Erlotinib Hydrochloride and Isotretinoin in Treating Patients With Recurrent Malignant Glioma

ClinicalTrials.gov

2017-05-25

Adult Anaplastic Astrocytoma; Adult Anaplastic Oligodendroglioma; Adult Diffuse Astrocytoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Oligodendroglioma; Recurrent Adult Brain Tumor

A Phase I Study of Mebendazole for the Treatment of Pediatric Gliomas

ClinicalTrials.gov

2018-03-07

Pilomyxoid Astrocytoma; Pilocytic Astrocytoma; Glioma, Astrocytic; Optic Nerve Glioma; Pleomorphic Xanthoastrocytoma; Glioblastoma Multiforme; Anaplastic Astrocytoma; Gliosarcoma; Diffuse Intrinsic Pontine Glioma; DIPG; Low-grade Glioma; Brainstem Glioma

18F-FDOPA PET/CT or PET/MRI in Measuring Tumors in Patients With Newly-Diagnosed or Recurrent Gliomas

ClinicalTrials.gov

2017-01-30

Adult Anaplastic Ependymoma; Adult Anaplastic Oligodendroglioma; Adult Brain Stem Glioma; Adult Diffuse Astrocytoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Oligodendroglioma; Adult Pilocytic Astrocytoma; Adult Pineal Gland Astrocytoma; Adult Subependymal Giant Cell Astrocytoma; Childhood High-grade Cerebellar Astrocytoma; Childhood High-grade Cerebral Astrocytoma; Childhood Low-grade Cerebellar Astrocytoma; Childhood Low-grade Cerebral Astrocytoma; Recurrent Adult Brain Tumor; Recurrent Childhood Anaplastic Astrocytoma; Recurrent Childhood Anaplastic Oligoastrocytoma; Recurrent Childhood Anaplastic Oligodendroglioma; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Diffuse Astrocytoma; Recurrent Childhood Fibrillary Astrocytoma; Recurrent Childhood Gemistocytic Astrocytoma; Recurrent Childhood Giant Cell Glioblastoma; Recurrent Childhood Glioblastoma; Recurrent Childhood Gliomatosis Cerebri; Recurrent Childhood Gliosarcoma; Recurrent Childhood Oligoastrocytoma; Recurrent Childhood Oligodendroglioma; Recurrent Childhood Pilomyxoid Astrocytoma; Recurrent Childhood Protoplasmic Astrocytoma; Recurrent Childhood Subependymal Giant Cell Astrocytoma; Recurrent Childhood Visual Pathway and Hypothalamic Glioma; Recurrent Childhood Visual Pathway Glioma; Untreated Childhood Anaplastic Astrocytoma; Untreated Childhood Anaplastic Oligoastrocytoma; Untreated Childhood Anaplastic Oligodendroglioma; Untreated Childhood Brain Stem Glioma; Untreated Childhood Cerebellar Astrocytoma; Untreated Childhood Cerebral Astrocytoma; Untreated Childhood Diffuse Astrocytoma; Untreated Childhood Fibrillary Astrocytoma; Untreated Childhood Gemistocytic Astrocytoma; Untreated Childhood Giant Cell Glioblastoma; Untreated Childhood Glioblastoma; Untreated Childhood Gliomatosis Cerebri; Untreated Childhood Gliosarcoma; Untreated Childhood Oligoastrocytoma; Untreated Childhood Oligodendroglioma; Untreated Childhood Pilomyxoid Astrocytoma; Untreated Childhood Protoplasmic Astrocytoma; Untreated Childhood Subependymal Giant Cell Astrocytoma; Untreated Childhood Visual Pathway and Hypothalamic Glioma; Untreated Childhood Visual Pathway Glioma

Hematopoietic Stem Cell Therapy to Countermeasure Cancer in Astronauts during Exploration of Deep Space

NASA Technical Reports Server (NTRS)

Ohi, S.; Kindred, R. P.; Roach, A-N.; Edossa, A.; Kim, B. C.; Gonda, S. R.; Emami, K.

2004-01-01

Exposure to cosmic radiation can cause chromosomal mutations, which may lead to cancer in astronauts engaged in space exploration. Therefore, our goals are to develop countermeasures to prevent space-induced cancer using hematopoietic stem cell therapy (HSCT) and gene therapy. This presentation focuses on HSCT for cancer. Our previous experiments on a simulated, space-induced immuno-deficiency model (mouse hind limb unloading ) indicated that transplanted hematopoietic stem cells (HSCs) could enhance the host's immunity by effectively eliminating bacterial infection (Ohi S, et. al. J Grav Physiol 10, P63-64, 2003; Ohi S, et. al. Proceedings of the Space Technology and Applications International Forum (STAIF) . American Institute of Physics, New York, pp. 938-950, 2004). Hence, we hypothesized that the HSCs might be effective in combating cancer as well. Studies of cocultured mouse HSCs with beta-galactosidase marked rat gliosarcoma spheroids (9L/lacZ), a cancer model, indicated antagonistic interactions , resulting in destruction of the spheroids by HSCs. Trypan Blue dye-exclusion assays were consistent with the conclusion. These results show potential usehlness of HSCT for cancer. Currently, the NASA Hydrodynamic Focusing Bioreactor (HFB), a space analog tissue/cell culture system, is being used to study invasion of the gliosarcoma (GS) spheroids into mouse brain with or without co-cultured HSCs. This may simulate the metastasis of gliosarcoma to brain. There is a tendency for the HSCs to inhibit invasion of GS spheroids into brain, as evidenced by the X-gal staining.

Gefitinib and Radiation Therapy in Treating Children With Newly Diagnosed Gliomas

ClinicalTrials.gov

2014-05-15

Untreated Childhood Anaplastic Astrocytoma; Untreated Childhood Anaplastic Oligodendroglioma; Untreated Childhood Brain Stem Glioma; Untreated Childhood Giant Cell Glioblastoma; Untreated Childhood Glioblastoma; Untreated Childhood Gliomatosis Cerebri; Untreated Childhood Gliosarcoma; Untreated Childhood Oligodendroglioma

Lapatinib in Treating Young Patients With Recurrent or Refractory Central Nervous System Tumors

ClinicalTrials.gov

2014-05-07

Recurrent Childhood Anaplastic Astrocytoma; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Ependymoma; Recurrent Childhood Giant Cell Glioblastoma; Recurrent Childhood Glioblastoma; Recurrent Childhood Gliosarcoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Oligodendroglioma

Bafetinib in Treating Patients With Recurrent High-Grade Glioma or Brain Metastases

ClinicalTrials.gov

2018-04-12

Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Oligodendroglioma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Recurrent Adult Brain Tumor; Tumors Metastatic to Brain; Adult Anaplastic Oligoastrocytoma

Photodithazine photodynamic effect on viability of 9L/lacZ gliosarcoma cell line.

PubMed

Fontana, Leticia C; Pinto, Juliana G; Pereira, André H C; Soares, Cristina P; Raniero, Leandro J; Ferreira-Strixino, Juliana

2017-08-01

Even with the advances of conventional treatment techniques, the nervous system cancer prognosis is still not favorable to the patient which makes alternative therapies needed to be studied. Photodynamic therapy (PDT) is presented as a promising therapy, which employs a photosensitive (PS) agent, light wavelength suitable for the PS agent, and molecular oxygen, producing reactive oxygen species in order to induce cell death. The aim of this study is to observe the PDT action in gliosarcoma cell using a chlorin (Photodithazine, PDZ). The experiments were done with 9L/lacZ lineage cells, grown in a DMEM medium supplemented with 10% fetal bovine serum and 1% penicillin/streptomycin solution and put in a culture chamber at 37 °C with an atmosphere of 5% CO 2 . The PS agent used was the PDZ to an LED light source device (Biopdi/IRRAD-LED 660) in the 660-nm region. The location of the PS agent was analyzed by fluorescence microscopy, and cell viability was analyzed by MTT assay (mitochondrial activity), exclusion by trypan blue (cell viability), and morphological examination through an optical microscope (Leica MD 2500). In the analysis of the experiments with PDZ, there was 100% cell death at different concentrations and clear morphological differences in groups with and without treatment. Furthermore, it was observed that the photodithazine has been focused on all nuclear and cytoplasmic extension; however, it cannot be said for sure whether the location is in the inside core region or on the plasma membrane. In general, the PDZ showed a promising photosensitive agent in PDT for the use of gliosarcoma.

Erlotinib and Temsirolimus in Treating Patients With Recurrent Malignant Glioma

ClinicalTrials.gov

2015-05-29

Adult Anaplastic Astrocytoma; Adult Anaplastic Oligodendroglioma; Adult Diffuse Astrocytoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Pilocytic Astrocytoma; Adult Pineal Gland Astrocytoma; Adult Subependymal Giant Cell Astrocytoma; Recurrent Adult Brain Tumor

Oncolytic HSV-1716 in Treating Younger Patients With Refractory or Recurrent High Grade Glioma That Can Be Removed By Surgery

ClinicalTrials.gov

2016-05-26

Recurrent Childhood Anaplastic Astrocytoma; Recurrent Childhood Anaplastic Oligoastrocytoma; Recurrent Childhood Anaplastic Oligodendroglioma; Recurrent Childhood Giant Cell Glioblastoma; Recurrent Childhood Glioblastoma; Recurrent Childhood Gliomatosis Cerebri; Recurrent Childhood Gliosarcoma

Evaluation of Antitumor Activity of Long-Circulating and pH-Sensitive Liposomes Containing Ursolic Acid in Animal Models of Breast Tumor and Gliosarcoma.

PubMed

Rocha, Talita Guieiro Ribeiro; Lopes, Sávia Caldeira de Araújo; Cassali, Geovani Dantas; Ferreira, Ênio; Veloso, Emerson Soares; Leite, Elaine Amaral; Braga, Fernão Castro; Ferreira, Lucas Antônio Miranda; Balvay, Daniel; Garofalakis, Anikitos; Oliveira, Mônica Cristina; Tavitian, Bertrand

2016-12-01

Background Ursolic acid (UA) is a triterpene found in different plant species, possessing antitumor activity, which may be a result of its antiangiogenic effect. However, UA has low water solubility, which limits its use because the bioavailability is impaired. To overcome this inconvenience, we developed long-circulating and pH-sensitive liposomes containing ursolic acid (SpHL-UA). We investigated the antiangiogenic effect of free UA and SpHL-UA in murine brain cancer and human breast tumor models by means of determination of the relative tumor volume, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and histopathological analysis. Methods The animals were treated with dimethyl sulfoxide in 0.9% (w/v) NaCl, free UA, long-circulating and pH-sensitive liposomes without drug (SpHL), or SpHL-UA. The animals were submitted to each treatment by intraperitoneal injection for 5 days. The dose of free UA or SpHL-UA was equal to 23 mg/kg. Results Tumor growth inhibition was not observed in human breast tumor-bearing animals. For murine gliosarcoma-bearing animals, a slight tumor growth inhibition was observed in the groups treated with free UA or SpHL-UA (9% and 15%, respectively). No significant change in any of the parameters evaluated by DCE-MRI for both experimental models could be observed. Nevertheless, the evaluation of the mean values of magnetic resonance parameters of human breast tumor-bearing animals showed evidence of a possible antiangiogenic effect induced by SpHL-UA. Histopathological analysis did not present significant change for any treatment. Conclusion SpHL-UA did not show antiangiogenic activity in a gliosarcoma model and seemed to induce an antiangiogenic effect in the human breast tumor model. © The Author(s) 2016.

Evaluation of Antitumor Activity of Long-Circulating and pH-Sensitive Liposomes Containing Ursolic Acid in Animal Models of Breast Tumor and Gliosarcoma

PubMed Central

Rocha, Talita Guieiro Ribeiro; Lopes, Sávia Caldeira de Araújo; Cassali, Geovani Dantas; Ferreira, Ênio; Veloso, Emerson Soares; Leite, Elaine Amaral; Braga, Fernão Castro; Ferreira, Lucas Antônio Miranda; Balvay, Daniel; Garofalakis, Anikitos; Oliveira, Mônica Cristina; Tavitian, Bertrand

2016-01-01

Background. Ursolic acid (UA) is a triterpene found in different plant species, possessing antitumor activity, which may be a result of its antiangiogenic effect. However, UA has low water solubility, which limits its use because the bioavailability is impaired. To overcome this inconvenience, we developed long-circulating and pH-sensitive liposomes containing ursolic acid (SpHL-UA). We investigated the antiangiogenic effect of free UA and SpHL-UA in murine brain cancer and human breast tumor models by means of determination of the relative tumor volume, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and histopathological analysis. Methods. The animals were treated with dimethyl sulfoxide in 0.9% (w/v) NaCl, free UA, long-circulating and pH-sensitive liposomes without drug (SpHL), or SpHL-UA. The animals were submitted to each treatment by intraperitoneal injection for 5 days. The dose of free UA or SpHL-UA was equal to 23 mg/kg. Results. Tumor growth inhibition was not observed in human breast tumor–bearing animals. For murine gliosarcoma-bearing animals, a slight tumor growth inhibition was observed in the groups treated with free UA or SpHL-UA (9% and 15%, respectively). No significant change in any of the parameters evaluated by DCE-MRI for both experimental models could be observed. Nevertheless, the evaluation of the mean values of magnetic resonance parameters of human breast tumor–bearing animals showed evidence of a possible antiangiogenic effect induced by SpHL-UA. Histopathological analysis did not present significant change for any treatment. Conclusion. SpHL-UA did not show antiangiogenic activity in a gliosarcoma model and seemed to induce an antiangiogenic effect in the human breast tumor model. PMID:27130721

Alisertib and Fractionated Stereotactic Radiosurgery in Treating Patients With Recurrent High Grade Gliomas

ClinicalTrials.gov

2017-10-25

Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Oligodendroglioma; Adult Brain Stem Glioma; Adult Diffuse Astrocytoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Oligodendroglioma; Adult Pilocytic Astrocytoma; Adult Pineal Gland Astrocytoma; Adult Subependymal Giant Cell Astrocytoma; Recurrent Adult Brain Tumor

Use of EF5 to Measure the Oxygen Level in Tumor Cells of Patients Undergoing Surgery or Biopsy for Newly Diagnosed Supratentorial Malignant Glioma

ClinicalTrials.gov

2013-01-15

Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Oligodendroglioma; Adult Diffuse Astrocytoma; Adult Ependymoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Myxopapillary Ependymoma; Adult Oligodendroglioma; Adult Pilocytic Astrocytoma; Adult Pineal Gland Astrocytoma; Adult Subependymoma

Cixutumumab and Temsirolimus in Treating Younger Patients With Recurrent or Refractory Sarcoma

ClinicalTrials.gov

2018-03-21

Childhood Alveolar Soft Part Sarcoma; Childhood Angiosarcoma; Childhood Epithelioid Sarcoma; Childhood Fibrosarcoma; Childhood Gliosarcoma; Childhood Leiomyosarcoma; Childhood Liposarcoma; Childhood Malignant Peripheral Nerve Sheath Tumor; Childhood Synovial Sarcoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Osteosarcoma; Rhabdomyosarcoma

Gliosarcoma developing from an irradiated ependymoma.

PubMed

Kepes, J J; Bastian, F O; Weber, E D

1996-11-01

A 17-year-old girl was operated for a cystic mass located deep within the left parieto-occipital white matter. Histologically the tumor was an ependymoma with a vascular stroma. In spite of irradiation the tumor recurred locally twice, 1 and 2 years respectively after the original operation. The ependymoma portion of the tumor remained unchanged, but the stroma showed increased vascular hyperplasia at the time of the second operation and transformation into a fibrosarcoma in the third operative specimen. Proliferating cell markers (MIB-1) were positive only in the ependymoma cell nuclei in the first two specimens, but were also extensively present in the nuclei of the fibrosarcoma in the third specimen. In the latter, the fibrosarcoma portion greatly overwhelmed the residual ependymoma islands, but remained sharply delineated from them. This is the first observed case of a gliosarcoma originating from an ependymoma. The histological pattern of this mixed tumor clearly indicates that the source of the sarcomatous portions was the neoplastically transformed fibrovascular stroma of the original tumor, rather than "desmoplastic" alterations of the neoplastic ependymal cells themselves.

Reproducibility and relative stability in magnetic resonance imaging indices of tumor vascular physiology over a period of 24h in a rat 9L gliosarcoma model.

PubMed

Nagaraja, Tavarekere N; Elmghirbi, Rasha; Brown, Stephen L; Schultz, Lonni R; Lee, Ian Y; Keenan, Kelly A; Panda, Swayamprava; Cabral, Glauber; Mikkelsen, Tom; Ewing, James R

2017-12-01

The objective was to study temporal changes in tumor vascular physiological indices in a period of 24h in a 9L gliosarcoma rat model. Fischer-344 rats (N=14) were orthotopically implanted with 9L cells. At 2weeks post-implantation, they were imaged twice in a 24h interval using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). Data-driven model-selection-based analysis was used to segment tumor regions with varying vascular permeability characteristics. The region with the maximum number of estimable parameters of vascular kinetics was chosen for comparison across the two time points. It provided estimates of three parameters for an MR contrast agent (MRCA): i) plasma volume (v p ), ii) forward volumetric transfer constant (K trans ) and interstitial volume fraction (v e , ratio of K trans to reverse transfer constant, k ep ). In addition, MRCA extracellular distribution volume (V D ) was estimated in the tumor and its borders, along with tumor blood flow (TBF) and peritumoral MRCA flux. Descriptors of parametric distributions were compared between the two times. Tumor extent was examined by hematoxylin and eosin (H&E) staining. Picrosirus red staining of secreted collagen was performed as an additional index for 9L cells. Test-retest differences between population summaries for any parameter were not significant (paired t and Wilcoxon signed rank tests). Bland-Altman plots showed no apparent trends between the differences and averages of the test-retest measures for all indices. The intraclass correlation coefficients showed moderate to almost perfect reproducibility for all of the parameters, except v p . H&E staining showed tumor infiltration in parenchyma, perivascular space and white matter tracts. Collagen staining was observed along the outer edges of main tumor mass. The data suggest the relative stability of these MR indices of tumor microenvironment over a 24h duration in this gliosarcoma model. Copyright © 2017. Published by Elsevier Inc.

A Pilot Feasibility Study of Oral 5-Fluorocytosine and Genetically-Modified Neural Stem Cells Expressing E.Coli Cytosine Deaminase for Treatment of Recurrent High Grade Gliomas

ClinicalTrials.gov

2017-11-07

Adult Anaplastic Astrocytoma; Recurrent Grade III Glioma; Recurrent Grade IV Glioma; Adult Anaplastic Oligodendroglioma; Adult Brain Tumor; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Recurrent Adult Brain Tumor; Adult Anaplastic Oligoastrocytoma; Recurrent High Grade Glioma

Fluorine F 18 Fluorodopa-Labeled PET Scan in Planning Surgery and Radiation Therapy in Treating Patients With Newly Diagnosed High- or Low-Grade Malignant Glioma

ClinicalTrials.gov

2018-04-30

Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Oligodendroglioma; Adult Brain Stem Glioma; Adult Diffuse Astrocytoma; Adult Ependymoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Myxopapillary Ependymoma; Adult Oligodendroglioma; Adult Pilocytic Astrocytoma; Adult Pineal Gland Astrocytoma; Adult Subependymal Giant Cell Astrocytoma; Adult Subependymoma

Efficacy of 68Ga-DOTATOC Positron Emission Tomography (PET) CT in Children and Young Adults With Brain Tumors

ClinicalTrials.gov

2017-04-27

Acoustic Schwannoma; Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Meningioma; Adult Anaplastic Oligodendroglioma; Adult Brain Stem Glioma; Adult Choroid Plexus Tumor; Adult Craniopharyngioma; Adult Diffuse Astrocytoma; Adult Ependymoblastoma; Adult Ependymoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Grade I Meningioma; Adult Grade II Meningioma; Adult Medulloblastoma; Adult Meningeal Hemangiopericytoma; Adult Mixed Glioma; Adult Myxopapillary Ependymoma; Adult Oligodendroglioma; Adult Papillary Meningioma; Adult Pilocytic Astrocytoma; Adult Pineal Gland Astrocytoma; Adult Pineoblastoma; Adult Pineocytoma; Adult Subependymal Giant Cell Astrocytoma; Adult Subependymoma; Adult Supratentorial Primitive Neuroectodermal Tumor (PNET); Childhood Choroid Plexus Tumor; Childhood Craniopharyngioma; Childhood Ependymoblastoma; Childhood Grade I Meningioma; Childhood Grade II Meningioma; Childhood Grade III Meningioma; Childhood High-grade Cerebellar Astrocytoma; Childhood High-grade Cerebral Astrocytoma; Childhood Infratentorial Ependymoma; Childhood Low-grade Cerebellar Astrocytoma; Childhood Low-grade Cerebral Astrocytoma; Childhood Medulloepithelioma; Childhood Supratentorial Ependymoma; Meningeal Melanocytoma; Newly Diagnosed Childhood Ependymoma; Recurrent Adult Brain Tumor; Recurrent Childhood Anaplastic Astrocytoma; Recurrent Childhood Anaplastic Oligoastrocytoma; Recurrent Childhood Anaplastic Oligodendroglioma; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Diffuse Astrocytoma; Recurrent Childhood Ependymoma; Recurrent Childhood Fibrillary Astrocytoma; Recurrent Childhood Gemistocytic Astrocytoma; Recurrent Childhood Giant Cell Glioblastoma; Recurrent Childhood Glioblastoma; Recurrent Childhood Gliomatosis Cerebri; Recurrent Childhood Gliosarcoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Oligoastrocytoma; Recurrent Childhood Oligodendroglioma; Recurrent Childhood Pilocytic Astrocytoma; Recurrent Childhood Pilomyxoid Astrocytoma; Recurrent Childhood Pineoblastoma; Recurrent Childhood Pleomorphic Xanthoastrocytoma; Recurrent Childhood Protoplasmic Astrocytoma; Recurrent Childhood Subependymal Giant Cell Astrocytoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor; Recurrent Childhood Visual Pathway and Hypothalamic Glioma; Recurrent Childhood Visual Pathway Glioma; Untreated Childhood Anaplastic Astrocytoma; Untreated Childhood Anaplastic Oligodendroglioma; Untreated Childhood Brain Stem Glioma; Untreated Childhood Cerebellar Astrocytoma; Untreated Childhood Cerebral Astrocytoma; Untreated Childhood Diffuse Astrocytoma; Untreated Childhood Fibrillary Astrocytoma; Untreated Childhood Gemistocytic Astrocytoma; Untreated Childhood Giant Cell Glioblastoma; Untreated Childhood Glioblastoma; Untreated Childhood Gliomatosis Cerebri; Untreated Childhood Gliosarcoma; Untreated Childhood Medulloblastoma; Untreated Childhood Oligoastrocytoma; Untreated Childhood Oligodendroglioma; Untreated Childhood Pilocytic Astrocytoma; Untreated Childhood Pilomyxoid Astrocytoma; Untreated Childhood Pineoblastoma; Untreated Childhood Pleomorphic Xanthoastrocytoma; Untreated Childhood Protoplasmic Astrocytoma; Untreated Childhood Subependymal Giant Cell Astrocytoma; Untreated Childhood Supratentorial Primitive Neuroectodermal Tumor; Untreated Childhood Visual Pathway and Hypothalamic Glioma; Untreated Childhood Visual Pathway Glioma

Phase I Study of Cellular Immunotherapy for Recurrent/Refractory Malignant Glioma Using Intratumoral Infusions of GRm13Z40-2, An Allogeneic CD8+ Cytolitic T-Cell Line Genetically Modified to Express the IL 13-Zetakine and HyTK and to be Resistant to Glucocorticoids, in Combination With Interleukin-2

ClinicalTrials.gov

2015-06-03

Anaplastic Astrocytoma; Anaplastic Ependymoma; Anaplastic Meningioma; Anaplastic Oligodendroglioma; Brain Stem Glioma; Ependymoblastoma; Giant Cell Glioblastoma; Glioblastoma; Gliosarcoma; Grade III Meningioma; Meningeal Hemangiopericytoma; Mixed Glioma; Pineal Gland Astrocytoma; Brain Tumor

Yoga Therapy in Treating Patients With Malignant Brain Tumors

ClinicalTrials.gov

2017-07-27

Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Meningioma; Adult Anaplastic Oligodendroglioma; Adult Brain Stem Glioma; Adult Choroid Plexus Tumor; Adult Diffuse Astrocytoma; Adult Ependymoblastoma; Adult Ependymoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Grade II Meningioma; Adult Medulloblastoma; Adult Meningeal Hemangiopericytoma; Adult Mixed Glioma; Adult Oligodendroglioma; Adult Papillary Meningioma; Adult Pineal Gland Astrocytoma; Adult Pineoblastoma; Adult Pineocytoma; Adult Supratentorial Primitive Neuroectodermal Tumor (PNET); Recurrent Adult Brain Tumor

Quantification of Superparamagnetic Iron Oxide (SPIO)-labeled Cells Using MRI

PubMed Central

Rad, Ali M; Arbab, Ali S; Iskander, ASM; Jiang, Quan; Soltanian-Zadeh, Hamid

2015-01-01

Purpose To show the feasibility of using magnetic resonance imaging (MRI) to quantify superparamagnetic iron oxide (SPIO)-labeled cells. Materials and Methods Lymphocytes and 9L rat gliosarcoma cells were labeled with Ferumoxides-Protamine Sulfate complex (FE-PRO). Cells were labeled efficiently (more than 95%) and iron concentration inside each cell was measured by spectrophotometry (4.77-30.21 picograms). Phantom tubes containing different number of labeled or unlabeled cells as well as different concentrations of FE-PRO were made. In addition, labeled and unlabeled cells were injected into fresh and fixed rat brains. Results Cellular viability and proliferation of labeled and unlabeled cells were shown to be similar. T2-weighted images were acquired using 7 T and 3 T MRI systems and R2 maps of the tubes containing cells, free FE-PRO, and brains were made. There was a strong linear correlation between R2 values and labeled cell numbers but the regression lines were different for the lymphocytes and gliosarcoma cells. Similarly, there was strong correlation between R2 values and free iron. However, free iron had higher R2 values than the labeled cells for the same concentration of iron. Conclusion Our data indicated that in vivo quantification of labeled cells can be done by careful consideration of different factors and specific control groups. PMID:17623892

Irradiation of intracerebral 9L gliosarcoma by a single array of microplanar x-ray beams from a synchrotron: balance between curing and sparing

NASA Astrophysics Data System (ADS)

Regnard, Pierrick; LeDuc, Géraldine; Bräuer-Krisch, Elke; Troprès, Irène; Siegbahn, Erik Albert; Kusak, Audrey; Clair, Charlotte; Bernard, Hélène; Dallery, Dominique; Laissue, Jean A.; Bravin, Alberto

2008-02-01

The purpose of this work was the understanding of microbeam radiation therapy at the ESRF in order to find the best compromise between curing of tumors and sparing of normal tissues, to obtain a better understanding of survival curves and to report its efficiency. This method uses synchrotron-generated x-ray microbeams. Rats were implanted with 9L gliosarcomas and the tumors were diagnosed by MRI. They were irradiated 14 days after implantation by arrays of 25 µm wide microbeams in unidirectional mode, with a skin entrance dose of 625 Gy. The effect of using 200 or 100 µm center-to-center spacing between the microbeams was compared. The median survival time (post-implantation) was 40 and 67 days at 200 and 100 µm spacing, respectively. However, 72% of rats irradiated at 100 µm spacing showed abnormal clinical signs and weight patterns, whereas only 12% of rats were affected at 200 µm spacing. In parallel, histological lesions of the normal brain were found in the 100 µm series only. Although the increase in lifespan was equal to 273% and 102% for the 100 and 200 µm series, respectively, the 200 µm spacing protocol provides a better sparing of healthy tissue and may prove useful in combination with other radiation modalities or additional drugs.

Palbociclib Isethionate in Treating Younger Patients With Recurrent, Progressive, or Refractory Central Nervous System Tumors

ClinicalTrials.gov

2017-09-27

Childhood Choroid Plexus Tumor; Childhood Ependymoblastoma; Childhood Grade III Meningioma; Childhood High-grade Cerebellar Astrocytoma; Childhood High-grade Cerebral Astrocytoma; Childhood Medulloepithelioma; Recurrent Childhood Anaplastic Astrocytoma; Recurrent Childhood Anaplastic Oligoastrocytoma; Recurrent Childhood Anaplastic Oligodendroglioma; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Giant Cell Glioblastoma; Recurrent Childhood Glioblastoma; Recurrent Childhood Gliomatosis Cerebri; Recurrent Childhood Gliosarcoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Pineoblastoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor

18F FPPRGD2 PET/CT or PET/MRI in Predicting Early Response in Patients With Cancer Receiving Anti-Angiogenesis Therapy

ClinicalTrials.gov

2017-03-12

Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Male Breast Cancer; Metastatic Squamous Neck Cancer With Occult Primary Squamous Cell Carcinoma; Recurrent Adenoid Cystic Carcinoma of the Oral Cavity; Recurrent Adult Brain Tumor; Recurrent Basal Cell Carcinoma of the Lip; Recurrent Breast Cancer; Recurrent Colon Cancer; Recurrent Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Recurrent Hypopharyngeal Cancer; Recurrent Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Recurrent Laryngeal Cancer; Recurrent Lip and Oral Cavity Cancer; Recurrent Lymphoepithelioma of the Nasopharynx; Recurrent Lymphoepithelioma of the Oropharynx; Recurrent Metastatic Squamous Neck Cancer With Occult Primary; Recurrent Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Recurrent Mucoepidermoid Carcinoma of the Oral Cavity; Recurrent Nasopharyngeal Cancer; Recurrent Non-small Cell Lung Cancer; Recurrent Oropharyngeal Cancer; Recurrent Pancreatic Cancer; Recurrent Paranasal Sinus and Nasal Cavity Cancer; Recurrent Rectal Cancer; Recurrent Renal Cell Cancer; Recurrent Salivary Gland Cancer; Stage IIIA Breast Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Breast Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer; Stage IV Non-small Cell Lung Cancer; Stage IV Pancreatic Cancer; Stage IV Renal Cell Cancer; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVA Salivary Gland Cancer; Stage IVB Colon Cancer; Stage IVB Salivary Gland Cancer; Stage IVC Salivary Gland Cancer; Tongue Cancer; Unspecified Adult Solid Tumor, Protocol Specific

Efficacy of pyropheophorbide-a-hexyl ether for photodynamic therapy of rat 9L gliosarcoma

NASA Astrophysics Data System (ADS)

Autry-Conwell, Susan A.; Edwards, Benjamin F.; Boggan, James E.; Gandour-Edwards, Regina; Pandey, Ravindra K.; Dougherty, Thomas J.

1993-06-01

In preliminary studies, the efficacy of a new photosensitizer, pyropheophorbide-(alpha) - hexyl ether (HPPH #23), for use in photodynamic therapy (PDT) was assessed using the rat 9L gliosarcoma tumor model in subcutaneous flank tumors, intracranial tumors, and in vivo. Flank and intracranial tumors were irradiated with 75 - 203 J/cm2 24 hours after 0.3 - 0.6 mg/kg IV injection of HPPH #23. At 24 hours post-PDT, and flank tumors showed a range of necrosis at the highest laser dose from 50 - 100%. The overlying skin and underlying muscle were spared. Intracranial tumors exhibited moderate to severe hemorrhagic necrosis. Areas of brain adjacent to tumor within the irradiated field also showed some damage. In vitro phototoxicity of HPPH #23 was compared to that of Photofrin II (PhII). Cells growing in culture dishes were exposed to HPPH #23 or PhII for 20 hours, washed free of unbound drug, then irradiated at 2.5 J/cm2, 17 mW/cm2 at 665 nm (HPPH #23) or 630 nm (PhII). Irradiated cultures were maintained in dark incubators for an additional 4 - 5 days, and phototoxic inhibition of cell proliferation was quantified by the sulphorhodamine B spectrophotometric assay. Under identical irradiation conditions, the IC50 for HPPH #23 (0.25 (mu) g/ml) was 10-fold lower than that of PhII (2.5 (mu) g/ml). Complete cell kill was achieved at sensitizer doses of 0.5 (mu) g/ml (HPPH #23) and 5.0 (mu) g/ml (PhII).

Positron Emission Tomography Using Fluorine F 18 EF5 to Find Oxygen in Tumor Cells of Patients Who Are Undergoing Surgery or Biopsy for Newly Diagnosed Brain Tumors

ClinicalTrials.gov

2013-01-15

Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Oligodendroglioma; Adult Brain Stem Glioma; Adult Central Nervous System Germ Cell Tumor; Adult Choroid Plexus Tumor; Adult Craniopharyngioma; Adult Diffuse Astrocytoma; Adult Ependymoblastoma; Adult Ependymoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Grade I Meningioma; Adult Grade II Meningioma; Adult Grade III Meningioma; Adult Medulloblastoma; Adult Meningeal Hemangiopericytoma; Adult Mixed Glioma; Adult Myxopapillary Ependymoma; Adult Oligodendroglioma; Adult Pilocytic Astrocytoma; Adult Pineoblastoma; Adult Pineocytoma; Adult Subependymoma; Adult Supratentorial Primitive Neuroectodermal Tumor (PNET); Meningeal Melanocytoma

Adenovirus-mediated p53 gene delivery potentiates the radiation-induced growth inhibition of experimental brain tumors.

PubMed

Badie, B; Kramar, M H; Lau, R; Boothman, D A; Economou, J S; Black, K L

1998-05-01

Patients with malignant gliomas continue to have very poor prognosis even after surgical resection, radiation and chemotherapy. Because these tumors often have alterations in the p53 tumor suppressor gene, which plays a key role in the cellular response to DNA damaging agents, we investigated the role of p53 gene therapy in conjunction with ionizing radiation in a rat brain tumor model. Exposure of cultured rat 9L gliosarcoma cells, which contain a mutant p53 gene, to a recombinant adenovirus-vector bearing the wild-type p53 gene (Adp53), induced apoptosis within 24 hours. Although ionizing radiation had no additional effect on apoptosis within this time frame, it caused G1 arrest in non-apoptotic cells after Adp53 therapy. In contrast, wild-type 9L cells demonstrated little G1 arrest after X-irradiation. When animals bearing brain tumors were irradiated after intratumoral Adp53 injections, more than 85% reduction in tumor size was noted. Moreover, the group of rats receiving both radiation and Adp53 therapy had a significant increase in survival as compared to animals receiving either therapy alone. These results support the use of p53 gene therapy as an adjunct to radiation in treatment of malignant brain tumors.

Epithelial and Pseudoepithelial Differentiation in Glioblastoma and Gliosarcoma: A Comparative Morphologic and Molecular Genetic Study

PubMed Central

Scheithauer, Bernd W.; Giannini, Caterina; Bryant, Sandra C.; Jenkins, Robert B.

2008-01-01

Background Glioblastomas exhibit a remarkable tendency to morphologic diversity. Although rare, pseudoepithelial components (adenoid or epithelioid) or true epithelial differentiation may occur and poses a significant diagnostic challenge. Methods H&E slides were reviewed and immunohistochemistry and fluorescence in situ hybridization were performed. Results The patients included 38 males and 20 females. Median age at diagnosis was 57 years (IQR, 50 to 67), and median overall survival was 7 months (IQR, 4 to 11). “Adenoid” glioblastomas (A-GBM) predominated (48%). True epithelial glioblastomas (TE-GBM) were next most frequent based on morphology and immunohistochemistry (35%), followed by epithelioid glioblastomas (E-GBM) (17%). Overall 25 (43%) tumors featured a sarcomatous component. Molecular cytogenetic abnormalities identified by FISH in A-GBM, EGBM and TE-GBM respectively included p16 deletion/-9 (60%, 71%, 64%); chromosome 10 loss (40%, 63%, 57%), chromosome 7 gain without EGFR amplification (70%, 38%, 40%), EGFR amplification (10%, 50%, 27%), PTEN deletion (10%, 25%,29%), PDGFRA amplification (10%, 25%, 0%), and RB1 deletion/-13q (50%, 0%, 14%). Abnormalities identified by IHC included p21 immunonegativity (60%, 25%, 93%), that was most frequent in TE-GBM (p=0.008), strong diffuse p53 staining (29%, 29%, 41%), strong membranous staining for EGFR (21%, 63%, 19%) most frequent in E-GBM (p=0.03), and an increased frequency of p27 immunonegativity in gliosarcomas (15% negative, 85% focal) compared to tumors without sarcoma (38% strongly positive)(p=0.009). Conclusion Pseudoepithelial and true epithelial morphology are rare phenomena in GBM and may be associated with a similar poor prognosis. These tumors demonstrate proportions of molecular genetic abnormalities varying somewhat from conventional GBM. PMID:18816605

Erythropoietin Augments Survival of Glioma Cells After Radiation and Temozolomide

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

Hassouna, Imam; Sperling, Swetlana; Kim, Ella

2008-11-01

Purpose: Despite beneficial effects of irradiation/chemotherapy on survival of glioblastoma (GBM) patients, collateral damage to intact neural tissue leads to 'radiochemobrain' and reduced quality of life in survivors. For prophylactic neuroprotection, erythropoietin (EPO) is a promising candidate, provided that concerns regarding potential tumor promoting effects are alleviated. Methods and Materials: Human GBM-derived cell lines U87, G44, G112, and the gliosarcoma-derived line G28 were treated with EPO, with and without combinations of irradiation or temozolomide (TMZ). Responsiveness of glioma cells to EPO was measured by cell migration from spheroids, cell proliferation, and clonogenic survival. Implantation of U87 cells into brains ofmore » nude mice, followed 5 days later by EPO treatment (5,000 U/kg intraperitoneal every other day for 2 weeks) should reveal effects of EPO on tumor growth in vivo. Reverse transcriptase-polymerase chain reaction was performed for EPOR, HIF-1{alpha}, and epidermal growth factor receptor (EGFR)vIII in cell lines and 22 human GBM specimens. Results: EPO did not modulate basal glioma cell migration and stimulated proliferation in only one of four cell lines. Importantly, EPO did not enhance tumor growth in mouse brains. Preincubation of glioma cells with EPO for 3 h, followed by irradiation and TMZ for another 24 h, resulted in protection against chemoradiation-induced cytotoxicity in three cell lines. Conversely, EPO induced a dose-dependent decrease in survival of G28 gliosarcoma cells. In GBM specimens, expression of HIF-1{alpha} correlated positively with expression of EPOR and EGFRvIII. EPOR and EGFRvIII expression did not correlate. Conclusions: EPO is unlikely to appreciably influence basal glioma growth. However, concomitant use of EPO with irradiation/chemotherapy in GBM patients is not advisable.« less

Density-Dependent Regulation of Glioma Cell Proliferation and Invasion Mediated by miR-9.

PubMed

Katakowski, Mark; Charteris, Nicholas; Chopp, Michael; Khain, Evgeniy

2016-12-01

The phenotypic axis of invasion and proliferation in malignant glioma cells is a well-documented phenomenon. Invasive glioma cells exhibit a decreased proliferation rate and a resistance to apoptosis, and invasive tumor cells dispersed in brain subsequently revert to proliferation and contribute to secondary tumor formation. One miRNA can affect dozens of mRNAs, and some miRNAs are potent oncogenes. Multiple miRNAs are implicated in glioma malignancy, and several of which have been identified to regulate tumor cell motility and division. Using rat 9 L gliosarcoma and human U87 glioblastoma cell lines, we investigated miRNAs associated with the switch between glioma cell invasion and proliferation. Using micro-dissection of 9 L glioma tumor xenografts in rat brain, we identified disparate expression of miR-9 between cells within the periphery of the primary tumor, and those comprising tumor islets within the invasive zone. Modifying miR-9 expression in in vitro assays, we report that miR-9 controls the axis of glioma cell invasion/proliferation, and that its contribution to invasion or proliferation is biphasic and dependent upon local tumor cell density. In addition, immunohistochemistry revealed elevated hypoxia inducible factor 1 alpha (HIF-1α) in the invasive zone as compared to the primary tumor periphery. We also found that hypoxia promotes miR-9 expression in glioma cells. Based upon these findings, we propose a hypothesis for the contribution of miR-9 to the dynamics glioma invasion and satellite tumor formation in brain adjacent to tumor.

Penetration of intra-arterially administered vincristine in experimental brain tumor1,2

PubMed Central

Boyle, Frances M.; Eller, Susan L.; Grossman, Stuart A.

2004-01-01

Vincristine is an integral part of the “PCV” regimen that is commonly administered to treat primary brain tumors. The efficacy of vincristine as a single agent in these tumors has been poorly studied. This study was designed to determine whether vincristine enters normal rat brain or an intracranially or subcutaneously implanted glioma and to assess the presence of the efflux pump P-glycoprotein (P-gp) on tumor and vascular endothelial cells. The 9L rat gliosarcoma was implanted intracranially and subcutaneously in three Fischer 344 rats. On day 7, [3H]vincristine (50 μCi, 4.8 μg) was injected into the carotid artery, and the animals were euthanized 10 or 20 min later. Quantitative autoradiography revealed that vincristine levels in the liver were 6- to 11-fold greater than in the i.c. tumor, and 15- to 37-fold greater than in normal brain, the reverse of the expected pattern with intra-arterial delivery. Vincristine levels in the s.c. tumor were 2-fold higher than levels in the i.c. tumor. P-gp was detected with JSB1 antibody in vascular endothelium of both normal brain and the i.c. tumor, but not in the tumor cells in either location, or in endothelial cells in the s.c. tumor. These results demonstrate that vincristine has negligible penetration of normal rat brain or i.c. 9L glioma despite intra-arterial delivery and the presence of blood-brain barrier dysfunction as demonstrated by Evan’s blue. Furthermore, this study suggests that P-gp-mediated efflux from endothelium may explain these findings. The lack of penetration of vincristine into brain tumor and the paucity of single-agent activity studies suggest that vincristine should not be used in the treatment of primary brain tumors. PMID:15494097

Phase I/II study of sorafenib in combination with temsirolimus for recurrent glioblastoma or gliosarcoma: North American Brain Tumor Consortium study 05-02

PubMed Central

Lee, Eudocia Q.; Kuhn, John; Lamborn, Kathleen R.; Abrey, Lauren; DeAngelis, Lisa M.; Lieberman, Frank; Robins, H. Ian; Chang, Susan M.; Yung, W. K. Alfred; Drappatz, Jan; Mehta, Minesh P.; Levin, Victor A.; Aldape, Kenneth; Dancey, Janet E.; Wright, John J.; Prados, Michael D.; Cloughesy, Timothy F.; Gilbert, Mark R.; Wen, Patrick Y.

2012-01-01

The activity of single-agent targeted molecular therapies in glioblastoma has been limited to date. The North American Brain Tumor Consortium examined the safety, pharmacokinetics, and efficacy of combination therapy with sorafenib, a small molecule inhibitor of Raf, vascular endothelial growth factor receptor 2, and platelet-derived growth factor receptor–β, and temsirolimus (CCI-779), an inhibitor of mammalian target of rapamycin. This was a phase I/II study. The phase I component used a standard 3 × 3 dose escalation scheme to determine the safety and tolerability of this combination therapy. The phase II component used a 2-stage design; the primary endpoint was 6-month progression-free survival (PFS6) rate. Thirteen patients enrolled in the phase I component. The maximum tolerated dosage (MTD) for combination therapy was sorafenib 800 mg daily and temsirolimus 25 mg once weekly. At the MTD, grade 3 thrombocytopenia was the dose-limiting toxicity. Eighteen patients were treated in the phase II component. At interim analysis, the study was terminated and did not proceed to the second stage. No patients remained progression free at 6 months. Median PFS was 8 weeks. The toxicity of this combination therapy resulted in a maximum tolerated dose of temsirolimus that was only one-tenth of the single-agent dose. Minimal activity in recurrent glioblastoma multiforme was seen at the MTD of the 2 combined agents. PMID:23099651

Selective enhancement of radiation response of herpes simplex virus thymidine kinase transduced 9L gliosarcoma cells in vitro and in vivo by antiviral agents

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

Kim, Jae Ho; Kim, Sang Hie; Kolozsvary, A.

1995-11-01

The purpose of this investigation was to demonstrate in a well-characterized tumor model that the radiosensitivity of tumor cells transduced with a herpes simplex virus thymidine kinase gene (HS-tk) would be selectively enhanced by antiviral agents. Rat 9L gliosarcoma cells transduced with a retroviral vector containing an HS-tk gene, 9L-tk cells were exposed to various doses or irradiation under either in vitro or in vivo conditions. The radiation sensitizing potential of two antiviral drugs, bromovinyl deoxyuridine (BVdU) and dihydroxymethyl ethyl methyl guanine (acyclovir), was evaluated in vitro. The radiosensitizing ability of BVdU was also evaluated with a 9L-tk tumor growingmore » in the rat brain. Tumors growing in the right hemisphere of rat brains were irradiated stereotactically with single-dose irradiation. The radiation response of 9L-tk cells was selectively enhanced by antiviral agents relative to nontransduced cells. In the cell culture, when a 24-h drug exposure (20 {mu}g/ml) preceded radiation, the sensitizer enhancement ratio (SER) for BVdU and acyclovir was 1.4 {plus_minus} 0.1 and 1.3 {plus_minus} 0.1, respectively. Exposure of cells to 10 {mu}g/ml acyclovir for two 24-h periods both pre- and postirradiation resulted in a SER of 1.6 {plus_minus} 0.1. In vivo, a significant increase in median survival time of rats with 9L-tk tumors was found when BVdU was administered prior to single-dose irradiation relative to the survival time of similar rats receiving radiation alone. An antiviral agent can enhance cell killing by radiation with selective action in cells transduced with the herpes simplex virus thymidine kinase gene. The results suggest that the three-pronged therapy of HS-tk gene transduction, systemically administered antiviral drug, and stereotactically targeted radiation therapy will improve the effectiveness of radiation therapy for the treatment of radioresistant tumors. 25 refs., 6 figs.« less

Differential pharmacodynamic effects of paclitaxel formulations in an intracranial rat brain tumor model.

PubMed

Zhou, Rong; Mazurchuk, Richard V; Tamburlin, Judith H; Harrold, John M; Mager, Donald E; Straubinger, Robert M

2010-02-01

Nano- and microparticulate carriers can exert a beneficial impact on the pharmacodynamics of anticancer agents. To investigate the relationships between carrier and antitumor pharmacodynamics, paclitaxel incorporated in liposomes (L-pac) was compared with the clinical standard formulated in Cremophor-EL/ethanol (Cre-pac) in a rat model of advanced primary brain cancer. Three maximum-tolerated-dose regimens given by intravenous administration were investigated: 50 mg/kg on day 8 (d8) after implantation of 9L gliosarcoma tumors; 40 mg/kg on d8 and d15; 20 mg/kg on d8, d11, and d15. Body weight change and neutropenia were assessed as pharmacodynamic markers of toxicity. The pharmacodynamic markers of antitumor efficacy were increase in lifespan (ILS) and tumor volume progression, measured noninvasively by magnetic resonance imaging. At equivalent doses, neutropenia was similar for both formulations, but weight loss was more severe for Cre-pac. No regimen of Cre-pac extended survival, whereas L-pac at 40 mg/kg x2 doses was well tolerated and mediated 26% ILS (p < 0.0002) compared with controls. L-pac at a lower cumulative dose (20 mg/kg x3) was even more effective (40% ILS; p < 0.0001). In striking contrast, the identical regimen of Cre-pac was lethal. Development of a novel semimechanistic pharmacodynamic model permitted quantitative hypothesis testing with the tumor volume progression data, and suggested the existence of a transient treatment effect that was consistent with sensitization or "priming" of tumors by more frequent L-pac dosing schedules. Therefore, improved antitumor responses of carrier-based paclitaxel formulations can arise both from dose escalation, because of reduced toxicity, and from novel carrier-mediated alterations of antitumor pharmacodynamic effects.

Recursive partitioning analysis (RPA) classification predicts survival in patients with brain metastases from sarcoma.

PubMed

Grossman, Rachel; Ram, Zvi

2014-12-01

Sarcoma rarely metastasizes to the brain, and there are no specific treatment guidelines for these tumors. The recursive partitioning analysis (RPA) classification is a well-established prognostic scale used in many malignancies. In this study we assessed the clinical characteristics of metastatic sarcoma to the brain and the validity of the RPA classification system in a subset of 21 patients who underwent surgical resection of metastatic sarcoma to the brain We retrospectively analyzed the medical, radiological, surgical, pathological, and follow-up clinical records of 21 patients who were operated for metastatic sarcoma to the brain between 1996 and 2012. Gliosarcomas, sarcomas of the head and neck with local extension into the brain, and metastatic sarcomas to the spine were excluded from this reported series. The patients' mean age was 49.6 ± 14.2 years (range, 25-75 years) at the time of diagnosis. Sixteen patients had a known history of systemic sarcoma, mostly in the extremities, and had previously received systemic chemotherapy and radiation therapy for their primary tumor. The mean maximal tumor diameter in the brain was 4.9 ± 1.7 cm (range 1.7-7.2 cm). The group's median preoperative Karnofsky Performance Scale was 80, with 14 patients presenting with Karnofsky Performance Scale of 70 or greater. The median overall survival was 7 months (range 0.2-204 months). The median survival time stratified by the Radiation Therapy Oncology Group RPA classes were 31, 7, and 2 months for RPA class I, II, and III, respectively (P = 0.0001). This analysis is the first to support the prognostic utility of the Radiation Therapy Oncology Group RPA classification for sarcoma brain metastases and may be used as a treatment guideline tool in this rare disease. Copyright © 2014 Elsevier Inc. All rights reserved.

Design and Implementation of A Backend Multiple-Processor Relational Data Base Computer System.

DTIC Science & Technology

1981-12-01

propogated to other parts of the data base. 18 Cost. As mentioned earlier, a primary motivation for the backend DBMS work is the development of an...uniquely identify the n- tuples of the relation is called the primary key. For example, in Figure 3, the primary key is NUMBER. A primary key is said to...identifying the tuple. For example, in Figure 3, (NUMBER,TITLE) would not be a nonredundant primary key for COURSE. A relation can contain more than one

25 CFR 556.5 - Tribal eligibility determination.

Code of Federal Regulations, 2013 CFR

2013-04-01

... INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS BACKGROUND INVESTIGATIONS FOR PRIMARY MANAGEMENT OFFICIALS AND KEY EMPLOYEES § 556.5 Tribal eligibility determination. A tribe shall conduct an... of a key employee or primary management official for granting of a gaming license, an authorized...

Laboratory Directed Research and Development Program: Annual report to the Department of Energy

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

Ogeka, G.J.; Romano, A.J.

1994-12-01

Project program summaries are presented for: effect of bacterial spore protein on mutagenesis; cellular toxicity of coaine and cocaethylene; calcinfication in marine alga (global carbon cycling); advanced permanent magnet materials; a high flux neutron source; genetics of drug addiction; microdialysis; analysis of powder diffraction data; accelerator technology; nucleic acids and proteins and their interactions, by small-angle XRD; enhancement of microplanar beam radiation therapy of gliosarcoma; relaxographic and functional MRI; low-temperature infrared laser absorption spectroscopy; photodesorption of H{sub 2}; helical magnet for RHIC; novel microporous solids; chemistry and physics of stratospheric aerosols (ozone depletion); rf source for linear colliders; resonance Ramanmore » detection of VOCs; synthesis of plant fatty acids with unusual double bond positions; outer surface proteins of the Lyme disease spirochete; multiwire proportional chambers for collider muons; self-organized criticality; PCR-SSCP detection of genetic changes at single cell level; proton facility for cancer therapy; and visible free-electron laser experiment.« less

25 CFR 558.3 - Procedures for forwarding applications and reports for key employees and primary management...

Code of Federal Regulations, 2010 CFR

2010-04-01

... INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GAMING LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY... at a gaming operation, a tribe shall: (1) Forward to the Commission a completed application for...

