Perspectives of rural and remote primary healthcare services on the meaning and goals of clinical governance.

PubMed

Kwedza, Ruyamuro K; Larkins, Sarah; Johnson, Julie K; Zwar, Nicholas

2017-10-01

Definitions of clinical governance are varied and there is no one agreed model. This paper explored the perspectives of rural and remote primary healthcare services, located in North Queensland, Australia, on the meaning and goals of clinical governance. The study followed an embedded multiple case study design with semi-structured interviews, document analysis and non-participant observation. Participants included clinicians, non-clinical support staff, managers and executives. Similarities and differences in the understanding of clinical governance between health centre and committee case studies were evident. Almost one-third of participants were unfamiliar with the term or were unsure of its meaning; alongside limited documentation of a definition. Although most cases linked the concept of clinical governance to key terms, many lacked a comprehensive understanding. Similarities between cases included viewing clinical governance as a management and administrative function. Differences included committee members' alignment of clinical governance with corporate governance and frontline staff associating clinical governance with staff safety. Document analysis offered further insight into these perspectives. Clinical governance is well-documented as an expected organisational requirement, including in rural and remote areas where geographic, workforce and demographic factors pose additional challenges to quality and safety. However, in reality, it is not clearly, similarly or comprehensively understood by all participants.

Improving Primary Care Provider Practices in Youth Concussion Management.

PubMed

Arbogast, Kristy B; Curry, Allison E; Metzger, Kristina B; Kessler, Ronni S; Bell, Jeneita M; Haarbauer-Krupa, Juliet; Zonfrillo, Mark R; Breiding, Matthew J; Master, Christina L

2017-08-01

Primary care providers are increasingly providing youth concussion care but report insufficient time and training, limiting adoption of best practices. We implemented a primary care-based intervention including an electronic health record-based clinical decision support tool ("SmartSet") and in-person training. We evaluated consequent improvement in 2 key concussion management practices: (1) performance of a vestibular oculomotor examination and (2) discussion of return-to-learn/return-to-play (RTL/RTP) guidelines. Data were included from 7284 primary care patients aged 0 to 17 years with initial concussion visits between July 2010 and June 2014. We compared proportions of visits pre- and post-intervention in which the examination was performed or RTL/RTP guidelines provided. Examinations and RTL/RTP were documented for 1.8% and 19.0% of visits pre-intervention, respectively, compared with 71.1% and 72.9% post-intervention. A total of 95% of post-intervention examinations were documented within the SmartSet. An electronic clinical decision support tool, plus in-person training, may be key to changing primary care provider behavior around concussion care.

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care.

PubMed

Cifuentes, Maribel; Davis, Melinda; Fernald, Doug; Gunn, Rose; Dickinson, Perry; Cohen, Deborah J

2015-01-01

This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews. Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs. Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators. © Copyright 2015 by the American Board of Family Medicine.

Relief, Recovery, Reform: The New Deal Congressional Reaction to the Great Depression.

ERIC Educational Resources Information Center

Koman, Rita G.

1998-01-01

Summarizes the relationship of President Franklin Roosevelt to Congress and its role in creating New Deal legislation. Presents a lesson plan using primary documents that allows students to explore congressional responsibility for enabling the Great Depression and for legislation to deal with its consequences. Includes copies of the documents.…

International directory of documentation services concerning forestry and forest products

Treesearch

Peter A. Evans; Gary L. Skupa

1981-01-01

This directory lists 120 documentation services concerned with forestry, forest products, or related fields in 28 countries. The entry for each service includes title of service, cost, publisher, subject coverage, formatting data, input sources, indexing and data-handling methods, and availability of special services other than the primary ones of indexing and...

Juvenile Onset HD

MedlinePlus

... the treating primary physician, neurologist, or psychiatrist including: Treating physician records documenting progression of motor, cognitive, and psychiatric symptoms, family history, and abnormal neurological exam findings consistent with ...

Multiple Solutions Approach (MSA): Conceptions and Practices of Primary School Teachers in Ghana

ERIC Educational Resources Information Center

Nabie, Michael Johnson; Raheem, Kolawole; Agbemaka, John Bijou; Sabtiwu, Rufai

2016-01-01

The study explored the curriculum guidelines and primary school teachers' conceptions and practices of the Multiple Solutions Approach (MSA) in teaching mathematics using basic qualitative research design. Informal conversation interviews (ICIs), observations, video and document analyses were used to collect data. Participants included a purposive…

A comparison of adverse event and fracture efficacy data for strontium ranelate in regulatory documents and the publication record

PubMed Central

Bolland, Mark J; Grey, Andrew

2014-01-01

Objective Recently, the European Medicines Agency reported that strontium ranelate increases myocardial infarction risk in postmenopausal women, 8.5 years after it was registered for use in osteoporosis. Unreported serious adverse events in clinical trials for other pharmaceuticals have been described in recent years. We assessed reporting of adverse events and fracture efficacy of strontium. Methods We compared data on adverse effects (myocardial infarction, venous thromboembolism and pulmonary embolism) and fracture efficacy of strontium in publicly available regulatory documents with data in publications retrieved from searching PubMed. Results We identified 5 regulatory documents and 9 primary publications of 7 randomised, placebo-controlled trials of strontium that reported relevant data. We identified several areas of concern in these reports: the increased risk of myocardial infarction with strontium was not identified in a pivotal phase 3 clinical trial despite specific regulatory review of cardiovascular events; data on myocardial infarction were not included in any primary publication; increased risks of venous thromboembolism and pulmonary embolism with strontium were not reported in either of the phase 3 clinical trials; data on venous thromboembolism were reported in only 5 of 9 primary publications, data on pulmonary embolism in only 2 of 9 primary publications, and either was discussed in <50% of subsequent review articles. There were differences in participant numbers, fracture cases and venous thromboembolism cases between regulatory documents and primary publications. Based on all available data from primary publications and regulatory documents, the number of fractures prevented by strontium use is similar to the number of extra cases of venous thromboembolism, pulmonary embolism and myocardial infarction caused by strontium use. Conclusions The risks of strontium use are similar to the benefits. Full disclosure of the clinical trial data and regulatory documents would allow clinicians and their patients to decide whether use of the drug is worthwhile. PMID:25293384

Nursing Minimum Data Sets for documenting nutritional care for adults in primary healthcare: a scoping review.

PubMed

Håkonsen, Sasja Jul; Pedersen, Preben Ulrich; Bjerrum, Merete; Bygholm, Ann; Peters, Micah D J

2018-01-01

To identify all published nutritional screening instruments that have been validated in the adult population in primary healthcare settings and to report on their psychometric validity. Within health care, there is an urgent need for the systematic collection of nursing care data in order to make visible what nurses do and to facilitate comparison, quality assurance, management, research and funding of nursing care. To be effective, nursing records should accurately and comprehensively document all required information to support safe and high quality care of patients. However, this process of documentation has been criticized from many perspectives as being highly inadequate. A Nursing Minimum Data Set within the nutritional area in primary health care could therefore be beneficial in order to support nurses in their daily documentation and observation of patients. The review considered studies that included adults aged over 18 years of any gender, culture, diagnosis and ethnicity, as well as nutritional experts, patients and their relatives. The concepts of interest were: the nature and content of any nutritional screening tools validated (regardless of the type of validation) in the adult population in primary healthcare; and the views and opinions of eligible participants regarding the appropriateness of nutritional assessment were the concept of interest. Studies included must have been conducted in primary healthcare settings, both within home care and nursing home facilities. This scoping review used a two-step approach as a preliminary step to the subsequent development of a Nursing Minimum Data Set within the nutritional area in primary healthcare: i) a systematic literature search of existing nutritional screening tools validated in primary health care; and ii) a systematic literature search on nutritional experts opinions on the assessment of nutritional nursing care of adults in primary healthcare as well as the views of patients and their relatives. Multiple databases (PubMed, CINAHL, Embase, Scopus, Swemed+, MedNar, CDC, MEDION, Health Technology Assessment Database, TRIP database, NTIS, ProQuest Dissertations and Theses, Google Scholar, Current Contents) were searched from their inception to September 2016. The results from the studies were extracted using pre-developed extraction tools to all three questions, and have been presented narratively and by using figures to support the text. Twenty-nine nutritional screening tools that were validated within a primary care setting, and two documents on consensus statements regarding expert opinion were identified. No studies on the patients or relatives views were identified. The nutritional screening instruments have solely been validated in an over-55 population. Construct validity was the type of validation most frequently used in the validation process covering a total of 25 of the 29 tools. Two studies were identified in relation to the third review question. These two documents are both consensus statement documents developed by experts within the geriatric and nutritional care field. Overall, experts find it appropriate to: i) conduct a comprehensive geriatric assessment, ii) use a validated nutritional screening instrument, and iii) conduct a history and clinical diagnosis, physical examination and dietary assessment when assessing primarily the elderly's nutritional status in primary health care.

FEATURES, EVENTS, AND PROCESSES: SYSTEM-LEVEL AND CRITICALITY

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

D.L. McGregor

The primary purpose of this Analysis/Model Report (AMR) is to identify and document the screening analyses for the features, events, and processes (FEPs) that do not easily fit into the existing Process Model Report (PMR) structure. These FEPs include the 3 1 FEPs designated as System-Level Primary FEPs and the 22 FEPs designated as Criticality Primary FEPs. A list of these FEPs is provided in Section 1.1. This AMR (AN-WIS-MD-000019) documents the Screening Decision and Regulatory Basis, Screening Argument, and Total System Performance Assessment (TSPA) Disposition for each of the subject Primary FEPs. This AMR provides screening information and decisionsmore » for the TSPA-SR report and provides the same information for incorporation into a project-specific FEPs database. This AMR may also assist reviewers during the licensing-review process.« less

Human Rights Texts: Converting Human Rights Primary Source Documents into Data.

PubMed

Fariss, Christopher J; Linder, Fridolin J; Jones, Zachary M; Crabtree, Charles D; Biek, Megan A; Ross, Ana-Sophia M; Kaur, Taranamol; Tsai, Michael

2015-01-01

We introduce and make publicly available a large corpus of digitized primary source human rights documents which are published annually by monitoring agencies that include Amnesty International, Human Rights Watch, the Lawyers Committee for Human Rights, and the United States Department of State. In addition to the digitized text, we also make available and describe document-term matrices, which are datasets that systematically organize the word counts from each unique document by each unique term within the corpus of human rights documents. To contextualize the importance of this corpus, we describe the development of coding procedures in the human rights community and several existing categorical indicators that have been created by human coding of the human rights documents contained in the corpus. We then discuss how the new human rights corpus and the existing human rights datasets can be used with a variety of statistical analyses and machine learning algorithms to help scholars understand how human rights practices and reporting have evolved over time. We close with a discussion of our plans for dataset maintenance, updating, and availability.

Human Rights Texts: Converting Human Rights Primary Source Documents into Data

PubMed Central

Fariss, Christopher J.; Linder, Fridolin J.; Jones, Zachary M.; Crabtree, Charles D.; Biek, Megan A.; Ross, Ana-Sophia M.; Kaur, Taranamol; Tsai, Michael

2015-01-01

We introduce and make publicly available a large corpus of digitized primary source human rights documents which are published annually by monitoring agencies that include Amnesty International, Human Rights Watch, the Lawyers Committee for Human Rights, and the United States Department of State. In addition to the digitized text, we also make available and describe document-term matrices, which are datasets that systematically organize the word counts from each unique document by each unique term within the corpus of human rights documents. To contextualize the importance of this corpus, we describe the development of coding procedures in the human rights community and several existing categorical indicators that have been created by human coding of the human rights documents contained in the corpus. We then discuss how the new human rights corpus and the existing human rights datasets can be used with a variety of statistical analyses and machine learning algorithms to help scholars understand how human rights practices and reporting have evolved over time. We close with a discussion of our plans for dataset maintenance, updating, and availability. PMID:26418817

Impact of registration on clinical trials on infection risk in pediatric acute myeloid leukemia.

PubMed

Dix, David; Aplenc, Richard; Bowes, Lynette; Cellot, Sonia; Ethier, Marie-Chantal; Feusner, Jim; Gillmeister, Biljana; Johnston, Donna L; Lewis, Victor; Michon, Bruno; Mitchell, David; Portwine, Carol; Price, Victoria; Silva, Mariana; Stobart, Kent; Yanofsky, Rochelle; Zelcer, Shayna; Beyene, Joseph; Sung, Lillian

2016-04-01

Little is known about the impact of enrollment on therapeutic clinical trials on adverse event rates. Primary objective was to describe the impact of clinical trial registration on sterile site microbiologically documented infection for children with newly diagnosed acute myeloid leukemia (AML). We conducted a multicenter cohort study that included children aged ≤18 years with de novo AML. Primary outcome was microbiologically documented sterile site infection. Infection rates were compared between those registered and not registered on clinical trials. Five hundred seventy-four children with AML were included of which 198 (34.5%) were registered on a therapeutic clinical trial. Overall, 400 (69.7%) had at least one sterile site microbiologically documented infection. In multiple regression, registration on clinical trials was independently associated with a higher risk of microbiologically documented sterile site infection [adjusted odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.53; p = 0.040] and viridans group streptococcal infection (OR 1.46, 95% CI 1.08-1.98; p = 0.015). Registration on trials was not associated with Gram-negative or invasive fungal infections. Children with newly diagnosed AML enrolled on clinical trials have a higher risk of microbiologically documented sterile site infection. This information may impact on supportive care practices in pediatric AML. © 2015 UICC.

Review of the Primary National Ambient Air Quality Standards for Nitrogen Dioxide: Risk and Exposure Assessment Planning Document

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) is conducting a review of the air quality criteria and the primary (health-based) national ambient air quality standards (NAAQS) for nitrogen dioxide (NO2). The major phases of the process for reviewing NAAQS include the following: (...

Review of the Primary National Ambient Air Quality Standard for Sulfur Oxides: Risk and Exposure Assessment Planning Document

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) is conducting a review of the air quality criteria and the primary (health-based) national ambient air quality standards (NAAQS) for sulfur oxides (SOx). The major phases of the process for reviewing NAAQS include the following: (1) ...

Promising More Information

NASA Technical Reports Server (NTRS)

2003-01-01

When NASA needed a real-time, online database system capable of tracking documentation changes in its propulsion test facilities, engineers at Stennis Space Center joined with ECT International, of Brookfield, Wisconsin, to create a solution. Through NASA's Dual-Use Program, ECT developed Exdata, a software program that works within the company's existing Promise software. Exdata not only satisfied NASA s requirements, but also expanded ECT s commercial product line. Promise, ECT s primary product, is an intelligent software program with specialized functions for designing and documenting electrical control systems. An addon to AutoCAD software, Promis e generates control system schematics, panel layouts, bills of material, wire lists, and terminal plans. The drawing functions include symbol libraries, macros, and automatic line breaking. Primary Promise customers include manufacturing companies, utilities, and other organizations with complex processes to control.

Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System.

PubMed

Patel, Malhar P; Schettini, Priscille; O'Leary, Colin P; Bosworth, Hayden B; Anderson, John B; Shah, Kevin P

2018-05-01

Ideally, a referral from a primary care physician (PCP) to a specialist results in a completed specialty appointment with results available to the PCP. This is defined as "closing the referral loop." As health systems grow more complex, regulatory bodies increase vigilance, and reimbursement shifts towards value, closing the referral loop becomes a patient safety, regulatory, and financial imperative. To assess the ability of a large health system to close the referral loop, we used electronic medical record (EMR)-generated data to analyze referrals from a large primary care network to 20 high-volume specialties between July 1, 2015 and June 30, 2016. The primary metric was documented specialist appointment completion rate. Explanatory analyses included documented appointment scheduling rate, individual clinic differences, appointment wait times, and geographic distance to appointments. Of the 103,737 analyzed referral scheduling attempts, only 36,072 (34.8%) resulted in documented complete appointments. Low documented appointment scheduling rates (38.9% of scheduling attempts lacked appointment dates), individual clinic differences in closing the referral loop, and significant differences in wait times and distances to specialists between complete and incomplete appointments drove this gap. Other notable findings include high variation in wait times among specialties and correlation between high wait times and low documented appointment completion rates. The rate of closing the referral loop in this health system is low. Low appointment scheduling rates, individual clinic differences, and patient access issues of wait times and geographic proximity explain much of the gap. This problem is likely common among large health systems with complex provider networks and referral scheduling. Strategies that improve scheduling, decrease variation among clinics, and improve patient access will likely improve rates of closing the referral loop. More research is necessary to determine the impact of these changes and other potential driving factors.

Cold Vacuum Drying facility civil structural system design description (SYS 06)

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

PITKOFF, C.C.

This document describes the Cold Vacuum Drying (CVD) Facility civil - structural system. This system consists of the facility structure, including the administrative and process areas. The system's primary purpose is to provide for a facility to house the CVD process and personnel and to provide a tertiary level of containment. The document provides a description of the facility and demonstrates how the design meets the various requirements imposed by the safety analysis report and the design requirements document.

Giving Women the Vote: Using Primary Source Documents to Teach about the Fight for Women's Suffrage.

ERIC Educational Resources Information Center

Jacobsen, Margaret

1988-01-01

Presents a lesson in which students use primary sources to learn about the organizing strategies used in the fight for women's suffrage. These sources will provide insights into the past and help students develop appreciation for the hardships suffragists endured. Includes objectives, procedures, and suggestions for activities. (LS)

What Educational Contexts Should Teachers Consider for Their Puberty Education Programmes?

ERIC Educational Resources Information Center

Collier-Harris, Christine A.; Goldman, Juliette D. G.

2017-01-01

This paper analyses some contemporary educational contexts that teachers should consider for their puberty education programmes and/or curricula, for primary and secondary school students. The educational contexts addressed here include significant international puberty education framework documents, socio-biological factors including earlier…

Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya.

PubMed

Asiki, Gershim; Shao, Shuai; Wainana, Carol; Khayeka-Wandabwa, Christopher; Haregu, Tilahun N; Juma, Pamela A; Mohammed, Shukri; Wambui, David; Gong, Enying; Yan, Lijing L; Kyobutungi, Catherine

2018-05-09

In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya. A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews. A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014-2030), The Kenya Health Sector Strategic and Investment Plan (2014-2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015-2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012-2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents. This review revealed important gaps in the policy environment for prevention, control and management of CVDs in PHC settings in Kenya. There is need to continuously engage the ministry of health and other sectors to prioritize inclusion of CVD services in PHC.

Geophysical investigations in the 100 Areas: Fiscal year 1991 through December 1993

NASA Astrophysics Data System (ADS)

Mitchell, T. H.

1994-09-01

The geophysical investigations identified in this document were conducted by the Westinghouse Hanford Company (WHC) Surface Geophysics Team, Geophysics Group, between October, 1991 and December, 1993. The investigations supported 100-Area activities for the Resource Conservation and Recovery Act of 1976 (RCRA) and the Comprehensive Environmental Response, Compensations and Liability Act of 1980 (CERCLA). The primary intent of this document is to provide a general map location and the associated document number for investigations that have been conducted as of December, 1993. The results of the individual investigations are not included here. The results of all of these investigations have been previously reported individually in WHC supporting documents. The investigations conducted during Fiscal Year (FY) 1992 are summarized in a single WHC document, WHC-SD-EN-TI-204, Rev. O. A brief summary of some of the successful applications of geophysics in the 100-Areas is included.

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

Barr, Jonathan L.; Taira, Randal Y.; Orr, Heather M.

The purpose of this document is to describe the operating concepts, capabilities, and benefits of RAMS including descriptions of how the system implementations can improve emergency response, damage assessment, task prioritization, and situation awareness. This CONOPS provides general information on operational processes and procedures required to utilize RAMS, and expected performance benefits of the system. The primary audiences for this document are the end users of RAMS (including flight operators and incident commanders) and the RAMS management team. Other audiences include interested offices within the Department of Homeland Security (DHS), and officials from other state and local jurisdictions who wantmore » to implement similar systems.« less

A comparison of adverse event and fracture efficacy data for strontium ranelate in regulatory documents and the publication record.

PubMed

Bolland, Mark J; Grey, Andrew

2014-10-07

Recently, the European Medicines Agency reported that strontium ranelate increases myocardial infarction risk in postmenopausal women, 8.5 years after it was registered for use in osteoporosis. Unreported serious adverse events in clinical trials for other pharmaceuticals have been described in recent years. We assessed reporting of adverse events and fracture efficacy of strontium. We compared data on adverse effects (myocardial infarction, venous thromboembolism and pulmonary embolism) and fracture efficacy of strontium in publicly available regulatory documents with data in publications retrieved from searching PubMed. We identified 5 regulatory documents and 9 primary publications of 7 randomised, placebo-controlled trials of strontium that reported relevant data. We identified several areas of concern in these reports: the increased risk of myocardial infarction with strontium was not identified in a pivotal phase 3 clinical trial despite specific regulatory review of cardiovascular events; data on myocardial infarction were not included in any primary publication; increased risks of venous thromboembolism and pulmonary embolism with strontium were not reported in either of the phase 3 clinical trials; data on venous thromboembolism were reported in only 5 of 9 primary publications, data on pulmonary embolism in only 2 of 9 primary publications, and either was discussed in <50% of subsequent review articles. There were differences in participant numbers, fracture cases and venous thromboembolism cases between regulatory documents and primary publications. Based on all available data from primary publications and regulatory documents, the number of fractures prevented by strontium use is similar to the number of extra cases of venous thromboembolism, pulmonary embolism and myocardial infarction caused by strontium use. The risks of strontium use are similar to the benefits. Full disclosure of the clinical trial data and regulatory documents would allow clinicians and their patients to decide whether use of the drug is worthwhile. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Medical errors in primary care clinics – a cross sectional study

PubMed Central

2012-01-01

Background Patient safety is vital in patient care. There is a lack of studies on medical errors in primary care settings. The aim of the study is to determine the extent of diagnostic inaccuracies and management errors in public funded primary care clinics. Methods This was a cross-sectional study conducted in twelve public funded primary care clinics in Malaysia. A total of 1753 medical records were randomly selected in 12 primary care clinics in 2007 and were reviewed by trained family physicians for diagnostic, management and documentation errors, potential errors causing serious harm and likelihood of preventability of such errors. Results The majority of patient encounters (81%) were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0) of medical records and management errors in 53.2% (95% CI: 46.3, 60.2). For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4) of records, investigation errors in 21.7% (95% CI: 16.5, 26.8) and decision making errors in 14.5% (95% CI: 10.8, 18.2). A total of 39.9% (95% CI: 33.1, 46.7) of these errors had the potential to cause serious harm. Problems of documentation including illegible handwriting were found in 98.0% (95% CI: 97.0, 99.1) of records. Nearly all errors (93.5%) detected were considered preventable. Conclusions The occurrence of medical errors was high in primary care clinics particularly with documentation and medication errors. Nearly all were preventable. Remedial intervention addressing completeness of documentation and prescriptions are likely to yield reduction of errors. PMID:23267547

Total Coliform Rule (TCR) Federal Register Notice

EPA Pesticide Factsheets

This document provides the FR notice to 40 CFR Parts 141 and 142 Drinking Water: National Primary Drinking Water Regulations; Total Coliforms (Including Fecal Coliforms and E. Coli); Final Rule (26 pp, 5 M).

Arctic Capability Inventory Tool User Guide: Version 2 (International References)

DTIC Science & Technology

2011-07-01

drawn from the primary source documents. In cases where the analyst included additional information, the text is included in [square brackets]. The...following: FERPistheallhazardsplanforacoordinatedfederalresponsetoemergencies. Inmost cases ,departmentsmanageemergencieswithevent...signed—(20)Andorra,Azerbaijan, Ecuador ,Eritrea,Israel,Kazakhstan, Kyrgyzstan,Peru,SanMarino,Syria,Tajikistan,TimorLeste,Turkey

Assessment for Learning in Norway and Portugal: The Case of Primary School Mathematics Teaching

ERIC Educational Resources Information Center

Nortvedt, Guri A.; Santos, Leonor; Pinto, Jorge

2016-01-01

In this study, we aim to understand the forces driving assessment for learning (AfL) in primary school teaching. By applying a case study design, including the two cases of Norway and Portugal and using mathematics teaching as an example, available policy documents and research reports are analysed to identify the differences and similarities that…

Audio-Visual Aids for Pre-School and Primary School Children. A Training Document. Aids to Programming UNICEF Assistance to Education.

ERIC Educational Resources Information Center

Narayan, Shankar

This discussion of the importance and scope of audiovisual aids in the educational programs and activities designed for children in developing countries includes the significance of audiovisual aids in pre-school and primary school education, types of audiovisual aids, learning from pictures, creative art materials, play materials, and problems…

Environmental Education (EE) Policy and Content of the Contemporary (2009-2017) Mexican National Curriculum for Primary Schools

ERIC Educational Resources Information Center

Paredes-Chi, Arely Anahy; Viga-de Alva, María Dolores

2018-01-01

In Mexico a reformed curriculum is being implemented at the national primary level focused on the competence model and incorporating EE as a key element. This article reports our analyses of what theories, policies and/or EE related-contents were included in the documents that integrated this curriculum: general study plan, study programs of…

Tank waste remediation system functions and requirements document

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

Carpenter, K.E

1996-10-03

This is the Tank Waste Remediation System (TWRS) Functions and Requirements Document derived from the TWRS Technical Baseline. The document consists of several text sections that provide the purpose, scope, background information, and an explanation of how this document assists the application of Systems Engineering to the TWRS. The primary functions identified in the TWRS Functions and Requirements Document are identified in Figure 4.1 (Section 4.0) Currently, this document is part of the overall effort to develop the TWRS Functional Requirements Baseline, and contains the functions and requirements needed to properly define the top three TWRS function levels. TWRS Technicalmore » Baseline information (RDD-100 database) included in the appendices of the attached document contain the TWRS functions, requirements, and architecture necessary to define the TWRS Functional Requirements Baseline. Document organization and user directions are provided in the introductory text. This document will continue to be modified during the TWRS life-cycle.« less

Effect of the PREPARE Website vs an Easy-to-Read Advance Directive on Advance Care Planning Documentation and Engagement Among Veterans: A Randomized Clinical Trial.

PubMed

Sudore, Rebecca L; Boscardin, John; Feuz, Mariko A; McMahan, Ryan D; Katen, Mary T; Barnes, Deborah E

2017-08-01

Documentation rates of patients' medical wishes are often low. It is unknown whether easy-to-use, patient-facing advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read advance directive (AD) to increase planning documentation. This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P <.001 at each follow-up). Easy-to-use, patient-facing ACP tools, without clinician- and/or system-level interventions, can increase planning documentation 25% to 35%. Combining the PREPARE website with an easy-to-read AD resulted in higher planning documentation than the AD alone, suggesting that PREPARE may increase planning documentation with minimal health care system resources. clinicaltrials.gov Identifier: NCT01550731.

76 FR 64825 - Approval and Promulgation of Air Quality Implementation Plans, Ohio and Indiana; Redesignation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-19

... emissions inventories for primary PM 2.5 ,\\1\\ NO X , and sulfur dioxide (SO 2 ),\\2\\ documented in Ohio and... measures include the following. Tier 2 Emission Standards for Vehicles and Gasoline Sulfur Standards. These... Tier 2 standards included the [[Page 64830

Finding Information on the State Virtual Libraries

ERIC Educational Resources Information Center

Pappas, Marjorie L.

2004-01-01

The number of state virtual libraries is rapidly expanding. These virtual libraries might include collections of subscription databases; state weblinks and resources; digital collections of primary source documents; and a state union catalog or links to school, public, and academic library catalogs. Most of these virtual libraries include an…

Aspects of U.S. Information Policy: An Annotated Bibliography of Federal Laws, Policies, Regulations, Congressional Hearings with Related Monographs, Serials and Studies from the Private Sector.

ERIC Educational Resources Information Center

National Commission on Libraries and Information Science, Washington, DC.

This annotated bibliography covers the period from 1974 to 1981, with primary emphasis on documents and publications produced between 1978 and 1981. The majority of the publications cited are U.S. government documents; however, the last section includes relevant monographs, journal articles, and conference papers that were selected by the National…

The conduct of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review.

PubMed

Farnbach, Sara; Eades, Anne-Maree; Gwynn, Josephine D; Glozier, Nick; Hackett, Maree L

2018-06-14

Objectives and importance of study: Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research (Values and ethics) describes key values that should underpin Aboriginal and Torres Strait Islander (Indigenous)-focused health research. It is unclear how research teams address this document in primary health care research. We systematically review the primary health care literature focusing on Indigenous social and emotional wellbeing (SEWB) to identify how Values and ethics and community preferences for standards of behaviour (local protocols) are addressed during research. Systematic review in accordance with PRISMA Guidelines and MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. We searched four databases and one Indigenous-specific website for qualitative, quantitative and mixed-method studies published since Values and ethics was implemented (2003). Included studies were conducted in primary health care services, focused on Indigenous SEWB and were conducted by research teams. Using standard data extraction forms, we identified actions taken (reported by authors or identified by us) relating to Values and ethics and local protocols. A total of 25 studies were included. Authors of two studies explicitly mentioned the Values and ethics document, but neither reported how their actions related to the document's values. In more than half the studies, we identified at least three actions relating to the values. Some actions related to multiple values, including use of culturally sensitive research processes and involving Indigenous representatives in the research team. Local protocols were rarely reported. Addressing Values and ethics appears to improve research projects. The academic community should focus on culturally sensitive research processes, relationship building and developing the Indigenous research workforce, to facilitate acceptable research that affects health outcomes. For Values and ethics to achieve its full impact and to improve learning between research teams, authors should be encouraged to report how the principles are addressed during research, including barriers and enablers that are encountered.

a Case Study in Documentation Production as Learning Tools Benefitting Multiple Stakeholders

NASA Astrophysics Data System (ADS)

Truesdale, T. J.; Hierlihy, B.; Jouan, P.

2017-08-01

The Fondation Strutt Foundation has taken on the conservation planning of the Strutt House as part of a P3 collaborative effort with the National Capital Commission (NCC). This paper will address three of the primary documents/data sets (documentary methodologies) being used on/for the Strutt House project. The Strutt House is a Recognized Federal Heritage Building and a significant example of Canadian modernist architecture. Stakeholder is a term often used in Architectural Projects reflecting an economic interest in success of the project. In conservation projects the stakeholder generally reflects social, cultural and/or economic interests in a given project. The Strutt House project has benefitted from stakeholders that have all been interested in the above, as well as the education of our future conservationists. The Strutt house was purchased from the architect's daughter in 2010, and as part of the acquisition, a Heritage Structure Report was commissioned and produced by PTAH Consultants Inc., Architects. The report forms the first of the primary referenced documents of this paper, including: a comprehensive photographic record of existing conditions; and, a building simulation model of the house `as designed/built'. This HSR and the accompanying data/documents have been adopted as the basis of an evolving document in the development of the Conservation Plan including: additional heritage surveys and technologies; traditional drawings, photographic and video records; and, a series of workshops on the structural stabilization efforts, thermography scans, and smoke/blow-door (air pressure) testing. In 2016, Pierre Jouan, a Master's thesis student from KU Leuvan, working with the Carleton University CIMS lab under the direction of Professor Mario Santana, and the FSF completed a 3-D scanning and photogrammetry workshop on the Strutt House and created a building information model (BIM model) from the collected data. The three primary documentation processes being addressed in this paper are really a series of directed research or focussed investigations resulting in a collection of data sets resolved -or combined- into a document. They will assist in the development of the long-term Programming and Conservation Management Plan of the Strutt House.

Documentation systems for educators seeking academic promotion in U.S. medical schools.

PubMed

Simpson, Deborah; Hafler, Janet; Brown, Diane; Wilkerson, LuAnn

2004-08-01

To explore the state and use of teaching portfolios in promotion and tenure in U.S. medical schools. A two-phase qualitative study using a Web-based search procedure and telephone interviews was conducted. The first phase assessed the penetration of teaching portfolio-like systems in U.S. medical schools using a keyword search of medical school Web sites. The second phase examined the current use of teaching portfolios in 16 U.S. medical schools that reported their use in a survey in 1992. The individual designated as having primary responsibility for faculty appointments/promotions was contacted to participate in a 30-60 minute interview. The Phase 1 search of U.S. medical schools' Web sites revealed that 76 medical schools have Web-based access to information on documenting educational activities for promotion. A total of 16 of 17 medical schools responded to Phase 2. All 16 continued to use a portfolio-like system in 2003. Two documentation categories, honors/awards and philosophy/personal statement regarding education, were included by six more of these schools than used these categories in 1992. Dissemination of work to colleagues is now a key inclusion at 15 of the Phase 2 schools. The most common type of evidence used to document education was learner and/or peer ratings with infrequent use of outcome measures and internal/external review. The number of medical schools whose promotion packets include portfolio-like documentation associated with a faculty member's excellence in education has increased by more than 400% in just over ten years. Among early-responder schools the types of documentation categories have increased, but students' ratings of teaching remain the primary evidence used to document the quality or outcomes of the educational efforts reported.

Positioning pharmacists' roles in primary health care: a discourse analysis of the compensation plan in Alberta, Canada.

PubMed

Hughes, Christine A; Breault, Rene R; Hicks, Deborah; Schindel, Theresa J

2017-11-23

A comprehensive Compensation Plan for pharmacy services delivered by community pharmacists was implemented in Alberta, Canada in July 2012. Services covered by the Compensation Plan include care planning services, prescribing services such as adapting prescriptions, and administering a drug or publicly-funded vaccine by injection. Understanding how the Compensation Plan was framed and communicated provides insight into the roles of pharmacists and the potential influence of language on the implementation of services covered by the Compensation Plan by Albertan pharmacists. The objective of this study is to examine the positioning of pharmacists' roles in documents used to communicate the Compensation Plan to Albertan pharmacists and other audiences. Publicly available documents related to the Compensation Plan, such as news releases or reports, published between January 2012 and December 2015 were obtained from websites such as the Government of Alberta, Alberta Blue Cross, the Alberta College of Pharmacists, the Alberta Pharmacists' Association, and the Blueprint for Pharmacy. Searches of the Canadian Newsstand database and Google identified additional documents. Discourse analysis was performed using social positioning theory to explore how pharmacists' roles were constructed in communications about the Compensation Plan. In total, 65 publicly available documents were included in the analysis. The Compensation Plan was put forward as a framework for payment for professional services and formal legitimization of pharmacists' changing professional roles. The discourse associated with the Compensation Plan positioned pharmacists' roles as: (1) expanding to include services such as medication management for chronic diseases, (2) contributing to primary health care by providing access to services such as prescription renewals and immunizations, and (3) collaborating with other health care team members. Pharmacists' changing roles were positioned in alignment with the aims of primary health care. Social positioning theory provides a useful lens to examine the dynamic and evolving roles of pharmacists. This study provides insight into how communications regarding the Compensation Plan in Alberta, Canada positioned pharmacists' changing roles in the broader context of changes to primary health care delivery. Our findings may be useful for other jurisdictions considering implementation of remunerated clinical services provided by pharmacists.

The Rise of Modern Japan. Teacher's Manual [and] Textbook.

ERIC Educational Resources Information Center

Menton, Linda K.; Lush, Noren W.; Tamura, Eileen H.; Gusukuma, Chance I.

This textbook highlights key aspects of Japan's history and culture from the Tokugawa era (1600-1868) to the present. The textbook includes role plays, primary documents, first-person accounts, diary entries, excerpts from literary works, songs, poems, maps and timelines, charts and graphs, and political cartoons. It also includes a glossary that…

Understanding primary school science teachers' pedagogical content knowledge: The case of teaching global warming

NASA Astrophysics Data System (ADS)

Chordnork, Boonliang; Yuenyong, Chokchai

2018-01-01

This aim of this research was to investigate primary school science teachers understanding and teaching practice as well as the influence on teaching and learning a topic like global warming. The participants were four primary science teachers, who were not graduated in science education. Methodology was the case study method, which was under the qualitative research regarded from interpretive paradigm. Data were collected by openended questionnaire, semi-structure interview, and document colleting. The questionnaire examined teachers' background, teachers' understanding of problems and threats of science teaching, desiring of development their PCK, sharing the teaching approaches, and their ideas of strength and weakness. a semi-structured interview was conducted based on the approach for capturing PCK of Loughran [23] content representation (CoRe). And, the document was collected to clarify what evidence which was invented to effect on students' learning. These document included lesson plan, students' task, and painting about global warming, science projects, the picture of activities of science learning, the exercise and test. Data analysis employed multiple approach of evidence looking an issue from each primary science teachers and used triangulation method to analyze the data with aiming to make meaning of teachers' representation of teaching practice. These included descriptive statistics, CoRe interpretation, and document analysis. The results show that teachers had misunderstanding of science teaching practice and they has articulated the pedagogical content knowledge in terms of assessment, goal of teaching and linking to the context of socio cultural. In contrast, knowledge and belief of curriculum, students' understanding of content global warming, and strategies of teaching were articulated indistinct by non-graduate science teacher. Constructing opportunities for personal development, the curiosity of the student learning center, and linking context of socio-culture were the creative factor in the teaching global warming. On the other hand, the teachers had an idea that lack of technology and the defect of child's intelligence were hinder factors teaching global warming.

Nitrogen Oxides (NOx) Primary NAAQS REVIEW: Integrated ...

EPA Pesticide Factsheets

The NOx Integrated Review Plan is the first document generated as part of the National Ambient Air Quality Standards (NAAQS) review process. The Plan presents background information, the schedule for the review, the process to be used in conducting the review, and the key policy-relevant science issues that will guide the review. The integrated review plan also discusses the frameworks for the various assessment documents to be prepared by the EPA as part of the review, including an Integrated Science Assessment (ISA), and as warranted, a Risk/Exposure Assessment (REA), and a Policy Assessment (PA). The primary purpose of the NOx Integrated Review Plan is to highlight the key policy-relevant issues to be considered in the Review of the NO2 primary NAAQS. A draft of the integrated review plan will be the subject of an advisory review with the Clean Air Scientific Advisory Committee (CASAC) and made available to the public for review and comment.

Sulfur Dioxide (SO2) Primary NAAQS Review: Integrated ...

EPA Pesticide Factsheets

The SO2 Integrated Review Plan is the first document generated as part of the National Ambient Air Quality Standards (NAAQS) review process. The Plan presents background information, the schedule for the review, the process to be used in conducting the review, and the key policy-relevant science issues that will guide the review. The integrated review plan also discusses the frameworks for the various assessment documents to be prepared by the EPA as part of the review, including an Integrated Science Assessment (ISA), and as warranted, a Risk/Exposure Assessment (REA), and a Policy Assessment (PA). The primary purpose of the SO2 Integrated Review Plan is to highlight the key policy-relevant issues to be considered in the Review of the SO2 primary NAAQS. A draft of the integrated review plan will be the subject of an advisory with the Clean Air Scientific Advisory Committee (CASAC) and made available to the public for review and comment.

Waste receiving and processing plant control system; system design description

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

LANE, M.P.

1999-02-24

The Plant Control System (PCS) is a heterogeneous computer system composed of numerous sub-systems. The PCS represents every major computer system that is used to support operation of the Waste Receiving and Processing (WRAP) facility. This document, the System Design Description (PCS SDD), includes several chapters and appendices. Each chapter is devoted to a separate PCS sub-system. Typically, each chapter includes an overview description of the system, a list of associated documents related to operation of that system, and a detailed description of relevant system features. Each appendice provides configuration information for selected PCS sub-systems. The appendices are designed asmore » separate sections to assist in maintaining this document due to frequent changes in system configurations. This document is intended to serve as the primary reference for configuration of PCS computer systems. The use of this document is further described in the WRAP System Configuration Management Plan, WMH-350, Section 4.1.« less

Development of the digital design environment ProjectWise(TM) - phase 1.

DOT National Transportation Integrated Search

2017-04-28

The goal of this research was to develop a project document management system capable of managing : Connecticut Department of Transportation (CTDOT) Capital Road and Bridge Program. Primary targets of : research and development included the system, c...

SeqAPASS (Sequence Alignment to Predict Across Species Susceptibility) software and documentation

EPA Science Inventory

SeqAPASS is a software application facilitates rapid and streamlined, yet transparent, comparisons of the similarity of toxicologically-significant molecular targets across species. The present application facilitates analysis of primary amino acid sequence similarity (including ...

The ACEE program and basic composites research at Langley Research Center (1975 to 1986): Summary and bibliography

NASA Technical Reports Server (NTRS)

Dow, Marvin B.

1987-01-01

Composites research conducted at the Langley Research Center during the period from 1975 to 1986 is described, and an annotated bibliography of over 600 documents (with their abstracts) is presented. The research includes Langley basic technology and the composite primary structures element of the NASA Aircraft Energy Efficiency (ACEE) Program. The basic technology documents cited in the bibliography are grouped according to the research activity such as design and analysis, fatigue and fracture, and damage tolerance. The ACEE documents cover development of composite structures for transport aircraft.

The Teaching-Learning Strategy of the Primary Science Project of the Science Education Programme for Africa. IIEP Seminar Paper 30.

ERIC Educational Resources Information Center

Dyasi, Hubert M.

This paper is concerned with the teaching-learning strategy of the Primary Science Project of the Science Education Program for Africa. It was presented in the 1976 seminar of the International Institute for Educational Planning (IIEP) of the UNESCO in Paris. The document includes six sections: (1) The concept of a strategy; (2) Description of the…

Successful Treatment of an Adolescent with Naegleria fowleri Primary Amebic Meningoencephalitis

PubMed Central

Linam, W. Matthew; Ahmed, Mubbasheer; Cope, Jennifer R.; Chu, Craig; Visvesvara, Govinda S.; da Silva, Alexandre J.; Qvarnstrom, Yvonne; Green, Jerril

2015-01-01

Naegleria fowleri is a thermophilic free-living ameba that causes primary amebic meningoencephalitis. Infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. Survival most likely resulted from a combination of early identification and treatment, use of a combination of antimicrobials including miltefosine and management of elevated intracranial pressure based on traumatic brain injury principles. PMID:25667249

Impact of the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention on adherence to national obesity clinical practice guidelines in a primary care centre.

PubMed

Barnes, Emily R; Theeke, Laurie A; Mallow, Jennifer

2015-04-01

Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits. © 2015 John Wiley & Sons, Ltd.

Improving Warfarin Management Within the Medical Home: A Health-System Approach.

PubMed

Rose, Anne E; Robinson, Erin N; Premo, Joan A; Hauschild, Lori J; Trapskin, Philip J; McBride, Ann M

2017-03-01

Anticoagulation clinics have been considered the optimal strategy for warfarin management with demonstrated improved patient outcomes through increased time in therapeutic international normalized ratio (INR) range, decreased critical INR values, and decreased anticoagulation-related adverse events. However, not all health systems are able to support a specialized anticoagulation clinic or may see patient volume exceed available anticoagulation clinic resources. The purpose of this study was to utilize an anticoagulation clinic model to standardize warfarin management in a primary care clinic setting. A warfarin management program was developed that included standardized patient assessment, protocolized warfarin-dosing algorithm, and electronic documentation and reporting tools. Primary care clinics were targeted for training and implementation of this program. The warfarin management program was applied to over 2000 patients and implemented at 39 clinic sites. A total of 160 nurses and 15 pharmacists were trained on the program. Documentation of warfarin dose and date of the next INR increased from 70% to 90% (P <.0001), documentation occurring within 24 hours of the INR result increased from 75% to 87% (P <.0001), and monitoring the INR at least every 4 weeks increased from 71% to 83% (P <.0001) per patient encounter. Time in therapeutic INR range improved from 65% to 75%. Incorporating a standardized approach to warfarin management in the primary care setting significantly improves warfarin-related documentation and time in therapeutic INR range. Copyright © 2016 Elsevier Inc. All rights reserved.

Exploration of the perceptions of emergency physicians and interns regarding the medical documentation practices of interns.

PubMed

Isoardi, Jonathon; Spencer, Lyndall; Sinnott, Michael; Nicholls, Kim; O'Connor, Angela; Jones, Fleur

2013-08-01

The primary objective of the present study was to learn the factors that influence the documentation practices of ED interns. A second objective was to identify the expectations of emergency physicians (EPs) towards the medical record documentation of ED interns. A qualitative design was adopted using semi-structured interviews in convenience samples drawn from both groups. Eighteen interviews were conducted with intern volunteers and 10 with EP volunteers. One (5%) intern and two (20%) EPs had received medical documentation training. Factors that encouraged interns' documentation included: patient acuity (the more critical the condition, the more comprehensive the documentation) and the support of senior colleagues. Inhibiting factors included uncertainty about how much to write, and the shift being worked (interns indicated they wrote less at night). Factors of consequence to senior personnel included the apparent reluctance of interns to document management plans. They noted that interns frequently confine their notes to assessment, investigations and treatments, whereas EPs preferred records that demonstrated intern thought processes and included such matters as future actions to follow immediate treatment. A positive theme that emerged included the high level of support interns received from their senior colleagues. Another theme, the influence of patient acuity, held both positive and negative implications for intern writing practices. The lack of formal training is an impediment to the production of useful medical records by ED interns. One solution proposed by both interns and senior personnel was the introduction of the subject into intern education programmes. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Hanford spent nuclear fuel hot conditioning system test procedure

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

Cleveland, K.J.

1997-09-16

This document provides the test procedures for cold testing of the prototype Hot Conditioning System (HCS) at the 306E Facility. The primary objective of this testing is to confirm design choices and provide data for the detailed design package prior to procurement of the process equipment. The current scope of testing in this document includes a fabricability study of the HCS, equipment performance testing of the HCS components, heat-up and cool-down cycle simulation, and robotic arm testing.

Everything you might want to know about the Internet but are afraid to ask!. A new users resource

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

Thiel, E.

This document is a guide to accessing the Internet and the services available on Internet. The document contains a short explanation of the Internet by E. Kroll and E. Hoffman, brief descriptions of the primary access tools, a glossary, answers to frequently asked questions about the Internet, J. Martin`s `Search for Internet Treasure` and other helpful information. The data access tools discussed in this document include Gopher, World Wide Web, WAIS, ASTRA, ARCHIE, WHOIS, NETSERV, and TRICKLE. The file transfer tool discussed is BITFTP. The two communication services discussed are NETNEWS and LISTSERV.

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

Guyer, H.B.; McChesney, C.A.

The overall primary Objective of HDAR is to create a repository of historical personnel security documents and provide the functionality needed for archival and retrieval use by other software modules and application users of the DISS/ET system. The software product to be produced from this specification is the Historical Document Archival and Retrieval Subsystem The product will provide the functionality to capture, retrieve and manage documents currently contained in the personnel security folders in DOE Operations Offices vaults at various locations across the United States. The long-term plan for DISS/ET includes the requirement to allow for capture and storage ofmore » arbitrary, currently undefined, clearance-related documents that fall outside the scope of the ``cradle-to-grave`` electronic processing provided by DISS/ET. However, this requirement is not within the scope of the requirements specified in this document.« less

The Cuban Missile Crisis. Lesson Plan.

ERIC Educational Resources Information Center

Miller, Linda K.; McAuliffe, Mary

1994-01-01

Presents a secondary lesson plan based on primary sources recently released by the Central Intelligence Agency on the Cuban Missile Crisis. Provides a background essay on the event. Includes five maps and three documents, all of which have been declassified from top secret or secret status. (CFR)

SELECTION AIDS ON LATIN AMERICA FOR PRIMARY AND SECONDARY SCHOOL LIBRARIES.

ERIC Educational Resources Information Center

SHEPARD, MARIETTA DANIELS

A SERIES OF BIBLIOGRAPHIES ARE INCLUDED IN THIS DOCUMENT. THE SCOPE OF THE LIST INCLUDES GENERAL BIBLIOGRAPHIES FROM LATIN AMERICA, AS WELL AS BOOKS FROM SPAIN, WHICH ARE PRINCIPALLY IN THE FIELDS OF HUMANITIES AND SOCIAL SCIENCES, ESPECIALLY LITERATURE AND HISTORY. A LIST OF SOURCES FOR THE PURCHASE OF BOOKS FROM LATIN AMERICA AND SPAIN IS ALSO…

Effects of documentation-based decision support on chronic disease management.

PubMed

Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B; Yu, D Tony; McColgan, Kerry E; Volk, Lynn A; Tsurikova, Ruslana; Melnikas, Andrea J; Einbinder, Jonathan S; Middleton, Blackford

2010-12-01

To evaluate whether a new documentation-based clinical decision support system (CDSS) is effective in addressing deficiencies in the care of patients with coronary artery disease (CAD) and diabetes mellitus (DM). Controlled trial randomized by physician. We assigned primary care physicians (PCPs) in 10 ambulatory practices to usual care or the CAD/DM Smart Form for 9 months. The primary outcome was the proportion of deficiencies in care that were addressed within 30 days after a patient visit. The Smart Form was used for 5.6% of eligible patients. In the intention-to-treat analysis, patients of intervention PCPs had a greater proportion of deficiencies addressed within 30 days of a visit compared with controls (11.4% vs 10.1%, adjusted and clustered odds ratio =1.14; 95% confidence interval, 1.02-1.28; P = .02). Differences were more pronounced in the "on-treatment" analysis: 17.0% of deficiencies were addressed after visits in which the Smart Form was used compared with 10.6% of deficiencies after visits in which it was not used (P <.001). Measures that improved included documentation of smoking status and prescription of antiplatelet agents when appropriate. Overall use of the CAD/DM Smart Form was low, and improvements in management were modest. When used, documentation-based decision support shows promise, and future studies should focus on refining such tools, integrating them into current electronic health record platforms, and promoting their use, perhaps through organizational changes to primary care practices.

The 'Amistad' Case. Lesson Plan.

ERIC Educational Resources Information Center

National Archives and Records Administration, Washington, DC.

Teaching about the Amistad case provides correlations to the National Standards for History, and Civics and Government. An overview of the events of 1839 is given in this lesson plan. Seven student activities include reading and using primary source documents, writing journal articles, viewing the movie "Amistad," and giving…

Selected Bibliography of Egyptian Educational Materials, Vol. 1, No. 1, 1975.

ERIC Educational Resources Information Center

Al-Ahram Center for Scientific Translations, Cairo (Egypt).

There are 101 selected entries in this annotated bibliography of Egyptian materials on education published in 1975. Materials include journal articles, books, and government documents. The bibliography covers the following topics: laws and legislation, meetings and symposia, primary schools, preparatory schools, secondary schools, experimental…

Internet Resources for Civic Educators. ERIC Digest.

