Stability of Initial Autism Spectrum Disorder Diagnoses in Community Settings

ERIC Educational Resources Information Center

Daniels, Amy M.; Rosenberg, Rebecca E.; Law, J. Kiely; Lord, Catherine; Kaufmann, Walter E.; Law, Paul A.

2011-01-01

The study's objectives were to assess diagnostic stability of initial autism spectrum disorder (ASD) diagnoses in community settings and identify factors associated with diagnostic instability using data from a national Web-based autism registry. A Cox proportional hazards model was used to assess the relative risk of change in initial ASD…

Application of “Systems Vaccinology” to Evaluate Inflammation and Reactogenicity of Adjuvanted Preventative Vaccines

PubMed Central

Lewis, David J. M.; Lythgoe, Mark P.

2015-01-01

Advances in “omics” technology (transcriptomics, proteomics, metabolomics, genomics/epigenomics, etc.) allied with statistical and bioinformatics tools are providing insights into basic mechanisms of vaccine and adjuvant efficacy or inflammation/reactogenicity. Predictive biomarkers of relatively frequent inflammatory reactogenicity may be identified in systems vaccinology studies involving tens or hundreds of participants and used to screen new vaccines and adjuvants in in vitro, ex vivo, animal, or human models. The identification of rare events (such as those observed with initial rotavirus vaccine or suspected autoimmune complications) will require interrogation of large data sets and population-based research before application of systems vaccinology. The Innovative Medicine Initiative funded public-private project BIOVACSAFE is an initial attempt to systematically identify biomarkers of relatively common inflammatory events after adjuvanted immunization using human, animal, and population-based models. Discriminatory profiles or biomarkers are being identified, which require validation in large trials involving thousands of participants before they can be generalized. Ultimately, it is to be hoped that the knowledge gained from such initiatives will provide tools to the industry, academia, and regulators to select optimal noninflammatory but immunogenic and effective vaccine adjuvant combinations, thereby shortening product development cycles and identifying unsuitable vaccine candidates that would fail in expensive late stage development or postmarketing. PMID:26380327

An analysis of population-based prenatal screening for overt hypothyroidism.

PubMed

Bryant, Stefanie N; Nelson, David B; McIntire, Donald D; Casey, Brian M; Cunningham, F Gary

2015-10-01

The purpose of the study was to evaluate pregnancy outcomes of hypothyroidism that were identified in a population-based prenatal screening program. This is a secondary analysis of a prospective prenatal population-based study in which serum thyroid analytes were obtained from November 2000 to April 2003. Initial screening thresholds were intentionally inclusive (thyroid-stimulating hormone [TSH], >3.0 mU/L; free thyroxine, <0.9 ng/dL); those who screened positive were referred for confirmatory testing in a hospital-based laboratory. Hypothyroidism was identified and treated if TSH level was >4.5 mU/L and if fT4 level was <0.76 ng/dL. Perinatal outcomes in these women and those who screened positive but unconfirmed to have hypothyroidism were compared with women with euthyroidism. Outcomes were then analyzed according to initial TSH levels. A total of 26,518 women completed initial screening: 24,584 women (93%) were euthyroid, and 284 women (1%) had abnormal initial values that suggested hypothyroidism. Of those referred, 232 women (82%) underwent repeat testing, and 47 women (0.2% initially screened) were confirmed to have hypothyroidism. Perinatal outcomes of women with treated overt hypothyroidism were similar to women with euthyroidism. Higher rates of pregnancy-related hypertension were identified in the 182 women with unconfirmed hypothyroidism when compared with women with euthyroidism (P < .001); however, this association was seen only in women with initial TSH >4.5 mU/L (adjusted odds ratio, 2.53; 95% confidence interval, 1.4-4.5). The identification and treatment of overt hypothyroidism results in pregnancy outcomes similar to women with euthyroidism. Unconfirmed screening results suggestive of hypothyroidism portend pregnancy risks similar to women with subclinical hypothyroidism, specifically preeclampsia; however, this increased risk was seen only in women with initial TSH levels of >4.5 mU/L and suggests that this is a more clinically relevant threshold than 3.0 mU/L. Copyright © 2015 Elsevier Inc. All rights reserved.

Energy in the Environment - Initiatives 2004-08

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

Paul Jehn

Under the Energy and Environment Initiative, the GWPC/GWPRF will expand the oil and gas electronic commerce initiatives used to enhance the Risk Based Data Management System (RBDMS) and the Cost Effective Regulatory Approach (CERA). The GWPC/GWPRF has identified the following priorities for work efforts during the time period that will act as the base from which selections for each work period will be proposed. Work tasks will be presented for each reporting period by the GWPC from areas selected from the general list of priorities.

"Life Could Be a Dream": What US-Based Management PhD Students Desire in an Initial Academic Appointment

ERIC Educational Resources Information Center

Flynn, C. Brian; Feild, Hubert S.; Bedeian, Arthur G.

2011-01-01

Purpose: The purpose of this paper is to first identify the work- and non-work-related criteria US-based management doctoral students consider important in selecting an initial academic appointment, and second, to explore whether gender and race/ethnicity are associated with the importance attached to these criteria. Design/methodology/approach:…

A Survey of Digital Cultural Heritage Initiatives and Their Sustainability Concerns. Managing Economic Challenges.

ERIC Educational Resources Information Center

Zorich, Diane M.

In September 2002, the Council on Library and Information Re-sources (CLIR) commissioned a survey of North American-based digital cultural heritage initiatives (DCHIs). The purpose of the survey was to identify the scope, financing, organizational structure, and sustainability of DCHIs. To gain a funder's perspective on these initiatives, the…

Identifying Gaps and Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit.

PubMed

Zaver, Fareen; Battaglioli, Nicole; Denq, William; Messman, Anne; Chung, Arlene; Lin, Michelle; Liu, Emberlynn L

2018-03-01

Burnout, depression, and suicidality among residents of all specialties have become a critical focus for the medical education community, especially among learners in graduate medical education. In 2017 the Accreditation Council for Graduate Medical Education (ACGME) updated the Common Program Requirements to focus more on resident wellbeing. To address this issue, one working group from the 2017 Resident Wellness Consensus Summit (RWCS) focused on wellness program innovations and initiatives in emergency medicine (EM) residency programs. Over a seven-month period leading up to the RWCS event, the Programmatic Initiatives workgroup convened virtually in the Wellness Think Tank, an online, resident community consisting of 142 residents from 100 EM residencies in North America. A 15-person subgroup (13 residents, two faculty facilitators) met at the RWCS to develop a public, central repository of initiatives for programs, as well as tools to assist programs in identifying gaps in their overarching wellness programs. An online submission form and central database of wellness initiatives were created and accessible to the public. Wellness Think Tank members collected an initial 36 submissions for the database by the time of the RWCS event. Based on general workplace, needs-assessment tools on employee wellbeing and Kern's model for curriculum development, a resident-based needs-assessment survey and an implementation worksheet were created to assist residency programs in wellness program development. The Programmatic Initiatives workgroup from the resident-driven RWCS event created tools to assist EM residency programs in identifying existing initiatives and gaps in their wellness programs to meet the ACGME's expanded focus on resident wellbeing.

Success factors for strategic change initiatives: a qualitative study of healthcare administrators' perspectives.

PubMed

Kash, Bita Arbab; Spaulding, Aaron; Johnson, Christopher E; Gamm, Larry

2014-01-01

Success factors related to the implementation of change initiatives are well documented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The purpose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader interviews at two large health systems implementing multiple change initiatives. In-depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives. Results from this analysis were compared to success factors identified in the literature, and generalizations were drawn that add significantly to the management literature, especially to that in the healthcare sector. Ten specific success factors were identified for the implementation of change initiatives. The top three success factors were (1) culture and values, (2) business processes, and (3) people and engagement. Two of the identified success factors are unique to the healthcare sector and not found in the literature on change models: service quality and client satisfaction (ranked fourth of 10) and access to information (ranked ninth). Results demonstrate the importance of human resource functions, alignment of culture and values with change, and business processes that facilitate effective communication and access to information to achieve many change initiatives. The responses also suggest opportunities for leaders of healthcare organizations to more formally recognize the degree to which various change initiatives are dependent on one another.

Using the knowledge-to-action framework to guide the timing of dialysis initiation.

PubMed

Sood, Manish M; Manns, Braden; Nesrallah, Gihad

2014-05-01

The optimal time at which to initiate chronic dialysis remains unknown. Using a contemporary knowledge translation approach (the knowledge-to-action framework), a pan-Canadian collaboration (CANN-NET) set out to study the scope of the problem, then develop and disseminate evidence-based guidelines addressing the timing of dialysis initiation. The purpose of this review is to summarize the key findings and describe the planned Canadian knowledge translation strategy for improving knowledge and practices pertaining to the timing dialysis initiation. New research has provided considerable insights regarding the initiation of dialysis. A Canadian cohort study identified significant variation in the estimated glomerular filtration rate level at dialysis initiation, and a survey of providers identified related knowledge gaps that might be amenable to knowledge translation interventions. A recent knowledge synthesis/guideline concluded that early dialysis initiation is costly, and provides no measureable clinical benefits. A systematic knowledge translation intervention including a multifaceted approach may aid in reducing variation in practice and improving the quality of care. Utilizing the knowledge-to-action framework, we identified practice variation and key barriers to the optimal timing for dialysis initiation that may be amenable to knowledge translation strategies.

Practical Challenges of Systems Thinking and Modeling in Public Health

PubMed Central

Trochim, William M.; Cabrera, Derek A.; Milstein, Bobby; Gallagher, Richard S.; Leischow, Scott J.

2006-01-01

Objectives. Awareness of and support for systems thinking and modeling in the public health field are growing, yet there are many practical challenges to implementation. We sought to identify and describe these challenges from the perspectives of practicing public health professionals. Methods. A systems-based methodology, concept mapping, was used in a study of 133 participants from 2 systems-based public health initiatives (the Initiative for the Study and Implementation of Systems and the Syndemics Prevention Network). This method identified 100 key challenges to implementation of systems thinking and modeling in public health work. Results. The project resulted in a map identifying 8 categories of challenges and the dynamic interactions among them. Conclusions. Implementation by public health professionals of the 8 simple rules we derived from the clusters in the map identified here will help to address challenges and improve the organization of systems that protect the public’s health. PMID:16449581

The Initial Conceptions for Earthquakes Phenomenon for Moroccan Students of the First Year Secondary College

ERIC Educational Resources Information Center

Eddif, Aâtika; Touir, Rachid; Majdoubi, Hassan; Larhzil, Hayat; Mousaoui, Brahim; Ahmamou, Mhamed

2015-01-01

This work proposes initially to identify the initial conceptions of Moroccan students in the first year of secondary college about the notion of earthquakes. The used methodology is based on a questionnaire addressed to students of life science and Earth in Meknes city, before any official teaching about the said phenomenon. The obtained results…

Stakeholder Education for Community-Wide Health Initiatives: A Focus on Teen Pregnancy Prevention.

PubMed

Finley, Cara; Suellentrop, Katherine; Griesse, Rebecca; House, Lawrence Duane; Brittain, Anna

2018-01-01

Teen pregnancies and births continue to decline due in part to implementation of evidence-based interventions and clinical strategies. While local stakeholder education is also thought to be critical to this success, little is known about what types of strategies work best to engage stakeholders. With the goal of identifying and describing evidence-based or best practice strategies for stakeholder education in community-based public health initiatives, we conducted a systematic literature review of strategies used for effective stakeholder education. Over 400 articles were initially retrieved; 59 articles met inclusion criteria. Strategies were grouped into four steps that communities can use to support stakeholder education efforts: identify stakeholder needs and resources, develop a plan, develop tailored and compelling messaging, and use implementation strategies. These strategies lay a framework for high-quality stakeholder education. In future research, it is important to prioritize evaluating specific activities taken to raise awareness, educate, and engage a community in community-wide public health efforts.

Key principles of community-based natural resource management: a synthesis and interpretation of identified effective approaches for managing the commons.

PubMed

Gruber, James S

2010-01-01

This article examines recent research on approaches to community-based environmental and natural resource management and reviews the commonalities and differences between these interdisciplinary and multistakeholder initiatives. To identify the most effective characteristics of Community-based natural resource management (CBNRM), I collected a multiplicity of perspectives from research teams and then grouped findings into a matrix of organizational principles and key characteristics. The matrix was initially vetted (or "field tested") by applying numerous case studies that were previously submitted to the World Bank International Workshop on CBNRM. These practitioner case studies were then compared and contrasted with the findings of the research teams. It is hoped that the developed matrix may be useful to researchers in further focusing research, understanding core characteristics of effective and sustainable CBNRM, providing practitioners with a framework for developing new CBNRM initiatives for managing the commons, and providing a potential resource for academic institutions during their evaluation of their practitioner-focused environmental management and leadership curriculum.

Consumer participation in quality improvements for chronic disease care: development and evaluation of an interactive patient-centered survey to identify preferred service initiatives.

PubMed

Fradgley, Elizabeth A; Paul, Christine L; Bryant, Jamie; Roos, Ian A; Henskens, Frans A; Paul, David J

2014-12-19

With increasing attention given to the quality of chronic disease care, a measurement approach that empowers consumers to participate in improving quality of care and enables health services to systematically introduce patient-centered initiatives is needed. A Web-based survey with complex adaptive questioning and interactive survey items would allow consumers to easily identify and prioritize detailed service initiatives. The aim was to develop and test a Web-based survey capable of identifying and prioritizing patient-centered initiatives in chronic disease outpatient services. Testing included (1) test-retest reliability, (2) patient-perceived acceptability of the survey content and delivery mode, and (3) average completion time, completion rates, and Flesch-Kincaid reading score. In Phase I, the Web-based Consumer Preferences Survey was developed based on a structured literature review and iterative feedback from expert groups of service providers and consumers. The touchscreen survey contained 23 general initiatives, 110 specific initiatives available through adaptive questioning, and a relative prioritization exercise. In Phase II, a pilot study was conducted within 4 outpatient clinics to evaluate the reliability properties, patient-perceived acceptability, and feasibility of the survey. Eligible participants were approached to complete the survey while waiting for an appointment or receiving intravenous therapy. The age and gender of nonconsenters was estimated to ascertain consent bias. Participants with a subsequent appointment within 14 days were asked to complete the survey for a second time. A total of 741 of 1042 individuals consented to participate (71.11% consent), 529 of 741 completed all survey content (78.9% completion), and 39 of 68 completed the test-retest component. Substantial or moderate reliability (Cohen's kappa>0.4) was reported for 16 of 20 general initiatives with observed percentage agreement ranging from 82.1%-100.0%. The majority of participants indicated the Web-based survey was easy to complete (97.9%, 531/543) and comprehensive (93.1%, 505/543). Participants also reported the interactive relative prioritization exercise was easy to complete (97.0%, 189/195) and helped them to decide which initiatives were of most importance (84.6%, 165/195). Average completion time was 8.54 minutes (SD 3.91) and the Flesch-Kincaid reading level was 6.8. Overall, 84.6% (447/529) of participants indicated a willingness to complete a similar survey again. The Web-based Consumer Preferences Survey is sufficiently reliable and highly acceptable to patients. Based on completion times and reading level, this tool could be integrated in routine clinical practice and allows consumers to easily participate in quality evaluation. Results provide a comprehensive list of patient-prioritized initiatives for patients with major chronic conditions and delivers practice-ready evidence to guide improvements in patient-centered care.

A model of roles and responsibilities in oral health promotion based on perspectives of a community-based initiative for pre-school children in the U.K.

PubMed

Henderson, E; Rubin, G

2014-03-01

(i) To explore dental, school and family perspectives of an oral health promotion (OHP) initiative to improve access for pre-school children in deprived communities; (ii) to develop a model of roles and responsibilities for OHP in community settings. Semi-structured focus groups (n = 6) with dental practice staff (n = 24), and semi-structured interviews with school staff (n = 9) and parents and children (n = 4) who were involved in an OHP initiative for pre-school children. Framework analysis was applied to identify themes. Themes were used to develop a model of roles and responsibilities for OHP, based on the WHO Planning and evaluating health promotion model. Respondents subscribed to a community-based approach to improving access to dental services for pre-school children in deprived areas, with an emphasis on shared responsibility and communication. In addition to macro-level actions in directing health policy and services, commissioners were held responsible for investing in micro-level actions, such as funding OHP training and involving parents, and meso-level actions such as reducing barriers to access. The model we have developed builds on WHO recommendations on health promotion to identify the key roles and responsibilities that should be incorporated into further initiatives in OHP.

End-of-life conversations and care: an asset-based model for community engagement.

PubMed

Matthiesen, Mary; Froggatt, Katherine; Owen, Elaine; Ashton, John R

2014-09-01

Public awareness work regarding palliative and end-of-life care is increasingly promoted within national strategies for palliative care. Different approaches to undertaking this work are being used, often based upon broader educational principles, but little is known about how to undertake such initiatives in a way that equally engages both the health and social care sector and the local communities. An asset-based community engagement approach has been developed that facilitates community-led awareness initiatives concerning end-of-life conversations and care by identifying and connecting existing skills and expertise. (1) To describe the processes and features of an asset-based community engagement approach that facilitates community-led awareness initiatives with a focus on end-of-life conversations and care; and (2) to identify key community-identified priorities for sustainable community engagement processes. An asset-based model of community engagement specific to end-of-life issues using a four-step process is described (getting started, coming together, action planning and implementation). The use of this approach, in two regional community engagement programmes, based across rural and urban communities in the northwest of England, is described. The assets identified in the facilitated community engagement process encompassed people's talents and skills, community groups and networks, government and non-government agencies, physical and economic assets and community values and stories. Five priority areas were addressed to ensure active community engagement work: information, outreach, education, leadership and sustainability. A facilitated, asset-based approach of community engagement for end-of-life conversations and care can catalyse community-led awareness initiatives. This occurs through the involvement of community and local health and social care organisations as co-creators of this change across multiple sectors in a sustainable way. This approach provides a framework for other communities seeking to engage with public awareness in end-of-life issues. 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.

Tumor initiation in human malignant melanoma and potential cancer therapies.

PubMed

Ma, Jie; Frank, Markus H

2010-02-01

Cancer stem cells (CSCs), also known as tumor-initiating cells, have been identified in several human malignancies, including human malignant melanoma. The frequency of malignant melanoma-initiating cells (MMICs), which are identified by their expression of ATP-binding cassette (ABC) family member ABCB5, correlates with disease progression in human patients. Furthermore, targeted MMIC ablation through ABCB5 inhibits tumor initiation and growth in preclinical xenotransplantation models, pointing to potential therapeutic promise of the CSC concept. Recent advances also show that CSCs can exert pro-angiogenic roles in tumor growth and serve immunomodulatory functions related to the evasion of host anti-tumor immunity. Thus, MMICs might initiate and sustain tumorigenic growth not only as a result of CSC-intrinsic self-renewal, differentiation and proliferative capacity, but also based on pro-tumorigenic interactions with the host environment.

Tumor Initiation in Human Malignant Melanoma and Potential Cancer Therapies

PubMed Central

Ma, Jie; Frank, Markus H.

2010-01-01

Cancer stem cells (CSCs), also known as tumor-initiating cells, have been identified in several human malignancies, including human malignant melanoma. The frequency of malignant melanoma-initiating cells (MMICs), which are identified by their expression of ATP-binding cassette (ABC) family member ABCB5, correlates with disease progression in human patients. Furthermore, targeted MMIC ablation through ABCB5 inhibits tumor initiation and growth in preclinical xenotransplantation models, pointing to potential therapeutic promise of the CSC concept. Recent advances also show that CSCs can exert pro-angiogenic roles in tumor growth and serve immunomodulatory functions related to the evasion of host anti-tumor immunity. Thus, MMICs might initiate and sustain tumorigenic growth not only as a result of CSC-intrinsic self-renewal, differentiation and proliferative capacity, but also based on pro-tumorigenic interactions with the host environment. PMID:20184545

Application of the accurate mass and time tag approach in studies of the human blood lipidome

PubMed Central

Ding, Jie; Sorensen, Christina M.; Jaitly, Navdeep; Jiang, Hongliang; Orton, Daniel J.; Monroe, Matthew E.; Moore, Ronald J.; Smith, Richard D.; Metz, Thomas O.

2008-01-01

We report a preliminary demonstration of the accurate mass and time (AMT) tag approach for lipidomics. Initial data-dependent LC-MS/MS analyses of human plasma, erythrocyte, and lymphocyte lipids were performed in order to identify lipid molecular species in conjunction with complementary accurate mass and isotopic distribution information. Identified lipids were used to populate initial lipid AMT tag databases containing 250 and 45 entries for those species detected in positive and negative electrospray ionization (ESI) modes, respectively. The positive ESI database was then utilized to identify human plasma, erythrocyte, and lymphocyte lipids in high-throughput LC-MS analyses based on the AMT tag approach. We were able to define the lipid profiles of human plasma, erythrocytes, and lymphocytes based on qualitative and quantitative differences in lipid abundance. PMID:18502191

Comparing Web-Based Provider-Initiated and Patient-Initiated Survivorship Care Planning for Cancer Patients: A Randomized Controlled Trial

PubMed Central

Tolbert, Elliott; Hannum, Susan M; Radhakrishnan, Archana; Zorn, Kelsey; Blackford, Amanda; Greco, Stephen; Smith, Karen; Snyder, Claire F

2016-01-01

Background Survivorship care plans (SCPs) are intended to facilitate communication and coordination between patients, oncologists, and primary care providers. Most SCP initiatives have focused on oncology providers initiating the SCP process, but time and resource barriers have limited uptake. Objective This trial compares the feasibility and value of 2 Web-based SCP tools: provider-initiated versus patient-initiated. Methods This mixed-methods study recruited clinicians from 2 academically-affiliated community oncology practices. Eligible patients were treated by a participating oncologist, had nonmetastatic cancer, completed acute treatment ≤ 2 months before enrollment, and had no evidence of disease. Patients were randomized 1:1 to either provider-initiated or patient-initiated SCPs—both are Web-based tools. We conducted qualitative interviews with providers at baseline and follow-up and with patients 2 months after enrollment. In addition, patients were administered the Preparing for Life as a (New) Survivor (PLANS) and Cancer Survivors’ Unmet Needs (CaSUN) surveys at baseline and 2 months. Results A total of 40 providers were approached for the study, of whom 13 (33%) enrolled. Providers or clinic staff required researcher assistance to identify eligible patients; 41 patients were randomized, of whom 25 completed follow-up (61%; 13 provider-initiated, 12 patient-initiated). Of the 25, 11 (44%) had initiated the SCP; 5 (20%) provided the SCP to their primary care provider. On the Preparing for Life as a (New) Survivor and Cancer Survivors’ Unmet Needs, patients in both arms tended to report high knowledge and confidence and few unmet needs. In qualitative interviews, providers and patients discussed SCPs’ value. Conclusions Regardless of patient- versus provider-initiated templates and the Web-based design of these tools, barriers to survivorship care planning persist. Further efforts should emphasize workflow functions for identifying and completing SCPs—regardless of the SCP form used. Trial Registration ClinicalTrials.gov NCT02405819; https://clinicaltrials.gov/ct2/show/NCT02405819 (Archived by WebCite at http://www.webcitation.org/6jWqcWOvK) PMID:28410187

Relationship between Teacher Views on Levels of Organizational Support--Organizational Identification and Climate of Initiative

ERIC Educational Resources Information Center

Nartgün, Senay Sezgin; Taskin, Sevgi

2017-01-01

This study aimed to identify secondary school teachers' views on levels of organizational support, organizational identification and climate of initiative and to determine whether there were any significant differences between these views based on teachers' demographic characteristics and whether there were significant differences between…

Whose place is it anyway? Representational politics in a place-based health initiative.

PubMed

Rushton, Carole

2014-03-01

The association between place and poor health, such as chronic disease, is well documented and in recent years has given rise to public health strategies such as place-based initiatives (PBIs). This article reports on the emergence of one such initiative in Australia, in regions identified as culturally diverse and socially disadvantaged. The study draws on the intellectual resources provided by governmentality and actor-network theory to provide insights into the reasons why community actors were excluded from a new governance body established to represent their interests. Risk-thinking and representational politics determined who represented whom in the PBI partnership. Paradoxically, actors representing 'community', identified as being 'at risk', were excluded from the partnership during its translation because they were also identified as being 'a risk'. As a consequence, contrary to federal government health and social policy in Australia, it was state government interests rather than the interests of community actors that influenced decisions made in relation to local health planning and the allocation of resources. Copyright © 2013 Elsevier Ltd. All rights reserved.

Pediatric Emergency Research Canada (PERC): Patient/Family-Informed Research Priorities for Pediatric Emergency Medicine.

PubMed

Bialy, Liza; Plint, Amy C; Freedman, Stephen B; Johnson, David W; Curran, Janet A; Stang, Antonia S

2018-06-06

A growing body of literature supports patient and public involvement in the design, prioritization and dissemination of research and evidence based medicine. The objectives of this project were to engage patients and families in developing a prioritized list of research topics for Pediatric Emergency Medicine (PEM) and to compare results with prior research prioritization initiatives in the ED (emergency department) setting. We utilized a systematic process to combine administrative data on frequency of patient presentations to the ED with multiple stakeholder input including an initial stakeholder survey followed by a modified Delphi consensus methodology consisting of two web-based surveys and a face-to-face meeting. The prioritization process resulted in a ranked list of 15 research priorities. The top five priorities were mental health presentations, pain and sedation, practice tools, quality of care delivery and resource utilization. Mental health, pain and sedation, clinical prediction rules, respiratory illnesses /wheeze, patient safety/medication error and sepsis were identified as shared priorities with prior initiatives. Topics identified in our process that were not identified in prior work included resource utilization, ED communication, antibiotic stewardship and patient/family adherence with recommendations. This work identifies key priorities for research in PEM. Comparing our results with prior initiatives in the ED setting identified shared research priorities and opportunities for collaboration among PEM research networks. This work in particular makes an important contribution to the existing literature by including the patient/family perspective missing from prior work. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Floor Identification with Commercial Smartphones in Wifi-Based Indoor Localization System

NASA Astrophysics Data System (ADS)

Ai, H. J.; Liu, M. Y.; Shi, Y. M.; Zhao, J. Q.

2016-06-01

In this paper, we utilize novel sensors built-in commercial smart devices to propose a schema which can identify floors with high accuracy and efficiency. This schema can be divided into two modules: floor identifying and floor change detection. Floor identifying module starts at initial phase of positioning, and responsible for determining which floor the positioning start. We have estimated two methods to identify initial floor based on K-Nearest Neighbors (KNN) and BP Neural Network, respectively. In order to improve performance of KNN algorithm, we proposed a novel method based on weighting signal strength, which can identify floors robust and quickly. Floor change detection module turns on after entering into continues positioning procedure. In this module, sensors (such as accelerometer and barometer) of smart devices are used to determine whether the user is going up and down stairs or taking an elevator. This method has fused different kinds of sensor data and can adapt various motion pattern of users. We conduct our experiment with mobile client on Android Phone (Nexus 5) at a four-floors building with an open area between the second and third floor. The results demonstrate that our scheme can achieve an accuracy of 99% to identify floor and 97% to detecting floor changes as a whole.

Tailoring a response to youth binge drinking in an Aboriginal Australian community: a grounded theory study.

PubMed

McCalman, Janya; Tsey, Komla; Bainbridge, Roxanne; Shakeshaft, Anthony; Singleton, Michele; Doran, Christopher

2013-08-07

While Aboriginal Australian health providers prioritise identification of local community health needs and strategies, they do not always have the opportunity to access or interpret evidence-based literature to inform health improvement innovations. Research partnerships are therefore important when designing or modifying Aboriginal Australian health improvement initiatives and their evaluation. However, there are few models that outline the pragmatic steps by which research partners negotiate to develop, implement and evaluate community-based initiatives. The objective of this paper is to provide a theoretical model of the tailoring of health improvement initiatives by Aboriginal community-based service providers and partner university researchers. It draws from the case of the Beat da Binge community-initiated youth binge drinking harm reduction project in Yarrabah. A theoretical model was developed using the constructivist grounded theory methods of concurrent sampling, data collection and analysis. Data was obtained from the recordings of reflective Community-Based Participatory Research (CBPR) processes with Aboriginal community partners and young people, and university researchers. CBPR data was supplemented with interviews with theoretically sampled project participants. The transcripts of CBPR recordings and interviews were imported into NVIVO and coded to identify categories and theoretical constructs. The identified categories were then developed into higher order concepts and the relationships between concepts identified until the central purpose of those involved in the project and the core process that facilitated that purpose were identified. The tailored alcohol harm reduction project resulted in clarification of the underlying local determinants of binge drinking, and a shift in the project design from a social marketing awareness campaign (based on short-term events) to a more robust advocacy for youth mentoring into education, employment and training. The community-based process undertaken by the research partnership to tailor the design, implementation and evaluation of the project was theorised as a model incorporating four overlapping stages of negotiating knowledges and meanings to tailor a community response. The theoretical model can be applied in spaces where local Aboriginal and scientific knowledges meet to support the tailored design, implementation and evaluation of other health improvement projects, particularly those that originate from Aboriginal communities themselves.

Evaluation of the RapID-ANA system for identification of anaerobic bacteria of veterinary origin.

PubMed

Adney, W S; Jones, R L

1985-12-01

This study evaluated the ability of the RapID-ANA system (Innovative Diagnostic Systems, Inc., Atlanta, Ga.) to accurately identify a spectrum of freshly isolated veterinary anaerobes. A total of 183 isolates were tested and included 7 Actinomyces spp., 53 Bacteroides spp., 32 Clostridium spp., 2 Eubacterium spp., 65 Fusobacterium spp., 1 Peptococcus spp., 22 Peptostreptococcus spp., and 1 Propionibacterium spp. All isolates were initially identified by conventional biochemical testing and gas-liquid chromatography of short-chain fatty acid metabolites. Additional tests were performed as required by the RapID-ANA system. Of these isolates, 81.4% were correctly identified to the genus level, including 59.6% to the species level, 14.2% were incorrectly identified at the genus level, and 4.4% were not identified. Initially, 20.2% of the strains were not identified because the microcodes were not in the code book. The majority of the incorrect identifications were caused by the misidentification of Fusobacterium spp. as Bacteroides spp. Errors also occurred when veterinary anaerobes not included in the data base were assigned an identification from the existing data base. The RapID-ANA system appears to be a promising new method for rapid identification of veterinary anaerobes; however, further evaluation with an extended data base is needed before the system can accurately identify all clinically significant anaerobes.

Why the MDGs need good governance in pharmaceutical systems to promote global health.

PubMed

Kohler, Jillian Clare; Mackey, Tim Ken; Ovtcharenko, Natalia

2014-01-21

Corruption in the health sector can hurt health outcomes. Improving good governance can in turn help prevent health-related corruption. We understand good governance as having the following characteristics: it is consensus-oriented, accountable, transparent, responsive, equitable and inclusive, effective and efficient, follows the rule of law, is participatory and should in theory be less vulnerable to corruption. By focusing on the pharmaceutical system, we explore some of the key lessons learned from existing initiatives in good governance. As the development community begins to identify post-2015 Millennium Development Goals targets, it is essential to evaluate programs in good governance in order to build on these results and establish sustainable strategies. This discussion on the pharmaceutical system illuminates why. Considering pharmaceutical governance initiatives such as those launched by the World Bank, World Health Organization, and the Global Fund, we argue that country ownership of good governance initiatives is essential but also any initiative must include the participation of impartial stakeholders. Understanding the political context of any initiative is also vital so that potential obstacles are identified and the design of any initiative is flexible enough to make adjustments in programming as needed. Finally, the inherent challenge which all initiatives face is adequately measuring outcomes from any effort. However in fairness, determining the precise relationship between good governance and health outcomes is rarely straightforward. Challenges identified in pharmaceutical governance initiatives manifest in different forms depending on the nature and structure of the initiative, but their regular occurrence and impact on population-based health demonstrates growing importance of addressing pharmaceutical governance as a key component of the post-2015 Millennium Development Goals. Specifically, these challenges need to be acknowledged and responded to with global cooperation and innovation to establish localized and evidence-based metrics for good governance to promote global pharmaceutical safety.

Why the MDGs need good governance in pharmaceutical systems to promote global health

PubMed Central

2014-01-01

Background Corruption in the health sector can hurt health outcomes. Improving good governance can in turn help prevent health-related corruption. We understand good governance as having the following characteristics: it is consensus-oriented, accountable, transparent, responsive, equitable and inclusive, effective and efficient, follows the rule of law, is participatory and should in theory be less vulnerable to corruption. By focusing on the pharmaceutical system, we explore some of the key lessons learned from existing initiatives in good governance. As the development community begins to identify post-2015 Millennium Development Goals targets, it is essential to evaluate programs in good governance in order to build on these results and establish sustainable strategies. This discussion on the pharmaceutical system illuminates why. Discussion Considering pharmaceutical governance initiatives such as those launched by the World Bank, World Health Organization, and the Global Fund, we argue that country ownership of good governance initiatives is essential but also any initiative must include the participation of impartial stakeholders. Understanding the political context of any initiative is also vital so that potential obstacles are identified and the design of any initiative is flexible enough to make adjustments in programming as needed. Finally, the inherent challenge which all initiatives face is adequately measuring outcomes from any effort. However in fairness, determining the precise relationship between good governance and health outcomes is rarely straightforward. Summary Challenges identified in pharmaceutical governance initiatives manifest in different forms depending on the nature and structure of the initiative, but their regular occurrence and impact on population-based health demonstrates growing importance of addressing pharmaceutical governance as a key component of the post-2015 Millennium Development Goals. Specifically, these challenges need to be acknowledged and responded to with global cooperation and innovation to establish localized and evidence-based metrics for good governance to promote global pharmaceutical safety. PMID:24447600

Development and Initial Validation of the Intimate Violence Responsibility Scale (IVRS)

ERIC Educational Resources Information Center

Yun, Sung Hyun; Vonk, M. Elizabeth

2011-01-01

The present study demonstrates the development and initial examination of psychometric properties of the Intimate Violence Responsibility Scale (IVRS) in a community-based sample (N = 527). The underlying factor structure of the IVRS was tested by the exploratory factor analysis (Principal Axis Factoring), which identifies the four factors:…

Assessing Landslide Mobility Using GIS: Application to Kosrae, Micronesia

NASA Astrophysics Data System (ADS)

Reid, M. E.; Brien, D. L.; Godt, J.; Schmitt, R. G.; Harp, E. L.

2015-12-01

Deadly landslides are often mobile landslides, as exemplified by the disastrous landslide that occurred near Oso, Washington in 2014 killing 43. Despite this association, many landslide susceptibility maps do not identify runout areas. We developed a simple, GIS-based method for identifying areas potentially overrun by mobile slides and debris flows. Our method links three processes within a DEM landscape: landslide initiation, transport, and debris-flow inundation (from very mobile slides). Given spatially distributed shear strengths, we first identify initiation areas using an infinite-slope stability analysis. We then delineate transport zones, or regions of potential entrainment and/or deposition, using a height/length runout envelope. Finally, where these transport zones intersect the channel network, we start debris-flow inundation zones. The extent of inundation is computed using the USGS model Laharz, modified to include many debris-flow locations throughout a DEM. Potential debris-flow volumes are computed from upslope initiation areas and typical slide thicknesses. We applied this approach to the main island of Kosrae State, Federated States of Micronesia (FSM). In 2002, typhoon Chata'an triggered numerous landslides on the neighboring islands of Chuuk State, FSM, resulting in 43 fatalities. Using an infinite-slope stability model calibrated to the Chuuk event, we identified potential landslide initiation areas on Kosrae. We then delineated potential transport zones using a 20º runout envelope, based on runout observations from Chuuk. Potential debris-flow inundation zones were then determined using Laharz. Field inspections on Kosrae revealed that our resulting susceptibility map correctly classified areas covered by previous debris-flow deposits and did not include areas covered by fluvial deposits. Our map has the advantage of providing a visual tool to portray initiation, transport, and runout zones from mobile landslides.

Health care administrators' perspectives on the role of absorptive capacity for strategic change initiatives: a qualitative study.

PubMed

Kash, Bita A; Spaulding, Aaron; Gamm, Larry; Johnson, Christopher E

2013-01-01

The dimensions of absorptive capacity (ACAP) are defined, and the importance of ACAP is established in the management literature, but the concept has not been applied to health care organizations attempting to implement multiple strategic initiatives. The aim of this study was to test the utility of ACAP by analyzing health care administrators' experiences with multiple strategic initiatives within two health systems. Results are drawn from administrators' assessments of multiple initiatives within two health systems using in-depth personal interviews with a total of 61 health care administrators. Data analysis was performed following deductive qualitative analysis guidelines. Interview transcripts were coded based on the four dimensions of ACAP: acquiring, assimilating, internalizing/transforming, and exploiting knowledge. Furthermore, we link results related to utilization of management resources, including number of key personnel involved and time consumption, to dimensions of ACAP. Participants' description of multiple strategic change initiatives confirmed the importance of the four ACAP dimensions. ACAP can be a useful framework to assess organizational capacity with respect to the organization's ability to concurrently implement multiple strategic initiatives. This capacity specifically revolves around human capital requirements from upper management based on the initiatives' location or stage within the ACAP framework. Strategic change initiatives in health care can be usefully viewed from an ACAP perspective. There is a tendency for those strategic initiatives ranking higher in priority and time consumption to reflect more advanced dimensions of ACAP (assimilate and transform), whereas few initiatives were identified in the ACAP "exploit" dimension. This may suggest that health care leaders tend to no longer identify as strategic initiatives those innovations that have moved to the exploitation stage or that less attention is given to the exploitation elements of a strategic initiative than to the earlier stages.

Studying the potential impact of automated document classification on scheduling a systematic review update.

PubMed

Cohen, Aaron M; Ambert, Kyle; McDonagh, Marian

2012-04-19

Systematic Reviews (SRs) are an essential part of evidence-based medicine, providing support for clinical practice and policy on a wide range of medical topics. However, producing SRs is resource-intensive, and progress in the research they review leads to SRs becoming outdated, requiring updates. Although the question of how and when to update SRs has been studied, the best method for determining when to update is still unclear, necessitating further research. In this work we study the potential impact of a machine learning-based automated system for providing alerts when new publications become available within an SR topic. Some of these new publications are especially important, as they report findings that are more likely to initiate a review update. To this end, we have designed a classification algorithm to identify articles that are likely to be included in an SR update, along with an annotation scheme designed to identify the most important publications in a topic area. Using an SR database containing over 70,000 articles, we annotated articles from 9 topics that had received an update during the study period. The algorithm was then evaluated in terms of the overall correct and incorrect alert rate for publications meeting the topic inclusion criteria, as well as in terms of its ability to identify important, update-motivating publications in a topic area. Our initial approach, based on our previous work in topic-specific SR publication classification, identifies over 70% of the most important new publications, while maintaining a low overall alert rate. We performed an initial analysis of the opportunities and challenges in aiding the SR update planning process with an informatics-based machine learning approach. Alerts could be a useful tool in the planning, scheduling, and allocation of resources for SR updates, providing an improvement in timeliness and coverage for the large number of medical topics needing SRs. While the performance of this initial method is not perfect, it could be a useful supplement to current approaches to scheduling an SR update. Approaches specifically targeting the types of important publications identified by this work are likely to improve results.

Studying the potential impact of automated document classification on scheduling a systematic review update

PubMed Central

2012-01-01

Background Systematic Reviews (SRs) are an essential part of evidence-based medicine, providing support for clinical practice and policy on a wide range of medical topics. However, producing SRs is resource-intensive, and progress in the research they review leads to SRs becoming outdated, requiring updates. Although the question of how and when to update SRs has been studied, the best method for determining when to update is still unclear, necessitating further research. Methods In this work we study the potential impact of a machine learning-based automated system for providing alerts when new publications become available within an SR topic. Some of these new publications are especially important, as they report findings that are more likely to initiate a review update. To this end, we have designed a classification algorithm to identify articles that are likely to be included in an SR update, along with an annotation scheme designed to identify the most important publications in a topic area. Using an SR database containing over 70,000 articles, we annotated articles from 9 topics that had received an update during the study period. The algorithm was then evaluated in terms of the overall correct and incorrect alert rate for publications meeting the topic inclusion criteria, as well as in terms of its ability to identify important, update-motivating publications in a topic area. Results Our initial approach, based on our previous work in topic-specific SR publication classification, identifies over 70% of the most important new publications, while maintaining a low overall alert rate. Conclusions We performed an initial analysis of the opportunities and challenges in aiding the SR update planning process with an informatics-based machine learning approach. Alerts could be a useful tool in the planning, scheduling, and allocation of resources for SR updates, providing an improvement in timeliness and coverage for the large number of medical topics needing SRs. While the performance of this initial method is not perfect, it could be a useful supplement to current approaches to scheduling an SR update. Approaches specifically targeting the types of important publications identified by this work are likely to improve results. PMID:22515596

Factors Influencing the Intention of Perinatal Nurses to Adopt the Baby-Friendly Hospital Initiative in Southeastern Quebec, Canada: Implications for Practice

PubMed Central

2014-01-01

Nurses play a major role in promoting the baby-friendly hospital initiative (BFHI), yet the adoption of this initiative by nurses remains a challenge in many countries, despite evidences of its positive impacts on breastfeeding outcomes. The aim of this study was to identify the factors influencing perinatal nurses to adopt the BFHI in their practice. Methods. A sample of 159 perinatal nurses from six hospital-based maternity centers completed a survey based on the theory of planned behavior. Hierarchical multiple linear regression analyses were performed to assess the relationship between key independent variables and nurses' intention to adopt the BFHI in their practice. A discriminant analysis of nurses' beliefs helped identify the targets of actions to foster the adoption the BFHI among nurses. Results. The participants are mainly influenced by factors pertaining to their perceived capacity to overcome the strict criteria of the BFHI, the mothers' approval of a nursing practice based on the BFHI, and the antenatal preparation of the mothers. Conclusions. This study provides theory-based evidence for the development of effective interventions aimed at promoting the adoption of the BFHI in nurses' practice. PMID:25101173

Factors influencing the intention of perinatal nurses to adopt the baby-friendly hospital initiative in southeastern quebec, Canada: implications for practice.

PubMed

Chabot, Guylaine; Lacombe, Marie

2014-01-01

Nurses play a major role in promoting the baby-friendly hospital initiative (BFHI), yet the adoption of this initiative by nurses remains a challenge in many countries, despite evidences of its positive impacts on breastfeeding outcomes. The aim of this study was to identify the factors influencing perinatal nurses to adopt the BFHI in their practice. Methods. A sample of 159 perinatal nurses from six hospital-based maternity centers completed a survey based on the theory of planned behavior. Hierarchical multiple linear regression analyses were performed to assess the relationship between key independent variables and nurses' intention to adopt the BFHI in their practice. A discriminant analysis of nurses' beliefs helped identify the targets of actions to foster the adoption the BFHI among nurses. Results. The participants are mainly influenced by factors pertaining to their perceived capacity to overcome the strict criteria of the BFHI, the mothers' approval of a nursing practice based on the BFHI, and the antenatal preparation of the mothers. Conclusions. This study provides theory-based evidence for the development of effective interventions aimed at promoting the adoption of the BFHI in nurses' practice.

Consumer Participation in Quality Improvements for Chronic Disease Care: Development and Evaluation of an Interactive Patient-Centered Survey to Identify Preferred Service Initiatives

PubMed Central

Paul, Christine L; Bryant, Jamie; Roos, Ian A; Henskens, Frans A; Paul, David J

2014-01-01

Background With increasing attention given to the quality of chronic disease care, a measurement approach that empowers consumers to participate in improving quality of care and enables health services to systematically introduce patient-centered initiatives is needed. A Web-based survey with complex adaptive questioning and interactive survey items would allow consumers to easily identify and prioritize detailed service initiatives. Objective The aim was to develop and test a Web-based survey capable of identifying and prioritizing patient-centered initiatives in chronic disease outpatient services. Testing included (1) test-retest reliability, (2) patient-perceived acceptability of the survey content and delivery mode, and (3) average completion time, completion rates, and Flesch-Kincaid reading score. Methods In Phase I, the Web-based Consumer Preferences Survey was developed based on a structured literature review and iterative feedback from expert groups of service providers and consumers. The touchscreen survey contained 23 general initiatives, 110 specific initiatives available through adaptive questioning, and a relative prioritization exercise. In Phase II, a pilot study was conducted within 4 outpatient clinics to evaluate the reliability properties, patient-perceived acceptability, and feasibility of the survey. Eligible participants were approached to complete the survey while waiting for an appointment or receiving intravenous therapy. The age and gender of nonconsenters was estimated to ascertain consent bias. Participants with a subsequent appointment within 14 days were asked to complete the survey for a second time. Results A total of 741 of 1042 individuals consented to participate (71.11% consent), 529 of 741 completed all survey content (78.9% completion), and 39 of 68 completed the test-retest component. Substantial or moderate reliability (Cohen’s kappa>0.4) was reported for 16 of 20 general initiatives with observed percentage agreement ranging from 82.1%-100.0%. The majority of participants indicated the Web-based survey was easy to complete (97.9%, 531/543) and comprehensive (93.1%, 505/543). Participants also reported the interactive relative prioritization exercise was easy to complete (97.0%, 189/195) and helped them to decide which initiatives were of most importance (84.6%, 165/195). Average completion time was 8.54 minutes (SD 3.91) and the Flesch-Kincaid reading level was 6.8. Overall, 84.6% (447/529) of participants indicated a willingness to complete a similar survey again. Conclusions The Web-based Consumer Preferences Survey is sufficiently reliable and highly acceptable to patients. Based on completion times and reading level, this tool could be integrated in routine clinical practice and allows consumers to easily participate in quality evaluation. Results provide a comprehensive list of patient-prioritized initiatives for patients with major chronic conditions and delivers practice-ready evidence to guide improvements in patient-centered care. PMID:25532217

42 CFR 421.501 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... licensed medical professional, for a billed item or service identified by data analysis techniques or probe... rate based on the results of a probe review prior to the initiation of complex medical review. Medical... licensed medical professional, for a billed item or service identified by data analysis techniques or probe...

42 CFR 421.501 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... licensed medical professional, for a billed item or service identified by data analysis techniques or probe... rate based on the results of a probe review prior to the initiation of complex medical review. Medical... licensed medical professional, for a billed item or service identified by data analysis techniques or probe...

42 CFR 421.501 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... licensed medical professional, for a billed item or service identified by data analysis techniques or probe... rate based on the results of a probe review prior to the initiation of complex medical review. Medical... licensed medical professional, for a billed item or service identified by data analysis techniques or probe...

Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases

PubMed Central

Huiart, Laetitia; Ferdynus, Cyril; Renoux, Christel; Beaugrand, Amélie; Lafarge, Sophie; Bruneau, Léa; Suissa, Samy; Maillard, Olivier; Ranouil, Xavier

2018-01-01

Objective Unlike several other national health agencies, French health authorities recommended that the newer direct oral anticoagulant (DOAC) agents only be prescribed as second choice for the treatment of newly diagnosed non-valvular atrial fibrillation (NVAF), with vitamin K antagonists (VKA) remaining the first choice. We investigated the patterns of use of DOACs versus VKA in the treatment of NVAF in France over the first 5 years of DOAC availability. We also identified the changes in patient characteristics of those who initiated DOAC treatment over this time period. Methods Based on the French National Health Administrative Database, we constituted a population-based cohort of all patients who were newly treated for NVAF between January 2011 and December 2015. Trends in drug use were described as the percentage of patients initiating each drug at the time of treatment initiation. A multivariate analysis using logistic regression model was performed to identify independent sociodemographic and clinical predictors of initial anticoagulant choice. Results The cohort comprised 814 446 patients who had received a new anticoagulant treatment for NVAF. The proportion of patients using DOACs as initial anticoagulant therapy reached 54% 3 months after the Health Ministry approved the reimbursement of dabigatran for NVAF, and 61% by the end of 2015, versus VKA use. In the multivariate analysis, we found that DOAC initiators were younger and healthier overall than VKA initiators, and this tendency was reinforced over the 2011–2014 period. DOACs were more frequently prescribed by cardiologists in 2012 and after (adjusted OR in 2012: 2.47; 95% CI 2.40 to 2.54). Conclusion Despite recommendations from health authorities, DOACs have been rapidly and massively adopted as initial therapy for NVAF in France. Observational studies should account for the fact that patients selected to initiate DOAC treatment are healthier overall, as failure to do so may bias the risk–benefit assessment of DOACs. PMID:29602837

Top 20 Collaborative Internet-Based Science Projects of 1998: Characteristics and Comparisons to Exemplary Science Instruction.

ERIC Educational Resources Information Center

Berg, Craig A.; Jefson, Cristy

This paper utilizes the characteristics of model science instruction to identify exemplary Internet-based science collaborations. The filter for attaining "exemplary" status was based on state and national standards-generating initiatives and the corresponding implications for appropriate student activity in science classrooms. Twenty…

Finding and Tracing the Effects of Governance Processes in the New Opportunities Initiative: An Outline

ERIC Educational Resources Information Center

Marques, Marcelo

2014-01-01

Based on a Globally Structured Agenda for Education, this article presents the construction of the New Opportunities Initiative in Portugal. Thus, it analyses the relationship between the European Union and the Portuguese State with regard to the construction of this programme, identifying for this purpose the effects of governance processes.…

Unraveling the proteomic profile of mice testis during the initiation of meiosis.

PubMed

Shao, Binbin; Guo, Yueshuai; Wang, Lei; Zhou, Quan; Gao, Tingting; Zheng, Bo; Zheng, Haoyu; Zhou, Tao; Zhou, Zuomin; Guo, Xuejiang; Huang, Xiaoyan; Sha, Jiahao

2015-04-29

In mice, once primordial germ cells (PGCs) are generated, they continue to proliferate and migrate to eventually reach the future gonads. They initiate sexual differentiation after their colonization of the gonads. During this process, retinoic acid (RA) induces meiosis in the female germ cells, which proceeds to the diplotene stage of meiotic prophase I, whereas the male germ cells initiate growth arrest. After birth, meiosis is initiated in mice spermatogonia by their conversion to preleptotene spermatocytes. There are evidences showing the roles of RA in the regulation of spermatogonial differentiation and meiosis initiation. However, it is still not well known on what responds to RA and how RA signaling engages meiosis. Thus, we constructed a proteomic profile of proteins associated with meiosis onset during testis development in mouse and identified 104 differentially expressed proteins (≥1.5 folds). Bioinformatic analysis showed proteins functioning in specific cell processes. The expression patterns of five selected proteins were verified via Western blot, of which we found that Tfrc gene was RA responsive, with a RA responsive element, and could be up regulated by RA in spermatogonial stem cell (SSC) line. Taken together, the results provide an important reference profile for further functional study of meiosis initiation. Spermatogenesis involves mitosis of spermatogonia, meiosis of spermatocytes and spermiogenesis, in which meiosis is a unique event to germ cells, and not in the somatic cells. Till now, the detailed molecular mechanisms of the transition from mitosis to meiosis are still not elucidated. With high-throughput proteomic technology, it is now possible to systemically identify proteins possibly involved. With TMT-6plex based quantification, we identified 104 proteins differentially between testes without meiosis (day 8.5) and those that were meiosis initiated (day 10.5). And a well-known protein essential for meiosis initiation, stra8, was identified to be differentially expressed in the study. And bioinformatic analysis and functional studies revealed several proteins regulated by retinoic acid, a chemical known to regulate the meiosis initiation. Thus, this quantitative proteomic approach can identify meiosis initiation regulating proteins, and further functional studies of these proteins will help elucidate the mechanisms of meiosis initiation. Copyright © 2015. Published by Elsevier B.V.

A Comparative Analysis of Meeting the Whole Child Initiatives through Standardized and Competency-Based Education Systems in Terms of Achievement and Meeting the Whole Child Initiatives: Comparing Professional Perceptions and Identified Measurable Results

ERIC Educational Resources Information Center

Ward, Jacqueline M.

2011-01-01

Traditional education (TE) largely uses a standardized (SbE) approach while alternatives (nTE) tend to more of a competency (CbE), or student-centered approach. This comparative analysis examines essential aspects of such pedagogies in determining the effectiveness of schooling systems in meeting the Whole Child Initiative (Souza, 1999; Carter et…

CFD validation experiments for hypersonic flows

NASA Technical Reports Server (NTRS)

Marvin, Joseph G.

1992-01-01

A roadmap for CFD code validation is introduced. The elements of the roadmap are consistent with air-breathing vehicle design requirements and related to the important flow path components: forebody, inlet, combustor, and nozzle. Building block and benchmark validation experiments are identified along with their test conditions and measurements. Based on an evaluation criteria, recommendations for an initial CFD validation data base are given and gaps identified where future experiments could provide new validation data.

The role of initial affective impressions in responses to educational communications: the case of carbon capture and sequestration (CCS).

PubMed

Bruine de Bruin, Wändi; Wong-Parodi, Gabrielle

2014-06-01

Emerging technologies promise potential benefits at a potential cost. Developers of educational communications aim to improve people's understanding and to facilitate public debate. However, even relatively uninformed recipients may have initial feelings that are difficult to change. We report that people's initial affective impressions about carbon capture and sequestration (CCS), a low-carbon coal-based electricity-generation technology with which most people are unfamiliar, influences how they interpret previously validated education materials. As a result, even individuals who had originally self-identified as uninformed persisted in their initial feelings after reading the educational communication-though perseverance of feelings about CCS was stronger among recipients who had originally self-identified as relatively informed (Study 1). Moreover, uninformed recipients whose initial feelings were experimentally manipulated by relatively uninformative pro-CCS or anti-CCS arguments persisted in their manipulated feelings after reading the educational communication, due to evaluating the educational communication in line with their manipulated impressions (Study 2). Hence, our results suggest that educational communications will have more impact if they are disseminated before people form strong feelings about the topic under consideration, especially if these are based on little to no factual understanding. PsycINFO Database Record (c) 2014 APA, all rights reserved.

A map of community-based obesity prevention initiatives in Australia following obesity funding 2009–2013

PubMed Central

Whelan, Jillian; Love, Penny; Romanus, Anne; Pettman, Tahna; Bolton, Kristy; Smith, Erin; Gill, Tim; Coveney, John; Waters, Elizabeth; Allender, Steve

2015-01-01

Abstract Objective: Obesity is the single biggest public health threat to developed and developing economies. In concert with healthy public policy, multi-strategy, multi-level community-based initiatives appear promising in preventing obesity, with several countries trialling this approach. In Australia, multiple levels of government have funded and facilitated a range of community-based obesity prevention initiatives (CBI), heterogeneous in their funding, timing, target audience and structure. This paper aims to present a central repository of CBI operating in Australia during 2013, to facilitate knowledge exchange and shared opportunities for learning, and to guide professional development towards best practice for CBI practitioners. Methods: A comprehensive search of government, non-government and community websites was undertaken to identify CBI in Australia in 2013. This was supplemented with data drawn from available reports, personal communication and key informant interviews. The data was translated into an interactive map for use by preventive health practitioners and other parties. Results: We identified 259 CBI; with the majority (84%) having a dual focus on physical activity and healthy eating. Few initiatives, (n=37) adopted a four-pronged multi-strategy approach implementing policy, built environment, social marketing and/or partnership building. Conclusion: This comprehensive overview of Australian CBI has the potential to facilitate engagement and collaboration through knowledge exchange and information sharing amongst CBI practitioners, funders, communities and researchers. Implications: An enhanced understanding of current practice highlights areas of strengths and opportunities for improvement to maximise the impact of obesity prevention initiatives. PMID:25561083

A map of community-based obesity prevention initiatives in Australia following obesity funding 2009-2013.

PubMed

Whelan, Jillian; Love, Penny; Romanus, Anne; Pettman, Tahna; Bolton, Kristy; Smith, Erin; Gill, Tim; Coveney, John; Waters, Elizabeth; Allender, Steve

2015-04-01

Obesity is the single biggest public health threat to developed and developing economies. In concert with healthy public policy, multi-strategy, multi-level community-based initiatives appear promising in preventing obesity, with several countries trialling this approach. In Australia, multiple levels of government have funded and facilitated a range of community-based obesity prevention initiatives (CBI), heterogeneous in their funding, timing, target audience and structure. This paper aims to present a central repository of CBI operating in Australia during 2013, to facilitate knowledge exchange and shared opportunities for learning, and to guide professional development towards best practice for CBI practitioners. A comprehensive search of government, non-government and community websites was undertaken to identify CBI in Australia in 2013. This was supplemented with data drawn from available reports, personal communication and key informant interviews. The data was translated into an interactive map for use by preventive health practitioners and other parties. We identified 259 CBI; with the majority (84%) having a dual focus on physical activity and healthy eating. Few initiatives, (n=37) adopted a four-pronged multi-strategy approach implementing policy, built environment, social marketing and/or partnership building. This comprehensive overview of Australian CBI has the potential to facilitate engagement and collaboration through knowledge exchange and information sharing amongst CBI practitioners, funders, communities and researchers. An enhanced understanding of current practice highlights areas of strengths and opportunities for improvement to maximise the impact of obesity prevention initiatives. © 2015 Public Health Association of Australia.

A School-Based Therapeutic/Educational Program for Severely Disturbed Latency Aged Children.

ERIC Educational Resources Information Center

Shelby, Madge E.

Through joint efforts of mental health and education professionals, a school-based therapeutic/educational program for seriously emotionally disturbed children, some of whom had additional identified disabilities such as mental retardation, was initiated with 15 students (ages 8-13). The educational component of the program was based on an…

Theory-Driven Longitudinal Study Exploring Indoor Tanning Initiation in Teens Using a Person-Centered Approach

PubMed Central

Hillhouse, Joel; Turrisi, Rob; Cleveland, Michael J.; Scaglione, Nichole M.; Baker, Katie; Florence, L. Carter

2015-01-01

Background Younger indoor tanning initiation leads to greater melanoma risk due to more frequent and persistent behavior. Despite this, there are no published studies exploring the predictors of indoor tanning initiation in teen populations. Purpose This longitudinal study uses latent profile analysis to examine indoor tanning initiation in indoor tanning risk subgroups from a national sample of female adolescents. Methods Latent profile analysis used indoor tanning beliefs and perceptions to identify indoor tanning initiation risk subgroups. The teens in each subgroup were reassessed on indoor tanning initiation after a year. Results Three subgroups were identified: a low-risk, Anti-Tanning subgroup (18.6%) characterized by low scores on positive indoor tanning belief scales and high scores on beliefs about indoor tanning dangers; a moderate-risk Aware Social Tanner subgroup (47.2%) characterized by high scores on positive indoor tanning belief scales but also high scores on beliefs about indoor tanning dangers; and a high-risk Risky Relaxation Tanner subgroup (34.2%) characterized by high scores on positive indoor tanning belief scales and low scores on beliefs about indoor tanning dangers. Teens in the Aware Social Tanner and Risky Relaxation Tanner subgroups were significantly more likely to initiate indoor tanning in the following year. Conclusions These findings highlight the need to identify teens at risk for indoor tanning initiation and develop tailored interventions that will move them to the lowest risk subgroup. Subgroup correlates suggest parent and peer-based interventions may be successful. PMID:26370893

Theory-Driven Longitudinal Study Exploring Indoor Tanning Initiation in Teens Using a Person-Centered Approach.

PubMed

Hillhouse, Joel; Turrisi, Rob; Cleveland, Michael J; Scaglione, Nichole M; Baker, Katie; Florence, L Carter

2016-02-01

Younger indoor tanning initiation leads to greater melanoma risk due to more frequent and persistent behavior. Despite this, there are no published studies exploring the predictors of indoor tanning initiation in teen populations. This longitudinal study uses latent profile analysis to examine indoor tanning initiation in indoor tanning risk subgroups from a national sample of female adolescents. Latent profile analysis used indoor tanning beliefs and perceptions to identify indoor tanning initiation risk subgroups. The teens in each subgroup were reassessed on indoor tanning initiation after a year. Three subgroups were identified: a low risk, anti-tanning subgroup (18.6 %) characterized by low scores on positive indoor tanning belief scales and high scores on beliefs about indoor tanning dangers; a moderate risk aware social tanner subgroup (47.2 %) characterized by high scores on positive indoor tanning belief scales but also high scores on beliefs about indoor tanning dangers; and a high risk risky relaxation tanner subgroup (34.2 %) characterized by high scores on positive indoor tanning belief scales and low scores on beliefs about indoor tanning dangers. Teens in the aware social tanner and risky relaxation tanner subgroups were significantly more likely to initiate indoor tanning in the following year. These findings highlight the need to identify teens at risk for indoor tanning initiation and develop tailored interventions that will move them to the lowest risk subgroup. Subgroup correlates suggest parent and peer-based interventions may be successful.

[Initial antiretroviral treatment in human immunodeficiency virus-infected patients in Spain: Decisions made in relation to particular immunovirological characteristics (PERFIL-es study)].

PubMed

Viciana, Pompeyo; Ocampo, Antonio; Hevia, Henar; Palazuelos, Marta; Ledesma, Francisco

2014-02-01

The purpose of Perfil-es study was to identify the proportion of patients starting ARV treatment based on NNRTIs or PI/r, and to identify the variables involved in the therapeutic decision-making in standard clinical practice. An observational retrospective study performed in 65 Spanish hospitals. Was a total of 1,687 starts: 53% with NNRTI-based regimen and 42% with PI/r, and of the 642 patients analyzed, 72% had a CD4 count<350 cells/μl. The initiation of ARV treatment is still late in Spain. NNRTIs are the more frequent choice, although PI/r plays an important role. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Identifying Threshold Concepts: Case Study of an Open Catchment Hydraulics Course

ERIC Educational Resources Information Center

Knight, D. B.; Callaghan, D. P.; Baldock, T. E.; Meyer, J. H. F.

2014-01-01

The Threshold Concept Framework is used to initiate a dialogue on an empirically supported pedagogy that focuses on students' conceptual understanding required for solving application-based problems. The present paper uses a triangulation approach to identify the threshold concept in a third-year undergraduate civil engineering course on open…

Space Communications Capability Roadmap Interim Review

NASA Technical Reports Server (NTRS)

Spearing, Robert; Regan, Michael

2005-01-01

Contents include the following: Identify the need for a robust communications and navigation architecture for the success of exploration and science missions. Describe an approach for specifying architecture alternatives and analyzing them. Establish a top level architecture based on a network of networks. Identify key enabling technologies. Synthesize capability, architecture and technology into an initial capability roadmap.

The Talents Dovetail: Initiative for Identifying Gifted and Talented Minority Students.

ERIC Educational Resources Information Center

Talents Unlimited, Inc., Mobile, AL.

The Talents Unlimited (TU) critical and creative thinking skills model is designed to help teachers recognize and nurture the multiple talents of all children. Research based on the work of Calvin Taylor, has identified high-level talent areas of productive thinking, communication, forecasting, decision making, and planning, in which all excel to…

Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

PubMed

White, Mark; Butterworth, Tony; Wells, John S G

2017-10-01

To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered. © 2017 John Wiley & Sons Ltd.

A Review on Critical Success Factors of Governance towards Sustainable Campus Operations

NASA Astrophysics Data System (ADS)

Halid Abdullah, Abd; Razman, Ruzaimah; Muslim, Rahmat

2017-08-01

Campus Sustainability is an effort that integrates environmentally sustainable practices into institutional practices. A successful transition to a sustainable campus requires the involvement of the university community; the administration, academics departments (faculty and students), researchers and he local community. Our research seeks to identify Critical Success Factors (CSFs) of university governance that contribute to the success in implementing Sustainable Campus Operation (SCO) initiatives. The common CSFs have been identified from 22 published and unpublished articles, conference proceedings, university reports, books, and website documents. The CSFs are mapped and ranked based on the frequency of the identified CSFs. 23 CSFs of SCO have been identified through this research. This research revealed that the CSF that contributes the highest frequency as indicated by most researchers is “developing network with external parties for gaining consensus and commitment”. By identifying these CSFs, this research will help assist universities in successfully plan and implement their SCO initiatives.

The Role for Community-Based Participatory Research in Formulating Policy Initiatives: Promoting Safety and Health for In-Home Care Workers and Their Consumers

PubMed Central

Gong, Fang; Ayala, Linda; Stock, Laura; McDevitt, Susannah; Heaney, Cathy

2009-01-01

Although community-based participatory research (CBPR) can be effective in influencing policy, the process of formulating policy initiatives through CBPR is understudied. We describe a case study to illustrate how alliances among various community partners could be united to formulate policy directions. In collaboration with partners, the National Institute for Occupational Safety and Health initiated a project aimed at improving health and safety for low-income elderly and disabled persons and their in-home care workers. Community partners and stakeholders participated in focus groups, stakeholder interviews, and meetings; they played multiple roles including identifying organizational policy changes the partners could initiate immediately, as well as broader public policy goals. Results indicated that a strong community partnership, participation, and shared values contributed to successful formulation of policy initiatives. PMID:19890153

Church-Based Recruitment to Reach Korean Immigrants: An Integrative Review.

PubMed

Park, Chorong; Jang, Myoungock; Nam, Soohyun; Grey, Margaret; Whittemore, Robin

2017-04-01

Although the Korean church has been frequently used to recruit Korean immigrants in research, little is known about the specific strategies and process. The purpose of this integrative review was to describe recruitment strategies in studies of Korean immigrants and to identify the process of Korean church-based recruitment. Thirty-three studies met inclusion criteria. Four stages of church-based recruitment were identified: initiation, endorsement, advertisement, and implementation. This review identified aspects of the church-based recruitment process in Korean immigrants, which are different from the Black and Hispanic literature, due to their hierarchical culture and language barriers. Getting permission from pastors and announcing the study by pastors at Sunday services were identified as the key components of the process. Using the church newsletter to advertise the study was the most effective strategy for the advertisement stage. Despite several limitations, church-based recruitment is a very feasible and effective way to recruit Korean immigrants.

