarian, Hrand; Baumgartner, Eric; Kennedy, Brett

    2008-01-01

    An electronics architecture has been developed to enable the rapid construction and testing of prototypes of robotic systems. This architecture is designed to be a research vehicle of great stability, reliability, and versatility. A system according to this architecture can easily be reconfigured (including expanded or contracted) to satisfy a variety of needs with respect to input, output, processing of data, sensing, actuation, and power. The architecture affords a variety of expandable input/output options that enable ready integration of instruments, actuators, sensors, and other devices as independent modular units. The separation of different electrical functions onto independent circuit boards facilitates the development of corresponding simple and modular software interfaces. As a result, both hardware and software can be made to expand or contract in modular fashion while expending a minimum of time and effort.

  13. Ceramic nanocarriers: versatile nanosystem for protein and peptide delivery.

    PubMed

    Singh, Deependra; Dubey, Pooja; Pradhan, Madhulika; Singh, Manju Rawat

    2013-02-01

    Proteins and peptides have been established to be the potential drug candidate for various human diseases. But, delivery of these therapeutic protein and peptides is still a challenge due to their several unfavorable properties. Nanotechnology is expanding as a promising tool for the efficient delivery of proteins and peptides. Among numerous nano-based carriers, ceramic nanoparticles have proven themselves as a unique carrier for protein and peptide delivery as they provide a more stable, bioavailable, readily manufacturable, and acceptable proteins and polypeptide formulation. This article provides an overview of the various aspects of ceramic nanoparticles including their classification, methods of preparation, latest advances, and applications as protein and peptide delivery carriers. Ceramic nanocarriers seem to have potential for preserving structural integrity of proteins and peptides, thereby promoting a better therapeutic effect. This approach thus provides pharmaceutical scientists with a new hope for the delivery of proteins and peptides. Still, considerable study on ceramic nanocarrier is necessary with respect to pharmacokinetics, toxicology, and animal studies to confirm their efficiency as well as safety and to establish their clinical usefulness and scale-up to industrial level.

  14. "We'll call you when the results are in": Preferences for how medical test results are delivered.

    PubMed

    Dooley, Michael D; Burreal, Shay; Sweeny, Kate

    2017-02-01

    Whether healthy or sick, adults undergo frequent medical testing; however, no guidelines currently exist as to how patients are informed of their medical test results. This short report provides an initial look at how healthcare professionals deliver medical test results and patient preferences regarding these procedures. We specifically focus on two options for delivery of results: (1) open-ended timing, in which patients are contacted without warning when test results become available; or (2) closed-ended timing, in which patients are provided with a specific day and time when they will learn their test results. Participants who underwent a recent medical test indicated which delivery method their healthcare professional provided and their preferred method. Findings demonstrate a large discrepancy between actual and preferred timing, stemming from a general trend towards providing open-ended timing, whereas patient preferences were evenly split between the two options. This study provides a first step in understanding the merits of two options for delivering medical test results to patients and suggests an opportunity to improve patient care. The findings from this study provide first steps toward the development of guidelines for delivering test results in ways that maximize the quality of patient care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. NHS Dentistry: Options for Change in context--a personal overview of a landmark document and what it could mean for the future of dental services.

    PubMed

    Pitts, N B

    2003-12-06

    The aims of this paper are to provide an impartial overview of the proposals and agenda for the future brought together in the NHS Dentistry: Options for Change document in the context of previous dental service delivery in primary care, and to start to explore what Options for Change could mean for the future of NHS dental services. Options has been described as perhaps the most radical and ground breaking opportunity for NHS dentistry to finally move forward after prolonged periods of stagnation and disharmony. The Options agenda has the potential to bring in a new style of NHS practice for dentistry, providing a way to finally get off the current 'treadmill' and to develop new NHS dental services where prevention is a priority and providing high quality dental treatment, tailored to the long term needs of the 21st century patient, is the driving aim. However, the difficulties on all sides of leaving behind decades of disputes and overcoming real access, workforce and funding issues must not be underestimated or dismissed. The report was prepared by a working group comprising representatives from the profession, of patient groups and various sections of the Department of Health in England which was brought together by the then Chief Dental Officer. The key themes and priorities for action identified in Options include: local commissioning and funding, methods of remuneration for general dental practitioners, prevention and an oral health assessment for patients, clinical pathways, information and communication technology, practice structure, development of the dental team and the patient experience. The document also contains comprehensive reports of the three Options for Change task groups making recommendations for: 1) a new deal for patients - national standards, 2) systems of delivery of dental care and 3) education, training and development of the dental team. Ways forward for delivering improved, modern, effective, preventive, patient-centred dental care have been identified. This potential can, however, only be realised if viable and sustainable agreements can be achieved to operationalise the best choices.

  16. Chronobiology of epilepsy: diagnostic and therapeutic implications of chrono-epileptology.

    PubMed

    Loddenkemper, Tobias; Lockley, Steven W; Kaleyias, Joseph; Kothare, Sanjeev V

    2011-04-01

    The combination of chronobiology and epilepsy offers novel diagnostic and therapeutic management options. Knowledge of the interactions between circadian periodicity, entrainment, sleep patterns, and epilepsy may provide additional diagnostic options beyond sleep deprivation and extended release medication formulations. It may also provide novel insights into the physiologic, biochemical, and genetic regulation processes of epilepsy and the circadian clock, rendering new treatment options. Temporal fluctuations of seizure susceptibility based on sleep homeostasis and circadian phase in selected epilepsies may provide predictability based on mathematical models. Chrono-epileptology offers opportunities for individualized patient-oriented treatment paradigms based on chrono-pharmacology, differential medication dosing, chrono-drug delivery systems, and utilization of "zeitgebers" such as chronobiotics or light-therapy and desynchronization strategies among others.

  17. Future Scenarios as a Research Tool: Investigating Climate Change Impacts, Adaptation Options and Outcomes for the Great Barrier Reef, Australia.

    PubMed

    Evans, Louisa S; Hicks, Christina C; Fidelman, Pedro; Tobin, Renae C; Perry, Allison L

    2013-01-01

    Climate change is a significant future driver of change in coastal social-ecological systems. Our knowledge of impacts, adaptation options, and possible outcomes for marine environments and coastal industries is expanding, but remains limited and uncertain. Alternative scenarios are a way to explore potential futures under a range of conditions. We developed four alternative future scenarios for the Great Barrier Reef and its fishing and tourism industries positing moderate and more extreme (2-3 °C above pre-industrial temperatures) warming for 2050 and contrasting 'limited' and 'ideal' ecological and social adaptation. We presented these scenarios to representatives of key stakeholder groups to assess the perceived viability of different social adaptation options to deliver desirable outcomes under varied contexts.

  18. Abdominal aortic aneurysm: An update

    PubMed

    Chuen, Jason; Theivendran, Mayo

    2018-05-01

    Abdominal aortic aneurysm (AAA) remains one of the hallmark pathologies in vascular surgery and an area of intense research interest. Treatment options have expanded in recent years to increase the range of morphology suitable for endovascular aneurysm repair (EVAR), and with potential implications on treatment thresholds. This article is the first of two that will outline current treatment options for AAA, including areas of controversy and research in AAA disease, to inform the development of Australasian clinical guidelines and health policy. Medical therapy options remain limited and no aneurysm-specific pharmacotherapy is currently available. Recent years have witnessed a significant shift in AAA surgery from open repair to EVAR and expansion of EVAR techniques. General management of cardiovascular risk factors remains key to reducing all-cause mortality for patients with AAA.

  19. Nonlethal weapons as force options for the Army

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

    Alexander, J.B.

    This paper suggests that future challenges to US national security will be very different from those previously experienced. In a number of foreseeable circumstances, conventional military force will be inappropriate. The National Command Authority, and other appropriate levels of command, need expanded options available to meet threats for which the application of massive lethal force is counterproductive or inadvisable. It is proposed that nonlethal concepts be developed that provide additional options for military leaders and politicians. Included in this initiative should be exploration of policy, strategy, doctrine, and training issues as well as the development of selected technologies and weapons.more » In addition, civilian law enforcement agencies have similar requirements for less-than-lethal systems. This may be an excellent example for a joint technology development venture.« less

  20. Atmospheric studies in complex terrain: a planning guide for future studies

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

    Orgill, M.M.

    The objective of this study is to assist the US Department of Energy in Conducting its atmospheric studies in complex terrain (ASCOT0 by defining various complex terrain research systems and relating these options to specific landforms sites. This includes: (1) reviewing past meteorological and diffusion research on complex terrain; (2) relating specific terrain-induced airflow phenomena to specific landforms and time and space scales; (3) evaluating the technical difficulty of modeling and measuring terrain-induced airflow phenomena; and (4) avolving severdal research options and proposing candidate sites for continuing and expanding field and modeling work. To evolve research options using variable candidatemore » sites, four areas were considered: site selection, terrain uniqueness and quantification, definition of research problems and research plans. 36 references, 111 figures, 20 tables.« less

  1. Personalized Medicine and Customized Drug Delivery Systems: The New Trend of Drug Delivery and Disease Management.

    PubMed

    Soni, Abhishek; Gowthamarajan, Kuppusamy; Radhakrishnan, Arun

    2018-01-01

    Over the past few decades, the concept of personalized medicine has proved to play an important role in the healthcare sector. Personalized medicine modifies the current dosage forms according to the needs of the patient. Based on this improved concept, we are now able to bring out best treatment options for a particular individual leading to better therapeutic outcomes and decreased adverse effects. It also has the potential to identify the disease at an earlier stage. It links the diseased condition of a person to the basic genetic and molecular profile causing better understanding of the condition of the patient and to pick out better treatment options. This review is to enlighten the past, present, and future perspective of personalized medicine and how the personalized-medicine approach is used as customized drug delivery, as well as the regulatory aspects towards it. Personalized medicine has the potential to modify the way we recognize and manage our health problems and has already proven to have a huge impact on patient care and on clinical research. The impact of personalized medicine is expected to increase with an increased knowledge about the term and related technologies. Copyright© by International Journal of Pharmaceutical Compounding, Inc.