Erlotinib in Treating Patients With Solid Tumors and Liver or Kidney Dysfunction

ClinicalTrials.gov

2013-01-15

Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Oligodendroglioma; Adult Brain Stem Glioma; Adult Diffuse Astrocytoma; Adult Ependymoblastoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Myxopapillary Ependymoma; Adult Oligodendroglioma; Adult Pilocytic Astrocytoma; Adult Primary Hepatocellular Carcinoma; Adult Subependymoma; Advanced Adult Primary Liver Cancer; Advanced Malignant Mesothelioma; Male Breast Cancer; Recurrent Adenoid Cystic Carcinoma of the Oral Cavity; Recurrent Adult Brain Tumor; Recurrent Adult Primary Liver Cancer; Recurrent Anal Cancer; Recurrent Basal Cell Carcinoma of the Lip; Recurrent Bladder Cancer; Recurrent Breast Cancer; Recurrent Cervical Cancer; Recurrent Colon Cancer; Recurrent Esophageal Cancer; Recurrent Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Recurrent Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Recurrent Lymphoepithelioma of the Nasopharynx; Recurrent Lymphoepithelioma of the Oropharynx; Recurrent Malignant Mesothelioma; Recurrent Metastatic Squamous Neck Cancer With Occult Primary; Recurrent Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Recurrent Mucoepidermoid Carcinoma of the Oral Cavity; Recurrent Non-small Cell Lung Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Pancreatic Cancer; Recurrent Prostate Cancer; Recurrent Rectal Cancer; Recurrent Salivary Gland Cancer; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Stage II Esophageal Cancer; Stage II Pancreatic Cancer; Stage III Esophageal Cancer; Stage III Pancreatic Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IV Adenoid Cystic Carcinoma of the Oral Cavity; Stage IV Anal Cancer; Stage IV Basal Cell Carcinoma of the Lip; Stage IV Bladder Cancer; Stage IV Breast Cancer; Stage IV Colon Cancer; Stage IV Esophageal Cancer; Stage IV Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage IV Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage IV Lymphoepithelioma of the Nasopharynx; Stage IV Lymphoepithelioma of the Oropharynx; Stage IV Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage IV Mucoepidermoid Carcinoma of the Oral Cavity; Stage IV Non-small Cell Lung Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Pancreatic Cancer; Stage IV Prostate Cancer; Stage IV Rectal Cancer; Stage IV Salivary Gland Cancer; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx; Stage IV Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IV Verrucous Carcinoma of the Larynx; Stage IV Verrucous Carcinoma of the Oral Cavity; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer; Unspecified Adult Solid Tumor, Protocol Specific; Untreated Metastatic Squamous Neck Cancer With Occult Primary

Developing "Algebraic Thinking": Two Key Ways to Establish Some Early Algebraic Ideas in Primary Classrooms

ERIC Educational Resources Information Center

Ormond, Christine

2012-01-01

Primary teachers play a key role in their students' future mathematical success in the early secondary years. While the word "algebra" may make some primary teachers feel uncomfortable or worried, the basic arithmetic ideas underlying algebra are vitally important for older primary students as they are increasingly required to use "algebraic…

Immunomodulation of glioma cells after gene therapy: induction of major histocompatibility complex class I but not class II antigen in vitro.

PubMed

Parsa, A T; Chi, J H; Hurley, P T; Jeyapalan, S A; Bruce, J N

2001-09-01

Acquired immunity has been demonstrated in Fischer rats bearing syngeneic 9L tumors after herpes simplex virus (HSV) thymidine kinase (TK) gene transfection and ganciclovir treatment. The nature of this immunity in rats and its relevance to the HSV TK/ganciclovir protocol for human subjects remain to be determined. In this study, levels of major histocompatibility complex (MHC) Class I and II antigen expression were measured before and after HSV TK transfection, in an effort to document immunomodulatory changes caused by gene therapy. Tumor cells from the 9L gliosarcoma cell line, three primary human glioma cultures, and the human glioma cell line U87 MG were transduced with HSV TK vector-containing supernatant from fibroblast-producing cells (titer of 5 x 10(6) colony-forming units/ml) and selected in G418 medium for neomycin resistance. Clones were pooled or individually selected for cell-killing assays with ganciclovir, to confirm TK expression (10(3) cells/well in a 96-well dish). Northern analyses using MHC Class I and Class II complementary deoxyribonucleic acid probes were performed on blots containing total ribonucleic acid from wild-type tumor cells and HSV TK transfectants. A beta-actin complementary deoxyribonucleic acid probe served as an internal control. Cell surface expression was confirmed with flow cytometry. The induction of MHC Class I was tested for cycloheximide and genistein sensitivity. All cell cultures exhibited increases in MHC Class I but not MHC Class II expression, as determined by Northern analysis densitometry and flow cytometry. Cycloheximide treatment did not diminish the up-regulation of MHC Class I after retroviral transfection, implicating a signal transduction pathway that does not require ongoing protein synthesis. Genistein pretreatment of cell cultures did diminish the up-regulation of MHC Class I, implicating a tyrosine kinase in the signaling cascade. Induction of MHC Class I in rat and human glioma cells after HSV TK retroviral gene therapy is a primary effect that is dependent on tyrosine kinase activity. Specific immune responses generated after transfection may represent an important general side effect of gene therapy protocols. Elucidation of the mechanism of immunomodulation after gene therapy will likely yield safer and more effective clinical protocols.

An update on the clinical trial of BNCT at the BMRR

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

Ma, R.; Capala, J.; Chanana, A.D.

1999-09-01

Boron neutron capture therapy (BNCT) was proposed more than six decades ago. It is a binary treatment modality that requires selective delivery of a {sup 10}B-labeled compound to a tumor and slow neutron irradiation of the tumor-bearing tissues. In order to improve the penetration of the neutron beam, an epithermal neutron beam was developed at the Brookhaven Medical Research Reactor (BMRR). This epithermal neutron beam can deliver relatively high thermal neutron fluence at depth without severe skin damage. Boronophenylalanine-fructose (BPA-F), a nontoxic boron carrier, was found to preferentially accumulate in tumor cells following intravenous infusion in patients with GBM. Inmore » preclinical BNCT studies in rats bearing 9L gliosarcoma, BPA-mediated BNCT was shown to be more efficacious than photon irradiation. In 1994, improvements in the neutron beam and in the understanding of the radiobiology of BPA-mediated BNCT led to the initiation of BNCT trials for human GBM at BMRR using BPA-F and epithermal neutrons. The primary objective of the phase I/II clinical trial of BPA-mediated BNCT at BMRR is to evaluate the safety of the BPA-F-mediated BNCT using epithermal neutrons in patients with GBM at a series of escalating BNCT doses. An incidental objective is to evaluate the therapeutic effectiveness of BNCT at each dose level. For each dose escalation group, the average brain dose (ABD) is escalated, as well as the minimum tumor dose. In summary, the BNCT procedure employed in the phase I/II clinical trial of BPA-F-mediated BNCT for GBM at BNL was found to be safe in all patients. The palliation afforded by a single session of BNCT compares favorably with palliation provided by fractionated photon therapy and adjuvant chemotherapy. If no evidence of radiation-induced brain toxicity is found in the current protocol, BNCT radiation dose will be further escalated.« less

Microbeam radiation therapy

NASA Astrophysics Data System (ADS)

Laissue, Jean A.; Lyubimova, Nadia; Wagner, Hans-Peter; Archer, David W.; Slatkin, Daniel N.; Di Michiel, Marco; Nemoz, Christian; Renier, Michel; Brauer, Elke; Spanne, Per O.; Gebbers, Jan-Olef; Dixon, Keith; Blattmann, Hans

1999-10-01

The central nervous system of vertebrates, even when immature, displays extraordinary resistance to damage by microscopically narrow, multiple, parallel, planar beams of x rays. Imminently lethal gliosarcomas in the brains of mature rats can be inhibited and ablated by such microbeams with little or no harm to mature brain tissues and neurological function. Potentially palliative, conventional wide-beam radiotherapy of malignant brain tumors in human infants under three years of age is so fraught with the danger of disrupting the functional maturation of immature brain tissues around the targeted tumor that it is implemented infrequently. Other kinds of therapy for such tumors are often inadequate. We suggest that microbeam radiation therapy (MRT) might help to alleviate the situation. Wiggler-generated synchrotron x-rays were first used for experimental microplanar beam (microbeam) radiation therapy (MRT) at Brookhaven National Laboratory's National Synchrotron Light Source in the early 1990s. We now describe the progress achieved in MRT research to date using immature and adult rats irradiated at the European Synchrotron Radiation Facility in Grenoble, France, and investigated thereafter at the Institute of Pathology of the University of Bern.

The Value Added National Project. Technical Report: Primary 4. Value-Added Key Stage 1 to Key Stage 2.

ERIC Educational Resources Information Center

Tymms, Peter

This is the fourth in a series of technical reports that have dealt with issues surrounding the possibility of national value-added systems for primary schools in England. The main focus has been on the relative progress made by students between the ends of Key Stage 1 (KS1) and Key Stage 2 (KS2). The analysis has indicated that the strength of…

25 CFR 558.5 - License suspension.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GAMING LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS § 558.5 License suspension. (a) If, after the issuance of a gaming license, the...

Key Performance Indicators for Primary Schools.

ERIC Educational Resources Information Center

Strand, Steve

Focusing mostly on their application for primary schools, this document describes the educational key performance indicators (KPI) employed by the Wendsworth, England, Local Educational Authority (LEA). Indicators are divided into 3 areas, educational context, resource development, and outcomes. Contextual indicators include pupil mobility, home…

Secondary reinforcement and number of primary reinforcements1

PubMed Central

Fantino, Edmund; Herrnstein, R. J.

1968-01-01

Pigeons' pecks on either of two concurrently available response keys produced secondary reinforcers according to independent one-minute variable-interval schedules. Different secondary reinforcers, in the presence of which the rates of primary reinforcement were equal, were associated with each key. The rate of pecking maintained by each secondary reinforcer varied directly, but nonproportionally, with the number of primary reinforcements given in the presence of the secondary reinforcer. PMID:5636860

25 CFR 558.1 - Scope of this part.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GAMING LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY... entity other than a tribe: (a) The licensing authority for class II or class III gaming is a tribal...

25 CFR 558.4 - Granting a gaming license.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Granting a gaming license. 558.4 Section 558.4 Indians NATIONAL INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GAMING LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY...

Climate Change? A Comparison of Language and Literacy Practices Relating to the Teaching of Science across the Key Stage 2/3 Interface in Two School Clusters

ERIC Educational Resources Information Center

McCullagh, John; Jarman, Ruth

2009-01-01

This paper reports the findings of a study of the literacy perceptions and practices of general primary teachers (Key Stage 2) and post-primary science teachers (Key Stage 3) within two clusters of schools. The study also explores the possible impact on pupils of any difference in the language climate which may accompany them on their journey…

25 CFR 558.2 - Eligibility determination for granting a gaming license.

Code of Federal Regulations, 2011 CFR

2011-04-01

... LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS § 558.2 Eligibility determination for granting a... record, if any, and reputation, habits and associations to make a finding concerning the eligibility of a...

25 CFR 558.2 - Eligibility determination for granting a gaming license.

Code of Federal Regulations, 2012 CFR

2012-04-01

... LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS § 558.2 Eligibility determination for granting a... record, if any, and reputation, habits and associations to make a finding concerning the eligibility of a...

25 CFR 522.2 - Submission requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... shall submit to the Chairman all of the following information with a request for approval of a class II... background investigations on key employees and primary management officials and to ensure that key employees and primary management officials are notified of their rights under the Privacy Act as specified in...

Polycystic ovary syndrome: perceptions and attitudes of women and primary health care physicians on features of PCOS and renaming the syndrome.

PubMed

Teede, Helena; Gibson-Helm, Melanie; Norman, Robert J; Boyle, Jacqueline

2014-01-01

Polycystic ovary syndrome (PCOS) is an under-recognized, common, and complex endocrinopathy. The name PCOS is a misnomer, and there have been calls for a change to reflect the broader clinical syndrome. The aim of the study was to determine perceptions held by women and primary health care physicians around key clinical features of PCOS and attitudes toward current and alternative names for the syndrome. We conducted a cross-sectional study utilizing a devised questionnaire. Participants were recruited throughout Australia via professional associations, women's health organizations, and a PCOS support group. Fifty-seven women with PCOS and 105 primary care physicians participated in the study. Perceptions of key clinical PCOS features and attitudes toward current and alternative syndrome names were investigated. Irregular periods were identified as a key clinical feature of PCOS by 86% of the women with PCOS and 90% of the primary care physicians. In both groups, 60% also identified hormone imbalance as a key feature. Among women with PCOS, 47% incorrectly identified ovarian cysts as key, 48% felt the current name is confusing, and 51% supported a change. Most primary care physicians agreed that the name is confusing (74%) and needs changing (81%); however, opinions on specific alternative names were divided. The name "polycystic ovary syndrome" is perceived as confusing, and there is general support for a change to reflect the broader clinical syndrome. Engagement of primary health care physicians and consumers is strongly recommended to ensure that an alternative name enhances understanding and recognition of the syndrome and its complex features.

78 FR 49728 - Availability of Seats for National Marine Sanctuary Advisory Councils

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-15

... (primary member); Research and Monitoring (alternate); Tourism--Lower Keys (primary member); and Tourism... member); Citizen-at-Large (alternate); Conservation (primary member); Conservation (alternate); Tourism (primary member); Tourism (alternate); L[amacr]na`i Island (primary member); L[amacr]na`i Island (alternate...

Morphologies of Primary Silicon in Hypereutectic Al-Si Alloys: Phase-Field Simulation Supported by Key Experiments

NASA Astrophysics Data System (ADS)

Wang, Kai; Wei, Ming; Zhang, Lijun; Du, Yong

2016-04-01

We realized a three-dimensional visualization of the morphology evolution and the growth behavior of the octahedral primary silicon in hypereutectic Al-20wtpctSi alloy during solidification in a real length scale by utilizing the phase-field simulation coupled with CALPHAD databases, and supported by key experiments. Moreover, through two-dimensional cut of the octahedral primary silicon at random angles, different morphologies observed in experiments, including triangle, square, trapezoid, rhombic, pentagon, and hexagon, were well reproduced.

Teaching Competences Necessary for Developing Key Competences of Primary Education Students in Spain: Teacher Assessments

ERIC Educational Resources Information Center

De-Juanas Oliva, Ángel; Martín del Pozo, Rosa; Pesquero Franco, Encarnación

2016-01-01

In Spain the syllabus of primary education students and their future teachers is broken down by competences. As teacher educators we were interested in finding out "which teaching competences teachers consider are most necessary to facilitate learning of student key competences." Therefore, we conducted a study with a sample of 286…

The Mars Telecommunications Orbiter a key asset in the Mars Network

NASA Technical Reports Server (NTRS)

Abilleira, Fernando

2006-01-01

The Mars Telecommunications Orbiter (MTO) to be launched in 2009 will play a key role in the Mars Network since it will be the first interplanetary mission whose primary objective is to provide communications to existing and upcoming Mars missions, This paper presents a basic description of the primary mission an provides trajectory information for the Mars Telecommunication Orbiter.

Gamma-Secretase Inhibitor RO4929097 and Cediranib Maleate in Treating Patients With Advanced Solid Tumors

ClinicalTrials.gov

2014-12-22

Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Oligodendroglioma; Adult Brain Stem Glioma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Solid Neoplasm; Male Breast Carcinoma; Recurrent Adult Brain Neoplasm; Recurrent Breast Carcinoma; Recurrent Colon Carcinoma; Recurrent Melanoma; Recurrent Non-Small Cell Lung Carcinoma; Recurrent Ovarian Carcinoma; Recurrent Ovarian Germ Cell Tumor; Recurrent Pancreatic Carcinoma; Recurrent Rectal Carcinoma; Recurrent Renal Cell Carcinoma; Stage III Pancreatic Cancer; Stage III Renal Cell Cancer; Stage IIIA Colon Cancer; Stage IIIA Non-Small Cell Lung Cancer; Stage IIIA Ovarian Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIA Rectal Cancer; Stage IIIA Skin Melanoma; Stage IIIB Breast Cancer; Stage IIIB Colon Cancer; Stage IIIB Non-Small Cell Lung Cancer; Stage IIIB Ovarian Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIB Rectal Cancer; Stage IIIB Skin Melanoma; Stage IIIC Breast Cancer; Stage IIIC Colon Cancer; Stage IIIC Ovarian Cancer; Stage IIIC Ovarian Germ Cell Tumor; Stage IIIC Rectal Cancer; Stage IIIC Skin Melanoma; Stage IV Breast Cancer; Stage IV Non-Small Cell Lung Cancer; Stage IV Ovarian Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Pancreatic Cancer; Stage IV Renal Cell Cancer; Stage IV Skin Melanoma; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer

Unusual sugar specificity of banana lectin from Musa paradisiaca and its probable evolutionary origin. Crystallographic and modelling studies.

PubMed

Singh, D D; Saikrishnan, K; Kumar, Prashant; Surolia, A; Sekar, K; Vijayan, M

2005-10-01

The crystal structure of a complex of methyl-alpha-D-mannoside with banana lectin from Musa paradisiaca reveals two primary binding sites in the lectin, unlike in other lectins with beta-prism I fold which essentially consists of three Greek key motifs. It has been suggested that the fold evolved through successive gene duplication and fusion of an ancestral Greek key motif. In other lectins, all from dicots, the primary binding site exists on one of the three motifs in the three-fold symmetric molecule. Banana is a monocot, and the three motifs have not diverged enough to obliterate sequence similarity among them. Two Greek key motifs in it carry one primary binding site each. A common secondary binding site exists on the third Greek key. Modelling shows that both the primary sites can support 1-2, 1-3, and 1-6 linked mannosides with the second residue interacting in each case primarily with the secondary binding site. Modelling also readily leads to a bound branched mannopentose with the nonreducing ends of the two branches anchored at the two primary binding sites, providing a structural explanation for the lectin's specificity for branched alpha-mannans. A comparison of the dimeric banana lectin with other beta-prism I fold lectins, provides interesting insights into the variability in their quaternary structure.

NASA Electronic Library System (NELS) database schema, version 1.2

NASA Technical Reports Server (NTRS)

Melebeck, Clovis J.

1991-01-01

The database tables used by NELS version 1.2 are discussed. To provide the current functional capability offered by NELS, nineteen tables were created with ORACLE. Each table lists the ORACLE table name and provides a brief description of the tables intended use or function. The following sections cover four basic categories of tables: NELS object classes, NELS collections, NELS objects, and NELS supplemental tables. Also included in each section is a definition and/or relationship of each field to other fields or tables. The primary key(s) for each table is indicated with a single asterisk (*), while foreign keys are indicated with double asterisks (**). The primary key(s) indicate the key(s) which uniquely identifies a record for that table. The foreign key(s) is used to identify additional information in other table(s) for that record. The two appendices are the command which is used to construct the ORACLE tables for NELS. Appendix A contains the commands which create the tables which are defined in the following sections. Appendix B contains the commands which build the indices for these tables.

Towards an international taxonomy of integrated primary care: a Delphi consensus approach.

PubMed

Valentijn, Pim P; Vrijhoef, Hubertus J M; Ruwaard, Dirk; Boesveld, Inge; Arends, Rosa Y; Bruijnzeels, Marc A

2015-05-22

Developing integrated service models in a primary care setting is considered an essential strategy for establishing a sustainable and affordable health care system. The Rainbow Model of Integrated Care (RMIC) describes the theoretical foundations of integrated primary care. The aim of this study is to refine the RMIC by developing a consensus-based taxonomy of key features. First, the appropriateness of previously identified key features was retested by conducting an international Delphi study that was built on the results of a previous national Delphi study. Second, categorisation of the features among the RMIC integrated care domains was assessed in a second international Delphi study. Finally, a taxonomy was constructed by the researchers based on the results of the three Delphi studies. The final taxonomy consists of 21 key features distributed over eight integration domains which are organised into three main categories: scope (person-focused vs. population-based), type (clinical, professional, organisational and system) and enablers (functional vs. normative) of an integrated primary care service model. The taxonomy provides a crucial differentiation that clarifies and supports implementation, policy formulation and research regarding the organisation of integrated primary care. Further research is needed to develop instruments based on the taxonomy that can reveal the realm of integrated primary care in practice.

The roles and training of primary care doctors: China, India, Brazil and South Africa.

PubMed

Mash, Robert; Almeida, Magda; Wong, William C W; Kumar, Raman; von Pressentin, Klaus B

2015-12-04

China, India, Brazil and South Africa contain 40% of the global population and are key emerging economies. All these countries have a policy commitment to universal health coverage with an emphasis on primary health care. The primary care doctor is a key part of the health workforce, and this article, which is based on two workshops at the 2014 Towards Unity For Health Conference in Fortaleza, Brazil, compares and reflects on the roles and training of primary care doctors in these four countries. Key themes to emerge were the need for the primary care doctor to function in support of a primary care team that provides community-orientated and first-contact care. This necessitates task-shifting and an openness to adapt one's role in line with the needs of the team and community. Beyond clinical competence, the primary care doctor may need to be a change agent, critical thinker, capability builder, collaborator and community advocate. Postgraduate training is important as well as up-skilling the existing workforce. There is a tension between training doctors to be community-orientated versus filling the procedural skills gaps at the facility level. In training, there is a need to plan postgraduate education at scale and reform the system to provide suitable incentives for doctors to choose this as a career path. Exposure should start at the undergraduate level. Learning outcomes should be socially accountable to the needs of the country and local communities, and graduates should be person-centred comprehensive generalists.

Improving pathways to primary health care among LGBTQ populations and health care providers: key findings from Nova Scotia, Canada.

PubMed

Gahagan, Jacqueline; Subirana-Malaret, Montse

2018-06-13

This study explores the perceived barriers to primary health care as identified among a sample of Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) identified individuals and health care providers in Nova Scotia, Canada. These findings, based on a province-wide anonymous online survey, suggest that additional efforts are needed to improve pathways to primary health among LGBTQ populations and in deepening our understanding of how to advance the unique primary health needs of these populations. Data were collected from the LGBTQ community through an online, closed-ended anonymous survey. Inclusion criteria for participation were self-identifying as LGBTQ, offering primary health care to LGBTQ patients, being able to understand English, being 16 years of age or older, and having lived in Nova Scotia for at least one year. A total of 283 LGBTQ respondents completed the online survey which included sociodemographic questions, perceptions of respondents' health status, and their primary health care experiences. In addition, a total of 109 health care providers completed the survey based on their experiences providing care in Nova Scotia, and in particular, their experiences and perceptions regarding LGBTQ access to primary health care and physician-patient interactions. Our results indicate that, in several key areas, the primary health care needs of LGBTQ populations in Nova Scotia are not being met and this may in turn contribute to their poor health outcomes across the life course. A framework of intersectionality and health equity was used to interpret and analyze the survey data. The key findings indicate the need to continue improving pathways to primary health care among LGBTQ populations, specifically in relation to additional training and related supports for health care providers who work with these populations.

The role of mental health in primary prevention of sexual and gender-based violence.

PubMed

Gevers, Aník; Dartnall, Elizabeth

2014-01-01

In this short communication, we assert that mental health has a crucial role in the primary prevention of sexual and gender-based violence (SGBV). However, we found that most research and practice to date has focused on the role of mental health post-violence, and SGBV primary prevention is relying on public health models that do not explicitly include mental health. Yet, key concepts, processes, and competencies in the mental health field appear essential to successful SGBV primary prevention. For example, empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial. Furthermore, competencies such as rapport building, group processing, emotional nurturing, modelling, and the prevention of vicarious trauma among staff are important for the successful implementation of SGBV primary prevention programmes. SGBV primary prevention work would benefit from increased collaboration with mental health professionals and integration of key mental health concepts, processes, and skills in SGBV research.

An Acquisition Guide for Executives

EPA Pesticide Factsheets

This guide covers the following subjects; What is Acquisition?, Purpose and Primary Functions of the Agency’s Acquisition System, Key Organizations in Acquisitions, Legal Framework, Key Players in Acquisitions, Acquisition Process, Acquisition Thresholds

Key Royale bridge five year evaluation.

DOT National Transportation Integrated Search

2013-06-01

This report describes the design, construction, instrumentation, and five-year evaluation of the Key Royale Bridge substructure. The primary focus was the evaluation of the implementation of highly reactive supplementary cementitious materials (SCM) ...

Key Principles of Superfund Remedy Selection

EPA Pesticide Factsheets

Guidance on the primary considerations of remedy selection which are universally applicable at Superfund sites. Key guidance here include: Rules of Thumb for Superfund Remedy Selection and Role of the Baseline Risk Assessment.

Internationalization versus Localization: "The Case of Primary Education in Taiwan"

ERIC Educational Resources Information Center

Wang, Li-Ping; Ho, Hsuan-Fu

2012-01-01

Internationalization is receiving increasing attention at academic institutions all over the world. Taiwan is no exception, where the government is promoting internationalization not only in higher education, but also at the primary education level. In this research we identified the key factors of the internationalization of primary education in…

Molecular and morphologic correlates of the alternative lengthening of telomeres phenotype in high-grade astrocytomas.

PubMed

Nguyen, Doreen N; Heaphy, Christopher M; de Wilde, Roeland F; Orr, Brent A; Odia, Yazmin; Eberhart, Charles G; Meeker, Alan K; Rodriguez, Fausto J

2013-05-01

Recent studies suggest that the telomere maintenance mechanism known as alternative lengthening of telomeres (ALT) is relatively more common in specific glioma subsets and strongly associated with ATRX mutations. We retrospectively examined 116 high-grade astrocytomas (32 pediatric glioblastomas, 65 adult glioblastomas, 19 anaplastic astrocytomas) with known ALT status using tissue microarrays to identify associations with molecular and phenotypic features. Immunohistochemistry was performed using antibodies against ATRX, DAXX, p53 and IDH1(R132H) mutant protein. EGFR amplification was evaluated by fluorescence in situ hybridization (FISH). Almost half of fibrillary and gemistocytic astrocytomas (44%) demonstrated ALT. Conversely all gliosarcomas (n = 4), epithelioid (n = 2), giant cell (n = 2) and adult small cell astrocytomas (n = 7) were ALT negative. The ALT phenotype was positively correlated with the presence of round cells (P = 0.002), microcysts (P < 0.0002), IDH1 mutant protein (P < 0.0001), ATRX protein loss (P < 0.0001), strong P53 immunostaining (P < 0.0001) and absence of EGFR amplification (P = 0.004). There was no significant correlation with DAXX expression. We conclude that ALT represents a specific phenotype in high-grade astrocytomas with distinctive pathologic and molecular features. Future studies are required to clarify the clinical and biological significance of ALT in high-grade astrocytomas. © 2012 The Authors; Brain Pathology © 2012 International Society of Neuropathology.

Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors.

PubMed

Valaitis, Ruta K; O'Mara, Linda; Wong, Sabrina T; MacDonald, Marjorie; Murray, Nancy; Martin-Misener, Ruth; Meagher-Stewart, Donna

2018-04-12

AimThe aim of this paper is to examine Canadian key informants' perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration. Primary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context. This interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.FindingsA total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor - effective communication - interacted with all of them. Results support and extend our understanding of what influences successful primary care and public health collaboration at these levels and are important considerations in building and sustaining primary care and public health collaborations.

A strategy for the implementation of a quality indicator system in German primary care.

PubMed

van den Heuvel, Henricus

2011-01-01

The Quality and Outcomes Framework (QOF) has had a major impact on the quality of care in British general practice. It is seen as a major innovation amongst quality indicator systems and as a result various countries are looking at whether such initiatives could be used in their primary care. In Germany also the development of similar schemes has started. To propose a strategy indicating key issues for the implementation of a quality indicator scheme in German primary care. Literature review with a focus on the QOF and German quality indicator literature. There are major differences between the German and British healthcare and primary care systems. The development of quality indicator systems for German general practice is in progress and there is a net force for the implementation of such systems. The following ten key factors are suggested for the successful implementation of such a system in German primary care: involvement of general practitioners (GPs) at all levels of the development, a clear implementation process, investment in practice information technology (IT) systems, an accepted quality indicator set, a quality indicator setting institution and data collection organisation, clear financial and non-financial incentives, a 'practice registration' structure, an exception reporting mechanism, delegation of routine clinical data collection tasks to practice assistants, a stepped implementation approach and adequate evaluation processes. For the successful implementation of a quality indicator system in German primary care a number of key issues, as presented in this article, need to be taken into account.

Developing CALL for Heritage Languages: "The 7 Keys of the Dragon"

ERIC Educational Resources Information Center

Revithiadou, Anthi; Kourtis-Kazoullis, Vasilia; Soukalopoulou, Maria; Konstantoudakis, Konstantinos; Zarras, Christos

2015-01-01

In this article we present an interactive extensible software, "The 7 Keys of the Dragon," for the teaching/learning of Albanian and Russian to students that attend primary and secondary education in Greece with the respective languages as their heritage languages. We address the key challenges we encountered during the conceptualization…

Role of Australian primary healthcare organisations (PHCOs) in primary healthcare (PHC) workforce planning: lessons from abroad.

PubMed

Naccarella, Lucio; Buchan, James; Newton, Bill; Brooks, Peter

2011-08-01

To review international experience in order to inform Australian PHC workforce policy on the role of primary healthcare organisations (PHCOs/Medicare Locals) in PHC workforce planning. A NZ and UK study tour was conducted by the lead author, involving 29 key informant interviews with regard to PHCOs roles and the effect on PHC workforce planning. Interviews were audio-taped with consent, transcribed and analysed thematically. Emerging themes included: workforce planning is a complex, dynamic, iterative process and key criteria exist for doing workforce planning well; PHCOs lacked a PHC workforce policy framework to do workforce planning; PHCOs lacked authority, power and appropriate funding to do workforce planning; there is a need to align workforce planning with service planning; and a PHC Workforce Planning and Development Benchmarking Database is essential for local planning and evaluating workforce reforms. With the Australian government promoting the role of PHCOs in health system reform, reflections from abroad highlight the key action within PHC and PHCOs required to optimise PHC workforce planning.

Teachers' Perceptions of the Standard-Based English Language Curriculum in Malaysian Primary Schools

ERIC Educational Resources Information Center

Sulaiman, Suriati; Sulaiman, Tajularipin; Rahim, Suzieleez Syrene Abdul

2017-01-01

Standard-based English language curriculum (SBELC) was fairly a new curriculum in Malaysian primary schools. The implementation of SBELC is a phenomenon affecting all teachers and pupils in primary education. Since curriculum implementation occurs mostly in the classroom and teachers are the key players in the implementation process, the initial…

Studies in Mathematics Education, Volume 3. The Mathematical Education of Primary-School Teachers.

ERIC Educational Resources Information Center

Morris, Robert, Ed.

Recognizing that the teacher is the key to improving any mathematics program, this volume examines the responsibility of primary school teachers for the mathematics component of the curriculum and the implications thereof for teacher education. The first two chapters focus on the responsibilities of teachers of primary mathematics and contemporary…

Distributed Leadership: Key to Improving Primary Students' Mathematical Knowledge

ERIC Educational Resources Information Center

Larson, Matthew R.; Smith, Wendy M.

2013-01-01

The purpose of this article is to present the findings of a quantitative study focused on primary mathematics teachers who participated in an intensive professional development program and then had leadership responsibility for the implementation of a new primary mathematics curriculum in their district. The study examines the effect of the…

The Primary Care Behavioral Health (PCBH) Model: An Overview and Operational Definition.

PubMed

Reiter, Jeffrey T; Dobmeyer, Anne C; Hunter, Christopher L

2018-06-01

The Primary Care Behavioral Health (PCBH) model is a prominent approach to the integration of behavioral health services into primary care settings. Implementation of the PCBH model has grown over the past two decades, yet research and training efforts have been slowed by inconsistent terminology and lack of a concise, operationalized definition of the model and its key components. This article provides the first concise operationalized definition of the PCBH model, developed from examination of multiple published resources and consultation with nationally recognized PCBH model experts. The definition frames the model as a team-based approach to managing biopsychosocial issues that present in primary care, with the over-arching goal of improving primary care in general. The article provides a description of the key components and strategies used in the model, the rationale for those strategies, a brief comparison of this model to other integration approaches, a focused summary of PCBH model outcomes, and an overview of common challenges to implementing the model.

Overcoming Barriers to Integrating Behavioral Health and Primary Care Services

PubMed Central

Grazier, Kyle L.; Smiley, Mary L.; Bondalapati, Kirsten S.

2016-01-01

Objective: Despite barriers, organizations with varying characteristics have achieved full integration of primary care services with providers and services that identify, treat, and manage those with mental health and substance use disorders. What are the key factors and common themes in stories of this success? Methods: A systematic literature review and snowball sampling technique was used to identify organizations. Site visits and key informant interviews were conducted with 6 organizations that had over time integrated behavioral health and primary care services. Case studies of each organization were independently coded to identify traits common to multiple organizations. Results: Common characteristics include prioritized vulnerable populations, extensive community collaboration, team approaches that included the patient and family, diversified funding streams, and data-driven approaches and practices. Conclusions: While significant barriers to integrating behavioral health and primary care services exist, case studies of organizations that have successfully overcome these barriers share certain common factors. PMID:27380923

Engine Tune-Up Service. Unit 3: Primary Circuit. Posttests. Automotive Mechanics Curriculum.

ERIC Educational Resources Information Center

Morse, David T.

This book of posttests is designed to accompany the Engine Tune-Up Service Student Guide for Unit 3, Primary Circuit, available separately as CE 031 211. Focus of the posttests is setting the primary ignition circuit. One multiple choice posttest is provided, covering the eight performance objectives contained in the unit. (No answer key is…

Engaging Parents with Sex and Relationship Education: A UK Primary School Case Study

ERIC Educational Resources Information Center

Alldred, Pam; Fox, Nick; Kulpa, Robert

2016-01-01

Objective: To assess an intervention to familiarise parents with children's books for use in primary (5-11 years) sex and relationship education (SRE) classes. Method: Case study of a 7-week programme in one London primary school, using ethnographic observation, semi-structured interviews and focus groups with parents (n = 7) and key stakeholders…

Access to Education in Bangladesh: Country Analytic Review of Primary and Secondary School

ERIC Educational Resources Information Center

Ahmed, Manzoor; Ahmed, Kazi Saleh; Khan, Nurul Islam; Ahmed, Romij

2007-01-01

This country analytical review examines the key issues in access to and participation in primary and secondary education in Bangladesh, with a special focus on areas and dimensions of exclusion. Against a background of overall progress, particularly in closing the gender gap in primary and secondary enrollment, the research applies a conceptual…

Rationality and Emotion in Primary School Leadership: An Exploration of Key Themes

ERIC Educational Resources Information Center

Crawford, Megan

2007-01-01

This article discusses the symbiotic relationship between emotion and rationality in leadership in primary schools. It uses the literature of both emotion and leadership to ask whether school leadership has learnt some of the lessons from the recent interest in emotion and leadership. Drawing on recent research into the lives of primary school…

Identifying Barriers to Collaboration Between Primary Care and Public Health: Experiences at the Local Level.

PubMed

Pratt, Rebekah; Gyllstrom, Beth; Gearin, Kim; Lange, Carol; Hahn, David; Baldwin, Laura-Mae; VanRaemdonck, Lisa; Nease, Don; Zahner, Susan

Interest is increasing in collaborations between public health and primary care to address the health of a community. Although the understanding of how these collaborations work is growing, little is known about the barriers facing these partners at the local level. The objective of this study was to identify barriers to collaboration between primary care and public health at the local level in 4 states. The study team, which comprised 12 representatives of Practice-Based Research Networks (networks of practitioners interested in conducting research in practice-based settings), identified 40 key informants from the public health and primary care fields in Colorado, Minnesota, Washington State, and Wisconsin. The key informants participated in standardized, semistructured telephone interviews with 8 study team members in 2014 and 2015. Interviews were audio recorded and transcribed verbatim. We analyzed key themes and subthemes by drawing on grounded theory. Primary care and public health participants identified similar barriers to collaboration. Barriers at the institutional level included the challenges of the primary care environment, in which providers feel overwhelmed and resources are tight; the need for systems change; a lack of partnership; and geographic challenges. Barriers to collaboration included mutual awareness, communication, data sharing, capacity, lack of resources, and prioritization of resources. Some barriers to collaboration (eg, changes to health care billing, demands on provider time) require systems change to overcome, whereas others (eg, a lack of shared priorities and mutual awareness) could be addressed through educational approaches, without adding resources or making a systemic change. Overcoming these common barriers may lead to more effective collaboration.

Carbon budget of oligotrophic mires in the Southern Taiga of Western Siberia under anthropogenic impact

NASA Astrophysics Data System (ADS)

Golovatskaya, Eugenia; Dyukarev, Egor

2010-05-01

Role of peatlands in the global greenhouse gases budget is highly relevant. According to present estimates peatlands in undisturbed conditions act as a sink for the atmospheric carbon. Anthropogenic impact on peatlands (melioration, changes in land use, influence of underground water catchments) results in water table lowering, changing in vegetation cover, and degradation of peat deposit. Peatlands could provide a significant positive feedback for climate changes if warming and peatlands drying stimulates bulk soil organic matter decomposition which enhances CO2 release to the atmosphere. Western Siberian peatlands usually represented big bog massifs. Big peatlands have higher stability to external influence. Small peatlands have all signs of big bogs but react on changes in environmental variables more quickly. The present study is devoted to investigation of primary carbon fluxes (CO2 emission and net primary productivity) and carbon balance at oligotrophic bogs in native condition (key area "Bakchar") and under anthropogenic impact (key area "Ob'-Tom'"). The key area "Bakchar" is located between the Iksa and Bakchar rivers (56o58`N 82o36`E) at the Bakcharskoe bog (area 1400 km2). The key area "Ob'-Tom'"is located in the northern part of Ob' and Tom' interfluve (56o21`N 82o31`E). The "Bakchar" key area includes the following ecosystems: pine- shrub-sphagnum community, a similar community with stunted (low) pine trees, and sedge-sphagnum fen. Two small peatlands were studied at Ob' and Tom' interfluve. Kirsanovskoe bog includes pine- shrub-sphagnum community and sedge fen. Timiryazevskoe bog was represented by pine- shrub-sphagnum (TPSS) community and sedge fen. An infrared gas analyzer OPTOGAS 500.4 (OPTEC Corp., St.-Petersburg, Russia) attached to a static opaque plastic been used for carbon dioxide emission measurements. The net primary productivity was measured by clipping method (Golovatskaya and Dyukarev, Plant Soil 2009). Peatlands at "Ob'-Tom'" key area are under impact of water catchments for Tomsk city supply. Changes in deep waters results in changes of hydrological regime and environment transformations. Water level drawdown leads to increase of aerobic layer thickness, intensification of plant remains decomposition, peat layers compacting and rises of CO2 emission from the surface. Carbon dioxide emission from bogs of "Ob'-Tom'" key area is about two times higher than emission from pristine bogs ("Bakchar" key area). Aboveground net primary productivity determined without tree layer at all studied peatlands has similar values. Belowground net primary productivity at "Ob'-Tom'" key area if 4-7 times higher than at "Bakchar" key area depending on the ecosystem type. An essential increase in root density after water level depletion results in increase on total net productivity by 2.4 times. Carbon budget for pristine peatlands ("Bakchar" key area) varies from 27 (open fen) to 46 (low ryam) gC/m2/yr. Peatlands of "Ob'-Tom'" key area accumulates about 210 gC/m2/yr in average. Our observations of the elements of carbon exchange have shown that at present all studied peatlands act as carbon sinks. Long-term water table lowering at least at first stage stipulates carbon removing from the atmosphere and accumulation in a form of peat. Work was partially supported by Russian Fund of Basic Researches (08-05-00426/a, 08-05-92501).

A Key Telegram and a Key Press Release on the Recognition of the State of Israel

ERIC Educational Resources Information Center

Byers, CeCe; Alexander, Mary

1978-01-01

Reviews the course of events leading to the founding of Israel in 1947. Presents primary source materials, activities, and discussion questions to help students analyze reasons for the Arab-Israeli conflict. (Author/DB)

Exploring Intercultural Awareness in the Primary Modern Language Classroom: The Potential of the New Model of European Language Portfolio Developed by the Irish Modern Languages in Primary Schools Initiative (MLPSI)

ERIC Educational Resources Information Center

Rantz, Frederique; Horan, Pascaline

2005-01-01

This paper reflects a key concern for teacher trainers: how can primary language teachers promote the development of intercultural awareness among their pupils? It addresses the concept of intercultural awareness as it applies to young learners and refers more specifically to the context of the Irish primary classroom and its curriculum. It argues…

A comprehensive health service evaluation and monitoring framework.

PubMed

Reeve, Carole; Humphreys, John; Wakerman, John

2015-12-01

To develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services. A targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders. The framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable. Data collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

After-visit summaries in primary care: mixed methods results from a literature review and stakeholder interviews.

PubMed

Lyles, Courtney R; Gupta, Reena; Tieu, Lina; Fernandez, Alicia

2018-05-28

After-visit summary (AVS) documents presenting key information from each medical encounter have become standard in the USA due to federal health care reform. Little is known about how they are used or whether they improve patient care. First, we completed a literature review and described the totality of the literature on AVS by article type and major outcome measures. Next, we used reputational sampling from large-scale US studies on primary care to identify and interview nine stakeholders on their perceptions of AVS across high-performing primary care practices. Interviews were transcribed and coded for AVS use in practice, perceptions of the best/worst features and recommendations for improving AVS utility in routine care. The literature review resulted in 17 studies; patients reported higher perceived value of AVS compared with providers, despite poor recall of specific AVS content and varied post-visit use. In key informant interviews, key informants expressed enthusiasm for the potential of using AVS to reinforce key information with patients, especially if AVS were customizable. Despite this potential, key informants found that AVS included incorrect information and did not feel that patients or their practices were using AVS to enhance care. There is a gap between the potential of AVS and how providers and patients are using it in routine care. Suggestions for improved use of AVS include increasing customization, establishing care team responsibilities and workflows and ensuring patients with communication barriers have dedicated support to review AVS during visits.

Stakeholder perceptions of a nurse led walk-in centre.

PubMed

Parker, Rhian M; Desborough, Jane L; Forrest, Laura E

2012-11-05

As many countries face primary care medical workforce shortages and find it difficult to provide timely and affordable care they seek to find new ways of delivering first point of contact health care through developing new service models. In common with other areas of rural and regional Australia, the Australian Capital Territory (ACT) is currently experiencing a general practitioner (GP) workforce shortage which impacts significantly on the ability of patients to access GP led primary care services. The introduction of a nurse led primary care Walk-in Centre in the ACT aimed to fulfill an unmet health care need in the community and meet projected demand for health care services as well as relieve pressure on the hospital system. Stakeholders have the potential to influence health service planning and policy, to advise on the potential of services to meet population health needs and to assess how acceptable health service innovation is to key stakeholder groups. This study aimed to ascertain the views of key stakeholders about the Walk-in Centre. Stakeholders were purposively selected through the identification of individuals and organisations which had organisational or professional contact with the Walk-in Centre. Semi structured interviews around key themes were conducted with seventeen stakeholders. Stakeholders were generally supportive of the Walk-in Centre but identified key areas which they considered needed to be addressed. These included the service's systems, full utilisation of the nurse practitioner role and adequate education and training. It was also suggested that a doctor could be available to the Centre as a source of referral for patients who fall outside the nurses' scope of practice. The location of the Centre was seen to impact on patient flows to the Emergency Department. Nurse led Walk-in Centres are one response to addressing primary health care medical workforce shortages. Whilst some stakeholders have reservations about the model others are supportive and see the potential the model has to provide accessible primary health care. Any further developments of nurse-led Walk-in Centres need to take into account the views of key stakeholders so as to ensure that the model is acceptable and sustainable.

Interventionist training and intervention fidelity monitoring and maintenance for CONNECT, a nurse-led primary palliative care in oncology trial.

PubMed

Robbins-Welty, Gregg A; Mueser, Lisa; Mitchell, Chandler; Pope, Nicole; Arnold, Robert; Park, SeoYoung; White, Doug; Smith, Kenneth J; Reynolds, Charles; Rosenzweig, Margaret; Bakitas, Marie; Schenker, Yael

2018-06-01

Intervention fidelity is a critical component of behavioral research that has received inadequate attention in palliative care studies. With increasing focus on the need for palliative care models that can be widely disseminated and delivered by non-specialists, rigorous yet pragmatic strategies for training interventionists and maintaining intervention fidelity are needed. (1) Describe components of a plan for interventionist training and monitoring and maintaining intervention fidelity as part of a primary palliative care trial (CONNECT) and (2) present data about perceived training effectiveness and delivery of key intervention content. Post-training evaluations, visit checklists, and visit audio-recordings. Data were collected from June, 2016 through April, 2017. We include procedures for (1) identification, training and certification of oncology nurses as CONNECT interventionists; (2) monitoring intervention delivery; and (3) maintaining intervention quality. All nurses (N = 14) felt prepared to deliver key competencies after a 3-day in-person training. As assessed via visit checklists, interventionists delivered an average of 94% (SD 13%) of key content for first intervention visits and 85% (SD 14%) for subsequent visits. As assessed via audio-recordings, interventionists delivered an average of 85% (SD 8%) of key content for initial visits and 85% (SD 12%) for subsequent visits. We present a 3-part strategy for training interventionists and monitoring and maintaining intervention delivery in a primary palliative care trial. Training was effective in having nurses feel prepared to deliver primary palliative care skills. As assessed via nursing checklists and visit audio-recordings, intervention fidelity was high.

What? Me? Teach Dance? Background and Confidence of Primary Preservice Teachers in Dance Education across Five Countries

ERIC Educational Resources Information Center

Russell-Bowie, Deirdre E.

2013-01-01

In primary schools across many countries, dance is now included within the arts key learning area with its own outcomes and content. But as future teachers of dance and other art forms, how do preservice generalist primary teachers perceive their background and confidence in relation to dance and dance education? This study investigates the…

Primary vaginal cancer: role of MRI in diagnosis, staging and treatment

PubMed Central

Sunil, J; Klopp, A H; Devine, C E; Sagebiel, T; Viswanathan, C; Bhosale, P R

2015-01-01

Primary carcinoma of the vagina is rare, accounting for 1–3% of all gynaecological malignancies. MRI has an increasing role in diagnosis, staging, treatment and assessment of complications in gynaecologic malignancy. In this review, we illustrate the utility of MRI in patients with primary vaginal cancer and highlight key aspects of staging, treatment, recurrence and complications. PMID:25966291

Revisiting Primary Care's Critical Role in Achieving Health Equity: Pisacano Scholars' Reflections from Starfield Summit II.

PubMed

Park, Brian; Coutinho, Anastasia J; Doohan, Noemi; Jimenez, Jonathan; Martin, Sara; Romano, Max; Wohler, Diana; DeVoe, Jennifer

2018-01-01

The second Starfield Summit was held in Portland, Oregon, in April 2017. The Summit addressed the role of primary care in advancing health equity by focusing on 4 key domains: social determinants of health in primary care, vulnerable populations, economics and policy, and social accountability. Invited participants represented an interdisciplinary group of primary care clinicians, researchers, educators, policymakers, community leaders, and trainees. The Pisacano Leadership Foundation was one of the Summit sponsors and held its annual leadership symposium in conjunction with the Summit, enabling several Pisacano Scholars to attend the Summit. After the Summit, a small group of current and former Pisacano Scholars formed a writing group to highlight key themes and implications for action discussed at the Summit. The Summit resonated as a call to action for primary care to move beyond identifying existing health inequities and toward the development of interventions that advance health equity, through education, research, and enhanced community partnerships. In doing so, the Summit aimed to build on the foundational work of Dr. Starfield, challenging us to explore the significant role of primary care in truly achieving health equity. © Copyright 2018 by the American Board of Family Medicine.

15 CFR 922.160 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-01-01

... MARINE SANCTUARY PROGRAM REGULATIONS Florida Keys National Marine Sanctuary § 922.160 Purpose. (a) The... Florida Keys National Marine Sanctuary by regulating activities affecting the resources of the Sanctuary... primary objective of resource protection all public and private uses of the resources of the Sanctuary not...

15 CFR 922.160 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-01-01

... MARINE SANCTUARY PROGRAM REGULATIONS Florida Keys National Marine Sanctuary § 922.160 Purpose. (a) The... Florida Keys National Marine Sanctuary by regulating activities affecting the resources of the Sanctuary... primary objective of resource protection all public and private uses of the resources of the Sanctuary not...

15 CFR 922.160 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-01-01

... MARINE SANCTUARY PROGRAM REGULATIONS Florida Keys National Marine Sanctuary § 922.160 Purpose. (a) The... Florida Keys National Marine Sanctuary by regulating activities affecting the resources of the Sanctuary... primary objective of resource protection all public and private uses of the resources of the Sanctuary not...

15 CFR 922.160 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-01-01

... MARINE SANCTUARY PROGRAM REGULATIONS Florida Keys National Marine Sanctuary § 922.160 Purpose. (a) The... Florida Keys National Marine Sanctuary by regulating activities affecting the resources of the Sanctuary... primary objective of resource protection all public and private uses of the resources of the Sanctuary not...

Improving Primary Care Provider Practices in Youth Concussion Management.

PubMed

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

2017-08-01

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

Understanding partnership practice in primary health as pedagogic work: what can Vygotsky's theory of learning offer?

PubMed

Hopwood, Nick

2015-01-01

Primary health policy in Australia has followed international trends in promoting models of care based on partnership between professionals and health service users. This reform agenda has significant practice implications, and has been widely adopted in areas of primary health that involve supporting families with children. Existing research shows that achieving partnership in practice is associated with three specific challenges: uncertainty regarding the role of professional expertise, tension between immediate needs and longer-term capacity development in families, and the need for challenge while maintaining relationships based on trust. Recently, pedagogic or learning-focussed elements of partnership practice have been identified, but there have been no systematic attempts to link theories of learning with the practices and challenges of primary health-care professionals working with families in a pedagogic role. This paper explores key concepts of Vygotsky's theory of learning (including mediation, the zone of proximal development, internalisation, and double stimulation), showing how pedagogic concepts can provide a bridge between the policy rhetoric of partnership and primary health practice. The use of this theory to address the three key challenges is explicitly discussed.

Emergency nursing management of the multiple trauma patient.

PubMed

Kosmos, C A

1989-01-01

This case study reinforces key principles in caring for multiply injured trauma victims. The Primary Survey is a tool developed to allow those caring for trauma patients to prioritize injuries. Those injuries identified in the Primary Survey will be the most life threatening.

Care of adults with developmental disabilities: Effects of a continuing education course for primary care providers.

PubMed

Balogh, Robert; Wood, Jessica; Lunsky, Yona; Isaacs, Barry; Ouellette-Kuntz, Hélène; Sullivan, William

2015-07-01

To evaluate the effects of an interdisciplinary, guideline-based continuing education course on measures related to the care of adults with developmental disabilities (DD). Before-and-after study with a control group. Ontario. Forty-seven primary care providers (physicians, registered nurses, and nurse practitioners). Participants either only received reference material about primary care of people with DD (control group) or participated in a continuing education course on primary care of people with DD in addition to receiving the reference material (intervention group). Participants reported on 5 key measures related to care of adults with DD: frequency of using guidelines, frequency of performing periodic health examinations, frequency of assessing patients who present with behaviour changes, level of comfort while caring for adults with DD, and knowledge of primary care related to adults with DD. Over time, the intervention group showed significant increases in 4 of the 5 key measures of care compared with the control group: the frequency of guideline use (P < .001), frequency of assessment of patients' behaviour change (P = .03), comfort level in caring for people with DD (P = .01), and knowledge of primary care related to adults with DD (P = .01). A continuing education course on primary care of adults with DD is a useful interdisciplinary model to train health professionals who provide primary care services to these patients.

ANALYSIS OF METEOROLOGICAL CONDITIONS DURING THE 1977 ANCLOTE KEYS PLUME STUDY

EPA Science Inventory

Meteorological conditions are described and analyzed for nine experimental observation periods of the Anclote Keys Plume Study, which was conducted near Tampa, Florida during February 1977. The primary objective of the Plume Study was to investigate both the short and long range ...

LABORATORY AND COMPUTATIONAL INVESTIGATIONS OF THE ATMOSPHERIC CHEMISTRY OF KEY OXIDATION PRODUCTS CONTROLLING TROPOSPHERIC OZONE FORMATION

EPA Science Inventory

Major uncertainties remain in our ability to identify the key reactions and primary oxidation products of volatile hydrocarbons that contribute to ozone formation in the troposphere. To reduce these uncertainties, computational chemistry, mechanistic and process analysis techniqu...

The Sector-Wide Approach in Bangladesh Primary Education: A Critical View. CREATE Pathways to Access. Research Monograph No. 57

ERIC Educational Resources Information Center

Ahmed, Manzoor

2011-01-01

This monograph, in the CREATE Pathways to Access series, is about the modality of cooperation and programme management in primary education in Bangladesh, based specifically on the experience of the Second Primary Education Development Programme (PEDP II). It is not intended to be an assessment of PEDP II accomplishments, but key information and a…

Primary Health Care--The Chinese Experience. Report of an Inter-regional Seminar on Primary Health Care (China, June 13-16, 1982).

ERIC Educational Resources Information Center

World Health Organization, Geneva (Switzerland).

