Students' Perspectives on Gatekeeping in Counselor Education: A Case Study

ERIC Educational Resources Information Center

Foster, Jennifer M.; Leppma, Monica; Hutchinson, Tracy S.

2014-01-01

Through in-depth interviews, the authors examined 10 master's-level counseling students' perceptions of gatekeeping. Case analysis resulted in 3 major themes pertaining to the necessity of gatekeeping, vital components, and counseling student characteristics. Implications of the findings are also discussed.

Mother Knows Best? Inhibitory Maternal Gatekeeping, Psychological Control, and the Mother-Adolescent Relationship

ERIC Educational Resources Information Center

Holmes, Erin Kramer; Dunn, KayLee C.; Harper, James; Dyer, W. Justin; Day, Randal D.

2013-01-01

We used structural equation modeling to explore associations between inhibitory maternal gatekeeping attitudes, reports of inhibitory maternal gatekeeping behaviors, maternal psychological control, observed mother-adolescent warmth, and adolescent reports of maternal involvement. Our random stratified sample consisted of 315 mothers and their…

Toward a Political-Organizational Model of Gatekeeping: The Case of Elite Colleges.

ERIC Educational Resources Information Center

Karen, David

1990-01-01

Develops a gatekeeping theory by stepping inside the black box of Harvard university's admissions process. Stresses how political and organizational contexts influence selection (gatekeeping). Analyzes how student merit and social class-based factors mutually determine selection. Links an understanding of the organizational field with process…

From Informal Gatekeeper to Information Counselor: Emergence of a New Professional Role.

ERIC Educational Resources Information Center

Dosa, Marta; And Others

Borrowed from the literature of more than two decades ago--when it alluded to key communicators within organizations--the concept of "gatekeeper" is reintroduced in this report. The role of information counselors, who, like informal gatekeepers, take part in liaison activities, networking, advising, information filtering, transmitting,…

The Gatekeeping Imperative in Counselor Education Admission Protocols: The Criticality of Personal Qualities

ERIC Educational Resources Information Center

McCaughan, Ann M.; Hill, Nicole R.

2015-01-01

Admission procedures in counselor education have received little focus regarding their essential function in gatekeeping. By exploring current admission trends, specifically as they relate to the identification of preferred personal qualities, implications for development of more rigorous admission gatekeeping procedures will be addressed. A call…

Appropriate Targets for Search Advertising as Part of Online Gatekeeping for Suicide Prevention.

PubMed

Sueki, Hajime; Ito, Jiro

2018-05-01

Gatekeeper training is an effective suicide prevention strategy. However, the appropriate targets of online gatekeeping have not yet been clarified. We examined the association between the outcomes of online gatekeeping using the Internet and the characteristics of consultation service users. An advertisement to encourage the use of e-mail-based psychological consultation services among viewers was placed on web pages that showed the results of searches using suicide-related keywords. All e-mails received between October 2014 and December 2015 were replied to as part of gatekeeping, and the obtained data (responses to an online questionnaire and the content of the received e-mails) were analyzed. A total of 154 consultation service users were analyzed, 35.7% of whom were male. The median age range was 20-29 years. Online gatekeeping was significantly more likely to be successful when such users faced financial/daily life or workplace problems, or revealed their names (including online names). By contrast, the activity was more likely to be unsuccessful when it was impossible to assess the problems faced by consultation service users. It may be possible to increase the success rate of online gatekeeping by targeting individuals facing financial/daily life or workplace problems with marked tendencies for self-disclosure.

Identifying Gatekeepers in Online Learning Networks

ERIC Educational Resources Information Center

Gursakal, Necmi; Bozkurt, Aras

2017-01-01

The rise of the networked society has not only changed our perceptions but also the definitions, roles, processes and dynamics of online learning networks. From offline to online worlds, networks are everywhere and gatekeepers are an important entity in these networks. In this context, the purpose of this paper is to explore gatekeeping and…

Gatekeeper Training in Campus Suicide Prevention

ERIC Educational Resources Information Center

Wallack, Cory; Servaty-Seib, Heather L.; Taub, Deborah J.

2013-01-01

Gatekeeper training is one of the most commonly employed methods for identifying and intervening with at-risk students (Davidson and Locke, 2010). Within the context of campus suicide prevention, a gatekeeper is broadly defined as any individual who has the potential to come into contact with at-risk students (Davidson and Locke, 2010). Although…

Gatekeeping and Competency-Based Education: Developing Behaviorally Specific Remediation Policies

ERIC Educational Resources Information Center

Hylton, Mary E.; Manit, Jill; Messick-Svare, Gloria

2017-01-01

Gatekeeping has long been an integral component of what is now referred to as the Implicit Curriculum, or the context in which professional social work education occurs. Despite its long-standing role within social work education, gatekeeping elicits conflict for both individual faculty members and entire programs of social work education. Much of…

Light-Induced Acid Generation on a Gatekeeper for Smart Nitric Oxide Delivery.

PubMed

Choi, Hyung Woo; Kim, Jihoon; Kim, Jinhwan; Kim, Yonghwi; Song, Hyun Beom; Kim, Jeong Hun; Kim, Kimoon; Kim, Won Jong

2016-04-26

We report herein the design of a light-responsive gatekeeper for smart nitric oxide (NO) delivery. The gatekeeper is composed of a pH-jump reagent as an intermediary of stimulus and a calcium phosphate (CaP) coating as a shielding layer for NO release. The light irradiation and subsequent acid generation are used as triggers for uncapping the gatekeeper and releasing NO. The acids generated from a light-activated pH-jump agent loaded in the mesoporous nanoparticles accelerated the degradation of the CaP-coating layers on the nanoparticles, facilitating the light-responsive NO release from diazeniumdiolate by exposing a NO donor to physiological conditions. Using the combination of the pH-jump reagent and CaP coating, we successfully developed a light-responsive gatekeeper system for spatiotemporal-controlled NO delivery.

Implementing an Audience-Specific Small-Group Gatekeeper Training Program to Respond to Suicide Risk among College Students: A Case Study

ERIC Educational Resources Information Center

Cimini, M. Dolores; Rivero, Estela M.; Bernier, Joseph E.; Stanley, Judith A.; Murray, Andrea D.; Anderson, Drew A.; Wright, Heidi R.; Bapat, Mona

2014-01-01

Objective: This case study evaluated the effectiveness of an audience-specific, single-session, small-group interactive gatekeeper training program conducted at a large northeastern public university. Participants: Participants were 335 faculty, staff, and students completing gatekeeper training programs tailored to their group needs. Methods:…

Food skills confidence and household gatekeepers' dietary practices.

PubMed

Burton, Melissa; Reid, Mike; Worsley, Anthony; Mavondo, Felix

2017-01-01

Household food gatekeepers have the potential to influence the food attitudes and behaviours of family members, as they are mainly responsible for food-related tasks in the home. The aim of this study was to determine the role of gatekeepers' confidence in food-related skills and nutrition knowledge on food practices in the home. An online survey was completed by 1059 Australian dietary gatekeepers selected from the Global Market Insite (GMI) research database. Participants responded to questions about food acquisition and preparation behaviours, the home eating environment, perceptions and attitudes towards food, and demographics. Two-step cluster analysis was used to identify groups based on confidence regarding food skills and nutrition knowledge. Chi-square tests and one-way ANOVAs were used to compare the groups on the dependent variables. Three groups were identified: low confidence, moderate confidence and high confidence. Gatekeepers in the highest confidence group were significantly more likely to report lower body mass index (BMI), and indicate higher importance of fresh food products, vegetable prominence in meals, product information use, meal planning, perceived behavioural control and overall diet satisfaction. Gatekeepers in the lowest confidence group were significantly more likely to indicate more perceived barriers to healthy eating, report more time constraints and more impulse purchasing practices, and higher convenience ingredient use. Other smaller associations were also found. Household food gatekeepers with high food skills confidence were more likely to engage in several healthy food practices, while those with low food skills confidence were more likely to engage in unhealthy food practices. Food education strategies aimed at building food-skills and nutrition knowledge will enable current and future gatekeepers to make healthier food decisions for themselves and for their families. Copyright © 2016 Elsevier Ltd. All rights reserved.

Factors Affecting Patient Satisfaction with Community Health Service under the Gatekeeper System: A Cross-sectional Study in Nanjing, China.

PubMed

Li, Wen Zhen; Gan, Yong; Zhou, Yan Feng; Chen, Ya Wen; Li, Jing; Kkandawire, Naomiem; Hu, Sai; Qiao, Yan; Lu, Zu Xun

2017-09-01

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service (CHS) under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor-patient relationships, information and support, organization of care, and accessibility (P < 0.001). One or more factors such as gender and self-perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients' satisfaction with CHS by strengthening their awareness of the gatekeeper policy. Copyright © 2017 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

Integrative Technologies and Knowledge Gatekeepers: Bridging the Gap between Epistemic Communities in the Case of Stem Cell Science

ERIC Educational Resources Information Center

Wink, Rudiger

2008-01-01

The article analyses the role of gatekeepers between regional and disciplinary innovation systems in stem cell research as a case of integrative technologies. Which kind of gatekeepers is needed and which function can be fulfilled, differs along the knowledge value chain. Empirical results are used to explain the rationality of stem cell policies…

The Impact of Experiential Exercises on Communication and Relational Skills in a Suicide Prevention Gatekeeper-Training Program for College Resident Advisors

ERIC Educational Resources Information Center

Pasco, Susan; Wallack, Cory; Sartin, Robert M.; Dayton, Rebecca

2012-01-01

Objective: In an effort to identify students at risk for suicide, many colleges are implementing suicide prevention training for campus gatekeepers. This study evaluated the efficacy of a 3-hour, experiential-based gatekeeper training that included an emphasis on enhancing communication skills and relational connection in addition to the didactic…

For Whose Eyes Only? The Gatekeeping of Sexual Images in the Field of Teen Sexuality

ERIC Educational Resources Information Center

Chittenden, Tara

2010-01-01

This article examines the ways in which gatekeepers shape the field of teen sexuality by controlling access to sexual images. I question who decides whether an image is "appropriate" for young adults and how such judgements shape the wider cultural field. The ways in which gatekeepers have attempted to shield teens from certain sexual images…

Randomized Trial of a Gatekeeper Program for Suicide Prevention: 1-year Impact on Secondary School Staff

PubMed Central

Wyman, Peter A.; Brown, C Hendricks; Inman, Jeff; Cross, Wendi; Schmeelk-Cone, Karen; Guo, Jing; Pena, Juan B.

2009-01-01

Gatekeeper-training programs, designed to increase identification and referral of suicidal individuals, are widespread but largely untested. A group-based randomized trial with 32 schools examined impact of QPR (Question, Persuade, Refer) training on a stratified random sample of 249 staff with one-year average follow-up. To test QPR impact, we introduced and contrasted two models of gatekeeper-training effects in a population: Gatekeeper Surveillance and Gatekeeper Communication. Intent-to-treat analyses showed that training increased self-reported knowledge (ES 0.41) and appraisals of efficacy (ES 1.22) and service access (ES 1.07). Training effects varied dramatically. Appraisals increased most for staff with lowest baseline appraisals, and suicide identification behaviors increased most for staff already communicating with students about suicide and distress. Consistent with the Communication model, increased knowledge and appraisals were not sufficient to increase suicide identification behaviors. Also consistent with the Communication model were results from 2,059 8th and 10th graders surveyed showing that fewer with prior suicide attempts endorsed talking to adults about distress. Skill training for staff serving as ‘natural-gatekeepers’ plus interventions that modify students’ help-seeking behaviors are recommended to supplement universal gatekeeper training. PMID:18229988

Condom Use Among Female Sex Workers in China: Role of Gatekeepers

PubMed Central

YANG, HONGMEI; LI, XIAOMING; STANTON, BONITA; FANG, XIAOYI; ZHAO, RAN; DONG, BAIQING; LIU, WEI; LIANG, SHAOLING; ZHOU, YUEJIAO; HONG, YAN

2007-01-01

Objective The objective of this study was to assess the potential role of gatekeepers of establishments in promoting condom use among female sex workers (FSWs) in China. Goals The goals of this study were to explore FSWs’ perceptions of gatekeeper attitudes and support for condom use, and to assess their association with FSWs’ practice, communication, intention, proper use, knowledge of correct use, and perceptions related to condom use. Study The authors conducted a cross-sectional study among 454 establishment-based FSWs in one Chinese county. Results Perceived gatekeeper support for condom use was low among FSWs. Perceived support was positively associated with condom use communication with sexual partners, condom use frequency and intention, but not associated with proper condom use among FSWs. Perceived support was significantly associated with most condom use-related perceptions (e.g., self-efficacy of condom use, barriers to condom use, and perceived peer condom use) among FSWs. Conclusions Healthcare professionals should work with gatekeepers to create a supportive local environment for condom use in sex work establishments. Gatekeepers need to clearly articulate their support for condom use to the FSWs. Training and skill acquisition regarding correct use of condoms among FSWs will be necessary. PMID:16118607

A gatekeeper chaperone complex directs translocator secretion during Type Three Secretion

DOE PAGES

Archuleta, Tara L.; Spiller, Benjamin W.; Kubori, Tomoko

2014-11-06

Many Gram-negative bacteria use Type Three Secretion Systems (T3SS) to deliver effector proteins into host cells. These protein delivery machines are composed of cytosolic components that recognize substrates and generate the force needed for translocation, the secretion conduit, formed by a needle complex and associated membrane spanning basal body, and translocators that form the pore in the target cell. A defined order of secretion in which needle component proteins are secreted first, followed by translocators, and finally effectors, is necessary for this system to be effective. While the secreted effectors vary significantly between organisms, the ~20 individual protein components thatmore » form the T3SS are conserved in many pathogenic bacteria. One such conserved protein, referred to as either a plug or gatekeeper, is necessary to prevent unregulated effector release and to allow efficient translocator secretion. The mechanism by which translocator secretion is promoted while effector release is inhibited by gatekeepers is unknown. We present the structure of the Chlamydial gatekeeper, CopN, bound to a translocator-specific chaperone. The structure identifies a previously unknown interface between gatekeepers and translocator chaperones and reveals that in the gatekeeper-chaperone complex the canonical translocator-binding groove is free to bind translocators. Thus, structure-based mutagenesis of the homologous complex in Shigella reveals that the gatekeeper-chaperone-translocator complex is essential for translocator secretion and for the ordered secretion of translocators prior to effectors.« less

Efficacy of Adolescent Suicide Prevention E-Learning Modules for Gatekeepers: A Randomized Controlled Trial.

PubMed

Ghoncheh, Rezvan; Gould, Madelyn S; Twisk, Jos Wr; Kerkhof, Ad Jfm; Koot, Hans M

2016-01-29

Face-to-face gatekeeper training can be an effective strategy in the enhancement of gatekeepers' knowledge and self-efficacy in adolescent suicide prevention. However, barriers related to access (eg, time, resources) may hamper participation in face-to-face training sessions. The transition to a Web-based setting could address obstacles associated with face-to-face gatekeeper training. Although Web-based suicide prevention training targeting adolescents exists, so far no randomized controlled trials (RCTs) have been conducted to investigate their efficacy. This RCT study investigated the efficacy of a Web-based adolescent suicide prevention program entitled Mental Health Online, which aimed to improve the knowledge and self-confidence of gatekeepers working with adolescents (12-20 years old). The program consisted of 8 short e-learning modules each capturing an important aspect of the process of early recognition, guidance, and referral of suicidal adolescents, alongside additional information on the topic of (adolescent) suicide prevention. A total of 190 gatekeepers (ages 21 to 62 years) participated in this study and were randomized to either the experimental group or waitlist control group. The intervention was not masked. Participants from both groups completed 3 Web-based assessments (pretest, posttest, and 3-month follow-up). The outcome measures of this study were actual knowledge, and participants' ratings of perceived knowledge and perceived self-confidence using questionnaires developed specifically for this study. The actual knowledge, perceived knowledge, and perceived self-confidence of gatekeepers in the experimental group improved significantly compared to those in the waitlist control group at posttest, and the effects remained significant at 3-month follow-up. The overall effect sizes were 0.76, 1.20, and 1.02, respectively, across assessments. The findings of this study indicate that Web-based suicide prevention e-learning modules can be an effective educational method to enhance knowledge and self-confidence of gatekeepers with regard to adolescent suicide prevention. Gatekeepers with limited time and resources can benefit from the accessibility, simplicity, and flexibility of Web-based training. Netherlands Trial Register NTR3625; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3625 (Archived by WebCite at http://www.webcitation.org/6eHvyRh6M).

What is the role and authority of gatekeepers in cluster randomized trials in health research?

PubMed Central

2012-01-01

This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs) in health research. In the introductory paper in this series, we set out six areas of inquiry that must be addressed if the CRT is to be set on a firm ethical foundation. This paper addresses the sixth of the questions posed, namely, what is the role and authority of gatekeepers in CRTs in health research? ‘Gatekeepers’ are individuals or bodies that represent the interests of cluster members, clusters, or organizations. The need for gatekeepers arose in response to the difficulties in obtaining informed consent because of cluster randomization, cluster-level interventions, and cluster size. In this paper, we call for a more restrictive understanding of the role and authority of gatekeepers. Previous papers in this series have provided solutions to the challenges posed by informed consent in CRTs without the need to invoke gatekeepers. We considered that consent to randomization is not required when cluster members are approached for consent at the earliest opportunity and before any study interventions or data-collection procedures have started. Further, when cluster-level interventions or cluster size means that obtaining informed consent is not possible, a waiver of consent may be appropriate. In this paper, we suggest that the role of gatekeepers in protecting individual interests in CRTs should be limited. Generally, gatekeepers do not have the authority to provide proxy consent for cluster members. When a municipality or other community has a legitimate political authority that is empowered to make such decisions, cluster permission may be appropriate; however, gatekeepers may usefully protect cluster interests in other ways. Cluster consultation may ensure that the CRT addresses local health needs, and is conducted in accord with local values and customs. Gatekeepers may also play an important role in protecting the interests of organizations, such as hospitals, nursing homes, general practices, and schools. In these settings, permission to access the organization relies on resource implications and adherence to institutional policies. PMID:22834691

"On the doctor's orders": A pilot study of the effects of website marketing for medical specialist providers under gatekeeping arrangements.

PubMed

Zwier, Sandra

2017-01-01

Websites from medical specialist providers are becoming increasingly marketing oriented, but there exists a paucity of empirical research on the effects. This experimental study explored effects of exposure to real websites from medical specialist providers among Dutch adults under physician gatekeeper arrangements. Exposure led to a stronger intention to seek treatment from the specialist provider and motivation to rely on the providers' claims. Weaker to absent effects were found for intention to question the physician gatekeeper's referral and this was chiefly motivated by the belief that "the doctor knows best." Implications for specialist provider marketing under gatekeeping arrangements are discussed.

Activation of tyrosine kinases by mutation of the gatekeeper threonine

PubMed Central

Azam, Mohammad; Seeliger, Markus A; Gray, Nathanael S; Kuriyan, John; Daley, George Q

2008-01-01

Protein kinases targeted by small-molecule inhibitors develop resistance through mutation of the ‘gatekeeper’ threonine residue of the active site. Here we show that the gatekeeper mutation in the cellular forms of c-ABL, c-SRC, platelet-derived growth factor receptor-α and -β, and epidermal growth factor receptor activates the kinase and promotes malignant transformation of BaF3 cells. Structural analysis reveals that a network of hydrophobic interactions—the hydrophobic spine—characteristic of the active kinase conformation is stabilized by the gatekeeper substitution. Substitution of glycine for the residues constituting the spine disrupts the hydrophobic connectivity and inactivates the kinase. Furthermore, a small-molecule inhibitor that maximizes complementarity with the dismantled spine (compound 14) inhibits the gatekeeper mutation of BCR-ABL-T315I. These results demonstrate that mutation of the gatekeeper threonine is a common mechanism of activation for tyrosine kinases and provide structural insights to guide the development of next-generation inhibitors. PMID:18794843

The impact of experiential exercises on communication and relational skills in a suicide prevention gatekeeper-training program for college resident advisors.

PubMed

Pasco, Susan; Wallack, Cory; Sartin, Robert M; Dayton, Rebecca

2012-01-01

In an effort to identify students at risk for suicide, many colleges are implementing suicide prevention training for campus gatekeepers. This study evaluated the efficacy of a 3-hour, experiential-based gatekeeper training that included an emphasis on enhancing communication skills and relational connection in addition to the didactic foci of standard gatekeeper training. Sixty-five college student resident advisors (RAs) were trained with Campus Connect. The training was dismantled to examine the specific contribution of experiential exercises on training outcomes. Compared to didactic training alone, following participation in experiential exercises RAs' training outcome scores exhibited additional improvement on the Suicide Intervention Response Inventory-2 and a 14-item self-report measure of self-efficacy for specific suicide- and crisis-related knowledge and skills. In gatekeeper training, experiential exercises emphasizing awareness and empathic responding and practice of these skills contribute to an improvement in crisis response skills above and beyond that of didactic training alone.

Mixture-based gatekeeping procedures in adaptive clinical trials.

PubMed

Kordzakhia, George; Dmitrienko, Alex; Ishida, Eiji

2018-01-01

Clinical trials with data-driven decision rules often pursue multiple clinical objectives such as the evaluation of several endpoints or several doses of an experimental treatment. These complex analysis strategies give rise to "multivariate" multiplicity problems with several components or sources of multiplicity. A general framework for defining gatekeeping procedures in clinical trials with adaptive multistage designs is proposed in this paper. The mixture method is applied to build a gatekeeping procedure at each stage and inferences at each decision point (interim or final analysis) are performed using the combination function approach. An advantage of utilizing the mixture method is that it enables powerful gatekeeping procedures applicable to a broad class of settings with complex logical relationships among the hypotheses of interest. Further, the combination function approach supports flexible data-driven decisions such as a decision to increase the sample size or remove a treatment arm. The paper concludes with a clinical trial example that illustrates the methodology by applying it to develop an adaptive two-stage design with a mixture-based gatekeeping procedure.

Gatekeeping versus direct-access when patient information matters.

PubMed

González, Paula

2010-06-01

We develop a principal-agent model in which the health authority acts as a principal for both a patient and a general practitioner (GP). The goal of the paper is to weigh the merits of gatekeeping versus non-gatekeeping approaches to health care when patient self-health information and patient pressure on GPs to provide referrals for specialized care are considered. We find that, when GPs incentives matter, a non-gatekeeping system is preferable only when (i) patient pressure to refer is sufficiently high and (ii) the quality of the patient's self-health information is neither highly inaccurate (in which case the patient's self-referral will be very inefficient) nor highly accurate (in which case the GP's agency problem will be very costly).

Who needs a gatekeeper? Patients' views of the role of the primary care physician.

PubMed

Gross, R; Tabenkin, H; Brammli-Greenberg, S

2000-06-01

The primary care physician serving as a 'gatekeeper' can make judicious decisions about the appropriate use of medical services, and thereby contribute to containing costs while improving the quality of care. However, in Israel, sick funds competing for members have not adopted this model for fear of endangering their competitive stance. The purpose of this study was to examine, for the first time, the stated preferences and actual behaviour of a national sample of members of the four Israeli sick funds regarding self-referral to specialists, and to identify the characteristics of patients who prefer the gatekeeper model. Data were derived from a national telephone survey carried out in 1997. A random representative sample of 1084 of all adult sick fund members were interviewed, with a response rate of 81%. Bivariate analysis was conducted using over all chi-square tests, and multivariate analysis was performed using logistic regression models. A third of all respondents prefer self-referral to a specialist, 40% prefer their family physician to act as gatekeeper and 19% prefer the physician to co-ordinate care but to refer themselves to a specialist. Independent variables predicting preference for the gatekeeper model are: living in the periphery, sick fund membership, low level of education, being male, fair or poor health status, having a permanent family physician and being satisfied with the professional level of the family physician. A significant correlation was found between practising self-referral and preference for self-referral. CONCLUSIONS.: The findings indicate the importance of surveying patients' attitudes as an input in policy formulation. The study identified specific population groups which prefer the gatekeeper model, and explored the advantages of a flexible model of gatekeeping.

How organizational context affects bioethical decision-making: pharmacists' management of gatekeeping processes in retail and hospital settings.

PubMed

Chiarello, Elizabeth

2013-12-01

Social science studies of bioethics demonstrate that ethics are highly contextual, functioning differently across local settings as actors make daily decisions "on the ground." Sociological studies that demonstrate the key role organizations play in shaping ethical decision-making have disproportionately focused on physicians and nurses working in hospital settings where they contend with life and death issues. This study broadens our understanding of the contexts of ethical decision-making by empirically examining understudied healthcare professionals - pharmacists - working in two organizational settings, retail and hospital, where they act as gatekeepers to regulated goods and services as they contend with ethical issues ranging from the serious to the mundane. This study asks: How do organizations shape pharmacists' identification, negotiation, and resolution of ethical challenges; in other words, how do organizations shape pharmacists' gatekeeping processes? Based on 95 semi-structured interviews with U.S. pharmacists practicing in retail and hospital pharmacies conducted between September 2009 and May 2011, this research finds that organizations influence ethical decision-making by shaping how pharmacists construct four gatekeeping processes: medical, legal, fiscal, and moral. Each gatekeeping process manifests differently across organizations due to how these settings structure inter-professional power dynamics, proximity to patients, and means of accessing information. Findings suggest new directions for theorizing about ethical decision-making in medical contexts by drawing attention to new ethical actors, new organizational settings, an expanded definition of ethical challenges, and a broader conceptualization of gatekeeping. Copyright © 2012 Elsevier Ltd. All rights reserved.

Suicide prevention through online gatekeeping using search advertising techniques: a feasibility study.

PubMed

Sueki, Hajime; Ito, Jiro

2015-01-01

Nurturing gatekeepers is an effective suicide prevention strategy. Internet-based methods to screen those at high risk of suicide have been developed in recent years but have not been used for online gatekeeping. A preliminary study was conducted to examine the feasibility and effects of online gatekeeping. Advertisements to promote e-mail psychological consultation service use among Internet users were placed on web pages identified by searches using suicide-related keywords. We replied to all emails received between July and December 2013 and analyzed their contents. A total of 139 consultation service users were analyzed. The mean age was 23.8 years (SD = 9.7), and female users accounted for 80% of the sample. Suicidal ideation was present in 74.1%, and 12.2% had a history of suicide attempts. After consultation, positive changes in mood were observed in 10.8%, 16.5% showed intentions to seek help from new supporters, and 10.1% of all 139 users actually took help-seeking actions. Online gatekeeping to prevent suicide by placing advertisements on web search pages to promote consultation service use among Internet users with suicidal ideation may be feasible.

Conserved nonsense-prone CpG sites in apoptosis-regulatory genes: conditional stop signs on the road to cell death.

PubMed

Zhao, Yongzhong; Epstein, Richard J

2013-01-01

Methylation-prone CpG dinucleotides are strongly conserved in the germline, yet are also predisposed to somatic mutation. Here we quantify the relationship between germline codon mutability and somatic carcinogenesis by comparing usage of the nonsense-prone CGA (→TGA) codons in gene groups that differ in apoptotic function; to this end, suppressor genes were subclassified as either apoptotic (gatekeepers) or repair (caretakers). Mutations affecting CGA codons in sporadic tumors proved to be highly asymmetric. Moreover, nonsense mutations were 3-fold more likely to affect gatekeepers than caretakers. In addition, intragenic CGA clustering nonrandomly affected functionally critical regions of gatekeepers. We conclude that human gatekeeper suppressor genes are enriched for nonsense-prone codons, and submit that this germline vulnerability to tumors could reflect in utero selection for a methylation-dependent capability to short-circuit environmental insults that otherwise trigger apoptosis and fetal loss.

A multilevel analysis of gatekeeper characteristics and consistent condom use among establishment-based female sex workers in Guangxi, China.

PubMed

Li, Qing; Li, Xiaoming; Stanton, Bonita; Fang, Xiaoyi; Zhao, Ran

2010-11-01

Multilevel analytical techniques are being applied in condom use research to ensure the validity of investigation on environmental/structural influences and clustered data from venue-based sampling. The literature contains reports of consistent associations between perceived gatekeeper support and condom use among entertainment establishment-based female sex workers (FSWs) in Guangxi, China. However, the clustering inherent in the data (FSWs being clustered within establishment) has not been accounted in most of the analyses. We used multilevel analyses to examine perceived features of gatekeepers and individual correlates of consistent condom use among FSWs and to validate the findings in the existing literature. We analyzed cross-sectional data from 318 FSWs from 29 entertainment establishments in Guangxi, China in 2004, with a minimum of 5 FSWs per establishment. The Hierarchical Linear Models program with Laplace estimation was used to estimate the parameters in models containing random effects and binary outcomes. About 11.6% of women reported consistent condom use with clients. The intraclass correlation coefficient indicated 18.5% of the variance in condom use could be attributed to their similarity between FSWs within the same establishments. Women's perceived gatekeeper support and education remained positively associated with condom use (P < 0.05), after controlling for other individual characteristics and clustering. After adjusting for data clustering, perceived gatekeeper support remains associated with consistent condom use with clients among FSWs in China. The results imply that combined interventions to intervene both gatekeepers and individual FSW may effectively promote consistent condom use.

Gatekeeper training for suicide prevention in First Nations community members: a randomized controlled trial.

PubMed

Sareen, Jitender; Isaak, Corinne; Bolton, Shay-Lee; Enns, Murray W; Elias, Brenda; Deane, Frank; Munro, Garry; Stein, Murray B; Chateau, Dan; Gould, Madelyn; Katz, Laurence Y

2013-10-01

Gatekeeper training aims to train people to recognize and identify those who are at risk for suicide and assist them in getting care. Applied Suicide Intervention Skills Training (ASIST), a form of gatekeeper training, has been implemented around the world without a controlled evaluation. We hypothesized that participants in 2 days of ASIST gatekeeper training would have increased knowledge and preparedness to help people with suicidal ideation in comparison to participants who received a 2-day Resilience Retreat that did not focus on suicide awareness and intervention skills (control condition). First Nations on reserve people in Northwestern Manitoba, aged 16 years and older, were recruited and randomized to two arms of the study. Self-reported measures were collected at three time points-immediately pre-, immediately post-, and 6 months post intervention. The primary outcome was the Suicide Intervention Response Inventory, a validated scale that assesses the capacity for individuals to intervene with suicidal behavior. Secondary outcomes included self-reported preparedness measures and gatekeeper behaviors. In comparison with the Resilience Retreat (n = 24), ASIST training (n = 31) was not associated with a significant impact on all outcomes of the study based on intention-to-treat analysis. There was a trend toward an increase in suicidal ideation among those who participated in the ASIST in comparison to those who were in the Resilience Retreat. The lack of efficacy of ASIST in a First Nations on-reserve sample is concerning in the context of widespread policies in Canada on the use of gatekeeper training in suicide prevention. © 2013 Wiley Periodicals, Inc.

A Multilevel Analysis of Gatekeeper Characteristics and Consistent Condom Use Among Establishment-Based Female Sex Workers in Guangxi, China

PubMed Central

Li, Qing; Li, Xiaoming; Stanton, Bonita; Fang, Xiaoyi; Zhao, Ran

2010-01-01

Background Multilevel analytical techniques are being applied in condom use research to ensure the validity of investigation on environmental/structural influences and clustered data from venue-based sampling. The literature contains reports of consistent associations between perceived gatekeeper support and condom use among entertainments establishment-based female sex workers (FSWs) in Guangxi, China. However, the clustering inherent in the data (FSWs being clustered within establishment) has not been accounted in most of the analyses. We used multilevel analyses to examine perceived features of gatekeepers and individual correlates of consistent condom use among FSWs and to validate the findings in the existing literature. Methods We analyzed cross-sectional data from 318 FSWs from 29 entertainment establishments in Guangxi, China in 2004, with a minimum of 5 FSWs per establishment. The Hierarchical Linear Models program with Laplace estimation was used to estimate the parameters in models containing random effects and binary outcomes. Results About 11.6% of women reported consistent condom use with clients. The intraclass correlation coefficient indicated 18.5% of the variance in condom use could be attributed to their similarity between FSWs within the same establishments. Women’s perceived gatekeeper support and education remained positively associated with condom use (P < 0.05), after controlling for other individual characteristics and clustering. Conclusions After adjusting for data clustering, perceived gatekeeper support remains associated with consistent condom use with clients among FSWs in China. The results imply that combined interventions to intervene both gatekeepers and individual FSW may effectively promote consistent condom use. PMID:20539262

Primary care, financing and gatekeeping in western Europe.

PubMed

Gérvas, J; Pérez Fernández, M; Starfield, B H

1994-09-01

Primary care in western Europe is delivered by general practitioners (GPs) but their role within the overall health system is poorly understood. The aim of this article is to present an overview of the characteristics of general practice in the context of health systems and to describe their variability and interrelationships. Data were obtained from two main sources: publications of official organizations and EC research projects. The characteristics of general practice are described and analysed with regard to three features: mode of payment, gatekeeper function and practice organization and workload. Despite their focus on general practice as the cornerstone of the health system, western European countries differ considerably in the major characteristics of primary care. There is variability in the ratio of GPs to population and in the extent to which patients relate to individual physicians. Although all countries have universal health insurance, the mode of payment of GPs differs. In some countries, the gatekeeper function of general practice is more highly developed and the use of specialist services varies accordingly. Practice characteristics such as workload, length of consultation, ordering of tests and reappointments also vary with differences in payment and gatekeeping arrangements. In particular, fee-for-service was associated with weaker physician-patient relationships, reduced attractiveness of general practice, more home visiting and longer consultations. Strong gatekeeping arrangements are not incompatible with high public satisfaction and are associated with lower visit rates. However, strong gatekeeping is not characteristic of fee-for-service arrangements. These findings suggest a need for more concerted research that could inform policy decisions concerning primary care in the USA as well as in Europe.

Efficacy of Adolescent Suicide Prevention E-Learning Modules for Gatekeepers: A Randomized Controlled Trial

PubMed Central

Gould, Madelyn S; Twisk, Jos WR; Kerkhof, Ad JFM; Koot, Hans M

2016-01-01

Background Face-to-face gatekeeper training can be an effective strategy in the enhancement of gatekeepers’ knowledge and self-efficacy in adolescent suicide prevention. However, barriers related to access (eg, time, resources) may hamper participation in face-to-face training sessions. The transition to a Web-based setting could address obstacles associated with face-to-face gatekeeper training. Although Web-based suicide prevention training targeting adolescents exists, so far no randomized controlled trials (RCTs) have been conducted to investigate their efficacy. Objective This RCT study investigated the efficacy of a Web-based adolescent suicide prevention program entitled Mental Health Online, which aimed to improve the knowledge and self-confidence of gatekeepers working with adolescents (12-20 years old). The program consisted of 8 short e-learning modules each capturing an important aspect of the process of early recognition, guidance, and referral of suicidal adolescents, alongside additional information on the topic of (adolescent) suicide prevention. Methods A total of 190 gatekeepers (ages 21 to 62 years) participated in this study and were randomized to either the experimental group or waitlist control group. The intervention was not masked. Participants from both groups completed 3 Web-based assessments (pretest, posttest, and 3-month follow-up). The outcome measures of this study were actual knowledge, and participants’ ratings of perceived knowledge and perceived self-confidence using questionnaires developed specifically for this study. Results The actual knowledge, perceived knowledge, and perceived self-confidence of gatekeepers in the experimental group improved significantly compared to those in the waitlist control group at posttest, and the effects remained significant at 3-month follow-up. The overall effect sizes were 0.76, 1.20, and 1.02, respectively, across assessments. Conclusions The findings of this study indicate that Web-based suicide prevention e-learning modules can be an effective educational method to enhance knowledge and self-confidence of gatekeepers with regard to adolescent suicide prevention. Gatekeepers with limited time and resources can benefit from the accessibility, simplicity, and flexibility of Web-based training. Trial Registration Netherlands Trial Register NTR3625; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3625 (Archived by WebCite at http://www.webcitation.org/6eHvyRh6M) PMID:26825006

Husband Gatekeeping in Childbirth.

ERIC Educational Resources Information Center

Block, Carolyn R.; And Others

1981-01-01

Interviews with new mothers document the husband's role as gatekeeper in his wife's preparing for and coping with childbirth. Social class, race, family stage, and the husband-wife relationship explain about 40 percent of the variance in whether husbands choose to prepare for childbirth. (Author)

Take the Reins on Model Quality with ModelCHECK and Gatekeeper

NASA Technical Reports Server (NTRS)

Jones, Corey

2012-01-01

Model quality and consistency has been an issue for us due to the diverse experience level and imaginative modeling techniques of our users. Fortunately, setting up ModelCHECK and Gatekeeper to enforce our best practices has helped greatly, but it wasn't easy. There were many challenges associated with setting up ModelCHECK and Gatekeeper including: limited documentation, restrictions within ModelCHECK, and resistance from end users. However, we consider ours a success story. In this presentation we will describe how we overcame these obstacles and present some of the details of how we configured them to work for us.

Effectiveness of suicide prevention gatekeeper-training for university administrative staff in Japan.

PubMed

Hashimoto, Naoki; Suzuki, Yuriko; Kato, Takahiro A; Fujisawa, Daisuke; Sato, Ryoko; Aoyama-Uehara, Kumi; Fukasawa, Maiko; Asakura, Satoshi; Kusumi, Ichiro; Otsuka, Kotaro

2016-01-01

Suicide is a leading cause of death among Japanese college and university students. Gatekeeper-training programs have been shown to improve detection and referral of individuals who are at risk of suicide by training non-mental-health professional persons. However, no studies have investigated the effectiveness of such programs in university settings in Japan. The aim of this study was to investigate the effectiveness of the gatekeeper-training program for administrative staff in Japanese universities. We developed a 2.5-h gatekeeper-training program based on the Mental Health First Aid program, which was originally developed for the general public. Seventy-six administrative staff at Hokkaido University participated in the program. Competence and confidence in managing suicide intervention, behavioral intention as a gatekeeper and attitude while handling suicidal students were measured by a self-reported questionnaire before, immediately after and a month after the program. We found a significant improvement in competence in the management of suicidal students. We also found improvements in confidence in management of suicidal students and behavioral intention as a gatekeeper after training, though questionnaires for those secondary outcomes were not validated. These improvements continued for a month. About 95% of the participants rated the program as useful or very useful and one-third of the participants had one or more chances to utilize their skills within a month. The current results suggest the positive effects of the training program in university settings in Japan. Future evaluation that includes comparison with standard didactic trainings and an assessment of long-term effectiveness are warranted. © 2015 The Authors. Psychiatry and Clinical Neurosciences © 2015 Japanese Society of Psychiatry and Neurology.

Gatekeepers for Pragmatic Clinical Trials

PubMed Central

Whicher, Danielle M.; Miller, Jennifer E.; Dunham, Kelly M.; Joffe, Steven

2015-01-01

To successfully implement a pragmatic clinical trial, investigators need access to numerous resources, including financial support, institutional infrastructure (e.g., clinics, facilities, staff), eligible patients, and patient data. Gatekeepers are people or entities who have the ability to allow or deny access to the resources required to support the conduct of clinical research. Based on this definition, gatekeepers relevant to the United States clinical research enterprise include research sponsors, regulatory agencies, payers, health system and other organizational leadership, research team leadership, human research protections programs, advocacy and community groups, and clinicians. This manuscript provides a framework to help guide gatekeepers’ decision-making related to the use of resources for pragmatic clinical trials. These include (1) concern for the interests of individuals, groups, and communities affected by the gatekeepers’ decisions, including protection from harm and maximization of benefits, (2) advancement of organizational mission and values, and (3) stewardship of financial, human, and other organizational resources. Separate from these ethical considerations, gatekeepers’ actions will be guided by relevant federal, state, and local regulations. This framework also suggests that to further enhance the legitimacy of their decision-making, gatekeepers should adopt transparent processes that engage relevant stakeholders when feasible and appropriate. We apply this framework to the set of gatekeepers responsible for making decisions about resources necessary for pragmatic clinical trials in the United States, describing the relevance of the criteria in different situations and pointing out where conflicts among the criteria and relevant regulations may affect decision-making. Recognition of the complex set of considerations that should inform decision-making will guide gatekeepers in making justifiable choices regarding the use of limited and valuable resources. PMID:26374683

Knowing Asia: Creative Policy Translation in an Australian School Setting

ERIC Educational Resources Information Center

Salter, Peta

2014-01-01

Policy implementation at school level is often recognised as transformative enactment. Positioning school leaders as gatekeepers in this enactment is limiting. This study of one Australian school explores the complex contextualised agency of school leaders showing that their role, far more than gatekeeping, can be enabling and transformative.…

The Affective Gatekeeper: A Synthesis of Perspectives on Creativity.

ERIC Educational Resources Information Center

Bagley, Dan S., III

1979-01-01

The article presents research reports on the nature of creativity, including such elements as its characteristics; the function of the affective gatekeeper (which filters the "reality" perceived by each individual); the constructs of perception; and the functions of role playing, altered states of consciousness, and fantasy. (PHR)

Randomized Trial of Suicide Gatekeeper Training for Social Work Students

ERIC Educational Resources Information Center

Jacobson, Jodi M.; Osteen, Phillip J.; Sharpe, Tanya L.; Pastoor, Jennifer B.

2012-01-01

Problem: Education and research on social work's role in preventing client suicide is limited. Method: Seventy advanced master of social work students were randomly assigned to either the training group (Question, Persuade, and Referral suicide gatekeeper training) or the control group. Outcomes measured over time included suicide knowledge,…

The Gatekeeping Impulse and Professor X: An Exploration

ERIC Educational Resources Information Center

Sonnenmoser, Richard

2009-01-01

College and university instructors who assess student writing, including but not limited to teachers of first-year composition, sometimes keep the gate. Gatekeeping by writing instructors is an activity directly related to grading practices and, in many cases, to grading practices which emphasize formal, mechanical, usually sentence-level choices…

Gatekeeper Training for Youth Workers

ERIC Educational Resources Information Center

Cartmill, Tania; Deane, Frank; Wilson, Coralie

2009-01-01

Adults who act as gatekeepers for young people may have the same barriers to help-seeking for mental health issues as young people. This study investigated the personal help-seeking practices of 47 Australian youth workers prior to and after a training workshop on youth mental health issues. Pre-post workshop evaluation revealed some increases in…

The Influence of Suicide Prevention Gatekeeper Training on Resident Assistants' Mental Health

ERIC Educational Resources Information Center

Becker, Martin A. Swanbrow; Drum, David J.

2015-01-01

This study explored the mental health influence on resident assistants associated with their training in suicide prevention and their subsequent role as campus mental health gatekeepers. Despite considerable prior personal experience with their own suicidal thinking as well as with others who have thoughts of suicide, a multiple regression…

Ambivalences: Voices of Indonesian Academic Discourse Gatekeepers

ERIC Educational Resources Information Center

Basthomi, Yazid

2012-01-01

This article presents voices of academic discourse gatekeepers in the Indonesian context. It reports on results of an attempt to re-read (re-analyze and re-interpret) the transcripts of interviews with Indonesian journal editors/reviewers in the area of English Language Teaching (ELT). The interviews were made with five editors/reviewers of two…

Gatekeeping in Counselor Education: Experiences of Terminating Students for Nonacademic Concerns

ERIC Educational Resources Information Center

Wissel, Adriana M.

2011-01-01

Counselor Educators are required by both the American Counseling Association Code of Ethics (2009) as well as the Council for Accreditation of Counseling & Counseling Related Programs (2010) to serve as gatekeepers to the counseling profession. In this role, counselor educators ensure the safety of future clients and the counseling profession,…

Project M.O.M.--Mothers & Others & MyPyramid

ERIC Educational Resources Information Center

Wansink, Brian

2008-01-01

In today's dynamic and complex family structures, sometimes the nutritional gatekeeper is a stay-at-home dad, grandparent, housekeeper, or older sibling. Yet, despite a record level of women in the workforce and high educational achievement, the responsibility of being a nutrition gatekeeper still mainly falls on mothers. It is not equitable, it…

The Impact of Gatekeeper Training for Suicide Prevention on University Resident Assistants

ERIC Educational Resources Information Center

Taub, Deborah J.; Servaty-Seib, Heather L.; Miles, Nathan; Lee, Ji-Yeon; Wachter Morris, Carrie A.; Prieto-Welch, Susan L.; Werden, Donald

2013-01-01

Resident assistants (RAs) can serve as important suicide prevention gatekeepers. The purpose of the study was to determine if training improved RAs' crisis communications skills and suicide-related knowledge and to determine if the knowledge elements predicted crisis communications skills. New RAs showed significant improvement in all areas from…

Expanding Capacity for Suicide Prevention: The ALIVE @ Purdue Train-the-Trainers Program

ERIC Educational Resources Information Center

Wachter Morris, Carrie A.; Taub, Deborah J.; Servaty-Seib, Heather L.; Lee, Ji-Yeon; Miles, Nathan; Werden, Donald; Prieto-Welch, Susan L.

2015-01-01

Suicide is the second leading cause of death among college students. One effective strategy for suicide prevention is gatekeeper training. Gatekeeper training has been described as a prevention strategy that improves detection and referral of at-risk individuals. Purdue recognized that only some of the resident assistants (RAs) were receiving this…

Counselor Educators' Experiences of Gatekeeping in Online Master's-Level Counseling Programs

ERIC Educational Resources Information Center

Gilbert, Amy L.

2014-01-01

Counselor educators protect public welfare and serve as gatekeepers for the counseling profession by ensuring that counselors-in-training who do not meet professional standards of counseling competence are remediated or prevented from entering the counseling field. Prior to this study, no researchers had examined the unique aspects of gatekeeping…

Marital Problems, Maternal Gatekeeping Attitudes, and Father-Child Relationships in Adolescence

ERIC Educational Resources Information Center

Stevenson, Matthew M.; Fabricius, William V.; Cookston, Jeffrey T.; Parke, Ross D.; Coltrane, Scott; Braver, Sanford L.; Saenz, Delia S.

2014-01-01

We evaluated maternal gatekeeping attitudes as a mediator of the relation between marital problems and father-child relationships in 3 waves when children were in Grades 7-10. We assessed each parent's contribution to the marital problems experienced by the couple. Findings from mediational and cross-lagged structural equation models revealed that…

Gatekeeping: Why Shouldn't We Be Ambivalent?

ERIC Educational Resources Information Center

Sowbel, Lynda R.

2012-01-01

An increase of 88% in programs from 1990 through 2004, low GRE scores, low entry- level wages, declining pass rates in licensing tests, and an increase in ethical violations reported all support the contention that there are higher enrollment rates and decreased gatekeeping selectivity in today's graduate MSW programs. This article discusses four…

[Pharmacist as gatekeeper: combating medication abuse and dependence].

PubMed

Shimane, Takuya

2013-01-01

  The nonmedical use of medications, including psychotropic drugs, is a growing health problem in Japan. According to a nationwide survey of mental hospitals, the proportion of patients with sedative (mainly benzodiazepine)-related disorders has more than doubled over the last decade. An association between psychotropic drug overdose and suicide risk has also been reported. Furthermore, over-the-counter drug abuse is still a serious problem in Japan. In recent years, pharmacists have been expected to act as gatekeepers, making timely identifications of suicide risk or substance abuse and directing these individuals to appropriate medical care facilities. In August 2012, the revised Comprehensive Suicide Measures Act identified pharmacists as one professional group that should act as gatekeepers. This article begins by reviewing the fundamental terms involved in understanding the nonmedical use of medications, including abuse, dependence, and intoxication. The current situation of substance abuse and dependence is then introduced through a summary of several epidemiological surveys conducted in Japan. Finally, the role of pharmacists as gatekeepers in preventing substance abuse and dependence on medications is discussed.

The need for a culturally-tailored gatekeeper training intervention program in preventing suicide among Indigenous peoples: a systematic review.

PubMed

Nasir, Bushra Farah; Hides, Leanne; Kisely, Steve; Ranmuthugala, Geetha; Nicholson, Geoffrey C; Black, Emma; Gill, Neeraj; Kondalsamy-Chennakesavan, Srinivas; Toombs, Maree

2016-10-21

Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: 'suicide', 'gatekeeper', 'training', 'suicide prevention training', 'suicide intervention training' and 'Indigenous'. Other internationally relevant descriptors for the keyword "Indigenous" (e.g. "Maori", "First Nations", "Native American", "Inuit", "Metis" and "Aboriginal") were also used. Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training. Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.

DFG-out Mode of Inhibition by an Irreversible Type-1 Inhibitor Capable of Overcoming Gate-Keeper Mutations in FGF Receptors

PubMed Central

2015-01-01

Drug-resistance acquisition through kinase gate-keeper mutations is a major hurdle in the clinic. Here, we determined the first crystal structures of the human FGFR4 kinase domain (FGFR4K) alone and complexed with ponatinib, a promiscuous type-2 (DFG-out) kinase inhibitor, and an oncogenic FGFR4K harboring the V550L gate-keeper mutation bound to FIIN-2, a new type-1 irreversible inhibitor. Remarkably, like ponatinib, FIIN-2 also binds in the DFG-out mode despite lacking a functional group necessary to occupy the pocket vacated upon the DFG-out flip. Structural analysis reveals that the covalent bond between FIIN-2 and a cysteine, uniquely present in the glycine-rich loop of FGFR kinases, facilitates the DFG-out conformation, which together with the internal flexibility of FIIN-2 enables FIIN-2 to avoid the steric clash with the gate-keeper mutation that causes the ponatinib resistance. The structural data provide a blueprint for the development of next generation anticancer inhibitors through combining the salient inhibitory mechanisms of ponatinib and FIIN-2. PMID:25317566

[Do gatekeeping programs increase equality of health care in Germany? A comparison of the health care situation of participants and nonparticipants].

PubMed

Schnitzer, S; Balke, K; Walter, A; Litschel, A; Kuhlmey, A

2011-08-01

This article compares the health care situation of participants in programs of general practitioner-centered health care (gatekeeping) in Germany (participants) with that of statutory health insurance holders who are not participating in such programs (nonparticipants). Because a key objective of the general practitioner model is to reduce the number of visits to specialists, the article also examines factors influencing frequent utilization of specialists in both groups. The analysis draws on a survey conducted by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, 2010) based on a sample representative of the German population. In this context, 5,232 holders of statutory health insurance aged between 18 and 79 years were interviewed on health care policy issues. The results show that regulating the utilization of specialists through the gatekeeping function of general practitioners succeeds in facilitating similar utilization rates across educational levels, between cities and towns, and between men and women. Thus, gatekeeping programs contribute to the reduction of health care inequalities.

How does gatekeeper training improve suicide prevention for elderly people in nursing homes? A controlled study in 24 centres.

PubMed

Chauliac, N; Brochard, N; Payet, C; Duclos, A; Terra, J-L

2016-09-01

The death rate due to suicide in elderly people is particularly high. As part of suicide selective prevention measures for at-risk populations, the WHO recommends training "gatekeepers". In order to assess the impact of gatekeeper training for members of staff, we carried out a controlled quasi-experimental study over the course of one year, comparing 12 nursing homes where at least 30% of the staff had undergone gatekeeper training with 12 nursing homes without trained staff. We collected data about the residents considered to be suicidal, their management further to being identified, as well as measures taken at nursing home level to prevent suicide. The two nursing home groups did not present significantly different characteristics. In the nursing homes with trained staff, the staff were deemed to be better prepared to approach suicidal individuals. The detection of suicidal residents relied more on the whole staff and less on the psychologist alone when compared to nursing homes without trained staff. A significantly larger number of measures were taken to manage suicidal residents in the trained nursing homes. Suicidal residents were more frequently referred to the psychologist. Trained nursing homes put in place significantly more suicide prevention measures at an institutional level. Having trained gatekeepers has an impact not only for the trained individuals but also for the whole institution where they work, both in terms of managing suicidal residents and routine suicide prevention measures. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Community Colleges as Gateways and Gatekeepers: Moving beyond the Access "Saga" toward Outcome Equity

ERIC Educational Resources Information Center

Dowd, Alicia C.

2007-01-01

Community colleges are essential--though often overlooked--institutions of higher education. In this essay, Alicia C. Dowd draws attention to the challenges facing community colleges as they seek to balance their roles as both gateways and gatekeepers with their multiple missions, which include meeting the diverse needs of students at the…

Does a Gatekeeper Suicide Prevention Program Work in a School Setting? Evaluating Training Outcome and Moderators of Effectiveness

ERIC Educational Resources Information Center

Tompkins, Tanya L.; Witt, Jody; Abraibesh, Nadia

2009-01-01

The current study sought to evaluate the suicide prevention gatekeeper training program QPR (Question, Persuade, and Refer) among school personnel using a non-equivalent control group design. Substantial gains were demonstrated from pre- to post-test for attitudes, knowledge, and beliefs regarding suicide and suicide prevention. Exploratory…

Understanding the Perceptions of Network Gatekeepers on Bandwidth and Online Video Streams in Ahmadu Bello University, Nigeria

ERIC Educational Resources Information Center

Odigie, Imoisili Ojeime; Gbaje, Ezra Shiloba

2017-01-01

Online video streaming is a learning technology used in today's world and reliant on the availability of bandwidth. This research study sought to understand the perceptions of network gatekeepers about bandwidth and online video streams in Ahmadu Bello University, Nigeria. To achieve this, the interpretive paradigm and the Network Gatekeeping…

The Role of Gatekeepers in the Asbestos Awareness Campaign.

