Missed opportunities and barriers for vaccination: a descriptive analysis of private and public health facilities in four African countries.

PubMed

Olorunsaiye, Comfort Zuyeali; Langhamer, Margaret Shaw; Wallace, Aaron Stuart; Watkins, Margaret Lyons

2017-01-01

Missed opportunities and barriers to vaccination limit progress toward achieving high immunization coverage and other global immunization goals. Little is known about vaccination practices contributing to missed opportunities and barriers among private healthcare providers in Africa. Service Provision Assessments (SPA) of representative samples of health facilities in four African countries (Kenya, Tanzania, Senegal, Malawi) in 2010-2015 were used to describe missed opportunities and barriers for vaccination in public, private for-profit, private not-for-profit and faith-based facilities. Data included vaccination practices, observations during sick child and antenatal visits, and exit interviews following sick child visits. Data from 3,219 health facilities, 11,613 sick child visits and 8,698 antenatal visits were included. A smaller proportion of for-profit facilities offered child vaccination services (country range, 25-37%) than did public facilities (range, 90-96%). The proportion of facilities offering pentavalent vaccine (diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenza type b antigens) daily ranged 0-77% across countries and facility types. Less than 33% of for-profit facilities in any country offered measles vaccination daily. A minority of public or private providers assessed the child's vaccination status during a sick child visit (range by country and facility type, 14-44%), or offered tetanus toxoid during antenatal visits (range, 19-51%). Very few providers discussed the importance of newborn vaccination. Substantial missed opportunities for, and barriers to, vaccination were identified across this representative sample of health facilities in four African countries. Strategies are needed to ensure that private and public providers implement practices to minimize barriers and missed opportunities for vaccination.

Missed opportunities and barriers for vaccination: a descriptive analysis of private and public health facilities in four African countries

PubMed Central

Olorunsaiye, Comfort Zuyeali; Langhamer, Margaret Shaw; Wallace, Aaron Stuart; Watkins, Margaret Lyons

2017-01-01

Introduction Missed opportunities and barriers to vaccination limit progress toward achieving high immunization coverage and other global immunization goals. Little is known about vaccination practices contributing to missed opportunities and barriers among private healthcare providers in Africa. Methods Service Provision Assessments (SPA) of representative samples of health facilities in four African countries (Kenya, Tanzania, Senegal, Malawi) in 2010-2015 were used to describe missed opportunities and barriers for vaccination in public, private for-profit, private not-for-profit and faith-based facilities. Data included vaccination practices, observations during sick child and antenatal visits, and exit interviews following sick child visits. Results Data from 3,219 health facilities, 11,613 sick child visits and 8,698 antenatal visits were included. A smaller proportion of for-profit facilities offered child vaccination services (country range, 25-37%) than did public facilities (range, 90-96%). The proportion of facilities offering pentavalent vaccine (diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenza type b antigens) daily ranged 0-77% across countries and facility types. Less than 33% of for-profit facilities in any country offered measles vaccination daily. A minority of public or private providers assessed the child’s vaccination status during a sick child visit (range by country and facility type, 14-44%), or offered tetanus toxoid during antenatal visits (range, 19-51%). Very few providers discussed the importance of newborn vaccination. Conclusion Substantial missed opportunities for, and barriers to, vaccination were identified across this representative sample of health facilities in four African countries. Strategies are needed to ensure that private and public providers implement practices to minimize barriers and missed opportunities for vaccination. PMID:29296141

Healthcare Systems in Comparative Perspective: Classification, Convergence, Institutions, Inequalities, and Five Missed Turns

PubMed Central

Beckfield, Jason; Olafsdottir, Sigrun; Sosnaud, Benjamin

2017-01-01

This essay reviews and evaluates recent comparative social science scholarship on healthcare systems. We focus on four of the strongest themes in current research: (1) the development of typologies of healthcare systems, (2) assessment of convergence among healthcare systems, (3) problematization of the shifting boundaries of healthcare systems, and (4) the relationship between healthcare systems and social inequalities. Our discussion seeks to highlight the central debates that animate current scholarship and identify unresolved questions and new opportunities for research. We also identify five currents in contemporary sociology that have not been incorporated as deeply as they might into research on healthcare systems. These five “missed turns” include an emphasis on social relations, culture, postnational theory, institutions, and causal mechanisms. We conclude by highlighting some key challenges for comparative research on healthcare systems. PMID:28769148

Opportunity seized or missed? A case study of leadership and organizational change in the creation of a Care Trust.

PubMed

Dickinson, Helen; Peck, Edward; Davidson, Deborah

2007-10-01

This paper describes an action research study which focused on an exploration of the aspirations for and initial achievements of Stratham Mental Health NHS and Social Care Trust. Local leaders perceived that Stratham had a good history of health and social care partnership working and as such, adopted an integrationist view of culture to help shape the context of the new structural form. In doing so, consistency remained a key message to staff throughout this organizational transition and the change did not appear to cause the distraction to core business which the literature suggests it would do so. However, this continuity may have come at a cost, at least initially. In the process of formalizing the previous partnership into a Care Trust, Stratham may not have produced all the beneficial effects of synergy which are usually (albeit eventually) associated with mergers in the private sector. Certainly, local actors could see opportunities that had been missed. By focusing on the structural manifestation of the relationship, the opportunities to broaden informal horizontal linkages may have been underexploited. The study of Stratham serves to confirm that the integrationist conception of culture is limited and that the differentiation of professional groupings and the ambiguity of individual experience will always make contested the meanings that are attributed to organizational change.

Near-misses are an opportunity to improve patient safety: adapting strategies of high reliability organizations to healthcare.

PubMed

Van Spall, Harriette; Kassam, Alisha; Tollefson, Travis T

2015-08-01

Near-miss investigations in high reliability organizations (HROs) aim to mitigate risk and improve system safety. Healthcare settings have a higher rate of near-misses and subsequent adverse events than most high-risk industries, but near-misses are not systematically reported or analyzed. In this review, we will describe the strategies for near-miss analysis that have facilitated a culture of safety and continuous quality improvement in HROs. Near-miss analysis is routine and systematic in HROs such as aviation. Strategies implemented in aviation include the Commercial Aviation Safety Team, which undertakes systematic analyses of near-misses, so that findings can be incorporated into Standard Operating Procedures (SOPs). Other strategies resulting from incident analyses include Crew Resource Management (CRM) for enhanced communication, situational awareness training, adoption of checklists during operations, and built-in redundancy within systems. Health care organizations should consider near-misses as opportunities for quality improvement. The systematic reporting and analysis of near-misses, commonplace in HROs, can be adapted to health care settings to prevent adverse events and improve clinical outcomes.

Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study

PubMed Central

Levy, Itzchak; Maor, Yasmin; Mahroum, Naim; Olmer, Liraz; Wieder, Anat; Litchevski, Vladislav; Mor, Orna; Rahav, Galia

2016-01-01

Objective To quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. Design A retrospective observational cohort study. Setting A central tertiary medical centre in Israel. Measures The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients. Results Between 2010 and 2015, 356 patients were diagnosed with HIV, 118 (33.4%) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 (95% CI 1.16 to 1.74)) and being heterosexual (OR=2.65 (95% CI 1.21 to 5.78)) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 months (IQR 10–30). 60% of CIDs were missed by a general practitioner and 40% by a specialist. Conclusions Missed opportunities to early diagnosis of HIV occur in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to a late diagnosis of HIV. PMID:28186940

Team Leadership and Cancer End-of-Life Decision Making.

PubMed

Waldfogel, Julie M; Battle, Dena J; Rosen, Michael; Knight, Louise; Saiki, Catherine B; Nesbit, Suzanne A; Cooper, Rhonda S; Browner, Ilene S; Hoofring, Laura H; Billing, Lynn S; Dy, Sydney M

2016-11-01

End-of-life decision making in cancer can be a complicated process. Patients and families encounter multiple providers throughout their cancer care. When the efforts of these providers are not well coordinated in teams, opportunities for high-quality, longitudinal goals of care discussions can be missed. This article reviews the case of a 55-year-old man with lung cancer, illustrating the barriers and missed opportunities for end-of-life decision making in his care through the lens of team leadership, a key principle in the science of teams. The challenges demonstrated in this case reflect the importance of the four functions of team leadership: information search and structuring, information use in problem solving, managing personnel resources, and managing material resources. Engaging in shared leadership of these four functions can help care providers improve their interactions with patients and families concerning end-of-life care decision making. This shared leadership can also produce a cohesive care plan that benefits from the expertise of the range of available providers while reflecting patient needs and preferences. Clinicians and researchers should consider the roles of team leadership functions and shared leadership in improving patient care when developing and studying models of cancer care delivery.

Human Papillomavirus Vaccination Coverage Among Girls Before 13 Years: A Birth Year Cohort Analysis of the National Immunization Survey-Teen, 2008-2013.

PubMed

Jeyarajah, Jenny; Elam-Evans, Laurie D; Stokley, Shannon; Smith, Philip J; Singleton, James A

2016-09-01

Routine human papillomavirus (HPV) vaccination is recommended at 11 or 12 years by the Advisory Committee on Immunization Practices. National Immunization Survey-Teen data were analyzed to evaluate, among girls, coverage with one or more doses of HPV vaccination, missed opportunities for HPV vaccination, and potential achievable coverage before 13 years. Results were stratified by birth year cohorts. HPV vaccination coverage before 13 years (≥1 HPV dose) increased from 28.4% for girls born in 1995 to 46.8% for girls born in 2000. Among girls born during 1999-2000 who had not received HPV vaccination before 13 years (57.2%), 80.1% had at least 1 missed opportunity to receive HPV vaccination before 13 years. Opportunities to vaccinate for HPV at age 11 to 12 years are missed. Strategies are needed to decrease these missed opportunities for HPV vaccination. This can be facilitated by the administration of all vaccines recommended for adolescents at the same visit. © The Author(s) 2015.

Clinical and Demographic Characteristics Associated With Suboptimal Primary Stroke and Transient Ischemic Attack Prevention: Retrospective Analysis.

PubMed

Turner, Grace M; Calvert, Melanie; Feltham, Max G; Ryan, Ronan; Finnikin, Samuel; Marshall, Tom

2018-03-01

Primary prevention of stroke and transient ischemic attack (TIA) is important to reduce the burden of these conditions; however, prescribing of prevention drugs is suboptimal. We aimed to identify individual clinical and demographic characteristics associated with potential missed opportunities for prevention therapy with lipid-lowering, anticoagulant, or antihypertensive drugs before stroke/TIA. We analyzed anonymized electronic primary care records from a UK primary care database that covers 561 family practices. Patients with first-ever stroke/TIA, ≥18 years, with diagnosis between January 1, 2009, and December 31, 2013, were included. Missed opportunities for prevention were defined as people with clinical indications for lipid-lowering, anticoagulant, or antihypertensive drugs but not prescribed these drugs before their stroke/TIA. Mixed-effect logistic regression models evaluated the relationship between missed opportunities and individual clinical/demographic characteristics. The inclusion criteria were met by 29 043 people with stroke/TIA. Patients with coronary heart disease, chronic kidney disease, peripheral arterial disease, or diabetes mellitus were at less risk of a missed opportunity for prescription of lipid-lowering and antihypertensive drugs. However, patients with a 10-year cardiovascular disease risk ≥20% but without these diagnoses had increased risk of having a missed opportunity for prescription of lipid-lowering drugs or antihypertensive drugs. Women were less likely to be prescribed anticoagulants but more likely to be prescribed antihypertensive drugs. The elderly (≥85 years of age) were less likely to be prescribed all 3 prevention drugs, compared with people aged 75 to 79 years. Knowing the patient characteristics predictive of missed opportunities for stroke prevention may help primary care identify and appropriately manage these patients. Improving the management of these groups may reduce their risk and potentially prevent large number of future strokes and TIAs in the population. © 2018 American Heart Association, Inc.

Missed Opportunities for Health Education on Pap Smears in Peru

ERIC Educational Resources Information Center

Bayer, Angela M.; Nussbaum, Lauren; Cabrera, Lilia; Paz-Soldan, Valerie A.

2011-01-01

Despite cervical cancer being one of the leading causes of cancer-related deaths among women in Peru, cervical Pap smear coverage is low. This article uses findings from 185 direct clinician observations in four cities of Peru (representing the capital and each of the three main geographic regions of the country) to assess missed opportunities for…

Austerity, new public management and missed nursing care in Australia and New Zealand.

PubMed

Willis, Eileen; Carryer, Jenny; Harvey, Clare; Pearson, Maria; Henderson, Julie

2017-12-01

To outline the way the culture of austerity arising from the Global Financial Crisis has been used by Australian and New Zealand governments to maintain and extend healthcare budget cuts, through new public management strategies leading to missed nursing care. Ten years on the cost of the Global Financial Crisis continues to be borne by tax payers and those employed by the welfare state, yet analysis shows clearly that it was caused by a failure to adequately regulate markets, particularly the banks and multinational corporations. In health care, one of the impacts is increased workload for nurses leading to missed care. Registered Nurses and midwives (n = 7,302) completed the MISSCARE surveys between 2012 - 2015, in four Australian states and New Zealand providing quantitative and qualitative responses. The qualitative comments were analysed using a template analysis approach based on key features of New Public Management. Sixty-two qualitative responses identified measures in place directly linked to austerity and new public management strategies that impacted on the quality of patient care and nursing work, as well as contributing to missed care. Opportunities for resistance may lie outside public and private health organizations in civil society, in the nurse union movements and other health and nursing professional associations. © 2017 John Wiley & Sons Ltd.

Children and Adolescents Unvaccinated Against Measles: Geographic Clustering, Parents' Beliefs, and Missed Opportunities

PubMed Central

Marcuse, Edgar K.; Seward, Jane F.; Zhao, Zhen; Orenstein, Walter A.

2015-01-01

Objective We evaluated the extent to which children and adolescents were not vaccinated against measles (“unvaccinated”), clustering within U.S. counties, and factors associated with unvaccination, including parents' vaccine-related beliefs and missed opportunities. Methods We analyzed data from the 2010–2013 National Immunization Survey (NIS) and NIS-Teen Survey of households with 19- to 35-month-old children and 13- to 17-year-old adolescents, respectively. We used provider-reported vaccination histories to assess measles vaccination status. Results In 2013, 7.5% of children and 4.5% of adolescents were unvaccinated against measles. Four-fifths (80.0%) of unvaccinated children lived in counties containing 41.9% of the nation's children, and 80.0% of unvaccinated adolescents lived in counties containing 30.4% of the nation's adolescents. Multivariable statistical analyses found that 74.6% of children who were unvaccinated against measles missed being vaccinated for reasons other than parents' negative vaccine-related beliefs, and 89.6% could be deemed as having at least one missed opportunity for being vaccinated against measles because they were administered at least one dose of other recommended vaccines after 12 months of age. Among adolescents, multivariable analyses found that only demographic factors, not vaccine-related parental beliefs, were independently associated with being unvaccinated. Conclusions Reasons other than negative vaccine-related beliefs, including missed opportunities, accounted for the vast majority of unvaccinated children and adolescents. PMID:26327727

An assessment of clinical pathways and missed opportunities for the diagnosis of nodular melanoma versus superficial spreading melanoma.

PubMed

Cicchiello, Mark; Lin, Matthew J; Pan, Yan; McLean, Catriona; Kelly, John W

2016-05-01

Missed opportunities in the diagnosis of nodular melanoma (NM) carry high prognostic penalties due to the rapid rate of NM growth. To date, an assessment of the pathways to diagnosis of NM versus superficial spreading melanoma (SSM) specifically comparing numbers of opportunities missed to undertake biopsy has not been performed. A retrospective questionnaire of 120 patients (60 NM patients, age and sex matched to 60 SSM patients) from the Victorian Melanoma Service (VMS) database was undertaken to assess pathways to diagnosis. The numbers of opportunities missed to undertake a biopsy and doctor behaviour at such encounters were recorded. Diagnostic delay (overall, patient's and doctor's delay) in terms of time was assessed. Significant differences in opportunities missed to make a diagnosis of NM compared to SSM were found. In all, 43% of NM were biopsied at a first encounter compared to 70% of SSM. All SSM were diagnosed within three reviews. Overall, 33% of NM required at least three and up six reviews until biopsy. Patients with NM were more likely than those with SSM to be reassured that their lesions were benign. No significant differences in terms of time delay to diagnosis between NM and SSM were found. NM contributes disproportionately to melanoma mortality in Australia. Addressing earlier diagnosis of NM with renewed focus may make the biggest impact on the overall mortality of melanoma. The message that a period of observation is not appropriate for patients re-presenting with lesions of concern must be more effectively communicated. © 2015 The Australasian College of Dermatologists.

Missed opportunities for preventing congenital syphilis infection in New York City.

PubMed

Patel, Sameer J; Klinger, Ellen J; OʼToole, Dana; Schillinger, Julia A

2012-10-01

To describe health care providers' missed opportunities for preventing and treating congenital syphilis in New York City. Review of congenital syphilis cases reported to the New York City Department of Health and Mental Hygiene from January 1, 2000 to December 31, 2009. Receipt and timing of prenatal care, serologic testing, and treatment of mothers and newborns were reviewed. Missed opportunities were defined as receipt of prenatal care plus one of the following: 1) lack of documented treatment for syphilis infection diagnosed before pregnancy; 2) absence of serologic testing during pregnancy; 3) late maternal treatment; 4) maternal treatment with a nonpenicillin regimen; or 5) lack of maternal treatment. In total, 195 newborns with congenital syphilis were born to 190 mothers with 191 pregnancies. Overall, 80% (95% confidence interval [CI] 74-86%, 152 of 190) of all mothers received prenatal care; 63% (95% CI 56-71%, 96 of 152) of these had one or more missed opportunities for prevention. Twelve mothers received inadequate treatment or no treatment during the case pregnancy for documented syphilis infection before pregnancy, and 42 mothers without previous syphilis diagnosis did not have serologic testing during the case pregnancy. Of 103 mothers with syphilis diagnosed before 30 weeks of gestation, 12 received late penicillin therapy, 27 received no therapy, and 3 received inappropriate (nonpenicillin) therapy. Seventeen percent (95% CI 12-22%, 33 of 193) of liveborn newborns received no treatment during their hospitalization. Providers missed well-defined opportunities to prevent congenital syphilis for the majority of cases. Combined efforts to prevent future cases include provider education and better integration of care between obstetricians and pediatricians. III.

Using administrative claims to identify children with chronic conditions in a statewide immunization registry.

PubMed

Dombkowski, Kevin J; Costello, Lauren; Dong, Shiming; Clark, Sarah J

2014-05-01

To demonstrate the feasibility and utility of using administrative claims data from commercial health plans to establish a high-risk indicator in a statewide immunization registry for enrollees with chronic conditions. Retrospective cohort analysis. Administrative data were used to identify children with 1 or more chronic conditions enrolled in 2 commercial health plans during the 2008-2009 and 2009-2010 influenza seasons and matched with a statewide immunization registry. The proportion of cases that successfully matched and historical health services utilization, including influenza vaccinations and missed opportunities, were assessed. A total of 93% of children with chronic conditions identified through administrative claims were successfully matched with the statewide registry. Less than one-third of children received the seasonal influenza vaccine in either the 2008-2009 (29%) or 2009-2010 (32%) seasons; 30% of children received the H1N1 vaccination in 2009-2010. Most children in the 2008-2009 (63%) and 2009-2010 (63%) seasons had at least 1 missed opportunity for seasonal influenza vaccination. Younger children had the highest percentage of missed opportunities while adolescents had the lowest rate of missed opportunities for vaccination. Conclusions It is feasible to identify children with chronic conditions using administrative data and to link them with a statewide immunization registry. Low influenza vaccination rates and high occurrences of missed opportunities among children with chronic conditions suggest the utility of integrating administrative claims data with statewide registries to support various outreach mechanisms, including physician-focused and parent-targeted reminder/recall, based on target age to improve vaccination rates.

A Retrospective Study of Non-Ventilator-Associated Hospital Acquired Pneumonia Incidence and Missed Opportunities for Nursing Care.

PubMed

Tesoro, Mary; Peyser, Diane J; Villarente, Farley

2018-05-01

To determine non-ventilator-associated hospital-acquired pneumonia (NV-HAP) incidence, assess negative impacts on patient outcomes and cost, and identify missed preventive nursing care opportunities. NV-HAP is inadequately studied and underreported. Missed nursing care opportunities, particularly oral care, may aid NV-HAP prevention. This descriptive, observational, retrospective chart review identified adult NV-HAP cases and associated demographic and hospital care data. Two hundred five NV-HAP cases occurred in 1 year at Montefiore Medical Center, equating to an incidence of 0.47 per 1000 patient-days and an estimated excess cost of $8.2 million. ICU transfer following pneumonia occurred in 15.6% of cases. Care requirements from specialist nursing facilities increased at discharge (26.8%), as compared with care requirements on admission (17.6%). Complete nursing care documentation was missing for most patients, with oral care undocumented 60.5% of the time. Preventable NV-HAP cases and their negative impact on cost and patient outcomes may decrease through improved basic nursing care.

Achieving the NOAA Arctic Action Plan: The Missing Permafrost Element - Permafrost Forecasting Listening Session Results

NASA Astrophysics Data System (ADS)

Buxbaum, T. M.; Thoman, R.; Romanovsky, V. E.

2015-12-01

Permafrost is ground at or below freezing for at least two consecutive years. It currently occupies 80% of Alaska. Permafrost temperature and active layer thickness (ALT) are key climatic variables for monitoring permafrost conditions. Active layer thickness is the depth that the top layer of ground above the permafrost thaws each summer season and permafrost temperature is the temperature of the frozen permafrost under this active layer. Knowing permafrost conditions is key for those individuals working and living in Alaska and the Arctic. The results of climate models predict vast changes and potential permafrost degradation across Alaska and the Arctic. NOAA is working to implement its 2014 Arctic Action Plan and permafrost forecasting is a missing piece of this plan. The Alaska Center for Climate Assessment and Policy (ACCAP), using our webinar software and our diverse network of statewide stakeholder contacts, hosted a listening session to bring together a select group of key stakeholders. During this listening session the National Weather Service (NWS) and key permafrost researchers explained what is possible in the realm of permafrost forecasting and participants had the opportunity to discuss and share with the group (NWS, researchers, other stakeholders) what is needed for usable permafrost forecasting. This listening session aimed to answer the questions: Is permafrost forecasting needed? If so, what spatial scale is needed by stakeholders? What temporal scales do stakeholders need/want? Are there key times (winter, fall freeze-up, etc.) or locations (North Slope, key oil development areas, etc.) where forecasting would be most applicable and useful? Are there other considerations or priority needs we haven't thought of regarding permafrost forecasting? This presentation will present the results of that listening session.

Value-based management of design reuse

NASA Astrophysics Data System (ADS)

Carballo, Juan Antonio; Cohn, David L.; Belluomini, Wendy; Montoye, Robert K.

2003-06-01

Effective design reuse in electronic products has the potential to provide very large cost savings, substantial time-to-market reduction, and extra sources of revenue. Unfortunately, critical reuse opportunities are often missed because, although they provide clear value to the corporation, they may not benefit the business performance of an internal organization. It is therefore crucial to provide tools to help reuse partners participate in a reuse transaction when the transaction provides value to the corporation as a whole. Value-based Reuse Management (VRM) addresses this challenge by (a) ensuring that all parties can quickly assess the business performance impact of a reuse opportunity, and (b) encouraging high-value reuse opportunities by supplying value-based rewards to potential parties. In this paper we introduce the Value-Based Reuse Management approach and we describe key results on electronic designs that demonstrate its advantages. Our results indicate that Value-Based Reuse Management has the potential to significantly increase the success probability of high-value electronic design reuse.

Twentieth anniversary of the European Union health mandate: taking stock of perceived achievements, failures and missed opportunities - a qualitative study.

PubMed

Rosenkötter, Nicole; Clemens, Timo; Sørensen, Kristine; Brand, Helmut

2013-11-14

The European Union (EU) health mandate was initially defined in the Maastricht Treaty in 1992. The twentieth anniversary of the Treaty offers a unique opportunity to take stock of EU health actions by giving an overview of influential public health related EU-level policy outputs and a summary of policy outputs or actions perceived as an achievement, a failure or a missed opportunity. Semi-structured expert interviews (N = 20) were conducted focusing on EU-level actions that were relevant for health. Respondents were asked to name EU policies or actions that they perceived as an achievement, a failure or a missed opportunity. A directed content analysis approach was used to identify expert perceptions on achievements, failures and missed opportunities in the interviews. Additionally, a nominal group technique was applied to identify influential and public health relevant EU-level policy outputs. The ranking of influential policy outputs resulted in top positions of adjudications and legislations, agencies, European Commission (EC) programmes and strategies, official networks, cooperative structures and exchange efforts, the work on health determinants and uptake of scientific knowledge. The assessment of EU health policies as being an achievement, a failure or a missed opportunity was often characterized by diverging respondent views. Recurring topics that emerged were the Directorate General for Health and Consumers (DG SANCO), EU agencies, life style factors, internal market provisions as well as the EU Directive on patients' rights in cross-border healthcare. Among these recurring topics, expert perceptions on the establishment of DG SANCO, EU public health agencies, and successes in tobacco control were dominated by aspects of achievements. The implementation status of the Health in All Policy approach was perceived as a missed opportunity. When comparing the emerging themes from the interviews conducted with the responsibilities defined in the EU health mandate, one can identify that these responsibilities were only partly fulfilled or acknowledged by the respondents. In general, the EU is a recognized public health player in Europe which over the past two decades, has begun to develop competencies in supporting, coordinating and supplementing member state health actions. However, the assurance of health protection in other European policies seems to require further development.

Twentieth anniversary of the European Union health mandate: taking stock of perceived achievements, failures and missed opportunities – a qualitative study

PubMed Central

2013-01-01

Background The European Union (EU) health mandate was initially defined in the Maastricht Treaty in 1992. The twentieth anniversary of the Treaty offers a unique opportunity to take stock of EU health actions by giving an overview of influential public health related EU-level policy outputs and a summary of policy outputs or actions perceived as an achievement, a failure or a missed opportunity. Methods Semi-structured expert interviews (N = 20) were conducted focusing on EU-level actions that were relevant for health. Respondents were asked to name EU policies or actions that they perceived as an achievement, a failure or a missed opportunity. A directed content analysis approach was used to identify expert perceptions on achievements, failures and missed opportunities in the interviews. Additionally, a nominal group technique was applied to identify influential and public health relevant EU-level policy outputs. Results The ranking of influential policy outputs resulted in top positions of adjudications and legislations, agencies, European Commission (EC) programmes and strategies, official networks, cooperative structures and exchange efforts, the work on health determinants and uptake of scientific knowledge. The assessment of EU health policies as being an achievement, a failure or a missed opportunity was often characterized by diverging respondent views. Recurring topics that emerged were the Directorate General for Health and Consumers (DG SANCO), EU agencies, life style factors, internal market provisions as well as the EU Directive on patients’ rights in cross-border healthcare. Among these recurring topics, expert perceptions on the establishment of DG SANCO, EU public health agencies, and successes in tobacco control were dominated by aspects of achievements. The implementation status of the Health in All Policy approach was perceived as a missed opportunity. Conclusions When comparing the emerging themes from the interviews conducted with the responsibilities defined in the EU health mandate, one can identify that these responsibilities were only partly fulfilled or acknowledged by the respondents. In general, the EU is a recognized public health player in Europe which over the past two decades, has begun to develop competencies in supporting, coordinating and supplementing member state health actions. However, the assurance of health protection in other European policies seems to require further development. PMID:24225055

Missed diagnostic opportunities within South Africa's early infant diagnosis program, 2010-2015.

PubMed

Haeri Mazanderani, Ahmad; Moyo, Faith; Sherman, Gayle G

2017-01-01

Samples submitted for HIV PCR testing that fail to yield a positive or negative result represent missed diagnostic opportunities. We describe HIV PCR test rejections and indeterminate results, and the associated delay in diagnosis, within South Africa's early infant diagnosis (EID) program from 2010 to 2015. HIV PCR test data from January 2010 to December 2015 were extracted from the National Health Laboratory Service Corporate Data Warehouse, a central data repository of all registered test-sets within the public health sector in South Africa, by laboratory number, result, date, facility, and testing laboratory. Samples that failed to yield either a positive or negative result were categorized according to the rejection code on the laboratory information system, and descriptive analysis performed using Microsoft Excel. Delay in diagnosis was calculated for patients who had a missed diagnostic opportunity registered between January 2013 and December 2015 by means of a patient linking-algorithm employing demographic details. Between 2010 and 2015, 2 178 582 samples were registered for HIV PCR testing of which 6.2% (n = 134 339) failed to yield either a positive or negative result, decreasing proportionally from 7.0% (n = 20 556) in 2010 to 4.4% (n = 21 388) in 2015 (p<0.001). Amongst 76 972 coded missed diagnostic opportunities, 49 585 (64.4%) were a result of pre-analytical error and 27 387 (35.6%) analytical error. Amongst 49 694 patients searched for follow-up results, 16 895 (34.0%) had at least one subsequent HIV PCR test registered after a median of 29 days (IQR: 13-57), of which 8.4% tested positive compared with 3.6% of all samples submitted for the same period. Routine laboratory data provides the opportunity for near real-time surveillance and quality improvement within the EID program. Delay in diagnosis and wastage of resources associated with missed diagnostic opportunities must be addressed and infants actively followed-up as South Africa works towards elimination of mother-to-child transmission.

Students as Prosocial Bystanders to Sexual Assault: Demographic Correlates of Intervention Norms, Intentions, and Missed Opportunities.

PubMed

Hoxmeier, Jill C; Acock, Alan C; Flay, Brian R

2017-01-01

Sexual assault is a major public health issue. Bystander engagement programs are becoming widely used to combat sexual assault on college campuses. The purpose of this study was to examine students' intervention norms, intentions, opportunities, and behaviors as bystanders to sexual assault. Undergraduate students ( N = 779) completed the Sexual Assault Bystander Behavior Questionnaire in the fall of 2014. The t tests revealed differences in students' intervention norms, intentions, opportunities, and missed opportunities based on sex, race/ethnicity, athletic participation, and fraternity/sorority membership. The findings support the use of additional measures to assess bystander behavior and to identify student subpopulations that may benefit from programs aimed at increasing prosocial intervention.

Missed Opportunities to Prevent Workplace Injuries and Fatalities.

PubMed

Woolford, Marta Helen; Bugeja, Lyndal; Driscoll, Tim; Ibrahim, Joseph Elias

2017-05-01

Prevention efforts, especially in high-income countries, have reduced work-related death and injury. Despite this, the global incidence of workplace fatalities remains unacceptably high with approximately 317 million incidents occurring on the job annually. Of particular concern is the occurrence and re-occurrence of incidents with a similar cause and circumstance, such as fatalities occurring in agriculture and transport industries. Efforts to reduce workplace fatalities include surveillance and reporting, investigation, and regulation. Challenges remain in all three domains, limiting the prevention of work-related injuries and deaths. In this commentary, the nature of these challenges and recommendations on how to overcome them are described. Examples of incidents of workplace injury and death, as well as injury prevention efforts are provided to ensure contextual understanding. Reflecting on the present enhances key stakeholders, policy and decision-makers' understanding of the opportunities to reducing harm and the associated human, and economic and legal costs.

Use of Six Sigma for eliminating missed opportunities for prevention services.

PubMed

Gittner, LisaAnn S; Husaini, Baqar A; Hull, Pamela C; Emerson, Janice S; Tropez-Sims, Suzanne; Reece, Michelle C; Zoorob, Roger; Levine, Robert S

2015-01-01

Delivery of primary care preventative services can be significantly increased utilizing Six Sigma methods. Missed preventative service opportunities were compared in the study clinic with the community clinic in the same practice. The study clinic had 100% preventative services, compared with only 16.3% in the community clinic. Preventative services can be enhanced to Six Sigma quality when the nurse executive and medical staff agree on a single standard of nursing care executed via standing orders.

Purchaser-provider: the international dimension.

PubMed

Mason, A; Morgan, K

1995-01-28

Purchaser-provider systems in health care are being implemented in several countries and are under consideration in many more. These new arrangements are described for the United Kingdom, Finland, New Zealand, and Australia, and in each case responsibility for funding, purchasing, providing, and ownership is identified. The four systems, along with managed care organisations in the United States, are also compared with regard to several important features. There is a fundamental similarity between these purchaser-provider arrangements but several key differences are well worth systematic study. This is a major challenge for academic bodies in Britain and other countries, and the opportunity to learn from each other should not be missed.

Patient versus health care provider perspectives on spirituality and spiritual care: the potential to miss the moment.

PubMed

Selby, Debbie; Seccaraccia, Dori; Huth, Jim; Kurppa, Kristin; Fitch, Margaret

2017-04-01

Spirituality and spiritual care are well recognized as important facets of patient care, particularly in the palliative care population. Challenges remain, however, in the provision of such care. This study sought to compare patient and health care professional (HCP) views on spirituality/spiritual care, originally with a view to exploring a simple question(s) HCP's could use to identify spiritual distress, but evolved further to a comparison of how patients and HCPs were both concordant and discordant in their thoughts, and how this could lead to HCP's 'missing' opportunities to both identify spirituality/spiritual distress and to providing meaningful spiritual care. Patients (n=16) with advanced illnesses and HCP's (n=21) with experience providing care to those with advanced disease were interviewed using a semi-structured interview guide. Qualitative analysis distress and spiritual care, and screening for spiritual distress). Within each category there were areas of both concordance and discordance. Most notably, HCP's struggled to articulate definitions of spirituality whereas patients generally spoke with much more ease, giving rich examples. Equally, HCP's had difficulty relating stories of patients who had experienced spiritual distress while patients gave ready responses. Key areas where HCP's and patients differed were identified and set up the strong possibility for an HCP to 'miss the moment' in providing spiritual care. These key misses include the perception that spiritual care is simply not something they can provide, the challenge in defining/ recognizing spirituality (as HCP and patient definitions were often very different), and the focus on spiritual care, even for those interested in providing, as 'task oriented' often with emphasis on meaning making or finding purpose, whereas patients much more commonly described spiritual care as listening deeply, being present and helping them live in the moment. Several discrepancies in perception of spirituality, spiritual distress and spiritual care may hinder the ability of HCP's to effectively offer meaningful spiritual care. A focus on active listening, being led by the patient, and by providing presence may help limit the risk of a disconnect, or a 'miss', in the provision of spiritual care.

Opportunities for strengthening provider-initiated testing and counselling for HIV in Namibia

PubMed Central

Davyduke, Tracy; Pietersen, Ismelda; Lowrance, David; Amwaama, Selma; Taegtmeyer, Miriam

2015-01-01

This short report identifies enablers and barriers to the uptake of provider-initiated testing and counselling for HIV (PITC) in Namibia and identifies key opportunities for strengthening this vital aspect of the national HIV response. We explored this through facility mapping, register reviews and qualitative methods including focus group discussions and in-depth interviews. Four health facilities (clinics and hospitals) in two regions were included in the study. We identified that PITC in Namibia was largely delivered by lay counsellors operating in designated rapid testing rooms located in health facilities and found a large number of missed opportunities for HIV testing through this model. Nurses did not see it as an integral part of their role, were not aware of HIV testing and counselling policy, felt inadequately trained and supported, and experienced staffing shortages. Institutional issues also acted as barriers to nurses performing or initiating discussions about PITC. Wider dissemination and implementation of policy, increasing privacy of consultation spaces and community sensitisation are simple measures that represent opportunities for strengthening this response and ensuring that symptomatic individuals who are unaware of their HIV status do not fall through the net. PMID:25771903

Missed opportunities for diagnosis of female genital mutilation.

PubMed

Abdulcadir, Jasmine; Dugerdil, Adeline; Boulvain, Michel; Yaron, Michal; Margairaz, Christiane; Irion, Olivier; Petignat, Patrick

2014-06-01

To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland. In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification. In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women's characteristics or FGM type) associated with missed diagnosis. Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia.

PubMed

Widyaningsih, Vitri; Khotijah; Balgis

2017-01-01

Indonesia still faces challenges in maternal health. Specifically, the lack of information on community-level maternal morbidity. The relatively high maternal healthcare non-utilization in Indonesia intensifies this problem. To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to evaluate the extent and determinants of missed opportunities in women with maternal morbidity. We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS 2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were estimated from 43,782 women. We analyzed missed opportunities in women who experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012 (n = 6762). There were significant increases in the crude and adjusted proportion of maternal morbidity from IDHS 2002 to IDHS 2012 (p < 0.05). In 2012, the crude proportion of maternal morbidity was 53.7%, with adjusted predicted probability of 51.4%. More than 90% of these morbidities happened during labor. There were significant decreases in non-utilization of maternal healthcare among women with morbidity. In 2012, 20.0% of these women did not receive World Health Organization (WHO) standard antenatal care. In addition, 7.1% did not have a skilled provider at birth, and 25.0% delivered outside of health facilities. Higher proportions of non-utilization happened in women who were younger, multiparous, of low socioeconomic status (SES), and living in less-developed areas. In multilevel analyses, missed opportunities in healthcare utilization were strongly related to low SES and low-resource areas in Indonesia. The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor. This condition is amplified by the concerning missed opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population.

Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia

PubMed Central

Widyaningsih, Vitri; Khotijah; Balgis

2017-01-01

ABSTRACT Background: Indonesia still faces challenges in maternal health. Specifically, the lack of information on community-level maternal morbidity. The relatively high maternal healthcare non-utilization in Indonesia intensifies this problem. Objective: To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to evaluate the extent and determinants of missed opportunities in women with maternal morbidity. Methods: We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS 2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were estimated from 43,782 women. We analyzed missed opportunities in women who experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012 (n = 6762). Results: There were significant increases in the crude and adjusted proportion of maternal morbidity from IDHS 2002 to IDHS 2012 (p < 0.05). In 2012, the crude proportion of maternal morbidity was 53.7%, with adjusted predicted probability of 51.4%. More than 90% of these morbidities happened during labor. There were significant decreases in non-utilization of maternal healthcare among women with morbidity. In 2012, 20.0% of these women did not receive World Health Organization (WHO) standard antenatal care. In addition, 7.1% did not have a skilled provider at birth, and 25.0% delivered outside of health facilities. Higher proportions of non-utilization happened in women who were younger, multiparous, of low socioeconomic status (SES), and living in less-developed areas. In multilevel analyses, missed opportunities in healthcare utilization were strongly related to low SES and low-resource areas in Indonesia. Conclusion: The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor. This condition is amplified by the concerning missed opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population. PMID:28649930

Research and Teaching: Correcting Missed Exam Questions as a Learning Tool in a Physiology Course

ERIC Educational Resources Information Center

Rozell, Timothy G.; Johnson, Jessica; Sexten, Andrea; Rhodes, Ashley E.

2017-01-01

Students in a junior- and senior-level Anatomy and Physiology course have the opportunity to correct missed exam questions ("regrade") and earn up to half of the original points missed. The three objectives of this study were to determine if: (a) performance on the regrade assignment was correlated with scores on subsequent exams, (b)…

Missed opportunities in crystallography.

PubMed

Dauter, Zbigniew; Jaskolski, Mariusz

2014-09-01

Scrutinized from the perspective of time, the giants in the history of crystallography more than once missed a nearly obvious chance to make another great discovery, or went in the wrong direction. This review analyzes such missed opportunities focusing on macromolecular crystallographers (using Perutz, Pauling, Franklin as examples), although cases of particular historical (Kepler), methodological (Laue, Patterson) or structural (Pauling, Ramachandran) relevance are also described. Linus Pauling, in particular, is presented several times in different circumstances, as a man of vision, oversight, or even blindness. His example underscores the simple truth that also in science incessant creativity is inevitably connected with some probability of fault. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Resident Reactions to Person-Centered Communication by Long-Term Care Staff.

PubMed

Savundranayagam, Marie Y; Sibalija, Jovana; Scotchmer, Emma

2016-09-01

Long-term care staff caregivers who are person centered incorporate the life history, preferences, and feelings of residents with dementia during care interactions. Communication is essential for person-centered care. However, little is known about residents' verbal reactions when staff use person-centered communication. Accordingly, this study investigated the impact of person-centered communication and missed opportunities for such communication by staff on resident reactions. Conversations (N = 46) between staff-resident dyads were audio-recorded during routine care tasks over 12 weeks. Staff utterances were coded for person-centered communication and missed opportunities. Resident utterances were coded for positive reactions, such as cooperation, and negative reactions, such as distress. Linear regression analyses revealed that the more staff used person-centered communication, the more likely that residents reacted positively. Additionally, the more missed opportunities in a conversation, the more likely that the residents reacted negatively. Conversation illustrations elaborate on the quantitative findings and implications for staff training are discussed. © The Author(s) 2016.

Missed Opportunities for Health Education on Pap Smears in Peru

PubMed Central

Bayer, Angela M.; Nussbaum, Lauren; Cabrera, Lilia; Paz-Soldan, Valerie A.

2013-01-01

Despite cervical cancer being one of the leading causes of cancer-related deaths among women in Peru, cervical Pap smear coverage is low. This article uses findings from 185 direct clinician observations in four cities of Peru (representing the capital and each of the three main geographic regions of the country) to assess missed opportunities for health education on Pap smears and other preventive women’s health behaviors during women’s visits to a health care provider. Various types of health establishments, provider settings, and provider types were observed. Opportunities for patient education on the importance of prevention were rarely exploited. In fact, health education provided was minimal. Policy and programmatic implications are discussed. PMID:21464205

Syphilis returns to the suburbs.

PubMed

Hargrove, Anna; Curtis, Nigel

2006-05-01

Congenital syphilis is now rare in Australia, particularly in suburban areas. The disease is both preventable and treatable, however, missed or late diagnosis can lead to catastrophic effects. We report an infant who developed congenital syphilis after multiple opportunities for preventing this condition were missed.

Index of Economic Freedom: Unrealized Pedagogical Opportunities

ERIC Educational Resources Information Center

Maier, Mark; Miller, John A.

2017-01-01

Although the Index of Economic Freedom appears in many economic textbooks, their coverage of the index misses opportunities to teach statistical and policy-related concepts important for the principles course. The standard textbook presentation passes up an opportunity to examine the statistical issues of weighting in composite index numbers and…

Missing clinical information in NHS hospital outpatient clinics: prevalence, causes and effects on patient care.

PubMed

Burnett, Susan J; Deelchand, Vashist; Franklin, Bryony Dean; Moorthy, Krishna; Vincent, Charles

2011-05-23

In Britain over 39,000 reports were received by the National Patient Safety Agency relating to failures in documentation in 2007 and the UK Health Services Journal estimated in 2008 that over a million hospital outpatient visits each year might take place without the full record available. Despite these high numbers, the impact of missing clinical information has not been investigated for hospital outpatients in the UK.Studies in primary care in the USA have found 13.6% of patient consultations have missing clinical information, with this adversely affecting care in about half of cases, and in Australia 1.8% of medical errors were found to be due to the unavailability of clinical information.Our objectives were to assess the frequency, nature and potential impact on patient care of missing clinical information in NHS hospital outpatients and to assess the principal causes. This is the first study to present such figures for the UK and the first to look at how clinicians respond, including the associated impact on patient care. Prospective descriptive study of missing information reported by surgeons, supplemented by interviews on the causes.Data were collected by surgeons in general, gastrointestinal, colorectal and vascular surgical clinics in three teaching hospitals across the UK for over a thousand outpatient appointments. Fifteen interviews were conducted with those involved in collating clinical information for these clinics.The study had ethics approval (Hammersmith and Queen Charlotte's & Chelsea Research Ethics Committee), reference number (09/H0707/27). Participants involved in the interviews signed a consent form and were offered the opportunity to review and agree the transcript of their interview before analysis. No patients were involved in this research. In 15% of outpatient consultations key items of clinical information were missing. Of these patients, 32% experienced a delay or disruption to their care and 20% had a risk of harm. In over half of cases the doctor relied on the patient for the information, making a clinical decision despite the information being missing in 20% of cases. Hospital mergers, temporary staff and non-integrated IT systems were contributing factors. If these findings are replicated across the NHS then almost 10 million outpatients are seen each year without key clinical information, creating over a million unnecessary appointments, and putting nearly 2 million patients at risk of harm. There is a need for a systematic, regular audit of the prevalence of missing clinical information. Only then will we know the impact on clinical decision making and patient care of new technology, service reorganisations and, crucially given the present financial climate, temporary or reduced staffing levels. Further research is needed to assess the relationship between missing clinical information and diagnostic errors; to examine the issue in primary care; and to consider the patients perspective.

Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices.

PubMed

Wallace, Aaron S; Willis, Fred; Nwaze, Eric; Dieng, Boubacar; Sipilanyambe, Naawa; Daniels, Danni; Abanida, Emmanuel; Gasasira, Alex; Mahmud, Mustapha; Ryman, Tove K

2017-12-04

The introduction of new vaccines highlights concerns about high vaccine wastage, knowledge of wastage policies and quality of stock management. However, an emphasis on minimizing wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate wastage rates and vaccine vial usage patterns. Nearly half of facilities had incomplete vaccine stock data for calculating wastage rates. Among facilities with sufficient data, mean monthly facility-level wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system's contradicting policies may force health workers to prioritize reduced wastage rates over vaccine administration, particularly for multi-dose vials. Published by Elsevier Ltd.

Missed Opportunities to Prescribe Preexposure Prophylaxis in South Carolina, 2013-2016.

PubMed

Smith, Dawn K; Chang, Man-Huei; Duffus, Wayne A; Okoye, Stella; Weissman, Sharon

2018-05-22

Expanding use of preexposure prophylaxis (PrEP) in ways that address current racial/ethnic disparities is an important HIV prevention goal. We investigated missed opportunities to provide PrEP during healthcare visits occurring prior to HIV infection. This retrospective cohort study linked South Carolina HIV case surveillance data to 3 statewide healthcare databases. Characteristics of patients, health care visits and providers, sexually transmitted diseases (STD), and other diagnoses, were assessed for medical encounters occurring before an initial HIV diagnosis. Adjusted odds ratios were used to identify correlates of missed opportunities for PrEP provision. Of 885 persons newly diagnosed during the study period, 586 (66%) had 4,029 visits to a health care facility prior to their HIV diagnosis (mean of 6.9 visits) with missed opportunities for provision of PrEP. Emergency medicine trained clinicians conducted (61%) and primary care clinicians (family practice or internal medicine) conducted. 10% of visits. 42% of visits were by persons who were uninsured or self-paid, 36% had public insurance, and 18% had commercial insurance In multivariable analyses, being female, African American, or < 30 years of age were statistically significant predictors of having prior health care visits. Among persons at least one health care visit prior to their HIV diagnosis, 28.5% had a diagnosis of gonorrhea, syphilis, or chlamydia at any visit. Healthcare visits occurring among persons who would benefit from provision of PrEP, especially persons with diagnosed STDs, should be leveraged to increase use of PrEP and reduce the risk of HIV acquisition.

Evaluating the Implementation Barriers of an Intranasal Fentanyl Pain Pathway for Pediatric Long-Bone Fractures.

PubMed

Arnautovic, Tamara; Sommese, Kathryn; Mullan, Paul C; Frazier, Steven Barron; Vazifedan, Turaj; Ramirez, Dana Erikson

2017-12-01

This study aimed to assess physician comfort, knowledge, and implementation barriers regarding the use of intranasal fentanyl (INF) for pain management in patients with long-bone fractures in a pediatric emergency department (ED) with an INF pain pathway. A retrospective chart review was conducted of patients, 3 to 21 years old, in our ED with an International Classification of Diseases-9th Revision code for a long-bone fracture from September 1, 2013, to August 31, 2015. Patients were divided into 4 groups: (1) received INF on the pathway appropriately; (2) "missed opportunities" to receive INF, defined as either INF was ordered and then subsequently canceled (for pain ratings, ≥6/10), or INF was ordered, cancelled, and intravenous (IV) morphine given, or INF was not ordered and a peripheral IV line was placed to give IV morphine as first-line medication; (3) peripheral IV established upon ED arrival; (4) no pain medication required. Additionally, a survey regarding practice habits for pain management was completed to evaluate physician barriers to utilization of the pathway. A total of 1374 patients met the inclusion criteria. Missed opportunities were identified 41% of the time. Neither younger patient age nor more years of physician experience in the ED were associated with increased rates of missed opportunities. The survey (95% response rate) revealed greater comfort with and preference for IV morphine over INF. The high rate of missed opportunities, despite the implementation of an INF pain pathway, indicates the need for further exploration of the barriers to utilization of the INF pain pathway.

Assessing missed opportunities for the prevention of mother-to-child HIV transmission in an Eastern Cape local service area.

PubMed

Rispel, L C; Peltzer, K; Phaswana-Mafuya, N; Metcalf, C A; Treger, L

2009-03-01

Prevention of new HIV infections is a critical imperative for South Africa; the prevention of mother-to-child transmission (PMTCT) is one of the most efficacious HIV prevention interventions. Assessment of a PMTCT programme to determine missed opportunities. The Kouga local service area (LSA), bordering Nelson Mandela Bay Municipality (Port Elizabeth) in the Eastern Cape. An assessment was conducted in 2007 before implementing technical support for strengthening the PMTCT programme, including: interviews with 20 PMTCT managers, 4 maternity staff and 27 other health workers on service provision, management, infrastructure, human resources and the health information system; 296 antenatal clinic users on their service perceptions; 70 HIV-positive women on HIV knowledge, infant feeding, coping, support and service perceptions; 8 representatives from community organisations and 101 traditional health practitioners (THPs). Observations were conducted during site visits to health facilities, and the District Health Information System (DHIS) data were reviewed. Staff had high levels of awareness of HIV policies and most had received some relevant training. Nevirapine uptake varied by clinic, with an average of 56%. There were many missed opportunities for PMTCT, with 67% of pregnant women tested for HIV and only 43% of antenatal care attendees tested during a previous pregnancy. Only 6% of HIV-positive women reported support group participation. Reducing missed opportunities for PMTCT requires strengthening of the formal health sector, intersectoral liaison, and greater community support. Priority areas that require strengthening in the formal health sector include HIV counselling and testing; family planning and nutrition counselling; infant follow-up; human resources; and monitoring and evaluation.

Missed Opportunities for Early HIV diagnosis: Critical Insights from Stories of Kenyan Women Living with HIV

PubMed Central

Kako, Peninnah M.; Stevens, Patricia E.; Mkandawire-Valhmu, Lucy; Kibicho, Jennifer; Karani, Anna K.; Dressel, Anne

2013-01-01

Early HIV testing is critical to prevention and timely treatment. Missed opportunities for HIV diagnosis can result in unnecessary deaths at a time when access to antiretroviral treatment proves life saving. While HIV prevention and treatment research has increased, less research exists on women's experiences with HIV diagnosis, despite the fact that women are most affected. Insights from local women are critical in designing culturally meaningful interventions that thwart missed opportunities for early HIV diagnosis. The purpose of our study was to uncover steps women took to know their HIV diagnosis. Using narrative inquiry methodology informed by post-colonial feminism, we interviewed 40 HIV- positive women in Kenya. Five themes emerged related to uptake of HIV testing for women: (a) spouse's critical illness or death; (b) years of suffering from HIV-related symptoms; (c) sick children; (d) prenatal testing; and (e) personal desire to know one's HIV status. These findings centered on women experiences provide an important basis for health promotion interventions related to HIV prevention, earlier detection, and treatment. PMID:24273455

The Role of Afterschool and Community Science Programs in the Lives of Urban Youth

ERIC Educational Resources Information Center

Rahm, Jrene; Moore, John C.; Martel-Reny, Marie-Paule

2005-01-01

Afterschool and community science programs have become widely recognized as important sanctuaries for science learning for low-income urban youth and as offering them with "missing opportunities." Yet, more needs to be known about how youth, themselves, perceive such opportunities. What motivates youth to seek out such opportunities in…

Human Trafficking: How Nurses Can Make a Difference.

PubMed

Scannell, Meredith; MacDonald, Andrea E; Berger, Amanda; Boyer, Nichole

Human trafficking is a human rights violation and a global health problem. Victims of human trafficking have medical and mental health sequelae requiring specific healthcare interventions. Healthcare professionals may be the initial contact that these victims make outside the world of trafficking. Healthcare professionals are key agents in the identification of human trafficking, which is essential in eliminating this public health problem. Unfortunately, healthcare professionals are not always able to detect signs of human trafficking. Failure to detect results in missed opportunities to assist victims. This is a case report of a victim of human trafficking who presented to an emergency department with medical and mental health issues. Despite numerous encounters with different healthcare professionals, signs and symptoms of human trafficking were not identified. Skilled assessment made by a forensic nurse alerted the healthcare team to clear features of human trafficking associated with this person. Through this case report we illustrate the key role the nurse played in identifying signs of human trafficking. Improvement of human trafficking educational programs is highlighted as a key adjunct to improving detection and facilitating the proper treatment of victims.

Electives: isn't it time for a change?

PubMed

Dowell, Jon; Merrylees, Neil

2009-02-01

Medical student electives are memorable learning experiences, of which approximately 40% are spent in developing countries. Students often have laudable motivation but are rarely helped to learn most effectively or contribute meaningfully whilst away. Each year an estimated 350 years of elective time is spent in developing countries (by students from the UK alone), which represents substantial opportunity. We conducted a literature search prior to developing an alternative approach towards electives based upon educational and ethical principles. Despite their anecdotal value there has been little empirical research conducted into electives. From our review we identified four key learning domains (Clinical Knowledge and Skills, Attitudes, Global Perspectives, Personal and Professional Development) and two broader issues (Institutional Benefits and Moral/Ethical Considerations). Potentially beneficial and more structured alternatives are emerging and improvements appear possible through institutional collaborations and greater planning in order to maximise the educational experience, opportunities to contribute and minimise the risks involved in electives. Electives are a highlight of clinical training but probably often represent missed opportunities. There are both educational and moral reasons for seeking more considered approaches to reduce the 'medical tourism' that can result from the current largely ad hoc arrangements.

Application of strict criteria in adrenal venous sampling increases the proportion of missed patients with unilateral disease who benefit from surgery for primary aldosteronism.

PubMed

Kline, Gregory; Leung, Alexander; So, Benny; Chin, Alex; Harvey, Adrian; Pasieka, Janice L

2018-06-01

Adrenal vein sampling (AVS) is intended to confirm unilateral forms of primary aldosteronism, which are amenable to surgical cure. Excessively strict AVS criteria to define lateralization may result in many patients incorrectly categorized as bilateral primary aldosteronism and opportunity for surgical cure missed. Retrospective review of an AVS-primary aldosteronism database in which surgical cases are verified by standardized outcomes. Having used 'less strict' AVS criteria for lateralization, we examined the distribution of AVS lateralization indices in our confirmed unilateral primary aldosteronism cases both with and without cosyntropin stimulation. The proportion of proven unilateral cases that would have been missed with stricter AVS interpretation criteria was calculated. Particular focus was given to the proportion of missed cases according to use of international guidelines. False-positive lateralization with 'less strict' interpretation was also calculated. Of 80 surgical primary aldosteronism cases, 10-23% would have been missed with AVS lateralization indices of 3 : 1 to 5 : 1, with or without cosyntropin. If strict selectivity indices (for confirmation of catheterization) were combined with strict lateralization indices, up to 70% of unilateral primary aldosteronism cases could have been missed. Use of Endocrine Society AVS guidelines would have missed 21-43% of proven unilateral cases. 'Less strict' AVS interpretation yielded one case (1.2%) of false lateralization. Excessively strict AVS interpretation criteria will result in a high rate of missed unilateral primary aldosteronism with subsequent loss of opportunity for intervention. Use of more lenient lateralization criteria will improve the detection rate of unilateral primary aldosteronism with very low false-positive rate.

Multidisciplinary Environments: A History of Engineering Framework Development

NASA Technical Reports Server (NTRS)

Padula, Sharon L.; Gillian, Ronnie E.

2006-01-01

This paper traces the history of engineering frameworks and their use by Multidisciplinary Design Optimization (MDO) practitioners. The approach is to reference papers that have been presented at one of the ten previous Multidisciplinary Analysis and Optimization (MA&O) conferences. By limiting the search to MA&O papers, the authors can (1) identify the key ideas that led to general purpose MDO frameworks and (2) uncover roadblocks that delayed the development of these ideas. The authors make no attempt to assign credit for revolutionary ideas or to assign blame for missed opportunities. Rather, the goal is to trace the various threads of computer architecture and software framework research and to observe how these threads contributed to the commercial framework products available today.