Addresses and team reports from an inter-regional seminar which examined aspects of primary health care in China are presented. Background information about the seminar is given along with an introduction to rural health services in China. The report considers four key issues: China's three-level health care network; involvement of the people;…

Flying the "Active School Flag": Physical Activity Promotion through Self-Evaluation in Primary Schools in Ireland

ERIC Educational Resources Information Center

Chroinin, Deirdre Ni; Murtagh, Elaine; Bowles, Richard

2012-01-01

Primary schools are key sites where children can be active, advance their knowledge and understanding of how to participate in physical activity (PA) and develop an appreciation of its importance in their lives. This study explored the role of schools in promoting PA asking: how do primary schools approach the promotion of whole-school PA? Data…

The Effect of Free Primary Education Policy on Late School Entry in Urban Primary Schools in Kenya

ERIC Educational Resources Information Center

Ngware, Moses W.; Oketch, Moses; Ezeh, Alex C.; Mutisya, Maurice

2013-01-01

Late school entry is driven by several factors, one of the key ones being the cost barrier to schooling. Policies such as free primary education (FPE) that advocate for universal coverage are therefore partly aimed at removing the cost barrier. The Kenyan Government, like many in sub-Saharan Africa (SSA), introduced FPE in 2003 with the aim of…

Health Education in Primary Schools: The Effects of an Educational Programme on the Representations of HIV/AIDS in Children

ERIC Educational Resources Information Center

Berger, Dominique; Jourdan, Didier; Barnoin, Judith

2006-01-01

Health education is a part of the primary school science curriculum in France. Teachers often consider sexuality education and sexually transmitted diseases prevention as a topic they cannot teach without the help of partners. This paper is an account of a research carried out to study the representations of primary school pupils (Key Stage 2,…

An International Study of the Changing Nature and Role of School Curricula: From Transmitting Content Knowledge to Developing Students' Key Competencies

ERIC Educational Resources Information Center

Hong, Won-Pyo

2012-01-01

The primary purpose of this study is to investigate how key competencies can be incorporated into school curricula, what relevant instructional methods are needed and what institutional support is required to make school curricula based more on key competencies. For this, the study uses qualitative data from three schools (one each in South Korea,…

Forecasting annual aboveground net primary production in the intermountain west

USDA-ARS?s Scientific Manuscript database

For many land manager’s annual aboveground net primary production, or plant growth, is a key factor affecting business success, profitability and each land manager's ability to successfully meet land management objectives. The strategy often utilized for forecasting plant growth is to assume every y...

Unveiling the South African Official Primary Mathematics Teacher Pedagogic Identity

ERIC Educational Resources Information Center

Pausigere, Peter; Graven, Mellony

2013-01-01

This article is theoretically informed by Bernstein's (2000) notion of pedagogic identity, supplemented by Tyler's (1999) elaboration of Bernstein's theory into an analytical framework that describes four possible identity positions relating to classification and framing properties. The article analyses key primary mathematics curriculum policy…

The control processes and subjective well-being of Chinese teachers: evidence of convergence with and divergence from the key propositions of the motivational theory of life-span development

PubMed Central

Wong, Wan-chi; Li, Yin; Sun, Xiaoyan; Xu, Huanu

2014-01-01

An analytical review of the motivational theory of life-span development reveals that this theory has undergone a series of elegant theoretical integrations. Its claim to universality nonetheless brings forth unresolved controversies. With the purpose of scrutinizing the key propositions of this theory, an empirical study was designed to examine the control processes and subjective well-being of Chinese teachers (N = 637). The OPS-Scales (Optimization in Primary and Secondary Control Scales) for the Domain of Teaching were constructed to assess patterns of control processes. Three facets of subjective well-being were investigated with the Positive and Negative Affect Schedule, the Life Satisfaction Scale, and the Subjective Vitality Scale. The results revealed certain aspects of alignment with and certain divergences from the key propositions of the motivational theory of life-span development. Neither “primacy of primary control” nor “primacy of secondary control” was clearly supported. Notably, using different criteria for subjective well-being yielded different subtypes of primary and secondary control as predictors. The hypothesized life-span trajectories of primary and secondary control received limited support. To advance the theory in this area, we recommend incorporating Lakatos' ideas about sophisticated falsification by specifying the hard core of the motivational theory of life-span development and articulating new auxiliary hypotheses. PMID:24904483

Political economy of decentralising HIV and AIDS treatment services to primary healthcare facilities in three Nigerian states.

PubMed

Mbachu, Chinyere; Onwujekwe, Obinna; Ezumah, Nkoli; Ajayi, Olayinka; Sanwo, Olusola; Uzochukwu, Benjamin

2016-09-01

Decentralisation is defined as the dispersion, distribution or transfer of resources, functions and decision-making power from a central authority to regional and local authorities. It is usually accompanied by assignment of accountability and responsibility for results. Fundamental to understanding decentralisation is learning what motivates central governments to give up power and resources to local governments, and the practical significance of this on their positions regarding decentralisation. This study examined key political and institutional influences on role-players' capacity to support decentralisation of HIV and AIDS treatment services to primary healthcare facilities, and implications for sustainability. In-depth interviews were conducted with 55 purposively selected key informants, drawn from three Nigerian states that were at different stages of decentralising HIV and AIDS treatment services to primary care facilities. Key informants represented different categories of role-players involved in HIV and AIDS control programmes. Thematic framework analysis of data was done. Support for decentralisation of HIV and AIDS treatment services to primary healthcare facilities was substantial among different categories of actors. Political factors such as the local and global agenda for health, political tenure and party affiliations, and institutional factors such as consolidation of decision-making power and improvements in career trajectories, influenced role-players support for decentralisation of HIV and AIDS treatment services. It is feasible and acceptable to decentralise HIV and AIDS treatment services to primary healthcare facilities, to help improve coverage. However, role-players' support largely depends on how well the reform aligns with political structures and current institutional practices.

75 FR 26739 - Notice of Intent To Prepare an Environmental Impact Statement (EIS) for Airfield Operations at...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-12

... training requirements. The primary users of NAS Key West are active and reserve Fleet F/A-18C Hornet and F... those aircraft replace the Navy's aging F/A-18C aircraft. Specifically, use of NAS Key West is necessary...

Key Data on Education in Europe 2012

ERIC Educational Resources Information Center

Ranguelov, Stanislav; De Coster, Isabelle; Norani, Sogol; Paolini, Giulia

2012-01-01

Key Data on Education in Europe 2012 is a Eurydice flagship publication tracing the main developments of European education systems over the last decade. The report combines statistical data with qualitative information to describe the organisation, management and functioning of 37 European education systems from pre-primary to higher education.…

25 CFR 556.5 - Report to Commission.

Code of Federal Regulations, 2010 CFR

2010-04-01

... official or a key employee, the tribe shall forward to the Commission a completed application containing... primary management official or to a key employee, a tribe shall forward to the Commission an investigative... (4) The bases for those conclusions. (c) When a tribe forwards its report to the Commission, it shall...

25 CFR 556.5 - Report to Commission.

Code of Federal Regulations, 2011 CFR

2011-04-01

... official or a key employee, the tribe shall forward to the Commission a completed application containing... primary management official or to a key employee, a tribe shall forward to the Commission an investigative... (4) The bases for those conclusions. (c) When a tribe forwards its report to the Commission, it shall...

Traditional African Dance Education as Curriculum Reimagination in Postcolonial Zimbabwe: A Rethink of Policy and Practice of Dance Education in the Primary Schools

ERIC Educational Resources Information Center

Gonye, Jairos; Moyo, Nathan

2015-01-01

This paper examines the teaching and learning of traditional dance at primary school level in Zimbabwe as a key aspect of postcolonial curriculum reimagination within the broader project of reclaiming a nation's heritage. The paper used the survey design to determine how a cohort of primary school teachers understood traditional dance and how they…

Primary Care Reform: Can Quebec's Family Medicine Group Model Benefit from the Experience of Ontario's Family Health Teams?

PubMed Central

Breton, Mylaine; Lévesque, Jean-Frédéric; Pineault, Raynald; Hogg, William

2011-01-01

Canadian politicians, decision-makers, clinicians and researchers have come to agree that reforming primary care services is a key strategy for improving healthcare system performance. However, it is only more recently that real transformative initiatives have been undertaken in different Canadian provinces. One model that offers promise for improving primary care service delivery is the family medicine group (FMG) model developed in Quebec. A FMG is a group of physicians working closely with nurses in the provision of services to enrolled patients on a non-geographic basis. The objectives of this paper are to analyze the FMG's potential as a lever for improving healthcare system performance and to discuss how it could be improved. First, we briefly review the history of primary care in Quebec. Then we present the FMG model in relation to the four key healthcare system functions identified by the World Health Organization: (a) funding, (b) generating human and technological resources, (c) providing services to individuals and communities and (d) governance. Next, we discuss possible ways of advancing primary care reform, looking particularly at the family health team (FHT) model implemented in the province of Ontario. We conclude with recommendations to inspire other initiatives aimed at transforming primary care. PMID:23115575

Third sector primary health care in New Zealand.

PubMed

Crampton, P; Dowell, A C; Bowers, S

2000-03-24

To describe key organisational characteristics of selected third sector (non-profit and non-government) primary health care organisations. Data were collected, in 1997 and 1998, from 15 third sector primary care organisations that were members of a network of third sector primary care providers, Health Care Aotearoa (HCA). Data were collected by face-to-face interviews of managers and key informants using a semi-structured interview schedule, and from practice computer information systems. Overall the populations served were young: only 4% of patients were aged 65 years or older, and the ethnicity profile was highly atypical, with 21.8% European, 36% Maori, 22.7% Pacific Island, 12% other, and 7.5% not stated. Community services card holding rates were higher than recorded in other studies, and registered patients tended to live in highly deprived areas. HCA organisations had high patient to doctor ratios, in general over 2000:1, and there were significant differences in management structures between HCA practices and more traditional general practice. Third sector organisations provide services for populations that are disadvantaged in many respects. It is likely that New Zealand will continue to develop a diverse range of primary care organisational arrangements. Effort is now required to measure quality and effectiveness of services provided by different primary care organisations serving comparable populations.

Reframing Primary Curriculum through Concepts of Place

ERIC Educational Resources Information Center

Power, Kerith; Green, Monica

2014-01-01

Australian curricula name "sustainability" as a key priority area with implications for preparing pre-service teachers. In the research that generated this paper, we asked: How can framing teaching through space and place inform pre-service teachers' pedagogical thinking and practice? In new third year Bachelor of Education (primary)…

Supporting Transition

ERIC Educational Resources Information Center

Qureshi, Asima; Petrucco, James

2018-01-01

Meadowbrook Primary School has explored the use of The Teacher Assessment in Primary Science (TAPS) to support transition, initially for transfer to secondary school and now for transition from Early Years Foundation Stage (EYFS) into Key Stage 1 (ages 5-7). This article will consider an example of a secondary transition project and discuss the…

QUANTIFYING UNCERTAINTY IN NET PRIMARY PRODUCTION MEASUREMENTS

EPA Science Inventory

Net primary production (NPP, e.g., g m-2 yr-1), a key ecosystem attribute, is estimated from a combination of other variables, e.g. standing crop biomass at several points in time, each of which is subject to errors in their measurement. These errors propagate as the variables a...

Bilingual Children with Primary Language Impairment: 3 Months after Treatment

ERIC Educational Resources Information Center

Pham, Giang; Ebert, Kerry Danahy; Kohnert, Kathryn

2015-01-01

Background: Evidence on the treatment effectiveness for bilingual children with primary language impairment (PLI) is needed to advance both theory and clinical practice. Of key interest is whether treatment effects are maintained following the completion of short-term intense treatments. Aims: To investigate change in select language and cognitive…

Progranulin-Associated Primary Progressive Aphasia: A Distinct Phenotype?

ERIC Educational Resources Information Center

Rohrer, Jonathan D.; Crutch, Sebastian J.; Warrington, Elizabeth K.; Warren, Jason D.

2010-01-01

The neuropsychological features of the primary progressive aphasia (PPA) syndromes continue to be defined. Here we describe a detailed neuropsychological case study of a patient with a mutation in the progranulin ("GRN") gene who presented with progressive word-finding difficulty. Key neuropsychological features in this case included gravely…

Mentoring Beginning Teachers in Primary Schools: Research Review

ERIC Educational Resources Information Center

Spooner-Lane, Rebecca

2017-01-01

While mentoring programmes have proven to be successful in reducing attrition and improving teaching ability in beginning teachers, there remains a lack of research delineating the key components of effective mentoring programmes in primary education. This integrative research review examines empirical studies conducted since 2000 on the nature…

New Roles for Medical Assistants in Innovative Primary Care Practices.

PubMed

Chapman, Susan A; Blash, Lisel K

2017-02-01

To identify and describe new roles for medical assistants (MAs) in innovative care models that improve care while providing training and career advancement opportunities for MAs. Primary data collected at 15 case study sites; 173 key informant interviews and de-identified secondary data on staffing, wages, patient satisfaction, and health outcomes. Researchers used snowball sampling and screening calls to identify 15 organizations using MAs in new roles. Conducted site visits from 2010 to 2012 and updated information in 2014. Thematic analysis explored key topics: factors driving MA role innovation, role description, training required, and wage gains. Categorized outcome data in patient and staff satisfaction, quality of care, and efficiency. New MA roles included health coach, medical scribe, dual role translator, health navigator, panel manager, cross-trained flexible role, and supervisor. Implementation of new roles required extensive training. MA incentives and enhanced compensation varied by role type. New MA roles are part of a larger attempt to reform workflow and relieve primary care providers. Despite some evidence of success, spread has been limited. Key challenges to adoption included leadership and provider resistance to change, cost of additional MA training, and lack of reimbursement for nonbillable services. © Health Research and Educational Trust.

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

EPA Pesticide Factsheets

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

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

EPA Pesticide Factsheets

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

Stakeholder Perspectives on Optimizing Communication in a School-Centered Asthma Program

ERIC Educational Resources Information Center

Snieder, Hylke M.; Nickels, Sarah; Gleason, Melanie; McFarlane, Arthur; Szefler, Stanley J.; Allison, Mandy A.

2017-01-01

Background: School-centered asthma programs (SAPs) can be an effective intervention to improve asthma control for underserved populations but little is known about how key stakeholders communicate within these programs. Therefore, our aim was to identify key components of effective communication in a SAP. Methods: Primary care providers (PCPs),…

America's Children: Key National Indicators of Well-Being, 2015

ERIC Educational Resources Information Center

Federal Interagency Forum on Child and Family Statistics, 2015

2015-01-01

The Federal Interagency Forum on Child and Family Statistics' primary mission is to enhance data collection and reporting on children and families. "America's Children: Key National Indicators of Well-Being, 2015" provides the Nation with a summary of national indicators of children's well-being and monitors changes in these indicators.…

America's Children: Key National Indicators of Well-Being, 2013

ERIC Educational Resources Information Center

Federal Interagency Forum on Child and Family Statistics, 2013

2013-01-01

The Federal Interagency Forum on Child and Family Statistics' primary mission is to enhance data collection and reporting on children and families. "America's Children: Key National Indicators of Well-Being, 2013" provides the Nation with a summary of national indicators of children's well-being and monitors changes in these indicators.…

Exploring the Moderating Role of Perceived Flexibility Advantages in Mobile Learning Continuance Intention (MLCI)

ERIC Educational Resources Information Center

Huang, Rui-Ting; Hsiao, Chia-Hua; Tang, Tzy-Wen; Lien, Tsung-Cheng

2014-01-01

The primary purpose of this study was to explore the key factors that could affect mobile learning continuance intention (MLCI), and examine the moderating effect of perceived flexibility advantages (PFA) on the relationship between key mobile learning elements and continuance intention. Five hundred undergraduate students who had previously…

Key Stage 3 Pupils' Views about Reading

ERIC Educational Resources Information Center

Atkinson, Cathy

2006-01-01

Recent developments in literacy teaching have tended to target the needs of primary, rather than high school pupils and focus on technical, rather than affective aspects of reading. This paper describes a questionnaire-based study undertaken to identify perceptions and views held by Key Stage 3 readers of different ages, genders and abilities.…

The organisational and human resource challenges facing primary care trusts: protocol of a multiple case study

PubMed Central

2001-01-01

Background The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs). Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. Methods The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development. PMID:11737883

Enquiry-Based Science in the Infant Classroom: "Letting Go"

ERIC Educational Resources Information Center

Byrne, Jenny; Rietdijk, Willeke; Cheek, Sue

2016-01-01

Enquiry-based science in primary classrooms is key to encouraging children's interest and curiosity about the world around them and as a result helps to stimulate their understanding and enjoyment of science. Yet many primary teachers lack the confidence to implement enquiry-based approaches effectively. The reasons are myriad and often result in…

Active Classroom Participation in a Group Scribbles Primary Science Classroom

ERIC Educational Resources Information Center

Chen, Wenli; Looi, Chee-Kit

2011-01-01

A key stimulus of learning efficacy for students in the classroom is active participation and engagement in the learning process. This study examines the nature of teacher-student and student-student discourse when leveraged by an interactive technology--Group Scribbles (GS) in a Primary 5 Science classroom in Singapore which supports rapid…

Literacy as Social Practice: Primary Voices K-6

ERIC Educational Resources Information Center

National Council of Teachers of English, 2004

2004-01-01

Based on a view of literacy as social practice, this book highlights the ways in which classroom teachers and educators have practiced and imagined teaching literacy in everyday classrooms. The twelve essays published here originally appeared in the NCTE journal Primary Voices K-6 and highlight four key issues essential to literacy practice in…

Pedagogical Renewal: Improving the Quality of Classroom Interaction in Nigerian Primary Schools

ERIC Educational Resources Information Center

Hardman, Frank; Abd-Kadir, Jan; Smith, Fay

2008-01-01

This study reports on an investigation of classroom interaction and discourse practices in Nigerian primary schools. Its purpose was to identify key issues affecting patterns of teacher-pupil interaction and discourse as research suggests managing the quality of classroom interaction will play a central role in improving the quality of teaching…

A Framework for Analysing ICT Adoption in Australian Primary Schools

ERIC Educational Resources Information Center

Way, Jenni; Webb, Colin

2007-01-01

Over 400 e-learning grant applications from Australian primary schools were analysed to determine the nature of the proposed ICT based projects in literacy and numeracy. Three key dimensions emerged from the teacher descriptions: ICT infrastructure, motivation and ICT use, and pedagogy and innovation. The three dimensions, and the interactions…

Tinker Tailor Robot Pi -- The Project

ERIC Educational Resources Information Center

Bianchi, Lynne

2017-01-01

Tinker Tailor Robot Pi (TTRP) is an innovative curriculum development project, which started in September 2014. It involves in-service primary and secondary teachers, university academic engineers, business partners and pupils at Key Stages 1, 2 and 3 (ages 5-14). The focus of the work has been to explore how a pedagogy for primary engineering…

Social Participation and Friendship Quality of Students with Special Educational Needs in Regular Greek Primary Schools

ERIC Educational Resources Information Center

Avramidis, Elias; Avgeri, Georgia; Strogilos, Vasilis

2018-01-01

The study addresses the social participation of integrated students with special educational needs (SEN) in upper primary regular classes in Greece alongside their perceptions of best friend quality. Social participation was defined as consisting of four key dimensions: students' acceptance by classmates, friendships, social self-perceptions, and…

The Directive Communication of Australian Primary School Principals

ERIC Educational Resources Information Center

De Nobile, John

2015-01-01

Directive communication is a key leadership practise in schools. However, very little direct attention has been given to this important feature of the school communication system. The purpose of the research reported here was to produce a richer description of directive communication in the context of Australian primary schools, and in so doing,…

Stressors and Stressor Response Levels of Hong Kong Primary School Music Teachers

ERIC Educational Resources Information Center

Wong, Marina Wai-yee; Chik, Maria Pik-yuk; Chan, Edmund Sze Shing

2018-01-01

Responses from 309 randomly sampled Hong Kong primary school music teachers to the shortened version of the Chinese Teacher Stress Questionnaire were subjected to a descriptive percentage analysis, one-way ANOVA and independent t test. Obtained results identify five key stressors: "changing education policy of the government";…

Primary Mental Health in Elementary Schools: Its Impact on Psychosocial Measures.

ERIC Educational Resources Information Center

Munoz, Marco A.

The Primary Mental Health Project (PMHP) is a research-based, selective program implemented by the Jefferson County Public Schools. The goal of the program is to enhance learning and other school-related competencies. Key structural components of the program include a focus on young children, early screening and selection, use of paraprofessionals…

Community Group Practices in Canada: Are They Ready to Reform Their Practice?

ERIC Educational Resources Information Center

Murray, Suzanne; Silver, Ivan; Patel, Dilip; Dupuis, Martin; Hayes, Sean M.; Davis, Dave

2008-01-01

Introduction: Governments and healthcare organizations in Canada are reforming the clinical practice structures and policies to deliver primary care to the population. A key component of primary healthcare reform is the establishment of an interdisciplinary, community-based team approach to patient care. This study was undertaken to provide…

Patient-level clinically meaningful improvements in activities of daily living and pain after total hip arthroplasty: data from a large US institutional registry.

PubMed

Singh, Jasvinder A; Lewallen, David G

2013-06-01

To characterize patient-level clinically meaningful improvements in pain and limitation of key activities of daily living (ADLs) after primary or revision total hip arthroplasty (THA). We analysed prospectively collected data from the Mayo Clinic Total Joint Registry to study clinically meaningful improvements in index hip pain severity and limitation in seven key ADLs (walking, climbing stairs, putting on shoes/socks, picking up objects, getting in/out of car, rising from a chair and sitting), from preoperative to 2- and 5-year post-THA. The primary THA cohort consisted of 6168 responders preoperatively, 5707 at 2 years and 3289 at 5 years postoperatively. The revision THA cohort consisted of 2063 responders preoperatively, 2682 at 2 years and 1627 at 5 years postoperatively. In the primary THA cohort, clinically meaningful pain reduction to mild or no hip pain at 2 years was reported by 94% with moderate and 91% with severe preoperative pain; respective proportions were 91% and 89% at 5-year follow-up. For revision THA, respective proportions were 84% and 77% at 2 years and 80% and 78% at 5 years. In the primary THA cohort, up to 4% with moderate and 17% with severe preoperative ADL limitation reported severe limitation in the respective activity 2 years post-primary THA; at 5 years, the respective proportions were up to 7% and 20%. Respective proportions for revision THA were up to 10% and 26% at 2 years and 13% and 30% at 5 years. These comprehensive data for patient-level clinically meaningful improvements in pain and seven key ADLs can help patients set realistic goals for improvement after THA.

Setting priorities in primary health care--on whose conditions? A questionnaire study.

PubMed

Arvidsson, Eva; André, Malin; Borgquist, Lars; Andersson, David; Carlsson, Per

2012-11-26

In Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. The aim of this study was to describe and analyse: 1) GPs', nurses', and patients' prioritising in routine primary care 2) The association between the three key priority setting criteria and the overall priority assigned by the GPs and nurses to individual patients. Paired questionnaires were distributed to all patients and the GPs or nurses they had contact with during a 2-week period at four health centres in Sweden. The staff registered the health conditions or health problem, and the planned intervention. Then they estimated the severity of the health condition, the expected patient benefit, and the cost-effectiveness of the planned intervention. Both the staff and the patients reported their overall prioritisation of the patient. In total, 1851 paired questionnaires were collected. Compared to the medical staff, the patients assigned relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions. Severity of the health condition was the priority setting criterion that had the strongest association with the overall priority for the staff as a whole, but for the GPs it was cost-effectiveness. The challenge for primary care providers is to balance the patients' demands with medical needs and cost-effectiveness. Transparent priority setting in primary care might contribute to a greater consensus between GPs and nurses on how to use the key priority setting criteria.

Essential elements of professional nursing environments in Primary Care and their influence on the quality of care.

PubMed

Gea-Caballero, Vicente; Castro-Sánchez, Enrique; Júarez-Vela, Raúl; Díaz-Herrera, Miguel Ángel; de Miguel-Montoya, Isabel; Martínez-Riera, José Ramón

Nursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality. We conducted a cross-sectional study in primary care organisations using the Practice Environment Scale - Nursing Work Index tool. We collected sociodemographic variables, scores, and selected the essential items conducive to optimal care. Appropriate parametric and non-parametric statistical tests were used to analyse relations between variables (CI = 95%, error = 5%). One hundred and forty-four nurses participated. The mean total score was 81.6. The results for the five dimensions included in the Practice Environment Scale - Nursing Work Index ranged from 2.25 - 2.92 (Mean). Twelve key items for quality of care were selected; six were positive in the Canary Islands, two were mixed, and four negative. 7/12 items were included in Dimension 2 (fundamentals of nursing). Being a manager was statistically associated with higher scores (p<.000). Years of experience was inversely associated with scores in the 12 items (p<.021). Nursing work environments in primary care settings in the Canary Islands are comparable to others previously studied in Spain. Areas to improve were human resources and participation of nurses in management decisions. Nurse managers must be knowledgeable about their working environments so they can focus on improvements in key dimensions. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Does the use of the Informed Healthcare Choices (IHC) primary school resources improve the ability of grade-5 children in Uganda to assess the trustworthiness of claims about the effects of treatments: protocol for a cluster-randomised trial.

PubMed

Nsangi, Allen; Semakula, Daniel; Oxman, Andrew D; Oxman, Matthew; Rosenbaum, Sarah; Austvoll-Dahlgren, Astrid; Nyirazinyoye, Laetitia; Kaseje, Margaret; Chalmers, Iain; Fretheim, Atle; Sewankambo, Nelson K

2017-05-18

The ability to appraise claims about the benefits and harms of treatments is crucial for informed health care decision-making. This research aims to enable children in East African primary schools (the clusters) to acquire and retain skills that can help them make informed health care choices by improving their ability to obtain, process and understand health information. The trial will evaluate (at the individual participant level) whether specially designed learning resources can teach children some of the key concepts relevant to appraising claims about the benefits and harms of health care interventions (treatments). This is a two-arm, cluster-randomised trial with stratified random allocation. We will recruit 120 primary schools (the clusters) between April and May 2016 in the central region of Uganda. We will stratify participating schools by geographical setting (rural, semi-urban, or urban) and ownership (public or private). The Informed Healthcare Choices (IHC) primary school resources consist of a textbook and a teachers' guide. Each of the students in the intervention arm will receive a textbook and attend nine lessons delivered by their teachers during a school term, with each lesson lasting 80 min. The lessons cover 12 key concepts that are relevant to assessing claims about treatments and making informed health care choices. The second arm will carry on with the current primary school curriculum. We have designed the Claim Evaluation Tools to measure people's ability to apply key concepts related to assessing claims about the effects of treatments and making informed health care choices. The Claim Evaluation Tools use multiple choice questions addressing each of the 12 concepts covered by the IHC school resources. Using the Claim Evaluation Tools we will measure two primary outcomes: (1) the proportion of children who 'pass', based on an absolute standard and (2) their average scores. As far as we are aware this is the first randomised trial to assess whether key concepts needed to judge claims about the effects of treatment can be taught to primary school children. Whatever the results, they will be relevant to learning how to promote critical thinking about treatment claims. Trial status: the recruitment of study participants was ongoing at the time of manuscript submission. Pan African Clinical Trial Registry, trial identifier: PACTR201606001679337 . Registered on 13 June 2016.

How do Policy and Institutional Settings Shape Opportunities for Community-Based Primary Health Care? A Comparison of Ontario, Québec and New Zealand

PubMed Central

Miller, Fiona; Breton, Mylaine; Couturier, Yves; Morton-Chang, Frances; Ashton, Toni; Sheridan, Nicolette; Peckham, Alexandra; Williams, A Paul; Kenealy, Tim; Wodchis, Walter

2017-01-01

Community-based primary health care describes a model of service provision that is oriented to the population health needs and wants of service users and communities, and has particular relevance to supporting the growing proportion of the population with multiple chronic conditions. Internationally, aspirations for community-based primary health care have stimulated local initiatives and influenced the design of policy solutions. However, the ways in which these ideas and influences find their way into policy and practice is strongly mediated by policy settings and institutional legacies of particular jurisdictions. This paper seeks to compare the key institutional and policy features of Ontario, Québec and New Zealand that shape the ‘space available’ for models of community-based primary health care to take root and develop. Our analysis suggests that two key conditions are the integration of relevant health and social sector organisations, and the range of policy levers that are available and used by governments. New Zealand has the most favourable conditions, and Ontario the least favourable. All jurisdictions, however, share a crucial barrier, namely the ‘barbed-wire fence’ that separates funding of medical and ‘non-medical’ primary care services, and the clear interests primary care doctors have in maintaining this fence. Moves in the direction of system-wide community-based primary health care require a gradual dismantling of this fence. PMID:28970754

The Pacific primary health care workforce in New Zealand: what are the needs?

PubMed

Ape-Esera, Luisa; Nosa, Vili; Goodyear-Smith, Felicity

2009-06-01

To scope future needs of the NZ Pacific primary care workforce. Semi-structured interviews with key informants including Pacific primary care workers in both Pacific and mainstream primary health care organisations and managers at funding, policy and strategy levels. Qualitative thematic analysis using general inductive approach. Thirteen stakeholders interviewed (four males, nine females) in 2006. Included both NZ- and Island-born people of Samoan, Tongan, Niuean, Fijian and NZ European ethnicities; age 20-65 years. Occupations included general practitioner, practice nurse, community worker, Ministry of Health official and manager representing mainstream and Pacific-specific organisations. Key themes were significant differences in attributes, needs and values between 'traditional' and contemporary Pacific people; issues regarding recruitment and retention of Pacific people into the primary health care workforce; importance of cultural appropriateness for Pacific populations utilising mainstream and Pacific-specific primary care services and both advantages and disadvantages of 'Pacific for Pacific' services. Interviews demonstrated heterogeneity of Pacific population regarding ethnicity, age, duration of NZ residence and degree of immersion in their culture and language. Higher rates of mental disorder amongst NZ-born Pacific signpost urgent need to address the impact of Western values on NZ-born Pacific youth. Pacific population growth means increasing demands on health services with Pacific worker shortages across all primary health care occupations. However it is not possible for all Pacific people to be treated by Pacific organisations and/or by Pacific health workers and services should be culturally competent regardless of ethnicity of providers.

Indonesian experts' perspectives on a curriculum for psychologists working in primary health care in Indonesia

PubMed Central

Setiyawati, Diana; Blashki, Grant; Wraith, Ruth; Colucci, Erminia; Minas, Harry

2014-01-01

Mental health is a critical issue in Indonesia, since its population ranks among the top five in the world and the prevalence of common mental disorders is 11.6% of the adult population. However, the need to build an effective mental health-care system that is accessible to the whole population has only been recently addressed. The Aceh tsunami in 2004 brought to the forefront an unexpected window of opportunity to build a mental health-care system. Integration of mental health care into primary health care is a key strategy to close the treatment gap for people with mental disorders. Existing integration of psychologists into primary health care is a big step to meet the shortage of mental health-care specialists. As primary mental health care is an emerging field, the perspectives of Indonesian experts on Indonesian mental health care are needed to develop a curriculum for training psychologists to work in primary health care. In this study, data have been collected through semi-structured interviews with 24 Indonesian mental health experts, and three focus group discussions with 26 psychologists. Overall, experts agreed that to be able to work in primary health-care psychologists should have roles and training ranging from clinical to advocacy skills. Participants also agreed that psychologists should work in the community and contribute to primary health care as service providers and that strong collaborations between psychologists and other primary health-care providers are the key; these can be developed partly through referral and by respecting each other's unique strengths. PMID:25750806

A meta-ethnography of organisational culture in primary care medical practice.

PubMed

Grant, Suzanne; Guthrie, Bruce; Entwistle, Vikki; Williams, Brian

2014-01-01

Over the past decade, there has been growing international interest in shaping local organisational cultures in primary healthcare. However, the contextual relevance of extant culture assessment instruments to the primary care context has been questioned. The aim of this paper is to derive a new contextually appropriate understanding of the key dimensions of primary care medical practice organisational culture and their inter-relationship through a synthesis of published qualitative research. A systematic search of six electronic databases followed by a synthesis using techniques of meta-ethnography involving translation and re-interpretation. A total of 16 papers were included in the meta-ethnography from the UK, the USA, Canada, Australia and New Zealand that fell into two related groups: those focused on practice organisational characteristics and narratives of practice individuality; and those focused on sub-practice variation across professional, managerial and administrative lines. It was found that primary care organisational culture was characterised by four key dimensions, i.e. responsiveness, team hierarchy, care philosophy and communication. These dimensions are multi-level and inter-professional in nature, spanning both practice and sub-practice levels. The research contributes to organisational culture theory development. The four new cultural dimensions provide a synthesized conceptual framework for researchers to evaluate and understand primary care cultural and sub-cultural levels. The synthesised cultural dimensions present a framework for practitioners to understand and change organisational culture in primary care teams. The research uses an innovative research methodology to synthesise the existing qualitative research and is one of the first to develop systematically a qualitative conceptual framing of primary care organisational culture.

Suicide prevention in primary care: General practitioners' views on service availability

PubMed Central

2010-01-01

Background Primary care may be a key setting for suicide prevention. However, comparatively little is known about the services available in primary care for suicide prevention. The aims of the current study were to describe services available in general practices for the management of suicidal patients and to examine GPs views on these services. We carried out a questionnaire and interview study in the North West of England. We collected data on GPs views of suicide prevention generally as well as local mental health service provision. Findings During the study period (2003-2005) we used the National Confidential Inquiry Suicide database to identify 286 general practitioners (GPs) who had registered patients who had died by suicide. Data were collected from GPs and practice managers in 167 practices. Responses suggested that there was greater availability of services and training for general mental health issues than for suicide prevention specifically. The three key themes which emerged from GP interviews were: barriers accessing primary or secondary mental health services; obstacles faced when referring a patient to mental health services; managing change within mental health care services Conclusions Health professionals have an important role to play in preventing suicide. However, GPs expressed concerns about the quality of primary care mental health service provision and difficulties with access to secondary mental health services. Addressing these issues could facilitate future suicide prevention in primary care. PMID:20920302

Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care.

PubMed

Sopcak, Nicolette; Aguilar, Carolina; O'Brien, Mary Ann; Nykiforuk, Candace; Aubrey-Bassler, Kris; Cullen, Richard; Grunfeld, Eva; Manca, Donna Patricia

2016-12-01

BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) is a patient-based intervention to improve chronic disease prevention and screening (CDPS) for cardiovascular disease, diabetes, cancer, and associated lifestyle factors in patients aged 40 to 65. The key component of BETTER is a prevention practitioner (PP), a health care professional with specialized skills in CDPS who meets with patients to develop a personalized prevention prescription, using the BETTER toolkit and Brief Action Planning. The purpose of this qualitative study was to understand facilitators and barriers of the implementation of the BETTER 2 program among clinicians, patients, and stakeholders in three (urban, rural, and remote) primary care settings in Newfoundland and Labrador, Canada. We collected and analyzed responses from 20 key informant interviews and 5 focus groups, as well as memos and field notes. Data were organized using Nvivo 10 software and coded using constant comparison methods. We then employed the Consolidated Framework for Implementation Research (CFIR) to focus our analysis on the domains most relevant for program implementation. The following key elements, within the five CFIR domains, were identified as impacting the implementation of BETTER 2: (1) intervention characteristics-complexity and cost of the intervention; (2) outer setting-perception of fit including lack of remuneration, lack of resources, and duplication of services, as well as patients' needs as perceived by physicians and patients; (3) characteristics of prevention practitioners-interest in prevention and ability to support and motivate patients; (4) inner setting-the availability of a local champion and working in a team versus working as a team; and (5) process-planning and engaging, collaboration, and teamwork. The implementation of a novel CDPS program into new primary care settings is a complex, multi-level process. This study identified key elements that hindered or facilitated the implementation of the BETTER approach in three primary care settings in Newfoundland and Labrador. Employing the CFIR as an overarching typology allows for comparisons with other contexts and settings, and may be useful for practices, researchers, and policy-makers interested in the implementation of CDPS programs.

From Our Practices to Yours: Key Messages for the Journey to Integrated Behavioral Health.

PubMed

Gold, Stephanie B; Green, Larry A; Peek, C J

The historic, cultural separation of primary care and behavioral health has caused the spread of integrated care to lag behind other practice transformation efforts. The Advancing Care Together study was a 3-year evaluation of how practices implemented integrated care in their local contexts; at its culmination, practice leaders ("innovators") identified lessons learned to pass on to others. Individual feedback from innovators, key messages created by workgroups of innovators and the study team, and a synthesis of key messages from a facilitated discussion were analyzed for themes via immersion/crystallization. Five key themes were captured: (1) frame integrated care as a necessary paradigm shift to patient-centered, whole-person health care; (2) initialize: define relationships and protocols up-front, understanding they will evolve; (3) build inclusive, empowered teams to provide the foundation for integration; (4) develop a change management strategy of continuous evaluation and course-correction; and (5) use targeted data collection pertinent to integrated care to drive improvement and impart accountability. Innovators integrating primary care and behavioral health discerned key messages from their practical experience that they felt were worth sharing with others. Their messages present insight into the challenges unique to integrating care beyond other practice transformation efforts. © Copyright 2017 by the American Board of Family Medicine.

Local Implementation of Alcohol Screening and Brief Intervention at Five Veterans Health Administration Primary Care Clinics: Perspectives of Clinical and Administrative Staff.

PubMed

Williams, Emily C; Achtmeyer, Carol E; Young, Jessica P; Rittmueller, Stacey E; Ludman, Evette J; Lapham, Gwen T; Lee, Amy K; Chavez, Laura J; Berger, Douglas; Bradley, Katharine A

2016-01-01

Population-based alcohol screening, followed by brief intervention for patients who screen positive for unhealthy alcohol use, is widely recommended for primary care settings and considered a top prevention priority, but is challenging to implement. However, new policy initiatives in the U.S., including the Affordable Care Act, may help launch widespread implementation. While the nationwide Veterans Health Administration (VA) has achieved high rates of documented alcohol screening and brief intervention, research has identified quality problems with both. We conducted a qualitative key informant study to describe local implementation of alcohol screening and brief intervention from the perspectives of frontline adopters in VA primary care in order to understand the process of implementation and factors underlying quality problems. A purposive snowball sampling method was used to identify and recruit key informants from 5 VA primary care clinics in the northwestern U.S. Key informants completed 20-30 minute semi-structured interviews, which were recorded, transcribed, and qualitatively analyzed using template analysis. Key informants (N=32) included: clinical staff (n=14), providers (n=14), and administrative informants (n=4) with varying participation in implementation of and responsibility for alcohol screening and brief intervention at the medical center. Ten inter-related themes (5 a priori and 5 emergent) were identified and grouped into 3 applicable domains of Greenhalgh's conceptual framework for dissemination of innovations, including values of adopters (theme 1), processes of implementation (themes 2 and 3), and post-implementation consequences in care processes (themes 4-10). While key informants believed alcohol use was relevant to health and important to address, the process of implementation (in which no training was provided and electronic clinical reminders "just showed up") did not address critical training and infrastructure needs. Key informants lacked understanding of the goals of screening and brief intervention, believed referral to specialty addictions treatment (as opposed to offering brief intervention) was the only option for following up on a positive screen, reported concern regarding limited availability of treatment resources, and lacked optimism regarding patients' interest in seeking help. Findings suggest that the local process of implementing alcohol screening and brief intervention may have inadequately addressed important adopter needs and thus may have ultimately undermined, instead of capitalized on, staff and providers' belief in the importance of addressing alcohol use as part of primary care. Additional implementation strategies, such as training or academic detailing, may address some unmet needs and help improve the quality of both screening and brief intervention. However, these strategies may be resource-intensive and insufficient for comprehensively addressing implementation barriers. Published by Elsevier Inc.

Digital Based Media Design: The Innovative Contribution of Design Graduates from Vocational and Higher Education Sectors

ERIC Educational Resources Information Center

Doloswala, Kalika Navin; Thompson, Darrall; Toner, Phillip

2013-01-01

Design is increasingly being recognised as a key source of competitive advantage in the innovation economy of many countries. The key objective of this research was to understand the contribution by design graduates to creative industries innovative activities. Primary research was conducted to understand barriers and limitations of graduate…

The Dynamics of Narrative Writing in Primary Grade Children: Writing Process Factors Predict Story Quality

ERIC Educational Resources Information Center

von Koss Torkildsen, Janne; Morken, Frøydis; Helland, Wenche A.; Helland, Turid

2016-01-01

In this study of third grade school children, we investigated the association between writing process measures recorded with key stroke logging and the final written product. Moreover, we examined the cognitive predictors of writing process and product measures. Analyses of key strokes showed that while most children spontaneously made local…

Creativity in the Hong Kong Classroom: What Is the Contextual Practice?

ERIC Educational Resources Information Center

Forrester, Victor; Hui, Anna

2007-01-01

A review is offered of Hong Kong's current education reform that sites a key role for "creativity." This key role leads us to ask "Creativity in the Hong Kong Classroom: what is the contextual practice?" To address this question 27 Primary classroom teachers across three subject areas were observed and rated using the Classroom…

Language Learning at Key Stage 2: Findings from a Longitudinal Study

ERIC Educational Resources Information Center

Cable, Carrie; Driscoll, Patricia; Mitchell, Rosamond; Sing, Sue; Cremin, Teresa; Earl, Justine; Eyres, Ian; Holmes, Bernardette; Martin, Cynthia; Heins, Barbara

2012-01-01

This paper discusses some of the findings from a 3-year longitudinal study of language learning in the upper stage of English primary schools, i.e. at Key Stage 2. This largely qualitative study (commissioned by the then Department for Children, Schools and Families) was designed to explore and document developing provision and practice in a…

Pupil Mobility, Attainment and Progress in Primary School

ERIC Educational Resources Information Center

Strand, Steve; Demie, Feyisa

2006-01-01

This article presents an analysis of the association between pupil mobility and educational attainment in the 2002 national end of Key Stage 2 (KS2) tests for 11-year-old pupils in an inner London education authority. The results show that pupil mobility is strongly associated with low attainment in the end of key stage tests. However, the…

Mechanisms that Trigger a Good Health-Care Response to Intimate Partner Violence in Spain. Combining Realist Evaluation and Qualitative Comparative Analysis Approaches.

PubMed

Goicolea, Isabel; Vives-Cases, Carmen; Hurtig, Anna-Karin; Marchal, Bruno; Briones-Vozmediano, Erica; Otero-García, Laura; García-Quinto, Marta; San Sebastian, Miguel

2015-01-01

Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence. A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software. The emerging programme theory highlighted the importance of the combination of each team's self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence. Interventions to improve primary health care teams' response to intimate partner violence should focus on strengthening team's self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the protocol combined with a large working experience in primary health care, and other factors such as training, a good team climate, and having a champion social worker on the team, also played a key role. Measures to sustain such interventions and promote these contextual factors should be encouraged.

[Interdisciplinary AWMF guideline for the diagnostics of primary immunodeficiency].

PubMed

Farmand, S; Baumann, U; von Bernuth, H; Borte, M; Foerster-Waldl, E; Franke, K; Habermehl, P; Kapaun, P; Klock, G; Liese, J; Marks, R; Müller, R; Nebe, T; Niehues, T; Schuster, V; Warnatz, K; Witte, T; Ehl, S; Schulze, I

2011-11-01

Primary immunodeficiencies are potentially life-threatening diseases. Over the last years, the clinical phenotype and the molecular basis of an increasing number of immunological defects have been characterized. However, in daily practice primary immunodeficiencies are still often diagnosed too late. Considering that an early diagnosis may reduce morbidity and mortality of affected patients, an interdisciplinary guideline for the diagnosis of primary immunodeficiencies was developed on behalf of the Arbeitsgemeinschaft Pädiatrische Immunologie (API) and the Deutsche Gesellschaft für Immunologie (DGfI). The guideline is based on expert opinion and on knowledge from other guidelines and recommendations from Germany and other countries, supplemented by data from studies that support the postulated key messages (level of evidence III). With the contribution of 20 representatives, belonging to 14 different medical societies and associations, a consensus-based guideline with a representative group of developers and a structured consensus process was created (S2k). Under the moderation of a representative of the Association of the Scientific Medical Societies in Germany (AWMF) the nominal group process took place in April 2011. The postulated key messages were discussed and voted on following a structured consensus procedure. In particular, modified warning signs for primary immunodeficiencies were formulated and immunological emergency situations were defined. © Georg Thieme Verlag KG Stuttgart · New York.

Embracing value co-creation in primary care services research: a framework for success.

PubMed

Janamian, Tina; Crossland, Lisa; Jackson, Claire L

2016-04-18

Value co-creation redresses a key criticism of researcher-driven approaches to research - that researchers may lack insight into the end users' needs and values across the research journey. Value co-creation creates, in a step-wise way, value with, and for, multiple stakeholders through regular, ongoing interactions leading to innovation, increased productivity and co-created outcomes of value to all parties - thus creating a "win more-win more" environment. The Centre of Research Excellence (CRE) in Building Primary Care Quality, Performance and Sustainability has co-created outcomes of value that have included robust and enduring partnerships, research findings that have value to end users (such as the Primary Care Practice Improvement Tool and the best-practice governance framework), an International Implementation Research Network in Primary Care and the International Primary Health Reform Conference. Key lessons learned in applying the strategies of value co-creation have included the recognition that partnership development requires an investment of time and effort to ensure meaningful interactions and enriched end user experiences, that research management systems including governance, leadership and communication also need to be "co-creative", and that openness and understanding is needed to work across different sectors and cultures with flexibility, fairness and transparency being essential to the value co-creation process.

The Practice of Continuous Assessment in Primary Schools: The Case of Chagni, Ethiopia

ERIC Educational Resources Information Center

Abejehu, Sintayehu Belay

2016-01-01

Continuous assessment is part and parcel of instructional process that has to be taken as a key tool in educational quality assurance endeavor. Thus, this article examined the actual practice of continuous assessment in primary schools of Chagni City Administration, Ethiopia. To address this purpose the study employed descriptive survey design.…

Towards an Effective Freeware Resource for Music Composition in the Primary Classroom

ERIC Educational Resources Information Center

Hart, Adam

2017-01-01

This paper presents an ongoing project to develop a freeware resource for music composition in the primary classroom. The national curriculum for music at Key Stages 1 and 2 calls for students to "compose music for a range of purposes using the inter-related dimensions of music", a challenging aim that demands significant guidance,…

Principals' and Teachers' Views of Spirituality in Principal Leadership in Three Primary Schools

ERIC Educational Resources Information Center

Gibson, Alaster

2014-01-01

This article discusses key findings from my doctoral research involving a qualitative case study inquiring into the lived experiences of spirituality in principal leadership and its influence on teachers and their teaching within three public primary school contexts in New Zealand. Spirituality is understood in this article as a complex and…

Teaching for Transfer: Insights from Theory and Practices in Primary-Level French-Second-Language Classrooms

ERIC Educational Resources Information Center

Thomas, Reed; Mady, Callie

2014-01-01

This paper illustrates teaching for transfer across languages by synthesizing key insights from theory and previously published research alongside our case study data from primary-level teachers in core French-second-language (CF) classrooms in Ontario, Canada. Drawing on research that redefines language transfer as a resource, this study drew on…

Teaching Mathematics with Technology. How to Win People and Influence Friends: Calculators in the Primary Grades.

ERIC Educational Resources Information Center

Taylor, Lyn, Ed.; Thompson, Virginia, Comp.

1992-01-01

Postulated here is the notion that the exploration of number patterns with calculators is a valuable mathematical learning activity that should be commenced in the primary grades. Various activities are presented that make use of the constant function key, which is available on many of the inexpensive four-function calculators. (JJK)

The Enhancement of Musical and Other Learning for Both Teachers and Students through a Weekly Choir Session

ERIC Educational Resources Information Center

Heyning, Lyndell

2010-01-01

Primary schools are such busy demanding places. Educators are concerned with a crowded curriculum and high emphasis placed on the development and cultivation of literacy and numeracy concepts. Teachers are generally concerned with the delivery and teaching expectations of all key learning areas of the primary school curriculum. However, the…

Child-Led Enquiry in Primary Science

ERIC Educational Resources Information Center

Dunlop, Lynda; Compton, Kirsty; Clarke, Linda; McKelvey-Martin, Valerie

2015-01-01

This research describes and evaluates the application of a child-led approach to scientific enquiry (the Community of Scientific Enquiry, CoSE) to children aged 8-11 (Key Stage 2) in Northern Ireland. Primary teachers were introduced to CoSE at a workshop and asked to evaluate its implementation with their class. Results from children (n = 364)…

Learning Support Policy for Mathematics in Irish Primary Schools: Equal Access but Unequal Needs

ERIC Educational Resources Information Center

Travers, Joseph

2010-01-01

This paper critiques learning-support policy for mathematics in Irish primary schools. The key policy question addressed is how equitable the development of the learning-support service has been in addressing low achievement in mathematics in designated schools compared to non-designated schools. The core argument developed is that there is a link…

Preservice Primary Teachers' Depth and Accuracy of Knowledge of Tropical Cyclones

ERIC Educational Resources Information Center

Lane, Rod; Catling, Simon

2016-01-01

Climatic hazards are a key feature of life. It is vital that teachers are knowledgeable about these phenomena in order to develop their students' understanding of them. This study used a mixed methods approach to examine the accuracy and depth of preservice primary teachers' (n = 430) knowledge of tropical cyclones. The findings suggest that…

Politics and Preschool: The Political Economy of Investment in Pre-Primary Education. Policy Research Working Paper 5647

ERIC Educational Resources Information Center

Kosec, Katrina

2011-01-01

What drives governments with similar revenues to publicly provide very different amounts of goods for which private substitutes are available? Key examples are education and health care. This paper compares spending by Brazilian municipalities on pre-primary education--a good that is also provided privately--with spending on public infrastructure…

How Cinchona Alkaloid-Derived Primary Amines Control Asymmetric Electrophilic Fluorination of Cyclic Ketones

PubMed Central

2015-01-01

The origin of selectivity in the α-fluorination of cyclic ketones catalyzed by cinchona alkaloid-derived primary amines is determined with density functional calculations. The chair preference of a seven-membered ring at the fluorine transfer transition state is key in determining the sense and level of enantiofacial selectivity. PMID:24967514

Educational Quality Differences in a Middle-Income Country: The Urban-Rural Gap in Malaysian Primary Schools

ERIC Educational Resources Information Center

Othman, Mariam; Muijs, Daniel

2013-01-01

Shortcomings of educational quality in rural schools remain a key focus in the literature related to developing countries. This paper studies whether rural primary schools in Malaysia, an upper middle-income developing country, are still experiencing lower levels of educational resources, school climate, school leadership, and parental involvement…

Informing One-to-One Computing in Primary Schools: Student Use of Netbooks

ERIC Educational Resources Information Center

Larkin, Kevin; Finger, Glenn

2011-01-01

Although one-to-one laptop programs are being introduced in many schools, minimal research has been conducted regarding their effectiveness in primary schools. Evidence-based research is needed to inform significant funding, deployment and student use of computers. This article analyses key findings from a study conducted in four Year 7 classrooms…

Inter-Professional Primary Care Practices Addressing Diabetes Prevention and Management

ERIC Educational Resources Information Center

Beagrie, Lesley

2011-01-01

Imagine a partnership of university and community which addresses the needs of the community to keep its citizens healthy as long as possible. Through a planning exercise to address the community's needs in primary health care and health promotion, the university has developed key strategic directions to help support the needs of the community it…

A Review of Homework Literature as a Precursor to Practitioner-Led Doctoral Research in a Primary School

ERIC Educational Resources Information Center

Rudman, Nicholas Paul Charles

2014-01-01

Homework in the primary school is a subject much debated by teachers, parents and pupils. This paper offers a brief critique of key issues in the current homework debate with particular reference to research literature, theoretical perspectives, educational policy and other professional publications. Consequently, a discourse between homework in…

Nutrition in primary health care: using a Delphi process to design new interdisciplinary services.

PubMed

Brauer, Paula; Dietrich, Linda; Davidson, Bridget

2006-01-01

A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers' nutrition services. The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

Integrating pharmacists into primary care teams: barriers and facilitators.

PubMed

Jorgenson, Derek; Laubscher, Tessa; Lyons, Barry; Palmer, Rebecca

2014-08-01

This study evaluated the barriers and facilitators that were experienced as pharmacists were integrated into 23 existing primary care teams located in urban and rural communities in Saskatchewan, Canada. Qualitative design using data from one-on-one telephone interviews with pharmacists, physicians and nurse practitioners from the 23 teams that integrated a new pharmacist role. Four researchers from varied backgrounds used thematic analysis of the interview transcripts to determine key themes. The research team met on multiple occasions to agree on the key themes and received written feedback from an external auditor and two of the original interviewees. Seven key themes emerged describing the barriers and facilitators that the teams experienced during the pharmacist integration: (1) relationships, trust and respect; (2) pharmacist role definition; (3) orientation and support; (4) pharmacist personality and professional experience; (5) pharmacist presence and visibility; (6) resources and funding; and (7) value of the pharmacist role. Teams from urban and rural communities experienced some of these challenges in unique ways. Primary care teams that integrated a pharmacist experienced several common barriers and facilitators. The negative impact of these barriers can be mitigated with effective planning and support that is individualized for the type of community where the team is located. © 2013 Royal Pharmaceutical Society.

Polyethyleneimine-modified iron oxide nanoparticles for brain tumor drug delivery using magnetic targeting and intra-carotid administration

PubMed Central

Chertok, Beata; David, Allan E.; Yang, Victor C.