  2. The perceval S aortic valve implantation in patients with porcelain aorta; is this ideal option?

    PubMed

    Baikoussis, Nikolaos G; Dedeilias, Panagiotis; Prappa, Efstathia; Argiriou, Michalis

    2017-01-01

    We would like to present in this paper a patient with severe aortic valve stenosis referred to our department for surgical aortic valve replacement. In this patient, it was intraoperatively detected an unexpected heavily calcified porcelain ascending aorta. We present the treatment options in this situation, the difficulties affronted intraoperatively, the significance of the preoperative chest computed tomography scan and the use of the Perceval S aortic valve as ideal bioprosthesis implantation. This is a self-expanding, self-anchoring, and sutureless valve with a wide indication in all patients requiring aortic bioprosthesis.

  3. Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis

    PubMed Central

    Mitsunaga, Lance K.; Klineberg, Eric O.; Gupta, Munish C.

    2012-01-01

    Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation and to preserve postoperative cervical stability and alignment. With the right surgical indications, reliable results can be expected with laminoplasty in treating patients with multilevel cervical myelopathy. PMID:22496982

  4. Empowering self-defense training.

    PubMed

    Thompson, Martha E

    2014-03-01

    The purpose of self-defense training is to expand people's options, yet it is often framed as a solely physical, and limiting, response to violence. I draw on my own experience as a self-defense instructor and that of others in the self-defense movement to argue that an empowerment approach to self-defense training contributes to the anti-violence movement in multiple ways: providing a pathway to increase women's and girls' safety and their potential for becoming powerful and effective social change agents right now, providing an informed and embodied understanding of violence, and offering comprehensive options to recognize, prevent, and interrupt violence.

  5. Gender Confirmation Surgery: An Update for the Primary Care Provider

    PubMed Central

    Schechter, Loren S.

    2016-01-01

    Abstract Increased advocacy efforts and expanded third-party insurance coverage have improved access to healthcare for transgender individuals. In conjunction with mental health and medical professionals, gender surgeries offer an important step in allowing individuals to realize their true selves. To provide quality multidisciplinary care, primary care doctors need to understand challenges facing transgender individuals and treatment options available to them. In this article, we will review the role of the surgeon and the goals of various gender confirming surgeries. In addition, we will provide an overview of the available surgical options. PMID:29159295

  6. Chemotherapy versus self-expanding metal stent as primary treatment of severe dysphagia from unresectable oesophageal or gastro-oesophageal junction cancer.

    PubMed

    Touchefeu, Yann; Archambeaud, Isabelle; Landi, Bruno; Lièvre, Astrid; Lepère, Céline; Rougier, Philippe; Mitry, Emmanuel

    2014-03-01

    To compare chemotherapy first (group 1) versus self-expanding metal stent first (group 2) for the management of malignant dysphagia in unresectable oesophageal or gastro-oesophageal junction cancer. Patients from two university hospitals with severe malignant dysphagia (dysphagia score ≥ 2) uneligible for surgery or radiochemotherapy were evaluated retrospectively. Forty-two patients were included in group 1, and 29 in group 2. After 4 weeks, dysphagia scores improved by at least 1 point in 67% of patients in group 1 versus 93% in group 2 (p=0.01); 48% of patients in group 1 were able to eat solid food versus 68% in group 2 (p=0.054). In group 1, a self-expanding metal stent was secondarily placed in 18 patients (42.9%), whereas in group 2 dysphagia required a second self-expanding metal stent placement in 33.3% of patients. Chemotherapy as the first treatment may be a valid option, avoiding self-expanding metal stent insertion in half of the patients. Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  7. Recent advances in ophthalmic drug delivery

    PubMed Central

    Kompella, Uday B; Kadam, Rajendra S; Lee, Vincent HL

    2011-01-01

    Topical ocular drug bioavailability is notoriously poor, in the order of 5% or less. This is a consequence of effective multiple barriers to drug entry, comprising nasolacrimal drainage, epithelial drug transport barriers and clearance from the vasculature in the conjunctiva. While sustained drug delivery to the back of the eye is now feasible with intravitreal implants such as Vitrasert™ (~6 months), Retisert™ (~3 years) and Iluvien™ (~3 years), currently there are no marketed delivery systems for long-term drug delivery to the anterior segment of the eye. The purpose of this article is to summarize the resurgence in interest to prolong and improve drug entry from topical administration. These approaches include mucoadhesives, viscous polymer vehicles, transporter-targeted prodrug design, receptor-targeted functionalized nanoparticles, iontophoresis, punctal plug and contact lens delivery systems. A few of these delivery systems might be useful in treating diseases affecting the back of the eye. Their effectiveness will be compared against intravitreal implants (upper bound of effectiveness) and trans-scleral systems (lower bound of effectiveness). Refining the animal model by incorporating the latest advances in microdialysis and imaging technology is key to expanding the knowledge central to the design, testing and evaluation of the next generation of innovative ocular drug delivery systems. PMID:21399724

  8. Nanoparticle-Enabled Transdermal Drug Delivery Systems for Enhanced Dose Control and Tissue Targeting.

    PubMed

    Palmer, Brian C; DeLouise, Lisa A

    2016-12-15

    Transdermal drug delivery systems have been around for decades, and current technologies (e.g., patches, ointments, and creams) enhance the skin permeation of low molecular weight, lipophilic drugs that are efficacious at low doses. The objective of current transdermal drug delivery research is to discover ways to enhance skin penetration of larger, hydrophilic drugs and macromolecules for disease treatment and vaccination. Nanocarriers made of lipids, metals, or polymers have been successfully used to increase penetration of drugs or vaccines, control drug release, and target drugs to specific areas of skin in vivo. While more research is needed to identify the safety of nanocarriers, this technology has the potential to expand the use of transdermal routes of administration to a wide array of therapeutics. Here, we review the current state of nanoparticle skin delivery systems with special emphasis on targeting skin diseases.

  9. Challenges in systematic reviews: synthesis of topics related to the delivery, organization, and financing of health care.

    PubMed

    Bravata, Dena M; McDonald, Kathryn M; Shojania, Kaveh G; Sundaram, Vandana; Owens, Douglas K

    2005-06-21

    Some important health policy topics, such as those related to the delivery, organization, and financing of health care, present substantial challenges to established methods for evidence synthesis. For example, such reviews may ask: What is the effect of for-profit versus not-for-profit delivery of care on patient outcomes? Or, which strategies are the most effective for promoting preventive care? This paper describes innovative methods for synthesizing evidence related to the delivery, organization, and financing of health care. We found 13 systematic reviews on these topics that described novel methodologic approaches. Several of these syntheses used 3 approaches: conceptual frameworks to inform problem formulation, systematic searches that included nontraditional literature sources, and hybrid synthesis methods that included simulations to address key gaps in the literature. As the primary literature on these topics expands, so will opportunities to develop additional novel methods for performing high-quality comprehensive syntheses.

  10. Nanoparticle enabled transdermal drug delivery systems for enhanced dose control and tissue targeting

    PubMed Central

    Palmer, Brian C.; DeLouise, Lisa A.

    2017-01-01

    Transdermal drug delivery systems have been around for decades, and current technologies (e.g. patches, ointments, and creams) enhance the skin permeation of low molecular weight, lipophilic drugs that are efficacious at low doses. The objective of current transdermal drug delivery research is to discover ways to enhance skin penetration of larger, hydrophilic drugs and macromolecules for disease treatment and vaccination. Nanocarriers made of lipids, metals, or polymers have been successfully used to increase penetration of drugs or vaccines, control drug release, and target drugs to specific areas of skin in vivo. While more research is needed to identify the safety of nanocarriers, this technology has the potential to expand the use of transdermal routes of administration to a wide array of therapeutics. Here, we review the current state of nanoparticle skin delivery systems with special emphasis on targeting skin diseases. PMID:27983701

  11. Intradermal vaccination using the novel microneedle device MicronJet600: Past, present, and future.

    PubMed

    Levin, Yotam; Kochba, Efrat; Hung, Ivan; Kenney, Richard

    2015-01-01

    Intradermal immunization has become a forefront of vaccine improvement, both scientifically and commercially. Newer technologies are being developed to address the need to reduce the dose required for vaccination and to improve the reliability and ease of injection, which have been major hurdles in expanding the number of approved vaccines using this route of administration. In this review, 7 y of clinical experience with a novel intradermal delivery device, the MicronJet600, which is a registered hollow microneedle that simplifies the delivery of liquid vaccines, are summarized. This device has demonstrated both significant dose-sparing and superior immunogenicity in various vaccine categories, as well as in diverse subject populations and age groups. These studies have shown that intradermal delivery using this device is safe, effective, and preferred by the subjects. Comparison with other intradermal devices and potential new applications for intradermal delivery that could be pursued in the future are also discussed.