ERIC Educational Resources Information Center

Freimuth, Vicki S.; Van Nevel, J. Paul

The role of news media as gatekeepers controlling the flow of information that the public receives was explored during the 1978 Asbestos Awareness campaign conducted by the Department of Health, Education, and Welfare (HEW). In an effort to inform high risk workers and the general public about the health hazards associated with asbestos exposure,…

Validation Study of a Gatekeeping Attitude Index for Social Work Education

ERIC Educational Resources Information Center

Tam, Dora M. Y.; Coleman, Heather

2011-01-01

This article reports on a study designed to validate the Gatekeeping Attitude Index, a 14-item Likert scaling index. The authors collected data from a convenience sample of social work field instructors (N = 188) with a response rate of 74.0%. Construct validation by exploratory factor analysis identified a 2-factor solution on the index after…

An Evaluation of a Unique Gatekeeper Training for Suicide Prevention of College Students: Demonstrating Effective Partnering within Student Affairs

ERIC Educational Resources Information Center

House, Lisa A.; Lynch, Joseph F.; Bane, Mary

2013-01-01

For college students, suicide is the second leading cause of death. In this study, we evaluated a gatekeeper training suicide prevention program that emphasizes emotional connectivity with students in crisis and incorporates the collaborative efforts between Housing/Residential Programs and the Counseling Center. Participants consisted of graduate…

Are Mothers Really "Gatekeepers" of Children?: Rural Mothers' Perceptions of Nonresident Fathers' Involvement in Low-Income Families

ERIC Educational Resources Information Center

Sano, Yoshie; Richards, Leslie N.; Zvonkovic, Anisa M.

2008-01-01

Guided by symbolic interactionism, this qualitative study based on interviews with 83 rural mothers investigated mothers' perceptions of nonresident fathers' involvement in low-income families. Contrary to some fathers' claims that mothers "gatekeep" their access to children, the majority of mothers in our study wanted increased father…

The Lucid Loneliness of the Gatekeeper: Exploring the Emotional Dimension in Principals' Work Lives

ERIC Educational Resources Information Center

Kelchtermans, Geert; Piot, Liesbeth; Ballet, Katrijn

2011-01-01

Based on a secondary analysis of studies on Flemish primary schools, the article argues that the metaphor of the gatekeeper, on the threshold between the outside-school and the inside-school world, is a powerful frame to capture some of the particular complexities of principals' emotional experience of themselves and their working conditions. More…

A Qualitative Study of the Experiences of Gatekeeping among PhD Counselor Educators

ERIC Educational Resources Information Center

Erbes, Carol A.

2013-01-01

The purpose of this study was to examine the gatekeeping experiences of a group of PhD counselor educators, by utilizing a phenomenological approach. This design was chosen as it could best examine the lived experiences of the participants. Nine PhD counselor educators participated in this study through a series of two interviews. All of the…

Pilot Study Evaluation of Suicide Prevention Gatekeeper Training Utilising STORM in a British University Setting

ERIC Educational Resources Information Center

Gask, Linda; Coupe, Nia; McElvenny, Damien; Green, Gill

2017-01-01

Recent years have seen increasing awareness of the wide range of mental health problems faced by students. Gatekeeper training has been shown to have a positive impact on knowledge and attitudes about suicide prevention, although the evidence for skills acquisition is limited. We utilised the STORM® training package in an exploratory study to…

The Short-Term Effectiveness of a Suicide Prevention Gatekeeper Training Program in a College Setting with Residence Life Advisers

ERIC Educational Resources Information Center

Tompkins, Tanya L.; Witt, Jody

2009-01-01

Although the college years prove to be a vulnerable time for students and a critical period for suicide prevention, few school-based prevention strategies have been empirically evaluated. The current study examined the short-term effects of Question, Persuade, and Refer (QPR), a gatekeeper training program that teaches how to recognize warning…

Exploring the Intersection of Beliefs toward Outdoor Play and Cold Weather among Northeast Minnesota's Formal Education and Non-Formal EE Communities

ERIC Educational Resources Information Center

Hughes, Amy Christine; Zak, Kevin; Ernst, Julie; Meyer, Rebecca

2017-01-01

In a notoriously cold-seasoned region, this paper explored how our formal education and non-formal environmental education (EE) gatekeepers of Northeastern Minnesota regard the importance of outdoor play and cold weather for young students. This research study explored the relationship between participant gatekeepers' beliefs of the benefits…

Coverage of Major Topics in Economics in the Undergraduate Curriculum: Economists as Gatekeepers.

ERIC Educational Resources Information Center

Prescott, Suzanne

Over the last 25 years, less attention has been devoted to the role of the economist as teacher or professor than to the role of economist as scholar or researcher. Teachers have been seen as passive recipients of advances in economics research that they simply hand on to their students. Yet teachers perform an important gatekeeping function when…

Meritocracy the Great American Myth? A Look at Gatekeeping in American Higher Education

ERIC Educational Resources Information Center

Pappas, Geri; Tremblay, Christopher W.

2010-01-01

Research on the concept of meritocracy and its role in college admissions is the major focus of this article. It explores the factors that contribute to the gatekeeping process and provides a historical context that led to the evolution of today's admission protocol. It focuses specifically on the strict meritocratic practices of many colleges as…

Acquiring Research Access: Perspectives from Gatekeepers and Parents of Children with Anorexia Nervosa

ERIC Educational Resources Information Center

Hunt, Tamara Jo-Lynne

2010-01-01

The purpose of this study was to understand the conditions necessary to gain research access to parents of children with anorexia. In this study, I also examined and explored avenues parents have for sharing their story and their experiences of parenting a child with anorexia as well as whether gatekeepers have a role in connecting parents and…

Social nature of eating could explain missing link between food insecurity and childhood obesity.

PubMed

Mata, Jutta; Dallacker, Mattea; Hertwig, Ralph

2017-01-01

We suggest that social factors are key to explain the missing link between food insecurity and obesity in children. Parents and public institutions are children's nutritional gatekeepers. They protect children from food insecurity by trimming down their consumption or by institutional support. To gauge children's food insecurity, evaluations across the different nutritional gatekeepers need to be integrated.

Bayer Facts of Science Education XV: A View from the Gatekeepers--STEM Department Chairs at America's Top 200 Research Universities on Female and Underrepresented Minority Undergraduate STEM Students

ERIC Educational Resources Information Center

Journal of Science Education and Technology, 2012

2012-01-01

Diversity and the underrepresentation of women, African-Americans, Hispanics and American Indians in the nation's science, technology, engineering and mathematics (STEM) fields are the subjects of the XV: A View from the Gatekeepers--STEM Department Chairs at America's Top 200 Research Universities on Female and Underrepresented Minority…

Don't Forget the Distributor! the Importance of Field Testing Draft Educational Materials with Key Gatekeepers before Production and Dissemination

ERIC Educational Resources Information Center

Flores, Alina L.; Prue, Christine E.; Panissidi, Paula

2010-01-01

Objective: This article presents the results of testing draft folic acid educational materials with key gatekeepers, leading to the development of a Spanish-language print advertisement, poster, and radio public service announcement (PSA) aimed at promoting folic acid consumption among 18- to 25-year-old young Latina adults, as well as a…

'We have the internet in our hands': Bangladeshi college students' use of ICTs for health information.

PubMed

Waldman, Linda; Ahmed, Tanvir; Scott, Nigel; Akter, Shahinoor; Standing, Hilary; Rasheed, Sabrina

2018-03-20

Information and Communications Technologies (ICTs) which enable people to access, use and promote health information through digital technology, promise important health systems innovations which can challenge gatekeepers' control of information, through processes of disintermediation. College students, in pursuit of sexual and reproductive health (SRH) information, are particularly affected by gatekeeping as strong social and cultural norms restrict their access to information and services. This paper examines mobile phone usage for obtaining health information in Mirzapur, Bangladesh. It contrasts college students' usage with that of the general population, asks whether students are using digital technologies for health information in innovative ways, and examines how gender affects this. This study relies on two surveys: a 2013-2014 General Survey that randomly sampled 854 households drawn from the general population and a 2015 Student Survey that randomly sampled 436 students from two Mirzapur colleges. Select focus group discussions and in-depth interviews were undertaken with students. Icddr,b's Ethical Review Board granted ethical clearance. The data show that Mirzapur's college students are economically relatively well positioned, more likely to own mobile and smart phones, and more aware of the internet than the general population. They are interested in health information and use phones and computers to access information. Moreover, they use digital technology to share previously-discreet information, adding value to that information and bypassing former gatekeepers. But access to health information is not entirely unfettered, affecting male and female students differently, and powerful gatekeepers, both old and new, can still control sources of information. Personal searches for SRH and the resultant online information shared through discrete, personal face-to-face discussions has some potential to challenge social norms. This is particularly so for women students, as sharing information may enable them to bypass gatekeepers and make decisions about reproduction. This suggests that digital health information seeking may be exercising a disruptive effect within the health sector. However, the extent of this disruption may depend, not on students' mobile phone usage, but on the degree to which powerful new gatekeepers are able to retain control over and market SRH information through students' peer-to-peer sharing.

Effect of Patient Experience on Bypassing a Primary Care Gatekeeper: a Multicenter Prospective Cohort Study in Japan.

PubMed

Aoki, Takuya; Yamamoto, Yosuke; Ikenoue, Tatsuyoshi; Kaneko, Makoto; Kise, Morito; Fujinuma, Yasuki; Fukuhara, Shunichi

2018-05-01

To discuss how best to implement the gatekeeping functionality of primary care; identifying the factors that cause patients to bypass their primary care gatekeepers when seeking care should be beneficial. To examine the association between patient experience with their primary care physicians and bypassing them to directly obtain care from higher-level healthcare facilities. This prospective cohort study was conducted in 13 primary care clinics in Japan. We assessed patient experience of primary care using the Japanese version of Primary Care Assessment Tool (JPCAT), which comprises six domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. The primary outcome was the patient bypassing their usual primary care physician to seek care at a hospital, with this occurring at least once in a year. We used a Bayesian hierarchical model to adjust clustering within clinics and individual covariates. Data were analyzed from 205 patients for whom a physician at a clinic served as their usual primary care physician. The patient follow-up rate was 80.1%. After adjustment for patients' sociodemographic and health status characteristics, the JPCAT total score was found to be inversely associated with patient bypass behavior (odds ratio per 1 SD increase, 0.44; 95% credible interval, 0.21-0.88). The results of various sensitivity analyses were consistent with those of the primary analysis. We found that patient experience of primary care in Japan was inversely associated with bypassing a primary care gatekeeper to seek care at higher-level healthcare facilities, such as hospitals. Our findings suggest that primary care providers' efforts to improve patient experience should help to ensure appropriate use of healthcare services under loosely regulated gatekeeping systems; further studies are warranted.

Explaining the present GM business strategy on the EU food market: the gatekeepers' perspective.

PubMed

Inghelbrecht, Linde; Dessein, Joost; Van Huylenbroeck, Guido

2015-01-25

The use of genetically modified (GM) crops and their applications is partially suppressed in European Union (EU) agriculture, even if one would expect otherwise given their complementarity with the neoliberal and industrialised EU agricultural regime in place. By applying a qualitative content analysis, this paper analyses how food manufacturers and retailers (referred to as gatekeepers in the food industry) explain and defend the exclusion of GM-labelled food products on the EU market. The study design places emphasis on the role of perceptions in the strategic behaviour of gatekeepers and on the role of interaction in this regard, as we assume that the way in which gatekeepers perceive the 'rules of the game' for commercialising GM crop applications on the EU food market will be influenced by their interaction with other agribusiness actors. In a first stage, the analysis determines thematic congruence in the (types of) perceptions that explain an agribusiness actor's overall interpretation of the EU business environment for GM crop applications. This perceived 'structuring arena' (SA) for GM crop applications - as conceptualised within our framework - contains areas of either internal and external tensions, that have a compelling or non-committal influence on the agribusiness actor's interpretation. In a second stage, the analysis particularly defines how gatekeepers in the food industry perceive and experience the SA for GM crop applications on the EU market, and how these perceptual tensions subsequently influence their strategic behaviour for GM-labelled products on the EU market. Finally, we highlight how these perceptions and actions (or inaction) suppress the main changes in practice that are necessary to manage this wicked problem. Copyright © 2014 Elsevier B.V. All rights reserved.

CRISPR-Cas Gatekeeper: Slow on the Uptake but Gets the Job Done.

PubMed

Whitaker, Rachel J; Vanderpool, Carin K

2016-02-10

Microbial CRISPR-Cas acts as a defense, but also as a gatekeeper controlling the flow of new genes into microbial genomes. In a recent Cell paper, Jiang et al. (2016) uncover the functional importance of transcription-dependent RNA targeting in type III-A CRISPR-Cas antiviral defense and provide insight into the co-evolution of virus-host symbioses. Copyright © 2016 Elsevier Inc. All rights reserved.

Defenders against Threats or Enablers of Opportunities: The Screening Role Played by Gatekeepers in Researching Older People in Care Homes

ERIC Educational Resources Information Center

Scourfield, Peter

2012-01-01

This paper emerges from a case study of the system of statutory reviews in older people's care homes in the UK. Informed by a review of selected literature on gaining access, this paper provides a critical account of the process of negotiating access with gatekeepers (chiefly, care home managers). The negotiations were time-consuming and largely…

Narratives and gatekeeping: making sense of triage nurses' practice.

PubMed

Johannessen, Lars E F

2018-04-17

It is well documented that emergency service staff consider some patients to be 'inappropriate attenders'. A central example is 'trivia', denoting patients with medical problems considered too 'trivial' to warrant attention. Although research has repeatedly shown that frontline staff violate guidelines in turning away 'trivial' patients, existing research has paid insufficient attention to why staff are willing to engage in guideline-violating gatekeeping, which may put both themselves and 'trivial' patients at risk. To address this issue, the present article explores nurses' narratives about 'trivial' patients - referred to in this context as 'GP patients' - drawing on fieldwork data from a Norwegian emergency service. The article reconstructs three narrative clusters, showing that nurses' gatekeeping is motivated by concerns for the patient being turned away, for nurses and more critically ill patients, and for the service they work for. Some of the issues embedded in these narratives have been under-analysed in previous research - most importantly, the role of identity and emotion in nurses' gatekeeping, and how patient narratives can function as 'social prognoses' in nurses' assessments. Analysis of these narratives also reveals an antagonistic relationship between nurses and 'trivial' patients that contradicts nurses' ethical guidelines and indicates a need for healthcare reform. © 2018 Foundation for the Sociology of Health & Illness.

Gatekeeping and its impact on father involvement among Black South Africans in rural KwaZulu-Natal.

PubMed

Makusha, Tawanda; Richter, Linda

2016-01-01

Involved and caring fatherhood contributes to the health and wellbeing of children, women and men. The corollary is also true - men, women and children are affected when fathers are not involved or supportive of their children. Many factors affect fathers' involvement, including women's attitudes, the history and nature of the relationship between mother and father, and the cultural context. This study explores gatekeeping and its impact on father involvement among Black South Africans in rural KwaZulu-Natal. Among married couples, gatekeeping occurs with respect to childcare and housework through women's attempts to validate their maternal identity according to socially and culturally constructed gender roles. Among unmarried, non-resident parents, women control father-child contact and involvement, with mothers and/or their families either facilitating or inhibiting father involvement. In this context, we found that cultural gatekeeping had a huge impact on father involvement, with the non-payment of inhlawulo or lobola regulating father-child involvement. In a country like South Africa, where there is high non-marital fertility and father-child non-residence, future research, parenting and family programmes should focus on strategies that encourage positive paternal involvement as well as maternal and cultural support for father involvement, regardless of parental relationship and residence status.

External validity and anchoring heuristics: application of DUNDRUM-1 to secure service gatekeeping in South Wales.

PubMed

Lawrence, Daniel; Davies, Tracey-Lee; Bagshaw, Ruth; Hewlett, Paul; Taylor, Pamela; Watt, Andrew

2018-02-01

Aims and method Structured clinical judgement tools provide scope for the standardisation of forensic service gatekeeping and also allow identification of heuristics in this decision process. The DUNDRUM-1 triage tool was completed retrospectively for 121 first-time referrals to forensic services in South Wales. Fifty were admitted to medium security, 49 to low security and 22 remained in open conditions. DUNDRUM-1 total scores differed appropriately between different levels of security. However, regression revealed heuristic anchoring on the 'legal process' and 'immediacy of risk due to mental disorder' items. Clinical implications Patient placement was broadly aligned with DUNDRUM-1 recommendations. However, not all triage items informed gatekeeping decisions. It remains to be seen whether decisions anchored in this way are effective. Declaration of interest Dr Mark Freestone gave permission for AUC values from Freestone et al. (2015) to be presented here for comparison.

Addiction Treatment Professionals Are Not the Gatekeepers of Recovery.

PubMed

Humphreys, Keith

2015-01-01

Addiction treatment is beneficial to many individuals who have substance use disorders. However, only a minority of individuals who recover from addiction receive it. Despite this, addiction treatment is sometimes granted the status of the "gatekeeper of recovery." The myth that treatment is necessary for recovery has no empirical support. It also undermines the confidence of individuals in their ability to change on their own and is unduly dismissive of the efforts of nonprofessional helpers.

Training of Attentional Filtering, but Not of Memory Storage, Enhances Working Memory Efficiency by Strengthening the Neuronal Gatekeeper Network.

PubMed

Schmicker, Marlen; Schwefel, Melanie; Vellage, Anne-Katrin; Müller, Notger G

2016-04-01

Memory training (MT) in older adults with memory deficits often leads to frustration and, therefore, is usually not recommended. Here, we pursued an alternative approach and looked for transfer effects of 1-week attentional filter training (FT) on working memory performance and its neuronal correlates in young healthy humans. The FT effects were compared with pure MT, which lacked the necessity to filter out irrelevant information. Before and after training, all participants performed an fMRI experiment that included a combined task in which stimuli had to be both filtered based on color and stored in memory. We found that training induced processing changes by biasing either filtering or storage. FT induced larger transfer effects on the untrained cognitive function than MT. FT increased neuronal activity in frontal parts of the neuronal gatekeeper network, which is proposed to hinder irrelevant information from being unnecessarily stored in memory. MT decreased neuronal activity in the BG part of the gatekeeper network but enhanced activity in the parietal storage node. We take these findings as evidence that FT renders working memory more efficient by strengthening the BG-prefrontal gatekeeper network. MT, on the other hand, simply stimulates storage of any kind of information. These findings illustrate a tight connection between working memory and attention, and they may open up new avenues for ameliorating memory deficits in patients with cognitive impairments.

GateKeeper: a new hardware architecture for accelerating pre-alignment in DNA short read mapping.

PubMed

Alser, Mohammed; Hassan, Hasan; Xin, Hongyi; Ergin, Oguz; Mutlu, Onur; Alkan, Can

2017-11-01

High throughput DNA sequencing (HTS) technologies generate an excessive number of small DNA segments -called short reads- that cause significant computational burden. To analyze the entire genome, each of the billions of short reads must be mapped to a reference genome based on the similarity between a read and 'candidate' locations in that reference genome. The similarity measurement, called alignment, formulated as an approximate string matching problem, is the computational bottleneck because: (i) it is implemented using quadratic-time dynamic programming algorithms and (ii) the majority of candidate locations in the reference genome do not align with a given read due to high dissimilarity. Calculating the alignment of such incorrect candidate locations consumes an overwhelming majority of a modern read mapper's execution time. Therefore, it is crucial to develop a fast and effective filter that can detect incorrect candidate locations and eliminate them before invoking computationally costly alignment algorithms. We propose GateKeeper, a new hardware accelerator that functions as a pre-alignment step that quickly filters out most incorrect candidate locations. GateKeeper is the first design to accelerate pre-alignment using Field-Programmable Gate Arrays (FPGAs), which can perform pre-alignment much faster than software. When implemented on a single FPGA chip, GateKeeper maintains high accuracy (on average >96%) while providing, on average, 90-fold and 130-fold speedup over the state-of-the-art software pre-alignment techniques, Adjacency Filter and Shifted Hamming Distance (SHD), respectively. The addition of GateKeeper as a pre-alignment step can reduce the verification time of the mrFAST mapper by a factor of 10. https://github.com/BilkentCompGen/GateKeeper. mohammedalser@bilkent.edu.tr or onur.mutlu@inf.ethz.ch or calkan@cs.bilkent.edu.tr. Supplementary data are available at Bioinformatics online. © The Author (2017). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

A Smart pH-responsive Nano-Carrier as a Drug Delivery System: A hybrid system comprised of mesoporous nanosilica MCM-41 (as a nano-container) & a pH-sensitive polymer (as smart reversible gatekeepers): Preparation, characterization and in vitro release studies of an anti-cancer drug.

PubMed

Abbaszad Rafi, Abdolrahim; Mahkam, Mehrdad; Davaran, Soodabeh; Hamishehkar, Hamed

2016-10-10

A smart pH-responsive drug nano-carrier for controlled release of anti-cancer therapeutics was developed through a facile route. The nano-carrier consisted of two main parts: first, the nano-container part (that mesoporous silica nanoparticles (MCM-41) were selected for this aim); and second, pH-sensitive gatekeepers (that a pH-sensitive polymer, Poly4-vinylpyridine, played this role). In the first step, MCM-41 was synthesized via template assisted sol-gel process. In the second step, polymerizable functional groups were attached onto pore entrances rather than inside walls. In the third step, polymeric gatekeepers were introduced onto pore entrances via precipitation polymerization of functionalized MCM-41 with monomers. Different methods and analysis, such as Fourier Transform Infrared Spectroscopy (FT-IR), X-ray Powder Diffraction (XRD), Thermo-Gravimetric Analysis (TGA), Energy-Dispersive X-ray Spectroscopy (EDX), Zeta Potentials, Dynamic Light Scattering (DLS), Field Emission Scanning Electron Microscope (FE-SEM) and Transmission Electron Microscopy (TEM) were employed to approve the successful attachment of gatekeepers. Furthermore, the release studies of methotroxate (MTX), an anti-cancer drug, were performed in different media (pH4, 5.8 and 7.4) at 37±1°C. The release profiles and curves show that the release rates are completely pH-dependent and it proceeds with a decrease in pH. It is concluded that in the higher pH the gatekeepers are in their close state, but they switch to the open state as a consequence of repulsive forces between positively charged polymer chains appear in acidic media. The results suggest that this smart nano-carrier can be considered as an appropriate candidate to deliver therapeutics to cancerous tissues. Copyright © 2016 Elsevier B.V. All rights reserved.

Fathers’ Involvement in Child Health Care: Associations with Prenatal Involvement, Parents’ Beliefs, and Maternal Gatekeeping

PubMed Central

Zvara, B.J.; Schoppe-Sullivan, Sarah J.; Dush, Claire M. Kamp

2015-01-01

Using data from 182 dual-earner couples experiencing the transition to parenthood, this study examined associations between prenatal involvement, gender role beliefs, and maternal gatekeeping and new fathers’ involvement in child health care. Results indicated that prenatal father involvement was associated with both fathers’ direct engagement in child health care and fathers’ perceived influence in child health-related decision-making. Fathers also demonstrated greater direct engagement in child health care when mothers held more nontraditional beliefs about gender roles. Moreover, when mothers were more encouraging of fathers’ involvement in childrearing, fathers felt more influential in child health-related decision-making, whereas when mothers engaged in greater gate closing behavior, fathers with more traditional gender role beliefs felt less influential in child health-related decision-making. This study suggests that fathers’ prenatal involvement, mothers’ beliefs, and maternal gatekeeping may play a role in the development of new fathers’ involvement in child health care at the transition to parenthood. PMID:26405366

From Regional to National Clouds: TV Coverage in the Czech Republic

PubMed Central

Sucháček, Jan; Sed’a, Petr; Friedrich, Václav; Wachowiak-Smolíková, Renata; Wachowiak, Mark P.

2016-01-01

Media, and particularly TV media, have a great impact on the general public. In recent years, spatial patterns of information and the relevance of intangible geographies have become increasingly important. Gatekeeping plays a critical role in the selection of information that is transformed into media. Therefore, gatekeeping, through national media, also co-forms the generation of mental maps. In this paper, correspondence analysis (a statistical method) combined with cloud lines (a new visual analytics technique) is used to analyze how individual major regional events in one of the post-communist countries, the Czech Republic, penetrate into the media on a national scale. Although national news should minimize distortions about regions, this assumption has not been verified by our research. Impressions presented by the media of selected regions that were markedly influenced by one or several events in those regions demonstrate that gatekeepers, especially news reporters, functioned as a filter by selecting only a few specific, and in many cases, unusual events for dissemination. PMID:27824947

Structural Mechanism of the Pan-BCR-ABL Inhibitor Ponatinib (AP24534): Lessons for Overcoming Kinase Inhibitor Resistance

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

Zhou, Tianjun; Commodore, Lois; Huang, Wei-Sheng

2012-01-20

The BCR-ABL inhibitor imatinib has revolutionized the treatment of chronic myeloid leukemia. However, drug resistance caused by kinase domain mutations has necessitated the development of new mutation-resistant inhibitors, most recently against the T315I gatekeeper residue mutation. Ponatinib (AP24534) inhibits both native and mutant BCR-ABL, including T315I, acting as a pan-BCR-ABL inhibitor. Here, we undertook a combined crystallographic and structure-activity relationship analysis on ponatinib to understand this unique profile. While the ethynyl linker is a key inhibitor functionality that interacts with the gatekeeper, virtually all other components of ponatinib play an essential role in its T315I inhibitory activity. The extensive networkmore » of optimized molecular contacts found in the DFG-out binding mode leads to high potency and renders binding less susceptible to disruption by single point mutations. The inhibitory mechanism exemplified by ponatinib may have broad relevance to designing inhibitors against other kinases with mutated gatekeeper residues.« less

Measuring the effectiveness of scientific gatekeeping.

PubMed

Siler, Kyle; Lee, Kirby; Bero, Lisa

2015-01-13

Peer review is the main institution responsible for the evaluation and gestation of scientific research. Although peer review is widely seen as vital to scientific evaluation, anecdotal evidence abounds of gatekeeping mistakes in leading journals, such as rejecting seminal contributions or accepting mediocre submissions. Systematic evidence regarding the effectiveness--or lack thereof--of scientific gatekeeping is scant, largely because access to rejected manuscripts from journals is rarely available. Using a dataset of 1,008 manuscripts submitted to three elite medical journals, we show differences in citation outcomes for articles that received different appraisals from editors and peer reviewers. Among rejected articles, desk-rejected manuscripts, deemed as unworthy of peer review by editors, received fewer citations than those sent for peer review. Among both rejected and accepted articles, manuscripts with lower scores from peer reviewers received relatively fewer citations when they were eventually published. However, hindsight reveals numerous questionable gatekeeping decisions. Of the 808 eventually published articles in our dataset, our three focal journals rejected many highly cited manuscripts, including the 14 most popular; roughly the top 2 percent. Of those 14 articles, 12 were desk-rejected. This finding raises concerns regarding whether peer review is ill--suited to recognize and gestate the most impactful ideas and research. Despite this finding, results show that in our case studies, on the whole, there was value added in peer review. Editors and peer reviewers generally--but not always-made good decisions regarding the identification and promotion of quality in scientific manuscripts.

Gatekeeping practices of music therapy academic programs and internships: a national survey.

PubMed

Hsiao, Feilin

2014-01-01

Gatekeeping safeguards access to the practice of a profession to ensure the quality of clinical services. It involves selective admission, continuous evaluation, and timely and ethical decisions in response to trainees with severe professional competency problems (SPCP). To date, little information is available concerning gatekeeping practices in the field of music therapy. This study investigated the extent and outcomes of gatekeeping practices across academic programs and National Roster internship sites approved by the American Music Therapy Association. Specifically, it examined the prevalence of trainees with SPCP, program-wide precautionary measures, common indicators of trainees with SPCP, remedial strategies, and supports and barriers to effective management. Thirty-two academic program directors and 77 internship directors completed an online survey. Responses were compiled into aggregate form (frequencies & percentages) for analysis. Chi-square tests with Yates' correction were applied to compare the differences between academic programs and internships. A significantly higher percentage of academic programs (93.8%) reported having at least one trainee with SPCP over the past 5 years than did internships (66.2%). The most common indicators of competency problems included inadequate music skill development, emotional instability, limited communication skills, deficient interpersonal skills, defensiveness in supervision, and lack of insight. Typical remedial methods included referral to personal therapy, increased supervision, and repetition of practicum or extension of internship. Issues regarding trainees with SPCP are frequently addressed by academic and internship program directors. Improving clarity within professional guidelines and establishing more rigorous and consistent standards across training programs are recommended. © the American Music Therapy Association 2014. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Marital Problems, Maternal Gatekeeping Attitudes, and Father-Child Relationships in Adolescence

PubMed Central

Stevenson, Matthew M.; Fabricius, William V.; Cookston, Jeffrey T.; Parke, Ross D.; Coltrane, Scott; Braver, Sanford L.; Saenz, Delia S.

2013-01-01

We evaluated maternal gatekeeping attitudes as a mediator of the relation between marital problems and father-child relationships in three waves when children were in 7th through 10th grade. We assessed each parent’s contribution to the marital problems experienced by the couple. Findings from mediational and cross-lagged structural equation models revealed that increased marital problem behaviors on the part of mothers at wave 1 predicted increased maternal gatekeeping attitudes at wave 2 which in turn predicted decreased amounts of father-adolescent interaction at wave 3. Decreased amounts of interaction with either parent were associated within each wave with adolescents’ perceptions that they mattered less to that parent. Amount of interaction with fathers at wave 2 positively predicted changes in boys’ perceptions of how much they mattered to their fathers at wave 3, and amount of interaction with mothers at wave 2 positively predicted changes in girls’ perceptions of how much they mattered to their mothers at wave 3. The findings did not differ for European-American versus Mexican-American families, or for biological fathers versus step-fathers. PMID:24364832

Reconsidering the Gatekeeper Paradigm for Percutaneous Coronary Intervention in Stable Coronary Disease Management.

PubMed

Schulman-Marcus, Joshua; Weintraub, William S; Boden, William E

2017-10-15

Major randomized clinical trials over the last decade support the role of optimal medical therapy for the initial management approach for patients with stable coronary artery disease (CAD), whereas percutaneous coronary intervention (PCI) ought to be reserved for patients with persistent symptoms despite optimal medical therapy. Likewise, several studies have continued to demonstrate the superiority of coronary artery bypass grafting surgery over PCI in many patients with extensive multivessel CAD, especially those with diabetes. Nevertheless, the decision-making paradigm for patients with stable CAD often continues to propagate the upfront use of "ad hoc PCI" and disadvantages alternative therapeutic approaches. In our editorial, we discuss how multiple systemic and interpersonal factors continue to favor early revascularization with PCI in stable patients. We discuss whether the interventional cardiologist can be an unbiased "gatekeeper" for the use of PCI or whether other physicians should also be involved with the patient in decision-making. Finally, we offer suggestions that can redefine the gatekeeper role to facilitate an evidence-based approach that embraces shared decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

Gatekeepers in the healthcare sector: Knowledge and Bourdieu's concept of field.

PubMed

Collyer, Fran M; Willis, Karen F; Lewis, Sophie

2017-08-01

Choice is an imperative for patients in the Australian healthcare system. The complexity of this healthcare 'maze', however, means that successfully navigating and making choices depends not only on the decisions of patients, but also other key players in the healthcare sector. Utilising Bourdieu's concepts of capital, habitus and field, we analyse the role of gatekeepers (i.e., those who control access to resources, services and knowledge) in shaping patients' experiences of healthcare, and producing opportunities to enable or constrain their choices. Indepth interviews were conducted with 41 gatekeepers (GPs, specialists, nurses, hospital administrators and policymakers), exploring how they acquire and use knowledge within the healthcare system. Our findings reveal a hierarchy of knowledges and power within the healthcare field which determines the forms of knowledge that are legitimate and can operate as capital within this complex and dynamic arena. As a consequence, forms of knowledge which can operate as capital, are unequally distributed and strategically controlled, ensuring democratic 'reform' remains difficult and 'choices' limited to those beneficial to private medicine. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Hospital clinical engineer orientation and function in the maintenance system of hospital medical equipment].

PubMed

Li, Bin; Zheng, Yunxin; He, Dehua; Jiang, Ruiyao; Chen, Ying; Jing, Wei

2012-03-01

The quantity of medical equipment in hospital rise quickly recent year. It provides the comprehensive support to the clinical service. The maintenance of medical equipment becomes more important than before. It is necessary to study on the orientation and function of clinical engineer in medical equipment maintenance system. Refer to three grade health care system, the community doctors which is called General practitioner, play an important role as the gatekeeper of health care system to triage and cost control. The paper suggests that hospital clinical engineer should play similar role as the gatekeeper of medical equipment maintenance system which composed by hospital clinical engineer, manufacture engineer and third party engineer. The hospital clinical engineer should be responsible of guard a pass of medical equipment maintenance quality and cost control. As the gatekeeper, hospital clinical engineer should take the responsibility of "General engineer" and pay more attention to safety and health of medical equipment. The responsibility description and future transition? development of clinical engineer as "General Engineer" is discussed. More attention should be recommended to the team building of hospital clinical engineer as "General Engineer".

Identification of a Non-Gatekeeper Hot Spot for Drug-Resistant Mutations in mTOR Kinase.

PubMed

Wu, Tzung-Ju; Wang, Xiaowen; Zhang, Yanjie; Meng, Linghua; Kerrigan, John E; Burley, Stephen K; Zheng, X F Steven

2015-04-21

Protein kinases are therapeutic targets for human cancer. However, "gatekeeper" mutations in tyrosine kinases cause acquired clinical resistance, limiting long-term treatment benefits. mTOR is a key cancer driver and drug target. Numerous small-molecule mTOR kinase inhibitors have been developed, with some already in human clinical trials. Given our clinical experience with targeted therapeutics, acquired drug resistance in mTOR is thought likely, but not yet documented. Herein, we describe identification of a hot spot (L2185) for drug-resistant mutations, which is distinct from the gatekeeper site, and a chemical scaffold refractory to drug-resistant mutations. We also provide new insights into mTOR kinase structure and function. The hot spot mutations are potentially useful as surrogate biomarkers for acquired drug resistance in ongoing clinical trials and future treatments and for the design of the next generation of mTOR-targeted drugs. Our study provides a foundation for further research into mTOR kinase function and targeting. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

GABAB receptor cell surface export is controlled by an endoplasmic reticulum gatekeeper

PubMed Central

Doly, Stéphane; Shirvani, Hamasseh; Gäta, Gabriel; Meye, Frank; Emerit, Michel-Boris; Enslen, Hervé; Achour, Lamia; Pardo-Lopez, Liliana; Kwon, Yang Seung; Armand, Vincent; Gardette, Robert; Giros, Bruno; Gassmann, Martin; Bettler, Bernhard; Mameli, Manuel; Darmon, Michèle; Marullo, Stefano

2016-01-01

Summary Endoplasmic reticulum (ER) release and cell surface export of many G protein-coupled receptors (GPCRs), are tightly regulated. For GABAB receptors of GABA, the major mammalian inhibitory neurotransmitter, the ligand-binding GB1 subunit is maintained in the ER by unknown mechanisms in the absence of hetero-dimerization with the GB2 subunit. We report that GB1 retention is regulated by a specific gatekeeper, PRAF2. This ER resident transmembrane protein binds to GB1, preventing its progression in the biosynthetic pathway. GB1 release occurs upon competitive displacement from PRAF2 by GB2. PRAF2 concentration, relative to that of GB1 and GB2, tightly controls cell surface receptor density and controls GABAB function in neurons. Experimental perturbation of PRAF2 levels in vivo caused marked hyperactivity disorders in mice. These data reveal an unanticipated major impact of specific ER gate-keepers on GPCR function and identify PRAF2 as a new molecular target with therapeutic potential for psychiatric and neurological diseases involving GABAB function. PMID:26033241

Designing dual inhibitors of Mdm2/MdmX: Unexpected coupling of water with gatekeeper Y100/99.

PubMed

Lee, Xiong An; Verma, Chandra; Sim, Adelene Y L

2017-08-01

Mdm2 and MdmX share high structural similarity in their N-terminal domains, yet dual inhibitors are challenging to design due to differences in the conformations of the binding pockets, and notably of the proposed gatekeeper residue, Y100/99. Analysis of crystal structures and molecular dynamics (MD) simulations of complexes of Mdm2 and MdmX resulted in the identification of a water molecule with a long residence time that appears to be modulated by the conformation of Y100/99. These observations lead us to speculate that dual inhibitors either (i) stabilize both Mdm2 and MdmX with Y100/99 in the open conformation typically seen in complexes of Mdm2 with p53, or (ii) the dual inhibitors are agnostic to the conformation of Y100/99. The recently developed potent dual inhibitory stapled peptide Atsp7041 appears to be agnostic to the conformation of the gatekeeper residue. Proteins 2017; 85:1493-1506. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

A state's approach to suicide prevention awareness: gatekeeper training in Kentucky.

PubMed

Cerel, Julie; Padgett, Jason H; Robbins, Vestena; Kaminer, Barbara

2012-01-01

As part of Preventing Suicide: Kentucky's Plan, a gatekeeper training was implemented. The implementation of this brief educational intervention and changes in participants' suicide prevention attitudes were examined. Data were collected from 3,958 people in 213 sessions from May 2004 to August 2006. Participants reported high levels of satisfaction with the trainings. Immediately following the training, participants showed substantial increases in their perception of their suicide knowledge and their perceived efficacy to help someone who displays signs of suicide. QPR was widely disseminated across the state and shows promise to change immediate beliefs and feelings of efficacy.

Exploring opportunities to project a "responsible man" image: gatekeepers views of young men's sexual and reproductive health needs in Uttaranchal, India.

PubMed

Khan, M E; Mishra, Anurag; Morankar, Sudhakar

Increase in extramarital sex among youths, gender-based violence, lack of contraceptive knowledge among newly married couples and lack of knowledge of protection against diseases like STIs/HIV are the information and service needs of young people that need to be addressed urgently in order to make them future knowledgeable, responsible, and non-violent partners. In addressing these needs the gatekeepers, including parents, formal and informal community leaders and teachers, play a critical role, by facilitating/hindering access to appropriate and correct information about sexual and reproductive health to young people. The study was conducted in a district of Uttaranchal, India. The specific objective was to understand the social context and gatekeepers' views on family planning and sexual and reproductive health needs of young men. Thirty-two in-depth interviews and four focus group discussions were conducted with parents, formal and informal community leaders, teachers, and selected development officials. The findings indicate that gatekeepers are worried about rapid changes in the aspiration, expectation, and behavior of young men. Most of them were seriously concerned about the increasing drinking habit, use of drugs, and changing values of sexuality leading to various risk behaviors among young men. They felt that many of these changes are consequences of wider societal changes, rising aspirations, explosion of electronic media, and globalization of a new youth culture where extramarital sex, alcohol consumption, and violence are expressions of different facets of masculinity and symbols of the affluent class. Overall, there was a feeling that TV/films and their peers now influence more the socialization of young people and parents are losing control in guidance and mentoring of their children.

Gatekeepers or intermediaries? The role of clinicians in commercial genomic testing.

PubMed

McGowan, Michelle L; Fishman, Jennifer R; Settersten, Richard A; Lambrix, Marcie A; Juengst, Eric T

2014-01-01

Many commentators on "direct-to-consumer" genetic risk information have raised concerns that giving results to individuals with insufficient knowledge and training in genomics may harm consumers, the health care system, and society. In response, several commercial laboratories offering genomic risk profiling have shifted to more traditional "direct-to-provider" (DTP) marketing strategies, repositioning clinicians as the intended recipients of advertising of laboratory services and as gatekeepers to personal genomic information. Increasing popularity of next generation sequencing puts a premium on ensuring that those who are charged with interpreting, translating, communicating and managing commercial genomic risk information are appropriately equipped for the job. To shed light on their gatekeeping role, we conducted a study to assess how and why early clinical users of genomic risk assessment incorporate these tools in their clinical practices and how they interpret genomic information for their patients. We conducted qualitative in-depth interviews with 18 clinicians providing genomic risk assessment services to their patients in partnership with DNA Direct and Navigenics. Our findings suggest that clinicians learned most of what they knew about genomics directly from the commercial laboratories. Clinicians rely on the expertise of the commercial laboratories without the ability to critically evaluate the knowledge or assess risks. DTP service delivery model cannot guarantee that providers will have adequate expertise or sound clinical judgment. Even if clinicians want greater genomic knowledge, the current market structure is unlikely to build the independent substantive expertise of clinicians, but rather promote its continued outsourcing. Because commercial laboratories have the most "skin in the game" financially, genetics professionals and policymakers should scrutinize the scientific validity and clinical soundness of the process by which these laboratories interpret their findings to assess whether self-interested commercial sources are the most appropriate entities for gate-keeping genomic interpretation.

An Overview on Coronary Heart Disease (A Comparative Evaluation of Turkey and Europe) and Cost-effectiveness of Diagnostic Strategies

PubMed Central

Taşçı, Cengiz; Özçelik, Nihat

2011-01-01

Objective: Coronary heart disease (CHD) is the leading cause of death for men and women in Turkey as it is in Europe and US. The prevalence of the disease is 3.8% in Turkey and 200,000 patients are added to the pool of CHD annually Because of genetic predisposition and high proportions of physical inactivity, smoking habit, and obesity, CHD is encountered in earlier ages in our country So, the economic burden of the disease is expected to be relatively high, but the amount of health expenditure is not always parallel to the prevalence of a disease in the community. This article was written to overview CHD statistics to make a comparison between Turkey and some European countries and to investigate the value of myocardial perfusion scan (MPS) as a gatekeeper in diagnosing CHD before invasive coronary angiography (ICA). The consequences were evaluated for Turkey In diagnosis; noninvasive testing gains importance in connection with the new approaches in treatment strategies, because a direct ICA strategy results in higher rates of revascularization without improvement in clinical outcomes. A "gatekeeper" is needed to select the patients who are not required to undergo angiography. MPS with its proved power in diagnosis and predicting prognosis, provides a cost-effective solution, and is accepted in some extensive analyses as a "gatekeeper" particularly in intermediate and high risk patients and in patients with known CHD. In conclusion, MPS may provide an optimal solution better than the ongoing situation in Turkey as well, when it is approved as a "gatekeeper in an algorithm before ICA. Conflict of interest:None declared. PMID:23487016

Therapeutic strategies to overcome crizotinib resistance in non-small cell lung cancers harboring the fusion oncogene EML4-ALK

PubMed Central

Katayama, Ryohei; Khan, Tahsin M.; Benes, Cyril; Lifshits, Eugene; Ebi, Hiromichi; Rivera, Victor M.; Shakespeare, William C.; Iafrate, A. John; Engelman, Jeffrey A.; Shaw, Alice T.

2011-01-01

The echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) fusion oncogene represents a molecular target in a small subset of non-small cell lung cancers (NSCLCs). This fusion leads to constitutive ALK activation with potent transforming activity. In a pivotal phase 1 clinical trial, the ALK tyrosine kinase inhibitor (TKI) crizotinib (PF-02341066) demonstrated impressive antitumor activity in the majority of patients with NSCLC harboring ALK fusions. However, despite these remarkable initial responses, cancers eventually develop resistance to crizotinib, usually within 1 y, thereby limiting the potential clinical benefit. To determine how cancers acquire resistance to ALK inhibitors, we established a model of acquired resistance to crizotinib by exposing a highly sensitive EML4-ALK–positive NSCLC cell line to increasing doses of crizotinib until resistance emerged. We found that cells resistant to intermediate doses of crizotinib developed amplification of the EML4-ALK gene. Cells resistant to higher doses (1 μM) also developed a gatekeeper mutation, L1196M, within the kinase domain, rendering EML4-ALK insensitive to crizotinib. This gatekeeper mutation was readily detected using a unique and highly sensitive allele-specific PCR assay. Although crizotinib was ineffectual against EML4-ALK harboring the gatekeeper mutation, we observed that two structurally different ALK inhibitors, NVP-TAE684 and AP26113, were highly active against the resistant cancer cells in vitro and in vivo. Furthermore, these resistant cells remained highly sensitive to the Hsp90 inhibitor 17-AAG. Thus, we have developed a model of acquired resistance to ALK inhibitors and have shown that second-generation ALK TKIs or Hsp90 inhibitors are effective in treating crizotinib-resistant tumors harboring secondary gatekeeper mutations. PMID:21502504

Demand management: an audit of chemical pathology test rejections by an electronic gate-keeping system at an academic hospital in Cape Town.

PubMed

Smit, Ida; Zemlin, Annalise E; Erasmus, Rajiv T

2015-07-01

Demand management is an area of laboratory activity, which is becoming increasingly important. Within the health-care system, demand management can be defined as the use of health resources to maximise its utility. Tygerberg Hospital has introduced an electronic gate-keeping system. Chemistry tests which generate the highest cost are subjected to this system and may be automatically rejected according to a set of rules. This study aimed: (1) to identify the number of chemistry tests rejected by the eGK; (2) to identify which of these rejected tests were subsequently restored and (3) to assess the impact of rejections on clinical outcome and cost-saving. A retrospective audit was conducted to determine the number of chemistry tests rejected and subsequently restored over a 6-month period. The case-notes of patients for whom requested tests previously rejected had been restored were randomly selected and investigated to assess clinical impact. Any cost-saving was calculated. A total of 68,480 tests were subjected to gate-keeping, and 4605 tests (6.7%) were rejected while 679 (14.7%) of these were restored by the requestor phoning the laboratory after obtaining authorisation. After examining a subset of clinical notes it was found that in most cases (80%), patient care was unaffected. The total cost saved was £ 25,387. The majority of the rejected tests were unnecessary and following rejection, real savings were made. Electronic gate-keeping is a simple, effective and sustainable method of demand management. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

A mixture gatekeeping procedure based on the Hommel test for clinical trial applications.

PubMed

Brechenmacher, Thomas; Xu, Jane; Dmitrienko, Alex; Tamhane, Ajit C

2011-07-01

When conducting clinical trials with hierarchically ordered objectives, it is essential to use multiplicity adjustment methods that control the familywise error rate in the strong sense while taking into account the logical relations among the null hypotheses. This paper proposes a gatekeeping procedure based on the Hommel (1988) test, which offers power advantages compared to other p value-based tests proposed in the literature. A general description of the procedure is given and details are presented on how it can be applied to complex clinical trial designs. Two clinical trial examples are given to illustrate the methodology developed in the paper.

Disrupting gatekeeping practices: Journalists’ source selection in times of crisis

PubMed Central

van der Meer, Toni G.L.A.; Verhoeven, Piet; Beentjes, Johannes W.J.; Vliegenthart, Rens

2016-01-01

As gatekeepers, journalists have the power to select the sources that get a voice in crisis coverage. The aim of this study is to find out how journalists select sources during a crisis. In a survey, journalists were asked how they assess the following sources during an organizational crisis: news agencies, an organization undergoing a crisis, and the general public. The sample consisted of 214 Dutch experienced journalists who at least once covered a crisis. Using structural equation modeling, sources’ likelihood of being included in the news was predicted using five source characteristics: credibility, knowledge, willingness, timeliness, and the relationship with the journalist. Findings indicated that during a crisis, news agencies are most likely to be included in the news, followed by the public, and finally the organization. The significance of the five source characteristics is dependent on source type. For example, to be used in the news, news agencies and organizations should be mainly evaluated as knowledgeable, whereas information from the public should be both credible and timely. In addition, organizations should not be seen as too willing or too eager to communicate. The findings imply that, during a crisis, journalists remain critical gatekeepers; however, they rely mainly on familiar sources. PMID:29278263

Entry one: striving for best practice in professional assessment.

PubMed

English, Justin M; Mykyta, Lu

2002-01-01

The aim of this study was to develop a best practice model of professional assessment to ensure efficient and effective delivery of home-based services to frail and disabled elders. In 2000, an innovative model of professional assessment was introduced by one of Australia's largest providers of home-based care in order to reduce multiple assessments and to reduce the utilisation of assessment as a gatekeeping tool for limiting access to services. Data was analysed from a random sample of 1500 clients drawn from a population of 5000 as well as through the use of a survey tool administered to the Organisation's assessment staff and other key stakeholders. Results revealed that, contrary to popular belief, carer advocacy plays a significant role in the professional assessment process to the point that clients with carers received significantly more services and service time that clients without such support. However, if not monitored, assessment can also be used as a gate-keeping tool as opposed to one that can provide significant benefits to the consumers through comprehensive need articulation. We argue that the "professional" approach does not preclude empowerment and that assessment should not be used as a gate-keeping tool.

Disrupting gatekeeping practices: Journalists' source selection in times of crisis.

PubMed

van der Meer, Toni G L A; Verhoeven, Piet; Beentjes, Johannes W J; Vliegenthart, Rens

2017-10-01

As gatekeepers, journalists have the power to select the sources that get a voice in crisis coverage. The aim of this study is to find out how journalists select sources during a crisis. In a survey, journalists were asked how they assess the following sources during an organizational crisis: news agencies, an organization undergoing a crisis, and the general public. The sample consisted of 214 Dutch experienced journalists who at least once covered a crisis. Using structural equation modeling, sources' likelihood of being included in the news was predicted using five source characteristics: credibility, knowledge, willingness, timeliness, and the relationship with the journalist. Findings indicated that during a crisis, news agencies are most likely to be included in the news, followed by the public, and finally the organization. The significance of the five source characteristics is dependent on source type. For example, to be used in the news, news agencies and organizations should be mainly evaluated as knowledgeable, whereas information from the public should be both credible and timely. In addition, organizations should not be seen as too willing or too eager to communicate. The findings imply that, during a crisis, journalists remain critical gatekeepers; however, they rely mainly on familiar sources.

Effects of a Program to Improve Mental Health Literacy for Married Immigrant Women in Korea.

PubMed

Choi, Yun-Jung

2017-08-01

This study aimed to develop and evaluate a mental health improvement program for the acculturative stress and mental health literacy of married immigrant women using bilingual gatekeepers. Bilingual gatekeepers were recruited from multicultural centers and trained to provide 8-week structured mental health improvement services to the women in the experimental group using a mental health improvement guidebook developed by the authors in 8 different languages. The program was effective in improving mental health and mental health literacy scores as well as reducing the degree of acculturative stress. This study offers a model of effective mental healthcare for multicultural communities. Copyright © 2017 Elsevier Inc. All rights reserved.

Does a gatekeeper suicide prevention program work in a school setting? Evaluating training outcome and moderators of effectiveness.

PubMed

Tompkins, Tanya L; Witt, Jody; Abraibesh, Nadia

2009-12-01

The current study sought to evaluate the suicide prevention gatekeeper training program QPR (Question, Persuade, and Refer) among school personnel using a non-equivalent control group design. Substantial gains were demonstrated from pre- to post-test for attitudes, knowledge, and beliefs regarding suicide and suicide prevention. Exploratory analyses revealed the possible moderating effects of age, professional role, prior training, and recent contact with suicidal youth on QPR participants' general knowledge, questioning, attitudes toward suicide and suicide prevention, QPR quiz scores, and self-efficacy. The need for replication using a more rigorous experimental design in the context of strong community collaboration is discussed.

Intimate Partner Violence, Maternal Gatekeeping, and Child Conduct Problems

PubMed Central

Zvara, Bharathi J.; Mills-Koonce, W. Roger; Cox, Martha

2017-01-01

We examined the mediating role of parenting behavior on the relationship between intimate partner violence and child conduct problems, as well as the moderating role of maternal gatekeeping to these associations. The sample (N = 395) is from a longitudinal study of rural poverty in the eastern United States, exploring the ways in which child, family, and contextual factors shape child development over time. Study findings indicate that a father’s harsh–intrusive parenting behavior may be a key mediating pathway linking intimate partner violence and child conduct problems. Study findings further provide evidence for problematic outcomes for children when mothers encourage fathers with high levels of harsh–intrusive parenting to interact with their children. PMID:28943690

The human tyrosine kinase Kit and its gatekeeper mutant T670I, show different kinetic properties: Implications for drug design.