2010-01-01

This study aimed to examine the applicability of polyethyleneimine (PEI)-modified magnetic nanoparticles (GPEI) as a potential vascular drug/gene carrier to brain tumors. In vitro, GPEI exhibited high cell association and low cell toxicity – properties which are highly desirable for intracellular drug/gene delivery. In addition, a high saturation magnetization of 93 emu/g Fe was expected to facilitate magnetic targeting of GPEI to brain tumor lesions. However, following intravenous administration, GPEI could not be magnetically accumulated in tumors of rats harboring orthotopic 9L-gliosarcomas due to its poor pharmacokinetic properties, reflected by a negligibly low plasma AUC of 12 ± 3 μg Fe/ml*min. To improve “passive” GPEI presentation to brain tumor vasculature for subsequent “active” magnetic capture, we examined the intra-carotid route as an alternative for nanoparticle administration. Intra-carotid administration in conjunction with magnetic targeting resulted in 30-fold (p = 0.002) increase in tumor entrapment of GPEI compared to that seen with intravenous administration. In addition, magnetic accumulation of cationic GPEI (ζ-potential = + 37.2 mV) in tumor lesions was 5.2-fold higher (p = 0.004) than that achieved with slightly anionic G100 (ζ-potential = −12 mV) following intra-carotid administration, while no significant accumulation difference was detected between the two types of nanoparticles in the contra-lateral brain (p = 0.187). These promising results warrant further investigation of GPEI as a potential cell-permeable, magnetically-responsive platform for brain tumor delivery of drugs and genes. PMID:20494439

Polyethyleneimine-modified iron oxide nanoparticles for brain tumor drug delivery using magnetic targeting and intra-carotid administration.

PubMed

Chertok, Beata; David, Allan E; Yang, Victor C

2010-08-01

This study aimed to examine the applicability of polyethyleneimine (PEI)-modified magnetic nanoparticles (GPEI) as a potential vascular drug/gene carrier to brain tumors. In vitro, GPEI exhibited high cell association and low cell toxicity--properties which are highly desirable for intracellular drug/gene delivery. In addition, a high saturation magnetization of 93 emu/g Fe was expected to facilitate magnetic targeting of GPEI to brain tumor lesions. However, following intravenous administration, GPEI could not be magnetically accumulated in tumors of rats harboring orthotopic 9L-gliosarcomas due to its poor pharmacokinetic properties, reflected by a negligibly low plasma AUC of 12 +/- 3 microg Fe/ml min. To improve "passive" GPEI presentation to brain tumor vasculature for subsequent "active" magnetic capture, we examined the intra-carotid route as an alternative for nanoparticle administration. Intra-carotid administration in conjunction with magnetic targeting resulted in 30-fold (p=0.002) increase in tumor entrapment of GPEI compared to that seen with intravenous administration. In addition, magnetic accumulation of cationic GPEI (zeta-potential = + 37.2 mV) in tumor lesions was 5.2-fold higher (p=0.004) than that achieved with slightly anionic G100 (zeta-potential= -12 mV) following intra-carotid administration, while no significant accumulation difference was detected between the two types of nanoparticles in the contra-lateral brain (p=0.187). These promising results warrant further investigation of GPEI as a potential cell-permeable, magnetically-responsive platform for brain tumor delivery of drugs and genes. 2010 Elsevier Ltd. All rights reserved.

Determination of ganglioside composition and structure in human brain hemangioma by chip-based nanoelectrospray ionization tandem mass spectrometry.

PubMed

Schiopu, Catalin; Flangea, Corina; Capitan, Florina; Serb, Alina; Vukelić, Zeljka; Kalanj-Bognar, Svjetlana; Sisu, Eugen; Przybylski, Michael; Zamfir, Alina D

2009-12-01

We report here on a preliminary investigation of ganglioside composition and structure in human hemangioma, a benign tumor in the frontal cortex (HFC) in comparison to normal frontal cortex (NFC) tissue using for the first time advanced mass spectrometric methods based on fully automated chip-nanoelectrospray (nanoESI) high-capacity ion trap (HCT) and collision-induced dissociation (CID). The high ionization efficiency, sensitivity and reproducibility provided by the chip-nanoESI approach allowed for a reliable MS-based ganglioside comparative assay. Unlike NFC, ganglioside mixture extracted from HFC was found dominated by species of short glycan chains exhibiting lower overall sialic acid content. In HFC, only GT1 (d18:1/20:0), and GT3 (d18:1/25:1) polysialylated species were detected. Interestingly, none of these trisialylated forms was detected in NFC, suggesting that such components might selectively be associated with HFC. Unlike the case of previously investigated high malignancy gliosarcoma, in HFC one modified O-Ac-GD2 and one modified O-Ac-GM4 gangliosides were observed. This aspect suggests that these O-acetylated structures could be associated with cerebral tumors having reduced malignancy grade. Fragmentation analysis by CID in MS(2) mode using as precursors the ions corresponding to GT1 (d18:1/20:0) and GD1 (d18:1/20:0) provided data corroborating for the first time the presence of the common GT1a and GT1b isomers and the incidence of unusual GT1c and GT1d glycoforms in brain hemangioma tumor.

Inhibition of angiogenesis and tumor growth in the brain. Suppression of endothelial cell turnover by penicillamine and the depletion of copper, an angiogenic cofactor.

PubMed Central

Brem, S. S.; Zagzag, D.; Tsanaclis, A. M.; Gately, S.; Elkouby, M. P.; Brien, S. E.

1990-01-01

Microvascular proliferation, a hallmark of malignant brain tumors, represents an attractive target of anticancer research, especially because of the quiescent nonproliferative endothelium of the normal brain. Cerebral neoplasms sequester copper, a trace metal that modulates angiogenesis. Using a rabbit brain tumor model, normocupremic animals developed large vascularized VX2 carcinomas. By contrast, small, circumscribed, relatively avascular tumors were found in the brains of rabbits copper-depleted by diet and penicillamine treatment (CDPT). The CDPT rabbits showed a significant decrease in serum copper, copper staining of tumor cell nuclei, microvascular density, the tumor volume, endothelial cell turnover, and an increase in the vascular permeability (breakdown of the blood-brain barrier), as well as peritumoral brain edema. In non-tumor-bearing animals, CDPT did not alter the vascular permeability or the brain water content. CDPT also inhibited the intracerebral growth of the 9L gliosarcoma in F-344 rats, with a similar increase of the peritumoral vascular permeability and the brain water content. CDPT failed to inhibit tumor growth and the vascularization of the VX2 carcinoma in the thigh muscle or the metastases to the lung, findings that may reflect regional differences in the responsiveness of the endothelium, the distribution of copper, or the activity of cuproenzymes. Metabolic and pharmacologic withdrawal of copper suppresses intracerebral tumor angiogenesis; angiosuppression is a novel biologic response modifier for the in situ control of tumor growth in the brain. Images Figure 2 Figure 4 Figure 5 Figure 6 Figure 8 Figure 10 Figure 12 Figure 15 Figure 16 PMID:1700617

Ultrastructural characterization of the new NG97ht human-derived glioma cell line using two different electron microscopy technical procedures.

PubMed

Machado, Camila Maria Longo; Zorzeto, Tatiane Queiroz; Bianco, Juares E Romero; Rosa, Renata Giardini; Genari, Selma Candelaria; Joazeiro, Paulo Pinto; Verinaud, Liana

2009-04-01

On the basis of transmission electron microscopy observations in tumor cell lines, oncologists have made innumerous diagnostic and therapeutical progresses. Following this path, the UNICAMP immunopathologies laboratory established the NG97 cell line derived from a human astrocytoma grade III, which when injected to the athymic nude mouse flank developed a grade IV astrocytoma. In this study, we focused on ultrastructural characterization of the NG97 cells after being recovered from xenotransplant (NG97ht). These cells in culture were assayed by two different electron microscopy procedures to characterize ultrastructures related to grade IV astrocytomas and to observe their structures through cell subcultivation. Additionally, comparative morphological descriptions of different cell passages in these technical procedures could be a useful tool for improving electron microscopy cell lineage protocols. Results from many cell passage observations showed ultrastructural similarities, which suggest malignant and glioblastoma phenotypes. In the first procedure, NG97ht cells were harvested and then incorporated into agarose before subjecting them to electron microscopy protocols, whereas in the second one, monolayer cells grew first on cover slides. Comparison among protocols revealed that organelles, cytoplasmatic extensions, spatial conformation of filopodia, and cell attachment to substrate were more preserved in the second procedure. Furthermore, in this latter procedure, a unique ellipsoidal structure was observed, which was already described when dealing with gliosarcoma cell line elsewhere. Therefore, these analyses demonstrated a morphological characterization of a new NG97ht cell line using electron transmission microscopy. Moreover, it has been shown that the second procedure provides more detailed information compared with the first.

High-sensitivity detection and monitoring of microcirculation using cutaneous and catheter probes for Doppler optical coherence tomography

NASA Astrophysics Data System (ADS)

Yang, Victor X.; Gordon, M. L.; Qi, B.; Yue, E. Seng; Tang, S.; Bisland, Stuart K.; Pekar, J.; Lo, S.; Marcon, Norman E.; Wilson, B.; Vitkin, Alex

2003-07-01

Background: Currently clinical Doppler ultrasound cannot detect microvascular blood flow and it is difficult to provide depth discrimination using laser Doppler flowmetry. Doppler optical coherence tomography (DOCT) is a novel technique for noninvasive subsurface imaging of microcirculation and tissue structure. Aims: To design handheld and catheter-based DOCT probes for clinical cutaneous and endoscopic imaging. To develop signal processing techniques for real-time detection and quantification of microvascular blood flow. Methods: A DOCT system, with interchangeable cutaneous and catheter probes, was developed. The axial spatial resolution was 10 μm, and the velocity resolution was 20 μm/s, using a 1300 nm broadband infrared light. The system achieved real-time imaging with frame rates up to 32 Hz at 512 x 256 pixels per frame. We used the system to detect microcirculation in human skin and rat esophagus, and to monitor microvascular responses to photodynamic therapy (PDT) in a rat tumor model. Results: We present experimental results from in vivo DOCT imaging of microcirculation in human skin arterio-venous malformations (AVM), normal rat esophagus, and a rat gliosarcoma PDT model. In the PDT model, we followed microvascular responses to PDT and observed differences in the microcirculation during and after therapy, which can have important implications for PDT dosimetry and treatment optimization. Conclusions: To our knowledge, this is the first demonstration of endoscopic catheter-based DOCT detection of microcirculation in vivo. In addition, AVM can be detected using handheld cutaneous DOCT probes under clinical settings. DOCT may serve as a real-time monitoring tool for PDT dosimetry, especially for vascular targeting photosensitizers.

Primary Immunodeficiency Diseases: An Update on the Classification from the International Union of Immunological Societies Expert Committee for Primary Immunodeficiency

PubMed Central

Al-Herz, Waleed; Bousfiha, Aziz; Casanova, Jean-Laurent; Chapel, Helen; Conley, Mary Ellen; Cunningham-Rundles, Charlotte; Etzioni, Amos; Fischer, Alain; Franco, Jose Luis; Geha, Raif S.; Hammarström, Lennart; Nonoyama, Shigeaki; Notarangelo, Luigi Daniele; Ochs, Hans Dieter; Puck, Jennifer M.; Roifman, Chaim M.; Seger, Reinhard; Tang, Mimi L. K.

2011-01-01

We report the updated classification of primary immunodeficiency diseases, compiled by the ad hoc Expert Committee of the International Union of Immunological Societies. As compared to the previous edition, more than 15 novel disease entities have been added in the updated version. For each disorders, the key clinical and laboratory features are provided. This updated classification is meant to help in the diagnostic approach to patients with these diseases. PMID:22566844

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders.

PubMed

Mashamba-Thompson, Tivani P; Jama, Ngcwalisa A; Sartorius, Benn; Drain, Paul K; Thompson, Rowan M

2017-01-08

Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients' needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

PubMed Central

Mashamba-Thompson, Tivani P.; Jama, Ngcwalisa A.; Sartorius, Benn; Drain, Paul K.; Thompson, Rowan M.

2017-01-01

Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics. PMID:28075337

Key Dimensions of Effective Leadership for Change: A Focus on Township and Rural Schools in South Africa

ERIC Educational Resources Information Center

Ngcobo, Thandi; Tikly, Leon Paul

2010-01-01

The article identifies key dimensions of effective leadership for change in historically disadvantaged, township and rural schools in South Africa. It is based on original case study research in 13 schools in Kwa-Zulu Natal. Although the sample included mainly township and rural primary and secondary schools it also included a smaller sample of…

Same pattern, different mechanism: Locking onto the role of key species in seafloor ecosystem process

PubMed Central

Woodin, Sarah Ann; Volkenborn, Nils; Pilditch, Conrad A.; Lohrer, Andrew M.; Wethey, David S.; Hewitt, Judi E.; Thrush, Simon F.

2016-01-01

Seafloor biodiversity is a key mediator of ecosystem functioning, but its role is often excluded from global budgets or simplified to black boxes in models. New techniques allow quantification of the behavior of animals living below the sediment surface and assessment of the ecosystem consequences of complex interactions, yielding a better understanding of the role of seafloor animals in affecting key processes like primary productivity. Combining predictions based on natural history, behavior of key benthic species and environmental context allow assessment of differences in functioning and process, even when the measured ecosystem property in different systems is similar. Data from three sedimentary systems in New Zealand illustrate this. Analysis of the behaviors of the infaunal ecosystem engineers in each system revealed three very different mechanisms driving ecosystem function: density and excretion, sediment turnover and surface rugosity, and hydraulic activities and porewater bioadvection. Integrative metrics of ecosystem function in some cases differentiate among the systems (gross primary production) and in others do not (photosynthetic efficiency). Analyses based on behaviors and activities revealed important ecosystem functional differences and can dramatically improve our ability to model the impact of stressors on ecosystem and global processes. PMID:27230562

Same pattern, different mechanism: Locking onto the role of key species in seafloor ecosystem process.

PubMed

Woodin, Sarah Ann; Volkenborn, Nils; Pilditch, Conrad A; Lohrer, Andrew M; Wethey, David S; Hewitt, Judi E; Thrush, Simon F

2016-05-27

Seafloor biodiversity is a key mediator of ecosystem functioning, but its role is often excluded from global budgets or simplified to black boxes in models. New techniques allow quantification of the behavior of animals living below the sediment surface and assessment of the ecosystem consequences of complex interactions, yielding a better understanding of the role of seafloor animals in affecting key processes like primary productivity. Combining predictions based on natural history, behavior of key benthic species and environmental context allow assessment of differences in functioning and process, even when the measured ecosystem property in different systems is similar. Data from three sedimentary systems in New Zealand illustrate this. Analysis of the behaviors of the infaunal ecosystem engineers in each system revealed three very different mechanisms driving ecosystem function: density and excretion, sediment turnover and surface rugosity, and hydraulic activities and porewater bioadvection. Integrative metrics of ecosystem function in some cases differentiate among the systems (gross primary production) and in others do not (photosynthetic efficiency). Analyses based on behaviors and activities revealed important ecosystem functional differences and can dramatically improve our ability to model the impact of stressors on ecosystem and global processes.

LitMiner and WikiGene: identifying problem-related key players of gene regulation using publication abstracts.

PubMed

Maier, Holger; Döhr, Stefanie; Grote, Korbinian; O'Keeffe, Sean; Werner, Thomas; Hrabé de Angelis, Martin; Schneider, Ralf

2005-07-01

The LitMiner software is a literature data-mining tool that facilitates the identification of major gene regulation key players related to a user-defined field of interest in PubMed abstracts. The prediction of gene-regulatory relationships is based on co-occurrence analysis of key terms within the abstracts. LitMiner predicts relationships between key terms from the biomedical domain in four categories (genes, chemical compounds, diseases and tissues). Owing to the limitations (no direction, unverified automatic prediction) of the co-occurrence approach, the primary data in the LitMiner database represent postulated basic gene-gene relationships. The usefulness of the LitMiner system has been demonstrated recently in a study that reconstructed disease-related regulatory networks by promoter modelling that was initiated by a LitMiner generated primary gene list. To overcome the limitations and to verify and improve the data, we developed WikiGene, a Wiki-based curation tool that allows revision of the data by expert users over the Internet. LitMiner (http://andromeda.gsf.de/litminer) and WikiGene (http://andromeda.gsf.de/wiki) can be used unrestricted with any Internet browser.

Tracking the Key Constituents of Concern of the WTP LAW Stream

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

Mabrouki, Ridha B.; Matlack, Keith S.; Abramowitz, Howard

The testing results presented in the present report were also obtained on a DM10 melter system operated with the primary WTP LAW offgas system components with recycle, as specified in the statement of work (SOW) [6] and detailed in the Test Plan for this work [7]. The primary offgas system components include the SBS, the WESP, and a recycle system that allows recycle of liquid effluents back to the melter, as in the present baseline for the WTP LAW vitrification. The partitioning of technetium and other key constituents between the glass waste form, the offgas system liquid effluents, the offgasmore » stream that exits the WESP, and the liquid condensate from the vacuum evaporator were quantified in this work. The tests employed three different LAW streams spanning a range of waste compositions anticipated for WTP. Modifications to the offgas system and operational strategy were made to expedite the approach to steady state concentrations of key constituents in the glass and offgas effluent solutions during each test.« less

Patient-Centered Appointment Scheduling Using Agent-Based Simulation

PubMed Central

Turkcan, Ayten; Toscos, Tammy; Doebbeling, Brad N.

2014-01-01

Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.e. improving access to acute care) might have a negative impact other components of the system (i.e. reduced continuity of care for chronic patients). Therefore, primary care clinics should consider implementing multiple interventions tailored for their patient population needs. We collected rapid ethnography and observations to better understand clinic workflow and key constraints. We then developed an agent-based simulation model that includes all access modalities (appointments, walk-ins, and after-hours access), incorporate resources and key constraints and determine the best appointment scheduling method that improves access and continuity of care. This paper demonstrates the value of simulation models to test a variety of alternative strategies to improve access to care through scheduling. PMID:25954423

Determinants of Primary School Non-Enrollment and Absenteeism: Results from a Retrospective, Convergent Mixed Methods, Cohort Study in Rural Western Kenya

PubMed Central

King, Nia; Dewey, Cate; Borish, David

2015-01-01

Background Education is a key element in the socioeconomic development required to improve quality of life in Kenya. Despite the introduction of free primary education, primary school enrollment and attendance levels remain low. Drawing on qualitative and quantitative data, this study explores the determinants of non-enrollment and absenteeism in rural western Kenya and potential mitigation strategies to address these issues. Methods The study was conducted in Bwaliro village in rural western Kenya. A random sample of 64 students was obtained by blocking the village primary school’s student population according to grade level, gender, and orphan status. Qualitative and quantitative data were collected through interviews with parents, guardians, and key informants, and focus group discussions with students. Quantitative data were compared using chi-square tests, Student’s T-test, and Poisson regressions. Qualitative data were analyzed using thematic content analysis. Results Malaria, menstruation, and lack of money were among the most notable determinants of primary school dropout and absenteeism, and these factors disproportionately impacted orphans and female students. Potential mitigation strategies suggested by the community included provision of malaria treatment or prevention, reduction in education costs, expansion of the established school-feeding program, and provision of sanitary pads. Conclusion Despite free primary education, numerous factors continue to prevent children in rural western Kenya from attending primary school. The findings suggest that interventions should primarily target orphaned and female students. Prior to implementation, suggested mitigation strategies should be assessed for cost-effectiveness. PMID:26371885

Regulation of dendrite growth and maintenance by exocytosis

PubMed Central

Peng, Yun; Lee, Jiae; Rowland, Kimberly; Wen, Yuhui; Hua, Hope; Carlson, Nicole; Lavania, Shweta; Parrish, Jay Z.; Kim, Michael D.

2015-01-01

ABSTRACT Dendrites lengthen by several orders of magnitude during neuronal development, but how membrane is allocated in dendrites to facilitate this growth remains unclear. Here, we report that Ras opposite (Rop), the Drosophila ortholog of the key exocytosis regulator Munc18-1 (also known as STXBP1), is an essential factor mediating dendrite growth. Neurons with depleted Rop function exhibit reduced terminal dendrite outgrowth followed by primary dendrite degeneration, suggestive of differential requirements for exocytosis in the growth and maintenance of different dendritic compartments. Rop promotes dendrite growth together with the exocyst, an octameric protein complex involved in tethering vesicles to the plasma membrane, with Rop–exocyst complexes and exocytosis predominating in primary dendrites over terminal dendrites. By contrast, membrane-associated proteins readily diffuse from primary dendrites into terminals, but not in the reverse direction, suggesting that diffusion, rather than targeted exocytosis, supplies membranous material for terminal dendritic growth, revealing key differences in the distribution of materials to these expanding dendritic compartments. PMID:26483382

Chemistry Provision for Primary Pupils: The Experiences of 10 Years of Bristol ChemLabs Outreach

ERIC Educational Resources Information Center

Harrison, Timothy G.; Shallcross, Dudley E.

2016-01-01

Bristol ChemLabS, the UK's Centre for Excellence in Teaching and Learning in practical chemistry, delivers numerous outreach activity days per year for thousands of primary school pupils annually. These mainly comprise demonstration assemblies and hands on workshops for pupils in the main. The activities support the UK's Key Stage 2 science…

Contextualising Teaching and Learning in Rural Primary Schools: Using Agricultural Experience. Volume 1 [and] Volume 2. Education Research.

ERIC Educational Resources Information Center

Taylor, Peter; Mulhall, Abigail

This research project examined the potential role of agricultural experiences as a vehicle for meeting the diverse learning needs of rural primary students in developing countries. Volume 1 of the project report represents a literature review that investigated a "new role" for agriculture as a key element for developing rural students'…

Conceptions of Responsibility within and beyond Neoliberal Frames: A Story of Leadership in an English Primary School

ERIC Educational Resources Information Center

Keddie, Amanda

2018-01-01

This paper explores different conceptions of responsibility within and beyond neoliberal frames. Such exploration draws on the experiences and accounts of "Ashleigh," a head teacher at a primary school in outer London that is part of an academy chain. Ashleigh and her school were key participants in a study that explored matters of…

Pupils' Environmental Awareness and Knowledge: A Springboard for Action in Primary Schools in Kenya's Rift Valley

ERIC Educational Resources Information Center

Mutisya, Sammy M.; Barker, Miles

2011-01-01

This study was carried out with 276 standard eight pupils in eleven primary schools in the rural town of Narok in Kenya's Rift Valley. It evaluated their awareness of key environmental issues in their local area and their knowledge about the causes, effects and solutions pertaining to these environmental issues. A descriptive research design was…

Primary Teachers' Understanding of Four Chemical Phenomena: Effect of an In-Service Training Course

ERIC Educational Resources Information Center

Papageorgiou, George; Stamovlasis, Dimitrios; Johnson, Philip

2013-01-01

One hundred and thirty Greek primary school teachers participated in a study, where the effectiveness of a specially designed intervention on chemical changes was tested. The study took place in the wider context of an in-service training course where the key feature was an innovative approach based on the concept of a substance and its…

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

ERIC Educational Resources Information Center

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

2018-01-01

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

Changing School Board Governance in Primary Education through School Inspections

ERIC Educational Resources Information Center

Ehren, Melanie C. M.; Honingh, M. E.; Hooge, E. H.; O'Hara, J.

2016-01-01

This paper addresses if, and to what extent, the current working methods of the Dutch Inspectorate of Education affect the governance of school boards in schools for primary education. A key facet of the working method is the inspection meeting with the school board. Drawing upon a large quantitative study (n = 244) we are able to identify some…

"I'm the Best in Maths. Boys Rule, Girls Drool." Masculinities, Mathematics and Primary Schooling

ERIC Educational Resources Information Center

Bhana, Deevia

2005-01-01

This article presents elements of an ethnographic study of gendered identities among boys and girls in the early years of primary schooling. Foregrounding group work in mathematics as a key arena for the production of young masculine identities, this article goes some way to addressing what is absent from sociological portrayals of young children,…

Relationships between net primary productivity and forest stand age in U.S. forests

Treesearch

Liming He; Jing M. Chen; Yude Pan; Richard Birdsey; Jens Kattge

2012-01-01

Net primary productivity (NPP) is a key flux in the terrestrial ecosystem carbon balance, as it summarizes the autotrophic input into the system. Forest NPP varies predictably with stand age, and quantitative information on the NPP-age relationship for different regions and forest types is therefore fundamentally important for forest carbon cycle modeling. We used four...

Chronicling Innovative Learning in Primary Classrooms: Conceptualizing a Theatrical Pedagogy to Successfully Engage Young Children Learning Science

ERIC Educational Resources Information Center

McGregor, Debra

2014-01-01

This article reports on an innovative pedagogical approach devised to re-envigorate primary (elementary) teachers' practice in the United Kingdom for older children. Learning science in elementary schools for 8-11 year olds (Key Stage 2 in England) has been constrained for several decades while teachers prepared them for national tests. The recent…

Primary Teachers' Particle Ideas and Explanations of Physical Phenomena: Effect of an In-Service Training Course

ERIC Educational Resources Information Center

Papageorgiou, George; Stamovlasis, Dimitrios; Johnson, Phil Michael

2010-01-01

This paper presents a study concerning Greek primary school teachers' (n = 162) ideas about the particulate nature of matter and their explanations of physical phenomena. The study took place during an in-service training course where the effectiveness of a specially designed intervention was tested. A key feature was an approach based on the…

Exploration of the Consortium on Reading Excellence Phonics Survey: An Instrument for Assessing Primary-Grade Students' Phonics Knowledge

ERIC Educational Resources Information Center

Reutzel, D. Ray; Brandt, Lorilynn; Fawson, Parker C.; Jones, Cindy D.

2014-01-01

This article examines the Consortium on Reading Excellence-Phonics Survey (CORE-PS), an informal, inexpensive, and widely disseminated assessment tool that is used to determine primary-grade students' knowledge of and abilities to apply key alphabetic and phonics understandings to decode a mix of real and pseudo-words. Evidence is reported of the…

Air Force Handbook. 109th Congress

DTIC Science & Technology

2009-01-01

FY06 Combat Survivor Evader Locator (CSEL) Acquisition Status Capabilities/Profile Functions /Performance Parameters 38 • Air Force’s primary source for...Broadcast Service (GBS) Capabilities/Profile Acquisition Status Functions /Performance Parameters • Purchase Requirements (Phase 2): • 3 primary ...Operations (AF CONOPS) that support the CSAF and joint vision of combat operations. • AF CONOPS describe key Air Force mission and/or functional areas

School Readiness: The Views of Pre-Service Preschool Teachers and Pre-Service Primary Teachers

ERIC Educational Resources Information Center

Sahin Sak, Ikbal Tuba

2016-01-01

This study compares the views of the concept of school readiness held by 50 pre-service preschool teachers and 50 pre-service primary teachers. Data were collected through a semi-structured interview protocol, and the word-list and key-words-in-context techniques were used for qualitative data analysis. Findings show that pre-service preschool…

Viking orbiter system primary mission

NASA Technical Reports Server (NTRS)

Goudy, J. R.

1977-01-01

An overview of Viking Orbiter (VO) system and subsystem performances during the primary mission (the time period from VO-1 launch on August 20, 1975, through November 15, 1976) is presented. Brief descriptions, key design requirements, pertinent historical information, unique applications or situations, and predicted versus actual performances are included for all VO-1 and VO-2 subsystems, both individually and as an integrated system.

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

PubMed

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

2015-01-01

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

Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries.

PubMed

Bitton, Asaf; Ratcliffe, Hannah L; Veillard, Jeremy H; Kress, Daniel H; Barkley, Shannon; Kimball, Meredith; Secci, Federica; Wong, Ethan; Basu, Lopa; Taylor, Chelsea; Bayona, Jaime; Wang, Hong; Lagomarsino, Gina; Hirschhorn, Lisa R

2017-05-01

Primary health care (PHC) has been recognized as a core component of effective health systems since the early part of the twentieth century. However, despite notable progress, there remains a large gap between what individuals and communities need, and the quality and effectiveness of care delivered. The Primary Health Care Performance Initiative (PHCPI) was established by an international consortium to catalyze improvements in PHC delivery and outcomes in low- and middle-income countries through better measurement and sharing of effective models and practices. PHCPI has developed a framework to illustrate the relationship between key financing, workforce, and supply inputs, and core primary health care functions of first-contact accessibility, comprehensiveness, coordination, continuity, and person-centeredness. The framework provides guidance for more effective assessment of current strengths and gaps in PHC delivery through a core set of 25 key indicators ("Vital Signs"). Emerging best practices that foster high-performing PHC system development are being codified and shared around low- and high-income countries. These measurement and improvement approaches provide countries and implementers with tools to assess the current state of their PHC delivery system and to identify where cross-country learning can accelerate improvements in PHC quality and effectiveness.

Primary Care Provider Views About Usefulness and Dissemination of a Web-Based Depression Treatment Information Decision Aid.

PubMed

Beaulac, Julie; Westmacott, Robin; Walker, John R; Vardanyan, Gohar

2016-06-08

Decisions related to mental health are often complex, problems often remain undetected and untreated, information unavailable or not used, and treatment decisions frequently not informed by best practice or patient preferences. The objective of this paper was to obtain the opinions of health professionals working in primary health care settings about a Web-based information decision aid (IDA) for patients concerning treatment options for depression and the dissemination of the resources in primary care settings. Participants were recruited from primary care clinics in Winnipeg and Ottawa, Canada, and included 48 family physicians, nurses, and primary care staff. The study design was a qualitative framework analytic approach of 5 focus groups. Focus groups were conducted during regular staff meetings, were digitally recorded, and transcripts created. Analysis involved a content and theme analysis. Seven key themes emerged including the key role of the primary care provider, common questions about treatments, treatment barriers, sources of patient information, concern about quality and quantity of available information, positive opinions about the IDA, and disseminating the IDA. The most common questions mentioned were about medication and side effects and alternatives to medication. Patients have limited access to alternative treatment options owing to cost and availability. Practitioners evaluated the IDA positively. The resources were described as useful, supportive of providers' messages, and accessible for patients. There was unanimous consensus that information needs to be available electronically through the Internet.

Older Patients' Perspectives on Quality of Serious Illness Care in Primary Care.

PubMed

Abu Al Hamayel, Nebras; Isenberg, Sarina R; Hannum, Susan M; Sixon, Joshua; Smith, Katherine Clegg; Dy, Sydney M

2018-01-01

Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. To explore older patients' perspectives on the quality of serious illness care in primary care. Qualitative interview study. Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic's quality improvement initiative. We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method. We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians' perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.

Primary Care Practice Development: A Relationship-Centered Approach

PubMed Central

Miller, William L.; Crabtree, Benjamin F.; Nutting, Paul A.; Stange, Kurt C.; Jaén, Carlos Roberto

2010-01-01

PURPOSE Numerous primary care practice development efforts, many related to the patient-centered medical home (PCMH), are emerging across the United States with few guides available to inform them. This article presents a relationship-centered practice development approach to understand practice and to aid in fostering practice development to advance key attributes of primary care that include access to first-contact care, comprehensive care, coordination of care, and a personal relationship over time. METHODS Informed by complexity theory and relational theories of organizational learning, we built on discoveries from the American Academy of Family Physicians’ National Demonstration Project (NDP) and 15 years of research to understand and improve primary care practice. RESULTS Primary care practices can fruitfully be understood as complex adaptive systems consisting of a core (a practice’s key resources, organizational structure, and functional processes), adaptive reserve (practice features that enhance resilience, such as relationships), and attentiveness to the local environment. The effectiveness of these attributes represents the practice’s internal capability. With adequate motivation, healthy, thriving practices advance along a pathway of slow, continuous developmental change with occasional rapid periods of transformation as they evolve better fits with their environment. Practice development is enhanced through systematically using strategies that involve setting direction and boundaries, implementing sensing systems, focusing on creative tensions, and fostering learning conversations. CONCLUSIONS Successful practice development begins with changes that strengthen practices’ core, build adaptive reserve, and expand attentiveness to the local environment. Development progresses toward transformation through enhancing primary care attributes. PMID:20530396

Expert opinion regarding the preparation of entry-level physiotherapists for primary healthcare practice, examined using Biggs 3P's model of teaching learning.

PubMed

McMahon, Sinead; O'Donoghue, Grainne; Doody, Catherine; O'Neill, Geraldine; Cusack, Tara

2016-05-01

The scope of contemporary physiotherapy practice is a critical factor in determining the appropriate educational preparation for physiotherapists now and into the future. The world-wide shift from secondary to primary healthcare has, and is, continuing to result in new and different ways of working. It is crucial that curricular changes reflect these developments. In this study a qualitative approach using Biggs 3P's - Pressage, Process and Product model to discuss curriculum design. The aim of the study was to explore the perspectives of both national and international physiotherapy educators/practitioners in primary healthcare, on the key elements required in physiotherapy education programmes to prepare future primary healthcare practitioners. Snowball sampling was used to identify experts in education and/or primary healthcare practice. Semi-structured interviews were conducted using an interview guide based on the Biggs 3P's model. Twelve participants were recruited from Ireland (n = 2), the UK (n = 4), Canada (n = 3), New Zealand (n = 2) and Australia (n = 1) using snowball sampling. Interviews were analysed using thematic analysis. Themes identified included; understanding the philosophy of physiotherapy practice, cultural competence, inter-disciplinary team working and communication skills. Contextual factors and teaching and learning strategies were discussed. There is an urgent need for physiotherapy education programmes to adopt the concept of primary healthcare as the basis for the physiotherapy curriculum and illuminate key components for consideration.

Bottom-up linkages between primary production, zooplankton, and fish in a shallow, hypereutrophic lake.

PubMed

Matsuzaki, Shin-Ichiro S; Suzuki, Kenta; Kadoya, Taku; Nakagawa, Megumi; Takamura, Noriko

2018-06-09

Nutrient supply is a key bottom-up control of phytoplankton primary production in lake ecosystems. Top-down control via grazing pressure by zooplankton also constrains primary production, and primary production may simultaneously affect zooplankton. Few studies have addressed these bidirectional interactions. We used convergent cross-mapping (CCM), a numerical test of causal associations, to quantify the presence and direction of the causal relationships among environmental variables (light availability, surface water temperature, NO 3 -N, and PO 4 -P), phytoplankton community composition, primary production, and the abundances of five functional zooplankton groups (large-cladocerans, small-cladocerans, rotifers, calanoids, and cyclopoids) in Lake Kasumigaura, a shallow, hypereutrophic lake in Japan. CCM suggested that primary production was causally influenced by NO 3 -N and phytoplankton community composition; there was no detectable evidence of a causal effect of zooplankton on primary production. Our results also suggest that rotifers and cyclopoids were forced by primary production, and cyclopoids were further influenced by rotifers. However, our CCM suggested that primary production was weakly influenced by rotifers (i.e., bidirectional interaction). These findings may suggest complex linkages between nutrients, primary production, and rotifers and cyclopoids, a pattern that has not been previously detected or has been neglected. We used linear regression analysis to examine the relationships between the zooplankton community and pond smelt (Hypomesus nipponensis), the most abundant planktivore and the most important commercial fish species in Lake Kasumigaura. The relative abundance of pond smelt was significantly and positively correlated with the abundances of rotifers and cyclopoids, which were causally influenced by primary production. This finding suggests that bottom-up linkages between nutrient, primary production, and zooplankton abundance might be a key mechanism supporting high planktivore abundance in eutrophic lakes. Because increases in primary production and cyanobacteria blooms are likely to occur simultaneously in hypereutrophic lakes, our study highlights the need for ecosystem management to resolve the conflict between good water quality and high fishery production. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Keys and the crisis in taxonomy: extinction or reinvention?

PubMed

Walter, David Evans; Winterton, Shaun

2007-01-01

Dichotomous keys that follow a single pathway of character state choices to an end point have been the primary tools for the identification of unknown organisms for more than two centuries. However, a revolution in computer diagnostics is now under way that may result in the replacement of traditional keys by matrix-based computer interactive keys that have many paths to a correct identification and make extensive use of hypertext to link to images, glossaries, and other support material. Progress is also being made on replacing keys entirely by optical matching of specimens to digital databases and DNA sequences. These new tools may go some way toward alleviating the taxonomic impediment to biodiversity studies and other ecological and evolutionary research, especially with better coordination between those who produce keys and those who use them and by integrating interactive keys into larger biological Web sites.

Primary Health Care: Comparing Public Health Nursing Models in Ireland and Norway

PubMed Central

Leahy-Warren, Patricia; Day, Mary Rose

2013-01-01

Health of populations is determined by a multitude of contextual factors. Primary Health Care Reform endeavors to meet the broad health needs of populations and remains on international health agendas. Public health nurses are key professionals in the delivery of primary health care, and it is important for them to learn from global experiences. International collaboration is often facilitated by academic exchanges. As a result of one such exchange, an international PHN collaboration took place. The aim of this paper is to analyse the similarities and differences in public health nursing in Ireland and Norway within the context of primary care. PMID:23606956

Chemical thermodynamic data. 1. The concept of links to the chemical elements and the historical development of key thermodynamic data

NASA Astrophysics Data System (ADS)

Wolery, Thomas J.; Jové Colón, Carlos F.

2017-09-01

Chemical thermodynamic data remain a keystone for geochemical modeling and reactive transport simulation as applied to an increasing number of applications in the earth sciences, as well as applications in other areas including metallurgy, material science, and industrial process design. The last century has seen the development of a large body of thermodynamic data and a number of major compilations. The past several decades have seen the development of thermodynamic databases in digital form designed to support computer calculations. However, problems with thermodynamic data appear to be persistent. One problem pertains to the use of inconsistent primary key reference data. Such data pertain to elemental reference forms and key, stoichiometrically simple chemical species including metal oxides, CO2, water, and aqueous species such as Na+ and Cl-. A consistent set of primary key data (standard Gibbs energies, standard enthalpies, and standard entropies for key chemical species) for 298.15 K and 1 bar pressure is essential. Thermochemical convention is to define the standard Gibbs energy and the standard enthalpy of an individual chemical species in terms of formation from reference forms of the constituent chemical elements. We propose a formal concept of "links" to the elemental reference forms. This concept involves a documented understanding of all reactions and calculations leading to values for a formation property (standard Gibbs energy or enthalpy). A valid link consists of two parts: (a) the path of reactions and corrections and (b) the associated data, which are key data. Such a link differs from a bare "key" or "reference" datum in that it requires additional information. Some or all of its associated data may also be key data. In evaluating a reported thermodynamic datum, one should identify the links to the chemical elements, a process which can be time-consuming and which may lead to a dead end (an incomplete link). The use of two or more inconsistent links to the same elemental reference form in a thermodynamic database will result in an inconsistency in the database. Thus, in constructing a database, it is important to establish a set of reliable links (generally resulting in a set of primary reference data) and then correct all data adopted subsequently for consistency with that set. Recommended values of key data have not been constant through history. We review some of this history through the lens of major compilations and other influential reports, and note a number of problem areas. Finally, we illustrate the concepts developed in this paper by applying them to some key species of geochemical interest, including liquid water; quartz and aqueous silica; and gibbsite, corundum, and the aqueous aluminum ion.

Primary Prevention Efforts: How Do We Implement and Monitor the Tier 1 Component of Our Comprehensive, Integrated, Three-Tiered (CI3T) Model?

ERIC Educational Resources Information Center

Lane, Kathleen Lynne; Oakes, Wendy Peia; Magill, Lauren

2014-01-01

In this article, the authors clarify the role of the leadership team, providing a rationale for one integrated team to examine academic, social, and behavioral programming, with careful attention to including all key stakeholders. Next, the authors discuss the procedures for teaching all key stakeholders the comprehensive, integrated, three-tiered…

Identifying people with type 2 diabetes and those at risk: lessons from the measure your waist (MY-WAIST) mixed-methods study in UK primary care.

PubMed

Aujla, Navneet; Stone, Margaret A; Taub, Nicholas; Davies, Melanie J; Khunti, Kamlesh

2013-12-01

This paper focuses mainly on explanations and lessons from a research-based programme for identifying undiagnosed type 2 diabetes and high risk. In addition to outlining key quantitative findings, we specifically aim to explore reasons for low uptake from the perspective of primary care staff involved. The MY-WAIST study was conducted in UK primary care and included the use of oral glucose tolerance tests (OGTTs) and waist measurement. Qualitative data from interviews with healthcare providers and records of meetings were analysed thematically. The key quantitative finding was low uptake of the assessments offered (8.6% overall, 2.6% in inner-city locations with high South Asian residency). In addition to confirming patient-reported barriers including those associated with OGTTs, qualitative findings highlighted a number of primary care provider barriers, including limited staff capacity. Interviewees suggested that those who attended were typically the 'worried well' rather than those from hard-to-reach groups. Implications discussed include the impact of low uptake on the usefulness of the quantitative data obtained, and lessons relevant to research design. Relevance to current guidance regarding early identification strategies is discussed and the importance of addressing the needs of less accessible groups is highlighted. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Health promotion interventions to address climate change using a primary health care approach: a literature review.

PubMed

Walker, Rae; Hassall, John; Chaplin, Sue; Congues, Janet; Bajayo, Rachael; Mason, Wendy

2011-12-01

This project explored the literature in which key concepts in primary health care and health promotion are overtly applied to the problem of climate change. This paper contains a discussion of the literature relevant to health promotion principles and intervention strategies for addressing climate change mitigation and adaptation in the primary health care sector. The concept of primary health care is that used by the World Health Organization, based on the Declaration of Alma Ata and often referred to as comprehensive primary health care to differentiate it from primary medical care. This was a review of literature identified in electronic databases using two sets of search terms. Set A consisted of 'climate change or global warming or greenhouse effect' and set B consisted of 11 key concepts in primary health care and health promotion, for example community resilience, health promotion, social change, food security and economic development. Relevant literature was identified at the intersection of search term A with a term from set B. A search was completed for each set B term. This paper reports a discussion of major categories of health promotion interventions, namely health communication, community building and settings approaches and uses examples drawn from literature on community resilience and summer heat. These interventions are all applicable to the primary health care sector. There is a small literature on health promotion interventions for climate change mitigation and adaptation but it is incomplete and scattered across many sources. An important area for further research is to link the logic of service provision in primary health care to the logic of mitigation and adaptation in a changing environment. Interventions that link the logic must also link diverse services to provide coherent action on local and domestic scales, the scales at which primary health care acts. Another research gap is in regard to institutional change in the primary health care sector. How do the patterns of knowledge, practice and values need to change in the array of organisations that make up comprehensive primary health care?

Strategies to Support the Integration of Behavioral Health and Primary Care: What Have We Learned Thus Far?

PubMed

Dickinson, W Perry

2015-01-01

The articles in this supplement contain a wealth of practical information regarding the integration of behavioral health and primary care. This type of integration effort is complex and greatly benefits from support from outside organizations, as well as collaboration with other practices attempting similar work. This editorial extracts from these articles some of the key lessons learned regarding the integration of behavioral health and primary care for practices and for organizations that support practice transformation. © Copyright 2015 by the American Board of Family Medicine.

Novel Role of MDA-9/Syntenin in Regulating Urothelial Cell Proliferation by Modulating EGFR Signaling

PubMed Central

Dasgupta, Santanu; Menezes, Mitchell E.; Das, Swadesh K.; Emdad, Luni; Janjic, Aleksandar; Bhatia, Shilpa; Mukhopadhyay, Nitai D; Shao, Chunbo; Sarkar, Devanand; Fisher, Paul B.

2013-01-01

Purpose Urothelial cell carcinoma (UCC) rapidly progresses from superficial to muscle-invasive tumors. The key molecules involved in metastatic progression and its early detection require clarification. The present study defines a seminal role of the metastasis-associated gene MDA-9/Syntenin in UCC progression. Experimental Design Expression pattern of MDA-9/Syntenin was examined in 44 primary UCC and the impact of its overexpression and knock down was examined in multiple cells lines and key findings were validated in primary tumors. Results Significantly higher (p= 0.002–0.003) expression of MDA-9/Syntenin was observed in 64% (28/44) of primary tumors and an association was evident with stage (p=0.01), grade (p=0.03) and invasion status (p=0.02). MDA-9/Syntenin overexpression in non-tumorigenic HUC-1 cells increased proliferation (p=0.0012), invasion (p=0.0001) and EGFR, AKT, PI3K and c-Src expression. Alteration of Beta-catenin, E-Cadherin, Vimentin, Claudin-1, ZO-1 and TCF4 expression were also observed. MDA-9/Syntenin knock down in 3 UCC cell lines reversed phenotypic and molecular changes observed in the HUC-1 cells and reduced in vivo metastasis. Key molecular changes observed in the cell lines were confirmed in primary tumors. A physical interaction and co-localization of MDA-9/Syntenin and EGFR was evident in UCC cell lines and primary tumors. A logistic regression model analysis revealed a significant correlation between MDA-9/Syntenin:EGFR and MDA-9/Syntenin: AKT expressions with stage (p=0.04, EGFR), (p=0.01, AKT). A correlation between MDA-9/Syntenin: β-catenin co-expression with stage (p=0.03) and invasion (p=0.04) was also evident. Conclusions Our findings indicate that MDA-9/Syntenin might provide an attractive target for developing detection, monitoring and therapeutic strategies for managing UCC. PMID:23873690

Novel role of MDA-9/syntenin in regulating urothelial cell proliferation by modulating EGFR signaling.

PubMed

Dasgupta, Santanu; Menezes, Mitchell E; Das, Swadesh K; Emdad, Luni; Janjic, Aleksandar; Bhatia, Shilpa; Mukhopadhyay, Nitai D; Shao, Chunbo; Sarkar, Devanand; Fisher, Paul B

2013-09-01

Urothelial cell carcinoma (UCC) rapidly progresses from superficial to muscle-invasive tumors. The key molecules involved in metastatic progression and its early detection require clarification. The present study defines a seminal role of the metastasis-associated gene MDA-9/Syntenin in UCC progression. Expression pattern of MDA-9/Syntenin was examined in 44 primary UCC and the impact of its overexpression and knockdown was examined in multiple cells lines and key findings were validated in primary tumors. Significantly higher (P=0.002-0.003) expression of MDA-9/Syntenin was observed in 64% (28 of 44) of primary tumors and an association was evident with stage (P=0.01), grade (P=0.03), and invasion status (P=0.02). MDA-9/Syntenin overexpression in nontumorigenic HUC-1 cells increased proliferation (P=0.0012), invasion (P=0.0001), and EGF receptor (EGFR), AKT, phosphoinositide 3-kinase (PI3K), and c-Src expression. Alteration of β-catenin, E-cadherin, vimentin, claudin-1, ZO-1, and T-cell factor-4 (TCF4) expression was also observed. MDA-9/Syntenin knockdown in three UCC cell lines reversed phenotypic and molecular changes observed in the HUC-1 cells and reduced in vivo metastasis. Key molecular changes observed in the cell lines were confirmed in primary tumors. A physical interaction and colocalization of MDA-9/Syntenin and EGFR was evident in UCC cell lines and primary tumors. A logistic regression model analysis revealed a significant correlation between MDA-9/Syntenin:EGFR and MDA-9/Syntenin:AKT expressions with stage (P=0.04, EGFR; P=0.01, AKT). A correlation between MDA-9/Syntenin:β-catenin coexpression with stage (P=0.03) and invasion (P=0.04) was also evident. Our findings indicate that MDA-9/Syntenin might provide an attractive target for developing detection, monitoring, and therapeutic strategies for managing UCC. ©2013 AACR.

Enhanced primary mental healthcare for Indigenous Australians: service implementation strategies and perspectives of providers.

PubMed

Reifels, Lennart; Nicholas, Angela; Fletcher, Justine; Bassilios, Bridget; King, Kylie; Ewen, Shaun; Pirkis, Jane

2018-01-01

Improving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations. We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers. We conducted semi-structured interviews with 31 service providers (primary care agency staff, referrers, and mental health professionals) that were analysed thematically and descriptively. Agency-level implementation strategies to enhance service access and cultural appropriateness included: the conduct of local service needs assessments; Indigenous stakeholder consultation and partnership development; establishment of clinical governance frameworks; workforce recruitment, clinical/cultural training and supervision; stakeholder and referrer education; and service co-location at Indigenous health organisations. Dedicated provider-level strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery (involving, flexible referral pathways, suitable locations, adaptation of client engagement and service feedback processes) and, to a lesser extent, the nature and content of interventions (provision of culturally adapted therapy). This study offers insights into key factors underpinning the successful national service implementation approach. Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare for Indigenous people are critically dependent on effective local agency- and provider-level strategies to optimise the integration, adaptation and broader utility of these services within local Indigenous community and healthcare service contexts. Despite the explicit provider focus, this study was limited by a lack of Indigenous stakeholder perspectives. Key study findings are of direct relevance to inform the future implementation and delivery of culturally appropriate primary mental healthcare programs for Indigenous populations in Australia and internationally.

Regional Sediment Management (RSM) Assessment of Longboat Pass, Manatee County, FL

DTIC Science & Technology

2016-06-01

determine the best channel configuration for navigation and most appropriate beneficial use of dredged sediments (the primary criteria used to... channel following the Authorized Channel configuration, and placing sediment on Longboat Key in conjunction with coastal structures to maintain the...use of dredged sediments (the two primary criteria used to evaluate the channel alternatives). RESULTS: Historical and present ebb shoal planform

Leadership Principles Leveraged from Key Civil War Battles

DTIC Science & Technology

2017-05-15

primary research method utilized for this research paper. The purpose of the literature review was to find data and information regarding analysis of...review was the primary research method utilized for this research paper. The purpose of the literature review was to find data and information...data generation and analysis. Organizational Research Methods , 15 (2), 316-335. Becker, W.S. & Burke, M.J. (2014). Instructional staff

The Social and Emotional Functioning of Students with an Autistic Spectrum Disorder during the Transition between Primary and Secondary Schools

ERIC Educational Resources Information Center

Fortuna, Ron

2014-01-01

The transition from the primary to the secondary phase in education can be a pivotal moment for many students, but for students who have autism, their difficulties with socialisation and emotional regulation can make this time period especially challenging. This article explores the experiences of key stakeholders regarding the issue of students…

Hares, Tortoises and the Social Construction of the Pupil: Differentiated Learning in French and English Primary Schools

ERIC Educational Resources Information Center

Raveaud, Maroussia

2005-01-01

This article examines differentiation by task as it is used and perceived in French and English primary schools. It highlights the influence of national context on teaching and learning. The study rests on classroom observations in 12 Key Stage 1 classes located in socially disadvantaged areas. The first section sets the mission of schooling in a…

Capacity Building for Primary Languages through Initial Teacher Education: Could Specialist and Non-Specialist Student Teachers' Complementary Skills Provide a Winning Combination?

ERIC Educational Resources Information Center

Rowe, Jan; Herrera, Maria; Hughes, Bernie; Cawley, Michael

2012-01-01

There has been much debate about the development of a suitably qualified workforce to deliver the objectives of the Key Stage 2 language learning entitlement in England. The model of a skilled primary languages subject leader, working in collaboration with enthusiastic generalist class teachers is emerging as a consistent preference. Relatively…

Comparative Examination of the Primary School Science Curricula in Turkey (Curricula of 1992, 2001, 2005, 2013 and 2017)

ERIC Educational Resources Information Center

Hamurcu, Hülya

2018-01-01

In the present study, the science course curricula of 1992, 2001, 2005, 2013 and 2017 taught at the primary school level in Turkey have been examined comparatively in terms of four main elements (Target, Content, Educational Status, and Measurement and Evaluation). The reason for investigating the science curriculum at five key years was to…

JWST ISIM Primary Structure and Kinematic Mount Configuration

NASA Technical Reports Server (NTRS)

Bartoszyk, Andrew; Carnahan, Tim; Hendricks, Steve; Kaprielian, Charles; Kuhn, Jonathan; Kunt, Cengiz

2004-01-01

In this presentation we will review the evolution of the ISIM primary structure tube topology and kinematic mount configuration to the current baseline concept. We will also show optimization procedures used and challenges resulting from complex joints under launch loads. Two additional key ISIM structure challenges of meeting thermal distortion and stability requirements and metal-composite bonded joint survivability at cryogenic temperatures are covered in other presentations.

Comparison of the Core Primary Curriculum in England to Those of Other High Performing Countries. Research Report DCSF-RW048

ERIC Educational Resources Information Center

Ruddock, Graham; Sainsbury, Marian

2008-01-01

This study looks at the curricula for mathematics, science and literacy, comparing England's curricula with those of other countries based on performance in international comparative surveys. The main objective was to answer the question: How does the content of the Primary Curriculum in England at Key stage 2 compare in literacy, math and science…

Leadership in primary health care: an international perspective.

PubMed

McMurray, Anne

2007-08-01

A primary health care approach is essential to contemporary nursing roles such as practice nursing. This paper examines the evolution of primary health care as a global strategy for responding to the social determinants of health. Primary health care roles require knowledge of, and a focus on social determinants of health, particularly the societal factors that allow and perpetuate inequities and disadvantage. They also require a depth and breadth of leadership skills that are responsive to health needs, appropriate in the social and regulatory context, and visionary in balancing both workforce and client needs. The key to succeeding in working with communities and groups under a primary health care umbrella is to balance the big picture of comprehensive primary health care with operational strategies for selective primary health care. The other essential element involves using leadership skills to promote inclusiveness, empowerment and health literacy, and ultimately, better health.