  12. Caring for Pregnant Women with Opioid Use Disorder in the USA: Expanding and Improving Treatment.

    PubMed

    Saia, Kelley A; Schiff, Davida; Wachman, Elisha M; Mehta, Pooja; Vilkins, Annmarie; Sia, Michelle; Price, Jordana; Samura, Tirah; DeAngelis, Justin; Jackson, Clark V; Emmer, Sawyer F; Shaw, Daniel; Bagley, Sarah

    Opioid use disorder in the USA is rising at an alarming rate, particularly among women of childbearing age. Pregnant women with opioid use disorder face numerous barriers to care, including limited access to treatment, stigma, and fear of legal consequences. This review of opioid use disorder in pregnancy is designed to assist health care providers caring for pregnant and postpartum women with the goal of expanding evidence-based treatment practices for this vulnerable population. We review current literature on opioid use disorder among US women, existing legislation surrounding substance use in pregnancy, and available treatment options for pregnant women with opioid use disorder. Opioid agonist treatment (OAT) remains the standard of care for treating opioid use disorder in pregnancy. Medically assisted opioid withdrawal ("detoxification") is not recommended in pregnancy and is associated with high maternal relapse rates. Extended release naltrexone may confer benefit for carefully selected patients. Histories of trauma and mental health disorders are prevalent in this population; and best practice recommendations incorporate gender-specific, trauma-informed, mental health services. Breastfeeding with OAT is safe and beneficial for the mother-infant dyad. Further research investigating options of OAT and the efficacy of opioid antagonists in pregnancy is needed. The US health care system can adapt to provide quality care for these mother-infant dyads by expanding comprehensive treatment services and improving access to care.

  13. Fusion Teaching: Utilizing Course Management Technology to Deliver an Effective Multimodal Pedagogy

    ERIC Educational Resources Information Center

    Childs, Bradley D.; Cochran, Howard H.; Velikova, Marieta

    2013-01-01

    Fusion teaching merges several pedagogies into a coherent whole. Course management technology allows for the digitization and delivery of pedagogies in an effective and exciting manner. Online course management options more easily enable outcome assessment and monitoring for continuous improvement.

  14. Alternative Education, Not Alternative Location

    ERIC Educational Resources Information Center

    Mills, Anna-Marie; O'Dwyer, Kevin

    2007-01-01

    The Adventure Based Learning Experience (ABLE) program is designed for students who require a non-traditional approach to learning with varied program delivery options or need a flexible learning landscape. This unique experiential learning program provides students from Mississauga and Brampton the opportunity to "learn from doing" in…

  15. School Neuropsychology Consultation in Neurodevelopmental Disorders

    ERIC Educational Resources Information Center

    Decker, Scott L.

    2008-01-01

    The role of school psychologists with training in neuropsychology is examined within the context of multitiered models of service delivery and educational reform policies. An expanded role is suggested that builds on expertise in the assessment of neurodevelopmental disorders and extends to broader tiers through consultation practice. Changes in…

  16. 7 CFR 3406.11 - Scope of a teaching proposal.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... new ideas and techniques. (v) Expand competence with new methods of information delivery, such as.... Proposals may focus on any subject matter area(s) in the food and agricultural sciences unless limited by... development, faculty enhancement, and student experiential learning in animal science; faculty enhancement in...

  17. Readers in Search of Authors: The Changing Face of the Middleman.

    ERIC Educational Resources Information Center

    Potter, William

    1986-01-01

    Discusses new information technologies which offer libraries increased opportunities to provide innovative services: linking automated technical processing systems with public systems to provide more timely information; using the expanding services of subscription agencies as a channel for electronic publications delivery; online catalogs; and…

  18. Combination of real options and game-theoretic approach in investment analysis

    NASA Astrophysics Data System (ADS)

    Arasteh, Abdollah

    2016-09-01

    Investments in technology create a large amount of capital investments by major companies. Assessing such investment projects is identified as critical to the efficient assignment of resources. Viewing investment projects as real options, this paper expands a method for assessing technology investment decisions in the linkage existence of uncertainty and competition. It combines the game-theoretic models of strategic market interactions with a real options approach. Several key characteristics underlie the model. First, our study shows how investment strategies rely on competitive interactions. Under the force of competition, firms hurry to exercise their options early. The resulting "hurry equilibrium" destroys the option value of waiting and involves violent investment behavior. Second, we get best investment policies and critical investment entrances. This suggests that integrating will be unavoidable in some information product markets. The model creates some new intuitions into the forces that shape market behavior as noticed in the information technology industry. It can be used to specify best investment policies for technology innovations and adoptions, multistage R&D, and investment projects in information technology.

  19. Critical considerations for developing nucleic acid macromolecule based drug products.

    PubMed

    Muralidhara, Bilikallahalli K; Baid, Rinku; Bishop, Steve M; Huang, Min; Wang, Wei; Nema, Sandeep

    2016-03-01

    Protein expression therapy using nucleic acid macromolecules (NAMs) as a new paradigm in medicine has recently gained immense therapeutic potential. With the advancement of nonviral delivery it has been possible to target NAMs against cancer, immunodeficiency and infectious diseases. Owing to the complex and fragile structure of NAMs, however, development of a suitable, stable formulation for a reasonable product shelf-life and efficacious delivery is indeed challenging to achieve. This review provides a synopsis of challenges in the formulation and stability of DNA/m-RNA based medicines and probable mitigation strategies including a brief summary of delivery options to the target cells. Nucleic acid based drugs at various stages of ongoing clinical trials are compiled. Copyright © 2016. Published by Elsevier Ltd.

  20. Extended ocular drug delivery systems for the anterior and posterior segments: biomaterial options and applications.

    PubMed

    Kang-Mieler, Jennifer J; Dosmar, Emily; Liu, Wenqiang; Mieler, William F

    2017-05-01

    The development of new therapies for treating various eye conditions has led to a demand for extended release delivery systems, which would lessen the need for frequent application while still achieving therapeutic drug levels in the target tissues. Areas covered: Following an overview of the different ocular drug delivery modalities, this article surveys the biomaterials used to develop sustained release drug delivery systems. Microspheres, nanospheres, liposomes, hydrogels, and composite systems are discussed in terms of their primary materials. The advantages and disadvantages of each drug delivery system are discussed for various applications. Recommendations for modifications and strategies for improvements to these basic systems are also discussed. Expert opinion: An ideal sustained release drug delivery system should be able to encapsulate and deliver the necessary drug to the target tissues at a therapeutic level without any detriment to the drug. Drug encapsulation should be as high as possible to minimize loss and unless it is specifically desired, the initial burst of drug release should be kept to a minimum. By modifying various biomaterials, it is possible to achieve sustained drug delivery to both the anterior and posterior segments of the eye.

  1. Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?

    PubMed Central

    2014-01-01

    Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. PMID:24564984

  2. Plant viruses and bacteriophages for drug delivery in medicine and biotechnology.

    PubMed

    Czapar, Anna E; Steinmetz, Nicole F

    2017-06-01

    There are a wide variety of synthetic and naturally occurring nanomaterials under development for nanoscale cargo-delivery applications. Viruses play a special role in these developments, because they can be regarded as naturally occurring nanomaterials evolved to package and deliver cargos. While any nanomaterial has its advantage and disadvantages, viral nanoparticles (VNPs), in particular the ones derived from plant viruses and bacteriophages, are attractive options for cargo-delivery as they are biocompatible, biodegradable, and non-infectious to mammals. Their protein-based structures are often understood at atomic resolution and are amenable to modification with atomic-level precision through chemical and genetic engineering. Here we present a focused review of the emerging technology development of plant viruses and bacteriophages targeting human health and agricultural applications. Key target areas of development are their use in chemotherapy, photodynamic therapy, pesticide-delivery, gene therapy, vaccine carriers, and immunotherapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. The role of intracochlear drug delivery devices in the management of inner ear disease.

    PubMed

    Ayoob, Andrew M; Borenstein, Jeffrey T

    2015-03-01

    Diseases of the inner ear include those of the auditory and vestibular systems, and frequently result in disabling hearing loss or vertigo. Despite a rapidly expanding pipeline of potential cochlear therapeutics, the inner ear remains a challenging organ for targeted drug delivery, and new technologies are required to deliver these therapies in a safe and efficacious manner. In addition to traditional approaches for direct inner ear drug delivery, novel microfluidics-based systems are under development, promising improved control over pharmacokinetics over longer periods of delivery, ultimately with application towards hair cell regeneration in humans. Advances in the development of intracochlear drug delivery systems are reviewed, including passive systems, active microfluidic technologies and cochlear prosthesis-mediated delivery. This article provides a description of novel delivery systems and their potential future clinical applications in treating inner ear disease. Recent progresses in microfluidics and miniaturization technologies are enabling the development of wearable and ultimately implantable drug delivery microsystems. Progress in this field is being spurred by the convergence of advances in molecular biology, microfluidic flow control systems and models for drug transport in the inner ear. These advances will herald a new generation of devices, with near-term applications in preclinical models, and ultimately with human clinical use for a range of diseases of the inner ear.