ERIC Educational Resources Information Center

Pinhey, Laura A.

The Internet is an important resource for K-12 citizenship education teachers. Curriculum guides, lesson plans, government documents, conference proceedings, databases, photographs, and multimedia files provide the classroom teacher with a variety of materials including many primary sources. An annotated list of 15 World Wide Web sites are…

Rethinking Silence in the Classroom: Chinese Students' Experiences of Sharing Indigenous Knowledge

ERIC Educational Resources Information Center

Zhou, Yanqiu Rachel; Knoke, Della; Sakamoto, Izumi

2005-01-01

Recent research has documented silence/reticence among East-Asian international students, including Chinese students, in Western/English classrooms. Students' communication competence and cultural differences from the mainstream Euro-American society have been identified as two primary barriers to participation. Placing emphasis on individual…

Coordination and collaboration to document the global cotton germplasm resources

USDA-ARS?s Scientific Manuscript database

Coordinated efforts to collect and maintain cotton genetic resources have increased over the last 100 years to insure the worldwide economic value of cotton fiber and cotton byproducts. The classified genetic resources of cotton are extensive and include five tetraploid species in the primary gene ...

Responding to the health needs of survivors of human trafficking: a systematic review.

PubMed

Hemmings, Stacey; Jakobowitz, Sharon; Abas, Melanie; Bick, Debra; Howard, Louise M; Stanley, Nicky; Zimmerman, Cathy; Oram, Sian

2016-07-29

Despite the multiple physical and psychological health consequences associated with human trafficking, there is little evidence-based guidance available for health providers on assessing and meeting the health needs of trafficked people. We aimed to review literature that provided guidance or research on care provision for people who had been trafficked. We conducted a systematic review and qualitative analysis of peer-reviewed and grey literature. Data sources included electronic databases, reference list screening, citation tracking, and expert recommendations. Documents were included if they reported on: 1) male or females (adults or children) who were currently or had previously been trafficked; 2) health interventions or service provision; 3) primary, secondary, tertiary or specialist post-trafficking services; and 4) World Bank high income countries. Two reviewers independently screened and quality appraised documents. Framework analysis was used to analyse extracted data. Forty-four documents were included, 19 of which reported findings of primary studies and nine of which exclusively addressed children. Evidence to inform the identification, referral and care of trafficked people is extremely limited. Within current literature on survivor identification, key indicators included signs of physical and sexual abuse, absence of documentation, and being accompanied by a controlling companion. Findings highlighted the importance of interviewing possible victims in private, using professional interpreters, and building trust. For provision of care, key themes included the importance of comprehensive needs assessments, adhering to principles of trauma-informed care, and cultural sensitivity. Further prominent themes were the necessity of multi-agency working strategies and well-defined referral pathways. Human trafficking survivors require healthcare that is trauma-informed and culturally sensitive to their particular needs. Coordination is needed between health providers and statutory and voluntary organisations. Future research should generate empirical evidence to develop trafficking indicators for use by health providers, alongside validated screening tools, and evaluate the effectiveness of psychological interventions.

Documenting coordination of cancer care between primary care providers and oncology specialists in Canada.

PubMed

Brouwers, Melissa C; Vukmirovic, Marija; Tomasone, Jennifer R; Grunfeld, Eva; Urquhart, Robin; O'Brien, Mary Ann; Walker, Melanie; Webster, Fiona; Fitch, Margaret

2016-10-01

To report on the findings of the CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum) Casebook project, which systematically documented Canadian initiatives (ie, programs and projects) designed to improve or support coordination and continuity of cancer care between primary care providers (PCPs) and oncology specialists. Pan-Canadian environmental scan. Canada. Individuals representing the various initiatives provided data for the analysis. Initiatives included in the Casebook met the following criteria: they supported coordination and collaboration between PCPs and oncology specialists; they were related to diagnosis, treatment, survivorship, or personalized medicine; and they included breast or colorectal cancer or both. Data were collected on forms that were compiled into summaries (ie, profiles) for each initiative. Casebook initiatives were organized based on the targeted stage of the cancer care continuum, jurisdiction, and strategy (ie, model of care or type of intervention) employed. Thematic analysis identified similarities and differences among employed strategies, the level of primary care engagement, implementation barriers and facilitators, and initiative evaluation. The CanIMPACT Casebook profiles 24 initiatives. Eleven initiatives targeted the survivorship stage of the cancer care continuum and 15 focused specifically on breast or colorectal cancer or both. Initiative teams implemented the following strategies: nurse patient navigation, multidisciplinary care teams, electronic communication or information systems, PCP education, and multicomponent initiatives. Initiatives engaged PCPs at various levels. Implementation barriers included lack of care standardization across jurisdictions and incompatibility among electronic communication systems. Implementation facilitators included having clinical and program leaders publicly support the initiative, repurposing existing resources, receiving financial support, and establishing a motivated and skilled project or program team. The lack of evaluative data made it difficult to identify the most effective interventions or models of care. The CanIMPACT Casebook documents Canadian efforts to improve or support the coordination of cancer care by PCPs and oncology specialists as a means to improve patient outcomes and cancer system performance. Copyright© the College of Family Physicians of Canada.

Defense Acquisition Research Journal. Volume 23, Number 4, Issue 79, October 2016

DTIC Science & Technology

2016-10-01

the final word on ship design decisions, including critical operational requirements and costs. Kuehn provides a captivating description of how the...requires using material from primary sources, including program documents, policy papers, memoranda, surveys , interviews, etc. Articles are...instrument, • describe the limitations of the research, • ensure results are quantitative and qualitative, • determine if the study can be replicated, and

Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis.

PubMed

Linam, W Matthew; Ahmed, Mubbasheer; Cope, Jennifer R; Chu, Craig; Visvesvara, Govinda S; da Silva, Alexandre J; Qvarnstrom, Yvonne; Green, Jerril

2015-03-01

Naegleria fowleri is a thermophilic, free-living ameba that causes primary amebic meningoencephalitis. The infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. The patient's survival most likely resulted from a variety of factors: early identification and treatment, use of a combination of antimicrobial agents (including miltefosine), and management of elevated intracranial pressure based on the principles of traumatic brain injury. Copyright © 2015 by the American Academy of Pediatrics.

MPS Solidification Model. Volume 2: Operating guide and software documentation for the unsteady model

NASA Technical Reports Server (NTRS)

Maples, A. L.

1981-01-01

The operation of solidification Model 2 is described and documentation of the software associated with the model is provided. Model 2 calculates the macrosegregation in a rectangular ingot of a binary alloy as a result of unsteady horizontal axisymmetric bidirectional solidification. The solidification program allows interactive modification of calculation parameters as well as selection of graphical and tabular output. In batch mode, parameter values are input in card image form and output consists of printed tables of solidification functions. The operational aspects of Model 2 that differ substantially from Model 1 are described. The global flow diagrams and data structures of Model 2 are included. The primary program documentation is the code itself.

IRIS TOXICOLOGICAL REVIEW AND SUMMARY DOCUMENTS FOR HYDROGEN SULFIDE (EXTERNAL REVIEW DRAFT)

EPA Science Inventory

Hydrogen sulfide (H2S) is a colorless gas with a strong odor of rotten eggs. Its primary uses include the production of elemental sulfur and sulfuric acid, the manufacture of heavy water and other chemicals. Occupational exposure occurs primarily from its presence in petroleum, n...

Tiggy, Primary Academics.

ERIC Educational Resources Information Center

Barrie, Joan

This document consists of three books in one. The first book is a reproducible book for students titled "Tiggy and Me and Butterfly, Too!" about traveling around the world. The second book, for the teacher, includes a guide to teaching the student's book and a comprehensive whole language, multicultural, multidisciplinary resource book. The third…

Archaeology of Early Colonial Life. Teaching with Primary Sources Series, Volume 13.

ERIC Educational Resources Information Center

West, Jean

This kit, for grades 5 and up, helps students master the content of Colonial American history and develops students' historiographic and upper level thinking skills. The documents and activities included in this volume allow students to become "historical detectives," peeling back the layers, deciphering archaic lettering, reassembling…

Celebrate Missouri Day in Your Classroom.

ERIC Educational Resources Information Center

Missouri State Dept. of Elementary and Secondary Education, Jefferson City.

This booklet provides suggested activities that can be used to enrich the observance of Missouri Day, a day commemorative of Missouri history. The document includes a chart specifying the date of Missouri day from 1990 through 1995, always the third Wednesday of October. Activities are recommended for primary, elementary, middle, and secondary…

Correspondence Urging Bombing of Auschwitz during World War II. Teaching with Documents.

ERIC Educational Resources Information Center

Blondo, Richard A.; Schmael, Wynell Burroughs

1993-01-01

Presents a classroom lesson that utilizes primary sources about Auschwitz, the World War II Nazi concentration camp. Two letters confronting the issue of whether or not U.S. planes should bomb the camps are included. Recommends seven teaching strategies for the lesson and identifies additional resources. (CFR)

Section 4 User Guide – Primary Support

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics (OPPT) Section 4 application submission process. This document is the user guide for the Primary Support user of the Section 4 tool.

Weighty Problems: Predictors of Family Physicians Documenting Overweight and Obesity.

PubMed

Cyr, Peggy R; Haskins, Amy E; Holt, Christina; Hanifi, Jasmine

2016-03-01

Documenting obesity on the problem list has been shown to promote action about obesity and overweight, yet a majority of primary care providers do not record obesity on the medical problem list. With this in mind, our objectives were to determine the proportion of physicians' documentation of overweight (OW) or obesity on the problem list in our primary care teaching practice and to identify predictors of physician documentation of OW/obesity. De-identified health records of 6,195 adult patients with BMI ? 25 kg/m2 seen by a family physician over a 2-year period were included. Using multivariate logistic regression, patient age, BMI, gender, race, insurance, comorbidities, number of visits, physician gender or role, and practice site (suburban versus urban) were examined in relation to inclusion of OW/obesity on the medical problem list. Few (21.1%) patients had OW/obesity on their problem list. In the multivariate model, female PCPs were significantly more likely to document OW/obesity (OR=1.39, 95% CI=1.18--1.63) compared to male PCPs, and faculty were 26% more likely to document obesity (95% CI=1.07--1.48) compared to residents. Female patients, those with hypertension, diabetes, hyperlipidemia, and those with six or more visits were significantly more likely to have obesity on their problem lists, while patients with Medicaid were less likely to have obesity recorded. No significant difference was seen by race. Nearly 80% of OW and obese patients were not identified on the problem list. Patient gender, comorbidity, and number of visits were associated with documentation. Future research should examine automatic documentation of OW/obesity on the medical problem list.

Pretest analysis document for Test S-FS-6

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

Shaw, R.A.; Hall, D.G.

This report documents the pretest analyses completed for Semiscale Test S-FS-6. This test will simulate a transient initiated by a 100% break in a steam generator bottom feedwater line downstream of the check valve. The initial conditions represent normal operating conditions for a C-E System 80 nuclear power plant. Predictions of transients resulting from feedwater line breaks in these plants have indicated that significant primary system overpressurization may occur. The enclosed analyses include a RELAP5/MOD2/CY21 code calculation and preliminary results from a facility hot, integrated test which was conducted to near S-FS-6 specifications. The results of these analyses indicate thatmore » the test objectives for Test S-FS-6 can be achieved. The primary system overpressurization will pose no threat to personnel or plant integrity.« less

Methane Hydrate Field Program: Development of a Scientific Plan for a Methane Hydrate-Focused Marine Drilling, Logging and Coring Program

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

Myers, Greg

This final report document summarizes the activities undertaken and the output from three primary deliverables generated during this project. This fifteen month effort comprised numerous key steps including the creation of an international methane hydrate science team, determining and reporting the current state of marine methane hydrate research, convening an international workshop to collect the ideas needed to write a comprehensive Marine Methane Hydrate Field Research Plan and the development and publication of that plan. The following documents represent the primary deliverables of this project and are discussed in summary level detail in this final report: Historical Methane Hydrate Projectmore » Review Report; Methane Hydrate Workshop Report; Topical Report: Marine Methane Hydrate Field Research Plan; and Final Scientific/Technical Report.« less

Energy: A special bibliography with indexes, April 1974

NASA Technical Reports Server (NTRS)

1974-01-01

This literature survey of special energy and energy related documents lists 1708 reports, articles, and other documents introduced into the NASA scientific and technical information system between January 1, 1968, and December 31, 1973. Citations from International Aerospace Abstracts (IAA) and Scientific and Technical Aerospace Reports (STAR) are grouped according to the following subject categories: energy systems; solar energy; primary energy sources; secondary energy sources; energy conversion; energy transport, transmission, and distribution; and energy storage. The index section includes the subject, personal author, corporate source, contract, report, and accession indexes.

Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis.

PubMed

Veinot, Tiffany C; Senteio, Charles R; Hanauer, David; Lowery, Julie C

2018-06-01

To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research. The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process. The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations. The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians.

Neoproterozoic marine carbonates and their paleoceanographic significance

NASA Astrophysics Data System (ADS)

Hood, Ashleigh van Smeerdijk; Wallace, Malcolm William

2018-01-01

The primary mineralogy of marine carbonate precipitates has been a crucial factor in constraining the major element composition of ancient oceans. Secular changes in Phanerozoic marine chemistry, including Mg/Ca, have been well-documented using the original carbonate mineralogy of ooids, marine cements and biominerals. However, the history of Precambrian seawater chemistry is not as well constrained, partially due to the prevalence of dolomitisation in the Precambrian geological record. The Neoproterozoic ( 1000 Ma to 541 Ma) record of primary carbonate mineralogy is documented here using a combination of literature data and new analysis of marine carbonate precipitates from the Otavi Fold Belt, Namibia, the Death Valley succession, USA and the Adelaide Fold Belt, Australia. These data suggest that the last 460 million years of the Proterozoic were dominated by aragonite and high-Mg calcite precipitation in shallow marine settings. In contrast, low-Mg calcite has only been recognised in a small number of formations. In addition to aragonite and calcite precipitation, marine dolomite precipitation was widespread in Neoproterozoic oceans, including mimetic (syn-sedimentary) dolomitisation and primary dolomite marine cementation. The combination of marine aragonite, high Mg-calcite and dolomite precipitation during the Neoproterozoic suggests extremely high seawater Mg/Ca conditions relative to Phanerozoic oceans. Marine dolomite precipitation may also be linked to widespread marine anoxia during this time.

Using Google Documents for Composing Projects that Use Primary Research in First-Year Writing Courses

ERIC Educational Resources Information Center

Strasma, Kip

2010-01-01

In this article, the author shares how efficient and effective Google Documents is for faculty seeking to engage students in inquiry-based, emergent, and primary research in first-year composition courses. The specific appeal of Google Documents is that it occupies a space between "open source"--defined by the Open Source Initiative as "free,…

Documentation of pain care processes does not accurately reflect pain management delivered in primary care.

PubMed

Krebs, Erin E; Bair, Matthew J; Carey, Timothy S; Weinberger, Morris

2010-03-01

Researchers and quality improvement advocates sometimes use review of chart-documented pain care processes to assess the quality of pain management. Studies have found that primary care providers frequently fail to document pain assessment and management. To assess documentation of pain care processes in an academic primary care clinic and evaluate the validity of this documentation as a measure of pain care delivered. Prospective observational study. 237 adult patients at a university-affiliated internal medicine clinic who reported any pain in the last week. Immediately after a visit, we asked patients to report the pain treatment they received. Patients completed the Brief Pain Inventory (BPI) to assess pain severity at baseline and 1 month later. We extracted documentation of pain care processes from the medical record and used kappa statistics to assess agreement between documentation and patient report of pain treatment. Using multivariable linear regression, we modeled whether documented or patient-reported pain care predicted change in pain at 1 month. Participants' mean age was 53.7 years, 66% were female, and 74% had chronic pain. Physicians documented pain assessment for 83% of visits. Patients reported receiving pain treatment more often (67%) than was documented by physicians (54%). Agreement between documentation and patient report was moderate for receiving a new pain medication (k = 0.50) and slight for receiving pain management advice (k = 0.13). In multivariable models, documentation of new pain treatment was not associated with change in pain (p = 0.134). In contrast, patient-reported receipt of new pain treatment predicted pain improvement (p = 0.005). Chart documentation underestimated pain care delivered, compared with patient report. Documented pain care processes had no relationship with pain outcomes at 1 month, but patient report of receiving care predicted clinically significant improvement. Chart review measures may not accurately reflect the pain management patients receive in primary care.

Translation of clinical practice guidelines for childhood obesity prevention in primary care mobilizes a rural Midwest community.

PubMed

Gibson, S Jo

2016-03-01

The purpose of this project was to implement clinic system changes that support evidence-based guidelines for childhood obesity prevention. Adherence rates for prevention and screening of children in a rural Midwest primary care setting were used to measure the success of the program. Retrospective chart reviews reflected gaps in current practice and documentation. An evidence-based toolkit for childhood obesity prevention was used to implement clinic system changes for the identified gaps. The quality improvement approach proved to be effective in translating knowledge of obesity prevention guidelines into rural clinic practices with significant improvements in documentation of prevention measures that may positively impact the childhood obesity epidemic. Primary care providers, including nurse practitioners (NPs), are at the forefront of diagnosing, educating, and counseling children and families on obesity prevention and need appropriate resources and tools to deliver premier care. The program successfully demonstrated how barriers to practice, even with the unique challenges in a rural setting, can be overcome. NPs fulfill a pivotal primary care role and can provide leadership that may positively impact obesity prevention in their communities. ©2015 American Association of Nurse Practitioners.

2016 eCDRweb User Guide–Primary Support

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics’ (OPPT) 2016 e-CDR web tool. This document is the user guide for the Primary Support user of the 2016 e-CDRweb tool.

A scoping review of traditional food security in Alaska.

PubMed

Walch, Amanda; Bersamin, Andrea; Loring, Philip; Johnson, Rhonda; Tholl, Melissa

2018-12-01

Food insecurity is a public health concern. Food security includes the pillars of food access, availability and utilisation. For some indigenous peoples, this may also include traditional foods. To conduct a scoping review on traditional foods and food security in Alaska. Google Scholar and the High North Research Documents were used to search for relevant primary research using the following terms: "traditional foods", "food security", "access", "availability", "utilisation", "Alaska", "Alaska Native" and "indigenous". Twenty four articles from Google Scholar and four articles from the High North Research Documents were selected. The articles revealed three types of research approaches, those that quantified traditional food intake (n=18), those that quantified food security (n=2), and qualitative articles that addressed at least one pillar of food security (n=8). Limited primary research is available on food security in Alaskan. Few studies directly measure food security while most provide a review of food security factors. Research investigating dietary intake of traditional foods is more prevalent, though many differences exist among participant age groups and geographical areas. Future research should include direct measurements of traditional food intake and food security to provide a more complete picture of traditional food security in Alaska.

Obesity perceptions and documentation among primary care clinicians at a rural academic health center.

PubMed

Aleem, Sohaib; Lasky, Rosalind; Brooks, W Blair; Batsis, John A

2015-01-01

Obesity recognition in primary care is important to address the epidemic. We aimed to evaluate primary care clinician-reported documentation, management practices, beliefs and attitudes toward obesity compared to body mass index (BMI) calculation, obesity prevalence and actual documentation of obesity as an active problem in electronic health record in a rural academic center. Our target population for previously validated clinician survey was 56 primary care providers working at 3 sites. We used calendar year 2012 data for assessment of baseline system performance for metrics of documentation of BMI in primary care visits, and proportion of visits in patients with obesity with obesity as a problem. Standard statistical methods assessed the data. Survey response rate was 91%. Average age of respondents was 48.9 years and 62.7% were females. 72.5% clinicians reported having normal BMI. The majority of clinicians reported regularly documenting obesity as an active problem, and utilized motivational interviewing and basic good nutrition and healthy exercise. Clinicians identified lack of discipline and exercise time, access to unhealthy food and psychosocial issues as major barriers. Most denied disliking weight loss discussion or patients taking up too much time. In 21,945 clinic visits and 11,208 annual preventive care visits in calendar year 2012, BMI was calculated in 93% visits but obesity documentation as an active problem only 27% of patients meeting BMI criteria for obesity. Despite high clinician-reported documentation of obesity as an active problem, actual obesity documentation rates remained low in a rural academic medical center. Copyright © 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Section 8(d) Health Safety Data Reporting User Guide – Primary Support

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics (OPPT) Section 8(d) Health & Safety Data Reporting application. This document is the user guide for the Primary Support user.

2016 eCDRweb User Guide–Primary Authorized Official

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics’ (OPPT) 2016 e-CDRweb tool. This document is the user guide for the Primary Authorized Official (AO) user of the 2016 e-CDR web tool.

The Potential Role of Schools and Teachers in the Character Development of Young People in England: Perspectives from Pupils and Teachers

ERIC Educational Resources Information Center

See, Beng Huat; Arthur, James

2011-01-01

This paper considers the potential role of schools and teachers in the character development of pupils aged 10-19. It is based largely on the views of 5207 pupils in England, drawn from 25 state schools, including five primaries. Data include document contents, interviews and surveys with pupils and their teachers. Pupil accounts suggest that…

Site scientific mission plan for the Southern Great Plains CART site, January-June 1995

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

Schneider, J.M.; Lamb, P.J.; Sisterson, D.L.

1994-12-01

The Southern Great Plains (SGP) Cloud and Radiation Testbed (CART) site is designed to help satisfy the data needs of the Atmospheric Measurement (ARM) Program Science Team. This document defines the scientific priorities for site activities during the six months beginning on January 1, 1995, and also looks forward in lesser detail to subsequent six-month periods. The primary purpose of this Site Scientific Mission Plan is to provide guidance for the development of plans for site operations. It also provides information on current plans to the ARM functional teams (Management Team, Experiment Support Team [EST], Operations Team, Data Management Teammore » [DMT], Instrument Team [IT], and Campaign Team) and serves to disseminate the plans more generally within the ARM Program and among the members of the Science Team. This document includes a description of the operational status of the site and the primary envisaged site activities, together with information concerning approved and proposed Intensive Observation Periods (IOPs). Amendments will be prepared and distributed whenever the content changes by more than 30% within a six-month period. The primary users of this document are the site operator, the site scientist, the Science Team through the ARM Program Science Director, The ARM Program Experiment Center, and the aforementioned ARM Program functional teams. This plan is a living document that will be updated and reissued every six months as the observational facilities are developed, tested, and augmented and as priorities are adjusted in response to developments in scientific planning and understanding.« less

Critical issues in an electronic documentation system.

PubMed

Weir, Charlene R; Nebeker, Jonathan R

2007-10-11

The Veterans Health Administration (VHA), of the U.S. Department of Veteran Affairs has instituted a medical record (EMR) that includes electronic documentation of all narrative components of the medical record. To support clinicians using the system, multiple efforts have been instituted to ease the creation of narrative reports. Although electronic documentation is easier to read and improves access to information, it also may create new and additional hazards for users. This study is the first step in a series of studies to evaluate the issues surrounding the creation and use of electronic documentation. Eighty-eight providers across multiple clinical roles were interviewed in 10 primary care sites in the VA system. Interviews were tape-recorded, transcribed and qualitatively analyzed for themes. In addition, specific questions were asked about perceived harm due to electronic documentation practices. Five themes relating to difficulties with electronic documentation were identified: 1) information overload; 2) hidden information; 3) lack of trust; 4) communication; 5) decision-making. Three providers reported that they knew of an incident where current documentation practices had caused patient harm and over 75% of respondents reported significant mis-trust of the system.

Excellence in Teaching Mathematics: Activities and Ideas from Ohio's Outstanding Teachers, 1994 District Winners.

ERIC Educational Resources Information Center

Borchers, Nancy, Ed.; Caniglia, Joanne, Ed.

This document is a collection of lesson plans written by 18 of Ohio's outstanding teachers chosen by the Ohio Council of Teachers of Mathematics. Each lesson plan includes reflection questions and some contain worksheets. Lesson plan titles for primary grades (grades 1-3) are: "Munching Fractions;""Math and…

Teenage Pregnancy and Primary Prevention: New Approaches to an Old Problem.

ERIC Educational Resources Information Center

Pate, David J., Jr.; Knight, Susan

This document describes the Parents Too Soon (PTS) program, a project which integrated a comprehensive array of services for teenagers in an effort to help prevent premature and unwanted pregnancies. Four components of the PTS program are listed: (1) comprehensive family planning medical services including provision of contraceptives; (2) social…

Today's Delinquent. Volumes 1 and 2.

ERIC Educational Resources Information Center

Hurst, Hunter, Ed.; And Others

1983-01-01

This document contains the first two volumes of "Today's Delinquent," an annual publication of the National Center for Juvenile Justice. The primary focus of both volumes is serious crime by juveniles. Articles in volume one include: (1) "Violent Juvenile Crime: The Problem in Perspective" (Howard N. Snyder); (2) "Canon to the Left, Canon to the…

Letter Proposing Candidates for the First UN Assembly. Teaching with Documents.

ERIC Educational Resources Information Center

Haverkamp, Beth; Schamel, Wynell

1994-01-01

Presents a secondary school lesson plan on the selection of delegates to the first United Nations Assembly meeting. Discusses the esteem of Eleanor Roosevelt at that time and how President Truman requested that she be one of five U.S. representatives. Includes two primary source letters and instructional procedures. (CFR)

A Process and Outcome Evaluation of an Affective Teacher Training Primary Prevention Program.

ERIC Educational Resources Information Center

Schaps, Eric; And Others

Effective Classroom Management (ECM)-Elementary, an in-service course in which teachers were taught various communication, problem solving, and self-esteem enhancement techniques was evaluated. Process evaluation data included: (1) documentation of in-service training by outside observers; (2) teacher feedback on the individual training sessions;…

Exploring a Paperless Business Administrative System (BAS) Implementation in a K-12 School

ERIC Educational Resources Information Center

Issa, Marwan M.

2011-01-01

The primary purpose of this qualitative study was to investigate how a paperless BAS can affect the overall performance of a school's administrative activities. The research included direct observation, survey questionnaires, document review, and both structured and unstructured interviews. The selected school, a K-12 charter school, was an ideal…

HEALTH MANPOWER RESEARCH. VOLUME 1.

ERIC Educational Resources Information Center

BUTTER, IRENE; AND OTHERS

THE TWO PARTS OF THE DOCUMENT REFLECT THE ACTIVITIES CARRIED OUT TO FULFILL THE PRIMARY PURPOSES OF A PUBLIC HEALTH SERVICE CONTRACT (1) TO STIMULATE FURTHER ACADEMICALLY BASED HEALTH MANPOWER RESEARCH, AND (2) TO EXAMINE THE FIELD IN ORDER TO RECOMMEND PRIORITY AREAS OF HEALTH MANPOWER RESEARCH. PART A INCLUDES--(1) REFERENCE TO A SURVEY PAPER…

A Corporate Reader: Work and Family Life in the 1980s.

ERIC Educational Resources Information Center

Bohen, Halcyone H., Comp.; And Others

Articles collected in this book address issues arising from the fact that the American workforce is increasingly composed of parents. Included in the collection are short newspaper and magazine selections as well as longer magazine articles and book chapters. These materials provide primary sources documenting an historical movement of social…

Documentation of Sexual Partner Gender Is Low in Electronic Health Records: Observations, Predictors, and Recommendations to Improve Population Health Management in Primary Care

PubMed Central

Yehia, Baligh R.

2015-01-01

Abstract The 2011 Institute of Medicine report on LGBT health recommended that sexual orientation and gender identity (SO/GI) be documented in electronic health records (EHRs). Most EHRs cannot document all aspects of SO/GI, but some can record gender of sexual partners. This study sought to determine the proportion of patients who have the gender of sexual partners recorded in the EHR and to identify factors associated with documentation. A retrospective analysis was done of EHR data for 40 family medicine (FM) and general internal medicine (IM) practices, comprising 170,570 adult patients seen in 2012. The primary outcome was EHR documentation of sexual partner gender. Multivariate logistic regression assessed the impact of patient, provider, and practice factors on documentation. In all, 76,767 patients (45%) had the gender of sexual partners recorded, 4.3% of whom had same-gender partners (3.5% of females, 5.6% of males). Likelihood of documentation was independently higher for women; blacks; those with a preventive visit; those with a physician assistant, nurse practitioner, or resident primary care provider (vs. attending); those at urban practices; those at smaller practices; and those at a residency FM practice. Older age and Medicare insurance were associated with lower documentation. Sexual partner gender documentation is important to identify patients for targeted prevention and support, and holds great potential for population health management, yet documentation in the EHR currently is low. Primary care practices should routinely record the gender of sexual partners, and additional work is needed to identify best practices for collecting and using SO/GI data in this setting. (Population Health Management 2015;18:217–222). PMID:25290634

Interdisciplinary evaluation of consecutive patients with unilateral cleft lip and palate at age 6, 15, and 25 years: a concurrent standardized procedure and documentation by plastic surgeon; speech and language pathologist; ear, nose, and throat specialist; and orthodontist.

PubMed

Tindlund, Rolf S; Holmefjord, Anders; Eriksson, Jens-Christian Haug; Johnson, Gunnar E; Vindenes, Hallvard

2009-09-01

To evaluate surgical results, speech, hearing, and craniofacial morphology after primary cleft repair performed from 1973 to 1979. During the years 1972 to 1985, all primary cleft surgeries were performed by 1 plastic surgeon, using Tennison lip closure combined with a periosteoplasty on the clefted alveolus at age 3 months. By mobilizing mucoperiosteal flaps, bony bridges were induced in the alveolar process in approximately 60% of the cases. All patients had the soft palate closed at age 24 months by a pushback technique. All children with complete unilateral clefts without soft tissue bands (unilateral cleft lip and palate) primary operated on 1973 to 1979 were included in the material, except 3 patients with a syndrome and 2 patients of foreign ethnicity. The material involved 30 consecutive patients with unilateral cleft lip and palate (20 boys and 10 girls; 16 left-sided and 14 right-sided clefts) who were operated on. Standardized records including photos, radiographs, lateral cephalograms, plaster model, and recording of speech and hearing were collected according to the treatment protocol at age 6, 15, and approximately 25 years. Evaluation included craniofacial descriptive cephalometric analysis, dentoalveolar morphology, dentofacial aesthetics, speech concerning articulation and nasality, and hearing status. Number of surgical interventions after primary surgery was recorded. Secondary revisions and candidates for orthognathic surgery are reported. Ten consecutive patients (case nos. 11-20) are demonstrated as clinical reports. : This longitudinal study shows how a multidisciplinary evaluation adequate for intercenter comparison can be performed when standardized procedures, registrations, and documentations are available.

Who has used internal company documents for biomedical and public health research and where did they find them?

PubMed

Wieland, L Susan; Rutkow, Lainie; Vedula, S Swaroop; Kaufmann, Christopher N; Rosman, Lori M; Twose, Claire; Mahendraratnam, Nirosha; Dickersin, Kay

2014-01-01

To describe the sources of internal company documents used in public health and healthcare research. We searched PubMed and Embase for articles using internal company documents to address a research question about a health-related topic. Our primary interest was where authors obtained internal company documents for their research. We also extracted information on type of company, type of research question, type of internal documents, and funding source. Our searches identified 9,305 citations of which 357 were eligible. Scanning of reference lists and consultation with colleagues identified 4 additional articles, resulting in 361 included articles. Most articles examined internal tobacco company documents (325/361; 90%). Articles using documents from pharmaceutical companies (20/361; 6%) were the next most common. Tobacco articles used documents from repositories; pharmaceutical documents were from a range of sources. Most included articles relied upon internal company documents obtained through litigation (350/361; 97%). The research questions posed were primarily about company strategies to promote or position the company and its products (326/361; 90%). Most articles (346/361; 96%) used information from miscellaneous documents such as memos or letters, or from unspecified types of documents. When explicit information about study funding was provided (290/361 articles), the most common source was the US-based National Cancer Institute. We developed an alternative and more sensitive search targeted at identifying additional research articles using internal pharmaceutical company documents, but the search retrieved an impractical number of citations for review. Internal company documents provide an excellent source of information on health topics (e.g., corporate behavior, study data) exemplified by articles based on tobacco industry documents. Pharmaceutical and other industry documents appear to have been less used for research, indicating a need for funding for this type of research and well-indexed and curated repositories to provide researchers with ready access to the documents.

Who Has Used Internal Company Documents for Biomedical and Public Health Research and Where Did They Find Them?

PubMed Central

Wieland, L. Susan; Rutkow, Lainie; Vedula, S. Swaroop; Kaufmann, Christopher N.; Rosman, Lori M.; Twose, Claire; Mahendraratnam, Nirosha; Dickersin, Kay

2014-01-01

Objective To describe the sources of internal company documents used in public health and healthcare research. Methods We searched PubMed and Embase for articles using internal company documents to address a research question about a health-related topic. Our primary interest was where authors obtained internal company documents for their research. We also extracted information on type of company, type of research question, type of internal documents, and funding source. Results Our searches identified 9,305 citations of which 357 were eligible. Scanning of reference lists and consultation with colleagues identified 4 additional articles, resulting in 361 included articles. Most articles examined internal tobacco company documents (325/361; 90%). Articles using documents from pharmaceutical companies (20/361; 6%) were the next most common. Tobacco articles used documents from repositories; pharmaceutical documents were from a range of sources. Most included articles relied upon internal company documents obtained through litigation (350/361; 97%). The research questions posed were primarily about company strategies to promote or position the company and its products (326/361; 90%). Most articles (346/361; 96%) used information from miscellaneous documents such as memos or letters, or from unspecified types of documents. When explicit information about study funding was provided (290/361 articles), the most common source was the US-based National Cancer Institute. We developed an alternative and more sensitive search targeted at identifying additional research articles using internal pharmaceutical company documents, but the search retrieved an impractical number of citations for review. Conclusions Internal company documents provide an excellent source of information on health topics (e.g., corporate behavior, study data) exemplified by articles based on tobacco industry documents. Pharmaceutical and other industry documents appear to have been less used for research, indicating a need for funding for this type of research and well-indexed and curated repositories to provide researchers with ready access to the documents. PMID:24800999

The efficacy of computer-enabled discharge communication interventions: a systematic review.

PubMed

Motamedi, Soror Mona; Posadas-Calleja, Juan; Straus, Sharon; Bates, David W; Lorenzetti, Diane L; Baylis, Barry; Gilmour, Janet; Kimpton, Shandra; Ghali, William A

2011-05-01

Traditional manual/dictated discharge summaries are inaccurate, inconsistent and untimely. Computer-enabled discharge communications may improve information transfer by providing a standardised document that immediately links acute and community healthcare providers. To conduct a systematic review evaluating the efficacy of computer-enabled discharge communication compared with traditional communication for patients discharged from acute care hospitals. MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials and MEDLINE In-Process. Keywords from three themes were combined: discharge communication, electronic/online/web-based and controlled interventional studies. Study types included: clinical trials, quasiexperimental studies with concurrent controls and controlled before--after studies. Interventions included: (1) automatic population of a discharge document by computer database(s); (2) transmission of discharge information via computer technology; or (3) computer technology providing a 'platform' for dynamic discharge communication. Controls included: no intervention or traditional manual/dictated discharge summaries. Primary outcomes included: mortality, readmission and adverse events/near misses. Secondary outcomes included: timeliness, accuracy, quality/completeness and physician/patient satisfaction. Description of interventions and study outcomes were extracted by two independent reviewers. 12 unique studies were identified: eight randomised controlled trials and four quasi-experimental studies. Pooling/meta-analysis was not possible, given the heterogeneity of measures and outcomes reported. The primary outcomes of mortality and readmission were inconsistently reported. There was no significant difference in mortality, and one study reported reduced long-term readmission. Intervention groups experienced reductions in perceived medical errors/adverse events, and improvements in timeliness and physician/patient satisfaction. Computer-enabled discharge communications appear beneficial with respect to a number of important secondary outcomes. Primary outcomes of mortality and readmission are less commonly reported in this literature and require further study.

Factors shaping intersectoral action in primary health care services.

PubMed

Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael

2014-12-01

To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

HIV counselling and testing practices for children seen in an urban emergency department of a tertiary referral hospital in Dar es Salaam, Tanzania: a retrospective cross-sectional study

PubMed Central

Sawe, Hendry R; Mfinanga, Juma A; Ringo, Faith H; Mwafongo, Victor; Reynolds, Teri A; Runyon, Michael S

2016-01-01

Objectives To describe the HIV counselling and testing practices for children presenting to an emergency department (ED) in a low-income country. Setting The ED of a large east African national referral hospital. Participants This retrospective review of all paediatric (<18 years old) ED visits in 2012 enrolled patients who had an HIV test ordered and excluded those without testing. Files were available for 5540/5774 (96%) eligible patients and 1632 (30%) were tested for HIV, median age 1.3 years (IQR 9 months to 4 years), 58% <18 months old and 61% male. Primary and secondary outcome measures The primary outcome measure was documentation of pretest and post-test counselling, or deferral of counselling, for children tested for HIV in the ED. Secondary measures included the overall rate of HIV testing, rate of counselling documented in the inpatient record when deferred in the ED, rate of counselling documented when testing was initiated by the inpatient service, rate of counselling documented by test result (positive vs negative) and the rate of referral to follow-up HIV care among patients testing positive. Results Of 418 patients tested in the ED, counselling, or deferral of counselling, was documented for 70 (17%). When deferred to the ward, subsequent counselling was documented for 15/42 (36%). Counselling was documented in 33% of patients testing positive versus 1.1% patients testing negative (OR 43 (95% CI 23 to 83). Of 199 patients who tested positive and survived to hospital discharge, 76 (38%) were referred for follow-up at the HIV clinic on discharge. Conclusions Physicians documented the provision, or deferral, of counselling for <20% of children tested for HIV in the ED. Counselling was much more likely to be documented when the test result was positive. Less than 40% of those testing positive were referred for follow-up care. PMID:26880672

Evaluating MJO Event Initiation and Decay in the Skeleton Model using an RMM-like Index

DTIC Science & Technology

2015-11-25

climatology and document 35 the occurrence of primary, continuing, and terminating MJO events in the skeleton model. The 36 overall amount of MJO...solutions in a framework consistent with observations including MJO event 104 climatology and the precursor conditions associated with the initiation and...the 112 7 model along with several applications that include a comparison to the observed MJO event 113 climatology and identification of

Proposed Actions at U.S. Army Kwajalein Atoll. Final Environmental Impact Statement (FEIS)

DTIC Science & Technology

1989-10-01

rocket launches, will be the site of new launch facili- ties. Construction on Kwajalein includes a desal- ination plant and family housing. On Roi-Namur...it includes a sewage treatment plant and document control facility. i Change of Duration Alternative. This alternative differs from the Proposed...Abundant rainfall is the primary source of freshwater for plant , animal, and human life. Because the groundwater aquifer is limited, water conservation

Section 8(a) PAIR User Guide – Primary Authorized Official

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics (OPPT) ‘Section 8(a) PAIR’ application submission process. This document is the user guide for the Primary Authorized Official (AO) user of the Section 8(a) PAIR tool.

Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators.

PubMed

Barber, Claire E H; Esdaile, John M; Martin, Liam O; Faris, Peter; Barnabe, Cheryl; Guo, Selynne; Lopatina, Elena; Marshall, Deborah A

2016-11-01

Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively). Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.

The Antebellum Women's Movement, 1820 to 1860. A Unit of Study for Grades 8-11.

ERIC Educational Resources Information Center

Leighow, Susan; Sterner-Hine, Rita

Using primary source documents, this teaching unit focuses on changing women's roles, growing awareness of gender inequities, and activist responses to these conditions in the United States between 1820 and 1860. Teacher background materials include a unit overview, correlation to National Standards for United States History, unit objectives, a…

A Review of e-Learning in Canada: Rejoinder to Commentaries

ERIC Educational Resources Information Center

Abrami, Philip C.; Bernard, Robert M.; Wade, C. Anne; Borokhovski, Eugene; Tamim, Rana; Surkes, Michael; Zhang, Dai

2006-01-01

Abrami et al. (this issue) provide a review of e-learning in Canada from 2000 onwards by synthesizing information drawn from multiple sources, not only primary research. In total, there were 726 documents included in our review: 235 views expressed in the public printed media (an expression of general public opinion); 131 views from…

The Nurse as a Primary Health Care Provider. And: The Nurse Practitioner: An Annotated Bibliography.

ERIC Educational Resources Information Center

Perry, Lesley

Issues and present trends related to the preparation and the expanded role of the nurse and physician's assistant in meeting health needs are the major concerns of part one, representing 100 pages of the document. Issues discussed include: (1) manpower considerations, (2) definition of responsibilities, training needs, and requirements, (3)…

Las ayudas educativas en la educacion primaria (Teaching Aids in Elementary Education).

ERIC Educational Resources Information Center

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

The Colombian Institute of Pedagogy (ICOLPE) has undertaken a study of the availability and use of teaching aids and instructional materials in that country on the primary level. This report contains the results of that study. The document provides a listing of companies producing teaching aids. Questionnaires (included) were sent to educational…

Woodrow Wilson and the U.S. Ratification of the Treaty of Versailles. Lesson Plan.

ERIC Educational Resources Information Center

Pyne, John; Sesso, Gloria

1995-01-01

Presents a high school lesson plan on the struggle over ratification of the Treaty of Versailles and U.S. participation in the League of Nations. Includes a timeline of events, four primary source documents, and biographical portraits of two opposing senators. Provides student objectives and step-by-step instructional procedures. (CFR)

The Educational Predicament Confronting Taiwan's Gifted Programs: An Evaluation of Current Practices and Future Challenges

ERIC Educational Resources Information Center

Kao, Chen-yao

2012-01-01

This study examines the current problems affecting Taiwan's gifted education through a large-scale gifted program evaluation. Fifty-one gifted classes at 15 elementary schools and 62 gifted classes at 18 junior high schools were evaluated. The primary activities included in this biennial evaluation were document review, observation of…

Diagnostic Profiles among Urban Adolescents with Unmet Treatment Needs: Comorbidity and Perceived Need for Treatment

ERIC Educational Resources Information Center

Hogue, Aaron; Dauber, Sarah

2013-01-01

The goal of this study was to document comorbidity profiles of psychiatric disorder and perceived need for treatment among urban adolescents with unmet behavioral health needs. Participants were 303 community-referred adolescents and their primary caregivers. Adolescents included both boys (54%) and girls and were primarily Hispanic (58%), African…

Report of the Secretary's Task Force on Youth Suicide. Volume 3: Prevention and Interventions in Youth Suicide.

ERIC Educational Resources Information Center

Feinleib, Marcia R., Ed.

Commissioned papers by a work group on prevention and interventions in youth suicide are presented in this document. Included are: (1) "Primary Prevention: A Consideration of General Principles and Findings for the Prevention of Youth Suicide" (Robert Felner); (2) "A Critical Review of Preventive Intervention Efforts in Suicide, with Particular…

"Dear Miss Breed": Using Primary Documents to Advance Student Understanding of Japanese Internment Camps

ERIC Educational Resources Information Center

Westcott, Patrick; Viator, Martha Graham

2008-01-01

The history of the United States includes myriad examples of courage and selflessness as well as instances of prejudice and discrimination. Many students believe that prejudice and discrimination are limited to individuals and do not realize that these can form part of government or national policy. In this article, the authors highlight the…

Nimble Fingers. From 19th Century New England Mills to 20th Century Global Assembly Lines.

ERIC Educational Resources Information Center

Reese, Lyn

1988-01-01

Covers women's labor history in the United States and in industrialized nations from the early 1800s to the present. Provides primary source documents from New England workers in the 1830s and 1840s and from women workers on global assembly lines in the 1980s. Includes discussion questions. (LS)

The Importance of Selected Categories of Employee Benefits to Public Junior College Teachers.

ERIC Educational Resources Information Center

Barber, Ronald Jerry

The primary purpose of this dissertation is to establish categories of employee benefits and to discover their importance to public junior college teachers. Faculty at 50 public junior colleges in the United States were sent an Employee Benefit Questionnaire developed by the author (included in this document). It was found that junior college…

Primary care interventions and current service innovations in modifying long-term outcomes after stroke: a protocol for a scoping review

PubMed Central

Pindus, Dominika M; Lim, Lisa; Rundell, A Viona; Hobbs, Victoria; Aziz, Noorazah Abd; Mullis, Ricky; Mant, Jonathan

2016-01-01

Introduction Interventions delivered by primary and/or community care have the potential to reach the majority of stroke survivors and carers and offer ongoing support. However, an integrative account emerging from the reviews of interventions addressing specific long-term outcomes after stroke is lacking. The aims of the proposed scoping review are to provide an overview of: (1) primary care and community healthcare interventions by generalist healthcare professionals to stroke survivors and/or their informal carers to address long-term outcomes after stroke, (2) the scope and characteristics of interventions which were successful in addressing long-term outcomes, and (3) developments in current clinical practice. Methods and analysis Studies that focused on adult community dwelling stroke survivors and informal carers were included. Academic electronic databases will be searched to identify reviews of randomised controlled trials (RCTs) and controlled trials, trials from the past 5 years; reviews of observational studies. Practice exemplars from grey literature will be identified through advanced Google search. Reports, guidelines and other documents of major health organisations, clinical professional bodies, and stroke charities in the UK and internationally will be included. Two reviewers will independently screen titles, abstracts and full texts for inclusion of published literature. One reviewer will screen search results from the grey literature and identify relevant documents for inclusion. Data synthesis will include analysis of the number, type of studies, year and country of publication, a summary of intervention components/service or practice, outcomes addressed, main results (an indicator of effectiveness) and a description of included interventions. Ethics and dissemination The review will help identify components of care and care pathways for primary care services for stroke. By comparing the results with stroke survivors' and carers' needs identified in the literature, the review will highlight potential gaps in research and practice relevant to long-term care after stroke. PMID:27798023

Pediatric asthma hospitalizations among urban minority children and the continuity of primary care.

PubMed

Utidjian, Levon H; Fiks, Alexander G; Localio, A Russell; Song, Lihai; Ramos, Mark J; Keren, Ron; Bell, Louis M; Grundmeier, Robert W

2017-12-01

To examine the effect of ambulatory health care processes on asthma hospitalizations. A retrospective cohort study using electronic health records was completed. Patients aged 2-18 years receiving health care from 1 of 5 urban practices between Jan 1, 2004 and Dec 31, 2008 with asthma documented on their problem list were included. Independent variables were modifiable health care processes in the primary care setting: (1) use of asthma controller medications; (2) regular assessment of asthma symptoms; (3) use of spirometry; (4) provision of individualized asthma care plans; (5) timely influenza vaccination; (6) access to primary healthcare; and (7) use of pay for performance physician incentives. Occurrence of one or more asthma hospitalizations was the primary outcome of interest. We used a log linear model (Poisson regression) to model the association between the factors of interest and number of asthma hospitalizations. 5,712 children with asthma were available for analysis. 96% of the children were African American. The overall hospitalization rate was 64 per 1,000 children per year. None of the commonly used asthma-specific indicators of high quality care were associated with fewer asthma hospitalizations. Children with documented asthma who experienced a lack of primary health care (no more than one outpatient visit at their primary care location in the 2 years preceding hospitalization) were at higher risk of hospitalization compared to those children with a greater number of visits (incidence rate ratio 1.39; 95% CI 1.09-1.78). In children with asthma, more frequent primary care visits are associated with reduced asthma hospitalizations.

Primary borderline parovarian tumor in pregnancy

PubMed Central

Kim, Jong-Hyun

2015-01-01

There are few reports of pregnancy complicated by a primary borderline parovarian tumor. A 32-year-old pregnant woman was found to have an ovarian tumor. At 13 weeks of gestation, cystectomy was performed and a diagnosis of primary borderline parovarian tumor was made. At 38 weeks of gestation, she underwent cesarean section combined with a restaging operation. A normal infant was delivered and there were no signs of recurrence. Currently, the patient is being followed for 24 months after the initial treatment and all imaging data show no evidence of recurrence. This report includes a short review of the existing literature on this topic and documents this case in detail. This case demonstrates the appropriate procedure for evaluating and treating a primary borderline parovarian tumor during pregnancy. PMID:26623422

Improving the primary school science learning unit about force and motion through lesson study

NASA Astrophysics Data System (ADS)

Phaikhumnam, Wuttichai; Yuenyong, Chokchai

2018-01-01

The study aimed to develop primary school science lesson plan based on inquiry cycle (5Es) through lesson study. The study focused on the development of 4 primary school science lesson plans of force and motion for Grade 3 students in KKU Demonstration Primary School (Suksasart), first semester of 2015 academic year. The methodology is mixed method. The Inthaprasitha (2010) lesson study cycle was implemented in group of KKU Demonstration Primary School. Instruments of reflection of lesson plan developing included participant observation, meeting and reflection report, lesson plan and other document. The instruments of examining students' learning include classroom observation and achievement test. Data was categorized from these instruments to find the issues of changing and improving the good lesson plan of Thai primary school science learning. The findings revealed that teachers could develop the lesson plans through lesson study. The issues of changing and improving were disused by considering on engaging students related to societal issues, students' prior knowledge, scientific concepts for primary school students, and what they learned from their changing. It indicated that the Lesson Study allowed primary school science teachers to share ideas and develop ideas to improve the lesson. The study may have implications for Thai science teacher education through Lesson Study.

3D model-based documentation with the Tumor Therapy Manager (TTM) improves TNM staging of head and neck tumor patients.

PubMed

Pankau, Thomas; Wichmann, Gunnar; Neumuth, Thomas; Preim, Bernhard; Dietz, Andreas; Stumpp, Patrick; Boehm, Andreas

2015-10-01

Many treatment approaches are available for head and neck cancer (HNC), leading to challenges for a multidisciplinary medical team in matching each patient with an appropriate regimen. In this effort, primary diagnostics and its reliable documentation are indispensable. A three-dimensional (3D) documentation system was developed and tested to determine its influence on interpretation of these data, especially for TNM classification. A total of 42 HNC patient data sets were available, including primary diagnostics such as panendoscopy, performed and evaluated by an experienced head and neck surgeon. In addition to the conventional panendoscopy form and report, a 3D representation was generated with the "Tumor Therapy Manager" (TTM) software. These cases were randomly re-evaluated by 11 experienced otolaryngologists from five hospitals, half with and half without the TTM data. The accuracy of tumor staging was assessed by pre-post comparison of the TNM classification. TNM staging showed no significant differences in tumor classification (T) with and without 3D from TTM. However, there was a significant decrease in standard deviation from 0.86 to 0.63 via TTM ([Formula: see text]). In nodal staging without TTM, the lymph nodes (N) were significantly underestimated with [Formula: see text] classes compared with [Formula: see text] with TTM ([Formula: see text]). Likewise, the standard deviation was reduced from 0.79 to 0.69 ([Formula: see text]). There was no influence of TTM results on the evaluation of distant metastases (M). TNM staging was more reproducible and nodal staging more accurate when 3D documentation of HNC primary data was available to experienced otolaryngologists. The more precise assessment of the tumor classification with TTM should provide improved decision-making concerning therapy, especially within the interdisciplinary tumor board.