PubMed

Kissova, Miroslava; Maga, Giovanni; Crespan, Emmanuele

2016-10-01

The tyrosine kinase Kit, a receptor for Stem Cell Factor, is involved, among others, in processes associated to cell survival, proliferation and migration. Upon physiological conditions, the activity of Kit is tightly regulated. However, primary mutations that lead to its constitutive activation are the causal oncogenic driver of gastrointestinal stromal tumours (GISTs). GISTs are known to be refractory to conventional therapies but the introduction of Imatinib, a selective inhibitor of tyrosine kinases Abl and Kit, significantly ameliorated the treatment options of GISTs patients. However, the acquisition of secondary mutations renders Kit resistant towards all available drugs. Mutation involving gatekeeper residues (such as V654a and T670I) influence both the structure and the catalytic activity of the enzyme. Therefore, detailed knowledge of the enzymatic properties of the mutant forms, in comparison with the wild type enzyme, is an important pre-requisite for the rational development of specific inhibitors. In this paper we report a thorough kinetic analysis of the reaction catalyzed by the Kit kinase and its gatekeeper mutated form T670I. Our results revealed the different mechanisms of action of these two enzymes and may open a new avenue for the future design of specific Kit inhibitors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effectiveness of adolescent suicide prevention e-learning modules that aim to improve knowledge and self-confidence of gatekeepers: study protocol for a randomized controlled trial.

PubMed

Ghoncheh, Rezvan; Kerkhof, Ad J F M; Koot, Hans M

2014-02-08

Providing e-learning modules can be an effective strategy for enhancing gatekeepers' knowledge, self-confidence and skills in adolescent suicide prevention. The aim of this study was to test the effectiveness of an online training program called Mental Health Online which consists of eight short e-learning modules, each capturing an important aspect of the process of recognition, guidance and referral of suicidal adolescents (12-20 years). The primary outcomes of this study are participant's ratings on perceived knowledge, perceived self-confidence, and actual knowledge regarding adolescent suicidality. A randomized controlled trial will be carried out among 154 gatekeepers. After completing the first assessment (pre-test), participants will be randomly assigned to either the experimental group or the waitlist control group. One week after completing the first assessment the experimental group will have access to the website Mental Health Online containing the eight e-learning modules and additional information on adolescent suicide prevention. Participants in both conditions will be assessed 4 weeks after completing the first assessment (post-test), and 12 weeks after completing the post-test (follow-up). At post-test, participants from the experimental group are asked to complete an evaluation questionnaire on the modules. The waitlist control group will have access to the modules and additional information on the website after completing the follow-up assessment. Gatekeepers can benefit from e-learning modules on adolescent suicide prevention. This approach allows them to learn about this sensitive subject at their own pace and from any given location, as long as they have access to the Internet. Given the flexible nature of the program, each participant can compose his/her own training creating an instant customized course with the required steps in adolescent suicide prevention. Netherlands Trial Register NTR3625.

Polydopamine-like Coatings as Payload Gatekeepers for Mesoporous Silica Nanoparticles.

PubMed

Moreno-Villaécija, Miguel-Ángel; Sedó-Vegara, Josep; Guisasola, Eduardo; Baeza, Alejandro; Regí, María Vallet; Nador, Fabiana; Ruiz-Molina, Daniel

2018-03-07

We report the use of bis-catecholic polymers as candidates for obtaining effective, tunable gatekeeping coatings for mesoporous silica nanoparticles (MSNs) intended for drug release applications. In monomers, catechol rings act as adhesive moieties and reactive sites for polymerization, together with middle linkers which may be chosen to tune the physicochemical properties of the resulting coating. Stable and low-toxicity coatings (pNDGA and pBHZ) were prepared from two bis-catechols of different polarity (NDGA and BHZ) on MSN carriers previously loaded with rhodamine B (RhB) as a model payload, by means of a previously reported synthetic methodology and without any previous surface modification. Coating robustness and payload content were shown to depend significantly on the workup protocol. The release profiles in a model physiological PBS buffer of coated systems (RhB@MSN@pNDGA and RhB@MSN@pBHZ) showed marked differences in the "gatekeeping" behavior of each coating, which correlated qualitatively with the chemical nature of their respective linker moieties. While the uncoated system (RhB@MSN) lost its payload almost completely after 2 days, release from RhB@MSN@pNDGA was virtually negligible, likely due to the low polarity of the parent bis-catechol (NDGA). As opposed to these extremes, RhB@MSN@pBHZ presented the most promising behavior, showing an intermediate release of 50% of the payload in the same period of time.

Joint marketing as a framework for targeting men who have sex with men in China: a pilot intervention study.

PubMed

Tan, Jingguang; Cai, Rui; Lu, Zuxun; Cheng, Jinquan; de Vlas, Sake J; Richardus, Jan Hendrik

2013-04-01

To apply the joint marketing principle as a new intervention approach for targeting men who have sex with men (MSM) who are often difficult to reach in societies with discrimination towards homosexuality and HIV/AIDS. A pilot intervention according to the principles of joint marketing was carried out by the CDC in Shenzhen, China, in MSM social venues. A self-designed questionnaire of HIV knowledge, condom use, and access to HIV-related services was used before and after the pilot intervention to evaluate its effectiveness. The CDC supported gatekeepers of MSM social venues in running their business and thereby increasing their respectability and income. In return, the gatekeepers cooperated with the CDC in reaching the MSM at the venues with health promotion messages and materials. Thus a win-win situation was created, bringing together two noncompetitive parties in reaching out to a shared customer, the MSM. The pilot intervention succeeded in demonstrating acceptability and feasibility of the joint marketing approach targeting MSM. HIV knowledge, the rate of condom use, and access to HIV-related services of participants in the pilot intervention increased significantly. The joint marketing intervention is an innovative way to create synergies between the gatekeepers of MSM social venues and public health officials for reaching and potentially changing HIV high-risk behaviors among MSM.

Druggists and pharmacists as gatekeepers: sales routines and compliance with sales protocols for over-the-counter naproxen 275 mg medicines in the Netherlands.

PubMed

van Hoof, Joris J; Cents, Michel H G; Megens, Nicole M J; van der Tang, Sijbrand J

2014-09-01

Since for the sales of over-the-counter (OTC) medicines, prescribing physicians are not involved, and written instructions on/in the medicine boxes are inefficient, druggists and pharmacists are important gatekeepers in preventing customers' accidents. In this study we investigated the sales routines, and compliance with sales protocols, in order to evaluate that gatekeeper's function. By means of the mystery shopping method, 228 pharmacies and drugstores in The Netherlands were visited and a naproxen 275mg medium-risk medicine was requested for a (fictitious) patient who was suffering from severe back pains. According to the sales protocols the vendors should never sell the requested medicine, because the mystery shoppers only gave an answer to one of the four mandatory sales protocol questions. Furthermore, the requested medicine is not the right or best choice for back pains. Four different scenarios were used in a 2×2 design (8-year-old patient vs. 25-year-old patient, and 1 box with 12 pills vs. 3 boxes with 12 pills). Of the drugstores and pharmacies only 16.7% complied with the sales protocols and did not sell the specific (or comparable) medicine, after asking all four mandatory questions (or already after one, two or three questions). Most vendors (83.3%) did not comply and sold the requested medicine, a comparable medicine, or even a more risky medicine after no question at all (or after asking some or even all four questions). Although both score low, pharmacists show better compliance (23.9%) than druggists (10.1%). When it comes to OTC medicines, druggists and pharmacists largely commit sloppy sales. The expected gatekeeping function of pharmacists and druggists is very limited, and customers might be in danger of inappropriate medicine selection, quantity and usage. We call for thorough evaluation of the over-the-counter system, improvement of the educational programs for medicine providers, and national campaigns to inform the public. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A clinical case-based hypothesis: secretory IgA operates as an electronic transistor controlling the selection or rejection of molecules in the absorption process in the lumen of gastrointestinal tract

PubMed Central

Zamm, Alfred V

2013-01-01

There is a clinical correlation between (1) an allergic patient’s ability to resist the development of symptoms that would have resulted from an allergenic challenge, (2) the magnitude of geomagnetism at a geographic site, and (3) the amount of solar energy falling on that site. It is suggested that the digestive membrane has an electronic gatekeeper that “decides” electronically which molecules to allow or not allow to pass on to the absorptive surface. The unique bipolar structure of secretory immunoglobulin A (IgA), having a central secretory piece and the resultant unique electronic function of this polarized molecule, allows it to function as an electronic transistor, producing an electronic gatekeeper in the form of an electronic sieve. PMID:24068871

A clinical case-based hypothesis: secretory IgA operates as an electronic transistor controlling the selection or rejection of molecules in the absorption process in the lumen of gastrointestinal tract.

PubMed

Zamm, Alfred V

2013-01-01

There is a clinical correlation between (1) an allergic patient's ability to resist the development of symptoms that would have resulted from an allergenic challenge, (2) the magnitude of geomagnetism at a geographic site, and (3) the amount of solar energy falling on that site. It is suggested that the digestive membrane has an electronic gatekeeper that "decides" electronically which molecules to allow or not allow to pass on to the absorptive surface. The unique bipolar structure of secretory immunoglobulin A (IgA), having a central secretory piece and the resultant unique electronic function of this polarized molecule, allows it to function as an electronic transistor, producing an electronic gatekeeper in the form of an electronic sieve.

Discovery of 5-(arenethynyl) hetero-monocyclic derivatives as potent inhibitors of BCR-ABL including the T315I gatekeeper mutant.

PubMed

Thomas, Mathew; Huang, Wei-Sheng; Wen, David; Zhu, Xiaotian; Wang, Yihan; Metcalf, Chester A; Liu, Shuangying; Chen, Ingrid; Romero, Jan; Zou, Dong; Sundaramoorthi, Raji; Li, Feng; Qi, Jiwei; Cai, Lisi; Zhou, Tianjun; Commodore, Lois; Xu, Qihong; Keats, Jeff; Wang, Frank; Wardwell, Scott; Ning, Yaoyu; Snodgrass, Joseph T; Broudy, Marc I; Russian, Karin; Iuliucci, John; Rivera, Victor M; Sawyer, Tomi K; Dalgarno, David C; Clackson, Tim; Shakespeare, William C

2011-06-15

Ponatinib (AP24534) was previously identified as a pan-BCR-ABL inhibitor that potently inhibits the T315I gatekeeper mutant, and has advanced into clinical development for the treatment of refractory or resistant CML. In this study, we explored a novel series of five and six membered monocycles as alternate hinge-binding templates to replace the 6,5-fused imidazopyridazine core of ponatinib. Like ponatinib, these monocycles are tethered to pendant toluanilides via an ethynyl linker. Several compounds in this series displayed excellent in vitro potency against both native BCR-ABL and the T315I mutant. Notably, a subset of inhibitors exhibited desirable PK and were orally active in a mouse model of T315I-driven CML. Copyright © 2011 Elsevier Ltd. All rights reserved.

Rationally engineered flavin-dependent oxidase reveals steric control of dioxygen reduction.

PubMed

Zafred, Domen; Steiner, Barbara; Teufelberger, Andrea R; Hromic, Altijana; Karplus, P Andrew; Schofield, Christopher J; Wallner, Silvia; Macheroux, Peter

2015-08-01

The ability of flavoenzymes to reduce dioxygen varies greatly, and is controlled by the protein environment, which may cause either a rapid reaction (oxidases) or a sluggish reaction (dehydrogenases). Previously, a 'gatekeeper' amino acid residue was identified that controls the reactivity to dioxygen in proteins from the vanillyl alcohol oxidase superfamily of flavoenzymes. We have identified an alternative gatekeeper residue that similarly controls dioxygen reactivity in the grass pollen allergen Phl p 4, a member of this superfamily that has glucose dehydrogenase activity and the highest redox potential measured in a flavoenzyme. A substitution at the alternative gatekeeper site (I153V) transformed the enzyme into an efficient oxidase by increasing dioxygen reactivity by a factor of 60,000. An inverse exchange (V169I) in the structurally related berberine bridge enzyme (BBE) decreased its dioxygen reactivity by a factor of 500. Structural and biochemical characterization of these and additional variants showed that our model enzymes possess a cavity that binds an anion and resembles the 'oxyanion hole' in the proximity of the flavin ring. We showed also that steric control of access to this site is the most important parameter affecting dioxygen reactivity in BBE-like enzymes. Analysis of flavin-dependent oxidases from other superfamilies revealed similar structural features, suggesting that dioxygen reactivity may be governed by a common mechanistic principle. Structural data are available in PDB database under the accession numbers 4PVE, 4PVH, 4PVJ, 4PVK, 4PWB, 4PWC and 4PZF. © 2015 FEBS.

Direct Substrate Identification with an Analog Sensitive (AS) Viral Cyclin-Dependent Kinase (v-Cdk).

PubMed

Umaña, Angie C; Iwahori, Satoko; Kalejta, Robert F

2018-01-19

Viral cyclin-dependent kinases (v-Cdks) functionally emulate their cellular Cdk counterparts. Such viral mimicry is an established phenomenon that we extend here through chemical genetics. Kinases contain gatekeeper residues that limit the size of molecules that can be accommodated within the enzyme active site. Mutating gatekeeper residues to smaller amino acids allows larger molecules access to the active site. Such mutants can utilize bio-orthoganol ATPs for phosphate transfer and are inhibited by compounds ineffective against the wild type protein, and thus are referred to as analog-sensitive (AS) kinases. We identified the gatekeeper residues of the v-Cdks encoded by Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) and mutated them to generate AS kinases. The AS-v-Cdks are functional and utilize different ATP derivatives with a specificity closely matching their cellular ortholog, AS-Cdk2. The AS derivative of the EBV v-Cdk was used to transfer a thiolated phosphate group to targeted proteins which were then purified through covalent capture and identified by mass spectrometry. Pathway analysis of these newly identified direct substrates of the EBV v-Cdk extends the potential influence of this kinase into all stages of gene expression (transcription, splicing, mRNA export, and translation). Our work demonstrates the biochemical similarity of the cellular and viral Cdks, as well as the utility of AS v-Cdks for substrate identification to increase our understanding of both viral infections and Cdk biology.

The Importance of a Gatekeeper Residue on the Aggregation of Transthyretin

PubMed Central

Sant'Anna, Ricardo; Braga, Carolina; Varejão, Nathalia; Pimenta, Karinne M.; Graña-Montes, Ricardo; Alves, Aline; Cortines, Juliana; Cordeiro, Yraima; Ventura, Salvador; Foguel, Debora

2014-01-01

Protein aggregation into β-sheet-enriched amyloid fibrils is associated with an increasing number of human disorders. The adoption of such amyloid conformations seems to constitute a generic property of polypeptide chains. Therefore, during evolution, proteins have adopted negative design strategies to diminish their intrinsic propensity to aggregate, including enrichment of gatekeeper charged residues at the flanks of hydrophobic aggregation-prone segments. Wild type transthyretin (TTR) is responsible for senile systemic amyloidosis, and more than 100 mutations in the TTR gene are involved in familial amyloid polyneuropathy. The TTR 26–57 segment bears many of these aggressive amyloidogenic mutations as well as the binding site for heparin. We demonstrate here that Lys-35 acts as a gatekeeper residue in TTR, strongly decreasing its amyloidogenic potential. This protective effect is sequence-specific because Lys-48 does not affect TTR aggregation. Lys-35 is part of the TTR basic heparin-binding motif. This glycosaminoglycan blocks the protective effect of Lys-35, probably by neutralization of its side chain positive charge. A K35L mutation emulates this effect and results in the rapid self-assembly of the TTR 26–57 region into amyloid fibrils. This mutation does not affect the tetrameric protein stability, but it strongly increases its aggregation propensity. Overall, we illustrate how TTR is yet another amyloidogenic protein exploiting negative design to prevent its massive aggregation, and we show how blockage of conserved protective features by endogenous factors or mutations might result in increased disease susceptibility. PMID:25086037

Absorptive capacity as a guiding concept for effective public sector management and conservation of freshwater ecosystems.

PubMed

Murray, K; Roux, D J; Nel, J L; Driver, A; Freimund, W

2011-05-01

The ability of an organisation to recognise the value of new external information, acquire it, assimilate it, transform, and exploit it, namely its absorptive capacity (AC), has been much researched in the context of commercial organisations and even applied to national innovation. This paper considers four key AC-related concepts and their relevance to public sector organisations with mandates to manage and conserve freshwater ecosystems for the common good. The concepts are the importance of in-house prior related knowledge, the importance of informal knowledge transfer, the need for motivation and intensity of effort, and the importance of gatekeepers. These concepts are used to synthesise guidance for a way forward in respect of such freshwater management and conservation, using the imminent release of a specific scientific conservation planning and management tool in South Africa as a case study. The tool comprises a comprehensive series of maps that depict national freshwater ecosystem priority areas for South Africa. Insights for implementing agencies relate to maintaining an internal science, rather than research capacity; making unpublished and especially tacit knowledge available through informal knowledge transfer; not underestimating the importance of intensity of effort required to create AC, driven by focussed motivation; and the potential use of a gatekeeper at national level (external to the implementing organisations), possibly playing a more general 'bridging' role, and multiple internal (organisational) gatekeepers playing the more limited role of 'knowledge translators'. The role of AC as a unifying framework is also proposed.

The role of primary care physicians in the Israel Defense Forces: a self-perception study.

PubMed

Zimlichman, Eyal; Mandel, Dror; Mimouni, Francis B; Vinker, Shlomo; Kochba, Ilan; Kreiss, Yitshak; Lahad, Amnon

2005-03-01

The health system of the medical corps of the Israel Defense Force is based primarily upon primary healthcare. In recent years, health management organizations have considered the primary care physician responsible for assessing the overall health needs of the patient and, accordingly, introduced the term "gatekeeper." To describe and analyze how PCPs in the IDF view their roles as primary care providers and to characterize how they perceive the quality of the medical care that they provide. We conducted a survey using a questionnaire that was mailed or faxed to a representative sample of PCPs. The questionnaire included demographic background, professional background, statements on self-perception issues, and ranking of roles as a PCP in the IDF. Statements concerning commitment to the patient were ranked higher than statements concerning commitment to the military organization. Most physicians perceive the quality of the medical care service that they provide as high; they also stated that they do not receive adequate continuous medical education. Our survey shows that PCPs in the IDF, like civilian family physicians, perceive their primary obligation as serving the needs of their patients but are yet to take on the full role of "gatekeepers" in the IDF's healthcare system. We conclude that the Medical Corps should implement appropriate steps to ensure that PCPs are prepared to take on a more prominent role as "gatekeepers" and providers of high quality primary medical care.

Paradigms, Exemplars and Social Change

ERIC Educational Resources Information Center

Lawson, Hal A.

2009-01-01

Researchers' social-cultural organization influences the scope, quality, quantity, coherence, dissemination, utilization and impact of research-based, theoretically sound knowledge. Five concepts--paradigm, exemplar, segment, network and gatekeeper--are salient to research on researchers' organization. Autobiographical reflections signal these…

Bioethics and its gatekeepers: does institutional racism exist in leading bioethics journals?

PubMed

Chattopadhyay, Subrata; Myser, Catherine; De Vries, Raymond

2013-03-01

Who are the gatekeepers in bioethics? Does editorial bias or institutional racism exist in leading bioethics journals? We analyzed the composition of the editorial boards of 14 leading bioethics journals by country. Categorizing these countries according to their Human Development Index (HDI), we discovered that approximately 95 percent of editorial board members are based in (very) high-HDI countries, less than 4 percent are from medium-HDI countries, and fewer than 1.5 percent are from low-HDI countries. Eight out of 14 leading bioethics journals have no editorial board members from a medium- or low-HDI country. Eleven bioethics journals have no board members from low-HDI countries. This severe underrepresentation of bioethics scholars from developing countries on editorial boards suggests that bioethics may be affected by institutional racism, raising significant questions about the ethics of bioethics in a global context.

Engaging Gatekeepers, Optimizing Decision Making, and Mitigating Bias: Design Specifications for Systemic Diversity Interventions.

PubMed

Vinkenburg, Claartje J

2017-06-01

In this contribution to the Journal of Applied Behavioral Science Special Issue on Understanding Diversity Dynamics in Systems: Social Equality as an Organization Change Issue, I develop and describe design specifications for systemic diversity interventions in upward mobility career systems, aimed at optimizing decision making through mitigating bias by engaging gatekeepers. These interventions address the paradox of meritocracy that underlies the surprising lack of diversity at the top of the career pyramid in these systems. I ground the design specifications in the limited empirical evidence on "what works" in systemic interventions. Specifically, I describe examples from interventions in academic settings, including a bias literacy program, participatory modeling, and participant observation. The design specifications, paired with inspirational examples of successful interventions, should assist diversity officers and consultants in designing and implementing interventions to promote the advancement to and representation of nondominant group members at the top of the organizational hierarchy.

Engaging Gatekeepers, Optimizing Decision Making, and Mitigating Bias: Design Specifications for Systemic Diversity Interventions

PubMed Central

Vinkenburg, Claartje J.

2017-01-01

In this contribution to the Journal of Applied Behavioral Science Special Issue on Understanding Diversity Dynamics in Systems: Social Equality as an Organization Change Issue, I develop and describe design specifications for systemic diversity interventions in upward mobility career systems, aimed at optimizing decision making through mitigating bias by engaging gatekeepers. These interventions address the paradox of meritocracy that underlies the surprising lack of diversity at the top of the career pyramid in these systems. I ground the design specifications in the limited empirical evidence on “what works” in systemic interventions. Specifically, I describe examples from interventions in academic settings, including a bias literacy program, participatory modeling, and participant observation. The design specifications, paired with inspirational examples of successful interventions, should assist diversity officers and consultants in designing and implementing interventions to promote the advancement to and representation of nondominant group members at the top of the organizational hierarchy. PMID:28546644

Noninvasive remote-controlled release of drug molecules in vitro using magnetic actuation of mechanized nanoparticles.

PubMed

Thomas, Courtney R; Ferris, Daniel P; Lee, Jae-Hyun; Choi, Eunjoo; Cho, Mi Hyeon; Kim, Eun Sook; Stoddart, J Fraser; Shin, Jeon-Soo; Cheon, Jinwoo; Zink, Jeffrey I

2010-08-11

Mesoporous silica nanoparticles are useful nanomaterials that have demonstrated the ability to contain and release cargos with mediation by gatekeepers. Magnetic nanocrystals have the ability to exhibit hyperthermic effects when placed in an oscillating magnetic field. In a system combining these two materials and a thermally sensitive gatekeeper, a unique drug delivery system can be produced. A novel material that incorporates zinc-doped iron oxide nanocrystals within a mesoporous silica framework that has been surface-modified with pseudorotaxanes is described. Upon application of an AC magnetic field, the nanocrystals generate local internal heating, causing the molecular machines to disassemble and allowing the cargos (drugs) to be released. When breast cancer cells (MDA-MB-231) were treated with doxorubicin-loaded particles and exposed to an AC field, cell death occurred. This material promises to be a noninvasive, externally controlled drug delivery system with cancer-killing properties.

Body integrity identity disorder beyond amputation: consent and liberty.

PubMed

White, Amy

2014-09-01

In this article, I argue that persons suffering from Body Integrity Identity Disorder (BIID) can give informed consent to surgical measures designed to treat this disorder. This is true even if the surgery seems radical or irrational to most people. The decision to have surgery made by a BIID patient is not necessarily coerced, incompetent or uninformed. If surgery for BIID is offered, there should certainly be a screening process in place to insure informed consent. It is beyond the scope of this work, however, to define all the conditions that should be placed on the availability of surgery. However, I argue, given the similarities between BIID and gender dysphoria and the success of such gatekeeping measures for the surgical treatment of gender dysphoria, it is reasonable that similar conditions be in place for BIID. Once other treatment options are tried and gatekeeping measures satisfied, A BIID patient can give informed consent to radical surgery.

Gatekeepers' perceptions of the quality and availability of services for breast and cervical cancer patients in the English-speaking Windward Islands: an exploratory investigation.

PubMed

Thomas-Purcell, Kamilah B; Tarver, Will L; Richards, Christine; Primus-Joseph, Marva

2017-11-01

Although extensive screening services for breast and cervical cancers are available in the Caribbean, these cancers continue to be the leading causes of cancer death among women in this region. The purpose of this study was to determine the quality and availability of breast and cervical cancer treatment care and support services from the perspective of the gatekeepers who provide care for the patients in the Windward Islands of Dominica, Grenada, St Lucia, and St. Vincent. A qualitative research design using semi-structured, in-depth interviews was used to gather data from gatekeepers who provided oncology prevention and care services to patients for at least one year. Data were collected on availability and quality of cancer care and treatment services and coded using the themes obtained via thematic analysis of the data. Twenty-three current providers participated in the study (Dominica, 5; Grenada, 7; St. Lucia, 5; St. Vincent and the Grenadines, 6). The participants' years of work experience ranged from 2 to 45 years. The codes encompassed a range of social ecological factors that influence breast and cervical cancer screening and treatment in the Windward Islands. The emergent themes were availability of resources, cost of care, and social support. The findings of this study emphasize the varying social determinants of health that affect breast and cervical cancer prevention and treatment. It also highlights the disparities in availability of treatment within the wider Caribbean. It is necessary to broaden the perspective on health from a purely biomedical paradigm to a social perspective.

Is the role as gatekeeper still feasible? A survey among Dutch general practitioners.

PubMed

Wammes, Joost Johan Godert; Jeurissen, Patrick Paulus Theodoor; Verhoef, Lise Maria; Assendelft, Willem J J; Westert, Gert P; Faber, Marjan J

2014-10-01

In the 2012 International Health Policy Survey by the Commonwealth Fund, 57% of Dutch GPs indicated that Dutch patients receive too much health care. This is an unexpected finding, given the clear gatekeeper role of Dutch GPs and recent efforts strengthening this role. The study aims to explore where perceived overuse of care prevails and to identify factors associated with too much care at the entry point of Dutch health care. An American survey exploring perceptions of the amount of care among primary care providers was modified for relevance to the Dutch health system. We further included additional factors possibly related to overuse based on 12 interviews with Dutch GPs. The survey was sent to a random sample of 600 GPs. Dutch GPs (N = 157; response rate 26.2%) indicated that patients receive (much) too much care in general hospitals, primary care, GP cooperatives as well as private clinics. The Dutch responding GPs showed a relatively demand-satisfying attitude, which contributed to the delivery of too much care, often leading to deviation from guidelines and professional norms. The increasing availability of diagnostic facilities was identified as an additional factor contributing to the provision of unnecessary care. Finally, funding gaps between primary care and hospitals impede cooperation and coordination, provoking unnecessary care. Our results--most notably regarding the demand-satisfying attitude of responding GPs--call into question the classical view of the guidance and gatekeeper role of GPs in the Dutch health care system. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Diffusion of Educational Knowledge Through Journals: Gatekeepers' Selection Criteria

ERIC Educational Resources Information Center

Silverman, Robert J.

1978-01-01

Report is made of a survey of 248 editors representing scholarly, professional, association, and research journals in regard to their editorial role, criteria for accepting or rejecting manuscripts, and selection of editorial boards and reviewers. (Author/MJB)

Connecting with the CEO.

ERIC Educational Resources Information Center

Dolbert, Susan Clouse

2002-01-01

Describes the roles played by college presidents in alumni relations, including campus beacon, institution tactician, alumni relations advocate, and campus connector. Discusses the responsibilities of alumni relations executives toward college presidents, including as a channel to alumni, presidential gatekeeper, and "outsider." Includes…

How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes.

PubMed

Harris, Michael; Frey, Peter; Esteva, Magdalena; Gašparović Babić, Svjetlana; Marzo-Castillejo, Mercè; Petek, Davorina; Petek Ster, Marija; Thulesius, Hans

2017-03-01

European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. A total of 14 countries. Consensus groups of PCPs. Probability of initial presentation to a PCP for four clinical vignettes. There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r  = -0.16, 95% CI -0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = -0.57, 95% CI -0.83 to -0.12; ovary: r = -0.13, 95% CI -0.57 to 0.38; breast r = 0.14, 95% CI -0.36 to 0.58; bowel: r = 0.20, 95% CI -0.31 to 0.62). There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a "PCP-as-gatekeeper" system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival. KEY POINTS European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.

Engaging Gatekeeper-Stakeholders in Development of a Mobile Health Intervention to Improve Medication Adherence Among African American and Pacific Islander Elderly Patients With Hypertension

PubMed Central

Bazargan, Mohsen; Jones, Loretta; Vawer, May; Seto, Todd B; Farooq, Summer; Taira, Deborah A

2016-01-01

Background Approximately 70 million people in the United States have hypertension. Although antihypertensive therapy can reduce the morbidity and mortality associated with hypertension, often patients do not take their medication as prescribed. Objective The goal of this study was to better understand issues affecting the acceptability and usability of mobile health technology (mHealth) to improve medication adherence for elderly African American and Native Hawaiian and Pacific Islander patients with hypertension. Methods In-depth interviews were conducted with 20 gatekeeper-stakeholders using targeted open-ended questions. Interviews were deidentified, transcribed, organized, and coded manually by two independent coders. Analysis of patient interviews used largely a deductive approach because the targeted open-ended interview questions were designed to explore issues specific to the design and acceptability of a mHealth intervention for seniors. Results A number of similar themes regarding elements of a successful intervention emerged from our two groups of African American and Native Hawaiian and Pacific Islander gatekeeper-stakeholders. First was the need to teach participants both about the importance of adherence to antihypertensive medications. Second, was the use of mobile phones for messaging and patients need to be able to access ongoing technical support. Third, messaging needs to be short and simple, but personalized, and to come from someone the participant trusts and with whom they have a connection. There were some differences between groups. For instance, there was a strong sentiment among the African American group that the church be involved and that the intervention begin with group workshops, whereas the Native Hawaiian and Pacific Islander group seemed to believe that the teaching could occur on a one-to-one basis with the health care provider. Conclusions Information from our gatekeeper-stakeholder (key informant) interviews suggests that the design of a mHealth intervention to improve adherence to antihypertensives among the elderly could be very similar for African Americans and Native Hawaiian and Pacific Islanders. The main difference might be in the way in which the program is initiated (possibly through church-based workshops for African Americans and by individual providers for Native Hawaiian and Pacific Islanders). Another difference might be who sends the messages with African Americans wanting someone outside the health care system, but Native Hawaiian and Pacific Islanders preferring a provider. PMID:27784651

[After the Great East Japan Earthquake : suicide prevention and a gatekeeper program].

PubMed

Otsuka, Kotaro; Sakai, Akio; Nakamura, Hikaru; Akahira, Mitsuko

2014-01-01

When considering approaches to mental health in areas affected by the 2011 Great East Japan Earthquake, as well as the resulting tsunami and Fukushima nuclear power plant accident, it is not sufficient to focus interventions solely on individuals experiencing mental health issues. The situation demands a comprehensive approach that includes programs that target improvements to mental health literacy among residents in areas affected by the disaster, the rebuilding of relationships between residents themselves, collaboration with recovery and support activities, and mental health support for people participating in recovery and support efforts. From a medium- to long-term perspective, suicide prevention is an important issue. Comprehensive suicide prevention efforts are being promoted in areas of Iwate Prefecture affected by the disaster. In suicide prevention programs, it is crucial to foster the development of human resources in the local community. In order to expand community supports, it is necessary to provide education on ways of supporting those affected by a disaster to local medical personnel, people staffing inquiry and consultation offices, and people in fields related to mental health. Suicide prevention and disaster relief efforts are both approaches that target people in difficulty, and they share commonalities in principles, systems, and approaches to human resource development. "Mental health first aid" is a program developed in Australia that defines methods of early intervention by non-professionals who encounter someone experiencing a mental health problem. The mental health first aid-based gatekeeper training program of the Japanese government's Cabinet Office, which the author's research team helped to develop, allows participants to obtain the knowledge and skills required of gatekeepers. In 2012, a module for disaster-affected areas was developed and added to the program, with additional content that provides program participants with the skills to respond in crisis situations encountered during advice/counseling work in evacuation centers and temporary housing facilities. In addition, since 2011 the Cabinet Office has offered a facilitator training program that was developed based on the gatekeeper training program. Program text materials may be downloaded from the Web site of the Cabinet Office, and it is hoped that they will be used in the education of those involved in caring for people affected by a disaster.

76 FR 79379 - Risk-Based Capital Guidelines: Market Risk; Alternatives to Credit Ratings for Debt and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-21

... play a critical ``gatekeeper'' role in the debt markets and perform evaluative and analytical services... assessments for fee-paying clients, nor does it provide the sort of evaluative and analytical services as...

Struggles of the Novice Counselor and Therapists.

ERIC Educational Resources Information Center

Skovholt, Thomas M.; Ronnestad, Michael H.

2003-01-01

Review of theory and research on counselor/therapist development identified seven stressors of novice practitioners, catalyzed by the ambiguity of professional work. Sources of stress include acute performance anxiety, scrutiny of professional gatekeepers, porous or rigid emotional boundaries, fragile and incomplete practitioner identity,…

Moving beyond the Typologies of Managed Care: The Example of Health Plan Predictors of Screening Mammography

PubMed Central

Tye, Sherilyn; Phillips, Kathryn A; Liang, Su-Ying; Haas, Jennifer S

2004-01-01

Objectives To develop a framework of factors to characterize health plans, to identify how plan characteristics were measured in a national survey, and to apply our findings to an analysis of the predictors of screening mammography. Data Source The primary data were from the 1996 Medical Expenditure Panel Survey. Study Design Women ages 40+, with private insurance, and no history of breast cancer were included in the study (N=2,909). We used multivariate logistic regression to estimate mammography utilization in the past two years relative to health plan and demographic factors. Health plan measures included whether there is a defined provider network, whether coverage is restricted to a network, use of gatekeepers, level of cost containment, copayment and deductible amounts, coinsurance rate, and breadth of benefit coverage. Principal Findings We found no significant difference in reported mammography utilization using a dichotomous comparison of individuals enrolled in managed care versus indemnity plans. However, women in health plans with a defined provider network were more likely to report having received a mammogram in the past two years than those without networks (adjusted OR=1.21, 95 percent CI=1.07–1.36), and women in gatekeeper plans were more likely to report receiving mammography than those without gatekeepers (adjusted OR=1.18, 95 percent CI=1.03–1.36). Restricted out-of-network coverage, use of cost containment, enrollee cost sharing, and breadth of benefit coverage did not appear to affect mammography use. Conclusions It is important to examine the effect of individual health plan components on the utilization of health care, rather than use the traditional broader categorizations of managed versus nonmanaged care or simple health plan typologies. PMID:14965083

A Worked Example for Creating Worked Examples

ERIC Educational Resources Information Center

McGinn, Kelly M.; Lange, Karin E.; Booth, Julie L.

2015-01-01

Researchers have extensively documented, and math teachers know from experience, that algebra is a "gatekeeper" to more advanced mathematical topics. Students must have a strong understanding of fundamental algebraic concepts to be successful in later mathematics courses. Unfortunately, algebraic misconceptions that students may form or…

The Moral Education of Journal Editors

ERIC Educational Resources Information Center

Krimsky, Sheldon

2010-01-01

Refereed journals in science and medicine are the gatekeepers and repositories of knowledge in their respective fields. Research reported in peer-reviewed journals builds professional careers, determines which drugs and medical devices are licensed, influences what medical treatments become standards of care, and establishes the veracity of…

A Randomized Control Trial of a Community Mental Health Intervention for Military Personnel

DTIC Science & Technology

2013-10-01

reporting period. 15. SUBJECT TERMS Mental health literacy , Mental Health First Aid (MHFA), curriculum adaptation 16. SECURITY CLASSIFICATION OF...Stress First Aid and suicide prevention gatekeeper training by providing a mental health literacy component that is currently not addressed

Open Education as a "Heterotopia of Desire"

ERIC Educational Resources Information Center

Gourlay, Lesley

2015-01-01

The movement towards "openness" in education has tended to position itself as inherently democratising, radical, egalitarian and critical of powerful gatekeepers to learning. While "openness" is often positioned as a critique, I will argue that its mainstream discourses--while appearing to oppose large-scale operations of…

Administrative gatekeeping - a third way between unrestricted patient advocacy and bedside rationing.

PubMed

Lauridsen, Sigurd

2009-06-01

The inevitable need for rationing of healthcare has apparently presented the medical profession with the dilemma of choosing the lesser of two evils. Physicians appear to be obliged to adopt either an implausible version of traditional professional ethics or an equally problematic ethics of bedside rationing. The former requires unrestricted advocacy of patients but prompts distrust, moral hazard and unfairness. The latter commits physicians to rationing at the bedside; but it is bound to introduce unfair inequalities among patients and lack of political accountability towards citizens. In this paper I shall argue that this dilemma is false, since a third intermediate alternative exists. This alternative, which I term 'administrative gatekeeping', makes it possible for physicians to be involved in rationing while at the same time being genuine advocates of their patients. According to this ideal, physicians are required to follow fair rules of rationing adopted at higher organizational levels within healthcare systems. At the same time, however, they are prohibited from including considerations of cost in their clinical decisions.

“Enjoy Your Sexuality, but Do it in Secret”: Exploring Undergraduate Women’s Reports of Friends’ Sexual Communications

PubMed Central

Trinh, Sarah L.

2015-01-01

In the current study I used mixed methods to explore the messages that undergraduate women (n = 415) reported receiving from their male and female friends regarding sex and romantic relationships. Reports of friends’ messages varied widely and entailed both support for and criticism of sexual gatekeeping and sex positivity (e.g., sexual agency) and advice regarding sex and romantic relationships. Four individuals, including the author, developed codes to examine this wide range of responses to sexual expectations and prohibitions and independently and reliably coded the data. Response patterns illustrate that reports of female friends’ messages were typically longer and more nuanced than reports of male friends’ messages. Sex-positive messages and sexual gatekeeping messages were frequently reported simultaneously, and this pattern of co-occurrence illustrates the tensions between diverse discourses regarding women’s sexuality. The diversity in reports of friends’ messages challenges popular notions that friends’ influences are wholly problematic and highlights a need for more gender-focused sex education curricula. PMID:27092014

Defining and Negotiating the Social Value of Research in Public Health Facilities: Perceptions of Stakeholders in a Research-Active Province of South Africa.

PubMed

Lutge, Elizabeth; Slack, Catherine; Wassenaar, Douglas

2017-02-01

This article reports on qualitative research conducted in KwaZulu-Natal, South Africa, among researchers and gate-keepers of health facilities in the province. Results suggest disparate but not irreconcilable perceptions of the social value of research in provincial health facilities. This study found that researchers tended to emphasize the contribution of research to the generation of knowledge and to the health of future patients while gate-keepers of health facilities tended to emphasize its contribution to the healthcare system and to current patients. Furthermore, relations between research stakeholders were perceived to be somewhat fragile, making it difficult for stakeholders to achieve consensus about the social value of research, as well as on ways to maximize value. Interventions to negotiate a shared perspective on the social value of research would appear to be warranted, and the findings of this study suggest some focus areas for such intervention. © 2017 John Wiley & Sons Ltd.

Positive Feedback From Male Authority Figures Boosts Women's Math Outcomes.

PubMed

Park, Lora E; Kondrak, Cheryl L; Ward, Deborah E; Streamer, Lindsey

2018-03-01

People often search for cues in the environment to determine whether or not they will be judged or treated negatively based on their social identities. Accordingly, feedback from gatekeepers-members of majority groups who hold authority and power in a field-may be an especially important cue for those at risk of experiencing social identity threat, such as women in math settings. Across a series of studies, women who received positive ("Good job!") versus objective (score only) feedback from a male (vs. female) authority figure in math reported greater confidence; belonging; self-efficacy; more favorable Science, Technology, Engineering, and Mathematics (STEM) attitudes/identification/interest; and greater implicit identification with math. Men were affected only by the type of math feedback they received, not by the source of feedback. A meta-analysis across studies confirmed results. Together, these findings suggest that positive feedback from gatekeepers is an important situational cue that can improve the outcomes of negatively stereotyped groups.

DEFINING AND NEGOTIATING THE SOCIAL VALUE OF RESEARCH IN PUBLIC HEALTH FACILITIES: PERCEPTIONS OF STAKEHOLDERS IN A RESEARCH-ACTIVE PROVINCE OF SOUTH AFRICA

PubMed Central

Lutge, Elizabeth; Slack, Catherine; Wassenaar, Douglas

2016-01-01

This paper reports on qualitative research conducted in KwaZulu-Natal, South Africa, among researchers and gate-keepers of health facilities in the province. Results suggest disparate but not irreconcilable perceptions of the social value of research in provincial health facilities. This study found that researchers tended to emphasise the contribution of research to the generation of knowledge and to the health of future patients while gate-keepers of health facilities tended to emphasise its contribution to the healthcare system and to current patients. Furthermore, relations between research stakeholders were perceived to be somewhat fragile, making it difficult for stakeholders to achieve consensus about the social value of research, as well as on ways to maximise value. Interventions to negotiate a shared perspective on the social value of research would appear to be warranted, and the findings of this study suggest some focus areas for such intervention. PMID:28060430

Bridging Education and Practice with a Competency-Based Learning Contract

ERIC Educational Resources Information Center

Molina, Veronica; Molina-Moore, Tammy; Smith, Misty G.; Pratt, Francine E.

2018-01-01

Field work programs have a substantial responsibility for providing support and gatekeeping functions while ensuring an educational experience that allows students to master the nine holistic, multidimensional social work accreditation competencies. With additional emphasis on field as a "signature pedagogy," field directors are tasked…

Targeting Summer Credit Recovery

ERIC Educational Resources Information Center

Eno, Jared; Heppen, Jessica

2014-01-01

Algebra is considered a key gatekeeper for higher-level mathematics course-taking in high school and for college enrollment (Adelman, 2006; Gamoran & Hannigan, 2000). Yet, algebra pass rates are consistently low in many places (Higgins, 2008; Ham & Walker, 1999; Helfand, 2006), including Chicago Public Schools (CPS). This is of particular…

"Ward v. Wilbanks": Counselor Educators Respond

ERIC Educational Resources Information Center

Burkholder, David; Hall, Stephanie F.; Burkholder, Jessica

2014-01-01

This article investigated 71 counselor educators' perspectives and pedagogical practices related to "Ward v. Wilbanks" (2009) and the American Counseling Association (ACA) response to the case. The authors used qualitative content analysis to identify 6 themes from survey data: (a) views on gatekeeping and student training; (b)…

Focus on Fractions to Scaffold Algebra

ERIC Educational Resources Information Center

Ooten, Cheryl Thomas

2013-01-01

Beginning algebra is a gatekeeper course into the pipeline to higher mathematics courses required for respected professions in engineering, science, statistics, mathematics, education, and technology. Beginning algebra can also be a perfect storm if the necessary foundational skills are not within a student's grasp. What skills ensure beginning…

Utilizing Online Training for Child Sexual Abuse Prevention: Benefits and Limitations

ERIC Educational Resources Information Center

Paranal, Rechelle; Thomas, Kiona Washington; Derrick, Christina

2012-01-01

The prevalence of child sexual abuse demands innovative approaches to prevent further victimization. The online environment provides new opportunities to expand existing child sexual abuse prevention trainings that target adult gatekeepers and allow for large scale interventions that are fiscally viable. This article discusses the benefits and…

Learning in the Beat: What Influences Environmental Journalists' Perception of Knowledge?

ERIC Educational Resources Information Center

Takahashi, Bruno; Tandoc, Edson C., Jr.

2013-01-01

We conducted a survey of environmental journalists in the United States to explore individual, routine, and organizational influences on perceived knowledge of environmental issues. Using the gatekeeping theory, we found that routine and organizational factors, such as orientation to particular sources and affiliation to an organization, predict…

What Turns Events into News?

ERIC Educational Resources Information Center

Tukachinsky, Riva

2013-01-01

"The New York Times" is known for its slogan ''All the News That's Fit to Print.'' But how do gatekeepers decide which events meet this criterion? Although some individuals might believe that the news constitutes an undistorted reflection of the social reality, students in communication courses have the…

MSW Programs: Gatekeepers to the Field of Developmental Disabilities

ERIC Educational Resources Information Center

Russo-Gleicher, Rosalie J.

2008-01-01

This article presents qualitative insights into the roles of master of social work programs in developing student practice interests in working with people with developmental disabilities (DD). Semistructured in-depth interviews were conducted with 24 MSW social workers practicing in the field of DD in the northeastern United States. Participants…

Marketing Academics' Perceptions of the Peer Review Process

ERIC Educational Resources Information Center

Bailey, Charles D.; Hair, Joe F.; Hermanson, Dana R.; Crittenden, Victoria L.

2012-01-01

Publication in refereed journals is critical to career success for most marketing faculty members, and the peer review process is the gatekeeper for a refereed journal. The study reported here examines marketing academics' perceptions of this peer review process. Based on responses from 653 marketing academics, we find favorable overall…

Is the Sky Falling? Grade Inflation and the Signaling Power of Grades

ERIC Educational Resources Information Center

Pattison, Evangeleen; Grodsky, Eric; Muller, Chandra

2013-01-01

Grades are the fundamental currency of our educational system; they signal academic achievement and noncognitive skills to parents, employers, postsecondary gatekeepers, and students themselves. Grade inflation compromises the signaling value of grades and undermines their capacity to achieve the functions for which they are intended. We challenge…

Projecting Project Management's Future within the Academic Landscape

ERIC Educational Resources Information Center

Halfond, Jay A.

2011-01-01

U.S. universities have had century-long success in absorbing existing professions into their curricula--by making academe their gatekeeper. These professions often started with apprenticeships and short training courses leading to a certification examination--and were then elevated and "academized" into a comprehensive body of knowledge,…

New Pathways to Credentialing: The Digital Badge

ERIC Educational Resources Information Center

DiSalvio, Philip

2016-01-01

With an increasing number of higher education institutions now offering "digital badges," some suggest that this credential has become a practical commodity in the world of college credentials. Colleges and universities are in a unique position to be the gatekeepers of many of those credentials. Among the many institutions of higher…

The Gatekeepers of Business Education Research: An Institutional Analysis

ERIC Educational Resources Information Center

Urbancic, Frank R.

2011-01-01

The author ranked the academic standing of universities based on faculty representation to the editorial boards of business education journals. Previous studies that ranked institutions for editorial board representation focused on journals that primarily favor publication of basic and applied research contributions. As a result, prior research…

K-8 Teachers' Self-Efficacy Beliefs for Teaching Mathematics

ERIC Educational Resources Information Center

Amankonah, Frank O.

2013-01-01

Mathematics knowledge and skills serve as the "gatekeeper" to students' choice of college majors, success obtaining college degrees, and entry into the workforce. However, on the mathematics portion of standardized tests, U.S. fourth and eighth graders performed below their peers in countries such as Singapore, Hong Kong, China, and…

Researchers at the Gate: Factors Influencing Districts' Right of Entry Decisions

ERIC Educational Resources Information Center

Melnick, Steven A.; Henk, William A.

2006-01-01

Background: The No Child Left Behind legislation creates an increased need for new school-based empirical studies whose implementation will depend largely on researchers' access to various school populations and records. Access decisions are typically made by superintendents, or their designees, functioning as gatekeepers who control right of…

Outcomes of a Suicide Prevention Gatekeeper Training on a University Campus

ERIC Educational Resources Information Center

Indelicato, Natalie Arce; Mirsu-Paun, Anca; Griffin, Wayne D.

2011-01-01

A university-wide suicide prevention program was implemented to provide students, faculty, and staff tools to identify, assist, and refer distressed and suicidal individuals. The study examined participant self-reports of suicide-related knowledge and prevention skills, group differences in suicide prevention knowledge and skills, group…

Postpartum Obesity: The Root Problem of Childhood Obesity?

ERIC Educational Resources Information Center

Keen, Valencia Browning; Potts, Claudia Sealey

2011-01-01

Remedying childhood obesity cannot take place without first identifying relevant issues commonly influencing gatekeepers of food for children as well as the role modeling for encouraging or discouraging daily activities. Children cannot drive to the store, form grocery lists or complete menu management tasks without adult assistance. Excessive…

Occluded Academic Genres: An Analysis of the MBA Thought Essay

ERIC Educational Resources Information Center

Loudermilk, Brandon Conner

2007-01-01

Several strands of research in applied linguistics have increasingly focused their attention on the application of genre theory to the classroom. In advanced academics, the genres of disciplinary communities serve gate-keeping functions that students must negotiate in order to succeed in their academic endeavors. Often without explicit…

Community College Developmental Education Students' Understanding of Foundational Fraction Concepts

ERIC Educational Resources Information Center

Alexander, Cathleen Marie

2013-01-01

Mathematics, in general, and algebra courses, in particular, have been categorized as "gatekeepers" for higher education, better jobs, and even citizenship. For many low-income and working adults, community college is the institution where they choose to develop their mathematics understanding so they can pursue their dreams.…

Chronicle of Higher Education. Volume 50, Number 43, July 2, 2004

ERIC Educational Resources Information Center

Chronicle of Higher Education, 2004

2004-01-01

"Chronicle of Higher Education" presents an abundant source of news and information for college and university faculty members and administrators. This July 2, 2004 issue of "Chronicle of Higher Education" includes the following articles: (1) "The Provost as Gatekeeper: A Former Provost Offers Advice on Managing the…

Barriers to Community Participation in Development Planning: Lessons from the Mutengene (Cameroon) Self-Help Water Project.

ERIC Educational Resources Information Center

Njoh, Ambe J.

2002-01-01

A community water supply project in Cameroon illustrates the following constraints on community participation in development: paternalistic authorities, prescriptive role of the state, selective participation, bias toward "hard" issues, inattention to negative results, group conflicts, gatekeeping, pressure for immediate results,…

Strategies low-income parents use to overcome their children's food refusal

USDA-ARS?s Scientific Manuscript database

Parents play a key role in the development of eating habits in preschool children, as they are the food "gatekeepers". Repeated exposure to new foods can improve child food preferences and consumption. The objective of this study was to determine parent feeding strategies used to influence child acc...

Gatekeeper or Lynchpin? The Role of the Principal in School-University Partnerships

ERIC Educational Resources Information Center

Nettleton, Kimberely Fletcher; Barnett, David

2016-01-01

Teacher education programs are always evolving. To provide opportunities for pre-service teachers to combine pedagogy with practical experience, many programs are developing school-university partnerships. The pairing of pre-service teachers with experienced mentor teachers offers enriched field experience opportunities. The effect of the…

Connections: A Journal of Adult Literacy. Volume IV.

ERIC Educational Resources Information Center

Connections: A Journal of Adult Literacy, 1991

1991-01-01

This journal provides a forum for adult educators to express their ideas on adult literacy. The following articles are included: "Teaching Moments: Teaching People, Not Lessons" (Patricia Wild); "Whole Language: Implications for the Adult Learner" (Jeri Gillin); "Gatekeepers or Advocates?" (Rosie Wickert); "Writing with Teen Mothers: I Have…

Fractions: Could They Really Be the Gatekeeper's Doorman?

ERIC Educational Resources Information Center

Booth, Julie L.; Newton, Kristie J.

2012-01-01

The National Mathematics Advisory Panel (NMAP, 2008) asserts that a foundational knowledge of fractions is crucial for students' success in algebra; however, empirical evidence for this claim is relatively nonexistent. In the present study, we examine the impact of middle school students' fraction and whole number magnitude knowledge on various…

Identifying Opinion Leaders to Promote Behavior Change

ERIC Educational Resources Information Center

Valente, Thomas W.; Pumpuang, Patchareeya

2007-01-01

This article reviews 10 techniques used to identify opinion leaders to promote behavior change. Opinion leaders can act as gatekeepers for interventions, help change social norms, and accelerate behavior change. Few studies document the manner in which opinion leaders are identified, recruited, and trained to promote health. The authors categorize…

Banking on Child Nutrition.

ERIC Educational Resources Information Center

Briley, Margaret; McBride, Andrea M.; Roberts-Gray, Cynthia

1997-01-01

The child-care facility is rapidly growing into the role of gatekeeper on food intake for children. This article describes guidelines for children's nutritional needs, what children are actually eating, how to make menus more nutritious (including recipes), how to strengthen menus and keep food costs low, and the use of food banks. (EV)

Counselor Educators and Students with Problems of Professional Competence: A Survey and Discussion

ERIC Educational Resources Information Center

Brown-Rice, Kathleen; Furr, Susan

2016-01-01

A total of 370 counselor educators in CACREP-accredited [Council for Accreditation of Counseling and Related Educational Programs] programs were surveyed to determine their knowledge of master's students' problems of professional competence (PPC) and their perception of roadblocks that affect gatekeeping practices. Findings suggest that educators…

The Great Bug Hunt 2011

ERIC Educational Resources Information Center

Dixon-Watmough, Rebecca

2011-01-01

The Association For Science Education's "schoolscience.co.uk Great Bug Hunt 2011," in association with Martin Rapley and Gatekeeper Educational, has been a resounding success--not only because it fits into the science curriculum so neatly, but also because of the passion it evoked in the children who took part. This year's entries were…

Youth Suicide: The Knowledge and Attitudes of Australian Teachers and Clergy.