What is an adequate sample size? Operationalising data saturation for theory-based interview studies.

PubMed

Francis, Jill J; Johnston, Marie; Robertson, Clare; Glidewell, Liz; Entwistle, Vikki; Eccles, Martin P; Grimshaw, Jeremy M

2010-12-01

In interview studies, sample size is often justified by interviewing participants until reaching 'data saturation'. However, there is no agreed method of establishing this. We propose principles for deciding saturation in theory-based interview studies (where conceptual categories are pre-established by existing theory). First, specify a minimum sample size for initial analysis (initial analysis sample). Second, specify how many more interviews will be conducted without new ideas emerging (stopping criterion). We demonstrate these principles in two studies, based on the theory of planned behaviour, designed to identify three belief categories (Behavioural, Normative and Control), using an initial analysis sample of 10 and stopping criterion of 3. Study 1 (retrospective analysis of existing data) identified 84 shared beliefs of 14 general medical practitioners about managing patients with sore throat without prescribing antibiotics. The criterion for saturation was achieved for Normative beliefs but not for other beliefs or studywise saturation. In Study 2 (prospective analysis), 17 relatives of people with Paget's disease of the bone reported 44 shared beliefs about taking genetic testing. Studywise data saturation was achieved at interview 17. We propose specification of these principles for reporting data saturation in theory-based interview studies. The principles may be adaptable for other types of studies.

Changes in breastfeeding initiation at hospital discharge between first and second births in Nova Scotia: a population-based cohort study

PubMed Central

Nix, Kimberley; Dodds, Linda

2017-01-01

Background: Breastfeeding has well-recognized health benefits for infants and mothers. However, little research has been conducted to investigate changes in breastfeeding from one pregnancy to another. This study was conducted to describe rates of breastfeeding initiation at hospital discharge for women's first and second births and to identify factors associated with changes in initiation at the second birth. Methods: We conducted a longitudinal, population-based cohort study involving women residing in Nova Scotia who delivered a first and second live-born singleton between 2007 and 2013. Separate analyses were conducted among women who breastfed their first infant and among women who did not breastfeed their first infant. Results: Of the 9643 (82.6%) mothers who initiated breastfeeding in the first birth, 973 (10.3%) did not initiate breastfeeding in the second birth. Of first-birth noninitiators, 526 (26.3%) initiated breastfeeding in the second birth. With the exception of smoking and cesarean births, factors that were associated with breastfeeding initiation in the second birth depended on breastfeeding initiation status in the first birth. These factors were associated with increased odds of not breastfeeding in the second birth among the subset of mothers who breastfed in the first birth, and decreased odds of breastfeeding in the second birth among the subset of mothers who did not breastfeed in the first birth. Interpretation: Most women continue the same method of infant feeding after their first and second births. Identifying factors associated with change in breastfeeding status between the first and second births may help to inform interventions for optimal breastfeeding initiation in the second birth. PMID:28401137

A CFD validation roadmap for hypersonic flows

NASA Technical Reports Server (NTRS)

Marvin, Joseph G.

1992-01-01

A roadmap for computational fluid dynamics (CFD) code validation is developed. The elements of the roadmap are consistent with air-breathing vehicle design requirements and related to the important flow path components: forebody, inlet, combustor, and nozzle. Building block and benchmark validation experiments are identified along with their test conditions and measurements. Based on an evaluation criteria, recommendations for an initial CFD validation data base are given and gaps identified where future experiments would provide the needed validation data.

A CFD validation roadmap for hypersonic flows

NASA Technical Reports Server (NTRS)

Marvin, Joseph G.

1993-01-01

A roadmap for computational fluid dynamics (CFD) code validation is developed. The elements of the roadmap are consistent with air-breathing vehicle design requirements and related to the important flow path components: forebody, inlet, combustor, and nozzle. Building block and benchmark validation experiments are identified along with their test conditions and measurements. Based on an evaluation criteria, recommendations for an initial CFD validation data base are given and gaps identified where future experiments would provide the needed validation data.

Initial use of echinocandins does not negatively influence outcome in Candida parapsilosis bloodstream infection: a propensity score analysis.

PubMed

Fernández-Ruiz, Mario; Aguado, José María; Almirante, Benito; Lora-Pablos, David; Padilla, Belén; Puig-Asensio, Mireia; Montejo, Miguel; García-Rodríguez, Julio; Pemán, Javier; Ruiz Pérez de Pipaón, Maite; Cuenca-Estrella, Manuel

2014-05-01

Concerns have arisen regarding the optimal antifungal regimen for Candida parapsilosis bloodstream infection (BSI) in view of its reduced susceptibility to echinocandins. The Prospective Population Study on Candidemia in Spain (CANDIPOP) is a prospective multicenter, population-based surveillance program on Candida BSI conducted through a 12-month period in 29 Spanish hospitals. Clinical isolates were identified by DNA sequencing, and antifungal susceptibility testing was performed by the European Committee on Antimicrobial Susceptibility Testing methodology. Predictors for clinical failure (all-cause mortality between days 3 to 30, or persistent candidemia for ≥72 hours after initiation of therapy) in episodes of C. parapsilosis species complex BSI were assessed by logistic regression analysis. We further analyzed the impact of echinocandin-based regimen as the initial antifungal therapy (within the first 72 hours) by using a propensity score approach. Among 752 episodes of Candida BSI identified, 200 (26.6%) were due to C. parapsilosis species complex. We finally analyzed 194 episodes occurring in 190 patients. Clinical failure occurred in 58 of 177 (32.8%) of evaluable episodes. Orotracheal intubation (adjusted odds ratio [AOR], 2.81; P = .018) and septic shock (AOR, 2.91; P = .081) emerged as risk factors for clinical failure, whereas early central venous catheter removal was protective (AOR, 0.43; P = .040). Neither univariate nor multivariate analysis revealed that the initial use of an echinocandin-based regimen had any impact on the risk of clinical failure. Incorporation of the propensity score into the model did not change this finding. The initial use of an echinocandin-based regimen does not seem to negatively influence outcome in C. parapsilosis BSI.

Regional cooperation and performance-based planning and programming in Indiana : a regional models of cooperation peer exchange summary report

DOT National Transportation Integrated Search

2016-05-01

This report highlights key themes identified at the Regional Cooperation and Performance-Based Planning and Programming in Indiana Peer Exchange held on May 25, 2016 in Indianapolis, Indiana. The Regional Models of Cooperation Initiative, which...

SOLVENT-BASED TO WATERBASED ADHESIVE-COATED SUBSTRATE RETROFIT - VOLUME II: PROCESS OVERVIEW

EPA Science Inventory

This volume presents initial results of a study to identify the issues and barriers associated with retrofitting existing solvent-based equipment to accept waterbased adhesives as part of an EPA effort to improve equipment cleaning in the coated and laminated substrate manufactur...

Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for new-onset polyarticular juvenile idiopathic arthritis.

PubMed

Ringold, Sarah; Weiss, Pamela F; Colbert, Robert A; DeWitt, Esi Morgan; Lee, Tzielan; Onel, Karen; Prahalad, Sampath; Schneider, Rayfel; Shenoi, Susan; Vehe, Richard K; Kimura, Yukiko

2014-07-01

There is no standardized approach to the initial treatment of polyarticular juvenile idiopathic arthritis (JIA) among pediatric rheumatologists. Understanding the comparative effectiveness of the diverse therapeutic options available will result in better health outcomes for polyarticular JIA. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans (CTPs) for use in clinical practice to facilitate such studies. A case-based survey was administered to CARRA members to identify the common treatment approaches for new-onset polyarticular JIA. Two face-to-face consensus conferences employed modified nominal group technique to identify treatment strategies, operational case definition, end points, and data elements to be collected. A core workgroup reviewed the relevant literature, refined plans, and developed medication dosing and monitoring recommendations. The initial case-based survey identified significant variability among treatment approaches for new-onset polyarticular JIA. We developed 3 CTPs based on treatment strategies for the first 12 months of therapy, as well as case definitions and clinical and laboratory monitoring schedules. The CTPs include a step-up plan (nonbiologic disease-modifying antirheumatic drug [DMARD] followed by a biologic DMARD), an early combination plan (nonbiologic and biologic DMARD combined within a month of treatment initiation), and a biologic only plan. This approach was approved by 96% of the CARRA JIA Research Committee members attending the 2013 CARRA face-to-face meeting. Three standardized CTPs were developed for new-onset polyarticular JIA. Coupled with data collection at defined intervals, use of these CTPs will enable the study of their comparative effectiveness in an observational setting to optimize initial management of polyarticular JIA. Copyright © 2014 by the American College of Rheumatology.

ITPI: Initial Transcription Process-Based Identification Method of Bioactive Components in Traditional Chinese Medicine Formula

PubMed Central

Zhang, Baixia; Li, Yanwen; Zhang, Yanling; Li, Zhiyong; Bi, Tian; He, Yusu; Song, Kuokui; Wang, Yun

2016-01-01

Identification of bioactive components is an important area of research in traditional Chinese medicine (TCM) formula. The reported identification methods only consider the interaction between the components and the target proteins, which is not sufficient to explain the influence of TCM on the gene expression. Here, we propose the Initial Transcription Process-based Identification (ITPI) method for the discovery of bioactive components that influence transcription factors (TFs). In this method, genome-wide chip detection technology was used to identify differentially expressed genes (DEGs). The TFs of DEGs were derived from GeneCards. The components influencing the TFs were derived from STITCH. The bioactive components in the formula were identified by evaluating the molecular similarity between the components in formula and the components that influence the TF of DEGs. Using the formula of Tian-Zhu-San (TZS) as an example, the reliability and limitation of ITPI were examined and 16 bioactive components that influence TFs were identified. PMID:27034696

Automatic selection of landmarks in T1-weighted head MRI with regression forests for image registration initialization.

PubMed

Wang, Jianing; Liu, Yuan; Noble, Jack H; Dawant, Benoit M

2017-10-01

Medical image registration establishes a correspondence between images of biological structures, and it is at the core of many applications. Commonly used deformable image registration methods depend on a good preregistration initialization. We develop a learning-based method to automatically find a set of robust landmarks in three-dimensional MR image volumes of the head. These landmarks are then used to compute a thin plate spline-based initialization transformation. The process involves two steps: (1) identifying a set of landmarks that can be reliably localized in the images and (2) selecting among them the subset that leads to a good initial transformation. To validate our method, we use it to initialize five well-established deformable registration algorithms that are subsequently used to register an atlas to MR images of the head. We compare our proposed initialization method with a standard approach that involves estimating an affine transformation with an intensity-based approach. We show that for all five registration algorithms the final registration results are statistically better when they are initialized with the method that we propose than when a standard approach is used. The technique that we propose is generic and could be used to initialize nonrigid registration algorithms for other applications.

No Differences in Achieving Hepatitis C Virus Care Milestones Between Patients Identified by Birth Cohort or Risk-Based Screening.

PubMed

Norton, Brianna L; Southern, William N; Steinman, Meredith; Smith, Bryce D; Deluca, Joseph; Rosner, Zachary; Litwin, Alain H

2016-09-01

National hepatitis C virus (HCV) screening guidelines recommended 1-time testing of persons born between 1945 and 1965. We performed a retrospective study to compare care milestones achieved by HCV-infected patients identified by birth cohort versus risk-based screens. We determined the proportions of patients newly identified with HCV infection who met care milestones (viral load, referral to and evaluation by a specialist, offer of treatment, initiation of treatment, and sustained viral response) and the time it took to reach them. We found no differences in HCV care milestones for patients identified via birth cohort testing versus risk-based screening. Overall, only 43% of HCV antibody-positive patients were referred to care, and less than 4% started treatment. The time to each care milestone was lengthy and varied greatly; treatment was initiated in a median of 308 days. Although birth cohort testing will likely increase identification of patients with HCV infection, it does not seem to increase the number of patients that meet management milestones. New methods are needed to increase access to care and establish efficient models of health care delivery. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Evidence-based guidelines for the use of tracheostomy in critically ill patients.

PubMed

Raimondi, Néstor; Vial, Macarena R; Calleja, José; Quintero, Agamenón; Cortés, Albán; Celis, Edgar; Pacheco, Clara; Ugarte, Sebastián; Añón, José M; Hernández, Gonzalo; Vidal, Erick; Chiappero, Guillermo; Ríos, Fernando; Castilleja, Fernando; Matos, Alfredo; Rodriguez, Enith; Antoniazzi, Paulo; Teles, José Mario; Dueñas, Carmelo; Sinclair, Jorge; Martínez, Lorenzo; von der Osten, Ingrid; Vergara, José; Jiménez, Edgar; Arroyo, Max; Rodríguez, Camilo; Torres, Javier; Fernandez-Bussy, Sebastián; Nates, Joseph L

2017-04-01

To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions. Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used. Copyright © 2016 Elsevier Inc. All rights reserved.

Automatic human body modeling for vision-based motion capture system using B-spline parameterization of the silhouette

NASA Astrophysics Data System (ADS)

Jaume-i-Capó, Antoni; Varona, Javier; González-Hidalgo, Manuel; Mas, Ramon; Perales, Francisco J.

2012-02-01

Human motion capture has a wide variety of applications, and in vision-based motion capture systems a major issue is the human body model and its initialization. We present a computer vision algorithm for building a human body model skeleton in an automatic way. The algorithm is based on the analysis of the human shape. We decompose the body into its main parts by computing the curvature of a B-spline parameterization of the human contour. This algorithm has been applied in a context where the user is standing in front of a camera stereo pair. The process is completed after the user assumes a predefined initial posture so as to identify the main joints and construct the human model. Using this model, the initialization problem of a vision-based markerless motion capture system of the human body is solved.

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.

Selective Laser Sintering of Nano Al2O3 Infused Polyamide

PubMed Central

Warnakula, Anthony; Singamneni, Sarat

2017-01-01

Nano Al2O3 polyamide composites are evaluated for processing by selective laser sintering. A thermal characterization of the polymer composite powders allowed us to establish the possible initial settings. Initial experiments are conducted to identify the most suitable combinations of process parameters. Based on the results of the initial trials, more promising ranges of different process parameters could be identified. The post sintering characterization showed evidence of sufficient inter-particle sintering and intra-layer coalescence. While the inter-particle coalescence gradually improved, the porosity levels slightly decreased with increasing laser power. The nano-filler particles tend to agglomerate around the beads along the solid tracks, possibly due to Van der Walls forces. The tensile stress results showed an almost linear increase with increasing nano-filler content. PMID:28773220

Jordanian Pre-Service Teachers' and Technology Integration: A Human Resource Development Approach

ERIC Educational Resources Information Center

Al-Ruz, Jamal Abu; Khasawneh, Samer

2011-01-01

The purpose of this study was to test a model in which technology integration of pre-service teachers was predicted by a number of university-based and school-based factors. Initially, factors affecting technology integration were identified, and a research-based path model was developed to explain causal relationships between these factors. The…

The STAR Data Reporting Guidelines for Clinical High Altitude Research.

PubMed

Brodmann Maeder, Monika; Brugger, Hermann; Pun, Matiram; Strapazzon, Giacomo; Dal Cappello, Tomas; Maggiorini, Marco; Hackett, Peter; Bärtsch, Peter; Swenson, Erik R; Zafren, Ken

2018-03-01

Brodmann Maeder, Monika, Hermann Brugger, Matiram Pun, Giacomo Strapazzon, Tomas Dal Cappello, Marco Maggiorini, Peter Hackett, Peter Baärtsch, Erik R. Swenson, Ken Zafren (STAR Core Group), and the STAR Delphi Expert Group. The STARdata reporting guidelines for clinical high altitude research. High AltMedBiol. 19:7-14, 2018. The goal of the STAR (STrengthening Altitude Research) initiative was to produce a uniform set of key elements for research and reporting in clinical high-altitude (HA) medicine. The STAR initiative was inspired by research on treatment of cardiac arrest, in which the establishment of the Utstein Style, a uniform data reporting protocol, substantially contributed to improving data reporting and subsequently the quality of scientific evidence. The STAR core group used the Delphi method, in which a group of experts reaches a consensus over multiple rounds using a formal method. We selected experts in the field of clinical HA medicine based on their scientific credentials and identified an initial set of parameters for evaluation by the experts. Of 51 experts in HA research who were identified initially, 21 experts completed both rounds. The experts identified 42 key parameters in 5 categories (setting, individual factors, acute mountain sickness and HA cerebral edema, HA pulmonary edema, and treatment) that were considered essential for research and reporting in clinical HA research. An additional 47 supplemental parameters were identified that should be reported depending on the nature of the research. The STAR initiative, using the Delphi method, identified a set of key parameters essential for research and reporting in clinical HA medicine.

Reviewing Evidence-Based Practice for Pupils with Dyslexia and Literacy Difficulties

ERIC Educational Resources Information Center

Griffiths, Yvonne; Stuart, Morag

2013-01-01

There is now a strong evidence base from theory and research providing a "template" to inform practice at Wave 2, guiding the design and implementation of time-limited effective early intervention programmes for pupils identified as "at risk" of reading difficulties following initial literacy instruction (Rose, 2009). In…

Enacting Teacher Leadership: The Role of Teachers in Bringing about Change

ERIC Educational Resources Information Center

Lai, Edith; Cheung, Derek

2015-01-01

This paper attempts to identify leadership practices and qualities of school teachers as they engaged in effecting change initiated by a curriculum reform in Hong Kong. Based on interview data of teachers from nine schools, this paper shows how teacher leadership manifested itself in schools. Three approaches to teacher leadership were identified,…

Studer Group® ' s evidence-based leadership initiatives.

PubMed

Schuller, Kristin A; Kash, Bita A; Gamm, Larry D

2015-01-01

The purpose of this paper is to analyze the implementation of an organizational change initiative--Studer Group®'s Evidence-Based Leadership (EBL)--in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative. This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes. Three themes associated with success and sustainability of EBL emerged at both health systems: leadership; culture; and organizational processes. The theme most frequently identified for both success and sustainability of EBL was culture. In contrast, there was a significant decline in salience of the leadership theme as attention shifts from success in implementation of EBL to sustaining EBL long term. Within the culture theme, accountability, and buy-in were most often cited by interviewees as success factors, while sense of accountability, buy-in, and communication were the most reported factors for sustainability. Cultural factors, such as accountability, staff support, and communication are driving forces of success and sustainability of EBL across both health systems. Leadership, a critical factor in several stages of implementation, appears to be less salient as among factors identified as important to longer term sustainability of EBL.

A Strategic Defense Initiative Organization Software Testing Initiative

DTIC Science & Technology

1990-10-01

One group of researchers is investigating a version of this analysis termed constrained expression analysis [Dillon 1988c]. Here a design is...examined. Academic researchers will assist in developing experiments. In addition, an organization or group of people will be identified 14 as the focal...to make the transition into common practice. Research is being conducted into control -based test data adequacy criteria to support the dynamic

Teacher Involvement as a Protective Factor from the Association between Race-Based Bullying and Smoking Initiation.

PubMed

Earnshaw, Valerie A; Rosenthal, Lisa; Carroll-Scott, Amy; Peters, Susan M; McCaslin, Catherine; Ickovics, Jeannette R

2014-06-01

Experiencing bullying as a victim is associated with negative health and health behavior outcomes, including substance use, among adolescents. However, understandings of protective factors - factors that enhance adolescents' resilience to the negative consequences of bullying - remain limited. The current study investigates whether teacher involvement protects adolescent students from the association between being bullied due to race and smoking initiation. Students were recruited from 12 Kindergarten through 8 th grade schools in an urban school district in the Northeast United States. The analytic sample included 769 students who responded to surveys in 5 th or 6 th grade (2009), and two years later in 7 th or 8 th grade (2011). Students primarily identified as Latino and/or Black, and 90% were eligible for free or reduced lunch. Fifty-four (7%) students initiated smoking between survey time points. Among students reporting lower teacher involvement, race-based bullying was associated with higher likelihood of smoking initiation (OR = 1.69, p = .03). In contrast, among students reporting higher teacher involvement, racebased bullying was not associated with higher likelihood of smoking initiation (OR = 0.95, p = .81). Results suggest that teacher involvement may protect students from the association between race-based bullying and smoking initiation. Enhancing teacher involvement among students experiencing race-based bullying in schools may limit smoking initiation.

Towards a comparable carbon footprint for local initiatives: The FP7 project TESS

NASA Astrophysics Data System (ADS)

Reusser, Dominik E.; Kropp, Jürgen P.

2014-05-01

TESS (Towards European Societal Sustainability -- www.tess-transition.eu) is a three-year, European-wide research project. It aims to reach an understanding of the potential for community-led initiatives to help deliver a truly sustainable, low-carbon future. Transitions to low-carbon societies take place at multiple and complementary scales. Transition processes are highly dependent on the innovative potential of community-based initiatives and their articulation with appropriate institutional architecture. Community-based initiatives are potentially more adaptable and less constrained by current structural circumstances than top-down policies and can give impetus to large-scale and technology driven changes. TESS will provide an understanding on the upscaling possibilities of such high-potential community-based initiatives by addressing two main questions: What is the impact of community-based initiatives in terms of carbon reduction potential and economic effect? What institutional structures (values, policies and mechanisms) support these initiatives in persisting beyond the initial phase and moving into an acceleration phase, spreading desired impacts? Answers will be provided through (1) a novel measuring, reporting and verification (MRV) framework for benchmarking community-based initiatives. This will enable quantifiable, comparable and standardised evaluation, and (2) the identification of success factors for the emergence, persistence and diffusion of promising initiatives, including online initiatives. We will identify these initiatives through case studies across regions and sectors and produce a systemic understanding of their impact on societal transitions towards sustainability. Our research will be integrated and transdisciplinary, with the unique opportunity to bring together social and natural scientists to foster a transition towards European societal sustainability. Our work will feed into and extend the Climate Adapt database to facilitate reconciliation of mitigation and adaptation and connect to Europe wide evaluation approaches such as the Common Monitoring and Evaluation Framework (CMEF) of the Rural Development Programmes. The poster will show the current state of the initiative selection process and of the method development.

Tailoring community-based wellness initiatives with latent class analysis--Massachusetts Community Transformation Grant projects.

PubMed

Arcaya, Mariana; Reardon, Timothy; Vogel, Joshua; Andrews, Bonnie K; Li, Wenjun; Land, Thomas

2014-02-13

Community-based approaches to preventing chronic diseases are attractive because of their broad reach and low costs, and as such, are integral components of health care reform efforts. Implementing community-based initiatives across Massachusetts' municipalities presents both programmatic and evaluation challenges. For effective delivery and evaluation of the interventions, establishing a community typology that groups similar municipalities provides a balanced and cost-effective approach. Through a series of key informant interviews and exploratory data analysis, we identified 55 municipal-level indicators of 6 domains for the typology analysis. The domains were health behaviors and health outcomes, housing and land use, transportation, retail environment, socioeconomics, and demographic composition. A latent class analysis was used to identify 10 groups of municipalities based on similar patterns of municipal-level indicators across the domains. Our model with 10 latent classes yielded excellent classification certainty (relative entropy = .995, minimum class probability for any class = .871), and differentiated distinct groups of municipalities based on health-relevant needs and resources. The classes differentiated healthy and racially and ethnically diverse urban areas from cities with similar population densities and diversity but worse health outcomes, affluent communities from lower-income rural communities, and mature suburban areas from rapidly suburbanizing communities with different healthy-living challenges. Latent class analysis is a tool that may aid in the planning, communication, and evaluation of community-based wellness initiatives such as Community Transformation Grants projects administrated by the Centers for Disease Control and Prevention.

Shining lights: studies that have most influenced the understanding of health promotion's financial impact.

PubMed

Golaszewski, T

2001-01-01

To examine the literature from the past 20 years and identify those studies that support the economic merit of health promotion. A panel of experts was used to identify the top studies supporting the purpose of this article. Studies were chosen based on the following criteria: the study (1) examined the relationship between health risks and financial outcomes, or health promotion programs and financial outcomes; (2) provided strong and compelling financial data supporting the worth of health promotion; (3) had a high-quality methodology; (4) answered an important question or replicated important findings with superior methodology; and (5) represented U.S.-based initiatives published since 1980. After initially nominating a group of studies for consideration, panelists rated each on a scale from 1 to 3 representing their opinion of importance. Studies rating the highest were included for this discussion. Studies were analyzed by population characteristics, design, statistical tests, limitations, and results. This information was summarized for each identified article. A relationship between modifiable health risk factors and health care costs is supported by research. Health promotion interventions appear to provide positive financial returns, most notably for health care costs and absenteeism reduction. Private sector initiatives seem to be driving economic-based research. Overall, health promotion shows promising results for providing financial advantages for its sponsors; however, if this discipline is to show its true worth, considerable funding is needed from government or philanthropic sources to cover the substantial costs of quality research.

Linking College and Work: Exemplary Policies and Practices of Two-Year College Work-Based Learning Programs.

ERIC Educational Resources Information Center

Bragg, Debra D.; Hamm, Russell E.

Based on an initial phase of a study conducted in 1993 that surveyed 1,200 two-year colleges to describe the scope and character of work-based learning programs already in existence, phase 2 sought a more in-depth understanding of selected exemplary work-based learning programs. Ten programs in eight two-year colleges were identified for further…

Education and training initiatives for crisis management in the European Union: a web-based analysis of available programs.

PubMed

Ingrassia, Pier Luigi; Foletti, Marco; Djalali, Ahmadreza; Scarone, Piercarlo; Ragazzoni, Luca; Corte, Francesco Della; Kaptan, Kubilay; Lupescu, Olivera; Arculeo, Chris; von Arnim, Gotz; Friedl, Tom; Ashkenazi, Michael; Heselmann, Deike; Hreckovski, Boris; Khorram-Manesh, Amir; Khorrram-Manesh, Amir; Komadina, Radko; Lechner, Kostanze; Patru, Cristina; Burkle, Frederick M; Fisher, Philipp

2014-04-01

Education and training are key elements of disaster management. Despite national and international educational programs in disaster management, there is no standardized curriculum available to guide the European Union (EU) member states. European- based Disaster Training Curriculum (DITAC), a multiple university-based project financially supported by the EU, is charged with developing a holistic and highly-structured curriculum and courses for responders and crisis managers at a strategic and tactical level. The purpose of this study is to qualitatively assess the prevailing preferences and characteristics of disaster management educational and training initiatives (ETIs) at a postgraduate level that currently exist in the EU countries. An Internet-based qualitative search was conducted in 2012 to identify and analyze the current training programs in disaster management. The course characteristics were evaluated for curriculum, teaching methods, modality of delivery, target groups, and funding. The literature search identified 140 ETIs, the majority (78%) located in United Kingdom, France, and Germany. Master level degrees were the primary certificates granted to graduates. Face-to-face education was the most common teaching method (84%). Approximately 80% of the training initiatives offered multi- and cross-disciplinary disaster management content. A competency-based approach to curriculum content was present in 61% of the programs. Emergency responders at the tactical level were the main target group. Almost all programs were self-funded. Although ETIs currently exist, they are not broadly available in all 27 EU countries. Also, the curricula do not cover all key elements of disaster management in a standardized and competency-based structure. This study has identified the need to develop a standardized competency-based educational and training program for all European countries that will ensure the practice and policies that meet both the standards of care and the broader expectations for professionalization of the disaster and crisis workforce.

Ways of providing the patient with a prognosis: a terminology of employed strategies based on qualitative data.

PubMed

Graugaard, Peter Kjær; Rogg, Lotte; Eide, Hilde; Uhlig, Till; Loge, Jon Håvard

2011-04-01

To identify, denote, and structure strategies applied by physicians and patients when communicating information about prognosis. A descriptive qualitative study based on audiotaped physician-patient encounters between 23 haematologists and rheumatologists, and 89 patients in Oslo. Classification of identified prognostic sequences was based on consensus. Physicians seldom initiated communication with patients explicitly to find out their overall preferences for prognostic information (metacommunication). Instead, they used sounding and implicit strategies such as invitations, implicatures, and non-specific information that might result in further disclosure of information if requested by the patients. In order to balance the obligation to promote hope and provide (true) information, they used strategies such as bad news/good news spirals, authentications, safeguardings, and softenings. Identified strategies applied by the patients to adjust the physician-initiated prognostic information to their needs were requests for specification, requests for optimism, and emotional warnings. The study presents an empirically derived terminology so that clinicians and educators involved in medical communication can increase their awareness of prognostic communication. Based on qualitative data obtained from communication excerpts, we suggest that individual clinicians and researchers evaluate the possible benefits of more frequent use of metacommunication and explicit prognostic information. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Brighter Smiles Africa--translation of a Canadian community-based health-promoting school program to Uganda.

PubMed

Macnab, A J; Radziminski, N; Budden, H; Kasangaki, A; Zavuga, R; Gagnon, F A; Mbabali, M

2010-08-01

PROJECT GOAL: To adapt a successful Canadian health-promoting school initiative to a Ugandan context through international partnership. Rural children face many health challenges worldwide; health professionals in training understand these better through community-based learning. Aboriginal leaders in a Canadian First-Nations community identified poor oral health as a child health issue with major long-term societal impact and intervened successfully with university partners through a school-based program called "Brighter Smiles". Makerere University, Kampala, Uganda (MUK) sought to implement this delivery model for both the benefit of communities and the dental students. MUK identified rural communities where hospitals could provide dental students with community-based learning and recruited four local schools. A joint Ugandan and Canadian team of both trainees and faculty planned the program, obtained ethics consent and baseline data, initiated the Brighter Smiles intervention model (daily at-school tooth-brushing; in-class education), and recruited a cohort to receive additional bi-annual topical fluoride. Hurdles included: challenging international communication and planning due to inconsistent internet connections; discrepancies between Canadian and developing world concepts of research ethics and informed consent; complex dynamics for community engagement and steep learning curve for accurate data collection; an itinerant population at one school; and difficulties coordinating Canadian and Ugandan university schedules. Four health-promoting schools were established; teachers, children, and families were engaged in the initiative; community-based learning was adopted for the university students; quarterly team education/evaluation/service delivery visits to schools were initiated; oral health improved, and new knowledge and practices were evident; an effective international partnership was formed providing global health education, research and health care delivery.

HPV vaccination: Population approaches for improving rates.

PubMed

Oliver, Kristin; Frawley, Alean; Garland, Elizabeth

2016-06-02

To review the literature on interventions to increase HPV vaccinations and assess whether The Community Preventive Services Task Force recommendations are supported by current evidence. We used a PubMed search to identify studies that assessed interventions that looked at provider assessment and feedback, provider reminders, client reminder and recall, and clinic based education programs. Of the 13 studies identified, 8 included client reminder and recall interventions, 4 included provider assessment and feedback and/or provider reminders and 2 included clinic based education. 11 of the 13 studies demonstrated a positive effect on HPV vaccine initiation or completion. Provider assessment and feedback studies were more likely to report a positive effect on HPV vaccine initiation than on series completion, while client reminder recall interventions more frequently produced an effect on series completion than on initiation. There is evidence to support the application of the Community Preventive Services Task Force recommendations specifically to HPV vaccination both for client reminder and recall programs and for provider assessment and feedback interventions. Multiple targeted approaches will be needed to substantially impact HPV vaccine rates.

Evolution of finite-amplitude localized vortices in planar homogeneous shear flows

NASA Astrophysics Data System (ADS)

Karp, Michael; Shukhman, Ilia G.; Cohen, Jacob

2017-02-01

An analytical-based method is utilized to follow the evolution of localized initially Gaussian disturbances in flows with homogeneous shear, in which the base velocity components are at most linear functions of the coordinates, including hyperbolic, elliptic, and simple shear. Coherent structures, including counterrotating vortex pairs (CVPs) and hairpin vortices, are formed for the cases where the streamlines of the base flow are open (hyperbolic and simple shear). For hyperbolic base flows, the dominance of shear over rotation leads to elongation of the localized disturbance along the outlet asymptote and formation of CVPs. For simple shear CVPs are formed from linear and nonlinear disturbances, whereas hairpins are observed only for highly nonlinear disturbances. For elliptic base flows CVPs, hairpins and vortex loops form initially, however they do not last and break into various vortical structures that spread in the spanwise direction. The effect of the disturbance's initial amplitude and orientation is examined and the optimal orientation achieving maximal growth is identified.

Bridging Technometric Method and Innovation Process: An Initial Study

NASA Astrophysics Data System (ADS)

Rumanti, A. A.; Reynaldo, R.; Samadhi, T. M. A. A.; Wiratmadja, I. I.; Dwita, A. C.

2018-03-01

The process of innovation is one of ways utilized to increase the capability of a technology component that reflects the need of SME. Technometric method can be used to identify to what extent the level of technology advancement in a SME is, and also which technology component that needs to be maximized in order to significantly deliver an innovation. This paper serves as an early study, which lays out a conceptual framework that identifies and elaborates the principles of innovation process from a well-established innovation model by Martin with the technometric method, based on the initial background research conducted at SME Ira Silver in Jogjakarta, Indonesia.

Follow-up of an Exercise-Based Treatment for Children with Reading Difficulties

ERIC Educational Resources Information Center

Reynolds, David; Nicolson, Roderick I.

2007-01-01

This study reports the results of a long-term follow-up of an exercise-based approach to dyslexia-related disorders (Reynolds, Nicolson, & Hambly, "Dyslexia," 2003; 9(1): 48-71). In the initial study, children at risk of dyslexia were identified in 3 years of a junior school. One half then undertook a 6 month, home-based exercise…

Making It Real: Project Managing Strategic e-Learning Development Processes in a Large, Campus-Based University

ERIC Educational Resources Information Center

Ward, Mary-Helen; West, Sandra; Peat, Mary; Atkinson, Susan

2010-01-01

The University of Sydney is a large, research-intensive, campus-based Australian University. Since 2004 a strategic initiative of project-based eLearning support has been creating teams of non-academic and academic staff, who have worked together to develop online resources to meet identified needs. The University's aims in continuing to provide…

Nurses and stress: recognizing causes and seeking solutions.

PubMed

Happell, Brenda; Dwyer, Trudy; Reid-Searl, Kerry; Burke, Karena J; Caperchione, Cristina M; Gaskin, Cadeyrn J

2013-05-01

To identify, from the perspectives of nurses, occupational stressors and ways in which they may be reduced. Nurses commonly experience high levels of occupational stress, with negative consequences for their physical and psychological health, health-care organisations and community. There is minimal research on reducing occupational stress. Six focus groups were conducted with 38 registered nurses using a qualitative exploratory approach. Participants were asked to identify sources of occupational stress and possible workplace initiatives to reduce stress. Sources of occupational stress were: high workloads, unavailability of doctors, unsupportive management, human resource issues, interpersonal issues, patients' relatives, shift work, car parking, handover procedures, no common area for nurses, not progressing at work and patient mental health. Suggestions for reduction included: workload modification, non-ward-based initiatives, changing shift hours, forwarding suggestions for change, music, special events, organisational development, ensuring nurses get breaks, massage therapists, acknowledgement from management and leadership within wards. The findings highlight the need to understand local perspectives and the importance of involving nurses in identifying initiatives to reduce occupational stress. Health-care environments can be enhanced through local understanding of the occupational stressors and productively engaging nurses in developing stress reduction initiatives. Nurse managers must facilitate such processes. © 2013 Blackwell Publishing Ltd.

Identifying Nursing Interventions in a Cancer Screening Program Using Nursing Interventions Classification Taxonomy.

PubMed

Benito, Llucia; Lluch, María Teresa; Falcó, Anna Marta; García, Montse; Puig, Montse

2017-04-01

This study aimed to investigate which Nursing Interventions Classification (NIC) labels correspond to specific nursing interventions provided during cancer screening to establish a nursing documentation system. This descriptive study was conducted to identify and classify the interventions that cancer screening nurses perform based on an initial list. The initial list was grouped into 15 interventions that corresponded to four domains and eight classes. The study found expert consensus regarding the duties of cancer screening nurses and identified 15 interventions that should be implemented in clinical practice for cancer screening care, according to the NIC taxonomy. This study is the first step in developing indicators to assess nursing performance in cancer screening, and it helps to establish the core competency requirements for cancer screening nurses. © 2015 NANDA International, Inc.

Students, Learning, and Race-Based Public Policy: A Look at Diversity Curriculum and Co-Curriculum.

ERIC Educational Resources Information Center

DeAngelo, Linda

This study is an attempt to bring together research examining diversity initiatives in curriculum and co-curriculum with research on race-based policies, specifically the policy of affirmative action in college admissions. The study attempted to identify and confirm unique background characteristics, beliefs, and predispositions that students…

A Cognitive Task Analysis for Dental Hygiene.

ERIC Educational Resources Information Center

Cameron, Cheryl A.; Beemsterboer, Phyllis L.; Johnson, Lynn A.; Mislevy, Robert J.; Steinberg, Linda S.; Breyer, F. Jay

2000-01-01

As part of the development of a scoring algorithm for a simulation-based dental hygiene initial licensure examination, this effort conducted a task analysis of the dental hygiene domain. Broad classes of behaviors that distinguish along the dental hygiene expert-novice continuum were identified and applied to the design of nine paper-based cases…

Public Health Adaptation to Climate Change in Large Cities: A Global Baseline.

PubMed

Araos, Malcolm; Austin, Stephanie E; Berrang-Ford, Lea; Ford, James D

2016-01-01

Climate change will have significant impacts on human health, and urban populations are expected to be highly sensitive. The health risks from climate change in cities are compounded by rapid urbanization, high population density, and climate-sensitive built environments. Local governments are positioned to protect populations from climate health risks, but it is unclear whether municipalities are producing climate-adaptive policies. In this article, we develop and apply systematic methods to assess the state of public health adaptation in 401 urban areas globally with more than 1 million people, creating the first global baseline for urban public health adaptation. We find that only 10% of the sampled urban areas report any public health adaptation initiatives. The initiatives identified most frequently address risks posed by extreme weather events and involve direct changes in management or behavior rather than capacity building, research, or long-term investments in infrastructure. Based on our characterization of the current urban health adaptation landscape, we identify several gaps: limited evidence of reporting of institutional adaptation at the municipal level in urban areas in the Global South; lack of information-based adaptation initiatives; limited focus on initiatives addressing infectious disease risks; and absence of monitoring, reporting, and evaluation. © The Author(s) 2015.

A Blueprint for Human Resource Development in the Third Decade of the Ontario Colleges of Applied Arts and Technology: Executive Summary.

ERIC Educational Resources Information Center

Giroux, Roy F.

In 1987, a review of Ontario's community college system was initiated to assess the system's present human resource development practices and plan future directions. A field-based study was conducted to identify and assess current human resource development efforts, identify areas for improvement, and suggest possible future directions. Through…

New Flexible Silicone-Based EEG Dry Sensor Material Compositions Exhibiting Improvements in Lifespan, Conductivity, and Reliability

PubMed Central

Yu, Yi-Hsin; Chen, Shih-Hsun; Chang, Che-Lun; Lin, Chin-Teng; Hairston, W. David; Mrozek, Randy A.

2016-01-01

This study investigates alternative material compositions for flexible silicone-based dry electroencephalography (EEG) electrodes to improve the performance lifespan while maintaining high-fidelity transmission of EEG signals. Electrode materials were fabricated with varying concentrations of silver-coated silica and silver flakes to evaluate their electrical, mechanical, and EEG transmission performance. Scanning electron microscope (SEM) analysis of the initial electrode development identified some weak points in the sensors’ construction, including particle pull-out and ablation of the silver coating on the silica filler. The newly-developed sensor materials achieved significant improvement in EEG measurements while maintaining the advantages of previous silicone-based electrodes, including flexibility and non-toxicity. The experimental results indicated that the proposed electrodes maintained suitable performance even after exposure to temperature fluctuations, 85% relative humidity, and enhanced corrosion conditions demonstrating improvements in the environmental stability. Fabricated flat (forehead) and acicular (hairy sites) electrodes composed of the optimum identified formulation exhibited low impedance and reliable EEG measurement; some initial human experiments demonstrate the feasibility of using these silicone-based electrodes for typical lab data collection applications. PMID:27809260

New Flexible Silicone-Based EEG Dry Sensor Material Compositions Exhibiting Improvements in Lifespan, Conductivity, and Reliability.

PubMed

Yu, Yi-Hsin; Chen, Shih-Hsun; Chang, Che-Lun; Lin, Chin-Teng; Hairston, W David; Mrozek, Randy A

2016-10-31

This study investigates alternative material compositions for flexible silicone-based dry electroencephalography (EEG) electrodes to improve the performance lifespan while maintaining high-fidelity transmission of EEG signals. Electrode materials were fabricated with varying concentrations of silver-coated silica and silver flakes to evaluate their electrical, mechanical, and EEG transmission performance. Scanning electron microscope (SEM) analysis of the initial electrode development identified some weak points in the sensors' construction, including particle pull-out and ablation of the silver coating on the silica filler. The newly-developed sensor materials achieved significant improvement in EEG measurements while maintaining the advantages of previous silicone-based electrodes, including flexibility and non-toxicity. The experimental results indicated that the proposed electrodes maintained suitable performance even after exposure to temperature fluctuations, 85% relative humidity, and enhanced corrosion conditions demonstrating improvements in the environmental stability. Fabricated flat (forehead) and acicular (hairy sites) electrodes composed of the optimum identified formulation exhibited low impedance and reliable EEG measurement; some initial human experiments demonstrate the feasibility of using these silicone-based electrodes for typical lab data collection applications.

Finding needles in a haystack: a methodology for identifying and sampling community-based youth smoking cessation programs.

PubMed

Emery, Sherry; Lee, Jungwha; Curry, Susan J; Johnson, Tim; Sporer, Amy K; Mermelstein, Robin; Flay, Brian; Warnecke, Richard

2010-02-01

Surveys of community-based programs are difficult to conduct when there is virtually no information about the number or locations of the programs of interest. This article describes the methodology used by the Helping Young Smokers Quit (HYSQ) initiative to identify and profile community-based youth smoking cessation programs in the absence of a defined sample frame. We developed a two-stage sampling design, with counties as the first-stage probability sampling units. The second stage used snowball sampling to saturation, to identify individuals who administered youth smoking cessation programs across three economic sectors in each county. Multivariate analyses modeled the relationship between program screening, eligibility, and response rates and economic sector and stratification criteria. Cumulative logit models analyzed the relationship between the number of contacts in a county and the number of programs screened, eligible, or profiled in a county. The snowball process yielded 9,983 unique and traceable contacts. Urban and high-income counties yielded significantly more screened program administrators; urban counties produced significantly more eligible programs, but there was no significant association between the county characteristics and program response rate. There is a positive relationship between the number of informants initially located and the number of programs screened, eligible, and profiled in a county. Our strategy to identify youth tobacco cessation programs could be used to create a sample frame for other nonprofit organizations that are difficult to identify due to a lack of existing directories, lists, or other traditional sample frames.

[Local food production for school feeding programmes in Spain].

PubMed

Soares, Panmela; Martínez-Mián, Maria Asunción; Caballero, Pablo; Vives-Cases, Carmen; Davó-Blanes, Mari Carmen

To identify and characterize initiatives that promote the purchase of locally-sourced foods to supply schools and the school centres carrying out the initiatives. Exploratory, descriptive study based on secondary data and key informant reports. A search of governmental and non-governmental initiatives was carried out at the autonomous community level. Government initiatives were located through school feeding programmes in the different autonomous communities, their nutritional guides and representatives of the councils for education and agriculture. Non-governmental initiatives were found through their own websites and the snowball technique. Initiatives were analysed by their geographic distribution, organizational area (government vs. non-government), number of school centres carrying out the initiatives, management style and organic food purchase. A descriptive analysis of the data was carried out. 12 initiatives carried out by 318 schools (2.16% of all the schools with food service in Spain) were identified. Among these, 6 are governmental initiatives with a scope of 274 schools (1.86%), and 6 are non-governmental initiatives with a scope of 44 schools (0.30%). Most of these schools have a public management system in place (n=284). All the initiatives provide for the purchase of organic food. Local food purchase initiatives in Spain have a limited reach. However, the existence of a state directive could support and strengthen the development of such initiatives, given that school commitment is greater when initiatives are driven by the public sector. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Finite element analysis of the influence of elastic anisotropy on stress intensification at stress corrosion cracking initiation sites in fcc alloys

NASA Astrophysics Data System (ADS)

Meric de Bellefon, G.; van Duysen, J. C.

2018-05-01

A recent finite-element method (FEM)-based study from the present authors quantified the effect of elastic anisotropy of grains on stress intensification at potential intergranular stress corrosion cracking (IGSCC) initiation sites in austenitic stainless steels. In particular, it showed that the auxetic behavior of grains (negative Poisson's ratio) in some directions plays a very important role in IGSCC initiation, since it can induce local stress intensification factors of about 1.6. A similar effect is expected for other fcc alloys such as Ni-based alloys. The present article confirms those results and paves the way to the definition of an IGSCC susceptibility index by identifying grain configurations that are the most favorable for crack initiation. The index will rely on the probability to get those configurations on surface of specimens.

An integrated one-step system to extract, analyze and annotate all relevant information from image-based cell screening of chemical libraries.

PubMed

Rabal, Obdulia; Link, Wolfgang; Serelde, Beatriz G; Bischoff, James R; Oyarzabal, Julen

2010-04-01

Here we report the development and validation of a complete solution to manage and analyze the data produced by image-based phenotypic screening campaigns of small-molecule libraries. In one step initial crude images are analyzed for multiple cytological features, statistical analysis is performed and molecules that produce the desired phenotypic profile are identified. A naïve Bayes classifier, integrating chemical and phenotypic spaces, is built and utilized during the process to assess those images initially classified as "fuzzy"-an automated iterative feedback tuning. Simultaneously, all this information is directly annotated in a relational database containing the chemical data. This novel fully automated method was validated by conducting a re-analysis of results from a high-content screening campaign involving 33 992 molecules used to identify inhibitors of the PI3K/Akt signaling pathway. Ninety-two percent of confirmed hits identified by the conventional multistep analysis method were identified using this integrated one-step system as well as 40 new hits, 14.9% of the total, originally false negatives. Ninety-six percent of true negatives were properly recognized too. A web-based access to the database, with customizable data retrieval and visualization tools, facilitates the posterior analysis of annotated cytological features which allows identification of additional phenotypic profiles; thus, further analysis of original crude images is not required.

Evidence-based guides in tracheostomy use in critical patients.

PubMed

Raimondi, N; Vial, M R; Calleja, J; Quintero, A; Cortés Alban, A; Celis, E; Pacheco, C; Ugarte, S; Añón, J M; Hernández, G; Vidal, E; Chiappero, G; Ríos, F; Castilleja, F; Matos, A; Rodriguez, E; Antoniazzi, P; Teles, J M; Dueñas, C; Sinclair, J; Martínez, L; Von der Osten, I; Vergara, J; Jiménez, E; Arroyo, M; Rodriguez, C; Torres, J; Fernandez-Bussy, S; Nates, J L

2017-03-01

Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

The data collection/data distribution center: building a sustainable African-American church-based research network.

PubMed

Goldmon, Moses; Roberson, James T; Carey, Tim; Godley, Paul; Howard, Daniel L; Boyd, Carlton; Ammerman, Alice

2008-01-01

This article describes the Carolina-Shaw Partnership for the Elimination of Health Disparities efforts to engage a diverse group of Black churches in a sustainable network. We sought to develop a diverse network of 25 churches to work with the Carolina-Shaw Partnership to develop sustainable health disparities research, education, and intervention initiatives. Churches were selected based on location, pastoral buy-in, and capacity to engage. A purposive sampling technique was applied. (1) Collecting information on the location and characteristics of churches helps to identify and recruit churches that possess the desired qualities and characteristics. (2) The process used to identify, recruit, and select churches is time intensive. (3) The time, energy, and effort required managing an inter-institutional partnership and engage churches in health disparities research and interventions lends itself to sustainability. The development of a sustainable network of churches could lead to successful health disparities initiatives.

Genomics in Public Health: Perspective from the Office of Public Health Genomics at the Centers for Disease Control and Prevention (CDC)

PubMed Central

Fisk Green, Ridgely; Dotson, W. David; Bowen, Scott; Kolor, Katherine; Khoury, Muin J.

2015-01-01

The national effort to use genomic knowledge to save lives is gaining momentum, as illustrated by the inclusion of genomics in key public health initiatives, including Healthy People 2020, and the recent launch of the precision medicine initiative. The Office of Public Health Genomics (OPHG) at the Centers for Disease Control and Prevention (CDC) partners with state public health departments and others to advance the translation of genome-based discoveries into disease prevention and population health. To do this, OPHG has adopted an “identify, inform, and integrate” model: identify evidence-based genomic applications ready for implementation, inform stakeholders about these applications, and integrate these applications into public health at the local, state, and national level. This paper addresses current and future work at OPHG for integrating genomics into public health programs. PMID:26636032

Market potential of nanoremediation in Europe - Market drivers and interventions identified in a deliberative scenario approach.

PubMed

Bartke, Stephan; Hagemann, Nina; Harries, Nicola; Hauck, Jennifer; Bardos, Paul

2018-04-01

A deliberate expert-based scenario approach is applied to better understand the likely determinants of the evolution of the market for nanoparticles use in remediation in Europe until 2025. An initial set of factors had been obtained from a literature review and was complemented by a workshop and key-informant interviews. In further expert engaging formats - focus groups, workshops, conferences, surveys - this initial set of factors was condensed and engaged experts scored the factors regarding their importance for being likely to influence the market development. An interaction matrix was obtained identifying the factors being most active in shaping the market development in Europe by 2025, namely "Science-Policy-Interface" and "Validated information on nanoparticle application potential". Based on these, potential scenarios were determined and development of factors discussed. Conclusions are offered on achievable interventions to enhance nanoremediation deployment. Copyright © 2017 Elsevier B.V. All rights reserved.

Genomics in Public Health: Perspective from the Office of Public Health Genomics at the Centers for Disease Control and Prevention (CDC).

PubMed

Green, Ridgely Fisk; Dotson, W David; Bowen, Scott; Kolor, Katherine; Khoury, Muin J

2015-01-01

The national effort to use genomic knowledge to save lives is gaining momentum, as illustrated by the inclusion of genomics in key public health initiatives, including Healthy People 2020, and the recent launch of the precision medicine initiative. The Office of Public Health Genomics (OPHG) at the Centers for Disease Control and Prevention (CDC) partners with state public health departments and others to advance the translation of genome-based discoveries into disease prevention and population health. To do this, OPHG has adopted an "identify, inform, and integrate" model: identify evidence-based genomic applications ready for implementation, inform stakeholders about these applications, and integrate these applications into public health at the local, state, and national level. This paper addresses current and future work at OPHG for integrating genomics into public health programs.

Applying a knowledge translation model to the uptake of the Baby Friendly Health Initiative in the Australian health care system.

PubMed

Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

2014-06-01

The Baby Friendly Hospital Initiative is a global, evidence-based, public health initiative. The evidence underpinning the Initiative supports practices promoting the initiation and maintenance of breastfeeding and encourages women's informed infant feeding decisions. In Australia, where the Initiative is known as the Baby Friendly Health Initiative (BFHI) the translation of evidence into practice has not been uniform, as demonstrated by a varying number of maternity facilities in each State and Territory currently accredited as 'baby friendly'. This variance has persisted regardless of BFHI implementation in Australia gaining 'in principle' support at a national and governmental level as well as inclusion in health policy in several states. There are many stakeholders that exert an influence on policy development and health care practices. Identify a theory and model to examine where and how barriers occur in the gap between evidence and practice in the uptake of the BFHI in Australia. Knowledge translation theory and the research to practice pipeline model are used to examine the identified barriers to BFHI implementation and accreditation in Australia. Australian and international studies have identified similar issues that have either enabled implementation of the BFHI or acted as a barrier. Knowledge translation theory and the research to practice pipeline model is of practical value to examine barriers. Recommendations in the form of specific targeted strategies to facilitate knowledge transfer and supportive practices into the Australian health care system and current midwifery practice are included. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Strengthening the role of the ward manager: a review of the literature.

PubMed

Pegram, Anne M; Grainger, Michelle; Sigsworth, Janice; While, Alison E

2014-09-01

The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. To identify initiatives that have strengthened the ward manager role. A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems. © 2013 John Wiley & Sons Ltd.

Using Stakeholder Input to Inform an Innovative Research and Policy Initiative to Improve Depression in Safety Net Communities.

PubMed

Khodyakov, Dmitry; Williams, Pluscedia; Bromley, Elizabeth; Chung, Bowen; Wells, Kenneth

Depression quality improvement programs based on chronic disease management models have been shown to improve depression outcomes. Nonetheless, access to and the use of such programs is limited in minority, under-resourced communities. We report on the outcomes of a Delphi-based consensus exercise conducted by our partnership at a community-wide conference in Los Angeles. Participants identified and prioritized the needs of depressed individuals that should be addressed in a county-wide Health Neighborhood Initiative designed to increase existing mental health, substance use, healthcare, and social services for individuals with low socioeconomic position. Participants agreed that housing is the number one priority. Delphi results also illustrate the importance of addressing social, spiritual, and healthcare access needs of depressed individuals. Our study shows how to systematically engage community-based organizations, patients, families, and community members in the process of improving the design of community-wide health policy initiatives.

Which Triple Aim related measures are being used to evaluate population management initiatives? An international comparative analysis.

PubMed

Hendrikx, Roy J P; Drewes, Hanneke W; Spreeuwenberg, Marieke; Ruwaard, Dirk; Struijs, Jeroen N; Baan, Caroline A

2016-05-01

Population management (PM) initiatives are introduced in order to create sustainable health care systems. These initiatives should focus on the continuum of health and well-being of a population by introducing interventions that integrate various services. To be successful they should pursue the Triple Aim, i.e. simultaneously improve population health and quality of care while reducing costs per capita. This study explores how PM initiatives measure the Triple Aim in practice. An exploratory search was combined with expert consultations to identify relevant PM initiatives. These were analyzed based on general characteristics, utilized measures and related selection criteria. In total 865 measures were used by 20 PM initiatives. All quality of care domains were included by at least 11 PM initiatives, while most domains of population health and costs were included by less than 7 PM initiatives. Although their goals showed substantial overlap, the measures applied showed few similarities between PM initiatives and were predominantly selected based on local priority areas and data availability. Most PM initiatives do not measure the full scope of the Triple Aim. Additionally, variety between measures limits comparability between PM initiatives. Consensus on the coverage of Triple Aim domains and a set of standardized measures could further both the inclusion of the various domains as well as the comparability between PM initiatives. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

SHM-Based Probabilistic Fatigue Life Prediction for Bridges Based on FE Model Updating

PubMed Central

Lee, Young-Joo; Cho, Soojin

2016-01-01

Fatigue life prediction for a bridge should be based on the current condition of the bridge, and various sources of uncertainty, such as material properties, anticipated vehicle loads and environmental conditions, make the prediction very challenging. This paper presents a new approach for probabilistic fatigue life prediction for bridges using finite element (FE) model updating based on structural health monitoring (SHM) data. Recently, various types of SHM systems have been used to monitor and evaluate the long-term structural performance of bridges. For example, SHM data can be used to estimate the degradation of an in-service bridge, which makes it possible to update the initial FE model. The proposed method consists of three steps: (1) identifying the modal properties of a bridge, such as mode shapes and natural frequencies, based on the ambient vibration under passing vehicles; (2) updating the structural parameters of an initial FE model using the identified modal properties; and (3) predicting the probabilistic fatigue life using the updated FE model. The proposed method is demonstrated by application to a numerical model of a bridge, and the impact of FE model updating on the bridge fatigue life is discussed. PMID:26950125

A multi-damages identification method for cantilever beam based on mode shape curvatures and Kriging surrogate model

NASA Astrophysics Data System (ADS)

Xie, Fengle; Jiang, Zhansi; Jiang, Hui

2018-05-01

This paper presents a multi-damages identification method for Cantilever Beam. First, the damage location is identified by using the mode shape curvatures. Second, samples of varying damage severities at the damage location and their corresponding natural frequencies are used to construct the initial Kriging surrogate model. Then a particle swarm optimization (PSO) algorithm is employed to identify the damage severities based on Kriging surrogate model. The simulation study of a double-damaged cantilever beam demonstrated that the proposed method is effective.

Automatic Image Registration of Multimodal Remotely Sensed Data with Global Shearlet Features

NASA Technical Reports Server (NTRS)

Murphy, James M.; Le Moigne, Jacqueline; Harding, David J.

2015-01-01

Automatic image registration is the process of aligning two or more images of approximately the same scene with minimal human assistance. Wavelet-based automatic registration methods are standard, but sometimes are not robust to the choice of initial conditions. That is, if the images to be registered are too far apart relative to the initial guess of the algorithm, the registration algorithm does not converge or has poor accuracy, and is thus not robust. These problems occur because wavelet techniques primarily identify isotropic textural features and are less effective at identifying linear and curvilinear edge features. We integrate the recently developed mathematical construction of shearlets, which is more effective at identifying sparse anisotropic edges, with an existing automatic wavelet-based registration algorithm. Our shearlet features algorithm produces more distinct features than wavelet features algorithms; the separation of edges from textures is even stronger than with wavelets. Our algorithm computes shearlet and wavelet features for the images to be registered, then performs least squares minimization on these features to compute a registration transformation. Our algorithm is two-staged and multiresolution in nature. First, a cascade of shearlet features is used to provide a robust, though approximate, registration. This is then refined by registering with a cascade of wavelet features. Experiments across a variety of image classes show an improved robustness to initial conditions, when compared to wavelet features alone.

Automatic Image Registration of Multi-Modal Remotely Sensed Data with Global Shearlet Features

PubMed Central

Murphy, James M.; Le Moigne, Jacqueline; Harding, David J.

2017-01-01

Automatic image registration is the process of aligning two or more images of approximately the same scene with minimal human assistance. Wavelet-based automatic registration methods are standard, but sometimes are not robust to the choice of initial conditions. That is, if the images to be registered are too far apart relative to the initial guess of the algorithm, the registration algorithm does not converge or has poor accuracy, and is thus not robust. These problems occur because wavelet techniques primarily identify isotropic textural features and are less effective at identifying linear and curvilinear edge features. We integrate the recently developed mathematical construction of shearlets, which is more effective at identifying sparse anisotropic edges, with an existing automatic wavelet-based registration algorithm. Our shearlet features algorithm produces more distinct features than wavelet features algorithms; the separation of edges from textures is even stronger than with wavelets. Our algorithm computes shearlet and wavelet features for the images to be registered, then performs least squares minimization on these features to compute a registration transformation. Our algorithm is two-staged and multiresolution in nature. First, a cascade of shearlet features is used to provide a robust, though approximate, registration. This is then refined by registering with a cascade of wavelet features. Experiments across a variety of image classes show an improved robustness to initial conditions, when compared to wavelet features alone. PMID:29123329

Bridging the gap between evidence-based innovation and national health-sector reform in Ghana.

PubMed

Awoonor-Williams, John Koku; Feinglass, Ellie S; Tobey, Rachel; Vaughan-Smith, Maya N; Nyonator, Frank K; Jones, Tanya C

2004-09-01

Although experimental trials often identify optimal strategies for improving community health, transferring operational innovation from well-funded research programs to resource-constrained settings often languishes. Because research initiatives are based in institutions equipped with unique resources and staff capabilities, results are often dismissed by decisionmakers as irrelevant to large-scale operations and national health policy. This article describes an initiative undertaken in Nkwanta District, Ghana, focusing on this problem. The Nkwanta District initiative is a critical link between the experimental study conducted in Navrongo, Ghana, and a national effort to scale up the innovations developed in that study. A 2002 Nkwanta district-level survey provides the basis for assessing the likelihood that the Navrongo model is replicable elsewhere in Ghana. The effect of community-based health planning and services exposure on family planning and safe-motherhood indicators supports the hypothesis that Navrongo effects are transferable to impoverished rural settings elsewhere, confirming the need for strategies to bridge the gap between Navrongo evidence-based innovation and national health-sector reform.

Retrospective qualitative analysis of ecological networks under environmental perturbation: a copper-polluted intertidal community as a case study.

PubMed

Ramos-Jiliberto, Rodrigo; Garay-Narváez, Leslie; Medina, Matías H

2012-01-01

The coast of Chañaral Bay in northern Chile has been affected by copper mine wastes for decades. This sustained perturbation has disrupted the intertidal community in several ways, but the mechanisms behind the observed shifts in local biodiversity remain poorly understood. Our main goal was to identify the species (lumped into trophic groups) belonging to the Chañaral intertidal community that, being directly affected by copper pollution, contributed primarily to the generation of the observed changes in community structure. These groups of species were called initiators. We applied a qualitative modelling approach based only on the sign and direction of effects among species, and present a formula for predicting changes in equilibrium abundances considering stress on multiple variables simultaneously. We then applied this technique retrospectively to identify the most likely set of initiators. Our analyses allowed identification of a unique set of four initiators in the studied intertidal system (a group of algae, sessile invertebrates, a group of herbivores and starfish), which were hypothesized to be the primary drivers of the observed changes in community structure. In addition, a hypothesis was derived about how the perturbation affected these initiators. The hypothesis is that pollution affected negatively the population growth rate of both algae and sessile invertebrates and suppressed the interaction between herbivores and starfish. Our analytic approach, focused on identifying initiators, constitutes an advance towards understanding the mechanisms underlying human-driven ecosystem disruption and permits identifying species that may serve as a focal point for community management and restoration.

Peptide Transduction-Based Therapies for Prostate Cancer

DTIC Science & Technology

2004-06-01

using an M13 peptide phage display library. Initial screening of the library for transduction of tumors in vivo has identified peptides able to...marker conjugates may have to be tested. (Months 6-12, Year 1) Progress: These experiments have been initiated. Task 4. An M13 peptide phage display ... phage 12 amino acid control peptide display library (New England Biolabs, Beverly, MA ) was used. Briefly, One nude mouse bearing a human tumor line

[Development of a Conceptual Framework for the Assessment of Chronic Care in the Spanish National Health System].

PubMed

Espallargues, Mireia; Serra-Sutton, Vicky; Solans-Domènech, Maite; Torrente, Elena; Moharra, Montse; Benítez, Dolors; Robles, Noemí; Domíngo, Laia; Escarrabill Sanglas, Joan

2016-07-07

The aim was to develop a conceptual framework for the assessment of new healthcare initiatives on chronic diseases within the Spanish National Health System. A comprehensive literature review between 2002 and 2013, including systematic reviews, meta-analysis, and reports with evaluation frameworks and/or assessment of initiatives was carried out; integrated care initiatives established in Catalonia were studied and described; and semistructured interviews with key stakeholders were performed. The scope and conceptual framework were defined by using the brainstorming approach.Of 910 abstracts identified, a total of 116 studies were included. They referred to several conceptual frameworks and/or assessment indicators at a national and international level. An overall of 24 established chronic care initiatives were identified (9 integrated care initiatives); 10 in-depth interviews were carried out. The proposed conceptual framework envisages: 1)the target population according to complexity levels; 2)an evaluation approach of the structure, processes, and outcomes considering the health status achieved, the recovery process and the maintenance of health; and 3)the dimensions or attributes to be assessed. The proposed conceptual framework will be helpful has been useful to develop indicators and implement them with a community-based and result-oriented approach and a territorial or population-based perspective within the Spanish Health System. This will be essential to know which are the most effective strategies, what are the key elements that determine greater success and what are the groups of patients who can most benefit.

The Delphi Technique in Identifying Learning Objectives for the Development of Science, Technology and Society Modules for Palestinian Ninth Grade Science Curriculum

ERIC Educational Resources Information Center

Abualrob, Marwan M. A.; Daniel, Esther Gnanamalar Sarojini

2013-01-01

This article outlines how learning objectives based upon science, technology and society (STS) elements for Palestinian ninth grade science textbooks were identified, which was part of a bigger study to establish an STS foundation in the ninth grade science curriculum in Palestine. First, an initial list of STS elements was determined. Second,…

Multivariate Protein Signatures of Pre-Clinical Alzheimer's Disease in the Alzheimer's Disease Neuroimaging Initiative (ADNI) Plasma Proteome Dataset

PubMed Central

Johnstone, Daniel; Milward, Elizabeth A.; Berretta, Regina; Moscato, Pablo

2012-01-01

Background Recent Alzheimer's disease (AD) research has focused on finding biomarkers to identify disease at the pre-clinical stage of mild cognitive impairment (MCI), allowing treatment to be initiated before irreversible damage occurs. Many studies have examined brain imaging or cerebrospinal fluid but there is also growing interest in blood biomarkers. The Alzheimer's Disease Neuroimaging Initiative (ADNI) has generated data on 190 plasma analytes in 566 individuals with MCI, AD or normal cognition. We conducted independent analyses of this dataset to identify plasma protein signatures predicting pre-clinical AD. Methods and Findings We focused on identifying signatures that discriminate cognitively normal controls (n = 54) from individuals with MCI who subsequently progress to AD (n = 163). Based on p value, apolipoprotein E (APOE) showed the strongest difference between these groups (p = 2.3×10−13). We applied a multivariate approach based on combinatorial optimization ((α,β)-k Feature Set Selection), which retains information about individual participants and maintains the context of interrelationships between different analytes, to identify the optimal set of analytes (signature) to discriminate these two groups. We identified 11-analyte signatures achieving values of sensitivity and specificity between 65% and 86% for both MCI and AD groups, depending on whether APOE was included and other factors. Classification accuracy was improved by considering “meta-features,” representing the difference in relative abundance of two analytes, with an 8-meta-feature signature consistently achieving sensitivity and specificity both over 85%. Generating signatures based on longitudinal rather than cross-sectional data further improved classification accuracy, returning sensitivities and specificities of approximately 90%. Conclusions Applying these novel analysis approaches to the powerful and well-characterized ADNI dataset has identified sets of plasma biomarkers for pre-clinical AD. While studies of independent test sets are required to validate the signatures, these analyses provide a starting point for developing a cost-effective and minimally invasive test capable of diagnosing AD in its pre-clinical stages. PMID:22485168

Initial development of prototype performance model for highway design

DOT National Transportation Integrated Search

1997-12-01

The Federal Highway Administration (FHWA) has undertaken a multiyear project to develop the Interactive Highway Safety Design Model (IHSDM), which is a CADD-based integrated set of software tools to analyze a highway design to identify safety issues ...