Following the money: copy-paste of lifestyle counseling documentation and provider billing

PubMed Central

2013-01-01

Background Evidence suggests that copy-pasted components of electronic notes may not reliably reflect the care delivered. Federal agencies have raised concerns that such components may be used to justify inappropriately inflated claims for reimbursement. It is not known whether copied information is used to justify higher evaluation and management (E&M) charges. Methods This retrospective cohort study aimed to assess the relationship between the level of evaluation and management (E&M) charges and the method of documentation (none, distinct or copied) of lifestyle counseling (diet, exercise and weight loss) for patients with diabetes mellitus. To determine the association, an ordered multinomial logistic regression model that corrected for clustering within individual providers and patients and adjusted for patient and encounter characteristics was utilized. E&M charge level served as the primary outcome variable. Patients were included if they were followed by primary care physicians affiliated with two academic hospitals for a minimum of two years between 01/01/2000 and 12/13/2009. Results Lifestyle counseling was documented in 65.4% of 155,168 primary care encounters of 16,164 patients. Copied counseling was identified in 12,527 encounters. In multivariable analysis higher E&M charges were associated with older patient age, longer notes, treatment with insulin, medication changes and acute complaints. However, copied lifestyle counseling was associated with a decrease of 70.5% in the odds of higher E&M charge levels when time spent on counseling (required to justify higher charges based on counseling) was recorded (p<0.0001). This finding is opposite to what would have been expected if the impetus for copied documentation of lifestyle counseling was an increase in submitted E&M charges. Conclusion There is no evidence that copied documentation of lifestyle counseling is used to justify higher evaluation and management charges. Higher charges were generally associated with indicators of complexity of care. PMID:24225135

Investigating Nigerian Primary School Teachers' Preparedness to Adopt Personal Response System in ESL Classroom

ERIC Educational Resources Information Center

Agbatogun, Alaba Olaoluwakotansibe

2012-01-01

This study investigated the extent to which computer literacy dimensions (computer general knowledge, documents and documentations, communication and surfing as well as data inquiry), computer use and academic qualification as independent variables predicted primary school teachers' attitude towards the integration of Personal Response System in…

A scoping review of traditional food security in Alaska

PubMed Central

Walch, Amanda; Bersamin, Andrea; Loring, Philip; Johnson, Rhonda; Tholl, Melissa

2018-01-01

ABSTRACT Food insecurity is a public health concern. Food security includes the pillars of food access, availability and utilisation. For some indigenous peoples, this may also include traditional foods. To conduct a scoping review on traditional foods and food security in Alaska. Google Scholar and the High North Research Documents were used to search for relevant primary research using the following terms: “traditional foods”, “food security”, “access”, “availability”, “utilisation”, “Alaska”, “Alaska Native” and “indigenous”. Twenty four articles from Google Scholar and four articles from the High North Research Documents were selected. The articles revealed three types of research approaches, those that quantified traditional food intake (n=18), those that quantified food security (n=2), and qualitative articles that addressed at least one pillar of food security (n=8). Limited primary research is available on food security in Alaskan. Few studies directly measure food security while most provide a review of food security factors. Research investigating dietary intake of traditional foods is more prevalent, though many differences exist among participant age groups and geographical areas. Future research should include direct measurements of traditional food intake and food security to provide a more complete picture of traditional food security in Alaska. PMID:29292675

Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

PubMed

Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J

2015-12-01

Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may be significant inter-observer variability.

Models of clinical reasoning with a focus on general practice: A critical review.

PubMed

Yazdani, Shahram; Hosseinzadeh, Mohammad; Hosseini, Fakhrolsadat

2017-10-01

Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.

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

Not Available

This document is a review journal that covers significant developments in the field of nuclear safety. Its scope includes the analysis and control of hazards associated with nuclear energy, operations involving fissionable materials, and the products of nuclear fission and their effects on the environment. Primary emphasis is on safety in reactor design, construction, and operation; however, the safety aspects of the entire fuel cycle, including fuel fabrication, spent-fuel processing, nuclear waste disposal, handling of radioisotopes, and environmental effects of these operations, are also treated.

ASRDI oxygen technology survey. Volume 5: Density and liquid level measurement instrumentation for the cryogenic fluids oxygen, hydrogen, and nitrogen

NASA Technical Reports Server (NTRS)

Roder, H. M.

1974-01-01

Information is presented on instrumentation for density measurement, liquid level measurement, quantity gauging, and phase measurement. Coverage of existing information directly concerned with oxygen was given primary emphasis. A description of the physical principle of measurement for each instrumentation type is included. The basic materials of construction are listed if available from the source document for each instrument discussed. Cleaning requirements, procedures, and verification techniques are included.

Gaining information about home visits in primary care: methodological issues from a feasibility study

PubMed Central

2014-01-01

Background Home visits are part of general practice work in Germany. Within the context of an expanding elderly population and a decreasing number of general practitioner (GPs), open questions regarding the organisation and adequacy of GPs’ care in immobile patients remain. To answer these questions, we will conduct a representative primary data collection concerning contents and organisation of GPs’ home visits in 2014. Because this study will require considerable efforts for documentation and thus substantial involvement by participating GPs, we conducted a pilot study to see whether such a study design was feasible. Methods We used a mixed methods design with two study arms in a sample of teaching GPs of the University Halle. The quantitative arm evaluates participating GPs and documentation of home visits. The qualitative arm focuses on reasons for non-participation for GPs who declined to take part in the pilot study. Results Our study confirms previously observed reasons for non-response of GPs in the particular setting of home visits including lack of time and/or interest. In contrast to previous findings, monetary incentives were not crucial for GPs participation. Several factors influenced the documentation rate of home visits and resulted in a discrepancy between the numbers of home visits documented versus those actually conducted. The most frequently reported problem was related to obtaining patient consent, especially when patients were unable to provide informed consent due to cognitive deficits. Conclusions The results of our feasibility study provide evidence for improvement of the study design and study instruments to effectively conduct a documentation-intensive study of GPs doing home visits. Improvement of instructions and questionnaire regarding time variables and assessment of the need for home visits will be carried out to increase the reliability of future data. One particularly important methodological issue yet to be resolved is how to increase the representativeness of home visit care by including the homebound patient population that is unable to provide informed consent. PMID:24884460

Evaluation of clinical pharmacy interventions in a Veterans Affairs medical center primary care clinic.

PubMed

Hough, Augustus; Vartan, Christine M; Groppi, Julie A; Reyes, Sonia; Beckey, Nick P

2013-07-01

The development of an electronic tool to quantify and characterize the interventions made by clinical pharmacy specialists (CPSs) in a primary care setting is described. An electronic clinical tool was developed to document the clinical pharmacy interventions made by CPSs at the Veterans Affairs Medical Center in West Palm Beach, Florida. The tool, embedded into the electronic medical record, utilizes a novel reminder dialogue to complete pharmacotherapy visit encounters and allows CPSs to document interventions made during patient care visits. Interventions are documented using specific electronic health factors so that the type and number of interventions made for both disease-specific and other pharmacotherapy interventions can be tracked. These interventions were assessed and analyzed to evaluate the impact of CPSs in the primary care setting. From February 2011 through January 2012, a total of 16,494 pharmacotherapy interventions (therapeutic changes and goals attained) were recorded. The average numbers of interventions documented per patient encounter were 0.96 for the management of diabetes mellitus, hypertension, dyslipidemia, and heart failure and 1.36 for non-disease-specific interventions, independent of those interventions being made by the primary physician or other members of the primary care team. A clinical reminder tool developed to quantify and characterize the interventions provided by CPSs found that for every visit with a CPS, approximately one disease-specific intervention and one additional pharmacotherapy intervention were made, independent of those interventions being made by the primary physician or other members of the primary care team.

Investigating Metacom's War: Analyzing Rowlandson's Primary Document in Upper-Elementary Classrooms

ERIC Educational Resources Information Center

Campbell, Susan E.

2011-01-01

Metacom's War, also known as King Phillip's War, sets a pattern of national expansion through displacement of native people that echoes throughout American history. Helping students further understand this war through the examination of Mary Rowlandson's primary document provides educators and students with an opportunity to delve deeper into the…

ASSET. Assessment Simplification System for Elementary Teachers.

ERIC Educational Resources Information Center

Kentucky State Dept. of Education, Frankfort.

This document is designed to show the connections between assessment tools available for primary and intermediate grades in the Kentucky public schools. Sections of the document outline the essential assessment tools and give information about how they support and mirror each other. These tools can be used to bridge the knowledge of primary and…

A Historical Analysis of Primary Mathematics Curricula in Terms of Teaching Principles

ERIC Educational Resources Information Center

Ozmantar, Mehmet Fatih

2017-01-01

This study carries out a comparative analysis of primary mathematics curricula put into practice during Turkish Republican period. The data for this study are composed of official curricula documents which are examined in terms of teaching principles. The study adopts a qualitative approach and employs document analysis method. The official…

Milestones for the Final Mile: Interspecialty Distinctions in Primary Palliative Care Skills Training.

PubMed

Harris, John A; Herrel, Lindsey A; Healy, Mark A; Wancata, Lauren M; Perumalswami, Chithra R

2016-09-01

Primary palliative care (PPC) skills are useful in a wide variety of medical and surgical specialties, and the expectations of PPC skill training are unknown across graduate medical education. We characterized the variation and quality of PPC skills in residency outcomes-based Accreditation Council for Graduate Medical Education (ACGME) milestones. We performed a content analysis with structured implicit review of 2015 ACGME milestone documents from 14 medical and surgical specialties chosen for their exposure to clinical situations requiring PPC. For each specialty milestone document, we characterized the variation and quality of PPC skills in residency outcomes-based ACGME milestones. We identified 959 occurrences of 29 palliative search terms within 14 specialty milestone documents. Within these milestone documents, implicit review characterized 104 milestones with direct saliency to PPC skills and 196 milestones with indirect saliency. Initial interrater agreement of the saliency rating among the primary reviewers was 89%. Specialty milestone documents varied widely in their incorporation of PPC skills within milestone documents. PPC milestones were most commonly found in milestone documents for Anesthesiology, Pediatrics, Urology, and Physical Medicine and Rehabilitation. PPC-relevant milestones were most commonly found in the Interpersonal and Communication Skills core competency with 108 (36%) relevant milestones classified under this core competency. Future revisions of specialty-specific ACGME milestone documents should focus on currently underrepresented, but important PPC skills. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

CHeCS: International Space Station Medical Hardware Catalog

NASA Technical Reports Server (NTRS)

2008-01-01

The purpose of this catalog is to provide a detailed description of each piece of hardware in the Crew Health Care System (CHeCS), including subpacks associated with the hardware, and to briefly describe the interfaces between the hardware and the ISS. The primary user of this document is the Space Medicine/Medical Operations ISS Biomedical Flight Controllers (ISS BMEs).

Spermicidal Condoms: Effective Primary Protection against AIDS, Other STDs, and Unintended Conceptions. We Can Reduce the Number of Teen Pregnancies.

ERIC Educational Resources Information Center

Brown, Michael D.

1990-01-01

This document consists of two articles on sex education programs aimed at reducing sexually transmitted diseases (STDs) and unintended pregnancies among American Indians. Both articles describe the problems of unwanted pregnancies and STDs, including acquired immune deficiency syndrome. During 1987, there were more than 3,000 live births to Native…

A Living Citizenship Model for the Public Schools: The Philosophical Foundations of Friendship in the Works of Epicurus and Ralph Waldo Emerson

ERIC Educational Resources Information Center

Sherblom, Debra

2012-01-01

In an interdisciplinary, hermeneutical study using primary and secondary documents from history, philosophy, political theory, and critical pedagogy, the dissertation focuses on dialogue, friendship, and citizenship. The philosophical foundations of friendship in the works of Epicurus and Ralph Waldo Emerson are discussed. Included in the study is…

Voices Rising: A Bulletin about Women and Popular Education. Volumes 1-4. 1987-1990.

ERIC Educational Resources Information Center

Voices Rising: A Bulletin about Women and Popular Education, 1990

1990-01-01

This document consists of the six issues of the serial "Voices Rising" issued during the four-year period 1987-1990. "Voices Rising" is the primary networking tool of the Women's Program of the International Council for Adult Education (ICAE). Articles in these issues include: "Tribute to a Courageous Woman--Nabila Breir"; "Centre for Women's…

International Data Archive and Analysis Center. I. International Relations Archive. II. Voluntary International Coordination. III. Attachments.

ERIC Educational Resources Information Center

Miller, Warren; Tanter, Raymond

The International Relations Archive undertakes as its primary goals the acquisition, management and dissemination of international affairs data. The first document enclosed is a copy of the final machine readable codebook prepared for the data from the Political Events Project, 1948-1965. Also included is a copy of the final machine-readable…

Content Analysis of Songs in Elementary Music Textbooks in Accordance with Values Education in Turkey

ERIC Educational Resources Information Center

Yalçinkaya, Begüm

2015-01-01

The aim of this study is to determine which values are included in education songs in elementary school textbooks and the level of these values. This study, conducted using document analysis method, involved primary education music class textbooks. Education songs in textbooks were analyzed within the frame of 29 values determined based on…

Science and Technology in the Early Years. An Equal Opportunities Approach. Gender and Education Series.

ERIC Educational Resources Information Center

Browne, Naima, Ed.

During the early 1980s there was a lack of research regarding gender issues for early childhood and elementary education. This document attempts to fill this chasm by addressing gender issues in science and technology for primary education schooling and early-years education. The following chapters are included: (1) "Science and Technology in the…

Panning for Gold: Utility of the World Wide Web for Metadata and Authority Control in Special Collections.

ERIC Educational Resources Information Center

Ellero, Nadine P.

2002-01-01

Describes the use of the World Wide Web as a name authority resource and tool for special collections' analytic-level cataloging, based on experiences at The Claude Moore Health Sciences Library. Highlights include primary documents and metadata; authority control and the Web as authority source information; and future possibilities. (Author/LRW)

Pretest analysis document for Semiscale Test S-LH-1

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

Shaw, R.A.

Results from various pretest calculations which were performed for Test S-LH-1 are included in this report. Test S-LH-1 has been designed to produce primary liquid holdup in the steam generator U-tubes similar to Tests S-UT-8. The analyses included in this report indicate liquid will be held in the tubes, the core liquid level will be appropriately depressed, and a core heater rod temperature excursion should occur. Several sensitivity studies are also included which identify parameters which could affect the response.

Yup'ik Understandings of the Environment: "The World is Changing Following Its People."

NASA Astrophysics Data System (ADS)

Fienup-Riordan, Ann

2012-05-01

My talk describes a decade of work with Yup'ik elders sponsored by the Calista Elders Council, the primary heritage organization in southwest Alaska. Our goal was to document the qanruyutet (instructions) that continue to guide Yup'ik interactions with ella--translated variously as weather, world, universe, and awareness. Elders addressed a range of topics, including weather, land, lakes and rivers, ocean, snow, ice, survival, environmental change, and of course stars. Many elders suffer over the fact that contemporary young people lack knowledge of ella. They actively support the documentation and sharing of traditional knowledge, which all view as possessing continued value in the world today.

Technology Development Plan for the Baseline Detector System of the X-Ray Microcalorimeter Spectrometer (XMS) of the International X-Ray Observatory (IXO)

NASA Technical Reports Server (NTRS)

Kilbourne, C. A.; Boriese, W. B.

2010-01-01

The primary purpose of this document is to present the technology development plan for the XMS detector system. It covers the current status (including assessment of the Technology Readiness Level, TRL, and a justification of the level assigned), the roadmap to progress to a level between TRL 5 and TRL 6 by the middle of 2012, and an assessment of the associated cost. A secondary purpose of this document is to address the Action Items raised at the XMS Phase-A Study Mid-Term Review that pertain to the detector system (AI #4, #8, and #9).

Do competing demands of physical illness in type 2 diabetes influence depression screening, documentation and management in primary care: a cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health care settings.

PubMed

Schierhout, Gill; Nagel, Tricia; Si, Damin; Connors, Christine; Brown, Alex; Bailie, Ross

2013-06-06

Relatively little is known about how depression amongst people with chronic illness is identified and managed in diverse primary health care settings. We evaluated the role of complex physical needs in influencing current practice of depression screening, documentation and antidepressant prescriptions during a 12-month period, among adults with Type 2 diabetes attending Aboriginal and Torres Strait Islander primary care health centres in Australia. We analysed clinical audit data from 44 health centres participating in a continuous quality improvement initiative, using previously reported standard sampling and data extraction protocols. Eligible patients were those with Type 2 diabetes with health centre attendance within the past 12 months. We compared current practice in depression screening, documentation and antidepressant prescription between patients with different disease severity and co-morbidity. We used random effects multiple logistic regression models to adjust for potential confounders and for clustering by health centre. Among the 1174 patients with diabetes included, median time since diagnosis was 7 years, 19% of patients had a co-existing diagnosis of Ischaemic Heart Disease and 1/3 had renal disease. Some 70% of patients had HbAc1>7.0%; 65% had cholesterol >4.0 mmol1-1 and 64% had blood pressure>130/80 mmHg. Documentation of screening for depression and of diagnosed depression were low overall (5% and 6% respectively) and lower for patients with renal disease (Adjusted odds ratio [AOR] 0.21; 95% confidence interval [CI] 0.14 to 0.31 and AOR 0.34; 95% CI 0.15 to 0.75), and for those with poorly controlled disease (HbA1c>7.00 (AOR 0.40; 95% CI 0.23 to 0.68 and AOR 0.51; 95% CI 0.30 to 84)). Screening for depression was lower for those on pharmaceutical treatment for glycaemic control compared to those not on such treatment. Antidepressant prescription was not associated with level of diabetes control or disease severity. Background levels of depression screening and documentation were low overall and significantly lower for patients with greater disease severity. Strategies to improve depression care for vulnerable populations are urgently required. An important first step in the Australian Indigenous primary care context is to identify and address barriers to the use of current clinical guidelines for depression screening and care.

Nuclear Safety

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

Silver, E G

This document is a review journal that covers significant developments in the field of nuclear safety. Its scope includes the analysis and control of hazards associated with nuclear energy, operations involving fissionable materials, and the products of nuclear fission and their effects on the environment. Primary emphasis is on safety in reactor design, construction, and operation; however, the safety aspects of the entire fuel cycle, including fuel fabrication, spent-fuel processing, nuclear waste disposal, handling of radioisotopes, and environmental effects of these operations, are also treated.

Primary perivascular epithelioid cell tumors of the liver: CT/MRI findings and clinical outcomes.

PubMed

O'Malley, Martin E; Chawla, Tanya P; Lavelle, Lisa P; Cleary, Sean; Fischer, Sandra

2017-06-01

The purpose of our study was to describe the CT and MRI features of primary PEComas of the liver and to document the associated clinical outcomes. Retrospective study included 20 patients with primary hepatic perivascular epithelioid cell tumors (PEComa) with pathology and clinical outcomes for correlation. Study group included 20 patients: 16 women, 4 men; mean age 53 (range 35-77) years. Initial pathology diagnoses were classic angiomyolipoma (AML) (n = 11), epithelioid AML (n = 7), and PEComa not otherwise specified (n = 2). Mean tumor size was 5.1 (range 1.3-15.0) cm. CT/MRI features included well-defined margins 20/20 (100%), arterial enhancement 18/19 (95%), subcapsular location 17/20 (85%), heterogeneous 16/20 (80%), dysmorphic vessels 14/20 (70%), fat 13/20 (65%), hemorrhage 4/20 (20%), cystic components 4/20 (20%), and calcification 1/20 (5%). At the time of discovery, 18 patients were asymptomatic and their tumors were incidentally detected on imaging, and 2 patients were symptomatic. Ultimately, 18 tumors were benign and 2 developed metastases. On CT/MRI, most primary hepatic PEComas were well-defined, arterial enhancing, subcapsular, heterogeneous masses that often had dysmorphic vessels and contained fat. Most tumors were benign but complications included local symptoms, bleeding, and malignant change.

Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement.

PubMed

Garner, Kimberly K; Dubbert, Patricia; Lensing, Shelly; Sullivan, Dennis H

2017-01-01

The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers. Published by Elsevier Inc.

Mineralocorticoid before glucocorticoid deficiency in a dog with primary hypoadrenocorticism and hypothyroidism.

PubMed

McGonigle, Kathryn M; Randolph, John F; Center, Sharon A; Goldstein, Richard E

2013-01-01

A dog with an unexpected presentation of primary hypoadrenocorticism was evaluated for clinical signs and electrolyte abnormalities characteristic of Addison's disease. Although the initial adrenocorticotropic hormone (ACTH) stimulation test documented serum cortisol concentrations within the reference range, subsequent assessments confirmed hypoaldosteronism. Mineralocorticoid replacement promptly normalized electrolytes and transiently improved clinical illness. Six weeks after initial ACTH stimulation testing, the dog became glucocorticoid deficient. Concurrent primary hypothyroidism was also documented. Hypoaldosteronism preceding hypocortisolemia is a unique presentation of canine Addison's disease.

Primary Payer at DX: Issues with Collection and Assessment of Data Quality.

PubMed

Sherman, Recinda L; Williamson, Laura; Andrews, Patricia; Kahn, Amy

2016-01-01

An individual's access to health insurance influences the amount and type of health services a patient receives for prevention and treatment, and, ultimately, influences survival. The North American Association of Central Cancer Registries (NAACCR) Item #630, Primary Payer at DX, is a required field intended to document health insurance status for the purpose of supporting patterns-of-care studies and other research. However, challenges related to the uniformity of collection and availability of data needed to populate this field diminish the value of the Primary Payer at DX data. A NAACCR taskforce worked on issues surrounding the collection of Primary Payer at DX; including proposing a crosswalk between Primary Payer at DX and the new Public Health Payment Typology standard, often available in hospital discharge databases. However, there are issues with compatibility between coding systems, intent of data collection, timelines for coding insurance, and changes in insurance coverage (partly due to the Affordable Care Act) that continue to complicate the collection and use of Primary Payer at DX data.

The future of bibliographic standards in a networked information environment

NASA Technical Reports Server (NTRS)

1997-01-01

The main mission of the CENDI Cataloging Working Group is to provide guidelines for cataloging practices that support the sharing of database records among the CENDI agencies, and that incorporate principles based on cost effectiveness and efficiency. Recent efforts include the extension of COSATI Guidelines for the Cataloging of Technical Reports to include non-print materials, and the mapping of each agency's export file structure to USMARC. Of primary importance is the impact of electronic documents and the distributed nature of the networked information environment. Topics discussed during the workshop include the following: Trade-offs in Cataloging and Indexing Internet Information; The Impact on Current and Future Standards; A Look at WWW Metadata Initiatives; Standards for Electronic Journals; The Present and Future Search Engines; The Roles for Text Analysis Software; Advanced Search Engine Meets Metathesaurus; Locator Schemes for Internet Resources; Identifying and Cataloging Web Document Types; In Search of a New Bibliographic Record. The videos in this set include viewgraphs of charts and related materials of the workshop.

Association of Medical Directors of Information Systems consensus on inpatient electronic health record documentation.

PubMed

Shoolin, J; Ozeran, L; Hamann, C; Bria, W

2013-01-01

In 2013, electronic documentation of clinical care stands at a crossroads. The benefits of creating digital notes are at risk of being overwhelmed by the inclusion of easily importable detail. Providers are the primary authors of encounters with patients. We must document clearly our understanding of patients and our communication with them and our colleagues. We want to document efficiently to meet without exceeding documentation guidelines. We copy and paste documentation, because it not only simplifies the documentation process generally, but also supports meeting coding and regulatory requirements specifically. Since the primary goal of our profession is to spend as much time as possible listening to, understanding and helping patients, clinicians need information technology to make electronic documentation easier, not harder. At the same time, there should be reasonable restrictions on the use of copy and paste to limit the growing challenge of 'note bloat'. We must find the right balance between ease of use and thoughtless documentation. The guiding principles in this document may be used to launch an interdisciplinary dialogue that promotes useful and necessary documentation that best facilitates efficient information capture and effective display.

The Italian Geographers' Document on the University Education of Future Primary School Teachers

ERIC Educational Resources Information Center

Giorda, Cristiano; Di Palma, Maria Teresa

2011-01-01

This article describes an important document compiled by a group of Italian geographers who teach in the Teaching Sciences faculty. Twenty-two university professors in an online community debated concepts and compared ideas in order to establish content, methods and didactic approaches to be applied when training Primary School teachers (pupils…

eCDRweb User Guide–Primary Support

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics’ (OPPT) e-CDR web tool. E-CDRweb is the electronic, web-based tool provided by the Environmental Protection Agency (EPA) for the submission of Chemical Data Reporting (CDR) information. This document is the user guide for the Primary Support user of the e-CDRweb tool.

eCDRweb User Guide–Primary Authorized Official

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics’ (OPPT) e-CDRweb tool. E-CDRweb is the electronic, web-based tool provided by the Environmental Protection Agency (EPA) for the submission of Chemical Data Reporting (CDR) information. This document is the user guide for the Primary Authorized Official (AO) user of the e-CDR webtool

Examining the Seven-Flag "Chieu Hoi" Pass: A Primary Document from the American War in Viet Nam

ERIC Educational Resources Information Center

Engelmann, Ted

2006-01-01

During the Viet Nam war, U.S. military helicopters dropped "Chieu Hoi" (safe conduct) passes over suspected enemy locations to encourage enemy soldiers to surrender. This article presents a classroom activity that encourages students to examine a "Chieu Hoi" pass as a primary historical document, identify its various elements,…

Constitutional Debates on Freedom of Religion: A Documentary History. Primary Documents in American History and Contemporary Issues.

ERIC Educational Resources Information Center

Patrick, John J., Ed.; Long, Gerald P., Ed.

Debates over the separation or accommodation of religion and government have divided the United States since its founding. This collection of over 70 primary documents represents the ideas and issues on the interpretation of the United States Constitution's First Amendment clauses pertaining to establishment and free exercise of religion. The…

Strengthening primary healthcare through community involvement in Cross River State, Nigeria: a descriptive study

PubMed Central

Adie, Hilary; Igbang, Thomas; Otu, Akaninyene; Braide, Ekanem; Okon, Okpok; Ikpi, Edet; Joseph, Charles; Desousa, Alexander; Sommerfeld, Johannes

2014-01-01

Introduction In preparation for implementation of primary healthcare (PHC) services in Cross River State, a study to identify perceptions of communities and health systems concerning such interventions was conducted. Methods Existing PHC practices were documented through observation and document reviews, including facility checklists at frontline levels. Perceptions of consumers and providers on PHC were elucidated through 32 Focus Group Discussions (FGDs) and 78 semi-structured questionnaires. Results There was some level of implementation of the Nigerian PHC policy in the study districts. However, this policy emphasized curative instead of preventive services. Private partners perceived healthcare programmes as largely donor driven with poor release of allocations for health by government. Conclusion Both providers and consumers presented similar perceptions on the current PHC implementation and similar perspectives on services to be prioritized. These common views together with their on-going participatory experience are important platforms for strengthening community participation in the delivery of PHC. PMID:25237418

Physician Information Needs and Electronic Health Records (EHRs): Time to Reengineer the Clinic Note.

PubMed

Koopman, Richelle J; Steege, Linsey M Barker; Moore, Joi L; Clarke, Martina A; Canfield, Shannon M; Kim, Min S; Belden, Jeffery L

2015-01-01

Primary care physicians face cognitive overload daily, perhaps exacerbated by the form of electronic health record documentation. We examined physician information needs to prepare for clinic visits, focusing on past clinic progress notes. This study used cognitive task analysis with 16 primary care physicians in the scenario of preparing for office visits. Physicians reviewed simulated acute and chronic care visit notes. We collected field notes and document highlighting and review, and we audio-recorded cognitive interview while on task, with subsequent thematic qualitative analysis. Member checks included the presentation of findings to the interviewed physicians and their faculty peers. The Assessment and Plan section was most important and usually reviewed first. The History of the Present Illness section could provide supporting information, especially if in narrative form. Physicians expressed frustration with the Review of Systems section, lamenting that the forces driving note construction did not match their information needs. Repetition of information contained in other parts of the chart (eg, medication lists) was identified as a source of note clutter. A workflow that included a patient summary dashboard made some elements of past notes redundant and therefore a source of clutter. Current ambulatory progress notes present more information to the physician than necessary and in an antiquated format. It is time to reengineer the clinic progress note to match the workflow and information needs of its primary consumer. © Copyright 2015 by the American Board of Family Medicine.

Anxiety Outcomes after Physical Activity Interventions: Meta-Analysis Findings

PubMed Central

Conn, Vicki S.

2011-01-01

Background Although numerous primary studies have documented the mental health benefits of physical activity (PA), no previous quantitative synthesis has examined anxiety outcomes of interventions to increase PA. Objectives This meta-analysis integrates extant research about anxiety outcomes from interventions to increase PA among healthy adults. Method Extensive literature searching located published and unpublished PA intervention studies with anxiety outcomes. Eligible studies reported findings from interventions designed to increase PA delivered to healthy adults without anxiety disorders. Data were coded from primary studies. Random-effects meta-analytic procedures were completed. Exploratory moderator analyses using meta-analysis ANOVA and regression analogues were conducted to determine if report, methods, sample, or intervention characteristics were associated with differences in anxiety outcomes. Results Data were synthesized across 3,289 subjects from 19 eligible reports. The overall mean anxiety effect size (d-index) for two-group comparisons was 0.22 with significant heterogeneity (Q = 32.15). Exploratory moderator analyses found larger anxiety improvement effect sizes among studies that included larger samples, used random allocation of subjects to treatment and control conditions, targeted only PA behavior instead of multiple health behaviors, included supervised exercise (vs. home-based PA), used moderate or high-intensity instead of low-intensity PA, and suggested subjects exercise at a fitness facility (vs. home) following interventions. Discussion These findings document that some interventions can decrease anxiety symptoms among healthy adults. Exploratory moderator analyses suggest possible directions for future primary research to compare interventions in randomized trials to confirm causal relationships. PMID:20410849

The effect of a resident-led quality improvement project on improving communication between hospital-based and outpatient physicians.

PubMed

Kalanithi, Lucy; Coffey, Charles E; Mourad, Michelle; Vidyarthi, Arpana R; Hollander, Harry; Ranji, Sumant R

2013-01-01

This article reports on a resident-led quality improvement program to improve communication between inpatient internal medicine residents and their patients' primary care physicians (PCPs). The program included education on care transitions, standardization of documentation, audit and feedback of documented PCP communication rates with public reporting of performance, rapid-cycle data analysis and improvement projects, and a financial incentive. At baseline, PCP communication was documented in 55% of patients; after implementation of the intervention, communication was documented in 89.3% (2477 of 2772) of discharges during the program period. The program was associated with a significant increase in referring PCP satisfaction with communication at hospital admission (baseline, 27.7% "satisfied" or "very satisfied"; postintervention, 58.2%; P < .01) but not at discharge (baseline, 14.9%; postintervention, 21.8%; P = .41). Residents cited the importance of PCP communication for patient care and audit and feedback of their performance as the principal drivers of their engagement in the project.

Aerospace Medicine and Biology: A continuing bibliography with indexes (supplement 259)

NASA Technical Reports Server (NTRS)

1984-01-01

A bibliography containing 476 documents introduced into the NASA scientific and technical information system in May 1984 is presented. The primary subject categories included are: life sciences, aerospace medicine, behavioral sciences, man/system technology, life support, and planetary biology. Topics extensively represented were space flight stress, man machine systems, weightlessness, human performance, mental performance, and spacecraft environments. Abstracts for each citation are given.

Perspectives. Teacher's Guide [and] Reflections of History [and] From Cottages to Corporations [and] World War I, The Home Front [and] The Great Depression.

ERIC Educational Resources Information Center

Procter & Gamble Co., Cincinnati, OH.

This publication includes a teacher's guide and four self-contained teaching units of primary source materials for use in secondary U.S. history, government, and sociology classes. Each unit, designed as supplemental material for one or two class periods, contains historical public records and documents from Procter and Gamble's archives and…

The Baghdad that Was: Using Primary Sources to Teach World History

ERIC Educational Resources Information Center

Schur, Joan Brodsky

2009-01-01

That primary source documents have the power to bring the past alive is no news to social studies teachers. What is new in the last 10 years is the number of digitized documents available online that teachers can download and use in their classrooms. Encouraging teachers to utilize this ever-increasing treasure trove of resources was the goal of…

Data and Primary Source Documents for Social Studies Classrooms from the Federal Reserve Bank of St. Louis

ERIC Educational Resources Information Center

Suiter, Mary C.; Stierholz, Katrina L.

2011-01-01

Data and primary source documents are important for understanding past and current events. The Federal Reserve Bank of St. Louis has committed itself to the collection and illumination of economic data and historical information for classroom teachers and researchers. The Federal Reserve Bank of St. Louis provides a number of services--including…

Improving Communication About Serious Illness in Primary Care: A Review.

PubMed

Lakin, Joshua R; Block, Susan D; Billings, J Andrew; Koritsanszky, Luca A; Cunningham, Rebecca; Wichmann, Lisa; Harvey, Doreen; Lamey, Jan; Bernacki, Rachelle E

2016-09-01

The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satisfaction, and lower health care costs; however, the role of primary care clinicians in driving conversations about goals and priorities in serious illness is not well defined. To present a review of a structured search of the evidence base about communication in serious illness in primary care. MEDLINE was searched, via PubMed, on January 19, 2016, finding 911 articles; 126 articles were reviewed and selected titles were added from bibliography searches. Review of the literature informed 2 major topic areas: the role of primary care in communication about serious illness and clinician barriers and system failures that interfere with effective communication. Literature regarding the role that primary care plays in communication focused primarily on the ambiguity about whether primary care clinicians or specialists are responsible for initiating conversations, the benefits of primary care clinicians and specialists conducting conversations, and the quantity and quality of discussions. Timely and effective communication about serious illness in primary care is hampered by key clinician barriers, which include deficits in knowledge, skills, and attitudes; discomfort with prognostication; and lack of clarity about the appropriate timing and initiation of conversations. Finally, system failures in coordination, documentation, feedback, and quality improvement contribute to lack of conversations. Clinician and system barriers will challenge primary care clinicians and institutions to meet the needs of patients with serious illness. Ensuring that conversations about goals and values occur at the appropriate time for seriously ill patients will require improved training, validation, and dissemination of patient selection tools, systems for conducting and revisiting conversations, accessible documentation, and incentives for measurement, feedback, and continuous improvement.

Automated Data Management Information System (ADMIS)

NASA Technical Reports Server (NTRS)

Blackstone, C.; Dunn, D.; Sullivan, E.; Whitlock, J.; Buehler, D.; Pratt, L.; Hoffiditz, T.; Rose, J.; Smithson, M.; Feeley, J.

1974-01-01

ADMIS stores and controls data and documents associated with manned space flight effort. System contains all data oriented toward a specific document; it is primary source of reports generated by the system. Each group of records is composed of one document record, one distribution record for each recipient of the document, and one summary record.

Phase I Contaminant Transport Parameters for the Groundwater Flow and Contaminant Transport Model of Corrective Action Unit 97: Yucca Flat/Climax Mine, Nevada Test Site, Nye County, Nevada, Revision 0

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

John McCord

2007-09-01

This report documents transport data and data analyses for Yucca Flat/Climax Mine CAU 97. The purpose of the data compilation and related analyses is to provide the primary reference to support parameterization of the Yucca Flat/Climax Mine CAU transport model. Specific task objectives were as follows: • Identify and compile currently available transport parameter data and supporting information that may be relevant to the Yucca Flat/Climax Mine CAU. • Assess the level of quality of the data and associated documentation. • Analyze the data to derive expected values and estimates of the associated uncertainty and variability. The scope of thismore » document includes the compilation and assessment of data and information relevant to transport parameters for the Yucca Flat/Climax Mine CAU subsurface within the context of unclassified source-term contamination. Data types of interest include mineralogy, aqueous chemistry, matrix and effective porosity, dispersivity, matrix diffusion, matrix and fracture sorption, and colloid-facilitated transport parameters.« less

Mobile Health Insurance System and Associated Costs: A Cross-Sectional Survey of Primary Health Centers in Abuja, Nigeria.

PubMed

Chukwu, Emeka; Garg, Lalit; Eze, Godson

2016-05-17

Nigeria contributes only 2% to the world's population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring. The purpose of this study was to document costs associated with a mobile technology-supported, community-based health insurance scheme. This analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent. All the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (P<.001). This indicates that average out-of-pocket cost of services at private health care facilities is significantly higher than at public primary health care facilities. Key informant interviews with a health management organizations and a telecom operator revealed high investment interests. Cost documentation analysis of income versus expenditure for the major maternal and child health service areas-antenatal care, routine immunization, and birth attendance for 1 year-showed that primary health facilities would still profit if technology-supported, health insurance schemes were adopted. This study demonstrates a case for the implementation of enrolment, encounter management, treatment verification, claims management and reimbursement using mobile technology for health insurance in Abuja, Nigeria. Available data show that the introduction of an electronic job aid improved efficiency. Although it is difficult to make a concrete statement on profitability of this venture but the interest of the health maintenance organizations and telecom experts in this endeavor provides a positive lead.

Mobile Health Insurance System and Associated Costs: A Cross-Sectional Survey of Primary Health Centers in Abuja, Nigeria

PubMed Central

Garg, Lalit; Eze, Godson

2016-01-01

Background Nigeria contributes only 2% to the world’s population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring. Objective The purpose of this study was to document costs associated with a mobile technology–supported, community-based health insurance scheme. Methods This analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent. Results All the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (P<.001). This indicates that average out-of-pocket cost of services at private health care facilities is significantly higher than at public primary health care facilities. Key informant interviews with a health management organizations and a telecom operator revealed high investment interests. Cost documentation analysis of income versus expenditure for the major maternal and child health service areas—antenatal care, routine immunization, and birth attendance for 1 year—showed that primary health facilities would still profit if technology-supported, health insurance schemes were adopted. Conclusions This study demonstrates a case for the implementation of enrolment, encounter management, treatment verification, claims management and reimbursement using mobile technology for health insurance in Abuja, Nigeria. Available data show that the introduction of an electronic job aid improved efficiency. Although it is difficult to make a concrete statement on profitability of this venture but the interest of the health maintenance organizations and telecom experts in this endeavor provides a positive lead. PMID:27189312

Engaging with communities, engaging with patients: amendment to the NAPCRG 1998 Policy Statement on Responsible Research With Communities.

PubMed

Allen, Michele L; Salsberg, Jon; Knot, Michaela; LeMaster, Joseph W; Felzien, Maret; Westfall, John M; Herbert, Carol P; Vickery, Katherine; Culhane-Pera, Kathleen A; Ramsden, Vivian R; Zittleman, Linda; Martin, Ruth Elwood; Macaulay, Ann C

2017-06-01

In 1998, the North American Primary Care Research Group (NAPCRG) adopted a groundbreaking Policy Statement endorsing responsible participatory research (PR) with communities. Since that time, PR gained prominence in primary care research. To reconsider the original 1998 Policy Statement in light of increased uptake of PR, and suggest future directions and applications for PR in primary care. This work contributed to an updated Policy Statement endorsed by NAPCRG in 2015. 32 university and 30 community NAPCRG-affiliated research partners, convened a workshop to document lessons learned about implementing processes and principles of PR. This document emerged from that session and reflection and discussion regarding the original Policy Statement, the emerging PR literature, and our own experiences. The foundational principles articulated in the 1998 Policy Statement remain relevant to the current PR environment. Lessons learned since its publication include that the maturation of partnerships is facilitated by participatory processes that support increased community responsibility for research projects, and benefits generated through PR extend beyond research outcomes. Future directions that will move forward the field of PR in primary care include: (i) improve assessment of PR processes to better delineate the links between how PR teams work together and diverse PR outcomes, (ii) increase the number of models incorporating PR into translational research from project inception to dissemination, and (iii) increase application of PR approaches that support patient engagement in clinical settings to patient-provider relationship and practice change research. PR has markedly altered the manner in which primary care research is undertaken in partnership with communities and its principles and philosophies continue to offer means to assure that research results and processes improve the health of all communities. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Colonization of Porphyromonas endodontalis in primary and secondary endodontic infections].

PubMed

Hong, Li; Hai, Ji; Yan-Yan, He; Shenghui, Yang; Benxiang, Hou

2015-02-01

This study aims to assess and compare the prevalence of Porphyromonas endodontalis (P. endodontalis) in root canals associated with primary and secondary endodontic infections by using 16s rDNA PCR and real-time fluorescence quantitative polymerase chain reaction (RTFQ-PCR). A total of 120 adult patients with one radiographically documented periapical lesion were included. Sixty teeth presented with primary endodontic infections and 60 with secondary endodontic infections requiring retreatment. P. endodontalis was identified by using 16s rDNA PCR techniques. The positive DNA expression of P. endodontalis in two types of infected root canals were quantitatively compared by using SYBR GREEN I RTFQ-PCR. The prevalence of P. endodontalis in the root canals with primary endodontic infections was significantly higher than that in root canals with secondary endodontic infections (P = 0.001). However, RTFQ-PCR results showed no significant difference in DNA expression quantities between the primary and secondary endodontic infections root canals (P = 0.303). P. endodontalis is more highly associated with root canals having primary endodontic infections, although P. endodontalis colonize in both root canals with primary and secondary chronic apical periodontitis.

Clinico-pathological Characteristics of Congenital Pulmonary Lymphangiectasis: Report of Two Cases

PubMed Central

Eom, Minseob; Choi, Yoo Duk; Kim, Youn Shin; Cho, Mee-Yon; Lee, Han Young

2007-01-01

Congenital pulmonary lymphangiectasis (CPL) is a rare, poorly documented disease, characterized by abnormal dilatation of pulmonary lymphatics without lymphatic proliferation. This disease is seen almost exclusively in infancy and early childhood. It can usually be divided into primary (congenital) and secondary forms. The primary form presents in neonates, and the patients mostly die due to the respiratory distress, shortly after birth. The authors experienced two cases of primary CPL in a 13-day-old male neonate and a one-day-old male neonate, showing prominent lymphatic dilatation in the septal, subpleural, and peri-bronchial tissue throughout both lungs. The latter case was associated with congenital cardiac anomaly including single ventricle. These are unique cases of CPL in Korea of which the diagnosis was established through post-mortem examination. Therefore, the authors report these two cases with primary CPL with a review of the literature. PMID:17728521

Initial Results from the Bloomsburg University Goniometer Laboratory

NASA Technical Reports Server (NTRS)

Shepard, M. K.

2002-01-01

The Bloomsburg University Goniometer Laboratory (B.U.G. Lab) consists of three systems for studying the photometric properties of samples. The primary system is an automated goniometer capable of measuring the entire bi-directional reflectance distribution function (BRDF) of samples. Secondary systems include a reflectance spectrometer and digital video camera with macro zoom lens for characterizing and documenting other physical properties of measured samples. Works completed or in progress include the characterization of the BRDF of calibration surfaces for the 2003 Mars Exploration Rovers (MER03), Martian analog soils including JSC-Mars-1, and tests of photometric models.

Mission safety evaluation report for STS-35: Postflight edition

NASA Technical Reports Server (NTRS)

Hill, William C.; Finkel, Seymour I.

1991-01-01

Space Transportation System 35 (STS-35) safety risk factors that represent a change from previous flights that had an impact on this flight, and factors that were unique to this flight are discussed. While some changes to the safety risk baseline since the previous flight are included to highlight their significance in risk level change, the primary purpose is to insure that changes which were too late too include in formal changes through the Failure Modes and Effects Analysis/Critical Items List (FMEA/CIL) and Hazard Analysis process are documented along with the safety position, which includes the acceptance rationale.

Trade study plan for Graphite Composite Primary Structure (GCPS)

NASA Technical Reports Server (NTRS)

Greenberg, H. S.

1994-01-01

This TA 2 document (with support from TA 1) describes the trade study plan that will identify the most suitable structural configuration for an SSTO winged vehicle capable of delivering 25,000 lbs to a 220 nm circular orbit at 51.6 degree inclination For this most suitable configuration the structural attachment of the wing, and the most suitable GCPS composite materials for intertank, wing, tail and thrust structure are identified. This trade study analysis uses extensive information derived in the TA 1 trade study plan and is identified within the study plan. In view of this, for convenience, the TA 1 study plan is included as an appendix to this document.

Reports of unintended consequences of financial incentives to improve management of hypertension.

PubMed

Hysong, Sylvia J; SoRelle, Richard; Broussard Smitham, Kristen; Petersen, Laura A

2017-01-01

Given the increase in financial-incentive programs nationwide, many physicians and physician groups are concerned about potential unintended consequences of providing financial incentives to improve quality of care. However, few studies examine whether actual unintended consequences result from providing financial incentives to physicians. We sought to document the extent to which the unintended consequences discussed in the literature were observable in a randomized clinical trial (RCT) of financial incentives. We conducted a qualitative observational study nested within a larger RCT of financial incentives to improve hypertension care. We conducted 30-minute telephone interviews with primary care personnel at facilities participating in the RCT housed at12 geographically dispersed Veterans Affairs Medical Centers nationwide. Participants answered questions about unintended effects, clinic team dynamics, organizational impact on care delivery, study participation. We employed a blend of inductive and deductive qualitative techniques for analysis. Sixty-five participants were recruited from RCT enrollees and personnel not enrolled in the larger RCT, plus one primary care leader per site. Emergent themes included possible patient harm, emphasis on documentation over improving care, reduced professional morale, and positive spillover. All discussions of unintended consequences involving patient harm were only concerns, not actual events. Several unintended consequences concerned ancillary initiatives for quality improvement (e.g., practice guidelines and performance measurement systems) rather than financial incentives. Many unintended consequences of financial incentives noted were either only concerns or attributable to ancillary quality-improvement initiatives. Actual unintended consequences included improved documentation of care without necessarily improving actual care, and positive unintended consequences. Clinicaltrials.gov Identifier: NCT00302718.

Consensus document for the use of the Polypill in the secondary prevention of cardiovascular disease.

PubMed

González-Juanatey, José Ramón; Mostaza, José María; Lobos, José María; Abarca, Benjamín; Llisterri, José Luis; Baron-Esquivias, Gonzalo; Galve, Enrique; Lidón, Rosa María; Garcia-Moll, Francisco Xavier; Sánchez, Pedro Luis; Suárez, Carmen; Millán, Jesús; Pallares, Vicente; Alemán, José Juan; Egocheaga, Isabel

2017-02-09

Cardiovascular disease is a chronic disorder which is usually already at an advanced stage when the first symptoms develop. The fact that the initial clinical presentation can be lethal or highly incapacitating emphasizes the need for primary and secondary prevention. It is estimated that the ratio of patients with good adherence to secondary prevention of cardiovascular disease is low and also decreases gradually over time. The Polypill for secondary prevention of cardiovascular disease is the first fixed-dose combination therapy of salicylic acid, atorvastatin and ramipril approved in Spain. The purpose of this consensus document was to define and recommend, through the evidence available in the literature and clinical expert opinion, the impact of treatment adherence in the secondary prevention of cardiovascular disease and the use of the Polypill in daily clinical practice as part of a global strategy including adjustments in patient lifestyle. A RAND/UCLA methodology based on scientific evidence, as well as the collective judgment and clinical expertise of an expert panel was used for this assessment. As a result, a final report of recommendations on the impact of the lack of adherence to treatment of secondary prevention of cardiovascular disease and the effect of using a Polypill in adherence of patients was produced. The recommendations included in this document have been addressed to all those specialists, cardiologists, internists and primary care physicians with competence in prescribing and monitoring patients with high and very high cardiovascular risks. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Primary care interventions and current service innovations in modifying long-term outcomes after stroke: a protocol for a scoping review.

PubMed

Pindus, Dominika M; Lim, Lisa; Rundell, A Viona; Hobbs, Victoria; Aziz, Noorazah Abd; Mullis, Ricky; Mant, Jonathan

2016-10-24

Interventions delivered by primary and/or community care have the potential to reach the majority of stroke survivors and carers and offer ongoing support. However, an integrative account emerging from the reviews of interventions addressing specific long-term outcomes after stroke is lacking. The aims of the proposed scoping review are to provide an overview of: (1) primary care and community healthcare interventions by generalist healthcare professionals to stroke survivors and/or their informal carers to address long-term outcomes after stroke, (2) the scope and characteristics of interventions which were successful in addressing long-term outcomes, and (3) developments in current clinical practice. Studies that focused on adult community dwelling stroke survivors and informal carers were included. Academic electronic databases will be searched to identify reviews of randomised controlled trials (RCTs) and controlled trials, trials from the past 5 years; reviews of observational studies. Practice exemplars from grey literature will be identified through advanced Google search. Reports, guidelines and other documents of major health organisations, clinical professional bodies, and stroke charities in the UK and internationally will be included. Two reviewers will independently screen titles, abstracts and full texts for inclusion of published literature. One reviewer will screen search results from the grey literature and identify relevant documents for inclusion. Data synthesis will include analysis of the number, type of studies, year and country of publication, a summary of intervention components/service or practice, outcomes addressed, main results (an indicator of effectiveness) and a description of included interventions. The review will help identify components of care and care pathways for primary care services for stroke. By comparing the results with stroke survivors' and carers' needs identified in the literature, the review will highlight potential gaps in research and practice relevant to long-term care after stroke. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Content of system design descriptions

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

NONE

A System Design Description (SDD) describes the requirements and features of a system. This standard provides guidance on the expected technical content of SDDs. The need for such a standard was recognized during efforts to develop SDDs for safety systems at DOE Hazard Category 2 nonreactor nuclear facilities. Existing guidance related to the corresponding documents in other industries is generally not suitable to meet the needs of DOE nuclear facilities. Across the DOE complex, different contractors have guidance documents, but they vary widely from site to site. While such guidance documents are valuable, no single guidance document has all themore » attributes that DOE considers important, including a reasonable degree of consistency or standardization. This standard is a consolidation of the best of the existing guidance. This standard has been developed with a technical content and level of detail intended to be most applicable to safety systems at DOE Hazard Category 2 nonreactor nuclear facilities. Notwithstanding that primary intent, this standard is recommended for other systems at such facilities, especially those that are important to achieving the programmatic mission of the facility. In addition, application of this standard should be considered for systems at other facilities, including non-nuclear facilities, on the basis that SDDs may be beneficial and cost-effective.« less

Readability of Hospice Materials to Prepare Families for Caregiving at the Time of Death

PubMed Central

Kehl, Karen A.; McCarty, Kayla N.