ERIC Educational Resources Information Center

Leane, Wendy; Shute, Rosalyn

1998-01-01

Professional groups identified as "gatekeepers" who might serve as first line of assistance for distressed young people were surveyed (N=219). Low levels of knowledge about suicide risk were found. Educational efforts directed at risk identification and prevention, attitudinal issues, and communication with young suicidal people are…

A Culturally Responsive Intervention for Addressing Problematic Behaviors in Counseling Students

ERIC Educational Resources Information Center

Goodrich, Kristopher M.; Shin, Richard Q.

2013-01-01

Counseling faculty serve as gatekeepers to protect the public from trainees who demonstrate significant deficiencies in professional functioning. Two issues that have not been thoroughly examined are how different cultural values may intersect with the assessment of appropriate professional competencies and whether the multicultural environment of…

Counselor Educators' Gatekeeping Responsibilities and Students' First Amendment Rights

ERIC Educational Resources Information Center

Hutchens, Neal; Block, Jason; Young, Marianne

2013-01-01

In 2 recent legal cases, graduate counselor education students challenged the imposition of remediation plans as violating their First Amendment rights of freedom of speech and religion. With special emphasis on this recent litigation, the article examines the legal standards governing the authority of counselor educators at public colleges and…

The Composition of the Editorial Boards of General Marketing Journals

ERIC Educational Resources Information Center

Pan, Yue; Zhang, Jason Q.

2014-01-01

Unlike the diversity issues in corporate governance, the diversity in top academic positions (e.g., editorial boards of academic journals in business) is rather underresearched. The editorial boards of academic marketing journals are important gatekeepers and trendsetters in the creation and dissemination of marketing knowledge. Membership on…

Attention Performance in Young Adults with Learning Disabilities

ERIC Educational Resources Information Center

Sterr, Annette M.

2004-01-01

Attention acts as the mind's "gatekeeper" by regulating and prioritizing the stimuli processed by the central nervous system. It is essential for cognitive performance, memory, and behavior, and we know that even slight deficiencies in attention compromise learning. Basic neuroscience research further indicates that attention consists of (fairly)…

Transnational Mobility and International Academic Employment: Gatekeeping in an Academic Competition Arena

ERIC Educational Resources Information Center

Cantwell, Brendan

2011-01-01

This article draws upon concepts developed in recent empirical and theoretical work on high skilled and academic mobility and migration including accidental mobility, forced mobility and negotiated mobility. These concepts inform a situated, qualitative study of mobility among international postdoctoral researchers in life sciences and engineering…

Working with Students with Psychiatric Disabilities or Other Emotional Problems

ERIC Educational Resources Information Center

Mazza, Elena T.

2015-01-01

The professional literature on gatekeeping in social work education has grown; however, there remains a dearth in the literature regarding how educators truly work to engage students who are experiencing a psychiatric disability or other emotional problem. This qualitative study explored the experiences of 26 social work educators from 22 colleges…

Rumor Has It: Investigating Teacher Licensure Exam Advice Networks

ERIC Educational Resources Information Center

Baker-Doyle, Kira; Petchauer, Emery

2015-01-01

In many countries, including the United States, England, Korea, Hong Kong, and Japan, individuals must pass some form of examination for entry into or completion of a teacher education program (Wang, Coleman, Coley, & Phelps, 2003). These exams are meant to act as gatekeeping mechanisms for teacher quality. In the majority of the countries…

Improving Student Learning and Views of Physics in a Large Enrollment Introductory Physics Class

ERIC Educational Resources Information Center

Shan, Kathy J.

2013-01-01

Introductory physics courses often serve as gatekeepers for many scientific and engineering programs and, increasingly, colleges are relying on large, lecture formats for these courses. Many students, however, leave having learned very little physics and with poor views of the subject. In interactive engagement (IE), classroom activities encourage…

Beyond Gatekeepers of Knowledge: Scholarly Communication Practices of Academic Librarians and Archivists at ARL Institutions

ERIC Educational Resources Information Center

Sugimoto, Cassidy R.; Tsou, Andrew; Naslund, Sara; Hauser, Alexandra; Brandon, Melissa; Winter, Danielle; Behles, Cody; Finlay, S. Craig

2014-01-01

Librarians and archivists are intimately involved in scholarly communication systems, both as information providers and instructors. However, very little is known regarding their activities as scholars. This study seeks to examine the scholarly communication practices of librarians and archivists, the role that tenure plays in scholarly…

French Immersion for English Language Learners?: Kindergarten Teachers' Perspectives

ERIC Educational Resources Information Center

Mady, Callie

2016-01-01

Given the increasingly diverse, multilingual student body in Canada, the call for increased inclusion in education, and in light of research highlighting the potential for inclusion in French immersion (FI) to be limited by gatekeepers, this study examines the beliefs of kindergarten teachers regarding the inclusion of English language learners in…

Suicide Intervention Training for College Staff: Program Evaluation and Intervention Skill Measurement

ERIC Educational Resources Information Center

Shannonhouse, Laura; Lin, Yung-Wei Dennis; Shaw, Kelly; Wanna, Reema; Porter, Michael

2017-01-01

Objective: Suicide remains a pressing issue for college communities. Consequently, gatekeeper trainings are often provided for staff. This study examines the effect of one such program, Applied Suicide Intervention Skills Training (ASIST). Participants: 51 college employees received ASIST in August of 2014 and were compared to 30 wait-list control…

Threats to Validity in the edTPA Video Component

ERIC Educational Resources Information Center

Choppin, Jeffrey; Meuwissen, Kevin

2017-01-01

The edTPA, a performance assessment designed to generate reliable and valid measures of teaching practice, increasingly is used as a gatekeeping mechanism for beginning teacher licensure in various states, including New York, Washington State, Wisconsin, and Georgia. One of the edTPA's key components is the demonstration of instructional practice…

Helping a District through a Paradigm Shift ... What Have I Gotten Myself into?

ERIC Educational Resources Information Center

Brelsford, Matthew

2010-01-01

Across the country, school psychologists are pushing for a role beyond the traditional refer-test-place model and "gatekeeper" of special education. The broad skill set of school psychologists, including knowledge of curriculum, instruction, data analysis, and intervention, can produce positive results for all students throughout the…

Teaching Nonliterate Adults in Oral Cultures: Findings from Practitioners

ERIC Educational Resources Information Center

Thompson, LaNette W.

2015-01-01

Literacy is the gatekeeper to modern information. In the world today, approximately 740 million adults are excluded from adult education if that education uses literate instructional strategies. Nearly 3/4 of a billion adults, many of whom speak unwritten languages, do not use reading to learn new information nor share information through writing.…

Thoughts on the Law, Gatekeepers, and Rerooting

ERIC Educational Resources Information Center

Shevock, Daniel J.

2017-01-01

This essay extends an open philosophy with a philosophy of music education on soil. An open philosophy emerges from analysis of Kafka's parable "Before the Law." I explore what "the law" might be, what it could mean for how people relate to "the law," and how critiquing "the law" allows music teachers and…

Gatekeepers of a Profession? Employability as Capital in the Recruitment of Medical Interns

ERIC Educational Resources Information Center

Lindberg, Ola

2013-01-01

The present article concerns employability in physicians' professional practice. Drawing on interview data from recruiters at 21 Swedish hospitals with the most applicants for a medical internship, the article seeks to develop a theory of what constitutes an "employable medical intern". Using Pierre Bourdieu's concept of capital, two…

Forum: Learning Outcomes in Communication. The LOCs and the Shift to Student-Centered Learning

ERIC Educational Resources Information Center

Brown, Timothy J.; Castor, Theresa; Byrnes-Loinette, Kerry; Bowman, Jonathan; McBride, Chad

2016-01-01

Traditional teaching is based upon a "teacher"-centered rather than a "student"-centered approach (Bain, 2004). A teacher-centered approach underscores the long held philosophy that instructors are the gatekeepers of knowledge whose job is to convey their knowledge through a lecture, with students as passive receivers during…

Curriculum Gatekeeping in Global Education: Global Educators' Perspectives

ERIC Educational Resources Information Center

Bailey, Robert W.

2013-01-01

Teaching social studies from a global perspective has been resisted by many since its inception (Kirkwood, 2009). Critics have labeled the theory anti-American and unpatriotic (Schlafly, 1986; Burack, 2001). Others are concerned with its shifting perspectives and apparent lack of core facts (Finn, 1988). Over time, some critics have changed their…

High School Teachers' Experiences with Suicidal Students: A Descriptive Study

ERIC Educational Resources Information Center

Freedenthal, Stacey; Breslin, Lindsey

2010-01-01

Teachers are widely considered key gatekeepers to mental health services for students at risk for suicide. Using data from 120 teachers at two Denver-area high schools, this study investigated teachers' experiences with suicidal students. Analyses revealed that the majority of teachers (58.8%) reported that at least one student had disclosed…

Community and Videos: An Action Plan to Increase Success Rates in California Community College Developmental Mathematics

ERIC Educational Resources Information Center

Long, Gary W.

2010-01-01

Success rates in California community college developmental mathematics courses have hovered around 50% for decades. These gatekeeper courses have prevented many students from earning college degrees. Since community college is the starting point for the majority of California's potential college graduates and the majority of these students…

Teacher Educators as Curriculum Developers: Exploration of a Professional Role

ERIC Educational Resources Information Center

Bouckaert, Marina; Kools, Quinta

2018-01-01

Teacher educators arguably fulfil several roles in their professional context: they can be seen as role models or teachers of teachers, and have additionally been characterised as researchers, mentors, gatekeepers, brokers, and curriculum developers. To address a perceived gap in the literature on the latter role, a quantitative and qualitative…

The Role of Legitimacy in Student Teaching: Learning to "Feel" Like a Teacher

ERIC Educational Resources Information Center

Cuenca, Alexander

2011-01-01

A key factor in learning to teach during student teaching is the cooperating teacher, who supports and mentors prospective teachers. In the apprenticeship that is student teaching, the cooperating teacher serves as a gatekeeper to the experiential learning of pre-service teachers. Although several studies indicate the significant influence…

Gateways, Not Gatekeepers

ERIC Educational Resources Information Center

Murray, Linda

2012-01-01

In its analysis of more than 15,000 high school transcripts, the Education Trust-West found that non-college-bound students tend to take a weak academic load and disconnected electives. As a result, far too many students--most often low-income students and students of color--are bound for low-level jobs, prepared for neither college nor career.…

Exploring Some Ethical Dilemmas and Obligations of the Ethnographer

ERIC Educational Resources Information Center

Barbour, Andrew

2010-01-01

This paper focuses on the ethical position of the ethnographer when encountering unethical activities. Ethnography affords a rich insight into cultures, often behind previously secure doors but it is also a demanding science. Our gatekeepers control our access and our relationships with them can determine our destiny. This paper offers an exchange…

Paternal Banking and Maternal Gatekeeping in Postdivorce Families

ERIC Educational Resources Information Center

Moore, Elena

2012-01-01

The research explores the way in which postseparated parents continue to exert a bidirectional force on each other following divorce and separation. The study draws on qualitative interviews with 39 separated mothers and fathers in Ireland, including five marital sets of former couples. The study found many fathers adopted a range of…

Ethnically Diverse Students' Knowledge Structures in First-Semester Organic Chemistry

ERIC Educational Resources Information Center

Lopez, Enrique J.; Shavelson, Richard J.; Nandagopal, Kiruthiga; Szu, Evan; Penn, John

2014-01-01

Chemistry courses remain a challenge for many undergraduate students. In particular, first-semester organic chemistry has been labeled as a gatekeeper with high attrition rates, especially among students of color. Our study examines a key factor related to conceptual understanding in science and predictive of course outcomes-knowledge structures.…

Research Questions: Women and Mass Media.

ERIC Educational Resources Information Center

Busby, Linda J.

Typically, research concerning media presentations of women has involved six types of analysis: (1) content analysis (what is said), (2) cultural and social analysis (why it is said), (3) control or gatekeeper analysis (by whom it is said), (4) audience analysis (to whom it is said), (5) media analysis (in which channel), and (6) effects analysis…

The Impact of Subjective Age and Stigma on Older Persons

ERIC Educational Resources Information Center

Ward, Russell A.

1977-01-01

This study investigated the impact of shifts in age identification by older people (N=323) from "middle-aged" to "elderly" within the context of the labeling theory of deviance. Age identification was unrelated to attitudes toward old people and the label "elderly" did not affect self-esteem through any "gate-keeping" process. (Author)

Race and Racelessness in CMO Marketing: Exploring Charter Management Organizations' Racial Construction and Its Implications

ERIC Educational Resources Information Center

Hernández, Laura E.

2016-01-01

As schools face growing competitive pressures, researchers have investigated the increasing reliance on marketing and its implications for various racial and socioeconomic groups. Although research has expanded our knowledge of marketing's gatekeeping qualities, it has less often considered the manner in which school marketing efforts contribute…

The Developmental Influence of the University Supervisor-Student Teacher Relationship during Clinical Experience

ERIC Educational Resources Information Center

Kucharczuk, Robert Thomas

2017-01-01

The following study examined the perceived developmental influence of the university supervisor-student teacher relationship during the student teaching phase of teacher preparation. Since the supervisor is viewed as the gatekeeper to eventual teacher certification and acts as an evaluator, mentor, and instructor (Borko & Mayfield, 1995;…

Charter School Appeals. Policy Guide

ERIC Educational Resources Information Center

O'Neill, Paul T.

2009-01-01

Authorizers must decide whether a proposed school should be allowed to open and whether it should be required to close. To enable authorizers to serve as quality gatekeepers for the sector, state policy must give authorizers clear power to deny low-quality charter school applications and to close charter schools that fail to meet expectations. At…

Shall We Overcome? Self-Efficacy, Teacher Licensure Exams, and African American Preservice Teachers

ERIC Educational Resources Information Center

Petchauer, Emery

2016-01-01

This article reports findings from a 3-year qualitative study exploring the experiences of African American preservice teachers as they prepared for the Praxis "basic skills" teacher-licensure exam, a gatekeeper to many teacher-education programs. Using the construct of self-efficacy, results illustrate how students assess their Praxis…

Easy as AcHGzrjq: the Quick Letter Name Knowledge Assessment

ERIC Educational Resources Information Center

Tortorelli, Laura S.; Bowles, Ryan P.; Skibbe, Lori E.

2017-01-01

A firm foundation in alphabet knowledge is critical for children learning to read. Under new literacy standards, letter name knowledge in preschool and kindergarten can function as a gatekeeper to the rest of the curriculum. Teachers need data about their students' alphabet knowledge early and often to plan differentiated instruction that moves…

Balancing the Equation: Do Course Variations in Algebra 1 Provide Equal Student Outcomes?

ERIC Educational Resources Information Center

Kenfield, Danielle M.

2013-01-01

Historically, algebra has served as a gatekeeper that divides students into academic programs with varying opportunities to learn and controls access to higher education and career opportunities. Successful completion of Algebra 1 demonstrates mathematical proficiency and allows access to a sequential and progressive path of advanced study that…

Deciding Access to Work-Integrated Learning: Human Resource Professionals as Gatekeepers

ERIC Educational Resources Information Center

Mackaway, Jacqueline; Winchester-Seeto, Theresa

2018-01-01

Universities, industry and professional bodies advocate work-integrated learning (WIL) as a valuable way to prepare graduates to meet the challenges of contemporary society. When organizations preference particular students over others to host on placement, the full individual and collective potential of WIL is not realized. This paper reports…

A Qualitative Study of One District's Efforts to Improve Mathematics Instruction to Scale

ERIC Educational Resources Information Center

Osborne, Brian George

2011-01-01

Mathematics learning is critical for student success, and frequently acts as a gatekeeper, preventing students from graduating from high school and pursuing higher education. While many districts have attempted to improve mathematics instruction by implementing some sort of reform, few districts have attempted to execute a multifaceted systems…

An Australian Indigenous community-led suicide intervention skills training program: community consultation findings.

PubMed

Nasir, Bushra; Kisely, Steve; Hides, Leanne; Ranmuthugala, Geetha; Brennan-Olsen, Sharon; Nicholson, Geoffrey C; Gill, Neeraj S; Hayman, Noel; Kondalsamy-Chennakesavan, Srinivas; Toombs, Maree

2017-06-13

Little is known of the appropriateness of existing gatekeeper suicide prevention programs for Indigenous communities. Despite the high rates of Indigenous suicide in Australia, especially among Indigenous youth, it is unclear how effective existing suicide prevention programs are in providing appropriate management of Indigenous people at risk of suicide. In-depth, semi-structured interviews and focus groups were conducted with Indigenous communities in rural and regional areas of Southern Queensland. Thematic analysis was performed on the gathered information. Existing programs were time-intensive and included content irrelevant to Indigenous people. There was inconsistency in the content and delivery of gatekeeper training. Programs were also not sustainable for rural and regional Indigenous communities. Appropriate programs should be practical, relevant, and sustainable across all Indigenous communities, with a focus on the social, emotional, cultural and spiritual underpinnings of community wellbeing. Programs need to be developed in thorough consultation with Indigenous communities. Indigenous-led suicide intervention training programs are needed to mitigate the increasing rates of suicide experienced by Indigenous peoples living in rural and remote locations.

The Ruler Protein EscP of the Enteropathogenic Escherichia coli Type III Secretion System Is Involved in Calcium Sensing and Secretion Hierarchy Regulation by Interacting with the Gatekeeper Protein SepL

PubMed Central

Shaulov, Lihi; Gershberg, Jenia; Deng, Wanyin; Finlay, B. Brett

2017-01-01

ABSTRACT The type III secretion system (T3SS) is a multiprotein complex that plays a central role in the virulence of many Gram-negative bacterial pathogens. To ensure that effector proteins are efficiently translocated into the host cell, bacteria must be able to sense their contact with the host cell. In this study, we found that EscP, which was previously shown to function as the ruler protein of the enteropathogenic Escherichia coli T3SS, is also involved in the switch from the secretion of translocator proteins to the secretion of effector proteins. In addition, we demonstrated that EscP can interact with the gatekeeper protein SepL and that the EscP-SepL complex dissociates upon a calcium concentration drop. We suggest a model in which bacterial contact with the host cell is accompanied by a drop in the calcium concentration that causes SepL-EscP complex dissociation and triggers the secretion of effector proteins. PMID:28049143

Characteristics of African American women caregivers of children with asthma.

PubMed

Sterling, Yvonne M; Peterson, Jane W

2003-01-01

To describe the attributes and characteristics of African American women who were the primary caregivers of children with asthma. Descriptive qualitative ethnography. Data collection consisted of formal interviews, participant observation, and fieldnotes. Each study participant was formally and informally interviewed (audiotaped) during a 1-year period. The researchers also observed and participated in family activities in various naturalistic settings. Six themes emerged that depict the characteristics of these women: (1) Knowledge about the child's asthma; (2) Gatekeepers to the child's care; (3) Being religious; (4) Support; (5) Roles as teacher, counselor, and advisor to the child; and (6) Self-sufficiency and industriousness. Nurses should use the information in this study to examine the ways in which they interact with caregivers of asthmatic children. The caregivers personal beliefs, need for information, and previous experiences with asthma and family illness should be assessed. These mothers and grandmothers should be respected as the gatekeeper to the family's healthcare. Nurses should be nonjudgmental and supportive of caregivers when they express their religious beliefs and practices. Nurses who understand how mothers cope can reinforce these coping skills and provide better nursing care.

Self-perceived Coparenting of Nonresident Fathers: Scale Development and Validation.

PubMed

Dyer, W Justin; Fagan, Jay; Kaufman, Rebecca; Pearson, Jessica; Cabrera, Natasha

2017-11-16

This study reports on the development and validation of the Fatherhood Research and Practice Network coparenting perceptions scale for nonresident fathers. Although other measures of coparenting have been developed, this is the first measure developed specifically for low-income, nonresident fathers. Focus groups were conducted to determine various aspects of coparenting. Based on this, a scale was created and administered to 542 nonresident fathers. Participants also responded to items used to examine convergent and predictive validity (i.e., parental responsibility, contact with the mother, father self-efficacy and satisfaction, child behavior problems, and contact and engagement with the child). Factor analyses and reliability tests revealed three distinct and reliable perceived coparenting factors: undermining, alliance, and gatekeeping. Validity tests suggest substantial overlap between the undermining and alliance factors, though undermining was uniquely related to child behavior problems. The alliance and gatekeeping factors showed strong convergent validity and evidence for predictive validity. Taken together, results suggest this relatively short measure (11 items) taps into three coparenting dimensions significantly predictive of aspects of individual and family life. © 2017 Family Process Institute.

Cultural stereotypes as gatekeepers: increasing girls' interest in computer science and engineering by diversifying stereotypes.

PubMed

Cheryan, Sapna; Master, Allison; Meltzoff, Andrew N

2015-01-01

Despite having made significant inroads into many traditionally male-dominated fields (e.g., biology, chemistry), women continue to be underrepresented in computer science and engineering. We propose that students' stereotypes about the culture of these fields-including the kind of people, the work involved, and the values of the field-steer girls away from choosing to enter them. Computer science and engineering are stereotyped in modern American culture as male-oriented fields that involve social isolation, an intense focus on machinery, and inborn brilliance. These stereotypes are compatible with qualities that are typically more valued in men than women in American culture. As a result, when computer science and engineering stereotypes are salient, girls report less interest in these fields than their male peers. However, altering these stereotypes-by broadening the representation of the people who do this work, the work itself, and the environments in which it occurs-significantly increases girls' sense of belonging and interest in the field. Academic stereotypes thus serve as gatekeepers, driving girls away from certain fields and constraining their learning opportunities and career aspirations.

Cultural stereotypes as gatekeepers: increasing girls’ interest in computer science and engineering by diversifying stereotypes

PubMed Central

Cheryan, Sapna; Master, Allison; Meltzoff, Andrew N.

2015-01-01

Despite having made significant inroads into many traditionally male-dominated fields (e.g., biology, chemistry), women continue to be underrepresented in computer science and engineering. We propose that students’ stereotypes about the culture of these fields—including the kind of people, the work involved, and the values of the field—steer girls away from choosing to enter them. Computer science and engineering are stereotyped in modern American culture as male-oriented fields that involve social isolation, an intense focus on machinery, and inborn brilliance. These stereotypes are compatible with qualities that are typically more valued in men than women in American culture. As a result, when computer science and engineering stereotypes are salient, girls report less interest in these fields than their male peers. However, altering these stereotypes—by broadening the representation of the people who do this work, the work itself, and the environments in which it occurs—significantly increases girls’ sense of belonging and interest in the field. Academic stereotypes thus serve as gatekeepers, driving girls away from certain fields and constraining their learning opportunities and career aspirations. PMID:25717308

The m-AAA Protease Associated with Neurodegeneration Limits MCU Activity in Mitochondria.

PubMed

König, Tim; Tröder, Simon E; Bakka, Kavya; Korwitz, Anne; Richter-Dennerlein, Ricarda; Lampe, Philipp A; Patron, Maria; Mühlmeister, Mareike; Guerrero-Castillo, Sergio; Brandt, Ulrich; Decker, Thorsten; Lauria, Ines; Paggio, Angela; Rizzuto, Rosario; Rugarli, Elena I; De Stefani, Diego; Langer, Thomas

2016-10-06

Mutations in subunits of mitochondrial m-AAA proteases in the inner membrane cause neurodegeneration in spinocerebellar ataxia (SCA28) and hereditary spastic paraplegia (HSP7). m-AAA proteases preserve mitochondrial proteostasis, mitochondrial morphology, and efficient OXPHOS activity, but the cause for neuronal loss in disease is unknown. We have determined the neuronal interactome of m-AAA proteases in mice and identified a complex with C2ORF47 (termed MAIP1), which counteracts cell death by regulating the assembly of the mitochondrial Ca 2+ uniporter MCU. While MAIP1 assists biogenesis of the MCU subunit EMRE, the m-AAA protease degrades non-assembled EMRE and ensures efficient assembly of gatekeeper subunits with MCU. Loss of the m-AAA protease results in accumulation of constitutively active MCU-EMRE channels lacking gatekeeper subunits in neuronal mitochondria and facilitates mitochondrial Ca 2+ overload, mitochondrial permeability transition pore opening, and neuronal death. Together, our results explain neuronal loss in m-AAA protease deficiency by deregulated mitochondrial Ca 2+ homeostasis. Copyright © 2016 Elsevier Inc. All rights reserved.

A descriptive study of baccalaureate nursing students' responses to suicide prevention education.

PubMed

Pullen, Julie M; Gilje, Fredricka; Tesar, Emily

2016-01-01

Internationally, little is known regarding the amount of educational content on suicide in undergraduate nursing curriculum. The literature conducted found few published research studies on implementation of suicide prevention instruction in baccalaureate nursing curriculum, even though various international healthcare and nursing initiatives address suicide prevention. The aim was to describe senior baccalaureate students' responses to an evidence-based suicide prevention gatekeeper training program entitled Question-Persuade-Refer implemented in a required course. This is a multi-method descriptive study. Data were collected utilizing a pre-post-survey questionnaire administered to 150 students in four classes of a psychiatric nursing course over a two-year period. The quantitative data were statistically significant (p < 0.000) indicating an overall positive rating of the training. From the qualitative data, the main theme was 'becoming capable intervening with persons at risk for suicide'. Students responded very positively to the evidence based suicide prevention gatekeeper training program. The instruction addresses various national initiatives and strategies filling a void in nursing curriculum, as well as empowering students to engage in suicide prevention interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Physicians as gatekeepers: illness certification as a rationing device.

PubMed

Stone, D A

1979-01-01

Illness or disability is often used as an eligibility criterion by public programs that distribute money, services, privileges, and exemptions. Physicians then play a central role in the allocation process. But physicians are caught between a large pool of applicants who want some benefit, on the one hand, and an organization with limited resources to distribute, on the other hand. Three conflicts are engendered in this gatekeeping role: the tension between trusting and mistrusting information provided by the patient, the tension between erring on the false positive side and the false negative side in diagnostic decision-making, and the tension between doing everything possible for each patient and allocating limited resources among several needy clients. Several non-medical factors influence the ultimate outcome of this allocation process, which, in theory, rests on clinical decision-making: the specificity and restrictiveness of the formal definitions of illness and disability used by a program; the structure of the determination process; the overall policy of the organization on distribution of benefits; and the ability of the organization to use administrative review, direct incentives, and written standards to control the certifying behavior of physicians.

Network gatekeeping: complementary medicine information on the websites of medical institutions.

PubMed

Keshet, Yael

2012-03-01

Integrative medicine - complementary and alternative medicine (CAM) practised in mainstream healthcare organizations - combines medical treatments based on incommensurable paradigms. As the Internet has been portrayed as a crucial pathway to CAM and sites administered by reputable organizations are considered to be relatively reliable sources of medical information, the research sought to explore and compare the ways in which CAM is presented on the Internet websites of diverse medical institutions. The contents of the websites of the Ministry of Health, the Israeli Medical Association and Israeli healthcare organizations were analysed, using an interdisciplinary theory of network gatekeeping. The websites were analysed not only according to the degree to which they are considered to be informative, but also with regard to the perceptions of integration that they convey. Comparison of the websites of community healthcare organizations and hospitals indicates that while the former display CAM treatments as an attractive commodity, the latter convey a message stressing the need to subject CAM to bio-medical scrutiny. Little or no information was provided concerning a number of important issues, such as research findings about efficacy and safety, risks and ethical considerations.

Time-Dependent CO[subscript 2] Sorption Hysteresis in a One-Dimensional Microporous Octahedral Molecular Sieve

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

Espinal, Laura; Wong-Ng, Winnie; Kaduk, James A.

2014-09-24

The development of sorbents for next-generation CO{sub 2} mitigation technologies will require better understanding of CO{sub 2}/sorbent interactions. Among the sorbents under consideration are shape-selective microporous molecular sieves with hierarchical pore morphologies of reduced dimensionality. We have characterized the non-equilibrium CO{sub 2} sorption of OMS-2, a well-known one-dimensional microporous octahedral molecular sieve with manganese oxide framework. Remarkably, we find that the degree of CO{sub 2} sorption hysteresis increases when the gas/sorbent system is allowed to equilibrate for longer times at each pressure step. Density functional theory calculations indicate a 'gate-keeping' role of the cation in the tunnel, only allowing CO{submore » 2} molecules to enter fully into the tunnel via a highly unstable transient state when CO{sub 2} loadings exceed 0.75 mmol/g. The energy barrier associated with the gate-keeping effect suggests an adsorption mechanism in which kinetic trapping of CO{sub 2} is responsible for the observed hysteretic behavior.« less

Mental Health Services for Children and Youth in the Child Welfare System: A Focus on Caregivers as Gatekeepers.

PubMed

Villagrana, Margarita

2010-05-01

Caregivers serve as gatekeepers for children while in the child welfare system, but few studies have focused on the caregiver and the factors that influence the use of mental health services for the children under their care. The purpose of this study was to examine the child's mental health need, the caregiver's level of stress, depression, and social support, and the utilization of mental health services by children using the three most common types of caregivers in the child welfare system (i.e., birth parent, relative caregiver, and foster parent). Data comes from the Patterns of Care (POC) study of five public sectors of care. The present study examined parents/caregivers and youth from the child welfare sector. Findings suggest that while birth parents were more likely to endorse more risk factors for themselves, and the children under their care had a higher level of mental health need, they were the least likely to utilize mental health services for the children under their care. Implications for the child welfare and mental health systems are discussed.

An Acquired HER2T798I Gatekeeper Mutation Induces Resistance to Neratinib in a Patient with HER2 Mutant-Driven Breast Cancer.

PubMed

Hanker, Ariella B; Brewer, Monica Red; Sheehan, Jonathan H; Koch, James P; Sliwoski, Gregory R; Nagy, Rebecca; Lanman, Richard; Berger, Michael F; Hyman, David M; Solit, David B; He, Jie; Miller, Vincent; Cutler, Richard E; Lalani, Alshad S; Cross, Darren; Lovly, Christine M; Meiler, Jens; Arteaga, Carlos L

2017-06-01

We report a HER2 T798I gatekeeper mutation in a patient with HER2 L869R -mutant breast cancer with acquired resistance to neratinib. Laboratory studies suggested that HER2 L869R is a neratinib-sensitive, gain-of-function mutation that upon dimerization with mutant HER3 E928G , also present in the breast cancer, amplifies HER2 signaling. The patient was treated with neratinib and exhibited a sustained partial response. Upon clinical progression, HER2 T798I was detected in plasma tumor cell-free DNA. Structural modeling of this acquired mutation suggested that the increased bulk of isoleucine in HER2 T798I reduces neratinib binding. Neratinib blocked HER2-mediated signaling and growth in cells expressing HER2 L869R but not HER2 L869R/T798I In contrast, afatinib and the osimertinib metabolite AZ5104 strongly suppressed HER2 L869R/T798I -induced signaling and cell growth. Acquisition of HER2 T798I upon development of resistance to neratinib in a breast cancer with an initial activating HER2 mutation suggests HER2 L869R is a driver mutation. HER2 T798I -mediated neratinib resistance may be overcome by other irreversible HER2 inhibitors like afatinib. Significance: We found an acquired HER2 gatekeeper mutation in a patient with HER2 -mutant breast cancer upon clinical progression on neratinib. We speculate that HER2 T798I may arise as a secondary mutation following response to effective HER2 tyrosine kinase inhibitors (TKI) in other cancers with HER2 -activating mutations. This resistance may be overcome by other irreversible HER2 TKIs, such as afatinib. Cancer Discov; 7(6); 575-85. ©2017 AACR. This article is highlighted in the In This Issue feature, p. 539 . ©2017 American Association for Cancer Research.

Nursing Home Staff Characteristics and Knowledge Gain from a Didactic Workshop on Depression and Behavior Management

ERIC Educational Resources Information Center

Meeks, Suzanne; Burton, Elizabeth G.

2004-01-01

Depression is a prevalent and serious problem among nursing home residents. Nursing home staff members are gatekeepers for mental health treatment for residents, but may know little about depression and its management. We evaluated a didactic workshop for nursing home staff on depressive symptoms and management. Results for 58 staff participants…

Strategies for Promoting Gatekeeper Course Success among Students Needing Remediation: Research Report for the Virginia Community College System

ERIC Educational Resources Information Center

Roksa, Josipa; Jenkins, Davis; Jaggars, Shanna Smith; Zeidenberg, Matthew; Cho, Sung-Woo

2009-01-01

The Virginia Community College System (VCCS) is engaged in a strategic planning process to improve performance beyond the goals in "Dateline 2009," the system's current vision and plan. A key objective is to encourage colleges to improve retention and academic success for students, particularly the substantial numbers who arrive…

Policies of Global English Tests: Test-Takers' Perspectives on the IELTS Retake Policy

ERIC Educational Resources Information Center

Hamid, M. Obaidul

2016-01-01

Globalized English proficiency tests such as the International English Language Testing System (IELTS) are increasingly playing the role of gatekeepers in a globalizing world. Although the use of the IELTS as a "policy tool" for making decisions in the areas of study, work and migration impacts on test-takers' lives and life chances, not…

Carnegie Math Pathways 2015-2016 Impact Report: A Five-Year Review. Carnegie Math Pathways Technical Report

ERIC Educational Resources Information Center

Hoang, Hai; Huang, Melrose; Sulcer, Brian; Yesilyurt, Suleyman

2017-01-01

College math is a gateway course that has become a constraining gatekeeper for tens of thousands of students annually. Every year, over 500,000 students fail developmental mathematics, preventing them from achieving their college and career goals. The Carnegie Math Pathways initiative offers students an alternative. It comprises two Pathways…

VA Community Mental Health Service Providers' Utilization of and Attitudes toward Telemental Health Care: The Gatekeeper's Perspective

ERIC Educational Resources Information Center

Jameson, John Paul; Farmer, Mary Sue; Head, Katharine J.; Fortney, John; Teal, Cayla R.

2011-01-01

Context: Mental health (MH) providers in community-based outpatient clinics (CBOCs) are important stakeholders in the development of the Veterans Health Administration (VA) telemental health (TMH) system, but their perceptions of these technologies have not been systematically examined. Purpose: The purpose of this study was to investigate the…

Research and Teaching: From Gatekeeper to Gateway: Improving Student Success in an Introductory Biology Course

ERIC Educational Resources Information Center

Scott, Amy N.; McNair, Delores E.; Lucas, Jonathan C.; Land, Kirkwood M.

2017-01-01

Introductory science, math, and engineering courses often have problems related to student engagement, achievement, and course completion. To begin examining these issues in greater depth, this pilot study compared student engagement, achievement, and course completion in a small and large section of an introductory biology class. Results based on…

Who Defends the Stem Cell's Citadel?

PubMed

Strick-Marchand, Hélène; Durantel, David

2018-03-01

Recently in Cell, Wu et al. (2018) demonstrated that intrinsic expression of a subset of interferon stimulated genes confers resistance to viral infections in stem cells both in vitro and in vivo, while differentiated cells lose this intrinsic gatekeeper expression pattern in favor of inducible interferon responses. Copyright © 2018 Elsevier Inc. All rights reserved.

Reinventing from within: Thinking Spherically as a Policy Imperative in Music Education

ERIC Educational Resources Information Center

Schmidt, Patrick

2009-01-01

If policy is the most significant gatekeeping element for access to and development of community goods and services, and if music educators have historically lived at the margins of policy, then who procures access for the field? How are visions for musical and educational development articulated and what are the resulting implications? This…

Global Times Call for Global Measures: Investigating Automated Essay Scoring in Linguistically-Diverse MOOCs

ERIC Educational Resources Information Center

Reilly, Erin D.; Williams, Kyle M.; Stafford, Rose E.; Corliss, Stephanie B.; Walkow, Janet C.; Kidwell, Donna K.

2016-01-01

This paper utilizes a case-study design to discuss global aspects of massive open online course (MOOC) assessment. Drawing from the literature on open-course models and linguistic gatekeeping in education, we position freeform assessment in MOOCs as both challenging and valuable, with an emphasis on current practices and student resources. We…

U.S. Gatekeepers and the New World Information Order: Journalistic Qualities and Their Impact.

ERIC Educational Resources Information Center

Chang, Tsan-Kuo; Lee, Jae-won

A national survey examined how United States newspaper editors responded to the 6 major issues surrounding the New World Information Order (NWIO) debate at the United Nations Educational, Scientific, and Cultural Organization (UNESCO) regarding the form and content of news flow at the international level. A 6-page questionnaire was completed by…

Getting Past the Gatekeeper: Safeguarding and Access Issues in Researching HIV+ Children in Jamaica

ERIC Educational Resources Information Center

Miller, Paul; Kelly, Kemesha; Spawls, Nicola

2013-01-01

This article is derived from a recently completed research study on the "Schooling Experiences of HIV+ Children in Jamaica". It is written against the background of researching children generally, and also in the context of researching vulnerable children, specifically those who are HIV+. Research carries with it various notions of power…

Fathers' Involvement in Child Care and Perceptions of Parenting Skill over the Transition to Parenthood

ERIC Educational Resources Information Center

Barry, Amy A.; Smith, JuliAnna Z.; Deutsch, Francine M.; Perry-Jenkins, Maureen

2011-01-01

This study explored first-time fathers' perceived child care skill over the transition to parenthood, based on face-to-face interviews of 152 working-class, dual-earner couples. Analyses examined the associations among fathers' perceived skill and prenatal perception of skill, child care involvement, mothers' breastfeeding, maternal gatekeeping,…

Achieving and Maintaining Change in Urban Schools: The Role of The School Psychologist

ERIC Educational Resources Information Center

Petry, Bradley; Serbonich, Nadine

2018-01-01

School psychologists in Baltimore (MD) City Public Schools are engaged in efforts to expand their professional roles from a traditional to a more comprehensive model. In Baltimore, school psychologists had been in the traditional role as a special education-specific gatekeeper and service provider. Starting in 2013, a group of school…

Gatekeepers or Facilitators: The Influence of Teacher Habitus on Students' Applications to Elite Universities

ERIC Educational Resources Information Center

Oliver, Caroline; Kettley, Nigel

2010-01-01

Low application rates of state school students to elite universities have been identified as a factor in their limited participation in elite universities. This article explores the role of teachers in state schools and colleges in guiding higher education (HE) choice. Drawing on qualitative research with teachers and students in six institutions,…

The State of the Gate: A Description of Instructional Practice in Algebra in Five Urban Districts

ERIC Educational Resources Information Center

Litke, Erica G.

2015-01-01

Algebra is considered a linchpin for success in secondary mathematics, serving as a gatekeeper to higher-level courses. Access to algebra is also considered an important lever for educational equity. Yet despite its prominence, large-scale examinations of algebra instruction are rare. In my dissertation, I endeavor to better understand what…

Wisdom from Conservatory Faculty: Insights on Success in Classical Music Performance

ERIC Educational Resources Information Center

Jarvin, Linda; Subotnik, Rena F.

2010-01-01

What does it take to become a successful performer of Western classical music in the United States today? What factors, beyond technical proficiency and musicality, come into play? We started exploring these questions in a study of gatekeepers' (e.g., critics, artistic directors) views on key variables that contribute to the career trajectories of…

Kinks in the STEM Pipeline: Tracking STEM Graduation Rates Using Science and Mathematics Performance

ERIC Educational Resources Information Center

Redmond-Sanogo, Adrienne; Angle, Julie; Davis, Evan

2016-01-01

In an effort to maintain the global competitiveness of the United States, ensuring a strong Science, Technology, Engineering and Mathematics (STEM) workforce is essential. The purpose of this study was to identify high school courses that serve as predictors of success in college level gatekeeper courses, which in turn led to the successful…

Educating Early Childhood Teachers about Nutrition: A Collaborative Venture

ERIC Educational Resources Information Center

Cotugna, Nancy; Vickery, Connie

2007-01-01

Nourishing the young child can be a challenge. This stage of life is critical to the development of positive attitudes toward maintaining a healthy diet and learning to make reasonable food choices. Educators of young children are often the gatekeepers of child nutrition. This article reports on the current nutrient needs of young children,…

Gatekeepers or Marketers: Reclaiming the Educational Role of Chief Admission Officers

ERIC Educational Resources Information Center

McDonough, Patricia; Robertson, Larry

2012-01-01

The U.S. college admission environment has changed enormously over the last three decades. What have those changes meant for the profession of college admission officers? In this paper, the authors will describe the enormous changes that have taken place in high schools, colleges, and the entrepreneurial admission sector. They will describe how…

Investigating Language Assessment Literacy: Collaboration between Assessment Specialists and Canadian University Admissions Officers

ERIC Educational Resources Information Center

Baker, Beverly A.; Tsushima, Rika; Wang, Shujiao

2014-01-01

There are increasing numbers of non-native English speaking applicants to Canadian universities (AUCC 2008a, 2010), which are committed to promoting linguistic and cultural diversity (AUCC 2008b). One result of this trend is that university admissions officers, as gatekeepers, are faced with a growing and potentially confusing array of language…

Bottom Line: Education Is the Great Equalizer. Or Is It?

ERIC Educational Resources Information Center

Marina, Brenda L. H.; Holmes, Nickole D.

2009-01-01

The American Higher Education System plays a crucial role in determining and perpetuating the inequalities in wealth, power, and social class in the society. It does so by serving as the gatekeeper to middle- and upper-class status. According to Lisa Tsui, higher education inherited this function when positions of power and privilege became…

Gender Differences in the Socialization of Preschoolers' Emotional Competence

ERIC Educational Resources Information Center

Denham, Susanne A.; Bassett, Hideko Hamada; Wyatt, Todd M.

2010-01-01

Preschoolers' socialization of emotion and its contribution to emotional competence is likely to be highly gendered. In their work, the authors have found that mothers often take on the role of emotional gatekeeper in the family, and fathers act as loving playmates, but that parents' styles of socialization of emotion do not usually differ for…

Second-Generation ALK Inhibitors: Filling the Non “MET” Gap

PubMed Central

Ramalingam, Suresh S.; Khuri, Fadlo R.

2015-01-01

Summary Ceritinib and other second-generation inhibitors have demonstrated promising anticancer activity in anaplastic lymphoma kinase (ALK)–positive non–small cell lung cancer (NSCLC). Specifically, they can overcome resistance due to certain gatekeeper mutations acquired following crizotinib exposure. These agents now provide new options for the management of ALK-positive NSCLC. PMID:24891360

Leveraging Innovation in Science Education: Using Writing and Assessment to Decode the Class Size Conundrum

ERIC Educational Resources Information Center

Camfield, Eileen Kogl; McFall, Eileen Eckert; Land, Kirkwood M.

2016-01-01

Introductory biology courses are supposed to serve as gateways for many majors, but too often they serve instead as gatekeepers. Reliance on lectures, large classes, and multiple-choice tests results in high drop and failure rates. Critiques of undergraduate science education are clear about the problems with conventional introductory science…

The Statement of Purpose in Graduate Program Applications: Genre Structure and Disciplinary Variation

ERIC Educational Resources Information Center

Samraj, Betty; Monk, Lenore

2008-01-01

Recent research of student writing has included a few studies of the statement of purpose submitted as part of the admission process to programs of study, which have indicated variations in expectations by disciplinary gatekeepers. These studies indicate a need for further study of statements of purpose submitted to different departments, informed…

A Framework for Understanding and Cultivating the Transition from Arithmetic to Algebraic Reasoning

ERIC Educational Resources Information Center

Nathan, Mitchell J.; Koellner, Karen

2007-01-01

Algebraic reasoning stands as a formidable gatekeeper for students in their efforts to progress in mathematics and science, and to obtain economic opportunities (Ladson-Billings, 1998; RAND, 2003). Currently, mathematics education research has focused on algebra in order to provide access and opportunities for more students. There is now a growing…

Of Gateways and Gatekeepers: Language, Education and Mobility in Francophone Africa

ERIC Educational Resources Information Center

Trudell, Barbara

2012-01-01

Over the past 15 years, a range of alternative education programs have been launched in Burkina Faso. The programs have been developed primarily by international or national NGOs, within a supportive policy space provided by the national government. They aim to respond to the widely recognized inadequacy of the French-language ecoles classiques to…

Linking Extreme Precocity and Adult Eminence: A Study of Eight Prodigies at International Chess

ERIC Educational Resources Information Center

Howard, Robert W.

2008-01-01

Do prodigies have extraordinary innate talent or do they just start very early and get much practice? Why do relatively few become eminent as adults? Is it because early and later success often need somewhat different abilities and gatekeepers rule? International chess is a good test domain for both issues because it has objective longitudinal…

Student Engagement and Completion in Precalculus Precalculus Mega Section: Efficiently Assisting Student Engagement and Completion with Communications and Information Technology

ERIC Educational Resources Information Center

Brusi, Rima; Portnoy, Arturo; Toro, Nilsa

2013-01-01

The Precalculus Mega Section project was developed with the main purpose of improving the overall performance of the student body in Precalculus, an important gatekeeper course that affects student engagement and completion, with typical drop/failure rates of over 50 percent. Strategies such as integration of technology and additional practice…

Public Service Announcements and the Fight against AIDS: A National Survey of Television and Radio Broadcasters' Attitudes and Policies.

ERIC Educational Resources Information Center

Swanson, Douglas J.

A follow-up national study surveyed 500 television and radio broadcasters to further understanding of their role as gatekeepers for public service announcements (PSAs) to educate audiences about AIDS, and to bring about "safe" behavior. Respondents were asked to provide information about their stations, and their stations' use of…

Beginning History Teachers' Enactment of Pedagogical Content Knowledge through Content Decision-Making

ERIC Educational Resources Information Center

Ellsworth, Tina M.

2017-01-01

Pedagogical Content Knowledge exists in some capacity in every teacher. It is more well-developed as the wisdom in practice informs it. In their capacity as curriculum gatekeepers, teachers enact their PCK as they decide which content to teach. But what knowledge is of most worth? How do teachers employ the structures unique to their disciplines…

Diffusion of Photovoltaic Occupational Skills Training: Awareness and Adoption in the North Carolina Community Colleges

ERIC Educational Resources Information Center

Porto, Deborah Ruth

2012-01-01

Educational administrators in the North Carolina Community College System (NCCCS) play a key role in the decisions to adopt or reject educational innovations and as a result are the gatekeepers of technology innovations reaching students. In this study the innovation-decision process and other aspects of the diffusion of innovation model are used…

Proceedings of the Annual Meeting of the Association for Education in Journalism and Mass Communication (84th, Washington, DC, August 5-8, 2001). Newspaper Division.

ERIC Educational Resources Information Center

Association for Education in Journalism and Mass Communication.

The Newspaper section, Part 1 of the proceedings contains the following selected papers: "Gatekeeping and the Editorial Cartoon: A Case Study of the 2000 Presidential Campaign Cartoons" (Jennifer M. Proffitt); "Campaign Contributions: Online Newspapers Go Beyond Shovelware in Covering Election 2000" (Jane B. Singer); "At…

The Relevance of Mathematics: Leaders and Teachers as Gatekeeper for Queensland Senior Calculus Mathematics

ERIC Educational Resources Information Center

Easey, Michael; Gleeson, Jim

2016-01-01

The aim of the larger study, of which this paper is a part, is to investigate the decline in Year 10 male students' participation in senior calculus mathematics courses at an independent boys' school located in metropolitan Queensland. This paper draws on Sealey and Noyes's (2010) relevance framework to conduct document analysis and interviews…

Unstandardized Responses to a "Standardized" Test: The edTPA as Gatekeeper and Curriculum Change Agent

ERIC Educational Resources Information Center

Ledwell, Katherine; Oyler, Celia

2016-01-01

We examine edTPA (a teacher performance assessment) implementation at one private university during the first year that our state required this exam for initial teaching certification. Using data from semi-structured interviews with 19 teacher educators from 12 programs as well as public information on edTPA pass rates, we explore whether the…

Myths and Facts about Suicide from Individuals Involved in Suicide Prevention

ERIC Educational Resources Information Center

Schurtz, David R.; Cerel, Julie; Rodgers, Philip

2010-01-01

Myth-busting, in which a so-called myth is presented and dispelled by facts, is used in suicide prevention gatekeeper trainings such as QPR. Evidence from other areas of public health shows this technique leads to memory for myths and not facts. An internet survey was used to determine if the "myths" and "facts" presented in QPR are endorsed as…

A Multimedia over IP Integrated System for Military Communications

DTIC Science & Technology

2006-12-01

stressed how communications requirements raise dramatically now, either in quantity either in quality, in order to effectively improve sensor...admission control based on network resources availability. We will stress the role of SIT and the characteristic of the Gatekeeper to act as the...considered: • Telecommuting - Telecommuting is a broad term referring to corporate employees who interact electronically with corporate resources

STEM Learning Opportunities Providing Equity (SLOPE): An Investing in Innovation (i3) Grant. Final Evaluation Report

ERIC Educational Resources Information Center

Gallagher, Carole; Huang, Kevin; Van Matre, Joseph

2015-01-01

This five-year evaluation examined the effectiveness of a promising middle-school mathematics intervention funded through an Investing in Innovation (i3) development grant. Evaluation objectives were to: (1) study the impact of an intervention aimed at increasing the academic achievement of students in Algebra I--a gate-keeping course--as measured…

A Portraiture of Six Hispanic Women's Academic Pursuit in a Community College Setting: A Qualitative Study

ERIC Educational Resources Information Center

Artiaga, Maria D.

2013-01-01

Community colleges in the United States serve as social, cultural, and intellectual hubs that take the role as gatekeepers by committing to opening up the doors of opportunity to the public (Vaughan, 2006). Community colleges prepare their students for the workforce by providing credit or non-credit courses, certifications, or degrees. Depending…

Gate-Keeping and the Ambiguities in the Nature of "Informed Consent" in Confucian Societies

ERIC Educational Resources Information Center

Katyal, Kokila Roy

2011-01-01

Scholars of international and comparative education have long endorsed the importance of context in conducting research. In this paper, I expand upon the theme to argue that just as educational policies and practices may be compromised in the process of transfer, so too may the research methodology used to draw inferences fail to resonate from one…

Do Not Enter: What Are the Risks of Gatekeeping Child and Youth Care?

ERIC Educational Resources Information Center

Vachon, Wolfgang

2013-01-01

There are multiple organizations striving to professionalize child and youth care (CYC) across North America. Two voices that appear to have been excluded from this dialogue are the young people CYCs work with and those who come to work in the field outside of formal training. This article asks who defines CYC practice, what the implications are…

The Child Care Director: Not Just Anyone Can Do This Job!

ERIC Educational Resources Information Center

Boulton, Pam

2008-01-01

In this article, the author discusses the importance of child care directors. Paula Jorde Bloom (1992) refers to the director as the "gatekeeper to quality" and Gwen Morgan (2000) writes of the director as the "key to quality." The child care director is responsible for every aspect of the early care and education program. Emerging from the…

The Acceptability of Online and For-Profit Nursing Degrees: A Study of Hiring Gatekeeper Perceptions

ERIC Educational Resources Information Center

Kinneer, James W.

2014-01-01

A national survey of health care recruiters was used to compare their attitudes toward four different RN-to-BSN degree options based on the method of instruction (classroom, online) and the type of college (traditional, forprofit). The analysis was based on the data received from 116 respondents who completed the questionnaire. The study findings…

Accept, Avoid, Resist: How Faculty Members Respond to Bias Against Caregiving ... and How Departments Can Help

ERIC Educational Resources Information Center

Colbeck, Carol L.; Drago, Robert

2005-01-01

A number of institutions have developed policies designed to foster family-friendly work environments, but bias against caregiving may lead gatekeepers to discourage faculty members from using them. The message sent to faculty and prospective faculty by this scenario is that it is too difficult to be a productive academic and an involved, caring…

Educational Assessment in the Republic of Korea: Lights and Shadows of High-Stake Exam-Based Education System

ERIC Educational Resources Information Center

Kwon, Suh Keong; Lee, Moonbok; Shin, Dongkwang

2017-01-01

Educational assessment in the Republic of Korea reflects social and cultural perspectives, as most assessments are considered as a "gatekeeper" of one's success in life, in terms of entering an elite school or having a better career. This paper presents a profile of the education system, especially focusing on the college entrance…

District Decision-Makers' Considerations of Equity and Equality Related to Students' Opportunities to Learn Algebra

ERIC Educational Resources Information Center

Herbel-Eisenmann, Beth A.; Keazer, Lindsay; Traynor, Anne

2018-01-01

Background/Context: In this article we explore equity issues related to school district decision-making about students' opportunities to learn algebra. We chose algebra because of the important role it plays in the U.S. as a gatekeeper to future academic success. Current research has not yet explored issues of equity in district-level…

Impact of Accreditation Actions: A Case Study of Two Colleges within Western Association of Schools and Colleges' Accrediting Commission for Community and Junior Colleges

ERIC Educational Resources Information Center

Patel, Dipte D.