Missing pieces to modeling the Arctic-Boreal puzzle

NASA Astrophysics Data System (ADS)

Fisher, Joshua B.; Hayes, Daniel J.; Schwalm, Christopher R.; Huntzinger, Deborah N.; Stofferahn, Eric; Schaefer, Kevin; Luo, Yiqi; Wullschleger, Stan D.; Goetz, Scott; Miller, Charles E.; Griffith, Peter; Chadburn, Sarah; Chatterjee, Abhishek; Ciais, Philippe; Douglas, Thomas A.; Genet, Hélène; Ito, Akihiko; Neigh, Christopher S. R.; Poulter, Benjamin; Rogers, Brendan M.; Sonnentag, Oliver; Tian, Hanqin; Wang, Weile; Xue, Yongkang; Yang, Zong-Liang; Zeng, Ning; Zhang, Zhen

2018-02-01

NASA has launched the decade-long Arctic-Boreal Vulnerability Experiment (ABoVE). While the initial phases focus on field and airborne data collection, early integration with modeling activities is important to benefit future modeling syntheses. We compiled feedback from ecosystem modeling teams on key data needs, which encompass carbon biogeochemistry, vegetation, permafrost, hydrology, and disturbance dynamics. A suite of variables was identified as part of this activity with a critical requirement that they are collected concurrently and representatively over space and time. Individual projects in ABoVE may not capture all these needs, and thus there is both demand and opportunity for the augmentation of field observations, and synthesis of the observations that are collected, to ensure that science questions and integrated modeling activities are successfully implemented.

International Space Station (ISS)

NASA Image and Video Library

2001-08-18

Astronaut Patrick G. Forrester works with the the Materials International Space Station Experiment (MISSE) during extravehicular activity (EVA). MISSE would expose 750 material samples for about 18 months and collect information on how different materials weather the space environment The objective of MISSE is to develop early, low-cost, non-intrusive opportunities to conduct critical space exposure tests of space materials and components plarned for use on future spacecraft. The experiment was the first externally mounted experiment conducted on the International Space Station (ISS) and was installed on the outside of the ISS Quest Airlock. MISSE was launched on August 10, 2001 aboard the Space Shuttle Orbiter Discovery.

Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

PubMed Central

Lionis, Christos; Symvoulakis, Emmanouil K; Markaki, Adelais; Vardavas, Constantine; Papadakaki, Maria; Daniilidou, Natasa; Souliotis, Kyriakos; Kyriopoulos, Ioannis

2009-01-01

Background Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development. PMID:19777112

Reconstructing (super)trees from data sets with missing distances: not all is lost.

PubMed

Kettleborough, George; Dicks, Jo; Roberts, Ian N; Huber, Katharina T

2015-06-01

The wealth of phylogenetic information accumulated over many decades of biological research, coupled with recent technological advances in molecular sequence generation, presents significant opportunities for researchers to investigate relationships across and within the kingdoms of life. However, to make best use of this data wealth, several problems must first be overcome. One key problem is finding effective strategies to deal with missing data. Here, we introduce Lasso, a novel heuristic approach for reconstructing rooted phylogenetic trees from distance matrices with missing values, for data sets where a molecular clock may be assumed. Contrary to other phylogenetic methods on partial data sets, Lasso possesses desirable properties such as its reconstructed trees being both unique and edge-weighted. These properties are achieved by Lasso restricting its leaf set to a large subset of all possible taxa, which in many practical situations is the entire taxa set. Furthermore, the Lasso approach is distance-based, rendering it very fast to run and suitable for data sets of all sizes, including large data sets such as those generated by modern Next Generation Sequencing technologies. To better understand the performance of Lasso, we assessed it by means of artificial and real biological data sets, showing its effectiveness in the presence of missing data. Furthermore, by formulating the supermatrix problem as a particular case of the missing data problem, we assessed Lasso's ability to reconstruct supertrees. We demonstrate that, although not specifically designed for such a purpose, Lasso performs better than or comparably with five leading supertree algorithms on a challenging biological data set. Finally, we make freely available a software implementation of Lasso so that researchers may, for the first time, perform both rooted tree and supertree reconstruction with branch lengths on their own partial data sets. © The Author 2015. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

Ebola virus disease contact tracing activities, lessons learned and best practices during the Duport Road outbreak in Monrovia, Liberia, November 2015.

PubMed

Wolfe, Caitlin M; Hamblion, Esther L; Schulte, Jacqueline; Williams, Parker; Koryon, Augustine; Enders, Jonathan; Sanor, Varlee; Wapoe, Yatta; Kwayon, Dash; Blackley, David J; Laney, Anthony S; Weston, Emily J; Dokubo, Emily K; Davies-Wayne, Gloria; Wendland, Annika; Daw, Valerie T S; Badini, Mehboob; Clement, Peter; Mahmoud, Nuha; Williams, Desmond; Gasasira, Alex; Nyenswah, Tolbert G; Fallah, Mosoka

2017-06-01

Contact tracing is one of the key response activities necessary for halting Ebola Virus Disease (EVD) transmission. Key elements of contact tracing include identification of persons who have been in contact with confirmed EVD cases and careful monitoring for EVD symptoms, but the details of implementation likely influence their effectiveness. In November 2015, several months after a major Ebola outbreak was controlled in Liberia, three members of a family were confirmed positive for EVD in the Duport Road area of Monrovia. The cluster provided an opportunity to implement and evaluate modified approaches to contact tracing. The approaches employed for improved contact tracing included classification and risk-based management of identified contacts (including facility based isolation of some high risk contacts, provision of support to persons being monitored, and school-based surveillance for some persons with potential exposure but not listed as contacts), use of phone records to help locate missing contacts, and modifications to data management tools. We recorded details about the implementation of these approaches, report the overall outcomes of the contact tracing efforts and the challenges encountered, and provide recommendations for management of future outbreaks. 165 contacts were identified (with over 150 identified within 48 hours of confirmation of the EVD cases) and all initially missing contacts were located. Contacts were closely monitored and promptly tested if symptomatic; no contacts developed disease. Encountered challenges related to knowledge gaps among contact tracing staff, data management, and coordination of contact tracing activities with efforts to offer Ebola vaccine. The Duport Road EVD cluster was promptly controlled. Missing contacts were effectively identified, and identified contacts were effectively monitored and rapidly tested. There is a persistent risk of EVD reemergence in Liberia; the experience controlling each cluster can help inform future Ebola control efforts in Liberia and elsewhere.

Ebola virus disease contact tracing activities, lessons learned and best practices during the Duport Road outbreak in Monrovia, Liberia, November 2015

PubMed Central

Schulte, Jacqueline; Williams, Parker; Koryon, Augustine; Enders, Jonathan; Sanor, Varlee; Wapoe, Yatta; Kwayon, Dash; Blackley, David J.; Laney, Anthony S.; Weston, Emily J.; Dokubo, Emily K.; Davies-Wayne, Gloria; Wendland, Annika; Daw, Valerie T. S.; Badini, Mehboob; Clement, Peter; Mahmoud, Nuha; Williams, Desmond; Gasasira, Alex; Nyenswah, Tolbert G.; Fallah, Mosoka

2017-01-01

Background Contact tracing is one of the key response activities necessary for halting Ebola Virus Disease (EVD) transmission. Key elements of contact tracing include identification of persons who have been in contact with confirmed EVD cases and careful monitoring for EVD symptoms, but the details of implementation likely influence their effectiveness. In November 2015, several months after a major Ebola outbreak was controlled in Liberia, three members of a family were confirmed positive for EVD in the Duport Road area of Monrovia. The cluster provided an opportunity to implement and evaluate modified approaches to contact tracing. Methods The approaches employed for improved contact tracing included classification and risk-based management of identified contacts (including facility based isolation of some high risk contacts, provision of support to persons being monitored, and school-based surveillance for some persons with potential exposure but not listed as contacts), use of phone records to help locate missing contacts, and modifications to data management tools. We recorded details about the implementation of these approaches, report the overall outcomes of the contact tracing efforts and the challenges encountered, and provide recommendations for management of future outbreaks. Results 165 contacts were identified (with over 150 identified within 48 hours of confirmation of the EVD cases) and all initially missing contacts were located. Contacts were closely monitored and promptly tested if symptomatic; no contacts developed disease. Encountered challenges related to knowledge gaps among contact tracing staff, data management, and coordination of contact tracing activities with efforts to offer Ebola vaccine. Conclusions The Duport Road EVD cluster was promptly controlled. Missing contacts were effectively identified, and identified contacts were effectively monitored and rapidly tested. There is a persistent risk of EVD reemergence in Liberia; the experience controlling each cluster can help inform future Ebola control efforts in Liberia and elsewhere. PMID:28575034

KSC-07pd3322

NASA Image and Video Library

2007-11-14

KENNEDY SPACE CENTER, FLA. -- In the Orbiter Processing Facility, technicians install the second Materials International Space Station Experiments, or MISSE, in space shuttle Endeavour's payload bay. The MISSE is part of the payload onboard Endeavour for mission STS-123. The MISSE project is a NASA/Langley Research Center-managed cooperative endeavor to fly materials and other types of space exposure experiments on the International Space Station. The objective is to develop early, low-cost, non-intrusive opportunities to conduct critical space exposure tests of space materials and components planned for use on future spacecraft. Photo credit: NASA/Kim Shiflett

Investigating influences on current community pharmacy practice at micro, meso, and macro levels.

PubMed

Hermansyah, Andi; Sainsbury, Erica; Krass, Ines

The nature of Australian community pharmacy is continually evolving, raising the need to explore the current situation in order to understand the potential impact of any changes. Although community pharmacy has the potential to play a greater role in health care, it is currently not meeting this potential. To investigate the nature of the contemporary practice of community pharmacy in Australia and examine the potential missed opportunities for role expansion in health care. In-depth semi-structured interviews with a wide-range of key stakeholders within and beyond community pharmacy circles were conducted. Interviews were audio-recorded, transcribed verbatim and analyzed for emerging themes. Twenty-seven key informants across Eastern half of Australia were interviewed between December 2014 and August 2015. Several key elements of the current situation representing the social, economic and policy context of community pharmacy have been identified. These elements operate interdependently, influence micro, meso and macro levels of community pharmacy operation and are changing in the current climate. Community pharmacy has untapped potential in primary health care, but it has been slow to change to meet opportunities available in the current situation. As the current situation is complex, interrelated and dynamic with often unintended and unpredictable consequences, this paper suggests that policy makers to consider the micro, meso and macro levels of community pharmacy operation when making significant policy changes. The framework proposed in this study can be a helpful tool to analyze the processes operating at these three levels and their influences on practice. Copyright © 2016 Elsevier Inc. All rights reserved.

Material wealth in 3D: Mapping multiple paths to prosperity in low- and middle- income countries.

PubMed

Hruschka, Daniel J; Hadley, Craig; Hackman, Joseph

2017-01-01

Material wealth is a key factor shaping human development and well-being. Every year, hundreds of studies in social science and policy fields assess material wealth in low- and middle-income countries assuming that there is a single dimension by which households can move from poverty to prosperity. However, a one-dimensional model may miss important kinds of prosperity, particularly in countries where traditional subsistence-based livelihoods coexist with modern cash economies. Using multiple correspondence analysis to analyze representative household data from six countries-Nepal, Bangladesh, Ethiopia, Kenya, Tanzania and Guatemala-across three world regions, we identify a number of independent dimension of wealth, each with a clear link to locally relevant pathways to success in cash and agricultural economies. In all cases, the first dimension identified by this approach replicates standard one-dimensional estimates and captures success in cash economies. The novel dimensions we identify reflect success in different agricultural sectors and are independently associated with key benchmarks of food security and human growth, such as adult body mass index and child height. The multidimensional models of wealth we describe here provide new opportunities for examining the causes and consequences of wealth inequality that go beyond success in cash economies, for tracing the emergence of hybrid pathways to prosperity, and for assessing how these different pathways to economic success carry different health risks and social opportunities.

Material wealth in 3D: Mapping multiple paths to prosperity in low- and middle- income countries

PubMed Central

Hadley, Craig; Hackman, Joseph

2017-01-01

Material wealth is a key factor shaping human development and well-being. Every year, hundreds of studies in social science and policy fields assess material wealth in low- and middle-income countries assuming that there is a single dimension by which households can move from poverty to prosperity. However, a one-dimensional model may miss important kinds of prosperity, particularly in countries where traditional subsistence-based livelihoods coexist with modern cash economies. Using multiple correspondence analysis to analyze representative household data from six countries—Nepal, Bangladesh, Ethiopia, Kenya, Tanzania and Guatemala—across three world regions, we identify a number of independent dimension of wealth, each with a clear link to locally relevant pathways to success in cash and agricultural economies. In all cases, the first dimension identified by this approach replicates standard one-dimensional estimates and captures success in cash economies. The novel dimensions we identify reflect success in different agricultural sectors and are independently associated with key benchmarks of food security and human growth, such as adult body mass index and child height. The multidimensional models of wealth we describe here provide new opportunities for examining the causes and consequences of wealth inequality that go beyond success in cash economies, for tracing the emergence of hybrid pathways to prosperity, and for assessing how these different pathways to economic success carry different health risks and social opportunities. PMID:28886176

College Scholarships for Latino Students: Are Opportunities Being Missed?

ERIC Educational Resources Information Center

Marquez, Amalia

2006-01-01

Previous research by The Tomas Rivera Policy Institute (TRPI) has demonstrated that extensive college financial aid opportunities are available in the form of scholarships, grants, and loans; yet many Latino students and their parents are not aware that numerous grants and scholarships are earmarked especially for them. This report provides…

Higher Education Research of Intercollegiate Athletics: A Missed Opportunity

ERIC Educational Resources Information Center

Hirko, Scott

2008-01-01

This study demonstrated the lack of research on college sports in significant higher education academic journals and conferences. Higher education peer-reviewed journals and conferences were considered the most common areas to reasonably measure the frequency of opportunity for national dialogue among scholars. The results found one percent of…

Winning One Program at a Time: A Systemic Approach

ERIC Educational Resources Information Center

Schultz, Adam; Zimmerman, Kay

2016-01-01

Many Universities are missing an opportunity to focus student recruitment marketing efforts and budget at the program level, which can offer lower priced advertising opportunities with higher conversion rates than traditional University level marketing initiatives. At NC State University, we have begun to deploy a scalable, low-cost, program level…

Armed to Farm: Developing training programs for military veterans in agriculture

USDA-ARS?s Scientific Manuscript database

Farming offers a viable avenue for returning veterans to transition and reincorporate into society. Farming opportunities for veterans are a natural fit and capitalize on skills that made them successful in the military. However, these opportunities may be missed due to lack of targeted training pr...

International Space Station (ISS)

NASA Image and Video Library

2001-08-17

Backdropped by a sunrise, the newly installed Materials International Space Station Experiment (MISSE) is visible on this image. MISSE would expose 750 material samples for about 18 months and collect information on how different materials weather the space environment. The objective of MISSE is to develop early, low-cost, non-intrusive opportunities to conduct critical space exposure tests of space materials and components plarned for use on future spacecraft. The experiment was the first externally mounted experiment conducted on the International Space Station (ISS) and was installed on the outside of the ISS Quest Airlock during extravehicular activity (EVA) of the STS-105 mission. MISSE was launched on August 10, 2001 aboard the Space Shuttle Orbiter Discovery.

How consumers respond to the behavior of missing a free gift promotion: inaction inertia effect on products offered as free gifts.

PubMed

Liu, Tsung-Chi; Cheng, Ti; Ni, Feng-Yu

2011-01-01

Inaction inertia describes the phenomenon that an individual is unlikely to act on an attractive opportunity after having bypassed an even more attractive one. The results of two experiments indicate that after missing an initial opportunity to obtain a product as a free gift during a promotional period, the inaction inertia effect reduces the likelihood of consumers buying the product at a discounted price (second, inferior opportunity), particularly if the free gift has a high regular price. Additionally, according to the results of Experiment 2, those consumers are less likely to buy a product that has been offered previously as a free gift when a greater total quantity of the free gift is offered during a promotional period. Moreover, the mediation analysis results indicate that anticipated regret and valuation significantly impact the mediating role of inaction inertia.

Medical surgical nurses describe missed nursing care tasks-Evaluating our work environment.

PubMed

Winsett, Rebecca P; Rottet, Kendra; Schmitt, Abby; Wathen, Ellen; Wilson, Debra

2016-11-01

The purpose of the study was to explore the nurse work environment by evaluating the self-report of missed nursing care and the reasons for the missed care. A convenience sample of medical surgical nurses from four hospitals was invited to complete the survey for this descriptive study. The sample included 168 nurses. The MISSCARE survey assessed the frequency and reason of 24 routine nursing care elements. The most frequently reported missed care was ambulation as ordered, medications given within a 30 minute window, and mouth care. Moderate or significant reasons reported for the missed care were: unexpected rise in volume/acuity, heavy admissions/discharges, inadequate assistants, inadequate staff, meds not available when needed, and urgent situations. Identifying missed nursing care and reasons for missed care provides an opportunity for exploring strategies to reduce interruptions, develop unit cohesiveness, improve the nurse work environment, and ultimately leading to improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

HIV and AIDS among adolescents who use drugs: opportunities for drug policy reform within the sustainable development agenda.

PubMed

Tinasti, Khalid

2018-02-01

The international community's commitment to halve by 2015 the HIV transmission among people who inject drugs has not only been largely missed, instead new HIV infections have increased by 30%. Moreover, drug injection remains one of the drivers of new HIV infections due to punitive responses and lack of harm reduction resourcing. In the midst of this situation, adolescents are a forgotten component of the global response to illegal drugs and their link with HIV infection. The Sustainable Development Goals (SDGs) present an opportunity to achieve the global objective of ending AIDS among adolescents who use drugs, by addressing the structural vulnerabilities they face be they economic, social, criminal, health-related or environmental. The implementation of the SDGs presents an opportunity to address the horizontal nature of drug policy and to efficiently address the drugs-adolescents-HIV risk nexus. Adolescent-focused drug policies are linked to goals 1, 3, 4, 10, 16 and 17. Goals 3 and 16 are the most relevant; the targets of the latter link to the criminalization of drug use and punitive policy environments and their impact on adolescents' health and HIV transmission risks. Moreover, it presents an opportunity to include adolescent needs that are missing in the three drug control conventions (1961, 1971 and 1988), and link them with the provisions of the Convention on the Rights of the Child (1989). Finally, the six principles to deliver on sustainable development are also an opportunity to divert adolescents who use drugs away from criminalization and punitive environments in which their vulnerability to HIV is greater. Addressing HIV among adolescents who use drugs is an extremely complex policy issue depending on different sets of binding and non-binding commitments, interventions and stakeholders. The complexity requires a horizontal response provided by the SDGs framework, starting with the collection of disaggregated data on this specific subgroup. Ending AIDS among adolescents who use drugs requires the implementation of national drugs and HIV plans based on the multi-sectoral approach and the transformative nature of the SDGs, to provide a comprehensive response to the epidemic among this key affected subgroup. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

An Industry Viewpoint on Electron Energy Distribution Function Control

NASA Astrophysics Data System (ADS)

Ventzek, Peter

2011-10-01

It is trite to note that plasmas play a key role in industrial technology. Lighting, laser, film coating and now medical technology require plasma science for their sustenance. One field stands out by virtue of its economic girth and impact. Semiconductor manufacturing and process science enabling its decades of innovation owe significant debt to progress in low temperature plasma science. Today, technology requires atomic level control from plasmas. Mere layers of atoms delineate good and bad device performance. While plasma sources meet nanoscale specifications over 100s cm scale dimensions, achieving atomic level control from plasmas is hindered by the absence of direct control of species velocity distribution functions. EEDF control translates to precise control of species flux and velocities at surfaces adjacent to the plasma. Electron energy distribution function (eedf) control is a challenge that, if successfully met, will have a huge impact on nanoscale device manufacturing. This lunchtime talk will attempt to provide context to the research advances presented at this Workshop. Touched on will be areas of new opportunity and the risks associated with missing these opportunities.

Arab petrodollars: dashed hope for a new economic order

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

Gauhar, A.

The North-South debate is currently quiescent, partly because Arab oil producers have failed to provide long-term support for Third World concerns. The author examines why the oil producers have abandoned the call for a New International Economic Order, and concludes that the key to understanding this missed opportunity is in the manner in which the oil-producing countries, particularly the Arab OPEC nations, deployed their income during the years of abundance. The Arab governments adopted a pattern of expenditure and investment that was clearly opposed to the interests and welfare of their own people for a variety of social and politicalmore » reasons. An important fact, which precluded cooperation among Third World countries, was the integrated nature of Arab financial capital within world capitalism.« less

Human Papillomavirus Vaccine Coverage and Prevalence of Missed Opportunities for Vaccination in an Integrated Healthcare System.

PubMed

Irving, Stephanie A; Groom, Holly C; Stokley, Shannon; McNeil, Michael M; Gee, Julianne; Smith, Ning; Naleway, Allison L

2018-03-01

Human papillomavirus (HPV) vaccination has been recommended in the United States for female and male adolescents since 2006 and 2011, respectively. Coverage rates are lower than those for other adolescent vaccines. The objective of this study was to evaluate an assessment and feedback intervention designed to increase HPV vaccination coverage and quantify missed opportunities for HPV vaccine initiation at preventive care visits. We examined changes in HPV vaccination coverage and missed opportunities within the adolescent (11-17 years) population at 9 Oregon-based Kaiser Permanente Northwest outpatient clinics after an assessment and feedback intervention. Quarterly coverage rates were calculated for the adolescent populations at the clinics, according to age group (11-12 and 13-17 years), sex, and department (Pediatrics and Family Medicine). Comparison coverage assessments were calculated at 3 nonintervention (control) clinics. Missed opportunities for HPV vaccine initiation, defined as preventive care visits in which a patient eligible for HPV dose 1 remained unvaccinated, were examined according to sex and age group. An average of 29,021 adolescents were included in coverage assessments. Before the intervention, 1-dose and 3-dose quarterly coverage rates were increasing at intervention as well as at control clinics in both age groups. Postimplementation quarterly trends in 1-dose or 3-dose coverage did not differ significantly between intervention and control clinics for either age group. One-dose coverage rates among adolescents with Pediatrics providers were significantly higher than those with Family Medicine providers (56% vs 41% for 11- to 12-year-old and 82% vs 69% for 13- to 17-year-old girls; 55% vs 40% for 11- to 12-year-old and 78% vs 62% for 13- to 17-year-old boys). No significant differences in HPV vaccine coverage were identified at intervention clinics. However, coverage rates were increasing before the start of the intervention and might have been influenced by ongoing health system best practices. HPV vaccine coverage rates varied significantly according to department, which could allow for targeted improvement opportunities. Copyright © 2017 Academic Pediatric Association. All rights reserved.

Obesity prevention in early life: an opportunity to better support the role of Maternal and Child Health Nurses in Australia.

PubMed

Laws, R; Campbell, K J; van der Pligt, P; Ball, K; Lynch, J; Russell, G; Taylor, R; Denney-Wilson, E

2015-01-01

Because parents with young children access primary health care services frequently, a key opportunity arises for Maternal and Child Health (MCH) nurses to actively work with families to support healthy infant feeding practices and lifestyle behaviours. However, little is known regarding the extent to which MCH nurses promote obesity prevention practices and how such practices could be better supported. This mixed methods study involved a survey of 56 MCH nurses (response rate 84.8 %), 16 of whom participated in semi-structured qualitative interviews. Both components aimed to examine the extent to which nurses addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behavior during routine consultations with young children 0-5 years. Key factors influencing such practices and how they could be best supported were also investigated. All data were collected from September to December 2013. Survey data were analysed descriptively and triangulated with qualitative interview findings, the analysis of which was guided by grounded theory principles. Although nurses reported measuring height/length and weight in most consultations, almost one quarter (22.2 %) reported never/rarely using growth charts to identify infants or children at risk of overweight or obesity. This reflected a reluctance to raise the issue of weight with parents and a lack of confidence in how to address it. The majority of nurses reported providing advice on aspects of infant feeding relevant to obesity prevention at most consultations, with around a third (37 %) routinely provided advice on formula preparation. Less than half of nurses routinely promoted active play and only 30 % discussed limiting sedentary behaviour such as TV viewing. Concerns about parental receptiveness and maintaining rapport were key barriers to more effective implementation. While MCH nurses are well placed to address obesity prevention in early life, there is currently a missed public health opportunity. Improving nurse skills in behaviour change counseling will be key to increasing their confidence in raising sensitive lifestyle issues with parents to better integrate obesity prevention practices into normal MCH service delivery.

Missed surgical intensive care unit billing: potential financial impact of 24/7 faculty presence.

PubMed

Hendershot, Kimberly M; Bollins, John P; Armen, Scott B; Thomas, Yalaunda M; Steinberg, Steven M; Cook, Charles H

2009-07-01

To efficiently capture evaluation and management (E&M) and procedural billing in our surgical intensive care unit (SICU), we have developed an electronic billing system that links to the electronic medical record (EMR). In this system, only notes electronically signed and coded by an attending generate billing charges. We hypothesized that capture of missed billing during nighttime and weekends might be sufficient to subsidize 24/7 in-house attending coverage. A retrospective chart EMR review was performed of the EMRs for all SICU patients during a 2-month period. Note type, date, time, attending signature, and coding were analyzed. Notes without attending signature, diagnosis, or current procedural terminology (CPT) code were considered incomplete and identified as "missed billing." Four hundred and forty-three patients had 465 admissions generating 2,896 notes. Overall, 76% of notes were signed and coded by an attending and billed. Incomplete (not billed) notes represented an overall missed billing opportunity of $159,138 for the 2-month time period (approximately $954,000 annually). Unbilled E&M encounters during weekdays totaled $54,758, whereas unbilled E&M and procedures from weeknights and weekends totaled $88,408 ($44,566 and $43,842, respectively). Missed billing after-hours thus represents approximately $530K annually, extrapolating to approximately $220K in collections from our payer mix. Surprisingly, missed E&M and procedural billing during weekdays totaled $70,730 (approximately $425K billing, approximately $170K collections annually), and typically represented patients seen, but transferred from the SICU before attending documentation was completed. Capture of nighttime and weekend ICU collections alone may be insufficient to add faculty or incentivize in-house coverage, but could certainly complement other in-house derived revenues to such ends. In addition, missed daytime billing in busy modern ICUs can be substantial, and use of an EMR to identify missed billing opportunities can help create solutions to recover these revenues.

Responsiveness-informed multiple imputation and inverse probability-weighting in cohort studies with missing data that are non-monotone or not missing at random.

PubMed

Doidge, James C

2018-02-01

Population-based cohort studies are invaluable to health research because of the breadth of data collection over time, and the representativeness of their samples. However, they are especially prone to missing data, which can compromise the validity of analyses when data are not missing at random. Having many waves of data collection presents opportunity for participants' responsiveness to be observed over time, which may be informative about missing data mechanisms and thus useful as an auxiliary variable. Modern approaches to handling missing data such as multiple imputation and maximum likelihood can be difficult to implement with the large numbers of auxiliary variables and large amounts of non-monotone missing data that occur in cohort studies. Inverse probability-weighting can be easier to implement but conventional wisdom has stated that it cannot be applied to non-monotone missing data. This paper describes two methods of applying inverse probability-weighting to non-monotone missing data, and explores the potential value of including measures of responsiveness in either inverse probability-weighting or multiple imputation. Simulation studies are used to compare methods and demonstrate that responsiveness in longitudinal studies can be used to mitigate bias induced by missing data, even when data are not missing at random.

Missed Opportunities: The IEA's Study of Civic Education and Civic Education in Post-Communist Countries

ERIC Educational Resources Information Center

Buk-Berge, Elisabeth

2006-01-01

This article argues that the opportunity in Phase I of the IEA's Civic Education Study to include the new democracies' experiences of citizenship education have not been sufficiently exploited. "Borrowing" citizenship education from abroad and citizenship education for "civil society" have been chosen as examples of problems in…

Vaccine exemptions and the kindergarten vaccination coverage gap.

PubMed

Smith, Philip J; Shaw, Jana; Seither, Ranee; Lopez, Adriana; Hill, Holly A; Underwood, Mike; Knighton, Cynthia; Zhao, Zhen; Ravanam, Megha Shah; Greby, Stacie; Orenstein, Walter A

2017-09-25

Vaccination requirements for kindergarten entry vary by state, but all states require 2 doses of measles containing vaccine (MCV) at kindergarten entry. To assess (i) national MCV vaccination coverage for children who had attended kindergarten; (ii) the extent to which undervaccination after kindergarten entry is attributable to parents' requests for an exemption; (iii) the extent to which undervaccinated children had missed opportunities to be administered missing vaccine doses among children whose parent did not request an exemption; and (iv) the vaccination coverage gap between the "highest achievable" MCV coverage and actual MCV coverage among children who had attended kindergarten. A national survey of 1465 parents of 5-7year-old children was conducted during October 2013 through March 2014. Vaccination coverage estimates are based provider-reported vaccination histories. Children have a "missed opportunity" for MCV if they were not up-to-date and if there were dates on which other vaccines were administered but not MCV. The "highest achievable" MCV vaccination coverage rate is 100% minus the sum of the percentages of (i) undervaccinated children with parents who requested an exemption; and (ii) undervaccinated children with parents who did not request an exemption and whose vaccination statuses were assessed during a kindergarten grace period or period when they were provisionally enrolled in kindergarten. Among all children undervaccinated for MCV, 2.7% were attributable to having a parent who requested an exemption. Among children who were undervaccinated for MCV and whose parent did not request an exemption, 41.6% had a missed opportunity for MCV. The highest achievable MCV coverage was 98.6%, actual MCV coverage was 90.9%, and the kindergarten vaccination gap was 7.7%. Vaccination coverage may be increased by schools fully implementing state kindergarten vaccination laws, and by providers assessing children's vaccination status at every clinic visit, and administering missed vaccine doses. Published by Elsevier Ltd.

KSC-07pd3320

NASA Image and Video Library

2007-11-14

KENNEDY SPACE CENTER, FLA. -- In the Orbiter Processing Facility, one of two Materials International Space Station Experiments, or MISSE, is lowered into space shuttle Endeavour's payload bay for installation. The MISSE is part of the payload onboard Endeavour for mission STS-123. The MISSE project is a NASA/Langley Research Center-managed cooperative endeavor to fly materials and other types of space exposure experiments on the International Space Station. The objective is to develop early, low-cost, non-intrusive opportunities to conduct critical space exposure tests of space materials and components planned for use on future spacecraft. Photo credit: NASA/Kim Shiflett

KSC-07pd3321

NASA Image and Video Library

2007-11-14

KENNEDY SPACE CENTER, FLA. -- In the Orbiter Processing Facility, the second of two Materials International Space Station Experiments, or MISSE, is lowered into space shuttle Endeavour's payload bay for installation. The MISSE is part of the payload onboard Endeavour for mission STS-123. The MISSE project is a NASA/Langley Research Center-managed cooperative endeavor to fly materials and other types of space exposure experiments on the International Space Station. The objective is to develop early, low-cost, non-intrusive opportunities to conduct critical space exposure tests of space materials and components planned for use on future spacecraft. Photo credit: NASA/Kim Shiflett

KSC-07pd3319

NASA Image and Video Library

2007-11-14

KENNEDY SPACE CENTER, FLA. -- In the Orbiter Processing Facility, one of two Materials International Space Station Experiments, or MISSE, is lowered into space shuttle Endeavour's payload bay for installation. The MISSE is part of the payload onboard Endeavour for mission STS-123. The MISSE project is a NASA/Langley Research Center-managed cooperative endeavor to fly materials and other types of space exposure experiments on the International Space Station. The objective is to develop early, low-cost, non-intrusive opportunities to conduct critical space exposure tests of space materials and components planned for use on future spacecraft. Photo credit: NASA/Kim Shiflett

Testing of NASA LaRC Materials under MISSE 6 and MISSE 7 Missions

NASA Technical Reports Server (NTRS)

Prasad, Narasimha S.

2009-01-01

The objective of the Materials International Space Station Experiment (MISSE) is to study the performance of novel materials when subjected to the synergistic effects of the harsh space environment for several months. MISSE missions provide an opportunity for developing space qualifiable materials. Two lasers and a few optical components from NASA Langley Research Center (LaRC) were included in the MISSE 6 mission for long term exposure. MISSE 6 items were characterized and packed inside a ruggedized Passive Experiment Container (PEC) that resembles a suitcase. The PEC was tested for survivability due to launch conditions. MISSE 6 was transported to the international Space Station (ISS) via STS 123 on March 11. 2008. The astronauts successfully attached the PEC to external handrails of the ISS and opened the PEC for long term exposure to the space environment. The current plan is to bring the MISSE 6 PEC back to the Earth via STS 128 mission scheduled for launch in August 2009. Currently, preparations for launching the MISSE 7 mission are progressing. Laser and lidar components assembled on a flight-worthy platform are included from NASA LaRC. MISSE 7 launch is scheduled to be launched on STS 129 mission. This paper will briefly review recent efforts on MISSE 6 and MISSE 7 missions at NASA Langley Research Center (LaRC).

Potential adjustment methodology for missing data and reporting delay in the HIV Surveillance System, European Union/European Economic Area, 2015.

PubMed

Rosinska, Magdalena; Pantazis, Nikos; Janiec, Janusz; Pharris, Anastasia; Amato-Gauci, Andrew J; Quinten, Chantal; Ecdc Hiv/Aids Surveillance Network

2018-06-01

Accurate case-based surveillance data remain the key data source for estimating HIV burden and monitoring prevention efforts in Europe. We carried out a literature review and exploratory analysis of surveillance data regarding two crucial issues affecting European surveillance for HIV: missing data and reporting delay. Initial screening showed substantial variability of these data issues, both in time and across countries. In terms of missing data, the CD4+ cell count is the most problematic variable because of the high proportion of missing values. In 20 of 31 countries of the European Union/European Economic Area (EU/EEA), CD4+ counts are systematically missing for all or some years. One of the key challenges related to reporting delays is that countries undertake specific one-off actions in effort to capture previously unreported cases, and that these cases are subsequently reported with excessive delays. Slightly different underlying assumptions and effectively different models may be required for individual countries to adjust for missing data and reporting delays. However, using a similar methodology is recommended to foster harmonisation and to improve the accuracy and usability of HIV surveillance data at national and EU/EEA levels.

Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project

PubMed Central

Djellouli, Nehla; Mann, Sue; Nambiar, Bejoy; Meireles, Paula; Miranda, Diana; Barros, Henrique; Bocoum, Fadima Y; Yaméogo, W Maurice E; Yaméogo, Clarisse; Belemkoabga, Sylvie; Tougri, Halima; Coulibaly, Abou; Kouanda, Seni; Mochache, Vernon; Mwakusema, Omar K; Irungu, Eunice; Gichangi, Peter; Dembo, Zione; Kadzakumanja, Angela; Makwenda, Charles Vidonji; Timóteo, Judite; Cossa, Misete G; de Melo, Malica; Griffin, Sally; Osman, Nafissa B; Foia, Severiano; Ogbe, Emilomo; Duysburgh, Els

2017-01-01

Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context–mechanism–outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by ‘bridging’ communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a ‘buzz’ for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs’ motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective. PMID:29225949

Moving beyond Naturalism: Using a Discussion of "Miss Julie" to Educate Students about Date Rape--and More

ERIC Educational Resources Information Center

Bloom, Davida

2006-01-01

In this article, the author talks about using the play entitled, "Miss Julie" to educate her students about date rape. According to her, the play presents a unique opportunity to bring up the topic of date rape. Several theories, including the social learning theory and the evolutionary theory, have been put forth to explain the existence of rape.…

Testing of Laser Components Subjected to Exposure in Space

NASA Technical Reports Server (NTRS)

Prasad, Narasimha S.

2010-01-01

Materials International Space Station Experiment (MISSE) missions provide an opportunity for developing space qualifiable materials by studying the response of novel materials when subjected to the synergistic effects of the harsh space environment. MISSE 6 was transported to the international Space Station (ISS) via STS 123 on March 11. 2008. The astronauts successfully attached the passive experiment containers (PEC) to external handrails of the international space station (ISS) and opened up for long term exposure. After more than a year of exposure attached to the station's exterior, the PEC with several hundred material samples returned to the earth with the STS-128 space shuttle crew that was launched on shuttle Discovery from the Kennedy Space Center, Fla., on Aug. 28. Meanwhile, MISSE 7 launch is scheduled to be launched on STS 129 mission. MISSE-7 was launched on Space Shuttle mission STS-129 on Atlantis was launched on November 16, 2009. This paper will briefly review recent efforts on MISSE 6 and MISSE 7 missions at NASA Langley Research Center (LaRC).

Performance Testing of Lidar Components Subjected to Space Exposure in Space via MISSE 7 Mission

NASA Technical Reports Server (NTRS)

Prasad, Narasimha S.

2012-01-01

.The objective of the Materials International Space Station Experiment (MISSE) is to study the performance of novel materials when subjected to the synergistic effects of the harsh space environment for several months. MISSE missions provide an opportunity for developing space qualifiable materials. Several laser and lidar components were sent by NASA Langley Research Center (LaRC) as a part of the MISSE 7 mission. The MISSE 7 module was transported to the international space station (ISS) via STS 129 mission that was launched on Nov 16, 2009. Later, the MISSE 7 module was brought back to the earth via the STS 134 that landed on June 1, 2011. The MISSE 7 module that was subjected to exposure in space environment for more than one and a half year included fiber laser, solid-state laser gain materials, detectors, and semiconductor laser diode. Performance testing of these components is now progressing. In this paper, the current progress on post-flight performance testing of a high-speed photodetector and a balanced receiver is discussed. Preliminary findings show that detector characteristics did not undergo any significant degradation.

Variations in Missed Care Across Oncology Nursing Specialty Units.

PubMed

Villamin, Colleen; Anderson, Jacqueline; Fellman, Bryan; Urbauer, Diana; Brassil, Kelly

2018-04-19

An opportunity was identified to compare perceptions of the occurrence and types of missed care at a comprehensive cancer center. The purpose was to evaluate the difference in perceived occurrence and types of missed care between medical, surgical, and hematologic oncology units in the context of a newly implemented patient care delivery system, Primary Team Nursing (PTN). A descriptive, repeated-measures design was used. The MISSCARE survey was distributed electronically to 580 staff members across 6 inpatient units. Frequently perceived elements of missed nursing care were ambulation, turning every 2 hours, and care conference attendance. At the time of study implementation, surgical units reported 0.24 higher scores than medical units (P = .017); hematology units reported 0.26 lower scores than surgical units (P = .005). PTN status did not affect MISSCARE scores (P = .525). Study findings suggest that perceived missed care in a comprehensive cancer center is similar to that in other hospital settings.

Self-Archiving Journal Articles: A Case Study of Faculty Practice and Missed Opportunity

ERIC Educational Resources Information Center

Covey, Denise Troll

2009-01-01

Carnegie Mellon faculty Web pages and publisher policies were examined to understand self-archiving practice. The breadth of adoption and depth of commitment are not directly correlated within the disciplines. Determining when self-archiving has become a habit is difficult. The opportunity to self-archive far exceeds the practice, and much of what…

Children as Researchers: What We Can Learn from Them about the Impact of Poverty on Literacy Opportunities?

ERIC Educational Resources Information Center

Kellett, Mary

2009-01-01

This paper challenges some of the assumptions about our understanding of and approaches to literacy. Crucially, it provides evidence hitherto missing from the body of research knowledge: children's own perspectives on literacy opportunities accessed by children themselves. Reading proficiency is pivotal in education, providing a platform on which…

The Design of Large-Scale Complex Engineered Systems: Present Challenges and Future Promise

NASA Technical Reports Server (NTRS)

Bloebaum, Christina L.; McGowan, Anna-Maria Rivas

2012-01-01

Model-Based Systems Engineering techniques are used in the SE community to address the need for managing the development of complex systems. A key feature of the MBSE approach is the use of a model to capture the requirements, architecture, behavior, operating environment and other key aspects of the system. The focus on the model differentiates MBSE from traditional SE techniques that may have a document centric approach. In an effort to assess the benefit of utilizing MBSE on its flight projects, NASA Langley has implemented a pilot program to apply MBSE techniques during the early phase of the Materials International Space Station Experiment-X (MISSE-X). MISSE-X is a Technology Demonstration Mission being developed by the NASA Office of the Chief Technologist i . Designed to be installed on the exterior of the International Space Station (ISS), MISSE-X will host experiments that advance the technology readiness of materials and devices needed for future space exploration. As a follow-on to the highly successful series of previous MISSE experiments on ISS, MISSE-X benefits from a significant interest by the

FameLab: A Communication Skills-Building Program Disguised as an International Competition

NASA Astrophysics Data System (ADS)

Scalice, D.

2015-12-01

One of the key pieces of training missing from most graduate studies in science is skills-building in communication. Beyond the responsibility to share their work with the public, good communication skills enhance a scientist's career path, facilitating comprehension of their work by stakeholders and funders, as well as increasing the ability to collaborate interdisciplinarily. FameLab, an American Idol-style communication competition for early career scientists, helps fill this void, and provides an opportunity to pratice communication skills, with the coaching of professionals, in a safe space. The focus is on training and networking with like-minded scientists. NASA's Astrobiology Program has been implementing FameLab in the US since 2011, but over 25 countries take part globally. Come learn about this innovative program, what impact it's had on participants, and how you can get involved.

Rethinking school-based health centers as complex adaptive systems: maximizing opportunities for the prevention of teen pregnancy and sexually transmitted infections.

PubMed

Daley, Alison Moriarty

2012-01-01

This article examines school-based health centers (SBHCs) as complex adaptive systems, the current gaps that exist in contraceptive access, and the potential to maximize this community resource in teen pregnancy and sexually transmitted infection (STI) prevention efforts. Adolescent pregnancy is a major public health challenge for the United States. Existing community resources need to be considered for their potential to impact teen pregnancy and STI prevention efforts. SBHCs are one such community resource to be leveraged in these efforts. They offer adolescent-friendly primary care services and are responsive to the diverse needs of the adolescents utilizing them. However, current restrictions on contraceptive availability limit the ability of SBHCs to maximize opportunities for comprehensive reproductive care and create missed opportunities for pregnancy and STI prevention. A clinical case explores the current models of health care services related to contraceptive care provided in SBHCs and the ability to meet or miss the needs of an adolescent seeking reproductive care in a SBHC.

Tennessee’s 3-Star Report: Using Available Data Systems to Reduce Missed Opportunities to Vaccinate Preteens

PubMed Central

Moore, Kelly L.; Fankhauser, Melissa K.; Hull, Pamela C.

2016-01-01

All preteens should receive tetanus–diphtheria–pertussis vaccine (Tdap), quadrivalent meningococcal vaccine (Men-ACWY), and the human papillomavirus (HPV) cancer vaccine series. In Tennessee, HPV vaccination rates have stagnated at low levels for a decade. Three fundamental strategies to reduce missed opportunities for immunization include administering all recommended vaccines at the same visit, making strong recommendations for vaccines, and auditing and feedback. In Tennessee, during each summer, a surge of preteens visit local health departments (LHDs) to receive a required Tdap vaccine before entering seventh grade, presenting an opportunity to administer Men-ACWY and HPV. The Tennessee Immunization Program (TIP) coined the term “3-Star visit” for such encounters and developed a monthly report to track them using data from the Patient Tracking Billing Management Information System (PTBMIS) used by LHDs across Tennessee. Implementation of this quality improvement report has correlated with a substantial increase in 3-Star visits from 2013 to 2016, particularly during the summer months. PMID:27980415

A study of using smartphone to detect and identify construction workers' near-miss falls based on ANN

NASA Astrophysics Data System (ADS)

Zhang, Mingyuan; Cao, Tianzhuo; Zhao, Xuefeng

2018-03-01

As an effective fall accident preventive method, insight into near-miss falls provides an efficient solution to find out the causes of fall accidents, classify the type of near-miss falls and control the potential hazards. In this context, the paper proposes a method to detect and identify near-miss falls that occur when a worker walks in a workplace based on artificial neural network (ANN). The energy variation generated by workers who meet with near-miss falls is measured by sensors embedded in smart phone. Two experiments were designed to train the algorithm to identify various types of near-miss falls and test the recognition accuracy, respectively. At last, a test was conducted by workers wearing smart phones as they walked around a simulated construction workplace. The motion data was collected, processed and inputted to the trained ANN to detect and identify near-miss falls. Thresholds were obtained to measure the relationship between near-miss falls and fall accidents in a quantitate way. This approach, which integrates smart phone and ANN, will help detect near-miss fall events, identify hazardous elements and vulnerable workers, providing opportunities to eliminate dangerous conditions in a construction site or to alert possible victims that need to change their behavior before the occurrence of a fall accident.

Neurofibromatosis

MedlinePlus

... pain clinic is advisable. top Are there prenatal tests for the neurofibromatoses? Clinical genetic testing can confirm ... their activities will offer scientists exciting opportunities to design drugs that could replace the missing proteins in ...

Point of care experience with pneumococcal and influenza vaccine documentation among persons aged ≥65 years: high refusal rates and missing information.

PubMed

Brownfield, Elisha; Marsden, Justin E; Iverson, Patty J; Zhao, Yumin; Mauldin, Patrick D; Moran, William P

2012-09-01

Missed opportunities to vaccinate and refusal of vaccine by patients have hindered the achievement of national health care goals. The meaningful use of electronic medical records should improve vaccination rates, but few studies have examined the content of these records. In our vaccine intervention program using an electronic record with physician prompts, paper prompts, and nursing standing orders, we were unable to achieve national vaccine goals, due in large part to missing information and patient refusal. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

KSC-07pd3316

NASA Image and Video Library

2007-11-14

KENNEDY SPACE CENTER, FLA. -- In the Orbiter Processing Facility, technicians help lift the first of the Materials International Space Station Experiments, or MISSE, from a shipping container. The MISSE is part of the payload onboard space shuttle Endeavour for mission STS-123. It will be installed in Endeavour's payload bay. The MISSE project is a NASA/Langley Research Center-managed cooperative endeavor to fly materials and other types of space exposure experiments on the International Space Station. The objective is to develop early, low-cost, non-intrusive opportunities to conduct critical space exposure tests of space materials and components planned for use on future spacecraft. Photo credit: NASA/Kim Shiflett

KSC-07pd3317

NASA Image and Video Library

2007-11-14

KENNEDY SPACE CENTER, FLA. -- In the Orbiter Processing Facility, technicians get ready to remove another Materials International Space Station Experiments, or MISSE, from a shipping container. The MISSE is part of the payload onboard space shuttle Endeavour for mission STS-123. It will be installed in Endeavour's payload bay. The MISSE project is a NASA/Langley Research Center-managed cooperative endeavor to fly materials and other types of space exposure experiments on the International Space Station. The objective is to develop early, low-cost, non-intrusive opportunities to conduct critical space exposure tests of space materials and components planned for use on future spacecraft. Photo credit: NASA/Kim Shiflett

KSC-07pd3315

NASA Image and Video Library

2007-11-14

KENNEDY SPACE CENTER, FLA. -- In the Orbiter Processing Facility, technicians get ready to remove one of two Materials International Space Station Experiments, or MISSE, from a shipping container. The MISSE is part of the payload onboard space shuttle Endeavour for mission STS-123. It will be installed in Endeavour's payload bay. The MISSE project is a NASA/Langley Research Center-managed cooperative endeavor to fly materials and other types of space exposure experiments on the International Space Station. The objective is to develop early, low-cost, non-intrusive opportunities to conduct critical space exposure tests of space materials and components planned for use on future spacecraft. Photo credit: NASA/Kim Shiflett

KSC-07pd3318

NASA Image and Video Library

2007-11-14

KENNEDY SPACE CENTER, FLA. -- In the Orbiter Processing Facility, one of two Materials International Space Station Experiments, or MISSE, is moved across facility toward space shuttle Endeavour. The MISSE is part of the payload onboard Endeavour for mission STS-123 and will be installed in the payload bay. The MISSE project is a NASA/Langley Research Center-managed cooperative endeavor to fly materials and other types of space exposure experiments on the International Space Station. The objective is to develop early, low-cost, non-intrusive opportunities to conduct critical space exposure tests of space materials and components planned for use on future spacecraft. Photo credit: NASA/Kim Shiflett

Developing a framework to review near-miss maternal morbidity in India: a structured review and key stakeholder analysis.

PubMed

Bhattacharyya, Sanghita; Srivastava, Aradhana; Knight, Marian

2014-11-13

In India there is a thrust towards promoting institutional delivery, resulting in problems of overcrowding and compromise to quality of care. Review of near-miss obstetric events has been suggested to be useful to investigate health system functioning, complementing maternal death reviews. The aim of this project was to identify the key elements required for a near-miss review programme for India. A structured review was conducted to identify methods used in assessing near-miss cases. The findings of the structured review were used to develop a suggested framework for conducting near-miss reviews in India. A pool of experts in near-miss review methods in low and middle income countries (LMICs) was identified for vetting the framework developed. Opinions were sought about the feasibility of implementing near-miss reviews in India, the processes to be followed, factors that made implementation successful and the associated challenges. A draft of the framework was revised based on the experts' opinions. Five broad methods of near-miss case review/audit were identified: Facility-based near-miss case review, confidential enquiries, criterion-based clinical audit, structured case review (South African Model) and home-based interviews. The opinion of the 11 stakeholders highlighted that the methods that a facility adopts should depend on the type and number of cases the facility handles, availability and maintenance of a good documentation system, and local leadership and commitment of staff. A proposed framework for conducting near-miss reviews was developed that included a combination of criterion-based clinical audit and near-miss review methods. The approach allowed for development of a framework for researchers and planners seeking to improve quality of maternal care not only at the facility level but also beyond, encompassing community health workers and referral. Further work is needed to evaluate the implementation of this framework to determine its efficacy in improving the quality of care and hence maternal and perinatal morbidity and mortality.

Multiple Imputation for Multivariate Missing-Data Problems: A Data Analyst's Perspective.

ERIC Educational Resources Information Center

Schafer, Joseph L.; Olsen, Maren K.

1998-01-01

The key ideas of multiple imputation for multivariate missing data problems are reviewed. Software programs available for this analysis are described, and their use is illustrated with data from the Adolescent Alcohol Prevention Trial (W. Hansen and J. Graham, 1991). (SLD)

Key issues and challenges in developing a pedagogical intervention in the simulation skills center--an action research study.

PubMed

Reierson, Inger Åse; Hvidsten, Anne; Wighus, Marianne; Brungot, Solvor; Bjørk, Ida Torunn

2013-07-01

Simulation skills centers (SSC) are considered important learning arenas for preparing and qualifying nursing students. Limited clinical placements and claims of diminished learning opportunities raise concerns that newly educated nurses lack proficiency in many psychomotor skills. Accordingly, there is an increased focus on learning in the SSC. However, it has been questioned if the pedagogical underpinning of teaching and learning in the SSC is missing or unclear. At a bachelor nursing education in Norway, there was a desire to change practice and enhance learning in the SSC by systematic use of The Model of Practical Skill Performance (Bjørk and Kirkevold, 2000). A participatory action research design was chosen. A pedagogical intervention was developed and implemented in 2010 in a cohort of eighty-seven first year bachelor nursing students during their basic nursing skill course. The intervention is shortly described. This article reports key issues and challenges that emerged during development of the new intervention. Data to inform the study were collected via thorough meeting minutes and the project leader's logbook, and analyzed using fieldnotes analysis. Six key issues and challenges were identified. These are presented and discussed consecutively in light of their importance for development and implementation of the new intervention. Copyright © 2013 Elsevier Ltd. All rights reserved.

Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE)

PubMed Central

Woldesenbet, Selamawit; Jackson, Debra; Lombard, Carl; Dinh, Thu-Ha; Puren, Adrian; Sherman, Gayle; Ramokolo, Vundli; Doherty, Tanya; Mogashoa, Mary; Bhardwaj, Sanjana; Chopra, Mickey; Shaffer, Nathan; Pillay, Yogan; Goga, Ameena

2015-01-01

Objectives We examined uptake of prevention of mother-to-child HIV transmission (PMTCT) services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa. Methods A cross-sectional survey was conducted among 4–8 week old infants receiving first immunisations in 580 nationally representative public health facilities in 2010. This included maternal interviews and testing infants’ dried blood spots for HIV. A weighted analysis was performed to assess uptake of antenatal and perinatal PMTCT services along the PMTCT cascade (namely: maternal HIV testing, CD4 count test/result, and receiving maternal and infant antiretroviral treatment) and predictors of dropout. The population attributable fraction associated with dropouts at each service point are estimated. Results Of 9,803 mothers included, 31.7% were HIV-positive as identified by reactive infant antibody tests. Of these 80.4% received some form of maternal and infant antiretroviral treatment. More than a third (34.9%) of mothers dropped out from one or more steps in the PMTCT service cascade. In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status. Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5–3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001). A third (33.8%) of infant HIV infections were attributable to dropout in one or more steps in the cascade. Conclusion A third of transmissions attributable to missed opportunities of PMTCT services can be prevented by optimizing the uptake of PMTCT services. Identified risk factors for low PMTCT service uptake should be addressed through health facility and community-level interventions, including raising awareness, promoting women education, adolescent focused interventions, and strengthening linkages/referral-system between communities and health facilities. PMID:26147598

[Missed lessons, missed opportunities: a role for public health services in medical absenteeism in young people].

PubMed

Vanneste, Y T M; van de Goor, L A M; Feron, F J M

2016-01-01

Young people who often miss school for health reasons are not only missing education, but also the daily routine of school, and social intercourse with their classmates. Medical absenteeism among students merits greater attention. For a number of years, in various regions in the Netherlands, students with extensive medical absenteeism have been invited to see a youth healthcare specialist. The MASS intervention (Medical Advice of Students reported Sick; in Dutch: Medische Advisering van de Ziekgemelde Leerling, abbreviated as M@ZL) has been developed by the West Brabant Regional Public Health Service together with secondary schools to address school absenteeism due to reporting sick. In this paper we discuss the MASS intervention and explain why attention should be paid by public health services to the problem of school absenteeism, especially absenteeism on health grounds.

Missed Opportunities: Origin, Growth, and Decline of Community College Fire Science Degree Programs in Alabama, 1977 to 2002

ERIC Educational Resources Information Center

Laughlin, Jerry W.

2007-01-01

There was rapid growth of Alabama community colleges in the late 1960s. At the same time, there was rapid growth nationally of fire science associate degree programs. With these concurrent events, one would expect fire department personnel in Alabama to benefit from new community college opportunities in fire science and fire administration.…

Learning from near misses: from quick fixes to closing off the Swiss-cheese holes.

PubMed

Jeffs, Lianne; Berta, Whitney; Lingard, Lorelei; Baker, G Ross

2012-04-01

The extent to which individuals in healthcare use near misses as learning opportunities remains poorly understood. Thus, an exploratory study was conducted to gain insight into the nature of, and contributing factors to, organisational learning from near misses in clinical practice. A constructivist grounded theory approach was employed which included semi-structured interviews with 24 participants (16 clinicians and 8 administrators) from a large teaching hospital in Canada. This study revealed three scenarios for the responses to near misses, the most common involved 'doing a quick fix' where clinicians recognised and corrected an error with no further action. The second scenario consisted of reporting near misses but not hearing back from management, which some participants characterised as 'going into a black hole'. The third scenario was 'closing off the Swiss-cheese holes', in which a reported near miss generated corrective action at an organisational level. Explanations for 'doing a quick fix' included the pervasiveness of near misses that cause no harm and fear associated with reporting the near miss. 'Going into a black hole' reflected managers' focus on operational duties and events that harmed patients. 'Closing off the Swiss-cheese holes' occurred when managers perceived substantial potential for harm and preventability. Where learning was perceived to occur, leaders played a pivotal role in encouraging near-miss reporting. To optimise learning, organisations will need to determine which near misses are appropriate to be responded to as 'quick fixes' and which ones require further action at the unit and corporate levels.