2012-01-01

Many health care materials are not written at levels that can be understood by most lay people. In this descriptive study, we examined the readability of documents used by hospices to prepare families for caregiving at the time of death. We used two common formulae to examine the documents. The mean Flesch-Kincaid grade level was 8.95 (SD 1.80). The mean Simple Measure of Gobbledygook grade level was 11.06 (SD 1.36). When we used the Colors Label Ease for Adult Readers instrument, it became evident that medical terminology was the primary reason for the high grade levels. Most documents (78%) included medical terms that were directly (46.2%) or indirectly (25.6%) explained in the text. Modification of hospice materials could improve families’ comprehension of information important for optimal end-of-life care. PMID:22492500

Three Proposed Compendia for Genesis Solar Wind Samples: Science Results, Collector Materials Characterization and Cleaning Techniques

NASA Technical Reports Server (NTRS)

Allton, J. H.; Calaway, M. J.; Nyquist, L. E.; Jurewicz, A. J. G.; Burnett, D. S.

2018-01-01

Final Paper and not the abstract is attached. Introduction: Planetary material and cosmochemistry research using Genesis solar wind samples (including the development and implementation of cleaning and analytical techniques) has matured sufficiently that compilations on several topics, if made publically accessible, would be beneficial for researchers and reviewers. We propose here three compendia based on content, organization and source of documents (e.g. published peer-reviewed, published, internal memos, archives). For planning purposes, suggestions are solicited from potential users of Genesis solar wind samples for the type of science content and/or organizational style that would be most useful to them. These compendia are proposed as living documents, periodically updated. Similar to the existing compendia described below, the curation compendia are like library or archival finding aids, they are guides to published or archival documents and should not be cited as primary sources.

Map showing areas serviced by public water-supply agencies in 1973 Greater Pittsburgh region, southwestern Pennsylvania

USGS Publications Warehouse

Beall, Robert M.

1974-01-01

Urban water planning, development, and management are many sectored, costly efforts, subject to a multitude of controls and demands including those imposed by nature. One primary concern in development is for providing a dependable and safe water supply. In spite of a bountiful natural availability, the process of satisfying consumer needs involves the resolution of a variety of problems, not the least of which are cooperation and coordination among suppliers. One of the fundamental requisites in seeking sound solutions to developmental and environmental problems is inventory documentation. This map is one facet of documentation; the data listing, given on sheet 2, is the companion inventory. These supplement State, regional, and local efforts directed toward both long-range planning and current evaluation programs. Such documentation also assists the assessment of the effect of one water-management subsystem on hydrologic characteristics.

Primary Palliative Care for the General Internist: Integrating Goals of Care Discussions into the Outpatient Setting

PubMed Central

Ahia, Chad L.; Blais, Christopher M.

2014-01-01

Background Primary palliative care consists of the palliative care competencies required of all primary care clinicians. Included in these competencies is the ability to assist patients and their families in establishing appropriate goals of care. Goals of care help patients and their families understand the patient's illness and its trajectory and facilitate medical care decisions consistent with the patient's values and goals. General internists and family medicine physicians in primary care are central to getting patients to articulate their goals of care and to have these documented in the medical record. Case Report Here we present the case of a 71-year-old male patient with chronic obstructive pulmonary disorder, congestive heart failure, and newly diagnosed Alzheimer dementia to model pertinent end-of-life care communication and discuss practical tips on how to incorporate it into practice. Conclusion General internists and family medicine practitioners in primary care are central to eliciting patients' goals of care and achieving optimal end-of-life outcomes for their patients. PMID:25598737

Involving Children in the Design and Development of Research Instruments and Data Collection Procedures: A Case Study in Primary Schools in Northern Ireland

ERIC Educational Resources Information Center

Turtle, Kellie; McElearney, Aisling; Scott, Joanne

2010-01-01

Children's right to participate as enshrined in Article 12 of the United Nations Convention on the Rights of the Child is increasingly evident in the rhetoric of policy documents as well as in practice and research with children and young people. Children's participation in research is being facilitated in a range of creative ways, including as…

CHeCS (Crew Health Care Systems): International Space Station (ISS) Medical Hardware Catalog. Version 10.0

NASA Technical Reports Server (NTRS)

2011-01-01

The purpose of this catalog is to provide a detailed description of each piece of hardware in the Crew Health Care System (CHeCS), including subpacks associated with the hardware, and to briefly describe the interfaces between the hardware and the ISS. The primary user of this document is the Space Medicine/Medical Operations ISS Biomedical Flight Controllers (ISS BMEs).

Langley Atmospheric Information Retrieval System (LAIRS): System description and user's guide

NASA Technical Reports Server (NTRS)

Boland, D. E., Jr.; Lee, T.

1982-01-01

This document presents the user's guide, system description, and mathematical specifications for the Langley Atmospheric Information Retrieval System (LAIRS). It also includes a description of an optimal procedure for operational use of LAIRS. The primary objective of the LAIRS Program is to make it possible to obtain accurate estimates of atmospheric pressure, density, temperature, and winds along Shuttle reentry trajectories for use in postflight data reduction.

Some Trends and Reforms in the Educational Policy of Norway in the Light of the Concept of Life-Long Education.

ERIC Educational Resources Information Center

Udjus, Ingelise

An emphasis on planned and completed educational reforms in Norway which reflect the attitude that education is a lifelong process is presented in this document. A study is made of some of the trends in the development of the formal school system which have been influenced by the concept of life-long education. This study includes primary,…

A View from the Inside: An In-Depth Look at a Female University Student's Experience with a Feel-Based Intervention to Enhance Self-Confidence and Self-Talk

ERIC Educational Resources Information Center

Guerin, Eva; Arcand, Isabelle; Durand-Bush, Natalie

2010-01-01

The primary goal of this investigation was to document, using the participatory paradigm, a female university student's experience with a feel-based intervention intended to enhance the quality of her academic experiences including her self-confidence and self-talk. In this unique qualitative case study, the student participated in a 15-week…

Including SENCOs in Behaviour Improvement: An Exploration of the Behaviour and Attendance Strands of the National Strategies

ERIC Educational Resources Information Center

Ellis, Simon; Tod, Janet

2005-01-01

In this article Simon Ellis and Janet Tod review the KS3 National Strategy Behaviour and Attendance strand (DfES, 2003a; 2004a) and the Behaviour and Attendance pilot materials from the Primary National Strategy (DfES, 2003b; 2003c; 2003d). Relevant policy documentation is examined in order to explore how the role of the special educational needs…

Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai'i.

PubMed

Volandes, Angelo E; Paasche-Orlow, Michael K; Davis, Aretha Delight; Eubanks, Robert; El-Jawahri, Areej; Seitz, Rae

2016-09-01

Advance care planning (ACP) seeks to promote care delivery that is concordant with patients' informed wishes. Scalability and cost may be barriers to widespread ACP, and video decision aids may help address such barriers. Our primary hypothesis was that ACP documentation would increase in Hilo after ACP video implementation. Secondary hypotheses included increased use of hospice, fewer deaths in the hospital, and decreased costs in the last month of life. The city of Hilo in Hawai'i (population 43,263), which is served by one 276-bed hospital (Hilo Medical Center), one hospice (the Hospice of Hilo), and 30 primary care physicians. The intervention consisted of a single, 1- to 4-h training and access to a suite of ACP video decision aids. Prior to implementation, the rate of ACP documentation for hospitalized patients with late-stage disease was 3.2 % (11/346). After the intervention, ACP documentation was 39.9 % (1,107/2,773) (P < 0.001). Primary care providers in the intervention had an ACP completion rate for patients over 75 years of 37.0 % (1,437/3,888) compared to control providers, who had an average of 25.6 % (10,760/42,099) (P < 0.001). The rate of discharge from hospital to hospice for patients with late-stage disease was 5.7 % prior to the intervention and 13.8 % after the intervention (P < 0.001). The average total insurance cost for the last month of life among Hilo patients was $3,458 (95 % CI $3,051 to 3,865) lower per patient after the intervention when compared to the control region. Implementing ACP video decision aids was associated with improved ACP documentation, greater use of hospice, and decreased costs. Decision aids that promote ACP offer a scalable and cost-efficient medium to place patients at the center of their care.

Hepatitis C risk assessment, testing and referral for treatment in urban primary care: Role of race and ethnicity

PubMed Central

Trooskin, Stacey B; Navarro, Victor J; Winn, Robert J; Axelrod, David J; McNeal, A Scott; Velez, Maricruz; Herrine, Steven K; Rossi, Simona

2007-01-01

AIM: To determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity. METHODS: Retrospective chart review from four primary care sites in Philadelphia; two academic primary care practices and two community clinics was performed. Demographics, HCV risk factors, and other risk exposure information were collected. RESULTS: Four thousand four hundred and seven charts were reviewed. Providers documented histories of injection drug use (IDU) and transfusion for less than 20% and 5% of patients, respectively. Only 55% of patients who admitted IDU were tested for HCV. Overall, minorities were more likely to have information regarding a risk factor documented than their white counterparts (79% vs 68%, P < 0.0001). Hispanics were less likely to have a risk factor history documented, compared to blacks and whites (P < 0.0001). Overall, minorities were less likely to be tested for HCV than whites in the presence of a known risk factor (23% vs 35%, P = 0.004). Among patients without documentation of risk factors, blacks and Hispanics were more likely to be tested than whites (20% and 24%, vs 13%, P < 0.005, respectively). CONCLUSION: (1) Documentation of an HCV risk factor history in urban primary care is uncommon, (2) Racial differences exist with respect to HCV risk factor ascertainment and testing, (3) Minority patients, positive for HCV, are less likely to be referred for subspecialty care and treatment. Overall, minorities are less likely to be tested for HCV than whites in the presence of a known risk factor. PMID:17373742

International energy annual, 1993

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

NONE

1995-05-08

This document presents an overview of key international energy trends for production, consumption, imports, and exports of primary energy commodities in over 200 countries, dependencies, and areas of special sovereignty. Also included are population and gross domestic product data, as well as prices for crude oil and petroleum products in selected countries. Renewable energy includes hydroelectric, geothermal, solar and wind electric power and alcohol for fuel. The data were largely derived from published sources and reports from US Embassy personnel in foreign posts. EIA also used data from reputable secondary sources, industry reports, etc.

Evaluation of a patient-centered after visit summary in primary care.

PubMed

Federman, Alex D; Jandorf, Lina; DeLuca, Joseph; Gover, Mary; Sanchez Munoz, Angela; Chen, Li; Wolf, Michael S; Kannry, Joseph

2018-03-06

To test the impact of a redesigned, patient-centered after visit summary (AVS) on patients' and clinicians' ratings of and experience with the document. We conducted a difference-in-differences (DiD) evaluation of the impact of the redesigned AVS before and after its introduction in an academic primary care practice compared to a concurrent control practice. Outcomes included ratings of the features of the AVS. The intervention site had 118 and 98 patients in the pre- and post-intervention periods and the control site had 99 and 105, respectively. In adjusted DiD analysis, introduction of the patient-centered AVS in the intervention site increased patient reports that the AVS was an effective reminder for taking medications (p = .004) and of receipt of the AVS from clinicians (p = .002). However, they were more likely to perceive it as too long (p = .04). There were no significant changes in overall rating of the AVS by clinicians or their likelihood of providing it to patients. A patient-centered AVS increased the number of patients receiving it and reporting that it would help them remember to take their medications. Improvements in the patient-centeredness of the AVS may improve its usefulness as a document to support self-management in primary care. Copyright © 2018. Published by Elsevier B.V.

The effect of menstruation on psychiatric hospitalization.

PubMed

Weston, Jaclyn; Speroni, Karen Gabel; Ellis, Terri; Daniel, Marlon G

2012-07-01

This study evaluated the effect of menstruation on psychiatric hospitalization. We conducted a retrospective chart review of the medical records of 177 women who met the eligibility criteria. Data collected included demographic details, primary and secondary diagnoses, date of last menstrual period (LMP), medication adherence, psychiatric hospitalization length of stay, previous psychiatric admissions (including those related to menstruation), discharge referrals, and readmissions. The majority of women were admitted for major depression, were single, Caucasian, and had a mean age of 34. A disproportionate percentage (37%) of women had their LMP within 5 days of psychiatric hospitalization (p = 0.0006). The overall average length of stay was 4.37 days, and 48.3% had a previous psychiatric admission. Medication adherence was routinely not documented (77.4%). Psychiatric hospitalizations for women are significantly greater within 5 days of their LMP. Nursing education and improved documentation are warranted to decrease the potential for readmission. Copyright 2012, SLACK Incorporated.

Barriers, supports, and effective interventions for uptake of human papillomavirus- and other vaccines within global and Canadian Indigenous peoples: a systematic review protocol.

PubMed

Mrklas, Kelly J; MacDonald, Shannon; Shea-Budgell, Melissa A; Bedingfield, Nancy; Ganshorn, Heather; Glaze, Sarah; Bill, Lea; Healy, Bonnie; Healy, Chyloe; Guichon, Juliet; Colquhoun, Amy; Bell, Christopher; Richardson, Ruth; Henderson, Rita; Kellner, James; Barnabe, Cheryl; Bednarczyk, Robert A; Letendre, Angeline; Nelson, Gregg S

2018-03-02

Despite the existence of human papilloma virus (HPV) vaccines with demonstrated safety and effectiveness and funded HPV vaccination programs, coverage rates are persistently lower and cervical cancer burden higher among Canadian Indigenous peoples. Barriers and supports to HPV vaccination in Indigenous peoples have not been systematically documented, nor have interventions to increase uptake in this population. This protocol aims to appraise the literature in Canadian and global Indigenous peoples, relating to documented barriers and supports to vaccination and interventions to increase acceptability/uptake or reduce hesitancy of vaccination. Although HPV vaccination is the primary focus, we anticipate only a small number of relevant studies to emerge from the search and will, therefore, employ a broad search strategy to capture literature related to both HPV vaccination and vaccination in general in global Indigenous peoples. Eligible studies will include global Indigenous peoples and discuss barriers or supports and/or interventions to improve uptake or to reduce hesitancy, for the HPV vaccine and/or other vaccines. Primary outcomes are documented barriers or supports or interventions. All study designs meeting inclusion criteria will be considered, without restricting by language, location, or data type. We will use an a priori search strategy, comprised of key words and controlled vocabulary terms, developed in consultation with an academic librarian, and reviewed by a second academic librarian using the PRESS checklist. We will search several electronic databases from date of inception, without restrictions. A pre-defined group of global Indigenous websites will be reviewed for relevant gray literature. Bibliographic searches will be conducted for all included studies to identify relevant reviews. Data analysis will include an inductive, qualitative, thematic synthesis and a quantitative analysis of measured barriers and supports, as well as a descriptive synthesis and quantitative summary of measures for interventions. To our knowledge, this study will contribute the first systematic review of documented barriers, supports, and interventions for vaccination in general and for HPV vaccination. The results of this study are expected to inform future research, policies, programs, and community-driven initiatives to enhance acceptability and uptake of HPV vaccination among Indigenous peoples. PROSPERO Registration Number: CRD42017048844.

49 CFR 1177.1 - Definitions and classifications of documents.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 8 2011-10-01 2011-10-01 false Definitions and classifications of documents. 1177.1 Section 1177.1 Transportation Other Regulations Relating to Transportation (Continued) SURFACE... Definitions and classifications of documents. (a) A “primary document” is a mortgage (excluding those under...

South Florida freight advanced traveler information system : architecture and implementation as built documentation report.

DOT National Transportation Integrated Search

2015-05-01

The primary purpose of the As Built Documentation is to provide a description of any modifications made to the original architecture along with justification as to why the architecture was changed. In addition, this documentation provides the followi...

Models of clinical reasoning with a focus on general practice: A critical review

PubMed Central

YAZDANI, SHAHRAM; HOSSEINZADEH, MOHAMMAD; HOSSEINI, FAKHROLSADAT

2017-01-01

Introduction: Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. Methods: A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Results: Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. Conclusion: A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed. PMID:28979912

Meta-Analysis of Workplace Physical Activity Interventions

PubMed Central

Conn, Vicki S.; Hafdahl, Adam R.; Cooper, Pamela S.; Brown, Lori M.; Lusk, Sally L.

2009-01-01

Context Most adults do not achieve adequate physical activity. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from these programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research. Evidence acquisition Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008. Evidence synthesis Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference (d) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21), fitness (0.57), lipids (0.13), anthropometric measures (0.08), work attendance (0.19), and job stress (0.33). The significant effect size for diabetes risk (0.98) is more tentative given small sample sizes. Significant heterogeneity documents intervention effects varied across studies. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on V02max of 3.5 mL/kg/min; for lipids, −0.2 on total cholesterol:HDL; and for diabetes risk, −12.6 mg/dL on fasting glucose. Conclusions These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity. PMID:19765506

Synthesizing diverse evidence: the use of primary qualitative data analysis methods and logic models in public health reviews.

PubMed

Baxter, S; Killoran, A; Kelly, M P; Goyder, E

2010-02-01

The nature of public health evidence presents challenges for conventional systematic review processes, with increasing recognition of the need to include a broader range of work including observational studies and qualitative research, yet with methods to combine diverse sources remaining underdeveloped. The objective of this paper is to report the application of a new approach for review of evidence in the public health sphere. The method enables a diverse range of evidence types to be synthesized in order to examine potential relationships between a public health environment and outcomes. The study drew on previous work by the National Institute for Health and Clinical Excellence on conceptual frameworks. It applied and further extended this work to the synthesis of evidence relating to one particular public health area: the enhancement of employee mental well-being in the workplace. The approach utilized thematic analysis techniques from primary research, together with conceptual modelling, to explore potential relationships between factors and outcomes. The method enabled a logic framework to be built from a diverse document set that illustrates how elements and associations between elements may impact on the well-being of employees. Whilst recognizing potential criticisms of the approach, it is suggested that logic models can be a useful way of examining the complexity of relationships between factors and outcomes in public health, and of highlighting potential areas for interventions and further research. The use of techniques from primary qualitative research may also be helpful in synthesizing diverse document types. Copyright 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Predictors of hypoglycaemia in insulin-treated type 2 diabetes patients in primary care: a retrospective database analysis.

PubMed

Kostev, Karel; Dippel, Franz-Werner; Rathmann, Wolfgang

2014-07-01

To investigate the frequency and predictors (diabetes care and treatment, comorbidity) of documented hypoglycaemia in primary care patients with insulin-treated type 2 diabetes. Data from 32,545 patients (mean age: 70 (SD 11) years, 50.3% males) from 1072 practices were retrospectively analyzed (Disease Analyzer database Germany: 09/2011-08/2012). Logistic regression (≥1 documented hypoglyemia) was used to adjust for confounders (age, sex, practice characteristics, diabetes treatment regimen). The prevalence of patients (12 months) with at least one reported hypoglycaemia was 2.2% (95% CI: 2.0-2.4%). The adjusted odds of having hypoglycemia were increased for renal failure (OR; 95% CI: 1.26; 1.16-1.37), autonomic neuropathy (1.34; 1.20-1.49), and adrenocortical insufficiency (3.08; 1.35-7.05). Patients with mental disorders including dementia (1.49; 1.31-1.69), depression (1.24; 1.13-1.35), anxiety (1.18; 1.01-1.37), and affective disorders (1.80; 1.36-2.38) also showed an increased odds of having hypoglycemia. Location of the practice in an urban area was associated with a lower odds ratio (0.74; 0.68-0.80). Both individual patient characteristics (e.g. comorbidity) and regional factors (practice location) have a substantial impact on hypoglycaemia in primary care patients with insulin therapy. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

[Consensus document for the detection and management of chronic kidney disease].

PubMed

Martínez-Castelao, Alberto; Górriz, José L; Bover, Jordi; Segura-de la Morena, Julián; Cebollada, Jesús; Escalada, Javier; Esmatjes, Enric; Fácila, Lorenzo; Gamarra, Javier; Gràcia, Silvia; Hernández-Moreno, Julio; Llisterri-Caro, José L; Mazón, Pilar; Montañés, Rosario; Morales-Olivas, Francisco; Muñoz-Torres, Manuel; de Pablos-Velasco, Pedro; de Santiago, Ana; Sánchez-Celaya, Marta; Suárez, Carmen; Tranche, Salvador

2014-11-01

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

[Consensus document for the detection and management of chronic kidney disease].

PubMed

Martínez-Castelao, Alberto; Górriz, José L; Bover, Jordi; Segura-de la Morena, Julián; Cebollada, Jesús; Escalada, Javier; Esmatjes, Enric; Fácila, Lorenzo; Gamarra, Javier; Gràcia, Silvia; Hernández-Moreno, Julio; Llisterri-Caro, José L; Mazón, Pilar; Montañés, Rosario; Morales-Olivas, Francisco; Muñoz-Torres, Manuel; de Pablos-Velasco, Pedro; de Santiago, Ana; Sánchez-Celaya, Marta; Suárez, Carmen; Tranche, Salvador

2014-11-01

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations. Copyright © 2014. Published by Elsevier Espana.

Proactive cancer care in primary care: a mixed-methods study

PubMed Central

Murray, Scott A

2013-01-01

Background. Current models of post-treatment cancer care are based on traditional practices and clinician preference rather than evidence of benefit. Objectives. To assess the feasibility of using a structured template to provide holistic follow-up of patients in primary care from cancer diagnosis onwards. Methods. A two-phase mixed methods action research project. An electronic Cancer Ongoing Review Document (CORD) was first developed with patients and general practitioners, and used with patients with a new diagnosis of cancer. This was evaluated through documentary analysis of the CORDs, qualitative interviews with patients, family carers and health professionals and record reviews. Results. The records of 107 patients from 13 primary care teams were examined and 45 interviews conducted. The document was started in 54% of people with newly diagnosed cancer, and prompted clear documentation of multidimension needs and understanding. General practitioners found using the document helped to structure consultations and cover psychosocial areas, but they reported it needed to be better integrated in their medical records with computerized prompts in place. Few clinicians discussed the review openly with patients, and the template was often completed afterwards. Conclusions. Anticipatory cancer care from diagnosis to cure or death, ‘in primary care’, is feasible in the UK and acceptable to patients, although there are barriers. The process promoted continuity of care and holism. A reliable system for proactive cancer care in general practice supported by hospital specialists may allow more survivorship care to be delivered in primary care, as in other long-term conditions. PMID:23382502

Proactive cancer care in primary care: a mixed-methods study.

PubMed

Kendall, Marilyn; Mason, Bruce; Momen, Natalie; Barclay, Stephen; Munday, Dan; Lovick, Roberta; Macpherson, Stella; Paterson, Euan; Baughan, Paul; Cormie, Paul; Kiehlmann, Peter; Free, Amanda; Murray, Scott A

2013-06-01

Current models of post-treatment cancer care are based on traditional practices and clinician preference rather than evidence of benefit. To assess the feasibility of using a structured template to provide holistic follow-up of patients in primary care from cancer diagnosis onwards. A two-phase mixed methods action research project. An electronic cancer ongoing review document (CORD) was first developed with patients and general practitioners, and used with patients with a new diagnosis of cancer. This was evaluated through documentary analysis of the CORDs, qualitative interviews with patients, family carers and health professionals and record reviews. The records of 107 patients from 13 primary care teams were examined and 45 interviews conducted. The document was started in 54% of people with newly diagnosed cancer, and prompted clear documentation of multidimension needs and understanding. General practitioners found using the document helped to structure consultations and cover psychosocial areas, but they reported it needed to be better integrated in their medical records with computerized prompts in place. Few clinicians discussed the review openly with patients, and the template was often completed afterwards. Anticipatory cancer care from diagnosis to cure or death, 'in primary care', is feasible in the U.K. and acceptable to patients, although there are barriers. The process promoted continuity of care and holism. A reliable system for proactive cancer care in general practice supported by hospital specialists may allow more survivorship care to be delivered in primary care, as in other long-term conditions.

Incorporating PROMIS Symptom Measures into Primary Care Practice-a Randomized Clinical Trial.

PubMed

Kroenke, Kurt; Talib, Tasneem L; Stump, Timothy E; Kean, Jacob; Haggstrom, David A; DeChant, Paige; Lake, Kittie R; Stout, Madison; Monahan, Patrick O

2018-04-05

Symptoms account for more than 400 million clinic visits annually in the USA. The SPADE symptoms (sleep, pain, anxiety, depression, and low energy/fatigue) are particularly prevalent and undertreated. To assess the effectiveness of providing PROMIS (Patient-Reported Outcome Measure Information System) symptom scores to clinicians on symptom outcomes. Randomized clinical trial conducted from March 2015 through May 2016 in general internal medicine and family practice clinics in an academic healthcare system. Primary care patients who screened positive for at least one SPADE symptom. After completing the PROMIS symptom measures electronically immediately prior to their visit, the 300 study participants were randomized to a feedback group in which their clinician received a visual display of symptom scores or a control group in which scores were not provided to clinicians. The primary outcome was the 3-month change in composite SPADE score. Secondary outcomes were individual symptom scores, symptom documentation in the clinic note, symptom-specific clinician actions, and patient satisfaction. Most patients (84%) had multiple clinically significant (T-score ≥ 55) SPADE symptoms. Both groups demonstrated moderate symptom improvement with a non-significant trend favoring the feedback compared to control group (between-group difference in composite T-score improvement, 1.1; P = 0.17). Symptoms present at baseline resolved at 3-month follow-up only one third of the time, and patients frequently still desired treatment. Except for pain, clinically significant symptoms were documented less than half the time. Neither symptom documentation, symptom-specific clinician actions, nor patient satisfaction differed between treatment arms. Predictors of greater symptom improvement included female sex, black race, fewer medical conditions, and receiving care in a family medicine clinic. Simple feedback of symptom scores to primary care clinicians in the absence of additional systems support or incentives is not superior to usual care in improving symptom outcomes. clinicaltrials.gov identifier: NCT02383862.

[Electronic data records in primary health care and aspects of their development in Bosnia and Herzegovina].

PubMed

Novo, Ahmed; Masić, Izet; Toromanović, Selim; Karić, Mediha; Zunić, Lejla

2004-01-01

In Medical Informatics medical documentation and evidention are most probably the key areas. Also, in primary health care it is very important and part of daily activity of medical staff. Bosnia and Herzegovina is trying to be close to developed countries and to modernize and computerize current systems of documentation and to cross over from manual and semi manual methods to computerized medical data analysis. The most of European countries have developed standards and classification systems in primary health care for collecting, examination, analysis and interpretation of medical data assessed. One of possibilities as well as dilemma, which data carrier should be used for storage and manipulation of patient data in primary health care, is use of electronic medical record. Most of the South East European countries use chip or smart card and some of countries in neighborhood (Italy) choose laser card as patient data carrier. Both technologies have the advantages and disadvantages what was comprehensively colaborated by the authors in this paper, with intention to help experts who make decisions in this segment to create and to correctly influence on improvement of quality, correctness and accuracy of medical documentation in primary health care.

Health, energy vulnerability and climate change: a retrospective thematic analysis of primary care trust policies and practices.

PubMed

Richardson, J; Kagawa, F; Nichols, A

2009-12-01

To review publicly available documents produced by primary care trusts (PCTs) to assess the extent to which local activity and planning consider energy vulnerability, climate change and sustainability. Retrospective thematic content analysis of publicly available materials located on PCT websites. Thematic content analysis of publicly available materials was undertaken by two researchers over a 6-month period in 2008. These materials were obtained from the websites of 30 PCTs in England. Materials included annual reports, plans, policies and strategy documents. Of the 30 PCT websites studied, four were found to have an absence of content related to climate change, energy vulnerability and sustainability. Of the remaining 26 PCT websites, consistent themes were found: strategic initiatives, joint working with other agencies, promoting sustainable communities, and targeted actions. Evidence of good examples in sustainable development was predominantly limited to policy statements and strategic aims; evidence of action was limited. As champions of the public health agenda, PCT action on sustainability should be integral to all aspects of organizational governance.

Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines.

PubMed

Hung, Dorothy; Martinez, Meghan; Yakir, Maayan; Gray, Caroline

2015-01-01

Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers. This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care. Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts. Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery.

Stories and metaphors in the sensemaking of multiple primary health care organizational identities.

PubMed

Rodríguez, Charo; Bélanger, Emmanuelle

2014-03-04

The Quebec primary health care delivery system has experienced numerous reforms over the last 15 years. In this study, we sought to examine how managers and primary care providers made sense of the creation of successive new primary care organizational forms. We conducted a longitudinal qualitative case study in a primary care practice group located in Montreal, Quebec, for over 6 years (2002 to 2008). The data sources for the study include 31 semi-structured interviews with key informants, in-situ observations of group meetings, as well as documents and field notes. Textual material was submitted to narrative and metaphor analysis. The core metaphor of the journey came from a set of stories in which the members of this primary care group depicted the processes undertaken towards developing a multidisciplinary cooperative practice, which include an uneasy departure, uncertainty about the destination, conflict among members who jump ship or stay on board, negotiations about the itinerary, and, finally, enduring challenges in leading the way and being pioneers of change in the organization of primary care in their institutional context. Identification with the initial family medicine unit identity was persistent over time, but successive reforms further enriched its meaning as it became a multidisciplinary primary care practice pioneering organizational change. In order to support primary care reforms in complex institutional fields, this study proposes that decision-makers undertake a journey in which they recognize both the need to capitalize on existing meaningful and legitimated organizational identities, as well as the necessity for collective leadership in the management of multiple organizational identities over time.

Documenting the Engineering Design Process

ERIC Educational Resources Information Center

Hollers, Brent

2017-01-01

Documentation of ideas and the engineering design process is a critical, daily component of a professional engineer's job. While patent protection is often cited as the primary rationale for documentation, it can also benefit the engineer, the team, company, and stakeholders through creating a more rigorously designed and purposeful solution.…

28 CFR 79.56 - Proof of primary renal cancer.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Proof of primary renal cancer. 79.56... cancer. (a) In determining whether a claimant developed primary renal cancer following pertinent... conclusion that a claimant developed primary renal cancer must be supported by medical documentation. In all...

28 CFR 79.45 - Proof of primary lung cancer.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Proof of primary lung cancer. 79.45... cancer. (a) In determining whether a claimant developed primary lung cancer following pertinent... conclusion that a claimant developed primary lung cancer must be supported by medical documentation. To prove...

28 CFR 79.54 - Proof of primary lung cancer.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Proof of primary lung cancer. 79.54... cancer. (a) In determining whether a claimant developed primary lung cancer following pertinent... conclusion that a claimant developed primary lung cancer must be supported by medical documentation. To prove...

28 CFR 79.54 - Proof of primary lung cancer.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Proof of primary lung cancer. 79.54... cancer. (a) In determining whether a claimant developed primary lung cancer following pertinent... conclusion that a claimant developed primary lung cancer must be supported by medical documentation. To prove...

28 CFR 79.45 - Proof of primary lung cancer.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Proof of primary lung cancer. 79.45... cancer. (a) In determining whether a claimant developed primary lung cancer following pertinent... conclusion that a claimant developed primary lung cancer must be supported by medical documentation. To prove...

28 CFR 79.56 - Proof of primary renal cancer.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Proof of primary renal cancer. 79.56... cancer. (a) In determining whether a claimant developed primary renal cancer following pertinent... conclusion that a claimant developed primary renal cancer must be supported by medical documentation. In all...

28 CFR 79.45 - Proof of primary lung cancer.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Proof of primary lung cancer. 79.45... cancer. (a) In determining whether a claimant developed primary lung cancer following pertinent... conclusion that a claimant developed primary lung cancer must be supported by medical documentation. To prove...

28 CFR 79.45 - Proof of primary lung cancer.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Proof of primary lung cancer. 79.45... cancer. (a) In determining whether a claimant developed primary lung cancer following pertinent... conclusion that a claimant developed primary lung cancer must be supported by medical documentation. To prove...

28 CFR 79.54 - Proof of primary lung cancer.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Proof of primary lung cancer. 79.54... cancer. (a) In determining whether a claimant developed primary lung cancer following pertinent... conclusion that a claimant developed primary lung cancer must be supported by medical documentation. To prove...

28 CFR 79.56 - Proof of primary renal cancer.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Proof of primary renal cancer. 79.56... cancer. (a) In determining whether a claimant developed primary renal cancer following pertinent... conclusion that a claimant developed primary renal cancer must be supported by medical documentation. In all...

28 CFR 79.54 - Proof of primary lung cancer.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Proof of primary lung cancer. 79.54... cancer. (a) In determining whether a claimant developed primary lung cancer following pertinent... conclusion that a claimant developed primary lung cancer must be supported by medical documentation. To prove...

28 CFR 79.45 - Proof of primary lung cancer.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Proof of primary lung cancer. 79.45... cancer. (a) In determining whether a claimant developed primary lung cancer following pertinent... conclusion that a claimant developed primary lung cancer must be supported by medical documentation. To prove...

28 CFR 79.56 - Proof of primary renal cancer.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Proof of primary renal cancer. 79.56... cancer. (a) In determining whether a claimant developed primary renal cancer following pertinent... conclusion that a claimant developed primary renal cancer must be supported by medical documentation. In all...

28 CFR 79.54 - Proof of primary lung cancer.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Proof of primary lung cancer. 79.54... cancer. (a) In determining whether a claimant developed primary lung cancer following pertinent... conclusion that a claimant developed primary lung cancer must be supported by medical documentation. To prove...

28 CFR 79.56 - Proof of primary renal cancer.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Proof of primary renal cancer. 79.56... cancer. (a) In determining whether a claimant developed primary renal cancer following pertinent... conclusion that a claimant developed primary renal cancer must be supported by medical documentation. In all...

Catalog of War Games

DTIC Science & Technology

1992-10-09

PROGRAM CATALOG OF WAR GAMES 92-30805 U *3fl91\\k~o 9 2 SECURITY CLASSIFICATION OF THIS PAGE I ,i REPORT DOCUMENTATION PAGE la. REPORT SECURITY...4401 Ford Ave ELEMENT NO. NO. NO. ACCESSION NO. AIyxndriA. VA 229i2-14O1 --. 11. TITLE (Include Security Classification) Catalog of War Games 12...SCURITY CLASSIFICATiON OF THIS PAGE DECLARATION OF ACCORD 1. PURPOSE This catalog provides information on the primary war games , combat simulations

The Catastrophe of Uninsured and Underinsured Americans: In Search of a U.S. Health Plan. Hearing before the Select Committee on Aging. House of Representatives, Ninety-Ninth Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Select Committee on Aging.

This document presents witnesses' testimonies from a Congressional hearing called to examine the health care access problems of the large number of Americans without health insurance and those suffering from underinsurance or inadequate coverage of primary acute or long-term care. Opening statements are included from Representatives Edward Roybal,…

Executive summary of the consensus document on post-exposure prophylaxis against HIV, HBV and HCV in adults and children.

PubMed

Polo Rodriguez, Rosa; Lozano, Fernando; González de Castro, Pedro; Jiménez, Ma Alonso; Miró, Oscar; Ramón Blanco, Jose; Moreno, David; Dueñas, Carlos; Muñoz Platón, Enriqueta; Fernández Escribano, Marina; Sanz Sanz, Jesús; Fumaz, Carmina; Santos, Ignacio; García, Federico; Téllez, Ma Jesús; González Montero, Raúl; Vals Jimenez, Ma Victoria; Losa, Juan Emilio; Valle Robles, Ma Luisa; Iribarren, Jose Antonio; Ortega, Enrique

2016-02-01

Post-exposure prophylaxis (PEP) can be a secondary measure to prevent infection by human immunodeficiency virus (HIV) when primary prevention has failed. PEP is advised for people with sporadic and exceptional risk exposure to HIV. This consensus document about occupational and non-occupational PEP recommendations aims to be a technical document for healthcare professionals. Its main objective is to facilitate the appropriate use of PEP. To this end, some recommendations have been established to assess the risk of transmission in different types of exposure, situations where PEP should be recommended, special circumstances to take into account, antiretroviral (ARV) guidelines including start and end of the treatment, early monitoring of tolerance and adherence to the treatment, subsequent monitoring of people exposed, independently of having received PEP or not, and need of psychological support. This document is intended for all professionals who work in clinical practice in the field of HIV infection. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Program and Project Management Framework

NASA Technical Reports Server (NTRS)

Butler, Cassandra D.

2002-01-01

The primary objective of this project was to develop a framework and system architecture for integrating program and project management tools that may be applied consistently throughout Kennedy Space Center (KSC) to optimize planning, cost estimating, risk management, and project control. Project management methodology used in building interactive systems to accommodate the needs of the project managers is applied as a key component in assessing the usefulness and applicability of the framework and tools developed. Research for the project included investigation and analysis of industrial practices, KSC standards, policies, and techniques, Systems Management Office (SMO) personnel, and other documented experiences of project management experts. In addition, this project documents best practices derived from the literature as well as new or developing project management models, practices, and techniques.

Advanced Transport Operating System (ATOPS) color displays software description microprocessor system

NASA Technical Reports Server (NTRS)

Slominski, Christopher J.; Plyler, Valerie E.; Dickson, Richard W.

1992-01-01

This document describes the software created for the Sperry Microprocessor Color Display System used for the Advanced Transport Operating Systems (ATOPS) project on the Transport Systems Research Vehicle (TSRV). The software delivery known as the 'baseline display system', is the one described in this document. Throughout this publication, module descriptions are presented in a standardized format which contains module purpose, calling sequence, detailed description, and global references. The global reference section includes procedures and common variables referenced by a particular module. The system described supports the Research Flight Deck (RFD) of the TSRV. The RFD contains eight cathode ray tubes (CRTs) which depict a Primary Flight Display, Navigation Display, System Warning Display, Takeoff Performance Monitoring System Display, and Engine Display.

Comparing Help-Seeking Behavior of Male and Female Survivors of Sexual Assault: A Content Analysis of a Hotline.

PubMed

Young, Stephen M; Pruett, Jana A; Colvin, Marianna L

2018-06-01

This content analysis examines written documentation of telephone calls to a regional sexual assault hotline over a 5-year period. All male callers identified as primary victims were selected for analysis ( n = 58) and a corresponding sample of female primary victims ( n = 58) were randomly selected for comparison to better understand the help-seeking behavior of sexual assault survivors and inform services accordingly. A summative content analysis revealed significant contrasting themes between male and female victims, including females significantly receiving more referrals and males accessing the hotline to tell their experience of being sexually assaulted due to perceived limited support. Implications for training, practice, and future research are discussed.

Evaluation of coated columbium alloy heat shields for space shuttle thermal protection system application. Volume 3, phase 3: Full size TPS evaluation

NASA Technical Reports Server (NTRS)

Baer, J. W.; Black, W. E.

1974-01-01

The thermal protection system (TPS), designed for incorporation with space shuttle orbiter systems, consists of one primary heat shield thermally and structurally isolated from the test fixture by eight peripheral guard panels, all encompassing an area of approximately 12 sq ft. TPS components include tee-stiffened Cb 752/R-512E heat shields, bi-metallic support posts, panel retainers, and high temperature insulation blankets. The vehicle primary structure was simulated by a titanium skin, frames, and stiffeners. Test procedures, manufacturing processes, and methods of analysis are fully documented. For Vol. 1, see N72-30948; for Vol. 2, see N74-15660.

Research needs for an improved primary care response to chronic non-communicable diseases in Africa.

PubMed

Maher, D; Sekajugo, J; Harries, A D; Grosskurth, H

2010-02-01

With non-communicable diseases (NCDs) projected to become leading causes of morbidity and mortality in developing countries, research is needed to improve the primary care response, especially in sub-Saharan Africa. This region has a particularly high double burden of communicable diseases and NCDs and the least resources for an effective response. There is a lack of good quality epidemiological data from diverse settings on chronic NCD burden in sub-Saharan Africa, and the approach to primary care of people with chronic NCDs is currently often unstructured. The main primary care research needs are therefore firstly, epidemiological research to document the burden of chronic NCDs, and secondly, health system research to deliver the structured, programmatic, public health approach that has been proposed for the primary care of people with chronic NCDs. Documentation of the burden and trends of chronic NCDs and associated risk factors in different settings and different population groups is needed to enable health system planning for an improved primary care response. Key research issues in implementing the programmatic framework for an improved primary care response are how to (i) integrate screening and prevention within health delivery; (ii) validate the use of standard diagnostic protocols for NCD case-finding among patients presenting to the local health facilities; (iii) improve the procurement and provision of standardised treatment and (iv) develop and implement a data collection system for standardised monitoring and evaluation of patient outcomes. Important research considerations include the following: selection of research sites and the particular NCDs targeted; research methodology; local research capacity; research collaborations; ethical issues; translating research findings into policy and practice and funding. Meeting the research needs for an improved health system response is crucial to deliver effective, affordable and equitable care for the millions of people with chronic NCDs in developing countries in Africa.

Utilizing Primary Sources as Building Blocks for Literacy.

ERIC Educational Resources Information Center

Massich, Mary; Munoz, Eric

1996-01-01

Describes instructional strategies using primary sources in middle school history instruction. Maintains that students need to make critical, personal connections to material before they understand it. The strategies examined use visual aids, living history presentations, realia, music, and primary documents. (MJP)

Key articles and guidelines in the management of pulmonary arterial hypertension: 2011 update.

PubMed

Johnson, Samuel G; Kayser, Steven R; Attridge, Rebecca L; Duvall, Laura; Kiser, Tyree H; Moote, Rebecca; Reed, Brent N; Rodgers, Jo E; Erstad, Brian

2012-06-01

Pharmacotherapeutic approaches for the management of pulmonary arterial hypertension (PAH) have expanded greatly in the last 10 years. Pulmonary arterial hypertension is a relatively rare disease and is associated with myriad disease processes. The older term for PAH, primary PAH, has been changed to represent these differences and to distinguish it from postcapillary PAH associated with left-sided heart failure. Limitations in evaluating treatment approaches for PAH include its rarity, the small number of patients included in clinical trials, and issues regarding the use of placebo-controlled trials in a disease with such a high mortality rate if left untreated. Management options include the use of prostacyclin and prostacyclin analogues, endothelin receptor antagonists, and phosphodiesterase inhibitors, as well as traditional background therapy with diuretics, digoxin, calcium channel blockers, and warfarin. Numerous drugs are under investigation to evaluate their possible roles in management. Combination therapy is increasingly becoming a standard approach to therapy, with mounting literature to document effectiveness. Current or emerging roles for the pharmacist in the management of PAH largely involves ensuring access to drug therapy, facilitating specialty pharmacy dispensing, and providing patient counseling. Newer roles may include future drug development, optimized use of investigational drugs, and specialized disease management programs. This compilation includes a series of articles identifying important literature in cardiovascular pharmacotherapy. This bibliography focuses on pharmacotherapeutic management of pulmonary arterial hypertension (PAH). Most of the cited works present the results of significant human clinical studies that have shaped the management of patients with PAH. Limited primary literature is available for some topics, so in addition, consensus documents prepared by expert panels are reviewed. This compilation may serve as a teaching tool, reference resource, or update of the literature for pharmacy clinicians, physicians, and students. © 2012 Pharmacotherapy Publications, Inc.

Dance Therapy: Focus on Dance VII.

ERIC Educational Resources Information Center

Mason, Kathleen Criddle, Ed.

This document is a collection of essays by various authors on the subject of dance therapy. Dance therapy, in the introduction of this document, is defined as a form of psychotherapy in which the therapist utilizes movement interaction as the primary means of accomplishing therapeutic goals. The document is divided into five parts: a)…

iDocument: How Smartphones and Tablets Are Changing Documentation in Preschool and Primary Classrooms

ERIC Educational Resources Information Center

Parnell, Will; Bartlett, Jackie

2012-01-01

With the increased prevalence of smartphones, laptops, tablet computers, and other digital technologies, knowledge about and familiarity with the educational uses for these devices is important for early childhood teachers documenting children's learning. Teachers can use smartphones every day to take photos, record video and audio, and make…

VET in Schools 2016: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2017

2017-01-01

This document covers the data terms used in the "VET in Schools 2016" summary publication. The primary purpose of this document is to assist users to understand the specific data terms. Terms that appear in the publication are listed in alphabetical order with the following information provided for each: (1) definition: a brief…

Apprentices and Trainees: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2017

2017-01-01

This document covers the data terms used in publications sourced from the National Apprentice and Trainee Collection and their associated data tables. The primary purpose of this document is to assist users of the publications to understand the specific data terms used within them. Terms are listed in alphabetical order with the following…

Students and Courses--Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2014

2014-01-01

This document covers the data terms used in publications sourced from the National VET Provider Collection and their associated data tables. The primary purpose of this document is to assist users of the publication to understand the specific data terms used within them. Terms that appear in the publications and data items are listed in…

Indigenous VET Research and Statistics: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

This document covers the data terms used in the "Indigenous Research and Statistics" resources. It covers information contained in the "Apprentices and Trainees June Quarter 2009 report," the "Students and Courses 2009" report and the "Student Outcomes 2009" report and their associated data tables. The primary purpose of this document is to assist…

Senior 4 Western Civilization: An Historical Review of Its Development. Interim Curriculum Document.

ERIC Educational Resources Information Center

Manitoba Dept. of Education and Training, Winnipeg. School Programs Div.

This guide complements the two other social studies documents at the Senior 4 level for the social studies curriculum sequence for schools in Manitoba, Canada. The primary focus of this document is to explore the impact made by significant historical developments, movements, and individuals that shaped and influenced Western Civilization…

Precise chronology of differentiation of developing human primary dentition.

PubMed

Hu, Xuefeng; Xu, Shan; Lin, Chensheng; Zhang, Lishan; Chen, YiPing; Zhang, Yanding

2014-02-01

While correlation of developmental stage with embryonic age of the human primary dentition has been well documented, the available information regarding the differentiation timing of the primary teeth was largely based on the observation of initial mineralization and varies significantly. In this study, we aimed to document precise differentiation timing of the developing human primary dentition. We systematically examined the expression of odontogenic differentiation markers along with the formation of mineralized tissue in each developing maxillary and mandibular teeth from human embryos with well-defined embryonic age. We show that, despite that all primary teeth initiate development at the same time, odontogenic differentiation begins in the maxillary incisors at the 15th week and in the mandibular incisors at the 16th week of gestation, followed by the canine, the first primary premolar, and the second primary premolar at a week interval sequentially. Despite that the mandibular primary incisors erupt earlier than the maxillary incisors, this distal to proximal sequential differentiation of the human primary dentition coincides in general with the sequence of tooth eruption. Our results provide an accurate chronology of odontogenic differentiation of the developing human primary dentition, which could be used as reference for future studies of human tooth development.

Risk factors for development of primary bladder squamous cell carcinoma

PubMed Central

Hubbard, R; Swallow, D; Finch, W; Wood, SJ; Biers, SM

2017-01-01

INTRODUCTION The aim of this study was to investigate the prevalence of risk factors for primary squamous cell carcinoma (SCC) of the bladder. MATERIALS A total of 90 cases of primary SCC of the bladder were identified through multicentre analysis. Patient demographics, stage and grade of cancer at presentation, management and outcomes were recorded. The presence of known risk factors (catheter use, neuropathic bladder, smoking history, recurrent urinary tract infection and bladder stones) was also documented. RESULTS Over half of the patients had at least one identifiable risk factor for the development of primary bladder SCC: 13.9% of patients had a history of catheter use (clean intermittent self-catheterisation [CISC] in 11.1%), 10.0% of patients had a neuropathic bladder, 27.8% were smokers or ex-smokers and 20.0% had a documented history of recurrent urinary tract infection. Statistical analysis of the results showed no association between risk factors and grade of tumour at presentation. CONCLUSIONS These data further support the association between primary bladder SCC and several of the well documented risk factors for its development. Chronic use of CISC may confer a greater risk for development of SCC than thought previously. Further evidence of the role of CISC in primary SCC is required to justify routine screening and to determine exactly when surveillance of the bladder should begin for this group of patients. PMID:27869492

78 FR 53237 - Airworthiness Directives; Airbus Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-29

... control secondary computers (FCSCs), rather than flight control primary computers (FCPCs). This document... control primary computers (FCPCs); modifying two flight control secondary computers (FCSCs); revising the... the AD, which specify FCSCs, instead of flight control primary computers FCPCs. No other part of the...

A Summary of Numerous Strain-Gage Load Calibrations on Aircraft Wings and Tails in a Technological Format

NASA Technical Reports Server (NTRS)

Jenkins, Jerald M.; DeAngelis, V. Michael

1997-01-01

Fifteen aircraft structures that were calibrated for flight loads using strain gages are examined. The primary purpose of this paper is to document important examples of load calibrations on airplanes during the past four decades. The emphasis is placed on studying the physical procedures of calibrating strain-gaged structures and all the supporting analyses and computational techniques that have been used. The results and experiences obtained from actual data from 14 structures (on 13 airplanes and 1 laboratory test structure) are presented. This group of structures includes fins, tails, and wings with a wide variety of aspect ratios. Straight- wing, swept-wing, and delta-wing configurations are studied. Some of the structures have skin-dominant construction; others are spar-dominant. Anisotropic materials, heat shields, corrugated components, nonorthogonal primary structures, and truss-type structures are particular characteristics that are included.