2012-01-01

The United States is unique with it non-governmental peer-review based accreditation system for oversight of higher education for quality assurance and improvement. In a triad relationship with federal and state governments for accountability, accreditation associations are the designated gatekeeper for federal financial assistance. Therefore,…

From the Margins to the Center: A Critical Examination of the Identity Constructions of Bosnian Adolescent Refugees in New York City

ERIC Educational Resources Information Center

Mosselson, Jacqueline

2009-01-01

This article explores the role of culture and social networks as relations of difference in refugee experiences by challenging the assumptions in mainstream psychology that objectify the experiences of refugees and act as gatekeepers to their subjectivity. The deterministic bent of existing psychological theories legitimates an essentialist…

Women's underrepresentation in science: sociocultural and biological considerations.

PubMed

Ceci, Stephen J; Williams, Wendy M; Barnett, Susan M

2009-03-01

The underrepresentation of women at the top of math-intensive fields is controversial, with competing claims of biological and sociocultural causation. The authors develop a framework to delineate possible causal pathways and evaluate evidence for each. Biological evidence is contradictory and inconclusive. Although cross-cultural and cross-cohort differences suggest a powerful effect of sociocultural context, evidence for specific factors is inconsistent and contradictory. Factors unique to underrepresentation in math-intensive fields include the following: (a) Math-proficient women disproportionately prefer careers in non-math-intensive fields and are more likely to leave math-intensive careers as they advance; (b) more men than women score in the extreme math-proficient range on gatekeeper tests, such as the SAT Mathematics and the Graduate Record Examinations Quantitative Reasoning sections; (c) women with high math competence are disproportionately more likely to have high verbal competence, allowing greater choice of professions; and (d) in some math-intensive fields, women with children are penalized in promotion rates. The evidence indicates that women's preferences, potentially representing both free and constrained choices, constitute the most powerful explanatory factor; a secondary factor is performance on gatekeeper tests, most likely resulting from sociocultural rather than biological causes. (c) 2009 APA, all rights reserved.

Recruiting and retaining Arab Muslim mothers and children for research.

PubMed

Aroian, Karen J; Katz, Anne; Kulwicki, Anahid

2006-01-01

To describe successful and not-so-successful strategies for recruiting and retaining Arab Muslim immigrant women and their adolescent children for research. A longitudinal study of mother-child adjustment of Arab immigrants to the US is used for illustration. A panel of experts was assembled and provided culturally specific advice about gatekeepers, advertising, data collectors, data collection, and how to track and encourage participation at subsequent time points in the study. Most of the strategies recommended by the panel were overwhelmingly positive, including advice about data collectors, how to collect data, financial incentives, avoiding offending families, and personal contacts. Hiring data collectors who were able to establish personal and culturally appropriate relationships with study participants was the single most successful recruitment and retention strategy. Advice from cultural experts about which gatekeepers to engage and how to advertise for study participants was not productive. Researchers should not only assemble a panel of cultural experts to provide advice about group specific strategies to build trust and maintain cultural sensitivity, but also to budget generously for time for data collectors to build and maintain rapport with study populations who, like Arab immigrant women, highly value personal relationships.

ICAO safety management systems (SMS) development in environmental contexts: A field study of greater China

NASA Astrophysics Data System (ADS)

Leib, Steven M.

This was a mixed-methods exploratory study to investigate association between environmental context and the implementation status of Safety Management Systems (SMS) at airports in Greater China. Using a framework of Institutional Theory, this study looked at three regions of Greater China and explored internal and external environments of SMS at airports within each region. It used ICAO standards to evaluate the implementation status of SMS at those airports based on the perceptions of 126 participants. This research also employed snowballing technique to spread a survey tool to participants in Greater China through several key gatekeepers, and then applied the Delphi method for interviews with key gatekeepers themselves. Analysis of the data suggested several associations between various sub-concepts of the external environment and different components of SMS in the three regions. In addition, the data suggested a relationship between the internal environment as a whole and the overall status of SMS implementation in each region. Lastly, the study makes several recommendations for future research regarding global standards implemented in local environments, the evaluation of SMS implementation status, and the theoretical implications of this study.

Outcomes of a Suicide Prevention Gatekeeper Training Program Among School Personnel.

PubMed

Lamis, Dorian A; Underwood, Maureen; D'Amore, Nicole

2017-03-01

Gatekeeper suicide prevention programs train staff to increase the identification and referral of suicidal individuals to the appropriate resources. We evaluated Act on FACTS: Making Educators Partners in Youth Suicide Prevention (MEP), which is an online training program designed to enhance the knowledge of suicide risk factors and warning signs as well as improve participants' attitudes and self-efficacy/confidence. School personnel (N = 700) completed a survey administered before and immediately after the training to assess gains in training outcomes and to evaluate participants' satisfaction with the training. Results indicated that MEP participants demonstrated significant increases in suicide knowledge, attitudes, and self-efficacy. Moreover, exploratory analyses revealed moderating effects of professional role on pre-/posttest changes in self-efficacy, but not suicide knowledge or attitudes. Specifically, guidance counselors demonstrated significantly smaller increases in self-efficacy/confidence compared with teachers and classroom aids, whereas teachers demonstrated significantly larger increases in self-efficacy/confidence compared with administrators. The majority of school personnel who completed the MEP program were satisfied with the training content and experience. Although the current findings are promising, more rigorous evaluations employing randomized controlled research designs are warranted to adequately determine the effectiveness of the MEP program.

A Genetically Optimized Predictive System for Success in General Chemistry Using a Diagnostic Algebra Test

NASA Astrophysics Data System (ADS)

Cooper, Cameron I.; Pearson, Paul T.

2012-02-01

In higher education, many high-enrollment introductory courses have evolved into "gatekeeper" courses due to their high failure rates. These courses prevent many students from attaining their educational goals and often become graduation roadblocks. At the authors' home institution, general chemistry has become a gatekeeper course in which approximately 25% of students do not pass. This failure rate in chemistry is common, and often higher, at many other institutions of higher education, and mathematical deficiencies are perceived to be a large contributing factor. This paper details the development of a highly accurate predictive system that identifies students at the beginning of the semester who are "at-risk" for earning a grade of C- or below in chemistry. The predictive accuracy of this system is maximized by using a genetically optimized neural network to analyze the results of a diagnostic algebra test designed for a specific population. Once at-risk students have been identified, they can be helped to improve their chances of success using techniques such as concurrent support courses, online tutorials, "just-in-time" instructional aides, study skills, motivational interviewing, and/or peer mentoring.

Grandmothers as gatekeepers? The role of grandmothers in influencing health-seeking for mothers and newborns in rural northern Ghana.

PubMed

Gupta, Mira L; Aborigo, Raymond Akawire; Adongo, Philip Baba; Rominski, Sarah; Hodgson, Abraham; Engmann, Cyril M; Moyer, Cheryl A

2015-10-01

Previous research suggests that care-seeking in rural northern Ghana is often governed by a woman's husband or compound head. This study was designed to explore the role grandmothers (typically a woman's mother-in-law) play in influencing maternal and newborn healthcare decisions. In-depth interviews were conducted with 35 mothers of newborns, 8 traditional birth attendants and local healers, 16 community leaders and 13 healthcare practitioners. An additional 18 focus groups were conducted with stakeholders such as household heads, compound leaders and grandmothers. In this region, grandmothers play many roles. They may act as primary support providers to pregnant mothers, care for newborns following delivery, preserve cultural traditions and serve as repositories of knowledge on local medicine. Grandmothers may also serve as gatekeepers for health-seeking behaviour, especially with regard to their daughters and daughters-in-law. This research also sheds light on the potential gap between health education campaigns that target mothers as autonomous decision-makers, and the reality of a more collectivist community structure in which mothers rarely make such decisions without the support of other community members.

Recruiting and Retaining Arab Muslim Mothers and Children for Research

PubMed Central

Aroian, Karen J.; Katz, Anne; Kulwicki, Anahid

2006-01-01

Purpose To describe successful and not-so-successful strategies for recruiting and retaining Arab Muslim immigrant women and their adolescent children for research. Design and Methods A longitudinal study of mother-child adjustment of Arab immigrants to the US is used for illustration. A panel of experts was assembled and provided culturally specific advice about gatekeepers, advertising, data collectors, data collection, and how to track and encourage participation at subsequent time points in the study. Findings Most of the strategies recommended by the panel were overwhelmingly positive, including advice about data collectors, how to collect data, financial incentives, avoiding offending families, and personal contacts. Hiring data collectors who were able to establish personal and culturally appropriate relationships with study participants was the single most successful recruitment and retention strategy. Advice from cultural experts about which gatekeepers to engage and how to advertise for study participants was not productive. Conclusions Researchers should not only assemble a panel of cultural experts to provide advice about group specific strategies to build trust and maintain cultural sensitivity, but also to budget generously for time for data collectors to build and maintain rapport with study populations who, like Arab immigrant women, highly value personal relationships. PMID:17044343

Discovery of 2,4-diarylaminopyrimidines bearing a resorcinol motif as novel ALK inhibitors to overcome the G1202R resistant mutation.

PubMed

Geng, Kaijun; Xia, Zongjun; Ji, Yinchun; Zhang, Ruisi Ruthy; Sun, Deqiao; Ai, Jing; Song, Zilan; Geng, Meiyu; Zhang, Ao

2018-01-20

To address drug resistance caused by ALK kinase mutations, especially the most refractory and predominant mutation G1202R for the second-generation ALK inhibitor, a series of new diarylaminopyrimidine analogues were designed by incorporating a resorcinol moiety (A-ring) to interact the ALK kinase domain where the G1202R is located. Compound 12d turns out as the most potent with IC 50 values of 1.7, 3.5, and 1.8 nM against ALK wild type, gatekeeper mutant L1196M, and the G1202R mutant, respectively. More importantly, compound 12d has excellent inhibitory effects against the proliferation of BaF3 cells specifically expressing ALK wild type, gatekeeper L1196M, and the most challenging mutant G1202R, with IC 50 values all less than 1.5 nM. Collectively, compound 12d is worthy of further investigation as a new more potent third-generation ALK inhibitor to circumvent drug resistance of both the first-generation and the second-generation inhibitors. Copyright © 2017. Published by Elsevier Masson SAS.

Inclusive intake screening: shaping medical problems into specialist-appropriate cases.

PubMed

Jean, Yvette A

2004-05-01

This paper examines medical intake screening through the process of making appointments with medical specialists. By employing a multi-method, qualitative approach, it shows how decisions to schedule doctors' appointments are based on medical knowledge about physicians' specialties and specific organisational practices. It draws on insights from first-contact interactions between clients and institutional gatekeepers to enrich our understanding of intake screening. In relation to gatekeeping, rationing commonly gets framed as restrictive screening practices, with a preference for denying or limiting access to treatment. Restrictive screening practices are typically organised to elicit a narrow range of information ('facts') relevant to specific eligibility criteria; whereas inclusive intake screening tends to involve less scripted, more complex and open-ended interactional exchanges between workers and clients, wherein workers help clients frame their claims in ways that will increase their chances of getting accepted. Front-office workers hold a preference for inclusive intake screening, a preference that is undergirded by the referral-driven nature of this stage of patient processing, and by a work environment that favours inclusive screening. This finding builds on the literature within medical sociology, but also extends our understanding of frontline decision-making and the distribution of resources within a variety of people-processing institutions.

Zinc as a Gatekeeper of Immune Function

PubMed Central

Wessels, Inga; Maywald, Martina; Rink, Lothar

2017-01-01

After the discovery of zinc deficiency in the 1960s, it soon became clear that zinc is essential for the function of the immune system. Zinc ions are involved in regulating intracellular signaling pathways in innate and adaptive immune cells. Zinc homeostasis is largely controlled via the expression and action of zinc “importers” (ZIP 1–14), zinc “exporters” (ZnT 1–10), and zinc-binding proteins. Anti-inflammatory and anti-oxidant properties of zinc have long been documented, however, underlying mechanisms are still not entirely clear. Here, we report molecular mechanisms underlying the development of a pro-inflammatory phenotype during zinc deficiency. Furthermore, we describe links between altered zinc homeostasis and disease development. Consequently, the benefits of zinc supplementation for a malfunctioning immune system become clear. This article will focus on underlying mechanisms responsible for the regulation of cellular signaling by alterations in zinc homeostasis. Effects of fast zinc flux, intermediate “zinc waves”, and late homeostatic zinc signals will be discriminated. Description of zinc homeostasis-related effects on the activation of key signaling molecules, as well as on epigenetic modifications, are included to emphasize the role of zinc as a gatekeeper of immune function. PMID:29186856

Utilisation of physician services in the 50+ population: the relative importance of individual versus institutional factors in 10 European countries.

PubMed

Bolin, Kristian; Lindgren, Anna; Lindgren, Björn; Lundborg, Petter

2009-03-01

We analysed the relative importance of individual versus institutional factors in explaining variations in the utilisation of physician services among the 50+ in ten European countries. The importance of the latter was investigated, distinguishing between organisational (explicit) and cultural (implicit) institutional factors, by analysing the influence of supply side factors, such as physician density and physician reimbursement, and demand side factors, such as co-payment and gate-keeping, while controlling for a number of individual characteristics, using cross-national individual-level data from SHARE. Individual differences in health status accounted for about 50% of the between-country variation in physician visits, while the organisational and cultural factors considered each accounted for about 15% of the variation. The organisational variables showed the expected signs, with higher physician density being associated with more visits and higher co-payment, gate-keeping, and salary reimbursement being associated with less visits. When analysing specialist visits separately, however, organisational and cultural factors played a greater role, each accounting for about 30% of the between-country variation, whereas individual health differences only accounted for 11% of the variation.

Mental health/illness and prisons as place: frontline clinicians׳ perspectives of mental health work in a penal setting.

PubMed

Wright, Nicola; Jordan, Melanie; Kane, Eddie

2014-09-01

This article takes mental health and prisons as its two foci. It explores the links between social and structural aspects of the penal setting, the provision of mental healthcare in prisons, and mental health work in this environment. This analysis utilises qualitative interview data from prison-based fieldwork undertaken in Her Majesty׳s Prison Service, England. Two themes are discussed: (1) the desire and practicalities of doing mental health work and (2) prison staff as mental health work allies. Concepts covered include equivalence, training, ownership, informal communication, mental health knowledge, service gatekeepers, case identification, and unmet need. Implications for practice are (1) the mental health knowledge and understanding of prison wing staff could be appraised and developed to improve mental healthcare and address unmet need. Their role as observers and gatekeepers could be considered. (2) The realities of frontline mental health work for clinicians in the penal environment should be embraced and used to produce and implement improved policy and practice guidance, which is in better accord with the actuality of the context - both socially and structurally. Copyright © 2014 Elsevier Ltd. All rights reserved.

Interventions for primary prevention of suicide in university and other post-secondary educational settings.

PubMed

Harrod, Curtis S; Goss, Cynthia W; Stallones, Lorann; DiGuiseppi, Carolyn

2014-10-29

Suicide is a leading cause of death among post-secondary students worldwide. Suicidal thoughts and planning are common among post-secondary students. Previous reviews have examined the effectiveness of interventions for symptomatic individuals; however, many students at high risk of suicide are undiagnosed and untreated. We evaluated the effect on suicide and suicide-related outcomes of primary suicide prevention interventions that targeted students within the post-secondary setting. We searched the following sources up to June 2011: Specialised Registers of two Cochrane Groups, Cochrane Central Register of Controlled Trials, and nine other databases, trial registers, conference proceedings, and websites of national and international organizations. We screened reference lists and contacted authors of included studies to identify additional studies. We updated the search in November 2013; we will include these results in the review's next update. We included studies that tested an intervention for the primary prevention of suicide using a randomized controlled trial (RCT), controlled before-and-after (CBA), controlled interrupted time series (CITS), or interrupted time series (ITS) study design. Interventions targeted students within the post-secondary setting (i.e. college, university, academy, vocational, or any other post-secondary educational institution) without known mental illness, previous suicide attempt or self-harm, or suicidal ideation. Outcomes included suicides, suicide attempts, suicidal ideation, changes in suicide-related knowledge, attitudes and behavior, and availability of means of suicide. We used standardized electronic forms for data extraction, risk of bias and quality of evidence determination, and analysis. We estimated standardised mean differences (SMD) with 95% confidence intervals (CIs). We analysed studies by intervention type and study design. We summarized RCT effect sizes using random-effects models meta-analyses; and analysed statistical heterogeneity using the Chi(2) test and I(2) statistic. We described narratively the results from studies that used other study designs. Eight studies met inclusion criteria. They were heterogeneous in terms of participants, study designs, and interventions. Five of eight studies had high risk of bias. In 3 RCTs (312 participants), classroom-based didactic and experiential programs increased short-term knowledge of suicide (SMD = 1.51, 95% CI 0.57 to 2.45; moderate quality evidence) and knowledge of suicide prevention (SMD = 0.72, 95% CI 0.36 to 1.07; moderate quality evidence). The effect on suicide prevention self-efficacy in one RCT (152 participants) was uncertain (SMD = 0.20, 95% CI -0.13 to 0.54; low quality evidence). One CBA analysed the effects of an institutional policy that restricted student access to laboratory cyanide and mandated professional assessment for suicidal students. The incidence of student suicide decreased significantly at one university with the policy relative to 11 control universities, 2.00 vs. 8.68 per 100,000 (Z = 5.90; P < 0.05). Four CBAs explored effects of training 'gatekeepers' to recognize and respond to warning signs of emotional crises and suicide risk in students they encountered. The magnitude of effect sizes varied between studies. Gatekeeper training enhanced short-term suicide knowledge in students, peer advisors residing in student accommodation, and faculty and staff, and suicide prevention self-efficacy among peer advisors. There was no evidence of an effect on participants' suicide-related attitudes or behaviors. One CBA found no evidence of effects of gatekeeper training of peer advisors on suicide-related knowledge, self-efficacy, or gatekeeper behaviors measured four to six months after intervention. We found insufficient evidence to support widespread implementation of any programs or policies for primary suicide prevention in post-secondary educational settings. As all evaluated interventions combined primary and secondary prevention components, we were unable to determine the independent effects of primary preventive interventions. Classroom instruction and gatekeeper training increased short-term suicide-related knowledge. We found no studies that tested the effects of classroom instruction on suicidal behavior or long-term outcomes. Limited evidence suggested minimal longer-term effects of gatekeeper training on suicide-related knowledge, while no evidence was found evaluating its effect on suicidal behavior. A policy-based suicide intervention reduced student suicide, but findings have not been replicated. Our findings are limited by the overall low quality of the evidence and the lack of studies from middle- and low-income countries. Rigorously designed studies should test the effects of preventive interventions on important health outcomes, including suicidal ideation and behavior, in varying post-secondary settings.

[Physician's anxiety and physician's elegance. Problems in dealing with cost reduction, education of general practitioners and optimal size of practice networks in a cross-national comparison].

PubMed

Behrens, J

2000-03-01

The key reason for physicians networking in managed care is to get a better coping with uncertainty on action (treatment) decisions. The second reason for networking in managed care are financial benefits grounds. But this reason is very ambivalent. Three different action problems (role conflicts) in managed care network are to solved, which was also in single practices. In the lecture the decision strategies and decision resources has been compared. Observations are done using expert interviews, patient interviews and analysis of documents in USA, Germany and Switzerland. The first problem is the choosing of a cost reduction strategy which is not reducing the effectiveness. Such "ugly" solution strategies like exclusion of "expensive" patients and a rationing of necessary medical services in a kind of McDonalds network of physicians will fail the target. The optimost way is a saving of all unnecessary medical even injourious performances. The chosen cost reduction strategy is not real visible from outside but in fact limited cognizable and controllable. Evidence based health care can be a resource of treatment decisions and could train such decisions but it will not substitute these decisions. The second problem is the making of real family practitioners as gatekeepers. Knowledge about the care system is still not making a real family practitioner, even if this is the minimum condition of their work. Also contractual relationships between insurance and doctor as a gatekeeper or financial incentives for patients are still making not a real family practitioner as a gatekpeeper. Only throughout the trust of patients supported by second opinions is making the real family practitioner as a gatekeeper. "Doctor hopping" could be the reaction by scarcity of trustworthy family practitioners as gatekeepers. The third problem is the choosing of the optimal scale of a network due to the very different optimal size of networks regarding the requirement of risk spreeds, of the motivated engagement, of competition, incentives of inclusion of insurantes, they always need other net sizes. But it is possible, for each requirement there could function different networks. A practice (doctor's office) can be a member in different networks in several levels. The social transition from a small office to a network of offices is in all business lines a cultural shock involving not only benefits also psychical and social distress. In this there is no difference between health or agriculture or each other business of trade and industry. The destiny of the joint doctor's offices in Germany suggest due to a very serious power to scatter this networks. The comparative analysis of conflicts, strains, resources and strategies of associations and networks could yield from a developed methodical repository in sociology and social psychology what exists since 40 years (see also Meyer--in this journal). But therefore must be included also the action problems, which are only mentioned in passing of the according profession horizon.

Forbidden Fruit: The Politics of Researching Young People's Use of Online Sexually Explicit Materials in South African Schools

ERIC Educational Resources Information Center

Carboni, Nicci; Bhana, Deevia

2017-01-01

This paper explores some of the difficulties of doing research concerning young people's use of online sexually explicit materials in three high schools in South Africa. Against the backdrop of young people's sexual agency, we elaborate on the ways in which getting permission to conduct the research unsettled gatekeepers, as research on young…

A Comparative Analysis of Social Work Faculty's Perception of Gatekeeping Procedures and Practices within Online and Traditional MSW Social Work Education

ERIC Educational Resources Information Center

Davis, Audrey R.

2017-01-01

The social work profession evolved from neighborly, volunteer-based efforts into a distinct profession. Throughout the evolvement of the profession, there has been a consistent focus on meeting the needs of the poor, oppressed, and impoverished individuals in a manner that demonstrates competency on behalf of the caregiver or practitioner. Present…

Investigating Approaches to Diversity in a National Survey of Physics Doctoral Degree Programs: The Graduate Admissions Landscape

ERIC Educational Resources Information Center

Potvin, Geoff; Chari, Deepa; Hodapp, Theodore

2017-01-01

Graduate admissions play a critical gatekeeping role in the physics community not only because they select students who are allowed to begin their graduate studies, but also because they influence how students perceive graduate school, and in some cases whether or not they will even choose to apply. In conjunction with the APS Bridge Program, we…

Digital Dividend Aware Business Models for the Creative Industries: Challenges and Opportunities in EU Markets

NASA Astrophysics Data System (ADS)

Cossiavelou, Vassiliki

EU counties have a historically unique opportunity to enable their creative industries to promote the knowledge societies, applying new business models to their media content and networks markets, that are digital dividend (DD) aware. This new extra-media gatekeeping factor could shape new alliances and co operations among the member states and the global media markets, as well.

VA Student Financial Aid. Opportunity To Reduce Overlap in Approving Education and Training Programs. Report to the Committee on Veterans' Affairs, U.S. Senate.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

The Department of Veterans Affairs (VA) contracts with state approving agencies (SAAs) to assess whether schools and training programs offer education of sufficient quality for veterans to receive VA education assistance benefits when attending them. The General Accounting Office examined the gatekeeping activities of the VA and the Department of…

Evaluating a Training Intervention to Prepare Geriatric Case Managers to Assess for Suicide and Firearm Safety

ERIC Educational Resources Information Center

Pope, Natalie D.; Slovak, Karen L.; Giger, Jarod T.

2016-01-01

The purpose of this article is to report on the implementation and initial evaluation of a 1-day training intervention targeting direct care providers in the Ohio aging services network. A primary objective is to describe the training intervention that consisted of two parts: (a) a gatekeeper training for assessing suicide risk among older adults,…

A Randomized Control Trial of a Community Mental Health Intervention for Military Personnel

DTIC Science & Technology

2014-12-01

trial to detect intervention effects. 15. SUBJECT TERMS Mental health literacy , Mental Health First Aid (MHFA), curriculum adaptation 16. SECURITY...KEYWORDS: National Guard; Mental Health First Aid; Mental Health Literacy ; Pilot Study; Veterans; Mental Health; Prevention; Access; Stigma OVERALL...gatekeeper training by providing a mental health literacy component that is currently not addressed. Despite the promise of m-MHFA to have substantial

The Muted Voice of the Catholic Church in Angola

DTIC Science & Technology

2016-12-01

Mozambique despite a common colonial and religious heritage. The analysis suggests that state resistance to international influence, or gatekeeping, is a...freedoms, was weaker in Angola than in Brazil and Mozambique despite a common colonial and religious heritage. The analysis suggests that state resistance...through religious evangelization. Second, this study will shed light on how and why societies institutionalize religious values. Due to advancing

One Small Droplet: News Media Coverage of Peer-Reviewed and University-Based Education Research and Academic Expertise

ERIC Educational Resources Information Center

Yettick, Holly

2015-01-01

Most members of the American public will never read this article. Instead, they will obtain much of their information about education from the news media. Yet little academic research has examined the type or quality of education research and expertise they will find there. Through the lens of gatekeeping theory, this mixed-methods study aims to…

The commodification of international migration: findings from Thailand.

PubMed

Jones, H; Pardthaisong, T

1999-01-01

"The organisation of international contract-labour migration within Asia has been increasingly dominated by commercial agencies acting as intermediaries between workers and foreign employers. The principles underpinning the gatekeeping role of such agencies in the East Asian migration system are examined. A consideration of the international labour recruitment system in Thailand is based on survey work among agents, community leaders and recently returned migrants." excerpt

Risk Dimensions and Political Decisions Frame Environmental Communication: A Content Analysis of Seven U.S. Newspapers from 1970-2010

ERIC Educational Resources Information Center

Grantham, Susan; Vieira, Edward T., Jr.

2014-01-01

This project examined the focus of environmental news frames used in seven American newspapers between 1970 and 2010. During this time newspapers were a primary source of news. Based on gatekeeping and agenda-setting theory, as well as source credibility, the content analysis of 2,123 articles examined the environmental topics within the articles,…

Proceedings of the Annual Meeting of the Association for Education in Journalism and Mass Communication (85th, Miami, Florida, August 5-8, 2002). Visual Communication Division.

ERIC Educational Resources Information Center

2002

The Visual Communication Division of the proceedings contains the following 7 papers: "Photography Editors as Gatekeepers: Choosing Between Publishing or Self-Censoring Disturbing Images of 9-11" (Renee Martin Kratzer and Brian Kratzer); "Jane Campion's 'The Piano': The Female Gaze, the Speculum and the Chora within the…

The Divisive Gate-Keeping Role of Languages in Jamaica: Establishing Post Primary Schools as Centres for Immersion in the Target Language

ERIC Educational Resources Information Center

Davids, Melva P.

2013-01-01

This paper seeks to examine the role of the official and "de facto" languages of anglophone Caribbean islands such as Jamaica. In reflecting on their statuses as users of language, tertiary level students registered in a Year One Performing Arts Program provided much insights into the interplay of both languages that coexist in society…

Super Searchers Go to the Source: The Interviewing and Hands-On Information Strategies of Top Primary Researchers--Online, on the Phone, and in Person. Super Searchers.

ERIC Educational Resources Information Center

Sacks, Risa

This book presents interviews with 12 of the best primary researchers in the business. These research professionals reveal their strategies for integrating online and offline resources, identifying experts, and getting past gatekeepers to obtain information that exists only in someone's head. Topics include how searchers use a combination of…

Case Study: Level 1 Skills to Succeed (S2S) Students and the Gatekeeping Function of GCSEs (General Certificate of Secondary Education) at an FE College

ERIC Educational Resources Information Center

Cornish, Carlene

2017-01-01

Raising of Participation Age (RPA) legislation mandates English youth to participate in post-16 education, employment or training. However, how does this particular college accommodate youth that were so-called disaffected learners and previously not in education, employment and training (NEET)? The aim was to investigate the educational…

Leading Preservice Teachers to Water...and Helping Them Drink: How Candidate Teachability Affects the Gatekeeping and Advocacy Roles of Teacher Educators

ERIC Educational Resources Information Center

Page, Michelle L.; Rudney, Gwen L.; Marxen, Carol E.

2004-01-01

This qualitative study is part of an ongoing, systematic self-study examining preservice teachers' growth from student to teacher. In this phase, the authors specifically explored student teacher growth and development in the context of a constructivist, developmental, and standards-based program. Research questions were: (1) How did a group of…

Adenosine-stress cardiac magnetic resonance imaging in suspected coronary artery disease: a net cost analysis and reimbursement implications.

PubMed

Pilz, Guenter; Patel, Pankaj A; Fell, Ulrich; Ladapo, Joseph A; Rizzo, John A; Fang, Hai; Gunnarsson, Candace; Heer, Tobias; Hoefling, Berthold

2011-01-01

The health and economic implications of new imaging technologies are increasingly relevant policy issues. Cardiac magnetic resonance imaging (CMR) is currently not or not sufficiently reimbursed in a number of countries including Germany, presumably because of a limited evidence base. It is unknown, however, whether it can be effectively used to facilitate medical decision-making and reduce costs by serving as a gatekeeper to invasive coronary angiography. We investigated whether the application of CMR in patients suspected of having coronary artery disease (CAD) reduces costs by averting referrals to cardiac catheterization. We used propensity score methods to match 218 patients from a CMR registry to a previously studied cohort in which CMR was demonstrated to reliably identify patients who were low-risk for major cardiac events. Covariates over which patients were matched included comorbidity profiles, demographics, CAD-related symptoms, and CAD risk as measured by Morise scores. We determined the proportion of patients for whom cardiac catheterization was deferred based upon CMR findings. We then calculated the economic effects of practice pattern changes using data on cardiac catheterization and CMR costs. CMR reduced the utilization of cardiac catheterization by 62.4%. Based on estimated catheterization costs of € 619, the utilization of CMR as a gatekeeper reduced per-patient costs by a mean of € 90. Savings were realized until CMR costs exceeded € 386. Cost savings were greatest for patients at low-risk for CAD, as measured by baseline Morise scores, but were present for all Morise subgroups with the exception of patients at the highest risk of CAD. CMR significantly reduces the utilization of cardiac catheterization in patients suspected of having CAD. Per-patient savings range from € 323 in patients at lowest risk of CAD to € 58 in patients at high-risk but not in the highest risk stratum. Because a negative CMR evaluation has high negative predictive value, its application as a gatekeeper to cardiac catheterization should be further explored as a treatment option.

Student questions in urban middle school science communities of practice

NASA Astrophysics Data System (ADS)

Groome, Meghan

This dissertation examines student questions within three Communities of Practice (CoP), all urban middle school science environments. The study analyzed student questions from a sociocultural perspective and used ethnographic research techniques to detail how the CoP's shaped questions in the classroom. In the first study, two case study girls attempted to navigate questioning events that required them to negotiation participation. Their access to participation was blocked by participation frameworks that elevated some students as "gatekeepers" while suppressing the participation of others. The next two studies detail the introduction of written questioning opportunities, one into a public middle school classroom and the other into an informal classroom. In both studies, students responded to the interventions differently, most notable the adoption of the opportunity by female students who do not participate orally. Dissertation-wide findings indicate all students were able to ask questions, but varied in level of cognitive complexity, and the diagnostic interventions were able to identify students who were not known to be "target students", students who asked a high number of questions and were considered "interested in science". Some students' roles were as "gatekeepers" to participation of their peers. Two out of three teachers in the studies reported major shifts in their teaching practice due to the focus on questions and the methods used here have been found to be effective in producing educational research as well as supporting high-need classrooms in prior research. In conclusion, these studies indicate that social factors, including participation frameworks, gender dynamics, and the availability of alternative participation methods, play an important role in how students ask science-related questions. It is recommended that researchers continue to examine social factors that reduce student questions and modify their teaching strategies to facilitate questioning. This data should be shared with teachers and teacher educators to inform them how to increase and use student questions as well as alternate participation methods that strive for "science for all". Future research should focus on how students act as "gatekeepers" for the participation and potential ways to shift underrepresented students into the STEM pipeline.

Adenosine-stress cardiac magnetic resonance imaging in suspected coronary artery disease: a net cost analysis and reimbursement implications

PubMed Central

Patel, Pankaj A.; Fell, Ulrich; Ladapo, Joseph A.; Rizzo, John A.; Fang, Hai; Gunnarsson, Candace; Heer, Tobias; Hoefling, Berthold

2010-01-01

The health and economic implications of new imaging technologies are increasingly relevant policy issues. Cardiac magnetic resonance imaging (CMR) is currently not or not sufficiently reimbursed in a number of countries including Germany, presumably because of a limited evidence base. It is unknown, however, whether it can be effectively used to facilitate medical decision-making and reduce costs by serving as a gatekeeper to invasive coronary angiography. We investigated whether the application of CMR in patients suspected of having coronary artery disease (CAD) reduces costs by averting referrals to cardiac catheterization. We used propensity score methods to match 218 patients from a CMR registry to a previously studied cohort in which CMR was demonstrated to reliably identify patients who were low-risk for major cardiac events. Covariates over which patients were matched included comorbidity profiles, demographics, CAD-related symptoms, and CAD risk as measured by Morise scores. We determined the proportion of patients for whom cardiac catheterization was deferred based upon CMR findings. We then calculated the economic effects of practice pattern changes using data on cardiac catheterization and CMR costs. CMR reduced the utilization of cardiac catheterization by 62.4%. Based on estimated catheterization costs of € 619, the utilization of CMR as a gatekeeper reduced per-patient costs by a mean of € 90. Savings were realized until CMR costs exceeded € 386. Cost savings were greatest for patients at low-risk for CAD, as measured by baseline Morise scores, but were present for all Morise subgroups with the exception of patients at the highest risk of CAD. CMR significantly reduces the utilization of cardiac catheterization in patients suspected of having CAD. Per-patient savings range from € 323 in patients at lowest risk of CAD to € 58 in patients at high-risk but not in the highest risk stratum. Because a negative CMR evaluation has high negative predictive value, its application as a gatekeeper to cardiac catheterization should be further explored as a treatment option. PMID:20524070

Genetic gatekeepers: regulating direct-to-consumer genomic services in an era of participatory medicine.

PubMed

Palmer, Jessica Elizabeth

2012-01-01

Should consumers be able to obtain information about their own bodies, even if it has no proven medical value? Direct-to-consumer ("DTC") genomic companies offer consumers two services: generation of the consumer's personal genetic sequence, and interpretation of that sequence in light of current research. Concerned that consumers will misunderstand genomic information and make ill-advised health decisions, regulators, legislators and scholars have advocated restricted access to DTC genomic services. The Food and Drug Administration, which has historically refrained from regulating most genetic tests, has announced its intent to treat DTC genomic services as medical devices because they make "medical claims." This Article argues that FDA regulation of genomic services as medical devices would be counterproductive. Clinical laboratories conducting genetic tests are already overseen by a federal regime administered by the Centers for Medicare and Medicaid Services. While consumers and clinicians would benefit from clearer communication of test results and their health implications, FDA's gatekeeping framework is ill-suited to weigh the safety and efficacy of genomic information that is not medically actionable in traditional ways. Playing gatekeeper would burden FDA's resources, conflict with the patient-empowering policies promoted by personalized medicine initiatives, impair individuals' access to information in which they have powerful autonomy interests, weaken novel participatory research infrastructures, and set a poor precedent for the future regulation of medical information. Rather than applying its risk-based regulatory framework to genetic information, FDA should ameliorate regulatory uncertainty by working with the Federal Trade Commission and Centers for Medicare and Medicaid Services to ensure that DTC genomic services deliver analytically valid data, market and implement their services in a truthful manner, and fully disclose the limitations of their services. Federal agencies with relevant expertise should collaborate on standards and best practices for interpreting genetic information in light of scientific uncertainty, and an adverse event reporting system should be established to collect empirical data verifying or disproving the speculative harms resulting from individual access to genetic information. Most of all, FDA should take advantage of this opportunity to adapt its regulatory process to an increasingly informational health ecosystem.

Medical versus fiscal gatekeeping: navigating professional contingencies at the pharmacy counter.

PubMed

Chiarello, Elizabeth

2014-01-01

This paper theorizes that care provision depends on the set of "contingencies," or organizational and institutional structures, rules, narratives, and routines, surrounding professional work. Drawing on 95 interviews with U.S. pharmacists, I demonstrate how pharmacists prioritize specific contingencies and reveal how ethical decision-making depends on both organizational positioning and locus in inter-professional hierarchies. © 2014 American Society of Law, Medicine & Ethics, Inc.

Are You Qualified to Be a Member of This "Elite Group"? A School Leadership Preparation Program Examines the Extent "Diverse" Candidates Are Admitted to Graduate School

ERIC Educational Resources Information Center

Boske, Christa; Elue, Chinasa

2017-01-01

This case outlines a dilemma encountered by faculty in a K-12 educational administration graduate program on the east coast. The case offers a detailed illustration of tensions arising when faculty discuss their graduate admissions process, their role as gatekeepers, understandings of merit, and the need for student diversity. Disrupting…

The evolving role of radiologists within the health care system.

PubMed

Knechtges, Paul Martin; Carlos, Ruth C

2007-09-01

The traditional view of radiologists as physicians who add value to the health care system solely by generating and interpreting diagnostic images is outdated. Radiologists' roles have expanded to encompass economic gatekeeping, political advocacy, public health delivery, patient safety, quality-of-care improvement, and information technology. It is through these roles that radiologists will continue to find new ways to add value to the health care system.

Textual analysis of tobacco editorials: how are Key media gatekeepers framing the issues?

PubMed

Smith, Katherine Clegg; Wakefield, Melanie

2005-01-01

The news media's potential to promote awareness of health issues is established, and media advocacy is now an important tool in combating tobacco use. This study examines newspaper editors' perspectives of tobacco-related issues. This study presents a textual analysis of tobacco-related editorials. The data consist of editorials on tobacco from a sample of 310 U.S. daily newspapers over the course of 1 year (2001). Data were sampled from a random one-third of the days per month, yielding 162 editorials for analysis. A qualitative textual analysis was conducted. Each editorial was coded for theme, position, and frame. We analyzed the topics gaining editorial attention and the arguments made to support various perspectives. Editorials discussed a variety of both positive and negative news events, largely conveying support for tobacco-control objectives. Various organizing frames were used-supporting policy interventions, condemning the industry, highlighting individual rights, and expressing general cynicism were most prevalent. Editors largely promoted tobacco-control efforts, particularly policy advances. There was, however, little coverage of key issues such as health effects and addiction-perhaps because they are no longer perceived to be contentious. Advocates should seek to address this area and minimize the cynicism of key media gatekeepers to avoid undermining policy and individual change efforts.

Discovery of 3-[2-(imidazo[1,2-b]pyridazin-3-yl)ethynyl]-4-methyl-N-{4-[(4-methylpiperazin-1-yl)methyl]-3-(trifluoromethyl)phenyl}benzamide (AP24534), a potent, orally active pan-inhibitor of breakpoint cluster region-abelson (BCR-ABL) kinase including the T315I gatekeeper mutant.

PubMed

Huang, Wei-Sheng; Metcalf, Chester A; Sundaramoorthi, Raji; Wang, Yihan; Zou, Dong; Thomas, R Mathew; Zhu, Xiaotian; Cai, Lisi; Wen, David; Liu, Shuangying; Romero, Jan; Qi, Jiwei; Chen, Ingrid; Banda, Geetha; Lentini, Scott P; Das, Sasmita; Xu, Qihong; Keats, Jeff; Wang, Frank; Wardwell, Scott; Ning, Yaoyu; Snodgrass, Joseph T; Broudy, Marc I; Russian, Karin; Zhou, Tianjun; Commodore, Lois; Narasimhan, Narayana I; Mohemmad, Qurish K; Iuliucci, John; Rivera, Victor M; Dalgarno, David C; Sawyer, Tomi K; Clackson, Tim; Shakespeare, William C

2010-06-24

In the treatment of chronic myeloid leukemia (CML) with BCR-ABL kinase inhibitors, the T315I gatekeeper mutant has emerged as resistant to all currently approved agents. This report describes the structure-guided design of a novel series of potent pan-inhibitors of BCR-ABL, including the T315I mutation. A key structural feature is the carbon-carbon triple bond linker which skirts the increased bulk of Ile315 side chain. Extensive SAR studies led to the discovery of development candidate 20g (AP24534), which inhibited the kinase activity of both native BCR-ABL and the T315I mutant with low nM IC(50)s, and potently inhibited proliferation of corresponding Ba/F3-derived cell lines. Daily oral administration of 20g significantly prolonged survival of mice injected intravenously with BCR-ABL(T315I) expressing Ba/F3 cells. These data, coupled with a favorable ADME profile, support the potential of 20g to be an effective treatment for CML, including patients refractory to all currently approved therapies.

Dispelling myths about a new healthful food can be more motivating than promoting nutritional benefits: the case of Tofu.

PubMed

Wansink, Brian; Shimizu, Mitsuru; Brumberg, Adam

2014-04-01

This study examines what factors impact the adoption of certain types of healthy foods, such as Tofu, by future nutritional gatekeepers. Information on perceived facilitators and barriers to the utilization of barriers would be obtained via interviews and surveys. In-depth laddering interviews and an online survey during 2012 were utilized. The in-depth laddering interviews were conducted with 83 young women and new mothers (non-vegetarians and non-Asians) who were enthusiastic lovers of Tofu. 502 women from the target demographic (between 20 and 35, non-Asian) were recruited from a national panel and surveyed online in 2012. Based on the interviews, 21 primary reasons for trying Tofu (facilitators) and 10 reasons that might be preventative (barriers) were identified. A key finding was that facilitators were not motivating factors for why women adopted Tofu into their diets. Instead, barriers explained more than 44% of the variance for not adopting tofu. When encouraging nutritional gatekeepers to add Tofu to their household diets, it may be more effective to focus on changing the barriers. This study suggests that nutritionists and health practitioners may be more successful in encouraging the adoption of healthy new foods by dispelling their misconceptions rather than focusing on their nutritional benefits. Copyright © 2014 Elsevier Ltd. All rights reserved.

Impartial judgment by the "gatekeepers" of science: fallibility and accountability in the peer review process.

PubMed

Hojat, Mohammadreza; Gonnella, Joseph S; Caelleigh, Addeane S

2003-01-01

High publication demands and the low acceptance rate of peer review journals place the journal editors and their reviewers in a powerful position. Journal reviewers have a vital role not only in influencing the journal editor's publication decisions, but also in the very nature and direction of scientific research. Because of their influence in peer review outcomes, journal reviewers are aptly described as the "gatekeepers of science." In this article we describe several pitfalls that can impede reviewers' impartial judgement. These include such issues as confirmatory bias, the negative results bias (the file drawer problem), the Matthew effect, the Doctor Fox effect, and gender, race, theoretical orientation, and "political correctness." We argue that procedures currently used by many professional journals, such as blind or masked review, may not completely alleviate the effects of these pitfalls. Instead, we suggest that increasing reviewers' awareness of the pitfalls, accountability, and vigilance can improve fairness in the peer review process. The ultimate responsibilities belong to the journal editors who are confronted with the difficult task of satisfying journal readers, contributors, reviewers, and owners. We recommend that the journal editors conduct periodic internal and external evaluations of their journals' peer review process and outcomes, with participation of reviewers, contributors, readers and owners.

Design and Implementation of a Three-Tiered Web-Based Inventory Ordering and Tracking System Prototype Using CORBA and Java

DTIC Science & Technology

2000-03-01

languages yet still be able to access the legacy relational databases that businesses have huge investments in. JDBC is a low-level API designed for...consider the return of investment . The system requirements, discussed in Chapter II, are the main source of input to developing the relational...1996. Inprise, Gatekeeper Guide, Inprise Corporation, 1999. Kroenke, D., Database Processing Fundementals , Design, and Implementation, Sixth Edition

A Defined and Flexible Pocket Explains Aryl Substrate Promiscuity by the Cahuitamycin Starter Unit Activating Enzyme CahJ.

PubMed

Sherman, David H; Tripathi, Ashootosh; Park, Sung Ryeol; Sikkema, Andrew; Cho, Hyo Je; Wu, Jianfeng; Lee, Brian; Xi, Chuanwu; Smith, Janet L

2018-05-09

Cahuitamycins are biofilm inhibitors biosynthesized by a convergent NRPS pathway. Previous genetic analysis indicated that a discrete enzyme, CahJ, serves as a gatekeeper for cahuitamycin structural diversification. Herein, the CahJ protein was probed structurally, functionally and through mutasynthesis. This analysis enabled production of a new cahuitamycin congener through targeted precursor incorporation. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.

PubMed

Shi, Leiyu; Lee, De-Chih; Liang, Hailun; Zhang, Luwen; Makinen, Marty; Blanchet, Nathan; Kidane, Ruth; Lindelow, Magnus; Wang, Hong; Wu, Shaolong

2015-11-30

Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness. The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics. Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by their providers. The study suggested that the Dongguan model (based on insurance mandate and using family practice physicians as 'gate-keepers') seemed to work best in terms of improving access and quality for patients with chronic conditions. The study suggested adequately funded and well-organized primary care system can play a gatekeeping role and has the potential to provide a reasonable level of care to patients.

Modeling the U.S. Border Patrol Tucson Sector for the Deployment and Operations of Border Security Forces

DTIC Science & Technology

2006-03-01

Crime_Trends_2005.pdf (accessed August 3, 2005). Consejo de Seguridad Publica , “Programa de Mediano Plazo 2004 - 2009: Seguridad Publica ,” http...international Southwest border. The issue of illegal human smuggling is not new to the United States- Mexico border or to law enforcement agencies...Operation Gatekeeper; Operation Hold the Line; Operation Stonegarden; Tucson Sector; US Border Patrol; US- Mexico border. 16. PRICE CODE 17. SECURITY

Gatekeeper Training for Suicide Prevention: A Theoretical Model and Review of the Empirical Literature

DTIC Science & Technology

2015-01-01

effectiveness of such trainings or of intervention behaviors. The model is consistent with Bandura’s social cognitive theory , which posits that...interactions between environmental and personal factors influence the learning of new behav- ior ( Bandura , 2001). The model is depicted in Figure 1. In the...A., “ Social Cognitive Theory : An Agentic Perspective,” Annual Review of Clinical Psychology, Vol. 52, 2001, pp. 1–26. Bean, G., and K. M. Baber

A salt bridge turns off the foot-pocket in class-II HDACs.

PubMed

Zhou, Jingwei; Yang, Zuolong; Zhang, Fan; Luo, Hai-Bin; Li, Min; Wu, Ruibo

2016-08-21

Histone Deacetylases (HDACs) are promising anticancer targets and several selective inhibitors have been created based on the architectural differences of foot-pockets among HDACs. However, the "gate-keeper" of foot-pockets is still controversial. Herein, it is for the first time revealed that a conserved R-E salt bridge plays a critical role in keeping foot-pockets closed in class-II HDACs by computational simulations. This finding is further substantiated by our mutagenesis experiments.

An acquired HER2 T798I gatekeeper mutation induces resistance to neratinib in a patient with HER2 mutant-driven breast cancer

PubMed Central

Hanker, Ariella B.; Brewer, Monica Red; Sheehan, Jonathan H.; Koch, James P.; Sliwoski, Gregory R.; Nagy, Rebecca; Lanman, Richard; Berger, Michael F.; Hyman, David M.; Solit, David B.; He, Jie; Miller, Vincent; Cutler, Richard E.; Lalani, Alshad S.; Cross, Darren; Lovly, Christine M.; Meiler, Jens; Arteaga, Carlos L.

2017-01-01

We report a HER2T798I gatekeeper mutation in a patient with HER2L869R-mutant breast cancer with acquired resistance to neratinib. Laboratory studies suggested that HER2L869R is a neratinib-sensitive, gain-of-function mutation that upon dimerization with mutant HER3E928G, also present in the breast cancer, amplifies HER2 signaling. The patient was treated with neratinib and exhibited a sustained partial response. Upon clinical progression, HER2T798I was detected in plasma tumor cell-free DNA. Structural modeling of this acquired mutation suggested that the increased bulk of isoleucine in HER2T798I reduces neratinib binding. Neratinib blocked HER2-mediated signaling and growth in cells expressing HER2L869R but not HER2L869R/T798I. In contrast, afatinib and the osimertinib metabolite AZ5104 strongly suppressed HER2L869R/T798I-induced signaling and cell growth. Acquisition of HER2T798I upon development of resistance to neratinib in a breast cancer with an initial activating HER2 mutation suggests HER2L869R is a driver mutation. HER2T798I-mediated neratinib resistance may be overcome by other irreversible HER2 inhibitors like afatinib. PMID:28274957

Telehealth as gatekeeper: policy implications for geography and scope of services.

PubMed

Kraetschmer, Nancy M; Deber, Raisa B; Dick, Paul; Jennett, Penny

2009-09-01

Why, despite enthusiasm, is telehealth still a relatively minor part of healthcare delivery in many health systems? We examined two less-considered policy issues: (1) the scope of services being offered by telehealth and how this matches existing arrangements for insured services; and (2) how the ability of telehealth services to minimize barriers associated with geography is dealt with in a system organized and financed on geographical boundaries. Fifty-three semistructured interviews with key stakeholders involved in the management of 43 Canadian telehealth programs were conducted. In addition, quantitative activity data were analyzed from 33 telehealth programs. Two telehealth approaches emerged: telephone-based (N = 3), and video-conferencing-based (N = 40). Most programs reflected, rather than superceded, existing geographical boundaries; with the technology being used, the videoconferencing models imposed significant barriers to unfettered access by outlying communities because they required sites to acquire expensive technology, be affiliated with an existing telehealth network, and schedule visits in advance. In consequence, much activity was administrative and educational, rather than clinical, and often extended beyond the set of mandatory insured services. Despite high hopes that telehealth would improve access to care for rural/remote areas, gatekeeping inherent in certain telehealth systems imposes barriers to unfettered use by rural/remote areas, although it does facilitate other valued activities. Policy approaches are needed to promote a closer match between the expectations for telehealth and the realities reflected by many existing models.

[Social change in the physician's role and medical practice caused by managed care in Switzerland].

PubMed

Meyer, P C; Denz, M D

2000-03-01

Switzerland is the first European country where health maintenance organizations (HMOs) characterised by capitation (per capita lumpsum) and gatekeeping were implemented according to the HMO staff model known in the USA. The development of managed health care in Switzerland relies on the belief that adequate economic incentives and competition result in cost reduction and high quality health care. Whether this is true or not--in any case the deregulation of legally accepted forms of health insurance and managed care result in profound changes in the Swiss health care system. Observations are made by using expert interviews and analysis of documents. The implementation of managed care induces socio-cultural changes of the medical profession which are as profound as the induced economic changes. We discuss conflicts of interests among physicians using four main dimensions of conflict: (1) control, (2) monopolization, (3) valuation, and (4) specialization. In the HMOs we observe pronounced conflicts of the physicians' role. The changes of the physicians' role in HMOs is on the one hand the result of new duties. On the other hand it expresses strategies of coping with the role conflict between the main clinical duties and the new obligation to control cost and to monitor treatment via gatekeeping. In HMOs the teamwork of doctors and the quality control of care promotes the satisfaction of physicians with their work, however, it can also have dysfunctional effects.

Endonuclease EEPD1 Is a Gatekeeper for Repair of Stressed Replication Forks*

PubMed Central

Kim, Hyun-Suk; Nickoloff, Jac A.; Wu, Yuehan; Williamson, Elizabeth A.; Sidhu, Gurjit Singh; Reinert, Brian L.; Jaiswal, Aruna S.; Srinivasan, Gayathri; Patel, Bhavita; Kong, Kimi; Burma, Sandeep; Lee, Suk-Hee; Hromas, Robert A.

2017-01-01

Replication is not as continuous as once thought, with DNA damage frequently stalling replication forks. Aberrant repair of stressed replication forks can result in cell death or genome instability and resulting transformation to malignancy. Stressed replication forks are most commonly repaired via homologous recombination (HR), which begins with 5′ end resection, mediated by exonuclease complexes, one of which contains Exo1. However, Exo1 requires free 5′-DNA ends upon which to act, and these are not commonly present in non-reversed stalled replication forks. To generate a free 5′ end, stalled replication forks must therefore be cleaved. Although several candidate endonucleases have been implicated in cleavage of stalled replication forks to permit end resection, the identity of such an endonuclease remains elusive. Here we show that the 5′-endonuclease EEPD1 cleaves replication forks at the junction between the lagging parental strand and the unreplicated DNA parental double strands. This cleavage creates the structure that Exo1 requires for 5′ end resection and HR initiation. We observed that EEPD1 and Exo1 interact constitutively, and Exo1 repairs stalled replication forks poorly without EEPD1. Thus, EEPD1 performs a gatekeeper function for replication fork repair by mediating the fork cleavage that permits initiation of HR-mediated repair and restart of stressed forks. PMID:28049724

A gatekeeping procedure to test a primary and a secondary endpoint in a group sequential design with multiple interim looks.