Pivot Points: Direct Measures of the Content and Process of Community-Based Learning

ERIC Educational Resources Information Center

Wickersham, Carol; Westerberg, Charles; Jones, Karen; Cress, Margaret

2016-01-01

This research is an initial investigation into the ways community-based learning increase the cognitive skills central to the exercise of the sociological imagination. In addition to identifying a means to reveal that learning had occurred, we looked for evidence that the students were mastering sociological content, especially the concepts and…

Two-part random effects growth modeling to identify risks associated with alcohol and cannabis initiation, initial average use and changes in drug consumption in a sample of adult, male twins

PubMed Central

Gillespie, Nathan A.; Lubke, Gitta H.; Gardner, Charles O.; Neale, Michael C.; Kendler, Kenneth S.

2012-01-01

Aims Our aim was to profile alcohol and cannabis initiation and to characterize the effects of developmental and environmental risk factors on changes in average drug use over time. Design We fitted a two-part random effects growth model to identify developmental and environmental risks associated with alcohol and cannabis initiation, initial average use and changes in average use. Participants 1796 males aged 24–63 from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Measurements Data from three interview waves included self-report measures of average alcohol and cannabis use between ages 15 and 24, genetic risk of problem drug use, childhood environmental risks, personality, psychiatric symptoms, as well as personal, family and social risk factors. Findings Average alcohol and cannabis use were correlated at all ages. Genetic risk of drug use based on family history, higher sensation seeking, and peer group deviance predicted both alcohol and cannabis initiation. Higher drug availability predicted cannabis initiation while less parental monitoring and drug availability were the best predictors of how much cannabis individuals consumed over time. Conclusion The liability to initiate alcohol and cannabis, average drug use as well as changes in drug use during teenage years and young adulthood is associated with known risk factors. PMID:22177896

Identification of a Novel and Selective Series of Itk Inhibitors via a Template-Hopping Strategy

PubMed Central

2013-01-01

Inhibition of Itk potentially constitutes a novel, nonsteroidal treatment for asthma and other T-cell mediated diseases. In-house kinase cross-screening resulted in the identification of an aminopyrazole-based series of Itk inhibitors. Initial work on this series highlighted selectivity issues with several other kinases, particularly AurA and AurB. A template-hopping strategy was used to identify a series of aminobenzothiazole Itk inhibitors, which utilized an inherently more selective hinge binding motif. Crystallography and modeling were used to rationalize the observed selectivity. Initial exploration of the SAR around this series identified potent Itk inhibitors in both enzyme and cellular assays. PMID:24900590

Marshall Space Flight Center Propulsion Systems Department (PSD) KM Initiative

NASA Technical Reports Server (NTRS)

Caraccioli, Paul; Varnadoe, Tom; McCarter, Mike

2006-01-01

NASA Marshall Space Flight Center s Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities with in the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center Of Excellence (AISCE), Intergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KM implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to support the planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have been performed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural/KM surveys and practitioner interviews include: executive and senior management sponsorship, KM awareness, promotion and training, cultural change management, process improvement, leveraging existing resources and new innovative technologies to align with other NASA KM initiatives (convergence: the big picture). To enable results based incremental implementation and future growth of the KM initiative, key performance measures have been identified including stakeholder value, system utility, learning and growth (knowledge capture, sharing, reduced anomaly recurrence), cultural change, process improvement and return-on-investment. The next steps for the initial implementation spiral (focused on SSME Turbomachinery) have been identified, largely based on the organization and compilation of summary level engineering process models, data capture matrices, functional models and conceptual-level systems architecture. Key elements include detailed KM requirements definition, KM technology architecture assessment, evaluation and selection, deployable KM Pilot design, development, implementation and evaluation, and justifying full implementation (estimated Return-on-Investment). Features identified for the notional system architecture include the knowledge presentation layer (and its components), knowledge network layer (and its components), knowledge storage layer (and its components), User Interface and capabilities. This paper provides a snapshot of the progress to date, the near term planning for deploying the KM pilot project and a forward look at results based growth of KM capabilities with-in the MSFC PSD.

Marshall Space Flight Center Propulsion Systems Department (PSD) Knowledge Management (KM) Initiative

NASA Technical Reports Server (NTRS)

Caraccioli, Paul; Varnedoe, Tom; Smith, Randy; McCarter, Mike; Wilson, Barry; Porter, Richard

2006-01-01

NASA Marshall Space Flight Center's Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities within the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center of Excellence (AISCE), lntergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KNI implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to suppoth e planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have beon pedormed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural1KM surveys and practitioner interviews include: executive and senior management sponsorship, KM awareness, promotion and training, cultural change management, process improvement, leveraging existing resources and new innovative technologies to align with other NASA KM initiatives (convergence: the big picture). To enable results based incremental implementation and future growth of the KM initiative, key performance measures have been identified including stakeholder value, system utility, learning and growth (knowledge capture, sharing, reduced anomaly recurrence), cultural change, process improvement and return-on-investment. The next steps for the initial implementation spiral (focused on SSME Turbomachinery) have been identified, largely based on the organization and compilation of summary level engineering process models, data capture matrices, functional models and conceptual-level svstems architecture. Key elements include detailed KM requirements definition, KM technology architecture assessment, - evaluation and selection, deployable KM Pilot design, development, implementation and evaluation, and justifying full implementation (estimated Return-on-Investment). Features identified for the notional system architecture include the knowledge presentation layer (and its components), knowledge network layer (and its components), knowledge storage layer (and its components), User Interface and capabilities. This paper provides a snapshot of the progress to date, the near term planning for deploying the KM pilot project and a forward look at results based growth of KM capabilities with-in the MSFC PSD.

Evidence-Based Performance Measures: Quality Metrics for the Care of Patients Undergoing Breast Reconstruction.

PubMed

Manahan, Michele A; Wooden, William A; Becker, Stephen M; Cacioppo, Jason R; Edge, Stephen B; Grandinetti, Amanda C; Gray, Diedra D; Holley, Susan O; Karp, Nolan S; Kocak, Ergun; Rao, Roshni; Rosson, Gedge D; Schwartz, Jaime S; Sitzman, Thomas J; Soltanian, Hooman T; TerKonda, Sarvam P; Wallace, Anne M

2017-12-01

The American Society of Plastic Surgeons commissioned the Breast Reconstruction Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing breast reconstruction surgery. Two outcome measures were identified. The first desired outcome was to reduce the number of returns to the operating room following reconstruction within 60 days of the initial reconstructive procedure. The second desired outcome was to reduce flap loss within 30 days of the initial reconstructive procedure. All measures in this report were approved by the American Society of Plastic Surgeons Breast Reconstruction Performance Measures Work Group and the American Society of Plastic Surgeons Executive Committee. The Work Group recommends the use of these measures for quality initiatives, Continuing Medical Education, Maintenance of Certification, American Society of Plastic Surgeons' Qualified Clinical Data Registry reporting, and national quality reporting programs.

SU-E-T-421: Failure Mode and Effects Analysis (FMEA) of Xoft Electronic Brachytherapy for the Treatment of Superficial Skin Cancers

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

Hoisak, J; Manger, R; Dragojevic, I

Purpose: To perform a failure mode and effects analysis (FMEA) of the process for treating superficial skin cancers with the Xoft Axxent electronic brachytherapy (eBx) system, given the recent introduction of expanded quality control (QC) initiatives at our institution. Methods: A process map was developed listing all steps in superficial treatments with Xoft eBx, from the initial patient consult to the completion of the treatment course. The process map guided the FMEA to identify the failure modes for each step in the treatment workflow and assign Risk Priority Numbers (RPN), calculated as the product of the failure mode’s probability ofmore » occurrence (O), severity (S) and lack of detectability (D). FMEA was done with and without the inclusion of recent QC initiatives such as increased staffing, physics oversight, standardized source calibration, treatment planning and documentation. The failure modes with the highest RPNs were identified and contrasted before and after introduction of the QC initiatives. Results: Based on the FMEA, the failure modes with the highest RPN were related to source calibration, treatment planning, and patient setup/treatment delivery (Fig. 1). The introduction of additional physics oversight, standardized planning and safety initiatives such as checklists and time-outs reduced the RPNs of these failure modes. High-risk failure modes that could be mitigated with improved hardware and software interlocks were identified. Conclusion: The FMEA analysis identified the steps in the treatment process presenting the highest risk. The introduction of enhanced QC initiatives mitigated the risk of some of these failure modes by decreasing their probability of occurrence and increasing their detectability. This analysis demonstrates the importance of well-designed QC policies, procedures and oversight in a Xoft eBx programme for treatment of superficial skin cancers. Unresolved high risk failure modes highlight the need for non-procedural quality initiatives such as improved planning software and more robust hardware interlock systems.« less

Comparative clinical effectiveness of various 5-HT3 RA antiemetic regimens on chemotherapy-induced nausea and vomiting associated with hospital and emergency department visits in real world practice.

PubMed

Hatoum, Hind T; Lin, Swu-Jane; Buchner, Deborah; Cox, David

2012-05-01

The aim of this study was to compare the risk of chemotherapy-induced nausea and vomiting (CINV) events for various 5-HT(3) RAs in patients who received moderately (MEC) or highly emetogenic chemotherapy (HEC) by evaluating hospital or emergency department (ED) admissions. PharMetrics claims database was used to identify patients diagnosed with breast cancer (BC) who were initiated on cyclophosphamide-based adjuvant chemotherapy or with lung cancer (LC) initiated on carboplatin-based or cisplatin-based chemotherapy between 2005 and 2008. Patients were stratified in two groups: those initiated and maintained on palonosetron versus those treated with any other 5-HT(3) RA regimens in the 6-month post first chemotherapy. Risk for CINV events, identified by ICD-9-CM for nausea, vomiting, and/or dehydration, were estimated using logistic regressions, controlling for age, gender, comorbidity, and total chemotherapy doses or days. Of the 4,868 cyclophosphamide-treated BC, 5,414 carboplatin-treated LC, and 1,692 cisplatin-treated LC identified, there were 1,864 BC (38.5%), 1,806 carboplatin-treated LC (33.4%), and 390 cisplatin-treated LC (23.0%) in the palonosetron-only group. Palonosetron-only group had significantly lower probability of CINV events associated with ED/hospital admissions in all three cohorts (3.5% vs. 6.3% in BC, 9.5% vs. 13.8% in carboplatin-treated LC, and 16.4% vs. 22.6% in cisplatin-treated LC, all at p < 0.05). Logistic regressions found palonosetron-only group had significantly lower risk of CINV events (odds ratios = 0.550, 0.653, and 0.689 in BC, carboplatin-treated LC and cisplatin-treated LC, respectively, p < 0.05). Patients with lung or breast cancer receiving MEC or HEC had significantly lower risk of CINV events associated with hospital/ED admissions if initiated and maintained on palonosetron relative to patients receiving 5-HT(3) RA regimens.

Using the base-of-the-pyramid perspective to catalyze interdependence-based collaborations

PubMed Central

London, Ted; Anupindi, Ravi

2012-01-01

Improving food security and nutrition in the developing world remains among society's most intractable challenges and continues despite a wide variety of investments. Both donor- and enterprise-led initiatives, for example, have explored including smallholder farmers in their value chains. However, these efforts have had only modest success, partly because the private and development sectors prefer to maintain their independence. Research from the base-of-the-pyramid domain offers new insights into how collaborative interdependence between sectors can enhance the connection between profits and the alleviation of poverty. In this article, we identify the strengths and weaknesses of donor-led and enterprise-led value chain initiatives. We then explore how insights from the base-of-the-pyramid domain yield a set of interdependence-based collaboration strategies that can achieve more sustainable and scalable outcomes. PMID:21482752

Using the base-of-the-pyramid perspective to catalyze interdependence-based collaborations.

PubMed

London, Ted; Anupindi, Ravi

2012-07-31

Improving food security and nutrition in the developing world remains among society's most intractable challenges and continues despite a wide variety of investments. Both donor- and enterprise-led initiatives, for example, have explored including smallholder farmers in their value chains. However, these efforts have had only modest success, partly because the private and development sectors prefer to maintain their independence. Research from the base-of-the-pyramid domain offers new insights into how collaborative interdependence between sectors can enhance the connection between profits and the alleviation of poverty. In this article, we identify the strengths and weaknesses of donor-led and enterprise-led value chain initiatives. We then explore how insights from the base-of-the-pyramid domain yield a set of interdependence-based collaboration strategies that can achieve more sustainable and scalable outcomes.

A new practice environment measure based on the reality and experiences of nurses working lives.

PubMed

Webster, Joan; Flint, Anndrea; Courtney, Mary

2009-01-01

To explore the underlying organizational issues affecting a nurses' decision to leave and to develop a contemporary practice environment measure based on the experiences of nurses working lives. Turnover had reached an unacceptable level in our organization but underlying reasons for leaving were unknown. In-depth interviews were conducted with 13 nurses who had resigned. Transcripts were analysed using the constant comparative method. Information from the interviews informed the development a new practice environment tool, which has undergone initial testing using the Content Validity Index and Chronbach's alpha. Two domains ('work life' and 'personal life/professional development') and five themes ('feeling safe', 'feeling valued', 'getting things done', 'professional development' and 'being flexible') emerged from the interviews. A content validity score for the new instrument was 0.79 and Chronbach's alpha 0.93. The new practice environment tool has shown useful initial reliability and validity but requires wider testing in other settings. The reality and experiences of nurses working lives can be identified through exit interviews conducted by an independent person. Information from such interviews is useful in identifying an organization's strength and weaknesses and to develop initiatives to support retention.

A prospective pilot study of genome-wide exome and transcriptome profiling in patients with small cell lung cancer progressing after first-line therapy.

PubMed

Weiss, Glen J; Byron, Sara A; Aldrich, Jessica; Sangal, Ashish; Barilla, Heather; Kiefer, Jeffrey A; Carpten, John D; Craig, David W; Whitsett, Timothy G

2017-01-01

Small cell lung cancer (SCLC) that has progressed after first-line therapy is an aggressive disease with few effective therapeutic strategies. In this prospective study, we employed next-generation sequencing (NGS) to identify therapeutically actionable alterations to guide treatment for advanced SCLC patients. Twelve patients with SCLC were enrolled after failing platinum-based chemotherapy. Following informed consent, genome-wide exome and RNA-sequencing was performed in a CLIA-certified, CAP-accredited environment. Actionable targets were identified and therapeutic recommendations made from a pharmacopeia of FDA-approved drugs. Clinical response to genomically-guided treatment was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. The study completed its accrual goal of 12 evaluable patients. The minimum tumor content for successful NGS was 20%, with a median turnaround time from sample collection to genomics-based treatment recommendation of 27 days. At least two clinically actionable targets were identified in each patient, and six patients (50%) received treatment identified by NGS. Two had partial responses by RECIST 1.1 on a clinical trial involving a PD-1 inhibitor + irinotecan (indicated by MLH1 alteration). The remaining patients had clinical deterioration before NGS recommended therapy could be initiated. Comprehensive genomic profiling using NGS identified clinically-actionable alterations in SCLC patients who progressed on initial therapy. Recommended PD-1 therapy generated partial responses in two patients. Earlier access to NGS guided therapy, along with improved understanding of those SCLC patients likely to respond to immune-based therapies, should help to extend survival in these cases with poor outcomes.

Identification of Potential Pharmacoperones Capable of Rescuing the Functionality of Misfolded Vasopressin 2 Receptor Involved in Nephrogenic Diabetes Insipidus.

PubMed

Smith, Emery; Janovick, Jo Ann; Bannister, Thomas D; Shumate, Justin; Scampavia, Louis; Conn, P Michael; Spicer, Timothy P

2016-09-01

Pharmacoperones correct the folding of otherwise misfolded protein mutants, restoring function (i.e., providing "rescue") by correcting their trafficking. Currently, most pharmacoperones possess intrinsic antagonist activity because they were identified using methods initially aimed at discovering such functions. Here, we describe an ultra-high-throughput homogeneous cell-based assay with a cAMP detection system, a method specifically designed to identify pharmacoperones of the vasopressin type 2 receptor (V2R), a GPCR that, when mutated, is associated with nephrogenic diabetes insipidus. Previously developed methods to identify compounds capable of altering cellular trafficking of V2R were modified and used to screen a 645,000 compound collection by measuring the ability of library compounds to rescue a mutant hV2R [L83Q], using a cell-based luminescent detection system. The campaign initially identified 3734 positive modulators of cAMP. The confirmation and counterscreen identified only 147 of the active compounds with an EC50 of ≤5 µM. Of these, 83 were reconfirmed as active through independently obtained pure samples and were also inactive in a relevant counterscreen. Active and tractable compounds within this set can be categorized into three predominant structural clusters, described here, in the first report detailing the results of a large-scale pharmacoperone high-throughput screening campaign. © 2016 Society for Laboratory Automation and Screening.

Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis.

PubMed

Burton, Rachel A; Lallemand, Nicole M; Peters, Rebecca A; Zuckerman, Stephen

2018-02-05

Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. Designers of future PCMH initiatives may increase their likelihood of generating net savings by incorporating the demonstration features we identified.

Multinomial logistic regression analysis for differentiating 3 treatment outcome trajectory groups for headache-associated disability.

PubMed

Lewis, Kristin Nicole; Heckman, Bernadette Davantes; Himawan, Lina

2011-08-01

Growth mixture modeling (GMM) identified latent groups based on treatment outcome trajectories of headache disability measures in patients in headache subspecialty treatment clinics. Using a longitudinal design, 219 patients in headache subspecialty clinics in 4 large cities throughout Ohio provided data on their headache disability at pretreatment and 3 follow-up assessments. GMM identified 3 treatment outcome trajectory groups: (1) patients who initiated treatment with elevated disability levels and who reported statistically significant reductions in headache disability (high-disability improvers; 11%); (2) patients who initiated treatment with elevated disability but who reported no reductions in disability (high-disability nonimprovers; 34%); and (3) patients who initiated treatment with moderate disability and who reported statistically significant reductions in headache disability (moderate-disability improvers; 55%). Based on the final multinomial logistic regression model, a dichotomized treatment appointment attendance variable was a statistically significant predictor for differentiating high-disability improvers from high-disability nonimprovers. Three-fourths of patients who initiated treatment with elevated disability levels did not report reductions in disability after 5 months of treatment with new preventive pharmacotherapies. Preventive headache agents may be most efficacious for patients with moderate levels of disability and for patients with high disability levels who attend all treatment appointments. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Treating Hepatitis C in a Ryan White-Funded HIV Clinic: Has the Treatment Uptake Improved in the Interferon-Free Directly Active Antiviral Era?

PubMed

Cope, Rebecca; Glowa, Thomas; Faulds, Samantha; McMahon, Deborah; Prasad, Ramakrishna

2016-02-01

Now that highly efficacious, interferon-free (IFN-free), direct acting antivirals (DAA) for the treatment of hepatitis C (HCV) have closed the gap between treatment and cure, identifying barriers that prevent initiation of treatment is more crucial than ever. This is a retrospective study utilizing Electronic Medical Records and Prior Authorization Records to identify HCV treatment gaps, including predictors for intention-to-treat and treatment initiation in the first 15 months of a Ryan White funded human immunodeficiency virus (HIV)/HCV co-infection clinic. This study included 128 adults ≥ 18 years old with HIV and chronic HCV infection who had visited the treatment center at least once since January 2013. Provider intent-to-treat was used to differentiate patients actively considered for treatment based on documentation kept by a multidisciplinary HCV team. Members of this group who had gone on to initiate treatment were identified. Baseline characteristics were compared. Rates of active treatment consideration and treatment initiation were 30% and 14%, respectively. HCV treatment-naïve individuals were less likely to be considered for treatment [risk ratio (RR) 1.58, 95% confidence interval (CI) 1.07-2.32] and initiate therapy (RR 2.33, 95% CI 0.97-5.60). Advanced liver disease had no significant association. Black race (RR 1.96, 95% CI 0.90-4.25) and Medicaid insurance holders (RR 1.90, 95% CI 0.95-3.82) tended to be less likely to initiate therapy. The availability of IFN-free DAA regimens has yet to increase HCV treatment uptake in our HIV/HCV co-infected population. Barriers to HCV treatment initiation have shifted from medical contraindications to socioeconomic variables.

Identifying protein complexes based on brainstorming strategy.

PubMed

Shen, Xianjun; Zhou, Jin; Yi, Li; Hu, Xiaohua; He, Tingting; Yang, Jincai

2016-11-01

Protein complexes comprising of interacting proteins in protein-protein interaction network (PPI network) play a central role in driving biological processes within cells. Recently, more and more swarm intelligence based algorithms to detect protein complexes have been emerging, which have become the research hotspot in proteomics field. In this paper, we propose a novel algorithm for identifying protein complexes based on brainstorming strategy (IPC-BSS), which is integrated into the main idea of swarm intelligence optimization and the improved K-means algorithm. Distance between the nodes in PPI network is defined by combining the network topology and gene ontology (GO) information. Inspired by human brainstorming process, IPC-BSS algorithm firstly selects the clustering center nodes, and then they are separately consolidated with the other nodes with short distance to form initial clusters. Finally, we put forward two ways of updating the initial clusters to search optimal results. Experimental results show that our IPC-BSS algorithm outperforms the other classic algorithms on yeast and human PPI networks, and it obtains many predicted protein complexes with biological significance. Copyright © 2016 Elsevier Inc. All rights reserved.

Multiple criteria-based screening of Trichoderma isolates for biological control of Botrytis cinerea on tomato

USDA-ARS?s Scientific Manuscript database

Seventy-two isolates of Trichoderma were obtained from Hubei Province of China and identified to species based on the ITS-rDNA sequences. The isolates were initially tested for invasive growth on the colonies of Botrytis cinerea in the dual cultures with B. cinerea on potato dextrose agar at 20°C. T...

Hierarchical Interactions Model for Predicting Mild Cognitive Impairment (MCI) to Alzheimer's Disease (AD) Conversion

PubMed Central

Li, Han; Liu, Yashu; Gong, Pinghua; Zhang, Changshui; Ye, Jieping

2014-01-01

Identifying patients with Mild Cognitive Impairment (MCI) who are likely to convert to dementia has recently attracted increasing attention in Alzheimer's disease (AD) research. An accurate prediction of conversion from MCI to AD can aid clinicians to initiate treatments at early stage and monitor their effectiveness. However, existing prediction systems based on the original biosignatures are not satisfactory. In this paper, we propose to fit the prediction models using pairwise biosignature interactions, thus capturing higher-order relationship among biosignatures. Specifically, we employ hierarchical constraints and sparsity regularization to prune the high-dimensional input features. Based on the significant biosignatures and underlying interactions identified, we build classifiers to predict the conversion probability based on the selected features. We further analyze the underlying interaction effects of different biosignatures based on the so-called stable expectation scores. We have used 293 MCI subjects from Alzheimer's Disease Neuroimaging Initiative (ADNI) database that have MRI measurements at the baseline to evaluate the effectiveness of the proposed method. Our proposed method achieves better classification performance than state-of-the-art methods. Moreover, we discover several significant interactions predictive of MCI-to-AD conversion. These results shed light on improving the prediction performance using interaction features. PMID:24416143

Comparison of international approaches to sustainable remediation.

PubMed

Rizzo, Erika; Bardos, Paul; Pizzol, Lisa; Critto, Andrea; Giubilato, Elisa; Marcomini, Antonio; Albano, Claudio; Darmendrail, Dominique; Döberl, Gernot; Harclerode, Melissa; Harries, Nicola; Nathanail, Paul; Pachon, Carlos; Rodriguez, Alfonso; Slenders, Hans; Smith, Garry

2016-12-15

Since mid-to-late 2000s growing interest for sustainable remediation has emerged in initiatives from several international and national organisations as well as other initiatives from networks and forums. This reflects a realisation that risk-management activities can about bring environmental, social, and economic impacts (positive or negative) in addition to achieving risk-based remediation goals. These ideas have begun to develop as a new discipline of "sustainable remediation". The various initiatives have now published a number of frameworks, standards, white papers, road maps and operative guidelines. The similarities and differences in the approaches by these outputs and general trends have been identified. The comparison is based on a set of criteria developed in discussion with members of these various initiatives, and identifies a range of similarities between their publications. Overall the comparison demonstrates a high level of consensus across definitions and principles, which leads to the conclusion that there is a shared understanding of what sustainable remediation is both across countries and stakeholder groups. Publications do differ in points of detail, in particular about the operational aspects of sustainable remediation assessment. These differences likely result from differences in context and legal framework. As this analysis was carried out its findings were debated with members of the various international initiatives, many of whom have been included as authors. Hence the outcomes described in this paper can be seen as the result of a sort of multi-level debate among international experts (authors) and so can offer a starting point to new sustainable remediation initiatives (for example in other countries) that aim to start developing their own documents. Copyright © 2016 Elsevier Ltd. All rights reserved.

Operationalizing quality improvement in a pediatric surgical practice.

PubMed

Arca, Marjorie J; Enters, Jessica; Christensen, Melissa; Jeziorczak, Paul; Sato, Thomas T; Thielke, Robert; Oldham, Keith T

2014-01-01

Quality improvement (QI) is critical to enhancing patient care. It is necessary to prioritize which QI initiatives are relevant to one's institution and practice, as implementation is resource-intensive. We have developed and implemented a streamlined process to identify QI opportunities in our practice. We designed a web-based Pediatric and Infant Case Log and Outcomes (PICaLO) instrument using Research Electronic Data Capture (REDCap™) to record all surgical procedures for our practice. At the time of operation, a surgeon completes a case report form. An administrative assistant enters the data in PICaLO within 5-7days. Outcomes such as complications, deaths, and "occurrences" (readmissions, reoperations, transfers to ICU, ER visit, additional clinic visits) are recorded at the time of encounter, during M & M Conferences, and during follow-up clinic visits. Variables were chosen and defined based on national standards from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), and Patient Based Learning Log. Occurrences are queried for potential QI initiatives. In 2012, 3597 patients were entered, totaling 5177 procedures. There were 220 complications, 278 occurrences, and 16 deaths. Specific QI opportunities were identified and put into place. Data on procedures and outcomes can be collected effectively in a pediatric surgery practice to delineate pertinent QI initiatives. PICaLO is recognized by the American Board of Surgery as a mechanism to meet Maintenance of Certification 4 criteria. © 2014.

Key principles for a national clinical decision support knowledge sharing framework: synthesis of insights from leading subject matter experts.

PubMed

Kawamoto, Kensaku; Hongsermeier, Tonya; Wright, Adam; Lewis, Janet; Bell, Douglas S; Middleton, Blackford

2013-01-01

To identify key principles for establishing a national clinical decision support (CDS) knowledge sharing framework. As part of an initiative by the US Office of the National Coordinator for Health IT (ONC) to establish a framework for national CDS knowledge sharing, key stakeholders were identified. Stakeholders' viewpoints were obtained through surveys and in-depth interviews, and findings and relevant insights were summarized. Based on these insights, key principles were formulated for establishing a national CDS knowledge sharing framework. Nineteen key stakeholders were recruited, including six executives from electronic health record system vendors, seven executives from knowledge content producers, three executives from healthcare provider organizations, and three additional experts in clinical informatics. Based on these stakeholders' insights, five key principles were identified for effectively sharing CDS knowledge nationally. These principles are (1) prioritize and support the creation and maintenance of a national CDS knowledge sharing framework; (2) facilitate the development of high-value content and tooling, preferably in an open-source manner; (3) accelerate the development or licensing of required, pragmatic standards; (4) acknowledge and address medicolegal liability concerns; and (5) establish a self-sustaining business model. Based on the principles identified, a roadmap for national CDS knowledge sharing was developed through the ONC's Advancing CDS initiative. The study findings may serve as a useful guide for ongoing activities by the ONC and others to establish a national framework for sharing CDS knowledge and improving clinical care.

Interventions to improve or facilitate linkage to or retention in pre-ART (HIV) care and initiation of ART in low- and middle-income settings – a systematic review

PubMed Central

Govindasamy, Darshini; Meghij, Jamilah; Negussi, Eyerusalem Kebede; Baggaley, Rachel Clare; Ford, Nathan; Kranzer, Katharina

2014-01-01

Introduction Several approaches have been taken to reduce pre-antiretroviral therapy (ART) losses between HIV testing and ART initiation in low- and middle-income countries, but a systematic assessment of the evidence has not yet been undertaken. The aim of this systematic review is to assess the potential for interventions to improve or facilitate linkage to or retention in pre-ART care and initiation of ART in low- and middle-income settings. Methods An electronic search was conducted on Medline, Embase, Global Health, Web of Science and conference databases to identify studies describing interventions aimed at improving linkage to or retention in pre-ART care or initiation of ART. Additional searches were conducted to identify on-going trials on this topic, and experts in the field were contacted. An assessment of the risk of bias was conducted. Interventions were categorized according to key domains in the existing literature. Results A total of 11,129 potentially relevant citations were identified, of which 24 were eligible for inclusion, with the majority (n=21) from sub-Saharan Africa. In addition, 15 on-going trials were identified. The most common interventions described under key domains included: health system interventions (i.e. integration in the setting of antenatal care); patient convenience and accessibility (i.e. point-of-care CD4 count (POC) testing with immediate results, home-based ART initiation); behaviour interventions and peer support (i.e. improved communication, patient referral and education) and incentives (i.e. food support). Several interventions showed favourable outcomes: integration of care and peer supporters increased enrolment into HIV care, medical incentives increased pre-ART retention, POC CD4 testing and food incentives increased completion of ART eligibility screening and ART initiation. Most studies focused on the general adult patient population or pregnant women. The majority of published studies were observational cohort studies, subject to an unclear risk of bias. Conclusions Findings suggest that streamlining services to minimize patient visits, providing adequate medical and peer support, and providing incentives may decrease attrition, but the quality of the current evidence base is low. Few studies have investigated combined interventions, or assessed the impact of interventions across the HIV cascade. Results from on-going trials investigating POC CD4 count testing, patient navigation, rapid ART initiation and mobile phone technology may fill the quality of evidence gap. Further high-quality studies on key population groups are required, with interventions informed by previously reported barriers to care. PMID:25095831

20 CFR 652.8 - Administrative provisions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... determination. Such determinations shall be based on the requirements of the Act, regulations, and State plan. (i) The initial determination shall identify the audit findings, state the Secretary's proposed determination of the allowability of questioned costs and activities, and provide for informal resolution of...

FIST: a sensory domain for diverse signal transduction pathways in prokaryotes and ubiquitin signaling in eukaryotes

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

Borziak, Kirill; Jouline, Igor B

2007-01-01

Motivation: Sensory domains that are conserved among Bacteria, Archaea and Eucarya are important detectors of common signals detected by living cells. Due to their high sequence divergence, sensory domains are difficult to identify. We systematically look for novel sensory domains using sensitive profile-based searches initi-ated with regions of signal transduction proteins where no known domains can be identified by current domain models. Results: Using profile searches followed by multiple sequence alignment, structure prediction, and domain architecture analysis, we have identified a novel sensory domain termed FIST, which is present in signal transduction proteins from Bacteria, Archaea and Eucarya. Remote similaritymore » to a known ligand-binding fold and chromosomal proximity of FIST-encoding genes to those coding for proteins involved in amino acid metabolism and transport suggest that FIST domains bind small ligands, such as amino acids.« less

Identification of spatially-localized initial conditions via sparse PCA

NASA Astrophysics Data System (ADS)

Dwivedi, Anubhav; Jovanovic, Mihailo

2017-11-01

Principal Component Analysis involves maximization of a quadratic form subject to a quadratic constraint on the initial flow perturbations and it is routinely used to identify the most energetic flow structures. For general flow configurations, principal components can be efficiently computed via power iteration of the forward and adjoint governing equations. However, the resulting flow structures typically have a large spatial support leading to a question of physical realizability. To obtain spatially-localized structures, we modify the quadratic constraint on the initial condition to include a convex combination with an additional regularization term which promotes sparsity in the physical domain. We formulate this constrained optimization problem as a nonlinear eigenvalue problem and employ an inverse power-iteration-based method to solve it. The resulting solution is guaranteed to converge to a nonlinear eigenvector which becomes increasingly localized as our emphasis on sparsity increases. We use several fluids examples to demonstrate that our method indeed identifies the most energetic initial perturbations that are spatially compact. This work was supported by Office of Naval Research through Grant Number N00014-15-1-2522.

A science-based, watershed strategy to support effective remediation of abandoned mine lands

USGS Publications Warehouse

Buxton, Herbert T.; Nimick, David A.; Von Guerard, Paul; Church, Stan E.; Frazier, Ann G.; Gray, John R.; Lipin, Bruce R.; Marsh, Sherman P.; Woodward, Daniel F.; Kimball, Briant A.; Finger, Susan E.; Ischinger, Lee S.; Fordham, John C.; Power, Martha S.; Bunch, Christine M.; Jones, John W.

1997-01-01

A U.S. Geological Survey Abandoned Mine Lands Initiative will develop a strategy for gathering and communicating the scientific information needed to formulate effective and cost-efficient remediation of abandoned mine lands. A watershed approach will identify, characterize, and remediate contaminated sites that have the most profound effect on water and ecosystem quality within a watershed. The Initiative will be conducted during 1997 through 2001 in two pilot watersheds, the Upper Animas River watershed in Colorado and the Boulder River watershed in Montana. Initiative efforts are being coordinated with the U.S. Forest Service, Bureau of Land Management, National Park Service, and other stakeholders which are using the resulting scientific information to design and implement remediation activities. The Initiative has the following eight objective-oriented components: estimate background (pre-mining) conditions; define baseline (current) conditions; identify target sites (major contaminant sources); characterize target sites and processes affecting contaminant dispersal; characterize ecosystem health and controlling processes at target sites; develop remediation goals and monitoring network; provide an integrated, quality-assured and accessible data network; and document lessons learned for future applications of the watershed approach.

What are the challenges in developing effective health policies for obesity?

PubMed

Binks, M; Chin, S-H

2017-06-01

Identifying and implementing thoughtful, evidence-based (or at least evidence-informed) public health approaches to influencing obesity is a complex issue fraught with multiple challenges. These challenges begin with determining whether obesity policy approaches should be implemented. This is considered within the broader context of how common public health policy approaches may be relevant and applied to obesity. Additional challenges discussed include inconsistencies in clearly identifying obesity policy targets (for example, prevention versus treatment), selection of appropriate intervention targets and the identification and measurement of meaningful outcomes. Current policy initiatives are drawn upon to illustrate these challenges in the context of promoting solution-focused dialog aimed toward improving current initiatives and informing the development of new programs.

Initial planetary base construction techniques and machine implementation

NASA Technical Reports Server (NTRS)

Crockford, William W.

1987-01-01

Conceptual designs of (1) initial planetary base structures, and (2) an unmanned machine to perform the construction of these structures using materials local to the planet are presented. Rock melting is suggested as a possible technique to be used by the machine in fabricating roads, platforms, and interlocking bricks. Identification of problem areas in machine design and materials processing is accomplished. The feasibility of the designs is contingent upon favorable results of an analysis of the engineering behavior of the product materials. The analysis requires knowledge of several parameters for solution of the constitutive equations of the theory of elasticity. An initial collection of these parameters is presented which helps to define research needed to perform a realistic feasibility study. A qualitative approach to estimating power and mass lift requirements for the proposed machine is used which employs specifications of currently available equipment. An initial, unmanned mission scenario is discussed with emphasis on identifying uncompleted tasks and suggesting design considerations for vehicles and primitive structures which use the products of the machine processing.

Nonlinear Modeling and Initial Condition Estimation for Identifying the Aerothermodynamic Environment of the Space Shuttle Orbiter.

DTIC Science & Technology

1983-12-01

8217°%. .. o..’% - * 2’ . *. -o- . *o.oo o ,o ;j ’:-’ List of Figures Figure Page 1. System Identification of the Aerothermodynamic Environment of... System (STS) has of fered the engineering community a unique opportunity to flight test a reentry, hypersonic vehicle. The key 4 to the Shuttle’s...of the system (Refs. 7,8,9,10). Although the initial test flights have now been completed, data analysis and expansion of the existing data base

Variables Affecting Pharmacy Students’ Patient Care Interventions during Advanced Pharmacy Practice Experiences

PubMed Central

Patterson, Brandon J.; Sen, Sanchita; Bingham, Angela L.; Bowen, Jane F.; Ereshefsky, Benjamin; Siemianowski, Laura A.

2016-01-01

Objective. To identify the temporal effect and factors associated with student pharmacist self-initiation of interventions during acute patient care advanced pharmacy practice experiences (APPE). Methods. During the APPE, student pharmacists at an academic medical center recorded their therapeutic interventions and who initiated the intervention throughout clinical rotations. At the end of the APPE student pharmacists completed a demographic survey. Results. Sixty-two student pharmacists were included. Factors associated with lower rates of self-initiated interventions were infectious diseases and pediatrics APPEs and an intention to pursue a postgraduate residency. Timing of the APPE, previous specialty elective course completion, and previous hospital experience did not result in any significant difference in self-initiated recommendations. Conclusion. Preceptors should not base practice experience expectations for self-initiated interventions on previous student experience or future intentions. Additionally, factors leading to lower rates of self-initiated interventions on infectious diseases or pediatrics APPEs should be explored. PMID:27756924

Quality improvement utilizing in-situ simulation for a dual-hospital pediatric code response team.

PubMed

Yager, Phoebe; Collins, Corey; Blais, Carlene; O'Connor, Kathy; Donovan, Patricia; Martinez, Maureen; Cummings, Brian; Hartnick, Christopher; Noviski, Natan

2016-09-01

Given the rarity of in-hospital pediatric emergency events, identification of gaps and inefficiencies in the code response can be difficult. In-situ, simulation-based medical education programs can identify unrecognized systems-based challenges. We hypothesized that developing an in-situ, simulation-based pediatric emergency response program would identify latent inefficiencies in a complex, dual-hospital pediatric code response system and allow rapid intervention testing to improve performance before implementation at an institutional level. Pediatric leadership from two hospitals with a shared pediatric code response team employed the Institute for Healthcare Improvement's (IHI) Breakthrough Model for Collaborative Improvement to design a program consisting of Plan-Do-Study-Act cycles occurring in a simulated environment. The objectives of the program were to 1) identify inefficiencies in our pediatric code response; 2) correlate to current workflow; 3) employ an iterative process to test quality improvement interventions in a safe environment; and 4) measure performance before actual implementation at the institutional level. Twelve dual-hospital, in-situ, simulated, pediatric emergencies occurred over one year. The initial simulated event allowed identification of inefficiencies including delayed provider response, delayed initiation of cardiopulmonary resuscitation (CPR), and delayed vascular access. These gaps were linked to process issues including unreliable code pager activation, slow elevator response, and lack of responder familiarity with layout and contents of code cart. From first to last simulation with multiple simulated process improvements, code response time for secondary providers coming from the second hospital decreased from 29 to 7 min, time to CPR initiation decreased from 90 to 15 s, and vascular access obtainment decreased from 15 to 3 min. Some of these simulated process improvements were adopted into the institutional response while others continue to be trended over time for evidence that observed changes represent a true new state of control. Utilizing the IHI's Breakthrough Model, we developed a simulation-based program to 1) successfully identify gaps and inefficiencies in a complex, dual-hospital, pediatric code response system and 2) provide an environment in which to safely test quality improvement interventions before institutional dissemination. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

In Good Faith.

ERIC Educational Resources Information Center

Colgan, Craig

2001-01-01

Since 1991, the number of school district/faith-based organization partnerships jumped from 3 to 40 percent, promoted by President Clinton and the federally funded 21st Century Community Learning Centers initiative. Keys to success are identified, and programs, benefits, and problems in three large urban districts are profiled. (MLH)

5 Indicators of Decimal Understandings

ERIC Educational Resources Information Center

Cramer, Kathleen; Monson, Debra; Ahrendt, Sue; Colum, Karen; Wiley, Bethann; Wyberg, Terry

2015-01-01

The authors of this article collaborated with fourth-grade teachers from two schools to support implementation of a research-based fraction and decimal curriculum (Rational Number Project: Fraction Operations and Initial Decimal Ideas). Through this study, they identified five indicators of rich conceptual understanding of decimals, which are…

The comprehensive community-based traffic safety program : phase II, program assessment for District 2 and District 7, final report.

DOT National Transportation Integrated Search

1987-01-01

The program assessment phase was designed to identify community resources and address the recommendation, made in Phase I, that initial countermeasures should target the program areas of occupant protection, alcohol, selective enforcement, and pedest...

RAPID HEALTH-BASED METHOD FOR MEASURING MICROBIAL INDICATORS OF RECREATIONAL WATER QUALITY

EPA Science Inventory

Because the currently approved cultural methods for monitoring indicator bacteria in recreational water require 24 hours to produce results, the public may be exposed to potentially contaminated water before the water has been identified as hazardous. This project was initiated t...

Self-Directed Teacher Learning in Collaborative Contexts

ERIC Educational Resources Information Center

Slavit, David; Roth McDuffie, Amy

2013-01-01

Two related case studies of secondary mathematics teachers examine the roles and conditions helpful in initiating, directing, and/or supporting teachers' own professional development. Using multiple data sources from school-based and professional settings, we applied analytic induction to identify patterns of similarities and differences in…

Automated work packages architecture: An initial set of human factors and instrumentation and controls requirements

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

Agarwal, Vivek; Oxstrand, Johanna H.; Le Blanc, Katya L.

The work management process in current fleets of national nuclear power plants is so highly dependent on large technical staffs and quality of work instruction, i.e., paper-based, that this puts nuclear energy at somewhat of a long-term economic disadvantage and increase the possibility of human errors. Technologies like mobile portable devices and computer-based procedures can play a key role in improving the plant work management process, thereby increasing productivity and decreasing cost. Automated work packages are a fundamentally an enabling technology for improving worker productivity and human performance in nuclear power plants work activities because virtually every plant work activitymore » is accomplished using some form of a work package. As part of this year’s research effort, automated work packages architecture is identified and an initial set of requirements identified, that are essential and necessary for implementation of automated work packages in nuclear power plants.« less

Incidence of Depression and Associated Factors in Patients With Type 2 Diabetes in Quebec, Canada: A Population-Based Cohort Study.

PubMed

Lunghi, Carlotta; Moisan, Jocelyne; Grégoire, Jean-Pierre; Guénette, Line

2016-05-01

It has been reported that the risk of depression is higher among people with type 2 diabetes compared with a nondiabetic population. Among diabetic patients, depression has been associated with worse self-care behaviors, poor glycemic control, and an increased risk of diabetes complications. Identifying factors associated with the occurrence of depression may help physicians identify earlier diabetic patients at a high risk of developing depression, improve prevention, and accelerate proper treatment. To our knowledge, very few population-based studies have reported on the incidence of clinically diagnosed depression as a consequence of type 2 diabetes over a long follow-up period. The objective of this study was to estimate the incidence of clinically diagnosed depression among type 2 diabetic patients newly treated with oral antidiabetic drugs (ADs) and to identify factors associated with the occurrence of depression.Administrative claims data from the public health insurance plan were used to identify a cohort of new oral AD users aged ≥18 years between 2000 and 2006. Patients were followed from oral AD treatment initiation until the diagnosis of depression, ineligibility for the public drug plan, death, or the end of the study, whichever came first. Incidence rates were determined using person-time analysis. Factors associated with depression were identified using multivariable Cox regression analysis.We identified 114,366 new oral AD users, of which 4808 had a diagnosis of depression. The overall incidence rate of depression was 9.47/1000 person-years (PYs) (10.72/1000 PYs for women and 8.27/1000 PYs for men). The incidence of depression was higher during the year after oral AD treatment initiation. Independent factors associated with depression included having had mental disorders other than depression, hospitalization, a higher number of different drugs taken and of physicians visited during the year before oral AD initiation. Moreover, we observed a statistically significant age-by-socioeconomic status interaction.The incidence of diagnosed depression is higher during the first year after oral AD treatment initiation. Clinicians could pay particular attention to women, patients starting an AD at a young age, those with a low socioeconomic status, and especially those with a history of anxiety or dementia.

The Role of Hemoglobin Laboratory Test Results for the Detection of Upper Gastrointestinal Bleeding Outcomes Resulting from the Use of Medications in Observational Studies.

PubMed

Patorno, Elisabetta; Gagne, Joshua J; Lu, Christine Y; Haynes, Kevin; Sterrett, Andrew T; Roy, Jason; Wang, Xingmei; Raebel, Marsha A

2017-01-01

The identification of upper gastrointestinal (UGI) bleeding and perforated ulcers in claims data typically relies on inpatient diagnoses. The use of hemoglobin laboratory results might increase the detection of UGI events that do not lead to hospitalization. Our objective was to evaluate whether hemoglobin results increase UGI outcome identification in electronic databases, using non-steroidal anti-inflammatory drugs (NSAIDs) as a test case. From three data partner sites within the Mini-Sentinel Distributed Database, we identified NSAID initiators aged ≥18 years between 2008 and 2013. Numbers of events and risks within 30 days after NSAID initiation were calculated for four mutually exclusive outcomes: (1) inpatient UGI diagnosis of bleeding or gastric ulcer (standard claims-based definition without laboratory results); (2) non-inpatient UGI diagnosis AND ≥3 g/dl hemoglobin decrease; (3) ≥3 g/dl hemoglobin decrease without UGI diagnosis in any clinical setting; (4) non-inpatient UGI diagnosis, without ≥3 g/dl hemoglobin decrease. We identified 2,289,772 NSAID initiators across three sites. Overall, 45.3% had one or more hemoglobin result available within 365 days before or 30 days after NSAID initiation; only 6.8% had results before and after. Of 7637 potential outcomes identified, outcome 1 accounted for 21.7%, outcome 2 for 0.8%, outcome 3 for 34.3%, and outcome 4 for 43.3%. Potential cases identified by outcome 3 were largely not suggestive of UGI events. Outcomes 1, 2, and 4 had similar distributions of specific UGI diagnoses. Using available hemoglobin result values combined with non-inpatient UGI diagnoses identified few additional UGI cases. Non-inpatient UGI diagnostic codes may increase outcome detection but would require validation.

Identifying the Role of National Digital Cadastral Database (ndcdb) in Malaysia and for Land-Based Analysis

NASA Astrophysics Data System (ADS)

Halim, N. Z. A.; Sulaiman, S. A.; Talib, K.; Yusof, O. M.; Wazir, M. A. M.; Adimin, M. K.

2017-10-01

This paper explains the process carried out in identifying the significant role of NDCDB in Malaysia specifically in the land-based analysis. The research was initially a part of a larger research exercise to identify the significance of NDCDB from the legal, technical, role and land-based analysis perspectives. The research methodology of applying the Delphi technique is substantially discussed in this paper. A heterogeneous panel of 14 experts was created to determine the importance of NDCDB from the role standpoint. Seven statements pertaining the significant role of NDCDB in Malaysia and land-based analysis were established after three rounds of consensus building. The agreed statements provided a clear definition to describe the important role of NDCDB in Malaysia and for land-based analysis, which was limitedly studied that lead to unclear perception to the general public and even the geospatial community. The connection of the statements with disaster management is discussed concisely at the end of the research.

The Cultural Adaptation of a Community-Based Child Maltreatment Prevention Initiative.

PubMed

McLeigh, Jill D; Katz, Carmit; Davidson-Arad, Bilha; Ben-Arieh, Asher

2017-06-01

A unique primary prevention effort, Strong Communities for Children (Strong Communities), focuses on changing attitudes and expectations regarding communities' collective responsibilities for the safety of children. Findings from a 6-year pilot of the initiative in South Carolina have shown promise in reducing child maltreatment, but efforts to adapt the initiative to different cultural contexts have been lacking. No models exist for adapting an initiative that takes a community-level approach to ensuring children's safety. Thus, this article addresses the gap by providing an overview of the original initiative, how the initiative was adapted to the Israeli context, and lessons learned from the experience. Building on conceptualizations of cultural adaptation by Castro et al. (Prevention Science, 5, 2004, 41) and Resnicow et al. (Ethnicity and Disease, 9, 1999, 11), sources of nonfit (i.e., sociodemographic traits, political conflict, government services, and the presence and role of community organizations) were identified and deep and surface structure modifications were made to the content and delivery. Ultimately, this article describes the adaption and dissemination of a community-based child maltreatment prevention initiative in Tel Aviv, Israel, and addresses researchers' calls for more publications describing the adaptation of interventions and the procedures that need to be implemented to achieve cultural relevance. © 2015 Family Process Institute.

Balancing Officer Community Manpower through Decentralization: Granular Programming Revisited (1REV)

DTIC Science & Technology

2017-08-01

supply-demand imbalances Economic theory identifies costs and benefits associated with decentralization. On the benefits side, decentralized decision...patterns rather than costs . Granular programming as a decentralized, market-based initiative The costs and benefits of decentralized (instead of...paygrade-specific rates were based on average MPN costs by paygrade. The benefits of this approach to granular programming are that it is conceptually

The Perceived Effectiveness of the School Based Support Program: A National Capacity Building Initiative by the National Center for Educational Development at Qatar University

ERIC Educational Resources Information Center

Abu-Tineh, Abdullah M.

2015-01-01

Purpose: This study aims to investigate the effectiveness of the school-based support program (SBSP) as perceived by teachers who participated in this program. SBSP was designed to collectively build the capacity and promote the overall quality of teaching and learning in identified independent schools in the State of Qatar.…

Annual Report to Congress

DTIC Science & Technology

2008-05-01

other product areas. Where unmet requirements are identified and where S&T is required to meet cost objectives, the CBRN defense homeland security... industrial base, which has scaled down since the end of the Cold War, has stabilized. Ongoing military operations and homeland defense initiatives...as well as shelf-life expirations for stockpiles built in the 1980s, have contributed to demand for industrial base services and products

Development of an Electronic Medical Record Based Alert for Risk of HIV Treatment Failure in a Low-Resource Setting

PubMed Central

Puttkammer, Nancy; Zeliadt, Steven; Balan, Jean Gabriel; Baseman, Janet; Destiné, Rodney; Domerçant, Jean Wysler; France, Garilus; Hyppolite, Nathaelf; Pelletier, Valérie; Raphael, Nernst Atwood; Sherr, Kenneth; Yuhas, Krista; Barnhart, Scott

2014-01-01

Background The adoption of electronic medical record systems in resource-limited settings can help clinicians monitor patients' adherence to HIV antiretroviral therapy (ART) and identify patients at risk of future ART failure, allowing resources to be targeted to those most at risk. Methods Among adult patients enrolled on ART from 2005–2013 at two large, public-sector hospitals in Haiti, ART failure was assessed after 6–12 months on treatment, based on the World Health Organization's immunologic and clinical criteria. We identified models for predicting ART failure based on ART adherence measures and other patient characteristics. We assessed performance of candidate models using area under the receiver operating curve, and validated results using a randomly-split data sample. The selected prediction model was used to generate a risk score, and its ability to differentiate ART failure risk over a 42-month follow-up period was tested using stratified Kaplan Meier survival curves. Results Among 923 patients with CD4 results available during the period 6–12 months after ART initiation, 196 (21.2%) met ART failure criteria. The pharmacy-based proportion of days covered (PDC) measure performed best among five possible ART adherence measures at predicting ART failure. Average PDC during the first 6 months on ART was 79.0% among cases of ART failure and 88.6% among cases of non-failure (p<0.01). When additional information including sex, baseline CD4, and duration of enrollment in HIV care prior to ART initiation were added to PDC, the risk score differentiated between those who did and did not meet failure criteria over 42 months following ART initiation. Conclusions Pharmacy data are most useful for new ART adherence alerts within iSanté. Such alerts offer potential to help clinicians identify patients at high risk of ART failure so that they can be targeted with adherence support interventions, before ART failure occurs. PMID:25390044

Development of an electronic medical record based alert for risk of HIV treatment failure in a low-resource setting.

PubMed

Puttkammer, Nancy; Zeliadt, Steven; Balan, Jean Gabriel; Baseman, Janet; Destiné, Rodney; Domerçant, Jean Wysler; France, Garilus; Hyppolite, Nathaelf; Pelletier, Valérie; Raphael, Nernst Atwood; Sherr, Kenneth; Yuhas, Krista; Barnhart, Scott

2014-01-01

The adoption of electronic medical record systems in resource-limited settings can help clinicians monitor patients' adherence to HIV antiretroviral therapy (ART) and identify patients at risk of future ART failure, allowing resources to be targeted to those most at risk. Among adult patients enrolled on ART from 2005-2013 at two large, public-sector hospitals in Haiti, ART failure was assessed after 6-12 months on treatment, based on the World Health Organization's immunologic and clinical criteria. We identified models for predicting ART failure based on ART adherence measures and other patient characteristics. We assessed performance of candidate models using area under the receiver operating curve, and validated results using a randomly-split data sample. The selected prediction model was used to generate a risk score, and its ability to differentiate ART failure risk over a 42-month follow-up period was tested using stratified Kaplan Meier survival curves. Among 923 patients with CD4 results available during the period 6-12 months after ART initiation, 196 (21.2%) met ART failure criteria. The pharmacy-based proportion of days covered (PDC) measure performed best among five possible ART adherence measures at predicting ART failure. Average PDC during the first 6 months on ART was 79.0% among cases of ART failure and 88.6% among cases of non-failure (p<0.01). When additional information including sex, baseline CD4, and duration of enrollment in HIV care prior to ART initiation were added to PDC, the risk score differentiated between those who did and did not meet failure criteria over 42 months following ART initiation. Pharmacy data are most useful for new ART adherence alerts within iSanté. Such alerts offer potential to help clinicians identify patients at high risk of ART failure so that they can be targeted with adherence support interventions, before ART failure occurs.

A prospective pilot study of genome-wide exome and transcriptome profiling in patients with small cell lung cancer progressing after first-line therapy

PubMed Central

Byron, Sara A.; Aldrich, Jessica; Sangal, Ashish; Barilla, Heather; Kiefer, Jeffrey A.; Carpten, John D.; Craig, David W.; Whitsett, Timothy G.

2017-01-01

Background Small cell lung cancer (SCLC) that has progressed after first-line therapy is an aggressive disease with few effective therapeutic strategies. In this prospective study, we employed next-generation sequencing (NGS) to identify therapeutically actionable alterations to guide treatment for advanced SCLC patients. Methods Twelve patients with SCLC were enrolled after failing platinum-based chemotherapy. Following informed consent, genome-wide exome and RNA-sequencing was performed in a CLIA-certified, CAP-accredited environment. Actionable targets were identified and therapeutic recommendations made from a pharmacopeia of FDA-approved drugs. Clinical response to genomically-guided treatment was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Results The study completed its accrual goal of 12 evaluable patients. The minimum tumor content for successful NGS was 20%, with a median turnaround time from sample collection to genomics-based treatment recommendation of 27 days. At least two clinically actionable targets were identified in each patient, and six patients (50%) received treatment identified by NGS. Two had partial responses by RECIST 1.1 on a clinical trial involving a PD-1 inhibitor + irinotecan (indicated by MLH1 alteration). The remaining patients had clinical deterioration before NGS recommended therapy could be initiated. Conclusions Comprehensive genomic profiling using NGS identified clinically-actionable alterations in SCLC patients who progressed on initial therapy. Recommended PD-1 therapy generated partial responses in two patients. Earlier access to NGS guided therapy, along with improved understanding of those SCLC patients likely to respond to immune-based therapies, should help to extend survival in these cases with poor outcomes. PMID:28586388

Effect of Statin Use on Acute Kidney Injury Risk Following Coronary Artery Bypass Grafting

PubMed Central

Layton, J. Bradley; Kshirsagar, Abhijit V.; Simpson, Ross J.; Pate, Virginia; Funk, Michele Jonsson; Sturmer, Til; Brookhart, M. Alan

2013-01-01

Acute kidney injury (AKI) is a serious complication of cardiovascular surgery. While some non-experimental studies suggest statin use may reduce post-surgical AKI, methodological differences in study designs leave uncertainty regarding the reality or magnitude of the effect. We estimated the effect of pre-operative statin initiation on post-coronary artery bypass graft (CABG) AKI using an epidemiologic approach more closely simulating a randomized controlled trial in a large CABG patient population. We utilized healthcare claims from large, employer-based and Medicare insurance databases for the years 2000 – 2010. To minimize healthy user bias, we identified patients undergoing non-emergency CABG who either newly initiated a statin within 20 days prior to surgery or were unexposed for 200+ days prior to CABG. AKI was identified within 15 days following CABG. We calculated multivariable adjusted risk ratios (RR) and 95% confidence intervals (CI) with Poisson regression. Analyses were repeated using propensity score methods adjusted for clinical and healthcare utilization variables. We identified 17,077 CABG patients. Post-CABG AKI developed in 3.4% of statin initiators and 6.2% of non-initiators. After adjustment, we observed a protective effect of statin initiation on AKI (RR = 0.78, 95% CI 0.63, 0.96). This effect differed by age: ≥65 years, RR=0.91 (95% CI: 0.68, 1.20); <65 years, RR=0.62 (95% CI: 0.45, 0.86), although AKI was more common in the older age group (7.7 vs. 4.0%). In conclusion, statin initiation immediately prior to CABG may modestly reduce the risk of post-operative AKI, particularly in younger CABG patients. PMID:23273532

A Pilot Study Using a Web Survey to Identify Characteristics That Influence Hypogonadal Men to Initiate Testosterone Replacement Therapy.

PubMed

Rosen, Raymond C; Seftel, Allen D; Ruff, Dustin D; Muram, David

2018-05-01

Men with hypogonadism (HG) who choose testosterone replacement therapy (TRT) may have distinct characteristics that provide insight as to why they may/may not initiate therapy. The aim of the current study was to identify trends in patient characteristics and attitudes in men diagnosed with HG who initiated TRT (TRT+) compared with men who were diagnosed with HG but did not initiate TRT (TRT-). The market research-based online survey conducted between 2012 and 2013 included patients from a Federated Sample, a commercially available panel of patients with diverse medical conditions. The current analysis was composed of two groups: TRT+ ( n = 155) and TRT- ( n = 157). Patient demographics, clinical characteristics, and attitudes toward HG and TRT were examined as potential predictors of primary adherence in men with HG; cohorts were compared by using Fisher's exact test. Significant associations among sexual orientation, relationship status, educational level, presence of comorbid erectile dysfunction, area of residence, and TRT initiation were present ( p ≤ .05). College-educated, heterosexual, married men with comorbid erectile dysfunction living in suburban and urban areas were more likely to initiate treatment. The most bothersome symptoms reported were lack of energy (90% vs. 81%, p = .075), decreased strength and endurance (86% vs. 76%, p = .077), and deterioration in work performance (52% vs. 31%, p = .004); lack of energy prompted men to seek help. Patients (48%) in the TRT+ group were more knowledgeable regarding HG as compared with TRT- respondents (14%, p < .001), and most men obtained their information from a health care professional (89% vs. 82%, p = .074). The current analysis identified distinct demographic and clinical characteristics and attitudes among TRT users compared with men who were diagnosed with HG yet remained untreated.

A Social Systems Approach to Evaluation Research.

ERIC Educational Resources Information Center

Olien, C. N.; And Others

An information-control systems model for evaluation of adult education programs is offered and illustrated. The model is based upon identifying principal subsystems, such as source, channel and audience, which are involved in initiation, production, delivery and reception of educational messages. These subsystems are seen as separate but…

A Collaborative Effort to Assess Environmental Health in Newport News, Virginia

EPA Science Inventory

The Region 3 “Making a Visible Difference in Communities” (MVD) initiative for Southeast Newport News, VA has taken a community-centric, place-based approach to identifying and delivering service to the area’s residents and the city as a whole. Beginning with a ...

Rural Practitioners' Involvement in Response to Intervention

ERIC Educational Resources Information Center

Cahill, Susan M.; McGuire, Beatriz; Krumdick, Nathaniel D.; Lee, Michelle M.

2015-01-01

Objective: This study describes perceived levels of involvement in school-based Response to Intervention (RtI) initiatives as reported by occupational therapy (OT) practitioners from different types of communities (i.e., rural, suburban, and urban). In addition, it identifies differences among practice patterns of rural OT practitioners, compared…

Assessing Surface Water Availability in the Santa Cruz Watershed

EPA Science Inventory

The Southwest Ecosystem Service Project (SwESP) is one of five place-based studies in the U.S. Environmental Protection Agency’s Ecosystem Services Research Program (ESRP). The goal of the SwESP is to identify, locate, and inventory ecosystem services. Initial research efforts ar...

Human machine interface display design document.

DOT National Transportation Integrated Search

2008-01-01

The purpose of this document is to describe the design for the human machine interface : (HMI) display for the Next Generation 9-1-1 (NG9-1-1) System (or system of systems) : based on the initial Tier 1 requirements identified for the NG9-1-1 S...

Macula segmentation and fovea localization employing image processing and heuristic based clustering for automated retinal screening.

PubMed

R, GeethaRamani; Balasubramanian, Lakshmi

2018-07-01

Macula segmentation and fovea localization is one of the primary tasks in retinal analysis as they are responsible for detailed vision. Existing approaches required segmentation of retinal structures viz. optic disc and blood vessels for this purpose. This work avoids knowledge of other retinal structures and attempts data mining techniques to segment macula. Unsupervised clustering algorithm is exploited for this purpose. Selection of initial cluster centres has a great impact on performance of clustering algorithms. A heuristic based clustering in which initial centres are selected based on measures defining statistical distribution of data is incorporated in the proposed methodology. The initial phase of proposed framework includes image cropping, green channel extraction, contrast enhancement and application of mathematical closing. Then, the pre-processed image is subjected to heuristic based clustering yielding a binary map. The binary image is post-processed to eliminate unwanted components. Finally, the component which possessed the minimum intensity is finalized as macula and its centre constitutes the fovea. The proposed approach outperforms existing works by reporting that 100%,of HRF, 100% of DRIVE, 96.92% of DIARETDB0, 97.75% of DIARETDB1, 98.81% of HEI-MED, 90% of STARE and 99.33% of MESSIDOR images satisfy the 1R criterion, a standard adopted for evaluating performance of macula and fovea identification. The proposed system thus helps the ophthalmologists in identifying the macula thereby facilitating to identify if any abnormality is present within the macula region. Copyright © 2018 Elsevier B.V. All rights reserved.

Risk Factors for Retreatment Following Myopic LASIK with Femtosecond Laser and Custom Ablation for the Treatment of Myopia.

PubMed

Kruh, Jonathan N; Garrett, Kenneth A; Huntington, Brian; Robinson, Steve; Melki, Samir A

2017-01-01

To identify risks factors for retreatment post-laser in situ keratomeliusis (LASIK). A retrospective chart review from December 2008 to September 2012 identified 1,402 patients (2,581 eyes) that underwent LASIK treatment for myopia with the Intralase™ FS, STAR S4 IR™ Excimer Laser, and WaveScan WaveFront™ technology. In this group, 83 patients were retreated. All charts were reviewed for preoperative age, gender, initial manifest refraction spherical equivalent (MRSE), total astigmatism, and iris registration. Increased incidence rates of retreatment post-LASIK were preoperative age >40 years (p < 0.001), initial MRSE > -3.0 D (p = 0.02), and astigmatism >1D (p = 0.001). Iris registration capture did not significantly reduce the retreatment rate (p = 0.12). Risk factors for retreatment included preoperative age >40 years, initial MRSE > -3.0 D, and astigmatism >1D. There was no difference in retreatment rate for patients based on gender or iris registration capture.

An investigation of the initiation stage of hot corrosion in Ni-base alloys

NASA Technical Reports Server (NTRS)

Huang, T. T.; Meier, G. H.

1979-01-01

The mechanisms which lead to the destruction of a normally protective scale during the initial stages of hot corrosion of 14 nickel-base alloys contaminated with Na2SO4 and other condensed deposits were investigated. A continuous reading microbalance was used to record weight changes at temperatures between 900 C and 1000 C at 1 atmosphere pressure of slowly flowing oxygen. The reaction was initiated by raising a preheated furnace around the quartz tube in which the specimen was supported with oxygen flowing. The furnace was raised in a time period of seconds. At 900 C, the system and specimen came to thermal equilibrium in less than one minute. Oxidized specimens were studied using optical and scanning electron metallography and X-ray diffraction techniques. Transmission electron microscopy and electron diffraction spectroscopy were also used to identify the structure of carbides in some of the commercial alloys.

Electron-transfer-initiated benzoin- and Stetter-like reactions in packed-bed reactors for process intensification.