Protocol for a nationwide survey of primary health care in China: the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) MPP (Million Persons Project) Primary Health Care Survey

PubMed Central

Su, Meng; Zhang, Qiuli; Lu, Jiapeng; Li, Xi; Tian, Na; Wang, Yun; Yip, Winnie; Cheng, Kar Keung; Mensah, George A; Horwitz, Ralph I; Mossialos, Elias; Krumholz, Harlan M; Jiang, Lixin

2017-01-01

Introduction China has pioneered advances in primary health care (PHC) and public health for a large and diverse population. To date, the current state of PHC in China has not been subjected to systematic assessments. Understanding variations in primary care services could generate opportunities for improving the structure and function of PHC. Methods and analysis This paper describes a nationwide PHC study (PEACE MPP Primary Health Care Survey) conducted across 31 provinces in China. The study leverages an ongoing research project, the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project (MPP). It employs an observational design with document acquisition and abstraction and in-person interviews. The study will collect data and original documents on the structure and financing of PHC institutions and the adequacy of the essential medicines programme; the education, training and retention of the PHC workforce; the quality of care; and patient satisfaction with care. The study will provide a comprehensive assessment of current PHC services and help determine gaps in access and quality of care. All study instruments and documents will be deposited in the Document Bank as an open-access source for other researchers. Ethics and dissemination The central ethics committee at the China National Centre for Cardiovascular Disease (NCCD) approved the study. Written informed consent has been obtained from all patients. Findings will be disseminated in future peer reviewed papers, and will inform strategies aimed at improving the PHC in China. Trial registration number NCT02953926 PMID:28851781

Integrated palliative care in the Spanish context: a systematic review of the literature.

PubMed

Garralda, Eduardo; Hasselaar, Jeroen; Carrasco, José Miguel; Van Beek, Karen; Siouta, Naouma; Csikos, Agnes; Menten, Johan; Centeno, Carlos

2016-05-13

Integrated palliative care (IPC) involves bringing together administrative, organisational, clinical and service aspects in order to achieve continuity of care between all actors involved in the care network of patients receiving palliative care (PC) services. The purpose of this study is to identify literature on IPC in the Spanish context, either in cancer or other advanced chronic diseases. Systematic review of the literature about IPC published in Spain between 1995 and 2013. Sources searched included PubMed, Cochrane Library, Cinahl, the national palliative care Journal (Medicina Paliativa), and Google. Evidence on IPC in care models, pathways, guidelines and other relevant documents were searched. Additionally, data were included from expert sources. Elements of IPC were considered based on the definition of IPC and the Emmanuel´s IPC tool. The main inclusion criterion was a comprehensive description of PC integration. Out of a total of 2,416 titles screened, 49 were included. We found two models describing IPC interventions achieving continuity and appropriateness of care as a result, 12 guidelines or pathways (most of them with a general approach including cancer and non-cancer and showing a theoretical IPC inclusion as measured by Emmanuel's tool) and 35 other significant documents as for their context relevance (17 health strategy documents, 14 analytical studies and 4 descriptive documents). These last documents comprised respectively: regional and national plans with an IPC inclusion evidence, studies focused on IPC into primary care and resource utilisation; and descriptions of fruitful collaboration programmes between PC teams and oncology departments. The results show that explications of IPC in the Spanish literature exist, but that there is insufficient evidence of its impact in clinical practice. This review may be of interest for Spanish-speaking countries and for others seeking to know the status of IPC in the literature in their home nations.

Data documentation for the bare soil experiment at the University of Arkansas, June - August 1980

NASA Technical Reports Server (NTRS)

Sadeghi, A. M.

1984-01-01

The primary objective of this study is to evaluate the relationships between soil moisture and reflectivity of a bare soil, using microwave techniques. A drainage experiment was conducted on a Captina silt loam in cooperation with personnel in the Electrical Engineering Department. Measurements included soil moisture pressures at various depths, neutron probe measurements, gravimetric moisture samples, and reflectivity of the soil surface at selected frequencies including 1.5 and 6.0 GHz and at the incident angle of 45 deg. All measurements were made in conjuction with that of reflectivity data.

Information system support as a critical success factor for chronic disease management: Necessary but not sufficient.

PubMed

Green, Carolyn J; Fortin, Patricia; Maclure, Malcolm; Macgregor, Art; Robinson, Sylvia

2006-12-01

Improvement of chronic disease management in primary care entails monitoring indicators of quality over time and across patients and practices. Informatics tools are needed, yet implementing them remains challenging. To identify critical success factors enabling the translation of clinical and operational knowledge about effective and efficient chronic care management into primary care practice. A prospective case study of positive deviants using key informant interviews, process observation, and document review. A chronic disease management (CDM) collaborative of primary care physicians with documented improvement in adherence to clinical practice guidelines using a web-based patient registry system with CDM guideline-based flow sheet. Thirty community-based physician participants using predominantly paper records, plus a project management team including the physician lead, project manager, evaluator and support team. A critical success factor (CSF) analysis of necessary and sufficient pathways to the translation of knowledge into clinical practice. A web-based CDM 'toolkit' was found to be a direct CSF that allowed this group of physicians to improve their practice by tracking patient care processes using evidence-based clinical practice guideline-based flow sheets. Moreover, the information and communication technology 'factor' was sufficient for success only as part of a set of seven direct CSF components including: health delivery system enhancements, organizational partnerships, funding mechanisms, project management, practice models, and formal knowledge translation practices. Indirect factors that orchestrated success through the direct factor components were also identified. A central insight of this analysis is that a comprehensive quality improvement model was the CSF that drew this set of factors into a functional framework for successful knowledge translation. In complex primary care settings environment where physicians have low adoption rates of electronic tools to support the care of patients with chronic conditions, successful implementation may require a set of interrelated system and technology factors.

Bibliography on aerodynamics of airframe/engine integration of high-speed turbine-powered aircraft, volume 1

NASA Technical Reports Server (NTRS)

Nichols, M. R.

1980-01-01

This bibliography was developed as a first step in the preparation of a monograph on the subject of the aerodynamics of airframe/engine integration of high speed turbine powered aircraft. It lists 1535 unclassified documents published mainly in the period from 1955 to 1980. Primary emphasis was devoted to aerodynamic problems and interferences encountered in the integration process; however, extensive coverage also was given to the characteristics and problems of the isolated propulsion system elements. A detailed topic breakdown structure is used. The primary contents of the individual documents are indicated by the combination of the document's title and its location within the framework of the bibliography.

Laron syndrome (primary growth hormone insensitivity): a unique model to explore the effect of insulin-like growth factor 1 deficiency on human hair.

PubMed

Lurie, R; Ben-Amitai, D; Laron, Z

2004-01-01

Classical Laron syndrome is a recessive disease of primary insulin-like growth factor 1 (IGF-1) deficiency and primary growth hormone insensitivity. Affected children have, among other defects, sparse hair growth and frontal recessions. The hair is thin and easy to pluck. Young adults have various degrees of alopecia, more pronounced in males. The aim of the present study was to investigate the effect of primary IGF-1 deficiency on hair structure. The study sample included 11 patients with Laron syndrome--5 children (2 untreated) and 6 adults (5 untreated). Hairs were examined by light and electron microscopy. The most significant structured defect, pili torti et canaliculi, was found in 2 young, untreated patients. Grooving, tapered hair and trichorrhexis nodosa were found in the remainder. IGF-1-treated patients had either none or significantly fewer pathological changes compared to the untreated patients. This is the first documentation of the role of primary IGF-1 deficiency on hair structure in human beings. Copyright 2004 S. Karger AG, Basel

Fragrance material review on benzyl alcohol.

PubMed

Scognamiglio, J; Jones, L; Vitale, D; Letizia, C S; Api, A M

2012-09-01

A toxicologic and dermatologic review of benzyl alcohol when used as a fragrance ingredient is presented. Benzyl alcohol is a member of the fragrance structural group Aryl Alkyl Alcohols and is a primary alcohol. The AAAs are a structurally diverse class of fragrance ingredients that includes primary, secondary, and tertiary alkyl alcohols covalently bonded to an aryl (Ar) group, which may be either a substituted or unsubstituted benzene ring. The common structural element for the AAA fragrance ingredients is an alcohol group -C-(R1)(R2)OH and generically the AAA fragrances can be represented as an Ar-C-(R1)(R2)OH or Ar-Alkyl-C-(R1)(R2)OH group. This review contains a detailed summary of all available toxicology and dermatology papers related to this individual fragrance ingredient and is not intended as a stand-alone document. Available data for benzyl alcohol were evaluated then summarized and includes physical properties, acute toxicity, skin irritation, mucous membrane (eye) irritation, skin sensitization, elicitation, phototoxicity, photoallergy, toxicokinetics, repeated dose, reproductive toxicity, genotoxicity, and carcinogenicity data. A safety assessment of the entire Aryl Alkyl Alcohols will be published simultaneously with this document; please refer to Belsito et al. (2012) for an overall assessment of the safe use of this material and all Aryl Alkyl Alcohols in fragrances. Copyright © 2011 Elsevier Ltd. All rights reserved.

Surface Water Treatment Rules State Implementation Guidance

EPA Pesticide Factsheets

These documents provide guidance to states, tribes and U.S. EPA Regions exercising primary enforcement responsibility under the Safe Drinking Water Act. The documents contain EPA’s recommendations for implementation of the Surface Water Treatment Rules.

39 CFR 3050.2 - Documentation of periodic reports.

Code of Federal Regulations, 2010 CFR

2010-07-01

... traced back to public documents or to primary data sources; and (3) Be submitted in a form, and be... Postal Service shall identify any input data that have changed, list any quantification techniques that...

HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil’s Unified Health System

PubMed Central

Rahman, Rahbel; Pinto, Rogério M.; Wall, Melanie M.

2017-01-01

Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil’s Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs—confidence, perseverance, knowledge, and skills. PMID:28335444

Naturally induced humoral immunity to West Nile virus infection in raptors.

PubMed

Nemeth, Nicole M; Kratz, Gail E; Bates, Rebecca; Scherpelz, Judy A; Bowen, Richard A; Komar, Nicholas

2008-09-01

West Nile virus (WNV) infection can be fatal to many bird species, including numerous raptors, though population- and ecosystem-level impacts following introduction of the virus to North America have been difficult to document. Raptors occupy a diverse array of habitats worldwide and are important to ecosystems for their role as opportunistic predators. We documented initial (primary) WNV infection and then regularly measured WNV-specific neutralizing antibody titers in 16 resident raptors of seven species, plus one turkey vulture. Most individuals were initially infected and seroconverted between July and September of 2003, though three birds remained seronegative until summer 2006. Many of these birds became clinically ill upon primary infection, with clinical signs ranging from loss of appetite to moderate neurological disease. Naturally induced WNV neutralizing antibody titers remained essentially unchanged in some birds, while eight individuals experienced secondary rises in titer presumably due to additional exposures at 1, 2, or 3 years following primary infection. No birds experienced clinical signs surrounding or following the time of secondary exposure, and therefore antibodies were considered protective. Results of this study have implications for transmission dynamics of WNV and health of raptor populations, as well as the interpretation of serologic data from free-ranging and captive birds. Antibodies in raptors surviving WNV may persist for multiple years and protect against potential adverse effects of subsequent exposures.

HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil's Unified Health System.

PubMed

Rahman, Rahbel; Pinto, Rogério M; Wall, Melanie M

2017-03-14

Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil's Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs-confidence, perseverance, knowledge, and skills.

Orbitofacial Metastatic Basal Cell Carcinoma: Report of 10 Cases.

PubMed

Branson, Sara V; McClintic, Elysa; Ozgur, Omar; Esmaeli, Bita; Yeatts, R Patrick

To explore the clinical features, management, and prognosis of metastatic basal cell carcinoma originating in the orbitofacial region. Ten cases of orbitofacial metastatic basal cell carcinoma were identified by searching databases at 2 institutions from 1995 to 2015. A retrospective chart review was performed. Main outcome measures included patient demographics, lesion size, location of metastases, histologic subtype, recurrence rate, time between primary tumor diagnosis and metastasis, perineural invasion, treatment modalities, and survival from time of metastasis. The median tumor size at largest dimension was 3.3 cm (range, 1.9-11.5 cm), and 6 of 10 patients had at least 1 local recurrence before metastasis (range, 0-2 recurrences). The most common sites of metastasis included the ipsilateral parotid gland (n = 6) and cervical lymph nodes (n = 5). Histologic subtypes included infiltrative (n = 5), basosquamous (n = 2), nodular (n = 1), and mixed (n = 1). The median time from primary tumor diagnosis to metastasis was 7.5 years (range, 0-13). The median survival time from diagnosis of metastasis to last documented encounter or death was 5.3 years (range, 7 months-22.8 years). Treatment regimens included surgical excision, radiotherapy, and hedgehog inhibitors. Based on our findings, the following features may be markers of high risk orbitofacial basal cell carcinoma: 1) increasing tumor size, 2) local recurrence of the primary tumor, 3) aggressive histologic subtype, and 4) perineural invasion. Screening should include close observation of the primary site and tissues in the distribution of regional lymphatics, particularly the parotid gland and cervical lymph nodes.

Metals and Disease: A Global Primary Health Care Perspective

PubMed Central

Mamtani, Ravinder; Stern, Penny; Dawood, Ismail; Cheema, Sohaila

2011-01-01

Metals are an important and essential part of our daily lives. Their ubiquitous presence and use has not been without significant consequences. Both industrial and nonindustrial exposures to metals are characterized by a variety of acute and chronic ailments. Underreporting of illnesses related to occupational and environmental exposures to chemicals including metals is of concern and presents a serious challenge. Many primary care workers rarely consider occupational and environmental exposures to chemicals in their clinical evaluation. Their knowledge and training in the evaluation of health problems related to such exposures is inadequate. This paper presents documented research findings from various studies that have examined the relationship between metal exposures and their adverse health effects both in developing and developed countries. Further, it provides some guidance on essential elements of a basic occupational and environmental evaluation to health care workers in primary care situations. PMID:22007209

[Connections among nursing, nutrition and social work, pioneering female careers in the healthcare area].

PubMed

Aperibense, Pacita Geovana Gama de Sousa; Barreira, Ieda de Alencar

2008-09-01

This is a historical-social research about the emergence of the nutrition and social work professions between the 1930's and the mid 20th century. This study analyzes the circumstances involved in the beginning of both courses, nutrition and social work, at Anna Nery School/FURJ and compares the work developed by nurses, nutritionists, and social workers at the time. The primary research sources are found at School of Nursing Anna Nery Archives Center/FURJ and among other documents they include written documents and oral speeches. The secondary sources were articles, books, and theses. The analyses of these texts and documents showed that the school played a decisive role in the emergence of these new professions, which contributed to a better organization and operation of health services and to a more complete care provision to the clients. At the same time, their feminine characteristics appeared to benefit the insertion of women in qualified work positions in the mental health area.

If you did not document it, it did not happen: rates of documentation of discussion of infertility risk in adolescent and young adult oncology patients' medical records.

PubMed

Quinn, Gwendolyn P; Block, Rebecca G; Clayman, Marla L; Kelvin, Joanne; Arvey, Sarah R; Lee, Ji-Hyun; Reinecke, Joyce; Sehovic, Ivana; Jacobsen, Paul B; Reed, Damon; Gonzalez, Luis; Vadaparampil, Susan T; Laronga, Christine; Lee, M Catherine; Pow-Sang, Julio; Eggly, Susan; Franklin, Anna; Shah, Bijal; Fulp, William J; Hayes-Lattin, Brandon

2015-03-01

The adolescent and young adult (AYA) population is underserved because of unique late-effect issues, particularly future fertility. This study sought to establish rates of documentation of discussion of risk of infertility, fertility preservation (FP) options, and referrals to fertility specialists in AYA patients' medical records at four cancer centers. All centers reviewed randomized records within the top four AYA disease sites (breast, leukemia/lymphoma, sarcoma, and testicular). Eligible records included those of patients: diagnosed in 2011, with no prior receipt of gonadotoxic therapy; age 18 to 45 years; with no multiple primary cancers; and for whom record was not second opinion. Quality Oncology Practice Initiative methods were used to evaluate documentation of discussion of risk of infertility, discussion of FP options, and referral to a fertility specialist. Of 231 records, 26% documented infertility risk discussion, 24% documented FP option discussion, and 13% documented referral to a fertility specialist. Records were less likely to contain evidence of infertility risk and FP option discussions for female patients (P = .030 and .004, respectively) and those with breast cancer (P = .021 and < .001, respectively). Records for Hispanic/Latino patients were less likely to contain evidence of infertility risk discussion (P = .037). Records were less likely to document infertility risk discussion, FP option discussion, and fertility specialist referral for patients age ≥ 40 years (P < .001, < .001, and .002, respectively) and those who already had children (all P < .001). The overall rate of documentation of discussion of FP is low, and results show disparities among specific groups. Although greater numbers of discussions may be occurring, there is a need to create interventions to improve documentation. Copyright © 2014 by American Society of Clinical Oncology.

The Nature of the Arguments for Creationism, Intelligent Design, and Evolution

ERIC Educational Resources Information Center

Barnes, Ralph M.; Church, Rebecca A.; Draznin-Nagy, Samuel

2017-01-01

Seventy-two Internet documents promoting creationism, intelligent design (I.D.), or evolution were selected for analysis. The primary goal of each of the 72 documents was to present arguments for creationism, I.D., or evolution. We first identified all arguments in these documents. Each argument was then coded in terms of both argument type…

VET in Schools 2009: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

This document covers the data terms used in the "VET in Schools 2009" report. The primary purpose of this document is to assist users of the report to understand the specific data terms used within it. Terms that appear in the report are listed in alphabetical order with the following information provided for each: (1) Definition: a…

Apprentice and Trainee Destinations 2010: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

This document covers the data terms used in the "Apprentice and Trainee Destinations Survey, 2010" report and its associated data tables. The primary purpose of this document is to assist users of the report to understand the specific data terms used within it. Terms that appear in the report are listed in alphabetical order with the…

Apprentices and Trainees: Early Trend Estimates, December 2010: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2011

2011-01-01

This document covers the data terms used in the "Australian Vocational Education and Training Statistics: Apprentices and Trainees--Early Trend Estimates December 2010" publication. The primary purpose of this document is to assist users of the report to understand the specific data terms used within it. Terms that appear in the report…

Apprentices and Trainees: March Quarter 2010. Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

This document covers the data terms used in the "Apprentices and Trainees: March quarter 2010" publication and its associated data tables. The primary purpose of this document is to assist users of the publication to understand the specific data terms used within it. Terms that appear in the publication are listed in alphabetical order…

Students and Courses 2009: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

This document covers the data terms used in the "Students and Courses 2009" publication and its associated data tables. The primary purpose of this document is to assist users of the publication to understand the specific data terms used within it. Terms that appear in the publication are listed in alphabetical order with the following…

VET in Schools 2008: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

This document covers the data terms used in the "VET in Schools 2008" report. The primary purpose of this document is to assist users of the report to understand the specific data terms used within it. Terms that appear in the report are listed in alphabetical order with the following information provided for each: (1) Definition: a…

VET in Schools, 2007: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2009

2009-01-01

This document covers the data terms used in the "VET in Schools, 2007" report. The primary purpose of this document is to help users of the report understand the specific data terms used in it. Terms that appear in the report are listed in alphabetical order with the following information provided for each: (1) Definition: a brief…

VET in Schools, 2006: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2008

2008-01-01

This document covers the data terms used in the "VET in Schools, 2006" report. The primary purpose of this document is to help users understand the specific data terms used in the report. Terms that appear in the report are listed in alphabetical order with the following information provided for each: (1) Definition: a brief explanation…

Apprentices and Trainees: September Quarter 2010. Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2011

2011-01-01

This document covers the data terms used in the "Apprentices and Trainees: September Quarter 2010" publication and its associated data tables. The primary purpose of this document is to assist users of the publication to understand the specific data terms used within it. Terms that appear in the publication are listed in alphabetical…

Apprentices and Trainees: Annual, 2009. Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

This document covers the data terms used in the "Apprentices and trainees: Annual 2009" publication and its associated data tables. The primary purpose of this document is to assist users of the publication to understand the specific data terms used within it. Terms that appear in the publication are listed in alphabetical order with the…

A population management system for improving colorectal cancer screening in a primary care setting.

PubMed

Wu, Charlotte A; Mulder, Amara L; Zai, Adrian H; Hu, Yuanshan; Costa, Manuela; Tishler, Lori Wiviott; Saltzman, John R; Ellner, Andrew L; Bitton, Asaf

2016-06-01

Provision of colorectal cancer (CRC) screening in primary care is suboptimal; failure to observe screening guidelines poses unnecessary risks to patients and doctors. Implement a population management system for CRC screening; evaluate impact on compliance with evidence-based guidelines. A quasi-experimental, prospective quality improvement study design using pre-post-analyses with concurrent controls. Six suites within an academic primary care practice. 5320 adults eligible for CRC screening treated by 70 doctors. In three intervention suites, doctors reviewed real-time rosters of patients due for CRC screening and chose practice delegate outreach or default reminder letter. Delegates tracked overdue patients, made outreach calls, facilitated test ordering, obtained records and documented patient deferral, exclusion or decline. In three control suites, doctors followed usual preventive care practices. CRC screening compliance (including documented decline, deferral or exclusion) and CRC screening completion rates over 5 months. At baseline, there was no significant difference in CRC screening compliance (I: 80.4% and C: 79.6%, P = 0.439) and CRC screening completion rates (I: 78.3% and C: 77.3%, P = 0.398) between intervention and control groups. Post-intervention, compliance rates (I: 88.1% and C: 80.5%, P < 0.01) and completion rates (I: 81.0% and C: 78.1%, P < 0.05) were significantly higher in the intervention group. A population management system using closed-loop communication may improve CRC screening compliance and completion rates within academic primary care practices. Team-based care using well-designed IT systems can enable sharing of patient care responsibilities and improve patient outcomes. © 2015 John Wiley & Sons, Ltd.

[Consensus document for the detection and management of chronic kidney disease].

PubMed

Martínez-Castelao, Alberto; Górriz, José L; Bover, Jordi; Segura-de la Morena, Julián; Cebollada, Jesús; Escalada, Javier; Esmatjes, Enric; Fácila, Lorenzo; Gamarra, Javier; Gràcia, Silvia; Hernández-Moreno, Julio; Llisterri-Caro, José L; Mazón, Pilar; Montañés, Rosario; Morales-Olivas, Francisco; Muñoz-Torres, Manuel; de Pablos-Velasco, Pedro; de Santiago, Ana; Sánchez-Celaya, Marta; Suárez, Carmen; Tranche, Salvador

2014-01-01

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Stories and metaphors in the sensemaking of multiple primary health care organizational identities

PubMed Central

2014-01-01

Background The Quebec primary health care delivery system has experienced numerous reforms over the last 15 years. In this study, we sought to examine how managers and primary care providers made sense of the creation of successive new primary care organizational forms. Methods We conducted a longitudinal qualitative case study in a primary care practice group located in Montreal, Quebec, for over 6 years (2002 to 2008). The data sources for the study include 31 semi-structured interviews with key informants, in-situ observations of group meetings, as well as documents and field notes. Textual material was submitted to narrative and metaphor analysis. Results The core metaphor of the journey came from a set of stories in which the members of this primary care group depicted the processes undertaken towards developing a multidisciplinary cooperative practice, which include an uneasy departure, uncertainty about the destination, conflict among members who jump ship or stay on board, negotiations about the itinerary, and, finally, enduring challenges in leading the way and being pioneers of change in the organization of primary care in their institutional context. Identification with the initial family medicine unit identity was persistent over time, but successive reforms further enriched its meaning as it became a multidisciplinary primary care practice pioneering organizational change. Conclusions In order to support primary care reforms in complex institutional fields, this study proposes that decision-makers undertake a journey in which they recognize both the need to capitalize on existing meaningful and legitimated organizational identities, as well as the necessity for collective leadership in the management of multiple organizational identities over time. PMID:24588933

E-health: an overview of the uses of the Internet, social media, apps, and websites for mood disorders.

PubMed

Parikh, Sagar V; Huniewicz, Paulina

2015-01-01

The current article defines and surveys E-health: Internet and technology-guided interventions and tools useful for mood disorders. E-health encompasses many categories, including computerized self-help strategies, online psychotherapy, websites that provide information, social media approaches including Facebook, Internet forums for health discussions, personal blogs, and videogames. Multiple tools exist to assess and document symptoms, particularly mood charts. Although all of these approaches are popular, only online psychotherapy and videogames have actually been evaluated in studies to evaluate both validity and efficacy. The face validity of social communication strategies including social media and blogs is strong, with clear implications for stigma reduction and peer support. Informational websites continue to be primary sources of psychoeducation on mental disorders. Social media sites have widespread use by the public and a profusion of health discussions and tools, but without published research evaluation of efficacy. E-health strategies, particularly online psychotherapy and tools to document symptoms, are useful and likely effective. Social communication strategies show enormous popularity, but urgently require research evaluation for impact.

[A descriptive analysis of naratriptan use among migraineurs in ambulatory medicine].

PubMed

Brudon-Mollard, F; Druais, P-L; Giacomino, A; Hinault, P; Lanteri-Minet, M; Zaïm, M; Chemali-Hudry, J; El Hasnaoui, A

2003-05-01

The objective of this study was to provide an epidemiological description of naratriptan use in ambulatory medicine. 1695 patients were recruited by 384 primary care physicians and 111 neurologists, and followed for 12 weeks. Physicians had to document the migraine history, and to report symptoms and health care in a structured case report form. Patients were to document each episode of migraine (EM) in a diary. At baseline, 45 p.cent of the patients reported their migraine treatment as unsatisfactory. Ninety-eight percent of included patients were migraineurs according to criteria of the International Headache Society (IHS), including migrainous disorders. Ninety-two percent of naratriptan prescriptions were established in the second intention in patients with migraine, according to the IHS classification, including migrainous disorders. A total of 79 p.cent of patients had complied with the good practices for all EMs. More appropriate health education strategies should target the small group of patients who over-use naratriptan, and patients with aura. However, this study shows that naratriptan tends to be correctly prescribed by physicians, and used by patients with acute migraine.

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

Elvado Environmental LLC; Environmental Compliance Department Environment, Safety, and Health Division Y-12 National Security Complex

This document presents the Groundwater Protection Program (GWPP) management plan for the U.S. Department of Energy (DOE) Y-12 National Security Complex (hereafter referenced as Y-12). The Y-12 GWPP functions as the primary point-of-contact for groundwater-related issues at Y-12, provides stewardship of the extensive network of groundwater monitoring wells at Y-12, and serves as a resource for technical expertise, support, and historical data for groundwater-related activities at Y-12. These organizational functions each serve the primary programmatic purpose of the GWPP, which is to ensure that groundwater monitoring activities within areas under Y-12 administrative control provide representative data in compliance with themore » multiple purposes of applicable state and federal regulations, DOE orders, and the corporate policies of BWXT Y-12, L.L.C. (hereafter referenced as BWXT), the Y-12 management and operations (M&O) contractor for DOE. This GWPP management plan addresses the requirements of DOE Order 450.1 (BWXT Y12 S/RID) regarding the implementation of a site-wide approach for groundwater protection at each DOE facility. Additionally, this plan is a ''living'' document that is reviewed annually, revised and reissued every three years, and is formatted to provide for updating individual sections independent of the rest of the document. Section 2 includes a short description of the groundwater system at Y-12, the history of groundwater monitoring at Y-12 and the corresponding evolution of the GWPP, and an overview of ongoing Y-12 groundwater monitoring activities. Section 3 describes the key elements of the GWPP management strategy. Organizational roles and responsibilities of GWPP personnel are outlined in Section 4. Section 5 presents an overview of the GWPP project plans for applicable programmatic elements. Section 6 lists the reports, plans, and documents that are referenced for technical and administrative details.« less

Y-12 Groundwater Protection Program Groundwater Monitoring Data Compendium, Revision 1

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

None

This document is a compendium of water quality and hydrologic characterization data obtained through December 2005 from the network of groundwater monitoring wells and surface water sampling stations (including springs and building sumps) at the U.S. Department of Energy (DOE) Y-12 National Security Complex (Y-12) in Oak Ridge, Tennessee that have been sampled since January 2003. The primary objectives of this document, hereafter referenced as the Y-12 Groundwater Protection Program (GWPP) Compendium, are to: (1) Serve as a single-source reference for monitoring data that meet the requirements of the Y-12 GWPP, as defined in the Y-12 GWPP Management Plan (BWXTmore » Y-12 L.L.C. [BWXT] 2004); (2) Maintain a detailed analysis and evaluation of the monitoring data for each applicable well, spring, and surface water sampling station, with a focus on results for the primary inorganic, organic, and radiological contaminants in groundwater and surface water at Y-12; and (3) Ensure retention of ''institutional knowledge'' obtained over the long-term (>20-year) history of groundwater and surface water monitoring at Y-12 and the related sources of groundwater and surface water contamination. To achieve these goals, the Y-12 GWPP Compendium brings together salient hydrologic, geologic, geochemical, water-quality, and environmental compliance information that is otherwise disseminated throughout numerous technical documents and reports prepared in support of completed and ongoing environmental contamination assessment, remediation, and monitoring activities performed at Y-12. The following subsections provide background information regarding the overall scope and format of the Y-12 GWPP Compendium and the planned approach for distribution and revision (i.e., administration) of this ''living'' document.« less

Promoting competition in Swedish primary care.

PubMed

Norén, Lars; Ranerup, Agneta

2015-01-01

The purpose of this paper is to examine the role of accreditation documents (ADs) in the competition based on provider quality in a quasi-market for primary healthcare. The paper uses a mixed-method research methodology to analyse two primary healthcare ADs in two Swedish regions. In total, 19 interviews were conducted with actors involved in the creation and use of such documents. This paper points to the crucial role of ADs in the identification of quality differences that influence the competition in primary healthcare. This finding contrasts with the commonly held laissez-faire idea that competition causes providers to develop their own service concepts and where the invisible hand creates quality differences. The paper adds to the discussion with its detailed description of how ADs create competition among primary healthcare providers through selection processes, quality differentiation, and ranking. The paper does not explore quality differences in the medical treatment of patients in primary healthcare centres. The paper provides insights for politicians on how to use ADs to control competition and regulate choice. The paper takes an innovative approach to the examination of how ADs increase the competition in primary healthcare choice.

Integrated testing and verification system for research flight software design document

NASA Technical Reports Server (NTRS)

Taylor, R. N.; Merilatt, R. L.; Osterweil, L. J.

1979-01-01

The NASA Langley Research Center is developing the MUST (Multipurpose User-oriented Software Technology) program to cut the cost of producing research flight software through a system of software support tools. The HAL/S language is the primary subject of the design. Boeing Computer Services Company (BCS) has designed an integrated verification and testing capability as part of MUST. Documentation, verification and test options are provided with special attention on real time, multiprocessing issues. The needs of the entire software production cycle have been considered, with effective management and reduced lifecycle costs as foremost goals. Capabilities have been included in the design for static detection of data flow anomalies involving communicating concurrent processes. Some types of ill formed process synchronization and deadlock also are detected statically.

The Algorithm Theoretical Basis Document for the Derivation of Range and Range Distributions from Laser Pulse Waveform Analysis for Surface Elevations, Roughness, Slope, and Vegetation Heights

NASA Technical Reports Server (NTRS)

Brenner, Anita C.; Zwally, H. Jay; Bentley, Charles R.; Csatho, Bea M.; Harding, David J.; Hofton, Michelle A.; Minster, Jean-Bernard; Roberts, LeeAnne; Saba, Jack L.; Thomas, Robert H.;

Advanced Transport Operating System (ATOPS) color displays software description: MicroVAX system

NASA Technical Reports Server (NTRS)

Slominski, Christopher J.; Plyler, Valerie E.; Dickson, Richard W.

1992-01-01

This document describes the software created for the Display MicroVAX computer used for the Advanced Transport Operating Systems (ATOPS) project on the Transport Systems Research Vehicle (TSRV). The software delivery of February 27, 1991, known as the 'baseline display system', is the one described in this document. Throughout this publication, module descriptions are presented in a standardized format which contains module purpose, calling sequence, detailed description, and global references. The global references section includes subroutines, functions, and common variables referenced by a particular module. The system described supports the Research Flight Deck (RFD) of the TSRV. The RFD contains eight Cathode Ray Tubes (CRTs) which depict a Primary Flight Display, Navigation Display, System Warning Display, Takeoff Performance Monitoring System Display, and Engine Display.

From Policy to Practice: Implementation of Treatment for Substance Misuse in Québec Primary Healthcare Clinics

PubMed Central

Maynard, Serge; Campbell, Emily; Boodhoo, Katie; Gauthier, Gail; Xenocostas, Spyridoula; Charney, Dara A.

2015-01-01

Background and Objectives: In 2007, the Québec Ministry of Health issued a policy document that specifically mandated the development of addiction treatment services including screening, brief interventions and referral (SBIR) to be delivered by primary healthcare clinics throughout Québec. The current study examined the level of implementation of SBIR one year following the end of the mandate (2007–2012). Approach: Semi-structured interviews were conducted with 45 participants from 21 primary health and social service centres throughout the province. Qualitative analysis was used to evaluate the level of success each centre had in implementing SBIR and to identify organizational measures that contributed to successful implementation. Results: The results show that Québec primary health and social service centres had limited success in their efforts to integrate SBIR into their services. A comparative analysis of the centres, categorized according to their level of implementation, revealed the presence of significant organizational- and staff-level factors, including the creation of formal action plans that were conducive to the successful implementation of SBIR in primary care. Conclusion: The findings highlight the importance of offering support and guidance, as well as a menu of specific practices that are likely to assist primary health and social services centres to implement SBIR. At the organizational level, the adoption of local action plans and formal service trajectories offers a framework that allows for horizontal and vertical integration of new practices. PMID:26742118

From Policy to Practice: Implementation of Treatment for Substance Misuse in Québec Primary Healthcare Clinics.

PubMed

Maynard, Serge; Campbell, Emily; Boodhoo, Katie; Gauthier, Gail; Xenocostas, Spyridoula; Charney, Dara A; Gill, Kathryn

2015-11-01

In 2007, the Québec Ministry of Health issued a policy document that specifically mandated the development of addiction treatment services including screening, brief interventions and referral (SBIR) to be delivered by primary healthcare clinics throughout Québec. The current study examined the level of implementation of SBIR one year following the end of the mandate (2007-2012). Semi-structured interviews were conducted with 45 participants from 21 primary health and social service centres throughout the province. Qualitative analysis was used to evaluate the level of success each centre had in implementing SBIR and to identify organizational measures that contributed to successful implementation. The results show that Québec primary health and social service centres had limited success in their efforts to integrate SBIR into their services. A comparative analysis of the centres, categorized according to their level of implementation, revealed the presence of significant organizational- and staff-level factors, including the creation of formal action plans that were conducive to the successful implementation of SBIR in primary care. The findings highlight the importance of offering support and guidance, as well as a menu of specific practices that are likely to assist primary health and social services centres to implement SBIR. At the organizational level, the adoption of local action plans and formal service trajectories offers a framework that allows for horizontal and vertical integration of new practices. Copyright © 2015 Longwoods Publishing.

Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance.

PubMed

Huh, Warner K; Ault, Kevin A; Chelmow, David; Davey, Diane D; Goulart, Robert A; Garcia, Francisco A R; Kinney, Walter K; Massad, L Stewart; Mayeaux, Edward J; Saslow, Debbie; Schiffman, Mark; Wentzensen, Nicolas; Lawson, Herschel W; Einstein, Mark H

2015-02-01

In 2011, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology updated screening guidelines for the early detection of cervical cancer and its precursors. Recommended screening strategies were cytology and cotesting (cytology in combination with hrHPV testing). These guidelines also addressed the use of hrHPV testing alone as a primary screening approach, which was not recommended for use at that time. There is now a growing body of evidence for screening with primary hrHPV testing, including a prospective US-based registration study. Thirteen experts including representatives from the Society of Gynecologic Oncology, American Society for Colposcopy and Cervical Pathology, American College of Obstetricians and Gynecologists, American Cancer Society, American Society of Cytopathology, College of American Pathologists, and the American Society for Clinical Pathology, convened to provide interim guidance for primary hrHPV screening. This guidance panel was specifically triggered by an application to the FDA for a currently marketed HPV test to be labeled for the additional indication of primary cervical cancer screening. Guidance was based on literature review and review of data from the FDA registration study, supplemented by expert opinion. This document aims to provide information for healthcare providers who are interested in primary hrHPV testing and an overview of the potential advantages and disadvantages of this strategy for screening as well as to highlight areas in need of further investigation. Copyright © 2015 Elsevier Inc. All rights reserved.

Advance care planning and end-of-life care in a network of rural Western Australian hospitals.

PubMed

Auret, Kirsten; Sinclair, Craig; Averill, Barbara; Evans, Sharon

2015-08-01

To provide a current perspective on end-of-life (EOL) care in regional Western Australia, with a particular focus on the final admission prior to death and the presence of documented advance care planning (ACP). Retrospective medical notes audit. One regional hospital (including colocated hospice) and four small rural hospitals in the Great Southern region of Western Australia. Ninety recently deceased patients, who died in hospitals in the region. Fifty consecutive patients from the regional hospital and 10 consecutive patients from each of the four rural hospitals were included in the audit. A retrospective medical notes audit was undertaken. A 94-item audit tool assessed patient demographics, primary diagnosis, family support, status on admission and presence of documented ACP. Detailed items described the clinical care delivered during the final admission, including communication with family, referral to palliative care, transfers, medical investigations, medical treatments and use of EOL care pathways. Fifty-two per cent were women; median age was 82 years old. Forty per cent died of malignancy. Median length of stay was 7 days. Thirty-nine per cent had formal or informal ACP documented. Rural hospitals performed comparably with the regional hospital on all measures. This study provides benchmarking information that can assist other rural hospitals and suggests ongoing work on optimal methods of measuring quality in EOL care. © 2015 National Rural Health Alliance Inc.

Worldwide estimates and bibliography of net primary productivity derived from pre-1982 publications

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

Esser, G.; Lieth, H.F.H.; Scurlock, J.M.O.

An extensive compilation of more than 700 field estimates of net primary productivity of natural and agricultural ecosystems worldwide was synthesized in Germany in the 1970s and early 1980s. Although the Osnabrueck data set has not been updated since the 1980s, it represents a wealth of information for use in model development and validation. This report documents the development of this data set, its contents, and its recent availability on the Internet from the Oak Ridge National Laboratory Distributed Active Archive Center for Biogeochemical Dynamics. Caution is advised in using these data, which necessarily include assumptions and conversions that maymore » not be universally applicable to all sites.« less

Calibration and Vegetation Field Spectra Collection for the 2000 AVIRIS Hawaii Deployment

NASA Technical Reports Server (NTRS)

Dennison, Philip E.; Gardner, Margaret E.; Roberts, Dar A.; Green, Robert O.

2001-01-01

As part of the April 2000 Airborne Visible/Infrared Imaging Spectrometer (AVIRIS) Hawaii deployment, two researchers from the University of California, Santa Barbara, were sent to Hawaii to collect supporting field data. The primary goal of the fieldwork was to obtain spectra of bright targets to be used for retrieving surface reflectance from AVIRIS imagery. Secondary goals included recording the spectra of dominant vegetation, marking the position of homogeneous land cover for use as potential image endmembers (PIEs), and recording firsthand impressions of cover types. Primary and secondary goals were met. Spectra were recorded for 12 calibration targets on 5 islands and spectra were obtained for 61 vegetation species. Twenty PIEs were located, and video was used to document cover at 56 locations.

Best practice in primary care pathology: review 9

PubMed Central

Smellie, W S A; Shaw, N; Bowlees, R; Taylor, A; Howell‐Jones, R; McNulty, C A M

2007-01-01

This ninth best‐practice review examines two series of common primary care questions in laboratory medicine: (i) potassium abnormalities and (ii) venous leg ulcer microbiology. The review is presented in question‐and‐answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence‐based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence‐based. They will be updated periodically to take account of new information. PMID:17259298

Group B streptococcal arthritis in adults.

PubMed

Small, C B; Slater, L N; Lowy, F D; Small, R D; Salvati, E A; Casey, J I

1984-03-01

Group B streptococcal arthritis in adults is uncommon. This report describes seven cases seen at these institutions over the past five years and reviews the previous 17 documented cases. Of seven adults, three were diabetics, three had prosthetic hips, and one had undergone splenectomy. Six had undergone no prior dental, genitourinary, or gastrointestinal procedures. The most common clinical presentation was fever and acute joint pain. Five patients had monoarticular arthritis; two had multiple joint involvement. Underlying joint abnormalities included osteoarthritis (two), prosthetic hip (three), and neuropathic joint (one). Bacteremia was documented in three and suspected in the remaining four patients, often without a primary source. Therapy included parenteral antibiotics, usually penicillin G, and drainage of the involved joint. Two of three patients with prosthetic implants required Girdlestone procedures; the third was apparently cured. The three diabetic patients died, one with resolution of group B streptococcal arthritis. The seventh patient was cured. Group B streptococcal arthritis is a serious infection in adults with diabetes and late prosthetic hip infections.

The long and winding road: the journey taken by headache sufferers in search of help.

PubMed

Davies, Paul T G; Lane, Russell J M; Astbury, Theresa; Fontebasso, Manuela; Murphy, Jill; Matharu, Manjit

2018-05-31

AimTo outline the pathways a cohort of first attendees to our headache clinics had taken over the years in search of explanations and treatment for their headaches. To establish a greater awareness of the shortcomings and failures in their medical journey in the hope that better headache management will emerge in primary care. At first attendance in primary care most headache sufferers will not receive a firm diagnosis. Treatments provided are often ineffective and so many patients embark on a somewhat random self-made journey searching for a remedy. If they reach a Headache Clinic the most common diagnoses are 'chronic migraine' and 'medication overuse headache'. They are either no better or worse than when their headaches first started despite their efforts. We undertook a prospective questionnaire-based study of over 200 patients on first attendance at each of our headache clinics, three based in District General Hospitals and one in a tertiary referral centre. We documented the patients' headache characteristics, the 'burden' of their headaches, functional handicap and the financial costs incurred seeking help before referral. We also documented what our patients understood about their headache disorder and the treatments previously tried.FindingsMost patients had not been given a formal diagnosis in primary care and many remained unconvinced of the benign nature of their headache problem and wanted further investigations. A few had sought help from headache charities. Many had unrealistic attitudes to their problem and medication overuse was rife. A few patients had been offered triptans in primary care. Key deficiencies in the primary care management of these patients included failure to provide a formal headache diagnosis, inadequate understanding of the nature and mechanism of headaches and failure to follow a resilient management strategy. We provide a more effective management pathway in primary care.

Can we make sense of multidisciplinary co-operation in primary care by considering routines and rules?

PubMed

Elissen, Arianne M J; van Raak, Arno J A; Paulus, Aggie T G

2011-01-01

Although it is widely acknowledged that the complex health problems of chronically ill and elderly persons require care provision across organisational and professional boundaries, achieving widespread multidisciplinary co-operation in primary care has proven problematic. We developed an explanation for this on the basis of the concepts of routines (patterns of behaviour) and rules, which form a relatively new yet promising perspective for studying co-operation in health-care. We used data about primary care providers situated in the Dutch region of Limburg, a region that, despite high numbers of chronically and elderly persons, has traditionally few healthcare centres and where multidisciplinary co-operation is limited. A qualitative study design was used, in which interviews and documents were the main data sources. Semi-structured interviews were conducted with providers from six primary care professions in the Dutch region of Limburg; relevant documents included co-operation agreements, annual reports and internal memos. To analyse the evidence, several data matrices were developed and all data were structured according to the main concepts under study, i.e. routines and rules. Although more research is needed, our study suggests that the emergence of more extensive multidisciplinary co-operation in primary care is hampered by the organisational rules and regulations prevailing in the sector. By emphasising individual care delivery rather than co-operation, these rules stimulate the perseverance of diversity between the routines by which providers perform their solo care delivery activities, rather than the creation of the amount of compatibility between those routines that is necessary for the current, rather limited shape of multidisciplinary co-operation to expand. Further research should attempt to validate this explanation by utilising a larger research population and systematically operationalising the rules existing in the legal and--more importantly--organisational environment of primary care. © 2010 Blackwell Publishing Ltd.

Effect of an obesity best practice alert on physician documentation and referral practices.

PubMed

Fitzpatrick, Stephanie L; Dickins, Kirsten; Avery, Elizabeth; Ventrelle, Jennifer; Shultz, Aaron; Kishen, Ekta; Rothschild, Steven

2017-12-01

The Centers for Medicare & Medicaid Services Electronic Health Record Meaningful Use Incentive Program requires physicians to document body mass index (BMI) and a follow-up treatment plan for adult patients with BMI ≥ 25. To examine the effect of a best practice alert on physician documentation of obesity-related care and referrals to weight management treatment, in a cluster-randomized design, 14 primary care clinics at an academic medical center were randomized to best practice alert intervention (n = 7) or comparator (n = 7). The alert was triggered when both height and weight were entered and BMI was ≥30. Both intervention and comparator clinics could document meaningful use by selecting a nutrition education handout within the alert. Intervention clinics could also select a referral option from the list of clinic and community-based weight management programs embedded in the alert. Main outcomes were proportion of eligible patients with (1) obesity-related documentation and (2) referral. There were 26,471 total primary care encounters with 12,981 unique adult patients with BMI ≥ 30 during the 6-month study period. Documentation doubled (17 to 33%) with implementation of the alert. However, intervention clinics were not significantly more likely to refer patients to weight management than comparator clinics (2.8 vs. 1.3%, p = 0.07). Although the alert was associated with increased physician meaningful use compliance, it was not an effective strategy for improving patient access to weight management services. Further research is needed to understand system-level characteristics that influence obesity management in primary care.

Health care professionals' perspectives of living and dying with primary malignant glioma: Implications for a unique cancer trajectory.

PubMed

Philip, Jennifer; Collins, Anna; Brand, Caroline A; Gold, Michelle; Moore, Gaye; Sundararajan, Vijaya; Murphy, Michael A; Lethborg, Carrie

2015-12-01

Health care professionals (HCPs) caring for people with primary malignant glioma (PMG) and their carers see many of the profound challenges facing this group, yet their perspectives are not documented. This study aimed to understand and document the unique perspective of HCPs in relation to the supportive and palliative care needs of patients with PMG and their carers, with a view to developing a model of care. Qualitative study involving semi-structured focus groups and interviews with 35 medical, nursing and allied health staff actively engaged in providing care for this patient group. Purposive and theoretical sampling from two major metropolitan hospitals and one community palliative care service in Australia was utilised to seek perspectives from a variety of disciplines and health care settings. Thematic analysis was conducted by three independent researchers, using a constant comparative method influenced by grounded theory. Key themes relating to the needs of people with PMG which were apparent from the HCPs included: The difference in the illness course of glioma compared to other cancers; Limitations of current medical care; Challenges in balancing hope with reality of the illness; and Recommendations to improve care, including recognising the role of family and moving from a model where services are offered in response to demonstrated needs. Significance of the results: Current models of care based upon the classic cancer trajectory are unresponsive to the needs of people with PMG. Care may be enhanced by moving towards a proactive approach, extending the goals of care beyond medical needs and broadening the focus of care to include family needs.

Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach.

PubMed

Ralph, Anna P; Fittock, Marea; Schultz, Rosalie; Thompson, Dale; Dowden, Michelle; Clemens, Tom; Parnaby, Matthew G; Clark, Michele; McDonald, Malcolm I; Edwards, Keith N; Carapetis, Jonathan R; Bailie, Ross S

2013-12-18

Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve quality of RHD care through development and implementation of a continuous quality improvement (CQI) strategy. We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008-2010. Participatory action research methods were employed to identify system barriers to delivery of high quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (≥80% of scheduled 4-weekly penicillin injections) and quality of documentation. Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ≥40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p = 0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p = 0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p = 0.001). However, the proportion receiving ≥80% of scheduled BPG did not change. Documentation in medical files improved: ARF episode documentation increased from 31/55 (56%) to 50/62 (81%) (p = 0.004), and RHD risk category documentation from 87/154 (56%) to 103/145 (76%) (p < 0.001). Large differences in performance were noted between health centres, reflected to some extent in SAT scores. A CQI process using a systems approach and participatory action research methodology can significantly improve delivery of ARF/RHD care.

Chemical Data Reporting Byproduct and Recycling Scenarios

EPA Pesticide Factsheets

This document addresses a series of 18 industry scenarios and questions related to EPA’s Chemical Data Reporting (CDR) rule. The primary goal of this document is to help the regulated community comply with the requirements of the CDR rule.

Protocol for a national prevalence study of advance care planning documentation and self-reported uptake in Australia

PubMed Central

Ruseckaite, Rasa; Detering, Karen M; Perera, Veronica; Walker, Lynne; Sinclair, Craig; Clayton, Josephine M; Nolte, Linda

2017-01-01

Introduction Advance care planning (ACP) is a process between a person, their family/carer(s) and healthcare providers that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care. The Australian government funds a number of national initiatives aimed at increasing ACP uptake; however, there is currently no standardised Australian data on formal ACP documentation or self-reported uptake. This makes it difficult to evaluate the impact of ACP initiatives. This study aims to determine the Australian national prevalence of ACP and completion of Advance Care Directives (ACDs) in hospitals, aged care facilities and general practices. It will also explore people’s self-reported use of ACP and views about the process. Methods and analysis Researchers will conduct a national multicentre cross-sectional prevalence study, consisting of a record audit and surveys of people aged 65 years or more in three sectors. From 49 participating Australian organisations, 50 records will be audited (total of 2450 records). People whose records were audited, who speak English and have a decision-making capacity will also be invited to complete a survey. The primary outcome measure will be the number of people who have formal or informal ACP documentation that can be located in records within 15 min. Other outcomes will include demographics, measure of illness and functional capacity, details of ACP documentation (including type of document), location of documentation in the person’s records and whether current clinical care plans are consistent with ACP documentation. People will be surveyed, to measure self-reported interest, uptake and use of ACP/ACDs, and self-reported quality of life. Ethics and dissemination This protocol has been approved by the Austin Health Human Research Ethics Committee (reference HREC/17/Austin/83). Results will be submitted to international peer-reviewed journals and presented at international conferences. Trial registration number ACTRN12617000743369 PMID:29101142

Protocol for a nationwide survey of primary health care in China: the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) MPP (Million Persons Project) Primary Health Care Survey.