Development and Process Evaluation of a Primary Care Internet-Based Intervention to Prevent Depression in Emerging Adults

PubMed Central

Van Voorhees, Benjamin W.; Ellis, Justin M.; Gollan, Jackie K.; Bell, Carl C.; Stuart, Scott S.; Fogel, Joshua; Corrigan, Patrick W.; Ford, Daniel E.

2007-01-01

Background: Primary care is a potential setting for implementation of depression prevention interventions using cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT). The purpose of this study was to develop and conduct a process evaluation of a primary care/ Internet-based intervention that addresses key dissemination barriers in a community setting. Method: We used an interdisciplinary team of investigators in a multistep intervention development process among a sample of primary care patients (aged 18 to 24 years). The intervention included an initial primary care motivational interview to engage the participant, 11 Internet-based modules based on CBT (to counter pessimistic thinking) and IPT (to activate social networks and strengthen relationship skills), and a follow-up motivational interview in primary care to enhance behavior change. Each component of the intervention was rated with regard to dissemination barriers of (1) fidelity, (2) motivation, (3) dose, (4) perceived helpfulness (rated on a Likert scale), and (5) potential costs. The study was conducted from April through June of 2004. Results: Fidelity checklist and serial reviews were satisfactory (100% core concepts translated into intervention). Key motivations for participation included (1) risk reduction, (2) intervention effectiveness, (3) “resiliency,” and (4) altruism. In terms of dose, 13 of 14 participants engaged the Internet-based components, completing a mean of 7.2 modules (SD = 3.9). The 2 primary care interviews and the self-assessment and resiliency modules received the highest helpfulness ratings. The duration of the 2 motivational interviews was approximately 17–18 minutes, which is similar to a typical primary care visit. Conclusions: By using multidisciplinary teams and incorporating the opinions of potential users, complex preventive mental health interventions can be translated into primary care settings with adequate fidelity, motivation, dose, and perceived helpfulness, and at a reasonably low cost. PMID:17998953

Measuring Local Public Health and Primary Care Collaboration: A Practice-Based Research Approach.

PubMed

Gyllstrom, Elizabeth; Gearin, Kimberly; Nease, Donald; Bekemeier, Betty; Pratt, Rebekah

2018-06-07

To describe the degree of public health and primary care collaboration at the local level and develop a model framework of collaboration, the Community Collaboration Health Model (CCHM). Mixed-methods, cross-sectional surveys, and semistructured, key informant interviews. All local health jurisdictions in Colorado, Minnesota, Washington, and Wisconsin. Leaders from each jurisdiction were identified to describe local collaboration. Eighty percent of local health directors completed our survey (n = 193), representing 80% of jurisdictions. The parallel primary care survey had a 31% response rate (n = 128), representing 50% of jurisdictions. Twenty pairs of local health directors and primary care leaders participated in key informant interviews. Thirty-seven percent of jurisdictions were classified as having strong foundational and energizing characteristics in the model. Ten percent displayed high energizing/low foundational characteristics, 11% had high foundational/low energizing characteristics, and 42% of jurisdictions were low on both. Respondents reported wide variation in relationship factors. They generally agreed that foundational characteristics were present in current working relationships but were less likely to agree that relationships had factors promoting sustainability or innovation. Both sectors valued working together in principle, yet few did. Identifying shared priorities and achieving tangible benefits may be critical to realizing sustained relationships resulting in population health improvement. Our study reveals broad variation in experiences among local jurisdictions in our sample. Tools, such as the CCHM, and technical assistance may be helpful to support advancing collaboration. Dedicated funding, reimbursement redesign, improved data systems, and data sharing capability are key components of promoting collaboration. Yet, even in the absence of new reimbursement models or funding mechanisms, there are steps leaders can take to build and sustain their relationships. The self-assessment tool and the CCHM can identify opportunities for improving collaboration and link practitioners to strategies.

Fruit and vegetables on prescription: a brief intervention in primary care.

PubMed

Buyuktuncer, Z; Kearney, M; Ryan, C L; Thurston, M; Ellahi, B

2014-04-01

Increasing fruit and vegetable consumption is a goal for the U.K. Therefore, the effectiveness of a fruit and vegetable voucher scheme coupled with key 'five-a-day' consumption messages as a brief intervention in primary care consultations was assessed in the present study. One thousand one hundred and eighty-eight vouchers as a prescription for fruits and vegetables were routinely distributed to patients attending a primary healthcare centre in a deprived area, and 124 volunteer patients routinely attending the centre were included. Telephone-based questionnaires were used to examine changes in consumption over the short and medium term. Other key aspects assessed in the evaluation related to fruit and vegetable purchasing behaviour, knowledge relating to what constitutes a portion size, the relationship between food and health, and barriers to consumption. Although 76.2% of participants used the prescription vouchers when purchasing fruits and vegetables, a significant change in the consumption or purchasing behaviour was not observed (P > 0.05). Participants' level of knowledge relating to the number of portions recommended and the portion size of different fruits and vegetables showed a moderate increase from baseline over the short and medium term. The primary barriers to fruit and vegetable consumption were reported as 'the quality of fresh fruits and vegetables' and 'the money available to spend on food'. The use of 'the fruit and vegetable on prescription' scheme was an effective method of engaging participants in improving awareness of key diet-related health messages. However, further intervention is required to produce a significant impact on the actual behaviour change. © 2013 The Authors Journal of Human Nutrition and Dietetics © 2013 The British Dietetic Association Ltd.

Physical activity intervention in primary care and rheumatology for the management of knee osteoarthritis: A review.

PubMed

Waugh, Esther; King, Lauren; Gakhal, Natasha; Hawker, Gillian; Webster, Fiona; White, Daniel

2018-06-19

Physical activity (PA) is recommended by osteoarthritis (OA) international organizations as an essential component of first-line management of knee OA. Primary care physicians (PCP) and rheumatologists can play a key role in promoting PA but the extent that PA recommendation is occurring in primary and rheumatology care is unclear. This review provides an overview of current practice of PCP- and rheumatology-delivered PA intervention in the United States, Canada and Europe for the management of knee OA and explores barriers to implementing PA intervention in primary and rheumatology care. A search of MEDLINE from 2000-April 2017 was conducted, 848 abstracts were identified from which 22 relevant articles were selected for this review. Overall, recommendation of PA is suboptimal - the majority of studies reported that < 50% of PCPs and rheumatologists make this recommendation to people with knee OA. Key barriers identified were time constraints, lack of patient motivation, PA-specific resources and financial reimbursement, concerns about inadequate training and knowledge for detailed exercise prescription and beliefs about the efficacy of exercise in the management of OA and their role in providing PA intervention. There is a sparsity of data about rheumatology practice and barriers to PA intervention among this group. In summary, this review suggests that there is a notable gap between what clinical guidelines recommend and what is happening in clinical practice. Addressing this practice gap through addressing key barriers provides an opportunity for improving OA care and ultimately, the health and quality of life of people with OA. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

24 CFR 3282.353 - Submission format.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Submission format. States and private organizations that wish to act as primary inspection agencies shall... key personnel who will perform the various functions required under these regulations; (4) The number...

Factors Influence the Digital Media Teaching of Primary School Teachers in a Flipped Class: A Taiwan Case Study

ERIC Educational Resources Information Center

Cheng, Yung-Hsun; Weng, Chia-Wen

2017-01-01

The current study focuses on the key roles that affect the success of a flipped classroom. The research was conducted with a questionnaire survey created from a study of literature review. Out of a total of 441 samples, 424 valid samples (96.14%) from teachers have been received. The study key conclusions are as follows: (1) a principal leadership…

Agreement in reporting between trial publications and current clinical trial registry in high impact journals: A methodological review.

PubMed

Kosa, Sarah Daisy; Mbuagbaw, Lawrence; Borg Debono, Victoria; Bhandari, Mohit; Dennis, Brittany B; Ene, Gabrielle; Leenus, Alvin; Shi, Daniel; Thabane, Michael; Valvasori, Sara; Vanniyasingam, Thuva; Ye, Chenglin; Yranon, Elgene; Zhang, Shiyuan; Thabane, Lehana

2018-02-01

The primary objective of this systematic survey was to examine the percentage of studies in which there was agreement in the reporting of the primary outcome between the currently updated version of the clinical trial registry and the published paper. We also investigated the factors associated with agreement in reporting of the primary outcome. We searched PubMed for all randomized control trials (RCT)s published in 2012-2015 in the top five general medicine journals (based on the 2014 impact factor). Two hundred abstracts (50 from each year) were randomly selected for data extraction. Agreement in reporting of 11 key study conduct items (e.g., sample size) and study characteristics (e.g., funding, number of sites) were extracted by two independent reviewers. Descriptive analyses were conducted to determine the proportion of studies on which there was agreement in reporting of key study conduct items. Generalized estimating equations were used to explore factors associated with agreement in reporting of the primary outcome. Of the 200 included studies, 87% had agreement in reporting of the primary outcome. After adjusting for other covariates, having greater than 50 sites was associated with an increased likelihood of agreement in reporting of the primary outcome (odds ratio=7.1, 95% confidence interval=1.39, 36.27, p=0.018). We identified substantive disagreement in reporting between publications and current clinical trial registry, which were associated with several study characteristics. Further measures are needed to improve reporting given the potential threats to the quality and integrity of scientific research. Copyright © 2017 Elsevier Inc. All rights reserved.

Using developmental research to design innovative knowledge translation technology for spinal cord injury in primary care: Actionable Nuggets™ on SkillScribe™.

PubMed

Smith, Karen M; Naumann, Danielle N; McDiarmid Antony, Laura; McColl, Mary Ann; Aiken, Alice

2014-09-01

Actionable Nuggets™ for spinal cord injury (SCI) are a knowledge translation tool facilitating evidence-based primary care practice, originally developed in 2010 and refined in 2013. Evaluation results from these two phases of development have informed the design of SkillScribe™, an innovative electronic platform intended to offer reflective continuing medical education (CME) programming through mobile devices in order to support the key features of the Actionable Nuggets™ approach. This brief article describes the ongoing development of Actionable Nuggets™ for SCI on SkillScribe™ by: (1) summarizing the work to date on Actionable Nuggets™; (2) describing evaluation results of Actionable Nuggets™; (3) placing SkillScribe™ in the context of adult education. Developmental Research Design. Canadian primary care. Primary care physicians; specialist physicians. Twenty educational modules on SCI. Pre- and post-test knowledge survey, feedback and use statistics, impact assessment survey, qualitative analysis of evaluation data. In both hard copy and electronic form, physicians report that Actionable Nuggets™ are an acceptable and useful approach to providing CME for low-prevalence, high-impact conditions like SCI. The key elements of this tool are that they: offer evidence-based information in small, focused "nuggets"; position information where physicians most frequently seek it; offer information in a format that permits direct translation into action in primary care; allow time for reflection; attach practice tools; and offer CME credit. Actionable Nuggets™ for SCI, delivered using a convenient and portable electronic medium, with time-released content and interactive testing has the potential to improve the primary care of patients with SCI.

Health-care users, key community informants and primary health care workers' views on health, health promotion, health assets and deficits: qualitative study in seven Spanish regions.

PubMed

Pons-Vigués, Mariona; Berenguera, Anna; Coma-Auli, Núria; Pombo-Ramos, Haizea; March, Sebastià; Asensio-Martínez, Angela; Moreno-Peral, Patricia; Mora-Simón, Sara; Martínez-Andrés, Maria; Pujol-Ribera, Enriqueta

2017-06-13

Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention. A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out. Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having implemented some change to promote their health. The most powerful motivators to change lifestyles are having a disease, fear of becoming ill and taking care of oneself to maintain health. Health-care users believe that the main difficulties are associated with the physical, social, working and family environment, as well as lack of determination and motivation. They also highlight the need for more information. In relation to the assets and deficits of the neighbourhood, each group identifies those closer to their role. Generally, participants showed a holistic and positive concept of health and a more traditional, individual approach to health promotion. We consider therefore crucial to depart from the model of health services that focuses on the individual and the disease toward a socio-ecological health model that substantially increases the participation of health-care users and emphasizes health promotion, wellbeing and community participation.

Expanding rural primary care training by employing information technologies: the need for participation by medical reference librarians.

PubMed

Coggan, J M; Crandall, L A

1995-01-01

The use of rural sites to train badly needed primary care providers requires access to sophisticated medical information not traditionally available outside of academic health centers. Medical reference librarians can play a key role in the development of primary care training sites in rural settings. Electronic information technologies, with proactive support from medical reference librarians, can provide current and detailed information without concern for distance from the health science center library. This paper discusses recent developments in technology, describes current challenges to the application of this technology in rural settings, and provides policy recommendations for medical reference librarians to enhance rural primary care training.

Twelve Factors Leading to Fundamental Pedagogical Change in a Primary School: A Case-Study

ERIC Educational Resources Information Center

Norris, Cathleen; Soloway, Elliot

2016-01-01

A school can change. In this case study, the authors describe the 12 factors they have identified as being key in the transformation of the core pedagogical practices at Nan Chiau Primary School, Singapore, from direct instruction to inquiry, from a 20th to a 21st century school. While the adoption of 1:1 mobile devices played a catalytic role in…

Friction Sensitivity of Primary Explosives

DTIC Science & Technology

1982-09-01

diffeomI from. Report) ISI. SUPPLEMENTARY NOTES It. KEY WORDS (Contflnuo on rvotr.. oldo. it nec~oaoty and Identify by block ri,uobr) Friction...friction senisitivity. Primary explosives RD 1333 lead azide, dextrinated lead azide, polyvinyl-alcohol (PVA)-lead a~.ide, colloidal lead azide, nocrnal lead...results for dextrinated lead azide duPont 52-127 13 4 A comparison of friction data at 10% probability of initiation 14 FIGURES 1 Working surfaces of BAM

Assessing the Impact of Free Primary Education Using Retrospective and Prospective Data: Lessons from the Nairobi Case Study

ERIC Educational Resources Information Center

Ngware, Moses Waithanji; Oketch, Moses; Ezeh, Alex Chika; Mutisya, Maurice; Ejakait, Charles Epari

2012-01-01

This paper describes the design and methodology used to assess the impact of free primary education (FPE) policy in Nairobi, Kenya. The key outcome of the study was to assess the impact of FPE on schooling outcomes among the urban poor. The study assesses the impact of FPE by examining how two non-comparable groups responded to the introduction of…

Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers.

PubMed

Cohen, Genna R; Adler-Milstein, Julia

2016-04-01

Stage 2 and proposed Stage 3 meaningful use criteria ask providers to support patient care coordination by electronically generating, exchanging, and reconciling key information during patient care transitions. A stratified random sample of primary care practices in Michigan (n = 328) that had already met Stage 1 meaningful use criteria was surveyed, in order to identify the anticipated barriers to meeting these criteria as well as the expected impact on patient care coordination from doing so. The top three barriers, as identified by >65% of the primary care providers surveyed, were difficulty sending and receiving patient information electronically, a lack of provider and practice staff time, and the complex workflow changes required. Despite these barriers, primary care providers expressed strong agreement that meeting the proposed Stage 3 care coordination criteria would improve their patients' treatment and ensure they know about their patients' visits to other providers. The survey results suggest the need to enhance policy approaches and organizational strategies to address the key barriers identified by providers and practices in order to realize important care coordination benefits. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Citizens advice in primary care: a qualitative study of the views and experiences of service users and staff.

PubMed

Burrows, J; Baxter, S; Baird, W; Hirst, J; Goyder, E

2011-10-01

To examine the views and experiences of staff and users of Citizens Advice Bureau (CAB) services located in general practice, and to identify key factors perceived as contributing to the intervention's effectiveness. A qualitative study in an urban and rural primary care setting in the UK. Semi-structured, face-to-face interviews (n = 22) with primary care and practice staff, CAB advisors and 12 service users. Key positive service features reported by all groups were: the confidential, non-stigmatizing and familiar environment of a general practitioner's (GP) surgery; the ability to make appointments and experienced advisor availability and continuity. Outcomes for service users were described as financial gain, managed debt, and beneficial social and mental health impacts. Perceived staff benefits were appropriate referral and better use of GP consultation time. Welfare advice in primary care has financial benefits and was perceived by participants to offer health and other benefits to patients and staff. However, while perceptions of gain from the intervention were evident, demonstration of measurable health improvement and well-being presents challenges. Further empirical work is needed in order to explore these complex cause-effect links and the cost-effectiveness of the intervention. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Techniques for identifying cross-disciplinary and 'hard-to-detect' evidence for systematic review.

PubMed

O'Mara-Eves, Alison; Brunton, Ginny; McDaid, David; Kavanagh, Josephine; Oliver, Sandy; Thomas, James

2014-03-01

Driven by necessity in our own complex review, we developed alternative systematic ways of identifying relevant evidence where the key concepts are generally not focal to the primary studies' aims and are found across multiple disciplines-that is, hard-to-detect evidence. Specifically, we sought to identify evidence on community engagement in public health interventions that aim to reduce health inequalities. Our initial search strategy used text mining to identify synonyms for the concept 'community engagement'. We conducted a systematic search for reviews on public health interventions, supplemented by searches of trials databases. We then used information in the reviews' evidence tables to gather more information about the included studies than was evident in the primary studies' own titles or abstracts. We identified 319 primary studies cited in reviews after full-text screening. In this paper, we retrospectively reflect on the challenges and benefits of the approach taken. We estimate that more than a quarter of the studies that were identified would have been missed by typical searching and screening methods. This identification strategy was highly effective and could be useful for reviews of broad research questions, or where the key concepts are unlikely to be the main focus of primary research. Copyright © 2013 John Wiley & Sons, Ltd.

The Virginia pharmacy practice transformation conference: outcomes and next steps.

PubMed

Silvester, Janet A

2012-04-01

Thought leaders in Virginia came together to achieve consensus on the pharmacy practice innovations required to advance the medication-related health outcomes of patients in the Commonwealth. The participants identified key elements and strategies needed for practice transformation and these became the foundation for practice change. The primary key elements included legislation and regulation modifications, payment reform, and business model development. The Virginia Pharmacy Congress, which represents key pharmacy stakeholders in the Commonwealth, became the home for the transformation movement and the development and implementation of a unified action plan for achieving the envisioned practice transformation.

Chemical thermodynamic data. 1. The concept of links to the chemical elements and the historical development of key thermodynamic data [plus Supplementary Electronic Annex 2

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

Wolery, Thomas J.; Jove Colon, Carlos F.

Chemical thermodynamic data remain a keystone for geochemical modeling and reactive transport simulation as applied to an increasing number of applications in the earth sciences, as well as applications in other areas including metallurgy, material science, and industrial process design. The last century has seen the development of a large body of thermodynamic data and a number of major compilations. The past several decades have seen the development of thermodynamic databases in digital form designed to support computer calculations. However, problems with thermodynamic data appear to be persistent. One problem pertains to the use of inconsistent primary key reference data.more » Such data pertain to elemental reference forms and key, stoichiometrically simple chemical species including metal oxides, CO 2, water, and aqueous species such as Na + and Cl -. A consistent set of primary key data (standard Gibbs energies, standard enthalpies, and standard entropies for key chemical species) for 298.15K and 1 bar pressure is essential. Thermochemical convention is to define the standard Gibbs energy and the standard enthalpy of an individual chemical species in terms of formation from reference forms of the constituent chemical elements. We propose a formal concept of “links” to the elemental reference forms. This concept involves a documented understanding of all reactions and calculations leading to values for a formation property (standard Gibbs energy or enthalpy). A valid link consists of two parts: (a) the path of reactions and corrections and (b) the associated data, which are key data. Such a link differs from a bare “key” or “reference” datum in that it requires additional information. Some or all of its associated data may also be key data. In evaluating a reported thermodynamic datum, one should identify the links to the chemical elements, a process which can be time-consuming and which may lead to a dead end (an incomplete link). The use of two or more inconsistent links to the same elemental reference form in a thermodynamic database will result in an inconsistency in the database. Thus, in constructing a database, it is important to establish a set of reliable links (generally resulting in a set of primary reference data) and then correct all data adopted subsequently for consistency with that set. Recommended values of key data have not been constant through history. We review some of this history through the lens of major compilations and other influential reports, and note a number of problem areas. Finally, we illustrate the concepts developed in this paper by applying them to some key species of geochemical interest, including liquid water; quartz and aqueous silica; and gibbsite, corundum, and the aqueous aluminum ion.« less

Chemical thermodynamic data. 1. The concept of links to the chemical elements and the historical development of key thermodynamic data [plus Supplementary Electronic Annex 2

DOE PAGES

Wolery, Thomas J.; Jove Colon, Carlos F.

2016-09-26

Chemical thermodynamic data remain a keystone for geochemical modeling and reactive transport simulation as applied to an increasing number of applications in the earth sciences, as well as applications in other areas including metallurgy, material science, and industrial process design. The last century has seen the development of a large body of thermodynamic data and a number of major compilations. The past several decades have seen the development of thermodynamic databases in digital form designed to support computer calculations. However, problems with thermodynamic data appear to be persistent. One problem pertains to the use of inconsistent primary key reference data.more » Such data pertain to elemental reference forms and key, stoichiometrically simple chemical species including metal oxides, CO 2, water, and aqueous species such as Na + and Cl -. A consistent set of primary key data (standard Gibbs energies, standard enthalpies, and standard entropies for key chemical species) for 298.15K and 1 bar pressure is essential. Thermochemical convention is to define the standard Gibbs energy and the standard enthalpy of an individual chemical species in terms of formation from reference forms of the constituent chemical elements. We propose a formal concept of “links” to the elemental reference forms. This concept involves a documented understanding of all reactions and calculations leading to values for a formation property (standard Gibbs energy or enthalpy). A valid link consists of two parts: (a) the path of reactions and corrections and (b) the associated data, which are key data. Such a link differs from a bare “key” or “reference” datum in that it requires additional information. Some or all of its associated data may also be key data. In evaluating a reported thermodynamic datum, one should identify the links to the chemical elements, a process which can be time-consuming and which may lead to a dead end (an incomplete link). The use of two or more inconsistent links to the same elemental reference form in a thermodynamic database will result in an inconsistency in the database. Thus, in constructing a database, it is important to establish a set of reliable links (generally resulting in a set of primary reference data) and then correct all data adopted subsequently for consistency with that set. Recommended values of key data have not been constant through history. We review some of this history through the lens of major compilations and other influential reports, and note a number of problem areas. Finally, we illustrate the concepts developed in this paper by applying them to some key species of geochemical interest, including liquid water; quartz and aqueous silica; and gibbsite, corundum, and the aqueous aluminum ion.« less

Use of electronic clinical reminders to increase preventive screenings in a primary care setting: blueprint from a successful process in Kodiak, Alaska.

PubMed

Onders, Robert; Spillane, James; Reilley, Brigg; Leston, Jessica

2014-01-01

The Kodiak Area Native Association (KANA) provides primary health care in Kodiak, Alaska and 6 outlying villages. KANA sought to actively improve key preventive screening rates for its patients. KANA adopted an electronic health record in 2008 and deployed national clinical reminders from the Indian Health Service for 5 key preventive screenings: tobacco use, alcohol use, depression, intimate partner violence, and a comprehensive cardiovascular exam. Clinical reminders were deployed in a 5-step process: (a) establish clinical demand, (b) pilot test reminder, (c) expand reminder to all providers, (d) measure outcomes and share results, and (e) delegate clinical reminder follow-up (primarily to nurses). Data from 2007-2011 show screening rates for all 5 measures improved considerably, to levels significantly above the national average for Indian Health Service facilities. Clinical reminders have been a key part of a multistep process to improve screening for depression, tobacco cessation, intimate partner violence, alcohol use, and cardiovascular disease. If deployed correctly, reminders are valuable tools in identifying patients who are overdue for preventive health screenings.

International Energy Annual, 1999

DOT National Transportation Integrated Search

2001-02-01

Presents an overview of key international energy trends for production, consumption, imports, and exports of primary energy commodities over 220 countries, dependencies, and areas of special sovereignty. Also included are populatin and gross domestic...

Primary health care in Canada: systems in motion.

PubMed

Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

2011-06-01

During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Host responses in tissue repair and fibrosis.

PubMed

Duffield, Jeremy S; Lupher, Mark; Thannickal, Victor J; Wynn, Thomas A

2013-01-24

Myofibroblasts accumulate in the spaces between organ structures and produce extracellular matrix (ECM) proteins, including collagen I. They are the primary "effector" cells in tissue remodeling and fibrosis. Previously, leukocyte progenitors termed fibrocytes and myofibroblasts generated from epithelial cells through epithelial-to-mesenchymal transition (EMT) were considered the primary sources of ECM-producing myofibroblasts in injured tissues. However, genetic fate mapping experiments suggest that mesenchyme-derived cells, known as resident fibroblasts, and pericytes are the primary precursors of scar-forming myofibroblasts, whereas epithelial cells, endothelial cells, and myeloid leukocytes contribute to fibrogenesis predominantly by producing key fibrogenic cytokines and by promoting cell-to-cell communication. Numerous cytokines derived from T cells, macrophages, and other myeloid cell populations are important drivers of myofibroblast differentiation. Monocyte-derived cell populations are key regulators of the fibrotic process: They act as a brake on the processes driving fibrogenesis, and they dismantle and degrade established fibrosis. We discuss the origins, modes of activation, and fate of myofibroblasts in various important fibrotic diseases and describe how manipulation of macrophage activation could help ameliorate fibrosis.

Valganciclovir and bevacizumab for recurrent glioblastoma: A single-institution experience

PubMed Central

PENG, CHENGWEI; WANG, JIALING; TANKSLEY, JARRED P.; MOBLEY, BRET C.; AYERS, GREGORY D.; MOOTS, PAUL L.; CLARK, STEPHEN W.

2016-01-01

Prolonged treatment with adjuvant valganciclovir has been shown in one retrospective study to exert a significant effect on overall survival (OS) in newly diagnosed patients with glioblastoma multiforme (GBM). However, studies evaluating the effectiveness of valganciclovir in the treatment of recurrent GBM have not been performed. We evaluated the effect of valganciclovir in the recurrent setting in combination with bevacizumab therapy. A retrospective analysis was performed on patients treated for recurrent GBM with off-label valganciclovir and bevacizumab at Vanderbilt University. We identified 13 patients who received valganciclovir plus bevacizumab at some point during their treatment, 8 of whom were started on valganciclovir and bevacizumab concurrently upon first recurrence, whereas 5 had valganciclovir added to their bevacizumab regimen prior to a second recurrence. of these patients, 12 were pathologically confirmed to have GBM, and 1 patient was diagnosed with gliosarcoma. We also identified an institutional cohort of 50 patients who had not been exposed to valganciclovir, but were treated with bevacizumab for first recurrence. The progression-free survival (PFS) at 6 months (PF6) and median OS (mOS) in the valganciclovir plus bevacizumab group was 62% and 13.1 months, respectively, for all 13 patients, and 50% and 11.3 months, respectively, for the 8 concurrently treated patients. In the institutional bevacizumab cohort, the PF6 and mOS were 34% and 8.7 months, respectively. In this retrospective analysis, valganciclovir in combination with bevacizumab exhibited a trend toward improved survival in patients with recurrent GBM. However, given the small sample size and the retrospective nature of this study, a larger prospective study is required to confirm these results. PMID:26893852

Increased Tumor Oxygenation and Drug Uptake During Anti-Angiogenic Weekly Low Dose Cyclophosphamide Enhances the Anti-Tumor Effect of Weekly Tirapazamine

PubMed Central

Doloff, J.C.; Khan, N.; Ma, J.; Demidenko, E.; Swartz, H.M.; Jounaidi, Y.

2010-01-01

Metronomic cyclophosphamide treatment is associated with anti-angiogenic activity and is anticipated to generate exploitable hypoxia using hypoxia-activated prodrugs. Weekly administration of tirapazamine (TPZ; 5 mg/kg body weight i.p.) failed to inhibit the growth of 9L gliosarcoma tumors grown s.c. in scid mice. However, the anti-tumor effect of weekly cyclophosphamide (CPA) treatment (140 mg/kg BW i.p.) was substantially enhanced by weekly TPZ administration. An extended tumor free period and increased frequency of tumor eradication without overt toxicity were observed when TPZ was given 3, 4 or 5 days after each weekly CPA treatment. Following the 2nd CPA injection, Electron Paramagnetic Resonance (EPR) Oximetry indicated significant increases in tumor pO2, starting at 48 hr, which further increased after the 3rd CPA injection. pO2 levels were, however, stable in growing untreated tumors. A strong negative correlation (−0.81) between tumor pO2 and tumor volume during 21 days of weekly CPA chemotherapy was observed, indicating increasing tumor pO2 with decreasing tumor volume. Furthermore, CPA treatment resulted in increased tumor uptake of activated CPA. CPA induced increases in VEGF RNA, which reached a maximum on day 1, and in PLGF RNA which was sustained throughout the treatment, while anti-angiogenic host thrombospondin-1 increased dramatically through day 7 post-CPA treatment. Weekly cyclophosphamide treatment was anticipated to generate exploitable hypoxia. However, our findings suggest that weekly CPA treatment induces a functional improvement of tumor vasculature, which is characterized by increased tumor oxygenation and drug uptake in tumors, thus counter-intuitively, benefiting intratumoral activation of TPZ and perhaps other bioreductive drugs. PMID:19754361

Weanling piglet cerebellum: a surrogate for tolerance to MRT (microbeam radiation therapy) in pediatric neuro-oncology

NASA Astrophysics Data System (ADS)

Laissue, Jean A.; Blattmann, Hans; Di Michiel, Marco; Slatkin, Daniel N.; Lyubimova, Nadia; Guzman, Raphael; Zimmermann, Werner; Birrer, Stephan; Bley, Tim; Kircher, Patrick; Stettler, Regina; Fatzer, Rosmarie; Jaggy, Andre; Smilowitz, Henry; Brauer, Elke; Bravin, Alberto; Le Duc, Geraldine; Nemoz, Christian; Renier, Michel; Thomlinson, William C.; Stepanek, Jiri; Wagner, Hans-Peter

2001-12-01

The cerebellum of the weanling piglet (Yorkshire) was used as a surrogate for the radiosensitive human infant cerebellum in a Swiss-led program of experimental microbeam radiation therapy (MRT) at the ESRF. Five weanlings in a 47 day old litter of seven, and eight weanlings in a 40 day old litter of eleven were irradiated in November, 1999 and June, 2000, respectively. A 1.5 cm-wide x 1.5 xm-high array of equally space approximately equals 20-30 micrometers wide, upright microbeams spaced at 210 micrometers intervals was propagated horizontally, left to right, through the cerebella of the prone, anesthetized piglets. Skin-entrance intra-microbeam peak adsorbed doses were uniform, either 150, 300, 425, or 600 gray (Gy). Peak and inter-microbeam (valley) absorbed doses in the cerebellum were computed with the PSI version of the Monte Carlo code GEANT and benchmarked using Gafchromic and radiochromic film microdosimetry. For approximately equals 66 weeks [first litter; until euthanasia], or approximately equals 57 weeks [second litter; until July 30, 2001] after irradiation, the littermates were developmentally, behaviorally, neurologically and radiologically normal as observed and tested by experienced farmers and veterinary scientists unaware of which piglets were irradiated or sham-irradiated. Morever, MRT implemented at the ESRF with a similar array of microbeams and a uniform skin-entrance peak dose of 625 Gy, followed by immunoprophylaxis, was shown to be palliative or curative in young adult rats bearing intracerebral gliosarcomas. These observations give further credence to MRT's potential as an adjunct therapy for brain tumors in infancy, when seamless therapeutic irradiation of the brain is hazardous.

Impact of Focused Ultrasound-enhanced Drug Delivery on Survival in Rats with Glioma

NASA Astrophysics Data System (ADS)

Treat, Lisa Hsu; Zhang, Yongzhi; McDannold, Nathan; Hynynen, Kullervo

2009-04-01

Malignancies of the brain remain difficult to treat with chemotherapy because the selective permeability of the blood-brain barrier (BBB) blocks many potent agents from reaching their target. Previous studies have illustrated the feasibility of drug and antibody delivery across the BBB using MRI-guided focused ultrasound. In this study, we investigated the impact of focused ultrasound-enhanced delivery of doxorubicin on survival in rats with aggressive glioma. Sprague-Dawley rats were implanted with 9 L gliosarcoma cells in the brain. Eight days after implantation, each rat received one of the following: (1) no treatment (control), (2) a single treatment with microbubble-enhanced MRI-guided focused ultrasound (FUS only), (3) a single treatment with i.v. liposomal doxorubicin (DOX only), or (4) a single treatment with microbubble-enhanced MRI-guided focused ultrasound and concurrent i.v. injections of liposomal doxorubicin (FUS+DOX). The survival time from implantation to death or euthanasia was recorded. We observed a modest but significant increase in median survival time in rats treated with combined MRI-guided focused ultrasound chemotherapy, compared to chemotherapy alone (p<0.001). There was no significant improvement in survival between those who received stand-alone chemotherapy and those who did not receive any treatment (p>0.10). Our study demonstrates for the first time a therapeutic benefit achieved with ultrasound-enhanced drug delivery across the blood-brain barrier. This confirmation of efficacy in an in vivo tumor model indicates that targeted drug delivery using MRI-guided focused ultrasound has the potential to have a major impact on the treatment of patients with brain tumors and other neurological disorders.

Indirect radio-chemo-beta therapy: a targeted approach to increase biological efficiency of x-rays based on energy

NASA Astrophysics Data System (ADS)

Oktaria, Sianne; Corde, Stéphanie; Lerch, Michael L. F.; Konstantinov, Konstantin; Rosenfeld, Anatoly B.; Tehei, Moeava

2015-10-01

Despite the use of multimodal treatments incorporating surgery, chemotherapy and radiotherapy, local control of gliomas remains a major challenge. The potential of a new treatment approach called indirect radio-chemo-beta therapy using the synergy created by combining methotrexate (MTX) with bromodeoxyuridine (BrUdR) under optimum energy x-ray irradiation is assessed. 9L rat gliosarcoma cells pre-treated with 0.01 μM MTX and/or 10 μM BrUdR were irradiated in vitro with 50 kVp, 125 kVp, 250 kVp, 6 MV and 10 MV x-rays. The cytotoxicity was assessed using clonogenic survival as the radiobiological endpoint. The photon energy with maximum effect was determined using radiation sensitization enhancement factors at 10% clonogenic survival (SER10%). The cell cycle distribution was investigated using flow cytometric analysis with propidium iodide staining. Incorporation of BrUdR in the DNA was detected by the fluorescence of labelled anti-BrUdR antibodies. The radiation sensitization enhancement exhibits energy dependence with a maximum of 2.3 at 125 kVp for the combined drug treated cells. At this energy, the shape of the clonogenic survival curve of the pharmacological agents treated cells changes substantially. This change is interpreted as an increased lethality of the local radiation environment and is attributed to supplemented inhibition of DNA repair. Radiation induced chemo-beta therapy was demonstrated in vitro by the targeted activation of combined pharmacological agents with optimized energy tuning of x-ray beams on 9 L cells. Our results show that this is a highly effective form of chemo-radiation therapy.

The translocator protein radioligand 18F-DPA-714 monitors antitumor effect of erufosine in a rat 9L intracranial glioma model.

PubMed

Awde, Ali R; Boisgard, Raphaël; Thézé, Benoit; Dubois, Albertine; Zheng, Jinzi; Dollé, Frédéric; Jacobs, Andreas H; Tavitian, Bertrand; Winkeler, Alexandra

2013-12-01

On the one hand, the translocator protein (TSPO) radioligand N,N-diethyl-2-(2-(4-(2-(18)F-fluoroethoxy)phenyl)-5,7-dimethylpyrazolo[1,5-a]pyrimidin-3-yl)acetamide ((18)F-DPA-714) has been suggested to serve as an alternative radiotracer to image human glioma, and on the other hand the alkylphosphocholine erufosine (ErPC3) has been reported to induce apoptosis in otherwise highly apoptosis-resistant glioma cell lines. The induction of apoptosis by ErPC3 requires TSPO, a mitochondrial membrane protein highly expressed in malignant gliomas. In this preclinical study, we monitored the effect of ErPC3 treatment in vivo using (18)F-DPA-714 PET. In vitro studies investigated the antitumor effect of ErPC3 in 9L rat gliosarcoma cells. In vivo, glioma-bearing rats were imaged with (18)F-DPA-714 for the time of treatment. A significant decrease in 9L cell proliferation and viability and a significant increase in apoptosis and caspase-3 activation were demonstrated on ErPC3 treatment in cell culture. In the rat model, ErPC3 administration resulted in significant changes in (18)F-DPA-714 tumor uptake over the course of the treatment. Immunohistochemistry revealed reduced tumor volume and increased cell death in ErPC3-treated animals accompanied by infiltration of the tumor core by CD11b-positive microglia/macrophages and glial fibrillary acidic protein-positive astrocytes. Our findings demonstrate a potent antitumor effect of ErPC3 in vitro, in vivo, and ex vivo. PET imaging of TSPO expression using (18)F-DPA-714 allows effective monitoring and quantification of disease progression and response to ErPC3 therapy in intracranial 9L gliomas.

Non-canonical IDH1 and IDH2 mutations: a clonal and relevant event in an Italian cohort of gliomas classified according to the 2016 World Health Organization (WHO) criteria.

PubMed

Visani, Michela; Acquaviva, Giorgia; Marucci, Gianluca; Paccapelo, Alexandro; Mura, Antonella; Franceschi, Enrico; Grifoni, Daniela; Pession, Annalisa; Tallini, Giovanni; Brandes, Alba A; de Biase, Dario

2017-11-01

According to the 2016 World Health Organization (WHO) classification of tumors of the central nervous system, assessment of exon 4 mutations in isocitrate dehydrogenase 1 or 2 genes (IDH1 or IDH2) is an essential step in the characterization of gliomas. The p.R132H mutation is the most frequent alteration in IDH genes, however other non-canonical IDH mutations can be identified. The aim of this study is to investigate in depth the prevalence of non-R132H IDH ("non-canonical") mutations in brain tumors classified according to the 2016 WHO scheme and their clonal distribution in neoplastic cells. A total of 288 consecutive cases of brain gliomas (grade II-IV) were analyzed for exon 4 IDH1 and IDH2 mutations. IDH1 and IDH2 analysis was performed using next generation sequencing. Non-canonical IDH mutations were identified in 13/52 (25.0%) grade II gliomas (astrocytomas: 8/31, 25.8%; oligodendrogliomas: 5/21, 23.8%) and in 5/40 (12.5%) grade III gliomas (astrocytomas: 3/25, 12.0%; oligodendrogliomas: 2/15, 13.3%). They were not identified in 196 grade IV gliomas (192 glioblastomas, 4 gliosarcomas). In the large majority (>80%) of tumors IDH mutations, both IDH1-R132H and the non-canonical ones, were present in the large majority (>80%) of neoplastic cells. Our data highlight the importance of investigating not only the IDH1-R132H mutation but also the non-canonical ones. These mutations are clonally distributed, with proportions of mutated neoplastic cells overlapping with those of p.R132H, a finding consistent with their driver role in gliomagenesis.

25 CFR 556.4 - Background investigations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... investigation for each primary management official and for each key employee of a gaming operation. (a) A tribe... of birth, citizenship, gender, all languages (spoken or written); (2) Currently and for the previous...

25 CFR 556.4 - Background investigations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... investigation for each primary management official and for each key employee of a gaming operation. (a) A tribe... of birth, citizenship, gender, all languages (spoken or written); (2) Currently and for the previous...

25 CFR 556.4 - Background investigations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... investigation for each primary management official and for each key employee of a gaming operation. (a) A tribe... of birth, citizenship, gender, all languages (spoken or written); (2) Currently and for the previous...

25 CFR 556.4 - Background investigations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... investigation for each primary management official and for each key employee of a gaming operation. (a) A tribe... of birth, citizenship, gender, all languages (spoken or written); (2) Currently and for the previous...

25 CFR 556.4 - Background investigations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... investigation for each primary management official and for each key employee of a gaming operation. (a) A tribe... of birth, citizenship, gender, all languages (spoken or written); (2) Currently and for the previous...

Improving collaboration between primary care and mental health services.

PubMed

Kates, Nick; Arroll, Bruce; Currie, Elizabeth; Hanlon, Charlotte; Gask, Linda; Klasen, Henrikje; Meadows, Graham; Rukundo, Godfrey; Sunderji, Nadiya; Ruud, Torleif; Williams, Mark

2018-06-20

Previous guidelines and planning documents have identified the key role primary care providers play in delivering mental health care, including the recommendation from the WHO that meeting the mental health needs of the population in many low and middle income countries will only be achieved through greater integration of mental health services within general medical settings. This position paper aims to build upon this work and present a global framework for enhancing mental health care delivered within primary care. This paper synthesizes previous guidelines, empirical data from the literature and experiences of the authors in varied clinical settings to identify core principles and the key elements of successful collaboration, and organizes these into practical guidelines that can be adapted to any setting. The paper proposes a three-step approach. The first is mental health services that any primary care provider can deliver with or without the presence of a mental health professional. Second is practical ways that effective collaboration can enhance this care. The third looks at wider system changes required to support these new roles and how better collaboration can lead to new responses to respond to challenges facing all mental health systems. This simple framework can be applied in any jurisdiction or country to enhance the detection, treatment, and prevention of mental health problems, reinforcing the role of the primary care provider in delivering care and showing how collaborative care can lead to better outcomes for people with mental health and addiction problems.

Transforming primary care in the New Orleans safety-net: the patient experience.

PubMed

Schmidt, Laura A; Rittenhouse, Diane R; Wu, Kevin J; Wiley, James A

2013-02-01

The patient-centered medical home (PCMH) is a key service delivery innovation in health reform. However, there are growing questions about whether the changes in clinics promoted by the PCMH model lead to improvements in the patient experience. To test the hypothesis that PCMH improvements in safety-net primary care clinics are associated with a more positive patient experience. Multilevel cross-sectional analysis of patients nested within the primary care clinics that serve them. Primary care clinic leaders and patients throughout the City of New Orleans health care safety-net. Dependent variables included patient ratings of accessibility, coordination, and confidence in the quality/safety of care. The key independent variable was a score measuring PCMH structural and process improvements at the clinic level. Approximately two thirds of patients in New Orleans gave positive ratings to their clinics on access and quality/safety, but only one third did for care coordination. In all but the largest clinics, patient experiences of care coordination were positively associated with the clinic's use of PCMH structural and process changes. Results for patient ratings of access and quality/safety were mixed. Among primary care clinics in the New Orleans safety-net, use of more PCMH improvements at the clinic level led to more positive patient rating of care coordination, but not of accessibility or confidence in quality/safety. Ongoing efforts to pilot, demonstrate, implement, and evaluate the PCMH should consider how the impact of medical practice transformation could vary across different aspects of the patient experience.

Public Stigma towards Older Adults with Depression: Findings from the São Paulo-Manaus Elderly in Primary Care Study

PubMed Central

Kester, Rachel; Braga, Patrícia Emília; Peluso, Érica T. P.; Blay, Sérgio L.; R. Menezes, Paulo; E. Ribeiro, Euler

2016-01-01

This study investigates three domains of public stigma (perceived negative reactions, perceived discrimination, and dangerousness) against older adults with depression. The sample comprised of older adults registered with primary care clinics (n = 1,291) and primary health care professionals (n = 469) from São Paulo and Manaus, Brazil. Participants read a vignette describing a 70-year-old individual (Mary or John) with a depressive disorder and answered questions measuring stigma. The prevalence of the three stigma domains was between 30.2 and 37.6% among older participants from São Paulo and between 27.6 and 35.4% among older participants from Manaus. Older adults from both cities reported similar prevalence of perceived stigma. Key factors associated with stigmatizing beliefs among older participants were reporting depressive symptoms, having physical limitations, and identifying the case of the vignette as a case of mental disorder. Among health professionals, the prevalence of the three stigma domains was between 19.8 and 34.8% in São Paulo and 30.2 and 44.6% in Manaus. The key factor associated with stigma among primary health care professionals was city, with consistently higher risk in Manaus than in São Paulo. Findings confirm that public stigma against older adults in Brazil is common. It is important to educate the public and primary health care providers in Brazil on stigma related to mental illness in order to reduce barriers to adequate mental health treatment. PMID:27352293

Primary care providers' lived experiences of genetics in practice.

PubMed

Harding, Brittany; Webber, Colleen; Ruhland, Lucia; Dalgarno, Nancy; Armour, Christine M; Birtwhistle, Richard; Brown, Glenn; Carroll, June C; Flavin, Michael; Phillips, Susan; MacKenzie, Jennifer J

2018-04-26

To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners' additional concerns included cost, distance, and poor patient engagement. PCPs' perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.

Primary Cilia Modulate IHH Signal Transduction in Response to Hydrostatic Loading of Growth Plate Chondrocytes

PubMed Central

Shao, Y, Yvonne Y.; Wang, Lai; Welter, J, Jean F.; Ballock, R. Tracy

2011-01-01

Indian Hedgehog (Ihh) is a key component of the regulatory apparatus governing chondrocyte proliferation and differentiation in the growth plate. Recent studies have demonstrated that the primary cilium is the site of Ihh signaling within the cell, and that primary cilia are essential for bone and cartilage formation. Primary cilia are also postulated to act as mechanosensory organelles that transduce mechanical forces acting on the cell into biological signals. In this study, we used a hydrostatic compression system to examine Ihh signal transduction under the influence of mechanical load. Our results demonstrate that hydrostatic compression increased both Ihh gene expression and Ihh-responsive Gli-luciferase activity. These increases were aborted by disrupting the primary cilia structure with chloral hydrate. These results suggest that growth plate chondrocytes respond to hydrostatic loading by increasing Ihh signaling, and that the primary cilium is required for this mechano-biological signal transduction to occur. PMID:21930256

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review.

PubMed

O'Reilly, Pauline; Lee, Siew Hwa; O'Sullivan, Madeleine; Cullen, Walter; Kennedy, Catriona; MacFarlane, Anne

2017-01-01

Interdisciplinary team working is of paramount importance in the reform of primary care in order to provide cost-effective and comprehensive care. However, international research shows that it is not routine practice in many healthcare jurisdictions. It is imperative to understand levers and barriers to the implementation process. This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1 barriers and facilitators to implementation of interdisciplinary teams in primary care and 2 the main research gaps. An integrative review following the PRISMA guidelines was conducted. Following a search of 10 international databases, 8,827 titles were screened for relevance and 49 met the criteria. Quality of evidence was appraised using predetermined criteria. Data were analysed following the principles of framework analysis using Normalisation Process Theory (NPT), which has four constructs: sense making, enrolment, enactment, and appraisal. The literature is dominated by a focus on interdisciplinary working between physicians and nurses. There is a dearth of evidence about all NPT constructs apart from enactment. Physicians play a key role in encouraging the enrolment of others in primary care team working and in enabling effective divisions of labour in the team. The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals. A key lever for interdisciplinary team working in primary care is to get professionals working together and to learn from each other in practice. However, the evidence base is limited as it does not reflect the experiences of all primary care professionals and it is primarily about the enactment of team working. We need to know much more about the experiences of the full network of primary care professionals regarding all aspects of implementation work. International Prospective Register of Systematic Reviews PROSPERO 2015: CRD42015019362.

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

PubMed Central

O’Reilly, Pauline; Lee, Siew Hwa; O’Sullivan, Madeleine; Cullen, Walter; Kennedy, Catriona; MacFarlane, Anne

2017-01-01

Background Interdisciplinary team working is of paramount importance in the reform of primary care in order to provide cost-effective and comprehensive care. However, international research shows that it is not routine practice in many healthcare jurisdictions. It is imperative to understand levers and barriers to the implementation process. This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1 barriers and facilitators to implementation of interdisciplinary teams in primary care and 2 the main research gaps. Methods and findings An integrative review following the PRISMA guidelines was conducted. Following a search of 10 international databases, 8,827 titles were screened for relevance and 49 met the criteria. Quality of evidence was appraised using predetermined criteria. Data were analysed following the principles of framework analysis using Normalisation Process Theory (NPT), which has four constructs: sense making, enrolment, enactment, and appraisal. The literature is dominated by a focus on interdisciplinary working between physicians and nurses. There is a dearth of evidence about all NPT constructs apart from enactment. Physicians play a key role in encouraging the enrolment of others in primary care team working and in enabling effective divisions of labour in the team. The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals. Conclusion A key lever for interdisciplinary team working in primary care is to get professionals working together and to learn from each other in practice. However, the evidence base is limited as it does not reflect the experiences of all primary care professionals and it is primarily about the enactment of team working. We need to know much more about the experiences of the full network of primary care professionals regarding all aspects of implementation work. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO 2015: CRD42015019362. PMID:28545038

Barriers and facilitators to providing undergraduate physiotherapy clinical education in the primary care setting: a three-round Delphi study.

PubMed

McMahon, S; Cusack, T; O'Donoghue, G

2014-03-01

With the global shift in health care from secondary to primary care, employment opportunities for newly qualified physiotherapists are likely to be in the primary care setting. However, to date, undergraduate physiotherapy clinical education has been centred around secondary care, focusing on acute services in large teaching hospitals. For contemporary physiotherapists to become effective first-contact primary care providers, they need to be exposed to the primary care environment during their undergraduate education. To explore the concept and identify perceived barriers and facilitators to providing physiotherapy undergraduate clinical placements in the primary healthcare setting A three-round Delphi survey was used. Participants were asked to answer open-ended questions with regard to: (i) student preparation for and (ii) provision of primary care placements (Round 1). Content analysis was employed to identify key themes. These themes generated statements for Round 2. In Round 2, participants were asked to rate their level of agreement/disagreement with the generated statements. In Round 3, a final rating process was conducted. Level of consensus was established as ≥70% agreement, with an interquartile range of ≤1. One hundred and ninety-eight primary care physiotherapy staff. Barriers identified included shortage of resources (e.g. staff) and a lack of tradition; in other words, students are not traditionally educated in the primary care setting. Response rates were 60% (120/198), 70% (84/120) and 76% (64/84) for Rounds 1, 2 and 3, respectively. All seven key facilitators identified reached consensus. They included additional support for staff taking students and motivated students. This study revealed that there is support for the provision of physiotherapy clinical education in the primary care setting. Through careful consideration with clear planning and collaboration with all stakeholders, it may be possible to convert the main barriers identified into facilitators to ensure that there will be an adequately prepared physiotherapy work force in the future. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Supporting nurse practitioners' practice in primary healthcare settings: a three-level qualitative model.

PubMed

Chouinard, Véronique; Contandriopoulos, Damien; Perroux, Mélanie; Larouche, Catherine

2017-06-26

While greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both registered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare nurse practitioners' integration. This study's main objective is to examine different structures and mechanisms put in place to support the development of primary healthcare nurse practitioner's practice in different healthcare settings, and develop a practical model for identifying and planning adequate support practices. This study is part of a larger multicentre study on primary healthcare nurse practitioners in the province of Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse practitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of location, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based on the analysis of available documentation in each primary healthcare setting and on semi-structured interviews with key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis approaches. This article identifies three types of support practices: clinical, team, and systemic. This three-level analysis demonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based, multilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very different implementation structures and practices, and different actors were involved at each of the three levels. The results also indicated that nursing departments played a decisive role at all three levels. Based on these findings, we suggest that support practices should be adapted to each organization's environment and experience and be modified as needed throughout the integration process. We also stress the importance of combining this approach with a strong coordination mechanism involving managers who have in-depth understanding of nursing professional roles and scopes of practice. Making primary healthcare nurse practitioner integration frameworks more flexible and clarifying and strengthening the role of senior nursing managers could be the key to successful integration.

24 CFR 3282.353 - Submission format.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Submission format. States and private organizations which wish to act as primary inspection agencies shall...) The capacity (DAPIA, IPIA) in which the party wishes to be approved to act; (3) A list of the key...

24 CFR 3282.353 - Submission format.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Submission format. States and private organizations which wish to act as primary inspection agencies shall...) The capacity (DAPIA, IPIA) in which the party wishes to be approved to act; (3) A list of the key...

24 CFR 3282.353 - Submission format.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Submission format. States and private organizations which wish to act as primary inspection agencies shall...) The capacity (DAPIA, IPIA) in which the party wishes to be approved to act; (3) A list of the key...

Optimizing the management of depression: primary care experience.

PubMed

Cameron, Catherine; Habert, Jeff; Anand, Leena; Furtado, Melissa

2014-12-01

This article is intended to identify some of the most important challenges faced by family physicians when treating MDD and to provide practical solutions. Key issues, reviewed from a primary care view point will include: treating to remission (and not just response), identification of high-risk groups, diagnosis, acute treatment approaches (including pharmacotherapy and the management of related side effects), the use of psychotherapy and somatic therapies, assessment of the adequacy of treatment including the assessment of remission, response measurement, optimal follow-up care throughout the phase of treatment, the key components of patient education and strategies for partial/limited response to the first-line antidepressant (switching, augmentation and combination strategies), how to provide support for improved treatment adherence, and approaches to prevent the recurrence of depressive episodes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Video or In-Clinic Consultation? Selection of Attributes as Preparation for a Discrete Choice Experiment Among Key Stakeholders.