PubMed

Zaghi, Anna; Ragno, Daniele; Di Carmine, Graziano; De Risi, Carmela; Bortolini, Olga; Giovannini, Pier Paolo; Fantin, Giancarlo; Massi, Alessandro

2016-01-01

A convenient heterogeneous continuous-flow procedure for the polarity reversal of aromatic α-diketones is presented. Propaedeutic batch experiments have been initially performed to select the optimal supported base capable to initiate the two electron-transfer process from the carbamoyl anion of the N , N -dimethylformamide (DMF) solvent to the α-diketone and generate the corresponding enediolate active species. After having identified the 2- tert -butylimino-2-diethylamino-1,3-dimethylperhydro-1,3,2-diazaphosphorine on polystyrene (PS-BEMP) as the suitable base, packed-bed microreactors (pressure-resistant stainless-steel columns) have been fabricated and operated to accomplish the chemoselective synthesis of aroylated α-hydroxy ketones and 2-benzoyl-1,4-diones (benzoin- and Stetter-like products, respectively) with a good level of efficiency and with a long-term stability of the packing material (up to five days).

Electron-transfer-initiated benzoin- and Stetter-like reactions in packed-bed reactors for process intensification

PubMed Central

Zaghi, Anna; Ragno, Daniele; Di Carmine, Graziano; De Risi, Carmela; Bortolini, Olga; Giovannini, Pier Paolo; Fantin, Giancarlo

2016-01-01

A convenient heterogeneous continuous-flow procedure for the polarity reversal of aromatic α-diketones is presented. Propaedeutic batch experiments have been initially performed to select the optimal supported base capable to initiate the two electron-transfer process from the carbamoyl anion of the N,N-dimethylformamide (DMF) solvent to the α-diketone and generate the corresponding enediolate active species. After having identified the 2-tert-butylimino-2-diethylamino-1,3-dimethylperhydro-1,3,2-diazaphosphorine on polystyrene (PS-BEMP) as the suitable base, packed-bed microreactors (pressure-resistant stainless-steel columns) have been fabricated and operated to accomplish the chemoselective synthesis of aroylated α-hydroxy ketones and 2-benzoyl-1,4-diones (benzoin- and Stetter-like products, respectively) with a good level of efficiency and with a long-term stability of the packing material (up to five days). PMID:28144342

Comparison and alignment of an academic medical center's strategic goals with ASHP initiatives.

PubMed

Engels, Melanie J; Chaffee, Bruce W; Clark, John S

2015-12-01

An academic medical center's strategic goals were compared and aligned with the 2015 ASHP Health-System Pharmacy Initiative and the Pharmacy Practice Model Initiative (PPMI). The department's pharmacy practice model steering committee identified potential solutions to narrow prioritized gaps using a modified nominal group technique and a multivoting dot technique. Five priority solutions were identified and assigned to work groups to develop business plans, which included admission medication history and reconciliation for high-risk patients and those with complex medication regimens, pharmacist provision of discharge counseling to high-risk patients and those with complex medication regimens, improved measurement and reporting of the impact of PPMI programs on patient outcomes, implementation of a departmentwide formalized peer review and evaluation process, and the greeting of every patient at some time during his or her visit by a pharmacy team member. Stakeholders evaluated the business plans based on feasibility, financial return on investment, and anticipated safety enhancements. The solution that received the highest priority ranking and was subsequently implemented was "improved measurement and reporting of the impact of PPMI programs on patient outcomes." A defined process was followed for identifying gaps among current practices at an academic medical center and the 2015 ASHP Health-System Pharmacy Initiative and the PPMI. A key priority to better document the impact of pharmacists on patient care was identified for our department by using a nominal group technique brainstorming process and a multivoting dot technique and creating standardized business plans for five potential priority projects. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

How healthcare systems evaluate their advance care planning initiatives: Results from a systematic review.

PubMed

Biondo, Patricia D; Lee, Lydia D; Davison, Sara N; Simon, Jessica E

2016-09-01

Advance care planning initiatives are being implemented across healthcare systems around the world, but how best to evaluate their implementation is unknown. To identify gaps and/or redundancies in current evaluative strategies to help healthcare systems develop future evaluative frameworks for ACP. Systematic review. Peer-reviewed and gray literature searches were conducted till February 2015 to answer: "What methods have healthcare systems used to evaluate implementation of advance care planning initiatives?" A PICOS framework was developed to identify articles describing the implementation and evaluation of a health system-level advance care planning initiative. Outcome measures were mapped onto a conceptual quality indicator framework based on the Institute of Medicine and Donabedian models of healthcare quality. A total of 46 studies met inclusion criteria for analysis. Most articles reported on single parts of a healthcare system (e.g. continuing care). The most common outcome measures pertained to document completion, followed by healthcare resource use. Patient-, family-, or healthcare provider-reported outcomes were less commonly measured. Concordance measures (e.g. dying in place of choice) were reported by only 26% of studies. The conceptual quality indicator framework identified gaps and redundancies in measurement and is presented as a potential foundation from which to develop a comprehensive advance care planning evaluation framework. Document completion is frequently used to evaluate advance care planning program implementation; capturing the quality of care appears to be more difficult. This systematic review provides health system administrators with a comprehensive summary of measures used to evaluate advance care planning and may identify gaps in evaluation within their local context. © The Author(s) 2016.

Identifying initiation and elongation inhibitors of dengue virus RNA polymerase in a high-throughput lead-finding campaign.

PubMed

Smith, Thomas M; Lim, Siew Pheng; Yue, Kimberley; Busby, Scott A; Arora, Rishi; Seh, Cheah Chen; Wright, S Kirk; Nutiu, Razvan; Niyomrattanakit, Pornwaratt; Wan, Kah Fei; Beer, David; Shi, Pei-Yong; Benson, Timothy E

2015-01-01

Dengue virus (DENV) is the most significant mosquito-borne viral pathogen in the world and is the cause of dengue fever. The DENV RNA-dependent RNA polymerase (RdRp) is conserved among the four viral serotypes and is an attractive target for antiviral drug development. During initiation of viral RNA synthesis, the polymerase switches from a "closed" to "open" conformation to accommodate the viral RNA template. Inhibitors that lock the "closed" or block the "open" conformation would prevent viral RNA synthesis. Herein, we describe a screening campaign that employed two biochemical assays to identify inhibitors of RdRp initiation and elongation. Using a DENV subgenomic RNA template that promotes RdRp de novo initiation, the first assay measures cytosine nucleotide analogue (Atto-CTP) incorporation. Liberated Atto fluorophore allows for quantification of RdRp activity via fluorescence. The second assay uses the same RNA template but is label free and directly detects RdRp-mediated liberation of pyrophosphates of native ribonucleotides via liquid chromatography-mass spectrometry. The ability of inhibitors to bind and stabilize a "closed" conformation of the DENV RdRp was further assessed in a differential scanning fluorimetry assay. Last, active compounds were evaluated in a renilla luciferase-based DENV replicon cell-based assay to monitor cellular efficacy. All assays described herein are medium to high throughput, are robust and reproducible, and allow identification of inhibitors of the open and closed forms of DENV RNA polymerase. © 2014 Society for Laboratory Automation and Screening.

Metabolic profiles of flooding-tolerant mechanism in early-stage soybean responding to initial stress.

PubMed

Wang, Xin; Zhu, Wei; Hashiguchi, Akiko; Nishimura, Minoru; Tian, Jingkui; Komatsu, Setsuko

2017-08-01

Metabolomic analysis of flooding-tolerant mutant and abscisic acid-treated soybeans suggests that accumulated fructose might play a role in initial flooding tolerance through regulation of hexokinase and phosphofructokinase. Soybean is sensitive to flooding stress, which markedly reduces plant growth. To explore the mechanism underlying initial-flooding tolerance in soybean, mass spectrometry-based metabolomic analysis was performed using flooding-tolerant mutant and abscisic-acid treated soybeans. Among the commonly-identified metabolites in both flooding-tolerant materials, metabolites involved in carbohydrate and organic acid displayed same profile at initial-flooding stress. Sugar metabolism was highlighted in both flooding-tolerant materials with the decreased and increased accumulation of sucrose and fructose, respectively, compared to flooded soybeans. Gene expression of hexokinase 1 was upregulated in flooded soybean; however, it was downregulated in both flooding-tolerant materials. Metabolites involved in carbohydrate/organic acid and proteins related to glycolysis/tricarboxylic acid cycle were integrated. Increased protein abundance of phosphofructokinase was identified in both flooding-tolerant materials, which was in agreement with its enzyme activity. Furthermore, sugar metabolism was pointed out as the tolerant-responsive process at initial-flooding stress with the integration of metabolomics, proteomics, and transcriptomics. Moreover, application of fructose declined the increased fresh weight of plant induced by flooding stress. These results suggest that fructose might be the critical metabolite through regulation of hexokinase and phosphofructokinase to confer initial-flooding stress in soybean.

Oral 5-Aminosalicylate, Mesalamine Suppository, and Mesalamine Enema as Initial Therapy for Ulcerative Proctitis in Clinical Practice with Quality of Care Implications.

PubMed

Richter, James M; Arshi, Nabeela K; Oster, Gerry

2016-01-01

Background. Ulcerative proctitis (UP) is typically treated initially with oral 5-aminosalicylate ("5-ASA"), mesalamine suppository, or mesalamine enema ("UP Rx"). Little is known about their effectiveness in practice. Methods. Using a US health insurance database, we identified new-onset UP patients between January 1, 2005, and December 31, 2007, based on the following: (1) initiation of UP Rx; (2) endoscopy in prior 30 days resulting in diagnosis of UP; and (3) no prior encounters for ulcerative colitis or Crohn's disease. We examined the incidence of therapy escalation and total costs in relation to initial UP Rx. Results. We identified 548 patients: 327 received mesalamine suppository, 138 received oral 5-ASA, and 83 received mesalamine enema, as initial UP Rx. One-third receiving oral 5-ASA experienced therapy escalation over 12 months, 21% for both mesalamine suppository and enema. Mean cumulative total cost of UP Rx over 12 months was $1552, $996, and $986 for patients beginning therapy with oral 5-ASA, mesalamine enema, and mesalamine suppository, respectively. Contrary to expert recommendations the treatments were often not continued prophylactically. Conclusions. Treatment escalation was common, and total costs of therapy were higher, in patients who initiated treatment with oral 5-ASA. Further study is necessary to assess the significance of these observations.

Oral 5-Aminosalicylate, Mesalamine Suppository, and Mesalamine Enema as Initial Therapy for Ulcerative Proctitis in Clinical Practice with Quality of Care Implications

PubMed Central

Richter, James M.; Arshi, Nabeela K.; Oster, Gerry

2016-01-01

Background. Ulcerative proctitis (UP) is typically treated initially with oral 5-aminosalicylate (“5-ASA”), mesalamine suppository, or mesalamine enema (“UP Rx”). Little is known about their effectiveness in practice. Methods. Using a US health insurance database, we identified new-onset UP patients between January 1, 2005, and December 31, 2007, based on the following: (1) initiation of UP Rx; (2) endoscopy in prior 30 days resulting in diagnosis of UP; and (3) no prior encounters for ulcerative colitis or Crohn's disease. We examined the incidence of therapy escalation and total costs in relation to initial UP Rx. Results. We identified 548 patients: 327 received mesalamine suppository, 138 received oral 5-ASA, and 83 received mesalamine enema, as initial UP Rx. One-third receiving oral 5-ASA experienced therapy escalation over 12 months, 21% for both mesalamine suppository and enema. Mean cumulative total cost of UP Rx over 12 months was $1552, $996, and $986 for patients beginning therapy with oral 5-ASA, mesalamine enema, and mesalamine suppository, respectively. Contrary to expert recommendations the treatments were often not continued prophylactically. Conclusions. Treatment escalation was common, and total costs of therapy were higher, in patients who initiated treatment with oral 5-ASA. Further study is necessary to assess the significance of these observations. PMID:27446860

Factors associated with the initiation of disease-modifying antirheumatic drugs in newly diagnosed rheumatoid arthritis: a retrospective claims database study.

PubMed

Bonafede, Machaon M K; Fox, Kathleen M; Johnson, Barbara H; Watson, Crystal; Gandra, Shravanthi R

2012-02-01

The objectives of this study were to quantify the proportion of US patients with newly diagnosed rheumatoid arthritis (RA) in whom disease-modifying antirheumatic drug (DMARD) therapy was initiated within 12 months following diagnosis, to determine mean time to initiation, to compare the characteristics of initiators versus noninitiators, and to identify factors associated with noninitiation. A retrospective study was conducted using claims from the databases of commercial managed care and Medicare supplemental managed care to identify patients with claims containing codes for RA dated January 1, 2004, through September 30, 2008. The percentage of patients with RA and a prescription for a DMARD within 12 months after the index date (initiators) was evaluated. The characteristics of DMARD initiators and noninitiators during the preindex period were compared, including demographic and clinical characteristics, health care resource utilization, and cost variables. The probability of DMARD initiation was determined using survival analysis. Multivariate analysis was performed to estimate mean time from diagnosis to DMARD initiation based on demographic and clinical variables. Of 26,911 patients with newly diagnosed RA identified in the database searches, 63% had been prescribed a DMARD within 12 months after diagnosis. DMARD initiators were significantly more likely to have had a rheumatologist visit and rheumatoid factor testing and were more likely to have received a corticosteroid and/or an NSAID (all, P < 0.001). DMARD initiators had significantly lower total costs ($10,534 vs $12,725, respectively) and pharmacy drug costs ($2438 vs $2822) over the preindex period compared with noninitiators (both, P < 0.001). Independent factors associated with a greater likelihood of DMARD initiation included a rheumatologist visit, rheumatoid factor testing, NSAID use, and corticosteroid use. Age ≥85 years and the presence of comorbidities were associated with a significantly lower likelihood of DMARD initiation. Among managed care enrollees in the present analysis, 37% of patients newly diagnosed with RA were not being treated with DMARDs in the first 12 months after diagnosis. Time to DMARD initiation plateaued after 90 days, suggesting that if a patient was not prescribed a DMARD soon after RA diagnosis, he or she was not likely to receive one. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Healthy and Ready to Learn: Effects of a School-Based Public Health Insurance Outreach Program for Kindergarten-Aged Children.

PubMed

Jenkins, Jade Marcus

2018-01-01

Rates of child insurance coverage have increased due to expansions in public programs, but many eligible children remain uninsured. Uninsured children are less likely to receive preventative care, which leads to poorer health and achievement in the long term. This study is an evaluation of a school-based health insurance outreach initiative, "Healthy and Ready to Learn," aiming to identify and enroll uninsured kindergarteners in areas of high economic need in 16 counties in North Carolina. Regression discontinuity design and difference-in-differences analyses were used to estimate the effect of the initiative on Medicaid and CHIP enrollment (primary outcome) and preventive care use (well-child visits; secondary outcome). Focus groups and key-informant interviews were conducted to assess best practices and identify barriers to outreach for child enrollment. The initiative increased enrollment rates by 12.2% points and increased well-child exam rates by 8.6% points in the RD models, but not differences-in-differences, and did not significantly increase well-child visits. Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low-income parents. © 2018, American School Health Association.

Evidence of reducing ethanol content in beverages to reduce harmful use of alcohol.

PubMed

Rehm, Jürgen; Lachenmeier, Dirk W; Llopis, Eva Jané; Imtiaz, Sameer; Anderson, Peter

2016-09-01

Alcohol use is a major contributor to the burden of gastrointestinal disease. WHO's global strategy to reduce harmful use of alcohol encourages the alcohol industry to contribute to this effort. However, evidence that alcohol producers have contributed to the reduction of harmful use of alcohol is scarce. Reduction of alcoholic strength of beer has been proposed and initiated as one potential way forward. We examine the evidence base for the success of such an initiative. Direct evidence from natural experiments or other controlled studies is scarce. We identified three potential mechanisms for how reduction of alcoholic strength could affect harmful use of alcohol: by current drinkers replacing standard alcoholic beverages with similar beverages of lower alcoholic strength, without increasing the quantity of liquid consumed; by current drinkers switching to no alcohol alternatives for part of the time, thereby reducing their average amount of ethanol consumed; and by initiating alcohol use in current abstainers. The first mechanism seems to be the most promising to potentially reduce harm, but much will depend on actual implementation, and only an independent assessment will be able to identify effects on harmful drinking. The potential of alcoholic strength reduction is independent of initiation by law or by self-initiative of the industry. Copyright © 2016 Elsevier Ltd. All rights reserved.

Consensus–based approach to develop a measurement framework and identify a core set of indicators to track implementation and progress towards effective coverage of facility–based Kangaroo Mother Care

PubMed Central

Guenther, Tanya; Moxon, Sarah; Valsangkar, Bina; Wetzel, Greta; Ruiz, Juan; Kerber, Kate; Blencowe, Hannah; Dube, Queen; Vani, Shashi N; Vivio, Donna; Magge, Hema; De Leon–Mendoza, Socorro; Patterson, Janna; Mazia, Goldy

2017-01-01

Background As efforts to scale up the delivery of Kangaroo Mother Care (KMC) in facilities are increasing, a standardized approach to measure implementation and progress towards effective coverage is needed. Here, we describe a consensus–based approach to develop a measurement framework and identify a core set of indicators for monitoring facility–based KMC that would be feasible to measure within existing systems. Methods The KMC measurement framework and core list of indicators were developed through: 1) scoping exercise to identify potential indicators through literature review and requests from researchers and program implementers; and 2) face–to–face consultations with KMC and measurement experts working at country and global levels to review candidate indicators and finalize selection and definitions. Results The KMC measurement framework includes two main components: 1) service readiness, based on the WHO building blocks framework; and 2) service delivery action sequence covering identification, service initiation, continuation to discharge, and follow–up to graduation. Consensus was reached on 10 core indicators for KMC, which were organized according to the measurement framework. We identified 4 service readiness indicators, capturing national level policy for KMC, availability of KMC indicators in HMIS, costed operational plans for KMC and availability of KMC services at health facilities with inpatient maternity services. Six indicators were defined for service delivery, including weighing of babies at birth, identification of those ≤2000 g, initiation of facility–based KMC, monitoring the quality of KMC, status of babies at discharge from the facility and levels of follow–up (according to country–specific protocol). Conclusions These core KMC indicators, identified with input from a wide range of global and country–level KMC and measurement experts, can aid efforts to strengthen monitoring systems and facilitate global tracking of KMC implementation. As data collection systems advance, we encourage program managers and evaluators to document their experiences using this framework to measure progress and allow indicator refinement, with the overall aim of working towards sustainable, country–led data systems. PMID:29057074

Consensus-based approach to develop a measurement framework and identify a core set of indicators to track implementation and progress towards effective coverage of facility-based Kangaroo Mother Care.

PubMed

Guenther, Tanya; Moxon, Sarah; Valsangkar, Bina; Wetzel, Greta; Ruiz, Juan; Kerber, Kate; Blencowe, Hannah; Dube, Queen; Vani, Shashi N; Vivio, Donna; Magge, Hema; De Leon-Mendoza, Socorro; Patterson, Janna; Mazia, Goldy

2017-12-01

As efforts to scale up the delivery of Kangaroo Mother Care (KMC) in facilities are increasing, a standardized approach to measure implementation and progress towards effective coverage is needed. Here, we describe a consensus-based approach to develop a measurement framework and identify a core set of indicators for monitoring facility-based KMC that would be feasible to measure within existing systems. The KMC measurement framework and core list of indicators were developed through: 1) scoping exercise to identify potential indicators through literature review and requests from researchers and program implementers; and 2) face-to-face consultations with KMC and measurement experts working at country and global levels to review candidate indicators and finalize selection and definitions. The KMC measurement framework includes two main components: 1) service readiness, based on the WHO building blocks framework; and 2) service delivery action sequence covering identification, service initiation, continuation to discharge, and follow-up to graduation. Consensus was reached on 10 core indicators for KMC, which were organized according to the measurement framework. We identified 4 service readiness indicators, capturing national level policy for KMC, availability of KMC indicators in HMIS, costed operational plans for KMC and availability of KMC services at health facilities with inpatient maternity services. Six indicators were defined for service delivery, including weighing of babies at birth, identification of those ≤2000 g, initiation of facility-based KMC, monitoring the quality of KMC, status of babies at discharge from the facility and levels of follow-up (according to country-specific protocol). These core KMC indicators, identified with input from a wide range of global and country-level KMC and measurement experts, can aid efforts to strengthen monitoring systems and facilitate global tracking of KMC implementation. As data collection systems advance, we encourage program managers and evaluators to document their experiences using this framework to measure progress and allow indicator refinement, with the overall aim of working towards sustainable, country-led data systems.

An efficient algorithm for computing fixed length attractors based on bounded model checking in synchronous Boolean networks with biochemical applications.

PubMed

Li, X Y; Yang, G W; Zheng, D S; Guo, W S; Hung, W N N

2015-04-28

Genetic regulatory networks are the key to understanding biochemical systems. One condition of the genetic regulatory network under different living environments can be modeled as a synchronous Boolean network. The attractors of these Boolean networks will help biologists to identify determinant and stable factors. Existing methods identify attractors based on a random initial state or the entire state simultaneously. They cannot identify the fixed length attractors directly. The complexity of including time increases exponentially with respect to the attractor number and length of attractors. This study used the bounded model checking to quickly locate fixed length attractors. Based on the SAT solver, we propose a new algorithm for efficiently computing the fixed length attractors, which is more suitable for large Boolean networks and numerous attractors' networks. After comparison using the tool BooleNet, empirical experiments involving biochemical systems demonstrated the feasibility and efficiency of our approach.

Direct Duplex Detection: An Emerging Tool in the RNA Structure Analysis Toolbox.

PubMed

Weidmann, Chase A; Mustoe, Anthony M; Weeks, Kevin M

2016-09-01

While a variety of powerful tools exists for analyzing RNA structure, identifying long-range and intermolecular base-pairing interactions has remained challenging. Recently, three groups introduced a high-throughput strategy that uses psoralen-mediated crosslinking to directly identify RNA-RNA duplexes in cells. Initial application of these methods highlights the preponderance of long-range structures within and between RNA molecules and their widespread structural dynamics. Copyright © 2016 Elsevier Ltd. All rights reserved.

New Erwinia-Like Organism Causing Cervical Lymphadenitis▿

PubMed Central

Shin, Sang Yop; Lee, Mi Young; Song, Jae-Hoon; Ko, Kwan Soo

2008-01-01

The first case of cervical lymphadenitis due to infection by a new Erwinia-like organism is reported. The organism was identified initially as Pantoea sp. by a Vitek 2-based assessment but was finally identified as a member of the genus Erwinia by 16S rRNA gene sequence analysis. The isolate displayed 98.9% 16S rRNA gene sequence similarity to that of E. tasmaniensis and showed phenotypic characteristics that were different from other Erwinia species. PMID:18614665

Genetic insights into age-related macular degeneration: Controversies addressing Risk, Causality, and Therapeutics

PubMed Central

Gorin, Michael B.

2012-01-01

Age-related macular degeneration (AMD) is a common condition among the elderly population that leads to the progressive central vision loss and serious compromise of quality of life for its sufferers. It is also one of the few disorders for whom the investigation of its genetics has yielded rich insights into its diversity and causality and holds the promise of enabling clinicians to provide better risk assessments for individuals as well as to develop and selectively deploy new therapeutics to either prevent or slow the development of disease and lessen the threat of vision loss. The genetics of AMD began initially with the appreciation of familial aggregation and increase risk and expanded with the initial association of APOE variants with the disease. The first major breakthroughs came with family-based linkage studies of affected (and discordant) sibs, which identified a number of genetic loci and led to the targeted search of the 1q31 and 10q26 loci for associated variants. Three of the initial four reports for the CFH variant, Y402H, were based on regional candidate searches, as were the two initial reports of the ARMS2/HTRA1 locus variants. Case-control association studies initially also played a role in discovering the major genetic variants for AMD, and the success of those early studies have been used to fuel enthusiasm for the methodology for a number of diseases. Until 2010, all of the subsequent genetic variants associated with AMD came from candidate gene testing based on the complement factor pathway. In 2010, several large-scale genome-wide association studies (GWAS) identified genes that had not been previously identified. Much of this historical information is available in a number of recent reviews.(Chen et al., 2010b; Deangelis et al., 2011; Fafowora and Gorin, 2012b; Francis and Klein, 2011; Kokotas et al., 2011) Large meta analysis of AMD GWAS has added new loci and variants to this collection.(Chen et al., 2010a; Kopplin et al., 2010; Yu et al., 2011) This paper will focus on the ongoing controversies that are confronting AMD genetics at this time, rather than attempting to summarize this field, which has exploded in the past 5 years. PMID:22561651

Key principles for a national clinical decision support knowledge sharing framework: synthesis of insights from leading subject matter experts

PubMed Central

Hongsermeier, Tonya; Wright, Adam; Lewis, Janet; Bell, Douglas S; Middleton, Blackford

2013-01-01

Objective To identify key principles for establishing a national clinical decision support (CDS) knowledge sharing framework. Materials and methods As part of an initiative by the US Office of the National Coordinator for Health IT (ONC) to establish a framework for national CDS knowledge sharing, key stakeholders were identified. Stakeholders' viewpoints were obtained through surveys and in-depth interviews, and findings and relevant insights were summarized. Based on these insights, key principles were formulated for establishing a national CDS knowledge sharing framework. Results Nineteen key stakeholders were recruited, including six executives from electronic health record system vendors, seven executives from knowledge content producers, three executives from healthcare provider organizations, and three additional experts in clinical informatics. Based on these stakeholders' insights, five key principles were identified for effectively sharing CDS knowledge nationally. These principles are (1) prioritize and support the creation and maintenance of a national CDS knowledge sharing framework; (2) facilitate the development of high-value content and tooling, preferably in an open-source manner; (3) accelerate the development or licensing of required, pragmatic standards; (4) acknowledge and address medicolegal liability concerns; and (5) establish a self-sustaining business model. Discussion Based on the principles identified, a roadmap for national CDS knowledge sharing was developed through the ONC's Advancing CDS initiative. Conclusion The study findings may serve as a useful guide for ongoing activities by the ONC and others to establish a national framework for sharing CDS knowledge and improving clinical care. PMID:22865671

Identifying the links between violence against women and HIV/AIDS: ecosocial and human rights frameworks offer insight into U.S. prevention policies.

PubMed

Teti, Michelle; Chilton, Mariana; Lloyd, Linda; Rubinstein, Susan

2006-01-01

While US government-sponsored HIV prevention initiatives have achieved notable successes, challenges remain to serving women effectively. Intimate partner violence hinders women's efforts to decrease their HIV risk behaviors. The global HIV/AIDS epidemic is often viewed as a human rights crisis. An analysis of US HIV prevention strategies based on ecosocial and health and human rights frameworks clarifies women's HIV risk practices and suggests opportunities for progress. These two frameworks help to (1) demonstrate how HIV/AIDS is a clinical manifestation of violence against women, (2) identify safety from violence as a human right necessary for well-being, and (3) suggest ways in which HIV prevention initiatives can more effectively improve women's health and fulfill their basic human rights.

Defining and Assessing Quality Improvement Outcomes: A Framework for Public Health

PubMed Central

Nawaz, Saira; Thomas, Craig; Young, Andrea

2015-01-01

We describe an evidence-based framework to define and assess the impact of quality improvement (QI) in public health. Developed to address programmatic and research-identified needs for articulating the value of public health QI in aggregate, this framework proposes a standardized set of measures to monitor and improve the efficiency and effectiveness of public health programs and operations. We reviewed the scientific literature and analyzed QI initiatives implemented through the Centers for Disease Control and Prevention’s National Public Health Improvement Initiative to inform the selection of 5 efficiency and 8 effectiveness measures. This framework provides a model for identifying the types of improvement outcomes targeted by public health QI efforts and a means to understand QI’s impact on the practice of public health. PMID:25689185

SU-E-T-446: Group-Sparsity Based Angle Generation Method for Beam Angle Optimization

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

Gao, H

2015-06-15

Purpose: This work is to develop the effective algorithm for beam angle optimization (BAO), with the emphasis on enabling further improvement from existing treatment-dependent templates based on clinical knowledge and experience. Methods: The proposed BAO algorithm utilizes a priori beam angle templates as the initial guess, and iteratively generates angular updates for this initial set, namely angle generation method, with improved dose conformality that is quantitatively measured by the objective function. That is, during each iteration, we select “the test angle” in the initial set, and use group-sparsity based fluence map optimization to identify “the candidate angle” for updating “themore » test angle”, for which all the angles in the initial set except “the test angle”, namely “the fixed set”, are set free, i.e., with no group-sparsity penalty, and the rest of angles including “the test angle” during this iteration are in “the working set”. And then “the candidate angle” is selected with the smallest objective function value from the angles in “the working set” with locally maximal group sparsity, and replaces “the test angle” if “the fixed set” with “the candidate angle” has a smaller objective function value by solving the standard fluence map optimization (with no group-sparsity regularization). Similarly other angles in the initial set are in turn selected as “the test angle” for angular updates and this chain of updates is iterated until no further new angular update is identified for a full loop. Results: The tests using the MGH public prostate dataset demonstrated the effectiveness of the proposed BAO algorithm. For example, the optimized angular set from the proposed BAO algorithm was better the MGH template. Conclusion: A new BAO algorithm is proposed based on the angle generation method via group sparsity, with improved dose conformality from the given template. Hao Gao was partially supported by the NSFC (#11405105), the 973 Program (#2015CB856000) and the Shanghai Pujiang Talent Program (#14PJ1404500)« less

The Precision Medicine Initiative's All of Us Research Program: an agenda for research on its ethical, legal, and social issues.

PubMed

Sankar, Pamela L; Parker, Lisa S

2017-07-01

The Precision Medicine Initiative (PMI) is an innovative approach to developing a new model of health care that takes into account individual differences in people's genes, environments, and lifestyles. A cornerstone of the initiative is the PMI All of Us Research Program (formerly known as PMI-Cohort Program) which will create a cohort of 1 million volunteers who will contribute their health data and biospecimens to a centralized national database to support precision medicine research. The PMI All of US Research Program is the largest longitudinal study in the history of the United States. The designers of the Program anticipated and addressed some of the ethical, legal, and social issues (ELSI) associated with the initiative. To date, however, there is no plan to call for research regarding ELSI associated with the Program-PMI All of Us program. Based on analysis of National Institutes of Health (NIH) funding announcements for the PMI All of Us program, we have identified three ELSI themes: cohort diversity and health disparities, participant engagement, and privacy and security. We review All of Us Research Program plans to address these issues and then identify additional ELSI within each domain that warrant ongoing investigation as the All of Us Research Program develops. We conclude that PMI's All of Us Research Program represents a significant opportunity and obligation to identify, analyze, and respond to ELSI, and we call on the PMI to initiate a research program capable of taking on these challenges.Genet Med advance online publication 01 December 2016.

Design and performance of A 3He-free coincidence counter based on parallel plate boron-lined proportional technology

DOE PAGES

Henzlova, D.; Menlove, H. O.; Marlow, J. B.

2015-07-01

Thermal neutron counters utilized and developed for deployment as non-destructive assay (NDA) instruments in the field of nuclear safeguards traditionally rely on 3He-based proportional counting systems. 3He-based proportional counters have provided core NDA detection capabilities for several decades and have proven to be extremely reliable with range of features highly desirable for nuclear facility deployment. Facing the current depletion of 3He gas supply and the continuing uncertainty of options for future resupply, a search for detection technologies that could provide feasible short-term alternative to 3He gas was initiated worldwide. As part of this effort, Los Alamos National Laboratory (LANL) designedmore » and built a 3He-free full scale thermal neutron coincidence counter based on boron-lined proportional technology. The boronlined technology was selected in a comprehensive inter-comparison exercise based on its favorable performance against safeguards specific parameters. This paper provides an overview of the design and initial performance evaluation of the prototype High Level Neutron counter – Boron (HLNB). The initial results suggest that current HLNB design is capable to provide ~80% performance of a selected reference 3He-based coincidence counter (High Level Neutron Coincidence Counter, HLNCC). Similar samples are expected to be measurable in both systems, however, slightly longer measurement times may be anticipated for large samples in HLNB. The initial evaluation helped to identify potential for further performance improvements via additional tailoring of boron-layer thickness.« less

Social conditions and trends in southeast Alaska.

Treesearch

Rhonda Mazza; Linda E. Kruger

2005-01-01

In 1997, scientists at the Pacific Northwest Research Station initiated several social science studies in response to information gaps identified while developing the Tongass Land Management Plan. Results presented here summarize findings from studies of demographic trends and tourism trends in the region based on data available through 2002. Demographic...

Development of an Interdisciplinary Dysphagia Team in the Public Schools.

ERIC Educational Resources Information Center

Homer, Emily M.; Bickerton, Cheryl; Hill, Sherry; Parham, Lisa; Taylor, Darlene

2000-01-01

This article describes the development of a school-based dysphagia team (swallowing action team (SWAT)) in Louisiana. It addresses how the team was initially formed, the process of identifying students who were exhibiting a swallowing disorder, steps taken for staff development, and problems encountered in seeking administrative approval.…

Merit Pay and Faculty Evaluation.

ERIC Educational Resources Information Center

Hudgins, James L.

A program linking merit pay and faculty evaluation was initiated at Sumter Area Technical College (SATC) in Sumter, South Carolina, in 1978. The performance-based evaluation system focuses on three elements: the job description, which identifies professional responsibilities and how they relate to the college's mission; the individual action plan;…

The geomorphic legacy of water and sediment control structures in a semiarid rangeland watershed

USDA-ARS?s Scientific Manuscript database

An inventory of water and sediment control structures remnant of historic cattle ranching was assembled for the Buenos Aires National Wildlife Refuge (BANWR) in southern Arizona, USA. An assessment of structural condition based on aerial imagery identified headcut initiation and channel incision as...

Planning Curriculum Development: With Examples from Projects for the Mentally Retarded.

ERIC Educational Resources Information Center

Mayer, William V., Ed.

Presented are guidelines based on five federally funded projects for planning and developing curriculum for the mentally retarded. Discussed are the initial steps of identifying the target population, needs, and objectives. Examples of curriculum design, including the rationale and conceptual framework, are provided. Considered are elements of…

Influence of Culture and Home Environment on Science Learning.

ERIC Educational Resources Information Center

Giddings, Geoff J.

This paper has the potential for identifying and codifying the home learning environment and parental factors in a unique multicultural setting within Australian schools, and for the establishment of research-based initiatives for more effective collaboration between schools and parents. The Third International Mathematics and Science Study…

RAPID HEALTH-BASED METHOD FOR MEASURING MICROBIAL INDICATORS OF RECREATIONAL WATER QUALITY - 2006 EPA SCIENCE FORUM

EPA Science Inventory

Because the current approved cultural methods for monitoring indicator bacteria in recreational water require 24 hours to produce results, the public may be exposed to potentially contaminated water before the water has been identified as hazardous. This project was initiated to...

Collaboration, Innovation, and Value Creation in a Global Telecom

ERIC Educational Resources Information Center

Allee, Verna; Taug, Jan

2006-01-01

Purpose: The purpose of this paper is to review a systemic organizational change initiative for improving collaboration, innovation and value creation at a global telecom. Design/methodology/approach: Based on a comprehensive internal assessment Telenor identified core issues and challenges in supporting collaboration after several years of…

Languages in Adult Literacy: Policies and Practices in Education for All and Beyond

ERIC Educational Resources Information Center

Robinson, Clinton

2016-01-01

Linguistic diversity characterizes many countries with large literacy needs. Meeting these needs will require a multilingual approach based on learning initial literacy in the learner's mother tongue, with other languages used subsequently. This article identifies five major challenges in implementing multilingual programmes and traces the…

Pre-Service Teachers' Conclusive Principles for Teaching Technology Education

ERIC Educational Resources Information Center

Snape, Paul

2016-01-01

What enduring knowledge and understanding from tertiary education study will learners remember most that will contribute to their on-going performance and understanding for effective teaching? This paper is based on research undertaken to identify what third-year initial teacher education students in a course including Technology Education…

A Collaborative Effort to Assess Environmental Health in Newport News, Virginia

EPA Science Inventory

The Region 3 “Making a Visible Difference in Communities” (MVD) initiative for Southeast Newport News, VA has taken a community-centric, place-based approach to identifying and delivering service to the area’s residents and the city as a whole. Beginning with a CARE (Community Ac...

Initial Factor Analysis and Cross-Validation of the Multicultural Teaching Competencies Inventory

ERIC Educational Resources Information Center

Prieto, Loreto R.

2012-01-01

The Multicultural Teaching Competencies Inventory (MTCI) contains items based on the tri-parte model of cultural competencies established by Sue and associates (Sue et al., 1992, 1982, 2003) that identify multicultural Awareness, Knowledge, and Skill as central characteristics of a culturally sensitive professional. The development and validation…

AN INTEGRATED SYNTHESIS OF KEY AND POLICY RELEVANT FINDINGS FROM EPA'S SUPERSITES PROGRAM AND RELATED STUDIES

EPA Science Inventory

This presentation provides an overview and initial insights into the findings based on results from EPA's PM Supersites Program and related studies. Many key atmospheric sciences findings have been identified through the research conducted during the last five years as part of t...

Business Case Analysis: Identifying Concerns for the Continuum of Care for United States Air Force Cadets with the Implementation of Base Realignment and Close Initiatives at the Air force Academy Hospital

DTIC Science & Technology

2006-12-31

et al, 2003). Another reason that downsizing is a popular way in which a healthcare organization can become more efficient based on institutional ... theory . This theory states that since other hospitals have used downsizing as a means to become more efficient, so will we. This theory states that

Integrating Game-Based Learning Initiative: Increasing the Usage of Game-Based Learning within K-12 Classrooms through Professional Learning Groups

ERIC Educational Resources Information Center

Denham, André R.; Mayben, Robert; Boman, Terri

2016-01-01

In the past 15 to 20 years there has been an increased interest in the use of games for learning. A considerable amount of work has already been done by educational researchers and theorists (Gee, Squire, Malone, Lepper, Shaffer, etc.) to identify and to operationalize the native affordances of games that make them good for learning. Unfortunately…

Geomorphic threshold conditions for gully erosion in Southwestern Iran (Boushehr-Samal watershed)

NASA Astrophysics Data System (ADS)

Nazari Samani, Aliakbar; Ahmadi, Hassan; Jafari, Mohammad; Boggs, Guy; Ghoddousi, Jamal; Malekian, Arash

2009-06-01

Globally, a large amount of research has been dedicated to furthering our understanding of the factors and mechanisms affecting gully erosion. However, despite the importance of gully erosion in arid and semi arid regions of Iran there has been no comprehensive study of the geomorphic threshold conditions and factors influencing gully initiation. The aim of this article is to investigate the gullying processes and threshold conditions of permanent gullies in an arid region of Iran based upon examination of the slope-area ( S = αA-β) relationship. The data were collected through field and laboratory studies as well as Digital Elevation Model (DEM) analyses. In total, 97 active headcuts were identified across the three study sites and classified based on dominant initiation process including piping, landsliding and overland flow. Soil properties, including EC, SAR and soil texture, as well as landuse practices were found to be the major factors initiating piping and bank gullies. All gullies initiated by landsliding and seepage processes were found to be located in steep areas (28-40% slope) with their distribution further influenced by the lithology and presence of a cohesionless sand layer within the soil profile. An inverse relationship between upslope area ( A) and local slope ( S), in which the α and β coefficients varied, was further investigated based on the dominant gullying process and land use. Gullies occurring in the rangelands that were dominated by overland flow had the strongest relationship while landsliding dominated gullies did not have a statistically significant S- A relationship. In comparison to theoretical and literature based relationships for gully initiation, relatively low values for β were obtained (-0.182 to -0.266), possibly influenced by the presence of seepage and subsurface processes in many gullies. However, this is consistent with other studies in arid regions and may reflect greater potential for gullying in arid zones due to low vegetation cover and high variation in rainfall. In addition, the soil attributes together with land use practices influenced gully initiation thresholds. Application of the solved S- A relation for predicting vulnerable areas to gullying indicates that it is possible to predict the location of gullies with an acceptable level of accuracy; however other environmental factors should be integrated with the S- A relationship to more accurately identify the location of permanent gullies in arid regions.

A Systematic Review of the Literature Addressing Veterinary Care for Underserved Communities.

PubMed

LaVallee, Elizabeth; Mueller, Megan Kiely; McCobb, Emily

2017-01-01

Currently, there is a care gap in veterinary medicine affecting low-income and underserved communities, resulting in decreased nonhuman-animal health and welfare. The use of low-price and community veterinary clinics in underserved populations is a strategy to improve companion-animal health through preventative care, spay/neuter, and other low-price care programs and services. Little research has documented the structure and effectiveness of such initiatives. This systematic review aimed to assess current published research pertaining to accessible health care, community-based veterinary medicine, and the use of community medicine in teaching programs. The review was an in-depth literature search identifying 51 publications relevant to the importance, benefits, drawbacks, and use of low-price and community clinics in underserved communities. These articles identified commonly discussed barriers to care that may prevent underserved clientele from seeking veterinary care. Five barriers were identified including the cost of veterinary care, accessibility of care, problems with or lack of veterinarian-client communication, culture/language, and lack of client education. The review also identified a need for additional research regarding evidence of effectiveness and efficiency in community medicine initiatives.

A rapid-screening approach to detect and quantify microplastics based on fluorescent tagging with Nile Red

NASA Astrophysics Data System (ADS)

Maes, Thomas; Jessop, Rebecca; Wellner, Nikolaus; Haupt, Karsten; Mayes, Andrew G.

2017-03-01

A new approach is presented for analysis of microplastics in environmental samples, based on selective fluorescent staining using Nile Red (NR), followed by density-based extraction and filtration. The dye adsorbs onto plastic surfaces and renders them fluorescent when irradiated with blue light. Fluorescence emission is detected using simple photography through an orange filter. Image-analysis allows fluorescent particles to be identified and counted. Magnified images can be recorded and tiled to cover the whole filter area, allowing particles down to a few micrometres to be detected. The solvatochromic nature of Nile Red also offers the possibility of plastic categorisation based on surface polarity characteristics of identified particles. This article details the development of this staining method and its initial cross-validation by comparison with infrared (IR) microscopy. Microplastics of different sizes could be detected and counted in marine sediment samples. The fluorescence staining identified the same particles as those found by scanning a filter area with IR-microscopy.

A rapid-screening approach to detect and quantify microplastics based on fluorescent tagging with Nile Red

PubMed Central

Maes, Thomas; Jessop, Rebecca; Wellner, Nikolaus; Haupt, Karsten; Mayes, Andrew G.

2017-01-01

A new approach is presented for analysis of microplastics in environmental samples, based on selective fluorescent staining using Nile Red (NR), followed by density-based extraction and filtration. The dye adsorbs onto plastic surfaces and renders them fluorescent when irradiated with blue light. Fluorescence emission is detected using simple photography through an orange filter. Image-analysis allows fluorescent particles to be identified and counted. Magnified images can be recorded and tiled to cover the whole filter area, allowing particles down to a few micrometres to be detected. The solvatochromic nature of Nile Red also offers the possibility of plastic categorisation based on surface polarity characteristics of identified particles. This article details the development of this staining method and its initial cross-validation by comparison with infrared (IR) microscopy. Microplastics of different sizes could be detected and counted in marine sediment samples. The fluorescence staining identified the same particles as those found by scanning a filter area with IR-microscopy. PMID:28300146

Healthcare costs among adults with type 2 diabetes initiating saxagliptin or linagliptin: a US-based claims analysis.

PubMed

Kong, Amanda M; Farahbakhshian, Sepehr; Pendergraft, Trudy; Brouillette, Matthew A; Mukherjee, Biswarup; Smith, David M; Sheehan, John J

2017-10-01

To compare healthcare costs of adults with type 2 diabetes (T2D) after initiation of saxagliptin or linagliptin, two antidiabetic medications in the dipeptidyl peptidase-4 inhibitor medication class. Patients with T2D who were at least 18 years old and initiated saxagliptin or linagliptin (index date) between 1 June 2011 and 30 June 2014 were identified in the MarketScan Commercial and Medicare Supplemental Databases. All-cause healthcare costs and diabetes-related costs (T2D diagnosis on a medical claim and/or an antidiabetic medication claim) were measured in the 1 year follow-up period. Saxagliptin and linagliptin initiators were matched using propensity score methods. Cost ratios (CRs) and predicted costs were estimated from generalized linear models and recycled predictions. There were 34,560 saxagliptin initiators and 18,175 linagliptin initiators identified (mean ages 57 and 59; 55% and 56% male, respectively). Before matching, saxagliptin initiators had significantly lower all-cause total healthcare costs than linagliptin initiators (mean = $15,335 [SD $28,923] vs. mean = $20,069 [SD $48,541], p < .001) and significantly lower diabetes-related total healthcare costs (mean = $6109 [SD $13,851] vs. mean = $7393 [SD $26,041], p < .001). In matched analyses (n = 16,069 per cohort), saxagliptin initiators had lower all-cause follow-up costs than linagliptin initiators (CR = 0.953, 95% CI = 0.932-0.974, p < .001; predicted costs = $17,211 vs. $18,068). There was no significant difference in diabetes-related total costs after matching; however, diabetes-related medical costs were significantly lower for saxagliptin initiators (CR = 0.959, 95% CI = 0.927-0.993, p = 0.017; predicted costs = $3989 vs. $4159). Adult patients with T2D initiating treatment with saxagliptin had lower total all-cause healthcare costs and diabetes-related medical costs over 1 year compared with patients initiating treatment with linagliptin.

Initial Results of Multigene Panel Testing for Hereditary Breast and Ovarian Cancer and Lynch Syndrome.

PubMed

Howarth, Dt R; Lum, Sharon S; Esquivel, Pamela; Garberoglio, Carlos A; Senthil, Maheswari; Solomon, Naveenraj L

2015-10-01

Multigene panel testing for hereditary cancer risk has recently become commercially available; however, the impact of its use on patient care is undefined. We sought to evaluate results from implementation of panel testing in a multidisciplinary cancer center. We performed a retrospective review of consecutive patients undergoing genetic testing after initiating use of multigene panel testing at Loma Linda University Medical Center. From February 13 to August 25, 2014, 92 patients were referred for genetic testing based on National Comprehensive Cancer Network guidelines. Testing was completed in 90 patients. Overall, nine (10%) pathogenic mutations were identified: five BRCA1/2, and four in non-BRCA loci. Single-site testing identified one BRCA1 and one BRCA2 mutation. The remaining mutations were identified by use of panel testing for hereditary breast and ovarian cancer. There were 40 variants of uncertain significance identified in 34 patients. The use of panel testing more than doubled the identification rate of clinically significant pathogenic mutations that would have been missed with BRCA testing alone. The large number of variants of uncertain significance identified will require long-term follow-up for potential reclassification. Multigene panel testing provides additional information that may improve patient outcomes.

Use of activity theory-based need finding for biomedical device development.

PubMed

Rismani, Shalaleh; Ratto, Matt; Machiel Van der Loos, H F

2016-08-01

Identifying the appropriate needs for biomedical device design is challenging, especially for less structured environments. The paper proposes an alternate need-finding method based on Cultural Historical Activity Theory and expanded to explicitly examine the role of devices within a socioeconomic system. This is compared to a conventional need-finding technique in a preliminary study with engineering student teams. The initial results show that the Activity Theory-based technique allows teams to gain deeper insights into their needs space.

Prostate specific antigen velocity as a measure of the natural history of prostate cancer: defining a 'rapid riser' subset.

PubMed

Nam, R K; Klotz, L H; Jewett, M A; Danjoux, C; Trachtenberg, J

1998-01-01

To study the rate of change in prostate specific antigen (PSA velocity) in patients with prostate cancer initially managed by 'watchful waiting'. Serial PSA levels were determined in 141 patients with prostate cancer confirmed by biopsy, who were initially managed expectantly and enrolled between May 1990 and December 1995. Sixty-seven patients eventually underwent surgery (mean age 59 years) because they chose it (the decision for surgery was not based on PSA velocity). A cohort of 74 patients remained on 'watchful waiting' (mean age 69 years). Linear regression and logarithmic transformations were used to segregate those patients who showed a rapid rise, defined as a > 50% rise in PSA per year (or a doubling time of < 2 years) and designated 'rapid risers'. An initial analysis based on a minimum of two PSA values showed that 31% were rapid risers. Only 15% of patients with more than three serial PSA determinations over > or = 6 months showed a rapid rise in PSA level. There was no advantage of log-linear analysis over linear regression models. Three serial PSA determinations over > or = 6 months in patients with clinically localized prostate cancer identifies a subset (15%) of patients with a rapidly rising PSA level. Shorter PSA surveillance with fewer PSA values may falsely identify patients with rapid rises in PSA level. However, further follow-up is required to determine if a rapid rise in PSA level identifies a subset of patients with an aggressive biological phenotype who are either still curable or who have already progressed to incurability through metastatic disease.

Predictors of initial weight loss among women with abdominal obesity: a path model using self-efficacy and health-promoting behaviour.

PubMed

Choo, Jina; Kang, Hyuncheol

2015-05-01

To identify predictors of initial weight loss among women with abdominal obesity by using a path model. Successful weight loss in the initial stages of long-term weight management may promote weight loss maintenance. A longitudinal study design. Study participants were 75 women with abdominal obesity, who were enrolled in a 12-month Community-based Heart and Weight Management Trial and followed until a 6-month assessment. The Weight Efficacy Lifestyle, Exercise Self-Efficacy and Health Promoting Lifestyle Profile-II measured diet self-efficacy, exercise self-efficacy and health-promoting behaviour respectively. All endogenous and exogenous variables used in our path model were change variables from baseline to 6 months. Data were collected between May 2011-May 2012. Based on the path model, increases in both diet and exercise self-efficacy had significant effects on increases in health-promoting behaviour. Increases in diet self-efficacy had a significant indirect effect on initial weight loss via increases in health-promoting behaviour. Increases in health-promoting behaviour had a significant effect on initial weight loss. Among women with abdominal obesity, increased diet self-efficacy and health-promoting behaviour were predictors of initial weight loss. A mechanism by which increased diet self-efficacy predicts initial weight loss may be partially attributable to health-promoting behavioural change. However, more work is still needed to verify causality. Based on the current findings, intensive nursing strategies for increasing self-efficacy for weight control and health-promoting behaviour may be essential components for better weight loss in the initial stage of a weight management intervention. © 2015 John Wiley & Sons Ltd.

Data visualization methods, data visualization devices, data visualization apparatuses, and articles of manufacture

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

Turner, Alan E.; Crow, Vernon L.; Payne, Deborah A.

Data visualization methods, data visualization devices, data visualization apparatuses, and articles of manufacture are described according to some aspects. In one aspect, a data visualization method includes accessing a plurality of initial documents at a first moment in time, first processing the initial documents providing processed initial documents, first identifying a plurality of first associations of the initial documents using the processed initial documents, generating a first visualization depicting the first associations, accessing a plurality of additional documents at a second moment in time after the first moment in time, second processing the additional documents providing processed additional documents, secondmore » identifying a plurality of second associations of the additional documents and at least some of the initial documents, wherein the second identifying comprises identifying using the processed initial documents and the processed additional documents, and generating a second visualization depicting the second associations.« less

Validity of Administrative Data in Identifying Cancer-related Events in Adolescents and Young Adults: A Population-based Study Using the IMPACT Cohort.

PubMed

Gupta, Sumit; Nathan, Paul C; Baxter, Nancy N; Lau, Cindy; Daly, Corinne; Pole, Jason D

2018-06-01

Despite the importance of estimating population level cancer outcomes, most registries do not collect critical events such as relapse. Attempts to use health administrative data to identify these events have focused on older adults and have been mostly unsuccessful. We developed and tested administrative data-based algorithms in a population-based cohort of adolescents and young adults with cancer. We identified all Ontario adolescents and young adults 15-21 years old diagnosed with leukemia, lymphoma, sarcoma, or testicular cancer between 1992-2012. Chart abstraction determined the end of initial treatment (EOIT) date and subsequent cancer-related events (progression, relapse, second cancer). Linkage to population-based administrative databases identified fee and procedure codes indicating cancer treatment or palliative care. Algorithms determining EOIT based on a time interval free of treatment-associated codes, and new cancer-related events based on billing codes, were compared with chart-abstracted data. The cohort comprised 1404 patients. Time periods free of treatment-associated codes did not validly identify EOIT dates; using subsequent codes to identify new cancer events was thus associated with low sensitivity (56.2%). However, using administrative data codes that occurred after the EOIT date based on chart abstraction, the first cancer-related event was identified with excellent validity (sensitivity, 87.0%; specificity, 93.3%; positive predictive value, 81.5%; negative predictive value, 95.5%). Although administrative data alone did not validly identify cancer-related events, administrative data in combination with chart collected EOIT dates was associated with excellent validity. The collection of EOIT dates by cancer registries would significantly expand the potential of administrative data linkage to assess cancer outcomes.

NMR screening in fragment-based drug design: a practical guide.

PubMed

Kim, Hai-Young; Wyss, Daniel F

2015-01-01

Fragment-based drug design (FBDD) comprises both fragment-based screening (FBS) to find hits and elaboration of these hits to lead compounds. Typical fragment hits have lower molecular weight (<300-350 Da) and lower initial potency but higher ligand efficiency when compared to those from high-throughput screening. NMR spectroscopy has been widely used for FBDD since it identifies and localizes the binding site of weakly interacting hits on the target protein. Here we describe ligand-based NMR methods for hit identification from fragment libraries and for functional cross-validation of primary hits.

76 FR 53934 - Delegation of Authority for the Center for Faith-Based and Neighborhood Partnerships

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-30

...Through this notice, the Secretary delegates to the Director, Center for Faith-Based and Neighborhood Partnerships, authority and responsibility for the direction of HUD's faith-based initiatives specifically relating to coordination with secular and faith-based nonprofit organizations seeking to partner with HUD, the provision of resources to those organizations, and the establishment of relationships between HUD and outside partners, practitioners, and organizations from the nonprofit and faith communities to more effectively identify and meet the needs of some of the Nation's most vulnerable citizens.

Rapid identification of Keap1-Nrf2 small-molecule inhibitors through structure-based virtual screening and hit-based substructure search.

PubMed

Zhuang, Chunlin; Narayanapillai, Sreekanth; Zhang, Wannian; Sham, Yuk Yin; Xing, Chengguo

2014-02-13

In this study, rapid structure-based virtual screening and hit-based substructure search were utilized to identify small molecules that disrupt the interaction of Keap1-Nrf2. Special emphasis was placed toward maximizing the exploration of chemical diversity of the initial hits while economically establishing informative structure-activity relationship (SAR) of novel scaffolds. Our most potent noncovalent inhibitor exhibits three times improved cellular activation in Nrf2 activation than the most active noncovalent Keap1 inhibitor known to date.

Getting right to the point: identifying Australian outpatients' priorities and preferences for patient-centred quality improvement in chronic disease care.

PubMed

Fradgley, Elizabeth A; Paul, Christine L; Bryant, Jamie; Oldmeadow, Christopher

2016-09-01

To identify specific actions for patient-centred quality improvement in chronic disease outpatient settings, this study identified patients' general and specific preferences among a comprehensive suite of initiatives for change. A cross-sectional survey was conducted in three hospital-based clinics specializing in oncology, neurology and cardiology care located in New South Wales, Australia. Adult English-speaking outpatients completed the touch-screen Consumer Preferences Survey in waiting rooms or treatment areas. Participants selected up to 23 general initiatives that would improve their experience. Using adaptive branching, participants could select an additional 110 detailed initiatives and complete a relative prioritization exercise. A total of 541 individuals completed the survey (71.1% consent, 73.1% completion). Commonly selected general initiatives, presented in order of decreasing priority (along with sample proportion), included: improved parking (60.3%), up-to-date information provision (15.0%), ease of clinic contact (12.9%), access to information at home (12.8%), convenient appointment scheduling (14.2%), reduced wait-times (19.8%) and information on medical emergencies (11.1%). To address these general initiatives, 40 detailed initiatives were selected by respondents. Initiatives targeting service accessibility and information provision, such as parking and up-to-date information on patient prognoses and progress, were commonly selected and perceived to be of relatively greater priority. Specific preferences included the need for clinics to provide patient-designated parking in close proximity to the clinic, information on treatment progress and test results (potentially in the form of designated brief appointments or via telehealth) and comprehensive and trustworthy lists of information sources to access at home. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Educating men about prostate cancer in the workplace.

PubMed

Ilic, Dragan

2013-07-01

Prostate cancer is a common cancer affecting men worldwide. Few men access health services with respect to early detection. Workplace health education initiatives can promote behavior change in men. A total of 12 in-depth interviews with men were conducted in this study to examine how a workplace-based educational campaign on prostate cancer influences the knowledge, awareness, and beliefs of male workers on screening for prostate cancer. Analyses of interview transcripts identified that men had a poor overall knowledge about prostate cancer, its screening, and treatment. Participants were receptive to the introduction of workplace-based health education initiatives to promote men's health issues but recommended an integrated health approach that incorporated information delivered by medical professionals, cancer survivors, supplemented with existing patient education materials. Further research is required to formally evaluate the impact of workplace-based education strategies on men's health.

Automated Identification of the Heart Wall Throughout the Entire Cardiac Cycle Using Optimal Cardiac Phase for Extracted Features

NASA Astrophysics Data System (ADS)

Takahashi, Hiroki; Hasegawa, Hideyuki; Kanai, Hiroshi

2011-07-01

In most methods for evaluation of cardiac function based on echocardiography, the heart wall is currently identified manually by an operator. However, this task is very time-consuming and suffers from inter- and intraobserver variability. The present paper proposes a method that uses multiple features of ultrasonic echo signals for automated identification of the heart wall region throughout an entire cardiac cycle. In addition, the optimal cardiac phase to select a frame of interest, i.e., the frame for the initiation of tracking, was determined. The heart wall region at the frame of interest in this cardiac phase was identified by the expectation-maximization (EM) algorithm, and heart wall regions in the following frames were identified by tracking each point classified in the initial frame as the heart wall region using the phased tracking method. The results for two subjects indicate the feasibility of the proposed method in the longitudinal axis view of the heart.

Classifying epileptic EEG signals with delay permutation entropy and Multi-Scale K-means.

PubMed

Zhu, Guohun; Li, Yan; Wen, Peng Paul; Wang, Shuaifang

2015-01-01

Most epileptic EEG classification algorithms are supervised and require large training datasets, that hinder their use in real time applications. This chapter proposes an unsupervised Multi-Scale K-means (MSK-means) MSK-means algorithm to distinguish epileptic EEG signals and identify epileptic zones. The random initialization of the K-means algorithm can lead to wrong clusters. Based on the characteristics of EEGs, the MSK-means MSK-means algorithm initializes the coarse-scale centroid of a cluster with a suitable scale factor. In this chapter, the MSK-means algorithm is proved theoretically superior to the K-means algorithm on efficiency. In addition, three classifiers: the K-means, MSK-means MSK-means and support vector machine (SVM), are used to identify seizure and localize epileptogenic zone using delay permutation entropy features. The experimental results demonstrate that identifying seizure with the MSK-means algorithm and delay permutation entropy achieves 4. 7 % higher accuracy than that of K-means, and 0. 7 % higher accuracy than that of the SVM.

Public health adaptation to climate change in Canadian jurisdictions.

PubMed

Austin, Stephanie E; Ford, James D; Berrang-Ford, Lea; Araos, Malcolm; Parker, Stephen; Fleury, Manon D

2015-01-12

Climate change poses numerous risks to the health of Canadians. Extreme weather events, poor air quality, and food insecurity in northern regions are likely to increase along with the increasing incidence and range of infectious diseases. In this study we identify and characterize Canadian federal, provincial, territorial and municipal adaptation to these health risks based on publically available information. Federal health adaptation initiatives emphasize capacity building and gathering information to address general health, infectious disease and heat-related risks. Provincial and territorial adaptation is varied. Quebec is a leader in climate change adaptation, having a notably higher number of adaptation initiatives reported, addressing almost all risks posed by climate change in the province, and having implemented various adaptation types. Meanwhile, all other Canadian provinces and territories are in the early stages of health adaptation. Based on publically available information, reported adaptation also varies greatly by municipality. The six sampled Canadian regional health authorities (or equivalent) are not reporting any adaptation initiatives. We also find little relationship between the number of initiatives reported in the six sampled municipalities and their provinces, suggesting that municipalities are adapting (or not adapting) autonomously.

MONOMIALS AND BASIN CYLINDERS FOR NETWORK DYNAMICS.

PubMed

Austin, Daniel; Dinwoodie, Ian H

We describe methods to identify cylinder sets inside a basin of attraction for Boolean dynamics of biological networks. Such sets are used for designing regulatory interventions that make the system evolve towards a chosen attractor, for example initiating apoptosis in a cancer cell. We describe two algebraic methods for identifying cylinders inside a basin of attraction, one based on the Groebner fan that finds monomials that define cylinders and the other on primary decomposition. Both methods are applied to current examples of gene networks.

MONOMIALS AND BASIN CYLINDERS FOR NETWORK DYNAMICS

PubMed Central

AUSTIN, DANIEL; DINWOODIE, IAN H

2014-01-01

We describe methods to identify cylinder sets inside a basin of attraction for Boolean dynamics of biological networks. Such sets are used for designing regulatory interventions that make the system evolve towards a chosen attractor, for example initiating apoptosis in a cancer cell. We describe two algebraic methods for identifying cylinders inside a basin of attraction, one based on the Groebner fan that finds monomials that define cylinders and the other on primary decomposition. Both methods are applied to current examples of gene networks. PMID:25620893

Characterization of potential driver mutations involved in human breast cancer by computational approaches

PubMed Central

Rajendran, Barani Kumar; Deng, Chu-Xia

2017-01-01

Breast cancer is the second most frequently occurring form of cancer and is also the second most lethal cancer in women worldwide. A genetic mutation is one of the key factors that alter multiple cellular regulatory pathways and drive breast cancer initiation and progression yet nature of these cancer drivers remains elusive. In this article, we have reviewed various computational perspectives and algorithms for exploring breast cancer driver mutation genes. Using both frequency based and mutational exclusivity based approaches, we identified 195 driver genes and shortlisted 63 of them as candidate drivers for breast cancer using various computational approaches. Finally, we conducted network and pathway analysis to explore their functions in breast tumorigenesis including tumor initiation, progression, and metastasis. PMID:28477017

Late initiation of combination antiretroviral therapy in Canada: a call for a national public health strategy to improve engagement in HIV care

PubMed Central

Cescon, Angela; Patterson, Sophie; Davey, Colin; Ding, Erin; Raboud, Janet M; Chan, Keith; Loutfy, Mona R; Cooper, Curtis; Burchell, Ann N; Palmer, Alexis K; Tsoukas, Christos; Machouf, Nima; Klein, Marina B; Rourke, Sean B; Rachlis, Anita; Hogg, Robert S; Montaner, Julio SG

2015-01-01

Introduction Combination antiretroviral therapy (ART) significantly decreases morbidity, mortality and HIV transmission. We aimed to characterize the timing of ART initiation based on CD4 cell count from 2000 to 2012 and identify factors associated with late initiation of treatment. Methods Participants from the Canadian Observational Cohort (CANOC), a multi-site cohort of HIV-positive adults initiating ART naively after 1 January 2000, in three Canadian provinces (British Columbia, Ontario and Québec) were included. Late initiation was defined as a CD4 count <200 cells/mm3 or an AIDS-defining illness before ART initiation (baseline). Temporal trends were assessed using the Cochran–Armitage test, and independent correlates of late initiation were identified using logistic regression. Results In total, 8942 participants (18% female) of median age 40 years (Q1–Q3 33–47) were included. The median baseline CD4 count increased from 190 cells/mm3 (Q1–Q3 80–320) in 2000 to 360 cells/mm3 (Q1–Q3 220–490) in 2012 (p<0.001). Overall, 4274 participants (48%) initiated ART with a CD4 count <200 cells/mm3 or AIDS-defining illness. Late initiation was more common among women, non-MSM, older individuals, participants from Ontario and BC (vs. Québec), persons with injection drug use (IDU) history and individuals starting ART in earlier calendar years. In sub-analysis exploring recent (2008 to 2012) predictors using an updated CD4 criterion (<350 cells/mm3), IDU and residence in BC (vs. Québec) were no longer significant correlates of late initiation. Conclusions This analysis documents increasing baseline CD4 counts over time among Canadians initiating ART. However, CD4 counts at ART initiation remain below contemporary treatment guidelines, highlighting the need for strategies to improve earlier engagement in HIV care. PMID:26443752

Late initiation of combination antiretroviral therapy in Canada: a call for a national public health strategy to improve engagement in HIV care.