PubMed

Su, Meng; Zhang, Qiuli; Lu, Jiapeng; Li, Xi; Tian, Na; Wang, Yun; Yip, Winnie; Cheng, Kar Keung; Mensah, George A; Horwitz, Ralph I; Mossialos, Elias; Krumholz, Harlan M; Jiang, Lixin

2017-08-28

China has pioneered advances in primary health care (PHC) and public health for a large and diverse population. To date, the current state of PHC in China has not been subjected to systematic assessments. Understanding variations in primary care services could generate opportunities for improving the structure and function of PHC. This paper describes a nationwide PHC study (PEACE MPP Primary Health Care Survey) conducted across 31 provinces in China. The study leverages an ongoing research project, the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project (MPP). It employs an observational design with document acquisition and abstraction and in-person interviews. The study will collect data and original documents on the structure and financing of PHC institutions and the adequacy of the essential medicines programme; the education, training and retention of the PHC workforce; the quality of care; and patient satisfaction with care. The study will provide a comprehensive assessment of current PHC services and help determine gaps in access and quality of care. All study instruments and documents will be deposited in the Document Bank as an open-access source for other researchers. The central ethics committee at the China National Centre for Cardiovascular Disease (NCCD) approved the study. Written informed consent has been obtained from all patients. Findings will be disseminated in future peer reviewed papers, and will inform strategies aimed at improving the PHC in China. NCT02953926. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The integration of occupational therapy into primary care: a multiple case study design

PubMed Central

2013-01-01

Background For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration. Methods A multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires. Results Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers. Conclusion With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group. An understanding of professional roles, trust and communication are foundations for interprofessional collaborative practice. PMID:23679667

FBI fingerprint identification automation study. AIDS 3 evaluation report. Volume 1: Compendium

NASA Technical Reports Server (NTRS)

Mulhall, B. D. L.

1980-01-01

The primary features of the overall study are encompassed and an evaluation of an automation system is presented. Objectives of the study are described, methods of evaluation are summarized and conclusions about the system's feasibility are presented. Also included is a brief history of fingerprint automation activities within the FBI, the organization of the FBI, a bibliography of documents and records, a data dictionary and a reference set of all of the transparencies presented throughout the study.

Analysis of the Concept of Primary Care for Children and Adolescents: A Policy Research Brief.

ERIC Educational Resources Information Center

Johansen, Anne S.; And Others

This document examines the 10 essential attributes of primary health care contained in the U.S. Maternal and Child Health Bureau's definition of primary care. Primary care for children and adolescents is personal health care delivered in the context of family, culture, and community; the range of services meets all but the most uncommon health…

Documents and Symbols of American Freedom. Elementary Grade Activity. Schools of California Online Resources for Education (SCORE): Connecting California's Classrooms to the World.

ERIC Educational Resources Information Center

Hutchens, Dorothy

This lesson plan for elementary-age children studies some of the primary source documents and symbols of freedom which were and are important for the nation. The lesson plan uses the following documents: "The Mayflower Compact"; "The Declaration of Independence"; "The Constitution"; and the "Bill of Rights."…

Apprentices and Trainees: December Quarter 2009: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

This document covers the data terms used in the Apprentices and trainees December quarter 2009 report and its associated data tables. The primary purpose of this document is to assist users of the report to understand the specific data terms used within it. Terms that appear in the report are listed in alphabetical order with the following…

Apprentices and Trainees: September Quarter 2009. Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

This document covers the data terms used in the "Apprentices and trainees September" quarter 2009 report and its associated data tables. The primary purpose of this document is to assist users of the report to understand the specific data terms used within it. Terms that appear in the report are listed in alphabetical order with the following…

Apprentices and Trainees: Early Trend Estimates. June 2010: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2010

2010-01-01

This document covers the data terms used in the "Apprentices and trainees early trend estimates June 2010" publication. The primary purpose of this document is to assist users of the report to understand the specific data terms used within it. Terms that appear in the report are listed in alphabetical order with the following information…

Outcomes from the Productivity Places Program 2009: Terms and Definitions. Support Document

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2009

2009-01-01

This document covers the data terms used in the "Outcomes from the Productivity Places Program 2009" report and its associated data tables. The primary purpose of this document is to assist users of the report to understand the specific data terms used within it. Terms that appear in the report are listed in alphabetical order with the…

Mission statements and vision documents in medical practices.

PubMed

Drury, Ivo; Slomski, Carol

2006-01-01

Thoughtful, carefully constructed mission statements and vision documents serve both to signal the purpose of a medical practice to the public and other professional colleagues, and to keep the practice's providers focused on its key purposes. Practice culture is the primary driver ofmission and vision. We clarify the differences between mission statements and vision documents, and offer guidelines to aid in constructing them.

Electronic Document Delivery: Converging Standards and Technologies. UDT Series on Data Communication Technologies and Standards for Libraries, Report #2.

ERIC Educational Resources Information Center

Cleveland, Gary

The development of information technologies such as public access catalogs and online databases has greatly enhanced access to information. The lack of automation in the area of document delivery, however, has created a large disparity between the speed with which citations are found and the provision of primary documents. This imbalance can…

Chronic traumatic encephalopathy.

PubMed

Omalu, Bennet

2014-01-01

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative syndrome, which is caused by single, episodic, or repetitive blunt force impacts to the head and transfer of acceleration-deceleration forces to the brain. CTE presents clinically as a composite syndrome of mood disorders and behavioral and cognitive impairment, with or without sensorimotor impairment. Symptoms of CTE may begin with persistent symptoms of acute traumatic brain injury (TBI) following a documented episode of brain trauma or after a latent period that may range from days to weeks to months and years, up to 40 years following a documented episode of brain trauma or cessation of repetitive TBI. Posttraumatic encephalopathy is distinct from CTE, can be comorbid with CTE, and is a clinicopathologic syndrome induced by focal and/or diffuse, gross and/or microscopic destruction of brain tissue following brain trauma. The brain of a CTE sufferer may appear grossly unremarkable, but shows microscopic evidence of primary and secondary proteinopathies. The primary proteinopathy of CTE is tauopathy, while secondary proteinopathies may include, but are not limited to, amyloidopathy and TDP proteinopathy. Reported prevalence rates of CTE in cohorts exposed to TBI ranges from 3 to 80% across age groups. © 2014 S. Karger AG, Basel.

Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.

PubMed

Richardson, Karen J; Sengstack, Patricia; Doucette, Jeffrey N; Hammond, William E; Schertz, Matthew; Thompson, Julie; Johnson, Constance

2016-02-01

The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population.

Combined cystometrography and electromyography of the external urethral sphincter following complete primary repair of bladder exstrophy.

PubMed

Borer, Joseph G; Strakosha, Ruth; Bauer, Stuart B; Diamond, David A; Pennison, Melanie; Rosoklija, Ilina; Khoshbin, Shahram

2014-05-01

Concern in patients with bladder exstrophy after reconstruction regarding potential injury to pelvic neurourological anatomy and a resultant functional deficit prompted combined (simultaneous) cystometrography and electromyography after complete primary repair of bladder exstrophy. We determined whether complete primary repair of bladder exstrophy would adversely affect the innervation controlling bladder and external urethral sphincter function. Complete primary repair of bladder exstrophy was performed via a modified Mitchell technique in newborns without osteotomy. Postoperative evaluation included combined cystometrography and needle electrode electromyography via the perineum, approximating the external urethral sphincter muscle complex. Electromyography was done to evaluate the external urethral sphincter response to sacral reflex stimulation and during voiding. Nine boys and 4 girls underwent combined cystometrography/electromyography after complete primary repair of bladder exstrophy. Age at study and time after complete primary repair of bladder exstrophy was 3 months to 10 years (median 11.5 months). Cystometrography revealed absent detrusor overactivity and the presence of a sustained detrusor voiding contraction in all cases. Electromyography showed universally normal individual motor unit action potentials of biphasic pattern, amplitude and duration. The external urethral sphincter sacral reflex response was intact with a normal caliber with respect to Valsalva, Credé, bulbocavernosus and anocutaneous (bilateral) stimulation. Synergy was documented by abrupt silencing of external urethral sphincter electromyography activity during voiding. After complete primary repair of bladder exstrophy combined cystometrography/electromyography in patients with bladder exstrophy showed normal neurourological findings, including sacral reflex responses, sustained detrusor voiding contraction and synergic voiding, in all patients postoperatively. These findings confirm the safety of complete primary repair of bladder exstrophy. Based on our results we have discontinued routine electromyography in these patients. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Are care plans suitable for the management of multiple conditions?

PubMed Central

Young, Charlotte E.; Boyle, Frances M.; Mutch, Allyson J.

2016-01-01

Background Care plans have been part of the primary care landscape in Australia for almost two decades. With an increasing number of patients presenting with multiple chronic conditions, it is timely to consider whether care plans meet the needs of patients and clinicians. Objectives To review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflicts and synergies between conditions, and (iv) setting dates for reviewing the care plan. Design Document analysis of Australian care plan templates published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Results Sixteen templates were reviewed. All of the care plan templates addressed patient preference, but this was not done comprehensively. Only three templates included setting priorities. None assisted in identifying conflicts and synergies between conditions. Fifteen templates included setting a date for reviewing the care plan. Conclusions Care plans are a well-used tool in primary care practice, but their current format perpetuates a single-disease approach to care, which works contrary to their intended purpose. Restructuring care plans to incorporate shared decision-making and attention to patient preferences may assist in shifting the focus back to the patient and their care needs. PMID:29090181

Instructions for Reporting for the 2006 Partial Updating of the TSCA Chemical Inventory Database

EPA Pesticide Factsheets

The primary goal of this document is to help the regulated community comply with the requirements of the IUR regulations. This document does not substitute for those regulations, nor is it a regulation itself.

Overseas Environmental Baseline Guidance Document

DTIC Science & Technology

2007-05-01

The primary purpose of this Overseas Environmental Baseline Guidance Document (OEBGD) is to provide criteria and management practices to be used by ...establishes standards for environmental compliance at Department of Defense controlled or operated installations in countries for which no FGS have been established.

Improved simulation of driver behavior : modeling protected and permitted left-turn operations at signalized intersections.

DOT National Transportation Integrated Search

2011-04-01

"This report documents the findings from a research project that is focused on modeling protected and permitted left-turn operations at signalized intersection approaches. The projects primary objective is to document the microscopic characteristi...

California aviation system plan : policy element.

DOT National Transportation Integrated Search

2011-10-01

The Policy Element (PE) is the primary document that explains and guides the business of the Division of Aeronautics (Division) that is housed in the California Department of Transportation (Caltrans). The Divisions primary duties and functions ar...

Spatially-Explicit Estimates of Greenhouse Gas Emissions from Fire and Land-Use Change in the Brazilian Cerrado

NASA Astrophysics Data System (ADS)

Galford, G. L.; Spera, S. A.; Coe, M. T.; Costa, C., Jr.

2014-12-01

Understanding the multiple types of land-use changes that can occur within an ecosystem provides a comprehensive picture of the human's impact on natural systems. We use the Cerrado (savanna) of Brazil to examine the primary and secondary impacts of land-use change on greenhouse gas emissions. The primary land-use changes include fires for land-clearing, conversions to pasture and row-crop agriculture, and shifting management practices of agricultural lands. Secondary land-use changes include savanna degradation due to fires that escape from intended burn areas. These escape fires typically have a lower combustion completion coefficient than clearing fires, so it is important to distinguish them to correctly estimate the regional greenhouse gas budget. We have created a first-order spatio-temporal model of greenhouse gas emissions that can be easily modified for other savanna regions using globally available data products as inputs. Our data inputs are derived from publically available remote sensing imagery. Initial biomass is estimated by Baccini et al. 2012, which is derived from LiDAR and MODIS imagery. All other input data sets give annual estimates. Clearing of the savanna is documented by LAPIG of Universidade Federal de Goias using MODIS (MOD13Q1), LANDSAT and CBERS images. MODIS burned area products delineate annual fires; in combination with the savanna clearing database we determine primary and escape fires. Pastures and row-crop agriculture are documented by LAPIG and Spera et al. 2014, respectively. The row-crop agriculture dataset enables us to estimate greenhouse gas emissions associated with specific crops (e.g., soy or maize) and management (e.g., fertilizer use). Recent contributions to the literature have provided many in situ measurements from the land-use changes of interest needed to estimate a regional greenhouse gas budget, including combustion coefficients of savanna sub-types, carbon emission soil stocks, nitrogen emissions from fertilizer, and carbon storage in pastures. With this wealth of information, we present a complete greenhouse gas portfolio including a sensitivity analysis for this dynamic region with an eye to applications for other savanna regions.

Ground Robotic Hand Applications for the Space Program study (GRASP)

NASA Astrophysics Data System (ADS)

Grissom, William A.; Rafla, Nader I.

1992-04-01

This document reports on a NASA-STDP effort to address research interests of the NASA Kennedy Space Center (KSC) through a study entitled, Ground Robotic-Hand Applications for the Space Program (GRASP). The primary objective of the GRASP study was to identify beneficial applications of specialized end-effectors and robotic hand devices for automating any ground operations which are performed at the Kennedy Space Center. Thus, operations for expendable vehicles, the Space Shuttle and its components, and all payloads were included in the study. Typical benefits of automating operations, or augmenting human operators performing physical tasks, include: reduced costs; enhanced safety and reliability; and reduced processing turnaround time.

Ground Robotic Hand Applications for the Space Program study (GRASP)

NASA Technical Reports Server (NTRS)

Grissom, William A.; Rafla, Nader I. (Editor)

1992-01-01

This document reports on a NASA-STDP effort to address research interests of the NASA Kennedy Space Center (KSC) through a study entitled, Ground Robotic-Hand Applications for the Space Program (GRASP). The primary objective of the GRASP study was to identify beneficial applications of specialized end-effectors and robotic hand devices for automating any ground operations which are performed at the Kennedy Space Center. Thus, operations for expendable vehicles, the Space Shuttle and its components, and all payloads were included in the study. Typical benefits of automating operations, or augmenting human operators performing physical tasks, include: reduced costs; enhanced safety and reliability; and reduced processing turnaround time.

Computer program documentation for the dynamic analysis of a noncontacting mechanical face seal

NASA Technical Reports Server (NTRS)

Auer, B. M.; Etsion, I.

1980-01-01

A computer program is presented which achieves a numerical solution for the equations of motion of a noncontacting mechanical face seal. The flexibly-mounted primary seal ring motion is expressed by a set of second order differential equations for three degrees of freedom. These equations are reduced to a set of first order equations and the GEAR software package is used to solve the set of first order equations. Program input includes seal design parameters and seal operating conditions. Output from the program includes velocities and displacements of the seal ring about the axis of an inertial reference system. One example problem is described.

Integration of Medical Scribes in the Primary Care Setting: Improving Satisfaction.

PubMed

Imdieke, Brian H; Martel, Marc L

There are little published data on the use of medical scribes in the primary care setting. We assessed the feasibility of incorporating medical scribes in our ambulatory clinic to support provider documentation in the electronic medical record. In our convenience sampling of patient, provider, and staff perceptions of scribes, we found that patients were comfortable having scribes in the clinic. Overall indicators of patient satisfaction were slightly decreased. Providers found scribe support to be valuable and overall clinician documentation time was reduced by more than 50% using scribes.

Using the Internet To Create Primary Source Teaching Packets.

ERIC Educational Resources Information Center

VanFossen, Phillip J.; Shiveley, James M.

2000-01-01

Describes strategies and guidelines for creating age- and content-appropriate primary source documents using the Internet. Discusses the value of using topic-specific primary source teaching packets, or jackdaws. Provides three Internet generated jackdaws: New Deal/FDR, Home Front during World War II, and the Gilded Age. Addresses fair use issues.…

Exploring Midwives' Need and Intention to Adopt Electronic Integrated Antenatal Care.

PubMed

Markam, Hosizah; Hochheiser, Harry; Kuntoro, Kuntoro; Notobroto, Hari Basuki

2018-01-01

Documentation requirements for the Indonesian integrated antenatal care (ANC) program suggest the need for electronic systems to address gaps in existing paper documentation practices. Our goals were to quantify midwives' documentation completeness in a primary healthcare center, understand documentation challenges, develop a tool, and assess intention to use the tool. We analyzed existing ANC records in a primary healthcare center in Bangkalan, East Java, and conducted interviews with stakeholders to understand needs for an electronic system in support of ANC. Development of the web-based Electronic Integrated ANC (e-iANC) system used the System Development Life Cycle method. Training on the use of the system was held in the computer laboratory for 100 midwives chosen from four primary healthcare centers in each of five regions. The Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire was used to assess their intention to adopt e-iANC. The midwives' intention to adopt e-iANC was significantly influenced by performance expectancy, effort expectancy and facilitating conditions. Age, education level, and computer literacy did not significantly moderate the effects of performance expectancy and effort expectancy on adoption intention. The UTAUT results indicated that the factors that might influence intention to adopt e-iANC are potentially addressable. Results suggest that e-iANC might well be accepted by midwives.

Coding of procedures documented by general practitioners in Swedish primary care-an explorative study using two procedure coding systems

PubMed Central

2012-01-01

Background Procedures documented by general practitioners in primary care have not been studied in relation to procedure coding systems. We aimed to describe procedures documented by Swedish general practitioners in electronic patient records and to compare them to the Swedish Classification of Health Interventions (KVÅ) and SNOMED CT. Methods Procedures in 200 record entries were identified, coded, assessed in relation to two procedure coding systems and analysed. Results 417 procedures found in the 200 electronic patient record entries were coded with 36 different Classification of Health Interventions categories and 148 different SNOMED CT concepts. 22.8% of the procedures could not be coded with any Classification of Health Interventions category and 4.3% could not be coded with any SNOMED CT concept. 206 procedure-concept/category pairs were assessed as a complete match in SNOMED CT compared to 10 in the Classification of Health Interventions. Conclusions Procedures documented by general practitioners were present in nearly all electronic patient record entries. Almost all procedures could be coded using SNOMED CT. Classification of Health Interventions covered the procedures to a lesser extent and with a much lower degree of concordance. SNOMED CT is a more flexible terminology system that can be used for different purposes for procedure coding in primary care. PMID:22230095

Definition and documentation of engineering processes

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

McDonald, G.W.

1997-11-01

This tutorial is an extract of a two-day workshop developed under the auspices of the Quality Engineering Department at Sandia National Laboratories. The presentation starts with basic definitions and addresses why processes should be defined and documented. It covers three primary topics: (1) process considerations and rationale, (2) approach to defining and documenting engineering processes, and (3) an IDEFO model of the process for defining engineering processes.

Best practice in primary care pathology: review 5

PubMed Central

Smellie, W S A; Forth, J; Ryder, S; Galloway, M J; Wood, A C; Watson, I D

2006-01-01

This fifth best practice review examines three series of common primary care questions in laboratory medicine: (1) minor liver function test abnormalities; (2) laboratory monitoring of patients receiving lithium; and (3) investigation of possible venous thromboembolism. The review is presented in question–answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence‐based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus‐based rather than evidence‐based. They will be updated periodically to take account of new information. PMID:16644875

Electronic Health Record Tools to Care for At-Risk Older Drivers: A Quality Improvement Project.

PubMed

Casey, Colleen M; Salinas, Katherine; Eckstrom, Elizabeth

2015-06-01

Evaluating driving safety of older adults is an important health topic, but primary care providers (PCP) face multiple barriers in addressing this issue. The study's objectives were to develop an electronic health record (EHR)-based Driving Clinical Support Tool, train PCPs to perform driving assessments utilizing the tool, and systematize documentation of assessment and management of driving safety issues via the tool. The intervention included development of an evidence-based Driving Clinical Support Tool within the EHR, followed by training of internal medicine providers in the tool's content and use. Pre- and postintervention provider surveys and chart review of driving-related patient visits were conducted. Surveys included self-report of preparedness and knowledge to evaluate at-risk older drivers and were analyzed using paired t-test. A chart review of driving-related office visits compared documentation pre- and postintervention including: completeness of appropriate focused history and exam, identification of deficits, patient education, and reporting to appropriate authorities when indicated. Data from 86 providers were analyzed. Pre- and postintervention surveys showed significantly increased self-assessed preparedness (p < .001) and increased driving-related knowledge (p < .001). Postintervention charts showed improved documentation of correct cognitive testing, more referrals/consults, increased patient education about community resources, and appropriate regulatory reporting when deficits were identified. Focused training and an EHR-based clinical support tool improved provider self-reported preparedness and knowledge of how to evaluate at-risk older drivers. The tool improved documentation of driving-related issues and led to improved access to interdisciplinary care coordination. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

For Your Information (FYI) User Guide – Primary Support

EPA Pesticide Factsheets

This document is the user guide for the Primary Support user of the FYI tool which is part of the Office of Pollution Prevention and Toxics (OPPT) ‘For Your Information (FYI)’ application submission process.

Risk prediction for chronic kidney disease progression using heterogeneous electronic health record data and time series analysis.

PubMed

Perotte, Adler; Ranganath, Rajesh; Hirsch, Jamie S; Blei, David; Elhadad, Noémie

2015-07-01

As adoption of electronic health records continues to increase, there is an opportunity to incorporate clinical documentation as well as laboratory values and demographics into risk prediction modeling. The authors develop a risk prediction model for chronic kidney disease (CKD) progression from stage III to stage IV that includes longitudinal data and features drawn from clinical documentation. The study cohort consisted of 2908 primary-care clinic patients who had at least three visits prior to January 1, 2013 and developed CKD stage III during their documented history. Development and validation cohorts were randomly selected from this cohort and the study datasets included longitudinal inpatient and outpatient data from these populations. Time series analysis (Kalman filter) and survival analysis (Cox proportional hazards) were combined to produce a range of risk models. These models were evaluated using concordance, a discriminatory statistic. A risk model incorporating longitudinal data on clinical documentation and laboratory test results (concordance 0.849) predicts progression from state III CKD to stage IV CKD more accurately when compared to a similar model without laboratory test results (concordance 0.733, P<.001), a model that only considers the most recent laboratory test results (concordance 0.819, P < .031) and a model based on estimated glomerular filtration rate (concordance 0.779, P < .001). A risk prediction model that takes longitudinal laboratory test results and clinical documentation into consideration can predict CKD progression from stage III to stage IV more accurately than three models that do not take all of these variables into consideration. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

National audit of continence care: adherence to National Institute for Health and Clinical Excellence (NICE) guidance in older versus younger adults with faecal incontinence.

PubMed

Harari, Danielle; Husk, Janet; Lowe, Derek; Wagg, Adrian

2014-11-01

previous UK National Audits of Continence Care showed low rates of assessment and treatment of faecal incontinence (FI) in older people. the 2009 audit assessed adherence to the National Institute for Health and Clinical Excellence guidelines on management of FI and compared care in older versus younger patients. fifteen older (65+) and 15 younger (18-65) patients with FI were to be audited in hospital (inpatient or outpatient), primary care (PC) and care home sites. data were submitted for n = 2,930 cases from 133 hospitals, n = 1,729 from 97 PC surgeries and n = 693 from 63 care homes. Bowel history was not documented in 41% older versus 24% younger patients in hospitals and 27 versus 19% in PC (both P < 0.001). In older people, there was no documented focused examination in one-third in hospitals, one-half in PC and three-quarters in care homes. Overall, <50% had documented treatment for an identified bowel-related cause of FI. FI was frequently attributed to co-morbidity. Few patients received copies of their treatment plan. Quality-of-life impact was poorly documented particularly in hospitals. this national audit shows deficits in documented assessment, diagnosis and treatment for adults with FI despite availability of clinical guidance. Overall care is significantly poorer for older people. Clinicians, including geriatricians, need to lead on improving care in older people including comprehensive assessment where needed. Improvement in some indicators in older people with successive audits suggests that ongoing national audit with linked information resources can be useful as both monitor and agent for change. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Informed consent for genetic research.

PubMed

Hamvas, Aaron; Madden, Katherine K; Nogee, Lawrence M; Trusgnich, Michelle A; Wegner, Daniel J; Heins, Hillary B; Cole, F Sessions

2004-06-01

Rapid technological advances in genetic research and public concern about genetic discrimination have led to anticipatory safeguards in the informed consent process in the absence of legal examples of proven discrimination. Despite federal and state regulations to restrict access to personal health information, including genetic information, institutional review boards have required the addition of language to informed consent documents that warns about the risks of discrimination with participation in genetic research. To determine the reasons that families refused consent for their infant's participation in a study evaluating a genetic cause of respiratory distress syndrome. Survey conducted between February 1, 2002, and March 31, 2003. Academic, tertiary free-standing children's hospital. A convenience sample of 465 families were approached for consent. The 135 families who refused consent were surveyed. Reasons for refusal. Of the nonconsenting families, 79% spontaneously and specifically identified institutionally required language in our consent form concerning the risk of denial of access to health insurance and employment as the primary reason for refusal; 97% indicated that their fears resulted directly from language in our consent form. Only 20% of families who refused consent cited inadequate time to consider the study. The institutionally required description of risk of genetic discrimination due solely to participation in genetic research was the primary reason for refusal to consent in this cohort. Information about federally and institutionally mandated protections for confidentiality of participants in genetic research should be included in the informed consent document to balance the description of hypothetical risks and more accurately inform subjects.

Global synthesis of the documented and projected effects of climate change on inland fishes

USGS Publications Warehouse

Myers, Bonnie; Lynch, Abigail; Bunnell, David; Chu, Cindy; Falke, Jeffrey A.; Kovach, Ryan; Krabbenhoft, Trevor J.; Kwak, Thomas J.; Paukert, Craig P.

2017-01-01

Although climate change is an important factor affecting inland fishes globally, a comprehensive review of how climate change has impacted and will continue to impact inland fishes worldwide does not currently exist. We conducted an extensive, systematic primary literature review to identify English-language, peer-reviewed journal publications with projected and documented examples of climate change impacts on inland fishes globally. Since the mid-1980s, scientists have projected the effects of climate change on inland fishes, and more recently, documentation of climate change impacts on inland fishes has increased. Of the thousands of title and abstracts reviewed, we selected 624 publications for a full text review: 63 of these publications documented an effect of climate change on inland fishes, while 116 publications projected inland fishes’ response to future climate change. Documented and projected impacts of climate change varied, but several trends emerged including differences between documented and projected impacts of climate change on salmonid abundance (P = 0.0002). Salmonid abundance decreased in 89.5% of documented effects compared to 35.7% of projected effects, where variable effects were more commonly reported (64.3%). Studies focused on responses of salmonids (61% of total) to climate change in North America and Europe, highlighting major gaps in the literature for taxonomic groups and geographic focus. Elucidating global patterns and identifying knowledge gaps of climate change effects on inland fishes will help managers better anticipate local changes in fish populations and assemblages, resulting in better development of management plans, particularly in systems with little information on climate change effects on fish.

Counting seizures: The primary outcome measure in epileptology from the patients' perspective.

PubMed

Blachut, Barbara; Hoppe, Christian; Surges, Rainer; Stahl, Jutta; Elger, Christian E; Helmstaedter, Christoph

2015-07-01

Patient-reported seizure counts represent a key outcome measure for individual treatments and clinical studies in epileptology. Video-EEG based research, however, demonstrated lack of validity due to underreporting. Here we examined the practice of keeping seizure diaries and the patients' attitudes toward seizure counting. Anticipating a low return rate, a comprehensive survey was mailed to 1100 adult outpatients. Besides methods and reasons to document or not to document seizures, the questionnaire addressed clinical, personality and sociodemographic characteristics as well as the subjective experience of seizures. Questionnaires from 170 patients (15%) could be included in our analysis. Patients estimated to be aware of 5.3 out of 10 daytime seizures (nocturnal seizures: 2.6) while they supposed that relatives/colleagues noticed 7.1 (nocturnal: 4.6). Almost two-thirds of the patients reported to keep a seizure diary with a self-estimated documentation rate of 8.7 out of 10 noticed daytime seizures (nocturnal: 7.7). Documenters and non-documenters showed only marginal group differences with regard to clinical, personality and sociodemographic characteristics. Importantly, patients were more committed to keep a seizure diary when they judged it to be relevant for clinical treatment decisions. Patients appear to know that they underreport seizures. According to their view, seizure unawareness as induced by seizures themselves seems to be a more important factor than omitting documentation of noticed seizures. Thus, the potential to improve the validity of seizure diaries of electronic devices which facilitate documenting noticed seizures appears limited. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Iron deficiency intravenous substitution in a Swiss academic primary care division: analysis of practices

PubMed Central

Varcher, Monica; Zisimopoulou, Sofia; Braillard, Olivia; Favrat, Bernard; Junod Perron, Noëlle

2016-01-01

Background Iron deficiency is a common problem in primary care and is usually treated with oral iron substitution. With the recent simplification of intravenous (IV) iron administration (ferric carboxymaltose) and its approval in many countries for iron deficiency, physicians may be inclined to overutilize it as a first-line substitution. Objective The aim of this study was to evaluate iron deficiency management and substitution practices in an academic primary care division 5 years after ferric carboxymaltose was approved for treatment of iron deficiency in Switzerland. Methods All patients treated for iron deficiency during March and April 2012 at the Geneva University Division of Primary Care were identified. Their medical files were analyzed for information, including initial ferritin value, reasons for the investigation of iron levels, suspected etiology, type of treatment initiated, and clinical and biological follow-up. Findings were assessed using an algorithm for iron deficiency management based on a literature review. Results Out of 1,671 patients, 93 were treated for iron deficiency. Median patients’ age was 40 years and 92.5% (n=86) were female. The average ferritin value was 17.2 μg/L (standard deviation 13.3 μg/L). The reasons for the investigation of iron levels were documented in 82% and the suspected etiology for iron deficiency was reported in 67%. Seventy percent of the patients received oral treatment, 14% IV treatment, and 16% both. The reasons for IV treatment as first- and second-line treatment were reported in 57% and 95%, respectively. Clinical and biological follow-up was planned in less than two-thirds of the cases. Conclusion There was no clear overutilization of IV iron substitution. However, several steps of the iron deficiency management were not optimally documented, suggesting shortcuts in clinical reasoning. PMID:27445502

After-hours/on-call experience during primary care nurse practitioner education utilizing standard scenarios and simulated patients.

PubMed

Kelly, Michelle M; Blunt, Elizabeth; Nestor, Kelly

2017-12-01

Few nurse practitioner (NP) programs include an after-hours/on-call component in their clinical preparation of NP students. This role is expected in many primary and specialty care practices, and is one that students feel unprepared to competently navigate. Utilizing simulated callers as patients or parents, NP students participated in a simulated after-hours/on-call experience that included receiving the call, managing the patient, and submitting documentation of the encounter. Students completed pre- and postparticipation evaluations, and were evaluated by the simulated patient callers and faculty using standardized evaluation tools. NP students rated the experience as an educationally valuable experience despite feeling anxious and nervous about the experience. Several essential skills were identified including critical thinking, clear communication, self-confidence, and access to resources. After participation NP students were more receptive to an NP position with an on-call component. Inclusion of a simulated on-call experience is a feasible component of NP education and should be added to the NP curriculum. ©2017 American Association of Nurse Practitioners.

In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices

PubMed Central

Sinsky, Christine A.; Willard-Grace, Rachel; Schutzbank, Andrew M.; Sinsky, Thomas A.; Margolius, David; Bodenheimer, Thomas

2013-01-01

We highlight primary care innovations gathered from high-functioning primary care practices, innovations we believe can facilitate joy in practice and mitigate physician burnout. To do so, we made site visits to 23 high-performing primary care practices and focused on how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life’s vocation. Innovations identified include (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) sharing clinical care among a team, with expanded rooming protocols, standing orders, and panel management; (3) sharing clerical tasks with collaborative documentation (scribing), nonphysician order entry, and streamlined prescription management; (4) improving communication by verbal messaging and in-box management; and (5) improving team functioning through co-location, team meetings, and work flow mapping. Our observations suggest that a shift from a physician-centric model of work distribution and responsibility to a shared-care model, with a higher level of clinical support staff per physician and frequent forums for communication, can result in high-functioning teams, improved professional satisfaction, and greater joy in practice. PMID:23690328

Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care.

PubMed

Kimerling, Rachel; Iverson, Katherine M; Dichter, Melissa E; Rodriguez, Allison L; Wong, Ava; Pavao, Joanne

2016-08-01

The objectives of this study were to identify the prevalence of past-year intimate partner violence (IPV) among women Veterans utilizing Veterans Health Administration (VHA) primary care, and to document associated demographic, military, and primary care characteristics. This was a retrospective cohort design, where participants completed a telephone survey in 2012 (84% participation rate); responses were linked to VHA administrative data for utilization in the year prior to the survey. A national stratified random sample of 6,287 women Veteran VHA primary care users participated in the study. Past-year IPV was assessed using the HARK screening tool. Self-report items and scales assessed demographic and military characteristics. Primary care characteristics were assessed via self-report and VHA administrative data. The prevalence of past-year IPV among women Veterans was 18.5% (se = 0.5%), with higher rates (22.2% - 25.5%) among women up to age 55. Other demographic correlates included indicators of economic hardship, lesbian or bisexual orientation, and being a parent/guardian of a child less than 18 years old. Military correlates included service during Vietnam to post-Vietnam eras, less than 10 years of service, and experiences of Military Sexual Trauma (MST). Most (77.3%, se = 1.2%) women who experienced IPV identified a VHA provider as their usual provider. Compared with women who did not report past-year IPV, women who reported IPV had more primary care visits, yet experienced lower continuity of care across providers. The high prevalence of past-year IPV among women beyond childbearing years, the majority of whom primarily rely on VHA as a source of health care, reinforces the importance of screening all women for IPV in VHA primary care settings. Key considerations for service implementation include sensitivity with respect to sexual orientation, race/ethnicity, and other aspects of diversity, as well as care coordination and linkages with social services and MST-related care.

40 CFR 141.25 - Analytical methods for radioactivity.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Monitoring and Analytical Requirements... obtaining these documents can be obtained from the Safe Drinking Water Hotline at 800-426-4791. Documents may be inspected at EPA's Drinking Water Docket, EPA West, 1301 Constitution Avenue, NW., Room 3334...

40 CFR 141.25 - Analytical methods for radioactivity.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Monitoring and Analytical Requirements... obtaining these documents can be obtained from the Safe Drinking Water Hotline at 800-426-4791. Documents may be inspected at EPA's Drinking Water Docket, EPA West, 1301 Constitution Avenue, NW., Room 3334...

40 CFR 141.25 - Analytical methods for radioactivity.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Monitoring and Analytical Requirements... obtaining these documents can be obtained from the Safe Drinking Water Hotline at 800-426-4791. Documents may be inspected at EPA's Drinking Water Docket, EPA West, 1301 Constitution Avenue, NW., Room 3334...

40 CFR 141.25 - Analytical methods for radioactivity.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Monitoring and Analytical Requirements... obtaining these documents can be obtained from the Safe Drinking Water Hotline at 800-426-4791. Documents may be inspected at EPA's Drinking Water Docket, EPA West, 1301 Constitution Avenue, NW., Room 3334...

Innovative Internal Camera Inspection and Data Management for Effective Condition Assessment of Collection Systems

EPA Science Inventory

The primary objective of this guidance document is to identify and evaluate innovative closed-circuit television (CCTV) and related technologies currently used by more advanced wastewater utilities to conduct condition assessment programs. The document is intended to facilitate ...

Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance.

PubMed

Huh, Warner K; Ault, Kevin A; Chelmow, David; Davey, Diane D; Goulart, Robert A; Garcia, Francisco A R; Kinney, Walter K; Massad, L Stewart; Mayeaux, Edward J; Saslow, Debbie; Schiffman, Mark; Wentzensen, Nicolas; Lawson, Herschel W; Einstein, Mark H

2015-02-01

In 2011, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology updated screening guidelines for the early detection of cervical cancer and its precursors. Recommended screening strategies were cytology or cotesting (cytology in combination with high-risk human papillomavirus [hrHPV] testing). These guidelines also addressed the use of hrHPV testing alone as a primary screening approach, which was not recommended for use at that time. There is now a growing body of evidence for screening with primary hrHPV testing, including a prospective U.S.-based registration study. Thirteen experts, including representatives from the Society of Gynecologic Oncology, the American Society for Colposcopy and Cervical Pathology, the American College of Obstetricians and Gynecologists, the American Cancer Society, the American Society of Cytopathology, the College of American Pathologists, and the American Society for Clinical Pathology, convened to provide interim guidance for primary hrHPV screening. This guidance panel was specifically triggered by an application to the U.S. Food and Drug Administration (FDA) for a currently marketed HPV test to be labeled for the additional indication of primary cervical cancer screening. Guidance was based on literature review and review of data from the FDA registration study, supplemented by expert opinion. This document aims to provide information for health care providers who are interested in primary hrHPV testing and an overview of the potential advantages and disadvantages of this strategy for screening as well as to highlight areas in need of further investigation.

For Your Information (FYI) User Guide–Primary Authorized Official

EPA Pesticide Factsheets

This document is the user guide for the Primary Authorized Official (AO) user of the FYI tool which is part of the Office of Pollution Prevention and Toxics (OPPT) ‘For Your Information (FYI)’ application submission process.

Section 8(e) Notice User Guide – Primary Support

EPA Pesticide Factsheets

This document is the user guide for the Primary Support user of the Section 8(e) Notice tool which is part of the Office of Pollution Prevention and Toxics (OPPT) ‘Section 8(e) Notice’ application submission process.

Pulmonary cholera due to infection with a non-O1 Vibrio cholerae strain.

PubMed

Shannon, Jack D; Kimbrough, Robert C

2006-09-01

We present 2 cases of primary pulmonary non-O1 Vibrio cholerae infection. We believe that these are the first documented cases of primary pulmonary infection due to this organism from a freshwater source.

Documenting How States Recently Upgraded to Primary Seat Belt Laws

DOT National Transportation Integrated Search

2011-09-01

States with primary seat belt enforcement laws consistently have higher observed daytime belt use rates than : secondary law States. Secondary belt law States, on the other hand, consistently have more occupant fatalities who : were not restrained th...

Coteaching in physical education: a strategy for inclusive practice.

PubMed

Grenier, Michelle A

2011-04-01

Qualitative research methods were used to explore the factors that informed general and adapted physical education teachers' coteaching practices within an inclusive high school physical education program. Two physical education teachers and one adapted physical education teacher were observed over a 16-week period. Interviews, field notes, and documents were collected and a constant comparative approach was used in the analysis that adopted a social model framework. Primary themes included community as the cornerstone for student learning, core values of trust and respect, and creating a natural support structure. Coteaching practices existed because of the shared values of teaching, learning, and the belief that all students should be included. Recommendations include shifting orientations within professional preparation programs to account for the social model of disability.

The AIMAR recommendations for early diagnosis of chronic obstructive respiratory disease based on the WHO/GARD model*

PubMed Central

2014-01-01

Respiratory diseases in Italy already now represent an emergency (they are the 3rd ranking cause of death in the world, and the 2nd if Lung cancer is included). In countries similar to our own, they result as the principal cause for a visit to the general practitioner (GP) and the second main cause after injury for recourse to Emergency Care. Their frequency is probably higher than estimated (given that respiratory diseases are currently underdiagnosed). The trend is towards a further increase due to epidemiologic and demographic factors (foremost amongst which are the widespread diffusion of cigarette smoking, the increasing mean age of the general population, immigration, and pollution). Within the more general problem of chronic disease care, chronic respiratory diseases (CRDs) constitute one of the four national priorities in that they represent an important burden for society in terms of mortality, invalidity, and direct healthcare costs. The strategy suggested by the World Health Organization (WHO) is an integrated approach consisting of three goals: inform about health, reduce risk exposure, improve patient care. The three goals are translated into practice in the three areas of prevention (1-primary, 2-secondary, 3-tertiary) as: 1) actions of primary (universal) prevention targeted at the general population with the aim to control the causes of disease, and actions of Predictive Medicine - again addressing the general population but aimed at measuring the individual’s risk for disease insurgence; 2) actions of early diagnosis targeted at groups or - more precisely - subgroups identified as at risk; 3) continuous improvement and integration of care and rehabilitation support - destined at the greatest possible number of patients, at all stages of disease severity. In Italy, COPD care is generally still inadequate. Existing guidelines, institutional and non-institutional, are inadequately implemented: the international guidelines are not always adaptable to the Italian context; the document of the Agency for Regional Healthcare Services (AGE.NA.S) is a more suited compendium for consultation, and the recent joint statement on integrated COPD management of the three major Italian scientific Associations in the respiratory area together with the contribution of a Society of General Medicine deals prevalently with some critical issues (appropriateness of diagnosis, pharmacological treatment, rehabilitation, continuing care); also the document “Care Continuity: Chronic Obstructive Pulmonary Disease (COPD)” of the Global Alliance against chronic Respiratory Diseases (GARD)-Italy does not treat in depth the issue of early diagnosis. The present document – produced by the AIMAR (Interdisciplinary Association for Research in Lung Disease) Task Force for early diagnosis of chronic respiratory disease based on the WHO/GARD model and on available evidence and expertise –after a general examination of the main epidemiologic aspects, proposes to integrate the above-mentioned existing documents. In particular: a) it formally indicates on the basis of the available evidence the modalities and the instruments necessary for carrying out secondary prevention at the primary care level (a pro-active,‘case-finding’approach; assessment of the individual’s level of risk of COPD; use of short questionnaires for an initial screening based on symptoms; use of simple spirometry for the second level of screening); b) it identifies possible ways of including these activities within primary care practice; c) it places early diagnosis within the “systemic”, consequential management of chronic respiratory diseases, which will be briefly described with the aid of schemes taken from the Italian and international reference documents. PMID:25473523

The AIMAR recommendations for early diagnosis of chronic obstructive respiratory disease based on the WHO/GARD model*.

PubMed

Nardini, Stefano; Annesi-Maesano, Isabella; Del Donno, Mario; Delucchi, Maurizio; Bettoncelli, Germano; Lamberti, Vincenzo; Patera, Carlo; Polverino, Mario; Russo, Antonio; Santoriello, Carlo; Soverina, Patrizio

2014-01-01

Respiratory diseases in Italy already now represent an emergency (they are the 3(rd) ranking cause of death in the world, and the 2(nd) if Lung cancer is included). In countries similar to our own, they result as the principal cause for a visit to the general practitioner (GP) and the second main cause after injury for recourse to Emergency Care. Their frequency is probably higher than estimated (given that respiratory diseases are currently underdiagnosed). The trend is towards a further increase due to epidemiologic and demographic factors (foremost amongst which are the widespread diffusion of cigarette smoking, the increasing mean age of the general population, immigration, and pollution). Within the more general problem of chronic disease care, chronic respiratory diseases (CRDs) constitute one of the four national priorities in that they represent an important burden for society in terms of mortality, invalidity, and direct healthcare costs. The strategy suggested by the World Health Organization (WHO) is an integrated approach consisting of three goals: inform about health, reduce risk exposure, improve patient care. The three goals are translated into practice in the three areas of prevention (1-primary, 2-secondary, 3-tertiary) as: 1) actions of primary (universal) prevention targeted at the general population with the aim to control the causes of disease, and actions of Predictive Medicine - again addressing the general population but aimed at measuring the individual's risk for disease insurgence; 2) actions of early diagnosis targeted at groups or - more precisely - subgroups identified as at risk; 3) continuous improvement and integration of care and rehabilitation support - destined at the greatest possible number of patients, at all stages of disease severity. In Italy, COPD care is generally still inadequate. Existing guidelines, institutional and non-institutional, are inadequately implemented: the international guidelines are not always adaptable to the Italian context; the document of the Agency for Regional Healthcare Services (AGE.NA.S) is a more suited compendium for consultation, and the recent joint statement on integrated COPD management of the three major Italian scientific Associations in the respiratory area together with the contribution of a Society of General Medicine deals prevalently with some critical issues (appropriateness of diagnosis, pharmacological treatment, rehabilitation, continuing care); also the document "Care Continuity: Chronic Obstructive Pulmonary Disease (COPD)" of the Global Alliance against chronic Respiratory Diseases (GARD)-Italy does not treat in depth the issue of early diagnosis. The present document - produced by the AIMAR (Interdisciplinary Association for Research in Lung Disease) Task Force for early diagnosis of chronic respiratory disease based on the WHO/GARD model and on available evidence and expertise -after a general examination of the main epidemiologic aspects, proposes to integrate the above-mentioned existing documents. In particular: a) it formally indicates on the basis of the available evidence the modalities and the instruments necessary for carrying out secondary prevention at the primary care level (a pro-active,'case-finding'approach; assessment of the individual's level of risk of COPD; use of short questionnaires for an initial screening based on symptoms; use of simple spirometry for the second level of screening); b) it identifies possible ways of including these activities within primary care practice; c) it places early diagnosis within the "systemic", consequential management of chronic respiratory diseases, which will be briefly described with the aid of schemes taken from the Italian and international reference documents.

The Draft National Curriculum for Primary Mathematics

ERIC Educational Resources Information Center

Thompson, Ian

2012-01-01

Draft curriculum documents offer a glimpse of the future. They demand a response as all too often the devil is in the detail. What are the devils and maybe demons that await primary mathematics? This forensic consideration of the content of the draft curriculum for primary mathematics catalogues a lack of evidence to underpin proposals. Is the…

Primary Education in the United Arab Republic, Its Development and Organization.

ERIC Educational Resources Information Center

Mehrez, Zainab

This document is an English-language abstract (approximately 1,500 words) of a comprehensive survey describing the growth of primary schooling in the UAR during the 19th and 20th centuries. Different types of elementary schools were unified in 1951 into one category, and in 1953, all fees were abolished and primary certificate examinations were…

The World of Barilla Taylor: Bringing History to Life through Primary Sources.

ERIC Educational Resources Information Center

Stearns, Liza

1997-01-01

Presents a lesson plan using material from a primary source-based curriculum kit titled "The World of Barilla Taylor." The kit uses personal letters, maps, hospital and work records, and other primary sources to document the life of a young woman working in the textile mills in 19th-century Massachusetts. (MJP)

Cyclone-Resistant Rural Primary School Construction - A Design Guide. Educational Building Report 7.

ERIC Educational Resources Information Center

Sinnamon, Ian T.; Loo, G. A. van't

One of a series of documents on design of disaster-resistant buildings, this publication treats construction of rural primary schools to resist destruction by wind and water from cyclones. Also appropriate for other buildings, material is aimed at rural primary schools because they are less likely to be professionally designed or supervised; the…

Strengthening "the Foundations" of the Primary School Curriculum

ERIC Educational Resources Information Center

Duncombe, Rebecca; Cale, Lorraine; Harris, Jo

2018-01-01

The low status of the foundation subjects (e.g. Music and Physical Education (PE)) in English primary schools is well documented. Using PE as an illustrative example, a thematic analysis of 51 PE trainee students' assignments, based on their perceptions of a two-week experience in a primary school, highlighted a number of areas of concern (e.g.…

Primary Geography Education in China: Past, Current and Future

ERIC Educational Resources Information Center

Xuan, Xiaowei; Duan, Yushan; Sun, Yue

2015-01-01

In China, geography education in primary schools (grades 1 to 6) has not been emphasized, although some scholars have done research in this area. In order to deepen the understanding of primary geography education in China, this paper examines its history, current situation, and future trends. The authors used the method of document analysis and…

Association of ABO and Rh blood groups with breast cancer.

PubMed

Meo, Sultan Ayoub; Suraya, Faryal; Jamil, Badar; Rouq, Fwziah Al; Meo, Anusha Sultan; Sattar, Kamran; Ansari, Mohammad Javed; Alasiri, Saleh A

2017-11-01

The aim of this study was to determine the association of "ABO" and "Rhesus" blood groups with incidence of breast cancer. In this study, we identified 70 research documents from data based search engines including "PubMed", "ISI-Web of Knowledge", "Embase" and "Google Scholar". The research papers were selected by using the primary key-terms including "ABO blood type", "Rhesus" blood type and "breast cancer". The research documents in which "ABO" and "Rhesus" blood types and breast cancer was debated were included. After screening, we reviewed 32 papers and finally we selected 25 research papers which met the inclusion criteria and remaining documents were excluded. Blood group "A" has high incidence of breast cancer (45.88%), blood group "O" has (31.69%); "B" (16.16%) and blood group "AB" has (6.27%) incidence of breast cancer. Blood group "A" has highest and blood group "AB" has least association with breast cancer. Furthermore, "Rhesus +ve" blood group has high incidence of breast cancer (88.31%) and "Rhesus -ve" blood group has least association with breast cancer (11.68%). Blood group "A" and "Rhesus +ve" have high risk of breast cancer, while blood type "AB" and "Rhesus -ve" are at low peril of breast cancer. Physicians should carefully monitor the females with blood group "A" and "Rh +ve" as these females are more prone to develop breast cancer. To reduce breast cancer incidence and its burden, preventive and screening programs for breast cancer especially in young women are highly recommended.

The quality of primary care provided to the elderly in Israel.

PubMed

Podell, Rachel; Shriqui, Vered Kaufman; Sagy, Yael Wolff; Manor, Orly; Ben-Yehuda, Arie

2018-06-04

In view of increasing global and local trends in population ageing and the high healthcare utilization rates among the elderly, this study assesses the quality of primary care provided to the elderly population in Israel. It examines changes in quality over time, how quality varies across sub-groups of the elderly, and how quality in Israel compares with other countries. Data originate from the National Program for Quality Indicators in Community Healthcare (QICH), which operates in full collaboration with Israel's four HMOs. The study population included all elderly Israeli residents aged 65 years or older during 2002-2015 (N = 879,671 residents in 2015). Seven elderly-specific quality indicators from within the QICH framework were included: influenza and pneumococcal vaccinations, benzodiazepine overuse, long-acting benzodiazepine use, body weight documentation, weight loss and underweight. In addition, two non-age specific quality indicators relating to diabetes mellitus were included: the rate of HbA1C documentation and uncontrolled diabetes. Data were collected from patient electronic medical records (EMR) in accordance with each HMO, and aggregated by three variables: gender, age, and socio-economic position (SEP). During the measurement period, vaccination rates significantly increased (Influenza: from 42.0% in 2002 to 63.2% in 2015; and pneumococcal vaccination: from 25.8% in 2005 to 77.0% in 2015). Body weight documentation (in 65-74 year old persons) increased from only 16.3% in 2003 to 80.9% in 2015. The rate of underweight (BMI < 23 kg/m 2 ) and significant weight-loss (10% or more of their body weight) was only measured in 2015. The overall rate of benzodiazepine overuse remained steady from 2011 to 2015 at around 5%, while the rate of long-acting benzodiazepine use decreased from 3.8% in 2011 to 2.4% in 2015. The rate of HbA1c documentation for elderly diabetics was higher than for non-elderly diabetics in 2015 (92.2% vs 87.9%). The rate of uncontrolled diabetes was lower for the elderly than the non-elderly population in 2015 (6.9% vs. 15.7%). Gender disparities were observed across all measures, after age stratification, with worse indicator rates among females compared to males. SEP-disparities were not consistent across measures. In all indicators except benzodiazepine overuse, Israel showed a higher quality of care for the elderly in comparison with the international healthcare community. Overall, the quality of care received by elderly Israelis has improved substantially since measurements first began; yet, females receive lower quality care than males. Monitoring results of primary care quality indicators can contribute to population's successful aging; both chronic conditions at earlier ages (e.g. diabetes), and short-term hazardous conditions such as the use of potentially harmful medications and weight loss should be evaluated.