PubMed

Chudner, Irit; Goldfracht, Margalit; Goldblatt, Hadass; Drach-Zahavy, Anat; Karkabi, Khaled

2018-06-09

Video consultations (VCs) provide increased accessibility of primary care to remote areas and overall improved care for chronic patients. They also contribute to higher patient satisfaction and improved resource management. Despite these benefits, VC integration into the health system is complex and slow. Understanding the VC-related preferences of three key stakeholders-patients, primary care physicians (PCPs) and policy makers (PMs)-is crucial for achieving optimal implementation. The aim of this study was to select relevant attributes and levels for a discrete choice experiment (DCE) of stakeholders' choice-VC or traditional in-clinic consultation (I-CC) in primary care. Ten semi-structured focus group interviews and 24 semi-structured individual interviews were conducted. Data analysis was performed inductively, using a thematic content analysis method. An attribute-ranking exercise was then conducted based on the results gleaned from the interviews. The most important attributes when choosing either VC or I-CC, for both patients and PMs, were: (1) time to next available appointment; (2) time in line before consultation; (3) relationship to PCP; and (4) quality of consultation. For PCPs, the most important attributes were: (1) time in line before consultation; (2) patient's self-management ability; (3) consultation purpose; (4) quality of consultation. This qualitative study identified attributes and levels for a DCE quantitative stage among three key stakeholder groups. It adds to the literature of examples of developing DCE attributes, and to literature about the stakeholder benefits in the area of telemedicine in healthcare.

African Primary Care Research: Participatory action research

PubMed Central

2014-01-01

Abstract This article is part of the series on African primary care research and focuses on participatory action research. The article gives an overview of the emancipatory-critical research paradigm, the key characteristics and different types of participatory action research. Following this it describes in detail the methodological issues involved in professional participatory action research and running a cooperative inquiry group. The article is intended to help students with writing their research proposal. PMID:26245439

Primary cilium - antenna-like structure on the surface of most mammalian cell types

NASA Astrophysics Data System (ADS)

Dvorak, J.; Sitorova, V.; Hadzi Nikolov, D.; Mokry, J.; Richter, I.; Kasaova, L.; Filip, S.; Ryska, A.; Petera, J.

2011-12-01

The primary cilium is a sensory solitary non-motile microtubule-based organelle protruding in the quiescent phase of the cell cycle from the surface of the majority of human cells, including embryonic cells, stem cells and stromal cells of malignant tumors. The presence of a primary cilium on the surface of a cell is transient, limited to the quiescent G1(G0) phase and the beginning of the S phase of the cell cycle. The primary cilium is formed from the mother centriole. Primary cilia are key coordinators of signaling pathways during development and tissue homeostasis and, when deffective, they are a major cause of human diseases and developmental disorders, now commonly referred to as ciliopathies. Most cancer cells do not possess a primary cilium. The loss of the primary cilium is a regular feature of neoplastic transformation in the majority of solid tumors. The primary cilium could serve as a tumor suppressor organelle. The aim of this paper was to provide a review of the current knowledge of the primary cilium.

Focus groups to explore healthcare professionals' experiences of care coordination: towards a theoretical framework for the study of care coordination.

PubMed

Van Houdt, Sabine; Sermeus, Walter; Vanhaecht, Kris; De Lepeleire, Jan

2014-12-24

Strategies to improve care coordination between primary and hospital care do not always have the desired results. This is partly due to incomplete understanding of the key concepts of care coordination. An in-depth analysis of existing theoretical frameworks for the study of care coordination identified 14 interrelated key concepts. In another study, these 14 key concepts were further explored in patients' experiences. Additionally, "patient characteristics" was identified as a new key concept in patients' experiences and the previously identified key concept "quality of relationship" between healthcare professionals was extended to "quality of relationship" with the patient. Together, these 15 interrelated key concepts resulted in a new theoretical framework. The present study aimed at improving our understanding of the 15 previously identified key concepts and to explore potentially previous unidentified key concepts and the links between these by exploring how healthcare professionals experience care coordination. A qualitative design was used. Six focus groups were conducted including primary healthcare professionals involved in the care of patients who had breast cancer surgery at three hospitals in Belgium. Data were analyzed using constant comparative analysis. All 15 previously identified key concepts of care coordination were further explored in healthcare professionals' experiences. Links between these 15 concepts were identified, including 9 newly identified links. The concept "external factors" was linked with all 6 concepts relating to (inter)organizational mechanisms; "task characteristics", "structure", "knowledge and information technology", "administrative operational processes", "cultural factors" and "need for coordination". Five of these concepts related to 3 concepts of relational coordination; "roles", "quality of relationship" and "exchange of information". The concept of "task characteristics" was only linked with "roles" and "exchange of information". The concept "patient characteristics" related with the concepts "need for coordination" and "patient outcome". Outcome was influenced by "roles", "quality of relationship" and "exchange of information". External factors and the (inter)organizational mechanism should enhance "roles" and "quality of relationship" between healthcare professionals and with the patient as well as "exchange of information", and setting and sharing of common "goals" to improve care coordination and quality of care.

Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health-Care Reform.

PubMed

Xue, Ying; Intrator, Orna

2016-02-01

The evolving role of nurse practitioners (NPs) as primary care providers, especially for vulnerable populations, is central to the debate regarding strategies to address the growing need for primary care services. The current article provides policy recommendations for leveraging and expanding the historic role of NPs in caring for vulnerable populations, by focusing on three key policy levers: NP scope-of-practice regulation, distribution of the NP workforce, and NP education. These policy levers must go hand in hand to build a sufficient and equitably distributed NP workforce, to help meet the escalating need for primary care in an era of health-care reform. © The Author(s) 2016.

Universal Health Coverage and Primary Healthcare: Lessons From Japan

PubMed Central

Bloom, Gerald

2017-01-01

A recent editorial by Naoki Ikegami has proposed three key lessons from Japan’s experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healthcare to influence decisions that influence their livelihoods. Although the context of low- and middle-income countries (LMICs) differs in many ways from Japan in the late 19th and early 20th centuries, the lesson that short-term initiatives to achieve universal coverage need to be complemented by an understanding of the factors influencing long-term change management remains highly relevant. PMID:28812806

Using developmental research to design innovative knowledge translation technology for spinal cord injury in primary care: Actionable Nuggets™ on SkillScribe™

PubMed Central

Smith, Karen M.; Naumann, Danielle N.; McDiarmid Antony, Laura; McColl, Mary Ann; Aiken, Alice

2014-01-01

Context/Objective Actionable Nuggets™ for spinal cord injury (SCI) are a knowledge translation tool facilitating evidence-based primary care practice, originally developed in 2010 and refined in 2013. Evaluation results from these two phases of development have informed the design of SkillScribe™, an innovative electronic platform intended to offer reflective continuing medical education (CME) programming through mobile devices in order to support the key features of the Actionable Nuggets™ approach. This brief article describes the ongoing development of Actionable Nuggets™ for SCI on SkillScribe™ by: (1) summarizing the work to date on Actionable Nuggets™; (2) describing evaluation results of Actionable Nuggets™; (3) placing SkillScribe™ in the context of adult education. Design Developmental Research Design. Setting Canadian primary care. Participants Primary care physicians; specialist physicians. Interventions Twenty educational modules on SCI. Outcome measures Pre- and post-test knowledge survey, feedback and use statistics, impact assessment survey, qualitative analysis of evaluation data. Results In both hard copy and electronic form, physicians report that Actionable Nuggets™ are an acceptable and useful approach to providing CME for low-prevalence, high-impact conditions like SCI. The key elements of this tool are that they: offer evidence-based information in small, focused “nuggets”; position information where physicians most frequently seek it; offer information in a format that permits direct translation into action in primary care; allow time for reflection; attach practice tools; and offer CME credit. Conclusion Actionable Nuggets™ for SCI, delivered using a convenient and portable electronic medium, with time-released content and interactive testing has the potential to improve the primary care of patients with SCI. PMID:25229739

Considering disparities: How do nurse practitioner regulatory policies, access to care, and health outcomes vary across four states?

PubMed

Sonenberg, Andréa; Knepper, Hillary J

Health disparities persist among morbidity and mortality rates in the United States. Contributing significantly to these disparities are the ability to pay for health care (largely, access to health insurance) and access to, and capacity of, the primary care health workforce. This article examines key determinants of health (DOH) including demographics, public and regulatory policies, health workforce capacity, and primary health outcomes of four states of the United States. The context of this study is the potential association among health care disparities and myriad DOH, among them, the restrictive nurse practitioner (NP) scope of practice (SOP) regulatory environment, which are documented to influence access to care and health outcomes. This descriptive study explores current NP SOP regulations, access to primary care, and health outcomes of key chronic disease indicators-diabetes, hypertension, and obesity in Alabama, Colorado, Mississippi, and Utah. These states represent both the greatest disparity in chronic disease health outcomes (obesity, diabetes, and hypertension) and the greatest difference in modernization of their NP SOP laws. The Affordable Care Act has greatly expanded access to health care. However, it is estimated that 23 million Americans, 7% of its total population, will remain uninsured by 2019. Restrictive and inconsistent NP SOP policies may continue to contribute to health workforce capacity and population health disparities across the country, with particular concern for primary care indicators. The study findings bring into question whether states with more restrictive NP SOP regulations impact access to primary care, which may in turn influence population health outcomes. These findings suggest the need for further research. NPs are essential for meeting the increasing demands of primary care in the United States, and quality-of-care indicator research supports their use. Copyright © 2016 Elsevier Inc. All rights reserved.

Sensing and Measurement Architecture for Grid Modernization

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

Taft, Jeffrey D.; De Martini, Paul

2016-02-01

This paper addresses architecture for grid sensor networks, with primary emphasis on distribution grids. It describes a forward-looking view of sensor network architecture for advanced distribution grids, and discusses key regulatory, financial, and planning issues.

Patient's access to healthcare and treatment in rheumatoid arthritis: the views of stakeholders in Portugal.

PubMed

Laires, Pedro A; Mesquita, Rui; Veloso, Luís; Martins, Ana Paula; Cernadas, Rui; Fonseca, João Eurico

2013-09-25

The access to healthcare and treatment by rheumatoid arthritis (RA) patients, particularly to biologics, differs significantly among European countries.We aimed to explore the views and experiences of Portuguese healthcare stakeholders on key barriers which limit the access to treatment, and ultimately to biologics, by RA patients and to find potential solutions (leverage points) to overcome the identified barriers. This was a qualitative research consisting of semi-structured face-to-face interviews with key stakeholders in RA framework. Thirty four individuals from eight groups of stakeholders were interviewed: rural and urban general practitioners (GPs), rheumatologists, hospital managers, hospital pharmacists, budget holders, representatives from the Portuguese Rheumatology Society and the RA Patient Association. Interviews were conducted between May and June 2011. Conventional content analysis with research triangulation was used. The key barriers identified were related to the accessibility to primary healthcare services, difficulties in RA diagnosis among GPs, inefficient referral to secondary healthcare and controlled process of biologics prescription in public hospitals. The leverage points identified included the improvement of epidemiological and clinical knowledge about RA in Portugal, a better understanding of the disease among patients and GPs, the clarification of biologics benefits among budget holders and a raised awareness of the current treatment guidelines. In order to further address the leverage points, the following key initiatives were proposed: optimization of RA national registry; dissemination of information on rheumatic symptoms in primary care facilities and among the general public; increase interaction between rheumatologists and GPs through clinical discussions of successfully treated patients or workshops; broader utilization of disease diagnosis and monitoring tools, such as DAS28, and implementation of hospital-based research to collect real-world data. Most of the key barriers limiting the access to treatment, including biologics, in RA in Portugal are upstream of rheumatology practice. Our findings suggest that future actions should be focused on the primary care level to improve referral to rheumatologists. In addition, the collection of real-world data seems essential to characterise the RA population, to improve disease management and to increase compliance with current treatment guidelines.

Managing malocclusion in the mixed dentition: six keys to success part 2.

PubMed

Fleming, Padhraig; Johal, Ama; DiBiase, Andrew T

2008-12-01

Regular recall strategies ensure the general dental practitioner is ideally placed to recognize, manage and correct many occlusal problems in the mixed dentition phase. The first paper focused on recognition of normal and abnormal occlusal development, cessation of habits and correction of crossbites. This paper considers management of leeway space, highlights the importance of palpation of unerupted maxillary canines, and discusses the need for judicious removal of primary teeth (Keys 4-6).

First direct landscape-scale measurement of tropical rain forest Leaf Area Index, a key driver of global primary productivity

Treesearch

David B. Clark; Paulo C. Olivas; Steven F. Oberbauer; Deborah A. Clark; Michael G. Ryan

2008-01-01

Leaf Area Index (leaf area per unit ground area, LAI) is a key driver of forest productivity but has never previously been measured directly at the landscape scale in tropical rain forest (TRF). We used a modular tower and stratified random sampling to harvest all foliage from forest floor to canopy top in 55 vertical transects (4.6 m2) across 500 ha of old growth in...

General Dialdehyde Click Chemistry for Amine Bioconjugation.

PubMed

Elahipanah, Sina; O'Brien, Paul J; Rogozhnikov, Dmitry; Yousaf, Muhammad N

2017-05-17

The development of methods for conjugating a range of molecules to primary amine functional groups has revolutionized the fields of chemistry, biology, and material science. The primary amine is a key functional group and one of the most important nucleophiles and bases used in all of synthetic chemistry. Therefore, tremendous interest in the synthesis of molecules containing primary amines and strategies to devise chemical reactions to react with primary amines has been at the core of chemical research. In particular, primary amines are a ubiquitous functional group found in biological systems as free amino acids, as key side chain lysines in proteins, and in signaling molecules and metabolites and are also present in many natural product classes. Due to its abundance, the primary amine is the most convenient functional group handle in molecules for ligation to other molecules for a broad range of applications that impact all scientific fields. Because of the primary amine's central importance in synthetic chemistry, acid-base chemistry, redox chemistry, and biology, many methods have been developed to efficiently react with primary amines, including activated carboxylic acids, isothiocyanates, Michael addition type systems, and reaction with ketones or aldehydes followed by in situ reductive amination. Herein, we introduce a new traceless, high-yield, fast click-chemistry method based on the rapid and efficient trapping of amine groups via a functionalized dialdehyde group. The click reaction occurs in mild conditions in organic solvents or aqueous media and proceeds in high yield, and the starting dialdehyde reagent and resulting dialdehyde click conjugates are stable. Moreover, no catalyst or dialdehyde-activating group is required, and the only byproduct is water. The initial dialdehyde and the resulting conjugate are both straightforward to characterize, and the reaction proceeds with high atom economy. To demonstrate the broad scope of this new click-conjugation strategy, we designed a straightforward scheme to synthesize a suite of dialdehyde reagents. The dialdehyde molecules were used for applications in cell-surface engineering and for tailoring surfaces for material science applications. We anticipate the broad utility of the general dialdehyde click chemistry to primary amines in all areas of chemical research, ranging from polymers and bioconjugation to material science and nanoscience.

Does surface roughness influence the primary stability of acetabular cups? A numerical and experimental biomechanical evaluation.

PubMed

Le Cann, Sophie; Galland, Alexandre; Rosa, Benoît; Le Corroller, Thomas; Pithioux, Martine; Argenson, Jean-Noël; Chabrand, Patrick; Parratte, Sébastien

2014-09-01

Most acetabular cups implanted today are press-fit impacted cementless. Anchorage begins with the primary stability given by insertion of a slightly oversized cup. This primary stability is key to obtaining bone ingrowth and secondary stability. We tested the hypothesis that primary stability of the cup is related to surface roughness of the implant, using both an experimental and a numerical models to analyze how three levels of surface roughness (micro, macro and combined) affect the primary stability of the cup. We also investigated the effect of differences in diameter between the cup and its substrate, and of insertion force, on the cups' primary stability. The results of our study show that primary stability depends on the surface roughness of the cup. The presence of macro-roughness on the peripheral ring is found to decrease primary stability; there was excessive abrasion of the substrate, damaging it and leading to poor primary stability. Numerical modeling indicates that oversizing the cup compared to its substrate has an impact on primary stability, as has insertion force. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

Selective Formation of Secondary Amides via the Copper-Catalyzed Cross-Coupling of Alkylboronic Acids with Primary Amides

PubMed Central

Rossi, Steven A.; Shimkin, Kirk W.; Xu, Qun; Mori-Quiroz, Luis M.; Watson, Donald A.

2014-01-01

For the first time, a general catalytic procedure for the cross coupling of primary amides and alkylboronic acids is demonstrated. The key to the success of this reaction was the identification of a mild base (NaOSiMe3) and oxidant (di-tert-butyl peroxide) to promote the copper-catalyzed reaction in high yield. This transformation provides a facile, high-yielding method for the mono-alkylation of amides. PMID:23611591

Quality of Type II Diabetes Care in Primary Health Care Centers in Kuwait: Employment of a Diabetes Quality Indicator Set (DQIS).

PubMed

Badawi, Dalia; Saleh, Shadi; Natafgi, Nabil; Mourad, Yara; Behbehani, Kazem

2015-01-01

Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from that developed by the National Diabetes Quality Improvement Alliance and the International Diabetes Federation. Five key care domains/measures were employed: (1) Blood glucose level measurement, (2) Cholesterol level measurement, (3) Blood pressure measurement, (4) Kidney function testing and (5) Smoking status check. The sample included the four major primary health care centers with the highest case load in Kuwait City, 4,241 patients in 2012 and 3,211 in 2010. Findings revealed the applicability and utility of employing performance indicators for diabetes care in Kuwait. Furthermore, findings revealed that many of the primary health care centers have achieved noteworthy improvement in diabetes care between 2010 and 2012, with the exception of smoking status check. The DQIS can help policymakers identify performance gaps and investigate key system roadblocks related to diabetes care in Kuwait.

Early mathematics development and later achievement: Further evidence

NASA Astrophysics Data System (ADS)

Aubrey, Carol; Godfrey, Ray; Dahl, Sarah

2006-05-01

There is a growing international recognition of the importance of the early years of schooling as well as an interest being shown in the relationship of early education to later achievement. This article focuses on a cohort of English pupils who have been tracked through primary school during the first five years of the new National Numeracy Strategy. It reports a limited longitudinal study of young children's early mathematical development, initially within three testing cycles: at the mid-point and towards the end of their reception year (at five years-of-age) and again at the mid-point of Year 1 (at six years-ofage). These cycles were located within the broader context of progress through to the end of Key Stage 1 (at seven years) and Key Stage 2 (at eleven years) on the basis of national standardised assessment tests (SATs). Results showed that children who bring into school early mathematical knowledge do appear to be advantaged in terms of their mathematical progress through primary school. Numerical attainment increases in importance across the primary years and practical problem solving remains an important element of this. This finding is significant given the current emphasis on numerical calculation in the English curriculum. It is concluded that without active intervention, it is likely that children with little mathematical knowledge at the beginning of formal schooling will remain low achievers throughout their primary years and, probably, beyond.

Final report for the Integrated and Robust Security Infrastructure (IRSI) laboratory directed research and development project

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

Hutchinson, R.L.; Hamilton, V.A.; Istrail, G.G.

1997-11-01

This report describes the results of a Sandia-funded laboratory-directed research and development project titled {open_quotes}Integrated and Robust Security Infrastructure{close_quotes} (IRSI). IRSI was to provide a broad range of commercial-grade security services to any software application. IRSI has two primary goals: application transparency and manageable public key infrastructure. IRSI must provide its security services to any application without the need to modify the application to invoke the security services. Public key mechanisms are well suited for a network with many end users and systems. There are many issues that make it difficult to deploy and manage a public key infrastructure. IRSImore » addressed some of these issues to create a more manageable public key infrastructure.« less

Lung Cancer Screening with Low-Dose Computed Tomography for Primary Care Providers

PubMed Central

Richards, Thomas B.; White, Mary C.; Caraballo, Ralph S.

2015-01-01

This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary care providers. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary care providers should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients. PMID:24830610

Diabetic retinopathy: a review for the primary care physician.

PubMed

Fonseca, V; Munshi, M; Merin, L M; Bradford, J D

1996-09-01

Hyperglycemia can result in key biochemical reactions that may contribute to thickening of basement membranes, dysfunction of pericytes and endothelial cells, and closure of retinal vessels. The Diabetes Control and Complications Trial has proved the value of good glycemic control in preventing retinopathy and/or delaying its progression. The primary care physician has a crucial role in translating these results into practice. Recognition and management of other risk factors, such as proteinuria, smoking, and hypertension, are easily done in the primary care setting. Also, appropriate referral to an ophthalmologist for retinal evaluation and treatment is both necessary and cost effective in reducing the burden of this devastating complication of diabetes.

Developing content for an interprofessional training on fear of cancer recurrence (FCR): Key informant interviews of healthcare professionals, researchers and cancer survivors.

PubMed

Berrett-Abebe, Julie; Cadet, Tamara; Vitello, Joan; Maramaldi, Peter

2018-04-10

Growing numbers of cancer survivors are receiving healthcare through primary care practitioners, who often lack cancer-specific expertise to effectively treat survivors' concerns. Addressing that gap, this study aimed to develop content for a training on fear of cancer recurrence (FCR), a common concern in survivorship. Grounded in naturalistic inquiry, 42 key-informant interviews were conducted, transcribed, and analyzed for themes. Participants were healthcare professionals, researchers, and cancer survivors Results: Results included themes ranging from: rich conceptualizations of FCR, opportunities and challenges for addressing FCR in healthcare settings, interventions to address FCR, and important information to include in a training on FCR. This paper provides content for an interprofessional training and highlights the importance of developing trainings for interprofessional teams, given identified barriers that physicians face in addressing FCR and other psychosocial concerns of survivors in primary care.

Barriers to Providing Health Education During Primary Care Visits at Community Health Centers: Clinical Staff Insights.

PubMed

Alicea-Planas, Jessica; Pose, Alix; Smith, Linda

2016-04-01

The rapid increase of diverse patients living in the US has created a different set of needs in healthcare, with the persistence of health disparities continuing to challenge the current system. Chronic disease management has been discussed as a way to improve health outcomes, with quality patient education being a key component. Using a community based participatory research framework, this study utilized a web-based survey and explored clinical staff perceptions of barriers to providing patient education during primary care visits. With a response rate of nearly 42 %, appointment time allotment seemed to be one of the most critical factors related to the delivery of health education and should be considered key. The importance of team-based care and staff training were also significant. Various suggestions were made in order to improve the delivery of quality patient education at community health centers located in underserved areas.

Logging cuts the functional importance of invertebrates in tropical rainforest

PubMed Central

Ewers, Robert M.; Boyle, Michael J. W.; Gleave, Rosalind A.; Plowman, Nichola S.; Benedick, Suzan; Bernard, Henry; Bishop, Tom R.; Bakhtiar, Effendi Y.; Chey, Vun Khen; Chung, Arthur Y. C.; Davies, Richard G.; Edwards, David P.; Eggleton, Paul; Fayle, Tom M.; Hardwick, Stephen R.; Homathevi, Rahman; Kitching, Roger L.; Khoo, Min Sheng; Luke, Sarah H.; March, Joshua J.; Nilus, Reuben; Pfeifer, Marion; Rao, Sri V.; Sharp, Adam C.; Snaddon, Jake L.; Stork, Nigel E.; Struebig, Matthew J.; Wearn, Oliver R.; Yusah, Kalsum M.; Turner, Edgar C.

2015-01-01

Invertebrates are dominant species in primary tropical rainforests, where their abundance and diversity contributes to the functioning and resilience of these globally important ecosystems. However, more than one-third of tropical forests have been logged, with dramatic impacts on rainforest biodiversity that may disrupt key ecosystem processes. We find that the contribution of invertebrates to three ecosystem processes operating at three trophic levels (litter decomposition, seed predation and removal, and invertebrate predation) is reduced by up to one-half following logging. These changes are associated with decreased abundance of key functional groups of termites, ants, beetles and earthworms, and an increase in the abundance of small mammals, amphibians and insectivorous birds in logged relative to primary forest. Our results suggest that ecosystem processes themselves have considerable resilience to logging, but the consistent decline of invertebrate functional importance is indicative of a human-induced shift in how these ecological processes operate in tropical rainforests. PMID:25865801

Logging cuts the functional importance of invertebrates in tropical rainforest.

PubMed

Ewers, Robert M; Boyle, Michael J W; Gleave, Rosalind A; Plowman, Nichola S; Benedick, Suzan; Bernard, Henry; Bishop, Tom R; Bakhtiar, Effendi Y; Chey, Vun Khen; Chung, Arthur Y C; Davies, Richard G; Edwards, David P; Eggleton, Paul; Fayle, Tom M; Hardwick, Stephen R; Homathevi, Rahman; Kitching, Roger L; Khoo, Min Sheng; Luke, Sarah H; March, Joshua J; Nilus, Reuben; Pfeifer, Marion; Rao, Sri V; Sharp, Adam C; Snaddon, Jake L; Stork, Nigel E; Struebig, Matthew J; Wearn, Oliver R; Yusah, Kalsum M; Turner, Edgar C

2015-04-13

Invertebrates are dominant species in primary tropical rainforests, where their abundance and diversity contributes to the functioning and resilience of these globally important ecosystems. However, more than one-third of tropical forests have been logged, with dramatic impacts on rainforest biodiversity that may disrupt key ecosystem processes. We find that the contribution of invertebrates to three ecosystem processes operating at three trophic levels (litter decomposition, seed predation and removal, and invertebrate predation) is reduced by up to one-half following logging. These changes are associated with decreased abundance of key functional groups of termites, ants, beetles and earthworms, and an increase in the abundance of small mammals, amphibians and insectivorous birds in logged relative to primary forest. Our results suggest that ecosystem processes themselves have considerable resilience to logging, but the consistent decline of invertebrate functional importance is indicative of a human-induced shift in how these ecological processes operate in tropical rainforests.

Relationship between mathematics teacher subject matter knowledge, pedagogical content knowledge and professional development needs

NASA Astrophysics Data System (ADS)

Tajudin, Nor'ain Mohd; Chinnappan, Mohan; Saad, Noor Shah

2017-05-01

Two key variables emerged from the literature review is that Specific Matter Knowledge [SMK] and Pedagogical Content Knowledge [PCK] can influence the mathematics teachers' Professional Development [PD] needs. However, the key variables of SMK and PCK that were being investigated were not defined clearly. Empirical evidence that support relationship between SMK and PD and PCK and PD were not verified. In addition, how does PCK mediate SMK and PD is not clear and somewhat lacking. Therefore, the purpose of this paper was to examine the relationship between primary mathematics teacher's SMK, PCK and PD needs. Results of path analysis with SmartPLS indicated that the direct effect of SMK on PD was mediated via PCK. This data provide support for the claim that PD programs for future teachers of primary mathematics should be driven by a more nuanced understanding of the link between SMK and PCK.

Launching forward: The integration of behavioral health in primary care as a key strategy for promoting young child wellness.

PubMed

Oppenheim, Jennifer; Stewart, Whitney; Zoubak, Ekaterina; Donato, Ingrid; Huang, Larke; Hudock, William

2016-03-01

In 2008, the Substance Abuse and Mental Health Services Administration (SAMHSA) created a national grant program, Project LAUNCH (Linking Actions for Unmet Needs in Children's Health), to improve behavioral health and developmental outcomes for young children through the incorporation of prevention and wellness promotion practices in key early childhood settings. Project LAUNCH supports states, tribal nations, and territories to improve coordination across early childhood systems and implement 5 core strategies of prevention and promotion. This article focuses on the lessons learned from 1 of the 5 core strategies: integration of behavioral health into primary care for young children. This paper analyzes the experiences of a sample of Project LAUNCH grantees, describing 10 common elements of integration approaches and exploring some of the challenges of promoting health and preventing social, emotional, and behavioral problems at a population level. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Brain metastasis detection by resonant Raman optical biopsy method

NASA Astrophysics Data System (ADS)

Zhou, Yan; Liu, Cheng-hui; Cheng, Gangge; Zhou, Lixin; Zhang, Chunyuan; Pu, Yang; Li, Zhongwu; Liu, Yulong; Li, Qingbo; Wang, Wei; Alfano, Robert R.

2014-03-01

Resonant Raman (RR) spectroscopy provides an effective way to enhance Raman signal from particular bonds associated with key molecules due to changes on a molecular level. In this study, RR is used for detection of human brain metastases of five kinds of primary organs of lung, breast, kidney, rectal and orbital in ex-vivo. The RR spectra of brain metastases cancerous tissues were measured and compared with those of normal brain tissues and the corresponding primary cancer tissues. The differences of five types of brain metastases tissues in key bio-components of carotene, tryptophan, lactate, alanine and methyl/methylene group were investigated. The SVM-KNN classifier was used to categorize a set of RR spectra data of brain metastasis of lung cancerous tissues from normal brain tissue, yielding diagnostic sensitivity and specificity at 100% and 75%, respectively. The RR spectroscopy may provide new moleculebased optical probe tools for diagnosis and classification of brain metastatic of cancers.

Is there a relationship between primary school children's enjoyment of recess physical activities and health-related quality of life? A cross-sectional exploratory study.

PubMed

Hyndman, Brendon; Benson, Amanda C; Lester, Leanne; Telford, Amanda

2017-03-01

Issue addressed An important strategy for increasing children's physical activity is to enhance children's opportunities for school recess physical activities, yet little is known about the influence of school recess physical activities on children's health-related quality of life (HRQOL). The purpose of the present study was to explore the relationship between Australian primary school children's enjoyment of recess physical activities and HRQOL. Methods The study consisted of children at two Australian primary schools (n=105) aged 8-12 years. The Lunchtime Enjoyment Activity and Play questionnaire was used to measure school children's enjoyment of school recess physical activities. The Pediatric Quality of Life Inventory 4.0 was used to measure children's HRQOL. Researchers applied linear regression modelling in STATA (ver. 13.0) to investigate the relationship between children's enjoyment of school recess physical activities and HRQOL. Results It was discovered that primary school children's enjoyment of more vigorous-type school recess physical activities and playing in a range of weather conditions was associated with children's improved HRQOL. Conclusion The findings from this study suggest that health providers and researchers should consider providing primary school children with opportunities and facilities for more vigorous-intensity school recess physical activities as a key strategy to enhance children's HRQOL. So what? Considering a social-ecological model framework of the key predictors of children's enjoyment of school recess physical activities may provide valuable insight for school health providers into the multiple levels of influence on children's HRQOL when developing school settings and activities for school recess.

Shared Care: A Quality Improvement Initiative to Optimize Primary Care Management of Constipation

PubMed Central

Vernacchio, Louis; Trudell, Emily; Antonelli, Richard; Nurko, Samuel; Leichtner, Alan M.; Lightdale, Jenifer R.

2015-01-01

BACKGROUND: Pediatric constipation is commonly managed in the primary care setting, where there is much variability in management and specialty referral use. Shared Care is a collaborative quality improvement initiative between Boston Children’s Hospital and the Pediatric Physician’s Organization at Children’s (PPOC), through which subspecialists provide primary care providers with education, decision-support tools, pre-referral management recommendations, and access to advice. We investigated whether Shared Care reduces referrals and improves adherence to established clinical guidelines. METHODS: We reviewed the primary care management of patients 1 to 18 years old seen by a Boston Children’s Hospital gastroenterologist and diagnosed with constipation who were referred from PPOC practices in the 6 months before and after implementation of Shared Care. Charts were assessed for patient factors and key components of management. We also tracked referral rates for all PPOC patients for 29 months before implementation and 19 months after implementation. RESULTS: Fewer active patients in the sample were referred after implementation (61/27 365 [0.22%] vs 90/27 792 [0.36%], P = .003). The duration of pre-referral management increased, and the rate of fecal impaction decreased after implementation. No differences were observed in documentation of key management recommendations. Analysis of medical claims showed no statistically significant change in referrals. CONCLUSIONS: A multifaceted initiative to support primary care management of constipation can alter clinical care, but changes in referral behavior and pre-referral management may be difficult to detect and sustain. Future efforts may benefit from novel approaches to provider engagement and systems integration. PMID:25896837

Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries.

PubMed

Petrazzuoli, Ferdinando; Vinker, Shlomo; Koskela, Tuomas H; Frese, Thomas; Buono, Nicola; Soler, Jean Karl; Ahrensberg, Jette; Asenova, Radost; Foguet Boreu, Quintí; Ceyhun Peker, Gülsen; Collins, Claire; Hanževački, Miro; Hoffmann, Kathryn; Iftode, Claudia; Kurpas, Donata; Le Reste, Jean Yves; Lichtwarck, Bjørn; Petek, Davorina; Pinto, Daniel; Schrans, Diego; Streit, Sven; Tang, Eugene Yee Hing; Tatsioni, Athina; Torzsa, Péter; Unalan, Pemra C; van Marwijk, Harm; Thulesius, Hans

2017-09-01

Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment. Key informant survey. Primary care practices across 25 European countries. Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. Two by two contingency tables with odds ratios and 95% confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs' attitude of "trying to establish a diagnosis of dementia on their own." Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95% CI 2.28-5.23). Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe.

From Efficacy to Effectiveness and Beyond: What Next for Brief Interventions in Primary Care?

PubMed Central

O’Donnell, Amy; Wallace, Paul; Kaner, Eileen

2014-01-01

Background: Robust evidence supports the effectiveness of screening and brief alcohol interventions in primary healthcare. However, lack of understanding about their “active ingredients” and concerns over the extent to which current approaches remain faithful to their original theoretical roots has led some to demand a cautious approach to future roll-out pending further research. Against this background, this paper provides a timely overview of the development of the brief alcohol intervention evidence base to assess the extent to which it has achieved the four key levels of intervention research: efficacy, effectiveness, implementation, and demonstration. Methods: Narrative overview based on (1) the results of a review of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare and (2) synthesis of the findings of key additional primary studies on the improvement and evaluation of brief alcohol intervention implementation in routine primary healthcare. Results: The brief intervention field seems to constitute an almost perfect example of the evaluation of a complex intervention. Early evaluations of screening and brief intervention approaches included more tightly controlled efficacy trials and have been followed by more pragmatic trials of effectiveness in routine clinical practice. Most recently, attention has shifted to dissemination, implementation, and wider-scale roll-out. However, delivery in routine primary health remains inconsistent, with an identified knowledge gap around how to successfully embed brief alcohol intervention approaches in mainstream care, and as yet unanswered questions concerning what specific intervention component prompt the positive changes in alcohol consumption. Conclusion: Both the efficacy and effectiveness of brief alcohol interventions have been comprehensively demonstrated, and intervention effects seem replicable and stable over time, and across different study contexts. Thus, while unanswered questions remain, given the positive evidence amassed to date, research efforts should maintain a continued focus on promoting sustained implementation of screening and brief alcohol intervention approaches in primary care to ensure that those who might benefit from screening and brief alcohol interventions actually receive such support. PMID:25221524

Stakeholders’ Perspectives on Strategies for the Recruitment and Retention of Primary Health Care Employees in Qatar: A Qualitative Approach

PubMed Central

Alameddine, Mohamad; Yassoub, Rami; Mourad, Yara; Khodr, Hiba

2017-01-01

This study explores the recruitment and retention conditions influencing primary health care (PHC) human resources for health (HRH) in Qatar and suggests strategies for their improvement. A qualitative design employing semistructured key informant interviews with PHC stakeholders in Qatar was utilized. Key interviewees were originally recognized, and snowball sampling was used to identify additional interviewees until reaching saturation point. Interview scripts were transcribed and then analyzed thematically using the Nvivo software package. Thematic analysis precipitated a number of themes. Under recruitment, the centrality of enhancing collaboration with academic institutions, enhancing extrinsic benefits, and strengthening human resources recruitment and management practices. Dedicated support needs to be provided to expatriate HRH especially in regard to housing services, children schooling, and streamlining administrative processes for relocation. Findings revealed that job security, continuous professional development, objective performance appraisal systems, enhanced job transparency, and remuneration are key retention concerns. The study provides a number of recommendations for the proper recruitment and retention of HRH. Health planners and decision makers must take these recommendations into consideration to ensure the presence of a competent and sustainable HRH in the PHC sector in the future. PMID:28853314

Stakeholders' Perspectives on Strategies for the Recruitment and Retention of Primary Health Care Employees in Qatar: A Qualitative Approach.

PubMed

Alameddine, Mohamad; Yassoub, Rami; Mourad, Yara; Khodr, Hiba

2017-01-01

This study explores the recruitment and retention conditions influencing primary health care (PHC) human resources for health (HRH) in Qatar and suggests strategies for their improvement. A qualitative design employing semistructured key informant interviews with PHC stakeholders in Qatar was utilized. Key interviewees were originally recognized, and snowball sampling was used to identify additional interviewees until reaching saturation point. Interview scripts were transcribed and then analyzed thematically using the Nvivo software package. Thematic analysis precipitated a number of themes. Under recruitment, the centrality of enhancing collaboration with academic institutions, enhancing extrinsic benefits, and strengthening human resources recruitment and management practices. Dedicated support needs to be provided to expatriate HRH especially in regard to housing services, children schooling, and streamlining administrative processes for relocation. Findings revealed that job security, continuous professional development, objective performance appraisal systems, enhanced job transparency, and remuneration are key retention concerns. The study provides a number of recommendations for the proper recruitment and retention of HRH. Health planners and decision makers must take these recommendations into consideration to ensure the presence of a competent and sustainable HRH in the PHC sector in the future.

Using movies in family medicine teaching: A reference to EURACT Educational Agenda

PubMed Central

Švab, Igor

2017-01-01

Abstract Introduction Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians’ competencies as listed in the Educational Agenda produced by the European Academy of Teachers in General Practice/Family Medicine (EURACT) can be found in movies, and to propose a template for teaching by these movies. Methods A group of family medicine teachers provided a list of movies that they would use in cinemeducation. The movies were categorised according to the key family medicine competencies, thus creating a framework of competences, covered by different movies. These key competencies are Primary care management, Personcentred care, Specific problem-solving skills, Comprehensive approach, Community orientation, and Holistic approach. Results The list consisted of 17 movies. Nine covered primary care management. Person-centred care was covered in 13 movies. Eight movies covered specific problem-solving skills. Comprehensive approach was covered in five movies. Five movies covered community orientation. Holistic approach was covered in five movies. Conclusions All key family medicine competencies listed in the Educational Agenda can be taught using movies. Our results can serve as a template for teachers on how to use any appropriate movies in family medicine education. PMID:28289469

Search for the sex-determining switch in monotremes: mapping WT1, SF1, LHX1, LHX2, FGF9, WNT4, RSPO1 and GATA4 in platypus.

PubMed

Grafodatskaya, Daria; Rens, Willem; Wallis, Mary C; Trifonov, Vladimir; O'Brien, Patricia C M; Clarke, Oliver; Graves, Jennifer A M; Ferguson-Smith, Malcolm A

2007-01-01

The duck-billed platypus has five pairs of sex chromosomes, but there is no information about the primary sex-determining switch in this species. As there is no apparent SRY orthologue in platypus, another gene must acquire the function of a key regulator of the gonadal male or female fate. SOX9 was ruled out from being this key regulator as it maps to an autosome in platypus. To check whether other genes in mammalian gonadogenesis could be the primary switch in monotremes, we have mapped a number of candidates in platypus. We report here the autosomal location of WT1, SF1, LHX1, LHX9, FGF9, WNT4 and RSPO1 in platypus, thus excluding these from being key regulators of sex determination in this species. We found that GATA4 maps to sex chromosomes Y1 and X2; however, it lies in the pairing region shown by chromosome painting to be homologous, so is unlikely to be either male-specific or differentially dosed in male and female.

Using movies in family medicine teaching: A reference to EURACT Educational Agenda.

PubMed

Klemenc Ketiš, Zalika; Švab, Igor

2017-06-01

Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians' competencies as listed in the Educational Agenda produced by the European Academy of Teachers in General Practice/Family Medicine (EURACT) can be found in movies, and to propose a template for teaching by these movies. A group of family medicine teachers provided a list of movies that they would use in cinemeducation. The movies were categorised according to the key family medicine competencies, thus creating a framework of competences, covered by different movies. These key competencies are Primary care management, Personcentred care, Specific problem-solving skills, Comprehensive approach, Community orientation, and Holistic approach. The list consisted of 17 movies. Nine covered primary care management. Person-centred care was covered in 13 movies. Eight movies covered specific problem-solving skills. Comprehensive approach was covered in five movies. Five movies covered community orientation. Holistic approach was covered in five movies. All key family medicine competencies listed in the Educational Agenda can be taught using movies. Our results can serve as a template for teachers on how to use any appropriate movies in family medicine education.

What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism?

PubMed

Young, William F; Stanson, Anthony W

2009-01-01

Adrenal venous sampling (AVS) is the criterion standard to distinguish between unilateral and bilateral adrenal disease in patients with primary aldosteronism. The keys to successful AVS include appropriate patient selection, careful patient preparation, focused technical expertise, defined protocol, and accurate data interpretation. The use of AVS should be based on patient preferences, patient age, clinical comorbidities, and the clinical probability of finding an aldosterone-producing adenoma. AVS is optimally performed in the fasting state in the morning. AVS is an intricate procedure because the right adrenal vein is small and may be difficult to locate - the success rate depends on the proficiency of the angiographer. The key factors that determine the successful catheterization of both adrenal veins are experience, dedication and repetition. With experience, and focusing the expertise to 1 or 2 radiologists at a referral centre, the AVS success rate can be as high as 96%. A centre-specific, written protocol is mandatory. The protocol should be developed by an interested group of endocrinologists, radiologists and laboratory personnel. Safeguards should be in place to prevent mislabelling of the blood tubes in the radiology suite and to prevent sample mix-up in the laboratory.

First results from the HST Grism Lens-Amplified Survey from Space (GLASS)

NASA Astrophysics Data System (ADS)

WANG, XIN; Schmidt, K. B.; Treu, T.; GLASS Team

2014-01-01

GLASS is a cycle-21 large program with the Hubble Space Telescope, targeting 10 massive clusters, including the 6 Frontier Fields, using the WFC3 and ACS grisms. The program consists of 140 primary orbits and 140 parallel orbits. Using the clusters as cosmic telescopes, GLASS is taking spectra of faint background galaxies with unprecedented sensitivity and angular resolution. GLASS has 3 primary science drivers, although a variety of other science investigations are possible in combination with existing and planned imaging campaigns. The first key science goal is to shed light upon the role of galaxies in reionizing the universe, the topology of high redshift intergalactic/interstellar medium and Lyman alpha escape fraction. The second key science goal is to study gas accretion, star formation and outflows by mapping spatially resolved star formation and metallicity gradients in galaxies at z=1.3-2.3. The third key science goal is to study the environmental dependence of galaxy evolution, by mapping spatially resolved star formation in galaxies in the cluster cores and infalling regions. We present the details of the program and results from the first cluster observed by GLASS MACS0717.5+3745.

Initial perceptions of key stakeholders in Ontario regarding independent prescriptive authority for pharmacists.

PubMed

Pojskic, Nedzad; MacKeigan, Linda; Boon, Heather; Austin, Zubin

2014-01-01

A number of jurisdictions, both in Canada and internationally, have recently expanded pharmacists' scope of practice to allow prescriptive authority. To ascertain the initial perceptions of the Ontario government and health professional stakeholder groups regarding the prospect of prescriptive authority for pharmacists. Qualitative research methods were used; data sources were policy documents and semi-structured interviews with key informants from the Ontario government and pharmacy and medical professional organizations. Purposive and snowball sampling strategies were used to identify 17 key informants. Fifty-one relevant policy documents were retrieved through searches of organizational websites and interviewee suggestions. Interview transcripts and documents were content analyzed independently by 2 researchers; and once consensus was achieved on key themes, the primary investigator analyzed the remainder. Pharmacy organizations and Ontario government representatives both expressed support for pharmacist prescriptive authority, suggesting that it would enhance patient access to primary care. Medical organizations were opposed to this expanded pharmacist role, arguing that pharmacists' lack of training and experience in diagnosis and prescribing would endanger patient safety. Other concerns were fragmentation of care and pharmacists' lack of access to patient clinical information. Some government and pharmacy informants felt that pharmacist prescribing would decrease health system costs through substitution of cheaper health professionals for physicians, while others felt that costs would increase due to increased utilization of services. Medical organizations preferred delegated medical authority as the policy alternative to pharmacist prescribing. Widely different views were expressed by the Ontario government and pharmacy organizations on the one hand and medical professional organizations on the other hand, regarding the potential impact of pharmacist prescribing on patient safety and access to primary care. This is likely due, at least in part, to the lack of evidence on the expected impact of this expanded pharmacist role. More research is needed to help inform discussions regarding this issue. Copyright © 2014 Elsevier Inc. All rights reserved.

On-line detection of key radionuclides for fuel-rod failure in a pressurized water reactor.

PubMed

Qin, Guoxiu; Chen, Xilin; Guo, Xiaoqing; Ni, Ning

2016-08-01

For early on-line detection of fuel rod failure, the key radionuclides useful in monitoring must leak easily from failing rods. Yield, half-life, and mass share of fission products that enter the primary coolant also need to be considered in on-line analyses. From all the nuclides that enter the primary coolant during fuel-rod failure, (135)Xe and (88)Kr were ultimately chosen as crucial for on-line monitoring of fuel-rod failure. A monitoring system for fuel-rod failure detection for pressurized water reactor (PWR) based on the LaBr3(Ce) detector was assembled and tested. The samples of coolant from the PWR were measured using the system as well as a HPGe γ-ray spectrometer. A comparison showed the method was feasible. Finally, the γ-ray spectra of primary coolant were measured under normal operations and during fuel-rod failure. The two peaks of (135)Xe (249.8keV) and (88)Kr (2392.1keV) were visible, confirming that the method is capable of monitoring fuel-rod failure on-line. Copyright © 2016 Elsevier Ltd. All rights reserved.

Primary Health Care

PubMed Central

Leslie, Laurel K.; Mehus, Christopher J.; Hawkins, J. David; Boat, Thomas; McCabe, Mary Ann; Barkin, Shari; Perrin, Ellen C.; Metzler, Carol W.; Prado, Guillermo; Tait, V. Fan; Brown, Randall; Beardslee, William

2017-01-01

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are: (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable home for family-focused prevention and suggest possibilities for sustainable funding of family-focused prevention programs. This paper discusses the existing advantages of primary care settings and lays out a plan to move toward realizing the potential public health impact of family-focused prevention through widespread implementation in primary healthcare settings. PMID:27498167

All Paths Lead to TRIM25.

PubMed

Zhou, Hengbo; Costello, James C

2017-10-01

Identifying key factors that regulate the transition from primary to metastatic cancer is a fundamental challenge. Walsh et al. took a systems biology approach integrating computational, in vitro, and in vivo experiments to identify TRIM25 (tripartite motif containing 25) as a key factor that regulates metastatic gene signatures both at the transcriptional and post-transcriptional level in breast cancer. Targeting TRIM25 therapeutically is attractive because it governs a broad set of coordinated transcriptional modules that dictate metastatic progression. Copyright © 2017 Elsevier Inc. All rights reserved.

Mammary Gland Tumor Development in Transgenic Mice Overexpressing Different Isoforms of the CDP/Cux Transcription Factor

DTIC Science & Technology

2009-03-01

tumors and in uterine leiomyomas , suggesting that these proteins play a key role in tumor development and progression. My project consisted in... leiomyomas , suggesting that these proteins could play a key role in tumor development and progression (6, 7). I have also previoulsly shown that...and p110 are involved in cancer development. The p110 and p75 isoforms are overexpressed in primary human tumors, such as in uterine leiomyomas and

Effects of sterilization methods on key properties of specialty optical fibers used in medical devices

NASA Astrophysics Data System (ADS)

Stolov, Andrei A.; Slyman, Brian E.; Burgess, David T.; Hokansson, Adam S.; Li, Jie; Allen, R. Steve

2013-03-01

Optical fibers with different types of polymer coatings were exposed to three sterilization conditions: multiple autoclaving, treatment with ethylene oxide and treatment with gamma rays. Effects of different sterilization techniques on key optical and mechanical properties of the fibers are reported. The primary attention is given to behavior of the coatings in harsh sterilization environments. The following four coating/buffer types were investigated: (i) dual acrylate, (ii) polyimide, (iii) silicone/PEEK and (iv) fluoroacrylate hard cladding/ETFE.

An illustrated key to the genera of Eumeninae from China, with a checklist of species (Hymenoptera, Vespidae)

PubMed Central

2018-01-01

Abstract An illustrated key to the currently recognized genera of the subfamily Eumeninae (Vespidae) from China is presented together with a list of 267 species and subspecies, belonging to 51 genera. Nortozumia van der Vecht, 1937 is reported for the first time from China. Two replacement names are proposed for junior primary homonyms: Ancistrocerus rufofrustius Tan & Carpenter, nom. n. replacing Ancistrocerus rufopictus (Kostylev) and Orientalicesa confasciatus Tan & Carpenter, nom. n. replacing Orientalicesa unifasciatus (von Schulthess, 1934). PMID:29674892

TCPD: A micropattern photon detector hybrid for RICH applications

NASA Astrophysics Data System (ADS)

Hamar, G.; Varga, D.

2017-03-01

A micropattern and wire chamber hybrid has been constructed for UV photon detection, and its performance evaluated. It is revealed that such combination retains some key advantages of both the Thick-GEM primary and CCC secondary amplification stages, and results in a high gain gaseous photon detector with outstanding stability. Key features such as MIP suppression, detection efficiency and photon cluster size are discussed. The capability of the detector for UV photon detection has been established and proven with Cherenkov photons in particle beam tests.

The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system.

PubMed

Moosa, Shabir; Mash, Bob; Derese, Anselme; Peersman, Wim

2014-06-25

Integrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being only fully registered as a full specialty in South Africa in 2008. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues. This was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposively selected leaders using an interview guide. Thematic content analysis was based on the framework method. Whilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and 'specialist' status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance/quality improvement; and providing support to community-oriented care. Respondents' urged family physicians to consolidate the development and training of family physicians, and shape human resource policy to include family physicians. Family physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care - a tall order, requiring strong teamwork. Innovative team-based service delivery is possible despite human resource challenges, but requires family physicians to proactively develop team-based models of care, reform education and advocate for clearer policy, based on the views of these respondents.

The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system

PubMed Central

2014-01-01

Background Integrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being only fully registered as a full specialty in South Africa in 2008. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues. Methods This was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposively selected leaders using an interview guide. Thematic content analysis was based on the framework method. Results Whilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and ‘specialist’ status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance/quality improvement; and providing support to community-oriented care. Respondents’ urged family physicians to consolidate the development and training of family physicians, and shape human resource policy to include family physicians. Conclusions Family physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care - a tall order, requiring strong teamwork. Innovative team-based service delivery is possible despite human resource challenges, but requires family physicians to proactively develop team-based models of care, reform education and advocate for clearer policy, based on the views of these respondents. PMID:24961449

A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home

PubMed Central

Gabbay, Robert A.; Friedberg, Mark W.; Miller-Day, Michelle; Cronholm, Peter F.; Adelman, Alan; Schneider, Eric C.

2013-01-01

PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and financial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices’ baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices’ structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care. PMID:23690393

Advancing team-based primary health care: a comparative analysis of policies in western Canada.

PubMed

Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T

2017-07-17

We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

Advancing primary care to promote equitable health: implications for China

PubMed Central

2012-01-01

China is a country with vast regional differences and uneven economic development, which have led to widening gaps between the rich and poor in terms of access to healthcare, quality of care, and health outcomes. China's healthcare reform efforts must be tailored to the needs and resources of each region and community. Building and strengthening primary care within the Chinese health care system is one way to effectively address health challenges. This paper begins by outlining the concept of primary care, including key definitions and measurements. Next, results from a number of studies will demonstrate that primary care characteristics are associated with savings in medical costs, improvements in health outcomes and reductions in health disparities. This paper concludes with recommendations for China on successfully incorporating a primary care model into its national health policy, including bolstering the primary care workforce, addressing medical financing structures, recognizing the importance of evidence-based medicine, and looking to case studies from countries that have successfully implemented health reform. PMID:22264309

Primary cilia modulate Ihh signal transduction in response to hydrostatic loading of growth plate chondrocytes.