Application of homomorphism to secure image sharing

NASA Astrophysics Data System (ADS)

Islam, Naveed; Puech, William; Hayat, Khizar; Brouzet, Robert

2011-09-01

In this paper, we present a new approach for sharing images between l players by exploiting the additive and multiplicative homomorphic properties of two well-known public key cryptosystems, i.e. RSA and Paillier. Contrary to the traditional schemes, the proposed approach employs secret sharing in a way that limits the influence of the dealer over the protocol and allows each player to participate with the help of his key-image. With the proposed approach, during the encryption step, each player encrypts his own key-image using the dealer's public key. The dealer encrypts the secret-to-be-shared image with the same public key and then, the l encrypted key-images plus the encrypted to-be shared image are multiplied homomorphically to get another encrypted image. After this step, the dealer can safely get a scrambled image which corresponds to the addition or multiplication of the l + 1 original images ( l key-images plus the secret image) because of the additive homomorphic property of the Paillier algorithm or multiplicative homomorphic property of the RSA algorithm. When the l players want to extract the secret image, they do not need to use keys and the dealer has no role. Indeed, with our approach, to extract the secret image, the l players need only to subtract their own key-image with no specific order from the scrambled image. Thus, the proposed approach provides an opportunity to use operators like multiplication on encrypted images for the development of a secure privacy preserving protocol in the image domain. We show that it is still possible to extract a visible version of the secret image with only l-1 key-images (when one key-image is missing) or when the l key-images used for the extraction are different from the l original key-images due to a lossy compression for example. Experimental results and security analysis verify and prove that the proposed approach is secure from cryptographic viewpoint.

Institutional Responsibility and the Flawed Genomic Biomarkers at Duke University: A Missed Opportunity for Transparency and Accountability.

PubMed

DeMets, David L; Fleming, Thomas R; Geller, Gail; Ransohoff, David F

2017-08-01

When there have been substantial failures by institutional leadership in their oversight responsibility to protect research integrity, the public should demand that these be recognized and addressed by the institution itself, or the funding bodies. This commentary discusses a case of research failures in developing genomic predictors for cancer risk assessment and treatment at a leading university. In its review of this case, the Office of Research Integrity, an agency within the US Department of Health and Human Services, focused their report entirely on one individual faculty member and made no comment on the institution's responsibility and its failure to provide adequate oversight and investigation. These actions missed an important opportunity to emphasize the institution's critical responsibilities in oversight of research integrity and the importance of institutional transparency and accountability.

Does emergency presentation of cancer represent poor performance in primary care? Insights from a novel analysis of linked primary and secondary care data.

PubMed

Murchie, Peter; Smith, Sarah M; Yule, Michael S; Adam, Rosalind; Turner, Melanie E; Lee, Amanda J; Fielding, Shona

2017-04-25

People diagnosed with cancer following emergency presentation have poorer short-term survival. To what extent this signifies a missed opportunity for earlier diagnosis in primary care remains unclear as little detailed data exist on the patient/general practitioner interaction beforehand. Analysis of primary care and regional data for 1802 cancer patients from Northeast Scotland. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) for patient and GP practice predictors of emergency presentation. Qualitative context coding of primary care interaction before emergency presentation. Emergency presentations equalled 20% (n=365). Twenty-eight per cent had no relevant prior GP contact. Of those with prior GP contact 30% were admitted while waiting to be seen in secondary care, and 19% were missed opportunities for earlier diagnosis. Associated predictors: no prior GP contact (OR=3.89; CI 95% 2.14-7.09); having lung (OR=23.24; 95% CI 7.92-68.21), colorectal (OR=18.49; CI 95% 6.60-51.82) and upper GI cancer (OR=18.97; CI 95% 6.08-59.23); ethnicity (OR=2.78; CI 95% 1.27-6.06). Our novel approach has revealed that emergency cancer presentation is more complex than previously thought. Patient delay, prolonged referral pathways and missed opportunities by GPs all contribute, but emergency presentation can also represent effective care. Resources should be used proportionately to raise public and GP awareness and improve post-referral pathways.

Hepatitis C performance measure on hepatitis A and B vaccination: missed opportunities?

PubMed

Hernandez, Bridget; Hasson, Noelle K; Cheung, Ramsey

2009-08-01

Prevention of hepatitis A virus (HAV) and hepatitis B virus (HBV) infection in patients with chronic hepatitis C (CHC) through vaccination is endorsed by all major professional societies. This study was conducted to determine adherence to the recently adopted physician performance measure on HAV and HBV vaccination. This was a retrospective study. Hepatitis A and B serology data and immunization records between 2000 and 2007 from CHC patients with detectable hepatitis C virus (HCV) RNA were analyzed. A total of 2,968 CHC patients were included in the study. Of these, 2,143 patients (72%) were tested for susceptibility to HAV, of which 53% had immunity. Of the non-immune patients, 746 (74%) were vaccinated as well as an additional 218 without prior testing. For HBV, 2,303 patients (78%) were tested for immunity and 782 (34%) were immune. Of the susceptible patients, 1,086 (71%) were vaccinated as well as an additional 197 patients without prior testing. The overall vaccination performance measure adherence rate was 71% for HAV, 70% for HBV, and 62% for both HAV and HBV. Random review of 176 charts found the major reasons for non-adherence were missed opportunity (41%), change of health care system (31%), and documented vaccination outside our health care system (22%). Our study found a high and improved adherence to the recommendations, but missed opportunity was still the main reason of non-adherence. This study also supported the strategy of selective vaccination in the veteran population.

Millennium Development Goals 4 and 5: progress and challenges.

PubMed

Bryce, Jennifer; Black, Robert E; Victora, Cesar G

2013-10-16

The Millennium Development Goals have galvanized efforts to improve child survival (MDG-4) and maternal health (MDG-5). There has been important progress on both MDGs at global level, although it now appears that few countries will reach them by the target date of 2015. There are known and efficacious interventions to address most of the major causes of these deaths, but important gaps remain. The biggest challenge is to ensure that all women and children have access to life-saving interventions. Current levels of intervention coverage are too low, representing missed opportunities. Providing services at the community level is an important emerging priority, but preventing maternal and neonatal deaths also requires access to health facilities. Readers of the Medicine for Global Health collection in BMC Medicine are urged to make maternal and child health one of their key concerns, even if they work on other topics.

Missing School Matters

ERIC Educational Resources Information Center

Balfanz, Robert

2016-01-01

Results of a survey conducted by the Office for Civil Rights show that 6 million public school students (13%) are not attending school regularly. Chronic absenteeism--defined as missing more than 10% of school for any reason--has been negatively linked to many key academic outcomes. Evidence shows that students who exit chronic absentee status can…

Missed Immunization Opportunities Among Children Under 5 Years Of Age Dwelling In Karachi City.

PubMed

Khaliq, Asif; Sayed, Sayeeda Amber; Hussaini, Syed Abdullah; Azam, Kiran; Qamar, Mehak

2017-01-01

Immunization is the safest and effective measure for preventing and eradicating various communicable diseases. A glaring immunization gap exists between developing and industrialized countries towards immunization, because the developing countries including Pakistan are still striving to provide basic immunization to their children. The purpose of this study was to access the prevalence and factors of missing immunization among under 5-year children of Karachi.. A cross sectional study was conducted from June 2015 to October 2015 among different outpatient clinics of Karachi. Parents who had child less than 5 year of age were approached by non-probability purposive sampling. Data was analysed by using Statistical Package of Social Sciences. There were around 59.09% (n=156) and 64.43% (n=165) parents who have correctly responded regarding the number of essential immunization visit during the first and second year of their child life respectively. About 28.12% (n=108) parents responded that they do not know about the name and number of missed doses of vaccines. 31.78% (n=122) parents responded that their children have missed either one or more than one doses of routine immunization vaccines. Of which 34.42% (n=42) children have missed more than one vaccine. Lack of knowledge regarding immunization schedule 28.68% (n=34), concern about vaccine side effects 21.31%, (n=26), child sickness 17.21% (n=21), and lack of trust about government 10.65%, (n=13) were the major barriers identified by parents for missed immunization opportunities. Parents have inadequate knowledge regarding routine immunization visits, immunization schedule and vaccine doses. The practices of parents for routine childhood immunization are also poor. Parents refuse to immunize their child because of lack of immunization visit knowledge and also because of their doubts regarding vaccine potency and side effects. A proper system of immunization promotion, advocacy and reminder systems with proper follow-up mechanism need to be developed by all healthcare centres.

Reminder cards and immunization rates among Latinos and the rural poor in Northeast Colorado.

PubMed

Hicks, Paul; Tarr, Gillian A M; Hicks, Ximena Prieto

2007-01-01

Immunization rates are static in the United States. Risk factors for not being up to date (UTD) include ethnicity and lower socioeconomic status. Reminder cards increase immunization rates in urban settings. Their effect in poor, Latino, and rural children is unknown. Language-appropriate reminder cards were sent to active patients not UTD listing the vaccines missing; the card served as the physician order for the vaccine. Missed opportunities were addressed through discussion with staff and posters in patient care rooms. UTD rates before and after intervention were measured. Dual-purpose reminder/order cards increased the rate of UTD from 61.3% to 73.4%; children living near the clinic, patients who speak only Spanish, and Latinos overall showed preferential effectiveness. Children eligible to participate in the Vaccines for Children program had similar increases in UTD rates but had lower baseline and final UTD rates than did children not eligible for the Vaccines for Children program. The rate of missed opportunities did not change. The number of children to whom reminder cards needed to be sent for them to become fully immunized is 8 (number needed to treat). In poor, rural, and Latino populations, language-appropriate reminder/order cards increase immunization rates.

Effect of an anonymous reporting system on near-miss and harmful medical error reporting in a pediatric intensive care unit.

PubMed

Grant, Mary Jo C; Larsen, Gitte Y

2007-01-01

Adverse event reporting is a key element for improving patient safety. This study describes a new voluntary, anonymous reporting system that facilitates reporting of near-miss and patient harm events and an assessment of patient harm by the bedside care provider in a pediatric intensive care unit. The results demonstrated the effectiveness of the Patient Safety Report as a method to capture near-miss and patient harm events.

Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

PubMed

Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

2002-12-01

Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.

Post-Flight Test Results of Acousto-Optic Modulator Devices Subjected to Space Exposure

NASA Technical Reports Server (NTRS)

Prasad, Narasimha S.; Trivedi, Sudhir; Rosemeier, Jolanta; Diestler, Mark

2014-01-01

The objective of the Materials International Space Station Experiment (MISSE) is to study the performance of novel materials when subjected to the synergistic effects of the harsh space environment for several months. MISSE missions provide an opportunity for developing space qualifiable materials. Several laser and lidar components were sent by NASA Langley Research Center (LaRC) as a part of the MISSE 7 mission. The MISSE 7 module was transported to the international space station (ISS) via STS 129 mission that was launched on Nov 16, 2009. Later, the MISSE 7 module was brought back to the earth via the STS 134 that landed on June 1, 2011. The MISSE 7 module that was subjected to exposure in a space environment for more than one and a half years included fiber laser, solid-state laser gain materials, detectors, and semiconductor laser diode. Performance testing of these components is now progressing. In this paper, the results of performance testing of a laser diode module sent by NASA Langley Research Center on MISSE 7 mission will be discussed. This paper will present the comparison of pre-flight and post-flight performance of two different COTS acousto-optic modulator (AOM) devices. Post-flight measurements indicate that these two devices did not undergo any significant performance degradation.

Post-flight test results of acousto-optic modulator devices subjected to space exposure

NASA Astrophysics Data System (ADS)

Prasad, Narasimha S.; Trivedi, Sudhir; Rosemeier, Jolanta; Diestler, Mark

2014-09-01

The objective of the Materials International Space Station Experiment (MISSE) is to study the performance of novel materials when subjected to the synergistic effects of the harsh space environment for several months. MISSE missions provide an opportunity for developing space qualifiable materials. Several laser and lidar components were sent by NASA Langley Research Center (LaRC) as a part of the MISSE 7 mission. The MISSE 7 module was transported to the international space station (ISS) via STS 129 mission that was launched on Nov 16, 2009. Later, the MISSE 7 modulewas brought back to the earth via the STS 134 that landed on June 1, 2011. The MISSE 7 module that was subjected to exposure in space environment for more than one and a half year included fiber laser, solid-state laser gain materials, detectors, and semiconductor laser diode. Performance testing of these components is now progressing. In this paper, the results of performance testing of a laser diode module sent by NASA Langley Research Center on MISSE 7 mission will be discussed. This paper will present the comparison of pre-flight and post-flight performance of two different COTS acousto-optic modulator devices. Post-flight measurements indicate that these two devices did not undergo any significant performance degradation.

Missing data within a quantitative research study: How to assess it, treat it, and why you should care.

PubMed

Bannon, William

2015-04-01

Missing data typically refer to the absence of one or more values within a study variable(s) contained in a dataset. The development is often the result of a study participant choosing not to provide a response to a survey item. In general, a greater number of missing values within a dataset reflects a greater challenge to the data analyst. However, if researchers are armed with just a few basic tools, they can quite effectively diagnose how serious the issue of missing data is within a dataset, as well as prescribe the most appropriate solution. Specifically, the keys to effectively assessing and treating missing data values within a dataset involve specifying how missing data will be defined in a study, assessing the amount of missing data, identifying the pattern of the missing data, and selecting the best way to treat the missing data values. I will touch on each of these processes and provide a brief illustration of how the validity of study findings are at great risk if missing data values are not treated effectively. ©2015 American Association of Nurse Practitioners.

Uptake of a Dashboard Designed to Give Realtime Feedback to a Sentinel Network About Key Data Required for Influenza Vaccine Effectiveness Studies.

PubMed

Pathirannehelage, Sameera; Kumarapeli, Pushpa; Byford, Rachel; Yonova, Ivelina; Ferreira, Filipa; de Lusignan, Simon

2018-01-01

Dashboards are technologies that bringing together a range of data sources for observational or analytical purposes. We have created a customised dashboard that includes all the key data elements required for monitoring flu vaccine effectiveness (FVE). This delivers a unique dashboard for each primary care provider (general practice) providing data to the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), one of the oldest European surveillance systems. These FVE studies use a test negative case control (TNCC) design. TNCC requires knowledge of practice denominator; vaccine exposure, and results of influenza virology swabs carried out to identify in an influenza-like-illness (ILI), a clinical diagnosis, really is influenza. The dashboard displays the denominator uploaded each week into the surveillance system, compared with the nationally known practice size (providing face-validity for the denominator); it identifies those exposed to the vaccine (by age group and risk category) and virology specimens taken and missed opportunities for surveillance (again by category). All sentinel practices can access in near real time (4 working days in areas) their rates of vaccine exposure and swabs conducted. Initial feedback is positive; 80% (32/40) practices responded positively.

Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.

PubMed

Goyder, Clare R; Jones, Caroline H D; Heneghan, Carl J; Thompson, Matthew J

2015-12-01

Because of the difficulties inherent in diagnosis in primary care, it is inevitable that diagnostic errors will occur. However, despite the important consequences associated with diagnostic errors and their estimated high prevalence, teaching and research on diagnostic error is a neglected area. To ascertain the key learning points from GPs' experiences of diagnostic errors and approaches to clinical decision making associated with these. Secondary analysis of 36 qualitative interviews with GPs in Oxfordshire, UK. Two datasets of semi-structured interviews were combined. Questions focused on GPs' experiences of diagnosis and diagnostic errors (or near misses) in routine primary care and out of hours. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. Learning points include GPs' reliance on 'pattern recognition' and the failure of this strategy to identify atypical presentations; the importance of considering all potentially serious conditions using a 'restricted rule out' approach; and identifying and acting on a sense of unease. Strategies to help manage uncertainty in primary care were also discussed. Learning from previous examples of diagnostic errors is essential if these events are to be reduced in the future and this should be incorporated into GP training. At a practice level, learning points from experiences of diagnostic errors should be discussed more frequently; and more should be done to integrate these lessons nationally to understand and characterise diagnostic errors. © British Journal of General Practice 2015.

Computerized crash reports usability and design investigation : final report.

DOT National Transportation Integrated Search

2016-06-01

Electronic crash reports are advantageous because they can limit missing data, transcription errors, and the space : limitations of a single sheet of paper. Advancing electronic reports through user-centered design affords an : opportunity to improve...

Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome

MedlinePlus

... estimated 21,732 infants were born with NAS —equivalent to one baby suffering from opiate withdrawal born ... for back pain shows missed opportunities to prescribe non-opioid medications ( June 2018 ) Methadone and buprenorphine reduce ...

Ecosystem Function: Cyanobacteria Solutions, A Missed Opportunity?

EPA Science Inventory

Stream and wetland riparian functions integrate the relationships between species, their habitats and fostering ecosystem resilience, which is critical to resilience – i.e., ensuring long-term sustainability. These relationships are dependent on the drivers of ecological functio...

A simple provider-based educational intervention to boost infant immunization rates: a controlled trial.

PubMed

Stille, C J; Christison-Lagay, J; Bernstein, B A; Dworkin, P H

2001-07-01

We sought to determine if a simple educational intervention initiated at the first well-child care visit, with reinforcement at subsequent visits, can improve inner-city infant immunization rates. We conducted a controlled trial involving 315 newborn infants and their primary caregivers in 3 inner-city primary care centers. Child health care providers gave caregivers in the intervention group an interactive graphic card with verbal reinforcement. At later visits, stickers were applied to the card when immunizations were given. Routine information was given to controls. After the trial, age-appropriate immunization rates at 7 months were 58% in each group. Intervention infants had 50% fewer missed opportunities to immunize (p=0.01) but cancelled 77% more appointments (p=0.04) than controls. We conclude that a brief educational intervention at the first well-child care visit did not boost 7-month immunization rates, although it was associated with fewer missed opportunities to immunize.

Completing the circle: follow-up screening of STD patients in three clinics of the United States Indian Health Service.

PubMed

Reilley, B; Redd, J T; Giberson, S; Sunde, S; Cullen, T

2011-01-01

We reviewed charts of newly diagnosed STD patients in three health facilities to determine the proportion who received follow-up STD screening. In a 12-month period, the three facilities had 140 STD cases. STD screening was not indicated for 50 (36%) patients. Among the 90 remaining STD patients, 29 (32%) were screened and 61 (68%) not screened. Among non-screened patients, 36% (22/61) were tested, but outside the time parameters allowed by the audit. The remaining 64% (39/61) received no screening at all, and represented clinical missed opportunities; in this group, nearly all (95%) had chlamydia but were not screened for HIV or syphilis. Linking chlamydia patients with a screen for HIV and syphilis using a clinical reminder in the facilities' electronic health record (EHR) or other tool, would eliminate 95% of the missed opportunities in this sample.

Equity and health services.

PubMed

Bayoumi, Ahmed M

2009-07-01

The Commission on Social Determinants of Health recognized the important role of health services as a determinant of health. While asserting that health was not a tradable commodity but rather a right, the Commission missed an opportunity to address how such a concept might remove a health care system from market forces. Examples include ensuring universal access to health care, not just universal insurance, severely limiting or eliminating profit-making in the delivery of health care services, and aggressive price regulations for the public good. While the Commission was appropriately sceptical of privileging efficiency as a principle for prioritization, it missed an opportunity to address how equity concerns can be incorporated into resources allocation decision making. A social justice orientation to the delivery of health care could serve as an important catalyst for equity-oriented health service change but the process is more complicated and political than that outlined in the Commission's report.

Predictors of missed appointments in patients referred for congenital or pediatric cardiac magnetic resonance.

PubMed

Lu, Jimmy C; Lowery, Ray; Yu, Sunkyung; Ghadimi Mahani, Maryam; Agarwal, Prachi P; Dorfman, Adam L

2017-07-01

Congenital cardiac magnetic resonance is a limited resource because of scanner and physician availability. Missed appointments decrease scheduling efficiency, have financial implications and represent missed care opportunities. To characterize the rate of missed appointments and identify modifiable predictors. This single-center retrospective study included all patients with outpatient congenital or pediatric cardiac MR appointments from Jan. 1, 2014, through Dec. 31, 2015. We identified missed appointments (no-shows or same-day cancellations) from the electronic medical record. We obtained demographic and clinical factors from the medical record and assessed socioeconomic factors by U.S. Census block data by patient ZIP code. Statistically significant variables (P<0.05) were included into a multivariable analysis. Of 795 outpatients (median age 18.5 years, interquartile range 13.4-27.1 years) referred for congenital cardiac MR, a total of 91 patients (11.4%) missed appointments; 28 (3.5%) missed multiple appointments. Reason for missed appointment could be identified in only 38 patients (42%), but of these, 28 (74%) were preventable or could have been identified prior to the appointment. In multivariable analysis, independent predictors of missed appointments were referral by a non-cardiologist (adjusted odds ratio [AOR] 5.8, P=0.0002), referral for research (AOR 3.6, P=0.01), having public insurance (AOR 2.1, P=0.004), and having scheduled cardiac MR from November to April (AOR 1.8, P=0.01). Demographic factors can identify patients at higher risk for missing appointments. These data may inform initiatives to limit missed appointments, such as targeted education of referring providers and patients. Further data are needed to evaluate the efficacy of potential interventions.

Identification and Validation of Human Missing Proteins and Peptides in Public Proteome Databases: Data Mining Strategy.

PubMed

Elguoshy, Amr; Hirao, Yoshitoshi; Xu, Bo; Saito, Suguru; Quadery, Ali F; Yamamoto, Keiko; Mitsui, Toshiaki; Yamamoto, Tadashi

2017-12-01

In an attempt to complete human proteome project (HPP), Chromosome-Centric Human Proteome Project (C-HPP) launched the journey of missing protein (MP) investigation in 2012. However, 2579 and 572 protein entries in the neXtProt (2017-1) are still considered as missing and uncertain proteins, respectively. Thus, in this study, we proposed a pipeline to analyze, identify, and validate human missing and uncertain proteins in open-access transcriptomics and proteomics databases. Analysis of RNA expression pattern for missing proteins in Human protein Atlas showed that 28% of them, such as Olfactory receptor 1I1 ( O60431 ), had no RNA expression, suggesting the necessity to consider uncommon tissues for transcriptomic and proteomic studies. Interestingly, 21% had elevated expression level in a particular tissue (tissue-enriched proteins), indicating the importance of targeting such proteins in their elevated tissues. Additionally, the analysis of RNA expression level for missing proteins showed that 95% had no or low expression level (0-10 transcripts per million), indicating that low abundance is one of the major obstacles facing the detection of missing proteins. Moreover, missing proteins are predicted to generate fewer predicted unique tryptic peptides than the identified proteins. Searching for these predicted unique tryptic peptides that correspond to missing and uncertain proteins in the experimental peptide list of open-access MS-based databases (PA, GPM) resulted in the detection of 402 missing and 19 uncertain proteins with at least two unique peptides (≥9 aa) at <(5 × 10 -4 )% FDR. Finally, matching the native spectra for the experimentally detected peptides with their SRMAtlas synthetic counterparts at three transition sources (QQQ, QTOF, QTRAP) gave us an opportunity to validate 41 missing proteins by ≥2 proteotypic peptides.

Does emergency presentation of cancer represent poor performance in primary care? Insights from a novel analysis of linked primary and secondary care data

PubMed Central

Murchie, Peter; Smith, Sarah M; Yule, Michael S; Adam, Rosalind; Turner, Melanie E; Lee, Amanda J; Fielding, Shona

2017-01-01

Background: People diagnosed with cancer following emergency presentation have poorer short-term survival. To what extent this signifies a missed opportunity for earlier diagnosis in primary care remains unclear as little detailed data exist on the patient/general practitioner interaction beforehand. Methods: Analysis of primary care and regional data for 1802 cancer patients from Northeast Scotland. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) for patient and GP practice predictors of emergency presentation. Qualitative context coding of primary care interaction before emergency presentation. Results: Emergency presentations equalled 20% (n=365). Twenty-eight per cent had no relevant prior GP contact. Of those with prior GP contact 30% were admitted while waiting to be seen in secondary care, and 19% were missed opportunities for earlier diagnosis. Associated predictors: no prior GP contact (OR=3.89; CI 95% 2.14–7.09); having lung (OR=23.24; 95% CI 7.92–68.21), colorectal (OR=18.49; CI 95% 6.60–51.82) and upper GI cancer (OR=18.97; CI 95% 6.08–59.23); ethnicity (OR=2.78; CI 95% 1.27–6.06). Conclusions: Our novel approach has revealed that emergency cancer presentation is more complex than previously thought. Patient delay, prolonged referral pathways and missed opportunities by GPs all contribute, but emergency presentation can also represent effective care. Resources should be used proportionately to raise public and GP awareness and improve post-referral pathways. PMID:28334728

Toward a method of collaborative, evidence-based response to desertification

USDA-ARS?s Scientific Manuscript database

Overgeneralized narratives about how desertified ecosystems will respond to restoration actions may result in wasted resources, missed opportunities, or accelerated degradation. Evidence-based collaborative adaptive management (CAM) could solve this problem by providing site-specific information tha...

Reflections on the Invisible: The Missing Social Context in Therapy.

ERIC Educational Resources Information Center

Hare-Mustin, Rachel T.

Constructivist approaches to therapy that view the therapist and patient as equal participants in co-creating a new dialogue render aspects of experience invisible. What is missing is an awareness of the dominant structures in society and the dominant ways of thinking and speaking. Three key factors need to be understood: first, the way meanings…

A conceptual and statistical framework for adaptive radiations with a key role for diversity dependence.

PubMed

Etienne, Rampal S; Haegeman, Bart

2012-10-01

In this article we propose a new framework for studying adaptive radiations in the context of diversity-dependent diversification. Diversity dependence causes diversification to decelerate at the end of an adaptive radiation but also plays a key role in the initial pulse of diversification. In particular, key innovations (which in our definition include novel traits as well as new environments) may cause decoupling of the diversity-dependent dynamics of the innovative clade from the diversity-dependent dynamics of its ancestral clade. We present a likelihood-based inference method to test for decoupling of diversity dependence using molecular phylogenies. The method, which can handle incomplete phylogenies, identifies when the decoupling took place and which diversification parameters are affected. We illustrate our approach by applying it to the molecular phylogeny of the North American clade of the legume tribe Psoraleeae (47 extant species, of which 4 are missing). Two diversification rate shifts were previously identified for this clade; our analysis shows that the first, positive shift can be associated with decoupling of two Pediomelum subgenera from the other Psoraleeae lineages, while we argue that the second, negative shift can be attributed to speciation being protracted. The latter explanation yields nonzero extinction rates, in contrast to previous findings. Our framework offers a new perspective on macroevolution: new environments and novel traits (ecological opportunity) and diversity dependence (ecological limits) cannot be considered separately.

Implementation of repeat HIV testing during pregnancy in southwestern Kenya: progress and missed opportunities.

PubMed

Rogers, Anna J; Akama, Eliud; Weke, Elly; Blackburn, Justin; Owino, George; Bukusi, Elizabeth A; Oyaro, Patrick; Kwena, Zachary A; Cohen, Craig R; Turan, Janet M

2017-12-01

Repeat HIV testing during the late antenatal period is crucial to identify and initiate treatment for pregnant women with incident HIV infection to prevent perinatal HIV transmission and keep mothers alive. In 2012, the Kenya Ministry of Health adopted international guidelines suggesting that pregnant women be offered retesting three months after an initial negative HIV test. Our objectives were to determine the current rate of antenatal repeat HIV testing; identify successes, missed opportunities and factors associated with retesting; and estimate the incidence of HIV during pregnancy. Retrospective analysis of longitudinal data was conducted for a cohort of 2145 women attending antenatal care clinic at a large district hospital in southwestern Kenya. Data were abstracted from registers for all women who attended the clinic from the years 2011 to 2014. Although 90.2% of women first came to clinic prior to their third trimester and 27.5% had at least four clinic visits, 58.0% of all women went to delivery without a retest. Missed opportunities for retesting included not returning to clinic at all, not returning when eligible, or late gestational age (>28 weeks) at first clinic visit making them ineligible for retesting (accounting for 14.2%, 26.8% and 9.6% of all clinic attendees respectively); and failure to be retested even when eligible at one or more visits (accounting for 73.2% of eligible returnees). Being unmarried and aged 20 or younger was associated with an increase in mean gestational age of first visit by 2.52 weeks (95% CI: 1.56, 3.48) and a 2.59 increased odds (95% CI: 1.90, 3.54) of failing to return to clinic, compared to those who were married and over 20 years of age. On retest, two women tested HIV positive, suggesting an incidence rate of 4.4 per 100 person-years. After adjusting for potential confounders, only later year of last menstrual period (2013 vs. 2012 and 2011) was associated with retesting. Adoption of retesting guidelines in 2012 appears to have successfully increased retesting rates, but missed opportunities to identify incident HIV infection during pregnancy may contribute to continuing high rates of perinatal HIV transmission in southwestern Kenya. © 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Osteoarthritis Management: Time to Change the Deck.

PubMed

Hunter, David J

2017-06-01

This Viewpoint highlights the shortcomings of existing osteoarthritis (OA) clinical practices and emphasizes the opportunity that can come about by virtue of adherence to appropriate management. In an effort to emphasize optimism, there are huge missed opportunities with existing efficacious treatments and tremendous developments that are currently going on that will positively influence future care. How we respond to that opportunity will not only impact the individuals disabled by the disease but also make a massive difference to our society through reducing underemployment and health care waste. J Orthop Sports Phys Ther 2017;47(6):370-372. doi:10.2519/jospt.2017.0605.

The missing links between planning and budgeting. Keys to survival in an era of entrepreneurialism.

PubMed

Rice, J A; Garside, P M

1984-03-01

For hospitals to survive the challenges of their turbulent environment, they must build stronger links between their planning and budgeting processes. Hospitals have traditionally experienced a gap between their long-range plans and short-range budgets. This article examines the scope, nature, and causes of this gap; clarifies the need to bridge this gap; and then discusses three major initiatives (missing links) to bridge the gap. Implications of these missing links for the hospital's board, physicians, managers, and systems are also described.

Case management: key to access, quality, and financial success.

PubMed

Smith, Alison P

2003-01-01

Several strategic, organizational, and operational variables drive successful case management programs. Organizational goals and accountability for support by administrative and medical staff leaders set the stage for a comprehensive program. The integration of utilization review, discharge planning, and other functions into the role of the case manager improves productivity and continuity. Choosing a model for assigning patients, a variable unique to the institution, should be carefully considered. Regardless of the power of strategic goals or the creative selection of a model, daily practices that promote daily review and communication will reveal all of the opportunities for improved performance. Complications are avoided one patient at a time and patients deserve vigilance. Length of stay is shortened 1 day at a time and we can no longer afford to miss these opportunities. In the period of high census, an unnecessary day for one patient at the end of his/her stay may mean another patient being diverted to another hospital away from his/her physician and past medical records. Creating constructive physician partnerships and cooperative relationships with postacute care providers can bring a case management program to higher level of performance. While many organizations have employees called "case managers," fewer have a comprehensive approach that has the potential to drive so many important indicators of performance.

Using global health initiatives to strengthen health systems: a civil society perspective.

PubMed

Cohn, Jennifer; Russell, Asia; Baker, Brook; Kayongo, Alice; Wanjiku, Esther; Davis, Paul

2011-01-01

Research into the effects of global health initiatives (GHIs) on health systems has largely left out the viewpoints and contributions of civil society. This study details civil society's perspective regarding the effects of two GHIs, the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), on country health systems and the added value of civil society interacting with GHIs to strengthen health systems. The study employed qualitative data collection methods using semi-structured interviews administered during focus groups and key informant interviews. A range of health system stakeholders were interviewed in Kenya, Malawi, Uganda and Zambia. Data were coded and analysed for themes and sub-themes. In total, 2910 civil society participants provided information individually or in focus groups. Respondents reported that GHIs have contributed to dramatic health benefits within and outside of a disease-specific focus, including health systems strengthening efforts. However, opportunities for synergy between GHIs and health systems have been missed, and GHIs have not worked sufficiently to close capacity gaps of grassroots civil society organisations. Despite some governance innovations, civil society's opportunities to participate meaningfully in GHI priority setting efforts are limited. Recommendations are included on how to best use GHIs to strengthen health systems by partnering with civil society.

Potentially Missed Diagnosis of Ischemic Stroke in the Emergency Department in the Greater Cincinnati/Northern Kentucky Stroke Study.

PubMed

Madsen, Tracy E; Khoury, Jane; Cadena, Rhonda; Adeoye, Opeolu; Alwell, Kathleen A; Moomaw, Charles J; McDonough, Erin; Flaherty, Matthew L; Ferioli, Simona; Woo, Daniel; Khatri, Pooja; Broderick, Joseph P; Kissela, Brett M; Kleindorfer, Dawn

2016-10-01

Missed diagnoses of acute ischemic stroke (AIS) in the ED may result in lost opportunities to treat AIS. Our objectives were to describe the rate and clinical characteristics of missed AIS in the ED, to determine clinical predictors of missed AIS, and to report tissue plasminogen (tPA) eligibility among those with missed strokes. Among a population of 1.3 million in a five-county region of southwest Ohio and northern Kentucky, cases of AIS that presented to 16 EDs during 2010 were identified using ICD-9 codes followed by physician verification of cases. Missed ED diagnoses were physician-verified strokes that did not receive a diagnosis indicative of stroke in the ED. Bivariate analyses were used to compare clinical characteristics between patients with and without an ED diagnosis of AIS. Logistic regression was used to evaluate predictors of missed AIS diagnoses. Alternative diagnoses given to those with missed AIS were codified. Eligibility for tPA was reported between those with and without a missed stroke diagnosis. Of 2,027 AIS cases, 14.0% (n = 283) were missed in the ED. Race, sex, and stroke subtypes were similar between those with missed AIS diagnoses and those identified in the ED. Hospital length of stay was longer in those with a missed diagnosis (5 days vs. 3 days, p < 0.0001). Younger age (adjusted odds ratio [aOR] = 0.94, 95% confidence interval [CI] = 0.89 to 0.98) and decreased level of consciousness (LOC) (aOR = 3.58, 95% CI = 2.63 to 4.87) were associated with higher odds of missed AIS. Altered mental status was the most common diagnosis among those with missed AIS. Only 1.1% of those with a missed stroke diagnosis were eligible for tPA. In a large population-based sample of AIS cases, one in seven cases were not diagnosed as AIS in the ED, but the impact on acute treatment rates is likely small. Missed diagnosis was more common among those with decreased LOC, suggesting the need for improved diagnostic approaches in these patients. © 2016 by the Society for Academic Emergency Medicine.

Consequences of Missed Opportunities for HIV Testing during Pregnancy and Delayed Diagnosis for Mexican Women, Children and Male Partners

PubMed Central

Kendall, Tamil

2014-01-01

Introduction HIV testing during pregnancy permits prevention of vertical (mother-to-child) transmission and provides an opportunity for women living with HIV to access treatment for their own health. In 2001, Mexico’s National HIV Action Plan committed to universal offer of HIV testing to pregnant women, but in 2011, only 45.6% of women who attended antenatal care (ANC) were tested for HIV. The study objective was to document the consequences of missed opportunities for HIV testing and counseling during pregnancy and late HIV diagnosis for Mexican women living with HIV and their families. Methods Semi-structured-interviews with 55 women living with HIV who had had a pregnancy since 2001 were completed between 2009 and 2011. Interviews were analyzed thematically using a priori and inductive codes. Results Consistent with national statistics, less than half of the women living with HIV (42%) were offered HIV testing and counseling during ANC. When not diagnosed during ANC, women had multiple contacts with the health-care system due to their own and other family members’ AIDS-related complications before being diagnosed. Missed opportunities for HIV testing and counseling during antenatal care and health-care providers failure to recognize AIDS-related complications resulted in pediatric HIV infections, AIDS-related deaths of children and male partners, and HIV disease progression among women and other family members. In contrast, HIV diagnosis permitted timely access to interventions to prevent vertical HIV transmission and long-term care and treatment for women living with HIV. Conclusions Omissions of the offer of HIV testing and counseling in ANC and health-care providers’ failure to recognize AIDS-related complications had negative health, economic and emotional consequences. Scaling-up provider-initiated HIV testing and counseling within and beyond antenatal care and pre-service and in-service trainings on HIV and AIDS for health-care providers can hasten timely HIV diagnosis and contribute to improved individual and public health in Mexico. PMID:25372464

Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics.

PubMed

Moy, Ernest; Barrett, Marguerite; Coffey, Rosanna; Hines, Anika L; Newman-Toker, David E

2015-02-01

An estimated 1.2 million people in the US have an acute myocardial infarction (AMI) each year. An estimated 7% of AMI hospitalizations result in death. Most patients experiencing acute coronary symptoms, such as unstable angina, visit an emergency department (ED). Some patients hospitalized with AMI after a treat-and-release ED visit likely represent missed opportunities for correct diagnosis and treatment. The purpose of the present study is to estimate the frequency of missed AMI or its precursors in the ED by examining use of EDs prior to hospitalization for AMI. We estimated the rate of probable missed diagnoses in EDs in the week before hospitalization for AMI and examined associated factors. We used Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases for 2007 to evaluate missed diagnoses in 111,973 admitted patients aged 18 years and older. We identified missed diagnoses in the ED for 993 of 112,000 patients (0.9% of all AMI admissions). These patients had visited an ED with chest pain or cardiac conditions, were released, and were subsequently admitted for AMI within 7 days. Higher odds of having missed diagnoses were associated with being younger and of Black race. Hospital teaching status, availability of cardiac catheterization, high ED admission rates, high inpatient occupancy rates, and urban location were associated with lower odds of missed diagnoses. Administrative data provide robust information that may help EDs identify populations at risk of experiencing a missed diagnosis, address disparities, and reduce diagnostic errors.

Are we missing an opportunity to teach future physicians about female pelvic floor disorders?

PubMed

Mueller, Elizabeth R; Kenton, Kimberly; Rogers, Rebecca G; Fenner, Dee E

2009-12-01

Many physicians in primary care and medical/surgical specialties will care for female patients with pelvic floor disorders (PFD). A survey was mailed to 266 United States and Canadian clerkship directors that queried how medical students were being educated in PFD. Forty-four percent of clerkship directors responded. The mean clerkship size was 105 medical students. Over 97% of third year medical students received lectures on hypertension in pregnancy, normal labor, and abnormal uterine bleeding and at least 90% received lectures on obstetric hemorrhage, placenta previa, and menstruation. Forty percent to 85% of medical students received lectures in PFD depending on the topic. Eighty percent of medical students had no exposure to PFD during their first 2 years of medical school. During their third year, 95% of the students were exposed to PFD topics but only 60% had an opportunity to spend at least a day in an urogynecology practice. Clerkship directors indicate that PFD are relevant to medical student training, however, they have limited time in the clerkship to cover all of the required topics. We are missing an important opportunity to educate future clinicians about PFD, which dramatically impact women's quality of life.

Post-Flight Test Results of Seed Laser Module Subjected to Space Exposure. Paper No. 8876-9

NASA Technical Reports Server (NTRS)

Prasad, Narasimha S.

2013-01-01

The objective of the Materials International Space Station Experiment (MISSE) is to study the performance of novel materials when subjected to the synergistic effects of the harsh space environment for several months. MISSE missions provide an opportunity for developing space qualifiable materials. Several laser and lidar components were sent by NASA Langley Research Center (LaRC) as a part of the MISSE 7 mission. The MISSE 7 module was transported to the international space station (ISS) via STS 129 mission that was launched on Nov 16, 2009. Later, the MISSE 7 module was brought back to the earth via the STS 134 that landed on June 1, 2011. The MISSE 7 module that was subjected to exposure in space environment for more than one and a half year included fiber laser, solid-state laser gain materials, detectors, and semiconductor laser diode. Performance testing of these components is now progressing. In this paper, the results of performance testing of a laser diode module sent by NASA Langley Research Center on MISSE 7 mission will be discussed. This paper will present the comparison of pre-flight and post-flight performance curves and discuss the effect of space exposure on the laser diode module. Preliminary findings on output power measurements show that the COTS laser diode characteristics did not undergo any significant performance degradation.

Extragenital Chlamydia and Gonorrhea in Young Black Men Who Have Sex With Men: Missed Treatment Opportunities for Human Immunodeficiency Virus-Infected Men Who Have Sex With Men?

PubMed

Mena, Leandro; Crosby, Richard A; Chamberlain, Nicholas

2018-05-01

This study of young black men who have sex with men (YBMSM) assessed the prevalence of extragenital chlamydia and gonorrhea among those testing negative for urethral infections, and compared prevalence of both by human immunodeficiency virus (HIV) status. A convenience sample of 609 YBMSM was recruited for a cross-sectional study from 2 sexual health clinics located in Jackson, MS. To detect Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), nucleic acid amplification testing was performed on urine, rectal swabs, and oral swabs. OraSure was used to detect HIV. Seventy-three percent of all chlamydia infections and 77% of gonorrhea infections were found from anal and oral swabs in the absence of urethral positivity. Compared with HIV-uninfected men, HIV-infected men were significantly more likely to have pharyngeal chlamydia (P = 0.03), multiple CT infections (P = 0.02), rectal NG (P < 0.001), multiple NG infections (P = 0.04), both CT/NG rectal infections (P = 0.001). As much as three quarters of all chlamydia and gonorrhea infections may be missed when only urine-based nucleic acid amplification testing is used to screen YBMSM for bacterial sexually transmitted infections. These missed opportunities for diagnosis may be particularly likely among HIV-infected YBMSM.

Missing: Prototype Vocational Guidance System.

ERIC Educational Resources Information Center

Weltin, Mary M.; Johnson, Richard M.

1985-01-01

Describes Army research in recruitment and vocational counseling. Discusses the Joint Optical Information Network, which offers career opportunity information, and the Army Research Institute's investigations of vocational counseling for high school and community college students and its prototype vocational guidance system. Encourages community…

Understanding repeated non-attendance in health services: a pilot analysis of administrative data and full study protocol for a national retrospective cohort.

PubMed

Williamson, Andrea E; Ellis, David A; Wilson, Philip; McQueenie, Ross; McConnachie, Alex

2017-02-14

Understanding the causes of low engagement in healthcare is a pre-requisite for improving health services' contribution to tackling health inequalities. Low engagement includes missing healthcare appointments. Serially (having a pattern of) missing general practice (GP) appointments may provide a risk marker for vulnerability and poorer health outcomes. A proof of concept pilot using GP appointment data and a focus group with GPs informed the development of missed appointment categories: patients can be classified based on the number of appointments missed each year. The full study, using a retrospective cohort design, will link routine health service and education data to determine the relationship between GP appointment attendance, health outcomes, healthcare usage, preventive health activity and social circumstances taking a life course approach and using data from the whole journey in the National Health Service (NHS) healthcare. 172 practices will be recruited (∼900 000 patients) across Scotland. The statistical analysis will focus on 2 key areas: factors that predict patients who serially miss appointments, and serial missed appointments as a predictor of future patient outcomes. Regression models will help understand how missed appointment patterns are associated with patient and practice characteristics. We shall identify key factors associated with serial missed appointments and potential interactions that might predict them. The results of the project will inform debates concerning how best to reduce non-attendance and increase patient engagement within healthcare systems. Significant non-academic beneficiaries include governments, policymakers and medical practitioners. Results will be disseminated via a combination of academic outputs (papers, conferences), social media and through collaborative public health/policy fora. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Preschool Attendance: How Researchers and Practitioners Are Working Together to Understand and Address Absenteeism among Our Youngest Students

ERIC Educational Resources Information Center

Ehrlich, Stacy B.; Gwynne, Julia; Allensworth, Elaine M.; Fatani, Serah

2016-01-01

Consistent school attendance is a key foundation of student learning. While missing one or two school days each year is not likely to have serious consequences, chronic absenteeism (missing 10% or more of enrolled school days) can seriously undermine the learning process (Allensworth & Easton, 2007). Given national efforts to increase the…

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

PubMed

Mata, Jutta; Dallacker, Mattea; Hertwig, Ralph

2017-01-01

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

When and how should multiple imputation be used for handling missing data in randomised clinical trials - a practical guide with flowcharts.

PubMed

Jakobsen, Janus Christian; Gluud, Christian; Wetterslev, Jørn; Winkel, Per

2017-12-06

Missing data may seriously compromise inferences from randomised clinical trials, especially if missing data are not handled appropriately. The potential bias due to missing data depends on the mechanism causing the data to be missing, and the analytical methods applied to amend the missingness. Therefore, the analysis of trial data with missing values requires careful planning and attention. The authors had several meetings and discussions considering optimal ways of handling missing data to minimise the bias potential. We also searched PubMed (key words: missing data; randomi*; statistical analysis) and reference lists of known studies for papers (theoretical papers; empirical studies; simulation studies; etc.) on how to deal with missing data when analysing randomised clinical trials. Handling missing data is an important, yet difficult and complex task when analysing results of randomised clinical trials. We consider how to optimise the handling of missing data during the planning stage of a randomised clinical trial and recommend analytical approaches which may prevent bias caused by unavoidable missing data. We consider the strengths and limitations of using of best-worst and worst-best sensitivity analyses, multiple imputation, and full information maximum likelihood. We also present practical flowcharts on how to deal with missing data and an overview of the steps that always need to be considered during the analysis stage of a trial. We present a practical guide and flowcharts describing when and how multiple imputation should be used to handle missing data in randomised clinical.

Mixing Decks: Frameworks for Master's Scholarship

ERIC Educational Resources Information Center

Bamber, Veronica

2015-01-01

Postgraduate taught education in universities is under-researched compared to research on undergraduate learning and teaching. This results in two missed opportunities: making evidence-informed improvements to postgraduate taught education and integrating such improvements into thinking and practice. A commitment to evidence-informed improvement…

Barriers to Vaccinating Preschool Children.

ERIC Educational Resources Information Center

Orenstein, Walter A.; And Others

1990-01-01

Despite the effectiveness of vaccinations in preventing disease, preschool children, particularly in the inner cities, are not being adequately immunized. Inadequate clinic staff and hours, inconvenient locations, prohibitive policies, and missed opportunities within the health care system may contribute to this problem. Suggests policy changes…

Being a Professional or Practising Professionally

ERIC Educational Resources Information Center

Dyer, Mary A.

2018-01-01

Research (Lloyd, E., and E. Hallet. [2010]. "Professionalising the Early Childhood Workforce in England: Work in Progress or Missed Opportunity?" "Contemporary Issues in Early Childhood" 11 (1): 75-788; Saks, M. [2012]. "Defining a Profession: The Role of Knowledge and Expertise." "Professions and…

The decline in vitamin research funding: a missed opportunity?

USDA-ARS?s Scientific Manuscript database

Background: The National Nutrition Research Roadmap has called for support of greater collaborative, interdisciplinary research for multiple areas of nutrition research. However, a substantial reduction in federal funding makes responding to these calls challenging. The objective of this study was t...

Safety, operational, and energy impacts of in-vehicle adaptive stop displays using connected vehicle technology.

DOT National Transportation Integrated Search

2015-07-01

Un-signalized intersections create multiple opportunities for missed or misunderstood information. : Stop sign-controlled intersections have also been shown to be a source of delay and emissions due : to their frequent, often inappropriate use. By us...

Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

PubMed Central

Stoll, Kathrin; MacDorman, Marian; Declercq, Eugene; Cramer, Renee; Cheyney, Melissa; Fisher, Timothy; Butt, Emma; Yang, Y. Tony; Powell Kennedy, Holly

2018-01-01

Poor coordination of care across providers and birth settings has been associated with adverse maternal-newborn outcomes. Research suggests that integration of midwives into regional health systems is a key determinant of optimal maternal-newborn outcomes, yet, to date, the characteristics of an integrated system have not been described, nor linked to health disparities. Methods Our multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and interprofessional collaboration. Items (110) detailed differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive authority; as well as restrictions that can affect patient safety, quality, and access to maternity providers across birth settings. A nationwide survey of state regulatory experts (n = 92) verified the ‘on the ground’ relevance, importance, and realities of local interpretation of these state laws. Using a modified Delphi process, we selected 50/110 key items to include in a weighted, composite Midwifery Integration Scoring (MISS) system. Higher scores indicate greater integration of midwives across all settings. We ranked states by MISS scores; and, using reliable indicators in the CDC-Vital Statistics Database, we calculated correlation coefficients between MISS scores and maternal-newborn outcomes by state, as well as state density of midwives and place of birth. We conducted hierarchical linear regression analysis to control for confounding effects of race. Results MISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state. Conclusion The MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes. PMID:29466389

Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

PubMed Central

Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

2002-01-01

BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children. PMID:12528583

Implementation Research to Address the United States Health Disadvantage: Report of a National Heart, Lung, and Blood Institute Workshop.

PubMed

Engelgau, Michael M; Narayan, K M Venkat; Ezzati, Majid; Salicrup, Luis A; Belis, Deshiree; Aron, Laudan Y; Beaglehole, Robert; Beaudet, Alain; Briss, Peter A; Chambers, David A; Devaux, Marion; Fiscella, Kevin; Gottlieb, Michael; Hakkinen, Unto; Henderson, Rain; Hennis, Anselm J; Hochman, Judith S; Jan, Stephen; Koroshetz, Walter J; Mackenbach, Johan P; Marmot, M G; Martikainen, Pekka; McClellan, Mark; Meyers, David; Parsons, Polly E; Rehnberg, Clas; Sanghavi, Darshak; Sidney, Stephen; Siega-Riz, Anna Maria; Straus, Sharon; Woolf, Steven H; Constant, Stephanie; Creazzo, Tony L; de Jesus, Janet M; Gavini, Nara; Lerner, Norma B; Mishoe, Helena O; Nelson, Cheryl; Peprah, Emmanuel; Punturieri, Antonello; Sampson, Uchechukwu; Tracy, Rachael L; Mensah, George A

2018-04-28

Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national and international health experts and stakeholders for a Think Tank meeting to explore the U.S. health disadvantage and to seek specific recommendations for implementation research opportunities for heart, lung, blood, and sleep disorders. Recommendations for National Heart, Lung, and Blood Institute consideration were made in several areas including understanding the drivers of the disadvantage, identifying potential solutions, creating strategic partnerships with common goals, and finally enhancing and fostering a research workforce for implementation research. Key recommendations included exploring why the United States is doing better for health indicators in a few areas compared with peer countries; targeting populations across the entire socioeconomic spectrum with interventions at all levels in order to prevent missing a substantial proportion of the disadvantage; assuring partnership have high-level goals that can create systemic change through collective impact; and finally, increasing opportunities for implementation research training to meet the current needs. Connecting with the research community at large and building on ongoing research efforts will be an important strategy. Broad partnerships and collaboration across the social, political, economic, and private sectors and all civil society will be critical-not only for implementation research but also for implementing the findings to have the desired population impact. Developing the relevant knowledge to tackle the U.S. health disadvantage is the necessary first step to improve U.S. health outcomes. Published by Elsevier B.V.

Using information technology to improve adult immunization delivery in an integrated urban health system.

PubMed

Swenson, Carolyn J; Appel, Alicia; Sheehan, Moira; Hammer, Anne; Fenner, Zita; Phibbs, Stephanie; Harbrecht, Marjie; Main, Deborah S

2012-01-01

Adult immunizations prevent morbidity and mortality yet coverage remains suboptimal, in part due to missed opportunities. Clinical decision support systems (CDSSs) can improve immunization rates when integrated into routine work flow, implemented wherever care is delivered, and used by staff who can act on the recommendation. An adult immunization improvement project was undertaken in a large integrated, safety-net health care system. A CDSS was developed to query patient records and identify patients eligible for pneumococcal, influenza, or tetanus immunization and then generate a statement that recommends immunization or indicates a previous refusal. A new agency policy authorized medical assistants and nurses in clinics, and nurses in the hospital, to use the CDSS as a standing order. Immunization delivery work flow was standardized, and staff received feedback on immunization rates. The CDSS identified more patients than a typical paper standing order and can be easily modified to incorporate changes in vaccine indications. The intervention led to a 10% improvement in immunization rates in adults 65 years of age or older and in younger adults with diabetes or chronic obstructive pulmonary disease. Overall, the improvements were sustained beyond the project period. The CDSS was expanded to encompass additional vaccines. Interdepartmental collaboration was critical to identify needs, challenges, and solutions. Implementing the standing order policy in clinics and the hospital usually allowed immunizations to be taken out of the hands of clinicians. As an on-demand tool, CDSS must be used at each patient encounter to avoid missed opportunities. Staff retraining accompanied by ongoing assessment of immunization rates, work flow, and missed opportunities to immunize patients are critical to sustain and enhance improvements.

Factors associated with late diagnosis of HIV infection and missed opportunities for earlier testing.

PubMed

Gullón, Alejandra; Verdejo, José; de Miguel, Rosa; Gómez, Ana; Sanz, Jesús

2016-10-01

Late diagnosis (LD) of human immunodeficiency virus (HIV) infection continues to be a significant problem that increases disease burden both for patients and for the public health system. Guidelines have been updated in order to facilitate earlier HIV diagnosis, introducing "indicator condition-guided HIV testing". In this study, we analysed the frequency of LD and associated risk factors. We retrospectively identified those cases that could be considered missed opportunities for an earlier diagnosis. All patients newly diagnosed with HIV infection who attended Hospital La Princesa, Madrid (Spain) between 2007 and 2014 were analysed. We collected epidemiological, clinical and immunological data. We also reviewed electronic medical records from the year before the HIV diagnosis to search for medical consultations due to clinical indicators. HIV infection was diagnosed in 354 patients. The median CD4 count at presentation was 352 cells/mm(3). Overall, 158 patients (50%) met the definition of LD, and 97 (30.7%) the diagnosis of advanced disease. LD was associated with older age and was more frequent amongst immigrants. Heterosexual relations and injection drug use were more likely to be the reasons for LD than relations between men who have sex with men. During the year preceding the diagnosis, 46.6% of the patients had sought medical advice owing to the presence of clinical indicators that should have led to HIV testing. Of those, 24 cases (14.5%) were classified as missed opportunities for earlier HIV diagnosis because testing was not performed. According to these results, all health workers should pursue early HIV diagnosis through the proper implementation of HIV testing guidelines. Such an approach would prove directly beneficial to the patient and indirectly beneficial to the general population through the reduction in the risk of transmission.

Missed opportunities for immunization.

PubMed

Verma, J; Sachar, R K; Prakash, V; Jain, G D; Sehgal, R

1990-01-01

A survey conducted in the outpatient departments of Dayanand Medical College and Hospital in Ludhiana, India, found that 13.4% of children aged 0-23 months and 33.0% of pregnant women were not being given due immunization. Maximum advantage, however, should be taken of every contact between health workers and clients to provide all available and required health interventions. 80% immunization coverage could be achieved if all children who are brought to clinics for whatever purpose were screened and immunized if necessary. Missed opportunities occur because immunization is not available on all days; there is no uniform contraindication policy; doctors schedule as they please, with only one or two vaccines given to children who are eligible for more; there is an unwillingness to combine vaccines; weak excuses prevent the administration of vaccines; due antigens are not given on discharge from hospitals following recovery; pregnancy of less than 16 weeks is supposed to be a contraindication to tetanus toxoid; there is vaccinator reluctance to open multi-dose BCG/measles vaccine vials for a small number of children for fear of wasting the vaccine; and vaccines may be out of stock. The following suggestions may help minimize missed opportunities for immunization: review of the immunization schedule to provide optimal protection at the earliest age, review of the policy on contraindications to avoid false contraindications, ensuring that all women and children receive all vaccines for which they are eligible, issuing immunization cards to all women and children and checking them on all subsequent visits, making vaccines available in all clinics, educating health care personnel on these issues, packing vaccines in smaller quantities to avoid wastage, and exploiting all contacts with the people to provide maximum health care interventions.

Remaining missed opportunities of child survival in Peru: modelling mortality impact of universal and equitable coverage of proven interventions.