PubMed

Cescon, Angela; Patterson, Sophie; Davey, Colin; Ding, Erin; Raboud, Janet M; Chan, Keith; Loutfy, Mona R; Cooper, Curtis; Burchell, Ann N; Palmer, Alexis K; Tsoukas, Christos; Machouf, Nima; Klein, Marina B; Rourke, Sean B; Rachlis, Anita; Hogg, Robert S; Montaner, Julio S G

2015-01-01

Combination antiretroviral therapy (ART) significantly decreases morbidity, mortality and HIV transmission. We aimed to characterize the timing of ART initiation based on CD4 cell count from 2000 to 2012 and identify factors associated with late initiation of treatment. Participants from the Canadian Observational Cohort (CANOC), a multi-site cohort of HIV-positive adults initiating ART naively after 1 January 2000, in three Canadian provinces (British Columbia, Ontario and Québec) were included. Late initiation was defined as a CD4 count <200 cells/mm(3) or an AIDS-defining illness before ART initiation (baseline). Temporal trends were assessed using the Cochran-Armitage test, and independent correlates of late initiation were identified using logistic regression. In total, 8942 participants (18% female) of median age 40 years (Q1-Q3 33-47) were included. The median baseline CD4 count increased from 190 cells/mm(3) (Q1-Q3 80-320) in 2000 to 360 cells/mm(3) (Q1-Q3 220-490) in 2012 (p<0.001). Overall, 4274 participants (48%) initiated ART with a CD4 count <200 cells/mm(3) or AIDS-defining illness. Late initiation was more common among women, non-MSM, older individuals, participants from Ontario and BC (vs. Québec), persons with injection drug use (IDU) history and individuals starting ART in earlier calendar years. In sub-analysis exploring recent (2008 to 2012) predictors using an updated CD4 criterion (<350 cells/mm(3)), IDU and residence in BC (vs. Québec) were no longer significant correlates of late initiation. This analysis documents increasing baseline CD4 counts over time among Canadians initiating ART. However, CD4 counts at ART initiation remain below contemporary treatment guidelines, highlighting the need for strategies to improve earlier engagement in HIV care.

How we used a patient visit tracker tool to advance experiential learning in systems-based practice and quality improvement in a medical student clinic.

PubMed

Chen, Chen Amy; Park, Ryan J; Hegde, John V; Jun, Tomi; Christman, Mitalee P; Yoo, Sun M; Yamasaki, Alisa; Berhanu, Aaron; Vohra-Khullar, Pamela; Remus, Kristin; Schwartzstein, Richard M; Weinstein, Amy R

2016-01-01

Poorly designed healthcare systems increase costs and preventable medical errors. To address these issues, systems-based practice (SBP) education provides future physicians with the tools to identify systemic errors and implement quality improvement (QI) initiatives to enhance the delivery of cost-effective, safe and multi-disciplinary care. Although SBP education is being implemented in residency programs and is mandated by the Accreditation Council for Graduate Medical Education (ACGME) as one of its core competencies, it has largely not been integrated into undergraduate medical education. We propose that Medical Student-Faculty Collaborative Clinics (MSFCCs) may be the ideal environment in which to train medical students in SBPs and QI initiatives, as they allow students to play pivotal roles in project development, administration, and management. Here we describe a process of experiential learning that was developed within a newly established MSFCC, which challenged students to identify inefficiencies, implement interventions, and track the results. After identifying bottlenecks in clinic operations, our students designed a patient visit tracker tool to monitor clinic flow and implemented solutions to decrease patient visit times. Our model allowed students to drive their own active learning in a practical clinical setting, providing early and unique training in crucial QI skills.

Incidence and risk factors of severe adverse events with nevirapine-based antiretroviral therapy in HIV-infected women. MTCT-Plus program, Abidjan, Côte d'Ivoire

PubMed Central

2010-01-01

Background In resource-limited settings where nevirapine-containing regimen is the preferred regimen in women, data on severe adverse events (SAEs) according to CD4 cell count are limited. We estimated the incidence of SAEs according to CD4 cell count and identify their risk factors in nevirapine-treated women. Methods All HIV-infected women who initiated nevirapine-containing regimen in the MTCT-Plus operational program in Abidjan, Côte d'Ivoire, were eligible for this study. Laboratory and clinical (rash) SAEs were classified as grade 3 and 4. Cox models were used to identify factors associated with the occurrence of SAEs. Results From August 2003 to October 2006, 290 women initiated a nevirapine-containing regimen at a median CD4 cell count of 186 cells/mm3 (IQR 124-266). During a median follow-up on treatment of 25 months, the incidence of all SAEs was 19.5/100 patient-years. The 24-month probability of occurrence of hepatotoxicity or rash was not different between women with a CD4 cell count >250 cells/mm3 and women with a CD4 cell count ≤250 cells/mm3 (8.3% vs. 9.9%, Log-rank test: p = 0.75). In a multivariate proportional hazard model, neither CD4 cell count >250 cells/mm3 at treatment initiation nor initiation NVP-based regimen initiated during pregnancy were associated with the occurrence of SAEs. Conclusion CD4 cell count >250 cells/mm3 was not associated with a higher risk of severe hepatotoxicity and/or rash, as well as initiation of ART during pregnancy. Pharmacovogilance data as well as meta-analysis on women receiving NVP in these settings are needed for better information about NVP toxicity. PMID:20576111

The relationship among learning, health beliefs, alcohol consumption, and tobacco use of primigravidas.

PubMed

Strychar, I M; Griffith, W S; Conry, R F

1990-01-01

The purposes of this study were to identify how pregnant women learned about alcohol consumption and tobacco use, and to identify the relationship between learning, health beliefs and behaviours. Determining how pregnant women learned was based upon Tough's and Knowles' view of learning and consisted of identifying knowledge levels, resources utilized, advice given, time in learning, and initiators of learning episodes. The ex post facto research design involved one-hour interviews with 128 primigravidas at 8 hospitals in British Columbia, 75% of the sample consumed alcoholic beverages before becoming pregnant and these women reduced their intake by an average of 82%; 39% smoked cigarettes before becoming pregnant and these women reduced their cigarette smoking by an average of 52%. Drinkers were advised not to consume alcoholic beverages during pregnancy, whereas smokers were told by friends and family members that it was okay to smoke during pregnancy. Engagement in other-initiated learning episodes was found to be correlated with reduced alcohol intake (p less than or equal to .05); whereas, health beliefs were not correlated with reduced alcohol intake. Neither self-initiated nor other-initiated learning was associated with reduced cigarette smoking; however, perceived risk was associated with reduced cigarette smoking. Knowledge about smoking was associated with health beliefs, suggesting that learning may be indirectly related to smoking behaviours. This study should be replicated with a larger sample to determine the directionality of the association between learning, beliefs and behaviours.

An update on sORFs.org: a repository of small ORFs identified by ribosome profiling.

PubMed

Olexiouk, Volodimir; Van Criekinge, Wim; Menschaert, Gerben

2018-01-04

sORFs.org (http://www.sorfs.org) is a public repository of small open reading frames (sORFs) identified by ribosome profiling (RIBO-seq). This update elaborates on the major improvements implemented since its initial release. sORFs.org now additionally supports three more species (zebrafish, rat and Caenorhabditis elegans) and currently includes 78 RIBO-seq datasets, a vast increase compared to the three that were processed in the initial release. Therefore, a novel pipeline was constructed that also enables sORF detection in RIBO-seq datasets comprising solely elongating RIBO-seq data while previously, matching initiating RIBO-seq data was necessary to delineate the sORFs. Furthermore, a novel noise filtering algorithm was designed, able to distinguish sORFs with true ribosomal activity from simulated noise, consequently reducing the false positive identification rate. The inclusion of other species also led to the development of an inner BLAST pipeline, assessing sequence similarity between sORFs in the repository. Building on the proof of concept model in the initial release of sORFs.org, a full PRIDE-ReSpin pipeline was now released, reprocessing publicly available MS-based proteomics PRIDE datasets, reporting on true translation events. Next to reporting those identified peptides, sORFs.org allows visual inspection of the annotated spectra within the Lorikeet MS/MS viewer, thus enabling detailed manual inspection and interpretation. © The Author(s) 2017. Published by Oxford University Press on behalf of Nucleic Acids Research.

Confirming the timing of phase-based costing in oncology studies: a case example in advanced melanoma.

PubMed

Atkins, Michael; Coutinho, Anna D; Nunna, Sasikiran; Gupte-Singh, Komal; Eaddy, Michael

2018-02-01

The utilization of healthcare services and costs among patients with cancer is often estimated by the phase of care: initial, interim, or terminal. Although their durations are often set arbitrarily, we sought to establish data-driven phases of care using joinpoint regression in an advanced melanoma population as a case example. A retrospective claims database study was conducted to assess the costs of advanced melanoma from distant metastasis diagnosis to death during January 2010-September 2014. Joinpoint regression analysis was applied to identify the best-fitting points, where statistically significant changes in the trend of average monthly costs occurred. To identify the initial phase, average monthly costs were modeled from metastasis diagnosis to death; and were modeled backward from death to metastasis diagnosis for the terminal phase. Points of monthly cost trend inflection denoted ending and starting points. The months between represented the interim phase. A total of 1,671 patients with advanced melanoma who died met the eligibility criteria. Initial phase was identified as the 5-month period starting with diagnosis of metastasis, after which there was a sharp, significant decline in monthly cost trend (monthly percent change [MPC] = -13.0%; 95% CI = -16.9% to -8.8%). Terminal phase was defined as the 5-month period before death (MPC = -14.0%; 95% CI = -17.6% to -10.2%). The claims-based algorithm may under-estimate patients due to misclassifications, and may over-estimate terminal phase costs because hospital and emergency visits were used as a death proxy. Also, recently approved therapies were not included, which may under-estimate advanced melanoma costs. In this advanced melanoma population, optimal duration of the initial and terminal phases of care was 5 months immediately after diagnosis of metastasis and before death, respectively. Joinpoint regression can be used to provide data-supported phase of cancer care durations, but should be combined with clinical judgement.

Interprofessional Care and Teamwork in the ICU.

PubMed

Donovan, Anne L; Aldrich, J Matthew; Gross, A Kendall; Barchas, Denise M; Thornton, Kevin C; Schell-Chaple, Hildy M; Gropper, Michael A; Lipshutz, Angela K M

2018-06-01

We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. Original articles, review articles, and systematic reviews were considered. Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care. A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.

A Risk and Maintenance Model for Bulimia Nervosa: From Impulsive Action to Compulsive Behavior

PubMed Central

Pearson, Carolyn M.; Wonderlich, Stephen A.; Smith, Gregory T.

2015-01-01

This paper offers a new model for bulimia nervosa (BN) that explains both the initial impulsive nature of binge eating and purging as well as the compulsive quality of the fully developed disorder. The model is based on a review of advances in research on BN and advances in relevant basic psychological science. It integrates transdiagnostic personality risk, eating disorder specific risk, reinforcement theory, cognitive neuroscience, and theory drawn from the drug addiction literature. We identify both a state-based and a trait-based risk pathway, and we then propose possible state-by-trait interaction risk processes. The state-based pathway emphasizes depletion of self-control. The trait-based pathway emphasizes transactions between the trait of negative urgency (the tendency to act rashly when distressed) and high-risk psychosocial learning. We then describe a process by which initially impulsive BN behaviors become compulsive over time, and we consider the clinical implications of our model. PMID:25961467

Initial apixaban dosing in patients with atrial fibrillation.

PubMed

Buchholz, Alexander; Ueberham, Laura; Gorczynska, Kaja; Dinov, Borislav; Hilbert, Sebastian; Dagres, Nikolaos; Husser, Daniela; Hindricks, Gerhard; Bollmann, Andreas

2018-05-01

Apixaban is a non-vitamin K oral anticoagulant approved for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF). Current labeling recommends dose reduction based on patient age, weight, and renal function. The aim of this study was to analyze adherence to current labeling instructions concerning initial apixaban dosing in clinical practice and identify factors associated with inappropriate dose reduction. Patients with AF initiated on apixaban in 2016 were identified in the Heart Center Leipzig database. Records were screened to identify patient characteristics, prescribed apixaban dose, renal function, and further dosing-relevant secondary diagnoses and co-medication. We identified 569 consecutive patients with AF initiated on apixaban. In 301 (52.9%) patients, apixaban was prescribed in standard dose (5 mg b.i.d.) and in 268 (47.1%) in a reduced dose (2.5 mg b.i.d.). Of 268 patients receiving a reduced dose, 163 (60.8%) did not meet labeling criteria for dose reduction. In univariate and multivariate regression analysis, age (OR: 0.736, 95% CI: 0.664-0.816, P < 0.0001), patient weight (OR: 1.120, 95% CI: 1.076-1.166, P < 0.0001), and serum creatinine level (OR: 0.910, 95% CI: 0.881-0.940, P < 0.0001) were independent predictors for apixaban underdosage. In clinical practice, apixaban dosing is frequently inconsistent with labeling. Factors associated with inappropriate dose reduction are age, patient weight, and serum creatinine level, the same factors used as criteria for dose adjustment. However, in underdosed patients, the 3 factors did not meet the criteria for dose reduction. © 2018 Wiley Periodicals, Inc.

Neural Correlates of Individual Differences in Infant Visual Attention and Recognition Memory

ERIC Educational Resources Information Center

Reynolds, Greg D.; Guy, Maggie W.; Zhang, Dantong

2011-01-01

Past studies have identified individual differences in infant visual attention based upon peak look duration during initial exposure to a stimulus. Colombo and colleagues found that infants that demonstrate brief visual fixations (i.e., short lookers) during familiarization are more likely to demonstrate evidence of recognition memory during…

A disciplined approach to capital: today's healthcare imperative.

PubMed

Dupuis, Patrick J; Kaufman, Kenneth

2007-07-01

BJC HealthCare's experience exemplifies several basic principles of a finance-based approach to capital. Organizations that adopt this approach look to improve processes first, remove costs second, and spend capital last. Multiyear planning is required to quantitatively identify the profitability and liquidity requirements of strategic initiatives and address essential funding and financing issues.

Cognitive Development of Social Justice through Re-Designed Courses and Community-Based Partnerships: An Initial Investigation

ERIC Educational Resources Information Center

Lee, Robert E.; Creasey, Gary; Showalter, Brent D.; D'Santiago, Verenice

2010-01-01

Identifying (and assessing) the mechanisms responsible for promoting social justice awareness represent a process that could be illuminated via theory building. To illustrate, integrated theories of moral reasoning and prosocial development stipulate that ultimate altruistic/benevolent intentions and behaviors are preceded by cognitive and…

Identifying Research Priorities for School Improvement in the Developing World

ERIC Educational Resources Information Center

Read, Robyn; Fernandez-Hermosilla, Magdalena; Anderson, Stephen; Mundy, Karen

2016-01-01

This paper discusses a research agenda setting project conducted for an international non-governmental organization which aims to help create a regionally relevant, high-quality knowledge base on key education issues of policy and practice. Specifically, we illustrate how our team adapted the Child Health and Nutrition Research Initiative (CHRNI)…

Electronic Monitoring of Sex Offenders: Identifying Unanticipated Consequences and Implications

ERIC Educational Resources Information Center

Demichele, Matthew; Payne, Brian K.; Button, Deeanna M.

2008-01-01

In recent years, increased legislative attention has been given to strategies to supervise sex offenders in the community. Among other policies, several states have passed laws calling for the use of electronic monitoring technologies to supervise sex offenders in the community. When initially developed, this community-based sanction was designed…

Forecasting Exposure in Order to Use High Throughput Hazard Data in a Risk-based Context (WC9)

EPA Science Inventory

The ToxCast program and Tox21 consortium have evaluated over 8000 chemicals using in vitro high-throughput screening (HTS) to identify potential hazards. Complementary exposure science needed to assess risk, and the U.S. Environmental Protection Agency (EPA)’s ExpoCast initiative...

Factors Influencing the Creation of a Wiki Culture for Knowledge Management in a Cross-Generational Organizational Setting

ERIC Educational Resources Information Center

Macro, Kenneth L., Jr.

2011-01-01

Initiatives within organizations that promote sharing of knowledge may be hampered by generational differences. Research on relationships between generations and technology-based knowledge sharing campaigns provides little managerial guidance for practitioners. The purpose of this ethnographic study was to identify the factors that influence the…

Six Stages for Learning To Use Technology.

ERIC Educational Resources Information Center

Russell, Anne L.

Learning to use technology can be traumatic for adults. This study is qualitative and based on personal e-mail diaries written by adult learners. It identifies six stages adults may go through as they learn to use technology to communicate electronically. Initially, 30 teachers studying in a post-graduate university course were involved in a…

Teaching and Program Variations in International Business: Past, Present and Future.

ERIC Educational Resources Information Center

Kaynak, Erdener; Schermerhorn, John R., Jr.

1999-01-01

This introductory article in a theme issue identifies common themes in the included papers, such as the need for more "active learning" and "project-based learning," the use of computer technology to facilitate "virtual teamwork," the importance of support services for these initiatives, and reliance on need-oriented programs and courses in…

How to Improve the Design and Delivery of High-Quality Technical Assistance. Newsletter

ERIC Educational Resources Information Center

Center for Comprehensive School Reform and Improvement, 2005

2005-01-01

Educators often use the term technical assistance to define services delivered or received in the pursuit of school- and district-improvement initiatives. More specifically, technical assistance can be defined as any assistance that identifies, selects, or designs research-based solutions and practices to support school improvement (Mattson &…

A Korean Language Translation of the Questions about Behavior Function: Initial Psychometric Evaluation

ERIC Educational Resources Information Center

Dixon, Dennis R.; Jang, Jina; Chung, Kyong-Mee; Jung, Woo Hyun; Matson, Johnny L.

2013-01-01

Identifying the function of behavior is crucial in formulating functionally-based treatment programs for people with challenging behaviors. The Questions About Behavior Function (QABF) is a well-established instrument with sound psychometric properties. The present study describes the development process for a Korean version of the QABF. The…

EMI-Sensor Data to Identify Areas of Manure Accumulation on a Feedlot Surface

USDA-ARS?s Scientific Manuscript database

A study was initiated to test the validity of using electromagnetic induction (EMI) survey data, a prediction-based sampling strategy and ordinary linear regression modeling to predict spatially variable feedlot surface manure accumulation. A 30 m × 60 m feedlot pen with a central mound was selecte...

76 FR 55001 - Intent To Prepare an Environmental Impact Statement; Umatilla National Forest, Walla Walla Ranger...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-06

... authorities of the Healthy Forest Restoration Act (HFRA) of 2004. After the initial request for public comment... and treatment of fuels within select Riparian Habitat Conservation Areas (RHCAs). RHCA treatment is... objectives were identified based on the intent of the 2004 Healthy Forest Restoration Act, the Umatilla...

Floristics [Chapter 3

Treesearch

J. D. Haines; R. C. Musselman; C. M. Regan

1994-01-01

The initial habitat classification as described in Chapter 2 was conducted in 1986 and 1987 based upon field identification of plant species. A field collection of vascular plant species was made during the 1988, 1989, and 1990 summer seasons. The plant species collected were identified and verified in cooperation with the Rocky Mountain Herbarium at the University of...

Why Inquiry Is Inherently Difficult...and Some Ways to Make It Easier

ERIC Educational Resources Information Center

Meyer, Daniel Z.; Avery, Leanne M.

2010-01-01

In this article, the authors offer a framework that identifies two critical problems in designing inquiry-based instruction and suggests three models for developing instruction that overcomes those problems. The Protocol Model overcomes the Getting on Board Problem by providing students an initial experience through clearly delineated steps with a…

Attitudes of Pre-Service Mathematics Teachers towards Modelling: A South African Inquiry

ERIC Educational Resources Information Center

Jacobs, Gerrie J.; Durandt, Rina

2017-01-01

This study explores the attitudes of mathematics pre-service teachers, based on their initial exposure to a model-eliciting challenge. The new Curriculum and Assessment Policy Statement determines that mathematics students should be able to identify, investigate and solve problems via modelling. The unpreparedness of mathematics teachers in…

From Essential Learnings to Tasmania's Curriculum: Will this Change Improve Curriculum Reform?

ERIC Educational Resources Information Center

Watt, Michael G.

2007-01-01

The purpose of this paper was to evaluate initiatives the state government announced in 2006 to review the curriculum and assessments, and enhance capacity building and accountability. The methodology for reviewing states' systemic reform policies devised by Achieve, an organisation based in Washington, DC, was applied to identify issues and…

Blended Learning from Design to Evaluation: International Case Studies of Evidence-Based Practice

ERIC Educational Resources Information Center

Vaughan, Norman; Reali, Aline; Stenbom, Stefan; Van Vuuren, Marieta Jansen; MacDonald, David

2017-01-01

This study compares and contrasts four international faculty development programs for blended learning in order to understand the benefits, challenges, lessons learned, and recommendations from such initiatives. The benefits identified for faculty members, who participated in these programs, were that they became more reflective of their teaching…

76 FR 27670 - Wacker Neuson Corporation, a Subsidiary of Wacker Neuson SE. Menomonee Falls, WI; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-12

... identifiable by product line. The initial investigation resulted in an affirmative determination based on the..., a Subsidiary of Wacker Neuson SE. Menomonee Falls, WI; Notice of Termination of Investigation By... the production of articles like or directly competitive with those produced by the workers, and that...

Health effects associated with exposure to ambient air pollution.

PubMed

Samet, Jonathan; Krewski, Daniel

2007-02-01

The World Health Organization has identified ambient air pollution as a high public health priority, based on estimates of air pollution related death and disability-adjusted life years derived in its Global Burden of Disease initiative. The NERAM Colloquium Series on Health and Air Quality was initiated to strengthen the linkage between scientists, policymakers, and other stakeholders by reviewing the current state of science, identifying policy-relevant gaps and uncertainties in the scientific evidence, and proposing a path forward for research and policy to improve air quality and public health. The objective of this paper is to review the current state of science addressing the impacts of air pollution on human health. The paper is one of four background papers prepared for the 2003 NERAM/AirNet Conference on Strategies for Clean Air and Health, the third meeting in the international Colloquium Series. The review is based on the framework and findings of the U.S. National Research Committee (NRC) on Research Priorities for Airborne Particulate Matter and addresses key questions underlying air quality risk management policy decisions.

Development of an HTS-Compatible Assay for Discovery of Melanoma-Related Microphthalmia Transcription Factor Disruptors Using AlphaScreen Technology.

PubMed

Wang, Jing; Fang, Pengfei; Chase, Peter; Tshori, Sagi; Razin, Ehud; Spicer, Timothy P; Scampavia, Louis; Hodder, Peter; Guo, Min

2017-01-01

Microphthalmia transcription factor (MITF) is a master transcription factor expressed in melanocytes, essential for melanocyte survival, differentiation, and pigment formation, and is a key oncogenic factor in melanoma initiation, migration, and treatment resistance. Although identified as an important therapeutic target for melanoma, clinical inhibitors directly targeting the MITF protein are not available. Based on the functional state of MITF, we have designed an MITF dimerization-based AlphaScreen (MIDAS) assay that sensitively and specifically mirrors the dimerization of MITF in vitro. This assay is further exploited for identification of the MITF dimer disruptor for high-throughput screening. A pilot screen against a library of 1280 pharmacologically active compounds indicates that the MIDAS assay performance exhibits exceptional results with a Z' factor of 0.81 and a signal-to-background (S/B) ratio of 3.92 while identifying initial hit compounds that yield an ability to disrupt MITF-DNA interaction. The results presented demonstrate that the MIDAS assay is ready to screen large chemical libraries in order to discover novel modulators of MITF for potential melanoma treatment.

Toward an understanding of global change: Initial priorities for US contributions to the International Geosphere-Biosphere Program

NASA Technical Reports Server (NTRS)

1988-01-01

A limited number of high-priority research initiatives are recommended for early implementation as part of the U.S. contribution to the preparatory phase of the International Geosphere-Biosphere Program. The recommendations are based on the committee's analysis of the most critical gaps in the scientific knowledge needed to understand the changes that are occurring in the earth system not being addressed by existing programs. The report articulates a number of important key issues and interactions that characterize global change in the geosphere-biosphere system on time scales of decades to centuries; identifies the knowledge that is the most urgently needed to improve understanding of those issues and interactions; and formulates initial priorities for initial U.S. contributions to the IGBP, recognizing the contributions of other ongoing and proposed programs.

The development of a network for community-based obesity prevention: the CO-OPS Collaboration

PubMed Central

2011-01-01

Background Community-based interventions are a promising approach and an important component of a comprehensive response to obesity. In this paper we describe the Collaboration of COmmunity-based Obesity Prevention Sites (CO-OPS Collaboration) in Australia as an example of a collaborative network to enhance the quality and quantity of obesity prevention action at the community level. The core aims of the CO-OPS Collaboration are to: identify and analyse the lessons learned from a range of community-based initiatives aimed at tackling obesity, and; to identify the elements that make community-based obesity prevention initiatives successful and share the knowledge gained with other communities. Methods Key activities of the collaboration to date have included the development of a set of Best Practice Principles and knowledge translation and exchange activities to promote the application (or use) of evidence, evaluation and analysis in practice. Results The establishment of the CO-OPS Collaboration is a significant step toward strengthening action in this area, by bringing together research, practice and policy expertise to promote best practice, high quality evaluation and knowledge translation and exchange. Future development of the network should include facilitation of further evidence generation and translation drawing from process, impact and outcome evaluation of existing community-based interventions. Conclusions The lessons presented in this paper may help other networks like CO-OPS as they emerge around the globe. It is important that networks integrate with each other and share the experience of creating these networks. PMID:21349185

Economic burden and cost-effective management of Clostridium difficile infections.

PubMed

Heimann, S M; Cruz Aguilar, M R; Mellinghof, S; Vehreschild, M J G T

2018-02-01

Clostridium difficile infection (CDI) is the most important cause of healthcare-associated infectious diarrhea in industrialized countries. We performed a literature review of the overall economic burden of initial and recurrent CDI as well as of the cost-effectiveness of the various treatment strategies applied in these settings. Even though analysis of health economic data is complicated by the limited comparability of results, our review identified several internationally consistent results. Authors from different countries have shown that recurrent CDI disproportionally contributes to the overall economic burden of CDI and therefore offers considerable saving potential. Subsequent cost-effectiveness analyses almost exclusively identified fidaxomicin as the preferred treatment option for initial CDI and fecal microbiota transplant (FMT) for recurrent CDI. Among the various FMT protocols, optimum results were obtained using early colonoscopy-based FMT. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Graduate capabilities for health service managers: reconfiguring health management education @UNSW.

PubMed

Meyer, Lois D; Hodgkinson, Alan R; Knight, Rosemary; Ho, Maria Theresa; di Corpo, Sophie K; Bhalla, Sonal

2007-08-01

The Master of Health Administration program at UNSW was extensively revised in 2006 to ensure that it effectively meets the challenging and dynamic environment of health service managers in local and global health contexts. This paper describes the innovative approach to the redesign of the health management program within the Faculty of Medicine. It outlines the method and considerations undertaken, particularly in identifying and embedding new graduate capabilities within the program. The paper concludes that using an outcomes-based approach and engaging with key stakeholders provides opportunity to identify and promote critical capabilities needed by managers to support the challenges confronting health services, including workforce flexibility. Further research is required on how such curriculum initiatives might impact on the performance of health service managers, but initial indications are that the health industry recognises the need and value of this approach.

An ongoing six-year innovative osteoporosis disease management program: challenges and success in an IPA physician group environment.

PubMed

Woo, Ann; Hittell, Jodi; Beardsley, Carrie; Noh, Charles; Stoukides, Cheryl A; Kaul, Alan F

2004-01-01

The goal of this ongoing comprehensive osteoporosis disease management initiative is to provide the adult primary care physicians' (PCPs) offices with a program enabling them to systematically identify and manage their population for osteoporosis. For over six years, Hill Physicians Medical Group (Hill Physicians) has implemented multiple strategies to develop a best practice for identifying and treating members who were candidates for osteoporosis therapy. Numerous tools were used to support this disease management effort, including: evidence-based clinical practice guidelines, patient education sessions, the Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire tool, member specific reports for PCPs, targeted member mailings, office-based Peripheral Instantaneous X-ray Imaging (PIXI) test and counseling, dual x-ray absorptiometry (DEXA) scan guidelines, and web-based Electronic Simple Calculated Osteoporosis Risk Estimation (eSCORE) questionnaire tools. Hill Physicians tabulated results for patients who completed 2649 SCORE tests, screened 978 patients with PIXI tests, and identified 338 osteopenic and 124 osteoporotic patients. The preliminary results of this unique six-year ongoing educational initiative are slow but promising. New physician offices express interest in participating and those offices that have participated in the program continue to screen for osteoporosis. Hill Physicians' message is consistent and is communicated to the physicians repeatedly in different ways in accordance with the principles of educational outreach. Physicians who have conducted the program have positive feedback from their patients and office staff and have begun to communicate their experience to their peers.

INTERNAL HAZARDS ANALYSIS FOR LICENSE APPLICATION

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

R.J. Garrett

2005-02-17

The purpose of this internal hazards analysis is to identify and document the internal hazards and potential initiating events associated with preclosure operations of the repository at Yucca Mountain. Internal hazards are those hazards presented by the operation of the facility and by its associated processes that can potentially lead to a radioactive release or cause a radiological hazard. In contrast to external hazards, internal hazards do not involve natural phenomena and external man-made hazards. This internal hazards analysis was performed in support of the preclosure safety analysis and the License Application for the Yucca Mountain Project. The methodology formore » this analysis provides a systematic means to identify internal hazards and potential initiating events that may result in a radiological hazard or radiological release during the repository preclosure period. These hazards are documented in tables of potential internal hazards and potential initiating events (Section 6.6) for input to the repository event sequence categorization process. The results of this analysis will undergo further screening and analysis based on the criteria that apply to the performance of event sequence analyses for the repository preclosure period. The evolving design of the repository will be re-evaluated periodically to ensure that internal hazards that have not been previously evaluated are identified.« less

Identifying job characteristics related to employed women's breastfeeding behaviors.

PubMed

Spitzmueller, Christiane; Zhang, Jing; Thomas, Candice L; Wang, Zhuxi; Fisher, Gwenith G; Matthews, Russell A; Strathearn, Lane

2018-05-14

For employed mothers of infants, reconciliation of work demands and breastfeeding constitutes a significant challenge. The discontinuation of breastfeeding has the potential to result in negative outcomes for the mother (e.g., higher likelihood of obesity), her employer (e.g., increased absenteeism), and her infant (e.g., increased risk of infection). Given previous research findings identifying return to work as a major risk factor for breastfeeding cessation, we investigate what types of job characteristics relate to women's intentions to breastfeed shortly after giving birth and women's actual breastfeeding initiation and duration. Using job titles and job descriptors contained in a large Australian longitudinal cohort data set (N = 809), we coded job titles using the U.S. Department of Labor (DOL)'s Occupational Information Network (O*NET) database and extracted job characteristics. Hazardous working conditions and job autonomy were identified as significant determinants of women's breastfeeding intentions, their initiation of breastfeeding, and ultimately their breastfeeding continuation. Hence, we recommend that human resource professionals, managers, and public health initiatives provide breastfeeding-supportive resources to women who, based on their job characteristics, are at high risk to prematurely discontinue breastfeeding to ensure these mothers have equal opportunity to reap the benefits of breastfeeding. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Getting men in the room: perceptions of effective strategies to initiate men's involvement in gender-based violence prevention in a global sample.

PubMed

Casey, Erin A; Leek, Cliff; Tolman, Richard M; Allen, Christopher T; Carlson, Juliana M

2017-09-01

As engaging men in gender-based violence prevention efforts becomes an increasingly institutionalised component of gender equity work globally, clarity is needed about the strategies that best initiate male-identified individuals' involvement in these efforts. The purpose of this study was to examine the perceived relevance and effectiveness of men's engagement strategies from the perspective of men around the world who have organised or attended gender-based violence prevention events. Participants responded to an online survey (available in English, French and Spanish) and rated the effectiveness of 15 discrete engagement strategies derived from earlier qualitative work. Participants also provided suggestions regarding strategies in open-ended comments. Listed strategies cut across the social ecological spectrum and represented both venues in which to reach men, and the content of violence prevention messaging. Results suggest that all strategies, on average, were perceived as effective across regions of the world, with strategies that tailor messaging to topics of particular concern to men (such as fatherhood and healthy relationships) rated most highly. Open-ended comments also surfaced tensions, particularly related to the role of a gender analysis in initial men's engagement efforts. Findings suggest the promise of cross-regional adaptation and information sharing regarding successful approaches to initiating men's anti-violence involvement.

A Review of Empirical Analyses of Disinvestment Initiatives.

PubMed

Chambers, James D; Salem, Mark N; D'Cruz, Brittany N; Subedi, Prasun; Kamal-Bahl, Sachin J; Neumann, Peter J

Disinvesting in low-value health care services provides opportunities for investment in higher value care and thus an increase in health care efficiency. To identify international experience with disinvestment initiatives and to review empirical analyses of disinvestment initiatives. We performed a literature search using the PubMed database to identify international experience with disinvestment initiatives. We also reviewed empirical analyses of disinvestment initiatives. We identified 26 unique disinvestment initiatives implemented across 11 countries. Nineteen addressed multiple intervention types, six addressed only drugs, and one addressed only devices. We reviewed 18 empirical analyses of disinvestment initiatives: 7 reported that the initiative was successful, 8 reported that the initiative was unsuccessful, and 3 reported that findings were mixed; that is, the study considered multiple services and reported a decrease in the use of some but not others. Thirty-seven low-value services were evaluated across the 18 empirical analyses, for 14 (38%) of which the disinvestment initiative led to a decline in use. Six of the seven studies that reported the disinvestment initiative to be successful included an attempt to promote the disinvestment initiative among participating clinicians. The success of disinvestment initiatives has been mixed, with fewer than half the identified empirical studies reporting that use of the low-value service was reduced. Our findings suggest that promotion of the disinvestment initiative among clinicians is a key component to the success of the disinvestment initiative. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Assessing various approaches for flash flood forecasting in the Yzeron periurban catchment (150 km2) south-east Lyon, France

NASA Astrophysics Data System (ADS)

Braud, Isabelle; Breil, Pascal; Javelle, Pierre; Pejakovic, Nikola; Guérin, Stéphane

2017-04-01

The Yzeron periurban catchment (150 km2) is prone to flash floods leading to overflow in the downstream part of the catchment. A prevention and management plan has been approved and the set-up of a flood forecasting system is planned. The present study presents a comparison of several solutions for flood forecasting in the catchment. It is based on an extensive data collection (rain gauges, radar/rain gauge reanalyses, discharge and water level data) from this experimental catchment. A set of rainfall-runoff events leading to floods (problematic and non-problematic floods) was extracted and formed the basis for the definition of a first forecasting method. It is based on data analysis and the identification of explaining factors amongst the following: rainfall amount, intensity, antecedent rainfall, initial discharge. Several statistical methods including Factorial Analysis of Mixed Data and Classification and Regression Tree were used for this purpose. They showed that several classes of problematic floods can be identified. The first one is related to wet conditions characterized with high initial discharge and antecedent rainfall. The second class is driven by rainfall amount, initial discharge and rainfall intensity. Thresholds of these variables can be identified to provide a first warning. The second forecasting method assessed in the study is the system that will be operational in France in 2017, based on the AIGA method (Javelle et al., 2016). For this purpose, 18-year discharge simulation using the hydrological model of the AIGA method, forced using radar/rain gauges reanalysis were available at 44 locations within the catchment. The dates for which quantiles of a given return period were overtopped were identified and compared with the list of problematic events. The AIGA method was found relevant in identifying the most problematic events, but the lead time needs further investigation in order to assess the usefulness for population warning. References: Pierre Javelle, Didier Organde, Julie Demargne, Clotilde Saint-Martin, Céline de Saint-Aubin, Léa Garandeau and Bruno Janet (2016). Setting up a French national flash flood warning system for ungauged catchments based on the AIGA method. E3S Web of Conferences 7, 18010 (2016), 3rd European Conference on Flood Risk Management (FLOODrisk 2016), http://dx.doi.org/10.1051/e3sconf/20160718010

Community Rates of Breastfeeding Initiation.

PubMed

Grubesic, Tony H; Durbin, Kelly M

2016-11-01

Breastfeeding initiation rates vary considerably across racial and ethnic groups, maternal age, and education level, yet there are limited data concerning the influence of geography on community rates of breastfeeding initiation. This study aimed to describe how community rates of breastfeeding initiation vary in geographic space, highlighting "hot spots" and "cool spots" of initiation and exploring the potential connections between race, socioeconomic status, and urbanization levels on these patterns. Birth certificate data from the Kentucky Department of Health for 2004-2010 were combined with county-level geographic base files, Census 2010 demographic and socioeconomic data, and Rural-Urban Continuum Codes to conduct a spatial statistical analysis of community rates of breastfeeding initiation. Between 2004 and 2010, the average rate of breastfeeding initiation for Kentucky increased from 43.84% to 49.22%. Simultaneously, the number of counties identified as breastfeeding initiation hot spots also increased, displaying a systematic geographic pattern in doing so. Cool spots of breastfeeding initiation persisted in rural, Appalachian Kentucky. Spatial regression results suggested that unemployment, income, race, education, location, and the availability of International Board Certified Lactation Consultants are connected to breastfeeding initiation. Not only do spatial analytics facilitate the identification of breastfeeding initiation hot spots and cool spots, but they can be used to better understand the landscape of breastfeeding initiation and help target breastfeeding education and/or support efforts.

Resting-state regional cerebral blood flow during adolescence: associations with initiation of substance use and prediction of future use disorders.

PubMed

Ramage, Amy E; Lin, Ai-Ling; Olvera, Rene L; Fox, Peter T; Williamson, Douglas E

2015-04-01

Adolescence is a period of developmental flux when brain systems are vulnerable to influences of early substance use, which in turn relays increased risk for substance use disorders. Our study intent was to assess adolescent regional cerebral blood flow (rCBF) as it relates to current and future alcohol use. The aim was to identify brain-based predictors for initiation of alcohol use and onset of future substance use disorders. Quantitative rCBF was assessed in 100 adolescents (age 12-15). Prospective behavioral assessments were conducted annually over a three-year follow-up period to characterize onset of alcohol initiation, future drinking patterns and use disorders. Comparisons amongst use groups (i.e., current-, future-, and non-alcohol using adolescents) identified rCBF associated with initiation of alcohol use. Regression by future drinking patterns identified rCBF predictive of heavier drinking. Survival analysis determined whether or not baseline rCBF predicted later development of use disorders. Baseline rCBF was decreased to the parietal cortex and increased to mesolimbic regions in adolescents currently using alcohol as well as those who would use alcohol in the future. Higher baseline rCBF to the left fusiform gyrus and lower rCBF to the right inferior parietal cortex and left cerebellum was associated with future drinking patterns as well as predicted the onset of alcohol and substance use disorders in this cohort. Variations in resting rCBF to regions within reward and default mode or control networks appear to represent trait markers of alcohol use initiation and are predictive of future development of use disorders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Setting Priorities for Regional Conservation Planning in the Mediterranean Sea

PubMed Central

Micheli, Fiorenza; Levin, Noam; Giakoumi, Sylvaine; Katsanevakis, Stelios; Abdulla, Ameer; Coll, Marta; Fraschetti, Simonetta; Kark, Salit; Koutsoubas, Drosos; Mackelworth, Peter; Maiorano, Luigi; Possingham, Hugh P.

2013-01-01

Spatial prioritization in conservation is required to direct limited resources to where actions are most urgently needed and most likely to produce effective conservation outcomes. In an effort to advance the protection of a highly threatened hotspot of marine biodiversity, the Mediterranean Sea, multiple spatial conservation plans have been developed in recent years. Here, we review and integrate these different plans with the goal of identifying priority conservation areas that represent the current consensus among the different initiatives. A review of six existing and twelve proposed conservation initiatives highlights gaps in conservation and management planning, particularly within the southern and eastern regions of the Mediterranean and for offshore and deep sea habitats. The eighteen initiatives vary substantially in their extent (covering 0.1–58.5% of the Mediterranean Sea) and in the location of additional proposed conservation and management areas. Differences in the criteria, approaches and data used explain such variation. Despite the diversity among proposals, our analyses identified ten areas, encompassing 10% of the Mediterranean Sea, that are consistently identified among the existing proposals, with an additional 10% selected by at least five proposals. These areas represent top priorities for immediate conservation action. Despite the plethora of initiatives, major challenges face Mediterranean biodiversity and conservation. These include the need for spatial prioritization within a comprehensive framework for regional conservation planning, the acquisition of additional information from data-poor areas, species or habitats, and addressing the challenges of establishing transboundary governance and collaboration in socially, culturally and politically complex conditions. Collective prioritised action, not new conservation plans, is needed for the north, western, and high seas of the Mediterranean, while developing initial information-based plans for the south and eastern Mediterranean is an urgent requirement for true regional conservation planning. PMID:23577060

"I Love Fruit But I Can't Afford It": Using Participatory Action Research to Develop Community-Based Initiatives to Mitigate Challenges to Chronic Disease Management in an African American Community Living in Public Housing.

PubMed

Rogers, Courtney; Johnson, Joy; Nueslein, Brianne; Edmunds, David; Valdez, Rupa S

2018-03-12

As chronic conditions are on the rise in the USA, management initiatives outside of the inpatient setting should be explored to reduce associated cost and access disparities. Chronic conditions disproportionately affect African American public housing residents due to the effects of historical marginalization on the manifestation of economic and social problems exacerbating health disparities and outcomes. Informed by participatory research action tenets, this study focused on identifying the challenges to management of chronic conditions and developing community-envisioned initiatives to address these challenges in a predominantly African American public housing community. Two focus groups were conducted with former and current public housing residents and were analyzed using inductive content analysis. Physical activity, the cost associated with healthy eating, and lack of information were noted as challenges to chronic disease management. Initiatives discussed were the formation of a walking partner's program to promote physical activity, a shopper's club to exchange coupons and learn how to prepare healthy meals, and a natural remedy's book to share information intergenerationally about management tactics. Challenges identified existed predominantly on the individual and the system level, while the initiatives generated target engaging interpersonal and community relationships. These community-envisioned approaches should be explored to facilitate chronic disease management in public housing neighborhoods.

Veterans' experiences initiating VA-based mental health care.

PubMed

Bovin, Michelle J; Miller, Christopher J; Koenig, Christopher J; Lipschitz, Jessica M; Zamora, Kara A; Wright, Patricia B; Pyne, Jeffrey M; Burgess, James F

2018-05-21

Military veterans who could benefit from mental health services often do not access them. Research has revealed a range of barriers associated with initiating United States Department of Veterans Affairs (VA) care, including those specific to accessing mental health care (e.g., fear of stigmatization). More work is needed to streamline access to VA mental health-care services for veterans. In the current study, we interviewed 80 veterans from 9 clinics across the United States about initiation of VA mental health care to identify barriers to access. Results suggested that five predominant factors influenced veterans' decisions to initiate care: (a) awareness of VA mental health services; (b) fear of negative consequences of seeking care; (c) personal beliefs about mental health treatment; (d) input from family and friends; and (e) motivation for treatment. Veterans also spoke about the pathways they used to access this care. The four most commonly reported pathways included (a) physical health-care appointments; (b) the service connection disability system; (c) non-VA care; and (d) being mandated to care. Taken together, these data lend themselves to a model that describes both modifiers of, and pathways to, VA mental health care. The model suggests that interventions aimed at the identified pathways, in concert with efforts designed to reduce barriers, may increase initiation of VA mental health-care services by veterans. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Prioritizing the causes and correctors of smoking towards the solution of tobacco free future using enhanced analytic hierarchy process

NASA Astrophysics Data System (ADS)

Halim, Tisya Farida Abdul; Sapiri, Hasimah; Abidin, Norhaslinda Zainal

2017-11-01

This paper presents a method for prioritizing the causes and correctors of smoking habits in Malaysia. In order to identify the driving forces that causes (initiation factors) smoking habits and its correctors (anti-smoking strategies), a method called Enhanced Analytic Hierarchy Process (EAHP) is employed. The EAHP has advantages over normal Analytic Hierarchy Process (AHP) based on its capability to eliminate inconsistency (consistency ratio > 0.1) in evaluating expert's judgment. Based on the Theory of Triadic Influence, the identified initiation factors were personal beliefs and values, personal psychological, family influence, psychosocial influence, culture and legislative. There are five anti-smoking strategies that have been implemented in Malaysia, namely packaging and labelling, pricing and taxation, advertising, smoke-free legislation and education and support. Findings from the study shows that psychosocial influence was considered as the initiation factor of smoking among Malaysian adults, and mass media campaign was the most effective anti-smoking strategies to reduce smoking prevalence. The implementation of an effective anti-smoking strategies should be considered towards the endgame of tobacco by the year 2040 as outlined by the government. The findings in turn can provide insights and guidelines for researchers as well as policy makers to assess the effectiveness of anti-smoking strategies towards a better policy planning decisions in the future.

The Greenwich Photo-heliographic Results (1874 - 1976): Initial Corrections to the Printed Publications

NASA Astrophysics Data System (ADS)

Erwin, E. H.; Coffey, H. E.; Denig, W. F.; Willis, D. M.; Henwood, R.; Wild, M. N.

2013-11-01

A new sunspot and faculae digital dataset for the interval 1874 - 1955 has been prepared under the auspices of the NOAA National Geophysical Data Center (NGDC). This digital dataset contains measurements of the positions and areas of both sunspots and faculae published initially by the Royal Observatory, Greenwich, and subsequently by the Royal Greenwich Observatory (RGO), under the title Greenwich Photo-heliographic Results ( GPR) , 1874 - 1976. Quality control (QC) procedures based on logical consistency have been used to identify the more obvious errors in the RGO publications. Typical examples of identifiable errors are North versus South errors in specifying heliographic latitude, errors in specifying heliographic (Carrington) longitude, errors in the dates and times, errors in sunspot group numbers, arithmetic errors in the summation process, and the occasional omission of solar ephemerides. Although the number of errors in the RGO publications is remarkably small, an initial table of necessary corrections is provided for the interval 1874 - 1917. Moreover, as noted in the preceding companion papers, the existence of two independently prepared digital datasets, which both contain information on sunspot positions and areas, makes it possible to outline a preliminary strategy for the development of an even more accurate digital dataset. Further work is in progress to generate an extremely reliable sunspot digital dataset, based on the long programme of solar observations supported first by the Royal Observatory, Greenwich, and then by the Royal Greenwich Observatory.

The role of evidence, standards and education in rock fishing safety in New South Wales, Australia.

PubMed

Mitchell, Rebecca J; Ware, Lauren; Bambach, Mike R

2014-12-01

To examine rock fishing-related fatalities and hospitalisations, identify initiatives aimed at improving safety and survey key rock fishing stakeholders about the strengths and limitations of each initiative. This research obtained information from mortality and hospitalisation statistics, the published literature and key stakeholders for opinions on the strengths, limitations and improvements for rock fishing safety initiatives. Injury patterns involving rock fishers have largely remained unchanged over time. The literature revealed that many rock fishing safety initiatives focused on awareness raising and engineering initiatives, but ignored the development of guidelines and the use of enforcement strategies. There had been limited evaluations conducted of any of the initiatives reviewed. It is likely that a combination of evidence-based, standard-focused and education initiatives would be useful in improving rock fishing safety in NSW, provided that the impact of these initiatives were routinely evaluated. Information from this research will be used to inform preventive strategies aimed at improving rock fishing safety through better coordination of the role of evidence in informing standards and practices and the continued evaluation of these initiatives. © 2014 Public Health Association of Australia.

Predicting High Imaging Utilization Based on Initial Radiology Reports: A Feasibility Study of Machine Learning.

PubMed

Hassanpour, Saeed; Langlotz, Curtis P

2016-01-01

Imaging utilization has significantly increased over the last two decades, and is only recently showing signs of moderating. To help healthcare providers identify patients at risk for high imaging utilization, we developed a prediction model to recognize high imaging utilizers based on their initial imaging reports. The prediction model uses a machine learning text classification framework. In this study, we used radiology reports from 18,384 patients with at least one abdomen computed tomography study in their imaging record at Stanford Health Care as the training set. We modeled the radiology reports in a vector space and trained a support vector machine classifier for this prediction task. We evaluated our model on a separate test set of 4791 patients. In addition to high prediction accuracy, in our method, we aimed at achieving high specificity to identify patients at high risk for high imaging utilization. Our results (accuracy: 94.0%, sensitivity: 74.4%, specificity: 97.9%, positive predictive value: 87.3%, negative predictive value: 95.1%) show that a prediction model can enable healthcare providers to identify in advance patients who are likely to be high utilizers of imaging services. Machine learning classifiers developed from narrative radiology reports are feasible methods to predict imaging utilization. Such systems can be used to identify high utilizers, inform future image ordering behavior, and encourage judicious use of imaging. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Gray matter atrophy in patients with mild cognitive impairment/Alzheimer's disease over the course of developing delusions.

PubMed

Fischer, Corinne E; Ting, Windsor Kwan-Chun; Millikin, Colleen P; Ismail, Zahinoor; Schweizer, Tom A

2016-01-01

We conducted a neuroimaging analysis to understand the neuroanatomical correlates of gray matter loss in a group of mild cognitive impairment and early Alzheimer's disease patients who developed delusions. With data collected as part of the Alzheimer's Disease Neuroimaging Initiative, we conducted voxel-based morphometry to determine areas of gray matter change in the same Alzheimer's Disease Neuroimaging Initiative participants, before and after they developed delusions. We identified 14 voxel clusters with significant gray matter decrease in patient scans post-delusional onset, correcting for multiple comparisons (false discovery rate, p < 0.05). Major areas of difference included the right and left insulae, left precuneus, the right and left cerebellar culmen, the left superior temporal gyrus, the right posterior cingulate, the right thalamus, and the left parahippocampal gyrus. Although contrary to our initial predictions of enhanced right frontal atrophy, our preliminary work identifies several neuroanatomical areas, including the cerebellum and left posterior hemisphere, which may be involved in delusional development in these patients. Copyright © 2015 John Wiley & Sons, Ltd.

Technology development for lunar base water recycling

NASA Technical Reports Server (NTRS)

Schultz, John R.; Sauer, Richard L.

1992-01-01

This paper will review previous and ongoing work in aerospace water recycling and identify research activities required to support development of a lunar base. The development of a water recycle system for use in the life support systems envisioned for a lunar base will require considerable research work. A review of previous work on aerospace water recycle systems indicates that more efficient physical and chemical processes are needed to reduce expendable and power requirements. Development work on biological processes that can be applied to microgravity and lunar environments also needs to be initiated. Biological processes are inherently more efficient than physical and chemical processes and may be used to minimize resupply and waste disposal requirements. Processes for recovering and recycling nutrients such as nitrogen, phosphorus, and sulfur also need to be developed to support plant growth units. The development of efficient water quality monitors to be used for process control and environmental monitoring also needs to be initiated.

Comparative Study on Synergetic Degradation of a Reactive Dye Using Different Types of Fly Ash in Combined Adsorption and Photocatalysis

NASA Astrophysics Data System (ADS)

Giri Babu, P. V. S.; Swaminathan, G.

2016-09-01

A comprehensive study was carried out on four different fly ashes used as a catalyst for the degradation of Acid Red 1 using ultraviolet rays. These fly ashes are collected from different thermal power stations located at various places in India and having different chemical compositions. Three fly ashes are from lignite-based thermal power plants, and one is from the coal-based power plant. One fly ash is classified as Class F, two fly ashes are classified as Class C and remaining one is not conforming to ASTM C618 classification. X-Ray Fluorescence analysis was used to identify the chemical composition of fly ashes and SiO2, Al2O3, CaO, Fe2O3 and TiO2 were found to be the major elements present in different proportions. Various analysis were carried out on all the fly ashes like Scanning Electron Microscopy to identify the microphysical properties, Energy Dispersive X-Ray spectroscopy to quantify the elements present in the catalyst and X-Ray Diffraction to identify the catalyst phase analysis. The radical generated during the reaction was identified by Electron paramagnetic resonance spectroscopy. The parameters such as initial pH of the dye solution, catalyst dosage and initial dye concentration which influence the dye degradation efficiency were studied and optimised. In 60 min duration, the dye degradation efficiency at optimum parametric values of pH 2.5, initial dye concentration of 10 mg/L and catalyst dosage of 1.0 g/L using various fly ashes, i.e., Salam Power Plant, Barmer Lignite Power Plant, Kutch Lignite Power Plant and Neyveli Lignite Thermal Power plant (NLTP) were found to be 40, 60, 67 and 95 % respectively. The contribution of adsorption alone was 18 % at the above mentioned optimum parametric values. Among the above four fly ash NLTP fly ashes proved to be most efficient.

A Population-Based Assessment of the Drug Interaction Between Levothyroxine and Warfarin

PubMed Central

Pincus, D; Gomes, T; Hellings, C; Zheng, H; Paterson, JM; Mamdani, MM; Juurlink, DN

2013-01-01

Most drug interaction resources suggest that levothyroxine can dramatically potentiate the effect of warfarin. However, the mechanistic basis of the interaction is speculative, and little evidence supports a meaningful drug interaction. We conducted a population-based nested case–control study to examine the risk of hospitalization for hemorrhage following the initiation of levothyroxine in a cohort of 260,076 older patients receiving warfarin. In this group, we identified 10,532 case subjects hospitalized for hemorrhage and 40,595 controls. In the primary analysis, we found no association between hospitalization for hemorrhage during warfarin therapy and initiation of levothyroxine in the preceding 30 days (adjusted odds ratio 1.11, 95% confidence interval 0.67–1.86). Secondary analyses using more remote initiation of levothyroxine also found no association. These findings suggest that concerns about a clinically meaningful levothyroxine–warfarin drug interaction are not justified. Drug interaction resources that presently characterize this interaction as important should reevaluate this classification. PMID:23093318

Clinical pathways for acute coronary syndromes in China: protocol for a hospital quality improvement initiative.

PubMed

Rong, Ye; Turnbull, Fiona; Patel, Anushka; Du, Xin; Wu, Yangfeng; Gao, Runlin

2010-09-01

Clinical pathways have been shown to be effective in improving quality of care for patients admitted to hospital for acute coronary syndromes (ACS) in high-income countries. However, their utility has not formally been evaluated in low- or middle-income countries. The Clinical Pathways for Acute Coronary Syndromes in China program is a 7-year study with the overall goal of reducing evidence-practice gaps in the management of patients admitted to hospitals in China with suspected ACS. The program comprises 2 phases: a prospective survey of current management of ACS patients to identify the areas that evidence-based patient care can be potentially improved, and a quality care initiative to maximize the use of evidence-based investigations and treatments for ACS patients in China. In this article, we outline the details of the study protocol, including key aspects of the development, implementation, and evaluation of the quality improvement initiative (clinical pathway) for management of patients with suspected ACS.

Installation Restoration Program. Phase II--Confirmation/Quantification. Stage 1.

DTIC Science & Technology

1985-03-01

four phases. Phase I, Initial Assessment/ Records Search, is designed to identify possible hazardous waste contami- nated sites and potential...7 71 -. - - IL’ -, 1% 33 AihlIII Is 33 n~iL t iiC UII! ii CL C LU 1-3, Phase II, Confirmation and Quantification, is designed to confirm the...additional monitoring data upon which design of mitigative actions are based. In Phase III, Technology Base Development, appropriate technology is selected and

Large-scale deployment of the Global Trigger Tool across a large hospital system: refinements for the characterisation of adverse events to support patient safety learning opportunities.

PubMed

Good, V S; Saldaña, M; Gilder, R; Nicewander, D; Kennerly, D A

2011-01-01

The Institute for Healthcare Improvement encourages use of the Global Trigger Tool to objectively determine and monitor adverse events (AEs). Baylor Health Care System (BHCS) is an integrated healthcare delivery system in North Texas. The Global Trigger Tool was applied to BHCS's eight general acute care hospitals, two inpatient cardiovascular hospitals and two rehabilitation/long-term acute care hospitals. Data were collected from a monthly random sample of charts for each facility for patients discharged between 1 July 2006 and 30 June 2007 by external professional nurse auditors using an MS Access Tool developed for this initiative. In addition to the data elements recommended by Institute for Healthcare Improvement, BHCS developed fields to permit further characterisation of AEs to identify learning opportunities. A structured narrative description of each identified AE facilitated text mining to further characterise AEs. INITIAL FINDINGS: Based on this sample, AE rates were found to be 68.1 per 1000 patient days, or 50.8 per 100 encounters, and 39.8% of admissions were found to have ≥1 AE. Of all AEs identified, 61.2% were hospital-acquired, 10.1% of which were associated with a National Coordinating Council - Medical Error Reporting and Prevention harm score of "H or I" (near death or death). To enhance learning opportunities and guide quality improvement, BHCS collected data-such as preventability and AE source-to characterise the nature of AEs. Data are provided regularly to hospital teams to direct quality initiatives, moving from a general focus on reducing AEs to more specific programmes based on patterns of harm and preventability.

Recruitment, selection and retention of nursing and midwifery students in Scottish Universities.

PubMed

Rodgers, Sheila; Stenhouse, Rosie; McCreaddie, May; Small, Pauline

2013-11-01

High attrition rates from pre-registration nursing and midwifery programmes have been reported in both the UK and in other countries. A study was conducted to identify best practice in recruitment, selection and retention across Scottish Universities providing pre-registration programmes. A survey of all universities providing pre-registration programmes in Scotland was conducted. Semi-structured interviews were conducted with key personnel in each university. Documentary evidence was collected to supplement interview data and evidence recruitment, selection and retention practices. All universities in Scotland providing pre-registration nursing and/or midwifery programmes. All 10 identified universities agreed to take part and a total of 18 interviews were conducted. Semi-structured face to face and telephone interviews were conducted. Relevant documentary evidence was collected. All data were subject to thematic analysis. Universities are predominantly concerned with recruiting to the institution and not to the professions. Interviews are widely used, and are a requirement in the United Kingdom. However, there is no evidence base within the literature that they have predictive validity despite creating scales and scoring systems which are largely unvalidated. The study identified initiatives aimed at addressing attrition/retention, however most had not been evaluated often due to the multi-factorial nature of attrition/retention and difficulties with measurement. Recruitment selection and retention initiatives were rarely evaluated, and if so, adopted a relatively superficial approach. Evidence from existing studies to support practices was mostly weakly supportive or absent. The study highlights the need for a coordinated approach, supporting the development of a robust evidence base through the evaluation of local initiatives, and evaluation of new strategies. Evaluation strategies must take account of the local context to facilitate transferability of findings across different settings. Copyright © 2013 Elsevier Ltd. All rights reserved.

Apoptosis and Self-Destruct: A Contribution to Autonomic Agents?

NASA Technical Reports Server (NTRS)

Sterritt, Roy; Hinchey, Mike

2004-01-01

Autonomic Computing (AC), a self-managing systems initiative based on the biological metaphor of the autonomic nervous system, is increasingly gaining momentum as the way forward in designing reliable systems. Agent technologies have been identified as a key enabler for engineering autonomicity in systems, both in terms of retrofitting autonomicity into legacy systems and designing new systems. The AC initiative provides an opportunity to consider other biological systems and principles in seeking new design strategies. This paper reports on one such investigation; utilizing the apoptosis metaphor of biological systems to provide a dynamic health indicator signal between autonomic agents.

Results of the Collaborative Energy and Water Cycle Information Services (CEWIS) Workshop on Heterogeneous Dataset Analysis Preparation

NASA Technical Reports Server (NTRS)

Kempler, Steven; Teng, William; Acker, James; Belvedere, Deborah; Liu, Zhong; Leptoukh, Gregory

2010-01-01

In support of the NASA Energy and Water Cycle Study (NEWS), the Collaborative Energy and Water Cycle Information Services (CEWIS), sponsored by NEWS Program Manager Jared Entin, was initiated to develop an evolving set of community-based data and information services that would facilitate users to locate, access, and bring together multiple distributed heterogeneous energy and water cycle datasets. The CEWIS workshop, June 15-16, 2010, at NASA/GSFC, was the initial step of the process, starting with identifying and scoping the issues, as defined by the community.

Normal aging affects movement execution but not visual motion working memory and decision-making delay during cue-dependent memory-based smooth-pursuit.

PubMed

Fukushima, Kikuro; Barnes, Graham R; Ito, Norie; Olley, Peter M; Warabi, Tateo

2014-07-01

Aging affects virtually all functions including sensory/motor and cognitive activities. While retinal image motion is the primary input for smooth-pursuit, its efficiency/accuracy depends on cognitive processes. Elderly subjects exhibit gain decrease during initial and steady-state pursuit, but reports on latencies are conflicting. Using a cue-dependent memory-based smooth-pursuit task, we identified important extra-retinal mechanisms for initial pursuit in young adults including cue information priming and extra-retinal drive components (Ito et al. in Exp Brain Res 229:23-35, 2013). We examined aging effects on parameters for smooth-pursuit using the same tasks. Elderly subjects were tested during three task conditions as previously described: memory-based pursuit, simple ramp-pursuit just to follow motion of a single spot, and popping-out of the correct spot during memory-based pursuit to enhance retinal image motion. Simple ramp-pursuit was used as a task that did not require visual motion working memory. To clarify aging effects, we then compared the results with the previous young subject data. During memory-based pursuit, elderly subjects exhibited normal working memory of cue information. Most movement-parameters including pursuit latencies differed significantly between memory-based pursuit and simple ramp-pursuit and also between young and elderly subjects. Popping-out of the correct spot motion was ineffective for enhancing initial pursuit in elderly subjects. However, the latency difference between memory-based pursuit and simple ramp-pursuit in individual subjects, which includes decision-making delay in the memory task, was similar between the two groups. Our results suggest that smooth-pursuit latencies depend on task conditions and that, although the extra-retinal mechanisms were functional for initial pursuit in elderly subjects, they were less effective.

System and method for integrating hazard-based decision making tools and processes

DOEpatents

Hodgin, C Reed [Westminster, CO

2012-03-20

A system and method for inputting, analyzing, and disseminating information necessary for identified decision-makers to respond to emergency situations. This system and method provides consistency and integration among multiple groups, and may be used for both initial consequence-based decisions and follow-on consequence-based decisions. The system and method in a preferred embodiment also provides tools for accessing and manipulating information that are appropriate for each decision-maker, in order to achieve more reasoned and timely consequence-based decisions. The invention includes processes for designing and implementing a system or method for responding to emergency situations.

A gradient based algorithm to solve inverse plane bimodular problems of identification

NASA Astrophysics Data System (ADS)

Ran, Chunjiang; Yang, Haitian; Zhang, Guoqing

2018-02-01

This paper presents a gradient based algorithm to solve inverse plane bimodular problems of identifying constitutive parameters, including tensile/compressive moduli and tensile/compressive Poisson's ratios. For the forward bimodular problem, a FE tangent stiffness matrix is derived facilitating the implementation of gradient based algorithms, for the inverse bimodular problem of identification, a two-level sensitivity analysis based strategy is proposed. Numerical verification in term of accuracy and efficiency is provided, and the impacts of initial guess, number of measurement points, regional inhomogeneity, and noisy data on the identification are taken into accounts.

Use of regionalisation approach to develop fire frequency curves for Victoria, Australia

NASA Astrophysics Data System (ADS)

Khastagir, Anirban; Jayasuriya, Niranjali; Bhuyian, Muhammed A.

2017-11-01

It is important to perform fire frequency analysis to obtain fire frequency curves (FFC) based on fire intensity at different parts of Victoria. In this paper fire frequency curves (FFCs) were derived based on forest fire danger index (FFDI). FFDI is a measure related to fire initiation, spreading speed and containment difficulty. The mean temperature (T), relative humidity (RH) and areal extent of open water (LC2) during summer months (Dec-Feb) were identified as the most important parameters for assessing the risk of occurrence of bushfire. Based on these parameters, Andrews' curve equation was applied to 40 selected meteorological stations to identify homogenous stations to form unique clusters. A methodology using peak FFDI from cluster averaged FFDIs was developed by applying Log Pearson Type III (LPIII) distribution to generate FFCs. A total of nine homogeneous clusters across Victoria were identified, and subsequently their FFC's were developed in order to estimate the regionalised fire occurrence characteristics.

Reforms from the ground up: a review of community-based forest management in tropical developing countries.

PubMed

Tole, Lise

2010-06-01

After an initial burst of enthusiasm in the 1990 s, community-based forest management (CBFM) is increasingly being viewed with a critical eye. Evidence suggests that many programs have failed to promote their stated objectives of sustainability, efficiency, equity, democratic participation and poverty reduction. A large volume of academic literature now exists on CBFM, examining both the success and failure of such initiatives in a wide variety of countries. Through analysis of key themes, concepts and issues in CBFM, this article provides a review of CBFM initiatives in tropical developing countries for policymakers, practitioners and planners wishing to gain an understanding of this wide-ranging, interdisciplinary academic literature. The article identifies key institutions and incentives that appear to significantly affect the success or failure of CBFM initiatives. In particular, it reports that consideration of institutional and socioeconomic factors along with personal characteristics of key stakeholders such as beliefs, attitudes, financial resources and skills are important determinants of CBFM outcomes. However, local incentive structures also appear to be important. There is increasing recognition in the literature of the need to consider the conditions under which local politicians entrusted with carrying out CBFM initiatives will deem it worthwhile to invest their scarce time and resources on environmental governance.

Reforms from the Ground Up: A Review of Community-Based Forest Management in Tropical Developing Countries

NASA Astrophysics Data System (ADS)

Tole, Lise

2010-06-01

After an initial burst of enthusiasm in the 1990s, community-based forest management (CBFM) is increasingly being viewed with a critical eye. Evidence suggests that many programs have failed to promote their stated objectives of sustainability, efficiency, equity, democratic participation and poverty reduction. A large volume of academic literature now exists on CBFM, examining both the success and failure of such initiatives in a wide variety of countries. Through analysis of key themes, concepts and issues in CBFM, this article provides a review of CBFM initiatives in tropical developing countries for policymakers, practitioners and planners wishing to gain an understanding of this wide-ranging, interdisciplinary academic literature. The article identifies key institutions and incentives that appear to significantly affect the success or failure of CBFM initiatives. In particular, it reports that consideration of institutional and socioeconomic factors along with personal characteristics of key stakeholders such as beliefs, attitudes, financial resources and skills are important determinants of CBFM outcomes. However, local incentive structures also appear to be important. There is increasing recognition in the literature of the need to consider the conditions under which local politicians entrusted with carrying out CBFM initiatives will deem it worthwhile to invest their scarce time and resources on environmental governance.