PubMed

Tamhane, Ajit C; Gou, Jiangtao; Jennison, Christopher; Mehta, Cyrus R; Curto, Teresa

2018-03-01

Glimm et al. (2010) and Tamhane et al. (2010) studied the problem of testing a primary and a secondary endpoint, subject to a gatekeeping constraint, using a group sequential design (GSD) with K=2 looks. In this article, we greatly extend the previous results to multiple (K>2) looks. If the familywise error rate (FWER) is to be controlled at a preassigned α level then it is clear that the primary boundary must be of level α. We show under what conditions one α-level primary boundary is uniformly more powerful than another. Based on this result, we recommend the choice of the O'Brien and Fleming (1979) boundary over the Pocock (1977) boundary for the primary endpoint. For the secondary endpoint the choice of the boundary is more complicated since under certain conditions the secondary boundary can be refined to have a nominal level α'>α, while still controlling the FWER at level α, thus boosting the secondary power. We carry out secondary power comparisons via simulation between different choices of primary-secondary boundary combinations. The methodology is applied to the data from the RALES study (Pitt et al., 1999; Wittes et al., 2001). An R library package gsrsb to implement the proposed methodology is made available on CRAN. © 2017, The International Biometric Society.

Chemotherapeutics-resistance "arms" race: An update on mechanisms involved in resistance limiting EGFR inhibitors in lung cancer.

PubMed

Singh, Pankaj Kumar; Silakari, Om

2017-10-01

Clinical reports suggest that EGFR-mutated lung cancer usually respond significantly towards small molecule tyrosine kinase inhibitors. Same studies also report the eventual development of acquired resistance within a median time interval of 9 to 14months. One of the major mechanisms involved in this acquired resistance was found to be a secondary point mutation at gate-keeper residue, EGFR T790M. However, there are other recent studies which disclose the role of few other novel key players such as, ZEB1, TOPK etc., in the development of tolerance towards the EGFR TKI's, along with other commonly known mechanisms, such as amplification of signalling pathways such as, c-MET, Erbb2, AXL, additional acquired secondary mutations (PIK3CA, BRAF), or phenotypic transformation (small cell or epithelial to mesenchymal transitions). Interestingly, a recent study showed development of resistance via another point mutation, C797S, in case of tumors which were previously resistant and were administered agents capable of overcoming T790M gatekeeper mutation based resistance. Thus, raising serious concern over the direction of drug development involving tyrosine kinases such as EGFR. Current approaches focussing on development of third generation inhibitors, dual inhibitors or inhibitors of HSP90 have shown significant activity but do not answer the long term question of resistance. Copyright © 2017 Elsevier Inc. All rights reserved.

Methods University Health System Can Use to Expand Medicaid Coverage to Uninsured Poor Parents with Medicaid Eligible Children: Policy Analysis

DTIC Science & Technology

2006-03-15

benefits that are monitored by a gatekeeper (J. Simmons personal communication, July 2005). 31 Bexar County Medicaid 32 Bexar County is committed to...and Ella, for their love and support during my residency year. Without you, my life would be empty. I would like to acknowledge the guidance and... Benefits . Carelink Program University Health System Table 7. Evaluation Options For Increasing Access To Care For Uninsured Low-Income Parents Of

Provider Network Development under the Department of Defense Coordinated Care Program: A Methodology for Primary Care Network Development and Its Implementation in the San Antonio Service Area

DTIC Science & Technology

1993-04-01

for using out-of- network benefits . * A gatekeeper physician controls access to the network and is paid on a capitated or discounted fee- for-service...Model ...................... 84 Figure 10. Organization Under Managed Care/HMO Concept ............... 94 APPENDIX 1. Benefit Under CCP 2. Group Model...increases, yet our health indicators have not improved (e.g., infant mortality, adult mortality, morbidity, or life expectancy). The aging population, the

Department of Education Information on Consolidation Opportunities and Student Aid. Testimony before the Subcommittee on Human Resources and the Intergovernmental Relations Committee on Government Reform and Oversight, House of Representatives. Statement of Cornelia M. Blanchette, Associate Director, Education and Employment Issues, Health, Education, and Human Services Division.

ERIC Educational Resources Information Center

Blanchette, Cornelia M.

This report evaluates Department of Education opportunities to consolidate overlapping education programs, to find cost savings, and to strengthen its "gatekeeping" over schools' participation in student financial aid programs. It notes that, besides already proposed program consolidation, other programs that could be streamlined include…

Determinants of healthcare system's efficiency in OECD countries.

PubMed

Hadad, Sharon; Hadad, Yossi; Simon-Tuval, Tzahit

2013-04-01

Firstly, to compare healthcare systems' efficiency (HSE) using two models: one incorporating mostly inputs that are considered to be within the discretionary control of the healthcare system (i.e., physicians' density, inpatient bed density, and health expenditure), and another, including mostly inputs beyond healthcare systems' control (i.e., GDP, fruit and vegetables consumption, and health expenditure). Secondly, analyze whether institutional arrangements, population behavior, and socioeconomic or environmental determinants are associated with HSE. Data envelopment analysis (DEA) was utilized to calculate OECD countries' HSE. Life expectancy and infant survival rate were considered as outputs in both models. Healthcare systems' rankings according to the super-efficiency and the cross-efficiency ranking methods were used to analyze determinants associated with efficiency. (1) Healthcare systems in nine countries with large and stable economies were defined as efficient in model I, but were found to be inefficient in model II; (2) Gatekeeping and the presence of multiple insurers were associated with a lower efficiency; and (3) The association between socioeconomic and environmental indicators was found to be ambiguous. Countries striving to improve their HSE should aim to impact population behavior and welfare rather than only ensure adequate medical care. In addition, they may consider avoiding specific institutional arrangements, namely gatekeeping and the presence of multiple insurers. Finally, the ambiguous association found between socioeconomic and environmental indicators, and a country's HSE necessitates caution when interpreting different ranking techniques in a cross-country efficiency evaluation and needs further exploration.

Tuberin and PRAS40 are anti-apoptotic gatekeepers during early human amniotic fluid stem-cell differentiation.

PubMed

Fuchs, Christiane; Rosner, Margit; Dolznig, Helmut; Mikula, Mario; Kramer, Nina; Hengstschläger, Markus

2012-03-01

Embryoid bodies (EBs) are three-dimensional multicellular aggregates allowing the in vitro investigation of stem-cell differentiation processes mimicking early embryogenesis. Human amniotic fluid stem (AFS) cells harbor high proliferation potential, do not raise the ethical issues of embryonic stem cells, have a lower risk for tumor development, do not need exogenic induction of pluripotency and are chromosomal stable. Starting from a single human AFS cell, EBs can be formed accompanied by the differentiation into cells of all three embryonic germ layers. Here, we report that siRNA-mediated knockdown of the endogenous tuberous sclerosis complex-2 (TSC2) gene product tuberin or of proline-rich Akt substrate of 40 kDa (PRAS40), the two major negative regulators of mammalian target of rapamycin (mTOR), leads to massive apoptotic cell death during EB development of human AFS cells without affecting the endodermal, mesodermal and ectodermal cell differentiation spectrum. Co-knockdown of endogenous mTOR demonstrated these effects to be mTOR-dependent. Our findings prove this enzyme cascade to be an essential anti-apoptotic gatekeeper of stem-cell differentiation during EB formation. These data allow new insights into the regulation of early stem-cell maintenance and differentiation and identify a new role of the tumor suppressor tuberin and the oncogenic protein PRAS40 with the relevance for a more detailed understanding of the pathogenesis of diseases associated with altered activities of these gene products.

The Emotional Gatekeeper: A Computational Model of Attentional Selection and Suppression through the Pathway from the Amygdala to the Inhibitory Thalamic Reticular Nucleus

PubMed Central

Bullock, Daniel; Barbas, Helen

2016-01-01

In a complex environment that contains both opportunities and threats, it is important for an organism to flexibly direct attention based on current events and prior plans. The amygdala, the hub of the brain's emotional system, is involved in forming and signaling affective associations between stimuli and their consequences. The inhibitory thalamic reticular nucleus (TRN) is a hub of the attentional system that gates thalamo-cortical signaling. In the primate brain, a recently discovered pathway from the amygdala sends robust projections to TRN. Here we used computational modeling to demonstrate how the amygdala-TRN pathway, embedded in a wider neural circuit, can mediate selective attention guided by emotions. Our Emotional Gatekeeper model demonstrates how this circuit enables focused top-down, and flexible bottom-up, allocation of attention. The model suggests that the amygdala-TRN projection can serve as a unique mechanism for emotion-guided selection of signals sent to cortex for further processing. This inhibitory selection mechanism can mediate a powerful affective ‘framing’ effect that may lead to biased decision-making in highly charged emotional situations. The model also supports the idea that the amygdala can serve as a relevance detection system. Further, the model demonstrates how abnormal top-down drive and dysregulated local inhibition in the amygdala and in the cortex can contribute to the attentional symptoms that accompany several neuropsychiatric disorders. PMID:26828203

Self-aggregation and coaggregation of the p53 core fragment with its aggregation gatekeeper variant.

PubMed

Lei, Jiangtao; Qi, Ruxi; Wei, Guanghong; Nussinov, Ruth; Ma, Buyong

2016-03-21

Recent studies suggested that p53 aggregation can lead to loss-of-function (LoF), dominant-negative (DN) and gain-of-function (GoF) effects, with adverse cancer consequences. The p53 aggregation-nucleating (251)ILTIITL(257) fragment is a key segment in wild-type p53 aggregation; however, an I254R mutation can prevent it. It was suggested that self-assembly of wild-type p53 and its cross-interaction with mutants differ from the classical amyloid nucleation-growth mechanism. Here, using replica exchange molecular dynamics (REMD) simulations, we studied the cross-interactions of this p53 core fragment and its aggregation rescue I254R mutant. We found that the core fragment displays strong aggregation propensity, whereas the gatekeeper I254R mutant tends to be disordered, consistent with experiments. Our cross-interaction results reveal that the wild-type p53 fragment promotes β-sheet formation of the I254R mutant by shifting the disordered mutant peptides into aggregating states. As a result, the system has similar oligomeric structures, inter-peptide interactions and free energy landscape as the wild type fragment does, revealing a prion-like process. We also found that in the cross-interaction system, the wild-type species has higher tendency to interact with the mutant than with itself. This phenomenon illustrates synergistic effects between the p53 (251)ILTIITL(257) fragment and the mutant resembling prion cross-species propagation, cautioning against exploiting it in drug discovery.

How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes

PubMed Central

Harris, Michael; Frey, Peter; Esteva, Magdalena; Gašparović Babić, Svjetlana; Marzo-Castillejo, Mercè; Petek, Davorina; Petek Ster, Marija; Thulesius, Hans

2017-01-01

Objective European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates. Design Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates. Setting A total of 14 countries. Subjects Consensus groups of PCPs. Main outcome measures Probability of initial presentation to a PCP for four clinical vignettes. Results There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r  = −0.16, 95% CI −0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95% CI −0.83 to −0.12; ovary: r = −0.13, 95% CI −0.57 to 0.38; breast r = 0.14, 95% CI −0.36 to 0.58; bowel: r = 0.20, 95% CI −0.31 to 0.62). Conclusions There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a “PCP-as-gatekeeper” system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival. Key points European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival. PMID:28277044

Reconsidering the Rhizome: A Textual Analysis of Web Search Engines as Gatekeepers of the Internet

NASA Astrophysics Data System (ADS)

Hess, A.

Critical theorists have often drawn from Deleuze and Guattari's notion of the rhizome when discussing the potential of the Internet. While the Internet may structurally appear as a rhizome, its day-to-day usage by millions via search engines precludes experiencing the random interconnectedness and potential democratizing function. Through a textual analysis of four search engines, I argue that Web searching has grown hierarchies, or "trees," that organize data in tracts of knowledge and place users in marketing niches rather than assist in the development of new knowledge.

Scouting, Signaling, and Gatekeeping: Chinese Naval Operations in Japanese Waters and the International Law Implications (China Maritime Study, Number 2)

DTIC Science & Technology

2009-02-01

homing tor- pedoes .27 If so, the Yuan is a potent threat to both surface and subsurface combatants. Supplementing its three Yuan-class vessels, the...Sub in Its Waters Was Chinese,” Voice of America, 12 November 2004, and “Japanese Minister Links China’s Sub Intrusion to Gas Explora- tion,” Voice...2008, available at www.iht.com/articles/ap/2008/ 06/18/asia/AS-GEN-Japan-China-Gas.php. 91. Herman, “Japanese Minister Links China’s Sub Intrusion to

Factors affecting recruitment into depression trials: Systematic review, meta-synthesis and conceptual framework.

PubMed

Hughes-Morley, Adwoa; Young, Bridget; Waheed, Waquas; Small, Nicola; Bower, Peter

2015-02-01

Depression is common and clinical trials are crucial for evaluating treatments. Difficulties in recruiting participants into depression trials are well-documented, yet no study has examined the factors affecting recruitment. This review aims to identify the factors affecting recruitment into depression trials and to develop a conceptual framework through systematic assessment of published qualitative research. Systematic review and meta-synthesis of published qualitative studies. Meta-synthesis involves a synthesis of themes across a number of qualitative studies to produce findings that are "greater than the sum of the parts". ASSIA, CINAHL, Embase, Medline and PsychInfo were searched up to April 2013. Reference lists of included studies, key publications and relevant reviews were also searched. Quality appraisal adopted the "prompts for appraising qualitative research". 7977 citations were identified, and 15 studies were included. Findings indicate that the decision to enter a depression trial is made by patients and gatekeepers based on the patient׳s health state at the time of being approached to participate; on their attitude towards the research and trial interventions; and on the extent to which patients become engaged with the trial. Our conceptual framework highlights that the decision to participate by both the patient and the gatekeeper involves a judgement between risk and reward. Only English language publications were included in this review. Findings from this review have implications for the design of interventions to improve recruitment into depression trials. Such interventions may aim to diminish the perceived risks and increase the perceived rewards of participation. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Suicide-Related Knowledge and Confidence Among Behavioral Health Care Staff in Seven States.

PubMed

Silva, Caroline; Smith, April R; Dodd, Dorian R; Covington, David W; Joiner, Thomas E

2016-11-01

Death by suicide is a serious and growing public health concern in the United States. This noncontrolled, naturalistic study examined professionals' knowledge about suicide and confidence in working with suicidal individuals, comparing those who had received either of two gatekeeper trainings-Question, Persuade, and Refer (QPR) or Applied Suicide Intervention Skills Training (ASIST)-or other suicide-relevant training or no training. Participants (N=16,693) were individuals in various professional roles in the field of behavioral health care in Indiana, Kentucky, New York, Pennsylvania, Tennessee, Texas, and Utah. Participants completed a survey assessing suicide knowledge and skills confidence. Most participants (52.9%) reported no previous suicide prevention or assessment training. Individuals with suicide-relevant training demonstrated greater suicide knowledge and confidence than those with no such training. Among those who had received any training, no differences were found in suicide knowledge; however, individuals who had received ASIST reported greater confidence in working with suicidal individuals, compared with those who had received other training. Professional role and prior experience with a client who had died by suicide had significant positive relationships with suicide knowledge and confidence. Regional differences emerged between states and are examined within the context of statewide suicide prevention initiatives. Increasing access to and incentives for participating in suicide-relevant training among behavioral health care staff may foster a more knowledgeable and confident group of gatekeepers. Future research should examine whether increases in knowledge and confidence among staff translate into actual changes in practice that help protect and serve at-risk individuals.

Structure-Based Mutational Analysis of the Hepatitis C Virus NS3 Helicase

PubMed Central

Tai, Chun-Ling; Pan, Wen-Ching; Liaw, Shwu-Huey; Yang, Ueng-Cheng; Hwang, Lih-Hwa; Chen, Ding-Shinn

2001-01-01

The carboxyl terminus of the hepatitis C virus (HCV) nonstructural protein 3 (NS3) possesses ATP-dependent RNA helicase activity. Based on the conserved sequence motifs and the crystal structures of the helicase domain, 17 mutants of the HCV NS3 helicase were generated. The ATP hydrolysis, RNA binding, and RNA unwinding activities of the mutant proteins were examined in vitro to determine the functional role of the mutated residues. The data revealed that Lys-210 in the Walker A motif and Asp-290, Glu-291, and His-293 in the Walker B motif were crucial to ATPase activity and that Thr-322 and Thr-324 in motif III and Arg-461 in motif VI significantly influenced ATPase activity. When the pairing between His-293 and Gln-460, referred to as gatekeepers, was replaced with the Asp-293/His-460 pair, which makes the NS3 helicase more like the DEAD helicase subgroup, ATPase activity was not restored. It thus indicated that the whole microenvironment surrounding the gatekeepers, rather than the residues per se, was important to the enzymatic activities. Arg-461 and Trp-501 are important residues for RNA binding, while Val-432 may only play a coadjutant role. The data demonstrated that RNA helicase activity was possibly abolished by the loss of ATPase activity or by reduced RNA binding activity. Nevertheless, a low threshold level of ATPase activity was found sufficient for helicase activity. Results in this study provide a valuable reference for efforts under way to develop anti-HCV therapeutic drugs targeting NS3. PMID:11483774

An effective utilization management strategy by dual approach of influencing physician ordering and gate keeping.

PubMed

Elnenaei, Manal O; Campbell, Samuel G; Thoni, Andrea J; Lou, Amy; Crocker, Bryan D; Nassar, Bassam A

2016-02-01

There is increasing recognition of the importance of appropriate laboratory test utilization. We investigate the effect of a multifaceted educational approach that includes physician feedback on individual test ordering, in conjunction with targeted restriction, on the utilization of selected laboratory tests. Scientific evidence was compiled on the usefulness and limitations of tests suspected of being over utilized in our laboratories. A variety of approaches were used to deliver education on each of the targeted tests, with greater focus on primary care physicians (PCPs). Feedback on requesting behavior of these tests was also communicated to the latter group which included an educational component. Laboratory based restriction of testing was also exercised, including the unbundling of our electrolyte panel. PCP requesting patterns for the selected tests were found to be markedly skewed. The interventions implemented over the study period resulted in a substantial 51% reduction in overall ordering of five of the targeted tests equating to an annual marginal cost saving of $60,124. Unbundling of the electrolyte panel resulted in marginal cost savings that equated annually to $42,500 on chloride and $48,000 on total CO2. A multifaceted educational approach combined with feedback on utilization and laboratory driven gate-keeping significantly reduced the number of laboratory tests suspected of being redundant or unjustifiably requested. Laboratory professionals are well positioned to manage demand on laboratory tests by utilizing evidence base in developing specific test ordering directives and gate-keeping rules. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

ISX is a retinoic acid-sensitive gatekeeper that controls intestinal β,β-carotene absorption and vitamin A production

PubMed Central

Lobo, Glenn P.; Hessel, Susanne; Eichinger, Anne; Noy, Noa; Moise, Alexander R.; Wyss, Adrian; Palczewski, Krzysztof; von Lintig, Johannes

2010-01-01

The uptake of dietary lipids from the small intestine is a complex process that depends on the activities of specific membrane receptors with yet unknown regulatory mechanisms. Using both mouse models and human cell lines, we show here that intestinal lipid absorption by the scavenger receptor class B type 1 (SR-BI) is subject to control by retinoid signaling. Retinoic acid via retinoic acid receptors induced expression of the intestinal transcription factor ISX. ISX then repressed the expression of SR-B1 and the carotenoid-15,15′-oxygenase Bcmo1. BCMO1 acts downstream of SR-BI and converts absorbed β,β-carotene to the retinoic acid precursor, retinaldehyde. Using BCMO1-knockout mice, we demonstrated increased intestinal SR-BI expression and systemic β,β-carotene accumulation. SR-BI-dependent accumulation of β,β-carotene was prevented by dietary retinoids that induced ISX expression. Thus, our study revealed a diet-responsive regulatory network that controls β,β-carotene absorption and vitamin A production by negative feedback regulation. The role of SR-BI in the intestinal absorption of other dietary lipids, including cholesterol, fatty acids, and tocopherols, implicates retinoid signaling in the regulation of lipid absorption more generally and has clinical implications for diseases associated with dyslipidemia.—Lobo, G. P., Hessel, S., Eichinger, A., Noy, N., Moise, A. R., Wyss, A., Palczewski, K., von Lintig, J. ISX is a retinoic acid-sensitive gatekeeper that controls intestinal β,β-carotene absorption and vitamin A production. PMID:20061533

Changing the navigator's course: How the increasing rationalization of healthcare influences access for undocumented immigrants under the Affordable Care Act.

PubMed

López-Sanders, Laura

2017-04-01

A number of researchers have shown that brokers (e.g., navigators and street-level bureaucrats) bridge access to healthcare services and information for immigrant patients through rich personal relationships and a mission of ethical care. An open question remains concerning how the increasing rationalization of healthcare over the past few decades influences brokerage for undocumented immigrant patients. Drawing from fieldwork and interviews conducted in California, as the Affordable Care Act (ACA) was implemented, I develop the concept of the "double-embedded-liaison." While other studies treat brokers as acting either as gatekeepers or patient representatives, this study explains how brokers simultaneously operate on multiple planes when new roles are added. I argue that with more formalization and scrutiny at health centers, the impact of brokerage is destabilized and, subsequently, diminished. Two consequences of the double-embedded-liaison brokerage form are: (1) some brokers become disillusioned and exit -resulting in the loss of valuable resources at the health centers, and (2) immigrants move away from the health centers that historically served them. In looking at brokers' simultaneous performance as gatekeepers and representatives, this research extends brokerage typologies and street-level bureaucracy arguments that largely treat brokerage in a mono-planar rather than in a bi-planar mode. Furthermore, in examining the risks and opportunities brokerage brings to addressing health disparities, the study provides insights into the effects of replacing the ACA or repealing it all together in the Post-Obama era. Copyright © 2017 Elsevier Ltd. All rights reserved.

Salt bridge as a gatekeeper against partial unfolding.

PubMed

Hinzman, Mark W; Essex, Morgan E; Park, Chiwook

2016-05-01

Salt bridges are frequently observed in protein structures. Because the energetic contribution of salt bridges is strongly dependent on the environmental context, salt bridges are believed to contribute to the structural specificity rather than the stability. To test the role of salt bridges in enhancing structural specificity, we investigated the contribution of a salt bridge to the energetics of native-state partial unfolding in a cysteine-free version of Escherichia coli ribonuclease H (RNase H*). Thermolysin cleaves a protruding loop of RNase H(*) through transient partial unfolding under native conditions. Lys86 and Asp108 in RNase H(*) form a partially buried salt bridge that tethers the protruding loop. Investigation of the global stability of K86Q/D108N RNase H(*) showed that the salt bridge does not significantly contribute to the global stability. However, K86Q/D108N RNase H(*) is greatly more susceptible to proteolysis by thermolysin than wild-type RNase H(*) is. The free energy for partial unfolding determined by native-state proteolysis indicates that the salt bridge significantly increases the energy for partial unfolding by destabilizing the partially unfolded form. Double mutant cycles with single and double mutations of the salt bridge suggest that the partially unfolded form is destabilized due to a significant decrease in the interaction energy between Lys86 and Asp108 upon partial unfolding. This study demonstrates that, even in the case that a salt bridge does not contribute to the global stability, the salt bridge may function as a gatekeeper against partial unfolding that disturbs the optimal geometry of the salt bridge. © 2016 The Protein Society.

Advancing intercultural competency: Canadian engineering employers' experiences with immigrant engineers

NASA Astrophysics Data System (ADS)

Friesen, Marcia; Ingram, Sandra

2013-05-01

This paper explores Canadian engineering employers' perceptions of and experiences with internationally educated engineers (recent immigrants to Canada) employed in their organisations for varying lengths of time. Qualitative data were collected from employers using focus group methodology. Findings reflected employers' observations of culturally different behaviours and characteristics in their internationally educated employees, employers' reactions to cultural differences ranging from negative attributions to tolerance, and the implementation of largely ad hoc intra-organisational strategies for managing cultural differences in employer-employee relationships. Findings exposed the lack of corporate intercultural competency in the Canadian engineering profession. Equity and gatekeeping implications are discussed.

What Is the Organizational Culture Regarding Use of Family Nurse Practitioners as Perceived by Selected Objective Medical Group Executives

DTIC Science & Technology

1997-05-01

life at work for members of the group. Who’s us? Who’s them? How do we treat us and 8 them? How do we do things around here and why? What...it! No difference between PA and FNP. Great addition as a gatekeeper ! 1 Have recently converted slot and acquired FNP who is working out very well...FL. 12/79-12/80. 4/79-12/79. 5/78-4/79. ui DISCLAIMER STATEMENT Department of Defense This work was supported by the Uniformed Services

Private sector data collection on optoelectronics markets and technologies in the U.S.

NASA Astrophysics Data System (ADS)

Polishuk, Paul J.; Taylor, K.

1992-05-01

Information Gatekeepers Inc. has been in the business of collecting and analyzing information in the fiber optics and optoelectronics industries for the past fourteen years through its publishing and consulting businesses. Since optoelectronic technologies are well reported by the scientific journals and conferences, only data on markets, competitive trends, production capabilities, etc., are discussed in this paper. The paper reviews the present situation of private sector data collection on optoelectronics technologies and markets, the problems that exist in data collection, and possible solutions to what is perceived as a serious national problem.

Gender differences in the socialization of preschoolers' emotional competence.

PubMed

Denham, Susanne A; Bassett, Hideko Hamada; Wyatt, Todd M

2010-01-01

Preschoolers' socialization of emotion and its contribution to emotional competence is likely to be highly gendered. In their work, the authors have found that mothers often take on the role of emotional gatekeeper in the family, and fathers act as loving playmates, but that parents' styles of socialization of emotion do not usually differ for sons and daughters. They also found several themes in the prediction of preschoolers' emotion knowledge and regulation. For example, sometimes mother-father differences in emotional style actually seem to promote such competence, and girls seem particularly susceptible to parental socialization of emotion. (c) Wiley Periodicals, Inc.

The Garrett Lee Smith Memorial Suicide Prevention Program

PubMed Central

Goldston, David B.; Walrath, Christine M.; McKeon, Richard; Puddy, Richard W.; Lubell, Keri M.; Potter, Lloyd B.; Rodi, Michael S.

2011-01-01

Responding to calls for greater efforts to reduce youth suicide, the Garrett Lee Smith (GLS) Memorial Act to date has provided funding for 68 state, territory, and tribal community grants, and 74 college campus grants for suicide prevention efforts. Suicide prevention activities supported by GLS grantees have included education, training programs including gatekeeper training, screening activities, infrastructure for improved linkages to services, crisis hotlines, and community partnerships. Through participation in both local- and cross-site evaluations, GLS grantees are generating data regarding the local context, proximal outcomes, and implementation of programs, as well as opportunities for improvement of suicide prevention efforts. PMID:20560746

The Garrett Lee Smith memorial suicide prevention program.

PubMed

Goldston, David B; Walrath, Christine M; McKeon, Richard; Puddy, Richard W; Lubell, Keri M; Potter, Lloyd B; Rodi, Michael S

2010-06-01

In response to calls for greater efforts to reduce youth suicide, the Garrett Lee Smith (GLS) Memorial Act has provided funding for 68 state, territory, and tribal community grants, and 74 college campus grants for suicide prevention efforts. Suicide prevention activities supported by GLS grantees have included education, training programs (including gatekeeper training), screening activities, infrastructure for improved linkages to services, crisis hotlines, and community partnerships. Through participation in both local- and cross-site evaluations, GLS grantees are generating data regarding the local context, proximal outcomes, and implementation of programs, as well as opportunities for improvement of suicide prevention efforts.

[The sense of taste in a clinical setting].

PubMed

Fjaeldstad, Alexander; Fernandes, Henrique; Nyengaard, Jens Randel; Ovesen, Therese

2018-04-30

As a gatekeeper, taste buds forage chemicals to identify both nutrition and toxins. This can be the decisive difference between initiating the swallow reflex or spitting out the oral contents. In addition to this simple function the sense of taste takes part in more complex relations such as reflexes vs learning, perception vs expectation, and pleasure vs disgust. All relations, which can be perturbed into unbalance, create great discomfort in patients suffering from a dysfunctional sense of taste. This review discusses the most important mechanisms of taste function and dysfunction as well as the possible avenues for treatment of the disorders.

New MSC: MSCs as pericytes are Sentinels and gatekeepers.

PubMed

Caplan, Arnold I

2017-06-01

Human Mesenchymal Stem Cells, hMSCs, were first named over 25 years ago with the "stem cell" nomenclature derived from the fact that we and others could cause these cells to differentiate into a number of different mesodermal phenotypes in cell culture. The capacity to form skeletal tissue in vitro encouraged the use of hMSCs for the fabrication of tissue engineered skeletal repair tissue with subsequent transplantation to in vivo sites. With the current realization that MSCs are derived from perivascular cells, pericytes, and the immunomodulatory and trophic capabilities of MSCs in both in vitro and in vivo test systems, a complete re-evaluation of the role and functions of MSCs in the body was required. Additionally, the skeleton is a preferred organ for cancer dissemination from various tumor malignancies. To date, most efforts to understand skeletal metastasis have focused on the invasive and digestive capability of disseminated tumor cells (DTCs). The contribution of the target organ-specific microvascular structure influencing extravasation is less well understood. Current targeted cancer therapies are designed to alter not only biological functions in DTCs, but also components of the tumor stroma/microenvironment such as blood vessels. We now have a comprehensive image of the critical role of the host vasculature as an instructive niche for DTCs. The focus of this manuscript is to present the current information about MSC function in situ and to emphasize how these new observations provide insight into understanding the role of the pericyte/MSC in skeletal activities including our new hypothesis for how these cells act as a gatekeeper for metastasis of melanoma into bone. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1151-1159, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Getting "to the point": the experience of mothers getting assistance for their adult children who are violent and mentally ill.

PubMed

Copeland, Darcy Ann; Heilemann, MarySue V

2008-01-01

If individuals with mental illness become violent, mothers are most often victims, yet there is little available research addressing how, when, and from whom mothers seek help for themselves or their children when they become victims of this form of familial violence. To describe how mothers understood violence their adult children with mental illness exhibited toward them and to articulate the process mothers used to get assistance and access mental health treatment when this violence occurred. : Grounded theory methods were used to explore and analyze mothers' experiences of violence perpetrated by their adult children with mental illness. Eight mothers of adult children who are violent with a diagnosed Diagnostic and Statistical Manual of Mental Disorders Axis I disorder participated in one to two open-ended interviews. Mothers were of diverse ethnic backgrounds. Getting immediate assistance involved a period of living on high alert, during which mothers waited in frustration for their children to meet criteria for involuntary hospitalization. This was a chaotic and fearful period. Fear and uncertainty eventually outweighed mothers' abilities to manage their children's behavior, at which time they called the police or psychiatric evaluation teams who served as gatekeepers to mental health treatment. Mothers accepted the consequences of being responsible for their children's involuntary hospitalization or of being left home with their children if the gatekeepers did not initiate involuntary hospitalization. Mothers can identify signs of decompensation in their children who are ill and recognize their need for hospitalization. They cannot, however, always access mental health treatment due to their children's refusal or failure to meet legal criteria for involuntary hospitalization. Mothers' inability to intervene early sometimes results in their own violent victimization.

Integrated primary care in Germany: the road ahead.

PubMed

Schlette, Sophia; Lisac, Melanie; Blum, Kerstin

2009-04-20

Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult. Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and 'community medicine nurses'. Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of providers.

Imidazopyridazine Inhibitors of Plasmodium falciparum Calcium-Dependent Protein Kinase 1 Also Target Cyclic GMP-Dependent Protein Kinase and Heat Shock Protein 90 To Kill the Parasite at Different Stages of Intracellular Development

PubMed Central

Moon, Robert W.; Whalley, David; Bowyer, Paul W.; Wallace, Claire; Rochani, Ankit; Nageshan, Rishi K.; Howell, Steven A.; Grainger, Munira; Jones, Hayley M.; Ansell, Keith H.; Chapman, Timothy M.; Taylor, Debra L.; Osborne, Simon A.; Baker, David A.; Tatu, Utpal

2015-01-01

Imidazopyridazine compounds are potent, ATP-competitive inhibitors of calcium-dependent protein kinase 1 (CDPK1) and of Plasmodium falciparum parasite growth in vitro. Here, we show that these compounds can be divided into two classes depending on the nature of the aromatic linker between the core and the R2 substituent group. Class 1 compounds have a pyrimidine linker and inhibit parasite growth at late schizogony, whereas class 2 compounds have a nonpyrimidine linker and inhibit growth in the trophozoite stage, indicating different modes of action for the two classes. The compounds also inhibited cyclic GMP (cGMP)-dependent protein kinase (PKG), and their potency against this enzyme was greatly reduced by substitution of the enzyme's gatekeeper residue at the ATP binding site. The effectiveness of the class 1 compounds against a parasite line expressing the modified PKG was also substantially reduced, suggesting that these compounds kill the parasite primarily through inhibition of PKG rather than CDPK1. HSP90 was identified as a binding partner of class 2 compounds, and a representative compound bound to the ATP binding site in the N-terminal domain of HSP90. Reducing the size of the gatekeeper residue of CDPK1 enabled inhibition of the enzyme by bumped kinase inhibitors; however, a parasite line expressing the modified enzyme showed no change in sensitivity to these compounds. Taken together, these findings suggest that CDPK1 may not be a suitable target for further inhibitor development and that the primary mechanism through which the imidazopyridazines kill parasites is by inhibition of PKG or HSP90. PMID:26711771

Verifiability of diagnostic categories and work ability in the context of disability pension award: A survey on "gatekeeping" among general practitioners in Norway

PubMed Central

Overland, Rein; Overland, Simon; Johansen, Kristian Nyborg; Mykletun, Arnstein

2008-01-01

Background Disability benefits exist to redeem social and financial consequences of reduced work ability from medical conditions. Physicians are responsible for identifying the medical grounds for benefit claims. The aim of this study was to explore physicians' views on verifiability of medical conditions and related work ability in this context. Methods Information on verifiability of diagnostic categories and work ability was obtained from a survey among a representative sample of general practitioners (GPs) in Norway (n = 500, 25.2% response rate). Verifiability was defined as to what extent the assessment is based on objective criteria versus on information from the patient. We enquired about the diagnostic categories used in official statistics on main disability benefit causes in Norway and elsewhere. Results On a scale from 0 (low verifiability) to 5 (high verifiability), the mean level of verifiability across all diagnostic categories was 3.7 (SD = 0.42). Degree of verifiability varied much between diagnostic categories, and was low in e.g. unspecified rheumatism/myalgia and dorsopathies, and high in neoplasms and congenital malformations, deformation and chromosomal abnormalities. Verifiability of work ability was reported to be more problematic than that of diagnostic categories. The diagnostic categories rated as the least verifiable, are also the most common in disability pension awards. Conclusion Verifiability of both diagnostic categories and work ability in disability assessments are reported to be moderate by GPs. We suggest that the low verifiability of diagnostic categories and related work ability assessments in the majority of disability pension awards is important in explaining why GPs find the gatekeeping-function problematic. PMID:18439251

Imidazopyridazine Inhibitors of Plasmodium falciparum Calcium-Dependent Protein Kinase 1 Also Target Cyclic GMP-Dependent Protein Kinase and Heat Shock Protein 90 To Kill the Parasite at Different Stages of Intracellular Development.

PubMed

Green, Judith L; Moon, Robert W; Whalley, David; Bowyer, Paul W; Wallace, Claire; Rochani, Ankit; Nageshan, Rishi K; Howell, Steven A; Grainger, Munira; Jones, Hayley M; Ansell, Keith H; Chapman, Timothy M; Taylor, Debra L; Osborne, Simon A; Baker, David A; Tatu, Utpal; Holder, Anthony A

2015-12-28

Imidazopyridazine compounds are potent, ATP-competitive inhibitors of calcium-dependent protein kinase 1 (CDPK1) and of Plasmodium falciparum parasite growth in vitro. Here, we show that these compounds can be divided into two classes depending on the nature of the aromatic linker between the core and the R2 substituent group. Class 1 compounds have a pyrimidine linker and inhibit parasite growth at late schizogony, whereas class 2 compounds have a nonpyrimidine linker and inhibit growth in the trophozoite stage, indicating different modes of action for the two classes. The compounds also inhibited cyclic GMP (cGMP)-dependent protein kinase (PKG), and their potency against this enzyme was greatly reduced by substitution of the enzyme's gatekeeper residue at the ATP binding site. The effectiveness of the class 1 compounds against a parasite line expressing the modified PKG was also substantially reduced, suggesting that these compounds kill the parasite primarily through inhibition of PKG rather than CDPK1. HSP90 was identified as a binding partner of class 2 compounds, and a representative compound bound to the ATP binding site in the N-terminal domain of HSP90. Reducing the size of the gatekeeper residue of CDPK1 enabled inhibition of the enzyme by bumped kinase inhibitors; however, a parasite line expressing the modified enzyme showed no change in sensitivity to these compounds. Taken together, these findings suggest that CDPK1 may not be a suitable target for further inhibitor development and that the primary mechanism through which the imidazopyridazines kill parasites is by inhibition of PKG or HSP90. Copyright © 2016 Green et al.

North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.

PubMed

Werth, S Rose; Sachdeva, Nidhi; Roberts, Andrew W; Garrettson, Mariana; Ringwalt, Chris; Moss, Leslie A; Pikoulas, Theodore; Skinner, Asheley Cockrell

2014-11-01

The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits.  To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.  We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability.  Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists.  Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.

Population-level preferences for primary care physicians' characteristics in Japan: a structural equation modeling.

PubMed

Takahashi, Osamu; Ohde, Sachiko; Jacobs, Joshua L; Tokuda, Yasuharu; Yanai, Haruo; Okubo, Tomoya; Shimbo, Takuro; Fukuhara, Shunichi; Hinohara, Shigeaki; Fukui, Tsuguya

2010-01-01

Primary care has potential to play a role for improving the patient care in Japanese health care system; however, little information is available about how patients perceive the roles of primary care physicians (PCPs) within the Japanese health care system. We aimed to assess population-level preferences for PCPs and investigated the extent to which preferences vary in relation to different population groups in Japan. Data were extracted from a cross-sectional questionnaire survey in October 2003. An 18-item questionnaire was used to measure the preferences for PCPs. Exploratory factor analysis was performed to identify latent factors, while confirmatory factor analysis was used to evaluate the fit of the structure using structural equation modeling (SEM). Nationally representative sample of the adult Japanese general population was chosen by controlling for age, sex, and the size of cities. A total of 2,453 adults>or=18-years-old were analyzed. SEM provided a 4-factor structural model of the population-level preference for PCPs, such as clinical competence (path coefficient (pc)=0.72), gate-keeping (pc=0.64), communication with patients or specialists (pc=0.49) and high education (pc=0.25) and demonstrated the best goodness-of-fit. Those who were middle aged, have a high family income, and a high level of education, placed more importance on gate-keeping characteristics, and the rural residents emphasized communication rather than clinical competence. Our results indicate that the preferences for PCPs are divided into four main factors and underscore the variation among preferences according to different population groups, such as age, socioeconomic and educational status, and places of living. These variations should be considered to improve the primary care system in Japan.

Integrated primary care in Germany: the road ahead

PubMed Central

Schlette, Sophia; Lisac, Melanie; Blum, Kerstin

2009-01-01

Problem statement Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult. Description of policy development Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and ‘community medicine nurses’. Conclusion and discussion Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of providers. PMID:19513180

Identification and Validation of Small-Gatekeeper Kinases as Drug Targets in Giardia lamblia

PubMed Central

Hennessey, Kelly M.; Smith, Tess R.; Xu, Jennifer W.; Alas, Germain C. M.; Ojo, Kayode K.; Merritt, Ethan A.

2016-01-01

Giardiasis is widely acknowledged to be a neglected disease in need of new therapeutics to address toxicity and resistance issues associated with the limited available treatment options. We examined seven protein kinases in the Giardia lamblia genome that are predicted to share an unusual structural feature in their active site. This feature, an expanded active site pocket resulting from an atypically small gatekeeper residue, confers sensitivity to “bumped” kinase inhibitors (BKIs), a class of compounds that has previously shown good pharmacological properties and minimal toxicity. An initial phenotypic screen for biological activity using a subset of an in-house BKI library found that 5 of the 36 compounds tested reduced trophozoite growth by at least 50% at a concentration of 5 μM. The cellular localization and the relative expression levels of the seven protein kinases of interest were determined after endogenously tagging the kinases. Essentiality of these kinases for parasite growth and infectivity were evaluated genetically using morpholino knockdown of protein expression to establish those that could be attractive targets for drug design. Two of the kinases were critical for trophozoite growth and attachment. Therefore, recombinant enzymes were expressed, purified and screened against a BKI library of >400 compounds in thermal stability assays in order to identify high affinity compounds. Compounds with substantial thermal stabilization effects on recombinant protein were shown to have good inhibition of cell growth in wild-type G. lamblia and metronidazole-resistant strains of G. lamblia. Our data suggest that BKIs are a promising starting point for the development of new anti-giardiasis therapeutics that do not overlap in mechanism with current drugs. PMID:27806042

Impact of clinical presentation and pretest likelihood on the relation between calcium score and computed tomographic coronary angiography.

PubMed

van Werkhoven, Jacob M; de Boer, Stephanie M; Schuijf, Joanne D; Cademartiri, Filippo; Maffei, Erica; Jukema, J Wouter; Boogers, Mark J; Kroft, Lucia J; de Roos, Albert; Bax, Jeroen J

2010-12-15

The purpose of the present study was to assess the impact of clinical presentation and pretest likelihood on the relation between coronary calcium score (CCS) and computed tomographic coronary angiography (CTA) to determine the role of CCS as a gatekeeper to CTA in patients presenting with chest pain. In 576 patients with suspected coronary artery disease (CAD), CCS and CTA were performed. CCS was categorized as 0, 1 to 400, and >400. On CT angiogram the presence of significant CAD (≥50% luminal narrowing) was determined. Significant CAD was observed in 14 of 242 patients (5.8%) with CCS 0, in 94 of 260 patients (36.2%) with CCS 1 to 400, and in 60 of 74 patients (81.1%) with CCS >400. In patients with CCS 0, prevalence of significant CAD increased from 3.9% to 4.1% and 14.3% in nonanginal, atypical, and typical chest pain, respectively, and from 3.4% to 3.9% and 27.3% with a low, intermediate, and high pretest likelihood, respectively. In patients with CCS 1 to 400, prevalence of significant CAD increased from 27.4% to 34.7% and 51.7% in nonanginal, atypical, and typical chest pain, respectively, and from 15.4% to 35.6% and 50% in low, intermediate, and high pretest likelihood, respectively. In patients with CCS >400, prevalence of significant CAD on CT angiogram remained high (>72%) regardless of clinical presentation and pretest likelihood. In conclusion, the relation between CCS and CTA is influenced by clinical presentation and pretest likelihood. These factors should be taken into account when using CCS as a gatekeeper for CTA. Copyright © 2010 Elsevier Inc. All rights reserved.

Content and communication: How can peer review provide helpful feedback about the writing?

PubMed Central

Shashok, Karen

2008-01-01

Background Peer review is assumed to improve the quality of research reports as tools for scientific communication, yet strong evidence that this outcome is obtained consistently has been elusive. Failure to distinguish between aspects of discipline-specific content and aspects of the writing or use of language may account for some deficiencies in current peer review processes. Discussion The process and outcomes of peer review may be analyzed along two dimensions: 1) identifying scientific or technical content that is useful to other researchers (i.e., its "screening" function), and 2) improving research articles as tools for communication (i.e., its "improving" function). However, editors and reviewers do not always distinguish clearly between content criteria and writing criteria. When peer reviewers confuse content and writing, their feedback can be misunderstood by authors, who may modify texts in ways that do not make the readers' job easier. When researchers in peer review confuse the two dimensions, this can lead to content validity problems that foil attempts to define informative variables and outcome measures, and thus prevent clear trends from emerging. Research on writing, revising and editing suggests some reasons why peer review is not always as effective as it might be in improving what is written. Summary Peer review could be improved if stakeholders were more aware of variations in gatekeepers' (reviewers' and editors') ability to provide feedback about the content or the writing. Gatekeepers, academic literacy researchers, and wordface professionals (author's editors, medical writers and translators) could work together to discover the types of feedback authors find most useful. I offer suggestions to help editologists design better studies of peer review which could make the process an even stronger tool for manuscript improvement than it is now. PMID:18237378

Content and communication: how can peer review provide helpful feedback about the writing?

PubMed

Shashok, Karen

2008-01-31

Peer review is assumed to improve the quality of research reports as tools for scientific communication, yet strong evidence that this outcome is obtained consistently has been elusive. Failure to distinguish between aspects of discipline-specific content and aspects of the writing or use of language may account for some deficiencies in current peer review processes. The process and outcomes of peer review may be analyzed along two dimensions: 1) identifying scientific or technical content that is useful to other researchers (i.e., its "screening" function), and 2) improving research articles as tools for communication (i.e., its "improving" function). However, editors and reviewers do not always distinguish clearly between content criteria and writing criteria. When peer reviewers confuse content and writing, their feedback can be misunderstood by authors, who may modify texts in ways that do not make the readers' job easier. When researchers in peer review confuse the two dimensions, this can lead to content validity problems that foil attempts to define informative variables and outcome measures, and thus prevent clear trends from emerging. Research on writing, revising and editing suggests some reasons why peer review is not always as effective as it might be in improving what is written. Peer review could be improved if stakeholders were more aware of variations in gatekeepers' (reviewers' and editors') ability to provide feedback about the content or the writing. Gatekeepers, academic literacy researchers, and wordface professionals (author's editors, medical writers and translators) could work together to discover the types of feedback authors find most useful. I offer suggestions to help editologists design better studies of peer review which could make the process an even stronger tool for manuscript improvement than it is now.

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management

PubMed Central

2012-01-01

Background In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. Methods A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana’s ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. Results The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Conclusion Study’s findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation. PMID:22726666

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management.

PubMed

Atinga, Roger A; Mensah, Sylvester A; Asenso-Boadi, Francis; Adjei, Francis-Xavier Andoh

2012-06-22

In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana's ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Study's findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation.

Getting to “The Point:” The Experience of Mothers Getting Assistance for Their Violent, Mentally Ill, Adult Children

PubMed Central

Copeland, Darcy Ann; Heilemann, MarySue V.

2014-01-01

Background If mentally ill individuals become violent, mothers are most often victims, yet there is little available research addressing how, when, and from whom mothers seek help for themselves and/or their children when they become victims of this form of familial violence. Objectives The purpose of this research was to describe how mothers understood violence their mentally ill, adult children exhibited towards them and to articulate the process mothers used to get assistance and access mental health treatment when this violence occurred. Method Grounded Theory methods were used to explore and analyze mothers’ experiences of violence perpetrated by their mentally ill, adult children. Eight mothers of violent, adult children with a diagnosed DSM Axis I disorder participated in one to two open-ended interviews. Mothers were of diverse ethnic backgrounds. Results Getting immediate assistance involved a period of living on high alert, during which mothers waited in frustration for their children to meet criteria for involuntary hospitalization. This was a chaotic and fearful period. Fear and uncertainty eventually outweighed mothers’ abilities to manage their children’s behavior, at which time they called the police or psychiatric evaluation teams, who served as gatekeepers to mental health treatment. Mothers accepted the consequences of being responsible for their children’s involuntary hospitalization or of being left home with their children if the gatekeepers did not initiate involuntary hospitalization. Discussion Mothers can identify signs of decompensation in their ill children and recognize their need for hospitalization. They cannot, however, always access mental health treatment due to their children’s refusal and/or failure to meet legal criteria for involuntary hospitalization. Mothers’ inability to intervene early sometimes results in their own violent victimization. PMID:18496098

Structural Analysis of DFG-in and DFG-out Dual Src-Abl Inhibitors Sharing a Common Vinyl Purine Template

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

Zhou, Tianjun; Commodore, Lois; Huang, Wei-Sheng

2010-09-30

Bcr-Abl is the oncogenic protein tyrosine kinase responsible for chronic myeloid leukemia (CML). Treatment of the disease with imatinib (Gleevec) often results in drug resistance via kinase mutations at the advanced phases of the disease, which has necessitated the development of new mutation-resistant inhibitors, notably against the T315I gatekeeper mutation. As part of our efforts to discover such mutation resistant Abl inhibitors, we have focused on optimizing purine template kinase inhibitors, leading to the discovery of potent DFG-in and DFG-out series of Abl inhibitors that are also potent Src inhibitors. Here we present crystal structures of Abl bound by twomore » such inhibitors, based on a common N9-arenyl purine, and that represent both DFG-in and -out binding modes. In each structure the purine template is bound deeply in the adenine pocket and the novel vinyl linker forms a non-classical hydrogen bond to the gatekeeper residue, Thr315. Specific template substitutions promote either a DFG-in or -out binding mode, with the kinase binding site adjusting to optimize molecular recognition. Bcr-Abl T315I mutant kinase is resistant to all currently marketed Abl inhibitors, and is the focus of intense drug discovery efforts. Notably, our DFG-out inhibitor, AP24163, exhibits modest activity against this mutant, illustrating that this kinase mutant can be inhibited by DFG-out class inhibitors. Furthermore our DFG-out inhibitor exhibits dual Src-Abl activity, absent from the prototypical DFG-out inhibitor, imatinib as well as its analog, nilotinib. The data presented here provides structural guidance for the further design of novel potent DFG-out class inhibitors against Src, Abl and Abl T315I mutant kinases.« less

Comparison of H.323 and SIP for IP telephony signaling

NASA Astrophysics Data System (ADS)

Dalgic, Ismail; Fang, Hanlin

1999-11-01

Two standards currently compete for the dominance of IP telephony signaling: the H.323 protocol suite by ITU-T, and the Session Initiation Protocol (SIP) by IETF. Both of these signaling protocols provide mechanisms for call establishment and teardown, call control and supplementary services, and capability exchange. We investigate and compare these two protocols in terms of Functionality, Quality of Service (QoS), Scalability, Flexibility, Interoperability, and Ease of Implementation. For fairness of comparison, we consider similar scenarios for both protocols. In particular, we focus on scenarios that involve a gatekeeper for H.323, and a Proxy/Redirect server for SIP. The reason is that medium-to-large IP Telephony systems are not manageable without a gatekeeper or proxy server. We consider all three versions of H.323. In terms of functionality and services that can be supported, H.323 version 2 and SIP are very similar. However, supplementary services in H.323 are more rigorously defined, and therefore fewer interoperability issues are expected among its implementations. Furthermore, H.323 has taken more steps to ensure compatibility among its different versions, and to interoperate with PSTN. The two protocols are comparable in their QoS support [similar call setup delays, no support for resource reservation or class of service (CoS) setting], but H.323 version 3 will allow signaling of the requested CoS. SIP's primary advantages are (1) flexibility to add new features, and (2) relative ease of implementation and debugging. Finally, we note that H.323 and SIP are improving themselves by learning from each other, and the differences between them are diminishing with each new version.

A policy of introducing a new contract and funding system of general practice in Estonia.

PubMed

Lember, Margus

2002-01-01

The socialist bloc of post-war Europe was obliged to follow the Soviet example with a hierarchical, centrally controlled health care system based on polyclinics and other facilities providing extensive specialist services at the first level of contact. All the countries of Central and Eastern Europe have now expressed their wish to totally change their health care systems. Changes in these countries include: the introduction of market economy mechanisms in health care, an increased focus on population health needs in guiding health care systems, and the possibility of introducing a more general type of care at primary level. Patient expectations of access, choice and convenience are factors in shaping new models of health care delivery. Appropriate timing is the key determinant of the success of reforms. In Estonia the beginning of the 1990s was the time when several interest groups in society supported changes in the health care system. The first step after regaining independence was the reintroduction of a Bismarck-type insurance system. In the late 1990s the primary care reforms have changed the initial plans and elements of a National Health Service were introduced, especially general practitioners' lists, capitation payment and gate-keeping principles. The family medicine reform in Estonia has two main objectives: introduction of general practice as a specialty into Estonian health care and changing the remuneration system of primary care doctors. The specific tasks are: to provide practising primary care doctors with opportunities for retraining to gain the specialty status of a general practitioner, to create a list system for the population to register with a primary care doctor, to introduce a partial gate-keeping system and to give the status of the independent contractor to primary care doctors.

The ecology of medical care on an isolated island in Okinawa, Japan: a retrospective open cohort study.