PubMed

Tam, Yvonne; Huicho, Luis; Huayanay-Espinoza, Carlos A; Restrepo-Méndez, María Clara

2016-10-04

Peru has made great improvements in reducing stunting and child mortality in the past decade, and has reached the Millennium Development Goals 1 and 4. The remaining challenges or missed opportunities for child survival needs to be identified and quantified, in order to guide the next steps to further improve child survival in Peru. We used the Lives Saved Tool (LiST) to project the mortality impact of proven interventions reaching every women and child in need, and the mortality impact of eliminating inequalities in coverage distribution between wealth quintiles and urban-rural residence. Our analyses quantified the remaining missed opportunities in Peru, where prioritizing scale-up of facility-based case management for all small and sick babies will be most effective in mortality reduction, compared to other evidenced-based interventions that prevent maternal and child deaths. Eliminating coverage disparities between the poorest quintiles and the richest will reduce under-five and neonatal mortality by 22.0 and 40.6 %, while eliminating coverage disparities between those living in rural and urban areas will reduce under-five and neonatal mortality by 29.3 and 45.2 %. This projected neonatal mortality reduction achieved by eliminating coverage disparities is almost comparable to that already achieved by Peru over the past decade. Although Peru has made great strides in improving child survival, further improvement in child health, especially in newborn health can be achieved if there is universal and equitable coverage of proven, quality health facility-based interventions. The magnitude of reduction in mortality will be similar to what has been achieved in the past decade. Strengthening health system to identify, understand, and direct resources to the poor and rural areas will ensure that Peru achieve the Sustainable Development Goals by 2030.

Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort.

PubMed

Jones, Rupert C M; Price, David; Ryan, Dermot; Sims, Erika J; von Ziegenweidt, Julie; Mascarenhas, Laurence; Burden, Anne; Halpin, David M G; Winter, Robert; Hill, Sue; Kearney, Matt; Holton, Kevin; Moger, Anne; Freeman, Daryl; Chisholm, Alison; Bateman, Eric D

2014-04-01

Patterns of health-care use and comorbidities present in patients in the period before diagnosis of chronic obstructive pulmonary disease (COPD) are unknown. We investigated these factors to inform future case-finding strategies. We did a retrospective analysis of a clinical cohort in the UK with data from Jan 1, 1990 to Dec 31, 2009 (General Practice Research Database and Optimum Patient Care Research Database). We assessed patients aged 40 years or older who had an electronically coded diagnosis of COPD in their primary care records and had a minimum of 3 years of continuous practice data for COPD (2 years before diagnosis up to a maximum of 20 years, and 1 year after diagnosis) and at least two prescriptions for COPD since diagnosis. We identified missed opportunites to diagnose COPD from routinely collected patient data by reviewing patterns of health-care use and comorbidities present before diagnosis. We assessed patterns of health-care use in terms of lower respiratory consultations (infective and non-infective), lower respiratory consultations with a course of antibiotics or oral steroids, and chest radiography. If these events did not lead to a diagnosis of COPD, they were deemed to be missed opportunities. This study is registered with ClinicalTrials.gov, number NCT01655667. We assessed data for 38,859 patients. Opportunities for diagnosis were missed in 32,900 (85%) of 38,859 patients in the 5 years immediately preceding diagnosis of COPD; in 12,856 (58%) of 22,286 in the 6-10 years before diagnosis, in 3943 (42%) of 9351 in the 11-15 years before diagnosis; and in 95 (8%) of 1167 in the 16-20 years before diagnosis. Between 1990 and 2009, we noted decreases in the age at diagnosis (0·05 years of age per year, 95% CI 0·03-0·07) and yearly frequency of lower respiratory prescribing consultations (rate ratio 0·982 opportunities per year, 95% CI 0·979-0·985). Prevalence of all comorbidities present at COPD diagnosis increased except for asthma and bronchiectasis, which decreased between 1990 and 2007, from 281 (33·4%) of 842 patients to 451 of 1465 (30·8%) for asthma, and from 53 of 842 (6·3%) to 53 of 1465 (3·6%) for bronchiectasis. In the 2 years before diagnosis, of 6897 patients who had had a chest radiography, only 2296 (33%) also had spirometry. Opportunities to diagnose COPD at an earlier stage are being missed, and could be improved by case-finding in patients with lower respiratory tract symptoms and concordant long-term comorbidities. UK Department of Health, Research in Real Life. Copyright © 2014 Elsevier Ltd. All rights reserved.

The progeny of Skylab - The pioneering phase of our expansion into space

NASA Technical Reports Server (NTRS)

Schmitt, H. H.

1974-01-01

The opportunities provided by such near-earth space resources as the continuous view of the earth, sun, and stars, the presence of ultrahigh vacuum, and the absence of gravitational stress are briefly reviewed, along with the significance of manned observation and experimentation in near-earth space. The stimulation triggered in young minds by a week or summer in space, as the Apollo and Skylab experiences show, simply defies the imagination. The plea is made not to miss these opportunities.

Informal Statistics Help Desk

NASA Technical Reports Server (NTRS)

Young, M.; Koslovsky, M.; Schaefer, Caroline M.; Feiveson, A. H.

2017-01-01

Back by popular demand, the JSC Biostatistics Laboratory and LSAH statisticians are offering an opportunity to discuss your statistical challenges and needs. Take the opportunity to meet the individuals offering expert statistical support to the JSC community. Join us for an informal conversation about any questions you may have encountered with issues of experimental design, analysis, or data visualization. Get answers to common questions about sample size, repeated measures, statistical assumptions, missing data, multiple testing, time-to-event data, and when to trust the results of your analyses.

Urethral lymphogranuloma venereum infections in men with anorectal lymphogranuloma venereum and their partners: the missing link in the current epidemic?

PubMed

de Vrieze, Nynke Hesselina Neeltje; van Rooijen, Martijn; Speksnijder, Arjen Gerard Cornelis Lambertus; de Vries, Henry John C

2013-08-01

Urethral lymphogranuloma venereum (LGV) is not screened routinely. We found that in 341 men having sex with men with anorectal LGV, 7 (2.1%) had concurrent urethral LGV. Among 59 partners, 4 (6.8%) had urethral LGV infections. Urethral LGV is common, probably key in transmission, and missed in current routine LGV screening algorithms.

Emerging Engineers Design a Paper Table

ERIC Educational Resources Information Center

Enderson, Mary C.; Grant, Melva R.

2013-01-01

With the advancement of specialized middle schools and high schools focusing on the arts, communication, engineering, mathematics, and science, many students who attend traditional schools miss out on valuable learning opportunities--in particular, when it comes to learning mathematics. Mathematics classrooms can be filled with real-world…

Deming's Quality: Our Last but Best Hope.

ERIC Educational Resources Information Center

Schenkat, Randy

1993-01-01

If educators endorse Alfie Kohn's surface message about Total Quality Management, they may miss opportunity to professionalize education. Deming's system of profound knowledge (interaction of theories of systems, knowledge, psychology, and variation) is a model for educated people grappling with life's complexities. Moreover, gaining community…

38 CFR 1.702 - Policy.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Official Mail in the Location and Recovery of Missing Children § 1.702 Policy. (a) The Department of Veterans Affairs will supplement and expand the national effort to assist in the location and recovery of.../or recommendations for additional cost-effective opportunities to use photographs and biographical...

Statistical Discourse Analysis: A Method for Modelling Online Discussion Processes

ERIC Educational Resources Information Center

Chiu, Ming Ming; Fujita, Nobuko

2014-01-01

Online forums (synchronous and asynchronous) offer exciting data opportunities to analyze how people influence one another through their interactions. However, researchers must address several analytic difficulties involving the data (missing values, nested structure [messages within topics], non-sequential messages), outcome variables (discrete…

The Clinton Legacy in Higher Education.

ERIC Educational Resources Information Center

Brainard, Jeffrey; Burd, Stephen; Gose, Ben

2000-01-01

Analyzes President Clinton's actions on higher education during his eight years in office. Notes progress on issues such as funding for middle-class students, biomedical research, and technology. Points out possible missed opportunities, including issues surrounding affirmative action. Concludes that Clinton helped make higher education a…

A new industrial order for physicians: a talk with Jeff C. Goldsmith, PhD. Interview by Richard L. Reece.

PubMed

Goldsmith, J C

2000-01-01

Richard L. Reece, MD, interviewed Jeff C. Goldsmith, PhD, President of Health Futures, Inc. on October 12, 1999 to discuss how the Internet will affect health care delivery in the millennium. One of the most profound changes that he sees is how the relationship between physicians and patients will be altered. Empowered consumers are where the real revolution is happening--a trend sometimes overlooked by physicians. Goldsmith says, "The key thing physicians have missed is that the patient is in charge of the process.... The Internet has enabled patients to aggregate their collective experience across disease entities." But there is too much information. "It is almost universally acknowledged by patients and physicians that there is a terrible quality problem. Getting from information to knowledge is a huge commercial opportunity for somebody." He doesn't think that people have put enough emphasis on the collective learning part of this new technology.

Wurtzite spin lasers

NASA Astrophysics Data System (ADS)

Faria Junior, Paulo E.; Xu, Gaofeng; Chen, Yang-Fang; Sipahi, Guilherme M.; Žutić, Igor

2017-03-01

Semiconductor lasers are strongly altered by adding spin-polarized carriers. Such spin lasers could overcome many limitations of their conventional (spin-unpolarized) counterparts. While the vast majority of experiments in spin lasers employed zinc-blende semiconductors, the room-temperature electrical manipulation was first demonstrated in wurtzite GaN-based lasers. However, the underlying theoretical description of wurtzite spin lasers is still missing. To address this situation, focusing on (In,Ga)N-based wurtzite quantum wells, we develop a theoretical framework in which the calculated microscopic spin-dependent gain is combined with a simple rate equation model. A small spin-orbit coupling in these wurtzites supports simultaneous spin polarizations of electrons and holes, providing unexplored opportunities to control spin lasers. For example, the gain asymmetry, as one of the key figures of merit related to spin amplification, can change the sign by simply increasing the carrier density. The lasing threshold reduction has a nonmonotonic dependence on electron-spin polarization, even for a nonvanishing hole spin polarization.

New Physics Opportunities in the Boosted Di-Higgs-Boson Plus Missing Transverse Energy Signature.

PubMed

Kang, Zhaofeng; Ko, P; Li, Jinmian

2016-04-01

The Higgs field in the standard model may couple to new physics sectors related to dark matter and/or massive neutrinos. In this Letter we propose a novel signature, the boosted di-Higgs-boson plus E_{T} (which is either a dark matter or neutrino), to probe those new physics sectors. In a large class of models, in particular, the supersymmetric standard models and low scale seesaw mechanisms, this signature can play a key role. The signature has a clear background, and at the sqrt[s]=14  TeV high luminosity LHC, we can probe it with a production rate as low as ∼0.1  fb. We apply it to benchmark models, supersymmetry in the bino-Higgsino limit, the canonical seesaw model, and the little Higgs model, finding that the masses of the Higgsino, right-handed neutrino, and heavy vector boson can be probed up to ∼500, 650, and 900 GeV, respectively.

Archaeal and eukaryotic homologs of Hfq

PubMed Central

Mura, Cameron; Randolph, Peter S.; Patterson, Jennifer; Cozen, Aaron E.

2013-01-01

Hfq and other Sm proteins are central in RNA metabolism, forming an evolutionarily conserved family that plays key roles in RNA processing in organisms ranging from archaea to bacteria to human. Sm-based cellular pathways vary in scope from eukaryotic mRNA splicing to bacterial quorum sensing, with at least one step in each of these pathways being mediated by an RNA-associated molecular assembly built upon Sm proteins. Though the first structures of Sm assemblies were from archaeal systems, the functions of Sm-like archaeal proteins (SmAPs) remain murky. Our ignorance about SmAP biology, particularly vis-à-vis the eukaryotic and bacterial Sm homologs, can be partly reduced by leveraging the homology between these lineages to make phylogenetic inferences about Sm functions in archaea. Nevertheless, whether SmAPs are more eukaryotic (RNP scaffold) or bacterial (RNA chaperone) in character remains unclear. Thus, the archaeal domain of life is a missing link, and an opportunity, in Sm-based RNA biology. PMID:23579284

An Introduction to Social Network Data Analytics

NASA Astrophysics Data System (ADS)

Aggarwal, Charu C.

The advent of online social networks has been one of the most exciting events in this decade. Many popular online social networks such as Twitter, LinkedIn, and Facebook have become increasingly popular. In addition, a number of multimedia networks such as Flickr have also seen an increasing level of popularity in recent years. Many such social networks are extremely rich in content, and they typically contain a tremendous amount of content and linkage data which can be leveraged for analysis. The linkage data is essentially the graph structure of the social network and the communications between entities; whereas the content data contains the text, images and other multimedia data in the network. The richness of this network provides unprecedented opportunities for data analytics in the context of social networks. This book provides a data-centric view of online social networks; a topic which has been missing from much of the literature. This chapter provides an overview of the key topics in this field, and their coverage in this book.

Missed opportunities in primary care: the importance of identifying depression through screening, family history, and chronic disease management.

PubMed

Maradiegue, Ann H; Khan, Fakiha

2013-02-01

This study explored the adequacy of depression screening in a community health center. The medical charts of individuals (N = 90) enrolled at a community health center were randomly selected, reviewed, and compared to current standard-of-care guidelines for four elements: family history, screening for depression, control of chronic illnesses, and missed opportunities for preventive care. Family history documentation collected by the providers was limited and 44.4% had no family history. There was no routine depression screening process, although 48.9% of the clients had red flags (warning signals) for depression. Laboratory values used for screening control of chronic disease in the medical records were: fasting glucose levels ⩽100 mg/dL (46%), total cholesterol levels ⩽200 mg/dL (38%), and blood pressure ⩽120/80 mmHg (23%). The results highlight the need to focus on depression screening as part of preventive care and the management of chronic disease in the primary care setting. Copyright 2013, SLACK Incorporated.

Primary prevention of neural-tube defects and some other congenital abnormalities by folic acid and multivitamins: history, missed opportunity and tasks

PubMed Central

Bártfai, Zoltán; Bánhidy, Ferenc

2011-01-01

The history of intervention trials of periconception folic acid with multivitamin and folic acid supplementation in women has shown a recent breakthrough in the primary prevention of structural birth defects, namely neural-tube defects and some other congenital abnormalities. Recently, some studies have demonstrated the efficacy of this new method in reducing congenital abnormalities with specific origin; for example, in the offspring of diabetic and epileptic mothers, and in pregnancy with high fever. The benefits and drawbacks of four possible uses of periconception folate/folic acid and multivitamin supplementation are discussed: we believe there has been a missed opportunity to implement this preventive approach in medical practice. The four methods are as follows: (i) dietary intake of folate and other vitamins, (ii) periconception folic acid/multivitamin supplementation, (iii) food fortification with folic acid, and (iv) the combination of oral contraceptives with 6S-5-methytetrahydrofolate (‘folate’). PMID:25083211

Antisocial personality disorder in DSM-5: missteps and missed opportunities.

PubMed

Lynam, Donald R; Vachon, David D

2012-10-01

This paper evaluates the proposal for antisocial personality disorder (ASPD) in the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5). Some aspects of the proposal are appealing: personality disorders will be assessed using trait criteria, and these criteria are similar to trait descriptions of DSM-IV ASPD. Other aspects of the proposal are less appealing. First, the DSM-5 will depend on a newly constructed personality trait system rather than relying on a well validated, widely studied one. Second, the trait profile of ASPD is incomplete; although this profile reflects the traits included in DSM-IV, it maps poorly onto the full personality profile of ASPD. Third, the DSM Workgroup missed an opportunity to finally unify ASPD and psychopathy; history and research suggest that these disorders have diverged mistakenly. Fourth, the newly proposed criteria of impairments in self- and interpersonal functioning are of questionable derivation and utility. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

A melding of the minds: when primatology meets personality and social psychology.

PubMed

Brosnan, Sarah F; Newton-Fisher, Nicholas E; van Vugt, Mark

2009-05-01

Social and personality psychology and behavioral primatology both enjoy long histories of research aimed at uncovering the proximate and ultimate determinants of primate-human and nonhuman-social behavior. Although they share research themes, methodologies, and theories, and although their studied species are closely related, there is currently very little interaction between the fields. This separation means that researchers in these disciplines miss out on opportunities to advance understanding by combining insights from both fields. Social and personality psychologists also miss the opportunity for a phylogenetic analysis. The time has come to integrate perspectives on primate social psychology. Here, the authors provide a historical background and document the main similarities and differences in approaches. Next, they present some examples of research programs that may benefit from an integrated primate perspective. Finally, the authors propose a framework for developing a social psychology inclusive of all primates. Such a melding of minds promises to greatly benefit those who undertake the challenge.

Psychiatric genetics in China: achievements and challenges

PubMed Central

Schulze, Thomas G.; Burmeister, Margit; Sham, Pak Chung; Yao, Yong-gang; Kuo, Po-Hsiu; Chen, Chao; An, Yu; Dai, Jiapei; Yue, Weihua; Li, Miao Xin; Xue, Hong; Su, Bing; Chen, Li; Shi, Yongyong; Qiao, Mingqi; Liu, Tiebang; Xia, Kun; Chan, Raymond C.K.

2016-01-01

To coordinate research efforts in psychiatric genetics in China, a group of Chinese and foreign investigators have established an annual “Summit on Chinese Psychiatric Genetics” to present their latest research and discuss the current state and future directions of this field. To date, two Summits have been held, the first in Changsha in April, 2014, and the second in Kunming in April, 2015. The consensus of roundtable discussions held at these meetings is that psychiatric genetics in China is in need of new policies to promote collaborations aimed at creating a framework for genetic research appropriate for the Chinese population: relying solely on Caucasian population-based studies may result in missed opportunities to diagnose and treat psychiatric disorders. In addition, participants agree on the importance of promoting collaborations and data sharing in areas where China has especially strong resources, such as advanced facilities for non-human primate studies and traditional Chinese medicine: areas that may also provide overseas investigators with unique research opportunities. In this paper, we present an overview of the current state of psychiatric genetics research in China, with emphasis on genome-level studies, and describe challenges and opportunities for future advances, particularly at the dawn of “precision medicine.” Together, we call on administrative bodies, funding agencies, the research community, and the public at large for increased support for research on the genetic basis of psychiatric disorders in the Chinese population. In our opinion, increased public awareness and effective collaborative research hold the keys to the future of psychiatric genetics in China. PMID:26481319

Requirements Flowdown for Prognostics and Health Management

NASA Technical Reports Server (NTRS)

Goebel, Kai; Saxena, Abhinav; Roychoudhury, Indranil; Celaya, Jose R.; Saha, Bhaskar; Saha, Sankalita

2012-01-01

Prognostics and Health Management (PHM) principles have considerable promise to change the game of lifecycle cost of engineering systems at high safety levels by providing a reliable estimate of future system states. This estimate is a key for planning and decision making in an operational setting. While technology solutions have made considerable advances, the tie-in into the systems engineering process is lagging behind, which delays fielding of PHM-enabled systems. The derivation of specifications from high level requirements for algorithm performance to ensure quality predictions is not well developed. From an engineering perspective some key parameters driving the requirements for prognostics performance include: (1) maximum allowable Probability of Failure (PoF) of the prognostic system to bound the risk of losing an asset, (2) tolerable limits on proactive maintenance to minimize missed opportunity of asset usage, (3) lead time to specify the amount of advanced warning needed for actionable decisions, and (4) required confidence to specify when prognosis is sufficiently good to be used. This paper takes a systems engineering view towards the requirements specification process and presents a method for the flowdown process. A case study based on an electric Unmanned Aerial Vehicle (e-UAV) scenario demonstrates how top level requirements for performance, cost, and safety flow down to the health management level and specify quantitative requirements for prognostic algorithm performance.

On the development of weighting factors for ballast ranking prioritization & development of the relationship and rate of defective segments based on volume of missing ballast

NASA Astrophysics Data System (ADS)

Cronin, John

This thesis explores the effects of missing ballast on track behavior and degradation. As ballast is an integral part of the track structure, the hypothesized effect of missing ballast is that defects will be more common which in turn leads to more derailments. In order to quantify the volume of missing ballast, remote sensing technologies were used to provide an accurate profile of the ballast. When the existing profile is compared to an idealized profile, the area of missing ballast can be computed. The area is then subdivided into zones which represent the area in which the ballast performs a key function in the track structure. These areas are then extrapolated into the volume of missing ballast for each zone based on the distance between collected profiles. In order to emphasize the key functions that the zones previously created perform, weighting factors were developed based on common risk-increasing hazards, such as curves and heavy axle loads, which are commonly found on railways. These weighting factors are applied to the specified zones' missing ballast volume when such a hazard exists in that segment of track. Another set of weighting factors were developed to represent the increased risk, or preference for lower risk, for operational factors such as the transport of hazardous materials or for being a key route. Through these weighting factors, ballast replenishment can be prioritized to focus on the areas that pose a higher risk of derailments and their associated costs. For the special cases where the risk or aversion to risk comes from what is being transported, such as the case with hazardous materials or passengers, an economic risk assessment was completed in order to quantify the risk associated with their transport. This economic risk assessment looks at the increased costs associated with incidents that occur and how they compare to incidents which do not directly involve the special cargos. In order to provide support for the use of the previously developed weightings as well as to quantify the actual impact that missing ballast has on the rate of geometry defects, analyses which quantified the risk of missing ballast were performed. In addition to quantifying the rate of defects, analyses were performed which looked at the impact associated with curved track, how the location of missing ballast impacts the rate of geometry defects and how the combination of the two compared with the previous analyses. Through this research, the relationship between the volume of missing ballast and ballast-related defects has been identified and quantified. This relationship is positive for the aggregate of all ballast-related defects but does not always exist for individual defects which occasionally have unique behavior. For the non-ballast defects, a relationship between missing ballast and their rate of occurrence did not always appear to exist. The impact of curves was apparent, showing that the rate of defects was either similar to or exceeded the rate of defects for tangent track. For the analyses which looked at the location of ballast in crib or shoulder, the results were quite similar to the previous analyses. The development, application and improvements of a risk-based ballast maintenance prioritization system provides a relatively low-cost and effective method to improve the operational safety for all railroads.

The Hepatitis Testing and Linkage-to-Care Data Review Process: An Approach to Ensuring the Quality of Program Data.

PubMed

Mezzo, Jennifer L; Lamia, Tamara L; Danelski, Lisa L; Schipani, Anne Marie; Stokes, Scott A; Jacobs-Ware, Elizabeth D

2016-01-01

CDC's 2012 Hepatitis Testing and Linkage to Care (HepTLC) initiative was a nationally coordinated effort to conduct hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites. This project provided support for data management and monthly data reviews between awardees and a data manager, which facilitated monitoring of awardee progress and regular program improvement opportunities. CDC provided technical assistance to awardees for testing processes and program improvement, including Internet-based data submission, reporting software and data management to awardees, offering assistance with submitting, and reviewing data in real time. We describe how one awardee, AIDS Resource Center of Wisconsin (ARCW), used the data management process to improve data quality, inform testing processes and implementation, and measure and report missing variables from an online database. From October 2012 through July 2014, ARCW performed 2,255 HCV antibody (anti-HCV) tests and 244 HCV ribonucleic acid (RNA) tests as part of the HepTLC initiative. Participants who tested HCV RNA positive (n=189) were referred to medical care. At the end of the study, no records were missing for the anti-HCV test result or HCV RNA test result variables, and only one record was missing for those who were referred to medical care. Regular data review and monitoring by awardees and CDC-supported data managers provided opportunities for data quality and program improvement. Through regular data review, ARCW reduced the amount of missing data and promoted timely follow-up with participants testing positive for HCV to ensure receipt of results and linkage to care. Other programs can adopt a similar data management model.

Sex Education: Talking to Your Teen about Sex

MedlinePlus

... might miss the best opportunities. Instead, think of sex education as an ongoing conversation. Here are some ideas to help you get started — and keep the discussion going. Seize the moment. When a TV program or music video raises issues about responsible sexual behavior, use it ...

The Rapid Benefit Indicators (RBI) Approach: A Process for Assessing the Social Benefits of Ecological Restoration

EPA Science Inventory

Environmental managers face difficult decisions about allocating resources to the most beneficial projects. Focusing solely on ecological outcomes can lead to missed opportunities to provide social benefits, yet few methods exist to easily compare the social benefits of ecologica...

ICT and Pedagogy: Opportunities Missed?

ERIC Educational Resources Information Center

Adams, Paul

2011-01-01

The pace of Information and Communications Technology (ICT) development necessitates radical and rapid change for education. Given the English prevalence for an economically determinist orientation for educational outcomes, it seems pertinent to ask how learning in relation to ICT is to be conceptualised. Accepting the view that education needs to…

Policy Inroads Undermining Women in Education

ERIC Educational Resources Information Center

Marshall, Catherine; Young, Michelle

2013-01-01

Over the last decades, policy trends have differentially and negatively affected women educators, defied, denied or repressed feminist values and missed opportunities for using feminist insights to reframe policy issues. This article provides a critical feminist analysis of educational and social policies with negative implications for women in…

HetMappsS: Heterozygous mapping strategy for high resolution Genotyping-by-Sequencing Markers

USDA-ARS?s Scientific Manuscript database

Reduced representation genotyping approaches, such as genotyping-by-sequencing (GBS), provide opportunities to generate high-resolution genetic maps at a low per-sample cost. However, missing data and non-uniform sequence coverage can complicate map creation in highly heterozygous species. To facili...

A Practical Technique for Measuring the Behavior of Foraging Animals.

ERIC Educational Resources Information Center

Smith, Rosemary J.; Brown, Joel S.

1991-01-01

An indirect procedure that uses the foraging behavior of animals at experimental food patches to address questions in animal behavior is discussed. Suggested projects that include the concepts of predation risk, harvest rates and metabolic costs, missed opportunity costs, and competition are described. (KR)

Professional Learning, Instructional Shifts, and Missed Opportunities

ERIC Educational Resources Information Center

Risko, Victoria J.

2017-01-01

In this article, Victoria Risko discusses the power of professional learning that is supported by knowledgeable others and recommends a multi-talented approach that draws on the expertise of reading specialists, literacy coaches, and classroom teachers. Next, she discusses the challenges one faces when implementing professional learning…

Incomplete Early Childhood Immunization Series and Missing Fourth DTaP Immunizations; Missed Opportunities or Missed Visits?

PubMed

Robison, Steve G

2013-01-01

The successful completion of early childhood immunizations is a proxy for overall quality of early care. Immunization statuses are usually assessed by up-to-date (UTD) rates covering combined series of different immunizations. However, series UTD rates often only bear on which single immunization is missing, rather than the success of all immunizations. In the US, most series UTD rates are limited by missing fourth DTaP-containing immunizations (diphtheria/tetanus/pertussis) due at 15 to 18 months of age. Missing 4th DTaP immunizations are associated either with a lack of visits at 15 to 18 months of age, or to visits without immunizations. Typical immunization data however cannot distinguish between these two reasons. This study compared immunization records from the Oregon ALERT IIS with medical encounter records for two-year olds in the Oregon Health Plan. Among those with 3 valid DTaPs by 9 months of age, 31.6% failed to receive a timely 4th DTaP; of those without a 4th DTaP, 42.1% did not have any provider visits from 15 through 18 months of age, while 57.9% had at least one provider visit. Those with a 4th DTaP averaged 2.45 encounters, while those with encounters but without 4th DTaPs averaged 2.23 encounters.

Network sampling coverage II: The effect of non-random missing data on network measurement

PubMed Central

Smith, Jeffrey A.; Moody, James; Morgan, Jonathan

2016-01-01

Missing data is an important, but often ignored, aspect of a network study. Measurement validity is affected by missing data, but the level of bias can be difficult to gauge. Here, we describe the effect of missing data on network measurement across widely different circumstances. In Part I of this study (Smith and Moody, 2013), we explored the effect of measurement bias due to randomly missing nodes. Here, we drop the assumption that data are missing at random: what happens to estimates of key network statistics when central nodes are more/less likely to be missing? We answer this question using a wide range of empirical networks and network measures. We find that bias is worse when more central nodes are missing. With respect to network measures, Bonacich centrality is highly sensitive to the loss of central nodes, while closeness centrality is not; distance and bicomponent size are more affected than triad summary measures and behavioral homophily is more robust than degree-homophily. With respect to types of networks, larger, directed networks tend to be more robust, but the relation is weak. We end the paper with a practical application, showing how researchers can use our results (translated into a publically available java application) to gauge the bias in their own data. PMID:27867254

Network sampling coverage II: The effect of non-random missing data on network measurement.

PubMed

Smith, Jeffrey A; Moody, James; Morgan, Jonathan

2017-01-01

Missing data is an important, but often ignored, aspect of a network study. Measurement validity is affected by missing data, but the level of bias can be difficult to gauge. Here, we describe the effect of missing data on network measurement across widely different circumstances. In Part I of this study (Smith and Moody, 2013), we explored the effect of measurement bias due to randomly missing nodes. Here, we drop the assumption that data are missing at random: what happens to estimates of key network statistics when central nodes are more/less likely to be missing? We answer this question using a wide range of empirical networks and network measures. We find that bias is worse when more central nodes are missing. With respect to network measures, Bonacich centrality is highly sensitive to the loss of central nodes, while closeness centrality is not; distance and bicomponent size are more affected than triad summary measures and behavioral homophily is more robust than degree-homophily. With respect to types of networks, larger, directed networks tend to be more robust, but the relation is weak. We end the paper with a practical application, showing how researchers can use our results (translated into a publically available java application) to gauge the bias in their own data.

Missed opportunities to counsel patients with malignant pleural mesothelioma about causation and potential compensation.

PubMed

Kuschner, Ware G; Varma, Radhika; Flores, Roberto; Agrawal, Madhuri; Guvenc-Tuncturk, Sebnem

2012-03-01

Malignant pleural mesothelioma (MPM) is a lethal malignancy strongly associated with occupational exposure to asbestos. The aims of this study were to assess the quality of counseling provided to patients with MPM about the causation of MPM and the potential for compensation. The authors conducted a structured retrospective chart review of patients with a diagnosis of MPM. They abstracted demographic data, occupational and environmental history and exposure data. They also searched for documentation of patient education and counseling. The authors identified 16 patients with a new diagnosis of MPM during the study period. A job title was documented at least once in the records of 12 (75%) patients. Documentation of occupational exposure to asbestos was found in the records of 12 (75%) patients. Two patients (13%) were presumed to have had bystander exposure to asbestos. Education about MPM causation and counseling about opportunities for compensation were documented in the record of 1 patient (6%). Among patients with MPM, documentation of some elements of an occupational history, including an occupational asbestos exposure history, was common. Advice to pursue compensation for potential occupation related MPM was rare. Physicians may be missing opportunities to provide beneficial information to patients with newly diagnosed MPM regarding potential legal redress and compensation.

Missing data in trial-based cost-effectiveness analysis: An incomplete journey.

PubMed

Leurent, Baptiste; Gomes, Manuel; Carpenter, James R

2018-06-01

Cost-effectiveness analyses (CEA) conducted alongside randomised trials provide key evidence for informing healthcare decision making, but missing data pose substantive challenges. Recently, there have been a number of developments in methods and guidelines addressing missing data in trials. However, it is unclear whether these developments have permeated CEA practice. This paper critically reviews the extent of and methods used to address missing data in recently published trial-based CEA. Issues of the Health Technology Assessment journal from 2013 to 2015 were searched. Fifty-two eligible studies were identified. Missing data were very common; the median proportion of trial participants with complete cost-effectiveness data was 63% (interquartile range: 47%-81%). The most common approach for the primary analysis was to restrict analysis to those with complete data (43%), followed by multiple imputation (30%). Half of the studies conducted some sort of sensitivity analyses, but only 2 (4%) considered possible departures from the missing-at-random assumption. Further improvements are needed to address missing data in cost-effectiveness analyses conducted alongside randomised trials. These should focus on limiting the extent of missing data, choosing an appropriate method for the primary analysis that is valid under contextually plausible assumptions, and conducting sensitivity analyses to departures from the missing-at-random assumption. © 2018 The Authors Health Economics published by John Wiley & Sons Ltd.

Maternal Near-Miss Audit: Lessons to Be Learnt.

PubMed

Kalhan, Meenakshi; Singh, Srishti; Punia, Anita; Prakash, Jai

2017-01-01

Mother and child constitute a large, vulnerable, and a priority group as the risk is involved with childbearing in women and of growth and development in children. For every woman who dies from pregnancy or childbirth-related causes, it is estimated that twenty more suffer from pregnancy-related illness or experience other severe complications. These women who nearly escape death are categorized under "near miss" which has been defined as "a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy." Maternal near-miss audits give us an opportunity to study the cases which were almost similar to those where maternal deaths happened; thus, their review may give concrete evidence of reasons/deficiencies in health care leading to severe complications and even grave consequences as maternal deaths. Near-miss audits will allow the care of critically ill women to be analyzed, deficiencies in the provision of care to be identified, and comparison within and between institutions and, ultimately, improve the quality of obstetric care and further reduce maternal morbidity and mortality.

Factors Accounting for a Missed Diagnosis of Cystic Fibrosis After Newborn Screening

PubMed Central

Rock, Michael J.; Levy, Hara; Zaleski, Christina; Farrell, Philip M.

2015-01-01

Summary Newborn screening is a public health policy program involving the centralized testing laboratory, infant and their family, primary care provider, and subspecialist for confirmatory testing and follow-up of abnormal results. Cystic fibrosis (CF) newborn screening has now been enacted in all 50 states and the District of Columbia and throughout many countries in the world. Although CF neonatal screening will identify the vast majority of infants with CF, there are many factors in the newborn screening system that can lead to a missed diagnosis of CF. To inform clinicians, this article summarizes the CF newborn screening system and highlights 14 factors that can account for a missed diagnosis of CF. Care providers should maintain a high suspicion for CF if there are compatible symptoms, regardless of the results of the newborn screening test. These factors in newborn screening programs leading to a missed diagnosis of CF present opportunities for quality improvement in specimen collection, laboratory analysis of immunoreactive tryspinogen (IRT) and CF mutation testing, communication, and sweat testing. PMID:22081556

Teaching Elections in a Secondary Classroom

ERIC Educational Resources Information Center

Schulzki, Anton

2016-01-01

Social studies teachers can certainly teach about elections at any time, but in light of the importance of a presidential election, this once-every-four-year civic extravaganza should not be missed! With the election of 2016 coming in the fall, it provides rich opportunities for discussions, classroom lessons, and community service opportunities…

Compassion and Caring: Missing Concepts in Social Studies Programs.

ERIC Educational Resources Information Center

Oliner, Pearl

1979-01-01

Current social studies programs do not include the study of prosocial behaviors such as altruism, generosity, and compassion. This omission legitimizes the view that human behaviors are self-serving. Curriculum developers should fashion programs which provide prosocial models and opportunities for students to conceptualize such behaviors and…

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

Prime, Michael B.; DeWald, Adrian T.; Hill, Michael R.

Forensic engineering - the scientific examination and analysis of failed structures and parts relating to their failure or cause of damage. Real advances in experimental mechanics require innovative theoretical and analytical thinking to go with innovative capabilities. For example, taking full field data (e.g., DIC) and treating it like discrete data (strain gauge) misses a wonderful opportunity.

Integrating Early Child Development and Violence Prevention Programs: A Systematic Review

ERIC Educational Resources Information Center

Efevbera, Yvette; McCoy, Dana C.; Wuermli, Alice J.; Betancourt, Theresa S.

2018-01-01

Limited evidence describes promoting development and reducing violence in low- and middle-income countries (LMICs), a missed opportunity to protect children and promote development and human capital. This study presents a systematic literature review of integrated early childhood development plus violence prevention (ECD+VP) interventions in…

Marbles, Anyone? Traditional Games in the Classroom.

ERIC Educational Resources Information Center

Casbergue, Renee M.; Kieff, Judith

1998-01-01

Children now play more solitary games, perhaps missing benefits of traditional games such as jacks, marbles, and dominoes. Such games offer children of all backgrounds the opportunity to consolidate knowledge and skills, develop a more orderly way of thinking, and establish themselves with peers. By making these games available in classrooms,…

Teaching the Value of Science

ERIC Educational Resources Information Center

Shumow, Lee; Schmidt, Jennifer A.

2015-01-01

Why and under what conditions might students value their science learning? To find out, the authors observed approximately 400 science classes. They found that although several teachers were amazingly adept at regularly promoting the value of science, many others missed out on important opportunities to promote the value of science. The authors…

Wikis for Building Content Knowledge in the Foreign Language Classroom

ERIC Educational Resources Information Center

Pellet, Stephanie H.

2012-01-01

Most pedagogical applications of wikis in foreign language education draw on this collaborative tool to improve (formal) writing skills or to develop target language cultural sensitivity, missing largely on the opportunity to support student-developed L2 content knowledge. Seeking an alternative to traditional teacher-centered approaches, this…

Bildungskrise und Bildungspolitik in Brasilien = Educational Crisis and Education Policy in Brazil.

ERIC Educational Resources Information Center

Freitag-Rouanet, Barbara

1991-01-01

Evaluates the United Nations 1990 Human Development Report's portrayal of Brazil. Attributes missed human development opportunities cited in the report to the Brazilian military rule of 1964 to 1984 and subsequent redemocratization. Cites possibilities for human development, particularly in education. Questions whether Brazil will be among the…

78 FR 22888 - Agency Information Collection Activities; Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-17

... respondents when there are missing data elements prior to submission. We acknowledge a change in the burden... with the requirement for opportunity for public comment on proposed data collection projects (Section... the data collection plans and draft instruments, email [email protected] or call the HRSA Reports...

Transnational Education -- An Opportunity and a Canadian Role

ERIC Educational Resources Information Center

Dennis, Roger

2013-01-01

Transnational education is a huge growth industry and a potential source of considerable income for Canadian educational institutions. Canadian educational establishments seem to be missing out on this, and this seems short sighted. Canada has a very good reputation globally; this could be utilized when selling Canadian educational institutions in…

School District Superintendents' Response to Ethical Dilemmas: A Grounded Theory

ERIC Educational Resources Information Center

Sprouse, Fay Simpson

2009-01-01

Ethical dilemmas, situations involving a conflict between values or principles, often arise when employees of school districts violate laws or professional codes of behavior. Ethical dilemmas also occur when there are inequities in educational programming, resulting in missed opportunities for students. This qualitative study, conducted with the…

Simply Performance Assessment

ERIC Educational Resources Information Center

McLaughlin, Cheryl A.; McLaughlin, Felecia C.; Pringle, Rose M.

2013-01-01

This article presents the experiences of Miss Felecia McLaughlin, a fourth-grade teacher from the island of Jamaica who used the model proposed by Bass et al. (2009) to assess conceptual understanding of four of the six types of simple machines while encouraging collaboration through the creation of learning teams. Students had an opportunity to…

Supporting Children's Oral Language Development in the Preschool Classroom

ERIC Educational Resources Information Center

Whorrall, Jennifer; Cabell, Sonia Q.

2016-01-01

Supporting children's oral language development during the preschool years is critical for later reading success. Research shows that preschool teachers may be missing opportunities to engage children in the kinds of conversations that foster the development of rich oral language skills. Teachers hoping to support these skills can provide children…

MRI Experiments for Introductory Physics

ERIC Educational Resources Information Center

Taghizadeh, Sanaz; Lincoln, James

2018-01-01

The introductory physics classroom has long educated students about the properties of the atom and the nucleus. But absent from these lessons has been an informed discussion of magnetic resonance imaging (MRI) and its parent science nuclear magnetic resonance (NMR). Physics teachers should not miss the opportunity to instruct upon this highly…

Hybridized Teacher Education Programs in NYC: A Missed Opportunity?

ERIC Educational Resources Information Center

Mungal, Angus Shiva

2015-01-01

This qualitative study describes the development of hybrid teacher preparation programs that emerged as a result of a "forced" partnership between university-based and alternative teacher preparation programs in New York City. This hybrid experiment was a short-lived, yet innovative by-product of a somewhat pragmatic arrangement between…

Evaluation as a Collaborative Activity to Learn Content Knowledge in a Graduate Course

ERIC Educational Resources Information Center

Hughes, Bob; Arbogast, Janet; Kafer, Lindsey; Chen, Julianna

2014-01-01

Teaching graduate students to conduct evaluations is typically relegated to evaluation methods courses. This approach misses an opportunity for students to collaboratively use evaluation skills to explore content. This article examines a graduate course, Issues in Adult Basic Education, in which students learned evaluation methods concurrently…

Integrated health messaging for multiple neglected zoonoses: Approaches, challenges and opportunities in Morocco.

PubMed

Ducrotoy, M J; Yahyaoui Azami, H; El Berbri, I; Bouslikhane, M; Fassi Fihri, O; Boué, F; Petavy, A F; Dakkak, A; Welburn, S; Bardosh, K L

2015-12-01

Integrating the control of multiple neglected zoonoses at the community-level holds great potential, but critical data is missing to inform the design and implementation of different interventions. In this paper we present an evaluation of an integrated health messaging intervention, using powerpoint presentations, for five bacterial (brucellosis and bovine tuberculosis) and dog-associated (rabies, cystic echinococcosis and leishmaniasis) zoonotic diseases in Sidi Kacem Province, northwest Morocco. Conducted by veterinary and epidemiology students between 2013 and 2014, this followed a process-based approach that encouraged sequential adaptation of images, key messages, and delivery strategies using auto-evaluation and end-user feedback. We describe the challenges and opportunities of this approach, reflecting on who was targeted, how education was conducted, and what tools and approaches were used. Our results showed that: (1) replacing words with local pictures and using "hands-on" activities improved receptivity; (2) information "overload" easily occurred when disease transmission pathways did not overlap; (3) access and receptivity at schools was greater than at the community-level; and (4) piggy-backing on high-priority diseases like rabies offered an important avenue to increase knowledge of other zoonoses. We conclude by discussing the merits of incorporating our validated education approach into the school curriculum in order to influence long-term behaviour change. Copyright © 2015 Elsevier B.V. All rights reserved.

Overcoming statistical bias to estimate genetic mating systems in open populations: a comparison of Bateman's principles between the sexes in a sex-role-reversed pipefish.

PubMed

Mobley, Kenyon B; Jones, Adam G

2013-03-01

The genetic mating system is a key component of the sexual selection process, yet methods for the quantification of mating systems remain controversial. One approach involves metrics derived from Bateman's principles, which are based on variances in mating and reproductive success and the relationship between them. However, these measures are extremely difficult to measure for both sexes in open populations, because missing data can result in biased estimates. Here, we develop a novel approach for the estimation of mating system metrics based on Bateman's principles and apply it to a microsatellite-based parentage analysis of a natural population of the dusky pipefish, Syngnathus floridae. Our results show that both male and female dusky pipefish have significantly positive Bateman gradients. However, females exhibit larger values of the opportunity for sexual selection and the opportunity for selection compared to males. These differences translate into a maximum intensity of sexual selection (S'max) for females three times larger than that for males. Overall, this study identifies a critical source of bias that affects studies of mating systems in open populations, presents a novel method for overcoming this bias, and applies this method for the first time in a sex-role-reversed pipefish. © 2012 The Author(s). Evolution© 2012 The Society for the Study of Evolution.

Seeking more Opportunities of Check Dams' harmony with nearby Circumstances via Design Thinking Process

NASA Astrophysics Data System (ADS)

Lin, Huan-Chun; Chen, Su-Chin; Tsai, Chen-Chen

2014-05-01

The contents of engineering design should indeed contain both science and art fields. However, the art aspect is too less discussed to cause an inharmonic impact with natural surroundings, and so are check dams. This study would like to seek more opportunities of check dams' harmony with nearby circumstances. According to literatures review of philosophy and cognition science fields, we suggest a thinking process of three phases to do check dams design work for reference. The first phase, conceptualization, is to list critical problems, such as the characteristics of erosion or deposition, and translate them into some goal situations. The second phase, transformation, is to use cognition methods such as analogy, association and metaphors to shape an image and prototypes. The third phase, formation, is to decide the details of the construction, such as stable safety analysis of shapes or materials. According to the previous descriptions, Taiwan's technological codes or papers about check dam design mostly emphasize the first and third phases, still quite a few lacks of the second phase. We emphases designers shouldn't ignore any phase of the framework especially the second one, or they may miss some chances to find more suitable solutions. Otherwise, this conceptual framework is simple to apply and we suppose it's a useful tool to design a more harmonic check dam with nearby natural landscape. Key Words: check dams, design thinking process, conceptualization, transformation, formation.

Survey Finds That Many Prisons And Jails Have Room To Improve HIV Testing And Coordination Of Postrelease Treatment

PubMed Central

Solomon, Liza; Montague, Brian T.; Beckwith, Curt G.; Baillargeon, Jacques; Costa, Michael; Dumont, Dora; Kuo, Irene; Kurth, Ann; Rich, Josiah D.

2014-01-01

Early diagnosis of HIV and effective antiretroviral treatment are key elements in efforts to reduce the morbidity and mortality associated with HIV. Incarcerated populations are disproportionately affected by HIV, with the disease’s prevalence among inmates estimated to be three to five times higher than among the general population. Correctional institutions offer important opportunities to test for HIV and link infected people to postrelease treatment services. To examine HIV testing and policies that help HIV-positive people obtain treatment in the community after release, we administered a survey to the medical directors of the fifty state prison systems and of forty of the largest jails in the United States. We found that 19 percent of prison systems and 35 percent of jails provide opt-out HIV testing, which is recommended by the Centers for Disease Control and Prevention (CDC). Additionally, fewer than 20 percent of prisons and jails conform to the CDC’s recommendations regarding discharge planning services for inmates transitioning to the community: making an appointment with a community health care provider, assisting with enrollment in an entitlement program, and providing a copy of the medical record and a supply of HIV medications. These findings suggest that opportunities for HIV diagnosis and linking HIV-positive inmates to community care after release are being missed in the majority of prison systems and jails. PMID:24590942

Statistical analysis and handling of missing data in cluster randomized trials: a systematic review.

PubMed

Fiero, Mallorie H; Huang, Shuang; Oren, Eyal; Bell, Melanie L

2016-02-09

Cluster randomized trials (CRTs) randomize participants in groups, rather than as individuals and are key tools used to assess interventions in health research where treatment contamination is likely or if individual randomization is not feasible. Two potential major pitfalls exist regarding CRTs, namely handling missing data and not accounting for clustering in the primary analysis. The aim of this review was to evaluate approaches for handling missing data and statistical analysis with respect to the primary outcome in CRTs. We systematically searched for CRTs published between August 2013 and July 2014 using PubMed, Web of Science, and PsycINFO. For each trial, two independent reviewers assessed the extent of the missing data and method(s) used for handling missing data in the primary and sensitivity analyses. We evaluated the primary analysis and determined whether it was at the cluster or individual level. Of the 86 included CRTs, 80 (93%) trials reported some missing outcome data. Of those reporting missing data, the median percent of individuals with a missing outcome was 19% (range 0.5 to 90%). The most common way to handle missing data in the primary analysis was complete case analysis (44, 55%), whereas 18 (22%) used mixed models, six (8%) used single imputation, four (5%) used unweighted generalized estimating equations, and two (2%) used multiple imputation. Fourteen (16%) trials reported a sensitivity analysis for missing data, but most assumed the same missing data mechanism as in the primary analysis. Overall, 67 (78%) trials accounted for clustering in the primary analysis. High rates of missing outcome data are present in the majority of CRTs, yet handling missing data in practice remains suboptimal. Researchers and applied statisticians should carry out appropriate missing data methods, which are valid under plausible assumptions in order to increase statistical power in trials and reduce the possibility of bias. Sensitivity analysis should be performed, with weakened assumptions regarding the missing data mechanism to explore the robustness of results reported in the primary analysis.

Update on antimicrobial resistance.

PubMed

Weber, Carol J

2005-02-01

WHO experts believe that antimicrobial resistance is potentially containable, but the window of opportunity to control and eventually eliminate the most dangerous infectious diseases is closing. If we miss our opportunity, it may become very difficult and expensive--and in some cases impossible--to treat infectious diseases. WHO's global strategy to contain antimicrobial resistance requires a massive effort and an alliance among countries, governments, international organizations, drug manufacturers, and private and public health care sectors. If infectious diseases are fought wisely and widely by the international community, drug resistance can be controlled and lives saved.

How to deal with missing longitudinal data in cost of illness analysis in Alzheimer's disease-suggestions from the GERAS observational study.

PubMed

Belger, Mark; Haro, Josep Maria; Reed, Catherine; Happich, Michael; Kahle-Wrobleski, Kristin; Argimon, Josep Maria; Bruno, Giuseppe; Dodel, Richard; Jones, Roy W; Vellas, Bruno; Wimo, Anders

2016-07-18

Missing data are a common problem in prospective studies with a long follow-up, and the volume, pattern and reasons for missing data may be relevant when estimating the cost of illness. We aimed to evaluate the effects of different methods for dealing with missing longitudinal cost data and for costing caregiver time on total societal costs in Alzheimer's disease (AD). GERAS is an 18-month observational study of costs associated with AD. Total societal costs included patient health and social care costs, and caregiver health and informal care costs. Missing data were classified as missing completely at random (MCAR), missing at random (MAR) or missing not at random (MNAR). Simulation datasets were generated from baseline data with 10-40 % missing total cost data for each missing data mechanism. Datasets were also simulated to reflect the missing cost data pattern at 18 months using MAR and MNAR assumptions. Naïve and multiple imputation (MI) methods were applied to each dataset and results compared with complete GERAS 18-month cost data. Opportunity and replacement cost approaches were used for caregiver time, which was costed with and without supervision included and with time for working caregivers only being costed. Total costs were available for 99.4 % of 1497 patients at baseline. For MCAR datasets, naïve methods performed as well as MI methods. For MAR, MI methods performed better than naïve methods. All imputation approaches were poor for MNAR data. For all approaches, percentage bias increased with missing data volume. For datasets reflecting 18-month patterns, a combination of imputation methods provided more accurate cost estimates (e.g. bias: -1 % vs -6 % for single MI method), although different approaches to costing caregiver time had a greater impact on estimated costs (29-43 % increase over base case estimate). Methods used to impute missing cost data in AD will impact on accuracy of cost estimates although varying approaches to costing informal caregiver time has the greatest impact on total costs. Tailoring imputation methods to the reason for missing data will further our understanding of the best analytical approach for studies involving cost outcomes.

Factors associated with failure to screen newborns for retinopathy of prematurity.

PubMed

Bain, Lisa Charo; Dudley, R Adams; Gould, Jeffrey B; Lee, Henry C

2012-11-01

To evaluate ROP screening rates in a population-based cohort; and to identify characteristics of patients that were missed. We used the California Perinatal Quality Care Collaborative data from 2005-2007 for a cross-sectional study. Using eligibility criteria, screening rates were calculated for each hospital. Multivariable regression was used to assess associations between patient clinical and sociodemographic factors and the odds of missing screening. Overall rates of missed ROP screening decreased from 18.6% in 2005 to 12.8% in 2007. Higher gestational age (OR = 1.25 for increase of 1 week, 95% CI, 1.21-1.29), higher birth weight (OR = 1.13; 95% CI, 1.10-1.15), and singleton birth (OR = 1.2; 95% CI, 1.07-1.34) were associated with higher probability of missing screening. Level II neonatal intensive care units and neonatal intensive care units with lower volume were more likely to miss screenings. Although ROP screening rates improved over time, larger and older infants are at risk for not receiving screening. Furthermore, large variations in screening rates exist among hospitals in California. Identification of gaps in quality of care creates an opportunity to improve ROP screening rates and prevent impaired vision in this vulnerable population. Copyright © 2012 Mosby, Inc. All rights reserved.

Making an unknown unknown a known unknown: Missing data in longitudinal neuroimaging studies.

PubMed

Matta, Tyler H; Flournoy, John C; Byrne, Michelle L

2017-10-28

The analysis of longitudinal neuroimaging data within the massively univariate framework provides the opportunity to study empirical questions about neurodevelopment. Missing outcome data are an all-to-common feature of any longitudinal study, a feature that, if handled improperly, can reduce statistical power and lead to biased parameter estimates. The goal of this paper is to provide conceptual clarity of the issues and non-issues that arise from analyzing incomplete data in longitudinal studies with particular focus on neuroimaging data. This paper begins with a review of the hierarchy of missing data mechanisms and their relationship to likelihood-based methods, a review that is necessary not just for likelihood-based methods, but also for multiple-imputation methods. Next, the paper provides a series of simulation studies with designs common in longitudinal neuroimaging studies to help illustrate missing data concepts regardless of interpretation. Finally, two applied examples are used to demonstrate the sensitivity of inferences under different missing data assumptions and how this may change the substantive interpretation. The paper concludes with a set of guidelines for analyzing incomplete longitudinal data that can improve the validity of research findings in developmental neuroimaging research. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Past and future implications of near-misses and their emotional consequences.

PubMed

Zhang, Qiyuan; Covey, Judith

2014-01-01

The Reflection and Evaluation Model (REM) of comparative thinking predicts that temporal perspective could moderate people's emotional reactions to close counterfactuals following near-misses (Markman & McMullen, 2003). The experiments reported in this paper tested predictions derived from this theory by examining how people's emotional reactions to a near-miss at goal during a football match (Experiment 1) or a close score in a TV game show (Experiment 2) depended on the level of perceived future possibility. In support of the theory it was found that the presence of future possibility enhanced affective assimilation (e.g., if the near-miss occurred at the beginning of the game the players who had nearly scored were hopeful of future success) whereas the absence of future possibility enhanced affective contrast (e.g., if the near-miss occurred at the end of the game the players who had nearly scored were disappointed about missing an opportunity). Furthermore the experiments built upon our theoretical understanding by exploring the mechanisms which produce assimilation and contrast effects. In Experiment 1 we examined the incidence of present-oriented or future-oriented thinking, and in Experiment 2 we examined the mediating role of counterfactual thinking in the observed effect of proximity on emotions by testing whether stronger counterfactuals (measured using counterfactual probability estimates) produce bigger contrast and assimilation effects. While the results of these investigations generally support the REM, they also highlight the necessity to consider other psychological mechanisms (e.g., social comparison), in addition to counterfactual thinking, that might contribute to the emotional consequences of near-miss outcomes.

The association between nurse staffing and omissions in nursing care: A systematic review.

PubMed

Griffiths, Peter; Recio-Saucedo, Alejandra; Dall'Ora, Chiara; Briggs, Jim; Maruotti, Antonello; Meredith, Paul; Smith, Gary B; Ball, Jane

2018-03-08

To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing. Research has established associations between nurse staffing levels and adverse patient outcomes including in-hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy. Systematic review. We searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles. Two reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were abstracted on study design, missed care prevalence and measures of association. Synthesis was narrative. Eighteen studies gave subjective reports of missed care. Seventy-five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care. Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Key terms for the assessment of the safety of vaccines in pregnancy: Results of a global consultative process to initiate harmonization of adverse event definitions.

PubMed

Munoz, Flor M; Eckert, Linda O; Katz, Mark A; Lambach, Philipp; Ortiz, Justin R; Bauwens, Jorgen; Bonhoeffer, Jan

2015-11-25

The variability of terms and definitions of Adverse Events Following Immunization (AEFI) represents a missed opportunity for optimal monitoring of safety of immunization in pregnancy. In 2014, the Brighton Collaboration Foundation and the World Health Organization (WHO) collaborated to address this gap. Two Brighton Collaboration interdisciplinary taskforces were formed. A landscape analysis included: (1) a systematic literature review of adverse event definitions used in vaccine studies during pregnancy; (2) a worldwide stakeholder survey of available terms and definitions; (3) and a series of taskforce meetings. Based on available evidence, taskforces proposed key terms and concept definitions to be refined, prioritized, and endorsed by a global expert consultation convened by WHO in Geneva, Switzerland in July 2014. Using pre-specified criteria, 45 maternal and 62 fetal/neonatal events were prioritized, and key terms and concept definitions were endorsed. In addition recommendations to further improve safety monitoring of immunization in pregnancy programs were specified. This includes elaboration of disease concepts into standardized case definitions with sufficient applicability and positive predictive value to be of use for monitoring the safety of immunization in pregnancy globally, as well as the development of guidance, tools, and datasets in support of a globally concerted approach. There is a need to improve the safety monitoring of immunization in pregnancy programs. A consensus list of terms and concept definitions of key events for monitoring immunization in pregnancy is available. Immediate actions to further strengthen monitoring of immunization in pregnancy programs are identified and recommended. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Missing data in trial‐based cost‐effectiveness analysis: An incomplete journey

PubMed Central

Gomes, Manuel; Carpenter, James R.