Development of a hospital-based program focused on improving healthcare value.

PubMed

Moriates, Christopher; Mourad, Michelle; Novelero, Maria; Wachter, Robert M

2014-10-01

Frontline physicians face increasing pressure to improve the quality of care they deliver while simultaneously decreasing healthcare costs. Although hospitals and physicians are beginning to implement initiatives targeting this new goal of healthcare value, few of them have a well-developed infrastructure to support this work. In March 2012, we launched a high-value care (HVC) program within the Division of Hospital Medicine at the University of California, San Francisco. The HVC program is co-led by a physician and the division's administrator, and includes other hospitalists, resident physicians, pharmacists, and administrators. The program aims to (1) use financial and clinical data to identify areas with clear evidence of waste in the hospital, (2) promote evidence-based interventions that improve both quality of care and value, and (3) pair interventions with evidence-based cost awareness education to drive culture change. We identified 6 ongoing projects during our first year. Preliminary data for our inaugural projects are encouraging. One initiative, which targeted decreasing nebulizer use on a high-acuity medical floor (often using metered-dose inhalers instead) led to a decrease in rates of more than 50%. The HVC program is proving to be a successful mechanism to promote improved healthcare value and clinician engagement. © 2014 Society of Hospital Medicine.

Comparison Between Individually and Group-Based Insulin Pump Initiation by Time-Driven Activity-Based Costing

PubMed Central

Ridderstråle, Martin

2017-01-01

Background: Depending on available resources, competencies, and pedagogic preference, initiation of insulin pump therapy can be performed on either an individual or a group basis. Here we compared the two models with respect to resources used. Methods: Time-driven activity-based costing (TDABC) was used to compare initiating insulin pump treatment in groups (GT) to individual treatment (IT). Activities and cost drivers were identified, timed, or estimated at location. Medical quality and patient satisfaction were assumed to be noninferior and were not measured. Results: GT was about 30% less time-consuming and 17% less cost driving per patient and activity compared to IT. As a batch driver (16 patients in one group) GT produced an upward jigsaw-shaped accumulative cost curve compared to the incremental increase incurred by IT. Taking the alternate cost for those not attending into account, and realizing the cost of opportunity gained, suggested that GT was cost neutral already when 5 of 16 patients attended, and that a second group could be initiated at no additional cost as the attendance rate reached 15:1. Conclusions: We found TDABC to be effective in comparing treatment alternatives, improving cost control and decision making. Everything else being equal, if the setup is available, our data suggest that initiating insulin pump treatment in groups is far more cost effective than on an individual basis and that TDABC may be used to find the balance point. PMID:28366085

England's Healthy Living Pharmacy (HLP) initiative: Facilitating the engagement of pharmacy support staff in public health.

PubMed

Donovan, G R; Paudyal, V

2016-01-01

The concept of the Healthy Living Pharmacy (HLP) in England was first piloted in Portsmouth in 2010. HLPs proactively promote health and wellbeing, offering brief advice, services or signposting on a range of health issues such as smoking, physical activity, sexual health, healthy eating and alcohol consumption. To explore the views and attitudes of pharmacy support staff on the Healthy Living Pharmacy (HLP) initiative. Qualitative semi-structured, face-to-face interviews were conducted with pharmacy support staff recruited from community pharmacies involved in the HLP initiative in the Northumberland region of England. A topic guide was developed which underwent face validity testing and piloting with one participant. Interviews were audio recorded, transcribed verbatim and analyzed using framework technique. A total of 21 pharmacy support staff from 12 HLPs participated in the study. Results suggest that involving pharmacy support staff at very early stages of the HLP planning process drives their motivation for service delivery. Level of engagement with HLP services was often related to support staff roles within pharmacy. Integration of public health roles with routine pharmacy activities was perceived to be more suited to pharmacy counter based roles than dispensing roles. Further training needs were identified around how to proactively deliver public health advice, mainly in service areas perceived 'difficult' by the participants, such as weight management. A total of 19 facilitators/barriers were identified from the data including training, access to information, client feedback, availability of space and facilities within pharmacies, time and competing priorities. Pharmacy support staff engagement with the HLP initiative can be promoted by involving them from the outset of the service introduction process. Support staff might benefit from targeted training around certain public health areas within the HLP initiative. Facilitators/barriers identified in this study will inform development and further roll out of HLP initiative in wider areas. Copyright © 2016 Elsevier Inc. All rights reserved.

iTRAQ-Based Quantitative Proteomic Analysis of the Initiation of Head Regeneration in Planarians.

PubMed

Geng, Xiaofang; Wang, Gaiping; Qin, Yanli; Zang, Xiayan; Li, Pengfei; Geng, Zhi; Xue, Deming; Dong, Zimei; Ma, Kexue; Chen, Guangwen; Xu, Cunshuan

2015-01-01

The planarian Dugesia japonica has amazing ability to regenerate a head from the anterior ends of the amputated stump with maintenance of the original anterior-posterior polarity. Although planarians present an attractive system for molecular investigation of regeneration and research has focused on clarifying the molecular mechanism of regeneration initiation in planarians at transcriptional level, but the initiation mechanism of planarian head regeneration (PHR) remains unclear at the protein level. Here, a global analysis of proteome dynamics during the early stage of PHR was performed using isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative proteomics strategy, and our data are available via ProteomeXchange with identifier PXD002100. The results showed that 162 proteins were differentially expressed at 2 h and 6 h following amputation. Furthermore, the analysis of expression patterns and functional enrichment of the differentially expressed proteins showed that proteins involved in muscle contraction, oxidation reduction and protein synthesis were up-regulated in the initiation of PHR. Moreover, ingenuity pathway analysis showed that predominant signaling pathways such as ILK, calcium, EIF2 and mTOR signaling which were associated with cell migration, cell proliferation and protein synthesis were likely to be involved in the initiation of PHR. The results for the first time demonstrated that muscle contraction and ILK signaling might played important roles in the initiation of PHR at the global protein level. The findings of this research provide a molecular basis for further unraveling the mechanism of head regeneration initiation in planarians.

NASA-UVa Light Aerospace Alloy and Structures Technology Program: Aluminum-Based Materials for High Speed Aircraft

NASA Technical Reports Server (NTRS)

Starke, E. A., Jr. (Editor)

1996-01-01

This report is concerned with 'Aluminum-Based Materials for High Speed Aircraft' which was initiated to identify the technology needs associated with advanced, low-cost aluminum base materials for use as primary structural materials. Using a reference baseline aircraft, these materials concept will be further developed and evaluated both technically and economically to determine the most attractive combinations of designs, materials, and manufacturing techniques for major structural sections of an HSCT. Once this has been accomplished, the baseline aircraft will be resized, if applicable, and performance objectives and economic evaluations made to determine aircraft operating costs. The two primary objectives of this study are: (1) to identify the most promising aluminum-based materials with respect to major structural use on the HSCT and to further develop those materials, and (2) to assess these materials through detailed trade and evaluation studies with respect to their structural efficiency on the HSCT.

Expedited Remedial Action Program (SB 923): A California Brownfields initiative

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

Cambridge, M.; Wolfenden, A.K.

California`s Expedited Remedial Action Program (ERAP) created a comprehensive program that promotes an equitable and expedited approach for redevelopment of properties contaminated with hazardous substances. This bill embodies an emerging trend in environmental policy that permits flexibility, cooperation and creativity without compromising protection to public health or the environment. Within the California Environmental Protection Agency, the Department of Toxic Substances Control (DTSC) is promoting a number of programs to facilitate the restoration of contaminated properties as part of its Brownfields initiative. ERAP represents a potentially more efficient process to remediate sites by minimizing economic risks through a clearly identified liabilitymore » scheme, indemnifying future owners through a covenant not to sue, and providing risk based cleanups that are based on the permanent use of the site.« less

Fatigue crack identification method based on strain amplitude changing

NASA Astrophysics Data System (ADS)

Guo, Tiancai; Gao, Jun; Wang, Yonghong; Xu, Youliang

2017-09-01

Aiming at the difficulties in identifying the location and time of crack initiation in the castings of helicopter transmission system during fatigue tests, by introducing the classification diagnostic criteria of similar failure mode to find out the similarity of fatigue crack initiation among castings, an engineering method and quantitative criterion for detecting fatigue cracks based on strain amplitude changing is proposed. This method is applied on the fatigue test of a gearbox housing, whose results indicates: during the fatigue test, the system alarms when SC strain meter reaches the quantitative criterion. The afterwards check shows that a fatigue crack less than 5mm is found at the corresponding location of SC strain meter. The test result proves that the method can provide accurate test data for strength life analysis.

Tiered High-Throughput Screening Approach to Identify ...

EPA Pesticide Factsheets

High-throughput screening (HTS) for potential thyroid–disrupting chemicals requires a system of assays to capture multiple molecular-initiating events (MIEs) that converge on perturbed thyroid hormone (TH) homeostasis. Screening for MIEs specific to TH-disrupting pathways is limited in the US EPA ToxCast screening assay portfolio. To fill one critical screening gap, the Amplex UltraRed-thyroperoxidase (AUR-TPO) assay was developed to identify chemicals that inhibit TPO, as decreased TPO activity reduces TH synthesis. The ToxCast Phase I and II chemical libraries, comprised of 1,074 unique chemicals, were initially screened using a single, high concentration to identify potential TPO inhibitors. Chemicals positive in the single concentration screen were retested in concentration-response. Due to high false positive rates typically observed with loss-of-signal assays such as AUR-TPO, we also employed two additional assays in parallel to identify possible sources of nonspecific assay signal loss, enabling stratification of roughly 300 putative TPO inhibitors based upon selective AUR-TPO activity. A cell-free luciferase inhibition assay was used to identify nonspecific enzyme inhibition among the putative TPO inhibitors, and a cytotoxicity assay using a human cell line was used to estimate the cellular tolerance limit. Additionally, the TPO inhibition activities of 150 chemicals were compared between the AUR-TPO and an orthogonal peroxidase oxidation assay using

Barriers and facilitators to childhood obesity prevention among culturally and linguistically diverse (CALD) communities in Victoria, Australia.

PubMed

Cyril, Sheila; Nicholson, Jan M; Agho, Kingsley; Polonsky, Michael; Renzaho, Andre M

2017-06-01

Childhood obesity is rising among culturally and linguistically diverse (CALD) groups who show poor engagement in obesity prevention initiatives. We examined the barriers and facilitators to the engagement of CALD communities in obesity prevention initiatives. We used the nominal group technique to collect data from 39 participants from Vietnamese, Burmese, African, Afghani and Indian origins living in disadvantaged areas of Victoria, Australia. Data analysis revealed ranked priorities for barriers and facilitators for CALD community engagement in obesity prevention initiatives. CALD parents identified key barriers as being: competing priorities in the post-migration settlement phase; language, cultural and program accessibility barriers; low levels of food and health literacy; junk food advertisement targeting children; and lack of mandatory weight checks for schoolchildren. Key facilitators emerged as: bicultural playgroup leaders; ethnic community groups; and school-based healthy lunch box initiatives. This study has identified several policy recommendations including: the implementation of robust food taxation policies; consistent control of food advertising targeting children; improving CALD health literacy using bicultural workers; and matching health promotional materials with CALD community literacy levels. Implications for Public Health: These recommendations can directly influence public health policy to improve the engagement of CALD communities in obesity prevention services and ultimately reduce the widening obesity disparities in Australia. © 2017 The Authors.

Mobile Health Initiatives in Vietnam: Scoping Study.

PubMed

Lam, Jeffrey A; Dang, Linh Thuy; Phan, Ngoc Tran; Trinh, Hue Thi; Vu, Nguyen Cong; Nguyen, Cuong Kieu

2018-04-24

Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been undertaken. ©Jeffrey A Lam, Linh Thuy Dang, Ngoc Tran Phan, Hue Thi Trinh, Nguyen Cong Vu, Cuong Kieu Nguyen. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 24.04.2018.

Mobile Health Initiatives in Vietnam: Scoping Study

PubMed Central

Lam, Jeffrey A; Dang, Linh Thuy; Phan, Ngoc Tran; Trinh, Hue Thi; Vu, Nguyen Cong

2018-01-01

Background Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. Objective The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. Methods This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. Results We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). Conclusions The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been undertaken. PMID:29691214

A conceptual model for megaprogramming

NASA Technical Reports Server (NTRS)

Tracz, Will

1990-01-01

Megaprogramming is component-based software engineering and life-cycle management. Magaprogramming and its relationship to other research initiatives (common prototyping system/common prototyping language, domain specific software architectures, and software understanding) are analyzed. The desirable attributes of megaprogramming software components are identified and a software development model and resulting prototype megaprogramming system (library interconnection language extended by annotated Ada) are described.

Professional Learning for Teaching Assistants and Its Effect on Classroom Roles

ERIC Educational Resources Information Center

Hurst, Chris; Sparrow, Len

2012-01-01

The Swan Valley Cluster of schools for the Make It Count project identified the professional learning of teachers and teaching assistants as a key factor in improving numeracy outcomes for urban Indigenous children. Initial training for assistants began in late 2010 and took the form of workshops based on a modified First Steps in Mathematics…

Teachers' Conceptions of Motivation and Motivating Practices in Second-Language Learning: A Self-Determination Theory Perspective

ERIC Educational Resources Information Center

Muñoz, Ana; Ramirez, Marta

2015-01-01

Based on self-determination theory, we conducted an exploratory study aimed at identifying teachers' beliefs about motivation and motivating practices in second-language teaching at a private language center in Medellin, Colombia. To gather data, 65 teachers were surveyed; from this initial group, 11 were interviewed and observed in class during…

The Professional Identities of Teacher Educators in Three Further Education Colleges: An Entanglement of Discourse and Practice

ERIC Educational Resources Information Center

Springbett, Octavia

2018-01-01

Initial teacher education programmes have been identified as crucial to meeting the twin policy aims of professionalising the further education (FE) workforce and achieving improved learner outcomes, yet college-based teacher educators are underrepresented in published research and commentary. Drawing on a case study of teacher educators employed…

Helping Residents Succeed on the Job: How To Design and Deliver an Effective Job Retention Program. Neighbor Networks.

ERIC Educational Resources Information Center

Department of Housing and Urban Development, Washington, DC. Office of Multifamily Housing.

This guide describes how Neighborhood Networks centers can identify, provide, and use local partners and center staff to deliver effective follow-up retention services to residents who have just made the transition from unemployment to employment. (Neighborhood Networks, a community-based initiative, encourages the development of resource and…

Costs of fire suppression forces based on cost-aggregation approach

Treesearch

Gonz& aacute; lez-Cab& aacute; Armando n; Charles W. McKetta; Thomas J. Mills

1984-01-01

A cost-aggregation approach has been developed for determining the cost of Fire Management Inputs (FMls)-the direct fireline production units (personnel and equipment) used in initial attack and large-fire suppression activities. All components contributing to an FMI are identified, computed, and summed to estimate hourly costs. This approach can be applied to any FMI...

The Role of Context in the Evaluation of Reinforcer Efficacy: Implications for the Preference Assessment Outcomes

ERIC Educational Resources Information Center

Mangum, Aphrodite; Fredrick, Laura; Pabico, Robert; Roane, Henry

2012-01-01

Highly preferred stimuli were identified via two preference assessments (based on Fisher et al., 1992), the second of which included stimuli that were ranked low in the initial preference assessment. Following the preference assessments, a subset of stimuli was evaluated as reinforcers in single- and concurrent-operant arrangements. In general,…

What Is the Criterion of Interest in Identifying Limited-English Speaking Students: Language Dominance or Proficiency?

ERIC Educational Resources Information Center

Estes, Gary D.; Estes, Carole

The issue of using language proficiency or language dominance to assess programs for high school students with limited English speaking backgrounds is addressed. The development and initial analyses of the Competency Based Oral Language Assessment (COLA) are discussed. Three components of oral language are rated separately: semantics; syntax and…

Correspondence between Video CD-ROM and Community-Based Job Preferences for Individuals with Developmental Disabilities

ERIC Educational Resources Information Center

Ellerd, David A.; Morgan, Robert L.; Salzberg, Charles L.

2006-01-01

This study examined correspondence in selections of job preference across a video CD-ROM assessment program, community jobs observed during employment site visits, and photographs of employment sites. For 20 participants ages 18 - 22 with developmental disabilities, the video CD-ROM program was initially administered to identify preferred jobs,…

Lexicogrammar in the International Construction Industry: A Corpus-Based Case Study of Japanese-Hong-Kongese On-Site Interactions in English

ERIC Educational Resources Information Center

Handford, Michael; Matous, Petr

2011-01-01

The purpose of this research is to identify and interpret statistically significant lexicogrammatical items that are used in on-site spoken communication in the international construction industry, initially through comparisons with reference corpora of everyday spoken and business language. Several data sources, including audio and video…

Truancy Programs: Are the Effects Too Easily Washed Away?

ERIC Educational Resources Information Center

Huck, Jennifer L.

2011-01-01

Truancy has been identified as a risk factor of criminal behavior but results are mixed as to the best means to reduce this school-based concern. The Truancy Prevention Initiative has been implemented in New Orleans post-Hurricane Katrina under the direction of the Recovery School District to reduce levels of truancy, increase graduation rates,…

Equal Opportunities and Vocational Training. Evaluation of In-Company Vocational Training Schemes for Women.

ERIC Educational Resources Information Center

Sensi, Dina; And Others

Equal opportunities programs in the Member States of the European Community (EC) are based on international law, EC law, and various legal provisions at the national level. Two main types of positive action can be identified among the various initiatives implemented in the different Member States: (1) governmental promotion of positive actions…

Regional Higher Education Reform Initiatives in Africa: A Comparative Analysis with the Bologna Process

ERIC Educational Resources Information Center

Woldegiorgis, Emnet Tadesse; Jonck, Petronella; Goujon, Anne

2015-01-01

Europe's Bologna Process has been identified as a pioneering approach in regional cooperation with respect to the area of higher education. To address the challenges of African higher education, policymakers are recommending regional cooperation that uses the Bologna Process as a model. Based on these recommendations, the African Union Commission…

Peer-Led Nutrition Education Programs for School-Aged Youth: A Systematic Review of the Literature

ERIC Educational Resources Information Center

Yip, Calvin; Gates, Michelle; Gates, Allison; Hanning, Rhona M.

2016-01-01

To date, the impacts of school-based, peer-led nutrition education initiatives have not been summarized or assessed collectively. This review presents the current evidence, identifies knowledge gaps, and provides recommendations for future research. PubMed, Scopus, ERIC and Google Scholar were searched for refereed Canadian and American primary…

Characteristics of Children with Autistic Spectrum Disorders Served in Comprehensive Community-Based Mental Health Settings

ERIC Educational Resources Information Center

Mandell, David S.; Walrath, Christine M.; Manteuffel, Brigitte; Sgro, Gina; Pinto-Martin, Jennifer

2005-01-01

This study describes the characteristics of children with autistic spectrum disorders (ASD) receiving treatment in community mental health settings. Data from a national community mental health initiative was used to identify children who had received a primary diagnosis of ASD. These children were compared with children with other diagnoses on…

Development of a Logic Model to Guide Evaluations of the ASCA National Model for School Counseling Programs

ERIC Educational Resources Information Center

Martin, Ian; Carey, John

2014-01-01

A logic model was developed based on an analysis of the 2012 American School Counselor Association (ASCA) National Model in order to provide direction for program evaluation initiatives. The logic model identified three outcomes (increased student achievement/gap reduction, increased school counseling program resources, and systemic change and…

Renal acidification responses to respiratory acid-base disorders.

PubMed

Madias, Nicolaos E

2010-01-01

Respiratory acid-base disorders are those abnormalities in acid-base equilibrium that are expressed as primary changes in the arterial carbon dioxide tension (PaCO2). An increase in PaCO2 (hypercapnia) acidifies body fluids and initiates the acid-base disturbance known as respiratory acidosis. By contrast, a decrease in PaCO2 (hypocapnia) alkalinizes body fluids and initiates the acid-base disturbance known as respiratory alkalosis. The impact on systemic acidity of these primary changes in PaCO2 is ameliorated by secondary, directional changes in plasma [HCO3¯] that occur in 2 stages. Acutely, hypercapnia or hypocapnia yields relatively small changes in plasma [HCO3¯] that originate virtually exclusively from titration of the body's nonbicarbonate buffers. During sustained hypercapnia or hypocapnia, much larger changes in plasma [HCO3¯] occur that reflect adjustments in renal acidification mechanisms. Consequently, the deviation of systemic acidity from normal is smaller in the chronic forms of these disorders. Here we provide an overview of the renal acidification responses to respiratory acid-base disorders. We also identify gaps in knowledge that require further research.

Balancing emotion and cognition: a case for decision aiding in conservation efforts.

PubMed

Wilson, Robyn S

2008-12-01

Despite advances in the quality of participatory decision making for conservation, many current efforts still suffer from an inability to bridge the gap between science and policy. Judgment and decision-making research suggests this gap may result from a person's reliance on affect-based shortcuts in complex decision contexts. I examined the results from 3 experiments that demonstrate how affect (i.e., the instantaneous reaction one has to a stimulus) influences individual judgments in these contexts and identified techniques from the decision-aiding literature that help encourage a balance between affect-based emotion and cognition in complex decision processes. In the first study, subjects displayed a lack of focus on their stated conservation objectives and made decisions that reflected their initial affective impressions. Value-focused approaches may help individuals incorporate all the decision-relevant objectives by making the technical and value-based objectives more salient. In the second study, subjects displayed a lack of focus on statistical risk and again made affect-based decisions. Trade-off techniques may help individuals incorporate relevant technical data, even when it conflicts with their initial affective impressions or other value-based objectives. In the third study, subjects displayed a lack of trust in decision-making authorities when the decision involved a negatively affect-rich outcome (i.e., a loss). Identifying shared salient values and increasing procedural fairness may help build social trust in both decision-making authorities and the decision process.

Fragment-based virtual screening approach and molecular dynamics simulation studies for identification of BACE1 inhibitor leads.

PubMed

Manoharan, Prabu; Ghoshal, Nanda

2018-05-01

Traditional structure-based virtual screening method to identify drug-like small molecules for BACE1 is so far unsuccessful. Location of BACE1, poor Blood Brain Barrier permeability and P-glycoprotein (Pgp) susceptibility of the inhibitors make it even more difficult. Fragment-based drug design method is suitable for efficient optimization of initial hit molecules for target like BACE1. We have developed a fragment-based virtual screening approach to identify/optimize the fragment molecules as a starting point. This method combines the shape, electrostatic, and pharmacophoric features of known fragment molecules, bound to protein conjugate crystal structure, and aims to identify both chemically and energetically feasible small fragment ligands that bind to BACE1 active site. The two top-ranked fragment hits were subjected for a 53 ns MD simulation. Principle component analysis and free energy landscape analysis reveal that the new ligands show the characteristic features of established BACE1 inhibitors. The potent method employed in this study may serve for the development of potential lead molecules for BACE1-directed Alzheimer's disease therapeutics.

Effects of visual cues of object density on perception and anticipatory control of dexterous manipulation.

PubMed

Crajé, Céline; Santello, Marco; Gordon, Andrew M

2013-01-01

Anticipatory force planning during grasping is based on visual cues about the object's physical properties and sensorimotor memories of previous actions with grasped objects. Vision can be used to estimate object mass based on the object size to identify and recall sensorimotor memories of previously manipulated objects. It is not known whether subjects can use density cues to identify the object's center of mass (CM) and create compensatory moments in an anticipatory fashion during initial object lifts to prevent tilt. We asked subjects (n = 8) to estimate CM location of visually symmetric objects of uniform densities (plastic or brass, symmetric CM) and non-uniform densities (mixture of plastic and brass, asymmetric CM). We then asked whether subjects can use density cues to scale fingertip forces when lifting the visually symmetric objects of uniform and non-uniform densities. Subjects were able to accurately estimate an object's center of mass based on visual density cues. When the mass distribution was uniform, subjects could scale their fingertip forces in an anticipatory fashion based on the estimation. However, despite their ability to explicitly estimate CM location when object density was non-uniform, subjects were unable to scale their fingertip forces to create a compensatory moment and prevent tilt on initial lifts. Hefting object parts in the hand before the experiment did not affect this ability. This suggests a dichotomy between the ability to accurately identify the object's CM location for objects with non-uniform density cues and the ability to utilize this information to correctly scale their fingertip forces. These results are discussed in the context of possible neural mechanisms underlying sensorimotor integration linking visual cues and anticipatory control of grasping.

Establishment of a Canine Rabies Burden in Haiti through the Implementation of a Novel Surveillance Program

PubMed Central

Wallace, Ryan M; Reses, Hannah; Franka, Richard; Dilius, Pierre; Fenelon, Natael; Orciari, Lillian; Etheart, Melissa; Destine, Apollon; Crowdis, Kelly; Blanton, Jesse D; Francisco, Calvin; Ludder, Fleurinord; Del Rio Vilas, Victor; Haim, Joseph; Millien, Max

2015-01-01

The Republic of Haiti is one of only several countries in the Western Hemisphere in which canine rabies is still endemic. Estimation methods have predicted that 130 human deaths occur per year, yet existing surveillance mechanisms have detected few of these rabies cases. Likewise, canine rabies surveillance capacity has had only limited capacity, detecting only two rabid dogs per year, on average. In 2013, Haiti initiated a community-based animal rabies surveillance program comprised of two components: active community bite investigation and passive animal rabies investigation. From January 2013 –December 2014, 778 rabies suspect animals were reported for investigation. Rabies was laboratory-confirmed in 70 animals (9%) and an additional 36 cases were identified based on clinical diagnosis (5%), representing an 18-fold increase in reporting of rabid animals compared to the three years before the program was implemented. Dogs were the most frequent rabid animal (90%). Testing and observation ruled out rabies in 61% of animals investigated. A total of 639 bite victims were reported to the program and an additional 364 bite victims who had not sought medical care were identified during the course of investigations. Only 31% of people with likely rabies exposures had initiated rabies post-exposure prophylaxis prior to the investigation. Rabies is a neglected disease in-part due to a lack of surveillance and understanding about the burden. The surveillance methods employed by this program established a much higher burden of canine rabies in Haiti than previously recognized. The active, community-based bite investigations identified numerous additional rabies exposures and bite victims were referred for appropriate medical care, averting potential human rabies deaths. The use of community-based rabies surveillance programs such as HARSP should be considered in canine rabies endemic countries. PMID:26600437

Extending systematic reviews to include evidence on implementation: methodological work on a review of community-based initiatives to prevent injuries.

PubMed

Roen, Katrina; Arai, Lisa; Roberts, Helen; Popay, Jennie

2006-08-01

Unintentional injury is a leading cause of mortality and disability among young and old. While evidence about the effectiveness of interventions in reducing injuries is accumulating, reviews of this evidence frequently fail to include details of implementation processes. Our research, of which the work reported here formed a part, had two main objectives: (1) to identify evidence about the implementation of interventions aimed at reducing unintentional injuries amongst children and young people; and (2) to explore methods for systematically reviewing evidence on implementation. Existing systematic reviews of the effectiveness of interventions aiming to reduce unintentional injuries in children and young people formed the starting point for the work reported here. In summary, many of the published papers we identified contained little information on implementation processes and, even when these were discussed, the extent to which authors' claims were based on research evidence was unclear. On the basis of the studies we reviewed implementation data were insufficiently strong to provide a sound evidence base for practitioners and policymakers. Notwithstanding this, we identified valuable data about the context in which such initiatives are implemented and the type of factors that might impinge on implementation. This work has implications in three areas: (1) researchers with an interest in evidence-based public health could be encouraged to consider implementation issues in the design of intervention studies; (2) funding bodies could be encouraged to prioritise intervention studies using mixed methods that will enable researchers to consider effectiveness and implementation; (3) journal editors could work towards increasing the quality of reporting on implementation issues through the development of guidelines.

[Training of resident physicians in the recognition and treatment of an anaphylaxis case in pediatrics with simulation models].

PubMed

Enríquez, Diego; Lamborizio, María J; Firenze, Lorena; Jaureguizar, María de la P; Díaz Pumará, Estanislao; Szyld, Edgardo

2017-08-01

To evaluate the performance of resident physicians in diagnosing and treating a case of anaphylaxis, six months after participating in simulation training exercises. Initially, a group of pediatric residents were trained using simulation techniques in the management of critical pediatric cases. Based on their performance in this exercise, participants were assigned to one of 3 groups. At six months post-training, 4 residents were randomly chosen from each group to be re-tested, using the same performance measure as previously used. During the initial training session, 56 of 72 participants (78%) correctly identified and treated the case. Six months after the initial training, all 12 (100%) resident physicians who were re-tested successfully diagnosed and treated the simulated anaphylaxis case. The training through simulation techniques allowed correction or optimization of the treatment of simulated anaphylaxis cases in resident physicians evaluated after 6 months of the initial training.

Evaluation of Fracture Initiation in the Mannesmann Piercing Process

NASA Astrophysics Data System (ADS)

Fanini, S.; Ghiotti, A.; Bruschi, S.

2007-04-01

One of the challenging objectives in studying the Mannesmann piercing process is to predict the fracture initiation, known as "Mannesmann effect", in order to design and optimize the working parameters of the piercing process. The objective of the paper is to investigate the workability of a tube steel tested in the same conditions of the Mannesman piercing process. The stress and strain states as well as temperature fields arising during the process are identified through numerical simulations. The hot tensile test is chosen for fundamental studies on fracture initiation, as a tensile state of stress in the centre of the billet in the first stages of the piercing process before the plug arrival seems to be one of the main causes of the crack initiation. The material constants of energy-based models implemented in FEM codes are calculated and numerical results are compared with non-plug piercing tests carried out on the industrial plant.

Spatial clustering of fatal, and non-fatal, suicide in new South Wales, Australia: implications for evidence-based prevention.

PubMed

Torok, Michelle; Konings, Paul; Batterham, Philip J; Christensen, Helen

2017-10-06

Rates of suicide appear to be increasing, indicating a critical need for more effective prevention initiatives. To increase the efficacy of future prevention initiatives, we examined the spatial distribution of suicide deaths and suicide attempts in New South Wales (NSW), Australia, to identify where high incidence 'suicide clusters' were occurring. Such clusters represent candidate regions where intervention is critically needed, and likely to have the greatest impact, thus providing an evidence-base for the targeted prioritisation of resources. Analysis is based on official suicide mortality statistics for NSW, provided by the Australian Bureau of Statistics, and hospital separations for non-fatal intentional self-harm, provided through the NSW Health Admitted Patient Data Collection at a Statistical Area 2 (SA2) geography. Geographical Information System (GIS) techniques were applied to detect suicide clusters occurring between 2005 and 2013 (aggregated), for persons aged over 5 years. The final dataset contained 5466 mortality and 86,017 non-fatal intentional self-harm cases. In total, 25 Local Government Areas were identified as primary or secondary likely candidate regions for intervention. Together, these regions contained approximately 200 SA2 level suicide clusters, which represented 46% (n = 39,869) of hospital separations and 43% (n = 2330) of suicide deaths between 2005 and 2013. These clusters primarily converged on the Eastern coastal fringe of NSW. Crude rates of suicide deaths and intentional self-harm differed at the Local Government Areas (LGA) level in NSW. There was a tendency for primary suicide clusters to occur within metropolitan and coastal regions, rather than rural areas. The findings demonstrate the importance of taking geographical variation of suicidal behaviour into account, prior to development and implementation of prevention initiatives, so that such initiatives can target key problem areas where they are likely to have maximal impact.

Crawler Acquisition and Testing Demonstration Project Management Plan

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

DEFIGH-PRICE, C.

2000-10-23

If the crawler based retrieval system is selected, this project management plan identifies the path forward for acquiring a crawler/track pump waste retrieval system, and completing sufficient testing to support deploying the crawler for as part of a retrieval technology demonstration for Tank 241-C-104. In the balance of the document, these activities will be referred to as the Crawler Acquisition and Testing Demonstration. During recent Tri-Party Agreement negotiations, TPA milestones were proposed for a sludge/hard heel waste retrieval demonstration in tank C-104. Specifically one of the proposed milestones requires completion of a cold demonstration of sufficient scale to support finalmore » design and testing of the equipment (M-45-03G) by 6/30/2004. A crawler-based retrieval system was one of the two options evaluated during the pre-conceptual engineering for C-104 retrieval (RPP-6843 Rev. 0). The alternative technology procurement initiated by the Hanford Tanks Initiative (HTI) project, combined with the pre-conceptual engineering for C-104 retrieval provide an opportunity to achieve compliance with the proposed TPA milestone M-45-03H. This Crawler Acquisition and Testing Demonstration project management plan identifies the plans, organizational interfaces and responsibilities, management control systems, reporting systems, timeline and requirements for the acquisition and testing of the crawler based retrieval system. This project management plan is complimentary to and supportive of the Project Management Plan for Retrieval of C-104 (RPP-6557). This project management plan focuses on utilizing and completing the efforts initiated under the Hanford Tanks Initiative (HTI) to acquire and cold test a commercial crawler based retrieval system. The crawler-based retrieval system will be purchased on a schedule to support design of the waste retrieval from tank C-104 (project W-523) and to meet the requirement of proposed TPA milestone M-45-03H. This Crawler Acquisition and Testing Demonstration project management plan includes the following: (1) Identification of acquisition strategy and plan to obtain a crawler based retrieval system; (2) Plan for sufficient cold testing to make a decision for W-523 and to comply with TPA Milestone M-45-03H; (3) Cost and schedule for path forward; (4) Responsibilities of the participants; and (5) The plan is supported by updated Level 1 logics, a Relative Order of Magnitude cost estimate and preliminary project schedule.« less

Impact of advanced pharmacy practice experience placement changes in colleges and schools of pharmacy.

PubMed

Duke, Lori J; Staton, April G; McCullough, Elizabeth S; Jain, Rahul; Miller, Mindi S; Lynn Stevenson, T; Fetterman, James W; Lynn Parham, R; Sheffield, Melody C; Unterwagner, Whitney L; McDuffie, Charles H

2012-04-10

To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload. Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes). APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes. APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates.

Indole RSK inhibitors. Part 1: discovery and initial SAR.

PubMed

Boyer, Stephen J; Burke, Jennifer; Guo, Xin; Kirrane, Thomas M; Snow, Roger J; Zhang, Yunlong; Sarko, Chris; Soleymanzadeh, Lida; Swinamer, Alan; Westbrook, John; Dicapua, Frank; Padyana, Anil; Cogan, Derek; Gao, Amy; Xiong, Zhaoming; Madwed, Jeffrey B; Kashem, Mohammed; Kugler, Stanley; O'Neill, Margaret M

2012-01-01

A series of inhibitors for the 90 kDa ribosomal S6 kinase (RSK) based on an 1-oxo-2,3,4,5-tetrahydro-1H-[1,4]diazepino[1,2-a]indole-8-carboxamide scaffold were identified through high throughput screening. An RSK crystal structure and exploratory SAR were used to define the series pharmacophore. Compounds with good cell potency, such as compounds 43, 44, and 55 were identified, and form the basis for subsequent kinase selectivity optimization. Copyright © 2011 Elsevier Ltd. All rights reserved.

Method for non-referential defect characterization using fractal encoding and active contours

DOEpatents

Gleason, Shaun S [Knoxville, TN; Sari-Sarraf, Hamed [Lubbock, TX

2007-05-15

A method for identification of anomalous structures, such as defects, includes the steps of providing a digital image and applying fractal encoding to identify a location of at least one anomalous portion of the image. The method does not require a reference image to identify the location of the anomalous portion. The method can further include the step of initializing an active contour based on the location information obtained from the fractal encoding step and deforming an active contour to enhance the boundary delineation of the anomalous portion.

Native State Mass Spectrometry, Surface Plasmon Resonance, and X-ray Crystallography Correlate Strongly as a Fragment Screening Combination.

PubMed

Woods, Lucy A; Dolezal, Olan; Ren, Bin; Ryan, John H; Peat, Thomas S; Poulsen, Sally-Ann

2016-03-10

Fragment-based drug discovery (FBDD) is contingent on the development of analytical methods to identify weak protein-fragment noncovalent interactions. Herein we have combined an underutilized fragment screening method, native state mass spectrometry, together with two proven and popular fragment screening methods, surface plasmon resonance and X-ray crystallography, in a fragment screening campaign against human carbonic anhydrase II (CA II). In an initial fragment screen against a 720-member fragment library (the "CSIRO Fragment Library") seven CA II binding fragments, including a selection of nonclassical CA II binding chemotypes, were identified. A further 70 compounds that comprised the initial hit chemotypes were subsequently sourced from the full CSIRO compound collection and screened. The fragment results were extremely well correlated across the three methods. Our findings demonstrate that there is a tremendous opportunity to apply native state mass spectrometry as a complementary fragment screening method to accelerate drug discovery.

Clinical significance of In vivo Cytarabine Induced Gene Expression Signature in AML

PubMed Central

Lamba, Jatinder K.; Pounds, Stanley; Cao, Xueyuan; Crews, Kristine R.; Cogle, Christopher R.; Bhise, Neha; Raimondi, Susana C.; Downing, James R.; Baker, Sharyn D.; Ribeiro, Raul C.; Rubnitz, Jeffrey E.

2016-01-01

Despite initial remission, approximately 60-70% of adult and 30% of pediatric patients experience relapse or refractory AML. Studies so far have identified base line gene expression profiles of pathogenic and prognostic significance in AML, however extent of change in gene expression post-initiation of treatment has not been investigated. Exposure of leukemic cells to chemotherapeutic agents such as cytarabine, a mainstay of AML chemotherapy can trigger adaptive response by influencing leukemic cell transcriptome and hence development of resistance or refractory disease. It is however challenging to perform such a study due to lack of availability of specimens post-drug treatment. In this study our primary objective was to identify in vivo cytarabine induced changes in leukemia cell transcriptome and to evaluate their impact on clinical outcome. Our results highlight genes relevant to cytarabine resistance and support the concept of targeting cytarabine-induced genes as a means of improving response. PMID:26366682

Clinical significance of in vivo cytarabine-induced gene expression signature in AML.

PubMed

Lamba, Jatinder K; Pounds, Stanley; Cao, Xueyuan; Crews, Kristine R; Cogle, Christopher R; Bhise, Neha; Raimondi, Susana C; Downing, James R; Baker, Sharyn D; Ribeiro, Raul C; Rubnitz, Jeffrey E

2016-01-01

Despite initial remission, ∼60-70% of adult and 30% of pediatric patients experience relapse or refractory AML. Studies so far have identified base line gene expression profiles of pathogenic and prognostic significance in AML; however, the extent of change in gene expression post-initiation of treatment has not been investigated. Exposure of leukemic cells to chemotherapeutic agents such as cytarabine, a mainstay of AML chemotherapy, can trigger adaptive response by influencing leukemic cell transcriptome and, hence, development of resistance or refractory disease. It is, however, challenging to perform such a study due to lack of availability of specimens post-drug treatment. The primary objective of this study was to identify in vivo cytarabine-induced changes in leukemia cell transcriptome and to evaluate their impact on clinical outcome. The results highlight genes relevant to cytarabine resistance and support the concept of targeting cytarabine-induced genes as a means of improving response.

Space Station Freedom Data Assessment Study

NASA Technical Reports Server (NTRS)

Johnson, Anngienetta R.; Deskevich, Joseph

1990-01-01

The SSF Data Assessment Study was initiated to identify payload and operations data requirements to be supported in the Space Station era. To initiate the study payload requirements from the projected SSF user community were obtained utilizing an electronic questionnaire. The results of the questionnaire were incorporated in a personal computer compatible database used for mission scheduling and end-to-end communications analyses. This paper discusses data flow paths and associated latencies, communications bottlenecks, resource needs versus availability, payload scheduling 'warning flags' and payload data loading requirements for each major milestone in the Space Station buildup sequence. This paper also presents the statistical and analytical assessments produced using the data base, an experiment scheduling program, and a Space Station unique end-to-end simulation model. The modeling concepts and simulation methodologies presented in this paper provide a foundation for forecasting communication requirements and identifying modeling tools to be used in the SSF Tactical Operations Planning (TOP) process.

Evaluating health-promoting schools in Hong Kong: development of a framework.

PubMed

Lee, Albert; Cheng, Frances F K; St Leger, Lawry

2005-06-01

Health-promoting schools (HPS)/healthy schools have existed internationally for about 15 years. Yet there are few comprehensive evaluation frameworks available which enable the outcomes of HPS initiatives to be assessed. This paper identifies an evaluation framework developed in Hong Kong. The framework uses a range of approaches to explore what schools actually do in their health promotion and health education initiatives. The framework, which is based on the WHO (Western Pacific Regional Office) Guidelines for HPS, is described in detail. The appropriate instruments for data collection are described and their origins identified. The evaluation plan and protocol, which underpinned the very comprehensive evaluation in Hong Kong, are explained. Finally, a case is argued for evaluation of HPS to be more in line with the educational dynamics of schools and the research literature on effective schooling, rather than focusing primarily on health-related measures.

Child-Level Predictors of Responsiveness to Evidence-Based Mathematics Intervention.

PubMed

Powell, Sarah R; Cirino, Paul T; Malone, Amelia S

2017-07-01

We identified child-level predictors of responsiveness to 2 types of mathematics (calculation and word-problem) intervention among 2nd-grade children with mathematics difficulty. Participants were 250 children in 107 classrooms in 23 schools pretested on mathematics and general cognitive measures and posttested on mathematics measures. We assigned classrooms randomly assigned to calculation intervention, word-problem intervention, or business-as-usual control. Intervention lasted 17 weeks. Path analyses indicated that scores on working memory and language comprehension assessments moderated responsiveness to calculation intervention. No moderators were identified for responsiveness to word-problem intervention. Across both intervention groups and the control group, attentive behavior predicted both outcomes. Initial calculation skill predicted the calculation outcome, and initial language comprehension predicted word-problem outcomes. These results indicate that screening for calculation intervention should include a focus on working memory, language comprehension, attentive behavior, and calculations. Screening for word-problem intervention should focus on attentive behavior and word problems.

Education for eHealth--a status analysis.

PubMed

Herzog, Juliane; Pohn, Birgit; Forjan, Mathias; Sauermann, Stefan; Urbauer, Philipp

2014-01-01

eHealth is not only a growing market, but also an important factor for new healthcare systems. National and European initiatives implicitly demand a higher level of knowledge in the areas of healthcare, engineering and management. As part of the eLearning4eHealth project an initial web based study was performed concentrating on European and global eHealth related educational programs. The results show that eHealth related courses do not evenly exist for the identified professions. 43% of the offered programs are focused on the engineering sector, whereas only 21% are available for the management sector. In order to offer compatible and comparable state of knowledge in the identified fields of profession and knowledge, further educational programs may be necessary. Despite the found shortcomings, results have shown that international activities have started in order to close the gaps and improve the quality of knowledge in the interdisciplinary field of eHealth.

Gene and translation initiation site prediction in metagenomic sequences

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

Hyatt, Philip Douglas; LoCascio, Philip F; Hauser, Loren John

2012-01-01

Gene prediction in metagenomic sequences remains a difficult problem. Current sequencing technologies do not achieve sufficient coverage to assemble the individual genomes in a typical sample; consequently, sequencing runs produce a large number of short sequences whose exact origin is unknown. Since these sequences are usually smaller than the average length of a gene, algorithms must make predictions based on very little data. We present MetaProdigal, a metagenomic version of the gene prediction program Prodigal, that can identify genes in short, anonymous coding sequences with a high degree of accuracy. The novel value of the method consists of enhanced translationmore » initiation site identification, ability to identify sequences that use alternate genetic codes and confidence values for each gene call. We compare the results of MetaProdigal with other methods and conclude with a discussion of future improvements.« less

Systems Harmonization and Convergence - the GIGAS Approach

NASA Astrophysics Data System (ADS)

Marchetti, P. G.; Biancalana, A.; Coene, Y.; Uslander, T.

2009-04-01

0.1 Background The GIGAS1 Support Action promotes the coherent and interoperable development of the GMES, INSPIRE and GEOSS initiatives through their concerted adoption of standards, protocols, and open architectures. 0.2 Preparing for Coordinated Data Access The GMES Coordinated Data Access System is under design and implementation2. This objective has motivated the definition of the interoperability standards between the contributing missions. The following elements have been addressed with associated papers submitted to OGC: The EO Product Metadata has been based on the OGC Geographic Markup Language, addressing sensor characteristics for optical, radar and atmospheric products. Collection and service discovery: an ISO extension package for CSW ebRim has been proposed. Catalogue Service (CSW): an Earth Observation extension package of the CSW ebRim has been proposed. Feasibility Analysis and Order: an Order interface control document and an Earth Observation profile of the Sensor Planning Service have been proposed. Online Data Access: an Earth Observation profile of the Web Map Services (WMS) for visualization and evaluation purposes has been proposed. Identity (user) management: the objective in the long term is to allow for a single sign-on to the Coordinated Data Access system by users registered in the various Earth Observation ground segments by providing a federated identity across participating ground segments, exploiting OASIS standards. 0.3 The GIGAS proposed harmonization approach The approach proposed by GIGAS is based on three elements: Technology watch Comparative analysis Shaping of initiatives and standards This paper concentrates on the methodology for technology watch and comparative analysis. The complexity of the GIGAS scenario involving huge systems (i.e. GEOSS, INSPIRE, GMES etc.) entails the interaction with different heterogeneous partners, each with a specific competence, expertise and know-how. 0.3.1 Technology watch The methodology proposed is based on an RM-ODP based study supported by interoperability use cases and scenarios used to derive requirements. GIGAS will monitor the INSPIRE, GMES and GEOSS evolution and analyze the requirements, the standards, the services and the architecture, the models, the processes and the consensus mechanisms with the same elements of the other systems under analysis. activities in the fields of standard development that are part of the three initiatives. This task will provide the basis for how these three initiatives will strategically support consensus and efficient standards development going forward. architecture, specifications, innovative concepts and software developments of past or ongoing FP6/FP7 research topics. The use of an RM-ODP approach is selected as: most of the architectural approaches to be compared are based on RM-ODP, it supports distributed processing, it aims at fostering interoperability across heterogeneous systems, it tries to hide distribution to systems developers. However, as most of the systems to be considered have the characteristic of a loosely-coupled network of systems and services instead of a "distributed processing system based on interacting objects", the RM-ODP concepts are tailored for the GIGAS needs. The usage of RM-ODP for GIGAS Requirements and Technology Watch is two-fold: Architectural analysis: It is performed for all projects and initiatives. Its purpose is to identify possibilities but also major obstacles for interoperability. Furthermore, it identifies the major use cases to be analysed in more detail. Use Case Implementation Analysis: It is used to describe how selected use cases of the projects and initiatives are implemented in the different architectures. Its purpose is to identify technological gaps and concrete problems of interoperability. It is performed only for selected use cases. The output of the Technology Watch is an RM-ODP based report containing parallel analysis on the same aspects on the three initiatives integrated by analysis of relevant FP6-FP7 projects and standardization activities. 0.3.2 Comparative Analysis Based on the outcomes of the previous monitoring tasks, GIGAS undertakes a comparative analysis on solutions, requirements, architecture, models, processes and consensus mechanisms used by INSPIRE, GMES and GEOSS, taking into account the inputs from the monitoring of FP6/FP7 research projects and the ongoing standardization activities. Initiative Contact Points will insure that the overall policy framework and schedules for each of the three initiatives will be factored in. The result of the Comparative Analysis includes: A list of recommendations to GEOSS, INSPIRE and GMES to be expanded and processed in depth in the following shaping phase The identification of technological gaps to be explored in the following shaping phase. Guidelines and objectives for the architectural approach within GIGAS Analysis on the schedules of the three initiatives and on the FP6/FP7 programs and standardization activities, with identification of key milestones or intervention points.

Identification of novel monoamine oxidase B inhibitors by structure-based virtual screening.

PubMed

Geldenhuys, Werner J; Darvesh, Altaf S; Funk, Max O; Van der Schyf, Cornelis J; Carroll, Richard T

2010-09-01

Parkinson's disease is a severe debilitating neurodegenerative disorder. Recently, it was shown that the peroxisome proliferating-activator receptor-gamma agonist pioglitazone protected mice from 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine neurotoxicity due to its ability to inhibit monoamine oxidase B (MAO-B). Docking studies were initiated to investigate pioglitazone's interactions within the substrate cavity of MAO-B. Modeling studies indicated that the thiazolidinedione (TZD) moiety was a likely candidate for its specificity to MAO-B. To explore this potential novel MAO-B scaffold, we performed a structure-based virtual screen to identify additional MAO-B inhibitors. Our search identified eight novel compounds containing the TZD-moiety that allowed for a limited study to identify structural requirements for binding to MAO-B. Inhibition assays identified two TZDs (A6355 and L136662) which were found to inhibit recombinant human MAO-B with IC(50) values of 82 and 195 nM, respectively. Copyright 2010 Elsevier Ltd. All rights reserved.

How cigarette design can affect youth initiation into smoking: Camel cigarettes 1983-93

PubMed Central

Wayne, G; Connolly, G

2002-01-01

Objective: To determine changes in the design of Camel cigarettes in the period surrounding the "Smooth Character" advertising campaign and to assess the impact of these changes on youth smoking. Data sources: Internal documents made available through the document website maintained by RJ Reynolds, manufacturer of Camel cigarettes. Study selection: Electronic searches using keywords to identify relevant data. Data extraction: A web based index search of documents targeting "smoothness" or "harshness" and "younger adult smokers" ("YAS") or "first usual brand younger adult smokers" ("FUBYAS") in the 10 year period surrounding the introduction of the "Smooth Character" campaign was used to identify Camel related product design research projects. A snowball methodology was used: initial documents were identified by focusing on key words, codes, researchers, committees, meetings, and gaps in overall chronology; a second set of documents was culled from these initial documents, and so on. Data synthesis: Product design research led to the introduction of redesigned Camel cigarettes targeted to younger adult males coinciding with the "Smooth Character" campaign. Further refinements in Camel cigarettes during the following five year period continued to emphasise the smoothness of the cigarette, utilising additives and blends which reduced throat irritation but increased or retained nicotine impact. Conclusions: Industry competition for market share among younger adult smokers may have contributed to the reversal of a decline in youth smoking rates during the late 1980s through development of products which were more appealing to youth smokers and which aided in initiation by reducing harshness and irritation. PMID:11893812

Early Complications and Outcomes in Combat Injury Related Invasive Fungal Wound Infections: A Case-Control Analysis

PubMed Central

Lewandowski, Louis R.; Weintrob, Amy C.; Tribble, David R.; Rodriguez, Carlos J.; Petfield, Joseph; Lloyd, Bradley A.; Murray, Clinton K.; Stinner, Daniel; Aggarwal, Deepak; Shaikh, Faraz; Potter, Benjamin K.

2015-01-01

Objective Clinicians have anecdotally noted that combat-related invasive fungal wound infections (IFIs) lead to residual limb shortening, additional days and operative procedures prior to initial wound closure, and high early complication rates. We evaluated the validity of these observations and identified risk factors that may impact time to initial wound closure. Design Retrospective review and case-control analysis. Setting Military hospitals. Patients/Participants United States military personnel injured during combat operations (2009–2011). The IFI cases were identified based upon the presence of recurrent, necrotic extremity wounds with mold growth in culture and/or histopathologic fungal evidence. Non-IFI controls were matched on injury pattern and severity. In a supplemental matching analysis, non-IFI controls were also matched by blood volume transfused within 24 hours of injury. Intervention None. Main Outcome Measurements Amputation revision rate and loss of functional levels. Results Seventy-one IFI cases (112 fungal-infected extremity wounds) were identified and matched to 160 control patients (315 non-IFI extremity wounds). The IFI wounds resulted in significantly more changes in amputation level (p<0.001). Additionally, significantly (p<0.001) higher number of operative procedures and longer duration to initial wound closure was associated with IFI. A shorter duration to initial wound closure was significantly associated with wounds lacking IFIs (Hazard ratio: 1.53; 95% CI: 1.17, 2.01). The supplemental matching analysis found similar results. Conclusions Our analysis indicates that IFIs adversely impact wound healing and patient recovery, requiring more frequent proximal amputation revisions and leading to higher early complication rates. PMID:26360542

Residents as health advocates: The development, implementation and evaluation of a child advocacy initiative at the University of Toronto (Toronto, Ontario).

PubMed

Au, Hosanna; Harrison, Megan; Ahmet, Alexandra; Orsino, Angela; Beck, Carolyn E; Tallett, Susan; Gans, Marvin; Birken, Catherine S

2007-09-01

Advocacy is an integral part of a paediatrician's role. The Royal College of Physicians and Surgeons of Canada has identified advocacy as one of the essential Canadian Medical Education Directives for Specialists competencies, and participation in child advocacy work as an important component of paediatric residency training. The objective of the present paper was to describe the development, implementation and evaluation of the first four years of the child advocacy initiative at the University of Toronto (Toronto, Ontario). Ideas for community child advocacy projects were generated through a literature review, and a link to a local elementary school was identified. Teacher and parent focus groups were conducted to identify areas for resident involvement. Workshops were then developed, implemented and evaluated by paediatric residents. Six child advocacy projects between 2001 and 2004 were conducted based on results from the focus groups. These included annual clothing drives, as well as workshops for parents and children about nutrition, safety, parenting, illness management and basic first aid. More than 95% of parents reported that the workshops were useful or very useful, more than 92% felt that they learned something new and more than 83% wanted the residents to return for further workshops. Teachers and residents gave positive informal feedback. Through the child advocacy initiative, paediatric residents had the opportunity to develop skills in advocacy, learn about the determinants of child health and become community partners in advocating for children. Such an initiative can be incorporated into the residency curriculum to help residents develop competency in advocacy.

pH and Organic Carbon Dose Rates Control Microbially Driven Bioremediation Efficacy in Alkaline Bauxite Residue.

PubMed

Santini, Talitha C; Malcolm, Laura I; Tyson, Gene W; Warren, Lesley A

2016-10-18

Bioremediation of alkaline tailings, based on fermentative microbial metabolisms, is a novel strategy for achieving rapid pH neutralization and thus improving environmental outcomes associated with mining and refining activities. Laboratory-scale bioreactors containing bauxite residue (an alkaline, saline tailings material generated as a byproduct of alumina refining), to which a diverse microbial inoculum was added, were used in this study to identify key factors (pH, salinity, organic carbon supply) controlling the rates and extent of microbially driven pH neutralization (bioremediation) in alkaline tailings. Initial tailings pH and organic carbon dose rates both significantly affected bioremediation extent and efficiency with lower minimum pHs and higher extents of pH neutralization occurring under low initial pH or high organic carbon conditions. Rates of pH neutralization (up to 0.13 mM H + produced per day with pH decreasing from 9.5 to ≤6.5 in three days) were significantly higher in low initial pH treatments. Representatives of the Bacillaceae and Enterobacteriaceae, which contain many known facultative anaerobes and fermenters, were identified as key contributors to 2,3-butanediol and/or mixed acid fermentation as the major mechanism(s) of pH neutralization. Initial pH and salinity significantly influenced microbial community successional trajectories, and microbial community structure was significantly related to markers of fermentation activity. This study provides the first experimental demonstration of bioremediation in bauxite residue, identifying pH and organic carbon dose rates as key controls on bioremediation efficacy, and will enable future development of bioreactor technologies at full field scale.

Molecular Mechanism of Scanning and Start Codon Selection in Eukaryotes

PubMed Central

Hinnebusch, Alan G.

2011-01-01

Summary: The correct translation of mRNA depends critically on the ability to initiate at the right AUG codon. For most mRNAs in eukaryotic cells, this is accomplished by the scanning mechanism, wherein the small (40S) ribosomal subunit attaches to the 5′ end of the mRNA and then inspects the leader base by base for an AUG in a suitable context, using complementarity with the anticodon of methionyl initiator tRNA (Met-tRNAiMet) as the key means of identifying AUG. Over the past decade, a combination of yeast genetics, biochemical analysis in reconstituted systems, and structural biology has enabled great progress in deciphering the mechanism of ribosomal scanning. A robust molecular model now exists, describing the roles of initiation factors, notably eukaryotic initiation factor 1 (eIF1) and eIF1A, in stabilizing an “open” conformation of the 40S subunit with Met-tRNAiMet bound in a low-affinity state conducive to scanning and in triggering rearrangement into a “closed” conformation incompatible with scanning, which features Met-tRNAiMet more tightly bound to the “P” site and base paired with AUG. It has also emerged that multiple DEAD-box RNA helicases participate in producing a single-stranded “landing pad” for the 40S subunit and in removing the secondary structure to enable the mRNA to traverse the 40S mRNA-binding channel in the single-stranded form for base-by-base inspection in the P site. PMID:21885680

Public Health Adaptation to Climate Change in Canadian Jurisdictions

PubMed Central

Austin, Stephanie E.; Ford, James D.; Berrang-Ford, Lea; Araos, Malcolm; Parker, Stephen; Fleury, Manon D.

2015-01-01

Climate change poses numerous risks to the health of Canadians. Extreme weather events, poor air quality, and food insecurity in northern regions are likely to increase along with the increasing incidence and range of infectious diseases. In this study we identify and characterize Canadian federal, provincial, territorial and municipal adaptation to these health risks based on publically available information. Federal health adaptation initiatives emphasize capacity building and gathering information to address general health, infectious disease and heat-related risks. Provincial and territorial adaptation is varied. Quebec is a leader in climate change adaptation, having a notably higher number of adaptation initiatives reported, addressing almost all risks posed by climate change in the province, and having implemented various adaptation types. Meanwhile, all other Canadian provinces and territories are in the early stages of health adaptation. Based on publically available information, reported adaptation also varies greatly by municipality. The six sampled Canadian regional health authorities (or equivalent) are not reporting any adaptation initiatives. We also find little relationship between the number of initiatives reported in the six sampled municipalities and their provinces, suggesting that municipalities are adapting (or not adapting) autonomously. PMID:25588156

Microstructure Modeling of 3rd Generation Disk Alloy

NASA Technical Reports Server (NTRS)

Jou, Herng-Jeng

2008-01-01

The objective of this initiative, funded by NASA's Aviation Safety Program, is to model, validate, and predict, with high fidelity, the microstructural evolution of third-generation high-refractory Ni-based disc superalloys during heat treating and service conditions. This initiative is a natural extension of the DARPA-AIM (Accelerated Insertion of Materials) initiative with GE/Pratt-Whitney and with other process simulation tools. Strong collaboration with the NASA Glenn Research Center (GRC) is a key component of this initiative and the focus of this program is on industrially relevant disk alloys and heat treatment processes identified by GRC. Employing QuesTek s Computational Materials Dynamics technology and PrecipiCalc precipitation simulator, physics-based models are being used to achieve high predictive accuracy and precision. Combining these models with experimental data and probabilistic analysis, "virtual alloy design" can be performed. The predicted microstructures can be optimized to promote desirable features and concurrently eliminate nondesirable phases that can limit the reliability and durability of the alloys. The well-calibrated and well-integrated software tools that are being applied under the proposed program will help gas turbine disk alloy manufacturers, processing facilities, and NASA, to efficiently and effectively improve the performance of current and future disk materials.

An ant colony based algorithm for overlapping community detection in complex networks

NASA Astrophysics Data System (ADS)

Zhou, Xu; Liu, Yanheng; Zhang, Jindong; Liu, Tuming; Zhang, Di

2015-06-01

Community detection is of great importance to understand the structures and functions of networks. Overlap is a significant feature of networks and overlapping community detection has attracted an increasing attention. Many algorithms have been presented to detect overlapping communities. In this paper, we present an ant colony based overlapping community detection algorithm which mainly includes ants' location initialization, ants' movement and post processing phases. An ants' location initialization strategy is designed to identify initial location of ants and initialize label list stored in each node. During the ants' movement phase, the entire ants move according to the transition probability matrix, and a new heuristic information computation approach is redefined to measure similarity between two nodes. Every node keeps a label list through the cooperation made by ants until a termination criterion is reached. A post processing phase is executed on the label list to get final overlapping community structure naturally. We illustrate the capability of our algorithm by making experiments on both synthetic networks and real world networks. The results demonstrate that our algorithm will have better performance in finding overlapping communities and overlapping nodes in synthetic datasets and real world datasets comparing with state-of-the-art algorithms.

Animal species endangerment: The role of environmental pollution

USGS Publications Warehouse

Pattee, Oliver H.; Fellows, Valerie L.; Bounds, Dixie L.; Hoffman, David J.; Rattner, Barnett A.; Burton, G. Allen; Cairns, John

2003-01-01

Multiple factors contribute to the decline of species. Habitat destruction is the primary factor that threatens species. affecting 73 % of endangered species. The second major factor causing species decline is the introduction of nonnative species. affecting 68% of endangered species. Pollution and overharvesting were identified as impacting, respectively, 38 and 15% of endangered species. Other factors affecting species decline include hybridization, competition, disease, and other interspecific interactions. Once a species is reduced to a remnant of its former population size and distribution, its vulnerability to catastrophic pollution events increases, frequently exceeding or replacing the factors responsible for the initial decline. Small, isolated populations are particularly vulnerable to catastrophic loss by an acute event. such as a chemical spill or pesticide application. However, when it comes to surviving a single disaster, widespread subpopulations of a species are far more resilient and ensure genetic survival. Hypothesizing theoretical concerns of potential factors that could affect an endangered species could predispose the scientific and political communities to jeopardizing threats. The user of recovery plans as a data source must be aware of the bias within the data set. These data should be used with the caveat that the source of information in recovery plans is not always based on scientific research and rigorous data collection. Over 58% of the information identifying species threats is based on estimates or personal communication. while only 42% is based on peer reviewed literature, academic research. or government reports. Many recovery plans were written when a species was initially listed in the 1970s or 1980s. Politics, human disturbance, and habitat demand issues evolve over a 20- to 30-year period. leaving much of the threats facing endangered species outdated and inadequate. These data are most valuable when used to facilitate reviews of Section 7 consultations and environmental impact statements, review permit applications, conduct environmental risk assessments, prioritize research needs. and identify limiting factors affecting species health. These data are also useful in identifying potential threats to species' health. Without properly identifying threats to endangered species based on sound. scientific research. there is little hope to successfully recover an endangered species.

Predicting Phosphorus Dynamics Across Physiographic Regions Using a Mixed Hortonian Non-Hortonian Hydrology Model

NASA Astrophysics Data System (ADS)

Collick, A.; Easton, Z. M.; Auerbach, D.; Buchanan, B.; Kleinman, P. J. A.; Fuka, D.

2017-12-01

Predicting phosphorus (P) loss from agricultural watersheds depends on accurate representation of the hydrological and chemical processes governing P mobility and transport. In complex landscapes, P predictions are complicated by a broad range of soils with and without restrictive layers, a wide variety of agricultural management, and variable hydrological drivers. The Soil and Water Assessment Tool (SWAT) is a watershed model commonly used to predict runoff and non-point source pollution transport, but is commonly only used with Hortonian (traditional SWAT) or non-Hortonian (SWAT-VSA) initializations. Many shallow soils underlain by a restricting layer commonly generate saturation excess runoff from variable source areas (VSA), which is well represented in a re-conceptualized version, SWAT-VSA. However, many watersheds exhibit traits of both infiltration excess and saturation excess hydrology internally, based on the hydrologic distance from the stream, distribution of soils across the landscape, and characteristics of restricting layers. The objective of this research is to provide an initial look at integrating distributed predictive capabilities that consider both Hortonian and Non-Hortonian solutions simultaneously within a single SWAT-VSA initialization. We compare results from all three conceptual watershed initializations against measured surface runoff and stream P loads and to highlight the model's ability to drive sub-field management of P. All three initializations predict discharge similarly well (daily Nash-Sutcliffe Efficiencies above 0.5), but the new conceptual SWAT-VSA initialization performed best in predicting P export from the watershed, while also identifying critical source areas - those areas generating large runoff and P losses at the sub field level. These results support the use of mixed Hortonian non-Hortonian SWAT-VSA initializations in predicting watershed-scale P losses and identifying critical source areas of P loss in landscapes with VSA hydrology.

A case study of polypharmacy management in nine European countries: Implications for change management and implementation.

PubMed

McIntosh, Jennifer; Alonso, Albert; MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

Whooping crane stopover site use intensity within the Great Plains

USGS Publications Warehouse

Pearse, Aaron T.; Brandt, David A.; Harrell, Wade C.; Metzger, Kristine L.; Baasch, David M.; Hefley, Trevor J.

2015-09-23

Whooping cranes (Grus americana) of the Aransas-Wood Buffalo population migrate twice each year through the Great Plains in North America. Recovery activities for this endangered species include providing adequate places to stop and rest during migration, which are generally referred to as stopover sites. To assist in recovery efforts, initial estimates of stopover site use intensity are presented, which provide opportunity to identify areas across the migration range used more intensively by whooping cranes. We used location data acquired from 58 unique individuals fitted with platform transmitting terminals that collected global position system locations. Radio-tagged birds provided 2,158 stopover sites over 10 migrations and 5 years (2010–14). Using a grid-based approach, we identified 1,095 20-square-kilometer grid cells that contained stopover sites. We categorized occupied grid cells based on density of stopover sites and the amount of time cranes spent in the area. This assessment resulted in four categories of stopover site use: unoccupied, low intensity, core intensity, and extended-use core intensity. Although provisional, this evaluation of stopover site use intensity offers the U.S. Fish and Wildlife Service and partners a tool to identify landscapes that may be of greater conservation significance to migrating whooping cranes. Initially, the tool will be used by the U.S. Fish and Wildlife Service and other interested parties in evaluating the Great Plains Wind Energy Habitat Conservation Plan.