PubMed

Kaneko, Makoto; Matsushima, Masato; Irving, Greg

2017-01-14

We aimed to describe the ecology of medical care on an isolated island with limited access to secondary care, and to evaluate the gatekeeping function of the island's primary care clinic through comparison with a previous nationwide survey. We conducted this retrospective, open cohort study on Iheya, an isolated island in Okinawa Prefecture that has one primary care clinic. We considered Iheya as unique location in which to examine the role of primary care in Japan. Participants were patients who visited the island's clinic between February 1, 2013 and January 31, 2014. We calculated the number of visits to the clinic and referrals to off-island medical facilities using electronic medical records. We also compared data for Iheya with a nationwide survey conducted in 2003. Iheya had 1314 inhabitants in 2013. Of the 5682 visits to the clinic in the 1-year study period, 290 people were referred to off-island medical institutions. There were 64 referrals to emergency departments; of these, 57 people were admitted to hospital. The rate of visits to the clinic per month per 1000 inhabitants was 360.4 visits (95% confidence interval: 351.0-369.7). Of these, 18.4 (16.3-20.5) were referred off-island, with 4.1 (3.1-5.1) referrals to emergency departments and 3.6 (2.6-4.6) hospitalizations. Despite the high incidence of visits to the primary care clinic, the rates of hospital-based outpatient clinic visits, emergency department visits, and hospitalizations were lower than rates reported in a previous Japanese study. This suggests that several dimensions of primary care, its gatekeeping function in particular, are likely to play important roles in this geographical setting.

Psychological Stressors in the Context of Commercial Sex Among Female Sex Workers in China

PubMed Central

Zhang, Chen; Hong, Yan; Li, Xiaoming; Qiao, Shan; Zhou, Yuejiao; Su, Shaobing

2014-01-01

Because of the illegality and stigma associated with female sex workers (FSW) in China, data were limited regarding their psychological stressors examined through the lens of occupational health. Analyzing qualitative data from 16 gatekeepers and 38 FSW, we explored these stressors in the context of commercial sex in China. We found that FSW faced a continuum of stressors that resulted from poverty, limited employment, lack of social protection, violence perpetrated by clients, and limited social support from peers and stable partners. We call for empowerment and a structural approach to address the needs of FSW to improve their psychological well-being. PMID:24180467

Sensitive Interviewing in Qualitative Research.

PubMed

Dempsey, Laura; Dowling, Maura; Larkin, Philip; Murphy, Kathy

2016-12-01

In this paper we focus on important considerations when planning and conducting qualitative interviews on sensitive topics. Drawing on experiences of conducting interviews with dementia caregivers, a framework of essential elements in qualitative interviewing was developed to emphasize study participants' needs while also providing guidance for researchers. Starting with a definition of sensitive research, the framework includes preparing for interviews, interacting with gatekeepers of vulnerable groups, planning for interview timing, and location, building relationships and conducting therapeutic interactions, protecting ethically vulnerable participants, and planning for disengagement. This framework has the potential to improve the effectiveness of sensitive interviewing with vulnerable groups. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

The expert witness. Neither Frye nor Daubert solved the problem: what can be done?

PubMed

Kaufman, H H

2001-01-01

Flawed expert scientific testimony has compromised truth finding in American litigation, including in medical malpractice and in product liability cases. The Federal Rules of Evidence and the Supreme Court in Daubert and other cases have established standards for testimony that include reliability and relevance, and established judges as gatekeepers. However, because of lack of understanding of scientific issues, judges have problems with this role, and juries have difficulties with scientific evidence. Professionals and the judiciary have made some advances, but a better system involving the court's use of neutral experts and a mechanism to hold experts accountable for improprieties is needed.

Nurses need a standard definition of a deprivation of liberty.

PubMed

Griffith, Richard

The House of Commons health committee has called for an urgent review of the implementation of the deprivation of liberty safeguards. They are particularly concerned that nurses, as gatekeepers of the safeguards, often do not know when a deprivation of liberty occurs in practice. In this article the author argues that given the lack of a standard definition of what amounts to a deprivation of liberty and the introduction by the courts of often contradictory factors that nurses are required to consider when determining if a patient is being deprived of their liberty it is little wonder that confusion is common place.

Health Information Systems.

PubMed

Sirintrapun, S Joseph; Artz, David R

2015-06-01

This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care. Copyright © 2015 Elsevier Inc. All rights reserved.

A question of style: method, integrity and the meaning of proper science.

PubMed

Penders, Bart; Vos, Rein; Horstman, Klasien

2009-09-01

Controversies in science often centre on methodology and integrity; these are the gatekeepers of proper science. But what exactly defines proper science as proper is not universal, especially in collaborative fields of enquiry where different perspectives meet. These encounters often result in friction, yet may equally give rise to new perspectives on proper science. A tour of collaborative endeavours like structural biology and nutrigenomics highlights some of those frictions and the controversies that can result from the encounter of 'wet' and 'dry' science. Attuning scientists to the plurality of proper science may safeguard many a scientist's integrity from being questioned unjustly.

Maintaining Masculinity in Mid-Twentieth-Century American Psychology: Edwin Boring, Scientific Eminence, and the "Woman Problem".

PubMed

Rutherford, Alexandra

2015-01-01

Using mid-twentieth-century American psychology as my focus, I explore how scientific psychology was constructed as a distinctly masculine enterprise and was navigated by those who did not conform easily to this masculine ideal. I show how women emerged as problems for science through the vigorous gatekeeping activities and personal and professional writings of disciplinary figurehead Edwin G. Boring. I trace Boring's intellectual and professional socialization into masculine science and his efforts to understand women's apparent lack of scientific eminence, efforts that were clearly undergirded by preexisting and widely shared assumptions about men's and women's capacities and preferences.

Are pharmaceutical marketing decisions calibrated to communications effects?

PubMed

Cavusgil, Erin; Calantone, Roger

2011-10-01

Marketing managers continually struggle with how to maximize the effects of an integrated marketing communications strategy. The growing number of available communication outlets, as well as highly varying competitive landscapes, adds further complexity to this challenge. This empirical study examines the differential impact within a pharmaceutical market therapeutic category where both "push" and "pull" communication strategies operate on consumers and gatekeepers alike, in an atmosphere of unrelenting product innovation and broad competition. Furthermore, we explore how two contingency variables-(a) the competitive landscape, and (b) the product's length of time on the market-interact with these communication efforts and affect brand and category sales.

The modernisation of general practice in the UK: 1980 to 1995 and beyond. Part I.

PubMed Central

Iliffe, S.

1996-01-01

The UK is unusual in providing universal free healthcare in which access to specialists is largely controlled by general practitioners with 24-hour responsibility, throughout the year, for a defined list of patients of all ages. It is generally considered that this gatekeeper function has contributed to the relatively low cost of the National Health Service, but major changes in the organisation and clinical role of general practitioners have occurred, culminating in a new contract that aims to re-orientate general practice towards health promotion, disease prevention and the management of chronic disease. The implications of these changes are discussed. PMID:8733525

Treatment of a Periodontic-Endodontic Lesion in a Patient with Aggressive Periodontitis.

PubMed

Fahmy, Mina D; Luepke, Paul G; Ibrahim, Mohamed S; Guentsch, Arndt

2016-01-01

Case Description. This case report describes the successful management of a left mandibular first molar with a combined periodontic-endodontic lesion in a 35-year-old Caucasian woman with aggressive periodontitis using a concerted approach including endodontic treatment, periodontal therapy, and a periodontal regenerative procedure using an enamel matrix derivate. In spite of anticipated poor prognosis, the tooth lesion healed. This case report also discusses the rationale behind different treatment interventions. Practical Implication. Periodontic-endodontic lesions can be successfully treated if dental professionals follow a concerted treatment protocol that integrates endodontic and periodontic specialties. General dentists can be the gatekeepers in managing these cases.

Treatment of a Periodontic-Endodontic Lesion in a Patient with Aggressive Periodontitis

PubMed Central

2016-01-01

Case Description. This case report describes the successful management of a left mandibular first molar with a combined periodontic-endodontic lesion in a 35-year-old Caucasian woman with aggressive periodontitis using a concerted approach including endodontic treatment, periodontal therapy, and a periodontal regenerative procedure using an enamel matrix derivate. In spite of anticipated poor prognosis, the tooth lesion healed. This case report also discusses the rationale behind different treatment interventions. Practical Implication. Periodontic-endodontic lesions can be successfully treated if dental professionals follow a concerted treatment protocol that integrates endodontic and periodontic specialties. General dentists can be the gatekeepers in managing these cases. PMID:27418983

Design, synthesis and pharmacological evaluation of 2-(thiazol-2-amino)-4-arylaminopyrimidines as potent anaplastic lymphoma kinase (ALK) inhibitors.

PubMed

Liu, Zhiqing; Yue, Xihua; Song, Zilan; Peng, Xia; Guo, Junfeng; Ji, Yinchun; Cheng, Zhen; Ding, Jian; Ai, Jing; Geng, Meiyu; Zhang, Ao

2014-10-30

A series of new 2,4-diarylaminopyrimidine analogues (DAAPalogues) was developed by incorporation of a substituted 2-aminothiazole component as the C-2 substituent of the center pyrimidine core. Compound 5i showed highest potency of 12.4 nM against ALK and 24.1 nM against ALK gatekeeper mutation L1196M. Although only having moderate cellular potency in the SUP-M2 cells harboring NPM-ALK, compound 5i showed good kinase selectivity and dose-dependently inhibited phosphorylation of ALK and its down-stream signaling pathways. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

A periodic table for cancer.

PubMed

Epstein, Richard J

2015-01-01

Cancers exhibit differences in metastatic behavior and drug sensitivity that correlate with certain tumor-specific variables such as differentiation grade, growth rate/extent and molecular regulatory aberrations. In practice, patient management is based on the past results of clinical trials adjusted for these biomarkers. Here, it is proposed that treatment strategies could be fine-tuned upfront simply by quantifying tumorigenic spatial (cell growth) and temporal (genetic stability) control losses, as predicted by genetic defects of cell-cycle-regulatory gatekeeper and genome-stabilizing caretaker tumor suppressor genes, respectively. These differential quantifications of tumor dysfunction may in turn be used to create a tumor-specific 'periodic table' that guides rational formulation of survival-enhancing anticancer treatment strategies.

Kisspeptin and KISS1R: a critical pathway in the reproductive system

PubMed Central

Gianetti, Elena; Seminara, Stephanie

2010-01-01

In 2003, three groups around the world simultaneously discovered that KISS1R (GPR54) is a key gatekeeper of sexual maturation in both mice and men. Developmental changes in the expression of the ligand for KISS1R, kisspeptin, support its critical role in the pubertal transition. In addition, kisspeptin, a powerful stimulus of GNRH-induced gonadotropin secretion and may modulate both positive and negative sex steroid feedback effects at the hypothalamic level. Genetic studies in humans have revealed both loss-of-function and gain-of-function mutations in patients with idiopathic hypogonadotropic hypogonadism and precocious puberty respectively. This review examines the kisspeptin/KISS1R pathway in the reproductive system. PMID:18515314

Identifying opinion leaders to promote behavior change.

PubMed

Valente, Thomas W; Pumpuang, Patchareeya

2007-12-01

This article reviews 10 techniques used to identify opinion leaders to promote behavior change. Opinion leaders can act as gatekeepers for interventions, help change social norms, and accelerate behavior change. Few studies document the manner in which opinion leaders are identified, recruited, and trained to promote health. The authors categorize close to 200 studies that have studied or used opinion leaders to promote behavior change into 10 different methods. They present the advantages and disadvantages of the 10 opinion leader identification methods and provide sample instruments for each. Factors that might influence programs to select one or another method are then discussed, and the article closes with a discussion of combining and comparing methods.

Affirmative Psychological Testing and Neurocognitive Assessment with Transgender Adults.

PubMed

Keo-Meier, Colton L; Fitzgerald, Kara M

2017-03-01

Neither consensus on best practice nor validated neuropsychological, intelligence, or personality testing batteries exist for assessment and psychological testing on the transgender population. Historically, assessment has been used in a gate-keeping fashion with transgender clients. There are no firm standards of care when considering the content and appropriateness of evaluations conducted presurgically. These evaluations are discussed in the setting of other presurgical evaluations, with a recommendation to move toward a competency to make a medical decisions model. Additional considerations are discussed, such as effects of transition on mood and how to interpret scores in a field where normative data are often gender stratified. Copyright © 2016 Elsevier Inc. All rights reserved.

The search for safety, control, and voice for mothers living with the legacy of childhood violence experiences: a critical feminist narrative inquiry.

PubMed

Pitre, Nicole Y; Kushner, Kaysi E; Hegadoren, Kathy M

2011-01-01

We explored the experiences of 12 women who mothered their children while they encountered challenges stemming from the legacy of childhood violence experiences. We examined the participants' narratives through critical, feminist, and symbolic interaction lenses to locate the forces and conditions facilitating and constraining women's mothering choices and decisions. Women's stories revealed their agency in the face of enduring distrust experiences. Women were determined to "change the story." They met pervasive self-doubt with a "search for anchors" and "constant comparisons." Persistent distrust of others meant women relied on "hypervigilance" and "gatekeeping." Implications for knowledge development, research, and practice are discussed.

Science from evaluation: testing hypotheses about differential effects of three youth-focused suicide prevention trainings.

PubMed

Coleman, Daniel; Del Quest, Aisling

2015-01-01

As part of an evaluation component of a youth suicide prevention, a quasi-experimental repeated measures design tested hypotheses about two brief suicide prevention gatekeeper trainings (Question, Persuade, Refer [QPR] and RESPONSE) and one longer suicide intervention skills training (Applied Suicide Intervention Skills Training [ASIST]). All three trainings showed large changes in prevention attitudes and self-efficacy, largely maintained at follow-up. ASIST trainees had large increases in asking at-risk youth about suicide at follow-up. Convergent with other research, modeling and role-play in training are crucial to increased prevention behaviors. Practice and research implications are discussed, including social work roles in suicide prevention and research.

Transitions of Care Model Inclusive of Unplanned Care Improves the Patient Experience

PubMed Central

Cox, Jon; Teague, Stephanie; Beck, Eric

2016-01-01

A major emphasis in health care is creating an experience whereby patients receive the right care at the right time from the right provider in the right setting at the right cost. Over the past several decades, there has been considerable effort in the area of medical management, with prior authorization, gatekeeper utilization management regimens, and other techniques designed to guide patients and caregivers into desired treatment pathways. Alternatively, the concept of demand management may be employed to achieve these desired outcomes by giving patients meaningful, expanded choices beyond traditional acute-care settings. The implementation of a novel, patient-centered, unplanned care delivery model is described along with illustrative case studies. PMID:28725828

School-wide staff and faculty training in suicide risk awareness: successes and challenges.

PubMed

Walsh, Elaine; Hooven, Carole; Kronick, Barbara

2013-02-01

Rates of youth suicide and suicidal behavior remain high despite prevention efforts. Training high school personnel as gatekeepers is an important strategy. Training was implemented in a school district's five comprehensive high schools. Surveys were conducted before and after training sessions, which targeted all adults working at the high school. Two hundred thirty-seven individuals completed the pretest and/or posttest. Participants reported gains in knowledge, confidence, and feelings of competence in recognizing, approaching, and connecting distressed youth to school-based resources. Training was well received. Training is acceptable and appropriate for school personnel. Increasing the number of school personnel who participate in the training is challenging. © 2012 Wiley Periodicals, Inc.

School-wide Staff and Faculty Training in Suicide Risk Awareness: Successes and Challenges

PubMed Central

Walsh, Elaine; Hooven, Carole; Kronick, Barbara

2012-01-01

Problem Rates of youth suicide and suicidal behavior remain high despite prevention efforts. Training high school personnel as gatekeepers is an important strategy. Methods Training was implemented in a school district’s 5 high schools. Surveys were conducted before and after training sessions, which targeted all adults working at the high school. Two-hundred thirty-seven individuals completed the pretest and/or posttest. Findings Participants reported gains in knowledge, confidence, and feelings of competence in recognizing, approaching, and connecting distressed youth to school-based resources. Training was well-received. Conclusion Training is acceptable and appropriate for school personnel. Increasing the number of school personnel who participate in the training is challenging. PMID:23351108

Demands on Intranets — Viable System Model as a Foundation for Intranet Design

NASA Astrophysics Data System (ADS)

Amcoff Nyström, Christina

2006-06-01

The number of Intranets increases in organizations but their potential to support viability is not fully exploited. The cybernetic model, the Viable System Model, has not been connected to the Intranet concept before. Characteristics of the VSM, such as highlighting the importance of production, monitoring of production units through Early Warning Systems, autonomy and empowerment, are used as patterns and a base for de-signing essential parts and/or functions of an Intranet. The result is a brief description of functions vital to the operational parts of organizations. Examples are Early Warning Systems, control systems, "gate-keepers," amplifying and damping information to and from the organization and "agents" supporting search abilities on an Intranet.

Fieldwork and social science research ethics.

PubMed

Contractor, Qudsiya

2008-01-01

Fieldwork as a part of social science research brings the researcher closest to the subject of research. It is a dynamic process where there is an exchange between the researcher, participants, stakeholders, gatekeepers, the community and the larger sociopolitical context in which the research problem is located. Ethical dilemmas that surface during fieldwork often pose a unique challenge to the researcher. This paper is based on field experiences during an action research study conducted with a human rights perspective. It discusses the role conflict that researchers face during fieldwork in a situation of humanitarian crisis. It raises issues pertaining to the need to extend the ethical decision-making paradigm to address ethical dilemmas arising during the course of fieldwork.

Single-step electrochemical functionalization of double-walled carbon nanotube (DWCNT) membranes and the demonstration of ionic rectification

PubMed Central

2013-01-01

Carbon nanotube (CNT) membranes allow the mimicking of natural ion channels for applications in drug delivery and chemical separation. Double-walled carbon nanotube membranes were simply functionalized with dye in a single step instead of the previous two-step functionalization. Non-faradic electrochemical impedance spectra indicated that the functionalized gatekeeper by single-step modification can be actuated to mimic the protein channel under bias. This functional chemistry was proven by a highly efficient ion rectification, wherein the highest experimental rectification factor of ferricyanide was up to 14.4. One-step functionalization by electrooxidation of amine provides a simple and promising functionalization chemistry for the application of CNT membranes. PMID:23758999

Exploring the communication between telenurse and caller-a critical discourse analysis.

PubMed

Hakimnia, Roya; Holmström, Inger K; Carlsson, Marianne; Höglund, Anna T

2014-01-01

Telenursing is an expanding service in most Western societies. Sweden is a front-line country, with all of its 21 counties connected to Swedish Healthcare Direct (SHD) 1177. The intention of the service is twofold: to make health care more efficient, while also making it more accessible and safe for patients. Previous research has shown, however, that the service is not used equitably. Gender, age, socio-economic, and ethnicity differences have been reported as determining factors for the use of the service and the advice given. The aim of the study was to explore the communication between telenurses and callers in authentic calls to SHD 1177. A qualitative method, using critical discourse analysis (CDA), was chosen. The approach was deductive, that is, the analysis was made in view of a predetermined framework of theory. Twenty calls were strategically chosen and included in the study. The CDA resulted in five types of calls, namely a gatekeeping call, a gendered call, a call marked by impersonal traits, a call with voices of the life world, and finally a counter discourse call. The dominating patterns in the calls were of gatekeeping and biomedical character. Patterns of the societal gender order were found, in that representations of the reluctant male caller and the ideal female caller were identified, but also a call representing a counter discourse. The service seemed difficult to use for patients with low language proficiency. Telenursing could potentially challenge inequalities in health care. However, the discourse of telenursing is dialectically related to neoliberal ideology and the ideology of medicine. It is also situated in a gendered context of ideal femininity and hegemonic masculinity. Through better awareness of gender biases and the callers' different resources for making themselves heard, the communication between telenurse and caller might become more equal and thereby better suitable for all callers.

HIV Pre-Exposure Prophylaxis Interest among Female Sex Workers in Guangxi, China

PubMed Central

Zou, Yunfeng; Yang, Xiaobo; Abdullah, Abu S.; Zhong, Xiaoni; Ruan, Yuhua; Lin, Xinqin; Li, Mingqiang; Wu, Deren; Jiang, Junjun; Xie, Peiyan; Huang, Jiegang; Liang, Bingyu; Zhou, Bo; Su, Jinming; Liang, Hao; Huang, Ailong

2014-01-01

Objectives Acceptability of pre-exposure prophylaxis (PrEP) and willingness to participate in a clinical trial for both safety and efficacy of PrEP were investigated among female sex workers (FSWs) in Guangxi, China. Methods A cross-sectional study was performed in three cities in Guangxi. Structured, self-administered questionnaires were used to assess the acceptability of PrEP and the willingness to participate in a clinical trial. Multivariable logistic regression models were fitted to identify predictors. Results Among 405 participants, 15.1% had heard of PrEP. If PrEP was deemed to be effective, safe and provided for free, 85.9% reported that they would accept it, and 54.3% of those who accepted PrEP said that they would participate in a clinical trial. The increased acceptability of PrEP was associated with working in male dominated venues, higher income, a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, not being forced to use condoms by the gatekeepers, consistent use of condoms, and use of drugs to prevent STD infection. The increased willingness to participate in a clinical trial was associated with a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, a willingness to adhere to daily PreP use, and not being concerned about discrimination by others. The main reason for rejecting PrEP or participating in a clinical trial was the concern about the side effects of PrEP. Conclusions Acceptability of PrEP among Guangxi FSWs is relatively high, indicating that PrEP intervention programs may be feasible for Chinese FSWs. Given the fact that most of the participants had never heard of PrEP before, and that family, gatekeepers, and social discrimination could significantly affect its acceptability, a comprehensive mix of multiple interventions is necessary for the successful implementation of a PrEP program among this population in Guangxi. PMID:24465956

[Suicidal behavior prevention for children under age 13: A systematic review].

PubMed

Baux-Cazal, L; Gokalsing, E; Amadeo, S; Messiah, A

2017-05-01

Our objective was to review international literature on suicidal behavior prevention for children under age 13. We gathered all relevant articles on suicide prevention for children under 13. We researched all publications in the French and English languages in PubMed (MEDLINE), PsychINFO and SUDOC databases published until February 2014, with the keywords "child", "child preschool", "prevention and control", "suicide", and "suicide attempted". Publications were included if they described suicidal behavior prevention programs (suicide prevention programs, attempted-suicide prevention programs, suicidal ideation screening programs), and if the studies concerned children under age 13. We also included references cited in the articles if they were not already present in our searches but met inclusion criteria. Studies were excluded if they analyzed populations of children and adolescents without sub-analysis for children under age 13. A total of 350 potentially relevant articles were identified, 33 of which met the inclusion criteria, including 4 retrieved from articles' bibliography. Preventive measures against suicidal behavior for children under 13 exist and include: social programs, maltreatment prevention, curriculum-based suicide prevention programs, suicide screening in schools, gatekeepers, reduction of access of lethal means of suicide, suicide screening by primary care, and post-suicide intervention programs. Overall, the evidence was limited by methodological concerns, particularly a lack of RCTs. However, positive effects were found: school-based suicide prevention programs and gatekeepers increased knowledge about suicide and how to seek help, post-suicide programs helped to reduce psychological distress in the short term. One study showed a decreased risk of attempted-suicide after entry into the child welfare system. There are promising interventions but there is not enough scientific evidence to support any efficient preventive measure against suicidal behavior for children under 13, whether primary, secondary, tertiary or post-intervention. More research is needed. Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

The roles of the conserved tyrosine in the β2-α2 loop of the prion protein.

PubMed

Huang, Danzhi; Caflisch, Amedeo

2015-01-01

Prions cause neurodegenerative diseases for which no cure exists. Despite decades of research activities the function of the prion protein (PrP) in mammalians is not known. Moreover, little is known on the molecular mechanisms of the self-assembly of the PrP from its monomeric state (cellular PrP, PrP(C)) to the multimeric state. The latter state includes the toxic species (scrapie PrP, PrP(Sc)) knowledge of which would facilitate the development of drugs against prion diseases. Here we analyze the role of a tyrosine residue (Y169) which is strictly conserved in mammalian PrPs. Nuclear magnetic resonance (NMR) spectroscopy studies of many mammalian PrP(C) proteins have provided evidence of a conformational equilibrium between a 3(10)-helical turn and a type I β turn conformation in the β2-α2 loop (residues 165-175). In vitro cell-free experiments of the seeded conversion of PrP(C) indicate that non-aromatic residues at position 169 reduce the formation of proteinase K-resistant PrP. Recent molecular dynamics (MD) simulations of monomeric PrP and several single-point mutants show that Y169 stabilizes the 3(10)-helical turn conformation more than single-point mutants at position 169 or residues in contact with it. In the 3(10)-helical turn conformation the hydrophobic and aggregation-prone segment 169-YSNQNNF-175 is buried and thus not-available for self-assembly. From the combined analysis of simulation and experimental results it emerges that Y169 is an aggregation gatekeeper with a twofold role. Mutations related to 3 human prion diseases are interpreted on the basis of the gatekeeper role in the monomeric state. Another potential role of the Y169 side chain is the stabilization of the ordered aggregates, i.e., reduction of frangibility of filamentous protofibrils and fibrils, which is likely to reduce the generation of toxic species.

Discovering indigenous science: Implications for science education

NASA Astrophysics Data System (ADS)

Snively, Gloria; Corsiglia, John

2001-01-01

Indigenous science relates to both the science knowledge of long-resident, usually oral culture peoples, as well as the science knowledge of all peoples who as participants in culture are affected by the worldview and relativist interests of their home communities. This article explores aspects of multicultural science and pedagogy and describes a rich and well-documented branch of indigenous science known to biologists and ecologists as traditional ecological knowledge (TEK). Although TEK has been generally inaccessible, educators can now use a burgeoning science-based TEK literature that documents numerous examples of time-proven, ecologically relevant, and cost effective indigenous science. Disputes regarding the universality of the standard scientific account are of critical importance for science educators because the definition of science is a de facto gatekeeping device for determining what can be included in a school science curriculum and what cannot. When Western modern science (WMS) is defined as universal it does displace revelation-based knowledge (i.e., creation science); however, it also displaces pragmatic local indigenous knowledge that does not conform with formal aspects of the standard account. Thus, in most science classrooms around the globe, Western modern science has been taught at the expense of indigenous knowledge. However, because WMS has been implicated in many of the world's ecological disasters, and because the traditional wisdom component of TEK is particularly rich in time-tested approaches that foster sustainability and environmental integrity, it is possible that the universalist gatekeeper can be seen as increasingly problematic and even counter productive. This paper describes many examples from Canada and around the world of indigenous people's contributions to science, environmental understanding, and sustainability. The authors argue the view that Western or modern science is just one of many sciences that need to be addressed in the science classroom. We conclude by presenting instructional strategies that can help all science learners negotiate border crossings between Western modern science and indigenous science.

Developing a new model for patient recruitment in mental health services: a cohort study using Electronic Health Records

PubMed Central

Callard, Felicity; Broadbent, Matthew; Denis, Mike; Hotopf, Matthew; Soncul, Murat; Wykes, Til; Lovestone, Simon; Stewart, Robert

2014-01-01

Objectives To develop a new model for patient recruitment that harnessed the full potential of Electronic Health Records (EHRs). Gaining access to potential participants’ health records to assess their eligibility for studies and allow an approach about participation (‘consent for contact’) is ethically, legally and technically challenging, given that medical data are usually restricted to the patient's clinical team. The research objective was to design a model for identification and recruitment to overcome some of these challenges as well as reduce the burdensome (and/or time consuming) gatekeeper role of clinicians in determining who is appropriate or not to participate in clinical research. Setting Large secondary mental health services context, UK. Participants 2106 patients approached for ‘consent for contact’. All patients in different services within the mental health trust are gradually and systematically being approached by a member of the clinical care team using the ‘consent for contact’ model. There are no exclusion criteria. Primary and secondary outcome measures Provision of ‘consent for contact’. Results A new model (the South London and Maudsley NHS Trust Consent for Contact model (SLaM C4C)) for gaining patients’ consent to contact them about research possibilities, which is built around a de-identified EHR database. The model allows researchers to contact potential participants directly. Of 2106 patients approached by 25 October 2013, nearly 3 of every 4 gave consent for contact (1560 patients; 74.1%). Conclusions The SLaM C4C model offers an effective way of expediting recruitment into health research through using EHRs. It reduces the gatekeeper function of clinicians; gives patients greater autonomy in decisions to participate in research; and accelerates the development of a culture of active research participation. More research is needed to assess how many of those giving consent for contact subsequently consent to participate in particular research studies. PMID:25468503

Evolving provider payment models and patient access to innovative medical technology.

PubMed

Long, Genia; Mortimer, Richard; Sanzenbacher, Geoffrey

2014-12-01

Abstract Objective: To investigate the evolving use and expected impact of pay-for-performance (P4P) and risk-based provider reimbursement on patient access to innovative medical technology. Structured interviews with leading private payers representing over 110 million commercially-insured lives exploring current and planned use of P4P provider payment models, evidence requirements for technology assessment and new technology coverage, and the evolving relationship between the two topics. Respondents reported rapid increases in the use of P4P and risk-sharing programs, with roughly half of commercial lives affected 3 years ago, just under two-thirds today, and an expected three-quarters in 3 years. All reported well-established systems for evaluating new technology coverage. Five of nine reported becoming more selective in the past 3 years in approving new technologies; four anticipated that in the next 3 years there will be a higher evidence requirement for new technology access. Similarly, four expected it will become more difficult for clinically appropriate but costly technologies to gain coverage. All reported planning to rely more on these types of provider payment incentives to control costs, but didn't see them as a substitute for payer technology reviews and coverage limitations; they each have a role to play. Interviews limited to nine leading payers with models in place; self-reported data. Likely implications include a more uncertain payment environment for providers, and indirectly for innovative medical technology and future investment, greater reliance on quality and financial metrics, and increased evidence requirements for favorable coverage and utilization decisions. Increasing provider financial risk may challenge the traditional technology adoption paradigm, where payers assumed a 'gatekeeping' role and providers a countervailing patient advocacy role with regard to access to new technology. Increased provider financial risk may result in an additional hurdle to the adoption of new technology, rather than substitution of provider- for payer-based gatekeeping.

Crystal structure of a macrophage migration inhibitory factor from Giardia lamblia

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

Buchko, Garry W.; Abendroth, Jan; Robinson, Howard

2013-06-15

Macrophage migration inhibitory factor (MIF) is a eukaryotic cytokine that affects a broad spectrum of immune responses and its activation/inactivation is associated with numerous diseases. During protozoan infections MIF is not only expressed by the host, but, has also been observed to be expressed by some parasites and released into the host. To better understand the biological role of parasitic MIF proteins, the crystal structure of the MIF protein from Giardia lamblia (Gl-MIF), the etiological agent responsible for giardiasis, has been determined at 2.30 Å resolution. The 114-residue protein adopts an α/β fold consisting of a four-stranded β-sheet with twomore » anti-parallel α-helices packed against a face of the β-sheet. An additional short β-strand aligns anti-parallel to β4 of the β-sheet in the adjacent protein unit to help stabilize a trimer, the biologically relevant unit observed in all solved MIF crystal structures to date, and form a discontinuous β-barrel. The structure of Gl-MIF is compared to the MIF structures from humans (Hs-MIF) and three Plasmodium species (falciparum, berghei, and yoelii). The structure of all five MIF proteins are generally similar with the exception of a channel that runs through the center of each trimer complex. Relative to Hs-MIF, there are differences in solvent accessibility and electrostatic potential distribution in the channel of Gl-MIF and the Plasmodium-MIFs due primarily to two “gate-keeper” residues in the parasitic MIFs. For the Plasmodium MIFs the gate-keeper residues are at positions 44 (Y==>R) and 100 (V==>D) and for Gl-MIF it is at position 100 (V==>R). If these gate-keeper residues have a biological function and contribute to the progression of parasitemia they may also form the basis for structure-based drug design targeting parasitic MIF proteins.« less

Evaluation of a multimodal school-based depression and suicide prevention program among Dutch adolescents: design of a cluster-randomized controlled trial.

PubMed

Gijzen, Mandy W M; Creemers, Daan H M; Rasing, Sanne P A; Smit, Filip; Engels, Rutger C M E

2018-05-10

Since 2010, suicide has been the most important cause of mortality in youth aged 15 to 29 years in the Netherlands. Depression is an important risk factor for suicidal behaviors (i.e., suicide ideation, deliberate self-harm, planning, and suicide attempts) in adolescents. Adolescents who develop depressive symptoms, are also at risk for adult depression. This developmental continuity is especially noticeable in adolescents compared to other age groups; therefore, it is necessary to develop preventive strategies for teens. This study will test a multimodal school-based approach to suicide and depression prevention, which integrates universal and targeted approaches and includes various stakeholders (schools, adolescents, parents, and mental health professionals) simultaneously. We will perform a cluster randomized controlled trial (RCT) with an intervention and control condition to test the effectiveness of a school-based multimodal stepped-prevention program for depression and suicidal behaviors in adolescents. Adolescents in their second year of secondary education will participate in the study. The participants in the intervention condition will receive the entire multimodal stepped-preventive program comprising early screening and detection of suicidal behaviors and depressive symptoms, a safety net consisting of gatekeepers at school, followed by universal and indicated prevention. The participants in the control condition will undergo only the screening and the safety net of gatekeepers at schools. They will complete assessments at baseline, post-intervention, and 6, 12, and 24-month follow-up. Primary outcome will be suicidal behaviors measured at 12-months follow-up. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of the program on various secondary outcomes. If the school-based multimodal stepped-prevention program proves to be effective, it could be implemented in schools on a large scale. The study is registered in the Dutch Trial Register ( NTR6622 ).

sequence of Gl-MIF and the other Crystal structure of a macrophage migration inhibitory factor from Giardia lamblia

PubMed Central

Abendroth, Jan; Robinson, Howard; Zhang, Yanfeng; Hewitt, Stephen N.; Edwards, Thomas E.; Van Voorhis, Wesley C.; Myler, Peter J.

2013-01-01

Macrophage migration inhibitory factor (MIF) is a eukaryotic cytokine that affects a broad spectrum of immune responses and its activation/inactivation is associated with numerous diseases. During protozoan infections MIF is not only expressed by the host, but, has also been observed to be expressed by some parasites and released into the host. To better understand the biological role of parasitic MIF proteins, the crystal structure of the MIF protein from Giardia lamblia (Gl-MIF), the etiological agent responsible for giardiasis, has been determined at 2.30 Å resolution. The 114-residue protein adopts an α/β fold consisting of a four-stranded β-sheet with two anti-parallel α-helices packed against a face of the β-sheet. An additional short β-strand aligns anti-parallel to β4 of the β-sheet in the adjacent protein unit to help stabilize a trimer, the biologically relevant unit observed in all solved MIF crystal structures to date, and form a discontinuous β-barrel. The structure of Gl-MIF is compared to the MIF structures from humans (Hs-MIF) and three Plasmodium species (falciparum, berghei, and yoelii). The structure of all five MIF proteins are generally similar with the exception of a channel that runs through the center of each trimer complex. Relative to Hs-MIF, there are differences in solvent accessibility and electrostatic potential distribution in the channel of Gl-MIF and the Plasmodium-MIFs due primarily to two “gate-keeper” residues in the parasitic MIFs. For the Plasmodium MIFs the gate-keeper residues are at positions 44 (Y⇒R) and 100 (V⇒D) and for Gl-MIF it is at position 100 (V⇒R). If these gate-keeper residues have a biological function and contribute to the progression of parasitemia they may also form the basis for structure-based drug design targeting parasitic MIF proteins. PMID:23709284

An Australian government dental scheme: Doctor-dentist-patient tensions in the triangle.

PubMed

Weerakoon, Arosha; Fitzgerald, Lisa; Porter, Suzette

2014-11-30

Autonomy of participants is challenged when legislation to provide a public health service is weakly designed and implemented. Australia's Chronic Disease Dental Scheme was instigated to provide a government subsidy for private dental treatment for people suffering chronic illness impacting their oral health or vice versa. They were allocated AUD$4250 towards comprehensive treatment over 2 years with their eligibility determined by their general medical doctor. A qualitative research study was conducted to explore the experiences from the perspectives of the patient, medical and dental practitioner. One of the research outcomes identified a frequently reported level of discomfort in the patient/doctor/dentist triangle. Doctors and dentists reported feeling forced by patients into positions that compromised their autonomy in obeying the intent (if not the law) of the scheme. Additionally, dentists felt under pressure from doctors and patients to provide subsidized treatment to those eligible. In turn, the patients reported difficulties in gaining access to the scheme and in some cases, experiencing full or partially unmet oral health needs. REASON FOR CONFLICT: Poor inter-professional communication and lack of understanding about profession-unique patient-driven pressures, ultimately contributed to dissonance. Ill-defined eligibility guidelines rendered the doctor's ability to gate-keep challenging. OUTCOME OF CONFLICT: Inefficient gate-keeping led to exponential increase in referrals, resulting in unprecedented cost blow-outs. Ensuing government-led audits caused political tensions and contributed to the media-induced vilification of dentists. In December 2013, government financing of dental treatment through Chronic Disease Dental Scheme was discontinued, leaving many Australians without a viable alternative. There is a need for qualitative research methods to help identify social issues that affect public health policy process. In order to succeed, new health policies should respect, consider and attempt to understand the autonomy of key participants, prior to and throughout.

Patient and parent views on a Web 2.0 Diabetes Portal--the management tool, the generator, and the gatekeeper: qualitative study.

PubMed

Nordfeldt, Sam; Hanberger, Lena; Berterö, Carina

2010-05-28

The Internet has undergone rapid development, with significant impact on social life and on modes of communication. Modern management of type 1 diabetes requires that patients have access to continuous support and learning opportunities. Although Web 2.0 resources can provide this support, few pediatric clinics offer it as part of routine diabetes care. We aimed to explore patients' and parents' attitudes toward a local Web 2.0 portal tailored to young patients with type 1 diabetes and their parents, with social networking tools such as message boards and blogs, locally produced self-care and treatment information, and interactive pedagogic devices. Opportunities and obstacles to the implementation of Web 2.0 applications in clinical practice were sought. Participants were 16 mothers, 3 fathers, and 5 young patients (ages 11-18 years; median 14 years) who each wrote an essay on their experience using the portal, irrespective of frequency and/or their success in using it. Two main guiding questions were asked. A qualitative content analysis was conducted of the essays as a whole. Three main categories of portal users' attitudes were found; we named them "the management tool," "the generator," and "the gatekeeper." One category was related to the management tool functionality of the portal, and a wide range of concrete examples was found regarding useful facts and updates. Being enabled to search when necessary and find reliable information provided by local clinicians was regarded as a great advantage, facilitating a feeling of security and being in control. Finding answers to difficult-to-ask questions, questions portal users did not know they had before, and questions focusing on sensitive areas such as anxiety and fear, was also an important feature. A second category was related to the generator function in that visiting the portal could generate more information than expected, which could lead to increased use. Active message boards and chat rooms were found to have great value for enhancing mediation of third party peer-to-peer information. A certain level of active users from peer families and visible signs of their activity were considered necessary to attract returning users. A third category was related to the gatekeeper function of the password requirement, which created various access problems. This and other unsuccessful experiences caused users to drop the portal. A largely open portal was suggested to enhance use by those associated with the child with diabetes, such as school personnel, relatives, friends and others, and also by young users somewhat unwilling to self-identify with the disease. Web 2.0 services have great potential for supporting parents and patients with type 1 diabetes by enhancing their information retrieval and disease management. Well-developed services, such as this one, may generate continued use and should, therefore, be carefully maintained and updated by health care professionals who are alert and active on the site with new information and updates. Login procedures should be simple and minimized as much as possible. The education of clinical practitioners regarding the use of Web 2.0 resources needs more attention.

Understanding Transgender and Medically Assisted Gender Transition: Feminism as a Critical Resource.

PubMed

Nelson, Jamie Lindemann

2016-11-01

Feminism has fought the trivialization of women's experiences, championed women's security, and insisted on respect for women's choices. In so doing, feminism has developed important perspectives on the complicated connections between what gender means as it plays itself in people's lives, and the inequalities of power and authority that structure much of human experience. Here, I put a few of these perspectives into contact with an issue where the interactions of gender and power are squarely in play: medicine's role in assisting gender transitioning generally and, specifically, the enduring controversy between medicine and many transgender people about the pathologization of transgender and the role of clinicians as gatekeepers to gender-transition interventions. © 2016 American Medical Association. All Rights Reserved.

Gatekeepers of science: attitudes toward the research participation of adults with intellectual disability.

PubMed

McDonald, Katherine E; Keys, Christopher B; Henry, David B

2008-11-01

Researchers and Institutional Review Board (IRB) members' attitudes influence scientific knowledge about individuals with intellectual disability. We recruited 260 intellectual disability researchers and IRB members to develop a measure of attitudes toward the research participation of adults with intellectual disability, the Participation in Research Attitude Scale. Findings suggest three conceptual domains: Opportunity and Choice, Help in Decision Making, and Beneficence. We also examined individual differences in attitudes and the relationships between general and specific attitudes. In general, intellectual disability researchers and those with closer relationships to individuals with disabilities had attitudes consistent with disability-rights principles. Some dimensions of global attitudes toward adults with intellectual disability predictedmore specific attitudes toward their research participation. Implications are discussed.

Can We Really Prevent Suicide?

PubMed Central

Schwartz-Lifshitz, Maya; Zalsman, Gil; Giner, Lucas; Oquendo, Maria A.

2012-01-01

Every year, suicide is among the top 20 leading causes of death globally for all ages. Unfortunately, suicide is difficult to prevent, in large part because the prevalence of risk factors is high among the general population. In this review, clinical and psychological risk factors are examined and methods for suicide prevention are discussed. Prevention strategies found to be effective in suicide prevention include means restriction, responsible media coverage, and general public education, as well identification methods such as screening, gatekeeper training, and primary care physician education. Although the treatment for preventing suicide is difficult, follow-up that includes pharmacotherapy, psychotherapy, or both may be useful. However, prevention methods cannot be restricted to the individual. Community, social, and policy interventions will also be essential. PMID:22996297

Extended-spectrum antiprotozoal bumped kinase inhibitors: A review.

PubMed

Van Voorhis, Wesley C; Doggett, J Stone; Parsons, Marilyn; Hulverson, Matthew A; Choi, Ryan; Arnold, Samuel L M; Riggs, Michael W; Hemphill, Andrew; Howe, Daniel K; Mealey, Robert H; Lau, Audrey O T; Merritt, Ethan A; Maly, Dustin J; Fan, Erkang; Ojo, Kayode K

2017-09-01

Many life-cycle processes in parasites are regulated by protein phosphorylation. Hence, disruption of essential protein kinase function has been explored for therapy of parasitic diseases. However, the difficulty of inhibiting parasite protein kinases to the exclusion of host orthologues poses a practical challenge. A possible path around this difficulty is the use of bumped kinase inhibitors for targeting calcium-dependent protein kinases that contain atypically small gatekeeper residues and are crucial for pathogenic apicomplexan parasites' survival and proliferation. In this article, we review efficacy against the kinase target, parasite growth in vitro, and in animal infection models, as well as the relevant pharmacokinetic and safety parameters of bumped kinase inhibitors. Copyright © 2017 Elsevier Inc. All rights reserved.

Teachers' Perspectives on Preventing Suicide in Children and Adolescents in Schools: A Qualitative Study.

PubMed

Ross, Victoria; Kõlves, Kairi; De Leo, Diego

2017-07-03

Given the important role teachers play as gatekeepers in school suicide prevention, this study explored teachers' perspectives on what should be done to improve current suicide prevention efforts. The study, in Queensland, Australia, was part of a large-scale survey examining teachers' knowledge, attitudes and experience of suicidality. One hundred and fifteen teachers responded to an online survey question regarding their views on the requirements for school suicide prevention. Qualitative analysis identified five themes from teachers' responses: awareness and stigma reduction, support services for students, education and training, bullying and the role of social media. The results of this study provide some profound insights into teachers' perspectives on suicide and highlight the critical need for improved suicide prevention efforts in schools.

Perceptions and psychosocial correlates of bullying among Lumbee Indian youth.

PubMed

Bell, Ronny; Arnold, Elizabeth; Golden, Shannon; Langdon, Sarah; Anderson, Andrea; Bryant, Alfred

2014-01-01

Although bullying has been linked to suicide among youth, little is known about bullying in American Indians, a population at high risk for suicide. Qualitative data from focus groups with Lumbee Indian youth (N = 31, 16 males, 15 females, 12-17 years of age) and in-depth interviews with gatekeepers in the Lumbee community revealed that bullying is common, and is perceived to contribute to depression and suicide. Youth expressed powerlessness to overcome bullying. Survey data (N = 79, 32 males, 47 females, 11-18 years of age) showed that bullied youth (11.5%) had lower self-esteem and higher levels of depressive symptoms. Interventions are needed to address this behavior that contributes to poor psychosocial health in Lumbee youth.

Pharmaceutical company influences on medication prescribing and their potential impact on quality use of medicines.

PubMed

Kyle, G J; Nissen, L M; Tett, S E

2008-10-01

Pharmaceuticals are big business, reporting strong market growth year after year. The 'gatekeepers' of this market are prescribers of medicines, who are the major target of pharmaceutical companies, utilizing direct and indirect influences. This paper draws on previous research investigating pharmaceutical company prescribing influences to develop a qualitative model demonstrating the synergism between commercial influences on prescribing. The generic model was used to explore a realistic but hypothetical scenario to ascertain the applicability of the model. A generic influence model was developed. The model was readily able to be adapted to reflect a realistic practice scenario. Prescriber awareness of the linkages between various seemingly separate marketing techniques could potentially improve medicines usage in an evidence-based practice paradigm.

Discovery of 4-chloro-3-(5-(pyridin-3-yl)-1,2,4-oxadiazole-3-yl)benzamides as novel RET kinase inhibitors.

PubMed

Han, Mei; Li, Shan; Ai, Jing; Sheng, Rong; Hu, Yongzhou; Hu, Youhong; Geng, Meiyu

2016-12-01

A series of novel 4-chloro-benzamides derivatives containing substituted five-membered heteroaryl ring were designed, synthesized and evaluated as RET kinase inhibitors for cancer therapy. Most of compounds exhibited moderate to high potency in ELISA-based kinase assay. In particular, compound I-8 containing 1,2,4-oxadiazole strongly inhibited RET kinase activity both in molecular and cellular level. In turn, I-8 inhibited cell proliferation driven by RET wildtype and gatekeeper mutation. The results implied that 4-chloro-3-(5-(pyridin-3-yl)-1,2,4-oxadiazole-3-yl)benzamides are promising lead compounds as novel RET kinase inhibitor for further investigation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Novel tetracyclic benzo[b]carbazolones as highly potent and orally bioavailable ALK inhibitors: design, synthesis, and structure-activity relationship study.

PubMed

Jiang, Xiaolong; Zhou, Ji; Ai, Jing; Song, Zilan; Peng, Xia; Xing, Li; Xi, Yong; Guo, Junfeng; Yao, Qizheng; Ding, Jian; Geng, Meiyu; Zhang, Ao

2015-11-13

Four series of tetracyclic benzo[b]carbazolone compounds possessing more rotatable bonds and higher molecular flexibility were designed by either inserting a linker within the C8-side chain or by opening the middle ketone ring on the basis of compound 5 (Alectinib, CH5424802). Compound 15b was identified showing nearly identical high potency against both wild-type and the gatekeeper mutant ALK kinase (3.4 vs 3.9 nM). This compound has favorable PK profile with an oral bioavailability of 67.1% in rats. Moreover, compound 15b showed significant growth inhibition against ALK driven cancer cells and KARPAS-299 xenograft model. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Women's characteristics and gender role attitudes: support for father involvement with children.

PubMed

Hoffman, C D; Moon, M

1999-12-01

Women's (N = 364) personal characteristics and gender role attitudes were examined in relation to their support for father involvement with children. The respondents completed measures of trust, attitudes toward women, hostility, self-esteem, and father involvement. Nontraditional gender role attitudes, positive ratings of their own interpersonal trust, and low hostility toward men were predictive of the respondents' support for father involvement. Participant demographics (including age, marital status, and number of children) were unrelated to their views of father involvement. Results indicate the importance of considering the characteristics and attitudes women bring to the co-parental relationship in the examination of factors influencing father involvement with children. Findings are discussed within the context of mothers' primary child-care and gatekeeping roles.

Cancer-related direct-to-consumer advertising: a critical review.

PubMed

Kontos, Emily Z; Viswanath, K

2011-02-01

The direct-to-consumer advertising (DTCA) phenomenon has received attention because of its attempt to reach out to consumers by bypassing important gatekeepers such as physicians. The emergence of new information platforms and the introduction of genetic tests directly to the consumer have heightened the concern with DTCA and its potential consequences. These effects of DTCA are particularly important given the communication inequalities among social groups, with class, race and ethnicity influencing how people access, seek, process and act on information. This Science and Society article reviews the major issues regarding general and cancer-related DTCA and also offers data from a national survey in the United States as an example of the communication inequalities in genetic testing awareness.

PERCEPTIONS AND PSYCHOSOCIAL CORRELATES OF BULLYING AMONG LUMBEE INDIAN YOUTH

PubMed Central

Bell, Ronny; Arnold, Elizabeth; Golden, Shannon; Langdon, Sarah; Anderson, Andrea; Bryant, Alfred

2014-01-01

Although bullying has been linked to suicide among youth, little is known about bullying in American Indians, a population at high risk for suicide. Qualitative data from focus groups with Lumbee Indian youth (N = 31, 16 males, 15 females, 12–17 years of age) and in-depth interviews with gatekeepers in the Lumbee community revealed that bullying is common, and is perceived to contribute to depression and suicide. Youth expressed powerlessness to overcome bullying. Survey data (N = 79, 32 males, 47 females, 11–18 years of age) showed that bullied youth (11.5%) had lower self-esteem and higher levels of depressive symptoms. Interventions are needed to address this behavior that contributes to poor psychosocial health in Lumbee youth. PMID:24788918

Partisan Bias in Message Selection: Media Gatekeeping of Party Press Releases

PubMed Central

Haselmayer, Martin; Wagner, Markus; Meyer, Thomas M.

2017-01-01

Parties try to shape media coverage in ways that are favorable to them, but what determines whether media outlets pick up and report on party messages? Based on content analyses of 1,496 party press releases and 6,512 media reports from the 2013 Austrian parliamentary election campaign, we show that media coverage of individual party messages is influenced not just by news factors, but also by partisan bias. The media are therefore more likely to report on messages from parties their readers favor. Importantly, this effect is greater rather than weaker when these messages have high news value. These findings have important implications for understanding the media’s role in elections and representative democracies in general. PMID:29170614

Is the Sky Falling? Grade Inflation and the Signaling Power of Grades

PubMed Central

Pattison, Evangeleen; Grodsky, Eric; Muller, Chandra

2014-01-01

Grades are the fundamental currency of our educational system; they signal academic achievement and non-cognitive skills to parents, employers, postsecondary gatekeepers, and students themselves. Grade inflation compromises the signaling value of grades, undermining their capacity to achieve the functions for which they are intended. We challenge the ‘increases in grade point average’ definition of grade inflation and argue that grade inflation must be understood in terms of the signaling power of grades. Analyzing data from four nationally representative samples, we find that in the decades following 1972: (a) grades have risen at high schools and dropped at four-year colleges, in general, and selective four-year institutions, in particular; and (b) the signaling power of grades has attenuated little, if at all. PMID:25288826

Strategies to circumvent the T315I gatekeeper mutation in the Bcr-Abl tyrosine kinase

PubMed Central

Bose, Prithviraj; Park, Haeseong; Al-Khafaji, Jawad; Grant, Steven

2013-01-01

Despite the remarkable success of imatinib against Bcr-Abl, development of secondary resistance, most often due to point mutations in the Bcr-Abl tyrosine kinase (TK) domain, is quite common. Of these, the T315I “gatekeeper” mutation is resistant to all currently registered Bcr-Abl TK inhibitors (TKIs) with the notable exception of ponatinib (Iclusig™), which was very recently approved by the United States Food and Drug Administration (FDA). Besides ponatinib, numerous strategies have been developed to circumvent this problem. These include the protein synthesis inhibitor omacetaxine (Synribo®), and “switch-control” inhibitors. Dual Bcr-Abl and aurora kinase inhibitors represent another promising strategy. Finally, several promising synergistic combinations, such as TKIs with histone deacetylase inhibitors (HDACIs), warrant attention. PMID:23977454

'A pill for every ill': explaining the expansion in medicine use.