  4. Measuring North Carolina pharmacists' support for expanded authority to administer human papillomavirus vaccines.

    PubMed

    Richman, Alice R; Swanson, Ryan S; Branham, Ashley R; Partridge, Brittney N

    2013-12-01

    To assess North Carolina pharmacists' level of support for expanded authority to administer human papillomavirus (HPV) vaccines to identify concerns/benefits about expanded authority and to understand what factors predict support for expanded authority. A 16-item electronic survey was e-mailed to all the pharmacists registered with the North Carolina Board of Pharmacy (n = 9502) between January and February 2011 (1600 pharmacists responded). The survey assessed HPV knowledge, level of support for expanded authority, and comfort level of HPV vaccine administration. Many (64%) pharmacists were supportive of a rule change/legislation that would authorize pharmacists to administer HPV vaccines. Younger pharmacists were more supportive of expansion when compared to older pharmacists (r = -.138, P < .001). Pharmacists with higher knowledge scores were more supportive of expansion (r = .223, P < .001). Reporting a higher level of comfort in administering HPV vaccines at their pharmacy was significantly and positively correlated with higher level of support for expansion (r = .624, P < .001). In the multivariate analysis, HPV knowledge, comfort level in administering vaccine, patient age, and type of pharmacy were all predictive of higher level of support for expanded authority where employed. A large proportion of pharmacists were supportive of an expanded role in providing HPV vaccines. Exploring alternate delivery mechanisms like this one is advantageous.

  5. Methods for Addressing Conflict in Cotaught Classrooms

    ERIC Educational Resources Information Center

    Conderman, Greg

    2011-01-01

    As a service delivery option for students with disabilities, coteaching continues to gain popularity. Successful coteaching largely rests upon the compatibility of coteachers. Sometimes conflict may occur when two teachers with different backgrounds and views work closely together. This article focuses on why conflict is inevitable in cotaught…

  6. Embracing Online Education: Exploring Options for Success

    ERIC Educational Resources Information Center

    Robinson, Leroy

    2017-01-01

    As the marketplace for higher education changes, attracting and retaining students is of utmost importance. Providing successful course delivery methods (e.g. face-to-face, fully online, hybrid) offers an opportunity for universities to differentiate from each other. This research investigates the relationships involved in student acceptance of…

  7. Team-based Service Delivery for Students with Disabilities: Practice Options and Guidelines for Success.

    ERIC Educational Resources Information Center

    Ogletree, Billy T.; Bull, Jeannette; Drew, Ruby; Lunnen, Karen Y.

    2001-01-01

    This article reviews the assessment procedures, treatment procedures, and the advantages and disadvantages of three professional-family team models: multidisciplinary teams, interdisciplinary teams, and transdisciplinary teams. Guidelines for optimal team participation are provided. The importance of mission statements, communication, trust,…

  8. Simple and Practical Efficiency Lessons

    ERIC Educational Resources Information Center

    Kolpin, Van

    2018-01-01

    The derivation of conditions necessary for Pareto efficient production and exchange is a lesson frequently showcased in microeconomic theory textbooks. Traditional delivery of this lesson is, however, limited in its scope of application and can be unnecessarily convoluted. The author shows that the universe of application is greatly expanded and a…

  9. Expanding Use of Telepractice in Speech-Language Pathology and Audiology

    ERIC Educational Resources Information Center

    Edwards, Marge; Stredler-Brown, Arlene; Houston, K. Todd

    2012-01-01

    Recent advances in videoconferencing technology have resulted in a substantial increase in the use of live videoconferencing--referred to here as telepractice--to diagnose and treat speech, language, and hearing disorders. There is growing support from professional organizations for use of this service delivery model, as videoconferencing…

  10. Delivering Training Strategies: The Balanced Scorecard at Work

    ERIC Educational Resources Information Center

    Baraldi, Stefano; Cifalinò, Antonella

    2015-01-01

    Aligning the value of training to organizational goals is an emerging need in human resource management. This study, aiming at expanding the research on training evaluation from a strategic management perspective, examines whether the use of the Balanced Scorecard approach can enable an effective delivery of training strategies, thus strengthening…

  11. Vocational-Technical Education Financial Study. Executive Summary.

    ERIC Educational Resources Information Center

    Indiana State Board of Vocational and Technical Education, Indianapolis.

    A review of Indiana's current system of financing public vocational-technical education was limited to these concerns: the resource needs of vocational-technical education to keep the current delivery system up-to-date and the resources necessary to expand vocational-technical education services to those not being served. Although the current…

  12. Teaching with Distance Delivery Systems: Strategies from Alpha to Omega.

    ERIC Educational Resources Information Center

    Rezabek, Landra L.

    Distance education can assume many forms, including videotaped lectures, computer-mediated communication among teacher and student, and instantaneous, live two-way interaction. This paper focuses on tips and strategies for educators wishing to expand their teaching repertoires to include the use of these technologies. Teacher strategies listed…

  13. Habitat and Recreational Fishing Opportunity in Tampa Bay: Linking Ecological and Ecosystem Services to Human Beneficiaries

    EPA Science Inventory

    Estimating value of estuarine habitat to human beneficiaries requires that we understand how habitat alteration impacts function through both production and delivery of ecosystem goods and services (EGS). Here we expand on the habitat valuation technique of Bell (1997) with an es...

  14. Boeing engineers perform air flow balance testing.

    NASA Image and Video Library

    2017-10-05

    Boeing engineers, Chris Chapman, left, Greg Clark, center, and Ashesh Patel, right, perform air flow balance testing on NASA's new Basic Express Racks. The racks, developed at Marshall, will expand the capabilities for science research aboard the International Space Station. Delivery to the station is scheduled for late 2018.

  15. The National Home Visiting Coalition: A History of Collaboration

    ERIC Educational Resources Information Center

    Callahan, Jane; Gavaghan, Bridget; Howard, Karen; Kelley, Melissa L.; Schwartz, Marvin; Walzer, Sarah

    2010-01-01

    The Home Visiting Coalition represents more than 75 organizations working together to articulate the effectiveness of home visiting to a range of policymakers and stakeholders in the early childhood field. Despite varying program goals and service delivery strategies, the Coalition participants share a commitment to expanding access to…

  16. Predictors of Recidivism to a Juvenile Assessment Center: An Expanded Analysis.

    ERIC Educational Resources Information Center

    Dembo, Richard; And Others

    1996-01-01

    Over 5,200 youths processed through a Juvenile Assessment Center during a 20-month period were involved in this study of recidivism predictors. Significant relationships were found between the youths' demographics, dependency referral factors, delinquency referral history variables, and recidivism. Direct implications for service delivery and…

  17. Students Flourish and Tutors Wither: A Study of Participant Experiences in a First-Year Online Unit

    ERIC Educational Resources Information Center

    Dodo-Balu, Andrea

    2017-01-01

    Contemporary higher education has been affected by policy pressures built around "flexibility". The policies of widening student participation and expanding flexible online delivery combine to provide the opportunity for a university education to students hitherto largely excluded. Flexible employment policies have increasingly placed…

  18. Thinking Globally, Working Locally: Employability and Internationalization at Home

    ERIC Educational Resources Information Center

    Watkins, Heather; Smith, Roy

    2018-01-01

    As an approach to the internationalization of higher education, Internationalization at Home (IaH) looks beyond the mobility of a minority of students, emphasizing instead the delivery to all students of an internationally focused curriculum and the embedding of intercultural communication. This can be expanded to include extracurricular…

  19. Exploring new packaging and delivery options for the immunization supply chain.

    PubMed

    Zehrung, Darin; Jarrahian, Courtney; Giersing, Birgitte; Kristensen, Debra

    2017-04-19

    A variety of vaccine packaging and delivery technologies may benefit the immunization supply chain. These include alternative primary packaging, such as blow-fill-seal polymer containers, and novel delivery technologies, such intradermal delivery devices, microarray patches, and sublingual formulations of vaccines, and others in development. The potential timeline to availability of these technologies varies and depends on their stage of development and the type of data necessary to achieve licensure. Some new delivery devices are anticipated to be introduced in 2017, such as intradermal devices for delivery of inactivated poliovirus vaccine to stretch vaccine supplies due to a supply limitation. Other new technologies requiring vaccine reformulation, such as microarray patches and sublingual vaccines, may become available in the long term (2021 and beyond). Development of many new technologies requires partnership between vaccine and technology manufacturers and identification of the applicable regulatory pathway. Interaction with public-sector stakeholders early on (through engagement with forums such as the World Health Organization's Immunization Practices Advisory Committee Delivery Technologies Working Group) is important to ensure suitability for immunization program use. Key considerations for programmatic suitability of a new vaccine, packaging, and delivery device include cold chain volume, costs, and health impact. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. A framework for expanding aqueous chemistry in the Community Multiscale Air Quality (CMAQ) model version 5.1

    EPA Science Inventory

    This paper describes the development and implementation of an extendable aqueous-phase chemistry option (AQCHEM − KMT(I)) for the Community Multiscale Air Quality (CMAQ) modeling system, version 5.1. Here, the Kinetic PreProcessor (KPP), version 2.2.3, is used t...

  1. Implementing the Expanded Core Curriculum in Specialized Schools for the Blind

    ERIC Educational Resources Information Center

    Lohmeier, Keri L.