Towards acute pediatric status epilepticus intervention teams: Do we need "Seizure Codes"?

PubMed

Stredny, Coral M; Abend, Nicholas S; Loddenkemper, Tobias

2018-05-01

To identify areas of treatment delay and barriers to care in pediatric status epilepticus, review ongoing quality improvement initiatives, and provide suggestions for further innovations to improve and standardize these patient care processes. Narrative review of current status epilepticus management algorithms, anti-seizure medication administration and outcomes associated with delays, and initiatives to improve time to treatment. Articles reviewing or reporting quality improvement initiatives were identified through a PubMed search with keywords "status epilepticus," "quality improvement," "guideline adherence," and/or "protocol;" references of included articles were also reviewed. Rapid initiation and escalation of status epilepticus treatment has been associated with shortened seizure duration and more favorable outcomes. Current evidence-based guidelines for management of status epilepticus propose medication algorithms with suggested times for each management step. However, time to antiseizure medication administration for pediatric status epilepticus remains delayed in both the pre- and in-hospital settings. Barriers to timely treatment include suboptimal preventive care, inaccurate seizure detection, infrequent or restricted use of home rescue medications by caregivers and pre-hospital emergency personnel, delayed summoning and arrival of emergency personnel, and use of inappropriately dosed medications. Ongoing quality improvement initiatives in the pre- and in-hospital settings targeting these barriers are reviewed. Improved preventive care, seizure detection, and rescue medication education may advance pre-hospital management, and we propose the use of acute status epilepticus intervention teams to initiate and incorporate in-hospital interventions as time-sensitive "Seizure Code" emergencies. Copyright © 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Identification of aberrant gene expression associated with aberrant promoter methylation in primordial germ cells between E13 and E16 rat F3 generation vinclozolin lineage.

PubMed

Taguchi, Y-h

2015-01-01

Transgenerational epigenetics (TGE) are currently considered important in disease, but the mechanisms involved are not yet fully understood. TGE abnormalities expected to cause disease are likely to be initiated during development and to be mediated by aberrant gene expression associated with aberrant promoter methylation that is heritable between generations. However, because methylation is removed and then re-established during development, it is not easy to identify promoter methylation abnormalities by comparing normal lineages with those expected to exhibit TGE abnormalities. This study applied the recently proposed principal component analysis (PCA)-based unsupervised feature extraction to previously reported and publically available gene expression/promoter methylation profiles of rat primordial germ cells, between E13 and E16 of the F3 generation vinclozolin lineage that are expected to exhibit TGE abnormalities, to identify multiple genes that exhibited aberrant gene expression/promoter methylation during development. The biological feasibility of the identified genes were tested via enrichment analyses of various biological concepts including pathway analysis, gene ontology terms and protein-protein interactions. All validations suggested superiority of the proposed method over three conventional and popular supervised methods that employed t test, limma and significance analysis of microarrays, respectively. The identified genes were globally related to tumors, the prostate, kidney, testis and the immune system and were previously reported to be related to various diseases caused by TGE. Among the genes reported by PCA-based unsupervised feature extraction, we propose that chemokine signaling pathways and leucine rich repeat proteins are key factors that initiate transgenerational epigenetic-mediated diseases, because multiple genes included in these two categories were identified in this study.

Identification of aberrant gene expression associated with aberrant promoter methylation in primordial germ cells between E13 and E16 rat F3 generation vinclozolin lineage

PubMed Central

2015-01-01

Background Transgenerational epigenetics (TGE) are currently considered important in disease, but the mechanisms involved are not yet fully understood. TGE abnormalities expected to cause disease are likely to be initiated during development and to be mediated by aberrant gene expression associated with aberrant promoter methylation that is heritable between generations. However, because methylation is removed and then re-established during development, it is not easy to identify promoter methylation abnormalities by comparing normal lineages with those expected to exhibit TGE abnormalities. Methods This study applied the recently proposed principal component analysis (PCA)-based unsupervised feature extraction to previously reported and publically available gene expression/promoter methylation profiles of rat primordial germ cells, between E13 and E16 of the F3 generation vinclozolin lineage that are expected to exhibit TGE abnormalities, to identify multiple genes that exhibited aberrant gene expression/promoter methylation during development. Results The biological feasibility of the identified genes were tested via enrichment analyses of various biological concepts including pathway analysis, gene ontology terms and protein-protein interactions. All validations suggested superiority of the proposed method over three conventional and popular supervised methods that employed t test, limma and significance analysis of microarrays, respectively. The identified genes were globally related to tumors, the prostate, kidney, testis and the immune system and were previously reported to be related to various diseases caused by TGE. Conclusions Among the genes reported by PCA-based unsupervised feature extraction, we propose that chemokine signaling pathways and leucine rich repeat proteins are key factors that initiate transgenerational epigenetic-mediated diseases, because multiple genes included in these two categories were identified in this study. PMID:26677731

Identifying critical transitions and their leading biomolecular networks in complex diseases.

PubMed

Liu, Rui; Li, Meiyi; Liu, Zhi-Ping; Wu, Jiarui; Chen, Luonan; Aihara, Kazuyuki

2012-01-01

Identifying a critical transition and its leading biomolecular network during the initiation and progression of a complex disease is a challenging task, but holds the key to early diagnosis and further elucidation of the essential mechanisms of disease deterioration at the network level. In this study, we developed a novel computational method for identifying early-warning signals of the critical transition and its leading network during a disease progression, based on high-throughput data using a small number of samples. The leading network makes the first move from the normal state toward the disease state during a transition, and thus is causally related with disease-driving genes or networks. Specifically, we first define a state-transition-based local network entropy (SNE), and prove that SNE can serve as a general early-warning indicator of any imminent transitions, regardless of specific differences among systems. The effectiveness of this method was validated by functional analysis and experimental data.

Risk factors for recurrent episodes of care and work disability: case of low back pain.

PubMed

Wasiak, Radoslaw; Verma, Santosh; Pransky, Glenn; Webster, Barbara

2004-01-01

Recurrences of injuries are common and have significant socioeconomic consequences; it is important to identify associated risk factors as potential opportunities for prevention. This study was conducted to identify risk factors for low back pain (LBP) recurrence and the extent that variation in recurrence definition impacts identified risk factors. Patients with new claims for LBP reported in New Hampshire to a workers' compensation provider were selected (n = 2023) with a minimum of 3-year follow up. Alternative definitions of recurrence included a new episode of medical care and a new episode of lost work time (work disability). Risk factors better predicted disability-based than treatment-based recurrence. Longer durations of the initial episode of care or work disability were the most powerful predictors of recurrence, implying that shorter episodes of care and early return to work contribute to better outcomes.

Breast cancer screening in an era of personalized regimens: a conceptual model and National Cancer Institute initiative for risk-based and preference-based approaches at a population level.

PubMed

Onega, Tracy; Beaber, Elisabeth F; Sprague, Brian L; Barlow, William E; Haas, Jennifer S; Tosteson, Anna N A; D Schnall, Mitchell; Armstrong, Katrina; Schapira, Marilyn M; Geller, Berta; Weaver, Donald L; Conant, Emily F

2014-10-01

Breast cancer screening holds a prominent place in public health, health care delivery, policy, and women's health care decisions. Several factors are driving shifts in how population-based breast cancer screening is approached, including advanced imaging technologies, health system performance measures, health care reform, concern for "overdiagnosis," and improved understanding of risk. Maximizing benefits while minimizing the harms of screening requires moving from a "1-size-fits-all" guideline paradigm to more personalized strategies. A refined conceptual model for breast cancer screening is needed to align women's risks and preferences with screening regimens. A conceptual model of personalized breast cancer screening is presented herein that emphasizes key domains and transitions throughout the screening process, as well as multilevel perspectives. The key domains of screening awareness, detection, diagnosis, and treatment and survivorship are conceptualized to function at the level of the patient, provider, facility, health care system, and population/policy arena. Personalized breast cancer screening can be assessed across these domains with both process and outcome measures. Identifying, evaluating, and monitoring process measures in screening is a focus of a National Cancer Institute initiative entitled PROSPR (Population-based Research Optimizing Screening through Personalized Regimens), which will provide generalizable evidence for a risk-based model of breast cancer screening, The model presented builds on prior breast cancer screening models and may serve to identify new measures to optimize benefits-to-harms tradeoffs in population-based screening, which is a timely goal in the era of health care reform. © 2014 American Cancer Society.

Spallation Neutron Source Second Target Station Integrated Systems Update

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

Ankner, John Francis; An, Ke; Blokland, Willem

The Spallation Neutron Source (SNS) was designed from the beginning to accommodate both an accelerator upgrade to increase the proton power and a second target station (STS). Four workshops were organized in 2013 and 2014 to identify key science areas and challenges where neutrons will play a vital role [1-4]. Participants concluded that the addition of STS to the existing ORNL neutron sources was needed to complement the strengths of High Flux Isotope Reactor (HFIR) and the SNS first target station (FTS). To address the capability gaps identified in the workshops, a study was undertaken to identify instrument concepts thatmore » could provide the required new science capabilities. The study outlined 22 instrument concepts and presented an initial science case for STS [5]. These instrument concepts formed the basis of a planning suite of instruments whose requirements determined an initial site layout and moderator selection. An STS Technical Design Report (TDR) documented the STS concept based on those choices [6]. Since issue of the TDR, the STS concept has significantly matured as described in this document.« less

Brain-Derived Neurotrophic Factor Levels in Autism: A Systematic Review and Meta-Analysis.

PubMed

Saghazadeh, Amene; Rezaei, Nima

2017-04-01

Brain-derived neurotrophic factor (BDNF) plays an important role in activity-dependent synaptic plasticity. Altered blood BDNF levels have been frequently identified in people with autism spectrum disorders (ASD). There are however wide discrepancies in the evidence. Therefore, we performed the present systematic review and meta-analysis aimed at qualitative and quantitative synthesis of studies that measured blood BDNF levels in ASD and control subjects. Observational studies were identified through electronic database searching and also hand-searching of reference lists of relevant articles. A total of 183 papers were initially identified for review and eventually twenty studies were included in the meta-analysis. A meta-analysis of blood BDNF in 887 patients with ASD and 901 control subjects demonstrated significantly higher BDNF levels in ASD compared to controls with the SMD of 0.47 (95% CI 0.07-0.86, p = 0.02). In addition subgroup meta-analyses were performed based on the BDNF specimen. The present meta-analysis study led to conclusion that BDNF might play role in autism initiation/ propagation and therefore it can be considered as a possible biomarker of ASD.

Microbial Monitoring of Common Opportunistic Pathogens by Comparing Multiple Real-Time PCR Platforms for Potential Space Applications

NASA Technical Reports Server (NTRS)

Oubre, Cherie M.; Birmele, Michele N.; Castro, Victoria A.; Venkateswaran, Kasthuri J.; Vaishampayan, Parag A.; Jones, Kathy U.; Singhal, Adesh; Johnston, Angela S.; Roman, Monserrate C.; Ozbolt, Tamra A.;

Impact of 2015 Update to the Beers Criteria on Estimates of Prevalence and Costs Associated with Potentially Inappropriate Use of Antimuscarinics for Overactive Bladder.

PubMed

Suehs, Brandon T; Davis, Cralen; Ng, Daniel B; Gooch, Katherine

2017-07-01

Research has demonstrated that the use of potentially inappropriate medication (PIM) is highly prevalent among older individuals and may lead to increased healthcare costs, adverse drug reactions, hospitalizations, and mortality. The purpose of this study was to examine the impact of the 2015 updates to the Beers Criteria on estimates of prevalence and cost associated with potentially inappropriate use of antimuscarinic medications indicated for treatment of overactive bladder (OAB). A retrospective database analysis was conducted using a historical cohort design and including data collected between 2007 and 2013. Claims data were used to identify Medicare Advantage patients aged ≥65 years newly initiated on antimuscarinic OAB treatment. Patients were classified with potentially inappropriate use of antimuscarinic OAB drugs based on either the 2012 Beers Criteria or the 2015 Beers Criteria. Prevalence of PIM at the time of antimuscarinic initiation was determined. Bivariate comparisons of healthcare costs and medical condition burden were conducted to compare the marginal groups of patients (who qualified based on the 2012 Beers Criteria only or the 2015 Beers Criteria only). Differences in healthcare costs for patients with and without potentially inappropriate use of urinary antimuscarinics based on the 2012 and 2015 Beers Criteria were also examined. Of 66,275 patients, overall prevalence of potentially inappropriate use of OAB antimuscarinics was higher using 2015 Beers Criteria than when using the 2012 Beers Criteria (25.0 vs. 20.6%). Dementia was the most common PIM-qualifying condition under both versions. The 2015 Beers Criteria identified more females, more White people, and a younger population with PIM. Comorbid medical condition burden was lower using the 2015 Beers Criteria. The 2015 Beers Criteria only group had lower median unadjusted healthcare costs ($7104 vs. 8301; p < 0.001). The incremental net cost associated with potentially inappropriate use of antimuscarinic medication was higher under the 2012 Beers Criteria than under the 2015 Beers Criteria. In this cohort of patients newly initiated on antimuscarinic OAB treatment, substantial overlap of patients identified with PIM based on the 2015 Beers Criteria compared with the 2012 Beers Criteria was observed. In addition, the findings suggest that, when applied to antimuscarinic initiators, the 2015 Beers Criteria result in a greater prevalence of PIM and the identification of patients with less overall medical morbidity than the 2012 Beers Criteria.

Practical recommendations for the evaluation of improvement initiatives

PubMed Central

Parry, Gareth; Coly, Astou; Goldmann, Don; Rowe, Alexander K; Chattu, Vijay; Logiudice, Deneil; Rabrenovic, Mihajlo; Nambiar, Bejoy

2018-01-01

Abstract A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. PMID:29447410

A systematic approach to evaluating public health training: the obesity prevention in public health course.

PubMed

Mainor, Avia; Leeman, Jennifer; Sommers, Janice; Heiser, Claire; Gonzales, Cecilia; Farris, Rosanne P; Ammerman, Alice

2014-01-01

Public health practitioners require new knowledge and skills to address the multilevel factors contributing to obesity. This article presents the systematic approach the Center of Excellence for Training and Research Translation (Center TRT) used both to assess practitioners' competencies to lead public health obesity prevention initiatives and to evaluate its annual, competency-based obesity prevention course. In 2006, Center TRT identified priority public health competencies for obesity prevention and then planned 7 annual courses to address the priority competencies progressively over time. Each year, a longitudinal evaluation based on Kirkpatrick's training evaluation framework was administered to course participants (n = 243) to assess perceptions of the course (daily), changes in self-reported competency (immediately pre- and postcourse), and course impact on practice over time (at 6 months). Participants rated the course highly for quality and relevance. Although many participants reported low levels of confidence prior to the course, following the course, at least 70% reported feeling confident to perform almost all competencies. At 6-month follow-up, the majority of participants reported completing at least 1 activity identified during course action planning. We identified practitioners' high-priority competency needs and then designed 7 annual courses to progressively address those needs and new needs as they arose. This approach resulted in trainings valued by practitioners and effective in increasing their sense of competence to lead public health obesity prevention initiatives. The course's continuing impact was evidenced by participants' high level of completion of their action plans at 6-month follow-up. Competency-based training is important to develop a skilled public health workforce.

Advanced space power requirements and techniques. Task 1: Mission projections and requirements. Volume 1: Technical report

NASA Technical Reports Server (NTRS)

Wolfe, M. G.

1978-01-01

The objectives of this study were to: (1) develop projections of the NASA, DoD, and civil space power requirements for the 1980-1995 time period; (2) identify specific areas of application and space power subsystem type needs for each prospective user; (3) document the supporting and historical base, including relevant cost related measures of performance; and (4) quantify the benefits of specific technology projection advancements. The initial scope of the study included: (1) construction of likely models for NASA, DoD, and civil space systems; (2) generation of a number of future scenarios; (3) extraction of time phased technology requirements based on the scenarios; and (4) cost/benefit analyses of some of the technologies identified.

Measures of Cultural Competence in Nurses: An Integrative Review

PubMed Central

2013-01-01

Background. There is limited literature available identifying and describing the instruments that measure cultural competence in nursing students and nursing professionals. Design. An integrative review was undertaken to identify the characteristics common to these instruments, examine their psychometric properties, and identify the concepts these instruments are designed to measure. Method. There were eleven instruments identified that measure cultural competence in nursing. Of these eleven instruments, four had been thoroughly tested in either initial development or in subsequent testing, with developers providing extensive details of the testing. Results. The current literature identifies that the instruments to assess cultural competence in nurses and nursing students are self-administered and based on individuals' perceptions. The instruments are commonly utilized to test the effectiveness of educational programs designed to increase cultural competence. Conclusions. The reviewed instruments measure nurses' self-perceptions or self-reported level of cultural competence but offer no objective measure of culturally competent care from a patient's perspective which can be problematic. Comparison of instruments reveals that they are based on a variety of conceptual frameworks and that multiple factors should be considered when deciding which instrument to use. PMID:23818818

Mechanism-based classification of PAH mixtures to predict carcinogenic potential

DOE PAGES

Tilton, Susan C.; Siddens, Lisbeth K.; Krueger, Sharon K.; ...

2015-04-22

We have previously shown that relative potency factors and DNA adduct measurements are inadequate for predicting carcinogenicity of certain polycyclic aromatic hydrocarbons (PAHs) and PAH mixtures, particularly those that function through alternate pathways or exhibit greater promotional activity compared to benzo[ a]pyrene (BaP). Therefore, we developed a pathway based approach for classification of tumor outcome after dermal exposure to PAH/mixtures. FVB/N mice were exposed to dibenzo[ def,p]chrysene (DBC), BaP or environmental PAH mixtures (Mix 1-3) following a two-stage initiation/promotion skin tumor protocol. Resulting tumor incidence could be categorized by carcinogenic potency as DBC>>BaP=Mix2=Mix3>Mix1=Control, based on statistical significance. Gene expression profilesmore » measured in skin of mice collected 12 h post-initiation were compared to tumor outcome for identification of short-term bioactivity profiles. A Bayesian integration model was utilized to identify biological pathways predictive of PAH carcinogenic potential during initiation. Integration of probability matrices from four enriched pathways (p<0.05) for DNA damage, apoptosis, response to chemical stimulus and interferon gamma signaling resulted in the highest classification accuracy with leave-one-out cross validation. This pathway-driven approach was successfully utilized to distinguish early regulatory events during initiation prognostic for tumor outcome and provides proof-of-concept for using short-term initiation studies to classify carcinogenic potential of environmental PAH mixtures. As a result, these data further provide a ‘source-to outcome’ model that could be used to predict PAH interactions during tumorigenesis and provide an example of how mode-of-action based risk assessment could be employed for environmental PAH mixtures.« less

Mechanism-Based Classification of PAH Mixtures to Predict Carcinogenic Potential.

PubMed

Tilton, Susan C; Siddens, Lisbeth K; Krueger, Sharon K; Larkin, Andrew J; Löhr, Christiane V; Williams, David E; Baird, William M; Waters, Katrina M

2015-07-01

We have previously shown that relative potency factors and DNA adduct measurements are inadequate for predicting carcinogenicity of certain polycyclic aromatic hydrocarbons (PAHs) and PAH mixtures, particularly those that function through alternate pathways or exhibit greater promotional activity compared to benzo[a]pyrene (BaP). Therefore, we developed a pathway-based approach for classification of tumor outcome after dermal exposure to PAH/mixtures. FVB/N mice were exposed to dibenzo[def,p]chrysene (DBC), BaP, or environmental PAH mixtures (Mix 1-3) following a 2-stage initiation/promotion skin tumor protocol. Resulting tumor incidence could be categorized by carcinogenic potency as DBC > BaP = Mix2 = Mix3 > Mix1 = Control, based on statistical significance. Gene expression profiles measured in skin of mice collected 12 h post-initiation were compared with tumor outcome for identification of short-term bioactivity profiles. A Bayesian integration model was utilized to identify biological pathways predictive of PAH carcinogenic potential during initiation. Integration of probability matrices from four enriched pathways (P < .05) for DNA damage, apoptosis, response to chemical stimulus, and interferon gamma signaling resulted in the highest classification accuracy with leave-one-out cross validation. This pathway-driven approach was successfully utilized to distinguish early regulatory events during initiation prognostic for tumor outcome and provides proof-of-concept for using short-term initiation studies to classify carcinogenic potential of environmental PAH mixtures. These data further provide a 'source-to-outcome' model that could be used to predict PAH interactions during tumorigenesis and provide an example of how mode-of-action-based risk assessment could be employed for environmental PAH mixtures. © The Author 2015. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

The knowledge-based framework for a nuclear power plant operator advisor

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

Miller, D.W.; Hajek, B.K.

1989-01-01

An important facet in the design, development, and evaluation of aids for complex systems is the identification of the tasks performed by the operator. Operator aids utilizing artificial intelligence, or more specifically knowledge-based systems, require identification of these tasks in the context of a knowledge-based framework. In this context, the operator responses to the plant behavior are to monitor and comprehend the state of the plant, identify normal and abnormal plant conditions, diagnose abnormal plant conditions, predict plant response to specific control actions, and select the best available control action, implement a feasible control action, monitor system response to themore » control action, and correct for any inappropriate responses. These tasks have been identified to formulate a knowledge-based framework for an operator advisor under development at Ohio State University that utilizes the generic task methodology proposed by Chandrasekaran. The paper lays the foundation to identify the responses as a knowledge-based set of tasks in accordance with the expected human operator responses during an event. Initial evaluation of the expert system indicates the potential for an operator aid that will improve the operator's ability to respond to both anticipated and unanticipated events.« less

Views and Experiences of Malaysian Family Medicine Trainees of Female Sexual Dysfunction.

PubMed

Lai, Pauline Siew Mei; Tan, Sing Yee; Liew, Su May

2016-11-01

Sociocultural factors have been shown to be important influencers of sexual health and sexuality. Hence, the aim of our study was to explore the views and experiences of family medicine trainees regarding female sexual dysfunction (FSD) with a focus on the barriers and facilitators towards the initiation of conversation on this topic. A qualitative study design involving semi-structured focus group discussions (FGDs) was conducted with 19 family medicine trainees in Malaysia. The conceptual framework used was based on the Theory of Planned Behavior. Thematic approach was used to analyze the data. Participants perceived FSD as being uncommon and unimportant. According to our participants, patients often presented with indirect complaints, and doctors were not proactive in asking about FSD. Three main barriers were identified: doctor factors, perceived patient factors, and system factors. Lack of confidence, knowledge, experience, time, and embarrassment were the key barriers identified at the doctors' level. Lack of awareness, among patients regarding FSD, and local cultural and religious norms were the perceived patient barriers. System barriers were lack of time and privacy. Various facilitators, such as continuous medical education and public forums, were suggested as means to encourage family medicine trainees to initiate discussion on sexual matters during consultations. In conclusion, family medicine trainees found it difficult to initiate conversation on FSD with patients. Interventions to encourage conversation on FSD should target this and other identified barriers.

Participatory Planning, Monitoring and Evaluation of Multi-Stakeholder Platforms in Integrated Landscape Initiatives.

PubMed

Kusters, Koen; Buck, Louise; de Graaf, Maartje; Minang, Peter; van Oosten, Cora; Zagt, Roderick

2018-07-01

Integrated landscape initiatives typically aim to strengthen landscape governance by developing and facilitating multi-stakeholder platforms. These are institutional coordination mechanisms that enable discussions, negotiations, and joint planning between stakeholders from various sectors in a given landscape. Multi-stakeholder platforms tend to involve complex processes with diverse actors, whose objectives and focus may be subjected to periodic re-evaluation, revision or reform. In this article we propose a participatory method to aid planning, monitoring, and evaluation of such platforms, and we report on experiences from piloting the method in Ghana and Indonesia. The method is comprised of three components. The first can be used to look ahead, identifying priorities for future multi-stakeholder collaboration in the landscape. It is based on the identification of four aspirations that are common across multi-stakeholder platforms in integrated landscape initiatives. The second can be used to look inward. It focuses on the processes within an existing multi-stakeholder platform in order to identify areas for possible improvement. The third can be used to look back, identifying the main outcomes of an existing platform and comparing them to the original objectives. The three components can be implemented together or separately. They can be used to inform planning and adaptive management of the platform, as well as to demonstrate performance and inform the design of new interventions.

A methodology to condition distorted acoustic emission signals to identify fracture timing from human cadaver spine impact tests.

PubMed

Arun, Mike W J; Yoganandan, Narayan; Stemper, Brian D; Pintar, Frank A

2014-12-01

While studies have used acoustic sensors to determine fracture initiation time in biomechanical studies, a systematic procedure is not established to process acoustic signals. The objective of the study was to develop a methodology to condition distorted acoustic emission data using signal processing techniques to identify fracture initiation time. The methodology was developed from testing a human cadaver lumbar spine column. Acoustic sensors were glued to all vertebrae, high-rate impact loading was applied, load-time histories were recorded (load cell), and fracture was documented using CT. Compression fracture occurred to L1 while other vertebrae were intact. FFT of raw voltage-time traces were used to determine an optimum frequency range associated with high decibel levels. Signals were bandpass filtered in this range. Bursting pattern was found in the fractured vertebra while signals from other vertebrae were silent. Bursting time was associated with time of fracture initiation. Force at fracture was determined using this time and force-time data. The methodology is independent of selecting parameters a priori such as fixing a voltage level(s), bandpass frequency and/or using force-time signal, and allows determination of force based on time identified during signal processing. The methodology can be used for different body regions in cadaver experiments. Copyright © 2014 Elsevier Ltd. All rights reserved.

CROI 2018: Advances in Antiretroviral Therapy.

PubMed

Tieu, Hong-Van; Taylor, Barbara S; Jones, Joyce; Wilkin, Timothy J

2018-05-01

The 2018 Conference on Retroviruses and Opportunistic Infections (CROI) showcased exciting data on new investigational agents including MK-8591 and tri-specific antibody targeting 3 highly conserved epitopes on HIV-1 in a single antibody. Clinical trials of initial antiretroviral therapy (ART) and switch studies involving bictegravir/emtricitabine/tenofovir alafenamide were presented. Intensification of initial ART with integrase strand transfer inhibitors did not increase the risk of immune reconstitution inflammatory syndrome. Pharmacokinetic issues were discussed, including the substantial drug-drug interactions between efavirenz-based ART and hormonal contraception delivered via a vaginal ring. Studies on pre-ART drug resistance and emergence of drug resistance after initial and second-line ART in different settings and populations were highlighted. Novel technologies to identify drug resistance included a free, cloud-based web service for HIV genotyping analysis and a promising technology for point-of-care drug resistance mutations testing. New strategies to improve the HIV care continuum included home-based testing with initiation of same-day ART and stratified care with specialized clinics to serve those disengaged in care, but the data on financial incentives were not encouraging. Several studies provided insights into the impact of early ART on decreasing the size of the HIV reservoir in HIV-infected infants. Pertinent conference findings relating to women's health issues included similar clinical outcomes between breastfeeding and formula feeding HIV-infected women, the problem of viral rebound and ART nonadherence in pregnancy and postpartum.

Delays in initiation of acyclovir therapy in herpes simplex encephalitis.

PubMed

Hughes, Peter S; Jackson, Alan C

2012-09-01

Diagnosis of herpes simplex encephalitis (HSE) is based on clinical findings, MRI, and detection of herpes simplex virus (HSV) DNA in cerebrospinal fluid (CSF) using polymerase chain reaction amplification. Delays in starting treatment are associated with poorer clinical outcomes. We assessed the timing of initiation of acyclovir therapy in HSE. Inpatient databases from seven hospitals in Winnipeg, Manitoba were used to identify individuals diagnosed with encephalitis and HSE from 2004 to 2009. The time taken to initiate therapy with acyclovir and the reasons for delays were determined. Seventy-seven patients were identified; 69 (90%) received acyclovir; in the others a non-HSV infection was strongly suspected. Thirteen patients were subsequently confirmed to have HSE. Acyclovir was initiated a median of 21 hours (3-407) after presentation in encephalitis cases, and a median of 11 hours (3-118) in HSE. The most common reason for delay was a failure to consider HSE in the differential diagnosis, despite suggestive clinical features. Where therapy was delayed in HSE patients, the decision to begin acyclovir was prompted by transfer of the patient to a different service (55%), recommendations by consultants (18%), imaging results (18%), and CSF pleocytosis (9%). Delays in initiating acyclovir for HSE are common, and are most often due to a failure to consider HSE in a timely fashion on presentation. In order to improve patient outcomes, physicians should be more vigilant for HSE, and begin acyclovir therapy expeditiously on the basis of clinical suspicion rather than waiting for confirmatory tests.

Factors Associated with Teacher Delivery of a Classroom-Based Tier 2 Prevention Program.

PubMed

Sutherland, Kevin S; Conroy, Maureen A; McLeod, Bryce D; Algina, James; Kunemund, Rachel L

2018-02-01

Teachers sometimes struggle to deliver evidence-based programs designed to prevent and ameliorate chronic problem behaviors of young children with integrity. Identifying factors associated with variations in the quantity and quality of delivery is thus an important goal for the field. This study investigated factors associated with teacher treatment integrity of BEST in CLASS, a tier-2 prevention program designed for young children at risk for developing emotional/behavioral disorders. Ninety-two early childhood teachers and 231 young children at-risk for emotional/behavioral disorders participated in the study. Latent growth curve analyses indicated that both adherence and competence of delivery increased across six observed time points. Results suggest that teacher education and initial levels of classroom quality may be important factors to consider when teachers deliver tier-2 (i.e., targeted to children who are not responsive to universal or tier-1 programming) prevention programs in early childhood settings. Teachers with higher levels of education delivered the program with more adherence and competence initially. Teachers with higher initial scores on the Emotional Support subscale of the Classroom Assessment Scoring System (CLASS) delivered the program with more competence initially and exhibited higher growth in both adherence and competence of delivery across time. Teachers with higher initial scores on the Classroom Organization subscale of the CLASS exhibited lower growth in adherence across time. Contrary to hypotheses, teacher self-efficacy did not predict adherence, and teachers who reported higher initial levels of Student Engagement self-efficacy exhibited lower growth in competence of delivery. Results are discussed in relation to teacher delivery of evidence-based programs in early childhood classrooms.

Cluster and Sporadic Cases of Herbaspirillum Species Infections in Patients With Cancer

PubMed Central

Chemaly, Roy F.; Dantes, Raymund; Shah, Dimpy P.; Shah, Pankil K.; Pascoe, Neil; Ariza-Heredia, Ella; Perego, Cheryl; Nguyen, Duc B.; Nguyen, Kim; Modarai, Farhad; Moulton-Meissner, Heather; Noble-Wang, Judith; Tarrand, Jeffrey J.; LiPuma, John J.; Guh, Alice Y.; MacCannell, Tara; Raad, Issam; Mulanovich, Victor

2015-01-01

Background. Herbaspirillum species are gram-negative Betaproteobacteria that inhabit the rhizosphere. We investigated a potential cluster of hospital-based Herbaspirillum species infections. Methods. Cases were defined as Herbaspirillum species isolated from a patient in our comprehensive cancer center between 1 January 2006 and 15 October 2013. Case finding was performed by reviewing isolates initially identified as Burkholderia cepacia susceptible to all antibiotics tested, and 16S ribosomal DNA sequencing of available isolates to confirm their identity. Pulsed-field gel electrophoresis (PFGE) was performed to test genetic relatedness. Facility observations, infection prevention assessments, and environmental sampling were performed to investigate potential sources of Herbaspirillum species. Results. Eight cases of Herbaspirillum species were identified. Isolates from the first 5 clustered cases were initially misidentified as B. cepacia, and available isolates from 4 of these cases were indistinguishable. The 3 subsequent cases were identified by prospective surveillance and had different PFGE patterns. All but 1 case-patient had bloodstream infections, and 6 presented with sepsis. Underlying diagnoses included solid tumors (3), leukemia (3), lymphoma (1), and aplastic anemia (1). Herbaspirillum species infections were hospital-onset in 5 patients and community-onset in 3. All symptomatic patients were treated with intravenous antibiotics, and their infections resolved. No environmental source or common mechanism of acquisition was identified. Conclusions. This is the first report of a hospital-based cluster of Herbaspirillum species infections. Herbaspirillum species are capable of causing bacteremia and sepsis in immunocompromised patients. Herbaspirillum species can be misidentified as Burkholderia cepacia by commercially available microbial identification systems. PMID:25216687

Use of an Innovative Personality-Mindset Profiling Tool to Guide Culture-Change Strategies among Different Healthcare Worker Groups.

PubMed

Grayson, M Lindsay; Macesic, Nenad; Huang, G Khai; Bond, Katherine; Fletcher, Jason; Gilbert, Gwendolyn L; Gordon, David L; Hellsten, Jane F; Iredell, Jonathan; Keighley, Caitlin; Stuart, Rhonda L; Xuereb, Charles S; Cruickshank, Marilyn

2015-01-01

Important culture-change initiatives (e.g. improving hand hygiene compliance) are frequently associated with variable uptake among different healthcare worker (HCW) categories. Inherent personality differences between these groups may explain change uptake and help improve future intervention design. We used an innovative personality-profiling tool (ColourGrid®) to assess personality differences among standard HCW categories at five large Australian hospitals using two data sources (HCW participant surveys [PS] and generic institution-wide human resource [HR] data) to: a) compare the relative accuracy of these two sources; b) identify differences between HCW groups and c) use the observed profiles to guide design strategies to improve uptake of three clinically-important initiatives (improved hand hygiene, antimicrobial stewardship and isolation procedure adherence). Results from 34,243 HCWs (HR data) and 1045 survey participants (PS data) suggest that HCWs were different from the general population, displaying more individualism, lower power distance, less uncertainty avoidance and greater cynicism about advertising messages. HR and PS data were highly concordant in identifying differences between the three key HCW categories (doctors, nursing/allied-health, support services) and predicting appropriate implementation strategies. Among doctors, the data suggest that key messaging should differ between full-time vs part-time (visiting) senior medical officers (SMO, VMO) and junior hospital medical officers (HMO), with SMO messaging focused on evidence-based compliance, VMO initiatives emphasising structured mandatory controls and prestige loss for non-adherence, and for HMOs focusing on leadership opportunity and future career risk for non-adherence. Compared to current standardised approaches, targeted interventions based on personality differences between HCW categories should result in improved infection control-related culture-change uptake. Personality profiling based on HR data may represent a useful means of developing a national culture-change "blueprint" for HCW education.

Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: An opportunity to address barriers to PrEP uptake and persistence

PubMed Central

Rendina, H. Jonathon; Grov, Christian

2017-01-01

Gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by the HIV epidemic. Despite the promise of pre-exposure prophylaxis (PrEP) in reducing HIV transmission risk, barriers for uptake and persistence exist. We sought to identify whether GBM in a nationwide cohort who have not yet initiated PrEP (n = 906) would prefer to get PrEP-related care from a primary care provider (PCP) compared to a specialist clinic or provider. We then sought to identify their level of interest and factors associated with preference for using home-based PrEP services (i.e., HB-PrEP), defined to participants as conducting HIV/STI self-testing from home with PrEP prescription mailing after an initial in-person clinic visit. We examined the associations of demographics, sexual HIV transmission risk, concern about frequent medical checkups associated with PrEP, health care access, and PrEP intentions with preferences for healthcare provider type and HB-PrEP. Concern about frequent medical checkups were associated with preferring a PCP for PrEP-related care, but men who perceived a barrier to bringing up the topic of PrEP with a doctor preferred a specialist clinic or provider more than a PCP. HB-PrEP was more appealing for younger men and those engaged in sexual HIV transmission risk, suggesting HB-PrEP could help reach GBM most vulnerable to HIV and in need of PrEP. HB-PrEP expansion has potential to increase PrEP uptake and persistence among GBM, particularly for men with barriers to clinic-based care and higher intentions to initiate PrEP. Clinical guidelines regarding HB-PrEP are needed to expand its use. PMID:29281688

Embarking on performance improvement.

PubMed

Brown, Bobbi; Falk, Leslie Hough

2014-06-01

Healthcare organizations should approach performance improvement as a program, not a project. The program should be led by a guidance team that identifies goals, prioritizes work, and removes barriers to enable clinical improvement teams and work groups to realize performance improvements. A healthcare enterprise data warehouse can provide the initial foundation for the program analytics. Evidence-based best practices can help achieve improved outcomes and reduced costs.

Addressing Substance Abuse Treatment Needs of Parents Involved with the Child Welfare System

ERIC Educational Resources Information Center

Oliveros, Arazais; Kaufman, Joan

2011-01-01

The goal of this paper is to synthesize available data to help guide policy and programmatic initiatives for families with substance abuse problems who are involved with the child welfare system, and identify gaps in the research base preventing further refinement of practices in this area. To date, Family Treatment Drug Court and newly developed…

Effectiveness of interventions for the development of leadership skills among nurses: a systematic review protocol.

PubMed

Darragh, Michael; Traynor, Victoria; Joyce-McCoach, Joanne

2016-06-01

What interventions are the most effective for the development of leadership skills for nurses?The review objective is to systematically review the evidence to identify the effectiveness of interventions for the development of leadership skills among nurses. Centre for Evidence-based Initiatives in Health Care - University of Wollongong: an Affiliate Center of the Joanna Briggs Institute.

Evaluation of a Statewide Initiative in the United States to Prevent/Reduce Sexual Harassment in Schools

ERIC Educational Resources Information Center

Weist, Mark D.; Bryant, Yaphet U.; Dantzler, Joyce; Martin, Saran; D'Amico, Marie; Griffith, Brian; Gallun, Betsy

2009-01-01

Purpose: The purpose of this paper is to identify best practices in the implementation of school-based sexual violence prevention education. Design/methodology/approach: A three-phase plan was implemented to evaluate the Sexual Harassment/Assault Prevention Project (SHAPP) in one state in the USA. First, a structured review of the prevention…

Development of the Language Subtest in a Developmental Assessment Scale to Identify Chinese Preschool Children with Special Needs

ERIC Educational Resources Information Center

Wong, Anita M. -Y.; Leung, Cynthia; Siu, Elaine K. -L.; Lam, Catherine C. -C.; Chan, Grace P. -S.

2011-01-01

This study reports on the development of the language subtest in the Preschool Developmental Assessment Scale (PDAS) for Cantonese-Chinese speaking children. A pilot pool of 158 items covering the two language modalities and the three language domains was developed. This initial item set was subsequently revised based on Rasch analyses of data…

Losing the Safety Net: How a Time-Limited Welfare Policy Affects Families at Risk of Reaching Time Limits

ERIC Educational Resources Information Center

Morris, Pamela A.; Hendra, Richard

2009-01-01

The authors examined the effects of Florida's Family Transition Program (FTP), one of the first welfare reform initiatives to include a time limit on the receipt of federal cash assistance with other welfare requirements, on single-mother welfare-receiving families. Using a regression-based subgroup approach, they identified a group of families…

The Student Voice Collaborative: An Effort to Systematize Student Participation in School and District Improvement

ERIC Educational Resources Information Center

Sussman, Ari

2015-01-01

This chapter recounts the first 3 years of the Student Voice Collaborative (SVC) in New York City, a district supported student leadership initiative that engages high school aged youth in school reform work at school and district levels. Based on his experiences developing and running the SVC, the author identifies nine design and implementation…

Correlates of Adherence to a Telephone-Based Multiple Health Behavior Change Cancer Preventive Intervention for Teens: The Healthy for Life Program (HELP)

ERIC Educational Resources Information Center

Mays, Darren; Peshkin, Beth N.; Sharff, McKane E.; Walker, Leslie R.; Abraham, Anisha A.; Hawkins, Kirsten B.; Tercyak, Kenneth P.

2012-01-01

This study examined factors associated with teens' adherence to a multiple health behavior cancer preventive intervention. Analyses identified predictors of trial enrollment, run-in completion, and adherence (intervention initiation, number of sessions completed). Of 104 teens screened, 73% (n = 76) were trial eligible. White teens were more…

Compacted Approach to Reading (CAR): An Intervention Program for At-Risk Beginning Readers.

ERIC Educational Resources Information Center

Gettys, Cynthia M.

A study determined the initial success of the Compacted Approach to Reading (CAR) program as measured at the end of the program's pilot year. Subjects were 21 first graders and 7 second graders in Tennessee identified and recommended by their first and second grade classroom teacher. The CAR program was developed based on concepts observed in the…

A Mediation Analysis of a Tobacco Prevention Program for Adolescents in India: How Did Project MYTRI Work?

ERIC Educational Resources Information Center

Stigler, Melissa Harrell; Perry, Cheryl L.; Smolenski, Derek; Arora, Monika; Reddy, K. Srinath

2011-01-01

This article presents the results of a mediation analysis of Project MYTRI (Mobilizing Youth for Tobacco Related Initiatives in India), a randomized, controlled trial of a multiple-component, school-based tobacco prevention program for sixth- to ninth-graders (n = 14,085) in Delhi and Chennai, India. A mediation analysis identifies "how"…

Mission Connect Mild TBI Translational Research Consortium

DTIC Science & Technology

2009-08-01

and only minimally effective in-vivo. Initially, we identified carbon nanomaterials as potent antioxidants using a chemical ORAC assay. We...radical absorbency capacity ( ORAC ) assay using a chemical source for the oxygen radical (,′-azodiisobutyramidine dihydrochloride) (Table 1). We...nanomaterials determined with a chemically based ORAC assay.a Nanomaterial Trolox Equivalents (TE) Trolox Mass Equivalents (TME) p-SWCNT 14046 5.02

Is Veteran Status and Suicide Risk Assessed in Community Long-Term Care? A Review of the States' Assessment Instruments

ERIC Educational Resources Information Center

Matthieu, Monica M.; Welch, Benjamin; Morrow-Howell, Nancy; Proctor, Enola; Nickel, Michael; Navarro, Jessica; Moon, Alyson

2010-01-01

Given recent policy initiatives to address suicide risk among older persons and veterans, community-based elder serving agencies may serve an important role in identifying and referring individuals at risk for suicide. A review of state-level long-term assessment instruments was conducted to determine whether veteran status and suicide are…

A Metadata Model for E-Learning Coordination through Semantic Web Languages

ERIC Educational Resources Information Center

Elci, Atilla

2005-01-01

This paper reports on a study aiming to develop a metadata model for e-learning coordination based on semantic web languages. A survey of e-learning modes are done initially in order to identify content such as phases, activities, data schema, rules and relations, etc. relevant for a coordination model. In this respect, the study looks into the…

[Choosing wisely recommendations in gastroenterology].

PubMed

Koop, H; Lynen Jansen, P; Zeuzem, S

2017-06-01

The Choosing wisely initiative of the German Society of Internal Medicine addresses procedures which are inadequately implemented (deficits in patient care) as well as those which are performed too often but without proven benefits for patients (misuse or overuse of health services). Based on their guidelines, The German Society of Gastroenterology, Digestive and Metabolic Diseases has identified such aspects and incorporated them into the respective recommendations.

Is there life after DEBI? Examining health behavior maintenance in the diffusion of effective behavioral interventions initiative.

PubMed

Feldman, Matthew B; Silapaswan, Andrew; Schaefer, Nathan; Schermele, Daniel

2014-06-01

The evidence-based interventions that are identified, packaged, and disseminated by the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention as part of the Diffusion of Effective Behavioral Interventions (DEBI) initiative-commonly referred to the "DEBIs"-currently represent a primary source of HIV prevention interventions for community-based providers. To date, little attention has focused on whether the intended outcomes of the DEBIs, i.e., reductions in HIV-related risk behaviors, are maintained over time. This review summarized evidence for the sustainability of the effects of the DEBIs on HIV sexual risk behavior and intravenous drug use from studies of original and adapted DEBIs. Evidence of intervention decay or a lack of any intervention effect was identified in several original and adapted versions of the DEBIs included in this review. Recommendations include modifications to current criteria for inclusion in the DEBI portfolio, in addition to the development of remediation strategies to address intervention decay. Further, theoretical models that specify the processes that underlie the maintenance of health behaviors over time should be used in developing HIV prevention interventions.

Stress urinary incontinence in women: Current and emerging therapeutic options

PubMed Central

Shamout, Samer; Campeau, Lysanne

2017-01-01

Surgical management of stress urinary incontinence (SUI) is most commonly achieved by midurethral synthetic sling (MUS) insertion as a first-line surgical option. A great deal of research continues to evolve new management strategies to reach an optimal balance of high efficacy and minimal adverse events. This expert opinion review provides a brief and comprehensive discussion of recent advances and ongoing research in the management of SUI, with an emphasis on single-incision mini-slings, vaginal laser treatment, and cell-based therapy. It is based on data obtained from numerous published meta-analyses and original studies identified through literature search. Single-incision mini-slings appear equally effective initially compared with standard MUS (retropubic or transobturator) for the treatment of female SUI; however, this efficacy lacks durability evidence beyond one-year followup. There is a lack of sufficient clinical evidence to currently confirm long-term safety and effectiveness of cell-therapy and non-ablative vaginal laser therapy, besides suggestion of apparent initial safety. There are still significant challenges to overcome before widespread clinical practice of the latter two modalities. Future research should be aimed at identifying groups of patients who might benefit from these minimally invasive therapeutic options. PMID:28616118

A continuous quality improvement approach to improving clinical practice in the areas of sedation, analgesia, and neuromuscular blockade.

PubMed

Arbour, Richard

2003-01-01

Practice concerns associated with the medical prescription and nurses' administration and monitoring of sedatives, analgesics, and neuromuscular blocking agents were identified by the clinical nurse specialist within a surgical intensive care unit of a large, tertiary-care referral center. These concerns were identified using a variety of needs assessment strategies. Results of the needs assessment were used to develop a program of care, including a teaching initiative, specific to these practice areas. The teaching initiative incorporated principles of andragogy, the theory of adult learning. Educational techniques included inservice education, bedside instruction using "teaching moments," competency-based education modules, and integration of instruction into critical care orientation. Content and approach were based on the background and level of experience of participants. Educational program outcomes included increased consistency in monitoring neuromuscular blockade by clinical assessment and peripheral nerve stimulation. A second outcome was more accurate patient assessment leading to the provision of drug therapy specific to the patients' clinical states, including anxiety or pain. The continuous quality improvement approach offers a model for improving patient care using individualized needs assessment, focused educational interventions, and program evaluation strategies.

Leigh Syndrome in Childhood: Neurologic Progression and Functional Outcome.

PubMed

Lee, Jin Sook; Kim, Hunmin; Lim, Byung Chan; Hwang, Hee; Choi, Jieun; Kim, Ki Joong; Hwang, Yong Seung; Chae, Jong Hee

2016-04-01

Few studies have analyzed the clinical course and functional outcome in Leigh syndrome (LS). The aim of this study was to determine the clinical, radiological, biochemical, and genetic features of patients with LS, and identify prognostic indicators of the disease progression and neurological outcome. Thirty-nine patients who had been diagnosed with LS at the Seoul National University Children's Hospital were included. Their medical records, neuroimaging findings, and histological/biochemical findings of skeletal muscle specimens were reviewed. Targeted sequencing of mitochondrial DNA was performed based on mitochondrial respiratory chain (MRC) enzyme defects. Isolated complex I deficiency was the most frequently observed MRC defect (in 42% of 38 investigated patients). Mitochondrial DNA mutations were identified in 11 patients, of which 81.8% were MT-ND genes. The clinical outcome varied widely, from independent daily activity to severe disability. Poor functional outcomes and neurological deterioration were significantly associated with early onset (before an age of 1 year) and the presence of other lesions additional to basal ganglia involvement in the initial neuroimaging. The neurological severity and outcome of LS may vary widely and be better than those predicted based on previous studies. We suggest that age at onset and initial neuroimaging findings are prognostic indicators in LS.

Hysteresis compensation of the Prandtl-Ishlinskii model for piezoelectric actuators using modified particle swarm optimization with chaotic map.

PubMed

Long, Zhili; Wang, Rui; Fang, Jiwen; Dai, Xufei; Li, Zuohua

2017-07-01

Piezoelectric actuators invariably exhibit hysteresis nonlinearities that tend to become significant under the open-loop condition and could cause oscillations and errors in nanometer-positioning tasks. Chaotic map modified particle swarm optimization (MPSO) is proposed and implemented to identify the Prandtl-Ishlinskii model for piezoelectric actuators. Hysteresis compensation is attained through application of an inverse Prandtl-Ishlinskii model, in which the parameters are formulated based on the original model with chaotic map MPSO. To strengthen the diversity and improve the searching ergodicity of the swarm, an initial method of adaptive inertia weight based on a chaotic map is proposed. To compare and prove that the swarm's convergence occurs before stochastic initialization and to attain an optimal particle swarm optimization algorithm, the parameters of a proportional-integral-derivative controller are searched using self-tuning, and the simulated results are used to verify the search effectiveness of chaotic map MPSO. The results show that chaotic map MPSO is superior to its competitors for identifying the Prandtl-Ishlinskii model and that the inverse Prandtl-Ishlinskii model can provide hysteresis compensation under different conditions in a simple and effective manner.

The Delphi Technique in Identifying Learning Objectives for the Development of Science, Technology and Society Modules for Palestinian Ninth Grade Science Curriculum

NASA Astrophysics Data System (ADS)

Abualrob, Marwan M. A.; Gnanamalar Sarojini Daniel, Esther

2013-10-01

This article outlines how learning objectives based upon science, technology and society (STS) elements for Palestinian ninth grade science textbooks were identified, which was part of a bigger study to establish an STS foundation in the ninth grade science curriculum in Palestine. First, an initial list of STS elements was determined. Second, using this list, ninth grade science textbooks and curriculum document contents were analyzed. Third, based on this content analysis, a possible list of 71 learning objectives for the integration of STS elements was prepared. This list of learning objectives was refined by using a two-round Delphi technique. The Delphi study was used to rate and to determine the consensus regarding which items (i.e. learning objectives for STS in the ninth grade science textbooks in Palestine) are to be accepted for inclusion. The results revealed that of the initial 71 objectives in round one, 59 objectives within round two had a mean score of 5.683 or higher, which indicated that the learning objectives could be included in the development of STS modules for ninth grade science in Palestine.

Environmental control medical support team

NASA Technical Reports Server (NTRS)

Crump, William J.; Kilgore, Melvin V., Jr.

1988-01-01

The activities conducted in support of the Environmental Control and Life Support Team during December 7, 1987 through September 30, 1988 are summarized. The majority of the ongoing support has focused on the ECLSS area. Through a series of initial meetings with the ECLSS team and technical literature review, an initial list of critical topics was developed. Subtasks were then identified or additional related tasks received as action items from the ECLSS group meetings. Although most of the efforts focused on providing MSFC personnel with information regarding specific questions and problems related to ECLSS issues, other efforts regarding identifying an ECLSS Medical Support Team and constructing data bases of technical information were also initiated and completed. The specific tasks are as follows: (1) Provide support to the mechanical design and integration of test systems as related to microbiological concerns; (2) Assist with design of Human Subjects Test Protocols; (3) Interpretation and recommendations pertaining to air/water quality requirements; (4) Assist in determining the design specifications required as related to the Technical Demonstration Program; (5) Develop a data base of all microorganisms recovered from previous subsystem testing; (6) Estimates of health risk of individual microbes to test subjects; (7) Assist with setting limits for safety of test subjects; (8) Health monitoring of test subjects; (9) Assist in the preparation of test plans; (10) Assist in the development of a QA/QC program to assure the validity, accuracy and precision of the analyses; and (11) Assist in developing test plans required for future man in the loop testing.

Framing global health: the governance challenge.

PubMed

McInnes, Colin; Kamradt-Scott, Adam; Lee, Kelley; Reubi, David; Roemer-Mahler, Anne; Rushton, Simon; Williams, Owain David; Woodling, Marie

2012-01-01

With the emergence of global health comes governance challenges which are equally global in nature. This article identifies some of the initial limitations in analyses of global health governance (GHG) before discussing the focus of this special supplement: the framing of global health issues and the manner in which this impacts upon GHG. Whilst not denying the importance of material factors (such as resources and institutional competencies), the article identifies how issues can be framed in different ways, thereby creating particular pathways of response which in turn affect the potential for and nature of GHG. It also identifies and discusses the key frames operating in global health: evidence-based medicine, human rights, security, economics and development.

Permutation on hybrid natural inflation

NASA Astrophysics Data System (ADS)

Carone, Christopher D.; Erlich, Joshua; Ramos, Raymundo; Sher, Marc

2014-09-01

We analyze a model of hybrid natural inflation based on the smallest non-Abelian discrete group S3. Leading invariant terms in the scalar potential have an accidental global symmetry that is spontaneously broken, providing a pseudo-Goldstone boson that is identified as the inflaton. The S3 symmetry restricts both the form of the inflaton potential and the couplings of the inflaton field to the waterfall fields responsible for the end of inflation. We identify viable points in the model parameter space. Although the power in tensor modes is small in most of the parameter space of the model, we identify parameter choices that yield potentially observable values of r without super-Planckian initial values of the inflaton field.

MobiPag: Integrated Mobile Payment, Ticketing and Couponing Solution Based on NFC †

PubMed Central

Rodrigues, Helena; José, Rui; Coelho, André; Melro, Ana; Ferreira, Marta Campos; Cunha, João Falcão e; Monteiro, Miguel Pimenta; Ribeiro, Carlos

2014-01-01

Mobile payments still remain essentially an emerging technology, seeking to fill the gap between the envisioned potential and widespread usage. In this paper, we present an integrated mobile service solution based on the near field communication (NFC) protocol that was developed under a research project called MobiPag. The most distinctive characteristic of Mobipag is its open architectural model that allows multiple partners to become part of the payment value-chain and create solutions that complement payments in many unexpected ways. We describe the Mobipag architecture and how it has been used to support a mobile payment trial. We identify a set of design lessons resulting from usage experiences associated with real-world payment situations with NFC-enabled mobile phones. Based on results from this trial, we identify a number of challenges and guidelines that may help to shape future versions of NFC-based payment systems. In particular, we highlight key challenges for the initial phases of payment deployments, where it is essential to focus on scenarios that can be identified as more feasible for early adoption. We also have identified a fundamental trade-off between the flexibility supported by the Mobipag solution and the respective implications for the payment process, particularly on the users' mental model. PMID:25061838

MobiPag: integrated mobile payment, ticketing and couponing solution based on NFC.

PubMed

Rodrigues, Helena; José, Rui; Coelho, André; Melro, Ana; Ferreira, Marta Campos; Falcão e Cunha, João; Monteiro, Miguel Pimenta; Ribeiro, Carlos

2014-07-24

Mobile payments still remain essentially an emerging technology, seeking to fill the gap between the envisioned potential and widespread usage. In this paper, we present an integrated mobile service solution based on the near field communication (NFC) protocol that was developed under a research project called MobiPag. The most distinctive characteristic of Mobipag is its open architectural model that allows multiple partners to become part of the payment value-chain and create solutions that complement payments in many unexpected ways. We describe the Mobipag architecture and how it has been used to support a mobile payment trial. We identify a set of design lessons resulting from usage experiences associated with real-world payment situations with NFC-enabled mobile phones. Based on results from this trial, we identify a number of challenges and guidelines that may help to shape future versions of NFC-based payment systems. In particular, we highlight key challenges for the initial phases of payment deployments, where it is essential to focus on scenarios that can be identified as more feasible for early adoption. We also have identified a fundamental trade-off between the flexibility supported by the Mobipag solution and the respective implications for the payment process, particularly on the users' mental model.

Techniques for identifying dust devils in mars pathfinder images

USGS Publications Warehouse

Metzger, S.M.; Carr, J.R.; Johnson, J. R.; Parker, T.J.; Lemmon, M.T.

2000-01-01

Image processing methods used to identify and enhance dust devil features imaged by IMP (Imager for Mars Pathfinder) are reviewed. Spectral differences, visible red minus visible blue, were used for initial dust devil searches, driven by the observation that Martian dust has high red and low blue reflectance. The Martian sky proved to be more heavily dust-laden than pre-Pathfinder predictions, based on analysis of images from the Hubble Space Telescope. As a result, these initial spectral difference methods failed to contrast dust devils with background dust haze. Imager artifacts (dust motes on the camera lens, flat-field effects caused by imperfections in the CCD, and projection onto a flat sensor plane by a convex lens) further impeded the ability to resolve subtle dust devil features. Consequently, reference images containing sky with a minimal horizon were first subtracted from each spectral filter image to remove camera artifacts and reduce the background dust haze signal. Once the sky-flat preprocessing step was completed, the red-minus-blue spectral difference scheme was attempted again. Dust devils then were successfully identified as bright plumes. False-color ratios using calibrated IMP images were found useful for visualizing dust plumes, verifying initial discoveries as vortex-like features. Enhancement of monochromatic (especially blue filter) images revealed dust devils as silhouettes against brighter background sky. Experiments with principal components transformation identified dust devils in raw, uncalibrated IMP images and further showed relative movement of dust devils across the Martian surface. A variety of methods therefore served qualitative and quantitative goals for dust plume identification and analysis in an environment where such features are obscure.

Identification of novel alleles of the rice blast resistance gene Pi54

NASA Astrophysics Data System (ADS)

Vasudevan, Kumar; Gruissem, Wilhelm; Bhullar, Navreet K.

2015-10-01

Rice blast is one of the most devastating rice diseases and continuous resistance breeding is required to control the disease. The rice blast resistance gene Pi54 initially identified in an Indian cultivar confers broad-spectrum resistance in India. We explored the allelic diversity of the Pi54 gene among 885 Indian rice genotypes that were found resistant in our screening against field mixture of naturally existing M. oryzae strains as well as against five unique strains. These genotypes are also annotated as rice blast resistant in the International Rice Genebank database. Sequence-based allele mining was used to amplify and clone the Pi54 allelic variants. Nine new alleles of Pi54 were identified based on the nucleotide sequence comparison to the Pi54 reference sequence as well as to already known Pi54 alleles. DNA sequence analysis of the newly identified Pi54 alleles revealed several single polymorphic sites, three double deletions and an eight base pair deletion. A SNP-rich region was found between a tyrosine kinase phosphorylation site and the nucleotide binding site (NBS) domain. Together, the newly identified Pi54 alleles expand the allelic series and are candidates for rice blast resistance breeding programs.

Family-based interventions for substance misuse: a systematic review of systematic reviews--protocol.

PubMed

Akram, Yasmin; Copello, Alex; Moore, David

2014-08-15

Worldwide, there are an estimated 15 million individuals with drug use disorders and over five times as many with alcohol use disorders (WHO 1:2, 2005). Most individuals with substance misuse have families who are affected. Initial scoping searches identified an expanse of broad and disparate studies and reviews on the family interventions for substance misuse. This systematic review of systematic reviews aims to bring together the expanse of research on the effectiveness of family-based interventions in substance misuse.Initial scoping searches identified an expanse of broad and disparate studies and reviews on the family interventions for substance misuse. This systematic review of systematic reviews aims to bring together the expanse of research on the effectiveness of family-based interventions in substance misuse. Extensive electronic and manual searches will be undertaken. Screening, data extraction and quality assessment will be undertaken by two reviewers with disagreements resolved through discussion.The inclusion criteria will be that the study is a systematically undertaken review, the population is individuals with substance misuse problems and the interventions include a family-focused component. Reviews that focus on prevention rather than treatment will be excluded. The reviews will be assessed for quality and relevance. The evidence from included systematic reviews will be mapped by focus of intervention (promoting engagement of user into treatment/joint involvement in treatment of user/treating family member in own right) for both adults and adolescents for drug and/or alcohol misusers to allow assessment of the density of available evidence. The higher-quality, up-to-date evidence for each domain will be identified and described, and conclusions will be drawn with limitations of the evidence highlighted. This systematic review of systematic reviews will be an efficient and robust way of looking at the current state of the evidence in the field of family-based interventions for substance misuse. It will evaluate all the available systematic-review-level literature to report on the effectiveness of family-based psychological interventions in improving substance-related outcomes and improving health and wellbeing of substance misusers and/or their families. This will inform future treatment policies and commissioning decisions.In addition, it will identify areas of poor quality, inconsistency and gaps in the evidence base for family-based psychological interventions in substance misuse with respect to secondary evidence in order to inform future research. PROSPERO CRD42014006834.

School based sex education and HIV prevention in low- and middle-income countries: a systematic review and meta-analysis.

PubMed

Fonner, Virginia A; Armstrong, Kevin S; Kennedy, Caitlin E; O'Reilly, Kevin R; Sweat, Michael D

2014-01-01

School-based sex education is a cornerstone of HIV prevention for adolescents who continue to bear a disproportionally high HIV burden globally. We systematically reviewed and meta-analyzed the existing evidence for school-based sex education interventions in low- and middle-income countries to determine the efficacy of these interventions in changing HIV-related knowledge and risk behaviors. We searched five electronic databases, PubMed, Embase, PsycInfo, CINAHL, and Sociological Abstracts, for eligible articles. We also conducted hand-searching of key journals and secondary reference searching of included articles to identify potential studies. Intervention effects were synthesized through random effects meta-analysis for five outcomes: HIV knowledge, self-efficacy, sexual debut, condom use, and number of sexual partners. Of 6191 unique citations initially identified, 64 studies in 63 articles were included in the review. Nine interventions either focused exclusively on abstinence (abstinence-only) or emphasized abstinence (abstinence-plus), whereas the remaining 55 interventions provided comprehensive sex education. Thirty-three studies were able to be meta-analyzed across five HIV-related outcomes. Results from meta-analysis demonstrate that school-based sex education is an effective strategy for reducing HIV-related risk. Students who received school-based sex education interventions had significantly greater HIV knowledge (Hedges g = 0.63, 95% Confidence Interval (CI): 0.49-0.78, p<0.001), self-efficacy related to refusing sex or condom use (Hedges g = 0.25, 95% CI: 0.14-0.36, p<0.001), condom use (OR = 1.34, 95% CI: 1.18-1.52, p<0.001), fewer sexual partners (OR = 0.75, 95% CI:0.67-0.84, p<0.001) and less initiation of first sex during follow-up (OR = 0.66, 95% CI: 0.54-0.83, p<0.001). The paucity of abstinence-only or abstinence-plus interventions identified during the review made comparisons between the predominant comprehensive and less common abstinence-focused programs difficult. Comprehensive school-based sex education interventions adapted from effective programs and those involving a range of school-based and community-based components had the largest impact on changing HIV-related behaviors.

Factors influencing adolescent girls' decision in initiation for human papillomavirus vaccination: a cross-sectional study in Hong Kong.

PubMed

Lee, Albert; Ho, Mandy; Cheung, Calvin Ka Man; Keung, Vera Mei Wen

2014-09-08

Cervical cancer is one of the common cancers among women worldwide. Despite HPV vaccination being one of the effective preventive measures, it is not included in government vaccination programme in Hong Kong. This study aimed to assess the knowledge of and attitude towards cervical cancer prevention among Chinese adolescent girls in Hong Kong, and to identify factors influencing the initiation of HPV vaccination. This was a cross-sectional study conducted in Hong Kong during the period of October 2010 to November 2010. A self-administered questionnaire was used, with 1,416 girls from 8 secondary schools completing the questionnaire. Knowledge scores were composited and initiation of HPV vaccination was staged based on stage of change. Analyses were conducted to identify the association of initiation of HPV vaccination with participant's personal and family factors as well as their knowledge and attitude towards cervical cancer prevention. The uptake rate of HPV vaccination was low (7%) with 58% respondents in pre-contemplation and contemplation stage. The survey identified a significant gap in knowledge on cervical cancer prevention. The main channels of information were from media and very few from schools or parents. However, 70% expressed their wishes to have more information on cancer prevention, and 78% stated that they were willing to change their lifestyles if they knew the ways of prevention. Multivariate analysis identified three independent significant factors for initiation of vaccination (action and intention): perceived cancer as terrifying disease, school should provide more information on cancer prevention, and comments from relatives and friends having received the vaccine. The cost of vaccination and socio-economic background were not found to be significant. Public education on cervical cancer needs to be well penetrated into the community for more sharing among friends and relatives. School as setting to provide source of information would facilitate uptake rate of HPV vaccine as students have expressed their wishes that school should provide more information on prevention of cancer. School and community education on cancer prevention would help adolescents to have better understanding of the seriousness of cancer.

Power system requirements and definition for lunar and Mars outposts

NASA Technical Reports Server (NTRS)

Petri, D. A.; Cataldo, R. L.; Bozek, J. M.

1990-01-01

Candidate power systems being considered for outpost facilities (stationary power systems) and vehicles (mobile systems) are discussed, including solar, chemical, isotopic, and reactor. The current power strategy was an initial outpost power system composed of photovoltaic arrays for daytime energy needs and regenerative fuel cells for power during the long lunar night. As day and night power demands grow, the outpost transitions to nuclear-based power generation, using thermoelectric conversion initially and evolving to a dynamic conversion system. With this concept as a guideline, a set of requirements has been established, and a reference definition of candidate power systems meeting these requirements has been identified.

Effects of soil-engineering properties on the failure mode of shallow landslides

USGS Publications Warehouse

McKenna, Jonathan Peter; Santi, Paul Michael; Amblard, Xavier; Negri, Jacquelyn

2012-01-01

Some landslides mobilize into flows, while others slide and deposit material immediately down slope. An index based on initial dry density and fine-grained content of soil predicted failure mode of 96 landslide initiation sites in Oregon and Colorado with 79% accuracy. These material properties can be used to identify potential sources for debris flows and for slides. Field data suggest that loose soils can evolve from dense soils that dilate upon shearing. The method presented herein to predict failure mode is most applicable for shallow (depth 8), with few to moderate fines (fine-grained content <18%), and with liquid limits <40.