PubMed

Shao, Yvonne Y; Wang, Lai; Welter, Jean F; Ballock, R Tracy

2012-01-01

Indian hedgehog (Ihh) is a key component of the regulatory apparatus governing chondrocyte proliferation and differentiation in the growth plate. Recent studies have demonstrated that the primary cilium is the site of Ihh signaling within the cell, and that primary cilia are essential for bone and cartilage formation. Primary cilia are also postulated to act as mechanosensory organelles that transduce mechanical forces acting on the cell into biological signals. In this study, we used a hydrostatic compression system to examine Ihh signal transduction under the influence of mechanical load. Our results demonstrate that hydrostatic compression increased both Ihh gene expression and Ihh-responsive Gli-luciferase activity. These increases were aborted by disrupting the primary cilia structure with chloral hydrate. These results suggest that growth plate chondrocytes respond to hydrostatic loading by increasing Ihh signaling, and that the primary cilium is required for this mechano-biological signal transduction to occur. Copyright © 2011 Elsevier Inc. All rights reserved.

Using Geographic Information Systems (GIS) to understand a community's primary care needs.

PubMed

Dulin, Michael F; Ludden, Thomas M; Tapp, Hazel; Blackwell, Joshua; de Hernandez, Brisa Urquieta; Smith, Heather A; Furuseth, Owen J

2010-01-01

A key element for reducing health care costs and improving community health is increased access to primary care and preventative health services. Geographic information systems (GIS) have the potential to assess patterns of health care utilization and community-level attributes to identify geographic regions most in need of primary care access. GIS, analytical hierarchy process, and multiattribute assessment and evaluation techniques were used to examine attributes describing primary care need and identify areas that would benefit from increased access to primary care services. Attributes were identified by a collaborative partnership working within a practice-based research network using tenets of community-based participatory research. Maps were created based on socioeconomic status, population density, insurance status, and emergency department and primary care safety-net utilization. Individual and composite maps identified areas in our community with the greatest need for increased access to primary care services. Applying GIS to commonly available community- and patient-level data can rapidly identify areas most in need of increased access to primary care services. We have termed this a Multiple Attribute Primary Care Targeting Strategy. This model can be used to plan health services delivery as well as to target and evaluate interventions designed to improve health care access.

[Rethinking the place of primary healthcare in France--role of general practice].

PubMed

Gay, B

2013-06-01

Primary healthcare is poorly structured in France while it is well defined at the international level: it is the point of first medical contact of the population with the healthcare system. General practice is the clinical specialty oriented to primary healthcare. Data in the scientific literature highlight the need of refocusing the health system on primary care known to improve both morbi-mortality and care efficiency. In France, health authorities acknowledge general practitioners as playing a key role in the health care system: its time to move from intention to action. Structural changes are needed to achieve this reinforcement of primary healthcare: to re-orientate medical studies towards primary care; to develop research in primary care; to promote cooperation between care providers; to ease the daily workload of practitioners; to diversify methods of payment; to propose a guide for patient's use of primary care. The transformation of the healthcare system in France requires a real strategy of primary healthcare implementation. Regardless of financial constraints, it is possible to redistribute the resources towards ambulatory care. Strengthening the role of general practice and favoring its societal recognition will be the major stages of this change. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Design concept for the microwave interrogation structure in PARCS

NASA Technical Reports Server (NTRS)

Dick, G. J.; Klipstein, W. M.; Heavner, T. P.; Jefferts, S. R.

2002-01-01

In this paper we will describe key aspects of the conceptual design of the microwave interrogation structure in the laser-cooled cesium frequency standard that is part of the Primary Atomic Reference Clock in Space (PARCS) experiment.

ANALYSIS OF PARTICULATE BOUND NUTRIENTS IN URBAN STORMWATER

EPA Science Inventory

Nutrients are important players in the degradation of waterbodies because they are often the elements that limit primary productivity and, hence, are the key factors controlling eutrophication. Eutrophication causes unsightly algal blooms leading to oxygen depletion, stress on o...

Performance oriented guidance for Mississippi chip seals - volume II.

DOT National Transportation Integrated Search

2013-12-01

A laboratory and field study was conducted related to long term chip seal performance. This reports primary : objective was to initiate development of a long term performance (LTP) test protocol for chip seals focused on : aggregate retention. Key...

Assessing Primary Literacy through Grammar Tests

ERIC Educational Resources Information Center

Hodgson, John

2017-01-01

Originally an editorial for "English in Education," this short article summarises key issues in the imposition of a separate test for grammar, punctuation and spelling. It illustrates the poor foundations, lack of clarity and distortion of curriculum which invalidate the test.

DSCOVR Public Release Statement

Atmospheric Science Data Center

2016-11-23

... its primary objective of monitoring the solar wind as well as observing the Earth from sunrise to sunset with two Earth Science ... radiative fluxes of the entire dayside of Earth (NISTAR) as well as key spectral radiative characteristics in 10 narrowband channels ...

How Do Health Care Providers Diagnose Primary Ovarian Insufficiency (POI)?

MedlinePlus

... Share Facebook Twitter Pinterest Email Print How do health care providers diagnose POI? The key signs of POI ... having periods for 4 months or longer, her health care provider may take these steps to diagnose the ...

KEY COMPARISON: Final report on CCQM-K9.2: Subsequent key comparison on pH determination of phosphate buffer by Harned cell measurements

NASA Astrophysics Data System (ADS)

Spitzer, Petra; Giera, Janine; Fraga, Isabel C.; Tønnes Jakobsen, Pia; Jensen, Hans D.; Hyllested, Peter; Karpov, Oleg; Kutovoy, Viatcheslav; Nakamura, Susumu; Vospelova, Alena; Zvezdina, Valentina

2008-01-01

CCQM-K9.2 was performed supplementary to the key comparison CCQM-K9 on the pH determination of a phosphate buffer with nominal pH ~ 6.9 (at 25 °C). The sample composition was very similar in both comparisons. Only the source of the starting material used for sample preparation was different. The comparison was restricted to the use of the primary method for pH (Harned cell measurement) as defined in the IUPAC Recommendations [2]. The measurement temperatures were 15 °C, 25 °C, 37 °C. CCQM-K9.2, CCQM-K.9 and the first supplementary comparison CCQM-K9.1 [5] are activities of the Electrochemical Working Group (EAWG) of the CCQM. All three comparisons were coordinated by the PTB, Germany. The Danish Primary Laboratory (DPL) successfully took part in the CCQM-K9. Meanwhile the primary set-up for pH in Denmark moved from DPL affiliated to Radiometer Medical to DFM, Denmark. The subsequent comparison allows assessing the degree of equivalence for the measurement of pH at DFM after the move. Due to the interest of other laboratories in demonstrating their progress in pH measurements on the primary level the CCQM-K9.2 supplementary comparison was extended to other participants than DFM, namely NMIJ, VNIIFTRI, INMETRO and CMI. The reported quantity for CCQM-K9.2 was not the pH of the sample but the acidity function at zero chloride molality (see chapter 12). To calculate the pH value from the acidity function it is necessary to know the ionic strength of the sample buffer solution, which was undisclosed by the coordinator. With the exception of the Czech Metrology Institute, CMI, good agreement in the determined acidity function is found between the participants. The results reported by DFM and by PTB agree within their measurement uncertainty at all measurement temperatures. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (MRA).

Electromagnetic deformable mirror for space applications

NASA Astrophysics Data System (ADS)

Kuiper, S.; Doelman, N.; Overtoom, T.; Nieuwkoop, E.; Russchenberg, T.; van Riel, M.; Wildschut, J.; Baeten, M.; Spruit, H.; Brinkers, S.; Human, J.

2017-09-01

To increase the collecting power and to improve the angular imaging resolution, space telescopes are evolving towards larger primary mirrors. The aerial density of the telescope mirrors needs to be kept low, however, to be compatible with the launch requirements. A light-weight (primary) mirror will introduce additional optical aberrations to the system. These may be caused by for instance manufacturing errors, gravity release and thermo-elastic effects. Active Optics (AO) is a key candidate technology to correct for the resultant wave front aberrations [1].

Perception of touch quality in piano tones.

PubMed

Goebl, Werner; Bresin, Roberto; Fujinaga, Ichiro

2014-11-01

Both timbre and dynamics of isolated piano tones are determined exclusively by the speed with which the hammer hits the strings. This physical view has been challenged by pianists who emphasize the importance of the way the keyboard is touched. This article presents empirical evidence from two perception experiments showing that touch-dependent sound components make sounds with identical hammer velocities but produced with different touch forms clearly distinguishable. The first experiment focused on finger-key sounds: musicians could identify pressed and struck touches. When the finger-key sounds were removed from the sounds, the effect vanished, suggesting that these sounds were the primary identification cue. The second experiment looked at key-keyframe sounds that occur when the key reaches key-bottom. Key-bottom impact was identified from key motion measured by a computer-controlled piano. Musicians were able to discriminate between piano tones that contain a key-bottom sound from those that do not. However, this effect might be attributable to sounds associated with the mechanical components of the piano action. In addition to the demonstrated acoustical effects of different touch forms, visual and tactile modalities may play important roles during piano performance that influence the production and perception of musical expression on the piano.

The Epidemiology of Primary and Revision Total Hip Arthroplasty in Teaching and Nonteaching Hospitals in the United States.

PubMed

Kowalik, Thomas D; DeHart, Matthew; Gehling, Hanne; Gehling, Paxton; Schabel, Kathryn; Duwelius, Paul; Mirza, Amer

2016-06-01

The purpose of this study was to examine the epidemiology of primary and revision total hip arthroplasty (THA) in teaching and nonteaching hospitals. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried from 2006 to 2010 to identify primary and revision THAs at teaching and nonteaching hospitals. A total of 1,336,396 primary and 223,520 revision procedures were identified. Forty-six percent of all primary and 54% of all revision procedures were performed at teaching hospitals. Teaching hospitals performed 17% of their THAs as revisions; nonteaching hospitals performed 12% as revisions. For primary and revision THAs, teaching hospitals had fewer patients aged >65 years, fewer Medicare patients, similar gender rates, more nonwhite patients, and more patients in the highest income quartile compared with nonteaching hospitals. Costs, length of stay, and Charlson Comorbidity Index scores were similar; however, the mortality rate was lower at teaching hospitals. This study found small but significant differences in key epidemiologic and outcome variables in examining primary and revision THA at teaching and nonteaching hospitals. Level III.

Understanding the implementation of interventions to improve the management of chronic kidney disease in primary care: a rapid realist review.

PubMed

Tsang, Jung Yin; Blakeman, Tom; Hegarty, Janet; Humphreys, John; Harvey, Gill

2016-04-04

Chronic kidney disease (CKD) is common and a significant marker of morbidity and mortality. Its management in primary care is essential for maintenance of cardiovascular health, avoidance of acute kidney injury (AKI) and delay in progression to end-stage renal disease. Although many guidelines and interventions have been established, there is global evidence of an implementation gap, including variable identification rates and low patient communication and awareness. The objective of this study is to understand the factors enabling and constraining the implementation of CKD interventions in primary care. A rapid realist review was conducted that involved a primary literature search of three databases to identify existing CKD interventions in primary care between the years 2000 and 2014. A secondary search was performed as an iterative process and included bibliographic and grey literature searches of reference lists, authors and research groups. A systematic approach to data extraction using Normalisation Process Theory (NPT) illuminated key mechanisms and contextual factors that affected implementation. Our primary search returned 710 articles that were narrowed down to 18 relevant CKD interventions in primary care. Our findings suggested that effective management of resources (encompassing many types) was a significant contextual factor enabling or constraining the functioning of mechanisms. Three key intervention features were identified from the many that contributed to successful implementation. Firstly, it was important to frame CKD interventions appropriately, such as within the context of cardiovascular health and diabetes. This enabled buy-in and facilitated an understanding of the significance of CKD and the need for intervention. Secondly, interventions that were compatible with existing practices or patients' everyday lives were readily accepted. In contrast, new systems that could not be integrated were abandoned as they were viewed as inconvenient, generating more work. Thirdly, ownership of the feedback process allowed users to make individualised improvements to the intervention to suit their needs. Our rapid realist review identified mechanisms that need to be considered in order to optimise the implementation of interventions to improve the management of CKD in primary care. Further research into the factors that enable prolonged sustainability and cost-effectiveness is required for efficient resource utilisation.

Bioassays with caged hyalella azteca to determine in situ toxicity downstream of two Saskatchewan, Canada, uranium operations.

PubMed

Robertson, Erin L; Liber, Karsten

2007-11-01

The main objectives of this in situ study were to evaluate the usefulness of an in situ bioassay to determine if downstream water bodies at the Key Lake and Rabbit Lake uranium operations (Saskatchewan, Canada) were toxic to Hyalella azteca and, if toxicity was observed, to differentiate between the contribution of surface water and sediment contamination to in situ toxicity. These objectives were achieved by performing 4-d in situ bioassays with laboratory-reared H. azteca confined in specially designed, paired, surface water and sediment exposure chambers. Results from the in situ bioassays revealed significant mortality, relative to the respective reference site, at the exposure sites at both Key Lake (p

History Sources on the Internet.

ERIC Educational Resources Information Center

Fink, Kenneth D.

This paper provides descriptions of key online history resources useful to teachers, librarians, and other education professionals. Highlights include: primary sources on the Internet; archives; Online Public Access Catalogs (OPACs); the American Historical Association (AHA) Web site; state and federal government resources; business history…

EPA scientists develop Federal Reference & Equivalent Methods for measuring key air pollutants

EPA Pesticide Factsheets

EPA operates a nationwide air monitoring network to measure six primary air pollutants: carbon monoxide, lead, sulfur dioxide, ozone, nitrogen dioxide, and particulate matter as part of its mission to protect human health and the environment.

[Clinical analysis of 138 multiple primary cancers diagnosed of digestive system malignant tumor initially].

PubMed

Lyu, J M; Xiong, H C; Wu, B; Zhou, X Q; Hu, J

2018-02-23

Objective: To study the clinical characteristics, strategy of treatment and prognosis of multiple primary cancers(MPC) diagnosed of digestive system malignant tumor firstly. Methods: From January, 2000 to December, 2015, the clinical, follow-up and prognostic data of 138 MPC patients diagnosed of digestive system malignant tumor firstly were retrospectively analyzed. Results: 138 cases were found in 10 580 cases with malignant tumors, and the incidence was 1.30%. There were 129 cases of duplex primary cancers, 8 cases of triple primary cancers and 1 case of quintuple primary cancers. The repetitive primary cancer was occurred in digestive system (61cases, 44.2%) most frequently, with the next in respiratory system (46 cases, 33.3%). 52.2% (72 cases) suffered second primary cancer in 2 years after first primary cancer diagnosed, and 75.4% (104 cases) in 5 years. The median overall survival in patients with all cancer lesions radically treated was 168 months, better than any other treatment (68 months, P <0.05). Conclusions: The second primary cancers of MPC cases initially diagnosed of digestive system malignant tumor most frequently occurred in the digestive system and respiratory system. More concern should be attracted in follow-up, especially in the first 5 years. The key to improve patient' prognosis was radical treatment to every primary cancer.

Parental help-seeking in primary care for child and adolescent mental health concerns: qualitative study.

PubMed

Sayal, Kapil; Tischler, Victoria; Coope, Caroline; Robotham, Sarah; Ashworth, Mark; Day, Crispin; Tylee, Andre; Simonoff, Emily

2010-12-01

Child and adolescent mental health problems are common in primary care. However, few parents of children with mental health problems express concerns about these problems during consultations. To explore the factors influencing parental help-seeking for children with emotional or behavioural difficulties. Focus group discussions with 34 parents from non-specialist community settings who had concerns about their child's mental health. All groups were followed by validation groups or semi-structured interviews. Most children had clinically significant mental health symptoms or associated impairment in function. Appointment systems were a key barrier, as many parents felt that short appointments did not allow sufficient time to address their child's difficulties. Continuity of care and trusting relationships with general practitioners (GPs) who validated their concerns were perceived to facilitate help-seeking. Parents valued GPs who showed an interest in their child and family situation. Barriers to seeking help included embarrassment, stigma of mental health problems, and concerns about being labelled or receiving a diagnosis. Some parents were concerned about being judged a poor parent and their child being removed from the family should they seek help. Primary healthcare is a key resource for children and young people with emotional and behavioural difficulties and their families. Primary care services should be able to provide ready access to health professionals with an interest in children and families and appointments of sufficient length so that parents feel able to discuss their mental health concerns.

Why are there gaps in our management of those with high cardiovascular risk?

PubMed

Doolan-Noble, Fiona; Tracey, Jocelyn; Mann, Stewart

2012-03-01

Multiple New Zealand and other international studies have identified gaps in the management of those identified at high risk of a future cardiovascular (CV) event. This study sought to explore the views of health professionals about the barriers and facilitators present within the current primary health care system to the optimal management of those at high CV risk. This qualitative study utilised a focus group methodology to examine the barriers and facilitators within primary health care (PHC), and employed a general inductive approach to analyse the text data. The analysis of text data resulted in the emergence of interrelated themes, underpinned by subthemes. The patient, their circumstances and their characteristics and perceptions provided the first key theme and subthemes. The next key theme was primary health care providers, with subthemes of communication and values and beliefs. The general practice was the third theme and included multiple subthemes: implementation planning and pathway development, time and workload and roles and responsibilities. The final main theme was the health system with the subthemes linking to funding and leadership. This study determined the factors that act as barriers and facilitators to the effective management of those at high CV risk within the New Zealand PHC sector. General practice has a pivotal role in preventive health care, but to succeed there needs to be a refocusing of the PHC sector, requiring support from policy makers, District Health Boards and Primary Health Organisations, as well as those working in the sector.

Evidence-informed primary health care workforce policy: are we asking the right questions?

PubMed

Naccarella, Lucio; Buchan, Jim; Brooks, Peter

2010-01-01

Australia is facing a primary health care workforce shortage. To inform primary health care (PHC) workforce policy reforms, reflection is required on ways to strengthen the evidence base and its uptake into policy making. In 2008 the Australian Primary Health Care Research Institute funded the Australian Health Workforce Institute to host Professor James Buchan, Queen Margaret University, UK, an expert in health services policy research and health workforce planning. Professor Buchan's visit enabled over forty Australian PHC workforce mid-career and senior researchers and policy stakeholders to be involved in roundtable policy dialogue on issues influencing PHC workforce policy making. Six key thematic questions emerged. (1) What makes PHC workforce planning different? (2) Why does the PHC workforce need to be viewed in a global context? (3) What is the capacity of PHC workforce research? (4) What policy levers exist for PHC workforce planning? (5) What principles can guide PHC workforce planning? (6) What incentives exist to optimise the use of evidence in policy making? The emerging themes need to be discussed within the context of current PHC workforce policy reforms, which are focussed on increasing workforce supply (via education/training programs), changing the skill mix and extending the roles of health workers to meet patient needs. With the Australian government seeking to reform and strengthen the PHC workforce, key questions remain about ways to strengthen the PHC workforce evidence base and its uptake into PHC workforce policy making.

How personal and standardized coordination impact implementation of integrated care.

PubMed

Benzer, Justin K; Cramer, Irene E; Burgess, James F; Mohr, David C; Sullivan, Jennifer L; Charns, Martin P

2015-10-02

Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.

Teamwork and delegation in medical homes: primary care staff perspectives in the Veterans Health Administration.

PubMed

True, Gala; Stewart, Greg L; Lampman, Michelle; Pelak, Mary; Solimeo, Samantha L

2014-07-01

The patient-centered medical home (PCMH) relies on a team approach to patient care. For organizations engaged in transitioning to a PCMH model, identifying and providing the resources needed to promote team functioning is essential. To describe team-level resources required to support PCMH team functioning within the Veterans Health Administration (VHA), and provide insight into how the presence or absence of these resources facilitates or impedes within-team delegation. Semi-structured interviews with members of pilot teams engaged in PCMH implementation in 77 primary care clinics serving over 300,000 patients across two VHA regions covering the Mid-Atlantic and Midwest United States. A purposive sample of 101 core members of pilot teams, including 32 primary care providers, 42 registered nurse care managers, 15 clinical associates, and 12 clerical associates. Investigators from two evaluation sites interviewed frontline primary care staff separately, and then collaborated on joint analysis of parallel data to develop a broad, comprehensive understanding of global themes impacting team functioning and within-team delegation. We describe four themes key to understanding how resources at the team level supported ability of primary care staff to work as effective, engaged teams. Team-based task delegation was facilitated by demarcated boundaries and collective identity; shared goals and sense of purpose; mature and open communication characterized by psychological safety; and ongoing, intentional role negotiation. Our findings provide a framework for organizations to identify assets already in place to support team functioning, as well as areas in need of improvement. For teams struggling to make practice changes, our results indicate key areas where they may benefit from future support. In addition, this research sheds light on how variation in medical home implementation and outcomes may be associated with variation in team-based task delegation.

Observations-based GPP estimates

NASA Astrophysics Data System (ADS)

Joiner, J.; Yoshida, Y.; Jung, M.; Tucker, C. J.; Pinzon, J. E.

2017-12-01

We have developed global estimates of gross primary production based on a relatively simple satellite observations-based approach using reflectance data from the MODIS instruments in the form of vegetation indices that provide information about photosynthetic capacity at both high temporal and spatial resolution and combined with information from chlorophyll solar-induced fluorescence from the Global Ozone Monitoring Experiment-2 instrument that is noisier and available only at lower temporal and spatial scales. We compare our gross primary production estimates with those from eddy covariance flux towers and show that they are competitive with more complicated extrapolated machine learning gross primary production products. Our results provide insight into the amount of variance in gross primary production that can be explained with satellite observations data and also show how processing of the satellite reflectance data is key to using it for accurate GPP estimates.

Towards Mechanistic Understanding of Mercury Availability and Toxicity to Aquatic Primary Producers.

PubMed

Dranguet, Perrine; Flück, Rebecca; Regier, Nicole; Cosio, Claudia; Le Faucheur, Séverine; Slaveykova, Vera I

2014-11-01

The present article reviews current knowledge and recent progress on the bioavailability and toxicity of mercury to aquatic primary producers. Mercury is a ubiquitous toxic trace element of global concern. At the base of the food web, primary producers are central for mercury incorporation into the food web. Here, the emphasis is on key, but still poorly understood, processes governing the interactions between mercury species and phytoplankton, and macrophytes, two representatives of primary producers. Mass transfer to biota surface, adsorption to cell wall, internalization and release from cells, as well as underlying toxicity mechanisms of both inorganic mercury and methylmercury are discussed critically. In addition, the intracellular distribution and transformation processes, their importance for mercury toxicity, species-sensitivity differences and trophic transfer are presented. The mini-review is illustrated with examples of our own research.

Welcome back? Frequent attenders to a pediatric primary care center.

PubMed

Klein, Melissa; Vaughn, Lisa M; Baker, Raymond C; Taylor, Trisha

2011-09-01

This study examines frequent attenders of a pediatric primary care clinic at a large urban children's hospital--who they are and their reasons for frequent attendance to the clinic. The literature suggests that some visits by frequent attenders may not be medically necessary, and these additional appointments may impair others' access to medical care within the same system. The key to eliminating excessive primary care visits is to determine if it is a problem in the primary care practice (quantify the problem), explore the reasons for the visits (from the patients' perspective), and then provide educational interventions that address the various causes for the extra visits and encourage the use of available resources, either ancillary services in the practice itself or resources and agencies available in the community (e.g. social service, legal aid).

Towards secure quantum key distribution protocol for wireless LANs: a hybrid approach

NASA Astrophysics Data System (ADS)

Naik, R. Lalu; Reddy, P. Chenna

2015-12-01

The primary goals of security such as authentication, confidentiality, integrity and non-repudiation in communication networks can be achieved with secure key distribution. Quantum mechanisms are highly secure means of distributing secret keys as they are unconditionally secure. Quantum key distribution protocols can effectively prevent various attacks in the quantum channel, while classical cryptography is efficient in authentication and verification of secret keys. By combining both quantum cryptography and classical cryptography, security of communications over networks can be leveraged. Hwang, Lee and Li exploited the merits of both cryptographic paradigms for provably secure communications to prevent replay, man-in-the-middle, and passive attacks. In this paper, we propose a new scheme with the combination of quantum cryptography and classical cryptography for 802.11i wireless LANs. Since quantum cryptography is premature in wireless networks, our work is a significant step forward toward securing communications in wireless networks. Our scheme is known as hybrid quantum key distribution protocol. Our analytical results revealed that the proposed scheme is provably secure for wireless networks.

Categorical counting.

PubMed

Fetterman, J Gregor; Killeen, P Richard

2010-09-01

Pigeons pecked on three keys, responses to one of which could be reinforced after a few pecks, to a second key after a somewhat larger number of pecks, and to a third key after the maximum pecking requirement. The values of the pecking requirements and the proportion of trials ending with reinforcement were varied. Transits among the keys were an orderly function of peck number, and showed approximately proportional changes with changes in the pecking requirements, consistent with Weber's law. Standard deviations of the switch points between successive keys increased more slowly within a condition than across conditions. Changes in reinforcement probability produced changes in the location of the psychometric functions that were consistent with models of timing. Analyses of the number of pecks emitted and the duration of the pecking sequences demonstrated that peck number was the primary determinant of choice, but that passage of time also played some role. We capture the basic results with a standard model of counting, which we qualify to account for the secondary experiments. Copyright 2010 Elsevier B.V. All rights reserved.

NREL: International Activities Home Page

Science.gov Websites

key international strategic objectives: economic development, energy security, and environmental protection at home and abroad. NREL's international work spans our full range of capabilities, which includes three primary areas of expertise: research and development, energy analysis, and commercialization and

Mechanistic understanding of human-wildlife conflict through a novel application of dynamic occupancy models.

PubMed

Goswami, Varun R; Medhi, Kamal; Nichols, James D; Oli, Madan K

2015-08-01

Crop and livestock depredation by wildlife is a primary driver of human-wildlife conflict, a problem that threatens the coexistence of people and wildlife globally. Understanding mechanisms that underlie depredation patterns holds the key to mitigating conflicts across time and space. However, most studies do not consider imperfect detection and reporting of conflicts, which may lead to incorrect inference regarding its spatiotemporal drivers. We applied dynamic occupancy models to elephant crop depredation data from India between 2005 and 2011 to estimate crop depredation occurrence and model its underlying dynamics as a function of spatiotemporal covariates while accounting for imperfect detection of conflicts. The probability of detecting conflicts was consistently <1.0 and was negatively influenced by distance to roads and elevation gradient, averaging 0.08-0.56 across primary periods (distinct agricultural seasons within each year). The probability of crop depredation occurrence ranged from 0.29 (SE 0.09) to 0.96 (SE 0.04). The probability that sites raided by elephants in primary period t would not be raided in primary period t + 1 varied with elevation gradient in different seasons and was influenced negatively by mean rainfall and village density and positively by distance to forests. Negative effects of rainfall variation and distance to forests best explained variation in the probability that sites not raided by elephants in primary period t would be raided in primary period t + 1. With our novel application of occupancy models, we teased apart the spatiotemporal drivers of conflicts from factors that influence how they are observed, thereby allowing more reliable inference on mechanisms underlying observed conflict patterns. We found that factors associated with increased crop accessibility and availability (e.g., distance to forests and rainfall patterns) were key drivers of elephant crop depredation dynamics. Such an understanding is essential for rigorous prediction of future conflicts, a critical requirement for effective conflict management in the context of increasing human-wildlife interactions. © 2015 Society for Conservation Biology.

Mapping South African allied health primary care clinical guideline activity: establishing a stakeholder reference sample.

PubMed

Dizon, Janine Margarita; Grimmer, Karen; Machingaidze, Shingai; McLaren, Pam; Louw, Quinette

2016-10-10

Little is known about allied health (AH) clinical practice guideline (CPG) activity in South Africa, and particularly in relation to primary health care (PHC). This paper reports on a scoping study undertaken to establish a reference framework, from which a comprehensive maximum variation sample could be selected. This was required to underpin robust sampling for a qualitative study aimed at understanding South African primary care AH therapy CPG activities. This paper builds on findings from the South African Guidelines Evaluation (Project SAGE) Flagship grant. South African government websites were searched for structures of departments and portfolios, and available CPGs. Professional AH association websites were searched for CPGs, purposively-identified key informants were interviewed, and CPGs previously identified for priority South African primary care conditions were critiqued for AH therapy involvement. Key informants described potentially complex relationships between players who may be engaged in South African AH CPGs, in both public and private sectors. There were disability/rehabilitation portfolios at national and provincial governments, but no uniformity in provincial government organisation of, or support for, PHC AH services. There were no AH primary care therapy CPGs on government websites, although there was 'clinical guidance' in various forms on professional association websites. Only two CPGs of priority South African PHC conditions included mention of any AH therapy (physiotherapy for adult asthma and chronic obstructive pulmonary disease). A comprehensive and wide-reaching stakeholder reference framework would be required in order to capture the heterogeneity of AH primary care CPG activity in South Africa. This should involve the voices of national and purposively-selected provincial governments, academic institutions, consultants, public sector managers and clinicians, private practitioners, professional associations, and private sector insurers. Provincial governments should be selected to reflect heterogeneity in local economics, population demographics and availability of university AH training programs. This investigation should aim to determine the areas of PHC in which AH are engaged.

Symmetric autocompensating quantum key distribution

NASA Astrophysics Data System (ADS)

Walton, Zachary D.; Sergienko, Alexander V.; Levitin, Lev B.; Saleh, Bahaa E. A.; Teich, Malvin C.

2004-08-01

We present quantum key distribution schemes which are autocompensating (require no alignment) and symmetric (Alice and Bob receive photons from a central source) for both polarization and time-bin qubits. The primary benefit of the symmetric configuration is that both Alice and Bob may have passive setups (neither Alice nor Bob is required to make active changes for each run of the protocol). We show that both the polarization and the time-bin schemes may be implemented with existing technology. The new schemes are related to previously described schemes by the concept of advanced waves.

Keys to successful organ procurement: An experience-based review of clinical practices at a high-performing health-care organization

PubMed Central

Wojda, Thomas R.; Stawicki, Stanislaw P.; Yandle, Kathy P.; Bleil, Maria; Axelband, Jennifer; Wilde-Onia, Rebecca; Thomas, Peter G.; Cipolla, James; Hoff, William S.; Shultz, Jill

2017-01-01

Organ procurement (OP) from donors after brain death and circulatory death represents the primary source of transplanted organs. Despite favorable laws and regulations, OP continues to face challenges for a number of reasons, including institutional, personal, and societal barriers. This focused review presents some of the key components of a successful OP program at a large, high-performing regional health network. This review focuses on effective team approaches, aggressive resuscitative strategies, optimal communication, family support, and community outreach efforts. PMID:28660162

Performance indicators and indices of sludge management in urban wastewater treatment plants.

PubMed

Silva, C; Saldanha Matos, J; Rosa, M J

2016-12-15

Sludge (or biosolids) management is highly complex and has a significant cost associated with the biosolids disposal, as well as with the energy and flocculant consumption in the sludge processing units. The sludge management performance indicators (PIs) and indices (PXs) are thus core measures of the performance assessment system developed for urban wastewater treatment plants (WWTPs). The key PIs proposed cover the sludge unit production and dry solids concentration (DS), disposal/beneficial use, quality compliance for agricultural use and costs, whereas the complementary PIs assess the plant reliability and the chemical reagents' use. A key PI was also developed for assessing the phosphorus reclamation, namely through the beneficial use of the biosolids and the reclaimed water in agriculture. The results of a field study with 17 Portuguese urban WWTPs in a 5-year period were used to derive the PI reference values which are neither inherent to the PI formulation nor literature-based. Clusters by sludge type (primary, activated, trickling filter and mixed sludge) and by digestion and dewatering processes were analysed and the reference values for sludge production and dry solids were proposed for two clusters: activated sludge or biofilter WWTPs with primary sedimentation, sludge anaerobic digestion and centrifuge dewatering; activated sludge WWTPs without primary sedimentation and anaerobic digestion and with centrifuge dewatering. The key PXs are computed for the DS after each processing unit and the complementary PXs for the energy consumption and the operating conditions DS-determining. The PX reference values are treatment specific and literature based. The PI and PX system was applied to a WWTP and the results demonstrate that it diagnosis the situation and indicates opportunities and measures for improving the WWTP performance in sludge management. Copyright © 2016 Elsevier Ltd. All rights reserved.

Development and psychometric evaluation of the Primary Health Care Engagement (PHCE) Scale: a pilot survey of rural and remote nurses.

PubMed

Kosteniuk, Julie G; Wilson, Erin C; Penz, Kelly L; MacLeod, Martha L P; Stewart, Norma J; Kulig, Judith C; Karunanayake, Chandima P; Kilpatrick, Kelley

2016-01-01

To report the development and psychometric evaluation of a scale to measure rural and remote (rural/remote) nurses' perceptions of the engagement of their workplaces in key dimensions of primary health care (PHC). Amidst ongoing PHC reforms, a comprehensive instrument is needed to evaluate the degree to which rural/remote health care settings are involved in the key dimensions that characterize PHC delivery, particularly from the perspective of professionals delivering care. This study followed a three-phase process of instrument development and psychometric evaluation. A literature review and expert consultation informed instrument development in the first phase, followed by an iterative process of content evaluation in the second phase. In the final phase, a pilot survey was undertaken and item discrimination analysis employed to evaluate the internal consistency reliability of each subscale in the preliminary 60-item Primary Health Care Engagement (PHCE) Scale. The 60-item scale was subsequently refined to a 40-item instrument. The pilot survey sample included 89 nurses in current practice who had experience in rural/remote practice settings. Participants completed either a web-based or paper survey from September to December, 2013. Following item discrimination analysis, the 60-item instrument was refined to a 40-item PHCE Scale consisting of 10 subscales, each including three to five items. Alpha estimates of the 10 refined subscales ranged from 0.61 to 0.83, with seven of the subscales demonstrating acceptable reliability (α ⩾ 0.70). The refined 40-item instrument exhibited good internal consistency reliability (α=0.91). The 40-item PHCE Scale may be considered for use in future studies regardless of locale, to measure the extent to which health care professionals perceive their workplaces to be engaged in key dimensions of PHC.

Free Energy Landscape - Settlements of Key Residues.

NASA Astrophysics Data System (ADS)

Aroutiounian, Svetlana

2007-03-01

FEL perspective in studies of protein folding transitions reflects notion that since there are ˜10^N conformations to scan in search of lowest free energy state, random search is beyond biological timescale. Protein folding must follow certain fel pathways and folding kinetics of evolutionary selected proteins dominates kinetic traps. Good model for functional robustness of natural proteins - coarse-grained model protein is not very accurate but affords bringing simulations closer to biological realm; Go-like potential secures the fel funnel shape; biochemical contacts signify the funnel bottleneck. Boltzmann-weighted ensemble of protein conformations and histogram method are used to obtain from MC sampling of protein conformational space the approximate probability distribution. The fel is F(rmsd) = -1/βLn[Hist(rmsd)], β=kBT and rmsd is root-mean-square-deviation from native conformation. The sperm whale myoglobin has rich dynamic behavior, is small and large - on computational scale, has a symmetry in architecture and unusual sextet of residue pairs. Main idea: there is a mathematical relation between protein fel and a key residues set providing stability to folding transition. Is the set evolutionary conserved also for functional reasons? Hypothesis: primary sequence determines the key residues positions conserved as stabilizers and the fel is the battlefield for the folding stability. Preliminary results: primary sequence - not the architecture, is the rule settler, indeed.

Standing on the Precipice: Evaluating Final-Year Physiotherapy Students' Perspectives of Their Curriculum as Preparation for Primary Health Care Practice

PubMed Central

O'Donoghue, Grainne; Doody, Catherine; O'Neill, Geraldine; Barrett, Terry; Cusack, Tara

2016-01-01

Purpose: To explore final-year physiotherapy students' perceptions of primary health care practice to determine (1) aspects of their curriculum that support their learning, (2) deficiencies in their curriculum, and (3) areas that they believe should be changed to adequately equip them to make the transition from student to primary health care professional. Methods: Framework analysis methodology was used to analyze group opinion obtained using structured group feedback sessions. Sixty-eight final-year physiotherapy students from the four higher education institutions in Ireland participated. Results: The students identified several key areas that (1) supported their learning (exposure to evidence-based practice, opportunities to practise with problem-based learning, and interdisciplinary learning experiences); (2) were deficient (primary health care placements, additional active learning sessions, and further education and practice opportunities for communication and health promotion), and (3) required change (practice placements in primary health care, better curriculum organization to accommodate primary health care throughout the programme with the suggestion of a specific primary health care module). Conclusion: This study provides important insights into physiotherapy students' perceptions of primary health care. It also provides important indicators of the curriculum changes needed to increase graduates' confidence in their ability to take up employment in primary health care. PMID:27909366

An algorithm to count the number of repeated patient data entries with B tree.

PubMed

Okada, M; Okada, M

1985-04-01

An algorithm to obtain the number of different values that appear a specified number of times in a given data field of a given data file is presented. Basically, a well-known B-tree structure is employed in this study. Some modifications were made to the basic B-tree algorithm. The first step of the modifications is to allow a data item whose values are not necessary distinct from one record to another to be used as a primary key. When a key value is inserted, the number of previous appearances is counted. At the end of all the insertions, the number of key values which are unique in the tree, the number of key values which appear twice, three times, and so forth are obtained. This algorithm is especially powerful for a large size file in disk storage.

The changing model of big pharma: impact of key trends.

PubMed

Gautam, Ajay; Pan, Xiaogang

2016-03-01

Recent years have seen exciting breakthroughs in biomedical sciences that are producing truly novel therapeutics for unmet patient needs. However, the pharmaceutical industry is also facing significant barriers in the form of pricing and reimbursement, continued patent expirations and challenging market dynamics. In this article, we have analyzed data from the 1995-2015 period, on key aspects such as revenue distribution, research units, portfolio mix and emerging markets to identify four key trends that help to understand the change in strategic focus, realignment of R&D footprint, the shift from primary care toward specialty drugs and biologics and the growth of emerging markets as major revenue drivers for big pharma. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Space station data system analysis/architecture study. Task 3: Trade studies, DR-5, volume 1

NASA Technical Reports Server (NTRS)

1985-01-01

The primary objective of Task 3 is to provide additional analysis and insight necessary to support key design/programmatic decision for options quantification and selection for system definition. This includes: (1) the identification of key trade study topics; (2) the definition of a trade study procedure for each topic (issues to be resolved, key inputs, criteria/weighting, methodology); (3) conduct tradeoff and sensitivity analysis; and (4) the review/verification of results within the context of evolving system design and definition. The trade study topics addressed in this volume include space autonomy and function automation, software transportability, system network topology, communications standardization, onboard local area networking, distributed operating system, software configuration management, and the software development environment facility.

Key techniques and risk management for the application of the Pile-Beam-Arch (PBA) excavation method: a case study of the Zhongjie subway station.

PubMed

Guan, Yong-ping; Zhao, Wen; Li, Shen-gang; Zhang, Guo-bin

2014-01-01

The design and construction of shallow-buried tunnels in densely populated urban areas involve many challenges. The ground movements induced by tunneling effects pose potential risks to infrastructure such as surface buildings, pipelines, and roads. In this paper, a case study of the Zhongjie subway station located in Shenyang, China, is examined to investigate the key construction techniques and the influence of the Pile-Beam-Arch (PBA) excavation method on the surrounding environment. This case study discusses the primary risk factors affecting the environmental safety and summarizes the corresponding risk mitigation measures and key techniques for subway station construction using the PBA excavation method in a densely populated urban area.

Physical, policy, and sociocultural characteristics of the primary school environment are positively associated with children's physical activity during class time.

PubMed

Martin, Karen; Bremner, Alexandra; Salmon, Jo; Rosenberg, Michael; Giles-Corti, Billie

2014-03-01

The objective of this study was to develop a multidomain model to identify key characteristics of the primary school environment associated with children's physical activity (PA) during class-time. Accelerometers were used to calculate time spent in moderate-to-vigorous physical activity during class-time (CMVPA) of 408 sixth-grade children (mean ± SD age 11.1 ± 0.43 years) attending 27 metropolitan primary schools in Perth Western Australia. Child and staff self-report instruments and a school physical environment scan administered by the research team were used to collect data about children and the class and school environments. Hierarchical modeling identified key variables associated with CMVPA. The final multilevel model explained 49% of CMVPA. A physically active physical education (PE) coordinator, fitness sessions incorporated into PE sessions and either a trained PE specialist, classroom teacher or nobody coordinating PE in the school, rather than the deputy principal, were associated with higher CMVPA. The amount of grassed area per student and sporting apparatus on grass were also associated with higher CMVPA. These results highlight the relevance of the school's sociocultural, policy and physical environments in supporting class-based PA. Interventions testing optimization of the school physical, sociocultural and policy environments to support physical activity are warranted.

Targeted Molecular Imaging in Adrenal Disease—An Emerging Role for Metomidate PET-CT

PubMed Central

Mendichovszky, Iosif A.; Powlson, Andrew S.; Manavaki, Roido; Aigbirhio, Franklin I.; Cheow, Heok; Buscombe, John R.; Gurnell, Mark; Gilbert, Fiona J.

2016-01-01

Adrenal lesions present a significant diagnostic burden for both radiologists and endocrinologists, especially with the increasing number of adrenal ‘incidentalomas’ detected on modern computed tomography (CT) or magnetic resonance imaging (MRI). A key objective is the reliable distinction of benign disease from either primary adrenal malignancy (e.g., adrenocortical carcinoma or malignant forms of pheochromocytoma/paraganglioma (PPGL)) or metastases (e.g., bronchial, renal). Benign lesions may still be associated with adverse sequelae through autonomous hormone hypersecretion (e.g., primary aldosteronism, Cushing’s syndrome, phaeochromocytoma). Here, identifying a causative lesion, or lateralising the disease to a single adrenal gland, is key to effective management, as unilateral adrenalectomy may offer the potential for curing conditions that are typically associated with significant excess morbidity and mortality. This review considers the evolving role of positron emission tomography (PET) imaging in addressing the limitations of traditional cross-sectional imaging and adjunctive techniques, such as venous sampling, in the management of adrenal disorders. We review the development of targeted molecular imaging to the adrenocortical enzymes CYP11B1 and CYP11B2 with different radiolabeled metomidate compounds. Particular consideration is given to iodo-metomidate PET tracers for the diagnosis and management of adrenocortical carcinoma, and the increasingly recognized utility of 11C-metomidate PET-CT in primary aldosteronism. PMID:27869719

Integrative proteomics and biochemical analyses define Ptc6p as the Saccharomyces cerevisiae pyruvate dehydrogenase phosphatase.

PubMed

Guo, Xiao; Niemi, Natalie M; Coon, Joshua J; Pagliarini, David J

2017-07-14

The pyruvate dehydrogenase complex (PDC) is the primary metabolic checkpoint connecting glycolysis and mitochondrial oxidative phosphorylation and is important for maintaining cellular and organismal glucose homeostasis. Phosphorylation of the PDC E1 subunit was identified as a key inhibitory modification in bovine tissue ∼50 years ago, and this regulatory process is now known to be conserved throughout evolution. Although Saccharomyces cerevisiae is a pervasive model organism for investigating cellular metabolism and its regulation by signaling processes, the phosphatase(s) responsible for activating the PDC in S. cerevisiae has not been conclusively defined. Here, using comparative mitochondrial phosphoproteomics, analyses of protein-protein interactions by affinity enrichment-mass spectrometry, and in vitro biochemistry, we define Ptc6p as the primary PDC phosphatase in S. cerevisiae Our analyses further suggest additional substrates for related S. cerevisiae phosphatases and describe the overall phosphoproteomic changes that accompany mitochondrial respiratory dysfunction. In summary, our quantitative proteomics and biochemical analyses have identified Ptc6p as the primary-and likely sole- S. cerevisiae PDC phosphatase, closing a key knowledge gap about the regulation of yeast mitochondrial metabolism. Our findings highlight the power of integrative omics and biochemical analyses for annotating the functions of poorly characterized signaling proteins. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

The policy context of patient centered medical homes: perspectives of primary care providers.

PubMed

Alexander, Jeffrey A; Cohen, Genna R; Wise, Christopher G; Green, Lee A

2013-01-01

Interest in the patient centered medical home (PCMH) model has increased significantly in recent years. Despite this attention, information is limited regarding the influence of policy context on implementation of the PCMH model. Using comparative, qualitative data, we identify several key policy impediments to PCMH implementation, and propose practical guidelines for addressing these issues. Qualitative, semi-structured in-person interviews with representatives of physician organizations and primary care practices pursuing PCMH. Practitioners and staff at 16 physician practices in Michigan, as well as key leaders of physician organizations. We identified five primary policy issues cited by physicians and physician organization leaders as most impactful on their efforts to adopt PCMH: misalignment of current reimbursement schemes, administrative burden, conflicting criteria for PCMH designation, workforce policy issues, and uncertainty of health care reform. These policies were largely seen as barriers to their ability to implement PCMH. Providers' motivation to embrace PCMH, and their level of confidence regarding the results of such change, are greatly influenced by their perception of the external environment and the control they believe they have over this environment. Having policies in place that shape the path to PCMH in a manner that makes it as easy as possible for providers to accomplish the desired changes could well make the difference in whether successful transformation is achieved.

Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond.

PubMed

Ortu, Giuseppina; Williams, Oliver

2017-09-27

Remarkable progress has been made in the fight against neglected tropical diseases, but new challenges have emerged. Innovative diagnostics, better drugs and new insecticides are often identified as the priority; however, access to these new tools may not be sufficient to achieve and sustain disease elimination, if certain challenges and priorities are not considered. The authors summarise key operational challenges, and based on these, identify two major priorities: strengthening the capacity of the primary health care health system in correctly diagnosing and managing neglected tropical diseases; and establishing an effective disease surveillance process. Five steps are proposed as concrete actions to build an effective primary health care service for neglected tropical diseases, and a health management information system capable of accurately reporting these diseases. Community engagement and formalization of community health workers role are proposed as essential components of these steps. Shift of financial support from disease oriented programmes to disease integrated interventions, improved access to international guidelines for primary health care staff, and availability of donated drugs in health care structures are also suggested as key elements of the proposed process. The authors conclude that failure to address these priorities now may lead to further challenges on the long path towards neglected tropical disease elimination and beyond.

African Primary Care Research: Qualitative data analysis and writing results

PubMed Central

Govender, Indiran; Ogunbanjo, Gboyega A.; Mash, Bob

2014-01-01

Abstract This article is part of a series on African primary care research and gives practical guidance on qualitative data analysis and the presentation of qualitative findings. After an overview of qualitative methods and analytical approaches, the article focuses particularly on content analysis, using the framework method as an example. The steps of familiarisation, creating a thematic index, indexing, charting, interpretation and confirmation are described. Key concepts with regard to establishing the quality and trustworthiness of data analysis are described. Finally, an approach to the presentation of qualitative findings is given. PMID:26245437

Child-led enquiry in primary science

PubMed Central

Dunlop, Lynda; Compton, Kirsty; Clarke, Linda; McKelvey-Martin, Valerie

2015-01-01

This research describes and evaluates the application of a child-led approach to scientific enquiry (the Community of Scientific Enquiry, CoSE) to children aged 8–11 (Key Stage 2) in Northern Ireland. Primary teachers were introduced to CoSE at a workshop and asked to evaluate its implementation with their class. Results from children (n = 364) and teachers (n = 19) found that CoSE engaged children with their science learning, and also developed confidence and oracy. However, teachers require more experience developing facilitation skills and in fitting science into a thematic teaching unit. PMID:27152060

Understanding Information Uncertainty within the Context of a Net-Centric Data Model: A Mine Warfare Example

DTIC Science & Technology

2008-06-01

key assumption in the calculation of the primary MIW MOEs of the estimated risk to a transitor and the expected time required to clear all of the mines...primary MOE of Risk, or Probability of Damage to a Ship Transitor , is calculated by using information in the highlighted circle on the left, to include...percent clearance achieved. 0 E( ) Pr( | , ) r R r r m p ∞ = = ∗∑ (0.2) Risk can be calculated for each transitor given the expected number of

African Primary Care Research: qualitative data analysis and writing results.

PubMed

Mabuza, Langalibalele H; Govender, Indiran; Ogunbanjo, Gboyega A; Mash, Bob

2014-06-05

This article is part of a series on African primary care research and gives practical guidance on qualitative data analysis and the presentation of qualitative findings. After an overview of qualitative methods and analytical approaches, the article focuses particularly on content analysis, using the framework method as an example. The steps of familiarisation, creating a thematic index, indexing, charting, interpretation and confirmation are described. Key concepts with regard to establishing the quality and trustworthiness of data analysis are described. Finally, an approach to the presentation of qualitative findings is given.

Primary studies of Chinese spaceborne SAR

NASA Technical Reports Server (NTRS)

Wang, Zhen-Song; Wu, Guo-Xiang; Guo, Hua-Dong; Wei, Zhong-Quan; Zhu, Min-Hui

1993-01-01

The primary studies on spaceborne synthetic aperture radar (SAR) in China are discussed. The SAR will be launched aboard a Chinese satellite and operated at L-band with HH polarization. The purpose of the mission in consideration is dedicated to resources and environment uses, especially to natural disaster monitoring. The ground resolution is designed as 25 m x 25 m for detailed mode and 100 m x 100 m for wide scan-SAR mode. The off-nadir angle can be varied from 20 to 40 deg. The key system concepts are introduced.

The Emerging Role of Social Work in Primary Health Care: A Survey of Social Workers in Ontario Family Health Teams.

PubMed

Ashcroft, Rachelle; McMillan, Colleen; Ambrose-Miller, Wayne; McKee, Ryan; Brown, Judith Belle

2018-05-01

Primary health care systems are increasingly integrating interprofessional team-based approaches to care delivery. As members of these interprofessional primary health care teams, it is important for social workers to explore our experiences of integration into these newly emerging teams to help strengthen patient care. Despite the expansion of social work within primary health care settings, few studies have examined the integration of social work's role into this expanding area of the health care system. A survey was conducted with Canadian social work practitioners who were employed within Family Health Teams (FHTs), an interprofessional model of primary health care in Ontario emerging from a period of health care reform. One hundred and twenty-eight (N = 128) respondents completed the online survey. Key barriers to social work integration in FHTs included difficulties associated with a medical model environment, confusion about social work role, and organizational barriers. Facilitators for integration of social work in FHTs included adequate education and competencies, collaborative engagement, and organizational structures.

Managing Asthma in Primary Care: Putting New Guideline Recommendations Into Context

PubMed Central

Wechsler, Michael E.

2009-01-01

Many patients with asthma are treated in the primary care setting. The primary care physician is therefore in a key position to recognize poorly controlled asthma and to improve asthma management for these patients. However, current evidence continues to show that, for a substantial number of patients, asthma control is inadequate for a wide variety of reasons, both physician-related and patient-related. The most recently updated treatment guidelines from the National Asthma Education and Prevention Program were designed to help clinicians, including primary care physicians, manage asthma more effectively with an increased focus on achieving and maintaining good asthma control over time. The current review is intended to assist primary care physicians in improving asthma control among their patients; this review clarifies the new guidelines and provides a specialist's perspective on diagnosis, appropriate therapy, disease control surveillance, and appropriate referral when necessary. This discussion is based primarily on the new guidelines and the references cited therein, supplemented by the author's own clinical experience. PMID:19648388

Health psychology in primary care: recent research and future directions.

PubMed

Thielke, Stephen; Thompson, Alexander; Stuart, Richard

2011-01-01

Over the last decade, research about health psychology in primary care has reiterated its contributions to mental and physical health promotion, and its role in addressing gaps in mental health service delivery. Recent meta-analyses have generated mixed results about the effectiveness and cost-effectiveness of health psychology interventions. There have been few studies of health psychology interventions in real-world treatment settings. Several key challenges exist: determining the degree of penetration of health psychology into primary care settings; clarifying the specific roles of health psychologists in integrated care; resolving reimbursement issues; and adapting to the increased prescription of psychotropic medications. Identifying and exploring these issues can help health psychologists and primary care providers to develop the most effective ways of applying psychological principles in primary care settings. In a changing health care landscape, health psychologists must continue to articulate the theories and techniques of health psychology and integrated care, to put their beliefs into practice, and to measure the outcomes of their work.

A Framework for Thinking about Informal Statistical Inference

ERIC Educational Resources Information Center

Makar, Katie; Rubin, Andee

2009-01-01

Informal inferential reasoning has shown some promise in developing students' deeper understanding of statistical processes. This paper presents a framework to think about three key principles of informal inference--generalizations "beyond the data," probabilistic language, and data as evidence. The authors use primary school classroom…

Iran Sanctions

DTIC Science & Technology

2012-12-07

resolutions. November 21, 2011: Treasury Department names Iranian financial sector as a jurisdiction of primary money laundering concern. December...imposes sanctions on several key sectors of Iran’s economic infrastructure. For a broader analysis of policy on Iran, see CRS Report RL32048, Iran...1 Energy Sector Sanctions: The Iran

Assessment: The Alternative

ERIC Educational Resources Information Center

FORUM: for promoting 3-19 comprehensive education, 2017

2017-01-01

This position statement presents a summative argument against current structures and practices of assessment in England's primary schools, and some key principles for its replacement. The text was agreed by More Than A Score, a broad coalition of professional, curriculum, research and campaigning organisations opposed to the current assessment…

Children's Mathematical Reasoning: Opportunities for Developing Understanding and Creative Thinking

ERIC Educational Resources Information Center

Vale, Colleen; Bragg, Leicha A.; Widjaja, Wanty; Herbert, Sandra; Loong, Esther Yook-Kin

2017-01-01

Reasoning underpins students' mathematical understanding and promotes creative thinking. It is regarded as a key mathematical proficiency. This article discusses the reasoning actions that primary children employed and teachers noticed for the "What else belongs?" task focused on forming and testing conjectures.