Reminder Cards Improve Physician Documentation of Obesity But Not Obesity Counseling.

PubMed

Shungu, Nicholas; Miller, Marshal N; Mills, Geoffrey; Patel, Neesha; de la Paz, Amanda; Rose, Victoria; Kropa, Jill; Edi, Rina; Levy, Emily; Crenshaw, Margaret; Hwang, Chris

2015-01-01

Physicians frequently fail to document obesity and obesity-related counseling. We sought to determine whether attaching a physical reminder card to patient encounter forms would increase electronic medical record (EMR) assessment of and documentation of obesity and dietary counseling. Reminder cards for obesity documentation were attached to encounter forms for patient encounters over a 2-week intervention period. For visits in the intervention period, the EMR was retrospectively reviewed for BMI, assessment of "obesity" or "morbid obesity" as an active problem, free-text dietary counseling within physician notes, and assessment of "dietary counseling" as an active problem. These data were compared to those collected through a retrospective chart review during a 2-week pre-intervention period. We also compared physician self-report of documentation via reminder cards with EMR documentation. We found significant improvement in the primary endpoint of assessment of "obesity" or "morbid obesity" as an active problem (42.5% versus 28%) compared to the pre-intervention period. There was no significant difference in the primary endpoints of free-text dietary counseling or assessment of "dietary counseling" as an active problem between the groups. Physician self-reporting of assessment of "obesity" or "morbid obesity" as an active problem (77.7% versus 42.5%), free-text dietary counseling on obesity (69.1% versus 35.4%) and assessment of "dietary counseling" as an active problem (54.3% versus 25.2%) were all significantly higher than those reflected in EMR documentation. This study demonstrates that physical reminder cards are a successful means of increasing obesity documentation rates among providers but do not necessarily increase rates of obesity-related counseling or documentation of counseling. Our study suggests that even with such interventions, physicians are likely under-documenting obesity and counseling compared to self-reported rates.

Primary restoration : guidance document for natural resource damage assessment under the Oil Pollution Act of 1990

DOT National Transportation Integrated Search

1996-08-01

The purpose of the [document] is to review the state of the art for restoration of certain habitats and biological natural resources and evaluate potential restoration actions following injury to natural resources resulting from the discharge of oil.

Evaluation of Kentucky's "Buckle Up Kentucky : It's the Law & It's Enforced" campaign.

DOT National Transportation Integrated Search

2003-08-01

The objective of this report was to document the results of the "Buckle Up Kentucky: It's the Law & It's Enforced" campaign in Kentucky. Data were also taken to document the change in usage after enactment of the primary enforcement law. The campaign...

77 FR 66663 - Agency Information Collection Activities: Proposed Information Collection; Submission for OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-06

... titled, ``Company-Run Annual Stress Test Reporting Template and Documentation for Covered Institutions... review and clearance. Company-Run Annual Stress Test Reporting Template and Documentation for Covered... savings associations, to conduct annual stress tests \\2\\ and requires the primary financial regulatory...

Incidence and management of arthralgias in breast cancer patients treated with aromatase inhibitors in an outpatient oncology clinic.

PubMed

Menas, Pamela; Merkel, Douglas; Hui, Wendy; Lawton, Jessica; Harper, Abigail; Carro, George

2012-12-01

Aromatase inhibitors (AIs) are routinely used as first-line adjuvant treatment of breast cancer in postmenopausal women with hormone receptor positive tumors. The current recommended length of treatment with an AI is 5 years. Arthralgias have been frequently cited as the primary reason for discontinuation of AI therapy. Various treatment strategies are proposed in literature, but a standardized treatment algorithm has not been established. The initial purpose of this study was to describe the incidence and management of AI-induced arthralgias in patients treated at Kellogg Cancer Center (KCC). Further evaluation led to the development and the implementation of a treatment algorithm and electronic medical record (EMR) documentation tools. The retrospective chart review included 206 adult patients with hormone receptor positive breast cancer who were receiving adjuvant therapy with an AI. A multidisciplinary treatment team consisting of pharmacists, collaborative practice nurses, and physicians met to develop a standardized treatment algorithm and corresponding EMR documentation tool. The treatment algorithm and documentation tool were developed after the study to better monitor and proactively treat patients with AI-induced arthralgias. RESULTS/ CONCLUSIONS: The overall incidence of arthralgias at KCC was 48% (n = 98/206). Of these patients, 32% were documented as having arthralgias within the first 6 months of therapy initiation. Patients who reported AI-induced arthralgias were younger than patients who did not report AI-induced arthralgias (61 vs. 65 years, p = 0.002). There was no statistical difference in the incidence of arthralgias in patients with a history of chemotherapy (including taxane therapy) compared to those who did not receive chemotherapy (p = 0.352). Of patients presenting with AI-induced arthralgias, 41% did not have physician-managed treatment documented in the EMR. A standardized treatment algorithm and electronic chart documentation tools were then developed by the multidisciplinary team.

Best practice in primary care pathology: review 7

PubMed Central

Smellie, W S A; Forth, J; Smart, S R S; Galloway, M J; Irving, W; Bareford, D; Collinson, P O; Kerr, K G; Summerfield, G; Carey, P J; Minhas, Rubin

2007-01-01

This seventh best‐practice review examines four series of common primary care questions in laboratory medicine: (1) blood count abnormalities 2; (2) cardiac troponins; (3) high‐density lipoprotein cholesterol; and (4) viral diseases 2. The review is presented in a question–answer format, with authorship attributed for each question series. The recommendations are a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence‐based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. The recommendations are not standards, but form a guide to be set in the clinical context. Most are consensus based rather than evidence based. They will be updated periodically to take account of new information. PMID:17046843

Role of the registered nurse in primary health care: meeting health care needs in the 21st century.

PubMed

Smolowitz, Janice; Speakman, Elizabeth; Wojnar, Danuta; Whelan, Ellen-Marie; Ulrich, Suzan; Hayes, Carolyn; Wood, Laura

2015-01-01

There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered. Copyright © 2015 Elsevier Inc. All rights reserved.

Automated payload experiment tool feasibility study

NASA Technical Reports Server (NTRS)

Maddux, Gary A.; Clark, James; Delugach, Harry; Hammons, Charles; Logan, Julie; Provancha, Anna

1991-01-01

To achieve an environment less dependent on the flow of paper, automated techniques of data storage and retrieval must be utilized. The prototype under development seeks to demonstrate the ability of a knowledge-based, hypertext computer system. This prototype is concerned with the logical links between two primary NASA support documents, the Science Requirements Document (SRD) and the Engineering Requirements Document (ERD). Once developed, the final system should have the ability to guide a principal investigator through the documentation process in a more timely and efficient manner, while supplying more accurate information to the NASA payload developer.

Medical professional liability claims for Mohs micrographic surgery from 1989 to 2011.

PubMed

D'Souza, Logan S; Jalian, H Ray; Jalian, Chris; Alam, Murad; Eisen, Daniel B; Avram, Mathew M; Ibrahimi, Omar A

2015-05-01

Few studies specifically address lawsuits involving Mohs surgery. To better characterize the types of medical professional liability claims involving Mohs surgery. Retrospective legal document review of an online national database. Any legal proceeding involving the search words Mohs and cancer was included. Number of medical professional liability claims involving Mohs surgery for factors including year of litigation, location, physician specialty, injury sustained, cause of legal action, and verdict. Forty-two cases were identified, which occurred from 1989 to 2011. Of the cases identified, 26 involved non-Mohs surgeons as the primary defendant, mostly due to a delay of or failure in diagnosis (n = 16), cosmetic outcome issues (n = 8), lack of informed consent (n = 7), and a delay of or failure in referral to a Mohs surgeon (n = 6). Common causes for litigation against Mohs surgeons as the primary defendant (n = 16) were lack of proper informed consent (n = 5) and cosmetic outcome issues (n = 4). Only 1 case against a Mohs surgeon was judged for the plaintiff. The most common lawsuits pertaining to Mohs surgery list non-Mohs surgeons as the primary defendants. Closer coordination between non-Mohs surgeons and Mohs surgeons may help minimize risk to both parties and lead to better patient care. Small sample size is the primary limitation, in part owing to exclusion of out-of-court settlements from the database.

Dynamics Explorer 1: Energetic Ion Composition Spectrometer (EICS)

NASA Technical Reports Server (NTRS)

Shelley, E. G.; Peterson, W. K.; Collin, H. L.

1994-01-01

The Energetic Ion Composition Spectrometer (EICS) experiment was selected as part of the Dynamics Explorer (DE) Program. One of the primary goals of the DE program was to investigate in detail the plasma physics processes responsible for energizing thermal (approximately 1 eV) ionospheric ions and transporting them to the earth's plasma sheet and distant polar cap. The results of the EICS data analysis (including support of other investigators) and of the archiving efforts supported by this contract are summarized in this document. Also reported are some aspects of our operational support activities.

Final technical report for DE-SC00012633 AToM (Advanced Tokamak Modeling)

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

Holland, Christopher; Orlov, Dmitri; Izzo, Valerie

This final report for the AToM project documents contributions from University of California, San Diego researchers over the period of 9/1/2014 – 8/31/2017. The primary focus of these efforts was on performing validation studies of core tokamak transport models using the OMFIT framework, including development of OMFIT workflow scripts. Additional work was performed to develop tools for use of the nonlinear magnetohydrodynamics code NIMROD in OMFIT, and its use in the study of runaway electron dynamics in tokamak disruptions.

Guidance Document: Surface Soils Sampling for Munitions Residues in Military Live Fire Training Ranges: Canadian Protocol

DTIC Science & Technology

2012-12-01

NA Boron B 0.5 NA Cadmium Cd 0.3 22 Calcium Ca 4.0 NA Chromium Cr 0.5 87 Cobalt Co 0.5 300 Copper Cu 0.4 91 Iron Fe 0.6 NA Lead Pb 2.5 600...on their susceptibility to initiation. Primary explosives, which include lead azide, lead styphnate, and mercury fulminate, are highly susceptible...ballistic properties. The degradation of NC leads to substances which speed up the degradation process, or else an autocatalytic reaction. To counteract

Project Developmental Continuity Evaluation: Site Visitors' Manual.

ERIC Educational Resources Information Center

Morris, Mary; Smith, Allen

This site visitors' manual is part of a series of documents on the evaluation of Project Developmental Continuity (PDC), a Head Start demonstration program aimed at providing educational and developmental continuity between children's Head Start and primary school experiences. The PDC evaluation documents and analyzes the process of program…

Investigating the Advantages of Constructing Multidigit Numeration Understanding through Oneida and Lakota Native Languages.

ERIC Educational Resources Information Center

Hankes, Judith Elaine

This paper documents a culturally specific language strength for developing number sense among Oneida- and Lakota-speaking primary students. Qualitative research methods scaffolded this research study: culture informants were interviewed and interviews were transcribed and coded for analysis; culture documents were selected for analysis; and…

Scientist contributions

Treesearch

R. Blank; W. Burkhardt; J. Chatterton; W. Dollarhide; L. James; D. Klebenow; W. Krueger; S. Leonard; E. Miller; N. Rimbey; K. Sanders; S. Swanson; R. Tausch; P. Tueller; N. West; J. Young

2008-01-01

The primary impetus for this Wildfire Forum is a document authored by John McLain and Sheila Anderson of Resource Concepts, Inc. entitled "Urgent Need for a Scientific Review of the Ecological and Management History of the Great Basin Natural Resources and Recommendations to Achieve Ecosystem Restoration." This document urged prominent scientists who have...

75 FR 10252 - Release of Draft Documents Related to the Review of the National Ambient Air Quality Standards...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-05

.... This draft document describes the quantitative analyses that are being conducted as part of the review... primary (health-based) CO NAAQS, the Agency is conducting qualitative and quantitative assessments... results, observations, and related uncertainties associated with the quantitative analyses performed. An...

Evaluation of Kentucky's "Buckle Up Kentucky : It's the Law & It's Enforced" 2007 campaign.

DOT National Transportation Integrated Search

2007-08-01

The objective of this report was to document the results of the "Buckle Up Kentucky: It's the Law & It's Enforced" 2007 campaign in Kentucky. Data were also taken to document the change in usage after enactment of the primary enforcement law. The cam...

Evaluation of Kentucky's "Buckle Up Kentucky : It's the Law & It's Enforced" 2004 campaign.

DOT National Transportation Integrated Search

2004-07-01

The objective of this report was to document the results of the "Buckle Up Kentucky: It's the Law & It's Enforced" 2004 campaign in Kentucky. Data were also taken to document the change in usage after enactment of the primary enforcement law. The cam...

Evaluation of Kentucky's "Buckle Up Kentucky : It's the Law & It's Enforced" 2006 campaign.

DOT National Transportation Integrated Search

2006-07-01

The objective of this report was to document the results of the "Buckle Up Kentucky: It's the Law & It's Enforced" 2006 campaign in Kentucky. Data were also taken to document the change in usage after enactment of the primary enforcement law. The cam...

Evaluation of Kentucky's "Buckle Up Kentucky : It's the Law & It's Enforced" 2005 campaign.

DOT National Transportation Integrated Search

2005-07-01

The objective of this report was to document the results of the "Buckle Up Kentucky: It's the Law & It's Enforced" 2005 campaign in Kentucky. Data were also taken to document the change in usage after enactment of the primary enforcement law. The cam...

11 CFR 9033.11 - Documentation of disbursements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... PRIMARY MATCHING FUND ELIGIBILITY FOR PAYMENTS § 9033.11 Documentation of disbursements. (a) Burden of proof. Each candidate shall have the burden of proving that disbursements made by the candidate or his... policy, such as a daily travel expense policy. (iv) If the purpose of the disbursement is not stated in...

Exploring Midwives' Need and Intention to Adopt Electronic Integrated Antenatal Care

PubMed Central

Markam, Hosizah; Hochheiser, Harry; Kuntoro, Kuntoro; Notobroto, Hari Basuki

2018-01-01

Documentation requirements for the Indonesian integrated antenatal care (ANC) program suggest the need for electronic systems to address gaps in existing paper documentation practices. Our goals were to quantify midwives' documentation completeness in a primary healthcare center, understand documentation challenges, develop a tool, and assess intention to use the tool. We analyzed existing ANC records in a primary healthcare center in Bangkalan, East Java, and conducted interviews with stakeholders to understand needs for an electronic system in support of ANC. Development of the web-based Electronic Integrated ANC (e-iANC) system used the System Development Life Cycle method. Training on the use of the system was held in the computer laboratory for 100 midwives chosen from four primary healthcare centers in each of five regions. The Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire was used to assess their intention to adopt e-iANC. The midwives' intention to adopt e-iANC was significantly influenced by performance expectancy, effort expectancy and facilitating conditions. Age, education level, and computer literacy did not significantly moderate the effects of performance expectancy and effort expectancy on adoption intention. The UTAUT results indicated that the factors that might influence intention to adopt e-iANC are potentially addressable. Results suggest that e-iANC might well be accepted by midwives. PMID:29618961

Prevalence of Heart Failure Signs and Symptoms in a Large Primary Care Population Identified Through the Use of Text and Data Mining of the Electronic Health Record

PubMed Central

Vijayakrishnan, Rajakrishnan; Steinhubl, Steven R.; Ng, Kenney; Sun, Jimeng; Byrd, Roy J.; Daar, Zahra; Williams, Brent A.; deFilippi, Christopher; Ebadollahi, Shahram; Stewart, Walter F.

2014-01-01

Background The electronic health record contains a tremendous amount of data that if appropriately detected can lead to earlier identification of disease states such as heart failure (HF). Using a novel text and data analytic tool we explored the longitudinal EHR of over 50,000 primary care patients to identify the documentation of the signs and symptoms of HF in the years preceding its diagnosis. Methods and Results Retrospective analysis consisting of 4,644 incident HF cases and 45,981 group-matched controls. Documentation of Framingham HF signs and symptoms within encounter notes were carried out using a previously validated natural language processing procedure. A total of 892,805 affirmed criteria were documented over an average observation period of 3.4 years. Among eventual HF cases, 85% had at least one criterion within a year prior to their HF diagnosis (as did 55% of controls). Substantial variability in the prevalence of individual signs and symptoms were found in both cases and controls. Conclusions HF signs and symptoms are frequently documented in a primary care population as identified through automated text and data mining of EHRs. Their frequent identification demonstrates the rich data available within EHRs that will allow for future work on automated criterion identification to help develop predictive models for HF. PMID:24709663

Information handoff and outcomes of critically ill patients transferred between hospitals

PubMed Central

Usher, Michael G.; Fanning, Christine; Wu, Di; Muglia, Christine; Balonze, Karen; Kim, Deborah; Parikh, Amay; Herrigel, Dana

2016-01-01

Purpose Patients transferred between hospitals are at high risk of adverse events and mortality. This study aims to identify which components of the transfer handoff process are important predictors of adverse events and mortality. Materials and Methods We conducted a retrospective, observational study of 335 consecutive patient transfers to three ICUs at an academic tertiary referral center. We assessed the relationship between handoff documentation completeness and patient outcomes. The primary outcome was in-hospital mortality. Secondary outcomes included adverse events, duplication of labor, disposition error, and length of stay. Results Transfer documentation was frequently absent with overall completeness of 58.3%. Adverse events occurred in 42% of patients within 24 hours of arrival, with an overall in-hospital mortality of 17.3%. Higher documentation completeness was associated with reduced in-hospital mortality (OR 0.07, 95% CI 0.02 to 0.38, p=0.002), reduced adverse events (coef −2.08, 95% CI −2.76 to −1.390, p<0.001), and reduced duplication of labor (OR 0.19, 95% CI 0.04 to 0.88, p=0.033) when controlling for severity of illness. Conclusions Documentation completeness is associated with improved outcomes and resource utilization in patients transferred between hospitals. PMID:27591388

Canadian Cardiovascular Society position statement on the management of thoracic aortic disease.

PubMed

Boodhwani, Munir; Andelfinger, Gregor; Leipsic, Jonathon; Lindsay, Thomas; McMurtry, M Sean; Therrien, Judith; Siu, Samuel C

2014-06-01

This Canadian Cardiovascular Society position statement aims to provide succinct perspectives on key issues in the management of thoracic aortic disease (TAD). This document is not a comprehensive overview of TAD and important elements of the epidemiology, presentation, diagnosis, and management of acute aortic syndromes are deliberately not discussed; readers are referred to the 2010 guidelines published by the American Heart Association, American College of Cardiology, American Association for Thoracic Surgery, and other stakeholders. Rather, this document is a practical guide for clinicians managing adult patients with TAD. Topics covered include size thresholds for surgical intervention, emerging therapies, imaging modalities, medical and lifestyle management, and genetics of TAD. The primary panel consisted of experts from a variety of disciplines that are essential for comprehensive management of TAD patients. The methodology involved a focused literature review with an emphasis on updates since 2010 and the use of Grading of Recommendations Assessment, Development, and Evaluation methodology to arrive at specific recommendations. The final document then underwent review by a secondary panel. This document aims to provide recommendations for most patients and situations. However, the ultimate judgement regarding the management of any individual patients should be made by their health care team. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Section 8(e) Notice User Guide – Primary Authorized Official

EPA Pesticide Factsheets

This document is the user guide for the Primary Authorized Official (AO) user of the Section 8(e) Notice tool which is part of the Office of Pollution Prevention and Toxics (OPPT) ‘Section 8(e) Notice’ application submission process.

78 FR 47191 - Air Quality Designations for the 2010 Sulfur Dioxide (SO2) Primary National Ambient Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

... Air Quality Designations for the 2010 Sulfur Dioxide (SO[bdi2]) Primary National Ambient Air Quality... air quality designations for certain areas in the United States for the 2010 primary Sulfur Dioxide... of this document? III. What is sulfur dioxide? IV. What is the 2010 SO 2 NAAQS and what are the...

A Very Historical Mode of Understanding: Examining Editorial and Ethnographic Relations in "The Primary" (2008)

ERIC Educational Resources Information Center

Warmington, Paul; Grosvenor, Ian

2011-01-01

This article offers an analysis of "The Primary," a television documentary broadcast in the UK in 2008 as part of a BBC series exploring multicultural Britain. The film documents a term at an inner-city primary school. It depicts school leadership, cultural diversity, relationships between the school and the local community, pupils'…

Institutional Determinants of Organizational Change in Primary Education in Nineteenth Century America and Britain. Final Report.

ERIC Educational Resources Information Center

Smelser, Neil J.

Using historical documents, this report traces the development of the system of primary education in Great Britain and the United States. During the period between 1810 and 1870, both Britain and the United States attempted to form an organization for primary schooling and achieved great progress in the institutionalization and growth of mass…

Pakistan's Primary Education Quality Improvement Program: Local Partners Work with Rural Communities to Support High Quality Education for Girls

ERIC Educational Resources Information Center

Afridi, Zahid A.

2006-01-01

This document describes the contributions made by the Primary Education Quality Improvement Program (1996-1999) to the broad goals of improved access, equity, and quality in girls' primary education in Pakistan. In Balochistan, the largest but least developed province of Pakistan, an innovative approach to educational development was successfully…

Integrated Science Assessment (ISA) for Sulfur Oxides ...

EPA Pesticide Factsheets

This draft document provides EPA’s evaluation and synthesis of the most policy-relevant science related to the health effects of sulfur oxides. When final, it will provide a critical part of the scientific foundation for EPA’s decision regarding the adequacy of the current primary (health-based) National Ambient Air Quality Standard (NAAQS) for sulfur dioxide. The references considered for inclusion in or cited in the external review draft ISA are available at https://hero.epa.gov/hero/sulfur-oxides. The intent of the ISA, according to the CAA, is to “accurately reflect the latest scientific knowledge expected from the presence of [a] pollutant in ambient air” (U.S. Code, 1970a, 1970b). It includes an assessment of scientific research from atmospheric sciences, exposure sciences, dosimetry, mode of action, animal and human toxicology, and epidemiology. Key information and judgments formerly found in the Air Quality Criteria Documents (AQCDs) for sulfur oxides (SOx) are included; Annexes provide additional details supporting the ISA. Together, the ISA and Annexes serve to update and revise the last SOx ISA which was published in 2008.

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018.

PubMed

Ozaki, Yukio; Katagiri, Yuki; Onuma, Yoshinobu; Amano, Tetsuya; Muramatsu, Takashi; Kozuma, Ken; Otsuji, Satoru; Ueno, Takafumi; Shiode, Nobuo; Kawai, Kazuya; Tanaka, Nobuhiro; Ueda, Kinzo; Akasaka, Takashi; Hanaoka, Keiichi Igarashi; Uemura, Shiro; Oda, Hirotaka; Katahira, Yoshiaki; Kadota, Kazushige; Kyo, Eisho; Sato, Katsuhiko; Sato, Tadaya; Shite, Junya; Nakao, Koichi; Nishino, Masami; Hikichi, Yutaka; Honye, Junko; Matsubara, Tetsuo; Mizuno, Sumio; Muramatsu, Toshiya; Inohara, Taku; Kohsaka, Shun; Michishita, Ichiro; Yokoi, Hiroyoshi; Serruys, Patrick W; Ikari, Yuji; Nakamura, Masato

2018-04-01

While primary percutaneous coronary intervention (PCI) has significantly contributed to improve the mortality in patients with ST segment elevation myocardial infarction even in cardiogenic shock, primary PCI is a standard of care in most of Japanese institutions. Whereas there are high numbers of available facilities providing primary PCI in Japan, there are no clear guidelines focusing on procedural aspect of the standardized care. Whilst updated guidelines for the management of acute myocardial infarction were recently published by European Society of Cardiology, the following major changes are indicated; (1) radial access and drug-eluting stent over bare metal stent were recommended as Class I indication, and (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. Although the primary PCI is consistently recommended in recent and previous guidelines, the device lag from Europe, the frequent usage of coronary imaging modalities in Japan, and the difference in available medical therapy or mechanical support may prevent direct application of European guidelines to Japanese population. The Task Force on Primary Percutaneous Coronary Intervention of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document for the management of acute myocardial infarction focusing on procedural aspect of primary PCI.

Impact of tobacco industry and other corporations in the defeat of the 1994 Clinton health care plan.

PubMed

Givel, Michael

2017-06-21

The primary reason cited by many scholars for the defeat of the Clinton Administration's 1994 health care reform bill has long been identified as Health Insurance Association of America and National Federation of Independent Businesses opposition to the bill. Given this predominant consensus combined with sizeable proposed funding for the bill by a large tobacco product tax, this manuscript examined what the tobacco industry's role was in whole or part in defeating the Clinton health care bill. This research occurred through crosschecking internal tobacco industry documents and Clinton White House documents. Prior to the passage of the bill, the tobacco industry accepted a compromise of 45 cents per pack increase phased in over five years. Due to this compromise, the industry or third party allies had no role in the ultimate defeat in the bill. The primary reason for the bill's ultimate defeat was general business (but not tobacco industry and third party ally) opposition, the bill running out of time, and conflicting bills. Secondary reasons for the bill's defeat included issues with: employer mandates, high taxes on insurance plans, impacts on medical research and education, Congressional attention to other issues, election year politics, and possible future excise tax possibilities.

Challenges in managing a school-based measles outbreak in Melbourne, Australia, 2014.

PubMed

Gibney, Katherine B; Brahmi, Aicha; O'Hara, Miriam; Morey, Rosemary; Franklin, Lucinda

2017-02-01

To identify barriers to control of a Victorian primary school-based measles outbreak. Confirmed measles cases notified in Victoria in 2014 were reviewed. Surveillance data, correspondence, and investigation notes for the school-based outbreak were assessed regarding timeliness of diagnosis and notification, and adequacy of school-based immunisation records. Twenty-three (31%) of the 75 measles cases notified in 2014 were school-aged (5-18 years); three had documentation of measles vaccination, 17 were unvaccinated, and three had unknown vaccination history. Eight measles outbreaks were identified, including a primary school-based outbreak with ten cases. Of the six unvaccinated pupils in the affected school, five (83%) contracted measles. The proportion of the school's prep students with documented vaccination records, as required by law, ranged from 39% in 2013 to 97% in 2014. Inadequately vaccinated students constitute a vulnerable population and schools are a potential site for measles outbreaks. Inadequate enforcement of school-based immunisation records impact the management and control of school-based measles outbreaks. Implications for Public Health: There is a need to educate clinicians on measles diagnosis and notification, and schools on the requirement to maintain up-to-date vaccination records. School entry is an opportunity to review student vaccination history and offer immunisations. © 2016 The Authors.

Ground-based grasslands data to support remote sensing and ecosystem modeling of terrestrial primary production

NASA Technical Reports Server (NTRS)

Olson, R. J.; Scurlock, J. M. O.; Turner, R. S.; Jennings, S. V.

1995-01-01

Estimating terrestrial net primary production (NPP) using remote-sensing tools and ecosystem models requires adequate ground-based measurements for calibration, parameterization, and validation. These data needs were strongly endorsed at a recent meeting of ecosystem modelers organized by the International Geosphere-Biosphere Program's (IGBP's) Data and Information System (DIS) and its Global Analysis, Interpretation, and Modelling (GAIM) Task Force. To meet these needs, a multinational, multiagency project is being coordinated by the IGBP DIS to compile existing NPP data from field sites and to regionalize NPP point estimates to various-sized grid cells. Progress at Oak Ridge National Laboratory (ORNL) on compiling NPP data for grasslands as part of the IGBP DIS data initiative is described. Site data and associated documentation from diverse field studies are being acquired for selected grasslands and are being reviewed for completeness, consistency, and adequacy of documentation, including a description of sampling methods. Data are being compiled in a database with spatial, temporal, and thematic characteristics relevant to remote sensing and global modeling. NPP data are available from the ORNL Distributed Active Archive Center (DAAC) for biogeochemical dynamics. The ORNL DAAC is part of the Earth Observing System Data and Information System, of the US National Aeronautics and Space Administration.

Completing below-ground carbon budgets for pastures, recovering forests, and mature forests of Amazonia

NASA Technical Reports Server (NTRS)

Davidson, Eric A.; Nepstad, Daniel C.; Trumbore, Susan E.

1995-01-01

This progress report covers the following efforts initiated for the year: year-round monthly soil CO2 flux measurements were started in both primary and secondary forests and in managed and degraded pastures; root sorting and weighing has begun and all four ecosystems at Paragominas have been analyzed through samples; regional modeling of soil water dynamics and minimum rooting depth has been done and the RADAMBRASIL soils database has been digitized and a 20 year record of the precipitation for the region has been produced, along with a hydrological ('bucket-tipping') model that will run within a GIS framework; prototype tension lysimeters have been designed and installed in soil pits to begin assessing the importance of DOC as a source of organic matter in deep soils; and many publications, listed in this document, have resulted from this year's research. Two of the papers published are included with this annual report document.

Ethical, Legal, and Administrative Considerations for Preparticipation Evaluation for Wilderness Sports and Adventures.

PubMed

Young, Craig C; Campbell, Aaron D; Lemery, Jay; Young, David S

2015-12-01

Preparticipation evaluations (PPEs) are common in team, organized, or traditional sports but not common in wilderness sports or adventures. Regarding ethical, legal, and administrative considerations, the same principles can be used as in traditional sports. Clinicians should be trained to perform such a PPE to avoid missing essential components and to maximize the quality of the PPE. In general, participants' privacy should be observed; office-based settings may be best for professional and billing purposes, and adequate documentation of a complete evaluation, including clearance issues, should be essential components. Additional environmental and personal health issues relative to the wilderness activity should be documented, and referral for further screening should be made as deemed necessary, if unable to be performed by the primary clinician. Travel medicine principles should be incorporated, and recommendations for travel or adventure insurance should be made. Copyright © 2015. Published by Elsevier Inc.

Fifth Annual Report: 2008 Pre-Construction Eelgrass Monitoring and Propagation for King County Outfall Mitigation

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

Woodruff, Dana L.; Judd, Chaeli; Thom, Ronald M.

2010-01-01

This is the fifth and final report in a series documenting progress of the pre-construction eelgrass restoration and mitigation activities for the proposed King County Brightwater marine outfall, discharging to Puget Sound near Point Wells, Washington. King County began implementing a multiyear eelgrass monitoring and restoration program in 2004, with the primary goal of returning intertidal and shallow subtidal habitat and eelgrass to pre-construction conditions, after construction of the outfall. Major eelgrass mitigation program elements include: a) pre-construction monitoring, i.e., documenting initial eelgrass conditions and degree of fluctuation over a 5 year period prior to construction, b) eelgrass transplanting, includingmore » harvesting, offsite propagation and stockpiling of local plants for post-construction planting, and c) post-construction planting and subsequent monitoring, occurring in 2009 and beyond. The overall program is detailed in the Eelgrass Restoration and Biological Resources Implementation Workplan (King County 2008).« less

Saline magnetic resonance arthrography in the evaluation of glenohumeral instability.

PubMed

Tirman, P F; Stauffer, A E; Crues, J V; Turner, R M; Nottage, W M; Schobert, W E; Rubin, B D; Janzen, D L; Linares, R C

1993-01-01

Sixty-five patients underwent magnetic resonance (MR) shoulder arthrography. Forty-eight of these patients underwent examination under anesthesia (EUA). MR images were retrospectively evaluated for signs felt to be imaging indicators of shoulder instability, including evaluation of various capsular measurements and the presence of glenoid labral tears, as well as Hill-Sachs fractures. Statistical analysis of the results showed that no correlation between capsular indicators with EUA-documented instability was found. However, there was a statistically significant correlation between the presence of a Bankart cartilaginous deformity (p = 0.000) and Hill-Sachs fractures (p = 0.022) with EUA-documented instability. Sensitivity to labral tears was 89% and specificity was 98%, whereas Hill-Sachs fracture detection was 69% and 87%, respectively. We believe that MR saline arthrography is of benefit in the evaluation of the anterior labrum when unenhanced MR imaging is inconclusive, and we speculate on the role of MR arthrography as a primary investigative tool.

Technical Support Document: Development of the Advanced Energy Design Guide for Large Hospitals - 50% Energy Savings

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

Bonnema, E.; Leach, M.; Pless, S.

2013-06-01

This Technical Support Document describes the process and methodology for the development of the Advanced Energy Design Guide for Large Hospitals: Achieving 50% Energy Savings Toward a Net Zero Energy Building (AEDG-LH) ASHRAE et al. (2011b). The AEDG-LH is intended to provide recommendations for achieving 50% whole-building energy savings in large hospitals over levels achieved by following Standard 90.1-2004. The AEDG-LH was created for a 'standard' mid- to large-size hospital, typically at least 100,000 ft2, but the strategies apply to all sizes and classifications of new construction hospital buildings. Its primary focus is new construction, but recommendations may be applicablemore » to facilities undergoing total renovation, and in part to many other hospital renovation, addition, remodeling, and modernization projects (including changes to one or more systems in existing buildings).« less

Ethical, Legal, and Administrative Considerations for Preparticipation Evaluation for Wilderness Sports and Adventures.

PubMed

Young, Craig C; Campbell, Aaron D; Lemery, Jay; Young, David S

2015-09-01

Preparticipation evaluations (PPEs) are common in team, organized, or traditional sports but not common in wilderness sports or adventures. Regarding ethical, legal, and administrative considerations, the same principles can be used as in traditional sports. Clinicians should be trained to perform such a PPE to avoid missing essential components and to maximize the quality of the PPE. In general, participants' privacy should be observed; office-based settings may be best for professional and billing purposes, and adequate documentation of a complete evaluation, including clearance issues, should be essential components. Additional environmental and personal health issues relative to the wilderness activity should be documented, and referral for further screening should be made as deemed necessary, if unable to be performed by the primary clinician. Travel medicine principles should be incorporated, and recommendations for travel or adventure insurance should be made.

Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma.

PubMed

Ong, Sally S; Sanka, Krishna; Mettu, Priyatham S; Brosnan, Thomas M; Stinnett, Sandra S; Lee, Paul P; Challa, Pratap

2013-12-01

To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients. Retrospective chart review. One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center. Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines. Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency. The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts. Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

A Prevalence and Management Study of Acute Pain in Children Attending Emergency Departments by Ambulance.

PubMed

Murphy, Adrian; McCoy, Siobhan; O'Reilly, Kay; Fogarty, Eoin; Dietz, Jason; Crispino, Gloria; Wakai, Abel; O'Sullivan, Ronan

2016-01-01

Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (<16 years) who had pain as a symptom (regardless of cause) at any stage during the prehospital phase of care were included in this study. Over the study period, 6,371 children attended the four EDs by emergency ambulance, of which 2,635 (41.4%, 95% confidence interval 40.2-42.3%) had pain as a documented symptom on the ambulance patient care report (PCR) form. Overall 32% (n = 856) of children who complained of pain were subject to a formal pain assessment during the prehospital phase of care. Younger age, short transfer time to the ED, and emergency calls between midnight and 6 am were independently associated with decreased likelihood of having a documented assessment of pain intensity during the prehospital phase of care. Of the 2,635 children who had documented pain on the ambulance PCR, 26% (n = 689) received some form of analgesic agent prior to ED arrival. Upon ED arrival 54% (n = 1,422) of children had a documented pain assessment and some form of analgesic agent was administered to 50% (n = 1,324). Approximately 41% of children who attend EDs in Ireland by ambulance have pain documented as their primary symptom. This study suggests that the management of acute pain in children transferred by ambulance to the ED in Ireland is currently poor, with documentary evidence of only 26% receiving prehospital analgesic agents.

Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach

PubMed Central

2013-01-01

Background Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve quality of RHD care through development and implementation of a continuous quality improvement (CQI) strategy. Methods We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008–2010. Participatory action research methods were employed to identify system barriers to delivery of high quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (≥80% of scheduled 4-weekly penicillin injections) and quality of documentation. Results Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ≥40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p = 0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p = 0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p = 0.001). However, the proportion receiving ≥80% of scheduled BPG did not change. Documentation in medical files improved: ARF episode documentation increased from 31/55 (56%) to 50/62 (81%) (p = 0.004), and RHD risk category documentation from 87/154 (56%) to 103/145 (76%) (p < 0.001). Large differences in performance were noted between health centres, reflected to some extent in SAT scores. Conclusions A CQI process using a systems approach and participatory action research methodology can significantly improve delivery of ARF/RHD care. PMID:24350582

Protocol for a national prevalence study of advance care planning documentation and self-reported uptake in Australia.

PubMed

Ruseckaite, Rasa; Detering, Karen M; Evans, Sue M; Perera, Veronica; Walker, Lynne; Sinclair, Craig; Clayton, Josephine M; Nolte, Linda

2017-11-03

Advance care planning (ACP) is a process between a person, their family/carer(s) and healthcare providers that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care. The Australian government funds a number of national initiatives aimed at increasing ACP uptake; however, there is currently no standardised Australian data on formal ACP documentation or self-reported uptake. This makes it difficult to evaluate the impact of ACP initiatives. This study aims to determine the Australian national prevalence of ACP and completion of Advance Care Directives (ACDs) in hospitals, aged care facilities and general practices. It will also explore people's self-reported use of ACP and views about the process. Researchers will conduct a national multicentre cross-sectional prevalence study, consisting of a record audit and surveys of people aged 65 years or more in three sectors. From 49 participating Australian organisations, 50 records will be audited (total of 2450 records). People whose records were audited, who speak English and have a decision-making capacity will also be invited to complete a survey. The primary outcome measure will be the number of people who have formal or informal ACP documentation that can be located in records within 15 min. Other outcomes will include demographics, measure of illness and functional capacity, details of ACP documentation (including type of document), location of documentation in the person's records and whether current clinical care plans are consistent with ACP documentation. People will be surveyed, to measure self-reported interest, uptake and use of ACP/ACDs, and self-reported quality of life. This protocol has been approved by the Austin Health Human Research Ethics Committee (reference HREC/17/Austin/83). Results will be submitted to international peer-reviewed journals and presented at international conferences. ACTRN12617000743369. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

National Wind Technology Center sitewide, Golden, CO: Environmental assessment

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

NONE

1996-11-01

The National Renewable Energy Laboratory (NREL), the nation`s primary solar and renewable energy research laboratory, proposes to expand its wind technology research and development program activities at its National Wind Technology Center (NWTC) near Golden, Colorado. NWTC is an existing wind energy research facility operated by NREL for the US Department of Energy (DOE). Proposed activities include the construction and reuse of buildings and facilities, installation of up to 20 wind turbine test sites, improvements in infrastructure, and subsequent research activities, technology testing, and site operations. In addition to wind turbine test activities, NWTC may be used to support othermore » NREL program activities and small-scale demonstration projects. This document assesses potential consequences to resources within the physical, biological, and human environment, including potential impacts to: air quality, geology and soils, water resources, biological resources, cultural and historic resources, socioeconomic resources, land use, visual resources, noise environment, hazardous materials and waste management, and health and safety conditions. Comment letters were received from several agencies in response to the scoping and predecisional draft reviews. The comments have been incorporated as appropriate into the document with full text of the letters contained in the Appendices. Additionally, information from the Rocky Flats Environmental Technology Site on going sitewide assessment of potential environmental impacts has been reviewed and discussed by representatives of both parties and incorporated into the document as appropriate.« less

Out-of-hours demand in primary care: frequency, mode of contact and reasons for encounter in Switzerland.

PubMed

Huber, Carola A; Rosemann, Thomas; Zoller, Marco; Eichler, Klaus; Senn, Oliver

2011-02-01

To investigate the demand for traditional out-of-hours general practitioner (GP) emergency care in Switzerland including GPs' satisfaction and reasons for encounter (RFE). During a 2-month period (2009), a questionnaire-based, cross-sectional study was performed in GPs participating in the mandatory out-of-hours service in the city of Zurich, Switzerland. The number and mode of patient contacts were assessed to investigate the demand for GP care in traditional out-of-hours services. GPs and patient characteristics, including RFE according to the International Classification of Primary Care, were noted. Descriptive statistics and non-parametric tests were conducted. Out of the 295 out-of-hours episodes during the study period, 148 (50%) duty periods were documented by a total of 93 GPs (75% men) with a mean (SD) age of 48.0 (6.2) years. The median (interquartile range) number of out-of-hours contacts was 5 (3-8) and the demand for home visits was significantly more common compared with practice and telephone consultations. A total of 112 different RFEs were responsible for the 382 documented patient contacts with fever accounting for the most common complaint (13.9%). Although 80% of GPs agreed to be satisfied overall with their profession as primary care provider, 57.6% among them were dissatisfied with the current out-of-hours service. Inappropriate payment and interference with their daily work in practice were most frequently reported. Our findings indicate that there is still strong patient demand for out-of-hours care with special need for home visits, suggesting that new organizational models such as integrating GPs into emergency care may not be an appropriate approach for all patients. Therefore, the ongoing reorganization of the out-of-hours-service in many health care systems has to be evaluated carefully in order not to miss important patient needs. © 2010 Blackwell Publishing Ltd.

Equity in primary health care delivery: an examination of the cohesiveness of strategies relating to the primary healthcare system, the health workforce and hepatitis C.

PubMed

Scarborough, Jane; Eliott, Jaklin; Miller, Emma; Aylward, Paul

2015-04-01

To suggest ways of increasing the cohesiveness of national primary healthcare strategies and hepatitis C strategies, with the aim of ensuring that all these strategies include ways to address barriers and facilitators to access to primary healthcare and equity for people with hepatitis C. A critical review was conducted of the first national Primary Healthcare System Strategy and Health Workforce Strategy with the concurrent Hepatitis C Strategy. Content relating to provision of healthcare in private general practice was examined, focussing on issues around access and equity. In all strategies, achieving access to care and equity was framed around providing sufficient medical practitioners for particular locations. Equity statements were present in all policies but only the Hepatitis C Strategy identified discrimination as a barrier to equity. Approaches detailed in the Primary Healthcare System Strategy and Health Workforce Strategy regarding current resource allocation, needs assessment and general practitioner incentives were limited to groups defined within these documents and may not identify or meet the needs of people with hepatitis C. Actions in the primary healthcare system and health workforce strategies should be extended to additional groups beyond those listed as priority groups within the strategies. Future hepatitis C strategies should outline appropriate, detailed needs assessment methodologies and specify how actions in the broad strategies can be applied to benefit the primary healthcare needs of people with hepatitis C.

Photoassisted physical vapor epitaxial growth of semiconductors: a review of light-induced modifications to growth processes

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

Alberi, Kirstin; Scarpulla, Michael A.

Herein, we review the remarkable range of modifications to materials properties associated with photoexcitation of the growth surface during physical vapor epitaxy of semiconductors. We concentrate on mechanisms producing measureable, utilizable changes in crystalline perfection, phase, composition, doping, and defect distribution. We outline the relevant physics of different mechanisms, concentrating on those yielding effects orthogonal to the primary growth variables of temperature and atomic or molecular fluxes and document the phenomenological effects reported. Based on experimental observations from a range of semiconductor systems and growth conditions, the primary effects include enhanced anion desorption, molecular dissociation, increased doping efficiency, modification tomore » defect populations and improvements to the crystalline quality of epilayers grown at low temperatures. Future research directions and technological applications are also discussed.« less

The impact of nursing leadership and management on the control of HIV/AIDS: an ethnographic study.

PubMed

Nawafleh, Hani; Francis, Karen; Chapman, Ysanne

2012-10-01

This paper reports on an aspect of a larger ethnographic study that sought to investigate the impact of HIV/AIDS on the practice of primary care nurses in Jordan. Nursing leadership and the style of management adopted by senior nursing and medical administrators at the Ministry of Heath were identified as factors impacting on the practice of the nurses and their capacity to raise community awareness and contribute to the prevention and control of HIV/AIDS. The study was undertaken in three rural and three urban primary health care centres (PHCC). Data collection included participant observation, key informant interviews, and document analysis. These data informed the development of descriptive ethnographic accounts that allowed for the subsequent identification of common and divergent themes reflective of factors recognized as influencing the practice of the nurse participants.

Photoassisted physical vapor epitaxial growth of semiconductors: a review of light-induced modifications to growth processes

DOE PAGES

Alberi, Kirstin; Scarpulla, Michael A.

2017-11-22

Herein, we review the remarkable range of modifications to materials properties associated with photoexcitation of the growth surface during physical vapor epitaxy of semiconductors. We concentrate on mechanisms producing measureable, utilizable changes in crystalline perfection, phase, composition, doping, and defect distribution. We outline the relevant physics of different mechanisms, concentrating on those yielding effects orthogonal to the primary growth variables of temperature and atomic or molecular fluxes and document the phenomenological effects reported. Based on experimental observations from a range of semiconductor systems and growth conditions, the primary effects include enhanced anion desorption, molecular dissociation, increased doping efficiency, modification tomore » defect populations and improvements to the crystalline quality of epilayers grown at low temperatures. Future research directions and technological applications are also discussed.« less

Volcanic Hazard Maps; the results and progress made by the IAVCEI Hazard Map working group

NASA Astrophysics Data System (ADS)

Calder, Eliza; Lindsay, Jan; Wright, Heather

2017-04-01

The IAVCEI Commission on Volcanic Hazards and Risk set up a working group on Hazard Maps in 2014. Since then, the group has led or co-organised three major workshops, and organized two thematic conference sessions. In particular we have initiated a series of workshops, named the "State of the Hazard Map" which we plan to continue (the first was held at COV8 (State of the Hazard Map 1) and second at COV9 (State of the Hazard Map 2) and the third will be held at IAVCEI General Assembly in Portland. The broad aim of these activities is to work towards an IAVCEI-endorsed considerations or guidelines document for volcanic hazard map generation. The workshops have brought together people from around the world working on volcanic hazard maps, and have had four primary objectives: 1) to review (and collect further data on) the diverse variety of methods and rationales currently used to develop maps; 2) to openly discuss approaches and experiences regarding how hazard maps are interpreted and used by different groups; 3) to discuss and prepare the IAVCEI Guidelines document; and lastly, 4) Discuss options for finalizing, publishing and disseminating the Guidelines document (e.g. wiki, report, open-source publication). This presentation will provide an update of the results and outcomes of those initiatives. This includes brief outcomes of the reviews undertaken, a survey that has been constructed in order to gather additional data, the planned structure for the guidelines documents and a summary of the key findings to date. The majority of the participants of these activities so far have come from volcano observatories or geological surveys, as these institutions commonly have primary responsibility for making operational hazard map. It is important however that others in the scientific community that work on quantification of volcanic hazard contribute to these guidelines. We therefore invite interested parties to become involved.

Towards a better understanding of the nomenclature used in information-packaging efforts to support evidence-informed policymaking in low- and middle-income countries

PubMed Central

2014-01-01

Background The growing recognition of the importance of concisely communicating research evidence and other policy-relevant information to policymakers has underpinned the development of several information-packaging efforts over the past decade. This has led to a wide variability in the types of documents produced, which is at best confusing and at worst discouraging for those they intend to reach. This paper has two main objectives: to develop a better understanding of the range of documents and document names used by the organizations preparing them; and to assess whether there are any consistencies in the characteristics of sampled documents across the names employed to label (in the title) or describe (in the document or website) them. Methods We undertook a documentary analysis of web-published document series that are prepared by a variety of organizations with the primary intention of providing information to health systems policymakers and stakeholders, and addressing questions related to health policy and health systems with a focus on low- and middle-income countries. No time limit was set. Results In total, 109 individual documents from 24 series produced by 16 different organizations were included. The name ‘policy brief/briefing’ was the most frequently used (39%) to label or describe a document, and was used in all eight broad content areas that we identified, even though they did not have obviously common traits among them. In terms of document characteristics, most documents (90%) used skimmable formats that are easy to read, with understandable, jargon-free, language (80%). Availability of information on the methods (47%) or the quality of the presented evidence (27%) was less common. One-third (32%) chose the topic based on an explicit process to assess the demand for information from policy makers and even fewer (19%) engaged with policymakers to discuss the content of these documents such as through merit review. Conclusions This study highlights the need for organizations embarking on future information-packaging efforts to be more thoughtful when deciding how to name these documents and the need for greater transparency in describing their content, purpose and intended audience. PMID:24889015

Best practice in primary care pathology: review 3

PubMed Central

Smellie, W S A; Forth, J; Bareford, D; Twomey, P; Galloway, M J; Logan, E C M; Smart, S R S; Reynolds, T M; Waine, C

2006-01-01

This best practice review examines four series of common primary care questions in laboratory medicine: (i) “minor” blood platelet count and haemoglobin abnormalities; (ii) diagnosis and monitoring of anaemia caused by iron deficiency; (iii) secondary hyperlipidaemia and hypertriglyceridaemia; and (iv) glycated haemoglobin and microalbumin use in diabetes. The review is presented in question–answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence‐based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards, but form a guide to be set in the clinical context. Most of the recommendations are based on consensus rather than evidence. They will be updated periodically to take account of new information. PMID:16873560

Aviation System Analysis Capability Quick Response System Report Server User’s Guide.

DTIC Science & Technology

1996-10-01

primary data sources for the QRS Report Server are the following: ♦ United States Department of Transportation airline service quality per- formance...and to cross-reference sections of this document. is used to indicate quoted text messages from WWW pages. is used for WWW page and section titles...would link the user to another document or another section of the same document. ALL CAPS is used to indicate Report Server variables for which the

[Lens luxation in dogs: a retrospective study of 134 dogs (2000-2011)].