    2005-01-01

    Historically, specialized schools for the blind were the only options for educational programming available to students with visual impairments. Throughout the 19th century and into the mid-20th century, the instruction in specialized schools consisted primarily of the core curriculum or academic areas (Zebehazy & Whitten, 1998). Current…

  2. Transforming the Doctorate from Residential to Online: A Distributed PhD Learning Technologies

    ERIC Educational Resources Information Center

    Jones, Greg; Warren, Scott J.; Ennis-Cole, Demetria; Knezek, Gerald; Lin, Lin; Norris, Cathie

    2014-01-01

    This article discusses a systemic change that expanded the doctorate in Learning Technologies at the University of North Texas to include a distributed option, delivered primarily online. It provides an overview of the development process from concept to initial implementation. The article examines the specific differences that make the online…

  3. Antelope Valley Community College District Education Center.

    ERIC Educational Resources Information Center

    Newmyer, Joe

    An analysis is provided of a proposal to the Board of Governors of the California Community Colleges by the Antelope Valley Community College District (AVCCD) to develop an education center in Palmdale to accommodate rapid growth. First, pros and cons are discussed for the following major options: (1) increase utilization and/or expand the…

  4. North Carolina's Emerging Forest Threats: Management Options for Healthy Forests

    Treesearch

    Lisa Jennings; Emrys Treasure; Jennifer Moore Myers; Steve McNulty; Sean Brogan; David Jones

    2012-01-01

    Forest landowners are seeing increased pressure from threats like fire, insects, disease, extreme weather, and drought on their land and resources. The last decade has brought record droughts to North Carolina, increasing wildfires, expanding insect and plant invasions, and more intense hurricane and tornado events. Scientists predict increases in temperature and...

  5. 76 FR 44388 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-25

    ... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-64914; File No. SR-BATS-2011-022] Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing and Immediate Effectiveness of Proposed Rule Change by BATS Exchange, Inc. To Expand the Short Term Option Program July 19, 2011. Pursuant to Section...

  6. Job Attainment and Perceived Role Differences of Cyberschool Leaders

    ERIC Educational Resources Information Center

    Richardson, Jayson W.; Beck, Dennis; LaFrance, Jason; McLeod, Scott

    2016-01-01

    As cyberschooling options expand, it is vital that we understand the nuances of these particular learning opportunities. Because little research exists on leaders of K-12 cyberschools, this exploratory case study had two purposes. We first examined how 18 cyberschool leaders in the United States obtained their position. Second, we explored the…

  7. Short Lumber: Concept and Acceptance

    Treesearch

    Janice K. Wiedenbeck

    1993-01-01

    The primary purpose of this study was to evaluate short length lumber (less than 8 feet long) utilization opportunities within the furniture and cabinet industries. If such a high-value market for short length lumber could be developed, the profit potential for many sawmills would increase and the forest resource management options in many areas would expand. Short...

  8. New York City's Small Public Schools: Opportunities for Achievement.

    ERIC Educational Resources Information Center

    Brownell, Carol, Ed.; Libby, Joan

    In 1994, four New York City school reform organizations joined to form the New York Networks for School Renewal (NYNSR) and received the first Annenberg Challenge urban grant. NYNSR goals are to expand the number of small, excellent public schools in New York City neighborhoods, particularly those with few educational options; encourage the spread…

  9. 78 FR 32661 - Medicare, Medicaid, and Children's Health Insurance Programs; Renewal of the Advisory Panel on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-31

    ...] Medicare, Medicaid, and Children's Health Insurance Programs; Renewal of the Advisory Panel on Outreach and... Medicaid and the Children's Health Insurance Program (CHIP), and also expanded the availability of other... are eligible for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) about options...

  10. Opening Doors to Nursing Degrees: A Proposal from Ontario's Colleges

    ERIC Educational Resources Information Center

    Colleges Ontario, 2010

    2010-01-01

    Ontario needs to expand nursing education options to improve access to the nursing profession, create better pathways amongst all nursing occupations, and build Ontario's capacity to meet the province's long-term nursing needs. Ontario's colleges are capable of playing a larger role within a long-term provincial strategy for sustaining and…

  11. Addressing the Context of E-Learning: Using Transactional Distance Theory to Inform Design

    ERIC Educational Resources Information Center

    Benson, Robyn; Samarawickrema, Gayani

    2009-01-01

    The rapidly expanding range of options available for innovative e-learning approaches based on emerging technologies has given renewed importance to teaching and learning issues that have long been familiar to distance educators. These issues arise from the separation between learners, and between teacher and learners, which occurs when learning…

  12. Prepaid College Tuition Plans: Promise and Problems.

    ERIC Educational Resources Information Center

    Olivas, Michael A., Ed.

    This book provides a group of articles concerning the equity and efficiency of prepaid college tuition plans. Chapters: (1) introduce the subject; (2) examine the competing financial theories at play in this field; (3) present a study of the Michigan Education Trust's decision to expand its subscriber base by offering a monthly payment option; (4)…

  13. Expanding Opportunities and Building Competencies for Young People: A New Agenda for Secondary Education

    ERIC Educational Resources Information Center

    Cuadra, Ernesto; Moreno, Juan Manuel

    2005-01-01

    The purpose of this report is to set forth policy options for supporting developing countries and transition economies in adapting their secondary education systems to demands arising from the successful expansion of primary education and the socioeconomic challenges presented by globalization and the knowledge-based economy. The report analyzes…

  14. The Role of MTurk in Education Research: Advantages, Issues, and Future Directions

    ERIC Educational Resources Information Center

    Follmer, D. Jake; Sperling, Rayne A.; Suen, Hoi K.

    2017-01-01

    The advent of online platforms such as Amazon's Mechanical Turk (MTurk) has expanded considerably researchers' options for collecting research data. Many researchers, however, express understandable skepticism of the viability of using platforms such as MTurk. In this article, we provide a background on the use of MTurk as a mechanism for…

  15. Site Management and Productivity in Tropical Forest Plantations

    Treesearch

    A. Tiarks; E.K.S. Nambiar; C. Cossalter

    1998-01-01

    Tropical countries are expanding plantation forestry to develop sustainable woodproduction systems. Much of this is based on short rotations of exotic species. These systems require large capital investments, represent intensive land use and increase the demands on the soil. To develop options for maintaining or increasing productivity a partner-project was initiated...

  16. 76 FR 8793 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Order Granting Approval of Proposed Rule...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-15

    ... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-63875; File No. SR-Phlx-2010-183] Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Order Granting Approval of Proposed Rule Change Expanding Its Short Term Option Program February 9, 2011. I. Introduction On December 15, 2010, NASDAQ OMX PHLX LLC...

  17. 75 FR 39923 - Office of Postsecondary Education; Overview Information; Pilot Program for Course Material Rental...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-13

    ... DEPARTMENT OF EDUCATION Office of Postsecondary Education; Overview Information; Pilot Program for... education (IHEs) for pilot programs that expand the services of bookstores to provide the option for... CFR 75.105(b)(2)(iv), this priority is from section 803 of the Higher Education Opportunity Act (HEOA...

  18. Community College of Rhode Island.

    ERIC Educational Resources Information Center

    Liston, Edward J.

    1999-01-01

    Describes the history, mission, financing, and enrollment of the Community College of Rhode Island (CCRI). Presents CCRI's goals: (1) expand the use of technology; (2) be more responsive to the business community and assist in strengthening the economy of the state; (3) become more student-centered; and (4) become a first-stop option for high…

  19. "It's Good to Have Wheels!" Perceptions of Cycling among Homeless Young People in Sydney, Australia

    ERIC Educational Resources Information Center

    Crawford, Belinda; Rissel, Chris; Yamazaki, Rowena; Franke, Elise; Amanatidis, Sue; Ravulo, Jioji; Bindon, Jenni; Torvaldsen, Siranda

    2012-01-01

    Participation in sporting or recreational programs can be unattainable for many disadvantaged young people. Encouraging regular cycling is an important public health strategy to increase participation in physical activity and expand personal transport options for marginalised youth. Perceptions and attitudes toward cycling were explored in eight…

  20. Songs in Our Hearts: The Affordances and Constraints of an Intergenerational Multimodal Arts Curriculum

    ERIC Educational Resources Information Center

    Heydon, Rachel; O'Neill, Susan

    2014-01-01

    This qualitative case study examines the affordances and constraints of an intergenerational multimodal arts curriculum that was designed to expand communication and identity options for children and elder participants. The authors drew on actor-network theory to conceptualize curriculum as a network effect and refer to literature on multimodal…

  1. Extending the Classroom: Transforming a School through Experiential Education

    ERIC Educational Resources Information Center

    Mierke, Sara

    2013-01-01

    Even the most traditional independent schools have a starting point for expanding or integrating experiential education. Hawken was founded in 1915 as an alternative to existing traditional private education options for boys in Cleveland. James A. Hawken, a progressive New York educator, founded the school in a small house on the edge of…

  2. Beyond a Terabyte File System

    NASA Technical Reports Server (NTRS)

    Powers, Alan K.

    1994-01-01

    The Numerical Aerodynamics Simulation Facility's (NAS) CRAY C916/1024 accesses a "virtual" on-line file system, which is expanding beyond a terabyte of information. This paper will present some options to fine tuning Data Migration Facility (DMF) to stretch the online disk capacity and explore the transitions to newer devices (STK 4490, ER90, RAID).