Indigenous Mortality (Revealed): The Invisible Illuminated

PubMed Central

Ring, Ian; Arambula Solomon, Teshia G.; Gachupin, Francine C.; Smylie, Janet; Cutler, Tessa Louise; Waldon, John A.

2015-01-01

Inaccuracies in the identification of Indigenous status and the collection of and access to vital statistics data impede the strategic implementation of evidence-based public health initiatives to reduce avoidable deaths. The impact of colonization and subsequent government initiatives has been commonly observed among the Indigenous peoples of Australia, Canada, New Zealand, and the United States. The quality of Indigenous data that informs mortality statistics are similarly connected to these distal processes, which began with colonization. We discuss the methodological and technical challenges in measuring mortality for Indigenous populations within a historical and political context, and identify strategies for the accurate ascertainment and inclusion of Indigenous people in mortality statistics. PMID:25211754

A manned lunar outpost. Design considerations for three key elements in an initial manned lunar outpost

NASA Technical Reports Server (NTRS)

Bell, Larry; Trotti, Guillermo; Brown, Jeff; Bhattacharya, Nilajan; Moore, Nathan; Polette, Tom; Toups, Larry

1988-01-01

The Initial Manned Lunar Outpost (IMLO) is proposed as the initial permanent base for manned activities on the Moon. The study concentrated on identifying the equipment, support systems, and initial base configuration necessary to accomplish the various science, industrial and exploration activities planned. The primary concepts of the MLO were the use of hard modules for habitation areas creating a flexible, modular transportation system; designing a multi-functional vehicle; and using an overhead radiation protection system. The transportation system, dubbed the Lunar Mobile Surface Transport System (LMSTS), carries the hard modules to the surface of the moon and provides a method to move them to the desired location through the use of interchangeable pallets. The avionics pallets are changed-out with wheel and hitch pallets, transforming the LMSTS into a "tractor trailer" used with the Multi-Functional Vehicle (MFV). The modules are placed under the Regolith Support Structure (RSS) which provides a stable environment and radiation protection for the entire base. The overhead structure was chosen over simply burying the modules to provide a study on the advantages and disadvantages of this type of system. The advantages include easy access to the exterior of the modules, providing a protected area for vehicles and equipment used in EVA, and creating an area of constant temperature. Disadvantages include a need for prefabrication of structural components, including the preconstruction and construction phases of the initial MLO. The design approach taken considered existing and near-term materials and technology only, without the consideration of possible future building technologies.

Clinical Management of ADHD in a Family Medicine Residency Program: Comparison with AAP Guidelines.

PubMed

Skelley, Jessica W; Carpenter, P Chase; Morehead, M Shawn; Murphy, Patrick L

2016-06-01

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder. Research has shown that even with the growing incidence of children diagnosed as having ADHD, physicians may find providing optimal care to these patients challenging. Our objective was to contrast existing clinical management of ADHD in a family medicine setting with published American Academy of Pediatrics guidelines and review the literature pertinent to differences. A report was generated for all visits with "ADHD" or "ADD" (attention-deficit disorder) as a current or past medical problem that had been addressed at the family medicine clinic from July 2012 to June 2014. A total of 60 pediatric patients were identified. A retrospective chart review of clinical practice and management patterns for these patients was completed using a standardized data collection form based on the 2011 ADHD treatment guidelines set by the American Academy of Pediatrics. Fifty-seven (95%) patients had documentation of at least one core symptom of ADHD, and 27 (45%) patients had documentation of these symptoms in more than one setting (clinic/school/home). Only 30 (50%) patients were assessed at the initial ADHD visit for coexisting conditions. Coexisting conditions were found to be present in 20 (33.3%) patients. Of these 20 patients, coexisting conditions were not addressed during the visit in 12 (60%) patients before drug therapy for ADHD was initially prescribed. Behavioral therapy was initiated as first-line monotherapy in one of the nine preschool-age patients (4-5 years old). Fifty-two (86.7%) patients received a preferred initial medication as identified by guidelines, and 41 (78.8%) of those patients received an appropriate initial dose. Fifty-one (85%) patients were assessed for improvement of symptoms, and 39 (65%) were assessed for adverse events. Of 62 documented medication adjustments, 54 (87.1%) adjustments coincided with current practice guidelines. Sixteen (26.7%) patients were referred to mental health specialists. This retrospective review identified areas of strength and weakness for attending physicians and medical residents in the diagnosis, evaluation, and treatment of children with ADHD. A significant need was identified for more physician-focused education on the evaluation of coexisting conditions and long-term management associated with ADHD therapy. Further training in the initiation of behavioral therapy as a first-line treatment above drug therapy and proper medication selection in children aged 4 to 5 years also are recommended.

Using the Entrustable Professional Activities Framework in the Assessment of Procedural Skills.

PubMed

Pugh, Debra; Cavalcanti, Rodrigo B; Halman, Samantha; Ma, Irene W Y; Mylopoulos, Maria; Shanks, David; Stroud, Lynfa

2017-04-01

The entrustable professional activity (EPA) framework has been identified as a useful approach to assessment in competency-based education. To apply an EPA framework for assessment, essential skills necessary for entrustment to occur must first be identified. Using an EPA framework, our study sought to (1) define the essential skills required for entrustment for 7 bedside procedures expected of graduates of Canadian internal medicine (IM) residency programs, and (2) develop rubrics for the assessment of these procedural skills. An initial list of essential skills was defined for each procedural EPA by focus groups of experts at 4 academic centers using the nominal group technique. These lists were subsequently vetted by representatives from all Canadian IM training programs through a web-based survey. Consensus (more than 80% agreement) about inclusion of each item was sought using a modified Delphi exercise. Qualitative survey data were analyzed using a framework approach to inform final assessment rubrics for each procedure. Initial lists of essential skills for procedural EPAs ranged from 10 to 24 items. A total of 111 experts completed the national survey. After 2 iterations, consensus was reached on all items. Following qualitative analysis, final rubrics were created, which included 6 to 10 items per procedure. These EPA-based assessment rubrics represent a national consensus by Canadian IM clinician educators. They provide a practical guide for the assessment of procedural skills in a competency-based education model, and a robust foundation for future research on their implementation and evaluation.

Morphological inversion of complex diffusion

NASA Astrophysics Data System (ADS)

Nguyen, V. A. T.; Vural, D. C.

2017-09-01

Epidemics, neural cascades, power failures, and many other phenomena can be described by a diffusion process on a network. To identify the causal origins of a spread, it is often necessary to identify the triggering initial node. Here, we define a new morphological operator and use it to detect the origin of a diffusive front, given the final state of a complex network. Our method performs better than algorithms based on distance (closeness) and Jordan centrality. More importantly, our method is applicable regardless of the specifics of the forward model, and therefore can be applied to a wide range of systems such as identifying the patient zero in an epidemic, pinpointing the neuron that triggers a cascade, identifying the original malfunction that causes a catastrophic infrastructure failure, and inferring the ancestral species from which a heterogeneous population evolves.

Functional genomics in zebrafish permits rapid characterization of novel platelet membrane proteins.

PubMed

O'Connor, Marie N; Salles, Isabelle I; Cvejic, Ana; Watkins, Nicholas A; Walker, Adam; Garner, Stephen F; Jones, Chris I; Macaulay, Iain C; Steward, Michael; Zwaginga, Jaap-Jan; Bray, Sarah L; Dudbridge, Frank; de Bono, Bernard; Goodall, Alison H; Deckmyn, Hans; Stemple, Derek L; Ouwehand, Willem H

2009-05-07

In this study, we demonstrate the suitability of the vertebrate Danio rerio (zebrafish) for functional screening of novel platelet genes in vivo by reverse genetics. Comparative transcript analysis of platelets and their precursor cell, the megakaryocyte, together with nucleated blood cell elements, endothelial cells, and erythroblasts, identified novel platelet membrane proteins with hitherto unknown roles in thrombus formation. We determined the phenotype induced by antisense morpholino oligonucleotide (MO)-based knockdown of 5 of these genes in a laser-induced arterial thrombosis model. To validate the model, the genes for platelet glycoprotein (GP) IIb and the coagulation protein factor VIII were targeted. MO-injected fish showed normal thrombus initiation but severely impaired thrombus growth, consistent with the mouse knockout phenotypes, and concomitant knockdown of both resulted in spontaneous bleeding. Knockdown of 4 of the 5 novel platelet proteins altered arterial thrombosis, as demonstrated by modified kinetics of thrombus initiation and/or development. We identified a putative role for BAMBI and LRRC32 in promotion and DCBLD2 and ESAM in inhibition of thrombus formation. We conclude that phenotypic analysis of MO-injected zebrafish is a fast and powerful method for initial screening of novel platelet proteins for function in thrombosis.

Functional genomics in zebrafish permits rapid characterization of novel platelet membrane proteins

PubMed Central

O'Connor, Marie N.; Salles, Isabelle I.; Cvejic, Ana; Watkins, Nicholas A.; Walker, Adam; Garner, Stephen F.; Jones, Chris I.; Macaulay, Iain C.; Steward, Michael; Zwaginga, Jaap-Jan; Bray, Sarah L.; Dudbridge, Frank; de Bono, Bernard; Goodall, Alison H.; Stemple, Derek L.; Ouwehand, Willem H.

2009-01-01

In this study, we demonstrate the suitability of the vertebrate Danio rerio (zebrafish) for functional screening of novel platelet genes in vivo by reverse genetics. Comparative transcript analysis of platelets and their precursor cell, the megakaryocyte, together with nucleated blood cell elements, endothelial cells, and erythroblasts, identified novel platelet membrane proteins with hitherto unknown roles in thrombus formation. We determined the phenotype induced by antisense morpholino oligonucleotide (MO)–based knockdown of 5 of these genes in a laser-induced arterial thrombosis model. To validate the model, the genes for platelet glycoprotein (GP) IIb and the coagulation protein factor VIII were targeted. MO-injected fish showed normal thrombus initiation but severely impaired thrombus growth, consistent with the mouse knockout phenotypes, and concomitant knockdown of both resulted in spontaneous bleeding. Knockdown of 4 of the 5 novel platelet proteins altered arterial thrombosis, as demonstrated by modified kinetics of thrombus initiation and/or development. We identified a putative role for BAMBI and LRRC32 in promotion and DCBLD2 and ESAM in inhibition of thrombus formation. We conclude that phenotypic analysis of MO-injected zebrafish is a fast and powerful method for initial screening of novel platelet proteins for function in thrombosis. PMID:19109564

It's in Your Hands: An Educational Initiative to Improve Parent/Family Hand Hygiene Compliance.

PubMed

Chandonnet, Celeste J; Boutwell, Kristan M; Spigel, Nadine; Carter, Judith; DeGrazia, Michele; Ozonoff, Al; Flaherty, Kathleen

Health care-associated infections contribute to increased morbidity and mortality, increased resource use, higher costs, and extended hospitalizations. Proper hand hygiene (HH) is essential to health care-associated infection prevention. Low compliance among parents in our neonatal intensive care unit (NICU) was identified and prompted development of an HH initiative. The objective of this quality improvement project was to improve parent HH practices with the ultimate goal of achieving 100% compliance with parent HH. Between December 2011 and November 2014, our NICU Infection Prevention Committee developed and implemented the parent/family HH initiative entitled "It's in Your Hands" and created learning materials based on the World Health Organization and Centers for Disease Control and Prevention recommendations. Materials included information sheets, posters, stickers, and checklists. Audits, based on the World Health Organization's Five Moments for Hand Hygiene, were performed several times per week to monitor compliance. Before the intervention, only 71% (n = 1143) of all observed parents and family members performed proper HH. After the intervention, proper HH increased to 89% (n = 939). An average compliance of 89% was maintained throughout the intervention phase. This initiative led to sustained improvements in HH compliance among NICU parents. It has empowered parents to speak up and request proper HH from health care providers when interacting with their child. This initiative has been adopted as a hospital-wide standard of care.

Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

PubMed

French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

2013-12-01

The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

Automated inhaled nitric oxide alerts for adult extracorporeal membrane oxygenation patient identification.

PubMed

Belenkiy, Slava M; Batchinsky, Andriy I; Park, Timothy S; Luellen, David E; Serio-Melvin, Maria L; Cancio, Leopoldo C; Pamplin, Jeremy C; Chung, Kevin K; Salinas, Josè; Cannon, Jeremy W

2014-09-01

Recently, automated alerts have been used to identify patients with respiratory failure based on set criteria, which can be gleaned from the electronic medical record (EMR). Such an approach may also be useful for identifying patients with severe adult respiratory distress syndrome (ARDS) who may benefit from extracorporeal membrane oxygenation (ECMO). Inhaled nitric oxide (iNO) is a common rescue therapy for severe ARDS which can be easily tracked in the EMR, and some patients started on iNO may have indications for initiating ECMO. This case series summarizes our experience with using automated electronic alerts for ECMO team activation focused particularly on an alert triggered by the initiation of iNO. After a brief trial evaluation, our Smart Alert system generated an automated page and e-mail alert to ECMO team members whenever a nonzero value for iNO appeared in the respiratory care section of our EMR. If iNO was initiated for severe respiratory failure, a detailed evaluation by the ECMO team determined if ECMO was indicated. For those patients managed with ECMO, we tabulated baseline characteristics, indication for ECMO, and outcomes. From September 2012 to July 2013, 45 iNO alerts were generated on 42 unique patients. Six patients (14%) met criteria for ECMO. Of these, four were identified exclusively by the iNO alert. At the time of the alert, the median PaO₂-to-FIO₂ ratio was 64 mm Hg (range, 55-107 mm Hg), the median age-adjusted oxygenation index was 73 (range, 51-96), and the median Murray score was 3.4 (range, 3-3.75), indicating severe respiratory failure. Median time from iNO alert to ECMO initiation was 81 hours (range, -2-292 hours). Survival to hospital discharge was 83% in those managed with ECMO. Automated alerts may be useful for identifying patients with severe ARDS who may be ECMO candidates. Diagnostic test, level V.

Data from Tiered High-Throughput Screening Approach to Identify Thyroperoxidase Inhibitors within the ToxCast Phase I and II Chemical Libraries

EPA Pesticide Factsheets

High-throughput screening for potential thyroid-disrupting chemicals requires a system of assays to capture multiple molecular-initiating events (MIEs) that converge on perturbed thyroid hormone (TH) homeostasis. Screening for MIEs specific to TH-disrupting pathways is limited in the U.S. Environmental Protection Agency ToxCast screening assay portfolio. To fill 1 critical screening gap, the Amplex UltraRed-thyroperoxidase (AUR-TPO) assay was developed to identify chemicals that inhibit TPO, as decreased TPO activity reduces TH synthesis. The ToxCast phase I and II chemical libraries, comprised of 1074 unique chemicals, were initially screened using a single, high concentration to identify potential TPO inhibitors. Chemicals positive in the single-concentration screen were retested in concentration-response. Due to high false-positive rates typically observed with loss-of-signal assays such as AUR-TPO, we also employed 2 additional assays in parallel to identify possible sources of nonspecific assay signal loss, enabling stratification of roughly 300 putative TPO inhibitors based upon selective AUR-TPO activity. A cell-free luciferase inhibition assay was used to identify nonspecific enzyme inhibition among the putative TPO inhibitors, and a cytotoxicity assay using a human cell line was used to estimate the cellular tolerance limit. Additionally, the TPO inhibition activities of 150 chemicals were compared between the AUR-TPO and an orthogonal peroxidase oxidat

Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria

PubMed Central

Folayan, Morenike Oluwatoyin

2016-01-01

Objectives Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status. Methods We analyzed data from 436 sexually active 10–19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman’s conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies. Results Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14–11.87), and transactional sex (OR: 2.80; 95% CI: 1.56–4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96–1.11) and loss and grief (OR: 1.34; 95% CI: 0.73–2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34–1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62–3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49–1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09–0.83). Conclusion History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries. PMID:27163436

Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria.

PubMed

Folayan, Morenike Oluwatoyin; Harrison, Abigail; Brown, Brandon; Odetoyinbo, Morolake; Stockman, Jamila K; Ajuwon, Ademola J; Cáceres, Carlos F

2016-01-01

Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status. We analyzed data from 436 sexually active 10-19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman's conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies. Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14-11.87), and transactional sex (OR: 2.80; 95% CI: 1.56-4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96-1.11) and loss and grief (OR: 1.34; 95% CI: 0.73-2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34-1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62-3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49-1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09-0.83). History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries.

Quality in-training initiative--a solution to the need for education in quality improvement: results from a survey of program directors.

PubMed

Kelz, Rachel R; Sellers, Morgan M; Reinke, Caroline E; Medbery, Rachel L; Morris, Jon; Ko, Clifford

2013-12-01

The Next Accreditation System and the Clinical Learning Environment Review Program will emphasize practice-based learning and improvement and systems-based practice. We present the results of a survey of general surgery program directors to characterize the current state of quality improvement in graduate surgical education and introduce the Quality In-Training Initiative (QITI). In 2012, a 20-item survey was distributed to 118 surgical residency program directors from ACS NSQIP-affiliated hospitals. The survey content was developed in collaboration with the QITI to identify program director opinions regarding education in practice-based learning and improvement and systems-based practice, to investigate the status of quality improvement education in their respective programs, and to quantify the extent of resident participation in quality improvement. There was a 57% response rate. Eighty-five percent of program directors (n = 57) reported that education in quality improvement is essential to future professional work in the field of surgery. Only 28% (n = 18) of programs reported that at least 50% of their residents track and analyze their patient outcomes, compare them with norms/benchmarks/published standards, and identify opportunities to make practice improvements. Program directors recognize the importance of quality improvement efforts in surgical practice. Subpar participation in basic practice-based learning and improvement activities at the resident level reflects the need for support of these educational goals. The QITI will facilitate programmatic compliance with goals for quality improvement education. Copyright © 2013 American College of Surgeons. All rights reserved.

PubMedMiner: Mining and Visualizing MeSH-based Associations in PubMed.

PubMed

Zhang, Yucan; Sarkar, Indra Neil; Chen, Elizabeth S

2014-01-01

The exponential growth of biomedical literature provides the opportunity to develop approaches for facilitating the identification of possible relationships between biomedical concepts. Indexing by Medical Subject Headings (MeSH) represent high-quality summaries of much of this literature that can be used to support hypothesis generation and knowledge discovery tasks using techniques such as association rule mining. Based on a survey of literature mining tools, a tool implemented using Ruby and R - PubMedMiner - was developed in this study for mining and visualizing MeSH-based associations for a set of MEDLINE articles. To demonstrate PubMedMiner's functionality, a case study was conducted that focused on identifying and comparing comorbidities for asthma in children and adults. Relative to the tools surveyed, the initial results suggest that PubMedMiner provides complementary functionality for summarizing and comparing topics as well as identifying potentially new knowledge.

Design and efficacy of an Ecohealth competency-based course on the prevention and control of vector diseases in Latin America.

PubMed

Magaña-Valladares, Laura; Rodríguez, Mario Henry; Betanzos-Reyes, Ángel Francisco; Riojas-Rodríguez, Horacio; Quezada-Jiménez, María Laura; Suárez-Conejero, Juana Elvira; Lamadrid-Figueroa, Héctor

2018-01-01

To design and analyze the efficacy of an Ecohealth competency-based course on the prevention and control of vector-borne-diseases for specific stakeholders. Multiple stakeholders and sectors of the region were consulted to identify Ecohealth group-specific competencies using an adjusted analysis matrix. Eight courses based on the competencies were implemented to train EA tutors. The effectiveness of the course was evaluated through the use of paired- t-tests by intervention group. Strategic, tactical, academia and community stakeholder groups and their competencies were identified. An overall gain of 43 percentage points (p<0.001) was observed in terms of competencies score in trained tutors, which further trained 1 033 people. The identification of the stakeholders and their competencies proved to be useful to guide training courses to significantly improve the initial competencies and create a critical mass to further advance the EA in the region.

National Delphi study to determine competencies for nursing leadership in public health.

PubMed

Misener, T R; Alexander, J W; Blaha, A J; Clarke, P N; Cover, C M; Felton, G M; Fuller, S G; Herman, J; Rodes, M M; Sharp, H F

1997-01-01

To identify competencies needed by nurse leaders in public health programs. Five-round national Delphi. Convenience sample of members of major public health nursing associations and nurse and non-nurse public health leaders in the USA. Mailed survey in 1994-1995 using a modified snowball technique based on a modification of the Pew Foundation health professions' competencies for Round 1. Four additional rounds produced consensus. Initially, 62 competencies were identified. Factor analysis resulted in four factors: political competencies, business acumen, program leadership, and management capabilities; 57 competencies were clustered in the four groupings and accounted for 91.4% of the variance. Graduate schools in nursing and public health must prepare students with broad-based competencies from a variety of disciplines. Findings of this national survey provide a database for curriculum development and evaluation of programs to prepare nurse leaders for roles in public health-based delivery systems.

High Pressure Coolant Injection (HPCI) System Risk-Based Inspection Guide for Browns Ferry Nuclear Power Station

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

Wong, S.; DiBiasio, A.; Gunther, W.

1993-09-01

The High Pressure Coolant Injection (HPCI) system has been examined from a risk perspective. A System Risk-Based Inspection Guide (S-RIG) has been developed as an aid to HPCI system inspections at the Browns Ferry Nuclear Power Plant, Units 1, 2 and 3. The role of. the HPCI system in mitigating accidents is discussed in this S-RIG, along with insights on identified risk-based failure modes which could prevent proper operation of the system. The S-RIG provides a review of industry-wide operating experience, including plant-specific illustrative examples to augment the PRA and operational considerations in identifying a catalogue of basic PRA failuremore » modes for the HPCI system. It is designed to be used as a reference for routine inspections, self-initiated safety system functional inspections (SSFIs), and the evaluation of risk significance of component failures at the nuclear power plant.« less

Local-feature analysis for automated coarse-graining of bulk-polymer molecular dynamics simulations.

PubMed

Xue, Y; Ludovice, P J; Grover, M A

2012-12-01

A method for automated coarse-graining of bulk polymers is presented, using the data-mining tool of local feature analysis. Most existing methods for polymer coarse-graining define superatoms based on their covalent bonding topology along the polymer backbone, but here superatoms are defined based only on their correlated motions, as observed in molecular dynamics simulations. Correlated atomic motions are identified in the simulation data using local feature analysis, between atoms in the same or in different polymer chains. Groups of highly correlated atoms constitute the superatoms in the coarse-graining scheme, and the positions of their seed coordinates are then projected forward in time. Based on only the seed positions, local feature analysis enables the full reconstruction of all atomic positions. This reconstruction suggests an iterative scheme to reduce the computation of the simulations to initialize another short molecular dynamic simulation, identify new superatoms, and again project forward in time.

Defining Uniform Processes for Remediation, Probation and Termination in Residency Training.

PubMed

Smith, Jessica L; Lypson, Monica; Silverberg, Mark; Weizberg, Moshe; Murano, Tiffany; Lukela, Michael; Santen, Sally A

2017-01-01

It is important that residency programs identify trainees who progress appropriately, as well as identify residents who fail to achieve educational milestones as expected so they may be remediated. The process of remediation varies greatly across training programs, due in part to the lack of standardized definitions for good standing, remediation, probation, and termination . The purpose of this educational advancement is to propose a clear remediation framework including definitions, management processes, documentation expectations and appropriate notifications. Informal remediation is initiated when a resident's performance is deficient in one or more of the outcomes-based milestones established by the Accreditation Council for Graduate Medical Education, but not significant enough to trigger formal remediation. Formal remediation occurs when deficiencies are significant enough to warrant formal documentation because informal remediation failed or because issues are substantial. The process includes documentation in the resident's file and notification of the graduate medical education office; however, the documentation is not disclosed if the resident successfully remediates. Probation is initiated when a resident is unsuccessful in meeting the terms of formal remediation or if initial problems are significant enough to warrant immediate probation. The process is similar to formal remediation but also includes documentation extending to the final verification of training and employment letters. Termination involves other stakeholders and occurs when a resident is unsuccessful in meeting the terms of probation or if initial problems are significant enough to warrant immediate termination.

The Relationship Between Guideline-Recommended Initiation of Therapy, Outcomes, and Cost for Patients with Metastatic Non-Small Cell Lung Cancer.

PubMed

Casebeer, Adrianne; Antol, Dana Drzayich; DeClue, Richard W; Hopson, Sari; Li, Yong; Khoury, Raya; Michael, Todd; Sehman, Marina; Parikh, Aparna; Stemkowski, Stephen; Bunce, Mikele

2018-06-01

Guideline-recommended therapy for metastatic non-small cell lung cancer (mNSCLC) encourages evidence-based treatment; however, there is a knowledge gap regarding the influence of guideline-recommended initiation of therapy on outcomes and cost. To investigate if lack of guideline-recommended initiation of first-line systemic therapy was associated with worse patient outcomes and increased costs for patients with mNSCLC. In this retrospective analysis, 1,344 Medicare patients with mNSCLC were identified from Humana data. Performance status (PS) was imputed using procedure, diagnosis, and durable medical equipment codes pre-index. Guideline-recommended initiation of therapy was defined as ≥1 cycle of National Comprehensive Cancer Network-recommended first-line therapy based on age and PS or targeted therapies regardless of age and PS. Demographics and clinical characteristics were compared by guideline-recommended initiation of therapy. A Cox model assessed factors associated with 6-month mortality. End-of-life quality of care indicators included hospital admission and oncology infusions 30 days preceding death and were evaluated using logistic regression models. A generalized linear model assessed the relationship between guideline-recommended initiation of therapy and total health care costs in the 6 months post-index controlling for clinical, demographic, and treatment characteristics. Logistic models for inpatient stays and emergency department visits were also evaluated. Guideline-recommended therapy initiation was observed in 75.5% of patients. Patients not initiating guideline-recommended therapy were older, with a mean (SD) age of 72.5 (6.7) versus 71.2 (6.2) years (P = 0.001), and more frequently identified as having a low-income subsidy (30.0% vs. 16.4%; P < 0.001). Among the 24.6% of patients who died ≤ 6 months post-index, a greater percentage had not initiated guideline-recommended therapy (28.8% vs. 23.2%; P = 0.040). In adjusted models, PS (not initiation of guideline-recommended therapy) was predictive of mortality (patients with poor PS had an 84% higher probability of death [P = 0.014]). Among decedents, 64.2% were hospitalized, and 33.9% had an oncology-related infusion within 30 days of death, with no differences by guideline-recommended initiation of therapy. These end-of-life quality indicators were not associated with guideline-recommended initiation of therapy in adjusted models. Overall, 47.5% of patients who initiated guideline-recommended therapy were hospitalized compared with 55.0% of patients who did not (P = 0.026). Patients initiating guideline-recommended therapy had higher post-index total and oncology-related health care costs and fewer hospitalizations. In models, these differences in costs and hospitalizations were not associated with initiation of guideline-recommended therapy. Most patients initiated guideline-recommended therapy, with no differences in mortality and quality of care at the end of life by guideline-recommended initiation of therapy, though adherence beyond treatment initiation was not assessed. Unadjusted hospitalization rates were lower and costs were higher for patients who initiated guideline-recommended therapy. These differences were no longer observed after risk adjustment, suggesting that they may have been influenced by patient characteristics, disease progression, and subsequent treatment decisions. This study was sponsored by Genentech. Khoury, Michael, Parikh, and Bunce are employed by Genentech. Casebeer, Drzayich Antol, DeClue, Hopson, Li, and Stemkowski are employed by Comprehensive Health Insights, Humana, which was contracted by Genentech to conduct this study. Sehman is employed by Humana. Based on this research, 2 posters were presented at the Academy of Managed Care Pharmacy Nexus 2017 on October 16-19, 2017, in Dallas, Texas. Another poster was also presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Annual European Congress on October 29-November 2, 2016, in Vienna, Austria.

Structure based alignment and clustering of proteins (STRALCP)

DOEpatents

Zemla, Adam T.; Zhou, Carol E.; Smith, Jason R.; Lam, Marisa W.

2013-06-18

Disclosed are computational methods of clustering a set of protein structures based on local and pair-wise global similarity values. Pair-wise local and global similarity values are generated based on pair-wise structural alignments for each protein in the set of protein structures. Initially, the protein structures are clustered based on pair-wise local similarity values. The protein structures are then clustered based on pair-wise global similarity values. For each given cluster both a representative structure and spans of conserved residues are identified. The representative protein structure is used to assign newly-solved protein structures to a group. The spans are used to characterize conservation and assign a "structural footprint" to the cluster.

MO-D-213-02: Quality Improvement Through a Failure Mode and Effects Analysis of Pediatric External Beam Radiotherapy

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

Gray, J; Lukose, R; Bronson, J

2015-06-15

Purpose: To conduct a failure mode and effects analysis (FMEA) as per AAPM Task Group 100 on clinical processes associated with teletherapy, and the development of mitigations for processes with identified high risk. Methods: A FMEA was conducted on clinical processes relating to teletherapy treatment plan development and delivery. Nine major processes were identified for analysis. These steps included CT simulation, data transfer, image registration and segmentation, treatment planning, plan approval and preparation, and initial and subsequent treatments. Process tree mapping was utilized to identify the steps contained within each process. Failure modes (FM) were identified and evaluated with amore » scale of 1–10 based upon three metrics: the severity of the effect, the probability of occurrence, and the detectability of the cause. The analyzed metrics were scored as follows: severity – no harm = 1, lethal = 10; probability – not likely = 1, certainty = 10; detectability – always detected = 1, undetectable = 10. The three metrics were combined multiplicatively to determine the risk priority number (RPN) which defined the overall score for each FM and the order in which process modifications should be deployed. Results: Eighty-nine procedural steps were identified with 186 FM accompanied by 193 failure effects with 213 potential causes. Eighty-one of the FM were scored with a RPN > 10, and mitigations were developed for FM with RPN values exceeding ten. The initial treatment had the most FM (16) requiring mitigation development followed closely by treatment planning, segmentation, and plan preparation with fourteen each. The maximum RPN was 400 and involved target delineation. Conclusion: The FMEA process proved extremely useful in identifying previously unforeseen risks. New methods were developed and implemented for risk mitigation and error prevention. Similar to findings reported for adult patients, the process leading to the initial treatment has an associated high risk.« less

Prioritizing human pharmaceuticals for ecological risks in the freshwater environment of Korea.

PubMed

Ji, Kyunghee; Han, Eun Jeong; Back, Sunhyoung; Park, Jeongim; Ryu, Jisung; Choi, Kyungho

2016-04-01

Pharmaceutical residues are potential threats to aquatic ecosystems. Because more than 3000 active pharmaceutical ingredients (APIs) are in use, identifying high-priority pharmaceuticals is important for developing appropriate management options. Priority pharmaceuticals may vary by geographical region, because their occurrence levels can be influenced by demographic, societal, and regional characteristics. In the present study, the authors prioritized human pharmaceuticals of potential ecological risk in the Korean water environment, based on amount of use, biological activity, and regional hydrologic characteristics. For this purpose, the authors estimated the amounts of annual production of 695 human APIs in Korea. Then derived predicted environmental concentrations, using 2 approaches, to develop an initial candidate list of target pharmaceuticals. Major antineoplastic drugs and hormones were added in the initial candidate list regardless of their production amount because of their high biological activity potential. The predicted no effect concentrations were derived for those pharmaceuticals based on ecotoxicity information available in the literature or by model prediction. Priority lists of human pharmaceuticals were developed based on ecological risks and availability of relevant information. Those priority APIs identified include acetaminophen, clarithromycin, ciprofloxacin, ofloxacin, metformin, and norethisterone. Many of these pharmaceuticals have been neither adequately monitored nor assessed for risks in Korea. Further efforts are needed to improve these lists and to develop management decisions for these compounds in Korean water. © 2015 SETAC.

Consistency mapping of 16 lymph node stations in gastric cancer by CT-based vessel-guided delineation of 255 patients.

PubMed

Xu, Shuhang; Feng, Lingling; Chen, Yongming; Sun, Ying; Lu, Yao; Huang, Shaomin; Fu, Yang; Zheng, Rongqin; Zhang, Yujing; Zhang, Rong

2017-06-20

In order to refine the location and metastasis-risk density of 16 lymph node stations of gastric cancer for neoadjuvant radiotherapy, we retrospectively reviewed the initial images and pathological reports of 255 gastric cancer patients with lymphatic metastasis. Metastatic lymph nodes identified in the initial computed tomography images were investigated by two radiologists with gastrointestinal specialty. A circle with a diameter of 5 mm was used to identify the central position of each metastatic lymph node, defined as the LNc (the central position of the lymph node). The LNc was drawn at the equivalent location on the reference images of a standard patient based on the relative distances to the same reference vessels and the gastric wall using a Monaco® version 5.0 workstation. The image manipulation software Medi-capture was programmed for image analysis to produce a contour and density atlas of 16 lymph node stations. Based on a total of 2846 LNcs contoured (31-599 per lymph node station), we created a density distribution map of 16 lymph node drainage stations of the stomach on computed tomography images, showing the detailed radiographic delineation of each lymph node station as well as high-risk areas for lymph node metastasis. Our mapping can serve as a template for the delineation of gastric lymph node stations when defining clinical target volume in pre-operative radiotherapy for gastric cancer.

Training and retaining staff to competently deliver an evidence-based practice: the role of staff attributes and perceptions of organizational functioning.

PubMed

Garner, Bryan R; Hunter, Brooke D; Godley, Susan H; Godley, Mark D

2012-03-01

Within the context of an initiative to implement evidence-based practices (EBPs) for adolescents with substance use disorders, this study examined the extent to which staff factors measured at an initial EBP training workshop were predictive of EBP competence and turnover status of staff (N = 121) measured 6, 9, and 12 months posttraining. By the final assessment point, 52.3% of staff transitioned to the employed/EBP-competent category, 26.6% transitioned to the not employed/not EBP-competent category, 4.6% transitioned to the not employed/EBP-competent category, and 16.5% had not transitioned out of the initial category. Multilevel multinomial regression analysis identified several measures that were significant predictors of staff transitions to the not employed/not EBP-competent category (e.g., program needs, job satisfaction, burnout) and transitions to the employed/EBP-competent category (e.g., months in position, pressures for change, influence). Findings have implications for the development and testing of strategies to train and retain staff to deliver EBPs in practice settings. Copyright © 2012 Elsevier Inc. All rights reserved.

Adolescent cortical thickness pre- and post marijuana and alcohol initiation.

PubMed

Jacobus, Joanna; Castro, Norma; Squeglia, Lindsay M; Meloy, M J; Brumback, Ty; Huestis, Marilyn A; Tapert, Susan F

Cortical thickness abnormalities have been identified in youth using both alcohol and marijuana. However, limited studies have followed individuals pre- and post initiation of alcohol and marijuana use to help identify to what extent discrepancies in structural brain integrity are pre-existing or substance-related. Adolescents (N=69) were followed from ages 13 (pre-initiation of substance use, baseline) to ages 19 (post-initiation, follow-up). Three subgroups were identified, participants that initiated alcohol use (ALC, n=23, >20 alcohol use episodes), those that initiated both alcohol and marijuana use (ALC+MJ, n=23, >50 marijuana use episodes) and individuals that did not initiate either substance regularly by follow-up (CON, n=23, <3 alcohol use episodes, no marijuana use episodes). All adolescents underwent neurocognitive testing, neuroimaging, and substance use and mental health interviews. Significant group by time interactions and main effects on cortical thickness estimates were identified for 18 cortical regions spanning the left and right hemisphere (ps<0.05). The vast majority of findings suggest a more substantial decrease, or within-subjects effect, in cortical thickness by follow-up for individuals who have not initiated regular substance use or alcohol use only by age 19; modest between-group differences were identified at baseline in several cortical regions (ALC and CON>ALC+MJ). Minimal neurocognitive differences were observed in this sample. Findings suggest pre-existing neural differences prior to marijuana use may contribute to initiation of use and observed neural outcomes. Marijuana use may also interfere with thinning trajectories that contribute to morphological differences in young adulthood that are often observed in cross-sectional studies of heavy marijuana users. Copyright © 2016 Elsevier Inc. All rights reserved.

Adolescent Cortical Thickness Pre- and Post Marijuana and Alcohol Initiation

PubMed Central

Jacobus, Joanna; Castro, Norma; Squeglia, Lindsay M.; Meloy, M.J.; Brumback, Ty; Huestis, Marilyn; Tapert, Susan F.

2016-01-01

Cortical thickness abnormalities have been identified in youth using both alcohol and marijuana. However, limited studies have followed individuals pre- and post initiation of alcohol and marijuana use to help identify to what extent discrepancies in structural brain integrity are pre-existing or substance-related. Adolescents (N=69) were followed from ages 13 (pre-initiation of substance use, baseline) to ages 19 (post-initiation, follow-up). Three subgroups were identified, participants that initiated alcohol use (ALC, n=23, >20 alcohol use episodes), those that initiated both alcohol and marijuana use (ALC+MJ, n=23, >50 marijuana use episodes) and individuals that did not initiate either substance regularly by follow-up (CON, n=23, <3 alcohol use episodes, no marijuana use episodes). All adolescents underwent neurocognitive testing, neuroimaging, and substance use and mental health interviews. Significant group by time interactions and main effects on cortical thickness estimates were identified for 18 cortical regions spanning the left and right hemisphere (ps<.05). The vast majority of findings suggest a more substantial decrease, or within-subjects effect, in cortical thickness by follow-up for individuals who have not initiated regular substance use or alcohol use only by age 19; modest between-group differences were identified at baseline in several cortical regions (ALC and CON>ALC+MJ). Minimal neurocognitive differences were observed in this sample. Findings suggest pre-existing neural differences prior to marijuana use may contribute to initiation of use and observed neural outcomes. Marijuana use may also interfere with thinning trajectories that contribute to morphological differences in young adulthood that are often observed in cross-sectional studies of heavy marijuana users. PMID:27687470

Mucosal immunity to poliovirus.

PubMed

Ogra, Pearay L; Okayasu, Hiromasa; Czerkinsky, Cecil; Sutter, Roland W

2011-10-01

The Global Polio Eradication Initiative (GPEI) currently based on use of oral poliovirus vaccine (OPV) has identified suboptimal immunogenicity of this vaccine as a major impediment to eradication, with a failure to induce protection against paralytic poliomyelitis in certain population segments in some parts of the world. The Mucosal Immunity and Poliovirus Vaccines: Impact on Wild Poliovirus Infection, Transmission and Vaccine Failure conference was organized to obtain a better understanding of the current status of global control of poliomyelitis and identify approaches to improve the immune responsiveness and effectiveness of the orally administered poliovirus vaccines in order to accelerate the global eradication of paralytic poliomyelitis.

Key Gaps for Enabling Plant Growth in Future Missions

NASA Technical Reports Server (NTRS)

Anderson, Molly; Motil, Brian; Barta, Dan; Fritsche, Ralph; Massa, Gioia; Quincy, Charlie; Romeyn, Matthew; Wheeler, Ray; Hanford, Anthony

2017-01-01

Growing plants to provide food or psychological benefits to crewmembers is a common vision for the future of human spaceflight, often represented in media and in serious concept studies. The complexity of controlled environment agriculture, and plant growth in microgravity have and continue to be the subject of dedicated scientific research. However, actually implementing these systems in a way that will be cost effective, efficient, and sustainable for future space missions is a complex, multi-disciplinary problem. Key questions exist in many areas: human medical research in nutrition and psychology, horticulture, plant physiology and microbiology, multi-phase microgravity fluid physics, hardware design and technology development, and system design, operations and mission planning. This paper describes key knowledge gaps identified by a multi-disciplinary working group within the National Aeronautics and Space Administration (NASA). It also begins to identify solutions to the simpler questions identified by the group based on work initiated in 2017. Growing plants to provide food or psychological benefits to crewmembers is a common vision for the future of human spaceflight, often represented in media and in serious concept studies. The complexity of controlled environment agriculture, and plant growth in microgravity have and continue to be the subject of dedicated scientific research. However, actually implementing these systems in a way that will be cost effective, efficient, and sustainable for future space missions is a complex, multi-disciplinary problem. Key questions exist in many areas: human medical research in nutrition and psychology, horticulture, plant physiology and microbiology, multi-phase microgravity fluid physics, hardware design and technology development, and system design, operations and mission planning. This paper describes key knowledge gaps identified by a multi-disciplinary working group within the National Aeronautics and Space Administration (NASA). It also begins to identify solutions to the simpler questions identified by the group based on work initiated in 2017.

Nonparametric evaluation of birth cohort trends in disease rates.

PubMed

Tarone, R E; Chu, K C

2000-01-01

Although interpretation of age-period-cohort analyses is complicated by the non-identifiability of maximum likelihood estimates, changes in the slope of the birth-cohort effect curve are identifiable and have potential aetiologic significance. A nonparametric test for a change in the slope of the birth-cohort trend has been developed. The test is a generalisation of the sign test and is based on permutational distributions. A method for identifying interactions between age and calendar-period effects is also presented. The nonparametric method is shown to be powerful in detecting changes in the slope of the birth-cohort trend, although its power can be reduced considerably by calendar-period patterns of risk. The method identifies a previously unidentified decrease in the birth-cohort risk of lung-cancer mortality from 1912 to 1919, which appears to reflect a reduction in the initiation of smoking by young men at the beginning of the Great Depression (1930s). The method also detects an interaction between age and calendar period in leukemia mortality rates, reflecting the better response of children to chemotherapy. The proposed nonparametric method provides a data analytic approach, which is a useful adjunct to log-linear Poisson analysis of age-period-cohort models, either in the initial model building stage, or in the final interpretation stage.

Data governance and data sharing agreements for community-wide health information exchange: lessons from the beacon communities.

PubMed

Allen, Claudia; Des Jardins, Terrisca R; Heider, Arvela; Lyman, Kristin A; McWilliams, Lee; Rein, Alison L; Schachter, Abigail A; Singh, Ranjit; Sorondo, Barbara; Topper, Joan; Turske, Scott A

2014-01-01

Unprecedented efforts are underway across the United States to electronically capture and exchange health information to improve health care and population health, and reduce costs. This increased collection and sharing of electronic patient data raises several governance issues, including privacy, security, liability, and market competition. Those engaged in such efforts have had to develop data sharing agreements (DSAs) among entities involved in information exchange, many of whom are "nontraditional" health care entities and/or new partners. This paper shares lessons learned based on the experiences of six federally funded communities participating in the Beacon Community Cooperative Agreement Program, and offers guidance for navigating data governance issues and developing DSAs to facilitate community-wide health information exchange. While all entities involved in electronic data sharing must address governance issues and create DSAs accordingly, until recently little formal guidance existed for doing so - particularly for community-based initiatives. Despite this lack of guidance, together the Beacon Communities' experiences highlight promising strategies for navigating complex governance issues, which may be useful to other entities or communities initiating information exchange efforts to support delivery system transformation. For the past three years, AcademyHealth has provided technical assistance to most of the 17 Beacon Communities, 6 of whom contributed to this collaborative writing effort. Though these communities varied widely in terms of their demographics, resources, and Beacon-driven priorities, common themes emerged as they described their approaches to data governance and DSA development. The 6 Beacon Communities confirmed that DSAs are necessary to satisfy legal and market-based concerns, and they identified several specific issues, many of which have been noted by others involved in network data sharing initiatives. More importantly, these communities identified several promising approaches to timely and effective DSA development, including: stakeholder engagement; identification and effective communication of value; adoption of a parsimonious approach; attention to market-based concerns; flexibility in adapting and expanding existing agreements and partnerships; and anticipation of required time and investment.

Matching Real and Synthetic Panoramic Images Using a Variant of Geometric Hashing

NASA Astrophysics Data System (ADS)

Li-Chee-Ming, J.; Armenakis, C.

2017-05-01

This work demonstrates an approach to automatically initialize a visual model-based tracker, and recover from lost tracking, without prior camera pose information. These approaches are commonly referred to as tracking-by-detection. Previous tracking-by-detection techniques used either fiducials (i.e. landmarks or markers) or the object's texture. The main contribution of this work is the development of a tracking-by-detection algorithm that is based solely on natural geometric features. A variant of geometric hashing, a model-to-image registration algorithm, is proposed that searches for a matching panoramic image from a database of synthetic panoramic images captured in a 3D virtual environment. The approach identifies corresponding features between the matched panoramic images. The corresponding features are to be used in a photogrammetric space resection to estimate the camera pose. The experiments apply this algorithm to initialize a model-based tracker in an indoor environment using the 3D CAD model of the building.

Patient engagement and attrition in pediatric obesity clinics and programs: results and recommendations.

PubMed

Hampl, Sarah; Paves, Heather; Laubscher, Katie; Eneli, Ihuoma

2011-09-01

Pediatric tertiary care institutions are well positioned to provide multidisciplinary, intensive interventions for pediatric obesity known as stage 3 treatment. One contributor to the difficulty in administering this treatment is the high rate of patient attrition. Little is known about the practices used by pediatric weight-management clinics and group-based programs to minimize attrition. Hospital members and nonmembers of FOCUS on a Fitter Future were surveyed on the methods used to engage and retain obese children in their clinics and programs. Shortly thereafter, a benchmarking activity that centered on rates of patient nonattendance at initial and follow-up clinic visits was initiated among FOCUS-group-participating hospitals. Clinic- and group-based program results were contrasted. Staff from group-based programs reported that the majority of patients did not complete even 50% of program follow-up visits. Multiple patient/family- and clinic/program-level barriers to retention were identified. Attention to successful techniques should be paid during planning for new programs and improvement of established ones.

Community based rehabilitation: a strategy for peace-building

PubMed Central

Boyce, William; Koros, Michael; Hodgson, Jennifer

2002-01-01

Background Certain features of peace-building distinguish it from peacekeeping, and make it an appropriate strategy in dealing with vertical conflict and low intensity conflict. However, some theorists suggest that attempts, through peace-building, to impose liberal values upon non-democratic cultures are misguided and lack an ethical basis. Discussion We have been investigating the peace-building properties of community based approaches to disability in a number of countries. This paper describes the practice and impact of peace-building through Community Based Rehabilitation (CBR) strategies in the context of armed conflict. The ethical basis for peace-building through practical community initiatives is explored. A number of benefits and challenges to using CBR strategies for peace-building purposes are identified. Summary During post-conflict reconstruction, disability is a powerful emotive lever that can be used to mobilize cooperation between factions. We suggest that civil society, in contrast to state-level intervention, has a valuable role in reducing the risks of conflict through community initiatives. PMID:12417012

From community-based pilot testing to region-wide systems change: lessons from a local quality improvement collaborative.

PubMed

Keyser, Donna J; Pincus, Harold Alan

2010-01-01

A community-based collaborative conducted a 2-year pilot study to inform efforts for improving maternal and child health care practice and policy in Allegheny County, Pennsylvania. (1) To test whether three small-scale versions of an evidence-based, systems improvement approach would be workable in local community settings and (2) to identify specific policy/infrastructure reforms for sustaining improvements. A mixed methods approach was used, including quantitative performance measurement supplemented with qualitative data about factors related to outcomes of interest, as well as key stakeholder interviews and a literature review/Internet search. Quantitative performance results varied; qualitative data revealed critical factors for the success and failure of the practices tested. Policy/infrastructure recommendations were developed to address specific practice barriers. This information was important for designing a region-wide quality improvement initiative focused on maternal depression. The processes and outcomes provide valuable insights for other communities interested in conducting similar quality improvement initiatives.

A National Needs Assessment to Identify Technical Procedures in Vascular Surgery for Simulation Based Training.

PubMed

Nayahangan, L J; Konge, L; Schroeder, T V; Paltved, C; Lindorff-Larsen, K G; Nielsen, B U; Eiberg, J P

2017-04-01

Practical skills training in vascular surgery is facing challenges because of an increased number of endovascular procedures and fewer open procedures, as well as a move away from the traditional principle of "learning by doing." This change has established simulation as a cornerstone in providing trainees with the necessary skills and competences. However, the development of simulation based programs often evolves based on available resources and equipment, reflecting convenience rather than a systematic educational plan. The objective of the present study was to perform a national needs assessment to identify the technical procedures that should be integrated in a simulation based curriculum. A national needs assessment using a Delphi process was initiated by engaging 33 predefined key persons in vascular surgery. Round 1 was a brainstorming phase to identify technical procedures that vascular surgeons should learn. Round 2 was a survey that used a needs assessment formula to explore the frequency of procedures, the number of surgeons performing each procedure, risk and/or discomfort, and feasibility for simulation based training. Round 3 involved elimination and ranking of procedures. The response rate for round 1 was 70%, with 36 procedures identified. Round 2 had a 76% response rate and resulted in a preliminary prioritised list after exploring the need for simulation based training. Round 3 had an 85% response rate; 17 procedures were eliminated, resulting in a final prioritised list of 19 technical procedures. A national needs assessment using a standardised Delphi method identified a list of procedures that are highly suitable and may provide the basis for future simulation based training programs for vascular surgeons in training. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Evaluating online diagnostic decision support tools for the clinical setting.

PubMed

Pryor, Marie; White, David; Potter, Bronwyn; Traill, Roger

2012-01-01

Clinical decision support tools available at the point of care are an effective adjunct to support clinicians to make clinical decisions and improve patient outcomes. We developed a methodology and applied it to evaluate commercially available online clinical diagnostic decision support (DDS) tools for use at the point of care. We identified 11 commercially available DDS tools and assessed these against an evaluation instrument that included 6 categories; general information, content, quality control, search, clinical results and other features. We developed diagnostically challenging clinical case scenarios based on real patient experience that were commonly missed by junior medical staff. The evaluation was divided into 2 phases; an initial evaluation of all identified and accessible DDS tools conducted by the Clinical Information Access Portal (CIAP) team and a second phase that further assessed the top 3 tools identified in the initial evaluation phase. An evaluation panel consisting of senior and junior medical clinicians from NSW Health conducted the second phase. Of the eleven tools that were assessed against the evaluation instrument only 4 tools completely met the DDS definition that was adopted for this evaluation and were able to produce a differential diagnosis. From the initial phase of the evaluation 4 DDS tools scored 70% or more (maximum score 96%) for the content category, 8 tools scored 65% or more (maximum 100%) for the quality control category, 5 tools scored 65% or more (maximum 94%) for the search category, and 4 tools score 70% or more (maximum 81%) for the clinical results category. The second phase of the evaluation was focused on assessing diagnostic accuracy for the top 3 tools identified in the initial phase. Best Practice ranked highest overall against the 6 clinical case scenarios used. Overall the differentiating factor between the top 3 DDS tools was determined by diagnostic accuracy ranking, ease of use and the confidence and credibility of the clinical information. The evaluation methodology used here to assess the quality and comprehensiveness of clinical DDS tools was effective in identifying the most appropriate tool for the clinical setting. The use of clinical case scenarios is fundamental in determining the diagnostic accuracy and usability of the tools.

A US database study characterizing patients initiating a budesonide-formoterol combination versus tiotropium bromide as initial maintenance therapy for chronic obstructive pulmonary disease.

PubMed

Kern, David M; Williams, Setareh A; Tunceli, Ozgur; Wessman, Catrin; Zhou, Siting; Pethick, Ned; Elhefni, Hanaa; Trudo, Frank

2014-01-01

To compare clinical and demographic characteristics, resource utilization and costs of chronic obstructive pulmonary disease (COPD) patients prior to initiating budesonide-formoterol combination (BFC) or tiotropium-maintenance therapy. This cross-sectional study used claims-based diagnosis to identify COPD patients in the HealthCore Integrated Research Database who initiated BFC or tiotropium therapy between March 1, 2009 and January 31, 2012 (intake period); the index date was defined as the initial prescription fill for either agent. Patients diagnosed with respiratory tract cancer or receiving inhaled corticosteroids/long-acting β2-adrenergic agonists or tiotropium in 12 months prior to index date were excluded. Categorical variables were evaluated with χ(2) tests; mean cost differences were evaluated using γ-regression. Overall, 6,940 BFC and 10,831 tiotropium patients were identified. The BFC group was younger (mean age 64 versus 67 years), with a greater proportion of females (54% versus 51%). BFC-treated patients had more comorbid respiratory conditions, including asthma (25% versus 13%), but fewer comorbid cardiovascular conditions, including atherosclerosis (7% versus 10%) and myocardial infarction (4% versus 6%). A greater proportion of BFC patients received prior respiratory medication, including oral corticosteroids (46% versus 35%) and short-acting β2-agonists (44% versus 35%). Tiotropium-treated patients had a greater mean number of COPD-related outpatient visits (4.6 versus 4.1). BFC-treated patients had lower total all-cause ($17,259 versus $17,926) and COPD-related ($1,718 versus $1,930) health care costs, driven by lower all-cause and COPD-related inpatient expenditures. Initiators of BFC or tiotropium showed differences in clinical and demographic characteristics and health care utilization and costs prior to starting COPD maintenance therapy.

Pediatric psychotropic medication initiation and adherence: a literature review based on social exchange theory.

PubMed

Hamrin, Vanya; McCarthy, Erin M; Tyson, Veda

2010-08-01

Psychotropic medication initiation and adherence is an identified problem. This literature review explores factors that determine families' decisions to initiate, sustain, or discontinue use of psychotropic medication in children and adolescents. Social exchange theory is used as a framework to explore decisions to initiate and adhere to psychotropic medications. Contributing factors related to psychotropic medication initiation, adherence, and discontinuation are explored. Themes in the literature encompassing costs and benefits of psychotropic medication adherence include family experiences with adverse effects, previous psychotropic medication experience, medication psychoeducation, stigma, societal views about psychotropic medication, particular diagnosis, the effect of comorbid diagnosis on adherence, attitudes and beliefs about medication by both children and parents, and relationships with the provider. The impact of family demographics including parent gender, age of the child, ethnicity, and parent educational level on psychotropic medication adherence is evaluated. International and U.S. studies from Medline, Cumulative Index for Nursing and Allied Health Literature and PsychInfo evaluating medication initiation and adherence in the pediatric psychiatric population and social exchange theory was incorporated from relevant textbook resources. Rewards experienced from medication treatment include improvement in symptoms, school performance and family relationships, and reduced level of parenting stress. Identified costs include impact of adverse side effects, social stigma, lack of response, fears of addiction, and changing the child's personality. Acceptance of the diagnosis influences adherence while medication education has varying effects. Families' attitudes, beliefs and perceptions about psychiatric illness and treatment play a large role in medication treatment decisions. A trusting provider relationship has a positive effect on adherence. Psychosocial treatment alternatives are preferred. With maturation, adolescents have more influence on decisions related to adherence.

Analysis of initial changes in the proteins of soybean root tip under flooding stress using gel-free and gel-based proteomic techniques.

PubMed

Yin, Xiaojian; Sakata, Katsumi; Nanjo, Yohei; Komatsu, Setsuko

2014-06-25

Flooding has a severe negative effect on soybean cultivation in the early stages of growth. To obtain a better understanding of the response mechanisms of soybean to flooding stress, initial changes in root tip proteins under flooding were analyzed using two proteomic techniques. Two-day-old soybeans were treated with flooding for 3, 6, 12, and 24h. The weight of soybeans increased during the first 3h of flooding, but root elongation was not observed. Using gel-based and gel-free proteomic techniques, 115 proteins were identified in root tips, of which 9 proteins were commonly detected by both methods. The 71 proteins identified by the gel-free proteomics were analyzed by a hierarchical clustering method based on induction levels during the flooding, and the proteins were divided into 5 clusters. Additional interaction analysis of the proteins revealed that ten proteins belonging to cluster I formed the center of a protein interaction network. mRNA expression analysis of these ten proteins showed that citrate lyase and heat shock protein 70 were down-regulated, whereas calreticulin was up-regulated in initial phase of flooding. These results suggest that flooding stress to soybean induces calcium-related signal transduction, which might play important roles in the early responses to flooding. Flooding has a severe negative effect on soybean cultivation, particularly in the early stages of growth. To better understand the response mechanisms of soybean to the early stages of flooding stress, two proteomic techniques were used. Two-day-old soybeans were treated without or with flooding for 3, 6, 12, and 24h. The fresh weight of soybeans increased during the first 3h of flooding stress, but the growth then slowed and no root elongation was observed. Using gel-based and gel-free proteomic techniques, 115 proteins were identified in root tips, of which 9 proteins were commonly detected by both methods. The 71 proteins identified by the gel-free proteomics were analyzed by a hierarchical clustering method based on induction levels during the flooding stress, and 5 protein clusters were recognized. Protein interaction analysis revealed that ten proteins belonging to cluster I formed the center of a protein interaction network. mRNA expression analysis of these ten proteins showed that citrate lyase and heat shock protein 70 were down-regulated in response to flooding stress, whereas calreticulin was up-regulated. These results suggest that flooding stress to soybean induces calcium-related signal transduction, which might play important roles in the early responses to flooding. Copyright © 2014 Elsevier B.V. All rights reserved.

Content based image retrieval for matching images of improvised explosive devices in which snake initialization is viewed as an inverse problem

NASA Astrophysics Data System (ADS)

Acton, Scott T.; Gilliam, Andrew D.; Li, Bing; Rossi, Adam

2008-02-01

Improvised explosive devices (IEDs) are common and lethal instruments of terrorism, and linking a terrorist entity to a specific device remains a difficult task. In the effort to identify persons associated with a given IED, we have implemented a specialized content based image retrieval system to search and classify IED imagery. The system makes two contributions to the art. First, we introduce a shape-based matching technique exploiting shape, color, and texture (wavelet) information, based on novel vector field convolution active contours and a novel active contour initialization method which treats coarse segmentation as an inverse problem. Second, we introduce a unique graph theoretic approach to match annotated printed circuit board images for which no schematic or connectivity information is available. The shape-based image retrieval method, in conjunction with the graph theoretic tool, provides an efficacious system for matching IED images. For circuit imagery, the basic retrieval mechanism has a precision of 82.1% and the graph based method has a precision of 98.1%. As of the fall of 2007, the working system has processed over 400,000 case images.

Initial Multidisciplinary Design and Analysis Framework

NASA Technical Reports Server (NTRS)

Ozoroski, L. P.; Geiselhart, K. A.; Padula, S. L.; Li, W.; Olson, E. D.; Campbell, R. L.; Shields, E. W.; Berton, J. J.; Gray, J. S.; Jones, S. M.;

Identifying Cognitive Mechanisms Targeted for Treatment Development in Schizophrenia: An Overview of the First Meeting of the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) Initiative

PubMed Central

Carter, Cameron S.; Barch, Deanna M.; Buchanan, Robert W.; Bullmore, Ed; Krystal, John H.; Cohen, Jonathan; Geyer, Mark; Green, Michael; Nuechterlein, Keith H.; Robbins, Trevor; Silverstein, Steven; Smith, Edward E.; Strauss, Milton; Wykes, Til; Heinssen, Robert

2008-01-01

This overview describes the generation and development of the ideas that led to the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) initiative. It also describes the organization, process and products of the first meeting. The CNTRICS initiative involves a series of three conferences that will systematically address barriers to translating paradigms developed in the basic animal and human cognitive neuroscience fields for use in translational research aimed at developing novel treatments for cognitive impairments in schizophrenia. The articles in this special section report on the results of the first conference, which used a criterion based consensus-building process to develop a set of cognitive constructs to be targeted for translation efforts. PMID:18466880

Navigating recurrent abdominal pain through clinical clues, red flags, and initial testing.

PubMed

Noe, Joshua D; Li, B U K

2009-05-01

Recurrent abdominal pain is a common chronic complaint that presents to your office. The constant challenge is one of detecting those with organic disease from the majority who have a functional pain disorder including functional dyspepsia, irritable bowel syndrome, functional abdominal pain, and abdominal migraine. Beginning with a detailed history and physical exam, you can: 1) apply the symptom-based Rome III criteria to positively identify a functional disorder, and 2) filter these findings through the diagnostic clues and red flags that point toward specific organic disease and/or further testing. Once a functional diagnosis has been made or an organic disease is suspected, you can initiate a self-limited empiric therapeutic trial. With this diagnostic approach, you should feel confident navigating through the initial evaluation, management, and consultation referral for a child or adolescent with recurrent abdominal pain.

Behavioral interventions for office-based care: behavior change.

PubMed

Delfino, Matthew; Larzelere, Michele McCarthy

2014-03-01

Family physicians play an important role in identifying and treating the behavioral etiologies of morbidity and mortality. Changing behavior is a challenging process that begins with identifying a patient's readiness to change. Interventions, such as motivational interviewing, are used to increase a patient's desire to change, and cognitive behavioral therapy can be initiated to increase a patient's likelihood of change, particularly if barriers are identified. After patients embark on change, family physicians are uniquely positioned to connect them to self-help programs, more intensive psychotherapy, and newer technology-based support programs, and to provide repeated, brief, positive reinforcement. Specific behavioral interventions that can be effective include computerized smoking cessation programs; electronic reminders and support delivered by family physicians or other clinicians for weight loss; linkage to community-based programs for seniors; increased length and demands of in-school programs to support exercise participation by children; and access reduction education to prevent firearm injury. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Managing Workplace Violence With Evidence-Based Interventions: A Literature Review.

PubMed

Martinez, Angel Johann Solorzano

2016-09-01

Workplace violence in health care settings is an occupational issue concerning nurses and other health care professionals. Patient aggression against nurses is often the most common form of violence in clinical settings, occurring in emergency departments, inpatient psychiatric settings, and nursing homes. Physical and verbal assaults are the major forms of workplace violence encountered by nurses. Current research has identified staff, environmental, and patient risk factors as the major precursors of workplace violence initiated by patients. Nurses often experience significant physical and psychological negative consequences after an episode of workplace violence. A review of the evidence was conducted to identify current evidence-based interventions that can help nurses minimize the incidence of workplace violence. [Journal of Psychosocial Nursing and Mental Health Services, 54(9), 31-36.]. Copyright 2016, SLACK Incorporated.

[Boundaries of the autonomy of local health administration: innovation, creativity and evidence-based decision-making].

PubMed

Silva, Silvio Fernandes da; Souza, Nathan Mendes; Barreto, Jorge Otávio Maia

2014-11-01

The scope of this article was to identify the boundaries of the autonomy of local administration in the context of the federal pact in the Brazilian Unified Health System and the importance and potential for promoting innovation, creativity and evidence-based decision-making by local governments. The methodology used was to ask questions that favored dialogue with the specific literature to identify the influence of centrally-formulated policies in spaces of local autonomy and then to identify strategies to foster innovation, creativity and the systematic use of evidence-based research in health policy implementation. A gradual reduction in municipal decision-making autonomy was detected due to increased financial commitment of the municipalities resulting from responsibilities assumed, albeit with the possibility of reverting this trend in the more recent context. Some determinants and challenges for the dissemination of innovative practices were analyzed and some relevant national and international experiences in this respect were presented. The conclusion drawn is that it is possible to make local decision-making more effective provided that initiatives are consolidated to promote this culture and the formulation and implementation of evidence-based health policies.

Identification of novel drug scaffolds for inhibition of SARS-CoV 3-Chymotrypsin-like protease using virtual and high-throughput screenings.

PubMed

Lee, Hyun; Mittal, Anuradha; Patel, Kavankumar; Gatuz, Joseph L; Truong, Lena; Torres, Jaime; Mulhearn, Debbie C; Johnson, Michael E

2014-01-01

We have used a combination of virtual screening (VS) and high-throughput screening (HTS) techniques to identify novel, non-peptidic small molecule inhibitors against human SARS-CoV 3CLpro. A structure-based VS approach integrating docking and pharmacophore based methods was employed to computationally screen 621,000 compounds from the ZINC library. The screening protocol was validated using known 3CLpro inhibitors and was optimized for speed, improved selectivity, and for accommodating receptor flexibility. Subsequently, a fluorescence-based enzymatic HTS assay was developed and optimized to experimentally screen approximately 41,000 compounds from four structurally diverse libraries chosen mainly based on the VS results. False positives from initial HTS hits were eliminated by a secondary orthogonal binding analysis using surface plasmon resonance (SPR). The campaign identified a reversible small molecule inhibitor exhibiting mixed-type inhibition with a K(i) value of 11.1 μM. Together, these results validate our protocols as suitable approaches to screen virtual and chemical libraries, and the newly identified compound reported in our study represents a promising structural scaffold to pursue for further SARS-CoV 3CLpro inhibitor development. Copyright © 2013. Published by Elsevier Ltd.

Greedy bases in rank 2 quantum cluster algebras

PubMed Central

Lee, Kyungyong; Li, Li; Rupel, Dylan; Zelevinsky, Andrei

2014-01-01

We identify a quantum lift of the greedy basis for rank 2 coefficient-free cluster algebras. Our main result is that our construction does not depend on the choice of initial cluster, that it builds all cluster monomials, and that it produces bar-invariant elements. We also present several conjectures related to this quantum greedy basis and the triangular basis of Berenstein and Zelevinsky. PMID:24982182

Welfare to Wages: Strategies To Assist the Private Sector To Employ Welfare Recipients. Companion Case Studies, Focus Groups & Data Analysis.

ERIC Educational Resources Information Center

Roberts, Brandon; Padden, Jeffrey D.

This report, which is directed toward policymakers at the local, state, and national levels, is based on an extensive nationwide study of welfare-to-work initiatives. It identifies strategies to assist the private sector in employing welfare recipients. The document begins with an executive summary that discusses the following: the research study…