PubMed

Betschart; Hässig; Spiess

2014-03-01

This retrospective study evaluated cases of lens luxation in dogs that were documented at the University of Zurich Veterinary Teaching Hospital between 2000 and 2011. A total 134 dogs were included in the study. This population of dogs with lens luxation represents 0.41 % of all dogs presented to the Zurich Veterinary Teaching Hospital (32'523) and 3.02 % of all dogs presented to the ophthalmology service during the same time period. The 134 dogs represented over 40 different breeds, including mixed breeds. 63 of the dogs were male, 71 were female. The 134 dogs were divided in primary lens luxation (86 of the 134 dogs, 64 %) and secondary lens luxation (48 dogs, 36 %). The most frequent causes for secondary lens luxation were glaucoma (58 %), cataract (19 %) and trauma (17 %). This study shows the predisposition for primary lens luxations in terrier breeds, Chinese Crested dogs, Pinscher and Spitz. In contrast, Siberian Huskies, Basset Hounds, Bearded Collies, Cairn Terriers, mixed breed dogs, Bolonka Zwetna, Boston Terriers, Borzoi, Doberman, Eurasian, Leonberg, Luzerner Niederlaufhund and Weimaraner suffered significantly more often from secondary lens luxation. There was no sex predilection for primary or secondary lens luxation. Dogs with primary lens luxation were on average 7.39 ± 3.02 years old, which is significantly younger than the dogs with secondary lens luxation (9.12 ± 3.38 years). Dogs with primary lens luxation showed a significantly higher rate of a bilateral development than those with secondary lens luxation (85.5 % of the dogs with primary lens luxation and only 14.5 % of the dogs with secondary lens luxation showed it in both their eyes).

Improving population management through pharmacist-primary care integration: a pilot study.

PubMed

Kennedy, Amanda G; Chen, Harry; Corriveau, Michele; MacLean, Charles D

2015-02-01

Pharmacists have unique skills that may benefit primary care practices. The objective of this demonstration project was to determine the impact of integrating pharmacists into patient-centered medical homes, with a focus on population management. Pharmacists were partnered into 5 primary care practices in Vermont 1 day per week to provide direct patient care, population-based medication management, and prescriber education. The main measures included a description of drug therapy problems identified and cost avoidance models. The pharmacists identified 708 drug therapy problems through direct patient care (336/708; 47.5%), population-based strategies (276/708; 38.9%), and education (96/708; 13.6%). Common population-based strategies included adjusting doses and discontinuing unnecessary medications. Pharmacists' recommendations to correct drug therapy problems were accepted by prescribers 86% of the time, when data about acceptance were known. Of the 49 recommendations not accepted, 47/49 (96%) were population-based and 2/49 (4%) were related to direct patient care. The cost avoidance model suggests $2.11 in cost was avoided for every $1.00 spent on a pharmacist ($373,092/$176,690). There was clear value in integrating pharmacists into primary care teams. Their inclusion prevented adverse drug events, avoided costs, and improved patient outcomes. Primary care providers should consider pharmacists well suited to offer direct patient care, population-based management, and prescriber education to their practices. To be successful, pharmacists must have full permission to document findings in the primary care practices' electronic health records. Given that many pharmacist services do not involve billable activities, sustainability requires identifying alternative funding mechanisms that do not rely on a traditional fee-for-service approach.

Implementing Quality Improvement in Small, Autonomous Primary Care Practices: Implications for the Patient Centered Medical Home

PubMed Central

Arar, Nedal H.; Noel, Polly H.; Leykum, Luci; Zeber, John E.; Romero, Raquel; Parchman, Michael L.

2012-01-01

Background Implementing improvement programs to enhance quality of care within primary care clinics is complex, with limited practical guidance available to help practices during the process. Understanding how improvement strategies can be implemented in primary care is timely given the recent national movement towards transforming primary care into patient-centered medical homes (PCMH). This study examined practice members’ perceptions of the opportunities and challenges associated with implementing changes in their practice. Methods Semi-structured interviews were conducted with a purposive sample of 56 individuals working in 16 small, community-based primary care practices. The interview consisted of open-ended questions focused on participants’ perceptions of: (1) practice vision, (2) perceived need for practice improvement, and (3) barriers that hinder practice improvement. The interviews were conducted at the participating clinics and were tape-recorded, transcribed, and content analyzed. Results Content analysis identified two main domains for practice improvement related to: (1) the process of care, and (2) patients’ involvement in their disease management. Examples of desired process of care changes included improvement in patient tracking/follow-up system, standardization of processes of care, and overall clinic documentations. Changes related to the patients’ involvement in their care included improving (a) health education, and (b) self care management. Among the internal barriers were: staff readiness for change, poor communication, and relationship difficulties among team members. External barriers were: insurance regulations, finances and patient health literacy. Practice Implications Transforming their practices to more patient-centered models of care will be a priority for primary care providers. Identifying opportunities and challenges associated with implementing change is critical for successful improvement programs. Successful strategy for enhancing the adoption and uptake of PCMH elements should leverage areas of concordance between practice members’ perceived needs and planned improvement efforts. PMID:22186171

Reduction of Family Violence in Aboriginal Communities: A Systematic Review of Interventions and Approaches1

PubMed Central

Shea, Beverley; Nahwegahbow, Amy; Andersson, Neil

2010-01-01

Many efforts to reduce family violence are documented in the published literature. We conducted a systematic review of interventions intended to prevent family violence in Aboriginal communities. We retrieved studies published up to October 2009; 506 papers included one systematic review, two randomized controlled trials, and fourteen nonrandomized studies or reviews. Two reviews discussed interventions relevant to primary prevention (reducing the risk factors for family violence), including parenting, role modelling, and active participation. More studies addressed secondary prevention (where risk factors exist, reducing outbreaks of violence) such as restriction on the trading hours for take away alcohol and home visiting programs for high risk families. Examples of tertiary prevention (preventing recurrence) include traditional healing circles and group counselling. Most studies contributed a low level of evidence. PMID:21052554

Disordered follicle development

PubMed Central

Chang, R. Jeffrey; Cook-Andersen, Heidi

2013-01-01

Alterations of ovarian follicle morphology and function have been well documented in women with PCOS. These include increased numbers of growing preantral follicles, failure of follicle growth beyond the mid-antral stage, evidence of granulosa call degeneration, and theca cell hyperplasia. Functional abnormalities include paradoxical granulosa cell hyperresponsiveness to FSH which is clinically linked to ovarian hyperstimulation during ovulation induction. In addition, there is likely a primary theca cell defect that accounts for the majority of excess androgen production in this disorder. The precise mechanisms responsible for altered follicle function are not completely clear. However, several factors appear to influence normal advancement of follicle development as well as impair ovarian steroidogenesis. These include intra- as well as extraovarian influences that distort normal ovarian growth and disrupt steroid production by follicle cells. PMID:22874072

Variation resources at UC Santa Cruz.

PubMed

Thomas, Daryl J; Trumbower, Heather; Kern, Andrew D; Rhead, Brooke L; Kuhn, Robert M; Haussler, David; Kent, W James

2007-01-01

The variation resources within the University of California Santa Cruz Genome Browser include polymorphism data drawn from public collections and analyses of these data, along with their display in the context of other genomic annotations. Primary data from dbSNP is included for many organisms, with added information including genomic alleles and orthologous alleles for closely related organisms. Display filtering and coloring is available by variant type, functional class or other annotations. Annotation of potential errors is highlighted and a genomic alignment of the variant's flanking sequence is displayed. HapMap allele frequencies and linkage disequilibrium (LD) are available for each HapMap population, along with non-human primate alleles. The browsing and analysis tools, downloadable data files and links to documentation and other information can be found at http://genome.ucsc.edu/.

Ethnohistory: A Researcher's Guide. Studies in Third World Societies Publication Number Thirty Five.

ERIC Educational Resources Information Center

Wiedman, Dennis, Ed.

This guide contains 15 articles that discuss materials to be used for ethnohistorical research; the guide also serves as a textbook for courses on ethnohistory and related subjects. The articles are: "The Anthropological Use of Historic Documents" (D. Wiedman); "Public Documents as Primary Sources for Ethnohistorical Research: The…

Mining for Evidence in Enterprise Corpora

ERIC Educational Resources Information Center

Almquist, Brian Alan

2011-01-01

The primary research aim of this dissertation is to identify the strategies that best meet the information retrieval needs as expressed in the "e-discovery" scenario. This task calls for a high-recall system that, in response to a request for all available relevant documents to a legal complaint, effectively prioritizes documents from an…

Connecticut's New Comprehensive and Universal Early Childhood Health Assessment Form

ERIC Educational Resources Information Center

Crowley, Angela A.; Whitney, Grace-Ann C.

2005-01-01

Health assessments are required for entrance into child care, Head Start, and preschool programs. However, state and federal screening and documentation mandates vary, and programs create their own forms for keeping required data on file. Inconsistent recording formats present challenges for primary care providers who must document each child's…

Conflicting Educational Ideals in America, 1775-1831: Selected Documentary Essays.

ERIC Educational Resources Information Center

Nakosteen, Mehdi

The purpose of this collection of 52 primary source documents is to sustain the continuity and interdependence of ideas, movements, and events in the development of educational theories and practices in Western culture. Among the concerns of these documents, written by statesmen, clergymen, business men, foreign observers. educators and others,…

Understanding Richard Wright's "Black Boy": A Student Casebook to Issues, Sources, and Historical Documents.

ERIC Educational Resources Information Center

Felgar, Robert

In "Black Boy," Richard Wright triumphs over an ugly, racist world by fashioning an inspiring, powerful, beautiful, and fictionalized autobiography. To help students understand and appreciate his story in the cultural, political, racial, social, and literary contexts of its time, this casebook provides primary historical documents,…

Rock 'n' Roll Heroes: Letter to President Eisenhower.

ERIC Educational Resources Information Center

Mueller, Jean W., Ed.

1985-01-01

This primary source document can be used to teach secondary students about the rock 'n' roll era that emerged in the 1950's. The document is a letter written in 1958 by three teenagers to President Eisenhower concerning the induction of Elvis Presley into the U.S. Army. Class activities are also suggested. (RM)

Intelligent transportation system (ITS) study for the Buffalo and Niagara Falls metropolitan area, Erie and Niagara Counties, New York : transportation systems and deficiencies, working paper #1

DOT National Transportation Integrated Search

1997-06-18

This document has been prepared as part of the New York State Department of Transportation (NYSDOT) Buffalo and Niagara Falls Intelligent Transportation Systems Study. The primary objective of this working paper is to define and document transportati...

Implementation of a Preventive Services Bundle in Academic Pediatric Primary Care Centers.

PubMed

Samaan, Zeina Marcho; Brown, Courtney M; Morehous, John; Perkins, Alison A; Kahn, Robert S; Mansour, Mona E

2016-03-01

Previous studies have documented poor rates of delivery of preventive services, 1 of the core services provided in the primary care medical home setting. We aimed to increase the reliability of delivering a bundle of preventive services to patients 0 to 14 months of age from 58% of patient visits to 95% of visits. The bundle includes administration of routine vaccinations, offering influenza vaccination, completed lead screening, completed developmental screening tool, screening for maternal depression and food insecurity, and documentation of gestational age. The setting was 3 academic pediatric primary care clinics that serve 31,000 patients (>90% Medicaid). Quality improvement methodology was used and key driver diagram was determined. Patient "Ideal Visit Flow" and the Responsible, Accountable, Support, Consulted, and Informed Matrix were developed to drive accountability for components of the ideal flow. Plan, Do, Study, Act cycles were used to develop successful interventions. The percent of patients seen who received all bundle elements for which they were eligible was plotted weekly on a run chart, and statistical process control methods were used to determine a significant change in performance. The preintervention percentage of patient visits ages 0 to 14 months receiving all preventive service bundle elements was 58%. The postintervention percentage is 92%. Innovative redesign led to improvement in percentage of patients age 0 to 14 months who received the entire preventive services bundle. Key elements for success were multidisciplinary site-specific teams, redesigned visit flow, effective communication, and resources for data and project management. Copyright © 2016 by the American Academy of Pediatrics.

Educational Triage and Ability-Grouping in Primary Mathematics: A Case-Study of the Impacts on Low-Attaining Pupils

ERIC Educational Resources Information Center

Marks, Rachel

2014-01-01

This case-study, drawing on an unanticipated theme arising from a wider study of ability-grouping in primary mathematics, documents some of the consequences of educational triage in the final year of one primary school. The paper discusses how a process of educational triage, as a response to accountability pressures, is justified by teachers on…

Standardizing communication from acute care providers to primary care providers on critically ill adults.

PubMed

Ellis, Kerri A; Connolly, Ann; Hosseinnezhad, Alireza; Lilly, Craig M

2015-11-01

To increase the frequency of communication of patient information between acute and primary care providers. A secondary objective was to determine whether higher rates of communication were associated with lower rates of hospital readmission 30 days after discharge. A validated instrument was used for telephone surveys before and after an intervention designed to increase the frequency of communication among acute care and primary care providers. The communication intervention was implemented in 3 adult intensive care units from 2 campuses of an academic medical center. The frequency of communication among acute care and primary care providers, the perceived usefulness of the intervention, and its association with 30-day readmission rates were assessed for 202 adult intensive care episodes before and 100 episodes after a communication intervention. The frequency of documented communication increased significantly (5/202 or 2% before to 72/100 or 72% after the intervention; P < .001) and the communication was considered useful by every participating primary care provider. Rates of rehospitalization at 30 days were lower for the intervention group than the preintervention group, but the difference was not statistically significant (41/202 or 23% vs 16/88 or 18% of discharged patients; P = .45; power 0.112 at P = .05). The frequency of communication episodes that provide value can be increased through standardized processes. The key aspects of this effective intervention were setting the expectation that communication should occur, documenting when communication has occurred, and reviewing that documentation during multiprofessional rounds. ©2015 American Association of Critical-Care Nurses.

Performance characteristics of visualising the cervix in symptomatic young females: a review of primary care records in females with and without cervical cancer.

PubMed

Lim, Anita Wey Wey; Hamilton, Willie; Hollingworth, Antony; Stapley, Sally; Sasieni, Peter

2016-03-01

The current strategy for timely detection of cervical cancer in young females centres on visualising the cervix when females present with gynaecological symptoms, but is based on expert opinion without an evidence base. To assess visualising the cervix in primary care in young females with gynaecological symptoms. A review of primary care records for females in England aged 20-29 years with cervical cancer (nationwide interview-based study) and in the general population (Clinical Practice Research Datalink database). From primary care records the proportion of females was identified with gynaecological symptoms who had documented cervical examination in the year before diagnosis (cancers) and in 1-year age bands (general population). Of these, the proportion was identified that was then referred for suspected malignancy. Only 39% of young females with cervical cancer had documented examination at symptomatic presentation. Visualisation resulted in referral for suspected malignancy for 18% of those examined (95% confidence interval = 5% to 40%). Very few (<1.7%) symptomatic females in the general population had documented cervical examination. None were referred for suspected malignancy at the time. The sensitivity of cervical examination to detect cancer is very low, highlighting the need for better triage tools for primary care. Until such tools are identified GPs should continue to consider cervical cancer when symptoms persist and the cervix is not obviously abnormal on clinical examination. Further research on additional triage tools such as cervical cytology used as a diagnostic aid is needed urgently. © British Journal of General Practice 2016.

Care interrupted: Poverty, in-migration, and primary care in rural resource towns.

PubMed

Rice, Kathleen; Webster, Fiona

2017-10-01

Internationally, rural people have poorer health outcomes relative to their urban counterparts, and primary care providers face particular challenges in rural and remote regions. Drawing on ethnographic fieldnotes and 14 open-ended qualitative interviews with care providers and chronic pain patients in two remote resource communities in Northern Ontario, Canada, this article examines the challenges involved in providing and receiving primary care for complex chronic conditions in these communities. Both towns struggle with high unemployment in the aftermath of industry closure, and are characterized by an abundance of affordable housing. Many of the challenges that care providers face and that patients experience are well-documented in Canadian and international literature on rural and remote health, and health care in resource towns (e.g. lack of specialized care, difficulty with recruitment and retention of care providers, heavy workload for existing care providers). However, our study also documents the recent in-migration of low-income, largely working-age people with complex chronic conditions who are drawn to the region by the low cost of housing. We discuss the ways in which the needs of these in-migrants compound existing challenges to rural primary care provision. To our knowledge, our study is the first to document both this migration trend, and the implications of this for primary care. In the interest of patient health and care provider well-being, existing health and social services will likely need to be expanded to meet the needs of these in-migrants. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Surgical pathology and the patient: a systematic review evaluating the primary audience of pathology reports.

PubMed

Mossanen, Matthew; True, Lawrence D; Wright, Jonathan L; Vakar-Lopez, Funda; Lavallee, Danielle; Gore, John L

2014-11-01

The pathology report is a critical document that helps guide the management of patients with cancer. More and more patients read their reports, intending to participate in decisions about their care. However, a substantial subset of patients may lack the ability to comprehend this often technical and complex document. We hypothesized that most literature on pathology reports discusses reports from the perspective of other physicians and not from the perspective of patients. An expert panel of physicians developed a list of search criteria, which we used to identify articles on PubMed, MEDLINE, Cochrane Reviews, and Google Scholar databases. Two reviewers independently evaluated all articles to identify for detailed review those that met search criteria. We identified the primary audience of the selected articles and the degree to which these articles addressed clarity of communication of pathology reports with patients. Of 801 articles identified in our search, 25 involved the formatting of pathology reports for clarity of communication. Recurrent themes in proposed improvements in reports included content standardization, variation in terminology, clarity of communication, and quality improvement. No articles discussed patients as their target audience. No study evaluated the health literacy level required of patients to comprehend pathology reports. In summary, there is a scarcity of patient-centered approaches to improve pathology reports. The literature on pathology reports does not include patients as a target audience. Limited resources are available to help patients comprehend their reports. Efforts to improve patient-centered communication are desirable to address this overlooked aspect of patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

77 FR 26063 - Self-Regulatory Organizations; Municipal Securities Rulemaking Board; Order Granting Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... Disclosure Subscription Service, that make documents and related indexing information available on a current... indexing information obtained through submissions to the Primary Market Disclosure Service (the ``Primary... amendments thereto, together with related indexing information, provided by submitters through EMMA, for an...

Teaching Challenging Topics with Primary Sources

ERIC Educational Resources Information Center

Singer, Alan J.

2012-01-01

The most common activity in a social studies classroom should be the analysis of primary sources. Students are intrigued and engaged by edited and unedited documents, written statements, transcribed speeches, photographs, pictures, charts, graphs, cartoons, and even material objects. Ideally, the goal of social studies teachers is to prepare…

Metastatic prostate adenocarcinoma to the penis: a series of 29 cases with predilection for ductal adenocarcinoma.

PubMed

Ellis, Carla L; Epstein, Jonathan I

2015-01-01

Twenty-nine men with metastatic prostate adenocarcinoma to the penis were identified at our institution between 1993 and 2013. Of the 29 patients, 19 had a prior history of adenocarcinoma of the prostate, and 8 of those had ductal features in the primary lesion. Sixteen of 29 revealed ductal features in the metastasis. Seven of the 8 cases with ductal features in the primary had ductal features in the penile metastasis. Seven penile metastases were proven to be of prostatic origin solely by immunohistochemistry. Three cases were originally misdiagnosed as urothelial carcinoma upon review of the penile lesion. Other variant morphologies in the metastases included sarcomatoid carcinoma, small cell carcinoma, and adenosquamous carcinoma. In summary, prostate carcinoma involving the penis displays ductal features considerably more often than prostate cancer in general. Features that can cause difficulty in recognizing metastatic prostate adenocarcinoma to the penis include the unusual anatomic site for prostate cancer, poor differentiation, an increased prevalence of variant morphology, a long interval from the primary lesion, and, in some cases, no documented history of a primary prostatic lesion. Immunohistochemical analysis should be performed to rule out prostate carcinoma in penile/penile urethral tumors with morphology that differs from typical squamous or urothelial carcinoma. Even in the setting of metastatic disease, there is a critical need for an accurate diagnosis so that the appropriate therapy can be initiated, symptomatic relief can be provided, and long-term survival achieved in some cases, while at the same time avoiding penectomy for a misdiagnosis of a primary penile cancer.

Inventory of gate-sensing equipment at 14 U.S. Army Corps of Engineers dams in Texas

USGS Publications Warehouse

Harwell, Glenn R.

2005-01-01

The U.S. Army Corps of Engineers (USACE) is a worldwide organization that provides engineering services, environmental restoration, and construction support for a wide variety of civil and military projects. The primary civil mission of the USACE is developing and managing the Nation's water resources. USACE develops projects to reduce flood damage, improve navigation channels and harbors, protect wetlands, and preserve, safeguard, and enhance the environment. Additional missions of the Corps include managing federal real estate, assisting communities with emergency operations and recovery, and providing recreation opportunities.Accurate and timely information on reservoir gate openings is critical for managing flood pools, reducing flood damage downstream from reservoirs, delivering drinking-water supplies, and meeting an assortment of competing downstream water-use needs. Documentation, operation, and maintenance of gate sensors are needed so that reliable, timely information is available to USACE to make reservoir operation decisions.USACE requested that the U.S. Geological Survey (USGS) prepare an inventory and documentation of existing gate-sensing equipment at 14 reservoirs that will serve as a user’s manual for operating the equipment. The 14 reservoirs include Aquilla Lake, Bardwell Lake, Benbrook Lake, Canyon Lake, Georgetown Lake, Granger Lake, Grapevine Lake, Jim Chapman Lake, Joe Pool Lake, Lake O’ the Pines, Ray Roberts Lake, Somerville Lake, Stillhouse Hollow Lake, and Wright Patman Lake.This report presents the inventory and documentation of the existing gate-sensing equipment at the 14. The report is organized by lake; information in each lake section includes location of lake and intake structure, directions to each lake (road log), access, equipment description, operation and maintenance information, job hazard analysis, wiring diagrams, photographs, and datalogger programs. The report also includes a list of contact information for the different manufacturers of equipment in service at the lakes.

The ICESat/GLAS Instrument Operations Report. Volume 4

NASA Technical Reports Server (NTRS)

Jester, Peggy L.

2012-01-01

The Geoscience Laser Altimeter System (GLAS) was the primary instrument aboard the first ICESat spacecraft. ICESat's primary objectives are to determine the mass balance of the polar ice sheets and their contributions to global sea level change, and to obtain essential data for prediction of future changes in ice volume and sea-level. ICESat launched successfully from Vandenberg Air Force Base on January 12, 2003 23:45 UT. The ICESat science mission began in February 2003 and ended on October 11, 2009. De-orbit of the spacecraft occurred on August 30, 2010. This document focusses on the GLAS instrument operations during the ICESat mission. This document will not discuss science results.

Improvement of medication event interventions through use of an electronic database.

PubMed

Merandi, Jenna; Morvay, Shelly; Lewe, Dorcas; Stewart, Barb; Catt, Char; Chanthasene, Phillip P; McClead, Richard; Kappeler, Karl; Mirtallo, Jay M

2013-10-01

Patient safety enhancements achieved through the use of an electronic Web-based system for responding to adverse drug events (ADEs) are described. A two-phase initiative was carried out at an academic pediatric hospital to improve processes related to "medication event huddles" (interdisciplinary meetings focused on ADE interventions). Phase 1 of the initiative entailed a review of huddles and interventions over a 16-month baseline period during which multiple databases were used to manage the huddle process and staff interventions were assigned via manually generated e-mail reminders. Phase 1 data collection included ADE details (e.g., medications and staff involved, location and date of event) and the types and frequencies of interventions. Based on the phase 1 analysis, an electronic database was created to eliminate the use of multiple systems for huddle scheduling and documentation and to automatically generate e-mail reminders on assigned interventions. In phase 2 of the initiative, the impact of the database during a 5-month period was evaluated; the primary outcome was the percentage of interventions documented as completed after database implementation. During the postimplementation period, 44.7% of assigned interventions were completed, compared with a completion rate of 21% during the preimplementation period, and interventions documented as incomplete decreased from 77% to 43.7% (p < 0.0001). Process changes, education, and medication order improvements were the most frequently documented categories of interventions. Implementation of a user-friendly electronic database improved intervention completion and documentation after medication event huddles.

Primary uterine inertia in four labrador bitches.

PubMed

Davidson, Autumn P

2011-01-01

Uterine inertia is a common cause of dystocia in the bitch and is designated as primary (i.e., uterine contractions fail to ever be initiated) or secondary (i.e., uterine contractions cease after a period of time but before labor is completed). The etiology of primary uterine inertia is not well understood. The accurate diagnosis of primary uterine inertia requires the use of tocodynamometry (uterine monitoring). Primary uterine inertia has been postulated to result from a failure of luteolysis resulting in persistently elevated progesterone concentrations. In this study, primary uterine inertia was diagnosed in a series of four bitches in which luteolysis was documented suggesting some other etiopathogenesis for primary uterine inertia.

Medication safety programs in primary care: a scoping review.

PubMed

Khalil, Hanan; Shahid, Monica; Roughead, Libby

2017-10-01

Medication safety plays an essential role in all healthcare organizations; improving this area is paramount to quality and safety of any wider healthcare program. While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated, no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliation or computerized physician order entry. This scoping review sought to map the current medication safety programs used in primary care. The current scoping review sought to examine the characteristics of medication safety programs in the primary care setting and to map evidence on the outcome measures used to assess the effectiveness of medication safety programs in improving patient safety. The current review considered participants of any age and any condition using care obtained from any primary care services. We considered studies that focussed on the characteristics of medication safety programs and the outcome measures used to measure the effectiveness of these programs on patient safety in the primary care setting. The context of this review was primary care settings, primary healthcare organizations, general practitioner clinics, outpatient clinics and any other clinics that do not classify patients as inpatients. We considered all quantitative studied published in English. A three-step search strategy was utilized in this review. Data were extracted from the included studies to address the review question. The data extracted included type of medication safety program, author, country of origin, aims and purpose of the study, study population, method, comparator, context, main findings and outcome measures. The objectives, inclusion criteria and methods for this scoping review were specified in advance and documented in a protocol that was previously published. This scoping review included nine studies published over an eight-year period that investigated or described the effects of medication safety programs in primary care settings. We classified each of the nine included studies into three main sections according to whether they included an organizational, professional or patient component. The organizational component is aimed at changing the structure of the organization to implement the intervention, the professional component is aimed at the healthcare professionals involved in implementing the interventions, and the patient component is aimed at counseling and education of the patient. All of the included studies had different types of medication safety programs. The programs ranged from complex interventions including pharmacists and teams of healthcare professionals to educational packages for patients and computerized system interventions. The outcome measures described in the included studies were medication error incidence, adverse events and number of drug-related problems. Multi-faceted medication safety programs are likely to vary in characteristics. They include educational training, quality improvement tools, informatics, patient education and feedback provision. The most likely outcome measure for these programs is the incidence of medication errors and reported adverse events or drug-related problems.

Provider and interpreter preferences among Somali women in a primary care setting.

PubMed

Odunukan, Olufunso W; Abdulai, Raolat M; Hagi Salaad, Misbil F; Lahr, Brian D; Flynn, Priscilla M; Wieland, Mark L

2015-04-01

Somali people are among the largest refugee populations to resettle in North America and Europe over the past 2 decades, and health disparities are well documented, including barriers to effective navigation of primary health care systems. Patient-provider gender discordance has been described as a barrier to health-seeking behaviors and effective communication by Somali women in past qualitative work. The objective of this study was to elucidate provider and interpreter preferences during clinical encounters according to gender and race among Somali women in the United States. Fifty Somali women empanelled to a large primary care practice completed pictorial surveys to elucidate preferences of Somali women for providers of different genders and race for different components of the clinical examination using a Likert-type scale. We found that Somali women generally preferred a female provider for conducting the physical examination, particularly for the pelvic, breast, and abdominal examinations. Likewise, Somali women strongly preferred female interpreters to be present during the physical examination. There was no stated preference for patient-provider racial concordance. These findings have implications for structural health care changes aimed at delivering culturally sensitive and effective primary care to Somali patients. © The Author(s) 2014.

Towards implementing coordinated healthy lifestyle promotion in primary care: a mixed method study.

PubMed

Thomas, Kristin; Bendtsen, Preben; Krevers, Barbro

2015-01-01

Primary care is increasingly being encouraged to integrate healthy lifestyle promotion in routine care. However, implementation has been suboptimal. Coordinated care could facilitate lifestyle promotion practice but more empirical knowledge is needed about the implementation process of coordinated care initiatives. This study aimed to evaluate the implementation of a coordinated healthy lifestyle promotion initiative in a primary care setting. A mixed method, convergent, parallel design was used. Three primary care centres took part in a two-year research project. Data collection methods included individual interviews, document data and questionnaires. The General Theory of Implementation was used as a framework in the analysis to integrate the data sources. Multi-disciplinary teams were implemented in the centres although the role of the teams as a resource for coordinated lifestyle promotion was not fully embedded at the centres. Embedding of the teams was challenged by differences among the staff, patients and team members on resources, commitment, social norms and roles. The study highlights the importance of identifying and engaging key stakeholders early in an implementation process. The findings showed how the development phase influenced the implementation and embedding processes, which add aspects to the General Theory of Implementation.

Calculation of natural convection test at Phenix using the NETFLOW++ code

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

Mochizuki, H.; Kikuchi, N.; Li, S.

2012-07-01

The present paper describes modeling and analyses of a natural convection of the pool-type fast breeder reactor Phenix. The natural convection test was carried out as one of the End of Life Tests of the Phenix. Objective of the present study is to assess the applicability of the NETFLOW++ code which has been verified thus far using various water facilities and validated using the plant data of the loop-type FBR 'Monju' and the loop-type experimental fast reactor 'Joyo'. The Phenix primary heat transport system is modeled based on the benchmark documents available from IAEA. The calculational model consists of onlymore » the primary heat transport system with boundary conditions on the secondary-side of IHX. The coolant temperature at the primary pump inlet, the primary coolant temperature at the IHX inlet and outlet, the secondary coolant temperatures and other parameters are calculated by the code where the heat transfer between the hot and cold pools is explicitly taken into account. A model including the secondary and tertiary systems was prepared, and the calculated results also agree well with the measured data in general. (authors)« less

Acute Care Referral Systems in Liberia: Transfer and Referral Capabilities in a Low-Income Country.

PubMed

Kim, Jimin; Barreix, Maria; Babcock, Christine; Bills, Corey B

2017-12-01

Introduction Following two decades of armed conflict in Liberia, over 95% of health care facilities were partially or completely destroyed. Although the Liberian health system has undergone significant rehabilitation, one particular weakness is the lack of organized systems for referral and prehospital care. Acute care referral systems are a critical component of effective health care delivery and have led to improved quality of care and patient outcomes. Problem This study aimed to characterize the referral and transfer systems in the largest county of Liberia. A cross-sectional, health referral survey of a representative sample of health facilities in Montserrado County, Liberia was performed. A systematic random sample of all primary health care (PHC) clinics, fraction proportional to district population size, and all secondary and tertiary health facilities were included in the study sample. Collected data included baseline information about the health facility, patient flow, and qualitative and quantitative data regarding referral practices. A total of 62 health facilities-41 PHC clinics, 11 health centers (HCs), and 10 referral hospitals (RHs)-were surveyed during the 6-week study period. In sum, three percent of patients were referred to a higher-level of care. Communication between health facilities was largely unsystematic, with lack of specific protocols (n=3; 5.0%) and standardized documentation (n=26; 44.0%) for referral. While most health facilities reported walking as the primary means by which patients presented to initial health facilities (n=50; 81.0%), private vehicles, including commercial taxis (n=37; 60.0%), were the primary transport mechanism for referral of patients between health facilities. This study identified several weaknesses in acute care referral systems in Liberia, including lack of systematic care protocols for transfer, documentation, communication, and transport. However, several informal, well-functioning mechanisms for referral exist and could serve as the basis for a more robust system. Well-integrated acute care referral systems in low-income countries, like Liberia, may help to mitigate future public health crises by augmenting a country's capacity for emergency preparedness. Kim J , Barreix M , Babcock C , Bills CB . Acute care referral systems in Liberia: transfer and referral capabilities in a low-income country. Prehosp Disaster Med. 2017;32(6):642-650.

Space Shuttle Main Engine structural analysis and data reduction/evaluation. Volume 6: Primary nozzle diffuser analysis

NASA Technical Reports Server (NTRS)

Foley, Michael J.

1989-01-01

The primary nozzle diffuser routes fuel from the main fuel valve on the Space Shuttle Main Engine (SSME) to the nozzle coolant inlet mainfold, main combustion chamber coolant inlet mainfold, chamber coolant valve, and the augmented spark igniters. The diffuser also includes the fuel system purge check valve connection. A static stress analysis was performed on the diffuser because no detailed analysis was done on this part in the past. Structural concerns were in the area of the welds because approximately 10 percent are in areas inaccessible by X-ray testing devices. Flow dynamics and thermodynamics were not included in the analysis load case. Constant internal pressure at maximum SSME power was used instead. A three-dimensional, finite element method was generated using ANSYS version 4.3A on the Lockheed VAX 11/785 computer to perform the stress computations. IDEAS Supertab on a Sun 3/60 computer was used to create the finite element model. Rocketdyne drawing number RS009156 was used for the model interpretation. The flight diffuser is denoted as -101. A description of the model, boundary conditions/load case, material properties, structural analysis/results, and a summary are included for documentation.

The Humanities in English Primary Schools: Struggling to Survive

ERIC Educational Resources Information Center

Barnes, Jonathan; Scoffham, Stephen

2017-01-01

This article surveys the state of the humanities in English primary schools drawing on evidence from serving head teachers, current literature and policy documents. The findings suggest that whilst the humanities are highly valued in schools, there are serious challenges which threaten the "broad and balanced" curriculum. It is suggested…

Peace Education's Effects on Aggression: A Mixed Method Study

ERIC Educational Resources Information Center

Sagkal, Ali Serdar; Turnuklu, Abbas; Totan, Tarik

2016-01-01

Problem Statement: Literature reviews clearly document that students still show a tendency to use violence in resolving interpersonal conflicts in school. Results from various research conducted in Turkey suggest that violence, aggression, and bullying behaviors are still rampant in the primary and high schools. Studies conducted in primary and…

75 FR 76988 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-10

... Enrollment, Chain and Ownership System (PECOS) Security Consent Form; Use: The primary function of the... for the proper performance of the agency's functions; (2) the accuracy of the estimated burden; (3... the primary document used by CMS in developing the national Medicaid budget estimates that are...

School Mental Health Professionals' Training, Comfort, and Attitudes toward Interprofessional Collaboration with Pediatric Primary Care Providers

ERIC Educational Resources Information Center

Arora, Prerna G.; Connors, Elizabeth H.; Biscardi, Krystin A.; Hill, Allison M.

2016-01-01

Despite the well-documented need for interprofessional collaboration (IPC) between school mental health (SMH) professionals and pediatric primary care providers (PCPs), research on current collaborative practices of these professionals is limited. Accordingly, using survey methodology, this study investigated SMH professionals' previous training…

Crunchier on the outside

ERIC Educational Resources Information Center

Marks, Sarah; Ranger, Emma

2005-01-01

The benefits of using investigation for promoting scientific skills and enhanced conceptual understanding within primary science are well documented. ISE (2000) defines investigations in primary science as "the means of carrying out a fair test to explore some of the children's own ideas on how the natural or man made world works". However, a…

Using Minimum Energy in Ireland's Schools

ERIC Educational Resources Information Center

Dolan, John

2007-01-01

Since 1998, the Department of Education and Science has been using a process of design, awareness, research and technology known as DART to develop energy efficiency in educational buildings. Currently all primary schools built in accordance with the Department's primary schools technical guidance documents are capable of being up to 2.3 times…

Elementary School Teachers' Use of Technology during Mathematics Teaching

ERIC Educational Resources Information Center

Polly, Drew

2014-01-01

Various educational technologies have been advanced as potential vehicles to transform teaching and learning. Still, research studies have documented that primary school teachers struggle to integrate technology in meaningful ways. This article presents the findings of a year-long study in which the author frequently observed three primary school…

Children's Learning Practices in Ethiopia: Observations from Primary School Classes

ERIC Educational Resources Information Center

Frost, Melanie; Little, Angela W.

2014-01-01

This paper explores questions of relevance to Ethiopian primary education policy. It examines (i) the match/mismatch between government-prescribed pedagogy and actual student learning practices and (ii) the relationship between those practices and school, class and teacher level factors. The paper employs evidence from government documents on…

Structure of Primary Mathematics Teacher Education Programs in Spain

ERIC Educational Resources Information Center

Cañadas, María C.; Gómez, Pedro; Rico, Luis

2013-01-01

Spain was 1 of the 17 countries that participated in the International Association for the Evaluation of Educational Achievement's Teacher Education and Development Study in Mathematics (TEDS-M 2008). In this paper, we explore and describe the structure of Spanish primary mathematics teacher education programs. We analyzed the documents collected…

Are We Alone in the Universe?

ERIC Educational Resources Information Center

Waring, Scott M.; Herlihy, Christine

2015-01-01

Primary sources, as defined by the Library of Congress, are the "raw materials of history--original documents and objects which were created at the time under study" (Library of Congress, 2014, p. 1). Primary sources differ from secondary sources, which interpret events without the benefit of firsthand experience. While often employed in…

Educating Girls: Strategies To Increase Access, Persistence, and Achievement.

ERIC Educational Resources Information Center

Tietjen, Karen; Prather, Cynthia, Ed.

This document reviews the interventions, such as policies, programs, and projects, that have been implemented by governments, donors, and other institutions to increase girls' access, persistence, and achievement at the primary school level. It examines both the formal system of primary education and nontraditional, alternative approaches to reach…

Literacy Instruction in Primary Level Deaf Education in China

ERIC Educational Resources Information Center

Wang, Qiuying; Andrews, Jean F.

2017-01-01

The national policy in deaf education in Mainland China primarily focuses on oral/aural instruction and hearing rehabilitation. The curriculum in primary grades is specifically structured on speech and hearing skills for language development. But there is little evidence that documents what early literacy instruction looks like or how teachers…

Monitored Geologic Repository Project Description Document

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

P. M. Curry

2001-01-30

The primary objective of the Monitored Geologic Repository Project Description Document (PDD) is to allocate the functions, requirements, and assumptions to the systems at Level 5 of the Civilian Radioactive Waste Management System (CRWMS) architecture identified in Section 4. It provides traceability of the requirements to those contained in Section 3 of the ''Monitored Geologic Repository Requirements Document'' (MGR RD) (YMP 2000a) and other higher-level requirements documents. In addition, the PDD allocates design related assumptions to work products of non-design organizations. The document provides Monitored Geologic Repository (MGR) technical requirements in support of design and performance assessment in preparing formore » the Site Recommendation (SR) and License Application (LA) milestones. The technical requirements documented in the PDD are to be captured in the System Description Documents (SDDs) which address each of the systems at Level 5 of the CRWMS architecture. The design engineers obtain the technical requirements from the SDDs and by reference from the SDDs to the PDD. The design organizations and other organizations will obtain design related assumptions directly from the PDD. These organizations may establish additional assumptions for their individual activities, but such assumptions are not to conflict with the assumptions in the PDD. The PDD will serve as the primary link between the technical requirements captured in the SDDs and the design requirements captured in US Department of Energy (DOE) documents. The approved PDD is placed under Level 3 baseline control by the CRWMS Management and Operating Contractor (M and O) and the following portions of the PDD constitute the Technical Design Baseline for the MGR: the design characteristics listed in Table 1-1, the MGR Architecture (Section 4.1), the Technical Requirements (Section 5), and the Controlled Project Assumptions (Section 6).« less

Cultural Competencies and Planning for Teaching Mathematics: Preservice Teachers Responding to Expectations, Opportunities, and Resources

ERIC Educational Resources Information Center

Wilson, Susanna; McChesney, Jane; Brown, Liz

2017-01-01

In this article, the authors report on a small-scale study set in a context of a firstyear mathematics education course for preservice primary teachers. Professional documentation from three different sources were analysed in relation to the national document "Tataiako: Cultural Competencies for Teachers of Maori Learners," which was…

Alcohol-Related Morbidity and Mortality in North Carolina. SCHS Studies No. 41.

ERIC Educational Resources Information Center

Buescher, Paul A.; Patetta, Michael J.

This document presents data from a variety of secondary sources in an attempt to document that alcohol abuse is a serious problem in North Carolina, resulting in sickness, medical care use, death, and substantial economic costs. The primary source of data presented in this report is the Medical Examiner data system, which contains information for…

Legal Language: What Is It and What Can We Do about It?

ERIC Educational Resources Information Center

Charrow, Veda R.; Crandall, JoAnn

Legal language is discussed in the context of concern about the comprehensibility of consumer documents and the trend toward simplification of the language used in these documents. Specific features of legal language and its functions within the legal community and society are identified. As a primary tool of the legal profession, legal language…

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

CATO DM; DAHL MM; PHILO GL

This report documents the results of tests designed to characterize the relationship between temperature and the measured potential of electrodes installed on multi-probe corrosion monitoring systems in waste tanks. This report also documents the results of tests designed to demonstrate the impact of liquid in-leakage into electrode bodies as well as the contamination of primary reference electrodes by diffusion through the electrode tip.

In-Trail Procedure (ITP) Algorithm Design

NASA Technical Reports Server (NTRS)

Munoz, Cesar A.; Siminiceanu, Radu I.

2007-01-01

The primary objective of this document is to provide a detailed description of the In-Trail Procedure (ITP) algorithm, which is part of the Airborne Traffic Situational Awareness In-Trail Procedure (ATSA-ITP) application. To this end, the document presents a high level description of the ITP Algorithm and a prototype implementation of this algorithm in the programming language C.

Evaluating the role of clinical pharmacists in pre-procedural anticoagulation management.

PubMed

Kataruka, Akash; Renner, Elizabeth; Barnes, Geoffrey D

2018-02-01

While physicians are typically responsible for managing perioperative warfarin, clinic pharmacists may improve pre-procedural decision-making. We assessed the impact of pharmacist-driven care for chronic warfarin-treated patients undergoing outpatient right heart catheterization (RHC). 200 warfarin patients who underwent RHC between January 2012 and September 2015 were analyzed. Pharmacist-care (n = 79) was compared to the usual care model (n = 121). The primary outcome was a composite of (1) documentation of anticoagulation plan, (2) holding warfarin at least 5 days prior to procedure, (3) guideline-congruent low molecular weight heparin (LMWH) bridging, and (4) correct LMWH dosing if bridging deemed necessary. Chi-squared test performed to assess the role of pharmacist. A multivariable logistic regression analysis was performed to the composite endpoint, adjusted for the month of procedure. Compared to the usual care model, pharmacist-driven care (OR 4.69, 95% CI 1.73-12.71, p = 0.002) and date of the procedure (OR 1.06/month, 95% CI 1.01-1.10, p = 0.011) were independently associated with the primary composite outcome. Of the individual outcome components, pharmacist-driven care was only associated with documentation (96.2% vs. 67.8%, OR 9.19, 95% CI 2.19-38.62, p = 0.002). Remaining components including hold warfarin for at least 5 days, appropriate bridging and correct LMWH dosing were not significantly associated with pharmacist-care. Pharmacist-care is associated with better guideline-based anticoagulation management, but this was primarily driven by improved documentation. The impact of pharmacist managed peri-procedural anticoagulation on clinical outcomes remains unknown.

Implementation of Patient Decision Support Interventions in Primary Care: The Role of Relational Coordination.

PubMed

Tietbohl, Caroline K; Rendle, Katharine A S; Halley, Meghan C; May, Suepattra G; Lin, Grace A; Frosch, Dominick L

2015-11-01

The benefits of patient decision support interventions (DESIs) have been well documented. However, DESIs remain difficult to incorporate into clinical practice. Relational coordination (RC) has been shown to improve performance and quality of care in health care settings. This study aims to demonstrate how applying RC theory to DESI implementation could elucidate underlying issues limiting widespread uptake. Five primary care clinics in Northern California participated in a DESI implementation project. We used a deductive thematic approach guided by behaviors outlined in RC theory to analyze qualitative data collected from ethnographic field notes documenting the implementation process and focus groups with health care professionals. We then systematically compared the qualitative findings with quantitative DESI distribution data. Based on DESI distribution rates, clinics were placed into 3 performance categories: high, middle, and low. Qualitative data illustrated how each clinic's performance related to RC behaviors. Consistent with RC theory, the high-performing clinic exhibited frequent, timely, and accurate communication and positive working relationships. The 3 middle-performing clinics exhibited high-quality communication within physician-staff teams but limited communication regarding DESI implementation across the clinic. The lowest-performing clinic was characterized by contentious relationships and inadequate communication. Limitations of the study include nonrandom selection of clinics and limited geographic diversity. In addition, ethnographic data collected documented only DESI implementation practices and not larger staff interactions contributing to RC. These findings suggest that a high level of RC within clinical settings may be a key component and facilitator of successful DESI implementation. Future attempts to integrate DESIs into clinical practice should consider incorporating interventions designed to increase positive RC behaviors as a potential means to improve uptake. © The Author(s) 2015.

Examining organizational change in primary care practices: experiences from using ethnographic methods.

PubMed

Russell, Grant; Advocat, Jenny; Geneau, Robert; Farrell, Barbara; Thille, Patricia; Ward, Natalie; Evans, Samantha

2012-08-01

Qualitative methods are an important part of the primary care researcher's toolkit providing a nuanced view of the complexity in primary care reform and delivery. Ethnographic research is a comprehensive approach to qualitative data collection, including observation, in-depth interviews and document analysis. Few studies have been published outlining methodological issues related to ethnography in this setting. This paper examines some of the challenges of conducting an ethnographic study in primary care setting in Canada, where there recently have been major reforms to traditional methods of organizing primary care services. This paper is based on an ethnographic study set in primary care practices in Ontario, Canada, designed to investigate changes to organizational and clinical routines in practices undergoing transition to new, interdisciplinary Family Health Teams (FHTs). The study was set in six new FHTs in Ontario. This paper is a reflexive examination of some of the challenges encountered while conducting an ethnographic study in a primary care setting. Our experiences in this study highlight some potential benefits of and difficulties in conducting an ethnographic study in family practice. Our study design gave us an opportunity to highlight the changes in routines within an organization in transition. A study with a clinical perspective requires training, support, a mixture of backgrounds and perspectives and ongoing communication. Despite some of the difficulties, the richness of this method has allowed the exploration of a number of additional research questions that emerged during data analysis.

Head and neck cutaneous squamous cell carcinoma metastatic to cervical sublevel IIb lymph nodes occurred from primary sites involving the auricle and adjacent neck.

PubMed

Maher, Nigel Gordon; Hoffman, Gary Russell

2014-03-01

Neck dissections that include sublevel IIb increase the risk of postoperative shoulder dysfunction. The purpose of this investigation was to document the incidence of level IIb metastatic lymphatic spread in a group of patients undergoing neck dissection as part of the surgical management of cutaneous squamous cell carcinoma of the head and neck. A retrospective review of the pathology records taken from 1 surgeon from June 2006 through June 2013 was carried out. The predictor variable was the primary tumor site. The outcome variable was the metastatic nodal involvement according to neck level and sublevel. Secondary variables included T stage, pathologist, tumor depth, and the presence of perineural, perilymphatic, and perivascular invasion. Data analyses were by descriptive statistics. Thirty-six patients with a total of 40 neck dissections met the inclusion criteria. The average primary site tumor depth was 14.7 mm, and there were 16 cases of poorly differentiated squamous cell carcinoma. Sublevel IIb was involved in 7.5% of cases, all of which occurred from lateralized primary sites of the head and neck. Cutaneous squamous cell carcinoma arising from the auricle and neck sites adjacent to sublevel IIb may have increased risk of metastatic involvement of sublevel IIb nodes. Further studies with larger numbers are required to determine the risk of metastasis to sublevel IIb from midline sites of the face. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Rice cultivation and methane emission: Documentation of distributed geographic data sets

NASA Technical Reports Server (NTRS)

Matthews, Elaine; John, Jasmin; Fung, Inez

1994-01-01

High-resolution global data bases on the geographic and seasonal distribution of rice cultivation and associated methane emission, compiled by Matthews et al., were archived for public use. In addition to the primary data sets identifying location, seasonality, and methane emission from rice cultivation, a series of supporting data sets is included, allowing users not only to replicate the work of Matthews et al. but to investigate alternative cultivation and emission scenarios. The suite of databases provided, at 1 latitude by 1 longitude resolution for the globe, includes (1) locations of rice cultivation, (2) monthly arrays of actively growing rice areas, (3) countries and political subdivisions, and (4) monthly arrays of methane emission from rice cultivation. Ancillary data include (1) a listing, by country, of harvested rice areas and seasonal distribution of crop cycles and (2) country names and codes. Summary tables of zonal/monthly distributions of actively growing rice areas and of methane emissions are presented. Users should consult original publications for complete discussion of the data bases. This short paper is designed only to document formats of the distributed information and briefly describe the contents of the data sets and their initial application to evaluating the role of rice cultivation in the methane budget.

Submergence Vulnerability Index development and application to Coastwide Reference Monitoring System Sites and Coastal Wetlands Planning, Protection and Restoration Act projects

USGS Publications Warehouse

Stagg, Camille L.; Sharp, Leigh A.; McGinnis, Thomas E.; Snedden, Gregg A.

2013-01-01

Since its implementation in 2003, the Coastwide Reference Monitoring System (CRMS) in Louisiana has facilitated the creation of a comprehensive dataset that includes, but is not limited to, vegetation, hydrologic, and soil metrics on a coastwide scale. The primary impetus for this data collection is to assess land management activities, including restoration efforts, across the coast. The aim of the CRMS analytical team is to provide a method to synthesize this data to enable multiscaled evaluations of activities in Louisiana’s coastal wetlands. Several indices have been developed to facilitate data synthesis and interpretation, including a Floristic Quality Index, a Hydrologic Index, and a Landscape Index. This document details the development of the Submergence Vulnerability Index, which incorporates sediment-elevation data as well as hydrologic data to determine the vulnerability of a wetland based on its ability to keep pace with sea-level rise. The objective of this document is to provide Federal and State sponsors, project managers, planners, landowners, data users, and the rest of the coastal restoration community with the following: (1) data collection and model development methods for the sediment-elevation response variables, and (2) a description of how these response variables will be used to evaluate CWPPRA project and program effectiveness.

Silencing the Snail-dependent RNA splice regulator ESRP1 drives malignant transformation of human pulmonary epithelial cells. | Office of Cancer Genomics

Cancer.gov

Epithelial-to-mesenchymal transition (EMT) is organized in cancer cells by a set of key transcription factors, but the significance of this process is still debated including in non-small cell lung cancer (NSCLC). Here we report increased expression of the EMT-inducing transcription factor Snail in premalignant pulmonary lesions, relative to histologically normal pulmonary epithelium. In immortalized human pulmonary epithelial cells and isogenic derivatives, we documented Snail-dependent anchorage-independent growth in vitro and primary tumor growth and metastatic behavior in vivo.