2018-01-01

SUMMARY Cost‐effectiveness analyses (CEA) conducted alongside randomised trials provide key evidence for informing healthcare decision making, but missing data pose substantive challenges. Recently, there have been a number of developments in methods and guidelines addressing missing data in trials. However, it is unclear whether these developments have permeated CEA practice. This paper critically reviews the extent of and methods used to address missing data in recently published trial‐based CEA. Issues of the Health Technology Assessment journal from 2013 to 2015 were searched. Fifty‐two eligible studies were identified. Missing data were very common; the median proportion of trial participants with complete cost‐effectiveness data was 63% (interquartile range: 47%–81%). The most common approach for the primary analysis was to restrict analysis to those with complete data (43%), followed by multiple imputation (30%). Half of the studies conducted some sort of sensitivity analyses, but only 2 (4%) considered possible departures from the missing‐at‐random assumption. Further improvements are needed to address missing data in cost‐effectiveness analyses conducted alongside randomised trials. These should focus on limiting the extent of missing data, choosing an appropriate method for the primary analysis that is valid under contextually plausible assumptions, and conducting sensitivity analyses to departures from the missing‐at‐random assumption. PMID:29573044

Reaching out to Multiple Risk Adolescents.

ERIC Educational Resources Information Center

Porter, Laura; Lindberg, Laura Duberstein

This brief describes multiple risk students and maps their links to settings such as the workplace, church, or the health care system. A secondary goal of the brief is to show that although high-risk students have contact with many social institutions, opportunities for interventions are being missed. Data from the 1995 National Longitudinal…

Middle School Foreign Language Instruction: A Missed Opportunity?

ERIC Educational Resources Information Center

Kissau, Scott; Adams, Mary Jo; Algozzine, Bob

2015-01-01

Multiple studies conducted over the past decade have suggested the motivational and proficiency-related benefits of commencing language instruction at an early age. Limitations in many of these studies, however, have prevented their results from being applied to the teaching of foreign languages in the United States. In response to calls for…

Thank You, Miss Katherine

ERIC Educational Resources Information Center

Compton, Cynthia

2008-01-01

Richmond Ballet's Mind in Motion program offers selected students an opportunity to take group dance lessons during 4th grade. Time taken away from academic instruction did not have a negative effect on standardized test scores and students reported feelings of greater success in school, more focus on school work, and greater ability to work with…

The Missing Middle: Aligning Education and the Knowledge Economy.

ERIC Educational Resources Information Center

Carnevale, Anthony P.; Desrochers, Donna M.

The growing importance of education in overall economic growth and individual opportunity has necessitated that education reformers address the need for the additional and better human capital needed to foster overall growth in the new knowledge-based economy. Education reformers must also work to reduce the growing differences in family incomes…

VA and DOD Health Care: Department-Level Actions Needed to Assess Collaboration Performance, Address Barriers, and Identify Opportunities

DTIC Science & Technology

2012-09-01

approximately 150 hospitals, 130 nursing homes, 800 community-based outpatient clinics, as well as other facilities to provide care to veterans. VA also...receive care and have to return for rescheduled appointments. Such missed appointments can lead to lost revenue for the military treatment facility

Explaining Differences in Age at Autism Spectrum Disorder Diagnosis: A Critical Review

ERIC Educational Resources Information Center

Daniels, Amy M.; Mandell, David S.

2014-01-01

The diagnosis of autism is often delayed, which translates into a missed opportunity to provide treatment during a critical developmental period. This study reviews studies that assessed factors associated with age at autism spectrum disorder diagnosis and provides recommendations on future research, programs, and policies to improve early…

Mental Health and Social Emotional Programming in Schools: Missing Link or Misappropriation?

ERIC Educational Resources Information Center

Even, Trigg A.; Quast, Heather L.

2017-01-01

While differences of opinion exist on whether mental health services fall within the scope of public education, schools may represent the best opportunity to provide young people with necessary access to mental health care. Professional school counselors are uniquely qualified by training and experience to address the mental health and social…

Mobile Learning in Medical Education: A Case Study through the Lens of Sleep Education

ERIC Educational Resources Information Center

Wells, Mary Ellen

2014-01-01

Sleep disorders affect millions of Americans and are directly associated with many deadly diseases, including neurological disorders. Despite this impact, sleep medicine education is not included in many U.S.-based neurology residency education programs, resulting in under-diagnosed patients and missed therapeutic opportunities. This study aims to…

Synthetic biology R&D risks: Social-institutional contexts matter!

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

Wolfe, Amy K.; Bjornstad, David J.; Shumpert, Barry L.

Social and institutional analyses currently are missing from considerations of synthetic biology R&D-related biosafety, which instead have bioethics, governance, or technical orientations. Social and institutional context shapes standard practice. Here, analyzing context helps identify circumstances that create, amplify, or diminish risk, thereby revealing new opportunities for avoiding or managing those risks.

Synthetic biology R&D risks: Social-institutional contexts matter!

DOE PAGES

Wolfe, Amy K.; Bjornstad, David J.; Shumpert, Barry L.; ...

2016-02-15

Social and institutional analyses currently are missing from considerations of synthetic biology R&D-related biosafety, which instead have bioethics, governance, or technical orientations. Social and institutional context shapes standard practice. Here, analyzing context helps identify circumstances that create, amplify, or diminish risk, thereby revealing new opportunities for avoiding or managing those risks.

Continuing Medical Education: What Delivery Format Do Physicians Prefer?

ERIC Educational Resources Information Center

Stancic, Nancy; Mullen, Patricia Dolan; Prokhorov, Alexander V.; Frankowski, Ralph F.; McAlister, Alfred L.

2003-01-01

Background: Although physicians are in a unique position to prevent life-threatening outcomes by counseling patients to stop smoking, many of them miss the opportunity to intervene in their patients' use of tobacco. Nicotine Dependence Across the Lifespan was developed as a continuing medical education (CME) program to teach and encourage…

Parents' Communication with Adolescents about Sexual Behavior: A Missed Opportunity for Prevention?

ERIC Educational Resources Information Center

Eisenberg, Marla E.; Sieving, Renee E.; Bearinger, Linda H.; Swain, Carolyne; Resnick, Michael D.

2006-01-01

Parents may wait to talk to their teens about sexuality until they believe their child is in a romantic relationship. To examine this, telephone surveys were conducted with 1069 parents of adolescents. Measures assessed parents' perception of teens' romantic involvement and parent-child communication about several sexuality topics. Multivariable…

Resilient Transportation Systems in a Post-Disaster Environment: A Case Study of Opportunities Realized and Missed in New Orleans and the Louisiana Coastal Region

DOT National Transportation Integrated Search

2010-10-01

Based upon our research in Post-Katrina New Orleans, we define transportation resiliency as a systems ability to function before, during and after major disruptions through reliance upon multiple mobility options. The importance of a resilient tra...

Missed Opportunities: Shoulda, Coulda, Woulda

ERIC Educational Resources Information Center

Slusser, Laura L.

2011-01-01

The author's first school librarian position was in her hometown elementary school where she had been a library aide in the fifth grade. The principal spelled out the problems with the situation she would be entering--the school library was the least favorite of the resources, many policies and procedures were antiquated, and the collection needed…

Heterozygous mapping strategy (HetMapps)for high resolution genotyping-by-sequencing markers: a case study in grapevine

USDA-ARS?s Scientific Manuscript database

Genotyping by sequencing (GBS) provides opportunities to generate high-resolution genetic maps at a low per-sample genotyping cost, but missing data and under-calling of heterozygotes complicate the creation of GBS linkage maps for highly heterozygous species. To overcome these issues, we developed ...

76 FR 20438 - Proposed Model Performance Measures for State Traffic Records Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-12

... what data elements are critical. States should take advantage of these decision-making opportunities to... single database. Error means the recorded value for some data element of interest is incorrect. Error... into the database) and the number of missing (blank) data elements in the records that are in a...

Missed Opportunities to Keep Children Safe? National Survey of Injury Prevention Activities of Children's Centres

ERIC Educational Resources Information Center

Watson, Michael Craig; Mulvaney, Caroline; Timblin, Clare; Stewart, Jane; Coupland, Carol A.; Deave, Toity; Hayes, Mike; Kendrick, Denise

2016-01-01

Objective: To ascertain the activities undertaken by children's centres to prevent unintentional injuries in the under-fives and, in particular, the prevention of falls, poisoning and scalds. Design: A questionnaire was posted to managers of 851 children's centres, using stratified cluster sampling. The questionnaire included questions on injury…

A Picture Is Worth a Thousand Words: Applying Image-Based Learning to Course Design

ERIC Educational Resources Information Center

Whitley, Cameron T.

2013-01-01

Although images are often used in the classroom to communicate difficult concepts, students have little input into their selection and application. This approach can create a passive experience for students and represents a missed opportunity for instructors to engage participation. By applying concepts found in visual sociology to techniques…

Professionalising the Early Childhood Workforce in England: Work in Progress or Missed Opportunity?

ERIC Educational Resources Information Center

Lloyd, Eva; Hallet, Elaine

2010-01-01

This article considers policies and strategies employed to professionalise the early childhood workforce in England since the Labour government took office in 1997. The term "professionalisation" is associated here with moves towards creating a graduate early years workforce, which could have implications for training, pay and employment…

Miss Willie and Nora Bonesteel: Teaching in Cyberspace.

ERIC Educational Resources Information Center

Atwell, Nedra Wheeler

Two of the author's favorite Appalachian women serve as thought mentors to help see the practical and educational opportunities available in cyberspace for meeting the critical shortage of teachers serving the Appalachian women and children of today. In classrooms and homes throughout Appalachia, women and children are logging on to computers to…

Educating for Environmental Sustainability and Educating for Creativity: Actively Compatible or Missed Opportunities?

ERIC Educational Resources Information Center

Stables, Kay

2009-01-01

This paper identifies the importance of both creativity and environmental sustainability for developing individual learners and society as a whole. It suggests that sometimes these two concepts appear to be in tension and that, politically, each is often championed by different communities. The relationship between creativity and environmental…

Using Print in the Environment to Promote Early Writing

ERIC Educational Resources Information Center

Gerde, Hope K.; Goetsch, Megan E.; Bingham, Gary E.

2016-01-01

Print in the environment is typically posted in early childhood classrooms. However, the print that exists is often not meaningful to children, and teachers rarely engage children in using the print. This is a missed opportunity to support children's writing. This article presents research-based ideas for engaging children with meaningful print in…

Professionalizing the Practice of Public Policy in the Prevention of Violence

ERIC Educational Resources Information Center

Dodge, Kenneth A.

2006-01-01

The State of the Science Conference Statement on "Preventing Violence and Related Health-Risking Social Behaviors in Adolescents" accurately summarizes the state of knowledge regarding risk factors for violence and intervention efficacy. The Statement missed an opportunity, however, to move the field of prevention practice and policy forward by…

Four of Ogden Lindsley's Unpublished Presentation Summaries

ERIC Educational Resources Information Center

Starlin, Clay M.

2010-01-01

As one might expect from the founder of Precision Teaching, Ogden Lindsley was precise in creating the summaries of his presentations. Ogden took the opportunity to share his latest thinking on a topic in his presentations. However, because the presentation summaries have not been published, many people have missed the advantage of this knowledge.…

Nearly One-Third Of Enrollees In California's Individual Market Missed Opportunities To Receive Financial Assistance.

PubMed

Fung, Vicki; Liang, Catherine Y; Donelan, Karen; Peitzman, Cassandra G K; Dow, William H; Zaslavsky, Alan M; Fireman, Bruce; Derose, Stephen F; Chernew, Michael E; Newhouse, Joseph P; Hsu, John

2017-01-01

The Affordable Care Act includes financial assistance that reduces both premiums and cost-sharing amounts for lower-income Americans, to increase the affordability of health insurance coverage and care. To receive both types of assistance, enrollees must purchase a qualified health plan through a public insurance exchange, and those eligible for the cost-sharing reduction must purchase a silver-tier plan. We estimate that 31 percent of individual-market enrollees in California who were likely eligible for financial assistance purchased plans that were not silver tier or that were not sold on the state's exchange and thus missed opportunities to receive premium or cost-sharing assistance or both. Lower-income enrollees who chose plans not eligible for subsidies had two to three times higher odds of reporting difficulty paying premiums and out-of-pocket expenses during the year, compared to those who chose eligible plans. Regardless of how the structure of the individual market evolves in the coming years, efforts are likely needed to steer lower-income enrollees away from financially suboptimal plan choices. Project HOPE—The People-to-People Health Foundation, Inc.

The Marseille Observatory 1860-1920: missed opportunities and elebrated achievements

NASA Astrophysics Data System (ADS)

Caplan, James

2001-10-01

After summarizing the early history of the Marseille Observatory (founded by the Jesuits and operational in 1702), I describe the circumstances leading to the takeover by Le Verrier in the 1860s. The observatory was rebuilt on the Plateau Longchamp and new instruments were installed, most notably the 80-cm Foucault glass-mirror telescope. The work of the new observatory is then presented, and the instruments described, starting with the Le Verrier period and continuing through the long directorship of Stephan, and then Bourget. The overall success of the observatory in its Longchamp site was due in part to the assiduous pursuit of routine observations and to the discovery of comets and asteroids, combined with the `exploratory' observations of `nebulae' by Stephan. In addition, the first stellar interferometry observations, and the first applications of the Fabry-Perot interferometer to nebular observations, were important achievements. On the other hand, the failure in the beginning of the twentieth century to adapt the telescopes to photography condemned the observatory to a long period of missed opportunities, from which it did not recover for several decades.

Minimax Rate-optimal Estimation of High-dimensional Covariance Matrices with Incomplete Data*

PubMed Central

Cai, T. Tony; Zhang, Anru

2016-01-01

Missing data occur frequently in a wide range of applications. In this paper, we consider estimation of high-dimensional covariance matrices in the presence of missing observations under a general missing completely at random model in the sense that the missingness is not dependent on the values of the data. Based on incomplete data, estimators for bandable and sparse covariance matrices are proposed and their theoretical and numerical properties are investigated. Minimax rates of convergence are established under the spectral norm loss and the proposed estimators are shown to be rate-optimal under mild regularity conditions. Simulation studies demonstrate that the estimators perform well numerically. The methods are also illustrated through an application to data from four ovarian cancer studies. The key technical tools developed in this paper are of independent interest and potentially useful for a range of related problems in high-dimensional statistical inference with missing data. PMID:27777471

Minimax Rate-optimal Estimation of High-dimensional Covariance Matrices with Incomplete Data.

PubMed

Cai, T Tony; Zhang, Anru

2016-09-01

Missing data occur frequently in a wide range of applications. In this paper, we consider estimation of high-dimensional covariance matrices in the presence of missing observations under a general missing completely at random model in the sense that the missingness is not dependent on the values of the data. Based on incomplete data, estimators for bandable and sparse covariance matrices are proposed and their theoretical and numerical properties are investigated. Minimax rates of convergence are established under the spectral norm loss and the proposed estimators are shown to be rate-optimal under mild regularity conditions. Simulation studies demonstrate that the estimators perform well numerically. The methods are also illustrated through an application to data from four ovarian cancer studies. The key technical tools developed in this paper are of independent interest and potentially useful for a range of related problems in high-dimensional statistical inference with missing data.

Using natural selection and optimization for smarter vegetation models - challenges and opportunities

NASA Astrophysics Data System (ADS)

Franklin, Oskar; Han, Wang; Dieckmann, Ulf; Cramer, Wolfgang; Brännström, Åke; Pietsch, Stephan; Rovenskaya, Elena; Prentice, Iain Colin

2017-04-01

Dynamic global vegetation models (DGVMs) are now indispensable for understanding the biosphere and for estimating the capacity of ecosystems to provide services. The models are continuously developed to include an increasing number of processes and to utilize the growing amounts of observed data becoming available. However, while the versatility of the models is increasing as new processes and variables are added, their accuracy suffers from the accumulation of uncertainty, especially in the absence of overarching principles controlling their concerted behaviour. We have initiated a collaborative working group to address this problem based on a 'missing law' - adaptation and optimization principles rooted in natural selection. Even though this 'missing law' constrains relationships between traits, and therefore can vastly reduce the number of uncertain parameters in ecosystem models, it has rarely been applied to DGVMs. Our recent research have shown that optimization- and trait-based models of gross primary production can be both much simpler and more accurate than current models based on fixed functional types, and that observed plant carbon allocations and distributions of plant functional traits are predictable with eco-evolutionary models. While there are also many other examples of the usefulness of these and other theoretical principles, it is not always straight-forward to make them operational in predictive models. In particular on longer time scales, the representation of functional diversity and the dynamical interactions among individuals and species presents a formidable challenge. Here we will present recent ideas on the use of adaptation and optimization principles in vegetation models, including examples of promising developments, but also limitations of the principles and some key challenges.

Spatial Heterogeneity in the Strength of Plant-Herbivore Interactions under Predation Risk: The Tale of Bison Foraging in Wolf Country

PubMed Central

Harvey, Léa; Fortin, Daniel

2013-01-01

Spatial heterogeneity in the strength of trophic interactions is a fundamental property of food web spatial dynamics. The feeding effort of herbivores should reflect adaptive decisions that only become rewarding when foraging gains exceed 1) the metabolic costs, 2) the missed opportunity costs of not foraging elsewhere, and 3) the foraging costs of anti-predator behaviour. Two aspects of these costs remain largely unexplored: the link between the strength of plant-herbivore interactions and the spatial scale of food-quality assessment, and the predator-prey spatial game. We modeled the foraging effort of free-ranging plains bison (Bison bison bison) in winter, within a mosaic of discrete meadows. Spatial patterns of bison herbivory were largely driven by a search for high net energy gains and, to a lesser degree, by the spatial game with grey wolves (Canis lupus). Bison decreased local feeding effort with increasing metabolic and missed opportunity costs. Bison herbivory was most consistent with a broad-scale assessment of food patch quality, i.e., bison grazed more intensively in patches with a low missed opportunity cost relative to other patches available in the landscape. Bison and wolves had a higher probability of using the same meadows than expected randomly. This co-occurrence indicates wolves are ahead in the spatial game they play with bison. Wolves influenced bison foraging at fine scale, as bison tended to consume less biomass at each feeding station when in meadows where the risk of a wolf's arrival was relatively high. Also, bison left more high-quality vegetation in large than small meadows. This behavior does not maximize their energy intake rate, but is consistent with bison playing a shell game with wolves. Our assessment of bison foraging in a natural setting clarifies the complex nature of plant-herbivore interactions under predation risk, and reveals how spatial patterns in herbivory emerge from multi-scale landscape heterogeneity. PMID:24039909

Symptomatic Patients without Epidemiological Indicators of HIV Have a High Risk of Missed Diagnosis: A Multi-Centre Cross Sectional Study.

PubMed

Brännström, Johanna; Svedhem, Veronica; Marrone, Gaetano; Andersson, Örjan; Azimi, Farshad; Blaxhult, Anders; Sönnerborg, Anders

2016-01-01

One quarter of HIV-1 positive individuals in Sweden present for care with HIV or AIDS associated conditions without an HIV test (missed presentations) and 16% report neglect of such symptoms. The objective of this study was to identify risk factors for these missed opportunities of HIV-1 diagnosis. A national study, recruiting 409 newly diagnosed HIV-1 infected adults over a 2.5-year period, was performed. Logistic regression models tested the relationship between missed presentation and patient's neglect versus socio-demographic and behavioural risk factors. Additionally the initiator of the HIV test was assessed. The odds for a missed presentation was lower for migrants (from East Europe, Asia, and Pacific (East): OR 0.4 (0.2-0.8); Sub-Saharan Africa (SSA): 0.3 (0.2-0.6); other: 0.5 (0.2-1.0)), compared to patients born in Sweden, just as symptoms neglected by the patient (East (0.3 (0.1-1.0); SSA (0.4 (0.2-0.8)). The latter was also lower for men who have sex with men (0.5 (0.2-1.0)), compared to patients infected heterosexually. Patients infected in the East, with present/previous substance use or a previous negative HIV test were more likely to take the initiative to test on their own, whereas those >50 years and with a previously missed presentation had significantly reduced odds, p<0.05. Individuals without epidemiological indicators of HIV are more likely to have a history of missed presentations, to neglect symptoms and are less prone to take an initiative to test for HIV themselves. It is important to further implement testing to include all patients with symptoms and conditions indicative of HIV.

Appointment keeping for medical review among patients with selected chronic diseases in an urban area of Uganda

PubMed Central

Kalyango, Joan Nakayaga; Hall, Maurice; Karamagi, Charles

2014-01-01

Introduction Proper management of chronic diseases is important for prevention of disease complications and yet some patients miss appointments for medical review thereby missing the opportunity for proper monitoring of their disease conditions. There is limited information on missed appointments among chronic disease patients in resource limited settings. This study aimed to determine the prevalence of missed appointments for medical review and associated factors among chronic disease patients in an urban area of Uganda. Methods Patients or caregivers of children with chronic diseases were identified as they bought medicines from a community pharmacy. They were visited at home to access their medical documents and those whose chronic disease status was ascertained were enrolled. The data was collected using: questionnaires, review of medical documents, and in-depth interviews with chronic disease patients. Results The prevalence of missed appointments was 42% (95%CI = 35-49%). The factors associated with missed appointments were: monthly income ≤30US Dollars (OR = 2.56, CI = 1.25–5.26), affording less than half of prescribed drugs (OR = 3.92, CI = 1.64–9.40), not experiencing adverse events (OR = 2.66, CI = 1.26–5.61), not sure if treatment helps (OR = 2.84, CI = 1.047.77), not having a medicines administration schedule (OR = 6.77, CI = 2.11–21.68), and increasing number of drugs (OR = 0.72, CI = 0.53–0.98). Conclusion Patients missed appointments mainly due to: financial and health system barriers, conflicting commitments with appointments, and perceptions of the disease condition. Patients should be supported with accessible and affordable health services. PMID:25838857

A cross sectional study of maternal 'near-miss' cases in major public hospitals in Egypt, Lebanon, Palestine and Syria.

PubMed

Bashour, Hyam; Saad-Haddad, Ghada; DeJong, Jocelyn; Ramadan, Mohammed Cherine; Hassan, Sahar; Breebaart, Miral; Wick, Laura; Hassanein, Nevine; Kharouf, Mayada

2015-11-13

The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria. We conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection. A total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6%) and Dar Al Tawleed hospital in Syria (14.3%), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO's Multicountry Survey using the same data collection tool, our study's mortality indices are higher than the index of 5.6% among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1%) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals. Findings from this formative stage confirmed the need for quality improvement interventions. The high reported coverage of the main clinical interventions in the study hospitals would appear to be in contradiction with the above findings as the level of coverage of key evidence-based interventions was high.

Bottlenecks in the implementation of essential screening tests in antenatal care: Syphilis, HIV, and anemia testing in rural Tanzania and Uganda.

PubMed

Baker, Ulrika; Okuga, Monica; Waiswa, Peter; Manzi, Fatuma; Peterson, Stefan; Hanson, Claudia

2015-06-01

To identify and compare implementation bottlenecks for effective coverage of screening for syphilis, HIV, and anemia in antenatal care in rural Tanzania and Uganda; and explore the underlying determinants and perceived solutions to overcome these bottlenecks. In this multiple case study, we analyzed data collected as part of the Expanded Quality Management Using Information Power (EQUIP) project between November 2011 and April 2014. Indicators from household interviews (n=4415 mothers) and health facility surveys (n=122) were linked to estimate coverage in stages of implementation between which bottlenecks can be identified. Key informant interviews (n=15) were conducted to explore underlying determinants and analyzed using a framework approach. Large differences in implementation were found within and between countries. Availability and effective coverage was significantly lower for all tests in Uganda compared with Tanzania. Syphilis screening had the lowest availability and effective coverage in both countries. The main implementation bottleneck was poor availability of tests and equipment. Key informant interviews validated these findings and perceived solutions included the need for improved procurement at the central level. Our findings reinforce essential screening as a missed opportunity, caused by a lack of integration of funding and support for comprehensive antenatal care programs. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Microbially Induced Sedimentary Structures Recording an Ancient Ecosystem in the ca. 3.48 Billion-Year-Old Dresser Formation, Pilbara, Western Australia

PubMed Central

Christian, Daniel; Wacey, David; Hazen, Robert M.

2013-01-01

Abstract Microbially induced sedimentary structures (MISS) result from the response of microbial mats to physical sediment dynamics. MISS are cosmopolitan and found in many modern environments, including shelves, tidal flats, lagoons, riverine shores, lakes, interdune areas, and sabkhas. The structures record highly diverse communities of microbial mats and have been reported from numerous intervals in the geological record up to 3.2 billion years (Ga) old. This contribution describes a suite of MISS from some of the oldest well-preserved sedimentary rocks in the geological record, the early Archean (ca. 3.48 Ga) Dresser Formation, Western Australia. Outcrop mapping at the meter to millimeter scale defined five sub-environments characteristic of an ancient coastal sabkha. These sub-environments contain associations of distinct macroscopic and microscopic MISS. Macroscopic MISS include polygonal oscillation cracks and gas domes, erosional remnants and pockets, and mat chips. Microscopic MISS comprise tufts, sinoidal structures, and laminae fabrics; the microscopic laminae are composed of primary carbonaceous matter, pyrite, and hematite, plus trapped and bound grains. Identical suites of MISS occur in equivalent environmental settings through the entire subsequent history of Earth including the present time. This work extends the geological record of MISS by almost 300 million years. Complex mat-forming microbial communities likely existed almost 3.5 billion years ago. Key Words: Archean—Biofilms—Microbial mats—Early Earth—Evolution. Astrobiology 13, 1103–1124. PMID:24205812

Cognitive distortions and gambling near-misses in Internet Gaming Disorder: A preliminary study

PubMed Central

Sescousse, Guillaume; Yu, Hongbo; Clark, Luke; Li, Hong

2018-01-01

Increased cognitive distortions (i.e. biased processing of chance, probability and skill) are a key psychopathological process in disordered gambling. The present study investigated state and trait aspects of cognitive distortions in 22 individuals with Internet Gaming Disorder (IGD) and 22 healthy controls. Participants completed the Gambling Related Cognitions Scale as a trait measure of cognitive distortions, and played a slot machine task delivering wins, near-misses and full-misses. Ratings of pleasure (“liking”) and motivation to play (“wanting”) were taken following the different outcomes, and gambling persistence was measured after a mandatory phase. IGD was associated with elevated trait cognitive distortions, in particular skill-oriented cognitions. On the slot machine task, the IGD group showed increased “wanting” ratings compared with control participants, while the two groups did not differ regarding their “liking” of the game. The IGD group displayed increased persistence on the slot machine task. Near-miss outcomes did not elicit stronger motivation to play compared to full-miss outcomes overall, and there was no group difference on this measure. However, a near-miss position effect was observed, such that near-misses stopping before the payline were rated as more motivating than near-misses that stopped after the payline, and this differentiation was attenuated in the IGD group, suggesting possible counterfactual thinking deficits in this group. These data provide preliminary evidence for increased incentive motivation and cognitive distortions in IGD, at least in the context of a chance-based gambling environment. PMID:29346434

Cognitive distortions and gambling near-misses in Internet Gaming Disorder: A preliminary study.

PubMed

Wu, Yin; Sescousse, Guillaume; Yu, Hongbo; Clark, Luke; Li, Hong

2018-01-01

Increased cognitive distortions (i.e. biased processing of chance, probability and skill) are a key psychopathological process in disordered gambling. The present study investigated state and trait aspects of cognitive distortions in 22 individuals with Internet Gaming Disorder (IGD) and 22 healthy controls. Participants completed the Gambling Related Cognitions Scale as a trait measure of cognitive distortions, and played a slot machine task delivering wins, near-misses and full-misses. Ratings of pleasure ("liking") and motivation to play ("wanting") were taken following the different outcomes, and gambling persistence was measured after a mandatory phase. IGD was associated with elevated trait cognitive distortions, in particular skill-oriented cognitions. On the slot machine task, the IGD group showed increased "wanting" ratings compared with control participants, while the two groups did not differ regarding their "liking" of the game. The IGD group displayed increased persistence on the slot machine task. Near-miss outcomes did not elicit stronger motivation to play compared to full-miss outcomes overall, and there was no group difference on this measure. However, a near-miss position effect was observed, such that near-misses stopping before the payline were rated as more motivating than near-misses that stopped after the payline, and this differentiation was attenuated in the IGD group, suggesting possible counterfactual thinking deficits in this group. These data provide preliminary evidence for increased incentive motivation and cognitive distortions in IGD, at least in the context of a chance-based gambling environment.

Study of the Martian Subsurface with a Fiber Optics Spectrometer: the Ma_Miss Experiment

NASA Astrophysics Data System (ADS)

Coradini, A.; de Sanctis, M. C.; Ammannito, E.; Boccaccini, A.; Battistelli, E.; Capanni, A.

2009-04-01

In this presentation is described the investigation that we intend to do with a small imaging spectrometer that will be inserted in the drill of the Exomars- Pasteur rover. This spectrometer is named Ma_miss (Mars Multispectral Imager for Subsurface Studies ). The Ma_Miss experiment is located in the drill ,that will be able to make a hole in the Mars soil and rock up to 2 m. Ma_Miss includes the optical head of the spectrometer, a lamp to illuminate the borehole walls, and the optical fiber that brings the signal to the spectrometer. The multispectral images are acquired by means of a sapphire window placed on the lateral wall of the drill tool, as close as possible to the drill head. The images are gathered by means of an optical fibre system and analyzed using the spectrometer. The Ma_Miss gathered light containing the scientific information is transferred to the array detector and electronics of the instrument by means of an optical rotary joint implemented in the roto-translation group of the drill, as shown in the next pictures In the figure is schematically represented the Ma_Miss- Dibs architecture. This experiment will be extremely valuable since it will allow, for the first time, to have an idea of the mineralogical composition of the Martian subsurface and to study freshly cut rocks. The study of surface and subsurface mineralogy of Martian soil and rocks is the key for understanding the chemico-physical processes that led to the formation and evolution of the Red Planet. The history of the water and other volatiles, as well as the signatures of weathering processes are important to understand present and past environmental conditions associated with the possibility of life. Surface samples are highly influenced by exogenous processes (weathering, erosion, sedimentation, impact) that alter their original properties. So, the analyses of uncontaminated samples by means of instrumented drills and in situ analytic stations are the key for unambiguous interpretation of the original environment that leading to the formation of rocks. Analysis of subsurface layers is the only approach that warranties measurements on samples close to their original composition. The upper few meters of the surface materials on Mars play a crucial role in its history, providing important constraints geologic, hydrologic, and climatic to the history of the planet. Drilling into the near-surface crust will provide an opportunity to assess variations in composition, texture, stratification, unconformities, etc. that will help define its lithology and structure, and provide important clues regarding its origin and subsequent evolution. The subsurface material can give information on the evolution of surface sediments (erosion, transport, deposition), on the relation between sediments and bedrock, on the relation between environmental conditions and surface processes permitting to "investigate planetary processes that influence habitability." Investigation of mineralogical composition of near-surface geological materials is needed to fully characterize the geology of the regions that will be visited by the Rover at all appropriate spatial scales, and to interpret the processes that have formed and modified rocks and regolith. Subsurface access, sampling material below the oxidized layer, can be the key to "assess the biological potential of the target environment (past or present)". To date, we have direct observations relative only to the Martian surface. Little is known about the characteristics of the first subsurface layers. The possibility to sample subsurface materials to be delivered to other instruments, and to record the context of the sampled soil doing in situ borehole mineralogical analysis, is fundamental to search for traces of past or present life on Mars. The spectrometer observes a single point target, having 0.1 mm diameter, on the borehole wall surface. Depending on the surface features we are interested in, the observation window can scan the borehole's surface by means of drill tip rotation or translation. When the drill is translated, a "Column Image" is acquired. This translation step can be equal to the observation spot (0.1 mm). The "Ring Image" can be obtained by rotation of the drill tip; a rotation step of about 0.5˚ (corresponding to 720 acquisitions in the ring) is sufficient to assure the full coverage of the ring.

Quantitative proteomic analysis in breast cancer.

PubMed

Tabchy, A; Hennessy, B T; Gonzalez-Angulo, A M; Bernstam, F M; Lu, Y; Mills, G B

2011-02-01

Much progress has recently been made in the genomic and transcriptional characterization of tumors. However, historically the characterization of cells at the protein level has suffered limitations in reproducibility, scalability and robustness. Recent technological advances have made it possible to accurately and reproducibly portray the global levels and active states of cellular proteins. Protein microarrays examine the native post-translational conformations of proteins including activated phosphorylated states, in a comprehensive high-throughput mode, and can map activated pathways and networks of proteins inside the cells. The reverse-phase protein microarray (RPPA) offers a unique opportunity to study signal transduction networks in small biological samples such as human biopsy material and can provide critical information for therapeutic decision-making and the monitoring of patients for targeted molecular medicine. By providing the key missing link to the story generated from genomic and gene expression characterization efforts, functional proteomics offer the promise of a comprehensive understanding of cancer. Several initial successes in breast cancer are showing that such information is clinically relevant. Copyright 2011 Prous Science, S.A.U. or its licensors. All rights reserved.

The making of an entrepreneurial science: biotechnology in Britain, 1975-1995.

PubMed

de Chadarevian, Soraya

2011-12-01

Monoclonal antibodies played a key role in the development of the biotechnology industry of the 1980s and 1990s. Investments in the sector and commercial returns have rivaled those of recombinant DNA technologies. Although the monoclonal antibody technology was first developed in Britain, the first patents were taken out by American scientists. During the first Thatcher government in Britain, blame for the missed opportunity fell on the scientists involved as well as on the National Research and Development Corporation, which had been put in place after World War II to avoid a repeat of the penicillin story, when patent rights were not sought. Instead of apportioning the blame, this essay suggests that despite past experiences and despite the new channels that were in place, Britain was not in a "patent culture" in the 1970s. It traces the long and painful process that made a commercial attitude among publicly funded British research scientists and in a civil service institution like the Medical Research Council both possible and desirable. In this process the meaning of the term "public science" also changed dramatically.

Missed Opportunities: Examining the Literacy Experiences of African American Students Displaced by Hurricane Katrina

ERIC Educational Resources Information Center

Pollard, Tamica McClarty

2011-01-01

The purpose of this study was to examine how five African American middle school students, who were displaced by Hurricane Katrina represent their literacy experiences before, during, and after their displacement. Specifically, the two research questions were: (a) What are the stories that these middle school students tell about their lives,…

Love the Lab, Hate the Lab Report?

ERIC Educational Resources Information Center

Bjorn, Genevive

2018-01-01

In the author's large, urban high school, enrollment in a laboratory science is mandatory. While the student participation rate for lab activities is over 98%, the turn-in rate for traditional lab reports averages just 35% to 85%. Those students who don't produce a lab report miss a critical opportunity to improve their skills in scientific…

The Missing Middle: Aligning Education and the Knowledge Economy

ERIC Educational Resources Information Center

Carnevale, Anthony P.; Desrochers, Donna M.

2002-01-01

While no one can predict the future, today's economic and demographic realities suggest the opportunities and challenges that will face America in the years to come. The U.S. economy has already undergone dramatic changes in the latter part of the twentieth century. The extension of product and labor markets has expanded global competition, and…

Goal-Setting in Youth Football. Are Coaches Missing an Opportunity?

ERIC Educational Resources Information Center

Maitland, Alison; Gervis, Misia

2010-01-01

Background: Goal-setting is not always the simple motivational technique when used in an applied sport setting especially in relation to the meaning of achievement in competitive sport. Goal-setting needs to be examined in a broader context than goal-setting theory, such as provided by social cognitive theories of motivation. In football, the…

Not Missing the Future: The Case for Technology and Business Process Change

ERIC Educational Resources Information Center

VanDenBerg, Doug

2010-01-01

As technology has evolved, the opportunity to transform and enhance the business processes of academic records managers has become more attractive. Many institutions embrace business-process change as a part of their ongoing strategy, but others defer--or simply avoid--any such change. But now more than ever, according to this author, it is…

The Rose Report [Continued]: "The Invisible Worm"

ERIC Educational Resources Information Center

Drummond, Mary Jane

2009-01-01

While Colin Richards' article is a trenchant analysis of the big themes and missed opportunities of the Rose Report, this response examines some of the small print. It concludes that the document is disfigured by many minor blemishes, and is also fatally flawed by a crude misapprehension of the nature of progress and the purpose of education.

Truancy and Chronic Absence in Redwood City. Youth Data Archive Issue Brief

ERIC Educational Resources Information Center

Sanchez, Monika

2012-01-01

When students are not in school, they miss the opportunity to grow academically, socially, and emotionally. These skills are critical for continued success in school, in the community, and onward into adulthood. Students with low attendance have been shown to be at heightened risk of high school dropout, as well as other potentially deleterious…

Making and Missing Connections: Exploring Twitter Chats as a Learning Tool in a Preservice Teacher Education Course

ERIC Educational Resources Information Center

Hsieh, Betina

2017-01-01

Research on social media use in education indicates that network-based connections can enable powerful teacher learning opportunities. Using a connectivist theoretical framework (Siemens, 2005), this study focuses on secondary teacher candidates (TCs) who completed, archived, and reflected upon 1-hour Twitter chats (N = 39) to explore the promise…

Mixed Messages and Missed Opportunities: Moments of Transformation in Writing Conferences and Teacher Education.

ERIC Educational Resources Information Center

Denyer, Jenny; Florio-Ruane, Susan

1995-01-01

Describes challenges for teacher educators who want to help students move beyond talk about text that recalls facts to talk that supports interpretation and crafting of text. A case study describes how one teacher candidate struggled to reconcile what she thought teaching was with new ways of talking about text. (SM)

Providing a Virtual Initiation for Epsilon Pi Tau

ERIC Educational Resources Information Center

Sanders, Craig S.; Griffin, Kathryn M.

2005-01-01

One of the requirements of the Epsilon Pi Tau (EPT) initiation is the apprentice has to physically be at the initiation (EPT, 2004). Since the majority of nontraditional students and working professionals are physically removed from an initiation site, they have missed the opportunity to join EPT. On 8 April, 2005, the Beta Mu Chapter of The…

Misbehavior or Missed Opportunity? Challenges in Interpreting the Behavior of Young Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Hart, Juliet E.; Whalon, Kelly

2013-01-01

Young children with autism spectrum disorder (ASD) are increasingly being included in early childhood classrooms that include typically developing peers and in general education classrooms once they enter school. Many of these learners have the requisite academic skills to be successful, yet their social communication and behavioral challenges…

Preventing Early Mathematics Difficulties: The Feasibility of a Rigorous Kindergarten Mathematics Curriculum

ERIC Educational Resources Information Center

Chard, David J.; Baker, Scott K.; Clarke, Ben; Jungjohann, Kathleen; Davis, Karen; Smolkowski, Keith

2008-01-01

Concern about poor mathematics achievement in U.S. schools has increased in recent years. In part, poor achievement may be attributed to a lack of attention to early instruction and missed opportunities to build on young children's early understanding of mathematics. This study examined the development and feasibility testing of a kindergarten…

Rooted in the Soil: How Understanding the Perspectives of Landowners Can Enhance the Management of Environmental Disputes.

ERIC Educational Resources Information Center

Peterson, Tarla Rai; Horton, Cristi Choat

1995-01-01

Uses mythic criticism to examine missed opportunities for identifying with landowners in ways that would enhance the constructive management of environmental disputes. Offers an alternative mythic understanding of the American West drawn from discourse with Texas ranchers. Argues for the inclusion of communities that are directly influenced, yet…

A Leadership Opportunity for School Social Workers: Bridging the Gaps in School Reentry for Juvenile Justice System Youths

ERIC Educational Resources Information Center

Goldkind, Lauri

2011-01-01

Social work is frequently missing when policy and practice conversations turn to juvenile justice system youths. However, school social workers are well positioned to have a vital role in the readmission and reentry process for these young people. Formerly incarcerated youths present unique challenges for themselves, their families, and…

A Case for Critical Literacy Analysis of the Advertising Texts of Menstruation: Responding to Missed Opportunities

ERIC Educational Resources Information Center

Agnew, Shire; Sandretto, Susan

2016-01-01

When Agnew found the same, largely negative, dominant discourses of menstruation present in classroom lessons that researchers have been identifying for over 30 years, she sought different approaches to menstruation education. In this article the authors highlight the power of the media to (re)construct dominant discourses of menstruation and the…

An Analysis of Context-Based Similarity Tasks in Textbooks from Brazil and the United States

ERIC Educational Resources Information Center

Barcelos Amaral, Rúbia; Hollebrands, Karen

2017-01-01

Three textbooks from Brazil and three textbooks from the United States were analysed with a focus on similarity and context-based tasks. Students' opportunities to learn similarity were examined by considering whether students were provided context-based tasks of high cognitive demand and whether those tasks included missing or superfluous…

Fast and robust generation of high-resolution genetic maps in grapevine interspecific hybrid half-sib families using the HetMappS pipeline and R/qtl

USDA-ARS?s Scientific Manuscript database

Genotyping-by-sequencing (GBS) provides an opportunity for fast and inexpensive generation of unbiased SNPs. However, due to its low coverage, GBS SNPs have a higher proportion of missing data and genotyping error associated with heterozygote undercalling than traditional genotyping platforms. These...

75 FR 23772 - Agency Information Collection Activities: Proposed Collection: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-04

... respondents when there are missing data elements prior to submission. The annual estimate of burden is as... opportunity for public comment on proposed data collection projects (section 3506(c)(2)(A) of Title 44, United... more information on the proposed project or to obtain a copy of the data collection plans and draft...

New York State School Facilities and Student Health, Achievement, and Attendance: A Data Analysis Report

ERIC Educational Resources Information Center

Boese, Stephen; Shaw, John

2005-01-01

Students who attend schools with environmental hazards that impact indoor air quality are more likely to miss class, and therefore lose learning opportunities. Yet school environmental health and safety remains largely unregulated and there is no state or federal agency in charge of protecting children's environmental health in schools. This…

The Student Homelessness Crisis and the Role of School Psychology: Missed Opportunities, Room for Improvement, and Future Directions

ERIC Educational Resources Information Center

Sulkowski, Michael L.

2016-01-01

Affecting more than 1 million youth, student homelessness is growing at an unprecedented rate in the United States. This is alarming because homeless students face significant barriers to their academic success and positive life outcomes. Unfortunately, despite the significant risks and challenges they face, homeless students often are overlooked…

Proposed State Budget Doesn't Do Enough for Kids

ERIC Educational Resources Information Center

Children Now, 2015

2015-01-01

The Administration's January proposal for the 2015-16 state budget does not do enough for California's top priority--the children. The failure to fund new preschool slots breaks last year's commitment to provide access to quality preschool for every low-income 4-year-old. The proposal also misses opportunities to fully support and improve access…

Articulate Bodies: The Value of a Somatic Curriculum in a Virtual World

ERIC Educational Resources Information Center

Larimer, Amy

2016-01-01

Despite the acknowledgment of kinesthetic processing as a recognized learning style, physical or experiential learning generally plays a minor role in the required curriculum of educational institutions. Although the body is addressed in education from a cerebral point of view, what is often missing is the opportunity for students to learn about…

Student Initiatives and Missed Learning Opportunities in an IRF Sequence: A Single Case Analysis

ERIC Educational Resources Information Center

Li, Houxiang

2013-01-01

Most conversation analysis (CA) studies of the initiation-response-feedback (IRF; Sinclair & Coulthard, 1975) sequence have focused on teacher actions in the feedback move. In this article, I use CA to analyze student initiatives (Waring, 2011) within an IRF sequence in one excerpt from a Chinese as a foreign language class. The excerpt…

The gap between what we measure and what we want to know about ecosystem services in streams and their linkages of human values

EPA Science Inventory

Background/Questions/Methods (190 words) We evaluate national stream monitoring data based on its capacity to link stream ecosystems to analyses of human well-being. As a nation we invest substantially in monitoring, but may miss opportunities to collect information that effecti...

Why Learner-Centered New Faculty Orientations Matter: Organizational Culture and Faculty Retention

ERIC Educational Resources Information Center

Scott, Whitney; Lemus, Daisy; Knotts, Greg; Oh, Janet

2016-01-01

A learner-centered New Faculty Orientation (NFO) can be a powerful way to immediately engage new faculty and develop their organizational identification to the institution and its values. Unfortunately, some NFOs do not model a learner-centered philosophy and miss opportunities to establish a collaborative and celebratory tone. In this paper, we…

The Decade Dance

PubMed Central

Neher, Jon O.

2005-01-01

This essay portrays the moment an adult survivor of childhood sexual abuse tells his physician about his traumatic past. Because of denial by both parties, the diagnosis had remained buried for years, and opportunities for appropriate intervention were repeatedly missed. When the patient is finally able to face his past, it unleashes a torrent of potentially lethal anger that challenges everyone involved. PMID:16189064

Are Low Performers Missing Learning Opportunities? PISA in Focus. No. 62

ERIC Educational Resources Information Center

OECD Publishing, 2016

2016-01-01

Although low performers should invest more time and effort in their studies, they seldom do. One reason is because they often feel that they get no return on their investment: more studying does not automatically lead to better marks in school. But with the right kind of in-school support, including creative and engaging mathematics-related…

Dramatic (and Simple!) Demonstration of Newton's Third Law

ERIC Educational Resources Information Center

Feldman, Gerald

2011-01-01

An operational understanding of Newton's third law is often elusive for students. Typical examples of this concept are given for contact forces that are closer to the students' everyday experience. While this is a good thing in general, the reaction force can sometimes be taken for granted, and the students can miss the opportunity to really think…

"I Didn't Know Anything about It": Critical Pedagogy, Cultural Literacy, and (Missed?) Opportunities for Praxis

ERIC Educational Resources Information Center

Cue, Erin N.; Casey, Zachary A.

2017-01-01

This study seeks to theorize and contextualize what happened in an undergraduate senior capstone course focusing on cultural literacy and critical pedagogy. Through our analysis and critical dialogue we came to recognize that while each cultural literacy circle reported positive outcomes, and positive feelings from group members about how they…

Correlation of Electronic Health Records Use and Reduced Prevalence of Diabetes Co-Morbidities

ERIC Educational Resources Information Center

Eller, James D.

2013-01-01

The general problem is Native American tribes have high prevalence rates of diabetes. The specific problem is the failure of IHS sites to adopt EHR may cause health care providers to miss critical opportunities to improve screening and triage processes that result in quality improvement. The purpose of the quantitative correlational study was to…

A Web Based Intelligent Training System for SMEs

ERIC Educational Resources Information Center

Mullins, Roisin; Duan, Yanqing; Hamblin, David; Burrell, Phillip; Jin, Huan; Jerzy, Goluchowski; Ewa, Ziemba; Aleksander, Billewicz

2007-01-01

It is widely accepted that employees in small business suffer from a lack of knowledge and skills. This lack of skills means that small companies will miss out on new business opportunities. This is even more evident with respect to the adoption of Internet marketing in Small and Medium Enterprises (SMEs). This paper reports a pilot research…

Early Childhood Policy in England 1997-2013: Anatomy of a Missed Opportunity

ERIC Educational Resources Information Center

Moss, Peter

2014-01-01

The new Labour government that entered office in 1997 made early childhood education and care (ECEC) a policy priority, after decades of neglect. The article provides an overview of the subsequent policy developments, looking at three areas in more detail: governance and finance; the organisation and management of services; and the workforce. It…

Security Sector Reform in Timor-Leste: Missed Opportunities and Hard Lessons in Empowering the Host-Nation

DTIC Science & Technology

2012-04-01

policing’: Voices of Australian po- lice peacekeepers in Operation Serene , Timor-Leste 2006," Policing and Society, Vol. 19, No. 2, pp. 119-133. 23...of Australian police peacekeepers in Operation Serene , Timor-Leste 2006," Policing and Society, Vol. 19, No. 2, pp. 119- 133. Hänggi, Heiner (2004

Dwindling Numbers of Female Computer Students: What Are We Missing?

ERIC Educational Resources Information Center

Saulsberry, Donna

2012-01-01

There is common agreement among researchers that women are under-represented in both 2-year and 4-year collegiate computer study programs. This leads to women being under-represented in the computer industry which may be limiting the progress of technology developments that will benefit mankind. It may also be depriving women of the opportunity to…

Estimation of the Percentage of Newly Diagnosed HIV-Positive Persons Linked to HIV Medical Care in CDC-Funded HIV Testing Programs.

PubMed

Wang, Guoshen; Pan, Yi; Seth, Puja; Song, Ruiguang; Belcher, Lisa

2017-01-01

Missing data create challenges for determining progress made in linking HIV-positive persons to HIV medical care. Statistical methods are not used to address missing program data on linkage. In 2014, 61 health department jurisdictions were funded by Centers for Disease Control and Prevention (CDC) and submitted data on HIV testing, newly diagnosed HIV-positive persons, and linkage to HIV medical care. Missing or unusable data existed in our data set. A new approach using multiple imputation to address missing linkage data was proposed, and results were compared to the current approach that uses data with complete information. There were 12,472 newly diagnosed HIV-positive persons from CDC-funded HIV testing events in 2014. Using multiple imputation, 94.1% (95% confidence interval (CI): [93.7%, 94.6%]) of newly diagnosed persons were referred to HIV medical care, 88.6% (95% CI: [88.0%, 89.1%]) were linked to care within any time frame, and 83.6% (95% CI: [83.0%, 84.3%]) were linked to care within 90 days. Multiple imputation is recommended for addressing missing linkage data in future analyses when the missing percentage is high. The use of multiple imputation for missing values can result in a better understanding of how programs are performing on key HIV testing and HIV service delivery indicators.

HIV-1 Full-Genome Phylogenetics of Generalized Epidemics in Sub-Saharan Africa: Impact of Missing Nucleotide Characters in Next-Generation Sequences

PubMed Central

Wymant, Chris; Colijn, Caroline; Danaviah, Siva; Essex, Max; Frost, Simon; Gall, Astrid; Gaseitsiwe, Simani; Grabowski, Mary K.; Gray, Ronald; Guindon, Stephane; von Haeseler, Arndt; Kaleebu, Pontiano; Kendall, Michelle; Kozlov, Alexey; Manasa, Justen; Minh, Bui Quang; Moyo, Sikhulile; Novitsky, Vlad; Nsubuga, Rebecca; Pillay, Sureshnee; Quinn, Thomas C.; Serwadda, David; Ssemwanga, Deogratius; Stamatakis, Alexandros; Trifinopoulos, Jana; Wawer, Maria; Brown, Andy Leigh; de Oliveira, Tulio; Kellam, Paul; Pillay, Deenan; Fraser, Christophe

2017-01-01

Abstract To characterize HIV-1 transmission dynamics in regions where the burden of HIV-1 is greatest, the “Phylogenetics and Networks for Generalised HIV Epidemics in Africa” consortium (PANGEA-HIV) is sequencing full-genome viral isolates from across sub-Saharan Africa. We report the first 3,985 PANGEA-HIV consensus sequences from four cohort sites (Rakai Community Cohort Study, n = 2,833; MRC/UVRI Uganda, n = 701; Mochudi Prevention Project, n = 359; Africa Health Research Institute Resistance Cohort, n = 92). Next-generation sequencing success rates varied: more than 80% of the viral genome from the gag to the nef genes could be determined for all sequences from South Africa, 75% of sequences from Mochudi, 60% of sequences from MRC/UVRI Uganda, and 22% of sequences from Rakai. Partial sequencing failure was primarily associated with low viral load, increased for amplicons closer to the 3′ end of the genome, was not associated with subtype diversity except HIV-1 subtype D, and remained significantly associated with sampling location after controlling for other factors. We assessed the impact of the missing data patterns in PANGEA-HIV sequences on phylogeny reconstruction in simulations. We found a threshold in terms of taxon sampling below which the patchy distribution of missing characters in next-generation sequences (NGS) has an excess negative impact on the accuracy of HIV-1 phylogeny reconstruction, which is attributable to tree reconstruction artifacts that accumulate when branches in viral trees are long. The large number of PANGEA-HIV sequences provides unprecedented opportunities for evaluating HIV-1 transmission dynamics across sub-Saharan Africa and identifying prevention opportunities. Molecular epidemiological analyses of these data must proceed cautiously because sequence sampling remains below the identified threshold and a considerable negative impact of missing characters on phylogeny reconstruction is expected. PMID:28540766

HIV-1 full-genome phylogenetics of generalized epidemics in sub-Saharan Africa: impact of missing nucleotide characters in next-generation sequences.

PubMed

Ratmann, Oliver; Wymant, Chris; Colijn, Caroline; Danaviah, Siva; Essex, M; Frost, Simon D W; Gall, Astrid; Gaiseitsiwe, Simani; Grabowski, Mary; Gray, Ronald; Guindon, Stephane; von Haeseler, Arndt; Kaleebu, Pontiano; Kendall, Michelle; Kozlov, Alexey; Manasa, Justen; Minh, Bui Quang; Moyo, Sikhulile; Novitsky, Vladimir; Nsubuga, Rebecca; Pillay, Sureshnee; Quinn, Thomas C; Serwadda, David; Ssemwanga, Deogratius; Stamatakis, Alexandros; Trifinopoulos, Jana; Wawer, Maria; Leigh Brown, Andrew; de Oliveira, Tulio; Kellam, Paul; Pillay, Deenan; Fraser, Christophe

2017-05-25

To characterize HIV-1 transmission dynamics in regions where the burden of HIV-1 is greatest, the 'Phylogenetics and Networks for Generalised HIV Epidemics in Africa' consortium (PANGEA-HIV) is sequencing full-genome viral isolates from across sub-Saharan Africa. We report the first 3,985 PANGEA-HIV consensus sequences from four cohort sites (Rakai Community Cohort Study, n=2,833; MRC/UVRI Uganda, n=701; Mochudi Prevention Project, n=359; Africa Health Research Institute Resistance Cohort, n=92). Next-generation sequencing success rates varied: more than 80% of the viral genome from the gag to the nef genes could be determined for all sequences from South Africa, 75% of sequences from Mochudi, 60% of sequences from MRC/UVRI Uganda, and 22% of sequences from Rakai. Partial sequencing failure was primarily associated with low viral load, increased for amplicons closer to the 3' end of the genome, was not associated with subtype diversity except HIV-1 subtype D, and remained significantly associated with sampling location after controlling for other factors. We assessed the impact of the missing data patterns in PANGEA-HIV sequences on phylogeny reconstruction in simulations. We found a threshold in terms of taxon sampling below which the patchy distribution of missing characters in next-generation sequences has an excess negative impact on the accuracy of HIV-1 phylogeny reconstruction, which is attributable to tree reconstruction artifacts that accumulate when branches in viral trees are long. The large number of PANGEA-HIV sequences provides unprecedented opportunities for evaluating HIV-1 transmission dynamics across sub-Saharan Africa and identifying prevention opportunities. Molecular epidemiological analyses of these data must proceed cautiously because sequence sampling remains below the identified threshold and a considerable negative impact of missing characters on phylogeny reconstruction is expected.

Apples and pears? A comparison of two sources of national lung cancer audit data in England

PubMed Central

Jack, Ruth H.; Vernon, Sally; Dickinson, Rosie; Wood, Natasha; Harden, Susan; Beckett, Paul; Woolhouse, Ian; Hubbard, Richard B.

2017-01-01

In 2014, the method of data collection from NHS trusts in England for the National Lung Cancer Audit (NLCA) was changed from a bespoke dataset called LUCADA (Lung Cancer Data). Under the new contract, data are submitted via the Cancer Outcome and Service Dataset (COSD) system and linked additional cancer registry datasets. In 2014, trusts were given opportunity to submit LUCADA data as well as registry data. 132 NHS trusts submitted LUCADA data, and all 151 trusts submitted COSD data. This transitional year therefore provided the opportunity to compare both datasets for data completeness and reliability. We linked the two datasets at the patient level to assess the completeness of key patient and treatment variables. We also assessed the interdata agreement of these variables using Cohen's kappa statistic, κ. We identified 26 001 patients in both datasets. Overall, the recording of sex, age, performance status and stage had more than 90% agreement between datasets, but there were more patients with missing performance status in the registry dataset. Although levels of agreement for surgery, chemotherapy and external-beam radiotherapy were high between datasets, the new COSD system identified more instances of active treatment. There seems to be a high agreement of data between the datasets, and the findings suggest that the registry dataset coupled with COSD provides a richer dataset than LUCADA. However, it lagged behind LUCADA in performance status recording, which needs to improve over time. PMID:28748189

Community management of intellectual disabilities in Pakistan: a mixed methods study.