Sustainability of NGO capacity building in southern Africa: successes and opportunities.

PubMed

Humphries, Debbie; Gomez, Ligia; Hartwig, Kari

2011-01-01

Despite an increase in organizational capacity building efforts by external organizations in low and middle income countries, the documentation of these efforts and their effects on health programs and systems remains limited. This paper reviews key frameworks for considering sustainability of capacity building and applies these frameworks to an evaluation of the sustainability of an AIDS non-governmental organization (NGO) capacity building initiative. From 2004-2007 Bristol-Myers Squibb Foundation's Secure the Future(TM) initiative in southern Africa funded a five country program, the NGO Training Institute (NGOTI), to build capacity of NGOs working to address HIV/AIDS. Lessons learned from this project include issues of ownership, the importance of integrating planning for sustainability within capacity-building projects, and the value of identifying primary capacity-building objectives in order to select sustainability strategies that are focused on maintaining program benefits. Sustainability for capacity building projects can be developed by discussing key issues early in the planning process with all primary stakeholders. Copyright © 2010 John Wiley & Sons, Ltd.

Effect of pirfenidone on proliferation, TGF-β-induced myofibroblast differentiation and fibrogenic activity of primary human lung fibroblasts.

PubMed

Conte, Enrico; Gili, Elisa; Fagone, Evelina; Fruciano, Mary; Iemmolo, Maria; Vancheri, Carlo

2014-07-16

Pirfenidone is an orally active small molecule that has been shown to inhibit the progression of fibrosis in animal models and in patients with idiopathic pulmonary fibrosis. Although pirfenidone exhibits well documented antifibrotic and antiinflammatory activities, in vitro and in vivo, its molecular targets and mechanisms of action have not been elucidated. In this study, we investigated the effects of pirfenidone on proliferation, TGF-β-induced differentiation and fibrogenic activity of primary human lung fibroblasts (HLFs). Pirfenidone reduced fibroblast proliferation and attenuated TGF-β-induced α-smooth muscle actin (SMA) and pro-collagen (Col)-I mRNA and protein levels. Importantly, pirfenidone inhibited TGF-β-induced phosphorylation of Smad3, p38, and Akt, key factors in the TGF-β pathway. Together, these results demonstrate that pirfenidone modulates HLF proliferation and TGF-β-mediated differentiation into myofibroblasts by attenuating key TGF-β-induced signaling pathways. Copyright © 2014 Elsevier B.V. All rights reserved.

The Olfactory Mosaic: Bringing an Olfactory Network Together for Odor Perception.

PubMed

Courtiol, Emmanuelle; Wilson, Donald A

2017-01-01

Olfactory perception and its underlying neural mechanisms are not fixed, but rather vary over time, dependent on various parameters such as state, task, or learning experience. In olfaction, one of the primary sensory areas beyond the olfactory bulb is the piriform cortex. Due to an increasing number of functions attributed to the piriform cortex, it has been argued to be an associative cortex rather than a simple primary sensory cortex. In fact, the piriform cortex plays a key role in creating olfactory percepts, helping to form configural odor objects from the molecular features extracted in the nose. Moreover, its dynamic interactions with other olfactory and nonolfactory areas are also critical in shaping the olfactory percept and resulting behavioral responses. In this brief review, we will describe the key role of the piriform cortex in the larger olfactory perceptual network, some of the many actors of this network, and the importance of the dynamic interactions among the piriform-trans-thalamic and limbic pathways.

Developing a research agenda for patient safety in primary care. Background, aims and output of the LINNEAUS collaboration on patient safety in primary care.

PubMed

Esmail, Aneez; Valderas, Jose M; Verstappen, Wim; Godycki-Cwirko, Maciek; Wensing, Michel

2015-09-01

This paper is an introduction to a supplement to The European Journal of General Practice, bringing together a body of research focusing on the issue of patient safety in relation to primary care. The supplement represents the outputs of the LINNEAUS collaboration on patient safety in primary care, which was a four-year (2009-2013) coordination and support action funded under the Framework 7 programme by the European Union. Being a coordination and support action, its aim was not to undertake new research, but to build capacity through engaging primary care researchers and practitioners in identifying some of the key challenges in this area and developing consensus statements, which will be an essential part in developing a future research agenda. This introductory article describes the aims of the LINNEAUS collaboration, provides a brief summary of the reasons to focus on patient safety in primary care, the epidemiological and policy considerations, and an introduction to the papers included in the supplement.

Developing a research agenda for patient safety in primary care. Background, aims and output of the LINNEAUS collaboration on patient safety in primary care

PubMed Central

Esmail, Aneez; Valderas, Jose M.; Verstappen, Wim; Godycki-Cwirko, Maciek; Wensing, Michel

2015-01-01

ABSTRACT This paper is an introduction to a supplement to The European Journal of General Practice, bringing together a body of research focusing on the issue of patient safety in relation to primary care. The supplement represents the outputs of the LINNEAUS collaboration on patient safety in primary care, which was a four-year (2009–2013) coordination and support action funded under the Framework 7 programme by the European Union. Being a coordination and support action, its aim was not to undertake new research, but to build capacity through engaging primary care researchers and practitioners in identifying some of the key challenges in this area and developing consensus statements, which will be an essential part in developing a future research agenda. This introductory article describes the aims of the LINNEAUS collaboration, provides a brief summary of the reasons to focus on patient safety in primary care, the epidemiological and policy considerations, and an introduction to the papers included in the supplement. PMID:26339828

4th annual primary care ethics conference: ethics education and lifelong learning

PubMed Central

Spicer, John; McKenzie-Edwards, Emma; Misselbrook, David

2014-01-01

Primary care ethics is a field of study that has recently found new life, with calls to establish the relevance of ethical discussion in general practice, to gather a body of literature and to carve out an intellectual space for primary care on the academic landscape of bioethics. In this report, we reflect on the key strands of the 4th primary care ethics conference held at the Royal Society of Medicine, on a theme of ethics education and lifelong learning: first, to produce insights that have relevance for policy and practice; and second, to illustrate the idea that not only is ethics relevant in primary care, but primary care is relevant in medical ethics. Core themes included the advantages and disadvantages of prescriptive ways of doing ethics in education, ethical reflection and potential risk to professional status, the need to deal with societal change and to take on board the insights gained from empirical work, whether this is about different kinds of fatherhood, or work on the causes of moral distress in healthcare workers. PMID:25949739

Beyond quality improvement: exploring why primary care teams engage in a voluntary audit and feedback program.

PubMed

Wagner, Daniel J; Durbin, Janet; Barnsley, Jan; Ivers, Noah M

2017-12-02

Despite its popularity, the effectiveness of audit and feedback in support quality improvement efforts is mixed. While audit and feedback-related research efforts have investigated issues relating to feedback design and delivery, little attention has been directed towards factors which motivate interest and engagement with feedback interventions. This study explored the motivating factors that drove primary care teams to participate in a voluntary audit and feedback initiative. Interviews were conducted with leaders of primary care teams who had participated in at least one iteration of the audit and feedback program. This intervention was developed by an organization which advocates for high-quality, team-based primary care in Ontario, Canada. Interview transcripts were coded using the Consolidated Framework for Implementation Research and the resulting framework was analyzed inductively to generate key themes. Interviews were completed with 25 individuals from 18 primary care teams across Ontario. The majority were Executive Directors (14), Physician leaders (3) and support staff for Quality Improvement (4). A range of motivations for participating in the audit and feedback program beyond quality improvement were emphasized. Primarily, informants believed that the program would eventually become a best-in-class audit and feedback initiative. This reflected concerns regarding existing initiatives in terms of the intervention components and intentions as well as the perception that an initiative by primary care, for primary care would better reflect their own goals and better support desired patient outcomes. Key enablers included perceived obligations to engage and provision of support for the work involved. No teams cited an evidence base for A&F as a motivating factor for participation. A range of motivating factors, beyond quality improvement, contributed to participation in the audit and feedback program. Findings from this study highlight that efforts to understand how and when the intervention works best cannot be limited to factors within developers' control. Clinical teams may more readily engage with initiatives with the potential to address their own long-term system goals. Aligning motivations for participation with the goals of the audit and feedback initiative may facilitate both engagement and impact.

Decentralization and primary health care: some negative implications in developing countries.

PubMed

Collins, C; Green, A

1994-01-01

Decentralization is a highly popular concept, being a key element of Primary Health Care policies. There are, however, certain negative implications of decentralization that must be taken into account. These are analyzed in this article with particular reference to developing countries. The authors criticize the tendency for decentralization to be associated with state limitations, and discuss the dilemma of relating decentralization, which is the enhancement of the different, to equity, which is the promotion of equivalence. Those situations in which decentralization can strengthen political domination are described. The authors conclude by setting out a checklist of warning questions and issues to be taken into account to ensure that decentralization genuinely facilitates the Primary Health Care orientation of health policy.

Spirometry in primary care

PubMed Central

Coates, Allan L; Graham, Brian L; McFadden, Robin G; McParland, Colm; Moosa, Dilshad; Provencher, Steeve; Road, Jeremy

2013-01-01

Canadian Thoracic Society (CTS) clinical guidelines for asthma and chronic obstructive pulmonary disease (COPD) specify that spirometry should be used to diagnose these diseases. Given the burden of asthma and COPD, most people with these diseases will be diagnosed in the primary care setting. The present CTS position statement was developed to provide guidance on key factors affecting the quality of spirometry testing in the primary care setting. The present statement may also be used to inform and guide the accreditation process for spirometry in each province. Although many of the principles discussed are equally applicable to pulmonary function laboratories and interpretation of tests by respirologists, they are held to a higher standard and are outside the scope of the present statement. PMID:23457669

Rapid identification of Corynebacterium vaginale in non-purulent vaginitis.

PubMed Central

Wells, J I; Goei, S H

1981-01-01

A simple set of tests is proposed to give excellent probability for the identification of Corynebacterium vaginale from clinical material. Using these tests, 380 C vaginale were isolated from genital tract specimens from 1402 patients. Of these isolates 70 were from symptomatic patients. These 70 isolates were subjected to a further set of tests to confirm their identity. The advantage of these primary tests is that they can be completed on the day of isolation of the organism. Of these 70 isolates 66 were confirmed as C vaginale thus giving the primary set of tests a 94% rate of accurate identification. However this rate may be increased beyond 97% by the promotion of one of the key secondary tests to the primary set. PMID:7024317

Factors shaping intersectoral action in primary health care services.

PubMed

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

2014-12-01

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

Impact evaluation of a health promotion-focused organisational development strategy on a health service's capacity to deliver comprehensive primary health care.

PubMed

Costello, Michelle; Taylor, Jane; O'Hara, Lily

2015-01-01

A comprehensive primary health care approach is required to address complex health issues and reduce inequities. However, there has been limited uptake of this approach by health services nationally or internationally. Reorienting health services towards becoming more health promoting provides a mechanism to support the delivery of comprehensive primary health care. The aim of this study was to determine the impact of a health promotion-focused organisational development strategy on the capacity of a primary health care service to deliver comprehensive primary health care. A questionnaire and semistructured individual interviews were used to collect quantitative and qualitative impact evaluation data, respectively, from 13 health service staff across three time points with regard to 37 indicators of organisational capacity. There were significant increases in mean scores for 31 indicators, with effect sizes ranging from moderate to nearly perfect. A range of key enablers and barriers to support the delivery of comprehensive primary health care was identified. In conclusion, an organisational development strategy to reorient health services towards becoming more health promoting may increase the capacity to deliver comprehensive primary health care.

Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care.

PubMed

O'Malley, Denalee; Hudson, Shawna V; Nekhlyudov, Larissa; Howard, Jenna; Rubinstein, Ellen; Lee, Heather S; Overholser, Linda S; Shaw, Amy; Givens, Sarah; Burton, Jay S; Grunfeld, Eva; Parry, Carly; Crabtree, Benjamin F

2017-02-01

This study describes the experiences of early implementers of primary care-focused cancer survivorship delivery models. Snowball sampling was used to identify innovators. Twelve participants (five cancer survivorship primary care innovators and seven content experts) attended a working conference focused on cancer survivorship population strategies and primary care transformation. Data included meeting discussion transcripts/field notes, transcribed in-depth innovator interviews, and innovators' summaries of care models. We used a multistep immersion/crystallization analytic approach, guided by a primary care organizational change model. Innovative practice models included: (1) a consultative model in a primary care setting; (2) a primary care physician (PCP)-led, blended consultative/panel-based model in an oncology setting; (3) an oncology nurse navigator in a primary care practice; and (4) two subspecialty models where PCPs in a general medical practice dedicated part of their patient panel to cancer survivors. Implementation challenges included (1) lack of key stakeholder buy-in; (2) practice resources allocated to competing (non-survivorship) change efforts; and (3) competition with higher priority initiatives incentivized by payers. Cancer survivorship delivery models are potentially feasible in primary care; however, significant barriers to widespread implementation exist. Implementation efforts would benefit from increasing the awareness and potential value-add of primary care-focused strategies to address survivors' needs. Current models of primary care-based cancer survivorship care may not be sustainable. Innovative strategies to provide quality care to this growing population of survivors need to be developed and integrated into primary care settings.

`You Have to Give Them Some Science Facts': Primary Student Teachers' Early Negotiations of Teacher Identities in the Intersections of Discourses About Science Teaching and About Primary Teaching

NASA Astrophysics Data System (ADS)

Danielsson, Anna T.; Warwick, Paul

2014-04-01

In the broadest sense, the goal for primary science teacher education could be described as preparing these teachers to teach for scientific literacy. Our starting point is that making such science teaching accessible and desirable for future primary science teachers is dependent not only on their science knowledge and self-confidence, but also on a whole range of interrelated sociocultural factors. This paper aims to explore how intersections between different Discourses about primary teaching and about science teaching are evidenced in primary school student teachers' talk about becoming teachers. The study is founded in a conceptualisation of learning as a process of social participation. The conceptual framework is crafted around two key concepts: Discourse (Gee 2005) and identity (Paechter, Women's Studies International Forum, 26(1):69-77, 2007). Empirically, the paper utilises semi-structured interviews with 11 primary student teachers enrolled in a 1-year Postgraduate Certificate of Education course. The analysis draws on five previously identified teacher Discourses: `Teaching science through inquiry', `Traditional science teacher', `Traditional primary teacher', `Teacher as classroom authority', and `Primary teacher as a role model' (Danielsson and Warwick, International Journal of Science Education, 2013). It explores how the student teachers, at an early stage in their course, are starting to intersect these Discourses to negotiate their emerging identities as primary science teachers.

Learning the Landscape: Implementation Challenges of Primary Care Innovators around Cancer Survivorship Care

PubMed Central

O’Malley, Denalee; Hudson, Shawna V.; Nekhlyudov, Larissa; Howard, Jenna; Rubinstein, Ellen; Lee, Heather S.; Overholser, Linda S.; Shaw, Amy; Givens, Sarah; Burton, Jay S.; Grunfeld, Eva; Parry, Carly; Crabtree, Benjamin F.

2016-01-01

PURPOSE This study describes the experiences of early implementers of primary care-focused cancer survivorship delivery models. METHODS Snowball sampling was used to identify innovators. Twelve participants (five cancer survivorship primary care innovators and seven content experts) attended a working conference focused on cancer survivorship population strategies and primary care transformation. Data included meeting discussion transcripts/field notes, transcribed in-depth innovator interviews, and innovators’ summaries of care models. We used a multi-step immersion/crystallization analytic approach, guided by a primary care organizational change model. RESULTS Innovative practice models included: 1) a consultative model in a primary care setting; 2) a primary care physician (PCP)-led, blended consultative/panel-based model in an oncology setting; 3) an oncology nurse navigator in a primary care practice; and 4) two sub-specialty models where PCPs in a general medical practice dedicated part of their patient panel to cancer survivors. Implementation challenges included: (1) lack of key stakeholder buy-in; (2) practice resources allocated to competing (non-survivorship) change efforts; and (3) competition with higher priority initiatives incentivized by payers. CONCLUSIONS Cancer survivorship delivery models are potentially feasible in primary care; however, significant barriers to widespread implementation exist. Implementation efforts would benefit from increasing the awareness and potential value-add of primary care-focused strategies to address survivors’ needs. PMID:27277895

[Legal health services of abortion in Uruguay. Strategies of the primary health care public services].

PubMed

López-Gómez, Alejandra; Couto, Martín; Píriz, Gabriela; Monza, Ana; Abracinskas, Lilián; Ituarte, María Luisa

2017-01-01

To analyze the strategies developed by the health centers to implement the law of legal abortion (LA) in public services of the primary care in Montevideo, Uruguay. A qualitative research was conducted combining techniques of document analysis, self-administered questionnaires to key informants, and in-depth interviews with directors of health centers. A simple summative index of accessibility to abortion services was built. The law approved in Uruguay in 2012 demanded the development of a strategy to promote women's accessibility to LA in the public primary care system. The services failed to fully implement the strategy, due to institutional barriers. Despite the wide availability of LA services in primary care and that they are an integral part of sexual and reproductive health benefits, there is an important barrier to their use in the number of gynecologists that appeal to conscientious objection.

Identification and Management of Chronic Pain in Primary Care: a Review.

PubMed

Mills, Sarah; Torrance, Nicola; Smith, Blair H

2016-02-01

Chronic pain is a common, complex, and challenging condition, where understanding the biological, social, physical and psychological contexts is vital to successful outcomes in primary care. In managing chronic pain the focus is often on promoting rehabilitation and maximizing quality of life rather than achieving cure. Recent screening tools and brief intervention techniques can be effective in helping clinicians identify, stratify and manage both patients already living with chronic pain and those who are at risk of developing chronic pain from acute pain. Frequent assessment and re-assessment are key to ensuring treatment is appropriate and safe, as well as minimizing and addressing side effects. Primary care management should be holistic and evidence-based (where possible) and incorporates both pharmacological and non-pharmacological approaches, including psychology, self-management, physiotherapy, peripheral nervous system stimulation, complementary therapies and comprehensive pain-management programmes. These may either be based wholly in primary care or supported by appropriate specialist referral.

Common variants in ZMIZ1 and near NGF confer risk for primary dysmenorrhoea

PubMed Central

Li, Zhiqiang; Chen, Jianhua; Zhao, Ying; Wang, Yujiong; Xu, Jinrui; Ji, Jue; Shen, Jingyi; Zhang, Weiping; Chen, Zuosong; Sun, Qilin; Mao, Lijuan; Cheng, Shulin; Yang, Bo; Zhang, Dongtao; Xu, Yufeng; Zhao, Yingying; Liu, Danping; Shen, Yinhuan; Zhang, Weijie; Li, Changgui; Shen, Jiawei; Shi, Yongyong

2017-01-01

Primary dysmenorrhoea, defined as painful menstrual cramps in the absence of pelvic pathology, is a common problem in women of reproductive age. Its aetiology and pathophysiology remain largely unknown. Here we performed a two-stage genome-wide association study and subsequent replication study to identify genetic factors associated with primary dysmenorrhoea in a total of 6,770 Chinese individuals. Our analysis provided evidence of a significant (P<5 × 10−8) association at rs76518691 in the gene ZMIZ1 and at rs7523831 near NGF. ZMIZ1 has previously been associated with several autoimmune diseases, and NGF plays a key role in the generation of pain and hyperalgesia and has been associated with migraine. These findings provide future directions for research on susceptibility mechanisms for primary dysmenorrhoea. Furthermore, our genetic architecture analysis provides molecular support for the heritability and polygenic nature of this condition. PMID:28447608

The assessment and management of chest pain in primary care: A focus on acute coronary syndrome

PubMed

Thomsett, Richard; Cullen, Louise

2018-05-01

Chest pain is a common presentation and diagnosis can be challenging. There are many causes for chest pain, including life-threatening conditions such as acute coronary syndrome (ACS), which can prove difficult to diagnose. This article focuses on diagnosis and early management of patients with possible ACS. Key differentials and essential primary care investigations and management are outlined. Hospital-based risk stratification and management are described, providing an outline of what patients can expect if referred to hospital. In primary care, an electrocardiogram (ECG) is the only investigation required for most patients while referral is made to hospital. Troponin testing should rarely be requested to investigate patients with suspected ACS in the primary care setting. Initial treatment may include aspirin, glyceryl trinitrate and oxygen if required. If ACS is suspected as the cause of the symptoms, urgent referral for definitive risk stratification is required.

From shared care to disease management: key-influencing factors.

PubMed

Eijkelberg, I M; Spreeuwenberg, C; Mur-Veeman, I M; Wolffenbuttel, B H

2001-01-01

In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called 'shared care' projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? The theoretical framework is based on the concept of the learning organisation. Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skillful way. Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed.

TECHNICAL INFORMATION POLICY AND GUIDE OF THE OFFICE OF RESEARCH AND DEVELOPMENT

EPA Science Inventory

One of the primary missions of the Office of Research and Development (ORD) is to generate technical information that is key to the protection of environmental quality. This information also influences national environmental policy. In this context, the way in which information i...

Role of PTEN in the Tumor Microenvironment

DTIC Science & Technology

2010-06-01

like tumor macro- phages modulate the extracellular microenvironment to pro- mote tumor growth and angiogenesis at both primary and tumor sites. A key...median lobe with a saline-moistened cotton tip. The median and left lateral lobe will be held against the diaphragm/thorax with a moistened cotton

Investigating the Watergate Scandal.

ERIC Educational Resources Information Center

Ritchie, Donald A.

1998-01-01

Summarizes the events leading up to and the investigation that followed the Watergate break-in. Presents a lesson plan using primary documents that allows students to explore the workings of congressional investigations, the key figures in the scandal, and the arguments of the different participants. Includes copies of the documents. (DSK)

Hydrology of Mid-Atlantic Freshwater Wetlands

EPA Science Inventory

Hydrology is a key variable in the structure and function of a wetland; it is a primary determinant of wetland type, and it drives many of the functions a wetland performs and in turn the services it provides. However, wetland hydrology has been understudied. Efforts by Riparia s...

Documenting taxonomic data quality for field fish identifications: a proposal for national surveys

EPA Science Inventory

The U.S. Environmental Protection Agency is in the midst of a multiyear series of natinal surveys of water resource conditions. Because communicating ecological condition is the primary objective of the surveys, quantitative biological indicators are key. Thus, if raw taxonomic d...

Family Factors and Primary Students' Reading Attainment: A Chinese Community Perspective

ERIC Educational Resources Information Center

Ko, Hwa Wei; Chan, Yi Ling

2009-01-01

This study examined the relationship between students' reading attainment scores and key family environmental factors in Chinese and non-Chinese communities. Six family environmental factors were considered: parents' evaluation of their offspring's early literacy skills, early home literacy activities (EHLA), reading activities involving parents…

Racial/Ethnic Disparities in Primary Care Quality Among Type 2 Diabetes Patients, Medical Expenditure Panel Survey, 2012.

PubMed

Hu, Ruwei; Shi, Leiyu; Liang, Hailun; Haile, Geraldine Pierre; Lee, De-Chih

2016-08-04

Racial and ethnic disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications and mortality rates, and the quality of diabetes care among Americans. We explored racial and ethnic disparities in primary care quality among Americans with type 2 diabetes. We analyzed data on adults with type 2 diabetes derived from the household component of the 2012 Medical Expenditure Panel Survey. Multiple regression and multivariate logistic regressions were used to examine the association between race/ethnicity and primary care attributes related to first contact, longitudinality, comprehensiveness, and coordination, and clusters of confounding factors were added sequentially. Preliminary findings indicated differences in primary care quality between racial/ethnic minorities and whites across measures of first contact, longitudinality, comprehensiveness, and coordination. After controlling for confounding factors, these differences were no longer apparent; all racial/ethnic categories showed similar rates of primary care quality according to the 4 primary care domains of interest in the study. Results indicate equitable primary care quality for type 2 diabetes patients across 4 key domains of primary care after controlling for socioeconomic characteristics. Additional research is necessary to support these findings, particularly when considering smaller racial/ethnic groups and investigating outcomes related to diabetes.

The isolation and characterization of a telomerase immortalized goat trophoblast cell line.

PubMed

Dong, F; Huang, Y; Li, W; Zhao, X; Zhang, W; Du, Q; Zhang, H; Song, X; Tong, D

2013-12-01

Trophoblast cells play vital roles in the processes of embryonic implantation and placentation. Many toxicological compounds can induce the malfunction of trophoblast cells, resulting in implantation failure or early embryonic loss. The finite lifespan of primary trophoblast cells limits investigation of the long-term effects of some toxicological compounds on trophoblast cells in vitro. In this study, primary goat trophoblast cells were purified by density gradient centrifugation and specific immuno-affinity purification. Then, the purified cells were immortalized through transfection of a plasmid containing the human telomerase reverse transcriptase (hTERT) gene. hTERT-transfected goat trophoblast cells (hTERT-GTCs) could steadily express hTERT gene and exhibit higher telomerase activity, and persistently proliferate without any signs of senescence up to 50 passages. The immortalized goat trophoblast cells still possessed the basic and key properties of normal primary goat trophoblast cells to express the specific intracellular marker cytokeratin 7 (CK-7) and secrete chorionic gonadotrophin β-subunit (CG-β) and placental lactogen (PL). Further studies showed that the immortalized goat trophoblast cells expressed vimentin and non-classical MHC class I antigen and exhibited invasive phenotype, suggesting that the immortalized goat trophoblasts resembled human extravillous trophoblasts. In addition, this cell line did not show neoplastic transformation either in vivo or in vitro. We concluded the immortalized goat trophoblast cells by hTERT transfection retained the basic and key characteristics of primary trophoblast cells and may provide a useful model to study the effects of some toxicological compounds on trophoblast cells. Copyright © 2013 Elsevier Ltd. All rights reserved.

Understanding Care Integration from the Ground Up: Five Organizing Constructs that Shape Integrated Practices.

PubMed

Cohen, Deborah J; Balasubramanian, Bijal A; Davis, Melinda; Hall, Jennifer; Gunn, Rose; Stange, Kurt C; Green, Larry A; Miller, William L; Crabtree, Benjamin F; England, Mary Jane; Clark, Khaya; Miller, Benjamin F

2015-01-01

To provide empirical evidence on key organizing constructs shaping practical, real-world integration of behavior health and primary care to comprehensively address patients' medical, emotional, and behavioral health needs. In a comparative case study using an immersion-crystallization approach, a multidisciplinary team analyzed data from observations of practice operations, interviews, and surveys of practice members, and implementation diaries. Practices were drawn from 2 studies of practices attempting to integrate behavioral health and primary care: Advancing Care Together, a demonstration project of 11 practices located in Colorado, and the Integration Workforce Study, a study of 8 practices across the United States. We identified 5 key organizing constructs influencing integration of primary care and behavioral health: 1) Integration REACH (the extent to which the integration program was delivered to the identified target population), 2) establishment of continuum of care pathways addressing the location of care across the range of patient's severity of illness, 3) approach to patient transitions: referrals or warm handoffs, 4) location of the integration workforce, and 5) participants' mental model for integration. These constructs intertwine within an organization's historic and social context to produce locally adapted approaches to integrating care. Contextual factors, particularly practice type, influenced whether specialty mental health and substance use services were colocated within an organization. Interaction among 5 organizing constructs and practice context produces diverse expressions of integrated care. These constructs provide a framework for understanding how primary care and behavioral health services can be integrated in routine practice. © Copyright 2015 by the American Board of Family Medicine.

Proteomic profiling of isogenic primary and metastatic medulloblastoma cell lines reveals differential expression of key metastatic factors.

PubMed

Gu, Shuo; Chen, Kai; Yin, Minzhi; Wu, Zhixiang; Wu, Yeming

2017-05-08

Medulloblastoma is the most common malignant brain tumor in children. Around 30% of medulloblastoma patients are diagnosed with metastasis, which often results in a poor prognosis. Unfortunately, molecular mechanisms of medulloblastoma metastasis remain largely unknown. In this study, we employed the recently developed deep proteome analysis approach to quantitatively profile the expression of >10,000 proteins from CHLA-01-MED and CHLA-01R-MED isogenic cell lines derived from the primary and metastatic tumor of the same patient diagnosed with a group IV medulloblastoma. Using statistical analysis, we identified ~1400 significantly altered proteins between the primary and metastatic cell lines including known factors such as placental growth factor (PLGF), LIM homeobox 1 (LHX1) and prominim 1 (PROM1), as well as the negative regulator secreted protein acidic and cysteine rich (SPARC). Additional transwell experiments and immunohistochemical analysis of clinical medulloblastoma samples implicated yes-associated protein 1 (YAP1) as a potential key factor contributing to metastasis. Taken together, our data broadly defines the metastasis-relevant regulated proteome and provides a precious resource for further investigating potential mechanisms of medulloblastoma metastasis. This study represented the first deep proteome analysis of metastatic medulloblastomas and provided a valuable candidate list of altered proteins in metastatic medulloblastomas. The primary data suggested YAP1 as a potential driver for the metastasis of medulloblastoma. These results open up numerous avenues for further investigating the underlying mechanisms of medulloblastoma metastasis and improving the prognosis of medulloblastoma patients. Copyright © 2017 Elsevier B.V. All rights reserved.

[Out-of-hours primary care in Germany: general practitioners' views on the current situation].

PubMed

Frankenhauser-Mannuß, J; Goetz, K; Scheuer, M; Szescenyi, J; Leutgeb, R

2014-07-01

The aim of this study was to explore views, experiences und perspectives of German GPs related to current out-of-hours service provision covering both urban and rural settings. In the context of the international project EurOOHnet (European Research Network for Out-of-Hours Primary Health Care) the German members (of EurOOHnet) developed a questionnaire about organisational structures, infrastructure requirements and the procedures of information flow between regular care and out-of-hours care in 2011. This questionnaire was adopted in every participating country. A comprehensive postal questionnaire was sent to 410 feneral practice cooperatives in Germany. Qualitative content analysis and an inductive reasoning process, supported by the use of Atlas.ti, were used to identify key themes from responses to open-ended questions in the survey. Results were grouped into 3 overarching categories and each of these were grouped into 3 sub-categories. The questionnaire response rate was 44% (181/410). The analysis identified organisational issues (e. g., financing) and infrastructure barriers (e. g., lack of motivated GPs for out-of-hours care) as key themes. Significantly, different priorities between rural and urban GPs were identified. In particular, rural GPs highlighted shortages of GPs and distance between the GP practice and patients' residence as concerning factors impacting on out-of-hours care. Based on reported views from survey respondents, urban and rural primary care service needs vary significantly and, therefore, different solutions are needed to improve out-of-hours primary care and optimise service quality. © Georg Thieme Verlag KG Stuttgart · New York.

Achieving benefit for patients in primary care informatics: the report of a international consensus workshop at Medinfo 2007.

PubMed

de Lusignan, Simon; Teasdale, Sheila

2007-01-01

Landmark reports suggest that sharing health data between clinical computer systems should improve patient safety and the quality of care. Enhancing the use of informatics in primary care is usually a key part of these strategies. To synthesise the learning from the international use of informatics in primary care. The workshop was attended by 21 delegates drawn from all continents. There were presentations from USA, UK and the Netherlands, and informal updates from Australia, Argentina, and Sweden and the Nordic countries. These presentations were discussed in a workshop setting to identify common issues. Key principles were synthesised through a post-workshop analysis and then sorted into themes. Themes emerged about the deployment of informatics which can be applied at health service, practice and individual clinical consultation level: 1 At the health service or provider level, success appeared proportional to the extent of collaboration between a broad range of stakeholders and identification of leaders. 2 Within the practice much is currently being achieved with legacy computer systems and apparently outdated coding systems. This includes prescribing safety alerts, clinical audit and promoting computer data recording and quality. 3 In the consultation the computer is a 'big player' and may make traditional models of the consultation redundant. We should make more efforts to share learning; develop clear internationally acceptable definitions; highlight gaps between pockets of excellence and real-world practice, and most importantly suggest how they might be bridged. Knowledge synthesis from different health systems may provide a greater understanding of how the third actor (the computer) is best used in primary care.

Resistance to Change and Relapse of Observing

PubMed Central

Thrailkill, Eric A; Shahan, Timothy A

2012-01-01

Four experiments examined relapse of extinguished observing behavior of pigeons using a two-component multiple schedule of observing-response procedures. In both components, unsignaled periods of variable-interval (VI) food reinforcement alternated with extinction and observing responses produced stimuli associated with the availability of the VI schedule (i.e., S+). The components differed in the rate of food arranged (Rich  = VI 30 s; Lean  =  VI 120 s). In Experiment 1, following baseline training, extinction of observing involved removal of both food and S+ deliveries, and reinstatement was examined by presenting either response-independent food or S+ deliveries. In Experiment 2, extinction involved removal of only food deliveries while observing responses continued to produce S+. Reinstatement was examined by delivering food contingent upon the first two food-key responses occurring in the presence of the S+. Experiment 3 assessed ABA renewal of observing by extinguishing food-key and observing responses in the presence of one contextual stimulus (i.e., B) and then returning to the original training context (i.e., A) during continued extinction. Experiment 4 examined resurgence by introducing food reinforcement for an alternative response during extinction, and subsequently removing that alternative source of food. Across experiments, relative resistance to extinction and relapse of observing tended to be greater in the component previously associated with the higher rate of primary reinforcement. Relapse of observing or attending to stimuli associated with primary reinforcement appears to be impacted by frequency of primary reinforcement in a manner similar to responding maintained directly by primary reinforcement. PMID:22693359

Key Techniques and Risk Management for the Application of the Pile-Beam-Arch (PBA) Excavation Method: A Case Study of the Zhongjie Subway Station

PubMed Central

Guan, Yong-ping; Zhao, Wen; Li, Shen-gang; Zhang, Guo-bin

2014-01-01

The design and construction of shallow-buried tunnels in densely populated urban areas involve many challenges. The ground movements induced by tunneling effects pose potential risks to infrastructure such as surface buildings, pipelines, and roads. In this paper, a case study of the Zhongjie subway station located in Shenyang, China, is examined to investigate the key construction techniques and the influence of the Pile-Beam-Arch (PBA) excavation method on the surrounding environment. This case study discusses the primary risk factors affecting the environmental safety and summarizes the corresponding risk mitigation measures and key techniques for subway station construction using the PBA excavation method in a densely populated urban area. PMID:25221783

Primary Discussion on Standardized Management of Purchasing Large Equipments for Measurement Technology Institution

NASA Astrophysics Data System (ADS)

Hu, Chang; Hu, Juanli; Zhou, Qi; Yang, Yue

In view of current situation and existing problem on purchasing equipment for measurement technology institution, this paper analyzes key factors that affect the standardization of equipment procurement and it proposes a set of scientific and standardized solutions for equipment procurement based on actual work.

Assessing Cumulative Impact and Risk - Approaches at the U.S. Environmental Protection Agency

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) has a mission and regulatory mandate to protect human health and the environment. EPA’s primary role is to implement environmental laws by developing and enforcing national regulation. Cogent to the goals of this workshop, key envi...

OECD in Figures, 2008

ERIC Educational Resources Information Center

OECD Publishing (NJ1), 2008

2008-01-01

"OECD in Figures" is a primary statistical source for key data on OECD countries, ranging from economic growth and employment to inflation, trade and environment. Information is presented in tabular form for: (1) Demography and Health; (2) Economy; (3) Energy; (4) Labour; (5) Science and Technology; (6) Environment; (7) Education; (8)…

USDA updates nutrient values for fast food pizza

USDA-ARS?s Scientific Manuscript database

Consumption of quick service pizza has increased as Americans are spending more on food away from home. Pizza is consistently a primary Key Food in the USDA National Food and Nutrient Analysis Program (NFNAP) because it is a contributor of more than 14 nutrients of public health significance to the...

Keys to Improving Writing in the Primary Grades.

ERIC Educational Resources Information Center

Bassett, Diane; DeVine, Denise; Perry, Nancy; Rueth, Catherine

This action research describes a program for improving writing skills. The targeted population consisted of first and third graders in two middle class communities in the southern suburbs of Chicago. The need for improvement in writing skills was documented through observation checklists, writing samples, and surveys. Data revealed a need for…

National Assessment Program--Science Literacy Year 6 Technical Report, 2006

ERIC Educational Resources Information Center

Wu, Margaret; Donovan, Jenny; Hutton, Penny; Lennon, Melissa

2008-01-01

In July 2001, the Ministerial Council on Education, Employment, Training and Youth Affairs (MCEETYA) agreed to the development of assessment instruments and key performance measures for reporting on student skills, knowledge and understandings in primary science. It directed the newly established Performance Measurement and Reporting Taskforce…

Does Proactive Personality Matter in Mobile Learning?

ERIC Educational Resources Information Center

Huang, Rui-Ting; Tang, Tzy-Wen; Lee, Yi Ping; Yang, Fang-Ying

2017-01-01

Increasing attention has been paid to mobile learning studies. However, there is still a dearth of studies investigating the moderating effect of proactive personality on mobile learning achievements. Accordingly, the primary purpose of this study is not only to investigate the key elements that could improve the effectiveness and efficiency of…

Sports Nutrition for the Primary Care Physician: The Importance of Carbohydrate.

ERIC Educational Resources Information Center

Wheeler, Keith B.

1989-01-01

Discusses the relationship between nutrition and fatigue and how carbohydrates and timing of carbohydrate consumption can affect fatigued athletes. Nutrition plays a significant role in successful training and competition. Key concerns are the specific needs of athletes for carbohydrates before, during, and after exercise. (Author/SM)

Metacognition and Transfer: Keys to Improving Marketing Education

ERIC Educational Resources Information Center

Ramocki, Stephen P.

2007-01-01

A primary purpose of marketing education is to prepare students to perform throughout their careers, and performance largely relies on transferability of knowledge. It has been demonstrated that training in metacognition, along with emphasis on transfer, does lead to increased probability that knowledge will be transferred into environments…

Sociocultural Perspectives on Transition to School from Pacific Islands Early Childhood Centres.

ERIC Educational Resources Information Center

Podmore, Valerie N.; Sauvao, Le'Autuli'ilagi M.; Mapa, Lia

2003-01-01

Summarizes research investigating children's transition to primary school from Pacific early childhood centers in New Zealand. Key issues emerging from the review include continuity of Pacific Islands languages and culture between home, early childhood center, and school; home-school partnership; teachers' and parents' expectations regarding…

A Primary Classroom Inquiry: Estimating the Height of a Tree

ERIC Educational Resources Information Center

Brown, Natalie; Watson, Jane; Wright, Suzie; Skalicky, Jane

2011-01-01

Measurement is one of the key areas of study in mathematics and features prominently in the "Australian Curriculum: Mathematics" (ACARA, 2010). In this set of investigations requiring students to estimate indirectly the height of a tree they are encouraged to use the "power of mathematical reasoning" and "apply their…

Relationship-Based Developmentally Supportive Approach to Infant Childcare Practice

ERIC Educational Resources Information Center

Kim, Yunhee

2016-01-01

Caregivers' warm, sensitive, and attentive interactions with their children have been widely considered key indicators of infant-caregiver interaction quality in childcare contexts. The primary purpose of this study was to explore infant's daily experiences and the characteristics of relationship-based supportive care practices in a childcare…

25 CFR 558.2 - Eligibility determination for granting a gaming license.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Eligibility determination for granting a gaming license. 558.2 Section 558.2 Indians NATIONAL INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GAMING LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES...

Insight into sediment transport processes on saline rangeland hillslopes using three-dimensional soil microtopography changes

USDA-ARS?s Scientific Manuscript database

In arid and semi-arid rangeland environments, an accurate understanding of runoff generation and sediment transport processes is key to developing effective management actions and addressing ecosystem response to changes. Yet, many primary processes (namely sheet and splash and concentrated flow ero...

Teaching Prevention on Sensitive Topics: Key Elements and Pedagogical Techniques

ERIC Educational Resources Information Center

Russell, Beth S.; Soysa, Champika K.; Wagoner, Marc J.; Dawson, Lori

2008-01-01

This paper presents a set of topical and pedagogical considerations for instructors teaching material on sensitive topics with either the primary or secondary aim of addressing prevention. Prevention can be approached as an effort to create changes in an individual's attitudes/beliefs, knowledge, and behavior. Following this framework, classroom…

DEMONSTRATION BULLETIN: THE BASIC EXTRACTIVE SLUDGE TREATMENT (B.E.S.T.) RESOURCES CONSERVATION COMPANY (RCC)

EPA Science Inventory

The Basic Extractive Sludge Treatment (B.E.S.T.®) process is a solvent extraction system that separates organic contaminants from sludges, soils, and sediments. The primary distinguishing feature of the process is the extraction agent, triethylamine. The key to the success of tri...

Current Genetic Discoveries and Education: "Strengths, Opportunities, and Limitations"

ERIC Educational Resources Information Center

Bates, Timothy C.

2008-01-01

This article notes that many key positive developments in education originated in research on the structure and genetics of abilities, providing primary evidence for ability in disadvantaged groups and playing a critical role in demonstrating the existence of developmental learning disorders and effective interventions. It is argued that new work…

Estimation in the Primary School: Developing a Key Mathematical Skill for Life

ERIC Educational Resources Information Center

Mildenhall, Paula

2016-01-01

Very recently, in the "Australian Association of Mathematics Teachers (AAMT)/Australian Industry Group quantitative report" (2014), concerns were raised that school mathematics is lacking real world application. This report highlighted the gaps between school mathematics and the requirements of the workplace. After interviewing industry…

Working with Bilingual Learners: An Introduction

ERIC Educational Resources Information Center

Willenberg, Ingrid

2015-01-01

This article seeks to provide a theoretical overview of bilingualism and discuss the key concepts and theories that inform classroom pedagogy with bilingual learners. Although some specific classroom strategies are introduced, the primary purpose is not to offer strategies, but rather to offer guiding principles based on theory and research to…

A Curriculum without Foundation

ERIC Educational Resources Information Center

Boyle, Bill; Bragg, Joanna

2006-01-01

Peter Tymms has written recently ("BERJ", August 2004) on the subject of measuring whether standards are rising in English and mathematics in primary schools based on pupil outcomes from national end of key stage tests. This article takes the position that the performance data debate is an interesting one but peripheral to a far bigger…

Multiple Intelligences: Curriculum and Assessment Project. Final Report

ERIC Educational Resources Information Center

Hyland, Aine, Ed.

2011-01-01

The "Multiple Intelligences, Curriculum and Assessment Project" at University College Cork was a collaborative project carried out between 1995 and 1999. The key research question focused on whether Howard Gardner's theory of Multiple Intelligences could be applied to, and enhance, aspects of curriculum and assessment at primary and…

Integrating Participatory Elements into an Effectiveness Evaluation

ERIC Educational Resources Information Center

Wallace, Tanner LeBaron

2008-01-01

This article describes an effectiveness evaluation of an intensive case management intervention coordinated by a non-profit organization in a midsize Midwest City. As an effectiveness evaluation, the primary evaluation question was causal in nature; the key task of the evaluative study was to establish and probe connections between the…

Consistent Query Answering of Conjunctive Queries under Primary Key Constraints

ERIC Educational Resources Information Center

Pema, Enela

2014-01-01

An inconsistent database is a database that violates one or more of its integrity constraints. In reality, violations of integrity constraints arise frequently under several different circumstances. Inconsistent databases have long posed the challenge to develop suitable tools for meaningful query answering. A principled approach for querying…

Sulfur Dioxide (SO2) Primary NAAQS Review: Integrated Review Plan - Advisory with CASAC

EPA Science Inventory

The SO2 Integrated Review Plan is the first document generated as part of the National Ambient Air Quality Standards (NAAQS) review process. The Plan presents background information, the schedule for the review, the process to be used in conducting the review, and the key policy-...

Marketing: Key to Institutional Survival and Success.

ERIC Educational Resources Information Center

Grossman, Robert J.

1987-01-01

The marketing concept holds that the primary task of an institution is to determine the needs, wants, and values of its target constituencies and to adapt itself to delivering desired satisfactions more effectively and efficiently than its competitors. Student orientation, marketing research, mission and goals, and institutional commitment are…

Investigating Antecedents of Task Commitment and Task Attraction in Service Learning Team Projects

ERIC Educational Resources Information Center

Schaffer, Bryan S.; Manegold, Jennifer G.

2018-01-01

The authors investigated the antecedents of team task cohesiveness in service learning classroom environments. Focusing on task commitment and task attraction as key dependent variables representing cohesiveness, and task interdependence as the primary independent variable, the authors position three important task action phase processes as…

Essential Map Concepts for Young Children.

ERIC Educational Resources Information Center

Hatcher, Barbara

This paper discusses four key concepts to help preschool and primary grade children develop the ability to read and understand maps. Examples of student activities to develop each of the concepts are provided. The essential concepts are representation, symbolization, perspective, and scale. Representation is vital. Children must perceive that a…

Few multiyear precipitation-reduction experiments find a shift in the productivity-precipitation relationship

USDA-ARS?s Scientific Manuscript database

Precipitation is a key driver of ecosystem net primary productivity and carbon cycling. Global warming is altering precipitation patterns globally, and longer and more intense drought episodes are projected for many temperate and Mediterranean regions. The challenge of predicting the effects of alt...

National Assessment Program--Science Literacy Year 6 School Release Materials, 2006

ERIC Educational Resources Information Center

Donovan, Jenny; Hutton, Penny; Lennon, Melissa; O'Connor, Gayl; Morrissey, Noni

2008-01-01

In July 2001, the Ministerial Council on Education, Employment, Training and Youth Affairs (MCEETYA) agreed to the development of assessment instruments and key performance measures for reporting on student skills, knowledge and understandings in primary science. It directed the newly established Performance Measurement and Reporting Taskforce…

Towards Effective Subject Leadership in the Primary School.

ERIC Educational Resources Information Center

Bell, Derek; Ritchie, Ron

This book examines the position of subject leader in elementary schools in light of four key areas identified by the National Standards for Subject Leadership: strategic direction and development, teaching and learning, leading and managing staff, and efficient and effective staff deployment. It combines existing research with new material,…

Assessing Teaching Skills with a Mobile Simulation

ERIC Educational Resources Information Center

Gibson, David

2013-01-01

Because mobile technologies are overtaking personal computers as the primary tools of Internet access, and cloud-based resources are fundamentally transforming the world's knowledge, new forms of teaching and assessment are required to foster 21st century literacies, including those needed by K-12 teachers. A key feature of mobile technology…

Preparing for Children with Disabilities in Early Childhood Classrooms.

ERIC Educational Resources Information Center

Favazza, Paddy C.

1998-01-01

Offers suggestions to kindergarten teachers for creating a more accepting environment in their classrooms for children with disabilities. Three key influences in attitude formation are discussed--indirect experiences, direct experiences, and the child's primary social group--and ideas for examining these influences and adapting them are suggested.…

Adapting My Weather Impacts Decision Aid (MyWIDA) to Additional Web Application Server Technologies

DTIC Science & Technology

2015-08-01

Oracle. Further, some datatypes that are used with HSQLDB are not compatible with Oracle. Most notably, the VARBINARY datatype is not compatible...with Oracle, and instead was replaced with the Binary Large Object (BLOB) datatype . Oracle additionally has a different implementation of primary keys

Alternatives to the fish early life-stage test: Developing a conceptual model for early fish development

EPA Science Inventory

Chronic fish toxicity is a key parameter for hazard classification and environmental risk assessment of chemicals, and the OECD 210 fish early life-stage (FELS) test is the primary guideline test used for various international regulatory programs. There exists a need to develop ...

Stories and Statistics: Describing a Mixed Methods Study of Effective Classroom Practice

ERIC Educational Resources Information Center

Kington, Alison; Sammons, Pam; Day, Christopher; Regan, Elaine

2011-01-01

The Effective Classroom Practice project aimed to identify key factors that contribute to effective teaching in primary and secondary phases of schooling in different socioeconomic contexts. This article addresses the ways in which qualitative and quantitative approaches were combined within an integrated design to provide a comprehensive…

Climate and Land-Cover Change Impacts on Stream Flow in the Southwest U.S.

EPA Science Inventory

Vegetation change in arid and semi-arid climatic regions of the American West are a primary concern in sustaining key ecosystem services such as clean, reliable water sources for multiple uses. Land cover and climate change impacts on stream flow were investigated in a southeast ...

Day-by-Day: Higher Education in Afghanistan

ERIC Educational Resources Information Center

Roof, David J.

2015-01-01

This paper examines higher education in Afghanistan. Based on qualitative research, including interviews with key policymakers and stakeholders, the paper examines the primary issues, challenges, progress, and future vision for higher education in the country. The research reveals that one of the most significant issues in the country in the…

Constructive Conflict Talk in Classrooms: Divergent Approaches to Addressing Divergent Perspectives

ERIC Educational Resources Information Center

Bickmore, Kathy; Parker, Christina

2014-01-01

Dialogue about social and political conflicts is a key element of democratic citizenship education that is frequently advocated in scholarship but rarely fully implemented, especially in classrooms populated by ethnically and economically heterogeneous students. Qualitative case studies describe the contrasting ways 2 primary and 2 middle-grade…

Problematising the Pursuit of Progress in Mathematics Education

ERIC Educational Resources Information Center

Llewellyn, Anna

2016-01-01

In this article, I use a Foucauldian poststructural analysis to examine productions of progress within key discursive spaces of mathematics education. These sites of production are educational policy, mathematics education research and case studies of primary school student-teachers in England. From my analysis, I show how progress governs what is…

Leadership of education psychological services: fit for purpose?

PubMed

Booker, Roger

2013-06-01

At a time of great change for educational psychology services in England, this paper reviews current theories of leadership and proposes how an integration of key aspects of these can be applied to support a self review of leadership practice, both by individual leaders and by services. The message from current theory is that in the midst of complexity and rapid change, a primary focus on the head of service is outdated; there should instead be a focus to develop the leadership capacity of the service as a whole. Key constructs considered are systems thinking, social identity, authenticity, and leadership as social construction.

Nutrient inputs from the watershed and coastal eutrophication in the Florida Keys

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

LaPointe, B.E.; Clark, M.W.

1992-12-01

Widespread use of septic tanks in the Florida Keys increase the nutrient concentrations of limestone ground waters that discharge into shallow nearshore waters, resulting in coastal eutrophication. This study characterizes watershed nutrient inputs, transformations, and effects along a land-sea gradient stratified into four ecosystems that occur with increasing distance from land: manmade canal systems, seagrass meadows, patch reefs, and offshore bank reefs. Soluble reactive phosphorus (SRP), the primary limiting nutrient, was significantly elevated in canal systems, while dissolved inorganic nitrogen (DIN; NH[sub 4][sup =] and NO[sub 3][sup [minus

KEY ITEMS OF INNOVATION MANAGEMENT IN THE PRIMARY HEALTHCARE CENTRES CASE STUDY: FINLAND.

PubMed

Aslani, Alireza; Zolfagharzadeh, Mohammad Mahdi; Naaranoja, Marja

2015-09-01

Trends such as aging populations, excess costs, rising public expectations, and progress in medical science and technologies point out the necessity of adaptation and development of innovation in the healthcare systems particularly in developed countries. The main objective of this article is to review diffusion of innovation in the healthcare sector. Different types of innovation, diffusion characteristics, and adoption mechanisms are the subjects that are discussed in the selected case study, Finland. Finally, the key items of innovation management in the Finnish health system are introduced. The results can be implemented in other countries as well.

Pressure and Friction Injuries in Primary Care.

PubMed

Phillips, Shawn; Seiverling, Elizabeth; Silvis, Matthew

2015-12-01

Pressure and friction injuries are common throughout the lifespan. A detailed history of the onset and progression of friction and pressure injuries is key to aiding clinicians in determining the underlying mechanism behind the development of the injury. Modifying or removing the forces that are creating pressure or friction is the key to both prevention and healing of these injuries. Proper care of pressure and friction injuries to the skin is important to prevent the development of infection. Patient education on positioning and ergonomics can help to prevent recurrence of pressure and friction injuries. Copyright © 2015 Elsevier Inc. All rights reserved.

The prevention of tobacco-related disease.

PubMed

Raw, M; McNeill, A

1994-11-01

The key components of a strategy to prevent tobacco-related disease are outlined. These measures aim to increase the cessation of tobacco use and reduce its uptake. Components are wide-ranging, including a taxation policy, a ban on advertising and promotion, a comprehensive health promotion programme including advice from primary health care professionals and the development of campaigning skills, particularly by the medical profession. The prevention of tobacco-related disease has moved into the domain of campaigners and lobbyists at political, economic and international levels. The key target is countering the activities, especially the unethical trade practices, of the wealthy and powerful tobacco industry.