  3. Experiences and unmet needs of women with physical disabilities for pain relief during labor and delivery.

    PubMed

    Long-Bellil, Linda; Mitra, Monika; Iezzoni, Lisa I; Smeltzer, Suzanne C; Smith, Lauren D

    2017-07-01

    Childbirth is widely acknowledged as one of the most painful experiences most women will undergo in their lifetimes. Alleviating labor and delivery pain for women with physical disabilities can involve an additional level of complexity beyond that experienced by most women, but little research has explored their experiences. The purpose of this study was to explore the experiences of women with physical disabilities with respect to pain relief during labor and delivery with the goal of informing their care. Data were collected using semi-structured interviews with twenty-five women with physical disabilities from across the United States. Women expressed specific preferences for the method of pain relief. Some confronted systemic barriers in exploring their options for pain relief, while others were given a choice. At times, anesthesiologists lacked knowledge and experience in caring for women with disabilities. Conversely, some women described how the administration of anesthesia was meticulously planned and attributed their positive labor and delivery experiences to this careful planning. Advanced, individualized planning and evaluation of their options for pain relief was most satisfying to women and enabled them to make an informed choice. This approach is consistent with the recommendations of clinicians who have successfully provided pain relief during labor to women with complex physical disabilities. Clinicians who have successfully delivered babies of women with these and similar disabilities emphasize the importance of a team approach where the anesthesiologist and other specialists are involved early on in a woman's care. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Cost-effectiveness of World Health Organization 2010 Guidelines for Prevention of Mother-to-Child HIV Transmission in Zimbabwe

    PubMed Central

    Ciaranello, Andrea L.; Perez, Freddy; Engelsmann, Barbara; Walensky, Rochelle P.; Mushavi, Angela; Rusibamayila, Asinath; Keatinge, Jo; Park, Ji-Eun; Maruva, Matthews; Cerda, Rodrigo; Wood, Robin; Dabis, Francois; Freedberg, Kenneth A.

    2013-01-01

    Background. In 2010, the World Health Organization (WHO) released revised guidelines for prevention of mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). We projected clinical impacts, costs, and cost-effectiveness of WHO-recommended PMTCT strategies in Zimbabwe. Methods. We used Zimbabwean data in a validated computer model to simulate a cohort of pregnant, HIV-infected women (mean age, 24 years; mean CD4 count, 451 cells/µL; subsequent 18 months of breastfeeding). We simulated guideline-concordant care for 4 PMTCT regimens: single-dose nevirapine (sdNVP); WHO-recommended Option A, WHO-recommended Option B, and Option B+ (lifelong maternal 3-drug antiretroviral therapy regardless of CD4). Outcomes included maternal and infant life expectancy (LE) and lifetime healthcare costs (2008 US dollars [USD]). Incremental cost-effectiveness ratios (ICERs, in USD per year of life saved [YLS]) were calculated from combined (maternal + infant) discounted costs and LE. Results. Replacing sdNVP with Option A increased combined maternal and infant LE from 36.97 to 37.89 years and would reduce lifetime costs from $5760 to $5710 per mother–infant pair. Compared with Option A, Option B further improved LE (38.32 years), and saved money within 4 years after delivery ($5630 per mother–infant pair). Option B+ (LE, 39.04 years; lifetime cost, $6620 per mother–infant pair) improved maternal and infant health, with an ICER of $1370 per YLS compared with Option B. Conclusions. Replacing sdNVP with Option A or Option B will improve maternal and infant outcomes and save money; Option B increases health benefits and decreases costs compared with Option A. Option B+ further improves maternal outcomes, with an ICER (compared with Option B) similar to many current HIV-related healthcare interventions. PMID:23204035

  5. Automating the Analytical Laboratories Section, Lewis Research Center, National Aeronautics and Space Administration: A feasibility study

    NASA Technical Reports Server (NTRS)

    Boyle, W. G.; Barton, G. W.

    1979-01-01

    The feasibility of computerized automation of the Analytical Laboratories Section at NASA's Lewis Research Center was considered. Since that laboratory's duties are not routine, the automation goals were set with that in mind. Four instruments were selected as the most likely automation candidates: an atomic absorption spectrophotometer, an emission spectrometer, an X-ray fluorescence spectrometer, and an X-ray diffraction unit. Two options for computer automation were described: a time-shared central computer and a system with microcomputers for each instrument connected to a central computer. A third option, presented for future planning, expands the microcomputer version. Costs and benefits for each option were considered. It was concluded that the microcomputer version best fits the goals and duties of the laboratory and that such an automted system is needed to meet the laboratory's future requirements.

  6. [Nursing as an option: profile of undergraduate of two teaching institutions].

    PubMed

    Spíndola, Thelma; Martins, Elizabeth Rose da Costa; Francisco, Márcio Tadeu Ribeiro

    2008-01-01

    This is a descriptive-exploratory study, aiming at comparing socioeconomic profile of students of two teaching institutions of the municipality of Rio de Janeiro and factors that interfere in their option to choose Nursing. The study was composed by 152 students of Institution (A) and 120 of (B) who were admitted to the undergraduate course in 2004 and 2005. The analysis evidenced that the majority belongs to middle and lower middle class and are young adults, single women. An expanding labor market and an opportunity of a better salary are the main factors that attract students of private schools to nursing career. It is important to the profession to be known in society and, especially, among students who search for a professional option, considering the lack of information of students who are admitted to the Nursing undergraduate course.

  7. Substantiating In Vivo Magnetic Brain Tumor Targeting of Cationic Iron Oxide Nanocarriers via Adsorptive Surface Masking

    PubMed Central

    Chertok, Beata; David, Allan E.; Moffat, Bradford A.; Yang, Victor C.

    2009-01-01

    Cationic magnetic nanoparticles are attractive as potential vehicles for tumor drug delivery due to their favorable interactions with both the tumor milieu and the therapeutic cargo. However, systemic delivery of these nanoparticles to the tumor site is compromised by their rapid plasma clearance. We developed a simple method for in vivo protection of cationic nanocarriers, using non-covalent surface masking with a conjugate of low molecular weight heparin and polyethylene glycol. Surface masking resulted in an 11-fold increase in plasma AUC and a 2-fold increase in the magnetic capture of systemically injected nanoparticles in orthotopic rodent brain tumors. Overall, the described methodology could expand the prospective applications for cationic magnetic nanoparticles in magnetically-mediated gene/drug delivery. PMID:19782394

  8. Recent advances in green nanoparticulate systems for drug delivery: efficient delivery and safety concern.

    PubMed

    Lam, Pik-Ling; Wong, Wai-Yeung; Bian, Zhaoxiang; Chui, Chung-Hin; Gambari, Roberto

    2017-02-01

    Nanotechnology manipulates therapeutic agents at the nanoscale for the development of nanomedicines. However, there are current concerns over nanomedicines, mainly related to the possible toxicity of nanomaterials used for health medications. Due to their small size, they can enter the human body more readily than larger sized particles. Green chemistry encompasses the green synthesis of drug-loaded nanoparticles by reducing the use of hazardous materials in the synthesis process, thus reducing the adverse health impacts of pharmaceutics. This would greatly expand their potential in biomedical treatments. This review highlights the potential risks of nanomedicine formulations to health, delivery routes of green nanomedicines, recent advances in the development of green nanoscale systems for biomedical applications and future perspectives for the green development of nanomedicines.

  9. Convergence of anatomy, technology, and therapeutics: a review of laser-assisted drug delivers.

    PubMed

    Brauer, Jeremy A; Krakowski, Andrew C; Bloom, Bradley S; Nguyen, Tuyet A; Geronemus, Roy G

    2014-12-01

    This is a very exciting time in cutaneous laser surgery with an ever-expanding therapeutic armamentarium and an increased sophistication of available technology. These recent trends have allowed for both a rapid development of interest and exploration of laser-assisted drug delivery and its potential applications. We review the current literature on anatomy, technology, and therapeutics as it relates to laser-assisted drug delivery. The focus of our review is on two areas of interest that have received much attention to date - photodynamic therapy in the treatment of actinic keratoses and nonmelanoma skin cancers as well as the treatment of scarring. We will also discuss potential complications of existing modalities used independently and in laser-assisted drug delivery and conclude with future indications for this burgeoning therapeutic methodology.

  10. Effective delivery of volatile biocides employing mesoporous silicates for treating biofilms

    PubMed Central

    Chan, Andrea C.; Townley, Helen E.

    2017-01-01

    Nanoparticulate delivery of biocides has the potential to decrease levels of exposure to non-target organisms, and miminize long-term exposure that can promote the development of resistance. Silica nanoparticles are an ideal vehicle since they are inert, biocompatible, biodegradable, and thermally and chemically stable. Encapsulation of biocides within nanoparticulates can improve their stability and longevity and maximize the biocidal potential of hydrophobic volatile compounds. Herein, we have shown that the plant secondary metabolites allyl isothiocyanate and cinnamaldehyde demonstrated increased antimicrobial activity against Escherichia coli in planktonic form, when packaged into mesoporous silica nanoparticles. Furthermore, the biocide-loaded nanoparticles showed activity against Pseudomonas aeruginosa biofilms that have inherent resistance to antimicrobial agents. The delivery platform can also be expanded to traditional biocides and other non-conventional antimicrobial agents. PMID:28077760

  11. Analysis of Shroud Options in Support of the Human Exploration of Mars

    NASA Technical Reports Server (NTRS)

    Feldman, Stuart; Borowski, Stanley; Engelund, Walter; Hundley, Jason; Monk, Timothy; Munk, Michelle

    2010-01-01

    In support of the Mars Design Reference Architecture (DRA) 5.0, the NASA study team analyzed several shroud options for use on the Ares V launch vehicle.1,2 These shroud options included conventional "large encapsulation" shrouds with outer diameters ranging from 8.4 to 12.9 meters (m) and overall lengths of 22.0 to 54.3 meters, along with a "nosecone-only" shroud option used for Mars transfer vehicle component delivery. Also examined was a "multi-use" aerodynamic encapsulation shroud used for launch, Mars aerocapture, and entry, descent, and landing of the cargo and habitat landers. All conventional shroud options assessed for use on the Mars launch vehicles were the standard biconic design derived from the reference shroud utilized in the Constellation Program s lunar campaign. It is the purpose of this paper to discuss the technical details of each of these shroud options including material properties, structural mass, etc., while also discussing both the volume and mass of the various space transportation and surface system payload elements required to support a "minimum launch" Mars mission strategy, as well as the synergy, potential differences and upgrade paths that may be required between the Lunar and Mars mission shrouds.