PubMed

Mirza, I; Tareen, A; Davidson, L L; Rahman, A

2009-06-01

Pakistan has one of the highest reported rates of childhood intellectual disabilities (ID) in the world. Prevalence estimates vary from 19.1/1000 for serious ID to 65/1000 for mild ID. We surveyed carers of persons with ID (n = 100) using quantitative and qualitative instruments. We conducted in-depth interviews of carers (n = 16) and key primary health providers (n = 10). We also carried out focus groups (n = 7). Data were triangulated and interpreted in light of peer reviewed literature. There was a delay of 2.92 (95% CI 1.9 to 3.94) to 4.17 (95% CI 2.34 to 6.01) years between detection and seeking of care. Parental stress associated with caring for these children was high (mean Self-Reporting Questionnaire score 8.4; 95% CI 6.80 to 9.91). Home management consisted mainly of physical containment. Stigma associated with ID contributed to decreased opportunity for these children and families to participate in community activities. There was a lack of knowledge about causation and effective interventions for ID. Our findings suggest that there is significant delay in detection of ID especially in rural setting where more than 70% of population of Pakistan resides. This missed opportunity for rehabilitation in early formative years is a cause of significant distress for the caregivers who rarely receive valid information about course, prognosis and what remedial action to take. There is a need to develop feasible, cost-effective, community level interventions, which can be integrated into existing healthcare systems.

Missing an opportunity: the embedded nature of weight management in primary care

PubMed Central

Osunlana, A. M.; Ogunleye, A. A.; Sharma, A. M.; Campbell‐Scherer, D.

2015-01-01

Summary The 5As Team study was designed to create, implement and evaluate a flexible intervention to improve the quality and quantity of weight management visits in primary care. The objective of this portion of the study was to explore how primary care providers incorporate weight management in their practice. 5AsT is a randomized controlled trial (RCT) on the implementation of a 6‐month 5 As Team (5AsT) intervention designed to operationalize the 5As of obesity management in primary care. Data for the qualitative portion of the study presented here included semi‐structured interviews with 29 multidisciplinary team providers and field notes of intervention sessions. Thematic analysis was undertaken. A key pattern that emerged from the data was that healthcare providers usually do not address obesity as a primary focus for a visit. Rather, obesity is embedded in a wide range of primary care encounters for other conditions. Implications were it can take extra time to discuss weight, it can be inappropriate to bring up weight as a topic, and treating risk factors and root causes of obesity have indirect benefits to patient weight management. Our findings have implications for obesity treatment approaches and tools that assume a discreet weight management visit. The embedded nature of obesity management in primary care can be harnessed to leverage multiple opportunities for asking and assessing root causes of obesity, and working longitudinally towards individual health goals. PMID:26303812

Measuring quality in maternal-newborn care: developing a clinical dashboard.

PubMed

Sprague, Ann E; Dunn, Sandra I; Fell, Deshayne B; Harrold, Joann; Walker, Mark C; Kelly, Sherrie; Smith, Graeme N

2013-01-01

Pregnancy, birth, and the early newborn period are times of high use of health care services. As well as opportunities for providing quality care, there are potential missed opportunities for health promotion, safety issues, and increased costs for the individual and the system when quality is not well defined or measured. There has been a need to identify key performance indicators (KPIs) to measure quality care within the provincial maternal-newborn system. We also wanted to provide automated audit and feedback about these KPIs to support quality improvement initiatives in a large Canadian province with approximately 140 000 births per year. We therefore worked to develop a maternal-newborn dashboard to increase awareness about selected KPIs and to inform and support hospitals and care providers about areas for quality improvement. We mapped maternal-newborn data elements to a quality domain framework, sought feedback via survey for the relevance and feasibility of change, and examined current data and the literature to assist in setting provincial benchmarks. Six clinical performance indicators of maternal-newborn quality care were identified and evidence-informed benchmarks were set. A maternal-newborn dashboard with "drill down" capacity for detailed analysis to enhance audit and feedback is now available for implementation. While audit and feedback does not guarantee individuals or institutions will make practice changes and move towards quality improvement, it is an important first step. Practice change and quality improvement will not occur without an awareness of the issues.

A sensitivity analysis for missing outcomes due to truncation by death under the matched-pairs design.

PubMed

Imai, Kosuke; Jiang, Zhichao

2018-04-29

The matched-pairs design enables researchers to efficiently infer causal effects from randomized experiments. In this paper, we exploit the key feature of the matched-pairs design and develop a sensitivity analysis for missing outcomes due to truncation by death, in which the outcomes of interest (e.g., quality of life measures) are not even well defined for some units (e.g., deceased patients). Our key idea is that if 2 nearly identical observations are paired prior to the randomization of the treatment, the missingness of one unit's outcome is informative about the potential missingness of the other unit's outcome under an alternative treatment condition. We consider the average treatment effect among always-observed pairs (ATOP) whose units exhibit no missing outcome regardless of their treatment status. The naive estimator based on available pairs is unbiased for the ATOP if 2 units of the same pair are identical in terms of their missingness patterns. The proposed sensitivity analysis characterizes how the bounds of the ATOP widen as the degree of the within-pair similarity decreases. We further extend the methodology to the matched-pairs design in observational studies. Our simulation studies show that informative bounds can be obtained under some scenarios when the proportion of missing data is not too large. The proposed methodology is also applied to the randomized evaluation of the Mexican universal health insurance program. An open-source software package is available for implementing the proposed research. Copyright © 2018 John Wiley & Sons, Ltd.

Constructing 'Black Sun': the Documentary Film of the 2012 Eclipses

NASA Astrophysics Data System (ADS)

Holbrook, Jarita

2014-06-01

2012 offered an opportunity that was not to be missed: two solar eclipses. Drs Alphonse Sterling and Hakeem Oluseyi began doing collaborative research during total solar eclipses in 2006 in Ghana. Since then they have continued to do eclipse observation when funds and whether permitted. As a filmmaker, the opportunity to film Sterling and Oluseyi during the 2012 eclipses in Tokyo and Cairns fulfilled the goal of showing the excitement of time-sensitive research, the lives of astrophysicists, and diversity within the astronomy community. As an astrophysicist who did not specialize in solar astrophysics, it was an opportunity for me both to learn and to solidify for the audience what we know about the sun and the importance of eclipse observation. Clips of the film will be included.

Simulation-based sensitivity analysis for non-ignorably missing data.

PubMed

Yin, Peng; Shi, Jian Q

2017-01-01

Sensitivity analysis is popular in dealing with missing data problems particularly for non-ignorable missingness, where full-likelihood method cannot be adopted. It analyses how sensitively the conclusions (output) may depend on assumptions or parameters (input) about missing data, i.e. missing data mechanism. We call models with the problem of uncertainty sensitivity models. To make conventional sensitivity analysis more useful in practice we need to define some simple and interpretable statistical quantities to assess the sensitivity models and make evidence based analysis. We propose a novel approach in this paper on attempting to investigate the possibility of each missing data mechanism model assumption, by comparing the simulated datasets from various MNAR models with the observed data non-parametrically, using the K-nearest-neighbour distances. Some asymptotic theory has also been provided. A key step of this method is to plug in a plausibility evaluation system towards each sensitivity parameter, to select plausible values and reject unlikely values, instead of considering all proposed values of sensitivity parameters as in the conventional sensitivity analysis method. The method is generic and has been applied successfully to several specific models in this paper including meta-analysis model with publication bias, analysis of incomplete longitudinal data and mean estimation with non-ignorable missing data.

Introducing a Morbidity and Mortality Conference in Rwanda.

PubMed

Abahuje, Egide; Nzeyimana, Innocent; Rickard, Jennifer L

To assess the structure, format, and educational features of a morbidity and mortality (M&M) conference in Rwanda. To determine factors associated with adverse events and to define opportunities for improvement. Retrospective, descriptive study of all cases presented at a surgical M&M conference over a 1-year period. Cases were reviewed for factors associated with adverse events and opportunities for improvement. Factors were characterized as delays in presentation, delays in diagnosis, delays in the operating room, errors in judgment, technical errors, advanced disease, and missing resources or malnutrition. Opportunities for improvement were categorized at the physician or hospital level. University Teaching Hospital of Kigali, a tertiary referral hospital in Rwanda. Cases presented at the surgical M&M conference over a 1-year period. Over a 1-year period, there were a total of 2231 operations with 131 in-hospital mortalities. There were 62 patients discussed at M&M conference. Of those discussed, there were 34 (55%) in-hospital deaths and 32 (52%) unplanned reoperations. Common diagnostic categories included 30 (48%) gastrointestinal, 15 (24%) trauma, and 10 (16%) neoplasm. Delays were commonly cited factors affecting outcomes. There were 22 (35%) delays in presentation, 23 (37%) delays in diagnosis or management, and 20 (32%) delays to the operating room. Errors in judgment occurred in 15 (24%) cases and technical errors occurred in 18 (29%) cases. Twenty-three (37%) patients had a critical resource missing and 17 (27%) patients had advanced disease. Malnutrition was associated with 11 (18%) adverse events. Participants identified opportunities for improvement in 48 (77%) cases. M&M conference can be used in a low-resource setting as an educational tool to address core competencies of practice-based learning and improvement and systems-based practice. It can define factors associated with surgical adverse events and opportunities for improvement at the physician and hospital levels. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Persons with dementia missing in the community: is it wandering or something unique?

PubMed

Rowe, Meredeth A; Vandeveer, Sydney S; Greenblum, Catherine A; List, Cassandra N; Fernandez, Rachael M; Mixson, Natalie E; Ahn, Hyo C

2011-06-05

At some point in the disease process many persons with dementia (PWD) will have a missing incident and be unable to safely return to their care setting. In previous research studies, researchers have begun to question whether this phenomenon should continue to be called wandering since the antecedents and characteristics of a missing incident are dissimilar to accepted definitions of wandering in dementia. The purpose of this study was to confirm previous findings regarding the antecedents and characteristics of missing incidents, understand the differences between those found dead and alive, and compare the characteristics of a missing incident to that of wandering. A retrospective design was used to analyse 325 newspaper reports of PWD missing in the community. The primary antecedent to a missing incident, particularly in community-dwelling PWD, was becoming lost while conducting a normal and permitted activity alone in the community. The other common antecedent was a lapse in supervision with the expectation that the PWD would remain in a safe location but did not. Deaths most commonly occurred in unpopulated areas due to exposure and drowning. Those who died were found closer to the place last seen and took longer to find, but there were no significant differences in gender or age. The key characteristics of a missing incident were: unpredictable, non-repetitive, temporally appropriate but spatially-disordered, and while using multiple means of movement (walking, car, public transportation). Missing incidents occurred without the discernible pattern present in wandering such as lapping or pacing, repetitive and temporally-disordered. This research supports the mounting evidence that the concept of wandering, in its formal sense, and missing incidents are two distinct concepts. It will be important to further develop the concept of missing incidents by identifying the differences and similarities from wandering. This will allow a more targeted assessment and intervention strategy for each problem.

Persons with dementia missing in the community: Is it wandering or something unique?

PubMed Central

2011-01-01

Background At some point in the disease process many persons with dementia (PWD) will have a missing incident and be unable to safely return to their care setting. In previous research studies, researchers have begun to question whether this phenomenon should continue to be called wandering since the antecedents and characteristics of a missing incident are dissimilar to accepted definitions of wandering in dementia. The purpose of this study was to confirm previous findings regarding the antecedents and characteristics of missing incidents, understand the differences between those found dead and alive, and compare the characteristics of a missing incident to that of wandering. Methods A retrospective design was used to analyse 325 newspaper reports of PWD missing in the community. Results The primary antecedent to a missing incident, particularly in community-dwelling PWD, was becoming lost while conducting a normal and permitted activity alone in the community. The other common antecedent was a lapse in supervision with the expectation that the PWD would remain in a safe location but did not. Deaths most commonly occurred in unpopulated areas due to exposure and drowning. Those who died were found closer to the place last seen and took longer to find, but there were no significant differences in gender or age. The key characteristics of a missing incident were: unpredictable, non-repetitive, temporally appropriate but spatially-disordered, and while using multiple means of movement (walking, car, public transportation). Missing incidents occurred without the discernible pattern present in wandering such as lapping or pacing, repetitive and temporally-disordered. Conclusions This research supports the mounting evidence that the concept of wandering, in its formal sense, and missing incidents are two distinct concepts. It will be important to further develop the concept of missing incidents by identifying the differences and similarities from wandering. This will allow a more targeted assessment and intervention strategy for each problem. PMID:21639942

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

Saaban, Azizan; Zainudin, Lutfi; Bakar, Mohd Nazari Abu

This paper intends to reveal the ability of the linear interpolation method to predict missing values in solar radiation time series. Reliable dataset is equally tends to complete time series observed dataset. The absence or presence of radiation data alters long-term variation of solar radiation measurement values. Based on that change, the opportunities to provide bias output result for modelling and the validation process is higher. The completeness of the observed variable dataset has significantly important for data analysis. Occurrence the lack of continual and unreliable time series solar radiation data widely spread and become the main problematic issue. However,more » the limited number of research quantity that has carried out to emphasize and gives full attention to estimate missing values in the solar radiation dataset.« less

Toward a hybrid brain-computer interface based on repetitive visual stimuli with missing events.

PubMed

Wu, Yingying; Li, Man; Wang, Jing

2016-07-26

Steady-state visually evoked potentials (SSVEPs) can be elicited by repetitive stimuli and extracted in the frequency domain with satisfied performance. However, the temporal information of such stimulus is often ignored. In this study, we utilized repetitive visual stimuli with missing events to present a novel hybrid BCI paradigm based on SSVEP and omitted stimulus potential (OSP). Four discs flickering from black to white with missing flickers served as visual stimulators to simultaneously elicit subject's SSVEPs and OSPs. Key parameters in the new paradigm, including flicker frequency, optimal electrodes, missing flicker duration and intervals of missing events were qualitatively discussed with offline data. Two omitted flicker patterns including missing black/white disc were proposed and compared. Averaging times were optimized with Information Transfer Rate (ITR) in online experiments, where SSVEPs and OSPs were identified using Canonical Correlation Analysis in the frequency domain and Support Vector Machine (SVM)-Bayes fusion in the time domain, respectively. The online accuracy and ITR (mean ± standard deviation) over nine healthy subjects were 79.29 ± 18.14 % and 19.45 ± 11.99 bits/min with missing black disc pattern, and 86.82 ± 12.91 % and 24.06 ± 10.95 bits/min with missing white disc pattern, respectively. The proposed BCI paradigm, for the first time, demonstrated that SSVEPs and OSPs can be simultaneously elicited in single visual stimulus pattern and recognized in real-time with satisfied performance. Besides the frequency features such as SSVEP elicited by repetitive stimuli, we found a new feature (OSP) in the time domain to design a novel hybrid BCI paradigm by adding missing events in repetitive stimuli.

International Perspective on Teaching Human Sexuality

ERIC Educational Resources Information Center

Wylie, Kevan; Weerakoon, Patricia

2010-01-01

Objective: The authors outline international training programs in human sexuality. Methods: The authors reviewed the international literature and Internet resources to identify key training opportunities and curricula, with particular emphasis on training opportunities for psychiatrists. Results: The authors outline key resources and training…

A comparative study on entrepreneurial attitudes modeled with logistic regression and Bayes nets.

PubMed

López Puga, Jorge; García García, Juan

2012-11-01

Entrepreneurship research is receiving increasing attention in our context, as entrepreneurs are key social agents involved in economic development. We compare the success of the dichotomic logistic regression model and the Bayes simple classifier to predict entrepreneurship, after manipulating the percentage of missing data and the level of categorization in predictors. A sample of undergraduate university students (N = 1230) completed five scales (motivation, attitude towards business creation, obstacles, deficiencies, and training needs) and we found that each of them predicted different aspects of the tendency to business creation. Additionally, our results show that the receiver operating characteristic (ROC) curve is affected by the rate of missing data in both techniques, but logistic regression seems to be more vulnerable when faced with missing data, whereas Bayes nets underperform slightly when categorization has been manipulated. Our study sheds light on the potential entrepreneur profile and we propose to use Bayesian networks as an additional alternative to overcome the weaknesses of logistic regression when missing data are present in applied research.

The Missing Link: Community-Based Organization Participation in ESL/Civics Classes.

ERIC Educational Resources Information Center

Medrani, Emelda

This memorandum discusses the need for civics and English-as-a-Second-Language (ESL) instruction as a result of the Immigration Reform and Control Act (IRCA) of 1986. IRCA provides an opportunity for illegal aliens to obtain legal resident status by successfully completing a test of English proficiency and a test of U.S. history and government, or…

Teaching the Personal Science: From Impeccable Trivia to the Blooming Buzzing Confusion

ERIC Educational Resources Information Center

Banyard, Philip

2010-01-01

The argument presented here is that the teaching of psychology in the UK is focused on the learning of technical skills and is missing the opportunity to enthuse and inspire students in the personal science. This focus mirrors a general educational drive in the UK towards achievement at external examinations which are assessed by narrow cognitive…

Missed Opportunities: The Subordination of Children in Philip Pullman's "His Dark Materials"

ERIC Educational Resources Information Center

Moruzi, Kristine

2005-01-01

In the "His Dark Materials" trilogy, Pullman reworks the fall of humanity into an ascent and suggests that ascent into adulthood through sexual experience is the desired goal for children. Although this ascent is accompanied by a radical reconceptualization of life and death, Pullman fails to offer any genuinely new ideas of the world with respect…

Schools: A Missed Opportunity to Inform African American Sexual and Gender Minority Youth about Sexual Health Education and Services

ERIC Educational Resources Information Center

Rose, India D.; Friedman, Daniela B.

2017-01-01

Sexual and gender minority (SGM) youth are at disproportionate risk for HIV. Schools play an integral role in educating young people about sexual health in addition to providing sexual health services. This qualitative study examined SGM youths' perception of school sexual health education and services. A total of 42 self-identified African…

Synthetic Biology R&D Risks: Social-Institutional Contexts Matter!

PubMed

Wolfe, Amy K; Campa, Maria Fernanda; Bergmann, Rachael A; Stelling, Savannah C; Bjornstad, David J; Shumpert, Barry L

2016-05-01

Factors that shape actual research practices - 'social and institutional context' - typically are missing from considerations of synthetic biology R&D-related risk and containment. We argue that analyzing context is essential in identifying circumstances that create, amplify, or diminish risk, and in revealing new opportunities for avoiding or managing those risks. Copyright © 2016 Elsevier Ltd. All rights reserved.

Chemistry in Past and New Science Frameworks and Standards: Gains, Losses, and Missed Opportunities

ERIC Educational Resources Information Center

Talanquer, Vicente; Sevian, Hannah

2014-01-01

Science education frameworks and standards play a central role in the development of curricula and assessments, as well as in guiding teaching practices in grades K-12. Recently, the National Research Council published a new Framework for K-12 Science Education that has guided the development of the Next Generation Science Standards. In this…

Missed Opportunities in the Labor Market or Temporary Disruptions? How Late Teacher Hiring Affects Student Achievement

ERIC Educational Resources Information Center

Papay, John P.; Kraft, Matthew A.; Bloom, Julia; Buckley, Kate; Liebowitz, David

2013-01-01

While there are many reasons why late hiring may affect student achievement, no empirical studies have documented this effect in practice. This paper presents the first estimates of the direct impact of late hiring on students' academic achievement, sheds light on two competing explanations for the struggles of late-hire teachers advanced in the…

Concerned about Their Learning: Mathematics Students with Chronic Illness and Their Teachers at School

ERIC Educational Resources Information Center

Wilkie, Karina J.

2014-01-01

Chronic illness often goes hand-in-hand with absence from school, and students miss out on learning opportunities at school for extended or accumulative periods of time. Many young people seek to continue their school studies nonetheless. The need to consider viable ways to support them academically arose in the context of a project called…

Missed Opportunities for Science Learning: Unacknowledged Unscientific Arguments in Asynchronous Online and Face-To-Face Discussions

ERIC Educational Resources Information Center

Callis-Duehl, Kristine; Idsardi, Robert; Humphrey, Eve A.; Gougis, Rebekka Darner

2018-01-01

We explored the scientific argumentation that occurs among university biology students during an argumentation task implemented in two environments: face-to-face in a classroom and online in an asynchronous discussion. We observed 10 student groups, each composed of three students. Our analysis focused on how students respond to their peers'…

Missing College Attendance Costs: Opportunity, Financing, and Risk. ACT Student Financial Aid Research Report Series 89-3.

ERIC Educational Resources Information Center

Mortenson, Thomas G.

The way in which costs enter the potential college student's calculation of the benefits of college attendance is examined. In particular, the paper considers how costs not considered in financial aid need analysis can increase college attendance costs and thereby decrease net benefits of college attendance for those who use financial aid. The…

The "Ongoing Culture Shock" of Upward Mobility: Cultural Capital, Symbolic Violence and Implications for Family Relationships

ERIC Educational Resources Information Center

Curl, Heather D.

2013-01-01

Social mobility is often viewed as a way to alleviate poverty and create equality; it represents the basis upon which the United States is viewed as a meritocratic nation of opportunity. Missing from this persistent narrative, however, is analysis of the actual experience of social mobility. This qualitative study explores the narratives of…

America After 3PM Special Report on Summer: Missed Opportunities, Unmet Demand

ERIC Educational Resources Information Center

Afterschool Alliance, 2010

2010-01-01

For many children in America, summer vacation means camp, trips to new or familiar destinations, visits to museums, parks and libraries, and a variety of enriching activities--either with families or as part of a summer learning program. But for millions of others, when schools close for the summer, safe and enriching learning environments are out…

Frederic Joliot, Irene Curie and the Early History of the Positron (1932-33)

ERIC Educational Resources Information Center

Leone, Matteo; Robotti, Nadia

2010-01-01

As is well known, the positron was discovered in August 1932 by Carl Anderson while studying cloud chamber tracks left by cosmic rays. Far less known is the fact that a few months before Anderson's discovery, in April 1932, Frederic Joliot and Irene Curie had missed an opportunity to discover the positron during a nuclear physics experiment. One…

A Cost-Effective Distributed Architecture for Content Delivery and Exchange over Emerging Wireless Technologies

ERIC Educational Resources Information Center

Islam, Khondkar R.

2013-01-01

Opportunities in education are lacking in many parts of the developed nations and are missing in most parts of the developing nations. This is, in significant part, due to shortages of classroom instructional resources such as quality teaching staff, hardware and software. Distance education (DE) has proved to be a successful teaching approach and…

The YouTube Makeup Class

ERIC Educational Resources Information Center

Haase, David G.

2009-01-01

When a college instructor goes out of town and must miss a lecture, the standard options are to cancel the class meeting or to enlist a colleague to fill in. In the former case a teaching opportunity is lost; in the latter the substitute may not lead the class in the same way as the instructor. Some students routinely skip lectures by a guest…

How to Ask Your Principal for Anything

ERIC Educational Resources Information Center

Adams, Caralee

2012-01-01

Often teachers do not think through how to ask for what they want, or they are too busy to even try. That attitude can result in missed opportunities. And grumbling in the faculty lounge, rather than raising the issue with the boss, will not get the results. In this article, the author talks about the importance of the ask and describes how to ask…

Examining the Effectiveness of an Academic Language Planning Organizer as a Tool for Planning Science Academic Language Instruction and Supports

ERIC Educational Resources Information Center

Jung, Karl G.; Brown, Julie C.

2016-01-01

To engage in the practices of science, students must have a strong command of science academic language. However, content area teachers often make academic language an incidental part of their lesson planning, which leads to missed opportunities to enhance students' language development. To support pre-service elementary science teachers (PSTs) in…

Teaching symmetry in the introductory physics curriculum

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

Hill, C. T.; Lederman, L. M.

Modern physics is largely defined by fundamental symmetry principles and Noether's Theorem. Yet these are not taught, or rarely mentioned, to beginning students, thus missing an opportunity to reveal that the subject of physics is as lively and contemporary as molecular biology, and as beautiful as the arts. We prescribe a symmetry module to insert into the curriculum, of a week's length.

Missed Opportunity? Was Iran s Green Movement an Unconventional Warfare Option?

DTIC Science & Technology

2014-12-12

leadership. Speeches , reports, websites, and foreign documents constituted the majority of usable research. The author assumed accurate translation of...expanding economic influence. The RAND Corporation’s study compiled research from the OpenSource website, scholarly reports, and translated speeches ...constructed from Mir Houssein Mousavi’s speeches . Although difficult to accredit, the manifesto echoed Green Movement leadership ideologies. This work

Symptom Recognition to Diagnosis of Autism in Nepal

ERIC Educational Resources Information Center

Shrestha, Merina; Shrestha, Rena

2014-01-01

Awareness and knowledge about autism is almost non-existent in Nepal. Children who eventually get the diagnosis often miss their opportunity for early intervention. The current study shows that medical help was seeked at mean age of 27.9 + 14.5 months and most of them were for delayed language and the first preference for parents were…

The Role of the Community in Transition to the Adult World for Students with Disabilities

ERIC Educational Resources Information Center

Hoover, Ariel

2016-01-01

Community activities can be an important part of the transition to adulthood, but many students with disabilities miss those experiences because they are not offered in their community or high school. This lack of opportunities in schools may account for the discrepancy that is found after high school graduation between the employment rates of…

Informal Statistics Help Desk

NASA Technical Reports Server (NTRS)

Ploutz-Snyder, R. J.; Feiveson, A. H.

2015-01-01

Back by popular demand, the JSC Biostatistics Lab is offering an opportunity for informal conversation about challenges you may have encountered with issues of experimental design, analysis, data visualization or related topics. Get answers to common questions about sample size, repeated measures, violation of distributional assumptions, missing data, multiple testing, time-to-event data, when to trust the results of your analyses (reproducibility issues) and more.

Intersectionality in psychotherapy: The experiences of an AfroLatinx queer immigrant.

PubMed

Adames, Hector Y; Chavez-Dueñas, Nayeli Y; Sharma, Shweta; La Roche, Martin J

2018-03-01

Culturally responsive and racially conscious psychotherapeutic work requires that therapists recognize the ways clients are impacted by their multiple marginalized identities and by systems of oppression (e.g., racism, ethnocentrism, sexism, heterosexism, and nativism). Attending exclusively to clients' marginalized identities (i.e., weak intersectionality) may drive therapists to only focus on internal, subjective, and emotional experiences, hence, missing the opportunity to consider and address how multiple sociostructural dimensions (i.e., strong intersectionality) may be impacting the client's presenting problems. Alternatively, focusing solely on the impact of sociostructural dimensions on the lives of clients may miss the more nuanced and variable individual personal experiences. In this article, we highlight the challenge of maintaining a culturally responsive and racially conscious stance when considering multiple marginalized identities, overlapping systemic inequities, and how both affect clients' lives and experiences. The case of an AfroLatinx queer immigrant is presented to illustrate some of the challenges and opportunities while simultaneously considering (a) the client's multiple marginalized identities, (b) the way clients are impacted by systemic oppression, and (c) integrating the client's personal experiences and narratives in psychotherapy. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Expanding roles within mental health legislation: an opportunity for professional growth or a missed opportunity?

PubMed

Hurley, J; Linsley, P

2007-09-01

This paper aims to highlight both the necessity, and the way forward for mental health nursing to integrate proposed legislative roles into practice. Argued is that community mental health nursing, historically absent from active participation within mental health law in the UK, is faced with new and demanding roles under proposed changes to the 1983 Mental Health Act of England and Wales. While supporting multidisciplinary training for such roles, the imperative of incorporating nursing specific values into consequent training programs is addressed through the offered educative framework. This framework explores the issues of power, ethics, legislative thematics and application to contemporary service structures.

Reconstruction of Missing Pixels in Satellite Images Using the Data Interpolating Empirical Orthogonal Function (DINEOF)

NASA Astrophysics Data System (ADS)

Liu, X.; Wang, M.

2016-02-01

For coastal and inland waters, complete (in spatial) and frequent satellite measurements are important in order to monitor and understand coastal biological and ecological processes and phenomena, such as diurnal variations. High-frequency images of the water diffuse attenuation coefficient at the wavelength of 490 nm (Kd(490)) derived from the Korean Geostationary Ocean Color Imager (GOCI) provide a unique opportunity to study diurnal variation of the water turbidity in coastal regions of the Bohai Sea, Yellow Sea, and East China Sea. However, there are lots of missing pixels in the original GOCI-derived Kd(490) images due to clouds and various other reasons. Data Interpolating Empirical Orthogonal Function (DINEOF) is a method to reconstruct missing data in geophysical datasets based on Empirical Orthogonal Function (EOF). In this study, the DINEOF is applied to GOCI-derived Kd(490) data in the Yangtze River mouth and the Yellow River mouth regions, the DINEOF reconstructed Kd(490) data are used to fill in the missing pixels, and the spatial patterns and temporal functions of the first three EOF modes are also used to investigate the sub-diurnal variation due to the tidal forcing. In addition, DINEOF method is also applied to the Visible Infrared Imaging Radiometer Suite (VIIRS) on board the Suomi National Polar-orbiting Partnership (SNPP) satellite to reconstruct missing pixels in the daily Kd(490) and chlorophyll-a concentration images, and some application examples in the Chesapeake Bay and the Gulf of Mexico will be presented.

Missed Work Due to Occupational Illness among Hispanic Horse Workers.

PubMed

Bush, Ashley M; Westneat, Susan; Browning, Steven R; Swanberg, Jennifer

2018-05-07

Occupational illnesses are inadequately reported for agriculture, an industry dominated by a vulnerable Hispanic population and high fatal and nonfatal injury rates. Work-related illnesses can contribute to missed work, caused by a combination of personal and work factors, with costs to the individual, employer, and society. To better understand agricultural occupational illnesses, 225 Hispanic horse workers were interviewed via community-based convenience sampling. Descriptive statistics, bivariate analyses, and log binomial regression modeling were used to: (1) describe the prevalence of missed work due to work-related illnesses among Hispanic horse workers, (2) examine work-related and personal factors associated with missed work, and (3) identify health symptoms and work-related characteristics potentially associated with missed work. Key findings reveal that having at least one child (PR = 1.71, 95% CI = 1.03, 2.84), having poor self-reported general health (PR = 0.72, 95% CI = 0.48, 1.08), experiencing stress during a typical workday (PR = 2.58, 95% CI = 1.25, 5.32), or spending less time with horses (PR = 1.87, 95% CI = 1.15, 3.05) are significant predictors of missing work. Interventions can be designed to identify workers most susceptible to missing work and provide resources to reduce absenteeism. Future research should examine work-related illness in agricultural horse production, including personal and work-related factors, in order to diminish occupational health disparities among these workers, who are more likely to be employed in hazardous agricultural work. Copyright© by the American Society of Agricultural Engineers.

mvp - an open-source preprocessor for cleaning duplicate records and missing values in mass spectrometry data.

PubMed

Lee, Geunho; Lee, Hyun Beom; Jung, Byung Hwa; Nam, Hojung

2017-07-01

Mass spectrometry (MS) data are used to analyze biological phenomena based on chemical species. However, these data often contain unexpected duplicate records and missing values due to technical or biological factors. These 'dirty data' problems increase the difficulty of performing MS analyses because they lead to performance degradation when statistical or machine-learning tests are applied to the data. Thus, we have developed missing values preprocessor (mvp), an open-source software for preprocessing data that might include duplicate records and missing values. mvp uses the property of MS data in which identical chemical species present the same or similar values for key identifiers, such as the mass-to-charge ratio and intensity signal, and forms cliques via graph theory to process dirty data. We evaluated the validity of the mvp process via quantitative and qualitative analyses and compared the results from a statistical test that analyzed the original and mvp-applied data. This analysis showed that using mvp reduces problems associated with duplicate records and missing values. We also examined the effects of using unprocessed data in statistical tests and examined the improved statistical test results obtained with data preprocessed using mvp.

Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study.

PubMed

Gatuguta, Anne; Merrill, Katherine G; Colombini, Manuela; Soremekun, Seyi; Seeley, Janet; Mwanzo, Isaac; Devries, Karen

2018-06-19

In Kenya, most sexual violence survivors either do not access healthcare, access healthcare late or do not complete treatment. To design interventions that ensure optimal healthcare for survivors, it is important to understand the characteristics of those who do and do not access healthcare. In this paper, we aim to: compare the characteristics of survivors who present for healthcare to those of survivors reporting violence on national surveys; understand the healthcare services provided to survivors; and, identify barriers to treatment. A mixed methods approach was used. Hospital records for survivors from two referral hospitals were compared with national-level data from the Kenya Demographic and Health Survey 2014, and the Violence Against Children Survey 2010. Descriptive summaries were calculated and differences in characteristics of the survivors assessed using chi-square tests. Qualitative data from six in-depth interviews with healthcare providers were analysed thematically. Among the 543 hospital respondents, 93.2% were female; 69.5% single; 71.9% knew the perpetrator; and 69.2% were children below 18 years. Compared to respondents disclosing sexual violence in nationally representative datasets, those who presented at hospital were less likely to be partnered, male, or assaulted by an intimate partner. Data suggest missed opportunities for treatment among those who did present to hospital: HIV PEP and other STI prophylaxis was not given to 30 and 16% of survivors respectively; 43% of eligible women did not receive emergency contraceptive; and, laboratory results were missing in more than 40% of the records. Those aged 18 years or below and those assaulted by known perpetrators were more likely to miss being put on HIV PEP. Qualitative data highlighted challenges in accessing and providing healthcare that included stigma, lack of staff training, missing equipment and poor coordination of services. Nationally, survivors at higher risk of not accessing healthcare include older survivors; partnered or ever partnered survivors; survivors experiencing sexual violence from intimate partners; children experiencing violence in schools; and men. Interventions at the community level should target survivors who are unlikely to access healthcare and address barriers to early access to care. Staff training and specific clinical guidelines/protocols for treating children are urgently needed.

Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values.

PubMed

Armstrong, Melissa J; Mullins, C Daniel

2017-02-01

Incorporation of patient values is a key element of patient-centered care, but consistent incorporation of patient values at the point of care is lacking. Shared decision making encourages incorporation of patient values in decision making, but associated tools often lack guidance on value assessment. In addition, focusing on patient values relating only to specific decisions misses an opportunity for a more holistic approach to value assessment that could impact other aspects of clinical encounters, including health care planning, communication, and stakeholder involvement. In this commentary, we propose a taxonomy of values underlying patient decision making and provide examples of how these impact provision of health care. The taxonomy describes four categories of patient values: global, decisional, situational, and external. Global values are personal values impacting decision making at a universal level and can include value traits and life priorities. Decisional values are the values traditionally conceptualized in decision making, including considerations such as efficacy, toxicity, quality of life, convenience, and cost. Situational values are values tied to a specific moment in time that modify patients' existing global and decisional values. Finally, discussion of external values acknowledges that many patients consider values other than their own when making decisions. Recognizing the breadth of values impacting patient decision making has implications for both overall health care delivery and shared decision making because value assessments focusing only on decisional values may miss important patient considerations. This draft taxonomy highlights different values impacting decision making and facilitates a more complete value assessment at the point of care. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Pooled individual patient data from five countries were used to derive a clinical prediction rule for coronary artery disease in primary care.

PubMed

Aerts, Marc; Minalu, Girma; Bösner, Stefan; Buntinx, Frank; Burnand, Bernard; Haasenritter, Jörg; Herzig, Lilli; Knottnerus, J André; Nilsson, Staffan; Renier, Walter; Sox, Carol; Sox, Harold; Donner-Banzhoff, Norbert

2017-01-01

To construct a clinical prediction rule for coronary artery disease (CAD) presenting with chest pain in primary care. Meta-Analysis using 3,099 patients from five studies. To identify candidate predictors, we used random forest trees, multiple imputation of missing values, and logistic regression within individual studies. To generate a prediction rule on the pooled data, we applied a regression model that took account of the differing standard data sets collected by the five studies. The most parsimonious rule included six equally weighted predictors: age ≥55 (males) or ≥65 (females) (+1); attending physician suspected a serious diagnosis (+1); history of CAD (+1); pain brought on by exertion (+1); pain feels like "pressure" (+1); pain reproducible by palpation (-1). CAD was considered absent if the prediction score is <2. The area under the ROC curve was 0.84. We applied this rule to a study setting with a CAD prevalence of 13.2% using a prediction score cutoff of <2 (i.e., -1, 0, or +1). When the score was <2, the probability of CAD was 2.1% (95% CI: 1.1-3.9%); when the score was ≥ 2, it was 43.0% (95% CI: 35.8-50.4%). Clinical prediction rules are a key strategy for individualizing care. Large data sets based on electronic health records from diverse sites create opportunities for improving their internal and external validity. Our patient-level meta-analysis from five primary care sites should improve external validity. Our strategy for addressing site-to-site systematic variation in missing data should improve internal validity. Using principles derived from decision theory, we also discuss the problem of setting the cutoff prediction score for taking action. Copyright © 2016 Elsevier Inc. All rights reserved.

Characteristics of patients with missing information on stage: a population-based study of patients diagnosed with colon, lung or breast cancer in England in 2013.

PubMed

Di Girolamo, Chiara; Walters, Sarah; Benitez Majano, Sara; Rachet, Bernard; Coleman, Michel P; Njagi, Edmund Njeru; Morris, Melanie

2018-05-02

Stage is a key predictor of cancer survival. Complete cancer staging is vital for understanding outcomes at population level and monitoring the efficacy of early diagnosis initiatives. Cancer registries usually collect details of the disease extent but staging information may be missing because a stage was never assigned to a patient or because it was not included in cancer registration records. Missing stage information introduce methodological difficulties for analysis and interpretation of results. We describe the associations between missing stage and socio-demographic and clinical characteristics of patients diagnosed with colon, lung or breast cancer in England in 2013. We assess how these associations change when completeness is high, and administrative issues are assumed to be minimal. We estimate the amount of avoidable missing stage data if high levels of completeness reached by some Clinical Commissioning Groups (CCGs), were achieved nationally. Individual cancer records were retrieved from the National Cancer Registration and linked to the Routes to Diagnosis and Hospital Episode Statistics datasets to obtain additional clinical information. We used multivariable beta binomial regression models to estimate the strength of the association between socio-demographic and clinical characteristics of patients and missing stage and to derive the amount of avoidable missing stage. Multivariable modelling showed that old age was associated with missing stage irrespective of the cancer site and independent of comorbidity score, short-term mortality and patient characteristics. This remained true for patients in the CCGs with high completeness. Applying the results from these CCGs to the whole cohort showed that approximately 70% of missing stage information was potentially avoidable. Missing stage was more frequent in older patients, including those residing in CCGs with high completeness. This disadvantage for older patients was not explained fully by the presence of comorbidity. A substantial gain in completeness could have been achieved if administrative practices were improved to the level of the highest performing areas. Reasons for missing stage information should be carefully assessed before any study, and potential distortions introduced by how missing stage is handled should be considered in order to draw the most correct inference from available statistics.

23 CFR 450.210 - Interested parties, public involvement, and consultation.

Code of Federal Regulations, 2012 CFR

2012-04-01

... opportunities for public review and comment at key decision points. (1) The State's public involvement process... agencies, representatives of public transportation employees, freight shippers, private providers of... comment at key decision points, including but not limited to a reasonable opportunity to comment on the...

23 CFR 450.210 - Interested parties, public involvement, and consultation.

Code of Federal Regulations, 2013 CFR

2013-04-01

... opportunities for public review and comment at key decision points. (1) The State's public involvement process... agencies, representatives of public transportation employees, freight shippers, private providers of... comment at key decision points, including but not limited to a reasonable opportunity to comment on the...

23 CFR 450.210 - Interested parties, public involvement, and consultation.

Code of Federal Regulations, 2014 CFR

2014-04-01

... opportunities for public review and comment at key decision points. (1) The State's public involvement process... agencies, representatives of public transportation employees, freight shippers, private providers of... comment at key decision points, including but not limited to a reasonable opportunity to comment on the...

Anesthesiology leadership rounding: identifying opportunities for improvement.

PubMed

Gravenstein, Dietrich; Ford, Susan; Enneking, F Kayser

2012-01-01

Rounding that includes participation of individuals with authority to implement changes has been advocated as important to the transformation of an institution into a high-quality and safe organization. We describe a Department of Anesthesiology's experience with leadership rounding. The Department Chair or other senior faculty designate, a quality coordinator, up to four residents, the ward charge nurse, and patient nurses participated in rounds at bedsides. During a 23-month period, 14 significant opportunities to improve care were identified. Nurses identified 5 of these opportunities, primary team physicians 2, the rounding team 4, and patients or their family members another 3. The anesthesiology service had sole or shared responsibility for 10 improvements. A variety of organizations track specific measures across all phases of the patient experience to gauge quality of care. Chart auditing tools for detecting threats to safety are often used. These measures and tools missed opportunities for improvement that were discovered only through rounding. We conclude that the introduction of leadership rounding by an anesthesiology service can identify opportunities for improving quality that are not captured by conventional efforts.

Pathology report assessment of incidental gallbladder carcinoma diagnosed from cholecystectomy specimens: results of a French multicentre survey.

PubMed

Chatelain, Denis; Fuks, David; Farges, Olivier; Attencourt, Christophe; Pruvot, François René; Regimbeau, Jean-Marc

2013-12-01

To assess the accuracy of pathology reports on gallbladder specimens from patients operated on for incidental gallbladder carcinoma. Demographic data, details on pathological reports including gross and microscopic features section were recorded in 100 selected patients with incidental gallbladder carcinoma diagnosed from 2004 to 2007. Pathology reports had a conventional format in 93% of cases, without any standardization. Turnaround time ranged from 1 to 35 days. Frozen sections were performed in 20% of cases. The reports failed to give information on prognostic histological factors: exact tumour site (missing in 55% of cases), depth of tumour infiltration within the gallbladder wall (missing in 10%), surgical margins (missing in 40% for the cystic duct margin), tumour differentiation (missing in 28%), vascular invasion (missing in 52%) and perineural invasion (missing in 51%). Lymph node status could be assessed in 44% of cases. Distances between the tumour and the cystic duct and circumferential margins were not specified in 68% and 84% of cases. Only 29% of the reports clearly stated the pTNM stage in the conclusion section. The pT stage with margin status and tumour site was only mentioned in 30% of the reports. Pathology reports on gallbladder carcinoma from participating centres frequently lacked important information on key prognostic histological factors. Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Nuclear and Membrane Actions of Estrogen Receptor Alpha: Contribution to the Regulation of Energy and Glucose Homeostasis.

PubMed

Guillaume, Maeva; Montagner, Alexandra; Fontaine, Coralie; Lenfant, Françoise; Arnal, Jean-François; Gourdy, Pierre

2017-01-01

Estrogen receptor alpha (ERα) has been demonstrated to play a key role in reproduction but also to exert numerous functions in nonreproductive tissues. Accordingly, ERα is now recognized as a key regulator of energy homeostasis and glucose metabolism and mediates the protective effects of estrogens against obesity and type 2 diabetes. This chapter attempts to summarize our current understanding of the mechanisms of ERα activation and their involvement in the modulation of energy balance and glucose metabolism. We first focus on the experimental studies that constitute the basis of the understanding of ERα as a nuclear receptor and more specifically on the key roles played by its two activation functions (AFs). We depict the consequences of the selective inactivation of these AFs in mouse models, which further underline the prominent role of nuclear ERα in the prevention of obesity and diabetes, as on the reproductive tract and the vascular system. Besides these nuclear actions, a fraction of ERα is associated with the plasma membrane and activates nonnuclear signaling from this site. Such rapid effects, called membrane-initiated steroid signals (MISS), have been characterized in a variety of cell lines and in particular in endothelial cells. The development of selective pharmacological tools that specifically activate MISS as well as the generation of mice expressing an ERα protein impeded for membrane localization has just begun to unravel the physiological role of MISS in vivo and their contribution to ERα-mediated metabolic protection. Finally, we discuss novel perspectives for the design of tissue-selective ER modulators.

The Spiral of Science (Mis)Education, Parker's "Multiple Influences," and Missed Opportunities

ERIC Educational Resources Information Center

Richardson Bruna, Katherine

2014-01-01

In this reflection on Carolyn Parker's article, I connect to my own professional work at the intersection of Latino education and science education as well as to my own personal interest in liberation theology. I use constructs central to liberation theology to indicate what a liberationist science might look like and push us, in doing so, to…

Space Odyssey Gift Shop

NASA Technical Reports Server (NTRS)

2000-01-01

The Space Odyssey Gift Shop located in StenniSphere at the John C. Stennis Space Center in Hancock County, Miss., offers every visitor the opportunity to go home with 'the right stuff' from his or her StenniSphere visit. The gift shop is located just inside the front doors to StenniSphere and offers a wide range of space-related apparel, memorabilia, toys, books, mission patches and more.

Followup Audit: DoD Military Treatment Facilities Continue to Miss Opportunities to Collect on Third Party Outpatient Claims

DTIC Science & Technology

2015-07-24

Business Office Manual at the six MTFs reviewed. Based on the statistical sample, there were 144,930 claims worth $34.8 million that had at least...19 Parameters ______________________________________________________________________________ 19 Statistical ...the UBO Manual at the six MTFs reviewed. Based on the statistical sample, there were 144,930 claims worth $34.8 million that had at least one

Get up and Sing! Get up and Move! Using Songs and Movement with Young Learners of English

ERIC Educational Resources Information Center

Shin, Joan Kang

2017-01-01

Teachers of young learners (YLs) often use songs and movement to engage children in the classroom. However, are there missed opportunities for language learning and practice that can be added to what they are already doing in their English for young learner (EYL) classes? A deeper understanding of the importance of music in children's lives and…

Timber productivity research gaps for extensive forest management

Treesearch

L.C. Irland

2011-01-01

On extensive areas of small scale forests, significant opportunities for improving the value of future timber harvests while also improving other resource values are now being missed. A new focus on practical extensive management research is needed, especially as implementation of intensive practices has been declining in many areas, and new ‘‘close to nature’’...

Asset-Based Civics for, with, and by Immigrant Students: Three Sites of Enriched Teaching and Learning for Immigrant and Native-Born Students

ERIC Educational Resources Information Center

Hilburn, Jeremy

2015-01-01

In this qualitative collective case study with 6 high school civics teachers, I found that using an asset-based approach to teaching civics for, with, and by immigrant students enriched teaching and learning for immigrant and native-born students, although participants missed some opportunities for deeper exploration. I used a combined theoretical…

Teaching the Mantle Plumes Debate

NASA Astrophysics Data System (ADS)

Foulger, G. R.

2010-12-01

There is an ongoing debate regarding whether or not mantle plumes exist. This debate has highlighted a number of issues regarding how Earth science is currently practised, and how this feeds into approaches toward teaching students. The plume model is an hypothesis, not a proven fact. And yet many researchers assume a priori that plumes exist. This assumption feeds into teaching. That the plume model is unproven, and that many practising researchers are skeptical, may be at best only mentioned in passing to students, with most teachers assuming that plumes are proven to exist. There is typically little emphasis, in particular in undergraduate teaching, that the origin of melting anomalies is currently uncertain and that scientists do not know all the answers. Little encouragement is given to students to become involved in the debate and to consider the pros and cons for themselves. Typically teachers take the approach that “an answer” (or even “the answer”) must be taught to students. Such a pedagogic approach misses an excellent opportunity to allow students to participate in an important ongoing debate in Earth sciences. It also misses the opportunity to illustrate to students several critical aspects regarding correct application of the scientific method. The scientific method involves attempting to disprove hypotheses, not to prove them. A priori assumptions should be kept uppermost in mind and reconsidered at all stages. Multiple working hypotheses should be entertained. The predictions of a hypothesis should be tested, and unpredicted observations taken as weakening the original hypothesis. Hypotheses should not be endlessly adapted to fit unexpected observations. The difficulty with pedagogic treatment of the mantle plumes debate highlights a general uncertainty about how to teach issues in Earth science that are not yet resolved with certainty. It also represents a missed opportunity to let students experience how scientific theories evolve, warts and all. Working with students to enable them to participate in the evolution of the subject and to share in the excitement of major developments is surely the best way to attract them to science.

Missed opportunities for HIV testing in health care settings among young African American men who have sex with men: implications for the HIV epidemic.

PubMed

Dorell, Christina G; Sutton, Madeline Y; Oster, Alexandra M; Hardnett, Felicia; Thomas, Peter E; Gaul, Zaneta J; Mena, Leandro A; Heffelfinger, James D

2011-11-01

Limited health care access and missed opportunities for HIV and other sexually transmitted infection (STI) education and testing in health care settings may contribute to risk of HIV infection. In 2008, we conducted a case-control study of African American men who have sex with men (MSM) in a southeastern city (Jackson, Mississippi) with an increase in numbers of newly reported HIV cases. Our aims were to evaluate associations between health care and HIV infection and to identify missed opportunities for HIV/STI testing. We queried 40 potential HIV-infected cases and 936 potential HIV-uninfected controls for participation in this study. Study enrollees included HIV-infected cases (n=30) and HIV-uninfected controls (n=95) who consented to participate and responded to a self-administered computerized survey about sexual risk behaviors and health care utilization. We used bivariate analysis and logistic regression to test for associations between potential risk factors and HIV infection. Cases were more likely than controls to lack health insurance (odds ratio [OR]=2.5; 95% confidence interval [CI]=1.1-5.7), lack a primary care provider (OR=6.3; CI=2.3-16.8), and to not have received advice about HIV or STI testing or prevention (OR=5.4; CI=1.3-21.5) or disclose their sexual identity (OR=7.0; CI=1.6-29.2) to a health care provider. In multivariate analysis, lacking a primary health care provider (adjusted odds ratio [AOR]=4.5; CI=1.4-14.7) and not disclosing sexual identity to a health care provider (AOR=8.6; CI=1.8-40.0) were independent risk factors for HIV infection among African American MSM. HIV prevention interventions for African American MSM should address access to primary health care providers for HIV/STI prevention and testing services and the need for increased discussions about sexual health, sexual identity, and sexual behaviors between providers and patients in an effort to reduce HIV incidence and HIV-related health disparities.

Pediatric Somatic Symptom Disorders.

PubMed

Malas, Nasuh; Ortiz-Aguayo, Roberto; Giles, Lisa; Ibeziako, Patricia

2017-02-01

Somatic symptom disorder (SSD) is a common disorder encountered in pediatric medicine. It involves the presentation of physical symptoms that are either disproportionate or inconsistent with history, physical examination, laboratory, and other investigative findings. SSDs result in significant impairment with considerable increase in healthcare utilization, school absenteeism, and the potential for unnecessary diagnostic evaluation and treatment intervention. Patients and families often feel dismissed and may worry that a serious condition has been missed. Primary care providers are frequently frustrated due to a lack of a successful approach to patients and families impacted by SSD. The result is often a cycle of disability, frustration and missed opportunities for collaboration towards enhanced patient functionality. This review summarizes the current evidence-based understanding, as well as insights from clinician experience, on the evaluation and management of pediatric SSD.

Clinical trials in pediatric neuro-oncology: what is missing and how we can improve.

PubMed

Byer, Lennox; Kline, Cassie; Mueller, Sabine

2016-10-01

Brain tumors are the most common solid tumor in childhood, yet outcomes vary dramatically. High-grade gliomas have dismal outcomes with poor survival. By contrast, low-grade gliomas, have high survival rates, but children suffer from morbidity of tumor burden and therapy-associated side effects. In this article, we discuss how current trial designs often miss the opportunity to include end points beyond tumor response and thus fail to offer complete assessments of therapeutic approaches. Quality of life, neurocognitive function and neurofunctional deficits need to be considered when assessing overall success of a therapy. Herein, we identify specific end points that should be included in the interpretation of clinical trial results and accordingly, offer a more comprehensive approach to treatment decision-making.

Traffic speed data imputation method based on tensor completion.

PubMed

Ran, Bin; Tan, Huachun; Feng, Jianshuai; Liu, Ying; Wang, Wuhong

2015-01-01

Traffic speed data plays a key role in Intelligent Transportation Systems (ITS); however, missing traffic data would affect the performance of ITS as well as Advanced Traveler Information Systems (ATIS). In this paper, we handle this issue by a novel tensor-based imputation approach. Specifically, tensor pattern is adopted for modeling traffic speed data and then High accurate Low Rank Tensor Completion (HaLRTC), an efficient tensor completion method, is employed to estimate the missing traffic speed data. This proposed method is able to recover missing entries from given entries, which may be noisy, considering severe fluctuation of traffic speed data compared with traffic volume. The proposed method is evaluated on Performance Measurement System (PeMS) database, and the experimental results show the superiority of the proposed approach over state-of-the-art baseline approaches.

Traffic Speed Data Imputation Method Based on Tensor Completion

PubMed Central

Ran, Bin; Feng, Jianshuai; Liu, Ying; Wang, Wuhong

2015-01-01

Traffic speed data plays a key role in Intelligent Transportation Systems (ITS); however, missing traffic data would affect the performance of ITS as well as Advanced Traveler Information Systems (ATIS). In this paper, we handle this issue by a novel tensor-based imputation approach. Specifically, tensor pattern is adopted for modeling traffic speed data and then High accurate Low Rank Tensor Completion (HaLRTC), an efficient tensor completion method, is employed to estimate the missing traffic speed data. This proposed method is able to recover missing entries from given entries, which may be noisy, considering severe fluctuation of traffic speed data compared with traffic volume. The proposed method is evaluated on Performance Measurement System (PeMS) database, and the experimental results show the superiority of the proposed approach over state-of-the-art baseline approaches. PMID:25866501

Using Large Diabetes Databases for Research.

PubMed

Wild, Sarah; Fischbacher, Colin; McKnight, John

2016-09-01

There are an increasing number of clinical, administrative and trial databases that can be used for research. These are particularly valuable if there are opportunities for linkage to other databases. This paper describes examples of the use of large diabetes databases for research. It reviews the advantages and disadvantages of using large diabetes databases for research and suggests solutions for some challenges. Large, high-quality databases offer potential sources of information for research at relatively low cost. Fundamental issues for using databases for research are the completeness of capture of cases within the population and time period of interest and accuracy of the diagnosis of diabetes and outcomes of interest. The extent to which people included in the database are representative should be considered if the database is not population based and there is the intention to extrapolate findings to the wider diabetes population. Information on key variables such as date of diagnosis or duration of diabetes may not be available at all, may be inaccurate or may contain a large amount of missing data. Information on key confounding factors is rarely available for the nondiabetic or general population limiting comparisons with the population of people with diabetes. However comparisons that allow for differences in distribution of important demographic factors may be feasible using data for the whole population or a matched cohort study design. In summary, diabetes databases can be used to address important research questions. Understanding the strengths and limitations of this approach is crucial to interpret the findings appropriately. © 2016 Diabetes Technology Society.

Factors associated with shift work disorder in nurses working with rapid-rotation schedules in Japan: the nurses' sleep health project.

PubMed

Asaoka, Shoichi; Aritake, Sayaka; Komada, Yoko; Ozaki, Akiko; Odagiri, Yuko; Inoue, Shigeru; Shimomitsu, Teruichi; Inoue, Yuichi

2013-05-01

Workers who meet the criteria for shift work disorder (SWD) have elevated levels of risk for various health and behavioral problems. However, the impact of having SWD on shiftworkers engaged in rapid-rotation schedules is unknown. Moreover, the risk factors for the occurrence of SWD remain unclear. To clarify these issues, we conducted a questionnaire-based, cross-sectional survey on a sample of shiftworking nurses. Responses were obtained from 1202 nurses working at university hospitals in Tokyo, Japan, including 727 two-shift workers and 315 three-shift workers. The questionnaire included items relevant to age, gender, family structure, work environment, health-related quality of life (QOL), diurnal type, depressive symptoms, and SWD. Participants who reported insomnia and/or excessive sleepiness for at least 1 mo that was subjectively relevant to their shiftwork schedules were categorized as having SWD. The prevalence of SWD in the sampled shiftworking nurses was 24.4%; shiftworking nurses with SWD showed lower health-related QOL and more severe depressive symptoms, with greater rates of both actual accidents/errors and near misses, than those without SWD. The results of logistic regression analyses showed that more time spent working at night, frequent missing of nap opportunities during night work, and having an eveningness-oriented chronotype were significantly associated with SWD. The present study indicated that SWD might be associated with reduced health-related QOL and decreased work performance in shiftworking nurses on rapid-rotation schedules. The results also suggested that missing napping opportunities during night work, long nighttime working hours, and the delay of circadian rhythms are associated with the occurrence of SWD among shiftworking nurses on rapid-rotation schedules.

Solutions for filling gaps in accountable care measure sets.