PubMed

Busfield, Joan

2010-03-01

This paper explores the major factors underpinning the expansion in medicine use over recent decades, using England as an example. It begins by constructing a 'progressive' model of the expansion and considers its limitations; it then uses a framework of countervailing powers to examine the contribution of key actors in the field. It examines the commercial orientation of the pharmaceutical industry and the strategies companies deploy to generate demand for their products. It explores the part played by doctors as researchers and gatekeepers to medicines, considering how features of medical knowledge and practice contribute to, rather than curtail, the expansion. It considers the role of the public as consumers of medicines, and the role of governments and insurance companies in both facilitating and controlling medicine use. Copyright 2009. Published by Elsevier Ltd.

Divorcing Strain Classification from Species Names.

PubMed

Baltrus, David A

2016-06-01

Confusion about strain classification and nomenclature permeates modern microbiology. Although taxonomists have traditionally acted as gatekeepers of order, the numbers of, and speed at which, new strains are identified has outpaced the opportunity for professional classification for many lineages. Furthermore, the growth of bioinformatics and database-fueled investigations have placed metadata curation in the hands of researchers with little taxonomic experience. Here I describe practical challenges facing modern microbial taxonomy, provide an overview of complexities of classification for environmentally ubiquitous taxa like Pseudomonas syringae, and emphasize that classification can be independent of nomenclature. A move toward implementation of relational classification schemes based on inherent properties of whole genomes could provide sorely needed continuity in how strains are referenced across manuscripts and data sets. Copyright © 2016 Elsevier Ltd. All rights reserved.

DSM-5 and posttraumatic stress disorder.

PubMed

Levin, Andrew P; Kleinman, Stuart B; Adler, John S

2014-01-01

The latest iteration of the posttraumatic stress disorder (PTSD) criteria presented in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes specific elaborations of the gatekeeper criteria, a new category of stressor, an expansion in the number of symptoms, addition of a new subtype of PTSD, and an enlarged text discussion that breaks new ground in defining the criteria. We first trace the rationale underlying these changes and their impact on the prevalence of PTSD diagnoses in clinical studies and then present potential implications of the new criteria for forensic assessment methodology and the detection of malingering, interpretations of criminal responsibility and mitigation, evaluation of the reliability of witnesses, the scope of claims in civil and employment cases, and eligibility for disability. © 2014 American Academy of Psychiatry and the Law.

Ethical and effective ethnographic research methods: a case study with afghan refugees in California.

PubMed

Smith, Valerie J

2009-09-01

SCHOLARLY STUDIES OF REFUGEES and other vulnerable populations carry special ethical concerns. In this invited case study of Afghan refugees in Fremont, California, I provide illustrations and recommendations of ethical research methods with refugees. I also compare and contrast some ethical issues in the U.S. with issues in Thailand. The qualitative, ethnographic methods I report here demonstrate how to conduct culturally sensitive investigations by ethically approaching gatekeepers and other community members to preserve autonomy, ensure confidentiality, build trust, and improve the accuracy of interpretations and results. Six groups at risk for being marginalized in multiple ways within refugee populations are described. Ten best practices are recommended for ethically acquiring an in-depth understanding of the refugees, their community, and appropriate research methods.

The neonatal methylome as a gatekeeper in the trajectory to childhood asthma.

PubMed

DeVries, Avery; Vercelli, Donata

2017-04-01

Asthma is a heterogeneous group of conditions that typically begin in early life and result in recurrent, reversible bronchial obstruction. The role played by epigenetic mechanisms in the pathogenesis of childhood asthma is understood only in part. Here we discuss asthma epigenetics within a developmental perspective based on our recent demonstration that the epigenetic trajectory to childhood asthma begins at birth. We next discuss how this trajectory may be affected by prenatal environmental exposures. Finally, we examine in vitro studies that model the impact of asthma-associated exposures on the epigenome. All of these studies specifically surveyed human DNA methylation and involved a genome-wide component. In combination, their results broaden our understanding of asthma pathogenesis and the role the methylome plays in this process.

Wayward Relations: Novel Searches of the Donor-Conceived for Genetic Kinship.

PubMed

Klotz, Maren

2016-01-01

Searching and finding supposedly anonymous sperm donors or half-siblings by diverting direct-to-consumer genetic testing is a novel phenomenon. I refer to such new forms of kinship as 'wayward relations,' because they are often officially unintended and do not correspond to established kinship roles. Drawing on data mostly from the United Kingdom, Germany and the United States, I argue that wayward relations are a highly contemporary means of asserting agency in a technological world characterized by tensions over knowledge acquisition. I make the case that such relations reaffirm the genetic grounding of kinship, but do not displace other ways of relating--they are complementary not colonizing. Wayward relations challenge the gate-keeper status of fertility clinics and regulators over genetic knowledge and classical notions of privacy.

[GERD: endoscopic antireflux therapies].

PubMed

Caca, K

2006-08-02

A couple of minimally-invasive, endoscopic antireflux procedures have been developed during the last years. Beside endoscopic suturing these included injection/implantation technique of biopolymers and application of radiofrequency. Radiofrequency (Stretta) has proved only a very modest effect, while implantation techniques have been abandoned due to lack of long-term efficacy (Gatekeeper) or serious side effects (Enteryx). While first generation endoluminal suturing techniques (EndoCinch, ESD) demonstrated a proof of principle their lack of durability, due to suture loss, led to the development of a potentially durable transmural plication technique (Plicator). In a prospective-randomized, sham-controlled trial the Plicator procedure proved superiority concerning reflux symptoms, medication use and esophageal acid exposure (24-h-pH-metry). While long-term data have to be awaited to draw final conclusions, technical improvements will drive innovation in this field.

Innovation adoption processes for third party property management companies

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

Shockman, Chris; Piette, Mary Ann

2000-07-01

Innovation adoption studies have never been applied to third party property management companies. These companies manage buildings for a fee as their primary business. Property management companies are influential in the adoption process for new technologies because they act as gatekeepers for technical information. This study analyzes radical and routine adoption process that are found in large, professionally operated property management companies. The process is explicated. The technical managers, and their role as technology gate keepers, are described. The distinction to the technical managers between routine and radical technology is that routine technologies do something in a new way andmore » radical technologies do something new. Observations concerning evaluation and adoption of information technologies are described. The findings suggest methods of successfully tailoring and introducing technologies to this market.« less

Sumoylation promotes optimal APC/C Activation and Timely Anaphase.

PubMed

Lee, Christine C; Li, Bing; Yu, Hongtao; Matunis, Michael J

2018-03-08

The Anaphase Promoting Complex/Cyclosome (APC/C) is a ubiquitin E3 ligase that functions as the gatekeeper to mitotic exit. APC/C activity is controlled by an interplay of multiple pathways during mitosis, including the spindle assembly checkpoint (SAC), that are not yet fully understood. Here, we show that sumoylation of the APC4 subunit of the APC/C peaks during mitosis and is critical for timely APC/C activation and anaphase onset. We have also identified a functionally important SUMO interacting motif in the cullin-homology domain of APC2 located near the APC4 sumoylation sites and APC/C catalytic core. Our findings provide evidence of an important regulatory role for SUMO modification and binding in affecting APC/C activation and mitotic exit. © 2018, Lee et al.

Female puberty acceleration by male odour in mice: neural pathway and behavioural consequences.

PubMed

Jouhanneau, Mélanie; Szymanski, Laura A; Keller, Matthieu

2014-08-01

In female mice, exposure to male chemosignals results in early puberty onset characterized by advanced vaginal opening and higher uterine weight. Evidence suggests that the male chemosignals responsible for acceleration of female puberty are androgen-dependent, but not all of the compounds that contribute to puberty acceleration have been identified. The male chemosignals are primarily detected and processed by the vomeronasal system including the vomeronasal organ, the accessory olfactory bulb and the medial amygdala. By contrast, the mechanism by which this olfactory information is integrated in the hypothalamus is poorly understood. In this context, the recent identification of the neuropeptide kisspeptin as a gatekeeper of puberty onset may provide a good candidate neuropeptide system for the transmission of chemosensory information to the gonadotrope axis.

Indigenous knowledge and languages in the teaching and learning of science: A focus on a rural primary school in Zimbabwe

NASA Astrophysics Data System (ADS)

Shizha, Edward

Teachers are known for their "gate-keeping" roles in schools, especially in the classroom setting. They process and decide what "knowledge" is "valid" and "appropriate" for students. They also decide when and how the knowledge should be mediated to students. Their gate-keeping role marginalizes some forms of knowledge while validating and legitimating others. This qualitative and constructivist-interpretive case study is an exploration and description of ten rural primary school teachers' experiences in teaching science using indigenous perspectives in Zimbabwe. The purpose of the study was to discover and describe, using qualitative inquiry, how teachers incorporate indigenous knowledge and languages in teaching science in a rural primary school in Zimbabwe. The study also sought to understand teachers' mediation techniques in the process of bridging the cultural gap between formal science and indigenous knowledge that students bring into the classroom from home. In this study, I elicited, from teachers, their understanding of the interconnectedness of indigenous knowledge and Western science. I employed qualitative inquiry to collect data from them in their natural working environment, the school and the classroom. Purposive sampling was utilized to select ten teachers who were observed teaching two science lessons each. All the lessons were captured using a video recorder, which facilitated the collection of as much information as possible from events occurring in the classroom. Later, semi-structured interviews/conversations were audio-recorded from the same teachers to elicit their insights and experiences in teaching science using indigenous perspectives and languages. Policy documents and science syllabuses were also perused for information on what teachers were expected to teach in science. Inductive analysis was employed to interpret findings that resulted in thick and in-depth narratives. The findings from these narratives revealed differences and similarities in teachers' views and experiences, and their fears and concerns in using indigenous knowledge and languages to teach science in Zimbabwe. The conclusions derived from these findings, though specific to the teachers in this study, gave rise to policy and pedagogical recommendations for increasing the use of indigenous knowledge and languages in the science curriculum in Zimbabwe.

Using the PRECEDE-PROCEED model for an online peer-to-peer suicide prevention and awareness for depression (SPAD) intervention among African American college students: experimental study.

PubMed

Shanta Bridges, Ledetra; Sharma, Manoj; Lee, Jung Hye Sung; Bennett, Russell; Buxbaum, Sarah G; Reese-Smith, Jacqueline

2018-01-01

Background: Suicide rates are high among African American students because they are at a greater risk of depression. A commonly used suicide prevention approach is the gatekeeper training. However, gatekeeper training is neither evidence-based nor has it been identified as culturally-appropriate for African American college students. Therefore, the purpose of this study was to develop and evaluate an online peer-to-peer PRECEDE-PROCEED model based depression awareness and suicide prevention program that was culturally appropriate for African American college students. Methods: The setting was a predominantly Black institution in southern USA. A pre-experimental repeated measures one group design was used to measure changes in peer educators' (n = 29) predisposing factors regarding knowledge, skills and attitudes pertaining to depression, reinforcing factors or receiving support from peers, healthcare professionals and teachers to help someone with depression, enabling factors or sureness of finding organizations to help someone with depression, and behavior for helping someone with depression at pretest, posttest and 1-month follow-up. A posttest only one group design was also used to measure effect on predisposing factors and behavior of students (n = 300) trained by peer educators. Results: There were statistically significant improvements in attitudes related to depression as disease (P = 0.003; η 2 = 0.39), attitudes about managing depression (P = 0.0001; η 2 = 0.30), skills(P = 0.0001; η 2 = 0.41), reinforcing factors (P = 0.018; η 2 = 0.13), enabling factors (P = 0.0001;η 2 = 0.31), and behavior (P = 0.016; η 2 = 0.14). Changes in knowledge about depression and attitudes about helping people with depression were not statistically significant over time for peer educators. The peer-to-peer training was not completely effective in transferring corresponding changes for students trained by peers. Conclusion: The program was effective for peer educators but peers could not significantly influence other students in all domains. This study provides a starting point toward evidencebased approaches for health promotion interventionists addressing depression awareness and suicide prevention among African American college students.

`Googling' Terrorists: Are Northern Irish Terrorists Visible on Internet Search Engines?

NASA Astrophysics Data System (ADS)

Reilly, P.

In this chapter, the analysis suggests that Northern Irish terrorists are not visible on Web search engines when net users employ conventional Internet search techniques. Editors of mass media organisations traditionally have had the ability to decide whether a terrorist atrocity is `newsworthy,' controlling the `oxygen' supply that sustains all forms of terrorism. This process, also known as `gatekeeping,' is often influenced by the norms of social responsibility, or alternatively, with regard to the interests of the advertisers and corporate sponsors that sustain mass media organisations. The analysis presented in this chapter suggests that Internet search engines can also be characterised as `gatekeepers,' albeit without the ability to shape the content of Websites before it reaches net users. Instead, Internet search engines give priority retrieval to certain Websites within their directory, pointing net users towards these Websites rather than others on the Internet. Net users are more likely to click on links to the more `visible' Websites on Internet search engine directories, these sites invariably being the highest `ranked' in response to a particular search query. A number of factors including the design of the Website and the number of links to external sites determine the `visibility' of a Website on Internet search engines. The study suggests that Northern Irish terrorists and their sympathisers are unlikely to achieve a greater degree of `visibility' online than they enjoy in the conventional mass media through the perpetration of atrocities. Although these groups may have a greater degree of freedom on the Internet to publicise their ideologies, they are still likely to be speaking to the converted or members of the press. Although it is easier to locate Northern Irish terrorist organisations on Internet search engines by linking in via ideology, ideological description searches, such as `Irish Republican' and `Ulster Loyalist,' are more likely to generate links pointing towards the sites of research institutes and independent media organisations than sites sympathetic to Northern Irish terrorist organisations. The chapter argues that Northern Irish terrorists are only visible on search engines if net users select the correct search terms.

In tepid defense of population health: physicians and antibiotic resistance.

PubMed

Saver, Richard S

2008-01-01

Antibiotic resistance menaces the population as a dire public health threat and costly social problem. Recent proposals to combat antibiotic resistance focus to a large degree on supply side approaches. Suggestions include tinkering with patent rights so that pharmaceutical companies have greater incentives to discover novel antibiotics as well as to resist overselling their newer drugs already on market. This Article argues that a primarily supply side emphasis unfortunately detracts attention from physicians' important demand side influences. Physicians have a vital and unavoidably necessary role to play in ensuring socially optimal access to antibiotics. Dismayingly, physicians' management of the antibiotic supply has been poor and their defense of population health tepid at best. Acting as a prudent steward of the antibiotic supply often seems to be at odds with a physician's commonly understood fiduciary duties, ethical obligations, and professional norms, all of which traditionally emphasize the individual health paradigm as opposed to population health responsibilities. Meanwhile, physicians face limited incentives for antibiotic conservation from other sources, such as malpractice liability, regulatory standards, and reimbursement systems. While multifaceted efforts are needed to combat antibiotic resistance effectively, physician gatekeeping behavior should become a priority area of focus. This Article considers how health law and policy tools could favorably change the incentives physicians face for antibiotic conservation. A clear lesson from the managed care reform battles of the recent past is that interventions, to have the best chance of success, need to respect physician interest in clinical autonomy and individualized medicine even if, somewhat paradoxically, vigorously promoting population health perspectives. Also, physicians' legal and ethical obligations need to be reconceptualized in the antibiotic context in order to better support gatekeeping in defense of population health. The principal recommendation is for increased use of financial incentives to reward physicians for compliance with recommended guidelines on antibiotic prescribing. Although not a panacea, greater experimentation with financial incentives can provide a much needed jump-start to physician interest in antibiotic conservation and likely best address physicians' legitimate clinical autonomy concerns.

What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care.

PubMed

Philips, Hilde; Remmen, Roy; Van Royen, Paul; Teblick, Marc; Geudens, Leo; Bronckaers, Marc; Meeuwis, Herman

2010-07-30

Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice. We used a prospective before/after interventional study design. The intervention was the implementation of a GPC. One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836). One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.

What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care

PubMed Central

2010-01-01

Background Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice. Methods We used a prospective before/after interventional study design. The intervention was the implementation of a GPC. Results One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836). Conclusions One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care. PMID:20673342

Astrocytes as gate-keepers in optic nerve regeneration--a mini-review.

PubMed

García, Dana M; Koke, Joseph R

2009-02-01

Animals that develop without extra-embryonic membranes (anamniotes--fish, amphibians) have impressive regenerative capacity, even to the extent of replacing entire limbs. In contrast, animals that develop within extra-embryonic membranes (amniotes--reptiles, birds, mammals) have limited capacity for regeneration as adults, particularly in the central nervous system (CNS). Much is known about the process of nerve development in fish and mammals and about regeneration after lesions in the CNS in fish and mammals. Because the retina of the eye and optic nerve are functionally part of the brain and are accessible in fish, frogs, and mice, optic nerve lesion and regeneration (ONR) has been extensively used as a model system for study of CNS nerve regeneration. When the optic nerve of a mouse is severed, the axons leading into the brain degenerate. Initially, the cut end of the axons on the proximal, eye-side of the injury sprout neurites which begin to grow into the lesion. Simultaneously, astrocytes of the optic nerve become activated to initiate wound repair as a first step in reestablishing the structural integrity of the optic nerve. This activation appears to initiate a cascade of molecular signals resulting in apoptotic cell death of the retinal ganglion cells axons of which make up the neural component of the optic nerve; regeneration fails and the injury is permanent. Evidence specifically implicating astrocytes comes from studies showing selective poisoning of astrocytes at the optic nerve lesion, along with activation of a gene whose product blocks apoptosis in retinal ganglion cells, creates conditions favorable to neurites sprouting from the cut proximal stump, growing through the lesion and into the distal portion of the injured nerve, eventually reaching appropriate targets in the brain. In anamniotes, astrocytes ostensibly present no such obstacle since optic nerve regeneration occurs without intervention; however, no systematic study of glial involvement has been done. In fish, vigorously growing neurites sprout from the cut axons and within a few days begin to re-enervate the brain. This review offers a new perspective on the role of glia, particularly astrocytes, as "gate-keepers;" i.e., as being permissive or inhibitory, by comparison between fish and mammals of glial function during ONR.

Staurosporine scaffold-based rational discovery of the wild-type sparing reversible inhibitors of EGFR T790M gatekeeper mutant in lung cancer with analog-sensitive kinase technology.

PubMed

Song, Xiaoyun; Liu, Xingcai; Ding, Xi

2017-04-01

The human epidermal growth factor receptor (EGFR) has been established as an attractive target for lung cancer therapy. However, an acquired EGFR T790M gatekeeper mutation is frequently observed in patients treated with first-line anticancer agents such as gefitinib and erlotinib to cause drug resistance, largely limiting the application of small-molecule kinase inhibitors in EGFR-targeted chemotherapy. Previously, the reversible pan-kinase inhibitor staurosporine and its several analogs such as Gö6976 and K252a have been reported to selectively inhibit the EGFR T790M mutant (EGFR T790M ) over wild-type kinase (EGFR WT ), suggesting that the staurosporine scaffold is potentially to develop the wild-type sparing reversible inhibitors of EGFR T790M . Here, we systematically evaluated the inhibitor response of 28 staurosporine scaffold-based compounds to EGFR T790M mutation at structural, energetic, and molecular levels by using an integrated in silico-in vitro analog-sensitive (AS) kinase technology. With the strategy, we were able to identify 4 novel wild-type sparing inhibitors UCN-01, UCN-02, AFN941, and SB-218078 with high or moderate selectivity of 30-, 45-, 5-, and 8-fold for EGFR T790M over EGFR WT , respectively, which are comparable with or even better than that of the parent compound staurosporine (24-fold). Molecular modeling and structural analysis revealed that van der Waals contacts and hydrophobic forces can form between the side chain of mutated residue Met790 and the pyrrolidinone moiety of inhibitor ligand UCN-02, which may simultaneously improve the favorable interaction energy between the kinase and inhibitor, and reduce the unfavorable desolvation penalty upon the kinase-inhibitor binding. A hydroxyl group of UCN-02 additional to staurosporine locates at the pyrrolidinone moiety, which can largely alter the electronic distribution of pyrrolidinone moiety and thus promote the intermolecular interaction with Met790 residue. This can well explain the measured higher selectivity of UCN-02 than staurosporine for mutant over wild-type kinase. Copyright © 2016 John Wiley & Sons, Ltd.

Spatiotemporally and Sequentially-Controlled Drug Release from Polymer Gatekeeper-Hollow Silica Nanoparticles

NASA Astrophysics Data System (ADS)

Palanikumar, L.; Jeena, M. T.; Kim, Kibeom; Yong Oh, Jun; Kim, Chaekyu; Park, Myoung-Hwan; Ryu, Ja-Hyoung

2017-04-01

Combination chemotherapy has become the primary strategy against cancer multidrug resistance; however, accomplishing optimal pharmacokinetic delivery of multiple drugs is still challenging. Herein, we report a sequential combination drug delivery strategy exploiting a pH-triggerable and redox switch to release cargos from hollow silica nanoparticles in a spatiotemporal manner. This versatile system further enables a large loading efficiency for both hydrophobic and hydrophilic drugs inside the nanoparticles, followed by self-crosslinking with disulfide and diisopropylamine-functionalized polymers. In acidic tumour environments, the positive charge generated by the protonation of the diisopropylamine moiety facilitated the cellular uptake of the particles. Upon internalization, the acidic endosomal pH condition and intracellular glutathione regulated the sequential release of the drugs in a time-dependent manner, providing a promising therapeutic approach to overcoming drug resistance during cancer treatment.

Health literacy of an urban business community.

PubMed

Johnson, Barbara H; Hayes, Sandra C; Ekundayo, Olugbemiga T; Wheeler, Primus; Ford, D'Arcy M

2012-02-01

The impact of community-based organizations on the delivery of health care knowledge is well documented. Little research has focused on the importance of health literacy in the dissemination of health care information by minority small business owners. This study sampled 38 business owners within a local business district to assess their level of health literacy. Although adequate health literacy is not required to serve as a community resource, it may be necessary to understand the health literacy level of local business owners as gatekeepers in order to develop appropriate training/educational programs. The results of this descriptive cross-sectional study indicate that for sample of business owners, health literacy levels are adequate. The findings suggest the feasibility of using local business owners as disseminators of health-related materials to the communities in which they operate their businesses.

A socio-technical critique of tiered services: implications for interprofessional care.

PubMed

Hood, Rick

2015-01-01

In the health and social care sector, tiered services have become an increasingly influential way of organising professional expertise to address the needs of vulnerable people. Drawing on its application to UK child welfare services, this paper discusses the merits of the tiered model from a socio-technical perspective - an approach that has emerged from the fields of accident analysis and systems design. The main elements of a socio-technical critique are outlined and used to explore how tiered services provide support to families and prevent harm to children. Attention is drawn to the distribution of expertise and resources in a tiered system, and to the role of referral and gate-keeping procedures in dispersing accountability for outcomes. An argument is made for designing systems "against demand", and the paper concludes by discussing some alternative models of multi-agency provision.

Psychology in the public service.

PubMed

Zimbardo, Philip G

2002-01-01

Philip G. Zimbardo outlines the challenges and opportunities he faces as the American Psychological Association's (APA's) 110th president. This article expands on remarks made in his introduction to Patrick H. DeLeon's presidential address at the APA's 2001 annual convention in San Francisco, California. Appearing now, mid-term in his presidency, that vision is a working blueprint of his activities and what he hopes to accomplish in his remaining tenure: enhancing psychologists' pride in psychology; developing more productive relationships with all media as gatekeepers to the public; publishing the standard high school psychology textbook; developing a compendium of all psychological research that illustrates how psychologists have made a significant difference in improving various aspects of the quality of life of individuals, groups, communities, and the United States; and encouraging greater unity of purpose and respect among psychologists across their many diverse domains and specialties.

Parental perceptions of the impacts the built environment has on young children׳s health: a qualitative examination and lay assessment amongst residents in four Scottish communities.

PubMed

Teedon, Paul; Gillespie, Morag; Lindsay, Kate; Baker, Keith

2014-07-01

The built environment is important for children׳s health and development. Qualitative research in four communities in Scotland explored with groups of parents of young children their lay perceptions of their local environment with specific reference to its impact upon their children׳s health. Valuing most strong supportive communities; good quality public spaces and social housing, parents׳ key concerns included anti-social behaviour, incivility and a range of locally-specific concerns. As knowledgeable key gatekeepers to children׳s use of home environments and public spaces, parent׳s qualitative lay input is important for the development of children׳s effective use of outdoor spaces and the built environment over the long term. Copyright © 2014 Elsevier Ltd. All rights reserved.

Improving Suicide Prevention in Dutch Regions by Creating Local Suicide Prevention Action Networks (SUPRANET): A Study Protocol.

PubMed

Gilissen, Renske; De Beurs, Derek; Mokkenstorm, Jan; Mérelle, Saskia; Donker, Gé; Terpstra, Sanne; Derijck, Carla; Franx, Gerdien

2017-03-28

The European Alliance against Depression (EAAD) program is to be introduced in The Netherlands from 2017 onwards. This program to combat suicide consists of interventions on four levels: (1) increasing the awareness of suicide by local media campaigns; (2) training local gatekeepers, such as teachers or police officers; (3) targeting high-risk persons in the community; and (4) training and support of professionals in primary care settings. The implementation starts in seven Dutch pilot regions. Each region is designated as a Suicide Prevention Action NETwork (SUPRANET). This paper describes the SUPRANET program components and the evaluation of its feasibility and impact. The findings will be used to facilitate the national implementation of EAAD in The Netherlands and to add new findings to the existing literature on EAAD.

Measurement of Nonribosomal Peptide Synthetase Adenylation Domain Activity Using a Continuous Hydroxylamine Release Assay.

PubMed

Duckworth, Benjamin P; Wilson, Daniel J; Aldrich, Courtney C

2016-01-01

Adenylation is a crucial enzymatic process in the biosynthesis of nonribosomal peptide synthetase (NRPS) derived natural products. Adenylation domains are considered the gatekeepers of NRPSs since they select, activate, and load the carboxylic acid substrate onto a downstream peptidyl carrier protein (PCP) domain of the NRPS. We describe a coupled continuous kinetic assay for NRPS adenylation domains that substitutes the PCP domain with hydroxylamine as the acceptor molecule. The pyrophosphate released from the first-half reaction is then measured using a two-enzyme coupling system, which detects conversion of the chromogenic substrate 7-methylthioguanosine (MesG) to 7-methylthioguanine. From profiling substrate specificity of unknown or engineered adenylation domains to studying chemical inhibition of adenylating enzymes, this robust assay will be of widespread utility in the broad field NRPS enzymology.

A mediation model of professional psychological help seeking for suicide ideation among Asian American and white American college students.

PubMed

Wong, Joel; Brownson, Chris; Rutkowski, Leslie; Nguyen, Chi P; Becker, Marty Swanbrow

2014-01-01

This study examined professional psychological help seeking among 1,045 white American and Asian American students from 70 U.S. colleges and universities who had seriously considered attempting suicide. The authors found that Asian American college students had lower rates of professional psychological help seeking for their suicide ideation than White American college students. Guided by social network perspectives on professional psychological help seeking, the authors also tested mediators of this racial disparity. Relative to white Americans, Asian Americans were advised by fewer people (especially fewer family members) to seek professional help, which was, in turn, associated with lower rates of professional psychological help seeking for suicide ideation. These findings underscore the importance of gatekeeping as a suicide prevention strategy for Asian American college students.

Science, politics, and identity in northern research ethics licensing.

PubMed

van den Scott, Lisa-Jo K

2012-02-01

The Nunavut Research Institute (NRI) is the ethics board that licenses all research conducted in Nunavut, Canada. The NRI is a gate-keeping institution that mediates the interaction of Inuit knowledge systems (presented as experientially based and orally communicated) and researchers (perceived as practicing harsh rationality communicated through inscription). The NRI works to discipline Southern ways of knowing into something more culturally appropriate for the Inuit, but at the same time also disciplines Inuit ways of knowing, creating a paradox even as the Inuit struggle to protect their cultural identity, which has been subject to a history of judgment and cultural appropriation. This article identifies three effects of this paradox on the NRI; the NRI takes on, first, a rigorousness in licensing; second, an emphasis on maximizing benefits to the community; and third, the role of defender of local knowledge.

Improving Suicide Prevention in Dutch Regions by Creating Local Suicide Prevention Action Networks (SUPRANET): A Study Protocol

PubMed Central

Gilissen, Renske; De Beurs, Derek; Mokkenstorm, Jan; Mérelle, Saskia; Donker, Gé; Terpstra, Sanne; Derijck, Carla; Franx, Gerdien

2017-01-01

The European Alliance against Depression (EAAD) program is to be introduced in The Netherlands from 2017 onwards. This program to combat suicide consists of interventions on four levels: (1) increasing the awareness of suicide by local media campaigns; (2) training local gatekeepers, such as teachers or police officers; (3) targeting high-risk persons in the community; and (4) training and support of professionals in primary care settings. The implementation starts in seven Dutch pilot regions. Each region is designated as a Suicide Prevention Action NETwork (SUPRANET). This paper describes the SUPRANET program components and the evaluation of its feasibility and impact. The findings will be used to facilitate the national implementation of EAAD in The Netherlands and to add new findings to the existing literature on EAAD. PMID:28350367

Resource Allocation in Healthcare: Implications of Models of Medicine as a Profession

PubMed Central

Kluge, Eike-Henner W.

2007-01-01

For decades, the problem of how to allocate healthcare resources in a just and equitable fashion has been the subject of concerted discussion and analysis, yet the issue has stubbornly resisted resolution. This article suggests that a major reason for this is that the discussion has focused exclusively on the nature and status of the material resources, and that the nature and role of the medical profession have been entirely ignored. Because physicians are gatekeepers to healthcare resources, their role in allocation is central from a process perspective. This article identifies 3 distinct interpretations of the nature of medicine, shows how each mandates a different method of allocation, and argues that unless an appropriate model of medicine is developed that acknowledges the valid points contained in each of the 3 approaches, the allocation problem will remain unsolvable. PMID:17435657

Navigating Through Chaos: Charge Nurses and Patient Safety.

PubMed

Cathro, Heather

2016-04-01

The aim of this study was to explore actions and the processes charge nurses (CNs) implement to keep patients safe and generate an emerging theory to inform CN job descriptions, orientation, and training to promote patient safety in practice. Healthcare workers must provide a safe environment for patients. CNs are the frontline leaders on most hospital units and can function as gatekeepers for safe patient care. This grounded theory study utilized purposive sampling of CNs on medical-surgical units in a 400-bed metropolitan hospital. Data collection consisted of 11 interviews and 6 observations. The emerging theory was navigating through chaos: CNs balancing multiple roles, maintaining a watchful eye, and working with and leading the healthcare team to keep patients safe. CNs have knowledge of patients, staff, and complex healthcare environments, putting them in opportune positions to influence patient safety.

The decline of judicial deference to medical opinion in medical negligence litigation in Malaysia.

PubMed

Kassim, Puteri Nemie J

2008-06-01

The decision of the Federal Court of Malaysia in abandoning the Bolam principle in relation to doctor's duty to disclose risks has clearly marked the decline of judicial deference to medical opinion in medical negligence litigation in Malaysia. It is undeniable that the Bolam principle has acted as a gatekeeper to the number of claims against medical practitioners. This has always been seen as necessary to protect the society from unwanted effects of defensive medicine. However, will these changes contribute significantly to the growth of medical negligence cases in Malaysia? This article will trace the development of the Bolam principle in medical negligence litigation in Malaysia since 1965 and analyse the influence of selected Commonwealth cases on the development. The implications of the Federal Court ruling will also be discussed.

Beware the Educational Fix: Limitations of Efforts to Promote Mental Health Literacy.

PubMed

Corrigan, Patrick

2018-04-01

Public health professionals seek to promote health literacy through education. In the mental health arena, such approaches have included teaching primary care gatekeepers to screen for early identification of suicide risk and teaching members of the general public to engage peers in need of mental health treatment and guide them into evidence-based care. Educational positivism is the belief that this pedagogic enterprise is unlimited, leading to a "more is better" approach. Despite its promise, however, educational approaches may have muted effects. Students in discrete training programs are often overwhelmed by too much information. Moreover, the effects of distributed training programs, which usually involve repeated training over longer periods, compete with already existing schemes of health action as well as the cacophony of other channels of information. Strategies to address these concerns are described.

Preparation of a mesoporous silica-based nano-vehicle for dual DOX/CPT pH-triggered delivery.

PubMed

Llinàs, Maria C; Martínez-Edo, Gabriel; Cascante, Anna; Porcar, Irene; Borrós, Salvador; Sánchez-García, David

2018-11-01

A dual doxorubicin/camptothecin (DOX/CPT) pH-triggered drug delivery mesoporous silica nanoparticle (MSN)-based nano-vehicle has been prepared. In this drug-delivery system (DDS), CPT is loaded inside the pores of the MSNs, while DOX is covalently attached to the surface of an aldehyde-functionalized MSN through a dihydrazide-polyethylene glycol chain. Thus, DOX and the linker act as pH-sensitive gatekeeper. The system is versatile and easy to assemble, not requiring the chemical modification of the drugs. While at physiological conditions the release of the drugs is negligible, at acidic pH a burst release of DOX and a gradual release of CPT take place. In vitro cytotoxicity tests have demonstrated that this DDS can deliver efficiently DOX and CPT for combination therapy.

A multidirectional communication model: implications for social marketing practice.

PubMed

Thackeray, Rosemary; Neiger, Brad L

2009-04-01

The landscape of sending and receiving information has changed dramatically in the past 25 years. The communication process is changing from being unidirectional to multidirectional as consumers are becoming active participants by creating, seeking, and sharing information using a variety of channels and devices. The purpose of this article is to describe how this shift in the communication process- where gatekeepers control the creation and content of information and consumers are less active recipients to one that reflects a multidirectional and more dynamic process with participative consumers-will affect the social marketing process. This shift in communication does not represent an option for social marketers so much as a necessity. As professionals respond to this evolving communication model, the practice of social marketing can remain vibrant as a relevant consumer-oriented approach to behavior change.

Human Dermal Mast Cells Contain and Release Tumor Necrosis Factor α, which Induces Endothelial Leukocyte Adhesion Molecule 1

NASA Astrophysics Data System (ADS)

Walsh, Laurence J.; Trinchieri, Giorgio; Waldorf, Heidi A.; Whitaker, Diana; Murphy, George F.

1991-05-01

Tumor necrosis factor α (TNF-α) is a proinflammatory cytokine that mediates endothelial leukocyte interactions by inducing expression of adhesion molecules. In this report, we demonstrate that human dermal mast cells contain sizeable stores of immunoreactive and biologically active TNF-α within granules, which can be released rapidly into the extracellular space upon degranulation. Among normal human dermal cells, mast cells are the predominant cell type that expresses both TNF-α protein and TNF-α mRNA. Moreover, induction of endothelial leukocyte adhesion molecule 1 expression is a direct consequence of release of mast cell-derived TNF-α. These findings establish a role for human mast cells as "gatekeepers" of the dermal microvasculature and indicate that mast cell products other than vasoactive amines influence endothelium in a proinflammatory fashion.

At the Atrioventricular Crossroads: Dual Pathway Electrophysiology in the Atrioventricular Node and its Underlying Heterogeneities

PubMed Central

George, Sharon A; Faye, N Rokhaya; Murillo-Berlioz, Alejandro; Lee, K Benjamin; Trachiotis, Gregory D; Efimov, Igor R

2017-01-01

The atrioventricular node (AVN) is a complex structure that performs a variety of functions in the heart. The AVN is primarily an electrical gatekeeper between the atria and ventricles and introduces a delay between atrial and ventricular excitation, allowing for efficient ventricular filling. The AVN is composed of several compartments that safely transmit electrical excitation from the atria to the ventricles via the fast or slow pathways. There are many electrophysiological differences between these pathways, including conduction time and electrical refractoriness, that increase the predisposition of the atrioventricular junction to arrhythmias such as atrioventricular nodal re-entrant tachycardia. These varied electrophysiological characteristics of the fast and slow pathways stem from their unique structural and molecular composition (tissue and cellular geometry, ion channels and gap junctions). This review summarises the structural and molecular heterogeneities of the human AVN and how they result in electrophysiological variations and arrhythmias. PMID:29326832

Depression Treatment Among Rural Older Adults: Preferences and Factors Influencing Future Service Use

PubMed Central

Kitchen, Katherine A.; McKibbin, Christine L.; Wykes, Thomas L.; Lee, Aaron A.; Carrico, Catherine P.; McConnell, Katelynn A.

2013-01-01

The purpose of this study was to investigate depression treatment preferences and anticipated service use in a sample of adults aged 55 years or older who reside in rural Wyoming. Sixteen participants (mean age = 59) completed 30- to 60-minute, semi-structured interviews. Qualitative methods were used to characterize common themes. Social/provider support and community gatekeepers were perceived by participants as important potential facilitators for seeking depression treatment. In contrast, perceived stigma and the value placed on self-sufficiency emerged as key barriers to seeking treatment for depression in this rural, young-old sample. Participants anticipated presenting for treatment in the primary care sector and preferred a combination of medication and psychotherapy for treatment. Participants were, however, more willing to see mental health professionals if they were first referred by a clergy member or primary care physician. PMID:24409008

Qualitative research ethics on the spot: Not only on the desktop.

PubMed

Øye, Christine; Sørensen, Nelli Øvre; Glasdam, Stinne

2016-06-01

The increase in medical ethical regulations and bureaucracy handled by institutional review boards and healthcare institutions puts the researchers using qualitative methods in a challenging position. Based on three different cases from three different research studies, the article explores and discusses research ethical dilemmas. First, and especially, the article addresses the challenges for gatekeepers who influence the informant's decisions to participate in research. Second, the article addresses the challenges in following research ethical guidelines related to informed consent and doing no harm. Third, the article argues for the importance of having research ethical guidelines and review boards to question and discuss the possible ethical dilemmas that occur in qualitative research. Research ethics must be understood in qualitative research as relational, situational, and emerging. That is, that focus on ethical issues and dilemmas has to be paid attention on the spot and not only at the desktop. © The Author(s) 2015.

An interglomerular circuit gates glomerular output and implements gain control in the mouse olfactory bulb

PubMed Central

Banerjee, Arkarup; Marbach, Fred; Anselmi, Francesca; Koh, Matthew S.; Davis, Martin B.; da Silva, Pedro Garcia; Delevich, Kristen; Oyibo, Hassana K.; Gupta, Priyanka; Li, Bo; Albeanu, Dinu F.

2015-01-01

Summary Odors elicit distributed activation of glomeruli in the olfactory bulb (OB). Crosstalk between co-active glomeruli has been proposed to perform a variety of computations, facilitating efficient extraction of sensory information by the cortex. Dopaminergic/GABAergic cells in the OB, which can be identified by their expression of the dopamine transporter (DAT), provide the earliest opportunity for such crosstalk. Here we show in mice that DAT+ cells carry concentration dependent odor signals and broadcast focal glomerular inputs throughout the OB to cause suppression of mitral/tufted (M/T) cell firing, an effect that is mediated by the external tufted (ET) cells coupled to DAT+ cells via chemical and electrical synapses. We find that DAT+ cells implement gain control and decorrelate odor representations in the M/T cell population. Our results further indicate that ET cells are gatekeepers of glomerular output and prime determinants of M/T responsiveness. PMID:26139373

Medicalization, ambivalence and social control: mothers' descriptions of educators and ADD/ADHD.

PubMed

Malacrida, Claudia

2004-01-01

Conrad notes that non-medical personnel often accomplish the routine, everyday work of medicalization. This is particularly so in the case of Attention Deficit (Hyperactivity) Disorder, where teachers, special educators and school psychologists identify, assess and administer medication to 'problematic' children. Drawing on data from interviews with Canadian and British mothers of ADD/ADHD children, this article explores mothers' perceptions of educators' roles in medicalizing children who are different, comparing medicalization in two divergent sites. In Canada, where ADD/ADHD is a highly medicalized phenomenon, and teachers have few alternative forms of social control available to them in classrooms, it appears that educators are prepared to identify problem children and press for medical treatment with remarkable vigor. In Britain, where medicalization remains incomplete, and where teachers and special educators have more stringent alternative forms of social control available to them, educators were often described as gatekeepers who will refuse the label or to administer medication.

When health means wealth, can bioethicists respond?

PubMed

Holmes, H B

2001-01-01

Around the world the wealthy can get their lives extended while the poor get little basic medical help. Over the same years that the field of bioethics has prospered and expanded, this disparity has increased. Reasons for the failure of bioethics to successfully address this health/wealth issue include its identification with the cognitive and social authority of medicine; its gatekeeping behavior; its funding sources; its questionable use of "principlism" and its emphasis on crises and dilemmas to the neglect of "housekeeping" issues. The work of most women in bioethics rarely addresses the health/wealth issue; if it does, their work may be ignored, as were the recommendations of Canadian feminists working under government grants. To achieve equity in health care, the structure of both medicine and bioethics needs to be changed. Yet, since bioethicists generally have accepted the status quo, this seems unlikely to happen.

The significance of the concept of disease for justice in health care.

PubMed

Schramme, Thomas

2007-01-01

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well.

How Not to Let Secrets Out When Conducting Qualitative Research With Dyads.

PubMed

Ummel, Deborah; Achille, Marie

2016-05-01

Confidentiality is one of the cornerstones of research involving human participants. Researchers are the frontline gatekeepers of their participants' right to confidentiality, and situations can arise that challenge this responsibility. This is the case when individuals who have shared a common experience (i.e., dyads) are interviewed separately, but interview results are disseminated within the context of dyads. Based on our experience of conducting research with dyads and given how little literature is available to serve as guide, we set out to write this article to share the knowledge we acquired and the solutions we found. We will describe both the ethical challenges and the methodological decisions involved in conducting qualitative research with dyads. The article also describes different modalities of dyadic analysis, their benefits and drawbacks. This endeavor seems especially relevant as research with dyads is emerging in several domains involving couples, families, caregivers and health. © The Author(s) 2016.

Direct-to-consumer genetic testing: where and how does genetic counseling fit?

PubMed

Middleton, Anna; Mendes, Álvaro; Benjamin, Caroline M; Howard, Heidi Carmen

2017-05-01

Direct-to-consumer genetic testing for disease ranges from well-validated diagnostic and predictive tests to 'research' results conferring increased risks. While being targeted at public curious about their health, they are also marketed for use in reproductive decision-making or management of disease. By virtue of being 'direct-to-consumer' much of this testing bypasses traditional healthcare systems. We argue that direct-to-consumer genetic testing companies should make genetic counseling available, pre- as well as post-test. While we do not advocate that mandatory genetic counseling should gate-keep access to direct-to-consumer genetic testing, if the testing process has the potential to cause psychological distress, then companies have a responsibility to provide support and should not rely on traditional healthcare systems to pick up the pieces. A video abstract is available for this article via this link .

An algorithm of opinion leaders mining based on signed network

NASA Astrophysics Data System (ADS)

Cao, Linlin; Zheng, Mingchun; Zhang, Yuanyuan; Zhang, Fuming

2018-04-01

With the rapid development of mobile Internet, user gradually become the leader of social media, the abruptly rise of new media has changed the traditional information's dissemination pattern and regularity. There is new era significance of opinion leaders, gatekeepers in the classical theory of mass communication, and it has further expansion and extension to a certain extent. In the existing mining of opinion leaders, it is mainly from the research of network structure and user behavior without considering an important attribute: whether the user has a real impact. In this paper, we take the symbolic network as the research tool, by giving symbol which correspondingly represents support or oppose to the link about point of view relationship between users and combining traditional algorithms of mining with symbolism which can describe the change of view between users, we will get the opinion leader who has real impact on users, then the result is more accurate and effective.

Engaging Inner City Students in Learning Through Designing Remote Operated Vehicles

NASA Astrophysics Data System (ADS)

Barnett, Michael

2005-03-01

For the past year we have been developing and implementing a program in which students design and construct remote operated vehicles. In this paper, we report on a pilot study that occurred over the course of an academic year in an inner city high school. Specifically, we have been investigating whether students learn meaningful science content through design activities. Through our teaching experiment methodological stance and analysis we found that (1) student attendance and engagement increased, (2) students learned physics content and recognized connections to their other coursework (3) teachers adopted an "organized chaos" posture and shifted their role from one of discipline keeper and content gatekeeper to one of coach and facilitator, (4) design projects need to be modularized if they are to be effective urban classrooms, and (5) teachers need to balance the tradeoffs between allowing students to develop aesthetically pleasing designs versus learning content and creating designs that are functional and useable.

What Barriers and Facilitators Do School Nurses Experience When Implementing an Obesity Intervention?

PubMed

Schroeder, Krista; Smaldone, Arlene

2017-12-01

A recent evaluation of a school nurse-led obesity intervention demonstrated a 5% implementation rate. The purpose of this study was to explore school nurses' perceived barriers to and facilitators of the intervention in order to understand reasons for the low implementation rate. Methods included semi-structured individual interviews with school nurses. Data were analyzed using content analysis and heat mapping. Nineteen nurses participated and eight themes were identified. Parental and administrative gatekeeping, heavy nurse workload, obesogenic environments, and concerns about obesity stigma were barriers to implementation. Teamwork with parents and school staff was a key facilitator of implementation. Nurses also noted the importance of cultural considerations and highlighted the need to tailor the intervention to the unique needs of their school environment and student population. These findings suggest that for school nurses to play a key role in school-based obesity interventions, barriers must be identified and addressed prior to program implementation.

Celebrity Appeal: Reaching Women to Promote Colorectal Cancer Screening

PubMed Central

Cooper, Crystale Purvis; Gelb, Cynthia A.; Lobb, Kathleen

2015-01-01

The Centers for Disease Control and Prevention’s Screen for Life: National Colorectal Cancer Action Campaign works with the Entertainment Industry Foundation’s National Colorectal Cancer Research Alliance to develop public service announcements (PSAs) featuring celebrities. Selection of Screen for Life celebrity spokespersons is based on a variety of factors, including their general appeal and personal connection to colorectal cancer. Screen for Life PSAs featuring celebrities have been disseminated exclusively through donated media placements and have been formatted for television, radio, print, and out-of-home displays such as dioramas in airports, other transit stations, and shopping malls. A 2012 national survey with women aged 50–75 years (n = 772) investigated reported exposure to Screen for Life PSAs featuring actor Terrence Howard. In total, 8.3% of women recalled exposure to the PSAs. Celebrity spokespersons can attract the attention of both target audiences and media gatekeepers who decide which PSAs will receive donated placements. PMID:25521047

Acquired Resistance to Crizotinib from a Mutation in CD74–ROS1

PubMed Central

Awad, Mark M.; Katayama, Ryohei; McTigue, Michele; Liu, Wei; Deng, Ya-Li; Brooun, Alexei; Friboulet, Luc; Huang, Donghui; Falk, Matthew D.; Timofeevski, Sergei; Wilner, Keith D.; Lockerman, Elizabeth L.; Khan, Tahsin M.; Mahmood, Sidra; Gainor, Justin F.; Digumarthy, Subba R.; Stone, James R.; Mino-Kenudson, Mari; Christensen, James G.; Iafrate, A. John; Engelman, Jeffrey A.; Shaw, Alice T.

2013-01-01

Summary Crizotinib, an inhibitor of anaplastic lymphoma kinase (ALK), has also recently shown efficacy in the treatment of lung cancers with ROS1 translocations. Resistance to crizotinib developed in a patient with metastatic lung adenocarcinoma harboring a CD74–ROS1 rearrangement who had initially shown a dramatic response to treatment. We performed a biopsy of a resistant tumor and identified an acquired mutation leading to a glycine-to-arginine substitution at codon 2032 in the ROS1 kinase domain. Although this mutation does not lie at the gatekeeper residue, it confers resistance to ROS1 kinase inhibition through steric interference with drug binding. The same resistance mutation was observed at all the meta-static sites that were examined at autopsy, suggesting that this mutation was an early event in the clonal evolution of resistance. (Funded by Pfizer and others; ClinicalTrials.gov number, NCT00585195.) PMID:23724914

Expert perspectives on Western European prison health services: do ageing prisoners receive equivalent care?

PubMed

Bretschneider, Wiebke; Elger, Bernice Simone

2014-09-01

Health care in prison and particularly the health care of older prisoners are increasingly important topics due to the growth of the ageing prisoner population. The aim of this paper is to gain insight into the approaches used in the provision of equivalent health care to ageing prisoners and to confront the intuitive definition of equivalent care and the practical and ethical challenges that have been experienced by individuals working in this field. Forty interviews took place with experts working in the prison setting from three Western European countries to discover their views on prison health care. Experts indicated that the provision of equivalent care in prison is difficult mostly due to four factors: variability of care in different prisons, gatekeeper systems, lack of personnel, and delays in providing access. This lack of equivalence can be fixed by allocating adequate budgets and developing standards for health care in prison.

Recent advances in the characterization of HIV-1 neutralization assays for standardized evaluation of the antibody response to infection and vaccination.

PubMed

Polonis, Victoria R; Brown, Bruce K; Rosa Borges, Andrew; Zolla-Pazner, Susan; Dimitrov, Dimiter S; Zhang, Mei-Yun; Barnett, Susan W; Ruprecht, Ruth M; Scarlatti, Gabriella; Fenyö, Eva-Maria; Montefiori, David C; McCutchan, Francine E; Michael, Nelson L

2008-06-05

In AIDS vaccine development the pendulum has swung towards a renewed emphasis on the potential role for neutralizing antibodies in a successful global vaccine. It is recognized that vaccine-induced antibody performance, as assessed in the available neutralization assays, may well serve as a "gatekeeper" for HIV-1 subunit vaccine prioritization and advancement. As a result, development of a standardized platform for reproducible measurement of neutralizing antibodies has received considerable attention. Here we review current advancements in our knowledge of the performance of different types of antibodies in a traditional primary cell neutralization assay and the newer, more standardized TZM-bl reporter cell line assay. In light of recently revealed differences (see accompanying article) in the results obtained in these two neutralization formats, parallel evaluation with both platforms should be contemplated as an interim solution until a better understanding of immune correlates of protection is achieved.

Identification, Response, and Referral of Suicidal Youth Following Applied Suicide Intervention Skills Training.

PubMed

Ewell Foster, Cynthia J; Burnside, Amanda N; Smith, Patricia K; Kramer, Anne C; Wills, Allie; A King, Cheryl

2017-06-01

Gatekeeper training is a public health approach to suicide prevention that encourages community members to identify those at risk for suicide, respond appropriately, and refer for clinical services. Despite widespread use, few studies have examined whether training results in behavior change in participants. This study employed a naturalistic pre-post design to follow 434 participants in Applied Suicide Intervention Skills Training, finding small but significant increases in self-reported identification of at-risk youth, some helpful responses to youth, and numbers of youth referred to treatment from pre-test to 6- to 9-month follow-up. Changes in active listening and helping behaviors meant to support treatment referrals (such as convincing a youth to seek treatment) were not observed over time. Additional analyses explored predictors of self-reported skill utilization including identification as a "natural helper" and attitudes about suicide prevention. © 2016 The American Association of Suicidology.

Review: Abortion care in Ghana: A critical review of the literature

PubMed Central

Rominski, Sarah D; Lori, Jody R

2015-01-01

The Government of Ghana has taken important steps to mitigate the impact of unsafe abortion. However, the expected decline in maternal deaths is yet to be realized. This literature review aims to present findings from empirical research directly related to abortion provision in Ghana and identify gaps for future research. A total of four (4) databases were searched with the keywords “Ghana and abortion” and hand review of reference lists was conducted. All abstracts were reviewed. The final include sample was 39 articles. Abortion-related complications represent a large component of admissions to gynecological wards in hospitals in Ghana as well as a large contributor to maternal mortality. Almost half of the included studies were hospital-based, mainly chart reviews. This review has identified gaps in the literature including: interviewing women who have sought unsafe abortions and with healthcare providers who may act as gatekeepers to women wishing to access safe abortion services. PMID:25438507

Histone deacetylase 10 structure and molecular function as a polyamine deacetylase

NASA Astrophysics Data System (ADS)

Hai, Yang; Shinsky, Stephen A.; Porter, Nicholas J.; Christianson, David W.

2017-05-01

Cationic polyamines such as spermidine and spermine are critical in all forms of life, as they regulate the function of biological macromolecules. Intracellular polyamine metabolism is regulated by reversible acetylation and dysregulated polyamine metabolism is associated with neoplastic diseases such as colon cancer, prostate cancer and neuroblastoma. Here we report that histone deacetylase 10 (HDAC10) is a robust polyamine deacetylase, using recombinant enzymes from Homo sapiens (human) and Danio rerio (zebrafish). The 2.85 Å-resolution crystal structure of zebrafish HDAC10 complexed with a transition-state analogue inhibitor reveals that a glutamate gatekeeper and a sterically constricted active site confer specificity for N8-acetylspermidine hydrolysis and disfavour acetyllysine hydrolysis. Both HDAC10 and spermidine are known to promote cellular survival through autophagy. Accordingly, this work sets a foundation for studying the chemical biology of autophagy through the structure-based design of inhibitors that may also serve as new leads for cancer chemotherapy.