  12. Student Perception of Online Learning in ESL Bilingual Teacher Preparation

    ERIC Educational Resources Information Center

    Daniel, Mayra C.; Schumacher, Gail; Stelter, Nicole; Riley, Carolyn

    2016-01-01

    Current technologies are changing delivery options for post-graduate teacher education. Many practicing teachers who return to school to prepare to educate English learners choose distance learning. This article explores teachers' perceived satisfaction with the quality of online courses, with the collaborative tasks required in these, and the…

  13. 17 CFR 37.3 - Requirements for underlying commodities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 5a(b)(3) of the Act, may trade any contract of sale of a commodity for future delivery (or option on... that are a security futures product, and the registered derivatives transaction execution facility is a... commodities. 37.3 Section 37.3 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION...

  14. Automated Feedback as a Convergence Tool

    ERIC Educational Resources Information Center

    Chenoweth, Tim; Corral, Karen; Scott, Kit

    2016-01-01

    This study evaluates two content delivery options for teaching a programming language to determine whether an asynchronous format can achieve the same learning efficacy as a traditional lecture (face-to-face) format. We use media synchronicity theory as a guide to choose media capabilities to incorporate into an asynchronous tutorial used…

  15. The Challenges of Online Learning Supporting and Engaging the Isolated Learner

    ERIC Educational Resources Information Center

    Gillett-Swan, Jenna

    2017-01-01

    Higher education providers are becoming increasingly aware of the diversity of their current and potential learners and are moving to provide a range of options for their engagement. The increasingly flexible delivery modes available for university students provide multiple pathways and opportunities for those seeking further education. In…

  16. Developing Online Courses: A Human-Centered Approach.

    ERIC Educational Resources Information Center

    Branon, Rovy; Beatty, Brian; Wilson, Jack

    Companies and universities are increasingly moving to online delivery for much of their training and education needs, and designing and building quality distance education is a challenge facing many organizations. Option Six is an independent company that is building customized e-learning solutions. Over the last 2 years, the instructional…

  17. Integrated Adult Education Data System. Policy Option Paper on Strategic Recommendation 8. First Edition.

    ERIC Educational Resources Information Center

    Porter, Dennis

    This document addresses the recommendation contained in the 1989 California Strategic Plan for Adult Education for an integrated adult education data system. The recommendation proposes collecting and organizing community adult education information into groups of data on: program services, program delivery, learner characteristics, and learning…

  18. Decentralisation and Privatisation of Education in Africa: Which Option for Nigeria?

    ERIC Educational Resources Information Center

    Geo-Jaja, Macleans A.

    2004-01-01

    Arguing that the politicisation of decentralisation appreciably reduces educational quality and efficient resource allocation and negatively affects matters of equity in and delivery of education, the present study provides a critique of decentralisation and privatisation in education in Africa with special reference to Nigeria. On the basis of…

  19. Advanced Seal Delivery System: Perspectives and Options

    DTIC Science & Technology

    2006-01-01

    in that order of importance. Once cracked by whatever mechanism, alloy 6-4 titanium (unlike some other titani - um materials) will fail immediately...NGC and its potential subcontractors is not as effective as it could be. Given the early history of the ASDS program, it does not surprise us that

  20. 12 CFR 221.1 - Authority, purpose, and scope.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Commodity Futures Trading Commission that accept deposits of margin stock in connection with: (i) The... security, certificate of deposit, securities index or foreign currency); or (ii) The guarantee of contracts for the purchase or sale of a commodity for future delivery or options on such contracts. (3) This...

  1. 12 CFR 221.1 - Authority, purpose, and scope.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Commodity Futures Trading Commission that accept deposits of margin stock in connection with: (i) The... security, certificate of deposit, securities index or foreign currency); or (ii) The guarantee of contracts for the purchase or sale of a commodity for future delivery or options on such contracts. (3) This...

  2. Database Selection: One Size Does Not Fit All.

    ERIC Educational Resources Information Center

    Allison, DeeAnn; McNeil, Beth; Swanson, Signe

    2000-01-01

    Describes a strategy for selecting a delivery method for electronic resources based on experiences at the University of Nebraska-Lincoln. Considers local conditions, pricing, feature options, hardware costs, and network availability and presents a model for evaluating the decision based on dollar requirements and local issues. (Author/LRW)

  3. Earning and Learning

    ERIC Educational Resources Information Center

    Haughton, Lesley

    2010-01-01

    The higher education landscape has changed considerably in the past decade, with the introduction of a range of flexible work-related opportunities to allow working people to study and progress at higher levels. This includes the development of modes of delivery such as distance and e-learning options, but also new ways of working between…

  4. Exploring the Efficacy of Online American Sign Language Instruction

    ERIC Educational Resources Information Center

    Radford, Curt L.

    2012-01-01

    Advances in technology have significantly influenced educational delivery options, particularly in the area of American Sign Language (ASL) instruction. As a result, ASL online courses are currently being explored in higher education. The review of literature remains relatively unexplored regarding the effectiveness of learning ASL online. In…

  5. Right on Course

    ERIC Educational Resources Information Center

    Brown, Don W.

    2011-01-01

    Lane County, Oregon, has 16 school districts, and up until last year, every one of them had its own online learning program. Some were more like correspondence courses, while others were closer to online curriculum delivery. No one had ever explored the options available, the cost savings that district collaboration might provide, or the benefits…

  6. Enhanced Online Access Requires Redesigned Delivery Options and Cost Models

    ERIC Educational Resources Information Center

    Stern, David

    2007-01-01

    Rapidly developing online information technologies provide dramatically new capabilities and opportunities, and place new responsibilities on all involved to recreate networks for scholarly communication. Collaborations between all segments of the information network are made possible and necessary as we attempt to find a balanced and mutually…

  7. Online Learning for the Left-Behind Generation

    ERIC Educational Resources Information Center

    Wake, Donna; Bunn, Gary

    2015-01-01

    Teacher education programs have increasingly embraced online education, and the number of candidates enrolled in distance coursework is rising. In response to changes in delivery methods brought about by this trend, programs seek to deliver content via distance learning options in ways that demonstrate pedagogical best practices. Through an…

  8. Database Marketplace 2010: Feast and Famine

    ERIC Educational Resources Information Center

    Tenopir, Carol; Baker, Gayle; Grogg, Jill

    2010-01-01

    With fancy new software developments and growth in both the richness of content and delivery options for information resources, the Database Marketplace 2010 is a feast for buyers. Unfortunately, institutional budget cuts may force more of a famine mentality--with belt-tightening for most, and only purchases that are life-sustaining being served…

  9. Delivery cost of human papillomavirus vaccination of young adolescent girls in Peru, Uganda and Viet Nam.

    PubMed

    Levin, Carol E; Van Minh, Hoang; Odaga, John; Rout, Swampa Sarit; Ngoc, Diep Nguyen Thi; Menezes, Lysander; Araujo, Maria Ana Mendoza; LaMontagne, D Scott

    2013-08-01

    To estimate the incremental delivery cost of human papillomavirus (HPV) vaccination of young adolescent girls in Peru, Uganda and Viet Nam. Data were collected from a sample of facilities that participated in five demonstration projects for hpv vaccine delivery: school-based delivery was used in Peru, Uganda and Viet Nam; health-centre-based delivery was also used in Viet Nam; and integrated delivery, which involved existing health services, was also used in Uganda. Microcosting methods were used to guide data collection on the use of resources (i.e. staff, supplies and equipment) and data were obtained from government, demonstration project and health centre administrative records. Delivery costs were expressed in 2009 United States dollars (US$). Exclusively project-related expenses and the cost of the vaccine were excluded. The economic delivery cost per vaccine dose ranged from US$ 1.44 for integrated outreach in Uganda to US$ 3.88 for school-based delivery in Peru. In Viet Nam, the lowest cost per dose was US$ 1.92 for health-centre-based delivery. Cost profiles revealed that, in general, the largest contributing factors were project start-up costs and recurrent personnel costs. The delivery cost of HPV vaccine was higher than published costs for traditional vaccines recommended by the Expanded Programme on Immunization (EPI). The cost of delivering HPV vaccine to young adolescent girls in Peru, Uganda and Viet Nam was higher than that for vaccines currently in the EPI schedule. The cost per vaccine dose was lower when delivery was integrated into existing health services.

  10. Rapid Response R&D for the Propulsion Directorate. Delivery Order 0019: Advanced Alternative Energy Technologies, Subtask: Life Cycle Greenhouse Gas Analysis of Advanced Jet Propulsion Fuels: Fischer-Tropsch Based SPK-1 Case Study

    DTIC Science & Technology

    2011-09-01

    carry finished jet fuel from the CBTL facility. The pipeline connects the CBTL facility to a petroleum refinery located in Wood River, Illinois...Under Option 1, all the blended jet fuel is transported via pipeline from the refinery in Wood River to Chicago’s O’Hare airport. Under Option 2...shipping F-T jet fuel to a refinery in Wood River, Illinois (near St. Louis, Missouri) for blending and final transport of the blended jet fuel to

  11. Mission Benefits of Gridded Ion and Hall Thruster Hybrid Propulsion Systems

    NASA Technical Reports Server (NTRS)

    Dankanich, John W.; Polsgrove, Tara

    2006-01-01

    The NASA In-Space Propulsion Technology (ISPT) Project Office has been developing the NEXT gridded ion thruster system and is planning to procure a low power Hall system. The new ion propulsion systems will join NSTAR as NASA's primary electric propulsion system options. Studies have been performed to show mission benefits of each of the stand alone systems. A hybrid ion propulsion system (IPS) can have the advantage of reduced cost, decreased flight time and greater science payload delivery over comparable homogeneous systems. This paper explores possible advantages of combining various thruster options for a single mission.