PubMed

Valuck, Tom; Dugan, Donna; Dubois, Robert W; Westrich, Kimberly; Penso, Jerry; McClellan, Mark

2015-10-01

A primary objective of accountable care is to support providers in reforming care to improve outcomes and lower costs. Gaps in accountable care measure sets may cause missed opportunities for improvement and missed signals of problems in care. Measures to balance financial incentives may be particularly important for high-cost conditions or specialty treatments. This study explored gaps in measure sets for specific conditions and offers strategies for more comprehensive measurement that do not necessarily require more measures. A descriptive analysis of measure gaps in accountable care programs and proposed solutions for filling the gaps. We analyzed gaps in 2 accountable care organization measure sets for 20 high-priority clinical conditions by comparing the measures in those sets with clinical guidelines and assessing the use of outcome measures. Where we identified gaps, we looked for existing measures to address the gaps. Gaps not addressed by existing measures were considered areas for measure development or measurement strategy refinement. We found measure gaps across all 20 conditions, including those conditions that are commonly addressed in current measure sets. In addition, we found many gaps that could not be filled by existing measures. Results across all 20 conditions informed recommendations for measure set improvement. Addressing all gaps in accountable care measure sets with more of the same types of measures and approaches to measurement would require an impractical number of measures and would miss the opportunity to use better measures and innovative approaches. Strategies for effectively filling measure gaps include using preferred measure types such as cross-cutting, outcome, and patient-reported measures. Program implementers should also apply new approaches to measurement, including layered and modular models.

Socioeconomic and Demographic Predictors of Missed Opportunities to Provide Advanced Imaging Services.

PubMed

Glover, McKinley; Daye, Dania; Khalilzadeh, Omid; Pianykh, Oleg; Rosenthal, Daniel I; Brink, James A; Flores, Efrén J

2017-11-01

The extent to which racial and socioeconomic disparities exist in accessing clinically appropriate, advanced diagnostic imaging has not been well studied. This study assesses the relationship between demographic and socioeconomic factors and the incidence of imaging missed care opportunities (IMCOs). We performed a retrospective review of outpatient CT and MRI appointments at a quaternary academic medical center and affiliated outpatient facilities during a 12-month period. Missed appointments not rescheduled in advance were classified as IMCOs. Appropriateness criteria scores and demographics were also obtained. Univariate and multivariate analyses were performed to determine if demographic and socioeconomic factors were predictive of IMCOs. Overall, 57,847 patients met inclusion criteria, representing 89,943 scheduled unique imaging appointments of which 5,840 (6.1%) were IMCOs; 0.8% of IMCO appointments had low appropriateness scores compared with 1.2% of completed appointments (P < .01). Appointments covered by commercial insurance (5.2%) had a significantly lower rate of IMCOs than other payers: Medicare = 6.3%, Medicaid = 14.5%, self-pay = 12.0% (P < .05). The following factors were independent predictors of a patient having ≥ 1 IMCO: noncommercial insurance [odds ratio (OR) = 1.7-2.6], African American (OR = 1.8), Hispanic (OR = 1.2), other race (OR = 1.1), language other than English or Spanish (OR = 1.2), male gender (OR = 1.2), age ≥ 65 (OR = 0.71), and median household income of patient home zip code <$50,000 (OR = 1.4). Race and socioeconomic status are independent predictors of IMCOs. In efforts to enhance patient engagement, radiologists should be aware of the impact of race and socioeconomic status on access to clinically appropriate advanced diagnostic imaging. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Filling gaps in large ecological databases: consequences for the study of global-scale plant functional trait patterns

NASA Astrophysics Data System (ADS)

Schrodt, Franziska; Shan, Hanhuai; Fazayeli, Farideh; Karpatne, Anuj; Kattge, Jens; Banerjee, Arindam; Reichstein, Markus; Reich, Peter

2013-04-01

With the advent of remotely sensed data and coordinated efforts to create global databases, the ecological community has progressively become more data-intensive. However, in contrast to other disciplines, statistical ways of handling these large data sets, especially the gaps which are inherent to them, are lacking. Widely used theoretical approaches, for example model averaging based on Akaike's information criterion (AIC), are sensitive to missing values. Yet, the most common way of handling sparse matrices - the deletion of cases with missing data (complete case analysis) - is known to severely reduce statistical power as well as inducing biased parameter estimates. In order to address these issues, we present novel approaches to gap filling in large ecological data sets using matrix factorization techniques. Factorization based matrix completion was developed in a recommender system context and has since been widely used to impute missing data in fields outside the ecological community. Here, we evaluate the effectiveness of probabilistic matrix factorization techniques for imputing missing data in ecological matrices using two imputation techniques. Hierarchical Probabilistic Matrix Factorization (HPMF) effectively incorporates hierarchical phylogenetic information (phylogenetic group, family, genus, species and individual plant) into the trait imputation. Advanced Hierarchical Probabilistic Matrix Factorization (aHPMF) on the other hand includes climate and soil information into the matrix factorization by regressing the environmental variables against residuals of the HPMF. One unique opportunity opened up by aHPMF is out-of-sample prediction, where traits can be predicted for specific species at locations different to those sampled in the past. This has potentially far-reaching consequences for the study of global-scale plant functional trait patterns. We test the accuracy and effectiveness of HPMF and aHPMF in filling sparse matrices, using the TRY database of plant functional traits (http://www.try-db.org). TRY is one of the largest global compilations of plant trait databases (750 traits of 1 million plants), encompassing data on morphological, anatomical, biochemical, phenological and physiological features of plants. However, despite of unprecedented coverage, the TRY database is still very sparse, severely limiting joint trait analyses. Plant traits are the key to understanding how plants as primary producers adjust to changes in environmental conditions and in turn influence them. Forming the basis for Dynamic Global Vegetation Models (DGVMs), plant traits are also fundamental in global change studies for predicting future ecosystem changes. It is thus imperative that missing data is imputed in as accurate and precise a way as possible. In this study, we show the advantages and disadvantages of applying probabilistic matrix factorization techniques in incorporating hierarchical and environmental information for the prediction of missing plant traits as compared to conventional imputation techniques such as the complete case and mean approaches. We will discuss the implications of using gap-filled data for global-scale studies of plant functional trait - environment relationship as opposed to the above-mentioned conventional techniques, using examples of out-of-sample predictions of foliar Nitrogen across several species' ranges and biomes.

Empirical Study of Family Background and Higher Education: Relationship to Acceptance Opportunities and Trends--Based on Surveys at a Key Beijing University from 2007 to 2012

ERIC Educational Resources Information Center

Silin, Huang; Ziqiang, Xin; Jiawei, Hou

2015-01-01

Which family had a child that was accepted at a key university? To investigate the relationship between family background and children obtaining higher education opportunities and developing trends, the authors analyze survey data from 2007 to 2012 at a key university in Beijing. The results show there is a clear trend of enlargement of the…

Identification of potential missed opportunities for human papillomavirus (HPV) vaccination in women referred to an academic colposcopy clinic for evaluation of abnormal cervical cytology.

PubMed

Dorton, Benjamin J; Vitonis, Allison F; Feldman, Sarah

2016-06-02

To identify possible predictors of missed opportunities for human papillomavirus (HPV) counseling and vaccination prior to presentation at an academic colposcopy clinic. We examined the characteristics of 638 vaccinated and 1,024 unvaccinated age-eligible patients using data from a patient registry of women presenting for colposcopic evaluation between 2/26/2007 and 3/10/2014 who were aged 26 or less at presentation. Demographics, smoking history, pregnancy history, sexually transmitted infections (STIs), sexual history, contraception use, immunosuppression, and medical problems were compared between HPV vaccinated and unvaccinated women. Multivariable logistic regression models included age, race, language, marital status, insurance type, lifetime number of sexual partners, other medical illnesses, number of pregnancies, contraception use, history of STIs, and smoking history to determine predictors of HPV vaccination. In multivariable analysis, race, marital status, and language were not significantly associated with HPV vaccination. Women with fewer pregnancies were more likely to be vaccinated (p-trend <0 .0001). Vaccinated women were more likely to have other medical illnesses (OR=1.44, 95% CI=1.13-1.83) and be aware of their HPV status (OR=1.75, 95% CI= 1.40-2.18). In this study, greater number of pregnancies was associated with lower vaccination rates as compared to women who had never been pregnant. Reproductive health visits, such as postpartum and family planning visits, represent an ideal opportunity to educate women about HPV and the importance of vaccination, and should be an area of focus to improve current HPV vaccination rates.

Living with gestational diabetes in a rural community.

PubMed

Abraham, Kylene; Wilk, Nancy

2014-01-01

To explore the lived experiences of women with a recent history of gestational diabetes mellitus (GDM) who live in rural communities. A phenomenological study exploring the lived experiences of 10 women aged 25 to 49 years with a history of GDM in the last 5 years. Data were collected through two semistructured short interviews that were conducted in person or by telephone. Five themes emerged: Authentic emotion, Judgment, It's only a matter of time, I can't do this alone, and Missed opportunities. Strong emotions were experienced at the time of diagnosis. Some women felt judged by healthcare professionals and others based on having GDM. Some were concerned about future risk of developing Type 2 DM. There is a lack of understanding of GDM by women at the time of diagnosis and after they give birth. The majority of women in this study noted that healthcare professionals did not discuss future implications of Type 2 DM and the need for follow-up glucose testing. Many opportunities are missed to provide education and support to facilitate lifestyle interventions. Self-management of GDM is more likely to be successful if women understand GDM and believe that they can manage it. Nurses should use every opportunity to provide women with GDM information and available resources. This may be important in rural communities where fewer resources are available for support. Nurses should recognize that negative emotions may affect motivation of women to understand and ask questions about GDM. Nurses can favorably influence the return rates for postpartum glucose testing by raising awareness of implications of GDM on future health.

Cupid's Arrow: An Innovative Nanosat to Sample Venus' Upper Atmosphere

NASA Technical Reports Server (NTRS)

Bienstock, Bernie; Darrach, Murray; Madzunkov, Stojan; Sotin, Christophe

2016-01-01

In NASA's Discovery 2014 AO, the opportunity to propose a Technology Demonstration Opportunity (TDO) to enhance the primary mission was specified. For the Venus Emissivity, Radio Science, InSAR, Topography, and Spectroscopy (VERITAS) mission, we elected to include the Cupid's Arrow nanosat TDO to sample and measure the abundances of noble gases and their isotopic ratios in Venus's upper atmosphere below the homopause. This paper will provide a basic overview of the VERITAS mission, with a focus on the Cupid's Arrow concept including a description of the mission, spacecraft design, and JPL's quadrupole ion trap mass spectrometer (QITMS) instrument specifications and design. In previous planetary entry probe mission designs, particularly at Venus, engineers w ere focused on entry and descent. A landed probe was also proposed for the New Frontiers SAGE mission. For Cupid's Arrow, the nanosat is designed to skim through the upper atmosphere, just below the homopause, in order to sample the atmosphere, perform the analysis, and then exit the atmosphere to transmit its data to the orbiting VERITAS spacecraft. Cupid's Arrow is a compelling addition to the VERITAS geology mission. A key missing link in our understanding of Venus' evolution is the noble gas abundances and their isotopic ratios. Not since Pioneer Venus have these measurements been made in the Venus atmosphere and never in the upper atmosphere, just below the homopause, to the degree of accuracy that will be accomplished by VERITAS' Cupid's Arrow nanosat.Such measurements were ranked as the number 1 investigation of the number 1 objective of the goal "Atmospheric Formation, Evolution, and Climate History ".

Community management of intellectual disabilities in Pakistan: a mixed methods study

PubMed Central

Mirza, I.; Tareen, A.; Davidson, L. L.; Rahman, A.

2015-01-01

Background Pakistan has one of the highest reported rates of childhood intellectual disabilities in the world. Prevalence estimates vary from 19.1/1000 for serious intellectual disability to 65/1000 for mild intellectual disability Methods We surveyed carers of persons with intellectual disabilities (n=100) using quantitative and qualitative instruments. We conducted in-depth interviews of carers (n=16) and key primary health providers (n=10). We also carried out focus groups (n=7). Data was triangulated and interpreted in light of peer reviewed literature Results There was a delay of 2.92 (95% CI 1.9 to 3.94) to 4.17 (95% CI 2.34 to 6.01) years between detection and seeking of care. Parental stress associated with caring for these children was high (mean SRQ score 8.4; 95%CI 6.80 to 9.91). Home management consisted mainly of physical containment. Stigma associated with intellectual disability contributed to decreased opportunity for these children and families to participate in community activities. There was a lack of knowledge about causation and effective interventions for intellectual disabilities. Conclusions Our findings suggest that there is significant delay in detection of intellectual disabilities especially in rural setting where more than 70% of population of Pakistan resides. This missed opportunity for rehabilitation in early formative years is a cause of significant distress for the caregivers who rarely receive valid information about course, prognosis and what remedial action to take. There is a need to develop feasible, cost effective, community level interventions, which can be integrated into existing healthcare systems. PMID:19504727

Mental health, mental illness, and human rights in India and elsewhere: What are we aiming for?

PubMed

Kelly, Brendan D

2016-12-01

The Mental Health Care Bill 2013 was introduced to the Rajya Sabha (India's upper house of parliament) in August 2013 and following 134 official amendments, passed in August 2016. Properly implemented, mental health legislation such as this plays a key role in protecting the rights of the mentally ill, ensuring access to care, and promoting social justice for the mentally ill, their families and carers. In this context, the 2006 United Nations' Convention on the Rights of Persons with Disabilities (CRPD) presents a real opportunity to improve the position of people with disabilities and those disabled by long-term mental illness. The CRPD also presents many challenges to mental health legislators and service-providers, especially in relation to involuntary care, mental capacity, and substitute decision-making. Nevertheless, the CRPD has still generated strong incentive for reform and is an opportunity that should not be missed. Legislation along the lines of India's 2013 Bill offers much that is positive and progressive in terms of standards of care, revised processes for involuntary admission, and enhanced governance throughout mental health services. In this way, this kind of legislation, although imperfect in certain respects, promotes the principles of the CRPD (as outlined in the preamble to India's 2013 Bill). It is important that such initiatives focus not only on the right to liberty but also on rights to treatment, social care, social inclusion, and political empowerment of the mentally ill. Globally, the mentally ill have been neglected for far, far too long. It is time to fix this.

Core competencies for natural resource negotiation

USGS Publications Warehouse

Gillette, S.C.; Lamb, B.L.

2005-01-01

Natural resource negotiation often involves multiple parties with overlapping interests and issues that can provide opportunities for mutually beneficial solutions. These opportunities can be missed, however, if negotiators are unable to comprehend the facts of a negotiation, understand the interests of other parties, or accurately evaluate the options that increase the size of the negotiation pie. Through structured personal interviews with more than 60 representatives from seven different hydropower negotiations, respondents identified core competencies that help negotiators succeed at accurately comprehending the facts of a negotiation, comprehending the interests of other parties, and fully understanding the available options and alternatives. We categorized those core competencies into three dimensions of negotiation - interpersonal, organizational, and operational.

Provider-Payer Partnerships as an Engine for Continuous Quality Improvement.

PubMed

Balfour, Margaret E; Zinn, Tylar E; Cason, Karena; Fox, Jerimya; Morales, Myra; Berdeja, Cesar; Gray, Jay

2018-06-01

The authors describe a quality improvement approach in which a crisis center and a payer collaborate to improve care. Each crisis visit is considered as a potentially missed opportunity for community stabilization. Daily data on crisis visits are sent to the payer for a more up-to-date analysis of trends than is possible with financial claims data, which may lag behind services provided by up to 90 days. Using these trend data, the two organizations collaborate to identify patterns that lead to opportunities for improvement and develop multiple rapid-cycle projects for better management of services, resulting in significant decreases in readmissions and in the number of high utilizers.

Black and White Women Managers: Access to Opportunity

ERIC Educational Resources Information Center

Hite, Linda M.

2004-01-01

This study explores the differing views of Black and White female managers regarding access to key career opportunities for White women and women of color. Items addressed include access to hiring, promotions, key assignments, salary increases, acknowledgment for work, and mentors. Access to each is described by comparing White women and women of…

How to survive the medical misinformation mess.

PubMed

Ioannidis, John P A; Stuart, Michael E; Brownlee, Shannon; Strite, Sheri A

2017-11-01

Most physicians and other healthcare professionals are unaware of the pervasiveness of poor quality clinical evidence that contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources. The Medical Misinformation Mess comprises four key problems. First, much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers. Second, most healthcare professionals are not aware of this problem. Third, they also lack the skills necessary to evaluate the reliability and usefulness of medical evidence. Finally, patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision-making. Increasing the reliability of available, published evidence may not be an imminently reachable goal. Therefore, efforts should focus on making healthcare professionals, more sensitive to the limitations of the evidence, training them to do critical appraisal, and enhancing their communication skills so that they can effectively summarize and discuss medical evidence with patients to improve decision-making. Similar efforts may need to target also patients, journalists, policy makers, the lay public and other healthcare stakeholders. © 2017 Stichting European Society for Clinical Investigation Journal Foundation.

Interdisciplinary Approach to the Development of Accessible Computer-Administered Measurement Instruments.

PubMed

Magasi, Susan; Harniss, Mark; Heinemann, Allen W

2018-01-01

Principles of fairness in testing require that all test takers, including people with disabilities, have an equal opportunity to demonstrate their capacity on the construct being measured. Measurement design features and assessment protocols can pose barriers for people with disabilities. Fairness in testing is a fundamental validity issue at all phases in the design, administration, and interpretation of measurement instruments in clinical practice and research. There is limited guidance for instrument developers on how to develop and evaluate the accessibility and usability of measurement instruments. This article describes a 6-stage iterative process for developing accessible computer-administered measurement instruments grounded in the procedures implemented across several major measurement initiatives. A key component of this process is interdisciplinary teams of accessibility experts, content and measurement experts, information technology experts, and people with disabilities working together to ensure that measurement instruments are accessible and usable by a wide range of users. The development of accessible measurement instruments is not only an ethical requirement, it also ensures better science by minimizing measurement bias, missing data, and attrition due to mismatches between the target population and test administration platform and protocols. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Integration of the subsurface and the surface sectors for a more holistic approach for sustainable redevelopment of urban brownfields.

PubMed

Norrman, Jenny; Volchko, Yevheniya; Hooimeijer, Fransje; Maring, Linda; Kain, Jaan-Henrik; Bardos, Paul; Broekx, Steven; Beames, Alistair; Rosén, Lars

2016-09-01

This paper presents a holistic approach to sustainable urban brownfield redevelopment where specific focus is put on the integration of a multitude of subsurface qualities in the early phases of the urban redevelopment process, i.e. in the initiative and plan phases. Achieving sustainability in brownfield redevelopment projects may be constrained by a failure of engagement between two key expert constituencies: urban planners/designers and subsurface engineers, leading to missed opportunities and unintended outcomes in the plan realisation phase. A more integrated approach delivers greater benefits. Three case studies in the Netherlands, Belgium and Sweden were used to test different sustainability assessment instruments in terms of the possibility for knowledge exchange between the subsurface and the surface sectors and in terms of cooperative learning among experts and stakeholders. Based on the lessons learned from the case studies, a generic decision process framework is suggested that supports holistic decision making. The suggested framework focuses on stakeholder involvement, communication, knowledge exchange and learning and provides an inventory of instruments that can support these processes. Copyright © 2016 Elsevier B.V. All rights reserved.

Establishing Networks to Lever Investments in Developing Capacity for Agricultural Monitoring: A GEOGLAM Perspective

NASA Astrophysics Data System (ADS)

Whitcraft, A. K.; Becker-Reshef, I.

2016-12-01

Since 2011, the Group on Earth Observations Global Agricultural Monitoring (GEOGLAM) Initiative has been working to strengthen the international community's capacity to use Earth observation (EO) data to derive timely, accurate, and transparent information on agriculture. A key component of GEOGLAM is the development of individual and institutional capacity for EO-based agricultural monitoring at multiple scales, from national to regional to global, in low-, middle-, and high-income countries. Despite the fact that the need for enhancing capacity is frequently acknowledged, there is little formal or informal literature documenting best practices for developing and implementing comprehensive capacity development strategies around Earth observations knowledge sharing. As a result, many projects and activities develop knowledge-sharing strategies on an ad hoc basis, and may be missing out on levering lessons, techniques, and toolsets already developed. In the past year, GEOGLAM has aimed to spur relationships and collaborations with capacity development initiatives and networks, toward sharing and documenting strategies and tactical experiences in this domain. This presentation will provide some perspective on challenges and opportunities encountered so far, from the GEOGLAM perspective, with the goal of continued dialogue and coordination with other session participants.

The use of genetically-engineered animals in science: perspectives of Canadian Animal Care Committee members.

PubMed

Ormandy, Elisabeth H; Dale, Julie; Griffin, Gilly

2013-05-01

The genetic engineering of animals for their use in science challenges the implementation of refinement and reduction in several areas, including the invasiveness of the procedures involved, unanticipated welfare concerns, and the numbers of animals required. Additionally, the creation of genetically-engineered animals raises problems with the Canadian system of reporting animal numbers per Category of Invasiveness, as well as raising issues of whether ethical limits can, or should, be placed on genetic engineering. A workshop was held with the aim of bringing together Canadian animal care committee members to discuss these issues, to reflect on progress that has been made in addressing them, and to propose ways of overcoming any challenges. Although previous literature has made recommendations with regard to refinement and reduction when creating new genetically-engineered animals, the perception of the workshop participants was that some key opportunities are being missed. The participants identified the main roadblocks to the implementation of refinement and reduction alternatives as confidentiality, cost and competition. If the scientific community is to make progress concerning the implementation of refinement and reduction, particularly in the creation and use of genetically-engineered animals, addressing these roadblocks needs to be a priority. 2013 FRAME.

New genetic discoveries and primary immune deficiencies.

PubMed

Hernandez-Trujillo, Vivian

2014-04-01

The field of immunology has undergone recent discoveries of genetic causes for many primary immunodeficiency diseases (PIDD). The ever-expanding knowledge has led to increased understanding behind the pathophysiology of these diseases. Since these diseases are rare, the patients are frequently misdiagnosed early in the presentation of their illnesses. The identification of new genes has increased our opportunities for recognizing and making the diagnosis in patients with PIDD before they succumb to infections that may result secondary to their PIDD. Some mutations lead to a variety of presentations of severe combined immunodeficiency (SCID). The myriad and ever-growing genetic mutations which lead to SCID phenotypes have been identified in recent years. Other mutations associated with some genetic syndromes have associated immunodeficiency and are important for making the diagnosis of primary immunodeficiency in patients with some syndromes, who may otherwise be missed within the larger context of their syndromes. A variety of mutations also lead to increased susceptibility to infections due to particular organisms. These patterns of infections due to specific organisms are important keys in properly identifying the part of the immune system which is affected in these patients. This review will discuss recent genetic discoveries that enhance our understanding of these complex diseases.

Concept recognition for extracting protein interaction relations from biomedical text

PubMed Central

Baumgartner, William A; Lu, Zhiyong; Johnson, Helen L; Caporaso, J Gregory; Paquette, Jesse; Lindemann, Anna; White, Elizabeth K; Medvedeva, Olga; Cohen, K Bretonnel; Hunter, Lawrence

2008-01-01

Background: Reliable information extraction applications have been a long sought goal of the biomedical text mining community, a goal that if reached would provide valuable tools to benchside biologists in their increasingly difficult task of assimilating the knowledge contained in the biomedical literature. We present an integrated approach to concept recognition in biomedical text. Concept recognition provides key information that has been largely missing from previous biomedical information extraction efforts, namely direct links to well defined knowledge resources that explicitly cement the concept's semantics. The BioCreative II tasks discussed in this special issue have provided a unique opportunity to demonstrate the effectiveness of concept recognition in the field of biomedical language processing. Results: Through the modular construction of a protein interaction relation extraction system, we present several use cases of concept recognition in biomedical text, and relate these use cases to potential uses by the benchside biologist. Conclusion: Current information extraction technologies are approaching performance standards at which concept recognition can begin to deliver high quality data to the benchside biologist. Our system is available as part of the BioCreative Meta-Server project and on the internet . PMID:18834500

Shifts in global immunisation goals (1984-2004): unfinished agendas and mixed results.

PubMed

Hardon, Anita; Blume, Stuart

2005-01-01

The turn of the millennium has been marked by a large-scale mobilisation of resources for immunisation programmes in developing countries. The resources have been generated by public and private sector parties collaborating in the Global Alliance for Vaccines and Immunization (GAVI). GAVI was formed in response to deteriorating immunisation coverage rates occurring in the late 1990s. GAVI is the latest in a line of vaccine initiatives, which have operated over the past 20 years. This article reviews the five most important global immunisation initiatives that have taken place over those past 20 years. It analyses their origins, shifts in global immunisation goals, identifies key actors, assesses the initiatives' capacity to mobilise resources and increase immunisation coverage, and points to possible unintended effects of the initiatives. The study argues that shifts in global immunisation goals lead to fragmentation in the implementation of vaccine programmes at the local level in developing countries. It also suggests that global actors involved in the formulation of these initiatives appear to miss opportunities to build on past experiences and fail to learn from previous mistakes. This raises questions about the initiatives' sustainability and relevance to the overall objective of preventing vaccine-preventable deaths.

Building the Plane While It's Flying: Enhancing the Missed Opportunity for Quality Assurance and Capacity-Building in Australian Private Higher Education

ERIC Educational Resources Information Center

Shah, Mahsood; Nair, Chenicheri Sid

2011-01-01

Higher education across the world has experienced the growth of private higher education. Based on this growth, it is apparent that the sector will continue to grow as a result of many factors such as: change in government policy that allows such providers to grow; government funding of student places in private colleges; the growth and demand for…

The spiral of science (mis)education, Parker's ``multiple influences,'' and missed opportunities

NASA Astrophysics Data System (ADS)

Richardson Bruna, Katherine

2014-06-01

In this reflection on Carolyn Parker's article, I connect to my own professional work at the intersection of Latino education and science education as well as to my own personal interest in liberation theology. I use constructs central to liberation theology to indicate what a liberationist science might look like and push us, in doing so, to put learning, not teaching, at the center of our efforts.

Recurrent generalized tetanus: a case report.

PubMed

Alhaji, M A; Mustapha, M G; Ashir, G M; Akuhwa, R T; Bello, M A; Farouk, A G

2011-04-01

We describe recurrent generalized tetanus in a four-year-old unimmunized boy following recurrent suppurative otitis media (SOM) within an 11-month period. There are not many published reports on recurrent tetanus. We highlight the importance of both primary immunizations and the need for active immunization before discharge as the infection does not confer a lifelong immunity. The usefulness of booster doses of tetanus toxoid and missed opportunities for immunization are emphasized.

Statistics of Scientific Procedures on Living Animals Great Britain 2015 - highlighting an ongoing upward trend in animal use and missed opportunities.

PubMed

Hudson-Shore, Michelle

2016-12-01

The Annual Statistics of Scientific Procedures on Living Animals Great Britain 2015 indicate that the Home Office were correct in recommending that caution should be exercised when interpreting the 2014 data as an apparent decline in animal experiments. The 2015 report shows that, as the changes to the format of the annual statistics have become more familiar and less problematic, there has been a re-emergence of the upward trend in animal research and testing in Great Britain. The 2015 statistics report an increase in animal procedures (up to 4,142,631) and in the number of animals used (up to 4,069,349). This represents 1% more than the totals in 2013, and a 7% increase on the procedures reported in 2014. This paper details an analysis of these most recent statistics, providing information on overall animal use and highlighting specific issues associated with genetically-altered animals, dogs and primates. It also reflects on areas of the new format that have previously been highlighted as being problematic, and concludes with a discussion about the use of animals in regulatory research and testing, and how there are significant missed opportunities for replacing some of the animal-based tests in this area. 2016 FRAME.

Adding "Missed" Science to Cassini's Ops Plan

NASA Technical Reports Server (NTRS)

Roy, Mou; Burton, Marcia E.; Edgington, Scott; Pitesky, Jo E.; Steadman, Kimberly B.; Ray, Trina L.; Evans, Mike

2014-01-01

The phenomenal success of the Cassini Mission at Saturn is largely due to flagship instruments, in a target rich environment, for a long period of time, executing almost error free complex mission operations. A smooth transition from cruise operations through the prime science mission and extended science (Equinox) mission culminating in the currently executing Solstice mission has folded in necessary procedural alterations due to improved understanding of the spacecraft, instruments, uplink and planning systems as well as additional science objectives. These have come with the maturation of the mission along with management of workforce reductions. One important set of operational changes has been initiated due to scientific findings highlighting "missed" science opportunities. This is the case for the Titan Meteorology Campaigns and Saturn Storm Watch Campaigns. These observations involve long term monitoring of the atmospheres of Titan and Saturn while the spacecraft and science teams are focused on other high priority targets of opportunity (like Enceladus). Our objective in this paper is to emphasize how a non-invasive strategy to get additional remarkable science was conceived and implemented in a mission with an already well defined operational plan. To illustrate this we will detail Titan Meteorology Campaign and Saturn Storm Watch Campaign integration and implementation strategies as well as the scientific goals and achievements of both.

An ICU Preanesthesia Evaluation Form Reduces Missing Preoperative Key Information.

PubMed

Chuy, Katherine; Yan, Zhe; Fleisher, Lee; Liu, Renyu

2012-09-28

A comprehensive preoperative evaluation is critical for providing anesthetic care for patients from the intensive care unit (ICU). There has been no preoperative evaluation form specific for ICU patients that allows for a rapid and focused evaluation by anesthesia providers, including junior residents. In this study, a specific preoperative form was designed for ICU patients and evaluated to allow residents to perform the most relevant and important preoperative evaluations efficiently. The following steps were utilized for developing the preoperative evaluation form: 1) designed a new preoperative form specific for ICU patients; 2) had the form reviewed by attending physicians and residents, followed by multiple revisions; 3) conducted test releases and revisions; 4) released the final version and conducted a survey; 5) compared data collection from new ICU form with that from a previously used generic form. Each piece of information on the forms was assigned a score, and the score for the total missing information was determined. The score for each form was presented as mean ± standard deviation (SD), and compared by unpaired t test. A P value < 0.05 was considered statistically significant. Of 52 anesthesiologists (19 attending physicians, 33 residents) responding to the survey, 90% preferred the final new form; and 56% thought the new form would reduce perioperative risk for ICU patients. Forty percent were unsure whether the form would reduce perioperative risk. Over a three month period, we randomly collected 32 generic forms and 25 new forms. The average score for missing data was 23 ± 10 for the generic form and 8 ± 4 for the new form (P = 2.58E-11). A preoperative evaluation form designed specifically for ICU patients is well accepted by anesthesia providers and helped to reduce missing key preoperative information. Such an approach is important for perioperative patient safety.

Expanded Learning Time and Opportunities: Key Principles, Driving Perspectives, and Major Challenges

ERIC Educational Resources Information Center

Blyth, Dale A.; LaCroix-Dalluhn, Laura

2011-01-01

If expanded learning is going to make a real difference, then three key principles must inform how communities overcome challenges and assure equitable access to learning opportunities. Much of today's debate is framed in the language of formal education systems--students, classrooms, schools--even though part of the expansion seeks to engage a…

Geology’s “Super Graphics” and the Public: Missed Opportunities for Geoscience Education

NASA Astrophysics Data System (ADS)

Clary, R. M.; Wandersee, J. H.

2009-12-01

The geosciences are very visual, as demonstrated by the illustration density of maps, graphs, photographs, and diagrams in introductory textbooks. As geoscience students progress, they are further exposed to advanced graphics, such as phase diagrams and subsurface seismic data visualizations. Photographs provide information from distant sites, while multivariate graphics supply a wealth of data for viewers to access. When used effectively, geology graphics have exceptional educational potential. However, geological graphic data are often presented in specialized formats, and are not easily interpreted by an uninformed viewer. In the Howe-Russell Geoscience Complex at Louisiana State University, there is a very large graphic (~ 30 ft x 6 ft) exhibited in a side hall, immediately off the main entrance hall. The graphic, divided into two obvious parts, displays in its lower section seismic data procured in the Gulf of Mexico, from near offshore Louisiana to the end of the continental shelf. The upper section of the graphic reveals drilling block information along the seismic line. Using Tufte’s model of graphic excellence and Paivio’s dual-coding theory, we analyzed the graphic in terms of data density, complexity, legibility, format, and multivariate presentation. We also observed viewers at the site on 5 occasions, and recorded their interactions with the graphic. This graphic can best be described as a Tufte “super graphic.” Its data are high in density and multivariate in nature. Various data sources are combined in a large format to provide a powerful example of a multitude of information within a convenient and condensed presentation. However, our analysis revealed that the graphic misses an opportunity to educate the non-geologist. The information and seismic “language” of the graphic is specific to the geology community, and the information is not interpreted for the lay viewer. The absence of title, descriptions, and symbol keys are detrimental. Terms are not defined. The absence of color keys and annotations is more likely to lead to an appreciation of graphic beauty, without concomitant scientific understanding. We further concluded that in its current location, constraints of space and reflective lighting prohibit the viewer from simultaneously accessing all subsurface data in a “big picture” view. The viewer is not able to fully comprehend the macro/micro aspects of the graphic design within the limited viewing space. The graphic is an example of geoscience education possibility, a possibility that is currently undermined and unrealized by lack of interpretation. Our analysis subsequently informed the development of a model to maximize the graphic’s educational potential, which can be applied to similar geological super graphics for enhanced public scientific understanding. Our model includes interactive displays that apply the auditory-visual dual coding approach to learning. Notations and aural explanations for geological features should increase viewer understanding, and produce an effective informal educational display.

3D-MICE: integration of cross-sectional and longitudinal imputation for multi-analyte longitudinal clinical data.

PubMed

Luo, Yuan; Szolovits, Peter; Dighe, Anand S; Baron, Jason M

2018-06-01

A key challenge in clinical data mining is that most clinical datasets contain missing data. Since many commonly used machine learning algorithms require complete datasets (no missing data), clinical analytic approaches often entail an imputation procedure to "fill in" missing data. However, although most clinical datasets contain a temporal component, most commonly used imputation methods do not adequately accommodate longitudinal time-based data. We sought to develop a new imputation algorithm, 3-dimensional multiple imputation with chained equations (3D-MICE), that can perform accurate imputation of missing clinical time series data. We extracted clinical laboratory test results for 13 commonly measured analytes (clinical laboratory tests). We imputed missing test results for the 13 analytes using 3 imputation methods: multiple imputation with chained equations (MICE), Gaussian process (GP), and 3D-MICE. 3D-MICE utilizes both MICE and GP imputation to integrate cross-sectional and longitudinal information. To evaluate imputation method performance, we randomly masked selected test results and imputed these masked results alongside results missing from our original data. We compared predicted results to measured results for masked data points. 3D-MICE performed significantly better than MICE and GP-based imputation in a composite of all 13 analytes, predicting missing results with a normalized root-mean-square error of 0.342, compared to 0.373 for MICE alone and 0.358 for GP alone. 3D-MICE offers a novel and practical approach to imputing clinical laboratory time series data. 3D-MICE may provide an additional tool for use as a foundation in clinical predictive analytics and intelligent clinical decision support.

Correcting bias due to missing stage data in the non-parametric estimation of stage-specific net survival for colorectal cancer using multiple imputation.

PubMed

Falcaro, Milena; Carpenter, James R

2017-06-01

Population-based net survival by tumour stage at diagnosis is a key measure in cancer surveillance. Unfortunately, data on tumour stage are often missing for a non-negligible proportion of patients and the mechanism giving rise to the missingness is usually anything but completely at random. In this setting, restricting analysis to the subset of complete records gives typically biased results. Multiple imputation is a promising practical approach to the issues raised by the missing data, but its use in conjunction with the Pohar-Perme method for estimating net survival has not been formally evaluated. We performed a resampling study using colorectal cancer population-based registry data to evaluate the ability of multiple imputation, used along with the Pohar-Perme method, to deliver unbiased estimates of stage-specific net survival and recover missing stage information. We created 1000 independent data sets, each containing 5000 patients. Stage data were then made missing at random under two scenarios (30% and 50% missingness). Complete records analysis showed substantial bias and poor confidence interval coverage. Across both scenarios our multiple imputation strategy virtually eliminated the bias and greatly improved confidence interval coverage. In the presence of missing stage data complete records analysis often gives severely biased results. We showed that combining multiple imputation with the Pohar-Perme estimator provides a valid practical approach for the estimation of stage-specific colorectal cancer net survival. As usual, when the percentage of missing data is high the results should be interpreted cautiously and sensitivity analyses are recommended. Copyright © 2017 Elsevier Ltd. All rights reserved.

Coping with missing data in phase III pivotal registration trials: Tolvaptan in subjects with kidney disease, a case study.

PubMed

Ouyang, John; Carroll, Kevin J; Koch, Gary; Li, Junfang

2017-07-01

Missing data cause challenging issues, particularly in phase III registration trials, as highlighted by the European Medicines Agency (EMA) and the US National Research Council. We explore, as a case study, how the issues from missing data were tackled in a double-blind phase III trial in subjects with autosomal dominant polycystic kidney disease. A total of 1445 subjects were randomized in a 2:1 ratio to receive active treatment (tolvaptan), or placebo. The primary outcome, the rate of change in total kidney volume, favored tolvaptan (P < .0001). The key secondary efficacy endpoints of clinical progression of disease and rate of decline in kidney function also favored tolvaptan. However, as highlighted by Food and Drug Administration and EMA, the interpretation of results was hampered by a high number of unevenly distributed dropouts, particularly early dropouts. In this paper, we outline the analyses undertaken to address the issue of missing data thoroughly. "Tipping point analyses" were performed to explore how extreme and detrimental outcomes among subjects with missing data must be to overturn the positive treatment effect attained in those subjects who had complete data. Nonparametric rank-based analyses were also performed accounting for missing data. In conclusion, straightforward and transparent analyses directly taking into account missing data convincingly support the robustness of the preplanned analyses on the primary and secondary endpoints. Tolvaptan was confirmed to be effective in slowing total kidney volume growth, which is considered an efficacy endpoint by EMA, and in lessening the decline in renal function in patients with autosomal dominant polycystic kidney disease. Copyright © 2017 John Wiley & Sons, Ltd.

Empathic communication and gender in the physician-patient encounter.

PubMed

Bylund, Carma L; Makoul, Gregory

2002-12-01

Although empathy in the physician-patient relationship is often advocated, a theoretically based and empirically derived measure of a physician's empathic communication to a patient has been missing. This paper describes the development and initial validation of such a measure, the Empathic Communication Coding System (ECCS), which includes a method for identifying patient-created empathic opportunities. To determine the extent to which empathic communication varies with physician and patient gender, we used the ECCS to code 100 videotaped office visits between patients and general internists. While male and female patients created a comparable number of empathic opportunities, those created by females tended to exhibit more emotional intensity than those created by males. However, female patients were no more likely than male patients to name an emotion in their empathic opportunities. Physician communication behavior was consistent with the literature on gender differences: female physicians tended to communicate higher degrees of empathy in response to the empathic opportunities created by patients. The ECCS appears to be a viable and sensitive tool for better understanding empathy in medical encounters, and for detecting modest gender differences in patients' creation of empathic opportunities and in physicians' empathic communication.

Food Composition Tables in Southeast Asia: The Contribution of the SMILING Project.

PubMed

Hulshof, Paul; Doets, Esmee; Seyha, Sok; Bunthang, Touch; Vonglokham, Manithong; Kounnavong, Sengchanh; Famida, Umi; Muslimatun, Siti; Santika, Otte; Prihatini, Sri; Nazarudin, Nazarina; Jahari, Abas; Rojroongwasinkul, Nipa; Chittchang, Uraiporn; Mai, Le Bach; Dung, Le Hong; Lua, Tran Thi; Nowak, Verena; Elburg, Lucy; Melse-Boonstra, Alida; Brouwer, Inge

2018-06-08

Objectives Food composition data are key for many nutrition related activities in research, planning and policy. Combatting micronutrient malnutrition among women and young children using sustainable food based approaches, as aimed at in the SMILING project, requires high quality food composition data. Methods In order to develop capacity and to align procedures for establishing, updating and assessing the quality of key nutrient data in the food composition tables in Southeast Asia, a detailed roadmap was developed to identify and propose steps for this. This included a training workshop to build capacity in the field of food composition data, and alignment of procedures for selecting foods and nutrients to be included for quality assessment, and update of country specific food composition tables. The SEA partners in the SMILING project finalised a country specific food composition table (FCT) with updated compositional data on selected foods and nutrients considered key for designing nutrient dense and optimal diets for the target groups. Results Between 140 and 175 foods were selected for inclusion in the country specific FCTs. Key-nutrients were: energy, protein, total fat, carbohydrates, iron, zinc, (pro-)-vitamin A, folate, calcium, vitamin D, vitamin B1, vitamin B2, vitamin B3, vitamin B6, vitamin B12 and vitamin C. A detailed quality assessment on 13 key-foods per nutrient was performed using international guidelines. Nutrient data for specific local food items were often unavailable and data on folate, vitamin B12 and vitamin B6 contents were mostly missing. For many foods, documentation was not available, thereby complicating an in-depth quality assessment. Despite these limitations, the SMILING project offered a unique opportunity to increase awareness of the importance of high quality well documented food composition data. Conclusion for Practise The self-reported data quality demonstrated that there is considerable room for improvement of the nutrient data quality in some countries. In addition, investment in sustainable capacity development and an urgent need to produce and document high quality data on the micronutrient composition of especially local foods is required.

Assessing Opportunities for Student Pharmacist Leadership Development at Schools of Pharmacy in the United States.

PubMed

Feller, Tara T; Doucette, William R; Witry, Matthew J

2016-06-25

Objective. To summarize student pharmacist leadership development opportunities delivered by pharmacy programs, to describe selected opportunities, and to assess how these opportunities meet leadership development competencies. Methods. A multi-method study was conducted that comprised a systematic content analysis of pharmacy education journals, pharmacy program websites, and telephone interviews with key informants, which included open-ended questions and scaled responses. Results. Review of six articles, 37 American Association of Colleges of Pharmacy (AACP) Annual Meeting abstracts, and 138 websites resulted in the identification of 191 leadership development opportunities. These consisted of courses, projects/programs, and events/speaker series. Interviews with 12 key informants detailed unique events that developed leadership competencies. Formal assessments of student leadership development were limited and primarily focused on informal feedback and course evaluations. Conclusion. Most US pharmacy programs offer their students an array of opportunities to develop leadership abilities. Pharmacy programs should consider expanding opportunities beyond elective courses, learn from the successes of others to implement new leadership development opportunities, and bolster the assessment of student leadership competencies and outcomes.

Assessing Opportunities for Student Pharmacist Leadership Development at Schools of Pharmacy in the United States

PubMed Central

Feller, Tara T.; Witry, Matthew J.

2016-01-01

Objective. To summarize student pharmacist leadership development opportunities delivered by pharmacy programs, to describe selected opportunities, and to assess how these opportunities meet leadership development competencies. Methods. A multi-method study was conducted that comprised a systematic content analysis of pharmacy education journals, pharmacy program websites, and telephone interviews with key informants, which included open-ended questions and scaled responses. Results. Review of six articles, 37 American Association of Colleges of Pharmacy (AACP) Annual Meeting abstracts, and 138 websites resulted in the identification of 191 leadership development opportunities. These consisted of courses, projects/programs, and events/speaker series. Interviews with 12 key informants detailed unique events that developed leadership competencies. Formal assessments of student leadership development were limited and primarily focused on informal feedback and course evaluations. Conclusion. Most US pharmacy programs offer their students an array of opportunities to develop leadership abilities. Pharmacy programs should consider expanding opportunities beyond elective courses, learn from the successes of others to implement new leadership development opportunities, and bolster the assessment of student leadership competencies and outcomes. PMID:27402982

The Economics of the Drug War: Effective Federal Policy of Missed Opportunity?

DTIC Science & Technology

2002-06-01

have had the sole practical result of protecting the peddler’s market, artificially inflating his prices, and keeping his profits fantastically high...later in life. To this end, the Strategy seeks to involve parents, coaches, mentors, teachers, clergy, and other role models in a broad prevention...GDP in the mid-1990s. These expenditures include the costs of incarcerating drug offenders, the healthcare costs of treating drug users, the law

JPRS Report, Science & Technology, Central Eurasia: Life Sciences.

DTIC Science & Technology

1992-05-27

would be the same thing as showing porno raise our entire public health giant to its feet-this aid will films in school rather than providing sex...The participants viewed videos about future science foreign technologies to our health care sector on a broader projects whose realization is now...must not be so irresponsible as to miss an excellent One of the videos told of the tragic history of the domestic opportunity to attract leading

RFID Meets GWOT: Considering a New Technology for a New Kind of War

DTIC Science & Technology

2006-06-01

creating a tag that will enable commuters to travel conveniently throughout the city’s subway system. While these items have yet to come, they are... food items that will let your refrigerator know what is missing inside. In turn, your refrigerator will communicate to your cell phone that you need...regular routines. Additionally, businesses reopened and outside investors sought new opportunities as they brought the island’s first franchise

Self-reported nonadherence to antiretroviral therapy as a predictor of viral failure and mortality.

PubMed

Glass, Tracy R; Sterne, Jonathan A C; Schneider, Marie-Paule; De Geest, Sabina; Nicca, Dunja; Furrer, Hansjakob; Günthard, Huldrych F; Bernasconi, Enos; Calmy, Alexandra; Rickenbach, Martin; Battegay, Manuel; Bucher, Heiner C

2015-10-23

To determine the effect of nonadherence to antiretroviral therapy (ART) on virologic failure and mortality in naive individuals starting ART. Prospective observational cohort study. Eligible individuals enrolled in the Swiss HIV Cohort Study, started ART between 2003 and 2012, and provided adherence data on at least one biannual clinical visit. Adherence was defined as missed doses (none, one, two, or more than two) and percentage adherence (>95, 90-95, and <90) in the previous 4 weeks. Inverse probability weighting of marginal structural models was used to estimate the effect of nonadherence on viral failure (HIV-1 viral load >500 copies/ml) and mortality. Of 3150 individuals followed for a median 4.7 years, 480 (15.2%) experienced viral failure and 104 (3.3%) died, 1155 (36.6%) reported missing one dose, 414 (13.1%) two doses and, 333 (10.6%) more than two doses of ART. The risk of viral failure increased with each missed dose (one dose: hazard ratio [HR] 1.15, 95% confidence interval 0.79-1.67; two doses: 2.15, 1.31-3.53; more than two doses: 5.21, 2.96-9.18). The risk of death increased with more than two missed doses (HR 4.87, 2.21-10.73). Missing one to two doses of ART increased the risk of viral failure in those starting once-daily (HR 1.67, 1.11-2.50) compared with those starting twice-daily regimens (HR 0.99, 0.64-1.54, interaction P = 0.09). Consistent results were found for percentage adherence. Self-report of two or more missed doses of ART is associated with an increased risk of both viral failure and death. A simple adherence question helps identify patients at risk for negative clinical outcomes and offers opportunities for intervention.

Opportunities and challenges in leveraging electronic health record data in oncology.

PubMed

Berger, Marc L; Curtis, Melissa D; Smith, Gregory; Harnett, James; Abernethy, Amy P

2016-05-01

The widespread adoption of electronic health records (EHRs) and the growing wealth of digitized information sources about patients is ushering in an era of 'Big Data' that may revolutionize clinical research in oncology. Research will likely be more efficient and potentially more accurate than the current gold standard of manual chart review studies. However, EHRs as they exist today have significant limitations: important data elements are missing or are only captured in free text or PDF documents. Using two case studies, we illustrate the challenges of leveraging the data that are routinely collected by the healthcare system in EHRs (e.g., real-world data), specific challenges encountered in the cancer domain and opportunities that can be achieved when these are overcome.

Missed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services.

PubMed

Arch, Allison E; Weisman, David C; Coca, Steven; Nystrom, Karin V; Wira, Charles R; Schindler, Joseph L

2016-03-01

The failure to recognize an ischemic stroke in the emergency department is a missed opportunity for acute interventions and for prompt treatment with secondary prevention therapy. Our study examined the diagnosis of acute ischemic stroke in the emergency department of an academic teaching hospital and a large community hospital. A retrospective chart review was performed from February 2013 to February 2014. A total of 465 patients with ischemic stroke were included in the analysis; 280 patients from the academic hospital and 185 patients from the community hospital. One hundred three strokes were initially misdiagnosed that is 22% of the included strokes at the combined centers. Fifty-five of these were missed at the academic hospital (22%) [corrected] and 48 were at the community hospital (26%, P=0.11). Thirty-three percent of missed cases presented within a 3-hour time window for recombinant tissue-type plasminogen activator eligibility. An additional 11% presented between 3 and 6 hours of symptom onset for endovascular consideration. Symptoms independently associated with greater odds of a missed stroke diagnosis were nausea/vomiting (odds ratio, 4.02; 95% confidence interval, 1.60-10.1), dizziness (odds ratio, 1.99; 95% confidence interval, 1.03-3.84), and a positive stroke history (odds ratio, 2.40; 95% confidence interval, 1.30-4.42). Thirty-seven percent of posterior strokes were initially misdiagnosed compared with 16% of anterior strokes (P<0.001). Atypical symptoms associated with posterior circulation strokes lead to misdiagnoses. This was true at both an academic center and a large community hospital. Future studies need to focus on the evaluation of identification systems and tools in the emergency department to improve the accuracy of stroke diagnosis. © 2016 American Heart Association, Inc.

Reflecting on how we remember the personal past: missing components in the study of memory appraisal and theoretical implications.

PubMed

Foley, Mary Ann

2018-05-01

The current paper offers a selective review of the study of memory appraisal, focusing on recollections of the personal past, with the goal to bring attention to a missing component in this study. To date, memory appraisal studies have concentrated on participants' assessments of the content of their personal recollections (e.g., their perceptual detail and story-like feel), including beliefs about the accuracy of that content. Participants' assessments of reflection processes accompanying their recollections (e.g., a sense of piecing-together recollection fragments) have yet to be extensively examined. The lack of information on process-based appraisals is related to prior studies' procedural constraints (e.g., kinds of cue prompts and their timing, minimal opportunities for reflection). Reasons for addressing this missing component provide the central themes of the paper. The reasons emerge from the analysis of autobiographical cueing studies, including integration of narrative research studies and autobiographical works. The analysis leads to suggestions for future research involving the use of personal narratives that are intended to address critiques of reconstruction accounts and unresolved questions in the study of memory appraisal.

Missed Opportunity to Deprescribe: Docusate for Constipation in Medical Inpatients.

PubMed

MacMillan, Thomas E; Kamali, Reza; Cavalcanti, Rodrigo B

2016-09-01

Hospital admissions provide an opportunity to deprescribe ineffective medications and reduce pill burden. Docusate sodium is a stool softener that is frequently prescribed to treat constipation despite poor evidence for efficacy, thus providing a good target for deprescription. The aims of this study were to characterize rates of use and discontinuation of docusate among internal medicine inpatients, as well as use of other laxatives. We conducted a retrospective observational study over 1 year on all patients admitted to internal medicine at 2 urban academic hospitals to determine rates of docusate use. We also evaluated laxative and opioid medication use on a random sample of 500 inpatients who received docusate to characterize patterns of prescription and deprescription. Fifteen percent (1169/7581) of all admitted patients received 1 or more doses of docusate. Among our random sample, 53% (238/452) received docusate before admission, and only 13% (31/238) had docusate deprescribed. Among patients not receiving docusate before admission, 33.2% (71/214) received a new prescription for docusate on discharge. Patients receiving opioids were frequently prescribed no laxatives or given docusate monotherapy (28%, 51/185). Docusate was frequently prescribed to medical inpatients despite its known ineffectiveness, with low deprescription and high numbers of new prescriptions. Docusate use was common even among patients at high risk of constipation. One third of patients not receiving docusate before admission were prescribed docusate on discharge, potentially exacerbating polypharmacy. Among patients already receiving docusate, 80% had it continued on discharge, indicating significant missed opportunities for deprescribing. Given the availability of effective alternatives, our results suggest that quality-improvement initiatives are needed to promote evidence-based laxative use in hospitalized patients. Copyright © 2016 Elsevier Inc. All rights reserved.

75 FR 65230 - Drawbridge Operation Regulation; Arkansas Waterway, Pine Bluff, AR

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

... requesting a draw opening. This keying will activate an indicator on the remote drawbridge operator's console... operated. Vessels requesting an opening shall establish contact by radio/telephone with the remote... drawspan opening delays experienced previously from missed calls under the prior regulatory guidance...

75 FR 66306 - Drawbridge Operation Regulation; Arkansas Waterway, Little Rock, AR

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-28

... a draw opening. This keying will activate an indicator on the remote drawbridge operator's console... position and is remotely operated. Vessels requesting an opening shall establish contact by radio/telephone... drawspan opening delays experienced previously from missed calls under the prior regulatory guidance...

Key Resources for Qualitative Congregational Research

ERIC Educational Resources Information Center

Ratcliff, Donald

2009-01-01

Congregational research using qualitative procedures is an important aspect of effective Religious Education, and appears to be growing in importance. In this article, the author focuses on several resources for qualitative congregational research. While many good sources will be considered, missing is a truly comprehensive source that examines…

Passings to note: Paul Michael Packman, MD; S. Charles Schulz, MD.

PubMed

Black, Donald W

2018-02-01

One of the keys to the success of Annals of Clinical Psychiatry has always been the tireless efforts of our dedicated Editorial Board. We recently lost 2 longtime Editorial Board members, Drs. Paul Michael Packman and S. Charles Schulz. Both will be greatly missed.

Mobile Pedagogy

ERIC Educational Resources Information Center

Schlenker, Lee

2013-01-01

How can higher education leverage information technology to address the importance of social and geographical context in learning? This reflection paper begins with a review of the literature on learning technologies to identify the key questions of study. Building upon the missing links of pedagogy, context and process, the author proposes an…

Feature Masking in Computer Game Promotes Visual Imagery

ERIC Educational Resources Information Center

Smith, Glenn Gordon; Morey, Jim; Tjoe, Edwin

2007-01-01

Can learning of mental imagery skills for visualizing shapes be accelerated with feature masking? Chemistry, physics fine arts, military tactics, and laparoscopic surgery often depend on mentally visualizing shapes in their absence. Does working with "spatial feature-masks" (skeletal shapes, missing key identifying portions) encourage people to…

Leadership Matters

ERIC Educational Resources Information Center

Chester, Barbara; Terry, Mark; Liddiard, Dwight; Cargile, Diane; Cobb, David P.; Sturdivant, Fidelia

2010-01-01

Though research tells that principals are key in raising student achievement, principals remain unsung heroes for the nation's children. Because they work on the front lines of education--student by student and class by class--to lead schools in preparing students for successful lives, it's possible to miss the entire significance of the…

Semiparametric Estimation of Treatment Effect in a Pretest–Posttest Study with Missing Data

PubMed Central

Davidian, Marie; Tsiatis, Anastasios A.; Leon, Selene

2008-01-01

The pretest–posttest study is commonplace in numerous applications. Typically, subjects are randomized to two treatments, and response is measured at baseline, prior to intervention with the randomized treatment (pretest), and at prespecified follow-up time (posttest). Interest focuses on the effect of treatments on the change between mean baseline and follow-up response. Missing posttest response for some subjects is routine, and disregarding missing cases can lead to invalid inference. Despite the popularity of this design, a consensus on an appropriate analysis when no data are missing, let alone for taking into account missing follow-up, does not exist. Under a semiparametric perspective on the pretest–posttest model, in which limited distributional assumptions on pretest or posttest response are made, we show how the theory of Robins, Rotnitzky and Zhao may be used to characterize a class of consistent treatment effect estimators and to identify the efficient estimator in the class. We then describe how the theoretical results translate into practice. The development not only shows how a unified framework for inference in this setting emerges from the Robins, Rotnitzky and Zhao theory, but also provides a review and demonstration of the key aspects of this theory in a familiar context. The results are also relevant to the problem of comparing two treatment means with adjustment for baseline covariates. PMID:19081743

Semiparametric Estimation of Treatment Effect in a Pretest-Posttest Study with Missing Data.

PubMed

Davidian, Marie; Tsiatis, Anastasios A; Leon, Selene

2005-08-01

The pretest-posttest study is commonplace in numerous applications. Typically, subjects are randomized to two treatments, and response is measured at baseline, prior to intervention with the randomized treatment (pretest), and at prespecified follow-up time (posttest). Interest focuses on the effect of treatments on the change between mean baseline and follow-up response. Missing posttest response for some subjects is routine, and disregarding missing cases can lead to invalid inference. Despite the popularity of this design, a consensus on an appropriate analysis when no data are missing, let alone for taking into account missing follow-up, does not exist. Under a semiparametric perspective on the pretest-posttest model, in which limited distributional assumptions on pretest or posttest response are made, we show how the theory of Robins, Rotnitzky and Zhao may be used to characterize a class of consistent treatment effect estimators and to identify the efficient estimator in the class. We then describe how the theoretical results translate into practice. The development not only shows how a unified framework for inference in this setting emerges from the Robins, Rotnitzky and Zhao theory, but also provides a review and demonstration of the key aspects of this theory in a familiar context. The results are also relevant to the problem of comparing two treatment means with adjustment for baseline covariates.

Terrestrial and Aquatic Biological Inventory Meredosia, Illinois; Meredosia; Willow Creek; and Coon Run Drainage and Levee District, Scott and Morgan Counties, Illinois.

DTIC Science & Technology

1982-12-01

DISTRIBUTION STATEMENT (of the abstract entered In Block 20, It different from Report) Unlimited OIL SUPPLEMENTARY NOTES 19. KEY WORDS (Continue on reverse...undoubtably missed due to the timing of the survey. In addition, the lack of key taxonomic characteristics such as flowers and fruit made the...Family) Viburnum prunifolium (Black haw) 1-0 Sambucus canadensis (Elderberry) 5-0 COMPOSITAE (Composite Family) Eupatorium rugosum (White snakeroot) 1-C

Reconstruction of missed critical frequency of F2-layer over Mexico using TEC

NASA Astrophysics Data System (ADS)

Sergeeva, M. A.; Maltseva, O. A.; Gonzalez-Esparza, A.; Romero Hernandez, E.; De la Luz, V.; Rodriguez-Martinez, M. R.

2016-12-01

The study of the Earth's ionosphere's state is one of the key issues within the Space Weather monitoring task. It is hard to overestimate the importance of diagnostics of its current state and forecasts of Space Weather conditions. There are different methods of short-time predictions for the ionosphere state change. The real-time monitoring of the ionospheric Total Electron Content (TEC) provides the opportunity to choose an appropriate technique for the particular observation point on the Earth. From September 2015 the continuous monitoring of TEC variations over the territory of Mexico is performed by the Mexican Space Weather Service (SCiESMEX). Regular patterns of the diurnal and seasonal TEC variations were revealed in base of past statistics and real-time observations which can be used to test the prediction method. Some specific features of the ionosphere behaviour are discussed. However, with all the merits of TEC as an ionospheric parameter, for the full picture of the processes in the ionosphere and for practical applications it is needed to identify the behaviour of other principal ionospheric parameters provided by ionosondes. Currently, SCiESMEX works on the project of the ionosonde installation in Mexico. This study was focused on the reconstruction of the critical frequency of F2-layer of the ionosphere (foF2) when this data is missing. For this purpose measurements of TEC and the median value of the equivalent slab thickness of the ionosphere were used. First, the foF2 values reconstruction was made for the case of the ionosonde data being absent during some hours or days. Second, the possibility of foF2 reconstruction was estimated for the Mexican region having no ionosonde using local TEC data and foF2 data obtained in the regions close to Mexico. Calculations were performed for quiet and disturbed periods. The results of reconstruction were compared to the foF2 obtained from the International Reference Model and to median foF2 values. Comparison with other low-and mid-latitude regions was made. It was shown that foF2 reconstructed using TEC have better agreement with the experimental data. Considering the said above, the use of the reconstructed foF2 values is a great aid for the ionosphere state estimation over Mexico when foF2 information is missed.

Identifying PHM market and network opportunities.

PubMed

Grube, Mark E; Krishnaswamy, Anand; Poziemski, John; York, Robert W

2015-11-01

Two key processes for healthcare organizations seeking to assume a financially sustainable role in population health management (PHM), after laying the groundwork for the effort, are to identify potential PHM market opportunities and determine the scope of the PHM network. Key variables organizations should consider with respect to market opportunities include the patient population, the overall insurance/employer market, and available types of insurance products. Regarding the network's scope, organizations should consider both traditional strategic criteria for a viable network and at least five additional criteria: network essentiality and PHM care continuum, network adequacy, service distribution right-sizing, network growth strategy, and organizational agility.

The missing link in preconceptional care: the role of comparative effectiveness research.

PubMed

Salihu, Hamisu M; Salinas, Abraham; Mogos, Mulubrhan

2013-07-01

This paper discusses an important element that is missing from the existing algorithm of preconception care, namely, comparative effectiveness research (CER). To our knowledge, there has been limited assessment of the comparative effectiveness of diverse interventions that promote preconception health, conditions under which these are most effective, for which particular populations, and their comparative costs. CER can improve the decision making process for the funding, development, implementation, and evaluation of comprehensive preconception care programs, specifically by identifying the most effective interventions with acceptable costs to society. This paper will examine the framework behind preconception care and how the inclusion of comparative effectiveness research and evaluation into the existing algorithm of preconception care could foster improvement in maternal and child health. We discuss challenges and opportunities regarding the utilization of CER in the decision making process in preconception health, and finally, we provide recommendations for future directions.

The Missing Link in Preconceptional Care: The Role of Comparative Effectiveness Research

PubMed Central

Salihu, Hamisu M.; Salinas, Abraham; Mogos, Mulubrhan

2012-01-01

This paper discusses an important element that is missing from the existing algorithm of preconception care, namely, comparative effectiveness research (CER). To our knowledge, there has been limited assessment of the comparative effectiveness of diverse interventions that promote preconception health, conditions under which these are most effective, for which particular populations, and their comparative costs. CER can improve the decision making process for the funding, development, implementation, and evaluation of comprehensive preconception care programs, specifically by identifying the most effective interventions with acceptable costs to society. This paper will examine the framework behind preconception care and how the inclusion of comparative effectiveness research and evaluation into the existing algorithm of preconception care could foster improvement in maternal and child health. We discuss challenges and opportunities regarding the utilization of CER in the decision making process in preconception health, and finally, we provide recommendations for future directions. PMID:22718466

German Ethics Council on genetic diagnostics: trend setting?

PubMed

Buechner, Bianca

2014-06-01

On 30 April 2013, the German Ethics Council ('Council') published its opinion on 'The future of genetic diagnostics--from research to clinical application' ('the Opinion'). The Council was asked by the German government to discuss the future of genetic diagnostic methods in relation to the current applicable laws and regulations as well as the ethical stand points. The Council's 23 recommendations show that the existing regulations in Germany, and indirectly on a European level, lack in protecting consumers sufficiently. Consumer protection built the major focus of the Council's opinion. However, the opinion misses a critical overall analysis of genetic testing and, for example, the potential misuse of genetic test results by insures or the risk of disclosure toward employers. The Council missed an opportunity to discuss which barriers are necessary from a legal and ethical perspective but which still do not prohibit genetic testing and research.

Packaging and distributing ecological data from multisite studies

NASA Technical Reports Server (NTRS)

Olson, R. J.; Voorhees, L. D.; Field, J. M.; Gentry, M. J.

1996-01-01

Studies of global change and other regional issues depend on ecological data collected at multiple study areas or sites. An information system model is proposed for compiling diverse data from dispersed sources so that the data are consistent, complete, and readily available. The model includes investigators who collect and analyze field measurements, science teams that synthesize data, a project information system that collates data, a data archive center that distributes data to secondary users, and a master data directory that provides broader searching opportunities. Special attention to format consistency is required, such as units of measure, spatial coordinates, dates, and notation for missing values. Often data may need to be enhanced by estimating missing values, aggregating to common temporal units, or adding other related data such as climatic and soils data. Full documentation, an efficient data distribution mechanism, and an equitable way to acknowledge the original source of data are also required.

The European Court of Human Rights’ Ruling on Unproven Stem Cell Therapies: A Missed Opportunity?

PubMed Central

Rial-Sebbag, Emmanuelle; Blasimme, Alessandro

2014-01-01

Abstract On May 6th 2014, the European Court of Human Rights added yet a new element to the judicial history of stem cells as it ruled in Durisotto v. Italy [appeal n. 62804/13]. The ruling rejected a patient claim to access an unproven cell therapy—an outcome that is certainly to be welcomed. However, this ruling is a missed occasion to clarify and reaffirm some important legal distinctions that could have greatly benefited the whole field of regenerative medicine. We claim that the ethical and political assumptions that sustain the regulation of expanded access programs to new therapies should be carefully scrutinized, with particular attention to the justifications for the risks connected to unconventional therapies. A clear legal definition of what counts as compassionate cure as distinct from unregulated and untested therapies cannot be provided unless those points are previously addressed. PMID:25457960

Using HFACS-Healthcare to Identify Systemic Vulnerabilities During Surgery.

PubMed

Cohen, Tara N; Francis, Sarah E; Wiegmann, Douglas A; Shappell, Scott A; Gewertz, Bruce L

2018-03-01

The Human Factors Analysis and Classification System for Healthcare (HFACS-Healthcare) was used to classify surgical near miss events reported via a hospital's event reporting system over the course of 1 year. Two trained analysts identified causal factors within each event narrative and subsequently categorized the events using HFACS-Healthcare. Of 910 original events, 592 could be analyzed further using HFACS-Healthcare, resulting in the identification of 726 causal factors. Most issues (n = 436, 60.00%) involved preconditions for unsafe acts, followed by unsafe acts (n = 257, 35.39%), organizational influences (n = 27, 3.72%), and supervisory factors (n = 6, 0.82%). These findings go beyond the traditional methods of trending incident data that typically focus on documenting the frequency of their occurrence. Analyzing near misses based on their underlying contributing human factors affords a greater opportunity to develop process improvements to reduce reoccurrence and better provide patient safety approaches.

Generating Discourse with Cookie and Doughnut Investigations

ERIC Educational Resources Information Center

Plankis, Brian; Vowell, Julie; Ramsey, John

2011-01-01

One key element sometimes missing from middle school science lessons is questioning designed to generate student discourse. The National Science Teachers Association recommends that the curriculum of middle school science programs includes "hands-on, minds-on" (NSTA 2003) inquiry-based science instruction, and according to Clough and Olson,…

Anxiety Sensitivity: A Missing Piece to the Agoraphobia-without-Panic Puzzle

ERIC Educational Resources Information Center

Hayward, Chris; Wilson, Kimberly A.

2007-01-01

This article reviews the controversy surrounding the diagnosis of agoraphobia without panic attacks and proposes a key role for anxiety sensitivity in explaining agoraphobic avoidance among those who have never experienced panic. Although rare in clinical samples, agoraphobia without panic is commonly observed in population-based surveys,…

Scientific Literacy: The Missing Ingredient. CenterView

ERIC Educational Resources Information Center

Center for the Future of Teaching and Learning, 2011

2011-01-01

Students' academic success in science is widely seen by political and business leaders as key to the nation's economic rebirth and future competitiveness. President Obama has made clear his belief in the importance of scientific literacy by stating that "our nation's long-term economic prosperity depends on providing a world-class education…

Applying LD Documentation Guidelines at the Postsecondary Level: Decision Making with Sparse or Missing Data

ERIC Educational Resources Information Center

Banerjee, Manju; Madaus, Joseph W.; Gelbar, Nicholas

2015-01-01

A key issue in fostering transition to postsecondary education for students with disabilities is documentation verifying the nature of the disability and supporting the need for services and reasonable accommodations. Documentation guidelines assist postsecondary disability service providers in making decisions about eligibility and reasonable…

Theorising Knowledge Practices: A Missing Piece of the Educational Technology Puzzle

ERIC Educational Resources Information Center

Howard, Sarah; Maton, Karl

2011-01-01

Educational technology research has been characterised as lacking theoretical frameworks that can enable cumulative knowledge-building across the field. This article explores the value of Legitimation Code Theory (LCT) for addressing these issues by discussing research into the key of integration of information and communication technologies in…

Objects of Desire: Power and Passion in Collaborative Activity

ERIC Educational Resources Information Center

Nardi, Bonnie A.

2005-01-01

This article uses activity theory to analyze the conduct of collaborative scientific research, showing how the conceptualization of object is critical to understanding key aspects of scientific collaboration. I argue that the passions and desires behind objects of scientific research are missing in most accounts. I suggest refinements to the…

Missing links between histones and RNA Pol II arising from SAND?

USDA-ARS?s Scientific Manuscript database

Eukaryotic SAND domain-containing proteins bind DNA and are implicated in direct target gene activation and chromatin-mediated gene regulation. We summarize our recent results demonstrating that the Arabidopsis SAND domain protein ULTRAPETALA1 (ULT1) plays a key role in counteracting target gene rep...

On measuring and decomposing inequality of opportunity in access to health services among Tunisian children: a new approach for public policy.

PubMed

Saidi, Anis; Hamdaoui, Mekki

2017-10-25

The early years in children's life are the key to physical, cognitive-language, and, socio-emotional skills development. So, it is of paramount importance in this period to be interested in different indicators that would influence the child's health. This paper measures inequality of opportunities among Tunisian children concerning access to nutritional and healthy services using Human Opportunity-Index and Shapely decomposition methods. Many disparities between regions have been detected since 1982 until 2012. Tunisian children face unequal opportunities to develop in terms of health, nutrition, cognitive, social, and emotional development. Likewise, we found that, parents' education, wealth, age of household head and geographic factors as key factors determining child development outcomes. Our findings suggested that childhood unequal opportunities in Tunisia are explained by pension funds deficiency and structural problem in the labor market. The results of a health care intervention on human participants "retrospectively registered".

Using Linked Electronic Health Records to Estimate Healthcare Costs: Key Challenges and Opportunities.

PubMed

Asaria, Miqdad; Grasic, Katja; Walker, Simon

2016-02-01

This paper discusses key challenges and opportunities that arise when using linked electronic health records (EHR) in health economics and outcomes research (HEOR), with a particular focus on estimating healthcare costs. These challenges and opportunities are framed in the context of a case study modelling the costs of stable coronary artery disease in England. The challenges and opportunities discussed fall broadly into the categories of (1) handling and organising data of this size and sensitivity; (2) extracting clinical endpoints from datasets that have not been designed and collected with such endpoints in mind; and (3) the principles and practice of costing resource use from routinely collected data. We find that there are a number of new challenges and opportunities that arise when working with EHR compared with more traditional sources of data for HEOR. These call for greater clinician involvement and intelligent use of sensitivity analysis.

Peering beyond the walls of healthcare institutions: a catalyst for innovation.

PubMed

Elrod, James K; Fortenberry, John L

2017-07-11

Healthcare providers operate in a unique industry characterized by pursuit of perhaps the most noble of missions: the delivery of vital health and medical services to those in need. Distinguishing features abound, differentiating the healthcare industry from others, with such facets having the potential to compel those serving in health and medical establishments to focus exclusively on their selected industry. But directing attention solely within can result in missed opportunities, especially regarding innovation. Many innovations which are well suited for healthcare establishments emerge externally, making at least some exposure beyond the healthcare industry essential for institutions desirous of operating on the innovation frontier. True innovation emerges from broad worldviews, allowing healthcare providers to comprehensively understand the current state of the art. With such an understanding, novel tools, techniques, and approaches, regardless of industry of origin, can be examined for their potential to elevate the status and stature of efforts within health and medical establishments. It is this very open, inquisitive mindset that permitted Willis-Knighton Health System to identify and incorporate a range of innovations which originated outside of the healthcare industry. Its embracement of and associated successes with the repurposing approach known as adaptive reuse, the delivery of complex medical services via centers of excellence, and the structuring of operations using the hub-and-spoke organization design, for example, would never have occurred had executives not directed attention externally in search of innovations that could be used within. Innovations offer key pathways for healthcare providers to enhance the depth and breadth of health and medical services offered in their establishments and communities. By peering beyond the walls of healthcare institutions, providers amplify opportunities to discover novel methods and approaches that potentially can be transferred into their own organizations, benefiting themselves and their patient populations.

Human factors in incident reporting

NASA Technical Reports Server (NTRS)

Jones, S. G.

1993-01-01

The paper proposes a cooperative research effort be undertaken by academic institutions and industry organizations toward the compilation of a human factors data base in conjunction with technical information. Team members in any discipline can benefit and learn from observing positive examples of decision making and performance by crews under stressful or less than optimal circumstances. The opportunity to note trends in interpersonal and interactive behaviors and to categorize them is terms of more or less desirable outcomes should not be missed.

Opportunity Missed: Congressional Reorganization of the Army Air Service 1917-1920

DTIC Science & Technology

1978-05-01

Syf~ot~~afi*) Unclassified 15a. DECLASSI FICATION/ DOWNGRADING Th,~.SCHEDULE 0.16. DISTRIBUTION STATEMENT (of this Report) C ) Approved for Public...Harvard Gibbs-Smith, Aviation An Historical Survey from its Origins-to the arid of World War II, 172-174; C . H. Hildreth and Bernard C . Nalty, 1001...engineers and aeronautical specialists under Colonel Raynal C . Bolling to study the situation in Europe and report on the types and numbers of

No Green-On-Blue Against the Reds?: Organizational Strategies Behind Insider Attacks in Afghanistan

DTIC Science & Technology

2013-06-01

Oaks, Calif: Sage Publications, 2003 ), 1. 46 Alexander L. George, Case Studies and Theory Development in the Social Sciences, BCSIA Studies in...the actions we take.2 For example, Kiras notes that the US missed opportunities to address the root causes of violence in Iraq during 2003 -2004...Warfare,” 230. 4 Merriam-Webster, Inc, Merriam-Webster’s Collegiate Dictionary, 11th ed (Springfield, Mass: Merriam-Webster, Inc, 2003 ), 649. 5

Missed Opportunities for Nutritional Rehabilitation in Children Admitted to Surgical Wards

PubMed Central

Dave, Pooja; Nimbalkar, Somashekhar; Phatak, Ajay; Desai, Rajendra; Srivastava, Shirish

2016-01-01

Background. Malnutrition in children has serious health and economic consequences. We studied documentation of malnutrition, actual prevalence, and treatment given in children admitted to surgical wards. Methods. Retrospective study of 154 patients aged <5 yrs admitted to general surgical, orthopedic, and otorhinolaryngology wards. Records were evaluated for completeness of data, way of documentation, and data quality. Descriptive analysis was done. If malnutrition was not identified and/or proper action was not taken, it was defined as a “missed opportunity.” Results. Of 154 records audited, 100 (64.94%) were males, 108 (70.13%) were from general surgery ward, and 78 (50.65%) were residing in suburban area. The mean (SD) age of the study population was 2.32 (1.16) years whereas mean (SD) duration of stay was 5.84 (6.29) days. Weight and height were mentioned in 116 (75.32%) and 8 (5.19%) records, respectively, mostly by nonsurgical personnel. Documentation and treatment of malnutrition were poor. Out of 106 apparently correct weight records, 19 (17.93%) children were severely undernourished and 30 (28.30%) were moderately undernourished whereas 20 (18.87%) children were not undernourished but required nutritional attention. Conclusion. There is poor documentation of nutritional indicators of children admitted to surgical wards. From data that was available, it is apparent that malnutrition is at high levels. “Identification” and hence management of malnutrition need more attention. PMID:27429836

Missed opportunity for alcohol problem prevention among army active duty service members postdeployment.

PubMed

Larson, Mary Jo; Mohr, Beth A; Adams, Rachel Sayko; Wooten, Nikki R; Williams, Thomas V

2014-08-01

We identified to what extent the Department of Defense postdeployment health surveillance program identifies at-risk drinking, alone or in conjunction with psychological comorbidities, and refers service members who screen positive for additional assessment or care. We completed a cross-sectional analysis of 333 803 US Army active duty members returning from Iraq or Afghanistan deployments in fiscal years 2008 to 2011 with a postdeployment health assessment. Alcohol measures included 2 based on self-report quantity-frequency items-at-risk drinking (positive Alcohol Use Disorders Identification Test alcohol consumption questions [AUDIT-C] screen) and severe alcohol problems (AUDIT-C score of 8 or higher)-and another based on the interviewing provider's assessment. Nearly 29% of US Army active duty members screened positive for at-risk drinking, and 5.6% had an AUDIT-C score of 8 or higher. Interviewing providers identified potential alcohol problems among only 61.8% of those screening positive for at-risk drinking and only 74.9% of those with AUDIT-C scores of 8 or higher. They referred for a follow-up visit to primary care or another setting only 29.2% of at-risk drinkers and only 35.9% of those with AUDIT-C scores of 8 or higher. This study identified missed opportunities for early intervention for at-risk drinking. Future research should evaluate the effect of early intervention on long-term outcomes.

Unconditional security of quantum key distribution over arbitrarily long distances

PubMed

Lo; Chau

1999-03-26

Quantum key distribution is widely thought to offer unconditional security in communication between two users. Unfortunately, a widely accepted proof of its security in the presence of source, device, and channel noises has been missing. This long-standing problem is solved here by showing that, given fault-tolerant quantum computers, quantum key distribution over an arbitrarily long distance of a realistic noisy channel can be made unconditionally secure. The proof is reduced from a noisy quantum scheme to a noiseless quantum scheme and then from a noiseless quantum scheme to a noiseless classical scheme, which can then be tackled by classical probability theory.

Competences for All: Recognizing and Developing Competences of Young People with Fewer Opportunities

ERIC Educational Resources Information Center

Usakli, Hakan

2016-01-01

This qualitative study clarifies opinion of 32 European volunteer youth leaders on concepts of competence, fewer opportunities and enlargement strategies on competence of fewer opportunities. Leaders underline main competencies as follows: tongue, languages, mathematical, digital, learning, social, entrepreneurship, cultural. Key competences are…

The Future of Clinical Education: Opportunities and Challenges from Allied Health Deans' Perspective.

PubMed

Romig, Barbara D; Tucker, Ann W; Hewitt, Anne M; O'Sullivan Maillet, Julie

2017-01-01

There is limited information and consensus on the future of clinical education and the key factors impacting allied health (AH) clinical training. AH deans identified both opportunities and challenges impacting clinical education based on a proposed educational model. From July 2013 to March 2014, 61 deans whose institutions were 2013 members of the Association of Schools of Allied Health Professions (ASAHP) participated in a three-round Delphi survey. Agreement on the relative importance of and the ability to impact the key factors was analyzed. Impact was evaluated for three groups: individual, collective, and both individual and collective deans. AH deans' responses were summarized and refined; individual items were accepted or rerated until agreement was achieved or study conclusion. Based on the deans' ratings of importance and impact, 159 key factors within 13 clinical education categories emerged as important for the future of clinical education. Agreement was achieved on 107 opportunities and 52 challenges. The Delphi technique generated new information where little existed specific to AH deans' perspectives on AH clinical education. This research supports the Key Factors Impacting Allied Health Clinical Education conceptual model proposed earlier and provides a foundation for AH deans to evaluate opportunities and challenges impacting AH clinical education and to design action plans based on this research.

X-Ray properties of Post-Merger Spheroidal Galaxies: The Missing Link in Understanding the Merger-AGN connection

NASA Astrophysics Data System (ADS)

Nair, Preethi

2017-09-01

We propose to characterize the AGN properties of post-merger spheroidal galaxies, a well-defined, significant post starburst phase in merging galaxies. These galaxies probe the "coalesced" late stage of mergers lying between ULIRGs and quenched elliptical galaxies. They are characterized by shells and tidal tails with lifetimes (0.5 - 1 Gyr) similar to those of low luminosity AGN. The AGN detection fraction for 12 serendipitous Chandra sources is 83%. These `shell' galaxies may represent a key time step in major mergers which has previously been unexplored. We propose to image a well selected sample of 12 shells drawn from SDSS to investigate this missing chapter in mergers.

Leveraging the Domain of Work to Improve Migrant Health

PubMed Central

Flynn, Michael A.; Wickramage, Kolitha

2017-01-01

Work is a principal driver of current international migration, a primary social determinant of health, and a fundamental point of articulation between migrants and their host society. Efforts by international organizations to promote migrant health have traditionally focused on infectious diseases and access to healthcare, while international labor organizations have largely focused on issues of occupational health. The underutilization of the domain of work in addressing the health of migrants is truly a missed opportunity for influencing worker well-being and reducing societal economic burden. Understanding of the relationships among migration, work, and health would facilitate further integration of migrant health concerns into the policy agenda of governments and international agencies that work at the nexus of labor, health and development. The domain of work offers an opportunity to capitalize on the existing health and development infrastructure and leverage technical resources, programs and research to promote migrant health. It also provides the opportunity to advance migrant health through new and innovative approaches and partnerships. PMID:29048386

Leveraging the Domain of Work to Improve Migrant Health.

PubMed

Flynn, Michael A; Wickramage, Kolitha

2017-10-19

Work is a principal driver of current international migration, a primary social determinant of health, and a fundamental point of articulation between migrants and their host society. Efforts by international organizations to promote migrant health have traditionally focused on infectious diseases and access to healthcare, while international labor organizations have largely focused on issues of occupational health. The underutilization of the domain of work in addressing the health of migrants is truly a missed opportunity for influencing worker well-being and reducing societal economic burden. Understanding of the relationships among migration, work, and health would facilitate further integration of migrant health concerns into the policy agenda of governments and international agencies that work at the nexus of labor, health and development. The domain of work offers an opportunity to capitalize on the existing health and development infrastructure and leverage technical resources, programs and research to promote migrant health. It also provides the opportunity to advance migrant health through new and innovative approaches and partnerships.

SME filter approach to multiple target tracking with false and missing measurements

NASA Astrophysics Data System (ADS)

Lee, Yong J.; Kamen, Edward W.

1993-10-01

The symmetric measurement equation (SME) filter for track maintenance in multiple target tracking is extended to the general case when there are an arbitrary unknown number of false and missing position measurements in the measurement set at any time point. It is assumed that the number N of targets is known a priori and that the target motions consist of random perturbations of constant-velocity trajectories. The key idea in the paper is to generate a new measurement vector from sums-of-products of the elements of 'feasible' N-element data vectors that pass a thresholding operation in the sums-of-products framework. Via this construction, the data association problem is completely avoided, and in addition, there is no need to identify which target measurements may correspond to false returns or which target measurements may be missing. A computer simulation of SME filter performance is given, including a comparison with the associated filter (a benchmark) and the joint probabilistic data association (JPDA) filter.

Reconsideration of Si pillar thermal oxidation mechanism

NASA Astrophysics Data System (ADS)

Kageshima, Hiroyuki; Shiraishi, Kenji; Endoh, Tetsuo

2018-06-01

The mechanism of Si pillar thermal oxidation is considered. The Si emission is discussed in the oxidation of three-dimensional structures, which must be fundamentally important to understand the oxidation mechanism. It is confirmed that the Si emission is enhanced in the three-dimensional structures by the geometrical and stress effects. The larger effect is expected for Si spheres rather than for Si pillars. More enhanced Si emission can be expected for the smaller spheres. Then the mechanism of Si missing and the effect of Si emission are also discussed. The oxide viscous flow mechanism is the promising candidate to explain the Si missing, because the oxide viscosity could be reduced by the SiO incorporation and the compressive stress. The geometrical effect induces the viscosity gradient, which is important to induce the Si missing. Interplay of the emitted SiO and the accumulated stress is the key in Si pillar oxidation. Careful approaches are suggested for the oxidation of three-dimensional structures.

Patient-, health worker-, and health facility-level determinants of correct malaria case management at publicly funded health facilities in Malawi: results from a nationally representative health facility survey.

PubMed

Steinhardt, Laura C; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

2014-02-20

Prompt and effective case management is needed to reduce malaria morbidity and mortality. However, malaria diagnosis and treatment is a multistep process that remains problematic in many settings, resulting in missed opportunities for effective treatment as well as overtreatment of patients without malaria. Prior to the widespread roll-out of malaria rapid diagnostic tests (RDTs) in late 2011, a national, cross-sectional, complex-sample, health facility survey was conducted in Malawi to assess patient-, health worker-, and health facility-level factors associated with malaria case management quality using multivariate Poisson regression models. Among the 2,019 patients surveyed, 34% had confirmed malaria defined as presence of fever and parasitaemia on a reference blood smear. Sixty-seven per cent of patients with confirmed malaria were correctly prescribed the first-line anti-malarial, with most cases of incorrect treatment due to missed diagnosis; 31% of patients without confirmed malaria were overtreated with an anti-malarial. More than one-quarter of patients were not assessed for fever or history of fever by health workers. The most important determinants of correct malaria case management were patient-level clinical symptoms, such as spontaneous complaint of fever to health workers, which increased both correct treatment and overtreatment by 72 and 210%, respectively (p<0.0001). Complaint of cough was associated with a 27% decreased likelihood of correct malaria treatment (p=0.001). Lower-level cadres of health workers were more likely to prescribe anti-malarials for patients, increasing the likelihood of both correct treatment and overtreatment, but no other health worker or health facility-level factors were significantly associated with case management quality. Introduction of RDTs holds potential to improve malaria case management in Malawi, but health workers must systematically assess all patients for fever, and then test and treat accordingly, otherwise, malaria control programmes might miss an opportunity to dramatically improve malaria case management, despite better diagnostic tools.

HPV vaccination coverage of teen girls: the influence of health care providers.

PubMed

Smith, Philip J; Stokley, Shannon; Bednarczyk, Robert A; Orenstein, Walter A; Omer, Saad B

2016-03-18

Between 2010 and 2014, the percentage of 13-17 year-old girls administered ≥3 doses of the human papilloma virus (HPV) vaccine ("fully vaccinated") increased by 7.7 percentage points to 39.7%, and the percentage not administered any doses of the HPV vaccine ("not immunized") decreased by 11.3 percentage points to 40.0%. To evaluate the complex interactions between parents' vaccine-related beliefs, demographic factors, and HPV immunization status. Vaccine-related parental beliefs and sociodemographic data collected by the 2010 National Immunization Survey-Teen among teen girls (n=8490) were analyzed. HPV vaccination status was determined from teens' health care provider (HCP) records. Among teen girls either unvaccinated or fully vaccinated against HPV, teen girls whose parent was positively influenced to vaccinate their teen daughter against HPV were 48.2 percentage points more likely to be fully vaccinated. Parents who reported being positively influenced to vaccinate against HPV were 28.9 percentage points more likely to report that their daughter's HCP talked about the HPV vaccine, 27.2 percentage points more likely to report that their daughter's HCP gave enough time to discuss the HPV shot, and 43.4 percentage points more likely to report that their daughter's HCP recommended the HPV vaccine (p<0.05). Among teen girls administered 1-2 doses of the HPV vaccine, 87.0% had missed opportunities for HPV vaccine administration. Results suggest that an important pathway to achieving higher ≥3 dose HPV vaccine coverage is by increasing HPV vaccination series initiation though HCP talking to parents about the HPV vaccine, giving parents time to discuss the vaccine, and by making a strong recommendation for the HPV. Also, HPV vaccination series completion rates may be increased by eliminating missed opportunities to vaccinate against HPV and scheduling additional follow-up visits to administer missing HPV vaccine doses. Published by Elsevier Ltd.

Impact of measles supplementary immunization activities on reaching children missed by routine programs.

PubMed

Portnoy, Allison; Jit, Mark; Helleringer, Stéphane; Verguet, Stéphane

2018-01-02

Measles supplementary immunization activities (SIAs) are vaccination campaigns that supplement routine vaccination programs with a recommended second dose opportunity to children of different ages regardless of their previous history of measles vaccination. They are conducted every 2-4 years and over a few weeks in many low- and middle-income countries. While SIAs have high vaccination coverage, it is unclear whether they reach the children who miss their routine measles vaccine dose. Determining who is reached by SIAs is vital to understanding their effectiveness, as well as measure progress towards measles control. We examined SIAs in low- and middle-income countries from 2000 to 2014 using data from the Demographic and Health Surveys. Conditional on a child's routine measles vaccination status, we examined whether children participated in the most recent measles SIA. The average proportion of zero-dose children (no previous routine measles vaccination defined as no vaccination date before the SIA) reached by SIAs across 14 countries was 66%, ranging from 28% in São Tomé and Príncipe to 91% in Nigeria. However, when also including all children with routine measles vaccination data, this proportion decreased to 12% and to 58% when imputing data for children with vaccination reported by the mother and vaccination marks on the vaccination card across countries. Overall, the proportions of zero-dose children reached by SIAs declined with increasing household wealth. Some countries appeared to reach a higher proportion of zero-dose children using SIAs than others, with proportions reached varying according to the definition of measles vaccination (e.g., vaccination dates on the vaccination card, vaccination marks on the vaccination card, and/or self-reported data). This suggests that some countries could improve their targeting of SIAs to children who miss other measles vaccine opportunities. Across all countries, SIAs played an important role in reaching children from poor households. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

32 CFR 191.8 - Defense equal opportunity council and EEO boards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... development in the Department of Defense. The Boards shall work with career management officials, other key... 32 National Defense 2 2010-07-01 2010-07-01 false Defense equal opportunity council and EEO boards... DEFENSE (CONTINUED) MISCELLANEOUS THE DOD CIVILIAN EQUAL EMPLOYMENT OPPORTUNITY (EEO) PROGRAM § 191.8...

Linking Complex Problem Solving to Opportunity Identification Competence within the Context of Entrepreneurship

ERIC Educational Resources Information Center

Baggen, Yvette; Mainert, Jakob; Lans, Thomas; Biemans, Harm J. A.; Greiff, Samuel; Mulder, Martin

2015-01-01

Today's working life is increasingly characterized by entrepreneurial challenges. Entrepreneurial challenges start at an individual level with the identification of entrepreneurial opportunities, which is acknowledged as one of the key competencies for lifelong learning. Since the identification of entrepreneurial opportunities relies heavily on…

Closing the Civic Opportunity Gap: The Imperative for Teacher Education

ERIC Educational Resources Information Center

Marri, Anand Reddy

2011-01-01

In teacher education, the key concern must be inequitable civic education, which includes economic education and opportunities available for underserved students. Inequitable civic education opportunities reinforce already-widening disparities between groups of citizens. This bodes ill for democracy and the ability to wrestle with the complex…

Students with Intellectual Disabilities Going to College? Absolutely!

ERIC Educational Resources Information Center

Kleinert, Harold L.; Jones, Melissa M.; Sheppard-Jones, Kathleen; Harp, Beverly; Harrison, Elizabeth M.

2012-01-01

In this article we describe the new opportunities for postsecondary education available to students with intellectual disabilities (ID) through the Higher Education Opportunities Act of 2008. We also identify the importance of these opportunities for students with ID, and key strategies for ensuring that their college experience is an important…

Pigs on the plains: Institutional analysis of a Colorado water quality initiative

USGS Publications Warehouse

King, D.; Burkardt, N.; Lee, Lamb B.

2006-01-01

We used the Legal-Institutional Analysis Model (LIAM) and Advocacy Coalition Framework (ACF) to analyze the campaign over passage of the Colorado Hogs Rule, an initiative passed by the voters in 1998 to require regulation of swine production facilities in Colorado. Used in tandem, LIAM and ACF provided an opportunity to develop a robust understanding of the obstacles and opportunities that face water quality managers in a state-centered multi-organizational decision process. We found that combining the LIAM with the ACF enhanced the understanding that could be achieved by using either model in isolation. The predictive capacity of the LIAM would have been reduced without information from the ACF, and the ACF by itself would have missed the importance of a single-case study.

Missed Policy Opportunities to Advance Health Equity by Recording Demographic Data in Electronic Health Records

PubMed Central

Dawes, Daniel E.; Holden, Kisha B.; Mack, Dominic

2015-01-01

The science of eliminating health disparities is complex and dependent on demographic data. The Health Information Technology for Economic and Clinical Health Act (HITECH) encourages the adoption of electronic health records and requires basic demographic data collection; however, current data generated are insufficient to address known health disparities in vulnerable populations, including individuals from diverse racial and ethnic backgrounds, with disabilities, and with diverse sexual identities. We conducted an administrative history of HITECH and identified gaps between the policy objective and required measure. We identified 20 opportunities for change and 5 changes, 2 of which required the collection of less data. Until health care demographic data collection requirements are consistent with public health requirements, the national goal of eliminating health disparities cannot be realized. PMID:25905840

Missed Opportunities for Improving Nutrition Through Institutional Food: The Case for Food Worker Training

PubMed Central

Deutsch, Jonathan; Patinella, Stefania; Freudenberg, Nicholas

2013-01-01

The institutional food sector—including food served in schools, child care settings, hospitals, and senior centers—is a largely untapped resource for public health that may help to arrest increasing rates of obesity and diet-related health problems. To make this case, we estimated the reach of a diverse institutional food sector in 1 large municipality, New York City, in 2012, and explored the potential for improving institutional food by building the skills and nutritional knowledge of foodservice workers through training. Drawing on the research literature and preliminary data collected in New York City, we discuss the dynamics of nutritional decision-making in these settings. Finally, we identify opportunities and challenges associated with training the institutional food workforce to enhance nutrition and health. PMID:23865653

Ruby on Rails Issue Tracker

NASA Technical Reports Server (NTRS)

Rodriguez, Juan Jared

2014-01-01

The purpose of this report is to detail the tasks accomplished as a NASA NIFS intern for the summer 2014 session. This internship opportunity is to develop an issue tracker Ruby on Rails web application to improve the communication of developmental anomalies between the Support Software Computer Software Configuration Item (CSCI) teams, System Build and Information Architecture. As many may know software development is an arduous, time consuming, collaborative effort. It involves nearly as much work designing, planning, collaborating, discussing, and resolving issues as effort expended in actual development. This internship opportunity was put in place to help alleviate the amount of time spent discussing issues such as bugs, missing tests, new requirements, and usability concerns that arise during development and throughout the life cycle of software applications once in production.

Preventing Infectious Pulmonary Tuberculosis Among Foreign-Born Residents of the United States

PubMed Central

Katz, Dolly; Ghosh, Smita; Blumberg, Henry; Tamhane, Ashutosh; Sevilla, Anna; Reves, Randall

2015-01-01

Objectives. We described risk factors associated with infectious tuberculosis (TB) and missed TB-prevention opportunities in foreign-born US residents, who account for almost two thirds of the nation’s TB patients. Methods. In a cross-sectional study at 20 US sites of foreign-born persons diagnosed with TB in 2005 through 2006, we collected results of sputum smear microscopy for acid-fast bacilli (a marker for infectiousness) and data on visa status, sociodemographics, TB-related care seeking, and latent TB infection (LTBI) diagnosis opportunities. Results. Among 980 persons with pulmonary TB who reported their visa status, 601 (61%) were legal permanent residents, 131 (13.4%) had temporary visas, and 248 (25.3%) were undocumented. Undocumented persons were more likely than permanent residents to have acid-fast bacilli–positive smears at diagnosis (risk ratio = 1.3; 95% confidence interval = 1.2, 1.4). Of those diagnosed 1 year or more after arrival, 57.3% reported LTBI screening opportunities; fewer than 25% actually were. Undocumented persons reported fewer LTBI screening opportunities and were less likely to be tested. Conclusions. Progress toward TB elimination in the United States depends upon expanding opportunities for regular medical care and promotion of LTBI screening and treatment among foreign-born persons. PMID:26180947

Evaluating New York City's abortion reporting system: insights for public health data collection systems.

PubMed

Toprani, Amita; Madsen, Ann; Das, Tara; Gambatese, Melissa; Greene, Carolyn; Begier, Elizabeth

2014-01-01

New York City (NYC) mandates reporting of all abortion procedures. These reports enable tracking of abortion incidence and underpin programs, policy, and research. Since January 2011, the majority of abortion facilities must report electronically. We conducted an evaluation of NYC's abortion reporting system and its transition to electronic reporting. We summarize the evaluation methodology and results and draw lessons relevant to other vital statistics and public health reporting systems. The evaluation followed Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems. We interviewed key stakeholders and conducted a data provider survey. In addition, we compared the system's abortion counts with external estimates and calculated the proportion of missing and invalid values for each variable on the report form. Finally, we assessed the process for changing the report form and estimated system costs. NYC Health Department's Bureau of Vital Statistics. Usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, timeliness, and stability of the abortion reporting system. Ninety-five percent of abortion data providers considered abortion reporting important; 52% requested training regarding the report form. Thirty percent reported problems with electronic biometric fingerprint certification, and 18% reported problems with the electronic system's stability. Estimated system sensitivity was 88%. Of 17 variables, education and ancestry had more than 5% missing values in 2010. Changing the electronic reporting module was costly and time-consuming. System operating costs were estimated at $80 136 to $89 057 annually. The NYC abortion reporting system is sensitive and provides high-quality data, but opportunities for improvement include facilitating biometric certification, increasing electronic platform stability, and conducting ongoing outreach and training for data providers. This evaluation will help data users determine the degree of confidence that should be placed on abortion data. In addition, the evaluation results are applicable to other vital statistics reporting and surveillance systems.

Reasons for missed appointments with a hepatitis C outreach clinic: A qualitative study.

PubMed

Poll, Ray; Allmark, Peter; Tod, Angela M

2017-01-01

Non-attendance in drug service hepatitis C outreach clinics means clients miss the opportunity of being given lifestyle advice and referral to hospital for assessment and treatment. A similar problem is experienced in other services throughout the UK. A qualitative study was undertaken to investigate the problem. Clients with a history of not attending the outreach clinic were invited to participate during a routine drug clinic appointment. A contact details sheet with a preferred telephone number was completed by those agreeing to take part. Verbal consent was taken and a telephone interview took place. The participants were remunerated for taking part with a five pounds high street voucher. The 'framework method' was used to analyse the data with key themes identified. Twenty-eight telephone interviews were undertaken from April to June 2012. All the clients gave 'prima-facie' reasons for non-attendance including 'not a priority' and 'forgot'. However, the study indicates these are insufficient to explain the various experiences and influences. Underlying reasons that impacted upon attendance were identified. These reasons relate to (i) client characteristics e.g. 'priority' to score drugs and the 'cost of travel' and (ii) clinic service e.g. 'difficult journey' to the clinic and timing of the 'appointment'. The reasons operated within a complex context where other factors had an impact including addiction, welfare policy, stigma and the nature of hepatitis C itself. The study revealed that beneath apparently simple explanations for non-attendance, such as clients' chaotic lifestyle resulting in them forgetting or not being bothered to attend, there were far more complex and varied underlying reasons. This has important implications for drug policy including the need to better incorporate clients' perspectives. Policy that is based only on the simple, surface reasons is unlikely to be effective. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

Burden of traumatic injuries in Saudi Arabia: lessons from a major trauma registry in Riyadh, Saudi Arabia.

PubMed

Alghnam, Suliman; Alkelya, Muhamad; Al-Bedah, Khalid; Al-Enazi, Saleem

2014-01-01

In Saudi Arabia (SA), injuries are the second leading cause of death; however, little is known about their frequencies and outcomes. Trauma registries play a major role in measuring the burden on population health. This study aims to describe the population of the only hospital-based trauma registry in the country and highlight challenges and potential opportunities to improve trauma data collection and research in SA. Using data between 2001 and 2010, this retrospective study included patients from a large trauma center in Riyadh, SA. A staff nurse utilized a structured checklist to gather information on patients' demographic, physiologic, anatomic, and outcome variables. Basic descriptive statistics by age group ( 14 years) were calculated, and differences were assessed using student t and chi-square tests. In addition, the mechanism of injury and the frequency of missing data were evaluated. 10 847 patients from the trauma registry were included. Over 9% of all patients died either before or after being treated at the hospital. Patients who were older than 14 years of age (more likely to be male) sustained traffic-related injuries and died in the hospital as compared to patients who were younger than or equal to years of age. Deceased patients were severely injured as measured by injury severity score and Glasgow Coma Scale (P < .001). Overall, the most frequent type of injury was related to traffic (52.0%), followed by falls (23.4%). Missing values were mostly prevalent in traffic-related variables, such as seatbelt use (70.2%). This registry is a key step toward addressing the burden of injuries in SA. Improved injury classification using the International Classification of Disease-external cause codes may improve the quality of the registry and allow comparison with other populations. Most importantly, injury prevention in SA requires further investment in data collection and research to improve outcomes.

Unmanned aerial survey of fallen trees in a deciduous broadleaved forest in eastern Japan.

PubMed

Inoue, Tomoharu; Nagai, Shin; Yamashita, Satoshi; Fadaei, Hadi; Ishii, Reiichiro; Okabe, Kimiko; Taki, Hisatomo; Honda, Yoshiaki; Kajiwara, Koji; Suzuki, Rikie

2014-01-01

Since fallen trees are a key factor in biodiversity and biogeochemical cycling, information about their spatial distribution is of use in determining species distribution and nutrient and carbon cycling in forest ecosystems. Ground-based surveys are both time consuming and labour intensive. Remote-sensing technology can reduce these costs. Here, we used high-spatial-resolution aerial photographs (0.5-1.0 cm per pixel) taken from an unmanned aerial vehicle (UAV) to survey fallen trees in a deciduous broadleaved forest in eastern Japan. In nine sub-plots we found a total of 44 fallen trees by ground survey. From the aerial photographs, we identified 80% to 90% of fallen trees that were >30 cm in diameter or >10 m in length, but missed many that were narrower or shorter. This failure may be due to the similarity of fallen trees to trunks and branches of standing trees or masking by standing trees. Views of the same point from different angles may improve the detection rate because they would provide more opportunity to detect fallen trees hidden by standing trees. Our results suggest that UAV surveys will make it possible to monitor the spatial and temporal variations in forest structure and function at lower cost.

Characterising Tidal Flow Within AN Energetic Tidal Environment

NASA Astrophysics Data System (ADS)

Neill, S. P.; Goward Brown, A.; Lewis, M. J.

2016-02-01

The Pentland Firth is a highly energetic and complex tidal strait separating the north of Scotland with the Orkney Islands and is a key location for tidal energy exploitation. Topographic features including islands and headlands, combined with bathymetric complexities within the Pentland Firth create turbulent hydrodynamic flows which are difficult to observe. Site selection in tidal energy environments historically focuses on tidal current magnitude. Without consideration for the more complex hydrodynamics of tidal energy environments tidal energy developers may miss the opportunity to tune their devices or create environment specific tidal energy converters in order to harness the greatest potential from site. Fully characterising these tidal energy environments ensures economic energy extraction. Understanding the interaction of energy extraction with the environment will reduce uncertainty in site selection and allow mitigation of any potential environmental concerns. We apply the 3D ROMS model to the Pentland Firth with the aim of resolving uncertainties within tidal energy resource assessment. Flow magnitudes and directions are examined with a focus on tidal phasing and asymmetry and application to sediment dynamics. Using the ROMS model, it is possible to determine the extent to which the tidal resource varies temporally and spatially with tidal energy extraction. Accurately modelling the tidal dynamics within this environment ensures that potential consequences of tidal energy extraction on the surrounding environment are better understood.

Fathering after military deployment: parenting challenges and goals of fathers of young children.

PubMed

Walsh, Tova B; Dayton, Carolyn J; Erwin, Michael S; Muzik, Maria; Busuito, Alexandra; Rosenblum, Katherine L

2014-02-01

Although often eagerly anticipated, reunification after deployment poses challenges for families, including adjusting to the parent-soldier's return, re-establishing roles and routines, and the potentially necessary accommodation to combat-related injuries or psychological effects. Fourteen male service members, previously deployed to a combat zone, parent to at least one child under seven years of age, were interviewed about their relationships with their young children. Principles of grounded theory guided data analysis to identify key themes related to parenting young children after deployment. Participants reported significant levels of parenting stress and identified specific challenges, including difficulty reconnecting with children, adapting expectations from military to family life, and coparenting. Fathers acknowledged regret about missing an important period in their child's development and indicated a strong desire to improve their parenting skills. They described a need for support in expressing emotions, nurturing, and managing their tempers. Results affirm the need for support to military families during reintegration and demonstrate that military fathers are receptive to opportunities to engage in parenting interventions. Helping fathers understand their children's behavior in the context of age-typical responses to separation and reunion may help them to renew parent-child relationships and reengage in optimal parenting of their young children.

Unmanned Aerial Survey of Fallen Trees in a Deciduous Broadleaved Forest in Eastern Japan

PubMed Central

Inoue, Tomoharu; Nagai, Shin; Yamashita, Satoshi; Fadaei, Hadi; Ishii, Reiichiro; Okabe, Kimiko; Taki, Hisatomo; Honda, Yoshiaki; Kajiwara, Koji; Suzuki, Rikie

2014-01-01

Since fallen trees are a key factor in biodiversity and biogeochemical cycling, information about their spatial distribution is of use in determining species distribution and nutrient and carbon cycling in forest ecosystems. Ground-based surveys are both time consuming and labour intensive. Remote-sensing technology can reduce these costs. Here, we used high-spatial-resolution aerial photographs (0.5–1.0 cm per pixel) taken from an unmanned aerial vehicle (UAV) to survey fallen trees in a deciduous broadleaved forest in eastern Japan. In nine sub-plots we found a total of 44 fallen trees by ground survey. From the aerial photographs, we identified 80% to 90% of fallen trees that were >30 cm in diameter or >10 m in length, but missed many that were narrower or shorter. This failure may be due to the similarity of fallen trees to trunks and branches of standing trees or masking by standing trees. Views of the same point from different angles may improve the detection rate because they would provide more opportunity to detect fallen trees hidden by standing trees. Our results suggest that UAV surveys will make it possible to monitor the spatial and temporal variations in forest structure and function at lower cost. PMID:25279817

The Impact of Polio Eradication on Routine Immunization and Primary Health Care: A Mixed-Methods Study

PubMed Central

Closser, Svea; Cox, Kelly; Parris, Thomas M.; Landis, R. Matthew; Justice, Judith; Gopinath, Ranjani; Maes, Kenneth; Banteyerga Amaha, Hailom; Mohammed, Ismaila Zango; Dukku, Aminu Mohammed; Omidian, Patricia A.; Varley, Emma; Tedoff, Pauley; Koon, Adam D.; Nyirazinyoye, Laetitia; Luck, Matthew A.; Pont, W. Frank; Neergheen, Vanessa; Rosenthal, Anat; Nsubuga, Peter; Thacker, Naveen; Jooma, Rashid; Nuttall, Elizabeth

2014-01-01

Background. After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC). Methods. Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review. Results. Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year. Conclusions. Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts. PMID:24690667

Employability and Employers: The Missing Piece of the Jigsaw. IES Report 361.

ERIC Educational Resources Information Center

Tamkin, P.; Hillage, J.

The approaches to employability being taken by United Kingdom employers were examined in a study that included three components: a literature review to develop a definition of employability and isolate its key elements; case studies of six organizations to identify employers' approaches to employability; and examination of related literature on…

Optimizing L2 Curriculum for China Post-Secondary Education

ERIC Educational Resources Information Center

Guadagni, Donald

2015-01-01

This instructional paper examines the lack of L2 English skills demonstrated by Chinese post-secondary education students and the results of empiric testing to determine what key language functions were missing from a student's tool box when exiting their primary education phase.The identification of these skills and ability gaps allowed for…

The Adventures of Miss Glucie

ERIC Educational Resources Information Center

Schmit, Palma J.; Freeman, Norman

1975-01-01

Presents one approach to helping students comprehend the subject of bioenergetics in the form of having students write and present a four act play about cellular metabolism and its significance in the production of energy. Key words required to be used in the play are listed and the script of one student play is included. (PB)

A Missing Piece of the Departure Puzzle: Student-Institution Fit and Intent to Persist

ERIC Educational Resources Information Center

Bowman, Nicholas A.; Denson, Nida

2014-01-01

According to prevailing theory and anecdotal evidence, the congruence between institutional attributes and students' needs, interests, and preferences plays a key role in promoting college satisfaction and retention. However, this assertion has received little direct empirical attention, and the few available studies appear to have some key…

Yearning and Its Uses

ERIC Educational Resources Information Center

Vakil, Ardashir

2013-01-01

This article makes a case for the centrality of yearning in fictional representations of characters. With the help of illustrations from Adam Phillips, Olen Butler and Ted Hughes I argue that this key element may be missing from the creative work of students. This is my attempt, through exercises and other stimuli, to generate this yearning or…

Resolving the Schwarzschild singularity in both classic and quantum gravity

NASA Astrophysics Data System (ADS)

Zeng, Ding-fang

2017-04-01

The Schwarzschild singularity's resolution has key values in cracking the key mysteries related with black holes, the origin of their horizon entropy and the information missing puzzle involved in their evaporations. We provide in this work the general dynamic inner metric of collapsing stars with horizons and with non-trivial radial mass distributions. We find that static central singularities are not the final state of the system. Instead, the final state of the system is a periodically zero-cross breathing ball. Through 3+1 decomposed general relativity and its quantum formulation, we establish a functional Schrödinger equation controlling the micro-state of this breathing ball and show that, the system configuration with all the matter concentrating on the central point is not the unique eigen-energy-density solution. Using a Bohr-Sommerfield like "orbital" quantisation assumption, we show that for each black hole of horizon radius rh, there are about e rh2 / ℓpl2 allowable eigen-energy-density profiles. This naturally leads to physic interpretations for the micro-origin of horizon entropy, as well as solutions to the information missing puzzle involved in Hawking radiations.

Lazy collaborative filtering for data sets with missing values.

PubMed

Ren, Yongli; Li, Gang; Zhang, Jun; Zhou, Wanlei

2013-12-01

As one of the biggest challenges in research on recommender systems, the data sparsity issue is mainly caused by the fact that users tend to rate a small proportion of items from the huge number of available items. This issue becomes even more problematic for the neighborhood-based collaborative filtering (CF) methods, as there are even lower numbers of ratings available in the neighborhood of the query item. In this paper, we aim to address the data sparsity issue in the context of neighborhood-based CF. For a given query (user, item), a set of key ratings is first identified by taking the historical information of both the user and the item into account. Then, an auto-adaptive imputation (AutAI) method is proposed to impute the missing values in the set of key ratings. We present a theoretical analysis to show that the proposed imputation method effectively improves the performance of the conventional neighborhood-based CF methods. The experimental results show that our new method of CF with AutAI outperforms six existing recommendation methods in terms of accuracy.

Napoleon’s Missed Opportunities to Maintain Combat Forces through Medical Innovations and Battling the Hidden Enemy

DTIC Science & Technology

2011-12-07

death due to combat injuries. Many of the doctors to include Larrey relied on the miasma theory to explain the fevers that afflicted the troops. Fever ...mindset came during his early years when he came down with a serious fever but survived with no after effects. Another instance was when Napoleon...through the pain, headaches, and intermittent fever .28 Furthermore, Napoleon thought that those who died of disease were not good enough, not

Improving Access to Care for Warfighters: Virtual Worlds Technology to Enhance Primary Care Training in Post-Traumatic Stress and Motivational Interviewing

DTIC Science & Technology

2017-10-01

chronic mental and physical health problems. Therefore, the project aims to: (1) iteratively design a new web-based PTS and Motivational Interviewing...result in missed opportunities to intervene to prevent chronic mental and physical health problems. The project aims are to: (1) iteratively design a new...intervene to prevent chronic mental and physical health problems. We propose to: (1) Iteratively design a new web-based PTS and Motivational

Popular sweetner sucralose as a migraine trigger.

PubMed

Patel, Rajendrakumar M; Sarma, Rakesh; Grimsley, Edwin

2006-09-01

Sucralose (trichlorogalactosucrose, or better known as Splenda) is an artificial sweetener from native sucrose that was approved by the FDA on April 1, 1998 (April Fool's Day). This observation of a potential causal relationship between sucralose and migraines may be important for physicians to remember this can be a possible trigger during dietary history taking. Identifying further triggers for migraine headaches, in this case sucralose, may help alleviate some of the cost burden (through expensive medical therapy or missed work opportunity) as well as provide relief to migraineurs.

Iran’s Post-9/11 Grand Bargain: Missed Opportunity for Strategic Rapprochement Between Iran and the United States

DTIC Science & Technology

2013-05-23

relations , since the 1953 CIA orchestrated coup of Mohammad Mossadeq, is one of mutual distrust and policy error. Although successive American presidents...since 1979 have tried to improve relations , each effort failed because both sides refused to adjust the context through which they viewed the other...became less productive in early 2003, Iran proposed a grand bargain to settle differences and resume diplomatic relations . But President Bush chose to end