  12. Transportation: Destination Mars

    NASA Technical Reports Server (NTRS)

    Eoff, Bill

    1998-01-01

    As the agency space transportation lead center, Marshall Space Flight Center has been conducting transportation assessments for future robotic and human Mars missions to identify critical technologies. Five human Mars options are currently under assessment with each option including all transportation requirements from Earth to Mars and return. The primary difference for each option is the propulsion source from Earth to Mars. In case any of the options require heavy launch capability that is not currently projected as available, an in-house study has been initiated to determine the most cost effective means of providing such launch capability. This assessment is only considering launch architectures that support the overall human Mars mission cost goal of $25B. The guidelines for the launch capability study included delivery of 80 metric ton (176 KLB) payloads, 25 feet diameter x 92 feet long, to 220 nmi orbits at 28.5 degrees. The launch vehicle concept of the study was designated "Magnum" to differentiate from prior heavy launch vehicle assessments. This assessment along with the assessment of options for all transportation phases of a Mars mission are on-going.

  13. NASA Advisory Council: Fact-Finding Session

    NASA Technical Reports Server (NTRS)

    Cohen, Aaron; Martin, Franklin D.; Craig, Mark K.; Duke, Michael B.

    1992-01-01

    The principal agenda item for this fact-finding meeting of the NASA Advisory Council was NASA's preliminary planning of options to implement the President's initiative for establishing a base on the Moon and launching a human expedition to Mars. NASA's presentation (1) reviewed the key elements in the President's speech of July 20, 1989, summoning the Nation to launch a new exploration initiative to the Moon and Mars; (2) outlined five candidate options analyzed in terms of schedule and scale of effort (for a return to the Moon and for a voyage to Mars); (3) outlined tentative robotic mission milestones for both a 'vigorous deployment' option and a 'paced deployment' option; (4) reviewed Earth-to-orbit delivery requirements for a lunar heavy-lift launch vehicle, the National Space Transportation System, and a Mars heavy-lift launch vehicle; (5) summarized the associated Space Station Freedom requirements; (6) outlined the technology as well as human factors requirements for the candidate options; and (7) summarized the themes and approaches that could be employed for the science aspects of a national Moon/Mars exploration program.

  14. Preparation of uniform-sized multiple emulsions and micro/nano particulates for drug delivery by membrane emulsification.

    PubMed

    Liu, Wei; Yang, Xiang-Liang; Ho, W S Winston

    2011-01-01

    Much attention has in recent years been paid to fine applications of drug delivery systems, such as multiple emulsions, micro/nano solid lipid and polymer particles (spheres or capsules). Precise control of particle size and size distribution is especially important in such fine applications. Membrane emulsification can be used to prepare uniform-sized multiple emulsions and micro/nano particulates for drug delivery. It is a promising technique because of the better control of size and size distribution, the mildness of the process, the low energy consumption, easy operation and simple equipment, and amendable for large scale production. This review describes the state of the art of membrane emulsification in the preparation of monodisperse multiple emulsions and micro/nano particulates for drug delivery in recent years. The principles, influence of process parameters, advantages and disadvantages, and applications in preparing different types of drug delivery systems are reviewed. It can be concluded that the membrane emulsification technique in preparing emulsion/particulate products for drug delivery will further expand in the near future in conjunction with more basic investigations on this technique. Copyright © 2010 Wiley-Liss, Inc. and the American Pharmacists Association

  15. Magnitude of institutional delivery service utilization and associated factors among women in pastoral community of Awash Fentale district Afar Regional State, Ethiopia.

    PubMed

    Assefa, Luelseged; Alemayehu, Mussie; Debie, Ayal

    2018-03-02

    Reduction of maternal mortality is a global priority particularly in developing countries like Ethiopia where maternal mortality ratio is one of the highest in the world. Most deliveries in developing countries occur at home without skilled birth attendants. Therefore, the objective of this study was to assess institutional delivery service utilization and associated factors among women in pastoral community of Awash Fentale district, Ethiopia. Overall, 35.2% of women delivered at health facilities. Women who had good knowledge AOR = 2.1, 95% CI 1.32, 4.87), Ante Natal Care (ANC) follow up (AOR = 3.2, 95% CI 1.55, 6.63), resided in a place where distance to reach at the nearby health facilities takes < 30 min (AOR = 3.1; 95% CI 2.57, 66.33) and women whose husband involved in decision regarding delivery place (AOR = 1.9; 95% CI 1.49, 5.07) were more likely to deliver at health facility. Therefore, strengthening ANC services, improving maternal knowledge, involving husbands in decision of delivery place and expanding health facilities in the community would enhance institutional delivery.

  16. Growth requirements for multidiscipline research and development on the evolutionary space station

    NASA Technical Reports Server (NTRS)

    Meredith, Barry; Ahlf, Peter; Saucillo, Rudy; Eakman, David

    1988-01-01

    The NASA Space Station Freedom is being designed to facilitate on-orbit evolution and growth to accommodate changing user needs and future options for U.S. space exploration. In support of the Space Station Freedom Program Preliminary Requirements Review, The Langley Space Station Office has identified a set of resource requirements for Station growth which is deemed adequate for the various evolution options. As part of that effort, analysis was performed to scope requirements for Space Station as an expanding, multidiscipline facility for scientific research, technology development and commercial production. This report describes the assumptions, approach and results of the study.

  17. Space civil engineering - A new discipline

    NASA Technical Reports Server (NTRS)

    Sadeh, Willy Z.; Criswell, Marvin E.

    1991-01-01

    Space Civil Engineering is an emerging engineering discipline that focuses on extending and expanding the Civil Engineering know-how and practice to the development and maintenance of infrastructure on celestial bodies. Space Civil Engineering is presently being developed as a new discipline within the Department of Civil Engineering at Colorado State University under a recently established NASA Space Grant College Program. Academic programs geared toward creating Space Civil Engineering Options at both undergraduate and graduate levels are being formulated. Basic ideas and concepts of the curriculum in the Space Civil Engineering Option at both undergraduate and graduate levels are presented. The role of Space Civil Engineering in the Space Program is discussed.

  18. Current stage in inflammatory bowel disease: What is next?

    PubMed Central

    Gómez-Gómez, Gonzalo Jesús; Masedo, Ángeles; Yela, Carmen; Martínez-Montiel, Maria del Pilar; Casís, Begoña

    2015-01-01

    In recent years, the incidence of inflammatory bowel disease (IBD) has been on the rise, extending to countries where it was infrequent in the past. As a result, the gap between high and low incidence countries is decreasing. The disease, therefore, has an important economic impact on the healthcare system. Advances in recent years in pharmacogenetics and clinical pharmacology have allowed for the development of treatment strategies adjusted to the patient profile. Concurrently, new drugs aimed at inflammatory targets have been developed that may expand future treatment options. This review examines advances in the optimization of existing drug treatments and the development of novel treatment options for IBD. PMID:26525013

  19. Learning to think strategically.

    PubMed

    1994-01-01

    Strategic thinking focuses on issues that directly affect the ability of a family planning program to attract and retain clients. This issue of "The Family Planning Manager" outlines the five steps of strategic thinking in family planning administration: 1) define the organization's mission and strategic goals; 2) identify opportunities for improving quality, expanding access, and increasing demand; 3) evaluate each option in terms of its compatibility with the organization's goals; 4) select an option; and 5) transform strategies into action. Also included in this issue is a 20-question test designed to permit readers to assess their "strategic thinking quotient" and a list of sample questions to guide a strategic analysis.

  20. Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization

    PubMed Central

    Hofer, Adam N; Abraham, Jean Marie; Moscovice, Ira

    2011-01-01

    Context: Provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA) expand Medicaid to all individuals in families earning less than 133 percent of the federal poverty level (FPL) and make available subsidies to uninsured lower-income Americans (133 to 400 percent of FPL) without access to employer-based coverage to purchase insurance in new exchanges. Since primary care physicians typically serve as the point of entry into the health care delivery system, an adequate supply of them is critical to meeting the anticipated increase in demand for medical care resulting from the expansion of coverage. This article provides state-level estimates of the anticipated increases in primary care utilization given the PPACA's provisions for expanded coverage. Methods: Using the Medical Expenditure Panel Survey, this article estimates a multivariate regression model of annual primary care utilization. Using the model estimates and state-level information regarding the number of uninsured, it predicts, by state, the change in primary care visits expected from the expanded coverage. Finally, the article predicts the number of primary care physicians needed to accommodate this change in utilization. Findings: This expanded coverage is predicted to increase by 2019 the number of annual primary care visits between 15.07 million and 24.26 million. Assuming stable levels of physicians’ productivity, between 4,307 and 6,940 additional primary care physicians would be needed to accommodate this increase. Conclusions: The PPACA's health insurance expansion parameters are expected to significantly increase the use of primary care. Two strategies that policymakers may consider are creating stronger financial incentives to attract medical school students to primary care and changing the delivery of care in ways that lead to operational improvements, higher throughput, and better quality of care. PMID:21418313

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